What Heals the Heart

by Karen A. Wyle

  The barber grinned. “Guess we might still tussle over some folks.” The grin faded. “But I won’t seek anyone out, for bleeding or anyone else, if you send folk to me from time to time. You might not think it, but I want you to stay in business. I might need doctoring someday.”

  “So you might.” Time to be diplomatic. “As good as you are with a razor, even you might get cut now and again. Or get sick like anyone else.” Joshua held up his almost-empty glass. “Shall we toast our truce?”

  The barber lifted his own glass, topped off both, and clinked his glass against Joshua’s. “To our bargain, then.” He and Joshua both drained their glasses, and Hawkins reached for the bottle. “One more?”

  Joshua put his glass on the table and stood up. “Best not, or you might be needing me soon, and I’ll be too drunk to tend you.”

  Leaving the barbershop, Joshua found that walking required somewhat more attention than usual. He should perhaps have taken one glass fewer of that whiskey.

  He found himself wanting to tell someone what he had — or hoped he had — just achieved. Robert? He would almost certainly be interested. But he was also likely to express some skepticism about the arrangement. Who might welcome the news while refraining from pessimistic predictions?

  The image of Clara Brook floated to mind. She would likely understand how draining the feud had been, how glad Joshua would be to leave it behind him. And she would appreciate the solution he had come up with. He was just about sure she shared his views about bloodletting as a cure-all.

  But she would also be well acquainted with the signs of inebriation. Whatever her opinion of him, he did not want to lessen it by approaching her with an unsteady gait and (probably) reddened eyes, to say nothing of whiskey on his breath. He sighed and headed home to tell the tale to Major. Major would thump his tail on the floor, and Joshua could take that as approval.

  Chapter 20

  Joshua lay lazy in bed on a Sunday morning and contemplated going to church. He didn’t go as often as he probably should, to reassure his neighbors if for no other reason. And he had plenty of time yet to get dressed and have some breakfast first. But after a long, trying week, he needed to sleep more than to spend time praying. And scandalous as the thought might be, he’d never known praying to do much for him or anyone.

  He had just decided to let himself go back to sleep when, as if to punish him for it, there came a pounding on the door. Major jumped off the bed barking; Joshua rubbed bleary eyes and called out over Major’s noise. “Hold on! I’m coming!”

  He cracked the door open and saw a boy, maybe thirteen years old, with eyes so wide the whites were showing, no room for pride in being chosen to come. This one was going to be bad. Joshua’s stomach sank to somewhere near his knees as he opened the door wider. “Come in while I get ready.”

  Major eeled out the door as the boy came in. Joshua considered putting some scraps on a plate outside his door, then decided against it. He’d probably end up feeding either strays or rats. Major was good at cadging scraps from the butcher. He’d be all right, even if Joshua didn’t make it home before evening.

  While Joshua dressed, the boy stammered out what he knew. His older brother had managed to let the plowshare, propped up for cleaning, fall on his leg. He was in the barn. Their pa had told the boy to come fetch the doctor. His brother was hollering so loud, the boy had trouble getting the horse to hold still for him to mount up.

  Joshua jammed his boots on, grabbed his bag, and stopped. He had better bring the bone saw. Cursing under his breath, trying not to let the boy hear, he dragged the saw in its case down from the shelf, threw it in his bag, and banged down the stairs ahead of the boy, running for the stable.

  Joshua’s horse and the boy’s were both winded when they arrived at the Barlow farm. Joshua paid little mind. The horses would, he feared, have plenty of time to recover before Joshua would need his own again. But he did tell the boy to put a blanket over Nellie-girl before striding toward the barn to see his patient.

  To his considerable surprise, Clara Brook emerged, her head bare, and came to meet him. Her pallor fit with all the other discouraging signs. She explained briefly that the patient’s mother had come to fetch her, seeing as she lived a good deal closer than town and might be able to help somehow until the doctor arrived. Joshua gathered that was pretty much a quote.

  He looked her in the eye. “How bad is it?”

  She held his gaze. “I’d rather let you be the judge of that. I might be making too much of it.”

  Clara might still have some hope that the man would keep his leg. Joshua couldn’t muster much of the same.

  He stopped short in the barn doorway as the patient came into view. The groaning, tossing figure, lying on a rough, torn blanket atop the straw, was barely more than a boy. Just around the age of all the men or boys Joshua had seen on blood-soaked tables, an Army doctor standing over them with a saw in his hand.

  He staggered and might have toppled sideways if Clara had not been there, grabbing his arm and steadying him. He turned toward her and saw her read, and then reflect, the anguish in his face. Her grip on his arm went from support to a more frantic clutch. She said under her breath, “You can get through this.” And after a long, shaky breath: “I’ll get you through it.”

  But her hand was trembling on his arm.

  He whispered, “I’ll do the same for you.”

  He heard multiple footsteps behind them and turned around. The boy, his parents, a sister, all looking at him with various mixtures of hope and terror. He turned back to his patient, approached him, knelt beside him. “What’s your name, son?”

  The young man looked up at him, straining as if he could hardly focus. “Tom. Are you the doctor?”

  “That’s right. So I’d better take a look at you.” He turned back the cloth someone had laid over the injured leg.

  He saw at once that there would be no saving the entire limb. It was crushed, mangled, a few inches below the knee. That left the grim question of whether to try for a below-the-knee amputation, and risk having to cut again higher after seeing what was left, or cut above the knee to start with and be sure of cutting only once.

  He could ask the parents what they wanted him to do, but that would be craven of him. They had no way to know what was best, even as much as he did.

  Clara had crouched down beside him. He said under his breath, “How many amputations have you assisted?”

  She answered in a monotone. “Too many. And saw the results of many, after.”

  “What think you? Above or below?”

  She looked toward his bag. “Your saw — is it good and sharp?”

  He so hated the sight of the thing, it had been some time since he sharpened it. But he couldn’t remember using it since — and he would have remembered. He fished the case out of his bag and inspected the blade, testing it with the forefinger of his left hand. It should do. “You’re thinking I can cut close enough, save the knee?”

  She said very quietly, “If it were mine to decide, which I’m thankful it isn’t, I’d be choosing so. If it’s the wrong choice, you can cut again, and by tomorrow it’ll make little difference. If you cut higher, there’s no going back from it.”

  Joshua swallowed the bile in his throat and nodded. Standing, he approached the huddled family group and said, “I’m afraid much of the leg has to go, or it’ll mortify and kill him.” He waited a moment for them to absorb that blow and then went on. “I’m going to amputate below the knee. But I must warn you, I won’t know for sure if that’s good enough until I try it.”

  He stood there awkwardly, as if waiting for absolution, and then returned to the barn. A sudden doubt assailed him: did his bag still contain the secondhand Army Surgeon’s Field Companion, with its tin of chloroform and sutures? He hurried over and threw the bag open, gasping in relief to find the kit there at the bottom, along with a sponge to use. He retrieved the kit and sponge, along with his case of scalpels. Returning to the family, wh
om he had left staring, he asked, “When was the last time he ate anything?”

  The mother answered. “He just took a little biscuit and coffee to sustain him while he did the morning chores. I was making him a big breakfast when — when —” She buried her face in her apron.

  It could be worse. If the injury had occurred after the boy had had a chance to eat that big breakfast, using chloroform would risk him vomiting and choking, and Joshua would have had to choose between that risk and using only morphine. He took a deep breath and said with as much command as he could muster, “While I’m getting ready, I’d appreciate it if you could fetch plenty of clean cloths and hot water.”

  The mother and sister ran toward the house. Joshua beckoned the father and drew him away from the boy. “I don’t think your other son needs to see this. And I don’t want any distractions I can avoid.”

  Rather than invite further discussion, he went back to his patient. The chloroform would render the young man insensible for the operation itself, but Joshua would need to administer morphine for the awful pain after. He pulled out his clean handkerchief, filled up his hypodermic syringe, and laid the syringe on the handkerchief.

  Blood was still welling up in the wound and dribbling out onto the straw. He needed to get to work. Standing and striding back into the yard, he demanded, “Where’s that water and the cloths!”

  The father, now standing alone, clenched his fists. “I’ll go see to it.” He strode off.

  Joshua knew he had spoken harshly, but he had no mind to spare for such things. In fact, mind, a clear head, was getting hard for him to manage, harder by the second. Was that the rumble of a cart he heard on the road, or the wheels of cannon being rolled into position? Why was he standing in a barn instead of a tent? Why the odor of blood mingled with that of fresh straw instead of stale?

  He started as a nurse — she looked familiar — shook his shoulder. “Doctor Gibbs!”

  He gasped for breath and came to himself. “I’m all right. Thank you.”

  She pointed toward the patient. He had somehow missed seeing one or both women in the family return and leave again. “The water and cloths are ready.”

  Joshua pulled out his smock and put it on, then knelt back by the soldier — no, the farm boy — and dipped a cloth in the water. The nurse took it from him and swabbed away the blood around the wound, then let the cloth fall into the gash and soak up more. The young man moaned.

  Joshua opened the tin of chloroform and carefully poured a small amount onto the sponge. He handed the sponge to the nurse; she held it over the man’s nose and mouth, murmuring to him, “Just breathe in. That’s right.”

  The man said something Joshua could barely understand, his voice twisted with pain and muffled by the cloth. “My leg . . . Can you save it?”

  The man spoke to the nurse — Clara, that was her name — but this news was Joshua’s to deliver. “I’m afraid not. We have to take it to save your life. We’re going to try cutting below the knee.”

  The man tried to sit up. Joshua pressed down on his shoulders as Clara held the cloth in place. The man moaned, and a single tear leaked down across his cheek and into the blanket below him.

  And then, again, as if for the first time, except the voice was weaker: “Can you save my leg? . . .”

  Joshua clenched his teeth and waited. As the chloroform took effect, the man’s muscles contracted and relaxed again, once and twice. Finally, they stayed relaxed. Clara lifted the man’s closed eyelid and said to Joshua, “He’s under.”

  “Keep the cloth on him whenever I don’t need you to do something else. Wet it again every few minutes. You know the amount?”

  “Yes. Shall I wipe here?” She indicated the point on the leg where Joshua would have to cut.

  He felt a deep thankfulness that she knew not just how to assist, but what questions to ask. “Please. And then stay alert to hold him down if he starts writhing about.”

  The nurse dipped a fresh cloth in the hot water and wiped in one steady motion. Joshua pulled the correct scalpel from the case and made a swift slashing cut, through skin and muscle down to the bone. He was dimly aware that Clara had added another few drops of chloroform to the sponge and put it in place again. He picked up the saw and with quick circular motions sawed through the bone and then down through the flesh beneath. Clara mopped up blood as he worked.

  The surgeons doing this gruesome job during the war had had to work as quickly as possible, and would simply slice on through the limb, leaving a raw stump that could take a long time to heal. Joshua could instead leave some skin from which to fashion a flap and sew it over the stump. It would heal more quickly, as long as he made sure to visit often enough to detect any signs of infection.

  When the lower leg was fully detached, Clara lifted it away and put it somewhere close by, then handed him a needle she had already threaded with silk thread. Joshua used a rasp to scrape the protruding piece of bone smooth at its end and edges before he trimmed the flap of skin, pulled it across the stump, and sewed the patchwork closed, leaving only a small hole for fluid to drain from. Then he slumped back on his heels, shuddering, as Clara deftly bandaged the stump.

  Where had he put the syringe? He fumbled for it, forced his hand steady, and injected the morphine into the man’s nearest upper arm. “You can take away the sponge now and let him come to.”

  Their patient came back to consciousness babbling, almost as if drunk. Joshua forced himself to stay by the man’s side as he surfaced. But the morphine kept the man dulled, peaceful. By the time he was able to rage and weep and despair, Joshua would be on Nellie-girl and heading for home.

  A hoarse, choking sob came not from the patient, but from somewhere behind. Joshua rose, joints protesting, to his feet and looked for the source. The man’s father was standing just inside the doorway to the barn. He might have been there the whole time, unable to do anything but witness the cutting off of his son’s leg and who knew how many of his hopes. Now he was staring at Joshua’s blood-soaked smock. Joshua pulled off the smock and threw it behind him.

  A rustling of straw came from the vicinity of the patient. Joshua turned back to see Clara sprawled on the straw next to the bloody blanket. Had she fainted? No, her eyes were open, staring upward, at the heavy wooden beams above or at some inward vision. He went to her and supported her into a sitting position, fumbling for and squeezing her hand. It took a worrisome few seconds before she squeezed back and said, “Help me up, if you would.”

  He pulled her upright and then dug in his bag for the other morphine, the powder. He approached the father, making as much noise with his feet as he could to give the man warning and a chance to collect himself. The father looked up at him, face working in sorrow. Joshua held out the can of powder. “If you should need to change the bandages before I return or between my subsequent visits, dust this on the stump. Keep it handy for me to use, as well. In the meantime, whenever the pain gets bad, give him laudanum.” Did the family have any, or know where to get it? Did they have bandages? He could not think about any of that now. He could not think about anything but leaving this place. But he would have to come back, tomorrow and the next day, to see to his patient. And then his patient would be able to tell him just what he had done.

  But at least he would not be back in this barn. Just another few minutes to pack up his things. Clara, during his brief talk with the father, had cleaned his saw and needle with the remaining water and wiped them dry, and rolled up his smock with the bloody side in. All that remained was Clara’s abandoned bonnet, the blanket as bloody as a battlefield, and some blood spatters on the straw nearby. Clara looked at the barn floor and back at Joshua before saying, “I’ll clean that up before I head for home.”

  She was pale and shivering. “Not by yourself. I can help you.”

  “The family can help me, if I need it.”

  “I’ll help. And then I can get you home. Nellie-girl can carry us both.”

  In another few minutes, he
was standing by Nellie-girl and staring at the mare’s back. Of course he had no side saddle. He asked Clara, resting against a tree stump with her bonnet back on, “Do you think you could sit astride the mare, if I assisted you?” If not, he could walk beside the mare and try to steady Clara sitting sideways.

  Clara managed something like a smile. “I have done, and with no one assisting me, when someone needed a message sent or help summoned in a hurry during the war.”

  He gave Clara a leg up and made sure she was secure sitting astride the puzzled mare. It then took him two tries, and the aid of the tree stump, to mount up behind her. Clara showed him where to go, Joshua not having approached the Brook farm from this direction before, and he let Nellie-girl set the pace at an easy walk. Clara might have been falling asleep, her body slumping forward, her belly soft beneath his encircling arm.

  Clara’s brother came out to meet them as they approached, looking a little puzzled. The boy and his father had probably expected Clara home hours earlier. Joshua pulled Nellie-girl to a halt, dismounted, and stood back for the man to help his sister down, saying to him, “She’s had a long day and a hard one.”

  The brother supported his sister in an awkward side embrace while looking at Joshua. “She was able to be of some help, then, in whatever you were doing?”

  Joshua put his hands hard against his sides to control their shaking. The fury sweeping through him was not, or barely, to do with the youth standing before him. “She was of great and much needed assistance.” And to her, though he was not sure she could hear him: “Thank you. I am deeply in your debt.”