The Serpent's Shadow

She turned to smile wanly at the Irishman, who, not being a surgeon, was acting as her anesthetist. O'Reilly's expression betrayed his strain despite the concealment of his red beard and mustache; he was only too correct that this was 'not an easy case.'

'After the way you helped with that little problem of mine, I could hardly refuse, now, could I? Besides, you know what anyone else would do with this girl.'

'Take appendix, uterus, and child, without a second thought,' O'Reilly said grimly. 'And she a good Catholic girl, and this her first child! It would break her heart.'

'If she lived through it,' Maya replied, just as grimly. 'Doctor, if I can save this girl without removing anything but what's diseased, you know I will.'

The patient in question, who was one of O'Reilly's, a young Irish woman who had been brought in thinking she was miscarrying of her first child, was in fact in the throes of an attack of acute appendicitis. She might come through this attack without surgery to remove the diseased organ, but neither her doctor nor Maya thought it at all likely. When this had been made plain to her—and the fact that she must have surgery immediately—her first thought had been for her unborn child. She had begged Maya, clutching Maya's skirt with both hands, to save her baby.

She was with her priest now, for even now the removal of an appendix was a risky procedure. If it had burst—if it was perforated—and the infection had spread within the body cavity—well, there was very little chance that she would survive. Her seven-month pregnancy made things doubly complicated. Maya hoped that the priest was human enough to give her absolution before she must go under the knife; whatever such blessing meant or did not mean to the girl's immortal soul, it would surely make her calmer.

As O'Reilly had pointed out, any other surgeon would simply excise the uterus and its contents without a pause, simply to remove that complication. After all, the girl was a charity patient, a nobody, and if she complained, no one would care. It wasn't as if she was a woman of good birth who was expected to produce an heir for a family with money or social standing. She'd even be better off without the handicap of breeding a brat a year—

Or so the male Protestant physicians would say. And never mind how she would feel.

The Female Operating Theater, located in the attic of the Female Wing, was stiflingly hot now that it was late into July. Why they couldn't have used the regular operating theater—

Because the women cry and carry on so, it might disturb the male patients. As if the men don't cry and carry on just as much. Or—women are embarrassed to be prepared for surgery in the same room as the men. As if, at that point, they are thinking of anything but the surgery to come.

The excuses made no sense, for they were only that, excuses. But at least, being at the top of the building, there was not as much room for observers here—and the light was excellent, for the theater had been provided with two broad skylights.

Since it was Maya who operated here today, it was Maya who made the rules for this case. She had abolished the practice of leaving the bloodstained aprons on hooks to be used and reused until they were stiff. Aprons were bleached with lye and boiled, then wrapped in clean paper and stored here until use. After the conclusion of an operation, used aprons were taken away immediately to be boiled and bleached again. Water was never left in the pitcher; it was brought fresh before each surgery. Physician and assistants scrubbed hands and arms up to the elbow— in Maya's case, higher than that—and the carbolic atomizer was as much a fixture as the ether mask. Maya used only her own personal set of surgical implements, because she made sure to keep her own scalpels sharp and sterile, and didn't trust those left for the use of others.

And all those preparations would be in vain if that poor girl's appendix was not intact.

'Bring her in,' Maya instructed, when her hands were just short of raw, O'Reilly and the nurse went to fetch the girl, and Maya saw to the laying out of her surgical instruments on the tray beside the wooden table.

O'Reilly carried the girl in his arms into the antechamber, wrapped in a clean sheet. She was in too much pain to walk, and in any case, Maya didn't want her to do anything that might stress that appendix. He put the patient down on the narrow table, giving her a reassuring smile before placing the prepared mask over her mouth and nose and pouring the anesthetic on it.

When she was asleep, they wheeled her into the operating theater and lifted her onto the immovable table. Maya adjusted the sheet she'd been wrapped in to expose as little as possible of anything other than the surgical site, then wiped the site itself clean with carbolic solution. Some physicians not only operated on patients while clothed in their street clothes, but on patients who were also still in their street clothes. and as unwashed as they had come in. This girl had been stripped and bathed by the nurses in the outer room, then wrapped in a sheet that, like the aprons. was boiled and bleached and kept wrapped in sterile paper until use. The plain, deal table had an inclined plane at one end to elevate the girl's head, and was covered with a piece of brown oilcloth. Once again, Maya's rules held sway here today; the oilcloth was new and had been wiped down with carbolic before being placed on the table.

As usual, the theater, was full—there was a reason why it was called a 'theater.' The actual amount of floor space devoted to the operation was small in comparison with the tiers of stand-places rising for four rows, at an angle of sixty degrees, so that those standing in each tier could have an unobstructed view of the operation below. The students' entrance was at the top tier, and a metal rail on which to lean ran at the edge of each tier. It was the students' business to attend every operation he (or rarely, she) possibly could, so even Maya's operations were fully attended, and she was by no means a famous surgeon.