City of Dreams (23 page)

The authorities had done little to make this place suitable for medical care, but they had remembered to sink a few metal hooks in the wall. He was able to tie the board into position at a right angle to the body. Finally, despite how often the old man gagged and retched, Christopher managed to pour nearly an entire flask of rum down his throat.

His grandfather, Lucas Turner, had used laudanum, at least until Lucas’s sister, Sally, married Jacob Van der Vries. That’s when she had stopped speaking to Lucas and he couldn’t get any more. According to his journals laudanum didn’t make for painless surgery—
that is a Hope for Fools and Children
—but it was far more effective than liquor.

Christopher agreed. He often sent his patients to buy laudanum from the apothecary shop Great-aunt Sally had opened on Pearl Street. Christopher would have liked to lay in a supply of the stuff for himself, but he could not go to the shop. For reasons having nothing to do with surgery, it wasn’t prudent for him to go anywhere near Pearl Street. So, since he had no wife to simple for him, he bought his stanching powder and other ordinary remedies from the housewives of the town. Few of them, however, knew how to make good laudanum. For this old man rum was the best Christopher could do.

When the flask was empty he pulled a chair up to the side of the bed, hiked up his sleeves, opened the leather case he’d inherited from his grandfather, and made a choice from among his knives.

His amputation technique was Lucas’s, learned from the journals, like almost everything else he knew of surgery.
I recommend to Begin with a Shallow Incision made through the
Membrana Adiposa
with the small Triangular Scalpel.
Christopher leaned forward and considered for a moment, seeing the procedure in his mind. Finally he lifted the hand holding the scalpel and with no hesitation drew the blade in a swiftly descending curve from the upper part of the shoulder across the pectoral muscle and down to the armpit.

Apparently the rum hadn’t helped much. The screams began instantly. “Stop! For the love of Jesus, stop!”

The old man’s underarm flesh was wrinkled and dry, each crease filled with a lifetime’s accumulated grime. It flaked away in the knife’s wake.
Then, saving as much Skin as possible, turn the Knife with its Edge upwards and Divide part of the Deltoid, which may be done without Danger of Wounding the Great Vessels, which will be Exposed by these openings.

“Jesus help me! Stop!”

He’d found some rags in the cupboard with the rope. He used them to sop up the flow of blood, then tied off the artery and the vein, as Lucas recommended, with a strong ligature of sheep’s stomach. Finally he reached for the broader, more spatulate scalpel and inserted the thin blade between the muscle and the skeleton and carefully—
with neither Undue Haste nor Wasteful Lingering
—began to scrape away the connective membrane and bare the bone.

The old man’s shrieks were ear-piercing.

In less than a minute the muscles were a floppy formless mass, disconnected from the shoulder and easily pushed aside. The bone was exposed. Christopher stopped scraping.

His patient’s screams became sobbing whispers. “… love of Jesus, stop. Telling the truth. Saw the chicken. Saw them drinking blood.”

“Sure you did, old friend. I know you’re telling the truth.” Once more Christopher used the rags to mop up the blood oozing into the wound from the vessels below the ligatures. “Listen to me, old man, no one’s punishing you for anything. I’m trying to save your life.” He reached for the saw. “I swear to you, it’s for your own good.”

For this he must stand. He did so, and began.

The patient arched and bucked, as much as the ropes allowed.

The soft cartilage parted. Christopher started on the bone. It was much harder work. He had to put his back into it. Ignore the old man’s screams, though they filled his ears and echoed in his brain. Think only about the saw. Back and forth. Back and forth. Back and forth.

“Jeeeeesusssss …”

Down to the marrow now. A little easier, but only for a short time. Then the hard stuff again. He was dripping with sweat by the time the arm tied to the board dropped away and swung free from the hook in the wall.

The old man was silent.

He might well be dead.

That was common enough with any surgery, more so in the case of amputation. Christopher was still struggling to catch his breath, and mopping his sweaty face when he bent his head to the man’s chest. The heart was beating at a much accelerated rate, but it was thumping strongly. The old derelict had been lucky for once in his life. He’d fainted.

In his journals Lucas boasted of keeping count of the passing seconds while he operated. Christopher didn’t know if his father had been able to do the same thing. After Chris’s mother died—the boy was eleven—Nicholas bought a slave to act as housekeeper for his son, and became a ship’s surgeon. He was lost at sea when Christopher was sixteen. But even when he’d been home Nicholas Turner had been a dark and forbidding man. A silent man. Christopher had never asked about the counting. All he knew was that he couldn’t manage the technique. Performing the surgery and observing the anatomy took all his attention. He could estimate only that amputating the arm had taken him something under an hour. And he still wasn’t finished.

He stitched the flap of skin over the empty shoulder socket, applied stanching powder, and bandaged the wound. Then he set three relaxed leeches to the man’s chest and another two to his neck to suck out any poison that had crept up from the affected lower arm. Finally, though he’d missed his dinner and it was already growing dark, he sat and watched the man for at least another hour. Possibly two. There was a well nearby, but like most on Manhattan it gave only brackish, virtually undrinkable water. A bucket of ale kept in the back of the room yielded a more potable liquid. Before he left Christopher saw to it that his patient took a few sips. “There, you daft old bugger, you couldn’t have had better care if you were a gentleman in a mahogany bed with damask hangings.”

The King’s High Way to Boston was well maintained, but narrow, like the old Indian path it followed. Completed thirty years earlier, it accommodated post riders carrying mail between New York and the New England colonies. The road went north as far as the small village of Harlem, then crossed to the mainland by way of the King’s Bridge.

The widened section of the Broad Way (only the few old Dutch speakers who hadn’t learned English still called it the Brede Wegh) ended where it joined the post riders’ road. North of that point it was a path through the woods, with a rope railing. There was talk of grading and widening that section as well, but it wouldn’t happen unless more people wanted to live so far from town, and up to now few did. Christopher made his way through a dense winter dark broken only by the distant glow from the windows of a few isolated farmhouses. Only the sound of his sturdy boots on the packed-dirt road broke the silence.

He crossed Washerwomen’s Creek and, beyond that, Maiden Lane. He was approaching the cobbled streets of the proper town when he realized he hadn’t soaked the bandages in wine. Hell, he’d had no wine, and the nearest tavern was still a few minutes’ walk away. Besides, Lucas himself had not been entirely sure the practice was salutary.
Sometimes I think I cling to the use of Wine for reasons more of Superstition than of Science,
he’d written.
Perhaps, in the end, I am as suggestible as I believe my Patients to be.

Nonetheless, Christopher was still fretting when he turned into Broad Street, a wide thoroughfare that ended in a stone-lined basin between West Dock and East Dock and the long wooden bridge that joined them. The houses of wealthy merchants—all redbrick and white pediments and perfect symmetry—faced one another across carefully laid cobbles. Such splendid houses made it difficult to remember that Broad Street was built over the infill of the old Dutch canal.

In its last days, when not even the tide was strong enough to carry away the quantities of garbage and slops tipped into it, the canal had become a festering sewer. Today it was the most fashionable street in the town. Elsewhere, every seventh house was obligated to hang a lantern from a pole and suspend it from an upstairs window as soon as it grew dark. Here on Broad Street a number of the wealthy residents had erected permanent standards by their front gates, each topped with a lantern, and every week a slave was appointed to tend to their lighting.

Progress, the mark of science. Wine be damned. He’d done well by the old souse.

The blood dripped slowly, drop by drop from the distended pig bladder into the thin glass tube that had been fitted with a hollow needle and inserted into an open vein in the old man’s right arm.

It was forty-eight hours since the surgery and the man’s fever hadn’t broken. However uncertain blood transfer might be, Christopher told himself, it was this patient’s final hope. Such thoughts answered the prick of doubt that said his own need to live up to Lucas’s legacy played as much a part in the decision as the survival of the man in the bed.

His grandfather (Christopher never thought of Lucas as his adoptive grandfather, though he knew that to be the legal truth) had died at age fifty-six, peacefully, with Marit holding his hand. She went a year later. Christopher knew them only from the portraits painted toward the end of their lives by an itinerant artist—a phizmonger, as folk called them.

Marit was said to have been a beauty. In the portrait her hair was white, but her eyes had still been large and blue, and there was a smile in them. Lucas looked more stern. Though he’d died three years after sitting for his portrait, his hair and his beard were still entirely black. The pictures hung on either side of the front door on Hall Place, looking down at the spot where, until their marriage transformed the butcher shop into a barber shop, Marit stood behind the wooden counter and hacked apart the haunches of venison that fed old Nieuw Amsterdam.

Christopher was sure Lucas would have been fascinated by this practice of putting fresh blood into a human body. His grandfather’s journals were proof of his concern with every conceivable surgical practice, though quite possibly, cut off from the medical literature that was available in Europe, Lucas had never heard of transfusion.

Christopher had heard. His education in surgery began with his grandfather’s journals, but it was completed by the books Nicholas brought home after he went to sea. Long after others were in bed, Christopher Turner sat at the kitchen table, reading his father’s books until the candle burned down to a guttering stub. No single thing had made a greater impression than the description of blood transfusion.

That was the real reason he’d accepted this thankless job as the hospital surgeon. Far more important than the stipend was the opportunity to have the sort of patients on whom he could try new things.

For the good of humanity, Christopher told himself. To further the interests of science.

He’d made four previous attempts at putting blood into a person. All had failed. Nonetheless, he’d come to the hospital that morning prepared to try again with the pig bladder, the glass pipette fitted with its hollow iron needle, the bandages, and the scalpels. And the blood.

He’d found the old man delirious, with a raging fever. He began the procedure immediately. It went well for the first twenty minutes; then the man’s breathing started to come harder and louder. Now each respiration had a little wheeze in it. Christopher began adjusting the neck of the pig bladder and looked anxiously at his patient. The man was ashen, and his eyes were open but staring unseeing at the ceiling. “Don’t die, damn you. After all my hard labor, don’t you dare die.”

Behind him the door opened.

Christopher stiffened. Almost no one came here except himself, the half-dozen constables who acted as police by day, and the four bellmen who did the job at night. “Who is it? Who’s there?”

“It’s me. Jeremy. I thought I’d find you here.”

“Damn your eyes, Jeremy. You frightened the bejesus out of me. I’m busy. What do you want?” Christopher spoke without turning around, preoccupied with the pig bladder. The blood poured down the tube so fast it was oozing between the needle and the old man’s skin.