Chapter 27 #2
Alasdair kept his face impassive. “I am hoping ’tis a small ureteral stone, my lord.
” But he knew it was not. The man had florid peritonitis.
But it was not a lie to say what he hoped.
The alternative was so much worse. “A small stone, much smaller than a bladder stone, moving from the kidney to the bladder. They cause excruciating pain. Like giving birth. But when the stone passes, the pain goes away.”
A frowning Morpeth searched his face. “You know it’s not a stone.”
“We will wait and see. I will attend on ye and see if yer condition improves or worsens.”
“Andrews,” Morpeth said peremptorily.
“Yes?” “Aye?” Alasdair and the butler answered simultaneously.
Morpeth turned his head to the butler. “Go get the doctor some kind of cloak so he can stay warm. He is not burning with fever like I am. And I would prefer my physician not to succumb to the cold while he is tending to me.”
“Yes, my lord,” the butler Andrews said, and after Lady Lyndmouth kissed Morpeth once on the lips, she rose and left the room with the butler.
The two men, patient and physician, were alone.
“I would,” Alasdair cleared his throat, “like to inform yer wife of yer condition.”
“No.”
“My lord—”
“Dr. Andrews, it does not inspire confidence that you want to tell her anything. You must think this is more serious than you let on. But I will not have my wife worried until she must be.”
“Aye, my lord.”
Alasdair sat in a chair and prepared, as he had so many times before, to wait through the night.
The butler Andrews quickly returned with a cloak and then left again, saying he would arrange for men to go to the carriage at first light and Dr. Andrews should ring if he thought of anything he needed. Lady Lyndmouth was back in half an hour, clutching two bottles of laudanum.
“We must hope,” she said, smiling thinly at Alasdair, “the marchioness still has enough for her own use so you don’t have another patient on your hands, Doctor. Because I am not giving these bottles back.”
At midnight, Morpeth consented to his first dose of laudanum.
Two hours before dawn, Lady Morpeth came into the room through a door in the wall that lay behind the head of Lord Morpeth’s bed. Nurse Gastrell supported her with one arm.
“Doctor,” Morpeth gasped as Lady Morpeth drew near. He looked accusingly at Alasdair.
“I could hear, Giles,” Lady Morpeth said as she approached the bed. “I could hear you in pain, the doctor’s voice, Lady Lyndmouth’s voice.” She fixed Lady Lyndmouth now in her gaze. “My bed is just there, on the other side of the wall. I can always hear what passes in this room.”
Lady Lyndmouth’s perfect composure was shaken. “My lady—”
Lady Morpeth raised her hand. “No. Not now.” She turned to Alasdair. “I am glad you are here, Dr. Andrews.”
He bowed. “Yer butler Andrews has said some men are going soon to fetch my bag from the carriage. Once the morphia in my bag thaws, we can give some to yer husband. ’Tis more potent than the laudanum.”
Morpeth raised his head. “No!”
Lady Lyndmouth instinctively lunged forward to touch his face and then stopped and withdrew her hand.
“Please, Lady Lyndmouth,” Lady Morpeth said and stepped away from the bed.
She murmured to her nurse, and Nurse Gastrell guided her to a chair, and Lady Morpeth sat down heavily.
“Please give him comfort. I would not deprive him of that since I cannot give it to him myself. Like so many other things a wife should provide.”
As he had so many other times in his career, Alasdair marveled at the resilience and infinite courage of the human female.
Lord Morpeth lay in his bed, rigid, covered in sweat, whimpering in pain.
The bedchamber continued to have three women in it. A weak Lady Morpeth, sitting in a chair, determined not to leave her husband’s room. Nurse Gastrell with her, of course. And Lady Lyndmouth was also there, clutching Lord Morpeth’s hand, changing the wet cloths on his forehead, murmuring to him.
Alasdair had never treated a patient where the mistress and the wife were both present at the same time. There was no etiquette governing this. He would have to make it up as he went.
He re-examined Morpeth before turning so he faced both Lady Lyndmouth and Lady Morpeth.
“I fear ’tis typhlitis,” he said.
There was a sound behind him. He turned. It was the butler Andrews, much the worse for wear like all of them in the room. He was clearing his throat and coming in the door with the basin of snow Alasdair had requested ten minutes earlier. He looked at Alasdair apologetically.
Arabella was behind him. “What is typhlitis?”
She had slept fitfully, weeping and then dreaming and then weeping some more.
She did not want to get out of bed, to begin the first day of the lonely future she had conjured for herself in such detail last night, but she forced herself to rise and dress.
She started downstairs for breakfast but saw the butler Andrews in the hallway with a basin of snow.
She worried it was for Alasdair’s shoulder, but Andrews told her that her husband’s shoulder was fine.
Her trunks had been recovered from the abandoned carriage and would be brought to her room shortly so she might have fresh clothes.
She stayed the butler with her hand on his arm.
“But my husband is well?”
“Yes, Mrs. Andrews, but I must deliver this snow to him before it melts.”
She wondered what need Alasdair had of snow if his shoulder was fine. She followed the butler Andrews to this room.
Alasdair, she noted, did not look tired. He was in his element. But he stiffened when he heard her question and saw her.
“Miss L— Mrs. Andrews, ye should nae be here.”
“Is it contagion?”
“Nae,” Alasdair said abruptly.
“Then why should I not be here? I can be of use.” To you, she added in her head.
“’Tis nae seemly.”
Arabella looked at Lady Lyndmouth. She was holding Giles’ hand, staring at him intently, her lips moving, perhaps in prayer. She looked at Lady Morpeth and the nurse.
She got very close to Alasdair and said, “Along with two of the other ladies here, I already have knowledge of Lord Morpeth’s body. You know I have no care for what is seemly, Dr. Andrews.”
Alasdair’s face went white. A muscle at his jaw flexed. He held himself very still. Oh, why had she reminded him of that? She had no right to hurt him, no matter how he had hurt her.
“Typhlitis is an inflammation of the bowel,” he said.
“There is an outpouching of the intestine, here,” he pointed to his own right lower abdomen with his good left hand, “and ’tis called the vermiform appendix.
It can become inflamed—sometimes because ’tis filled with stones—and it can rupture.
Parkinson and Wegeler have described it. ”
“Then what happens?” Arabella asked.
He took her arm and drew her aside, away from the sick bed and Lady Lyndmouth and Lady Morpeth.
“Some die. Some get better.”
“How many get better?”
“Many. But I dinnae ken how many get well when they are as ill as Lord Morpeth is.” Alasdair kept his voice and face calm, but Arabella could sense the situation was grave.
“What is the treatment?”
“Morphia and laudanum. We keep his fever down with cold compresses made with snow and ice.”
Lady Lyndmouth spoke with urgency, “There must be something that can be done!”
Alasdair turned to her. “We will give more morphia.”
“I do not mean easing his pain. I mean curing him.”
“There have been . . . but ’tis dangerous.”
“Tell us,” Lady Lyndmouth begged.
“There have been attempts to remove the appendix with surgery.”
“Where has this been done?” asked Lady Morpeth.
“In London, but the appendix had herniated into the scrotum. A much easier surgery. In France, but the patient died.”
“Giles is a man who thrives on risk. He will not turn away from risk now, I believe. Not when the stakes are his life on either side,” Lady Morpeth said.
“I am nae the man for it,” Alasdair said. Arabella admired his mild voice, his stoic expression.
“We will send for another doctor,” said Lady Lyndmouth, her own voice tinged with panic.
The butler Andrews spoke up, “The roads are still impassable.”
“I dinnae ken there are many doctors who are familiar with the history of the surgery and disease,” Alasdair said. “I am because I had a patient die this way five years ago.”
“Did you operate on him, Doctor?”
“I did. The surgery was a failure. And I caused him a great deal of pain before he died. I should have let him alone.”
“Primum non nocere,” Arabella said without thinking.
Alasdair glanced at her, and she wanted to tell him how much she admired his courage. How bravely he faced death every day in his profession.
“I do not understand,” said Lady Lyndmouth angrily. “He is going to die.”
Lady Morpeth stood, clutching her nurse’s arm. “I must talk to my husband, and we will see what he wants you to do.” She approached the bed. She leaned forward and spoke in Giles’ ear. No one else could hear what she said.
Giles’ eyes opened and sought out his wife’s face hovering above him.
“Dr. Andrews said that?” he asked, and there was a smile even as he gasped in pain.
“The doctor said maybe. From . . . that time three months ago. Maybe.”
Giles’ hands fumbled at Lady Morpeth’s and grabbed them and held them to his lips and kissed them. Arabella was strangely moved by this. The man who was the villain in her own life, so tender with his wife.
“Giles, you must listen now,” Lady Morpeth said gently. “Dr. Andrews says you have a diseased bowel. There is a surgery to cut away the bad part. Very few people have had the surgery. Even fewer have survived.”
“None,” Alasdair’s voice cut through. “Nae of the type of surgery that Lord Morpeth requires.”
“What do you want?” Lady Morpeth asked, but the man had closed his eyes. “Giles!”
He opened his eyes. “As in everything else, I leave it to you, my wife.”