Arnold blinked, and Jamie would have smiled had he not been worrit for the lass—she was fierce, but she looked pale, and her fists were clenched in the cloth of her apron. It might have been to keep her from slapping the governor, but he rather thought it was to hide the fact that her hands were trembling—and he realized with a shock that she was afraid.
Not afraid of the circumstance or any future danger—afraid that she couldn’t do what she knew she must.
His heart smote him at the thought. He took Arnold firmly by the upper arm, compelling him toward the stair.
“Aye,” he said abruptly to Claire. “We’ll take the man to Lord John’s house, and whilst ye fettle him for the job there, I’ll fetch what ye need from the shop. The general will help me to move him.”
Arnold’s stiff resistance ceased abruptly as he took Jamie’s meaning.
“Yes,” he said. “Yes, I—” A long moan from above interrupted him, and Claire’s face tightened.
“There isn’t time,” she said, quite calmly. “Miss Shippen—Peggy. Fetch me the largest knife you have in the kitchen, and do it now. Have your servants bring more hot water and cloth for bandages. A strong sewing needle and black thread.” Her eyes sought Jamie’s, and he let go of the governor at once and went to her.
“Ye’re all right, lass?” he said quietly, taking her elbow.
“I am,” she said, and squeezed his hand briefly. “This is very bad, though. I don’t—I’m sorry, I’ll need you to help hold him.”
“I’ll be fine,” he said. “Dinna be worrit. Only do what ye need to do. I promise I willna vomit on him while ye’re taking off his leg.”
He hadn’t actually meant that to be funny, and was surprised—but pleased—when she laughed. Not much of a laugh, but the tension in her arm relaxed, and her fingers were steady on his.
He could tell the minute they entered the room. He didn’t know what it was had changed, but clearly Claire had heard the beating of the wings of Death from the floor below; he could sense them now. Bledsoe was still conscious, but barely so; a slice of white showed as one eyelid lifted at their entrance.
“We’re here, man,” Jamie whispered, sinking to his knees and grasping Bledsoe’s hand. It was cold to the touch and clammy with sweat. “Dinna fash, we’re here. It’ll be done soon.”
There was a strong smell of laudanum in the air, together with the stink of tar and blood and burnt hair. Claire was on the other side of the bed, holding Bledsoe’s wrist, her eyes flickering from his slack face to the mangled leg.
“Sepsis,” she said, quietly but in a normal voice. “Do you see the red line there?” She gestured at the wounded leg, and Jamie saw it clearly: a streak of an ugly dark-red color that he thought hadn’t been there before—or perhaps it had, and he’d not noticed. The sight of it made the fine hairs ripple on his shoulders, and he shifted uneasily.
“Blood poisoning,” Claire said. “Bacteria—germs—in the blood. It moves very fast, and if it should get into the body proper . . . there’s nothing I can do.”
He looked up sharp, hearing a tiny tremor in her voice.
“But before that, ye might? There’s a chance?” He tried to sound encouraging, though the thought of the alternative made the gooseflesh that much worse.
“Yes. But it isn’t a good one.” She swallowed. “The shock of the amputation may well kill him on the spot. And if it doesn’t, there’s still a great chance of infection.”
He stood up then and came round the bed to her, taking her gently but solidly by the shoulders. Her bones were close to the surface, and he thought her feelings were, too.
“If he’s got a chance, we must give it to him, Sassenach.”
“Yes,” she murmured, and he felt the shiver go all through her, though the air was hot and close. “God help me.”
“He will,” Jamie whispered, folding his arms briefly round her. “So will I.”
I WAS STANDING in the wrong place. The fact that I understood what was happening to me didn’t help at all.
A trained surgeon is also a potential killer, and an important bit of the training lies in accepting the fact. Your intent is entirely benign—or at least you hope so—but you are laying violent hands on someone, and you must be ruthless in order to do it effectively. And sometimes the person under your hands will die, and knowing that . . . you do it anyway.
I had had them bring more candles, though the air in the room was already suffocating. The miasma of humidity and slowly evaporating sweat made the light of the candelabra fill the chamber with a gentle, romantic glow; just the thing for a dinner party filled with wine, flirtations, and dancing.
The wine could wait, and any surgeon dances with death routinely. The problem was that I’d forgotten the steps and was flirting with panic.
I bent to check Tench’s heart rate and respiration. He was breathing shallowly but fast. Lack of oxygen, severe blood loss . . . and I felt my own chest tighten, heaving for air, and stood up, giddy, heart hammering.
“Sassenach.” I turned, hand on the bedpost, to see Jamie watching me, eyebrows drawn together. “Are ye all right?”
“Yes,” I said, but my voice sounded queer even to my own ears. I shook my head hard, trying to clear it. Jamie came close to me and put his hand on mine, where it rested on the bedpost. It was big and steady, and it helped.
“Ye willna help him, lass, if ye faint in the midst of it,” he said, low-voiced.
“I’m not going to faint,” I said, made a bit testy by anxiety. “I just—I—I’m fine.”
His hand fell away, and after a long, searching look into my face, he nodded soberly and stepped back.
I wasn’t going to faint. Or at least I hoped not. But I was trapped there in that close, hot room, smelling blood and tar and the scent of myrrh in the laudanum, feeling Tench’s agony. And I could not do that. I couldn’t, I mustn’t.
Peggy hurried in, a maidservant behind her, several large knives clutched to her bosom.
“Will one of these do?” She laid them in a clinking heap at the foot of the bed, then stood back, gazing anxiously at her cousin’s pale, slack face.
“I’m sure one will.” I stirred the heap gingerly, extracting a couple of possibilities: a carving knife that looked sharp, and a big, heavy knife of the sort used for chopping vegetables. And, with a vivid recollection of what it felt like to sever tendons, I picked up a paring knife with a freshly sharpened, silvered edge.
“Do you butcher your own meat? If you have something like a bone saw . . .”
The servant went as pale as a black man reasonably can, and went out, presumably to acquire one.
“Boiling water?” I asked, brows raised.
“Chrissy is bringing it,” Peggy assured me. She licked her lips, uneasy. “Do you—mmm.” She broke off, narrowly avoiding saying what she so plainly thought: “Do you know what you’re doing?”
I did. That was the trouble. I knew much too much about what I was doing—from both sides.
“Everything will be fine,” I assured her, with a decent appearance of calm and confidence. “I see we have needles and thread. Would you take the biggest needle—a carpet needle, perhaps—and thread it for me, please? And then a couple of smaller ones, just in case.” Just in case I had time and opportunity to actually capture and ligate blood vessels. It was much more likely that the only choice I would have was cautery—a brutal searing of the fresh stump to stanch the bleeding, for Tench didn’t have enough blood left to be able to spare any of it.
I needed to be alone in my head, in a calm, clear place. The place from which I could see everything, sense the body under my hand in all its particularities—but not be that body.
I was about to disjoint Tench Bledsoe’s leg like a chicken’s. Throw away his bones and flesh. Sear the stump. And I felt his fear in the pit of my stomach.
Benedict Arnold had come in with an armload of firewood and a silver table knife in one hand—my cautery iron, if there wasn’t time to stitch. He set them down on the hearth, and the butler began to poke up the fire.
I closed my eyes for an instant, trying not to breathe through my nose, shutting out the candle glow. Denny Hunter had operated on me by candlelight; I remembered watching through a haze of eyelashes, unable to open my eyes more than a crack, as each of the six big candles was lit, the flames rising up pure and hot—and smelling the small iron heating in the brazier beside them.
A hand touched my waist, and, gulping air, I leaned blindly into Jamie.
“What’s wrong, a nighean?” he whispered to me.
“Laudanum,” I said, almost at random. “You don’t—you don’t lose consciousness altogether. It makes the pain go away—not stop, just seem not connected to you—but it’s there. And you . . . you know what’s happening to you.” I swallowed, forcing down bile.
I felt it. The hard probe jabbing its way into my side, startling. The remarkable sense of cold intrusion, mingled with incongruous faint warm echoes of internal movement, the forceful jabs of a child in the womb.
“You know what’s happening,” I repeated, opening my eyes. I found his, looking down at me with gentleness.
“I ken that, aye?” he whispered, and cupped my cheek with his four-fingered hand. “Come and tell me what ye need me to do, mo ghràidh.”
THE MOMENTARY PANIC was subsiding; I forced it aside, knowing that even to think about it was to slide headfirst back into it. I laid a hand on Tench’s injured leg, willing myself to feel it, find the truth of it.
The truth was all too obvious. The lower leg was a complete wreck, mechanically, and so compromised by septicemia that there was no chance of saving it. I was searching desperately for a way to save the knee; having a knee made a tremendous difference in the ability to walk, to manage. But I couldn’t do it.
He was far gone from injury, blood loss, and shock; he was a stubborn man, but I could feel his life flickering in his flesh, dying away in the midst of infection, disruption, and pain. I could not ask his body to withstand the longer, painstaking surgery that would be necessary to amputate below the knee—even if I felt sure that such an amputation would be sufficient to forestall the advancing septicemia, and I didn’t.
“I’m going to take his leg off above the knee,” I said to Jamie. I thought I spoke calmly, but my voice sounded odd. “I need you to hold the leg for me and move it as I tell you. Governor”—I turned to Arnold, who stood with a reassuring arm about Peggy’s Shippen’s waist—“come and hold him down.” Laudanum alone wasn’t going to be enough.
To his credit, Arnold came instantly and laid a hand against Tench’s slack cheek for a moment in reassurance before taking firm hold of his shoulders. His own face was calm, and I remembered the stories I’d heard of his campaigns into Canada: frostbite, injury, starvation . . . No, not a squeamish man, and I felt a small sense of reassurance from the presence of my two helpers.
No, three: Peggy Shippen came up beside me, pale to the lips and with her throat bobbing every few seconds as she swallowed—but jaw set with determination.
“Tell me what to do,” she whispered, and clamped her mouth shut hard as she caught sight of the mangled leg.
“Try not to vomit, but if you must, turn away from the bed,” I said. “Otherwise—stand there and hand me things as I ask.”
There was no further time for thought or preparation. I tightened the tourniquet, grasped the sharpest knife, nodded to my helpers, and began.
A deep incision, fast, around and across the top of the leg, cutting hard down to expose the bone. An army surgeon could lop off a leg in less than two minutes. So could I, but it would be better if I could manage to cut flaps to cover the stump, could seal the major vessels. . . .
“Big needle,” I said to Peggy, holding out my hand. Lacking a tenaculum to seize the large blood vessels that snapped back into the flesh when severed, I had to probe for them with the point of the needle and drag them out, anchor them into the raw, exposed flesh, and then ligate them as fast as I could, whipping thread round them with one of the smaller needles and tying it off. Better than cautery, if there was time . . .
Sweat was running into my eyes; I had to dash it away with my bared forearm; my hands were bloody to the wrist.
“Saw,” I said, and no one moved. Had I spoken aloud? “Saw,” I said, much louder, and Jamie’s head twisted toward the implements on the table. Leaning heavily on Tench’s leg with one hand, he stretched to grab the saw from the table with the other.
Where was Peggy? On the floor. I saw the bloom of her skirt from the corner of my eye and felt vaguely through the floorboards the steps of a servant coming to haul her out of the way.
I groped for another suture, blind, and the jar of brandy in which I’d stowed them tipped, spilling on the sheet and adding its sweet stickiness to the atmosphere. I heard Jamie gag, but he didn’t move; his fingers squeezed the thigh hard above the tourniquet. Tench would have bruises there, I thought idly. If he lived long enough for his capillaries to bleed. . . .
The saw had been made to disjoint hogs. Sturdy, not sharp, and not well kept—half the teeth were bent, and it jumped and skittered in my hand, grating over the bone. I clenched my teeth and pushed, my hand slipping on the handle, greased with blood and sweat.
Jamie made a deep, desperate noise and moved suddenly, taking the saw from my hand and nudging me aside. He gripped Tench’s knee and bore down on the saw, driving it into the bone by main force. Three, four, five dragging strokes, and the bone, three-quarters sawn through, made a cracking noise that jolted me into action.
“Stop,” I said, and he did, white-faced and pouring sweat. “Lift his leg. Carefully.” He did, and I made the cut from below, long, deep strokes of the knife deepening the incision at an angle to make the flap, joining the cut with the upper incision. The sheet was wet and dark with blood—but not too much. Either the tourniquet was holding, or the man had so little blood left to lose . . .
