Chapter 27
Daniel pretended not to notice as Horace evaluated the neat row of sutures. The patient slept soundly, blissfully unaware of the careful slices and ligatures Daniel had employed to excise the rocky tumor from her neck.
“You could have done the surgery easily, Horace. I saw your dissection work this week. I wish you’d at least join me.”
Daniel headed St. Bartholomew’s women’s ward, which meant he could only operate on the females in his care, but Horace was still titular head surgeon and could practice on any ward in the hospital. Daniel missed the days of watching his mentor race breathlessly through surgery after surgery.
Horace gave a small shrug. “I could do the routine surgeries, but where is the diversion in that?” He smiled impishly. “I did receive a note today from a visiting Hungarian royal. She’d very much like me to oversee the birth of her spaniel’s litter.”
Daniel burst into laughter. “Attend the delivery of puppies?”
Horace’s face shone with amusement as he instinctively began cleaning instruments. “So long as it goes well, I believe I could persuade her to contribute to Nora’s hospital.”
“Of all the strange—”
Daniel broke off as Jeffers careened into the room. “You’re needed now, Dr. Gibson.” His mottled red face and urgent words demanded speed.
“What is it? I’m still with Mrs. Hatfield.”
Jeffers surveyed the peaceful patient. “I’ll stay with her until she’s awake. Wilkins needs you in the delivery room.”
“What happened?” Daniel asked as he headed for the door, Horace at his heels.
“He just delivered a baby and he’s having trouble with the placenta.”
Daniel didn’t wait to hear more. One of his most traumatic patient fatalities had come after delivering a placenta. There was no room for error. “Who’s Wilkins?” Horace asked as he managed to keep up with Daniel. “Not a doctor here.”
“Student. I don’t think he’s ever seen a delivery.”
They reached the room at the same time as Adams, nearly colliding. “What are you doing here?” Daniel asked, not sparing time for manners.
“Wilkins is my student.”
“And this is my ward,” Daniel returned. “Wilkins should have told me he was delivering.” He rushed to the bedside, where Wilkins sweated in a panic as the mother moaned quietly.
“The placenta doesn’t look right,” Wilkins said, eager to move aside and hand the stippled mass to Daniel. “And it’s not coming away.”
Daniel slid into position, his blood going cold as his eyes surveyed the scene. The firm, veined flesh was no placenta.
Horace swore. “Inverted uterus. Fully exterior.”
“Dear Lord,” Adams muttered behind them. “What happened?”
“What’s wrong?” The woman yelped, catching the dismay in Adams’s voice.
Horace tamed his anger long enough to give her a smile. “Nothing we can’t fix.”
Horace turned back to Adams, his eyes burning blue flames as his voice dropped to a vicious whisper. “What happened is your student has been tugging this woman’s organ out of her body.”
Wilkins’s eyes reddened desperately. “I did everything they said in the lecture last year. I wouldn’t even be on this ward at all, but the other students have cholera and you were in surgery,” he said to Daniel as if he was to blame.
“Lecture last year,” Horace scoffed. But when it came to midwifery, few doctors started their own practices with more than a lecture or two and, if fortunate, a birth they’d seen from the back of a flock of students.
“What is it?” the woman cried again, trying to sit up for a view.
“Just a displacement of the uterus,” Horace said, soothing, coaxing her back down, knowing the words meant little to her. “Get me a long-necked bottle and a pitcher of salt water,” Horace ordered, pushing up his shirtsleeves. Wilkins stared, perplexed, until Horace shouted, “Now!”
Wilkins scrambled to obey.
“We need the vaporizer,” Daniel said. “If she’s awake, we’ll never overcome the after contractions.”
“Never?” Horace challenged. “Nonetheless, it will be easier when she’s unconscious.”
When Daniel returned with the device, Horace fit the mask over the mother’s confused face, promising all would be well. “Just a slight complication, but when you wake, it will feel much better.”
“Her eyes are closing,” Daniel announced after a few frightened jerks of the woman’s head.
Horace anointed the inside-out organ with water, which pinked as it collected traces of blood and spilled onto the floor. Daniel watched in confusion. Whatever Horace had up his sleeve, Daniel was as in the dark as anyone else.
“Salt will shrink the engorged uterus, making it easier to work it back into place,” Horace explained, taking up a jar of salt and sprinkling grains liberally across the bloody landscape like falling snow. “Just another sprinkle and a bit of wine, as well.”
Adams scowled. “Why do all your treatments sound more like recipes, Croft?”
Horace grunted and ignored the man, keeping his eyes on Daniel. “Let Jeffers man the ether for a bit. This part is laborious.”
Daniel winced. From Horace, that meant a nearly impossible task.
“Thread some sutures and have them standing by, in case,” Horace instructed without taking his eyes from the patient. “There!” Lightning quick, he indicated a spot with a probe. “A tumor. Inside the womb.”
Sure enough, a misshapen ball of tissue, the size of a small pocket watch, glistened white and yellow through the membrane of the uterus.
In two minutes or so—twice as long as it would have taken him before, but still an impressive time—Horace held the offending tumor in his palm. He set it aside and began sliding sutures into place with more care than a tailor. “Now, start easing it back into place,” he directed.
Daniel frowned. Easier said than done when everything insisted on slipping through his fingers.
“How in the hell did your student not notice he was tugging out this woman’s womb?” Horace growled at Adams.
“I—I was removing the placenta,” Wilkins stammered quietly through pale lips.
“And when it came out attached to the uterus, you continued to pull?” Horace demanded.
“I didn’t…” The terror of being responsible for someone’s demise visibly washed over him. Daniel shivered. Every doctor knew the sensation.
“She needs a hysterectomy. Best to remove it entirely,” Adams said, avoiding conversation about his dresser. “You’ll never get it back in place intact, Horace. And if you did, it would prolapse again. We can ligate it.”
Horace checked the patient’s pulse. “We have more time with the anesthesia. She’s breathing easily. Proceed, Gibson.”
If only he could. Daniel had managed only to prod a few millimeters back into place, but salt was drawing out the bloating fluids, and slowly, slowly, with his finagling, the organ retracted farther inside the birth canal.
Horace took a turn when Daniel grew too frustrated, and between the two of them, they finally maneuvered the last bit through the cervix.
Daniel sighed with relief. His shoulders ached with the strain. “Is the patient still stable?” he asked.
“Enjoying a postpartum nap,” Horace said. “Let me finish.”
Daniel ceded his chair to the older man. Only when he turned did he realize how many doctors had crammed into the room.
“You cannot just leave the uterus in place once you return it,” Horace said airily, as if discussing how to prune roses or select a wine for dinner.
“The round ligaments are now degraded from pregnancy and injury. Imagine it in a deflated state, vulnerable to prolapse.” Horace taught as he always did—conversationally.
Even the seasoned surgeons held their breath as they observed.
“Now that Gibson has returned the organ to its rightful place inside the body, we can proceed. This bottle is filled with warm salinized water. I will invert the bottle and release the fluid, effectively inflating the organ to help it hold its shape and position. This will also help the ovaries to return to their place.”
The room erupted into boisterous applause as Horace proceeded. One student removed his hat and dashed it against his leg in disbelief. A hurrah sounded from the back of the mob, growing as orderlies and other students tried to cram inside to see what they’d missed.
“I’ve never seen uterine polyps contribute to a complete external prolapse,” Adams grumbled over the buzz of excitement.
Horace stood slowly, unrolling his spine and taking care to plant his feet. “Now you have.”
“Where did you learn it?” a student demanded, his young eyes sparking with wonder like train wheels on the rails.
Horace grinned as he rinsed the blood from his hands. “A farmer in Edinburgh.”
“Farmer?” Daniel frowned with contracted eyebrows.
“He learned it from his grandfather. One of their heifers pushed her whole sack out with the calf, and they salted it to shrink it and showed me how to use the bottle. Took us three hours to push that uterus back in.”
Horace surveyed the incredulous doctors. “You never dismiss a good idea, no matter where it comes from—even toothless, illiterate farmers.” He settled a heavy stare on Adams, his soft Scottish brogue more distinct than usual. “We doctors do not have a monopoly on knowledge.”
***
Nora stayed up that night, reading and waiting for Daniel. The clock struck eleven, twelve, then one, before she finally heard the distant groan of the front door. Fifteen minutes passed, but he didn’t come upstairs.
Fine.
Putting on her slippers, she tied herself inside her thickest wrapper and abandoned the warmth of the bed, armed with a flickering candle.
She found him in the library with a book. He looked up in surprise and something else—a mixture, perhaps, of equal parts shame and stubbornness.
Setting aside her candle, Nora took the opposite chair, tucking up her feet to keep them warm.
“I was reading, too,” she said. “Don’t tell me I should have been sleeping. You could also use the rest.”
“I wasn’t going to say that.”
She nodded at the book. “Any good?”
His mouth hitched, then fell as he let out a sigh. “I haven’t understood a word.”