City of Dreams (78 page)

Andrew put a hand over Luke’s heart. The beat was thready, unstable. So much rum was bound to have that effect, particularly when a man was already at death’s door. Sweet Jesus Christ. He couldn’t do this. But he had to. He’d given his word.

Everything was ready. Jane had poured enough rum down the old man’s throat to make him unconscious. Andrew had roped him securely to the chaise, spreading oiled cloths on the floor so the flesh and bone he’d sawed off could be gathered up and discarded.

His instruments were ready. They had been given to him over the years by his grandfather, each the acknowledgment of some newly acquired skill. Four fluted probes. Three curved needles of different sizes, and plenty of carefully made ligatures. Half a dozen variously sized scalpels, all sharpened to a fine edge. Two saws, each freshly oiled to prevent snagging. He’d even read through the instructions concerning amputations of the leg in Lucas Turner’s journal.

Gunshot Wounds, compound Fractures, and all sudden Accidents requiring Amputation are attended with the best Success if immediately performed. When a Leg is to be amputated the manner of doing it is this: While an Assistant holds the Leg, you must roll a Slip of fine Rag half an inch broad three or four times round it, about four or five Inches below the inferior Extremity of the Patella ..
.

“Jane, can you assist me?”

She swallowed and took a breath so deep her chest heaved. “If it’s necessary, I’ll try.”

“Of course it’s necessary.” It was a role he’d often filled for his grandfather. Andrew knew exactly what was required. “You have to hold the leg steady, on an even plane. If you lift it my saw will clog, and if you drop it the bone might snap. That’s bad, because we need a clean break and— Jane, are you all right?”

“Of course I’m not all right.” She was pressing her pocket cloth to her forehead. “Please, Andrew. Just tell me what’s required as you progress. I’ll do my best.”

“Yes, very well.”

Damned women. Ah, that wasn’t fair. Jane couldn’t help being a female. But what was his excuse? His hands were shaking. Both of them. He’d seen his grandfather do this at least a dozen times, and he could recall every movement and every word of explanation. But actually doing it, on his own gravely wounded father … Sweet Christ, he had to get control of his hands.

Andrew took a few more deep breaths, then leaned forward and rolled back the blankets, lifting them over the barrel staves. Luke groaned once, then lapsed back into unconsciousness. Andrew took the staves away and bent close to his father’s shattered legs. He could feel heat rising, the beginning of the inflammation that would lead to gangrene and death. They should have delayed long enough for him to ride up to Yonkers and bring back Hezekiah Jackson.

“Hezekiah’s weak on diagnosis,” Grandfather always said, “but a fine hand with a knife.” There was no diagnosis required here, and Jackson had been in practice these past fifteen years. Nothing but family pride made Grandfather say Andrew was the best student he’d ever had, and now that pride was going to kill his father. Sweet Christ, he’d given his word to a dying man. He had to find the strength to do what he’d promised to do.

A tourniquet around the thigh first. A strong band of leather with a slit, so he could pass one flap through the other and draw the thing as tight as his strength would allow. Luke groaned again.

“You’re hurting him,” Jane murmured. Then added, “I’m sorry, that’s an idiotic thing to say.”

“I have to compress the artery so it doesn’t bleed.”

“Yes, I see. Will you do both legs at once?” She was trying to sound normal, but her voice was high-pitched and breathy, and it shook.

“No, one at a time. I think that’s more sensible.”

“You think? Dear heaven, Andrew, are you not sure?”

“Of course I’m not sure! How could I be? I’ve never done this, Jane.”

“Don’t shout, Andrew. It will only wake him. I merely asked a question.”

“Well, don’t ask any more. Not until we’ve finished.” He didn’t tell her that however quiet they were, the first cut would wake the patient. He’d never seen it any other way. Alcohol might lessen the suffering somewhat, but it didn’t make a man insensible of pain.

You must begin your Incision just below the linen Roller you have carefully put in place, on the under part of the Limb, bringing your Knife toward you, which at one Sweep may cut more than the Semicircle
.

Luke’s first shriek sent Jane reeling back from the chaise. She dropped the leg she’d been holding steady and screamed, “Stop! You’re killing him, Andrew! Stop!”

Damn her! He’d been afraid of exactly this. “Get out!” Andrew shouted. “Now! Go!”

“No, please.” Jane pressed both hands to her chest as if she could physically stop her heart from pounding. “I’m sorry, I want to help. It was just the shock. I’ll be fine.”

Andrew swabbed at the blood oozing from his first cut and didn’t lift his head. “Get out,” he repeated. “Send Sarah to me. Maybe she’s strong enough to do what needs to be done.”

He heard Jane’s muffled sobs and the door opening and closing, but he didn’t turn his head to see her go.

Thanks to the tourniquet he’d put in place around the thigh, the bleeding from the incision was a minor matter. In moments he could see well enough to make the second cut.
Begin your second Wound on the upper part. It must be continued from one Extremity to the other of the first Wound so the two form one line, and both must cut quite through the
Membrana Adiposa
as far as but not including the Muscles
.

The screams of suffering were relentless, like an ocean pounding at the shore. They pierced his skull. Andrew knew he must shut them out or he could not do his job. He knew, too, that they were going to get much worse when he started to saw through the bone.

His hands were shaking again, and his patient was thrashing and twisting against the ties that bound him to the chaise. If the restraints were accidentally loosened his father might move. There were times when a slip of the scalpel—or worse, the saw—could be disastrous. He could not do this without assistance. Damn Jane! Damn all women! Why were they so weak and stupid? And where in hell was Sarah?

The door behind him opened and closed. Thank God. “Sarah, come here. You must wipe away the blood so I can see what I’m doing. And hold the leg steady. Straight out. I’ll show you what I mean. Just come do what I say.”

Footsteps approached. Andrew didn’t turn his head. A hand reached out and touched the patient’s forehead. The arm was covered by a long black sleeve.

He’d been swabbing at the wound with a rag. Andrew stopped, turned. “What are you doing here?”

“I came to bring this.” Squaw DaSilva held out a small brown-glass bottle. “It’s laudanum, the best and most potent quality. I got it from Phoebe. I didn’t know you were operating, I just thought it might help with the pain.”

Andrew nodded curtly. “Give it to him. I should have thought of laudanum myself. I was so worried I forgot.” No time now to charge her and her rotten son with being the cause of all their grief.

He watched his aunt pull the cork from the bottle and little by little tip the contents into Luke’s mouth, waiting for the natural instinct to swallow to take over after each tiny draught. “Jane said you needed help, Andrew,” she said softly, keeping her eyes on her brother rather than turning to face his son. “Will you allow me to assist you?”

“You won’t swoon, or start to scream? Jane tried to help but—”

“I promise you I will neither swoon nor scream.”

She spoke from behind her veil, and her tone was serious, but he could have sworn he saw a smile playing about her mouth.
Your aunt Jennet always spied on every operation your grandfather performed
. Father had said that just five days ago. “I should be glad of your help. If you will.”

“Oh yes, I will,” she said softly. She bent forward, inspecting the leather tourniquet around the thigh, the band of linen cloth that had been carefully tied below it, and the perfectly even, circular cut Andrew had made through the skin. She began to speak, softly, with a ring of certitude that Andrew had only ever heard in his grandfather’s voice. “’Then taking off the linen Roller, and an Assistant drawing back the Skin as far as it will go …’” She was acting as she spoke, her hands competent, sure. They might have been his grandfather’s hands. Or his own. “’… you make your wound from the flesh to the bone, cutting through the muscles as swiftly and decisively as you severed the skin.’”

“That’s what Lucas Turner wrote,” he whispered.

“Yes. I read his journals when I was a girl. I’ve never forgotten.”

Andrew looked at the shattered mess below his father’s right knee. Less than a minute had passed since he’d made the initial cutaneous cut. The bleeding was mere seepage, easily controlled, and the laudanum seemed to have helped. Father’s breathing was deeper, more steady. Still Andrew hesitated.

“I can remind you of Lucas’s instructions as you proceed,” his aunt said. “If you like.”

Andrew’s throat was too constricted to allow him to answer. He nodded, then picked up the largest triangular scalpel and began the task of severing the layer of muscle and exposing the bone.

Luke’s cries of anguish began again as soon as he made the first cut. Andrew kept telling himself that it wasn’t as bad for his father now. The laudanum puts some kind of screen between a patient and his pain, his grandfather said. A surgeon has to stop listening and just do his job.

His aunt’s voice, pitched low, was soothing and calm. It helped him block out his father’s cries. “‘Stand to the inside face of the leg,’” she quoted, “‘so you may at the same time saw through the tibia and the fibula and there is less chance of splintering.’”

Andrew changed his position, moving to the other side of the chaise, and selected a saw. He ran a tentative finger over the edge, hearing Christopher’s words once more.
Remember, lad, bones have no feeling. It’s the ratcheting back and forth of the saw, all the friction you cause to the wound, that gives such intense pain. The faster and surer your movements the better. Sooner you’re done, sooner it’ll be over. So get on with it
. He bent over the leg, set the saw in position, and began.

Luke raised his head and shrieked. It was the wordless howl of a tortured animal. Andrew froze.

“You must not stop,” Squaw DaSilva said. “The laudanum has carried away his senses. The screams are simply a reflex.”

“I know, but—” Andrew looked from her to his father, then at the saw.

“Go on,” she urged. “You must. Do it, Andrew and you will save your father’s life.”

Andrew bent to the job.
Put your back into it, lad
. It was as if Christopher were standing behind him, watching over his shoulder.
You’ve the Turner legacy behind you. Get it done!

The Turner legacy. “‘When the leg is taken off the next regard is stopping the blood’,” his aunt quoted. “‘There is no method for this purpose so secure as tying the extremities of the vessels with a ligature. Use a crooked needle to pass twice through the flesh, almost around them, and thus hold them in stricture.’”

Andrew could no longer hear his father’s screams. Only his aunt’s voice. The force of her will sustained him.

“‘To discover the orifice of the various vessels, your assistant must every time loosen the tourniquet.’” Her competent hands matched the words. Each time he tied off a bleeder she opened the leather binding long enough for a spurt of blood to help him locate the next one.

Six, maybe seven. He lost count. It didn’t matter, the bleeding had stopped entirely, even though the tourniquet was gone. Her voice remained his anchor and his guide.

“‘Now you must begin to roll the skin from the lower part of the thigh down to the extremity of the stump. This is why you put on the linen roller. Not simply as a guide for your scalpel, but so it might prevent the skin from shrinking upward as it is inclined to do. But if you have followed my instructions and made the double incision through first the skin and then the muscle, rather than cutting them both in one swift but less precise manner, you have lessened this tendency of the skin to shrink. You can stitch it well and neatly in place, which will guard the stump from ulceration.’”

The right leg was done. Now they must do it all a second time.

The tourniquet, the linen roller, the small scalpel, then the large one. The screams. The saw. More screams. His aunt’s voice …

At last Andrew drew the final stitch, securing the skin over the second stump. “Done,” he murmured.

“Well done,” she said. Her words, not Lucas’s. He couldn’t recall how long it had been since she’d spoken her own thoughts. “How long?” he asked.

She glanced at the clock above the mantel in the small treatment room. “Since I arrived, an hour and twenty-seven minutes. Good time.” She touched her brother’s forehead. He’d passed out some while before, but he was sleeping normally now, and his skin was cool. “He’ll raise a fever soon,” she said. “I’ll have Phoebe send syrup of lemon and monkshood, and instruct Jane as to the dosage.”

“Yes. Whatever you say.” He was staggering with exhaustion, wiping the sweat from his forehead with his own blood-soaked sleeve. “An hour and twenty-seven minutes. That’s not—”

“Since I came. Had you started long before?”

“No, a few minutes only. I stopped when Jane started her yowling.”

“Call it an hour and a half then. It’s a fine beginning, Andrew. Your grandfather would be pleased.”

He thought so too. It was as if he could feel the old man’s hand on his shoulder.

“Well done, lad. You’ve probably saved him.”

“Not surely, Grandfather?”

“Never that, lad. Remember, in surgery—in all medicine—there is no such thing as ‘surely.’”

They left Jane with the patient and went to the kitchen to wash the blood from their hands. Sarah was standing by with the three buckets of water she’d filled at the pump in the street. “You be wanting something to drink or eat, maybe? I got decent ale. Or my own root beer. And there be fresh johnnycakes. Thirsty work you been doin’ from the sound of it.”