The journey up the stairs to fetch his sister was the longest of Alistair Finch's life. Each step was a leaden weight, the murmur of the two women below fading into a dull roar in his ears. His hands, usually so steady, trembled. He wiped them on his trousers, leaving faint, damp streaks.
The door to the small bedroom was ajar. Mrs. Dobbs had left a single lamp burning, casting a soft, golden glow that felt like a mockery of the grim task ahead. Clara lay still, her breathing a faint, rasping whisper. She was so deeply under she did not stir as he entered.
"Clara," he whispered, his voice cracking. He laid a hand on her forehead. It was fever-dry and too warm. "I am here. I am going to try now. Please," he begged, though he did not know who he was begging, "please be strong."
He could not carry her. She was too fragile. He found the wooden board they used sometimes to move her when the bed linens needed changing. It was a cruel, clinical thing. Gently, with a tenderness that felt at odds with the violence he was about to commit, he slid it beneath her and lifted.
She weighed nothing. It was like carrying a bundle of twigs and feathers. The short journey to the basement door was an agony. He had to balance her, maneuver the board, and open the door. His heart hammered against his ribs, a frantic drum counting down the seconds.
He managed the coded knock with his elbow. The bolt shot back instantly. Elara stood there, her face a mask of grim readiness. Her eyes widened slightly at the sight of Clara, so small and lifeless on the board. Without a word, she moved to the foot of the board, taking some of the weight, helping him guide his sister down the steps.
Mrs. Dobbs gasped softly as they laid Clara on the stone table. The lamplight was brighter here, harsher. It showed the stark reality of Clara's condition in brutal detail, the sharp cheekbones, the blue veins tracing her translucent eyelids. She looked like a effigy on a tomb.
"Oh, my sweet girl," Mrs. Dobbs murmured, her hands fluttering nervously before she pressed them to her mouth.
"The restraints," Alistair said, his voice stripped of all emotion, becoming that of the surgeon. It was the only way he could function.
Elara moved without hesitation. They had laid out soft leather straps. Together, they secured Clara's wrists and ankles to the table. It was a necessary horror. Even in her deep sleep, the body could jerk, could fight the knife. One twitch at the wrong moment would be fatal.
Alistair washed his hands in the basin of carbolic acid solution, the sharp smell cutting through the basement's funk. He scrubbed his nails, his knuckles, his forearms until the skin was red and raw.
"The anesthetic," he instructed Elara. "The cloth. Steady, small drops."
Elara picked up the soaked rag. Her hand was steady. She looked at Mrs. Dobbs. "You must hold her head," she said, her voice low and calm. "Keep it turned to the side. Ensure she does not inhale it."
Mrs. Dobbs, galvanized by the clear instruction, moved to the head of the table, her capable hands gently cradling Clara's skull. Elara began to drip the solution onto the cloth held just above Clara's nose and mouth.
Alistair watched his sister's breathing deepen, slow. He checked her pulse at her neck. Thready, but steady. It was time.
He picked up the scalpel. The lamplight caught its edge, a line of pure, cold light. He looked at Elara, then at Mrs. Dobbs. Their eyes were on him, wide with fear and a desperate, prayerful hope.
"Now," he said.
His first incision was a swift, clean line below the collarbone. Mrs. Dobbs made a small, choked sound and looked away, her face pale. Elara did not flinch. Her eyes were fixed on the wound, on his hands, her entire being focused on his every move.
Blood welled up, dark and shockingly red against Clara's pale skin. "Swab," he said, and Elara was there, pressing a linen pad to the wound's edge, soaking it up.
He worked quickly, with a precision born of a thousand hours of study. He knew the layers, the feel of the tissue. Fat, fascia, muscle. He used retractors to hold the wound open, revealing the intricate architecture of the rib cage.
"The saw," he said.
This was the worst part. The sound. The grating, grinding screech of the bone saw biting into Clara's rib. It was a sound that belonged in a butcher's shop, not a sickroom. Mrs. Dobbs whimpered, tears streaming down her face silently. Elara's jaw was clenched so tight he could see the muscle jumping.
A piece of rib came free. He set it aside on a clean cloth. And there it was. The lung, moving in a shallow, labored rhythm. The phrenic nerve, a delicate white thread laid over the beating heart.
This was it. The moment of no return.
His own breath hitched. The world narrowed to the space between his fingers. The scalpel in his hand felt alien, a instrument of destruction, not healing.
He could feel Elara's presence beside him, a silent pillar of strength. He could not fail. Not in front of her. Not with Mrs. Dobbs watching.
He positioned the blade. His hand trembled.
And then, a warm, solid weight settled over his fingers. Elara had placed her hand over his, steadying it. She didn't look at him. Her eyes were on the nerve. She said nothing. She just held his hand, her touch firm and sure.
It was all he needed.
The tremor stopped. His world snapped back into sharp, crystalline focus.
He began to work. It was a dance of unimaginable delicacy. A nudge. A precise slice. A minute adjustment. He was barely breathing. Sweat dripped from his brow, and Elara, without being asked, wiped it away with her sleeve.
He could see it. The nerve. He could see the connection. He applied a tiny, specialized clamp.
The effect was not dramatic. There was no gasp of air. No miracle.
But slowly, gradually, the frantic, jerking spasm of Clara's diaphragm… stilled. The lung continued to move, but the desperate, tearing hitch was gone. The rhythm was smoother. Deeper.
He had done it.
He stared, hardly daring to believe it. He looked at Elara, and he saw the same stunned realization in her eyes.
"It's done," he whispered, the words a prayer.
The relief was so immense it was almost painful. He began the process of closing, his hands moving on their own, suturing the muscle, the tissue, the skin. The final stitch was placed. A clean, neat line of black thread against pale skin.
He stepped back from the table, his legs buckling. He caught himself on the edge of the instrument table, sending a tray clattering. The sound echoed in the sudden silence.
It was over.
Mrs. Dobbs was openly crying now, tears of relief and exhaustion. "You did it, Doctor. You did it."
Elara was still staring at Clara, at the steady, even rise and fall of her chest. There was no triumph on her face, only a profound, weary awe.
And then Clara coughed.
It was a small, weak sound. But it was a cough.
Alistair's head snapped up, his heart seizing with a fresh, ice-cold terror.
No. No, no, no. It wasn't supposed to happen. He had fixed it.
Clara's body twitched on the table. Her head rolled to the side. And then the cough came again, stronger this time, a wet, rattling sound that was horrifyingly familiar.
Blood, bright and arterial, frothed from her lips and trickled down her cheek.
The sight was like a physical blow. Alistair stumbled forward. "No! Clara!"
He pressed a swab to her mouth, but it was instantly soaked through. The coughs were coming stronger now, wracking her fragile body, straining against the leather straps. The steady breathing was gone, replaced by the same desperate struggle for air.
He had failed. He had made it worse. He had cut into her and somehow unleashed the flood.
"What's happening?" Mrs. Dobbs cried, her voice shrill with panic. "Doctor, what's wrong?"
Alistair could not speak. He could only stare, paralyzed by the catastrophic failure unfolding before him. All his knowledge, all his planning, evaporated into useless ash.
It was Elara who moved. She leaned in close, her eyes not on the wound, but on Clara's face, on the blood.
"It's not the nerve," she said, her voice sharp, clear, cutting through his panic. "Alistair, look at me. It's not the nerve."
He forced his eyes to hers, drowning.
"The cough," she said, her words rapid and sure. "It's not a spasm. It's fluid. It's in her lungs. You stopped the spasm but the fluid is still drowning her. She can't clear it."
Understanding, terrible and complete, dawned on him. He had treated the symptom, not the disease. The consumption was still there, filling her lungs with fluid. He had taken away her body's only way to fight it, however feeble that fight was.
He had not saved her.
He had silenced her scream while the house burned down around her.
He stood there, over his dying sister, the bloody scalpel still in his hand, and knew with utter, soul-crushing certainty that he had killed her.