Diagnosis and Outlook.
Robert stood up from his patient and spoke. “I think there are three ribs damaged, but not entirely broken. I can feel slight movement and some irregularity, though they are healing now. Two on that side and one on this, and all at the back, probably where she hit the ground, but I could be mistaken. I hope I am.
She was lucky not to have had her back broken. Not particularly bad breaks, if they are breaks at all. A lot of general bruising and scrapes and superficial cuts, but the bruising is subsiding now. She probably landed on gravel, or something irregular on the ground. No sharp edges to puncture a lung, or it would have been obvious days ago. Her sternum is intact from what I can detect.” He stood there in thought, lost in whatever he was thinking and feeling.
“She does not have a crushed chest, so we can get that out of way. In fact, I doubt she has injuries to her chest at all. There is obvious and severe bruising still evident here and there”—he pointed— “but there is little else to suggest a more severe problem than cracked ribs. I do not know what internal injuries there may be lower down, just yet, but they cannot be too severe up here. Almost certainly there is no serious puncture to her lungs or I think she would not long have survived.” He looked again at Sophia.
“Did anyone tell you how the wheel was resting on her? Where the hub was?”
“No sir. It was others who came across her, and in the heat of the moment no-one thought to ask or say, I think.”
“I thought so! Pity! But any bleeding from superficial injuries could confuse anyone. I would think that from the pattern of the bruising and scrapes on the loose flesh on the inside of her left arm, here”—he moved her arm out to show Sophia some obvious and severe scraping on both her inner arm and at the side of her chest— “that the hub landed here, between her arm and her body. There is a distinct and awkward scrape mark on this side of her chest too, and more severe bruising and scratches here, on the inside of her arm.” Sophia seemed less shocked now by his disturbingly familiar, but clinical actions, than she had earlier.
“She was lucky. The wheel spokes seem to have caused the radiating bruising across her upper body, but without doing severe damage.” He traced the bruising out from her side, as he explained what he meant. No one had noticed, or pointed that out to her before, but then the patient had never been so extensively uncovered before, and the light was so much better, now.
“Two inches one way or the other and she would likely either have been dead on the spot by being crushed, as was initially surmised, or with a badly shattered arm that might have needed prompt removal.” His voice seemed to falter for a moment and he had to close his eyes, as though to regain control of his emotions. She began to wonder about certain things, watching him, and how he responded. He soon recovered and spoke again.
“She was lucky. She was doubly lucky that Jessop did not have to see to anything like that.”
She was surprised by his disregard of her sister’s nakedness, while he pointed out such things. He showed no signs whatsoever of being embarrassed at the indelicacy of what he was doing, to trespass so personally and so extensively. However, he did seem to know what he was doing.
“Has she passed water yet?”
“She seemed alarmed by that question, but she was rapidly being forced to get over any concern of what he was doing or asking.”
“A little. I took the towels away.”
“Not much, I wager, if she had little to drink. Was there any blood to see?” What would he not ask?
He brought her nightdress back up on her arms, up about her body and back, and then brought it to a close across her chest, tying it as before.
He held her forward by grasping her nightdress. “I will get you to remove two of these pillows please and we will get her lying down more. It will make it easier if she is lying more flat. I have learned much already. The only thing that would ever be wrong with any of this, is if it were not done.”
She began to believe that he might be correct and did as he asked.
When he pulled the bottom of her nightdress up above her waist. Sophia was just as alarmed as before but had learned to say nothing. She would soon get over it.
There was still some remaining bruising to see on her upper legs, as with her upper body, but no obvious puncture wounds or marks that might have been left from the extreme pressure of a hub of a wheel or any other part of it on her lower abdomen. He put his hand flat upon her pubic bone, and directly onto the hair there. He could sense the critical observer beside him. She was still not fully at ease with anything he was doing, and probably never would be. He no longer felt impatient with her.
Robert placed his other hand on one side of her hip and moved it a little. There was no unexpected movement beneath his upper hand, nor sign or sounds of pain from her, but he did not expect any if she were truly unconscious, and they would have found that problem by now. He switched hands and did the same on the far side.
The patient still continued to breathe steadily.
“Her pelvis does not seem to be broken. I am sure Jessop found this out too if he thought to do any of this with Nurse hovering about him.” He pushed his hands under her and felt along her lower back and sacrum, as he had done for her upper body.
He sat back up and started on her abdomen; moving his hands over it slowly, feeling for swelling, or anything unusual. There was nothing to feel.
He palpated her abdomen on both sides, and behind, low at first, and then gradually higher, pausing as he considered what he learned, and on each side up to her ribs. As before, his eyes were either closed, or far away in thought, concerning what he could sense with his fingers, and then brought the nightdress down to relieve the obvious, but lessening, agitated concerns of her sister beside him.
He then moved to her head and re-examined that again, more thoroughly than he had done earlier. She did not appear to have any broken bones in her cheeks nor her jaw. He opened her mouth and tried to see inside, but the light was too poor. He noticed that Sophia had passed him a mirror, so that he might direct the light from the window into her mouth, so that he could see more.
By the time he had finished, and after asking other questions that no-one else seemed to have thought to ask, and pointing out things that no others had seemed to notice or question, his observer had begun to see things in a different light, and her level of outrage had notably decreased. She began to believe that the outlook for her sister was not as bleak as others might have believed. She saw him close his eyes for a few moments and hang his head. His hands were trembling. He might almost be praying. Or holding back tears, but without success. She saw at least one, until he turned away from being seen.