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Predatory Health Care, The Novel

Connie Herzberg Mayo’s riveting tale captures the injustices of the U.S. medical system with surgical precision.

Eleanor J. Bader Apr 6

Immediately after teenaged sisters Lillian and Marie Dolan move out of their mother’s apartment and rent a tiny flat of their own in New York City’s Hell’s Kitchen, money worries begin to mount. Marie, blind, mute and intellectually disabled due to a childhood bout of scarlet fever, needs 24/7 supervision and Lillian quickly realizes that she not only needs a job, but also needs a caretaker for Marie to make out-of-home work possible.  

Luck comes her way. When a low-level nursing assistant position at the New York Cancer Hospital — the precursor of today’s Memorial Sloan-Kettering Cancer Center — opens up, Lillian is hired and a neighbor steps in to take charge of Marie. But almost from day one, there are problems that require Lillian to think on her feet and adapt to the challenges that come her way. 

On one hand, The Sharp Edge of Mercy, set in 1890, is a historical novel about surmounting obstacles. But it’s also far more. It’s an incisive, revelatory look at the inner workings of the first cancer hospital in the United States that raises a host of personal and political concerns. 

For example, as Lillian settles into the multi-faceted position, she is warned by her colleagues not to get too close to patients and simply do the menial chores that she is assigned. But how to keep her distance?  How to keep from developing an emotional attachment and caring about the women languishing on the ward? 

It’s a question that continues to vex today’s medical workers. And while Mayo invented much of what transpires in the novel, the fact that it is grounded in concern over pragmatic matters and real medical history gives it resonance and contemporary relevance. Take her inclusion of gynecologist J. Marion Sims, one of the hospital’s founders, who perfected fistula correction surgery by operating on enslaved women without using anesthesia. One particular patient, 17-year-old Anarcha Westcott, had 30 excruciating surgeries over a four-year period. Lillian learns the horrific story from brothers Jupiter and Solomon Scott, Anarcha’s fictional nephews, who describe the long-term impact of the abuse their aunt endured. It’s a gut-wrenching account of medical racism.

As Lillian settles into the multi-faceted position, she is warned not to get too close to patients and simply do the menial chores that she is assigned. But how to keep her distance?

And this is not the only social history reported in The Sharp Edge of Mercy. The novel also presents the class-tiered system that provided rudimentary treatment to poor and working-class women — the New York Cancer Hospital did not initially admit male patients — in crowded wards while catering to wealthy full-payers. The latter, Mayo writes in an afterword, were treated like guests at a luxury spa, with private rooms, afternoon rides in hansom cabs and daily champagne cocktails, amenities, Mayo notes, that were part-and-parcel of the palliative care provided to the well-heeled.

It’s both shocking and not.

The novel tackles a plethora of other concerns: race relations, queer life in turn-of-the-century Manhattan, sexual harassment, alcoholism, euthanasia, domestic violence, prostitution and the development of the burgeoning field of nursing, then coming into its own as an exclusively-female profession.

It’s a lot to cram into 288 pages, but Mayo’s writing is crisp and has tremendous emotional appeal, so the many issues that are raised never feel forced. Indeed, The Sharp Edge of Mercy does not sacrifice craft even as it juggles a slew of historical facts and social issues. The end result is an entertaining and enlightening dive into U.S. medical history and the ethics that guide medical practice. It’s both provocative and moving.Put simply, The Sharp Edge of Mercy is a riveting and compelling read. It will have you cheering for Lillian at every turn.

The Sharp Edge of Mercy
by Connie Herzberg Mayo
Heliotrope Books; 288 pages; 6 May 2022

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