Medicine in Doc O’Brien Meets His Match: Why Patrick’s “Eccentricities” Matter and a Crucial Era of Change in Medicine
Doc O’Brien Meets His Match opens with the first encounter of Maggie Sinclair and Patrick O’Brien, when he’s summoned to treat Maggie’s cousin and travel companion, Clara Pemberton, for what turns out to be pneumonia. While waiting, Maggie, whose mind automatically searches for stories, imagines a frontier doctor: a kindly older man, grizzled, weathered, hands that could set broken bones and dig out bullets, without the finer points of medicine that doctors back in Philadelphia knew.
The man who walks in the door defies all her expectations. First, (and kind of important in a romance) he is not the gentle elder fellow she anticipates. He’s young and vigorous, well-groomed and well-dressed, and she’s annoyed at herself for noticing he’s attractive. But far more importantly, he startles her with his first action: he thoroughly washes his hands.
Today, that detail feels too obvious to remark upon. In Maggie and Patrick’s world, it was not obvious at all. The understanding of germ theory was far from well-established, especially in the United States, and many doctors had no understanding that they could transmit illness from one patient to another through their hands.
The history of handwashing in medicine is especially sobering: reformers such as Ignaz Semmelweis had already shown in the 1840s that hand hygiene could dramatically reduce maternal deaths by reducing the transmission of puerperal (“childbed” fever), yet his ideas were not widely embraced and were often met with intense resistance (despite his superior mortality rates.) Semmelweis was mocked and reviled, even though he was right.
Many doctors were openly hostile to even the suggestion they could be harming their patients themselves by contagion on their hands. However, that didn’t stop others from observing the benefits of hygiene in hospital settings. Florence Nightingale’s work in the 1850s made a strong case for the the life-saving importance of cleanliness and sanitary nursing care.
That is one reason the 1860s are such an important period in medical history. Physicians of the decade did not invent the idea that cleanliness saved lives, but the idea began to develop a scientific foundation. Pasteur’s work helped strengthen the case that microscopic life was involved in putrefaction and infection, and Joseph Lister drew on that emerging understanding in developing antiseptic surgical methods.
In other words, medicine was beginning to move from “cleanliness now seems helpful” to “infection has a cause, and disciplined hygiene can prevent it.” That was a profound change. I think of it as a “watershed” period of medicine: there was before the understanding of microbes and germ theory and after — and the after changed medicine forever, though it took time to spread and become common practice.
So why is it surprising, in 1875, that a doctor is washing his hands before seeing a patient? First, as stated above, the idea of cleanliness saving lives was not yet universally accepted. Patrick is aware of it as he attended the prestigious University of Edinburgh and was earning his Doctor of Medicine degree in the same time Dr. Lister was demonstrating his success with sterilizing surgical instruments with carbolic acid.
I like to imagine Patrick visiting Glasgow (where Lister was Professor of Surgery) as a young student. He would have been fascinated by Lister’s groundbreaking research and 1867 paper Antiseptic Principle of the Practice of Surgery. By 1869, when Patrick earned his own Doctor of Medicine (an advanced research degree at the University of Edinburgh) Dr. Lister made his own move to Edinburgh. This puts Patrick O’Brien right at the epicenter of the most advanced medicine in the western world.
That is one of the things I most wanted to capture in Doc O’Brien Meets His Match. I did not want to wave my hands and say, “trust me, he’s a good doctor.” I wanted his medical world to feel rooted in a real historical transition—one where seemingly simple practices like washing hands between patients could mark the difference between the old ways of medicine and the new, a difference that was just beginning in the time period of this novel.
Upon his graduation, Patrick had his own personal reasons for emigrating to America (it’s part of the story.) I imagine that he might have been a bit taken aback when he arrived. While many eastern hospitals were fairly current, the practice of medicine as a whole in the United States lagged behind the rigor of Britain and Europe. The problem in the United States was not that every doctor was ignorant or every practice backward. It was that standards were uneven. Training varied widely. Regulation and licensing were inconsistent.
He would have been surprised to find that many practitioners didn’t have degrees; a man could hang out a shingle and call himself a physician (unlike Britain, which had a General Medical Council.) American medicine was still developing, to the point where even as late as 1881, when U.S. President Garfield was shot, he was treated by physicians who did not follow handwashing or antiseptic practice (which undoubtedly contributed to his subsequent death and was finally starting to draw criticism.)
Patrick’s journey west to Colorado Territory brought advanced medical knowledge and practice to a frontier mining town — a place he stumbled on and ended up never leaving. Buckhorn Gap comes to revere the doctor whose arrival dramatically lowered mortality rates for obstetric and surgical patients, but they still thought Dr. O’Brien was a bit eccentric for that handwashing business. (They also think his interest in indigenous remedies is quirky, but that’s another part of the story.)
“Doc,” as he is affectionately known, is also a stickler about what substances he gives his patients. Doctors of the era frequently used substances that we know today can be harmful: for example calomel, which led to mercury poisoning. Laudanum, an alcohol-based tincture of opium, was used for nearly every kind of discomfort — and as Patrick brusquely points out when questioned, “dulls breathing, appetite, judgment.”
He refuses to use it until he knows what he is dealing with medically, as it could cloud accurate diagnosis. He treats coughs and fevers with local remedies he finds much safer and often more effective. While Maggie is dubious at first, she soon learns that Patrick is not only brilliant —he cares deeply about his patients. This level of care is why he is so exacting and precise, demanding nothing less than the best of himself in every patient interaction.
Buckhorn Gap is lucky to have their sometimes stern but also compassionate Irish physician. He’s immensely overqualified to be a frontier doctor, but he believes that the miners, ranchers, Chinese laborers, and occasional Ute patients that he sees are no less deserving of the top-notch medical care he can provide than rich people in Dublin or London. That is the essence of Patrick Brendan O’Brien, M.D., University of Edinburgh, Class of 1869.
Further Reading
If you enjoy the research side of historical romance/fiction and want to fall down the same rabbit holes I did, these are wonderful places to start:
“The little-known history of cleanliness and the forgotten pioneers of handwashing” — a fascinating overview of how handwashing slowly, painfully gained ground.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9632745/
“Pioneering Hand Hygiene: Ignaz Semmelweis and the Fight Against Puerperal Fever” — excellent on Semmelweis and the cost of being right before the medical world was ready to listen.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11568873/
The University of Edinburgh’s medical history pages — helpful for understanding why Patrick’s Edinburgh training carried such weight.
The Garfield medical-history article — demonstrates that even by 1881, antiseptic practice was far from universal in the United States.
