Ten minutes earlier Elise had been looking forward to the garden and putting her feet up for the twenty minutes she allotted herself; now she felt as though she could sprout wings and fly.

They set off for New-York Hospital on foot, matching Anna’s quick pace. Elise was curious about the surgery, but she kept her silence and listened to the snatches of conversations that came to her about exams, a visit home, a lost notebook, a recent case they had been called on to write up as an assignment and how strictly Dr. Savard marked their efforts.

She wondered if these young women talked about Anna when she was out of earshot, and decided that they almost certainly did. About her classes and expectations, but also about her recent marriage. One of the nurses had approached her and asked straight out was it true, Dr. Savard had married an Italian? Because she couldn’t indulge in irritation, Elise feigned confusion. Better to be thought a little dim than to gossip about the person who had made this new life possible.

Even when the subject wasn’t forbidden, Elise often found herself at a loss, listening to the young women talk among themselves. They were hardworking, ambitious, and serious about their studies; they had made choices knowing full well that the goals they set for themselves would likely cut them off from the things most young women hoped for. Some of them would marry, according to Anna, but most would not. And still they admired men, and thought of them as potential mates, or at least bed partners.

Chiara had been the one to point out to Elise that men watched her.

“Watch me? Why?”

“Why not? You’re pretty.”

“I’m odd looking.” She ruffled her short hair.

“You’re pretty in an uncommon way, and you move like a ballerina.”

Upon close questioning it turned out that Chiara had never seen a ballerina except on a poster, but she stuck stubbornly to her assessment.

“I am a dumpling in the making,” Chiara insisted. “It’s the family curse. Age fifty, I’ll blow up.” She puffed out her cheeks to demonstrate. “But you’ve got long legs and a long neck and skin like silk. Men watch you because you’re nice to look at.”

The whole subject made her uncomfortable, but Chiara had started something that Rosa picked up on. When they were out in public together they kept a constant vigil and pointed out every admirer, some of which Elise truly believed they manufactured solely to fluster her. On the omnibus, a fair-haired man with a stack of books on his lap. A clerk at the notions counter at Denning’s Dry Goods with ears that stuck out from his head. The grooms standing outside Stewart’s stables, cheeky monkeys, every one. They swore that there were three different young men living in the Jansen Apartments—just across the way—who had gotten into the sudden habit of walking past the house at least twice a day, morning and evening. Chiara made up names for each of them, and jobs too: Alto was the tallest one and an assistant manager at a bank, Bruno had a big dark brown beard and taught at the Academy of Music, and Bello, with a face like an angel, was a passenger agent on the White Star Line. And all of them lived for a glimpse of Elise.

“If you’re right about this,” she wanted to know, “why haven’t any of them said a word to me?”

“Because you are pretty but distant. What’s the word—”

“Uninterested.”

“That’s not it. Distante. Aloof!”

Elise wondered if it was true. Did strangers see her as arrogant? Conceited? These were serious character flaws that were dealt with summarily in the convent. Had she learned them in the few weeks since she left?

This line of thought stayed with her until they reached the hospital, where they filed through the doors like so many schoolgirls. The smell of carbolic and lye soap stripped away all the trappings and just that easily they were physicians in training, sober, observant, somber.

It was a relief to be back in a familiar environment, where there were things to occupy her beyond the mysteries of men. There was, in fact, a delicate, dangerous procedure that involved wielding a scalpel to remove the thyroid, cocooned in veins, embedded in the platysma, sternothyroid, and sternohyoid muscles at the base of throat, without damaging carotid arteries, leaving the trachea and the larynx intact. She wondered if they might get a piece of the tissue to study under a microscope.

•   •   •

ANNA SENT HER students back to the New Amsterdam and went in search of an orthopedic surgeon she knew, hoping he’d have a minute to discuss a case. His office door stood open and the office was empty, but she could hear a conversation going on farther down the hall and so she went to investigate.

Dr. Mayfair stood with two colleagues in a triangle, their heads bent together. She began to back away, but David Mayfair looked up and caught sight of her.

“Dr. Savard.” He gestured for her to come closer. “Let me introduce you.”

There were reasons for her to be on her way, but it was a rare opportunity to meet with male colleagues who saw her not as an upstart or a threat, but as an equal. It made her nervous, she could admit that, because she so much wanted to be accepted. Striking the right tone was far more tiring than surgery, this kind of interaction.

“We were just talking about one of Dr. Harrison’s cases,” Dr. Mayfair said. “A young mother, and a terrible loss. You do more gynecological surgery than anyone here, maybe you could make more sense of it.”

All thoughts of the cuneiform osteotomy she had wanted to discuss disappeared. She cleared her throat. “What kind of case?”

Emil Harrison was a slight man of average height with a luxurious head of hair and the habit of picking at his beard. Anna couldn’t recall ever hearing his name before, but there were so many physicians in the city, that was nothing unusual. He seemed to be hesitant, and Anna was ready to excuse herself when Albert Wesniewski spoke up.

“I’d like to hear her opinion.”

“Fine, let’s go have a look.” Harrison didn’t sound as though he relished the idea.

David Mayfair said, “It’s too bad your students have gone already, Dr. Savard. This would have been an excellent experience.”

•   •   •

THE PHRASE THAT kept coming back to Anna later was excellent experience. David Mayfair wasn’t purposefully trivializing what had happened to the dead woman, and in fact he was more respectful than most. But it was an irritation, and one she could do nothing about, especially when he had gone out of his way to include her. Young women studying medicine would have to learn this lesson as well.

On the way to the morgue Emil Harrison gave her his patient’s history. He had been treating Irina Dmitrievna Svetlova for five years, and knew her quite well: age twenty-eight, born in St. Petersburg, the wife of a professor of Russian language and literature at Columbia College. Two sons, both born in New York and delivered by a German midwife without incident. The boys were thriving, and neither had there been anything wrong with Irina Svetlova except the fact that she was pregnant and did not want to be.

Dr. Harrison didn’t perform abortions, and did not refer her to any other doctor who might have done the procedure, for obvious reasons. But on Thursday morning he had been called to their home.

“The note said only that she was unwell,” Harrison went on. The Svetlovs lived in an elegant French flat on Fifth Avenue, where he found her in danger of her life.

“My first inclination was to attend her there so that she could die at home with her family nearby, but her husband insisted on a laparotomy.”

Something in the back of Anna’s mind suddenly became clear: they only knew about the deaths that came to the attention of the authorities. There could be many more, women who had gone home to die and been tended to by their own people. That idea so distracted her that she found it hard to shift her attention when they reached the morgue.

Anna steeled herself, but it was no good. No human being could look upon such devastation and remain unmoved. The postmortem would reduce what had happened to this woman to cold observations: tears and puncture wounds to the cervix, uterus, omentum, large intestine, and the body’s frantic response to the invasion of bacteria: infection, exudate, and pus. What had been a well-formed, healthy human body laid waste.

“Have you ever seen such an extreme example of malpractice?” Mayfair asked her.

“I’m sorry to say I have,” Anna answered. “Almost exactly like this. Do you know who did the procedure?”

“No,” said Harrison. “By the time I saw her she was convulsing from the fever. She never regained consciousness.”

“The husband?”

“He’s in shock.”

“I’d like to talk to him, if I may.”

•   •   •

ANNA FOUND PROFESSOR Svetlov sitting in the main lobby, his hat clamped between his hands, his head lowered. At the sound of her voice a tremor ran through him.

“Professor Svetlov,” Anna repeated. “May I speak with you? I’m Doctor Anna Savard.”

Anna dealt with grieving husbands and fathers, brothers and sons every day. She strove for calm compassion without emotional attachment, but it was a battle that would never be completely won.