The surgeons daughter, p.1
The Surgeon's Daughter, page 1
Also by Audrey Blake
The Girl in His Shadow
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Books. Change. Lives.
Copyright © 2022 by Audrey Blake
Cover and internal design © 2022 by Sourcebooks
Cover design by James Iacobelli
Cover images by Crow’s Eye Productions/Arcangel Images, Alex Korzun/Shutterstock, Channarong Pherngjanda/Shutterstock, Ann Muse/Shutterstock
Internal design by Ashley Holstrom/Sourcebooks
Sourcebooks and the colophon are registered trademarks of Sourcebooks.
All rights reserved. No part of this book may be reproduced in any form or by any electronic or mechanical means including information storage and retrieval systems—except in the case of brief quotations embodied in critical articles or reviews—without permission in writing from its publisher, Sourcebooks.
The characters and events portrayed in this book are fictitious or are used fictitiously. Apart from well-known historical figures, any similarity to real persons, living or dead, is purely coincidental and not intended by the author.
Published by Sourcebooks Landmark, an imprint of Sourcebooks
P.O. Box 4410, Naperville, Illinois 60567-4410
(630) 961-3900
sourcebooks.com
Library of Congress Cataloging-in-Publication Data
Names: Blake, Audrey, active 2020, author.
Title: The surgeon’s daughter / Audrey Blake.
Description: Naperville, Illinois : Sourcebooks Landmark, [2022]
Identifiers: LCCN 2022000205 (print) | LCCN 2022000206 (ebook) | (trade paperback) | (epub)
Classification: LCC PS3602.L3415 S87 2022 (print) | LCC PS3602.L3415 (ebook) | DDC 813/.6--dc23
LC record available at https://lccn.loc.gov/2022000205
LC ebook record available at https://lccn.loc.gov/2022000206
Contents
Front Cover
Title Page
Copyright
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
Chapter 21
Chapter 22
Chapter 23
Chapter 24
Chapter 25
Chapter 26
Chapter 27
Chapter 28
Chapter 29
Chapter 30
Chapter 31
Chapter 32
Chapter 33
Chapter 34
Chapter 35
Chapter 36
Chapter 37
Chapter 38
Chapter 39
Chapter 40
Chapter 41
Chapter 42
Chapter 43
Chapter 44
Chapter 45
Historical Note
Reading Group Guide
A Conversation with the Authors
Acknowledgments
About the Authors
Back Cover
To Jeff. You’re such an enabler. XO
For Karina and Keisha, a mother and daughter who know a love stronger than death. You have inspired and changed me.
Chapter 1
Pain was not unusual in those who came to the Grande Ospedale della Vita e della Morte in Bologna, Italy, but never more evident than in the horde waiting for treatment today. Nora was used to these beleaguered souls who hobbled, limped, or were carried to Via Riva di Reno from the alleys of the Quadrilatero. She’d walked those narrow, medieval streets herself this morning to the aptly named Grand Hospital of Life and Death, but with a brisk and resolute step, not like the fearful, sick, and bleeding sufferers who came from that slum in endless succession, day after day.
The trouble was, even with her best attention, a brilliantly deduced diagnosis, and skilled treatment, too much depended on chance. She surveyed the registration room with a practiced eye, silently praying she’d be accurate in her winnowing. Life and death. Screams, pleas, and whimpers, however striking, were less important than their causes, and causes needed to be determined quickly. A quiet fever, if ignored, would spread through the air if the patient wasn’t quarantined. Broken arms, though agonizing, must be forced to wait.
“Dottoressa.” A boy holding a younger child reached for Nora’s arm. She wasn’t a doctor, not yet, but the title brought a flush to her cheeks. Soon.
“Un momento,” Nora said, her eyes flying past him to a woman leaning against the hospital door, silhouetted against the late afternoon sun. Her breath was as labored and ponderous as the music of a child forced to thump out exercises on the piano. Forgetting the seeping wound on the cheek of the young child in front of her, Nora hurried to the woman’s side. “Signora, what’s wrong?”
She was poor, obviously; in labor, obviously; but women delivered their babies at home. They did not shuffle down hot, dusty streets, shielding their bellies one-handed, to this hospital, especially when there were so many cases of erysipelas in the wards. The highly contagious fever kept many would-be patients from seeking help, because the people of this city seized and scattered bad news of the hospital before even the doctors caught wind of it.
“It’s been a day and a night. I need help.” The woman gasped, then gritted her teeth as a contraction sized her, only moments after the last.
“Piero! Quick!” Nora called, as she took the woman’s weight on her arm. At this rate, they might not make it inside. Piero, the burliest orderly, swooped in with a wheeled chair, collected the woman, and swerved past the registration desk without breaking his stride. Impervious to protests from the crowd of waiting patients, he wheeled the woman down the corridor to the women’s ward. Nora raced after him. Unable to find an empty bed, she hastily erected a screen.
“Not much time with this one, eh?” Piero whispered to Nora. “Maybe I should just leave her in the chair.”
Nora frowned, recalling the woman’s statement. It’s been a day and a night. “It won’t be much longer,” Nora said to the woman. What had she been thinking, trekking here? “Put her on the table so I can take a look,” she told Piero.
In spite of the woman’s ungainly shape and agonized groans, Piero swung her easily onto the table as Nora set aside bundles of fresh linen and the carefully blended bottles of liniment and neatly pressed pills from Sister Madonna Agnes’s pharmacy. As soon as she had room to work, Nora lifted away the ragged skirts, the hems stained the same perpetual rusty brown as everything else in the city. She paused in surprise, for she fully expected to see the head crowning, but it didn’t even look like the fluids had ruptured, and when Nora felt for the head, she found almost no cervical dilation at all.
Something must have shown in her face, because the woman pushed up on her elbows and clicked her tongue to get Nora’s attention. “Will I die?” she demanded.
“Of course not,” Nora said, pretending she wasn’t both puzzled and dismayed. “What’s your name?”
“It feels like this one is killing me,” the woman answered instead, ending on another groan. Her hands crumpled into fists until the contraction passed, then she collapsed onto the tabletop.
“You’ve birthed children before?” Nora asked.
“Four. Two still living,” she gasped. “Never had any trouble, but—” Her face contorted, and she was once again in another realm, a place of consuming focus and pain.
Piero sent Nora an inquiring look—one she couldn’t answer. For the past thirty years, all female medical students at the University of Bologna had ended up focusing on obstetrics, if they weren’t simply diverted to midwifery in the first place. It was considered natural for them to exercise their skills on other women, so Nora had attended extra lectures, studied, and worked to hone her skills. But she didn’t know what to do now, and this woman’s life was worth more than her pride.
“I don’t know,” Nora hissed. “In the name of… Fetch somebody!” This was beyond her, but it required little skill to know there wasn’t much time. Though she’d never seen it, Nora knew the dangers of everlasting labor: fits, apoplexy, puerperal fever.
Piero returned a blank look. “Who?”
“Anyone. Does it look like I can help her?” Professor Perra was good with difficult births. So was Sister Paula Benedicta. Hopefully one of them wasn’t far off. Nora’s cheeks burned with shame and frustration as Piero jogged off. She called for the ward sister, Maria Celeste, and asked for hot water and rags. Together,
Nora didn’t recognize her from anywhere, though she carried a doctor’s bag.
“What have you here?” the woman demanded. She was tall, with loose black curls gathered rather carelessly for working in a hospital. Her soft jawline made a stark contrast to her severe eyebrows, bent in concentration.
Sister Maria Celeste sighed in relief, and Nora relaxed a little. Whoever the woman was, she had the sister’s confidence.
“I’m not sure,” Nora admitted. “Contractions are fast, less than thirty seconds apart—”
“I can see that,” the woman interrupted. “And no dilation, I suppose, or you wouldn’t have sent for me. Have you measured her pelvis?”
“I only checked the cervix,” Nora said with a flush. She was being ordered about, but by whom? “She’s had other live births, so the distance should be adequate.”
“Just because she’s delivered before doesn’t mean her body can’t change. Look at her,” the woman snapped. “Short neck, stooped back. You have to recognize these signs.” She shouldered Nora away from the bottom of the table. “Let me examine her.”
Without a word to the patient, she reached beneath her skirts. Nora shot a pained look at Piero who silently mouthed Dottoressa over the woman’s bent back.
“Just as I thought,” the dottoressa said a moment later. “Her bones are collapsing. Poor nutrition. She’s got less than five centimeters anteroposteriorly, and not much more than that from side to side.” She reached over and began rummaging through Nora’s open bag.
Nora didn’t stop her. She’d read of a case where a woman’s pelvis had narrowed after numerous births, but until this mysterious doctor’s sharp reminder, she’d forgotten it. “I don’t have a crotchet,” she said quietly. She’d seen craniotomies in London, where doctors killed and removed an infant piecemeal in hopes of saving a mother, but she hadn’t thought to use one here since they weren’t permitted by the Catholic church.
The doctor looked at her in surprise. “God in heaven, I hope not.” She drew out her scalpel and examined the blade. “Crotchet,” she muttered under her breath with contempt. “You must be the English girl who does ether experiments. Get your needles ready while I talk to the patient. We’re going to do a cesarean.”
Nora kept her hands and her gaze steady, nodding because it was impossible to speak. She’d read of cesarean sections the same way she’d read of fairy tales and sea monsters. In England, she knew of one reported case where mother and child survived. The story was close to a hundred years old, more legend than fact, of a country midwife named Alice O’Neil who had used a razor for the operation while a man ran a mile to bring her silk thread and tailor’s needles. Cesarean sections were not the stuff of myth here on the Continent, but they were still rare and deadly. In the year she’d spent in Bologna, Nora hadn’t witnessed one and didn’t expect to.
Some of her fear must have shown. The dottoressa cocked her head. “You’ve not seen one before?”
“No,” Nora admitted, shrinking in her shoes. Now she’d be banished or sent to fetch someone competent.
“Can you follow directions?”
Nora nodded, like a child promising obedience to avoid the switch.
“Good. I haven’t tried this with ether yet, and I hear you’ve a wealth of experience there.”
Nora opened her mouth, but the woman’s eyebrows lifted. “Yes, at once,” Nora said instead, and ran to fetch her vaporizer.
* * *
“She’s asleep,” Nora said five minutes later and lifted the inhaler from the patient’s face. “I used twenty drops. That should give us—” Her voice broke off. The woman doctor was already cutting.
“Explain your wonder drug later. We need to work,” the doctor snapped.
“We haven’t checked to see if she’s insensible!” Nora hissed, aghast at the size of the incision. Nor did she know the patient’s pulse or rate of respiration, essential markers for using ether safely.
“She’s insensible,” the woman said. “Hasn’t even twitched. After such a protracted labor there’s no time to waste. I’ll need your help with the retractors.”
Nora jumped to her bag.
“Mine are out on the table. There, beside her leg.” The doctor jerked her head impatiently, and Nora reached across her to grab them, groping until she located them beneath the tangle of skirts. “You’re blocking the light,” the doctor scolded. “I know you must have been in surgeries before, so try not to act as if this is your first.”
Nora clenched her lips to school the trembling that threatened them and sponged as quickly and skillfully as she knew how. She poised the retractors to wait for the doctor’s order.
“You need to be faster. I tied off the vessels ages ago.”
“I’m sorry, Dr…” Nora waited for the woman or for Sister Maria Celeste to provide the missing name. No one answered.
“Sponge.”
Nora sponged again. The incision ran lengthwise between the pubis and ribs, an inch to the right of the navel. Had this doctor cut blindly? Or had she done something to try to avoid the placenta? There was an alarming amount of blood, but Nora’s reading told her if the placenta had been cut, they’d be up to their elbows by now.
“How did—”
“I need more room. Pull harder.”
Nora tugged on the retractors, eyeing the blood and fluid spilling from the wound. Even if she dared, there was no time to express her misgivings. The doctor thrust past her, plunging her hands deep. Nora flinched. This woman acted without an ounce of humility or caution, like Liston and Vickery, London surgeons famous for their speed and recklessness.
“Baby is face forward,” the dottoressa muttered. “Nothing but trouble today.” Her forearms tensed as she pulled, and the baby came free, smeared in blood and vernix. The spindly limbs snapped straight, spreading as wide as the points of the compass.
“She’s alive.” Nora let out the breath she’d been holding, her chest loosening.
“That one is,” the doctor said briskly, thrusting the infant—squalling now—at Sister Maria Celeste. Then she snatched up a needle and elbowed past Nora. “You’re in my way again,” she snapped.
Not wishing to be told a third time, Nora stepped back, though she hated to lose sight of the incision margins and the rapidly—almost haphazardly—flying needle. Was she suturing in layers? What type of stitch? Nora knew one of the chief obstacles to a cesarean was a stitch strong enough to withstand the powerful contractions of afterbirth without being so invasive as to cause infection. Weak stitches tore free and left the womb gaping—a long and painful death.
You’ll get a look before applying the dressing, Nora told herself, but when the time came, she was dispatched to the patient’s head to check her pulse and her breathing, while Sister Maria Celeste was entrusted with the bandaging.
“How long until she wakes?” the doctor demanded.
“I can’t say for certain, but it shouldn’t be much longer now,” Nora said, wishing she could give a more precise answer. Vagueness seemed better than being wrong, however, so she held her tongue when the doctor’s lips compressed with irritation.
Quietly, Nora busied herself wiping instruments and washing out sponges between checks. The patient’s pupils were reacting normally, and she stirred now when Nora pricked her finger.
“A minute or two longer, no more,” Nora hazarded.
The doctor nodded and continued firing instructions to Sister Maria Celeste. “She’s to have fluids only. Broth, milk, barley water, but as much of them as she can stand. And keep a close eye on the dressing.”
The patient groaned.
“Everything is fine. You are well, and so is your baby,” Nora said, bending close. Her words were thick and clumsy, because she hadn’t expected to say them, and the relief of it seized her while she spoke. “Be still. You must rest.”
The eyes fluttered open, searching the room blindly. A clammy hand fumbled for Nora’s wrist, then closed around it with startling, but rapidly fading strength. Panic.
“Hush,” Nora murmured, cutting off a terrified babble in an incomprehensible dialect of Italian. Seeing the doctor frowning beside her, she added, “Sometimes they are confused when waking.”
