At Close Quarters (11 page)

Jaime felt that that simple gesture abolished the distance between them. The woman was staring at him again, with a look full of trepidation and yearning. He dried his hands slowly, put back the towel on the rack and crossed the corridor into the bedroom.

The cheque was lying next to her hips, which he pictured round and warm like bread, the kind of bread that’s no longer crispy and fresh but still tender. He took a few steps with a feeling of desire and affection, and thought: ‘Don’t worry now, stop shaking. The fact that you’re so fragile and so afraid of what you’re doing makes you all the more charming. Stop shaking. For two hours we’ll be happy.’

He had just buttoned up his white coat when his pager buzzed and a message flashed annoyingly on the screen: ‘Dr Beltrán, urgently needed at the operating theatre.’

He almost slammed shut the door of his office, which had a plaque that read Dr L. Beltrán, Anaesthetist, and quickly strode down the corridor towards the wide staircase. He’d been back at work for less than a month after his four-year suspension, and was still feeling the weight of responsibility, though not the
apprehension
of the beginner. He’d always felt at ease at the hospital; it was his home, and for him the word ‘hospital’ signified healing, not pain. In the few days he’d been back, he had reacquainted himself with the nurses’ shoes swishing along the corridors; the smell of disinfectant; the blue and red reflections that came in through the windows of dark rooms, indicating that an ambulance was bringing in another patient; the air of anxiety and hope on the faces of patients’ relatives; the procedures involved in operations; the fear with which patients touched their faces when they came round, checking if their beard had grown so as to gauge how long they’d been under the effects of the anaesthetics, as if they feared it had been years. When he reached the ground floor he almost bumped into Dr Añil, the chief surgeon, also in a hurry as she flicked through a report covered in handwritten notes.

‘What is it?’ he asked her.

‘A boy. Sixteen years old. Crashed his motorcycle into the
fence of a roundabout and flew over the handlebars. What’s the world coming to?’ she added with a tone of disappointment and complaint.

‘Teenagers!’

‘Teenagers, and their parents! The admissions people fear he’s on drugs or something. We’ll have the test results in a minute, but it could be one of those new drugs that the lab has problems analysing. What’s the world coming to?’ she repeated.

They pushed the swinging doors open and walked into the prep room. A nurse was waiting for them, and handed the doctor an X-ray of the patient’s neck and chest, an electrocardiogram and some initial test results.

‘There’s no cranioencephalic trauma. Fortunately he was wearing a helmet. Quite a blow and first-degree burns on his left leg. The neck seems to be okay,’ she said looking at the X-ray on the viewer. ‘But it would seem the spleen is burst,’ she said reading the chart. ‘And another thing. He had these in his pocket.’ She showed them two capsules, one of them open. ‘Speed.’

‘Speed?’ said Beltrán.

‘Ketamine pills, if it’s not cut with something else. Will you be able to get him off to sleep? Is it compatible with the anaesthetic?’

Dr Añil eyed him over her glasses and he guessed she was remembering what had happened four years earlier and wondering whether his present apprehension and caution might not affect the normal course of his work. The inquisitive gaze brought back with painful clarity the image of the woman’s bandaged head during the five days she’d been in a coma. He feared that, on his reinstatement, he’d become an awkward colleague, who would hesitate too much before making a decision and get alarmed at the appearance of any anomalous symptoms. And in ER there was no room for fear. Quick and clear decisions had to be made, and the reasoning behind them defended later no matter what the result might be. Fear widened the margin of error.

‘I don’t know,’ he replied. ‘If he hasn’t taken a high dose, I think I can manage. But we’ll need to keep a closer eye on hemodynamics.’

‘I’ll see you inside then,’ said Dr Añil, as she saw two orderlies bring in the patient on a gurney. They left him with the boy and the nurse.

‘What’s your name?’ he asked.

‘Iago,’ the boy replied with a whimper. ‘Santiago.’

His face looked extremely pale and sweaty; his hair was cropped in bizarre furrows. When the nurse held up his arm to take his blood pressure, he resisted with an expression of pain.

‘Easy now,’ he said, ‘easy. I’ll examine your stomach now.’

He pulled up the boy’s shirt and palpated him. The abdomen was swollen, tense like a drumhead, pulsating. According to the tests, his haemoglobin levels had been pretty stable on admission, but his condition seemed to be worsening and he needed to be operated on straight away.

‘Five eight,’ said the nurse.

‘Are you going to operate on me?’ asked the boy, almost in tears.

‘Calm down. Yes, we are, but stay calm. It’s not serious.’

‘Will it hurt?’

The boy looked him straight in the eye. Patients usually did that. When they spoke to the surgeon who was going to operate on them, they paid attention to his hands, hoping that they were clean and delicate, that they not shake, did no more harm than necessary. But they looked him in the eye in silent prayer, as if imploring him to control the pain, to alleviate the suffering. ‘Please don’t let me suffer. Please.’

‘No, it won’t hurt. A little when you wake up, maybe. It’ll only take a few minutes,’ he lied.

‘Have you told my family?’

‘Of course. They’re on their way. When you wake up they’ll be waiting for you. Don’t worry.’

‘My mother …’

‘Yes, don’t worry now. She’ll be the first person you’ll see when you wake up.’

The boy shut his eyes to fight back the tears that, nevertheless, seemed to seep through his thin eyelids and slide down his
temples, between two furrows of hair. The anaesthetist waited a couple of seconds before asking:

‘Did you take anything tonight?’

‘Take anything?’ the boy echoed, opening his eyes with
suspicion
, ready to deny everything even before he’d fully understood the question.

‘Have you had dinner? Drunk anything?’

‘Yes, I did have dinner.’

‘How long ago?’

‘What time is it?’ he asked, disconcerted.

Lesmes looked at the clock.

‘Three o’clock.’

The boy shut his eyes, calculating the time and the best way to lie, still putting up a hard front over his pain and his fear.

‘I had dinner at nine.’

‘And later, did you take anything? Did you have anything to drink?’

‘A little,’ he replied, pale, aloof, hostile, with that annoyed attitude typical of adolescents who believe they’re owed something, that the world is always asking them questions and never giving them satisfactory answers.

‘Have you taken anything else?’

‘No.’

‘Pills?’

‘No!’

‘Fine. Calm down,’ he said, and then whispered to the nurse: ‘We’ll have to pump his stomach. Get the catheter ready.’ Then he told the boy: ‘Open your mouth.’

Ignoring the smell of Coca-Cola and cheap wine he exhaled, Lesmes helped him take off his braces, which were in the way.

He left the boy in the nurse’s hands and went into the operating theatre to check everything, well aware that there was no room for improvisation and that preparation was as important as the execution itself. The nurse had already laid out the catheter, the laryngoscope and the seven-and-a-half inch tube on the kidney-shaped tray.

‘Is the blood ready?’

‘Yes,’ she said, pointing to the two bags that shone, fat and dark, on the work surface to one side.

A few moments later Dr Añil walked in, followed by an attending and a resident, all wearing caps and gloves, their masks hanging from their necks.

‘We’re ready.’

Lesmes went back out. The nurse had already emptied the boy’s stomach; he looked paler, almost waxen now.

‘We’re going in. Don’t worry. It’ll only take a few minutes.’

‘Doctor,’ the boy called out. Fear had reappeared on his face and his hostility was directed only at himself.

‘Yes?’

‘No, nothing …’

They went into the operating theatre, and the boy shut his eyes when they placed him under the intense glare of the lights. Lesmes fixed the electrodes on him and checked that his arterial blood pressure and heartbeat were fine on the screen. He ensured the capnographer was working properly, as the memory of the woman, her face all bandaged up except for her eyes, once again flooded his thoughts. The heart of an anaesthetised patient goes on functioning, but not his lungs – the machine does the breathing. If the machine stops working and it doesn’t alert them … He blinked away the memories and applied an analgesic. Then, thinking of the empty ketamine capsule, he measured the dose of hypnotic and let it slowly penetrate into the vein; he felt the eyes of his three colleagues studying his every movement.

‘Don’t worry,’ he said one last time, ‘now you’re going to fall asleep,’ he said, as if he wasn’t a doctor telling his patient about the process but a hypnotist ordering him to withdraw into unconsciousness.

Half a minute later he touched the boy’s eye with his thumb. It was unresponsive, the boy was asleep. Once he had intubated him, the graphs of the respirator indicated everything was all right, and it was only then that, without raising his eyes to his colleagues, he said:

‘Whenever you’re ready.’

Several gloved hands – precise, efficient – made contact with the body of the boy as soon as the nurse disinfected his chest and stomach.

Lesmes sat by the boy’s head, in that station he’d feared he’d lost forever, checking his vitals on the screens as the scalpel cut through his skin. He saw the inverted sleeping face, strangely serene now, oblivious to the pain and anxiety that a few metres away, out in the corridor, was no doubt taking hold of his relatives, who must all be arriving now, after having been awakened in the middle of the night by a distressing phone call, and who must be asking what had happened, where he was, why they couldn’t see him. Sixteen years old, barely two years younger than Lesmes’s own children: an age when they seem to be always on the move, even if they don’t know why, or where they’re going, or for how long; an age when they’re uneasy about having lost the graciousness and charm of childhood and have not yet picked any of the fruits born of an adult character. The strong lights brought out the boy’s strange haircut: he had fine shaven furrows on his scalp, front to back, so that his head looked like a field sown with tiny black plants. Lesmes wondered whether girls his age found that repellent or terribly attractive, but he had no way of knowing. The world of teenagers was
incomprehensible
to him. He didn’t find it easy to communicate with them; at times they spoke like parrots and at others barely used one-syllable words. He was disconcerted by their sudden oscillations between apathy and excess, the enthusiasm with which they embraced some fashion and the scorn with which they later rejected it, their nearly violent sulkiness and their occasional, impulsive displays of affection, the sincerity of their promises and the ease with which they broke them, their lack of appetite and their feeding frenzies, when they used the knife like a saw and the fork like a shovel. They seemed to him half-formed beings, and he couldn’t imagine the outcome of their jumpy growth, their teeth imprisoned in braces, their eyes outgrowing their glasses, their skin riddled with acne – all that imbalance of gangling legs and childlike torsos.

He had two children, Ana, who was nineteen, and Lesmes, eighteen. Both had gone to study in Madrid. At least, now that he was back at work, he wouldn’t find it so hard to pay for their life away from home, their costly university fees and accommodation. They’d never said as much, but he’d suspected that their choice of courses answered less a real calling than a need to distance themselves from home, to avoid the sad, oppressive atmosphere that had surrounded them during the years he’d been out of work. They were good children, though, in spite of their move, which he didn’t want to view as an escape in the strictest sense, but rather as the kind of need that makes a diver return to the surface in a moment of tension, not because his tank is short on oxygen, but because he has to see the light, the sky, the clean air. They phoned often enough, got good marks and did not seem prone to excesses.

On one occasion, two or three years previously, he’d overheard a conversation between Lesmes and a friend. Both were in his son’s room, allegedly doing homework but actually talking about girls.

‘Have you ever been happy?’ he heard his son ask.

‘Yes,’ replied his friend after a couple of seconds’ hesitation. ‘I’m pretty happy. Aren’t you?’

‘I’ve been happy this week. And it’s great! I can’t believe how good it is!’

He stood still in the corridor, near the doorway, and retraced his steps without making a noise, overwhelmed by anxiety.

When the judge ruled against him and he was suspended, family life became very complicated. He still got up in the morning at the usual time, as if he had work to do, but only to face a day that was eminently empty, hollow even, of all that had filled it before. He would make breakfast for his children and Carolina, who got up a bit later when she smelled the freshly made coffee. The children left for school and the two of them stayed alone. Unhurried, they would drink a second cup of coffee in the kitchen, smoke too many cigarettes, and listen to the news and the talk shows on the radio, sometimes to a programme for job hunters. Carolina had left her office job at a laboratory when she’d got pregnant and had
never worked again outside the home. It was unthinkable for her to look for work after twenty years, to catch up with so many new techniques. However, four years was a long time, and he had to do something. He knew that once the period of suspension was over it wouldn’t be hard to return to work: the present world had become too hedonistic and couldn’t stand any pain. Professionals who eased its suffering would always be needed.

His professional insurance policy had barely covered the one hundred and fifty thousand euros established as compensation. As it happened they had some savings put aside for a beach house, a dream that would never materialise. That gave them a measure of financial security, but not for long. They soon discovered that money doesn’t last long, flows like water, dries out; it was
astonishing
how quickly one’s bank balance decreased when no wages replenished it at the end of every month.

‘You have to find something,’ she would say, encouraging him out of the apathy he’d sunk into. ‘He has really hurt us, but we cannot let him destroy our lives completely.’