Haines reached out and set his wineglass down, practically in slow motion. “Almost,” he sighed, and flashed a grin at Alvi and then Thomas.
“Let me,” Riggs said, already on his feet. “Enjoy your dinner.” He strode out of the dining room, and Thomas could then hear an agitated voice on the front porch. In a moment, Riggs reappeared.
“Nathan Unger, John.”
“Nathan? I instructed him to drive his daughter to St. Mary’s.”
“It appears that he didn’t,” Riggs said. “What would you like me to tell him?”
“Good God,” Haines muttered, and pushed himself to his feet. “Thomas, I may need you.”
Chapter Thirty-eight
With the scalpel tip, Thomas scratched a faint line on the pearl-white skin of the child’s lower abdomen, a scratch perhaps three inches long just outside of the right semilunar line, ending an inch above Poupart’s ligament. He hesitated, heart pounding. That was the location the textbook had outlined, but…
“Let the appendix itself be your guide,” Dr. Roberts had lectured at the university, exhorting his students to avoid a standard “one incision fits all” mentality. Thomas’ mind raced. He had actually felt an inflamed appendix only twice in his student career, and neither time had he been sure of himself. This time, the patient’s small body was so slender, so entirely lacking in adipose padding, that the swollen organ presented itself as the slightest imperfection, so painful that even the gentlest touch caused distress.
He glanced over at John Haines, who raised an eyebrow as he moved around the small patient’s head. The little girl lay under the ether now, quiet and relaxed.
Thomas swallowed hard and looked up again at John Haines, who appeared serene and confident. “I have assisted once and observed another time,” Thomas said.
Haines nodded enthusiastically. “Well, that’s plenty, then. You’re an old hand at it. I did my first on a kitchen table with everyone watching, including the damn dog. I think he was waiting for scraps. Haines stroked the girl’s forehead. “Just take it one layer at a time, just as the books say. That’s all there is to it. You know that. The young lady and I are both ready when you are.”
Thomas glanced across at Bertha Auerbach, who tended the generous selection of accoutrements arranged in neat order on the small, linen-covered table. She was either confident or an accomplished actress. Out in the waiting room, Mary and Nathan Unger sat with hands entwined and frightened black-hollowed eyes. Alvina Haines kept them company.
They needed encouraging, Thomas had reflected. They might not have known that John Haines was half blind and more than half inebriated, but they could hardly fail to notice the bandaging that encircled the young surgeon’s left hand and skull. Facing the knife was a fright in the best of circumstances, he knew, let alone in the middle of the night with two cripples wielding sharp instruments.
“Simply know what you’re going to do before you do it,” Haines said easily. “That’s the trick.”
“Indeed,” Thomas said. Adjusting his stance once more to take his weight entirely on his right leg, with his hip braced against the side of the table, he bent slightly at the waist, took a long, slow breath, bit his lip, and drew the first incision. The skin split like that of a peach, blood welling up as Bertha’s deft fingers worked the gauze sponges.
The moment the bistoury parted the skin, Thomas’ pulse slowed, and the rest of the room ceased to be. He deepened the incision to the first mass of abdominal muscle below the skin and fat. He worked with restraint, since the bands of muscle weren’t the tough, clearly defined layers of a lumberjack or sailor. This child patient, not yet eleven years old, was not simply an adult in miniature. The muscle masses were still developing, without the definition that marked a fit adult.
Bertha sensed when Thomas might struggle. They worked together, even their breath in synch, she with forceps and Thomas with the scalpel turned so that he could employ its polished handle to compress the thin layer of the peritoneum away, freeing the thin, elastic layer from the tissues of the intestines that lay underneath. The extra set of hands worked as if they were linked directly to his own mind.
Fortune was with little Louella. The appendix itself, swollen and inflamed, had not ruptured, and was easily separated from mesentery. When he was satisfied with the clamp around its base, he tended to the fine ligatures. By the time he was prepared to tackle the appendix itself, he could feel the sweat running down into his eyes, and he straightened for a moment so Bertha could mop his face.
“Splendid,” Haines said, and Thomas wasn’t sure what the older man was referring to, since Haines was staring off into space as if communing with spirits. Little Louella slept on, her respiration strong and even.
With another ligature around the base of the appendix, he deftly tied the purse-string sutures.
“A moment,” Bertha said, and nestled another layer of sterile sponges around the area.
Confident of his ligatures and sutures, Thomas excised the diseased appendix, then spent several minutes disinfecting the area. In another moment, the stump of the appendix was invaginated back into the wall of the cecum.
Retracing his steps for closure, he took extra time with each layer of sutures, making them as elegantly small and neat as he could.
When he finally straightened up as Bertha swabbed the area around the tiny line of fine stitchery that now marked the lower right quadrant of the little girl’s abdomen, he felt as if Horace’s wagon had rolled back and forth over his lower back and hip.
“A wonder,” John Haines said. He had capped the ether bottle a few moments before. He stifled a belch and looked at Thomas with affection. “Why don’t you talk with her parents?” he suggested. “You’ll want her in the ward for the remainder of the night?” He pulled out his watch. “It’s just after eleven.”
“Yes. We’ll see her through the wake-up. That can be terrifying for children.” He blushed when he realized what he had said, since he had never actually seen a child awaken from anesthesia. But the books said so.
“Not just children,” Haines said. “Well, if she’s staying, we’ll figure out something. You’re staying the night?” he asked Bertha.
“I think I should,” she replied.
“Thomas is staying. One or both of her parents may decide to be with her as well.”
“If you don’t think it’s necessary…”
Haines shrugged. “It’s just that tomorrow is another day, Bertha. Someone in this outfit has to be clearheaded come morning.” He grinned lopsidedly. “I won’t be, that’s certain.”
“Then after the little angel is situated, I’ll be off,” Bertha said. “And return promptly at six.”
Thomas settled into his wheelchair and pushed open the door. The parents looked up as if for a moment they didn’t know where they were.
“Oh,” Mrs. Unger managed. “How is she?”
“She’ll be just fine, ma’am,” Thomas said. “There were no complications. The appendix had not burst, so there’s little danger of peritonitis. Still, coming out of the ether is always something of a trial. It would be a benefit if one of you were to remain with her for the night?”
“She can’t go home?” Nathan Unger asked. He was a tiny, angular man.
“No. That is to say, she could, I suppose, but subjecting her to a wagon ride in the middle of the night would be a pointless risk. She’s going to be very sore for a day or so, and then for several days, excessive movement will be a trial. Tonight, the nurse will administer an injection that will help her rest, and tomorrow we’ll see what can be done. I’d prefer if you can give us two or three days, to make sure.”
“Can we see her?”
“Of course you can.”
The couple rose, leaving Alvi sitting on the bench, and made their way with obvious trepidation to the surgery. Thomas heard John Haines greet them.
&nb
sp; “You look exhausted,” Alvi said.
“I confess I am.”
“It went well, though?”
“Perfectly. I couldn’t remember where the appendix was, so I just started at the neck until I found what I thought was it.”
Alvi nodded soberly. “Sometimes that’s the best way.” She turned as the front door opened. Zachary Riggs stepped inside. He closed the door quickly to shut off the rush of sodden, cold air.
“Ah,” Riggs said. “Here we are.”
“We just finished the surgery,” Thomas said.
“Good. Everything is well?”
“Perfectly.”
“And good again. You look a wreck, my friend.”
“It’s temporary.”
“Of course. Of course.” Riggs drew his watch out of his vest and regarded it thoughtfully. “Well, tomorrow is another day. I think if there’s nothing more I can do, I’ll retire for the night.” He pointed upward. “You’ll visit later? You never did have the chance to enjoy your brandy this evening.”
“Ah, no,” Thomas said with a smile. “I’m not ready for the stairs again, thanks just the same.”
“Well, imagine that,” Riggs said, and laughed. He winked at Alvi. “Good night then, all. Good work, young man.”
“Thank you.” He watched Riggs stride off down the hall and listened to the rhythmic thudding of his boots on the stairs.
“Something bothers you,” Alvi said softly.
“I’m just tired.”
“When Zachary arrived, I could see the veil come down,” Alvi said.
He found it impossible to dissemble with her. “I think that I will send a sample of each of the potions that he bottles for an analysis.”
Alvi nodded but said nothing. Thomas found himself wishing that she was transparent.
“What would you do for the patient then?” she asked quietly.
“I can do nothing from a thousand miles away, other than advising them to visit a competent surgeon. If a cancer has progressed sufficiently, then there’s nothing the surgeon can do, either.”
“And if he is unable to visit this surgeon? What then?”
Thomas shrugged in defeat. “Then he makes his peace,” he said. “He does what he can to bolster his body’s systems.”
“Just so.” Alvi said. “The Universal Tonic does exactly that.”
“But it is promoted as a cure,” Thomas persisted. “It is not a cure. A palliative, perhaps. That’s all.”
“What are you suggesting?” Alvi asked. “That we advertise by saying, ‘Buy our tonic and feel a little better while you wait to die’?”
“It would certainly be more honest,” he replied. “How can he address the myriad questionnaires presenting all manner of afflictions?”
“He doesn’t work alone.”
“Obviously not. But Doctors Tessier and Sorrels are inventions. You’re suggesting that your father has the energy to do so?”
“We had hoped that with your arrival…”
Thomas scoffed. “You expect I should spend my days reading the mail and writing palliative responses to be packaged with worthless snake oil?” His tone was sharper than he would have liked, but Alvi didn’t flinch or respond in kind.
“And the surgery you just performed,” she said gently. “Do you think that the thirty-five dollars we will receive from the Ungers will pay for expansions to the clinic? For the new equipment which you will want to buy? For nursing staff? Even your thousand dollars a month stipend? Or Bertha’s fifty dollars a week? Or the support of the household at one-oh-one?”
“Of course not,” Thomas said. “But—”
“On the other hand, can you imagine how many people we have reached? How many we have helped? How much pain and suffering we have assuaged?”
“I think I can. Upstairs, I see six desks where the ladies work for you. Each is piled high with various correspondence. I looked at only the first.”
“And mine.”
“True.”
She regarded him in silence for a moment, and Thomas could hear the hushed voices from the surgery. Bertha appeared, and nodded at the two of them.
“We’ll move her now,” she said, and vanished into the ward.
Thomas started to turn his chair, but Alvi reached out and rested her hand on his right arm.
“Three thousand, four hundred and sixty-five dollars, Dr. Thomas. And some odd cents,” she whispered, and first clenched his arm for emphasis, then released him. “Think on that.”
“The number means nothing to me,” Thomas said.
“It means that you would have to put the knife to a hundred Louella Ungers to equal it,” Alvi countered.
“This clinic has operated on three patients in the past twenty-four hours,” Thomas said. “And seen a dozen more.”
A faint smile touched her lips. “You are splendid,” she said. “Imagine what you might do when you are on your feet.”
“Just so.”
She nodded and stretched, bracing her hands on her hips and arching her spine. “You need rest,” Alvi said. “Let’s get little Louella settled, and then do the same for you.”
As he wheeled after her toward the surgery, she turned and bent down, blocking his path. Her lips brushing his left ear, her whisper husky.
“By the way. Dr. Thomas, that three thousand five hundred dollars represents one week. The income from only a single, average week. You think on that.” She patted him affectionately on the shoulder.
Chapter Thirty-nine
My, what a brave little girl. Bertha Auerbach reported. Thomas looked up from the desk where, without energy to do anything else at this hour, he had been recording the events of the day in his journal.
“The pain should not be great,” he said, and then had second thoughts. Bertha voiced them first. “Well, perhaps not to you,” the nurse admonished kindly. “But to a child, I suppose it feels as if large hands have been rummaging about in her insides, cutting and stitching and snipping. Most delicate and expert work. Doctor, but painful nevertheless.”
Bemused, Thomas nodded agreement. “She’s resting comfortably?”
“As much as can be expected.”
“The acute pain should last only a few hours—perhaps a day or so at most. Warm pads over the area of the incision will be soothing.” He sat back, realizing with a jolt just how easy it was to slip into the physician’s efficient mode, assuming that pain was something the patient must endure.
“Her mother is with her for the night,” Bertha said.
“Good. You’re going home now?” Thomas stretched back. “You have an escort?”
“As it happens, Constable Eastman is outside. He will see me home safely. And you should go back to one-oh-one for some rest,” she said.
“I’ll be fine, really.” He glanced toward the door and lowered his voice. “It would be convenient if Dr. Riggs would occasionally descend from his aerie. Does he ever? In an emergency, for instance?”
“No.”
“If I had not been here, and if Dr. Haines had been unable to operate on the little girl, what would have happened?”
“She would either survive the carriage ride to St. Mary’s, or she would not,” Bertha replied. “Poultices might have helped.”
“Poultices?” Thomas said incredulously. “I think not. Even in a matter of life or death, Dr. Riggs would not operate?”
“Doctor Thomas,” Bertha Auerbach said, heavily emphasizing the word, “Mr. Riggs is no physician. Certainly he is no surgeon.”
“I wasn’t aware that I had voiced that opinion,” Thomas said.
“You don’t need to. Bandages over your face or not, poker should never be your game.” She raised an eyebrow at him. “I had best not keep Edgar waiting.”
“Thank you for all you’ve done.” Thomas escorted he
r to the front door and, when he opened it, smelled pungent cigar smoke. A huge figure emerged from the shadows.
“All is well?” Constable Eastman asked.
“It is,” Thomas replied. “Thank you.” He watched Eastman offer his left arm and Bertha hooked hers through his, the size differential comical. “Good night, then.”
Back inside, he returned to the office and spent half an hour finishing his journal entry. Finally, with eyes refusing to focus, he laid down the pen and wheeled into the ward. Thomas didn’t feel confident about Howard Deaton. Once bones were shattered out of line, the natural pull of tendons and muscles made matters worse. A fracture box or a plaster cast, no matter how skillfully employed, most often produced cripples. If he was very lucky, Deaton would spend the rest of his life with a cane and an awkward limp.
The man appeared to be asleep, and Thomas passed by.
Behind the screens, Mrs. Unger was seated in a straight chair beside her daughter’s bed. She looked up as Thomas approached.
“She is asleep,” she whispered.
“Good,” Thomas said. He wheeled close to the cot and reached out to touch the child’s forehead. A degree or two, no more. No sign of bleeding marked the small bandage on her belly, and only slight swelling.
“Good,” he said again.
“My husband says that you were nearly killed.”
Thomas glanced across at the woman, noting the black circles under her eyes and the pale cheeks.
“It was not one of my more graceful moments,” he replied. “It is of the utmost importance to keep her quiet and relaxed for the next few days,” he said. “Is she normally a sprightly child? Active by nature?”
“Oh, a dervish,” Mrs. Unger replied with pride.
“Well, the dervish needs to be harnessed for several days to allow the incision time to heal. Tomorrow and the next day, she will be allowed a thin, easy broth only. We have no kitchen facilities yet, so if you would arrange that? When she can sit up with only modest discomfort, she may start with the softest foods, in small quantities, still with a great deal of liquids.” He saw her eyes shift as her gaze strayed past the corner of the divider, focusing toward the front of the ward. At the same time he heard footsteps.
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