London, November 3, 1839
Swirling fog and mizzling rain settled about Sarah Lowell like a shroud, clinging to her hair and skin and clothes, a faint damp sheen. Her boots rang on the wet cobbles, her steps sure and quick, her heart beating a rhythm in time to her pace as she ducked through the dim alleys and twisting lanes, past wretched houses and tenements, and rows of windows, patched and broken.
‘Twas a dangerous route, one that carried her through the edge of St. Giles, north of Seven Dials—a route made all the more distressing by the dying moments of darkness and shadow that fought to stave off the first creeping fingers of the dawn.
A part of her was attuned to the street before her, the gloomy, faintly sinister doorways, the courtyards that broke from the thoroughfare. And a part of her was ever aware of the road behind, dim and draped in fog and menace. Beneath her cloak, she closed her fist tight about her cudgel, a short, sturdy stick that saw her from point to point in the place she was forced to live. She never left her room in the lodging house on Coptic Street without it. With good reason.
This was not a place for a woman alone, but she had no choice but to be here. Her choice lay in protecting herself. That she could do, though she had neither the means nor the inclination to own a pistol, and she had considered—and discarded—the possibility of defending herself with a knife.
So a cudgel would do, and she prayed she never found herself in a circumstance where she would be required to use it.
She suspected that surprise would be one thing in her favor should her prayers go unheeded. An attacker would have no expectation that she had strength in her small frame, but then, he would have no knowledge of the years she had spent by her father’s side, honing her muscles lifting and turning patients who could not do so for themselves. With her wide hazel eyes and her straight dark hair pulled back in a knot at her nape, she had a delicate appearance that was deceiving. Her father had always said she was sturdy in both body and spirit. She wished it had not taken his death and the desperate turn of her life to prove his assertions true.
A muffled sound to her left made her spin and peer down the alley next to the darkened chandler’s shop. Her heart gave a terrible lurch in her breast, and her fingers closed tight about the cudgel as she dragged it free of her cloak. With a moan, a man stumbled toward her, then veered away to lean, panting, against the wall. Muttering and cursing with a drunken slur, he fumbled at the flap of his breeches.
Turning away, Sarah paused but an instant to steady her nerves, then walked on, willing her racing pulse to settle. Perhaps it was the cold that made her shiver, but she thought it was unease that did the deed. More nights than not she felt as though unseen eyes watched her from the gloom, footsteps dogging her every move.
Now, in the early moments before dawn, it was no different. The feeling of being watched, being stalked, oozed across her skin like a slug. She never saw anyone, though she took care to look over her shoulder often. But when she looked, there were only the empty street and hollowed doorways behind her.
She quickened her pace and hurried on.
“Almost there now,” she murmured, with yet another glance about. She dared not relax her attention, not even for a second.
Her destination was Portugal Street and the old St. Clement Danes workhouse that now housed King’s College Hospital. There was talk of a new building, but for now there were some hundred and twenty beds split into several overcrowded wards that offered care to the sick poor.
No one of wealth and means would step foot in King’s College. By choice, the rich would be seen to in their own homes, and because of it, they were more likely to survive. But the poor could not afford that luxury, and so they came to King’s College, and often enough they died.
There were those who would argue that they would die regardless, and that the hospital offered some hope, however small. Sarah was inclined to favor that belief because, somehow, they did manage to save some.
Still, she found it a horrific irony that King’s College was situated squarely between a crumbling graveyard and the abattoirs of Butcher’s Row, and she had her own well-guarded opinion that some doctors and surgeons here might be better suited to work in the slaughterhouses.
At least there, death was the expected outcome.
As the cheerless building loomed before her, she paused and glanced about once more. A shiver chased along her spine. There, near the graveyard, she swore she saw a black-cloaked figure, painted in shades of pewter and coal and ash, clinging to the shadows. Watching.
Genuine fear touched her, with cold, slimy fingers that reached deep into her soul.
Each night, she felt the unnerving suspicion that she was being followed, but proof of her supposition was, for the most part, absent. This was only the second time that a form had actually materialized from the mist. Or had it? She stared hard at the spot, but could not be certain she saw anything more than a man-shaped shadow.
Regardless, she intended to exercise every caution.
She had come early for her shift this morn, determined to vary her schedule. Tomorrow, she would vary her route, as well.
Reaching the safety of the hospital, she hurried into the building and made her way first to the nurses’ cloakroom, where she divested herself of her damp overgarment, then through the dim hallways to the women’s sick ward. There was a patient here she wished to check on, a woman who was so ill she had not been able to eat or drink or even void for two days. It was as though her body refused to carry out the normal functions of life. Sarah hoped she had taken a turn for the better, though she knew in her heart that would not be the case.
She paused in the hallway near the ward. The only light was the eking dawn that filtered through grimy windows to steal across the floor in pale slashes. The sounds of suffering carried through the place, eerie moans and louder cries, a sob, the creak of a bed as someone shifted, then shifted again.
Moving forward, Sarah stepped through the doorway. She dared not breathe too deeply. No matter how much lime wash was slapped on the plaster, no matter how many scrubbings with yellow soap the floors took, the smell—the metallic bite of blood, the raw-onion stink of old sweat, the harsh ammonia of urine—never quite melted away. These small battles might beat back the wretched stench for a time, but in truth, the war was long lost. The sick ward was forever infused with the vestiges of human misery.
Her gaze slid over the beds. Each one was full. Some even had two patients crowded into a space meant to hold only one.
In the corner was the bed she sought. Little light inched that far into the gloom, and Sarah could see only the outline of pale sheets. She took a step forward, then froze with a gasp.
There was someone sitting on a stool at the far side of the bed, a man, garbed all in black, the pale ghosting of the patient’s partially upraised arm a stark contrast against the dark background offered by his coat.
He held the woman’s wrist. Sarah could see that now.
She must have made a sound that alerted him to her presence, for he raised his head. She saw only the faint highlight of his features, so deep was the gloom that surrounded him.
“Miss Lowell.” His voice reached across the space that separated them, low, pleasant, and though he was wreathed in darkness and she could see almost nothing of his face, she knew the speaker.
Killian Thayne.
Her pulse jolted at the realization.
“Mr. Thayne,” she acknowledged.
Neither said anything more, and Sarah remained where she was, frozen, strangely disturbed by the sight of the patient’s white forearm contrasted against the cloth of Mr. Thayne’s black-clad form.
A moan sounded from behind her, drawing her from her frozen state with a jolt. “Water,” came a woman’s plea. “I am so thirsty. Please, water.”
Sarah glanced about, and saw the night watch nurse curled in a corner by the fire, sleeping. She could not help but feel pity for her, a widow with three small children who, after working the day as a charwoman, came to sit the night through for a shilling and her supper, leaving her little ones with a neighbor, and paying her in turn.
With a sigh, Sarah turned away to tend to the patient herself.
When she was done, she looked back to where she had seen the surgeon, Mr. Thayne, sitting in the darkness. University-trained physicians were addressed as Dr., apprentice trained surgeons as Mr., and there was a distinct barrier between them, not only at King’s College, but at any hospital throughout the city.
He was gone, the patient asleep, her head lolling to one side, her arm hanging across the far edge of the bed.
Another patient called to her. Sarah hesitated, a feeling of wariness sluicing through her. Stepping forward, she almost went to the patient Mr. Thayne had been tending. Then she wondered what she was thinking. What could she do for her that he had not? The woman was sleeping now. Best to leave her undisturbed.
Again, the patient behind her called out, becoming more insistent. Sarah moved to her side and offered a sip of water, and then noting the time, she made her way to the surgical ward.
Only hours later did she learn that the patient in the corner had died in the silvered moments when night turned to day, discovered by the night nurse when she roused from her slumber.
Only then did Sarah hear the whispers that the woman’s wrist had been torn open, with nary a drop of blood spilled to mark the sheets.
Mr. Simon, the head surgeon, determined that she had injured herself on a sharp edge of the bedstead, and in truth, they found a smear of blood there that offered some proof of the supposition.
But throughout that day and well into the night, Sarah could not dispel the memory of Killian Thayne, swathed in darkness, his head bowed, and the woman’s arm so white against the black of his coat.
The bell tolled—once, twice, thrice—a solemn and sinister peal that carried through walls of ancient, crumbling plaster and floorboards of greasy, rotting wood.
Two weeks had passed since the woman had died in the sick ward, her wrist torn open, her skin white as fresh-fallen snow. Sarah’s gaze slid to the bed in the corner. A new patient lay there now, moaning softly.
A shiver crawled up her spine, the memory and the hollow sound of the bell leaving her anxious and distressed. It rang out not to mark the time, but to summon the attendants.
She ought to be used to it by now, ought to have learned to slam the door against her horror and dismay. But she had not, and that was no one’s failing but her own.
A moment later came the pounding of feet in the hallway. Summoned, they came, burly men in stained coats. The attendants. Their footsteps echoed through walls and closed doors, down the dim corridor toward the surgical ward, heavy and ominous.
She closed her eyes, imagined the scene as it would be, and felt a chill of horror. The attendants would hold the patient down and the surgeon would be quick, the blades sharp, the ligatures tight, but it would not be enough. It was never enough. The screams would come, the tears and pleas. And for all that suffering, by tomorrow or the next day, the patient was as like to be dead as not.
On a sharp exhale, Sarah opened her eyes and forced her attention to her task. She ladled porridge from the massive cauldron on the floor at her feet into small bowls, and lined them in neat rows on the tray atop the square table by her side. If she leaned in, she could detect the slightly acrid scent, as though the gruel had cooked on too hot a flame, or perhaps too long, and burned a little at the bottom.
One more unpleasant scent to add to the slurry.
The grimy windows let in little of the morning light, and what did filter through was browned and thinned by the filth. Bedbugs bit at the patients, and cockroaches scurried down the walls. Just last week, the matron had said they ought to hire a man like the one at Guy’s Hospital to deal with the bugs. Sarah thought the plan meretricious. All the staff here gossiped about the state of the hospital; they had not the funds to pay such a man.
As she turned her attention back to her task, a sudden chill of premonition crawled across the back of her neck, raising the fine hairs at her nape. Or perhaps she heard a whisper of sound. She could not say with certainty.
Pausing in her actions, she raised her head, alert and cautious.
In the corners, the shadows breathed and waited.
Surreptitiously, she looked about, but saw nothing to cause her alarm. As for the occupants of the ward, the poor souls in their filthy, reeking beds focused on nothing but their own pain.
There was no danger here, unless it was the danger of human suffering and tragedy.
Turning her head, she glanced at the half-open door to the hallway just in time to catch sight of a black-clad form—broad shouldered, long limbed, sun-bright hair drawn back and tied at his nape.
That glimpse was enough. She knew him.
Killian Thayne.
Light in the darkness.
Her belly fluttered and danced, the sensation having nothing to do with ill ease, and everything to do with Mr. Thayne.
With her head cricked to one side, she leaned back, just a little, trying to see the last of him. But he was gone, and she was left with only the faintest echo of his boot heels on the floorboards.
Facing the room once more, she cut a glance through her lashes to see if any of the other day nurses had noticed her inappropriate interest in Mr. Thayne.
He was a mystery, a man who kept to himself, preferring the night and shadows over the daylight, and the company of his books to that of his fellows.
She found him both fascinating and frightening.
With a swish of her black skirts, Mrs. Bayley, a widow who worked with Sarah as a day nurse on the ward, approached. She hefted the heavy tray and waited as Sarah set down her ladle.
“There are three on the list today,” Mrs. Bayley intoned, jerking her head in the general direction of the surgical ward. “Bless their poor souls.”
“Three?” Sarah asked as they moved between the beds, shoulder to shoulder in the narrow space. She knew that Mrs. Carmichael’s two rotten fingers were to be cut away, and Mr. Riley’s foot at the ankle. Both surgeries were to be done by Mr. Simon, the head surgeon. But she hadn’t known of a third.
“Mmm-hmm. Mr. Scully’s doing poorly. The blister on his stump burst, and he’s been feverish the night through. Mr. Franks wants to cut away the rest of the leg at the hip.”
“The hip?” Sarah repeated. Such a high amputation was fraught with danger. The patient rarely survived, and in this case, Sarah was almost certain he would not. A week past, the first surgery that had seen his leg taken just below the knee had almost killed him. A second such intervention surely would.
“Pity they must do their grisly work there on the ward,” Mrs. Bayley said, stopping to let Sarah pass the bowls to the patients on either side. “My sister was at St. Thomas. In Southwark. For the cholera. Spent a week there, and glad she was for the mercury the doctor gave her. Do you know they have a real operating theater? Built in the old herb garret of the church. Imagine!”
“An operating theater? I cannot imagine,” Sarah replied as she waited for the patient to haul herself to a sitting position using the rope that was strung between two tall poles attached to the bed, one fore, one aft. Sarah was heartened to see such progress, for the previous day the woman had been able to do little more than lie on her back and stare at the ceiling with tears creeping from the corners of her eyes.
With a smile, she reached down and drew the blanket smooth across the patient’s legs.
“Feeling stronger today?” she asked.
“A mite,” came the reply, accompanied by a wan smile.
After passing off the bowl and spoon, Sarah followed Mrs. Bayley and thought about the operating theater—a wonderful thing, in her estimation. King’s College had no such luxury. Surgeries took place on the ward, with the surgical and apothecary apprentices gathered tight around the table, and all the other patients watching and listening in horror and distress as the attendants held the patient down.
Continuing along the row of beds, Sarah doled out her porridge to those well enough to eat it, and made silent note of those who were not, intending to return and assess their condition once she was done handing out the meal.
The situation was horribly frustrating to her.
She was a day nurse, in essence a domestic servant in the ward, charged with cleaning and serving meals and little more. The head nurse or the sisters under her supervision were responsible for direct patient care. On the surgical ward, the apprentices were often tasked with the care if it was a complicated case. It ate at Sarah that she was capable of doing more, wanted to do more, and she was prohibited.
Once, several weeks past, she had braved the office of the matron to request additional duties and chores. She had worked by her father’s side—both in his surgery and at the homes of patients—for almost her entire life, and she wanted to do more than work as a char. Her father’s training should not go to waste.
But the matron had reminded her that she was lucky to have a position at all, and that her presence here was suffered only on the memory of her father’s good work and good name.
“I can finish this, Miss Lowell,” Mrs. Bayley offered when the tray had been emptied twice and only a handful of patients remained to be fed. “You go on to the surgical ward.”
With a nod, Sarah took her leave and moved along the dim corridor, her black cotton skirt swishing softly as she walked.
She had not even passed through the doors of the surgical ward before she heard the argument already in full vigor.
“I say we cut just above midthigh,” came the voice of Mr. Simon, his tone tight with anger. “We can do it this very morning, before the other two.”
Pausing in the doorway, she glanced at the group who stood by Mr. Scully’s bedside. The man had been brought in more than a week past. He had fractured his tibia and fibula in a fall, and the jagged shards had come through the skin. Open fractures were the most dangerous, the most prone to suppuration. Within two days Mr. Scully’s limb had become infected, and he was left with only two options. Amputation or death.
He had chosen the former, and Mr. Simon had sawed off the limb below the knee.
For some days, Mr. Scully had done relatively well, but then his eyes had become glassy, his skin flushed and hot to the touch, and red streaks had begun to crawl up what was left of his leg.
Sarah had seen such an outcome many times before, and she knew it boded ill for the man’s survival.
“And I say we must cut higher, closer to the hip,” insisted Mr. Franks. “Do you not smell it? Sickly sweet? ’Tis not the rancid wet gangrene we deal with here, gentlemen, but the galloping gas gangrene. It will reach high into the healthy tissue and foul it as surely as I live and breathe.”
There were murmurs of agreement from the group of gentlemen who hung on Mr. Franks’s every word.
Sarah hovered in the background, listening to the discussion as she began to ladle portions from a fresh kettle of porridge that had been brought from the kitchen by a lad with a low, wheeled cart.
The gentlemen pressed together in a throng. Mr. Franks was the peacock of the bunch, his black frock coat the single somber element of his attire. He wore buff trousers and a red waistcoat over his protuberant belly, and a bright blue stock high about his neck.
His appearance contrasted starkly with Mr. Simon, an extremely tall and gangly man, dressed all in black, his bony wrists sticking out beyond his cuffs, his hands milk white with long, slender fingers.
To his left was a young apothecary apprentice, his dark green frock coat and navy trousers covered by a white bib apron, the only one of the group who bothered in any way to protect his attire from the gore of the ward, or perhaps he sought to protect the patients from the unhealthy humors that might cling to his clothing.
Sarah’s father had ever insisted that humors brought in from the street might create an unhealthy miasma for the patient. In her months working at King’s College, she had seen much to support his theories.
“We’ll take the midthigh amputation,” Mr. Simon decreed with finality.
Sarah set down her ladle and angled closer to the bed, until she could peer around the press of bodies to better see the patient for herself. His skin was as pasty as freshly boiled linens with two bright, flushed spots, one on each cheek. His eyes were glassy, his breathing labored. She had no doubt that were she to have the opportunity to feel for his pulse, it would be rapid and wild.
There was a terrible odor coming from the stump of his leg. She could smell it even at this distance. Sarah disagreed with Mr. Franks on this. The smell was not sickly sweet, but the horrific stink of rotting flesh. Thick, rancid pus oozed from the stump, and the free ends of the ligatures draped across the sheet, leaving trails of yellow-green suppuration.
“The hip it must be,” cried Mr. Franks.
“I beg to differ, sir. I must insist on midthigh,” came Mr. Simon’s sharp reply. “You well know that the higher the amputation the greater the risk of death.”
“His risk is great enough from the spread of the poison. Do you not see it, man, crawling up his thigh like a spider?” Mr. Franks turned and looked about at his supporters, who murmured agreement.
The patient, Mr. Scully, roused himself enough to look slowly back and forth between the doctors, his entire body trembling, his lips working but making no sound. Sarah wondered if he understood what they were saying, or if he was caught in a delirium brought on by the poison that was leaching through his body.
From the corner of her eye, she saw the attendants moving about, preparing the large wooden table for the operations to come, scattering fresh sawdust on the floor beneath to catch the blood that would drip down. There was only a curtain separating that table from the remainder of the ward.
On a smaller, low wooden bench were laid out the necessary implements. Sharp knives, some curved, some straight, designed to sweep clear through skin and muscle, down to the bone. An ebony-handled saw. Petit’s screw tourniquets. Curved needles. Tenaculums to grab the artery and allow for the silk ligature to tie it off. A basin.
How many times had she stood by her father’s side and handed him each item as he needed it, no words exchanged, no request necessary?
From him, she had learned how to tighten the tourniquet, tie a ligature, even the appropriate way to cut flaps of skin and allow for healing by first intention.
Of course, she had never done a surgery on her own, but she had worked at her father’s side for years, never thinking about whether she liked the role, whether she wanted to be there. She was there because he needed her hands.
And then, abruptly, he was gone. Dead. He had left her alone and destitute, forced to take a position at King’s College as a day nurse, because there was no other option open to her. Well…not unless she wanted to stand on a corner, leaning against a post by the gin houses of Seven Dials.
Sarah was grateful that the physicians of King’s College remembered her father with fond respect, and so recommended her to the matron for a position in the wards.
She had thought a great deal about her preferences since then, and she had realized that though her emotions rebelled against the suffering of the sick and injured, she yearned to help them, to offer comfort and solace and what little healing she could. What had begun as a path followed in her father’s footsteps had become her own inclination somewhere in time.
The surgeons were still discussing the relative merits of a higher versus a lower amputation, and Sarah sensed the patient’s growing distress. With a cry, he reared up and peered around the crowd to lock his gaze on the area being prepared for his care.
Thrashing, he turned his gaze to Sarah, and she saw that his eyes were fever bright. He began to moan, short sobbing sounds, and she felt them in the marrow of her bones, in her viscera. His gaze was locked on her, his attention complete.
She stood, frozen. All eyes turned in her direction, and she was caught like a rabbit in an open field. Her heart twisted in a tight, black knot.
All around her, other patients shifted restlessly, disturbed by Mr. Scully’s cries. Some called out, and some stayed stoically silent.
“Enough.” A single word, spoken in a mellifluous tone. And it was enough, for the sounds settled and somehow, the tension in the ward seemed to ease.
Killian Thayne stepped from the shadows on the far side of the bed. He was garbed all in black, the somber tone a contrast to the bright glittering gold of his hair.
Slowly, he reached up to remove the strange bottle-green spectacles she had never seen him without. Head bowed, he folded the arms of the spectacles with meticulous care and placed them in the inside breast pocket of his impeccably cut coat. Then he raised his head and his gaze slid past each gentleman in turn, to the attendants setting up the operating table, and finally to Sarah herself.
The force of his direct stare made her gasp.
His eyes were gray. Not the soft color of a dove, but the rough, turbulent shade of a raging winter storm. A powerful storm.
He held it leashed, that power. She felt that as a certainty.
And it made her shiver.