Hospital of the Transfiguration

ADVOCATUS DIABOLI

It was May. The bas-relief crescent of woods that ringed the asylum glistened with generous green. New flowers blossomed every night, and leaves that had hung with folded wings opened to the air. No longer gentle silver columns, the birch trees were loud white flames. The heart-shaped leaves of the poplars drank in the sun’s warmth and absorbed its bright hues. Bare mounds of loam showed like honeycombs scattered on the joyous landscape.

Kauters ordered Stefan to examine an engineer named Rabiewski, who had been brought by car from the nearby town. The patient’s wife recounted the strange transformation of her husband in recent months. He had been a skilled worker, but after the Germans came and bombed the factory, he began supporting himself by teaching vocational courses. Easygoing and phlegmatic, he had been a passionate fisherman, book collector, and vegetarian. An honest man, he would not hurt a fly. Since the beginning of the year, he had been sleeping more and more. By now it had got so, he would doze off during dinner and wake up with a start like a beetle that had been poked. He became lazy and reluctant to go to his lectures, and at home he was a different man; he would fly into a rage for no reason at all and then quiet down equally suddenly. He would fall asleep for hours and wake up with a throbbing headache. He also began to tell strange jokes—he would burst out laughing at things no one else found funny.

The orderly, a strapping young man known as Young Joseph, to distinguish him from the orderly Joseph, had deft hands that could break the most despairing clinch; he led Rabiewski into the examining room. The patient was a fat, balding man with a wreath of gray hair. He wore a purple hospital robe as he limped to a chair and dropped into it so awkwardly that his teeth snapped together. He answered questions only after a long pause, or after they had been rephrased in the simplest possible terms. At one point he noticed the stethoscope lying on the desk and began to giggle.

Having scrupulously recorded the history of the illness, Stefan began to test the engineer’s reflexes. He had him lie down on the oilcloth-covered examining table. The day was bright with sunshine, and reflected prisms showered from all the chrome fittings in the room. While Stefan was tapping the patient’s tendons, Kauters appeared.

“Well, how does it look?” he asked, brisk and animated. He listened to Stefan’s exposition with satisfaction.

“Interesting,” the surgeon said. “For the moment let’s put: suspectio quoad tumorem. We’ll do a specular eye examination. And a tap. And then…”

He took the hammer and struck Rabiewski’s thin leg.

“Aha! What’s this? Please touch your right knee with your left heel. No, not like that. Show him,” he told Stefan, and walked over to the window. Stefan explained. Kauters came back with a leaf he had tom from a branch near the window, rubbing it between his fingers. Sniffing his slender, sinewy hand, he said with content, “Perfect. Ataxia too.”

“Cerebellar, doctor?”

“Perhaps not. Too early to tell. But there is a disturbance in thinking. Abulia. Now let’s see.” He tore a sheet of paper from his notebook and drew a circle on it. Then he showed it to Rabiewski. “What’s this?”

“It’s a part,” the engineer answered after long thought. His voice sounded pained.

“A part of what?”

“A spiral.”

“You see!”

Stefan reported the incident with the stethoscope.

Kauters rubbed his hands. “Perfect. Witzelsucht. A textbook case, don’t you think? I’m convinced it’s a small tumor in the frontal lobe. Time will tell. Please write everything down.”

The patient was lying on the table, his slightly goggled eyes staring at the ceiling. As he exhaled noisily, his lips parted to reveal long, yellow teeth.

That evening, Stefan came down with a headache and fever. He took two aspirin, and Staszek brought a bottle of vodka, which should have helped. But the weakness, chills, and fever lasted for four days. On the fifth day Stefan was finally able to get out of bed. After breakfast he went straight to Rabiewski’s room, curious to find out what was happening. The ordinary hospital bed had been replaced by a special one with nets at the sides and on top. The engineer lay as if caught in a web in the cage that they created, no more than a foot and a half high. His whole body seemed swollen. Kauters was leaning over looking at him attentively, moving his head out of the way when the prisoner tried to spit in his face. The thick lines around Rabiewski’s mouth were white with foam. The surgeon took off his glasses and Stefan had his first clear look at his eyes. They bulged, devoid of any sparkle, and were dark like the eyes of an insect seen through a magnifying glass.

“The tumor is growing,” Stefan said in a half-whisper. The surgeon paid no attention. He backed away again when the patient managed to turn his head and sprayed saliva. The patient grunted, tensing the muscles of his immobilized body.

“Pressure on the motor region,” Kauters murmured.

“Are you thinking of operating, doctor?”

“We’ll do a tap today.”

That evening, the brain that was lashing Rabiewski’s body seemed to reach a paroxysm of vexation. Knots of muscles cramped and rippled beneath his sweaty skin. The netting on the bed resonated like strings on a musical instrument. Stefan gave him two injections, which did not help much: the chloral narcosis stilled the fury only for a short while. When he came out of the anesthesia, the engineer reacted to the first light he had seen in many hours and mumbled hoarsely, “I know… it’s me… help.”

Stefan shivered. After the tapping of spinal fluid, there was an insignificant improvement. Kauters sat in the room for days on end, pretending that he had just come in to check when Stefan happened to appear. At first Stefan merely wondered why the surgeon was stalling. Then he grew depressed: the chances for a successful operation were decreasing every day.

The state of excitement passed. The engineer was able to sit in a chair. Pale and unshaven, he was the shadow of the burly man who had arrived three weeks earlier. His eyesight was gradually failing. Stefan no longer dared to ask about the date of the operation. Kauters was obviously upset, as if waiting for something to happen. Rabiewski had become his favorite patient, and the surgeon brought him lumps of sugar and sat watching him smack his lips and try to orient himself in relation to his own body, touching his thigh, his calf, his foot. His senses were slowly declining, and the world was fading for him. If you screamed into his ear, his twitching eyelids indicated that he could still hear.

On June 10, Kauters stuck his head out the door and called Stefan in from the corridor. The room was almost empty: no table or chairs. Rabiewski was back in his net, swollen, naked, and huge.

“Pay close attention,” Kauters said, beaming.

Rabiewski’s body shuddered, his hands burrowing in the netting like unconscious animals. Then violent convulsions began. The cage screeched, its iron legs banging against the floor. The bed almost tipped over, and both doctors had to press it hard against the wall. The attack subsided as quickly as it had come. The body hung in the net like a board. Feverish shudders ran through an arm or a leg. Then this, too, ceased.

“Do you know what this is?” the surgeon asked Stefan, as if he were giving an examination.

“Irritation of the motor region caused by pressure from the tumor?”

Kauters shook his head. “No, my friend. The cortex has entered necrosis. An ‘acortical man’ is emerging. Freed from the cortex’s inhibiting influence, the older, earlier evolved parts of the brain, still unaffected, are speaking up. That attack was Bewegungssturm, the motor storm, which occurs in all animals from infusorians to the birds. The animal is trying to escape, in the face of a threat to its life. The subsequent torpidity is the second stage of the same reactive apparatus. The so-called Totstellreflex, playing dead. Dung beetles do the same thing. See what it looks like? Now it’s receding beautifully!” he cried, excited. The engineer, racked by cramps, was now arching his back, pressing against the nets.

“Yes… that comes from the quad protuberance. A classic case! The mechanism that served the amphibians millions of years ago now emerges in Homo sapiens when the more recently evolved parts of the brain drop away.”

“Should I make the preparations for an operation?” Stefan asked, unable to look either at the convulsing body or at the surgeon’s joy,

“What? No, no. I’ll let you know.”

After his rounds, Stefan looked in on Sekułowski. Their relations had developed from their earlier unsettled state into a clearly established order: the master and the pupil who had to put up with his abuse. As a rule Stefan did not discuss patients with him, but Rabiewski was an exception: Stefan was desperate and needed advice. He dared not act on his own, and he was not sure what he could do anyway. Go to Pajączkowski? But that would mean lodging a complaint against Kauters, who was his superior and an experienced physician. So he settled on describing the engineer’s condition to the poet, even if that might cause an outburst of passion and indignation. But Sekułowski himself had not been feeling well of late, and he was eager to hear the tale of someone worse off than he.

Plumping up the pillow behind his back, Sekułowski delivered a long exposition: “Once—maybe it was in ‘The Tower of Babel,’ I said that man presents a particular image to me. It is as if someone had labored for centuries to make the most beautiful golden sculpture, adorning every centimeter of its surface with varied forms: hushed melodies, miniature frescos, all the beauty of the world captured in a single totality obeying a thousand magical laws. And this sublime sculpture is mounted in the depths of a huge roiling dung heap. That, more or less, is man’s position in the world. What genius, what precise craftsmanship! The beauty of the organs! The stubborn mind that harnesses the impassioned atoms, electron clouds, and wild elements, imprisons them in the body, and compels them to deeds alien to their nature. The infinite patience of designing the joints, the complex architecture of the bones, the labyrinth of circulating blood, the miraculous optical system, the finery of the fabric of nerves, thousands upon thousands of mutually restraining mechanisms, rising above anything we can think of. And all of it completely unnecessary!”

Stefan, shocked, was unable to reply. The poet smacked his hand against a large open book that had been covered by sheets of paper now strewn across the bedding: it was an anatomical atlas Stefan had lent him.

“What a disparity of means and ends. Your engineer vegetated, oblivious to what was fettered inside him, until suddenly the cells slipped their chains and their powers—until then directed inward, doing the bidding of kidneys and intestines—were suddenly liberated! The explosion of a thousand pent-up potentials. The spirit bursts through its chrysalis and appears in sudden enlargement: a watch with its works in revolt.”

“Are you thinking of the malignancy?”

“That’s what you call it. But what a name for it! You see, doctor, your ideas are pickled in formalin. For God’s sake, show a little imagination! Cancer? That is simply the side door, the Seitensprung, of the organism. My Blind Powers, securing the living tissue against accidents of a hundred thousand kinds, seem to have left one vent ajar. Everything was working perfectly, and suddenly—out of control! Have you ever seen a child playing with a watch, the way the child pulls off the hour hand, which makes the second hand spin and buzz like a horsefly? Instead of measuring the hours, the hands gobble up fictitious time! A tumor is a little sprout that grows from one mutinous cell. Slowly, you understand? Slowly it develops in the brain, draws nourishment from the blood, invades, eats through, and destroys those well-tended flower gardens planted in the human fodder…”

“You may be right,” said Stefan, “but why doesn’t Kauters operate?”

The poet, writing so feverishly that his pen point kept making holes in the paper, did not reply. There was a long silence. Outside the window, a bronze ray broke through the clouds and lit the treetops. The room drank in the light, which abruptly vanished. Stefan’s heart was pounding. Suddenly he asked, entirely out of context; “Excuse me. Why did you write Reflections on Statebuilding?”

Sekułowski, who had been lying on his side, turned and looked Stefan in the eye. Stefan could see the blood rising in the poet’s face, but he still was glad that he had asked the question.

“What do you care?” Sekułowski retorted in a deep voice that Stefan had not heard before. “Please stop boring me! I have to write!”

And he turned his back on Stefan.

Stefan decided to see Staszek. Perhaps he could help.

Staszek tied a ribbon around the thesis he was working on and put it away in a drawer. He complained to Stefan. The hospital did not keep him busy, he was bored with the patients. It was an enormous effort to put in his hours. He could not walk, sit, or lie down; Nosilewska’s image stayed with him constantly.

“You’ve got to make up your mind,” Stefan said, overcome by sudden compassion. “If you want, I’ll invite her to my room tonight, you come along, and then I’ll say I have to get things ready for an operation and I’ll leave you alone with her.”

But Nosilewska declined the invitation. She was busy copying out data from a large German anatomy textbook. The green ink staining her fingertips made her look girlish. She said she had to go see Rygier right away. Rygier had once taught anatomy in medical school, and he could help her with some of this pathology material.

Staszek, who had been waiting in Stefan’s room for the results of the expedition, now found new reasons to suffer. He was convinced that Rygier had invited Nosilewska for extra-scientific purposes.

“Well, maybe,” Stefan thought. “Do you love her?”

Staszek shrugged. He was sitting sideways in the chair, his legs hanging over the arm, kicking nervously.

“I won’t answer stupid questions. I can’t work or read, I can’t sleep, I’ve lost control of my thoughts, I’m going to hell in a handbasket, and that’s it.

Stefan nodded. “It could be love. Let me ask you a couple of crucial questions. First, would you use her toothbrush?”

“Come on!”

“Yes or no.”

Staszek hesitated. “Well, maybe yes.”

“Do you feel a ripping and bursting in your chest, a divine fire?”

“Sometimes.”

“Well, well. And now you’re in a state because she’s going to Rygier’s? Amor fulminans progrediens in stadio valde periculoso. The diagnosis is a snap. No time for preventive measures. You need treatment.”

Staszek looked at him gloomily. “Don’t be a fool.”

Stefan smiled because it had just occurred to him that if he wanted Nosilewska himself, he would have no trouble at all. “Don’t get angry. I’ll invite her tomorrow—or better yet, after the operation, once I get that off my mind.”

“What do you mean? What’s the difference what’s on your mind?”

“Oh, so you’re jealous of me too!” Stefan laughed. “I’ll get some bromural for you, okay?”

“Thanks, but I have my own.”

Staszek took a book from the shelf: Magic Mountain. He leafed through it, put it down, and took The Green Python instead.

“It’s a detective story. Terrible,” Stefan warned.

“So much the better. Then it’ll fit my mood.”

He headed for the door. Stefan’s sympathy suddenly vanished. “Listen,” he asked, “would you rather if she betrayed you or if something bad happened to her?”

“First, she can’t betray me, because there’s no connection between us. And anyway, what kind of choice is that?”

“It’s a psychological test. Answer.”

Staszek pushed the door open and slammed it as he rushed out. Stefan lay down on the bedspread in his clothes. Belatedly he realized that he had been angry with Staszek all evening because he had been unable to talk to him about the engineer. He got up, went to the shelf, and looked for the neurosurgery text. Maybe Kauters was doing the right thing. But he couldn’t believe that. The text settled nothing. The sheer curtain rustled at the open window. Someone knocked at the door.

It was Kauters.

“Dr. Trzyniecki, please come to the operating room right away.”

Stefan jumped up, but the surgeon was already gone, the fluttering folds of his unbuttoned smock disappearing into the dark corridor. Stefan ran down the stairs, forgetting to turn off the light in his room.

It was a warm, damp night. The wind carried the strong tickling smell of ripe grain. Stefan cut across the grass and ran up the iron steps to the second floor of the surgical wing, dew glistening on his shoes. White figures moved back and forth behind the frosted glass.

The operating room had begun as a small facility for procedures such as draining abcesses, to avoid having to transport patients to town. But there had been room for expansion, and Kauters had seized the opportunity. Now there was a table that could handle any kind of operation, along with oxygen bottles, a wall-mounted electric bone cutter, and a diathermal unit that resembled an oversized radio. A short passageway, lined with the usual little yellow tiles, led to a second room where rows of chemical bottles, piles of rubber hoses, and linen under a glass bell stood on metal tables. Two wide cabinets held instruments neatly laid out on perforated trays. This corner full of sharp scalpels, hooks, and pincers glimmered even in the dark. Balls of catgut were soaking in amber lugol on a separate table. Rows of glass tubes containing white silk sutures shined on a shelf above.

Sister Gonzaga rolled the instrument cart up to the massive, three-legged operating table. Next she brought up the big nickel sterilizers, that looked like beehives on their high stands. Stefan was disoriented. He could not ask the nurse who the patient was. Gonzaga had already begun scrubbing up, so he threw on a long rubber apron and began to soap his hands under a roaring stream of water. Drops splashed onto the mirror and left opal tracks as they rolled down the mercury surface. White suds formed a ring in the basin.

Suddenly he heard Kauters’s voice inside. “Take it easy, will you?” Then there was a deep sigh, as if someone was lifting a weight. Through the swinging doors, Stefan saw the bald head of the older male orderly, Joseph, who had Rabiewski’s inert form draped over his shoulder. He set him down on the table with a bang.

Kauters, pulling on white rubber galoshes, asked the nurse, “Are the first and second sets ready?”

“Yes, doctor.”

Tying the ribbons of his apron behind his neck, the surgeon stepped on the water pedal and began scrubbing up, his movements automatic.

“Are the syringes ready?”

“Yes, doctor.”

“Make sure the needles are sharp.”

He spoke mechanically, without even looking at the table. Joseph undressed Rabiewski, turned him onto his back, tied his arms and legs to handles with white straps, and began to shave his head with a straight razor, without lather. Stefan could not bear the dull scraping sound.

“For the love of God, Joseph, use a little soap and water!”

Joseph mumbled—when Kauters was around, he listened to no one else—but finally decided to moisten the engineer’s head. Rabiewski’s breathing was slow and shallow. Holding a few wisps of gray hair, Joseph attached a large anode pad to the patient’s thigh and drew back from the table. Sister Gonzaga finished scrubbing with her third brush, dropped it into the bag, and walked toward the sterilizer with upraised hands. Joseph helped her on with a yellow mask, a coat, and thin fabric gloves. Next she went to the instrument stand, where three trays were still wrapped in the compresses in which they had come out of the autoclave. She unpinned the fabric and laid out the shining steel tweezers and rods in order of their importance.

Stefan and Kauters finished scrubbing at the same time. Stefan had to wait while the surgeon rinsed his hands in undiluted alcohol, and when his turn came, he held his fingers under the thin, stinging stream. Shaking his hands dry, he looked at them with concern.

“I have a splinter,” he said, angrily touching the red spot near his fingernail. Kauters was putting on his rubber gloves, having a hard time with it because they were out of talc and his hands were wet.

“Don’t worry. He certainly does not have PP. Anyway, things like that don’t happen in the brain.”

Joseph, unsterilized, was standing back from the table.

“Lights!” the surgeon commanded. Joseph threw a switch, the transformer roared, and the large flat Jupiter angled over the table ringed them in a bluish light.

Kauters turned to the window for a moment. His face, masked up to the eyes, seemed darker than usual. The doctors approached the patient from opposite sides of the table. Joseph leaned nonchalantly against the sink, the reflection of his bald head like a sunflower in the mirror.

They began covering Rabiewski with compresses. Fishing them from the sterilizer with long forceps, Gonzaga was virtually hurling them into the surgeon’s hands. The large squares of overlapping sterile cloth were laid from the patient’s torso to his face. Stefan was pinning them together on the other side of the table.

“What are you doing? To the skin, to the skin!” the surgeon snapped sharply but quietly, plucking the fold of skin with his pincers. Though he had long grown accustomed to the sight of bodies being cut open, Stefan could never stop himself from shuddering when the compresses at the site of an operation were pinned to a patient’s skin, even when he knew the patient was under anesthesia. And the engineer was merely unconscious. At just that moment the figure under the cloth trembled, grinding his teeth like flint scraping glass. Stefan automatically looked at Kauters. The surgeon looked back, then gestured as if to say: Go ahead and use a local anesthetic if it makes you happy.

After putting iodine on the portion of the head that stuck out of the tight ring of compresses, Stefan injected novocaine in several places and lightly rubbed the bumps the needle left on the skin. When Stefan had thrown away the iodine-stained pad, the surgeon reached back without looking. Sister Gonzaga placed the first scalpel in his hand. He touched the steel blade to the forehead, then made an oval incision. Kauters cleared away the connecting tissue down to the bone, using anatomical pincers that made a dull grating sound. Then he laid the instruments on the patient’s chest and reached for the trepan, an egg-shaped motor connected to an auger by a steel snake. Gonzaga stood immobile, several instruments in each raised hand. Stefan had just managed to blot the bright red streaks of blood around the incision when Kauters turned on the trepan. He held it like a pen. The auger bit into the bone, pitching out little particles that formed a line of bloody paste along the incision.

The buzzing stopped. The surgeon swung the auger away and called for a rasp. The plate of bone would not come free: it was sticking somewhere. Kauters pressed it delicately with three fingers, as if trying to push it into the skull.

“Chisel!”

He set the chisel at an angle and tapped it with a wooden hammer. Streams of blood wound along the skin and the compresses slowly turned crimson. Suddenly the plate of bone trembled. Kauters worked the rasp under it and leaned. There was a sharp crack like a nutshell breaking. The plate flipped over and fell off.

The meninges, the membrane surrounding the brain, swelled and glinted in the light. A network of dark veins could be seen in its depths. Kauters moved his hand away and came back with a long needle. He pricked the membrane in several places, once, twice, three times.

“Just as I thought,” he murmured. Above his mask, his glasses reflected a miniature image of the lamp. Until that moment, Stefan had been applying sterile pads to stanch the flow of blood into the wound. Now he leaned forward. Their gauze-capped heads touched.

Kauters hesitated. Holding his left hand at the edge of the incision, he touched the membrane delicately with his right. The brain underneath, pulsing gray and pink, showed more clearly. Kauters looked up as if he expected a sign from above. His large black eyes looked so vacant that Stefan was almost frightened. Kauters ran his rubber-covered finger twice around the exposed membrane in a circle.

“Scalpel!”

It was a small, special knife. At first the membrane would not yield, but suddenly it split like a blister and brain burst through from below. It throbbed, swelling red in the tear from which viscid threads of blood trickled.

“Knife!”

Now there was a new sound, a bass rumbling of the diathermal apparatus. Gonzaga unwound the gauze from the electric knife and placed it in Kauters’s hand. Both doctors leaned forward. The flow of blood was not significant; no major vessels had been severed. But the situation was murky. Slowly, millimeter by millimeter, Kauters widened the opening in the membrane. At last, everything was clear: the protruding, swollen part was the forward pole of the frontal lobe. When the surgeon poked at it with his finger, the yellow tumor appeared deep in the cleft between the two hemispheres. Getting to it would be difficult. He slid his index finger along the bulging folds of the cortex. He finally managed to reach the growth with the pincers. The tumor lay at the base of the skull, which for an instant showed pearly-blue like the inside of a seashell; then blood covered it. The tumor extended in both directions, compact at the bottom and plump at the top. It was covered with a brown paste.

“Scoop!”

Kauters began raking out blood-soaked scraps, threads, and strips. Then suddenly he jerked back. Stefan froze for an instant before he understood what had happened. A needle-thin stream of blood was shooting straight up from the bottom of the wound, from between the two hemispheres of the brain that the surgeon was holding apart with his fingers. An artery. Kauters blinked. Several drops had hit him in the eye.

“Damn it!” he said. “Gauze!”

Blood saturated the tampon, part of the tumor remained, and it was impossible to see anything. Kauters pulled his belly back from the table, looked up at the ceiling, and moved his finger around in the wound. This continued as the compresses soaked up blood, which seeped onto the pads put down at the beginning of the operation. New compresses were added because hands and instruments were getting slippery. Stefan stood looking at Kauters, helpless. His mask had slipped and was pressing against his nose, but he could not touch it.

The surgeon turned on the diathermal apparatus with the foot pedal and moved the knife closer.

Blood throbbed visibly in the mangled tissue of the tumor. Then the first faint blue smoke of scorched protein rose and Stefan smelled the characteristic stench through his gauze mask. The hemorrhage stopped. Only where tweezers had been left clamped in the wound did tiny red drops crawl like ants.

“Scoop!”

The operation continued. The surgeon ran the thermocoagulator over the tumor’s surface. When it had cooled and solidified, he spooned it out, going after the remains with a crooked finger. But the longer this went on, the worse things got. The tumor pushed the lobe upward and pressed into it. The surgeon worked more and more briskly. At one point, reaching deep into the wound, he shuddered: when he pulled his hand out, the glove was ripped. The yellow rubber peeled back from his finger, cut by a sharp edge of bone.

“Shit!” Kauters said in a dull voice. “Please get this off for me.”

“A new pair, doctor?” asked Gonzaga, instantly lifting a packet from the sterilizer with a fluid movement of her forceps.

“The hell with it!”

Kauters ground the strips of rubber into the floor. His anger gathered in the wrinkles around his eyes, and shiny bluish drops of sweat sparkled on his narrow brow. The muscles at his temples bulged: he was grinding his teeth. He moved his fingers more and more brutally in the wound, pulling out and tossing aside ragged scraps, necrotic tissue, and the burst remains of some vessel. The floor was spattered with bloody commas and question marks.

The clock read ten: the operation had lasted an hour so far.

“Take a look at his pupils.”

Stefan lifted the sheet, which was heavy and stiff with coagulation, soaked with red blotches. Rabiewski’s face was shiny, pale as paper, as Stefan lifted his eyelids with tweezers. The pupils were tiny. Suddenly the patient’s eyes danced wildly, as if someone was pulling them on a string.

“Well?” Kauters asked.

“Nystagmus,” said Stefan, stupefied.

“Yes, of course.”

Kauters’s voice sounded derisive. He was drawing a needle across the cortex. The brain was deeply open, and there was more and more necrotic mass, fusing with the spirals and convolutions. Stefan looked at the wound, which gaped like an open mouth. He could see the white tissue of nerves shining like a hulled walnut and the gray matter, which was actually brownish, with lighter, narrow smears. Drops of blood shined like rubies here and there.

Irritated, the surgeon drew a convolution sideways; it stretched like rubber. “Let’s finish up!” he barked.

That meant he was giving up. His fingers worked quickly now, deftly pushing as much as possible of the bulging hemisphere back into the cavity of the skull. Bleeding started again somewhere. Kauters touched the dark end of the electric knife to a vessel and stanched the hemorrhage. But suddenly he froze.

Stefan, who had been staring at the mummy-like figure on the table during this last procedure, understood. Rabiewski’s chest had stopped moving. Without worrying about infecting his hand, the surgeon grabbed the bottom of the sheet covering the patient’s chest and face, tugged it aside, listened for a moment, and walked silently from the table. He kicked his bloody rubber galoshes off against the wall. Gonzaga took the edge of the sheet and drew it sacramentally over the stricken face. Stefan went to the window to catch his breath. Gonzaga was collecting the instruments on metal trays behind him, water roared in the autoclave, and Joseph mopped blood from the floor. Stefan stood leaning on the window ledge. A great, silent darkness spread before him. At the junction of sky and earth, he thought, loomed something darker than the night. The warehouses of Bierzyniec shined like a diamond necklace against dark fur. The wind faded in the trees and the stars trembled. The last of the water gurgled in the drain.