Tess Gerritsen - The Bone Garden - A Novel

It was certainly obvious to everyone else, thought Norris. There'd been no student so unskilled with a knife, no one so ill prepared to tackle the grim realities of their chosen profession. The anatomy lab had been just a taste of what a physician faced. There would be far worse ordeals to come: the stench of typhus, the shrieks from the surgeon's table. Dissecting a corpse was nothing; the dead don't complain. The real horror was in living flesh.

They heard a knock at the front door. Mrs. Furbush, the housekeeper, scurried down the hall to greet the new visitor.

— Oh, Dr. Sewall! Thank heavens you've arrived! Mrs. Lackaway is frantic, and Dr. Grenville has already bled him twice, but it has not touched the fever, and he is anxious for your opinion. —

— I'm not sure that my skills are yet needed. —

— You may change your mind when you see his hand. —

Norris glimpsed Dr. Sewall as he walked past the parlor doorway, carrying his instrument bag, and heard him climb the stairs to the second floor. Mrs. Furbush was about to follow him upstairs when Wendell called out to her.

— How is Charles? —

Mrs. Furbush looked at them through the doorway, and her only answer was a sad shake of the head.

Edward murmured, — This is starting to look quite bad. —

From upstairs came the sound of men's voices, and Mrs. Lackaway's sobbing. We should leave, Norris thought. We're intruding on this family's grief. But his two companions made no move to depart, even as the afternoon wore on and the parlor maid brought them another pot of tea, another tray of cakes.

Wendell touched none of it. He sank into an armchair and stared with fierce concentration into the fire. — She had childbed fever, — he said suddenly.

— What? — said Edward.

Wendell looked up. — The cadaver he dissected that day, when he cut himself. It was a woman, and Dr. Sewall said she died of childbed fever. —

— So? —

— You saw his hand. —

Edward shook his head. — A most gruesome case of erysipelas. —

— That was gangrene, Eddie. Now he's febrile and his blood is poisoned, by something he must have acquired with one small nick of the knife. Is it only by chance, do you think, that the woman, too, died of a fulminating fever? —

Edward shrugged. — Many women die of it. There've been more this month than ever. —

— And most of them were attended by Dr. Crouch, — said Wendell quietly. Once again, he stared into the fire.

They heard heavy footsteps descend the stairs and Dr. Sewall appeared, his hulking frame taking up the entire doorway. He looked over the three young men gathered in the parlor, then said, — You, Mr. Marshall! And Mr. Holmes, too. Both of you come upstairs. —

— Sir? — said Norris.

— I need you to hold down the patient. —

— What about me? — said Edward.

— Do you really think you're ready for this, Mr. Kingston? —

— I— I believe so, sir. —

— Then come along. We can certainly make use of you. —

The three young men followed Sewall up the stairs, and with every step Norris's dread mounted, for he could guess what was about to happen. Sewall led them along the upstairs hallway, and Norris caught a fleeting glimpse of family portraits on the wall, a long gallery of distinguished men and handsome women. They stepped into Charles's room.

The sun was setting, and the last wintry light of afternoon glowed in the window. Around the bed, five lamps were burning. At their center lay a ghostly pale Charles, his left hand concealed beneath a drape. In a corner, his mother sat rigid with her hands balled tightly in her lap, her eyes aglow with panic. Dr. Grenville stood at his nephew's bedside, his head drooped in weary resignation. A row of surgical instruments gleamed on a table: knives and a saw and silk sutures and a tourniquet.

Charles gave a whimper. — Mother, please, — he whispered. — Don't let them. —

Eliza turned desperate eyes to her brother. — Is there no other way, Aldous? Tomorrow he might be better! If we could wait— —

— If he had shown us his hand earlier, — said Grenville, — I might have been able to arrest the process. A bleeding, at the outset, might have drained the poison. But it's far too late now. —

— He said it was just a small cut. Nothing of significance. —

— I have seen the smallest cuts fester and turn to gangrene, — said Dr. Sewall. — When that happens, there is no other choice. —

— Mother, please . — Charles turned his panicked gaze to his classmates. — Wendell, Norris— don't let them do this. Don't let them! —

Norris could offer no such promises; he knew what had to be done. He stared at the knife and bone saw laid out on the table and thought: Dear God, I don't want to watch this. But he stood firm, for he knew his assistance was vital.

— If you cut it off, Uncle, — said Charles, — I'll never be a surgeon! —

— I want you to take another draught of morphine, — said Grenville, lifting his nephew's head. — Go on, drink it. —

— I'll never be what you wanted! —

— Drink it, Charles. All of it. —

Charles settled back on the pillow and gave a soft sob. — That's all I ever wanted, — he moaned. — That you be proud of me. —

— I am proud of you, boy. —

— How much have you given him? — asked Sewall.

— Four draughts now. I don't dare give him more. —

— Then let's do it, Aldous. —

— Mother? — pleaded Charles.

Eliza rose and tugged desperately at her brother's arm. — Could you not wait another day? Please, just another day! —

— Mrs. Lackaway, — said Dr. Sewall, — another day will be too late. — He lifted the drape that covered the patient's left arm, revealing Charles's grotesquely swollen hand. It was taut as a balloon, and the skin was greenish black. Even from where Norris stood, he could smell the rotting flesh.

— This has gone beyond simple erysipelas, madam, — said Sewall. — This is wet gangrene. The tissue has necrosed, and in just the short time I have been here, it has swollen even larger, filling with poisonous gases. Already there is red streaking here, up the arm, toward the elbow, an indication that the poison is spreading. By tomorrow, it may well be up to the shoulder. And then nothing, not even amputation, will reverse it. —

Eliza stood with her hand pressed to her mouth, her stricken gaze on Charles. — Then there is nothing else to be done? No other way? —

— I have attended too many cases like this. Men whose limbs were crushed in accidents or pierced by bullets. I've learned that once wet gangrene sets in, there is only a finite time in which to act. Too many times I've delayed, always to my regret. I've learned that it's better to amputate sooner than later. — He paused, his voice softer, gentler. — The loss of a hand is not the loss of a soul. With luck, you will still have your son, madam. —

— He is my only child, — Eliza whispered through her tears. — I cannot lose him, or I swear I shall die. —

— Neither of you will die. —

— Do you promise it? —

— Fate is always in God's hands, madam. But I will do my best. — He paused and glanced at Grenville. — Perhaps it would be best if Mrs. Lackaway stepped out of the room. —

Grenville nodded. — Go, Eliza. Please. —

She lingered for a moment, staring hungrily at her son, whose eyelids were drifting shut in a narcotic daze. — Let nothing go wrong, Aldous, — she said to her brother. — If we lose him, there will be no one to comfort us in our old age. No one to take his place. — Stifling a sob, she left the room.

Sewall turned to the three medical students. — Mr. Marshall, I suggest you remove your topcoat. There will be blood. Mr. Holmes, you will hold down the right arm. Mr. Kingston, the feet. Mr. Marshall and Dr. Grenville will take the left arm. Even four draughts of morphine will not be enough to mask this pain, and he will fight us. Complete immobilization of the patient is vital to my success. The only merciful way to do this is quickly, with no hesitation and no wasted effort. Do you understand, gentlemen? —