Everybody's plans are thrown into confusion when Mamoot's upset stomach turns out to be something life-threatening instead. Ursula is forced to take charge and show those of Joth just what it is she can do. Unfortunately, she has overlooked some important considerations...

The Voyage of the Visund

A tale of Anmar by Penny Lane

20 - Emergency Room

Disclaimer: The original characters and plot of this story are the property of the author. No infringement of pre-existing copyright is intended. This story is copyright (c) 2019 Penny Lane. All rights reserved.

---

The hammering on the bedroom door was not gentle. Ursula and Bennet looked at each other with surprise.

"I wonder what has happened," the guardswoman commented as she went to answer. "I have heard no alarms from those who guard this place." She paused, a hand on the door handle. "At least, none I would recognize. While I am familiar with the new system now used in the palace, I do not know what they do here."

She partially opened the door to be met by a breathless Heris.

"Mistress! Your pardon, it is Mistress Ursula I seek, there is an emergency. Is she within?"

"Aye, but we have not yet finished dressing. Why? What has happened?"

"One of the men-at-arms is ill, the dark one called Mamoot."

"We know him. Continue."

"He suffers terrible pains of the stomach, Mistress, and asks for Mistress Ursula to come, as she suggested yesterday evening that she might do. Is that right? Did she offer?"

"Aye, she did, as we were retiring for the night. She also said that, while she might say what afflicted him, there was probably little she might do until Mistress Senia or another healer from the city could be summoned. Mistress Ursula is not yet wise in the lore of the potions used here, so I am told."

"Ah. Well, if she could attend, once she is ready. At least there might be more information to give to the healers when they arrive, and they will be better informed too."

"As you say! Then, by your leave, we must attire ourselves for the day."

"Indeed, Mistress Bennet. I will find an armsman to wait here and show Mistress Ursula the way when she is ready."

Bennet closed the door and turned to look at Ursula. "Is it what you expected?"

"I did not expect anything after last night, but an emergency this morning tells me that I probably know what it might be," Ursula replied. She was both annoyed at the interruption yet also somewhat relieved to be delaying her trip to the stables. "I think I need to wear something different," she observed. "This riding skirt is probably not the best thing to be wearing around a sick person. Help me to change, please, Bennet. A ship dress will do for now, I can always come back and change if it is a false alarm."

"As you desire, Mistress."

Bennet went to the dressing room while Ursula immediately began removing the clothes she had already put on, intended for this morning's riding lesson. It was the work of a moment to lay those on the bed and to slip into one of the simple shifts she now regularly wore around the city.

She asked Bennet, "Do you need help with that sash?"

"If you would, Mistress. I am in two minds whether to change as well, but the call was only for you so I will remain as I am for now. If needs be, I can always change later as well."

Once dressed, Bennet opened the door again to find an armsman waiting. "If you would follow me, Mistress."

Ursula looked at Bennet. "Come on, I might need some help." To the man she said, "Lead the way."

He led them over the carriageway arch and into what Ursula thought of as the 'barracks' part of the complex. Heading for the nearby stairs, he led them up to the topmost level and out along the balcony which ran around two sides of the courtyard at that level. Stopping at the fourth door, he gestured.

"Mistress. Mistresses. If you would enter. Our chambers are not big enough for so many people at a time."

Inside Ursula found Hambran, Maralin and a woman she didn't know. On one of the four beds lay Mamoot, his face pained and covered in sweat. The bedclothes were in disarray where he had been thrashing in the night. The woman turned to Ursula.

"Oh, good! Mistress Ursula, I am Kendra, a wife of one of His Grace's men-at-arms. I have a little knowledge of herbal lore and often help the men with small cuts and bruises. This, I deem, is well beyond my skill. I would not seek to tell you your work, but to me it looks like poor Mamoot has been poisoned."

"Um." It most likely wasn't poison, but she didn't want to upset the woman, who had only been doing her best to help. "It is possible. Perhaps I had better talk to him myself."

She crouched down by the bed and looked at Mamoot. "Can you point to where it hurts most, Mamoot?"

He indicated an area just inside his right groin, to which Ursula nodded.

"Very well. Now I want to have a gentle feel around there myself, will you let me do that? I'll try not to make it hurt too much more. Oh, and I'll have to lift your clothes to touch your skin."

"Mistress," he gasped, "look where you will. It cannot be worse than it is now."

She gently pulled his nightshirt up and eased his underpants down far enough to expose the skin, then very carefully ran her fingertips around the area he had indicated. There were several intakes of breath which showed where it hurt most. Grimacing, she adjusted his clothes and stood.

"Captain, can I have a word with you in private?"

Hambran looked at her expression then gave an abrupt nod. "Outside, on the walkway, Mistress."

They found a location between two doors, with Maralin keeping people away one side and Bennet the other.

"Captain, I don't know how much you know about what happens inside a person's body."

"We guess at certain functions, Mistress, but we know nothing of the workings in the way that you must do." His expression was questioning. "If you would explain."

"Simply, then. There is long tube which begins at mouth, works its way down to become stomach, and then coils round and comes out of bottom. Food goes in top and you know what comes out other end, waste products."

Hambran nodded. "As you say, Mistress. It is well known that food is digested in our stomachs... but how, we do not know." He shrugged. "So, what you imply is that something... serious... has happened inside Mamoot's stomach."

"That is correct. Now Mistress Kendra suggested that it might be poison, but the pain is localized and I do not think she is right. There are many things that can go wrong causing different symptoms, some of which can become fatal. This one is fatal. Unless I can get inside and remove infected part, he will die and probably today, in great pain."

"He will die?" Hambran did a double take. "Wait, you want to go inside... how do you do that? Is this some kind of wonder treatment from Earth, then?"

"I wish it were that simple, Captain. No, no wonder treatment, I have to do it normal way. It will mean making small incision, about this long, in stomach, reaching in and cutting off infected part, then sewing him up again." She grimaced. "There is no equipment here that would normally be used for operation like this but I'm sure that there are alternatives that can be used."

Hambran had gone white. "What are the risks, Mistress? How long will it take?"

Ursula shrugged. "Certain death weighed against chance of not dying, Captain. As for how long, until we determine when and where operation can be done, I could not say how long. It is simple enough procedure, if everything goes as it should, we could be finished by lunchtime."

"Where will you do it? Can it be done in his chamber?"

She shook her head. "I would need more space than that, and certainly more light! Besides, everything we use that goes near him will need to be boiled. My preference would be kitchen, to be near hot water, but I do not know if that would be possible."

The captain instinctively looked over the railing and down at the kitchen on the far side of the courtyard. He could not see in through the windows because of the roof overhanging the walkway, but he knew that Farren and his crew would be busy preparing breakfast for most of the household.

Making up his mind, he nodded and turned to Ursula. "Of course the mansion has a small Chamber of the Sick, mainly for armsmen who are injured during practice or for other reasons, but it is not well lit and water must needs be brought from the kitchen anyway. Your suggestion to use the kitchen itself therefore sounds reasonable, but I cannot make this decision. We must needs go and find His Grace. What you ask is unexpected, but if it may save a man's life... Shall you come with me? Maralin, Mistress Bennet, walk with us, if you please. We go to consult His Grace."

With a word to those inside the room, Hambran led the way along the balcony, then back down the stairs to the domestic corridor. Leading them along this, he knocked at a door and waited. It was opened slightly and Wallesan looked out.

"Hambran! Good morning!" He noticed the others. "Is something wrong?"

"Your Grace, one of your armsmen is very ill and Ursula says that he will die unless she attends him today. For some reason she would like to do what she needs to do in the kitchen."

"What? Who? I didn't think we had anyone that ill at the moment."

Maralin replied. "Mamoot, Your Grace. From what Ursula says, I would guess he has a burst appendix. Such a thing would have happened overnight, though I remember he complained of a pain yesterday evening."

"What is a burst... what was that word?"

"Appendix, Your Grace. It is a small part of the lower stomach, around here." He pointed.

Wallesan shook his head. "Never mind. You recognize this ailment?" Maralin nodded. "It is fatal?"

"Unless she goes in and removes the infected part, Your Grace. It will need sharp tools and plenty of boiling water to sterilize everything. She suggests using the kitchen for that reason."

The Duke came out into the corridor, closing the door behind him. He had on underwear and tights but was naked from the waist up. He held a tunic in his hand.

"Mistress Ursula? You will confirm what Maralin has said?"

"Yes, Your Grace."

"The kitchen... Doing what I suspect you intend to do in there will cause much disruption, and at an awkward time. I expect that you yourself have not yet broken your fast?"

"Your Grace?" Ursula struggled with the dialect. "Uh, no, Your Grace. I doubt anybody has." She waved a hand. "Nothing can be done until Healer Senia arrives, in any event. Breakfast may continue as usual, though I hope you will forgive me if I do not stay too long."

The Duke nodded. "That is well. We will do as you ask, my dear. Maralin, take Ursula along to the kitchen and request that they speed the meal preparations, find out what must needs be arranged there. Hambran, has anyone yet sent for Senia?"

"Aye, Your Grace, I sent a runner as soon as I was notified of Mamoot's illness. Since it is yet early, I do not know how long it will be before she will arrive, though."

"No matter, the important thing is that a runner has already been sent. Mistress, when should Mamoot be moved?"

Ursula understood the point. Too soon, and they would still be cooking. Too late and it might be too late.

"Your Grace, I will send word once I have spoken with Farren and decided what to do. There is a side room where meat is prepared, it has a big table and I had thought to use that. That at least will keep most of it out of sight of the kitchen staff." She thought. "Probably just after breakfast, since it will depend on Senia."

"As you say. Hambran?"

The captain nodded. "I will have a stretcher prepared and waiting, Your Grace."

"Good. Then, let me finish dressing and join you downstairs. Dismissed."

The Duke went back into his chambers and closed the door.

"Come on, Mistress," Maralin said. "We can use the service stairs at the other end of the corridor."

As he led Ursula along the corridor, he remarked, "I noticed that your speech patterns have changed this morning. You sound... more Russian, I think, though of course I am no expert in languages."

Ursula thought. "It is because I am thinking about problem so hard, I think. I do not know how translate mechanism works, but maybe not so good when I concentrate."

Maralin's eyes narrowed. "That could be it, I suppose. I know no more about how that works than you do. Ah, here we are."

The narrow stairs brought the two - plus Bennet, who had followed Ursula - out through a small door in the corner of the antechamber where food was put into bowls before being served. The servants busy there stared at them in surprise but Maralin just waved a hand in greeting and continued into the kitchen.

"Farren! We have a problem."

"Tenant Maralin! And Mistress Ursula." He took in their expressions and became serious. "What has happened?"

"Mamoot has become very ill and Mistress Ursula thinks the only way to save him is to..." He stopped, suddenly aware of what he had been about to describe. "Um, It is going to involve opening him up and removing the bad part. That means she will need a lot of boiling water to sterilize everything she will use, to make it safe, and somewhere nearby to do it in."

Ursula added, "I thought to use that tiled side room where you cut up the sides of meat, Master Farren."

Farren scratched his chin. "Mamoot is as ill as that? How soon must you needs do this thing?"

"Mamoot will probably die unless I can operate today, so the earlier the better. But I cannot do anything until Healer Senia arrives," she replied. "So that means that you can carry on with breakfast as usual, but... His Grace has suggested speeding things up a little if that is possible."

"He will die? Then by all means let us help you however we can." He turned to the chamber and clapped his hands, stopping everyone in their tracks. "Armsman Mamoot is gravely ill, and will die unless Healer Ursula can attend to him today. That will mean boiling water and the use of the Meat Preparation Chamber. If you would all help to prepare the breakfast faster, please."

There was a murmur and a bustle as everyone turned back to their tasks.

"If you would follow me," Farren said. "We can look at the chamber, see if it would indeed be suitable for you."

The chamber was about six meters - strides. I must call them strides - on a side and faced away from the courtyard. This meant that it did not get the sun in the morning, but the two large windows permitted a lot of light. These began about two strides up so that no-one could see in easily. The walls and floor were tiled with glazed red terracotta tiles, which made it a little darker but also made the room easy to clean, important where raw meat was concerned.

In the center was a table about three strides by two, made of a single slab of wood that must have cost the Duke a fortune. It had been worn smooth and cleaned and recleaned for a considerable period of time, as cutting blocks are, but Ursula already knew that it was washed down with boiling water before and after every use. To one side were rails where sides of meat would hang until required, to the other was a stand with tools, mostly large knives and saws, but also a large hammer and several chisels for obstinate joints.

She nodded. "Yes, this will do for what I need. Is this going to cause you any trouble today, Master Farren, if I use it?"

"We may always find other things to feed our household, Mistress, things which do not involve this chamber. So. What do you need me to do, then? It will not just be boiling water, I deem."

"No, it will not. Firstly, have this room washed out as you would normally do. Then, some medium sized pots with water to ensure a continuous supply."

"Ah, I understand what you mean. The water will boil quicker, and to start a new pot as one begins to boil."

"That's right. Then, I'll need some small and very sharp knives. Like those you use to take the stalks out of the yellow fruits, perhaps?"

"Aye, that we can do. I will make certain that they are freshly sharpened for you."

"The knives, and anything else we use, will also have to be boiled. Then they will need to be put down on something else that has been boiled, like a large metal plate. Is that going to be possible?"

"Aye, of course. Maker! Is all this boiling really necessary?"

"You know to keep surfaces, knives, pots, plates clean else food will go bad."

"Aye, of course. We have done so for hundreds of years."

"This is the same. Any dirt, food, anything, even fingerprints from unwashed hands that might touch patient may pass on infection. If clean knife is put on plate, and plate is not clean... You understand?"

"Looked at that way, of course. It shall be done, Mistress. Anything else?"

"Some cloths, I think. Some for wiping, some torn into smallish squares for... mopping up blood. All will have to be boiled as well. Some bowls for putting used cloths and... other waste... in. Those will not have to be boiled. There are some other things I will need, but I do not think the kitchen can provide them, so I will have to go and speak to the Duchess next."

"As you say. How soon will you begin work, then? Immediately after breakfast?"

She shook her head. "I have to wait for Healer Senia first. Then we will have to do some preparation work before we can start the operation. Captain Hambran has to arrange for the patient to be brought down from the top floor to here as well."

Farren nodded. "Then, once we have begun to serve breakfast, by your leave I will have this chamber washed down ready for you. That way you should not say that the kitchen has caused you any delay."

She smiled at Farren. "Thank you, Master Farren. I didn't want to use the kitchen but I couldn't think of anywhere else that would be suitable. You have been most helpful."

"In some ways I am only returning the favor, Mistress, considering the bells you spend helping in here. And if it is to save a life, then of course it is our duty to help."

"As you say. Maralin? Anything to add?"

"I am impressed by your efficiency, Mistress, but of course it is what you have been trained for. I just hope that you can manage this without all the usual equipment to be found in an operating theater."

"So do I, Maralin. So do I."

* * *

Fanis was interested when Ursula and Maralin entered the dining room.

"Ursula, Maralin, good morning. I hear that Mamoot is unwell and that you intend to do something to help him."

"Your Grace, good morning," Ursula replied. "Mamoot is not just unwell, I believe that he will die unless I do something to save him."

Fanis's eyes were round. "Oh, my! I did not realize... Yet it must be something which you consider Senia cannot attend to."

Ursula nodded. "I do not think that the medical abilities of Joth will be enough to save him, Your Grace. However, I must wait until Senia arrives to confirm that. What I want to do will involve her anyway. I would not think of attempting something new without her at hand, it would be insulting."

"And what is it you plan, then? Can someone like myself understand your explanation?"

Ursula looked around as the room began to fill. Wallesan, Eriana, Semma and Hambran arrived together, which made up her mind.

"Your Grace, I don't want to discuss it before we eat, it might make you uncomfortable." She added, "Senia has been sent for, so she may arrive while we are eating."

"Ah, I see. I will instruct that an extra place be set at table, to provide for her." Fanis turned and studied the room, receiving a nod from her husband. "It seems that everyone else has arrived, so I suggest that we all find our seats. If you would sit by my side today, my dear."

Eriana this time sat facing Wallesan, so that it was easy for her to ask Ursula questions.

"Wallesan has told me that an armsman is ill and that you know what is wrong."

"That is so, Highness, but I want to leave the explanations until afterwards."

"As you say, my dear," Wallesan agreed. "It is not a suitable subject for table, Eriana, though doubtless you and your men might speak of such things."

The Princess grinned at the Duke. "We are not so uncivilized as that, Wallesan! We are hardy folk, it is true, but such talk is usually left until the beer has flowed a while."

Fanis rolled her eyes. "And I thought that our men were bad enough! Do you tell me that you were part of such nonsense?"

"Sometimes, though my father would have forbidden me if he could. Still, I would speak of more serious matters now, Fanis. Ursula, is there anything we might do to help?"

"I have a question for Her Grace, actually," Ursula replied. "I will have need of needles and thread. Two different kinds of thread. I do not know if you do such things as embroidery here? I mean, in the mansion? I know the seamstresses do it, because all the uniform badges I have seen here are embroidered. Getting needles and thread that way might take too long, though."

"I understand what you mean," Fanis said, nodding. "Of course we have embroidery needles and thread here, such arts are always to be found in noble houses in the Great Valley."

"Oh. I did not know that."

"I was made to do embroidery too, when younger," Eriana commented. "I cursed every hour I spent doing it, too, though the skill has since been of some little use. You mean to sew him up after doing... whatever you need to do."

Ursula grimaced. "I am trying to avoid giving too much detail while we eat, Highness, but you are part right. I will need curved needles for sewing afterwards with thin thread, possibly of silk if you have any. Also some thicker thread, like embroidery thread, to help me during the operation."

"I can easily find those for you, dear," Fanis said, "Our two daughters did their part when they lived with us and I'm sure that their sewing boxes may be found. I will have someone look for them when we rise from table."

"Thank you, Your Grace."

The rest of the meal passed reasonably quietly, though everybody was on edge. Towards the end, Senia was shown into the dining room.

"Your Grace." She curtseyed before adding, "Your Highness, Your Grace. I came as soon as I could."

Wallesan waved a hand at the empty chair. "Join us, Senia, if you would. Have you yet broken your fast?"

She replied, as she sat down, "Your Grace, as a Healer who must always be ready to depart my residence I keep some small items to hand which I may eat as I walk. I have done so this morning, but I would accept your offer of a morsel or two more, if I may. A mug of pel would also be of help."

"As it is to all of us, my dear." He smiled at Senia. "Has any yet told you why we asked you to come today?"

"A sick armsman, so I was told, and that it was urgent." Senia looked around the table. "Yet, if I may be plain, I see no signs of urgency here."

Fanis explained, "That is because Ursula did not wish to proceed without your presence here, Senia. Though I deem she feels confident in what she proposes to do, yet there are certain aspects which may require your advice and assistance."

"Oh, I see." Senia leaned out over the table to speak to Ursula. "Good morning, Ursula. If I may be of assistance."

"Good morning, Senia," Ursula responded. "Though the time is short, some preparation must be done before we can begin. I do not want to speak of what has happened while we are eating, though, it could upset some to hear such details."

"As you say, Ursula! Then, by your leave, I will finish my breakfast and we can start... whatever it is you plan to do."

Senia picked a hot pastry from a serving plate and gratefully accepted a steaming mug of pel.

Maralin asked, "Do you need to draw some diagrams, Mistress Ursula? There is a blackboard and chalks in His Grace's office. By his leave, of course."

Ursula nodded. "That will be of help, yes. Thank you."

* * *

In the Duke's office, Ursula took charge.

"I can perform operation myself, but if I do I cannot manage patient at the same time. Tenant Maralin, I would ask you to be anesthetist."

"Me? I know nothing about surgical matters! Not to mention the fact that, as far as I know, there are no anesthetics on Anmar yet."

"Not gas, no, but Healer Senia spoke to me yesterday about herbs that can make patient insensible. We will give some to patient because otherwise he will move with pain during operation. For you, you have some idea of Earth procedures so can watch patient for anything that might indicate trouble."

Maralin nodded. "Aye, I can do that. After all, out of everyone here I have more knowledge of what you are going to do than anyone else."

"Exactly. Senia, that herb you spoke of? Have you any with you?"

"Which, the Anoteris root?" Ursula nodded. "I always carry a small amount, it is true, but... how long will he need to be unconscious?"

"A bell, maybe two." Ursula frowned. "If I take longer, patient is already in trouble."

"Two bells... It might just be enough. Tell me, is he a large man?"

"He is Mamoot. Surely you know him?"

"Of course." Senia considered. "I might need more." She turned to the Duke. "If I may ask for somebody to go for further supplies, Your Grace."

Wallesan nodded. "Of course, Senia."

The arrangements were made to collect further supplies of Anoteris root and some other materials Ursula and Senia agreed would be useful.

"So," Senia asked once the messenger had departed, "I do not yet know what is wrong with Mamoot, that needs such drastic treatment."

"Let me draw a part of body," Ursula said.

She drew a torso and part of the intestines within it, including the junction between intestine and bowel.

"Here is joining of two parts of digestive system," she explained. "For some reason, a little pocket is left here called appendix. This can become inflamed and, if it bursts, will kill patient."

"What is it you plan to do, then?"

"Appendix can be cut out without problem to patient. End of intestine must be tied off, then patient sewn up."

"Ah, I see." Senia studied the diagram. "Will you need to make a big opening?"

"Depends. With proper tools, can be done with cut about length of big finger. We do not have proper tools so cut will be bigger."

"Proper tools?" The Duke echoed. "What is it you require, Mistress? Mayhap we could have tools of use about the mansion."

"Knife I can get from kitchen. May need retractor" - this word came out in English - "and forceps."

"I don't know what the first one is, but our leather workers use forceps. Hambran, send someone for Duban."

"Aye, Your Grace."

Maralin explained, "A retractor, if I understand correctly, is a tool that is used to keep the hole open so that the surgeon can go deeper. Naturally, as you know, any cut tries to close itself up and that makes going deeper, as Mistress Ursula will have to do, to be difficult."

"Like a sword wound, you mean?" Wallesan nodded. "Aye, I understand." He turned to Ursula. "Once you have finished today, my dear, if you would explain this tool to our smiths, we may be able to provide what you desire. For now, I fear that you will have to use some other method."

"Thank you, Your Grace," Ursula replied. "That is another reason I wanted to have Senia here, both so that she can learn from what I do and to help." She considered. "It might be necessary for Maralin to hold wound open instead of Senia, I do not know what strength may be needed."

Ursula and Senia were discussing the procedure when a footman returned with Duban, the mansion's saddler.

"Your Grace?"

"Mistress Ursula has urgent need of some forceps. Is there any you may lend her for today?"

"Forceps?" Duban was surprised but considered the request. "Aye, Your Grace, I have two or three pairs that might suffice." He turned to Ursula. "Small or large, Mistress?"

"Small, probably, Master Duban."

"I'll have them for you as soon as I return to my workshop. You'll need them cleaned?"

"Yes, please, as clean as you can make them, but know that they will be boiled before we use them."

"Boiled? As you say, Mistress. Your Grace, by your leave?"

"Aye, Duban. Mamoot's life may depend on your tools."

* * *

"Maker, no! You mean to butcher me! This cannot be right!"

Mamoot's horror at his predicament when the two armsmen brought his stretcher into the tiled chamber was obvious, despite his pain and weakened state. Ursula was quick to soothe him.

"Mamoot, we would not do that." Though, in fact, we are going to do a little 'butchering'. "As we told you, we have to make sure everything is clean and the best place for that is near to kitchen. This room is easy to clean and has convenient table."

"Mistress -" The armsman tensed as another spasm hit him. "If you say it is so, then I must believe. What must I do?"

"We will put you onto table and then Senia will give you something to take pain away. When we are finished, and you are recovering, we will tell you all you need to know."

"Ahh."

Mamoot relaxed, and let the men, with the assistance of Hambran, Maralin, Ursula and Senia, carefully transfer him to the table top. Once there Senia handed him a mug she had prepared while the men brought Mamoot down from the barracks. It took a few moments before he calmed down and slowly drifted off.

"Captain, it might be better if you waited by door, to prevent interruptions. There is not enough room in here for all of us."

"As you say, Mistress. I can pass on requests for water and so on."

"Thank you, Captain."

Ursula looked at Senia. "Are you ready?"

"Yes, Ursula. I assume you want to make a cut now, to get to the... appendix? Is that the right name?"

"Appendix, yes, but that is Earth name. You might call it something else here."

Ursula pulled up Mamoot's nightshirt and rolled it up out of the way. She lowered his underpants also, but preserving the minimum of modesty. The flesh by his right groin was beginning to look red.

She frowned. "Everything else has been washed, we have fresh aprons which will have to do, but body is not washed."

Senia nodded. "But you cannot wash him with boiling water."

"No. There are... liquids... we would usually use to clean body before operation."

Maralin spoke up, from his position by Mamoot's head. "They might know iodine here." He nodded, the word had been recognized, but translated into a short phrase, 'Sea leaf orange'.

"Sea leaf orange?" Senia stared at Maralin. "Aye, it is a rare dye sometimes used by the cloth makers. How may it be used here?"

"It can be painted around where the operation will take place, Mistress Senia. It kills... anything that may be on the flesh."

"And it does not cause harm? I have not heard of such a thing."

"It is perfectly safe, Senia," Ursula confirmed. "If nothing else is available, iodine good enough. For today, we use soap and water."

A bowl of hot water was brought, together with some small squares of cloth and a bar of soap. Farren grinned as he handed them to Senia.

"Her Grace is thinking of sending out for more cloth, since almost every scrap of spare material in the mansion has been boiled and brought in here. Have you enough, Mistress?"

"This should be ample, Farren. Thank you."

Ursula cleaned the whole area as best as she could, dropping the waste cloths into a bucket on the floor. Then she turned to the pewter plate which held the few instruments they had been able to scrounge, picking up a small coring knife that had been specially sharpened. She brought the knife down to where she intended to make her cut, but the knife never reached the skin.

I cannot do this! I am not person who made incisions a year ago. Look at hands! They are steady enough, but they are different hands than I had before. I do not know if I can do this. Memory is still there but body is different.

"What is the matter?" Maralin saw her hesitation.

"I am... different. I do not think I can do this."

"What do you mean?" Maralin asked. He realized that Senia didn't know that Ursula came from another world and that explaining could be awkward - especially at the moment. He thought furiously for a way to resolve the problem, whatever it was. "Do you mean, because you haven't done anything like this for a while?"

The look that Maralin gave Ursula told her that he was trying to keep her origins a secret. "That is part of problem, yes. I have not done anything like this for some time, ever since I left city of birth. Things are... different here, as you will realize."

"Oh, I do, believe me. My situation was very similar when I first came to Joth. However, I would point out that you are the only person on the planet who can do this particular operation, and that Mamoot will likely die if you cannot."

She stared at him. He claimed to have once been a woman, how could he now be so cold-blooded?

"Ursula?" That was Senia, looking at her with concern. "I thought that you were familiar with what you intended to do."

"That is not problem, Senia," she replied with a sigh. "I am familiar with operation, not familiar with body and hands, which have not done anything like this for... some time. This will be first time for me, in such a place and time."

"Oh, yes, I forgot how you were found. Do you think it is too soon for you to be attempting something this complicated?"

"Is not complicated, really. Many other operations more complicated, but cannot be done here because we do not have equipment or trained... healers... who know what to do." She looked at the knife, at her hands. "Maralin, you are right. Without operation, Mamoot will certainly die. Even if I make mistake, Mamoot will have chance he would not otherwise have. I will do it."

The knife came down, skin was cut, and Senia was there to mop up the inevitable trickle of blood. More confident now, Ursula went deeper, explaining to Senia about the different layers and how she hoped to restore them afterwards. Soon, the abdominal cavity was revealed. It became hard to see, though, even with the good light in the room, because the wound kept closing itself.

"I need retractors, but we do not have any. Wound must be held open with fingers, then, but I am afraid I might cut fingers instead of patient."

"I have an idea," Maralin said. "I'll have to go and speak to Farren."

"Then do so, and quickly. Timer has started now, we must be finished as quickly as possible."

Maralin left the room and found Farren, who was with all the other kitchen staff, watching the action from a safe distance.

"Master Farren, I wonder, have you two old spoons you would be willing to sacrifice? Fairly small ones, about the size of those at table."

"Why, of course, Maralin. Sacrifice? What do you intend to do with them?"

"Beat them flat and bend them, Master Farren. It would take too long to explain how they will be used, I need them right away."

"As you wish, Maralin. Come with me."

Farren led Maralin out into the ante-room and pulled a drawer open. "Here! Will any of these do? They are old cutlery which was all that was left when the invaders departed. Take any that you wish."

Maralin selected two small silver spoons and turned back to the kitchen. "Now, how do I flatten these?"

"You want to squash the bowls flat, I deem," Farren mused. "Now Fess caught his fingers in the door the other day -"

"Good idea!"

Maralin pushed the spoons into the hinge side of an open door and then pulled the heavy door closed, crushing the bowls almost flat. Then he went back into the kitchen to bend the handles at right angles on the edge of a table.

"Right. Now I need to boil these, and quickly."

Several interested bystanders pointed to the pots of water gently simmering on one of the ranges. Maralin dropped the spoons into the most active-looking one, and after a few seconds fished them out again with a pair of wooden tongs. He hurried back into the 'theater'.

"Will these do? They are crude but should do the job. I have boiled them, briefly."

Ursula quirked a brief smile. "Russian tools often look crude but do job. You will have to stand there and hold them the whole time I am inside."

"I understand that."

Ursula nodded and gestured. Maralin inserted the two tools and gently pulled on the handles, opening the wound so that Ursula could see inside.

"Is good. Senia, come and look at this." The healer came and peered over at what was revealed. "That is appendix, color indicates it is inflamed. I must tie off intestine above, then cut appendix away. Have you got the embroidery thread?"

White thread had been chosen, on the grounds that it would show up better inside, but of course it immediately became soaked with the blood that was welling in the cavity. Ursula used tweezers to maneuver it around the intestine and then tied it off with difficulty, cursing the lack of suitable forceps with which to tie the knot.

"Is done. Now, I need knife again. Have bowl ready to take appendix, then small cloths I can use to mop out inside."

Mamoot, while insensible, still twitched when she grabbed the appendix with the oversize forceps provided by the saddler. Ursula gave him a quick glance to assure herself that he was still out, then reached in with the knife. The cut was awkward, especially with a knife never intended for use in such an enclosed space. The offending body part was brought out and dumped in the bowl.

"Good. We will keep that for a while to examine before it is discarded. Now, I need curved needle and thread to sew up each layer."

Again, it was awkward to tie off each knot without the proper equipment, but Ursula decided that, considering the usual state of people who had suffered wounds from fights, her attempts were probably at least as good as that which existing healers could provide. Finally, she was back at the skin level, where it was easier to manipulate the thread, so she made sure that the closure would heal as a tidy scar. A pad of boiled cloth was used to protect the wound, then a bandage was with difficulty wrapped around the armsman's body to hold it in place.

She sagged with relief. "It is done. Now patient can be taken away, to wake up somewhere less... threatening."

Hambran was at the entrance to the room, so he called the stretcher bearers back to load the limp form onto the stretcher and take him to the Chamber for the Sick. Ursula gave instructions.

"He must be made to lie flat for three to four days, Captain. Plenty of fluids... drinks, and soft food only for a week. I will check him at least twice every day until we know if he will survive."

Hambran bowed. "As you command, Mistress. You have done Joth a great service this day."

"I hope so, Captain."

As the stretcher party moved away Ursula put her hands down flat on the table and leaned on her straightened arms. Her head went down and she sighed.

Maralin asked, "Are you all right?"

"Was hard. Harder than expected. Forgot about changes to me."

Senia was curious. "What do you mean, Ursula? I was impressed by your knowledge and ability today. I did not know such things as you have just done were even possible."

Maralin looked at the sagging Ursula. "Mistress Senia, I think we had better clean up this chamber so that Master Farren may have it back. All the waste needs to be thrown away..." He thought. "...or, preferably, burned. The tools will have to be thoroughly cleaned and returned to their owners, of course. Then we can all go and find a room elsewhere to talk about what just happened."

He thought again. "I believe that I must ask His Grace for advice, though that can wait. First, the cleaning up. Ursula, do you want to go through into the kitchen and sit down? I am certain that Master Farren will have some pel brewing. We can handle the rest."

"Yes, Maralin. Is good idea."

As Ursula walked off Senia turned to Maralin. "Her voice sounded funny today. Do you know why?"

"Aye, Mistress. You should know that the Valley tongue is not her birth tongue. Of course she thinks in her own tongue, and sometimes drops words or says them in a strange way, especially if she concentrates on a problem or is stressed. If she decides to remain in Joth, as I have, then doubtless her speech will change over time as she begins to think the same way we do."

Senia nodded. "As you say. I remember, when you first joined the Duke's household, you had a very strange accent but now it has entirely disappeared. You are saying that is what will happen to Ursula."

"Very likely, Mistress."

A short time later Maralin looked in at the Duke.

"If I may briefly interrupt, Your Grace. Having watched Ursula perform the operation, Mistress Senia has begun asking questions."

"Hmm? Oh, yes."Wallesan switched his attention from the large parchment document in front of him. "Did everything go as expected?"

"You know that I know almost nothing about medical matters, Your Grace? It seems to me that Ursula did what was expected, yes. Only time will tell if we have done enough to save Mamoot."

"As you say. Senia is curious, then? You have a suggestion, I deem."

"Your Grace, I think that Mistress Senia needs to be told the truth about Ursula's off-world origins, and, possibly, about the fact that she used to be male. Today the problem was not with the patient, but with Ursula herself. Since she has now become female, that means that her body is now different and that her strengths and weaknesses are also different. I do not think that she consciously realized this before today."

"Her body is different? Aside from the obvious, how should this cause her problems?"

"I'm not entirely certain, Your Grace, but it is small things... like the fact her hands are smaller, her arms are shorter. Her grip will be different, her fine manual control different, her eyesight different." He shrugged. "Physical things like that are what comes to mind, but there may be... emotional differences... and also psychological differences. You must remember that she is now in a very different place than she was before."

"And this affected her during the operation, is what you are telling me."

"Aye, Your Grace. Senia noticed but could not understand why."

Wallesan nodded. "Then by all means Senia must be told. As a healer, she will know enough to keep the matter confidential. Shall you require my presence?"

"It would be better, Your Grace, to give the information more credibility."

"As you say."

* * *

Maralin, Ursula and Senia filed into Wallesan's office where the Duke and Duchess were already waiting. With a gesture Wallesan invited them to take seats, before asking an unexpected question.

"Mistress Ursula, before we come to the real reason for this meeting, if I may first ask whether... what you did this morning... went as expected."

She replied, "Your Grace, what I did was an operation. I operated on Armsman Mamoot, making an incision in his abdomen and exposing the appendix, which I judged to be so inflamed that it threatened his life. There are certain parts of a body which are not vital to life, as the heart is, or maybe the brain or lungs. These other parts can sometimes be removed without the patient dying as a result. That is what I did, briefly."

"Ah, I see. And you were successful?"

"So far as we can tell, Your Grace. The greatest danger is from infection which happens during the operation, which is why I asked for extreme precautions to be taken, such as washing down the room first and then boiling everything that would touch the patient."

Wallesan raised an eyebrow. "Including your hands?"

"Your Grace, of course we may not boil our hands. We did wash them very thoroughly before we began, though."

"These infections, do you know how they are caused? I am sure that Healer Senia has some idea, but the matter may be of some interest to the rest of us if... operations... are to happen again in the future."

Ursula nodded. "That is true, Your Grace. Infections are -"

"Excuse me, Ursula," Senia said. "Your Grace, while we have some knowledge as how to prevent infections, we do not, as a rule, know what causes them. If Ursula has knowledge of such matters, it would be of vital interest to all healers, I am certain."

Ursula spread her hands. "Infection is a broad subject, Senia. There are many, many ways a person can become infected and it also depends on the person themself. The problem is, most infections are caused by creatures so small that they cannot be seen with the naked eye." She turned to Wallesan. "I do not know how we can proceed, Your Grace."

Maralin said, "If I may, Your Grace. Among the items sent from Palarand is a microscope. This is an instrument especially designed to see such small creatures." He considered. "To make best use of it will essentially mean setting up a small research project, somewhere in the city, and run by the healers."

Ursula was surprised. "You have a microscope here? I did not know that. Since I was not aware that it existed, we destroyed the appendix after giving it a close examination. With a microscope, we could have looked at the bacteria that were in it."

Maralin shrugged. "A great number of items arrived in that consignment, Mistress, and I was not aware of your particular interest then. We will know better next time."

"Very well," Wallesan stepped in. "We did not meet here to assign blame, one to the other. Maralin, seek out the microscope and make it available to Ursula for her immediate use. Mistress Senia, once you have seen what the microscope can do, bring me a plan for a workshop... no, now what did Garia name it..? Ah, a laboratory, aye, that is the word. A place where you and your colleagues may advance your knowledge of the healer's arts. For now, if we may turn to the reason for this meeting.

"Mistress Senia, first I must ask you to make an oath that you will not speak to anyone except those now in this room concerning what I am about to reveal. All those already here have made similar oaths."

"Why, of course, Your Grace, but what could possibly be so -"

Wallesan just looked at Senia, who shrugged.

"As you desire, Your Grace. I hereby swear that I shall not reveal anything that I may be told in this room, to any person other than those present today. Is that sufficient?"

Fanis glanced at Maralin, who looked puzzled. She said, "Maralin, Ursula makes her oath to Wallesan, so he cannot make witness. Since I am his wife, it is preferable that I do not either."

"Oh, of course, Your Grace. Er, heard and witnessed."

Ursula watched these proceeding with puzzlement. The 'oath' business seemed to be significantly more serious than it was taken on Earth, and she realized that it would be easy for her to accidentally do something somewhat more permanent than she might intend.

I need to ask somebody about the business of oaths. I do not want to end up committing myself to something I did not understand! And I have heard mention of the 'Ring of Honor'. What is that?

The Duke turned to Senia. "Now I understand that you have been told that Ursula comes from a distant land called Alberta."

"That is correct, Your Grace, although I have never heard of such a land." She shrugged. "I am no traveler, doubtless there are many lands I have never heard of."

"You could not have heard of this one, though, simply because it is not in Alaesia nor even anywhere on Anmar at all. Ursula comes from another world named Earth."

"Another world?"

Wallesan continued, "The situation that has recently been revealed is... curious, and I will tell you now that we do not understand much of what is happening. A small number of people from this other world, Earth, have been... transported here, let us say, in order, we think, to bring fresh knowledge from that world to Anmar. Ursula is one of them, Maralin is another, and Princess Garia is a third. We believe, though the proof is small, that Yod had yet another person there, which may be the reason for the recent war."

Senia's mouth opened and stayed there. Finally her mental processes caught up and she began asking questions.

"Another world, Your Grace? How can this be? Everyone knows that Anmar... The Great Convocation? What proof is there of any of this?"

"There is proof enough, Mistress, that I have seen with my own eyes, but I have myself given an oath not to describe anything in so much detail. The Great Convocation remains true. What has happened involves no magic and no gods, but... qualities, let me say, of the natural world that we have not yet explored. Maralin?"

"Your Grace." Maralin turned to Senia. "Mistress, I was delivered to Joth on the night that the invaders took the city. It is thought that the confusion made by the evacuation covered my appearance, in a ditch beside the Galdarin Gate. For five days or so, I did not know who I was or where I was. When my memory returned, as Ursula's did, I was horrified by my new situation." He turned to Wallesan. "Your Grace, should I tell her the rest? It will make what happened this morning more understandable."

"As you say." Wallesan gestured.

"Mistress Senia," Maralin took a deep breath. Every time he told this part of his story was a strain, and it was something he did not wish to become common knowledge. "On the world I came from, Earth, I was not a man but a woman. Similarly, both Ursula and Princess Garia were born male on Earth. Though our memories and personalities are more or less the same as what we were on Earth, our bodies have been incorrectly remade by a fault in the transfer mechanism."

Senia's mouth opened again.

"It is true, Senia," Ursula said. "That is one reason I had difficulty this morning. I prepared as though I was the same person I had been on Earth, but discovered that things were different here. I could not hold the knife the same way and I was not sure of my ability to do the cutting and sewing." She grimaced. "I will have to learn to be a surgeon all over again, I think."

"There will also be hormonal differences," Maralin reminded her. "You now have little testosterone flowing through your veins while I have much more than I did before. That is going to make a big difference to your physical and mental processes."

Ursula raised an eyebrow. "How do you..? Oh, of course, you have had more time to think about all this. Senia, I have all the memories I had before, but I have a whole new body that I need to learn to use. That will take time and it may affect certain things I can do. At least for now."

The healer was sympathetic. "I think that I understand, Ursula, though it will take me some while to become used to the idea. If you were a man before, does it not feel uncomfortable now? I mean," she glanced briefly at Wallesan, "intending no disrespect, Your Grace, but the lives of men and women are surely different. How can you bear the change?"

Ursula's mouth twitched. "It has been no problem for me, Senia, since my mind was always that of a woman, even in a boy's body. Then, though, I did not have the body I wanted, and learning to cope with the reality has been... interesting."

"You were a woman... in a boy's body? But how...?" Senia turned to Wallesan. "Your Grace, I could spend bells asking questions of Ursula and Maralin but that is not your purpose today. Will you permit me to learn more of this unbelievable circumstance?"

The Duke thought, then nodded. "A certain amount, Senia. We understand that you must satisfy yourself that what we tell you is, in fact, the truth. Both Ursula and Maralin can offer details of the transfer which are beyond the understanding of anyone else in Joth but, as a healer, you might understand. I would ask you to ensure that no-one may overhear any conversations that you do have, of course."

"As you command, Your Grace." Senia thought. "Does this mean that there might be others from this other world, here on Anmar?"

Wallesan shrugged. "Probably. I am certain, though, that they will desire to keep their origins concealed, as Maralin did. If they should tell the truth, with little proof, they would be considered crazy."

"As you say, Your Grace. Ah! That explains the clothes that Maralin showed us the other day! I wondered where such amazing stitching could come from. Do you tell me that those clothes came from the other world?"

"Indeed, Senia. When someone is sent from that world to this, they are wearing whatever they were wearing on Earth, and they have in their possession anything that they were carrying at the time. Some of those items, a very small number, may be of use to us here."

"Then I must needs accept that clothing as proof of Ursula's origins, Your Grace. You may be assured that nothing we have spoken of today will be mentioned to anyone else at all."

* * *

"Come in, please."

Eriana had gotten used to using the word "Please", though it had taken some time and immersion in the more polite societies of the Great Valley to make it a comfortable part of her vocabulary. Bennet followed Ursula into Eriana's small sitting room, while behind them Semma closed the door and returned to her seat. The two visitors found comfortable chairs around the unlit fire.

"So, this morning you did what you had been trained to do on the mother world."

"That is so, Highness." Ursula had seen less of Eriana than the others since her discovery but even so, she felt more comfortable in the presence of the Princess. "In medical terms, it was a straightforward operation, and appears to have been successful, but we will not know for certain until Armsman Mamoot has recovered and is back to duty."

Eriana nodded. "As you say. Did you feel that His Grace offered you what you needed to do this operation?"

"Of course he did, Highness, although I would have preferred somewhere more suitable. On Earth, we have special rooms fitted out for such operations. Here, I had to make use of a side room in the kitchens."

"So I understand." The Princess frowned, and then waved her hand as if dismissing a thought. "I shall not enquire the reasons since I would probably not understand them. Tell me, do you believe that your future may lie with Joth, making more of these operations in a place which Wallesan will certainly provide for you? I am sure you would be made welcome here, as Maralin was."

Ursula's reply was hesitant. "Highness, it is too soon for me to be making such decisions! I have barely been here for two weeks and I still know next to nothing about the land, the people or the society I am now in. From what I understand, making such an oath to the Duke is a serious decision and one that it might not be easy to reverse." She shrugged. "The matter of oaths is one thing I know little about, for example."

"I agree, in the Valley they take oaths very seriously indeed. In Einnland we had oaths, it is true, but mostly to my father the King." A lopsided grin. "It did not stop many of his men from breaking those oaths the first chance they had. In the Great Valley, though, it would be a matter of honor to abide your oath."

"Ah, I see. I was right to be cautious, then."

"As you say. You have not been here long, you have plenty of time yet to decide your place in this world." Eriana switched subjects. "Tell me, I heard from Heris this afternoon that you had a meeting with Wallesan. I assume that was to discuss the operation?"

"It was, but it was really to tell Senia about my Earthly origins... and my change of gender. The fact that I am a woman now may affect the way I can handle instruments, for example. Senia noticed this during the operation, so I felt obliged to let her know the reason why."

"Your Earthly origins!" The Princess leaned forward. "Did he say aught of anything else related to your transfer?"

Ursula shook her head. "Not really, although he did tell us that he knew more but could not say anything." She considered. "Was that what you meant the other day?"

"Aye, it was. I understand that he and Maralin have taken oaths but this is intolerable. This matter concerns you and you should be fully informed of everything he knows."

"I am inclined to agree, Highness. What should I do?"

"You will get no more from them, I deem. I have no doubt that Duke Wallesan is an honorable man but that still leaves room for much that may not be in your favor. Ursula, do you trust me?"

Ursula eyed the Princess. "I think so, Highness, but I should tell you that I think you are making much out of nothing. I met you at the same time I met the Duke and Maralin and none of you have done anything - yet - that I could object to."

"Well said, Ursula. I am used to plain speaking, though sometimes I object to the message, it is true. I was about to add that if you should have questions the locals will not answer, or should you have doubts about what is asked of you, you may always come to me for advice. I may not be able to satisfy every question but I would be your friend, if I may."

"Thank you, Highness." She hesitated. "The truth is, I feel more comfortable with one or more of you around. Maybe it is a natural thing with women, I do not know. I never experienced anything like this on Earth."

"Since I have never been to Earth, I could not say. You are right, around here the women often have their own, more gentle society which the men are barely aware of. You will remember my offer?"

"I will, Highness."

"Then, by your leave, we will now speak of something more comfortable, and that is our ride out today."

Again Ursula hesitated. What is the matter with me today? "Highness, I have to tell you that I am not looking forward to riding. I understand that I will have to do it, in order to go places, but I do not think I will be comfortable on the back of an animal."

"You will not know unless you try, Ursula. I will tell you now that it is less than a year since any of us first sat on a frayen. It is only since the coming of Princess Garia that any woman has ridden as we do."

A sudden memory came and Eriana grinned. "I shall describe to you what happened when my men first came to Palarand! I had lived in the palace myself for several weeks at that point, with only a few retainers. When King Robanar asked if we would be able to assault Boldan's Rock, I sent for my men and joined them at a country estate nearby. Now these are the same men, mostly, that you already know from the Visund. In those days, though, they were a rough crew who drank a lot, swore a lot, wenched a lot, wore the same furs for weeks on end and washed not at all. Garia changed all that! The first morning..."