After breakfast Kai carries the chairs through from the yard to the verandah and sets them out in rows. By seven-thirty he is on his way to the hospital. The traffic is light, he makes good time. In the staff room he pours himself his third cup of coffee and sits with it, watching his hands holding the cup, the surface of the black liquid vibrating, the reflections shimmering and shifting. The last few nights have not been good. Hard to know if the coffee improves matters or makes them worse. Another few sips and he sets the cup down. He needs to prepare. He makes his way to the changing rooms for the operating theatres. Nobody is there. Just Mrs Goma’s wig hanging on a peg like a dead bird. Time alone is all he needs. It is an important day, the second operation of the elective, out of a total of four. When it is all over, and if everything goes according to plan, if no serious infections set in, and if all their projections are correct, a few months from now Foday will walk. Not the way he walks now, every step a flailing uphill struggle. Foday will walk tall.
In the first operation they had broken and reset the tibia of the right leg. Today they would perform the same operation on the left leg.
Kai strips off his day clothes and selects a green scrub suit from the shelves. He’s restless, nervous and overly alert. At the sink he washes his face in cold water and inspects himself in the mirror, pulling down his bottom eyelid and inspecting his gums. His skin is dry and taut. He feels queasy. He runs the tap and drinks from his hand. The water is warm and only slightly refreshing.
He sits on the bench and holds his hands up to his face. The tremble is still there. He closes his eyes and leans back against the lockers, feels his breathing slow, his heart quieten. He spreads his fingers out upon his thighs; his body begins to feel lighter.
A knock on the door. He opens his eyes. ‘Yes?’
‘Dr Mansaray?’
‘Yes?’
It is one of the theatre nurses with a message. ‘You’re wanted in emergency.’
‘Did you tell them I’m about to go into surgery?’
‘Yes. They say there’s nobody else.’
He sighs, rises and opens the door, but she has already turned away. He sees her shoulder her way into the theatre where Mrs Goma is working. Swiftly he changes his shoes and makes his way upstairs and through the building to the emergency unit. The unit doesn’t stay open all hours. They don’t have the staff. Instead it opens at ten in the morning and people begin to gather long before. Most conditions can be treated routinely, even when they are serious. But those times there is a real emergency out of hours, you can be drafted in from anywhere.
A massive iron gate had fallen while being lowered into place by a crane, trapping three workmen beneath it. Two of the men had escaped with broken bones and were already being attended to. The third man is the one Kai has been called to look at. The nurse indicates a man lying on his back on the far side of the room. He is not yet forty by Kai’s guess, though he is gaunt and this makes him appear older. He lies without speaking, his eyes open.
‘Hello,’ says Kai. ‘How do you feel? Are you in pain?’
‘Not so much pain, Doctor. Only I cannot feel my body.’
Kai reads the notes the nurse has given him. Suspected spinal injury. He examines the man briefly, calls the nurse and asks for a pin. Starting high on the man’s chest, he delivers pinpricks at regular intervals. ‘Tell me if you can feel this.’ The man nods and whispers, ‘Yes. Yes. Yes.’ Then silence. Just above his navel. Kai backs up and repeats the pinpricks, this time to check the exact location where the sensation disappears. ‘Yes, yes.’ When he reaches the same spot, there is silence once again. Next he checks the deep-tendon reflexes at the Achilles tendon. Nothing.
‘I’ll be back,’ he tells the man. ‘Who is here with you? Family?’
He shakes his head. ‘Mr Sesay.’
‘Who’s that, your boss?’
A nod.
At the nurse’s station Kai gives his diagnosis. Likely severance of the spinal cord at T8. To be confirmed by X-ray.
‘Shall I admit him?’ asks the nurse.
Kai shakes his head. ‘Ask him to let us call his family. Someone will need to explain to them.’ He exhales. He hates this most of all. ‘And to him.’ He hands her the notes. She takes them without looking up.
‘Who will explain to them?’ No doubt she is already worried the job might fall to her.
‘I’ll do it. Call me when the X-rays are ready. Otherwise I’ll come back and check after theatre.’
Outside he calls Mr Sesay’s name. The foreman steps forward, pulling off his woollen hat. Kai explains to him, in a way he hopes he can understand, the nature of the injury. The foreman isn’t stupid. He has lost a worker. He listens attentively, shakes his head, promises to bring the family himself. He is still standing there holding on to his woollen hat as Kai walks away. Kai thinks of all the things he has not told the foreman. In particular of Mrs Mara’s decision not to admit any more spinal-injury patients. In past times they’d kept men alive for months only to have them die within weeks of being discharged back to their panbodies, where nobody had the time or the expertise to care for them, to manage their bowel and bladder movements, to turn them several times a day; no money to buy catheters and equipment. Better let them die sooner than later — the brutal fact of it. He considers how much to tell the family, whether to confine himself to explaining how to care for their father and wait for the inevitable. The bed sores are the worst of it. With luck pneumonia would take him first. Kai glances at his watch. He will have to move if he is to be ready for the start of the operation. If they miss the slot they might have to reschedule.
In the theatre they are ready to begin. Foday has been wheeled down and is already on the table, one arm hooked up to the blood-pressure monitor. He is lying on his back, the massive chest rising above him, both his muscular arms outstretched, the shape of a crucifix. His penis lies flung to one side, shaved balls nestle between strong thighs tapering into underdeveloped calves, one splayed, one now straight, down to the out-turned ankles. On the light box on the wall, X-rays of those same frog legs. Kai bids Foday good morning, earns a smile, silent and serene. Foday’s confidence should be heartening. Instead Kai feels a quickening of the stomach muscles. The team is the same as before. Seligmann, the lead surgeon. Kai. The anaesthetist, Salamatu. All except Wilhemina. In her place the nurse who called him to the emergency unit. She is busy layering sterile drapes over Foday’s body, returning him to modesty. Her hands are quick, professional, her face unsmiling. She is the sole OR nurse now. From the instrument trolley Kai picks up a kidney bowl of water, iodine and ampicillin and begins to swab Foday’s leg. Seligmann is photographing Foday’s left leg. He steps forward, shifts the position of the leg and returns to take the photograph. The flash bounces off the white walls causing Foday to raise his head.
‘Photograph,’ explains Salamatu. She slides a needle into his arm. Reaches up to the IV line and injects a fluid into it.
‘Passport photo,’ says Kai. ‘For your honeymoon.’
Foday rolls his head in Kai’s direction and grins at him. He seems about to respond, when his eyes lose focus, the lids flutter closed.
‘Good,’ says Seligmann, putting down the camera. He peers at Foday.
They are ready to begin. The nurse tightens the tourniquet around Foday’s thigh.
‘Over or under?’ asks Seligmann. ‘Under or over?’
They assess the point of entry, agree to go in under the muscle. Seligmann makes the first incision. Blood oozes from the wound. ‘Tourniquet,’ he says. The nurse tightens the tourniquet further. Kai meanwhile stands by with the diathermy wand. He glances down. The tip of the wand is waving. He takes a quick, deep breath, tries to steady his arm and his hand to stop the involuntary movement of the wand. He looks up to check whether anybody else has noticed. The nurse is finishing off the tourniquet. Seligmann waits to continue the incision. Salamatu is sitting next to Foday’s head. None of them are looking in his direction. Kai flexes his arm, at the same time lowering the wand below the level of the table. He counts and breathes. One, two, three. It’s worked before. He concentrates all his energy into stilling his hand and arm. The waving is arrested sure enough, but the tip of the wand continues to shiver. He can do nothing to control it. Any moment now, Seligmann will ask him to begin cauterising the ends of blood vessels left by his incision. The nurse has tied off the tourniquet and now resumes her place next to Seligmann. Seligmann bends his head, adjusts his grip on the scalpel and prepares to begin again.