“And, shortly after, I met your mother,” Carriscant said.
“In Manila?” All these revelations were confusing me.
“Of course. Where did you think?”
“It doesn’t matter.” We were strolling back to our hotel from a chop house on Forty-first Street. “And then the war started,” Carriscant said with a shrug.
“What war?”
“The war between the USA and the Philippines.”
I decided that was enough questions for this evening.
In the morning, after I had visited the Portuguese consulate to have a visa stamped in my passport (Carriscant, being British, did not require one), I visited a bookshop to try to discover more about this American-Filipino conflict but could find nothing. However, in a small volume entitled A Pocket History of the United States of America 1492-1930 I came across the following paragraph and copied it down.
One consequence of the Spanish-American War was that the Philippine Islands were liberated from the yoke of imperial power when Commodore George Dewey destroyed the Spanish fleet in Manila Bay on I May 1898. Filipino rebels, led by Emilio Aguinaldo, who had been in revolt against their Hispanic masters for several years, saw the Spanish-American War as an opportunity to declare their independence and form a Philippine republic. When they discovered that the United States proposed merely to substitute its rule for Spain’s the insurrectos, as they were known, promptly attacked their former liberators on 4 February 1899 and laid siege to Manila. The subsequent war lasted three years and was only concluded after the capture of the rebel leader, Aguinaldo, in 1901. This war, one of the most prolonged and deadly in the annals of empire, exerted a high toll. Some 230,000 men, women and children perished, of which 4,234 were brave American soldiers, and the cost to the nation’s exchequer was an enormous 600 million dollars.
Archibald and Juliana Carriscant and their son Salvador…Commodore George Dewey and the battle of Manila Bay…The capture of Emilio Aguinaldo…Six hundred million dollars of American taxpayers’ money spent on a forgotten and bloody colonial adventure half a world away…What did all this have to do with me? I wondered how it could possibly explain my journey to Lisbon with a man who claimed to be my father in search of a woman whose face I knew from a torn-out page in a 1927 pictorial magazine.
We had a rare and gratifyingly tranquil voyage on the SS Herzog. The Atlantic swell remained glassy and docile as we cruised eastwards through mild hazy sunshine, the fraying rope of smoke from our two tall stacks trailing persistently behind us as if reluctant to be dispersed on the gentle oceanic breezes.
During our ten-day journey Carriscant was as good as his word—he told me everything, and answered every interrogation I put to him without demur however embarrassing my enquiry or however damaging it might prove to the portrayal of his character and motives. As you will see, his candour was impressive. I kept copious notes of everything he told me and wherever possible attempted to catch him out or corroborate details. In the relaying of his story I have allowed myself some of the licence of a writer of fiction, have embellished it with information I obtained later and with facts gleaned from my own researches. But in the end this is Salvador Carriscant’s story and I have had to trust the teller, as we all must in these circumstances, but what follows is, I believe, as close to the truth as anyone could come.
MANILA, 1902
TONGUE
According to his best recollection, on the day of the first killing, Dr Salvador Carriscant—the most celebrated surgeon in the Philippines—suffering from a mild headache, left his house and decided as was his occasional habit to walk to work. Nobody of any importance or self-regard, with even the slightest modicum of self-esteem, walked in Manila in those days but Dr Carriscant relished the short stroll from his fine house on Calle de la Victoria to the San Jeronimo hospital, not only for the pleasant sensation of libertarian fellow feeling it provoked in him but also because the interlude allowed him to calm down, to forget the irritations and frustrations of his home life, and clear his mind for the exhilarating but complicated business of the day’s work waiting for him in the surgical wards.
The San Jeronimo hospital in Manila was a comparatively recent building, having been completed in 1878 and renovated again nearly twenty years later when the electric light was installed. It was to some extent modelled, so Carriscant had been informed by an elderly member of the hospital’s board of governors, on the Palazzo Salimberri in Sienna and certainly the streetfront facade bore some resemblance to a crude quattrocento building, made of well-cut adobe brick, with a simple hipped roof of terracotta tiles, much overgrown with ferns, moss and other greenery. There was a very high arched gateway with heavy wooden doors and a row of small square windows set in the walls above, bestowing a solid and uncompromising character, as if the place might have to be defended in times of insurrection or be called on to do duty as a prison. Inside, however, was a wide paved courtyard with arched cloisters on three sides and set behind that was a mature walled garden and arboretum crisscrossed by gravelled paths. Various consulting rooms for physicians, administrative offices and the dispensary led off the cloistered arcades, but the operating theatres, and there were two of them, were contained in two stubby projecting wings, east and west, on either side of the garden, almost as if they had been added as an afterthought. Dr Carriscant’s theatre was in the east wing. The medical director of the San Jeronimo hospital, Dr Isidro Cruz, practised his art in the western projection.
The design of the San Jeronimo was simple and, as long as numbers of patients did not grow too rapidly, as they did when the cholera and smallpox epidemics erupted, was quite effective. Patients first visited the physicians on the ground floor who then, where necessary, referred them to the surgeons. Post–operative care took place in the wards that occupied the floor above. The one disadvantage of the place was that there were no laboratories or dissecting rooms and that the morgue was a little on the small side. Consequently any anatomical or experimental work had to be carried out at the San Lazaro hospital or in private premises. The reputation of the San Jeronimo had been high, almost from its inception, owing to the celebrated dexterity of Dr Cruz (who on one day in 1882 had performed over three dozen amputations) but it had been augmented in recent years as a result of Salvador Carriscant’s return from Scotland in 1897 and his introduction of Listerism and the latest surgical methods and the remarkable success rate these innovations had produced. The hospital board had increased his basic salary four times and had awarded him the honorific title of surgeon-in-chief, a move that Dr Cruz had vehemently and publicly protested and which had set the seal on and, as it were, formalised the doctors’ personal animosity to each other. In public the two men maintained an air of courteous but professional reserve, but everyone knew that Dr Cruz detested Dr Carriscant and everything he stood for medically. The feelings were reciprocal: to Cruz Carriscant was an obsessed faddist and heedless experimenter; to Carriscant Cruz was an antediluvian sawbones cum sinister circus performer, and so on.
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 we
re 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 fractio
us 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.