Alasdair made a large incision, much larger than the organ he hoped to remove. He might need a large surgical field to see well. And, in truth, he had only ever seen one vermiform appendix and did not know if he would be able to find it today.
In addition to the knife, he used some instruments from his bag, tweezers and small forceps, to assist in dissecting through the skin, the scant subcutaneous fat, the fascia and finally the muscle. It took him quite a long time and despite the coldness of the room, he felt himself covered in sweat.
And throughout it all, he was aware of Arabella at his elbow. He had feared she would be a distraction, but she was not. He felt almost as if she were a replacement for Dr. Murray—observing, urging him on silently, supporting his efforts with her own intensity. A few times he almost turned to her to ask her opinion, before remembering that she would have never seen something like this before.
He hit only a few small vessels that he was able to cauterize quickly with his metal tweezers heated in a candle flame, so there was some blood but not much.
Finally, he was in the peritoneum. His shoulder ached. He put the knife and tweezers down and flexed his fingers.
He looked at Morpeth’s face. The man still breathed. Alasdair could see his rapid pulse in his neck. Good.
He looked at Arabella. Her eyes were on him, not on Morpeth, not on the gaping abdomen in front of him. She was not pale. She did not look as if she were about to vomit.
“How is your arm, Dr. Andrews?”
He smiled. “’Tis fine,” he lied.
“You must tell me how and when I can help you,” she said.
“Aye.”
The butler Andrews was at his side, averting his eyes from the surgical site as most of the rest of the men were doing as well. He offered Alasdair some water from a cup, and Alasdair drank thirstily.
Alasdair had bent some long-handled metal spoons into hooks and he put those now into his opening and had men with long arms reaching over and pulling on them to keep his incision open. He asked for more light.
He felt like he was hours poking in the peritoneum, going over miles of intestine, before he found what he was looking for. But it was likely minutes.
There. A swollen finger of a thing, oozing pus, firm and full of stones, apparently partially perforated. The vermiform appendix. Yes, here is where it attached to the rest of the bowel. He must remove it. Then close the stump, the hole in the bowel he would create by cutting off the appendix. Consider gently washing the pus from the area. And then the slow surgical withdrawal from the peritoneum. Closing the layers of fascia, skin.
Alasdair managed to get a firm grasp on the proximal end of the appendix with his forceps.
“Please hold these, Arabella. Dinnae let them go.” And her small hand came into his field of view and took the forceps from him. He then seized the distal end of the appendix with his tweezers in his left hand and took the boning knife in his right and cut the appendix free.
Relief.
But just as he did that, his right arm was shaken by a spasm and he nearly dropped the boning knife.
“Alasdair,” Arabella said, her voice hushed.
He brought the appendix out of the cavity with the tweezers still in his left hand and put the grotesque specimen on a cloth on the mattress next to Lord Morpeth. He also put the tweezers there and then used his left hand to take the boning knife from his right hand.
He allowed himself a look at Arabella. “There, hold those forceps tightly now. Dinnae let them go. Cutting is done. Now ’tis all sewing.”
“Yes, you had better let me do that, hadn’t you?”
He looked down and his right hand was tremoring uncontrollably.
“I can sew, Alasdair.”
He put the boning knife in his left hand down. “I’ll have ye thread the needle to start.” He used his left hand to take the forceps from her.
A man holding a lamp on the other side of the bed turned his head to the side and vomited onto the floor almost noiselessly.
Arabella found one of the lengths of gut that Alastair had taken from his bag and threaded it onto one of his needles.
“This looks like one of my embroidery needles.” She pulled the gut through the tiny eye, sticking out her tongue and biting on it as she did so.
“Aye, I buy all my needles at ordinary shops. I get quite funny looks from the shopkeepers.”
