A 'lady doctor' goes to war: meet Clara Heywood, the Surgeon of Royaumont

Royal Prince Alfred Hospital, Sydney, February 1914

Long before the first rays of light penetrated the room, and before the screaming of the corellas, Clara was wide awake. She picked up her pillow from where it had landed during a night of tossing and turning, cricked her neck back into place and prepared for the most significant day of her life.

'You've spent years training for this, Doctor Heywood,' she said to her reflection in the cedar-framed mirror while fixing her silk necktie with a pearl button. 'Now is your chance.'

She did one final check to ensure no strands of hair had escaped from her loosely plaited chignon, patted down her ankle-length skirts, and headed downstairs. With each footstep along the tiled corridors of the grand Victorian hospital building, her heart raced. At the entrance to the children's ward, she stopped to savour the aroma of bleach and carbolic that wafted from under the doors. Clara loved that smell.

It represented everything she dreamed of. For the next six months this would be her ward and her responsibility.

She pulled herself up to her full height of five feet and four inches, took a deep breath and pushed the doors open.

A tall and imposing figure with a flowing white veil headed towards Clara, accompanied by the dull rustle of heavy cotton skirts and the jangle of brass keys concealed in the folds of her apron.

'Good morning, Doctor Heywood. We have been expecting you. I am Sister Reid.'

'Thank you, Sister. I am excited to finally be here.'

The ward sister's features tightened into a disapproving mask. 'I am well aware that the Board has seen fit to allocate you to this ward. You should be aware, however, that I will show no leniency towards your sex, nor tolerate any alterations to our ward routines. Now, I expect you will want to meet our patients?'

Before Clara could reply, Sister Reid clapped her hands and the ward fell silent except for a concerto of snuffles, coughs and rustling starched bedsheets. Clara hastily stepped in beside the ward sister and they processed along the neat rows of low-set, iron-framed beds. There were ten each side of the ward, with four wooden cots at the far end. Nearly all the beds were occupied, by children of differing ages and in various states of sitting or lying beneath neatly folded coverlets, but universally clad in blue-striped flannel pyjamas. Clara deliberately smiled at each of her new little patients, but their faces reflected only anxiety, or perhaps curiosity about the arrival of a lady doctor.

In the third bed, a young boy of about eight was propped up on pillows. Had he been well, his face, surrounded by an untamed mass of blond curls, would have been cherubic. Instead, a fevered pallor suffused his skin, his eyes were hollow, his lips chapped and dry.

'Master James has been here two days,' Sister Reid told Clara. 'Bronchitis. Nurse Brown, fetch Doctor the medication charts.'

Sister Reid's tone was more a command than a request, sending the young nurse scurrying to the notes trolley.

To Clara's surprise the child didn't protest when the nurse sat him up. Clara examined him carefully, first checking the hue and temperature of his skin. His small plump hands were hot and damp to her touch. She moved her stethoscope over his back and watery crackles bubbled through her earpieces. His chest heaved with each breath as he struggled noisily to draw in air.

'You can rest now, James,' she said, smoothing the child's starched sheets back into place.

That was easy. Thankfully the diagnosis was clear.

'Pneumonia most likely,' Clara said. 'Right lower lobe. He should respond to a treatment of steam vapour and eucalyptus oil.'

Sister Reid raised an eyebrow. 'Doctor Burnett prescribed vapour of ammonia and camphor compresses. I imagine you will want to continue that?'

It wasn't Clara's first choice. She wavered for a moment. A small voice urged her to stand her own ground. But perhaps it would not be prudent to contradict the previous doctor's orders, especially on her first day.

'Of course, if Doctor Burnett has already written up the order ...' she said.

They worked their way along the ward and through an encyclopaedic collection of childhood illnesses - skin infections, an assortment of fevers, young boys in plaster casts. Clara marvelled at Sister Reid's knowledge of each of their conditions. By the tenth patient, she wished she had brought a notebook. How would she ever keep track of all their names and ailments? To make things worse, at every bed her own treatment suggestions were cut off in deference to Doctor Burnett's various prescriptions. It wasn't as if Clara hadn't also trained for years for this. How was she ever to establish her own authority?

At the far end of the ward, behind a screen, lay a skinny, dishevelled young boy with sallow skin and sunken eyes. The nurse beside him, wearing the lilac uniform of a probationer, stood to attention. A damp face washer suspended from her hand threatened to drip onto the stiffened sheets that were already soaked with rivulets of perspiration.

A woman - Clara presumed her to be the boy's mother - sat beside his bed. Her hair was a tangled mop of brown and grey, and her fraying underskirt was visible through the worn fabric of her dress. Clara detected a faint smell of liquor emanating from her and supposed years of drinking had made her seem so much older than she must have been.

'When's the doctor going to fix my boy?' she said with a heavy Irish lilt. 'All this poking and prodding and my Tommy's no better than when we got here.'

'Why don't you step outside, Mrs O'Driscoll, while Doctor Heywood examines Master Thomas and does what is necessary,' Sister Reid said in a voice that conveyed compassion but would brook no dissent.

'She ain't no doctor! Where's Doctor Burnett?' the woman said. 'He's supposed to be looking after my Tommy.'

'Doctor Burnett has taken on other responsibilities. Doctor Heywood is responsible for this ward now, Mrs O'Driscoll. I am sure she will be very gentle with your son.'

'Well, I never - a lady doctor! Is she any bloody good?'

'I have trained at the best medical school in Australia, Mrs O'Driscoll, right here at the Alfred,' Clara replied, her face reddening. 'Please try not to worry. We will take good care of Tommy.'

Begrudgingly Mrs O'Driscoll allowed herself to be ushered out of the room.

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Clara examined the boy carefully. His skin was hot and damp, but his lips were cracked and dry. His pulse was thready and rapid under her fingers, and as the nurse unbuttoned his pyjama shirt Clara could see his skinny chest rising with each rasping breath.

Fever. Sepsis. The three common causes in children are ...

She felt his neck, then took a wooden spatula from the instrument tray on the bedside table and examined inside his mouth.

'Quinsy,' she exclaimed. 'His tonsils are both swollen, but here on the left there is an abscess. He has quinsy.'

'Yes, I am familiar with the condition,' said Sister Reid archly.

'This needs to be drained. When can we get him to the operating theatre?'

'Mr Galbraith did his rounds yesterday. There is no visiting surgeon and no theatre until tomorrow.'

For a moment Clara was unable to breathe. Her heartbeat escalated.

'But, Sister, we can't afford to wait until tomorrow. This child needs immediate surgical attention.'

'I am sure that we can call for one of the male residents,' Sister Reid said. 'For a second opinion. They do have more experience after all.'

Clara looked at the child. His face was ashen, and between each rasping breath his eyes pleaded with her.

'This quinsy is putting considerable pressure on the child's airway,' she said. 'He can't wait any longer. He is already struggling to breathe. We will simply have to drain it here.'

'Very well, if you think it is necessary I will summon Doctor Burnett -'

'We cannot wait for Doctor Burnett,' Clara said, trying to keep the irritation out of her voice. I am the doctor here. 'I will need a tray, sterile gauze, a long handle and a fine blade. And draw up a small dose of laudanum, please, Sister.'

'You intend to do the procedure yourself? This is most irregular. Nurse,' Sister Reid said, clapping her hands, 'call for Doctor Burnett. I am sure he will want to supervise.'

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If he gets here in time.

Clara's throat was tight. She swallowed hard. She wasn't about to admit that the most serious thing she had done before graduating was to lance a boil.

She turned to Tommy. 'Now, Tommy, I need you to be brave. This will hurt just a bit, but as soon as it is done the pain will go and your breathing will be easier.' She kept her tone light, as if the boy just needed coaxing to do some unpleasant chore. 'Now, open as wide as you can.'

He obeyed, and the nurse delivered six drops of dark viscous liquid onto his tongue. Clara knew he wouldn't be able to swallow it, but the opioid would take effect in a few minutes regardless.

Her heart hammered against her ribs as she fumbled to pull on a pair of gloves. She turned to the tray and reached for the double-edged lancet. As she pushed it onto the scalpel handle it slipped, almost slicing her fingers. She gripped the handle tightly. Dear God. She was terrified to admit she had never done this before. She had seen it done. Watched from a distance. But there was no time to second-guess herself now.

'Tommy, I need you to be quite still,' she coaxed, more to herself than him. Cold perspiration seeped through the back of her pin-tucked blouse and she bit into her lower lip. A wave of dread and doubt swept over her. Am I doing the right thing? Clara could feel Sister Reid's disapproval of her actions piercing her, but while she might make inferences and unwelcome suggestions, the sister would never openly contradict a doctor's decision - not even a woman doctor's.

The nurse steadied Tommy's forehead. His eyes were glazed now, a sign the laudanum had kicked in, but even half-insensible he was still gasping for breath. His lips were blue.

Clara pulled down his lower jaw and was met with a waft of rank breath. Her hand trembled as she brought the tip of the blade against the bulky red layers of swollen flesh.

You've trained for this. Remember your lessons. Remember the anatomy.

She pressed the lance deeply into the tonsil. Instantly a pressurised spurt of creamy pus mixed with blood disgorged and the swelling collapsed. The boy coughed and choked, his arms clutching at the air, his eyes suddenly wide and fearful. He clawed at Clara's sleeve and the scalpel dropped from her grasp to the floor.

A rancid foetor, like putrefying offal, rose from his mouth and Clara gagged. 'Gauze, please, Nurse.'

Clara wiped away the purulent liquid, her insides heaving. Sweat soaked the collar of her blouse. Tommy continued to gasp, voraciously sucking in air, but already colour suffused back into his face and lips.

Clara thrust her gloves into the metal bowl beside Tommy's bed. She pressed her hands tightly together to stop them from shaking.

'He will need salt gargles,' she said. 'Every four hours. And nothing to eat until tomorrow. I will check on him later.'

'Yes, Doctor,' replied Sister Reid.

For a moment the two women's eyes locked but the Sister's expression was unreadable.

A rising tide of acid burned the back of Clara's throat. Her knees suddenly started to shake as adrenaline coursed through her body. She covered her mouth and walked the length of the ward without looking back, desperately hoping that no one, particularly Sister Reid, would notice she was trying not to vomit.

As Clara stepped into the corridor, her hands still trembling slightly, she collided with one of the senior registrars. Her breath caught in her throat as she recognised him immediately - Doctor Burnett himself - two years ahead of her at medical school and, according to Sister Reid, her superior in every way. Certainly now, his pristine white coat contrasted sharply with her stained and dishevelled appearance.

'It's Doctor Heywood, isn't it?' he asked. 'Are you all right? You look dreadfully pale.'

Clara fought to compose herself, swallowing hard against rising bile in her throat. 'Yes,' she stammered, her voice barely above a whisper. 'Just lanced a quinsy, that's all.'

'Not the O'Driscoll boy?'

Clara nodded, feeling a flush creep up under her collar.

'Well, that's brave of you,' Doctor Burnett remarked. 'Not sure many of the first-year residents would have had the courage to do that.'

Clara's cheeks burned with embarrassment and she wished the floor would open and swallow her whole.

'Seriously, I think I might need to prescribe you a pot of steaming tea,' he added with a mixture of awe and concern.

'Thank you, perhaps some other time,' Clara said weakly, her veneer of professionalism barely holding against a tide of nausea.

She hurried away down the tiled corridor, her heart pounding in her chest. This was not at all how she had envisioned her first day. Her journey as a doctor may just be beginning, but Clara couldn't shake a sense of unease about the challenges ahead.