Wild Women Of The West: Bessie Efner

Twenty-four-year-old Dr. Bessie Efner peered through the dusty windows of the passenger car on the Chicago, Burlington, & Quincy Railroad at the endless Wyoming prairie. Sagebrush and buffalo grass dotted the landscape. The tough, tenacious plants emitted a peculiar, pungent odor that wafted through the opened windows next to the seats across the aisle. As the train slowed to a stop, Bessie gently woke the three, red-headed girls sleeping on either side of her, their heads resting on her shoulders and in her lap. Ina was thirteen, Elsie was twelve, and Reta was five. The children had been living with Bessie in Sioux City, Iowa, since their parents tragically died in 1904. She struggled to care for her nieces on the modest salary she earned at her small practice in Moville, Iowa, eighteen miles east of Sioux City. The chance to be a better provider inspired her to travel west. 

Thousands of young farmers and aspiring ranchers had rushed to take advantage of the federal government’s offer for free land to anyone who wanted to settle west of the Mississippi. As a result, new communities had sprung into being throughout sparsely populated areas like Wyoming. Sections of land in those new communities had been set aside for people who supplied essential services, such as teachers, ministers, and physicians, to build homes. Bessie was encouraged to come to Laramie County, Wyoming, by promoters with the Union Pacific Railroad Company. She was promised a homestead and the opportunity to establish a lucrative medical practice in a spot in the country lacking a doctor. Two months after the house Bessie had built was completed, she moved her family to Carpenter. 

When the train had come to a complete stop, Bessie gathered her nieces and belongings and made her way to the exit. Beyond the doors she expected to see a modest depot, one showing a comfortable resistance to innovation. There wasn’t anything at all to see when she and the girls disembarked on December 15, 1907. The train had stopped at what was to soon become Carpenter, but at that time there was nothing.

Bessie scanned the endless open range stretched in front of them. In the near distance, she saw a wagon quickly traveling toward her and the girls. Beyond that, some two miles out, was Baxter Ranch. “And so this is Wyoming, my new home,” Bessie said out loud to no one in particular, “the glamorous West of cowboys and cattle about which I have heard and dreamed so much.”  

After the driver of the wagon introduced himself and apologized for being late, he explained he was on orders from the town founders to take the new doctor to her home. Bessie and her nieces helped load their modest belongings onto the vehicle, climbed aboard, and, in a moment, they were on their way. Bessie listened as the train’s panting engine gained steam and started down the track. She looked back just as it pulled away from where they had all once been standing. Reta grabbed her aunt’s hand and squeezed. Bessie turned toward the five-year-old and smiled. The doctor then set her sights on what lay ahead. 

Bess “Bessie” Lee was born on March 28, 1873, in Galesburg, Jasper County, Iowa. Her mother was Priscilla Templeton (a niece to Robert E. Lee), and her father was a third-generation doctor named William Efner. In addition to her father, grandfather, and great grandfather having a career in medicine, Bessie’s brother and uncle were also physicians. Her love for the profession began at eight years old. She enjoyed spending time with her father and watching him work. By the time she was a teenager, she was assisting him in his office by preparing prescriptions and treating patents’ minor injuries. When Bessie graduated from high school in approximately 1889, she knew she wanted to follow in her father’s footsteps and become a doctor. The realization of such a dream seemed far-fetched. Young women like herself were expected to marry and have families Their aspirations were to center solely on being wives and mothers.

For a time, Bessie tried to conform to midwestern society’s expectations. She was pursued by one of Galesburg’s most eligible bachelors, a banker’s son who showed great promise in the field of finance. He proposed, but she postponed giving him an answer. Although she knew the sincere desire of her heart, she wanted time to think. While wrestling with the decision, a family friend who recognized Bessie’s talents suggested she go to college and study medicine. 

The recommendation helped Bessie clearly see what she needed to do. Before breaking the news to the man who’d asked her for her hand in marriage, she spoke with her father about the possibility. Dr. Efner was surprised to learn his daughter had such ambitions. He had assumed she wanted to get married. After explaining the years of commitment that accompanied the pursuit to become a doctor and warning her of the many people who opposed a woman in the field, he gave her his blessing and promised to do everything he could to help her.

In September 1890, Bessie enrolled at Morningside University in Sioux City, Iowa. Not long after she’d settled into school and begun attending classes, she received a letter from home informing her that the gentleman who wanted to marry her had married another. “I was hurt in my pride but now felt absolved from all obligations, and it removed a most serious obstacle that had stood in the way of my goal,” Bessie later wrote in her memoirs.

Bessie excelled at school and graduated with honors. Before she could continue her education, she needed to earn money for tuition to the Sioux City School of Medicine. She took a job teaching for a year to earn the funds needed to carry on. Bessie was one of only two women in the class of hopeful physicians attending the prestigious institution. Male students referred to her and Clara McManus as “hen medics.”  They were tolerated by the men but not encouraged. Bessie and Clara were regarded as unfit for the medical profession simply because they were females.

Among the many courses Bessie was required to take were pathology, bacteriology, histology, obstetrics, and internal medicine. A handful of the professors Bessie studied under proved to be inspirations. In addition to being teachers, they were also surgeons who treated their patients with dignity and respect. While interning at their medical offices, Bessie learned the importance of making the sick and hurting feel at ease. 

Of all the classes Bessie had, anatomy served to be the most meaningful to her. “It opened my eyes to the wonders and complexities of the human body, the most wonderful organism and machine in the universe,” she recalled years later. “Man in his very being is the mystery of mysteries. No one can fully understand him, and no one has expressed this more beautifully than the psalmist who said: ‘I will praise Thee, for I am fearfully and wonderfully made; marvelous are Thy works, and that my soul knoweth right well.’” 

Time in the anatomy lab posed a problem for Bessie. She struggled in the beginning with dissecting cadavers. Many of the subjects were derelicts, drunks, drug addicts, or prostitutes whose bodies went unclaimed when they passed away. The thought of the disenfranchised dying alone, the smell associated with the procedure, and the spectacle of fellow students huddled around the remains like vultures surrounding a carcass was difficult to handle. In time, Bessie learned to adjust to the necessary task, but it was a chore. 

Prior to graduating from medical school, Bessie was granted an opportunity to intern at a hospital in Sioux City run by the Sisters of Mercy. She enjoyed her time working with the nuns and believed the experience added greatly to her education.  When Bessie received her degree in 1894, she made a point of sharing with fellow graduates how grateful she was to have had the privilege to train at the Sisters of Mercy medical facility. 

Having taken the Hippocratic Oath and with degree in hand, Bessie set her sights on passing the state board examinations. Her test scores were among the highest of all aspiring doctors in the area. With certification in hand, Bessie struck out on the most difficult part of her journey, that of finding a place where a woman doctor could find employment. Something her father told her before she left for college echoed repeatedly in her head, “…Even if you graduate from medical school, you may not be able to practice your profession because society will not accept you.”  She knew the odds were against her, but she was determined. 

When Bessie learned the small town of Hinton, twelve miles away from Sioux City, Iowa, did not have a doctor in its community, she decided to open a practice there. She borrowed money to make the move, rent office space and a place to live, and purchase supplies and equipment. She had a sign painter stencil the name “Dr. B. L. Efner” on the door leading into the office and then waited for patients to come. 

After several weeks, a frantic young farmer arrived on the scene. He’d driven his horse and buggy to town to find a doctor to help his wife who was in labor. The man had given the name on the door a quick glance and wrongfully assumed that Dr. B. L. Efner was a man. The soon-to-be father was surprised when Bessie introduced herself as the doctor. “Well, I’m looking for a real doctor, like other doctors,” he explained. Bessie informed him there was no other doctor in the immediate area besides her. She assured him that she was qualified, and he finally agreed to take her to his wife.

The expectant mother was just as stunned as her husband to learn Bessie was a doctor. Bessie sat beside her on the bed and shared her background and love for medicine, and the woman soon agreed to let the doctor help her. Dr. Bessie delivered the couple’s son without complications.

The successful delivery of the little boy led to Bessie being entrusted to help a young man suffering with pneumonia living on a farm eight miles from town. Treating pneumonia was complicated before the invention of penicillin. Various treatments had to be employed before the right one was found. Dr. Bessie was attentive to her patient, refusing to leave his side until his fever broke.

“While working on this case, I noticed that the boy’s little sister, about seven or eight years old, had been watching me with unusual curiosity, following every movement with a sort of whimsical expression on her face,” Bessie later recalled. “But I was so busy with her brother that I could pay no attention to her. As I was about to leave the room, she ran to her mother and in a quite audible whisper said to her: ‘Mother, isn’t that a funny doctor? He has no beard and wears dresses like a woman.’”

The illness finally passed, and the teenager slowly began to improve. Both the successful treatment of the young boy and the delivery of a baby demonstrated to the citizens of Hinton that Bessie was a competent physician. The doctor went from having no one visit her office to a steady flow of people needing care. Bessie’s fees were modest. Office calls ranged from fifty cents to a dollar; house calls were $1.50 during the day and $2 at night. Mileage for calls outside town were fifty cents a mile.

Just as the residents of Hinton were beginning to accept the woman physician, Bessie was presented with a medical case that challenged the confidence in her abilities and threatened to undo the progress she’d made with the townspeople. An itinerant worker had been thrown from the buggy he was driving, and his spooked horse dragged him several feet before stopping. The man had been drinking at the saloon before the incident occurred and, in his drunken state, could not explain the extent of his injuries when friends carried him to Bessie’s office.

After a thorough examination, Dr. Bessie determined he was suffering with a double fracture in his jaw, and he’d sustained multiple cuts and severe bruises. Treating the cuts and bruises was easy, but how to handle the jaw required deep thought.  She couldn’t cast or splint the break, and a bandage wasn’t sufficient to hold the bones in place after she reset them. She decided the best course of action was to remove one of the man’s molars which would provide a space for a feeding tube to be inserted. Once that was done, she brought the edges of the bones together, then wound the upper and lower teeth together and tightened it in a way that would keep the jaw firmly in place. She finished off the procedure with a sturdy bandage around the chin, jaw, and head.

Weeks passed before Dr. Bessie could determine if the treatment worked. “When [the] day came, I was overjoyed to see the result,” she recalled later in her journal. “The experiment had been successful. The bones had healed, the jaw was firm, the teeth were in perfect alignment, and there was not the slightest indication of a facial deformity.”

After her first year in practice, Dr. Bessie was a respected member of the community. Her practice was thriving, and the money she made allowed her to live modestly but comfortably. She was able to pay back the loan she’d taken out to set up her office and even considered the possibility of purchasing a fluoroscope (X-ray machine) in time. Nothing could have prepared her for the life change to come. Within a few months, she lost her beloved brother and sister-in-law. Nellie Efner died of an infection a day after giving birth to her fifth child. William was killed in a tragic accident three months later. 

At first, Nellie and William’s children were separated and sent to live with various friends and relatives. Bessie was brokenhearted the siblings could not stay together because they had lost so much in a short amount of time. She entertained the idea of taking in the three little girls but knew it would be a struggle because she barely made enough to keep herself afloat. Bessie had also met a man in Hinton with whom she’d fallen in love, and the two planned to be married. She wasn’t certain he’d be as inclined to take her as his wife if three children were a part of the equation. She had plans to discuss the situation with him when she returned to town after her brother’s funeral in Pierson, but her betrothed suddenly passed away. The string of tragedies overwhelmed Bessie. Crushed and defeated she traveled back to Hinton.

It was difficult for Bessie to pick up where she left off before the heartbreaking events occurred. She thought about leaving and starting over again. She reasoned that she would be so busy in a new location the memory of her deceased loved ones might lessen. A surprise visit from her father helped her decide what she should do. He had come not only to see how she was doing, but also to let her know of another town in need of a doctor. A long-time physician in the town of Moville, eighteen miles east of Sioux City, was retiring, and Bessie’s father felt she was the perfect one to take his place. He also felt opportunities for advancement would be greater for his daughter there. Moville was larger than Hinton. 

Bessie wasted no time relocating to Moville. She found a suitable site for her office and home. The change did indeed do her good. She focused on being a good doctor and learning more about medicine through hands-on experience.  The local newspaper printed an article announcing that Dr. Bessie had arrived and introduced readers to her background and previous experience. Her practice became a busy one with the bulk of her new patients being obstetric cases. In many instances, at least in Moville, it appeared women preferred to see a female physician. In time, Bessie’s sadness began to slowly subside. Thoughts of her nieces and of the dying words of her sister-in-law to her to “not let my children come to want” only intensified, however. Bessie decided she had to bring the girls to her home to live. Her father and other relatives tried to convince her she was taking on more than she could know, but she believed it was for the best.

“I…fully realized that with the three children depending upon me I could never expect to look forward to an acceptable marriage or a home and family of my own, something that every woman looks forward to as the final and full realization of her own womanhood,” Bess recalled in her memoirs. “I considered all that and lost much sleep over it, but I always came back to the same conclusion: I have no choice. I cannot do otherwise. May the consequences be for me what they will, God will help me.”

More than a few adjustments had to be made to accommodate Bessie’s nieces. She had to make room for them in the living quarters above her office, get them to school, and find someone who could stay with the girls when she had to be gone several days on various house calls. The monumental task provided Bessie with a renewed sense of purpose and motivation to carry on. She was perpetual motion. Her home life was blurred activity, and her practice was flourishing. A year after she opened her office in Moville, she’d earned enough money to purchase her own home. The house she selected was large enough for herself, her nieces, and her ever expanding business.

Dr. Bessie had a reputation for responding quickly to calls for medical help, braving the harshest elements to get to patients in need, and being discreet. There was one occasion, however, where she was forced to be less close-lipped about a case. She was called to a farm ten miles out of town to respond to a woman who was about to give birth to her twelfth child. The delivery of the baby was successful, and the doctor returned home once it was clear mother and infant were doing well. Two days later, Bessie received a call to hurry back to the farm. The mother had become ill.

Bessie examined the patient who was suffering with abdominal pain and running an elevated temperature. She believed the woman could be suffering with a virulent infection. She took a sample from the mother’s pelvic region and sent it to a laboratory in Sioux City for testing. The results showed that the woman had gonorrhea. Her husband had been unfaithful to her with prostitutes and had infected his wife in the last stage of her pregnancy. It was all the doctor could do to hold her tongue when relaying the woman’s condition to the husband. She didn’t say anything about the nature of the infection but did express the seriousness of his wife’s condition.

Instead of expressing his gratitude for the diagnosis and proper treatment his wife could now be given, he went into a rage. He cursed Dr. Bessie and accused her of neglecting the mother of his children. He told her he was not going to pay her and threatened to sue her for malpractice. He then rode into town and told all who would listen that Bessie was responsible for his wife’s poor health.

Dr. Bessie sought legal advice. She wanted the vile rumors to cease and knew of no other way to ensure her reputation be kept intact. “I called my attorney, told him of the case, also explained the evidence that I had, and instructed him to institute legal action against this man and to bring him to court, where I could present my evidence and expose him publicly for his contemptible behavior, unless he would immediately stop spreading this rumor, but rather pay his bill in full by the next morning,” she recalled years later.  “My attorney did as I had instructed him and served notice on him, informing him of the evidence I had. The result was that by the next morning I had my pay in full, and the slanders he had been spreading stopped from that time on."

Bessie and her family lived happy lives in Moville for more than two years. With rare exceptions, they liked the people in town, and residents liked and respected Dr. Bessie and her girls. It seemed they were destined to continue thriving in the charming Iowa community, but the bank panic of 1907 brought a halt to the dream of living happily ever after in Moville. The financial crisis was set off by a series of bad banking decisions and a frenzy of withdrawals caused by public distrust in the banking system. According to Bessie’s memoirs, “The panic did not last very long, but was disastrous while it lasted, and brought to an abrupt end the universal prosperity the country had enjoyed for the past ten years. Several railroads went into receivership, thirteen New York banks went into bankruptcy, affecting thousands of banks throughout the country. A serious unemployment situation and a drastic cut in wages followed. People had no money and could not borrow any. Farmers couldn’t sell or buy, the banks refused to release any money, and the whole country became panicky.”

As a result, Bessie’s funds quickly depleted. She had expenses of her own to pay and no money coming in. Her patients couldn’t pay their doctor’s bill, and no new patients were coming into her office because most of the people in the area considered her services a luxury they could do without. As a result, Bessie struggled to make ends meet. She managed to keep food on the table but couldn’t afford to pay the mortgage on her home and business. Since she had acquired the loan to construct her house and office, she’d never missed a payment. She explained her circumstances to the lender, but they were unsympathetic. The lender started foreclosure procedures, and Bessie and her girls were forced out. Another doctor, a young man who had grown up in Moville and who had recently graduated from medical school moved into Dr. Bessie’s home and office. He took over the space with his new wife, a woman who happened to be the daughter of the town’s most wealthy citizen.

Humiliated and financially destitute, Bessie contemplated her options. She felt she had no one to turn to, not even her father. He had been one of those who had warned her against taking in the children. All she believed was left for her to do was pray. An answer to her prayers came in the form of an elderly man the townspeople called Uncle Ira. Ira was moved by what had happened to Bessie and offered to help. He offered to loan the doctor $100. He hoped it would be enough to get her through the set back. She gratefully accepted.

The doctor used the funds to settle her affairs and purchase train fare West for herself and her family. They would make a new life for themselves in Wyoming.

Bessie’s home in Carpenter, Wyoming, was a simple, one-and-half story house with three rooms downstairs and one upstairs. One of the downstairs rooms would serve as the doctor’s office and another as an examination room and a place where patients needing extra care could stay overnight.

The cost to move, equip the home and office with necessities, and purchase a small amount of food was more than Bessie anticipated. She had exactly seventy-five cents to her name and Christmas was close at hand. Since Carpenter wasn’t yet a bustling town, Bessie suspected it would take a while to build her practice. She had no one to inform the community her office was open for business. There were no phones, no newspapers, no school, church, or post office, only ranches scattered miles apart throughout the prairie. 

Ranch hands were the first to come to her door in need of a doctor. Unfortunately for Bessie, they weren’t needing help for a human being but a horse. “I have very urgent case,” the panic-stricken man announced when she answered his persistent knock on her office door. “One of my horses is very sick, and I might lose him if I am not able to get him immediate help. I have only one team, and if I lose this horse I am ruined.”  Bessie explained to the man that she wasn’t a horse doctor, but a doctor for people and that she didn’t know anything about treating animals. The rancher insisted that if she could treat a man, she could treat a horse. As he was describing the sick animal’s symptoms, it occurred to her the horse might be suffering from colic. The details of the ailment sounded the same as a human being suffering from the malady. He pleaded with her for a remedy. She told him she could prescribe some medicine and informed the rancher he’d have to increase the dosage to be four times stronger than what a man would be given. Dr. Bessie told the owner of the horse that she’d only let him have the medicine if he absolved her of any responsibility. He assured her he would assume all the risk. She reluctantly agreed, and he hurried off with the medication. She charged the rancher, her first patient in Wyoming, seventy-five cents for the services.

The rancher returned to Dr. Bessie’s office the following day with news that the horse made a full recovery. He was grateful for her help and told everyone in the area that she was an amazing doctor and boasted that if she could cure a horse, she would be able to work wonders for sick people. 

Below freezing temperatures, prairie fires, and violent hailstorms were just a few disagreeable conditions Bessie and her family endured during their first year in Carpenter. The doctor and her girls grew close as they weathered the elements. Bessie was thankful for their time together, but the downside was the lack of patients. Even with the positive word of mouth from the rancher with the now healthy horse, people didn’t venture out in the bitter cold or when their livelihood was threatened with incineration. With no patients, there was no money coming in. Bessie and the girls sustained on what little food the doctor grew herself or could afford to buy. The diet consisted of potatoes, pork-n-beans, turnips, and prunes. It took two years of hard living before Doctor Bessie’s practice reached the same level of success she had in Moville.

Dr. Bessie’s services comprised a territory of about thirty miles. She was the only doctor between Cheyenne and the Nebraska state line to the east. To the south, her practice extended into Colorado, and, northwest, she served people beyond Burns and the Union Pacific Railroad to the border of the open grazing land in the northern part of Laramie County. More than once, Bessie was caught in the middle of a rainstorm either going on a house call or returning home. She credited her faithful horse for safely getting her from one patient to another and home again. There were times when Bessie needed another form of transportation to get her to sick or injured people in need of her help. Such was the case one late evening in the fall of 1909.

A loud pounding on the doctor’s office door rousted her out of bed. She was half asleep when she cautiously answered the door. Two, grim-faced, Hispanic gentlemen, who barely spoke English, greeted Bessie and quickly handed her a note. The note explained that the men were employees of the railroad who were living in a small town in Colorado with their families. One of the section worker’s wives had written the note requesting Bessie come quickly because she was having a baby and needed help. The men had traveled to the doctor’s office by handcar and would use the same mode of transportation to take her to the expectant mother. Bessie quickly dressed, grabbed her medicine case, and the three hurried on their way. The railroad tracks were three city blocks from the doctor’s office. By gesture and using a few words in English, the men let Dr. Bessie know to climb onboard the handcar and take a seat.

“It was a crisp fall night; overhead was a beautiful starry heaven, and a waning moon was approaching the western horizon,” Bessie wrote later in her memoirs. “As I was traveling along on this unusual conveyance at a pace much faster than the average horse would travel, trying to beat the stork in this race, I began to feel quite at ease and rather enjoyed this experience, which was most unusual even here in this new, wild, and woolly country, where almost anything could happen. 

“When we arrived at the designated town, my Mexican companions escorted me to the house from which the call had come, bowed courteously, said something in their language which I did not understand but presumed that it meant good night or goodbye, and then I in turn thanked them for the courteous service they had rendered me, and thereupon they turned and disappeared into the darkness.

“The husband and the wife who had called me were happy and grateful that I had arrived and that I had succeeded in beating the stork in this race. In about an hour or so I delivered a healthy baby. When mother and child were cared for and comfortable again, I managed to get a few hours’ rest myself and then returned home the next morning on the mixed train that made a daily run between points in Colorado and Cheyenne.”  

Dr. Bessie’s career as a physician in the rugged West was trying but ultimately richly rewarding. She learned how to do with limited equipment, diagnosing broken or fractured bones by touch because she didn’t have an X-ray machine. Her nieces acted as her nurses when needed, helping to assist her in minor surgeries and even with tooth extractions. When medical supplies such as bandages or crutches were lacking, she used strips of bed sheets and wooden boards cut to fit for her patients. She carried her own stock of standard drugs and filled her own prescriptions.

“As I now look back on those years of my practice on the frontier and recall to my mind the physical hardships,” Bessie later noted in her memoirs, “the professional handicaps, the hazardous drives, the long and tedious vigils in the crowded homesteaders’ shacks and the meager financial rewards I received, I wonder now how I had the courage to go on.

“But I survived, and so did my patients despite all these hardships and disadvantages. All of which proves again that man by nature is a pretty tough creature.”

Bessie was the first female doctor in Carpenter and also the town’s first postmistress. She received her commission on March 31, 1908.

In the summer of 1909, Dr. Bessie traveled to the town of Burns, thirteen miles north of Carpenter, to help deliver a baby. After the child was born, she stopped to have dinner at a local hotel, and it was there she met a Lutheran minister who would one day become her husband. Ironically, shortly after their first meeting, Reverend Alfred M. Rehwinkel became Bessie’s patient. The minister’s leg had been cut on a wire fence, and he needed stitches. The couple courted for more than a year before becoming engaged. Bessie and Alfred were married in Cheyenne, Wyoming, on September 28, 1912. Shortly after they were wed, the couple moved to Western Canada where Alfred was hired to lead a parish in a place called Pincher Creek. Bessie’s nieces Elsie and Ina were then old enough to be on their own. Elsie was attending nurse’s training school in a hospital in Cheyenne, and Ina was in college in the same city studying to become a teacher. Reta accompanied her aunt and Reverend Rehwinkel to their new home.

While in Canada, the Rehwinkels had three children of their own, a son and two daughters. Bessie and Alfred were married for fifty plus years. 

Dr. Bessie Efner Rehwinkel died on May 26, 1962, of cerebral thrombosis. She was eight-nine years old.