The Medicine Woman of Galveston

“Dr. John Langdon Down believed children like him had dampened and defective emotionality. That the more advanced of them were merely mimics. And it was true Toby looked to her for emotional cues. He laughed when she laughed. Smiled when she smiled. Frowned when she was stern or upset. But it wasn’t mere mimicry. He might not always have the words to express himself, but he had a sense—better than anyone she’d known—of what others were feeling.”

Tucia reflects on how she believes Dr. Down’s work on people with Toby’s condition—Down syndrome—is flawed. Tucia’s desire to dismantle the prevalent and limiting stereotypes about people with Down syndrome is motivated by her love for her child and her desire for him to have a good life. Her experience with Toby’s condition also predisposes her to view other biological conditions with curiosity rather than judgment. In this way, Tucia’s perspective helps shape the theme of Examining and Dismantling Stereotypes and Prejudice.

“Poorhouse inmates were branded drunkards, idlers, and incorrigible sinners. Tucia had thought so herself before she’d learned how savage life could be.”

Tucia balks at the idea that she may have to go to the “poorhouse,” reflecting on the stereotypes associated with people who inhabit such spaces. Tucia’s own difficult circumstances have allowed her to gain greater empathy for those viewed negatively in society. She understands that sometimes, one’s choices in life are dictated by uncontrollable circumstances—another example of Examining and Dismantling Stereotypes and Prejudice.

“He spoke with such confidence Tucia half believed him. But he was still a medicine man. A huckster, a swindler—there was no other type. These were the sorts of men who sowed distrust in proper medicine and gave real doctors a bad name.”

Tucia meets Huey, who offers her a job in his medicine show. This passage highlights two things: Huey’s exceptional skill with words and undeniable charm, for even Tucia, a licensed doctor, is almost entirely taken in by his confidence. However, she recognizes that despite Huey’s sweet-talking, the medicine show is a fraudulent affair. This awareness leads to Tucia’s ever-present ethical dilemma about her work in the medicine show, allowing for the exploration of The Ethics of Survival.

“He must have had rickets as a boy. A severe case, by the looks of it. She couldn’t help but wonder what fool of a physician had treated him. If he’d been treated at all. Fresh air, a good diet, and a daily dose of cod-liver oil would have prevented such deformity.”

When Tucia first notices Cal’s bowlegs, rather than judge or recoil she assesses the situation with a physician’s mindset, identifying the biological factors that contributed to Cal’s condition. Tucia’s background in medicine has armed her with information that allows her to look past stereotypes and prejudices that exist about physical appearance. Her reaction here is an example of how accurate information can help dismantle stereotypes.

“But Tucia liked to think her real mother would understand. Would have made the same bargain. Toby was safe and well-fed, after all. No one was banging on her door, coming to take him away to some crumbling asylum. That was all that mattered.”

As Tucia worries about the choice she has made of joining the medicine show and The Ethics of Survival, she reassures herself by rationalizing how her decisions are rooted in what is best for Toby. Skenandore repeatedly positions intent as an important consideration for whether an unethical action is excusable or not. Tucia is armed with an unquestionable motivation throughout the book: a mother’s love and protectiveness. Thus, despite some of the unethical acts Tucia is forced to carry out, she is absolved of blame because of her motivations.

“Rationally, she knew that if she slowed her rapid-fire breathing, the balance of oxygen and carbon dioxide in her blood would stabilize and her dizziness diminish. The same way she knew the next item Huey would find among the crowd was a necktie then a brooch then a sun bonnet. But the rational part of her was nothing but a distant echo.”

Tucia attempts to breathe and physically calm herself down when she experiences a “hysterical attack” on stage. Tucia rationally understands what she needs to do, but cannot bring herself to act. This passage is an illustration of how mental health challenges are more complex and nuanced than just approaching a situation with information. Despite the information at Tucia’s disposal, she is not always able to effectively allay her anxiety. This not only indicates the need for professional help, but also outlines how anxiety and other mental health conditions are not controllable by individuals who experience them.

“When I had my son, there were plenty who whispered that his condition was God punishing me for my sins. But I believe someday we’ll discover it’s just a difference of biology. Not the act of a vindictive God.”

Tucia explains to Fanny how gigantism, like Down syndrome, eventually comes down to a “difference in biology” rather than a punishment from a higher power. The latter belief, prevalent at the time of the book, is one rooted in misinformation and actively contributes to harmful stereotypes about people with physical differences and different abilities. Once again, Tucia’s scientific and rational approach, which is devoid of any judgment of character, showcases the importance of Examining and Dismantling Stereotypes and Prejudices.

“The alienist she’d seen had diagnosed Tucia as having a nervous organization and an innate frailty on account of her sex. But what if her hysterical attacks were more like a sickness of the brain, something that could infect anyone under the right circumstances? Could these mind tricks Fanny suggested alleviate that sickness the way quinine reduced a fever?”

Tucia reflects on how the “alienist” she had consulted (an outdated term for psychiatrists) attributed her mental health challenges to being a woman. However, when Fanny counsels her to breathe through the anxiety, for the very first time Tucia considers the possibility that her “hysterical attacks” are akin to an illness of the brain. This perspective reflects a more contemporary approach to mental health: The understanding that mental illnesses, like physical illnesses, are not a character flaw but a health condition that require treatment and management without stigmatization.

“She assumed they’d all joined for the good money and easy life. Though that easy life was shaping up to be a lot more work than she’d expected. Adventure, then? She glanced from Lawrence to Cal and Fanny to Darl. Something told her it wasn’t just greed or slothfulness or thrills. They, too, had secrets.”

Tucia begins to wonder about the other performers’ reasons for being part of the medicine show. Tucia’s initial assumptions about their motivations reveal that she is not immune to unconscious bias or prejudice, as she had mistakenly believed the others to be lazy and greedy. It is only after Tucia learns about Fanny’s past that she begins to see how, just like her own situation, the others around her are also just trying to survive, invoking The Ethics of Survival in desperate circumstances.

“The bag popped open, and a tearing sound rang through the tent. The handle Tucia was holding ripped free from the bag, and she fell backward, landing on her rear while her carefully guarded tools spilled onto the ground around her.”

Huey forcibly grabs Tucia’s medicine bag, wanting to use it as a prop for his case-taking tent. This a symbolic moment: Tucia’s hard-earned instruments and supplies are wrested from her by force, signifying how she is being forced to participate in the fraudulent medicine show. The bag ripping symbolizes how Tucia’s conscience is fraying under the strain of the unethicality she is forced to participate in.

“‘Sometimes medicine presents us with impossible choices.’ ‘Sometimes life does as well.’”

Tucia is confronted by another physician, Dr. Kramer, in one of the towns the show visits. Tucia defends her participation in the show to Dr. Kramer by pointing out how life, like medicine, creates extenuating circumstances that force one to make difficult choices about The Ethics of Survival. This is the argument that Huey initially used to convince Tucia to join the show; however, even though Tucia parrots the argument here, her motivation and circumstances are entirely different.

“His attentions thrilled and flattered her. Legitimized her claim upon the profession. So she didn’t object when he stood too close. Or casually brushed a hand against hers. Or complimented her lovely complexion and alluring eyes. Far better that than being ignored. Or so Tucia thought.”

Tucia remembers how Dr. Addams paid her special attention when she began working with him, something that Tucia mistook as a positive sign, having thus far only experienced neglect or hostility from other men in the field. This leaves her unprepared to judge Dr. Addams’s behavior correctly—she is unable to recognize the signs of sexual harassment until it is too late. Both of these situations remain relevant to The Workplace Challenges Faced by Women even in contemporary times.

“Whatever he’d said, it had been an act of defiance. Small perhaps, but potent. A way to show Texas Joe and the audience—even if they didn’t realize it—that he was no one’s man but his own. Could Tucia find a way to do the same?”

Tucia watches the “Kickapoo Indian Medicine Company” and notices how one of the performers appears to say something different in his native language than what he has been instructed to by Texas Joe. This act of defiance and the insight it offers Tucia is an important one—it inspires Tucia to eventually set up the palmistry tent and secretly dispense medical advice. Witnessing resistance in an unexpected form alerts Tucia to the fact that one can often exert some agency within the circumstances they find themselves in.

“Tucia ignored the slight and watched the man shuffle away. He’d only made the same assumption everyone else did. An assumption, a charade, they took pains to sow. And no matter if he thought her a nurse or assistant, for the first time since joining the show, a buoyant feeling filled her chest. She’d made a positive difference. Perhaps even saved the man’s life.”

Tucia refuses to “treat” a patient who comes to the case-taking tent with an apparent case of tuberculosis, and ensures that he receives actual medical advice instead of Huey’s fake medicine. This instance highlights two things: First, the ease with which the man assumes Huey to be the doctor despite Tucia being the one who counsels him throughout the examination. This reiterates the gendered notions that persisted in professional fields like medicine, invoking The Workplace Challenges Faced by Women. Second, despite the patient’s response, Tucia feels purposeful after having dispensed helpful medical advice. Her changing emotions indicate that she is slowly beginning to rediscover her confidence in her medical abilities.

“She supposed if she looked at him closely—the curl in his brown hair, the fullness of his lips—she might guess at it. He was certainly the handsomer for it. They were just traits, after all, passed down like tallness or baldness. She’d seen enough bodies splayed open on the dissection table to know what lay inside was the same.”

Tucia is surprised to learn that Darl is half Black. However, she does not respond to this information with any sort of prejudice, reflecting on how ultimately, even skin color can be boiled down to biological and genetic traits with no bearing on value or character. Tucia’s characteristic objectivity invokes the importance of Examining and Dismantling Stereotypes and Prejudices.

“Her palmistry was a favorite wherever they went. Sitters might be few the first night, but interest increased with each passing show. Most seemed positively grateful for the bits of health advice she wove into her readings, and some asked for it outright, having heard from neighbors and friends about her particular talents.”

Tucia’s palmistry tent takes off, finding far more success than she initially imagined. While its growing success highlights Tucia’s increasing confidence and comfort in conducting medical examinations again, it also serves as an instance of The Workplace Challenges Faced by Women: Tucia finds it easier to attract customers who seek her out for medical advice when she is garbed as a palm reader than when she presents herself as a doctor, simply because she is a woman.

“For now, she leaned back and admired the island stretching before them. Sunlight gleamed off the windows of the nearing buildings. A gentle breeze stirred the air, fragrant with the scent of brine and earth. Frogs croaked, and bees hummed. What harm could possibly come to them here?”

As the group arrives in Galveston, Tucia admires the island and is lulled into a false sense of security by its beauty. This is an instance of irony, as there is no scenario in which Tucia escapes some distress. The actual eventuality is that the hurricane will strike Galveston, ravaging the island and causing untold death and destruction.

“She’d learned about venereal disease in school and shared Dr. Blackwell’s belief that prostitution reduced men to brutes and women to machines. But for all her notions on the matter, Tucia had not actually met a prostitute before. Certainly never shaken one’s hand. Fresh out of medical school, she would have looked down on these women, and perhaps offered some trite and moralizing advice. Now, she found them little different from herself—women making the most of life’s hard knocks.”

Tucia meets sex workers who live in the same neighborhood in Galveston. Her reflections here once again show how her own life experiences have broadened her world view and left her open and empathetic to the life choices and circumstances of those different than her. Tucia is able to see herself reflected in different kinds of people, and this allows her to embrace Examining and Dismantling Stereotypes and Prejudices. Her recognition of the economic necessity the women face also speaks to The Ethics of Survival.

“He eyed her not with derision but a sort of wonder. ‘The Medical Department next door graduated its first woman doctor just three years ago. A gentle lady but brave and independent. You seem like the same sort, and experience or no, we certainly need your help.’”

Tucia takes Fanny to the hospital to get the latter’s injuries further tended to, and for the first time, Tucia is met with appreciation rather than disdain. Dr. Burns is already predisposed to the idea of a “woman doctor,” having met one previously; additionally, Tucia proves that she is skilled and capable with her handiwork in a time of crisis. In this manner, the storm brings destruction to many, but a fresh start and opportunity to others, especially the performers in Huey’s medicine show.

“As promised, she stopped whenever someone looked ill or injured. Most had minor wounds that were quick to clean and dress. Others she stabilized with a tourniquet or sling and sent in the care of family or friends to the hospital. One man she found impaled on a fence post. After dosing him with morphine to ease his pain, she sat with him until he died.”

Tucia refuses to stay behind and help out at the hospital as she is still searching for Toby, but she promises to stop and help tend to the wounded in the streets along the way. Despite her own stresses and deep maternal concern for her child, Tucia is true to her word. Her ability to help whoever she can even when she herself is in distress sharply contrasts with Huey’s behavior—he is only concerned with his own losses after the storm, and rather than help people, he actively steals from the dead. Their differing approaches to The Ethics of Survival turn Tucia and Huey into foils of one another.

“‘Huey said you killed a man. A guard during your escape,’ she said, instead of the I’m sorry that hung on her lips. […] ‘And if I did?’ Tucia stopped and faced him. ‘If you did, well…we’re more than our worst mistakes, aren’t we?’”

Tucia confronts Darl about Huey’s assertion that Darl killed a man while they were escaping prison. Darl in turn reveals that it was Huey who killed the guard, not him; however, even before this clarification, Tucia has already accepted this possibility. Her attitude stems from a profound understanding of the “impossible choices” life sometimes presents one with; these choices do not define one’s character, especially when these decisions are forced upon the individual rather than motivated by avarice or cruelty.

“‘The storm took everything from us, Tucia. The museum. The wagons. The money I had secreted away.’ Something else too. Tucia could see it in the sheen of sweat at his temples, in his watery eyes and dilated pupils. His opium. No wonder he seemed half mad. He stepped toward her, grabbing her by the shoulders before she could back away.”

Tucia observes that Huey’s reckless behavior following the storm is at least partially caused by his opium dependency. While the book examines other aspects of mental health and mental illness in an empathetic manner, Huey’s substance use does not receive the same treatment; it is presented almost as a character flaw that contributes to or enhances his villainy.

“He could have helped her. Should have helped her. Should have saved their patient. But he’d wanted Tucia to fail badly enough that he’d let the woman die. That was not the action of a doctor. It was the action of a small, petty, insecure man. Tucia would not do the same.”

After Tucia shoots Huey in self-defense, she doesn’t leave him for dead; rather, she tends to his wounds herself and ensures that he receives further medical care. Tucia’s decision to do so stems from a desire to distinguish herself from the unethical and manipulative behavior of Dr. Addams and Huey himself. Past circumstances have forced Tucia into difficult, unethical choices; however, when she is presented with a semblance of control, she willingly chooses differently, showcasing her inherent integrity in The Ethics of Survival.