Engineering by SurgicalSteel

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Story Notes:

Warning for medically graphic material.


“Master Talagan, are you up there?”

The Chief Surgeon of the Houses of Healing sighed. He should have known that someone would have remembered his propensity to climb up onto the roof when he wanted a few minutes alone. He honestly didn’t begrudge anyone his services usually – but damnitall, he was supposed to have been in Lamedon for his sister’s wedding, and then damned Dol Amroth had to be slammed with Ossë’s wrath, and here he was still, dealing with the injured evacuees as they arrived. Damn them.

Some small still part of him insisted that it wasn’t as if any of these poor folk had intended to be storm victims, far less had they done it to spoil his plans. The part of him that had decided to seek refuge on the roof was wondering if the Hallows would have been a better hiding place.

“Master Talagan?”

Yes, Handir, I’m coming,” he called down to the senior apprentice on duty, and then climbed down the drain-pipe and re-entered his office through the window. “How many more refugees do we have today?” he asked.

“Ten,” Handir said promptly. “Four pregnant women near their time…”

“I’m not a damn midwife,” Talagan snapped.

Handir grinned nervously, but plowed on, “You did ask how many. You’ve berated me more than once for not telling you about all of them, sir. If you’re going to scold me, I’d rather have it be for giving you too much information rather than too little.”

Talagan let out a short bark of laughter at that. “You’ll do, Handir, you’ll do. The remainder?”

“Three with what looks like typhoid, being confined to one of the outer houses under quarantine,” Handir started. “One unresponsive near-drowning…”

Talagan snorted at that. Not that anyone here could do anything miraculous for that – the near-drowning would either recover or he wouldn’t and all they’d be able to do was keep him clean and nourished.

“One head-injury, already post-trephination, low grade fevers, Master Gwainor’s examining the wound.”

“That’s nine. The tenth?” Talagan asked.

“Traumatic foot amputation – nine-year-old girl. I thought…” Handir said began, and then stopped, shrugging. “She’s such a young one, I thought…”

Well, the apprentices were all more nervous of treating the children than they were of treating the adults. That was common enough.

“And her father’s one of the wealthier traders in Dol Amroth, I’m told,” Handir said.

“Who’s her father?” Talagan asked, his curiosity now piqued. Some of those traders brought useful herbs and other products to the Houses, if he actually had one of them in his debt, it could be useful.

“Írimon,” Handir answered.

“Are you sure?” Talagan asked. Damn, Írimon was the one who kept them supplied with coca-leaf and brought them new aloe plants. This could be really useful.

“That’s what the girl said,” Handir said with another shrug. “Should I bring her up so you can look at her foot? From what we’ve seen coming back from Dol Amroth recently…”

Talagan simply waved his hand, indicating that yes, Handir should bring the girl up for examination. From what they’d seen coming back from Dol Amroth recently, it would surprise him a bit if the girl’s foot required revision. And damn, but he hoped the girl’s mother was here or an aunt or someone. Young girls had a disturbing tendency to cry and scream at the worst possible moments.

Handir left the office, reappearing a few minutes later with the girl in his arms. She was all arms and legs and dark hair and grey eyes wide open with – not fear, but curiosity? That was unusual. Before he had a chance to complete that thought, Handir had set the girl down in a chair as gently as possible, and began unwrapping the mass of bandages from her left foot. She only winced once, as Handir tugged a bit of bandage material free from where it stuck to the raw end of what remained of the foot.

Talagan muttered an oath, and the girl’s eyes widened for a moment, but then she giggled.

“Sorry, little one,” Talagan said. “I’m Master Talagan, the chief surgeon – and you are?”

“Serindë,” she said, and then asked, “Is somethin’ wrong with my foot? ‘Side from half of it bein’ gone…”

Something definitely was wrong with that stump. Whoever had done the initial work had simply hacked off the damaged forefoot, leaving jagged, splintered ends of metatarsal bones and tendon ends that looked to Talagan as if they’d been torn rather than cut and muscle that looked as if it had been gnawed through and nowhere nearly enough skin remained to even make an attempt at closing the wound. He’d have to take bone all the way back to the ankle to do a tension free closure, and that would be even harder for this girl to get around on than what she currently had.

An open wound that’ll likely take a couple of months to fully heal, or a less-functional stump that’ll heal in a couple of weeks, Talagan thought.

“Sir?” Serindë asked, and Talagan realized he’d become lost in his own thoughts.

“This will never heal properly as it is,” Talagan said – and was gratified that she didn’t start crying, but still simply looked curious. “At a minimum, the bone ends should be trimmed…”

“Wouldn’t it make wound care easier if you went back to the ankle? The heel pad is still salvageable,” Handir said.

“You want to cut off even more of my foot?” Serindë asked, and now she did look a bit frightened.

“No,” Talagan said, making his decision and a mental note to have words with Handir regarding his manner around children. “Just going to clean up what’s left so that it’ll heal properly. Like pruning a bush,” he said. “Handir, why don’t you take Serindn5; down to one of the examination rooms and give her a bit of poppy and valerian…”

“Do I haveta have the poppy?” Serindë asked. “It makes my head go all swimmy and my tummy upset.”

“It’s going to hurt a bit, so you’ll need the poppy,” Talagan said, and then addressed himself to Handir again. “Get some of the coca-leaf, too, and the plaster, and the cotton batting – I’ll be along directly.” He watched his apprentice carry the girl out of the room, and then began rummaging in the disorganized chest that held his instruments. He wouldn’t need the major amputation set – but the bone-cutting forceps he’d need, and the rasp, scissors for the tendon ends – perhaps he could tack down some of those tendon ends that used to help dorsiflex the foot, stitch those ends to the metatarsal bones, that might give her a bit more upward mobility in the stump.

The Warden would likely tell him he was making too much of an effort – but then the only effort the Warden made with any regularity these days was to make it to meals on time. Lazy article, should be replaced, Talagan thought, but then gathered up his instruments and headed down to the examination rooms. The poor girl’s eyes had gone glassy and her eyelids drooped, but she was making a valiant effort to stay awake, watching every motion he made as he washed his hands in the basin.

“This will sting a bit,” Talagan said, accepting a cloth soaked in coca-leaf tincture from Handir and pressing it to Serindë’s foot.

“Not lyin’,” she slurred.

There was something rather endearing about the way in which this nine-year-old girl was attempting to make jokes about her own injury, and actually trying to watch what Talagan was doing.

Bone ends first, that would help him determine what to do with the tendons and the remaining soft tissue. “This may hurt a bit, too, sweetling,” Talagan said, picking up the bone-cutters. The fifth metatarsal – the one which used to connect to the small toe – that one had the shortest fragment it looked like, so he’d start with that one, grasping the pointed sharp end of splintered bone with forceps and then snapping through with the bone cutters.

He looked up at that point – and Serindë had gotten a sort of oddly set look on her face, her jaw clenched, and that was odd that she wasn’t crying, but Talagan kept working through the other four metatarsal bones, trimming them to an even length. She finally let out a little strangled gasp as he snipped through the last one, but shook her head at him when he looked up – and he somehow knew that she was trying to non-verbally tell him to bloody well get on with it.

So he did, taking the rasp and smoothing the edges of the trimmed bones, and then trimming the tendons with the sharp scissors he usually used for working on cataracts, tacking them down to the periosteum, the outer coating of the bones. Finally, the muscle and skin that had that dark devitalized look was cut away with a scalpel, and a saline-moistened dressing was placed over the revised stump – one which now looked as if someone had cut through the foot with a cleaver rather than as if some animal had chewed through it.

“What’s the plaster for?” Handir asked as Talagan began dipping larger bandage strips into it.

“Splint – to keep her foot in a neutral position. If we don’t do something to maintain a neutral position of the foot, she’ll end up with an equinovarus deformity…”

“Wha’s equin-equino-thingy?” Serindë asked.

Handir began laughing, and Talagan desperately wanted to, but he maintained enough composure to answer the question. “The foot gets pulled downward and inward permanently. You can’t walk like that, so we’ll stop it from happening by splinting your foot in a normal position.”

“Oh,” Serindë said, and her jaw was set again, and she kept swallowing while Talagan padded her leg with the cotton batting, molded the plaster bandages to the back of her leg and underside of her foot stump, and then finally secured the bandages in place. He was about to tell Handir to take her to one of the children’s wards when she asked in a very small voice, “C’n I be sick now?”

That question sent Handir scurrying for a basin, which he unfortunately didn’t get into place in time to save his shoes. Once the girl finished vomiting, Handir put the basin aside, wiped her mouth, and then scooped her back up. “Children’s ward, nothing more than broth and toast tonight, keep the foot elevated, change the bandage twice daily?” he said.

“You’ll do, Handir,” Talagan said. “And see if she wants anything to read once she’s feeling a little less sick – she’s likely to get bored if she’s got nothing to do.”

Well, the wound would likely heal well enough now, although it would definitely take a bit of time. With luck, her father the trader would be grateful – and with a bit more luck, Talagan could translate that gratitude into better prices on certain goods. With a bit of extraordinary luck, if that played out in the hoped for manner, the other senior healers could be persuaded…

One step at a time, Talagan, one step at a time. Getting the Warden to step down is a task for another day.




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