"Are you Mary Sutter?" Hours had passed since James Blevens had called for the midwife. All manner of shouts and tumult drifted in from the street, and so he had answered the door to his surgery rooms with some caution, but the young woman before him made an arresting sight: taller and wider than was generally considered handsome, with an unflattering hat pinned to an unruly length of curls, though an enticing brightness about the eyes compensated. "Mary Sutter, the midwife?" he asked.

"Yes, I am Mary Sutter." The young woman looked from the address she had inscribed that afternoon in her small, leather-bound notebook to the harried man in front of her, wondering how he could possibly know who she was. He was all angles, and his sharp chin gave the impression of discipline, though his uncombed hair and unbuttoned vest were damp with sweat.

"Oh, thank God," he said, and catching her by the elbow, pulled her inside and slammed the door shut on the cold April rain and the stray warble of a bugle in the distance. James Blevens knew Mary Sutter only by reputation. She is good, even better than her mother, people said. Now, he formed an indelible impression of attractiveness, though there was nothing attractive about her. Her features were far too coarse, her hair far too wild and already beginning to silver. People said she was young, but you could not tell that by looking at her. She was an odd one, this Mary Sutter.

A kerosene lantern flickered in the late afternoon dimness, revealing shelves of medical instruments: scales, tensile prongs, hinged forceps, monoral and chest stethoscopes, jars of pickled fetal pigs, ether stoppered in azure glass, a femur bone stripped in acid, a human skull, a stomach floating in brine, jars of medicines, an apothecary's mortar and pestle. Mary could barely tear her eyes from the bounty.

"She is here, at last," the man said over his shoulder. Mary Sutter peered into the darkness and saw a young woman lying on an exam table, a blanket thrown across her swollen belly, betraying the unmistakable exhaustion of late labor.

"Yes, yes," he said, waving her question away with irritation. "Didn't my boy send you here?"

"No. I came to see you on my own. Are you Doctor Blevens?"

"Of course I am."

Now that her chance had come, Mary felt almost shy, the humiliation of her afternoon rearing up, along with the anger that had propelled her here, looking for a last chance.

"Doctor Blevens, I came here today-" Mary stopped and exhaled. All the hope of the past year spilled over as she stumbled over her words. "Today I sat in the lobby of the medical college for four hours waiting for Doctor Marsh, and he didn't even have the courtesy to see me." Mary shut out the memory of her afternoon spent in the unwelcoming misery of the Albany Medical College, where after several hours the corpulent clerk had finally hissed, Doctor Marsh no longer wishes to receive letters of application from you, so you are to respectfully desist in any further petition.

"When he refused to see me, I decided to come and ask something of you," Mary said.

"Would you mind asking me later?" Blevens asked, propelling Mary toward the young woman. "I need your help. This is Bonnie Miles. Her husband dropped her here early this afternoon. He said she has lost a child before-her first. I think the baby's head is stuck."

Mary pulled off her gloves and unwrapped her shawl, her quest forgotten for the moment, all her attention focused on the woman's exhaustion and youth. Bonnie was small-boned, tiny in all her features, too young, Mary thought, perhaps fifteen, maybe seventeen.

She resembled Jenny. It was something about the way she spoke, the shape of her lips against her teeth. It was then that Mary knew she had to guard against the resemblance, for her antipathy to her sister might cause her to be unkind toward this girl who needed her.

"My last one died," Bonnie said, whispering, drawing Mary close to her, her face transforming from a feverish daze to one of grief.

"I beg your pardon?"

"The baby before this," Bonnie said, her eyes half-closed. "I didn't know it was labor I was taken with, you see?"

The ignorance! It was exactly like Jenny. But Jenny's ignorance was something altogether different, a refusal to engage, to exert herself. A lack of curiosity.

Outside, above the street clatter of carriages and vendors came the hard clang of the fire bell, and cries of "On to the South!"

Blevens rushed to the window and threw it open as Mary whispered to Bonnie not to worry. The rising strains of a band joined the bugle, producing a festive, off tune march that beckoned like a piper. A swelling crowd hurried along the turnpike, shoulders and wool hats bent against the rain. In the distance the flat pop of gunfire sounded.

"You there! Hello? Can you give me the news?" Blevens cried.

A man who had stopped to don an oilskin looked up, revealing a slick, battered face, pocked, the doctor was certain, at the ironworks where the spitting metal often scarred workers' faces.

"Haven't you heard?" the man shouted. "The Carolinians fired on Fort Sumter!"

"Has Lincoln called for men?" the doctor asked, but the scarred man melted into the stream of revelers pushing down the muddy turnpike toward the music as if something were reeling them in. James Blevens slammed down the window and turned.

"I cannot believe it," he said. "It is war."

The title, My Name Is Mary Sutter, is an assertive statement, direct and confident, like Mary herself. Why did you choose this title? Were there others that you had in mind while you were writing?

You tackled an enormous amount of research for this novel. How do you find, organize, and incorporate such a wealth of information?