“So what? So have I. My mother lives in San Teodoro.”
“And during the war, in February and March of 1902 Colonel Sieverance’s regiment was operating there. Too many connections, Carriscant, I can’t ignore them.”
“You’re grasping at straws,” Carriscant said. “The flimsiest, most ephemeral of straws…Listen, I could have taken that scalpel. Any of my staff, any porter. Dr Cruz, Dr Wieland. Even Colonel Sieverance, even you. You’ve all been in my operating theatre, or have access to it.”
Bobby coloured and for a second or two looked very uncomfortable. “There’s no need for that quality of sarcasm, Carriscant. I have to follow up everything.”
Carriscant made an apologetic gesture, bowing his head. “The scalpel does set up all manner of questions, I agree,” he said, looking hard at Bobby who, he thought, seemed particularly uneasy beneath his gaze. “If we hadn’t found it I would say that the woman’s murder was completely unconnected to the soldiers’…She was pregnant, by the way, four months.” He paused: he decided to tell Bobby his own hypothesis. “If you want my opinion, that scalpel was deliberately placed there. Not to implicate Dr Quiroga…But to implicate me.”
“For God’s sake! Now you’re being absurd. Who would do such a thing?”
“Dr Cruz or Dr Wieland. Or both of them.”
Bobby laughed, his confidence suddenly returning. “You’re saying they murder some peasant woman and then place one of your scalpels by the body? It makes no sense. These are men of genuine standing in the community. No, no.”
“I don’t say murder. But they’re more than capable of, of taking an opportunity to try and disgrace me. Cruz has many contacts with the police. Tondo police bring many fight victims to the hospital. To Cruz’s wards.”
“I can’t accept that.”
“They are completely unscrupulous and sworn enemies of mine.”
“This is fantasy. Pure melodrama.”
“I have to tell you what I think. They want to discredit me and they don’t care how. I don’t say they murdered the woman. There’s a cholera epidemic in the provinces. Dozens of people die every week. And God knows how many spare bodies Cruz has in his fiendish laboratory. He could have—”
“No, stop. This is completely out of control. My dear Carriscant, these are ravings, nonsense. I’m surprised at you, old fellow, I always had you placed as a cooler, more collected type of person.”
“I’m convinced that scalpel was stolen from my operating theatre.”
“Look, I think we’re jumping too far ahead. Damn rain’s rotting our minds. Growing mildew.”
Carriscant decided to leave it at that. He was satisfied, however: his confession had achieved something unexpected. Bobby’s relief at his accusations had been manifest, and too enthusiastically rebuffed. He was convinced now that the theft of the scalpel from his theatre was carried out by none other than Chief of Constabulary Paton Bobby.
THE SUTURED HEART
Annaliese Carriscant spooned honey on to another triangle of toast and licked the spoon before returning it to the pot. She’s eating too much, Carriscant thought, putting on more weight. There was a small bulge of flesh, an incipient double chin, growing beneath her jaw. With a sour pang of clarity Carriscant saw how unattractive his wife was, all of a sudden—how pinched, despite her new corpulence, how bland. Beside Delphine, she was—He pushed away his plate of chicken and rice. How could she eat toast and honey, slice after slice, all evening?
“I have to go to the hospital,” he said.
She looked at him, impassivity shading into contempt, he thought.
“I won’t wait up.”
Carriscant pulled the dressing back over the wound. The patient was an Englishman, an officer in the coast guard, who had developed a large bronchocele or goitrous cyst on his neck which had grown to the size of an aubergine and which had been removed two days previously. He was still weak, but he appeared to be making progress. Carriscant moved on to the next bed but was interrupted by one of the nurses, Sister Encarnacion, who had hurried into the ward.
“Dr Carriscant, please, ward eleven. An emergency.” Carriscant followed her quickly along the corridor in the direction of the western wing of the hospital. Ward eleven was one of Dr Cruz’s wards. As he left his own area of the hospital it was like crossing a frontier, he thought, or travelling backwards through time. At the extremities of his sphere of influence were the trestle tables with the enamel basins of disinfectant and carbolic soap, the trays of lime powder on the floor into which everyone entering his wards from Cruz’s was obliged to step. Even the quality of the air seemed to change: here were old smells of putrefaction and unchanged linen and unwashed bodies. The corridors were grubby, the floors unswept, the walls printed with fingermarks and the greasy shine of human contact. Cruz still believed firmly in the airborne transmission of disease, that infection was caused by foul and noxious currents of air and as a result all the windows and doors of his wards were tightly sealed. Sister Encarnacion pushed open the door of ward eleven and led Carriscant into a long room, foetid and close, divided into cubicles, wooden walls floor to ceiling, with one bed inside each stall. The aim being, Carriscant supposed sardonically, the better to impede the noisome breezes that were killing 60 per cent of Cruz’s patients. The nurse showed him into a cubicle and Carriscant peered down at a young man, a Filipino, who, he saw at once, had only a few days left to live.
“What’s happened here?” he asked.
Sister Encarnacion explained that the man had been reroofing his hut, had fallen and had impaled himself on the bamboo fence that surrounded his garden. A sharp sliver of bamboo had entered his body just below the breastbone and had travelled upwards to pierce the heart.
A waterproofed canvas bag full of ice was resting on the man’s chest. Carriscant lifted it off to reveal the heavy bandaging beneath. To his surprise he saw a rubber tube extending from the bandages leading into a glass bottle which was half full of blood. Drips fell from the tube’s end.
“What’s this?”
“A drain from the pericardium.”
“What?” This made no sense. Carriscant felt the man’s pulse, very faint and irregular.
“What operation has Dr Cruz performed here?”
Sister Encarnacion told him, and added that Dr Cruz had been highly pleased with the result and had wanted the patient closely observed. A messenger had been despatched to Cruz’s house, but the doctor would surely not arrive in time and seeing that Dr Carriscant was in the hospital…
Carriscant was amazed, more than amazed. Some more questioning elicited the facts that Cruz had opened the man’s chest and exposed the sac that contained the heart and that had been pierced by the bamboo sliver. He had sewn up the wound in the pericardium leaving a trocar pushed into the heart cavity to drain it. Carriscant looked at the man. His face was blanched and pallid, covered in sweat, and he was breathing with difficulty. Cruz may have sewn up the wound in the pericardium but it was clear that the heart had been pierced also. There must be a tiny wound in the heart still pumping blood into the cavity, too much for any drain. Soon the pressure of the blood filling the heart cavity would stifle, and silence the beating, or else the lungs would give out, as the blood had probably flowed into the thoracic cavity too, crowding the lungs. There was nothing he could do. He turned away, frustrated and angry, and paced up the ward looking into the other cubicles, noting the grime on the shuttered windows. Most were empty: in one bed was a dead body, the sheet pulled over the face. Two other cubicles contained patients—a young boy and a young man—both had ice bags on their chests.
“What’s this ward for?”
“Only chest wounds. Dr Cruz has asked that this be kept exclusively for chest wounds.” Sister Encarnacion looked unhappy. “We get too many criminals, Dr Carriscant. The police from Tondo bring them here when they are injured in fights. Dr Cruz has asked only for those with chest wounds. The worst sort of individual…” She lowered her voice. “We’re n
ot used to this in the San Jeronimo. Not at all.”
It was only as he approached the rear of the Sieverance house that Carriscant’s thoughts turned to something other than Dr Isidro Cruz and his daring new operations. He had hired a carromato to take him to Uli-Uli, a village just beyond the Palace, and had trudged back towards the Calle Lagarda before leaving the road and making his way across country towards the cul de sac and its sumptuous residences. The sky was largely covered but from time to time a three-quarter moon appeared between the shreds of cloud to light his way. He reached the rear hedge bordering the Sieverance garden without serious mishap. One slithering fall down the banked dyke of a rice paddy had soaked a shoe and muddied a trouser leg, but otherwise he was in good order as he pushed his way through the thick cogal and hibiscus bushes and crept across the moon washed garden towards the house.
And once again he asked himself what exactly he was hoping to achieve and as always the realisation came that it was the effort itself that provided the justification. It was inertia that finished him: to be doing something, however pointless, however foolish, was crucial. So he took up his position behind a dense humped mass of bougainvillaea that had engulfed a wooden pergola and waited. Perhaps she would venture out on to the azotea for some fresh air and he would be able to call discreetly to her. Even to glimpse her would be sufficient reward. He could see that many of the house’s rear windows were illuminated and he could hear the chatter of servants and the clanging of pots and utensils from the ground-floor kitchen area. The evening meal over, he guessed. He was sure he knew where her bedroom was, and also the library, but he felt it would be foolhardy to throw a pebble at either of these windows in the hope of attracting her attention. What if a maid was in the room? Or worse, Nurse Aslinger? He had better wait and pray his luck would hold.
Occasionally, he saw shadows pass in front of the screened windows but they were too vague and diffuse to make identification possible. And then he heard some piano music—that must be her, he thought—a series of arpeggios against a held note, then a haunting snatch of melody, some quickly played scales, up and down, and then silence. More shadows flicked in front of the windows and the fancy entered his mind that she was pacing about the rooms of the house, restless, her mind working, unable to settle, thinking about him just as he was thinking about her. Perhaps his very presence in the garden, his proximity, was provoking this delicious edginess…He concentrated hard, sending his thought-waves out, willing her to open a door and step out on to the rear terrace. But she did not appear. He heard a door slam, saw the light go out in what he took to be her bedroom and then nothing more. The wetness in the grass soon soaked through his remaining dry sole and he felt the cooler breezes on his neck carrying with them the earth-reek that warned of approaching rain. It began to drizzle steadily and in the next-door garden a dog started to bark tetchily, setting off another in the servants’ quarters of the Sieverance house. It was time to leave. He felt oddly satisfied as he renegotiated his way through the hedge and regained the road. In anyone else’s eyes his damp vigil in the garden would have seemed absurd and a futile waste of time, but to a lover, he said to himself as he tramped into San Miguel looking for a carromato, to a lover such needless discomfort has its own private import, signalling the depth of his devotion. The tune, the melody she had briefly played, remained in his head. He found he was still humming it as he settled down in his divan bed and prepared for sleep.
AN OFFICIAL ENTERTAINMENT
Carriscant was tidying away his papers into his desk when there was a knock at his door and one of the nursing sisters appeared.
“Excuse me, Dr Carriscant, Dr Cruz sends his compliments and would like you to visit him in his theatre. It’s a matter of some urgency.”
Carriscant was very surprised. He and Cruz had barely exchanged a word since the row over Delphine’s appendicitis.
“In his theatre, you say?”
“Yes. At once, if you please.”
Carriscant crossed the courtyard towards Cruz’s consulting rooms. He followed the nurse down an ill-lit corridor towards the operating theatre. The walls here were painted with ancient yellow distemper which was flaking and peeling, and there was a curious smell in the air, a sweetish fatty cloying reek which lingered in the nose, coating the palate almost as if it were designed to be tasted rather than smelt. It was the smell of old untended food, an exudation of dirty kitchens. Carriscant recognised it at once as the smell of putrefaction.
Cruz’s operating theatre was, to Carriscant’s eyes, a scene from one of the circles of hell. Old cracked terracotta tiles on the floor and smudged plaster walls covered, for some reason, in scribbles of handwriting, ancient wooden trays and tables. Cruz stood tall in his domain, in his famous frock coat with its filthy veneer, its pustulent lichen, the cuffs unbuttoned and the sleeves of his coat and shirt folded back to reveal his powerful forearms with their pelt of dark hair. His hands were smeared with blood as he towelled them off on a scrap of cloth. Three theatre nurses stood around the operating table alongside another doctor, Dr Filomeno, who acted as Cruz’s anaesthetist. Dr Filomeno wore a light brown suit, ruined by a splash of blood down the right side. He was dabbing at this with a bundle of swabs and complaining vigorously to one of the nurses.
“Ah, Carriscant,” Cruz said, tossing the towel away on to a tray of instruments. “Glad you could make it.” The self-satisfaction, the barely suppressed delight in his voice, made him drawl the words out as if he were intoxicated. “I very much wanted you to see this.” He waved Carriscant up to the table.
A man lay there, his chest cavity open, retractors holding the wound wide. Peering closer, Carriscant could see that the pericardium had also been cut open, the sides held back by clamp forceps.
“Look,” Cruz said. There, amidst the coagulated blood and the severed tissue Carriscant saw the man’s beating heart, pulsing irregularly like some sea creature, half vegetable, half shell-less bivalve, something that clung to rocks deep at the bottom of the sea, expanding and contracting weakly, only just alive. Carriscant turned back to Cruz. The man ran his hands through his wiry hair and began to roll down his cuffs.
“I’ve summoned a photographer,” he said proudly. “The world is about to learn about Isidro Cruz. You’re not the only surgeon around here that can make an impression.”
“What’re you talking about?”
“Look,” Cruz said, approaching the body. “Just look, Carriscant.”
He stared at the twitching heart. Six taut sutures, knotted silk. Cruz’s blunt finger entered the chest cavity and touched the pulsing organ.
“Cardiac sutures, Carriscant. In a knife wound.”
The nurses fussed over the body, checking the drains from the pericardium and pleura.
“Dr Filomeno will replace the rib and close the wound. I shall be issuing a statement to the press.”
Carriscant could not resist it: he reached out a finger and gently touched the surface of the beating heart as it wobbled and bulged, slick in its cavity. The six stitches sealed a neat wound about an inch long in the left ventricle. Carriscant’s eye fell on a bag of ice on a nearby trolley. He looked at the man’s face.
“May I?” He removed the mask that covered it: the man’s skin was practically grey. Carriscant recognised him.
“The left lung collapsed,” Dr Filomeno explained.
Carriscant nodded. This was the man he had seen in Cruz’s ward just two days previously. But the nurse had said nothing about a wound in the heart. In the pericardium, she had said. Carriscant’s mind began to work: the man could not have had this gash in the heart then or he would have died within the hour. A tiny perforation perhaps, that had been his diagnosis, but not a wound of this size. So where had he received this neat wound that Cruz had sutured? Surely, not even Cruz could be so—
“Cardiac sutures,” Cruz taunted. “Cardiac sutures, Carriscant.”
“This man will die.”
“I doubt it. The bleeding has sto
pped. The lung will reflate.”
“Even so. No, it’s the filth of this place that will do for him. Look at you. I saw you run your fingers through your hair just before you touched his heart.”
“Modern nonsense, Carriscant. Modish dogma.”
“You might as well have operated on a cadaver.”
“Professional jealousy is the most demeaning of emotions, wouldn’t you say, Filomeno?”
“Without any kapffneu!” Filomeno sneezed, his hand going to his nose a second too late. Carriscant turned away and looked around at the foetid, badly lit room full of people in their street clothes, scratching and sniffing, the dried blood and feculence of dozens of operations stiff and crumbling on their coat fronts.
A porter appeared at the doorway. “A gentleman is here from the Manila Times, sir,” he said.
Carriscant could not resist. Later he wished he had let Cruz suffer the full force of public humiliation and ignominy but this personal victory was too sweet to be resisted.
“I congratulate you on your sutures, Cruz. Neat work, as always. But you’re too late. If I were you I would set out straightaway on the road of aseptic surgery. Who knows, you might achieve great things.”
“What do you mean, too late?”
“Seven years too late to be precise. The first cardiac sutures performed on a living patient—who survived—took place in 1896. Frankfurt-am-Main. Dr Louis Rehn was the surgeon.” He smiled. “Nice try. Now if you’ll excuse me I have an official entertainment to attend.”
The launch was waiting for them at the wharf by the Cold Storage buildings. Carriscant helped Annaliese down into the well behind the engine and waited as the other members of their party climbed aboard. The night air was sultry and warm and he found himself wondering why formal receptions in the tropics had to be governed by the same manners and decorum suitable for temperate climates. To be wearing a tail coat, a stiff collar and white tie to attend a function on an island in the middle of the China Sea seemed to be ludicrously pretentious, not to say sheer folly. All his satisfaction at having put Cruz so unequivocally in his place had evaporated, to be replaced by irritation and bad grace. He dropped down into the launch and it was pushed away from the wharf and began to motor up the Pasig towards the Malacanan Palace. Here at least was some relief, a little coolness, and he stretched his neck above his collar and spread his moist palms to catch the breeze created by their progress. Around him, chattering excitedly, were the members of their party—Annaliese’s friends, not his, he corrected himself. The invitation had been extended to the bishop and his staff, hence Annaliese’s insistence that they go. He looked back at them: Mr and Mrs Freer, middle-aged English, he an oculist; Monsieur and Madame Champoursin, he was a journalist; Señora Pilar Prospero, headmistress of the cathedral school; Father Agoncillo, a plump young priest and a special friend of Annaliese; and Mrs Kelly, a friend of the Freers, wife of a veterinary surgeon in Iloilo, visiting Manila for a month. What an impoverished crowd, he thought sourly. The men were all in evening dress like him, the women might have been going to a ball in any provincial city in Europe—long dresses, petticoats, demure jewels, silk, lace and taffeta, corsets and hair-combs and high-heeled slippers. One or two carried fans, otherwise they might have been in Aberdeen or Bristol, Lyons or Hamburg, Genoa or Seville. He was determined, at all costs, not to enjoy himself.