She took out her prescription pad and wrote as Mrs. Townsend disappeared behind the chinoiserie screen to dress.
Lydia sighed. She had a stack of patient notes to write before the day was done and Mrs. Townsend's concerns were nothing new. But the patient needed time to fully voice her complaints or else the visit would take twice as long.
An iron tonic would be little more than a placebo, Lydia thought. She had done a thorough exam as she always did: listening to the heart and lungs, palpating the abdomen, noting normal vital signs. An extensive laboratory evaluation had revealed nothing suspicious.
Mrs. Townsend reemerged, elegantly dressed in a cream silk taffeta that pooled at her feet. Lydia knew they were fortunate to have wealthy patients who sought treatment from a "lady doctor"; these patients' ability to pay provided much-needed revenue to support the work of the clinic.
Mrs. Townsend fastened the buttons at the top of her bodice. Her jeweled rings slipped atop gnarled joints, brown age spots mottling the backs of her hands. Lydia could see that her hands shook as she struggled to do up the buttons. No doubt severe arthritis was causing considerable pain. Lydia felt a stab of compassion as she watched the older woman take a deep breath and patiently begin again. Lydia knew wealth conferred no immunity from suffering. Mrs. Townsend's only daughter had died of rheumatic fever the year before and many of her visits stemmed from the void of loss.
Lydia handed over the prescription.
"If you like, you could try a daily tonic. But I would recommend light exercise. Start with a half-hour walk daily. It will make you feel better," she said gently. "I suppose it can't hurt," Mrs. Townsend admitted.
"I would also suggest taking off your corset." Lydia could not resist a chance to dispense this advice. "It is a terrible constriction to the abdominal organs and can impair your breathing."
The remark was greeted with silence. Then Mrs. Townsend ventured, "Well, I don't know. It doesn't seem proper to be without a corset..."
"Please try it. I will look forward to our next meeting," Lydia said as she ushered Mrs. Townsend out of her office.
The Spruce Street Clinic had been founded by a group of doctors from the Woman's Medical College, fervent idealists who believed that medical care was not the sole province of the rich. It served a thriving working-class community and many of the shopkeepers, seamstresses, and livery drivers that Lydia had treated in the early days were still her loyal patients. Lydia met people from all walks of life, many her own age, who had endured unimaginable trials of sickness and loss.
The building had been a small textile factory, and the industrial flavor was still evident. The knotty pine boards on the floor were burnished to a sheen from countless boots trudging through the rooms in all weather. The former factory floor was divided into exam rooms and a reception hall. The upstairs floor could function as a small hospital ward, with a few beds for those whose conditions required more intense monitoring. There was an airiness to the waiting room, with its high ceilings and large windows. The walls were painted white, adorned with a few bland landscape paintings. It was as if the décor was an afterthought. The simplicity reflected the attitude of its founders: this was a serious place of work and it needed no distraction from the mission it served.
As she walked back down the hallway, the sound of Lydia's footsteps echoed through the empty rooms. She was alone, the last group of students having left a few hours before. The oil lamps were turned down and tepid gaslight from the street filtered through the mullioned windows in the hallway.
Lydia closed the chamber door behind her and paused for a moment at the mirror above the sink. She adjusted a few dark hairs back into place, tucking the mother-of-pearl pin in at a rakish angle. She stepped back in approval: the dark eyes held only a trace of tiredness. Her silk brocade dress was simple but to a studied eye, of the utmost elegance; the gold threads woven into the fabric glinted in the dim light. She touched the ivory brooch that sat over the top button. Lydia wore all black on her teaching days but allowed herself one memento, a cameo brooch with an elephant figure in the center. It was a gift from her English mother, from her own childhood in India. Lydia was never without it. Ganesh, the bestower of blessings and the remover of obstacles, watched over her always.
She turned up the lamp, casting light into the corners of the room. She pulled her Kashmiri shawl tight around her shoulders, the itchiness of the wool tickling her chin and the movement releasing the familiar smell of sandalwood. The office was sparsely furnished as it was used in rotation by all the doctors. But she carried all she needed in a capacious leather bag as she moved nimbly between her roles as professor of medicine at the Woman's Medical College and attending physician.