The fewer questions she asked at this stage, the sooner a patient would come to the point. Mrs. Campbell started slowly, relating facts about the new baby and the older three, her hands clasped in her lap so hard that her knuckles went white.

“And how are you, how is your health?”

Mrs. Campbell drew in a breath and held it for three heartbeats. “I don’t know,” she said. “I don’t know how I am.”

“Have you seen Dr. Heath since the birth?”

She shook her head, quite sharply.

“Then what can I do for you today?”

The pale face came up suddenly, her gaze fixed on Sophie. “I want you to examine me.”

Rather than ask questions, Sophie went to wash her hands while Mrs. Campbell disrobed behind the privacy screen. Throughout the examination she was quiet and cooperative, staring at the ceiling overhead blankly, hands still wound together.

“You are healing well,” Sophie said. “But you are losing weight, and too quickly. You need four or five small meals throughout the day. Nothing too heavy or spicy. A poached egg and a piece of bread would do, or oatmeal with cream. Meat or fish once a day, but in small amounts. Leeks, collards, spinach, any kind of bean will provide you with the iron you need as a nursing mother.”

The thin mouth contorted and an arm came up to cover her eyes.

“I’m pregnant, aren’t I.”

Sophie had turned away to pick up an instrument, but she looked over her shoulder in surprise.

“Pardon?”

Mrs. Campbell sat up, rough patches of color rising in her cheeks. “I know I am, I can always tell.”

“What makes you think that? Have you missed your menses?”

“I haven’t had a period for four years,” Mrs. Campbell said. “Doesn’t seem to matter, I fall pregnant anyway.”

“I saw no indication of pregnancy,” Sophie said.

“But I could be,” Mrs. Campbell said. “He’s been at me morning and night. I could be. And if not now, then next week.”

Sophie spread out a hand. “It’s not likely, Mrs. Campbell, but it’s possible. In any case, there isn’t any way for me to diagnose a pregnancy at such an early stage.”

“I know what I know.” There were tears in her eyes.

Women often did know very early that they had conceived, but in this case it was hard to say. Mrs. Campbell might still be feeling the aftereffects of pregnancy and birth, or in her anxiety and fear—because she was terribly afraid, without doubt—she could convince herself of something that simply wasn’t true.

But she could be pregnant. Children born ten months apart were not all that unusual.

“Would you like me to write a letter ordering no intimacies for health reasons, until further notice?”

“He wouldn’t credit it,” Mrs. Campbell said, bitterly.

And that was certainly true; Mr. Campbell would ignore what she had to say. The situation was simple and familiar and heartrending, because Sophie had no solutions to offer. She could not even ask if Mrs. Campbell had received the pamphlet she had sent, because she still could not be absolutely sure of the woman’s true purpose.

Mrs. Campbell spoke under her breath, as if giving Sophie permission to ignore her. “I cannot, I cannot have another baby so soon. It will kill me.”

Sophie could simply send the woman on her way with a few carefully chosen platitudes; it would be the safest and soundest thing to do. But it would also be cowardly and worse, a violation of the oath she had taken. She must try, at least, to pass on information the woman could use to help herself.

For a moment she imagined Anthony Comstock standing out in the hall, a smirk on his face, and then she looked at her patient and all other concerns had to be set aside.

“You realize the importance of attention to hygiene while you are still healing?”

Mrs. Campbell’s expression shifted, something of hope there now. “I have heard something about that, but I don’t know where to start.”

“Let me explain to you about the most effective ways to maintain personal hygiene. If you have time?”

“I do,” Mrs. Campbell said. “For this I do have time.”

•   •   •

AN HOUR LATER as she was getting ready to leave, Janine Campbell paused as if she had something she needed to say but would leave unsaid without encouragement.

“Mrs. Campbell, I can’t promise to have an answer to every question, but I will do what I can for you.”

“If scrupulous attention to personal hygiene is not enough, if I am already pregnant—”

The silence drew out for a long moment.

“Mrs. Campbell,” Sophie said quietly. “I have given you all the information I have to share.”

She closed her eyes for a moment, then opened them, looking resigned.

“But I can come back to see you?”

“Normally I would be happy to have you as a patient,” Sophie said. “But I am just about to leave on a longer journey. I may be gone a year, or possibly more.” Or far less, she added to herself.

It often fell to Sophie to give a patient very bad news. An imminent stillbirth, malignant tumors that could not be excised, a child who would not survive the night. She had seen all manner of grief and sorrow and anger, raging and tears and those who fell away into unconsciousness rather than face tragedy. She was seeing many of those things on Mrs. Campbell’s face along with a cold resignation, and the force of it struck her.

“I have a number of colleagues who would give you excellent care,” Sophie said. “Shall I give you some names? Female physicians, women I went to school with?”

“No,” Janine Campbell said, her voice low and soft and hoarse. “No. I’ll figure something out. But thank you.”

•   •   •

ANNA GOT TO the hospital at dawn just as a cab pulled up. The door flew open and Sister Mary Augustin jumped down before the cabby could even get off the box. She was so intent on helping Sister Francis Xavier step down safely that she didn’t notice Anna, standing a few feet away.

What Anna saw was that the older nun and the cabby wore almost identical expressions. Crankit, Aunt Quinlan would have called it, a bit of Scots left over from her first marriage.

While Sister Xavier fussed at Mary Augustin, the cabdriver dumped their satchels on the ground and turned to stalk away. Anna called after him.

“Take those inside, please,” she said. “And leave them with the porter.”

He gave her a long and speculative look, which Anna took to mean that he had been paid but not tipped. Nuns might not know about what a working man has coming, his look seemed to say, but you should. Anna produced a quarter dollar from her pocket and held it up; the cabby retrieved the bags with a surly grunt.

“Dr. Savard.” Sister Xavier’s voice was hoarse and brimming with impatience. Anna didn’t expect pleasantries from people in pain, but then again she was glad that Mary Augustin had been sent along as Xavier’s private nurse.

Now she smiled at both of them. “Good morning,” she said. “Come, I’ll show you to your room and you can make yourself comfortable.”

“Comfortable,” sputtered Sister Xavier. “I’m too old for fairy tales, and so are you.”

•   •   •

MARY AUGUSTIN DID what she could to put her very agitated patient at ease, but by the time Sister Xavier was settled in the bed, all color had drained from her face and her complexion was the texture of candle wax.

It was very wrong, Mary Augustin told herself, to be so happy under these circumstances. To take pleasure in an opportunity that existed only because of Sister Xavier’s pain was something she would have to confess, but absolution required repentance, and that was something she could not manage. She had been hoping for this ever since the day in Hoboken when she learned that women could be doctors and surgeons. She had tried to put that idea—that outrageous, impossible, unattainable idea—out of her head, without success.

There was a soft knock at the door and things began to happen very quickly. Later she would have trouble sorting it all out: nurses and medical students came and went, sometimes, it seemed, with the sole purpose of irritating Sister Xavier, which wasn’t very hard to do anyway. Then Dr. Savard came in pushing a cart full of equipment, trailing two assistants behind her.

Under other circumstances the look on Sister Xavier’s face might have struck her as funny, but it was only later that she could smile about it to herself. Fortunately Dr. Savard didn’t seem put out by the tone of the questions that came her way in such rapid fire. She introduced her assistants as medical students and explained the purpose of the different objects on the rolling cart: the stethoscope made it possible to listen to the heart beating and blood moving—Sister Xavier shot Mary a sharp and questioning look, and she nodded.

“And that?” she pointed to a contraption that was quite odd, with multiple arms and pads and bulbs of India rubber. “There’s a needle in there somewhere, I know it.”