Preparation for Hulla’s surgery took much of the remaining daylight. Time was of the essence, but there was no sense in attempting a surgery unless everything was in order. The lepers initially debated amongst each other whether the procedure was worth doing at all. As they had already come to accept that the boy would pass, they quickly reached an accord: Hulla would either likely die during the surgery, or certainly die without it.
Appo was fearful of their willingness. He had been honest about the boy’s chances, but he hadn’t explained the complications other men had faced after such injuries. Permanent paralyzation, blindness, loss of mental capacity, to name a brief few, and those were the ones who woke from their comas. Appo didn’t want to think about what would happen if the lepers lost their boy twice in less than two moons.
First, Appo needed a sedative. He had not brought drawstring with him, and his spirit wasn’t strong enough. Instead, he asked the lepers if any had any opium among them. He was well aware of the poppy seed’s addictive nature and knew many traveled with some on hand. With reluctance, one of the older women revealed she carried several seeds on her person. Despite receiving harsh looks from the lepers, Appo was thankful: the woman’s addiction would be of great benefit to the surgery.
As Appo gathered his tools, one-by-one the Yald family offered their help. He would have preferred someone less emotionally invested in the procedure, but he needed whatever help he could get. Tomi’s mother, who eventually introduced herself as Erish, was the closest thing the village had to a healer. While unfamiliar with the intricacies of human anatomy, Erish was skilled with suture and praised for her steady hand. Appo decided she would be responsible for cauterizing any excessive bleeding. Garabi would stand at her side, maintaining a small fire for sterilization.
Despite her parents’ objections, Tomi insisted she be involved. Realizing her abilities allowed her to sense Gizzal’s diminished breathing, she offered to stay close to Hulla and observe his airway while she relayed his pulse. It was a simple assignment, but Appo quickly realized the value of her abilities. She could effectively keep constant track of internal vitals; it would’ve been a Godsend in previous surgeries.
In the end, that left Uten to offer to hold Hulla’s head. It would be physically and mentally tasking, while being by far the most tedious role to have. It didn’t matter, for Uten wanted to help his younger brother in any way he could. If there was anyone to fulfill that duty, it would be Uten. Appo knew from firsthand experience how strong the boy’s grip was.
Eventually, it was time for the surgery to begin. Hulla’s blanket draped over his body, with a small square cut out to visualize the right side of his head. When Appo removed the bandages earlier, he realized why the family thought so little of his initial fall: the swelling and bruising of his head above the ear was hardly one of concern for a skull fracture. When Appo palpated the boy’s head, he felt only a slight bump in the skull underneath the edema. Hulla’s injury was unperceivable to the naked eye, but that was the nature of hematomas. There was no telling how much blood pooled underneath the skull, building more and more pressure on the boy’s brain with every passing second.
Appo double checked everything as everyone settled into position. The other lepers looked on from a safe distance. Even Gizzal, who had remained silent since his arrival, kept watch on the surgery while crouched under a particularly ugly stump of the Thornewood. After Appo sterilized his equipment, he gave Erish a brief rundown of what each instrument did and what he called them. He reminded Tomi to give him immediate updates if she suspected anything went wrong.
Before they began, Appo stood up and addressed the men and women around him. “I want to remind everyone to keep their distance. Even if things go wrong, any help you want to give could kill him. If you wish to support him, do from where you stand now.”
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The lepers nodded.
“That being said… You all know Hulla Yald, not me. Your help will get him through this. If you would like, pray to whoever you wish. We could certainly use their help right now.”
The lepers all bowed their heads in quiet murmurings that Appo had come to recognize as Ati’s prayer. As they did, Appo pulled out Lowya’s adamantine pendant, which he now wore across his neck. He kissed it, not knowing how much Lowya would influence proceedings from here on out. He had given little thought that she was likely responsible for the Screamers that had harassed them down below.
“You worship an old God.” It was Garabi, astute as ever. “Will it help?”
“As long as she steadies my hand, she just might.”
As the prayer concluded, Appo met each of the Yald family in the eyes. None of them wavered. They were ready to begin.
Appo decided on using a small fraction of the poppy seed. In prior instances, he would harvest a specific amount of latex, the gel like substance of the plant, and soak it in a sponge for his patient to inhale. This was impossible, as Hulla was breathing so shallowly and the seed had long since dried. He instead opened the seed and had Uten grind it into a paste within the opium pipe. After lighting the pipe and puffing on it for a moment, Garabi handed the pipe to Tomi, who inserted it into Hulla’s nose.
Appo could sense the unease the family had seeing such a small child using opium. Any responsible parent would. He explained his progress as he continued. “Opium numbs the senses, much like how spirit makes it easier to tolerate pain. Note how he’s still reactive to touch.” Appo pinched Hulla’s right finger, resulting in a slight flexion. “We are going to be causing trauma, something that would be impossible to tolerate if awake. We’re going to give him a small amount until he is no longer curling his fingers.”
The Yalds were receptive to Appo’s explanations. Under a surgical setting, Appo had the inflexible confidence of a general and the tranquility of a monk.
“I need you to talk to me, Tomi,” reminded Appo. “I’d rather you tell me too much than too little.”
Tomi nodded. “His heartbeat is steady, from what I can tell. He’s getting good air, though he’s slowing.”
“Very good. Don’t let it get too slow. He needs to breathe steady.” Appo pinched Hulla’s finger again. Still reflexive, though somewhat delayed. He looked up and saw that Tomi had expected his question and handed the pipe back to Garabi. Garabi held the pipe awkwardly in his sleeves, perhaps concerned about the heat. He stoked the pipe over the fire again and handed it back to Tomi.
After the second inhalation, Tomi’s brow furrowed.
“What’s wrong?” asked Appo.
“His breathing is too slow now. Way too slow.”
Appo tried to visualize the boy’s chest. Its motions were already unperceivable, but he knew Tomi’s connection with the air was far more attuned than his own. Appo pinched Hulla’s finger one more time. No reaction. He lifted one of Hulla’s eyelids. Constricted pupils. It was too quick for that to happen.
Without asking, Appo grabbed one of Erish’s illuminated metal rods and jammed it into Hulla’s thigh. The flesh seared for a moment, eliciting gasps from the lepers. Thankfully, none of the Yalds moved. Appo held the rod into Hulla’s thigh until he saw the boy’s toes curl. He then released the rod, leaving a small burnt circle on his leg.
“You could have killed him,” spat Uten.
Appo ignored the insult. “Tomi, how is he now?”
Tomi clasped Hulla’s wrist in her hand. “It’s… better. He’s breathing slowly, but its not going down.”
Appo turned to Uten, looking directly at the irritated young man. “I gave his heart the extra energy to pump blood. What I just did saved him from an overdose. If we did nothing, he would have gone numb and he would have suffocated. We had an imperfect dose, now we know to give him a little more time.” Appo turned back to Tomi, speaking calmly, though stern. “You. Talk to me, regardless of what is going on. Even if there’s nothing to say.” He redirected his attention back at Uten. “I know you wish the best for Hulla. But if you don’t trust me, leave now. Because once the surgery begins, I will not stop.”
Both siblings hesitated. One after the other, they both nodded at Appo’s requests. Appo felt he effectively channeled a lecture Parbast would have given him during his early surgery days, only with significantly less swearing than his mentor.
“His pulse is light, but steady,” Tomi announced loudly. “His breathing is calm. I think he’s good now.”
“Sounds like he’s stable. Very good. Thank you, Tomi.” Appo motioned Erish to hand him another metal rod. This time, he stuck it at the edge of the boy’s finger. There was no reaction. Appo nodded in approval. “We have sedated the boy. We can begin surgery, now.”