An Echo in the Bone

Page 112

“There we are,” I said with satisfaction, checking the array one last time. Everything must be ready, since I was working by myself; if I forgot something, no one would be at hand to fetch it for me.
“It seems a great deal o’ preparation, for one measly finger,” Jamie observed behind me.
I swung around to find him leaning on one elbow, watching, the cup of laudanum undrunk in his hand.
“Could ye not just whack it off wi’ a wee knife and seal the wound with hot iron, like the regimental surgeons do?”
“I could, yes,” I said dryly. “But fortunately I don’t have to; we have enough time to do the job properly. That’s why I made you wait.”
“Mmphm.” He surveyed the row of gleaming instruments without enthusiasm, and it was clear that he would much rather have had the business over and done with as quickly as possible. I realized that to him this looked like slow and ritualized torture, rather than sophisticated surgery.
“I mean to leave you with a working hand,” I told him firmly. “No infection, no suppurating stump, no clumsy mutilation, and—God willing—no pain, once it heals.”
His eyebrows went up at that. He had never mentioned it, but I was well aware that his right hand and its troublesome fourth finger had caused him intermittent pain for years, ever since it had been crushed at Wentworth Prison, when he was held prisoner there in the days before the Stuart Rising.
“A bargain’s a bargain,” I said, with a nod at the cup in his hand. “Drink it.”
He lifted the cup and poked a long nose reluctantly over the rim, nostrils twitching at the sickly-sweet scent. He let the dark liquid touch the end of his tongue and made a face.
“It will make me sick.”
“It will make you sleep.”
“It gives me terrible dreams.”
“As long as you don’t chase rabbits in your sleep, it won’t matter,” I assured him. He laughed despite himself, but had one final try.
“It tastes like the stuff ye scrape out of horses’ hooves.”
“And when was the last time you licked a horse’s hoof?” I demanded, hands on my hips. I gave him a medium-intensity glare, suitable for the intimidation of petty bureaucrats and low-level army officials.
He sighed.
“Ye mean it, aye?”
“I do.”
“All right, then.” With a reproachful look of long-suffering resignation, he threw back his head and tossed the contents of the cup down in one gulp.
A convulsive shudder racked him, and he made small choking noises.
“I did say to sip it,” I observed mildly. “Vomit, and I’ll make you lick it up off the floor.”
Given the scuffled dirt and trampled grass underfoot, this was plainly an idle threat, but he pressed his lips and eyes tight shut and lay back on the pillow, breathing heavily and swallowing convulsively every few seconds. I brought up a low stool and sat down by the camp bed to wait.
“How do you feel?” I asked, a few minutes later.
“Dizzy,” he replied. He cracked one eye open and viewed me through the narrow blue slit, then groaned and closed it. “As if I’m falling off a cliff. It’s a verra unpleasant sensation, Sassenach.”
“Try to think of something else for a minute,” I suggested. “Something pleasant, to take your mind off it.”
His brow furrowed for a moment, then relaxed.
“Stand up a moment, will ye?” he said. I obligingly stood, wondering what he wanted. He opened his eyes, reached out with his good hand, and took a firm grip of my buttock.
“There,” he said. “That’s the best thing I can think of. Having a good hold on your arse always makes me feel steady.”
I laughed and moved a few inches closer to him, so his forehead pressed against my thighs.
“Well, it’s a portable remedy, at least.”
He closed his eyes then and held on tight, breathing slowly and deeply. The harsh lines of pain and exhaustion in his face began to soften as the drug took effect.
“Jamie,” I said softly, after a minute. “I’m sorry about it.”
He opened his eyes, looked upward, and smiled, giving me a slight squeeze.
“Aye, well,” he said. His pupils had begun to shrink; his eyes were sea-deep and fathomless, as though he looked into a great distance.
“Tell me, Sassenach,” he said, a moment later. “If someone stood a man before ye and told ye that if ye were to cut off your finger, the man would live, and if ye did not, he would die—would ye do it?”
“I don’t know,” I said, slightly startled. “If that was the choice, and no doubt about it, and he was a good man … yes, I suppose I would. I wouldn’t like it a bit, though,” I added practically, and his mouth curved in a smile.
“No,” he said. His expression was growing soft and dreamy. “Did ye know,” he said after a moment, “a colonel came to see me, whilst ye were at work wi’ the wounded? Colonel Johnson; Micah Johnson, his name was.”
“No; what did he say?”
His grip on my bottom was beginning to slacken; I put my own hand over his, to hold it in place.
“It was his company—in the fight. Part of Morgan’s, and the rest of the regiment just over the hill, in the path of the British. If the charge had gone through, they’d ha’ lost the company surely, he said, and God knows what might have become o’ the rest.” His soft Highland burr was growing broader, his eyes fixed on my skirt.
“So you saved them,” I said gently. “How many men are there in a company?”
“Fifty,” he said. “Though they wouldna all have been killed, I dinna suppose.” His hand slipped; he caught it and took a fresh grip, chuckling slightly. I could feel his breath through my skirt, warm on my thighs.
“I was thinking it was like the Bible, aye?”
“Yes?” I pressed his hand against the curve of my hip, keeping it in place.
“That bit where Abraham is bargaining wi’ the Lord for the Cities of the Plain. ‘Wilt thou not destroy the city,’ ” he quoted, “ ‘for the sake of fifty just men?’ And then Abraham does Him down, a bit at a time, from fifty to forty, and then to thirty, and twenty and ten.”
His eyes were half closed, and his voice peaceful and unconcerned.
“I didna have time to inquire into the moral state of any o’ the men in that company. But ye’d think there might be ten just men among them—good men?”
“I’m sure there are.” His hand was heavy, his arm gone nearly limp.
“Or five. Or even one. One would be enough.”
“I’m sure there’s one.”
“The apple-faced laddie that helped ye wi’ the wounded—he’s one?”
“Yes, he’s one.”
He sighed deeply, his eyes nearly shut.
“Tell him I dinna grudge him the finger, then,” he said.
I held his good hand tightly for a minute. He was breathing slowly and deeply, his mouth gone slack in utter relaxation. I rolled him gently onto his back and laid the hand across his chest.
“Bloody man,” I whispered. “I knew you’d make me cry.”
THE CAMP OUTSIDE lay quiet, in the last moments of slumber before the rising sun should stir the men to movement. I could hear the occasional call of a picket and the murmur of conversation as two foragers passed close by my tent, bound for the woods to hunt. The campfires outside had burned to embers, but I had three lanterns, arranged to cast light without shadow.
I laid a thin square of soft pine across my lap as a working surface. Jamie lay facedown on the camp bed, head turned toward me so I could keep an eye on his color. He was solidly asleep; his breath came slow and he didn’t flinch when I pressed the sharp tip of a probe against the back of his hand. All ready.
The hand was swollen, puffy, and discolored, the sword wound a thick black line against the sun-gold skin. I closed my eyes for a moment, holding his wrist, counting his pulse. One-and-two-and-three-and-four…
I seldom prayed consciously when preparing for surgery, but I did look for something—something I could not describe but always recognized: a certain quietness of soul, the detachment of mind in which I could balance on that knife-edge between ruthlessness and compassion, at once engaged in utmost intimacy with the body under my hands and capable of destroying what I touched in the name of healing.
One-and-two-and-three-and-four…
I realized with a start that my own heartbeat had slowed; the pulse in my fingertip matched that in Jamie’s wrist, beat for beat, slow and strong. If I was waiting for a sign, I supposed that would do. Ready, steady, go, I thought, and picked up the scalpel.
A short horizontal incision over the fourth and fifth knuckles, then down, cutting the skin nearly to the wrist. I undermined the skin carefully with the scissors’ tips, then pinned back the loose flap of skin with one of the long steel probes, digging it into the soft wood of the board.
I had a small bulb atomizer filled with a solution of distilled water and alcohol; sterility being impossible, I used this to lay a fine mist over the operating field and wash away the first welling of blood. Not too much; the vasoconstrictor I had given him was working, but the effect wouldn’t last long.
I gently nudged apart the muscle fibers—those that were still whole—to expose the bone and its overlying tendon, gleaming silver among the vivid colors of the body. The sword had cut the tendon nearly through, an inch above the carpal bones. I severed the few remaining fibers, and the hand twitched disconcertingly in reflex.
I bit my lip, but it was all right; aside from the hand, he hadn’t moved. He felt different; his flesh had more life than that of a man under ether or Pentothal. He was not anesthetized but only drugged into stupor; the feel of his flesh was resilient, not the pliant flaccidity I had been accustomed to in my days at the hospital in my own time. Still, it was a far cry—and an immeasurable relief—from the live and panicked convulsions that I had felt under my hands in the surgeon’s tent.
I brushed the cut tendon aside with the forceps. There was the deep branch of the ulnar nerve, a delicate thread of white myelin, with its tiny branches spreading into invisibility, deep in the tissues. Good, it was far enough toward the fifth finger that I could work without damage to the main nerve trunk.
You never knew; textbook illustrations were one thing, but the first thing any surgeon learned was that bodies were unnervingly unique. A stomach would be roughly where you expected it to be, but the nerves and blood vessels that supplied it might be anywhere in the general vicinity, and quite possibly varying in shape and number, as well.
But now I knew the secrets of this hand. I could see the engineering of it, the structures that gave it form and movement. There was the beautiful strong arch of the third metacarpal, and the delicacy of the web of blood vessels that supplied it. Blood welled, slow and vivid: deep red in the tiny pool of the open field; brilliant scarlet where it stained the chopped bone; a dark and royal blue in the tiny vein that pulsed below the joint; a crusty black at the edge of the original wound, where it had clotted.
I had known, without asking myself how, that the fourth metacarpal was shattered. It was; the blade had struck near the proximal end of the bone, splintering its tiny head near the center of the hand.
I would take that, too, then; the free chunks of bone would have to be removed in any case, to prevent them irritating the adjoining tissues. Removing the metacarpal would let the third and fifth fingers lie close together, in effect narrowing the hand and eliminating the awkward gap that would be left by the missing finger.
I pulled hard on the mangled finger, to open the articular space between the joints, then used the tip of the scalpel to sever the ligament. The cartilages separated with a tiny but audible pop! and Jamie jerked and groaned, his hand twisting in my grasp.
“Hush,” I whispered to him, holding tight. “Hush, it’s all right. I’m here, it’s all right.”
I could do nothing for the boys dying on the field, but here, for him, I could offer magic and know the spell would hold. He heard me, deep in troubled opium dreams; he frowned and muttered something unintelligible, then sighed deeply and relaxed, his wrist going once more limp under my hand.
Somewhere near at hand, a rooster crowed, and I glanced at the wall of the tent. It was noticeably lighter, and a faint dawn wind drifted through the slit behind me, cool on the back of my neck.
Detach the underlying muscle with as little damage as could be managed. Tie off the small digital artery and two other vessels that seemed large enough to bother with, sever the last few fibers and shreds of skin that held the finger, then lift it free, the dangling metacarpal surprisingly white and naked, like a rat’s tail.
It was a clean, neat job, but I felt a brief sense of sadness as I set the mangled piece of flesh aside. I had a fleeting vision of him holding newly born Jemmy, counting the tiny fingers and toes, delight and wonder on his face. His father had counted his fingers, too.
“It’s all right,” I whispered, as much to myself as to him. “It’s all right. It will heal.”
The rest was quick. Forceps to pluck out the tiny pieces of shattered bone. I debrided the wound as best I could, removing bits of grass and dirt, even a tiny swatch of fabric that had been driven into the flesh. Then no more than a matter of cleaning the ragged edge of the wound, snipping a small excess of skin, and suturing the incisions. A paste of garlic and white-oak leaves, mixed with alcohol and spread thickly over the hand, a padding of lint and gauze, and a tight bandage of linen and adhesive plasters, to reduce the swelling and encourage the third and fifth fingers to draw close together.
The sun was nearly up; the lantern overhead seemed dim and feeble. My eyes were burning from the close work and the smoke of fires. There were voices outside, the voices of officers moving among the men, rousing them to face the day—and the enemy?