by Eric Flint
"It still hurts to lose a patient, whatever the circumstances. I knew things had been difficult, but I hadn't realized how difficult. I am sorry." Werner could certainly understand what it was to be spread so thin. The university had gotten much smaller with the war. Everyone was taking on a variety of roles. His feelings about the lack of materials from Grantville diminished. In its place was the realization that none of them had gone to Grantville's aide. When Grantville had first appeared, no one had known what was happening or what to think or do about them. Later, he had thought the Grantvillers could handle things themselves and that they were so advanced, he and his colleagues wouldn't have been of any use. Now, he wondered if that had been true. How can they be so cheerful then, so optimistic? The situation there may be worse than I thought. What does that mean for us?
"We don't expect you to be miracle workers. From our view though, the things you can accomplish do seem miraculous. Thank you for explaining. We did not understand why you didn't approach us sooner. Truthfully, we resented it. I understand a bit more now about why you are here and why now. To be frank, the meeting yesterday went far better than I had hoped."
"I'm also pleased by how the meeting went yesterday. We still have a great many details to take care of but I think we can do it. At least as we started getting down to some of the details in the afternoon, we weren't having major disagreements."
"It is, as you Americans say, early days yet. I hope we can work out any problems. Tell me, Frau MacDonald, do you think all your people in Grantville will be as open to working with us and our students?"
Beulah paused a moment before answering. "Most of them will, just as I hope is the case here." Hearing the questioning tone in her voice, he nodded but kept silent. She provided him with what she called "thumbnail sketches" of some of those he would be meeting soon. He would have to remember the phrase. He looked forward to meeting Ray and Stoner to talk about plants, and Balthazar who was from his own time but was being treated as a valued member of the team by the Grantvillers. Werner had a great many questions for Balthazar Abrabanel. The respect in her voice when she spoke of him was obvious. Less obvious were her reservations about Mara. It wasn't anything she said, so much as what she didn't say that piqued his interest. The contrast with the way she spoke of Starr and Garnet was what made her reservations so evident. Werner could appreciate both the gesture of trust she showed by providing the information about her staff and the discretion. When she spoke of Fritz and her hopes that he would be in the first class, Werner fit that in with the rest of what he had seen and heard the last few months. They really do want to make this a partnership.
"I have no doubt you'll want to share some of what we have talked about this morning with your faculty. That's fine. I would also like to arrange time to talk with you privately about some things as my counterpart. There are undoubtedly things that we wouldn't even consider because we aren't originally from this time or issues we should discuss between us before talking with the others. I hope you will share any concerns or problems you see."
"An excellent idea. Since we both enjoy the garden, perhaps we could meet here early each morning to talk."
"I'll look forward to it. And please, call me Beulah."
4
"Everyone ready to go?" Ann looked around the common room of the Black Bear Inn in northern Jena to make sure the others had everything they needed for the Jena tour. Werner and Phillip arrived to be their tour guides as she finished speaking. Willi and Kunz had classes this morning and couldn't come. Since there would be six of them and the streets were rather narrow, that was probably just as well.
"All set here." Mary Pat was carrying what Beulah would have called a visit bag in her public health days. Instead of the brown leather bag Beulah had carried, Mary Pat had turned her WVU book backpack into a mobile emergency kit. The kits had been standardized and accompanied all the teams that left Grantville with a medical type. Other kits had been made up for those without trained medical personnel along given the skills needed to use some of the equipment.
As they stepped into the street, Ann couldn't help but appreciate the lack of odor. Jena's town fathers planned on developing indoor plumbing but right now, emptying chamber pots wherever was still the order of the day. Jena did have one crucial advantage however. At night, the city flushed the streets from a water reservoir so the city was actually much cleaner than most. What having raw sewage flushed downstream did to others was another issue. They were all concerned about what the level of sanitation meant for public health. Now wasn't the time to say anything about that, though, and the Grantville team followed Werner and Phillip through the streets with their colorful red-roofed buildings to the local clinic. They were only a short distance from the clinic when they were hailed.
"Herr Doktor! Ah, und Herr Doktor Ackermann." The rather breathless student looked relieved to see Werner and Phillip but barely glanced at the others. From what Beulah gathered between pants, a young printer had been working, suddenly became short of breath and collapsed. His fellow workers had brought him to the clinic. Werner and Phillip headed for the clinic at a rapid walk. Mary Pat and Beulah exchanged a glance. Someone this short of breath and they weren't running?
* * *
The clinic was on the first floor of a building indistinguishable to Mary Pat from its neighbors. Inside, the clinic was an open area divided into several sections. One section looked like storage, another a procedure area and the third had cots set up. About half the cots had patients in them, including one near the door with the breathless young man. Tall, thin, Caucasian, young male, severe shortness of breath, supraclavicular retractions, touch cyanotic. Don't see any Jugular venous distention or tracheal deviation. Mary Pat could see Beulah making her own assessment as automatically while Werner and Phillip bent over to examine him.
"What happened to him before this started?" Mary Pat asked a nearby man in a printer's apron similar to the young man's.
"Veit just coughed and suddenly there was terrible pain in his chest and he couldn't breathe."
"He hadn't been injured or feeling ill before this?" she asked.
"No." The man turned away to watch the doctors, clearly thinking that Mary Pat was asking questions that were none of her business. It wasn't the first time she had seen that attitude and wouldn't be the last, no doubt. She had seen it during her deployments in Somalia and Yugoslavia but not to the degree she had seen it traveling around 1630s Germany. Right now, she didn't have time to pander to their delicate sensibilities about women and health care.
"Spontaneous pneumothorax?" Beulah's pronouncement caught the attention of Werner and Phillip. Mary Pat was already swinging her backpack around and unzipping it. She nodded and handed Beulah the stethoscope, then reached back into the bag. "I need to listen to see if air is still moving properly in his lungs. Sit him up, please."
No one moved despite the clear command in Beulah's voice. "We will treat him, Frau MacDonald." Phillip's voice held enough dismissive know your place to make Mary Pat flush angrily. She hadn't had too much exposure to that attitude in her previous life. Beulah glanced quickly at her then back to Philip.
"In just a minute, I can tell you if this is what I think it is. I need to use this to listen to his chest. If I'm right, we only have a few minutes to act before he is in very serious trouble."
"You do not consider this serious?" Werner's tone was disbelieving.
"Serious headed for critical and possibly life threatening. If there is nothing you're going to do for him in the next couple of minutes, what have you got to lose by letting us try to help him?" To someone who knew her as well as Mary Pat did, it was obvious it took everything Beulah had not to physically push them out of the way and to keep her voice level. The patient would soon be losing consciousness. There was no time for this. Beulah obviously thought so too.
"Hayes? About a thirty-degree angle. Please take care not to compress his chest."
Hayes didn't waste time with quest
ions. He just moved behind the gasping young man and propped him up. Given his size and the element of surprise, the others moved out of his way quickly. Ann started clearing out the ward to give them more room, moving people out of the way. She knew what a spontaneous pneumothorax was, even if she wasn't a clinician and couldn't treat it. There were still people hovering in the doorway but now there was a good sized circle of empty space around the cot. From the looks on Werner and Phillip's faces, however this turned out with the patient, it wouldn't be good. She took note of the confusion, anger, curiosity and resentment there. She hoped things went well for the patient but the timing probably couldn't have been worse. Hi, we've been here less than twenty-four hours to set up a partnership with you and we shove you aside to treat the first of your patients we see. There didn't seem to be a good resolution from a political standpoint. If they couldn't save the patient after this, it would be even worse. If they did, it was rubbing salt in a very tender wound but at least the patient would be alive.
Beulah looked up at Mary Pat. "Pneumo, big one. Left lung is almost entirely down. Got a flutter valve in there? Lay him back down please Hayes and prop up his feet."
Mary Pat handed her an alcohol-based cleaning agent in a squirt bottle, and gauze. "Yeah, there are only a few left. I'll insert it." Mary Pat went after his shirt with a pair of industrial sized scissors. They were great for cutting through clothes. The young man was losing consciousness now and they were out of time. She wished she had even a few liters of oxygen by cannula to make this a little better.
"Hurry, trachea beginning to shift." While Mary Pat cut the shirt away, Beulah was already wiping the skin under the shirt with the alcohol. Ideally they'd let it dry but this would have to do. Mary Pat had the small package containing the flutter valve and a few other pieces of equipment in hand.
"Wait, what are you doing?" demanded Werner.
"I'll explain later. For now, get out of the light," snapped Beulah.
Mary Pat hooked up the syringe to the end of the one-way valve and pulled the 16 gauge needle cap off the other end. She'd splashed alcohol over her hands. She didn't take time to put on gloves, just hoped she didn't hit a vessel. Second intercostal space, midclavicular line. She'd done this before and her movements were rapid and crisp. No fumbling. The needle slid right in and Mary Pat pushed a little further, feeling for it—ah, got it—and ignoring the gasps and chatter of the onlookers. The one-way flutter valve allowed air and fluid to escape but not to go back into the patient. As the air began to rush out of the pleural space through the valve, it made a honking sound, further startling the onlookers. Werner and Phillip were demanding to know what was going on. There was more to do so she and Beulah ignored them for the time being. Beulah had the suture ready to go and stitched the valve in place while Mary Pat reached for dressings, scissors and tape. They needed to get this secure. The valves were almost gone, since they needed plastic materials to make them. Plastic Grantville couldn't produce anymore. The flutter valves were just a stopgap with a big pneumo anyway. There were a few minutes of onlooker chaos but Ann had them in hand.
"His breathing is easing. Hayes, put this pillow under his feet. His pressure is probably somewhere in the basement." Beulah reached for the stethoscope again, listened. "Breath sounds are improving, respiratory rate a little better, too. Nice work you, guys."
Werner was tightlipped. "Does this mean you will finally explain what you have done to our patient?" Phillip looked too angry to even talk without yelling.
"Given the signs and symptoms we saw and the brief history Mary Pat got, we realized we were probably dealing with a medical emergency called a spontaneous pneumothorax. Young, thin white males are at particular risk for this. What happens is that a part of the lung is weak and bursts. Instead of air going in and out when he breathes, it gets trapped in the pleural lining between the lung and the chest wall. Each breath, more air goes in than comes out. The air builds up in the pleural space and begins pressing on the lung. The lung cannot properly expand anymore. If enough air gets into the space, the lung will start to press on the heart. A sign of that was the tracheal shift I mentioned. The air has to be removed right away so that the lung can reexpand and heal. We used a small piece of equipment called a flutter valve that will help with that." Beulah kept the explanation simple but Mary Pat could tell that some of it still went over their heads.
Beulah glanced back at their patient. His breathing was more regular and he was beginning to pink up nicely. Mary Pat took a turn explaining the procedure and how the valve worked. When she got into chest tubes and X-Rays, Beulah stopped her. It wouldn't do any good to make the local doctors look more ignorant in front of their townfolk. Besides, she though uneasily, I don't think they're getting this. Is it that they are too angry to think or something else?
Mary Pat frowned and turned to Beulah. "He needs a chest tube. You can't just drop a lung like that and expect a flutter valve to fix it. An X-Ray will tell us how bad it is."
"Agreed. We may not be able to hook him up to wall suction but at least in Grantville, they can put in a chest tube and hook him up to a waterseal system."
* * *
Phillip had had enough of them using words that he couldn't understand. Even if they were speaking German for most of it. There was nothing he or Werner could have done for the man but watch him die. They didn't even know what had happened to him. These women had known at a glance. Phillip didn't even understand what had happened in just a few minutes. The two women had done something in front of their students and townfolk that seemed incredible. The speed and skill with which they had acted was impressive. More confused than he had ever been in his entire life, he turned around and walked out, not waiting to see what those women, who weren't even doctors, would do next.
5
"I had thought you would be getting some sleep but Leutnant Flanagan said you had come here".
Werner's voice brought Beulah out of her thoughts. The stone bench she had been waiting on was not exactly comfortable but at least it had a nice view of the garden. She noted the change from Fraulein to Leutnant when he referred to Mary Pat with a sinking heart. "We had agreed to meet here in the mornings. Did our patient get off to Grantville all right?"
"Our patient? Interesting choice of words, but yes, Veit and Leutnant Flanagan just left. I would have thought you would be getting some sleep."
"It will take them most of the day to get to Grantville. They'll have to go slowly, even with the new suspension on the coach." She smiled softly. "As for sleep, talking with you is far more important. It's been a while since I've sat up all night with a patient. Not that I could have done much else for him if anything had gone wrong. The supplies and equipment are in Grantville. So are the people who can fix it if the lung doesn't reexpand. As for Veit being our joint patient, yes, he is." The testiness she heard in her own voice was enough to make Beulah wince. Every joint she had hurt and she had to face the fact that what had started so promisingly in Jena was rapidly falling apart. Add that to her fears about their patient's outcome and a sleepless night, and she wasn't at her most tactful. That was still no excuse for taking her feelings out of Werner.
"Look, I'm sorry. I shouldn't have snapped at you, now or yesterday. Not exactly professional behavior on my part. Let's be clear on a few things here. I'm not sorry that a man who would have died is still breathing. I am sorry for the way things happened. There were two choices, treat him or stay silent. I knew you didn't have the resources we did to treat him. If I had stayed silent, he could have very well died. How would you be feeling about this if I had and later, you found out we could have treated him but didn't for the sake of political expediency? What else could I have done?"
* * *
Werner was quiet a moment, weighing what she said. His innate fairness was warring with his anger and humiliation. How much of the humiliation he felt was because Veit had been saved by two women who weren't even physicians? What would he have done in her place? Given th
e stakes, would he have held one life as highly as she clearly did? What else could she have done, indeed? He spent a few minutes trying to get his thoughts together, to say what he had to say without making things worse.
"I can understand why you did what you did and I am very glad Veit did not die. That doesn't change the facts. You brushed us aside to treat one of our people. As though we were nothing, knew nothing. We are not used to being treated in such a fashion, especially by women. Don't you understand? That you were right, that we could do nothing while you could save him just makes it harder for us to bear. Phillip and I have spent our entire lives caring for our patients, studying, teaching and trying to give the best care we could. You gave us a graphic demonstration of how little we know, how limited is our skill. And you did it in front of our students and townfolk. I know things happened quickly, but what happened couldn't have been more poorly timed or more painful to us. How can we have any confidence that we have anything to offer you? That we aren't nothing next to you?"
"Please, Werner, sit down with me."
While he sat stiffly at the opposite end of the bench, it was her turn to struggle to find words. "If any of us thought you were nothing or that you had nothing to offer, we wouldn't be here. What you have to offer hasn't changed since our first meeting. The last thing any of us wanted is to make you feel that way. I've thought about it all night but I don't know what to do to try to make this better."
