Open Wound: The Tragic Obsession of Dr. William Beaumont

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Overview

"This is an excellent historical novel, so real that the biting winds of the western frontier seem to flutter across its pages and cool our sweaty brows. Within this, however, is something much more profound---a dark and gripping morality play about friendship, ambition, and the very essence of what it means to be a doctor. This should be required reading in medical schools. I will not soon forget this book."
---Jake Halpern, author of Fame Junkies and commentator for NPR's All Things Considered

"The ethical ...

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Overview

"This is an excellent historical novel, so real that the biting winds of the western frontier seem to flutter across its pages and cool our sweaty brows. Within this, however, is something much more profound---a dark and gripping morality play about friendship, ambition, and the very essence of what it means to be a doctor. This should be required reading in medical schools. I will not soon forget this book."
---Jake Halpern, author of Fame Junkies and commentator for NPR's All Things Considered

"The ethical questions that envelop Doctor Beaumont and his patient are here laid bare for all to see---sliced through by Karlawish's sharp scalpel of finely-honed research . . . One can't judge this tale without pondering the possible experimental horrors our own bones and flesh might be enduring in our own time."
---Jackson Taylor, author of The Blue Orchard

"This is a remarkable story, compellingly written, of how one man's ambition brings him both the fame he coveted and crushing failure. The propriety of a physician treating his patient as a living laboratory and as an avenue to personal glory is set down for the reader to judge. Beaumont was a man both desperate and delusional, yet one who advanced medical science albeit with questionable methods. A provocative read from cover to cover."
---Don Faber, author of The Toledo War

"A highly readable and plausible reconstruction of the medical and personal interaction between St. Martin and Beaumont."
---Richard Selzer, surgeon and author of Mortal Lessons: Notes on the Art of Surgery and the novel Knife Song Korea

"Open Wound is a fascinating novel about scientific ambition on the American frontier. Read this fine book for its meticulous reconstruction of nineteenth-century life, and for its evocative portrait of a medical researcher whose hunger for success leads him down an ethically dubious path."
---Karl Iagnemma, author of The Expeditions
 

 A shotgun misfires inside the American Fur Company store in Northern Michigan, and Alexis St. Martin's death appears imminent. It's 1822, and, as the leaders of Mackinac Island examine St. Martin's shot-riddled torso, they decide not to incur a single expense on behalf of the indentured fur trapper. They even go so far as to dismiss the attention of U.S. Army Assistant Surgeon William Beaumont, the frontier fort's only doctor.

But in the name of charity and goodness, Beaumont ignores the orders and saves the young man's life. What neither the doctor nor his patient understands---yet---is that even as Beaumont's care of St. Martin continues for decades, the motives and merits of his attention are far from clear. In fact, for what he does to his patient, Beaumont will eventually stand trial and be judged.

Rooted deeply in historic fact, Open Wound artfully fictionalizes the complex, lifelong relationship between Beaumont---a prominent figure in Michigan's medical past and present---and his illiterate French Canadian patient. The young trapper's injury never completely heals, leaving a hole into his stomach that the curious doctor uses as a window to understand the mysteries of digestion. Eager to rise up from his humble origins and self-conscious that his medical training occurred as an apprentice to a rural physician rather than at an elite university, Beaumont seizes the opportunity to experiment upon his patient's stomach in order to write a book that he hopes will establish his legitimacy and secure his prosperity. As Karlawish portrays him, Beaumont, always growing hungrier for more wealth and more prestige, personifies the best and worst aspects of American ambition and power.

 

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Editorial Reviews

New York Times
"The relationship between doctor and patient is hard enough to parse when both are in the same room. …And of the gallons of ink spilled over the centuries in attempts at clarification, few efforts in recent memory lay out the frustrations and confusions and crystalline moments of grace better than Dr. Jason Karlawish's marvelous new book Open Wound."
—Abigail Zuger, M.D., New York Times

— Abigail Zuger, M.D.

Wall Street Journal Marketwatch
"In this historical novel, [Beaumont and St. Martin] become entwined in each other's lives medically, financially and even legally. Karlawish sketches their fraught relationship in the ensuing decades artfully, with clear relevance to the ethical questions of modern medicine."
—Kristen Gerencher, Wall Street Journal Marketwatch

— Kristen Gerencher

Historical Novels Review
"I recommend this well-written and fascinating book to anyone interested in early medicine."
— Susan Zabolotny
The Lancet
"...an excellent work of fiction with the power to illuminate difficult ethical issues."
—Noah Raizman, The Lancet

— Noah Raizman

JAMA
"...this novel is great food for thought about the ongoing issues of informed consent and the hazards of financial incentives in the field of medical research."
—Natasha Bagdasarian, MD, MPH, JAMA
From the Publisher

“The relationship between doctor and patient is hard enough to parse when both are in the same room. …And of the gallons of ink spilled over the centuries in attempts at clarification, few efforts in recent memory lay out the frustrations and confusions and crystalline moments of grace better than Dr. Jason Karlawish’s marvelous new book Open Wound.” --- Abigail Zuger, M.D., New York Times

New York Times - Abigail Zuger
"The relationship between doctor and patient is hard enough to parse when both are in the same room. …And of the gallons of ink spilled over the centuries in attempts at clarification, few efforts in recent memory lay out the frustrations and confusions and crystalline moments of grace better than Dr. Jason Karlawish's marvelous new book Open Wound."
—Abigail Zuger, M.D., New York Times
Wall Street Journal Marketwatch - Kristen Gerencher
"In this historical novel, [Beaumont and St. Martin] become entwined in each other's lives medically, financially and even legally. Karlawish sketches their fraught relationship in the ensuing decades artfully, with clear relevance to the ethical questions of modern medicine."
—Kristen Gerencher, Wall Street Journal Marketwatch
Historical Novels Review - Susan Zabolotny
"I recommend this well-written and fascinating book to anyone interested in early medicine."
—Susan Zabolotny, The Historical Novels Review
The Lancet - Noah Raizman
"...an excellent work of fiction with the power to illuminate difficult ethical issues."
—Noah Raizman, The Lancet
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Product Details

  • ISBN-13: 9780472118014
  • Publisher: University of Michigan Press/Regional
  • Publication date: 8/30/2011
  • Pages: 280
  • Product dimensions: 6.30 (w) x 9.00 (h) x 1.00 (d)

Meet the Author

Jason Karlawish is Professor of Medicine and Medical Ethics and Senior Fellow of the Center for Bioethics at the University of Pennsylvania. He studied medicine at Northwestern University and trained in internal medicine and geriatric medicine at Johns Hopkins University and the University of Chicago. His research examines issues in bioethics, and his clinical practice focuses on the diagnosis and treatment of persons with Alzheimer's disease and related disorders. 
 
jasonkarlawish.com

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Read an Excerpt

Open Wound

THE TRAGIC OBSESSION OF DR. WILLIAM BEAUMONT
By Jason Karlawish

THE UNIVERSITY OF MICHIGAN PRESS

Copyright © 2011 the University of Michigan
All right reserved.

ISBN: 978-0-472-11801-4


Chapter One

June 6, 1822 Mackinac Island in Lake Huron, Michigan Territory

DR. WILLIAM BEAUMONT WAS AT HIS DESK in the army hospital when he heard the gunshot. It came from the bottom of the hill, in the direction of the American Fur Company's warehouses along the Mackinac Island harbor. He rose from his chair and stood before the small office window. The gate of the fort at the top of the hill was open, and several soldiers at arms ran down the hill. Within the minute, Elias Farnham, Beaumont's steward, flung open the door.

"Doc Beaumont, there's been a shooting in the company store. A young fur trapper's shot bad."

Elias held out Beaumont's surgical kit. Beaumont took it in hand, hefted the thing before he tucked it into his coat pocket, then together they ran down the dirt road to the American Fur Company store. The sweating crowd of fur trappers, Indians and soldiers stood in a golden halo of road dust as they tugged at their ringing ears. Dogs were barking. A child was crying.

"Doctor's here, let him in! Let him in!"

A soldier held open the door.

A ring of men, some standing, others squatting, surrounded a man lying on the floor and moaning. The smells of gunpowder and burnt flannel and flesh hung in the thick air. A young man, his clerk's apron blood-spattered, ran up to Beaumont. It was Theodore Mathews, the manager of the store.

"It's horrible, Doctor! Horrible! A shotgun discharged right here inside the store, and this fella took the blast close on."

Beaumont nodded. He knelt before the wounded man and reached out to lay his hand on the young man's shoulder.

"Easy there, lad. Easy. I'm Dr. Beaumont. I'll take care of you."

He took his surgical kit from his coat pocket.

"Elias, unroll my kit on the floor just to my left." He gestured to two men. "You there, ease out this lad's legs, one man on each leg. I need you to keep him from writhing about. Elias, you take his arms. And if you don't need to be here, please leave. I don't need an audience."

As he gave these orders, he was carefully stripping off the young man's red flannel shirt, using his jackknife to slice it away at the sleeves. The blast had torn a hole in the shirt. The edges of the hole were burnt, and the cloth was wet with the distinct smell of coffee and bits of what looked like breakfast meat and bread.

"Jesus," he murmured.

It was a horrible wound, the size of a man's palm, riddled with bits of fractured rib and cartridge wadding. Someone handed Beaumont a rag. He wiped away the blood and started to pick away the debris. The fur trapper moaned and coughed, and a protrusion of flesh heaved up, and the source of the coffee and food was revealed. The blast had torn a hole into the man's stomach. Beaumont sucked in his breath. Just above the injured stomach, a lobe of lung was caught on the ragged edge of a fractured rib. The man's breath bubbled through the blood that soaked the lobe. Beaumont used his penknife to snip the tip of that rib, then eased the lobe back into place.

"William, can I talk to you as you work?"

It was a voice as steady as Beaumont's.

"Yes of course, Captain."

Captain Pearce, the commander of Fort Hill and the Mackinac Island garrison, stood beside the doctor, watching him.

"I've got the assailant outside under guard. Teddy Mathews says he saw the fella set his gun down—set it down like it was a walking stick—and the lad here was right in the way of the blast. The balance of the witnesses' testimony is that this was an accident." He eyed the fur trapper. "A tragic accident," he said. "Look like that to you?"

"Hard to tell, but the shot's not direct. There's a bit of an angle to it, sort of upward and outward." He looked up and whispered to the captain. "If it was dead on, I wouldn't be needed here."

The captain's eyes narrowed as he peered at the wound.

"What on earth is that thing that looks like a turkey's egg?"

"Lobe of lung."

The captain grimaced. "Ah, Christ." He shook his head slowly.

It took the doctor twenty minutes to superficially clean the wound and apply a compress dressing. When he finished, he turned to Elias Farnham and ordered him to fetch a stretcher so they could carry the lad up to the hospital.

"William?"

Beaumont turned. It was Ramsay Crooks, the American Fur Company's principal agent on Mackinac Island. He was a large, red-headed man with a raw strength gained from some twenty years leading fur trapping expeditions as far west as the Oregon territory. Crooks gestured with his chin for Beaumont to step closer, and when Beaumont did he placed the length of his thick right arm upon Beaumont's shoulders and eased the doctor to a quiet corner of the store.

"You've done fine work with that Frenchie, William. Fine work. I always tell my sweet Emilie how lucky we are to have you on this island." He bit his lower lip, and looked in the direction of the young man. "You think that boy'll live?"

Beaumont considered the question. "He's not sinking."

Crooks grimaced. He tightened his grip.

"But do you think he'll survive the day?"

"In the war I managed wounds far worse than this. A few lived."

Crooks lowered his voice. "Let's just have him stay here."

"Here?"

"Here, yes. In the storeroom." Crooks released Beaumont and gestured to the door to the storeroom. "There's plenty of room, and there's always someone there. It's clean, dry and temperate. I've slept there myself some nights."

Beaumont frowned.

"Ramsay, I think perhaps ..."

Crooks interrupted him. "Captain Pearce," he called.

The captain stepped over.

"I was just saying to William here that we can set the wounded trapper up on a cot in the storeroom. I'll be there at my desk to watch over him, and if I'm not, Teddy or one of the other clerks can see to his care, and William can check on him as he requires. Remember that fellow with the broken leg last year? And he was certain to live, and that's simply not the case with this one."

Pearce listened and nodded. Beaumont looked back and forth from the captain to Crooks. Speechless.

"What is it, William?" Captain Pearce snapped.

"Captain, the wound engages both lung and stomach, and I simply gave it a superficial cleaning. If he survives the morning, there's likely more to debride, and I'd rather manage that in the hospital."

Crooks smiled, and placed a hand on Beaumont's shoulder.

"It's a short walk down the hill, and you can come whenever you require. I'll even lend you a key to the storeroom." He spoke in a high tone, practically singing.

"But Ramsay."

Crooks tugged Beaumont closer to him. "William, you know as well as I do that I don't pay for these Frenchies to stay in the army's hospital. You start moving them in there, and then I've got some thousand men, women and children—white and Indian—living on that beach who can lay claim to a company-sponsored stay in the hospital. People with injuries far simpler than this man's. Think of the precedent, William. Think."

"I've plenty of empty beds."

"But you won't if you start fillin' them with the company's voyageurs and their families," Captain Pearce interjected.

Beaumont was incredulous. He looked around seeking an ally, but Elias was staring at his boots.

"Captain, this is an accident, not the war, and the lad's not dying. He's my patient now."

"Keep your voice down, Assistant Surgeon. I don't need a scene." The captain stared coldly at the doctor. "It's up to Ramsay, really. If he wants to pay room and board, I won't stop you from moving the lad to the hospital. A day costs little, and he ain't eatin'."

"I should say it's up to you, Captain." Crooks gestured to the wounded fur trapper. "That boy there is one of my indentured servants, and if he's anything like the lot of them, he owes me dollars against his indenture. But with a wound like that, even if by some miracle he survives the day, I'm never going to see that money. And now add to that a bill to house a dying man, not to mention the others who will come to expect the same. I can't run a charity hospital for the village of trappers along the beachfront. This doctor's your charge," he insisted. "He wears your uniform. And I might add that he seems quite busy stirring things up. Penning circulars about the expansion of the company warehouses and now standing here and telling me I've got to foot the bill for a lost cause."

He was speaking of a circular Dr. Beaumont had issued the other day to protest the company's plan to expand a warehouse onto the land where the garrison maintained a vegetable garden.

Beaumont stared at Crooks.

Captain Pearce exhaled heavily. The store was beginning to fill once more. They were being watched with increasing interest. Men were whispering.

"William, if Ramsay wants to pay for this Gumbo's room and board at the army's hospital, you can take care of him there. Otherwise, you care for him where he lays. That's what the army's agreement with the company stipulates. Be reasonable. I was in the war too. That lad's gonna die. You know that as well as I do."

Crooks nodded smartly. "I've heard enough," he murmured, and then stepped over to the wounded man. His eyes were closed and his breathing shallow. Crooks reached into his pocket and produced a handkerchief. He wiped his eyes and his brow, and then he slowly lowered himself to his knees and wiped the wounded man's brow. He looked at the men around him.

"Friends, this here is a terrible tragedy. It's sad to see one of the company's brave trappers wounded in the line of duty. He's like a fallen soldier." Crooks shook his head mournfully.

"Teddy, you and the boys ease this young fellow onto a cot there in the storeroom. We'll set him right by my desk so I can watch over him and pray for him like he was my son."

Chapter Two

THE VILLAGE OF MACKINAC ISLAND and the beachfront camps along the shore of Lake Michigan were astir with the labors of the day. The white walls of Fort Hill gleamed like a hilltop temple.

Beaumont was seated at his desk in his cluttered office at the hospital. His inkpot and leather notebook lay open as he had left them when Farnham came with the news of the shooting. His habit was to begin his day writing. The notebook served as both his personal diary and his professional record of cases. It contained notes on his travels and letters written and received. There were copied passages from the poet Burns, as well as his own observations upon the nature of man. Numbers and computations interspersed the written words, accounting his credits and debts, the former finally ahead of the latter. The notebook had become a collected record of his wealth, the chronicle of his ambition.

He dipped his pen and tried to resume writing. Ramsey Crooks was proposing to expand a company warehouse into the land the garrison used for a garden. The project threatened the plots of medicinal herbs and wheat Beaumont had planted. Beaumont drew a line beneath his notes about the garden controversy and wrote, "Tended to a young voyageur at the Company's store. Shot into his left lower chest. Accident. Wound engages both lung & stomach, likely mortal." He looked at these words, and then he set his pen down.

He gazed out the window at two men sawing a log. It was brutal, tiring work. The stack of raw timbers beside their saw pit would take at least a day.

During the war he could have filled pages of his notebook with cases like this young fur trapper, and for several weeks he had. And then he stopped. The war was fine training for an apprentice-trained surgeon with aspirations, but it was a cruel university.

After some battles, the wounded came without surcease, begging for relief. Some pled to have their arms, legs or even their heads cut off. Many of the chest and abdominal wounds, wounds like the fur trapper's wound, the doctors simply cleaned and packed as best they could to limit the egress of innards and left the men to die.

The doctors worked with increasing haste as the numbers of wounded multiplied. The maimed, gashed and dying lay upon whatever surface was available. The agonies of men dying or wishing they could die and the murderous grating of saws working through long bones filled the air. After several hours, their brutal work built several fly-covered piles of amputated arms and legs, some of the legs still dressed in stockings or boots.

He remembered one frigid evening in a ruined fort they occupied as a hospital, when the littlest of the stewards was clutching the amputated leg of a black man as he hesitated before the pile of white legs until Beaumont signaled with his chin to set it among the rest.

Even the name of the war was changing. The Second War of Independence was now simply the War of 1812. It was as though the three long and bloody years had become one, and the war was for nothing. It was just a single year when America and Great Britain decided to fight and then to make their peace. History was not a nation's diary of the facts but the selective forgetting of those facts.

Beaumont reread the lines he had written in his notebook, added the date and put away his pen.

"Goddamn," he muttered. In the war treating every man was impossible. But not here.

He looked at the nail of his throbbing right index finger. He had picked a rent into that nail until he tore it to its sore and bleeding cuticle. He snipped the errant nail between his teeth and spat it upon the floor.

In his walk back to the hospital, he had heard the murmurs, seen the men nodding, children wide-eyed and women whispering and pointing. The news of the plan to keep the young fur trapper on the cot in the supply room was spreading fast through the village, up the hill to the fort and throughout the camps along the lakefront. The more he reviewed that decision, the more he regretted his part. It was different when there were not one but one hundred men or more. When it was war and you were following orders. But then another thought struck him. What could Pearce and Crooks do if he were to carry the wounded man to the hospital?

For several minutes, he watched the under man in the saw pit struggle to manage the force the over man applied to the handsaw, and then he stood up with such force that he had to grab his chair to keep it from toppling.

"Elias," he called. "Elias!"

There was the quick shuffling of shoes across the gritty floor. The old man appeared at the door.

"Yes, Doctor?"

"Gather up my surgical kit. We're going to the company store to fetch that lad."

Elias did not move. "I thought the plan was that he was to be stayin' at the store? That you'd tend to him there."

Beaumont nodded. "I said, gather up my surgical kit."

WHEN BEAUMONT AND ELIAS reached the store, they heard the sound of men's laughter from within. Ramsay Crooks and three other officials of the American Fur Company were gathered about a table sipping from blue tin cups. Crooks was recounting his story of outwitting the Teton Sioux along the James River. A sunbeam illuminated a whiskey bottle at the center of the table. A haze of cigar smoke swirled above their heads. They turned when Beaumont entered the store.

Crooks blew out a stream of smoke.

"We didn't call, did we?" He looked at the others. The men shook their heads. Crooks motioned with his smoking hand to the open supply room door. "As you left him, William. Teddy's tending to him. Fancies himself some manner of hospital steward now."

The men laughed.

Beaumont went directly to the supply room. Theodore Mathews was wiping the man's face with a damp rag. He stepped away to give Beaumont room. The boy was awake, wide-eyed and breathing rapidly.

"I'm sorry, Doctor. I was just trying to help."

"No worries, Theodore. I'll take care of him now."

(Continues...)


Excerpted from Open Wound by Jason Karlawish Copyright © 2011 by the University of Michigan . Excerpted by permission of THE UNIVERSITY OF MICHIGAN PRESS. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents

Prologue I

Part I The Taker Made Mad 3

Part 2 The Only Men Entitled to Happiness 129

Part 3 The Immortal Part Cracked 223

Epilogue 259

Author's Note 263

Acknowledgments 269

About the Author 270

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  • Posted October 28, 2012

    more from this reviewer

    Excellent historical fiction

    Wow. This is one of those books that make you feel like you're still a part of the character's life even after you have stopped reading. Dr. Beaumont's story is so relatable and so tragic, it's hard to pull yourself away from his experiences. The inside flap of the book's cover says, "even as Beaumont's care of St. Martin continues for decades, the motives and merits of his attention are far from clear." This couldn't be more true. I found myself flip-flopping throughout the novel on who I felt was the victim and who was the oppressor. At some points, I felt like Beaumont was only acting out of altruism and charity, and that Alexis was ungratefully taking advantage of him. Then in the next chapter, I felt like Beaumont was using his power over Alexis unethically, and that Alexis was trapped in a hopeless, unfair situation. Beaumont admits that he is ambitious and wants to leave a lasting legacy, but his obsession seems to be driven by something deeper and darker, something that neither Beaumont nor the reader are able to truly identify. Beaumont's obsession is truly tragic. There were so many moments where I wanted to grab Beaumont by the shoulders and shake him and yell, "Let it go!" He makes some progress and gains small successes, which encourage him to continue, but he loses so much over the course of the novel. There is a moment towards the end where it all starts to unravel, where it seems like everything he has done in his life is going to amount to nothing, and I just wanted to cry. I think it would be very difficult to read this book without getting invested in Beaumont's story, regardless of whether you view him as the victim, the oppressor, or both. { I received this book for free as a Goodreads First Reads giveaway. }

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