'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.
My wife would like to see you.'
Sieverance accompanied him back to the bedroom. Her face had a wracked, exhausted look to it. Her hair was damp around her brow and temples.
'I heard your voices raised,' she said. 'What's happening?'
'Dr Wieland counsels against surgery,' Sieverance said.
She looked at Carriscant, directly. The dark eyes seemed bigger than ever. 'What do you think?'
'I think… ' The question unmanned him completely and he felt an upswelling of an emotion in him that he did not recognise. Her gaze held him to the exclusion of everything else. 'I think Wieland is a fool and a charlatan and anyone who listened to him would be mad,' he said. He wanted to reach forward and take her hand and press it to his lips. 'You don't have much time,' he said with controlled passion. 'This operation is very straightforward. It's only when people delay that there is real danger.' He hoped his eyes said everything his words could not: I will save you, I will make you well, trust me with your life, no one else will cherish it like I do.
She raised her hand weakly, and seemed to offer it to him, as if she had heard his thoughts. Sieverance stepped forward and took it.
'I want to go with Dr Carriscant,' she said.
INTO THE BODY
The morphine had sedated her, her mouth was slack, her eyes half closed, unfocused, seeing the world through the screen of her lashes. Pantaleon stood at her head with his mask and his chloroform drop-bottle. Two theatre nurses with their starched pinafores and frilled caps waited beside the grooved trays of gleaming instruments. Delphine Sieverance lay on the operating table still in her nightgown, having been brought directly to the theatre from her house. There was no time to lose; everything had been prepared with the utmost speed.
Pantaleon looked at him. 'The wind is freshening. Time to weigh anchor.'
Carriscant nodded and Pantaleon dripped chloroform on to the mask. She was unconscious within seconds. Carriscant reached for the hem of her nightgown and remembered. A crucial act of preparation…
He cleared his throat. 'Would you please leave the room. Just for a moment or two. Everyone, please, Pantaleon.'
The nurses and Pantaleon glanced at each other and left the room without further question. Carriscant closed his eyes and a slow shudder ran through his body. He gripped the nightdress hem and lifted it up, pulling it up her body until it bunched at her ribs. His eye went first to the dense golden-ginger furze of her pubic hair and then took in the paleness of her torso, almost bleached in contrast to the stretched inflamed area of her lower belly where the infection glowed luridly beneath her skin, the fateful roseate blush of incipient peritonitis. He drew a great gulp of air into his lungs, turned and went to search in a cupboard beneath the sink for the implements he needed. He found them and stropped the razor rapidly on the thick leather band hanging above the taps.
Over her body once more he quickly foamed up a lather on the shaving soap with the brush and then, with short circular sweeps, he worked the white spumy suds into the wiry curls of her pubic hair. Reflexively he tested the edge of the blade on his thumb before, with four or five firm passes, he shaved away the hair on her mound. He wiped the remaining soap away with a towel and, unable to resist, he placed his hand there a moment, feeling it smooth and cool, until the heat of his palm warmed the skin. He moved his hand inches to the left and, palpating gently, felt the engorged shape of the abscess. He made tiny marks on her skin with a chinagraph pencil to act as a guide – my marks, he thought, my sign – and delineate the area where he would cut. He laid white cloths over her belly and thighs, leaving only the area to be operated on clear, and called the others back in. They said nothing, made no reference to what might have happened in their absence, and took up their positions again.
'Scalpel.'
Carriscant felt the nurse press the slim weighted heel of the knife into his open palm. His fingers closed around it and the sudden terror that sluiced through him almost made him stagger with alarm. In all his years as a surgeon, all the hundreds of times he had stood poised with a knife above a living human being, he had felt nothing but the elation of the job he was about to do. This bowel-loosening anguish was shockingly unfamiliar. He felt a tremor in his hands as he laid them on her taut flushed belly. What was happening to him? Where was this awful fear, this uncertainty coming from?
He forced the curved blade to indent the flesh, just above Poupart's ligament on the right side, and forced himself to apply more pressure until it bit through the epidermis and the blood came. He drew the knife across, making a cut of about six inches, revealing the blood-flecked fatty tissue and then the nacreous surface of the peritoneum, like a soft red-veined yellow marble. Here was the moment: another cut and the abdominal cavity was exposed. He widened the opening and then reached down with his finger and pushed it into her body to find the appendix. He located it, now enlarged to a swollen suppurating abscess, and drew it gently out of the body. He
