Beckah laughed before covering her mouth.
Master Eckerd arched a brow. “You find this woman’s illness amusing?” he asked.
Beckah shook her head. “I’m sorry, Master. It’s just that Matthias can clearly see that she’s breathing. And she has a bounding pulse. I can see it in her neck. His exam is more for show.”
Master Eckerd nodded once. “Wonderful observations.” He tapped Matthias on the shoulder, forcing him to step back. “Yes. You can see her breathing, and her pulse is readily visible. This is not foxglove.”
“Probably good,” Matthias muttered. “I hear the other patient given foxglove didn’t make it.”
Master Eckerd frowned again. He looked over at Alec before turning his attention back to the woman. “Yes. Well, can anyone tell me any other observations here? We have decided this is not foxglove. We have decided this is not solpace juice. What else would you question?”
“Have there been any signs of fever?” Beckah asked.
“No fever. Any other questions?”
Everyone fell silent, most simply staring at the woman, waiting for Master Eckerd to explain what had happened. Alec didn’t want to answer. He had suspicions, but after what had happened with Master Eckerd the last time, he didn’t want to speak up and hesitated saying too much, otherwise he ran the risk of getting taunted again. It was bad enough that someone—likely Mathias—had left clippings of leaves at his door.
“None?”
Beckah elbowed Alec, and he shot her a look before taking an unintentional step forward.
“Mr. Stross. What would your assessment be?”
“He probably thinks some magical spell was placed on her,” Matthias said.
A few of the people on the other side of the cot—including Karen and Nanci—laughed.
Alec took a deep breath. “Has she had any injury?”
“You can see that she hasn’t,” Matthias said.
Master Eckerd watched Alec. “Assuming no visible injury, why would you ask?”
Alec took another step forward. He was already committed, and now, it was too late to step back. He slipped his hands under the woman shoulder and tipped her, looking at her back and up to her head. There was no sign of any injury. Had there been, he suspected that Master Eckerd wouldn’t have chosen her as an example.
His father had once used a similar example.
“The people who brought her in. Did they mention any previous injury?” Alec said.
Master Eckerd smiled. “Is that the path you would like to go down?” he asked.
“I just thought I’d ask,” Alec said.
Master Eckerd came around the end of the cot and pointed to a spot on the back of her head. “She was seen slipping near the canals after stepping off one of the barges about a week before she was brought to us. There is no visible injury, but her husband claims she hit her head and had been complaining of a headache for the last week.”
“Wouldn’t you see signs of an injury sooner than this?” Matthias asked.
“Not if she had internal bleeding. There are some injuries that take time, and bleed slowly, before becoming incapacitating,” Alec said.
Master Eckerd watched him a moment. “Yes. There are many hemorrhages inside the brain that will lead to swelling. We have tested this with mice and have seen similar effects.”
“Is that what happened to her?” Beckah asked. She looked up at Alec, a curious expression on her face.
“Unfortunately, there is little we can do to determine that. Given the history that we were given, it is entirely likely that is the cause of her symptoms.”
“What can be done?” Stefan asked.
“There are no medicines that will reverse this,” Master Eckerd said. “At this time, it’s mostly a matter of waiting to see what will happen, but we can also attempt to remove some of the pressure.”
“Pressure? That means—” Matthias said.
Master Eckerd nodded. “Yes. That means she will be taken to surgery. Mr. Stross, as you seem to have diagnosed her, I would ask if you would be interested in attending the surgery.”
Alec made a point of only looking at Master Eckerd. It was uncommon for first-year students to be allowed into the surgical suites. They were reserved for upper-level students and physickers only. For him to be given that opportunity was more than an honor; it was unheard of.
“I would be happy to,” Alec said.
“Good. We will take her now. The rest of you will go with Physicker Terrence, and he will review the remaining new patients with you.”
Terrence walked up to Master Eckerd. He was a junior physicker and looked older than his likely age. He was thin, with a narrow beard, and nodded to Master Eckerd. “Are the students ready for me?”
“They are.”
“Good luck,” Beckah said to Alec. “And you better be prepared to tell me all about it later.”
“I’ll tell you what I can,” Alec said.
She elbowed him as she moved away from the cot and joined the line of students at the next bed. Alec watched them until Master Eckerd cleared his throat.
“Are you ready?” Alec nodded. “Good. I will need your help wheeling her out of the hospital and into the surgical area.”
Alec assisted Master Eckerd as they pushed her down the hall. They took a route he’d not taken before, and the hallway was wide, practically cavernous as they made their way through it. Enormous double doors opened up off the hall, and Eckerd nodded toward them and turned the cot to go through.
A master physicker—as designated by the jacket she wore—much older than Master Eckerd stood on the other side. She had gray hair pulled into a tight bun and stepped forward to welcome to Master Eckerd. Two junior-level physickers, a man and a woman, stood behind her. Both were older than Alec.
The other master glanced at Eckerd but said nothing. Eckerd pushed the cot toward the middle of the room then addressed the rest of us. “Today, Master Helen and I are going to try to relieve some swelling in this woman’s head,” Master Eckerd said. “This will require us to remove a piece of her skull bone, which means a steady hand. Physicker Abigail has been chosen to assist. Physicker Jeremy is here to observe.”
Alec stood at the back, suspecting that as a student, he had little right to be too close to the activity. He preferred to be up close and would prefer to watch what Eckerd did, but was simply thankful that he was allowed in here at all.
He watched as Master Eckerd and Master Helen prepared for the procedure, and was impressed by the way they moved efficiently, both masters using balsping oil on their hands, a liniment that had a sharp, pungent odor, but was widely known as an effective antiseptic. They used the same oil on the woman’s scalp, scrubbing through her hair. Physicker Jeremy remained nearby and stepped in to remove the liniment container.
Master Helen procured a scalpel and stood back, waiting for Eckerd to signal her. He nodded, and she leaned forward and made a sharp incision, cutting into the woman’s scalp. She worked quickly and had a steady hand.
Alec couldn’t help himself, and crept forward, watching as they peeled back a layer of skin, exposing the bone. He’d seen injuries where the bone of the skull was revealed but had never imagined cutting into the scalp to reveal it. His father was skilled with medicines but had never attempted any surgeries. That was the role of the university, and his father had never shown any desire to offend them by overstepping his place.
Master Eckerd took a shiny hammer and a sharp, spike-like instrument off the table next to the cot. Placing the spike against the exposed bone, he gently tapped the hammer against the spike, then moved the spike to a new spot, tapping again. Working quickly, he formed a circle in the skull, and with one final tap, Alec could see the center mass separate from the rest of the skull.
Alec heard gagging and looked up to see Physicker Abigail looking ashen, her face pale.
“You can step out if you’re going to be sick, Abigail,” Master Helen said.
Abigail clenched her jaw and sho
ok her head. “I’ll… I’ll be fine.”
“If you vomit on our patient, she will get an infection in her head, and there will be no way she’ll survive this.”
Abigail paled even more before nodding and hurrying from the surgical room.
“Alec, step into Abigail’s place,” Master Eckerd said.
Eckerd glanced over at Master Helen who looked at him with an unreadable expression. Alec hurried around the table and stood where Abigail had been. From this vantage, he could see a little better. He saw the way Master Eckerd held the instrument, and the way he made a series of movements that lifted the bone free. From there, the brain matter was visible.
“What do you—” Master Helen began.
Blood began seeping from the hole in the woman’s skull.
Eckerd breathed out. “Ahh. Excellent.”
“Why excellent?” Alec asked. He knew that he should be quiet, that he was here only as a courtesy, but he couldn’t help himself. It was the same tendency that always seemed to get him in trouble. He couldn’t keep himself silent when he was curious about something.
“There are times when the blood is deeper. Other times, when we don’t cut in the right place.”
“How did you know where to cut?” Alec asked.
Master Helen frowned. “There were slight discolorations of the skin.” She turned her attention to Master Eckerd. “Did you need to bring a chatty student into the surgical suite?”
Eckerd glanced up and met her gaze. “He has diagnosed both solpace injection as well as her injury.”
“Her injury? Three masters examined this patient before—”
Eckerd nodded. “Exactly. You now can understand the reason I decided to have him join me?”
Master Helen grunted but said nothing else. She took a towel and began dabbing at the blood seeping from the woman’s wound, saying nothing as she did.
“You were able to make the diagnosis?”
Alec turned to the other junior physicker beside him. Jeremy had a plain face and was of average height. Alec was a few inches taller than he and wondered what the young man was be able to see. It was difficult enough for Alec to see the patient from his vantage. If he were any shorter, he would not see anything.
“I only asked about injury,” Alec said. “There can be a delay in swelling following a head injury.”
“How is it that a student knows this?”
“My father is an apothecary in one of the middle sections of the city.”
He knew that wasn’t a perfect answer, especially considering how few people at the university cared for apothecaries, but honesty was the only way he was going to not be overlooked.
“Your father must be an impressive apothecary for him to have taught you that diagnostic skill.”
“He is. He trained at the university.”
“An apothecary trained in the university? Why did he leave?”
The masters were simply waiting, holding pressure against the woman’s skull, soaking up the blood. Alec heard them talking quietly to each other, but they weren’t speaking loudly enough for him to hear. The surgery must have been completed, and Alec wondered what they would do next. Now that the section of skull had been removed, where did that leave the woman?
“I don’t know why he left. I only learned recently that he had trained here.”
“An apothecary hid that he’d trained at the university?”
Alec shrugged. “He didn’t think it necessary. I think part of him thought it was better to conceal that than to make it widely known.”
“Imagine the rates he could have charged had he shared that he trained at the university.”
Alec chuckled. “My father was never very concerned about how much he could charge.”
“Seems like a wasted opportunity to me. Why wouldn’t you take an opportunity to make as much as possible?”
He didn’t need to answer. Master Eckerd spoke up, looking over at Alec. “Tell me, Mr. Stross, if you weren’t able to reach the swelling, what would you do?”
Alec glanced over and saw the physicker looking at him, a deep frown pulling the corners of his mouth, before turning back to Master Eckerd. “If I opened up the skull and there was no way to reach the swelling?”
“Yes. What would you do?”
Alec had no surgical experience. He had stitched wounds closed, but that was the extent. Anything greater than that his father had always sent to the university. Was Master Eckerd asking him a question about a technique that he assumed he would have read about, or learned from his father?
No. Eckerd would’ve known that Alec had no experience, and the first-year students rarely ventured into the surgical section of the library. Alec hadn’t even considered it, mostly because there was more value in learning various medicinal treatments. He was much more interested in finding various combinations of medicines and liniments that might produce a response. There were few illnesses that required cutting.
If Master Eckerd didn’t expect him to know some mysterious surgical technique, what was he getting at?
Maybe it was something as simple as how to find the area of swelling.
Alec thought about what he knew of anatomy, having studied that for years, and thought about how everything in the brain was interconnected. There seemed to be a way that you could evaluate for pressure, and Alec imagined looking into a patient’s eyes, or possibly in their ears with the right type of implement, but neither of those would give the origin of the swelling.
“Couldn’t you simply look into her throat?” the other physicker asked.
Master Eckerd looked over at the man with a hint of disgust. “Throat? Perhaps you need to review your anatomy, Jonas.”
Master Helen had given some idea, suggesting the discoloration on the skin would reveal where the injury had taken place, but it seemed like even that missed something.
“I think if you tried to use an instrument within the brain cavity itself, you would run the risk of damaging the tissue,” Alec said.
“You would,” Master Eckerd agreed.
“You would need some sort of flexible device to run along the inside of the skull, and use that to allow whatever blood is there to run along it, or, if it’s hollow, through it.”
Master Eckerd considered him a moment. “Good. Come over here.”
Alec blinked but did as he was instructed and made his way over to Master Eckerd.
“Use balsping oil on your hands first.”
Alec turned to the jar of oil and used the section of cloth that was lying on the table next to it to apply it to his hands, rubbing it in. He was familiar with the oil, having used it when stitching people up. His father had always claimed that application of the oil inhibited infection, but he’d never had any way of proving that. It was simply something his father had taught him. Other things his father taught him were verifiable, and he could apply them to illnesses, or injury, and test whether they were as effective as his father believed.
The oil tingled on his skin and created a coating.
“Take the krashole,” Master Eckerd said.
Alec shook his head. “I’m not sure what that is.”
Master Helen reached for a thin, long rod. As she held it up, he noted that it was flexible, bending in her hand. “It’s named after the master who created it,” she said, handing it to him.
Alec took it from her and studied it. It was hollowed out along the length of it, and he marveled at the skill that must’ve been required to make such a thing.
“Now, you put a slight curvature into the krashole, and you slide along the inside of the skull.”
“You want me to do this?”
“Would you prefer Jonas have the opportunity?”
“I don’t want to take an opportunity from a physicker,” Alec said.
“Perhaps I was mistaken.”
Master Eckerd reached for the instrument, but Alec pulled back.
“No. I’ll do it.”
Jonas glared at him, but Alec
ignored it. He had been invited into the surgical suite, and he needed to take advantage of that opportunity. How often was it that a first-year student was given the opportunity to perform surgery, and brain surgery at that?
Eckerd smiled tightly. “Now. You will slide this up along the inside, moving slowly and feeling for any change in resistance.”
Alec followed his instructions, inserting the krashole into the skull and sliding it. It went smoothly, and he pushed toward the back of her skull, feeling no resistance.
“What am I looking for?” he asked.
“If you notice bleeding, you’ve either penetrated the tissue, or you found the source of the bleeding.”
“I thought the source was where the incision was made.”
“It should be, but you will make another test. Let’s say for the sake of argument that her husband reported that she had struck her head on the railing of the barge as she got off.”
Alec glanced up, following his train of thought. “Then she’d have hit the back of her head, probably not the side of it.”
“Indeed. Had she fallen forward, it would have been more likely for her to strike her temple, but if she truly fell backward, we need to ensure that there is no pressure remaining there that needs to be relieved.”
Alec continued to slide the device along the back of her head. He felt a hint of pressure and stopped.
“What have you detected?” Master Eckerd asked.
“There’s resistance.”
“Then you need to redirect. Withdraw the krashole a slight amount and then push forward again.”
“What would happen if I pushed forward without withdrawing?” Alec asked.
“We’ve done experiments on animals and have concluded the risk of penetrating healthy brain tissue is too great. If part of the brain is injured, there are significant detrimental effects. Has your father treated people who’ve hit their head or injured themselves in such a way that they never completely recover?”
Alec nodded.
“As I suspected. This would be the same thing you would find were you to push too hard here. You don’t want to penetrate healthy tissue. There’s a good chance she won’t survive this, anyway, but we want to give her every opportunity possible.”
Poisoned: The Book of Maladies Page 15