NOT FOR POLLING - The story is way over the word limit.
After thirty plus years in perioperative nursing, I couldn’t pass up this prompt.
This story takes place in my “Terms” universe. Although, It can be read as a standalone with no problem.
A Delicate Operation
Cough, cough, cough. The man on horseback reigned in his black stallion and sat still in the saddle, catching his breath. He was on the last leg of his two-week trip from checking in on the Heyes and Curry Agency’s security accounts in the area between Victor and Cripple Creek and Denver. He was pleased to find out that almost all the security measures Heyes and he had put in place for the various accounts were still effective. Only a few tweaks to routes and procedures were needed as the clients had expressed their satisfaction with the Agency’s services. Despite the positive report he was bringing back, Kid Curry felt awful.
He had left Will-O-Wisp early in the morning, intending to push through the forty or so miles to Denver to be home in one day. However, what he thought was just a cold four days ago seemed to be developing into something more. His throat was terribly sore, a headache was pounding away, and he was feeling chilled, despite the warm weather. Taking a drink from the canteen proved to be a mixed endeavor, his thirst was satisfied but it hurt like the dickens to swallow. A sudden wave of intense fatigue swept over Kid and that clinched his decision to look for an appropriate campsite as he didn’t think he would even make the next town. The comforts of home and family would have to wait until the next day.
Finally reaching the Denver area was an exercise in endurance. Kid had ridden many times when all he wanted to do was rest and lie down but this last leg of this trip ranked right up there with the most difficult. The beginnings of the cold he left Cripple Creek with had intensified into real illness with each passing day and mile. It was getting late in the day and Curry had originally planned to stop by the office before heading home but instead went straight to the sprawling horse ranch outside Denver.
Erin Curry was just coming down the stairs with two-year old Michael clinging like a limpet to her hip and clutching a slightly tatty stuffed pinto horse. She gave a look of admonishment over her shoulder at the thump, thump she heard behind her. Sean, who was almost four, was caught in the act of hopping down the polished wood stairs, and flashed his mother a big blue-eyed look of innocence he inherited from his father along with Jed’s looks. Erin smiled inwardly to herself at the attempt in the face of blatant disobedience. Erin continued down the stairs on her way to the kitchen to see if the Moira, the family housekeeper, needed help with dinner when she looked towards the front door, Jed should have been home by now.
“Jed, are you alright?” gasped Erin as her eyes widened in alarm even as she saw her husband was plainly not alright. She lowered Michael to the floor in haste and started for the front door. The two curly, tow-headed boys took off in a rush to greet their Dad.
Jedediah Curry stood shakily in the front doorway, clutching the door jam in a desperate attempt to hold himself steady. Dark blond ringlets clung to his sweaty forehead; his glassy blue eyes swept the center hall as if he were searching for something. His chest rose and fell rapidly as a fit of barking coughs erupted before he managed a hoarse whisper that left him breathless, “Erin…you and the kids… keep away...I’m sick” while his left hand came up palm outward in the universal stop gesture.
Erin managed reached out and grabbed the back of the boys’ shirts right before they could launch themselves at their father, certain he would catch them. Erin crouched down and drew them back close to her, murmuring, “Not now, Daddy’s not feeling well.” She kept her hazel-green eyes on Jed and her worry increased. “Moira! Moira, can you come to here!” Erin yelled loudly in order to be heard in the kitchen. Both boys’ eyes grew wide.
“Mommy yelled in the house.” Sean decided to tell his father just in case he didn’t realize the misbehavior. Michael plopped down on the floor, staring at his Dad, and pulling Finley, the family fat orange-striped tabby into his lap for a group hug with the beloved stuffed pinto pony.
Kid staggered a few steps into the house and sank onto the bench set against the foyer wall, opposite the large coat closet. His back was stiff and he leaned forward with his straight arms planted on his knees, supporting his weight. He concentrated on drawing breaths in between the bouts of barking coughs. His throat seemed on fire and it was starting to take work to breathe.
Moira, Sarah, the eldest of Jed’s two stepdaughters, with Carrie and Charlie, the Curry spaniels, came hurrying into the center hall. Moira took one look and yelled even louder than her mistress, “Rachel, before you come here go get Mr. Dunne, quickly now! Tell him your father needs him.” The housekeeper was a little breathless herself in her haste to get to the center hall of the large ranch house. “What do you need me to do, Mum,” she asked Erin Curry while she was wringing the bottom of her apron in her hands.
“Shoo, you mangy mutts, shoo!” Moira tried to herd the female English Springer spaniel and male Brittany away from her employer. They were dancing around the sick man, vying for his attention.
Erin turned towards Sarah, “Lovey, please go ‘round to the stable yard and tell someone we need the ranch foreman or his assistant, you know, Mr. Wheat or Mr. Kyle in the house right now.” She then aimed her attention to Moira Dunne. “When the men get here, one can go for the doctor while the other can help me get Jed into the kitchen. He sounds like he may have the croup. Remember, how Sean sounded with that harsh cough, when he was two. Doesn’t he sound like that? Can you start some water to boil? Breathing in the steam helped.”
“Erin…” panted Kid. “Please…the children…I’m scarin’...them.” his gaze was centered on the two small boys. Michael looked like he was trying to squeeze the stuffing out of his pony and poor Finley was squirming in discomfort but tolerating the tight hold within one chubby arm while the other hand had a firm grasp on his mother’s hem. Sean was staring with wide eyes, his good-natured excitement at his father’s return had morphed into uncertainty. He was rocking back and forth on his heels while half hiding behind his mother and grabbing onto the back of her dress with both fists.
Both women looked appraisingly at the sick man and neither liked what they saw. Erin tried to stand back up and was almost pulled back down from little hands clutching her skirts. She gently loosened their holds, all the while trying to remain calm.
~~~~~~~~~~~ASJ~~~~~~~~~~~
Hannibal Heyes was alone in his office, finishing up on some paperwork. Everyone had already left the office or was out on assignment. He checked his watch and decided to call it a day. Heyes was anxious to hear how his partner’s business trip went. According to the Kid’s last telegram he expected him to arrive in the office yesterday or early afternoon at the latest. Maybe he went straight home, after all he was bound to have missed his family, and especially since his wife was about five months pregnant with what the doctor thought may be twins.
Heyes owned a townhouse in Denver but also had a suite of rooms at the Curry ranch and he divided his time between the two locations. When the Kid was away and Heyes still in Denver, he made a point of staying at the ranch. Not that he really needed to, Connor Dunne, the general handyman and caretaker, was a competent and genial man. Wheat Carlson and Kyle Murtrey, after finally petitioning for amnesty and having it granted in only one year, a fact that still greatly annoyed Heyes, had looked up their old gang members. Kid, despite the misgivings expressed by Heyes, had hired them as Foreman and Assistant Foreman on the horse ranch that was expanding from a hobby into a money-making business. The old friends had developed a fondness for the Curry family and could be counted on to be protective if need be.
The senior partner of the Agency gathered his things and made ready to ride out to the ranch. After dinner was his best bet of catching his partner’s undivided attention before tomorrow’s business claimed their time.
~~~~~~~~ASJ~~~~~~~~~
“Bandit, what are you doing wandering round out here?” Heyes exclaimed. Kid’s spirited black stallion was grazing three quarters of the way down the lane leading to the ranch. He gathered the trailing reins of the errant horse and walked his chestnut gelding and Kid’s black around the back and into the family stable yard. He handed them off to one of the ranch hands. At least he knew Kid was home but Heyes couldn’t imagine his partner leaving his horse still tacked up and free to wander around. He hurriedly made his way to the kitchen back entrance and walked into chaos.
Sharp brown eyes took in the situation at a glance. Wheat and Moira were hovering over a hunched figure, head draped in a towel, sitting at the large oak kitchen table. Erin, who was sitting alongside Jed was holding a bowel of steaming water in front of her husband with the ends of the towel draped around the bowel, forming a loose tent. A big pot of water was boiling away on the stove. The family pets were all under the table in a heap with Kid’s youngest son Michael buried among them. Kyle was corralling Sean, Rachel, and Sarah in the Corner, passing them cookies. All three children appeared to be on the verge of tears. Heyes couldn’t help but notice that Sean was stuffing cookies into his mouth as fast as Kyle was passing them out, like father like son; he was not one to let anything get in the way of a good snack. The girls were just holding theirs at their sides. Pervading the scene were the harsh sounds of rapid breathing with even harsher barking coughs interspersed.
“Kid’s under that towel?” Heyes looked directly at Wheat, who nodded affirmatively.
“Oh, Heyes! I’m glad you’re here. Jed came home sick. He’s got a high fever and sounds awful. I thought it might be the croup but the steam doesn’t seem to be helping.” Kid’s wife rushed to explain. Erin put the bowel down and pushed a few limp light auburn hairs behind her ears that had come undone from her chignon. Her shapely brows drew down and her forehead furrowed as she glanced towards her husband.
Kid tried to sit up straight but after a moment resumed his forward leaning position. The towel slipped from over his sweaty and damp head to rest around his heaving shoulders. He panted out, “Heyes…get…Erin and…” and then ran out of breath as another coughing fit started.
“I’m not leaving,” Erin stated firmly as she batted her husband’s hand away when he weaky sought to nudge her up off the chair.
“Did anyone go for the doctor?” Heyes once again turned towards Wheat.
“Yeah, Heyes. Connor Dunne left a while ago. Even before Rachel found me. If the doc was home, they should be here real soon. Me and Kyle got the Kid in here.” Wheat gestured to Heyes to come closer. Heyes stepped over and leaned in. “Kid’s real sick, Heyes. He can hardly breathe and Erin is right, he’s burning up.”
“Thanks Wheat. Kyle, take the children into the parlor, or the play room or anywhere but here and keep them occupied.”
Kyle nodded at his orders and gently took the girls’ hands to shepherd them out with Sean in front.
“Kyle! You’re forgetting one.” Heyes pointed under the table.
The diminutive assistant foreman bent down and reached in amid the two dogs and one cat to gently pull the toddler out from his hiding place. That set the dogs barking in protest as well as causing Michael to howl. Kyle spied the stuffed pony lying under the cat and retrieved the comfort item. The little boy removed his fist from his mouth to grab the toy, hiccupped and let Kyle pick him up to join his brother and sisters.
The children and Kyle were just out of sight when Rachel paused, looking back to the kitchen doorway, her lower lip trembling and dark brown eyes filling with tears.
“Sarah, Is Daddy going to heaven like papa did?”
Kyle squatted down and gathered all four children into his arms as best he could. He looked his friend’s sable-haired stepdaughters, ten-year-old Sarah and eight-year-old Rachel, as well as the two blond, blue-eyed boys right into their eyes in turn. With his voice solemn and as confident as true belief could make it, he answered Rachel’s question, “No, your Dad is real sick but he’s staying right here. I’ve known the Kid, I mean your Dad for a lotta years. I’ve seen him pretty sick before back at the Hole and he always fights mighty hard to get better. With your mom’s, Uncle Heyes’, the Doc’s and everyone else’s help and his plain ol’ stubbornness, your Dad will get through this. You’ll see.”
The little group huddled on the floor looked up at the heavy tread of fast-moving footsteps that could be heard coming their way.
Connor Dunne had brought the doctor.
~~~~~~~~~~~ASJ~~~~~~~~~~~
Doctor Richard Bartlett could hear his patient before he even entered the room. The sound of an upper respiratory obstruction was distinctive and he knew what the chief problems was, if not the cause, before he set his large black bag down on the table in front of his patient.
“Hello, Jed.” The doctor, who was in his late thirties, greeted his patient as he opened his bag and started to take a selection of needed items out and placed them on the table. His intelligent eyes noted the flushed cheeks, damp with sweat skin, the heaving shoulders, swollen neck, rapid movement of the man’s chest, and the typical respiratory distress tripod posture at a glance. There was no time to waste with small talk and social niceties.
“Mrs. Curry, can you get his shirt off for me? I need to listen to his chest.” He was already fitting the ear pieces of the stethoscope into place.
After a careful listen to the front and back of the chest along with the heart sounds as well as palpating the swollen neck, feeling the enlarged lymph nodes, the doctor put down his stethoscope and donned a headband with a concave large, highly polished mirror at the front. He looked towards Moira, the housekeeper. “Do you have a bright lamp? I need to look down his throat.” Moira hurried off to find an acceptable oil lamp. Wheat and Connor Dunne backed off along the side of the room to stay out of the way. Heyes had his arm around his best friend’s wife’s trembling shoulders.
“Alright, I know this will be uncomfortable but I need to look down your throat. Jed, open your mouth as wide as you can, I’m going to press down on your tongue with the wooden depressor. I promise I’ll be as quick as I can.”
Kid heaved as deep a breath as he could without coughing and opened his mouth. He flushed even redder as a bit of saliva dribbled down his chin. He could barely swallow. Erin leaned forward to dab the spit and withdrew so the doctor could look.
Doc Bartlett sighed as he put the lamp down on the table. He saw what he expected to see and it was not good news. He laid a hand on his patient’s shoulder and gave a small squeeze of encouragement.
“Okay, Jed has a very serious case of diphtheria. It’s a good thing that you came and got me when you did. Diphtheria is an infection of the upper respiratory tract, that is the back of the nose, mouth, throat and affecting the lymph nodes in his neck. It’s contagious and after we take care of Jed, I’ll need to explain what else must be done. For now, you can see that his neck is swollen from the infection. I can tell that the infection is caused by the diphtheria bacteria or germ as there is the characteristic gray pseudomembrane covering his tonsils and coating the back of the throat. Between the swollen lymph nodes, the membrane, and swollen tissues of his tonsils and throat, his upper airway is being slowly closed off.” The doctor paused in his explanation but he didn’t have much time to explain everything before action would need to be taken. As he was talking, he was searching his bag for the little used canvas roll of instruments that would be needed today.
Heyes spoke up first. “Doc, how bad is it going to get and what can we do about it.”
The doctor looked around at the very concerned faces surrounding him and delivered his recommendation. He held out the canvas roll of medical instruments. “Mrs. Dunne, please take everything out of this roll and put it in the pot of boiling water you have on the stove.” He directed his next words towards Erin and Heyes. “Jed, is struggling to get air past the obstruction the swelling is causing in his throat. You can see it is taking a lot of work to breath. See how his muscles between the ribs and the shoulder and neck muscles are moving with his breathing. That means Jed is using accessory muscles or muscles not normally used to help him pull air in and expel it out. It’s very tiring to breathe this way as it takes a lot of energy. He will not be able to keep up the tremendous effort to breathe and he’ll tire, won’t get enough air and eventually suffocate.” He reached down and grabbed one of Jed’s hands to hold out for Erin Curry and Heyes to examine. “See, he’s not getting enough air now, his nail beds are blue, and if you look closely his lips are blueish, too.”
Heyes and Erin looked at each other, so far, they could see everything the doctor was pointing out and their anxiety was increasing. Erin was searching the doctor’s face for some sort of reassurance her husband would be alright. Although Kid had not said a word since the doctor arrived, Heyes knew when he locked eyes with his struggling partner that he had heard and followed every word.
Dr. Bartlett took a deep breath in readiness to explain his plan for treatment. This was the part that spooked the patient and the family. It was sometimes difficult to get family members to agree to the delicate operation that was necessary to save a life. “There are things that we can do to reduce the swelling but they are limited in effectiveness. Currently, time for the disease to run its course is really the only cure. I’ve read in my journals that a company in Philadelphia is doing research on a diphtheria antitoxin made from horse serum that’s promising but it’s not ready for market yet, so we must wait. Unfortunately, with such a severe case as Jed’s we can’t afford to wait without a surgical intervention.” His eyes went around the room to gauge how his patient’s friends and family were following his explanation. The Doc was satisfied with what he saw. Erin Curry was visibly upset but maintaining control over her emotions and dividing her attention between her husband and him. Heyes was very focused and his intense dark eyes and set jaw gave evidence to his attention and grasp of the seriousness of the situation. The ranch foreman and caretaker both looked concerned but trying not to show how much. Moira Dunne had her back to him and was busy watching the instruments in the boiling water.
Kid reached out shakily and tapped Heyes’ thigh. With great difficulty he rasped out, “Avoided…hanging…don’t…wanna…die…like…this…now. Gotta…do…somethin’.” His eyelids fluttered and his body swayed in his seat. Heyes grasped his best friend’s hand and squeezed it tightly before surrendering it to Erin.
“You heard the man, Doc. What do you have to do?”
“Jed needs a tracheostomy. That is, I have to cut a small opening in his neck below the voice box into his windpipe and insert a curved metal tube into the opening so that he can breathe. His lungs sound fine. The metal tube will stay in until the swelling in his throat and neck goes down enough to breath normally, then I’ll take the tube out and the hole will close naturally. While the tube is in place, Jed will not be able to talk since it will be below the voice box, However, he will be able to drink and eventually eat soft foods with it in.” The doctor checked his watch to see how long the instruments had been sterilizing.
Erin gasped and she stepped closer to Jed, instinctually seeking comfort, before she realized she should be comforting him. The situation must be dire if such a drastic operation must be done. Her back stiffened, and the tears dried up as she willed herself back to calmness. She met Heyes’ brown eyes and drew strength from the concerned determination she saw there. She was not going to lose a second husband to illness. Erin was going to have done whatever was necessary to hold on to the love she didn’t know was possible until she met Jedediah Curry.
“I’m going to need a clean towel and a serving tray to lay the instruments on, another towel rolled up to shove under Jed’s shoulders to extend his neck for better exposure, and I’ll need the men to help hold him down once we get him positioned. We can use this table right here. It’s big enough for him to lie on and the firm surface is better than a soft bed.” The doctor looked apologetically at his patient and his family. “I can only use a tiny bit of Chloroform as I need Jed to be consciousness and actively working to breath as long as possible. When we lay him down, he won’t be able draw enough air in and will probably become agitated and try to fight us before he finally passes out. I’ll go as fast as I can but it’s important to hold his head and neck still. You think you can do that Heyes? Oh, and I might need you, Heyes, to hold a retractor for me. Mr. Dunne and your foreman can hold his legs down. Mrs. Dunne can hold the lamp for me.”
“What do you need me to do, Dr. Bartlett?” Erin noticed she was the only one not assigned a task.
Kid’s hot and sweaty hand slipped from his wife’s grasp to rest briefly on her softly swelling abdomen before planting once again on his knee, supporting his weight as he leaned forward. He wondered if he would ever know his growing blessing.
Heyes bent down to his partner’s level at the weak bat at his thigh to listen hard at the faint raspy whisper, “Erin…no…watch…children…take care…if…die.” He whispered back fiercely, “Kid, listen to me. You are not going to die. We didn’t make it this far for it to end this way. But I’ll make sure she isn’t in the room during the operation.” His attention was yanked back to the doctor as he was finished making his preliminary preparations.
Doc Bartlett reached to take Erin Curry’s hand between his and gave a little pat to the top. “Mrs. Curry, perhaps it would be best if you wait with in another room. You can determine where we can settle your husband after the surgery. He will need to be propped up in a reclining or almost sitting position to breathe easier. A window to let in fresh air would be helpful and if you can find somewhere close or on this floor so we don’t have to carry him far or upstairs would be ideal. Can you do that?”
“I don’t want to leave him.” The titian-haired woman worried her lower lip, her brow furrowed and the smattering of freckles across her nose stood out in a face going pale as she glanced between her suffering husband and the pot on the stove containing strange and slightly barbaric instrumentation. She reluctantly admitted her decision, “Yes, I can do that. I don’t want to cause Jed any more anxiety than he has already and I know he’s trying to protect me. I…I think…I think the chaise in the library will do. I’ll check. But first I should see how the children are doing. They have never seen their father sick with anything other than a cold. And the girls’ father passed away after a sudden illness, I need to reassure them that Jed will not do the same. He will get better?” Erin cringed as she heard her own voice go quickly from confident to pleading.
Wheat escorted his friend’s wife to join Kyle and the Curry children in the upstairs playroom to wait for the outcome. He promised to come get Erin as soon as the procedure was finished before he hurried back to the kitchen. It wouldn’t be the first time he had to hold Kid down but somehow removing bullets seemed a lot less scary than cutting a hole in someone’s neck even if it was a doctor doing it. He involuntarily shuddered at the thought.
All was set. While the doctor and Heyes thoroughly washed their hands, Moira wiped her employer’s neck with a gauze pad saturated from the small bottle of isopropyl alcohol the doctor had in his bag. The boiled sterilized instruments and metal tracheostomy tube, a stack of gauze pads, suture material, and needles were laid on a clean towel set upon a tray.
The men lifted Kid onto the table and sat him upright, supported by his partner’s strong arms. They could all see that the Kid was getting tired. He was blinking slowly and his eyelids were at half-mast. The rapid breathing was slowing and getting very shallow. The towel roll was in position towards the end of the table and Wheat and Connor Dunne were stationed at Kid’s legs. Moira had a lamp, burning brightly, in her hand ready to shine light where the doctor was working. Doc Bartlett felt the fast, irregular pulse at his patient’s wrist and frowned.
“Okay, is everyone ready and knows what they are supposed to do? We have to do this as fast as we can,” asked the doc while looking at each of his helpers in turn.
“Wait, Doc. Not for nothin’ but how many of these operations have you done?” Wheat wanted to know if he was going to have to watch his employer and longtime friend pass away.
Heyes straighten up and his brown eyes shot daggers at the man. “Wheat! What kind of question is that to ask now?” He spat out.
“No, it’s a legitimate question. This operation is not one that I have had to do very often since I moved out west. However, when I was in medical school and training in Baltimore, I had to perform it many times. Don’t worry, I do know what I am doing.”
Curry’s eyes shot open in panic and he managed to grab a fistful of Heyes’ sleeve. The older cousin whispered soothingly into the younger’s ear, “Doc Bartlett isn’t the fake doc, Kid. Remember, before you let him tend to Erin we investigated. He’s a legitimate doctor who went to one medical school, the University of Maryland. It’s a good school.”
A slight upturn of Heyes’ thinned lips acknowledged the doctor’s raised eyebrows and questioning look as the doc passed a gauze sponge with a few drops of chloroform on it under the patient’s nose and then his mouth. “Don’t take offense, Doc. We had our reasons and it’s a long story, which we’ll tell you sometime. Now, let’s get on with it.”
“Quite right. Lay him down slowly with the rolled towel under his shoulders so his head is tilted back. It’s okay if the top of his head is hanging slightly off the table. The most important thing is to stretch the neck out. Moira, shine the light over my left shoulder so there are less shadows.”
The helpers rushed to comply with the directions. As soon as the patient was lying down, it was evident that it was becoming impossible for him to breath. Kid’s legs started to kick and his arms came up in an attempt to get his elbows under him to push up from the table while he was trying to toss his head side to side in a desperate effort to draw breath. The men exerted pressure to keep him still but the effort wasn’t needed for long as Curry rapidly tired, his eyes closed, and his body became still. By the time the helpers fearfully looked up they realized the doctor had already made his incision and had a variety of small metal instruments clamped onto what they couldn’t see and wouldn’t know what the structures were even if they could.
“Heyes, hold this. Keep it where I have it.” Doc Bartlett had placed a metal instrument with a hook at one end in the operative field and gave it a small jerk to indicate that Heyes should grab the straight end. “Here, hold this second one in your other hand.”
Hannibal Heyes was repulsed by the idea that Kid had his throat cut and his best friend would have to breathe through a hole in the neck with a metal tube in it. But the intellectually curious side of the ex-outlaw was also fascinated with the procedure. Heyes, since he was standing at the top of Kid’s head with the doctor at the side of the neck, had a great view of the operation and he found himself watching closely.
Wheat, surprisingly, shared the impulse to look and watched as best he could from where he was since Kid wasn’t moving. Connor Dunne, however, was keeping his hands on his employer’s legs but had twisted to look away and struggled to hold his stomach contents in place. Moira had turned white while holding the lamp and but managed to keep it steady.
In a few moments the doctor was carefully inserting the metal curved tube into the tracheal opening that he made. The helpers startled when the patient’s chest heaved. One breath was followed by another deep breath and another before the breathing settled down into a regular rhythm. The doctor pressed firmly into the side of the swollen neck with two bloody fingers, feeling for the carotid pulse.
“He’s doing fine. Hold him just a little bit longer while I finish up in case he starts to come around now that his breathing is unencumbered.” The doctor started to anchor the side flanges of the metal tracheostomy tube to the neck with strong sutures to prevent the tube from becoming dislodged. Everyone took a deep breath of their own in thankfulness.
~~~~~~~~~~~ASJ~~~~~~~~~~
A cleaned up Jedediah Curry was sleeping peacefully on the large comfortable chaise in the first floor library, which Kid and Heyes also used as an office when they were at the ranch. He was exhausted from his ordeal and once he was moved and settled Kid had fallen into a deep slumber quickly. Erin Curry sat by her husband’s side, watching his chest rise and fall in an easy rhythm. It was a little disconcerting to see the small metal tube sticking out of Jed’s neck, but she would gladly get used to the sight for the time it was needed to keep him alive and with her and the children. The four children were standing lined up in the doorway asking tentative questions that their mother answered as best she could. Kyle, with a big smile on his face now that he knew Kid would survive, made sure the Kid’s kids did not enter the room per the doctor’s instructions. He gently prodded them away from the door when a cleaned up Heyes, Wheat, and the doctor came to his side.
“Thanks, Kyle. You’ve been a big help.” Heyes murmured to his former gang’s ex-explosive man as the little group passed by him and entered the library to stand looking down at the peaceful patient.
Doc Bartlett crossed over the large curved window seat set into the corner of the room. He pushed the curtains all the way to the sides and opened several of the windows in the turreted structure. A warm gentle breeze wafted in. He turned to the anxious group.
“The immediate crisis is over but Jed is not out of the woods yet. I’ll stay the night and a good portion of tomorrow to show one or two of you how to care for him and make sure everything is going well.”
Someone heaved a grateful sigh and Heyes would later swear it was Wheat.
“Now, while Moira is re-boiling the instruments before I can pack them away, I have more bad news.” The doctor pulled a chair around from in front of the desk and sat wearily. He wiped his brow with a handkerchief retrieved from a pocket. An emergency tracheostomy was always a delicate operation and stressful for both the patient and himself.
Heyes started pacing the length of the room with nervous energy that needed an outlet. Erin Curry squeezed her husband’s limp hand tighter as everyone directed their attention to the physician.
“Diphtheria is contagious. Everyone who has been exposed, that is the Dunnes, Heyes, your foreman and his assistant, as well as you, Mrs. Curry and the children will have to be quarantined for at least two weeks, possibly a little longer. That means everyone will need to stay away from others and remain at the ranch. It is best to limit the people in contact with our patient, and if someone does have contact with Jed or anything used by him such as glasses, dishes, and personal items will need to wash their hands immediately afterwards. Don’t worry, I’ll teach one or two of you how to mange his care. The rest will need to stay out of this room unless it is absolutely necessary to enter. You’ll need to keep the door closed most of the time, the windows open to circulate fresh air and the curtains open to let in the natural light.”
The Doc looked directly at his patient’s pregnant wife and delivered his recommendation that he knew she wouldn’t like but hoped she would see reason. “Mrs. Curry, because you are in the family way…”
Heyes chuckled to himself, despite the situation. Since the Kid had married Erin there wasn’t much time that she wasn’t in the family way. Jed Curry was certainly making up for lost time in having a family. He pushed the inappropriate thought back into the recesses of his mind and once more focused on what the physician was saying.
“…I’m recommending that you are not one of those tending to Jed. Instead you should focus on keeping yourself and your children, including the little ones yet to be born, as healthy as they can be.”
Erin dropped Jed’s hand as she stood up to protest. The man who was for all intents and purposes her brother-in-law quickly strode to her side and took her into his arms. He tilted her head up so he could look straight into her eyes and delivered a solemn promise.
“Erin, you know the doc is right. Kid wouldn’t want you to bear what he just went through. I promise I’ll take good care of him. It’s second nature for me, I’ve been doing it almost all my life as he has done for me.”
There was an abrupt clearing of a throat. “I’ll help take care of him, too.”
Heyes whipped his head around to stare with incredulity at Wheat.
The gruff man looked affronted. “What? I’ve done it before, when Kid’s been shot. I’ve helped with you too, Heyes, a time or two.”
Heyes’ expression softened slowly to one acknowledging the truth, Wheat Carlson had helped take care of both of the ex-leaders of the Devil’s Hole Gang at various times and had done a good job of it, at that. Despite the often contentiousness of their relationship, Heyes wouldn’t deny that Wheat, and also Kyle, for that matter, were loyal and hidden under their rough exterior was a man capable of compassion. Just don’t ever, tell them that though. Heyes and the Kid had earned their loyalty many times over the years not the least by taking a chance and employing them at the ranch as well as using Wheat and Kyle occasionally when the Agency needed their unique talents and ability to blend in.
“Thank you, Wheat, I know Jed will much appreciate you volunteering to help Heyes and will tell you so when he can talk again.” Erin leaned up to lightly kiss Heyes on the cheek, and whispered into his ear, “I don’t know what we would do without you, thank you from the bottom of my heart for doing what I want to do but shouldn’t.” She wiggled out of her husband’s partner’s arms and with tears once more beginning in her eyes rushed over to Wheat to give him a peck on his stubbled cheek.
Wheat blushed beet red as he quickly looked down, hiding his face.
Knock, knock. “Excuse me, I’ve got the doctors things, all boiled clean and dried, wrapped up in his canvas roll, Mum. I’ll put in on the foyer table with his bag. No one had any dinner, I can put together a tray of sandwiches with some cookies, and coffee and bring it to you. Would that be good?”
Erin looked over her shoulder at the others. “Forgive me for forgetting.” She turned back to the cook and housekeeper, “I couldn’t eat a thing but a small light supper would not be remiss. Thank you.”
“Well, now that we’ve got that decided, why don’t we all sit down, and I’ll go over some simple care instructions. I’ll leave detailed written instructions before I leave tomorrow and after that I’ll come by often to check up on Jed and the rest of the household who was exposed.”
As Jedediah Curry slept the others sat around the desk, learned what could be expected, how they should manage the challenges, and planned for his recovery and to mitigate the risks to the household.
EpilogueEight days after surgery, the tracheostomy tube was removed from Jed Curry’s neck. Five weeks to the day he was firmly on his way to a complete recovery when he sat down to his first large meal of regular food. He was ravenous after over a month of nothing but liquids then very soft foods. The Kid was left with a small scar in the hollow of his neck that added to existing collection of scar, which told one kind of story of the man’s life.
Everyone who was exposed to the contagion of diphtheria managed to avoid contracting the disease with the exception of one.
Wheat Carlson came down with a very mild case of diphtheria and was competently taken care of by Hannibal Heyes to the disgust of both men. Wheat recovered quickly and was back to his old self before Kid was eating solid food.
The ranch and ranch hands survived Kyle Murtrey’s time as ranch foreman, while Wheat was laid up. It was determined that Kyle who spent minimal time with Kid Curry could escape quarantine after seven days with no symptoms.
Hannibal Heyes left the ranch outside Denver and retreated to his town house for much needed rest and solitude as soon as Kid was firmly on the road to recovery and the quarantine period was lifted by Doctor Bartlett. Heyes had taken care of Kid and then Wheat as well as dealing with Agency business that was dropped off at the ranch at regular intervals with his characteristic high level of competence.
Fourteen weeks after the surgery, Erin Curry delivered small but healthy twin baby girls. They were named Elizabeth and Bridget after Jedediah’s and Hannibal’s mothers.
Notes:Upon reading this prompt, I knew I would have to do a story regarding an operation in the medical sense. Tracheostomy came to mind as that particular surgery has been around since ancient times. Early in the COVID pandemic before the medical community learned how to best treat the disease many patients were maintained on ventilators, always a double-edged sword, for a long time. The OR was doing so many tracheostomies it seemed like the ENTs were having a two-for-one sale on them. Now I just had to find the right disease for an adult that would necessitate the surgery as I didn’t want to go the near hanging route.
Diphtheria -Diphtheria is an infection caused by the bacterium Corynebacterium diphtheriae. Signs and symptoms may vary from mild to severe. Symptoms of diphtheria include fever of 38 °C (100.4 °F) or above; chills; fatigue; bluish skin coloration (cyanosis); sore throat; hoarseness; cough; headache; difficulty swallowing; painful swallowing; difficulty breathing; rapid breathing; foul-smelling and bloodstained nasal discharge; and lymphadenopathy. They usually start two to five days after exposure. Symptoms often come on fairly gradually, beginning with a sore throat and fever. The neck may swell in part due to enlarged lymph nodes. The most notable feature of diphtheria infection, however, is the formation of a thick gray substance called a pseudomembrane over the nasal tissues, tonsils, larynx, and/or pharynx. This can block the airway and create a barking cough as in croup.
The disease may remain manageable, but in more severe cases, lymph nodes in the neck may swell, and breathing and swallowing are more difficult. People in this stage should seek immediate medical attention, as obstruction in the throat may require intubation or a tracheotomy. An infected person, unless treated with antibiotics, is infectious for two to three weeks.
In 1883, Edwin Klebs identified the bacterium causing diphtheria and named it Klebs-Loeffler bacterium. The club shape of this bacterium helped Edwin to differentiate it from other bacteria. Over the period of time, it was called Microsporon diphtheriticum, Bacillus diphtheriae, and Mycobacterium diphtheriae. Current nomenclature is Corynebacterium diphtheriae. In 1895, H. K. Mulford Company of Philadelphia started production and testing of diphtheria antitoxin in the United States. Park and Biggs described the method for producing serum from horses for use in diphtheria treatment.
The current U.S. childhood immunization schedule for diphtheria includes five diphtheria toxoid immunizations before age six years, plus one booster dose for adolescents. (A toxoid is a toxin modified to invoke an antibody response, but not capable of causing disease.) All diphtheria immunizations for children are given in a single injection combined with tetanus toxoid and pertussis vaccine (known as DTP or DTaP). Adults receive diphtheria toxoid in combination with a tetanus toxoid booster, which is recommended every ten years. The adult product can protect against tetanus and diphtheria (a vaccine known as Td) or all three diseases (a vaccine known as Tdap).
https://www.historyofvaccines.org/timeline/diphtheriaTracheostomy - Tracheostomy is a life saving procedure done to establish airway in-patients with upper respiratory tract obstruction. It requires an opening to be made in anterior wall of trachea and a tube is inserted through the opening to allow passage of air and removal of secretions. Instead of breathing through the nose and mouth, the patient now breathes through the tracheostomy tube. If we look into history, the tracheotomy is one of the oldest surgical procedures, which was dreaded with complications until 19th century when procedure was understood clearly and indications properly defined. The etymology of the word tracheotomy comes from two Greek words: the root tom- (from Greek τομή tomḗ) meaning "to cut", and the word trachea (from Greek τραχεία tracheía).The word tracheostomy, including the root stom- (from Greek στόμα stóma) meaning "mouth," refers to the making of a semi-permanent or permanent opening, and to the opening itself.
By the late 19th century, some surgeons had become proficient in performing the tracheotomy procedure. The main instruments used were:
"Two small scalpels, one short grooved director, a tenaculum, two aneurysm needles which may be used as retractors, one pair of artery forceps, haemostatic forceps, two pairs of dissecting forceps, a pair of scissors, a sharp-pointed tenotome, a pair of tracheal forceps, a tracheal dilator, tracheotomy tubes, ligatures, sponges, a flexible catheter, and feathers".
Haemostatic forceps were used to control bleeding from separated vessels that were not ligatured because of the urgency of the operation. Generally, they were used to expose the trachea by clamping the isthmus thyroid gland on both sides. To open the trachea physically, a sharp-pointed tentome allowed the surgeon easily to place the ends into the opening of the trachea. The thin points permitted the doctor a better view of his incision. Tracheal dilators, such as the "Golding Bird", were placed through the opening and then expanded by "turning the screw to which they are attached". The optimum tracheal tube at the time caused very little damage to the trachea and "mucus membrane"
In the 1820s, the tracheotomy began to be recognized as a legitimate means of treating severe airway obstruction. In 1832, French physician Pierre Bretonneau employed it as a last resort to treat a case of diphtheria. In 1880 Morell Mackenzie's book discussed the symptoms indicating a tracheotomy and when the operation is absolutely necessary.
http://ispub.com/IJORL/4/2/7498https://en.wikipedia.org/wiki/TracheotomyAlcohol has been used as an antiseptic as early as 1363, with evidence to support its use becoming available in the late 1800s. It is on the World Health Organization's List of Essential Medicines. Commercial formulations of alcohol-based hand rub or with other agents such as chlorhexidine are available. At concentrations greater than 60 percent, alcohol effectively kills germs on the skin and household surfaces. Microbes including bacteria, viruses, and fungi are susceptible to alcohol's germicidal effects.
A 70% concentration of ethanol or isopropyl alcohol has been demonstrated to be the most effective. Water acts as a catalyst and plays a key role in denaturing the proteins of vegetative cell membranes. The water content slows evaporation, therefore increasing surface contact time and enhancing effectiveness. At concentrations higher than 80-85% the effectiveness of alcohol as a disinfectant decreases.
The Johns Hopkins University School of Medicine (JHUSOM), located in Baltimore, Maryland, is the research-intensive medical school of Johns Hopkins University. Founded in 1893, the School of Medicine shares a campus with the Johns Hopkins Hospital and Johns Hopkins Children's Center, established in 1889. Johns Hopkins has consistently ranked among the top medical schools in the United States, in terms of the number of research grants awarded by the National Institutes of Health, among other measures.
When I think of medical schools in Baltimore, Johns Hopkins immediately comes to mind, however it was not established in time for this story as the first graduating class would have been 1897.The University of Maryland School of Medicine (abbreviated UMSOM), located in Baltimore City, Maryland, U.S., is the medical school of the University of Maryland, Baltimore and is affiliated with the University of Maryland Medical Center and Medical System. Established in 1807 as the College of Medicine of Maryland, it is the first public and the fifth oldest medical school in the United States. It was also the first medical school to institute a residency training program. UMB SOM's campus includes Davidge Hall, which was built in 1812, and is the oldest building in continuous use for medical education in the Northern Hemisphere.
Sat May 01, 2021 5:06 am
(I am healing up nicely thank you.)
"My task, which I am trying to achieve is, by the power of the written word, to make you hear, to make you feel -- it is, before all, to make you see..." ~~ Joseph Conrad ~~ 