The Outlandish Companion - Diana Gabaldon [257]
A short horizontal incision over the fourth and fifth knuckles, then down, cutting the skin nearly to the wrist. I undermined the skin carefully with the scissors’ tips, then pinned back the loose flap of skin with one of the long steel probes, digging it into the soft wood of the board.
I had a small bulb atomizer, filled with a solution of distilled water and alcohol; sterility being impossible, I used this to lay a fine mist over the operating field and wash away the first welling of blood. Not too much; the vasoconstrictor I had given him was working, but the effect wouldn’t last long.
I gently nudged apart the muscle fibers—those that were still whole—to expose the bone and its overlying tendon, gleaming silver among the vivid colors of the body. The sword had cut the tendon nearly through, an inch above the carpal bones. I severed the few remaining fibers, and the hand twitched disconcertingly in reflex. I bit my lip, but it was all right; aside from the hand, he hadn’t moved. He felt different; his flesh had more life than that of a man under ether or pentothal. He was not anesthetized, but only drugged into stupor; the feel of his flesh was resilient, not the pliant flaccidity I had been accustomed to in my days at the hospital in my own time. Still, it was a far cry—and an immeasurable relief—from the live and panicked convulsions that I had felt under my hands in the surgeon’s tent.
I brushed the cut tendon aside with the forceps. There was the deep branch of the ulnar nerve, a delicate thread of white myelin, with its tiny branches spreading into invisibility, deep in the tissues. Good, it was far enough toward the fifth finger that I could work without damage to the main nerve trunk.
You never knew; textbook illustrations were one thing, but the first thing any surgeon learned was that bodies were unnervingly unique; a stomach would be roughly where you expected it to be, but the nerves and blood vessels that supplied it might be anywhere in the general vicinity, and quite possibly varying in shape and number as well.
But now I knew the secrets of this hand. I could see the engineering of it, the structures that gave it form and movement. There was the beautiful, strong arch of the third metacarpal, and the delicacy of the web of blood vessels that supplied it. Blood welled, slow and vivid: deep red in the tiny pool of the open field, brilliant scarlet where it stained the chopped bone; a dark and royal blue in the tiny vein that pulsed below the joint, a crusty black at the edge of the original wound, where it had clotted.
I had known, without asking myself how, that the fourth metacarpal was shattered; the joint of the fourth finger that lay within the hand. It was; the blade had struck near the proximal end, splintering the head of the tiny bone near the center of the hand.
I would take that, too, then; the free chunks of bone would have to be removed in any case, to prevent them irritating the adjoining tissues. Removing the finger from the metacarpal joint would let the third and fifth fingers lie close together, in effect narrowing the hand and eliminating the awkward gap that would be left by the missing finger.
I pulled hard on the mangled finger, to open the articular space between the joints, then used the tip of the scalpel to sever the ligament. The cartilages separated with a tiny but audible pop! and Jamie jerked and groaned, his hand twisting in my grasp.
“Hush,” I whispered to him, holding tight. “Hush, it’s all right. I’m here, it’s all right.”
I could do nothing for the boys dying on the field, but here, for him, I could offer magic, and know the spell would hold. He heard me, deep in troubled opium dreams; he frowned and muttered something unintelligible, then sighed deeply and relaxed, his wrist going once more limp under my hand.
Somewhere near at hand, a rooster crowed, and I glanced at the wall of the tent. It was noticeably lighter, and a faint dawn wind drifted