Page 153 of Bone Year

My hand doesn’t shake.

Some distant part of me starts to think of my father on the table. Of the forceps stuck inside him. Of the bleeding I couldn’t stop. But I breathe through it, and I feel Poppy sending calming energy through our bond.

My confidence takes over. I can do this, and I’m not alone this time. Professor Bale is here with me, and he knows exactly what to do.

The scalpel goes in cleanly. I make the incision long, slow, parallel to the wood. The skin parts. The fascia parts. The muscle layers underneath part with the precision Bale taught me to use, layer by layer, identifying each one before I cut it.

“Good. Keep going. Identify the peritoneum. Do not breach it yet.”

“Identifying.”

“There.”

“I see it,” I tell him.

“Is the object touching it?”

“Yes, the object has gone through fascia and muscle and is sitting against the peritoneum. I can see where it has dimpled the membrane.”

“Has it punctured?” he asks.

“I can’t tell yet.”

“Open it carefully. If she has a hemoperitoneum, blood will come up the moment you breach. Be ready,” he instructs.

I take a breath and open the peritoneum with the tip of the blade.

Blood does not come up.

“Clean,” Bale says with relief. “She didn’t penetrate the abdominal cavity. The object is contained in the retroperitoneum. Spleen is unlikely then. Likely it is the diaphragm.”

“Air.”

“Look for air.”

I lean closer. The wound bed is dark, but I can see the white of the diaphragm underneath, and I can see the hole.

“It punctured the diaphragm. I can see a small tear, maybe a centimeter, around the tip of the object.”

“That is a fixable injury. Listen carefully. We are going to clamp around the tip of the object and remove it slowly. I will pull. You will hold the diaphragm closed with the curved forceps as it comes out. The instant the wood is clear, you suture the tear. Three interrupted sutures. Silk.”

“I haven’t stitched a diaphragm before.”

“You have stitched in the lab. The diaphragm is muscle you can see. Stitch the muscle. I will guide you if you hesitate.” His voice is completely calm and not the battlefield yelling I’m used to hearing from him.

“Yes.” I nod.

Mender Theo places the forceps in my left hand. The needle driver and pre-loaded silk in my right.

“Position.”

I lean over Ellavee. I don’t look at her face. I look at the diaphragm.

“On three. One, two, three.”

Bale pulls the wood in one long careful motion, and I clamp the diaphragm closed with the forceps. The wood clears the wound. Bale tosses it onto a tray and grabs a suction tube from the mender without looking.

“Suture. Now.”