Outlander [08] Written in My Own Heart's Blood

by Diana Gabaldon

  “Blood poisoning,” Claire said. “Bacteria—germs—in the blood. It moves very fast, and if it should get into the body proper … there’s nothing I can do.”

  He looked up sharp, hearing a tiny tremor in her voice.

  “But before that, ye might? There’s a chance?” He tried to sound encouraging, though the thought of the alternative made the gooseflesh that much worse.

  “Yes. But it isn’t a good one.” She swallowed. “The shock of the amputation may well kill him on the spot. And if it doesn’t, there’s still a great chance of infection.”

  He stood up then and came round the bed to her, taking her gently but solidly by the shoulders. Her bones were close to the surface, and he thought her feelings were, too.

  “If he’s got a chance, we must give it to him, Sassenach.”

  “Yes,” she murmured, and he felt the shiver go all through her, though the air was hot and close. “God help me.”

  “He will,” Jamie whispered, folding his arms briefly round her. “So will I.”

  I WAS STANDING in the wrong place. The fact that I understood what was happening to me didn’t help at all.

  A trained surgeon is also a potential killer, and an important bit of the training lies in accepting the fact. Your intent is entirely benign—or at least you hope so—but you are laying violent hands on someone, and you must be ruthless in order to do it effectively. And sometimes the person under your hands will die, and knowing that … you do it anyway.

  I had had them bring more candles, though the air in the room was already suffocating. The miasma of humidity and slowly evaporating sweat made the light of the candelabra fill the chamber with a gentle, romantic glow; just the thing for a dinner party filled with wine, flirtations, and dancing.

  The wine could wait, and any surgeon dances with death routinely. The problem was that I’d forgotten the steps and was flirting with panic.

  I bent to check Tench’s heart rate and respiration. He was breathing shallowly but fast. Lack of oxygen, severe blood loss … and I felt my own chest tighten, heaving for air, and stood up, giddy, heart hammering.

  “Sassenach.” I turned, hand on the bedpost, to see Jamie watching me, eyebrows drawn together. “Are ye all right?”

  “Yes,” I said, but my voice sounded queer even to my own ears. I shook my head hard, trying to clear it. Jamie came close to me and put his hand on mine, where it rested on the bedpost. It was big and steady, and it helped.

  “Ye willna help him, lass, if ye faint in the midst of it,” he said, low-voiced.

  “I’m not going to faint,” I said, made a bit testy by anxiety. “I just—I—I’m fine.”

  His hand fell away, and after a long, searching look into my face, he nodded soberly and stepped back.

  I wasn’t going to faint. Or at least I hoped not. But I was trapped there in that close, hot room, smelling blood and tar and the scent of myrrh in the laudanum, feeling Tench’s agony. And I could not do that. I couldn’t, I mustn’t.

  Peggy hurried in, a maidservant behind her, several large knives clutched to her bosom.

  “Will one of these do?” She laid them in a clinking heap at the foot of the bed, then stood back, gazing anxiously at her cousin’s pale, slack face.

  “I’m sure one will.” I stirred the heap gingerly, extracting a couple of possibilities: a carving knife that looked sharp, and a big, heavy knife of the sort used for chopping vegetables. And, with a vivid recollection of what it felt like to sever tendons, I picked up a paring knife with a freshly sharpened, silvered edge.

  “Do you butcher your own meat? If you have something like a bone saw …”

  The servant went as pale as a black man reasonably can, and went out, presumably to acquire one.

  “Boiling water?” I asked, brows raised.

  “Chrissy is bringing it,” Peggy assured me. She licked her lips, uneasy. “Do you—mmm.” She broke off, narrowly avoiding saying what she so plainly thought: “Do you know what you’re doing?”

  I did. That was the trouble. I knew much too much about what I was doing—from both sides.

  “Everything will be fine,” I assured her, with a decent appearance of calm and confidence. “I see we have needles and thread. Would you take the biggest needle—a carpet needle, perhaps—and thread it for me, please? And then a couple of smaller ones, just in case.” Just in case I had time and opportunity to actually capture and ligate blood vessels. It was much more likely that the only choice I would have was cautery—a brutal searing of the fresh stump to stanch the bleeding, for Tench didn’t have enough blood left to be able to spare any of it.

  I needed to be alone in my head, in a calm, clear place. The place from which I could see everything, sense the body under my hand in all its particularities—but not be that body.

  I was about to disjoint Tench Bledsoe’s leg like a chicken’s. Throw away his bones and flesh. Sear the stump. And I felt his fear in the pit of my stomach.

  Benedict Arnold had come in with an armload of firewood and a silver table knife in one hand—my cautery iron, if there wasn’t time to stitch. He set them down on the hearth, and the butler began to poke up the fire.

  I closed my eyes for an instant, trying not to breathe through my nose, shutting out the candle glow. Denny Hunter had operated on me by candlelight; I remembered watching through a haze of eyelashes, unable to open my eyes more than a crack, as each of the six big candles was lit, the flames rising up pure and hot—and smelling the small iron heating in the brazier beside them.

  A hand touched my waist, and, gulping air, I leaned blindly into Jamie.

  “What’s wrong, a nighean?” he whispered to me.

  “Laudanum,” I said, almost at random. “You don’t—you don’t lose consciousness altogether. It makes the pain go away—not stop, just seem not connected to you—but it’s there. And you … you know what’s happening to you.” I swallowed, forcing down bile.

  I felt it. The hard probe jabbing its way into my side, startling. The remarkable sense of cold intrusion, mingled with incongruous faint warm echoes of internal movement, the forceful jabs of a child in the womb.

  “You know what’s happening,” I repeated, opening my eyes. I found his, looking down at me with gentleness.

  “I ken that, aye?” he whispered, and cupped my cheek with his four-fingered hand. “Come and tell me what ye need me to do, mo ghràidh.”

  THE MOMENTARY PANIC was subsiding; I forced it aside, knowing that even to think about it was to slide headfirst back into it. I laid a hand on Tench’s injured leg, willing myself to feel it, find the truth of it.

  The truth was all too obvious. The lower leg was a complete wreck, mechanically, and so compromised by septicemia that there was no chance of saving it. I was searching desperately for a way to save the knee; having a knee made a tremendous difference in the ability to walk, to manage. But I couldn’t do it.

  He was far gone from injury, blood loss, and shock; he was a stubborn man, but I could feel his life flickering in his flesh, dying away in the midst of infection, disruption, and pain. I could not ask his body to withstand the longer, painstaking surgery that would be necessary to amputate below the knee—even if I felt sure that such an amputation would be sufficient to forestall the advancing septicemia, and I didn’t.

  “I’m going to take his leg off above the knee,” I said to Jamie. I thought I spoke calmly, but my voice sounded odd. “I need you to hold the leg for me and move it as I tell you. Governor”—I turned to Arnold, who stood with a reassuring arm about Peggy’s Shippen’s waist—“come and hold him down.” Laudanum alone wasn’t going to be enough.

  To his credit, Arnold came instantly and laid a hand against Tench’s slack cheek for a moment in reassurance before taking firm hold of his shoulders. His own face was calm, and I remembered the stories I’d heard of his campaigns into Canada: frostbite, injury, starvation … No, not a squeamish man, and I felt a small sense of reassurance from the presence of my t
wo helpers.

  No, three: Peggy Shippen came up beside me, pale to the lips and with her throat bobbing every few seconds as she swallowed—but jaw set with determination.

  “Tell me what to do,” she whispered, and clamped her mouth shut hard as she caught sight of the mangled leg.

  “Try not to vomit, but if you must, turn away from the bed,” I said. “Otherwise—stand there and hand me things as I ask.”

  There was no further time for thought or preparation. I tightened the tourniquet, grasped the sharpest knife, nodded to my helpers, and began.

  A deep incision, fast, around and across the top of the leg, cutting hard down to expose the bone. An army surgeon could lop off a leg in less than two minutes. So could I, but it would be better if I could manage to cut flaps to cover the stump, could seal the major vessels.…

  “Big needle,” I said to Peggy, holding out my hand. Lacking a tenaculum to seize the large blood vessels that snapped back into the flesh when severed, I had to probe for them with the point of the needle and drag them out, anchor them into the raw, exposed flesh, and then ligate them as fast as I could, whipping thread round them with one of the smaller needles and tying it off. Better than cautery, if there was time …

  Sweat was running into my eyes; I had to dash it away with my bared forearm; my hands were bloody to the wrist.

  “Saw,” I said, and no one moved. Had I spoken aloud? “Saw,” I said, much louder, and Jamie’s head twisted toward the implements on the table. Leaning heavily on Tench’s leg with one hand, he stretched to grab the saw from the table with the other.

  Where was Peggy? On the floor. I saw the bloom of her skirt from the corner of my eye and felt vaguely through the floorboards the steps of a servant coming to haul her out of the way.

  I groped for another suture, blind, and the jar of brandy in which I’d stowed them tipped, spilling on the sheet and adding its sweet stickiness to the atmosphere. I heard Jamie gag, but he didn’t move; his fingers squeezed the thigh hard above the tourniquet. Tench would have bruises there, I thought idly. If he lived long enough for his capillaries to bleed.…

  The saw had been made to disjoint hogs. Sturdy, not sharp, and not well kept—half the teeth were bent, and it jumped and skittered in my hand, grating over the bone. I clenched my teeth and pushed, my hand slipping on the handle, greased with blood and sweat.

  Jamie made a deep, desperate noise and moved suddenly, taking the saw from my hand and nudging me aside. He gripped Tench’s knee and bore down on the saw, driving it into the bone by main force. Three, four, five dragging strokes, and the bone, three-quarters sawn through, made a cracking noise that jolted me into action.

  “Stop,” I said, and he did, white-faced and pouring sweat. “Lift his leg. Carefully.” He did, and I made the cut from below, long, deep strokes of the knife deepening the incision at an angle to make the flap, joining the cut with the upper incision. The sheet was wet and dark with blood—but not too much. Either the tourniquet was holding, or the man had so little blood left to lose …

  “Saw again,” I said urgently, discarding the knife. “Hold steady! Both pieces.” There was no more than a thin section of bone remaining; the spongy bone of the marrow showed, blood flowering slowly from the cut surface. I put no pressure on the saw; the last thing I wanted was to crack the bone in some awkward way. It wasn’t working, though, and I looked back toward the line of tools, desperate to find something else.

  “Rasp,” Jamie said, his voice rough with strain. He nodded toward the table. “There.”

  I seized the rasp, a rat-tailed thing, drenched it with brandy, and, turning it sideways, filed through the last bit of bone, which parted gently. With a ragged edge, but intact, not shattered.

  “Is he breathing?” I asked. I was having trouble breathing myself, and couldn’t sense the patient’s vital signs—save to notice his heart was beating, because blood was pulsing slightly out of the smaller vessels—but Arnold nodded, his head bowed, intent on Tench’s face.

  “He’ll do,” he said, his voice firm and loud, and I knew he was speaking as much to Tench as to me. Now I could feel the stir in the upper leg, a violent reflexive urge to move, and Jamie leaned hard on it. My fingers brushed the discarded lower leg, the flesh horribly flaccid and rubbery, and I snatched them back, wiping them convulsively on my apron.

  I swiped the bloody apron then across my face and pushed back loosened bits of hair with the back of my hand. It was shaking; they both were.

  What the bloody hell are you shaking now for? I thought irritably. But I was, and it took much longer than it should have to cauterize the last few small bleeders—adding the ghastly smell of roasting flesh to everything else in the room; I thought even General Arnold might throw up—stitch the flaps, bandage the wound, and, at last, loosen the tourniquet.

  “All right,” I said, and straightened up. “Now …” But if I said anything else, I didn’t hear it. The room revolved slowly round me and dissolved into a flicker of black and white spots, and then everything went black.

  THE SECOND LAW OF THERMODYNAMICS

  TENCH LIVED.

  “I should have known you would,” I said to him. “If you were determined enough to survive all night in the river, plainly a mere amputation wouldn’t slow you down.”

  He hadn’t enough strength to laugh—the journey by litter to Chestnut Street had left him white-faced and gasping—but he did twitch his mouth enough to qualify his expression as a smile.

  “Oh … I’ll live,” he managed. “Wouldn’t … give ’em … the satis … faction … of dying.” Worn out by this, he closed his eyes, chest heaving. I wiped his face gently with my handkerchief, patted his shoulder, and left him to rest.

  I had had the litter bearers take him upstairs, to what had been my bedroom, and I closed the door behind me now with a queerly mixed feeling of triumph and depression.

  I had spent the morning with Mrs. Figg and the housemaid, Doreen, packing away what remained of Lord John’s furnishings—for many had already been shipped to New York—and rearranging the house to serve as a temporary surgery. Even if we were to leave for North Carolina soon—and the sooner the better—I did have to have someplace to put Tench where he could be looked after in conditions approaching comfort and hygiene. And the patients I had been seeing at the printshop could certainly be taken care of more conveniently here.

  At the same time … being here again brought back echoes of the numb despair I had lived with all those weeks of believing Jamie dead. I thought the bustle of work and the clean sweep of furnishings would perhaps obviate that distant sense of drowning, but at the moment it was an uneasy swirl around my ankles.

  Mental oppression was not the only debilitating condition connected with the new situation. Leaving Number 17 to return to the Shippen house, I had been followed in the street by a gang of young men. Mostly boys, but some big fellows of sixteen or seventeen, big enough to make me uneasy with their glances.

  Still more uneasy when they began to draw up close to me, taking a quick step to whisper, “King’s whore!” in my ear before falling back, or to try to tread on the hem of my skirt, sniggering.

  I thought I had seen one or two of them in the mob when I’d brought Hal here. Perhaps they’d followed me then and, finding that I was married to Lord John, assumed I was a turncoat, a traitor to the Rebel cause. Or possibly, I thought, stiffening my spine, they were just troublemaking pipsqueaks.

  I whirled round to face them, gripping my parasol. It wasn’t much of a weapon, but no physical weapon would have been of use against so many. Even a twelve-year-old boy was likely stronger than I was at the moment.

  “What do you want?” I demanded, using the memory of my matron’s voice, whipcrack and steel—or at least I hoped I could still do that.

  Some of the little warts blinked and took a step back, but one of the bigger ones took a step toward me, grinning. It took all my control not to recoil.

  “I don’t know, hinnie,�
� he said, looking me up and down with a lazy insolence. “What does a Loyalist lady have that we might want?”

  “A swift poke in the eye is all I can offer you,” I informed him crisply, with a meaningful pointing of my parasol. “Apparently I’m walking too slowly and blocking your progress, gentlemen. Do go on ahead of me.” Holding his eye with a menacing stare, I stepped into the street and gestured with my parasol, indicating that they should pass on.

  That made some of them giggle, but the big fellow flushed a nasty pink that made his adolescent pimples fluoresce. I stepped back farther into the street, in an imitation of politeness, but actually in hopes of attracting some attention.

  I was lucky: a rag-and-bone cart was coming down the road, the horse’s hooves clopping on the cobbles, and I moved still farther, blocking the way. The carter, aroused from semi-somnolence, half-stood, peering out from under his hat.

  “What the devil are you idle buggers a-doing in the road? Get your fat arses out my way!” He raised his whip in a menacing fashion, and the boys, who had started to advance on me, quickly retreated.

  The carter stood up all the way, took off his hat, and bowed to me.

  “Good day, your ladyship; I hopes I sees you well. Can I offer you a ride, mayhap?” He was speaking in jest; I didn’t think he actually knew I had recently been a ladyship. He was certainly surprised when I swept up my skirts and mounted his cart, though.

  “Home, James,” I said, furling my parasol, “and don’t spare the horses.”

  The recollection made me smile a little, but the smile faded at the thought that the louts who had accosted me certainly lived somewhere nearby. I mightn’t be as lucky a second time. And at that thought, a wave of cold terror washed over me and I felt a band of soreness across my middle, the chafing and bruising from hours spent tied facedown across a horse’s back, being carried helpless to—