WHEN Doctor Hillhouse arrived at his office, it lacked only a quarter of an hour to twelve, the time fixed for the operation on Mrs. Carlton. He found Doctor Kline and Doctor Angier, who were to assist him, both awaiting his return.
"I thought twelve o'clock the hour?" said Doctor Kline as he came in hurriedly.
"So it is. But everything has seemed to work adversely this morning. Mr. Ridley's wife is extremely ill—dying, in fact—and I have had to see her too or three times. Other calls have been imperative, and here I am within a quarter of an hour of the time fixed for a most delicate operation, and my preparations not half completed."
Doctor Kline regarded him for a few moments, and then said:
"This is unfortunate, doctor, and I would advise a postponement until to-morrow. You should have had a morning free from anything but unimportant calls."
"Oh no. I cannot think of a postponement," Doctor Hillhouse replied. "All the arrangements have been made at Mr. Carlton's, and my patient is ready. To put it off for a single day might cause a reaction in her feelings and produce an unfavorable condition. It will have to be done to-day."
"You must not think of keeping your appointment to the hour," said Doctor Kline, glancing at his watch. "Indeed, that would now be impossible. Doctor Angier had better go and say that we will be there within half an hour. Don't hurry yourself in the slightest degree. Take all the time you need to make yourself ready. I will remain and assist you as best I can."
A clear-seeing and controlling mind was just what Doctor Hillhouse needed at that moment. He saw the value of Doctor Kline's suggestion, and promptly accepted it. Doctor Angier was despatched to the residence of Mr. Carlton to advise that gentleman of the brief delay and to make needed preparations for the work that was to be done.
The very necessity felt by Doctor Hillhouse for a speedy repression of the excitement from which he was suffering helped to increase the disturbance, and it was only after he had used a stimulant stronger than he wished to take that he found his nerves becoming quiet and the hand on whose steadiness so much depended growing firm.
At half-past twelve Doctor Hillhouse, in company with Doctor Kline, arrived at Mr. Carlton's. The white face and scared look of the female servant who admitted them showed how strongly fear and sympathy were at work in the house. She directed them to the room which had been set apart for their use. In the hall above Mr. Carlton met them, and returned with a trembling hand and silent pressure the salutation of the two physicians, who passed into a chamber next to the one occupied by their patient and quickly began the work of making everything ready. Acting from previous concert, they drew the table which had been provided into the best light afforded by the room, and then arranged instruments, bandages and all things needed for the work to be done.
When all these preparations were completed, notice was given to Mrs. Carlton, who immediately entered from the adjoining room. She was a beautiful woman, in the very prime of life, and never had she appeared more beautiful than now. Her strong will had mastered fear, strength, courage and resignation looked out from her clear eyes and rested on her firm lips. She smiled, but did not speak. Doctor Hillhouse took her by the hand and led her to the table on which she was to lie during the operation, saying, as he did so, "It will be over in a few minutes, and you will not feel it as much as the scratch of a pin."
She laid herself down without a moment's hesitation, and as she did so Doctor Angier, according to previous arrangement, presented a sponge saturated with ether to her nostrils, and in two minutes complete anaesthesis was produced. On the instant this took place Doctor Hillhouse made an incision and cut down quickly to the tumor. His hand was steady, and he seemed to be in perfect command of himself. The stimulants he had taken as a last resort were still active on brain and nerves. On reaching the tumor he found it, as he had feared, much larger than its surface presentation indicated. It was a hard, fibrous substance, and deeply seated among the veins, arteries and muscles of the neck. The surgeon's hand retained its firmness; there was a concentration of thought and purpose that gave science and skill their best results. It took over twenty minutes to dissect the tumor away from all the delicate organs upon which it had laid its grasp, and nearly half as long a time to stanch the flow of blood from the many small arteries which had been severed during the operation. One of these, larger than the rest, eluded for a time the efforts of Doctor Hillhouse at ligation, and he felt uncertain about it even after he had stopped the effusion of blood. In fact, his hand had become unsteady and his brain slightly confused. The active stimulant taken half an hour before was losing its effect and his nerves beginning to give way. He was no longer master of the situation, and the last and, as it proved, the most vital thing in the whole operation was done imperfectly.
At the end of thirty-five minutes the patient, still under the influence of ether was carried back to her chamber and laid back upon her bed, quiet as a sleeping infant.
"It is all over," said Doctor Hillhouse as the eyes of Mrs. Carlton unclosed a little while afterward and she looked up into his face. He was no longer the impassive surgeon, but the tender and sympathizing friend. His voice was flooded with feeling and moisture dimmed his eyes.
What a look of sweet thankfulness came into the face of Mrs. Carlton as she whispered, "And I knew nothing of it!" Then, shutting her eyes and speaking to herself, she said, "It is wonderful. Thank God, thank God!"
It was almost impossible to, restrain Mr. Carlton, so excessive was his delight when the long agony of suspense was over. Doctor Hillhouse had to grasp his arm tightly and hold him back as he stooped down over his wife. In the blindness of his great joy he would have lifted her in his arms.
"Perfect quiet," said the doctor. "There must be nothing to give her heart a quicker pulsation. Doctor Angier will remain for half an hour to see that all goes well."
The two surgeons then retired, Doctor Kline accompanying Doctor Hillhouse to his office. The latter was silent all the way. The strain over and the alcoholic stimulation gone, mind and body had alike lost their abnormal tension.
"I must congratulate you, doctor," said the friendly surgeon who had assisted in the operation. "It was even more difficult than I had imagined. I never saw a case in which the sheathings of the internal jugular vein and carotid artery were so completely involved. The tumor had made its ugly adhesion all around them. I almost held my breath when the blood from a severed artery spurted over your scalpel and hid from sight the keen edge that was cutting around the internal jugular. A false movement of the hand at that instant might have been fatal."
"Yes; and but for the clearness of that inner sight which, in great exigencies, so often supplements the failing natural vision, all might have been lost," replied Doctor Hillhouse, betraying in his unsteady voice the great reaction from which he was suffering. "If I had known," he added, "that the tumor was so large and its adhesion so extensive, I would not have operated to-day. In fact, I was in no condition for the performance of any operation. I committed a great indiscretion in going to Mr. Birtwell's last night. Late suppers and wine do not leave one's nerves in the best condition, as you and I know very well, doctor; and as a preparation for work such as we have had on hand to-day nothing could be worse."
"Didn't I hear something about the disappearance of a young man who left Mr. Birtwell's at a late hour?" asked Doctor Kline.
"Nothing has been heard of the son of Wilmer Voss since he went away from Mr. Birtwell's about one o'clock," replied Doctor Hillhouse, "and his family are in great distress about him. Mrs. Voss, who is one of my patients, is in very delicate health and when I saw her at eleven o'clock to-day was lying in a critical condition."
"There is something singular about that party at Mr. and Mrs. Birtwell's, added Doctor Hillhouse, after a pause. I hardly know what to make of it."
"Singular in what respect?" asked the other.
The face of Doctor Hillhouse grew more serious:
"You know Mr. Ridley, the lawyer? He was in Congress a few years ago."
"Yes."
"He was very intemperate at one time, and fell so low that even his party rejected him. He then reformed and came to this city, where he entered upon the practice of his profession, and has been for a year or two advancing rapidly. I attended his wife a few days ago, and saw her yesterday afternoon, when she was continuing to do well. There were some indications of excitement about her, though whether from mental or physical causes I could not tell, but nothing to awaken concern. This morning I found her in a most critical condition. Puerperal fever had set in, with evident extensive peritoneal involvement. The case was malignant, all the abdominal viscera being more or less affected. I learned from the nurse that Mr. Ridley was away all night, and that Mrs. Ridley, who was restless and feverish through the evening, became agitated and slightly delirious after twelve o'clock, talking about and calling for her husband, whom she imagined dying in the storm, that now raged with dreadful violence. No help could be had all night; and when we saw her this morning, it was too late for medicine to control the fatal disease which was running its course with almost unprecedented rapidity. She was dying when I saw her at half-past eleven this morning. This case and that of Mrs. Voss were the ones that drew so largely on my time this morning, and helped to disturb me so much, and both were in consequence of Mr. Birtwell's party."
"They might have an indirect connection with the party," returned Doctor Kline, "but can hardly be called legitimate consequences."
"They are legitimate consequences of the free wine and brandy dispensed at Mr. Birtwell's," said Doctor Hillhouse. "Tempted by its sparkle and flavor, Archie Voss, as pure and promising a young man as you will find in the city, was lured on until he had taken more than his brain would bear. In this state he went out at midnight alone in a blinding storm and lost his way—how or where is not yet known. He may have been set upon and robbed and murdered in his helpless condition, or he may have fallen into a pit where he lies buried beneath the snow, or he may have wandered in his blind bewilderment to the river and gone down under its chilling waters.
"Mr. Ridley, with his old appetite not dead, but only half asleep and lying in wait for an opportunity, goes also to Mr. Birtwell's, and the sparkle and flavor of wine and the invitations that are pressed upon him from all sides prove too much for his good resolutions. He tastes and falls. He goes in his right mind, and comes away so much intoxicated that he cannot find his way home. How he reached there at last I do not know—he must have been in some station-house until daylight; but when I saw him, his pitiable suffering and alarmed face made my heart ache. He had killed his wife! He, or the wine he found at Mr. Birtwell's? Which?"
Doctor Hillhouse was nervous and excited, using stronger language than was his wont.
"And I," he added, before Doctor Kline could respond—"I went to the party also, and the sparkle and flavor of wine and spirit of conviviality that pervaded the company lured me also—not weak like Archie, nor with a shattered self-control like Mr. Ridley—to drink far beyond the bounds of prudence, as my nervous condition to-day too surely indicates. A kind of fatality seems to have attended this party."
The doctor gave a little shiver, which was observed by Doctor Kline.
"Not a nervous chill?" said the latter, manifesting concern.
"No; a moral chill, if I may use such a term," replied Doctor Hillhouse—"a shudder at the thought of what might have been as one of the consequences of Mr. Birtwell's liberal dispensation of wine."
"The strain of the morning's work has been too much for you, doctor, and given your mind an unhealthy activity," said his companion. "You want rest and time for recuperation."
"It would have been nothing except for the baleful effects of that party," answered the doctor, whose thought could not dissever itself from the unhappy consequences which had followed the carousal (is the word too strong?) at Mr. Birtwell's. "If I had not been betrayed into drinking wine enough to disturb seriously my nervous system and leave it weak and uncertain to-day, if Mr. Ridley had not been tempted to his fall, if poor Archie Voss had been at home last night instead of in the private drinking-saloon of one of our most respected citizens, do you think that hand," holding up his right hand as he spoke, "would have lost for a moment its cunning to-day and put in jeopardy a precious life?"
The doctor rose from his chair in much excitement and walked nervously about the room.
"It did not lose its cunning," said Doctor Kline, in a calm but emphatic voice. "I watched you from the moment of the first incision until the last artery was tied, and a truer hand I never saw."
"Thank God that the stimulus which I had to substitute for nervous power held out as long as it did. If it had failed a few moments sooner, I might have—"
Doctor Hillhouse checked himself and gave another little shudder.
"Do you know, doctor," he said, after a pause speaking in a low, half-confidential tone and with great seriousness of manner, "when I severed that small artery as I was cutting close to the internal jugular vein and the jet of blood hid both the knife-points and the surrounding tissues, that for an instant I was in mental darkness and that I did not know whether I should cut to the right or to the left? If in that moment of darkness I had cut to the right, my instrument would have penetrated the jugular vein."
It was several moments before either of the surgeons spoke again. There was a look something like fear in both their faces.
"It is the last time," said Doctor Hillhouse, breaking at length the silence and speaking with unwonted emphasis, "that a drop of wine or brandy shall pass my lips within forty-eight hours of any operation."
"I am not so sure that you will help as much as hurt by this abstinence," replied Doctor Kline. "If you are in the habit of using wine daily, I should say keep to your regular quantity. Any change will be a disturbance and break the fine nervous tension that is required. It is easy to account for your condition to-day. If you had taken only your one or two or three glasses yesterday as the case may be, and kept away from the excitement and—pardon me excesses of last night—anything beyond the ordinary rule in these things is an excess, you know—there would have been no failure of the nerves at a critical juncture."
"Is not the mind clearer and the nerves steadier when sustained by healthy nutrition than when toned up by stimulants?" asked Doctor Hillhouse.
"If stimulants have never been taken, yes. But you know that we all use stimulants in one form or another, and to suddenly remove them is to leave the nerves partially unstrung."
"Which brings us face to face with the question whether or not alcoholic stimulants are hurtful to the delicate and wonderfully complicated machinery of the human body. I say alcoholic, for we know that all the stimulation we get from wine or beer comes from the presence of alcohol."
While Doctor Hillhouse was speaking, the office bell rang violently. As soon as the door was opened a man came in hurriedly and handed him, a slip of paper on which were written these few words:
"An artery has commenced bleeding. Come quickly! ANGIER"
Doctor Hillhouse started to his feet and gave a quick order for his carriage. As it drove up to the office-door soon after, he sprang in, accompanied by Doctor Kline. He had left his case of instruments at the house with Doctor Angier.
Not a word was spoken by either of the two men as they were whirled along over the snow, the wheels of the carriage giving back only a sharp crisping sound, but their faces were very sober.
Mr. Carlton met them, looking greatly alarmed.
"Oh, doctor," he exclaimed as he caught the hand of Doctor Hillhouse, almost crushing it in his grasp, "I am so glad you are here. I was afraid she might bleed to death."
"No danger of that," replied Doctor Hillhouse, trying to look assured and to speak with confidence. "It is only the giving way of some small artery which will have to be tied again."
On reaching his patient, Doctor Hillhouse found that one of the small arteries he had been compelled to sever in his work of cutting the tumor away from the surrounding parts was bleeding freely. Half a dozen handkerchiefs and napkins had already been saturated with blood; and as it still came freely, nothing was left but to reopen the wound and religate the artery.
Ether was promptly given, and as soon as the patient was fairly under its influence the bandages were removed and the sutures by which the wound had been drawn together cut. The cavity left by the tumor was, of course, full of blood. This was taken out with sponges, when at the lower part of the orifice a thin jet of blood was visible. The surrounding parts had swollen, thus embedding the mouth of the artery so deeply that it could not be recovered without again using the knife. What followed will be best understood if given in the doctor's own words in a relation of the circumstances made by him a few years afterward.
"As you will see," he said, "I was in the worst possible condition for an emergency like this. I had used no stimulus since returning from Mr. Carlton's though just going to order wine when the summons from Doctor Angier came. If I had taken a glass or two, it would have been better, but the imperative nature of the summons disconcerted me. I was just in the condition to be disturbed and confused. I remembered when too late the grave omission, and had partly resolved to ask Mr. Carlton for a glass of wine before proceeding to reopen the wound and search for the bleeding artery. But a too vivid recollection of my recent conversation with him about Doctor Kline prevented my doing so.
"I felt my hand tremble as I removed the bandages and opened the deep cavity left by the displaced tumor. After the blood with which it was filled had been removed, I saw at the deepest part of the cavity the point from which the blood was flowing, and made an effort to recover the artery, which, owing to the uncertainty of hand which had followed the loss of stimulation, I had tied imperfectly. But it was soon apparent that the parts had swollen, and that I should have to cut deeper in order to get possession of the artery, which lay in close contact with the internal jugular vein. Doctor Kline was holding the head and shoulders of the patient in such a way as to give tension to all the vessels of the neck, while my assistant held open the lips of the wound, so that I could see well into the cavity.
"My hand did not recover its steadiness. As I began cutting down to find the artery I seemed suddenly to be smitten with blindness and to lose a clear perception of what I was doing. It seemed as if some malignant spirit had for the moment got possession of me, coming in through the disorder wrought in my nervous system by over stimulation, and used the hand I could no longer see to guide the instrument I was holding, for death instead of life. I remember now that a sudden impulse seemed given to my arm as if some one had struck it a blow. Then a sound which it had never before been my misfortune to hear—and I pray God I may never hear it again—startled me to an agonized sense of the disaster I had wrought. Too well I knew the meaning of the lapping, hissing, sucking noise that instantly smote our ears. I had made a deep cut across the jugular vein, the wound gaping widely in consequence of the tension given to the vein by the position of the patient's head. A large quantity of air rushed in instantly.
"An exclamation of alarm from Doctor Kline, as he changed the position of the patient's neck in order to force the lips of the wound together and stop the fatal influx of air, roused me from a momentary stupor, and I came back into complete self-possession. The fearful exigency of the moment gave to nerve and brain all the stimulus they required. Already there was a struggle for breath, and the face of Mrs. Carlton, which had been slightly suffused with color, became pale and distressed. Sufficient air had entered to change the condition of the blood in the right cavities of the heart, and prevent its free transmission to the lungs. We could hear a churning sound occasioned by the blood and air being whipped together in the heart, and on applying the hand to the chest could feel a strange thrilling or rasping sensation.
"The most eminent surgeons differ in regard to the best treatment in cases like this, which are of very rare occurrence; to save life the promptest action is required. So large an opening as I had unhappily made in this vein could not be quickly closed, and with each inspiration of the patient more, air was sucked in, so that the blood in the right cavities of the heart soon became beaten into a spumous froth that could not be forced except in small quantities through the pulmonary vessels into the lungs.
"The effect of a diminished supply of blood to the brain and nervous centres quickly became apparent in threatened syncope. Our only hope lay in closing the wound so completely that no more air could enter, and then removing from the heart and capillaries of the lungs the air already received, and now hindering the flow of blood to the brain. One mode of treatment recommended by French surgeons consists in introducing the pipe of a catheter through the wound, if in the right jugular vein—or if not, through an opening made for the purpose in that vein—and the withdrawal of the air from the right auricle of the heart by suction.
"Doctor Kline favored this treatment, but I knew that it would be fatal. Any reopening of the wound now partially closed in order to introduce a tube, even if my instrument case had contained one of suitable size and length, must necessarily have admitted a large additional quantity of air, and so made death certain.
"Indecision in a case like this is fatal. Nothing but the right thing done with an instant promptness can save the imperiled life. But what was the right thing? No more air must be permitted to enter, and the blood must be unloaded as quickly as possible of the air now obstructing its way to the lungs, so, that the brain might get a fresh supply before it was too late. We succeeded in the first, but not in the last. Too much air had entered, and my patient was beyond the reach of professional aid. She sank rapidly, and in less than an hour from the time my hand, robbed of its skill by wine, failed in its wonted cunning, she lay white and still before me."
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