An hour before surgery Dr Duncan ducked into the men’s bathroom. The women’s was another twenty-minute walk away and usually, on this side of the hospital, the bathroom was empty. But there was Ian, a surgical resident, posed against the grotty sinks. His phone lifted above his head, angled down, one hand moving beneath the blue of his scrubs. The moment he saw her, he stopped. A statue. But he did not withdraw his hand. The shape of his fingers flattened as he launched into an apology.
It’s just a photo, he spoke softly. It’s just a photo, honestly.
I shouldn’t have been in here, Dr Duncan replied. It’s fine.
Still he did not withdraw his hand. He put his phone beside the sink, screen down. Unhygienic, she thought, looking at the phone, imagining the dirty glass pressed to his ear. The bathroom’s details were otherwise familiar. She knew which cubicle had the cracked toilet seat, which tap ran viciously hot. Before he could say anything else she stepped back into the corridor.
Had things gone differently, Dr Duncan would have let Ian take the lead on the appendectomy. He’d have had the opportunity to gently push the tube, containing the light and camera, through the opened belly button and watch the inching of the large intestine as it appeared on the screen. Instead she would perform the first cut. Skin prised underneath the blade. The camera sunk in. She would have remarked, had Ian been holding the scalpel, that the large intestine was like a sea monster, mythical, moved along by its own pink pulse. She would have shaken her head and expressed her awe at the human body, asked him to consider that he might be the only person to ever see this part of the patient, that it was important not to let the significance of that intimacy pass you by. But Dr Duncan had changed her mind.
Ian paused, seemingly unfazed, beside the operating table. His hands in blue latex gloves. He did everything handsomely. He was gay, very gay, in his own words, and the other female residents flocked to him, knowing they wanted a piece of the ancient light that bounced off his body.
At Dr Duncan’s command, Ian dutifully took the disposal razor and tried to shave the top rows of the patient’s pubic hair. He struggled to find the right angle, twisting his elbows this way and that, dragging too lightly across the tough hairs, then too hard, threatening to nick the skin. One of the nurses flinched. When it was done, the low boil of a rash left behind, he did not look at Dr Duncan. He focused on the screen that showed the camera’s worming journey.
This would be the last operation of Dr Duncan’s shift. Later she would collect her son from the airport. He’d chosen a cheap flight, one that landed just before midnight. She had not seen him in a few months. Alex, who had grown up to be tall and broad, who was also handsome.
As the camera advanced through the bowel, she hummed quietly, a kind of theme tune. Alex had got into a decent university, if a little far away, and at eighteen was now old enough that they indulged in similar tastes; he claimed to like red wine, which he swished and swilled, named music she remembered from when she was his age. He’d told her, on his last visit, that he and his friends had drunk the bottle she’d sent to him out of stained mugs, knowing it might rile her. She resisted. Well, as long as you enjoyed it. Oh, we did, he said, insinuating what was just out of shot, the part of the picture she couldn’t see.
Through the belly button she filled the patient’s abdomen with gas, pushing out the walls of the large intestine, making it easier to navigate the sluggish turns. After that came the camera and the private, fleshy undertones, the surfaces slick and shining.
The appendix appeared. Half of it already distended, deep maroon, a twisted and flashing smile. Dr Duncan was satisfied. She had been right. The patient, who had arrived yesterday evening, complaining of pain in her right-hand side, no fever but an elevated white blood cell count, had been suffering from appendicitis. Now it had been caught before a perforation. She announced this to Ian, asked him to look at the appendix, veins drifting thin as hair, the bloated glow. He nodded over her shoulder. Briefly her elbow made contact with his chest.
The patient had tattoos. Not only down her arms but, as Dr Duncan looked back at her body from the screen, along the tops of her thighs. One was a quote in cursive that was too difficult to read upside down, then a giant flower, maybe a magnolia, that bloomed all the way to her knee. There was a smaller scene, birds across a sunset, a boat, the whole thing very elaborate.
Dr Duncan had her own tattoo. In black ink along her ribs, on the left-hand side. It was Alex’s full name, Alexander, done when he was already twelve years old. She’d practised writing it out beforehand, wanted it in lower case, lengthening the first ‘e’ so it would not be immediately recognisable as his, adding a flourish to the ‘r’. A literal impulse, she knew. Her body was already marked by his birth, the scar of the C-section faint but still visible across her stomach. It was around the time that the name she’d given him had begun to permanently change, his loud friends calling him Al, or, inexplicably, X. Her ex-husband, too, who had never said Alexander. Right from the beginning, he had always used Alex. These were the names her son chose to have on his homework, the signatures he gave on her birthday cards.
At the parlour, sitting on an old leather sofa, she’d been asked about placement. The tattoo artist listed body parts with bizarre distortions, inside finger, soft bit of forearm, lower-back dip, upper-back spine, pelvic gutter. Just somewhere it won’t be seen, she’d stated. He’d twisted then, pointed to his own ribcage. Yes, there.
Dr Duncan clamped and quickly clipped the appendix free. It was then scooped out in a small wire basket, which, despite the meticulously tried and tested design, always made Dr Duncan think of catching fish in a deep-fat fryer. At the incision’s entrance, she repositioned and slowly pulled the appendix through. The patient’s skin puckered, beastly, glorious, protesting with an organised spill of blood.
Hey presto, she said aloud.
Ian smiled too large behind his mask, she saw the lift of his eyes, thrilled by a catchphrase that barely belonged to her.
The whole idea, she added quickly, was of course to avoid perforation while it was still inside the body, thus the basket, thus the swift and gentle exit.
Thus, Ian echoed, hey presto.
Dr Duncan did not advance. She let the appendix hover over the patient’s body. In Ian’s tone she’d heard the arrogance of a private joke, where no joke had been shared. He stood, hands outstretched and empty. She took another few seconds. Brought the appendix close to her face. Saw again confirmation that her instincts were good, that she’d been right to operate. She pinched it and felt the leathery resistance of the infected end. The other half was still bright, spongy. Another couple of days though, even one more day, and it might have burst.
She passed it on to Ian, who stepped away. Set the appendix in a metal bowl. A nurse collected it. From this moment on it would become a specimen, sent to the hospital lab for a few further tests, which would most likely reveal nothing they couldn’t already see.
On the way to the airport she would need to stop at the supermarket. Dr Duncan wondered whether she should buy the body wash her son liked. Last time she’d noticed, when she’d gone into the bathroom after he’d used it, a strong minty smell that carried on the residual steam. He’d brought with him small, travel-size containers, a brand she didn’t recognise at first but had since seen in a pharmacy, on the shelves of the supermarket. Maybe he used something different, now. That had been two, no, three months ago.
The small opening in the large intestine was stapled shut. Gas was released from the patient’s abdomen. Later she might experience a pain both sharp and blunt between her shoulder blades, as if she had been flicked and the flick had held, as a few escaped bubbles travelled north. The patient, hopefully, would have only one night in hospital before being discharged. There had been an anomaly, blood in her urine, but this could be an oncoming period, unrelated to the appendicitis. On admission the patient could not remember where she was in her cycle. Mid? she’d replied, eyebrows raised, as if this was something Dr Duncan could confirm.
She allowed Ian to stitch the incision across the abdomen. She pointed at the opened belly button, the smaller, second incision to the left.
Do those too, and do them well.
He nodded, his eyes on the abdomen.
Yes?
Yes, I’ll do them.
Alex saw her tattoo when he was thirteen, a year or so after she’d had it done. They were on a beach holiday and she’d opted to wear a bikini. It was just the two of them, her divorce already under way and her ex-husband living moodily in a new city. She waited, that first day in the sun, for Alex to ask what was written beneath her armpit. He stalked the shoreline, crouching to sort through shells, his legs and ankles thick with those interim years, his body not yet ascended into the muscle and stretch of teenagedom. He glanced at her tattoo, or at least she thought he had, but said nothing. She became bolder, turned, angled her left-hand side so it faced him. Still nothing. He was a private child and it seemed he’d given her this in return, a privacy, whether she wanted it or not. She supposed, applying suncream to the backs of his legs, his neck, the tops of his ears, the places he forgot, that this was being a mother.
The nurses wheeled the patient into the recovery bay. Many patients, as they saw Dr Duncan standing over their bodies, the pain of which they could not yet feel, would sob softly. She knew that this was for various, impersonal reasons. Namely the thinning out of the general anaesthetic, the patients arriving back into the world on a foreign, tidal pull. They would remember nothing of the interaction afterwards.
As the patient’s eyelids bobbed, the eyeballs searching underneath the delicate skin, Dr Duncan stood beside her and waited. The patient’s hair was short, curly, shaved beside the ears. As she opened her eyes Dr Duncan could see the surgery’s effect, her pupils lost to its heavy weather. Sure enough the patient began to sob silently, to reject the tube in her throat. Her hand, the cannula tugging in her forearm, moved to find Dr Duncan, who squeezed her palm.
It’s all fine, everything is fine, it went very well indeed.
The patient nodded. Fell back to sleep.
Another mother – was it her own? – said to her that you knew a child’s body best in illness. It was true enough. When he was six, Alex had two bouts of pneumonia. In bed for a month, then more. She intuited when he was lying on his back from the distant wheeze in his exhale. If he was lying on his front, the note would shift into a whistle. A long, boneless breath meant he could not easily be woken, that his fever remained at a peak. She could recall the scatter of his room, toys boxed in by other toys, arranged in concentric audiences, just as he’d left them before he was ill. She never tidied them away. The bears watched the toy soldiers who watched the race cars who watched the marbles. There was the pretty way Alex looked at her, too, eyes glassy, his hair spread neat and still against the pillow. As an adult he claimed not to remember any of it. She’d tried to prompt him. Mentioned the splendid delirium of his dreams. That when she’d soothed him he’d press into her neck and offer solitary, wandering words. Rhubarb, otter, flute. He’d only shake his head. Sorry, guess I was pretty out of it! Key, grass, hat.
Ian watched Dr Duncan reassure the patient. The way he leaned into the door frame, his hip tilted, arms folded, indicated that it was she, Dr Duncan, who might have something to learn. To leave the room she had to walk right up to him, see his arms fall back to his sides, palms wiped briefly on his thighs. He moved with her into the corridor. An urgency in his proximity. He spoke too close to her ear.
That all went smoothly, didn’t it?
What do you think?
Her authority was lessened, she felt, by the way her shoes squeaked against the pale green linoleum. She did not want his apology. It was building in him, she could feel it, that terrible crescendo. Twice he inhaled deeply. Twice he released the sigh through his nose, sounding all the dramatic tones of a poorly played instrument. Nothing had to be acknowledged. In this, the aftermath, they ought to dim the bathroom’s unforgiving brightness, let the scene, the slow movement of his hand, recede into whatever darkness. Time would take care of things. When it came to the next appendectomy she would likely let him make the first cut.
She kept on walking, though was no longer sure where she should walk to. She was concerned Ian might place his hand on her shoulder. He kept pace, watching his feet, or listening to hers.
The first or second day of his residency she found Ian’s eyes washed up on her collarbone. He watched the movement of her two necklaces, how they’d entwined, seeking out the disc the size of a thumbprint, St Christopher hunched over and on his sanctified way. Later, when she’d removed her jewellery for a gallbladder procedure, Ian had watched again, this time following her fingers as she’d worked the two clasps, then dropped the necklaces into the small dish.
Was there anything else?
No, no. Ian retreated.
Dr Duncan slipped into a nurses’ station. Brewed a coffee. Ran through the meals she had made Alex on his last visit. On the final night she’d cooked a chicken chasseur, a dish she’d recently learned. It had never occurred to her to take apart a whole chicken, to lever the knife through the joints, slide out the breasts. Alex wandered into the kitchen. Mum, Jesus, that’s a bit intense. Still, he’d stood and watched, impressed, unable to fight his own fascination. Once she finished the job, her hands washed, she turned to face him. He was holding his breath tightly. It was a child’s habit, the lesson learned early on, an attempt to pause fear, to force the chest steady. Between them was an anticipatory silence, the rock before it hits the water. She waited. He certified some unknown feature of her gaze. Said absolutely nothing where there was something. He gave up their moment quickly, breaking it with a yawn, a faux stretch. He pointed at her new and enormous knife. Fucking hell, so when did you buy that?
She checked the clock above the sink. The surgery had been faster than scheduled. Alex would be at the airport waiting to board. He did like to send a message, to let her know that it was all on time, add the crossed-fingers emoji, sometimes a blue heart. The university was not so far away. If he’d learned to drive then he could have covered the distance by car. But he’d shown no interest, none of the usual boyish and chaotic excitement that she had seen in his schoolmates. When she’d pushed, explained that it wasn’t so hard, that he should really get on with it, his lack of interest had become a kind of protest.
Dr Duncan had taken the next day off. She would not be around to, if all went well overnight, discharge the patient herself. She wanted some time with Alex. Had not told him though, it occurred to her now, and he might have made other plans. There were still a couple of school friends that hadn’t yet gone to university, working instead, saving money to travel. There was a moment when Alex might have done the same. A couple of years ago he kept a world map preciously on his bedroom wall. Made his own key, a star for where he definitely wanted to go, a circle for a maybe. Dotted lines showed flight paths, a few costs had even been labelled. But then his plan had changed with no explanation, the whole map ripped down. Not thrown away, she’d noticed, but folded and slid underneath his bed.
She decided on a lasagne. An old dish, the kind of thing she’d batch-cooked when Alex was still a pre-teen, enjoyed a little fame for it, his friends requesting it when they came to stay. They could eat it tomorrow night. She’d already ordered some decent red wine online, planned to put his palate to the test, and he’d roll his eyes but be quietly pleased.
Her office was small and virtually pointless. She was almost never in it. But she took a moment now to check her phone. Sipped her coffee. Yes, Alex had sent two messages, All on time! Followed by his blue heart. She replied with a thumbs up. She ought to write a shopping list, knew the way her mind could slip once she left the hospital.
A gentle knocking. Ian spoke into the crack in the door, not showing his face.
Do you have a minute?
Exactly one.
So it would have to happen, this apology. He did not enter the room immediately. She imagined he rehearsed his lines again, a phraseology second-guessed and adjusted.
Are you coming in?
He closed the door gently. Please, she wanted to scream, dear God, don’t create an atmosphere. The office was ugly. There were no paintings on the walls, not a photo in sight.
How can I help?
I just wanted to say that before, he cleared his throat, with what happened before, I don’t want you to get the wrong idea, those photos, they were just for my boyfriend, that’s all, it’s just a bit of fun.
There was a benefit, at least, to being the bearer of forgiveness. In the long beat of an apology, there is a luxury of seconds, a surplus, permission to really look at a person. The expert melancholia in his eyes. His skin very clear, his nails very short, a nice shape. A scar, like a white comma, across the knuckle of his pinky finger.
Please. She held up her hand. It’s fine, like I said before, I shouldn’t have been in the men’s. She leaned forward for effect. I should say though, while we’re here, that it’s just important to be professional. That’s all I ask, for you to conduct yourself in a certain way. Don’t get upset, it’s just part of the job, an easy part if you’d just let it be easy.
He sucked in his cheeks.
I do, I do see.
Good, that’s all I ask.
She pretended to dial a number. Nodded. Waved him back out of the door.
Dr Duncan wondered if it was true, whether Ian really had sent the picture to his boyfriend, if he even had only one boyfriend. And whoever it was for, what was understood about the image, then, once it was received, once it had left the hospital’s apparently irresistible space and travelled elsewhere, into a different room, a different building entirely. The body translated and re-translated, then well used by somebody else. It was a favour, she guessed, that would have to be returned. Ian had held the phone above his head so carefully, lifted his chin precisely to the right, left room for the flat of his stomach, the bulge of his crotch, the landscape of his fist visible through the thin cotton. She could’ve counted the knuckles.
Dr Duncan and Ian were not close, but at fifty-seven, her gender, the fact she was a woman surgeon, had meant interest in her life where there had been none before. It was a temperamental currency but she was happy to engage, to say yes when invited to speak, to nod in empathetic agreement that it must have been terribly hard.
Ian’s fixation was Dr Duncan’s time in Strasbourg. She told him she’d been the only woman studying and specialising in laparoscopic procedures at the university there, although it wasn’t the truth. There had been at least two, no, three other women she could remember. She recalled his wide expression, her fingers on her St Christopher pendant as he listened, asked questions. The conversation had delighted him. He wanted to travel, he spoke to the history of laparoscopy, pointed out the obvious, that it was not one man that had invented, or even pioneered the concept, but a series of separate nineteenth-century surgeons who had all landed on the same thought, across different continents. When Ian said ‘man’ he added air quotations, not to doubt their maleness, she gathered, but to acknowledge the deficit. It was always the daring predictability of the human body that enamoured him, he’d added, wanting to impress her, that these ‘men’ would individually come to the same conclusion, that the appendix would be found at the end of the large intestine. Yes, she’d agreed. Suspended as a lone piece of grammar. He’d liked that.
When it came to words, her ex-husband had been no good. Every thought of him she resisted, the eye of her memory half shut. There was one that broke through with irritating regularity. A fight, only medium-sized, and him with a small towel wrapped around his thickened waist. The sentences that left his mouth. He stood damp and stupid in the corner of their old bedroom. Hence, he shouted. Thus, therefore, ergo. Periphrastic, she should have accused.
There was nothing left to sign. Thankfully no new emergency admissions that needed her. Dr Duncan locked her office door. Normally, she’d throw on jeans, boots, leave on her clean scrub top. Maybe a jumper. But this time she wanted a gentle difference, to look a little less like his mother. Her mascara was clumpy, old and barely used, but she applied it in persuasive strokes. Lipstick on, then removed, it was too much. There was, as it turned out, a line. Hair down, brushed, she sprayed through dry shampoo and hated, really hated, the sweet smell. She went to switch out her jewellery and then stopped.
She sat back at her desk. There really was nothing in the room to look at. She didn’t know if the other surgeons, those with offices, bothered with pictures. Perhaps an ailing plant. Ian had stood there and seen nothing else of her. Only a torso, her face and neck. The St Christopher, which he already knew.
She took out her phone. Typed gay porn into the search bar. Chose the first website, with its promise of FREE and SKILLED MOUTHS. She scrolled down the page, each video on offer played briefly, the highlights, she supposed, as her thumb slid over the screen. One after another. Volume up, then down. SEXY STUDS squatted on a blue carpet. An open car door, a man bent over another man’s lap, a third man in the passenger seat. Denim was unbuttoned, hard cocks revealed. No underwear, she noted. There was a state of readiness. A kiss with an apocalyptic urgency. In an empty gym, they knelt, sucked, eyes not closed but opened. Moved like winners. She had expected something else but didn’t know what.
In the women’s bathroom she pumped pink soap into her hands. She leaned closer to the mirror. Decided she looked nice, the mascara was worth it. But the lipstick had not been properly removed, caught in the cracks. She rubbed her mouth with the back of her hand.
A few bits of paperwork to sign and then she could leave. She walked out of the hospital, unlocked her car and sat in the driver’s seat. She always took exactly a minute, hands placed on the wheel, without turning on the engine. It wasn’t a ritual so much as a reckoning with the world, the one that existed separately to the hospital’s surging and specific reality. It was the light. Tonight, her vision smoky with fatigue, it was a navy blue, full of shadows and gaps, almost everything reduced to its simplest shape. There was a time, during her first months as a general surgeon, when she found it hard to reconcile, to decide which was truer, the hospital or the rest, whatever came after. Now she knew it didn’t matter. It was only the light. Her retinas adjusting, contracting.
Alex had taken a similar flight last time, landing late. Once again she would be picking him up after a long shift. When she was younger she’d woken up to the sound of traffic cones hitting her bumper, having briefly fallen asleep at the wheel. She didn’t sleep well. Alex had been an insomniac toddler, in need of company. He’d quietly enter their bedroom, wake her up by placing his cold hands on her cheeks. For a few years, too many years maybe, she’d made up a single mattress for him on the floor beside her.
She started the engine. Would skip the supermarket for tonight. There’d be a chance to go first thing, before he was up, breakfast would be ready before he’d even realised she had gone.
It was expensive to park at the airport and so she’d instructed him to wait by the kerb. She spotted him easily. His lovely shoulders in a nice shirt, a new jacket, both black and stylish. She saw, too, that he was talking to somebody, laughing into his phone. He spotted her seconds later, waving, hanging up as he did so. She did not ask, once he’d settled into the passenger seat, who it had been and he did not offer the information either. An ellipsis strung between them. A slight and shifting tension, elbow to elbow.
She asked ordinary questions.
How was the flight, had he eaten, what were his plans, how was his course, did he have enough money?
He answered fully. Kept his phone in his pocket. She heard
it vibrate.
They picked up a pizza. He was tired, happy to eat in front of the TV. Later, when he’d fallen asleep on the sofa, she picked it up and tried to guess his passcode. Not his birthday, not her birthday. He slept on, his lips pursed, the way he looked as a child, his hands slid down his trackpants to grip his knees. It was a decision as obvious as her tattoo. Not a sense of ownership but an impulse, fragile, that deserved to be acted on. There was no futurity, what she expected to find, and then what she might feel as a consequence. She’d tried his father’s birthday, not that either. There had been no pets in the family, no short and beloved names she could try and translate into the numeric. He stirred, repositioned his body. She stood beside him. The phone glowed in her hand.
Alex’s screen saver was a pile of small, pinkish shells on a wooden surface, either a dining table or a windowsill. The image was zoomed in, his fingers dragged across the screen to enlarge what he’d noticed. It meant nothing to her. A shaft of light fell across the centre of the pile, turning those shells pinker. She supposed Alex had found the moment beautiful, enough that he wanted to look at it every day, every few minutes, however often he lifted his phone to his face.
As if she had caught its scent, Dr Duncan thought of the second house she had bought with her ex-husband. It had been her favourite. A purchase made on certain romantic whims. The complication of wisteria, untended for decades, across the arched, single-glazed windows. A large pond in the back garden, supposedly made by seventeenth-century monks, surrounded by rare varieties of self-seeded mint that had once been planted in a kind of holy herb garden. Out the back of the house, over a wall, was a field, also theirs. At the closest end was a large, grassy mound. A burial cairn, empty after raids over the ensuing centuries, of which they were now the official guardians.
Alex, too, had loved that house. He’d just turned nine. Together they bullied her ex-husband into taking it on. He was put off by old buildings, thanks to childhood summers spent in a great aunt’s collapsing cottage, where he’d placed a Bible beneath his pillow, believing it would ward off any evil as he slept.
Alex made a brief friend at his new school. A boy with a laugh that came out of nowhere, it made her jump, leaving such quiet in its wake. For a month or so the boy would come over every other day, staying for dinner, the pair of them obsessed with treasure. Thrilled to find a small blue apothecary bottle beneath a floorboard, a possible arrowhead in the garden. Their archive collected on a kitchen windowsill, where it had stayed, even after the friendship had ended. Together they kneeled over portions of earth and dug ferociously. Celebrating, high-fiving, grabbing each other’s shoulders over broken bits of clay pipe, shards of pottery, shapely stones.
That summer, from her bedroom window, she watched them poised on the mound, the burial cairn, lying on their stomachs, positioning and repositioning their shattered objects. Alex took on the boy’s laugh, getting louder, and they then laughed into each other, heavily, sides colliding. Reached across lower backs to move things this way and that. There was a secret formula, a pattern they wanted to achieve. They liked, if it was the weekend and could wait out the dusk, to turn over onto their backs and lie underneath the fading orange sunset. And she’d let them. n
Photograph by Lewis Khan, Theatre, 2020
