The Girl in His Shadow is the second novel by Audrey Blake, the pen name of the writing team comprised of Regina Sirois and Jaima Fixsen. This work of historical fiction examines the arbitrary standards for men and women that characterized London in the mid-19th century. The protagonist, Nora Beady, is orphaned by cholera and raised by a leading surgeon named Dr. Horace Croft. Under Croft’s care, Nora becomes a capable surgeon, but she is prohibited from practicing medicine due to her sex. Her work and her social standing are threatened when Croft invites Daniel Gibson to study with him, and when her participation in a risky but successful surgery is revealed, she is condemned by her community. Though Daniel proposes to her, Nora elects to follow her ambition and pursue an opportunity at the University of Bologna. Blake has also written a sequel to The Girl in His Shadow called The Surgeon’s Daughter, which follows Nora’s experiences in Italy.

This guide refers to the 2021 paperback edition published by Sourcebooks.

Content Warning: Both the source text and this guide contain descriptions of rape, attempted suicide, and abortion.

Plot Summary

Dr. Horace Croft traverses the London streets in 1832, treating those afflicted by cholera. When everyone at the Beady home dies except eight-year-old Nora, he takes the sick child home with him. His housekeeper, Mrs. Phipps, quickly grows to love the girl and insists that they keep her.

Thirteen years later, Nora opens the door to Dr. Daniel Gibson, a young surgeon who has come to study with Croft. The housekeeper scrambles to find him a room while Nora glowers at the man she fears will replace her. Though her participation in Croft’s work is illegal, Nora serves as Croft’s clinic assistant and skillfully dissects corpses, conducts experiments, and produces medical illustrations. Daniel’s arrival jeopardizes her secret, especially because he is fastidious regarding social standards that govern relations between the sexes. When he accompanies Croft to a difficult childbirth that ends with the mother’s death, Daniel’s intense emotions show that he is, in one respect, unconventional himself. He is particularly affected by others’ pain, but his empathy embarrasses him.

Daniel also works at St. Bartholomew’s, the charity hospital at which Croft practices, and he supports Croft in the surgeon’s ongoing conflict with Dr. Silas Vickery, the chief surgeon. (The two doctors loathe one another.) One day, the body of a former patient is delivered to Croft’s surgery at home, and Nora begins a dissection to ascertain the cause of death. When Daniel abruptly enters, he is horrified and assumes that Croft forces Nora to do this work. Nora corrects him, but he recoils from her lack of delicacy, fearing this “new species” of woman.

Daniel is deeply uncomfortable with the situation; he acknowledges Nora’s skill but loathes the illegality of her actions. Croft tells Daniel that he is free to leave if he likes, and Daniel goes to his parents’ house, unsure if he’ll return to work with Croft. His fiancée, Mae Edwards, is there, but he refuses to “sully” her with talk of his work. Daniel returns to the hospital and invites his friend Dr. Harry Trimble to see Croft’s surgery. Harry is delighted by Nora’s unconventional personality.

Daniel treats a woman whose hand was run over by a wagon. After he amputates her finger, Vickery orders him to cauterize, but Daniel refuses, citing the additional trauma. At home, Harry asks Nora out and she accepts, happy for his attention. The next day, Daniel learns that his patient is septic, and Vickery blames Daniel’s failure to cauterize. Daniel gets drunk at a gentleman’s club and starts ranting about Vickery’s faults as a doctor. Endeavoring to put a stop to Daniel’s behavior before he ruins his reputation and Croft’s, Harry goes in search of Croft but finds Nora instead. He tells her about Daniel, and she accompanies him to their men-only club. Inside, she is subjected to lewd comments and glares from male patrons, causing such a stir that it makes the papers the next day, along with Daniel’s drunkenness. Croft reassures Daniel that his patient’s infection is likely the result of the pig dung contaminating her wound, and cauterization would not have prevented it.

That Sunday, Nora asks Harry’s opinion about a patient who died of a ruptured appendix. He says that abdominal surgery is always inadvisable, despite one doctor’s success in very particular circumstances. Nora compares Harry’s openness to Daniel’s conservative manner, though she recognizes Daniel’s skill and empathy. In the aftermath of Daniel’s humiliation at the club, Mae breaks off her engagement to him, prompting him to go home. Meanwhile, Nora begins to collect materials to support Croft’s theory that pig dung can contaminate wounds and cause sepsis. Harry tells her that Daniel will have to give up medicine in order to win Mae back.

Croft goes to Scotland to observe another doctor’s experiments with ether. Upon his return, he demonstrates the effectiveness of the gas on Nora. Daniel returns, realizing how much he has missed them. He distracts himself from thoughts of Mae or the hospital, from which he has been banned. While helping Nora with her experiment, he realizes the depths of her courage. The three consider the uses of ether, and Nora realizes that her feelings for Harry are lessening as her feelings for Daniel grow. Croft leaves town again, and a friend of Harry’s, John Prescott, arrives in urgent need of medical care. Nora and Daniel use ether in order to operate on Prescott’s abdomen. He has a hernia and an obstructed bowel, which Nora saves. Despite the risks, the surgery and ether are successful, and Daniel publishes their discoveries. Because they cannot mention Nora, Daniel asks Harry to lie and claim that he witnessed the surgery. Harry agrees, but he is angry that Daniel allowed Nora to operate. Then he finds Nora and Daniel kissing.

Daniel’s parents come to town, and Nora and Croft join the Gibsons for dinner and a show. Mrs. Gibson is haughty and disapproves of Nora, whom Croft defends, in part, by announcing that she is his heir. Hearing this, Daniel worries that if he tells Nora about his feelings now, she might think that he is more interested in her inheritance than in her. In light of the successful operation on Prescott, Daniel is reinstated at the hospital. Vickery calls a public meeting, challenging Daniel and Croft to defend their claims about the incredible surgery. Harry confronts Nora, Croft, and Daniel, protesting that he shouldn’t be at the meeting, but they reassure him that he is needed. Daniel speaks well, but Vickery claims to have proof that Harry was not there, and Harry confesses to this fact. Without a witness, Daniel’s account is suspect, so Nora admits that she witnessed the operation. She also admits to being “extra hands” by holding clamps and passing tools. Vickery accuses her of practicing medicine, and his questions reveal that she actually proposed the use of ether and performed the operation herself. After the meeting, a stranger tries to get Nora’s attention, but Daniel rushes her away.

That night, Daniel refuses to speak with Harry, and Croft is furious about his decision to admit that he did not witness the surgery; now that the public knows of Nora’s involvement, it is unclear what the repercussions will be. The next day, Nora finds Harry, and he tells her that Vickery blackmailed him. On the night of Prescott’s surgery, Harry was treating a friend’s daughter, who was raped, became pregnant, and tried to take her own life. If Harry refused to comply with Vickery, Vickery would ruin the girl and reveal that Harry aborted her fetus. Reporters swarm the house. Mrs. Phipps informs Nora that Croft and Daniel want them to leave town until things calm down, and Nora is angry that they have made the decision for her.

The next day, the unknown man from the public meeting comes to the door. He is Salvio Perra, a professor at the University of Bologna. In Italy, women can learn and practice medicine, and he invites Nora to study with him. He encourages her not to sacrifice her skill to “English convention.” Daniel insists that Nora go to the country, but she sees Bologna as a more viable option. She tells Daniel and Croft that they cannot understand her feelings, because they have never been denied opportunities because of their sex. Mrs. Phipps agrees to be Nora’s chaperone in Bologna, and she and Mrs. Phipps sail soon after. Daniel does not ask Nora to promise him fidelity, but his kiss makes it clear that he will wait for her. On board, Nora feels the wind at her back and looks toward the future.