Over her body once more he quickly foamed up a lather on the shaving soap with the brush and then, with short circular sweeps, he worked the white spumy suds into the wiry curls of her pubic hair. Reflexively he tested the edge of the blade on his thumb before, with four or five firm passes, he shaved away the hair on her mound. He wiped the remaining soap away with a towel and, unable to resist, he placed his hand there a moment, feeling it smooth and cool, until the heat of his palm warmed the skin. He moved his hand inches to the left and, palpating gently, felt the engorged shape of the abscess. He made tiny marks on her skin with a chinagraph pencil to act as a guide – my marks, he thought, my sign – and delineate the area where he would cut. He laid white cloths over her belly and thighs, leaving only the area to be operated on clear, and called the others back in. They said nothing, made no reference to what might have happened in their absence, and took up their positions again.

'Scalpel.'

Carriscant felt the nurse press the slim weighted heel of the knife into his open palm. His fingers closed around it and the sudden terror that sluiced through him almost made him stagger with alarm. In all his years as a surgeon, all the hundreds of times he had stood poised with a knife above a living human being, he had felt nothing but the elation of the job he was about to do. This bowel-loosening anguish was shockingly unfamiliar. He felt a tremor in his hands as he laid them on her taut flushed belly. What was happening to him? Where was this awful fear, this uncertainty coming from?

He forced the curved blade to indent the flesh, just above Poupart's ligament on the right side, and forced himself to apply more pressure until it bit through the epidermis and the blood came. He drew the knife across, making a cut of about six inches, revealing the blood-flecked fatty tissue and then the nacreous surface of the peritoneum, like a soft red-veined yellow marble. Here was the moment: another cut and the abdominal cavity was exposed. He widened the opening and then reached down with his finger and pushed it into her body to find the appendix. He located it, now enlarged to a swollen suppurating abscess, and drew it gently out of the body. He inserted a rubber tube into the cavity it left and drained the fluid out. The nurses swabbed and cleaned. He tied off the appendix from the caecum and cut it free. He closed the wound and stitched it, dressing the cut with iodoform gauze.

He stepped back and looked at the clock on the wall – only thirty-five minutes had passed. He felt exhausted, ruined. He washed his hands and moved through in a daze to the dressing room. He sat in a chair, elbows on his knees, head hanging, watching the sweat drops fall from his nose on to the hexagonal tiles beneath his feet. He heard Pantaleon come in and felt his reassuring squeeze on his shoulder.

'Very successful,' Pantaleon said. 'I think we had an hour or two to spare.'

'I'd better see Sieverance.'

He changed his clothes and went through to his consulting room where Sieverance was waiting and told him that the operation was over and seemed to have passed off well. To his alarm and embarrassment, Sieverance collapsed in his arms, in a kind of weeping swoon and had to be revived with a small glass of brandy.

'It's all right,' Carriscant said to him. 'It's over. It went well. I'm sure she'll be fine.'

Sieverance clung to him, fingers clutching his biceps, like a drowning man just hauled from the water.

'Bless you, Carriscant,' he said. 'Bless you, I'll never forget this.'

Carriscant said something to him, something bland and consolatory, knowing that there was a double dose of truth in Sieverance's affirmation. He would never forget, that was for sure, as it was also for sure that he would never cease to regret, either.

Salvador Carriscant stared at the interleaved fingers of his hands, trying to pray, contemplating the horizontal and vertical creases on his knuckles, each one unique and different, like Chinese ideograms scored in the loose flesh above the fingerbones. Why should that be, he wondered, idly? The first joint, say, of my left little finger moves identically to the right joint, yet the creased flesh on the left forms a distinct starburst effect, whereas on the right – He raised his eyes, to the nape of the man's neck bowed in the pew in front of him. Collar too tight, small canopies of flesh overlapping on either side. Hair growing right down the neck too. No. Rather growing up, from his back. How far down should the barber trim? Kindly remove your shirt, sir. He looked back at his prayer-clasped hands: the skin between the finger joints with their small neat patches of hair, almost tended-looking, all growing in the same direction. Densest on the ring finger, curiously, wonder if that's true of other men? Liver spot on his hand-back. Or a big freckle, maybe?

He thought at once of the freckles on Delphine Sieverance's forearm, upon and over which his eyes had rested and travelled as he had taken her pulse the day before. Freckles at her throat too, at the top of her chest and the tender indentations of the collarbone. How far down did they go, he asked himself. Would her breasts and shoulders be dappled with pigment, like a trout, like some hen's eggs you see, a light shading? There were none on her belly, none on her- He closed his eyes as the priest invited the congregation to join him in prayer. Carriscant moved his lips and felt a sound blurt from his chest, half moan of longing, half frustrated grunt of pain. Annaliese nudged him sharply with her elbow and he looked round at her, his eyes full of pious apology, and he tapped his chest and made a face as if he had indigestion.

'… tibi Domine commendamus animam famuli tui, ut de-functum saeculo, tibi vivat… '

'Amen,' he managed to say.

The congregation gathered on the steps of the Santa Clara church while they waited for their carriages to arrive. Annaliese chatted with acquaintances while Carriscant stood alone, hands behind his back, head down, the toe of his shoe tapping out a rhythm on the cracked marble steps. He exhaled and put on a smile for a Spanish family that he vaguely knew – a man helping his ancient, lace-shrouded mother-in-law down the shallow steps to the waiting victoria. Her face was white and dull, matt with face powder. How old? Somewhere in her eighties. What changes she had witnessed! If she looked to her right she could see the big Stars and Stripes flying over Fort Santiago; to her left the Plaza Mayor, now renamed Plaza McKinley in honour of the assassinated president. Sixty years ago, when she was a haughty young peninsulara such notions, such transformations, would have seemed beyond the bounds of wildest fantasy. She was settled delicately in the little carriage now and some granddaughters climbed in beside her. She looked straight ahead, squid-black eyes moist and unforgiving. How much more of this new century would she see, he wondered? Probably ready to go now, keen. It happens. The body tires, the mind senses its fatigue: ready to go.

He was still pondering this question as he and Annaliese sat side by side in their carriage as they were driven down Calle Palacio towards their house. Annaliese was relating some article of gossip which he was barely registering. The carriage had to make a detour up Calle da Ando as the Americans were digging up a cobblestoned stretch of Palacio in order to macadamise the street. They turned left and as they crossed the Calle Real he suddenly told Constancio, the coachman, to stop.

'Where are you going?' Annaliese said in surprise as he opened the small door at his side.

'The hospital. As we're so close. It occurred to me that there's a patient I must see. I operated yesterday. I'm a little concerned.'