Gray (Book 3)

by Lou Cadle

  Julie raised her foot from the bucket and looked down. “Oh, God. That looks bad.”

  Coral watched Edith try to soothe the patient, but Julie was looking at Coral. “It is bad,” she said. “I’m sorry.”

  “Will I lose them?” She reached for her foot.

  “Don’t.” Coral took her hand and held it back. She did know that much. “Don’t rub them or pop the blisters or even move the foot around. It’ll make it worse.”

  “Don’t let me die.”

  “You won’t die,” Coral said, as Edith made soothing sounds. She bent closer to the foot and studied it. A thin liquid was oozing out of cracks in the blisters. She sniffed it, and it smelled foul. “But I don’t know yet about your toes. They may not make it.”

  “Oh, God,” Julie said.

  “I know it’s impossible not to worry,” said Coral. “But worry won’t change the outcome.”

  “I didn’t know it was this bad. Try to save them.”

  “I will,” said Coral. “I’ll do everything I can. Can we have a little more wood in the stove, Edith?”

  Coral pulled the exam table a few inches closer to the stove. Edith wrapped another blanket around the patient, and Coral let her talk to and distract the patient while she kept an eye on the toes.

  When Julie vomited, Coral knew this wasn’t going to turn out well. She had no experience with this. She had no internet pictures to check. But she thought she was looking at gangrene. When she felt Julie’s face and neck, she felt warm. Fever? Maybe.

  Coral felt the weight of the responsibility and wished to be anywhere but here, and anyone but the person responsible. When a knock came at the treatment room door, she hoped for a crazy second that it was someone to deliver her from her position of responsibility.

  No such luck, but when Edith answered and she saw Benjamin and Abigail in the hall, she felt better.

  “Edith told us what was happening earlier, at supper,” said Abigail. “We thought you might need some help. Or a break?”

  “Thank you,” Coral said. “Could you sit with Julie for a moment, Abigail?” She leaned in and whispered. “Try to distract her.” Coral motioned Edith over, and the two of them and Benjamin went into the waiting room. It was empty and, once they had shut the door to the treatment room, nearly black.

  She shuffled over to the seats and groped around until she found one. She sat, taking a moment to hold her head in her hands and have a split-second breakdown. Then she took a deep breath and said, “I’m going to have to amputate those toes.”

  “I think you should,” said Edith. Her calm voice made Coral feel better.

  Benjamin said, “Is there anything I can do?”

  Coral almost said “the cutting,” but, while Benjamin might in fact be a better surgeon, with his experience in dressing game, it was Coral’s responsibility, and she wouldn’t hand it over to anyone else. “Yes. You might need to help hold her down.”

  “What will you use for anesthetic?” asked Edith.

  “I want to give her one of the Tylenol with codeine.” They didn’t have very much in the way of pain pills, and that was going to be a problem. “No, two. And I guess it’s time to try out the local we found in the barn.” At least Edith would know how much of that to give. “Can you think of anything else we can do, Edith?”

  “No.”

  “You lost someone to frostbite, didn’t you?” It had slipped her mind.

  “I did,” she said.

  “Am I doing the wrong thing here, Edith?” Coral felt a stab of guilt. She wasn’t a doctor. She shouldn’t be playing at being one.

  Edith said, “In the old world, maybe they’d have had other treatments to try first. Now? We can’t afford to wait, I don’t think. Get rid of the dead tissue now, before the infection kills her.” Her voice dropped again so that it was barely audible. “I don’t want to lose another patient.”

  “We won’t lose Julie,” Coral said, hoping the promise wasn’t a lie. “We have some drugs. We have disinfectant. She’s young and healthy. And it’s not her big toe, so she won’t even be terribly disabled by it. We can do this.”

  We have to do this.

  Having given the pep speech to her team, Coral felt marginally better herself. First, she’d give Julie a pain pill, then Edith would sterilize the area. Coral would inject the local. Abigail and Benjamin could hold Julie down—she’d have Benjamin, stronger, take the legs—and Edith could talk to her, trying to distract and sooth her.

  Benjamin said, “What do you have for antiseptic?”

  “There’s a full bottle of vodka,” said Edith. “I’ll get water on the full boil now, sterilize the instruments both ways.”

  There were a few surgical instruments from a vet’s office—scalpel, forceps, clamp, probe. Coral said, “Good. I need the anatomy atlas, too. And I want to look at it where Julie can’t see me.”

  Edith said. “Anything else?”

  “No, I’ll meet you in the other exam room in a minute.” As Edith hurried off, Coral said to Benjamin, “Am I crazy to be thinking of doing this?”

  “I don’t think so. Her toes can’t be saved?”

  “They’re dead. They’d fall off anyway, but it’s the infection that could kill her. I’m afraid to act, but I’m more afraid to wait.”

  “Go with your gut.”

  “My gut is telling me I’m a fake doctor. I’m nineteen years old, Benjamin.”

  “No, not really. No, wait, don’t interrupt. Technically, yeah, that’s your age. But in experience? You’re older. You’ve doctored me twice for serious injuries and never taken a wrong turn. You’re not some irresponsible child. I trust you. You can trust yourself.”

  “I don’t want to screw this up.”

  “Then don’t.”

  “That easy, is it?”

  “You’ll do fine. Tell me what you need me to do.”

  “Moral support, I guess, while I read up on bones and ligaments and nerves.”

  In the empty exam room, she took the anatomy book—photos and diagrams, both—and studied the human foot. She was planning to remove the distal phalange bones, numbers three and four. She could do it on a dead animal in a lab, no problem. Her dissections always got top grades for neatness and accuracy.

  But dead animals in the lab did not scream when you cut into a nerve. They didn’t bleed from functioning blood vessels. Dead animals’ ligaments had lost their elasticity. This would be an entirely new experience for her.

  She stared at the photos, memorizing what she was about to see in real life. But what would her patient feel? Coral stripped off her shoe and sock and palpated her own toes, hunting for the sensitive spots, hoping that she felt nothing along those toes. She jabbed herself with her fingernails.

  “Ow,” she said. No, she felt that.

  “Don’t hurt yourself,” Benjamin said. He had been quietly sitting with her while she prepared.

  “I think her toes don’t feel anything—but I’ll have to cut up to where she does feel it. It’ll hurt.”

  “You’re a brave person.”

  “Julie is going to have to be the brave one,” she said. “I don’t know how it’ll go in there. You might have to really sit on her leg to keep it still.”

  “Okay.”

  She went back to studying the photos and diagrams, mumbling anatomical terms to herself to remember them. She used to drive her roommate crazy doing that, but it helped her retain the information.

  Her pocketknife was in her pocket, as always, and she took it out, flipped open the longest blade, and reversed the knife so the dull side was down. She rehearsed on her own toes the cuts she would have to make on Julie’s. There, and there. Probably need to cauterize a vein at that point. She could leave the tip of a probe in the fire as she started, grab it with a piece of cotton bandaging to keep from burning herself. Cauterize, drop the probe, cut the ligaments here and here. Bones should detach pretty easily then. At that point, she needed to look at the remaining tissue, the damage to it
and slice away everything necrotic.

  Again, she rehearsed the moves. And again. A shudder ran through her. Not nerves.

  “You getting cold?”

  “Yeah. Grab the book, please, and bookmark this page in case I need to look at it while I’m operating.” She hoped she wouldn’t need to and that Julie wouldn’t notice if she did need to. Nothing worse than watching your doctor learning as she wields a scalpel.

  “Will do.”

  “Let’s see how the patient is,” she said, grabbing the lamp.

  The other exam room was toasty warm. Coral went to Julie and Abigail backed off to let her close to the patient. “Pills taking effect yet?”

  “I’m feeling them,” Julie said, but her eyes were still alert.

  “We’ll give them a few more minutes,” Coral said. She turned to the stove. The water was boiling, the instruments in it. Edith had pulled out a stack of cotton bandages.

  Coral closed her eyes while she mentally rehearsed. The voices of the others were low, but as she played out the operation in her imagination, they faded to nothing.

  Edith’s voice broke through the wall of her concentration. “The instruments are ready.”

  “Good,” said Coral. She was, too, or as ready as she was going to get. “I need to wash my hands.”

  “I have warm water over here for you.”

  Coral washed twice with the homemade soap, scrubbing under her nails and around her cuticles carefully. They had no latex gloves, so it was going to be bare-handed work. Edith scrubbed Julie’s foot up to the knee, and the surface of the table, and when they were ready, Coral held her hands over Julie’s bare foot and Edith drizzled the vodka over all. She had tossed a couple towels on the floor to soak it up—and to soak up blood.

  “Ready?” said Edith.

  “You okay, Julie?” said Coral.

  “I’m fine. Sort of floaty,” said Julie, her voice slurring slightly.

  Everyone was in place and had their instructions. Coral started with the local, pulling it up into her makeshift syringe and then sliding it into the healthy tissue of Julie’s foot. Julie jerked back, and Benjamin leaned in to hold her leg steady.

  Coral said to him. “You can let go for now. We need to give this five minutes to take effect.”

  The only sound for that five minutes was Abigail talking to Julie and the clink of instruments as Edith laid them out in a neat row on some of the precious sterile gauze. She opened several two by twos, leaving them on the paper, for Coral to grab as needed.

  About three operations, and they’d run through all their supplies. A problem to think about on another day. Coral took up a scalpel and tapped the top of Julie’s foot. “You feel that?”

  “Vaguely. Are you cutting?”

  “Yes,” Coral lied. And then she did, leaning in, pressing the scalpel in, and making the first incision through the skin at the base of the blackened toe.

  The smell that wafted out as she cut reassured her she was doing the right thing. Already the odor of rot was strong. She reassessed and cut higher into the foot than she had planned.

  An extra pair of hands would be useful about now, but she didn’t have that. As she cut into the edge of healthy flesh, Julie began to struggle, and Edith and Benjamin were both busy holding her still so that Coral could work. Abigail’s voice went on, trying to distract Julie, but Coral didn’t pay attention to her words. She had work to do.

  She cauterized the biggest of the veins, and then daubed away the blood. She could see the point of attachment of the ligament, on a rough indentation of the bone. Here goes. Grasping the scalpel firmly, she cut through the ligament.

  Julie’s leg bounced, and she yelped.

  “Hold her tighter,” she said to Benjamin, without looking up.

  Coral severed the ligaments to the second toe. Julie began to moan, but Coral tuned it out. She took a two by two and cleaned the area of blood. She could see the nerve that ran through there. The toes were drooping off the foot. She steadied the foot, slipped the scalpel blade under the nerve, and, quick as she could, cut.

  Julie shrieked, not a sound that could be tuned out.

  “That’s the worst of it,” Coral said. “It gets easier now, Julie.”

  The scream eased off as Julie ran out of breath. She was still whimpering when Coral went back to work. She wished she knew how much tissue to sacrifice. She didn’t want to have to operate again, but she didn’t want Julie any more disabled than she had to be.

  The severed nerve and ligament had retreated up into the foot. The toes were lying on the table, black and dead.

  The blood was making it hard to see. She cauterized again, dabbed at the wound, got a good look at the raw tissue of the foot. No blackened tissue was left, but there was a patch of white she thought was not going to heal on its own anyway. Its absence shouldn’t make much difference to Julie’s balance or mobility. So she carved it away.

  Another two minutes, and it was done. A sewing needle threaded with dental floss was set out, and she took it up and sewed, her hands still steady. Ten tiny stitches, and she backed up and looked at her work. Blood was still seeping in one spot, so she took two more stitches there and tied off the thread. The knot wasn’t as close to the skin as it needed to be, so she tried again and got it right the second time.

  She backed off and the room swam back into her awareness. Julie was sobbing. Benjamin looked pale and shocked. “Don’t go anywhere,” she said to him. She took up the bottle of local and the syringe and drew up another dose, and, after glancing to make sure Benjamin was hanging on to the leg, injected it. “It’s okay,” Coral told everyone. “Almost done. Just one more shot.”

  She glanced down the line of supplies Edith had lined up. “Edith, I’m not seeing the antibiotic.”

  “Right.” Edith went over to the cabinets and opened first one, then another, finally coming out with a bottle of antibiotic Coral had taken out of the animal barn.

  She had no idea of the correct dose, so she was conservative. She could dose her again tomorrow morning if there’d been no ill effects. Probably the gluteus would be a better injection site, but Julie’s calf was right here, plenty of muscle tissue, and it was already sterile. She injected the antibiotic quickly and then backed away.

  The severed toes were still lying on the table. She reached forward and flicked them to the floor, where they lay on the vodka-soaked towels. She kicked the towel over to hide them.

  With every second, her awareness expanded beyond Julie’s toes. The room was hot, and a scene of carnage, and everyone in the room but her was looking traumatized. Maybe not Edith so much, but the others. Even Benjamin.

  Julie was sobbing, still. Coral picked up the bottle of vodka and handed it to Edith. “Give her a drink, see if it helps at all.”

  She went to stand by Julie’s head. “I’m sorry it hurt so much.”

  Julie shook her head, back and forth, slowly. Coral had no idea what she was trying to communicate, if anything at all.

  She patted her arm. “You did great, Julie.” She backed off and looked at Edith. “I need a second,” she said, and left the room.

  Chapter 19

  In the waiting room, for some reason, she could smell the scent of rotting flesh more strongly. Her mind was replaying the operation, every cut, every decision. The whiteness of the nerve. Red blood oozing over blistered and blackened flesh.

  She had to run for the front door. Outside, she leaned over and vomited onto the snow.

  It wasn’t the smell or the blood, though; it was the responsibility that was making her sick. What if she’d failed Julie? What if she’d put her through that pain and failed to save her?

  She spat, and then walked a few steps away. Her knee ran into a berm of snow, piled up from the shoveling. She couldn’t see a damned thing out here.

  The door behind her opened with a squeak. “I brought you the bottle of booze.” Benjamin.

  “Save it for disinfectant.”

  “I have som
e water, too.”

  “Yeah, that’d be good.”

  She felt his body bump against her, and then he pressed a plastic bottle into her hand. She took off the cap and held it a few inches from her fouled mouth, poured some, swished it around her mouth and spat it out. She did that again, and then she took a swallow, feeling the slight burn of bile in her throat. She took another drink to wash the taste away, and handed him back the empty bottle. “Sorry, I finished it.”

  “No worry,” he said. “Come back inside. It’s cold out here.” He put an arm around her shoulder and guided her back inside.

  “You see better in the dark than I do,” she said.

  “You were amazing in there,” he said.

  “Not really.”

  “I was watching you. Your focus was, like….” He trailed off. “I don’t even have the word. Complete. Impressive.”

  “You’re nice,” she said.

  “I can’t believe how fast you did that. It was like you’d been doing it your whole life.”

  “I didn’t want her in pain for any longer than she had to be.”

  “She’ll be okay,” he said.

  “I hope.” Coral took a deep breath, and it felt like the first time she’d breathed in minutes. “If you want to go home, go on. I need to stay with her. Make sure she doesn’t have problems.” Though if she had problems, Coral didn’t know what she could do. A reaction to the antibiotic, shock, anything like that, and she’d be out of her depth. Bleeding, she could stop. A stitch could be replaced. But anything more?

  “She’ll be fine,” said Benjamin.

  “You think so?”

  “Thanks to you.”

  It was nice of him to say so, but Coral was not feeling proud of what she’d done. Maybe it had to be done. Maybe Coral was the only person among the three hundred people in Boise who could have done it. But it didn’t feel good that this was the case. It felt like an enormous burden. “Okay. I’m ready to face her again.”