ah.thefinaldiagnosis-第55部分

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　For　having　lost　but　once　your　prime；
　You　may　for　ever　tarry。〃
　
　〃I　get　the　point；〃　Denise　said。　She　turned　to　O'Donnell。　〃I　may　tell　you；　Kent；　that　my　children　are　perennially　pressing　me　to　remarry。〃
　〃We　simply　think　it's　the　best　thing　for　you；〃　Philippa　interjected。　She　put　down　the　book。
　〃They　do　it　under　the　guise　of　practicality；〃　Denise　went　on。　〃Actually　they're　both　revoltingly　sentimental。〃　She　turned　to　Philippa。　〃How　would　you　feel　if　I　married　Dr。　O'Donnell？〃
　〃Has　he　asked　you？〃　Philippa's　interest　was　prompt。　Without　waiting　for　an　answer　she　exclaimed；　〃You're　going　to；　of　course。〃
　〃It　will　depend；　dear；〃　Denise　said。　〃There　is；　of　course；　the　trifling　matter　of　a　divorce　to　be　arranged。〃
　〃Oh；　that！　Daddy　was　always　so　unreasonable　about　you　doing　it。　Besides；　why　do　you　have　to　wait？〃　She　faced　O'Donnell。　〃Why　don't　you　just　live　together？　Then　you'd　have　the　evidence　already　arranged　and　Mother　wouldn't　have　to　go　away　to　one　of　those　awful　places　like　Reno。〃
　〃There　are　moments；〃　Denise　said；　〃when　I　have　grave　doubts　about　the　value　of　progressive　education。　That；　I　think；　will　be　all。〃　She　stepped　lightly　to　Philippa。　〃Good　night；　dear。〃
　〃Oh；　Mother！〃　the　girl　said。　〃Sometimes　you're　so　antediluvian。〃
　〃Good　night；　dear。〃　Denise　repeated　it　firmly。
　Philippa　turned　to　O'Donnell。　〃I　guess　I　have　to　go。〃
　He　said；　〃It's　been　a　pleasure；　Philippa。〃
　The　girl　came　to　him。　She　said　artlessly；　〃If　you're　going　to　be　my　stepfather；　I　suppose　it's　all　right　to　kiss　you。〃
　He　answered；　〃Why　don't　we　chance　it？…whichever　way　it　goes。〃
　He　leaned　toward　her　and　she　kissed　him　on　the　lips；　then　stood　back。　There　was　a　slight　smile；　then　she　said；　〃You're　cute。〃　She　warned　Denise；　〃Mother；　whatever　you　do；　don't　lose　this　one。〃
　〃Philippa！〃　This　time　the　note　of　discipline　was　unmistakable。
　Philippa　laughed　and　kissed　her　mother。　Waving　airily；　she　picked　up　her　book　of　poems　and　went　out。
　O'Donnell　leaned　back　against　the　terrace　wall　and　laughed。　At　this　moment　his　bachelorhood　at　Burlington　seemed　incredibly　empty　and　dull；　the　prospect　of　life　with　Denise　in　New　York　more　glowingly　attractive　by　the　second。
　
　Eighteen
　
　The　amputation　of　Vivian's　left　leg　began　at　8：30　A。M。　precisely。　Punctuality　in　the　operating　rooms　was　something　that　Dr。　O'Donnell　had　insisted　on　when　he　first　became　chief　of　surgery　at　Three　Counties；　and　most　surgeons　plied　with　the　rule。
　The　procedure　was　not　plicated；　and　Lucy　Grainger　anticipated　no　problems　other　than　routine。　She　had　already　planned　to　amputate　the　limb　fairly　high；　well　above　the　knee　and　in　the　upper　part　of　the　femur。　At　one　point　she　had　considered　disarticulating　at　the　hip　in　the　belief　that　this　might　give　a　better　chance　of　getting　ahead　of　the　spreading　malignancy　from　the　knee。　But　the　disadvantage　here　would　be　extreme　difficulty　later　on　in　fitting　an　artificial　limb　to　the　inadequate　stump。　That　was　why　she　had　promised　in　planning　to　leave　intact　a　portion　of　the　thigh。
　She　had　also　planned　where　to　cut　her　flaps　so　that　the　flesh　would　cover　the　stump　adequately。　In　fact；　she　had　done　this　last　night；　sketching　out　the　necessary　incisions　in　her　mind；　while　allowing　Vivian　to　believe　that　she　was　making　another　routine　examination。
　That　had　been　after　she　had　broken　the　news　to　Vivian；　of　course…a　sad；　strained　session　in　which　the　girl　at　first　had　been　dry…eyed　and　posed　and　then；　breaking　down；　had　clung　to　Lucy；　her　despairing　sobs　acknowledging　that　the　last　barriers　of　hope　had　gone。　Lucy；　although　accustomed　by　training　and　habit　to　be　clinical　and　unemotional　at　such　moments；　had　found　herself　unusually　moved。
　The　session　with　the　parents　subsequently；　and　later　when　young　Dr。　Seddons　had　e　to　see　her；　had　been　less　personal　but　still　troubling。　Lucy　supposed　she　would　never　insulate　entirely　her　own　feelings　for　patients　the　way　some　people　did；　and　sometimes　she　had　had　to　admit　to　herself　that　her　surface　detachment　was　only　a　pose；　though　a　necessary　one。　There　was　no　pose；　though；　about　detachment　here　in　the　operating　room；　that　was　one　place　it　became　essential；　and　she　found　herself　now；　coolly　and　without　personal　feelings；　assessing　the　immediate　surgical　requirements。
　The　anesthetist；　at　the　head　of　the　operating　table；　had　already　given　his　clearance　to　proceed。　For　some　minutes　now　Lucy's　assistant…today；　one　of　the　hospital　interns…had　been　holding　up　the　leg　which　was　to　be　removed；　so　as　to　allow　the　blood　to　drain　out　as　far　as　possible。　Now　Lucy　began　to　arrange　a　pneumatic　tourniquet　high　on　the　thigh；　leaving　it；　for　the　moment；　loosely　in　position。
　Without　being　asked　the　scrub　nurse　handed　scissors　across　the　table；　and　Lucy　began　to　snip　off　the　bandages　which　had　covered　the　leg　since　it　had　been　shaved；　then　prepped　with　hexachlorophene；　the　night　before。　The　bandages　fell　away　and　the　circulating　nurse　removed　them　from　the　floor。
　Lucy　glanced　at　the　clock。　The　leg　had　been　held　up；　close　to　vertical；　for　five　minutes　and　the　flesh　appeared　pale。　The　intern　changed　hands　and　she　asked　him；　〃Arms　getting　tired？〃
　He　grinned　behind　his　face　mask。　〃I　wouldn't　want　to　do　it　for　an　hour。〃
　The　anesthetist　had　moved　to　the　tourniquet　and　was　looking　at　Lucy　inquiringly。　She　nodded　and　said；　〃Yes；　please。〃　The　anesthetist　began　to　pump　air　into　the　rubber　tourniquet；　cutting　off　circulation　to　the　leg；　and　when　he　had　finished　the　intern　lowered　the　limb　until　it　rested　horizontally　on　the　operating　table。　Together　the　intern　and　scrub　nurse　draped　the　patient　with　a　sterile　green　sheet　until　only　the　operative　portion　of　the　leg　remained　exposed。　Lucy　then　began　the　final　prepping；　painting　the　surgical　area　with　alcoholic　zephiran。
　There　was　an　audience　in　the　O。R。　today…two　medical　students　from　the　university；　and　Lucy　beckoned　them　closer。　The　scrub　nurse　passed　a　knife；　and　Lucy　began　to　scrape　the　tip　of　the　blade　against　the　exposed　flesh　of　the　thigh；　talking　as　she　worked。
　〃You'll　notice　that　I'm　marking　the　level　of　the　flaps　by　scratching　them　on　first。　That's　to　give　us　our　landmarks。〃　Now　she　began　to　cut　more　deeply；　exposing　the　fascia　immediately　below　the　skin；　with　its　layer　of　yellow　fatty　tissue。　〃It's　important　always　to　make　the　front　flap　longer　than　the　back　one；　so　that　afterward　the　suture　line　es　a　little　posterially。　In　that　way　the　patient　won't　have　a　scar　right　at　the　end　of　the　stump。　If　we　did　leave　a　scar　in　that　position　it　could　be　extremely　sore　when　any　weight　was　put　upon　it。〃
　Now　the　flesh　was　cut　deeply；　the　lines　of　both　flaps　defined　by　the　blood　which　had　begun　to　seep　out。　The　effect；　front　and　rear；　was　rather　like　two　shirttails…one　long；　one　short…which　eventually　would　be　brought　together　and　sewn　neatly　at　their　edges。
　Using　a　scalpel　and　working　with　short；　sharp　movements；　Lucy　began　to　strip　back　the　flesh；　upward；　exposing　the　bloody　red　mass　of　underlying　tissue。
　〃Rake；　please！〃　The　scrub　nurse　passed　the　instrument　and　Lucy　positioned　it；　holding　back　the　loose；　cut　flesh；　clear　of　the　next　layer　below。　She　signaled　to　the　intern　to　hold　the　rake　in　place；　which　he　did；　and　she　applied　herself　to　cutting　deeper；　through　the　first　layer　of　quadriceps　muscle。
　〃In　a　moment　we　shall　expose　the　main　arteries。　Yes；　here　we　are…first　the　femoral　vessel。〃　As　Lucy　located　it　the　two　medical　students　leaned　forward　intently。　She　went　on　calmly；　matching　her　action　to　the　words。　〃We'll　try　to　free　the　vessels　as　high　up　as　possible；　then　pull　them　down　and　tie　off　so　that　they　retract　well　clear　of　the　stump。〃　The　needle　which　the　scrub　nurse　had　passed　danced　in　and　out。　Lucy　tied　the　big　vessels　twice　to　be　sure　they　were　secure　and　would　remain　so；　any　later　hemorrhage　in　this　area　could　be　catastrophic　for　the　patient。　Then；　holding　her　hand　for　scissors；　she　took　them　and　severed　the　main　artery　leading　to　the　lower　limb。　The　first　irrevocable　step　to　amputation　had　now　been　taken。
　The　same　procedure　followed　quickly　for　the　other　arteries　and　veins。　Then；　cutting　again　through　muscle；　Lucy　reached　and　exposed　the　nerve　running　parallel　downward。　As　her　gloved　hands　ran　over　it　exploringly；　Vivian's　body　stirred　suddenly　on　the　table　and　all　eyes　switched　quickly　to　the　anesthetist　at　its　head。　He　nodded　reassuringly。　〃The　patient's　doing　fine；　no　problems。〃　One　of　his　hands　was　against　Vivian's　cheek；　it　was　pale；　but　her　breathing　was　deep　and　regular。　Her　eyes　were　open　but　unseeing；　with　her　head　fully　back；　untilted　to　one　side　or　the　other；　the　pockets　of　her　eyes　were　deep　with　water…her　own　tears；　shed　in　unconsciousness。
　〃We　follow　the　same　procedure　with　the　nerve；　as　with　the　arteries　and　veins…pull　it　down；　tie　it　off　as　high　as　possible；　then　cut　and　allow　it　to　retract。〃　Lucy　was　talking　almost　automatically；　the　words　following　her　hands；　the　habit　of　teaching　strong。　She　went　on　calmly；　〃There's　always　been　a　lot　of　discussion　among　surgeons　on　the　best　way　to　treat　nerve　ends　during　amputation。　The　object；　naturally；　is　to　avoid　pain　afterward　at　the　stump。〃　She　deftly　tied　a　knot　and　nodded　to　the　intern；　who　snipped　off　the　spare　ends　of　suture。　〃Quite　a　few　methods