Once the attendant had given assurances that he would take them to Artyom’s father, Maksim said his good-byes and wished them luck. He slipped some money into Artyom’s mother’s hand, but she refused to take it. They struggled for a few moments, grasping each other’s wrists, and Maksim kept saying, “Please,” even though he was the one leaving the money and, eventually, Artyom’s mother relented. He left them his phone number. “Please. You’ve no one to look after you. If you need help, I’ll help,” and walked out the door. Each one of them called out their thanks, but he batted it away, kept his head down.
In the corridor on the third floor the attendant introduced them to the nurse. She took Artyom’s mother aside and spoke to her quietly. As their conversation continued, Artyom watched his mother edge away from her, palms raised, as if she had just walked into the cage of a wild animal.
He heard the woman say, “His skull is compromised.”
He heard the woman say, “His central nervous system is compromised.”
Sofya heard it too.
Artyom asked Sofya, “Compromised from what?”
Sofya wouldn’t reply.
Compromise. Isn’t that something you do when you can’t agree? How can a skull be compromised?
They walked into the room, and everything was much better than Artyom expected it to be. His father was sitting on the bed, playing cards with men they knew: some of their neighbours—Yuri Polovinkin, Gennady Karbalevich, Eduard Demenev. It was surreal to see them all sitting here, as if they were at home, chatting after a meal, whiling away the hours before sleep.
Artyom’s father looked up and saw them enter, and Artyom noticed his eyes flare, his pupils expand. He thought his father might drop the cards in his hand, his muscles going slack with surprise.
He turned to the other men. “I’m in trouble now.”
The men laughed.
He embraced each of them, wrapping his arms around them, pressing their bodies into his. And even though the nurse advised against it, they didn’t hesitate to touch him. How could they? And Artyom’s mother didn’t scold. But when they turned around and faced the other men, there was an odd force in the air, a wariness. They didn’t volunteer to come forward, they just nodded. The men, for their part, stayed withdrawn.
Artyom’s father was wearing pajamas that were too small for him; they rode up his arms and legs, clung to his chest. It made him look like a small boy who had grown magically overnight.
IN THE STERILIZING ROOM, Grigory stands in front of the sink, surgical hat tied in a knot at the back of his head, goggles and thyroid collar on, and cleans under his nails with a plastic disposable pick. He has long, deft fingers, disproportionate to his short palm. When he’s satisfied, he takes the scrub to his hands, lather forming around his knuckles. Five, six operations a day and still he feels the absence of his wedding ring, nothing to place on the steel shelf in front of him; instead it lies abandoned in the upper drawer of his bedside locker, back there in his city. He works the tap with his elbows and rinses his hands, seeing the skin emerge sleek from under the foam and backs into the operating room, holding his hands up, palms facing him, the nurse helping him to slip on the gown and gloves.
His team is already gathered around the bed. An infant, three weeks old, lies on the operating table, dwarfed under a surgical blanket.
Grigory looks at the tiny girl, her eyes peacefully closed, her neck hardly bigger than his wrist. A human life in its most vulnerable state: a shallow-breathing infant resting on a narrow ledge between the twin precipices of birth and death. An urge rises in him to touch the child in reassurance, let her feel the warm hand under his glove, but he looks away from the peaceful face, from the flickering eyelids, turns his concentration to her beating chest.
The child has a congenital heart disease, truncus arteriosus—rare everywhere but here—her aorta and coronary and pulmonary arteries all emerging from a single stalk. A complicated operation; one that will take hours. He’ll have to separate the pulmonary arteries from the aortic trunk and patch any defects that emerge, then close two ventricular septal defects, holes in the walls between the two lower chambers of the heart. Lastly he will place a connection between the right ventricle and the pulmonary arteries.
They have a single cardiopulmonary bypass machine in the clinic—continuously in use due to the sheer numbers of surgeries they are required to perform—into which they will divert her blood.
He takes the scalpel and rotates the handle in his fingers, readying himself. He presses into and pierces the small chest, feeling the skin give way. He holds back the fragile ribs with a clamp, then inserts a thin tube into the femoral vein to withdraw blood from the body, passing it through the machine to be filtered, cooled, oxygenated, and returned by way of the artery. Through the magnifying lenses that sit on top of his goggles, he can see her quivering heart, light purple, carrying on in its dutiful rhythm. So tiny, half the size of his fist.
They work at a pace now, other hands contributing, entering and exiting his line of sight. Grigory hears no sound, not the bleep of the CBM machine nor the mutterings of his team, the suction of the vacuum pump that the junior registrar uses to keep the area clean. This is the stage when he functions only by vision and touch. These are the moments for which he is respected, for which all his silences, his distance, are forgiven him by his subordinates. They too understand the demands of the work, many of them running on false energy, anything to get them through. Grigory has noticed an attendant or a nurse move swiftly the few times he’s entered the storage room they use as a dispensary. He is beyond asking questions. Medical supplies are one of the few things they have in sufficient quantity, and his theatre runs flawlessly. Everything else is outside his concern.
If the team need to communicate with him, they wave a finger in the periphery of his visual field and, on the few occasions they do this, he looks up, taking a brief moment to locate himself in his surroundings, sound streaming back in, a sensation that reminds him of emerging from the swimming pool. He stops only to drink from a straw that the nurse holds close, attuned to his signals, or to communicate with his staff, no more than a few fragmented sentences. He works steadily throughout, neither too confident nor overly tentative. He has to feel his way through, let his thoughts merely drift along the surface of his mind. Hours in this state of intensity.
Sweat trails down the ridge of his skewed spine. He hasn’t had a swim in six months, and this is taking its toll, his scoliosis asserting its grip on him in the hours before bed, so that most nights he can be found lying twisted on the floor of his room, contorting his body at various angles, breathing deeply, waiting for his muscles to relent. Quick spasms dart their way up his back, but he ignores them. The pain can come later.
Nearing the end, he sews Gore-Tex patches into the septum holes, secreting them inside the lining of the heart, where they will expand as the organ grows, if it does grow.
When he is finished, he can put down his instruments and look at her again. Perhaps she will live, he thinks. Perhaps there is no radiation stealthily making its way through the long grass of her metabolism. These infants, to him, are flickering flames in the midst of so much darkness, so much extinguished hope. He wants to cup his hands around them, protect them from the pervading winds.
His junior closes up, and Grigory walks into the afternoon sunlight, discarding his surgical wear into the appointed basket as he goes. Outside, he bends over, hands on his knees, and takes in great gulps of fresh air, free now of responsibility, however temporarily.