"No, but it wasn't my fault." He summoned a weak, pain-edged grin. "McDavie—" one hand caressed his abdomen—"guards the—cupboard too well."
Mac McDavie raised his head but didn't speak and Sarah wondered if he was feeling as trapped as she was.
Here they were, with an appendix that might perforate at any minute—
She had seen peritonitis, had assisted in operations on patients whose appendices had perforated before they'd called the doctor, even. It wasn't a pretty memory. Neither was what had happened afterward. The struggle (which sometimes wasn't won even when there were antibiotics to help) against the spreading infection that made the abdomen boardlike, that sent the temperature skyrocketing—
"Look—Miss Bennett—"
George Jefferson broke off to lie for a long minute, his jaw set against the pain.
"If this thing perforates—that's—it, isn't it?"
"It might not be."
He shook his head at her. "Don't give me that, Miss Bennett."
She should have known better than to have tried, Sarah thought. George Jefferson would know about peritonitis—
She said, "Peritonitis is a dangerous thing, Mr. Jefferson."
Which was putting it mildly. She tried to remember figures she had heard Dr. Cal quote—not to tell them to George Jefferson but to herself—but they were lost in a ground-swell of panic that rolled into her mind.
Suppose he did perforate? She couldn't just stand by and let him die! She'd have to try—
Oh, God, she thought. Could she?
With only a vial of chloroform and no surgical instruments, no experienced hands but her own and not even they experienced in performing surgery, would she dare attempt an operation even as a last resort?
The McBurney incision that Dr. Cal always used leaped into her mind's eye, but with Dr. Cal's capable, rubber-gloved hands on the scalpel and her own passing a fresh, sterile scalpel to replace the one he had used for the initial incision—
George Jefferson writhed into a new, but no more comfortable position.
For him, now, there was no comfort, Sarah thought. There wouldn't be as long as that pus-mass was growing, spreading its poison.
And when the pain ceased, abruptly—if it did—it would be too late…
It was a long rest-of-the-night. Mr. Jefferson's temperature, which Sarah checked every hour, climbed steadily.
103.8.
—point 9.
104.3—
Her heart lurched crazily at that.
Four-tenths in an hour?
"What is it?" George Jefferson asked. He always asked—
Sarah told him. It might not be hospital routine, but this wasn't a hospital. Oh, God! if only it were! she thought.
Jan-Doreen's baby had been different. Anyone could deliver a baby. Nature did most of the work and as long as the mother was strong and healthy—
"Look, Miss Bennett—"
Again George Jefferson broke off, grim faced, jaws set against the pain that must have washed over him in a new wave.
"I know fever. If this keeps up I'm going to be out of my head. I think—I'd better get this said while I'm lucid and"—he squinched his eyes tight against another onslaught of pain—"while McDavie and Malcolm are here to hear it."
The hard, cold knot that had lain dormant behind Sarah's sternum, waiting, fanned out, dispersing its shower of icy needle-pricks that were fear, apprehension, a sure knowledge of what he was going to say.
He went on, straining against the agony that all night had grown more acute, "If this damned thing perforates, I've had it. Alexander warned me it might happen—gave me odds, the mortality rate, the works, I guess you could say—but hell, who counted on a mess like this!" It wasn't a question.
"Don't interrupt, Miss Bennett," when she started to. "I know my chances. If it looks like perforation, I want you to operate. With this fever it's apt to be your decision and I want you to be free to—"
"I'm a nurse, Mr. Jefferson," she reminded him, "not a surgeon."
"You're a surgery nurse. Hell, Miss Bennett!" he burst out. "I know what I'm doing—I'm grasping at what may be my only chance. I'll take it."
Impulsively Sarah touched the wet forehead. "Let's not worry about it now. You haven't perforated."
"And maybe I won't. I know." His tormented eyes went from her face to Al's and Mac McDavie's. "I just wanted it said—before witnesses."
Easing his legs over the side of the bed, he sat up. Very carefully. "Now you get out of here, Miss Bennett. Even a sick man's got to have privacy for some things."
The combination of snow and moon filled the valley with an eerie brilliance. Sarah walked through it slowly, past the cabin she shared with Mrs. Emlyn and Jan-Doreen Stevanic and the baby to the signal fire, which was burning lower.
The ground around it was sodden and spongy where the fire had melted the snow and thawed the frozen topsoil. The snow water that hadn't run off because there was no place for it to run to since the hard-frozen ground beneath had it trapped as surely as if a basin lay underneath the thin layer of thawed soil, sent its icy chill through the leather of her pumps. Only half aware of the cold, she threw a spruce bough on the fire, then another and another, and watched flames and sparks shoot toward the bright star-studded sky.
The possibility of attempting surgery if Mr. Jefferson's appendix perforated, or even before it did, had entered her mind—more than entered, she thought.
But could she do it?
There was a tremendous difference in assisting in performing she had no idea how many appendectomies and actually performing one. Especially here, she warned herself, where operative conditions would be primitive at the very best. Suppose she operated and George Jefferson died? It wouldn't matter that he would have died anyhow—that the emergency surgery had been a desperate attempt to save his life.
"Oh, God—"
The sound of her voice, the anguished whisper, was the shock therapy she needed.
Although there was no need for her to—Al or Mac McDavie would see to it—she threw more logs onto the fire before she returned to the cabin.
Jan-Doreen was sitting up in bed, nursing the baby. "I know it's not time," she said when Sarah entered, "but she was hungry and I was overflowing." And quickly, "Is Mr. Jefferson as bad as Andy thinks he is?"
"I'm afraid so."
"Oh."
Andy Stevanic turned from the fireplace where he had been standing, staring into the flames, lost in thought.
"I can try to get out. I should have, before this, but there was Jan-Doreen and—"
"And now there's the baby," Sarah said, interrupting him. "No, Andy."
Sarah sat on a suitcase pulled up close to the fire and toed off her wet pumps, which, bedraggled as they were beginning to be, looked more incongruous than ever with Andy Stevanic's trousers. She pressed her fingertips to temples that were beginning to throb.
"There wouldn't be time. Besides, if we stay together, a plane may see our signals. The fire or the SOS."
He didn't say anything, and she wondered if he felt as discouraged in this moment as she did.
"What about Mr. Jefferson?" Jan-Doreen asked.
Sarah shook her head. She wished she knew what about Mr. Jefferson, she thought. She couldn't let the man die without at least trying, and yet—
"He—gave me permission to—to operate."
Her voice sounded strange, a faraway voice that belonged to someone off yonder in the mountains.
"Are you—" Andy Stevanic gulped— "going to?"
"I'm not a surgeon, Andy."
The voice was hers again, but registering the indecision that was torturing her.
Oh, God, she wasn't!
But here she was, and here was a man who almost surely would die a horribly agonizing death if his appendix perforated and he wasn't gotten to a hospital quickly.
Of course it might not perforate—there was the possibility, but a remote one. Almost as remote as Mr. Jefferson's Ultima Th
ule or Sannikov Island.
She heard herself saying, "I'm hoping his temperature will level off, indicating that the infection at least isn't worsening," and knew what Dr. Cal would say to that.
Dr. Cal didn't believe in what he called "postponing decision and gambling with a patient's life when you do it."…
By mid-morning Mr. Jefferson's temperature had climbed to 105.1 and he was intermittently in and out of a feverish stupor that was punctuated by mumbles and moans. She was going to have to make a decision soon, Sarah told herself. If his temperature kept on climbing she wouldn't dare wait.
But would she dare go ahead? she asked herself.
Did George Jefferson, whom she hadn't even heard of a week ago, have the right to ask her to risk everything she'd dreamed about since grade-school days?
She tried not to think that he was risking more— his life. Men in desperate straits will try anything, grasp at any straw in the hope of finding one strong enough to save them.
Was that what she was doing? she asked herself.
Playing it safe, praying that help would come in time, trying to convince herself that that rapidly mounting infection was going to taper off, perhaps even subside, when for ten hours now it had been rampaging?
Was she gambling with George Jefferson's life? She wasn't Dr. Cal—
"Sarah."
Al had come into the cabin silently and was standing at the window beside her. "I'd like to talk to you."
Nodding, she followed him outside, leaving the worry-filled quiet to Mrs. Emlyn and Jan-Doreen.
Although in Dayton, in October, the sun was pleasantly warm this sun held no warmth. Only a cold, remote brilliance that was worse, somehow, than the thick, white snow-fog that had enfolded the small valley during the blizzard.
Sarah lowered her lids against the assault How did Paul and Mr. Norstead stand it?
Or—did they?
The question was there suddenly, terrifyingly. Were Paul and John Norstead wandering around, snow-blinded?
Was she entertaining a fool's dream when she expected help to come in time to save Mr. Jefferson?
"Al—"
"I can't let you do it, Sarah."
He sounded as if she'd already made up her mind— "He may die, Al."
"What if you operate and he dies anyhow?" he demanded. "Isn't there something or other about knowledge of the risks involved making you responsible?"
Sarah drew a breath that felt as if it drained her to her toes. He was putting into words the fears that, until now, had tossed within her.
She nodded.
"As a nurse who has done considerable work in surgery, you would be more liable than, for instance, I, wouldn't you, because you know those risks? If he should die during or following an operation, I mean."
She nodded. "But, Al, don't you see—"
She was the one who was sounding as if her mind was made up, she thought. As, she supposed, it had been from the first—
"As a human being I'm going to be liable to myself for the rest of my life if I don't at least try. Don't you see that, Al?" The whisper hurt her throat.
For a long time he didn't look at her. Then his thumb and forefinger tipped her chin upward until her eyes met his.
"All right, Sarah. I'm with you… all the way."
He didn't say: No matter what happens.
Telling herself that, conscious of chilling prickles moving along the back of her neck, Sarah started back toward the cabin.
If George Jefferson died she would need Al—oh. God, she would need him! And Mac McDavie.
What would they call it, practicing surgery without a license?
Or—or criminal negligence?
Either, it didn't matter, she would never nurse again.
The deep breath was a scalpel, writhing and twisting in her ribs.
Chapter 13
Cradling his half-emptied coffee mug in both hands, Fletch Minsen leaned back against the wall near the pot-bellied, cast-iron stove that kept the radio shack warm even when it was forty below and the wind was yowling down out of them mountains that made the North Fork of Forty-Mile the miserablest place in Alaska, almost.
Mac never seemed to mind the wind, or the loneliness—he didn't mind them because every so often he'd hop Paul Fergis's plane or one of the others that dropped down at Killmoose and go down to Copper Creek, and in between times he'd go around with that walls-of-his-world-pulled-up-close look. Thinking about that damn woman—
Jeez, Fletch Minsen thought.
What he wouldn't give to see Mac stretched out on the bunk, arms under his head, looking moon-eyed!
Or to hear the sound of a plane's motors and know they were Paul Fergis's—
Shaking it off, he made himself listen to the commercial that always preceded Ward Barthey's news. Funny thing, about advertisements, he thought. No matter where you are, they're all alike. Jeez, he might as well be back in Macon, Georgia—sometimes he almost wished—
He shook the incipient nostalgia off, fast.
Then Barthey was on, his vibrant, dramatic baritone filling the tiny shack, sharing with Fletcher Minsen some of the world outside:
"The mystery surrounding the disappearance of ten of the thirteen persons known to have been aboard the Alaska Passenger and Freight Airways plane when it disappeared five days ago today became more complex with word from the Federal Bureau of Investigation in Washington, D. C, that fingerprints of one of the three men whose bodies were found in the wreckage of the plane and who had been identified by papers he carried as Howard Rand, actually are those of Howard Ring, who for the last year has been in contempt of Congress for failure to answer a subpoena to appear before a House committee investigating Un-American activities."
"Ring, apparently tipped off in advance of hearings a year ago that Herman Thornton Elder, who was appearing before the committee, was going to put the finger on him, disappeared. He since has been reported in various places in the United States, Mexico, and South America, but not, however, in Alaska."
"Elder, who is one of the missing APF passengers, at the same time made no secret of his coming to Alaska. He has lived in comparative seclusion in Juneau."
"Identification of Ring as leader of the trio which was being sought for questioning in the reported attempt to sabotage a Distant Early Warning station has aroused considerable conjecture that Elder also may have been involved in the attempt, although there has been no official comment along that line. There are unconfirmed reports that Elder has been under surveillance since his coming to Alaska, but that also seems to come under the strict security cloak that has enveloped the entire investigation into the sabotage attempt."
"In the meantime, searching Air Force and private planes are systematically combing the rugged and isolated mountain areas in which it is thought the APF passengers may have been abandoned. The few lonely private airstrips on which the plane might have touched down already have been checked without finding any trace of the other seven passengers, one of them nineteen-year-old pregnant Mrs. Jan-Doreen Stevanic, wife of an airman stationed at Ladd Air Force Base at Fairbanks, and the three crew members."
"Mrs. Stevanic was going to her former home in Vincennes, Indiana, to have her baby, which is due next week, friends in Fairbanks said."
"Areas in the mountains in which a twin-engine passenger plane could be landed and then take off again are few and an appeal is being made to oldtime prospectors, many of whom live in the Fairbanks area, in an effort to pinpoint some of them. Authorities in charge of the search operation admit it is a slim chance—"
Jeez, was it! Fletch Minsen thought.
Shaking his head, he looked a long time at his coffee cup, still half full and lukewarm.
The knives she had brought from the plane's galley, the scissors from the First Aid kit, the needles and plain white thread that Mrs. Emlyn's sewing kit had yielded were sterilized after being boiled in the iron kettle. Spruce boughs swept from the plank door that had been Jan-Doreen's bed and whi
ch now was to be the operating table. A cone for administering the chloroform improvised from the stiffened lining from one of the suitcases and Mac McDavie instructed in its use—
Swiftly, efficiently, Sarah checked her mental list of things already done in preparation for the emergency appendectomy, trying as she did so not to think of Dr. Cal's superbly equipped and staffed o. r. at the hospital in Dayton.
The operating room, sterile and shining, with its array of instruments and Dr. Cal flanked by other white-gowned, masked and capped figures that were assisting surgeons, surgical nurses, anesthesiologist, orderlies, seemed on another planet. It seemed equally impossible that she had been one of them and now was here, amid surroundings and circumstances that would make Lister turn over in his grave.
She didn't even have soap, much less the soft soap solution that surgeons and nurses use for scrubbing.
And staph germs, here, could be as dangerous as the peritonitis evolving from a perforation of that appendix—
She bit her lip at the thought. She was going to need Deo adjuvante, she thought. Mr. Jefferson knew that—it was the reason he had written the note. She touched it, tucked into her jacket pocket, for reassurance.
To Whom It May Concern: (She didn't have to unfold it to know every word, written in the not-quite-steady, sick man's hand. If she never saw it again, she thought, she would see it in her mind's eye, until the day she died.) Being fully aware of the consequences following perforation of this damned appendix, I have given Sarah Bennett, R.N., permission to operate. The decision is mine, so shall the responsibility be. Dr. K. Alexander—there followed an address in Seattle— warned me of the probability of perforation should the inflammation flare up again, and with fever steadily climbing—it is 105.7 as I write this—I feel the risk is less this way. Only God knows when we will be found if Fergis didn't make it. With Deo adjuvante, I intend to. George Jefferson.
With God assisting, so did she intend to, Sarah thought. And accompanied by George Jefferson alive—
She drew a deep breath. She wished she dared wait longer.
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