Of Flesh and Blood (5 page)

“Dr. Montgomery flatters me, Mr. Alfredson,” Evan said. “However, I have taken extra training in San Francisco with some of the most reputable surgeons at the Morgan Clinic.”

“Reputable perhaps,” Marshall snorted. “But I still have my doubts about the whole profession. During the war, when I was only eighteen, I spent
time in a Union field hospital. It was my first exposure to the
medical
world. Frankly, I never noticed much of a difference between the work of the surgeons and the pig butchers.”

Evan didn’t flinch at the insult. Fear of surgery was still pervasive in society and, as in Marshall’s case, often justified by traumatic firsthand experience. “Drastic advances have been made in our field since the Civil War.”

“Glad to hear it,” Marshall muttered, unconvinced. He consulted his pocket watch. “Time is wasting, Dr. McGrath. Perhaps you will examine my daughter now?”

“Of course.”

Marshall turned for the door and Evan followed, clutching his bulky bag close to his hip. “Mr. Alfredson, when did your daughter first fall ill?” he asked.

“Five days ago Olivia began to complain of discomfort below her chest. She soon lost all appetite. Then the ague set in. The Sisters have been using cold compresses and ice, but the fevers have persisted.”

“Of course,” Evan said. “Has there been vomiting?”

“Every day. Sometimes several episodes.”

“And her bowels?” Evan asked.

Marshall’s pale skin flushed and he looked away in embarrassment. “I was told they have not been at all right.”

They stopped outside the closed door at the end of the corridor. Marshall turned to Evan. “Olivia’s mother passed a few years ago.” A glimmer of vulnerability flitted across his face. “Olivia is all the family I have in this house.” His expression hardened. “I hope you understand, Dr. McGrath. It is essential that she be treated with the absolute best of care.”

Evan met Marshall’s warning stare. “Mr. Alfredson, I believe that every patient deserves that same level of care.”

Marshall gripped the knob and pushed the door open. Evan followed him into a room that was noticeably cooler than the rest of the house. A loud, steady buzz immediately drew Evan’s attention to its source—a machine perched on a night table near the bed. Evan had read about electric fans, but he had never seen one. He was momentarily transfixed by the blur of motion from the invisible blades and the breeze that flapped the bedsheet covering Olivia Alfredson. On the far side of the four-poster bed, a nurse in a full white nun’s habit held a compress to Olivia’s cheek.

Olivia possessed the same wild red hair and pale complexion as her father, but now her face was flushed crimson and the pillow around her head was ringed with sweat. Eyes closed, she moaned and her head rolled from side to side. “Mother?” the twenty-one-year-old muttered. “Mother, can you please come? My dress is all wrong.”

Evan turned to her father. “When did the delirium set in?”

“Only this morning.” Marshall’s features creased with concern. “When she began calling for her deceased mother.”

Evan dropped his bag to the floor and strode over to the bed. He nodded to the Sister and then turned to Olivia. A bead of sweat ran down from the edge of the girl’s hairline, which the nurse immediately dabbed away.

“Miss Alfredson, I am Dr. McGrath,” he said. “I have come to see if I can be of service.”

Evan waited for a response, but none came. He sniffed a few times and, under the scent of perspiration, picked up a subtle stale aroma that he recognized well. He did not need to touch her brow to know that she was suffering from toxemia, but when the back of his hand brushed her forehead he was alarmed by the height of her fever. He slid his fingers to her neck and felt the rapid weak pulse. His concern deepened. Evan looked over at Marshall, who now hovered at the end of the bed. “Mr. Alfredson, I will need to examine your daughter’s abdomen.”

Marshall grunted his consent and then turned his head to look away. Evan pulled the sheet down to the level of Olivia’s bloomers. Her thin chest rose and fell in rapid shallow respirations, and her plain white chemise was soaked around her neck. She had yet to open her eyes, but her head swiveled more rapidly from side to side.

“Miss Alfredson, I must lay my hand on your belly now,” Evan said softly. “Is that all right?”

Olivia’s head stopped moving and her eyelids snapped open. She gaped at him with widely dilated green eyes. “Of course, Doctor,” she said in a whimper.

Evan slid Olivia’s undergarment up to the level of her breasts. He gently rested his right hand on the center of her upper abdomen. The moment he made contact, she caught her breath. He pressed a little harder, and the muscles in her abdomen stiffened in response. He moved his hands over the rest of the belly, repeating the light pressure and meeting the same rigidity each
time. When he reached the right lower quadrant, she grimaced and gasped involuntarily.

How did they let it get this far?
Evan wondered with disgust. He smoothed the chemise over her exposed skin and pulled the sheet back on top of her. “Thank you, Miss Alfredson.” He nodded once. “If you will excuse me, I need to have a few words with your father.”

Outside in the corridor, Marshall had barely closed the door when he demanded, “Well, Dr. McGrath?”

“Your daughter is afflicted by generalized peritonitis, I am certain. And I strongly suspect that an inflamed appendix has initiated it.”

Marshall nodded gravely. Out of habit, he reached for his pocket watch and checked the time. “Dr. Montgomery felt much the same,” he grunted.

“Then you will agree to surgery?”

“
Surgery?
” Marshall dropped the watch and it fell to his hip, dangling by its chain. “Certainly not! The girl is far too ill to even consider it.”

“An operation is the only reasonable course of action.”

“Nonsense!” Marshall snapped. “Look at you. You are still wet behind the ears. How dare you come in here and tell me that the only way to save my Olivia is to slice her open? It is preposterous.”

Evan understood the father’s visceral reaction, but it didn’t stop his own temper from rising. He took a long slow breath and measured his words. “In San Francisco, I performed several appendectomies—the procedure for excising an inflamed appendix. Though it is a relatively new surgery, I have witnessed good results.”

“Maybe you have, Dr. McGrath,” Marshall said through gritted teeth. “But I will not allow you to risk my daughter’s life in order to establish your reputation on the back of our family name.”

“I care nothing for your family name!” Evan spat before salvaging his calm. He locked eyes with the man. “Mr. Alfredson, I will put it to you in these simple terms: If Olivia does not have surgery, and very soon, it is my opinion that the toxemia will kill her.”

Marshall folded his arms across his chest and glowered for a long moment. Finally, he uncrossed his arms and pointed at Evan with a long finger. “Again, let me put it to you in these simple terms, Dr. McGrath: If my daughter dies because of
your
surgery, you will never ply your trade in the Pacific Northwest again.”

Evan summoned the last of his restraint and broke off eye contact. His entire life, he had refused to relent to men like Marshall Alfredson. He wasn’t about to back down from Alfredson, but he appreciated that now was not the time for confrontation. “Olivia is too unwell to be carried to the hospital,” he said. “We have to perform the operation here.”

Marshall swallowed. “I see.”

“I will need two pots of boiling water and at least four sets of clean linens,” Evan said as he reached for the door handle.

“I intend to watch the whole endeavor,” Marshall announced.

Evan turned incredulously to the man. “That is entirely inappropriate, Mr. Alfredson. It is accepted practice that only trained medical personnel and assistants will attend an operation.”

“This is my house. And Olivia is my daughter. And by God, I will be present when you do this to her!”

Evan recognized the futility in arguing. “I need those supplies now,” he said as he opened the door and reentered the bedroom.

Thirty minutes passed before the servants had gathered the necessary supplies. After Evan had carefully unloaded his bag onto the table he had moved to the right side of the bed, he spent his time sterilizing instruments in the boiling water, laying out the tools in the order he would require them, and threading catgut onto needles of various sizes. After he deemed his equipment ready, he removed his jacket and slipped into the long white apron and cap that he had brought with him.

When Evan insisted that Marshall Alfredson cover his clothes with a clean sheet and a pillowcase tied over his hair, the older man balked. “What kind of quackery is this?” Marshall said. “Are you some kind of druid now?”

Swallowing more anger, Evan scrubbed his hands with soap and washed them in a pot of cold water. “I expect you have not read the work of Dr. Louis Pasteur or Dr. Joseph Lister on germ theory?”

“Sounds like bunkum to me,” Marshall said, pushing away the pillow cover that the Sister was trying to apply to his head.

“Germs are everywhere, Mr. Alfredson,” Evan said. “We carry them on our clothes and in our hair like leaves on a tree. We cannot see them without a microscope, but if they get into open wounds they can initiate lethal infections. Nowadays, all competent surgeons practice aseptic techniques. And you will not stay in this room without taking similar precautions!”

Olivia lifted her head and spoke up for the first time in ages. “Please, Papa. Listen to the doctor.”

Marshall melted at his daughter’s voice. He dropped his hand and stooped forward so that the nurse could tie the pillowcase over his scalp.

Evan turned to Olivia. Her pretty plaintive face set his heart racing. Despite his air of self-assurance, he knew that the procedure would be risky for a patient so gravely ill. As he stared into her wide jade eyes, it occurred to him how high the stakes were. He mustered a smile to mask his sudden case of nerves. “Miss Alfredson, I’m going to have to put you to sleep now.”

She nodded understandingly. Evan glanced over at Marshall. He reached out and squeezed his daughter’s foot through the sheet. “You remember, Liv. We Alfredsons come from the heartiest stock.” His voice cracked, and he paused to clear his throat. “You will improve quickly after this, you understand.” The words emerged as more command than reassurance.

Evan reached for the bottle of ether and the facecloth on the table. He uncorked the bottle and carefully poured the colorless liquid onto the cloth until it was saturated. The smell of ether drifted to his nostrils, and the pungent aroma relaxed him. He pressed the cloth gently over Olivia’s lips. She stared up at Evan, her eyes brimming with trust.

“I’m going to count aloud now, Olivia. All I need is for you to breathe deeply,” Evan soothed. “One . . . two . . . three . . . four . . .”

By the time he reached fifteen, Olivia’s eyelids fluttered and then shut. He passed the cloth to the nurse and told her to keep it near the patient’s lips and reapply at his command. Then he moved over to the side of the bed and pulled the sheets down and Olivia’s chemise up, exposing her belly from the bottom of her chest to the tufts of pubic hair poking from above the lowered waist of her bloomers. He washed his hands again, and then soaked a cloth with an iodine solution. Beginning around the belly button, he meticulously cleaned her abdomen in circular motions from the center out, repeating the procedure three times.

Evan glimpsed Marshall again. The man held the same clenched-jaw stare as ever, his face etched with silent threat.

Evan mentally walked himself through each step of the procedure as he reached for the scalpel on the table beside him.
One layer at a time, McGrath
, the words and Scottish lilt of his surgical mentor, Dr. Hugh Dundee, rang in his ears. With his left hand, Evan palpated the area over the appendix
known as McBurney’s point. And with his right, he brought the scalpel blade down and drew horizontally for six inches as though applying a pen to paper but with slightly more pressure. Evan glanced up at Olivia, relieved to see she maintained her blank-faced anesthetized gaze.

He picked up a pair of steel forceps and used them to bluntly dissect through the scant amount of fat beneath Olivia’s skin. Lost in concentration, he lifted the scalpel again and cut through the beefy red abdominal muscle. As soon as the blade penetrated through the peritoneum and into the abdominal cavity, pus welled up through the incision. The putrid smell of infection permeated the room. Evan glanced to Marshall. Though his face had drained of color, Marshall’s expression remained steadfast as he kept a tight hold on his daughter’s foot.

Evan grabbed for a fresh cloth and sponged urgently at the thick greenish yellow discharge. He jammed the scalpel back into the wound and extended the incision another three or four inches to allow him to visualize the area more clearly. The lacerated edges of muscle leaked fresh blood that mingled with the pus and turned the discharge a disconcerting brown.

Sweat trickled into Evan’s eyes. Without prompting the nurse reached over and mopped at his brow with a clean cloth. Then she reached a hand out and felt Olivia’s neck. “Dr. McGrath, the pulse is faster and weaker,” she said in an even voice, though her implication was clear: Olivia was verging on a state of shock.

Evan grabbed for one of the needles that he had loaded with catgut. Deftly, he threaded the suture around the largest of the bleeding veins and tied them off. The blood flow lessened to a trickle. And after a few more dabs of his now-soaked cloth, the yellow ooze slowed.

Evan dug his bare hand deep inside the wound and grabbed hold of the slippery loops of bowel. He ran his fingers blindly along the rubbery intestine until he felt a thickening that he recognized as the cecum, the beginning of the colon. He pulled the cecum through the open wound. He twisted it over to expose the underside of the bowel, where the attached appendix was so black that it stuck out like an embalmed thumb. He tied off the base of the gangrenous appendix with three coils of his suture, and then cut it free with the scalpel blade and dropped it into the bowl the nurse held out for him. Evan tucked the cecum and attached bowel back into the abdominal
cavity. He ran his hand along the inside of her belly to make sure he had not missed any other pockets of infection.