WITH A MODERN hospital and equipment, I would have done the surgery transvaginally. Given my current resources, though, it would have to be abdominal. With Mrs. Bradshaw anxiously perched on a stool out of the way—she wouldn’t leave, and I hoped she wouldn’t faint—and Rachel carefully counting drops of ether under her breath, I took my best scalpel and cut into Sophronia’s fresh-scrubbed belly. The stretch marks left by her pregnancy were fading but still visible on her very young flesh.
I had makeshift stirrups, should I need them, made by nailing blocks of wood to the table at an angle, and I’d put a wadded towel between her thighs, soaked with the antibacterial lotion I’d scrubbed her with, an alcoholic extraction of crushed garlic mixed with a hot-water extract of lemon balm. It smelled pleasantly kitchen-like and did something to kill the sewage smell—as well as germs, I hoped.
The ether, though, was stronger than anything else, and within ten minutes of starting, I began to feel a slight swimming in my head.
“Mrs. Bradshaw,” I called over my shoulder. “Will you open the window, please? And the shutters?” I hoped we wouldn’t attract any spectators—but the need for fresh air was imperative.
The vesicovaginal fistula was luckily fairly small and in a reasonably easy position to reach. Rachel was holding a retractor for me with one hand, keeping the other on Sophronia’s pulse, and administering more ether every few minutes.
“Are you all right, Rachel?” I asked, trimming back the edges of the fistula in order to get a decent field for stitching—the edges were flattened and macerated, and the tissue would shred and pull apart under any sort of pressure. I’d had some hesitation in asking her to help today; I would have asked Jenny, but she was suffering from what was called the catarrh, and sneezing and coughing were the last things I wanted in a surgical assistant.
“I am,” she answered, her voice slightly muffled behind her not-quite-sterile-but-at-least-boiled mask. She’d used one of Ian’s handkerchiefs for the purpose; it was an incongruously cheerful calico in dark-pink-and-white checks. Ian’s taste in clothing was strongly Mohawk.
“Good. Tell me if you feel at all dizzy.” I had no idea what I’d do if she did feel dizzy—perhaps Mrs. Bradshaw could take over the dropping bottle for a few minutes. . . .
I spared a quick glance over my shoulder. Mrs. Bradshaw sat on her stool, gloved hands clasped tight in her lap and her face pale as a sheet, but she sat firm.
“It’s going well so far,” I said to her, trying to sound as reassuring as possible through my own chaste white mask. The masks seemed to unnerve her, and she looked away, swallowing.
It really was going well, though. While it was Sophronia’s youth that had caused the problem, that also meant that her tissues were healthy, in good shape, and she had considerable animal vitality. If the surgery was successful, if there was little or no subsequent infection, she’d heal very quickly. If.
“Ifs” hover in the air above your head all the time when you’re doing surgery, like a cloud of gnats. For the most part, though, they keep a respectful distance, only buzzing dimly in the background.
Done.
“One down, one to go,” I murmured, and, dipping a wad of sterilized gauze into my cheese lotion, I daubed some—not without a qualm—over the newly stitched repair. “Onward.”
The bowel repair was easier—though more unpleasant. It was quite cold in the surgery—I hadn’t lit a fire, not wanting soot in the air—but I was sweating; beads of perspiration ran tickling down the side of my nose and down my neck from my bound-up hair.
I could feel the girl, though, the life of her echoing in my hands, her heartbeat strong and steady—there was a large blood vessel visible on the surface of the uterus, and I could see it pulsing. She’d been lucky in the one thing: the uterus hadn’t been perforated, and looked healthy. I couldn’t tell whether there was internal scarring, but when I cupped my hand gently over the organ, it felt normal to me. For a moment, I closed my eyes, feeling deeper, and found what I thought I needed. I opened them again, blotted the ooze of blood from the cut tissues, and reached for a fresh needle.
How long? Anesthesia complications were one of the nasty little flying “ifs,” and that one flew down and perched on my shoulder. I had no clock or pocket watch but had brought a small sandglass borrowed from our landlady.
“How long has it been, Rachel?”
“Twenty minutes.” Her voice was soft, and I looked up, but she was still steady, her eyes fixed on the open belly. She was nearly four months’ pregnant, her own belly slightly rounded. “Don’t worry,” I said to her briefly. “It won’t happen to you.”
“Surely it could?” she said, still more softly.
I shook my head.
“Not if I’m with you when you give birth.”
She made a small amused sound and picked up the dropping bottle again.
“Thee will be, I assure thee, Claire.”
Rachel was shivering slightly by the time I’d finished; I was wringing wet but feeling the glow of at least temporary victory. The fistulas were repaired, the leakage stopped. I irrigated the surgical field with saline solution and the organs glistened, the beautiful deep colors of the body unmarred by smears of fecal matter.
I paused for a moment to admire the neat compactness of the pelvic organs, all in their places. There was a tiny trickle of pale urine from the catheter, staining the towel with a faint yellow shadow. In a modern hospital, I would have left the catheter in during the healing, but it would be difficult to manage without a drainage bag, and the chances of irritation or infection from the device were likely greater than the possible benefits of leaving it. I eased it free of her body, watching. Within a few seconds, the flow of urine ceased, and I let out a breath I hadn’t realized I was holding.
I had taken up a fresh needle threaded with silk, to close the incision, when something occurred to me.
“Rachel—do you want to look? Closely, I mean.” Sophronia had had ether within the last couple of minutes and was still deeply under; Rachel checked her color and breathing and then came round the table to stand beside me.
I didn’t think she’d be disturbed by the blood or the sight of organs, given the things she’d seen in military camps and battlefields. She wasn’t, but she was disturbed.
“That—” She swallowed and put a hand to her swelling stomach, very gently. “So beautiful,” she whispered. “How the body is made. How such things can be.”
“It is,” I said, her awe making me lower my own voice.
“To think of her poor infant, though . . . and she no more than a child . . .”
I glanced at Rachel and saw tears standing in her eyes. And I saw the thought cross her face, masked as it was: It could happen to me.
“Yes,” I said quietly. “Go back to the ether; I’ll close the incision now.” But as I dipped my hands again in the bowl of alcohol and water, something else occurred to me.
Oh, God, I thought, appalled at the thought. But . . .
“Mrs. Bradshaw,” I said. She was sitting with her head bowed, arms wrapped round herself against the chill, perhaps half asleep. When I spoke, though, her head came up sharply.
“Is it over?” she asked. “Does she live?”
“She does,” I said. “And, with luck, will continue to do so. But . . .” I hesitated, but I had to ask. And I had to ask this woman.
“Before I sew up the incision . . . I can—do a very minor procedure that will stop Sophronia from becoming pregnant again.”
Mrs. Bradshaw blinked.
“You can?”
“Yes. It’s a simple thing to do—but, once done, it can’t be undone. She’d never be able to have babies.” A fresh cloud of “ifs” had formed, buzzing anxiously over my shoulder.
She was thirteen. She was a slave. And had a master who used her. If she were to become pregnant again soon, she might well die during the labor and would almost certainly be seriously damaged. It might never be safe for her to bear a child—but it wasn’t safe for any woman, ever. And “never” is a very big word.
Mrs. Bradshaw had drifted slowly toward the table, her eyes twitching toward the exposed, half-draped body, then away, unable either to look or to stay away. I put out a hand, warding her off.
“Don’t come closer, please.”
“He was sad when the baby died. He cried.” I could still hear the sadness in Sophronia’s voice; she mourned her child. How could she not? Could I take away the possibility of another—forever—without even asking her what she felt about it?
And yet . . .
If she bore a child, it, too, would be a slave; it might be taken from her and sold. Even if not, it would likely live and die in slavery.
And yet . . .
“If she wasn’t able to bear children . . .” Mrs. Bradshaw said slowly. She stopped speaking, and I could see the thoughts crossing her white, pinched face; her lips had all but disappeared, so tightly were they pressed together. I didn’t think she was concerned with the fact that Sophronia’s value would be diminished if she couldn’t reproduce.
Would the fear of damage due to pregnancy stop Mr. Bradshaw from using the girl?
If she were barren, would he feel no hesitation?
“He didn’t hesitate because she was twelve,” I said, my words cold as pellets of ice. “Would the chance of killing her next time stop him?”
She stared at me in shock, mouth hanging open. She blinked, swallowed, and looked at Sophronia, limp and helpless, body gaping open on the blood-soaked towels, the floor around her thickly spattered with her fluids.
“I think thee cannot,” Rachel said quietly. She looked from me to Mrs. Bradshaw, and it wasn’t clear to whom she was speaking: perhaps both of us. She was holding Sophronia’s hand.
“She felt her child move within her. She loved it.” Rachel’s voice broke, and she choked a little. Tears welled and rolled down to disappear into her mask. “She wouldn’t . . . she . . .” She stopped, gulping a little, and shook her head, unable to go on.
Mrs. Bradshaw put a hand clumsily over her face, as though to stop me seeing her thoughts.
“I can’t,” she said, and repeated almost angrily, behind the shield of her hand, “I can’t. It isn’t my fault! I tried—I tried to do the right thing!” She wasn’t talking to me; I didn’t know if it was to Mr. Bradshaw or God.
The “ifs” were all still there, but so was Sophronia, and I couldn’t leave her any longer.
“All right,” I said quietly. “Go and sit down, Mrs. Bradshaw. I said I’d take care of her, and I will.”
My hands were cold, and the body under them was very warm, pulsing with life. I picked up the needle and put in the first suture.