Chapter 36
New Beginnings
August 1947
In August 1947, Edna’s niece, Virginia Allen, arrived at Sea View from Detroit, Michigan. She was sixteen, newly graduated from high school, and had no experience with children aside from babysitting her two younger brothers. But she was charismatic and easygoing, with a playful imagination. These qualities, along with the demand for nurses, impressed the head nurse at the children’s hospital. Virginia was perfect for pediatrics.
A decade old, the children’s hospital sat on an isolated section of the property, behind the original complex. Surrounded by a densely wooded slope, it was a grand structure, sleek and modern, finished in cream-colored brick and limestone trim. Rising five stories high, it insinuated itself into the landscape, making it both part of the complex and its own entity.
Inside, Virginia walked down broad hallways, the antithesis of the narrow pea-green corridors in the pavilions. She marveled at the terra-cotta tiles and the floor-to-ceiling windows that lined each side. They lent the wards a lofty, airy feeling, but one glance left or right and the buoyancy of beauty led the eye to an endless row of cribs and beds. Walkers and wheelchairs sat in the corners, and children’s toys—stuffed bears and rabbits and rag dolls, little cars and crayons and coloring books—were scattered on the white Sea View blankets or tossed under and around the beds.
Then came the noise, so much noise. A dissonance of sounds—crying, giggling, babbling, whining, moaning, and always one of those openmouthed wails, those screeches that stilled a room. At first it was shocking, but once Virginia fell into the rhythm of work, the clamor receded.
In those first months of training, she learned that tuberculosis in children often made them susceptible to secondary conditions like diabetes, measles, chicken pox, and impetigo, an infection that created a maze of rashes and bumps and pus-filled blisters on the skin. Calamine lotion and other topical creams did little; sometimes sulfathiazole, a sulfa drug, worked. But until the rash subsided, the children spent hours itching and picking at the scabs with their tiny fingers. Some blistered and bled and became infected, causing larger wounds that festered, requiring penicillin or their hands to be wrapped in gauze.
Comforting them, Viriginia realized, was difficult. They were fussy and wheezy and upset, and some threw their food, toys, or pillows and then sniveled for hours, a constant low, nasally whine punctuated by crackling and hacking coughs. The sound, similar to the hum and buzz of a loose electrical wire, grated on the brain.
A good handful of the children fumed, their faces and necks turning red and their fingers clenched into small fists; they shouted and thrashed and threw long-lasting tantrums. In the daily logbook, the nurses tried to pinpoint why the children acted out: “Quite miserable, uncomfortable . . . listless + helpless . . . purulent mucus . . . many lesions on face-body crusted . . . infected lesions . . . new impetigo . . . infected left foot . . . fever spiked . . . appears quite ill—appears partially paralyzed.”
Those daily notes, however brief, taught Virginia how physical pain was a handmaiden to an excruciating parental ache. In between the lines of rage, a different story emerged. Nurses wrote about children who missed their families. Here was Richard, Ruth, Anita, Eleanor, Jack, Robert, Cheri, Michael, Louie, and many others: “Usual day homesick . . . depressed wants to leave . . . misses home . . . wants mom . . . lonesome . . . despondent . . . worried . . . calls for mama . . . dad left . . . mom died . . .”
And on went the somber, evolving narrative of yearning and sorrow that no amount of singing and reading or playing with puppets or cars or paper dolls could eradicate.
Each age brought its own despair, but for Virginia, the toddlers were the most heartbreaking bunch. They were in between baby and little kid, language and babble, and satisfying their needs was a grand challenge. She spent a long time holding them, cradling their bodies, and wiping their cheeks, often red and inflamed, and their noses dripping with green snot that dribbled onto their stuffed dogs or bears or bunnies, tangling up their fur. On days when the fussing stopped, she read them books from the library cart. They loved the new Little Golden Book series, featuring The Poky Little Puppy, Johnny Appleseed, and The Color Kittens, a story about two little kittens who make all the colors in the world.
These days brought hope.
But they came infrequently, and sometimes Virginia needed to step away, to gather herself, to find a space to process the weight of human sorrow. The more seasoned nurses mentored her, explaining how the children’s hospital existed in a time and space all its own; how working there collapsed the normal pattern of thinking that children got sick and went to the hospital and fully recovered. That rarely happened at Sea View.
A better way of thinking, they said, was to look at how medicine had progressed in the past two decades. Prewar they had nothing. There was no sulfa, no antimicrobials, no penicillin, only sunshine and bed rest, and compounds of gold cyanide, chlorine gas, gambine (used in antifreeze), and lots of elixirs, such as iron quinine and strychnine. There were also quacks and medicine men who brewed tonics and antidotes in giant cauldrons in their kitchens: wolf liver boiled in wine, mice boiled in salt and oil, or the hot blood of young calves. Drinks of petroleum and turpentine were offered, so were slices of dog fat and small piles of Saharan sand. Ground-up human eyeballs. Opium. Cod-liver oil. Tanner’s oil (the runoff from slaughterhouses). Bloodletting.
Edna told her niece that patients had died from these sham cures and from now-treatable skin or strep infections. She also shared how some had woken up during surgery because no one understood the finer workings of anesthesia.
Now Virginia’s generation of nurses had antibiotics and new anesthetics. Electric lights had replaced the skylights that once lit the operating room, and every day more drugs were being discovered and tested. Recently, the army had finished its trials on streptomycin, allowing the government to lift all restrictions on the drug, and it had arrived at Sea View.
“It was like a new beginning,” one nurse said.
“Like a fresh start,” another added.
Almost overnight, its presence swept away a collective despair. Here was the drug that arrested tuberculosis, not just masked the pain. Each day, nurses up and down the wards pulled the thick liquid into syringe barrels and injected it into patients, who now sat up, daring to imagine a life after Sea View. They shared their dreams; some were grand: marriage, a new job, maybe college or kids or a career. But sickness had humbled too many, reducing their wants to simple gestures: brushing their teeth, tying a shoe, bathing alone, walking without falling, and, for one patient, to “pray without praying to die.”
On the men’s and women’s wards, nurses noted the side effects, which for many were almost unendurable. But they knew the paradox: either tolerate the experience or die. Doctors faced their own issues with cost and supply. Streptomycin was expensive, and it passed through the system quickly, requiring re-dosing every six hours. With their limited funds, many hospitals stocked only several weeks’ worth, forcing doctors into making punishing decisions: who would and wouldn’t be treated. In Michigan, a $400,000 shortage, the total cost to treat all TB patients with streptomycin, ensnared lawmakers in a heated debate: Was their duty saving money or lives?
Robitzek hoped to avoid these ethical dilemmas. But each day drew him closer to one.
From the wards abounded stories of patients feeling better. They came from the young and old, the newly diagnosed and the lungers, like Missouria’s patient Philip Thompson, “the old hand at TB,” who had spent almost five years in and out of the hospital. This time, the thick, painful shot might save him. The good news also came down from the children’s hospital.
First, a visiting physician had aerosolized streptomycin, allowing it to reach the lungs quicker and in heavier doses. The only downside: administering it took over an hour and required someone to hold the inhaler over the child’s mouth. Virginia and the other aides were being trained to hold it, and soon babies as young as eight months old could be treated.
But the big news was about two patients. The first was Hilda Ali, who, much to everyone’s surprise, had survived and become strong enough for doctors to operate and perform the much-needed lobectomy, where they removed a portion of her lung. The surgery was a success, which allowed her to receive streptomycin. The drug worked, and after three and a half consecutive years of being at Sea View, Hilda Ali was finally going home. Her medical card now read “far advanced pulmonary tuberculosis: arrested.”
The second patient was a wispy four-year-old, languishing from miliary and meningeal tuberculosis, the latter inflaming his brain, causing him to lose muscular coordination and experience punishing headaches. Days after he started streptomycin, his headaches tapered off. He stood without falling and chewed without choking; his cheeks and ribs filled out. And he asked to play.
With more and more success stories, journalists found a niche: feel-good stories. In Atlanta, they discovered Mr. Frank Edwards, who two months earlier had been planning his funeral: “He was going down steady,” his ward mate said, “but by George, he really came out of it when he took that new stuff.” At the Glen Lake Sanatorium near Minneapolis, the drug saved the lives of Anna Olson and her sandy-haired six-year-old, Jimmy Olson, stricken with TB meningitis: “Without streptomycin this was rapidly fatal,” said Jimmy’s doctors, adding that if external organizations didn’t pay for the treatment, which topped $900, Jimmy would have died.
Even those who worked at one of the eleven companies processing the drug celebrated: at a Pfizer plant, employees covered the walls with morale-building placards and posters showing patients being injected with streptomycin. In Pennsylvania, the Gazette’s headline was simple: “Streptomycin Conquers Tuberculosis.”
These stories, all of them, painted a bright, longed-for future, one without tuberculosis. But away from the wards and the public anecdotes of people recovering, Robitzek and the nurses knew something was amiss. First, they noticed that the drug worked fast; while that was good, no one had determined how or why it was working. All of it, the dosage and frequency, was guesswork, and to Robitzek, administering drugs by chance was courting disaster. He knew any scientifically effective treatment, especially one considered curative, needed strict regulations, and more important, he wondered what good was a cure that few could afford.
For Robitzek, cures that cost money weren’t cures but rather options for those who had funds and torture for those who didn’t. To him, any medicine that promoted healing, especially for this disease, should be free; no one, he believed, had the right to capitalize on illness. But the endless reports of streptomycin’s expense were now forcing him to think about cost versus treatment and how the drug was becoming a kind of boutique medication, available for some but not all. These days, he was reading more frequently about people like Arthur T., who was stuck in a municipal hospital no different from Sea View. A lack of funds had forced a rationing of the drug, and Arthur wasn’t chosen. He subsequently died, repeating, “I need streptomycin.”
It was only a matter of time before this happened at Sea View.