to walk to work. Nobody of any importance or self-regard, with even the slightest modicum of selfesteem, 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 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 Senora 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 Senora 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 fiancee, 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
