Simon Scarrow: Britannia

Cato watched with morbid fascination as the surgeon reinserted the bronze instrument, eased it over the flat arrowhead and twisted it to gain purchase.

‘Here we go,’ Pausinus muttered as he began to draw the arrowhead towards the incision. The iron was coated with blood, which made it slippery, and the extractor lost its grip. The surgeon patiently took hold of the missile again and continued to draw it out until it stood proud of the incision, between the levers in Cato’s hands. As soon as he could see enough of the shaft to get his finger and thumb around it, Pausinus lowered his instruments and eased the shaft out of the incision. Another eight inches of the gore-coated wood emerged, and then, with a soft plop, it came free and the surgeon held it up as he straightened his back. ‘Very nasty indeed.’

Cato nodded as he examined the wide, flat iron head with its nipped-off barbs. It was easy to see now why it had been necessary to follow the procedure that Pausinus had chosen. Any attempt to pull the arrow out the way it had gone in would have torn Macro’s thigh badly, ripping apart muscle and blood vessels.

‘Now we need to clean out and close up,’ Pausinus announced. Taking some lint from the medicine chest, he placed it in a small brass bowl and then soused it in vinegar. When it had soaked up as much of the liquid as it was going to, he took it out and packed it tightly into the incision, then did the same for the entry wound.

‘You can remove the levers now, sir.’

Cato carefully worked the hooks free and put the slender bronze rods down on the table. Meanwhile Pausinus soaked two sponges and held them out for the orderly. ‘Put pressure on the wounds until I say.’

‘Yes, sir.’

As the orderly took over, the surgeon stood up and rolled his shoulders. ‘That went as well as it could. Managed to avoid doing any further damage. Provided the wound does not become mortified, and he rests and lets it heal, he should make a good recovery. He’s going to find the leg a little stiff for a few months, but that’s to be expected. You don’t take a hunting arrow in the thigh and shrug it off. Is he the kind of man who is likely to make a bad bed-patient?’

Cato made a face. ‘You can’t imagine . . .’

‘Well then, you must order him to do as I say, sir. Just because he is an officer doesn’t entitle him to jeopardise my hard work. I dare say you will need to issue him with strict instructions to do as he’s told until he has recovered.’

‘I will see to it.’ Cato could imagine how that was going to go down with Macro. Still, orders were orders and his friend would just have to endure it.

‘Then I’ll arrange a bed for him in the dormitory.’ Pausinus turned his attention back to his medicine chest and took out a needle and a length of twisted gut. Once the needle was threaded, he added three closed pins to his prepared materials. ‘The entry wound is small enough to suture,’ he explained. ‘The fibulae are to close up the incision of the exit wound. The beauty of them is that you can pop them in and out if you need to examine the wound. Of course, it hurts like hell, but there’s no getting round that. All right, take the sponges off.’

The orderly released the pressure on the wounds and tossed the sponges into the bucket while Pausinus gently extracted the lint. He smiled. ‘There! Now that’s left things nice and clean. No visible clots. There will be some, there always are, but it will all come out when we drain the pus from the wound over the next few days. It won’t look pretty. There’ll be some inflammation. That’s normal, and a little of it is good. Too much might indicate mortification. If that happens . . .’ He sucked his teeth. ‘You might want to make an offering to Asclepius on the centurion’s behalf.’

‘I’ll see to it personally.’

‘Good. Then let’s finish the job.’ Pausinus pinched the torn flesh around the entry wound together and poked the point of the needle through Macro’s skin. ‘You have to go deep enough so that there’s no chance of the stitches tearing. I use a twisted sheepgut thread. It’s strong enough for the job.’ He put in four stitches and then cut the thread and tied it off. Next he turned his attention to the incision and closed it up with the fibulae, before taking one off to make an adjustment and then poking the point through Macro’s flesh one last time. He nodded with satisfaction. ‘There. Orderly, get a dressing on that.’

Cato looked on as the linen was wrapped round Macro’s thigh. ‘And now?’

Pausinus crossed the treatment room to the bowl and ewer on a small table in the corner. He washed the blood off his hands as he addressed his commanding officer. ‘Now? We have to wait and see if your friend gets better. Aside from the danger of mortification of the wound, he’s going to be in a lot of pain. Usually I’d give my patients a few drops of poppy tears. It’s easy enough to come by in the eastern provinces, but rare as a boil on Venus’s backside here in Britannia. I exhausted the last of my stock months ago. So the centurion will have to settle for mandragora root soaked in heated wine. It’ll dull the pain and make him drowsy. If he’s sleeping then he can’t disturb his wounds too much.’

‘How soon will we know if he’s going to recover?’

The surgeon finished rinsing his hands and then dried them on a strip of linen. ‘By the fifth day, as a rule. By then, the degree of inflammation will tell us all we need to know. If it’s bad, then there’s likely to be something left in the wound that’s causing the problem. In which case I’ll have to go back in, clean it out with more vinegar, followed by warm honey in water, and then stitch him up again.’

‘I see.’ A thought occurred to Cato. ‘And if there’s no inflammation, then I can take it that Macro will be on the mend.’

‘Hardly. If there’s no indication of inflammation at all, then that’s almost always a bad sign.’

‘It is?’ Cato could not follow the logic of the surgeon’s statement. ‘Why’s that?’

‘It means the flesh is dying. Although if that’s the case, I’ll be able to tell from the smell coming from the wound. In which case, all I will be able to do is make him as comfortable as possible before he dies.’ Pausinus stood over his patient as the orderly turned Macro on to his back. He tapped a finger on the centurion’s shin. ‘If the wound was lower down the limb, I would be able to cut away the dead flesh, and a small amount of good flesh to be safe, saw through the bone and amputate the leg. His soldiering days would be over, but he would stand a fair chance of surviving that. Against certain death if we didn’t cut it off. But this high up it is tricky. The procedure takes longer and there’s more loss of blood.’ He reflected for a moment and shrugged. ‘So let’s pray that Asclepius is looking kindly on us and Centurion Macro makes a full recovery.’

Cato was growing a little tired of the surgeon’s manner and rounded on him with a cold expression. ‘I am making Macro’s recovery your personal responsibility. You will see to it that he is given constant attention and that his needs are met. Food, drink and toilet. He is the kind of officer it is extremely difficult to replace, and the army needs him. I will be displeased, to say the very least, if he dies. I can always find a place in the front line for an ex-army surgeon. Do I make myself clear?’

Pausinus met his stare unflinchingly. ‘There’s no need for threats, sir. I take my responsibilities every bit as seriously as you do. And I don’t favour any particular one of my patients. They all get the best I can manage, regardless of rank. I give you my word on that.’

Cato searched his face for any sign of insincerity, but there was none and he relented. ‘Very well. Keep me informed of his progress.’