Inside Passage near Juneau, Alaska; March 30, 1888
How did a man get a doctor to Tanana, Alaska, three times a year?
Nathan Reid shoved a hand through his hair, then sat back, ignoring the gentle swaying of the ship beneath him as it cut north through the waters of the Inside Passage, heading for Juneau. A swinging lantern hung from the ceiling above him, and with the gray daylight filtering through the cabin’s small window, its glow cast just enough light for him to study the giant map he’d tacked to the desk.
The Yukon River sprawled across the map like a mighty serpent winding its way through the rugged terrain of Alaska. Even on paper, the river appeared vast, an artery that pulsed through nearly two thousand miles of wilderness before finally flowing into the Bering Sea. The tiny village of Tanana sat almost directly in the center of the river, at the confluence of the Yukon and Tanana Rivers, in the middle of a land filled with endless trees and mountains.
The people of Tanana had no doctor, not even a nurse. No one to provide medical care if anyone grew ill or became injured in that small town. The only way to reach it was by boat up the Yukon. But Tanana wasn’t the only settlement in the interior without access to medical care. There were a handful of others located on the Yukon River and its tributaries, like Fort Yukon, Anvik, and Nulato.
If he wanted to get a doctor into each of these towns three times a year, then he’d have to create a route for a traveling doctor. It would work for the summer months, but what would happen if Tanana or Fort Yukon experienced a smallpox outbreak in the dead of winter? There was no way to get inoculations to the community, except perhaps by dogsled.
And how many people would die in the time it took a dogsled team to reach Tanana?
Nathan sighed. He was probably wasting his time even trying to figure this out, because what were the chances he could find a doctor willing to spend his summers traveling up and down the Yukon River, and his winters dogsledding over the frozen route?
And what was the likelihood he could find a boat that would transport this doctor in the first place? The government didn’t have any ships that traveled up the Yukon River.
Nathan tossed his pencil onto the desk and crossed his arms. Maybe it was best to just station a doctor in Tanana and not have him travel.
But then how would Fort Yukon and Anvik get care? And what about Fort Selkirk, which sat farther up the river in Canada? He doubted anyone with a medical bag had ever walked its streets, let alone someone distributing smallpox inoculations.
Nathan blew out a breath, then rolled his neck, which was growing tense from spending too many hours hunched over the map.
“It’s raining again. Can you believe that?” The door to the small passenger cabin opened, and Nathan turned to find his partner, Dr. Victor Ellingsworth, stepping inside and closing the door behind him.
He pulled his wide-brimmed hat off his head and hung it on the peg by the door, revealing a head that had more skin than gray hair underneath.
A stream of water ran from the brim onto the floor, and Ellingsworth scowled down at the puddle. “I swear that’s all it does here. Rain.”
“It’s supposed to rain.” Nathan shifted in his chair again, trying to make the crude wooden frame a bit more comfortable to sit on. “Didn’t you read the journal article I sent you on the climate of Southeast Alaska? The meteorologist who wrote it says the Pacific Northwest should be classified as a temperate rain forest. The water from the ocean collects and forms clouds that hit the mountains and cool quickly due to the cold air from the Arctic, which causes frequent and heavy rainfall. The meteorologist claimed that this part of the Alaskan and Canadian coasts is one of the wettest regions in the world.”
“Yes, well, the water doesn’t need to collect constantly, does it? A bit of sun isn’t too much to ask for.” Ellingsworth rubbed a hand over the bald spot on the top of his head, as though the pale skin would do anything other than turn bright red if it got a hint of sunlight.
Nathan shifted his gaze to the cabin’s single, small window, which revealed they were passing a small island covered in rock and trees. “I think it’s rather lovely. There’s something majestic about mountains rising out of the sea in every direction you look, even if they’re always shrouded in mist.”
Ellingsworth snorted. “As though you would know. You’ve barely been on the deck.”
Nathan rubbed the back of his neck, which still felt stiff despite his stretching. If only he had time to spend on the deck, watching the scenery and getting acquainted with the land that was to be his home for the next three years. “I keep promising myself I can spend some time up there after I figure out how to get a doctor to every village in Alaska three times a year.”
“Don’t tell me you’re looking at that dratted map again.” Ellingsworth crossed the cabin to Nathan’s desk, rainwater still dripping from the cuffs of his trousers. “How many times do I have to tell you? This is a fool’s mission. Alaska’s too big. You’ll never be able to provide medical care for all the inhabitants.”
“It’s not a fool’s mission. If we can get the surgeon general to give us two more doctors—”
“Two more doctors?” Ellingsworth frowned. “You’ve already asked for five to be sent to this godforsaken place, and now you want two more?”
Nathan tapped his finger against the small dot that marked Tanana’s location on the map. “The Yukon River is going to need its own route for a traveling doctor. And there’s no way for me to get a doctor up to Barrow three times a year. I’ll have to permanently station one who lives in the community.”
Ellingsworth crossed his arms over his chest. He was a big man, and though his muscles had started to go a bit soft given his age, his chest was still twice as broad as Nathan’s, his arms far more muscular. He was large enough and strong enough that he could walk into a room full of sailors and have every man there instantly pay attention. A rather useful skill for a person tasked with doctoring sailors.
“Those settlements have been getting along fine without doctors for centuries.” Ellingsworth gestured toward Barrow on the map. The village was positioned at the very top of Alaska on the coast of the Arctic Ocean.
How could the man say such a thing, especially about Barrow? “Have you forgotten the diphtheria epidemic that swept through Barrow last year? Or the bout of smallpox that swept through Anvik two years before that?”
Ellingsworth just shook his head, which caused drops of water to sprinkle across the map. “I appreciate what you’re trying to do, Reid, but you’re too optimistic for your own good. The Marine Hospital Service is just that, the Marine Hospital Service. We’ve got no business trying to provide medical care to every last person in Alaska, and I’ve told that to John more than once.”
John would be Dr. John B. Hamilton, the surgeon general of the United States, with whom Ellingsworth was on a first-name basis. The two men had been working for the Marine Hospital Service for decades. While Dr. Hamilton had turned to a management role, Dr. Ellingsworth became known as an expert in communicable diseases. One might not be able to tell it by looking at him, but he’d been credited with saving over three hundred lives, most of it due to quickly establishing quarantine facilities during various disease outbreaks.
But disease expert or not, he was wrong about Alaska. “Someone needs to provide care to people in remote areas of Alaska, just like someone needs to provide care to remote regions of the Louisiana Bayou and Appalachia and the Texan Desert.” Nathan stood, his chair scraping against the wooden floor of the ship. “People in these places die every day because of things that a doctor in a city could easily treat.”
“Then more doctors should go to those regions.” Ellingsworth planted his hands on the desk, two meaty palms with thick fingers. “I have no problem with convincing doctors to go to those areas. What I’m saying is it shouldn’t concern the Marine Hospital Service. We treat seamen.”
“Not in Alaska. The surgeon general has tasked us with treating the general populace.”
Ellingsworth shook his head and muttered something under his breath.
Nathan held in his sigh—barely. In any other circumstance, he would be grateful to work under such an experienced doctor. But to have Ellingsworth with him in Juneau, when the man didn’t even agree with the MHS’s goal? When he had no interest in providing care to people living in remote locations?
“We’ve been over this before, Reid. You’ve read the same reports I have.” Ellingsworth turned and stalked back to the door, where he took off his oilskin coat and hung it on the peg beside his hat. “There’s no difference in mortality rates between people in rural areas without access to medical care and people in urban areas.”
“That’s because diseases spread more rapidly in urban areas—too rapidly to control. Unless we can convince city planners to spread out the new houses and tenements being built, we have little hope of correcting that. But rural mortality rates are different. We can improve those if we simply provide access to—”
“You’re not going to change the world. You might have talked John into this fancy new plan of yours, but like I’ve already told you, it’s not the Marine Hospital Service’s job to treat the people of Juneau or Sitka, let alone Indians living in villages that take months to reach. I’ll give it six months before John revokes funding.”
Six months? Nathan’s blood turned cold. When he’d presented his plan to the surgeon general, he’d asked for five years to establish a system of care that treated not just sailors but the residents of Alaska as well.
The surgeon general said he could have three years. That didn’t seem like remotely long enough, but he might have had a chance of succeeding—if the surgeon general had put him in charge of the project.
Instead, he’d selected Ellingsworth to lead it as chief medical director of Alaska.
Up until about a month ago, Nathan had been somewhat in awe of the man. How could he not be? Ellingsworth had treated enough diseases and led the MHS through enough outbreaks of cholera, typhus, and yellow fever on ships that he was something of a legend.
But within a day or two of being dubbed the chief medical director of Alaska, Ellingsworth had made it clear he thought MHS funds should stay focused on ensuring contagious diseases didn’t enter the country through the sailors who traveled the world.
So even though Nathan had been the one to approach the surgeon general about the need for more medical care in Alaska . . .
Even though he’d come up with a plan to establish a hospital that would treat not just seamen but also the general populace in Juneau and bring five new doctors to Alaska . . .
He wasn’t the one in charge of implementing any of it.
But Nathan wasn’t going to let the plan fail that easily. He could still remember what it felt like to stand over his mother’s grave as an eleven-year-old boy, still recall how her casket had looked as it was slowly lowered into the ground, still quote verbatim what the doctor had said when he’d pronounced his mother dead.
If you’d gotten to town faster, I could have saved her.
Nathan didn’t care how big Alaska was, or how remote, or how difficult travel was in winter. Nor did he care how much Ellingsworth mocked him for studying his map rather than taking in the stunning landscape surrounding them. If he could save even one life by stationing a doctor in a remote place, then he’d have succeeded.
But he didn’t intend to save just one life. He intended to save dozens, or maybe even hundreds, like Ellingsworth. And after he did it in Alaska, he’d convince the surgeon general to let him do it again in the Outer Banks of North Carolina and the swamps of Louisiana. In the thick Northwoods of the Midwest, and anywhere else that needed doctors.
He might not have been able to save his own mother, but he fully intended to save someone else’s.
