Touchstone Anthology of Contemporary Creative Nonfiction (85 page)

That was all I was to see of the countryside. From then on, there was only the derelict hospital of Comayagua, with the smell of spoiling bananas and the accumulated odors of everyone who had been sick there for the last hundred years. Of the two, I much preferred the frank smell of the sick. The heat of the place was incendiary. So hot that, as we stepped from the bus, our own words did not carry through the air, but hung limply at our lips and chins. Just in front of the hospital was a thirsty courtyard where mobs of waiting people squatted or lay in the meager shade, and where, on dry days, a fine dust rose through which untethered goats shouldered. Against the walls of this courtyard, gaunt, dejected men stood, their faces, like their country, preternaturally solemn, leaden. Here no one looked up at the sky. Every head was bent beneath a wide-brimmed straw hat. In the days that followed, from the doorway of the dispensary, I would watch the brown mountains sliding about, drinking the hospital into their shadow as the afternoon grew later and later, flattening us by their very altitude.

The people were mestizos, of mixed Spanish and Indian blood. They had flat, broad, dumb museum feet. At first they seemed to me indistinguishable the one from the other, with out animation. All the vitality, the hidden sexuality, was in their black hair. Soon I was to know them by the fissures with which each face was graven. But, even so, compared to us, they were masked, shut away. My job was to follow Dr. Franciscus around, photograph the patients before and after surgery, interpret and generally act as aide-de-camp. It was exhilarating. With in days I had decided that I was not just useful, but essential. Despite that we spent all day in each other’s company, there were no overtures of friendship from Dr. Franciscus. He knew my place, and I knew it, too. In the afternoon he examined the patients scheduled for the next day’s surgery. I would call out a name from the doorway to the examining room. In the courtyard someone would rise. I would usher the patient in, and nudge him to the examining table where Franciscus stood, always, I thought, on the verge of irritability. I would read aloud the case history, then wait while he carried out his examination. While I took the “before” photographs, Dr. Franciscus would dictate into a tape recorder:

“Ulcerating basal cell carcinoma of the right orbit — six by eight centimeters — involving the right eye and extending into the floor of the orbit. Operative plan: wide excision with enucleation of the eye. Later, bone and skin grafting.” The next morning we would be in the operating room where the procedure would be carried out.

We were more than two weeks into our tour of duty — a few days to go — when it happened. Earlier in the day I had caught sight of her through the window of the dispensary. A thin, dark Indian girl about fourteen years old. A figurine, orange-brown, terra-cotta, and still attached to the unshaped clay from which she had been carved. An older, sun-weathered woman stood behind and somewhat to the left of the girl. The mother was short and dumpy. She wore a broad-brimmed hat with a high crown, and a shapeless dress like a cassock. The girl had long, loose black hair. There were tiny gold hoops in her ears. The dress she wore could have been her mother’s. Far too big, it hung from her thin shoulders at some risk of slipping down her arms. Even with her in it, the dress was empty, something hanging on the back of a door. Her breasts made only the smallest imprint in the cloth, her hips none at all. All the while, she pressed to her mouth a filthy, pink, balled-up rag as though to stanch a flow or buttress against pain. I knew that what she had come to show us, what we were there to see, was hidden beneath that pink cloth. As I watched, the woman handed down to her a gourd from which the girl drank, lapping like a dog. She was the last patient of the day. They had been waiting in the courtyard for hours.

“Imelda Valdez,” I called out. Slowly she rose to her feet, the cloth never leaving her mouth, and followed her mother to the examining-room door. I shooed them in.

“You sit up there on the table,” I told her. “Mother, you stand over there, please.” I read from the chart:

“This is a fourteen-year-old girl with a complete, unilateral, left-sided cleft lip and cleft palate. No other diseases or congenital defects. Laboratory tests, chest X ray — negative.”

“Tell her to take the rag away,” said Dr. Franciscus. I did, and the girl shrank back, pressing the cloth all the more firmly.

“Listen, this is silly,” said Franciscus. “Tell her I’ve got to see it. Either she behaves, or send her away.”

“Please give me the cloth,” I said to the girl as gently as possible. She did not. She could not. Just then, Franciscus reached up and, taking the hand that held the rag, pulled it away with a hard jerk. For an instant the girl’s head followed the cloth as it left her face, one arm still upflung against showing. Against all hope, she would hide herself. A moment later, she relaxed and sat still. She seemed to me then like an animal that looks outward at the infinite, at death, with out fear, with recognition only.

Set as it was in the center of the girl’s face, the defect was utterly hideous — a nude rubbery insect that had fastened there. The upper lip was widely split all the way to the nose. One white tooth perched upon the protruding upper jaw projected through the hole. Some of the bone seemed to have been gnawed away as well. Above the thing, clear almond eyes and long black hair reflected the light. Below, a slender neck where the pulse trilled visibly. Under our gaze the girl’s eyes fell to her lap where her hands lay palms upward, half open. She was a beautiful bird with a crushed beak. And tense with the expectation of more shame.

“Open your mouth,” said the surgeon. I translated. She did so, and the surgeon tipped back her head to see inside.

“The palate, too. Complete,” he said. There was a long silence. At last he spoke.

“What is your name?” The margins of the wound melted until she herself was being sucked into it.

“Imelda.” The syllables leaked through the hole with a slosh and a whistle.

“Tomorrow,” said the surgeon, “I will fix your lip.
Mañana.
”

It seemed to me that Hugh Franciscus, in spite of his years of experience, in spite of all the dreadful things he had seen, must have been awed by the sight of this girl. I could see it flit across his face for an instant. Perhaps it was her small act of concealment, that he had had to demand that she show him the lip, that he had had to force her to show it to him. Perhaps it was her resistance that intensified the disfigurement. Had she brought her mouth to him willingly, with out shame, she would have been for him neither more nor less than any other patient.

He measured the defect with calipers, studied it from different angles, turning her head with a finger at her chin.

“How can it ever be put back together?” I asked.

“Take her picture,” he said. And to her, “Look straight ahead.” Through the eye of the camera she seemed more pitiful than ever, her humiliation more complete.

“Wait!” The surgeon stopped me. I lowered the camera. A strand of her hair had fallen across her face and found its way to her mouth, becoming stuck there by saliva. He removed the hair and secured it behind her ear.

“Go ahead,” he ordered. There was the click of the camera. The girl winced.

“Take three more, just in case.”

When the girl and her mother had left, he took paper and pen and with a few lines drew a remarkable likeness of the girl’s face.

“Look,” he said. “If this dot is
A
, and this one
B
, this,
C
and this,
D
, the incisions are made
A
to
B
, then
C
to
D. CD
must equal
AB.
It is all equilateral triangles.” All well and good, but then came
X
and
Y
and rotation flaps and the rest.

“Do you see?” he asked.

“It is confusing,” I told him.

“It is simply a matter of dropping the upper lip into a normal position, then crossing the gap with two triangular flaps. It is geometry,” he said.

“Yes,” I said. “Geometry.” And relinquished all hope of becoming a plastic surgeon.

In the operating room the next morning the anesthesia had already been administered when we arrived from Ward Rounds. The tube emerging from the girl’s mouth was pressed against her lower lip to be kept out of the field of surgery. Already, a nurse was scrubbing the face which swam in a reddish-brown lather. The tiny gold earrings were included in the scrub. Now and then, one of them gave a brave flash. The face was washed for the last time, and dried. Green towels were placed over the face to hide everything but the mouth and nose. The drapes were applied.

“Calipers!” The surgeon measured, locating the peak of the distorted Cupid’s bow.

“Marking pen!” He placed the first blue dot at the apex of the bow. The nasal sills were dotted; next, the inferior philtral dimple, the vermilion line. The
A
flap and the
B
flap were outlined. On he worked, peppering the lip and nose, making sense out of chaos, realizing the lip that lay waiting in that deep essential pink, that only he could see. The last dot and line were placed. He was ready.

“Scalpel!” He held the knife above the girl’s mouth.

“O.K. to go ahead?” he asked the anesthetist.

“Yes.”

He lowered the knife.

“No! Wait!” The anesthetist’s voice was tense, staccato. “Hold it!”

The surgeon’s hand was motionless.

“What’s the matter?”

“Something’s wrong. I’m not sure. God, she’s hot as a pistol. Blood pressure is way up. Pulse one eighty. Get a rectal temperature.” A nurse fumbled beneath the drapes. We waited. The nurse retrieved the thermometer.

“One hundred seven…no…eight.” There was disbelief in her voice.

“Malignant hyperthermia,” said the anesthetist. “Ice! Ice! Get lots of ice!” I raced out the door, accosted the first nurse I saw.

“Ice!” I shouted. “
Hielo!
Quickly!
Hielo!
” The woman’s expression was blank. I ran to another. “
Hielo! Hielo!
For the love of God, ice.”

“Hielo?”
She shrugged.
“Nada.”
I ran back to the operating room.

“There isn’t any ice,” I reported. Dr. Franciscus had ripped off his rubber gloves and was feeling the skin of the girl’s abdomen. Above the mask his eyes were the eyes of a horse in battle.

“The EKG is wild…”

“I can’t get a pulse…”

“What the hell…”

The surgeon reached for the girl’s groin. No femoral pulse.

“EKG flat. My God! She’s dead!”

“She can’t be.”

“She is.”

The surgeon’s fingers pressed the groin where there was no pulse to be felt, only his own pulse hammering at the girl’s flesh to be let in.

It was noon, four hours later, when we left the operating room. It was a day so hot and humid I felt steamed open like an envelope. The woman was sitting on a bench in the courtyard in her dress like a cassock. In one hand she held the piece of cloth the girl had used to conceal her mouth. As we watched, she folded it once neatly, and then again, smoothing it, cleaning the cloth which might have been the head of the girl in her lap that she stroked and consoled.

“I’ll do the talking here,” he said. He would tell her himself, in whatever Spanish he could find. Only if she did not understand was I to speak for him. I watched him brace himself, set his shoulders. How could he tell her? I wondered. What? But I knew he would tell her everything, exactly as it had happened. As much for himself as for her, he needed to explain. But suppose she screamed, fell to the ground, attacked him, even? All that hope of love…gone. Even in his discomfort I knew that he was teaching me. The way to do it was professionally. Now he was standing above her. When the woman saw that he did not speak, she lifted her eyes and saw what he held crammed in his mouth to tell her. She knew, and rose to her feet.

“Señora,”
he began, “I am sorry.” All at once he seemed to me shorter than he was, scarcely taller than she. There was a place at the crown of his head where the hair had grown thin. His lips were stones. He could hardly move them. The voice dry, dusty.

“No one could have known. Some bad reaction to the medicine for sleeping. It poisoned her. High fever. She did not wake up.” The last, a whisper. The woman studied his lips as though she were deaf. He tried, but could not control a twitching at the corner of his mouth. He raised a thumb and forefinger to press something back into his eyes.

“Muerte,”
the woman announced to herself. Her eyes were human, deadly.

“Sì, muerte.”
At that moment he was like someone cast, still alive, as an effigy for his own tomb. He closed his eyes. Nor did he open them until he felt the touch of the woman’s hand on his arm, a touch from which he did not with draw. Then he looked and saw the grief corroding her face, breaking it down, melting the features so that eyes, nose, mouth ran together in a distortion, like the girl’s. For a long time they stood in silence. It seemed to me that minutes passed. At last her face cleared, the features rearranged themselves. She spoke, the words coming slowly to make certain that he understood her. She would go home now. The next day her sons would come for the girl, to take her home for burial. The doctor must not be sad. God has decided. And she was happy now that the harelip had been fixed so that her daughter might go to Heaven with out it. Her bare feet retreating were the felted pads of a great bereft animal.