The Past As It Ought to Be

The Heart Specialist ends with this afterword:

And therein lies the challenge. What counts as “purely”? And how much impurity turns fantasy into history? After all, history—even good history—is fiction with footnotes.

So enshrouded in mystery is Abbott’s life that invention may be the best way to remember her: novels can throw open the past. Canadian examples of medico-historical fiction include Margaret Atwood’s Alias Grace, Matt Cohen’s The Spanish Doctor, Hugh MacLennan’s The Watch That Ends the Night and Ralph Connor’s The Doctor. A robust subgenre focuses on medical women. The cross-dressing British officer James Miranda Barry inspired several writers. Barbara Wood’s harlequinesque Domina is (almost) Elizabeth Blackwell. Novels of pediatrician Perri Klass draw on her practice. Following a pattern of aspiration, disappointment and achievement, these tales chart the course of exceptional women in a man’s world.

The Heart Specialist fits the genre well.

Agnes White, Rothman’s fictional protagonist, is a good soul, brilliant but naive, sensitive but strong, accomplished but unappreciated. Clumsy and accident prone, she considers herself unattractive. She is always underpaid. These traits resemble Maude Abbott, as do the following dramatic events.

Accused of murdering his disabled sister, her father abandoned his daughters and his wife, who died soon after. Their maternal grandmother adopted the girls, gave them her surname and raised them in rural Quebec, near Montreal.

Agnes loves learning, and enters McGill on a scholarship. She sets her sights on medicine, gathering public support and media interest; however, McGill refuses her application because she is a woman. Instead, she attends Bishop’s College, completing her MD in 1894. But finding sufficient clinical work is difficult for a woman, especially with Agnes’s burden of a chronically ill sister. Having once rejected her, the McGill professors now offer her a task that no one wants: the reorganization of the medical museum, a long-neglected collection of anatomical specimens. This work leads to her international recognition in both cardiology and medical museology.

Encouraged by a famous physician who leaves Canada for the United States and England, Agnes unravels the bewildering heart defects of blue babies. Before her meticulous analysis, heart surgery was inconceivable. Nevertheless, some view her achievements as “unoriginal” plodding. She also devises a classification system for anatomical specimens that is used around the world. Students gravitate to this natural teacher; consequently, educational responsibilities that bore others fall to her. Her affection for the distinguished ex-pat physician is ridiculed as a product of repressed sexuality. Notwithstanding her successes, she is never promoted beyond assistant professor and can afford only to live in rented rooms.

All the foregoing life events Rothman’s Agnes shares with the real Maude Abbott.

Many other historical impurities pervade this “purely fictional” account. The dates are exact; the names of places and institutions correct. Allusions are made to real actors: Gertrude Stein, who studied medicine in Baltimore, and (if you had not already guessed) the distinguished ex-pat, whom Rothman calls William Howlett, is a convincing rendition of William Osler, complete with wife, née Revere, son Revere and Oxford home named the “Open Arms.” The real Montreal doctor, William Hingston, perhaps arbitrarily, is cast as the misogynist father of another woman aiming for medicine. This last detail demands a confession: the wonderful painting of Hingston performing surgery at Montreal’s Hôtel-Dieu graces the cover of one of my books; he also turned up recently in the Vatican archives, landing a place inside another. Was he really that heartless? I must look into it.

In her craft, the novelist draws a line between history and fiction, departing from known events, but daring to suggest, explain and satisfy where history is mute. Thanks to Rothman’s imagination, some things differ and a few gaping holes are neatly closed.

Agnes White’s beloved father, Honoré Bourret, was a skilled doctor and mentor of the distinguished ex-pat, Howlett (Osler). Agnes realizes that her father and Howlett had dissected the specimens on which she is building her reputation. The museum chaos resulted from deliberate eradication of Bourret’s name after the murder accusation (and acquittal). Her puzzlement over a three-chambered (instead of four-chambered) heart leads her, through Howlett, to her father. Indeed, recovery of lost identity supplies a plausible explanation for why a successful woman might remain in derisory circumstances—underpaid in an institution that continued to reject women.

Also intriguing is Howlett’s role in barring Agnes from medical school and her late disenchantment. All right, this is not biography, but the disillusionment will have Abbott fans cheering after having endured many portrayals of her respectful admiration as blind worship, her accomplishments as his. The past as it ought to be.

The story stops with the end of World War One, the waning of influenza and the death of Howlett. Maybe after 1919 Agnes will live happily ever after.

But Maude lived on to 1940 and, for all we know, it was a solitary existence working at McGill and occupying those rented rooms. Yet she accomplished other admirable things that I wished Agnes had done too. She belonged to an activist group for social justice called Themis and helped found the Federation of Medical Women in Canada. Her Atlas of Congenital Cardiac Disease, lavishly illustrated with photographs and drawings, appeared in 1936. Now a hard-to-find classic, facsimiles fetch handsome prices. Rothman selects fragments from the Atlas as stylish epigraphs. Ironically, given the argument of this review, Abbott also wrote several respected works of history and compiled a bibliography and a festschrift on Osler.

The numerous, accurate impurities in The Heart Specialist raise new questions about what is retained or discarded, and about the writing process itself. Why not use Abbott’s and Osler’s real names? And why not include a note on sources as other novels do? It could repay debts to scholarship and guide curious readers. History spawning fiction spawning history.

However, we must not blame fiction for not being history.

A professor of creative writing, Rothman is sensitive to atmosphere, conversation and female sentiment, evoking Jane Austen or the Brontës. The gentle clarity of her prose hints at L.M. Montgomery, accessible to young and old with charming descriptions of turn-of-the-century Montreal and country life. Hearts, both physical and metaphorical, are ever present; Agnes specializes in the former and is baffled by the latter. Rothman bestows some lovely characters as friends. The wise, open-minded governess is reminiscent of Helen Keller’s Annie Sullivan. A kindly professor helps in crucial moments. Another doctor, equally enamoured of Howlett and perhaps not of women, writes from the war, provoking horror over the carnage that jars with the heroic posture thrust on anxious families. Agnes’s discovery of sexuality is a bold flourish— going well beyond Austen or any Brontë; however, being unable to lose Abbott, this reader found it tilted in the direction of too much information.

Truth may be stranger than fiction, but it suffers from many more holes and imponderable loose ends. A hearty dose of good historical fiction, like The Heart Specialist, helps to remedy those chronic failings, celebrate worthy figures and challenge tired assumptions.