Kauters, pulling on white rubber galoshes, asked the nurse, “Are the first and second sets ready?”
“Yes, doctor.”
Tying the ribbons of his apron behind his neck, the surgeon stepped on the water pedal and began scrubbing up, his movements automatic.
“Are the syringes ready?”
“Yes, doctor.”
“Make sure the needles are sharp.”
He spoke mechanically, without even looking at the table. Joseph undressed Rabiewski, turned him onto his back, tied his arms and legs to handles with white straps, and began to shave his head with a straight razor, without lather. Stefan could not bear the dull scraping sound.
“For the love of God, Joseph, use a little soap and water!”
Joseph mumbled—when Kauters was around, he listened to no one else—but finally decided to moisten the engineer’s head. Rabiewski’s breathing was slow and shallow. Holding a few wisps of gray hair, Joseph attached a large anode pad to the patient’s thigh and drew back from the table. Sister Gonzaga finished scrubbing with her third brush, dropped it into the bag, and walked toward the sterilizer with upraised hands. Joseph helped her on with a yellow mask, a coat, and thin fabric gloves. Next she went to the instrument stand, where three trays were still wrapped in the compresses in which they had come out of the autoclave. She unpinned the fabric and laid out the shining steel tweezers and rods in order of their importance.
Stefan and Kauters finished scrubbing at the same time. Stefan had to wait while the surgeon rinsed his hands in undiluted alcohol, and when his turn came, he held his fingers under the thin, stinging stream. Shaking his hands dry, he looked at them with concern.
“I have a splinter,” he said, angrily touching the red spot near his fingernail. Kauters was putting on his rubber gloves, having a hard time with it because they were out of talc and his hands were wet.
“Don’t worry. He certainly does not have PP. Anyway, things like that don’t happen in the brain.”
Joseph, unsterilized, was standing back from the table.
“Lights!” the surgeon commanded. Joseph threw a switch, the transformer roared, and the large flat Jupiter angled over the table ringed them in a bluish light.
Kauters turned to the window for a moment. His face, masked up to the eyes, seemed darker than usual. The doctors approached the patient from opposite sides of the table. Joseph leaned nonchalantly against the sink, the reflection of his bald head like a sunflower in the mirror.
They began covering Rabiewski with compresses. Fishing them from the sterilizer with long forceps, Gonzaga was virtually hurling them into the surgeon’s hands. The large squares of overlapping sterile cloth were laid from the patient’s torso to his face. Stefan was pinning them together on the other side of the table.
“What are you doing? To the skin, to the skin!” the surgeon snapped sharply but quietly, plucking the fold of skin with his pincers. Though he had long grown accustomed to the sight of bodies being cut open, Stefan could never stop himself from shuddering when the compresses at the site of an operation were pinned to a patient’s skin, even when he knew the patient was under anesthesia. And the engineer was merely unconscious. At just that moment the figure under the cloth trembled, grinding his teeth like flint scraping glass. Stefan automatically looked at Kauters. The surgeon looked back, then gestured as if to say: Go ahead and use a local anesthetic if it makes you happy.
After putting iodine on the portion of the head that stuck out of the tight ring of compresses, Stefan injected novocaine in several places and lightly rubbed the bumps the needle left on the skin. When Stefan had thrown away the iodine-stained pad, the surgeon reached back without looking. Sister Gonzaga placed the first scalpel in his hand. He touched the steel blade to the forehead, then made an oval incision. Kauters cleared away the connecting tissue down to the bone, using anatomical pincers that made a dull grating sound. Then he laid the instruments on the patient’s chest and reached for the trepan, an egg-shaped motor connected to an auger by a steel snake. Gonzaga stood immobile, several instruments in each raised hand. Stefan had just managed to blot the bright red streaks of blood around the incision when Kauters turned on the trepan. He held it like a pen. The auger bit into the bone, pitching out little particles that formed a line of bloody paste along the incision.
The buzzing stopped. The surgeon swung the auger away and called for a rasp. The plate of bone would not come free: it was sticking somewhere. Kauters pressed it delicately with three fingers, as if trying to push it into the skull.
“Chisel!”
He set the chisel at an angle and tapped it with a wooden hammer. Streams of blood wound along the skin and the compresses slowly turned crimson. Suddenly the plate of bone trembled. Kauters worked the rasp under it and leaned. There was a sharp crack like a nutshell breaking. The plate flipped over and fell off.
The meninges, the membrane surrounding the brain, swelled and glinted in the light. A network of dark veins could be seen in its depths. Kauters moved his hand away and came back with a long needle. He pricked the membrane in several places, once, twice, three times.
“Just as I thought,” he murmured. Above his mask, his glasses reflected a miniature image of the lamp. Until that moment, Stefan had been applying sterile pads to stanch the flow of blood into the wound. Now he leaned forward. Their gauze-capped heads touched.
Kauters hesitated. Holding his left hand at the edge of the incision, he touched the membrane delicately with his right. The brain underneath, pulsing gray and pink, showed more clearly. Kauters looked up as if he expected a sign from above. His large black eyes looked so vacant that Stefan was almost frightened. Kauters ran his rubber-covered finger twice around the exposed membrane in a circle.
“Scalpel!”
It was a small, special knife. At first the membrane would not yield, but suddenly it split like a blister and brain burst through from below. It throbbed, swelling red in the tear from which viscid threads of blood trickled.
“Knife!”
Now there was a new sound, a bass rumbling of the diathermal apparatus. Gonzaga unwound the gauze from the electric knife and placed it in Kauters’s hand. Both doctors leaned forward. The flow of blood was not significant; no major vessels had been severed. But the situation was murky. Slowly, millimeter by millimeter, Kauters widened the opening in the membrane. At last, everything was clear: the protruding, swollen part was the forward pole of the frontal lobe. When the surgeon poked at it with his finger, the yellow tumor appeared deep in the cleft between the two hemispheres. Getting to it would be difficult. He slid his index finger along the bulging folds of the cortex. He finally managed to reach the growth with the pincers. The tumor lay at the base of the skull, which for an instant showed pearly-blue like the inside of a seashell; then blood covered it. The tumor extended in both directions, compact at the bottom and plump at the top. It was covered with a brown paste.
“Scoop!”
Kauters began raking out blood-soaked scraps, threads, and strips. Then suddenly he jerked back. Stefan froze for an instant before he understood what had happened. A needle-thin stream of blood was shooting straight up from the bottom of the wound, from between the two hemispheres of the brain that the surgeon was holding apart with his fingers. An artery. Kauters blinked. Several drops had hit him in the eye.
“Damn it!” he said. “Gauze!”
Blood saturated the tampon, part of the tumor remained, and it was impossible to see anything. Kauters pulled his belly back from the table, looked up at the ceiling, and moved his finger around in the wound. This continued as the compresses soaked up blood, which seeped onto the pads put down at the beginning of the operation. New compresses were added because hands and instruments were getting slippery. Stefan stood looking at Kauters, helpless. His mask had slipped and was pressing against his nose, but he could not touch it.
The surgeon turned on the diathermal apparatus with the foot pedal and moved the knife closer.
“Scoop!”
The operation continued. The surgeon ran the thermocoagulator over the tumor’s surface. When it had cooled and solidified, he spooned it out, going after the remains with a crooked finger. But the longer this went on, the worse things got. The tumor pushed the lobe upward and pressed into it. The surgeon worked more and more briskly. At one point, reaching deep into the wound, he shuddered: when he pulled his hand out, the glove was ripped. The yellow rubber peeled back from his finger, cut by a sharp edge of bone.
“Shit!” Kauters said in a dull voice. “Please get this off for me.”
“A new pair, doctor?” asked Gonzaga, instantly lifting a packet from the sterilizer with a fluid movement of her forceps.
“The hell with it!”
Kauters ground the strips of rubber into the floor. His anger gathered in the wrinkles around his eyes, and shiny bluish drops of sweat sparkled on his narrow brow. The muscles at his temples bulged: he was grinding his teeth. He moved his fingers more and more brutally in the wound, pulling out and tossing aside ragged scraps, necrotic tissue, and the burst remains of some vessel. The floor was spattered with bloody commas and question marks.
The clock read ten: the operation had lasted an hour so far.
“Take a look at his pupils.”
Stefan lifted the sheet, which was heavy and stiff with coagulation, soaked with red blotches. Rabiewski’s face was shiny, pale as paper, as Stefan lifted his eyelids with tweezers. The pupils were tiny. Suddenly the patient’s eyes danced wildly, as if someone was pulling them on a string.
“Well?” Kauters asked.
“Nystagmus,” said Stefan, stupefied.
“Yes, of course.”
Kauters’s voice sounded derisive. He was drawing a needle across the cortex. The brain was deeply open, and there was more and more necrotic mass, fusing with the spirals and convolutions. Stefan looked at the wound, which gaped like an open mouth. He could see the white tissue of nerves shining like a hulled walnut and the gray matter, which was actually brownish, with lighter, narrow smears. Drops of blood shined like rubies here and there.
Irritated, the surgeon drew a convolution sideways; it stretched like rubber. “Let’s finish up!” he barked.
That meant he was giving up. His fingers worked quickly now, deftly pushing as much as possible of the bulging hemisphere back into the cavity of the skull. Bleeding started again somewhere. Kauters touched the dark end of the electric knife to a vessel and stanched the hemorrhage. But suddenly he froze.
Stefan, who had been staring at the mummy-like figure on the table during this last procedure, understood. Rabiewski’s chest had stopped moving. Without worrying about infecting his hand, the surgeon grabbed the bottom of the sheet covering the patient’s chest and face, tugged it aside, listened for a moment, and walked silently from the table. He kicked his bloody rubber galoshes off against the wall. Gonzaga took the edge of the sheet and drew it sacramentally over the stricken face. Stefan went to the window to catch his breath. Gonzaga was collecting the instruments on metal trays behind him, water roared in the autoclave, and Joseph mopped blood from the floor. Stefan stood leaning on the window ledge. A great, silent darkness spread before him. At the junction of sky and earth, he thought, loomed something darker than the night. The warehouses of Bierzyniec shined like a diamond necklace against dark fur. The wind faded in the trees and the stars trembled. The last of the water gurgled in the drain.
WOCH THE SUBSTATION OPERATOR
June was edging toward a heat wave. The forests, malachite green and fawn, shaded the view of the hills. There were silver birches, sodden evenings, and crystal dawns. Birds chirped endlessly. One evening the first thunderstorm struck. The landscape gleamed in the flashes of lightning.
Stefan went for long walks in the fields near the woods. The telegraph poles hummed like drunken tuning forks.
When he tired, he would rest under a tree or sit on a bed of pine needles. One day, as he wandered, he found a place where three great beech trees grew above a bare patch of ground. They rose from a single stump and leaned gently away from one another. Nearby was an oak tree, not as tall, its branches forming horizontal, Japanese lines. It seemed to be standing on tiptoe, for the spring rains had washed the earth from between its roots. The forest ended a few hundred feet farther on. A row of beehives painted green and red like roadside shrines seemed to march up the hill. There was an echo; Stefan clapped his hands and the hot air answered several times. The buzzing of the bees underlined the silence. Now and then, a hive would sing more insistently. He walked on and was surprised to find that the buzzing of the beehives, far from fading, was growing louder. A deep humming filled the air.
When the gorge he was walking through rose to the level of the surrounding meadow, Stefan found himself near a square brick building that looked like a box on short concrete legs. Rows of wooden poles strung with wires led away from the building in three directions; the sound was coming from an open window. As he came closer, Stefan saw two men sitting on the grass in the shade below the window. He gave a start because at first he thought that one of them was his cousin Grzegorz, whom he had not seen since the funeral in Nieczawy. But then he realized that it was the stranger’s fair hair, the way he held his head, and his soldier’s uniform with the insignia ripped off that accounted for the resemblance. Stefan left the path and walked across the grass, gazing into the distance so as to look like an aimless wanderer. The others did not notice him until he was quite close. Then they looked up and Stefan met two pairs of eyes. He stopped. There was an uncomfortable silence. The man he had taken for Grzegorz sat still, his arms resting on his knees and his muddy boots crossed; a bronze triangle of naked chest was visible under his unbuttoned shirt, and his coppery hair covered his head like a helmet. He squinted as he turned his thin, hard face toward Stefan. The other man was older. Big but not fat, he had ash-colored skin. He wore a cap with the visor turned to the back, and he was missing an ear. In its place was a tiny, twisted flap of red flesh, sticking out like a flower petal.
“Is this a power station?” Stefan finally asked to end the silence. The only sound was the humming from the window. Then he noticed that a third person, a pale old man, was standing inside the window. His dark blue work-suit made him almost invisible against the dim interior. The young man glanced up at him and then back at Stefan. Without looking him in the eye, he said ominously, “You better stay away from here.”
“What?” Stefan said.
“I said you better stay away. Or there might be trouble.”
But the man missing an ear cut him off. “Hold it. Where are you from, sir?”
“The hospital. I’m a doctor. Why?”
“Aaah,” drawled the man without the ear, settling down with his elbow on the grass so he could talk more comfortably. “Do you take care of those—you know?” He pointed a finger to his temple and made a rotating gesture.
“Yes.”
The man without the ear laughed. “Well, I guess it doesn’t matter.”
“I’m not allowed to walk here?” Stefan asked.
“Sure. Why not?”
“I mean,” Stefan said, completely confused, “isn’t this a power station?”
“No,” said the old man in the window. Copper wires shined behind him. He leaned out the window to clean his pipe, and his forearms, covered with a tracing of veins, poked out beyond his short sleeves. “No, it’s only a sixty-kilowatt substation,” he said, concentrating on his pipe.
Stefan pretended that he knew what that meant and asked, “You supply current to the hospital, then?”
“Mmm,” answered the old man, sucking in his cheeks as he tried his pipe.
“
Look, can I walk around here or not?” Stefan asked, not knowing why he needed reassurance.
“Why not?”
“Because he said…” and Stefan turned to the young man, who broke into a wide smile that showed his sharp teeth.
“So I did,” he said.
When Stefan did not leave, the man without the ear apparently decided to clear things up. “How was he supposed to know who you were, sir?” he said. “You made a mistake, kid. But if I may say so, sir, your face is pretty dark. That’s why.”
Seeing that Stefan still hadn’t got the point, he touched him amiably on the knee. “He thought you were from Bierzyniec. That you were one of the ones being shipped out all over the place.” He gestured as if he was draping something over his right shoulder and it finally dawned on Stefan: He thought I was a Jew. That had happened before.
The man without the ear was watching Stefan’s reaction closely, but Stefan said nothing. He only blushed slightly. The other man made conversation to cover the awkward silence.
“You work in the hospital, doctor?” he asked. “Well I work here. My name’s Woch. Operator. But not lately, because I’ve been sick. Too bad I didn’t know about you, doctor,” he added. “I would have asked for some advice.”
“Were you sick?” Stefan asked pleasantly. He stood there, for some reason unable to walk away. It was his misfortune never to know how to strike up a conversation with a stranger or how to end one.
“I was sick. The way it happened, first one eye pointed this way and the other one that way, then everything started to go around and around, and my sense of smell got so—ah!”
“And then?” Stefan felt foolish listening to the description.
“Nothing. It just went away by itself.”
Hospital of the Transfiguration Page 10