“The Sharp Edge of Mercy” Explores a Dark History

Connie Hertzberg Mayo’s second novel, The Sharp Edge of Mercy,  is dedicated to her mother, Dr. Clinton Hertzberg, a woman she describes as both trailblazing and traditional.

Although her  mother did not live to see the book’s completion, Mayo says that her influence spills onto the page in the ethical dilemmas that are posed in this immersive, complex, and revelatory work.

“I was eight when my mother went back to school, and 13 when she got her PhD in anatomy,” Mayo told Lilith. “My mom used the phrase ‘quality of life’ a lot. She opposed extending life when someone was in pain and there was no hope of recovery, so we had a lot of interesting conversations in our family.”  

Mayo says that she has spent a lot of time thinking about this, which is why she included the theme of assisted suicide in The Sharp Edge of Mercy. But this is not the only thorny subject the novel broaches. Set in the 1890s, the story centers on 16-year-old Lillian as she struggles to support herself and her disabled sister. Her low-level nursing assistant job at the New York Cancer Hospital – the forerunner of the Memorial Sloan-Kettering Cancer Center – allows Mayo to cover expansive terrain, from medical and societal racism, to sexual harassment, to queer life in late 19th century Manhattan. All told, the history is fascinating and offers an insightful peek into the sordid back story of Sloan-Kettering, still regarded as a world-class provider of cancer care.

Mayo spoke to reporter Eleanor J. Bader in late March about both the book and about writing historical fiction more generally.

Eleanor J. Bader: Let’s start with the research you did to write The Sharp Edge of Mercy. How did you learn so much about the New York Cancer Hospital?

Connie Hertzberg Mayo: When I set out to do research for the novel, I discovered that the records were stored at the Rockefeller Archive Center in Sleepy Hollow, New York rather than at Sloan-Kettering or elsewhere in Manhattan. The Archive had surgical notes and records stored on microfiche; these records were really important to the development of the book and helped me understand the way the hospital cared for its patients.

I learned, for example, that when the hospital first opened in 1884, it only served women, but social class played a role in who got what, with rich and poor women receiving very different treatment. The upper classes were actually served palliative champagne cocktails and taken on afternoon carriage rides to distract them. Poor women were given shots of whiskey, which was evidently the Tylenol with codeine of the late 19th century.  

EJB: Besides the disparate treatment of rich and poor, were you surprised by anything else in the hospital’s history? 

CHM: I had heard about Dr. J. Marion Sims, the so-called “father of gynecology,” who had perfected surgical procedures for fistula repair in the 1840s – a fistula is a tear between the uterus and bladder that causes constant pain and urine leakage –  by operating on enslaved women without anesthesia.  But I had no idea that he was one of the founders of the New York Cancer Hospital. When I discovered that he was a primary mover-and-shaker in the hospital’s development, I knew I needed to include him even though he died before the hospital opened. I developed the characters of Jupiter Scott and his brother Solomon to talk about the traumatic legacy of Sims’ racist behavior.

I was also surprised that the hospital kept people a little buzzed as a form of palliative care.  The treatments we now have for cancer, chemo and radiation, did not exist then and doctors typically performed radical surgery, cutting more and more to try to remove all of the cancer. The amount of cutting seems Draconian today, but you can understand why it was done. 

Another thing that floored me – and I would not have believed it if I had not seen it written in the surgical notes – was that when a patient was not doing well on the operating table, they injected her with whiskey. The patient, of course, was supposed to be unconscious already, but if she did not respond well to ether, whiskey was supposed to revive her.  

EJB: The novel touches on an array of issues without seeming didactic or forced. Did you intend to include racism, sexual harassment, queer life, disability, family discord, and poverty when you began writing?  

CHM: No. The plan was for the main character, Lillian, to start off as a fairly judgmental young person who changes as she enters the work world and begins to question what it means to care for the sick. She also has to deal with becoming a self-supporting adult. 

As she becomes more and more immersed in nursing, Dr. Bauer, a surgeon, begins to interact with her in a way that we’d consider inappropriate today. She’s so naive, though, that she actually thinks that Dr. Bauer admires her intelligence. Even later, she believes she can handle him and it is only when she tells her cousin Michael, and Michael’s close friend, Josephine, about what’s going on that she begins to wonder about her assumptions. 

This is also true when it comes to her attitudes about sex work, homosexuality, and the compromises we make to survive. As time passes, she begins to see the many shades of gray that exist between black and white. As I was writing, numerous social and political issues came up and it just made sense to include them.

EJB: How about the characters you created?

CHM: I developed characters to fit the setting. 

I knew I wanted to write about medical ethics but when I began writing in 2017, Harvey Weinstein’s sexual misconduct was all over the news and all these stories were pouring out. I knew I wanted to have a young female protagonist working with an arrogant male surgeon and I thought it would be unrealistic not to include incidents of sexual harassment. 

Similarly, my depiction of Michael and his decision to marry a woman to please his parents, choosing a safe life over an authentic life as a gay man, felt realistic. Although Michael eventually rejects this idea, I wanted to show queer life and depict the thriving gay scene that existed in lower Manhattan during these years. Michael sees this scene, and with his friend Josephine, a lesbian, he grapples with what it means to come out and follow his heart. At the same time both are aware of the risk of homophobic violence.

And I wanted to show that relationships between Black and white people existed. There were Black and Tan establishments, bars, most of them run by Black entrepreneurs, where people like Lillian, Jupiter, and Solomon could socialize. Jupiter and Solomon knew how important this was. They’d moved to New York from the south and understood that the City allowed people to live more freely because of the diversity. 

EJB: Lillian judges her mother harshly and while they eventually reconcile, their conflict packs a punch.

CHM: I have a 22-year-old daughter who recently graduated college and now lives in Philadelphia. I think that when children move out on their own and become self-supporting, they develop more of an appreciation of what it means to be independent. They learn that there is more than one way to live. 

At 16, Lillian is kind of prudish, and instinctively judges her mother’s behavior as immoral. She then takes impulsive action and moves herself and her sister out of the family’s apartment to get away from her. But Lillian’s sister, Marie, needs 24/7 care and Lillian has to work outside the home. This causes Lillian to make compromises of her own and she comes to see that it is possible to feel multiple ways about her mother’s actions. In addition, I didn’t want to make Lillian into an angel. It was important to me to present her as someone trying to navigate the world, doing a good, but not a great, job of balancing everything in her life.

EJB: Lillian also considers the ethics of assisted suicide in the novel, after a patient asks her to do something to end her suffering.

CHM: I wanted the book to raise questions about subjects that are ambiguous. I understand the slippery slope argument. On one hand, in some situations, opting for assisted suicide might be the right decision, while a different situation might be less clear or totally inappropriate. What I’m really hoping is that this becomes a conversation, a debate, that readers can have. 

EJB: You have a full-time job as a systems analyst. How did you find time to write a novel?  

CHM: I began working on The Sharp Edge of Mercy when my daughter went to college. I knew that because my job is sedentary, sitting still to write would be bad for my health, so I got up early, exercised, and wrote for two hours a day. I then worked at my job between 11 and 6. It worked for me. Also, many of the scenes included in the book were written in my head before I sat down at the computer — I created them in the shower or while taking a walk. Since they were basically already formed, they spilled out, making the writing process a bit easier.