by Yann Martel
"All right, I'll perform an autopsy on your husband. You'll have to wait here."
"Why?"
"Autopsies are not a public spectacle."
Not true, of course. They have been a public spectacle throughout the history of medicine. But not for the general public. More for the specialized public. How else would doctors learn their trade?
"I'm not a spectator. I was his wife for sixty years. I will be there with him."
There is a forceful finality to her last sentence, the words of a woman who has so few wants left that the ones she still has are filled to the brim with her will.
It is unseemly to argue late at night, even more so with a grieving widow. Again his practicality suggests a solution. He will stand her next to a chair. At the first cut, the one that opens the chest, she will feel faint. He will assist her to the chair, and then, when she's recovered, bring her to his office, where he will leave her while he finishes his work.
"Very well. Have it your way, Senhora Castro. But I warn you, an autopsy, to the uninitiated, is not a pretty sight."
"I've slaughtered my share of pigs and chickens. A body is a body."
Except for the swirl of emotions, Eusebio observes to himself. We don't love our pigs and chickens. We don't mourn our pigs and chickens. We don't even remember our pigs and chickens. But let her see for herself. That is the very meaning of the word "autopsy", from the Greek, to see with one's own eyes. She will not last. Even the toughest old peasant, placed so close to death, will want to retreat back to life. Only she must not fall and hurt herself.
"Perhaps you could help me with the body," he says.
A few minutes later, Rafael Miguel Santos Castro is lying on his back on one of the two operating tables of the pathology department. Without any fuss, Maria Castro helps him remove all her husband's clothes. She pats down his hair. She rights his penis, setting it straight over the scrotum. Then she surveys his body as she might her vegetable garden, pleased to see that everything is in good order.
Eusebio is unnerved. This is how he looked at a body when he was a medical student, interested, curious, game. Death was an impersonal sport. This here is her husband. He regrets his decision to allow Maria Castro to assist at the autopsy of her husband. What was he thinking? It's the fatigue. He will not face any problems with the hospital or the medical college. There are no rules about who can assist at an autopsy. He is captain of his ship. Only this is no sight for a loved one, the raw nakedness of the man, in a setting that is necessarily cold and sterile--and that's before he has even touched the peasant's body with his science. How will the man's wife react then?
He dons his apron and ties the knot. He could offer one to Maria Castro but thinks better of it. An apron will encourage her to get close.
He looks at his tray of tools. They are simple but effective: a few sharp scalpels and knives, some forceps and clamps, a pair of blunt-nosed curved scissors, a chisel, a wooden mallet, a good saw, a scale to weigh organs, a ruler clearly marked in centimetres and millimetres to measure them, a long, flat knife to slice them, sundry sponges, and needle and twine, to sew the body up afterwards. And the pail for slop, at the foot of the table. Of course his main tool is his microscope, with which he examines the slides of the biopsied and excisional specimens and the samples of body fluids. That is a key part of his work, the histological work. Under the pathologist's microscope, life and death fight in an illuminated circle in a sort of cellular bullfight. The pathologist's job is to find the bull among the matador cells.
He should have taken the body away and returned a few minutes later with some slides, claiming they were specimens from her husband's body. She wouldn't know better. Flying over these colourful landscapes using Jose's two-headed microscope, he would have spouted medical hocus-pocus. Ah yes, it's absolutely clear to me, Senhora Castro. You see the pattern here and here. It's the classic architecture. No doubt about it. Your husband died of liver cancer. Or, since she avoided the word, he would have said that her husband lived of liver cancer. Then she would have gone away, sad but satisfied, able to move on--and spared the butchery of her husband.
But it's too late for that. There she stands, next to the table, without the least interest in the chair he has brought in for her.
Perhaps he could get her to sit in Senhora Melo's alcove. What would he and Jose do without the indefatigable Senhora Melo? Her office, which is not much wider than the table on which rests her typewriter, abuts the wall shared by the two autopsy rooms. On either side of it, at the level of her head, is an opening fitted with a panel of straw weave that gives onto each room. The multiple tiny holes of the weave allow her to hear with her ears but not see with her eyes. If it were otherwise, if she saw the dripping organs and the disembowelled bodies, she would shriek and faint, and she is there to record, not to react. She types with extraordinary speed and accuracy, and her Latin spelling is excellent. Senhora Melo's assistance allows him and Jose to observe and speak as they are doing, without having to stop to write. They have so many autopsies to do. As it is, while one doctor works and dictates, the other finishes up with a body, takes a break, then prepares for the next case. Alternating like this, the two doctors efficiently perform autopsy after autopsy.
Sometimes, after he has made his confession to Father Cecilio, it occurs to him that Senhora Melo might be a better confessor. To her, many more harsh truths have been revealed than to Father Cecilio.
He normally wears rubber gloves when he performs an autopsy--a fairly recent and welcome advance in technology. He treats his gloves with great care, washing them with soap and water every day and keeping them moist with mercury biniodide spirit. But he hesitates to pull them out now. Maria Castro might think that by wearing them he is expressing disdain for her husband's body. Better in this case to go back to the old bare-hands technique.
But first he will replace the strip of flypaper. Flies are a persistent problem in Portugal's climate. They thrive as peddlers of contagion. He makes it his regular business to replace the yellow coils that hang in the autopsy rooms.
"If you'll excuse me," he says to Maria Castro. "Hygiene, order, routine--all very important." He takes the chair intended for her and places it under the used strip, climbs onto it, removes the strip studded with the fat bodies of dead flies, and replaces it with a new, bright, gluey strip.
Maria Castro watches him silently.
From the chair he gazes down at the autopsy table. They never look very big on the table, the bodies. It's built to accommodate the largest frames, there's that. And they're naked. But it's something else. That parcel of the being called the soul--weighing twenty-one grams, according to the experiments of the American doctor Duncan MacDougall--takes up a surprising amount of space, like a loud voice. In its absence, the body seems to shrink. That is, before the bloat of decomposition.
Of which Rafael Castro seems to be free, likely the result of the cold, but also of the jumbling of his body while travelling in a suitcase. Eusebio is used to being greeted by the Mortis sisters when he comes to work. The oldest, Algor, chills the patient to the ambient temperature; Livor, the middle sister, neatly applies her favourite colour scheme--yellowish grey to the top half of the patient and purple red to the bottom half, where the blood has settled--and Rigor, the youngest, so stiffens the body that bones can be broken if limbs are forced. They are cheery ones, these sisters, eternal spinsters who ravish innumerable bodies.
Rafael Castro's ears are deep purple; there is only that touch of Livor Mortis. And his mouth is open. The agonal moment is the last knock of the body at the door of the eternal before that door swings open. The body convulses, the breath rattles in the chest, the mouth opens, and it's over. Perhaps the mouth opens to release the twenty-one grams. Or perhaps it's nothing more than a relaxing of the mandibular muscles. Whatever the case, the mouth is usually closed, because bodies always come to him washed and prepared, the jaw tied shut with a strip of cotton fabric, the knot resting on top of the head, th
e hands bound together in front of the body, and the rectum and, if the case be, the vagina packed with cotton batting. Cutting these ligatures and removing these stops are the first steps in opening the book of the body.
The teeth seem in good condition, a departure from the stock peasant with the healthy bones but the decayed teeth.
No identifying tag is attached to the big toe. Eusebio has to take it on faith that the dead man is indeed Rafael Miguel Santos Castro, from the village of Tuizelo. But he has no reason to doubt that Maria Castro is telling the truth.
Nor is there a clinical report. That report is like the jacket copy of a book, announcing what is to come. But just as jacket copy can stray from the actual content of a book, so can a clinical report. With no knowledge of the case at all, he will nonetheless find out what racked Rafael Castro, what pushed his body to give up.
He steps off the chair. He looks at the shelf of bottles along the wall near the table. He picks out the bottle of carbolic oil. Since he's not going to use his rubber gloves, he smears his hands with the oil to protect them. Then he finds the bar of Marseille soap and scratches it so that slivers of soap stick under his fingernails. This precaution, along with vigorous hand washing and the application of scented oils, means that he can reach for his wife in the evenings without her recoiling and beating him away.
He will start with words. Words will be the anaesthetic that will prepare Maria Castro for what he is about to do.
"Senhora Castro, let me explain a little what is going to happen. I will now perform an autopsy on your husband. The purpose of it will be to discover the physiological abnormality--that is, the disease or the injury--that led to his death. In some instances, when the clinical report is very clear, this object is determined fairly easily, as a result of examining a single organ, say the heart or the liver. The healthy body is a balancing act of a thousand parts, and the serious imbalance of a single part can, on its own, throw a life off its tightrope. But in other cases, where we have no clinical information, as is the case here, the dead body is, well, a murder mystery. Needless to say, I'm using this as a figure of speech. I don't mean a real murder. I mean the body becomes a house inhabited by a cast of characters, each of whom denies having anything to do with the death, but in a few rooms we will find clues. The pathologist is the detective who pays close attention and uses his grey cells to apply order and logic until the mask of one of the organs can be torn off and its true nature, its black guilt, proved beyond a doubt."
He smiles to himself. Maria, his Maria, would be pleased with his murder-mystery analogy. Maria Castro just stares at him steadily. He moves on.
"Where do we begin? With the surface. Before any incision is made, the body undergoes a surface examination. Does the body appear to have been nourished appropriately? Is it thin or emaciated or, on the contrary, obese? Is the chest barrel-shaped, indicative of bronchitis and emphysema, or is there a pigeon breast, a sign of rickets in early life? Is there unusual pallor to the skin or the opposite, any deepening of the colour or any sign of jaundice? Skin eruptions, scars and lesions, fresh wounds--all these must be noted, their extent, their severity.
"The orifices of the body--the mouth, the nose, the ears, the anus--must be checked for discharges or abnormalities, as must the external genitalia. Lastly, the teeth.
"In your husband's case, everything seems in order. I look here and here. Here. Here. He looks like a normal, externally healthy man of his age who died of an internal cause. I notice, here, an old scar."
"He slipped on a rock," Maria Castro says.
"It's a source of no concern. I am only noting it. This external part of the examination is usually cursory, since it adds little to my findings. Disease most often develops from the inside to the outside. So the liver fails before the skin turns yellow, for example. There are notable exceptions, of course: skin cancers, lesions and the like, and accidents. And death by crime often starts on the outside, but that is not an issue here. In this case, the skin has little to tell us.
"Now we must, well, we must enter the body, we must examine it on the inside. It is safe to say there's no reason to start an autopsy with an extremity, say, the patient's feet. In pathology, the equivalent of the king and the queen in chess are the thorax and the head. Each is vital to the game, so to speak, and one can start an autopsy with either one. The pathologist's standard opening gambit is the thorax."
Eusebio mentally curses himself. Why is he talking about chess? Enough of this prattle!
"I will start by cutting a Y-shaped incision in your husband's chest, using this scalpel, starting at the shoulders and meeting over the sternum, then heading down over the abdomen to the pubic mound. You will notice that subcutaneous fat is very yellow, and muscles look very much like raw beef, very red. That is normal. Already I'm looking for indicators. The appearance of the muscles, for example, which could signal a wasting disease or a toxic one, such as typhoid fever.
"Next the sternum and the anterior part of the ribs are removed. I will use these curved scissors to cut through the ribs"--his wife uses an identical pair in their garden and swears by them--"making sure not to damage underlying organs. Now the innards are exposed, lying in a colourful mass. I will look to see how they sit with each other. Organs are siblings that work in the same family business. Is there any obvious abnormality that has thrown the family into disarray? Any swelling? Any unusual colouration? Normally, the surface of the viscera should be shiny and smooth.
"After this overview, I need to look at the organs individually. Since we don't know what brought on your husband's death, I am inclined to take out his thoracic contents altogether to examine them in continuity, before separating them and studying each component on its own.
"I will ask of each organ roughly the same questions. What is its general form? Is it shrunken or, on the contrary, swollen? The surface of the organ--is there any exudate, that is, any matter that has flowed out? Does the exudate crumble easily, or is it stringy and difficult to remove? Are there any areas that are pearly white, indicating chronic inflammation? Are there cicatrices--scars--or rugosity, wrinkles if you want, a sign of fibrosis? And so on. Next will come the internal examinations. I will incise each organ--I will use this knife--with the idea of assessing its inner condition. The heart is the locus of many pathological possibilities, and I will examine it with extra care."
He pauses. The woman says nothing. Perhaps she is overwhelmed. It is time to abridge and sum up.
"The abdominal viscera will be next, the small and large intestines, the stomach, the duodenum, the pancreas, the spleen, the kidneys--I will be thorough in my approach." He sweeps a hand over the torso. "The king is done. Now we can move on to the queen, that is, the head. Examining your husband's brain and stem will involve removing the scalp by means of an incision and sawing through the skull--but never mind that. Details, details. Lastly, I may examine peripheral nerves, bones, joints, vessels, et cetera, if I feel there is a need. Throughout, I will be excising samples--small bits of organs--which I'll fix in formalin, embed in paraffin, then slice, stain, and examine under the microscope. This lab work comes later.
"At this stage the essential work on your husband's body is over, Senhora Castro. I will return his organs to his body and fill any hollowness with newspaper. I will replace the sternum and sew the skin shut, the same with the top of his skull. There, the job is done. Once dressed, your husband will look as if nothing has happened to him and no one outside this room will know better--but science will. We will know with certainty how and why your husband died--or, as you put it, how he lived. Do you have any questions?"
The old woman sighs and shakes her head. Did she roll her eyes?
All right, then. Reluctantly, he picks up the scalpel. "This is the scalpel," he says.
The sharp blade hovers over Rafael Castro's chest. Eusebio's mind is racing. There's no way around it. He will have to open the thorax. But he will zero in quickly on an organ--the heart. Oh, this explains it. W
e clearly have our answer right here. We need proceed no further.
"Well, here we go..."
"Start with the foot," Maria Castro says.
He looks up. What did she say? Did she say pe or fe--foot or faith? And what does that mean, Start with the faith? Does she want him to say a prayer before he starts? He's happy to oblige, not that he's ever done that in the autopsy room. The Body of Christ is elsewhere. Here is more simply the body of a man.
"I'm sorry. What did you say?" he asks.
Maria repeats herself. "Start with the foot."
This time she points. He looks at Rafael Castro's yellowed feet. They are as far away from the acute myocardial infarction he wants to diagnose as is physiologically possible.
"But Senhora Castro, as I just explained to you, in fact using that very example, it makes no sense to start an autopsy with a patient's foot. Feet are peripheral organs, both literally and pathologically. And as concerns your husband's feet, I see no sign of fractures or any other injury--no, nothing at all--nor any sign of a skin tumour or other disease, or any condition at all, bunions, ingrown toenails, anything. There's some slight peripheral oedema--swelling, that is--but that is normal for someone who has been dead three days. There is also a trace of livor mortis around the heel. Once again, that is normal."
Maria Castro says it a third time. "Start with the foot."
He is silent. What a disaster of a night. He should have stayed at home. Not only will he get no work done, but now he has an insane peasant woman in his autopsy room. This is precisely why he went into pathology, to avoid situations like this. He can deal with the clogging and liquefaction of bodies, but not the clogging and liquefaction of emotions. What is he to do? Say no and tell her to go slice her husband's feet on her kitchen table if she's so keen on it? That would mean stuffing the old man in the suitcase again, naked this time. And would the old battleaxe go quietly? He doubts it.
He gives up. She will have it her way. He feels like a hawker at a market, selling his wares. Autopsy, autopsy, who wants an autopsy? Don't hesitate, step right up! Today's special: Pay for one eyeball, get the other free. You, senhor, how about a testicle, just one testicle for starters? Come on, get your autopsy! Why not start with the feet? If she wants her husband's autopsy to start there, then let it start there. Whatever the customer wants. He sighs and moves to the distal extremity of the body, scalpel in hand. Maria Castro joins him.