The Moon by Night

by Lynn Morris

  Cheney’s head popped up. Shiloh could see only one sleepy eye beneath the tumble of curls. “What’d you say?”

  “Blegger joo. Oh, and rankoo,” Shiloh answered, munching noisily.

  The single green eye blinked. “I want some bacon. And coffee,” she said distinctly.

  “I know, I know. The savage beast must be fed.” Shiloh sighed, putting down his paper and beginning to fix Cheney’s breakfast tray. He liked doing this.

  Cheney sat up, pushed her hair back, and looked around, dazed. “There is so much room in this bed. I dreamed we lived here. On the bed. Forever.”

  “Didja?” Shiloh asked with amusement. “Here, Doc, drink this. Please.” He handed her a steaming cup of coffee with two sugars and heavy cream, just as she liked it.

  She took several cautious but appreciative sips, then looked at him accusingly. “You’re already dressed. What time is it?”

  “Must be 4:34 now.” Shiloh never said it was “about noon” or “around half past.”

  “Why don’t you open the drapes,” Cheney mumbled. “Maybe it’ll help me wake up to see the outside world.”

  “’Cause you can’t see the outside world. Only the outside dark. And I think it’s gonna snow again.”

  “Great,” Cheney grumbled. “More broken bones and frostbite.” Cheney had been at the hospital until after two that morning, because an entire family who lived in a sodden cellar in a West Side tenement had run out of coal, and all six of them had suffered frostbite as they slept. The mother had awakened and made them all walk fourteen blocks to the hospital.

  Shiloh buttered a biscuit, which Cheney snatched out of his hand. With a long-suffering sigh he buttered another one, slopped raspberry preserves all over it, then took a huge bite before Cheney could steal it. “You know, Doc, I’ve been thinking. I don’t think Eugènie is the best horse for long hard rides, especially in cold weather and snow.”

  “I’m afraid you’re right,” she reluctantly agreed. “Besides her small size, Thoroughbreds are not particularly hardy horses. I can tell she has a really hard time in the bitterest cold, and sometimes I just shudder when I think of those slender racer’s legs plowing through knee-deep snowdrifts.”

  Shiloh nodded. “So how about this? I was talking to Andrew Roe while I waited for you last night, and we talked about a little two-wheeled buggy for you like they make in England, with a good solid Morgan trotting horse. Would you consider that?”

  Shiloh was extremely cautious with suggestions such as this. Cheney was notoriously hardheaded about making her own decisions and maintaining her independence. If she thought Shiloh was being condescending to her, she would likely refuse the suggestion, no matter how much sense it made, out of sheer contrariness.

  But to his relief she said thoughtfully, “Actually, that sounds really wonderful, Shiloh. One of those little two-seaters? With a collapsible canvas roof? Yes, I think I’d like that.”

  “Good,” Shiloh said with satisfaction. “Then I’m going to ride in with you to talk to young Mr. Roe. He doesn’t know where one of those buggies might be sold, because for some reason all of the American carriage makers only make the four-wheeled ones. But if you’ll let me, Doc, I’ll find one or have it made, and if you want, I’ll buy the horse for you.”

  “Would you?” she said, smiling up at him. “That’s nice. I’m beginning to see some advantages in having a husband.” Suddenly she yawned hugely, much like a sleepy cat. “I can’t believe I’m getting up at dark-thirty-four to go do an operation. I mean, I was actually excited about it last night.”

  “Yeah, Doc, but unfortunately by ‘last night’ what you mean is ‘two hours ago.’ You haven’t slept quite two hours. No wonder you’re not excited about blood ’n guts yet.”

  “You were up with me. You got as much—I mean as little—sleep as I did,” Cheney said accusingly. “You look all awake and alert, and besides that you smell so good, like outside. Royal Lyme. Did you have a bath?”

  “Uh-huh, a nice hot one,” Shiloh answered. “You want one?”

  “Yes, yes, yes!”

  “Your smallest wish is my command, my lady,” Shiloh said, slipping out of bed. He went to Cheney’s dressing room while she contentedly ate their favorite breakfast: fried eggs with hot bubbling cheese on top, bacon, and biscuits with melted butter and Dally’s preserves. She heard him rustling around, the sounds of tinkling bottles and the little busy noises of gathering up brushes and washing flannels and perfumes and oils for the bath. She smiled, her eyes dreamy. Lord, how in this world did I ever manage to latch on to him? No, I know that’s silly. He’s a gift, a pure gift from heaven, and I’ll never be able to thank You enough.

  ****

  Dev always used Surgery 3 at St. Luke’s. It was a plain room, identical to Surgery 1 and Surgery 2, but the entire staff knew that very skilled and sought-after physicians had their little quirks that must be catered to, so Nurse Flagg had carefully set up Surgery 3 for Rebecca Green’s surgery. Dev had recommended Mrs. Flagg for the position of head of nursing, for he had observed her as a ward nurse at Bellevue and had found her to be hardworking and knowledgeable. She had the quiet, calm steadiness that was an invaluable trait in a nurse. An older woman, she was rather plain, with gray hair that still curled prettily, and thoughtful dark eyes. Dev had used her as a nurse-anesthetist in two previous operations, and he had found her unobtrusive efficiency to be a real asset in the tension of an operating room.

  Nurse Flagg and Cheney stood slightly behind Dev as he finished his lecture to the observers, the three student doctors, Dev’s preceptees: a rakish young man named Duncan Gilder, a studious, thoughtful, shy student named Stephen Varick, and Dr. Lawana White. The patient wasn’t yet in the room.

  “I removed three cancerous lesions from another of my patients, a young woman close to Mrs. Green’s age, eleven months ago. She suddenly died last week. When Dr. Duvall and I did an autopsy, we found no evidence of new lesions in either breast, so we extended the search to the organs. Still no malignant tumors were found. Dr. Duvall suggested that we investigate the lymph glands located in the shoulder and armpit. There, upon microscopic examination of samples, she found tiny cancerous cells.

  “And so I have decided to introduce an innovation in this surgery on Mrs. Rebecca Green. The lump in the patient’s breast on the left side is here”—Dev pointed high up on his chest—“and she has given us permission to perform an experimental exploratory procedure. I will make the incision just so, but I will extend the incision up into the shoulder and axilla. Before I excise the cyst, I will take a sample of the lymph glands and the lymphatic fluid. As I then continue to remove the primary mass, Dr. Duvall will simultaneously examine the biopsied lymphatic material for any indication of malignancy. Any questions?”

  Dr. Duncan Gilder, a rather cocksure son of privilege, exclaimed, “So Dr. Duvall is going to, in essence, be a part of the surgical team as a pathologist?”

  “Just so,” Dev answered. “Understand that these two procedures illustrate what might be called surgical pathology as opposed to clinical pathology. In a dissection we saw and learned of the changes occurring in an organ and in the bodily fluids caused by a disease, which is classical clinical pathology. Today we hope to find out the pathology of a disease in order to determine the correct surgical procedure, which I have termed surgical pathology.”

  Light seemed to dawn on the three fresh eager faces. Dev nodded with satisfaction and continued, “We will have a discussion after the surgery, but I must stress to you that though I am using this as a teaching case, I will not be lecturing during the procedure, and I do not want anyone to ask any questions. I insist that you remain silent throughout the surgery. Mrs. Green is very young and impressionable, and naturally she is very frightened. As I’m sure you all observed this morning, Mr. Green, in insisting that he must be present here in the surgery, upset the patient even more. Of course I can’t allow him to be in here, and I finally persuaded him of that. But the p
oint is that the entire episode only agitated the patient more, so in this room there must be nothing but a calm, professional, confident air.”

  The students nodded solemnly.

  Dev turned to Nurse Flagg and asked, “Did you give her the absinthe?”

  “Yes, sir,” the nurse answered, “but she just tossed it back, and it didn’t seem to do much good for her, the poor thing. So I asked Dr. Pettijohn for permission to give her another dose, and he consented. After that she calmed down somewhat.”

  Dev nodded. “All right, let’s go get her.”

  They left through the swinging door that connected into Surgery 2. Rebecca Green and her husband had been in Surgery 2 for an hour as she was being prepared for surgery. Ira Green had finally begrudgingly agreed to wait in this room during his wife’s procedure.

  Dev and Nurse Flagg wheeled the tall surgical bed into Surgery 3 and positioned it. Nurse Flagg was at the head with her rolling table of instruments and supplies. Dev and Cheney were on the patient’s left side, as was Cheney’s table with her instruments, paper and pencil for sketching and notes, her microscope, her slides and dissection instruments, and a small but very high-burning oil lamp for lighting up the microscope.

  Dev bent close over the girl and took both of her hands in his. They were icy cold. He asked quietly, “Now, Mrs. Green, are you relaxed?”

  She nodded rather tremulously. Her eyes were dulled and heavy-lidded, but she did not have that pleasant dreaminess that the powerful narcotic drink usually induced. Dev asked, “Are you cold?”

  “N-no,” she whispered with a darting look at the people in the room. She was familiar with everyone, of course, for she had been in the hospital for ten days and knew all the staff and doctors. But she was still fearful, it was plain to see, and this troubled Dev.

  He rubbed her hands lightly, then placed them on her abdomen and kept his hand over hers. He said, “Now Nurse Flagg is going to place a cloth over your nose and mouth. It will smell sweet. I don’t want you to be afraid, Mrs. Green. Just try to breathe as normally as you can, and you will drop off to sleep.” He nodded at the nurse.

  She uncorked a brown bottle, inserted a long eyedropper with a rubber bulb, withdrew it, and carefully dropped two sizable swatches onto a piece of gauze that had been folded many times to give it thickness and absorbency. Carefully she placed the square over Mrs. Green’s face. Above the cloth the young woman’s eyes darted back and forth, then fixed, with some desperation, on Dev. Immediately he began speaking to her, but he couldn’t get very close or he, too, would be affected by the chloroform fumes. She clung to his hand like a vise. “Just relax, Mrs. Green…don’t be afraid. I’m right here. I’ll take good care of you. That’s it…just let your eyes close.”

  He kept speaking softly to her, but twice he exchanged quick grave looks with Nurse Flagg. It was taking much too long for her to go into the drugged sleep. Once the nurse motioned silently toward the brown bottle—a question—but Dev shook his head very slightly, continuing to speak in the same soothing, hypnotic tone. Finally the girl’s eyes closed, and her head lolled slightly to the side.

  Dev let go of her hands and quickly washed his in the basin of carbolic acid on Cheney’s supply table. With quick efficient movements Cheney scrubbed Dev’s hands and fingernails with a small brush, then dried them on a clean towel. Nurse Flagg bent over Mrs. Green, lifted up her eyelid, nodded with satisfaction, and lifted the cloth from Mrs. Green’s face to store it on her supply table.

  “Your patient is ready, Dr. Buchanan,” she said. Cheney pulled back the coverlet to expose the surgical area and neatly tucked it securely around the patient, leaving her right hand outside the covers. Sometimes a patient would move slightly, and talk too, under the anesthesia, so it was necessary to restrict them as much as possible. But Dev liked his patients’ pulse and the temperature of the extremities to be monitored closely, which was why Cheney had left Mrs. Green’s right arm outside the sheet. Now Nurse Flagg checked Mrs. Green’s pulse as Cheney handed a scalpel to Dev. He bent over Mrs. Green and made the incision, an S-shaped one to include the lump and both the axillary and shoulder lymph glands.

  He and Cheney worked quickly and efficiently, their hands never bumping each other, as they tied off the largest of the severed veins and packed the smallest ones with fine rolled gauze to lessen the blood flow. Cheney often used a baby aspirator to suction excess blood. Dev’s and her eyes met in a mutually understood signal: Shiloh’s invention.

  Dev was tying off a spurting vein when his hands jerked and he frowned ferociously. Cheney looked up, and Nurse Flagg quickly handed him more sutures. The suture had broken as he knotted it.

  It happened again. He looked up and barked, “Are all of these from the same lot?”

  “I-I don’t know, Doctor,” Nurse Flagg said nervously.

  He and Cheney both looked closely at the lengths of black thread in their hands. Cheney narrowed her eyes as she lifted a single thread up to a better light. “I can see tiny bits of lint on these,” she said. “Have they been soaked in carbolic acid?”

  “I d-don’t know—”

  “Do you know if they have been treated with chromic salts?” Cheney demanded.

  Nurse Flagg was getting flustered. She bit her lip and looked confused.

  “Never mind that now, Cheney,” Dev said calmly. “Nurse Flagg, go tell whoever is at the nurses’ station—”

  “I know where the treated sutures are stored downstairs, sir. I can go fetch them quickly,” Dr. White blurted out, then looked appalled at her impulsiveness.

  One of Dev’s eyebrows arched, but he said evenly, “Very well, Dr. White. Hurry, please.” The girl flew out of the room, while the two male students rolled their eyes as if to say, Teacher’s pet.

  Dev continued, “Dr. Duvall, here, just hold—yes, that’s good, right there. Nurse Flagg, please roll more gauze just in case there is no suitable catgut to be had.”

  Catgut was not truly the intestines of a cat. It was string made from the intestinal lining of sheep and other animals. Its great virtue was that after staying intact for about a week it gradually dissolved in the healing tissues and could be absorbed by them.

  According to Dr. Lister’s newly published work on antisepsis, catgut must be soaked in carbolic acid just as all instruments and hands must be in order to maintain an antiseptic environment for the surgery. Lister had found that soaking the catgut weakened it somewhat, so it did have a tendency to break. With further study, he had discovered that by permeating the sutures with salts of chromic acid, the material was re-strengthened, which gave the sutures longer life. Lister’s study had barely been published, but Dev, who was acquainted with the gentleman, had been apprised of his progress in this area several months before. Consequently one of the requirements Dev had made for the surgical unit of the hospital was that the plain catgut, upon delivery, be immediately sterilized and processed into chromic sutures.

  Dr. White burst back into the room holding a thick loop of catgut. Carefully she placed it on Nurse Flagg’s instrument table and backed away. Quickly the nurse cut suitable lengths and started handing them to Cheney and Dev.

  Cheney’s broke.

  Dev’s broke. His second one broke.

  Cheney made a sound of furious exasperation. Dev was frowning darkly, and Nurse Flagg’s face was filled with dread. Cheney opened her mouth, her cheeks colored with indignation, but Dev said quietly, “Never mind, Cheney, let’s just see if we can find enough to tie off the largest vessels, and we’ll pack enough to have tamponotic arrest of the bleeding. At least the gauze is working,” he added with arid humor.

  They worked quickly, Nurse Flagg rolling small lengths of gauze into tight cylinders and handing them to Cheney as fast as she could.

  Finally Dev was free to resume the procedure. With a scalpel as small and delicate as an artist’s brush, Dev began the painstaking procedure of removing a sample of the tiny nodes called lymph glands. Cheney readied the slides and her
microscope.

  Suddenly under Dev’s hands, Mrs. Green jumped.

  Dev froze.

  His abrupt stillness alerted Cheney. Nurse Flagg stopped rolling gauze. They all focused on Mrs. Green’s face. Her eyes were open, wide with pain and filled with horror. Before anyone could move, she screamed. It was the worst sound Cheney had ever heard.

  “Nurse Flagg,” Dev said sternly but calmly, “hurry.”

  The patient began trembling, and her free arm jerked up and struck Dev’s chest hard. Of necessity he had to pin her down. A patch of bright crimson spread rapidly across Mrs. Green’s chest and onto the white sheets.

  Nurse Flagg was dropping more anesthesia on the cloth, and Cheney was going to move to help her, but at that instant the patient drew a deep shuddering breath and screamed again, and her feet started drumming against the bed. Cheney had to hold her ankles down.

  Then—the nightmare worsened every second—the connecting door swung open, and Ira Green came charging in. Cheney would never forget the look of blind fear and rage on his face. He was pale but his cheeks were slashed with furious red; his eyes bulged; he had flecks of spittle on his mouth; sweat poured down his face. “Becky, Becky, I’m here. I’m coming,” he roared, then grabbed Dev by the shoulder.

  Incredibly Dev was still calm and as solid as a brick wall. Though Ira Green was a stout manual laborer, even his strength of panic couldn’t move Dev. He stood still, his shoulders bunched with fighting the pressure the man was putting on him. Crazily Mr. Green seemed to be trying to spin him around.

  Mrs. Green still screamed.

  Nurse Flagg finally clapped the cloth over the patient’s face, but now Mrs. Green was like a savage cornered animal, without reason. Her scream became a garbled high undulating shriek that was even worse than before. Maniacally she yanked her head from side to side. Mrs. Flagg leaned close over her, trying to hold the cloth over her nose without suffocating the struggling woman.

  Still Mr. Green shouted and pounded on Dev’s back.