1993 - The Blue Afternoon (9 page)

Dr Salvador Carriscant passed through the wide arched gateway, acknowledging the respectful salute of the porter on duty. His headache was easing, he was happy to note, and he was looking forward to the first operation of the day, the extirpation of a large tumour from an adolescent boy’s tongue. He was planning to make a new form of incision, one that would allow him to sew up the wound rather than sear it as was normal, in a way that should allow the lad to speak, after a fashion, once he had healed. Such extirpations were Dr Cruz’s stock in trade, it took him a matter of seconds he boasted, like lancing a boil, but Manila was full of mumbling semi-mutes with needlessly stumpy tongues as a consequence of Cruz’s heavy-handed speediness. If that day’s operation proved a success it would further undermine Cruz’s unwarranted eminence: the medical director of the San Jeronimo hospital would have even less work to do.

Carriscant crossed the courtyard towards his consulting rooms, noting that the waiting room was already full and there were half a dozen people sitting on a wooden form outside. He glanced over at Cruz’s equivalent suite of rooms and saw that the main door was closed and the shutters unopened. Cruz’s patients had declined steadily in the years since Carriscant had arrived and now it was either ignorance or agonised desperation that led anyone to demand a consultation with the old surgeon. He was a dying breed, was Cruz, Carriscant reflected, a historical curiosity, an emblem of the bad old days of the profession, but he was good with the knife, Carriscant had to admit, and his eye was impeccably sure. He was fast, Cruz—damned fast. The war had seen a surge in demand for his expertise, he had carried out hundreds of amputations, but since it had ended, business had slackened again and now the old man spent much of his time on his large ranch at Flores and in his personal laboratories which he had had constructed there and where he kept his hand in by operating on monkeys and dogs. Carriscant never forgot the first and almost the last operation he had performed with Cruz. Cruz had watched him washing his hands prior to entering the theatre. “You prefer to wash your hands before the operation I see, Carriscant,” Cruz had commented acidly. “I prefer to wash mine afterwards.” On his rounds of the wards too his brutal frankness was legendary: “That’s one of the worst cancers I’ve seen,” he would tell some suffering soul cowering in his bed. Or, “The leg will have to go, off at the hip too, let’s not take any chances.” Or, “Conditions such as yours, my dear fellow, are inevitably fatal. I doubt you’ll be seeing the outside of this hospital again.”

Dr Carriscant was greeted by his secretary Señora Diaz, a small, homely, efficient woman with an unfortunate profusion of facial hair, and glanced through the day’s schedule she had prepared for him. The boy with the tumour was already here and prepared. He had time briefly to visit the patients in his ward before he started work.

“Is Dr Quiroga here?” Carriscant asked. “Yes. He went to the dispensary.”

Pantaleon Quiroga was his anaesthetist and his best friend. He was a young man, in his late twenties, a Filipino—an ilustrado, as the educated classes were known—from southern Luzon who had been educated in Manila and who had studied medicine in Madrid and later Berlin. Like Carriscant he had become enthused with the latest developments in surgical practice and had returned to Manila determined to provide his people with the benefits of medical science. He was not a natural surgeon, however, he lacked the mysterious ‘touch’, that gift one possessed and that could not be acquired, and it was Carriscant who had persuaded him to concentrate on anaesthesia. Working as a team at the San Jeronimo the two of them had developed an understanding that was unique in Filipino medicine. Because of his training Quiroga could also assist at the more complicated operations if required—it was like having four hands, Carriscant said—and his skill with the chloroform bottle was the equal of any more exalted anaesthetist in Baltimore or Paris, Carriscant maintained.

There was a soft rap at the door and Pantaleon Quiroga came in. He was already wearing his white surgical gown and carried his skullcap in his hand. He was a painfully thin young man and tall, unusually so for a Filipino, a good head higher than Carriscant, with a neat moustache and melancholy eyes. He was unmarried and lived alone (his parents were deceased) outside Intramuros in Santa Cruz, whence he travelled each day by horse tram. Carriscant often found himself wondering what Pantaleon did with his considerable salary and the supplementary fees that were charged on his behalf. He supposed that much of it went back to the family in Southern Luzon—the uncles and aunts, the grandmother, the endless cousins—certainly Pantaleon lived very frugally as a result.

They shook hands warmly, as they did at the beginning of each working day.

“The dough is in the oven,” Pantaleon said. “Ready to bake.”

“Have I time to do my rounds?”

“I think the poor fellow will have a fit. The sooner the better, you know.”

“Let’s go then.” He glanced at Señora Diaz’s list on his desk: two amputations—a hand, then a leg at the knee—a strangulated hernia and a vaginal fistula. He could do the amputations before luncheon; the hernia and the fistula would take up the afternoon. He followed Pantaleon’s tall frame down the corridor to the preparation room, noticing that the young man’s hair was thinning rapidly at the crown. He tried to imagine Pantaleon bald and for some reason the notion filled him with a sharp and sudden sadness. He needed something more in his life, did Pantaleon, something beyond his work at San Jeronimo—a love affair, a fiancée, a wife, a family…

Carriscant removed his coat, put on a freshly laundered white gown, changed his shoes and washed his hands with a powerful carbolic soap before going through into the operating theatre. Here the smell of disinfectant made his eyes tingle as he greeted his nurses, Nurse Santos and Nurse Arrieta, and glanced around the room. The wooden floor was scrubbed to a pale grey, every surface was clean, gleaming and moist. A faint hum emanated from the big electric arc light mounted above the operating table and there was a tinny rattle of instruments vibrating in the steam sterilisers set on tin tables to one side. He took a discreet deep breath: already he could feel that delicious weakening sensation spreading upwards from the soles of his feet, a loosening, a slackening in his bowels, the hairs pricking on the nape of his neck.

The patient was a young Chinese boy, fourteen years old, son of a wealthy merchant from Cavite. He leaned back against the steeply angled table, angled so his tongue could better fall forward, the tumour clearly visible, the size of a small apple, forcing his lips apart, making him look imbecilic. There was sweat on his forehead and his eyes flicked towards Carriscant and then flicked away again.

Carriscant uttered some token words of reassurance and turned to his instruments as Pantaleon fitted the gauze mask over the boy’s mouth and nose.

“I see the bridge is down at Jacinto,” Pantaleon said.

“I had terrible trouble getting in this morning,” Nurse Arrieta said, handing Carriscant a scalpel. “Terrible.”

“You should take a barca to work. Have you got that clamp?”

“I can’t see Nurse Santos in a barca,” Pantaleon said. “She doesn’t want to drown before she gets married.”

“Dr Quiroga, do you mind!” Nurse Santos was distinctly portly. There was a lot of banter in the theatre about her size. Everyone laughed. The Chinese boy looked at their grinning mouths and shaking shoulders incomprehensibly.

“Don’t fit the mouth wedge before Pantaleon knocks him out.” Carriscant said. “Do your stuff, Doctor.”

Still chuckling, Pantaleon began to drip chloroform from the calibrated glass drop-bottle on to the gauze mask, holding it upright from time to time to check the reading. When the boy lost consciousness the two nurses held his head forward and forced his jaws apart. Carriscant fitted a clamp just behind the tumour, turned it tight and drew the tongue as far out of the mouth as possible. Nurse Santos took the handle from him, pulling on the tongue firmly. Pantaleon touched the boy’s eye to check the lid reflex. He opened the eye with thumb and forefinger: the size of the pupil would tell him to what extent the nervous system was depressed. He nodded his approval.

Carriscant felt his breathing slow and his brain clear as he paused for a moment before changing his scalpel for a smaller one with a long fine blade. After all these years, all these operations, the feeling never altered: his senses felt fresh, newly minted, acutely aware; his consciousness seemed suddenly highly attuned, not simply in an extra appreciation of the physicality of the objects in the room—the spangling glare of chrome, the perfect fan of the boy’s eyelashes resting against his lower lid, the frayed cuff of Pantaleon’s right sleeve—but also in a preternatural understanding of the other human beings present at this moment. He sensed the unrelenting melancholy in Pantaleon’s soul as if it had been his own; he felt the weight and softness of Nurse Santos’s breasts pressing against the starched blue cotton of the smock she was wearing; he shared in the weariness of Nurse Arrieta who had been up throughout the night tending to her fractious and incontinent father-in-law…All these emotions, all these sensations were present to him, gifted to him, flowed into his all-encompassing and receptive mind and were logged and acknowledged. I know you all, his silent gaze said to them, I know your suffering humanity, your anxieties, your needs, your itches, your callouses, your aching backs, your tiredness…I know. I understand. I understand everything.

He raised the scalpel, felt its small weight, his eye caught the gleam of its thin bevelled blade. Nurse Santos, unbidden, moved an enamel bowl beneath the boy’s chin. With three careful swift strokes Carriscant cut through the fungiform pappillae to the muscle tissue beneath, slicing back at an angle of forty-five degrees towards the throat. Blood welled from the partially severed tongue. Nurse Arrieta applied a swab. He lifted the clamp revealing the underside and he cut again making a lateral fork in the tongue, so that a longer lower flap was formed. The tumour fell dully into the bowl. Nurse Arrieta handed him the needle and gut. Antiseptic fluid was poured over the wound and he sewed the two short flaps of the tongue together.

He turned away, his brow dry, his throat parched, the fingers of his right hand slick with the brightness of the boy’s blood. He moved to a sink at the side of the room and ran water over his bloodied fingers. There were fat spots of blood on his tunic too, he noted, absentmindedly. He removed the gown slowly and dropped it in the wicker basket by the door thinking, suddenly, of Cruz and how he still persisted in operating in a black frock coat, its reveres and front encrusted with dried pus and blood like some obscene blazon honouring his trade.

A rare and untypical nausea made his gorge rise. The tongue was such a curious part of the body, a flickering pulsing muscle with its two senses—taste and touch—a kind of amphibian organ planted in the throat like an anemone anchored to its rock, unsure whether it should be inside or outside the body. When he cut it seemed to flinch.

He stopped himself, angrily: why was he thinking like this? He felt his keening headache return and with it the memory of its cause, the brief intense argument he had had with Annaliese that morning. “Work, work, work,” she had cried spitefully at him as he dressed for work. “Why get married, why bother having me in your life?…Why indeed”, he had shouted back, if this is meant to be wedded bliss. Stupid, purblind woman.

The porters wheeled away the still comatose Chinese boy and he and Pantaleon moved next door to change back into their clothes.

“What do you think?” Pantaleon asked. “It seemed to go well.”

“We’ll see how it heals. At least he’s got some tongue left.”

“Cruz will go mad if it works,” Pantaleon smiled. “Madder.”

“If it works we photograph the next one. Write it up.”

“The Carriscant glossectomy.”

Señora Diaz interrupted their self-satisfied chuckles to tell them that someone from the Governor’s office was looking for Dr Cruz. Carriscant shrugged on his coat, straightened his necktie and walked up the corridor to his office, rubbing his hands together vigorously—the carbolic in the soap dried the skin and caused flaking at the knuckles. He opened his office door and a man in military uniform—khaki, leather–belted—rose to his feet from the chair in front of the desk and saluted. He was portly, running to fat, and his uniform was tight across his belly. He had a high forehead and thinning hair, and a neatly trimmed wide moustache that effectively divided his face in two.

“Dr Carriscant, thank you for seeing me,” he said. “I’m Paton Bobby, Chief of Constabulary.”

D
r Carriscant stood beside Paton Bobby in the rice field looking down at the naked half-submerged body of what had been an eighteen-year-old Kansas militiaman.

“That is no fucking gu-gu,” Bobby said, a frown pulling his eyebrows together and cabling his forehead. “In fact that is just about the whitest man I’ve ever seen.”

There was a peculiar bluish, icy tone to the body’s general pallor, it was true. The fat on the buttocks seemed to shine through the skin like ice-cream wrapped in parchment, Carriscant thought, quite pleased with his simile.

“That’s because we’re standing in a solution of his blood,” Carriscant pointed out. The body lay in the centre of a dark brown stain, still spreading, stirred by the sloshing of the men’s boots. Carriscant leaned over: there was a pestilential buzzing of insects and the solitary eye that was above the surface of the water was dark with flies feeding on its jelly.

“Has anybody moved it?”

“The farmer who found him, turned him over. Got a look,” Bobby said. “That’s how we knew we needed a doctor.”

“What about Dr Wieland?” Dr Wieland was acting medical superintendent to the US Governor. Carriscant had met him several times, a genial, superannuated alcoholic whose medical knowledge was about as far advanced as Cruz’s.

“Dr Wieland is…unwell, today,” Bobby said, half concealing a smile. “He suggested we consult Dr Cruz,” he shrugged. “He wasn’t there. But we are very happy with you. No disrespect.”