And Joel managed the operation, though not without considerable expense of pain to his patient, who turned so pitiably pale while tightening his mind, that Joel remarked, "Ah, sir, you aren't used to it, that's how it is. 
And Joel managed the operation, though not without much pain to his patient, who turned so pale that Joel remarked, "Ah, sir, you aren't used to it, that's how it is. 