It was perfectly normal for babies to lose a little weight at first, I told myself. It was.
A patent ductus arteriosus may have no symptoms, beyond that odd, continuous murmur. But it may. A bad one deprives the child of needed oxygen; the main symptoms are pulmonary—wheezing; rapid, shallow breathing; bad color—and failure to thrive, because of the energy burned up in the effort to get enough oxygen.
“Just let Grannie have a little listen again,” I said, laying her down on the quilt I’d spread over the surgery table. She gurgled and kicked as I picked up the Pinard and placed it on her chest again, moving it over neck, shoulder, arm …
“Oh, Jesus,” I whispered, closing my eyes. “Don’t let it be bad.” But the sound of the murmur seemed to grow louder, drowning my prayers.
I opened my eyes to see Brianna, standing in the doorway.
“I knew there was something wrong,” she said steadily, wiping Mandy’s bottom with a damp rag before rediapering her. “She doesn’t nurse like Jemmy did. She acts hungry, but she’ll only nurse for a few minutes before she falls asleep. Then she wakes up and fusses again a few minutes later.”
She sat down and offered Mandy a breast, as though in illustration of the difficulty. Sure enough, the baby latched on with every evidence of starvation. As she nursed, I picked up one of the tiny fists, unfolding her fingers. The minute nails were faintly tinged with blue.
“So,” Brianna said calmly, “what happens now?”
“I don’t know.” This was the usual answer in most cases, truth be told—but it was always unsatisfactory, and clearly not less so now. “Sometimes there are no symptoms, or only very minor ones,” I said, trying for amendment. “If the opening is very large, and you have pulmonary symptoms—and we have—then … she might be all right, only not thriving—not growing properly, because of the feeding difficulties. Or”—I took a deep breath, steeling myself—“she could develop heart failure. Or pulmonary hypertension—that’s a very high blood pressure in the lungs—”
“I know what it is,” Bree said, her voice tight. “Or?”
“Or infective endocarditis. Or—not.”
“Will she die?” she asked bluntly, looking up at me. Her jaw was set, but I saw the way she held Amanda closer, waiting for an answer. I could give her nothing but the truth.
“Probably.” The word hung in the air between us, hideous.
“I can’t say for sure, but—”
“Probably,” Brianna echoed, and I nodded, turning away, unable to look at her face. Without such modern assistances as an echocardiogram, I of course couldn’t judge the extent of the problem. But I had not only the evidence of my eyes and ears, but what I had felt passing from her skin to mine—that sense of not-rightness, that eerie conviction that comes now and then.
“Can you fix it?” I heard the tremor in Brianna’s voice, and went at once to put my arms around her. Her head was bent over Amanda, and I saw the tears fall, one, then another, darkening the wispy curls on top of the baby’s head.
“No,” I whispered, holding them both. Despair washed over me, but I tightened my hold, as though I could keep time and blood both at bay. “No, I can’t.”
“Well, there’s no choice, is there?” Roger felt preternaturally calm, recognizing it as the artificial calm produced by shock but wishing to cling to it as long as possible. “You’ve got to go.”
Brianna leveled a look at him, but didn’t reply. Her hand roamed over the baby, sleeping in her lap, smoothing the woolly blanket over and over again.
Claire had explained it all to him, more than once, patiently, seeing that he could not take it in. He still did not believe it—but the sight of those tiny fingernails, turning blue as Amanda strove to suck, had sunk into him like an owl’s talons.
It was, she had said, a simple operation—in a modern operating room.
“You can’t …?” he’d asked, with a vague motion toward her surgery. “With the ether?”
She’d closed her eyes and shaken her head, looking nearly as ill as he felt.
“No. I can do very simple things—hernias, appendixes, tonsils—and even those are a risk. But something so invasive, on such a tiny body … no,” she repeated, and he saw resignation in her face when she met his eyes. “No. If she’s to live—you have to take her back.”
And so they had begun to discuss the unthinkable. Because there were choices—and decisions to be made. But the unalterable basic fact was clear. Amanda must go through the stones—if she could.
Jamie Fraser took his father’s ruby ring, and held it over the face of his granddaughter. Amanda’s eyes fixed on it at once, and she stuck out her tongue with interest. He smiled, despite the heaviness of his heart, and lowered the ring for her to grab at.
“She likes that well enough,” he said, skillfully removing it from her grip before she could get it into her mouth. “Let’s try the other.”
The other was Claire’s amulet—the tiny, battered leather pouch given to her by an Indian wisewoman years before. It contained assorted bits and bobs, herbs, he thought, and feathers, perhaps the tiny bones of a bat. But in among them was a lump of stone—nothing much to look at, but a true gemstone, a raw sapphire.
Amanda turned her head at once, more interested in the pouch than she had been in the shiny ring. She made cooing noises and batted wildly with both hands, trying to reach it.
Brianna took a deep, half-strangled breath.
“Maybe,” she said, in the voice of one who fears as much as hopes. “But we can’t tell for sure. What if I—take her, and I go through, but she can’t?”
They all looked at one another in silence, envisioning the possibility.
“You’d come back,” Roger said gruffly, and put a hand on Bree’s shoulder. “You’d come right back.”
The tension in her body eased a little at his touch. “I’d try,” she said, and attempted a smile.
Jamie cleared his throat.
“Is wee Jem about?”
Of course he was; he never went far from home or Brianna these days, seeming to sense that something was wrong. He was retrieved from Jamie’s study, where he had been spelling out words in—
“Jesus Christ on a piece of toast!” his grandmother blurted, snatching the book from him. “Jamie! How could you?”
Jamie felt a deep blush rise over him. How could he, indeed? He’d taken the battered copy of Fanny Hill in trade, part of a parcel of used books bought from a tinker. He hadn’t looked at the books before buying them, and when he did come to look them over … Well, it was quite against his instincts to throw away a book—any book.
“What’s P-H-A-L-L-U-S?” Jemmy was asking his father.
“Another word for prick,” Roger said briefly. “Don’t bloody use it. Listen—can ye hear anything, when ye listen to that stone?” He indicated Jamie’s ring lying on the table. Jem’s face lighted at sight of it.
“Sure,” he said.
“What, from there?” Brianna said, incredulous. Jem looked around the circle of parents and grandparents, surprised at their interest. “Sure,” he repeated. “It sings.”
“Do ye think wee Mandy can hear it sing, too?” Jamie asked carefully. His heart was beating heavily, afraid to know, either way.
Jemmy picked up the ring and leaned over Mandy’s basket, holding it directly over her face. She kicked energetically and made noises—but whether because of the ring, or merely at the sight of her brother …
“She can hear it,” Jem said, smiling into his sister’s face.
“How do you know?” Claire asked, curious. Jem looked up at her, surprised.
“She says so.”
Nothing was settled. At the same time, everything was settled. I was in no doubt as to what my ears and my fingers told me—Amanda’s condition was slowly worsening. Very slowly—it might take a year, two years, before serious damage began to show—but it was coming.
Jem might be right; he might not be. But we had to proceed on the assumption t
hat he was.
There were arguments, discussions—tears. Not yet any decision as to who should attempt the journey through the stones. Brianna and Amanda must go; that was certain. But ought Roger to go with them? Or Jemmy?
“I will not let you go without me,” Roger said through his teeth.
“I don’t want to go without you!” Bree cried, looking exasperated. “But how can we leave Jemmy here, without us? And how can we make him go? A baby—we think that can work, because of the legends, but Jem—how will he make it? We can’t let him risk being killed!”
I looked at the stones on the table—Jamie’s ring, my pouch with the sapphire.
“I think,” I said carefully, “that we need to find two more stones. Just in case.”
And so, in late June, we came down from the mountain, into turmoil.
PART TWELVE
Time Will Not Be
Ours Forever
115
NOSEPICKER
July 4, 1776
It was close and hot in the Inn room, but I couldn’t go out; little Amanda had finally fussed herself to sleep—she had a rash on her bottom, poor thing—and was curled in her basket, tiny thumb in her mouth and a frown on her face.
I unfolded the gauze mosquito netting and draped it carefully over the basket, then opened the window. The air outside was hot, too, but fresh, and moving. I pulled off my cap—without it, Mandy was fond of clutching my hair in both her hands and yanking; she had an amazing amount of strength, for a child with a heart defect. For the millionth time, I wondered whether I could have been wrong.
But I wasn’t. She was asleep now, with the delicate rose bloom of a healthy baby on her cheeks; awake and kicking, that soft flush faded, and an equally beautiful but unearthly blue tinge showed now and then in her lips, in the beds of her tiny nails. She was still lively—but tiny. Bree and Roger were both large people; Jemmy had put on weight like a small hippopotamus through his first several years of life. Mandy weighed scarcely more than she had at birth.
No, I wasn’t wrong. I moved her basket to the table, where the warm breeze could play over her, and sat down beside it, laying my fingers gently on her chest.
I could feel it. Just as I had in the beginning, but stronger now that I knew what it was. If I had had a proper operating suite, the blood transfusions, the calibrated and carefully administered anesthesia, the oxygen mask, the swift, trained nurses … No surgery on the heart is a minor thing, and surgery on an infant is always a great risk—but I could have done it. Could feel in the tips of my fingers exactly what needed to be done, could see in the back of my eyes the heart, smaller than my fist, the slippery, pumping, rubbery muscle and the blood washing through the ductus arteriosus, a small vessel, no bigger than an eighth of an inch in circumference. A small nick in the axillary vessel, a quick ligation of the ductus itself with a number-8 silk ligature. Done.
I knew. But knowledge is not, alas, always power. Nor is desire. It wouldn’t be me who would save this precious granddaughter.
Would anyone? I wondered, giving way momentarily to the dark thoughts I fought to keep at bay when anyone else was near. Jemmy might not be right. Any baby might grab at a brightly colored shiny thing like a ruby ring—but then I remembered her cooing, batting at my decrepit leather amulet pouch with the raw sapphire inside.
Perhaps. I didn’t want to think about the dangers of the passage—or the certainty of permanent separation, no matter whether the journey through the stones was successful or not.
There were noises outside; I looked toward the harbor, and saw the masts of a large ship, far out to sea. Another, still farther out. My heart skipped a beat.
They were oceangoing ships, not the little packet boats and fishing smacks that sailed up and down the coast. Could they be part of the fleet, sent in answer to Governor Martin’s plea for help to suppress, subdue, and reclaim the colony? The first ship of that fleet had arrived at Cape Fear in late April—but the troops it carried had been lying low, waiting for the rest.
I watched for some time, but the ships didn’t come in closer. Perhaps they were hanging off, waiting for the rest of the fleet? Perhaps they weren’t British ships at all, but Americans, escaping the British blockade of New England by sailing south.
I was distracted from my thoughts by the clumping of male feet on the stairs, accompanied by snorts and that peculiarly Scottish sort of giggling usually depicted in print—but by no means adequately—as “Heuch, heuch, heuch!”
It was clearly Jamie and Ian, though I couldn’t understand what was giving rise to so much hilarity, since when last seen they had been bound for the docks, charged with dispatching a shipment of tobacco leaves, obtaining pepper, salt, sugar, cinnamon—if findable—and pins—somewhat rarer than cinnamon—for Mrs. Bug, and procuring a large fish of some edible sort for our supper.
They’d got the fish, at least: a large king mackerel. Jamie was carrying it by the tail, whatever it had been wrapped in having evidently been lost in some accident. His queue had come undone, so that long red strands frayed out over the shoulder of his coat, which in turn had a sleeve half wrenched off, a fold of white shirt protruding through the torn seam. He was covered with dust, as was the fish, and while the latter’s eyes both bulged accusingly, one of his own was swollen nearly shut.
“Oh, God,” I said, burying my face in one hand. I looked up at him through splayed fingers. “Don’t tell me. Neil Forbes?”
“Ach, no,” he said, dropping the fish with a splat on the table in front of me. “A wee difference of opinion wi’ the Wilmington Chowder and Marching Society.”
“A difference of opinion,” I repeated.
“Aye, they thought they’d throw us in the harbor, and we thought they wouldn’t.” He slung a chair round with his boot and sat down on it backward, arms crossed on its back. He looked indecently cheerful, face flushed with sun and laughter.
“I don’t want to know,” I said, though of course I did. I glanced at Ian, who was still sniggering quietly to himself, and observed that while he was slightly less battered than Jamie, he had one forefinger lodged in his nose up to the knuckle.
“Have you got a bloody nose, Ian?”
He shook his head, still giggling. “No, Auntie. Some o’ the Society do, though.”
“Well, why have you got your finger up your nose, then? Have you picked up a tick or something?”
“No, he’s keepin’ his brains from falling out,” Jamie said, and went off into another fit. I glanced at the basket, but Mandy slept peacefully on, quite used to racket.
“Well, maybe you’d best stick both your own fingers up your nose, then,” I suggested. “Keep you out of trouble for a moment or two, at least.” I tilted up Jamie’s chin to get a better look at the eye. “You hit someone with that fish, didn’t you?”
The giggling had died down to a subterranean vibration between them, but threatened at this to break out anew.
“Gilbert Butler,” Jamie said with a masterful effort at self-control. “Smack across the face. Sent him straight across the quay and into the water.”
Ian’s shoulders shook with remembered ecstasy.
“Bride, what a splash! Oh, it was a braw fight, Auntie! I thought I’d broke my hand on a fellow’s jaw, but it’s all right now the deadness has worn off. Just a bit numb and tingly.” He wiggled the free fingers of his hand at me in illustration, wincing only slightly as he did so.
“Do take your finger out of your nose, Ian,” I said, anxiety over their condition fading into annoyance at how they’d got that way. “You look like a half-wit.”
For some reason, they both found that hysterically funny and laughed like loons. Ian did, however, eventually withdraw the finger, with an expression of wary cautiousness, as though he truly expected his brains to follow in its wake. Nothing did emerge, though, not even the ordinary bits of unsavory excreta one might expect from such a maneuver.
Ian looked puzzled, then mildly alarmed. He sniffed, prodding exper
imentally at his nose, then stuck the finger back into his nostril, rooting vigorously.
Jamie went on grinning, but his amusement began to fade as Ian’s explorations became more frantic.
“What? Ye’ve not lost it, have ye, lad?”
Ian shook his head, frowning.
“Nay, I feel it. It’s …” He stopped, giving Jamie a panic-stricken look over the embedded finger. “It’s stuck, Uncle Jamie! I canna get it out!”
Jamie was on his feet at once. He pulled the finger from its resting-place with a moist, sucking noise, then tilted back Ian’s head, peering urgently up his nose with his one good eye.
“Bring a light, Sassenach, will ye?”
There was a candlestick on the table, but I knew from experience that the only likely effect of using a candle to look up someone’s nose was to set their nose hairs on fire. Instead, I bent and pulled my medical kit out from under the settle where I had stowed it.
“I’ll get it,” I said, with the confidence of one who has removed everything from cherry pits to live insects from the nasal cavities of small children. I drew out my longest pair of thin forceps, and clicked the slender blades together in token of assurance. “Whatever it is. Just keep quite still, Ian.”
The whites of Ian’s eyes showed briefly in alarm as he looked at the shining metal of the forceps, and he looked pleadingly at Jamie.
“Wait. I’ve a better idea.” Jamie laid a quelling hand on my arm for an instant, then disappeared out the door. He thundered downstairs, and I heard a sudden burst of laughter from below, as the door to the taproom opened. The sound was as suddenly cut off as the door closed, like the valve on a faucet.
“Are you all right, Ian?” There was a smear of red on his upper lip; his nose was beginning to bleed, aggravated by his jabbings and pokings.
“Well, I do hope so, Auntie.” His original jubilation was beginning to be replaced by a certain expression of worry. “Ye dinna think I can have pushed it into my brain, do ye?”
The Outlander Series 7-Book Bundle Page 742
