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general anaesthetic for the entire head was of raw flesh, a bland
expressionless head, a head like a child's drawing, crude lines and
harsh colours, hairless, earless, streaked and mottled with yellow runs
and patches of soft pus and corruption.
We are getting a response from the Cloxacillin, it's looking a lot
healthier, sister. The naked flesh of his eyelids had contracted,
pulling back like the glistening petals of a pink rose, exposing the
eyeballs to the air without respite. They had filled the eyes sockets
with a yellow ointment to soothe and moisten them, to keep out the
loathsome infection that covered his head. The ointment prevented
vision.
I think we'll go for an abdominal pedicel now. Will you prep for
afternoon theatre, please, sister? Now it was time for the knife, and
David was to learn that the pain and the knife lived together in
terrible sin.
They lifted a long flap of skin and flesh from his belly, leaving it
still attached at one end, and they rolled it into a fat sausage, then
they strapped his good arm, the one without the plaster cast, to his
side and they stitched the free end of the sausage to his forearm,
training it to draw its blood supply from there. Then they brought him
back from theatre and left him trussed and helpless and blind with the
pedicel fastened to his arm, like a remora. to the belly of a shark.
Well, we have saved both eyes, the voice was proud, fond almost, and
David looked up and saw them for the first time. They were gathered
around his cot, a circle of craning heads, mouths and noses covered by
surgical masks, but his vision was still smeary with ointment and
distorted by the drip irrigation that had replaced it. Now we will go
for the eyelids. It was the knife again, the contracted and
bunchedelids split and re-shaped and stitched, the knife up ey and pain
and the familiar sickly taste and stink of anaesthetic that saturated
his body and seemed to exude from the very pores of his skin.
Beautiful, really lovely, we have cleaned up the infection nicely. Now
we can begin. The head was cleansed of its ru
now it was glistening and wet, bald and bright red, the colour of a
cocktail cherry as granulation tissue formed. There were two gnarled
and twisted flaps for ears, the double row of teeth startlingly white
and perfect where the lips had been eaten away, a long white blade of
exposed bone outlined the point of the jaw, the nose was a stump with
the nostrils like the double muzzles of a shotgun, and only the eyes
were still beautiful, dark indigo and flawlessly white between lids of
shocking crimson and neatly laid back stitches.
We'll begin at the back of the neck. Will you prep for this afternoon's
theatre, please, sister? It was a variation on the theme of the knife.
They planed sheets of live skin from his thighs and meshed them to allow
a wider spread, then they laid them over the exposed flesh, covering a
little at each session, and evaluating each attempt while David lay in
his cot and rode the long swells of pain.
That one is no good. I'm afraid we will have to scrap it and try again.
While his thighs grew a new crop of skin, they planed fresh sheets from
his calves, so that each donor-site became a new source of pain.
Lovely! An edge-to-edge take with that graft Slowly the cap of skin
extended -up across the nape of his neck and over his scalp. The
meshing of the skin grafts gave them a patterned effect, regular as the
scales of a fish, and the new grafts were hard-looking and raised. We
can move the pedicel up now. 'This afternoon's theatre, doctor? 'Yes,
please, sister. David came to know that they operated every Thursday in
the burns unit. He came to dread the Thursday morning rounds when the
consultant and his staff crowded around his cot and touched and prodded
and discussed the restructuring of his flesh with an impersonal candour
that chilled him.
They freed the fat sausage of flesh from his belly and it dangled from
his arm like some grotesque white leech, seeming to have a life of its
own, drawing blood and sustenance from its grip upon his forearm.
They lifted his arm and strapped it across his chest, and the raw end of
the pedicel they split and stitched to his jaw and to the stump of his
nose.
It's taken very nicely. We will begin shaping it this afternoon. We'll
have him at the head of the theatre list.
Will you see to that please, sister? With the living flesh that they
had stolen from his belly they fashioned a crude lump of a nose, taut,
narrow lips and a new covering for his jawbone.
The oedema has settled. This afternoon I will go for the bone-graft on
the jaw.
They opened his chest and split his fourth rib laterally, robbing it of
a long sliver of bone and they grafted this to the damaged jaw-bone,
then they spread the flesh of the pedicel over it and stitched it all
into place.
On Thursdays it was the knife and the stink of anaesthetic, and for the
days in between it was the ache and pain of abused and healing flesh.
They fined down the new nose, piercing it with nostrils, they finished
the reconstruction of his eyelids.
They laid the last grafts behind his ears, they cut a double zigzag
incision around the base of his jaw where the contracting scar tissue
was trying to draw his chin down on to his chest. The new lips took
firm hold on the existing muscles and David gained control of them so he
could form his words again and speak clearly.
The last area of raw flesh was closed beneath the patchwork of skin
grafts, flesh grafts and stitches. David was no longer a high-infection
risk and he was moved from a sterile environment. Once again he saw
human faces, not merely eyes peering over white surgical masks. The
faces were friendly, cheerful faces. Men and women proud of their
achievement in saving him from death and refreshing his ravaged head.
You'll be allowed visitors now, and I expect you'll welcome that, said
the consultant. He was a distinguished-looking young surgeon who had
left a highly paid post at a Swiss Clinic to head this burns and plastic
surgery unit.
I don't think I will be having any visitors, David had lost contact with
the reality of the outside world during the nine months in the burns
unit.
Oh, yes, you will, the surgeon told him. We've had regular inquiries on
your progress from a number of people. Isn't that correct, sister?
"That's right, doctor. You can let them know that he is allowed
visitors now. The consultant and his group began to move on.
Doctor, David called him back. I want a look at a mirror, and they were
all silent, immediately embarrassed. This request of his had been
denied many times over the last months.
Damn it, David became angry. You can't protect me from it for ever. The
consultant gestured for the others to leave and they filed out of the
ward, while he came back to David's bed.
All right, David, he agreed gently. We'll find you a mirror, though we
don't have much use for them around here! For the first time in the
many months he had known him, David glimpsed the depths of his
compassion, and he wondered at it. That a man who lived constantly
amongst great pain and terrible disfigurement could still be moved by
it.
You must understand that how you are now is not how you will always be.