The Crimson Portrait

by Jody Shields

  After midnight, there was shouting directly below Catherine’s window, and she leaned out to watch two men hop and spin, arms extended and faces upturned, gleeful at the downpour. The light from a lower window struck the rain into brilliance, so the men appeared to be held upright by thousands of moving strings.

  She slept. Suddenly she was jarred awake, aware that the mirrors in the attic were absorbing light from the landscape—the minute reflections of water on grass and leaves, puddles, the faint gleam of gray gravel in the drive—and redirecting it as a beacon for enemy aircraft. Their bombs would find their target, would shatter the mirrors in the attic, sending shards of glass—certain as daggers—straight to her heart.

  Under the tight bedsheets, her legs were pinned in a ballet dancer’s position, making her helpless. Her legs were stilts. The immense glittering weight of the mirrors pressed down on her. Terrified, she waited, unable to move, listening for the droning of the aircraft she was certain would come.

  Chapter Two

  DR. MCCLEARY HAD ceremoniously placed the lid on an empty sterilizing jar, and this delicate click had signaled the end of forty-one years as a practicing surgeon. He had driven to Bruisyard in east Suffolk and settled in a ramshackle country house, formerly a nunnery of the Order of Saint Clare. He fished, organized his classics library, spoiled his dogs. Although he had never married, the solitude of retirement didn’t suit him. Fifteen months later, the war found him.

  He had packed scores of Hagedorn’s half- and full-curved needles and holders, rongeurs, wire-working pliers, sets of mouth retractors, extracting forceps and knives, an assortment of hemostats, a tracheotomy kit, and a sharpening stone of Carborundum into his medical bag and joined Dr. Cole, the chief surgeon of the Maxillofacial Department at King George Hospital. There, colleagues had affectionately called McCleary “the grand old man,” acknowledging his age and formal character. “Don’t go showing off or they’ll send you to the front,” the youngest resident had teased. “We can’t do without you, Doctor.” It was September, and everyone was confident the war would be over in a few months. Surely by Christmas.

  Since injuries to the face were uncommon during peacetime, surgeons were woefully unprepared for the severity of the wounds caused by bombs and shell fragments. McCleary had limited surgical experience with facial injuries, but what knowledge he possessed was enough to make him a specialist.

  At a medical conference held at the hospital the week after his arrival, there had been no speaker on jaw grafts because none of the surgeons had ever performed the procedure. In fact, the majority of current papers on facial surgery had been published in foreign journals.

  As required by his early medical training, McCleary had memorized the skin’s topography as an aid to diagnosis. The skin was rich with infoldings, outfoldings, multiple layers, stoppered orifices (the ear), and open orifices (the nose). The slightest invaginations were foveas, a term applying to dimples and the tongue, its macroscopically pitted surface dense with foveas identified as “follicular crypts.” Skin made invaginated folds around a flexed limb; smaller creases formed around these folds; wrinkles and macroscopic lines, including the whorls and ridges on the fingers and palms, extended their nearly invisible pattern over the entire body, binding it with a pattern, the finest of skeins. The largest folds of skin outside the body were mostly sexual: the penis, prepuce, scrotum, labia, and clitoris.

  However, McCleary had known nothing about the development of facial surgery, and the scant and haphazard information in the Royal College of Physicians library astonished him. There was little evidence of systematic progress in the history of maxillofacial surgery, which bore out Hippocrates’ observation that “war is the only proper school of surgeons.” McCleary had realized that he had the peculiar privilege of witnessing the establishment of a corpus of knowledge, as surgeons were now compelled to consult forgotten or rejected documents to aid the wounded.

  During his weeks of research, McCleary discovered that the first book about skin, De Morbis Cutaneis, appeared in 1572, and it was another two hundred years before the second book on the subject was published. During much of this time, it was strictly taboo to cut or violate the surface of the body for anatomical dissection.

  The words used to describe skin were dense, unexpectedly multifarious. In Greek, derma for “hide” was familiar, and it was only one of the many subtle aspects of skin the language defined. There were also multiple words in Latin, including cutis for living skin and pellis for skin that was sloughed, dead. Horror was traced to the horrilation, or “lifting,” of the skin.

  Plato believed skin was “a canopy of flesh,” merely “felting” laid over the interior organs as protection. Aristotle claimed skin had been formed by “drying of flesh, like the scum upon boiled substances.” These dismissive attitudes—skin as crust, a curdled material, congealed fluid, a temporary substance, a jelly-like covering—lasted for centuries. By the eighteenth century, skin was finally recognized as a permeable membrane, a threshold for exchange of fluids and air with the exterior world.

  Curiously, the actual color of skin was rarely described, but McCleary had found a beautiful citation in the Mishneh Torah, a fourteen-volume work by Moses Maimonides dating from the twelfth century. Skin could have degrees of whiteness, like “snow in wine” or “blood in milk.” It could be white as lime or “the skin in an egg.” The Hebrew words for “light” and “skin” were closely related. One text stated that skin affected by leprosy had thirty-six distinct colors; another author claimed seventy-two. There were limited choices for the appearance of damaged skin; scars were “livid” or “angry.”

  Early accounts of facial surgery were as fantastical as mythological tales. In India, around the sixth century BC, the renowned Hindu surgeon Susruta wrote the first treatise on facial surgery, Salya-tantra, which instructed how to transplant skin, suture muscle, tie veins, and monitor a patient’s dreams for healing, finally translated into English in 1794. Many of Susruta’s patients were adulterers who had been punished by amputation of their nose. McCleary had discovered a passage he admired from Susruta’s work and copied it into his commonplace book: “Those diseases which medicine does not cure, the knife cures; those which iron cannot cure, fire cures; and those which fire cannot cure, are to be reckoned wholly incurable.”

  In the ancient world, it was believed to be impossible to graft skin between individuals, as there was a “mystic sympathy” between skin and its owner. McCleary had diligently tracked down fragmented accounts, written hundreds of years ago, of a nose grafted from a slave onto a wealthy man. The donor nose had failed along with its original human source.

  In the early fifteenth century, the Branca family of Sicily were renowned for their secret facial-reconstruction techniques, learned from the Greeks or Arabs. A professor at the University of Bologna, Gaspare Tagliacozzi, became the first European to illustrate and describe the reconstruction of the nose, ears, and lips with the publication of De Curtorum Chirurgia in 1597. However, Tagliacozzi was accused of practicing magic; Paré and Fallopius, the most famous surgeons of the time, denounced him; and the Church prohibited his surgical techniques. Years after his death, a voice told the nuns in the convent of San Giacomo that Tagliacozzi was damned and must be disinterred from their burial ground. The nuns exhumed his body. Though Tagliacozzi was cleared by the Tribunal of the Inquisition and reburied, his techniques were lost. Surgical advances languished.

  In 1743, Henri François Le Drean repaired the lower lid of a fourteen-year-old boy with a flap of skin moved from his nose. Nearly fifty years later, François Chopart reconstructed a lower lip with skin obtained from the patient’s neck. By the nineteenth century, pioneering developments in soft-tissue repair were published in Handbuch der operativen Chirurgie by J. von Szymanowski. La Rhinoplastic by Nélaton and Ombrédanne also offered a wealth of information on skin flaps.

  In 1869, Jacques-Louis Reverdin grafted a millimeter of skin onto a patient’s wound. Although the
transplant flourished and successfully healed, Reverdin’s discovery was dismissed and he was ridiculed. However, Louis Ollier and Carl Thiersch persevered, developing a razor-cutting technique to obtain thinner areas of skin. The Ollier-Thiersch graft laid the foundation for plastic surgery.

  McCleary had been oddly comforted by this disjointed history, as if in the last chapter of his working life he had joined an exalted but little-understood and secretive brotherhood.

  When he had read that the word flesh in Sanskrit was from the prefix pluta, meaning “floating,” it was a revelation. He then understood the skin was neither liquid nor solid, but a curtain of sensation. Mutable, pliable, and unstable, its boundaries were undefinable, uncertain as smoke. Skin was simultaneously a canvas and the paint on its surface. McCleary had also been jolted into recognizing a simple truth: by changing color, the skin communicated an expression while remaining absolutely still. An involuntary system. The face represented both the skin and the mind.

  MCCLEARY WAS ROTATED to different hospitals, from a forty-bed unit established by the Red Cross at Brook Street to a larger facility at 24 Norfolk Street, then Roehampton and the majestic General Hospital, which had been converted from a former orphanage. He was also assigned to evacuate men with face wounds as they arrived at Waterloo Station, a cavernous structure that echoed with shouts and the whistled blasts of the ambulance trains.

  The fighting intensified and casualties mounted while McCleary was posted at King George Hospital. The medical staff worked with a raw energy. No one slept. The situation was intense, fluid, and the disorganization was shocking, as hospitals were never notified until the last minute about the number of incoming wounded. This was done deliberately, to confuse enemy spies and avoid alarming civilians.

  McCleary had been on duty when one of the first groups of face-injured soldiers arrived. He waited as the canvas flap at the rear of the Commer ambulance was thrown back and thin torchlight hesitantly intruded into the dim interior of the vehicle, faintly illuminating six seated men, their heads misshapen by enormous bandages, their bodies strapped to chairs against the walls. They were unmoving, still as rocks or guardian figures at the entrance to a sacred cave. Because they were absolutely silent, McCleary momentarily thought their mouths were sealed by thin, dark bandages until he saw that their jaws were wired shut. They had been transported sitting upright—never prone on a stretcher—because they could choke to death lying on their backs.

  Some of the men were conscious, and McCleary tried to catch their eyes to reassure them. One man, his face heavily bandaged, signaled weakly with his good hand and struggled to speak with his damaged lips. McCleary couldn’t understand his words and leaned closer, his nostrils filling with the terrible smell of infection that carried the man’s whisper, “Kill me. Kill me.”

  The face-injured men who had been sent to regular hospitals in error were immediately isolated or transferred to special maxillofacial units. Other patients refused to share a ward with the disfigured men, as they were a depressing influence. Some men with shattered faces had been shuttled to eight different hospitals within a few months, paper tags scrawled with their names and terse descriptions of their injuries tied to their toes if they were unable to speak.

  Months later, after spending fifteen hours in the operating theater, McCleary had stripped off his jacket and moved in a daze of fatigue down an empty corridor, the sunlight spread in dazzling stripes under his feet. From the window overlooking the hospital garden he watched two patients—slightly hobbled by the casts on their legs—use bayonets to attack a cloth dummy in enemy uniform swinging from a tree.

  He closed his eyes, unable to bear witness.

  That afternoon, he requested transfer to a hospital outside the city.

  EVEN BEFORE MCCLEARY had toured the estate, he’d ordered the mirrors removed from the house. No patient was allowed to use or own a mirror. He controlled their images, protecting them from their own faces.

  “Truth won’t heal these men,” McCleary had later told the medical staff assembled in the ballroom. “The sight of their damaged faces will hinder recovery. Better to keep their hope alive.”

  If anyone in the room disagreed with McCleary, they left it unspoken.

  It became policy that the orderlies would search each man admitted to the hospital and confiscate anything with a reflective, shining surface: shaving mirrors, flasks, cigarette cases, compasses, scissors, bottles of spirits, letter openers and penknives with gleaming blades. Even an ink bottle with a flat gold cap, a framed photograph, and a polished watchcase were forbidden and locked up in the supply room. They were as dangerous as weapons.

  WHEN MCCLEARY FIRST evaluated a patient, he spoke briefly and used Latin terminology for the muscles and bones of the face, since elevated language strangely comforted the men. He’d tell them that the Greek word for skin, thumos, had two interpretations, “anger” and “spirit.”

  “Your skin is a live, constantly changing thing, and healing is a process,” he’d explain. “New surgical techniques are always being discovered. I will do everything in my power for you.”

  McCleary had always been able to anticipate the progression of healing the way other men could predict time, weather, the risk of a bet. But there was no such certainty here. Some of the patients’ faces were so cruelly damaged he couldn’t reassure them that his work would be successful. He couldn’t promise that their faces would become whole again or even passable enough to join their families, earn a living, simply walk down a street without drawing stares. No explanation of why they weren’t allowed a mirror was offered unless a patient asked. He struggled to evade his patients, to give them an honest but indirect diagnosis in order to extend a green branch of hope.

  Hearing their fate, few men wept. Few asked questions other than When can I go home? When will my bandage be removed? This scene was repeated over and over.

  A great number of patients were fixated on time and constantly spoke of exactly when they had been wounded. The moment, the hour, day, month when it happened was observed as an anniversary. It has been a week since I was injured, Nurse. It has been forty-seven days since I was injured, Doctor.

  Most men were proudly self-reliant and grateful for McCleary’s attention, but a few reacted violently to the doctor, misinterpreting his expression, becoming hurt, and raging against him. Their gaze was barbed, heightened, as if the expression that injury had taken from their faces had magnified their ability to decipher expressions on others’. McCleary was conscious that the patients waited to ambush the slightest sign of uncertainty, pity, or disgust in his eyes, watched for the delicate, telltale tremor of his zygomaticus major, pulling the left corner of his upper lip into a false smile, marked by its asymmetry. He directed compassion to flow through his hands while his eyes remained firm, clear, neutral. A rock in a pool.

  It was far easier for McCleary to examine an unconscious patient, since a neutral expression required a discipline of deceit that was almost impossible to maintain. At times, he felt himself lose control, transformed from a neutral doctor into an observer who judged a man’s maimed face.

  Plato believed there must be a bond between doctor and patient, a profound understanding. This would be created by “a beautiful discourse,” a charm, the epôdê. The patient must relinquish himself, offer his soul to the doctor, or the medicine would not work and no cure could take place. Why did the men need mirrors when he offered his compassion and learned interpretation? McCleary reasoned.

  Some men under McCleary’s care didn’t seek intimacy or comfort from their doctors and fellow patients. They needed distance—or a state of willful ignorance—to heal. They were the worst patients. Difficult to treat. Slow to mend. Impossible to console.

  But a pair of unasked questions was always suspended between McCleary and his patients. How can I bear this? How can I live in the world again?

  HANDS ACHING AFTER hours of surgery, McCleary returned to his quarters in the former coachman’s house nea
r the stables. His room was austerely furnished with an iron bed, a nightstand, a worn high-backed chair retrieved from the main house. A collection of books, finely bound in full Morocco and inelegantly shelved in boxes, was the only personal memento.

  The lamp propped next to the bed barely illuminated the room or the book in his hands, but he found the soft light comforting after the exacting glare of the operating theater. When he puzzled over a certain procedure or a patient’s healing, he shared his thoughts with no one but turned to the works of Henri de Mondeville, a fourteenth-century physician-surgeon and demiurge who had attended King Philip the Good and his son.

  His discovery of Mondeville’s Chirurgie while still a student had been an inspiration, as the author was a renegade who had harnessed the patient’s own belief to his cure, certain this was equally as effective as medical treatment. When all other measures failed, Mondeville recommended a practice called pious frauds, telling lies to the gravely ill, bringing a patient “false letters telling of the death or downfall of his enemies, if he expects some promotion after their death. His visions and dreams must be given a favorable interpretation.”

  Mondeville also urged the healer to be silently present for the patient, secretly directing positive thoughts toward him, binding them together in a web that only one of them had spun. This gift of imagination was as potent as the promise of relief in a sleeping draft.