by William Boyd
“I’ll die.” She looked at him candidly.
“Yes.”
When the two men returned to the living room Sieverance sat down in a chair and began to weep softly. Carriscant felt a huge awkwardness, but managed to stand by him until he composed himself, squeezing his shoulder in what he hoped was a comforting way. He felt like weeping himself as he explained what the future held for her and what had to be done.
“There is no other course of action, Colonel Sieverance. She’ll die, I’ve seen it happen countless times.”
“But this operation, have you ever performed it?”
“It’s rare. I’ve done it twice, but without success unfortunately.”
“Meaning what?”
“I was too late. The appendix had ruptured, sepsis was advanced, uncontrollable.”
“Jesus Christ, you want to cut her open and you’ve never saved a patient with this operation?”
“Look, Wieland’s ridiculous purgatives are just going to weaken her faster. You might as well cast a spell for all the good it’ll do. She has to have the operation.”
“I can’t risk it.”
“Ask her.”
“She’s in pain. How can she make a clear judgement?” His voice was shrill, girlish, demented with worry. He stood up and walked to the window and peered out into the night. “Wieland’s due here in half an hour.”
“Don’t ask him, man. He knows nothing. Take her to the hospital, we’ll operate tonight.”
“I want to wait for Wieland. Then I’ll decide.”
Dr Wieland did not bother to conceal his huge displeasure, and neither did Dr Cruz, whom Wieland had asked to accompany him, so he said, to confirm his diagnosis.
“Dr Carriscant has absolutely no business here,” Wieland said, anger distorting his voice. “Mrs Sieverance is my patient.”
“He has my authority,” Sieverance insisted. “My wife is ill and I want the best for her.”
Wieland had to accept this which he did with manifest bad grace before pronouncing his diagnosis.
“We think, and Dr Cruz agrees with me on this, that the gut is inflamed due to a lack of mobility. The calomel will encourage movement of the gut and at the same time the opium will control the pain. Within two or three weeks—”
“—she will be dead and buried,” Carriscant said brutally. He saw Sieverance flinch.
Cruz rounded on him and spoke harshly and rapidly in Spanish. “How dare you contradict us. This is as clear a case of perityphlitis as I’ve ever seen. All this fashionable nonsense about the appendix is unforgivable in the current circumstances. I deplore your presence here and I order—”
“Gentlemen, please,” Sieverance said. “Let me understand this: you completely oppose Dr Carriscant’s idea of surgery, and you wish to continue with the purgatives and the opium.”
“And a broth four times a day,” Cruz added in English. “With alcohol. For to strengthen.”
“Colonel Sieverance, do not delay, I beg you,” Carriscant said. “Your wife must be operated on at once.”
“This is a colic which has inflamed the intestine!” Wieland shouted at him. “To open the abdomen is tantamount to murder.”
“The king of England had his appendix removed a matter of months ago,” Carriscant retorted, keeping his voice calm. “It saved his life.”
This seemed to silence them for a moment. Then Wieland said, without much confidence, “We are not talking about the same problem here, it’s a false analogy.” He turned to Sieverance. “The problem with someone like Dr Carriscant is that he will operate without reflection. If you had indigestion he would suggest removing your appendix. This is the so-called modern approach, and Carriscant does not care—”
“Just one minute,” Carriscant interrupted, approaching Wieland, who backed off. “Be very careful what you say, Wieland. If you slander me, I won’t answer for—”
“For God’s sake!” Sieverance was exasperated. “I’m going to talk with my wife. A moment, please.” He left them alone in the room.
Cruz said, malevolently, “You’re finished, Carriscant. This is a gross violation of medical ethics.”
“Sieverance called me in himself, you stupid old fool.”
“Yes, you bastard,” Wieland shouted at him, “only because of the filthy rumours you’ve been whispering in Taft’s ear.” He pointed a shaking forefinger at him. “What is it with people like you, Carriscant? You’re knife-happy. Can’t wait to cut, cut, cut. Mrs Sieverance isn’t some corpse in a dissecting room!”
“Of course she’s not.” Carriscant caught himself just in time, his voice heavy with emotion. “She is on the verge of death. I can save her. You two idiots would just prolong her agony, draw it out for a day or two with your useless potions.”
“You disgust me,” Cruz said. “You’re a worm, an insect, you dishonour the profession.”
The three of them faced each other, silenced by their virulent animosity. Carriscant felt a vast weariness of spirit sweep through him. They could trade insults for hours, he realised; neither of them would yield an inch of ground. He turned his back on them and walked across the room. There was a small grand piano at the far end, with piles of sheet music stacked on the cover. This was her music, he knew intuitively, as he picked up some of the scores—Brahms, Mendelssohn, Mozart—and he raised the edge of a piano concerto to his nose as if expecting it to be redolent of her, somehow.
“Dr Carriscant,” Sieverance said, re-entering the room.
“My wife would like to see you.”
Sieverance accompanied him back to the bedroom. Her face had a wracked, exhausted look to it. Her hair was damp around her brow and temples.
“I heard your voices raised,” she said. “What’s happening?”
“Dr Wieland counsels against surgery,” Sieverance said. She looked at Carriscant, directly. The dark eyes seemed bigger than ever. “What do you think?”
“I think…” The question unmanned him completely and he felt an upswelling of an emotion in him that he did not recognise. Her gaze held him to the exclusion of everything else. “I think Wieland is a fool and a charlatan and anyone who listened to him would be mad,” he said. He wanted to reach forward and take her hand and press it to his lips. “You don’t have much time,” he said with controlled passion. “This operation is very straightforward. It’s only when people delay that there is real danger.” He hoped his eyes said everything his words could not: I will save you, I will make you well, trust me with your life, no one else will cherish it like I do.
She raised her hand weakly, and seemed to offer it to him, as if she had heard his thoughts. Sieverance stepped forward and took it.
“I want to go with Dr Carriscant,” she said.
INTO THE BODY
The morphine had sedated her, her mouth was slack, her eyes half closed, unfocused, seeing the world through the screen of her lashes. Pantaleon stood at her head with his mask and his chloroform drop–bottle. Two theatre nurses with their starched pinafores and frilled caps waited beside the grooved trays of gleaming instruments. Delphine Sieverance lay on the operating table still in her nightgown, having been brought directly to the theatre from her house. There was no time to lose; everything had been prepared with the utmost speed.
Pantaleon looked at him. “The wind is freshening. Time to weigh anchor.”
Carriscant nodded and Pantaleon dripped chloroform on to the mask. She was unconscious within seconds. Carriscant reached for the hem of her nightgown and remembered. A crucial act of preparation…
He cleared his throat. “Would you please leave the room. Just for a moment or two. Everyone, please, Pantaleon.”
The nurses and Pantaleon glanced at each other and left the room without further question. Carriscant closed his eyes and a slow shudder ran through his body. He gripped the nightdress hem and lifted it up, pulling it up her body until it bunched at her ribs. His eye went first to the dense golden-ginger furze of her pubic hair and then took in the
paleness of her torso, almost bleached in contrast to the stretched inflamed area of her lower belly where the infection glowed luridly beneath her skin, the fateful roseate blush of incipient peritonitis. He drew a great gulp of air into his lungs, turned and went to search in a cupboard beneath the sink for the implements he needed. He found them and stropped the razor rapidly on the thick leather band hanging above the taps.
Over her body once more he quickly foamed up a lather on the shaving soap with the brush and then, with short circular sweeps, he worked the white spumy suds into the wiry curls of her pubic hair. Reflexively he tested the edge of the blade on his thumb before, with four or five firm passes, he shaved away the hair on her mound. He wiped the remaining soap away with a towel and, unable to resist, he placed his hand there a moment, feeling it smooth and cool, until the heat of his palm warmed the skin. He moved his hand inches to the left and, palpating gently, felt the engorged shape of the abscess. He made tiny marks on her skin with a chinagraph pencil to act as a guide—my marks, he thought, my sign and delineate the area where he would cut. He laid white cloths over her belly and thighs, leaving only the area to be operated on clear, and called the others back in. They said nothing, made no reference to what might have happened in their absence, and took up their positions again.
“Scalpel.”
Carriscant felt the nurse press the slim weighted heel of the knife into his open palm. His fingers closed around it and the sudden terror that sluiced through him almost made him stagger with alarm. In all his years as a surgeon, all the hundreds of times he had stood poised with a knife above a living human being, he had felt nothing but the elation of the job he was about to do. This bowel-loosening anguish was shockingly unfamiliar. He felt a tremor in his hands as he laid them on her taut flushed belly. What was happening to him? Where was this awful fear, this uncertainty coming from?
He forced the curved blade to indent the flesh, just above Poupart’s ligament on the right side, and forced himself to apply more pressure until it bit through the epidermis and the blood came. He drew the knife across, making a cut of about six inches, revealing the blood-flecked fatty tissue and then the nacreous surface of the peritoneum, like a soft red-veined yellow marble. Here was the moment: another cut and the abdominal cavity was exposed. He widened the opening and then reached down with his finger and pushed it into her body to find the appendix. He located it, now enlarged to a swollen suppurating abscess, and drew it gently out of the body. He inserted a rubber tube into the cavity it left and drained the fluid out. The nurses swabbed and cleaned. He tied off the appendix from the caecum and cut it free. He closed the wound and stitched it, dressing the cut with iodoform gauze.
He stepped back and looked at the clock on the wall—only thirty-five minutes had passed. He felt exhausted, ruined. He washed his hands and moved through in a daze to the dressing room. He sat in a chair, elbows on his knees, head hanging, watching the sweat drops fall from his nose on to the hexagonal tiles beneath his feet. He heard Pantaleon come in and felt his reassuring squeeze on his shoulder.
“Very successful,” Pantaleon said. “I think we had an hour or two to spare.”
“I’d better see Sieverance.”
He changed his clothes and went through to his consulting room where Sieverance was waiting and told him that the operation was over and seemed to have passed off well. To his alarm and embarrassment, Sieverance collapsed in his arms, in a kind of weeping swoon and had to be revived with a small glass of brandy.
“It’s all right,” Carriscant said to him. “It’s over. It went well. I’m sure she’ll be fine.”
Sieverance clung to him, fingers clutching his biceps, like a drowning man just hauled from the water.
“Bless you, Carriscant,” he said. “Bless you, I’ll never forget this.”
Carriscant said something to him, something bland and consolatory, knowing that there was a double dose of truth in Sieverance’s affirmation. He would never forget, that was for sure, as it was also for sure that he would never cease to regret, either.
A ‘SIMPLE SURGEON’
Salvador Carriscant stared at the interleaved fingers of his hands, trying to pray, contemplating the horizontal and vertical creases on his knuckles, each one unique and different, like Chinese ideograms scored in the loose flesh above the fingerbones. Why should that be, he wondered, idly? The first joint, say, of my left little finger moves identically to the right joint, yet the creased flesh on the left forms a distinct starburst effect, whereas on the right—
He raised his eyes, to the nape of the man’s neck bowed in the pew in front of him. Collar too tight, small canopies of flesh overlapping on either side. Hair growing right down the neck too. No. Rather growing up, from his back. How far down should the barber trim? Kindly remove your shirt, sir. He looked back at his prayer-clasped hands: the skin between the finger joints with their small neat patches of hair, almost tended-looking, all growing in the same direction. Densest on the ring finger, curiously, wonder if that’s true of other men? Liver spot on his hand-back. Or a big freckle, maybe?
He thought at once of the freckles on Delphine Sieverance’s forearm, upon and over which his eyes had rested and travelled as he had taken her pulse the day before. Freckles at her throat too, at the top of her chest and the tender indentations of the collarbone. How far down did they go, he asked himself. Would her breasts and shoulders be dappled with pigment, like a trout, like some hen’s eggs you see, a light shading? There were none on her belly, none on her—
He closed his eyes as the priest invited the congregation to join him in prayer. Carriscant moved his lips and felt a sound blurt from his chest, half moan of longing, half frustrated grunt of pain. Annaliese nudged him sharply with her elbow and he looked round at her, his eyes full of pious apology, and he tapped his chest and made a face as if he had indigestion.
“…tibi Domine commendamus animam famuli tui, ut de-functum saeculo, tibi vivat…”
“Amen,” he managed to say.
The congregation gathered on the steps of the Santa Clara church while they waited for their carriages to arrive. Annaliese chatted with acquaintances while Carriscant stood alone, hands behind his back, head down, the toe of his shoe tapping out a rhythm on the cracked marble steps. He exhaled and put on a smile for a Spanish family that he vaguely knew—a man helping his ancient, lace-shrouded mother-in–law down the shallow steps to the waiting victoria. Her face was white and dull, matt with face powder. How old? Somewhere in her eighties. What changes she had witnessed! If she looked to her right she could see the big Stars and Stripes flying over Fort Santiago; to her left the Plaza Mayor, now renamed Plaza McKinley in honour of the assassinated president. Sixty years ago, when she was a haughty young peninsulara such notions, such transformations, would have seemed beyond the bounds of wildest fantasy. She was settled delicately in the little carriage now and some granddaughters climbed in beside her. She looked straight ahead, squid-black eyes moist and unforgiving. How much more of this new century would she see, he wondered? Probably ready to go now, keen. It happens. The body tires, the mind senses its fatigue: ready to go.
He was still pondering this question as he and Annaliese sat side by side in their carriage as they were driven down Calle Palacio towards their house. Annaliese was relating some article of gossip which he was barely registering. The carriage had to make a detour up Calle da Ando as the Americans were digging up a cobblestoned stretch of Palacio in order to macadamise the street. They turned left and as they crossed the Calle Real he suddenly told Constancio, the coachman, to stop.
“Where are you going?” Annaliese said in surprise as he opened the small door at his side.
“The hospital. As we’re so close. It occurred to me that there’s a patient I must see. I operated yesterday. I’m a little concerned.”
“But it’s Sunday.” Annaliese protested, her eyes heavy with…with what? Disappointment? Suspicion?
“My dear, ill health doesn�
�t take weekends off.”
“Don’t patronise—” She started again in a low raw voice, conscious of the broad back of Constancio, listening. “But you’re never at home, never, nowadays. Why don’t you move in, set up your bed there?”
“A most amusing suggestion, my dear, but really—”
“Salvador,” her voice brooked no further argument. “It can wait ‘til tomorrow. Nothing is so urgent.”
“You don’t understand. The new American hospital’s providing stiff competition. All these contract surgeons they’re bringing over. I’m only thinking of our future.” The lie sounded feeble and inept; he felt he could taste it in his mouth, a sour ashy thing. He backed away without a further word, waved and smiled and strode off up the Calle Real towards his hospital.
Delphine Sieverance had made a slow but sure recovery from her operation. The first week had been the worst with the agonising fear of peritonitis on everyone’s mind, but as time passed and she regained her strength it became clear that the operation had been a total success. She had been in the San Jeronimo now for almost two weeks, in a private room, and was now able to swing herself out of bed and take a few shuffling steps across the floor to the window. Carriscant saw her every day without fail, even if it was only for a matter of a few minutes, but rarely alone. Sieverance had employed an American nurse to sit with her at nights and he himself was often there. She had many visits from friends, also, and the news of the operation, its danger and her steady recovery had already brought Carriscant an increase in American patients. His renown had spread and he was busier than ever. But the important factor for him was her presence: she was there, close, under his roof. He could climb the stairs, knock on her door, take her temperature, consult her charts, order her dressing changed. He could be near her, he could be with her whenever he wished. The itch could always be scratched, the craving always satisfied. But now it was the thought of her leaving that began to weigh on him. Sieverance had asked if she might be home for Christmas and Carriscant said that he was sure it would be possible. The very fact that she was beginning to walk again made it difficult for him to insist on her staying in the hospital any longer.