A Constellation of Vital Phenomena - By Anthony Marra Page 0,27
with saline.
With swift, well-rehearsed movements, Sonja inserted IVs of glucose and Polyglukin into the man’s arms. She pulled a surgical saw from the cabinet and disinfected the blade as Deshi called out blood-pressure readings. At seventy over fifty, she injected Lidocaine just above the tourniquet. Deshi anticipated her requests, and the clamps he’d boiled were in her reach before she asked. She worked without looking at the man’s face or hearing his cries as though her patient were no more than his most grievous wound. Blood reached her elbows but her scrubs remained white. The man, and he was a man, it was so easy to forget that with all his insides leaking out, had graduated from architecture school and had been searching for employment when the first bombs fell. When the land mine took his leg, he had already spent nine years searching for his first architectural commission. Another six and three-quarter years would pass before he got that first commission, at the age of thirty-eight. With only twenty percent of the city still standing, he would never be without work again.
“Come here,” Sonja called. Akhmed looked over his shoulder to summon a more capable ghost from the Brezhnev-beige wall. “Akhmed, come here,” she repeated. He stepped forward, wiggling his toes in his boots. One step and then the next, with an immense gratitude for each. The skin was peeled back toward the knee. The calf muscle, cut away. The bone wasn’t wider than a chair leg.
She gestured with her scalpel. “For a below-the-knee amputation, you want to keep in mind that stumps close to the knee joint will be difficult to fit for a prosthesis. Long stumps are also difficult to fit and can lead to circulation issues. First, you’ll need to make a fish-mouth incision superior to the point of amputation. You want a posterior flap long enough to cover the padded stump and to ensure a tensionless closure when sutured.” She described how to isolate the anterior, lateral, and posterior muscular compartments in dissection. She showed him how she had ligated the tibial, peroneal, and saphenous veins, and noted that the blood pressure always rose after the peroneal artery was tied off. She transected the sural nerve above the amputation line and let it retract into the soft-tissue bed to reduce the phantom limb sensation. With a clean scalpel she incised the dense periosteum. She gave directions in the flat, bored tone of a carpenter teaching a child to measure and cut wood, and Akhmed heard her without listening. All her Latin words and surgical jargon couldn’t mitigate the helplessness he felt while watching her finish what the land mine had begun.
“Leg amputations are normal business here,” she said, and handed him the saw. He held it, expecting her to ask for it back. She looked to it and nodded. No, she couldn’t be serious. She didn’t expect him to do that, did she? She barely trusted him to fold bedsheets properly. “You should get comfortable with this procedure as soon as possible.”
He gazed from the blade to the bone. The bone was a disconcerting shade of reddish gray; he’d expected it to be white. He had been six years old when he first realized that the drumstick he slurped the grease from was, in principle, the same as the bone that allowed him to walk, run, and win after-school soccer matches. He hadn’t eaten meat again for two years, so great and implacable was his fear that another carnivore would consume his own leg in reprisal. “I’m not qualified for this,” he stammered.
“This is the deal,” she said calmly. She reached for his hand. That grip held more of her compassion than the past two days combined, and then it was gone, replaced by hard pragmatism, and her fingers wrapped his around the foam grip. “This is what we do. This is what it means for you to work here.”
His hands shook and hers steadied them. The last leg surgery he had performed had been after the zachistka, on a boy named Akim. He had tried his best, he really had, but he couldn’t be faulted for his lack of supplies and experience, for the lack of blood in the boy’s body and the great abundance drenching the floor, for the bullet he didn’t shoot, or for the war he had no say in; if anyone had bothered to ask his opinion, he would have happily told them that war was, generally speaking, a bad