Digby stares at Rune as if at a madman. Then he nods. “Yes.”
Rune is impressed. Cowasjee was a cart driver for the British. He was captured by Tipu Sultan’s army in a battle with the British in the eighteenth century. Tipu’s men cut off Cowasjee’s hand and his nose and set him free. One can live without a hand, but nothing is more disfiguring or shameful than a hole in the face. Since the British surgeons could do nothing about his appearance, Cowasjee vanished, only to return a few months later displaying his new nose. He’d been operated on by the bricklayers in Poona, who practiced a seventh-century technique passed down from Sushruta, the “father of surgery.” The bricklayers made a wax nose—a hollow pyramid—to fit over the hole in Cowasjee’s face. They removed this mold, flattened it out, and put it upside down at the center of Cowasjee’s forehead to serve as a template. With a scalpel they traced an incision on the forehead around this template, save for the bottom, where the eyebrows met. Dispensing with the template, they undermined and lifted the forehead skin into a flap, hinged between the eyebrows. Swinging it down, they sewed it to the edges of the nose hole, with small sticks to keep the nostril holes patent. It healed well, since it had an intact blood supply from its attachment near the eyebrows. True, it was a bit floppy from no cartilage, but air could pass, and more importantly, his looks were restored. A British surgeon reported this technique in a journal.
“Is that what you have in mind for me? A flap?” Digby says.
Rune parries with his own questions. “Why did it take us in the West centuries to learn a technique that was right under our nose? What else don’t we know, eh, Digby? What else?”
“Dr. Orqvist. Please. What do you propose?”
“Call me Rune, please. Homo proponit, sed Deus disponit,” Rune says, pointing heavenward. “I propose that you come to Saint Bridget’s. We’ll leave in the morning. But it’s contingent on one thing.”
Digby looks anxious. “What?”
“Tell me you like our plum wine.”
CHAPTER 32
The Wounded Warrior
1936, Saint Bridget’s
Digby has landed on an alien planet. After weeks living at high altitude at AllSuch, the heat and humidity of the lowlands add to his dislocation. He is a guest in Rune’s cozy bungalow. On his first day, Rune leads him through well-tended gardens to his clinic, chatting in Malayalam with residents they meet. Digby brings his hands together stiffly to return their greeting. His experience with leprosy is limited to seeing street beggars in Madras. He has too many other worries to worry about contracting leprosy; it helps that Rune seems unconcerned.
In what looks like an orthopedic cast room, the big Swede vigorously massages and stretches Digby’s hands, gauging the degree of contracture. The inhabitants of Saint Bridget’s crowd around the open windows like gawkers at a carnival’s freak show, intrigued by this sight. When Digby yells with pain, the audience breaks into excited murmurs. “Well, you’ve convinced them you don’t have leprosy,” Rune says. “They scream for many reasons, but never from pain.” Rune readies a syringe. “Your right needs a lot more flexibility in the wrist before I think of operating. But the left? That we make right today, okay?” He is like an overgrown child, Digby thinks, laughing uproariously at his own pun. Rune sketches for Digby on a paper what he plans to do. “I thought I invented this. But a Frenchman claimed it before me. He called it the ‘mèthode de pivotement.’ I call it the mark of Zorro. It makes this horizontal scar into a vertical one and creates space. Yes?”
Not waiting for an answer, Rune injects local anesthetic over the nerves in two spots at Digby’s wrist as well as directly into the thick horizontal scar. He scrubs the palm with antiseptic, and then draws on it with a surgical pen, making use of a protractor and ruler. By the time Rune walks Digby down a hallway to the small operating theater, all sensation in his palm is gone. Rune puts on gloves and a mask and makes the long, horizontal incision along his pen mark, right through the middle of the scar. From the ends of this long cut, he makes two smaller cuts at sixty degrees, resulting in a . Digby observes as if from outside of his own body. Rune, using forceps and scalpel, raises triangular flaps from the two corners by undermining the skin. Then he transposes them, swinging the bottom wedge up and the top one down, suturing them in place. The has now become a , creating slack in the scar. Digby sees his fingers already straightening out.
“Voilà!” Rune says, stripping off his gloves. “The mark of Zorro!”
Every morning and evening Rune works to loosen Digby’s right wrist, torture sessions that leave Digby sweating. The Swede seems to enjoy having a houseguest to talk to, even if the conversations are one-sided. One evening, as Rune comes into the house, his face looks ashen, his right hand on his chest while he leans on the doorframe. Digby rises automatically to go to him but Rune waves him off. “I just need to catch my breath . . . I get this . . . nuisance sometimes in my chest. When it is hot and I walk uphill from the clinic to the house. It passes.” And it does.
Ten days after Digby’s arrival, Rune says, “No dinner for you tonight, Digby. We operate tomorrow on your right hand. This time we put you to sleep.” Digby is astonished when Rune describes what he has in mind.
Once the ether takes hold, Rune preps and cleans Digby’s right hand and does the same for the skin over Digby’s left breast. Using scalpel and forceps, he laboriously picks away at the back of Digby’s right hand, removing Digby’s pinch grafts as well as the intervening scar. “Don’t feel bad, my friend,” Rune mutters. “Your grafts helped a little. Without them, your tendons would be fixed in cement. Now they are just being strangled by weeds.” It takes over an hour before the back of the hand from the wrist to the knuckles is exposed, raw, and bleeding, with the tendons laid bare but moving freely. The cocked wrist flattens out when Rune presses down.
Rune positions Digby’s right hand, palm facing down, on the left side of his chest. Then he traces its outline on the chest with a surgical pen, the tip dipping down in between the spread fingers.