Die Once Live Twice (7 page)

Patrick was scared. He had never considered he might die of injury. Too tough, too lucky. But the field doctor said he might die. He had never associated the dead soldiers around him with his own death. That was their fault—he knew he was smarter and tougher than any rebel. But now, death filled his mind. He dwelled on his father’s death and the fear he would never see Katherine again. A night of constant pain, dehydration, blood loss, and whiskey gave him intermittent sleep and vivid dreams.

His whiskey-laced brain returned to his trip home six months ago, when his father was dying in January 1863. It was the first time he and Katherine had been together since their picnic in 1861.

Patrick and Katherine sat facing each other on the couch in front of the fireplace of Patrick’s parents’ home. “I see my father lying helpless with a broken hip on that icy bridge. It is a dreadful image. He was so strong, so smart, and always in charge. For him to be mortally injured by a horse accident is just unimaginable. When we broke horses, none could throw him. He always taught me to jump free if a horse was going down.”

“The wooden bridge was very icy, Patrick. With his broken hip, Jeffrey couldn’t get up or move off the bridge. He shot the injured horse so it wouldn’t kick him with its flailing legs. The horse fell into the icy creek below. I am sure it all happened very fast.”

“Maybe the horse suffered the least. My father is unable to get out of bed. Skin sores that are infected. He was the one I was fighting for in this war.” Tears ran down Patrick’s cheeks.

“I can cry with you, my darling. You know my mother is gone, but I’ve never told you how painful it was. I was only thirteen.” Katherine told Patrick all of it: the draining sores, the putrid smells, the weight loss, the weakness. “Her own body ate her alive.”

Patrick locked on Katherine’s deep blue eyes, a film of tears dulling her sparkle. Her auburn hair and those blue eyes stirred his passions. A familiar churning in his stomach unnerved his calm—the same churning he had when he fantasized about being with her. Involuntarily his eyes left hers and shifted to his desire.

Katherine felt his passionate gaze burn into her breasts. For two years he was her last thought as she put her head on her pillow. How many nights did she lay awake with desire? Should she? Could she bear two more years of longing? What if he were killed and their love went unfulfilled? Her proud refusal would become a lifetime regret. A much worse guilt than giving herself to him before marriage.

She slid her shoulder-high, short-sleeved bodice off her right arm and then off her left. Her camisole fell off with her bodice. She wore no corset. Her breasts were bared and Patrick thought she was like an alabaster statuette, but her mouth was open and she was breathing heavily. He realized this was his dream. She was seducing him. Sliding across the couch, Patrick’s open mouth met hers and their tongues touched. The crackling of the fireplace was the only sound in the room until both began moaning softly. When Patrick returned to war they were engaged.

“Hey, wake up, Captain!” Doctor Thomas Franklin shook Patrick vigorously by his shoulder. “Wake up.” As Patrick turned his head to see the surgeon, Franklin continued. “It’s like this, Captain. You have a broken bone in the thigh and have lost a lot of blood. I’m going to amputate your leg. Do you understand me, Captain?”

“No! You
cannot
amputate my leg!” Patrick ignored his pain and lifted himself on his elbows to look the surgeon in the eye. He was shocked to realize the man was no older than he. It further eroded his confidence.

“You have no choice,” Franklin answered rather weakly. He didn’t want to admit he knew no other operation. Six months out of medical school, he had learned all he knew about surgery in the field of battle. He went to medical school from the farm at the age of nineteen, having quit school after eighth grade. He grew to like surgery when they castrated calves. His father paid twenty-five dollars, nearly all their savings, to pay for his son’s admittance to a medical school in St. Louis. The course of study was nine months long and Franklin never saw a patient nor an operation.

“I do have a choice. It is
my
leg. I am from a prominent family in Philadelphia and if you don’t listen to me, I’ll have you court-martialed. Just take the ball out!”

The finality of Patrick’s decision scared the young doctor. No patient ever countered his orders. “Yes, sir. I understand. That is all that I will do.” He spun around and hurried back the way he had come, calling over his shoulder to give the patient some laudanum.

Franklin briskly moved out of the farmhouse to his operating theater. His operating table was a door set on four sawhorses under the branches of a large oak tree. Four dressers, his aides, restrained a patient when the anesthetic powers of whiskey were insufficient. Ether, administered by a physician colleague of Franklin’s, was in short supply and reserved for officers.

“Two of you,” Franklin nearly shouted, “go out back and bring a body to me.” The tool shed behind the house was a morgue for the dead waiting to be buried. As two dressers hurried off, Franklin said to his anesthetist, “I will need you for this operation, but I have to practice on a corpse. Go get some coffee.”

Franklin was inexperienced and barely competent—which was the standard for the Union Army—but determined to improve his skills. He frequently operated on the dead to learn anatomy and improve his technique. While the dressers laid a stiff corpse on the operating table, Franklin pulled his table of four blood-stained tools—a forceps, scalpel, tissue clamp, and saw—closer to him. Franklin cleaned these by wiping the fresh blood off on his apron, which he donned over his uniform.

He made an incision in the thigh of the corpse.
No worry about blood in this operation,
he thought with a smile. Slicing the fat and muscle with the scalpel, he opened the leg so he could feel with his left thumb and index finger for the femur bone. A strong band of tissue resisted him. He cut into that. “Hold this open for me,” Franklin said to a dresser, who used his bare hands to pull the wound edges apart.
I’ve never quite had this view,
Franklin thought with some excitement. Exploring the inside of the leg he found the main nerves and the femoral artery. “I must avoid this artery or he’ll bleed to death,” Franklin commented to the dresser. He memorized the relationships of the anatomical structures.

Finally Franklin stood and wiped off his tools on his pant leg. “Okay, boys, take the stiff back and bring out the live one. Tell the anesthetist to finish his coffee. It’s time for me to take out this conceited captain’s musket ball, though he’ll probably just get an infection and lose the leg anyway.”

Patrick’s drugged sleep was rudely interrupted by four men lifting him from his cot to a stretcher. Crying out in pain, Patrick was told by one of the dressers, “Shut up. You’re about to get some ether. Lucky you’re an officer.” The four stretcher-bearers delivered him to Franklin, waiting under the shade of the old oak tree.

Franklin was sweating before he even cut into Patrick. Swirls of smoke drifted into the tree as the ash of his cigar grew while he worked. Following the track of the musket ball by sticking his bare index finger into the leg, he felt wadding. He ripped open the muscle and motioned to the dresser to spread the wound, but his hands were slick with blood and he slipped once before he got it open. Franklin spied the wadding and grabbed it with a forceps. “Gotcha,” he exclaimed in triumph as he removed it. With the knife he cut away more muscle and groped around the broken bone for the musket ball. “Ouch, dammit.” He spit out the words around his cigar as he cut his finger on a spike of the broken bone. As he quickly withdrew his hand, the musket ball came with it. He held it up as if he had secured it on purpose. “Finished.” Standing, he pulled his cigar from his mouth, knocked off the ash, and pointed to the wound. “Plug it,” he ordered.

The dresser packed the wound open with linens soaked in chlorine. A farmer’s wife, a friend of Franklin’s mother in Missouri, had told him this cleaned the sores of her twelve children, so he used it in the dressings of all his patients.

Patrick’s lower leg was wrapped first with linen, then with rope and finally with plaster around the rope and linen. The ends of the rope were extended beyond Patrick’s foot and tied to a hook on which weights were hung to pull on the leg. The assembly, known as Buck’s traction, gave some stability to the broken bone fragments and helped hold the leg still.

Franklin spit out bits of tobacco. “Now we’ll see if God likes this arrogant asshole.”

Chapter Six

A
fter escaping the Union ambush, General Stonewall Jackson and his soldiers, galloping toward rebel lines, had surprised some North Carolina infantrymen, who could not identify the riders in the darkness and opened fire. Jackson instinctively turned toward the fire and raised both hands, palms outward. Each hand took a ball in the palm, but the truly devastating injury was a ball to his left arm, which fractured his humerus bone and severed an artery. Jackson tried desperately to stay atop his horse, but fell from his saddle into the arms of his junior officer, who broke his fall. The officer took off his own shirt, ripped it apart, and tied a tourniquet to staunch the heavy bleeding from Jackson’s arm.

Jackson was carried on a litter to a horse-drawn wagon, which bore him two miles to a farmhouse that had been converted to a field hospital. Doctor Hunter McGuire, chief surgeon of Jackson’s Second Corps, was waiting there for Jackson. The twenty-seven year-old surgeon stood tall at six-feet two-inches, with kind eyes that nonetheless had an intense gaze. His hair was thick and dark and he wore a full moustache. McGuire had saved Jackson’s finger after the first battle of Manassas.

McGuire knew immediately that Jackson’s only hope for survival was amputation of his injured left arm. The right hand might be of little use in the future, but it could be saved. He ordered the field medics to move Jackson straight to the kitchen, which served as the operating room. The kitchen door had been removed from its hinges and set between two tables to function as the operating table. It was night, so four medics surrounded the table, holding lanterns to illuminate the area where the surgeon worked. There were but three or four tools and no antiseptic for them or the wound. There were only two sources of hope for any operation: the surgeon’s skill and God.

McGuire spoke to Jackson before administering the ether. “General, can you hear me?” Jackson nodded. “Your bone was shattered by the musket ball and the artery is severed. Your skin has also been severely torn. I’m going to have to amputate your arm.” Jackson slowly shook his head no. “Sir, you will quickly develop gangrene of your arm if I don’t. I’m terribly sorry, but I have no choice. We have to work fast, so we’re going to start getting you ready. General, can you still hear me? We are going to place a cloth over your face.”

“Do for me whatever you think best,” Jackson assented. “I am sure that my faith will keep me safe. Only God will decide when I am to die.” He closed his eyes to pray as ether was dripped onto a cloth over his mouth and nose. “What an infinite blessing!” Jackson said as the anesthesia began to relieve the acute pain. He repeated the word “blessing” until he was unconscious.

McGuire moved skillfully to remove the arm, assisted by two dressers named Judah and Thomas. His instruments were kept in boiling water while he positioned a tourniquet strap as high on the arm as possible and ratcheted its metal clamp tight to compress the blood vessels. He wore no mask, no gloves, and no special clothes. His bloodsoaked apron was worn to protect his uniform.

Jackson’s injury lay at two-thirds the distance between his shoulder and his elbow. “Judah,” McGuire said, “bend the elbow to relax the biceps muscle,” which would help him control the level of his cuts. Judah chomped down hard on his cigar as he concentrated on his task. McGuire cut the skin and fat circumferentially in one sweeping motion at the middle of the upper arm. Quickly wiping off the blade with his apron, he cut the biceps muscle. “Now extend the elbow so I can cut the triceps while it is relaxed.” Slicing that muscle obliquely off the humerus bone, McGuire used his bare hand to push the cut muscles upward an inch or two. To hold back the muscles and allow McGuire to remove his hand, Thomas slipped a piece of linen with a small hole cut in its middle over the bone, which protruded through the cloth.

McGuire wiped Jackson’s blood off on his apron and, picking up a square-shaped saw with his right hand, used a fingernail of his left to mark a place on the bone where he wanted to begin his cut. Placing the blade just above his fingernail, he slowly drew the saw backward with a long, gentle movement, creating a smooth cut. An even edge to the bone was critical for wound closure, especially since there was not enough time to snip off bone fragments with the bone nippers. Judah started to shift his position to get a stronger hold on the arm, but McGuire cautioned, “Judah, don’t move. If you bend the arm, it will splinter.” Beads of sweat from McGuire’s brow dripped into the wound. He knew too well the consequences if he failed to save Jackson’s life. Judah held fast and McGuire quickly finished his cut, thankful the end of the bone stayed smooth.

Having completed the amputation, McGuire grasped the brachial artery with the forceps, tied it off with a ligature, and removed the tourniquet. Sponges soaked in warm water cleansed the cut surface of the stump and removed coagulated blood. Thomas released the linen holding the muscle, fat, and skin so that these tissues could cover the cut bone end. McGuire made sure the wound edges were aligned, then applied strips of adhesive plaster across the stump to keep the edges together. He finished the dressing by covering the adhesive with linen cloths. Turning his attention to Jackson’s right hand, he quickly removed the musket ball.

McGuire’s work was done for now. All he could do was pray that he had done his best to execute God’s plan for his patient.