"Mortal Lessons: Notes on the Art of Surgery" Richard Selzer
"On the bulletin board in the front hall of the hospital where I work, there appeared an
announcement. "Yeshi Dhonden", it read, "will make rounds at six o'clock on the mor-
ning of June 10." The particulars were then given, followed by a notation: "Yeshi Dhonden is Personal Physician to the Dalai Lama." I am not so leathery a skeptic that I would not knowingly ignore an emissary from the gods. Not only might such sang-froid
be inimical to one's earthly well-being, it could take care of eternity as well. Thus, on the morning of June 10, I join the clutch of whitecoats waiting in the small conference room adjacent to the ward selected for the rounds. The air in the room is heavy with ill-concealed dubiety and suspicion of bamboozlement. At precisely six o'clock, he mat-erializes, a short, golden, barrelly man dressed in a sleeveless robe of saffron and mar-
oon. His scalp is shaven, and the only visible hair is a scanty black line over each hood-
He bows in greeting while the young interpreter makes the introduction. Yeshi Dhonden
, we are told, will examine a patient selected by a member of the staff. The diagnosis is as unknown to Yeshi Dhonden as it is to us. The examination of the patient will take place in our presence, after which we will reconvene in the conference room where Yeshi Dhonden will discuss the case. We are further informed that for the past two hours Yeshi Dhonden has purified himself by bathing, fasting, and prayer. I, having breakfasted well, performed only the most desultory of ablutions, and given no thought at all to my soul, glance furtively at my fellows. Suddenly, we seem a soiled, uncouth lot.
THe patient had been awaken early and told that she was to be examined by a foreign doctor, and had been asked to produce a fresh specimen of urine, so when we enter her
room, the woman shows no surprise. She has long ago taken on that mixture of compli-ance and resignation that is the facies of chronic illness. This was to be but another in an endless series of tests and examinations. Yeshi Dhonden steps to the bedside while the others stand apart, watching. For a long time he gazes at the woman, favoring no part of her body with his eyes, but seeming to fix his glance at a place just above her
supine form. I, too, study her. No physical sign nor obvious symptom gives a clue to the nature of her disease.
At last he takes her hand, raising it in both of his own. Now he bends over the bed in a kind of crouching stance, his head drawn down into the collar of his robe. His eyes are closed as he feels for her pulse. In a moment he has found the spot, and for the next half-hour he remains thus, suspended above the patient like some exotic golden bird with folded wings, holding the pulse of the woman beneath his fingers, cradling her hand in his. All the power of the man seems to have been drawn down into this one purpose. It is palpation of the pulse raised to the status of ritual. From the foot of the bed, where I stand, it is as though he and the patient have entered a special place of
isolation, of apartness, about which a vacancy hovers, and across which no violation is possible. After a moment the woman rests back upon her pillow. From time to time, she raises her head to look at the strange figure above her, then sinks back once more. I cannot see their hands joined in a correspondence that is exclusive, intimate, his fin-gers receiving the voice of her sick body through the rhythm and throb she offers at her wrist. All at once I am envious - not of him, not of Yeshi Dhonden for his gift of beauty and holiness, but of her. I want to be held like that, touched so, received. And I know that I, who have palpitated a hundred thousand pulses, have not felt a single one.
At last Yeshi Dhonden straightens, gently places the woman's hand upon the bed, and
steps back. The interpreter produces a small wooden bowl and two sticks. Yeshi Dhon-
den pours a portion of the urine specimen into the bowl, and proceeds to whip the liquid with the two sticks. This he does for several minutes until a foam is raised. Then, bowing above the bowl, he inhales the odor three times. He sets down the bowl and turns to leave. All this while, he has not uttered a single word. As he nears the door, the woman raises her head and calls out to him in a voice at once urgent and se-rene. "Thank you, doctor", she says, and touches with her other hand the place he had
held onto her wrist, as though to recapture something that had visited there. Yeshi
Dhonden turns back for a moment to gaze at her, then steps into the corridor. Rounds are at an end.
We are seated once more in the conference room. Yeshi Dhonden speaks now for the first time, in soft Tibetan sounds that I have never heard before. He had barely begun when the young interpreter begins to translate, the two voices continuing in tandem - a biblical fugue, the one chasing the other. It is like the chanting of monks. He speaks of winds coursing through the body of the woman, currents that break against barriers, eddying. These vortices are in her blood, he says. The last spendings of an imperfect heart. Between the chambers of her heart, long, long before she was born, a wind had come and blown open a deep gate that must never be opened. Through it charge the full waters of her river, as the mountain stream cascades in the springtime, battering, knocking loose the land, and flooding her breath. Thus he speaks, and is silent.
"May we now have the diagnosis?" a professor asks.
The host of these rounds, the man who knows, answers.
"Congenital heart disease", he says. "Interventricular septal defect, with
resultant heart failure."
A gateway in the heart, I think. That must not be opened. Through it charge the full
waters that flood her breath. So! Here then is the doctor listening to the sounds of the body to which the rest of us are deaf. He is more than doctor. He is priest."