The Art of Sewing and Curing

Of all the ironies my sentence obliges me to board with, the roundest is this: the Holy Office, having weighed my life, condemned me to a hospital. There are men at that tribunal who believe themselves subtle. Not one of them, I promise you, saw the shape of what they did — that they sentenced a man to the scene of his conversion. I first learned the wards as a volunteer in Madrid; I serve them now as a penitent in Toledo; and between those two hospitals runs the entire road of my rising, which tonight's ink must now walk. It is the chapter I have waited for, I confess it. Every man likes best the page where he becomes himself.

I came to Madrid in the year '75 or '76 — a tailor still, following the court as every trade follows it, for where the King sets his table the crumbs are architectural. Understand what Madrid was in those years: a town lately promoted beyond its wardrobe, a building site with a monarchy attached — scaffolds and mud and money, whole streets going up raw, carts of dressed stone arguing with carts of cabbages in gates never built for either, and packed into every finished and half-finished room a nation of men from every kingdom of Spain who had come to be nearer the sun: clerks, place-hunters, soldiers between wars, widows with lawsuits, Genoese with ledgers, and trades, trades, trades — everyone in that city was selling something to someone newly arrived, and half of what was sold was appearance. For appearance, legs; for legs, hose. Stockings sold themselves. A calcetero of my quality did not seek custom in Madrid; he defended himself against it. Within a year I had a bench, a room above it, credit with the wool merchants, and the first fixed address of my adult life — and it was there, of all places, in the fat of my first comfort, that the trouble began. For the want I had carried down from the Alpujarras did not fade with the war, as honest wants are supposed to. It sat in me like a retained ball, aching in cold weather. I would finish a gentleman's hose and find my mind still standing in that mountain lee, holding a man's arm steady for the barber, quiet in my hands. Comfort — I say this now as a diagnostician — was not the cure of that ache but the first symptom of its next stage: a man only hears what he lacks when the noise of need stops.

The man who lanced the matter was a surgeon of Valencia. I will not name him — the record does not, and I have explained this account's policy on the names of the innocent — but I will describe him, because he deserves the ink: a man neither young nor old, built like a wine barrel with forearms, with a laugh like a bone-saw and hands I would put against any doctor's in the two Castiles; a man who had cut on galleys and in sieges and in the beds of the great, and had settled at last into Madrid practice the way a ship settles into harbor, still creaking of the weather it had been in. He took his wine at the tavern where I took mine, and we knew each other the way tavern regulars know each other, by bench and by nod, until the night of the carter.

It was a Madrid night like the rest — the tavern loud, the street louder — and then the street came indoors: a carter, young, drunk exactly enough, had gone under his own wheel in the lane, and the wheel had opened his scalp from crown to ear, and his friends carried him in roaring, because a scalp bleeds like a slaughter and every man in the room but two believed he was watching a death. The two were the Valencian, who kept his bench and his cup and watched over the rim with a professional's serenity, and me. I did not decide; I was moving before deciding, the war's grammar — pressure, wine for washing since wine was nearest, the wound's edges read with my fingers through the blood the way you read a seam through pile. Somebody's needle-case was in my pack because it was always in my pack, and silk, hosier's silk, waxed; and I put the carter's scalp back together on the tavern table by lamplight, eleven years of seams and two years of war in every stitch, some soul holding a candle so close it singed my hair, the room gone church-quiet the way rooms do around work. The carter lived to be carried home cursing, which in his trade is convalescence. And the Valencian came over to the table as I was washing my hands in what remained of the washing-wine, looked at the work, looked at me, and said the sentence that reset my course. I do not put quotations into living mouths, but the sense of it has governed my life: that the scalp was the best-sewn wound he had seen that year, and that it was a scandal before God for such hands to be wasted on the vanity of calves.

He took me on in the manner of those years — no articles, no guild, a man teaching a man in exchange for labor and company. What he taught was el arte de coser y curar, the art of sewing and curing, and I ask you to sit a moment with that phrase as I first sat with it. Sewing. The noble half of medicine belonged to the physicians, the lettered men, the Latin men, who diagnose from the pulse and the flask and would not touch a wound with their own fingers on a wager; but surgery, the craft I was entering by the servants' door, was in its very name a needle trade. I had been in training for it since Granada without knowing the syllabus. Cloth had taught me tension, bias, the behavior of edges, the reading of material through the fingers; the loom had taught me what happens when a flaw is carried forward; the war had taught me the material itself; bodies I had been measuring for twenty years. He showed me wounds and I saw seams. He showed me a fracture and I saw a botched hem to be picked out and laid straight. He showed me a fistula — attend, old soldier, three beds down, this is your provenance — and I saw what every needlewoman knows, that a channel wrongly healed must be opened before it can close true. I do not say the learning was quick; flesh forgives less than wool, and its thread is in Someone Else's keeping, and between the tavern night and my licence lay years. But it was learning with the grain of me, the first apprenticeship of my life that asked me to become more of what I was rather than less.

His teaching had a shape I have kept and use on the young barbers here, so let me enter it as method, for it was the best schooling I ever had from a living man. First you watch, and you are questioned on what you saw — not what he did; what you saw, which is a different examination entirely and reveals to most men for the first time that they are blind. Then you assist, and the questions run backward: why did I clamp there, why wine and not oil here, why did I stop. Then you do, with his eyes on your hands and his silence getting longer as your work got worthier — I have told you what his best silence was; I hunted that silence for three years the way other men hunt gold. And throughout, one law, delivered the first week over wine and never once relaxed: the patient is not the wound. The wound is on a man, the man is in a life, and the surgeon who forgets it will do correct work on despairing flesh and lose patients arithmetic says he should have kept. The physicians mocked such talk as barber's philosophy. I have buried fewer patients than the physicians, and I decline to argue the point further than that.

Two schools ran side by side, for days belonged to him and to the bench that still fed me, and nights belonged to the letters. I must give the letters their own passage, for of all my possessions they are the one I earned strangest and prize first. Letters came to me late — how and where is a small story, and I had meant to keep it, but no, this table has no patience for coyness: I learned as I learned everything, sideways, in service and on roads — a priest's housekeeper in one town who traded alphabet for mending; a printed ballad-sheet carried in my pack for a year, spelled out syllable by syllable at fairs until the ballad and I knew each other by heart and I could hang the sounds on the shapes; then a primer bought whole in Seville with the hems' money, the single most extravagant purchase of my life to that date and the shrewdest. I remember to the hour the evening the words stood still — when the labor of decoding fell away between one line and the next and the page simply spoke, the way a language you are drowning in one year is suddenly the water you swim in the next. I sat very quietly with the candle going, understanding what I had picked: the one lock in Spain behind which they keep everything. A woman-born, marked, mulata child of an owned mother, and there would sit — a few years on, in a rented Madrid room — Guy de Chauliac open on my knee, the great Chirurgia in its Castilian dress, taking instruction from the dead as though I had papers. No porter at any door of learning to look at my chin. The dead are the one faculty that admits everybody.

I began to buy books before I could well afford them and never afterward stopped. Volume by volume, candle by candle, I assembled a library that would one day astonish better-born men than me — the surgeries first, Chauliac and the moderns, then the anatomies as they could be had, then whatever the shops of the Calle de Santiago would yield of the ancients in translation, Pliny among them, in whose crowded cabinet of the world's wonders I found, one evening I have entered elsewhere in this book, my own drawer. Sewn quires bound in skins; even the books, I always noted, were needlework and surgery agreeing with each other. When, later, the Holy Office sequestered my goods, it was the library I grieved — not the plate, not the wool — and if some fiscal's nephew is tonight misreading my Chauliac by a good fire, I hope the margins bite him. I annotated, reader. Late, hungrily, in a hand taught by ballad-sheets — and there is my whole scholarship: a man who came to the feast through the kitchen and never learned to eat slowly.

The third school was the wards. The Hospital de la Corte took willing hands the way armies take recruits, examining chiefly the willingness — the court's own house for its sick, and beyond it the general misery of a city growing faster than its drains; plague seasons least of all could a pair of exact hands go unemployed. The wards taught what no master can and no book pretends to: the smell that says a wound has turned before the eye knows it; the particular silence of a man who has decided to die, which must be interrupted early or not at all — I learned to hear it across a room, I heard it three beds down two winters ago and talked half a night against it, and the old soldier is alive tonight to snore at my chapter, which is the only rebuttal death respects; the management of the dying's relatives, which is surgery of another kind, performed without instruments on the standing; and the great leveling fact of the wards, which the palaces of Madrid never learn, that misery is one nation. Rank comes off with the shirt. Under it every man is the same three questions — will it hurt, will I mend, will someone stay — and the answerer who has himself been poor, marked, frightened, and nobody holds, I found, a licence for that work no Protomedicato issues.

In time — years of this, bench and master and text and ward — I hung out my own sign, and Madrid, which examines nothing it can assume, assumed me. Patients came, were mended, sent their cousins. The bench's earnings turned to instruments and books; the tailoring thinned to the fine work I kept for pleasure and for certain old customers who would not be reassigned; and I was, by the middle of the decade, that ordinary prodigy of growing towns, a man practicing his way into a profession sideways while the profession looked elsewhere. It could not look elsewhere forever. Prosperity is the one symptom your rivals never fail to detect.

The accusation, when it came, was correct. I want that entered with the date-line of honesty this whole book claims: certain surgeons of the city denounced me for intrusismo — practicing the art without licence or examination — and as charges against me go, this one was true. I had no paper. I had a dead Frenchman's book, a living Valencian's silences, a war, a thousand ward nights, and hands the accusers' own patients had begun to prefer, which was of course the true bill of indictment; no man denounces an incompetent rival, incompetence being the best neighbor competence ever had. There was a day of genuine cold reckoning — I have never pretended otherwise at this table. The old road stood open, as it always stood: decamp, one town ahead of the writ, as the marked and the mothered-by-slaves are expected to; the hems knew the drill; the feet knew it. And I stood in my room above the bench with the summons in my hand, among my books and my instruments and my seven years of Madrid, and I found that the man who had been assembled in that room out of all the foregoing chapters would not pack. Running is a young trade, and I had changed trades. Let it be said plainly, since the fiscal later made my whole life a flight: the one time flight was the professional counsel, I rode toward the examiners.

To Cuenca, then, where the Protomedicato's examiners were to be had — the crown's own tribunal over the healing trades, empowered to test, to licence, and to bar. The road up from Madrid climbs into stonier and stonier country until the town itself appears, hung over its gorges like washing between two lines, and I had three days of riding to rehearse being examined, an art, the reader now knows, in which I was extensively practiced — though never before, mark, in a matter where I wanted the examiners to look closely. That inversion kept me company all the way up the gorge road, grinning at me like a traveling companion with news it would not tell.

Set the scene fully, for I mean this page to be read twice. A board of the King's examiners, Latin-lettered, robed, empowered; before them a smooth-chinned surgeon of no university, no lineage he cared to elaborate, and a face that asked all the usual questions. They could not have known what they were to me. Or rather: what they were was exactly what every tribunal of my life has been, a row of eyes weighing an unlikely body — but this tribunal, alone in the series, was obliged by its office to weigh the hands as well. They put their questions. Anatomy, first, the bones and vessels named in order like a muster; then wounds and their accidents — what proud flesh is, and how managed; when a wound may be closed at once and when it must be kept open against corruption, and how you know, and what you smell; fractures simple and compound, and the compound's dangers, which I had from the war before any book confirmed them; ulcers, apostemas, the stone — I told them honestly what I would and would not undertake alone, and where I would call the physician, and I have said already what that particular honesty buys, and it buys the same from examining boards. Where the book and the ward disagreed I said so, and defended the ward, which I am told is either the best or the worst thing a candidate can do depending on the board; this board, God keep every one of them, was of the better kind — working examiners, men who had smelled wounds themselves, and once or twice in the questioning I caught the flicker that passes between tradesmen over the heads of the theory, the freemasonry of people who have actually done the thing. Then the demonstration — there was commonly a demonstration, and mine had been preparing for thirty years: sutures on the board's chosen subject, bandaging, the reduction of a dislocation described and mimed to their satisfaction, my needle-case opened and discussed like a relic, which in a sense it was. And at the end, the wait in a cold corridor, which I will not pretend was nothing; I had waited in corridors before and have waited in worse since, but no wait of my life has weighed like that one, because no other verdict, fair or foul, was ever going to be about the hands alone.

They passed me. In the latter part of '77, as I reckon it — the year has been variously reported, like everything of mine, but late '77 is my own count and I was there — the royal Protomedicato examined Eleno de Céspedes and found him fit, and licensed him to practice the art of surgery in the King's dominions; and a second, humbler licence besides, for bleeding and purging, the barber's daily bread, which I took without embarrassment, grandeur being a luxury of men with pedigrees to protect. I rode out of Cuenca with both papers on my body, and I will confess at this table what I have confessed nowhere else: on an empty stretch of that gorge road I stopped the horse and took the licence out and read it through twice, aloud, to an audience of rocks. The muster roll had taken my word. This was another order of instrument entirely. This was the crown of Castile, upon examination, certifying in ink what I was — a surgeon; licit; Eleno — for presentation to whom it might concern. The child written into other people's registers had ridden to Cuenca and come back with a register of his own. That the same crown's Holy Office would one day file a contrary opinion, at greater length and without examining my stitching once, belongs to a later chapter; tonight I choose to remain on the Cuenca road a while longer, reading my name to the rocks, and the rocks, reader, raised no objection, and I have preferred their jurisprudence ever since.

The decade that followed was the plainest and best of my life, and plainness makes short entries, which is the injustice of ledgers; so I will spend a little longer than the matter strictly needs, as a man lingers over the one season the weather was kind. I practiced first in Madrid, then — the city's rents and rivalries encouraging a wider parish — through the corridor between the capital and Toledo, settling at last into the towns of that road: Yepes, Ocaña, market country, olive and vine, close enough to both cities for hard cases to find me and far enough for a man to be esteemed by neighbors rather than inspected by them. What is a country surgeon's decade? It is harvest fractures, wheels and hooves and the fury of mules; fevers after the floods and quartans after the harvest; a carter under his own load at dusk — always carters; God made carters to keep surgeons humble and fed — and the lantern-lit ride out, the kitchen-table theater, the household holding candles in a ring of faces you must govern as surely as the wound. It is teeth, tumors, sutures, splints, the stone diagnosed and referred, childbeds — yes, that art too; the country surgeon does what is nearest, and I brought children into the world with these hands, reader, and I will let you sit with everything that sentence carries, as I sat with it some nights, riding home at dawn. It is the same faces mending year over year, the same children I had splinted pointing me out at fairs to smaller children as the man who sewed their father. Doctors of physic consulted with me and did not condescend more than doctors must. The alcaldes of two towns had my stitching under their shirts. When, later, the fiscal wanted witnesses to the man I had been in those years, the countryside sent them up by the dozen — doctors, patients, neighbors, men of standing — and under oath, in that terrible room, with everything to lose by kindness, they testified with one voice to the thing I had actually been: a competent surgeon and a man of good standing among them. Not one had ever looked at me twice. I had built, at last, out of licences and mended bones and ten years of ordinary mornings, the estate I had walked out of Jerez to find. I was an assumption. God keep you, reader, from learning at whose pleasure assumptions hold.

The candle knows the hour better than I do, and the bled man in the far ward will want looking at before I lie down, and tomorrow the boy with the arm returns to have his splint judged. Let the decade rest at its high-water mark, then: the surgeon of Yepes at forty, propertied in skill, papered by the crown, welcome at respectable tables, his library on its shelf and his horse in its stall and his name — his own name, taken at his own word, confirmed by examination — good across two towns and the road between. It wants only one thing to be a life, says the world to every such man at every such table, and the world means a wife; and for once the world and my own heart were in perfect, fatal agreement. She was of Ciempozuelos, south of Madrid — an artisan's daughter, with about twenty-four years to my about forty. Her name was María del Caño, and she is the next chapter, and I find I must sharpen the quill before I write her, and not only the quill.