Kathleen, Lady Trenear, came to Garrett. “Whose housemaids would he be referring to?” she asked dryly. “Ours will be crowding into the scullery to obtain the best possible view.”
“Is he reliable?” Garrett asked.
“Solid as a rock. West manages the estate farms and leaseholds, and is experienced at everything from spring lambing to tending sick livestock. He can handle anything, no matter how revolting. And I’m usually like that also, but . . .” Kathleen paused and looked chagrined. “I’m with child again, and I’m queasy most of the time.”
Garrett looked at the countess with concern, seeing that she was clammy and ashen, and visibly unsteady. The foul smell of polluted water must have made her wretched. “It’s not good for you to be exposed to this contamination,” she said. “You must bathe at once, and lie down in a well-ventilated room. Also, have your cook make tea with fresh gingerroot. That will help to settle your stomach.”
“I will.” Kathleen smiled at her. “You’ll have West and the servants to help you. My husband will be making arrangements for Mr. Ransom to be spirited away from London as soon as possible. He must be taken to a safe place until he’s well again.”
“I fear you may have rather too much faith in my abilities,” Garrett said grimly.
“After the surgery you performed on Pandora? . . . there’s no doubt in any of our minds that you have miracles up your sleeves.”
“Thank you.” To Garrett’s annoyance, her eyes began to water again.
Kathleen’s small hands came to hers and gripped them warmly. “Do your best, and let fate take its course. You can’t blame yourself for the outcome if you know you did everything you could.”
Garrett managed a wobbly smile. “Forgive me, my lady . . . but you don’t know much about doctors.”
“Artery forceps,” Garrett said, pointing in turn to the gleaming sterilized instruments on a linen-covered tray. “Torsion forceps. Wound forceps. Suture forceps. Amputating knife. Double-edged amputating knife. Catlin knife. Resection knife. Middle pointed scalpel, curved scalpel, straight and curved scissors—”
“You’ll have to tell me as we go along. My mind went blank after ‘amputating knife.’”
West Ravenel stood beside Garrett at the library table, where Ethan’s unconscious form was draped in clean white sheets and a cotton blanket. Garrett had administered chloroform by careful drops into a cylindrical inhaler filled with sterilized lint, while Ravenel had held a nose-and-mouth piece attached to a length of silk-covered tubing over Ethan’s face.
Carefully Garrett folded back the sheets to expose the sinewed, powerfully honed shape of his torso down to his navel.
“What a specimen,” she heard Ravenel say flippantly. “He has muscles in places I didn’t know there were muscles.”
“Mr. Ravenel,” Garrett said, picking up a large irrigator syringe, “please keep your remarks to a minimum.” Carefully she flushed out the wound with a chloride of zinc solution, and set the syringe aside. “Hand me the Nélaton probe—the one tipped with unglazed porcelain.”
After inserting the probe, she discovered the bullet’s path was a straight track, running at a slight upward slant toward the outer border of the first rib. The probe’s tip tapped against something hard. Garrett withdrew the probe, and regarded the blue mark on the end.
“What is that?” Ravenel asked.
“The porcelain turns blue where it comes into contact with lead.”
The bullet had ended up in an area rich with major veins, arteries, and nerves, all protected by an abundance of tough, unyielding muscle.
Garrett had been taught in medical school never to operate on a family relation or someone with whom she had an emotional attachment. A surgeon needed objectivity. But as she looked at Ethan’s still face, she realized she was about to begin one of the most difficult procedures of her career on a man she’d fallen in love with. God help me, she thought, not as blasphemy but as prayer.
“I need the scalpel with the curved edge,” she said.
Ravenel gingerly handed the instrument to her. As she prepared to make an incision just beneath the clavicle bone, she heard him ask, “Do I have to watch this part?”
“I would prefer that you hand me the correct instrument when I ask for it,” she said crisply, “which would require keeping your eyes open.”
“Just asking,” he said. “They’re open.”
She cut down carefully, dividing fibrous tissue and fascia, and clamped the edges of the incision.
The bullet was lodged in the axillary artery, along with what appeared to be a bit of woven fabric from a shirt or waistcoat. As Havelock had suspected, the ends of the severed artery had contracted and sealed inside its sheath. The other side was blocked by the lead slug.
“He should have bled to death within minutes,” she murmured. “But the bullet has temporarily occluded the artery. That, along with coagulum, is acting as a plug.” Still staring intently at the wound, she asked, “Can you thread a needle?”
“Yes.”
“Good, use a pair of forceps to remove a catgut ligature from that bottle, and use it to thread the thinnest needle on the tray.” She positioned Ethan’s arm farther upward to form a right angle with his chest.
As Ravenel saw where she was preparing to make a second incision, he asked, “Why are you going to cut near his armpit when the wound is on his chest?”
“I need to tie off the distal end of the artery first. Please let me concentrate.”
“Sorry. I’m used to operations on farm animals. If he were a plague-ridden cow, I would understand exactly what was happening.”
“Mr. Ravenel, if you don’t stop talking, I will chloroform you and do this by myself.”
He shut his mouth obligingly.
For the next several minutes, Garrett performed the delicate work of ligating the artery in two places, taking care not to damage the network of nerves and veins in the axillary region. She removed the bullet and the bit of cloth, debrided damaged tissue, and irrigated the wound to flush out debris and bacteria. At her direction, Ravenel used a curette to freshen the exposed incisions with antiseptic solution. She installed rubber drainage tubes, painstakingly stitched them in place with carbolized silk, and dressed the wounds with boracic gauze.
“Are we finished?” Ravenel asked.
Garrett was too occupied with evaluating Ethan’s condition to reply immediately.
His knees and feet had acquired a mottled appearance, and his countenance was deathly white. His pulse had fallen to forty beats per minute.
He was sinking.
“Not yet,” she said, trying to think herself into calmness. Her insides were roiling. “I need . . . we need someone else. One person to donate blood, and the other to assist me. The . . . the Roussel apparatus . . . where is it? . . .”
“You’re talking about a blood transfusion?” Ravenel asked. “Does that usually work?”
She didn’t look at him as she replied flatly, “At least half the cases die within an hour.”
Lord Trenear’s quiet voice came from the corner of the room. “I have the apparatus right here.”