Britannia

CHAPTER TWO

‘Get him on the table,’ the surgeon ordered as the auxiliaries entered the treatment room in the small infirmary next to the fort’s headquarters block. Macro hung limply between them, an arm draped round each man’s shoulder. He was barely conscious and his head lolled, and Cato was shocked to see how white and drained his face looked. Outside, the day was drawing to a close and a trumpet had just sounded the changing of the watch. The daily routine of the garrison continued without regard for the small drama played out as the patrol galloped in through the main gate.

Surgeon Pausinus was one of the rare medical officers who was not Greek or from one of the eastern provinces, where medical expertise was more readily come by. He had been selected from the ranks to train as a wound dresser before advancing to his current position, where he had many years’ experience in attending to the wounds, injuries and illnesses of soldiers. The examination table had a thin leather bolster at one end for patients to rest their heads. The men supporting Macro heaved the centurion up on to the hard surface, and Cato stood to one side as Pausinus took charge.

‘Take off his harness and armour. Boots, too. Just leave him in his tunic.’

While the auxiliaries did as they were told, Macro muttered curses at them, his eyelids fluttering as he rolled his head slowly from side to side. Meanwhile the surgeon took out his case of instruments and carefully selected a small range of tools, which he set out on a stool set down beside the table. He called for one of his orderlies to fetch linen dressings, vinegar and his herb chest, then opened the shutters of the window on the other side of Macro to admit as much light as possible.

‘Out of the way there!’ He swept one of the auxiliaries aside. ‘Stand back.’ He bowed his head towards Cato. ‘Not you, of course, sir. Just keep to one side, though, eh?’

Cato nodded and stood where he could see his friend’s pale face without hindering the surgeon or his staff.

Once Macro’s armour had been removed, Pausinus undid the neckcloth dressings and tossed the bloodstained strips of cloth into a wooden pail below the table. He leaned closer to inspect the stump of the arrow, then straightened up and addressed Macro.

‘I’m going to have to cut your breeches open to get at the wound, sir.’

‘No . . .’ Macro protested feebly. ‘Only just worn them in . . .’

‘That’s too bad.’ Pausinus took up a small pair of shears and began to cut the leather up to the wound, then carefully picked his way round the shaft and continued to Macro’s hip until the breeches were laid open and could be peeled away from the centurion’s thigh. Dried and fresh blood was smeared around the clotted mass where the arrow had pierced the flesh. The surgeon tested the area around the wound with his fingers, and Macro let out a deep groan.

‘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.’

Cato nodded as he examined the wide, flat iron head with its nipped-off barbs. It was easy to see now why it had been necessary to follow the procedure that Pausinus had chosen. Any attempt to pull the arrow out the way it had gone in would have torn Macro’s thigh badly, ripping apart muscle and blood vessels.

‘Now we need to clean out and close up,’ Pausinus announced. Taking some lint from the medicine chest, he placed it in a small brass bowl and then soused it in vinegar. When it had soaked up as much of the liquid as it was going to, he took it out and packed it tightly into the incision, then did the same for the entry wound.

‘You can remove the levers now, sir.’

Cato carefully worked the hooks free and put the slender bronze rods down on the table. Meanwhile Pausinus soaked two sponges and held them out for the orderly. ‘Put pressure on the wounds until I say.’

‘Yes, sir.’

As the orderly took over, the surgeon stood up and rolled his shoulders. ‘That went as well as it could. Managed to avoid doing any further damage. Provided the wound does not become mortified, and he rests and lets it heal, he should make a good recovery. He’s going to find the leg a little stiff for a few months, but that’s to be expected. You don’t take a hunting arrow in the thigh and shrug it off. Is he the kind of man who is likely to make a bad bed-patient?’

Cato made a face. ‘You can’t imagine . . .’

‘Well then, you must order him to do as I say, sir. Just because he is an officer doesn’t entitle him to jeopardise my hard work. I dare say you will need to issue him with strict instructions to do as he’s told until he has recovered.’

‘I will see to it.’ Cato could imagine how that was going to go down with Macro. Still, orders were orders and his friend would just have to endure it.

‘Then I’ll arrange a bed for him in the dormitory.’ Pausinus turned his attention back to his medicine chest and took out a needle and a length of twisted gut. Once the needle was threaded, he added three closed pins to his prepared materials. ‘The entry wound is small enough to suture,’ he explained. ‘The fibulae are to close up the incision of the exit wound. The beauty of them is that you can pop them in and out if you need to examine the wound. Of course, it hurts like hell, but there’s no getting round that. All right, take the sponges off.’

The orderly released the pressure on the wounds and tossed the sponges into the bucket while Pausinus gently extracted the lint. He smiled. ‘There! Now that’s left things nice and clean. No visible clots. There will be some, there always are, but it will all come out when we drain the pus from the wound over the next few days. It won’t look pretty. There’ll be some inflammation. That’s normal, and a little of it is good. Too much might indicate mortification. If that happens . . .’ He sucked his teeth. ‘You might want to make an offering to Asclepius on the centurion’s behalf.’

‘I’ll see to it personally.’

‘Good. Then let’s finish the job.’ Pausinus pinched the torn flesh around the entry wound together and poked the point of the needle through Macro’s skin. ‘You have to go deep enough so that there’s no chance of the stitches tearing. I use a twisted sheepgut thread. It’s strong enough for the job.’ He put in four stitches and then cut the thread and tied it off. Next he turned his attention to the incision and closed it up with the fibulae, before taking one off to make an adjustment and then poking the point through Macro’s flesh one last time. He nodded with satisfaction. ‘There. Orderly, get a dressing on that.’

Cato looked on as the linen was wrapped round Macro’s thigh. ‘And now?’

Pausinus crossed the treatment room to the bowl and ewer on a small table in the corner. He washed the blood off his hands as he addressed his commanding officer. ‘Now? We have to wait and see if your friend gets better. Aside from the danger of mortification of the wound, he’s going to be in a lot of pain. Usually I’d give my patients a few drops of poppy tears. It’s easy enough to come by in the eastern provinces, but rare as a boil on Venus’s backside here in Britannia. I exhausted the last of my stock months ago. So the centurion will have to settle for mandragora root soaked in heated wine. It’ll dull the pain and make him drowsy. If he’s sleeping then he can’t disturb his wounds too much.’

‘How soon will we know if he’s going to recover?’

The surgeon finished rinsing his hands and then dried them on a strip of linen. ‘By the fifth day, as a rule. By then, the degree of inflammation will tell us all we need to know. If it’s bad, then there’s likely to be something left in the wound that’s causing the problem. In which case I’ll have to go back in, clean it out with more vinegar, followed by warm honey in water, and then stitch him up again.’

‘I see.’ A thought occurred to Cato. ‘And if there’s no inflammation, then I can take it that Macro will be on the mend.’

‘Hardly. If there’s no indication of inflammation at all, then that’s almost always a bad sign.’

‘It is?’ Cato could not follow the logic of the surgeon’s statement. ‘Why’s that?’

‘It means the flesh is dying. Although if that’s the case, I’ll be able to tell from the smell coming from the wound. In which case, all I will be able to do is make him as comfortable as possible before he dies.’ Pausinus stood over his patient as the orderly turned Macro on to his back. He tapped a finger on the centurion’s shin. ‘If the wound was lower down the limb, I would be able to cut away the dead flesh, and a small amount of good flesh to be safe, saw through the bone and amputate the leg. His soldiering days would be over, but he would stand a fair chance of surviving that. Against certain death if we didn’t cut it off. But this high up it is tricky. The procedure takes longer and there’s more loss of blood.’ He reflected for a moment and shrugged. ‘So let’s pray that Asclepius is looking kindly on us and Centurion Macro makes a full recovery.’

Cato was growing a little tired of the surgeon’s manner and rounded on him with a cold expression. ‘I am making Macro’s recovery your personal responsibility. You will see to it that he is given constant attention and that his needs are met. Food, drink and toilet. He is the kind of officer it is extremely difficult to replace, and the army needs him. I will be displeased, to say the very least, if he dies. I can always find a place in the front line for an ex-army surgeon. Do I make myself clear?’

Pausinus met his stare unflinchingly. ‘There’s no need for threats, sir. I take my responsibilities every bit as seriously as you do. And I don’t favour any particular one of my patients. They all get the best I can manage, regardless of rank. I give you my word on that.’

Cato searched his face for any sign of insincerity, but there was none and he relented. ‘Very well. Keep me informed of his progress.’

‘Yes, sir.’ Pausinus bowed his head.

Cato turned to look down at Macro before he left. His friend’s breathing was shallow and more regular than before, and a pulse flickered on his neck. Cato patted him lightly on the shoulder. ‘Take care, my friend,’ he said softly.

Then he made for the door and left the fort’s small hospital block. Outside, the dying light of the day filtered low across the battlements and cast long shadows over the lines of garrison blocks with their wood-shingle roofs. He crossed the main thoroughfare and made for the entrance to headquarters, exchanging a salute with the sentries at the gate. His personal quarters comprised a modest suite of rooms at the end of the main hall. As soon as he reached his office, he slipped his cloak off and called out for his servant. Thraxis, a dour-looking Thracian with cropped dark hair, emerged hurriedly from his sleeping cell.

‘Prefect?’

‘Help me remove my armour.’

Cato raised his arms and leaned towards Thraxis, working his way out as the servant gathered the folds of the scale vest and pulled them over his head. The layer of padding followed. With a relieved grunt, he stood up and stretched his shoulders. Then he saw the streaks of dried blood on the metal scales and looked down to see more caked on his fingers.

Macro’s blood.

It was a moment before he shook off the feeling of dread for his friend. Clearing his throat, he addressed the servant.

‘I want meat, bread and wine. And get a fire going in the brazier. You can clean my kit afterwards.’

‘Yes, sir. And will Centurion Macro be joining you?’

Cato hesitated. He was too weary to explain. ‘Not tonight.’

‘Very well, sir.’

The Thracian left him alone. Cato stared dumbly at his hands for a moment before following the example of the surgeon and washing his hands using the bowl and Samian-ware jug of water on the camp table opposite his simple desk. He had to work at the dried blood, using his fingernails to flake it away from his skin. When the last of it had been wiped clear, he gazed down into the stained water and sighed in frustration. What had Macro been thinking when he charged towards the young native? It had been foolhardy, and he had paid a grievous price for his folly. If he died, it would be an ignominious end. But then so many soldiers shared that fate. Far more died due to accidental injuries or sickness than fell in battle. But somehow Cato had never imagined his friend’s end coming in any way other than at the head of his cohort. That was the character of the man.

He dried his hands and moved across the room to sit on the stool behind the desk. With Macro bed-ridden for an indeterminate period, his men would need a temporary commander. The obvious choice was Centurion Crispus. A giant of a man, though what he possessed in physical presence, he certainly lacked in good humour. But there was no helping it. Crispus would have to do. Cato resolved to tell him as soon as he had eaten.

First, there was one other matter that could not wait. Taking one of the blank folded slates at the side of the desk, he flipped it open and picked up the brass stylus lying beside it. Thraxis had made a good job of preparing the wax, and the surface was smooth and unmarked. Cato sat still for a moment, staring at the opposite wall, as he composed his recollection of what he had seen at the native settlement, then he bent to his task.

‘To Legate Gaius Quintatus, of the Fourteenth Legion, greetings. I respectfully beg to report . . .’