"As you will see," he said, "I was in the worst possible condition for an emergency like this. I had used no stimulus since returning from Mr. Carlton's though just going to order wine when the summons from Doctor Angier came. If I had taken a glass or two, it would have been better, but the imperative nature of the summons disconcerted me. I was just in the condition to be disturbed and confused. I remembered when too late the grave omission, and had partly resolved to ask Mr. Carlton for a glass of wine before proceeding to reopen the wound and search for the bleeding artery. But a too vivid recollection of my recent conversation with him about Doctor Kline prevented my doing so.
"I felt my hand tremble as I removed the bandages and opened the deep cavity left by the displaced tumor. After the blood with which it was filled had been removed, I saw at the deepest part of the cavity the point from which the blood was flowing, and made an effort to recover the artery, which, owing to the uncertainty of hand which had followed the loss of stimulation, I had tied imperfectly. But it was soon apparent that the parts had swollen, and that I should have to cut deeper in order to get possession of the artery, which lay in close contact with the internal jugular vein. Doctor Kline was holding the head and shoulders of the patient in such a way as to give tension to all the vessels of the neck, while my assistant held open the lips of the wound, so that I could see well into the cavity.
"My hand did not recover its steadiness. As I began cutting down to find the artery I seemed suddenly to be smitten with blindness and to lose a clear perception of what I was doing. It seemed as if some malignant spirit had for the moment got possession of me, coming in through the disorder wrought in my nervous system by over stimulation, and used the hand I could no longer see to guide the instrument I was holding, for death instead of life. I remember now that a sudden impulse seemed given to my arm as if some one had struck it a blow. Then a sound which it had never before been my misfortune to hear—and I pray God I may never hear it again—startled me to an agonized sense of the disaster I had wrought. Too well I knew the meaning of the lapping, hissing, sucking noise that instantly smote our ears. I had made a deep cut across the jugular vein, the wound gaping widely in consequence of the tension given to the vein by the position of the patient's head. A large quantity of air rushed in instantly.
"An exclamation of alarm from Doctor Kline, as he changed the position of the patient's neck in order to force the lips of the wound together and stop the fatal influx of air, roused me from a momentary stupor, and I came back into complete self-possession. The fearful exigency of the moment gave to nerve and brain all the stimulus they required. Already there was a struggle for breath, and the face of Mrs. Carlton, which had been slightly suffused with color, became pale and distressed. Sufficient air had entered to change the condition of the blood in the right cavities of the heart, and prevent its free transmission to the lungs. We could hear a churning sound occasioned by the blood and air being whipped together in the heart, and on applying the hand to the chest could feel a strange thrilling or rasping sensation.
"The most eminent surgeons differ in regard to the best treatment in cases like this, which are of very rare occurrence; to save life the promptest action is required. So large an opening as I had unhappily made in this vein could not be quickly closed, and with each inspiration of the patient more, air was sucked in, so that the blood in the right cavities of the heart soon became beaten into a spumous froth that could not be forced except in small quantities through the pulmonary vessels into the lungs.
"The effect of a diminished supply of blood to the brain and nervous centres quickly became apparent in threatened syncope. Our only hope lay in closing the wound so completely that no more air could enter, and then removing from the heart and capillaries of the lungs the air already received, and now hindering the flow of blood to the brain. One mode of treatment recommended by French surgeons consists in introducing the pipe of a catheter through the wound, if in the right jugular vein—or if not, through an opening made for the purpose in that vein—and the withdrawal of the air from the right auricle of the heart by suction.
"Doctor Kline favored this treatment, but I knew that it would be fatal. Any reopening of the wound now partially closed in order to introduce a tube, even if my instrument case had contained one of suitable size and length, must necessarily have admitted a large additional quantity of air, and so made death certain.
"Indecision in a case like this is fatal. Nothing but the right thing done with an instant promptness can save the imperiled life. But what was the right thing? No more air must be permitted to enter, and the blood must be unloaded as quickly as possible of the air now obstructing its way to the lungs, so, that the brain might get a fresh supply before it was too late. We succeeded in the first, but not in the last. Too much air had entered, and my patient was beyond the reach of professional aid. She sank rapidly, and in less than an hour from the time my hand, robbed of its skill by wine, failed in its wonted cunning, she lay white and still before me."