by Eric Flint
Sharon shook her head. They'd reached the table now, and there was no time to think about anything other than the work ahead of her. The OR table itself was something Sharon had had designed weeks earlier, blessedly, in case of an emergency. It was a well-made local product, heavily shellacked and polished, and now covered with sterilized absorbent fabric. It wasn't quite as good as an up-time OR gurney—and certainly a lot harder to move around, between the weight of the wood and the lack of wheels—but it would do fine.
She looked down at the patient lying on the OR table. She'd wondered if it would bother her, having to operate on someone she knew. To her relief, she discovered that it didn't. The man on the table bore a vague resemblance to a man named Ruy Sanchez, what she could see of the face above the gauze over the nose and mouth that Stoner would use to keep administering the anesthetic. But that was all it was. Just a resemblance. The animation was gone. The skin was pale, the cheeks were flushed. That was fever and blood loss.
The key, though, was the eyes. The patient's eyes were closed now, but Sharon had seen the dullness come into them in the hours after the fight. Not even Don Quixote on steroids could shrug off these kinds of injuries. The cut to the leg, maybe; that had been a simple flesh wound which Sharon had treated and sewn up quickly hours earlier. But certainly not the other trauma.
That one was a killer. The type of abdominal wound which, at any time prior to the late nineteenth century, would have been accepted as well-nigh certain death. A slow and tortured death, to boot. Sharon knew full well that the reason Stoner had been able to pack the huge salon with observers was because they all wanted to see if the exotic American Dottoressa could do what had always been considered impossible.
She took a slow, deep breath. A man named Ruy Sanchez with dull eyes simply did not exist in the world, she told herself firmly.
Could not exist. A contradiction in terms. All that lay here was a patient. A body. If she did her job, a human being might return into that body. But, for now, it was just a body. One of many. She'd studied and handled bodies for years now. The father who had sired her and raised her and given her his own talent and love for medicine had done the same for decades before that.
She felt calm, now. She'd gained that emotional detachment which, however inhuman it might be from one angle, was utterly necessary for what lay ahead of her.
Stoner had already moved to his part of the OR table and was checking the patient's vital signs.
"The last urine sample we got wasn't too bad," he said. "That was a little over an hour ago. Low volume, but I don't think there's any danger of immediate kidney failure. His pulse right now is . . . pretty good, I'd say. Weak and rapid, of course, but I don't think he's missing any beats."
"What's the systolic pressure?"
"That's the good news. A hundred and ten."
Sharon hummed a little note of satisfaction. She needed a minimum of ninety to risk an operation like this, and had wanted a hundred. A hundred and ten was higher than she'd dreamed of.
For an instant, a treacherous little thought tried to worm its way forward. How could I do otherwise? A wish from my intended is like a command from—
She squashed that, right quick. "Please introduce me to my colleagues," she said, more loudly than she'd meant to. "And I think we should begin speaking in Italian"—that last sentence said in the language—"except in such instances where I might encounter an emergency."
In which case, all bets are off and I'll probably start hollering at them incoherently. But she saw no reason to add that. The two Venetian doctors standing at the table in their own scrub gowns looked to be even more nervous than she'd been.
Tom nodded. "To your left, Dottoressa Nichols, is Dottor Fermelli. He has agreed to serve as your first assist and scrub."
He used the English word scrub, not the Italian translation of it. The full term in English would have been "scrub nurse," but that last word needed to be avoided. In the parlance of the seventeenth century, "nurses" were purely scut-work menials with about as much skill and training—and social status—as a janitor. That was the reason, of course, that the embassy had from the beginning introduced Sharon as a Dottoressa. And since the Italian word for scrub was every bit as prosaic as the English term, Tom had apparently decided to fall back on the ancient trick—perfected by French chefs—of making something sound glamorous by using a foreign term for it.
Fermelli nodded politely. Sharon returned the nod and took the opportunity to gauge the man as best she could. He'd be the key assistant. The second Venetian doctor would be the circulating nurse. Which meant, under the circumstances, nothing much more than a gofer. That doctor was standing next to the small table that held the instruments and absorbents. She'd be curious to see what title Stoner had decided to bestow upon him in order to avoid the dreaded "nurse" label. Circulator, probably.
But it was Fermelli she'd be counting on, in case of trouble. And, perhaps more to the point, it would be Fermelli who'd have to be able to help her with the really grisly parts of the operation. Sharon could well remember her very first experience in an operating room. The operation she was about to do wasn't that much different. It had been an abdominal hysterectomy. She'd almost lost it when they pulled the woman's guts out and plopped them on her chest. To this day, she couldn't eat sausage links.
And she'd just been an observer. Fermelli was the guy who would have to hold the patient's guts once Sharon hauled them out so that she could examine them.
Because of the surgical mask Fermelli was wearing, Sharon couldn't see most of his face. But the calm and steady look in his eyes reassured her. She'd told Stoner to make sure he found someone who had real hands-on surgical experience. Most seventeenth-century doctors—in Germany at least; she wasn't sure about Italian practice—were really more in the way of medical theorists. Advisers and consultants, potion-prescribers and the like, not what Sharon thought of as a "surgeon." The word itself was ancient, her father had once told her, deriving from the Greek kheirourgia and passing through the Old French serurgien before entering the English language. But, despite its majestic lineage, it had entered English through the cellar, not the front door. Until fairly recently in the universe she'd come from—not much more than a century, she thought—the distinction between doctor and surgeon had been entirely in favor of the doctor. The "surgeon" was the lowlife who sawed off legs, using booze for an anesthetic—and, like as not, did so while half-drunk himself.
Satisfied, Sharon looked at the other Venetian doctor. "And this is Dottor d'Amati," Stoner completed the introductions. "He has agreed to serve as the gofer."
D'Amati's chest swelled and he beamed at her. It was all Sharon could do not to burst into laughter. She should have known! Leave it to Tom Stone to call a gofer a gofer. There were times Sharon really liked that old hippie. She had no doubt at all that by the time Stoner finished with his lectures in Venice and Padua, Italian medical practitioners would have gofer firmly planted in their prestigious lexicon. He'd probably even manage, somehow, to get them clawing for the honor of being called a nurse. Which, as far as Sharon was concerned—she really looked at the world from a nurse's perspective, not a doctor's—would be just dandy.
She felt good. Really good. She'd been almost petrified in the hours leading up to this, knowing that for the first time in her life she'd have to be the one in charge of a critical operation. Now . . .
Flesh and blood. She could almost feel James Nichols' big, capable hands settling over her shoulders, as if from half a continent away his spirit was calming her and guiding her.
The sensation was powerful enough that by the time Sharon finished sterilizing with alcohol the area where she'd be operating—she'd have preferred iodine but they hadn't been able to turn up enough in the short time they'd had—she decided she would explain what she was doing while she worked. She'd seen her father do that, before students. He'd told her afterward that he found it a steadying influence on himself.
"I'm goi
ng to begin with what we call an exploratory laparotomy." She gave Dottors Fermelli and d'Amati a smile, hoping they could detect it under her own mask. "That's just a fancy phrase that means I'm going to cut the patient open and go exploring to see what's happening in there."
They seemed to be smiling back. Judging from his eyes, Fermelli's smile was even cheerful.
Splendid. She made sure of her grip on the scalpel. "The initial incision needs to be made in one firm stroke. It must be firm enough to cut through the skin and part of the initial subcutaneous layer. That's just another fancy word for 'fat.' Judging from appearance, I don't think we'll find a very thick layer of that with this patient. For a man of his age, he appears—make that any age, actually—to have a very low percentage of body fat."
She slid the scalpel in. "I'll open him from an inch or so below the breast bone to about four inches above the pubic bone. Like—"
It was a good cut. Really good.
"So."
* * *
Cardinal Bedmar was not the only spectator who looked away, at that point. But he suspected he was the only one who did so for spiritual reasons.
Like—
So.
The cardinal from Spain understood many things now which had been murky to him before.
Some, which had been murky for a short time, he understood very well. Ruy Sanchez's obsession with the woman had become a mystery to Bedmar, as the weeks had gone by since the doge's levee. The cardinal had assumed, at first, that the Catalan's fascination was nothing more complicated than a taste for exotic flesh.
And indeed, so it might have been, at the beginning. In the costumes they favored for their wealthy women, as in so many things, the Venetians enjoyed thumbing their noses at the Spain that controlled half of Italy. Where the Spanish style that still dominated much of the continent encased the female form in rigid, stiff—above all, high-necked—apparel, the Venetians preferred to see their women. Decadent and lascivious, in this as in all things.
And, see them they did. The first time Bedmar had ever attended a Venetian levee, as a man in his mid-thirties born and raised in Spain, he had thought himself somewhere at sea—with surging half-bare breasts making up the waves. He'd been quite shocked at the time, though he'd diplomatically kept it from showing.
He had not been shocked, of course, when he saw the Nichols woman so attired at the levee in February. By then, the man of thirty-five was a man of sixty-two, the marquis had become a cardinal, and Bedmar was as well traveled, cosmopolitan and sophisticated as any man in Europe. Yet even he had been arrested, for a moment, by the sight of such a magnificent and well-displayed bosom. All the more so when the flesh was as darkly colored as undiluted coffee.
But he had misgauged the Catalan, he now realized. Seeing the same woman wearing garments that, though they could not hide the female form did nothing to display it either, had laid bare the truth.
All his life—and Bedmar had known him since he was a young man—Ruy Sanchez had never been able to resist a challenge. In that, he was much akin to the hero of the Cervantes story that he so adored. The flesh was not the challenge, of course. For a man like Sanchez, flesh was no longer a challenge at all. The challenge came from meeting the first woman in the Catalan's life who intimidated him.
And how delightful a thought that was! Ruy Sanchez, abashed.
A woman so young, yet who moved like a queen, serenely and calmly—even more so in the garments she wore today than she had in the costumes she favored for the levees and operas—and could slice a man open while she described the deed itself. Calmly, serenely; not a tremor in her voice.
It was all the cardinal could do not to laugh aloud. Don Quixote, indeed, facing the largest windmill he had ever seen. No wonder Ruy had seemed so perplexed; yet, at the same time, so exultant. To such a windmill, such a man would devote the rest of his life. If he could only figure out what sort of lance would do the trick. The one between his legs that had served him so well in the past was hardly up to this exploit. Not on its own, certainly.
Bedmar's eyes drifted to the windows. The light was blinding for a moment, as if the rising sun were challenging the cardinal.
Which, indeed, it was. Bedmar sighed softly, all thought of laughter gone. The sun was made by God, as He had made all things. And now, after a long lifetime devoted to matters of the flesh—politics and intrigue, if not the cruder forms—He who had created Alphonso de la Cueva, marquis de Bedmar, was reminding him none too gently that He could and did make much greater things than a marquis and a cardinal.
The sound of many gags being suppressed simultaneously drew Bedmar's attention back to the center of the room.
One of those things was the man lying on the table. Not for many years now had Bedmar fooled himself which was the greater, the master or the servant. Did the rest of mankind fulfill their appointed roles on Earth with as much unflinching courage, honor and loyalty as that Catalan once-peasant, Satan's domains would be far more sparsely populated.
Granted, Purgatory would be full.
Another—and Bedmar suspected a greater still—
There came another and louder simultaneous gag; in two cases, not suppressed. Idly, Bedmar wondered which of these disturbingly efficient Americans had thought to provide those useful sacks he had wondered about, positioned conveniently here and there.
His own stomach, however, had never been given to queasiness. He leaned forward, to see what was happening better.
Yes. As he'd thought. The woman was handing the intestines to her assistant. As much of them, at least, as she could pry out of the body. Bedmar wondered, for a moment, if he might someday be able to prevail upon her to allow one of those magnificent Flemish painters—he was partial to Van Dyck himself—to do a portrait of her in the act.
Probably not. There would also be the problem of keeping the painter to the work, of course. Some of them were delicate fellows.
A pity, really. It would make such a splendid allegory. The world had many queens—and far more kings—who could disembowel men at a distance using the instrument of their armies. How many did it have who could disembowel a man with her own hands in order to save his life?
The sun shone in the cardinal's eyes, asking him God's question. Bedmar, no fool, did not fail to note that it was a rising sun.
* * *
"—can see only one nick on the intestines themselves. I'll sew that up later. That's worrisome, because any cut in the intestinal tract is almost sure to result in peritonitis. But I was a lot more worried that I'd find one of the loops completely severed. That would have been a real nightmare, given what we've got available. This cut is small enough that I'm pretty sure we can contain the infection with the sulfa powder I'll be using as well as the chloramphenicol we gave the patient a few hours ago."
Sharon was almost done running the intestines now. "I'd be a lot happier, of course, if we didn't have such a small supply of the chloram. Uh, that's a nickname we made up for chloramphenicol. But at least we're in pretty good shape with the sulfa drugs."
She then took a couple of minutes to double-check herself and make sure she hadn't overlooked anything. "I don't need to check the liver or the bladder, given the location of the wound. I will need to check the stomach but I'll do that later. Right now, the spleen's in the way."
She pulled her head back. "How are the vital signs looking, Stoner?"
"Holding up. I don't think he'll make the marathon, though. Not next month's, anyway."
Sharon chuckled, making no attempt any longer to maintain her earlier reserve. By now they were well into the operation and her team was shaping up as a good one. Fermelli was splendid. D'Amati was still catching up, but doing better than she'd expected. A little relaxed banter was just part of the process.
That was the way her father ran operating teams, anyway. Sharon knew that some other surgeons didn't. There was one surgeon back in Chicago whom James Nichols always privately called "the pencil sharpener." The reference wa
s not to his bookkeeping fussiness—though the man had that in full measure also—but to a portion of the surgeon's anatomy.
Graveside humor, granted. But what else do you expect to hear on the edge of a grave? Of course, if the patients could hear the jokes, they'd probably die right then and there. Of terminal indignation, if nothing else.
For the first time since she'd begun the operation, that treacherous little voice crept back.
Ruy Sanchez wouldn't. He'd probably kill himself from making the surgeons laugh too hard. His English was even getting the right idiom.
Never has a man been felt up so well by his woman! I, Ruy Sanchez de Casador y Ortiz, swear it is—
SQUASH.
Once she was sure the damn thought was flat as a bug, Sharon straightened and took a deep breath.
"Okay. The main damage was to the spleen and I'm going to remove it entirely. We call that a splenectomy. The 'ectomy' part of it is just a fancy way of saying 'yank it out.' And why am I telling you that, anyway? I'm sure your Latin is way better than mine."
Her assistants chuckled; then again, and more loudly, when Fermelli added: "Actually, it's Greek. We Latins are more inclined to putting things in. Unfortunately, the common term for that does not adapt well to medical terminology."
Sharon bent over, smiling, back to the work. "There's going to be a lot of blood coming out here. From the looks of it, the capsule that surrounds the spleen tampanaded the bleeding. That's good—I was hoping for it—because it means the capsule would have acted as a temporary pressure dressing and slowed the bleeding. That's really important with spleen injuries, since the spleen is the most vascular organ in the body and is normally perfused by something like three hundred and fifty liters of blood a day."
It was an odd little speech. The sentence structure was Italian but so many of the words were English. Sharon knew Fermelli and d'Amati would barely be able to follow her here. So why had she spoken at all?