1993 - The Blue Afternoon (18 page)

“I’m overwhelmed, Panta, overwhelmed.” He embraced him. “After a day such as I’ve had you don’t know what a tonic you are, my friend, what an inspiration.”

Carriscant supervised the installation of the ice chests in the new morgue himself. They were in fact used for the refrigerated transportation of perishable food at sea, first developed in Australia, Udo Leys had told him, when Carriscant had first described Cruz’s arrangement. And it was Udo who had managed to procure these three second-hand examples for him, not quite as large as Cruz’s, but capacious enough to hold two bodies very comfortably. He had had the interior lining cavity restuffed with new straw and had had the stencilled sign on the side, “Oh Chung Lu, Meat & Fish Importers”, painted over. Filled with ice, the chests (one containing Ward, whom he had rescued from the old morgue, one containing Braun) were pushed against three walls of the new morgue while in the middle of the room was an enamel-topped examination table with three tin basins beneath. There was already a sink against the fourth wall and the wooden floorboards had been covered with a waterproof cork carpet on his instructions. The morgue would function perfectly until he could secure Cruz’s dismissal. It also provided him, he realised, with an ideal place for his own dissections and investigations, should he require it. There was no longer any need to visit the anatomy laboratory at San Lazaro hospital: everything necessary was now under his own roof.

He was standing in the new morgue at 6 o’clock the next evening, indecisive, wondering whether he should return home now the day’s work was done, or whether he should make one further tour of his wards, when a porter knocked on the door with an envelope marked “urgent and personal”. He tore it open and read the large rapid scrawl.

Dear Carriscant,

 

I need your help with the utmost urgency on a delicate medical matter. I would be most grateful if you could call on me this evening at my house, 5 Lagarda Street in San Miguel, at your earliest convenience, any time this evening. I count on your help and your confidentiality.

 

Yours faithfully,

Jepson Sieverance.

Sieverance’s house was one of five large newish villas built in the Antillean style not far from the Malacanan Palace, all occupied by members of the Governor’s staff, that formed a small compound called the Calle Lagarda. There was even a marine on guard at the entrance to the cul de sac, sitting idly in a sentry box. He waved Carriscant’s victoria through with barely a glance.

Carriscant was shown up to the living room on the first floor where Sieverance greeted him, clearly in a state of anxiety, his face drawn, and somehow sucked in, as if he had lost weight dramatically in the last twenty-four hours. He shook Carriscant’s hand over-eagerly, almost abject in his gratitude.

“I can’t thank you enough, Carriscant. I’m in your debt.”

“It’s nothing, really. What’s the trouble? You don’t look at all well, I must say.”

“This way, please.”

He led Carriscant out of the living room and down a corridor towards, Carriscant imagined, a bedroom where he could be examined in privacy. He paused at a door and knocked gently on it.

“Delphine?” he said. “May we come in?”

He knew at once, of course, immediately, with no doubts or second thoughts. He was vaguely aware of Sieverance opening the door, and of following him into the room. Oil lamps, turned down by a bedside. A gauzy tent of mosquito netting. The sway of the punkah fan on the ceiling, to and fro, to and fro…

He ordered his legs to carry him to the bedside as Sieverance gently folded back the netting. He held his face immobile, eyes still, as she turned from her doze to see who it was.

She was propped on several pillows, her dull chestnut hair spread, loose, a moist sheen of perspiration on her pale stressed face.

Sieverance said to her softly, “This is the doctor I was telling you about, my love. This is Dr Carriscant.”

She frowned, lifted an arm as if to block the glare from a lamp and her eyes grew wide with incredulity.

“How do you do, Mrs Sieverance,” he managed somehow to say quickly. “I’m very sorry to find you unwell.”

He felt his face hot, is skin itched. “Dr Carriscant?…Doctor?” She shook her head, trying to clear it.

“The doctor I told you about. The hospital, remember? Every latest style of equipment.”

She closed her eyes and exhaled. He knew, suddenly, instinctively, that she would say nothing.

“Dr Carriscant…” she repeated. “Thank you for coming.”

He allowed himself a weak, twitching smile. He felt he was about to fall over. He felt the sweat roll from his armpits, his shirt sticking damply to his back. He reached out and pulled a chair to the bed. Not too close.

“What seems to be the trouble?”

She told him, prompted occasionally by Sieverance, that she had been suffering from pains in the abdomen for a week or so but she had thought nothing of it, suspecting a digestive problem. Then that afternoon she had been stricken by a severe attack of vomiting and the pain had reached intolerable levels. She felt feverish. A friend had called the doctor.

“She called Dr Wieland,” Sieverance interjected. “I was at work. Dr Wieland was called.” He glanced meaningfully at Carriscant, apologetically. “He is our medical officer. It was the natural thing to do, unfortunately.”

“What did he diagnose?”

“He didn’t offer one. He prescribed a purgative and opium.”

“I see. Have you taken them?” He turned his gaze back to her. Delphine. Even sickly and in pain that face, her hair loose, makes me…He smiled, all reassurance.

“Yes, of course,” she said, a hint of irritation in her voice. “What else was I meant to do? The pain has gotten less, but the purgative…” She winced. “But the fever is worse, and the pain is coming back, badly.”

“Which is why I called you.” Sieverance looked pleadingly at him.

“Strictly speaking Mrs Sieverance is Dr Wieland’s patient now. I can’t really—”

“To hell with that,” Sieverance said with untypical fierceness. “I’m not going to worry about the niceties of medical protocol. My wife is seriously ill. I don’t care—”

“Jepson,” she said, wearily. “Don’t worry. Dr Carriscant will help.” She knew her power. Already we had a secret between us. A silent promise had passed between us, he thought.

“Where is the pain?” he asked.

“My stomach, low to the right side.”

“Did Dr Wieland examine you?”

“No.”

He sighed. Unbelievable. “I have to,” he said. “If you’ll permit me. I’m sorry to sound like a textbook but palpation is often our best diagnostic tool. May I?”

Sieverance looked at his wife for permission.

“Of course,” she said. “Please do.”

Carefully he folded the sheet back to her knees. She was wearing a white cotton nightdress with frilled bib-effect over the chest. A smell rose up from the bed, briefly. Her smell, a trace of perfume and powder, of fresh sweat and a sour, momentary reek of shit. He filled his nostrils before the punkah fan swished it away.

“Would you mind indicating…”

Her finger went to a point three inches to the left of her right hip. Very gently he rested the tips of his right hand’s fingers on her body, feeling its softness through the cotton, feeling its heat, and pressed down.

“It’s generally sore, down there. I can’t really say—”

“Tell me when there’s a spasm.”

He moved his hand further to the left. Beneath the tip of his little finger he felt the prickle of her pudenda, a wiry yielding. He moved again a little lower. She gave a gasp of pain. Beneath his fingers he felt the stretched ripe capsule of the abscess, tuberous, rotten, ready to burst.

“May I smell your breath?” He moved his face, not capable of meeting her eyes, and she breathed upon him, brackish and foul. He took her temperature: 102 degrees.

“Dr Wieland said I should take the purgatives every four hours.”

“Of course he would. He has no idea what he’s doing. May I have them please?”

Sieverance handed him a dozen brown paper sachets from the drawer of a bedside cabinet and Carriscant put them in his pocket. He sat back in his chair, steepling his hands, pressing the fingers together to stop them trembling.

“Mrs Sieverance, you have what they call in America
appendicitis
.”

“What’s that?”

“There is a small vermiform appendage to part of your intestine called the
blind gut
. Literally an
appendix
to your gut, which has become inflamed and swollen. I imagine it is already perforated which is causing the pain and vomiting. It has caused an abscess which will rupture, I should say, sometime in the next twenty-four hours.” He paused. “What happens then is that the corrupt matter will be released into the abdominal cavity, the peritoneum. And once that occurs there is very little we can do.”

“I’ll die.” She looked at him candidly.

“Yes.”

When the two men returned to the living room Sieverance sat down in a chair and began to weep softly. Carriscant felt a huge awkwardness, but managed to stand by him until he composed himself, squeezing his shoulder in what he hoped was a comforting way. He felt like weeping himself as he explained what the future held for her and what had to be done.

“There is no other course of action, Colonel Sieverance. She’ll die, I’ve seen it happen countless times.”

“But this operation, have you ever performed it?”

“It’s rare. I’ve done it twice, but without success unfortunately.”

“Meaning what?”

“I was too late. The appendix had ruptured, sepsis was advanced, uncontrollable.”

“Jesus Christ, you want to cut her open and you’ve never saved a patient with this operation?”

“Look, Wieland’s ridiculous purgatives are just going to weaken her faster. You might as well cast a spell for all the good it’ll do. She has to have the operation.”

“I can’t risk it.”

“Ask her.”

“She’s in pain. How can she make a clear judgement?” His voice was shrill, girlish, demented with worry. He stood up and walked to the window and peered out into the night. “Wieland’s due here in half an hour.”

“Don’t ask him, man. He knows nothing. Take her to the hospital, we’ll operate tonight.”

“I want to wait for Wieland. Then I’ll decide.”

Dr Wieland did not bother to conceal his huge displeasure, and neither did Dr Cruz, whom Wieland had asked to accompany him, so he said, to confirm his diagnosis.

“Dr Carriscant has absolutely no business here,” Wieland said, anger distorting his voice. “Mrs Sieverance is my patient.”

“He has my authority,” Sieverance insisted. “My wife is ill and I want the best for her.”

Wieland had to accept this which he did with manifest bad grace before pronouncing his diagnosis.

“We think, and Dr Cruz agrees with me on this, that the gut is inflamed due to a lack of mobility. The calomel will encourage movement of the gut and at the same time the opium will control the pain. Within two or three weeks—”

“—she will be dead and buried,” Carriscant said brutally. He saw Sieverance flinch.

Cruz rounded on him and spoke harshly and rapidly in Spanish. “How dare you contradict us. This is as clear a case of perityphlitis as I’ve ever seen. All this fashionable nonsense about the appendix is unforgivable in the current circumstances. I deplore your presence here and I order—”

“Gentlemen, please,” Sieverance said. “Let me understand this: you completely oppose Dr Carriscant’s idea of surgery, and you wish to continue with the purgatives and the opium.”

“And a broth four times a day,” Cruz added in English. “With alcohol. For to strengthen.”

“Colonel Sieverance, do not delay, I beg you,” Carriscant said. “Your wife must be operated on at once.”

“This is a colic which has inflamed the intestine!” Wieland shouted at him. “To open the abdomen is tantamount to murder.”

“The king of England had his appendix removed a matter of months ago,” Carriscant retorted, keeping his voice calm. “It saved his life.”

This seemed to silence them for a moment. Then Wieland said, without much confidence, “We are not talking about the same problem here, it’s a false analogy.” He turned to Sieverance. “The problem with someone like Dr Carriscant is that he will operate without reflection. If you had indigestion he would suggest removing your appendix. This is the so-called
modern
approach, and Carriscant does not care—”

“Just one minute,” Carriscant interrupted, approaching Wieland, who backed off. “Be very careful what you say, Wieland. If you slander me, I won’t answer for—”

“For God’s sake!” Sieverance was exasperated. “I’m going to talk with my wife. A moment, please.” He left them alone in the room.

Cruz said, malevolently, “You’re finished, Carriscant. This is a gross violation of medical ethics.”

“Sieverance called me in himself, you stupid old fool.”

“Yes, you bastard,” Wieland shouted at him, “only because of the filthy rumours you’ve been whispering in Taft’s ear.” He pointed a shaking forefinger at him. “What is it with people like you, Carriscant? You’re knife-happy. Can’t wait to cut, cut, cut. Mrs Sieverance isn’t some corpse in a dissecting room!”

“Of course she’s not.” Carriscant caught himself just in time, his voice heavy with emotion. “She is on the verge of death. I can save her. You two idiots would just prolong her agony, draw it out for a day or two with your useless potions.”

“You disgust me,” Cruz said. “You’re a worm, an insect, you dishonour the profession.”

The three of them faced each other, silenced by their virulent animosity. Carriscant felt a vast weariness of spirit sweep through him. They could trade insults for hours, he realised; neither of them would yield an inch of ground. He turned his back on them and walked across the room. There was a small grand piano at the far end, with piles of sheet music stacked on the cover. This was her music, he knew intuitively, as he picked up some of the scores—Brahms, Mendelssohn, Mozart—and he raised the edge of a piano concerto to his nose as if expecting it to be redolent of her, somehow.

“Dr Carriscant,” Sieverance said, re-entering the room.