Steward Fontaine led the doctors and Nurse Cécile inside the château and upstairs toward the bed chambers as Nurse Maria met the group at the top of the staircase in a panic.
"Doctors, thank God, we need help in here," the nurse announced. "It's Aramis; there's something very wrong."
"No, not Aramis!" Cécile cried as she ran ahead of the group with the two doctors and the steward just behind her. "Captain, oh God, how is he?" the nurse asked. She gasped when she saw Aramis unconscious on the bed with bloody sputum sprayed around his mouth, spattering his clothes and his cot.
"Not well, I'm afraid, Cécile," the captain shook his head. He got up from the cot to move out of the way when he saw the doctors approach. "Thank God, you're here. Thank you both for coming."
Doctors Molyneux and Berteau rushed to the bedside to find Aramis lying on his side with a thin stream of bubbling blood dripping from his mouth. Molyneux turned the medic on his back to place his ear on Aramis' chest; he listened to the lungs, all the while watching the lopsided and labored rise and fall of his chest.
"He has no breath sounds coming from the right lung and his chest rises only on the left side." Doctor Molyneux sat up then shook his head grimly. "Judging from the bloody sputum, I believe his lung has been punctured and has collapsed."
"I wrapped Aramis' ribs just before he left Orléans in search of his friends," Cécile informed the doctor. "He said that he had been attacked by highwaymen who brutally kicked and beat him. I believed then that his ribs were broken, but he only allowed me to wrap them; he said he was in a hurry to leave with Athos."
"I'll need to do surgery immediately," Doctor Molyneux stated. "Cécile, I will need my medical bag and tools; I also need clean towels, water and brandy. In addition, I will need cotton, a small glass bowl, and a candle for lighting when I need it."
"I will have the servants retrieve the miscellaneous items for you doctor," Steward Fontaine offered.
"Doctors, contrary to what Aramis wrote with regard to our three wounded, I actually have four men needing immediate surgery and treatment-as I'm sure Aramis did not include himself. Porthos has a probable diaphragm injury with increasingly labored breathing; d'Artagnan has an infected right shoulder; Athos …" Captain Tréville paused as he turned to motion toward the ghostly white face of the Musketeer tucked underneath a pile of blankets.
The two doctors and Cécile turned to follow the captain's gaze to the Musketeer lying unmoving and ghostly pale under the blankets. "Athos, what happened to him?" Cécile asked.
"Athos had at least four pints of blood taken from his arm and neck; he is cold, pale and unresponsive," the captain reported.
"God have mercy!" Molyneux glanced with horror at Athos, his former patient. "How…"
"We don't have time to explain right now," the captain replied impatiently. "Will both of you be doing surgery on Aramis, or can one of you take care Porthos, who is in very bad condition right now."
"Doctors, I can help with Athos," Nurse Maria interjected. "I have extensive experience working with wounded soldiers suffering from extreme blood loss; I even assisted the physicians with the saline transfusions. However, I do not have the proper equipment necessary for the transfusion, nor the saline ratio, but if you can instruct me…" the nurse paused, waiting for a response.
"Gauging by the frantic nature and the extent of injuries Aramis listed in his letter, we brought all the tools and supplies we thought might come in handy—to include the tools for a transfusion," Doctor Molyneux informed the nurse.
"If we can get the saline solution prepared, while one of you doctors set up the transfusion equipment, I can take care of Athos," Nurse Maria offered. "This will allow one doctor to work on Aramis, while the transfusion is in process; and the other doctor begins treatment on Porthos and then d'Artagnan."
"Yes, that is a wonderful idea, nurse," Doctor Berteau nodded with approval. "For the saline solution, we need nine grams of sodium chloride mixed with one thousand milliliters of sterile water…" the doctor paused as Steward Fontaine began writing down the solution ingredients.
"I will get that mixture together then brought up immediately." Steward Fontaine quickly turned on his heel and ran from the room.
"Doctor Molyneux, why don't you stay and treat the two men in this room, while I go see what needs to be done with the other two patients." Doctor Berteau nodded, while looking between the doctor and the captain. "We can take care of the men faster and more efficiently if we separate."
"Thank you, doctor," Captain Tréville sighed with relief. "I will show you to their rooms and tell you about Porthos' chest wound while we walk. Oh, and there are two very capable and experienced nurses, Marta and Adele, who will be able to assist you with surgery and treatment."
"Wonderful!" Doctor Berteau gathered his kit and supplies. "Lead the way, Captain."
~§~
Steward Fontaine returned with the saline solution and set it on the table beside Athos' bed. "Here is the prepared saline, Doctor."
"Thank you, Steward." Doctor Molyneux looked up from his examination of Athos. "We will be doing multiple repetitions of the saline treatment. Do you have enough sodium chloride to make several batches of solution?"
"Absolutely," Steward Fontaine replied. "If not, I will purchase more," he said as he departed to make more saline solution.
"I will need you to hold the cow's bladder while I pour the solution in." Doctor Molyneux instructed Maria as he held up the bladder. "You will continue holding it up as the saline drains into Athos, if this is acceptable?" he asked the nurse.
"Why, yes, of course," Maria agreed. "I have done this procedure before, doctor."
"That is very impressive, Nurse. I am happy to work with someone who is experienced in this procedure," the doctor smiled. Doctor Molyneux began the transfusion by inserting a small ivory tube into the cow's bladder; next, he pulled the delicate skin over the tube until it fit perfectly and created a vacuum. The doctor lifted the sleeve on Athos' right arm and found the small bandage where the bloodletting incision had been covered. "I'll just take out these sutures here in the vein and use this location for the needle."
Once he had removed the sutures, the doctor carefully inserted a goose quill into the large vein then plugged the end with his finger to stop the flow of blood, while elevating Athos' arm. "Nurse Maria, bring the bladder here, quickly!" Doctor Molyneux instructed as he kept the quill plugged.
"Let's switch places with our fingers," Maria suggested, "I'll keep Athos' arm elevated and plug the quill while you get the bladder ready." The duo easily traded duties, freeing the doctor to finish putting together the transfusion apparatus.
The doctor took the ivory tube then attached it to the end of the quill. Satisfied with the tube and quill attached together, he lowered Athos' arm so the saline would begin to flow into the vein. "Now, keep a good eye on the flow," the doctor instructed. "Don't let it flow too quickly; keep it at a slower pace, for now, and we'll see how he reacts to it. If you can handle things here with Athos, Maria, I will begin treating Aramis, yes?"
"Yes, doctor." Nurse Maria nodded as she held the bladder, not too high as to keep a slower flow.
Aramis:
"Cécile, I will need your assistance with surgery and as we begin mihceme," Molyneux stated. He looked to see if all the necessary supplies were in the room then nodded with satisfaction. "I believe we are ready to begin."
Doctor Molyneux soaked a towel with brandy then swabbed where he had detected the broken ribs on the right side. He took his scalpel and made a small incision. "Swab the blood please, Cécile," he requested. "I'll need you to hold the incision open while I repair the lung and the ribs."
"Yes, doctor," Cécile nodded as she mopped up the blood with a towel.
"Ah, yes, I see the tear in the lung where the jagged end of a broken rib punctured it. I can easily fix the tear and then repair those bones," the doctor said. The man moved his head around to optimize his inspection of the injuries inside Aramis' chest then nodded quietly to himself.
The doctor proceeded to suture the torn lung without conversation. Once finished with the sutures, he repaired the broken ribs by carefully readjusting the bones, fitting the parts together like interlocking pieces. "Alright, we are now ready to begin the aspiration process, Cécile," Molyneux said as he finished swabbing away blood from the area.
With both hands, Molyneux held a small bowl by the rim, watching as Cécile took a piece of cotton soaked with brandy then lit it on fire. With a pair of tongs, she placed the fiery cotton inside the bowl where it was allowed to burn for a few seconds before quickly removing it again with the tongs.
The doctor immediately turned the bowl open side down over the incision on Aramis' chest where the heat would create a vacuum and begin sucking excess fluid and oxygen from the chest cavity. The bowl was left in place a few minutes for absolute suction before it was removed; the process was repeated over and again until the doctor saw no more frothy blood being pulled from the pleural cavity.
"Very good, mihceme is finished and appears to have been successful," the doctor reported with a smile. "We're ready to close him up." Molyneux stitched the incision closed then finished with a thorough swabbing of the area with some brandy.
"Now, I will cover the incision with a small bandage," the doctor articulated while he worked. "Cécile, if you will assist me with the bandage, we can wrap up his ribs tightly and we'll be finished. We'll need to gather several pillows to elevate his upper body for easier breathing; he must lie very still for a few days to allow those ribs to heal."
"What about his lung, doctor?" Nurse Cécile asked.
"Fortunately, the lung is a very resilient organ," Molyneux replied. "Now that the excess fluid and air has been removed from the pleural space, the lung will naturally reinflate itself and begin healing in a matter of days. However, complete healing of the lung, combined with the injured ribs, will take weeks."
"Well, let's hope Aramis will give his injuries time to heal before charging off on some new adventure," Cécile chuckled as they finished bandaging the medic's ribs.
"How is Athos doing over there, Nurse Maria?" Doctor Molyneux inquired, looking over his shoulder.
"The saline solution is about half-finished, doctor," Maria replied. She sat patiently holding the bladder, watching closely as the saline solution flowed at a precise pace.
"Alright Cécile, we have finished with Aramis now; let us leave him be so he can rest. I will go see what I can do for poor Athos," Doctor Molyneux frowned. "I told this young man to take it easy—allow himself time to heal after his illness with catarrh—but it is obvious that he did not listen to me. Now he is in worse shape than before," the doctor muttered.
"Well, if anyone can help Athos, Doctor Molyneux, you can," Cécile replied with confidence. "I wonder how everything is going with Doctor Berteau? I sure hope he can help Porthos."
Porthos:
Doctor Berteau examined Porthos' chest wound and then listened to his lungs with his ear pressed against the left side of the Musketeer's chest. "I still hear breathing sounds from the left lung," he informed Nurse Marta. "I see the chest rises evenly together, which is indeed a very good sign."
"I've been monitoring his breathing, as well as the breathing sounds inside his chest closely; I never got the impression that his lung collapsed," Nurse Marta replied.
"What is causing Porthos so much distress while breathing then?" Captain Tréville asked.
"Given the location of the stab wound, and that he has had difficulty breathing, I am guessing there is damage to his diaphragm. However, I will not know the extent of such damage until I open him up in surgery."
"What exactly does the diaphragm do, doctor?"
"The diaphragm is a muscle that controls the lung's respiration," the doctor explained. "When the diaphragm contracts, the lungs expand. Without realizing it, we rely heavily on our diaphragm; if it is injured, our ability to breathe is impaired, though not in the same manner as a collapsed lung. It could be a very serious injury, but let us hope that it is not."
"Doctor, we have everything ready to begin surgery," the nurse interjected. "I am Nurse Marta, by the way, and I will be your assistant."
"Hello, Nurse Marta," Doctor Berteau nodded and smiled. "We shall get started after we administer dwale to the patient; I do not want him waking in the middle of surgery. I have the ingredients for the potion in my bag," the doctor instructed.
Nurse Marta assisted the doctor in preparing the dwale while Captain Tréville kept an eye on the patient.
Porthos was awake, though still groggy from the laudanum. "Porthos, I don't know if you remember me or not, but I am Doctor Berteau; we met at the Château Chamarande."
"Yes, I 'member you, doctor," Porthos nodded as he closed his eyes.
"I am going to be taking care of the stab wound here in your chest and then, hopefully, we will quickly get you on the road to recovery. I have some dwale for you to drink; it will help you sleep during surgery so you will not feel pain. Sound good, yes?"
Porthos took the proffered cup from Captain Tréville; he hesitated a moment as he glanced at his captain.
"Go on and drink it, Porthos," the captain encouraged. "You'll be alright; I promise you, the dwale is safe."
Porthos nodded then drank the potion until it was gone; he handed the cup back to the captain.
"Very good, Porthos," the doctor smiled. "Now we shall wait for it to take effect before we get started."
After the large Musketeer fell asleep, Doctor Berteau poured an ample amount of brandy over the chest as Nurse Marta mopped up the liquid with a towel. He took the scalpel and made a long incision by the wound, just under the last rib on the left side. "Nurse, if you would please hold the skin back and keep the incision open, I will proceed." The doctor used a probing tool to go underneath the ribs to examine the smooth, deep-red diaphragm; he soon found a jagged tear in the lower right corner of the muscle. "Ah, here is the cut made by the knife," the doctor exclaimed. "Now, let us see how deep the laceration is."
Doctor Berteau examined the diaphragm, carefully probing into the laceration until he found the bottom of the cut. "Thank God," the doctor sighed and nodded. "The knife did not penetrate the liver—the liver is unharmed! Let us see if we can figure out what happened here…" Berteau's voice trailed as he looked for clues.
"Ah, I see why the knife didn't penetrate deeper," Doctor Berteau exclaimed happily. "His ninth rib has a deep gouge in it, obviously caused by the blade glancing then scraping along the bone. The rib prevented the knife from penetrating through the diaphragm and into the liver. If the blade had penetrated the liver," he paused then sucked a long breath through his teeth. "Well, we would not be having this surgery, Captain; instead, you would have been preparing for his funeral."
Captain Tréville said nothing, but he swallowed hard and shook his head. "Thank God that is not the case," he whispered quietly to himself.
"Alright, I will suture this tear in the diaphragm and we'll close him up." The doctor stitched the muscle tear closed; he then dabbed all around on the inside of the diaphragm cavity with a cotton swab, cleaning up the blood before closing the incision. Once the outer incision was stitched then cleaned with brandy, the area was covered with salve and bandaged.
"We must keep an eye on this incision and the surrounding area for infection," the doctor instructed the nurse. "Check the dressing every two or three hours; make sure you change it, every time. Reapply the salve when you change the dressing. Hopefully, with these precautions we will avoid any chance of infection."
"Yes, doctor," Nurse Marta replied.
"Now, let me take a look at these many lacerations. . ." his voice trailed. "Poor son, what did they do to you?"
"I haven't heard the full story myself, but the evidence of their handiwork is quite clear." Captain Tréville stated angrily.
"Indeed it is, Captain," the doctor agreed. "Look at these wrist wounds!" He held up Porthos' large wrist, turning it while frowning at the deep cuts in the skin. "It appears that he tried to fight against the manacles; perhaps he tried to pull his hand free. It is too late to stitch these wounds, they're already scabbing over. I will apply a salve and bandage them."
"Would you like help applying salve to the lacerations, doctor?" Captain Tréville asked.
"Yes, that would be most helpful, Captain," the doctor agreed. "We must first tend to these lacerations on his front; we will then roll him over to treat his back. Between the three of us, it shouldn't take us too long—so let us all get busy."
Once the salve and bandages were finished on Porthos' front, the three worked together to gently roll the Musketeer onto his right side, being observant of the recent chest incision, as they propped him against a mountain of pillows. "My God, I can't imagine the suffering this man endured."
"I have to warn you, doctor," the captain stated grimly. "D'Artagnan is every bit as bad."
"I cannot fathom the kind of person who could do this to another human being," Berteau shook his head with disgust. "I've spent my entire career fixing up the broken bodies and mending the damage done in the name of war; oppression; regional conflict; punishment and torture. There is no limit to the anguish and calamity human beings are willing to inflict on others. I find it all rather disturbing."
"I agree with you, doctor," Captain Tréville replied. "I wonder if we will ever live in a world without humanity suffering in such a way? In our line of work, perhaps, we have become too accustomed to the conflict going on around us. Our focus is, not just a personal fight for survival, but personal sacrifice as we try to protect our brother beside us. For the Musketeers, fighting and war—conflict—it is the very nature of our work, doctor."
"I understand, Captain," the doctor frowned. "The need for your job is mandated by the unrelenting suffering imposed on those who are weaker; the poor people who are unable to defend against power, wealth, and unyielding greed. Unfortunately, I don't believe we will ever see a world without suffering, Captain. No, humanity will never know a world coexisting in peace."
"That is a very sad and bleak outlook on life, doctor—albeit very truthful." Captain Tréville frowned as he finished applying his portion of salve to the cuts.
"I will need your need help applying these bandages over his back," the doctor requested of his two assistants. "Captain, if you would lift Porthos up while I thread the bandage underneath him to Nurse Marta, we can all help him get him bandaged. We shall keep Porthos propped on his side to keep the weight off these wounds; he should begin healing in a few days."
Once finished, the doctor told the nurse to ask for help before changing the bandages; he reminded her when they did change the bandages, the salve must be also be reapplied.
"I will be back to check on his progress in a few hours," Doctor Berteau stated. "Now, let's see what we can do for our young Gascon, shall we?"
"I hope Aramis and Athos are nearly finished in surgery." Captain Tréville sighed to himself as he gazed at the opposite end of the hall. "Once d'Artagnan is finished, my men can finally begin healing."
Athos:
"Athos, what have you done to yourself?" Doctor Molyneux sat on the edge of the Musketeer's bed to begin examination after beginning the first round of transfusions. The doctor pulled the blankets down to the waist then laid a hand on Athos' chest; he frowned and shook his head at the cool temperature and pallor of the skin. "His temperature is still too low and his skin too pale," he frowned. "How many pints did the doctor take from Athos?"
"I don't know for certain, doctor," the nurse replied. "No one was in the room when the doctor did his procedure on Athos. . ." her voice trailed as pictured the gory scene in her mind. At that instant, she snapped her fingers as a memory came to mind. "I remember seeing three bowls on the table; there was another bowl on the floor that had been knocked from his hand, so that makes four—at least."
"It's at least four because I had to remove three fresh stitches from his right arm before I began the transfusion," the doctor said, motioning to the arm with the quill still inserted in the vein. "He may have taken a pint from the arm, possibly bringing the loss of blood to nearly five pints. Nurse, what happened to his left arm?"
"Aramis said that he was hit with a cat's paw- a torture device- when rescuing Porthos from the dungeon," Maria shook her head sadly. "Reportedly, the doctor saw that the muscle had been torn but he was not skilled enough as a surgeon and, therefore, could not fix the wound."
"Oh dear." Doctor Molyneux's eyes grew wide as he quickly unwrapped the arm to check the damage. "That doctor may have left the wound untreated too long; I don't know if I'll be able to repair the damage."
"Doctor, Aramis did pack the arm with ice," the nurse reported. "At least, he did until he was overcome by his wounds and fell asleep."
"When was that, Nurse?" Molyneux inquired as he examined the arm. "Aramis fell asleep in the chair just before the doctor told us to leave; it was just before he bled Athos last night."
"Ice," Doctor Molyneux smiled as he huffed in amazement. "I keep telling that young medic, he missed his true calling. I wonder if the captain would mind it terribly if I permanently borrowed his medic and made him my assistant?" the doctor asked with a grin.
"Yes, actually, I think the captain would mind." Nurse Cécile smiled, proud of her lover. "Aramis is the regiment's best medic; he has saved many lives that otherwise would have been lost. I know Captain Tréville and the Musketeer regiment could not afford to lose him, Doctor."
"Can Athos survive losing four or five pints of blood without any residual effects, Doctor?" Nurse Maria asked, her brow furrowed with worry.
"Even if he was healthy to begin with, his outcome would be rather questionable; as it is now, however, it is hard to be optimistic. Athos was not healthy and was falling ill again, hence the bloodletting to cure him." Molyneux pressed his ear against the Musketeer's chest to listen to both lungs then cursed.
"I hear rattling in the lungs from congestion—probably bronchitis," the doctor frowned. "I am certain this is why the doctor tried bloodletting; he hoped to cure the bronchitis. The problem is that he was not experienced enough to have tried such a dangerous procedure as bloodletting from the jugular vein—that was very foolish of him."
"Foolish is not the word I would use," Cécile grumbled under her breath.
"Doctor, how many saline transfusions do we give him?" the nurse asked. "I know that he needs fluids, but how much salt water is safe?"
"We will just do the one thousand milliliters per day," the doctor replied. "We cannot overdose him with too much saline in a twenty-four hour period."
"Since I am still holding the saline bag, will Cécile be able to assist you on his arm, Doctor?" Nurse Maria asked.
"I'd be happy to assist you," Cécile offered, stepping forward to the sickbed. "We should have everything we need to get started."
The doctor took the bottle of brandy then liberally poured the alcohol over the open wound of the forearm; he allowed the alcohol to sit a moment before dabbing the arm dry with a towel. "If you would take the retractors to hold back the edges, Cécile, I will get started."
Doctor Molyneux used tweezers to pull back the jagged edges of the torn muscle to realign the ends together. Using the probing tool, he pushed the larger torn pieces of the muscle together, readying them to be sutured. "Cécile, if you would use the tweezers to push against the edges here while I sew…" the doctor's voice trailed as he motioned with his needle.
With Cécile as his assistant, Doctor Molyneux slowly and carefully sutured the torn muscle together; without further conversation, the duo finished the surgery, each smiling with satisfaction. The doctor sanitized the wound, once again dabbing it dry with a clean towel, before applying an herbal salve and a loose bandage. "Alright, now we wait and pray his arm will heal properly." Molyneux wiped the sweat from his brow. "Let me check this neck wound to see how it is healing," he said as he peeled away the bandage. "Nurse Maria, who stitched up this wound?"
"Captain Tréville did, doctor," Maria replied with a smile. "Why, did he do something wrong?"
"No, quite the opposite, actually," Molyneux answered. "Captain Tréville did a fine job stitching his neck; in fact, I am quite impressed with his suturing talent," he smiled.
"I am sure he would be very pleased to hear you say that, doctor," Cécile smiled.
"Nurse, hand me the salve in my bag so I can reapply more ointment—to be safe—before redressing it."
Finally as the team finished with the patient, the doctor leaned back in his chair exhausted. "I'll let Athos rest a while longer before trying to wake him, but it's vital we get some water in him as soon as possible so we can monitor his kidneys."
"Even if we do get water into his system, doctor," the nurse interjected. "How long will it take before it goes through the kidneys and out of his system?"
"Well, it depends on the person, but it can be anywhere from an hour to five or six hours," the doctor answered. "If he starts drinking water and hasn't put out any urine within twenty four hours…" he sighed and shook his head. "Nevertheless, we won't know the extent of any potential kidney damage until we can monitor his urine output. Until then, we'll keep pumping the fluids into him; only then will we know if his kidneys are working correctly. . . or not."
d'Artagnan:
Doctor Berteau followed Captain Tréville into d'Artagnan's room where they both sat in chairs on opposite sides of the bed. The doctor peeled away the bandage on the shoulder, examining the wound closely as it was revealed.
"Who treated this shoulder?" the doctor asked as he examined the sutures and the swollen wound.
"Doctor Bonét and Aramis did the first time," Nurse Adele answered. "It was Captain Tréville and I who treated it the second time. We finished bandaging his wound behind Doctor Bonét as he was too rushed to do it himself. Since then, we have been keeping warm compresses on it to encourage draining of the infection."
"Thank you, Adele," Berteau complimented the nurse. "It appears the wound is trying to rid itself of the infection, and your actions certainly have aided in healing; the infection—I'm afraid—is being rather stubborn, however. I'm going to remove the stitches and completely clean out the wound. I will pack an herbal poultice inside the wound before restitching it closed—we'll keep the wound open until the infection is gone."
"Do you think the infection has already moved into his bloodstream?" Captain Tréville asked with worry. "Can you save him?"
"I will do everything I can to keep the infection from getting any worse, Captain," the doctor said, setting his jaw with determination. "I am a physician who has treated a multitude of injuries and illnesses but there is little I hate more than infections. Wound infections enjoy taking a backdoor approach in stealing a man's health from him like a thief—but I will not allow it."
"What are you going to do, doctor?" Nurse Adele asked, trading glances with Captain Tréville.
"Well, first I will remove the stitches and clean out the wound—drain out the pus and infected fluids—and then I'll fill the wound with herbs that are synonymous with healing infections. We must do everything possible to prevent the infection from spreading into his bloodstream."
The doctor took the scalpel and cut through Aramis' previous work; he removed the sutures to allow for drainage of the infection-filled pus with firm pressure of a towel across the surface of the wound. After the pus was pushed out and the fluid drained, Doctor Berteau proceeded to clean and irrigate the open wound with a brine solution to sanitize. "It is good that d'Artagnan is not aware of this treatment, else he would be screaming in agony due to the salt burning."
"He already had salt deliberately poured onto his wounds at the dungeon," Nurse Adele whispered. "He told me that it felt like he had been lit on fire."
"When did d'Artagnan tell you this, nurse?" Captain Tréville asked, as this was the first time he had heard of the brine solution being poured on his men.
"Sometime last night," the nurse replied. "I was trying to get him to talk to me, tell me about what happened. He shouldn't carry the burden of its memory around with him; it will drag him down with its heavy weight."
"Indeed it will, Nurse," Captain Tréville smiled. "You are a very wise nurse; one who is a good counselor, who mends not just the body, but the mind as well. Thank you for taking such good care of my men."
"It is my pleasure, Captain," the nurse blushed.
"I will leave the wound open but will pack it with gauze for twenty-four to forty-eight hours to absorb the pus and discharge." Doctor Berteau voiced aloud as he finished his work. "We must irrigate the wound with the salt solution twice per day and repack it with the gauze until there is no further pus visible. Let us pray this takes care of the infection." The doctor instructed the nurse as she watched him complete his work on the shoulder.
"Now, let us see what else we can do for the rest of these terrible wounds over his front and back, shall we?" Doctor Berteau asked, though of no one in particular.
"Doctor, if you will treat the lacerations on his chest and stomach, I will treat and bandage his wrists so we can then turn him over to work on his back," Adele suggested.
"Agreed," the doctor nodded. "Nurse, you said that this young man and Porthos were subjected to a brine solution being splashed over their wounds as a deliberate torment? I know the salt must have burned his wounds as though his skin had been set alight," the doctor shook his head sadly. "However, what the tormentors did not realize is that they did d'Artagnan and Porthos a favor by irrigating and sanitizing these open wounds."
"Don't let d'Artagnan hear you say that those monsters did him a favor," Captain Tréville interjected. "I'm sure he wasn't thinking of the medical benefits as salt was being sadistically poured over his wounds."
"Oh, believe me, Captain, I can only imagine the terror this young man went through—and I do not belittle his suffering at all," Doctor Berteau replied. "However, I do know dungeons are typically filthy and caked with dried body fluids, blood and gore; most people tormented in those hellish places—if they have not died from the torture method themselves—will end up dying from infection."
"I understand what you are saying, doctor; though I don't believe they would agree about the salt," the captain muttered to himself.
"The salt solution cleaned out the wounds and prevented infection from settling in. So, while it was indeed quite painful, the salt and the water did keep the wounds clean… and probably saved their lives."
"Well, we may never learn who those monsters were that tormented them, or who hired them, since they were all killed," Captain Tréville said.
"It is too bad all of them were killed." Doctor Berteau stated as he finished with the bandaging. "Those men took valuable information with them to the grave; you may never know who hired those tormentors to bring such suffering to your men."
"Oh, but I do intend to find out who it was that hired those tormentors," Tréville spat with an incensed growl. "I won't stop looking until I find out who it was and then I'll make him pay for what he did to my men."
Hallway, Returning to room of Athos and Aramis:
"Captain Tréville, I have some good news for you," Steward Fontaine announced in the hallway.
"What is it, Steward?" The captain was visibly fatigued from maneuvering between four men and four emotionally exhausting surgeries.
"I have just learned that Gaston, Duke of Orléans and Marie de Hautefort will be arriving at the château early tomorrow morning; they are both aware that you and your Musketeers are here and they look forward to meeting you."
"Thank God," Captain Tréville scrubbed a hand over his face, overcome with relief. "At last, I will find out if this mission was worth it. Our part in this mission is complete only when I see Mademoiselle Marie de Hautefort and place a letter in her hand- a letter which nearly cost my men their lives."
A/N:
An early description of traumatic pneumothorax secondary to rib fractures appears in Imperial Surgery by Turkish surgeon Şerafeddin Sabuncuoğlu (1385–1468), which recommended a method of simple aspiration, mihceme.
The chest tube was unknown in the 15th century, but one of Sabuncuoglu's management methods was ahead of its time with a procedure known as "mihceme" (aspiration by negative pressure).
Mihceme is a "cupping therapy" that has been in traditional use in China, Egypt, and Turkey since ancient times—a procedure in which the skin is incised and blood is drawn by suction. Customarily, an flammable object, such as a piece of cotton, was set on fire inside a glass bowl to burn the oxygen to create a vacuum. The bowl was then turned upside down over the open wound to suck out excess fluids and air from the wound. Sabuncuoglu recommended mihceme especially in instances of rib fractures which collapsed the lung with fluid in the pleura, or pneumothorax aspiration. He indicates that this management gave good results.
** It was common practice to wrap rib injuries with compression bandages but it is now known to cause worse injury! Don't wrap broken ribs with compression wraps or bandages, even if it decreases pain. Wrapping broken ribs may prevent a patient from taking deep breaths and may increase chances of developing pneumonia.