Still Life in ShadowbyAdrian Leverkuhn©
She was in her outlook a simple woman, and it had been said of her for as long as anyone on the island could remember that she had been unassuming even when she was young, when she first arrived here oh so long ago. Plain, some used to say. But that was long ago . . .
She was considered brilliant, but then again she always had been, and that doesn't really account for what happened. Maria Louisa Delasandro was her name. She was Swiss, but after finishing her medical studies she had unaccountably settled in Horta, on the island of Faial in the Azores, and she had lived there for almost thirty years when I became a party to these events.
She was a surgeon at the hospital on the island, and she ran an inter-island clinic for off-islanders as well, and was regarded as something of a saint by almost every inhabitant of the island chain. She was an oddity within the medical profession, too. She had trained in cardiovascular surgery and simply left that world - the bustle of Zurich, the promise of a celebrated career - and she had moved to this final outpost of the Portuguese empire, this end of the line, to get as far from that fast-paced world as she could.
No one knew why. Those who spend their lives worried about such things often speculated that a man had been involved, but it wasn't really an open mystery anymore. It had, over the years, simply become irrelevant. Gone too were the days when the young doctor was looked on with suspicion because she wasn't native to the islands. The men who had once tried to win her heart were now, as well, all gone, gone to make homes with other women, gone to the sea, fishing perhaps, and thence on to their final rest . . . Yes, that part of her life was now little more than a memory, the mysteries of uncertain unions, too, were now all of an undefined past. Maria Louisa Delasandro had watched it all come and go, and with a kind heart, a patient heart, for she was in word and deed a kind soul. A Saint, if you really must know the truth of it.
Maria lived in a small white house on the south side of the island in a little village outside of Horta known as Pasteleiro. Her house, like the others in the village, fronted a gently terraced hillside overlooking the Atlantic Ocean, yet it was in her garden - a world apart full of gardenia and azalea blossoms most of the year - that Maria found what peace there was to be had in this life. When not working in her clinic or at the hospital, Maria could inevitably be found on her knees in this garden, slowly, so slowly, so lovingly - working on the petals of her God's creation.
Almost without exception, Maria would each day take her dinner at home. When the weather was stormy she could be found inside by the house's old, stone fireplace with Max, her playfully faithful, and very old Bernese Mountain Dog. She would on stormy evenings look out on the mad, storm-tossed sea and wonder what furies danced so to create such majestic anarchy. Max would watch her with all the love and affection of an old husband, and he was happy in this world, happy of his life with Maria in the true way that only dogs know.
In the normal, sun-drenched evenings of her island home, Maria would sit in her garden as the sun set and have a light salad, and perhaps some cheese, with her wine, and invariably, no matter what the weather, she would sit in the afterglow of another day and read the poetry of Donne and Yeats. She often read these words aloud to Max, and he would sit by the wall of her garden with the last of the day's sun on his neck, and he looked at her with what surely must have been love on his face.
Some might find such an existence quite mundane, even boring. But few people knew the meaning of peace or the myriad ways the soul of man can be ripped asunder the way Maria Louisa Delasandro did. Maria was an expert at recognizing a soul's dis-ease, you see, because hers had been dead for such a very, very long time.
At least, she told me that was so after the events in this story were over. Yes, that was what she felt when she dared to think about herself.
I first heard David Latham's voice over the radio, and he sounded very stressed out.
But I'm getting ahead of myself. So please, let me digress.
Let me go back to the late afternoon of a blustery May day a few years back, and I was en-route from the States to the Mediterranean via Bermuda and the Azores on a friend's sailboat. I had done some sailing before, but this was my first long ocean crossing, and I had been - to say the least - hesitant to make the trip. But Harry Stinson, an old and most loyal friend, had begged and pleaded with me to make the trip with him, and in the end he simply hammered away at my resolve until I gave in. Harry was taking his wife and nineteen year old daughter with him, and they wanted company for the crossing, which they rightly considered the hardest part of the journey. My wife, bless her blackened heart, simply refused to join us, as she refused to do anything not of her own choosing.
We had departed the Connecticut coast and made for Bermuda, and arrived there after a leisurely six days that I will always remember with a certain fondness in my heart for the amount of time that I spent on my knees hurling the contents of my stomach into the sea. I could write volumes on the subtle forms human misery can take when I think about the nausea that hit me that first night at sea, and of the avalanche that followed.
Suffice to say that as Bermuda hove into view I swore I'd jump ship and never set foot on another sailboat for as long as I lived.
That is, until I found out what a same-day purchase, one-way ticket home would cost.
At heart I am frugal, some would say downright cheap. In the end, that's why I - allegedly - stayed onboard and agreed to finish the trip to Gibraltar. The other reason I refuse to talk about publicly. If it must be known, it was because I really enjoyed myself the last four days of that trip in so many ways I can't even begin to relate them all to you. I had never known such peace, or had such fun. Let's just say that Harry's daughter had a lot to do with my decision to remain on board. Could we just leave it at that?
We left Bermuda in mid-May and began the long, hard slog across the Atlantic towards the Azores. Ten days out and as the sun was rising we saw a sailboat ahead; not a few minutes later the young man on this boat tried to hail us on his VHF radio.
"Hello, sailing vessel near three eight zero three north by three eight five eight west, this is the Bolero, over. Sailing vessel near three eight zero three north by three eight five eight west, this is the Bolero, over."
"Bolero, this is the Sea Witch. What can we do for you?" Harry said.
"Ah, Sea Witch, I think I'm pretty sick, could use a hand over here."
That's when Harry sent his wife below to wake me, for you see, I too am a physician. That's also when Harry's wife found me seriously ensconced in her daughter. It was an ugly scene for a couple of minutes, but the exigencies of the moment prevailed.
"Sea Witch, Sea Witch, this is Bolero. You still with me?"
"Ten four, Bolero, stand by one, we have a doctor on board."
"Oh thank God!" came the young man's reply. "I'm going to drop sail; can you head toward my position?"
"Roger, Bolero, we'll be with you in an hour or so."
Jennifer Stinson, Harry's daughter was banished to the forepeak while Harry and Trina ripped into me back in the cockpit. I had violated there trust, Trina yelled, and Harry looked on me with barely concealed contempt. I'd earned it, I knew, but Jennifer was one in a million. I knew I was in love with her. I was willing to forgo everything I owned to be with her forever. I wanted to run away with her, journey to the far ends of the earth with her hand in mine, forever and ever. I had, in short, completely lost my mind.
With these facts firmly in mind, it was with no small amount of regret that as we drew nearer to Bolero it was all too obvious to us that my time on the Sea Witch was drawing rapidly to an unhappy end. When we pulled alongside Bolero, we could see an emaciated young man wallowing in the cockpit, and we could see that he was indeed very, very ill.
Despite the fact that Harry was a lawyer, he still had a few bits of compassion left in his heart, and he immediately took over responsibility for the lad in Bolero.
"Pete, get your medical bag up here, then jump across; we'll stand by while you figure out what we need to do."
A few minutes later and I was on Bolero's deck; I thank God to this day that the water had been calm enough to make the jump without incident. In rough seas we might never have made the transfer. In any event, Bolero was tiny in comparison to the Sea Witch. She was wallowing a bit now that her sail was down, but I hoisted the jib and she steadied up a bit, and tracked again to the east.
I took in David Latham for the first time. He was a sturdy looking fellow, late twenties, but he was sweaty and obviously in a great deal of pain.
"What seems to be the problem," I asked him after a while.
"What kind of doctor are you," he asked me. "Not a shrink or something like that?"
"No, David, I'm an anesthesiologist. A gas-passer."
"Oh? You fart for a living?!" he joked. Always a good sign.
"So, what's wrong, David?"
"My balls hurt."
"I suppose you've tried jacking off, cleared the mechanism, so to speak?"
"No, it's not that. One of 'em hurts real bad, and is as hard as a rock."
"That been going on long?"
"Been a lot of pain down there for a couple of weeks; some shooting pains down there for a, well, maybe six months."
Step back with me here, will you? Imagine this conversation in your mind. Imagine a doctor's office, clean walls, antiseptic smell, a nurse waiting in the hall to draw blood or set up tests. Everything seems nice and orderly in your mind when you think about this conversation David and I were having. Only problem here was that we were in the middle of the Atlantic Ocean, and I was standing in the cockpit of his 34 foot long boat. I had no nurse with me, no tests to offer, and to make matters even more inconclusive, I wasn't a Urologist. What he was describing to me sounded dreadfully like testicular cancer to me, and if he'd been symptomatic for six months - time was of the essence. It could very well be too late.
I hated to ask it of the young man, but I asked if I could feel the offending nut. Often times a testis can get wrapped in cord and swell up, causing immense pain; this usually results in loss of the testis but typically isn't a fatal affair. Some penetrating hernia can flair up and cause pain in the region, but typically in these cases don't present with an enlarged testis. In order to confirm my suspicions, I really needed to, well, get a handle on things.
Anyway, David dropped his drawers and I felt the offending nut. One was normal, soft and pliable, and it's cord was soft, too. The other was larger than a golf ball, and at least as hard. I could feel the cord - stiff and barely flexible for as far up as I could feel it - and I knew this kid was in for a rough ride. I took his temperature while I continued my history. He hadn't been able to hold food down for two days now, and was febrile, so I took him below and made him comfortable, then got on the radio when I got back up in the cockpit.
"What is it, you son of a bitch?"
"This kid's sick, Harry. I mean real sick. Cancer is my guess, and we need to get him to a hospital as soon as we can."
The change in Harry was immediate. "OK, Pete," he said gently. "What do you need from here?"
"I'm going to need to start an IV and get some pain meds in him, so I'm going to need an extra set of hands over here for the ship and to help out with getting him secured. You might want to see if we can get a hold of someone in the Azores, alert them to the situation."
"OK, buddy. I'll send Trina over as soon as she gets the stuff together."
I know I didn't mention that Trina and I had dated a long time ago. She'd been a nurse when I was an intern at Mass General, and she worked to put Harry through law school at Yale. She knew the drill, anyway. Now it was just a matter of her not killing me when I wasn't looking . . .
By mid-afternoon Harry had talked with Radio Azores on his single-side-band radio, and while we were out of helicopter range they advised that we call them the next day and relay our patient's condition. If he was deteriorating, they would come pick him up; if not, they would have medical attention standing by for our arrival at Horta.
Trina and I got an IV working on David Latham, and I slipped him a small dose of morphine when it was apparent to both of us that lesser medications weren't doing the job. As the sun went down I could tell that the kid would have to be airlifted out of here as soon as possible; he was slipping into a deep fever and doubtless had some kind of septicemia working in the area of his groin or thighs, which were now hot and growing rigid. We started a bolus of antibiotics and crossed our fingers.
Sea Witch sailed alongside us during the night, and at first light Harry called Azores Radio and apprised them of the situation. An hour and fifty minutes later we heard a helicopter approaching, and we made ready to transfer Latham to the aircraft.
When the chopper settled in overhead, I was surprised to see a man in orange coveralls descending on the rescue hoist. He discharged static electricity from the rotors while he dropped, than helped us put Latham in the gurney they lowered. The man, who spoke in thickly accented English, then told me he would sail the boat into Horta, and that I was to accompany Latham on the helicopter back to the island.
Conveying this to Harry by radio, we said good bye to one another and he advised they would see me in Horta - most likely the day after tomorrow. I was then hooked up in the hoist and raised into the hovering helicopter. I sat by Latham while he writhed in pain during the ninety minute flight back to Horta.
He kept looking up at me during those tense minutes, thanking me with his eyes. I held his hands from time to time when his eyes were open, then I saw the islands of the Azores slip into view, and I was entranced by their timeless beauty as they grew larger and larger outside my window. The helicopter slipped over the northeast corner of the island and began it's descent into Horta, and we touched down at a Coast Guard pad near the hospital. We loaded Latham into the waiting ambulance and drove the few short blocks to the Hospital da Horta.
A tall, dark eyed woman was waiting for us when we turned onto the hospital grounds.
That was my first memory of seeing Maria Louisa Delasandro. A tall woman, dressed in a white lab coat over a long black dress; her huge black eyes standing in wild contrast to her alabaster skin, her expression almost unreadable at first. She stood in the quiet shadow of the hospital building, looking at us as we turned in that morning with what I mistook as contempt on her face.
She spoke English, of course, probably better than I did. She moved to Latham's side as we pulled his gurney from the ambulance, and she quickly checked his vitals out there on the driveway while I filled her in on my observations?
"You are the physician?" she asked me as I spoke.
"Yes, doctor, I'm an anesthesiologist at Brigham and Women's in Boston."
"Excellent. Our anesthetist is in Lisbon this week. We can put you to work!"
Nothing like a working vacation.
We walked inside and directly to a radiology room, and a nurse with ultrasound equipment in hand was waiting for us. Maria took the hand unit as the nurse doused the area over Latham's groin and upper thighs with surgical jelly. When the machine was ready, Maria ran the wand over the area several times, looking at the screen as she did and nodding from time to time. When she was finished, she ordered an AFP test and called the operating room to book the procedure. She told them that there was an anesthetist on the grounds now, and I heard her tell them that she would ask.
"Ask what?" I said.
"There are about ten cases in need right now, but they are on hold until Doctor Avilas returns. They have asked me to see if you would consent to help out while you are here."
"Well, whatever I can do to help. What about legalities, licensing and the like."
"Ah, yes, You are an American. I forgot. Don't worry about that. We practice medicine here to cure the sick. It isn't a profit making enterprise. And the lawyer, well, he is a friend."
I smiled, nodded understanding, but hated the implicit condemnation of America in her words.
We scrubbed and went into the operating room. Most of the equipment was, by current standards at least, somewhat antiquated, but the procedures used weren't unfamiliar to me. I put Latham under, and after the nurse shaved away his pubic hair, Maria made a four inch long incision just above his penis on the wall of his belly. She retracted the skin and felt for the cord, then pulled the affected testis out of Latham's groin and felt along the cord. She held the swollen gland in her hand and turned it over in the light; theoretically, if it wasn't cancerous she could pop it back in and sow him up and after a few miserable days he would be free to resume a normal life. I looked at the white lesions that covered the orb and knew as well as she did: Latham had a vicious cancer.
"It is hard all the way up," she said to the room. "I was afraid of this." She snipped the cord and clamped it off, then put the shining pink orb into a shallow stainless steel bowl and walked it out of the operating room. It's standard procedure to do this. She was carrying it to the lab, where a waiting pathologist would cold section the testis and the cord to identify the cell types and classify the cancer, and therefore determine how far up the cord it had spread. With that information, a post-op treatment plan could be formulated.
She returned a half hour later.
"All three. Seminoma, teratoma, and granuloma. I'm sure it has spread into the lymph, but without a CT scan there's no way to measure the involvement. I suspect we should wake him and let him regain his strength for a few days. With more information we can decide how to proceed." She nodded to her nurse, "Okay. Let's close now."
I brought Latham out of the ether a little later, when he'd been moved to the hospital's little post-op ward, and I was there when he popped out of his fog.
"Howya doin', shipmate?" I said to him when it was apparent he could talk.
"So. How'd it go?"
"Well, David, you're alive. I'll let the doc tell you what she found."
"Not good, is it?'"
"No, not really, but I don't know the extent of it. She can better fill you in on your options. Right now, you get some rest."
"Am I gonna die, doc?"
"David, we're all going to die. Right now, we're all going to concentrate on getting you better. That's all. That's what you've got to concentrate on."
I smiled at him as he drifted off to sleep . . .
". . . Doctor Patterson? Doctor Patterson? . . ."
I woke with a start. Maria was standing over me.
"Yo!" I felt like I was in residence again, pulling forty-eight hour shifts in the emergency room.
"We have a critical cardiac case flying in right now; can you look over the equipment and see if you have everything you need?"
"Do you have a nurse that speaks English?" I asked hopefully.
"Sister Magdalena is on her way."
I shook myself awake and walked from the Doctor's lounge to the cardiac care/operating room and found the Sister waiting for me. She walked me through the hospitals best equipment - it was surprisingly up to date - and we set about getting the room ready for the arrival of our next patient.