Decades ago, when he was working at the coroner’s office, he’d been assigned the autopsy of a young woman who’d hanged herself after learning that her husband had frequented a brothel during her pregnancy. She would have been at term in a few weeks, and in her suicide note, she wrote of her intention to free herself of this unjust life and take her child with her. And that she did, for on the slab, her thin corpse was distended with what lay still within her. As part of regular autopsy protocol, he was required to extract the inhabitant of her womb, a cold and unmoving foetus that had never known the world outside her and now never would.
Later that day, unexpected visitors had knocked on his office door.
‘Doctor Saheb.’
Raising his eyes from his papers, he, a young man then, saw two aged, myopic faces.
‘The girl on whom you performed an autopsy today … we’re her parents.’
‘The morgue is to the left. A man there will have you sign some paperwork, and then you can take her for your rites. It shouldn’t take much time.’
It was a perfunctory response, his attempt to make the meaninglessness of death bearable through protocol. If only mourners could just occupy themselves with the mechanics of planning a funeral. Second door to the left. Sign here, here and here, that form too. And don’t forget to write the address of the crematorium.
But this elderly couple couldn’t be dismissed so easily. They stood there, waiting for something else.
He peeled his glasses off his head and laid them on the desk. It was a trite gesture, but it helped him offer his trite sympathies. ‘It’s so terrible this happened. So terrible you have to bear this. My condolences.’
‘Did she really take her own life?’ the mother asked.
His throat felt dry. He now noticed two shabby, discoloured bags on the floor behind them. They’d just travelled here from some distant village. Probably on the first bus they could board, jostled for hours by strangers who had no idea how their world had just been smashed. There was a good chance this morgue, and maybe his office, was their first destination from the railway station. Perhaps all they knew of her death was the little they’d been told over a bad telephone connection.
‘Did she really take her own life?’ she asked again.
What answer was he supposed to give? The simplest and truest?
‘Yes, she did.’
From beyond the swinging door came a distant guffaw. The attendants in the common room were sharing some lunchtime joke.
‘But why?’ the mother cried. ‘Why didn’t she just come to us? Did she think we wouldn’t take her back?’
All he could do was fidget with the pen in his hand.
And then she asked, ‘Was it a boy or a girl?’
Her words fell on his ears but did not sink in.
‘Was it a boy or a girl?’ she asked once more.
‘A boy or a girl?’ he repeated. Then the meaning of her question dawned on him. ‘Why are you asking me that? Why do you want to know?’
The woman put her palms together. ‘Forgive me, Doctor Saheb. We know you’re busy. We won’t take any more of your time. Please tell us if it was a boy or a girl, and we’ll go.’
‘It was a boy,’ he said, faltering, and then corrected himself. ‘It would have been a boy.’
At this, the old woman clasped her bony fists to her mouth and sobbed, as though with his words he had made flesh before her the tiny hands and toes and lips of her unseen grandchild. And not just that, but also the swollen face of her daughter and the furrow of that noose imprinted in her neck. He closed his eyes and turned away. The swinging door creaked as it swung again, and even after it stopped, he could still hear the sobs as the old man led his wife away.
In the coroner’s office, he steeled his heart against his work, dissociated from the subjects that lay uncomplaining on his slab. After all, what hope would he have of keeping his sanity if he took it upon himself to probe into the life of every corpse? He only needed to think of them as clocks that had stopped, and of himself as the watchmaker assigned to list the springs and coils that had failed. No obligation to repair anything. He did this for two years, but then it became too oppressive, and he wanted something more. The empty ambition of youth, as he thought of it now. Look what it had brought him.
‘I’ll have to shave your hair,’ he said to the teacher’s wife.
She looked startled. ‘All of it?’
‘Just the back of your neck and a little way up. Is that all right?’
‘Yes, Saheb, I didn’t mean to question you. Whatever you need to do.’
‘Put on this gown.’
He thought of stepping out of the room so that she could change in private, but it would require him to reshuffle the cart and trays he had arranged in the cramped space behind him. So he just cleared his throat and turned to the wall. Behind his back, the dead woman undressed from the waist up and slipped on the tattered green surgical gown.
‘I’m ready.’
Using a fresh razor, he shaved her nape and the back of her head. Fine strands fell on her shoulders. The hair of the dead, no more or less dead than the hair of the living. He brushed it into a tray. The rest of her hair he helped bundle into a surgical cap. He positioned her, neck arched backward, head elevated with wooden blocks, contorted into a pose that would allow him full advantage of the meagre light. The position would have been unbearable to anyone capable of feeling pain, but he found that she could hold it without complaint, as if she were a mannequin. After cleaning her wounds with iodine and alcohol, he draped her so that only her neck and its injuries were exposed. Only when he’d laid a drape across her face, covering her eyes, did his shoulders relax a fraction. He didn’t want her looking at him while he worked. He could not bear her unreasonable hope.
Her neck had suffered at least two deep strokes and a few shallower ones. The skin was shredded and hung in strips, and the tissues beneath were sliced at jagged angles. Some muscles had been partially cut as well, even the one that was supposed to be necessary for her to turn her head. That she could support and move it naturally despite this was as remarkable as her ability to speak.
Part of the larynx lay open before him in a macabre display of cartilage. Now, with her neck bent back, air puffed through the opening with every breath. Blood vessels with dull red clots within them poked out of the ravaged mess. The most prominent vessel – the carotid artery – was also the one that had suffered the most ominous damage, for the two deepest knife strokes had cut into it at different angles, detaching a flap from one of its sides. This had carved a window into the vessel, through which her blood had probably spurted out with such speed that her suffering had likely been the shortest of the three. But the flap had somehow stayed in place, attached by a strip of tissue so narrow that he was surprised it hadn’t fallen off in the few hours since she’d appeared in his clinic. If it had, there would have been a gaping hole in the vessel, and nothing here would have allowed him to close that.
He wasn’t trained to deal with injuries like these, to the neck, to the larynx. Even recalling some of the fascial planes, the names of the smaller muscles, the positions of the nerves, was beyond him now. There was a volume of anatomy in his cupboard somewhere, three decades old at least, its binding tattered. He wished he’d thought to skim through it earlier, but it was too late for that now, and he wasn’t sure it would have helped. He would have to feign a mastery he did not possess, and braid together the frayed threads of her life as best he could.
He unwrapped the suture casing and grasped with his forceps his thinnest needle and suture. With it he pierced the lower half of the carotid stub. The needle made too large a hole in the gossamer structure, and the suture looked thick and unwieldy, a jute rope hooped through silk. He passed the needle through the corresponding point in the upper half of the vessel and tried to bring the two edges together, but one of the ends had retracted between the muscles of the neck, and his thread tugged at the vessel’s edge, threatening to te
ar it. Only the first stitch, and already there were premonitions of defeat. In slow, painstaking loops, his needle crept one stitch at a time around the curve of the vessel.
The night wore on, his back stiffening as he stooped over his work. Finally, with difficulty, he stood upright again. Over an hour had likely passed since the surgery began, and the woman hadn’t made a sound, hadn’t moved, hadn’t so much as inflated her chest. Surely she was just holding her breath to help him, but perhaps it wasn’t a bad idea to confirm that she was still there, still alive. Though alive wasn’t the right word, of course. There was no vocabulary for this kind of thing.
‘Is everything fine?’ he asked.
There was a movement under the covers, lips brushing against drapes, neck muscles twitching as she moved her jaw to speak. Was that even necessary, though? Maybe the dead could speak like ventriloquists if they wished, with mouths slack and tongues still.
‘Yes, Saheb.’
‘Any pain? Any discomfort? Do you need to change your position?’
‘No, Saheb, don’t worry about me.’
It was remarkable how one could get accustomed to even such things. The surgeon no longer felt the deep, acrid bite of moments like these. He could speak calmly to a woman whose neck lay open before him, forceps sticking out between her cartilage and muscles. A glaze of unreality had settled over everything, as though his vision had permanently warped.
He looked up at the wall to his right, but it was bare. He’d forgotten to hang the clock up again after he changed its battery. And he’d removed his wristwatch and left it on his desk in the other room. Unless he either broke his sterile field and ventured out of the room, or called out to the pharmacist, who was probably sleeping as he’d instructed her to, he had no way of knowing what time it was. He closed his eyes for a moment, trying to add up every stitch he’d placed and multiply that number by the time each one had taken, and at once devious sleep hooked its anchors on his eyelids. He opened them in panic and stamped hard on one foot with the other, making his toe pulse with pain. It was still night. He had to stay awake.
Pushing all other thoughts away, he again took stock of the surgical field. All of this time spent, and so little accomplished. He’d sutured the upper edge of the carotid flap to the margin from which it had been torn, and just begun working on the other. The flap bristled with sutures. Clumsier than the precise work he’d once been capable of, his stitching had pulled and constricted the artery into an angular shape, as though an unskilled plumber had forced together a series of crooked and ill-fitting pipes. And the hole in the vessel still gaped. Any attempt to close it would only twist it further.
The fluorescent light emitted a low electric buzz that he hadn’t noticed before. Outside the window, a lone crow cawed – a cry of insomnia and longing, if indeed the fauna of this earth were subject to the same torments as mankind. He looked up at the metal loop in the ceiling and shifted his neck this way and that, but it no longer seemed like an eye. It just returned to him the bland look of an inanimate object. The ceiling had no sight, nor did anything beyond it. The dead had been flung at his feet and abandoned.
What was he going to say to them? How would he tell them that she wouldn’t survive?
The sweat was making his brow itch, and he dabbed at it with his sleeve, careful not to let his glove touch anything that might not be sterile. He abandoned the suturing of the carotid artery for now. He would tackle the trachea instead.
‘This part of your throat, the part through which air flows to your lungs, it’s damaged. If I leave it this way, you’ll have trouble breathing in the morning. So I’ll have to make another hole right here, lower in your neck. To help the air flow.’
The surgeon explained the plan with as much optimism as he could summon up, and the woman nodded under the drapes. Whether she understood a word, he had no way of knowing. She would have nodded at anything he said.
He rolled his gloved fingers over the skin that covered the cartilaginous bumps under her larynx, and decided on an appropriate spot at the midline of the neck, just a little above the point where the collarbones met the sternum. It would have to be a little lower than was customary, yes. The murderer hadn’t thought of surgical convenience when he slashed with his blade. The surgeon sliced the skin cleanly and teased away the thin, bloodless layers of tissue with his knife and forceps, pushing aside the muscles that ran like straps along either side of the trachea. Her thyroid was a little larger than he’d expected, and its bridge gripped and covered the front of the trachea. He cut through it. Now he could feel the tracheal rings, and he made a neat cut through them as well. Even though he had no need to fear that she would die on him, his heart still pounded at this step from force of ancient habit. He didn’t have a tracheostomy tube, but he’d managed to dig out an endotracheal tube from some old supplies. He inserted one end into the trachea and closed the skin around it. The other end protruded from the neck, and he harnessed it to the skin with loop after loop of suture. The sutures slipped against the smooth plastic, and some fell loose even as he placed them. The tube wasn’t designed to be tied like this. He secured it as best he could.
Then he turned to the larynx and began to sew the torn sections of cartilage back together. It was slow, painstaking work, and there was really no way to hurry. There were other arteries and veins too. Diligently he addressed them, trying to pretend that the most crucial problems had been resolved, and now he was just finessing the details. But the carotid would determine whether she lived or died, there was no doubt about that. He felt like a labourer pressing a thousand pellets of clay into hairline cracks in a breached dam, as if all of that toil would somehow compensate for the enormous rift in the centre. Holding sleep at bay with every blink, he focused on the blood vessels, one by one, reconnecting some, tying the superfluous ones into blind stumps.
Finally there was nothing left to do but put the last sutures in the flap of the carotid. As he tightened the last knot, he couldn’t help but cringe. But he could either do this or just leave it open, and there was no possible world in which the second choice was the better of the two. The result was terribly unsatisfactory. The vessel looked deformed. There was none of the craftsmanship of which he’d once thought himself capable. He imagined the vessel pulsing with blood, and then imagined it immediately tearing or clotting.
He stitched the torn ends of the muscles together and closed the tissue planes. There was no clean incision along which to close the skin, so he sewed it back along the lines of its rupture, along the blueprint that the murderer had forced upon him. The jagged rows of stitches looked like railway tracks placed by a deranged engineer, crossing each other at strange angles. If the carotid were to leak, the mesh of skin and nylon would never endure the strain of the expanding pocket of blood.
Perhaps he could save her husband, so that the boy wouldn’t end up all alone.
And then, just for a moment, he allowed himself a thought that was unacceptable for him: perhaps it might be better if he sabotaged the surgeries, made sure that they all died, all three of them. At least in the afterlife they would remain together. Dawn would come, and it would all be over. The dead would return to where they belonged, and the living would mourn and, in time, forget them. And he would sleep, let his eyelids fall and sleep, let all darken, let the world grow quiet. It would be so easy, nothing much, a couple of cuts, a few slit blood vessels. So many people died every day, what difference would it make if there were a few more? He would be doing them a favour anyway, sparing them so much agony. In the long run, they would be thankful, and they really had no business on this side anyway. This was the side of the living. The dead ought to have known better, ought to have stayed where they were so that the living could continue with their days and nights, with their work and their sleep. Perhaps he could turn them out into the dark, force them across the village boundary, by trickery if need be, so that they could drop there. What a silent, painless end it would be. If only everyone could be so fort
unate, blessed with the option to just walk into an invisible wall and disrobe from their skins, walk into the embrace of death, which would welcome the dead, so that the living could go on to live, and rest, and sleep.
It was dreadful, what he was capable of thinking, what he might even be capable of doing, just to appease the demons of his exhaustion.
The surgery was done. He undraped the teacher’s wife and raised her from her reclining position, supporting the back of her head so that the sutures wouldn’t pull. He then wrapped and taped bandages around the neck, around the endotracheal tube, until the neck appeared almost twice its natural thickness. The tube protruded from the front like a proboscis, bobbing under her chin with every movement. He screwed an inflatable bag to the tube’s outer end and forced air through it, confirming with his stethoscope that both lungs filled with each puff.
‘The less you move your neck, the better. I’ve stitched the tube in place, so it shouldn’t fall out. But be careful. Your ability to breathe will depend on it.’
Then the surgeon busied himself gathering and wiping his instruments so that he wouldn’t have to answer her eyes. She sat still, so still, and for so long, while he cleared his trays, that his silence began to feel more and more unacceptable. Since he couldn’t bring himself to offer her a prognosis, he just said, ‘Come, I’ve finished. I did what I could.’
Her face appeared taut. ‘I’m not afraid of death, Doctor Saheb. Just save my son and my unborn child.’
The walls of the operating room, grey and yellow in the murky light, seemed to close in on the surgeon. He willed the claustrophobia away, wished for it to be replaced with light and air and breath, but he had as little power over this as over anything else. So he just helped the woman down from the table.
Ten
THE PHARMACIST WASHED THE DRAPES and instruments from the boy’s surgery and packed them in a drum that she lowered into the pressure autoclave. After tightening the screws around the edge of the lid, she pressed down a switch on the wall, and a small red light glowed. The temperature gauge was broken, its hand stuck at the fifty-degree mark, so she wet the tip of her finger with her tongue and touched the drum a few times to make sure it was heating as it should. When it began to hiss and steam, she wiped her finger on her dress.
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