Weeks passed and the whispers about the strange deaths at King’s College waned.

As was her habit, Sarah crept through her lodging house long before dawn, taking care to avoid the creaking stair and the floorboard in the corridor that groaned under the slightest weight. The building was old, musty, her chamber small and dark and damp, but it was inexpensive and the landlady was kind, both high recommendations as far as Sarah was concerned.

She had seen Mr. Thayne several times in the wards in recent days; there was nothing unusual in that.

She had dreamed of him last night; there was nothing unusual in that either. In her dream, he had stood between her and the shadowy form that followed her through the alleys of St. Giles. An interesting thing, given that she had not been plagued by the man who watched her in over a week. She almost dared hope that she had imagined the whole of it, that there was no man, no shadow, no threat.

As she passed the open door to the dining room, her landlady’s voice carried from the darkness, slurred words and a petulant tone. “Rent’s due. And why’re you leaving so early?”

Sarah turned and lifted her candle to find Mrs. Cowden sitting on a chair in the dining room, elbows on the table, palms cupping her chin. There was an empty bottle of gin lying on its side on the floor.

“Have you been here all night?” Sarah asked as she retrieved the empty bottle and set it upright on the table.

“I have,” Mrs. Cowden said. “My bed seemed too far away. Too quiet.” She paused. “Mr. Cowden’s been gone a year today. Or was it yesterday?” She paused again. “He used to make me laugh. We’d laugh and talk and sometimes he’d hum a tune and grab me about the waist and dance me around the parlor.” She looked around as though expecting Mr. Cowden to step from the shadows at any second. Then she closed her eyes, lowered her forearms to the tabletop, and fell forward to rest her forehead on her crossed wrists. Just when Sarah thought she was asleep, she sat up straight and pinned Sarah with a sorrowful gaze. “It’s a heartsick thing, missing someone you love.”

“Come along, now,” Sarah said holding out her hand. “I’ll help you to bed. But we must be quick. I can’t be late.”

Mrs. Cowden ignored the offer of her hand. Instead, she patted the chair beside her. “Sit,” she said. “Talk to me. Talk to me for just a little while. I am lonely.”

A heaviness settled in the center of Sarah’s chest, the weight challenging her every breath. But she refused to succumb to melancholy. “How can you be lonely when your house is full of people?” she asked with a forced smile.

“They’re gone all day, working for the coin to pay the rent. And they sleep all night. And even when they are about, they are not him. I feel as if my arm is missing. My right arm.” Mrs. Cowden sighed. “I miss him so.”

Sarah swallowed against the lump in her throat. “I know.”

Peering up at her with a poorly focused gaze, Mrs. Cowden said, “Rent’s due.”

Sarah patted her hand. “I paid the rent three days ago.”

Mrs. Cowden narrowed her eyes. “You wouldn’t lie to an old lady, would you?” She frowned and lifted a finger. “No…wait…you did pay the rent. I remember now. You are a good girl. Smart, too.” She stared up at Sarah, her brown eyes unfocused. Seconds ticked past then Mrs. Cowden asked, “What do you want, my dear? Truly want? Surely it is more than what you have. You should have more, a girl like you…”

Sarah hesitated, then said, “I want many things.”

“A handsome husband. Children. All women want that,” Mrs. Cowden said with a nod, and Sarah made no effort to correct her. It wasn’t that she didn’t want a husband and children. It was that she wanted many other things as well, most of which she would likely never have.

“I wanted children,” Mrs. Cowden said. “I had three, you know.”

“I know,” Sarah said, and rubbed the woman’s shoulder.

“They all died. Babes so small, dressed in white, sleeping in tiny coffins. I wanted more, but they never came. Mr. Cowden said we had each other and we were blessed to have that. He said that wanting more would only make me cry.” Tears welled and spilled over Mrs. Cowden’s lower lashes to wet her wrinkled cheeks. “He’s dead,” she said. “Dead and buried.” She caught Sarah’s hand, squeezing hard, her gaze intent. “Tell me, my dear. Tell me one thing you want with all your heart. I know it is something grand.” She nodded. “I know.”

Sarah said nothing.

“Tell me,” Mrs. Cowden whispered, the words thick and slow. Then her gaze grew unfocused once more, her grip loosened, and she slumped forward, her cheek pressed to the table.

“What do I truly want?” Sarah said as Mrs. Cowden emitted a soft snore. “I want to ease the suffering of others. I want to learn, to become a vessel of great knowledge, to satisfy the curiosity that burns inside me.” She bent and retrieved Mrs. Cowden’s shawl from the floor. “I want friendships that feed my mind and soul with lively discourse and debate. I want to be a surgeon.” She set the shawl around the woman’s shoulders and stroked her back. “I want to have a great and terrible love, one that is worth any price.”

They were dreams. Only dreams. But dreams were the food of the soul and Sarah refused to stop dreaming, no matter how unlikely her success and how meager her circumstance. “I want a life well lived,” she whispered. “One that matters.”

But another soft snore told her only the shadows were listening.

She snuffed the candle and left the room, left the house, and began her walk to King’s College.

The grim weather of the past week had eased, leaving the temperature cold and crisp. No rain. No clouds. Only the dark predawn sky. And the sound of footsteps behind her.

He was back. She could sense him there, watching her. Even when his footsteps grew silent, she knew he was there. Rage ignited even as unease uncurled, the two blending in an unpleasant mix. She resented his presence, feared it, but had no real idea how to remove it. The best she could do was ignore it just as she had been, but she didn’t know how long she could continue with that course, how long he would be satisfied to remain at a distance.

As she passed the graveyard, the shadows breathed and waited. She hurried on, resisting the urge to turn and search for him in the gloom.

Even once she reached the ward, she felt as though someone watched her here among the sick and dying as she moved between the beds, checking on the patients, taking note of glassy eyes or rapid breathing, offering water to those who asked.

She looked to each corner in turn. In one was a bucket and mop, in another a straight-backed chair. The third held a table and the fourth was empty. Nothing was out of place. There was no danger here unless it was the danger of human suffering and tragedy.

Moments later, two boys hauled in a massive cauldron of porridge and set it on the floor beside the square table. As Sarah drew near, she detected an acrid scent; the gruel had cooked on too hot a flame. One more unpleasant scent to add to the slurry. She was careful not to dip the ladle too deep or scrape the burnt gruel up from the bottom as she ladled it into small bowls and lined them in neat rows on the tray atop the table by her side.

With a swish of her black skirts, Elinor Bayley approached. She was a young widow, just a few years older than Sarah, and she had once confided that she regretted the loss of Mr. Bayley not at all. He had been forty years her senior, over-fond of drink, and—Sarah understood from the things that Elinor didn’t say—a strong believer in physically disciplining his wife for any transgression, real or imagined.

During the first several weeks they had worked together, Sarah had been polite but reserved. Then one day, Elinor had thrown up her hands and said, “You must call me Elinor. And I shall call you Sarah. It’s ridiculous that we should work together, changing linens stained with other people’s sh—” She had pressed two fingers to her lips.

“Shite,” Sarah had finished for her, unoffended.

“Quite,” Elinor had replied. “It is ridiculous that we call each other Miss Lowell and Mrs. Bayley. We are friends. I am Elinor. You are Sarah.” And that had been that.

Now Elinor turned and dipped her chin toward one of the beds, the gathered tufts of blond corkscrew curls on either side of her head bouncing. “Mrs. Cook’s covered in bites. Bed bugs. And this morning the cockroaches are knee deep in the corners.”

Sarah cut her a sidelong glance. “Knee deep?”

Elinor smiled, dimples in both cheeks. “Well, ankle deep. Just last week, the matron said we ought to hire a man like the one at Guy’s Hospital to deal with the bugs.”

“The matron’s right, but we have not the funds,” Sarah said.

“A sad truth.” Elinor lined up three more empty bowls on the tray.

As Sarah ladled porridge and filled the bowls, she caught a flicker of movement from the corner of her eye. She glanced at the half open door to the hallway just in time to see the back of a black clad form—broad shouldered, long limbed, sun-bright hair drawn back and tied at his nape.

That glimpse was enough. She knew him.

Mr. Thayne.

Light in the darkness.

Her belly fluttered and danced, the sensation having nothing to do with ill ease, and everything to do with Killian Thayne.

With her head cricked to one side, she leaned back, just a little, trying to see the last of him. But he was gone, and she was left with only the faintest echo of his boot-heels on the floorboards.

She was both amused and embarrassed by her own behavior. She had no reason to crave the sight of him, no reason at all.

But reason or not, she did crave the sight of him, and she spent far too much time thinking about him. He was a mystery, a man who kept to himself, preferring the night and shadows over the daylight, and the company of his books to that of his fellows.

She found him both fascinating and frightening.

“What are you looking at?” Elinor asked.

“Cockroaches,” Sarah said. “Knee deep.”

Elinor snorted. “Oh, I think not, missy. You were—”

The bell tolled cutting off her words—once, twice, thrice—a solemn and sinister peal that carried through walls of ancient, crumbling plaster and floorboards of greasy, rotting wood. It rang out not to mark the time, but as a summons.

A moment later feet pounded in the hallway. Summoned, they came, burly men in stained coats. The attendants. Their footsteps echoed through walls and closed doors, down the dim corridor toward the surgical ward, heavy and ominous.

They came because there was no laudanum for the poor and so the attendants would hold the patient down and the surgeon would be quick, the blades sharp, the ligatures tight, but it would not be enough. It was never enough. The screams would come, the tears and pleas. But the surgeon would cut off the limb regardless. And for all that suffering, by tomorrow or the next day, the patient was as like as not to be dead.

It was not surgery itself that disturbed Sarah. She had assisted her father so often that she thought she could likely perform one herself, longed to perform one herself, to apply all he had taught her. It was the ineffectiveness, the limited options the surgeons could offer. They saved few and lost many, and that was what ate at her. She ought to be used to it by now, ought to have learned to slam the door against her horror and dismay at the futility of trying to save them all. But she had not, and that was no one’s failing but her own.

“There are three on the list today,” Elinor said, jerking her head in the general direction of the surgical ward as she hefted the tray with the bowls of porridge. “Bless their poor souls.”

“Three?” Sarah asked as they moved between the beds, shoulder to shoulder in the narrow space as they handed out breakfast. “There’s Mrs. Smith.” Her two rotten fingers were to be cut away. An appropriate treatment. Their removal would mean that Mrs. Smith would live instead of die, and since the mangled digits were the fourth and fifth on her left hand, her life would not be so very different with eight fingers rather than ten. “And Mr. Riley.” They were to take his right foot at the ankle. He’d slipped in the muddy road and a carriage had crushed the bones of his foot. There was really no choice. Not if he wanted to live. Both surgeries were to be done by Mr. Simon, the head surgeon. He was an unpleasant person but a competent surgeon. “But who is the third?”

“Mr. Scully’s doing poorly.” Elinor shook her head. “The blister on his stump burst, and he’s been feverish the night through. Mr. Franks wants to cut away the rest of the limb at the hip.”

“The hip?” Sarah asked. Such a high amputation was fraught with danger. The patient rarely survived, and in this case, Sarah was almost certain he would not. A week ago, the first surgery had taken his limb just below the knee. It had almost killed him. A second such intervention surely would.

“Pity they must do their grisly work there on the ward,” Elinor said, stopping with the tray to let Sarah pass the bowls to the patients on either side. “My sister was at St. Thomas. In Southwark. For the cholera. Spent a week there, and glad she was for the mercury the doctor gave her. Do you know they have a real operating theatre? Built in the old herb garret of the church. They do their surgeries there. Imagine!”

“An operating theater? I cannot imagine,” Sarah replied then asked, “How are you today, Mrs. Toombs?” as she waited for the patient to haul herself to a sitting position using the rope that was strung between two tall poles attached to the bed, one fore, one aft.

“A mite better,” Mrs. Toombs said, smiling her toothless smile. “Yesterday, all I could do was lie here and cry. Thought I was done for for certain. Then last night Mr. Thayne came and had me drink something vile—” she made a face “—and then this morning I woke up feeling hungry. Isn’t it a wonder?”

“And here I am with breakfast,” Sarah said. “A happy circumstance.”

After passing off the bowl and spoon, Sarah followed Elinor and thought about the operating theater—a grand thing, in her estimation. King’s College had no such luxury. Surgeries took place on the ward, with the surgical and apothecary apprentices gathered tight around the table, and all the other patients watching and listening as the attendants held the patient down. Sarah’s father had not been in favor of such public practice. He believed a calm mind and soul went a far way toward healing the body. He had argued that surgeries ought to be performed in a separate room, but few of his colleagues had been inclined to listen.

“Was it Mr. Thayne you were so interested in earlier? Was it him you watched through the doorway?” Elinor asked, her tone wary.

“I watched no one,” Sarah said. Truth. She hadn’t watched him. He had already been gone and she had only glimpsed his passage.

Elinor rested her hand on Sarah’s arm. “He’s a handsome devil, I’ll give him that. But…”

Sarah said nothing, even when it was clear that Elinor waited for either a reaction or an invitation to continue. She offered no such invitation.

Finally, Elinor shook her head, curls bouncing, and sighed. “None of my affair, I suppose.”

“There is no affair, so it can be neither none nor some,” Sarah replied, hoping that was the end of that. It was one thing to admire the breadth of Mr. Thayne’s shoulders or the timbre of his voice in her own private thoughts. Quite another to have such ponderings noticed by another.

Continuing along the row of beds, Sarah doled out her porridge to those well enough to eat it, and made silent note of those who were not, intending to return and assess their condition once she was done handing out the meal.

The situation was frustrating for her. She was a day nurse, in essence a domestic servant in the ward, charged with cleaning and serving meals and little more. The head nurse or the sisters under her supervision were responsible for direct patient care. On the surgical ward, the apprentices were tasked with the care of complicated cases. It ate at Sarah that she was capable of doing more, wanted to do more, but she was prohibited.

She had been at King’s College for a month when she had braved the office of the matron to request additional duties and chores. She had worked by her father’s side—both in his surgery and at the homes of patients—for almost her entire life, and she wanted to do more than work as a char. Her father’s training should not go to waste. She knew well enough how to clean and dress a wound, lance a boil, treat a carbuncle. She wanted her knowledge to be put to good use.

But the matron had reminded her that she was lucky to have a position at all and that her presence here was suffered only on the memory of her father’s good work and good name. Then she had sent Sarah on her way with an abrupt dismissal. Sarah was not so unwise as to have visited Matron with that request again.

When almost all the bowls had been distributed and only a handful of patients remained to be fed, Elinor offered, “I can finish this, Sarah. You go on to the surgical ward. They’ll want someone to serve the meal there and gather the refuse. I’ll be along when I’m done here.”

With a nod, Sarah took her leave and moved along the dim corridor, her black skirt swishing as she walked.