The man closed a lid over his papers, muscles bunching in his jaw as if he weren’t happy. When he spoke, he sounded grim, “She’s my daughter.”
“Well,” Vail said cheerfully, extending his hand to shake. “Good news. I’m Baron Vail and I’m considering taking her as a wife.”
The man looked at but didn’t take Vail’s hand. He said, “That’d be up to her… I don’t think she’d be happy about the idea.”
Vail frowned, “I thought you said she was your daughter?”
The man nodded.
“And you don’t make such decisions for her?”
He slowly shook his head, but said nothing.
“Well then, where is she?” Vail said, feeling exasperated. “I’ll talk to her myself.”
Saying nothing, the man reached back over his shoulder and scratched his shoulder blade a moment. Vail couldn’t interpret the look on the man’s face, but thought he might actually refuse. Abruptly the man turned, “I’ll see if she’s here.”
Vail watched him walk over to the door that Vail thought led to the kitchen. At least, that’s where the amazing ‘pizza’ had come from the last time Vail had been there. A moment later, the man came out, walked back across the room, and went up the stairs that led to the healers’ rooms.
He didn’t even glance at the baron as he crossed the room.
~~~
When Daum opened the room to the clinic, Eva, Vyrda, and Daussie looked up from their studies and copying. He looked thunderous. “What’s the matter?” Eva asked.
“That pissant of a baron’s downstairs. Where’s Kazy?”
Eva glanced at Daussie who looked alarmed. Daussie said, “He wants Kazy?!”
Daum shook his head, “He wants you. I want Kazy so she can tell me what his intentions are.”
Daussie paled further, “Kazy went out with Nylin and Grace. I’m not sure where they went.” She glanced at Eva, “Maybe Mom can get a read on him?”
Eva winced, “To read people at all I have to get within a half meter. They think I’m acting weird. I can go down and try, but I’ll probably only be able to get a vague sense of his general attitude.”
Daussie turned to Daum, “What’d you tell him?”
“That I didn’t know where you were. That I’d go see if you were here.” He turned toward the door, “I’ll tell him you’re gone.”
Daussie shook her head, “He’d just come back. What’d he say he wanted?”
Looking dyspeptic, Daum said, “That he was ‘considering taking you as his wife.’” Daum shook his head disgustedly, “I’ve heard he has several.”
Daussie stood reluctantly, “I’ll tell him I’m not interested.”
Daum said slowly, “I get the impression people don’t say no to him very often.”
“Well, I’m not marrying him.” She looked at her mother, “Maybe another sneezing fit might convince him he’s allergic to me?”
Eva spoke as calmly as she could, “Just try saying no first, okay? Politely. Politeness goes a lot farther than you might think.”
Daussie started toward the door.
Eva said, “Wait. Let Dad and I go first. Maybe I can get close enough to read him a little. You stay a long way away from him.”
~~~
Daussie waited until her parents had time to descend the stairs and walk out into the room. When she got down, she stopped on the little landing at the bottom of the stairs. Eva had stopped a couple of meters from the baron and seemed to be speaking, but it was barely audible. The baron leaned closer to her saying, “What?”
Eva stepped closer to him and apparently repeated herself. The man leaned a little closer yet.
Daussie was just about to admire her mother’s strategy for getting close to the man when he abruptly looked up and saw Daussie.
Ignoring Eva, he stepped around her, saying, “There she is!” He approached Daussie and said, “Your father tells me that I don’t need his permission to ask your hand in marriage so I’m coming directly to you.”
Daussie saw the frustrated look on her mother’s face as she turned. Eva hunched her shoulders a little, then started slowly moving up behind the baron. I need to give her a few moments to get closer, Daussie thought. She turned her eyes to the baron and raised her eyebrows inquisitively.
The baron lifted an eyebrow, “So what do you think? D’you fancy being a baron’s wife?”
Daussie couldn’t think how to respond. After a moment, she said, “Um, I hear you have several wives?”
“Only four at present. One died recently.” He actually said this as if her death were a good thing.
The end of an impediment. Daussie thought. Something that’d made room for another wife.
Eva casually edged up behind the baron.
“I’d… I’d like to be my husband’s only wife,” Daussie ventured.
The baron laughed as if she’d said something funny. “Far better to be a Baron’s fifth wife than some peasant’s only wife, eh?”
Daussie shook her head, “Besides, I’m too young to be married. No…” Then she remembered Eva’d told her to be polite. Though it felt difficult, Daussie said, “No, thank you.” She started to turn toward the stairs.
“Too young?! Don’t be ridiculous!” The baron turned to one of his guardsmen while waving at Daussie, “You can tell by the look of her that she’s ready to be bred, can’t you?”
Daussie bolted up the stairs.
Behind her, she heard the baron say, presumably to her father, “For God sakes man, talk some sense into her!”
Daum’s voice sounded strange as he said, “I said it was her decision, and it is.”
~~~
About ten minutes later, Eva came into Daussie’s bedroom, sitting beside her and putting an arm around her trembling shoulders. “He’s gone.”
“How did he take it?”
“Very badly.”
Daussie produced a disconsolate little moan.
***
Vyrda woke to an insistent pounding on her door. Rolling out of bed, she made her way into her office, sending out her ghirit to get an idea who was out there. A horse and four people, she thought, one lying in the cart behind the horse. Most likely someone bringing a very sick patient, not someone here to rob me.
Vyrda opened the door. “What happened?” she asked as she stepped past the man and boy at the door and strode to the cart. The person lying listlessly in the cart was a woman, as was the person crouching over her.
The man spoke, “She got a headache. Said it came on sudden, like someone struck her with a wooden baulk. Uh, we thought it’d get better, but it didn’t. She started throwing up. Then she got sleepy… So we brought her to you.”
The woman crouching in the cart—older, probably the mother—said, “I said we should come sooner! I think we waited too long!”
Sounding frustrated, the man snapped, “You said that about three minutes before we left.”
The boy said, “She’ll be all right, won’t she?”
Her ghirit deep in the woman’s head, Vyrda barked, “Quiet! Give me a moment to see what’s going on here!” She concentrated, The fluid around the brain, it’s different… Oh! she realized. It feels more like blood. More like blood beneath the brain than around it. She’s bleeding under there somewhere… Vyrda suddenly realized that one of the arteries that made a circle beneath the brain—the circle of Willis—had a bulge coming out of it. Vyrda rocked back, It’s an aneurysm! she realized. Something Vyrda’d read about in one of Eva’s books, but not given a lot of thought to. Brain aneurysms seemed like such a calamitous disaster she’d dismissed them as one of those things that’d be impossible to treat and moved on.
Grimly, Vyrda started climbing into the wagon, “Take us to the Hyllis Tavern! It’s her only chance.”
As if startled, the three people stood motionless. The older woman said, “But—”
“You can just take her straight to the cemetery if you want.” Vyrda interrupted, “But, if you want he
r to live, you’ll get moving! Now!”
The man practically flew into the driver’s seat, jolting the horse into motion. The boy had to run behind the cart a few steps before he managed to climb in.
As they traveled, Vyrda learned her assumptions were correct. The woman was thirty and had been healthy until this evening. The other three were her husband, mother, and son.
“What is it?” the boy asked fearfully.
“She’s bleeding…” Vyrda said, wondering how much to explain. She settled for, “… bleeding in her head.”
Sounding badly frightened, the boy asked, “Will she bleed to death?”
“It’s not how much she’s bleeding that’s the problem,” Vyrda said grimly, wanting to follow Eva’s dictates to speak truth, but not sure how much they could understand. “The, uh, blood makes… her brain sick.”
“Brain?” the boy asked, uncertainly.
“It’s the organ you think with,” Vyrda said, trying not to be too short with the child. “Now, be quiet so I can think.”
“But—” the boy began, then cut off abruptly.
Vyrda assumed he’d been interrupted by his grandmother. As she’d wanted, she turned her whirling thoughts to the aneurysm, a distended little sphere of thin-walled vessel protruding from the artery. It was shaped like a blueberry. “Berry aneurysm,” she suddenly remembered from her reading. She couldn’t remember reading about their treatment, but it was hard to imagine what you could do for a ballooning area of weakened tissue. Could Tarc tie a ligature around the base of it? she wondered. She put her head right down next to the woman’s skull and sent her ghirit in for the better kind of picture they got when the distance was close.
The wall of the aneurysm seemed thin near the base of the berry, right where a ligature would need to be tied. Vyrda immediately pictured the thin tissue rupturing as the sutures sawed tight around it. Rupturing, then bleeding so rapidly that the woman might indeed bleed to death, Except, there isn’t enough room in the skull for that much blood. The pressure on her brain from the hematoma would kill her long before the blood loss did.
She shook her head. I guess we’ll have to try it, she thought. We can’t leave her like this.
Vyrda wondered what they’d do if the aneurysm did rupture and start bleeding. Tarc could hold back the bleeding for a while, and I guess I could do it for a few seconds at a time, but that won’t solve the problem, just put it off.
Vyrda thought about how Tarc had put sutures in front of and behind the bleeding area in the woman’s stomach. But interfering with the blood supply to the stomach seemed to be well tolerated. Vyrda wasn’t absolutely sure why, but she thought interfering with the blood supply to a part of the brain could be a disaster in some way that interfering with blood supply to other parts of the body wasn’t. Probably due to differences in the collateral circulation, Vyrda thought, thinking of the term for tissues that had blood vessels coming in from multiple directions. Vessels that took over for each other if one was lost.
Wait, she thought, the circle of Willis—where the arteries beneath the brain made a sort of circle fed from several locations—seems like a form of collateral circulation. Perhaps Tarc could tie off the artery on either side of the aneurysm, counting on flow through the rest of the circle to keep the brain alive?
Vyrda looked up. They were arriving at the tavern. Shouting, “Carry her in,” Vyrda jumped out of the cart and ran up the stairs to pound on the door to the tavern.
The family had her most of the way up the stairs when Tarc opened the door. Vyrda thought it odd that he was scratching his back, then she remembered he kept his knives back there. He stepped out and went to help the man carry his wife in.
Eva, Daussie, and Kazy were just coming out of the bottom of the stairs. Vyrda spoke loudly so everyone would hear, trusting that the family wouldn’t really understand. “She has a leaking berry aneurysm at the front of her circle of Willis. There’s blood in the fluid around her brain. Her symptoms started with a sudden headache, progressed to vomiting, then drowsiness.”
Eva said, “Don’t bother trying to get her upstairs.” She waved, “Lay her out on the table here.” She looked around and saw her husband, “Daum, light some of the lanterns so we can see.” She turned to Daussie, “Do you remember where the collagen is? The stuff Mr. Geller brought us?”
Daussie turned and ran for the stairs.
Eva crouched over the woman, as did Tarc and Kazy. Vyrda didn’t want to interrupt their examination, but she didn’t want time wasted either. Collagen was supposed to help stop bleeding, but it wouldn’t strengthen the thin walls of that aneurysm. “Should I tell Daussie to bring some suture packets too?”
Eva didn’t look up, “Yes, good idea. That’ll be our bailout.”
Vyrda ran for the stairs wondering what plan A was going to be.
By the time Vyrda and Daussie got back downstairs, Daum had all the lanterns burning to light the room brightly. He was ushering the family off to one side and having them sit down at one of the tables. Vyrda heard him say, “Two chamomile teas and a beer, coming right up.” He headed for the bar.
Nylin suddenly appeared next to him, saying, “I’ll brew the tea if you’ll get the beer.”
Vyrda stepped over to the family and spoke quickly, “If anyone can save her, Eva Hyllis can. But she’ll be too busy to answer any questions for a while. Give us some time, okay?”
Looking completely adrift, the husband and mother nodded. The boy said, “But…?”
His father quelled him with a look so Vyrda turned back to the table. Leaning in close, she whispered, “What’s the plan?”
Eva said, “Send in your ghirit and see. Daussie’s ported some collagen into the aneurysm. Tarc’s making sure it doesn’t escape back into the artery. He’ll hold it there until it clots. Once that happens she should be fairly safe.”
Astonished, Vyrda said, “How in the world did you think of that?”
Eva said, “The ancients treated these by opening up the skull and putting little clips across the base of the aneurysm. Or—”
“They didn’t ligate them?”
Eva shook her head, “Maybe they did at one point, but I’ve never seen anything about that. If you think about it, there isn’t much room to work beneath the brain. I suspect they’d have had difficulty tying a suture under there. Besides, the walls of this one are so thin I think the suture might cut through them.”
Vyrda said, “I was afraid of that too. I thought we’d have to tie off the artery on either side of the aneurysm. Trust the circle of Willis to act as collateral circulation.”
Surprising Vyrda, Tarc said, “Collateral?”
Eva patiently explained how collaterals were another path for blood to flow to an area.
Vyrda knew Tarc hadn’t been reading and studying as much as Daussie and Kazy, but she’d thought perhaps it was because he was already far ahead. I guess not. He’s probably just not as driven as the girls are. Vyrda wondered why Eva didn’t nag him to study more, then decided it probably wouldn’t work anyway—from what Vyrda knew of teenagers. Someday he may decide he wants to study, and if he does—as smart as he is—he’ll probably leave us all in the dust.
Eva’d continued explaining the ancients’ treatments. Apparently, later they’d started threading little tubes up through the arteries from the hip. They’d send the tip of the tube into the aneurysm. Then they’d insert little coils that clotted off the aneurysms. At the time of the worldwide epidemic that destroyed the ancients’ civilization, they’d still been debating whether open surgery with clips or clotting with coils was the best treatment. “But,” Eva said, “we don’t have any clips. If we did, they might be the safest for us because we wouldn’t have to open the skull and move the brain to put them in. Since we don’t, I think clotting the aneurysm with some collagen’s the safest.”
“Are you sure the collagen’s going to cause clotting?”
Eva nodded, “Daussie’s ported some collagen into blood s
amples up in the clinic. They clotted very quickly. My main worry’s that the collagen will cause a clot that extends out into the circle of Willis. Clotting the whole thing would be a huge disaster.”
“Oh!” Vyrda said, horrified, realizing such a clot would cause a massive stroke and rapid death.
Daussie patted Vyrda’s hand where she was using it to brace against the table while she bent over the young woman. Quietly, she said, “That’s why my ghirit’s still in there. If the clot starts to extend, I’ll port everything out of there. Collagen, clot, and some of the nearby blood. Then we’ll have to try your idea of trying off the artery on either side of the aneurysm.”
Vyrda focused her ghirit. “I think… The blood’s clotting, isn’t it?”
Eva nodded, “And the clot’s getting pretty firm without extending. I think this’s going to work.” She lifted her eyes to Vyrda, “I’d like Daussie to wash some of that blood out of the patient’s CSF. Can you get a jar of saline?”
“CSF?”
“Cerebrospinal fluid. The fluid around the brain.”
“I’m on it,” Vyrda said, heading for the stairs up to the clinic room. I guess Tarc’s not the only one who needs to study harder, she thought with some chagrin.
Daussie called after her, “Bring a pan too.”
A few minutes later Daussie was porting splashes of bloody CSF into the pan and replacing them with sterile saline.
Vyrda sat down across from Tarc, “Want me to hold the collagen in place for a while so you can take a break?”
He looked up with a grin, “That’d be nice…”
~~~
Vyrda slept in the tavern that night, taking her turn with the others—each making sure the clot didn’t move or extend. Daussie slept on the gurney next to the patient’s—standing by to port the clot away if it did start to extend.
In the morning the young woman was still alive. Complaining of a headache and some mild nausea… but alive, awake, and—most importantly—with an apparently fully functioning brain.
***
Psychicians (a Hyllis family story #5) Page 15
