The Outlandish Companion
Page 39
Most forums have members who participate regularly, as well as those who “lurk,” reading messages but rarely responding, and some who simply wander in from time to time. Since the “Research and the Craft of Writing” section is “mine,” I’m well acquainted with most of the regular participants and therefore know something of their own interests and backgrounds; other people I know only by name. To give more insight on the following thread, I’ve provided a quick capsule description of the participants.3
Elise Skidmore is an industrial technician by profession, who is section leader for the “Writing Exercises” section of the Writers Forum.
Rosina Lippi-Green is a professor of sociolinguistics and creative writing, and a published historical novelist (writing as Sara Donati).
Mira Kolar-Brown is a Project Manager (Employment Initiatives) based in Manchester, England, presently working on a mystery novel.
Coleen Harman is a veterinarian.
Ellen Mandell, an M.D. with specialties in OB/GYN and epidemiology, was following a trail of breadcrumbs when
she plunged down a rabbit hole and hasn’t been seen since. Alan Smithee is a specialist in medical radiology.
Beth Shope is raising a family in Switzerland and working on a fantasy novel.
Barbara Schnell is a German photojournalist and novelist, who also did the (excellent) German translation of Drums of Autumn (Der Ruf der Trommel).
Marte Brengle is a software expert and technical writer, working on a novel.
Betty Babas is a section leader in the Romance Forum.
Jo C. Harmon is an RN.
Susan Martin is my co-section leader in “Research and the Craft of Writing” and is at work on a historical mystery set in France.
Arlene McCrea is a retired academic.
Eve Ackerman is Librarian for several R&WI forums, and is working on a historical novel.
#: 470986 S8/Research & craft [WRITERS]
23-Aug-97 03:48:21 Sb: SPOILER—Penicillin Fm: Diana Gabaldon 76530,523 To: All
SPOILER
Whew. Had a migraine all yesterday, and didn’t get _anything_ done, but finally finished this penicillin scene tonight. This is a somewhat longer scene than I’d usually post on the boards, but it’s kind of all-of-a-piece, so it didn’t seem suitable just to put up the first bit.
IN ORDER TO GIVE the flavor of this sort of online exchange, minimal editing has been done, and small conventions of online communication have been left as they appeared in the original messages. These include underscore marks (_) used to indicate italics or other emphasis in the text, abbreviations of commonly used terms, and assorted “emoticons.”
Since it isn’t possible to transmit tones of voice, facial expressions, or other nonverbal cues that people normally use in face-to-face conversations, many people use symbols known as “emoticons,” to indicate these cues and clarify the meaning of their messages. Such symbols as appear in this thread include:
:) = also a smile (look at the symbol sideways)
;) = a wink
<<>>= brackets enclose text that is quoted from an earlier message, in order to make it clear when a subsequent message is addressing a particular point from the earlier message.
SPOILER is used at the head of messages that contain excerpts of a to-be-published book or story, or that include discussions of published work (or films) that might give away important material concerning the plot. This is a courtesy warning to people who don’t want to know anything about a book, film, etc., prior to seeing the completed work.4
IANAD = “I am not a doctor.” (also IANAL = “I am not a lawyer”) A disclaimer of expert knowledge, preceding an opinion.
LOL = “Laughing out loud” OTOH = “On the other hand” FWTW = “For what it’s worth” IOW = “In other words”
It occurs to me that Alan might not want to read this, if he’s only beginning with OUTLANDER. But if you’re around, Ellen, (or any other of the medically knowledgeable) I’d appreciate any comments on plausibilities and procedures—just so I don’t get rashes of letters from People Who Know, later on.
Thanks,—Diana
Excerpt THE FIERY CROSS Copyright © 1997 Diana Gabaldon
[date]
_Was called from churning to attend Rosamund Lindsey, who arrived in late afternoon with a severe laceration to the left hand, sustained with an axe while girdling trees. Wound was extensive, having nearly severed the left thumb; laceration extended from base of index finger to two inches above the styloid process of the radius, which was superficially damaged. Injury had been sustained approximately three days prior, treated with rough binding and bacon grease. Extensive sepsis apparent, with suppuration, gross swelling of hand and forearm. Thumb blackened; gangrene apparent; characteristic pungent odor. Subcutaneous red streaks, indicative of blood poisoning, extended from site of injury nearly to antecubital fossa.
Patient presented with high fever (est. 104 degrees F, by hand), symptoms of dehydration, mild disorientation. Tachycardia evident.
In view of the seriousness of patient’s condition, recommended immediate amputation of limb at elbow. Patient refused to consider this, insisted instead upon application of pigeon poultice, consisting of the split body of a freshly killed pigeon, applied to wound (patient’s husband had brought pigeon, neck freshly wrung). Removed thumb at base of metacarpal, ligated remains of radial artery (crushed in original injury) and superficialis volae. Debrided and drained wound, applied approximately ½ oz. crude penicillin powder (source: rotted casaba rind, batch #23, prep. 15/4/71) topically, followed by application of mashed raw garlic (three cloves), barberry salve—and pigeon poultice, at insistence of husband. Administered fluids by mouth; febrifuge mixture of red centaury, bloodroot, and hops; water ad lib. Injected liquid penicillin mixture (batch #23, suspended in sterile water), IV, dosage ¼ oz. in suspension in sterile water.
Patients condition deteriorated rapidly, with increasing symptoms of disorientation and delirium, high fever. Extensive urticaria appeared on arm and upper torso. Attempted to relieve fever by repeated applications of cold water, to no avail. Patient being incoherent, requested permission to amputate from husband; permission denied on grounds that death appeared imminent, and patient “would not want to be buried in pieces.”
Repeated penicillin injection. Patient lapsed into unconsciousness shortly thereafter, and expired just before dawn, [date]._
I dipped my quill again, but then hesitated, letting the drops of ink slide off the sharpened point into the small gourd I used as an inkwell. How much more should I say?
The deeply ingrained disposition for scientific thoroughness warred with caution. It was important to describe what had happened, as fully as possible. At the same time, I hesitated to put down in writing what might amount to an admission of manslaughter—it wasn’t murder, I assured myself, though my guilty feelings made no such distinctions.
[continued]
#: 470987 S8/Research & craft [WRITERS]
23-Aug-97 03:52:01 Sb: #470986-SPOILER—Pencillin Fm: Diana Gabaldon 76530,523 To: All
[continued]
“Feelings aren’t truth,” I murmured. Across the room, Brianna looked up from the bread she was slicing, but I bent my head over the page, and she returned to her whispered conversation with Marsali by the fire. It was no more than midafternoon, but dark and rainy outside. I had lit a candle by which to write, but the girls’ hands flickered over the dim table like moths, lighting here and there among the plates and platters.
The truth was that I didn’t think Rosamund Lindsey had died of septicemia. I was fairly sure that she had died of an acute reaction to an unpurified penicillin mixture—of the medicine I gave her, in short. Of course, the truth al
so was that the blood poisoning would certainly have killed her, left untreated.
The truth also was that I had had no way of knowing what the effects of the penicillin would be—but that was rather the point, wasn’t it? To make sure someone else _might_ know?
I twiddled the quill, rolling it between thumb and forefinger. I had kept a faithful account of my experiments with penicillin— the growing of cultures on media ranging from bread to chewed paw-paw and rotted melon rind, painstaking descriptions of the microscopic and gross identification of the _Penicillium_ molds, the effects of—to this point—very cautious applications.
Yes, certainly I must include a description of the effects. The real question, though, was—for whom was I keeping this careful record? I bit my lip, thinking. If it was only for my own reference, it would be a simple matter; I could simply record the symptoms, timing and effects, without explicitly noting the cause of death; I was unlikely to forget the circumstances, after all. But if this record were ever to be useful to someone else… someone who had no notion of the benefits and dangers of an antibiotic…
The ink was drying on the quill. I lowered the point to the page. _Age—44_, I wrote slowly. In this day, casebook accounts like this often ended with a pious description of the deceased’s last moments, marked—presumably—by Christian resignation on the part of the holy, repentance by the sinful. Neither attitude had marked the passage of Rosamund Lindsey.
I glanced at the coffin, sitting on its trestles under the rain-smeared window. The Lindseys’ cabin was no more than half-built; not suited for a funeral in the pouring rain. The coffin was open, awaiting the evening wake, but the muslin shroud had been drawn up over her face.
Rosamund had been a whore in Boston; growing too stout and too old to ply her trade with much profit, she had drifted south, looking for a husband. “I couldn’t bide another of them winters,” she had confided to me, soon after her arrival on the Ridge. “Nor yet another of them stinkin’ fishermen.”
She had found the necessary refuge in Kenneth Lindsey, who was looking for a wife to share the work of homesteading. Not a match born of physical attraction—the Lindseys had had perhaps six sound teeth between them—or emotional compatibility, still it had seemed an amicable relationship.
Shocked rather than grief-stricken, Kenny had been taken off by Jamie for medication with whisky—a somewhat more effective treatment than my own. At least I didn’t think it would be lethal.
Immediate cause of death_—I wrote, and paused again. I doubted that Rosamund’s response to approaching death would have found outlet in either prayer or philosophy, but she had had opportunity for neither. She had died blue-faced, congested and bulging-eyed, unable to force word or breath past the swollen tissues of her throat.
My own throat felt tight at the memory, as though I were being choked. I picked up the cooling cup of catmint tea and took a sip, feeling the pungent liquid slide soothingly down. It was little comfort that the septicemia would have killed her more lingeringly. Suffocation was quicker, but not much more pleasant.
I tapped the quill point on the blotter, leaving inky pinpoints that spread through the rough fibers of the paper, forming a galaxy of tiny stars. As to that—there was another possibility. Death might conceivably have been due to a pulmonary embolism—a clot in the lung. That would be a not-impossible complication of the septicemia, and could have accounted for the symptoms.
It was a hopeful thought, but not one I placed much credence in. It was the voice of experience, as much as the voice of conscience, that bade me dip the quill and write down “_anaphylaxis_,” before I could think again.
Was anaphylaxis a known medical term yet? I hadn’t seen it in any of Rawlings’s notes—but then, I hadn’t read them all. Still, while death from the shock of allergic reaction was not unknown in any time, it wasn’t common, and might not be known by name. Better describe it in detail, for whoever might read this.
And that was the rub, of course. Who _would_ read it? I thought it unlikely, but what if a stranger should read this and take my account for a confession of murder? That was far-fetched—but it could happen. I had come perilously close to being executed as a witch, in part because of my healing activities. Once almost burnt, twice shy, I thought wryly.
[continued]
#: 470988 S8/Research & craft [WRITERS]
23-Aug-97 03:52:08 Sb: #470986-SPOILER—Penicillin Fm: Diana Gabaldon 76530,523 To: All
[continued]
_Extensive swelling in affected limb_, I wrote, and lifted the quill, the last word fading as the pen ran dry. I dipped it again and scratched doggedly on. _Swelling extended to upper torso, face, and neck. Skin pale, marked with reddish blotches. Respiration increasingly rapid and shallow, heartbeat very fast and light, tending to inaudibility. Palpitations evident. Lips and ears cyanotic. Pronounced exophthalmia._
I swallowed again, at the thought of Rosamund’s eyes, bulging under the lids, rolling to and fro in uncomprehending terror. We had tried to shut them, when we cleansed the body and laid it out for burial. It was customary to uncover the corpse’s face for the wake; I thought it unwise in this case.
I didn’t want to look at the coffin again, but did, with a small nod of acknowledgment and apology. Brianna’s head turned toward me, then sharply away. The smell of the food laid out for the wake was filling the room, mingling with the scents of oak-wood fire and oak-gall ink—and the fresh-planed oak of the coffin’s boards. I took another hasty gulp of tea, to stop my gorge rising.
I knew damn well why the first line of Hippocrates’ oath was, “First, do no harm.” It was too bloody easy to do harm. What hubris it took to lay hands on a person, to interfere. How delicate and complex were bodies, how crude a physician’s intrusions.
I could have sought seclusion in surgery or study, to write these notes. I knew why I hadn’t. The coarse muslin shroud glowed soft white in the rainy light from the window. I pinched the quill hard between thumb and forefinger, trying to forget the pop of the cricoid cartilage, when I had jabbed a penknife into Rosamund’s throat in a final, futile attempt to let air into her straining lungs.
And yet… there was not one practicing physician, I thought, who had never faced this. I had had it happen a few times before— even in a modern hospital, equipped with every life-saving device known to man— then.
Some future physician here would face the same dilemma; to undertake a possibly dangerous treatment, or to allow a patient to die who _might_ have been saved. And that was my own dilemma—to balance the unlikely possibility of prosecution for manslaughter against the unknown value of my records to someone who might seek knowledge in them.
Who might that be? I wiped the pen, thinking. There were as yet few medical schools, and those few, mostly in Europe. Most physicians gained their knowledge from apprenticeship and experience. I slipped a finger into the casebook, feeling blind between the early pages, kept by the book’s original owner, Daniel Rawlings.
Rawlings had not gone to medical school. Though if he had, many of his techniques would still have been shocking by my standards. My mouth twisted at the thought of some of the treatments I had seen described in those closely written pages—infusions of liquid mercury to cure syphilis, cupping and blistering for epileptic fits, lancing and bleeding for every disorder from indigestion to impotence.
And still, Daniel Rawlings had been a doctor. Reading his case notes, as I sometimes did, I could feel his care for his patients, his curiosity regarding the mysteries of the body.
Moved by impulse, I turned back to the pages containing Rawlings’s notes. Perhaps I was only delaying to let my subconscious reach a decision—or perhaps I felt the need of communication, no matter how remote, with another physician, someone like me.
Someone like me. I stared at the page, with its neat, small writing, its careful illustration, seeing none of the details. Who was there, like me? No one. I had thought of it before, but only vaguely, in the way of a problem acknowledged, but
so distant as not to require any urgency. In the colony of North Carolina, so far as I knew, there was only one formally designated “doctor”—Fentiman. I snorted, and took another sip of tea. Better Murdock MacLeod and his nostrums—most of those were harmless, at least.
I sipped my tea, regarding Rosamund. The simple truth was that I wouldn’t last forever, either. With luck, a good long time yet—but still, not forever. I needed to find someone to whom I could pass on at least the rudiments of what I knew.
A stifled giggle from the table, the girls whispering over the pots of headcheese, the bowls of sauerkraut and boiled potatoes. No, I thought, with some regret. Not Brianna.
She would be the logical choice; she knew what modern medicine was, at least. There would be no overcoming of ignorance and superstition, no need to convince of the virtues of asepsis, the dangers of germs. But she had no natural inclination, no instinct for healing. She was not squeamish or afraid of blood—she had helped me with any number of childbirths and minor surgical procedures—and yet she lacked that peculiar mixture of empathy and ruthlessness a doctor needs.
She was perhaps Jamie’s child more than mine, I reflected, watching the firelight ripple in the falls of her hair as she moved. She had his courage, his great tenderness—but it was the courage of a warrior, the tenderness of a strength that could crush if it chose. I had not managed to give her my gift; the knowledge of blood and bone, the secret ways of the chambers of the heart. Brianna’s head lifted sharply, turning toward the door. Marsali, slower, turned too, listening.
It was barely audible through the thrumming of the rain, but knowing it was there, I could pick it out—a male voice, raised high, chanting. A pause, and then a faint answering rumble that might have been distant thunder, but wasn’t. The men were coming down from the shelter on the mountain.