After three days on Christmas Island I take night call. The phone rings at 0045. It’s Henry the Team Leader, Henry the unflappable, Henry who smiles at every reverse, at all bad news.

Henry has the oblong face and slab-shaped skull of the adult who was once a very premature infant. His crooked smiles and wry look – ‘it could be worse’ – sit well on the slopes of that narrow face. Tonight, however, his voice is direct: no smile is audible: “Security is bringing five men in to the clinic who’ve slashed themselves and another man who tried to hang himself.”

“I’m on my way.”

The drive along half known, unmade, unlit roads  takes longer than it should, as I make a number of wrong turns. There is a moon, bright against the island’s dark sky. A black cloud bisects the moon transversely, sitting across its upper half. The black is very black, the white brilliantly silvery. I have never seen a southern hemisphere of moon like this.

When I arrive in the clinic, all cubicles are full. There are the five men who have cut themselves, and not one, but two, who’ve tried to hang.

I don’t know where to look first. I don’t want to look at all.

In the nearest cubicle a man lies flat on his back, his throat livid in the glare of the examination light. He does not move.

I speak, asking his name.

No word, no movement. 

I speak loudly into his ear.

Nothing.

I press my index finger tip hard against his sternum, a really unpleasant experience for a person whose body parts retain their connections with the brain. A person with a broken neck loses such connection.

The really unpleasant stimulus evokes no response. I press harder: no response.

I rest the pulps of my fingers against the inside of his wrist. His heart does not dissimulate: it sends a pulse of blood along the man’s radial artery, at a rate of seventy times a minute. My own heart slows a little.

I try not to look too hard at the man’s throat. The damage here is only skin deep. There are more vital sites elsewhere: I check for damage to the neck vertebrae, assess pupils and reflexes and muscle tone. All are reassuring.

Now the throat is inescapable. It is a horrible thing to see – a human neck skinned at the front. There is little or no bleeding, just a broad scarf of raw red meat, overlying a peeled adam’s apple. It is the neck of a rooster in a slaughterhouse, grotesque, the more so with a good-looking face above it and a normal torso below.

To this delicate bodily junction the detained man applied twisted sheeting, then jumped. There was not sufficient fall to damage neck bones or spinal cord; just enough to skin him.

In the bright light he is a painting, a human still life: on one side his bronze skin sheens; on his shaded parts, it darkens. A stubble bristles on his chin. I think of those drowned at sea; they say the hair and nails keep growing for some days after they die.

My patient’s arms, lightly muscled, lie flaccid at his sides. His legs neither move nor resist movement. I watch his thin torso for rise and fall. A hint of expansion only, unconvincing, inconclusive.

This man is alive. But he does not betray any sign of consciousness. Why?

I look at his file for his SIEV number. The lower the number, the earlier the date of arrival. His is in the low 100’s. He has been waiting here a long time. Tonight was to be the end of his wait.

Now, defeated by life, he is embarrassed to know and be known by us. He lies and pretends his wish had come true. I can make out a faint snoring sound, very soft, almost inaudible. I think of my wife. She maintains she hears sounds like this in our bed.

In the next cubicle, another who has cheated his own noose: his throat flames, an accusation. He too is unresponsive to all stimuli. I tap his knees, his Achilles, his elbows; I am unable to evoke any tendon jerks. I am troubled by this one: what if there is a cervical fracture that we have not detected? We don’t have facilities to x-ray the cervical spine, let alone do an MRI.

I lean over his unmoving body to look again at his pupils. As my little finger and the edge of my hand inadvertently brush the abraded neck, the man jumps: all his limbs move! A happy accident: his spinal cord is very okay.

On their separate couches lie the slashed men. Raised above the neighbouring skin, parallel lines of red glisten and coagulate. The lacerations are multiple, situated on their left arms and the left side of abdomens.

The sole left hander has slashed his right shoulder. A dozen narrow ribbons of his skin lie, oozing slightly, a bloody epaulette. There is insufficient width of skin to accept an anchoring suture. In time he will heal, leaving a grid of ugly scar, an obscure tattoo. All of his cuts are shallow: human meat as sashimi, unrepaired.

One more, one last harmer in this outbreak of harm. The nurse says: “He’s swallowed a razor blade.”

The razors of my acquaintance are large objects, too large to pass safely into the opening of a human throat. This man looks well.

The nurse notices my puzzlement: “The guards give them very small fine blades for shaving. They usually pass all the way through without harm. We’ve x-rayed this bloke. His is safely in his stomach. He’ll get it back in a day or two, I reckon.”

In time, the battle station has been emptied of the skin-wounded. The hanged men will stay here overnight, under observation.

There remains one man, older, silent and red-eyed. I search for the site of his wound. It is too deep to be seen. The weeping man weeps for all he has witnessed, for the sorrow, for his sons. They were all my sons.

I look at his face. O, what a grief looks through his eyes. In his crying, his mouth twists in a tragic smile. His old eyes look into mine. I take his hand, lost for words, and sit down beside him. He gazes into my face as if into a mirror. He shakes his head sadly and presses my hand.

Why is he here? His guards were troubled and decided to bring him to the clinic. His grief overwhelmed them, those large phlegmatic men. It is the guards who seek his sedation, a vicarious remedy for the circumambient pain.

Through an interpreter, I offer him a tablet. I tell him it will help him to sleep. Before the interpreter can translate, the old man shows me again that woeful smile. He has no more tears. He presses my hand. He says: Ta shakour, ta shakour. Thank you, thank you.