‘Hmmm. Nasty. I can’t feel the head of the arrow. It’s gone in deep.’ Pausinus stroked his bristling chin, leaving a crimson smear on his skin.
‘What are you going to do?’ asked Cato.
‘It’s straightforward enough, sir. A progressive extraction should do the job.’
Cato sighed and raised an eyebrow. ‘Care to explain?’
‘While I work, yes, sir. The centurion’s still losing blood, so there’s no time to waste.’ Pausinus turned to the auxiliaries. ‘Roll him on to his side and hold him there. When I get started, he can’t be allowed to move. Understand? Good! Then let’s do it.’
‘Let me.’ Cato pushed one of the auxiliaries aside and took Macro’s shoulders.
Pausinus glanced at him with a surprised expression, then shrugged. ‘As you wish. Ready? Now.’
With the surgeon guiding them, they eased Macro on to his side, with the wound uppermost and the shaft facing into the room.
‘Hold him down,’ Pausinus instructed as he took up a bronze scalpel and sighted the angle of the shaft as it entered the thigh. He took a deep breath and inserted the tip of the instrument into the flesh on the opposite side of Macro’s thigh. Bright red blood spilled from the fresh wound and streamed down Macro’s skin on to the table. The centurion let out a fresh groan and tried to move. Cato held his friend down while the auxiliary pinned his legs in place. He felt Macro’s body trembling in his grip.
‘If he’s losing blood, then why cut him a fresh wound?’
Without looking up or pausing, the surgeon replied calmly, ‘As I said, the missile has penetrated deeply. Furthermore, I can feel that the head is broad. A hunting arrow most like. If I try a regressive extraction and attempt to move it out the way it came in, then it will cause much more damage and loss of blood. So the trick is to make an incision opposite the point of entry and draw the arrow through from that direction.’ He glanced up. ‘Of course it’s harder than it sounds. It’s no wonder Celsus was always bitching about it. I don’t suppose you’ve read his work.’
‘I’ve heard the name.’
‘Hearing the name and knowing his work is not quite the same thing, sir,’ Pausinus said wryly as he continued his incision. ‘The De Medicina is the standard reference text for army surgeons. Celsus covers most of the ground well enough, but there’s no substitute for experience. It’s like Hippocrates said: “He who desires to practise surgery must go to war.” And thanks to the protracted campaigns we have been fighting in Britannia, I’ve been getting rather more experience than most in my profession. Certainly more than some.’ He nodded towards the orderly. ‘So you can rest assured that the centurion is in good hands.’
He withdrew his scalpel and laid the bloodied instrument down on the stool, then reached for a probe. ‘Now comes the delicate part.’
Using the fingers of his left hand, he eased the incision apart to reveal the raw red muscle beneath. The blood flowed freely.
‘Need to staunch that. Orderly, some vinegar here!’
His assistant leaned over the wound, pulled out the stopper of a small flask and poured liberally, wiping the excess and the blood from around the wound before splashing more directly into the incision. Macro lurched beneath Cato’s hands and bellowed: ‘Fuck! That . . . hurts . . .’
With a groan, he went limp. Cato’s heart froze. ‘What’s happened?’
‘Passed out, that’s all. Not surprised, really. He’s a tough one, the centurion. Most faint from lack of blood and shock before this. Guess the vinegar finally tipped him over the edge.’ Pausinus pulled the flesh further apart and carefully inserted the probe. Clenching his jaw, he worked the instrument around, then nodded. ‘Found it. Get the levers on the incision and then hand me the extractor.’
The orderly hesitated, and Pausinus hissed with frustration. ‘That one there, with the notch.’
With the required instruments to hand, the surgeon looked at Cato. ‘This is where it gets interesting. I think you might have a steadier hand than this fool.’ He nodded at the orderly. ‘Would you change places, sir? I need to be sure I have someone who can be relied on under pressure.’
Cato swallowed. ‘If it helps.’
He eased his hold on Macro and the orderly took over. Pausinus handed Cato the levers: two slender instruments with blunt hooked ends. ‘I need you to hold the edges of the incision open so I can get at the arrowhead. Not so wide that you do the centurion more harm, but wide enough that I can see what I am doing. Is that clear?’
‘I think so.’
Pausinus scrutinised him for a moment and spoke gently. ‘He’s not just a comrade, is he? He’s more than that. A friend?’
‘The best,’ Cato replied. ‘I’ve known him since I joined the army.’
‘I see. Then you must understand this. If we are to do the best for him, then we must not be moved by his suffering. We have to do what is necessary to save him.’
‘I understand.’
‘Then to work! Get the wound open and keep out of my way as much as you can while I do the rest.’ When he saw Cato hesitate, the surgeon nodded at the incision. ‘It’s not going to hold itself open, sir.’
‘All right, damn you.’ Cato held the levers out and pressed the hooked ends into the cut flesh, then eased the skin apart to expose the crimson muscle inside. At once Pausinus sluiced the opening with more vinegar.
‘Keep your hands still, sir.’
Cato tightened his grip on the levers and tensed his arms while Pausinus edged to one side to let the light from the window fall on the incision. Then he went in with the original probe, teasing the muscles apart as he searched for the head of the arrow again. Knowing roughly where to look from his first incursion, it was the work of a moment.
‘There you are, my little friend. Do you see?’
He held apart a section of fibrous muscle and used the extractor to indicate the iron point.
‘Very nice,’ Cato responded, feeling somewhat sick. ‘What does Celsus say we do next?’
Pausinus did not reply at first as he slipped the extractor over the arrowhead, turned the notched end to engage the bottom of the iron head and gave it the gentlest of pulls.
‘Damn . . .’
‘What is it?’
‘As I feared. A hunting arrow. The head’s flat and flanged with barbs. I’ll do more damage if I try and take it out as it is. Never mind. Just have to use a different tool, eh?’ He put the extractor down beside the incision and reached for a delicate set of pincers. As he concentrated on the wound once more, he commanded the orderly to hold the shaft still.
While the man did as he was told, the surgeon reached in with the pincers and pushed aside the damaged muscle tissue to expose the first of the barbs. Clamping the pincers round the sharply angled iron, he nipped it off as close to the centre of the arrowhead as possible.
‘There’s one.’ He pulled the barb out and held it up for Cato to see before tossing it into the bucket under the table. ‘Now for the other.’
He repeated the procedure before setting the pincers down and taking up the extractor. ‘Now we can finish the job.’
Cato watched with morbid fascination as the surgeon reinserted the bronze instrument, eased it over the flat arrowhead and twisted it to gain purchase.
‘Here we go,’ Pausinus muttered as he began to draw the arrowhead towards the incision. The iron was coated with blood, which made it slippery, and the extractor lost its grip. The surgeon patiently took hold of the missile again and continued to draw it out until it stood proud of the incision, between the levers in Cato’s hands. As soon as he could see enough of the shaft to get his finger and thumb around it, Pausinus lowered his instruments and eased the shaft out of the incision. Another eight inches of the gore-coated wood emerged, and then, with a soft plop, it came free and the surgeon held it up as he straightened his back. ‘Very nasty indeed.’