PART 4
The kitchen door was still propped open but the door to the living room had been closed all evening, and so she held it open for the two men as Siegfried half assisted and half had to carry his little brother into the sitting room and over towards the sofa. It had not been unknown for the youngest Farnham to over play and exaggerate his symptoms of illness in the past, especially when he'd been suffering from one of many a hangover and wanted to make it appear as though he might be sickening for something more serious, and not so self-inflicted, in order to avoid the reproach of his brother - but Siegfried was an expert at reading Tristan and could tell from the obvious difficulty he was having walking, and by his general weakness, that this time there was evidently something very seriously wrong. Tristan had very little strength left by the time Siegfried helped him to the sofa and instructed him to lay down, and as soon as his head made contact with the cushion his older brother placed at the base of his skull his eyes began to close.
"Tristan?" Siegfried called to his younger brother softly as he shook him gently by the shoulder until Tristan opened his eyes again. "Don't go to sleep. Don't forget, that leg still needs seeing to..."
"I'm not..." Tristan sighed, "To be honest Siegfried, I don't think I could sleep now even if I wanted to." He explained. "I feel kind of strange... washed out, but not tired. Perhaps if I wasn't in quite so much pain I would feel differently but..."
Tristan's words were cut short however as he suddenly blanched, swallowing hard.
"Siegfried... I feel sick." He gulped. His voice shook as he spoke and he took an uneasy breath to try and settle his upset stomach, but it still wasn't enough to prevent the rising tide of bile making its way up the back of his throat, nor to suppress the inevitable gag - unable any longer to suppress his nausea.
"Oh God..." Deidre exclaimed as he dry heaved, realising what was about to happen and hurrying off into the kitchen and returning with a bowl just in time as Tristan vomited violently over the side of the sofa.
"Siegfried I really think we ort to get him to hospital." She exclaimed, stroking the sweaty mop of mousy blonde hair away from his clammy forehead as Tristan vomited again and again. His whole body shook as each time he heaved he brought up a little less than before until there was nothing left for him to expel. Finally he fell back against the seat, exhausted.
She was beginning to panic, but Siegfried knew that the severe pain of his injury coupled with the growing infection could account for Tristan's nausea, and so he wasn't overly concerned about it for the moment. His priority was to try and bring his brother's fever down, and to clean his wounds as best he could to minimise the spread of the infection.
He made sure that his brother was as comfortable as possible under the circumstances, placing a gentle palm to his warm forehead and shushing him when he groaned, before turning to look at Deidre whose eyes were still upon him expectantly, and shaking his head.
"Ordinarily I would agree with you my dear." He took her aside calmly. "But the snows coming down thick and fast out there now." He explained. "The roads are treacherous. There is no way an ambulance would get through in this weather, and I don't want to take the risk of trying to get him there ourselves. There is no guarantee we would make it, and it's better if we stay put for the time being where it's dry and warm. We have more control over the situation here. I can keep a closer eye on him, and administer any drugs he might need."
"Shouldn't we wait until the doctor to arrives?" Deidre asked.
"In an ideal world yes." Siegfried nodded, quite agreeing with her. He looked down at his brother, trying to access his general condition besides the obvious gaping wound in the back of his leg. He looked so small he thought, not like a man of his thirties but like a little boy. He appeared even paler than he had done in the kitchen, there were dark shadows beneath his slightly sunken eyes and there was a general feeling of malaise about him which Siegfried found somewhat worrisome - but he realised that his recent vomiting spell could account for some of that. He was already dehydrated, the hot tea Deirdre had been plying him with all evening had gone some way to replace the fluids he'd lost throughout the hours the wound had been bleeding, but he couldn't afford to lose anymore. As Siegfried watched his brother Tristan put a shaky hand to his head and groaned, indicative of some degree of headache - which in itself was a sign of dehydration.
He leaned in closer to Deidre, drawing her away from Tristan, and when he spoke again he adopted a hushed tone. "But he needs medical attention now." He explained. "I'm afraid he's not going to be able to wait until Doctor Alanson gets here... whenever that may be... it is becoming increasingly clear that he has the beginnings of a very serious infection. He needs anti-biotics now, and I need to clean the wound to minimise the spread of the poison to his blood."
"Siegfried?" Tristan whimpered, and winced as he struggled to change position. He screwed his eyes shut as he tried without very much success to blot out the pain.
"It's alright little brother, I'm still here." He assured him, making his way back over to the sofa and leaning down beside him. "I'm here. You really must try to rest."
"I'll fetch him a blanket and let Helen know what's going on." Deidre offered. She waited for Siegfried to respond, but upon receiving no answer to the contrary decided to take it upon herself to do as she had offered anyway. She took the bowl, and as she began to make her way towards the door Siegfried turned to look at her and smiled gratefully.
"Yes, thank you my dear." He nodded, already in the process of removing the crochet throw from the back of the arm chair to drape it over his little brother. "Helen should be informed of the situation of course, and an extra blanket would probably help with the shock."
"I'm not in shock." Tristan mumbled.
"You've been through quite an ordeal little brother, of course you're in shock." Siegfried quietly hushed him, taking him gently by his pale wrist and checking his pulse against the second hand on his watch. It was fast but steady, which concerned him slightly – not the steady part, but the rapid heartbeat although not necessarily serious, nor entirely out of the ordinary for someone who'd just been through what he'd been through, could be an indication that the infection was taking hold. Siegfried rubbed his hand across his face in a fraught manner, and squeezed the bridge of his nose.
When Deidre had gone, he asked his brother;
"Still dizzy?"
"A little..." Tristan nodded.
Siegfried sighed.
"You've lost a lot of blood." He told him gravely. "And I'm afraid the wound is still bleeding." He explained, as he observed more fresh blood oozing out in a tiny trickle, from between the cracks which had appeared in the old clots of dried blood.
He carefully undid the first few buttons of Tristan's shirt with this, and, rummaging around in the depths of his jacket pocket, pulled out his stethoscope which until now Tristan had been unaware his brother still carried on him. He realised that this must have been where Siegfried had stuffed it as he made his way home with James at the end of their final house call of the evening.
Tristan shivered as the cold, metal plate made contact with his warm skin. He waited whilst Siegfried listened carefully to the sound of his heart and lungs for a moment, a concerned frown painted upon his face as he appeared to linger rather too long over the area of Tristan's heart. His younger brother watched him anxiously as he moved the plate in one direction and then the other, before finally standing back and removing the buds of the stethoscope from his ears.
"Anything the matter?" Tristan asked.
"There's some fluid on your lungs and you're tachycardic." He explained. "Probably caused by the blood loss, and not aided by the shock. Nothing to worry about little brother." He patted him gently on his good leg in an attempt to reassure him. "It'll probably pass soon. Just lay still for a while and I will check it again when you are a little more settled."
A few minutes then passed between them in relative silence, as Siegfried set about performing a more thorough examination of his brother's leg, whilst Tristan's eyes began to close for a second time. He seemed quite unable to keep them open, and for some time Siegfried suspected that he'd probably fallen asleep.
It was only when they heard the sound of footsteps in the hall about ten minutes later and Siegfried turned around just in time to be able to help Deidre as she came into the room bearing a pile of blankets, spare pillows, and a hot water bottle, that Tristan opened his eyes again and the older Farnham brother realised that he'd merely been dozing - teetering on the cusp of consciousness, unable to resist his body's need for sleep, but in too much discomfort to completely resign himself to the oblivion which beckoned to him. Deirdre had also brought with her a fresh bowel - in case Tristan was sick again.
"Oh my dear," he exclaimed as he jumped up to help, taking the load from her and placing it down upon the armchair opposite where his brother was laid up, "you really are an angel in mortal form."
"Thank you Deidre." Tristan smiled weakly.
"It's no problem." Deidre returned the gesture.
"Did you manage to speak to Helen?" Siegfried asked conversationally, trying to keep the discourse between them as casual and matter of face as possible, as he then set about wrapping another blanket around Tristan and gently replacing the cushion with a pillow beneath his head. Deirdre slipped the hot water bottle underneath the blanket at his side.
She nodded.
"Yes," she answered, "she was very worried, understandably. I had to stop her trying to get out of bed. I don't think I could have done if she'd physically been able to, but I've managed to pacify her for now by assuring her that there's really nothing more she could do even if she could get up, and I've promised to keep her informed."
"Well thank God you managed to stop her." Siegfried considered, as he went back to carefully examining Tristan's leg. "The last thing we need in this house at the moment is poor old Helen doing herself any more damage... I wonder my dear," he thought out loud as he accidently pressed down a little too hard on the inflamed tissue surrounding the area of the bite and Tristan cried out. He looked up and exchanged a silent apologetic glance with his younger brother, observing how hot the flesh was becoming, "would you mind just keeping an eye on Tristan whilst I nip out for a moment?" He asked her. "I need to grab a few supplies from the consulting room."
"Of course not." Deidre replied.
"Oh come on Siegfried," Tristan scoffed, "I don't think I'm as frail as all that that you can't leave me alone for a few minutes." He grimaced again as he tried to sit up and Siegfried immediately placed his hands upon his brothers shoulders and gently lowered him back down onto the sofa.
"Tristan, just try to take it easy." He ordered him.
"Well you're only going to be in the next room Siegfried," He exclaimed, "not in the next village. Tell me, what harm could you possibly think I could come to? You're within shouting distance for Christ sake?" He asked.
"With the scrapes you always seem to manage to get yourself into I wouldn't put anything past you little brother." He retorted. "Your leg is infected, and you're feverish! I'm not taking any chances!"
Siegfried looked kindly upon Deidre, although she could see the disguised anxiety within his eyes, carefully cached beyond the facade of feigned calm.
He was a good man, she thought. Although his fuse was often short, and he was prone to something of a fiery temper, especially where his brother was concerned, his heart was never anything other than in the right place. He loved Tristan very much, and despite how much they both quarrelled, and one would complain bitterly about the other behind the others back - feigning disapproval or intolerance - it was in moments like this that one could see that they really did love each other. Tristan relied on his older brother a lot more than he would care to admit, and Siegfried, despite all of his protestations, never let him down. She found it all really rather endearing, and, although she would never have thought it possible, it made her love them both all the more.
She smiled as he affectionately brushed her cheek with a gentle finger, before taking one more look at his younger brother and hurrying from the room.
"Oh Tristan, what are we going to do with you?" She asked him in her broad Scottish accent once Siegfried had gone, making her way over and perching herself down on the arm of the sofa beside his head. She ran her fingers soothingly through his mousy blonde hair, and he allowed himself to sink even deeper into the soft pillow Siegfried had given him.
"I don't mean for these things to happen Deidre." He implored her, and yawned, exhaustion evidently beginning to take its toll, but he fought hard against it to try and stay awake. "Honestly I don't..."
"I know you don't Tris." She sighed.
"All this does tend to get rather wearing after the millionth time you find yourself in the same situation." He explained. "I'm fed up Deidre, and Siegfried must be so sick of having to pick up after me all the time."
"I'm sure that's not true." She forced herself to smile.
"Well he goes on about it often enough!" Tristan exclaimed. "And who could blame him? I mean, look at me Deidre, I'm a mess!"
"Oh Tris, it's all talk, you know that." She rubbed at his shoulder in what she hoped would be construed as a gesture of comfort. "How often have you yourself said things you don't mean in the heat of the moment?" She asked him. "He loves you, and you know he'll always scrub up rather well when the chips are really down."
Tristan craned his neck to look up at her. He was by now deathly pale, any colour which had initially remained upon his face when he'd first collapsed had now been drained, and even the rosy flush to his cheeks had started to fade, to be replaced by an unhealthy pale hue.
"Oh, you're right, of course." He conceded.
"Of course I am..." She said, looking down at him, and watching as he allowed himself to be swallowed up by the pillow and blankets which shrouded him. He was doing his best not to move, every tiny jolt set his leg alight with the searing pain again. It felt as though all three layers of skin had been stripped from the limb, and a blow torch taken to what remained of the mangled flesh and tissue. The raw wound remained unprotected from the external elements which irritated and exacerbated the exposed nerves - the cool air of the winter evening quickly dried the blood which still seeped and oozed from many of the smaller puncture marks, forming a flaking and sticky crust on the surface of his leg. She noticed that the usual sparkle was missing from his eyes, and he appeared so incredibly drawn and unusually tired.
"Oh come on Tristan, snap out of it." She implored him. "Feeling sorry for yourself won't help matters much. It's not like you to be defeatist."
"Well, that's where you're wrong Deidre, it's exactly like me." He snapped, rolling over onto his side rather impulsively and letting out a pained hiss as the sudden movement sent another wave of pain shooting up the length of his leg. Several hours of sweat and dirt had by now been given the chance to settle into some of the smaller superficial flesh wounds, let alone the gaping hole in the back of his ankle, and the bacteria in the dogs saliva had caused significant swelling and inflammation around the sight of the injury. Although he had done his best to cleanse it with warm water when he and Deidre had first returned home the pain had prohibited him from doing a thorough enough job of cleaning it. Deidre looked down at him disapprovingly, but rubbed at his shoulder as she waited for the fit to pass. She felt his body, rigid beneath her hand, and tracked the progress of the painful impulse as he slowly began to relax again, before finally going limp at her side.
He lay there for a while, breathing heavily, as he struggled to regain at least some of his lost composure. When he'd recovered slightly he looked up at her, a small but clearly forced smile lifting his drawn features.
"Well, it is today. Alright?" He asked her.
"Alright." She conceded defeat, and he did his best to try and manage something akin to a laugh, which turned into a small, weak splutter.
To Deidre's undisguised relief Siegfried soon returned with a fresh and unopened ball of cotton wool dressing, gauze bandages, and several glass vials of medication. Deidre quickly moved out of the way to allow him more room to manoeuvre, and as she retreated to the relative safety of the armchair he held out a thermometer for his brother to take.
"Here, pop that under your tongue Tristan." He instructed him. "I want to see how bad that fever of yours is. It'll give us a better indication of how advanced the infection is."
"That hasn't been anywhere near a cow's backside has it?" Tristan asked, eyeing the proffered thermometer suspiciously.
"Certainly not!" Siegfried exclaimed, incredulous that his younger brother could even think that it might have been - but he suspected that Tristan's fever had spiked. He was now sweating profusely, and he could tell that he was not completely compos mentis - although still able to hold a conversation, it was with some evident difficulty, and was taking some effort on his part. The raised temperature had clouded his judgment and Siegfried suspected that he was not currently capable of reasoned nor rational thought... if Tristan had ever been capable of those two things in the first place.
"It's from the first aid box in the kitchen." He told him.
"Oh... well that's alright then." Tristan sighed, seemingly sufficiently reassured as he opened his mouth and allowed Siegfried to pop the thermometer underneath his tongue. As he did so Siegfried placed the back of his hand to his brother's forehead and grimaced slightly as he felt the heat still radiating from the flesh beneath – if anything he felt even hotter than the last time he'd checked.
"You're very hot." He hissed, and removed the hot water bottle Deirdre had only recently placed at Tristan's side, replacing it instead with a wet flannel to his forehead. Tristan shivered as the cold water made contact with his skin.
"Please Seigfried, it's so cold in here." Tristan protested, his bottom lip beginning to tremble and his teeth chattering around the glass thermometer as he felt the loss of the hot water bottle. Seigfried considered this for a moment. He weighed up the heat of his evident fever against his shivering form. Although the young man's temperature was actually very high the chill he felt in his bones was very real - the result of a simple biochemical reaction in his brain. He couldn't risk doing anything which would send Tristan's fever shooting up any higher, but at the same time he recognised that the distress he felt at having the hot water bottle taken away from him was indeed genuine. This was a little more than the simple chill one felt with a cold or flu. The sooner they got some anti-biotics into him the better, Siegfried thought.
He did however come to what he thought was quite an amicable compromise. If Tristan kept the cold flannel on his forehead and allowed him to take away one of the blankets he might be able to justify asking Deidre to put just one log on the fire.
He turned to the young woman and when he spoke his voice was a raised whisper, but his tone was characteristically warm despite the dectectable strain.
"Get a fire going would you Deidre?" He asked her, as he took the crochet throw from his brother. "Just one log should be sufficient."
She nodded.
Tristan then watched his brother as he unpackaged a new syringe, holding it up to the light as he began to fill it with the liquid from one of the vials of medication. The clear liquid bubbled in the glass vial.
"What's that?" He asked suspiciously through slightly clenched teeth so as not to dislodge the thermometer.
"Pethadine for the pain." Siegfried explained, placing the syringe down on the table whilst he leant in to take the thermometer from between his brother's pale lips.
"38.8." He frowned as he took the reading.
"Is that bad?" Deidre asked.
"Well," Siegfried considered as he shook the thermometer to restore the mercury to its original state, and gently rolled Tristan's sleeve up. He took a very small pinch of cotton wool and began to swab the upper part of Tristan's arm with antiseptic. "It's high, my dear." He explained. "A healthy person's body temperature is generally considered to be around 37 degrees Celsius, anything between that and 39 degrees is considered to be a low grade fever, so it's currently at the top end of the spectrum. I'm not too worried about it at the moment, but we're going to have to keep a very close eye on it."
Tristan was by now shivering more violently than before. He flinched as he felt the needle pierce his flesh and the rush of liquid into his blood stream. It made his arm ache, but Siegfried evidently wasn't finished yet as he observed him fill the syringe again with the contents of a second vial of medication. Siegfried caught his younger brother watching him as he did this, and smiled.
"I'm just giving you penicillin for the infection, and then a tetanus booster." He explained. "I'm sorry, but the second and third injections are probably going to sting a little more than the first."
Tristan looked up at him, and nodded, albeit somewhat reservedly. He resigned himself to the necessity of having the medication his brother offered, preferring the brief sharp scratch of the needle to the potential complications of blood poisoning or lock-jaw, but there was a silent plea in his eyes for him to at least get it over with quickly. Tristan knew well enough that it was going to hurt, and a lot more than Siegfried made out for that matter. He'd never really liked needles.
"I'll try to make this as quick as I possibly can Tristan." His older brother promised "But you must try to remain still."
He then quickly injected the contents of the second needle into his upper arm muscle, before refilling it with the third and final dose. Tristan clenched his jaw tight and gritted his teeth as he waited for the inevitable sharp prick of the proverbial bee sting. He winced when it finally came, but Siegfried was quick to apply a small ball of cotton wool to the puncture sight, to stem the tiny droplet of blood drawn by the now empty hypodermic, and as he gently began to roll down his sleeve Tristan finally felt able to relax - the series of injections finally over with for now. Although he realised that there would probably be more when the doctor arrived.
"Now Tristan," Siegfried declared once he'd determined that his brother had recovered sufficiently to be able to handle the next necessary step, "I'm going to flush out the wound with saline," He explained, "which is going to hurt I'm afraid, but I might leave the stitching to Doctor Alanson when he comes. He can give you a local, which I of course can't, and I don't want to risk stitching in any infection. I also want him to see the extent of the damage done."
Deidre couldn't help but notice the look of relief upon Tristan's face as his brother said this. She realised that he must have been dreading having to have the torn and shredded tissue stitched without even so much as a local anaesthetic to ease the inevitable agony that the process of binding the two flaps of flesh was likely to cause - the tugging and the pulling of the jagged skin was only likely to aggravate the deep and seeping puncture. Although he would have, without question, gone along with his brother's recommendations, it was of course much better for him in the long term if the procedure could wait until the doctor arrived.
The flushing out of the wound was by no means any more of a pleasant prospect however. Tristan consented, knowing the likely alternative if he did not, but he had to fight very hard not to resist as Siegfried stedied his leg against the arm of the sofa and began to gently pour the clear liquid over the wound. The flushing out of a wound with pure saline was usually a completely painless procedure - but having neglected his leg over the course of the past few hours meant that even the cold evening air caused an intense burning sensation.
The cries and whimpers which emanated from Tristan as the sterile saline solution sloshed over his raw flesh were hard for both his brother and Deidre to have to listen to. The twitch of a tiny nerve in Siegfried's cheek as he clenched his jaw together, all the time never averting his eyes from Tristan's paling face, a clear indication of the distress the sound caused him. As the sterile fluid invaded the wound and permeated through layers of lacerated skin and swollen tissue it stripped away the clots of dried blood, dirt and bacteria - but this was of little consolation to Siegfried.
The maxim 'to be cruel to be kind' did occasionally have it's place in 'The Siegfried Farnham Handbook to Raising a Younger Brother', but there was a vast amount of difference between landing him with a long list of unnecessary and quite unpleasant duties as recompense for another late night spent picking his liver at the Drovers, or teasing him over the breakfast table whilst he nursed the monster of all hangovers, to being the cause of what was, for the record, really quite genuine distress.
His every instinct was, and always had been, to protect his brother. It went against every fibre of his being.
Deirdre couldn't help herself, she was a tender and gentle woman, and at the sound of Tristan's cries she left stoking the small fire and hurried over to his side. She perched herself down on the arm of the seat beside him, taking him firmly by the hand and stroked his damp and sweaty locks tenderly. It only took a matter of seconds, but all three were quite relieved when the procedure was finally over with, and Siegfried finished by rubbing the smallest amount of iodine into the wound before setting about bandaging it as tightly as he could to try and stem the still small trickle of blood until the doctor arrived.
Tristan continued to lie unnervingly still, sweating and shaking, doing his best to try and steady his ragged and laboured breathing, until finally Siegfried tied the final knot on the bandage and he finally felt able to breathe a sigh of relief.
"There we go my good fellow." Siegfried forced a smile, his own voice shaking somewhat as he sat back to admire his handywork. He patted Tristan's good leg warmly. "You just lie there and rest for a while." He soothed.
"I think I'll just pop upstairs and let Helen know that we've done all we can for now." Deirdre breathed, releasing a pent up breath herself which she hadn't even been aware she'd been holing onto. There were several small indentations and graze marks on the back of her small hand where Tristan had dug his nails into her pail skin - but she hadn't even noticed that as it had been happening at the time.
"Of course my dear." Siegfried nodded as be began to clear away the empty vials of medication, bottles of antiseptic and left over roles of bandages before unwinding the stethoscope from around his neck and leaning over Tristan to glean another listen of his chest.
She gently ruffled Tristan's hair as she got to her feet, and Siegfried went back to tidying up the used medical supplies.
"Alright there old fellow?" He asked with a frown, as he looked up from what he was doing to see that Tristan's eyes were now closed, but that his breathing remained slightly laboured.
"Just about, I think, Siegfried." He responded weakly.
"There's a good man." Siegfried sighed with relief.
Deidre stood in the doorway for a second or two, watching the two men, and she smiled - Tristan would be alright, she told herself, Siegfried would continue to take good care of him.
When she'd gone the oldest Farnham brother wiped his hands on one of the damp towels he'd originally brought for Tristan's forehead and wearily took a seat in the armchair opposite.
Tristan appeared to have finally fallen asleep now.
His gaze subconsciously drifted, surveying the room, and when he looked over at his brother again he couldn't help but permit himself a small half-smile. Tristan lay stretched out on the sofa, his breathing still uneven but now much easier in sleep than it had been in wakefulness. He'd worn himself out, Siegfried sighed, but the past hour had rather taken it out of him to. The blood had already started to seep through the several layers of bandages swathed around his brother's leg, and had started to stain the sterile dressings crimson, but he'd done everything he could for now, and all that was left was for him to hope that it had been enough to temporarily hold the wound together until the doctor arrived.
He couldn't bear the thought of having to put Tristan through another ordeal like the one he'd just been through, or one much worse if he found himself forced to stitch the wound himself after all. He took some small comfort none the less from the fact that for now he at least appeared rather more settled and comfortable than he had been, and feeling significantly reassured by this he permitted his own eyes to close, if only for a moment.
The final image he saw before his own head slipped forwards onto his chest was that of his peacefully sleeping brother.
