The Man Who Wasn't There: Investigations into the Strange New Science of the Self (12 page)

The morning that David was scheduled for surgery I went to meet him and Patrick in their hotel suite. We had flown thousands of miles to be there, in a crowded Asian city. Outside the hotel, the weather was hot and muggy, the traffic heavy. Luxury cars and jalopies jostled for street space alongside buses and two-wheelers. Diesel fumes stung my nostrils. A fetid stream wound its way between high-end hotels and office buildings. Inside the hotel, the wood-paneled suite was air-conditioned, hushed.

I had spent the night thinking about David’s surgery, and all I had felt was anxiety. I imagined the fear that David must be experiencing: fear of surgery, fear of confrontations with family and friends, fear of disability. But that morning David himself showed no such emotions. He said he had moved beyond those worries. Instead, he fretted about the paperwork. Whom should he put down as emergency contacts? Should he divulge their addresses and phone numbers? Patrick suggested putting down the wrong numbers; maybe change a digit or two. “You’ll have to get used to lying,” he said.

Questions kept occurring to me. I asked David if he had been evaluated by a psychiatrist. Usually, Patrick recommended someone for surgery only after a psychiatrist confirmed that he or she was suffering from BIID. David said no. Patrick had used his own judgment in recommending him to the surgeon, saying that he saw himself in David—the same agony, the same mental torture. Plus, David couldn’t afford a psychiatric evaluation. He had to scrape and scrounge and go deeply into debt to come up with the $25,000 needed to cover the surgeon’s fees, the airfare, and ten days of hotel accommodation for two.

Dr. Lee had agreed to the surgery based on Patrick’s recommendation. The two had been working together ever since they met via the
BIID network about six years ago. David was thankful for Dr. Lee’s help. “As you know,” he told me in the hotel room, “I was in a DIY mode, where I was going to hurt myself.” Suddenly, David started sobbing. Patrick consoled him; David apologized. “Every time I talk about hurting myself, it makes me cry,” he said. David again expressed certainty that if the surgery didn’t go through, he would attempt cutting his leg off himself. “I can’t go on any longer.”

The surgeon picked us up in the early afternoon. Given that David’s procedure would require subterfuge to get past hospital staff and nurses, Dr. Lee appeared surprisingly calm. “Have to be,” he replied when I asked him later about his demeanor. “Cannot show the patient that I’m nervous.” He drove us to his house, ushered us into the living room, and asked David to sit down.

Dr. Lee laid out the plan: he would get David admitted to a hospital, saying he needed surgery for a vascular disorder. The unwitting staff would then prepare the patient for an ordinary operation—and then, under the surgical lights, Dr. Lee would say that the leg needed removing and conduct the amputation. Inside, the anesthesiologist and other surgeons would be in on the plan; the nurses would not know.

In his living room, Dr. Lee laid an old garment on the floor, and set David’s foot on it.
Working swiftly, he bandaged the foot, ankle, and calf as a precaution. It wouldn’t do to have curious hospital staff see that the foot was healthy. He wrote the admitting order on his prescription pad and instructed David in the sequence of symptoms he ostensibly had endured over the past few days: pain, followed by some cramping, and eventually numbness. This was for the benefit of the hospital admissions staff. The diagnosis that these symptoms implied would give Dr. Lee the option of amputating during surgery, a
judgment that could not be questioned by anyone who wasn’t in the operating room.

We drove to a small hospital on the outskirts of the city. The high-rise hotels gave way to low-slung buildings and occasional homes with makeshift tin roofs alongside unpaved muddy alleys.
The hospital itself was on a major road lined with an odd assortment of shops: a butcher, a pawnshop, an electronics repair outfit, and a hairdresser who promised safe and effective hair straightening.

Dr. Lee was not on staff at this hospital; like many doctors in private practice he had surgical privileges at a number of different hospitals. He dropped us off outside. David, now on crutches, would have to get past the hospital staff. Would they buy his story? We walked into the emergency room. It was a simple affair. Ten iron-frame beds and mattresses covered with spotless sheets were separated by thick curtains. This was not a high-tech, First-World ER, but it was clean and functional.

A nurse asked David to sit down and asked what was wrong with him. He gave her Dr. Lee’s admitting order. The attending physician, a bespectacled man in a blue-striped shirt with a stethoscope around his neck, took the order and frowned as he read it. He leaned over the counter to take a look at David’s leg. He noted the bandaging and asked if David had suffered an accident. No, said David, and he quietly repeated the sequence of symptoms. The man got up and walked away.

David was subdued. Patrick, wearing his prosthetic leg, appeared to be feeling fine; he had been through this scenario many times. David, beneath his quiet demeanor, was nervous, as was I, even though I was just an observer. My mind raced through all that could go wrong. What if the attending doctor asked more questions? What were the three of us, two of whom were on crutches, doing in this part of the
world? What if they called the police? Then, once David was done filling in the paperwork, a nurse brought him a wheelchair. She inserted a catheter into David’s left hand and hooked it up to an IV bag hanging off of a pole on the wheelchair. She left. I looked at Patrick. “I can’t believe it’s really happening,” he whispered in relief. A male nurse came in, and we got up and followed him as he wheeled David up to his hospital room. They had bought the story.

In the hospital room, we sent the surgeon a text message to say that David had checked in. Dr. Lee told me later that his own nervousness usually sets in the moment he receives that message. Now all was in motion.

As we waited in the hospital room, Patrick started giving David advice about life as a leg amputee. Don’t ever close your eyes when you’re standing without support, he said. You’ll lose balance and topple over. Always carry powerful painkillers: stumbling and landing on your stump can be excruciating.

A nurse came in and informed David that the doctor would operate in a few hours, then left us alone again. We counted the saline drops dripping into David’s veins: about twelve drops per minute. I asked David about his cover story for when he got back home. He said he would tell people at home the story he had told the hospital. Dr. Lee would provide him a full medical report to take back. Patrick recalled his own cover story: he’d picked up a rapidly spreading infection called St. Anthony’s Fire while on vacation; the rampant infection turned the leg gangrenous, leading to the amputation. It had worked well for him. Then Patrick told David to do something one last time, for once the operation was complete, he would never be able to do it again: cross his legs. David did so. It was as if we were mourning an impending loss with a collective moment of silence.

Soon, two male nurses wheeled in a gurney. David lay down on it and he was taken away to surgery. Patrick gave him a thumbs-up. I didn’t know what to say, so I just muttered, “Good luck,” under my breath.

The hospital has gone quiet, and empty benches line the dimly lit corridors. Only the operating room shows signs of activity. David lies on the operating table, anesthetized and oblivious to pain. An overhead surgical lamp illuminates his upper thigh. Dr. Lee picks up a scalpel and makes a long, deep incision precisely where David had requested, in a leg that is athletic, muscular, healthy. The surgeon swiftly cuts through muscle, working hard. He cauterizes the smaller blood vessels as he goes while keeping clear of the large veins, arteries, and nerves. He pulls at the nerves, teases them free of the surrounding muscles, cuts, then lets go. The nerves retract into the soft tissue of the upper thigh like rubber bands. He clamps the large blood vessels, snips them, and ties up the proximal and distal ends, the proximal end three times for peace of mind. The surgery is taking longer than anticipated because the leg is so robust, engorged with blood. Finally, he slips a wire saw under the femur. An assistant presses down on the leg. Dr. Lee begins sawing and soon pulls the saw through the strongest bone in the body. He then attends to the blood vessels, nerves, muscle, and skin on the underside of the bone until the leg is finally detached. It is time to suture. First he sews up the muscles, then the fascia, the strong fibrous tissue surrounding the muscles. Suturing the fascia correctly is critical, because mistakes can lead to muscle herniation, a serious complication. Finally, the surgeon stiches up the skin and the subcutaneous tissues. Where once there was a leg, only a stump remains.

I wasn’t in the operating room that night. But I did walk the empty corridors outside, trying to peer discreetly over the frosted glass panes of the doors leading into the OR. I have thought about the surgery (which Dr. Lee had described to me in detail) many times since. Each time I have felt fear and sadness. Here was a perfectly healthy man with a perfectly healthy leg, yet he went under the knife voluntarily, in a foreign country. He trusted a surgical team that worked under a cloak of deception. How much must a man suffer to come to this: lying by himself on an operating table, attended only by strangers, in a small, obscure hospital thousands of miles from his home in America?

Patrick was asleep when I heard the knock on the door. It was more than three hours since David had been wheeled away. It was a male nurse in surgical robes and rubber gloves. He turned to Patrick and said, “The leg has to be buried as soon as possible.” He needed money to take care of the burial. Patrick handed him some cash. “Do you want to see the leg?” the nurse asked. “It’s already in the box.” Patrick didn’t. The nurse left. “Well, he’s an amp now. I’m glad,” said Patrick. “It’s what he wanted. It’s what he needed.”

Dr. Lee appeared soon after. The surgery went well, he said, though it had taken longer than usual. David was fine and lay asleep in recovery. Dr. Lee offered to give me a ride back to my hotel, and I accepted. During the ride he talked about David’s long operation. “His muscles were well built,” said Dr. Lee. “They contract and they also bleed more. You have to be careful.” Still, there was the satisfaction of a job well done. “What’s fascinating is that you can really see the
transformation,” he said. He meant the change in the demeanor of his BIID patients after surgery. “You’ll notice it tomorrow.”

The next day, I couldn’t wait to get back to the hospital. I bought a bar of bittersweet chocolate for David and hailed a taxi. When we arrived, I walked in through the front door, past the ER, and paused for a moment at the frosted glass doors of the operating room. Then I went to David’s room and knocked on the door. Most patients would be flat on their backs recovering after such a major surgery, but David was sitting up in his bed, his stump heavily bandaged and covered in white gauze. He was still on an IV. Tramadol, a narcotic-like analgesic, was dripping into his veins. He was tethered to a urine bag. He looked tired, but then it was only twelve hours since the operation. I shook his hand and gave him the chocolate. David opened the wrapper, broke off a piece, and began to eat. He sat on the hospital bed as if nothing dramatic had happened the night before. Our conversation eventually wore him out. He fell asleep.