They turned back to concentrate on the doctor. Now they were looking at him as if their submissiveness might foster the transformation that everyone hopes to witness in cases like these, in order that, from the eyes of the man of science, a Christ might emerge, marching across the cornea’s aqueous surface. Radiant. Beaming. That he might utter the word.
“We cannot entirely exclude the metastatic infiltration of the regional lymph nodes, Signora.”
They knew that he had won the Swiss Cancer League’s Robert Wenner Prize at an age when other doctors are going in search of their first fellowship. His fame had filled them with hope in the previous weeks. The young man had searched the online forums where patients exchanged advice about medicines and treatments. They’d even calculated his astrological sign. April 20, 1963. It was written on the Institute’s website. They had no idea that his sister had been buried the day before.
Ruggero checked the data on the medical report. With his other eye, he was checking his desk diary. The woman was the third of sixteen patients he’d need to see before going home. No one could have said a thing if he’d simply canceled all his appointments right through to the end of the week.
“What do you mean, the lymph nodes are at risk?” the woman asked.
The Cancer Institute of the Mediterranean had been founded with objective of providing an alternative to the major medical centers in the north. They came from all over Campania, from Molise, to be examined there. They would board a bus, leaving the mountains of Basilicata behind them at the first light of dawn.
“It means that our examination of the axillary cavities revealed the presence of lymph nodes with a diameter greater than three centimeters. Which ought to put us on alert.”
“In Potenza they told us that that’s a normal by-product of the operation,” said the young man, hardening his tone.
This was how they began to lose faith. Ruggero knew how it worked. In order to quash a doubt, they’d bring a report from another oncologist, who’d say something that didn’t perfectly match the words of the first one. This made it advisable to go to a third oncologist for yet another opinion. Only then the third oncologist would say something completely different from the first two. Tamoxifen instead of Arimidex. A bone scintigraphy was absolutely necessary. What! No one had recommended it?
“Listen,” Ruggero suffocated a still-nascent instinct, “the situation will become clearer in a couple of months, when your mother . . . when you, Signora,” he shifted his gaze over to the woman, “are strong enough to undergo another . . . ”
The phone started ringing. The young assistant looked up, startled. Everyone at the Institute knew that Professor Salvemini wasn’t to be disturbed while he was with patients. Except in a very grave emergency. Ruggero wondered how it could be that a man who could rely on a thousand bulldozers always seemed to need a hand. He lifted the receiver.
The switchboard operator informed him that his father was waiting for him at the reception desk. The day before, after the funeral, Vittorio had announced that he’d come by to see him. “In a week or so,” he’d said.
“All right.” Ruggero put down the receiver. “What were we saying?” He tried to smile, but some strange expression must have appeared on his face, given the way that mother and son had started looking at him.
In the reception area, he found Vittorio.
He was sitting among the patients. His hands on his knees, wearing a cotton sweater. Ruggero studied him from the receptionists’ desk, like someone laboring under the illusion that watching people in their sleep is the same as learning their secrets.
Then the old man saw him. He lifted a corner of his lips. He got up, accentuating the fatigue involved, and walked toward him. Two male nurses walked in front of him. Vittorio had a grim expression on display. He was brandishing the black power of grief as if Clara had had a father and never a mother, never an older brother.
They spoke next to a beverage vending machine, their cheeks brushing, extending their necks toward each other. From the reception area, two patients elbowed each other. The doctor seemed angry. At a certain point he got upset. As he spoke, his face reddened. He leveled his forefinger at his father.
Half an hour later Ruggero was speeding through the streets of Bari in his BMW convertible. He was cursing. He slammed a fist down on the steering wheel. On his left, the Sheraton loomed. On the opposite side of the street, the apartment buildings of the various quarters of the city streamed past, orderly, sand-colored constructions, cleansed by the spring light. He turned onto Viale De Laurentiis. Rusty playground equipment, kids in the public park. When he’d asked Dr. Spagnulo to stand in for him, he’d sensed confusion all around him. He’d recovered now, hitting the steering wheel like that.
It hadn’t taken much for Vittorio to talk him into it. Ruggero had felt the blood pulse in his head when it became clear that he was going to have to sacrifice the day. He’d verbally assaulted his father, and only when the old man took the punishment without reacting had it dawned on Ruggero that what he himself was experiencing was pleasure, not anger. Let his son blow off some steam, accept the dressing down. If the old man had gotten in his face, underlining the weight of the interests at play (not even a Nobel Prize in medicine could have reversed Salvemini Construction’s priorities in this situation), then his son’s fury would have been authentic. Breaking down an unlocked door, Ruggero had instead heard his footsteps echo in an enormous empty space. Dead leaves in dead afternoon light. A weight not unlike regret, or a sense of guilt. The remote, always postponed chance of embracing his father, of curling up with him in a cold grave. “All right,” he’d hissed. Then he’d felt an even stronger blow to the head, the sensation of three mornings ago, when Vittorio had come to tell him about Clara. He’d asked Dr. Spagnulo to stand in for him. Without really knowing exactly what was happening, he’d found himself on the phone with the head of orthopedics at the general hospital. He’d walked through the automatic doors, the hot sunlight after the artificial bulbs, fooling himself into thinking that haste might erase the error, much like a sin you abjure by staining yourself with it.
So now he was going to pick up Engineer Ranieri. Together they’d go to the general hospital. There, apparently, the engineer was supposed to meet with a patient who’d had one of his legs amputated. Ruggero looked around. The city was streaming past him as if from another dimension. A large silent house surrounded by greenery. A wooden table amidst the weeds. Beneath it, an obscure, formless world was moving, twisted roots, tiny blind insects, the phosphorescent presence of his sister Clara. Michele was coming home. Motionless in the train compartment, his head resting against the glass of the Eurostar window.
Ruggero turned at Viale Gandhi. A chaotic mess of tiny shops, mopeds, and double-parked delivery vans. His father asked for help and everyone came running. Vittorio knew what to do. He could give the impression of a loser who needed a hand even when the company was bursting with health. Never mind now, with the Porto Allegro problems.
Thirty years ago, when you crossed through Bari, the sense of plenty was tangible. The windows of the boutiques were cleaned and polished three times a day. The terraces outlined in the rich summer skies where the green of the ferns seemed to burn with a life of its own. Many of those steel shutters now were closed, or rusty. The streets half shattered. So, Ruggero thought, this time the threat is real.
He drove past Via Petroni. He turned right again. He remembered when he was a medical student. In bed before midnight. He’d fall asleep thinking about the next exam. He looked forward to the moment when the professor would admit his astonishment at how well he had studied. The mechanisms of ventricular fibrillation. Acute and chronic pericarditis. Eyes closed, tucked under the sheets. The textbook stamped clearly in his head. A noise from the bathroom of the master bedroom. The perfection of those pages crumbled under the blows of his real cardiac acceleration. For days his father had been com
plaining about a delay on a major payment. His face dark, his mouth a macabre fissure. Maybe no one really had overturned the medicine chest in the bathroom. Ruggero felt Vittorio’s anxiety inside him, the violence of his father’s insomnia. He was endangering Ruggero’s university career.
Ruggero would wake up in the middle of the night, knocking his histology textbook off the bed. (He’d breathe slowly, observing the chilly winter lights through the half-closed shutters). In early June, he’d knock over the molecular biology textbook. He’d find himself in his underwear in the small bathroom, clammy with sweat at three in the morning, the volume on forensic medicine hurled against the wall, staring at himself in the mirror in the deadly muggy heat of the summer night. His folks were on holiday in Tunisia. Michele and Clara were on a camping trip. The city was half-deserted, the house was empty. Which meant that no one could have turned on the television set downstairs. No one had broken a plate in the kitchen, and yet that plate had shattered into a thousand pieces. His father’s ghost had become very cunning, now it was active even when the old man wasn’t there, sabotaging the exam that Ruggero was scheduled to take in early September. Technical consultation at criminal trials, autopsy and external examination, the notion of mental competency, the putrefaction, maceration, and mummification of a corpse, instigation to suicide, gang rape, fingerprinting, the cooling of bodies, the professor wouldn’t even have time to fully frame his question before he was halfway through his answer, but that was only provided that the seven hundred seventy pages of forensic medicine were absorbed according to schedule, twelve hours a day, two and a half pages an hour, plus two hours of general review, which was unlikely if he wasn’t getting sleep. Ruggero would throw open the window, feeling the hot wind on his skin, observing the hedges in the garden below, the fountain surrounded by the eucalyptus trees. There’s something more, he told himself, something I can’t even imagine.
No one was moving furniture in the living room. No one was driving nails into the wall after midnight. Ruggero stared wide-eyed in November. He bit his pillow on February nights. He’d wake up coughing at a quarter to two in the morning. Through the crack in the door placental gleams were moving. A thunderous noise forced him fully awake. Ruggero leapt out of bed, hurried out into the hallway, and was overwhelmed by the billowing cloud of smoke. He braved the stairs, two shadows shot past amid the sparks and all around him he felt the desire for their deaths, his parents burnt alive. But a short while later, safe and sound, outside the villa’s front door, when he noticed Michele emerging from the bushes with a gas can in one hand, and Clara following behind, at the moment he saw his sister and half-brother walking toward the house, only then did he realize that it was their desire, not his, it had belonged to Ruggero only the way that someone else’s music played at full blast does, he was full of a filial love, it was they who hated.
He accelerated down Via Fanelli. The buildings thinned out. Tennis courts popped up, brief untilled stretches. He passed a gas pump. Two young African women flooded with light in the parking area. He continued toward Mungivacca.
Engineer Ranieri was waiting for him outside a tobacconist’s shop. A light-blue suit, brylcreemed hair. Ruggero pulled the BMW to a halt. The man walked toward him, then embraced him. “Try to be strong.” He’d already said it at the funeral.
Now they were again heading toward the center of town. The engineer gestured toward the sky.
“Spring has returned.”
Though he was only two years older than him, Engineer Ranieri had been working for his father since Ruggero was in high school. That established a boundary that Ruggero felt incapable of crossing. Engineer De Palo and Engineer Ranieri. The subtlety of the older man. The passionate adulation of the younger. Ruggero remembered his smile as he congratulated him on graduating from high school, before vanishing into his father’s office. Electrified by the 4.0 GPA he’d just earned, Ruggero felt he could talk about the future as if he were the legal representative of a major cement manufacturer.
“Give this idiot a listen,” said Vittorio, smiling at him from behind the desk.
The university was important. But it was important for the children of newsagents. “From today to the day you graduate from medical school with a specialization, you’d make more money than a good doctor will earn in his first ten years practicing.” To join him at the company, right away. To spend the summer learning the ropes, going back and forth to the provincial urban planning offices. That’s what his father proposed, as he stubbed out his Marlboro in the crystal ashtray. He had realized that the summons to sacrifice—celebrating the completion of his secondary education by getting to work—was for a first-born son at once a knightly challenge, and a twisted proof of love. For Vittorio, the matter came down to something much simpler. The timing was good. The size of the company at this point demanded perhaps not so much actual effectiveness as the idea of an heir who was up to the task.
“Give this idiot a listen.” And even though Ruggero had only just legally become an adult, the hidden dangers of the wordplay didn’t elude him.
One day his father unrolled on his desk plans for a small shopping center that the company had recently finished building. Those plans were the playing field on which Ruggero would have a chance to test his valor.
“You’re a smart, reliable, motivated young man. How much are you willing to bet?” asked Vittorio lighting a cigarette. He stood up, his face dappled with the shadow of the kentia palm in whose vase dozens of cold cigarette butts lay scattered. “Do you want to bet that if I entrust you with the industrial sheds, you can get them all rented in a month? If you can’t rent them in thirty days, I’ll give you a car. You’ve got a driver’s license, you need a car. A nice Porsche. What do you think? But I’ll tell you this: If you come to work for the company you’ll never get that car out of me!”
He burst out laughing, drowning in optimism and sincerity, a man at the height of his powers.
The light turned green. Ruggero jammed his foot down on the accelerator pedal. With a quick zigzagging maneuver he shot past the other vehicles in line ahead of him. Engineer Ranieri instinctively grabbed for the assist grip.
Ruggero had spent the summer ricocheting from one office to another, his briefcase filled with land registry certificates and permits for mid-project variations. He never set foot on a beach except on Sundays, when he went to Monopoli to see a former high school classmate, a girl, not especially good looking, with whom he had sex until the first rains began to fall. Then, in September, without a word to a soul, he enrolled in medical school.
He strode into Vittorio’s office full of the energy that had coursed into him the moment he’d handed his form to the department secretary. He was ready to take his father on. The old man’s face hardened for an moment or two. Then his cheeks relaxed. “You’ll have to study hard. But a doctor in the family might always come in handy. I’m sure you’ll acquit yourself honorably.” He invited him downstairs for a drink at the bar.
He’d won without fighting. And yet, as he rode down in the elevator with him, he had a strange sensation. He couldn’t prove it, but he would have sworn that for Vittorio, in the space between one floor and another, something was moving back into place. He noticed the curl of the lip that he knew so well, as if his enrolment at the university had laid waste to his father’s plans but all the same, Vittorio was picking up the broken shards in such a way as to visualize then and there an even more reckless project.
On Via Scipione l’Africano, they saw the four palm trees that surrounded the fountain in the piazza. Then the general hospital appeared. Engineer Ranieri put on a worried face. He coughed. He recovered his joviality, but built atop his previous state of mind.
After he finished training in his medical specialty, Ruggero was awarded a clinical fellowship at the Netherlands Cancer Institute in Amsterdam. Three wonderful years, far away from everything, under the tutelage of a giant in the field, Pro
fessor Aron Helmerhorst. Whole days spent observing the TIC10 molecule at work. It wasn’t so much the distance from Bari as the brand new atmosphere that protected him. The nightly phantoms no longer came to bother him, and he came close to forgetting them entirely. The obsession with his father wasn’t the only one to vanish. The times he spoke to Clara on the phone, his sister’s calm and radiant voice was reabsorbed by the banality of the words she spoke, and not by what her physical presence communicated. Michele was a young man full of problems and Gioia was a girl with too few, but at last the boundaries were clear. At night, he’d stroll past the Nieuwe Kerk feeling something approaching happiness.
A residue of the old furor surfaced in the long hours of work. Under Helmerhorst’s supervision, he was studying the effects of dacarbazine on mammary carcinomas. It gave Ruggero an animal-like pleasure to see the compound acting on the DNA, preventing it from duplicating itself. A feeling of revenge. They’d spend Saturday afternoons in the half-empty laboratories. They’d check their progress on the apoptotic drugs. Programmed cell suicide. He’d read about it in his textbooks. But when he actually observed the tissue sections from the mice whose tumoral cells he’d inoculated, it left him breathless. The less resistant cells began to vibrate, the chromatin went into crisis and, at a certain point, like balloons, the cells burst, leaving behind a fragile luminescence.
They realized that the drug worked on pulmonary tumors. It was effective on colon cancer. As they continued their research they discovered (to even Helmerhorst’s surprise) that the molecule was capable of bypassing the blood-brain barrier, arriving virtually intact on the other side.
Weeks passed. The guinea pigs’ survival curve lengthened. Ruggero was exhausted, proud, sleepless, and fearless when he signed the article that appeared in The Lancet, together with the others. The summer passed. From Zurich came the news that they had won the Swiss Cancer League’s Robert Wenner Prize.
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