“And did you then cut him, Cousin Nicholas?
Nick shook his head. “No. I couldn’t bring myself to cut into perfectly healthy flesh simply to prove a point.”
“Well then?”
“I’m not sure. The crafty widow wanted to cut him herself—they’re obviously in league over this—but I wouldn’t let her. So the other men pinched and pummeled him a bit more. No response whatever. He woke up after about fifteen minutes. It was like a deep faint, Cousin Manon, one that can be induced at will. It could be marvelous. For necessary surgery, of course.” And for research. He didn’t dare say it aloud, but the possibility of opening up a live patient and seeing the organs actually function…Every time he thought of it he was both chilled with terror and dizzy with excitement.
“My husband took laughing gas once,” Manon said. “He told me about it. He was very young, only sixteen, and on the ship coming from Canton to New York to study medicine. Some of the passengers had the stuff and they would hold parties. For the silliness. But when Joyful took a whiff, he passed out and hit his head and he didn’t feel a thing.”
“Did he ever use it medically?”
“I don’t think so. At least he never said. I don’t believe he’d have known where to get this laughing gas.”
“Those skilled in chemistry can produce laughing gas I know, but Mr. Graves assures me his Somnus is something entirely different. He’s not prepared to say what, only to sell it already made up.”
Manon cocked her head. “And have you then bought a supply of Mr. Grave’s secret mixture?”
Nick nodded. “I couldn’t resist. Don’t know if I’ll have the nerve to try it on a real patient, but I do have some if the proper opportunity comes round.”
Little Annie Jablonski arrived in his hospital two days later.
Annie was not an orphan, but her mother had been caught stealing a loaf of bread and there was nothing the Police Justice could do but send her to the women’s prison in the almshouse. That necessitated putting six-year-old Annie in the gentle care of Warden Frankly Clement.
“A rat bite, I expect,” Monty Chance said when he showed the gangrenous leg to his chief. “She must have been bitten a week or so ago.”
“At least that, probably longer,” Nick said. The small leg was black and putrid and swollen to well up the calf. “The bite was simply ignored, the way everything usually is over there. Damn both Clement and his wife. If there’s any justice there’s a place in hell with their names on it.” Little Annie stared up at him. Though she spoke almost no English, she seemed to have picked up something from his tone. Big tears rolled down her cheeks, though she didn’t make a sound.
“Leg has to come off, doesn’t it, sir?”
“Yes, Dr. Chance, it does. Above the knee. She hasn’t a chance otherwise.”
“Not much of a life afterwards, a girl like her, with only one leg.”
“It’s certain death with two. The more immediate problem is how to be sure she will live through the surgery. She’s wickedly malnourished and very ill. The shock of the pain is likely to stop her heart.”
“I can see if old man Potter has any laudanum in the dispensary, but last time I asked, he had none. And who’s to pay if he has?”
“We’d find the money.” Nick would pay, as he always did. “Thing is, if we give her enough laudanum to really deaden the pain, that might kill her as well.”
“I’ve not seen laudanum kill anyone.”
“It might, Dr. Chance. Look how thin she is.”
“Just as you say, Dr. Turner. I agree. What do we do then? Allow her to die, I suppose.”
“Absolutely not, Dr. Chance. Tomorrow we are going to put her into a deep sleep and cut off her leg before she wakes up. She will not feel a thing.”
“Not even when we saw through the bone?”
“Not even then.”
“Sounds like magic, sir.”
“Not a bit of it, Dr. Chance. It is science.”
Somnus might be science, but as far as Nick actually knew, it might as well be witchcraft. He went to the Widow Turnbull’s the next day but found a notice tacked to the door saying that Mrs. Turnbull regretted having been called away and promised to serve dinner again the following day. So forget for the time being his only connection with Mr. Graves of Westchester.
He had to administer enough to keep the child asleep for at least half an hour; no way he could do this sort of surgery any faster than that. Graves had taken two deep whiffs and been out fifteen minutes. As for how much it would take to insure little Annie Jablonski painless surgery, Nick could do nothing but guess.
There was no proper operating theater at Bellevue. One had been planned when the original hospital was conceived in 1816 and even slated to be enlarged during additional building in 1825, but the budget constraints of the city and the greed of men like Tobias Grant had overrun the planners’ good intentions. The operating theater had become a ward like any other, and now most surgeries were performed wherever the patient lay. Not this one. Nick decided to cut off Annie Jablonski’s leg in the director’s room off the ground floor lobby. He’d asked Manon to find him a blanket he might lay over the desk and perhaps a pillow for the child’s head. She brought both from her lodgings on Vandam Street as well as a pair of lanterns and a large supply of scrupulously clean rags. “There’s bound to be a lot of blood. I thought you might need these, considering how short of bandages this place always is.”
“Indeed I will, Cousin Manon. Thank you. The lanterns will be useful as well.” The hospital was supposed to have been piped for gas lighting the previous summer. Nick was not in the least surprised that it had not happened. No doubt the funds had provided a brace or two of fat pheasant for Tobias Grant’s table.
“I thought they might do,” Manon said. “And I’ve an extra supply of whale oil. In case it takes longer than you intend.”
“Hard to know with surgery,” Nick agreed. “You’re a wonder, Cousin Manon.”
“Don’t flatter me, Cousin Nicholas. Grant me a privilege instead.”
“Whatever you like,” he said. “Though I can’t think what would possibly be in my gift that’s of any value to you.”
“Allow me to observe.”
“Observe the surgery?”
“Exactly.”
“My dear Cousin Manon, you’re an indomitable woman, as I well know, but surgery of this sort…it’s no place for a lady, I assure you.”
“It’s little to ask, Cousin Nicholas, and I might be useful. I’m not a bad nurse, you know.”
“But why?”
“May I be present, yes or no?” She had no intention of telling him her reason for asking.
“Yes, very well. But you are to stand near the door so you can slip outside if you feel faint. It’s a bloody business, dear Manon. And while I have hopes, I can’t promise the child won’t be screaming in agony.”
“Two o’clock is it?”
“Two sharp,” he concurred. “Dr. Chance and Dr. Klein are to assist me.”
Judging by the crowd trying to get in at the door of the director’s room a few minutes before two, all of Bellevue had come to watch. Nick spotted half a dozen ambulatory patients, the three medical students currently working at the hospital, the warden of the orphanage, even the one-eyed apothecary who ruled the dispensary. In nearly two years he’d never before seen Jeremy Potter above his basement dungeon. “What are you all doing here? Go away. I can’t—”
“We are here to see a miracle, Dr. Turner.” Tobias Grant himself and a strange man with him. The stranger stayed just inside the door, but Grant pushed his way through the jam and came to stand almost nose to nose with his Senior Medical Attendant. “It is my understanding that’s what you’ve promised. A miracle.”
“Dr. Grant, I never—”
“One that is to take place at—” Grant pulled his watch from his waistcoat pocket and flipped it open—“two sharp. Ah, here is your patient.”
Manon came in carryi
ng the child wrapped in a blanket, and laid her down on the desk, hushing the little girl’s sobs. “She’s feverish, Dr. Turner. I gave her willow tonic and it helped some, but she’s still quite hot.”
“Salicylic acid,” Potter intoned. “Make it up myself from willow bark. Best thing for a fever.”
“Yes, well, that will help I’m sure. But I can’t perform this surgery with an audience.”
Grant turned to the patients and the medical students. “Everybody out!” With some grumbling the crowd of observers left. “Now, Dr. Turner, your patient is technically in the care of Mr. Clement here, seeing as he’s warden of the orphanage. Mr. Potter prepared the medicine the child has recently received. This gentleman is Mr. Henry Morrison; he is my guest. And I, as you well know, am responsible for everything that happens in this institution. So we all have a reason to remain. With the exception of Mrs. Turner, of course.”
Manon stood at the top of the desk, cradling Annie’s head and shoulders in her arms. Nick hesitated a moment then said, “She may stay. Annie appears to take some comfort from her presence. Are you willing to remain where you are, Mrs. Turner?”
“Certainly, Dr. Turner.” Manon shot him a grateful look.
“Very well,” Grant said, “that gives you an audience of the lady, myself, my guest, the director of the dispensary, and the warden of the orphanage. Not too many, I trust.” Grant shut the door with a decisive slam. “Proceed, Dr. Turner.”
“Very well. But I won’t be responsible for any weak stomachs among you.”
Monty Chance had laid out the instruments: four scalpels of different sizes, two saws, a number of needles threaded with catgut, a pair of retractors, and a couple of probes. An old metal washtub would receive the diseased leg once Nick had cut it off. It was a dark gray day, but everything in the temporary operating theater was bathed in the yellow light of the lanterns suspended from the ceiling.
“Dr. Klein,” Nick murmured.
Ben Klein stepped forward with a clean towel and a basin of water, in which floated a lump of strong brown soap. Nick and the other two doctors, having already taken off their coats and rolled up the sleeves of their shirts, scrubbed and dried their hands.
The canister of Somnus he’d purchased from Mr. Graves of Westchester was in the pocket of Nick’s coat, which was hanging on a hook beside the door. He had to push between Grant and the mysterious Mr. Morrison to get it. He felt their eyes on him all the while. “Take this please, Dr. Klein. Remove the stopper as quickly as you can, and I shall put this cloth over the opening straightaway.”
In the farmhouse Graves had used his handkerchief, one of Manon’s rags would do today. Nick clamped it on top of the canister as soon as Ben had removed the cork. A sickly sweet smell filled the air straightaway. “Dr. Chance, the window.”
Chance cracked it slightly and cold air rushed into the room. Nick put the cloth dampened with Somnus under the little girl’s nose. Annie opened her mouth as if to scream or sob, then lifted her hand to push his away but only half completed the gesture. Her arm fell limp to her side, her eyes closed, and her head lolled against Manon’s breast.
Nick mentally ticked off ten seconds, which felt like an hour, then took the cloth away and pinched the little girl’s cheek as hard as he could. The mark he left was bright red, but she didn’t so much as sigh. A pinch to her arm and another to her thigh had the same effect. The open window had cleared away the sickening smell. “Very well, gentlemen. Let us begin. Please tie a tourniquet right here, Dr. Chance.”
He indicated a spot some two inches above the girl’s knee, and Monty Chance tied a leather thong around it. “Tight as you can, Doctor,” Nick said. The tourniquet would cut off as much as possible of the supply of blood to the rest of the leg, and inhibit bleeding from severed veins and arteries during surgery. “Excellent. Now the linen bandage.” That went just below the tourniquet. Later it would help to roll the skin in place over the stump. “The leg, Dr. Klein.” Ben took hold of the child’s heel and raised her black and swollen leg into the air. “Very good, hold it absolutely steady, Doctor.” Nick turned to his knives.
He selected a four-inch scalpel from the array and made the first incision, starting on the underside of the leg and drawing the knife towards him in a half circle that ended at the midpoint of the diameter of the thigh just above the knee. He had heard grown men shriek for their mothers when the cold steel of a scalpel first bit into soft adipose tissue. Annie Jablonski didn’t make a sound.
The tourniquet meanwhile was doing its job. Blood pooled around the wound he’d made, but it oozed rather than spurted. Monty Chance sopped what there was with a wad of rags.
Nick heard someone gagging behind him. He cut again, once more starting from under the leg, but this time drawing the scalpel in the opposite direction. The second incision met the first with precision. A clean circular cut now separated the skin of the upper thigh from that just above the knee. Back when he was a student and later as a doctor in Providence, he’d never considered himself a particularly skilled surgeon, but he’d had plenty of practice since coming to Bellevue; the destitute were always arriving at his door with one or another limb crushed beyond hope. These days the scalpel felt like an extension of his hand, but until this moment only the dead had lain silent beneath his knife. The child’s chest was rising and falling in a steady rhythm, and her eyes remained closed. “All right?” he murmured to Manon, who still held the girl’s shoulders in the crook of her arm.
“Entirely all right,” she whispered back. “A miracle after all.”
Nick smiled and returned to his task. The muscles had to be severed next, but first, “The linen roller, Dr. Chance.” Monty Chance put both hands around the circle of cloth he’d tied below the tourniquet and used it to help him draw back the skin the incision had loosened.
Saving as much skin as possible to stitch over the stump was the key to an amputation that did not later fester. Among Nick’s most precious possessions was a journal written by his four times great grandfather; back in 1670. As long ago as that, old Lucas Turner the barber surgeon had noted the need to save skin when amputating. “Very good, Dr. Chance. Hold the leg absolutely still, Dr. Klein.” Nick took up his largest scalpel and with two more semicircular cuts severed the muscle all the way to the bone. There was much more blood now, but Monty Chance had both hands occupied in protecting the skin. “Dr. Klein,” Nick said. He spoke quietly because it was one of the surgeon’s jobs to keep the operating theater calm and focused. Chaos was a deadly enemy when scalpels and saws were involved. “Sop the blood with your free hand, please, Dr. Klein. But don’t lose your grip on that leg.” Nick turned to the instrument array, seeking the retractor. Manon, relying on nothing but instinct and her powers of observation, had already picked it up and was holding it out to him. Moments later, when it was time for the large triangular saw, she held that out as well.
Nick looked at Annie one more time. She still slept. He began to saw.
Bones have no feeling. So every medical student was told when he began the study of surgery. It’s the ratcheting back and forth of the saw, the friction to the wounds you’ve made with your scalpel, that causes such intense pain. Be as quick and as decisive as you can; that’s in the best interest of your patient. Make sure your tools are sharp and well oiled, and cut with the attention you’d apply to the last log in the world’s last forest. Not that this particular amputation would require much effort. Still, quick was best. Nick leaned forward and put his back into it.
He heard someone retching behind him.
He heard, as well, Annie Jablonski moan.
“She’s coming round, Dr. Turner,” Manon said, an edge of panic in her voice.
Nick felt panic too. After years of cutting in the midst of howling agony he had, in just a few minutes, become accustomed to the wonder of an operation performed without screams. He stopped sawing, took a step closer to the child’s head, and grabbed his black stethoscope and pressed it to her chest. A
steady enough heartbeat. Rapid, but that was to be expected. He lifted her hands. They were caked with grime, but he could see no sign of blue beneath her nails. His patient was not in shock. The mysterious Somnus was simply wearing off.
Nick grabbed the canister, prized out the cork, and shoved it below the child’s nose. Manon took it out of his hand. “I’ll do it.”
“Count of twenty,” he said.
This time the small room reeked of the sickly sweet smell of the stuff. It was making him lightheaded, and he could hear someone behind him struggling with a hacking cough. Manon put the cork back in the canister. Nick went to the window and threw it wide open. Fearsome cold, but it felt refreshing. “Deep breaths of fresh air everyone. We don’t all want to go to sleep.”
He went back to sawing. A few seconds more were all that was required and the lower half of the leg was free. Ben Klein caught it as it fell, and turned and plopped the thing into the washtub. There was more retching from one of the observers, then the sound of the door being opened and shut. Good riddance. Please God it was Tobias Grant.
Nick began trying off the arteries and blood vessels with catgut ligatures, instructing Monty Chance to continually loosen the tourniquet so that more would be revealed as the flow of blood returned to Annie Jablonski’s thigh. Finally he rolled the reserved skin over the stump and stitched it carefully in place. Through it all the little girl didn’t so much as murmur.
He put down the last of his instruments. “Done,” he said. “Thank you, gentlemen. And you, Mrs. Turner.”
His assistants, all three including Manon, were grinning at him. He was grinning as well, he realized. All of them as satisfied as cats with a bowl of cream. Painless surgery was a thing longed for since the days of Hippocrates. At last it had happened; they had witnessed a miracle. Nick turned to see if the sense of wonder had spread to the onlookers. Tobias Grant, he noted, looked pleased, though he wasn’t actually smiling. Mr. Morrison had a notepad and a stub of pencil and was busy scribbling away. Frankly Clement looked positively grim. Not one of them seemed to have any idea of what an astounding sight they’d seen. Jeremiah Potter was gone. He’d been the retcher, then. That would teach the hateful old troglodyte to venture from his cave.
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