But in the night, with no light but from the fire, she couldn't possibly attempt the operation.
It was going to be trickily difficult enough anyway, with light from only one window. That was the reason they were going to use this cabin; it had glass instead of Old Ram's hide covering the window opening. The bank of lights above the operating table in Dr. Cal's o. r., lights arranged so that not even the ghost of a shadow ever touched any segment of the operative area, flitted into her consciousness and out, as quickly as that.
There was no time to yearn for them—nor for the tanks of cyclopropane with Dr. Pfrank's calm efficient hands operating the controls, or for the continuous procaine spinal anesthesia— All she had was chloroform and a crude cone to administer it… she didn't even have an artificial airway—
"Fire's out, Miss Bennett," Andy Stevanic reported from the fireplace behind her. "Every spark?"
With chloroform it would take only one—
He echoed, "Every spark." But he probed the sodden ashes again to make doubly sure.
Sarah took another quick stock of preparations. She wished she had catgut or cargile membrane, but the plain white Number 40 thread, boiled to make it sterile, was going to have to do.
So were the ordinary sewing needles instead of the atraumatic needle that Dr. Cal preferred for delicate work… and there hadn't always been absorbable sutures and eyeless needles, she reminded herself. It didn't help.
Neither did the chill that already was beginning to creep into the cabin.
"Please tell them I'm ready, Andy." He all but bolted from the cabin, and Sarah couldn't blame him. She felt like running too—running, running, running—and she couldn't. Mr. Jefferson looked to her as his lone, slender chance and she knew in her heart that he was right. Only if help came in a few hours, only if a plane could land in this snow and fly him to a hospital—
She closed her mind to the possibility. It was too remote. They didn't even know if Paul and Mr. Norstead had survived that first night in the blizzard, and except for that one high-flying plane—so high that they had seen only its vapor trail—they had seen no sign of air activity.
"Your patient, Doctor." George Jefferson tried for lightness when Al and Mac McDavie carried him in on a saddle of their clasped hands, and failed. He was too feverish, in too much agony.
But the same wellspring of strength, summoned from some private ultima thule, that had helped him to write that To Whom It May Concern, buoyed him now, somehow had kept him from slipping into the fevered stupor into which that 105.8 temperature should have sent him…
Sarah found a smile. "Still want to part with it?"
"Sublata causa, tollitur effectus, Miss Bennett."
"Come again?" Al Malcolm said as they helped him onto the crude operating table.
Sarah translated, "The cause being removed, the effect ceases." Oh, God, I hope it does— "Al—Mr. McDavie—"
"Put me deep, boy," Mr. Jefferson said as Mac McDavie adjusted the cone over his mouth and nose and prepared to release the chloroform fumes from the container.
"Count on it."
"Just breathe deep and easy, Mr. Jefferson," Sarah told him, "and don't fight it. Al's going to paint you with iodine now—"
And then Al and Mrs. Emlyn were going to help her while Mac McDavie stayed with the anesthetic and Andy Stevanic stood by to do whatever needed doing. Jan-Doreen and the baby were comfortable in the other cabin. Jan-Doreen was sitting up now and able to walk about for very brief periods, so for the time the operation would take they needn't worry about her. Sarah had instructed everybody else in what they would—or might—have to do…
Praying that everybody remembered, that she did, she cleaned her hands with their precious isopropyl alcohol, the nearest she could come to making herself surgically clean; and when it was time, when Mr. Jefferson, painted with iodine, his lower body covered with towels, the only surgical drapes they had, was breathing in the deep slowness of full anesthesia, took the sterile knife from Mrs. Emlyn.
Now—
Please, God—as she folded back a towel, exposing the abdominal area.
She made the first incision, not with Dr. Cal's skilled swiftness but carefully, praying that the somewhat curved line would cross the lateral margin of the right rectus muscle at the proper point for a good McBurney.
There was a quick stain of blood and from someone—Andy Stevanic?—came a sharp intake of breath as she moved again, this time to take a fresh knife from Mrs. Emlyn and then to incise the underlying fibers to expose the internal oblique—
"Al," she said and strong, long fingers, painted with iodine to make them as surgically clean as possible, went into action.
The only retractors she could bring into use and please, God, let them be steady—
They were, rock-steady.
As rock-steady as Dr. Cal's rubber-gloved hands which by some miracle of recall were moving as if on some motion-picture screen that was reflected on her retina, guiding her, showing her how— How many times had she seen those hands performing this same operation? Incising that internal oblique band of muscle, separating the transversalis fascia with surgical scissors, as she was doing now?
"Swab, Mrs. Emlyn," she said, and the thin, blue-veined hand was there, deftly moving the sterile gauze and cotton swab to remove the blood that was beginning to block her view…
She was at the peritoneum, the serous membrane that lines the abdominal cavity, and incising it, seeing Al Malcolm's bloody, iodined fingers pull back that incision too—
"That's fine, Al—"
She might have been Dr. Cal himself, an oddly detached portion of her consciousness that seemed to be standing off, observing, told her.
"Now hold it—"
The caecum lay exposed, but where was that inflamed, full-almost-to-bursting bag of poisons?
She explored gently but swiftly.
An appendectomy is one of the shorter operations, but she had neither Dr. Cal's skill nor his speed, and only her own hands to do things like tying off blood vessels—and every vessel tied off had used up valuable time—
"Mr. McDavie?" she prompted her anesthetist for the information she had warned him she would request from time to time.
"He's breathing free and easy, Miss Bennett."
Thank you, God—There it was!
Tucked away behind the caecum— Oh, God, look at it!
If she got that out of there without it bursting—
"Can you give me more room, Al?"
Obediently, his fingers widened the combination of incisions. Only slightly… but enough for her to maneuver the swollen appendix through the wound.
Holding her breath, almost, she tied off the base of the appendix, began carefully to separate it from the mesentery, that fold of membranous tissue that duplicates the peritoneum, ligating each of the blood vessels as she went—without actually thinking it, marveling at the way things were going, at the way Al, Mrs. Emlyn, Mr. McDavie functioned as if they had been in operating rooms all their lives instead of never. . . .
Then she was incising the appendix, saying, "Needle and thread," (which were ready and waiting) as if she were going to sew on a strap, and suturing the opening. This was the hardest part, she thought, managing an interrupted suture with an ordinary needle and then closing the wound, layer by layer… How many times had she heard Dr. Cal proclaim, "Thank God for the gridiron! He hasn't lost any more blood than if he'd cut his finger," although of course the patient had.
But it was a rare appendectomy that required transfusion— The knowledge reassured her, sustained her.
"You can let up on the anesthetic now, Mr. McDavie," she instructed.
"Right," as he lifted the cone from its position covering Mr. Jefferson's mouth and nose.
He dropped the cone to the floor, stoppered the container from which the chloroform fumes had risen steadily, uninterruptedly, stood watching her clean the area around the incision and apply the sterile square of cotton and gauze.
"There's a first time for everything, they say. Damn," Mac said, with obvious relief.
Sarah tried to smile and found she couldn't. She hadn't the strength left, now that it was over.
She, Sarah Bennett, who had been circulating nurse, surgical nurse, "office-dressing," had removed an appendix—
She, shouldn't be terrified now, she told herself. It was over. The appendix was out; Mr. Jefferson was all right; she was weaker than Andrea Stevanic had been in those first minutes outside Jan-Doreen's womb.
"Forty-three minutes," Mac McDavie said into the relieved silence. "I thought it was a week."
She hadn't—she hadn't thought it was anything, Sarah realized.
For her, time had ceased to exist in that infinitesimal span during which she had made that initial incision.
But she was surprised to find that it had been only forty-three minutes. Thirty minutes was the usual time for an appendectomy—and that in a hospital surgical suite, not in an isolated log cabin…
She taped the bandage in place, and straightened, every muscle in her crying out in protest at the rush of weariness that assaulted her.
"Mr. McDavie," she said across their patient, "I agree with you. Damn."
Mac McDavie gave her an understanding grin.
"I wonder if we ought to save it for him?" Al was looking at the appendix as if he couldn't believe his eyes.
As she almost hadn't, Sarah thought.
An appendix like that, distended with pus and fecal matter, should have perforated hours ago.
Only some miracle had kept it from bursting, she thought, and if it had— Mr. Jefferson had been right.
They had been getting along Deo juvante all the time—
"Miss Bennett!"
Mac McDavie's voice was a whip cracking through the tiny, still-smelling-of-chloroform room. "He's stopped breathing!"
Chapter 14
Throughout the operation there had been no indication of any respiratory disturbance, none of the snoring sounds that may be warning of the tongue falling back to block the breathing passage, nor the stridor that Sarah had heard, though infrequently, in the operating room. With Dr. Cal's skilled anesthesiologist managing the anesthesia, ready at the first sign of trouble— The sick realization that she didn't even have a hand bellows resuscitator, let alone oxygen came to her. Pushing the thought aside, she sprang to her patient's side, her fingers seeking the pulse-points beneath his jaws.
Thank God—there was a pulse! Thready, as it would be with breathing interrupted, but—
Swiftly she forced open Mr. Jefferson's jaws, inserted a forefinger—not even wrapped in gauze, Dr. Cal would explode— The thought fled even the periphery of her consciousness. His tongue hadn't fallen back.
Oh, God.
He hadn't known of any cardiac abnormality, but one could have existed, hearts were like that… but wouldn't Dr. Alexander have found some trace of it in his examination? He might not have, she knew. Hearts also were like that.
There was no time to attempt diagnosis, even if she could. George Jefferson was dying.
As surely as if that knife had slipped in her fingers and slashed into some vital organ, and—
Sarah wasn't thinking then, not even of the fear that was cold and hard and desperate in the pit of her stomach.
Thumb and forefinger grasped George Jefferson's cheeks, forcing his mouth open, her own mouth was covering it, she was breathing steadily, strongly, into his mouth and forcing the air from his still lungs. Breathe, force exhalation. Breathe, force exhalation.
Breathe, force exhalation, until her own lungs were bursting from the exertion.
She didn't dare attempt the Holger-Nielsen or the Silvester methods. With that fresh incision the pressure might rupture the suturing, and here—
The toxicity of chloroform sprinted through her mind. Dr. Cal rarely used it—
Breathe in, forcing air deep into the air passages, applying the gentle pressure to expel it. Breathe— "Let me, Sarah."
Al's voice came from beyond the sunlit dazzling mountains, muffled by the incessant thundering that was in her ears.
Exhausted, Sarah stepped aside, and instantly, with scarcely a break in the rhythm, Al took her place. Breathe, carefully force the air out. Breathe— Trembling from the exertion, Sarah found the pulse-points in Mr. Jefferson's throat. Was his pulse stronger? Please, God, let it be—
Oh, God, if he dies—
She wouldn't let herself think about it. She forced herself to breathe deeply, slowly, willing the feeling of exhaustion from her.
The air in here—cold, sharp, fresh air, uncluttered by that remnant of chloroform—
Quick as the thought, she opened the door, felt the stinging slap of the cold air in her own lungs. It wasn't oxygen, but— She knew now how Dr. Cal and the other surgeons felt when they had pulled a patient through an operation only to have something like this happen, some unanticipated condition that electrified the operating room, alerting it for action, as surely as did that first incision with the sharp, curved edge of the scalpel.
She had shared that sense of desperate, frantic helplessness with them, yes—she and all the other operative aides had felt the same twisting lancet that accompanies alarm—but even that had been different.
This had been her hands, her skill, pitted against that terribly swollen, inflamed appendix.
And now—
Her fingertips sought the pulses in his throat again and she heard a note of elation creep into her voice. "They're stronger."
Then it was Mac McDavie, relieving Al, who straightened, red-faced and breathing hard, his eyes meeting hers for one sick moment and then going back to George Jefferson.
Breathe in, then a careful pressure to force exhalation. Breathe in, force the air out. Breathe in—
It was an exhausting routine—and a futile one? She tried not to think that, but the gnawing fear was there, shivering in her consciousness.
Suppose he didn't respond?
It wouldn't matter that technically the operation had been a success.
There would be questions asked, doubts raised that, if she had waited, the appendix might not have perforated—that even if it had—
"Oh, God."
Until Al Malcolm's arm went about her shoulders she had no idea she had spoken aloud, that the anguished whisper she'd heard had come from her own lips. "I'm with you, Sarah. All the way." Al's words were there suddenly in her memory, lending her strength.
So were George Jefferson's: Deo adjuvante.
Only God hadn't—wasn't—
Breathe in… steady gentle pressure, expelling the air. Breathe in—
"I'll take it now, Mr. McDavie."
She was astounded that she could sound so calm, so as if this were the superbly equipped recovery room along the corridor from Dr. Cal's o. r. with every conceivable emergency aid and the surgeon himself standing by, if he were needed, instead of this cabin in the middle of—of Sannikov Island (George Jefferson's reference to their isolation sprang into her mind) with only their own breathing to coax the still lungs into action once more.
Artificial respiration could go on, and discouragingly, for a long time, Sarah knew, and as long as there was even the faintest whisper of a pulse beat— Breathe in… the gentle pressure… breathe in— She had heard surgeons discuss the sometimes sudden and intense constriction of the bronchi.
But wasn't that always when liquid ether had gotten into the lungs?
And would they be able to force-breathe air into Mr. Jefferson's lungs, in that case—even if chloroform produced the same result?
But with the chloroform administered as they had administered it, using the cone to guide the vapors from the container to Mr. Jefferson's mouth and nose, it couldn't have been forced into his lungs. And vaporization wouldn't— Breathe in, forcing the air deep. The cautious but firm pressure that expelled it.
Breathe in, aware that Andy Stevanic, after whom Mrs. Emlyn had scurried, was standing by if they ne
eded him.
Force the air out— Shouldn't there be some sign?
Shouldn't there?
Something besides that faint, struggling pulse?
"Miss Bennett," Andy Stevanic said.
Andy.
Then Al Malcolm, and Mac McDavie.
Oh, God, Sarah thought, watching. His color wasn't ashen, as it would have been in shock.
He just wasn't breathing—
Then it was her turn again and her torment re-treated beyond the desperate need for the rhythmic breathe-in, exhale-by-pressure routine. There had been no detectable change in the pulse beat and, minutes ago, when she had listened to his heart through the stethoscope the sounds had been steady, though weaker than they normally would be.
But the reassurance she should have felt wasn't there.
Unless something happened, and soon—unless it was, indeed, Deo juvante—
Inhaling until her own lungs were straining, she forced the air into George Jefferson's mouth, felt the slow, slight movement of his chest as the breath rustled through air passages. Then he was exhaling—
He was!
Not from the gentle pressure—she hadn't yet begun to apply it—but there was a movement of his chest! The faintest whisper of breath from his lips and an odd little gasping sound, as if he'd just now caught his breath—
"Oh, Al!"
"Steady, honey."
She heard him—and didn't hear him, she tried telling herself, later, when she could. When there was time for treasuring a word… a tone.
Now there wasn't. George Jefferson was breathing again, but raggedly, and if they didn't get him covered, and that door shut—and a fire in here—
They could have a fire now that the volatile chloroform fumes had vanished, and pneumonia could be a worse specter than that dangerously bulging appendix…
The cabin, securely chinked against the wind that some time during the afternoon had come whining down from the mountains, warmed quickly and by the time George Jefferson began to toss and mumble in the uneasy emergence from anesthesia was cozy as an igloo, Mac McDavie said. Sarah smiled, but wearily, at that.
She didn't mind the weariness now, she thought. She was back in her own world, nursing, not catapulted by sheer necessity onto the thin ice that is surgery—sometimes even for a skilled surgeon.
Wings for Nurse Bennett Page 13
