A/N: So sorry about the sadness of the last couple of chapters. I promise, after this chapter things will get better!
***WARNING! This chapter contains graphic descriptions of an amputation. Reader discretion advised***
No matter how many times an operation had been performed successfully, any time there was even a single incision made, a risk was taken. As careful as one could be in sterilizing, cleaning, and avoiding contamination, the chance of a potentially life-threatening complication never went away. There was always danger. A patient could die of infection, blood loss, overdose of anesthetic, or even shock.
Amputations in particular were quite risky. The procedure was rather simple, at least in concept; the removal of a limb or digit that was beyond saving. But there was much more to it than simply hacking off an arm or leg and wrapping the stump. Precision was involved. There were nerves and tendons to cut, arteries to close, and skin and muscle to shape and close. But, as long as no complications arose, an amputation had a higher overall success rate.
None of this information comforted Dr. Quinn as her patient was prepared for surgery. Fear of failure was not something to be dwelt upon, and she tried very hard not to. What bothered her most about amputations was guilt. The person would go the rest of their lives with something missing that would never grow back, nor could it be adequately replaced. Hands and arms were almost worse than legs. When a person lost a foot or leg, all they had to learn was to walk with crutches or even a peg leg. When they lost a hand or arm, everything from dressing, to feeding, to bathing had to be re-learned.
Also, it was one thing to lose a limb directly in an accident. It was quite another for the doctor to do everything in their power to save the limb...and then have to amputate anyway.
The woman's hands shook as she surveyed the operating room. Everything was ready. I'm not, thought Michaela. Her eyes stung as she felt a comforting presence come up behind her and lay a warm hand on her shoulder.
"Hey," said Sully, quiet and gentle as he always was. "You okay?"
Michaela clung to his hand. "Why does it have to be like this? I could have prevented this-"
"Now don't go blamin' yourself again." Sully gently turned her around. "You did everythin' in your power to save her hand, right?"
Wordlessly Michaela nodded.
"Then you got nothin' to feel guilty for. You tried. That's all ya can ask of anybody...even a doctor."
Tears overflowed Michaela's face and she willingly leaned into Sully's embrace. "I don't want to do this, Sully. Her stunts bring her so much joy...and now I'm going to take it away from her."
Sully held her close, swinging slowly back and forth. "Ya sure ya have to?"
Michaela nodded firmly. "The infection isn't healing. If I don't amputate, it could kill her."
"Then you'll be savin' her life."
It was a comfort, but a small one. All Michaela could think about was how much Clara would be losing. Still...it was better than certain death. The doctor pulled back, sniffling, and nodded. "You're right." After wiping her watery eyes, she padded over to the water basin and thoroughly washed her hands. When she reached for the towel, Sully handed it to her instead. She thanked him with a wan smile and welcomed his hand on her shoulder.
At that moment Colleen, garbed similarly to Dr. Quinn with apron, rolled sleeves, and hair tied well away from her face, entered the room, sad reluctance etched on her youthful features. "Miss Clara's ready."
This is it. Michaela nodded and began walking toward the room's exit. She hardly heard Sully offer to carry the patient in before she was thanking him.
Clara was oddly calm as she lay on the operating table, clad in a sleeveless nightgown, a white sheet covering her from mid-chest to toes. Her right arm was covered instead by a short white cloth. The paleness of her features and the sweat upon her brow were the only things amiss. Her brown eyes were quiet in surveying the group now crowded around her.
There was Jake, no longer wearing a smirk but a serious, almost concerned expression, standing at her head. By him was a clean cloth mask and a bottle of chloroform.
To her right were Dr. Quinn and Colleen, both trying desperately not to show the fear they surely felt. Dr. Quinn's eyes were red, as if she'd been crying. For Clara there was no anger, only sad acceptance. She knew what would happen if her hand was not amputated. Even life without a hand was preferable to death.
At the foot of the bed stood Sully. His muscular arms were bare and he stood ready with a lantern. His eyes kept darting toward Dr. Mike, as if in worry.
Dr. Quinn laid a reassuring hand on Clara's arm. "Don't be afraid," she said, trying and failing to smile. "You'll be asleep for the entire operation and won't feel any pain. There will be pain later, but...just...try to relax."
Clara gave a tired nod. "I trust you." Tired brown eyes closed and she turned her face to the ceiling. "I'm ready."
Half wishing those words had not been spoken, the doctor gave Clara's arm a slight squeeze before nodding to Jake.
Jake put the thin mask over Clara's mouth and nose and let a single drop of chloroform fall onto it. The routine would be repeated once every minute.
Clara's face twisted somewhat, as if in reaction to the strong smell of chloroform, but the reaction did not last long. In less than a minute she went utterly limp upon the table. Her breathing grew deep and even.
When at last Dr. Quinn was satisfied that Clara was completely unconscious, she took a deep, steadying breath and closed her eyes to send a silent prayer of safety and forgiveness to the Unknown. Then she lifted the cloth off of Clara's arm.
The hand was red, inflamed, and oozing foul-smelling pus. The edges of the numerous wounds had pulled away from the stitching and turned brown and gangrenous. The broken bones, nowhere near mending, kept the joints at weird angles. Meanwhile angry red lines spread halfway up Clara's arm. There was little left of the fingers that could be recognized. The whole thing was rather sickening to look at.
Dr. Quinn swallowed the tears of sympathy and guilt and focused on the job. She gave but a brief glance to her assistants before picking up the metal tourniquet and sliding it halfway up Clara's forearm. The padded clamp was soon closed, the screws tightened. Now the blood supply to the hand was completely cut off.
"Small scalpel, Colleen," requested the doctor. The instrument was soon in her hand. Memories of practicing amputations on cadavers rushed back, and she mentally went through the routine for performing a wrist disarticulation.
First the skin and muscle must be cut in a V pattern, with the 'V' over the sides of the wrist joint. This Dr. Quinn quickly and skillfully did, first with the skin and subcutaneous layer, then, requesting a larger scalpel, with the muscle. "Clamps, please," she requested.
Colleen, biting her lip, nodded and picked up the clamps. Carefully the layers were pulled aside, revealing the thick muscles of the acrobat's wrist. White lines of tendons and red tubes that were blood vessels sat at differing places in the arm. Far below was the hint of white bone and cartilage that made up the wrist joint.
One by one, the tendons were cut. With nothing to attach themselves to, they retreated back into the arm like a snapped band of rubber. "Clamp, Colleen," asked the doctor again. It was time to cut the blood vessels.
Colleen moved quickly, her small mouth hanging open in unease and amazement. At times she felt a morbid curiosity. So this is what the inside of your arm looks like. But the thought was quickly shoved aside upon remembering what was really happening.
First the artery, then the vein was clamped shut. Then they were sliced in two. The arm was regularly rotated to keep the job as neat and even as possible.
At last, when everything else had been cut away, all that remained was the cartilage and bone.
Dr. Quinn always hated this part. It made the amputation final. She wasn't sure what was worse; cutting bone with the bone saw, or cutting through cartilage like de-boning a chicken. With a wrist disarticulation, the cartilage was cut. It was a difficult job, and the largest, sharpest scalpel in her bag of instruments outside the saw was needed. It looked like a butcher knife. Her bloodied hands were shaking as she took the knife from Colleen and began to cut.
It was horrible work, both physically and emotionally tiring. The knife had to wind its way between the myriad bones in the wrist, which were bound tightly. Not many could stand to watch. Jake had long since turned his face to the wall and was taking deep breaths through his mouth. Sully looked away, even as he held the lantern high. Even Colleen turned aside, choking back tears...but she couldn't look away when the doctor needed her help. A gentle nudge from Dr. Quinn's elbow turned her back. The girl began shaking, biting hard on her lip.
Finally, the last of the cartilage had been cut through...as had the nerve, which was not visible between the bones. The severed hand was wrapped in a cloth and put into a small metal pan, blood draining out and pooling.
Dr. Quinn let out a shuddering breath and set down the dreaded knife. "All right. Now to stitch the blood vessels shut." After Colleen handed her the needle and thread, the doctor went back to work with a somewhat easier conscience. Cutting someone always pained her...stitching them up was better. It felt more like healing and less like maiming them. The vessels were shut in due time, and the clamps removed. Next the layers of muscle were brought together over the exposed bone and sewn shut. And at last, with a fresh needle and thread, the final layer was brought together. "Closing," she said at almost a whisper.
Only then could the uneasy assistants turn back, including Jake. He blinked hard, glanced at what the doctor was doing, and then turned back to his watch and the chloroform. Another drop melted into the face mask.
Stitch by stitch, the incisions were closed. With each stitch everyone breathed a little easier. But even then the job was not done. Blood still oozed out between the edges. Michaela gave her hands a brief washing before picking up the pile of bandages and beginning to wrap. The thick bandage extended almost to Clara's elbow and ended in a round edge over the stump.
Then, it was over. Clara was still in a deep sleep, unaware of what had just happened to her over the last hour. Everyone present breathed a sigh of relief. Michaela regarded each of them as she looked around the room. "Thank you...everyone. I couldn't have done it without your help. You can go and wash up now." She turned to her beau, who was somewhat pale. "Sully, could you take her back to her room, please?"
Sully nodded, clearing his throat. "Sure."
Only after the hand was tossed into a garbage heap and the bloodstained sheets cleared off the operating table did Colleen finally break down and sob into Dr. Quinn's shoulder. The doctor held the girl for a long while, trying to say everything would be all right...she only hoped it would be.
While the amputation was happening, a small crowd had gathered in front of the clinic. Whether or not the patient was known- or liked -curiosity and even worry brought the town together. Some of the residents felt guilt for wishing ill on the acrobat...especially Loren. He sat on the bench with his arm around Brian, who had cried into the old man's shoulder. Robert E, Grace, Dorothy, Horace, and Myra were also among the quiet crowd.
Quietest of all was Timothy. He had alternated pacing, sitting, praying, and fighting tears, glancing every so often at the door. To him every minute seemed like a hour. His prayers were at first ones of anger at the situation, asking God why He could allow something so terrible to happen to someone so kind and pious. Then, asking forgiveness for his anger, he pleaded that Clara would come through the operation...and for peace regarding the new situation. He wasn't sure how he would feel seeing Clara without a hand, nor was he sure how she would feel about it.
Finally, after what seemed like an age, the door opened. Everyone lifted their heads in anticipation, while Reverend Johnson jumped to his feet. "How is she?" he blurted at once.
Dr. Quinn's face was pale and etched with fatigue. "She survived the operation. At this point it appears to be a success...all of the diseased tissue was removed...but I won't know for certain for several days, until the infection clears."
A collective sigh of both relief and sympathy swept through the crowd. One by one, they began to dissipate, some offering encouraging looks to the doctor as they left. Brian unexpectedly leapt to his feet and ran off to cry alone.
Reverend Johnson, twisting his flat hat between his hands, waited until the rest had left before approaching Dr. Quinn. His face was anxious. "Can I see her?"
The doctor hesitated, then shook her head. "Not yet, Reverend. It would be better to wait a day or two."
God, please...His face fell. "She'll...she'll be all right, won't she?"
Michaela seemed to shrug. "Physically, she has a good chance. She's young and strong and, assuming the infection clears, should recover. But emotionally..." She bit her lip. "Losing a limb is like losing anything else. There's grief involved...anger, fear, sadness...in order for her to recover, she's going to need all the support she can get." With every pause her voice lowered. She took the Reverend's arm. "Given how much you care for her, you may go through the same emotions. It may be a shock to see her."
A storm of emotions passed over the Reverend's face, but he cleared them quickly and took a deep breath. "I don't care what she looks like. I just want to see her...talk to her."
Michaela sighed, then nodded. "She's still asleep. Just for a minute."
"Thank you." Relief rose on his face, and he eagerly followed his friend inside.
Once again, Clara's room was not devoid of any company as she slept. This time Colleen sat listlessly by her side, alternately staring out the window or at the drowsy acrobat. The girl looked up and managed a slight smile for Dr. Mike.
"Her fever's getting better," she reported.
"Thank you, Colleen," smiled Michaela with relief. "Why don't you see if you can find Brian? He ran off again."
"OK." Colleen nodded and shuffled out into the hall.
With his hat in his hands, the Reverend all but tiptoed up to the bed. He was relieved that she was already looking better than she had in the past two days. The beads of sweat upon her brow were gone and her breathing was far more even.
Reverend Johnson closed his eyes, and sighed, mouthing a silent prayer to God. "Oh Lord, thank you." He eased into the beside chair and reached over to put his hand on Clara's. In doing so his gaze wandered over to the other side of the bed...and stopped.
There sat Clara's arm, bandaged and swollen and much too short. A small bit of blood had reached the outside of the bandage, turning it red.
The memory of exactly what had happened returned, impossible to deny. Clara's hand had been cut off. Timothy felt his stomach churn. He closed his eyes, his breathing shallow. For a moment he feared losing his lunch. "How..." he cleared his raspy throat and turned away to regard Dr. Mike. "How long will she sleep?"
Dr. Mike shrugged. "I can't be sure. She was weak before the operation and lost quite a bit of blood. It could be a few hours...or a few days." Seeing his pale face she touched his arm in comfort. "Don't worry. The infection seems to be leaving, and you know how strong Clara is,"
Timothy nodded, closing his eyes again. He wanted to turn to Clara and brush the damp hair from her face, but he couldn't bring himself to touch her. He couldn't even look at her. Suddenly the Reverend rose to his feet and began fiddling with his hat. His stomach continued to lurch. "I...thank you, Dr. Mike, I...I'd better let her sleep, then."
The doctor frowned in worry and confusion. From anything she had seen, she'd expected the Reverend to stay as long as he could. "Well...you're welcome to stay for a while longer."
"No, I...I can't, I have..." The hat was wrung back and forth in his hands as he began to head for the door. "I have things to do." And with that, Timothy dashed out the door, swept past Colleen, and slapped the hat back on his head. With every step he fought tears and nausea and hardly heard the voice of Dr. Mike calling him back. While he berated himself for his weakness and even revulsion, Timothy knew that if he turned and went back to Clara he would either break down into sobs or vomit. Lord, how could you let this happen? Why Clara? Why?
