The Outlander Series 7-Book Bundle (801 page)

He became slowly aware again of where he was. There was a hand on his arm—Roger Mac, white-faced, but steady.

“I am going to see to them,” Roger Mac said, with a brief nod toward the creek. “You’re all right, yourself?”

“Aye, of course,” he said, though with the feeling he so often had in waking from a dream—as though he were not in fact quite real.

Roger Mac nodded and turned to walk away. Then suddenly turned back, and laying his hand once more on Jamie’s arm, said very quietly,
“Ego te absolvo.”
Then turned again and went resolutely to tend the dying and bless the dead.

114

AMANDA

FROM
L’Oignon–Intelligencer, May 15, 1776

INDEPENDENCE!!

In the Wake of the famous Victory at Moore’s Creek Bridge, the Fourth Provincial Congress of North Carolina has voted to adopt the Halifax Resolves. These Resolutions authorize Delegates to the Continental Congress to concur with the other Delegates of the other Colonies in declaring Independency and forming foreign Alliances, reserving to this Colony the sole and exclusive Right of forming a Constitution and Laws for this Colony, and by Passage of the Halifax Resolves, North Carolina thus becomes the first Colony officially to indorse Independency.

THE FIRST SHIP of a Fleet commanded by Sir Peter Parker has arrived at the Mouth of the Cape Fear River, upon the eighteenth of April. The Fleet consists of nine Ships in total, and is bringing British Troops to pacify and unite the Colony, by the Word of Governor Josiah Martin.

STOLEN: Goods amounting to twenty-six Pounds, ten Shillings and Fourpence in Total, abstracted from the Warehouse of Mr. Neil Forbes on Water Street. Thieves broke a Hole in the Back of the Warehouse during the Night of May twelfth, and carried the Goods away by means of a Wagon. Two Men, one White, one Black, were seen driving a Wagon away with a Team of bay Mules. Any Word pertaining to this atrocious Crime will be generously Rewarded. Apply to W. Jones, in care of the Gull and Oyster on the Market Square.

BORN, to Captain Roger MacKenzie of Fraser’s Ridge and his lady, a girl, on the twenty-first of April. Child and Mother are reported in good Health, the Child’s name given as Amanda Claire Hope MacKenzie.

Roger had never felt so terrified as he did when his newborn daughter was placed in his arms for the first time. Minutes old, skin tender and perfect as an orchid’s, she was so delicate he feared he would leave fingerprints on her—but so alluring that he had to touch her, drawing the back of his knuckle gently, so gently, down the perfect curve of her fat little cheek, stroking the black cobweb silk of her hair with an unbelieving forefinger.

“She looks like you.” Brianna, sweaty, disheveled, deflated—and so beautiful he could scarcely bear to look at her—lay back against the pillows with a grin that came and went like the Cheshire Cat’s—never entirely absent, even though it faded now and then from tiredness.

“Does she?” He studied the tiny face with complete absorption. Not for any sign of himself—only because he couldn’t take his eyes off her.

He had come to know her intimately, through the months of being roused suddenly by pokes and kicks, of watching the liquid heave of Brianna’s belly, of feeling the little one swell and retreat under his hands as he lay behind his wife, cupping her stomach and making jokes.

But he’d known her as Little Otto, the private name they’d used for the unborn child. Otto had had a distinct personality—and for a moment, he felt a ridiculous pang of loss, realizing that Otto was gone. This tiny, exquisite being was someone entirely new.

“Is she Marjorie, do you think?” Bree was lifting her head, peering at the blanket-wrapped bundle. They’d discussed names for months, making lists, arguing, making fun of each other’s choices, choosing ridiculous things like Montgomery or Agatha. At last, tentatively, they’d decided that if it was a boy, the name might be Michael; if a girl, Marjorie, after Roger’s mother.

His daughter opened her eyes quite suddenly and looked at him. Her eyes were slanted; he wondered if they would stay that way, like her mother’s. A sort of soft, middle blue, like the sky in mid-morning—nothing remarkable, at a glance, but when you looked straight into it … vast, illimitable.

“No,” he said softly, staring into those eyes. Could she see him yet? he wondered.

“No,” he said again. “Her name’s Amanda.”

I hadn’t said anything to begin with. It was a common thing in newborns—especially babies born a bit early, as Amanda had been—nothing to worry about.

The ductus arteriosus is a small blood vessel that in the fetus joins the aorta to the pulmonary artery. Babies have lungs, of course, but prior to birth don’t use them; all their oxygen comes from the placenta, via the umbilical cord. Ergo, no need for blood to be circulated to the lungs, save to nourish the developing tissue—and so the ductus arteriosus bypasses the pulmonary circulation.

At birth, though, the baby takes its first breath, and oxygen sensors in this small vessel cause it to contract—and close permanently. With the ductus arteriosus closed, blood heads out from the heart to the lungs, picks up oxygen, and comes back to be pumped out to the rest of the body. A neat and elegant system—save that it doesn’t always work properly.

The ductus arteriosus doesn’t always close. If it doesn’t, blood still does go to the lungs, of course—but the bypass is still there. Too much blood goes to the lungs, in some cases, and floods them. The lungs swell, become congested, and with diverted blood flow to the body, there are problems with oxygenation—which can become acute.

I moved my stethoscope over the tiny chest, ear pressed to it, listening intently. It was my best stethoscope, a model from the nineteenth century called a Pinard—a bell with a flattened disc at one end, to which I pressed my ear. I had one carved of wood; this one was made of pewter; Brianna had sand-cast it for me.

In fact, though, the murmur was so distinct that I felt as though I barely needed a stethoscope. Not a click or a misplaced beat, not a too-long pause or a leaky swish—there were any number of unusual sounds a heart could make, and auscultation was the first step of diagnosis. Atrial defects, ventral defects, malformed valves—all have specific murmurs, some occurring between beats, some blending with the heart sounds.

When the ductus arteriosus fails to close, it’s said to be “patent”—open. A patent ductus arteriosus makes a continuous shushing murmur, soft, but audible with a little concentration, particularly in the supraclavicular and cervical regions.

For the hundredth time in two days, I bent close, ear pressed to the Pinard as I moved it over Amanda’s neck and chest, hoping against hope that the sound would have disappeared.

It hadn’t.

“Turn your head, lovey, yes, that’s right.…” I breathed, delicately turning her head away from me, Pinard pressed to the side of her neck. It was hard to get the stethoscope close to her fat little neck … there. The murmur increased. Amanda made a little breathy noise that sounded like a giggle. I brought her head back the other way—the sound decreased.

“Oh, bloody hell,” I said softly, so as not to scare her. I put down the Pinard and picked her up, cradling her against my shoulder. We were alone; Brianna had gone up to my room for a nap, and everyone else was out.

I carried her to the surgery window and looked out; it was a beautiful day in the mountain spring. The wrens were nesting under the eaves again; I could hear them above me, rustling round with sticks, conversing in small, clear chirps.

“Bird,” I said, my lips close to her tiny seashell of an ear. “Noisy bird.” She squirmed lazily, and farted in reply.

“Right,” I said, smiling despite myself. I held her out a little, so I could look into her face—lovely, perfect—but not as fat as it had been when she was born a week before.

It was perfectly normal for babies to lose a little weight at first, I told myself. It was.

A patent ductus arteriosus may have no symptoms, beyond that odd, continuous murmur. But it may. A bad one deprives the child of needed oxygen; the main symptoms are pulmonary—wheezing; rapid, shallow breathing; bad color—and failure to thrive, because of the energy burned up in the effort to get enough oxygen.

“Just let Grannie have a little listen again,” I said, laying her down on the quilt I’d spread over the surgery table. She gurgled and kicked as I picked up the Pinard and placed it on her chest again, moving it over neck, shoulder, arm …

“Oh, Jesus,” I whispered, closing my eyes. “Don’t let it be bad.” But the sound of the murmur seemed to grow louder, drowning my prayers.

I opened my eyes to see Brianna, standing in the doorway.

“I knew there was
something
wrong,” she said steadily, wiping Mandy’s bottom with a damp rag before rediapering her. “She doesn’t nurse like Jemmy did. She acts hungry, but she’ll only nurse for a few minutes before she falls asleep. Then she wakes up and fusses again a few minutes later.”

She sat down and offered Mandy a breast, as though in illustration of the difficulty. Sure enough, the baby latched on with every evidence of starvation. As she nursed, I picked up one of the tiny fists, unfolding her fingers. The minute nails were faintly tinged with blue.

“So,” Brianna said calmly, “what happens now?”

“I don’t know.” This was the usual answer in most cases, truth be told—but it was always unsatisfactory, and clearly not less so now. “Sometimes there are no symptoms, or only very minor ones,” I said, trying for amendment. “If the opening is very large, and you have pulmonary symptoms—and we have—then … she
might
be all right, only not thriving—not growing properly, because of the feeding difficulties. Or”—I took a deep breath, steeling myself—“she could develop heart failure. Or pulmonary hypertension—that’s a very high blood pressure in the lungs—”

“I know what it is,” Bree said, her voice tight. “Or?”

“Or infective endocarditis. Or—not.”

“Will she die?” she asked bluntly, looking up at me. Her jaw was set, but I saw the way she held Amanda closer, waiting for an answer. I could give her nothing but the truth.

“Probably.” The word hung in the air between us, hideous.

“I can’t say for sure, but—”

“Probably,” Brianna echoed, and I nodded, turning away, unable to look at her face. Without such modern assistances as an echocardiogram, I of course couldn’t judge the extent of the problem. But I had not only the evidence of my eyes and ears, but what I had felt passing from her skin to mine—that sense of not-rightness, that eerie conviction that comes now and then.

“Can you fix it?” I heard the tremor in Brianna’s voice, and went at once to put my arms around her. Her head was bent over Amanda, and I saw the tears fall, one, then another, darkening the wispy curls on top of the baby’s head.

“No,” I whispered, holding them both. Despair washed over me, but I tightened my hold, as though I could keep time and blood both at bay. “No, I can’t.”