Cutting for Stone - Abraham Verghese [230]
For the operation they took him to a tiled room with high windows. It seemed bare but for a narrow raised table in the middle, over which was suspended a giant dish light resembling the compound eye of an insect. The place left a strong impression on the boy. It was otherworldly, hallowed ground, but still secular. The name “theater” was fitting.
Ross cut into the skin, under local anesthesia, just to the outside of the left nipple, then exposed three adjacent ribs and cut out short segments from them, thereby unroofing, or “saucerizing,” the empyema cavity. The pus had no place to collect. Despite the anesthesia, Thomas had moments of excruciating pain.
When he could speak, Thomas asked, “Won't an opening like that destroy the vacuum in the pleural space? Won't it cause air to rush in and the whole lung to collapse?”
“Brilliant question, lad,” Ross said, delighted. “It would collapse in anybody else. But the infection, the empyema, has stiffened the lining of your lung, made it thick and inflexible, like a scab. So in your case, the lung won't collapse back.”
For a week, pus oozed out onto gauze padding strapped over the hole. When it slowed to a trickle, Ross stuffed the wound with gauze tape, to cause it to “heal by secondary intention.” During dressing changes, Thomas studied his crater with a mirror, taking perverse pride in what it produced and the day-to-day changes as his body made repairs.
Ross was a short, cheerful man with the roundest and most forgettable of faces and the bow legs of a jockey. He always warmed the chest piece of his stethoscope in his chubby hands before letting the metal touch Thomas's skin. He percussed Thomas's chest, sounding it out skillfully. Ross pulled out the gauze and they peered into the crater. “You see the red, pebbly-looking base, Thomas? We call that granulation tissue. It will slowly fill up the wound and allow skin to form over it.” And that was exactly what happened. At one point the granulation tissue grew excessively, pouching out like a strawberry. “Proud flesh,” Ross called it. Holding a crystal of copper sulfate in his forceps, he rubbed it over the proud flesh, burning it back.
One day Ross brought him Metchnikoff s Immunity in Infectious Diseases along with Osler's Principles and Practice of Medicine. Metchnikoff was hard going, but Thomas liked the drawings of white cells eating bacteria. Osler was surprisingly readable.
In a life that was merely a prelude to death, Thomas found he looked forward to Ross's visit, to the short man's daily rituals. And yet he held back his affection for the doctor, because that was a recipe for loss. “I'm not going away, lad,” Ross said one day. “And since you are staying, why don't you join us on rounds.” Ross turned and left, not waiting for an answer.
WHEN ROSS PRONOUNCED him healed, Thomas had been at the sanatorium for a year and a half. During that time he never saw his father. Fothergill came twice, saying Justifus Stone was too ill to travel. Thomas asked Ross about the illness from which his father suffered. Ross said, “It's not tuberculosis, but something else.”
“To do with his legs?”
Ross tousled Thomas's hair. “Something punky, lad. Unfortunate, it is. He is bedridden. You'll learn in medical school,” he said.
It was the first time Ross had ever uttered the words “medical school” to Thomas. Thomas couldn't control the fluttering in his heart, as if a door had cracked open in his coal cellar, bringing in light, promising a future when he had visualized none.
ROSS, NOW OFFICIALLY THOMAS'S GUARDIAN, decided Thomas should go to boarding school in England. Thomas didn't even consider going to see his father in the infirmary in Madras before he sailed.
Two terms had gone by when Ross wrote to say that Justifus had died. A modest inheritance under Ross's guardianship would allow him to finish schooling and go to university.
Ross had led Thomas in the direction of medical school as if it were inevitable.