William Boyd - The Blue Afternoon

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. 'Wieiand'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.'