Not for the first time, she was bone-grateful for the good health and regular food she'd enjoyed before disguising her sex and enlisting in the newly formed U.S. Army Medical Corps in 1862. After so many losses at the Battle of Bull Run, when thousands died from lack of access to medical treatment and the general dearth of physicians among the regiments, recruiters accepted anyone with the vaguest sort of medical training. No one looked carefully at the credentials, or the gender, of the inductees.

"We're low on chloroform," Milton said.

Vance nodded, considering herself fortunate that they had any of the fairly new substance at all. Rumor had it that the Southern surgeons had been making do with ether for months, a far less reliable anesthetic. "We've plenty of morphine and laudanum if we run out of the anesthesia."

"Well, if I need any cuttin' done, I want you to be the one doin' it."

Milton turned his head and spat a stream of dark brown tobacco juice.

"Ain't none of the others as quick and clean as you."

"Thank you, Milton," Vance said, having long since lost count of the hundreds of limbs she had removed. "Make sure you keep the basin of carbolic full and close by today."

"Yep. Don't suppose we'll be runnin' out of that real soon, seein' how you're the only one usin' it."

Vance knew that Milton, along with her fellow surgeons, thought the practice of dipping her hands into the caustic liquid between surgeries was not only time consuming, but foolish superstition. Nevertheless, Dr. Lister's theories about sanitation made sense to her. She thought of how many soldiers she had lost, not to injury, but to gangrene. Far more than she had saved. Her face, thinned down to bone from subsisting on little more than hardtack and salt-pork for months, grew grimmer still. "There's little enough we can do for them. I don't see that it will hurt."

"Right enough." As if recognizing Vance's dark mood, Milton said quietly, "This war can't last much longer. Not with Lee's forces split and us between 'em."

"I hope you're right. There's been far too much death." With a sigh, Vance straightened her shoulders and turned to check the progress of the soldiers assigned to the ambulance corps who were erecting the hospital tent and bringing up the supply wagons. Her operating table consisted of a wooden door removed from a grand plantation house balanced across two empty ammunition barrels. Her instruments were her own, brought from Philadelphia when she'd left her post at the hospital to take her skills where they were most needed. Those she cleaned and cared for herself, carrying them in an engraved wooden case that had been presented to her by her father the day she graduated from the Women's Medical College of Pennsylvania. That day in 1861, she'd imagined a life very different than this. But since then, everything had changed.

The sound of small arms fire drew her from a past that had seemed so certain into the present, to a life that might now be measured only in fleeting moments. An eerie sound drifted on the pristine whiffs of white smoke that rose into the air beyond the Union lines like so many puffs of breath. A keening, undulating cry of defiance and, oddly, joy.

The Rebel Yell.

"Here they come," Milton whispered with near reverence.

"Yes," Vance said, striding quickly toward the hospital staging area. She removed her coat and rolled back the cuffs of her white cotton shirt as she walked. Once there, she retrieved her surgical kit from the wagon and spread her instruments out on a rough pine bench next to the makeshift operating table. She doubted she would need more than the probes, the amputation knife, and the saw for the first round.

Minnie balls and cannon canisters left her little choice but to amputate.

She dipped her hands into the carbolic acid and shook off the excess, scanning the nearby rise for the first sign of wounded.

v "Look smart, men," General Philip Sheridan exhorted as he galloped up and down the forward line of the first of his three cavalry divisions, saber rattling against his thigh in its gold-braided scabbard.

"Lee's infantry will be upon us before the sun burns the dew from the grass."

Sheridan's line of mounted cavalry, poised for the signal to strike, shifted in the sunlight like a huge black snake, the horse soldiers and animals alike agitated by the sound of weapon fire and men screaming.

The light artillery, mounted on wooden platforms, bucked and belched fire as they disgorged their deadly hail of grapeshot. The ground trembled with the force of thousands of feet pounding the hard-packed red earth, and the air shimmered with the ominous thunder of war.

Vance heard the bugler signal the charge, and Sheridan's cavalry stormed toward the advancing rebel lines. Then from out of the smoke and shifting shadows she saw the first stretcher bearers emerge, running as fast as they could with their burdens of damaged humanity in tow.

When the first man was laid upon her table, the battle receded from her consciousness. There were only the wounded now.

"Change the saw blade," Vance said as she turned from the table and immersed her hands in the blood-tinged antiseptic in the basin balanced on a tree stump by her right side.

"Ain't got but two left," Milton said as he sluiced the blood and gore off the wooden tabletop with a bucket of water.

Vance looked at the line of waiting wounded. Those who could walk were sitting under the shelter of the trees, bandaging themselves or their friends. She might get to some of them before the day was over, but those who weren't seriously injured would wander back to their regiments before she ever had a chance to tend them. They knew as well as she that there was little she could do beyond what they had already done for themselves. Those who needed her services were the soldiers with major injuries to body or limb, and these waited on the bare ground in a dense semicircle that stretched as far she could see.

"We'll make do with the one we're using for now," she said. It had taken her a little over fifteen minutes to amputate the last leg because the saw blade was so dull she'd had to wrench it through the bone by sheer force for the last half inch. She'd always been active, eschewing the carriage to walk whenever she could and working in the gardens that surrounded her family home in the spare moments between her studies. She was strong enough in body to do what needed to be done, but her heart suffered. "Next."

The boy looked no older than fourteen and might not have been, because as the war had dragged on, anyone who could carry a rifle and declared they were sixteen was welcome in the ranks. The cannonball had struck him just below the knee, destroying most of his lower leg bone and leaving only a mangled mass of muscle connected to his foot.

She looked into the boy's eyes.

"I'm going to remove your leg, son, and you're going to live."

Vance nodded to Milton, who stood to her left with a cloth and a can of chloroform in his hand, and as he pressed the anesthetic to the boy's face, she tightened the leather strap around his lower thigh with one firm yank. Once again, she picked up the amputation knife bare- handed and swiftly cut down to bone, four inches below his knee. With a circular rotation of her wrist, she completed the incision around the stump and dropped the knife on the table in exchange for the saw. It should have taken her less than two minutes to transect the bone, but it required twice that long to worry the blunt teeth through the young healthy leg. When the destroyed portion fell onto the door that served as her table with a thump, Milton picked it up and tossed it onto a nearby pile of amputated limbs.

"Damn flies," Vance muttered, waving at the ever-present insects that buzzed around her head and the boy's motionless body, obscuring her vision. Milton passed her a straight needle threaded with black silk, and she rapidly located and sewed closed the major vessels in the stump. Then she covered the end of the exposed bone with a flap of skin and muscle and swiftly sutured it in place to complete the amputation.

Somewhere behind her she could hear men shouting, even above the cannon barrage and general cacophony of battle.

"Move him to the evacuation wagon. Next."

When another body did not immediately appear before her, she looked up questioningly. Sweat and blood spatter ran into her eyes and she blinked, then automatically wiped her face on her sleeve. Seeing Milton gesticulating wildly as a lieutenant on horseback leaned down and shouted something at him, Vance called out, "What is it?"

"Lee has broken Sheridan's line," Milton called on the run. "We're to fall back."

Vance looked at the wounded covering nearly every inch of ground around her and shook her head. "We can't move all these soldiers."

"Then we'll leave them for Lee's surgeons," Milton said, hurriedly gathering drugs and instruments.

"No. Lee's surgeons will take care of their own first, and these men need attention now. You go. I'll stay."

Milton stopped what he was doing and stared at Vance. "If you stay, they'll make you a prisoner."

"That may be. But I'm a surgeon and I'll be valuable to them. Go on, Sergeant. Leave me enough medicine for these men and go."

"I don't think I can do that, Doc." Milton moved up beside her.

"We fought together side by side these three years. Wouldn't be right.

Besides, my mama didn't raise me to leave a woman to stand alone when times got hard."

Vance stared into his placid brown eyes. "You know?" He nodded.

"Does everyone?"