by Jody Shields
He found himself staring at the statue of Diana and Actaeon, the statue’s imperfections—grainy stone, pocked and rough as pebble—clearly visible in this light. Why have I wandered here to stare at the ruined heads of a statue? All I see are faces. At night, his dreams had become crowded with faces, their eyes angry and demanding, more disturbing than his actual patients.
Perhaps he needed rest. To spend a day in a museum studying precious fragments. Or Greek vases, their streamlined figures frozen in motion. Faces without eyes to return his gaze.
McCleary returned to his quarters and slowly readied for bed. The sunlight flattened the shadows of the iron bedstead into spiked black angles on the wall and whitened the bedclothes. He could count every stitch on the counterpane, as if he were looking into a mirror that reflected the room more sharply than he could see.
The sense of comfort created by Kazanjian had vanished, his words morphed into a meaningless humming, a vibration lodged in the spiral of McCleary’s ear, the cochlea, a spiral vestibule lined with a pulp of nerves.
A phrase of music brought relief, a lieder that his beloved had sung. “Ich bin der Welt abhanden gekommen,” “I Have Lost Track of the World.” Gustav Mahler. Hearing this lieder for the first time, he had been certain she sang exclusively for him, the words a reference to their intimacy. Her voice carried her emotion. There were no accurate words for love, just as there was no accurate description of suffering.
He closed his eyes. Minutes or perhaps hours passed until his consciousness dissolved into sleep. Had he been gifted with a more visual imagination, he could have pictured it rising over him like mist. Or a halo.
CATHERINE SILENTLY WALKED into McCleary’s office. “I did knock,” she said apologetically.
Flustered, McCleary asked if she was looking for something and picked up a stethoscope as if preparing for a patient, hoping this would send her away. He installed his hand in his pocket and waited.
“I don’t like to see my house rearranged, but I am curious.” Her nervous gaze moved around the room, rapid as a blink. “The light here is the same, although all the furnishings have vanished. But no matter.” She handed him a small envelope. “I’m here on an errand. Artis is the only remaining soul who knew my husband, Charles, and I’d like to do something in his memory. I will pay extra wages every week so Artis may assist you with the patients.”
“Very kind of you, ma’am.” There was no point in mentioning that the boy might be drafted and deny him the extra wages.
“It’s better that Artis works in the house, not in the studio. Sometimes he disturbs Anna. Young men can be so careless.”
“Artis is hardly careless.”
Catherine’s nose wrinkled, her upper eyelid lifted, signaling her disapproval of his comment, and McCleary quickly offered to guide her through the offices.
He ushered her into the pantry, which had been converted into a diagnostics room. “Let me explain what you see,” he said, proudly indicating a bulky piece of equipment and a padded table. “The men lie down here, and the roentgen machine registers the image of their body, simply as a camera.”
On the corkboard, tacked-up black-and-white sheets of film hung stiffly, as if frozen.
“May I look?”
Without waiting for his answer, she held one of the translucent films to the light, and the curve of a skull blazed before her eyes, sharp and brilliant as the moon, the interior clotted with gray matter. She gasped. “It’s a head, isn’t it? Is he dead?”
“No. He was photographed by the roentgen machine. We can see directly inside the living body without opening it.”
“It’s strangely beautiful. The brain is a fog surrounded by bone.” She stared at him over the film in her hand. “What I see is a true image?”
“You see the temporal nature of identity. The nose, lips, eyes—all flesh vanishes. Only bones remain.” McCleary was reminded of Kazanjian’s claim that bones were the body’s superior material. Bones, our master. His finger indicated a small, irregular shape suspended in the skull. “Here, shrapnel. Cause of injury. The dark line is a fracture.”
What else could this machine reveal? The flush of the emotions on the brain? Her secret desire for Julian, her lies, her wish that Artis would leave the estate? Could it expose her deceitful red heart woven with veins, hidden in the chamber of the body, no longer the most private of spaces? The film slid from her fingers to the table.
“I wish I’d never seen this. The bone under the skin.”
He understood her stricken look. “It is shocking. As if green were stripped from the grass. When I saw an image made by the roentgen for the first time, I realized what I knew about the body was incorrect in an instant.”
“Nothing is the same these days. I value different things. All my dresses and jewels have been put away.” Her voice faltered. “But I have purpose, like everyone here. Not like before.”
Did she expect his blessing?
Catherine wanted to tell McCleary that what she had believed was permanent was an error of perception. You know this; you recognize it too.
His expression softened as if he were reacting to her unspoken thoughts. “I’m an old man, and change is all I have to anticipate.”
“But you’ll see the war end. It won’t be long. Every week the newspapers say we’re closer to breaking through the enemy lines.”
He was touched, not offended, by her dismissal of his frailty, and invited her to share the salvation he had discovered. “Ovid claimed nothing perishes on this earth. Everything is renewed in a changed form and continues. I believe this.”
“But you’re a doctor. You expect change.”
“Doctors are trained to witness life gradually diminish and to do what we can to halt the process.” His words were grave, but something in their intonation had the lilt and cadence of a question that seemed to require a reassuring answer.
“I don’t wish to be forward, but you should allow someone to comfort you.”
They looked at each other for a moment, then Catherine abruptly wished him good day.
After she had left, McCleary regarded her with the tenderness he refused himself. A woman marked by suffering. Under other circumstances, he would have pitied or discouraged her intimate involvement with Julian, but now his objections seemed of little consequence. Silently, he directed her to pick up happiness like loose stones on a path or seek the quiet of a cloud, a tree, a bird, reflected in all their temporary perfection in water.
MCCLEARY ESCORTED ANNA through the ward, and the patients whispered or signaled greetings as she was an easily recognizable figure in her smock of rough gray linen. He quieted the room, asking them to welcome Mrs. Coleman, who had been assigned to sketch several patients for the purpose of advancing medical knowledge.
He had hardly finished his introduction before patients began quarreling loudly about who would be Mrs. Coleman’s model. The depth of their boredom was sobering.
Anna’s first subject was a strapping man with the thick shoulders of an athlete, his jaw hooked by wires to a vulcanite cast suspended from a leather band around his head. More delicate silver wire was threaded through his nostrils, the ends secured with lead shot to keep his nasal passages open. When a nurse checked his bandages, the angry crimson of one injury was briefly visible on his cheek, and his fine body tensed in silent pain.
The men who were able to walk gathered to watch Anna sketch, and even the harried nurses and V.A.D. women slowed their steps as they passed the little gathering. Gradually, bolder individuals peered directly over the artist’s shoulder and began to narrate a comical step-by-step account of the portrait as she worked.
Anna pleaded for silence. “Please, move back a little. Let the model have some air.”
“But he’ll suffer from so much attention, ma’am. His head will swell, even more than it already has.”
“We’re only concerned for his health.”
The strapping man made a loud grunt, which his fellow patients translat
ed as his claim to be Anna’s favorite model.
“I have no favorites.” She smiled.
“What, no wrapped gifts for us at Christmas?”
“Your one arm is gimpy and you’ve got no teeth to open a package, old man,” retorted another patient.
Their banter provoked ready laughter, as insulting jokes and merciless name-calling were familiar exchanges in the wards. Wit was the patients’ suit of armor, and it was their conceit that these cruelties never drew blood. The able-bodied were excluded from participating, and the shocked, inexperienced young nurses would invariably and unsuccessfully attempt to make the men apologize to one another.
Several days later, during a modeling session, a patient begged Anna to finish her work as quickly as possible.
“Why, what bothers you?” She respectfully folded her hands in her lap. “Are you uncomfortable with the pose?”
“I don’t know.” The man was clearly unhappy. “Before I went to war, the officers photographed me for the first time. They kept the photograph. Now you draw my face. I was a verger in Christchurch. No one ever took any account of my looks.” Then he dropped his head and whispered, “Except for my best girl.”
Anna touched his hand. “When the doctors have finished all your operations, I promise to do a portrait you can take home. It will be our secret.” Her promise was against McCleary’s policy, as all finished drawings were to be secured in a portfolio and never shown to the models.
She spent days in the ward and became accustomed to their faces, obscured by a variety of splints, bandages, and specially made devices to secure their skull bones in place. Yet Anna never lost the impression that each man, bearing with a dramatically different injury, represented a particular fault or flaw, like Hogarth’s engraving of lunatics at Bethlem Hospital, and only the ceaseless scratch of her chalk kept such chaotic madness at bay.
Once the portraits on paper were completed, McCleary’s project was continued in the studio. The faces of a dozen patients and separate details of their injuries—a chin, a nose and upper lip, an ear with a bit of jaw, an eye isolated in a jagged scrap of cheek—were roughly cast in plaster. The masks hung on the wall like macabre trophies. Or death masks, their lopsided features fixed into a distorted expression, as if they’d witnessed an unspeakable horror.
While waiting for his face to be cast, a patient hesitatingly told McCleary that the display of plaster heads was disturbing.
“I would be interested to know why they upset you, after all you’ve seen,” McCleary said.
The middle-aged man, clearly ill at ease complaining to a doctor, quietly explained that these specimens looked worse than the real faces. McCleary instantly understood that the stark white plaster lacked the forgiveness of skin.
“It’s a boneyard of hope,” mumbled another patient, standing unnoticed in the back of the studio.
Kazanjian surveyed the wall of plaster faces, muttered, “The gorgon. Medusa’s lair,” and fell silent, lost in contemplation.
Anna was overly sensitive when questioned or criticized in her studio, but she let his comment pass. Since their estrangement, Kazanjian had been unfailingly courteous, surprising, since she’d expected him to react with anger or cold distance after she’d refused him. After the bricks she’d raised against him. Occasionally, she had even wished to spend time with him, and this thought was instantly colored by resentment that his claim on her had somehow been reestablished.
She suspected that his patience was stubborn and infinite, although the working of his mind wasn’t easily deciphered. He was a foreigner.
WEEKS AGO, KAZANJIAN and McCleary had treated a severely injured man whose nose had been obliterated by shrapnel. As if bodiless, reduced to the smallest point of his eye’s focus, McCleary had considered the site of the future skin graft from every angle, hovering and twisting over the cavity in the man’s face, anticipating the delicate pull of the sutures his hand would weave, the skin’s resilience, the progress of healing after the passing of days and weeks.
One surgical option was a rhinoplasty devised by Dieffenbach: a patient’s upraised arm was positioned alongside his head and secured with leather straps and plaster. A long, narrow strip of skin was cut from the underside of the arm, stretched over to the nasal area of the patient’s face, and the end was sutured down. This skin “bridge”—and the patient’s arm—remained in place for weeks, until the graft took. McCleary hesitated, knowing that patients dreaded this protracted treatment.
Consulting Mondeville for guidance, McCleary had found a single sentence: “Anyone who believes that the same thing can be suited to everyone is a great fool, since medicine is practiced not on mankind in general, but on every individual in particular.”
He had examined the patient a second time and decided to rebuild the man’s nose with a tubed-pedicle graft, adapted from a technique pioneered centuries ago in India. Kazanjian then prepared a series of drawings that detailed each consecutive stage of surgery.
During the operation, a narrow flap of skin was cut from the patient’s forehead, and one end was secured into a tube and allowed to heal. After fourteen days, the distal end of the skin “tube” was moved down, positioned over the man’s missing nose, and sewn with silkworm gut to his upper lip and cheeks. Until this fresh graft was established, the proximal flap remained connected to his forehead, allowing blood to circulate in the tube. To prevent the new nose from contracting, it was lined with a Thiersch graft.
The patient had borne the pain without complaint, although the scar tissue on his forehead where skin had been removed to create the nose was a crimson, pulsing swath. If the new nose graft failed to establish itself on the man’s face, a Dieffenbach rhinoplasty would be attempted, again with no guarantee of success. There were no other options.
The fashioning of a facial feature was a process, and several more operations, some spaced a year apart, would be necessary until the grafted nose was properly reshaped, the bridge of the nose structured with a homograft of cartilage, and the patient was able to breathe without difficulty. New eyebrows would be created by transplanting grafts of hairy scalp taken from behind each ear. Delicate massage, gentle heat, and needling would aid recovery.
Enough time had passed since the graft that it could now be evaluated. McCleary looked down at the patient and fearlessly met his eyes. The man’s worried expression—the corrugator muscle on his forehead—relaxed. The expectation of the silent observers surrounding the patient on the examining table was almost a physical pressure against McCleary. He glimpsed Artis peering over a doctor’s shoulder, fraught with concern, and gave him the slightest of smiles.
McCleary carefully, haltingly peeled away the bandages, alert for the slightest foul smell, which would betray the presence of necrosis. The last fine crosshatch of gauze was lifted free, revealing a very crude nose with the deeply pink, slightly swollen gleam of healthy skin, and simultaneously there was a murmur of relief from the onlookers.
“You can’t see yourself just yet, sir, but take my word for it. Your operation has been a total success.”
Because of his wounds, the patient could not speak, but relief was inscribed on his body, and gratitude communicated by his hands, palms open, a gesture of blessing.
Suddenly, McCleary sensed ripples of joy, wave after wave of emotion, spreading throughout the ward, as actors in moving pictures silently reacted to something that happened in their mysterious black-and-white realm, invisible to the flesh-and-blood audience.
MCCLEARY WAS QUIETLY pleased when a senior medical officer at a city hospital requested drawings and models of the surgical techniques that had been developed under his tutelage at the estate. He understood that this was a tribute to his patients, enshrining the mortifications they had suffered in surgery’s great history.
McCleary had no illusions about the long-term significance of his own contributions to surgery, predicting they were as evanescent as the body. Time passed over the face, wearing it like water over a p
ebble or shell. Everything could be worn away, damaged. Everything was temporary. He’d witnessed the beautiful and temporary fragility of the body, knew the angle at which a bone would break and the strength of the skin, a barrier frail as paper. For Kazanjian, time passed in a different manner, calculated according to a subtle marker, the slow, unseen knitting of bones. Hidden knowledge.
In the future, surgeons would be gifted with almost holy powers, their vision and the skill of their hands expanded with powerful devices, able to mend faces with fantastic methods and materials. Skin would be cultivated as easily as moss, away from the site of the body, or grafted from one face to another as simply as a swatch of silk. The very color and texture of the skin itself would be altered. Bones and teeth would be built up like coral in the wet lagoon of the mouth. Infection would be conquered, veins and nerves repaired with stitches finer than a scratch, the minute mechanics of a smile or even a dimple easily restored.
Medicine was a strangely personal yet anonymous practice. Although every surgical procedure had a precedent, very few individual surgeons received any recognition or credit. McCleary had first been aware of this as a medical student when he had been shown a rare and valuable book, published by Ackerknecht, that contained examples of every known suture up to the eighteenth century. Each suture had been carefully executed in thread on a thin piece of leather mounted on a page, but the originators of the techniques were not identified. A number of sutures were familiar and still employed in surgery, but others were impossible to understand, their purpose lost, a baffling arrangement of snug threads indecipherable as a foreign script.
The sutures were the result of hundreds of hours of painstaking observation and trial, their creators as anonymous as the craftsmen who had toiled in the great cathedrals.
MCCLEARY HAD CAREFULLY organized his schedule, cleared half a day and an evening in the middle of the week, and marked his calendar with a red 0. No name, no details. He took the train alone to the city for the appointment, which he kept private.
