SEVENTEEN

The Physiatric Institute, Morristown, New Jersey, November 1921

LATE ONE AFTERNOON IN THE MONTH OF THANKSGIVING, DR. ALLEN went into his study with the intention of writing a letter to Antoinette Hughes. It was a letter that he had avoided writing for quite some time, a letter he did not now want to write, but for Elizabeth’s sake, he would.

Outside the window of Dr. Allen’s office, Belle Wishart was crossing unseen through the early darkness to the groundskeeper’s cottage, holding an empty birdcage before her like a lantern without a flame. The air was thick with the threat of a storm; she pulled her sweater more closely around her. There had been a sprinkling of rain that afternoon, and the grass was still wet. Miss Wishart moved slowly, lifting her feet high with each step like a wading shore bird.

Inside the cottage, the old man was sitting beside a woodstove, hunched over the seat of a chair that he was recaning with strong, knobby hands. Hearing Wishart approach, the old man unfolded himself, crossed to the Dutch door, swung open the top panel, and frowned.

He had been the groundskeeper for Mr. Kahn, and he hadn’t had an easy time transitioning to the new regime. It wasn’t that he minded the extra work or the restricted budget. It was that he could still see the place all lit up for a party on a summer night, with torcheres blazing and jazzmusic floating through the portico and ladies in silk and gentlemen in spats strolling the topiary garden, smoking and laughing. It was hard to get used to the deathly quiet.

She came forward with the birdcage.

“Good evening,” she said.

He nodded.

“Thank you,” she said simply. The old man’s hands remained in his pockets.

“Isn’t that the cage the little girl borrowed?”

“Yes.”

“Want me to get her another bird? I could catch one easy. A finch or a chickadee.”

“It wasn’t her bird. It belonged to another patient. A boy named Eddie.”

“Does he want another bird?”

Miss Wishart shook her head. Reluctantly, the old man took the cage, lifted it over the lower part of the door and set it down on the floor.

“What’d he die of?”

“Diabetes.”

The groundskeeper’s eyebrows registered disbelief.

“Not the bird. The boy. Eddie died,” Miss Wishart explained. “He ate the birdseed and it threw his meta— his system into shock.”

The old man frowned, straining to understand.

“Thank you for the cage. For obvious reasons we will have no more birds as pets.” Miss Wishart turned and began making her way with slow storklike steps back to the mansion house. He watched her for several steps and then, still frowning, called after her.

“Miss Wishart, ma’am. But what happened to the bird?”

Miss Wishart did not stop. She turned and called back over her shoulder.

“I opened the window and set it free.”

The groundskeeper swung the top door shut, rubbed his grizzled face, and returned to the warmth of the woodstove, leaving the empty cage by the door. There it remained for weeks. He could not bring himself to look at it, unable to shake off the gruesome idea that Wishart had been lying, that the child might have eaten more than just the birdseed. He had seen the small spectral faces that sometimes appeared at the windows of the great house. Even from a distance he could sense their desperation.

What could Allen do but use the tragic loss of Eddie as a cautionary tale for all the residents of the Physiatric Institute? If he did not do so, no good would come of his death, and that would add tragedy to tragedy. So Allen instructed Belle Wishart to tell the nurses to tell the patients the truth about what happened, providing facts and details as requested.

Although Allen hoped that Eddie’s death would be a lesson to the patients, it was he who felt the most chastened by it. He was deeply ashamed of himself for the lapse in judgment, for allowing himself to be persuaded to permit the boy to keep a bird in the first place. There was a place for leniency to be sure, but it was in the accounts receivable department, not in the clinical treatment of patients.

In November 1921 Elizabeth’s weight had dropped to fifty-two pounds and plateaued. She had been a semi-i nvalid for the better part of a year. Most of her hair had fallen out. Her skin was slack and parched. Allen took out the last letter he had received from Antoinette and smoothed the monarch page on his desk blotter. In it she informed the doctor that, because Elizabeth could not possibly sustain the stress of even a common cold, she intended for Elizabeth and Blanche to spend several months in Bermuda during that winter. He had never replied, being reluctant to disappoint her with his objections. But now Eddie’s death quite literally forced his hand: He must never again allow a soft heart to jeopardize a patient.

He must speak up lest he lose the keel of his conscience. When a cure was found—as he knew it would be—they would thank him for keeping Elizabeth alive to see that great day dawn. But how to address this worrisome emotional intimacy? Blanche and Elizabeth traveled together to Lake George, Washington, New York, and—soon—Bermuda. They knitted sweaters together. They took daily walks on which they collected things to add to Elizabeth’s prodigious collections of natural artifacts: shells, feathers, leaves, flowers, and seed pods. They were fond of reading aloud together, handing the book back and forth or huddling close with Elizabeth’s head resting in the crook of her nurse’s neck. Sometimes they read plays aloud, this way each taking on the roles of various characters. When hunger became unbearable, Blanche would gather Elizabeth into her lap and rock her.

Did Mrs. Hughes realize, he began, that the body’s delicate metabolic balance can be upset by subtle emotional changes, climate changes, situational changes. He was concerned that Elizabeth’s relationship with Blanche had become (how could he put it), emotionally exciting, and that this might prove detrimental to Elizabeth in the future. The Allen treatment was a comprehensive hormonal alchemy. For the good of the patients, he strove to maintain a constant and neutral atmosphere within the institute.

Indeed, it was easy to see the increasing intimacy between the two. Elizabeth had initially called her nurse Mrs. Burgess, then Mrs. B and then simply Blanche.

He stopped and began again. As she was no doubt aware, Elizabeth’s treatment had been unorthodox in many ways. There was, for instance, the outpatient arrangement and the insistence on a private nurse. Indeed, it was this latter situation that placed him in the uncomfortable position about which he was compelled to write to her. Were Blanche employed by the institute, there would be no need to trouble Mrs. Hughes with his concern. In that case the course of action would be obvious, unpalatable, perhaps, but obvious. However, Blanche was employed by the secretary of state and her patient was the daughter of the secretary of state. Moreover, the secretary was among the major benefactors of the institute. It was his imprimatur on the letterhead, Dr. Allen knew, that had allowed Allen to raise the funds to launch the institute. And the future financial health of the institute, despite its good work and innovative business model, was far from secure.

He stopped again. This last effort piqued a particularly sore spot of indignation. He resented the need to split his time and energy between what he considered to be his real work and that greedy ancillary endeavor which was the work of supporting the work. Few were the days when he was free from the worry that, at any moment, this ancillary work would completely engulf his real work. On bad days he felt that, despite his medical degree and his reputation, his actual occupation was something between a professional sycophant and an emergency mason, constantly trying through all means of financial spackle, mortar, putty, grout, and crutches to shore up a structure that was forever on the verge of toppling. From the start the two roles had been at odds within him: He must do what was best for Elizabeth and he must be careful not to offend her parents. Hadn’t he started his own institute in order to avoid politics?

He would try to adopt an avuncular rather than punitive tone. This thought brought an immediate smirk to his face. He thought about Otto Kahn, the dapper, well-loved, prominent New York financier and patron of the arts who had built the grand estate that now housed the Physiatric Institute. It occurred to Allen that Kahn was all of the things that he was not. Kahn made money for the rich. Allen denied food to the starving. Kahn’s clients showered him with praise and invited him to tony social events. Allen’s clients endured him because he was saving their lives. Allen was not warm. He was not suave. He was not dapper. Despite his being a successful doctor at the top of his career in a nation whose population of eligible men had been vastly depleted by the war, he had remained a bachelor until October, just weeks before, when, at the age of forty-two, he and Belle Wishart were married.

If Allen remained silent Elizabeth and Blanche would sail for Bermuda. They would be away for months. He could only imagine that their intimate connection would grow in such an idyllic setting. He imagined luxurious boat rides in sapphire water, picnics on the bluffs overlooking clusters of quaint whitewashed cottages, exotic birds, and the breeze infused with the scent of oleander. Weren’t they to stay in a place called “Honeymoon Cottage”? Surely it was only a matter of time before pity would weaken Blanche’s resolve to maintain the diet. And need he remind Mrs. Hughes that a cure was at hand?

He could not have known just how near.

As Allen struggled to write a letter in the stillness of the palatial Phys- iatric Institute, an unknown, impoverished surgeon sat in a laboratory in Toronto, smoking incessantly to mitigate the odor of dog feces as he struggled to write a paper that would document the summer’s work.

In just a few weeks, and little more than a hundred miles from Allen’s desk, Banting would deliver this paper to a group of eminent physicians, including Allen and Elliott Joslin. The paper, “The Beneficial Influences of Certain Pancreatic Extracts on Pancreatic Diabetes,” would change the world dramatically, and within a decade Allen would be forgotten, his reputation eclipsed, and the Physiatric Institute abandoned forever.