Diana Gabaldon - Written in My Own Heart’s Blood

I needed to be alone in my head, in a calm, clear place. The place from which I could see everything, sense the body under my hand in all its particularities—but not be that body.

I was about to disjoint Tench Bledsoe’s leg like a chicken’s. Throw away his bones and flesh. Sear the stump. And I felt his fear in the pit of my stomach.

Benedict Arnold had come in with an armload of firewood and a silver table knife in one hand—my cautery iron, if there wasn’t time to stitch. He set them down on the hearth, and the butler began to poke up the fire.

I closed my eyes for an instant, trying not to breathe through my nose, shutting out the candle glow. Denny Hunter had operated on me by candlelight; I remembered watching through a haze of eyelashes, unable to open my eyes more than a crack, as each of the six big candles was lit, the flames rising up pure and hot—and smelling the small iron heating in the brazier beside them.

A hand touched my waist, and, gulping air, I leaned blindly into Jamie.

“What’s wrong, a nighean?” he whispered to me.

“Laudanum,” I said, almost at random. “You don’t—you don’t lose consciousness altogether. It makes the pain go away—not stop, just seem not connected to you—but it’s there. And you . . . you know what’s happening to you.” I swallowed, forcing down bile.

I felt it. The hard probe jabbing its way into my side, startling. The remarkable sense of cold intrusion, mingled with incongruous faint warm echoes of internal movement, the forceful jabs of a child in the womb.

“You know what’s happening,” I repeated, opening my eyes. I found his, looking down at me with gentleness.

“I ken that, aye?” he whispered, and cupped my cheek with his four-fingered hand. “Come and tell me what ye need me to do, mo ghràidh.”

* * *

THE MOMENTARY PANIC was subsiding; I forced it aside, knowing that even to think about it was to slide headfirst back into it. I laid a hand on Tench’s injured leg, willing myself to feel it, find the truth of it.

The truth was all too obvious. The lower leg was a complete wreck, mechanically, and so compromised by septicemia that there was no chance of saving it. I was searching desperately for a way to save the knee; having a knee made a tremendous difference in the ability to walk, to manage. But I couldn’t do it.

He was far gone from injury, blood loss, and shock; he was a stubborn man, but I could feel his life flickering in his flesh, dying away in the midst of infection, disruption, and pain. I could not ask his body to withstand the longer, painstaking surgery that would be necessary to amputate below the knee—even if I felt sure that such an amputation would be sufficient to forestall the advancing septicemia, and I didn’t.

“I’m going to take his leg off above the knee,” I said to Jamie. I thought I spoke calmly, but my voice sounded odd. “I need you to hold the leg for me and move it as I tell you. Governor”—I turned to Arnold, who stood with a reassuring arm about Peggy’s Shippen’s waist—“come and hold him down.” Laudanum alone wasn’t going to be enough.

To his credit, Arnold came instantly and laid a hand against Tench’s slack cheek for a moment in reassurance before taking firm hold of his shoulders. His own face was calm, and I remembered the stories I’d heard of his campaigns into Canada: frostbite, injury, starvation . . . No, not a squeamish man, and I felt a small sense of reassurance from the presence of my two helpers.

No, three: Peggy Shippen came up beside me, pale to the lips and with her throat bobbing every few seconds as she swallowed—but jaw set with determination.

“Tell me what to do,” she whispered, and clamped her mouth shut hard as she caught sight of the mangled leg.

“Try not to vomit, but if you must, turn away from the bed,” I said. “Otherwise—stand there and hand me things as I ask.”

There was no further time for thought or preparation. I tightened the tourniquet, grasped the sharpest knife, nodded to my helpers, and began.

A deep incision, fast, around and across the top of the leg, cutting hard down to expose the bone. An army surgeon could lop off a leg in less than two minutes. So could I, but it would be better if I could manage to cut flaps to cover the stump, could seal the major vessels. . . .

“Big needle,” I said to Peggy, holding out my hand. Lacking a tenaculum to seize the large blood vessels that snapped back into the flesh when severed, I had to probe for them with the point of the needle and drag them out, anchor them into the raw, exposed flesh, and then ligate them as fast as I could, whipping thread round them with one of the smaller needles and tying it off. Better than cautery, if there was time . . .

Sweat was running into my eyes; I had to dash it away with my bared forearm; my hands were bloody to the wrist.

“Saw,” I said, and no one moved. Had I spoken aloud? “Saw,” I said, much louder, and Jamie’s head twisted toward the implements on the table. Leaning heavily on Tench’s leg with one hand, he stretched to grab the saw from the table with the other.

Where was Peggy? On the floor. I saw the bloom of her skirt from the corner of my eye and felt vaguely through the floorboards the steps of a servant coming to haul her out of the way.

I groped for another suture, blind, and the jar of brandy in which I’d stowed them tipped, spilling on the sheet and adding its sweet stickiness to the atmosphere. I heard Jamie gag, but he didn’t move; his fingers squeezed the thigh hard above the tourniquet. Tench would have bruises there, I thought idly. If he lived long enough for his capillaries to bleed. . . .

The saw had been made to disjoint hogs. Sturdy, not sharp, and not well kept—half the teeth were bent, and it jumped and skittered in my hand, grating over the bone. I clenched my teeth and pushed, my hand slipping on the handle, greased with blood and sweat.

Jamie made a deep, desperate noise and moved suddenly, taking the saw from my hand and nudging me aside. He gripped Tench’s knee and bore down on the saw, driving it into the bone by main force. Three, four, five dragging strokes, and the bone, three-quarters sawn through, made a cracking noise that jolted me into action.

“Stop,” I said, and he did, white-faced and pouring sweat. “Lift his leg. Carefully.” He did, and I made the cut from below, long, deep strokes of the knife deepening the incision at an angle to make the flap, joining the cut with the upper incision. The sheet was wet and dark with blood—but not too much. Either the tourniquet was holding, or the man had so little blood left to lose . . .

“Saw again,” I said urgently, discarding the knife. “Hold steady! Both pieces.” There was no more than a thin section of bone remaining; the spongy bone of the marrow showed, blood flowering slowly from the cut surface. I put no pressure on the saw; the last thing I wanted was to crack the bone in some awkward way. It wasn’t working, though, and I looked back toward the line of tools, desperate to find something else.

“Rasp,” Jamie said, his voice rough with strain. He nodded toward the table. “There.”

I seized the rasp, a rat-tailed thing, drenched it with brandy, and, turning it sideways, filed through the last bit of bone, which parted gently. With a ragged edge, but intact, not shattered.

“Is he breathing?” I asked. I was having trouble breathing myself, and couldn’t sense the patient’s vital signs—save to notice his heart was beating, because blood was pulsing slightly out of the smaller vessels—but Arnold nodded, his head bowed, intent on Tench’s face.

“He’ll do,” he said, his voice firm and loud, and I knew he was speaking as much to Tench as to me. Now I could feel the stir in the upper leg, a violent reflexive urge to move, and Jamie leaned hard on it. My fingers brushed the discarded lower leg, the flesh horribly flaccid and rubbery, and I snatched them back, wiping them convulsively on my apron.

I swiped the bloody apron then across my face and pushed back loosened bits of hair with the back of my hand. It was shaking; they both were.

What the bloody hell are you shaking now for? I thought irritably. But I was, and it took much longer than it should have to cauterize the last few small bleeders—adding the ghastly smell of roasting flesh to everything else in the room; I thought even General Arnold might throw up—stitch the flaps, bandage the wound, and, at last, loosen the tourniquet.

“All right,” I said, and straightened up. “Now . . .” But if I said anything else, I didn’t hear it. The room revolved slowly round me and dissolved into a flicker of black and white spots, and then everything went black.

TENCH LIVED.

“I should have known you would,” I said to him. “If you were determined enough to survive all night in the river, plainly a mere amputation wouldn’t slow you down.”

He hadn’t enough strength to laugh—the journey by litter to Chestnut Street had left him white-faced and gasping—but he did twitch his mouth enough to qualify his expression as a smile.

“Oh . . . I’ll live,” he managed. “Wouldn’t . . . give ’em . . . the satis . . . faction . . . of dying.” Worn out by this, he closed his eyes, chest heaving. I wiped his face gently with my handkerchief, patted his shoulder, and left him to rest.

I had had the litter bearers take him upstairs, to what had been my bedroom, and I closed the door behind me now with a queerly mixed feeling of triumph and depression.