“Thank God, he’s finally out,” one of the guards says as they release him and relax, remaining in place in case Henley should wake again.
The king turns to Hannah. “I had not imagined that a woman physician could be so effective.” He raises his brow slightly. “Well done.”
The guards find benches for the king and his entourage to sit upon. While they are being seated—the tack room being transformed into an operating theater of sorts—Hannah walks around the table to better inspect Nat Henley’s leg.
It is brutally injured, that much is obvious even before she removes the blood-soaked rag that’s been wrapped around the wounded limb. With it she wipes away some blood from the calf so she can more clearly assess the damage. Both bones of the lower leg are broken beyond repair. Their splintered ends are visible, having burst through the torn skin about four inches below the knee. The anterior and lateral calf muscles are cut and bleeding, but the posterior muscles and tendons are still intact and connect the knee to the ankle. The foot is twisted around so far that it is nearly facing backward. It is astonishing that Mr. Henley was able to withstand the pain as long as he did before passing out.
She is in no doubt about what must be done: the leg will have to be amputated. It is not possible for Henley to survive this injury. The bones cannot be set, and so there is no way for it to heal on its own. His chance of surviving the operation is perhaps fifty percent, perhaps not even that, but without it he will certainly die.
“Well, Mrs. Devlin?” the king says. “What do you make of it?”
She turns to face him and her audience, three rows of pale faces in the shadows: the king and Arlington, Montagu and the other courtiers, their footmen in the back. The king appears unusually interested: he is known to have an interest in medicine, particularly in the surgical arts. This is not uncommon among kings, who are always looking for new ways to solve the problems of injury and disease among their fighting forces, but Charles is more involved than most monarchs, visiting hospitals, the Barber-Surgeon’s Hall, and the College of Physicians to witness surgeries and dissections, and allowing the Banqueting House to be used as a site for anatomical trials upon cows and sheep, trials in which he sometimes takes part. Perhaps the king looks upon Mr. Henley’s misfortune as another opportunity for experiment. Arlington looks seriously annoyed. Most of the courtiers seem to be anticipating some sort of entertainment. What kind of place makes a spectacle out of a man’s suffering? It reminds her again that she does not really belong here.
Just as she is about to speak, she is aware of a disturbance in her vision, a bright, wavy line that crosses her sight like a flash of lightning. Her head has ached all morning, and now, with the tension of the moment and apprehension of the task ahead, it has grown worse. In her pocket she has a vial of poppy syrup which has become her constant companion, but she will not be able to use it now, not here. She steals a glance at Mr. Henley, and an idea occurs to her. Usually strong drink is all that’s given to a patient under these circumstances, but according to the captain, Mr. Henley is already drunk, and it might be worth a try. With effort, she steadies herself and speaks.
“Mr. Henley’s leg needs to be amputated.” A murmur goes through the small crowd, but the king says nothing. “This is the best time to operate, while the patient is still suffering from the shock of the injury. It will cause him the least amount of additional pain.” She pauses, focusing her thoughts. “Obviously, I do not have any surgical instruments with me. Are there any here at court?”
“You intend to perform the surgery?” Arlington asks, alarmed.
“Mr. Henley will not survive long without it.”
“Have you ever amputated a leg before?”
“No, my lord. But many times I assisted my father, and as you know, he was a skilled surgeon.”
“Excellent,” the king says decisively. “Let’s see what she can do, Arlington. I daresay you’ve never seen a woman cut off a man’s leg before.”
“I’ve never seen a monkey cut out a kidney stone before, but that does not mean I should like to,” Arlington answers sourly, but he calls his footman over and instructs him to go at once to the king’s laboratory and bring back a set of surgical tools.
Henley stirs and moans, as if to remind them that he is still among the living. Hannah imagines that her patient is only slightly less frightened than she is. She has often done the small surgeries—let blood, lance boils, sew up wounds—that most physicians know how to perform. She has amputated frostbitten toes and gangrenous fingers, and she once removed the ear of a man who was troubled with a tumor. And once, with her father, she helped cut off a man’s badly broken arm. She knows what needs to be done, but she has never before amputated a leg, and certainly not the leg of a man this size. Cutting through muscle and bone, especially bone, is difficult; it requires strength. She is not certain that she can do it.
“Captain, I’ll also need a box of straw to put below the table to catch the blood, some linen to make pledgets and bandages, and a few threaded needles for the ligatures—”
“Your Majesty!” A familiar and unwelcome voice calls from the doorway. Sir Granville Haines enters, followed by another man. Sir Granville instantly spots the king and hurries across the room to make his humble obeisance. “A thousand apologies for not being available the moment you summoned me.”
“I summoned you?”
“I was told you were in need of a court physician, and I—” He catches sight of Hannah. “What is she doing here?”
“I asked her to attend to the coachman,” the king answers.
Sir Granville squints at Henley, not believing what he sees. “But that man needs his leg cut off!”
“Yes, and Mrs. Devlin is going to do it.”
“Majesty, I must protest! With all due respect, sir, all the physicians of your court—nay, London—will be up in arms over such an outrage. Surely you will not endorse this affront to our dignity.”
“From what I hear, Sir Granville, you affront your own dignity every day.”
The courtiers laugh. Sir Granville is not amused. “The College of Physicians will be in an uproar, make no mistake,” he warns.
Lord Arlington cocks his head to speak into the king’s ear. Charles listens for a while, then sighs. “Enough, enough,” he says to Arlington, and then, as if to himself, “as usual, someone has managed to take the fun out of my fun. What do you suggest we do, Sir Granville? There seem to be no other doctors available, and Mrs. Devlin insists that she has the requisite skill. Not to mention that it is the king’s desire to see a woman perform such a feat. Would you deny me my amusements, Sir Granville?”
“Oh no, Majesty, never,” Sir Granville grovels. “I am only thinking of the future of medicine and how to protect our esteemed calling from those who are unworthy.” He looks pointedly at Hannah. “Edward, if you please,” he says after a moment. Sir Granville’s companion comes forward and bows before the king. “Your Majesty, may I present my nephew, the Honorable Dr. Edward Strathern. He is an excellent surgeon recently returned from his medical studies in Leyden. I propose that he perform this operation.”
Edward Strathern bears little resemblance to his uncle, being more soberly attired and modestly bewigged. No ceruse or patches, either, but he has a self-satisfied air that Hannah dislikes at once. She catches a vain glint of gold braid on his cuffs and lace on his cravat. She knows Strathern’s type instantly: a university-trained physician with his head full of a thousand useless theories and no experience in the real world. He’s no older than twenty-eight, she guesses, thirty at most. Now he’s come to court to claw his way up, under the auspices of his well-connected uncle. She grants that he’ll need all the help he can get: even if he’s twice as clever as Sir Granville, he’ll still be an idiot.
The king clears his throat. She supposes he will ask Strathern to list his qualifications. Surely he will require more than Sir Granville’s endorsement. “Dr. Strathern,” the king says, “how did you find the ale
in Leyden?”
“Not nearly as good as English ale, Majesty.”
What a ridiculous charade. The man has probably never even held a knife. Surely the king won’t allow him to operate, but she reminds herself that he is called Dr. Strathern and, no matter how accomplished she becomes, she will always be Mrs. Devlin. The footman arrives, out of breath and carrying an elegant carved wood box.
“Your Majesty,” Hannah interrupts, but she receives a warning look from Arlington.
“Of course, of course, we must not delay,” the king says. “I have decided that the two physicians will work together.”
Hannah can hardly conceal her shock and dismay. What if Strathern makes a mess of it? She is even more appalled when she sees the doctor looking at her in precisely the same manner. She turns away, takes the instrument case from the footman, and opens it. Inside is a double-bladed catlin knife, a scalpel, a lancet, and a fine-toothed saw. The instruments are a bit small for this particular task, but they appear new and well made. She takes out the catlin knife and places the box on the floor near her feet, where she will have easy access to it.
“Captain, would you have your men position Mr. Henley so that the injured part of his leg is off the table?” she asks. “Dr. Strathern, if you would take hold of his ankle, please?”
Though Strathern is standing beside her, he does nothing. Hannah feels the king’s, and everyone else’s, eyes upon them. The physician turns his back to their audience and speaks softly. “His Majesty said that we were to work together.”
“Yes, and you can help by holding the patient’s ankle,” she whispers in return.
“I think I should perform the surgery.”
“You are ambitious, aren’t you? I happen to be more qualified for this task than you.”
“And how do you know that?”
“Dr. Strathern, you do not look like a surgeon.”
“Pardon me for saying so, but neither do you. And yet here we are.”
“I have performed many surgeries in the past, including the amputation of an arm.” She is exaggerating slightly, but with good reason.
“You have?”
“Yes.”
“Oh.” Strathern seems surprised. “The truth is I am not precisely a physician or a surgeon.”
“Then what are you?”
“An anatomist.”
“You dissect dead bodies?”
“Yes.”
“Mother of Christ,” Hannah lowers her voice even further. “You’ll kill him.”
“And how do you deduce that? A man’s body is designed the same whether he is living or dead.”
“There is a great deal of difference between operating on a dead body that feels nothing and a living man who will most likely be screaming and thrashing about in pain.”
Is she imagining it, or does he blanch just a little? It gives her a strange sort of pleasure. “You must make the incisions very quickly,” she continues, “so as to cause as little suffering as possible. Can you do that?”
He hesitates. “In truth, I’m not accustomed to working in haste.”
“Then I will resect the skin and muscle, and perhaps you could saw the bone.” She doesn’t look at him while she waits for an answer. She doesn’t want him to know that by agreeing he’ll be doing her a favor.
“All right then.” Strathern looks down at his coat. “We’ll need aprons.” One of the guards goes off into a corner of the tack room and returns with two blacksmith’s aprons. Hannah gives the captain her vial of poppy syrup.
“When Mr. Henley wakes,” she says, “which he probably will, instruct your men to hold him as still as they possibly can. I know this will be difficult, but you will be doing him a service if you remain strong.”
“Yes, ma’am.”
“When Mr. Henley opens his mouth, pour this in. Half will be fine to start, but he is a big man and may require more. It should make him calmer and easier.”
Hannah double-checks the position of Henley’s body. His injured leg juts off the table. Dr. Strathern holds his ankle, while his other limbs and his shoulders are firmly secured by the guards. “Is everyone ready?” she asks, and she receives nods all around. “Your Majesty, we will begin.” She takes a final measure of Henley’s calf and lightly places her knife for the first incision.
“You’re too low on the leg,” Strathern whispers. “The bone is shattered closer to the knee.”
“We’re not going to resect the bone here,” Hannah says, annoyed. “Just the integument. We’ll need as much healthy tissue as we can salvage to form a stump.” She turns her attention to the task before her. “Don’t interrupt me again.”
She quickly makes an incision halfway around the leg, about a quarter-inch deep; and then another in the opposite direction, so that the two incisions nearly meet—or would if the leg were not broken. Henley groans loudly and instinctively tries to pull his leg away, surprising Strathern most of all, who looks on uneasily as the leg moves in his hands.
“Captain, the medicine, please,” Hannah says.
The captain lifts Henley’s head and tips the vial into his mouth. “How much?”
“All of it.”
Henley gags on the syrup and spits some of it out. He moans and tries to move, then finds that he can’t. His eyes flick open as his consciousness returns.
“My leg!” he screams. “My sodding leg. You bloody bastards. My God, it hurts!” The guards struggle to keep him still as Henley’s sobs rack his body.
“Hold his leg down harder, there just above the knee,” she commands the guard closest to her. He complies, and she raises the knife again. She feels a ring of perspiration break out on her forehead and the annoying tickle of a single bead of sweat as it rolls down her face. Only a profound resolve keeps her hands from shaking. She gently separates and slices through the muscles one at a time, working through the peroneus, the soleus, the tibialis. This is the most agonizing part of the surgery, and under her knife Henley trembles violently. She has never caused anyone so much pain before; it is nothing less than horrible, yet she knows it must be done. As she cuts the tendons, Henley is still sobbing and moaning, but she can feel his anguish subside a little. With any luck he will be unconscious again before they saw off the jagged ends of the broken bones. She severs the last bits of muscle, tendon, and skin. Arterial blood spurts forth, splattering her and Strathern. Their audience gasps. The sound seems to come from very far away.
She turns to the other physician, who now holds Henley’s foot and ankle in his hand. Their eyes meet, and she sees that his are a deep blue-gray, intense, and intelligent, a fact which registers in her mind with a simultaneous sense of surprise. Strathern’s face and forehead are streaked with blood; at some point he must have wiped one of his hands across his brow. For a moment they do nothing more than look at each other, at their blood-splattered selves. In God’s name, what have they done? Have they just killed a man or let him live? It is impossible to know. Then Strathern lowers his gaze to the severed limb in his hands. It’s already turning blue.
“Put it in the box,” Hannah says. Without question and without emotion, Strathern places Henley’s foot into the box of bloodied straw. He opens the instrument case and removes the saw, then straightens and regards the amputated leg in front of him with a practiced composure.
The rest of the operation goes smoothly. Nat Henley lapses into blessed unconsciousness. Hannah ties off the bleeding blood vessels. Using thin strips of fabric, she retracts the severed muscles up toward the knee, and Strathern saws off the jagged ends of the bones. They form a stump by overlapping the muscles and skin and sewing them into place. Hannah rips up the rest of the sheet to use as a dressing. Nat Henley is lifted from the table and carried to a cot set up in a corner of the tack room.
The king stands and stretches. Arlington waits anxiously for his verdict. If the king banishes her from court, Hannah thinks, so be it. She would be happy to see no more of it. Arlington can do whatever he will with her.
>
“Excellently done,” the king says to the two physicians. Arlington’s relief is immediately evident. “Dr. Strathern, I hear you are in charge of the new anatomy theatre at the College of Physicians.”
“Yes, Majesty.”
“I wish you well. Please keep me apprised of your work there. I am always interested in the latest discoveries. Mrs. Devlin, you have earned your two weeks. But the court will have a dance then, I will insist upon it.” He takes out his pocket watch. “It’s time for dinner. Who’s joining me?”
The king departs, followed by the group of pale-faced courtiers, none of whom looks in the mood to eat.
“This should keep you in good stead with Arlington,” Montagu manages to whisper to her on his way out. “You might be disappointed that you’ll be kept at court a while longer, but I’m not.”
The room empties, and Hannah searches the operating table for her bottle of syrup. Even a few drops would help ease her pain. She finds it on the floor, without the stopper. It is disappointingly empty. She puts the vial in her pocket and goes over to check on Mr. Henley. Dr. Strathern is covering him up with a wool blanket that smells strongly of horse.
“What will you do with the foot?” he asks. It has been wrapped in a section of sheet and placed in a clean box of straw beneath the cot.
“It isn’t mine to do anything with. If Mr. Henley lives, he can bury it himself, and if he does not, his family can bury it with his body. You didn’t think you would have it for one of your anatomical studies, did you?”
The Devlin Diary Page 17