by Russ Rymer
“Willem, it’s not that. What about the patient? When do I meet our mystery man?”
“You have the profile,” he said. “It’s sufficient, and I can tell you whatever else you need to know.”
“Don’t be a putz, Will, c’mon.” He’d dumbfounded me thoroughly. I protested that I didn’t care if I was administering Novocain for a root canal, I wanted to see the patient, even if that wasn’t how everybody else worked; it was just how I did things, as he well knew. The patient’s anxiety level, for example, was for me alone to judge, in person, and that was just for starters. I’d want to get a good peek at his jaw too, judge if his chin was prominent or weak. The length of the line from lip to larynx (or, more technically, from chin tip to the edge of the thyroid cartilage) can make a life-and-death difference when you go to stick a tube down someone’s throat, which is why we anesthesiologists walk through the world compulsively judging everyone’s thyromental distance. Introduced to a stranger at a party, we don’t think, Soulful eyes, or Lovely hair, we think, Get a load of that thyromental distance! And still it was never included on the chart. Hadn’t Willem got me here so things would be done right? Ergo, we needed to meet, this man and I. “It is a him, isn’t it?” I said. I’d studied the sufficient profile and noticed that its sufficiency lacked a basic thing or two, like gender. Like a name.
“Perhaps.”
“Willem, for Chrissakes.”
“Look, Tilde—”
“Please don’t ‘look’ me!”
“Look, okay, sorry, I know this may not sound orthodox to a disciple of the great god Maasterlich, but if this weren’t an exceptional situation, then you—we—wouldn’t be here. The whole thing demands flexibility. No, you can’t interview our client, because our client’s not around—”
“Meaning he’s still in Lahore.”
“—right now. What makes you think—”
“Oh, gee, I don’t know. Maybe it’s just not possible to visit France these days without bumping into the crème de la crème of the Pakistani med corps, never mind a Pakistani potentate. Don’t screw with me, Willem. I know how to use my feet.”
“I recall,” he spat back. “Why not run toward something, for once?”
He paused a moment for this to sink in, then said, “He’s not from Pakistan.”
“Who?”
“Your potentate. Sahran’s from Paris.”
“Right,” I said. “Why don’t you tell me a little about Mr. Sahran.”
Which he did, precisely: a little. How Emil Sahran was that rare distillation, a man from a haute Paris family of North African descent, a family established and wealthy enough to have amassed considerable influence, which Sahran had expended (in part) advancing third-world health. His efforts were long-standing but had escalated dramatically in the past year, after he had a run-in with cancer. Lymphoma. An early diagnosis, a successful lymphectomy, and a deft application of radiation had cured him, but the experience had confirmed his conviction that the practices that had saved his lucky life should be available to those on earth least lucky. He redoubled his efforts, in part through an exceedingly handsome endowment to Willem’s foundation, currently being finalized, and also by escalating his own work.
Sahran handled the delicate political side of trauma relief: getting care to refugees and field surgeries to civilians caught in civil war, and sparing the survivors of natural disasters the subsequent disaster of cholera. He ran interference behind the scenes, flattering the vanities of dictators and calming the suspicions of local chieftains so the medical teams could safely get into the villages. That’s how Willem and Sahran had met, one monsoon-season night between the Niles, in the guest bar of a rattletrap, previously grand colonial hotel in Khartoum, a city made of sand and no higher than a sand dune, where they’d begun a conversation whose eventual fruits included the Frenchman’s fiscal support for Willem’s foundation. And also, eventually, Willem’s involvement in this surgery, for which Sahran was the major-domo.
“Calming suspicions?” I ventured. “Or flattering vanities?”
Willem snorted. “Look,” he said. “I owe him, and I’m delighted that I do. He does things his own way, but he does them right, which for you means you’ll have everything you need. You’ll have more essential information than any physician in any operation that’s ever been performed. Your patient’s been tested and retested and re-retested, and you’ll get the full dossier. And if there’s some iota of mystery that you can unearth that you think needs addressing, ask me. I’ll tell you.”
“All right, then,” I said, not to be shrugged off with boys’ adventures in colonial Khartoum. “Who’s the patient?”
“Who’s the patient,” Willem echoed, with dismay. His head rolled in frustration. “Who is the patient. Well, that’s easy: Someone interested in privacy and able to afford it. And in dire need of a new heart. That’s it. That’s already more than you need to know.”
I pursed my lips, aware that I’d hit a dead end. I looked around at the basking crowd and caught an image from on high of the two of us, statuary gnomes squabbling amid the hollyhocks.
“What beautiful weather,” Willem said, clinching his victory with largess, turning his face to be a flower too. He peeked at me sidelong and placed a conspiratorial hand on my arm. “It’s okay,” he said, and then, in the voice of another, “Only a house divided against itself can stand.” He laughed, and I couldn’t help it and laughed with him.
“Are we finally entering our golden age?” he asked.
Joined at the hip, I thought, not happily.
The day was too lovely to defile with a direct route home, and once our curdled brunch had ended—none too thankfully soon—I kissed Willem’s cheek and headed out, intending to get lost. I succeeded, but only geographically. The farther I got from Willem, the clearer it was that I wasn’t going to leave him behind. The man was like the human corpus we delight in describing to schoolchildren: mostly water. Only a quarter of Willem was solid; I’d give him maybe 30 percent, at the most. The rest, for me, was a shifting, murky gel of memory and apprehension. Our brunch together had punched big holes in the great cosmic membrane, that essential diaphragm that seals the present safely away from the past. Now the barrier was breached and the phantoms released, and as I walked I struggled to get my mingled lives re-sorted out.
Toward something, for once . . . was that really what I was, a runaway from love? That’s what he’d meant, in all his snottiness—and a runaway not just from love, but from him. He’d paused to let his arrow land, and when it did, I had the reaction I’d always had when his arrows landed, back in those days when I knew him a little better. Poor Willem, he’d always been the type who couldn’t fire back without revealing his position, who couldn’t land a punch without setting himself up for the kill. Which was why being the target of his zingers had often given me a bit of guilty pleasure, as it did now. Why, Willem! I’d thought to myself with amazement, and some fondness, after his outburst in Le Faux Henry. After all this time!
But as my guilty pleasure faded, offense blossomed within me: even to consider the question was to collude in his presumptions. Yes, we’d had a fling, a student affair or whatever you wanted to call it—a mistake, an entanglement—and yes, it was I who’d ended it, who’d done the spurning, and it had been decades since I was able to remember it with any precision beyond some dim scenes of resentful sulking in places where we couldn’t avoid each other, Maasterlich’s classroom prominent among them. But I remembered it well enough to know I hadn’t ditched Willem because I loved him too much, as agreeable as that formula might sound to him in retrospect; to the contrary, there hadn’t been any love worth ditching, not on my part, anyway. And now, these many years later, to be diagnosed with a fatal character flaw by the light of a carried torch! (And to have poor great-god Maasterlich obscurely singed in the indictment.)
Maasterlich! Once the heartless old bastard had been invoked, he refused to be evicted from my thoughts. Heartless old soft
hearted bastard. Concerning surgery, he was more than merely a teacher: he was a paradigm, a pure example of the form in action. In his lectures, he’d carved into our young, unblemished minds with consummate skill and with an absence of mercy, to our eventual good, of course. Eventual was the key: you had to do some healing first before you could admit to the benefit. We cringed, we railed at his cruelties, his excessive incisiveness, his trite formulations: “Failure to prepare is preparation for failure”; “Anything worth suturing is worth suturing twice.” We searched his character for any imperfection that would diminish his dominion, give us a fighting chance.
We found what we sought in the doubleness of his nature, his (as we insisted on seeing it) Janus face on a bipolar soul. For he’d hammer us on procedure, hammer and hammer and hammer, and when he had us as hardened as tool steel, he’d soften us up with philosophy—if that’s what you could call his wandering, melancholic free associations—the combination driving us crazy with its inconsistency. Every time we encountered this ruminative side, this pudding within the granite, it seemed to us as weirdly misplaced as a swamp on a mountaintop. That’s how we felt; we felt it was something freaky, and suspected we’d been badly used—had he led us up the face of the Matterhorn just to plant our flag in a bog? Yet dutifully we climbed, and dutifully we bogged, not realizing until later that the two sides of his pedagogy weren’t hard and soft, but hard and harder yet. He taught like a surgeon, but it would mean something to me, much later on, that Professor Maasterlich was an anesthesiologist by specialty. He knew how to dwell in the middle realms.
My walk had led from the square up Quai de Jemmapes, where I paused by the old canal to watch some boys bombard with windfall chestnuts a boat they’d fashioned out of alley flotsam. When the enemy craft had been decisively sunk and they’d run off to make and launch another, an impulse drew me away and up the hill through an indecisive quartier where vendors sold Arab goods from sidewalk stalls beneath the tolling of cathedral bells and from there eventually to the perimeter of the Parc des Buttes-Chaumont.
In front of the guignol stage at the entrance to the park, children were gathered in a noisy flock under a translucent harlequin awning to await the puppet show. The sun through the awning chalked the pavement with a flowing pastel rainbow, and the children too. They chased one another in circles in the kaleidoscope light. I turned into the park along a path lined with benches, where men and women sat talking or (mostly) silent, taking in the sun in their church clothes, rocking prams, or hidden behind newspapers whose headlines feted me with impending war, with mounting protests and sham diplomacies, along with the winnings and losings of the fútbol teams.
“What marvelous fortune,” Maasterlich had congratulated us one important afternoon—important for me, anyway, as I could still recall every word of that lecture, and evidently Willem could too (he’d been slumped in the chair right beside me)—“that we might by chance assemble here at the advent of surgery’s golden age.” Then he had itemized: how, with superstition and ignorance banished at last from the operating theater (so recently!), surgeons and anesthesiologists now worked as one, saw as one, our diverse disciplines marching united in the cause of human improvement.
“As you go forth from here to pursue your chosen specialty, you will keep that in mind, won’t you? Many methods, one goal,” he said, hectoring, pacing the pit at the front of the amphitheater lecture hall, a lumbering scold. “Herein lies our profession’s strength! Correct?”
“Can’t wait to find out where this one’s going,” Willem muttered.
“Then tell me this, please, regarding our precious unity,” our professor demanded. “Why is it that the definition of the anesthesiologist’s success is precisely the definition of the surgeon’s failure?”
Silence dwelt among us.
The path brought me to the lake in the middle of the park and lured me on around its shore, a lake so dominated by the precipitous island in its center that the placid pool seemed parenthetical, a moat for a citadel. Only in relation to the lake was the island big at all, but it loomed far larger than its size, with its histrionic crags and battlements, a bonsai mountain, enormousness in miniature. Crowning this basalt pillar was a little belvedere surrounded by columns, a sibyl’s temple in a summit glade of trees. A high, single-arch bridge connected the island to the shore. The chasm it leaped was as narrow and deep as though cut with a cleaver, so deep that the span, though short, had proved uncrossable for many; its nickname (I learned later) was le Pont des Suicidés. I didn’t venture to traverse it, preferring my privileged prospect of the island to the experience of the island itself. I located an empty lakeside bench and collapsed to absorb the view.
“You in this room are—are about to become—the two necessaries of modern surgery, surgeon and anesthesiologist,” Maasterlich had said. “In major procedures you will neither of you work without the other at your side. You will be equals in your precision, the rigors of your task,” but that didn’t mean we should mistake each other for friends, he said, “for you must understand that you subscribe to opposing creeds. The surgeon’s one job is to change someone,” Maasterlich said. “Your success will be judged by how deftly you effect that change; your fame will depend on how dramatic and daring and unnatural are the changes you effect.” For those entering anesthesiology, he said, “Your core job, your one imperative, is to leave someone unchanged. Never underestimate the force of this distinction,” he instructed, “for it doesn’t live in the operating room—it lives in the world. In truth, you are enemies joined at the hip. It’s a miracle of human comity that you will get along at all!”
As Maasterlich launched into “the world,” his flights of significance and ramification grew even loopier—how we should relish our essential incompatibility, how that was the mark of any golden age worth crowing about, for “only a house divided against itself is strong enough to stand,” take Spain, for example, in those halcyon centuries before the Catholics chased away the Moors, or Germany before it incinerated its Jews. What had befallen these societies when they’d achieved the purity they’d so desperately sought by driving out the best they had?
The snickers had begun, along with a quiet groan or two. “Things to do,” Willem explained, slipping past my knees with his books under his arm just as Maasterlich got to “the Soviet before the purges,” but I hardly noticed his departure, was riveted by the scene before me, which remains bolted into memory intact, the folding wooden seats in their descending rows, the lecturer’s rostrum as heavy as a catafalque, the blackboards on which figures and terms had been dispelled by erasure and overwriting and erasure again into swirling calcite cumuli, a billowing fog of chalk, as the hulking madman in the fog-smeared suit stalked the pit, raving at whoever was left.
“You surgeons, your belief is in improvability, perhaps ultimately in human perfectibility. Your journey is linear; its compass always points toward progress. Good! It must! How else are you to take knife and bone saw and commit the irrevocable? You don’t turn away. You are epic. You step through. Your violence has the name of optimism; it is the violence to push the moment to its crisis.”
And then he addressed the opposing side, or rather, as I heard it, me, for in the next few minutes, the rest of my life was determined, its banes and blessings defined and named. “You anesthesiologists, your journeys are lyric and, if they are to be successful, circular,” Maasterlich said. “While the surgeon’s every sun ascends to noon, to the zenith, you, by contrast—you will traffic in twilight.” In those hours when the surgeon opened to the examining lamp recesses that were never meant to see the sun or feel the air, in those same bright hours I would lead the conscious mind into proscribed darknesses. But with caution: I would never push the moment, would shy from the brink. That would be my talent, in a nutshell, knowing where the brink was and when to shy, when to release my patient to retrace his path back upward toward the light, to surface in the very ripple where his dive had commenced, with no more than a dime of a br
uise or a Band-Aid over a needle prick to remind him of his hour in oblivion.
Except for those—and this was something Maasterlich failed to mention, a phenomenon not easily discussed that some of us would notice over the years and learn to be on the lookout for—except for those patients who remembered, not the surgery, but the oblivion. It didn’t occur with every operation—heart procedures seemed to be the worst—or in every patient. Only in a very, very few patients, actually, and maybe only those very few who were fated to such perceptions anyway, who already knew how death inhabits life. We could spot the signs when the patients came around—a hollowness in the eye, a metallic blankness haunting the gaze in the aftermath of surgery—and then, usually a couple days later, the delirium set in. For these few, the awareness lingered of how, in the course of outrunning pain, they’d traveled to the border of mortality.
Rarely did the sensation become permanent, though there were those occasional witnesses for whom the stupor and the haunted eye never fully lifted, and we had a name for those people, gleaned from a paper in a German academic journal that was the only piece I ever read that addressed the syndrome, likening it to the mindset of survivors of historic trauma and referring to its exemplars as die Wiedergänger: the revenants, returners from places that could not be described. Generally, though, the condition persisted some several hours, a day or two at most, and finally was gone, and the hollowness and the blankness abated into ordinary cheer.
Then, for some reason, as I was sitting on the bench, looking out at the templed island and the Suicide Bridge and the promenade along the lakeshore, and thinking about all these things and Maasterlich, a horrible realization sprang into my mind, as motivating as a bee sting, that I’d left the window open.
V
I DON’T REALLY KNOW where my frenzy came from—was I alarmed that too much light might leak in and stain the gloom of that dank box?—but I got myself to Sèvres-Babylone as quickly as I could. I was irritated, predictably. As I drew nearer I became aware of another and insurgent emotion. My irritation felt like a cover for something more perverse, less admissible, and as I walked down the impasse, pushed through the entry into the cour, climbed the precipitous stairs, and turned the key in the lock, I put a name to it: anticipation. My destination had been transfigured by its status in my mind: what had been, on my first visit, an enigma, something unknown that the world had withheld from me, had become my secret knowledge, something private I was withholding from the world. Could anything be more precious?
