The Moon by Night (3 page)

“Wait—” Shiloh finally came alive. He darted in front of the horse, grabbed the boy by the shirt collar, and dragged him out from under Balaam's hooves. Shiloh shook him. “Get up, you!”

The boy was limp in his grasp, his head lolling like a broken doll.

“Aw, man, you aren't dead, are you?” Kneeling quickly and cradling the boy's head, Shiloh looked close—it was so dark he could hardly make out the features, though the face was a deadly white blur—and felt his head. He could see that this was a man—a very slight man, but he did have a mustache—with thin, greasy hair. Shiloh could feel the warmth of blood on his fingers. But the man was breathing. He even murmured slightly and his hand scrabbled vaguely. Shiloh felt his pulse. It was weak but steady. The man's hands and face, however, were icy cold and corpselike.

“Great,” Shiloh rasped. “Okay, Mr. Big Bad, you did it. You're gonna have to carry him. But—” Shiloh heaved up the unconscious man—”it's not going to be that big a pain, 'cause this little piffle doesn't weigh as much as the doc does. But don't tell her I said that,” Shiloh added hastily. He tossed the man over the saddle like a bag of flour—a long, thin bag, perhaps—and then stooped to pick up the robber's weapon.

It was an umbrella. A very nice umbrella, actually, made of fine black silk, with no broken spokes and a hand-carved wooden handle. Shiloh couldn't see what the carving was, but he could feel the delicate etching of some hard, highly polished wood.

“What's a fine muffin like this doin', anyway, mugging self-respecting men and horses out here like this?” Shiloh asked Balaam, shoving the umbrella into the saddlebag. “Aw, quit your whinin'. It's all your fault anyway, knockin' him out cold like that. Speakin' of cold, let's step it up a little, Balaam. Snow's getting heavy, and I guess I need to get this little sneak-thief someplace warm before he dies on me.”

“Put him in Surgery 3,” Cheney told James and John as they carried Cornelius Melbourne into the hospital on the stretcher. They turned left into surgery while Cheney started toward the nurses' station straight ahead. A weak cry from the litter stopped her, so she motioned to the duty nurse, and the two followed James and John into the operating room. The boys placed the patient, litter and all, on the surgical table. Cheney said firmly to Melbourne, “This is Nurse Kitty Kalm, Mr. Melbourne. She is going to stay with you, because I must attend—”

“No, no,” he said. “Don't leave me, Dr. Duvall. Please don't leave me….” He was beginning to show signs of increasing agitation, though only his hands twitched. He kept his eyes locked on Cheney's face. She knew that sometimes patients with horrible-looking injuries could not bear the sight of them, so they obsessively fixated on something else. In Mr. Melbourne's case, Cheney seemed to be his tenuous lifeline.

She took his hand. “All right, then, I won't leave you.”

He relaxed a little, and some of the dreadful panic diminished in his eyes and expression. His hand was cold and clammy. His lips were blue. Cheney knew that he must have surgery immediately. To Nurse Kalm she spoke in the quiet monotone that seemed to soothe the patient regardless of what she was saying. “Is Dr. Batson here?” “Here” for Cleve meant at the hospital, the office, or his home, as they were all on the same block. He always alerted the hospital of his whereabouts.

“No, ma'am. He came in after lunchtime and said he was going downtown, that he had several patient calls to make. He left a list if you would like—”

“No,” Cheney said, the casual tone in her voice belying the urgency in her eyes. “Mr. Melbourne must have surgery immediately.”

Nurse Kalm nodded. She was a cheerful, capable young woman who had that rare intuitive gift of understanding sick people and their needs. Now she considered the pale man on the surgical table thoughtfully. His expression did not change, and his gaze did not waver from Cheney's face.

“I can assist,” Nurse Kalm said in the same confident tone Cheney had been using, perceiving the patient's state of mind. “I have anesthetized in eight procedures, all successful.”

“I'm going to assist,” Cheney said. “I need a surgeon.”

Kitty's eyes widened, but she was careful to speak quietly. “Aren't you going to do the surgery, Dr. Duvall?”

“No. I'm not qualified to do such a procedure.”

“Then Dr. Pettijohn will have to do it.”

She and Cheney locked eyes for long moments. Cheney's mind was a whirl of confusion. Nurse Kalm watched Cheney with what seemed to be clinical curiosity, waiting for her momentous decision.

To their surprise Cornelius Melbourne whispered weakly, “Dr. Duvall…have you ever…done surgery?”

She looked down at him and started to make excuses, but in that moment, her mind quieted and she answered with the simplicity of truth. “Yes, I have. I have just never done the particular surgery that you require.”

To her amazement the barest flicker of amusement showed in his dull eyes. “Never had…anyone…with a steel spike sticking…out of his chest? Fancy that. I…want you to do it, Dr. Duvall. I want you…to operate on me.”

She smiled at him, suddenly calm and sure. “Very well, Mr. Melbourne, I will.” He even managed a weak smile as he clung to her hand.

Now certain of her course, Cheney told Nurse Kalm, “I want you to go tell Nurse Nilsson to take charge of the wards and do rounds with Dr. Pettijohn. Ask Dr. White to join us, and you come back to assist.”

“Yes, Doctor.” She hurried out.

Cheney looked down at Cornelius Melbourne, and he looked up at her. He was growing weaker by the minute. The procedure to remove the spike and repair the damage was going to be perilous. His chances of surviving the surgery were not good.

As she looked deep into his eyes and studied his expression, she could see that he knew all of that. He was afraid, but he had put his hope and trust in her. Cheney knew she had one more duty to perform for this patient before she sent him on what might be his last journey.

“Are you a Christian, Mr. Melbourne?” she asked. “Do you know the Lord Jesus Christ?”

“No,” he answered. “I have attended church all of my life, and I know of the Lord and His salvation, but I have never asked Him to save me. I would like to do that now, and I want you to pray for me.”

Cheney bowed her head and closed her eyes. She knew that he kept his gaze trained on her. “Dearest Lord, Mr. Melbourne needs your love, your salvation, and your healing. I pray that in his heart he will seek you in spirit and in truth, for you have promised that those who do will find you, and you will take them in.

“Give me strength as I operate on him. I humbly ask that you guide my hands and my eyes and my thoughts so that I may perform this procedure perfectly. And I ask that you heal this man, Lord. Amen.”

He closed his eyes and prayed, “I am a sinner, lost in darkness, Lord Jesus. Save my…soul. Give Dr. Duvall skill and knowledge and the guidance she needs, Lord. And if you…decide to bring me home, I ask that she will always know in her heart…that I have been saved.”

When he opened his eyes again, Cheney could see fear still lurking, but he seemed more at ease than before. She said, “I'm going to go wash my hands and get the surgical supply tables ready. Just over there, do you see? I'm not leaving the room.” He nodded, then let go of his death grip on her hand. As she moved away, she paid close attention to the sound of his breathing. His respiration was still shallow, but he didn't immediately start hyperventilating as soon as she got out of his line of vision.

“Nurse Flagg is going to give you an anesthetic, chloroform, which is going to put you to sleep,” she told him as she worked. “And Dr. White, who was with us in the ambulance, will be assisting me with the surgery. You are in St. Luke's hospital, and when you wake up, you will be in a comfortable private room.”

She kept talking until Dr. White and Nurse Kalm returned. They scrubbed their hands, and Dr. White and Cheney took their places beside the bed as Nurse Kalm readied the anesthetic. Cheney smiled at him. “I will see you later, Mr. Melbourne.”

“Yes, and whatever happens, Dr. Duvall, I'm glad that you are the doctor taking care of me. Don't forget that.”

“I won't,” Cheney promised him. “Now Nurse Kalm is going to anesthetize you. Just close your eyes…relax…”

As soon as he was unconscious, Cheney yanked the blankets off him and said to Dr. White, “Hurry. Cut the clothes off him. Nurse Kalm, I want you to continually monitor his respiration and pulse and take his temperature every five minutes. Let me know immediately if there is any change.”

“Yes, Doctor.”

“Oh, Dr. Duvall, he is absolutely filthy,” Dr. White said. “The mud has soaked through his clothes, and it's caked all around the injury.”

“I know. I didn't want to take off his clothes and clean him up until he was unconscious.” Cheney began sponging him off with a saline solution. Taking a plunger, she began squirting jets of the solution all around the spike in his chest. “He was half-frozen already, and I didn't want to make him more miserable than he was. All right, this is good enough, Dr. White. We can finish cleaning him up after the surgery. Try not to touch any place but this area where we've washed him off. Now let's wash our hands again in the carbolic acid solution and swab his whole chest area with it.”

“I don't really know how to assist you, Dr. Duvall,” Dr. White said uncertainly. “I've never even seen an operation like this, much less assisted at one.”

“Neither have I,” Cheney said, “so we'll just have to figure it out together. Nurse Kalm, have you ever seen a procedure like this?”

“No, Doctor,” she answered. “When I worked at Bellevue, I saw two patients come in who had been stabbed, and the knives were still imbedded in their chests. But they were both dead.”

Cheney nodded. “It's a miracle this man is still alive.”

Dr. White observed, “There's so little blood. I would have thought a person would just be swimming in it with an injury like this.”

As Cheney carefully swabbed around the wound, she could see that almost no blood was seeping from around the spike. “That's because the spike itself is exerting enough pressure on the blood vessels to stop them up, as it were. Visualize sticking a pencil through a piece of paper and then looking at the underside where the pencil has gone through. Little bits of the paper will be turned under all round the pencil, correct? Just so here. The ends of the severed vessels are turned under all around the spike, so there's minimal bleeding. Of course, this tamponotic effect wouldn't have worked if the spike had struck a major artery, because the pressure of the blood flow would be too strong.”

“Yes, I understand,” Dr. White said thoughtfully.

Cheney continued, “Now I'm going to make two shallow incisions through the dermal layers: one horizontal and one vertical, with the spike at the center. Dr. White, peel back the four sections while I hold the spike steady. Very good. No, don't worry about suction right now, just clamp each section. All right, let me see what we have here…yes, just as I thought. It's wedged tightly between the ribs….”

****

Steel spike one inch in diameter was lodged in right hypochondriac region between the fourth and fifth true rib. Ribs were left intact with no fracture or chipping.

Spike imbedded approximately six inches; four inches exposed. Frontal middle lobe of right lung perforated, posterior surface of middle lobe untouched. Further impalement effectively prevented by position of the spike wedged tightly between the ribs
.

Cheney reread the sketchy description she had made of Cornelius Melbourne's injury. There was much more to be entered in his file, but Cheney had decided to describe the injury while she had it vividly imprinted on her brain and enter the details of the surgery the next day. She had finished the surgery three hours earlier, but this was the first opportunity she'd had to make a patient file for Cornelius Melbourne.

The lady who had been with Melbourne—now in the hospital's morgue—was still unidentified. Officer Goodin had not come to the hospital yet to take statements from everyone, as he was obliged to do when an accident involved a death.

Though Cornelius Melbourne had awakened soon after the surgery was completed, Cheney had asked him only about his family, not about the accident or the woman. He said that his parents lived in Brooklyn, then he drifted off into a peaceful sleep again. Cheney composed a telegram and sent James Roe to Yancy's Telegraph Station, alerting the Brooklyn police to find Mr. and Mrs. Douglas Melbourne and give them the information about their son.

She made a few more sketchy notes in Cornelius Melbourne's file to help her recall some details of his surgery.
He's actually alive and doing miraculously well, considering,
she thought with satisfaction.
I stressed that his nursing care was to be on the basis of his being in
guarded
condition, but that was very conservative, and everyone knew it. He actually woke up and smiled! Oh, Lord, you are good, and your mercy endures forever!

She closed the file and placed it by her medical bag so she would remember to take it back up to the nurses' station before she left. Checking the watch that was pinned to her coverall, she was amazed to find that it was only eleven o'clock, for it had been a very long day—and night. Still, her shift was from two o'clock until midnight, and she never left early, even after a busy shift.

I can get that autopsy done,
she thought with determination.
Seems days ago I started it
.

Quickly she straightened the supply table that she had left in disarray that afternoon, then rolled the dissection table out of the morgue into the lab area again and went to work.