The Americans

by John Jakes

  It was McCauley’s shot that killed the older doctor. Almost immediately, Corso fired at Jo. She was hit as she ran to the fallen physician. She rose on tiptoe, an astonished expression on her face. Her hands groped toward a small black hole in the lower right side of her apron.

  She staggered against Vlandingham’s desk, breathing hard and blinking rapidly. Will had the Adams in his right hand now. Corso tore down one of the curtains with his free hand, flinging it behind him and laughing as he pointed the muzzle of his gun at Will through the swirling smoke—

  Will fired.

  Corso’s derby flipped up in the air and over the back of his head. A red cavity had been scooped from the center of his forehead.

  “Ahhh!” He seemed to be struggling for breath. Parallel streams of blood ran down the sides of his nose and dripped into his open mouth as he toppled backward into the passage.

  Behind Will, Drew was panting and struggling with someone. Will spun and saw Drew break free of McCauley’s grip and lurch toward one of the equipment cabinets. Mrs. Grimaldi and Tomaso were getting to their feet. Jo was bending forward, her arms crossed over her stomach as if to contain her pain.

  Drew managed to open the cabinet with his unbandaged left hand. Instruments came clattering out. Slitted eyes shining with enjoyment, Dave McCauley grabbed Drew from behind. With his other hand he brought a huge old horse pistol up to the back of Drew’s head.

  “Let him go!” Will yelled.

  McCauley pivoted, squinting. Will squeezed the Adams’ trigger. He felt sudden stiffness in the mechanism and applied more pressure—

  Nothing happened. Something had jammed or broken.

  McCauley held Drew’s collar with his left hand while leveling his gun at Will. The round black muzzle aligned with Will’s forehead. Will dodged to one side. McCauley followed him unerringly.

  Drew wrenched away from McCauley. Will dove for the floor and landed next to the examination table, expecting to feel the impact of a bullet any second.

  McCauley let out a choked cry just as his gun boomed. His explosion of breath escalated into a moan, then to a shrill cry of pain.

  The bullet from McCauley’s gun missed Will by a foot or so. Groggy, he climbed to his feet. Jo was walking in a small circle, moving rapidly and shaking her head as she talked to herself.

  “I didn’t get hurt. Somehow I didn’t get hurt. It was like a bee sting. Can you imagine—?”

  He recognized the delirium and wild excitement produced by a gunshot wound. She was in shock. The wound might be far more serious than she realized.

  He turned to find Drew, who was reaching to yank the horse pistol out of McCauley’s hand. The big man was mewling like a child. Finally Will saw why. Drew had snatched a scalpel from the cabinet. Its handle jutted from a rip in McCauley’s left sleeve. The blade was imbedded in the big triceps muscle.

  “Jesus Christ, don’t let me die. Don’t let me die like a dog,” McCauley babbled, slipping sideways to the wall and then dropping to his knees. Tears of terror trickled down his face. It was a wound easily survived, but McCauley didn’t know that.

  Drew seized the advantage. “No one will help you unless you tell us who sent you here.”

  Weaving back and forth on his knees and crying, McCauley managed to say, “Don Andreas. Who else do you think it would be?”

  Over the sound of Jo’s agitated voice, Mrs. Grimaldi spoke to her son. “La polizia, Tomaso! In fretta!”

  The husky young man cast one more awed glance at the carnage in the surgery, then bolted out through the reception room. In the outer hall, Will glimpsed pale faces— tenement dwellers wanting to see what had happened, yet too frightened to step over the threshold.

  Drew grabbed McCauley’s jaw with his left hand. “Confessing to me isn’t good enough. You’ll have to speak your piece at Elizabeth Street. And in a courtroom.”

  “I will if you don’t let me die. I swear to God I will. Just help me. Help me.”

  Wrathful, Drew reached across with his left hand, grasped the scalpel and tore it out. McCauley shrieked and fell sideways, fainting: Drew looked at him with disgust. Then he dropped the bloody scalpel on McCauley’s shirt.

  He turned to his sister. She was still following that small circular path and holding her stomach. Fear on his face, he hurried to her with Will only a step behind.

  v

  A sergeant and two patrolmen from Elizabeth Street arrived shortly. Ten minutes later attendants from a horsedrawn ambulance carried McCauley out on a litter. Will had applied a Spanish windlass tourniquet to arrest the bleeding of the man’s arm.

  The attendants returned and wrapped Vlandingham’s body, then Corso’s. They took both from the tenement.

  Will struggled against the shock beginning to build up within him. He’d shot and killed a man. He told himself he’d had no choice—or even any time for rational decision. Still, the fact was inescapable. He’d killed a man. A worthless thug, maybe. But a human being.

  One thing helped stave off the full impact: the sight of Jo lying under a sheet on the examination table where Drew had carefully placed her. She was white as milk. And awake, although her eyes didn’t quite focus. From time to time she spoke softly, laughed, or sang snatches of a song. All of it was incoherent.

  Mrs. Grimaldi watched Jo anxiously. Will walked to the cabinet for a decanter of medicinal whiskey. He tugged at the stopper but seemed to lack strength. His fingers had a queer, lifeless feel.

  Killed a man.

  The police sergeant said to Drew, “Should we dump the two bodies in the courtyard and let your sister have a place in the ambulance?”

  Drew’s voice took on that high, nasal quality. “We can’t risk the ride to the hospital.”

  “Hurt that bad, is she? Sure don’t look it. There ain’t much blood—”

  Drew exploded. “How long have you been on the force? That’s a classic gunshot wound. Very probably clotted already. There may be bad internal hemorrhaging.”

  Will’s hands froze on the decanter. He had just realized what had to be done.

  “I won’t risk dislodging a clot during a rough ride. We’ll remove the bullet here, and determine the extent of the injuries.”

  Drew folded the sheet back and studied the hole in Jo’s apron. It was a small black crater into whose center scraps of cloth had been driven by the bullet’s passage. There was some blood showing, but not much.

  Talking more to himself than to the others, Drew continued. “Maybe the bullet spent itself in the abdominal wall. But it’s more likely that the cavity was penetrated. From the position and angle of the wound, I’d suspect a perforated small intestine. That generally means several holes rather than one—” Suddenly his eyes focused on Will. “For God’s sake put that whiskey away.”

  “Why?”

  “Because—”

  Drew brought his bandaged right hand up from behind the examination table. “You’re the only one who can open her up and see how badly she’s hurt.”

  vi

  The accumulated shock and horror of the past hour overwhelmed Will then. His hands started to shake.

  He pushed the glass stopper back into the decanter and held it tightly. “Look, Drew, I know she needs help. But I don’t think I can—”

  “Jesus, let’s not repeat Castle Garden. You’ve had surgical training. Heard all the lectures. Watched the demonstrations—”

  “But I’ve never done a procedure like this.”

  “Are you afraid to try?”

  Bungler.

  Drew mistook his frightened silence for consent. “We’ll go slowly. Step by step. I’ll give you advice if you need it, though I don’t think you do. Mrs. Grimaldi will help too.”

  The stout woman raised her eyebrows, then frowned. “I’ll do anything you ask, dottore. As best I can.”

  Will fought to overcome a sense of certain failure. “Drew, I don’t have the skill!”

  His friend stared at him. “You’d better. Unless you want her
to die.”

  vii

  Will fixed his attention on Jo’s white face. Her eyes were nearly closed but her lips were still moving, uttering airy, cheerful words he couldn’t understand. Suffering from shock, she was in some other, happier place.

  He struggled to collect himself. As Drew had said, Jo’s was almost a textbook wound. Gunshot victims frequently reported little pain. Most said the wound felt as if a small stone had hit them, or a light blow of a cane.

  He recalled a Harvard lecture on the tragic lessons of 1881. On June 30 of that year, President Garfield had been shot. He had languished and ultimately died in September because exploratory surgery was still suspect; no attending physician had been willing to probe for the assassin’s bullet and remove it. The two young men didn’t want to make the same mistake.

  Drew’s gaze fixed on his friend’s face. So did Mrs. Grimaldi’s and that of the police sergeant. Will stared at the freckles that Jo’s pallor emphasized so dramatically. He thought of all she’d come to mean to him—and what she meant to his future.

  She meant everything.

  His head cleared a little more. He rubbed his eyes with his palms—

  “All right. I’ll do it.”

  A moment later, he said to the sergeant, “Please keep people away from that window, and out of the waiting room.” The sergeant pivoted and left.

  “Mrs. Grimaldi, light those lamps. Every one of them. What kind of surgical books do you have, Drew?”

  “Let’s see. We have an Ashhurst, and a Wyeth. A Smith’s Operative Surgery, too.”

  The last was a Harvard text. “Get all of them.”

  Drew nodded. For a moment, intense emotion misted his eyes. He knew, as did Will, that physicians with close personal ties to a patient should never operate on that patient. But circumstances had forced the abandonment of the rule. Drew’s glance said he’d be forever grateful to his friend.

  Trying to keep his mind from the frightening possibility of failure, Will went on. “Anesthetic, now. Do you have ether?”

  “Yes, plenty.”

  “An inhaler—?”

  “That too. We have everything necessary.”

  “We’ll need the carbolic—” Again he rubbed his eyes. Mrs. Grimaldi put the chimney back on one lamp and removed another. “With all that’s happened, I can’t seem to remember where you keep it.”

  Drew laughed in a ragged way. “You know something? Neither can I. But we’ll find it.”

  Together they started the search as lamp after lamp spread blazing light in the room.

  CHAPTER XIV

  UNDER THE KNIFE

  i

  UNDER DREW’S SUPERVISION, MRS. Grimaldi uncorked a can of ether, poured the proper amount onto the gauze inside the inhaler, then lowered the inhaler over Jo’s face. Drew watched for signs that the ether was irritating his sister’s respiratory passages. The first few minutes would be the most critical.

  Will, meantime, cut away Jo’s clothing, struggling to maintain a dispassionate professional attitude as he did so. It was impossible to be completely free of emotion. He was pink-faced when he pulled the last of her undergarments from beneath the sheet with which he’d draped her.

  He folded the sheet down, laying it so the turned edge covered her to just above her pubis. He was struck by the fragile whiteness of her body. A deep sense of love swept through him, followed by an overwhelming fear of losing her through chance or, worse, lack of skill—

  No. He wouldn’t let that happen. He would not.

  If he wanted to be with Jo for the rest of his life, his mind had to function clearly, and without error. His hand had to be steady. He concentrated on achieving that steadiness as he temporarily covered the wound with a layer of gauze soaked with carbolic, then added a second layer, and a third.

  Jo’s sputtering cough brought Will’s head up sharply. Drew whispered urgent instructions to Mrs. Grimaldi. She grasped Jo’s forearms while he took hold of her shoulders as best he could. Will got ready to step in, should the ether produce the violent resistance that it sometimes did.

  But Jo only coughed once more, lightly; she was resisting less than the average, uninjured patient. In this case, her state of shock had been of benefit.

  When Drew told Mrs. Grimaldi that she could let go, Will went back to work. He hurriedly dipped surgical instruments, including a Nélaton probe, in a tray of antiseptic solution. One by one he laid the instruments within easy reach on a small, towel-draped table.

  Next he soaked a number of elephant-ear sponges that would be used to remove blood and secretions from the wound and the peritoneal cavity. Just a couple of days before, Drew had spoken of the new gauze sponges being adopted in many hospitals; as yet no one at the little clinic had had time to cut and sew any of them, so it was necessary to stick with the marine sponges that had been in wide use for years.

  Drew was at the head of the operating table, Mrs. Grimaldi next to him at Jo’s right shoulder. Will could feel his friend’s eyes on him as he scrutinized the wound—a small, relatively bloodless hole two and three quarter inches to the right of the umbilicus, and half an inch below.

  He drew another deep breath. Reached out to dip both hands through the carbolic solution one last time. Then, with the utmost care, he inserted his right index finger into the wound.

  Blood oozed. “Not large enough,” he muttered, and quickly expanded the wound with scissors. The added quarter of an inch afforded him the room he needed. But he couldn’t locate the bullet.

  Next he tried Nélaton’s probe, an instrument capped with unglazed porcelain. When the probe came in contact with a bullet, the bullet would mark the porcelain with a metallic streak. This time there was no mark. Grim, Will withdrew the probe and looked at his friend.

  “I can’t find it. And the peritoneum’s torn. The bullet’s gone into the abdominal cavity.”

  It was what they’d feared—the possibility of visceral damage. Drew quirked the corners of his mouth, as if the thought of the next step was almost too painful. But he recovered quickly, giving a little nod. “Go ahead and open her, then. The quicker the better.”

  Once more Will studied the wound. “The direction of the entry is anterior to posterior and the angle seems to tend toward the center—a median incision would be indicated. Do the texts go along with that?”

  Drew glanced down at the books open on the floor between the head of the table and the place where Will stood with his back to the lamps. Drew kicked one of the texts and said with that nasal tone, “You don’t need the books. You know what to do. Get busy and do it, for God’s sake.”

  ii

  Will reached for the scalpel, adjusted it for proper fit in his hand, and stepped a half pace to the left in the hope of obtaining better light. As best he could, he obliterated Jo’s identity from his mind. Then he touched the scalpel to the skin at the chosen site.

  He applied downward pressure. Watched the indentation appear in her skin, then a thin redness as he started the section.

  He lengthened the incision to an inch.

  Two inches.

  Three.

  He heard whispering—Drew giving instructions. Mrs. Grimaldi stepped to Will’s side. “Stop a moment. I’ll wipe your face.”

  Gratefully, he held the scalpel steady while she reached around with a towel to pat his forehead and eyebrows dry. He blinked to express his thanks, somehow incapable of uttering so much as an extraneous word now. Every bit of his concentration was fixed on what had become his universe—the operative field, and the incision which he now completed to its initial length of six inches.

  He’d made his incision directly in the midline through the linea alba, without disturbing the muscles on either side. Fortunately, as he’d hoped, there was minimal bleeding. Mrs. Grimaldi responded speedily when he summoned her and she deftly sopped up the blood with one of the marine sponges.

  He reached for the forceps. Transferred them to his left hand and carefully picked up a little fold of the
peritoneum, into which he cut with the scalpel. The incision was small. He left it that way as he caught each side of the wound with a hemostat, then temporarily closed the belly while he stepped away from the table and again ran his hands through the antiseptic solution. Several trays of it had been set up on the desk beforehand.

  With scissors, Will enlarged the peritoneal incision until he was sure he could introduce his disinfected right hand. Then, softly: “Drew, can you manage the anesthesia from now on?”

  “Yes.”

  “Mrs. Grimaldi, give him the inhaler. Then clean your hands and come here beside me.”

  As soon as she was in position, he said, “I hope your stomach’s strong.”

  Almost annoyed, she shot back, “Worry about the poor child, not me.”

  “Very well. Here’s what I’m going to do.”

  He described the procedure. Despite her protest a moment ago, she swallowed and blinked rapidly when he concluded, “Each section must be supported under some of that toweling stacked on the stool. And you mustn’t let the gut slip or fall back into the cavity—understand?”

  White-faced, she nodded. He closed his teeth on his lower lip and, after a last glance at Drew’s tense face, slipped his hand into Jo’s body.

  iii

  He began with the loops of small intestine which presented at the incision. When he’d slowly withdrawn about nine inches of gut, he found the punctures—five of them.

  Where was the bullet? That would have to wait. For the moment, his work was with the ragged multiple perforation in the gut wall.

  Mrs. Grimaldi’s eyes were huge. Despite obvious fear and her unfamiliarity with the glistening internal organs of a human body, she was doing an expert job of cushioning the portions of intestine brought out through the incision and placed on towels soaked in Thiersch solution.

  There’d been no time to properly empty Jo’s gut, so before attempting to close the wounds, Will had to gently express the contents upward beyond the last puncture, then prevent their return by applying a clamp across the intestine. He expressed some remaining material downward and applied a second clamp. He was sweating heavily again, but he could no longer call on Mrs. Grimaldi for relief.