Chapter 28
Twenty-Eight
The room was blazing with light, as bright as Lady Morpeth’s room the day Alasdair had first examined her. The curtains were open to allow the sunlight to pour in and join the lamplight. He only hoped the sunshine, the first he had seen in days, was a good omen.
Lady Morpeth and Lady Lyndmouth had been escorted from the room, told there was nothing they could do, they must go and rest in their own rooms.
“Because he will need yer strength afterwards,” Alasdair said with a confidence he did not feel.
Every footman and groom had been called upon. Lord Morpeth was a large man and would need a great deal of strength to hold him down, even with straps tying him to the bed and despite the dangerously large dose of morphia Alasdair intended to give him.
Paterson assisted the head groom with using the leather straps from the stable to secure the delirious Morpeth to the bed.
“I was a surgeon’s assistant for a time. In the Royal Navy, as ye were. The blood willnae bother me. I can help hold Lord Morpeth.”
Alasdair looked at him hopefully. “So ye might be able to help if my right arm fails me with the most delicate work?” Arabella could leave the room and be spared this horror.
“Nae.” Paterson shook his head and held up his right hand. Alasdair cursed silently. He had never noticed Paterson had no right thumb. Paterson grunted and went on, “Cannon. One of ours, misfiring.”
“Ye have done very well without it,” Alasdair said and clapped him on the shoulder. “And I will appreciate yer help in holding.”
“The lad Ewen wanted to come, too, but I locked him in with the cows to keep him away. I must remember to let him out when this is done.”
“Aye.”
Alasdair allowed himself to glance over at Arabella. Like him, she had shrouded her clothes in an apron from the kitchen. For the moment, she was sitting in a chair and drinking tea the butler had brought her.
Dauntless Arabella.
He thought briefly of taking her back into Lord Morpeth’s dressing room and kissing her.
Because he longed for her. And because she would never permit it afterwards, not when she no longer needed him to save Lord Morpeth.
And certainly not when Morpeth died and Alasdair had allowed her to be part of this desperate endeavor.
But kissing would not help sharpen his mind. Or hers.
It was time.
Alasdair took off his sling and gave a large draft of morphia to Morpeth, his head held up and immobile by the largest footman and Paterson. Morpeth swallowed and did not choke. Alasdair only hoped the dose was not so large that it would stop Morpeth’s breath.
His shoulder ached without the sling. He turned to Arabella. He did not know how to address her, so he said what was in his heart.
“Arabella, my love.” She looked up at him, astonishment in her eyes, the same astonishment that had been there when he had first kissed her. Did she know him so little?
“Let us wash our hands.”
“Yes, Alasdair.”
“I dinnae ken why, but washing hands before surgery seems to improve the chances of recovery.”
She watched how he scrubbed his hands with the bar of soap that had been brought from Lady Morpeth’s boudoir by Nurse Gastrell earlier. He rinsed his hands carefully, and she followed him.
“’Tis unnecessary for ye to see this part. I will tell ye if I come to need ye.”
Her face was a bit pale, but she stood taller. “I have to see what you do with your hands in case I must manage something myself.”
They walked together to the bed. Half a dozen men held Lord Morpeth, and half a dozen men held lamps aloft. There was a space for two people on the right side of Morpeth’s abdomen.
Alasdair took a deep breath. He selected a small boning knife. Using his left hand, he created a tension in the skin over the man’s right lower abdomen.
“Hold him, men.”
He cut. The men did very well, and, although Lord Morpeth moaned, his trunk moved very little under Alasdair’s knife. Alasdair knew the morphia helped, but he also thought Morpeth’s strength was near its end.
Alasdair made a large incision, much larger than the organ he hoped to remove. He might need a large surgical field to see well. And, in truth, he had only ever seen one vermiform appendix and did not know if he would be able to find it today.
In addition to the knife, he used some instruments from his bag, tweezers and small forceps, to assist in dissecting through the skin, the scant subcutaneous fat, the fascia, and, finally, the muscle.
It took him quite a long time and despite the coldness of the room, he felt himself covered in sweat.
Throughout it all, he was aware of Arabella at his elbow.
He had feared she would be a distraction, but she was not.
He felt almost as if she were a replacement for Dr. Murray—observing, urging him on silently, supporting his efforts with her own intense absorption in the problem.
A few times he almost turned to ask her opinion before remembering she would have never seen something like this before.
He cut through only a few small vessels, and he was able to cauterize them quickly with his metal tweezers heated in a candle flame so there was some blood, but not much.
Finally, he was through the peritoneum. His shoulder ached. He put the knife and tweezers down and flexed his fingers.
He looked at Morpeth’s face. The man still breathed. Alasdair could see his rapid pulse in his neck. Good.
He looked at Arabella. Her eyes were on him, not on Morpeth, not on the gaping abdomen in front of them. She was not pale. She did not look as if she were about to vomit.
“How is your arm, Dr. Andrews?”
He smiled. “’Tis fine,” he lied.
“You must tell me how and when I can help you,” she said.
“Aye.”
The butler Andrews was at his side, averting his eyes from the surgical site as most of the rest of the men were. He offered Alasdair some water from a cup, and Alasdair drank thirstily.
Alasdair had bent some long-handled metal spoons into hooks, and he put those now into his opening and had men with long arms reaching over and pulling on them to keep his incision open. He asked for more light.
He knew it was likely only minutes, but it felt like he was hours poking in the peritoneal cavity, going over miles of intestine, before he found what he was looking for.
There. A swollen finger of a thing, a worm oozing pus, firm and full of stones, apparently partially perforated.
The vermiform appendix. Yes, here is where it attached to the rest of the bowel.
He must remove it. Then close the stump, the hole in the bowel he would create by cutting off the appendix.
Wash the pus from the area. And then the slow surgical withdrawal from the peritoneal cavity. Closing the layers of fascia, skin.
Alasdair managed to get a firm grasp on the proximal end of the appendix with his forceps.
“Please hold these, Arabella. Dinnae let them go.” Her small hand came into his field of view and took the forceps from him. He seized the distal end of the appendix with his tweezers in his left hand and took the boning knife in his right and cut the appendix free.
Relief.
But just as he did that, his right arm was shaken by a spasm, and he nearly dropped the boning knife.
“Alasdair,” Arabella said, her voice hushed.
He brought the appendix out of the cavity with the tweezers still in his left hand and put the grotesque specimen on a cloth on the mattress next to Lord Morpeth. He also put the tweezers there and used his left hand to take the boning knife from his right hand.
He allowed himself a look at Arabella. “Hold those forceps tightly now. Dinnae let them go. Cutting is done. Now ’tis all sewing.”
“Yes, you had better let me do that, hadn’t you?”
He looked down, and his right hand was trembling uncontrollably.
“I can sew, Alasdair.”
He put the boning knife down. “I’ll have ye thread the needle to start.” He used his left hand to take the forceps from her.
A man holding a lamp on the other side of the bed turned his head to the side and vomited onto the floor.
Arabella found one of the lengths of gut Alasdair had taken from his bag and threaded it onto one of his needles.
“This looks like one of my embroidery needles.” She pulled the gut through the tiny eye, sticking out her tongue and biting on it as she did so.
“Aye, I buy all my needles at ordinary shops. I get odd looks from the shopkeepers.”
“Shall I double the thread?”
“Aye, and knot the two ends together. I dinnae want to risk the gut coming out of the needle before I finish.”
Arabella made a neat knot and looked at him expectantly.
“Ye take the forceps again and give me the needle.”
“Yes.” She took the forceps from his left hand and put the needle flat on his left palm.
But when he attempted to transfer the needle to his right hand, his right hand shook, and he could not get his fingers to close properly around the needle.
He looked at Arabella. Her blue eyes, so trusting, were fixed on his.
She longed to push the dark-red lock away from his left eye. But she did not. She stared at his right eye and waited for him. For his direction.
I am here, Alasdair. Tell me what to do. I can be your hands.
“I think,” he said slowly. “I think ye had better do the sewing. I will tell ye what to do. Ye will do nothing unless I tell ye to do it.”
“Aye,” she said without even thinking about her choice of word.
He smiled briefly. “Dinnae worry. There are plenty of good surgeons who dinnae hail from Scotland.”
But none who are women.
“I must be here, at yer back,” he said and stepped behind her.
She moved into his place, still holding the forceps tightly.
She felt his breath on her left ear, his left arm coming down and taking the forceps from her.
On her other side, his right arm came around her, and he held out his shaking right palm with the threaded needle on it.
She took the needle.
“First,” he said, “do ye see where the forceps are, where I made my cut?”
“Yes.”
“This is the most important part of the sewing, Arabella. We must close this stump so the contents of the gut dinnae leak out into the cavity. That has already started because the appendix was perforated, and ’tis what has made Lord Morpeth so ill.
If we fail in this, the surgery will be for naught. ”
She liked that he said we.
“Do ye ken how to make a stitch like the top of a purse? That we can draw together, and it will be tight?
“Yes, Alasdair.”
“Ye might need the tweezers to move the tissue as ye sew. I try nae to touch the bowel too much. I will stop ye if I see anything amiss.”
“You will tell me if I do something wrong?” She was able to keep her voice from quavering, and, for that, she was glad.
“Since nae a one has ever done this before, in precisely this way, ’twould be a difficult task for me to correct ye.”
Arabella stuck her chin out. He had said that before, but she had not taken it in. She was among the first. Maybe she was the first. She would do this.
She leaned closer and asked for more light. Obliging grooms and footmen raised their lamps to help. She sank the needle into the small tube of flesh, not drawing the thread taut, but leaving a sizable tail. She waited.
“Good. Go on,” Alasdair said.
“How many stitches do you think there should be around the edge, Alasdair?”
He considered. “Five to seven.”
She made six careful circumferential stitches around the stump. She waited.
“Good. Now ye will gently pull on the purse string so it cinches the stump closed.”
She did so.
“Tighter,” and then, “Tighter still,” and then, “Stop and knot it off without losing the tightness of the cinch.” She did so. He came around her, bent over and was able to get the tweezers into his right hand to poke and prod at the stitch.
“Very good. It looks fast. The tissue here is healthy. It should hold.”
Arabella breathed a sigh of relief. He stepped behind her again.
“But this is exactly when new doctors and surgeons make their errors. When they think the most difficult part is done. Ye need to cut the tails of the knot. Ye must nae cut anything else. Nae flesh, nae bowel, nae the stitches ye have just made.”
She picked up the boning knife, and, using the utmost care, she cut the tails of the gut free from the knot. She straightened her back.
“Can we,” she cleared her throat, “send someone to Lady Rebecca Dalrymple and ask for a loan of her smallest embroidery scissors?”
“Aye.” She heard Alasdair dispatch one of the footmen. She started threading the needle with more gut. Alasdair poked at the stitch again and released the forceps.
“I will see if I can wash the pus from this area. Water and linen, please.”
Arabella stepped away, and Alasdair poured water into the cavity and then soaked it up with linen. He did this several times, using clean linen each time. Then he inspected her stitch again.
“’Tis a good ligature, Arabella.”
He looked up at Giles’ face, and she followed his gaze. Giles was pale, and his breathing was shallow.
“I cannae give him more morphia. Ye men will have to continue to hold him fast as the wound is closed.”
Under Alasdair’s direction, Arabella used a running stitch to close the first layer of fascia. The footman came back with Rebecca’s little gold scissors, and Arabella felt much more at ease cutting the tails of the knot off with the scissors as opposed to the sharp boning knife.
Giles did not move. He did not cry out.
She repeated her work with the next layer of fascia, her and Alasdair’s left hands working to bring the fascia together as she stitched.
And then, finally, blessedly, the skin. Alasdair had moved away from her, trusting she could tie off the gut and clip it. He was at the head of the bed, feeling Giles’ pulse at his neck.
Arabella had a sinking feeling. Had all this been for nothing?
“He is warm. He still has a pulse. He still breathes,” Alasdair said.
A ragged cheer erupted from the men around the bed.
Arabella stepped away and quickly found a chair. She did not want to faint. And Alasdair was at her side, kneeling, taking her pulse.
“I think I need some luncheon,” she said.
He put his hands in her bloody ones.
“Ye are very brave,” he said. “And ye have good hands. A strong stomach. A stout heart.”
“Thank you for trusting me. What now?”
“A bath and luncheon for ye. And rest.” He stood and released her hands.
“What now for Giles?”
“He sleeps. And I watch and wait.”