November 10th, 1916
No. 8 Canadian General Hospital, Saint Cloud, France
And things look blue
"It is essential to leave enough skin," Dr MacIver explains, his voice as steady as the scalpel in his hand, positioned a little below the patient's knee. In one circular motion he cuts through the skin.
"Enough skin," I repeat with a nod, watching him carefully detach the different layers of skin from the underlying muscles. Once he is finished, I take the scalpel he holds up to me without once taking his eyes off of the patient in front of us. For Dr MacIver might be a man of few manners and much obstinacy – stubborn enough to steadfastly refuse to operate with an assistant, at any rate – and he swears decidedly too often, but in the theatre he is never anything but fully concentrated on his work.
And he is a man of his word. He promised to teach me what I need to know, and he did. The hours I spend next to him in the operating theatre are veritable lessons for me. Admittedly, I have managed to incur his wrath more than once in the past few days, but never for not knowing something. He does not suffer fools, Dr MacIver, and he hates having to explain something twice. It's only when I still don't know what to do after him having explained it, that the curses descend unto me.
Right now, though, he is calm and concentrated as he lifts the flap of skin and folds it back over the patient's knee. It bleeds less than one might expect, thanks to a tourniquet tied firmly around the thigh.
"Knife," demands Dr MacIver and I hand him the requested instrument. As a theatre nurse my tasks not only include assisting during the actual operation, but also the preparation of the theatre and all instruments, including disinfection. It's up me to make sure that everything is in the right place and aseptically clean.
With a steady hand, Dr MacIver severs muscles and tendons. "The French use guillotines for amputations," he informs me while working, "god-damned guillotines! Barbarians, the lot of them! The just want it to be as quick as possible, when an amputation is actually a form of art, I am telling you. Every operation is art!"
Whether I share his use of expression, I am not entirely sure, but I am willing to admit that every operation demands great dexterity of the surgeon. Artists they may not be, strictly speaking, but the work they do is akin to fine mechanics and the outcome is, if everything goes well, a life saved.
Maybe it really is art after all.
Skilfully Dr MacIver applies his knife to the soft tissues, finally exposing the bone. Not looking at me, he waves the knife in my general direction and, cautiously, I take it from him, pressing the bone saw in his waiting hand instead. The orderly, standing on the other side of the table, reaches across it, holding up the flaps of skin and meat and muscle out of the saw's reach.
I am not entirely sure whether the sawing of bones really does sound differently from the sawing of, say, wood, or if that's just down to the fact that you know it to be bone, but it is excruciating in any case. A sound to make it drip down one's spine, all cold and tingling.
Instinctively, I raise my shoulders, draw in the head. My gaze meets that of the anaesthetist, standing next to the patient's head, and he gives me a reassuring smile. But only once Dr MacIver raises the bone saw, making the sound break off abruptly, does the strain leave my shoulders. There are things in life one simply does not get used to.
The freshly amputated leg lies on the operating table and, somehow, does not look at all like something that was a body part only moment ago. To be honest, I am a little grateful it falls to the orderly to get rid of it. Bodiless legs tend to make me feel uncomfortable.
Drawing my gaze away, I exchange the saw for the bone-cutting forceps Dr MacIver uses to remove protruding pieces of bone. "Tibia. Tends to splinter easily," he comments while working.
Having returned the forceps to me, he bends over the stump he has just created and inspects it with a critical eye. "Suture," he demands. Having anticipated this request, I hand him a curved needle with a silk thread of suture already attached. Next, I take up two spatulas, using them to hold apart the tissue, the easier for Dr MacIver to reach the arteries and suture them.
Finally, the flaps of skin are stitched up over the stump, neatly explaining the need to "leave enough skin". While doing so, we secure a tube so as to enable the wound fluid to leave the wound until it is more healed. Likely, this won't be the last operation this patient will have to suffer through, but for the time being, things are looking satisfactory, I'd say.
"A good stump," Dr MacIver exclaims, clearly pleased, and thus confirming my assessment of the situation. "A good, tidy stump. Even the French should be able to fit prosthesis with a stump like that."
On the whole, his opinion of the French is… ah, somewhat critical.
Forcefully he turns, not waiting for a reply, and strides off. Instead, I turn to the anaesthesiologist. "When do you suppose he will wake up, Dr Thomas?"
His answer can only ever be an estimate, I know. Anaesthetics make every operation that much easier – not least for the patient who sleeps through all of it – but their administration is a highly complex process. It's difficult to decide beforehand what dosage every individual patient needs and therefore it is not unusual for them to keep sleeping for quite a while after the operation is finished. This, though, is vastly preferable to the opposite outcome, when patients become conscious during an ongoing operation, which is so unpleasant for everyone involved, I much prefer them to sleep a little longer.
Just as Dr Thomas starts to answer, a voice carries over to us from the other side of the room. Dr MacIver. The satisfaction he felt over an operation well done has, apparently, vanished, to be replaced by clear irritation. Probably the French again. Out of the corner of my eye I see Dr Thomas raise an eyebrow and fight back a smile myself.
"Look! Look!" Dr MacIver demands, crossing the room with large steps. "An ingrown toenail! All this because of an ingrown toenail! It's a right disgrace!"
He pushes something at me and it takes a second or three until my brain allows me to recognize this something as the amputated leg. When I do, the floor beneath my feet suddenly feels strangely mobile.
Not that Dr MacIver is one to take note of my sensitivities. Shaking the leg slightly, he calls out, "Here, look! He had an ingrown toenail – a goddamned ingrown toenail! And instead of doing something against it, they wait until it gets infected and now the poor devil is less one leg. A disgrace, I am telling you! Bloody French!"
The more rational part in me wonders why he gets worked up about this only now. Surely he must have known the reason for the amputation beforehand? But maybe it's simply not given to him to miss an opportunity to curse the "bloody French." Really, whoever thought it a good idea to post this man to this hospital must have had his tea spiked!
The more irrational part in me only wants him to take the leg away.
He, of course, does not do me the favour. Instead he pushes the leg a little closer still, peers at me from those unblinking eyes.
"What happened?" I ask, voice weak.
The question, however, seems to have been the right one, for MacIver begins shaking the leg accusingly. "It got infected, that's what happened! We could have simply pulled the toe nail and he would have been on his way right as rain – on both legs! But no, they keep him in those cursed trenches for weeks, standing up to his knees in water and slush. No wonder it got infected, and this is the outcome!" Another shake of the leg.
"Trench foot," I mutter, having just thought of the correct term.
A vigorous nod from Dr MacIver. "Too right! One of the most easily preventable ailments in this easily preventable war. But they can't look out for their soldiers, can they? Goddamned French!" He's basically growling by now.
Now, I could tell him that trench foot is as prevalent in Imperial hospitals as it is here and that, according to Shirley, the English and Canadian armies are just as relentless about letting their soldiers endure the mud as the French seem to be. I could. It's just that the only thing I want right now is for him to take that leg away and the world to be still once more and the quickest way to achieve that is to keep this whole conversation as short as possible.
Fortunately, Dr MacIver apparently considers his newest lesson learned by now, because he turns abruptly and sweeps through the theatre. Walking, he thrusts the leg at the smirking orderly and I might be a little pleased to see the smirk drop from his face faster than you can say schadenfreude. Holding the leg with outstretched arms, he hurries to follow Dr MacIver from the room, the faster to get rid of the leg.
For a moment or two I look after them, keep my gaze fixed on the door and wait for it to stop moving from side to side. In over three years of nursing, I've seen my share of, well, things, and even more of them in the past few months, but I would gladly have eschewed a closer look at that sawed-off, dead leg.
"Head between your knees. That'll help," a kind voice instructs.
I turn, quickly, to face Dr Thomas, whose presence I had almost forgotten. He watches me, all calm and friendliness, as he is always calm and friendly. Dr Thomas might just be one of the most tranquil people I have ever met.
"I'll take your word for it," I answer weakly and try to produce a smile.
In turn, I receive an encouraging pat on the shoulder. "Happens to the best of us. No shame in it, really," he comforts, "it's only bad when it stops bothering you at all."
I nod, despite not being able to even imagine there might come a day when any of this won't bother me anymore.
Dr Thomas takes the patient's pulse and breath frequency one last time, directs a kind nod in my direction, then strolls out of the room as well. That just leaves me with the sleeping patient, who has been rid of his ingrown toenails but has lost a lower leg in the process.
Actually, Dr MacIver is quite right. It is a disgrace!
"What did he say? Head between the knees?" I ask of the sleeping patient. Naturally, my question remains unanswered, but instead, Dr Thomas' advice turns out pretty useful. After sitting still for a few minutes, head bend low, I start to feel a little better – at least as long as I manage to discipline my thoughts and keep them far away from sawed-off legs!
"Alright, let's get you moving then," I murmur, half to myself and half to the patient, after having risen again.
I organize two orderlies, instructing them to help me move to patient to the post-op ward. I was with him when he was prepared for operation and I will be with him when he wakes up. This, too, is part of the duties of a theatre nurse. From a strictly medical viewpoint it makes sense for someone to keep an eye on the patient during the whole process, the faster to recognize changes in his condition. A side benefit, not to be underestimated, is that the patient will see the same face waking up as when falling asleep, which usually calms them a whole lot.
So I stay with my patient, watching him slowly regain consciousness, and when I transfer him to the night sister's care at the end of my shift, I am satisfied he's quite well, all things considered.
"I'll be back tomorrow to look after you, alright?" I reassure him, knowing how reluctant he is to let me leave. But it's been a long day, I am suitably tired – it can be surprisingly exhausting just to stand on your feet for couple of hours – and nothing save for an emergency will keep me from my bed just about now.
Shuffling back to my tent, I wonder idly what the matron would have to say about my bad posture. Quite a lot, probably, more so as she has not yet forgiven me for being made theatre nurse, inadvertently as it might have been. However, my tiredness beating out my fear of her, I don't attempt to raise my dragging feet any higher.
As I raise the tent's cover, I am overcome by a yawn and thus, it takes me a moment to notice the other person standing next to the rickety desk, just now turning to look at me. With a jolt, I am wide awake.
Looks like my roommate is back from leave.
For a second or two we just stand there, appraising each other. She makes no move to greet me, so finally I step forward, extend a hand. "Hello. You must be Colette."
"Colette Tremblay." My offered hand she simply ignores.
"I am…" I start, not getting very far though. My hand hangs in the air between us, useless.
"I know who you are," she interrupts harshly, "you're the English girl who took Louise's place in the theatre."
Slowly, I draw back my hand.
"I didn't mean to…" I try again.
A quick movement of her hand lets me fall silent. "Oh, but of course you didn't mean to! Just been in the right place at the right time, yes?" Her voice drips with sarcasm.
I nod, the tiniest of movements. That's exactly what happened after all. But with a huff, she merely turns back around.
"I asked them to put you in a different tent, but they're all occupied," she informs me over her shoulder, "so, I am stuck with you. Be so kind as to never speak to me again, yes?"
It's a question hardly asking for an answer, so I don't bother. Instead, I walk over to my bed, silent, and make sure not to look at my roommate again. She, similarly, does not turn to me again.
As I strip off my uniform, my head tries to make sense of the conversation I've just had. I didn't expect us to be the best of friends right away, merely because fate – or the diseased lungs of my predecessor – put us in the same tent, but… to be met with such, well, hostility I did not expect either.
Yes, I replaced Louise Gagné in Dr MacIver's operating theatre – though I still maintain none of this was actually my fault. And yes, I am an 'English girl', at least inasmuch as I am not French-Canadian. But good god – is that really quite so horrible?
Impatiently I pull at an obstinate button that refuses to fit through its hole, only to result in tearing it loose from my uniform. With a silent sigh I stare down at the button on my open hand. I'll have to sew it back on tomorrow, which, having never been altogether very enthused by needlework, is an irritating prospect. Somehow, this day simply cannot end fast enough.
Climbing into my camp bed, I risk a short glance in the direction of Colette. She has already laid down, having her back resolutely turned to me. I scrutinize the back of her head, in the vain hope of finding an explanation for her strange behaviour. No such luck, of course.
Shaking my own head slightly, I extinguish the lamp hanging next to my bed, letting darkness fall.
Truth is, I am disappointed. I didn't expect to meet a best friend, but… well, a friend would have been nice. I had to leave Polly and Betty in England and only now, not having them around anymore, have I noticed how much easier they made things for me. Because they used to laugh and rant with me and comforted me when I didn't feel well. Somehow, I expected that to always be the case – a natural form of companionship, built upon shared work.
Foolish, probably. Certainly naïve.
Generally speaking, the other nurses of Saint-Cloud have not met me with the same hostility Colette has just shown – though Louise Gagné has a dirty look for me whenever I dare to venture too close to her – but they definitely do not exude the same warmth Betty and Polly have in spades. I've been the first new nurse to be put in their midst for a while now and they simply have no use for me, I think. Their friendships are already forged, their social dynamics secure. I fit nowhere and why should they make the effort to make me fit in?
The hardest part is not having anyone to talk to. Someone to tell how I worry for them. For Shirley, exposed to frost and shells at the front. For Walter, still caught up in the claws of that horrible fever. For Jem, stuck in disease-ridden Greece. For my parents, who are not getting any younger and who might yet pay a higher tribute to this war than I can fathom.
And for Nan, to whom I've yet to write the truth about Jerry. I scattered some hints throughout my letters, tried to calm her, but every time I try to put the truth to paper, my head is bare of any words. Maybe there are no words for this or maybe I am just unable to find them? In the end, I compromised with myself, deciding to wait until I have seen him with my own two eyes, because only then can I be sure of his true condition. Sounds reasonable, doesn't it? Only, once I stop lying to myself, I have to admit it's really only cowardice.
I don't dare tell her, so I don't. It's as simple as that. That's neither very brave nor very honest and while I've never counted honesty among my particular virtues, I've always considered myself to be fairly brave. But, I reckon, we are all brave until bravery is truly required of us.
Shivering, I pull the covers closer. November is nearly half gone and the nights are icy. It promises to be a long, hard winter and I can't say that particular realization does anything to lift my mood.
Because, for how badly I wanted to come to France, those not quite two weeks have already started to gnaw at me. I miss home, my family, in a way I never used to back in England. Sometimes, in very dark moments, I even catch myself wondering whether it was really such a great idea to come here.
And, I guess, I counted on the dark moments to become lighter once my unknown roommate returned. Once I wasn't so alone anymore. Now though, in this dark, icy tent, listening to Colette's uneven breaths, I realize I've never felt lonelier in my life.
The title of this chapter is taken from the song 'If your were the only girl in the world' from 1916 (lyrics by Clifford Grey, music by Nat D. Ayer).