Read Online Thoreau at Devil's Perch by B.B. Oak - Free Book Online Page B

spirit rise above such a belief. I nodded to her, and we got down to it.
    Julia brought me water and a clean cloth to swab the wound site, and, after I cleared out grass, leaf, dirt, clotted blood, and matted hair, I observed the skull fracture more closely. The pericranium was open, and the right back parietal bone stove in. Fragments and spiculae of bone and hair intruded into the cranium, and to determine if the dura mater had been breached I would have to trepan. Before I went ahead with the procedure, I thought best to forewarn Julia.
    â€œI am going to bore a hole right through our patient’s skull so I can lift out those broken pieces of bone and relieve the pressure being exerted on the brain tissue,” I told her. “Unless that is accomplished with dispatch, he will surely die.”
    She did not so much as blink. “Then by all means bore away, doctor. And I will pray he survives it.”
    â€œHe has survived worse,” I said, indicating a deep dent on the other side of his head above the temple. “Such a scar as that indicates he was shot in the head.”
    â€œHow extraordinary.” Julia regarded our patient more closely. “What if he awakens during the surgery?”
    â€œHe is so insensate that it is most unlikely.”
    â€œBut what if he does? ” she insisted. “Will he feel pain?”
    â€œSome,” I allowed. “But less than you would expect. The skull has no nerves.”
    I asked her to shave away the hair around the wound as I laid out my scalpels and tools. She commented that the trephine I would use to bore the skull hole looked much like a corkscrew. I showed her that instead of a screw tip, the trephine had a circular, serrated-edge saw that cut into the bone. This made her shudder only slightly.
    And so we began. With Julia at the ready with clean strips of linen, I picked up a scalpel and without hesitation sliced through the flesh and pericranium right to the bone, bisecting the wound indentation. Our patient’s legs twitched slightly. Two more cuts at right angles to the first made it possible to fold back the flaps of skin surrounding the wound. As instructed, Julia used the linen strips to press down on the flaps and stanch the flow of blood.
    I had never performed such an operation as this before, only observed it being performed in the operating dome of Massachusetts General Hospital when I was a medical student. Yet I proceeded without hesitation or trepidation. I somehow felt in my marrow that I had done all this before in some previous time and place. I realize this makes no sense, but it gave me great confidence nevertheless.
    I placed the bit of the trephine a quarter-inch to the left side of the shattered skull opening and began to saw into the raw, white bone, pulling back the instrument occasionally so that Julia could clear away skull fragments. I proceeded with great caution, for I could not allow the trephine to fully penetrate the bone and thrust into the brain, thus instantly killing my patient. When that became a definite danger, I put the trephine aside and cut away the last of the circular piece of bone with the edge of a serrated scalpel. I asked Julia for a beaker of water and deposited the piece in it to keep it fresh until it was time to put it back in place.
    I was relieved to see that no part of the crushed cranium had broken through the thin membrane of dura mater surrounding the brain like a protective sack. With firm pressure I used the edge of my scalpel to ease out the loose fragments. I then scraped away all the jagged bits of bone to form a clean edge around the wound. As I worked, a bit of sawn bone slipped between the edge of the skull and the dura mater and alas, out of sight.
    Julia had been busy stanching the blood around the wound. I told her to desist for I needed her to perform a more urgent duty. As I pushed down on the dura mater, she must pick out the lost bone fragment with a pair of