Sarah had not even passed through the doors of the surgical ward before she heard an argument already in full vigor.

“I say we cut just above mid-thigh,” came the voice of Mr. Simon, his tone tight with anger. “We can do it this very morning, before the other two.”

Pausing in the doorway, she glanced at the group who stood by Mr. Scully’s bedside. The man had been brought in more than a week ago. He had fractured his tibia and fibula in a fall, and the jagged shards had come through the skin. Open fractures were the most dangerous, the most prone to suppuration, and sure enough, within two days Mr. Scully’s limb had become infected, and he was left with only two options. Amputation, or death.

He had chosen the former, and Mr. Simon had sawed off the limb below the knee.

For some days, Mr. Scully had done relatively well, but then his eyes had become glassy, his skin flushed and hot to the touch, and red streaks had begun to crawl up what was left of his leg.

Sarah had seen such an outcome many times before, and she knew it boded ill for the man’s survival.

“And I say we must cut higher, closer to the hip,” insisted Mr. Franks. “Do you not smell it? Sickly sweet? It is not the rancid wet gangrene we deal with here, gentlemen, but the galloping gas gangrene. It will reach high into the healthy tissue and foul it as surely as I live and breathe.”

There were murmurs of agreement from the group of gentlemen who hung on Mr. Franks’ every word. And all this was said with Mr. Scully lying in the bed, mumbling and feverish.

Sarah hovered in the background, listening to the discussion as she began to ladle portions from a fresh kettle of porridge that had been brought from the kitchen by the same two lads who had lugged the first.

The gentlemen pressed together in a throng. Mr. Franks was the peacock of the group, his black frock coat the single somber element of his attire. He wore buff trousers and a red waistcoat over his protuberant belly, and a bright blue stock high about his neck.

His appearance contrasted starkly with Mr. Simon, a tall and gangly man, dressed all in black save for his white shirt, his bony wrists sticking out beyond his cuffs, his hands milk-white with long, slender fingers.

To his left was a young apothecary apprentice, his dark green frock coat and navy trousers covered by a white bib apron, the only one of the group who bothered in any way to protect his attire from the gore of the ward, or perhaps he sought to protect the patients from the unhealthy humors that might cling to his clothing.

Sarah’s father had ever insisted that humors brought in from the street might create an unhealthy miasma for the patient. In her months working at King’s College, she had seen much to support his theories.

She realized with a start that the apprentice was staring at her. He didn’t look away when he saw that she had caught him. Instead, he lifted his brows and continued to stare. Unsettled, she turned her attention back to her task and when she glanced at him once more, he had looked away.

Sarah set down her ladle and angled closer to the bed until she could peer around the press of bodies to better see the patient for herself. His skin was as pasty as freshly boiled linens, slick with sweat. His eyes were glassy, his breathing labored. She had no doubt that was she to have the opportunity to feel for his pulse, it would be rapid and wild.

There was a terrible odor coming from the stump. She could smell it even at this distance. Sarah disagreed with Mr. Franks on this. The smell was not sickly sweet, but the stink of rotting flesh. Thick, rancid pus oozed from the stump, and the free ends of the ligatures draped across the sheet, leaving trails of yellow-green suppuration.

“The hip it must be,” said Mr. Franks.

“I beg to differ, sir. I must insist on mid-thigh,” came Mr. Simon’s sharp reply. “You well know that the higher the amputation the greater the risk of death.”

“His risk is great enough from the spread of the poison. Do you not see it, man, crawling up his thigh like a spider?” Mr. Franks turned and looked about at his supporters, who murmured agreement.

He was wrong. The poison was not crawling up his thigh. It was well past that point, streaks of red extending all the way up, past his hip.

The patient, Mr. Scully, roused himself enough to look slowly back and forth between the doctors, his entire body trembling, his lips working but making no sound. Sarah wondered if he understood what they were saying, or if he was caught in a delirium brought on by the poison that was flowing through his body.

Off to one side, the attendants moved about, preparing the large wooden table for the operations to come, scattering fresh sawdust on the floor beneath to catch the blood that would drip down. There was only a curtain separating the table from the remainder of the ward.

On a smaller wooden bench were laid out the necessary implements. Sharp knives, some curved, some straight, designed to sweep clear through skin and muscle, down to the bone. An ebony handled saw. Petit’s screw tourniquets. Curved needles. Tenaculum to grab the artery and allow for the silk ligature to tie it off. A basin.

How many times had she stood by her father’s side and handed him each item as he needed it, no words exchanged, no request necessary?

From him, she had learned how to tighten the tourniquet, tie a ligature, even the appropriate way to cut flaps of skin and allow for healing by first intention.

Of course, she had never done a surgery on her own, but she had worked at her father’s side for years, never thinking about whether she liked the role, whether she wanted to be there. She had been there because he needed her hands, because the patients needed the care, because she could not deny succor to any who suffered. It was not in her nature. And because she was good at it, her instincts sure and true. Her father had remarked on that often, even going so far as to occasionally follow a path she suggested instead of the one he had planned.

Then, abruptly, her father was gone. Dead. He had left her alone and destitute, forced to take a position at King’s College as a day nurse, because there was no other option open to her. Well…not unless she wanted to stand on a corner dressed in bright colors with her bodice cut low, leaning against a post by the gin houses of Seven Dials.

Sarah was grateful that the physicians of King’s College remembered her father with fond respect, and so recommended her to the matron for a position in the wards.

She had thought a great deal about her preferences since then, and she had realized that though her emotions rebelled against the suffering of the sick and injured, and the environment itself made her at times feel sad and drained and worn, she yearned to help these people, to offer comfort and solace and what little healing she could. What had begun as a path following in her father’s footsteps simply because he expected it had become her own inclination somewhere in time. Had she been her father’s son rather than his daughter, she would be one of the surgeons on this ward.

For an instant, she wondered what she might say if she were one of the surgeons standing by the bed. Not the high amputation; it was too dangerous. But given the red streaks that marked the path of the poison, she feared that the lower amputation would do no good at all. Neither path appeared to offer any better hope than doing nothing at all.

As the men continued their argument, Sarah sensed the patient’s growing distress. With a cry, he reared up and peered around the crowd to lock his gaze on the operating table.

Thrashing, he turned toward Sarah, and she saw that his eyes were fever bright. He began to sob, deep, guttural sounds that she felt in the marrow of her bones. Then his gaze locked on her, his attention complete.

“Please,” he said. “Do not let them do this. Do not.”

She stood, frozen. All eyes turned in her direction, and she was caught like a rabbit in an open field. Her heart twisted in a tight, black knot. She had drawn attention to herself. There was real danger in that. What had possessed her to step up and insinuate herself at the edges of the group? It was far better to avoid notice, to go about her duties like a wraith. She could not afford their notice, could not afford to have one of them decide she was unwelcome here at King’s College.

“Please,” Mr. Scully begged. “You cannot understand what it was like to be cut like that, to feel as if time stopped in the instant of that agony, trapping me there. Never have I known such darkness, such despair. Never have I so truly believed that my maker had deserted me, left me in a cauldron of pain and suffering, left me there alone.”

All around them, other patients shifted restlessly, disturbed by Mr. Scully’s cries. Some called out, and some stayed stoically silent.

“Enough.” A single word, spoken in a low, even tone. And it was enough, for the sounds settled and somehow, the tension in the ward eased.

Killian Thayne stepped through the door of the ward and made his way to the far side of Mr. Scully’s bed. As was his habit, he was garbed all in black, the somber tone a contrast to the pale gold of his hair.

Slowly, he reached up to remove his spectacles. His hands were large, strong, his nails smooth and clean. The spectacles looked small and fragile in his grasp, yet he held them with the gentlest care as he folded the arms. After a moment, he placed them in the inside breast pocket of his impeccably cut coat. When he raised his head, his gaze slid past each of the surgeons in turn, to the attendants setting up the operating table, and finally to Sarah herself.

This was the first time she had ever seen him without his spectacles. His eyes were gray. Not the soft color of a dove, but the rough, turbulent shade of a raging winter storm. A powerful storm.

He held it leashed, that power.

And it made her shiver.

“Your thoughts?” Mr. Thayne asked, and Sarah’s heart slammed against her ribs. He could not be asking her here, in front of all and sundry. He could not be drawing such attention to her.

Barely had those thoughts formed than he swung his gaze to a surgical apprentice and listened patiently while the man replied. Sarah sagged in relief. But even as she eased away from the group back toward the kettle of porridge, she thought that the question had been aimed at her, that Mr. Thayne would have liked to know her opinion on the matter, that he had turned away at the last second only out of deference to her position.

Answering his query would have been disastrous, for he was certainly the only one in the group who would want the opinion of a day nurse, a woman, though she had studied under her father for more years than any of the surgical apprentices here. Lifting her ladle, she feigned absorbed interest in her task.

From the corner of her eye, she caught Mr. Thayne staring at her for a heartbeat, then he looked down at the man in the bed and said, “Mr. Scully, you have an infection in the flesh of your stump, and a poison in the blood.” His tone was calm, compassionate. “My companions suggest that if they do a second amputation, higher than the first, they might save your life.”

The patient ceased his moaning and restless thrashing the moment Mr. Thayne turned his attention to him. Sarah had seen this before. Killian Thayne ever had a calming effect on the sick and dying.

She wondered at that, wondered how a man who caused such upheaval inside of her could so effortlessly soothe the emotions of those in physical torment.

“Mr. Simon argues for the thigh, Mr. Franks for the hip,” he continued.

“I fear it will not save me,” the patient said, surprisingly lucid, though his voice trembled. “I fear I will die regardless what they do now. I feel it. I feel the poison working through me, an evil humor. So, you tell me…which will save me, the higher or the lower? Or do they propose the cutting only as a means to show these apprentices the way of things?”

“I say,” interjected Mr. Simon, his tone outraged. Then he exchanged a glance with Mr. Franks, and Sarah read the truth in that. They were inclined to insist upon the surgery in order to offer the learning experience to their apprentices, for how were prospective surgeons to know the way of things except by observation of the operations in question?

Though she understood the logic, the thought of seeing Mr. Scully—or any patient—subjected to such horror merely as a teaching tool revolted her.

As Mr. Scully raised his hand from the mattress, the limb shaking wildly, Mr. Thayne grasped it, his gaze never leaving the man’s face. Sarah held her breath, waiting for his answer, wondering what he would say, for she suspected that he thought as she did, that it was far too late for Mr. Scully, that no intervention would save this man’s life.

Mr. Simon and Mr. Franks interjected with, “I say,” and “Here now,” but it mattered not. The patient’s entire focus was on Killian Thayne’s eyes.

“Mr. Simon truly believes he can save you,” Mr. Thayne said. He made no mention of Mr. Franks.

“But do you believe it?” Mr. Scully asked.

The entire ward stilled, hanging on Killian Thayne’s reply. But when he spoke it was to offer a question rather than an answer.

“You say that you fear you will die regardless, but is it death you fear, sir?” Mr. Thayne’s voice was low, smooth. Enticing. Luring the true secrets of the patient’s deepest deliberations.

Sarah thought that should he ask her a question in that tone, with that intent look fixed upon her, she would surely bare the entirety of her heart and soul.

“Fear death?” Mr. Scully frowned and pondered that for an instant, then he went on, speaking with unexpected eloquence for one who had been mired for days in the depths of delirium. “No. I do not fear it. My wife has passed on ahead of me, and all four of my sons. I’ve little left here, and I suppose—” he shot a glance at Mr. Simon “—that no matter where they make their barbarous cut, I shall die regardless. I can feel the weight of death’s touch on my shoulder.”

“Yes,” Mr. Thayne agreed. “Death’s touch is upon you.”

The gaggle of murmuring apprentices fell silent at the low-spoken pronouncement.

Sarah swallowed, unnerved, for it was Mr. Thayne’s free hand that rested upon Mr. Scully’s shoulder.

“I do not want the surgery. Let death come,” the patient said, vehement. “You asked if it is death I fear? Not at all. I fear they’ll cut me in bits and pieces until there’s no more of me to cut. But I am already dead. There’s just the shell of me what’s got to give up the spirit. I feel it inside of me, the poison. I feel it.”

His words were clear and certain, and again Sarah could not help but wonder at that, at his lucidity of the moment. He had been nothing of the sort for days now, instead rambling and moaning and insisting he saw his wife sitting at the foot of his bed, talking to her, though she had been dead these past four years.

She had the unexpected thought that it was Mr. Thayne—his touch on the man’s shoulder; the unwavering connection of his gaze—that steadied him. Rationality argued against the possibility, but Sarah could not discount it.

“You have no say here, Thayne,” Mr. Franks interjected, spittle flying from his lips as his agitation spurred his words. “The patient is not yours, and I will thank you to mind yourself.”

“And the limb is not yours,” Mr. Thayne replied, unperturbed. His tone was ice and steel and not one of them dared to interject or voice objection. His lips turned, as though he found the other surgeon amusing or, perhaps, contemptible. “Look here—” he gestured to the red streaks on the patient’s limb “—and here. Even taking the leg at the hip will not stop the spread.” It had already moved too far. They could all see it.

For a long moment, no one spoke, then Mr. Simon offered a curt nod of agreement.

Mr. Thayne turned to him. “We both know that your proposed intervention will not succeed.” He glanced at Mr. Franks. “And yours is more likely to kill than to cure. The patient has said he has no wish for your further surgical involvement, and I am of the opinion that his decision is wise.” He paused. “Can you tell me that you have even a marginal hope of saving his life with your knives and saws?”

Mr. Simon swallowed, glanced at the patient, and said, “There is always hope,” though his tone and expression suggested he harbored none.

“Is there?’ Mr. Thayne asked.

Yes, Sarah wanted to say. There is always hope. Without hope, we are nothing. But perhaps hope took different forms and when the hope for survival was gone, one could hope for a gentle passing from this life to the next. Had her father known a gentle passing beneath the dark and oily surface of the Thames?

When Mr. Simon made no reply, Mr. Thayne continued. “If you were the one lying in this bed, what would you choose?” There was a silky threat in his tone.

Mr. Simon glanced at Mr. Franks, opened his mouth, and then closed it without uttering a word.

Sarah’s gaze slid back and forth between the two, then Mr. Thayne made a smooth gesture of dismissal and turned to the matron who stood in the doorway. “Offer him as much gin as he can swallow. Laudanum, if you have it. Dull the pain as best you can, and let him make this journey in whatever peace he can find.”

With that, he returned his attention to the man on the bed, leaning low to say something near his ear. Sarah could hear none of it, and from the expressions on the faces of the group of apprentices and surgeons, they could hear nothing of the exchange either. It irked them. That much was obvious.

Whatever quiet words Mr. Thayne offered, they had an immediate further calming effect on the patient, a lessening of visible agitation. Mr. Scully’s eyes slid shut and the tension in his body eased.

Surprised, Sarah wondered if Mr. Thayne were a mesmerist.

Before his death, her father had taken her to see a public demonstration put on by the mesmerist John Elliotson. He had laid his hands upon a woman and sent her into catalepsy from which loud noises and even needles poked into her skin had not roused her. Now, Sarah could not help but note the similarities between Elliotson’s display and the way that Mr. Scully eased so completely from distress into relaxation.

Regardless of the reason, she was glad that Mr. Thayne’s presence offered some relief for the patient’s suffering, and she was glad, too, that he was here to speak against the futile amputation of the remainder of the limb. The interventions of mortals could not change the outcome for Mr. Scully. If he was destined to live, it would be a heavenly intervention that made it so.

Again, Mr. Thayne’s gaze slid to hers, and he made a small nod, as though he knew and understood her thoughts. As though they shared some sort of collusion.

Awareness shivered through her, an instant of connection.

Mr. Simon and Mr. Franks walked on, followed by their entourage.

Moving to Mr. Scully’s side, Sarah wet the corner of a cloth and dabbed moisture along his cracked lips. He opened his eyes, and murmured, “Sit with me for a bit, Martha. Sit with me for a bit and sing to me the way you sang to our babes when they were small.” He caught her wrist, his grasp weak as he frowned up at her as though he was trying to remember who she was. At length, he said, “He made the arrangements as I asked. He’s bought you passage to Edinburgh, to your sister. You needn’t stay here alone. He’s a good one, Martha. A good one. I had not the coin to pay your way, but he said it was of no concern.”

Sarah frowned, trying to make sense of his words. Martha—Mr. Scully’s wife—was dead… She glanced at Mr. Thayne then returned her gaze to Mr. Scully. “Whom do you send to Edinburgh?” she asked.

He frowned and then his expression cleared. “My sister. I send my sister to Martha’s sister so neither needs be alone.”

Of course. His sister, Mary. She sold posies during the day, but Sarah had seen her here beside his bed in the evenings; they’d spoken briefly.

He shifted restlessly and scratched vigorously first at his neck, then at his arm. “Itchy,” he muttered, then made a watery laugh. “Sleep tight. Don’t let the bedbugs bite.” He closed his eyes again and, after a moment, fell into fitful slumber.

She raised her gaze to Mr. Thayne and found him watching her.

“The fever makes his skin itch,” she murmured, compelled to fill the silence. “Or the bedbugs.”

He studied her face in silence, and his straight, dark gold brows drew together, as though he puzzled through some particular matter. She felt undone by that look, felt that with it he reached beyond her skin and looked deep inside her heart and soul.

“Your thoughts?” he asked.

So, she had been right. He did want to hear her opinion. After making certain there was no one close enough to overhear, she rested her fingers on the side of Mr. Scully’s throat, counting his pulse, watching the rise and fall of his chest. “Fever. Rapid breathing. Rapid pulse.” She looked up. “He is confused and disoriented. I saw earlier that the putrefaction and rot have spread past the hip. There are red and purple streaks all the way to his waist. I do not think there is much we can do but make him as comfortable as possible.”

Mr. Thayne nodded. “If you had been responsible for his care from the moment he arrived, what would you have done?”

Sarah wet her lips. “I would have amputated. But I would have first boiled the linens for his bed and the cloth used for dressing the wound. I would have made my cut a little higher, above the infection. My father taught me that it is essential to remove as much damaged tissue as possible. I would have changed the dressing more frequently. And—” She hesitated to say the next bit. He would think her mad.

“Go on,” he said, a command.

“And directly after the amputation I would have applied molding bread before the dressing.” There. She had said it. She waited for him to dismiss her words.

Instead, he said, “Molding bread? Why?”

In for a penny, in for a pound. Her chin kicked up. “My father learned the technique from a woman in Scotland years ago. He had traveled to Edinburgh to attend the anatomy lectures of Robert Knox and he stayed on to travel the countryside. The woman was a healer. The folk in her village both respected and feared her skill. She told my father the mold lessened putrefaction. She gave him a jar as a parting gift. When I was small, it was my job to feed it.”

“Your job to feed it? Now there’s an image.” The corners of Mr. Thayne’s lips lifted. Sarah stared at his mouth. She had elicited that tiny smile. It was for her and her alone.

She could not help but smile in return. “I added stale crusts of bread and the mold proliferated. When my father used it up in treatment, I fed it more bread.”

He made a soft laugh. “An odd pet.”

“It was,” she said, his laughter warming her even more than his smile.

“And did the mold save your father’s patients?”

“Some,” Sarah said as she glanced about once more. The matron watched her from across the ward, arms crossed, a frown clouding her features.

Mr. Thayne followed her gaze and intuited the situation. With a dip of his chin, he said, “We will speak of your pet another day. I leave the patient in your most competent care, Miss Lowell.”

His words shimmered through her, and she wondered if he knew how much she valued his acknowledgment of her skill. She knew she was competent. It wasn’t that she needed his validation, but acknowledgment was…nice.

As Mr. Thayne turned to leave, Mr. Scully lurched up and caught hold of his frock coat, tightening his fingers in the material so that his knuckles showed white.

“Please,” he begged, his voice slurred, as though he had already been well dosed with the gin Mr. Thayne had recommended. “Please do it for me. Do it quick. With a knife, or some other way. Fast and clean. This is a terrible suffering, and we both know they’ll only come again. What if you are not here to speak for me? What if they drag me to that table and hold me down and cut my flesh? I do not want to die that way, sawed into sections like wood for a fire.” He paused, and then said in a clear, ringing voice, “Kill me and be done with it. You know the way of it, Mr. Thayne.”

A heavy hush fell on the ward. Many eyes watched the scene unfold and many ears listened.

Mr. Thayne held the man’s gaze for a moment, his expression ruthlessly neutral. “Sleep now,” he said. Then he reached into his pocket, withdrew his bottle-green spectacles, and slid them on to hide his eyes.

A mask, Sarah thought. A wall.

With a groan, Mr. Scully loosened his hold and dropped his hand back to the sheets, his eyes rolling back and his lids lowering. His hand slid down to hang at an uncomfortable angle, and Sarah moved forward to set it back on the bed.

When she looked up once more, a single shaft of light broke through the grime of the window to cut across the floor exactly where Mr. Thayne had stood.

But he was gone. Disappeared. His passage silent as the mist.