William Boyd - The Blue Afternoon

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 fractious 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.

A rare and untypical nausea made his gorge rise. The tongue was such a curious part of the body, a flickering pulsing muscle with its two senses – taste and touch -a kind of amphibian organ planted in the throat like an anemone anchored to its rock, unsure whether it should be inside or outside the body. When he cut it seemed to flinch – He stopped himself, angrily: why was he thinking like this? He felt his keening headache return and with it the memory of its cause, the brief intense argument he had had with Annaliese that morning. 'Work, work, work,' she had cried spitefully at him as he dressed for work. 'Why get married, why bother having me in your life?… Why indeed, he had shouted back, if this is meant to be wedded bliss. Stupid, purblind woman.

The porters wheeled away the still comatose Chinese boy and he and Pantaleon moved next door to change back into their clothes.

'What do you think?' Pantaleon asked. 'It seemed to go well.'

'We'll see how it heals. At least he's got some tongue left.'

'Cruz will go mad if it works,' Pantaleon smiled. 'Madder.'

'If it works we photograph the next one. Write it up.'

'The Carriscant glossectomy.'

Senora Diaz interrupted their self-satisfied chuckles to tell them that someone from the Governor's office was looking for Dr Cruz. Carriscant shrugged on his coat, straightened his necktie and walked up the corridor to his office, rubbing his hands together vigorously – the carbolic in the soap dried the skin and caused flaking at the knuckles. He opened his office door and a man in military uniform – khaki, leather-belted – rose to his feet from the chair in front of the desk and saluted. He was portly, running to fat, and his uniform was tight across his belly. He had a high forehead and thinning hair, and a neatly trimmed wide moustache that effectively divided his face in two.

'Dr Carriscant, thank you for seeing me,' he said. 'I'm Paton Bobby, Chief of Constabulary.'

Dr Carriscant stood beside Paton Bobby in the rice field looking down at the naked half-submerged body of what had been an eighteen-year-old Kansas militiaman.

'That is no fucking gu-gu,' Bobby said, a frown pulling his eyebrows together and cabling his forehead. 'In fact that is just about the whitest man I've ever seen.'

There was a peculiar bluish, icy tone to the body's general pallor, it was true. The fat on the buttocks seemed to shine through the skin like ice-cream wrapped in parchment, Carriscant thought, quite pleased with his simile.

'That's because we're standing in a solution of his blood,' Carriscant pointed out. The body lay in the centre of a dark brown stain, still spreading, stirred by the sloshing of the men's boots. Carriscant leaned over: there was a pestilential buzzing of insects and the solitary eye that was above the surface of the water was dark with flies feeding on its jelly.

'Has anybody moved it?'

'The farmer who found him, turned him over. Got a look,' Bobby said. 'That's how we knew we needed a doctor.'

'What about Dr Wieland?' Dr Wieland was acting medical superintendent to the US Governor. Carriscant had met him several times, a genial, superannuated alcoholic whose medical knowledge was about as far advanced as Cruz's.