Dr Carriscant was greeted by his secretary Senora Diaz, a small, homely, efficient woman with an unfortunate profusion of facial hair, and glanced through the day's schedule she had prepared for him. The boy with the tumour was already here and prepared. He had time briefly to visit the patients in his ward before he started work.

'Is Dr Quiroga here?' Carriscant asked.

'Yes. He went to the dispensary.'

Pantaleon Quiroga was his anaesthetist and his best friend. He was a young man, in his late twenties, a Filipino – an ilustrado, as the educated classes were known – from southern Luzon who had been educated in Manila and who had studied medicine in Madrid and later Berlin. Like Carriscant he had become enthused with the latest developments in surgical practice and had returned to Manila determined to provide his people with the benefits of medical science. He was not a natural surgeon, however, he lacked the mysterious 'touch', that gift one possessed and that could not be acquired, and it was Carriscant who had persuaded him to concentrate on anaesthesia. Working as a team at the San Jeronimo the two of them had developed an understanding that was unique in Filipino medicine. Because of his training Quiroga could also assist at the more complicated operations if required-it was like having four hands, Carriscant said – and his skill with the chloroform bottle was the equal of any more exalted anaesthetist in Baltimore or Paris, Carriscant maintained.

There was a soft rap at the door and Pantaleon Quiroga came in. He was already wearing his white surgical gown and carried his skullcap in his hand. He was a painfully thin young man and tall, unusually so for a Filipino, a good head higher than Carriscant, with a neat moustache and melancholy eyes. He was unmarried and lived alone (his parents were deceased) outside Intramuros in Santa Cruz, whence he travelled each day by horse tram. Carriscant often found himself wondering what Pantaleon did with his considerable salary and the supplementary fees that were charged on his behalf. He supposed that much of it went back to the family in Southern Luzon -the uncles and aunts, the grandmother, the endless cousins – certainly Pantaleon lived very frugally as a result.

They shook hands warmly, as they did at the beginning of each working day.

'The dough is in the oven,' Pantaleon said. 'Ready to bake.'

'Have I time to do my rounds?'

'I think the poor fellow will have a fit. The sooner the better, you know.'

'Let's go then.' He glanced at Senora Diaz's list on his desk: two amputations – a hand, then a leg at the knee-a strangulated hernia and a vaginal fistula. He could do the amputations before luncheon; the hernia and the fistula would take up the afternoon. He followed Pantaleon's tall frame down the corridor to the preparation room, noticing that the young man's hair was thinning rapidly at the crown. He tried to imagine Pantaleon bald and for some reason the notion filled him with a sharp and sudden sadness. He needed something more in his life, did Pantaleon, something beyond his work at San Jeronimo-a love affair, a fiancee, a wife, a family…

Carriscant removed his coat, put on a freshly laundered white gown, changed his shoes and washed his hands with a powerful carbolic soap before going through into the operating theatre. Here the smell of disinfectant made his eyes tingle as he greeted his nurses, Nurse Santos and Nurse Arrieta, and glanced around the room. The wooden floor was scrubbed to a pale grey, every surface was clean, gleaming and moist. A faint hum emanated from the big electric arc light mounted above the operating table and there was a tinny rattle of instruments vibrating in the steam sterilisers set on tin tables to one side. He took a discreet deep breath: already he could feel that delicious weakening sensation spreading upwards from the soles of his feet, a loosening, a slackening in his bowels, the hairs pricking on the nape of his neck.

The patient was a young Chinese boy, fourteen years old, son of a wealthy merchant from Cavite. He leaned back against the steeply angled table, angled so his tongue could better fall forward, the tumour clearly visible, the size of a small apple, forcing his lips apart, making him look imbecilic. There was sweat on his forehead and his eyes flicked towards Carriscant and then flicked away again.

Carriscant uttered some token words of reassurance and turned to his instruments as Pantaleon fitted the gauze mask over the boy's mouth and nose.

'I see the bridge is down at Jacinto,' Pantaleon said.

'I had terrible trouble getting in this morning,' Nurse Arrieta said, handing Carriscant a scalpel. 'Terrible.'

'You should take a barca to work. Have you got that clamp?'

'I can't see Nurse Santos in a barca,' Pantaleon said. 'She doesn't want to drown before she gets married.'

'Dr Quiroga, do you mind!' Nurse Santos was distinctly portly. There was a lot of banter in the theatre about her size. Everyone laughed. The Chinese boy looked at their grinning mouths and shaking shoulders incomprehensibly.

'Don't fit the mouth wedge before Pantaleon knocks him out.' Carriscant said. 'Do your stuff, Doctor.'

Still chuckling, Pantaleon began to drip chloroform from the calibrated glass drop-bottle on to the gauze mask, holding it upright from time to time to check the reading. When the boy lost consciousness the two nurses held his head forward and forced his jaws apart. Carriscant fitted a clamp just behind the tumour, turned it tight and drew the tongue as far out of the mouth as possible. Nurse Santos took the handle from him, pulling on the tongue firmly. Pantaleon touched the boy's eye to check the lid reflex. He opened the eye with thumb and forefinger: the size of the pupil would tell him to what extent the nervous system was depressed. He nodded his approval.

Carriscant felt his breathing slow and his brain clear as he paused for a moment before changing his scalpel for a smaller one with a long fine blade. After all these years, all these operations, the feeling never altered: his senses felt fresh, newly minted, acutely aware; his consciousness seemed suddenly highly attuned, not simply in an extra appreciation of the physicality of the objects in the room-the spangling glare of chrome, the perfect fan of the boy's eyelashes resting against his lower lid, the frayed cuff of Pantaleon's right sleeve – but also in a preternatural understanding of the other human beings present at this moment. He sensed the unrelenting melancholy in Pantaleon's soul as if it had been his own; he felt the weight and softness of Nurse Santos's breasts pressing against the starched blue cotton of the smock she was wearing; he shared in the weariness of Nurse Arrieta who had been up throughout the night tending to her fractious and incontinent father-in-law… All these emotions, all these sensations were present to him, gifted to him, flowed into his all-encompassing and receptive mind and were logged and acknowledged. I know you all, his silent gaze said to them, I know your suffering humanity, your anxieties, your needs, your itches, your callouses, your aching backs, your tiredness… I know. I understand. I understand everything.

He raised the scalpel, felt its small weight, his eye caught the gleam of its thin bevelled blade. Nurse Santos, unbidden, moved an enamel bowl beneath the boy's chin. With three careful swift strokes Carriscant cut through the fungiform pappillae to the muscle tissue beneath, slicing back at an angle of forty-five degrees towards the throat. Blood welled from the partially severed tongue. Nurse Arrieta applied a swab. He lifted the clamp revealing the underside and he cut again making a lateral fork in the tongue, so that a longer lower flap was formed. The tumour fell dully into the bowl. Nurse Arrieta handed him the needle and gut. Antiseptic fluid was poured over the wound and he sewed the two short flaps of the tongue together.