The intellect of man is forced to choose perfection of the life, or of the work, And if it take the second must refuse A heavenly mansion, raging in the dark.
William Yeats, “The Choice”
CAPTAIN GETACHEW SELASSIE—no relation to the Emperor— piloted the East African Airways 707 that flew me out of Nairobi. I heard his calm voice twice during the abbreviated night. I had a new respect for his line of work, which brought him closer to God than any cleric. He was the first of three pilots who carried me through nine time zones.
Rome.
London.
New York.
THE RITUAL OF IMMIGRATION and baggage claim at Kennedy Airport went by so quickly that I wondered if I'd missed it. Where were the armed soldiers? The dogs? The long lines? The body searches? Where were the tables where your luggage was laid open and a knife taken to the lining? I passed into marbled hallways, up and then down escalators and into a cavernous receiving area which, even with two planes disgorging passengers, looked half empty. There was no one to herd us from one spot to the next.
Before I knew it, I was out of the sterile, hushed incubator of Customs. The automatic doors swished shut behind me as if to seal out the contamination of the cacophonous crowd outside, held back by a metal barrier.
A Ghanaian woman, whose flowered gown and headcloth had made her look so regal when she boarded in Nairobi, walked out from Customs beside me. We were both exhausted, dazed, unprepared for the sea of faces scrutinizing us. We stood there, manila X-ray folders (a requirement for immigration which no one checked) clutched awkwardly, baggage straps crisscrossing our chests, wide-eyed like animals coming off the Ark.
What struck me first was that the locals were of all colors and shapes, not the sea of white faces I had expected. Their lewd, inquisitive gazes traveled over us. In the cross fire of bewildering new scents, I picked up the Ghanaian woman's fear. She pressed close to me. Men in black suits held up signs on which they had printed names. Their gazes were flat, like overseers taking the measure of the Ghanaian woman's pelvis, noting the gap between her first and second toe which everyone knows is the only reliable gauge of fecundity. I had a vision of the Middle Passage, of blacks shuffling down the gangplank, shackles clinking while a hundred pairs of eyes probed their flanks, their biceps, and studied the exposed flesh for yaws, which was the Old World syphilis. As for me, I was nobody, her eunuch. She dropped her bag, she was so rattled.
It was while bending down to help her that I saw the sign in the hand of a swarthy brown-eyed man. He held it at waist level, as if he didn't want to be identified with the liveried sign holders. His bush shirt hung out over baggy white pajama pants. Brown sandals on sockless feet completed his outfit. The letters on his sign could have spelled MARVIN or MARMEN or MARTIN. The second word was STONE.
“Is that supposed to say ‘Marion’?” I asked.
He surveyed me from top to bottom, and then he looked away as if I weren't worth a reply. The Ghanaian woman gave a cry of recognition and rushed away to family.
“Excuse me,” I said, stepping into the man's line of sight. “I'm Marion Stone. For Our Lady of Perpetual Succour?”
“Marion is girl!” he said, his accent guttural and raw.
“Not this one,” I said. “I'm named after Marion Sims, famous gynecologist?”
There was (according to the Encyclopaedia Britannica) a statue of Marion Sims in Central Park, at 103rd Street and Fifth Avenue. For all I knew, it was a landmark for taxis. Though Sims started off in Alabama, his success with fistula surgery brought him to New York City, where he opened the Woman's Hospital and then a cancer hospital, which later was named Memorial Sloan-Kettering.
“Gynecology should be woman!” he rasped, as if I'd broken a fundamental rule.
“Well, Sims wasn't and neither am I.”
“You are not gynecologist?”
“No, I meant I'm not a woman. And yes, I'm not a gynecologist.”
He was confused. “Kis oomak,” he said, at last. I knew enough Arabic to understand that he'd just invoked a gynecological term that made reference to my mother.
THE BLACK-SUITED DRIVERS led their passengers to sleek black cars, but my man led me to a big yellow taxi. In no time we were driving out of Kennedy Airport, heading to the Bronx. We merged at what I thought was dangerous speed onto a freeway and into the slipstream of racing vehicles. “Marion, jet travel has damaged your eardrums,” I said to myself, because the silence was unreal. In Africa, cars ran not on petrol but on the squawk and blare of their horns. Not so here: the cars were near silent, like a school of fish. All I heard was the whish of rubber on concrete or asphalt.
Superorganism. A biologist coined that word for our giant African ant colonies, claiming that consciousness and intelligence resided not in the individual ant but in the collective ant mind. The trail of red taillights stretching to the horizon as day broke around us made me think of that term. Order and purpose must reside somewhere other than within each vehicle. That morning I heard the hum, the respiration, of the superorganism. It's a sound I believe that only the new immigrant hears, but not for long. By the time I learned to say “Six-inch number seven on rye with Swiss hold the lettuce,” the sound, too, was gone. It became part of what the mind would label silence. You were now subsumed into the superorganism.
The silhouette of this most famous city—the twin exclamation marks at one end, King Kong's climbing toy in the middle—was familiar. Charles Bronson, Gene Hackman, Clint Eastwood, the Empire Theater, and Cinema Adowa had seen to that. My hubris was to think I understood America from such movies. But the real hubris I could see now was America's and it was hubris of scale. I saw it in the steel bridges stretching out over water; I saw it in the freeways looping over one another like tangled tapeworms. Hubris was my taxi's speedometer, wider than the steering wheel, as if Dali had grabbed the round gauge and pulled its ears. Hubris was the needle now showing seventy miles per hour, or well over one hundred and ten kilometers per hour, a speed unimaginable in our faithful Volkswagen—even if we'd found a suitable road.
What human language captures the dislocation, the acute insufficiency of being in the presence of the superorganism, the sinking, shrinking feeling at this display of industrial steel and light and might? It was as if nothing Id ever done in my life prior to this counted. As if my past life was revealed to be a waste, a gesture in slow motion, because what I considered scarce and precious was in fact plentiful and cheap, and what I counted as rapid progress turned out to be glacially slow.
The observer, that old record keeper, the chronicler of events, made his appearance in that taxi. The hands of my clock turned elastic while I imprinted these feelings in memory. You must remember this. It was all I had, all I've ever had, the only currency, the only proof that I was alive.
Memory.
I WAS ALONE in my hemisection of Mr. K. L. Hamid's cab, my luggage next to me, and a scratched Plexiglas partition between us. Two strangers, isolated and distant, in a car so broad that the backseat alone could have held five humans and two sheep.
My muscles were tense because of our speed, worrying about a child drying cow patties on the hot tarmac or the cow or goat that surely would wander into the road. But I saw no animals, no humans except in cars.
Hamid's bullet-shaped head was covered with tight black swirls. On the laminated license next to the meter, the camera had caught his shock and surprise. The whites of his eyes showed. I convinced myself it was a picture taken on the day he landed in America, the day he saw and felt what I saw.
Which was why Hamid's discourtesy so wounded me. He wouldn't look my way. Perhaps when one has driven a taxi for a long time, the passenger becomes an object defined by destination and nothing else, just as (if one isn't careful) patients can become the “diabetic foot in bed two” or the “myocardial infarction in bed three.”
Did Hamid think that if he looked I'd want his reassurance? Did he think I'd seek his explanation of every sight along the way so as to assuage my fears? He would have been right.
In that case, I said to myself, Hamid's silence must be instructive! An admonishment of sorts, the gentle warning of one who arrived on an earlier ship: You there! Listen! Independence and resilience. This is what the new immigrant needs. Don't get fooled by all this activity. Don't invoke the superorganism. No, no. One functions alone in America. Begin now. That was his message. That was the point of his rudeness: Find your backbone, or be swallowed whole.
I smiled now, relaxing, letting the scenery rush by. It was exhilarating to have arrived at this insight. I slapped the seat. I voiced my thoughts.
“Yes, Hamid. Screw your courage to the sticking place,” I said aloud, invoking Ghosh, who never got to see what I was seeing, never heard the superorganism. How joyfully he would have embraced this experience.
Hamid jerked back at the sound of my voice. He glanced at me in the mirror, then away, then back again. Eye contact for the first time! Only now did he seem to acknowledge he was carrying something other than a sack of potatoes.
“Thank you, Hamid!” I said.
“What? What you say?”
“I said, ‘thank you.’ “
“No, before that!”
“Oh, that. It's Macbeth,” I said, leaning forward to the Plexiglas, overeager for conversation. “Lady Macbeth, actually. My father used to say that to us all the time. ‘Screw your courage to the sticking place.’ “
He was silent, his gaze flitting from road to rearview mirror. Finally he burst out.
“You insult me?”
“Beg your pardon? No. No! I was merely talking to myself. It is as—”
“Screw me? Screw you!” he said.
My mouth fell open. Was it possible to be so completely misunderstood? His face in the mirror said indeed it was. I sank my neck back and shook my head in resignation. I had to laugh. To think that Ghosh—or Lady Macbeth—would be so misinterpreted.
Hamid still glared at me. I winked at him.
I saw him reach into the glove compartment. He pulled out a gun. He brandished it, showing me its different aspects through the dirty Plexiglas, as if he were trying to hawk it to me, or prove to me that it was in fact a gun, not a cheap plastic toy, which is what it looked like.
“You think I joke?” he said, a wicked energy taking over his face, as if the object in his hand made him not a joker but a philosopher.
I didn't mean to add fuel to the fire. I don't see myself as foolhardy or brave. But I found this little revolver pathetic and I simply didn't believe, indeed I was certain, he couldn't possibly use it. It was hilarious. I knew guns. I'd made a crater in a man's belly with one twice that size. I had buried gun and owner in a swamp (from which he still threatened to rise every night). Just four months ago, I had operated on rebels felled by guns. This popgun of his on this day, in the context of America, where cars stayed in lanes, where Customs never opened your bags, seemed like a prop, a cosmic joke. Could I not have had a proper American driver? Failing that, at least a gun that Dirty Harry wouldn't have been embarrassed to hold? Why escape Addis, flee Asmara, get out of Khartoum, and abandon Nairobi, only to face this?
Being the firstborn gives you great patience. But you reach a point where after trying and trying you say, Patience be damned. Let them suffer their distorted worldview. Your job is to preserve yourself, not to descend into their hole. It's a relief when you arrive at this place, the point of absurdity, because then you are free, you know you owe them nothing. I'd reached that point with Hamid. My body was shaking with laughter. Fatigue, jet lag, and disorientation contributed to my finding this so funny.
Hamid's use of the verb “screw” was quite different from screwing one's courage to the sticking place. His saying that word made me think of that story which had circulated when I had more pimples than common sense, more curiosity than sound sexual knowledge. It was the myth of the beautiful blonde and her brother whom one might meet at the airport when landing in America. They offered you a ride, took you home for a drink, at which point the brother brandished a weapon and said, “Screw my sister or you will die!” Long after I knew the story to be ridiculous, it retained its charm as a comic fantasy. Screw my sister or you will die! Here I was, well after the tale had slipped my mind, newly landed in America, and, sure enough, a man brandished a gun. I wished I could have shared the moment with Gaby, the schoolmate who first reported the story to me. A perverse impulse in me made me now repeat the phrase we schoolboys loved to say to each other, a challenge, a veiled threat, even though I was laughing hard: “Brother, put away the gun, I'll screw your sister for free.” I don't know if he picked up the change in my tone and mood, or even if he heard me. Perhaps he just decided that my kind of lunacy wasn't to be toyed with. In any case, he had a change of heart.
THE WROUGHT-IRON GATES of Our Lady of Perpetual Succour were wide open. Dr. Abramovitz, the chief of surgery, was supposed to interview me at 10:00 a.m. My plan was to finish my interview, take another taxi to Queens, and then look for a hotel in which to get over my jet lag. I had interviews lined up in the next few days in Queens, Jersey City, Newark, and Coney Island.
A man with LOUIS embroidered on his blue overalls approached just as Hamid's taxi pulled out of the gate.
“Lou Pomeranz, Chief Caretaker of Our Lady of Perpetual Succour,” he said, gripping my hand. A soft pack of Salems showed in his breast pocket. He was barrel-chested and top-heavy. “Do you play cricket?”
“Yes.”
“Batsman or bowler?”
“Wicketkeeper and opening batsman.” That was Ghosh's legacy to me.
“Good! Welcome to Our Lady. I hope you'll be happy,” Mr. Pomeranz said. He thrust a sheaf of papers at me. “Here's your contract. I'll show you to the interns’ quarters and you can sign. This silver key is for the main door. The gold key is for your room. This is your temporary identification badge. When Personnel take your mug shot, you'll get a permanent badge.”
He took off with my suitcase and I followed. “But …,” I said, juggling the stuff in my hands to reach for the letter in my coat pocket. I showed it to him. “I don't want to mislead you. I am only here for my interview with Dr. Abramovitz.”
“Popsy?” He chuckled. “Naw! Popsy don't interview no one. You see the signature?” He tapped on my letter as if it were a piece of wood. “That's really Sister Magda's writing.” He looked back at me and grinned. “Interview? Forget about it. Taxi was prepaid. Cost you an arm and a leg otherwise. You're hired. I gave you the contract, didn't I? Yerhired!”
I didn't know what to say. It was Mr. Eli Harris of the Houston Baptists who suggested I apply to specific hospitals in New York and New Jersey for an internship in surgery. Eli Harris clearly knew what he was doing, because as soon as I applied, a telegram had arrived in Nairobi from Popsy (or perhaps it was from Sister Magda) inviting me to interview. A letter and brochure followed. Every hospital Harris suggested had also replied promptly, within a few days.
“Mr. Pomeranz. Are you sure I am hired? Your internship must be competitive. Surely many American medical students apply to be interns here?”
Louis stopped in his tracks to look at me. He laughed. “Ha! That's a good one, Doc. American medical students? I wouldn't know what they look like.”
We rounded a dry fountain, streaked with pigeon droppings. It resembled the magnificent one depicted in the brochure, but the bronze monsignor who was the centerpiece leaned precariously forward. The monsignor's features were worn down like the sphinx's. Also not in the brochure was the iron rod wedged between the rim of the fountain and the monsignor's waist to keep him from falling over. It looked as if the monsignor was using his blessedly long phallus for support.
“Mr. Pomeranz—”
“I know. It does look like his pecker,” he said, wheezing. “We're going to get around to it.”
“That wasn't what—”
“Call me Louis.”
“Louis … are you sure you have the right person? Marion? Marion Stone?”
He stopped. “Doc, take a look at the contract, wouldja?”
My name was on the top line.
“If that's who you are, that's who I was expecting.”
A thought clouded his face. “You passed your ECFMG, didn't ya?”
The exam of the ECFMG—Educational Commission for Foreign Medical Graduates—established that I had the knowledge and credentials to pursue postgraduate training in America.
“Yes, I passed.”
“So what gives? … Wait a minute. Wait just a minute. Don't tell me those bastards in Coney Island or Jersey got to you? Did they mail you a contract? Sons of bitches! I've been telling Sister Magda we should be doing that. Send out a contract sight unseen. The taxi was her idea, but it's not enough.” He came up close to me. “Doc, let me tell you about those places. They're terrible.” Louis was short of breath, his nostrils flaring. His rheumy eyes narrowed. “I'll tell you what,” he said. “Give you the corner room in the interns’ quarters. Has a small balcony. How's that?”
“No, no, you see—”
“Was it the Lincoln-Misericordia folks? Harlem? Newark? You shopping around to get the best deal?”
“No, I assure you—”
“Look, Doc, let's not play games. You just tell me yes or no, do you want an internship here?” His hands were on his hips, his chest heaving up and down.
“No, I mean yes … I do have interviews in other places … This is my first stop. But frankly … I thought it would be difficult to get an internship … Id love to … Yes!”
“Good! Then sign the bleeding contract, for the love of Mary, and I'm not even Catholic.”
I signed, standing by the fountain.
“Welcome to Our Lady, Doctor,” Louis said, relieved, grabbing the contract and shaking my hand. He gestured expansively at the buildings around us. “This is the only place I've worked. My first job when I left the service … and probably my last. I've seen docs like you come and go. Oh, yeah. From Bombay, Poona, Jaipur, Ahmedabad, Karachi, you name it. Never had one from Africa before. I thought you'd look different. Let me tell you, we worked them all hard. But they gave us their best. They learned a lot here. I love ‘em all. Love their food. They even got me to love cricket. I'm nuts about it. Listen, baseball has nothing on cricket. My boys are out there now,” he said, pointing over the walls. “Raking in the dough in Kentucky or South Dakota—wherever they need docs bad. Dr. Singh sent me a plane ticket to fly to El Paso for his daughter's wedding. He comes to see me if he's in New York. We have an Old Boys Eleven that plays us every year. The Old Boys built us a new cricket pitch and batting nets. They're proud to be ‘Pee Esses’—Perpetual Suckers is what we call our alums. They'll drive up here in fancy cars. I tell them, ‘Don't put on airs for me. I remember when you didn't know your ass from your elbow. I remember when we could hardly understand a word you said. Now look at you!’ “
I was impressed by what I could see of Our Lady of Perpetual Succour. The hospital was L-shaped, the long limb seven stories high, overlooking the street, a wall separating it from the sidewalk. The short limb was newer and just four stories high with a helicopter parked on top. The tiled roof of the older section sagged between the chimneys while the middle floors pushed out gently like love handles. The decorative grille under the eaves had oxidized to a bile green, old corrosion ran down the brick like mascara, parallel to the drainpipes. A lone gargoyle jutted out on one side of the entrance, its twin on the other side reduced to a faceless nub. But for me, fresh from Africa, these were not signs of decay, merely the dusting of history.
“It's grand,” I said to Mr. Pomeranz.
“It's not much, but it's home,” Mr. Pomeranz said, gazing at the building with obvious affection.
Undoubtedly, there were other hospitals that were newer and bigger, at least as depicted in their brochures. But you couldn't trust a brochure, I was discovering.
Fifty yards to the side of the hospital stood the two-story house staff quarters to which he led me. On the glass door to its lobby, someone had taped a handwritten sign in thick black felt-tip pen on yellow legal paper.
India Versus Australia, 2nd Test At Brisbane
Special Cable Viewing In B. C. Gandhi's Room
(Pakistanis, Sri Lankans, Bangladeshis, and West Indians welcome,
but if you cheer for Australia management reserves the right to eject you.)
Friday Night, July 11, 1980, 7 p.m.
($10 a person and bring drink and non-veg dish, repeat, non-veg dish only.
If it didn't move before it was cooked, we don't want it!!!
Single ladies free and chairs provided.
If you bring spouse, $10 extra and bring your own chair.)
B. C. Gandhinesan M.D.,
Captain Our Lady's Eleven,
Cricket Commissioner, Our Lady of Perpetual Succour
In the lobby I registered coriander, cumin—the familiar scents of Almaz's kitchen. On the stairs I inhaled the very brand of incense that Hema lit each morning. I heard the faint drone on the second-floor landing of “Suprabhatam” sung by M. S. Subbulakshmi and the sound of a bell being rung, as someone in some other room did their puja. I felt a twinge of homesickness. We paused for Mr. Pomeranz to get his breath. “We had to put industrial-size fans in the hoods above the cooking stoves on both floors. Had to! When they start cooking that masala, forget about it!”
A tall, good-looking Indian man with long hair still wet from the shower came bounding down the stairs. He had big strong teeth, a winning smile, and an aftershave that smelled simply wonderful. (I found out later it was Brut.)
“B. C. Gandhinesan,” he said sticking out his hand.
“Marion Stone.”
“Excellent! Call me B.C. or Gandhi,” he said squeezing my hand. “Or call me Captain. Do you—?”
“Wicketkeeper,” Pomeranz said, triumphantly. “And opening batsman.”
B. C. Gandhi struck his forehead and staggered back. “God is great! Wonderful! Can you keep wickets for a pace bowler? A genuine fast bowler?”
“That's the kind I like best,” I said.
“Smashing! I'm a fourth-year resident. Chief Resident–to–be next year. Deepak is our Chief Resident. I'm also captain of Our Lady's First Eleven. Winners of the interhospital trophy for two years. Until those chutyas from a residency program I shall not name brought in a batsman from Hyderabad last year. Test-level player. I lost big money on that. It took me all year to get out of debt.”
“Jerks,” Louis said, his face dark, referring I think to the other program. “They should have forfeited that last game.”
“Turned out their star's a batsman all right, but not really a doctor,” B.C. said. “The bugger was a photocopy expert. But on paper, by the statutes of New York, he was a doctor when we played, Lou. So we don't get our money back.”
“Cocksuckers,” Lou said. “They killed us.”
“This year we have our own secret weapon,” B.C. said to me, a consoling arm around Lou. “I personally flew to Trinidad with one of our Old Boys to recruit him. You'll meet him soon. Nestor. Tall, strong fellow. Six foot four. Fast bowler, new-ball bowler, seam bowler, body-line bowler. But none of us can keep wickets for him—ferocious pace. Now, with you, we will kill those chutyas, and the trophy will be ours. Go get some rest, Marion. We shall see you at batting practice in twenty-four hours.”
PATIENT IS UNDER. What are we waiting for? Who is doing the case?” Dr. Ronaldo asked.
“I am,” I said.
Ronaldo spun a dial on the anesthesia cart, as if this news mandated a change in the gas mixture.
“Deepak is supervising me,” I offered, but Ronaldo ignored this.
Sister Ruth, the scrub nurse, unfolding her tray, shook her head. “I'm afraid not. Popsy just called. He wants to operate. Marion, you'd better come over to this side.”
“Popsy! God help us,” Dr. Ronaldo said, slapping his palm to his cheek. “Take the clock down. Call my wife, tell her I'll be late for dinner.”
I picked up the scent of Brut and then Winston tobacco, and seconds later B. C. Gandhi was at my shoulder. He must have had a last drag in the locker room.
“I know. I heard,” he said before I could say anything. “I'm doing that gallbladder in the next room. Listen, Marion. In case Deepak doesn't get here before Popsy, your job is to contaminate the old man as soon as he picks up the scalpel.”
“What? How?”
“I don't know. Scratch your butt and touch his glove. You're a smart bugger. You'll think of something. Just don't let him get past skin, okay?” Gandhi walked off.
“Is he serious?” I asked.
Ronaldo said, “Gandhi is never serious. But he is right. Contami nate him.”
I turned to Sister Ruth, hoping she could help.
“Pray for the intercession of Our Lady,” she said. “And contami nate him.”
IT WAS THE TWELFTH WEEK of my surgery internship at Our Lady of Perpetual Succour.
Little did I know that the thirty-minute drive from the airport to the Bronx would be the only glimpse of America I would have for three months.
After just a week in the hospital, I felt Id left America for another country. My world was a land of fluorescent lights where day and night were the same, and where more than half the citizens spoke Spanish. When they spoke English it wasn't what I expected in the land of George Washington and Abraham Lincoln. The bloodlines from the Mayflower hadn't trickled down to this zip code.
Three months at Our Lady of Perpetual Succour had gone by at lightning speed. We were severely shorthanded, compared with the norm in other American hospitals, but I didn't know the norm. At Missing, there were only four or five doctors at the best of times; here we had three times that number of physicians in surgery alone. But at Our Lady of Perpetual Succour, we saw more patients. We kept so many complicated trauma patients alive on ventilators in the ICU, generated so many lab tests and so much paperwork, that the experience was completely different from Missing, where Ghosh or Hema rarely made more than a cryptic entry in the chart, leaving the rest to the nurses. I learned those quiet, long American cars, those floating living rooms on wheels, caused monstrous injuries when they crashed. The ambulance crews brought the victims to us before the tires on the wreck stopped spinning. They salvaged people we'd never see in Missing, because no one would have tried to bring them to a hospital. Judging someone to be beyond help never crossed the minds of police, firemen, or doctors here.
AT OUR LADY, we pulled every-other-night call. I had no time to be homesick. My typical day started in the early morning, when I made rounds with my team leader, B. C. Gandhi. Then my team and the other surgical teams came together to make formal rounds with Deepak Jesudass, the Chief Resident, at 6:30 a.m. On operating days, which were Tuesdays and Fridays, we interns manned the wards and the emergency room. We worked till early evening. Then if I was on call, I simply worked on through the night admitting patients from the emergency room while caring for my existing patients and those of the interns who were not on call. Our chances to assist or even to operate as interns came when we were on call. It was rare to get any sleep on call nights. I didn't even try. The next day we kept going till the late afternoon, when I was finally off. For my off night all I could do was fall on the bed in my quarters and sink into a deep sleep. The next morning, the cycle started again. My senior resident, B. C. Gandhi, asked me late one night when we were both punch-drunk from lack of sleep, “Do you know the disadvantage of every-other-night call?” It was an imponderable question. I shook my head. He smiled and said, “You miss half the interesting patients.”
The schedule was brutal, dehumanizing, exhausting.
I loved it.
At midnight, when the corridors became deserted, there were places in the hospital where the lights dimmed and where I could see traces of Our Lady of Perpetual Succour's past glory; it showed in the gold filigree work above the archways, in the high ceilings of the old maternity wing, in the marble floor of the administrative foyer, and the stained-wood cupola of the chapel. Once the pride of a rich Catholic community, and then a middle-class Jewish community Our Lady of Perpetual Succour went the way of the neighborhood: it became poor in catering to the poor. B. C. Gandhi explained it to me: “The poorest in America are the sickest. Poor people can't afford preventive care or insurance. The poor don't see doctors. They show up at our doorstep when things are advanced.”
“Who pays for all this, then?” I asked.
“The government pays with Medicaid and Medicare, from your taxes.”
“How come we can afford a helicopter and a helipad if we're so poor?” The bull's-eye atop the newer four-story part of Our Lady, with the blue flashing perimeter lights and the shiny helicopter that came and went, seemed incongruous for our setting.
“Salah, you don't know about our claim to fame? Our number one industry? Sometimes I forget you just got off the boat. Man, that helipad was paid for by hospitals that are the opposite of ours. The helicopter is really theirs, not ours. Rich hospitals. Taking care of the wealthy, the insured. Even if some of them take care of the poor, they have a big university or a university private practice to underwrite their costs. That kind of ‘taking care of the poor’ is noble.”
“And our kind of taking care?”
“Shameful. The work of untouchables. Those rich hospitals up and down the East Coast got together and paid for our helipad so they can fly here. Why? Ischemia time! You see, what we have here in our neighborhood is an abundance of guns, ABMs, and ALMs—Angry Black Males, Angry Latin Males, and actually angry males of all stripes, not to mention jealous females. The man on the street is more likely to carry a gun than a pen. Bang! Bang! Chitty! Chitty! And so we wind up with too many GPO patients—Good for Parts Only. Young, otherwise healthy, but brain-dead. Pristine hearts, livers, and whatnot. Under warranty to keep going long after your pecker droops. Great organs. Great for transplant. Transplants which we can't do. But we can keep them alive till the vultures get here. They get the organ and run. Next time you hear the whup-whup-whup, don't think helicopter blades. Think paysa, moola, dinero! Heart transplant costs, what, half a million dollars? Kidneys a hundred thousand or more?”
“That's how much they pay us?”
“Us?They don't pay us a fucking cent! That's how much they make. They come, cut, and take, show us the middle finger, and ride off in their whirlybird leaving us on our camels. Next time you hear the helicopter, come see what masters of medicine, the sahibs, look like.”
I had seen them more than once, their white coats emblazoned with vivid university logos on breast and shoulder, and the same icons on ice chests, on the igloos on wheels, and even on the helicopter. I saw in their faces the same variety of fatigue that I experienced, but theirs somehow seemed more noble.
DR. RONALDO CROSSED and uncrossed his arms, looking at the clock, then the door, for any sign of Popsy. I draped the sterile towels to outline a perfect rectangle, the portal to Hugh Walters Jr.'s abdomen.
Mr. Walters, a graying gentleman, showed up in our emergency room the week before. That particular night, stretchers spilled out of the ER's trauma bays into hallways. Alcohol had leached out of the lungs, out of skin pores, out of the secretions of enough men and women to make the place smell like a cocktail lounge. There were two inebriated men vomiting blood, competing to see who could be louder. When Mr. Walters arrived, also vomiting blood, I unfairly assumed he was one of their kin, related through alcohol and cirrhosis. I assumed that his bleeding came from wormlike varicose veins blooming in his stomach from the scarring in the liver. Over the course of the next twenty-four hours, I slipped a gastroscope down each bleeder's throat and peered into the stomach. Unlike the other two, Mr. Walters had none of the angry redness of alcoholic gastritis, and no bleeding varicose veins to suggest cirrhosis. What he did have was a large oozing gastric ulcer. I took biopsies through the scope.
A few hours after the endoscopy Mr. Walters, in a quiet dignified voice, again assured me that alcohol had never crossed his lips, and this time I believed him. He was a man of the cloth. He taught junior high school for a living. I chastised myself for lumping him in with the other two stomach bleeders. We started intense therapy to heal his ulcer.
Mr. Walters, I found, knew about my birth land. “When Kennedy died, I watched that funeral on TV. Your Emperor Haile Selassie came all the way. He was the shortest man there. But also the biggest man there. The only Emperor. The only Emperor. He was in the first row of dignitaries walking behind that coffin. He made me proud to be bl-ack.” When Mr. Walters said the word, he gave it a weight and a heft.
Mr. Walters read the New York Times every day. That and a Bible were a constant at his bedside. “I could never afford college. Just Bible school. I tell my students, ‘If you read this newspaper every day for a year, you'll have the vocabulary of a Ph.D. and you will know more than any college graduate. I guarantee you.’ “
“Do they listen?”
He held up a finger. “Every year one does,” he said, grinning. “But that one makes it worthwhile. Even Jesus only did twelve. I try to get one a year.”
Despite antacids and H2 blockers, Mr. Walters s ulcer was still bleeding. His stools remained the consistency and color of tar, a sure sign of blood being acted on by stomach acid. Five days after his admission, our troop had gathered at his bed during evening sign-out rounds.
Deepak Jesudass, our Chief Resident, sat on the edge of Mr. Walters s bed. “Mr. Walters, we have to operate tomorrow. Your ulcer is still bleeding. It isn't showing signs of stopping.” He sketched out on a piece of paper what a partial gastrectomy would look like—removal of the acid-producing area of his stomach. I admired Deepak's quiet careful manner, his way of being with patients that made them feel they were the focus of all his attention and that there was nowhere else he had to be. Most of all I admired his wonderful, very British accent, which seemed doubly exotic in that it came from a South Asian man. It was the result of his having lived in Britain for years. Deepak inspired confidence in patients.
As Deepak spoke, B. C. Gandhi looked at me and rolled his eyes. He was reminding me of something hed told me just the previous night. “You can be a cretin, but if you have the Queen's accent, next thing you know you are on Johnny Carson and he'll laugh at anything you say.”
B.C. was being facetious, but on the sitcoms I caught while going in and out of patients’ rooms, I had so far seen a black but very British butler serving a black American family; an eccentric Englishman who was the neighbor to a rich black family on the Upper East Side of Manhattan; and a rich British widower with a pretty Brooklyn nanny.
Mr. Walters had hung on Deepak's every word. At last he'd said, “I have faith in you. But for you-all, there wouldn't be any doctors here. I have faith in someone else, too,” he said, pointing to the ceiling.
The day of surgery, I rose at four-thirty to review the steps of the operation in my Zollinger's Surgical Atlas. Deepak had let me know that it was my case, and I would stand on the right while he assisted me. I was thrilled and nervous. It would be my first time to work directly with the Chief Resident.
But Popsy had ruined our plans. I stood on the patient's left, awaiting the legendary Dr. Abramovitz. I had yet to meet him. There was no sign of Deepak.
AND SUDDENLY POPSY WAS THERE, his head perilously close to the operative lights. He had a deeply furrowed face, kind blue eyes, the pupils rimmed with gray but retaining a curious, little-boy quality. His mask hung just under his nose, wire-brush hairs poking out from his nostrils. He held out his gloved hand for the knife. Sister Ruth hesitated, glancing at me before putting it in his palm.
Popsy made a sound in his throat. The scalpel quivered in his fingers. Sister Ruth nudged me. Before I could do anything, Popsy made his incision. It was bold. Very bold. I dabbed and I clamped tiny bleeding vessels, and when Popsy didn't move to tie them off, I did. Popsy handled the forceps to pick up the peritoneum. He couldn't get purchase on the tissue.
For good reason. In one spot his skin incision had cut through fascia and peritoneum. Liquid matter, looking suspiciously like bowel content, welled into the wound. Ronaldo peered over the anesthesia screen and his eyebrows disappeared under his surgical cap.
Popsy tried again with the forceps, but the instrument slipped from his fingers and clattered to the floor. He brought his hand up, minus the forceps. “I touched the side of the table …” He was looking at me, as if I might dispute his account. “I've contaminated myself.”
“I think you did,” Sister Ruth said hastily when she saw that I was tongue-tied.
“You did, sir,” Ronaldo said.
But Popsy still looked at me.
“Yes, sir,” I stammered.
“Carry on,” he said. He shuffled out of the room.
“POPSY, WHAT DID YOU DO?” Deepak muttered under his mask as he brought out the injured loop of small intestine. I stayed on the left side of the table. “They say there are old surgeons, and bold surgeons, but no old-bold surgeons. But whoever said that never met Popsy. Fortunately it's a small-bowel tear and we can just stitch it over.”
“I tried to—” I stammered.
“We have a bigger problem,” Deepak said. He pointed to what looked like a small barnacle on the surface of the bowel. Once I saw that first one, I saw them everywhere, even on the apron of fat that covered the bowel. The liver was misshapen, with three ominous bumps within making it look like a hippo's head.
“Poor man,” Deepak said. “Feel his stomach.” The stomach wall was rock hard. “Marion, you biopsied the ulcer when you ‘scoped him, right?”
“Yes. The report said benign,” I said.
“But this was a large ulcer on the greater curvature?”
“Yes.”
“And which ulcers in the stomach are more likely to be malignant?”
“Those on the greater curvature.”
“So your suspicion for malignancy was high, right? Did you look at the slides with the pathologist?”
“No, sir,” I said, dropping my eyes.
“I see. You trusted the pathologist to read the biopsies for you?”
I said nothing.
Deepak's voice wasn't raised. He could have been talking about the weather. Dr. Ronaldo couldn't hear him.
Deepak explored the pelvis, swept with his fingers to those places we could not see. Finally he said, almost under his breath, “Marion, when it's your patient and you are basing your surgery on a biopsy, be sure to look at the slides with the pathologist. Particularly if the result isn't what you expect. Don't go by the report.”
I felt terrible for Mr. Walters. I could have spared him this operation, spared him Popsy In retrospect, Mr. Walters s liver function tests were marginally off, and that should have been a clue.
Deepak repaired the hole in the bowel. Fortunately, there was just one. He oversewed the bleeding ulcer in the stomach; it would in time bleed again. We washed out the abdominal cavity with several liters of saline, pouring it in, then suctioning it out.
“Okay, come to this side, Marion. I want you to close.”
I worked steadily under his eagle eye.
“Stop,” Deepak said. He cut away the knot I had tied. “I know you have probably done a lot of surgery in Africa. But practice doesn't make perfect if you repeat a bad practice. Let me ask you something, Marion … Do you want to be a good surgeon?”
I nodded.
“The answer isn't an automatic yes. Ask Sister Ruth. In my time here, I've asked that question of a few others.” I could feel my ears turning red. “They say yes, but some should have said no. They didn't know themselves. You see, you can be a bad surgeon, and as a rule you will make more money. Marion, I must ask you again, do you really want to be a good surgeon?”
I looked up.
“I guess I should ask what does it involve?”
“Good. You should ask. To be a good surgeon, you need to commit to being a good surgeon. It's as simple as that. You need to be meticulous in the small things, not just in the operating room, but outside. A good surgeon would want to redo this knot. You're going to tie thousands of knots in your lifetime. If you tie each one as well as humanly possible, you'll experience fewer complications. I want to see even tension on both limbs. The last thing you want is for Mr. Walters to have a burst abdomen when he gets post-op bloating. That knot, done well, may allow him to go home and get things in order. Done poorly it could keep him in hospital with one complication after another till he dies. The big things in surgery depend on the little things.”
That afternoon we sat in the cramped office of Dr. Ramuna, the pathologist. She found cancer in the edge of one of the six biopsies I had taken days ago. A stern lady, Dr. Ramuna had a way of pursing her lips that reminded me of Hema. She was unfazed about having missed the cancer the first time. She pointed to the teetering stack of cardboard slide trays by her microscope—biopsies waiting to be read. “I'm doing the work of four pathologists, but I'm only here half-time. Our Lady can't afford more that that. But they don't give me half the work. I can't spend enough time with each specimen. Of course I missed it! No one comes down here to go over slides with me, other than you, Deepak. They call. ‘Have you read this specimen yet? Have you read that specimen?’ If it matters to you, come down, I say. Give me good clinical information and I can do a better job of interpreting what I see.”
I KEPT VIGIL over Mr. Walters. We had passed a tube through his nose into his stomach and connected it to wall suction, to keep his gut empty for the next few days. He was miserable with the tube and hardly spoke.
On the third post-op day I took out the nasogastric tube. He sat up, smiled for the first time, taking a deep breath through his nose.
“That tube is the Devil's own instrument. If you gave me all of Haile Selassie's riches, I'd still say no to that tube.”
I took my own deep breath. I sat on the edge of his bed. I held his hand. “Mr. Walters, I'm afraid I have some bad news. We found something unexpected in your belly.” This was the first time in America that I had to give someone news of a fatal illness, but it felt like the first time ever. It was as if in Ethiopia, and even in Nairobi, people assumed that all illness—even a trivial or imagined one—was fatal; they expected death. The news to convey in Africa was that you'd kept death at bay. Those things that you couldn't do, and those diseases you couldn't reverse, were left unspoken. It was understood. I don't recall an equivalent word for “prognosis” in Amharic, and I'd never tried to speak to a patient about five-year survival or anything like that. In America, my initial impression was that death or the possibility of it always seemed to come as a surprise, as if we took it for granted that we were immortal, and that death was just an option.
Mr. Walters s expression went from joy over the tube being out, to shock, and finally sadness. A single tear trickled down his cheek. My gaze turned foggy. My beeper went off, but I ignored it.
I don't think you can be a physician and not see yourself reflected in your patient's illness. How would I deal with the kind of news I'd given Mr. Walters?
After a few minutes, he wiped his face with his sleeve. A smile cracked his features. He patted my hand.
“Death is the cure of all disease, isn't it? No one is prepared for news like this, no matter what. I'm sixty-five years old. An old man. I have had a good life. I want to meet my Lord and Savior.” A mischievous light flashed in his eye. “But not just yet,” he said, holding up a finger and laughing, a slow metronomic sound, heh-heh-heh …
I found myself smiling with him.
“We always want more, heh-heh-heh“ he said. “Ain't that the truth, Dr. Stone? Lord, I'm a-coming. Not just yet. I'll be right there, now. You go on, Lord. I'll catch up with you.”
I admired Mr. Walters. I wanted to learn to be this way, to possess his steady rhythm, to have that inner beat playing quietly inside me.
“You see, young Dr. Marion, that's what makes us human. We always want more.” He clasped my hand now, as if he was ministering to me, as if Ihad come to sit on his bed for reassurance, courage, and faith. “Now you go on. I know you're busy. Everything's just fine. Just fine. I just got to think this one out.”
I left him smiling at me, as if I had given him the greatest gift one man could ever give another.
AFTER LEAVING MR. WALTERS'S ROOM, I sat on the park bench by the house staff quarters. How unfair to Mr. Walters that his darkest day should be so impossibly beautiful. The trees of Our Lady turned colors I had never seen in Africa. And then they blessed the ground below with a fiery red, orange, and yellow carpet, which crunched underfoot and released a dry but sweet fragrance.
The laughter and shrieks coming from inside our building, from the patio, felt sacrilegious. B. C. Gandhi had christened our quarters “Our Mistress of Perpetual Fornication.” There were days when I felt I lived in Sodom.
When it turned chilly, I went inside. I caught a glimpse of the roaring wood fire in the cast-iron pot on the patio, and the scent of tobacco and something more pungent. Nestor, our Carribean fast bowler and my fellow intern, had a herb garden at the back of our building. The summer we arrived he grew a bumper crop of curry leaves, tomatoes, sage—and cannabis.
Beyond the herb garden the meadow sloped down to a brick fence topped with razor wire. It separated us from a housing project named Friendship by the city authorities twenty years ago. It was now called Battleship by one and all. At night we heard the pop of handguns from Battleship and saw comet streaks, messages from earth to sky.
On Mondays we gathered at the nurses’ quarters for a communal dinner at their invitation. But on this day it was their turn to visit us. I joined the crowd.
“How did it go?” B.C. said, coming over, putting his arm around my shoulders. I told him about my conversation with Mr. Walters.
B.C. listened quietly, and then said, “What a good man he is! What courage. You know, we've been lucky with Mr. Walters, particularly since he's a zero-to-one dirtballer. What's a dirt ball? The hard, stinky concretion that forms in the belly button. A patient with four dirt balls is often an alcoholic. He's had one or two heart attacks. Beats his wife. He's been shot a couple of times. He has diabetes. Kidney function is borderline. You try a BFO for a Triple A, guess what happens?”
“BFO” was Big Fucking Operation, and “Triple A” was Abdominal Aortic Aneurysm. B.C. loved acronyms and claimed to have invented a good many of them. A patient near death was CTD—Circling The Drain.
“A four dirtballer? … I guess he does terribly with a big operation?” I offered.
“No! Just the opposite. You see, he's already demonstrated his capacity to survive. Heart attacks, strokes, stabbings, falls off buildings—his protoplasm is resilient. Lots of collateral vessels, backup mechanisms. He waltzes out of the recovery room, farts the first night, pees on the floor trying to get to the bathroom, and does great despite the bourbon the family sneaks in to add flavor to the ice chips, which are all he's supposed to eat.
“The zero-to-one dirtballers are the ones to watch out for. They are your preachers or doctors. Men like Walters. They live good clean lives, stay married to the same woman, raise their kids, go to church on Sundays, watch their blood pressure, don't eat ice cream. You try a BFO for a Triple A and you will be CDSCWP.”
Canoeing Down Shit Creek Without a Paddle.
“As soon as the anesthesiologist brings the mask near their face, your zero dirtballer has a heart attack on the goddamn table. If you manage to operate, the kidneys conk out or the wound breaks down. Or they get confused, and before you can call the Freud Squad they've jumped out of the window. So you see, your Mr. Walters was lucky.”
Deepak took a drag on a cigar-size joint that Nestor passed to him. He handed it to me. “Here,” he said, holding the smoke in, and speaking in a clipped voice. “The point is … clean living will kill you, my friend.”
The cannabis did nothing for my fatigue. Soon I felt my face and body turn to wax. I stared into the sky above Battleship. The sounds— good-natured yelling, screams, the throb of a boom box, the clang of a basketball rattling the metal rim, the squeal of tires—were a symphony. They matched the chiaroscuro designs on the brick wall. I felt I could see into Battleship and that I was watching the lives of the hundreds of Americans living there, families who got their medical care from us. I felt like a visionary.
“Doesn't it seem strange,” I said, after a long while, struggling to frame my question so it wouldn't sound silly, “doesn't it seem strange that … here we all are, foreign doctors—”
“You mean Indian doctors,” Gandhi said. “You're half Indian, but luckily for you it's the pretty half. Even Nestor here has an Indian father, he just doesn't know it.”
Nestor threw a bottle cap at Gandhi.
“Yes, well, doesn't it seem strange,” I went on, “that here we are, a hospital full of Indian doctors and on the other side of that wall are the patients we are taking care of. American patients, but not representative of—”
“You mean black patients, mon,” Nestor said in his lilting accent. “And you mean Puerto Ricans.”
“Yes … but what I am getting at is where are the other American patients? Where are the other American doctors for that matter?”
“You mean where are the white patients? Where are the white doctors, mon?”
“Yes!” I said. “Precisely!”
“Look here, Marion,” Gandhi said. “You mean to say you hadn't noticed this fact till just this moment?”
“No … I mean, yes, I have. Don't be silly. But my question is, are all hospitals in America like this?”
“My goodness, Marion, you do understand why you are here and not at the Mass General?”
“Because … I didn't apply there.”
I was unprepared for the laughter that greeted me. Just when I thought I was on to something profound.
Nestor got up and jogged in place. He chanted, “Heenot not apply there! Heenot not apply there!” The cannabis seemed to facilitate their hysterical giggles, but it was doing nothing for me. I was getting angry. I rose to leave.
Gandhi grabbed my arm. “Marion, sit down. Wait. Of course you didn't apply,” he said soothingly. “You didn't want to waste your time on the Massachusetts General Hospital.”
I still didn't get it.
“See here,” he said, taking a saltshaker and pepper shaker and putting them side by side. “This pepper shaker is our kind of hospital. Call it a—”
“Call it a shit hole, mon,” said Nestor.
“No, no. Let's call it an Ellis Island hospital. Such hospitals are always in places where the poor live. The neighborhood is dangerous. Typically such hospitals are not part of a medical school. Got it? Now take this saltshaker. That is a Mayflower hospital, a flagship hospital, the teaching hospital for a big medical school. All the medical students and interns are in super white coats with badges that say SUPER MAYFLOWER DOCTOR. Even if they take care of the poor, it's honorable, like being in the Peace Corps, you know? Every American medical student dreams of an internship in a Mayflower hospital. Their worst nightmare is coming to an Ellis Island hospital. Here's the problem—who is going to work in hospitals like ours when there is a bad neighborhood, no medical school, no prestige? No matter how much the hospital or even the government is willing to pay, they won't find full-time doctors to work here.
“So Medicare decided to pay hospitals like ours for internship and residency training programs, get it? It's a win-win, as they say—the hospital gets patients cared for by interns and residents around the clock, people like us who live on site, and whose stipend is a bloody fraction of what the hospital would pay full-time physicians. And Medicare delivers health care to the poor.
“But when Medicare came up with this scheme, it created a new problem. Where do you get your interns to fill all these new positions? There are many more internship positions available than there are gradua ting American medical students. American students have their pick, and let me tell you, they don't want to come and be interns here. Not when they can go to a Mayflower hospital. So every year, Our Lady and all the Ellis Island hospitals look for foreign interns. You are one of hundreds who came as part of this annual migration that keeps hospitals like ours going.”
B.C. sat back in his chair. “Whatever America needs, the world will supply. Cocaine? Colombia steps to the plate. Shortage of farmworkers, corn detasselers? Thank God for Mexico. Baseball players? Viva Dom i n ica. Need more interns? India, Philippines zindabad!”
I felt stupid for not having seen this before. “So the hospitals where I was going to interview,” I said. “In Coney Island, Queens—”
“All Ellis Island hospitals. Just like us. Allthe house staff are foreigners and so are many of the attending physicians. Some are all Indian. Some have more of a Persian flavor. Others are all Pakistani or all Fili pino. That's the power of word of mouth. You bring your cousin who brings his classmate and so on. And when we finish training here, where do we go, Marion?”
I shook my head. I didn't know.
“Anywhere. That's the answer. We go to the small towns that need us. Like Toejam, Texas, or Armpit, Alaska. The kinds of places American doctors won't go and practice.”
“Why not?”
“Because, salah, in those villages there's no symphony! No culture! No pro-ball team! How is an American doctor supposed to live there?”
“Is that where you will go, B.C.? To a small town?” I said.
“Are you kidding? You expect me to live without a symphony? Without the Mets or the Yankees? No, sir. Gandhi is staying in New York. I am Bombay born and Bombay bred, and what is New York but Mumbai Lite? I'll have my office on Park Avenue. You see, there is a crisis in health care on Park Avenue. The citizens are suffering because their breasts are too small or their nose is too big, or they have a roll around the belly. Who will be there for them?”
“You will?”
“Fucking right, boys and girls. Hold on, ladies, hold on! Gandhi is coming. B.C. will make it smaller, bigger, softer, cuter, whatever you want, but always better.”
He held his beer aloft. “A toast! Ladies and gentlemen. May no Ameri can venture out of this world without a foreign physician at his or her side, just as I am sure there are none who venture in.”
ONE AFTERNOON, in my ninth month at Our Lady of Perpetual Succour, as we were on our way to the operating room, a bailiff served Deepak Jesudass with papers. My Chief Resident took them without comment, and we went on with our work. Well after midnight, as we sat in the locker room outside the theater and smoked, he smiled at me and said, “Anyone else would have asked me what the papers were about.”
“You'll tell me if it concerns me,” I said.
Deepak was perhaps thirty-seven when I met him. He had a youthful face and boyish shoulders that belied the bags under his eyes and the gray streaks in his hair. Had you seen us all in the cafeteria, you would have guessed B. C. Gandhi was the Chief Resident, because B.C. looked the part. But when I reflect back on my surgical training, I'm indebted to a small, dark man, a self-effacing surgeon whom the world might never celebrate. In the operating room, Deepak was patient, forceful, brilliant, creative, painstaking, and decisive—a true artisan.
“Don't stutter with that needle holder.” “Self-discipline with those hands, Marion. Do each step just once, no wasted motion.” When I learned to cross my hands the way he suggested to get equal tension on both limbs of the knot, a new problem arose: “Keep your elbows in, unless you're trying to fly.” I redid more knots than I tied when I was with him. I took down entire suture lines and started again till he was satisfied. I gave new thought to light and exposure. “Working in the dark is for moles. We are surgeons.” His advice was sometimes counter intuitive: “When you are driving, you look to see where you are going, but when you are making an incision, you look to see where you have been.”
Deepak was from Mysore in southern India. That night in the locker room, he told me what I don't think he had told anyone else at Our Lady. When he graduated from medical school, his parents hastily arranged a marriage to a British-born Indian girl living in Birmingham; shed been a reluctant bride, bullied into marriage by her parents who didn't like the crowd she was hanging around with. She flew down with her family a few days before the wedding and left the day after, because she was attending college. It took six months for Deepak to get his visa and join her at her parents’ home. He found that if he opened his mouth he embarrassed her. She didn't want him near her in public or private. He left the house after a few weeks and found a house-officer position (equivalent to the internship in America) in Scotland. After a year he advanced to registrar, then to senior registrar. He passed the difficult exams to become a Fellow of the Royal College of Surgeons, the magic letters FRCS behind his name.
“I could have gone back to Mysore. With my FRCS up on a board, I would have done very well. But I pictured all the people who'd come to my wedding. I didn't want to face them … I just couldn't.”
The next step for him in England would have been to be a surgical consultant appointed to a hospital. “There aren't many consultant jobs. Someone has to die for an opening to come up.” After six years of working as a senior registrar, a consultant's understudy, doing all the emergency cases, Deepak decided to come to America.
“It meant starting all over again, because here you don't get credit for postgraduate training anywhere else. At my age, and after all the years of training, I wondered if I had it in me.”
The American system of surgical training was different: after a year of internship and then four years as a surgical resident with ever increasing responsibilities (the last year as Chief Resident), one was allowed to sit for the exam to become a board-certified surgeon, a consultant.
“I did my internship in a prestigious place in Philadelphia. I worked hard for them …” He closed his eyes and shook his head at the memory. “When my father died, I didn't even tell them. I didn't even try to take one day off for that. I was promoted to second year, even though I was performing at a much higher level, and they actually used me almost like a Chief Resident. But they bumped me after the third year. One of my attending physicians who went to bat for me wound up resigning over this. He was so incensed.
“I could have gone into urology or plastic. That's what people often do if they're bumped at that stage. Many foreign graduates give up and wind up in psychiatry or something. But I love general surgery The same guy who went to bat for me got me into another hospital, this time in Chicago, with the promise that I'd be promoted if I repeated my third year. I worked even harder—and got bumped again.” He laughed at my expression of incredulity. “It helps to be me, I suppose. To not expect too much. To love surgery for its own sake. But I was lucky. One of the attending physicians in Chicago went out on a limb for me. He called Popsy, and he arranged for me to come here as a fourth-year resident. That's the funny thing about America—the blessed thing. As many people as there are to hold you back, there are angels whose humanity makes up for all the others. I've had my share of angels. Popsy was one of those.”
Popsy made Deepak Chief Resident overnight, but with the proviso that he be Chief Resident for two years. Deepak was in his last year of training when I arrived.
“So you will be done the same day I finish my internship?”
His silence made me anxious.
Slowly he shook his head.
“We got notice today of a site visit soon from the people who accredit our residency training program. If they don't like what they see, they can shut us down. We've got too few interns. And too few resident physicians at every level for the patient volume we handle. Not to mention too few faculty.”
“How did this happen?”
“Our competition is sweetening the pot. We were lucky to get you and Nestor and Rahul. We need more interns, more full-time faculty. Popsy just isn't as influential as he once was to attract good faculty. At this point, it's only Popsy s credentials and academic history that give our program accreditation. On paper, Popsy is golden. If Popsy steps down, or word gets out that he has early dementia, the house of cards falls.”
I must have looked concerned because he said, “Don't worry. You'll be able to find another slot and get credit for this year.”
“Is that what it is about—the bailiff serving you papers?”
“Oh, that's my so-called wife. Now she thinks I must be making a lot of money so she is filing in New York for spousal support. I have a lawyer who tells me that I have nothing to worry about. I owe her nothing.”
“What about you, Deepak? What will you do if this place closes?”
“I don't know, Marion. I can't go through this again. Can't keep assisting someone who is my ‘senior’ but is butchering the case and doesn't have the sense to ask me to help. Maybe I'll just keep on working here. Sister Magda says the hospital will employ me. I'll live here, just like Popsy lives here. I'll operate. The hospital doesn't care if I am board certified or not, particularly if the residency program closes. Our Lady needs a surgeon. I'll be another Popsy. Believe it or not, Popsy, till his breakdown, was a super surgeon,” Deepak said. “What's more important, he was a fine man. Truly color-blind.”
After Mr. Walters's surgery, Deepak had spread the word that Popsy was not to operate anymore at any cost.
“Is there anything we can do to keep them from shutting us down?” I asked Deepak.
“Pray,” he said.
IPRAYED, BUT IT DIDN'T HELP. With two months to go to finish my internship and for Deepak to finish his Chief Residency, our program was placed on probation. I worried about my fate. It was bad enough that we might be closed down, but it would be worse not to get credit for the year I'd put in. I felt terrible for Deepak, who had come so close to finishing his Chief Resident year. Until our appeal was heard, though, and the final order came to shut us down, there was little to do but plod on.
On a Friday evening, I was summoned to the trauma room, and I reached there just as the ambulance roared in. The crew slid out a stretcher, snapped its wheels down, then raced in with it as if it were a battering ram. The glass doors parted just in time. I thought of these things as minor miracles, everyday efficiencies that were such a contrast to what I'd known in Africa. I jogged alongside. After almost a year at Our Lady, I'd done this many times, but the adrenaline still surged.
“John Doe, MVA, barely breathing at the scene,” one of the men pushing the stretcher said. “Ran a red light, got broadsided by a van on driver's side. No seatbelt—went airborne through windshield … Then, if you can believe this, his own car, spinning around, slammed into his body. Fly ball to centerfield … Kid you not. Eyewitnesses. He landed on the pavement. No obvious neck injuries. Left ankle shattered … bruises on chest and belly.” I saw a handsome black male, clean-cut and no older than twenty.
The ambulance crew had two bags of intravenous saline going wide open. They had drawn blood, and now they handed over the red-, blue-, and lavender-topped tubes to the lab technician, who would begin typing and cross matching for blood before we'd even cut off the patient's clothes.
“There's more to this,” the ambulance driver said. “Reason he ran the red light is because he was in a gunfight with gangbangers. One of them got shot in the head. An ambulance is on its way with that guy. Don't worry … it ain't no emergency. They had to scoop parts of his brain off the sidewalk—kindergarten through fifth grade from the looks of it. This guy,” he said, pointing to our patient, “did the shooting.”
Our patient's skull was intact, but he was unconscious. The part buzzed into his short hair was as straight as if it had been applied with a ruler. It was one of the strange things one noticed at such times. His pupils constricted briskly to the light I shone at them, a crude but reassuring sign that his brain was all right. His pulse was thready and racing under my fingers. The monitor read one hundred sixty beats a minute.
A nurse called out the pressure. “Eighty over nothing.” A few seconds later she said, “Fifty over zero.”
Fluids were pouring in, blood was on its way. There was a bruise over the lower right ribs. His belly was tense and it seemed to be swelling under my eyes.
“No pressure,” the nurse announced just as the X-ray technician arrived with the portable machine.
“No time for this. He's exsanguinating,” I said. “Let's take him to the operating room. It's his only chance.”
Nobody moved.
“Now!” I said, giving the stretcher a push. “Call my backup, let them know.”
In the operating room, I scrubbed for just thirty seconds, while Dr. Ronaldo, the anesthetist, adjusted the tracheal tube. Ronaldo looked at me and shook his head.
I pulled on my gloves while looking at what the scrub nurse had laid out.
“Forget sponges. Let's get lap packs. Open them out. We won't have time to unfold them. There is going to be so much blood. We'll need big basins to hold the clots.”
The patient's belly was more tense than it had been downstairs.
Ronaldo, peering crocodilelike above his mask, shrugged when I looked at him for the signal to start.
“Get ready,” I said to Ronaldo, “ ‘cause when I open, the pressure is going to bottom out.”
“What pressure?” Ronaldo said. “No pressure.”
For now, the blood expanding the belly was serving as a compress, tamping off the bleeding vessel wherever it was. But the moment I opened the belly, the geyser would open again. I layered pads all around. I poured Betadine over the skin, swabbed it off, said a prayer, and cut.
Blood welled out, spilled over the edge of the wound like a storm surge. Despite all the pads, despite my suction hose sucking greedily, the blood lapped over the drapes, onto the table, and splashed to the floor. I felt it soak through my gown, felt it on my thighs, in my socks, my feet squishing in my shoes.
“More packs!” Id tried to warn the nurses, but we were still unprepared for the torrent.
I reached in with my hand, displacing a second wave of blood as I grabbed the small bowel. With two hands now, I pulled loops out, fed them onto a towel by the side of the incision. In seconds I had effectively disemboweled the patient.
Deepak appeared across from me, scrubbed and ready. I clasped my hands together, stepped back to cross to the other side of the table, but he shook his head.
“Stay there,” he said. He grabbed a retractor and pulled so I could see under the diaphragm.
I stuffed the lap packs all around the liver. Then I did the same on the left side, in the vicinity of the spleen. With cupped fingers, I scooped out the big clots that remained in the abdominal cavity. I jammed more packs all over the abdomen and into the pelvis, until everything was wedged tight. No blood vessel was pumping that I could see.
We could stop and take a breath.
“Are we catching up on blood?” I asked Ronaldo.
“We never catch up,” he said. When I kept staring at him, he shrugged; he nodded at his dials as if to say things were no worse than when we began—that's what I hoped he had said.
Now I carefully removed the packs, starting with the spots where the bleeder was least likely to be. The pelvis was clean—no gusher there. Off came the pack around the spleen. If the patient's belly was a room, the furniture—the most movable, central structures—had been pulled out so we had a good view to the rear. If there was a bleed from a torn aorta or its branches, then this back wall of the abdomen—the retroperitoneum—would have shown a big ugly swelling, a hematoma. But that was clean, too.
I had a premonition that we would find the bleeder behind the liver. A place full of shadows, hard to see or fix. This was where the inferior vena cava, the largest vein in the body, carried blood back from the lower limbs and trunk, running through and behind the liver on its way to the heart. While coursing through the liver, it picked up the stumpy, taut hepatic veins that drained that organ.
I took the pack away from the liver. Nothing.
I gently pulled the liver forward, to look at its dark side.
An angry gush of blood filled the empty bowl of the abdomen. I hastily pushed the liver back, and the pumping ceased. Things were all right as long as we didn't touch the liver. What was it that Solomon, operating in the bush, had called this? The injury in which the surgeon sees God.
“Okay,” Deepak said, “let's leave it like that.”
“What now?”
“He's oozing from the skin incision and from all the IV sites. His blood isn't clotting.” Deepak had a soft voice, and I had to lean over to hear him. “It's inevitable with this much trauma. We open them up, pour fluids into them, and the body temperature drops … We have diluted the clotting system so it stops working. Let's pack around the liver and get out. Put him in ICU where we can warm him up, give him more fresh frozen plasma and blood. In a couple of hours, if he's alive, if he is more stable, we can come back.”
I sandbagged the liver and fed the small bowel back into the wound. Instead of suturing the skin, we used towel clips to hold the wound edges together.
“The transplant teams will be here to harvest the corneas, heart, lungs, liver, and kidneys from the man he shot,” Deepak said. “This theater is bigger, and I'll let them have it.”
IN THE INTENSIVE CARE UNIT, two hours later, the oozing from the puncture wounds ceased. The cluster of poles and machinery around the bed made it tricky to get near Shane Johnson Jr.—that was his name. His family was in the waiting room, trying to fathom the unfathomable. Fresh frozen plasma, warmed blood, and fluids had given Junior a recordable blood pressure and a respectable temperature. He was alive, but just barely.
“Okay,” Deepak said after reassessing the patient, and looking at the clock. “Let's go take another look.”
This time we were in the smaller operating room. Ronaldo was still all gloom. Junior's face and limbs were puffy, his capillaries leaking out what was being poured into him. But we still had to pour fluid in to keep a blood pressure—it was like keeping a bucket full despite the holes in its side.
Deepak insisted that I be on the patient's right again. It took just seconds to remove the drapes, swab his skin, and pop open the towel clips that held the skin edges together. I removed the packs.
Deepak guided my fingers to the stalk of vessels that led into the liver. “Okay,” he said. “Squeeze there.” This was the Pringle maneuver. I squeezed, choking off the blood supply to the liver, while Deepak removed the last pad and lifted the liver forward. Blood gushed out at once, turning the dry clean field into a sopping red mess.
“Okay, you can let go,” he said, pushing the liver back. “That's what I was afraid of. The vena cava is torn for sure. That's why, even with the Pringle maneuver, it still bleeds.”
In some people, the inferior vena cava barely indents the back of the liver. In our patient, the vena cava was swathed by liver like a pig in a blanket. When Junior went airborne, then hit the pavement, his liver kept traveling; its momentum tore the short veins that anchored it to the vena cava, leaving a jagged rent.
Deepak asked for a suture on a long needle holder. At his signal I pulled the liver forward, and he tried to put the needle in one end of the tear. But before he could even see it, the field was awash with blood.
“God,” I said, violating a cardinal rule about keeping quiet when assisting, “how do we fix this?”
Deepak said, “Oh, it's easy to repair the cava—it's just that the liver is in the way.” It took me a second to realize this was as close as Deepak came to joking during surgery.
He was silent for a good while, almost in a trance, and I tried not to make a sound. At last, like a priest finishing a prayer, he moved. “Okay,” he said. “It's a long shot. Let's switch sides.”
I was unprepared for what followed. All I could do was marvel and be the best second pair of hands that I could be. Deepak swabbed Junior's chest, then cut vertically down over the breastbone from top to bottom, then ran an electric saw in the same groove. The smell of burning flesh and bone hung in the air. Suddenly the chest popped open like an overstuffed suitcase.
I didn't ask what he was doing. He didn't explain. My exposure to chest surgery had consisted mostly of draining fluid collections outside the lung or, rarely, watching Deepak resect a cancerous lobe. Three times during my internship we had cracked the chest and oversewn a stab injury to the heart. One of the three survived. This was one of the deficits in our program, one of the reasons we were being shut down: we had to ship off much of the thoracic surgery, not to mention much of the urology and plastic surgery, to other hospitals.
Junior's heart, a fleshy, yellow-streaked mass covered by the pericardial sac, was exposed, pumping away, as it had done for all his nineteen years. It had never been more threatened. Deepak cut open the pericardium.
I was aware of activity in the operating room behind me and in the scrub area that was shared. At one point, I looked around, and through the three sets of windows, I saw a crowd of white faces around the other operating table.
Deepak put a purse-string suture around the right atrium, the upper chamber of the heart that received blood from the vena cava. He took a chest tube and cut side holes in it with scissors. Now he made a nick in the atrium of the heart, in the center of his purse-string suture. Then he slid his newly fashioned tube into the atrium, using the purse string to cinch the tissue around the tube which he pushed down through the orifice of the inferior vena cava, and down to where our problem was.
“Tell me when it reaches the level of the renal veins,” he said.
I saw the inferior vena cava distend, like a garden hose filling with water. “Now,” I said.
“The tube serves as a stent for the inferior vena cava,” Deepak said, leaning over to look from below. “It's also a crude bypass so blood from the trunk can return to the heart while we make the repair. Now … let's see if we can fix this.”
He adjusted the overhead lights. When I lifted the liver, the bleeding was much less than before, and what's more, the torn edges of the vein were visible on the backdrop of the tube. Deepak grabbed one edge of the tear with long forceps and passed the curved needle through and then grabbed the other edge, passed the needle through that and out, and tied a knot. I let the liver back down. It was a laborious process: lift, grab, pass needle, mop, pass needle to other side, mop, tie, relax the pull on liver.
At some point, just as were nearing completion, I sensed someone at my shoulder. Deepak glanced up but did not say anything.
“Is that a Shrock shunt, son?” a voice behind me said. It was a male voice, polite enough, conscious that it was a delicate moment to intrude, but with the authority of one who is entitled to ask.
Deepak looked up again, then back to his work. “Yes, sir,” he said.
“How big was the tear?”
Deepak pulled up the liver and adjusted the overhead light so the visitor could see. “It was three-quarters of the way around the cava.” The tube hed pushed down from the heart made a lovely internal splint for the vein, and running across it like a crease was the first part of Deepak's neat repair. It was a beautiful sight, order restored from chaos.
“Very impressive,” the voice said. There was no sarcasm, just genuine admiration. I stepped back so the visitor could have a better look, and when I did, he leaned in. “Very, very nice. Id put some gel foam around the raw area of the liver. Were you planning to leave some drains?”
“Yes, sir.”
“I'm assuming you are the attending physician?” the voice said.
“No, I'm the Chief Resident. My name is Deepak.”
“Where is your attending?”
Deepak met the speaker's eyes, and said nothing.
“I see. Not one to get out bed for this sort of thing. Do you ever see him?”
As if in reply, Ronaldo snorted and turned to his dials, feigning disinterest. The visitor looked to Ronaldo and seemed about to bite his head off, but then remembering this wasn't his theater, he didn't.
“And how many Shrock shunts have you done before, Deepak?”
“This is my sixth.”
“Really? In what period of time.”
“In two years here … Unfortunately we see a lot of trauma.”
“Unfortunate, yes. But fortunate for us. We are not ungrateful … Still, six Shrocks, did you say? Remarkable. How have they done?”
“One died, but a week after the surgery. He was walking, eating. Probably a pulmonary embolus.”
“Did you get an autopsy?”
“Partial. The family allowed us to reopen the belly. The repair to the cava looked good. We took photographs.”
“And the others?”
“Second, third, and fifth are alive and well, six months after the operation. Fourth died on the table before I got this far. I had just opened the heart.”
“Do you count that one?”
“I should. ‘Intention to treat’ … that counts.”
“Good man. You should count it. Most surgeons wouldn't. And your sixth?”
“This is him,” Deepak said.
“Right. Well, that's better than my experience. I've done four. That's over six years. They all died. Two on the table, two so close after surgery that it was as good as dying on the table. They weren't all trauma like this. Two were tears from someone trying to remove an adherent cancerous mass. You ought to write up your experience.”
Deepak cleared his throat. “With all due respect, sir. I have. No one will publish a report from Our Lady—”
“Nonsense. What is your full name?”
“Deepak Jesudass, sir. This is my intern—”
“I tell you what, write up this case and add him to your series, and then let me take a look at your paper. If it's good, I'll see that it gets published. I'll send it to the editor of the American Journal of Surgery. I'll check with you to see how this patient does. Good luck. By the way, my name is—”
“I know who you are, sir. Thank you.”
The visitor must have been walking away when Deepak said, “Sir? … If you were to … never mind.”
“What is it, man? I have a cadaver organ that I should have in the air by now. I just stopped to admire your work.”
“If you were to show us how to harvest the liver … we could start it for you, save you time.”
I tried to turn around to look, but because I was holding a retractor, I couldn't.
“I don't trust anyone else to do it,” the voice said. “That's why I do it myself. My chief residents don't have the skill … Smart boys, but they don't get the volume you have in a place like this.”
“We get the volume. And they are shutting us down.”
“What? I had heard some such rumor. I heard Popsy … True?”
Deepak just nodded.
“This is your fifth year?” the voice said.
“Seventh. Eighth. Tenth. Depends how you count, sir.” He didn't mention his training in England.
He didn't need to, because the visitor said, “I hear a Scotch inflection. Were you in Scotland? Took your FRCS?”
“Yes.”
“Glasgow?”
“Edinburgh. I worked in Fife. All over there,” Deepak said.
There was a profound silence. The man behind me hadn't moved. He seemed to be considering this.
“What will you do if they shut down?”
Deepak dropped his eyes. “I'll just keep working. Probably here. I love surgery …”
After an eternity the voice said, “Deepak Jesudass, with a J?” And then he spelled it out. “Did I get that right? Come see me in Boston, Dr. Jesudass. We'll pay your fare. I'll arrange for you to come up to my dog lab. We'll get you going. If anyone can harvest for me, you probably can. When you come up we'll visit at length. Have to run now. Good work, Deepak.”
We heard the door swing behind him.
We worked in silence. At last, Deepak said, “He heard my name just once … and he was able to repeat it.” Deepak's repair was done. He was closing up now, as carefully and efficiently as he had opened. He asked for gel foam from the scrub nurse. “In all my years here, no one's been able to remember my name when I'm introduced. No one has bothered. They usually see us as types, not as individuals.”
His shoulders were straighter, his eyes bright and glowing. I'd never seen my Chief Resident like this. I was happy for him, and proud.
“Who was that?” I said, at last unable to contain my curiosity.
“Call me old-fashioned,” Deepak said, “but I've always believed that hard work pays off. My version of the Beatitudes. Do the right thing, put up with unfairness, selfishness, stay true to yourself … one day it all works out. Of course, I don't know that people who wronged you suffer or get their just deserts. I don't think it works that way. But I do think one day you get your reward.”
“Did you know him?” I said again.
Deepak sidestepped my question and turned to the circulating nurse.
“Did that particular team come for liver or heart?”
“Liver. Another team took the heart and ran.”
Deepak smiled and turned to me. “Marion, I'm not a hundred percent sure, because of his mask; had I seen his fingers I could have been certain. But I have a pretty good idea. You just met one of the foremost liver surgeons in the world, a pioneer of liver transplants.
“What's his name?”
“Thomas Stone.”
IBELIEVE IN BLACK HOLES. I believe that as the universe empties into nothingness, past and future will smack together in the last swirl around the drain. I believe this is how Thomas Stone materialized in my life. If that's not the explanation, then I must invoke a disinterested God who leaves us to our own devices, neither causing nor preventing tornadoes or pestilence, but a God who will now and then stick his thumb on the spinning wheel so that a father who put a continent between himself and his sons should find himself in the same room as one of them.
As a child Id longed for Thomas Stone or at least the idea of him. So many mornings I waited for him at the gates of Missing. I saw that vigil now as necessary, a prerequisite for my insides to harden and cure just like the willow of a cricket bat must cure to be ready for a lifetime of knocks. That was the lesson at Missing's gates: the world does not owe you and neither does your father.
I hadn't forgotten what Ghosh asked of me. Let's just say I'd set it aside. I didn't feel guilty about not following through; I never had time to seek out Thomas Stone, and moreover, wherever he was, I never felt as if I was in his America. I was on an island, a protectorate, a territory that America claimed only in name. In carrying his textbook with me from Addis to Sudan and Kenya and then to America, I had developed a grudging respect for the author. I told myself that the book was my touchstone to Sister Mary Joseph Praise: I saw her hand in the line drawings and I carried the bookmark with her handwriting in my wallet. I'd discovered Thomas Stone in the text, just as he must have discovered himself in the discipline of making notes in a landscape of disease and poverty overcoming his fatigue to fill exercise books with his observations. I was convinced that it was the accumulation of these journals that he pulled together to form a textbook. In doing so, he made his knowledge incarnate.
But when that writer, the sole living author of my DNA, stood peering over my shoulder, it was flesh that became incarnate, flesh of my flesh, with a scent that I should have recognized as kin and a voice that was my inheritance. When he leaned over the patient's belly to see our handiwork, cocked his skull on the atlas and axis vertebrae just so, tucked his arms to his chest, his scapulae gliding out, making himself small so as not to contaminate our field—those movements were echoes of my own.
Surely Thomas Stone sensed some disturbance in the universe and that is why he appeared in our theater. I confess when I didn't know who he was, I felt nothing: no aura, no tingling, nothing other than pride in the miracle Deepak had performed with PVC tube and the uncommon skill in his hands, a skill that the stranger appreciated. When I learned our visitor was Thomas Stone, I was unprepared. Should my first reaction have been anger? Righteousness? I had missed my chance to react while he was there. But now, for the first time since childhood, I wanted to do more than study his nine-fingered portrait. I wanted to know about the living, breathing surgeon who had stood next to me.
In the days that followed, I looked up Thomas Stone in Index Medicus in our library, pulling down one by one the oversize volumes, beginning with 1954, the year of my birth. I wanted to know about the post– Short Practice Stone; I wanted to see what scholarly contributions he had made after leaving the tropics. Ours was a small library, but Popsy had donated his collection of surgical journals dating back to the fifties. I found most of the papers listed in Index Medicus.
In my notebook I plotted out Thomas Stone's scientific career as reflected in his published work. In America his interest was liver surgery, and his career was interwoven with the history of transplantation, with the audacious idea of taking an organ from Peter to save the life of Paul. The story began well before Stone, of course, with Sir Peter Medawar and Sir Macfarlane Burnet in the 1940s, who showed us how the immune system recognizes “self” from foreign tissues and rejects and destroys the latter. Two months before our birth, Thomas Stone published a letter to the editor of the British Medical Journal describing the extraordinary length and redundancy of the colon of many Ethiopians, which he believed explained why it so readily twisted on itself—a condition called sigmoid volvulus. By 1967, when Christian Barnard in Cape Town's Groote Schuur Hospital re placed Lewis Washkansky's scarred and diseased heart with the heart of young Denise Darvall, killed in a car wreck, my father, now in Boston, had become interested in liver resection. His research question was, how much liver could you cut away and still leave enough behind to sustain life?
The transplant field in America was led by a brilliant surgeon— another Thomas, this one with the last name of Starzl. Working in Colorado, Starzl did the first human liver transplants in ‘63 and ‘64, but neither patient survived. Thomas Stone of Boston, the footnotes will show, also tried and failed in ‘65. Despite increasing public criticism, Starzl didn't give up. He performed the first successful liver transplant in 1967. Soon others, Thomas Stone included, managed the same feat. It was still very high risk, but by publishing their experience with such tricks as bypassing portal blood to the superior vena cava during the long surgery, or using the “University of Wisconsin solution” to better preserve cadaver livers, results were improving. The problem was no longer technical, even though this was the most technically difficult operation anyone could perform, the equivalent of a pianist playing Rachmaninoff's “Rhapsody on a Theme by Paganini,” except that one dare not miss a note or fluff a phrase. The operation lasted ten, sometimes twenty hours. Starzl showed it could be done. The two new hurdles were finding sufficient organs to transplant, and of course the problem of rejection of the transplant by the immune system.
In 1980, the year of my internship, Starzl turned his attention increasingly to rejection, focusing on a promising new drug that Sir Roy Calne's group at Cambridge discovered—cyclosporine.
THOMAS STONE TOOK a different approach; he focused on the problem of the shortage of organs and pursued a solution that most others considered a dead end: removing part of a liver from a living healthy parent and giving that to a child whose liver was failing. At least in dogs, he found the liver grew in size to compensate for its loss, while the transplanted segment of liver sustained the recipient. But splitting the donor's liver introduced complications such as bile leaks and clots in the hepatic artery that feeds the liver. It also put a healthy donor's life in real jeopardy, as the liver, unlike the kidney, is unpaired. Even more promising and immediately useful was Stone's work using animal liver cells, trying to strip the cells of those surface antigens which made humans cells recognize them as foreign, and then grow them in sheets on a membrane and use them as a sort of artificial liver—a dialysis type of solution.
As I read about transplants, I was excited. It was clearly one of the most compelling stories in American medicine.
JUNIOR WAS THE CENTER of attention in our ICU. He was deeply sedated, eyeballs roving under closed lids. The kind of trauma hed been through resulted in “shock” lung, or Da Nang lung (recognized in GIs who were resuscitated on the battlefield, only to develop this strange lung stiffness), along with kidney shutdown. According to B. C. Gan dhi's rules, if you had more than seven tubes in you, you were as good as dead. Junior had nine. But one by one, over the weeks, the tubes came out and he got better. It required meticulous nursing care, and Deepak and me poring over his daily flowcharts, anticipating his needs, and intervening with ongoing problems. J.R., as his family called him, left the ICU for a regular room after forty-three days. A week later, smiling sheepishly, he walked out on his own steam with the ICU and trauma teams lined up on either side of the hospital entrance to cheer. If hed shot someone, the witnesses had all vanished, and the police had lost interest, so J.R. was going home. I think it was the sight of J.R. walking out of the hospital that set me on course as a trauma surgeon. His kind of recovery was by no means a rule in trauma surgery, but it happened often enough, particularly in those who were young and previously healthy, that it made the heroic efforts worthwhile. The mind was fragile, fickle, but the human body was resilient.
AS INTERNS we were allowed to attend one national conference, all expenses paid. I chose a liver transplant conference in May in Boston. I arrived on a lovely spring day. Boston's downtown fit every notion I had of what colonial America was like, and it felt steeped in history, completely different from my section of the Bronx. I told myself that it was coincidence that the conference was in Boston, walking distance from where Thomas Stone worked. I told myself I wasn't there to meet Thomas Stone, but to hear the keynote speaker, Thomas Starzl. As for Thomas Stone's plenary session—I was undecided about attending.
The morning of the conference I could no longer lie to myself. I skipped the transplant meeting and walked the six blocks to the hospital in which Thomas Stone had worked all these years. After wearing scrubs for almost a year, my suit and tie felt strange, as if I were in fancy dress.
“Send them to Mecca” was an expression we used when we dispatched patients to places that offered what Our Lady of Perpetual Succour could not. It was a common medical expression in hospitals all over America, when sending patients to any of the top referral places in the country—Id even seen it in letters to the editor in the medical journals. Now I was going to Mecca.
“MECCA” CONSISTED OF a spanking-new hospital tower, weirdly shaped and shining as if it were made of platinum. It was the kind of structure architects compete to build. From a patient's perspective, it didn't look welcoming. The tower hid the older brick sections of the hospital, whose architecture felt authentic and aligned with the neighborhood.
“Good morning, sir,” a young man in a purple jacket said to me. I glared at him, thinking he was being sarcastic. Then I realized that he and two others stood there ready to park cars and assist patients into wheelchairs.
The revolving doors led to a glass-walled atrium, the ceiling extending up at least three stories and accommodating a real tree. A grand piano played itself by some mysterious mechanism. Around it were plush leather chairs, lamps. Beyond this was a waterfall trickling gently over a slab of granite. Then a reception desk where a concierge, one of three, looked up, smiling, eager to help. I followed the blue line on the floor to the elevators of Tower A, which took me to the Department of Surgery on the eighteenth floor, just as she said it would, but I made no promise about having a nice day. I found it difficult to believe I was in a hospital.
When I emerged from the elevators I was met by five men and one woman of my age, all dressed in dark suits, chests labeled with visitor tags exactly like mine. “We're supposed to wait here,” the woman said to me, helpfully.
Just then a young man, a white coat covering his blue scrubs, approached. “Sorry I'm late,” he said, not sounding sorry at all. “Welcome to the Department of Surgery. My name's Matthew.” He grinned at us. “God, a year ago I was in your shoes, interviewing for my internship. Time flies! Love the suits! Okay, we have about twenty minutes before morbidity and mortality conference. I'll give you a quick tour of the Department of Surgery. After M&M you'll have lunch with the house staff, then your individual interviews begin, and then the grand tour of the hospital. When I get you to the conference room, I'll break off. One of my patients is being presented at M&M. I have to go strap on the body armor.”
In the year I'd been at Our Lady of Perpetual Succour, I had yet to take any potential intern recruits around. Indeed, I'd never seen anyone come to be interviewed. At Mecca this was a weekly event. I tagged along.
The individual on-call rooms had a television on the wall, a fridge, a nice desk, and an attached bathroom; it was a far cry from Our Lady's solitary on-call room crammed with bunk beds, with just one phone and interns from all the specialties expected to bed there; I never used it. Next, Matthew showed us the “small” conference room where the Mecca surgical team held their morning report. It looked like a corporate boardroom with high-backed leather chairs around a long table. Oil portraits of the past chairmen of surgery stared down from the walls, a who's who of surgery.
“Check this out,” Matthew said, pushing a button. Screens came down behind the curtains to black out the room, and a projector rose out of what I took to be a coffee table. Constance, the woman in our group, rolled her eyes as if she thought this was so gauche.
When we arrived at the auditorium where morbidity and mortality conference was to be held, Matthew excused himself. “I have to change out of scrubs. Dr. Stone is a stickler for that. He doesn't even like scrubs on rounds.”
The auditorium was a small version of the Cinema Adowa in Addis, only with better seats, upholstered in a nubby beige fabric that felt smooth to the touch. A steep incline made the view from the back excellent, and this is where we prospective interns sat. A bank of motorized X-ray viewing panels was built into one side of the wall behind the podium. A resident stood loading films, stepping on a pedal to advance panels.
Constance sat next to me. A gaggle of medical students in short white coats filed in and joined us in the back. I'd forgotten about the existence of medical students. How nice it would be at Our Lady of Perpetual Succour to have someone below me on the food chain. The residents wore longer coats, and their expressions were not as carefree as the students’. The attending physicians wore the longest coats and were the last to come in. We interviewees in our dark suits stood out like penguins at a polar bear convention. In all my time at Our Lady, we never had this kind of an assembly. Deepak got us together regularly for coaching sessions, but one sensed a tradition in this room, a way of doing things that had not changed for decades.
“So what school are you from?” Constance asked. Id overheard her say she trained in Boston, but it wasn't at this institution.
“I went to school in Ethiopia,” I said. If she could have moved one seat over, she probably would have.
Thomas Stone didn't look at the crowd when he walked in; he assumed their presence. He was taller than I'd realized from seeing him in the theater, almost as tall as Shiva or me. The room turned quiet. His hands were in the pockets of his white coat. The way he slid into his seat, the ease and fluidity of that motion, reminded me of Shiva. He was alone in the front row. I was well behind him but off to one side, so I could see his profile. This was my first good look at my father. I felt my body grow warm; it wasn't possible to study him dispassionately, clinically. My mind was racing, my heart pounding—I worried that I was giving away my presence. I looked away to try and calm down. When I looked back, Stone was studying a paper in his hand—it was hard to tell he was missing a finger. His hair was quite gray at the temples, but still dark brown on top. His masseter muscles stood out, outlining his jaw, as if he habitually clenched his teeth. The one eye socket that I could see was a recessed dark hollow on his face. I noticed that he kept his head exceptionally still.
I CAN'T TELL YOU MUCH about the case being discussed or exactly what transpired. While I looked at Thomas Stone and sat next to the supercilious Constance, a slow fuse burned inside me and it was about to ignite. I was ready to hurl furniture, activate the ceiling sprinklers, scream obscenities, and disrupt this orderly meeting. I felt an impending loss of control. At one point I had to grab the arms of my chair as my rage peaked, and then gradually subsided.
“It was my fault,” Thomas Stone said, turning to face me. For a moment, I thought he was clairvoyant. He had heard me. Earlier, Matthew, our escort and the presenter of the case, came under harsh criticism from different quarters of the room. Matthew was only the messenger, but since his attending physician and the Chief Resident didn't come to his defense, he took the brunt of the attack. The snapping jaws were silenced when Thomas Stone stood up.
“Yes, it was my fault. Without a doubt we can do better surgically. I am installing a video camera in the two trauma bays. I want us to review the video after every major trauma that comes in. Were we standing in the right place? Did we take three steps to reach for an endotracheal tube when it should have been at hand? Did someone have to ask for something that should have been there? Did we distract each other with what we said? Who didn't need to be there? Is there a better way? That is always the challenge.” He pulled out a piece of paper from his pocket and unfolded it.
“I take responsibility also for something addressed in this letter.” His accent was faintly British, the years in America having softened it, but without accruing any jarring American inflections. The day he spoke to Deepak over my shoulder in the operating room at Our Lady, I hadn't registered a particular accent. “This letter came to me from the deceased patient's mother. I want to make sure that this does not happen again. Here is what she says: ‘Dr. Stone— My son's terrible death is not something I will ever get over, but perhaps in time it will be less painful. But I cannot get over one image, a last image that could have been different. Before I was asked to leave the room in a very rough manner, I must tell you that I saw my son was terrified and there was no one who addressed his fear. The only person who tried was a nurse. She held my son's hand and said, “Don't worry, it will be all right.” Everyone else ignored him. Sure, the doctors were busy with his body. It would have been merciful if he had been unconscious. They had important things to do. They cared only about his chest and belly. Not about the little boy who was in fear. Yes, he was a man, but at such a vulnerable moment, he was reduced to a little boy. I saw no sign of the slightest bit of human kindness. My son and I were irritants. Your team would have preferred for me to be gone and for him to be quiet. Eventually they got their wish. Dr. Stone, as head of surgery, perhaps as a parent yourself, do you not feel some obligation to have your staff comfort the patient? Would the patient not be better off with less anxiety less fright? My son's last conscious memory will be of people ignoring him. My last memory of him will be of my little boy, watching in terror as his mother is escorted out of the room. It is the graven image I will carry to my own deathbed. The fact that people were attentive to his body does not compensate for their ignoring his being.’ “
Thomas Stone folded the letter and put it away in his breast pocket. There was a rustle in the auditorium, a murmur, an uncomfortable shifting of body weight. I sensed a willingness in the room to shrug off the letter, to scoff at what it said, but Stone's demeanor made it necessary to conceal that urge. Stone stood there, silent, looking out, as if considering the letter's context himself, unaware of his audience. No one spoke. As the moment stretched on, even the smallest noises were stilled until there was only the hum of the air-conditioning. Thomas Stone's expression was reflective, certainly not angry. Now, as if waking up, he searched the room for a reaction, seeing if the writer struck a chord. The scoffers had reconsidered their position.
When Stone finally spoke, it was in a quiet voice that was firm and commanded attention. He asked a question.
I knew the answer because it was in his book, a book I'd read carefully and more than once in my voyage out of Ethiopia and during my stay in Kenya.
“What treatment in an emergency is administered by ear?”
Surely with about two hundred people in the room, at least fifty would know the answer.
No one spoke.
He waited. The discomfort grew even more acute. I could sense Constance stiffening next to me.
Thomas Stone spread his feet and put his hands behind his back. He appeared willing to stand there all day. He raised his eyebrows. Waiting. The students sitting to my left were too scared to blink.
Stone looked over to me, surprised to see a response from the row of dark suits. I felt his eyes bore into mine. It was only the second time he registered my being in this world; the first was when I was born. This time, I only had to raise my hand.
“Yes?” he said. “Tell us, please, what treatment in an emergency is administered by ear?”
All eyes were on me. I was in no hurry. None at all.
Then my sight turned misty as I thought of Ghosh and the sacrifice he'd made for us. Though he died of leukemia, it now felt to me as if he'd given up his life from the time we were infants so that Shiva and I should have ours. When he died, it was as if a second umbilical cord had been severed. I thought of Hema, widowed, now laboring alone with Shiva at Missing, writing to me to say that her heart was breaking not to have me there, and would I forgive her for not giving me the attention and love I deserved? And all through those years, Thomas Stone probably never missed an M&M conference, never had a day of discomfort over Shiva, or over me. I thought of Matron, holding Missing together, an active and loving godmother to two boys, an anchor in our lives, and I thought of Gebrew, Almaz, and Rosina, who had stepped in to fill the void of this man's absence.
How unjust it was that Thomas Stone's reward for his failings, for his selfishness, should be to preside in that chair and command the respect, the awe, and the admiration of the likes of Constance and others in this room. Surely you couldn't be a good doctor and a terrible human being— surely the laws of man, if not of God, didn't allow it.
I met his gaze and I did not blink. “Words of comfort,” I said to my father.
The intervening years lay compressed between us as if by bookends. The others in the room looked from my face to his, distressed, uncertain if mine was the right answer. But no one else existed for me or for him.
“Thank you,” he said, his voice altered. “Words of comfort.”
He left the room, but looked back at me once when he reached the door.
I FOUND WHERE HE LIVED by accident. An elegant condominium complex across the river would have been my guess. But at the base of Tower A, I saw a glass door leading to the outside. Across the street was the lobby to another building. I saw Thomas Stone enter and a doorman greet him. I waited. A few minutes later he emerged, without his white coat and with a yellow-and-black box in his hand—a slide carousel. He was on his way to the transplant conference. I gave him half an hour, and then I went up to the doorman. I flashed my badge. “I'm Marion Stone. Dr. Stone forgot some slides he needed for a talk he is giving. He sent me to pick them up.”
He was about to quiz me, deny me, but then he cocked his head. “You a relative?”
“I'm his son.”
“By God you are!” he said, coming closer to look into my eyes, as if that was where the similarity resided. He beamed as if the news vindicated him. As if it gave Thomas Stone a human dimension, a redeeming quality.
“By God you are!” He slapped his thigh in delight. “And not a word to us all this time.”
“He never knew till this year,” I said, winking.
“Joseph and Mary! Get out of here!”
I smiled and looked at my watch.
“You know where it is?” he said.
“Fourth floor?”
“Four-oh-nine.”
I ENTERED HIS HOUSE using my penknife and the sort of ancillary surgical skills only a B. C. Gandhi can teach you.
It was a one-bedroom apartment.
The living-dining room had nothing to justify that label. A large worktable like a draftsman's desk occupied most of that area, with two side tables at its ends to form a U. There were papers in neat stacks on the side tables. Sectional bookcases covered three walls and were full of books and papers. They weren't arranged for display but for access.
The coffeepot in the kitchen was collecting dust. The stove appeared never to have been used. A toaster on the counter had a trace of crumbs on the top. The refrigerator held only a carton of orange juice, a stick of butter, and a half loaf of bread.
His bedroom was dark, the curtains drawn. There were no books or papers here. Only an army cot, a blanket folded neatly at its foot, as if he were camping for one night.
A single framed snapshot sat on the mantelpiece above the electric fireplace. The airbrush technique of the 1920S gave mother and son alabaster skin. They were posed like Madonna and Child. The boy was perhaps three, ensconced in the lap of the woman who must have been my grandmother—a presence in the world I realized I'd never once thought about.
Next to the picture was a glass cylinder, filled with murky fluid. Closer inspection revealed a human finger floating in the liquid.
I had come there wanting to … to do damage.
That picture made me change my mind.
Instead, I opened all the kitchen cabinets and left the doors ajar. I pulled down the oven door. I opened both sides of the fridge. I took the top off the juice container. I opened the bathroom cabinets. I unscrewed toothpaste, shampoo, and conditioner, setting the tops carefully alongside the bottles. I opened anything that had a lid or a cover. I left open wardrobe, chest of drawers, filing cabinet, ink bottle, medicine bottles. I opened the windows.
In the center of his desk I placed the bookmark with Sister Mary Joseph Praise's writing on it.
I felt certain he had the letter my mother referred to. Now, in his home, I asked myself again: Where was it … and what did it say? I was tempted to ransack the place to find it but that would have spoiled what I had created.
I twisted open the formalin bottle, fished out his finger, shook it free of fluid, and put it next to the bookmark. I studied what Id done. I changed my mind about the finger. I put it back in the formalin bottle, capped it, and took it with me. It was only fair. After all, Id left him something of mine.
I propped the door open on my way out.
IT WAS TWO WEEKS LATER on a Sunday that I heard the knock on my door. We had beaten our archrivals from Coney Island at a limited overs match on their turf, coming away with the interhospi-tal cricket trophy Nestor had taken six wickets for twenty-five runs in a torrid spell of pace bowling, and four of those were by catches I took standing well behind the wicket. I had slipped away from the festivities in B. C. Gandhi's room, my fingers sore despite the keeper's gloves and my knees aching. I planned an early night.
“Come in,” I said.
He scanned the dark room, getting his bearings. If he saw the shadow of my bed, he didn't see me because he looked away, to the light leaking from under the bathroom door. Then to the curtained window. When he looked back I was sitting up. It gave him a start.
He shut the door and stood there, a man who had walked into his past.
I waited. I hadn't invited him here. The seconds ticked away and he showed no inclination to speak. I had to give him this: he tracked me down, he figured it out. Perhaps he did register my presence in the opera ting room the day he peeked over my shoulder. Perhaps in the auditorium when I answered his question he saw in my face features of my mother or of himself. How strange to spot a son you've never seen or thought of till the day he appears at morbidity and mortality conference and gives new meaning to that activity.
“You might as well sit,” I said. I didn't offer to turn on the light.
There was a chair beyond my bed. He walked forward quickly like a blind man who'd risk bumping into something rather than seem hesitant or ask for help. He sat down hard.
I didn't think he could see my face. I studied his. As his eyes adjusted, he looked at my possessions. I had more things than he did. If you didn't count books. I saw him linger on the framed print of the Ecstasy of St. Teresa—he must have recognized at once where that came from. Oh yes, and the finger in the jar. He knew he was in the right room.
The minutes passed. It was ten at night.
“Mind if I smoke?” he said at last.
“You don't smoke.” I hadn't picked up the smell of cigarettes in his condo. Just his scent, which my nostrils registered again.
“I do now … When did you start?”
His nose was pretty good. I took my time answering.
“Since coming here. It's a prerequisite for surgical training. Go ahead.”
He fumbled in his shirt pocket and brought out two cigarettes. I thought of Ali and his little souk, the only place I knew where you could buy loose smokes. In America you bought them in cartons or by the truckload.
He held a cigarette out to me. I stared at it. He was about to withdraw his hand when I took it. He flicked his lighter and stood to meet me as I swung my feet over the side of the bed.
His fingers shielded the fire, a nine-fingered sepulchre. I bowed to the flame and drew till my tip glowed.
Thank you, Father.
I sat back on the bed. He found an old Styrofoam cup in arm's reach. I took a thoughtful draw, passing judgment on his cigarette. It was a Rothmans, a throwback to his Ethiopia days, or, lest I forget, his British days. Rothmans was also what we puffed at Our Lady, courtesy of B. C. Gandhi, who got cartons at deep discount from Canal Street.
The smoke made sinuous shapes in the shaft of light leaking past the bathroom door. I remembered our kitchen at Missing and how the dust motes dancing in the morning rays formed their own galaxy. When I was a child, that sight had hinted at the wonderful and frightening complexity of the universe, of how the closer one looked the more one saw revealed, and one's imagination was the only limit.
“I don't expect you to understand,” he said, and for a moment I thought he was talking about the dust motes. The sound of his voice irritated me. Who gave him permission to speak? In my room?
“Then let's not talk about it.”
More silence.
He cracked first. “How do you like surgery?”
Did I really want to answer him? By answering, was I conceding something? I had to think about this for a few minutes. Let him sweat.
“How do I like surgery? Hmmm … I am lucky to have Deepak. He takes great pains with me. The basics, good habits. I think it is so important …” I clammed up then. I felt I had said too much. I detected in my tone a need for his approval, his affirmation—that was the last thing I wanted. I thought of Ghosh who became an accidental surgeon because of Stone's departure. He had no one to teach him. Ah, Ghosh! Ghosh's dying wish was that—
“I know some of the people Deepak trained with,” Stone said, interrupting my train of thought. Ghosh's message to him could wait. This wasn't the time. I wasn't in the mood.
“Oh, really?”
“I made inquiries about him. You are lucky.”
“But Deepak isn't lucky. He is going to get screwed all over again. In fact, we all are.”
“Maybe not,” he said.
I didn't pursue this. No favors, please. I wanted nothing from him. He squirmed in his chair, but not from discomfort. It was what he was holding back, waiting for me to ask. I would not give him the pleasure.
“I had a Deepak in my life,” he said. “All it takes is one. Mine was a Dr. Braithwaite. A stickler for the right way. I appreciate him more now than I did then. Despite him, after all these years, I find it extraordinarily difficult to …”
The words had dried up on his tongue. This was such an effort, a physical trial for him to converse. He wasn't a man who ever spoke like this, I didn't think. Sharing his inner thoughts wasn't something he had practiced. Not even with himself. I gave him lots of time.
“What? You find it extraordinarily difficult to … what?”
I should have just told him to leave. Here I was conversing, helping him along.
“I find it difficult to operate. Particularly elective surgery. I have anxieties.” He spoke slowly, drawing out his words. “No one knows. Even if I'm doing a hernia or a hydrocele … in fact the simpler the operation, the more likely this is to happen … I have to look up the surgical anatomy, go over all the steps in an operative book, even though after all these years I don't need to. I'm terrified I will forget. Or that my mind will go blank … Sometimes I throw up in the lounge. I feel sick, dizzy. It has never stopped. It made me consider giving up surgery. It's worse if it's someone I know, a hospital employee brings his mother …”
I thought of the surgical anatomy atlas I had seen in his condominium, a big folio book, and next to it an operative anatomy atlas, both open on his desk as if they were the last things he looked at before he left his apartment.
“What about the day I … the day of your morbidity and mortality conference?”
“Exactly. Early that morning I had to do a simple breast lump excision, and if the biopsy was positive, then a mastectomy and auxiliary node dissection. I've done hundreds of them. Maybe more. But this was one of our nurses. Someone putting faith in me.”
“So what happened?”
“I walked into the theater, feeling as if I were about to faint. No one knows, of course. The mask helps. But as soon as I make the incision, it all vanishes. Then it feels silly to have been so anxious. Ridiculous. It'll never happen again, I tell myself. But it does.”
“Did it ever happen in Ethiopia?”
He shook his head. “I think it was because I knew I was the only choice the patient had. There were no other options. Two other surgeons in the whole city. Here there are so many surgeons.”
“Or maybe those lives weren't as valuable. Natives, right? Who cares? The alternative was death anyway, so why worry? Just like you come and take organs from our patients at Our Lady.”
He flinched. I sensed that no one ever talked to him in this manner. We hadn't agreed to any rules. If he didn't like it, he could just leave. He had come to Our Lady. This wasn't Mecca.
He clamped his lips together. “I don't expect you to understand,” he said.
I knew he wasn't talking about his surgical anxieties.
He patted his pockets. He didn't find what he was looking for. So he just sat there and blinked, waiting for more punishment.
He slumped down in the chair. He had crossed his legs, and hooked his free foot under the calf of the other, like a twisted vine. “You see … Mar-ion—” He wasn't used to saying my name. “I … It is not as if everything can be explained by logic.”
Now he uncrossed his legs and leaned forward. “I can't give you a neat explanation about why … I did what I did, because I don't understand it myself. Even after all these years …”
Which “it” was he talking about? I had my daggers lined up, and my lances and mace ready just behind them. I thought of all kinds of clever things to say: Save your breath. Or, I understand all'right. You took the path less traveled. You bailed out. What else is there to understand? But perhaps he meant the “it” of impregnating my mother.
“Ghosh said you didn't know how it happened. That it was a mystery to you.”
“Yes!” he said, relieved, but then I sensed he was blushing. “He said that? Yes, it was.”
“Like Joseph? Clueless about Mary and the baby? Babies, in your case.”
“… Yes.” He crossed his legs.
“Maybe you don't think you are my father.”
“No, it's not that. I am your father. I—”
“No, you're not! Ghosh was my father. He raised me. He taught me everything from riding a bike to hitting a square drive off the back foot. He gave me my love for medicine. He raised me and Shiva. I am here because of Ghosh. A greater man never lived.”
I had baited the trap, lured him in. But I was the one who snapped.
“ ‘Lived’ … ?” he said, leaning forward, the foot no longer wagging.
“Ghosh is dead.”
His features turned leaden, then pale.
I let him ruminate on that. I'm sure he wanted to know how, why, but he couldn't ask. The news had stopped him cold, saddened him, I could see. Good. I was touched. But I wasn't done kicking him. I was impressed that he took it, waited for more.
“So you are off the hook,” I said. “I had a father.”
He sighed. “I don't expect you to understand,” he said again.
“Tell me anyway.”
“Where shall I start?”
“ ‘Begin at the beginning and go on until you come to the end,’ the King said, very gravely, ‘then stop.’ Do you know who said that?”
I was enjoying myself. The famous Thomas Stone being grilled, getting screwed, getting a dose of his own medicine. Sure, he could rattle off the branches of the external carotid artery, or the boundaries of the foramen of Winslow, but did he know his Lewis Carroll? Did he know his Alice in Wonderland?
He surprised me with his answer. It was wrong but it was right.
“Ghosh,” he said, and the air went out of his lungs.
WHEN THOMAS STONE WAS A CHILD, he asked the—the gardener—where little boys came from. The ma-alt, a dark man with muddy eyes and acid breath from the previous night's arrack, said, “You came with the evening tide, of course! I found you. You were succulent and pink with one long fin and no scales. Such fish they say only exist in Ceylon, but there you were. I almost ate you, but I wasn't hungry. I cut off the fin with this very sickle and brought you to your mother.”
“I don't believe you. My mother and I must have washed in from the sea together. We were one large fish. I was in her belly and came out,” the little boy said, walking away. The maali could coax roses out of the earth where their neighbors failed. But Hilda Stone would have fired him for telling such tales to her only child.
The little boy's home was just outside the rock walls of Fort St. George in Madras, India. The spire of St. Mary's poked up from behind the incomplete battlements. Its quaint, well-tended cemetery was his playground, a place where more than five generations of English men, women, and babies were buried, taken by typhoid, malaria, kala azar, and rarely old age.
Fort St. George was the first home of the East India Company. St. Mary's, built in 1680, was the first Anglican church in India (but by no means the first church, that being the one built in A.D. 54 by St. Thomas the Apostle, who landed on the Kerala coast). A plaque inside St. Mary's commemorated the marriage of Lord Clive, and another that of Governor Elihu Yale, who later founded a university in America. But the little boy saw no plaque to commemorate the marriage of Hilda Masters of Fife, tutor and governess, to Justifus Stone, civil servant in the British Raj and almost two decades her senior.
Thomas thought every child grew up as he did—in sight of the Indian Ocean, hearing the fearsome-sounding waves crashing around Fort St. George. And he assumed that all fathers were like his, crashing into furniture and making alarming sounds at night.
Justifus Kaye Stone's voice rumbled down from a height, and his bottle-brush mustache kept little boys at bay. District collectors in the Indian Civil Service were demigods, with secretaries and peons hovering around them like flies around overripe mangoes. Collectors went on tours for weeks at a time, holding court in each city. When Justifus Stone was home, despite his noisy presence, he was somehow not there. Thomas understood (in that way that children do, even though they lack words to express themselves) that Justifus was a self-centered man and neglectful of his wife. Perhaps this was why Hilda turned to religion. To imagine Christ's suffering allowed her to live with hers.
Blessed are the meek.
Blessed are the peacemakers.
Blessed the young governess who marries a DC hoping to clear his yellow-tinged skin of quinine and cure his taste for gin and native women, for hers is the kingdom of heaven.
Hilda's blessing came in the form of her blue-eyed, towheaded boy whose feet she hardly let touch the ground, even when he was old enough to walk.
The little boy's ayah, Sebestie, had nothing to do other than join in the play since it was Hilda who let him ride on her back pretending he was Jim Corbett, the big-game hunter, and she the elephant carrying him to the tiger blind. Hilda drew red-chalk wickets on the whitewashed walls and bowled to him with a tennis ball. She sang hymns to him, and fanned him when it was too humid to fall asleep. The bell-like clarity of her voice caused somnolent lizards on the wall to snap to attention. Her brown hair, parted in the center, fell from a steepled head. Regardless of how she restrained it, a frizzy halo framed her face.
In the middle of the night he reached for her and she was there. But on the nights Justifus Stone was home, the little boy slept poorly, fearful for his mother because those were the only times she left his bed. He kept vigil with his cricket bat outside the closed bedroom door, prepared to break in if the noises did not subside. They always did and only then would he retreat to his room. In the morning, when he opened his eyes, she would be back in his bed, awake and peering out through her fringe of hair.
Every child should have a mother of such even temperament, her rare displeasure evidenced so gently that the effect was lasting. Thomas lived to please his mother and he was earnest in his pleasing. It was as if they both knew, though they could not have known, that life was short, the moment fleeting.
HE WAS EIGHT when Hilda had to excuse herself from the St. Mary's choir. A cough that at first was like distant artillery soon sounded like nails rattling in a paper bag. Dr. Winthrop, an overdressed man who did not converse as much as make pronouncements, said mother and son were to sleep apart, “for the child's betterment.”
The little boy heard her nightly paroxysms from the other room and covered his ears with the pillows. “Undoubtedly consumption,” Dr. Winthrop said to Thomas one day, using a delicate word for tuberculosis as he put away his stethoscope and thermometer. “It has turned dry. The sicca form of phthisis, you know.” He talked to the little boy as if to a colleague and shook his hand with gravity. When would she get better? “Rest and diet and hydrotherapy,” said the doctor. “Some of the time— let's say, much of the time—it becomes quiescent. After all, it's not up to us, is it, Master Stone?” When Thomas asked, Please, sir, whom might it be up to, Winthrop raised his eyes to the ceiling. It was only later that the little boy understood the doctor did not mean Justifus, whose heavy tread shook the chandelier. He meant God.
One morning Thomas awoke dreaming of horse-drawn carriages, and with the thunder of hooves echoing in his ears. He discovered that in the night his mother had coughed up blood, lots of it, and Winthrop had been summoned. They bundled her off, not letting her kiss her son's brow. She traveled to Coimbatore, and from there the narrow-gauge toy train took her up the mountain to a hill station sitting just below Ooty. Dr. Ross had built a sanatorium in the Nilgiri Hills fashioned after Trudeau's famed Saranac Lake in New York. The white cottages around the hospital were replicas of those at Saranac, with the same airy porches and trundle beds.
Thomas wept himself to sleep on Sebestie's bony chest. He was angry with Hilda for getting sick, for having fostered such a closeness with him so as to make this separation unbearable. He was not like his schoolmates who loved their ayahs more than their parents and cared nothing about long separations. Overnight, Sebestie blossomed into a surrogate mother, but Thomas was wary of giving her his love. For then she, too, might disappear.
Before school Thomas visited St. Mary's and recited fifty Our-Father-Hail-Marys and did the same on his way back. He was on his knees so often that boggy sacs formed under his kneecaps. Around his neck he fastened with twine the heavy crucifix that had been on her wall, hiding it under his school uniform, where it gouged the skin over his breastbone and the twine cut into his neck. Not having a firstborn or a ram or ewe, he sacrificed his Don Bradman signature cricket bat, smashed it on the washing stone. He fasted till he was dizzy. He cut his forearm with a razor, spilling blood onto the shrine for the Virgin Mary that he built in his room. Sebestie took him to the Mambalam Temple and even to the tiny pavement temple behind their house. If it was up to God, He did not seem to listen.
Meanwhile his father never missed a stop on his circuit: Vellore, Madurai, Tuticorin, and parts in between. When Justifus Stone was home, he barely had time to remove his pith helmet or unpack his bags before he was off again. Justifus called his son the Archbishop of Canterbury, and if these were words of reassurance, they did nothing for Thomas. He spoke to his son as if he were addressing multitudes. At night Thomas could hear his uneven footsteps like those of a giant in a bedroom of Lilliputian dimensions who could not help knocking over furniture. It was a relief when Justifus went out on tour again.
A YEAR PASSED with Thomas living all but parentless in the big house, along with Sebestie, Durai (the cook), the maali, Sethuma (who washed clothes and swabbed the tile floors), and an untouchable who came once a week to clean the toilets—that was his family.
On Christmas Day, son and backslapping father came together for dinner; his father's clerk, Andrew Fothergill, was their sole guest. “Well, what a feast! Good to have you all. Fine repast, just fine. Eat, do eat”—this when it was just the three of them at the table, with Durai waiting behind the kitchen door. “We can't let them get away with it all. There is money to be made in coir. Rope, you know, or matting. We deserve, we earned it, I'll say, and by golly we are going to have it,” and on he went, barely stopping to swallow, the crumbs spraying from his lips. Fothergill tried valiantly to connect Justifus's thoughts, to give his superior's scattered remarks a spine, a thread of meaning. Justifus began to rub one thigh, then the other, fidgeting, glancing down with irritation as if the dog were underfoot, but of course she never came into the house when Justifus was around. By the time pudding was served the leg rubbing was so furious that Thomas had to ask, Please, sir, what is wrong.
“I have fur on me legs, son. Keeps me from feeling, it does. Ruddy nuisance.” His father struggled to rise, almost upsetting the table in the process. He stumbled out, grabbing sideboard and wall, his feet sticking like magnets to the floor. Thomas remembered Fothergill's look of consolation as the boy saw the guest to the door.
Jan. 20,
My darling son,
My temperatures were 36.7, 37.2. 37. 8, 37.3. I threw out the 38.6 because I didn't believe it. They roll our beds out to the porch, and back in at night. In and out. I'm not even allowed to go the lavatory. TOTAL BED REST, though the huge effort this requires seems to be against the idea of rest. I find it difficult to believe that on this porch, with the mist outside and the air so cold, that a body can generate a temperature over 36 degrees. No wonder we are called warm-blooded animals.
She had circled a splotch on the page and captioned it with “My tears, as I cry for you, my darling boy.” In each letter Hilda told him that he must be brave, and be patient.
TIME FOR THOMAS was no longer divided by days and nights or seasons. Time was a seamless yearning for his mother.
They say I have not made any great improvement but that I should be glad I am no worse …
He went through the motions at school. She exhorted him to pray, told him that she prayed every hour and that God listened and prayer never failed. He prayed constantly, convinced that at the very least the prayers kept her alive.
I know God did not mean to keep us apart, and soon he will bring us back together.
ONE DAY, Thomas woke to find his pillow moist. When Sebestie lit the lamp, there was the mark of the beast: a fine red spray on his pillow, a strangely beautiful pattern. Sebestie wept, but he was overjoyed. He knew this meant he would see his mother again. Why didn't he think of this sooner?
Two barefoot stretcher bearers in crisp white drill met his train in Ooty. They took him directly to Hilda's cottage. He climbed into her narrow cot, into her arms. He was eleven years old. “Your coming is the best and worst present I could ever have,” she said.
Gray and shrunk to her bones, she was a shadow of the mother he once knew. Her playfulness was gone, but then so was the reciprocity it might have found in this gangly son of hers whose eyes were haunted and ringed by worry lines. They sat side by side on the porch of their cottage, their fingers intertwined like dried roots. In the early morning they watched the tea pickers float by on the footpath, their feet hidden in the mist, their lunch pails creaking with every step. During the day only the nurses interrupted their solitude to take their temperatures and to bring tiffin and medications. By dusk, when they saw the tea pickers head home, it was time for sleep.
Since Hilda had no wind, he read to her. She wept with pride at his precocious fluency. The cane-bottomed lounge chairs had large armrests and a writing palette made of the same teak. Here they penned letters to each other, put them into envelopes, and sealed them; after lunch they exchanged envelopes, tore them open, and read their letters. They prayed at least three times a day. In the most bitter cold they remained outside, bundled up.
At first Thomas was light-headed from the altitude. He grew stronger. His cough lessened. But nothing—not fresh air, or milk, meat, or eggs or the tonics that were forced on her—helped Hilda. Her cough was different. It was a honking, bleating sound. He noticed that she had an exquisitely painful swelling at her breastbone, pushing up under her blouse. He was embarrassed to ask about it, and careful not to let his head rest there. Once, when she was undressing, he caught a glimpse. It was as big as a robin's egg but of a darker color. He assumed it was the consumption, the phthisis, the tubercle bacillus, the Koch's agent, TB, the mycobacterium—whatever name it had, it was a treacherous enemy ripening within her.
ONE EVENING as they lay next to each other, their beds pulled together, and as he read to her from the daily worship book, she exclaimed in surprise. He looked back at the sentence to see if he had missed a word. He looked up to see blood staining her white nightgown and spreading out as if she had been shot.
As long as he lived he would remember that in the awful moment when she realized she was dying, and when her eyes sought his, her first thought, her only thought, was about abandoning her son.
For a second Thomas was paralyzed. Then he jumped up and pulled aside the soggy blouse. A red geyser shot up from her chest and arced to the ceiling, then fell to earth. In the next instant it did it again. And again. A pulsing obscene blood fountain, timed to every beat of her heart, kept striking the ceiling, showering him, the bed, and her face with blood, soaking the pages of the open book.
He recoiled from the monstrous sight, this eruption from his mother's chest which painted everything around it red. When it occurred to him to try to staunch it with the bedsheet, the jet was already dropping in height, as if the tank were empty. Hilda lay soaked in her blood, her face white as porcelain and flecked with scarlet. She was gone.
Thomas cradled her soggy head, his tears falling on her face. When Dr. Ross arrived, a white coat thrown over his pajamas, he said to Thomas, “It was inevitable. That aneurysm has been ticking in her chest for over a year. It was just a matter of time.” He reassured Thomas that the blood was not infective—the thought had not crossed the boy's mind.
ALONE, TRULY ALONE, Thomas developed fever, and a cough. He refused to be moved from the cottage to the infirmary; the cottage was the last thing on earth to connect him to his mother. He let them take him for an X-ray. Later he watched Muthukrishnan, the compounder, arrive with a pushcart carrying the bulky pneumothorax apparatus in its polished wooden case. Muthu squatted on the balcony and, after wiping his face with a towel, he opened the wings of the fancy box and began unpacking the large bottles, manometers, and tubing. Dr. Ross, himself once a consumptive, soon cycled up. “The X-ray was no good, lad. No good at all,” Ross said.
It is just a matter of time, Thomas thought. He looked forward to joining his mother.
He didn't flinch as the needle went between his ribs posteriorly and into the pleural space that lined the lung, a space that was normally a vacuum, Ross explained. “Now we measure pressures.” He maneuvered the needle while Muthu fiddled with the two bottles, raising and lowering them on Ross's command. “This is ‘artificial pneumothorax.’ Fancy way of saying we put air in that vacuum that lines your chest to collapse the infected part of the lung, lad. Those Koch bacteria need their oxygen to thrive, and we won't give it to them, will we?”
Facedown, from the depths of his illness, Thomas thought this reasoning was illogical: What about my oxygen, Dr. Ross? But he said nothing.
For twenty-four hours Thomas had to lie prone, propped in position by sandbags. Muthu came by many times a day to check on him. Muthu noted the sudden fever and the chills. The artificial pneumothorax had introduced other bacteria into the pleural space around the lung. He heard Ross's voice from afar. “Empyema, my boy. That's what we call pus collecting around the lung. Doesn't happen that often in my hands, but it does happen. I am so sorry. Alas, the pus is too thick to come out with a needle,” Ross said.
For the operation they took him to a tiled room with high windows. It seemed bare but for a narrow raised table in the middle, over which was suspended a giant dish light resembling the compound eye of an insect. The place left a strong impression on the boy. It was otherworldly, hallowed ground, but still secular. The name “theater” was fitting.
Ross cut into the skin, under local anesthesia, just to the outside of the left nipple, then exposed three adjacent ribs and cut out short segments from them, thereby unroofing, or “saucerizing,” the empyema cavity. The pus had no place to collect. Despite the anesthesia, Thomas had moments of excruciating pain.
When he could speak, Thomas asked, “Won't an opening like that destroy the vacuum in the pleural space? Won't it cause air to rush in and the whole lung to collapse?”
“Brilliant question, lad,” Ross said, delighted. “It would collapse in anybody else. But the infection, the empyema, has stiffened the lining of your lung, made it thick and inflexible, like a scab. So in your case, the lung won't collapse back.”
For a week, pus oozed out onto gauze padding strapped over the hole. When it slowed to a trickle, Ross stuffed the wound with gauze tape, to cause it to “heal by secondary intention.” During dressing changes, Thomas studied his crater with a mirror, taking perverse pride in what it produced and the day-to-day changes as his body made repairs.
Ross was a short, cheerful man with the roundest and most forgettable of faces and the bow legs of a jockey. He always warmed the chest piece of his stethoscope in his chubby hands before letting the metal touch Thomas's skin. He percussed Thomas's chest, sounding it out skillfully. Ross pulled out the gauze and they peered into the crater. “You see the red, pebbly-looking base, Thomas? We call that granulation tissue. It will slowly fill up the wound and allow skin to form over it.” And that was exactly what happened. At one point the granulation tissue grew excessively, pouching out like a strawberry. “Proud flesh,” Ross called it. Holding a crystal of copper sulfate in his forceps, he rubbed it over the proud flesh, burning it back.
One day Ross brought him Metchnikoff s Immunity in Infectious Diseases along with Osler's Principles and Practice of Medicine. Metchnikoff was hard going, but Thomas liked the drawings of white cells eating bacteria. Osler was surprisingly readable.
In a life that was merely a prelude to death, Thomas found he looked forward to Ross's visit, to the short man's daily rituals. And yet he held back his affection for the doctor, because that was a recipe for loss. “I'm not going away, lad,” Ross said one day. “And since you are staying, why don't you join us on rounds.” Ross turned and left, not waiting for an answer.
WHEN ROSS PRONOUNCED him healed, Thomas had been at the sanatorium for a year and a half. During that time he never saw his father. Fothergill came twice, saying Justifus Stone was too ill to travel. Thomas asked Ross about the illness from which his father suffered. Ross said, “It's not tuberculosis, but something else.”
“To do with his legs?”
Ross tousled Thomas's hair. “Something punky, lad. Unfortunate, it is. He is bedridden. You'll learn in medical school,” he said.
It was the first time Ross had ever uttered the words “medical school” to Thomas. Thomas couldn't control the fluttering in his heart, as if a door had cracked open in his coal cellar, bringing in light, promising a future when he had visualized none.
ROSS, NOW OFFICIALLY THOMAS'S GUARDIAN, decided Thomas should go to boarding school in England. Thomas didn't even consider going to see his father in the infirmary in Madras before he sailed.
Two terms had gone by when Ross wrote to say that Justifus had died. A modest inheritance under Ross's guardianship would allow him to finish schooling and go to university.
Ross had led Thomas in the direction of medical school as if it were inevitable. Thomas had no reason to resist. Life thus far had convinced him of his aptitude for two things: sickness and suffering.
In medical school in Edinburgh, he lost himself in his studies, finding a stability and a sanctity missing before. He had no need to lift his head from his books, no desire to go anywhere but for classes or demonstrations. When his eyes tired, he went diffidently to the infirmary, hoping no one would throw him out. He got to know a house officer here, a senior student there, and before long, and well before his class had reached the clinical years, he was being pointed to interesting patients.
The hospital porter nicknamed him “the Lurker,” and Thomas didn't mind. In the organized chaos of the hospital, in the labyrinth of corridors, in the stink and confinement of its walls, he found both order and refuge; he found home. Misery and suffering were his closest kin.
A drunk named Jones looked eerily like his father; Thomas realized it was the waxy complexion, the swollen parotids, the loss of the outer third of the eyebrows, and the puffy eyelids of alcoholism that gave both men a leonine appearance. Now that he was trained to see, he put together the other clues he recalled: red palms, the starburst of capillaries on cheek and neck, the womanly breasts, and the absence of armpit hair. His father had cirrhosis. Perhaps that was the “punky” thing that Ross had been too polite to mention.
IT WAS SLEETING on a bitter cold evening in the Founders’ Library when the final piece came together, and when it did, Thomas slammed his book shut, alarming Mrs. Pincus, the librarian. The young man, who practically lived in the study carrel farthest from the fireplace, suddenly ran out into the spitting snow, hatless and distraught.
Thomas negotiated the long corridor leading to his room in the pitch-dark. Walking in the dark was something his father could not have done. The signals coming up from Thomas's toe and ankle and knee told him where he was in space, but in Justifus Stone those messages had been blocked in his spinal cord. His father's stamping, crashing gait, always worse at night when he no longer could see where his feet were planted—that was from syphilis of the spinal cord, or tabes dorsalis. No child should possess such knowledge of a parent.
The meandering conversation, the boastful tales at the dinner table, the delusions of grandeur—that was syphilis of the brain, not just the spinal cord.
Once in his room, Thomas stripped before the wardrobe mirror. With a second handheld mirror he examined every inch of his skin. No syphilids. No gumma on his skin. He listened to his heart but heard nothing unusual. He'd been spared congenital syphilis. But then he realized that his fear was absurd because congenital syphilis had to come through the placenta to him, it had to come from his mother. Absurd for him to worry. What his mother had was tuberculosis. Pure as the Virgin, his mother could never have had….
He cried out suddenly, the anguish of a child whose final illusion is stripped away. He understood at last.
It had been under his nose all this time. Tuberculosis didn't cause aneurysms like the one that killed her, but syphilis did. “Mother. Poor Mother,” he cried, grieving for her all over again. His father had murdered Hilda with his unbridled lust. She might have recovered from her TB, but she probably never knew she had syphilis until that aneurysm blossomed and began eroding painfully through the breastbone when she was at the sanatorium. Ross would have told her what it was. She knew. By that point neither salvarsan nor even penicillin, had it been available, would have been of any use.
WHEN THOMAS STONE BOUGHT his own cadaver in his final year of medical school, it was unheard-of, but did not surprise anyone. He was planning a second complete dissection, searching for mastery of the human body.
“Is Stone around?” was a common question in the casualty room, because he was the medical student who was more constant than Hogan or the other porters, always willing to stitch up a laceration, or pass a stomach tube, or run to the blood bank. He was the happiest of students when asked to scrub in and hold a retractor during emergency surgery.
One night, Dr. Braithwaite, Senior Consultant Surgeon and Chief Examiner for the Royal College of Surgeons, came in to see a patient with a high stab wound to the abdomen. Braithwaite was a legend for having pioneered a new operation for esophageal cancer, a notoriously difficult condition to cure. The patient, already inebriated, was terrified, abusive, and combative. Braithwaite, a compact man with silver hair, wore a blue three-piece suit that was the same shade as his blue eyes; he dismissed the porters restraining the patient and he put his hand gently on the man's shoulder and said, “Don't worry. It is going to be all right.” He kept his hand there, and the patient, staring at the elegant doctor, quieted down and stayed that way during the brief interview. Then Braithwaite examined him quickly and efficiently. When he was done, Braithwaite addressed his patient as if he were a peer, someone he might see later in the day at his club. “I'm glad to tell you that the knife spared your big blood vessels. I am confident you are going to do very well, so I want you not to worry. I'll operate, to repair whatever is cut or torn. We are going to take you to the operating theater now. Everything is going to be fine.” The docile patient extended a grubby hand of thanks.
When they were out of earshot of the patient, Braithwaite asked the entourage of registrars and house-officers, “What treatment is offered by ear in an emergency?”
This was an old saw, particularly in Edinburgh. Still, the old saws were not well known anymore, a matter that distressed Braithwaite greatly. He saw it as emblematic of a slackness in the new generation of trainees, and it was sad that only one person knew the answer. And that too a medical student, of all people.
“Words of comfort, sir.”
“Very good. You can come and assist me in surgery if you like, Mr. …”
“Stone, sir. Thomas Stone.”
During the surgery Braithwaite found Thomas knew how to stay out of the way. When Braithwaite asked him to cut a ligature, Stone slid his scissors down to the knot and then turned the scissors at a forty-five-degree angle and cut, so there was no danger to the knot. Indeed, Stone so clearly understood his role that when the senior registrar showed up to assist, Braithwaite waved him off.
Braithwaite pointed to a vein coursing over the pylorus. He asked Thomas what it was.
“The pyloric vein of Mayo, sir …,” Thomas said, and appeared about to add something. Braithwaite waited, but Thomas was done.
“Yes, that's what it's called, though I think that vein was there long before Mayo spotted it, don't you think? Why do you think he took the trouble to name it?”
“I believe it was as a useful landmark to identify the prepyloric from the pyloric area when operating on an infant with pyloric stenosis.”
“That's right,” Braithwaite said. “They should really call it the pre -pyloric vein.”
“That would be better, sir. Because the right gastric vein is also referred to in some books as the ‘pyloric vein.’ Which is very confusing.”
“Indeed, it is, Stone,” Braithwaite said, surprised that this student had picked up on something that even surgeons with a special interest in the stomach might not know. “If we have to give it an eponym, maybe call it the vein of Mayo if we must, or even the vein of Laterjet, which seems to me much the same thing. Just don't call it pyloric.”
Braithwaite's questions became more difficult, but he found the young man's knowledge of surgical anatomy to be shockingly good.
He let Thomas close the skin, and he was gratified to see him use both hands and take his time. There was room for improvement, but this was clearly a student who'd spent many waking hours tying knots one-handed and two-handed. Stone had the good sense to stick to a two-handed knot, tied well and with care, rather than showing off to Braithwaite with one-handed knots.
The next morning, when Braithwaite returned, he found Stone asleep in a chair at the bedside in the recovery room, having kept an all-night vigil on the patient. He did not wake him.
At year's end, after passing his final exams, when Thomas was appointed to the coveted position of Braithwaite's house officer, Shawn Grogan, a bright and well-connected medical student, found the courage to ask Braithwaite what he might have done to be selected instead of Stone.
“It's quite simple, Grogan,” Braithwaite said. “All you have to do is know your anatomy inside out, never leave the hospital, and prefer surgery over sleep, women, and grog.” Grogan became a pathologist, famous as a teacher in his own right, and famous for his extraordinary girth.
During the war, Thomas was commissioned. He traveled with Braith waite to a field hospital in Europe. In 1946, he returned to Scotland, became a junior registrar, then a senior registrar. He'd skipped a real childhood and gone directly to doctorhood.
Ross came to Scotland on a rare visit. He told Thomas how proud he was of him. “You're my consolation for never having married. That wasn't by choice, by the way—not being married. ‘Perfection of the life or of the work’—I could only do the one. I hope you don't make that mistake.”
Ross planned to retire near the sanatorium, to play rummy at the Ooty Club every night, to catch up on a lifetime of reading, and to learn to play golf with the retired officers who lived there. But just as he did, a cancer made itself known in Ross's good lung. Thomas returned to India at once. He stayed with Ross for the next six months, during which time the cancer spread to his brain. Ross died peacefully, Thomas at his side, the faithful Muthu, old and gray, on the other side, with the many nurses and attenders who had worked with Ross holding vigil.
The funeral brought Europeans and Indians from as far away as Bombay and Calcutta to pay tribute. Ross was buried in the same cemetery where many of his patients rested. “They are heroes, one and all, all those who sleep in this cemetery,” said the Reverend Duncan at the graveside service. “But no greater hero, and no humbler a man, and no better servant of God is buried here than George Edwin Ross.”
THOMAS TOOK AN APPOINTMENT as a consultant surgeon in the Government General Hospital, Madras. But after independence in 1947, things were not the same. Indians now ran the Indian Medical Service, and they were not excited by Englishmen who wanted to stay on, though many did. Thomas knew he had to leave; if it had ever been his land, it no longer was. And that was how, in response to a notice from Matron in the Lancet, he made his voyage on the Calangute to Aden. It was on that ship that Sister Mary Joseph Praise literally fell into his arms and entered his life.
Thomas Stone believed there existed within him the seeds for harshness, for betrayal, for selfishness, and for violence—after all, he was his father's son. He believed the only virtues passed down to him were the virtues of his profession, and they came through books and by apprenticeship. The only suffering that interested him was that of the flesh. For the heartache and the grief of his own loss, he had found the cure and he'd found it by himself. Ross had it wrong, or so Thomas thought: perfection of the life came from perfection of the work. Thomas stumbled on an address by Sir William Osler to graduating medical students in which the man articulated this very thesis:
The master-word is Work, a little one, as I have said, but fraught with momentous sequences if you can but write it on the tablets of your hearts, and bind it upon your foreheads.
“The master-word is Work.” Stone bound it to his forehead. He wrote it on the tablet of his heart. He woke to it and fought sleep for it. Work was his meat, his drink, his wife, his child, his politics, his religion. He thought work was his salvation, until the day he found himself seated in Our Lady of Perpetual Succour, in the room of a child he had abandoned; only then did he admit to his son how completely work had failed him.
HE STOPPED TALKING at this point. In the silence that followed, it seemed to me he was debating what to tell me next. When he resumed, I thought at first that he had leapfrogged over his years at Missing, dismissed the existence of my mother, and I nearly said something rude to interrupt him, but I'm glad I didn't, because what followed was all about her …
THE OAKS AND MAPLES outside the window of his room are wild men with their heads on fire. He shuts his eyes, but the view inside his eyelids is the same nightmare. His nerves are lancinating cables under his skin that send jolts of electricity to his muscles. He is so tremulous that when he brings a glass of water to his lips, he has spilled most of it before he can take a sip. He pukes his insides out, till he imagines the lining of his stomach is smooth and shiny like a copper pot. But the impulse to run is gone. He has put one or perhaps two oceans between him and the place he flees.
Eli Harris and another man, a doctor perhaps, judging by his detachment, leave him tincture of paregoric in a tiny bottle by the bedside. Thomas fails to see it at first, imagining that the peculiar scent of aniseed and camphor is a hallucination. But once he spies the bottle he drinks it as if it holds redemption. The antiseptic odor fills the room, and then it comes off his breath. It is the tiny amount of opium in paregoric that gives him some ease, or so he tells himself. Surely it isn't the alcohol base of the tincture. He is done with alcohol.
The only two women he has ever loved have died, and though one death occurred years before the other, they became superimposed in his brain. It made him lose his mind. He fled. He ran without knowing where to or what from. He has now run far enough. He has no memory of how he arrived in New Jersey from Kenya, except that he has a benefactor, Eli Harris.
A week passes, measured not in days, but in cold sweats and night terrors. It is two weeks before the agitation and the shakes ease, and before the ugly little invertebrates begin a retreat. For so long they have been on his skin and on the edge of his sheets, scurrying to the periphery of his vision when he turns to look at them. Now they retreat to the chitinous underworld from where they came.
There is bread and cheese by his bed, sitting on a newspaper that is two days old. The paregoric bottle is empty. A pitcher of water has been refilled. When at last he feels it safe to take his chair to the window, the leaves have gone from carrot to brick to crimson and every hue in between, a palette beyond the imagination of any painter. He sits there like a statue, grateful for being able to sit, to see things for what they are. Leaves spiral down, each descent unique and never to be repeated. A million voyagers leave their invisible trails in the air.
One morning he is steady enough to go downstairs. A sparrow hops on the warped wood of the porch, the varnish flaking under its feet. Stone sees the ginger kitten inching forward from the wisteria, its shoulder blades gliding like pistons under its fur. He wonders if he is hallucinating. The kitten's unblinking eyes are locked on its prey. The bird tilts its head like a coquettish woman to regard man and beast.
Just when Thomas thinks the tension is unbearable, the kitten pounces, but the sparrow hops easily to the railing and out of reach. Thomas feels something crack inside, releasing him from the torpor that stifled his movements and slowed his thoughts. He has emerged to a world where a sparrow's fate and that of a man can be decided in the blink of a cat's eye, such is the true measure of time.
HE KNOWS THE CEILING in his bedroom better than he knows his body. He has studied the molding. The decorative grooves are even in depth and width. He sees the handiwork of a craftsman. A clumsy amateur later subdivided the house with plywood partitions and with prefabricated doors. But the master's imprint is there to see.
At first he credits the paregoric for the curious phenomenon, but it continues after the paregoric is long gone: like a cinema projectionist he watches his life play out on the screen of the blank ceiling, or sometimes in the light playing on his window. He cannot control the content or order of the reels. What he can do is observe dispassionately, separate emotions from event, and judge the actor who plays him.
AN EARLY WINTER STORM comes over Ocean City and reaches inland by afternoon, first with freezing rain, crackling on the window, and then snow so heavy that when he stands outside it weighs down his eyelashes. It blankets northern New Jersey, five to six inches in as many hours. It shuts down interstates, airports, schools, and all commerce, but he knows nothing of this as he retreats to his room. Ice forms around the edges of his window, leaving a narrow prism through which to look onto a still and ghostly world. It is on this evening that he witnesses a scene from his life which makes him want to end it. He is seated on his bed, staring through that narrow breach in the frosted window. His mind is motionless and hushed like the landscape outside. The only thing that stirs is the ebb and flow of his breath, but even that seems to cease.
Then suddenly, he feels a quickening, as if the wearing away of brain cells has unroofed a lacuna of memory.
What spews out that winter's night is a vivid, colorful, and specific memory of Sister Mary Joseph Praise.
He is simply the observer, a man watching a bird, unaware of the feral cat lurking in the wisteria. This is what he sees, what he remembers:
Addis Ababa.
Missing Hospital.
Work.
He sees himself in the rhythm of operating, of clinics, of writing, forcing himself to sleep, his days full and satisfying. The weeks and months roll by. The master word. Work. And suddenly the machinery seizes …
(He thinks of this as his “Missing Period.” He prefers that to “breakdown.”)
It always begins the same way. He wakes from sleep in his quarters at Missing, wakes in terror, unable to breathe, as if he is about to die, as if the next breath will trigger the explosion. Though he is awake, the tentacles of dream and nightmare won't let go. A terrifying spatial distortion is the hallmark of this state. His bedroom in his quarters begins to shrink. His pen, the doorknob, his pillow—ordinary objects that normally do not merit a second glance—balloon in size. They become colossal and threaten to impale him, to suffocate him. He has no control over this state. He cannot turn it off by sitting up or moving around. He becomes neither child nor man, does not know where he is, or what scene he is reliving, but he is terrified.
Alcohol is not the antidote. It does not break the spell, yet it dulls the terror. It comes with a price: instead of straddling the line between wakefulness and nightmare, he crosses over. He roams in a world of familiar objects turned into symbols; he traipses through scenes of his childhood and through hell's portals. He hears a nonstop dialogue, like cricket commentary on the radio. That is the backdrop to these night terrors in Ethiopia. The commentator's voice is indistinct—sometimes it sounds like his own voice. As he drinks, he loses his fear but not his sorrow. He who has no tears in his waking now weeps like a child. He sees Ghosh—probably the real Ghosh, not a dream figure—standing before him, concerned, the Ghosh lips moving but the words drowned out by the commentator.
Then she is there. He cannot hear her words, but her presence is reassuring, and ultimately, only she stays, only she keeps vigil. She must have been asleep when she was summoned, because she wears a head scarf and a dressing gown. She holds him to her when a new wave of tears appears, and she cries with him, trying to rescue him from his nightmare but, in the process, she gets sucked in. (Every time he recalls this, there is a stirring in him.) In their work together, they share an intimacy that involves the body of another who lays between them, unconscious, naked, and exposed. But this weeping in her arms is shockingly different from their gowned forearms brushing or heads bumping during surgery. Separated as they are by an operating table for so many hours a day, when she holds him, the absence of the table, or of the mask, or the gloves, is startling. He feels like a newborn placed against its mother's naked belly. She whispers in his ear. What does she say? How he wishes he could remember. It sounds improvised, not a formal prayer. It succeeds in blunting the commentator's voice.
He remembers her blouse, damp with his tears—no, both their tears.
He remembers clinging to her, pressing his face to her bosom, sleeping, waking, clinging, weeping, sleeping again. She asks again and again, What is it? What is it that has come over you? For hours, days, who knows how long, she stays with him as he holds on for dear life, the storm raging, battering him, trying to pry him out of her grasp.
He remembers a lull, a startling silence which is a change in the pattern. Her blouse has opened.
Like a surgeon working to develop a tissue plane under the incision, he wills the blouse to open farther, and perhaps his nose, his cheeks, help it along. Her nipples stir from the coins on which they lie, and now her breasts escape her blouse to meet his lips. Her face must be a mirror of his because what he sees in it is fear coupled with desire.
She hovers over him, naked, her breasts full and reassuring, tears of relief on both their faces, their kisses devouring each other to make up for time lost. Then he is above her, and she looks up at him as if he is the Savior. When he enters her, he is anchoring himself to her goodness, a goodness and innocence he lost so young, from which he has drifted away, and which he vows never to let go …
Sitting on his bed in his New Jersey exile, the world outside muted in a canopy of snow, his heart is racing, a dangerous tachycardia, his shirt soaked with sweat despite the cold. There is a dull ache under his breastbone. How he wishes that he could recall the exact feel of her lips, of her breasts.
But he recalls this (and he prays it is a true image):
He recalls how he loses himself in her, pulling her like a soft lamb coat over him. She settles on him, smothers him like nightfall over a meadow. In their coming together they thwart the demons, his and hers, and when his cry of release comes it punctuates her soft exclamations. Order is restored. Proportion returns. Sleep comes as a blessing.
HIS CURSE IS THIS (and he weeps in New Jersey at the recollection, he beats his head with his hand): when he wakes from his Missing Period, he senses only a perturbation in space, a gap in time, a deep embarrassment and shame, the reason for which he cannot recall, but which he can only heal by throwing himself into his work anew. He has blocked out what came before.
How cruel it is that this memory should surface in a winter storm so long after she is dead. How cruel to have this fleeting, fragmented vision, seen through an ice-crusted window, then to wonder if it is real, or if it is the perturbation of a brain undone by alcohol. He has reassembled the memory like a shattered relic, and it is finally whole; and still he has doubts. He will never see her more clearly than that night at 529 Maple. When he recalls it in later years, he will wonder if he is distorting it, embellishing it, because each time he consciously recalls her, thatforms a new memory, a new imprint to be stacked on top of the previous one. He fears that too much handling will make it crumble.
“You saved my life,” he says aloud to Sister Mary Joseph Praise, seated on his small bed in New Jersey “And my stupidity, my indecision, my panic, caused you to lose yours.” Though it is much too late to say it to her, he knows it must be said, and though he is a nonbeliever, he hopes that somehow she is listening. “I cannot love any human being more than I love you.” What he cannot bring himself to mention is the children; he feels he can do even less for them than he can do for Sister Mary Joseph Praise; they exist, two boys, twins, he knows, he remembers, in a universe even more removed than the one in which Sister resides.
But it is too late to say all this to Sister Mary Joseph Praise. Even this memory of her, beautiful and erotic, cannot arouse him or fill him with joy. Instead, when he sees her nakedness, his engorgement, the miscibil-ity of their parts, what he feels is a violent jealousy, as if another person occupies his naked body and straddles the woman he loves, an illusion des soises—That is me, but it is not me. His thrusting body, the dark triangles of his shoulder blades, the hollows and dimples of the low back, only foretell death and destruction. They are an augury to a terrible end because this carnal pleasure will doom Mary, though she does not know it as yet, but he, watching the scene, does. His punishment is even worse: he must live.
THOMAS STONE STAYED IN MY ROOM past midnight. At some point he became one with the dark shadows, his voice filling my space as if no other words had ever been spoken there. I didn't interrupt him. I forgot he was there. I was inhabiting his story, lighting a candle in St. Mary's Church in Fort St. George, Madras, holding my own in an English boarding school, seeing how an unroofing of memory might lead to a vision of Mary. And if visions could happen in Fatima and Lourdes and Guadalupe, who was I to doubt that a secular vision of my mother had not appeared to him in a frost-rimmed rooming house window, just as I had seen and felt her in the autoclave room as a young boy? His voice walked me into a past that preceded my birth, but it was still mine as much as the color of my eyes or the length of my index finger.
I became conscious of Thomas Stone only when he was done; I saw a man under the spell of his own tale, a snake charmer whose serpent has become his turban. The silence afterward was terrible.
THOMAS STONE SAVED our surgery program.
He did it by making Our Lady of Perpetual Succour an affiliate of Mecca in Boston. All it took was his affixing his signature to a letter saying it was so. But Our Lady of Perpetual Succour was no mere paper affiliate of Mecca. Each month, four medical students and two surgical residents came down from Mecca to do a rotation with us. “A safari to see the natives killing each other, and to catch a few Broadway shows,” is how B. C. Gandhi put it when he heard about the plan. But each of us also had opportunities to do specialty rotations up in Boston.
I finished my internship and began my second year of residency. The most important result of our affiliation with Mecca was that it allowed Deepak, the Wandering Jew of surgery (as B.C. referred to him), to finish. He was now a board-certified surgeon and could have gone anywhere to set up practice. Instead, he stayed on at Our Lady with the title of Director of Surgical Training; he was also appointed Clinical Assistant Professor at Mecca. I had never seen Deepak happier. Thomas Stone, true to his word, paved the way for publication of Deepak's study on in juries to the vena cava. That paper in the American Journal of Surgery became a classic, one that everyone quoted when discussing liver injuries. Though Deepak was getting a consultant's salary, he continued to live in the house-staff quarters. Courtesy of the Mecca surgical residents who came down to the Bronx for rotations, we had more manpower and Deepak got more sleep. In an unused basement space, Deepak researched the effects of different interruptions to the blood supply of pig and cow livers.
Popsy's dementia no longer needed to be concealed. He roamed safely throughout Our Lady, wearing scrubs, and with a mask dangling from his neck. He was turned away every time he wandered into the operating room, or tried to leave the premises, but he didn't seem to mind. He would sometimes stop people and declare, “I contaminated myself.”
LATE ON A FRIDAY EVENING, a few months after Thomas Stone's first visit to my room, I heard a knock at my door. There he stood, tentative, embarrassed, and unsure what his reception would be.
My father's long confessional had changed things for me; it had been much easier to stay angry with him, to trash his apartment and violate his space, before I heard his story. Now his presence felt awkward and I didn't invite him in.
“I can't stay but I wondered … want to ask if … would you care to join me for dinner at an Ethiopian restaurant in Manhattan tomorrow, Saturday? … Here's the address—about seven?”
This was the last thing I expected from him. If he'd invited me to go to the Met, or to dine at the Waldorf-Astoria, I would have declined without any hesitation. But when he said “Ethiopian restaurant,” it conjured up the sour taste of injera and a fiery wot and my mouth began watering and my tongue stopped working. I nodded, even though I really didn't want to be around him. But we had unfinished business.
On Saturday I emerged from the subway and I saw Thomas Stone at a distance standing outside the Meskerem in Greenwich Village. Though hed been in America more than twenty years, he looked out of place. He had no interest in the menu displayed outside, and he did not notice the students pouring out from a New York University building, instrument cases in their hands, their hair, clothing, and multiple ear piercings setting them apart from other pedestrians. When he saw me he was visibly relieved.
Meskerem was small, with dark red curtains and walls that recalled the inside of a chikka hut. The aroma of coffee beans roasted over charcoal and the peppery smell of berbere made it feel a world away from Manhattan. We sat on rough-hewn, three-legged wooden stools, low to the ground, with a woven basket table between us. A long mirror behind Thomas Stone allowed me to see both the back of his head and people entering or leaving the restaurant. The posters thumbtacked to the walls showed the castles of Gondar, a portrait of a smiling Tigre woman with strong perfect teeth, a close-up of the wrinkled face of an Ethiopian priest, and an aerial view of Churchill Road, each with the same caption: THIRTEEN MONTHS OF SUNSHINE. Every Ethiopian restaurant I subsequently visited in America relied heavily on the same Ethiopian Airlines calendar for decor.
The waitress, a short, bright-eyed Amhara, brought us menus. Her name was Anna. She almost dropped her pencil when I said in Amharic that I'd brought my own knife and I was so hungry that if she pointed me to where the cow was tethered, I'd get started. When she brought our food out on a circular tray, Thomas Stone looked surprised, as if he'd forgotten that we would eat with our fingers off a common plate. To his dismay, Anna (who hailed from the neighborhood of Kebena in Addis, not that far away from Missing) gave me gursha—she tore off a piece of injera, dipped it in curry, and fed me with her fingers. Thomas Stone hastily rose and asked for the restroom, lest she turn to him.
“Blessed St. Gabriel,” Anna said, watching him leave. “I scared your friend with our habesha customs.”
“He should know. He lived in Addis for seven years.”
“No! Really?”
“Please don't take offense.”
“It's nothing,” she said, smiling. “I know that type of ferengl. Spend years there, but they look through us. But don't worry. You make up for it, and you're better looking.”
I could have taken up for him. I could have said he was my father. I smiled. I'm sure I blushed. I said nothing.
When Thomas Stone returned, he made a halfhearted effort to eat. Inevitably, one of the songs that cycled through the ceiling speakers was “Tizita.” I studied his face to see if it meant anything to him. It didn't.
The mark of a native is that your fingers are never stained by the curry; you use the injera as your tongs, as a barrier, while you pick up a piece of chicken or beef sopped in the sauce. Thomas Stone's nails were red.
Tilahoun singing “Tizita,” the cocoonlike atmosphere, and the frank incense brought memories bubbling to the surface. I thought of mornings at Missing and how the mist had body and weight as if it were a third element after earth and sky, but then it vanished when the sun was high; I remembered Rosina's songs, Gebrew's chants, and Almaz's magical teat; I recalled the sight of a younger Hema and Ghosh leaving for work, as we waved through the kitchen window; I could see those halcyon days, shiny like a new coin, glinting in sunlight.
“Do you plan to finish your next four years of residency at Our Lady?” Thomas Stone said, abruptly, breaking into my reverie. “If you were interested in moving to Boston …” So much for his perceptiveness. Just when I was ready to talk about the past, he wanted to know about my future.
“I don't want to leave Our Lady. The hospital is my Missing equivalent. I never wanted to leave Missing or Addis, but I had to. Now I don't want to leave Our Lady.”
Any other man would have asked me why I had to leave Missing. That was my fault—had he posed the question, I might not have answered. And perhaps he knew that.
As she cleared our plates, Anna said to Thomas Stone in English, “How did you like the food?”
“It was good,” he said, barely glancing at her. He reddened as she and I studied him. “Thank you,” he added, as if he hoped that would help get rid of her. She took two packaged towelettes out from her apron pocket and put them on the table.
I said to Anna, “Honestly, it was good, but you could make the wot hotter.”
“Of course we can,” she said in Amharic, a little taken aback by the implied criticism. “But then people like him won't be able to touch the food. Also we use local butter, so even if we make it hotter, it won't taste the same as home. Only someone like you would know the difference.”
“You mean there is no place to get real habesha food? The real thing? With all these Ethiopians in New York?”
She shook her head. “Not here. If you ever visit Boston, go see the Queen of Sheba. She's in Roxbury She is famous. The house is like our embassy. Upstairs, in one room, they sell groceries, and downstairs they serve home food. Cooked with true Ethiopian butter. The Ethiopian Airlines crew bring it just for her. All the Ethiopian taxi drivers eat there. You won't see anybody but Ethiopians there.”
THOMAS STONE HAD WATCHED this exchange, his face blank. When Anna left, he reached into his pocket. I thought he was reaching for his billfold. Instead, he pulled out the bookmark I had left in his room, the one on which Sister Mary Joseph Praise had written her note to him.
I dried my hands carefully and took it from him. I realized that I had missed it; it felt as if it shouldn't be here on a basket table but in a bank vault. It had been my talisman on a harrowing journey, an escape from Ethiopia which he knew nothing about. I read her last lines—”Also, I am enclosing a letter to you from me. Please read at once. SMJP”—and then I looked up.
Thomas Stone fidgeted in his seat. He swallowed hard, leaning on the basket table.
“Marion. This bookmark … was in the textbook, I presume?”
“Yes, it was. I have the textbook.”
He grew stiff, his hands trapped under his thighs as if an electric current were running through him. “Would you … Can I ask if … Do you have … Was there a letter?”
He looked helpless, sitting so low to the ground, like a parent visiting kindergarten, his knees under his chin.
“I thought you had the letter,” I said.
“No!” he said, so emphatically that Anna looked over at us.
“I'm sorry,” I said, though I wasn't sure what I was sorry for. “I assumed that you took the letter when you left. That you left the book with the bookmark in it.”
His face, so expectant a moment ago, collapsed.
“I took almost nothing,” he said. “I walked out of Missing with the clothes I had on and one or two things from the office. I never went back.”
“I know,” I said.
He cringed when I said those words. No wonder he was reluctant to probe my past. No blade can puncture the human heart like the well-chosen words of a spiteful son. But did he really think of me this way? As a son? “But you took the finger with you?” I went on.
“Yes … that's all I took. It was in her room. I went back there.” He looked up.
I said, “I'm sorry. I wish I had the letter.”
“And the bookmark?” he said. “How did you get it?”
I sighed. Anna served us coffee. The small cup with no handle felt inadequate for my task of trying to cover a lifetime for this man. “I had to leave Ethiopia in haste. The authorities were looking for me … It's a long story. They thought I was involved in the hijacking of an Ethiopian Airlines plane. They thought I was a sympathizer for the Eritrean cause. Ridiculous, right? You remember your maid, Rosina? One of the hijackers was Rosina's daughter, Genet. Rosina is dead, by the way. Hanged herself.”
It was more than he could digest.
“Rosina and Genet …,” I began. “Suffice it to say, I had an hour to get out of town. As I was leaving, climbing over Missing's wall, I said my good-byes to Hema, Matron, Gebrew, Almaz, and to Shiva, my brother …” I stopped. I had hit a roadblock. “Shiva, your other son … ?”
Stone swallowed. This was proving impossible. And yet he needed to know, particularly if it was painful.
“My son …,” he said, trying out the word.
“Your son. You want to see what he looks like?” He nodded, expecting me to pull out a wallet. “Look at that mirror behind you.”
He hesitated as if this might be a joke, a trick. But he turned, and our eyes met in the mirror, startling me, because it was suddenly more intimate than I'd expected. “Shiva and I are mirror images.”
“What is he like?” he asked without turning around.
I sighed. I shook my head. I dropped my gaze. He turned back to me.
“Shiva is … very different. A genius, I would say. But not in the usual way. Impatient with school. He'd never answer an exam question in a way that might make him pass, not because he didn't know … He has never understood the need to subscribe to convention. But he knows more medicine, certainly more gynecology than I do. He works with Hema doing fistula work. He's a brilliant surgeon. Trained, but by Hema. No medical school.” None of this would have been difficult for Stone to discover on his own had he been interested. He was interested now.
“I was very close to Shiva when we were little boys.”
Stone's eyes were unblinking. I couldn't tell him the details of what had happened since. I had told no one. Only Genet and Shiva knew the truth.
“He and Genet did something to hurt me that I cannot forgive …”
“Something related to the hijacking?”
“No, no. It happened long before. Anyway, I was and still am very angry with him. But he is my brother—my twin—and so when I had one hour to leave the city, when the time came to say good-bye to Shiva— well, it was very painful for both of us.” Suddenly I found myself fighting for composure. It was terribly important for me not to cry in front of Thomas Stone. I pinched the inside of my thigh. “As I was saying good-bye to Shiva, he handed me two books. One was his Gray's Anat omy. That was his most valued possession. He dragged it around like a blanket.
“And the second was your book, with that bookmark inside. I didn't know how he got it, or how long he had it. I didn't even know you had written a book. The book was hardly opened. I don't think Shiva ever read it, certainly not like he devoured his Gray's. He probably saw and read the bookmark. But you have to know Shiva. He wouldn't be curious about the bookmark or the letter she referred to. Shiva lives in the now. I don't know just how he got the book or why he wanted to give it to me.”
Stone remained silent, his gaze on the empty basket between us, as if it stood in for all that was unknown about his past, our past. His look of pain was so intense, it pierced me. “I can ask him,” I offered. I wanted to know just as much as Thomas Stone did. “I will ask him,” I said.
Thomas Stone was a world away. When he lifted his gaze, I understood the depths of his sorrow; I saw it in a darkening of his iris, even though that delicate structure should not change color. I could see that the almost mystical aura of this legendary surgeon—the single-mindedness, the dedication, the skill—was mere surface. The surgical persona was something he had crafted to protect himself. But what he had created was a prison. Anytime he strayed from the professional to the personal, he knew what to expect: pain.
When he spoke, his voice sounded tired, old. “And here I thought you had it, and you thought I …”
“What do you think is in the letter?”
“How I wish I knew,” he said abruptly. “I'd give my right arm …”
It had been a few months since I met Thomas Stone. The anger I felt obliged to have had subsided. The story he told me of his childhood, his mother's death—it should have been enough to forgive him, but I didn't think I was ready for that. I hadn't forgiven Shiva, so why forgive Thomas Stone? Even if I had forgiven him, a perverse streak in me refused to let him know that. But I had unfinished business with him.
“There's something I have to tell you,” I said. I never thought I would be ashamed in front of this man. “Something I was charged to tell you by Ghosh.” Ghosh's wish had seemed irrational to me at the time. But now, looking into that hard, craggy face, I understood why Ghosh had wanted me to reach out to Stone. Ghosh knew Thomas, but Ghosh had overestimated my maturity.
“Ghosh had a dying wish which I promised to fulfill. But I didn't. I ignored it. I hope you—and he—will forgive me. Ghosh told me that he felt his life would be incomplete without my doing this … His wish was for me to come and find you. To let you know that he considered you a brother.”
This was hard, both because I could recall Ghosh's labored breathing, could recall Ghosh's every word, and because I was now seeing the effect these words had on Thomas Stone. Other than his mother, and Dr. Ross in the sanatorium, who had ever expressed love for him? Sister Mary Joseph Praise perhaps, but did she ever get to tell him, and if she did, did he hear?
“Ghosh was disappointed that you never contacted him. But he wanted you to know that whatever your reason was for being silent all those years, it was all right with him.” Ghosh had felt it was shame that kept Thomas from looking back. He was right, because it was shame that colored his face now.
“I'm so sorry,” Stone said. I don't know whether he was speaking to me, or Ghosh, or the universe. It wasn't enough, but it was about time.
If there were other people in the restaurant, I was no longer aware of them. If there was music playing, I couldn't hear it.
I studied my father as I might study some specimen set before me: I saw the smile that struggled for purchase on his face and failed, and then I saw the haunted and hunted look that came in its wake. God help us if such a man had tried to raise us, if he had taken us away from Ethiopia. With all the sorrow and loss I'd experienced, I'd never have traded my past at Missing for a life in Boston with him. I should have thanked Thomas Stone for leaving Ethiopia. The love he felt for Sister Mary Joseph Praise had come too late. She was the mystery, the great regret that he would take to his grave—and he would regret nothing more than not knowing what she said in that letter.
“I'll write to Shiva,” I said. “I'll ask about the letter.” I suppose I understood Thomas Stone's shutting people out. After Genet's betrayal, I never wanted to have such strong feelings for a woman again. Not unless I had a written guarantee. I'd encountered a medical student from Mecca, a saint compared with my first love; she was kind, generous, beautiful, and seemed to transcend herself, as if her existence was secondary to her interest in the world and the things in it, including me. My belated and muted response must have pushed her away, lost me any chance of a future with her. Did I feel sad? Yes. And stupid? Yes, but I also felt relieved. By losing her, I was protected from her and she from me. I had that in common with this man sitting before me. I thought of a watch that had stopped ticking, and how it showed the correct time twice a day. He paid. I rose with him. At the door of the restaurant, our hands in our pockets, I waited.
“ ‘Call no man happy until he dies,’ “ he said. Before I could tell if that was a smile or an expression of sadness on his face, he nodded and walked away.
JUST AFTER MIDNIGHT on the first Sunday of every month, I would ring Hema at her bungalow. It was seven o'clock, Monday morning, Addis time. The rates were best at this hour, but since Almaz, Gebrew, and sometimes Matron came on before Hema, it could still be a long and expensive call. Ever since Hema delivered Mengistu's—sorry, Comrade Mengistu's—child, we no longer worried about the secret police eavesdropping on us; besides, they were preoccupied with real enemies. Mengistu Haile Mariam, Strength of Mary, Secretary General of the Council of Peasants and Workers, Chairman of the Military Council of Socialist Ethiopia, President-for-Life of the Armed Forces of the Democratic Peoples of Ethiopia, General in Command of the Bureau for Armed Struggle Against Imperial Aggression in Tigre and Eritrea, had adopted an Albanian style of Marxism. The upper and middle classes and even the working poor had their houses confiscated and land taken away. But favors to Mengistu and particularly favors to his wife weren't forgotten; Missing's medicines and supplies were not held up in the Customs godown, and there were no palms to grease.
As I dialed Hema's number that Sunday, I pictured my Missing family watching the clock, coffee cups in their hands, waiting for the phone to ring from a continent none of them had seen. Almaz picked up the receiver, with Gebrew leaning in, both of them suddenly shy and self-conscious. Their side of the conversation consisted of repeated Ende-menneh? Dehna-ne-woy?—How-are-you? Are-you-well, then?—until these godparents of mine were satisfied that their lij, their child, was all right. They told me they kept me in their prayers, fasted for me. “Pray that I'll see you soon and may God take care of you and your health,” I said. Matron was just the opposite, chatty and spontaneous, as if we had run into each other in the corridor outside her office.
I had reported to Hema my first sighting of Thomas Stone. Shed listened without comment, and she must have smiled when she heard of her son breaking and entering Thomas Stone's apartment. I didn't censor information for her benefit; surely, Thomas Stone was no longer the threat he'd once been to her when we were minors. When I had told her about placing the bookmark on Stone's desk as my calling card, I had read from Hema's silence that she'd known nothing about Shiva's having The Expedient Operator: A Short Practice of Tropical Surgery. I surmised from that and later confirmed from Matron that Hema had made every attempt to banish the book from Missing; she'd never wanted me or Shiva to see his work, much less a picture of him.
“I had dinner with Thomas Stone, Ma,” I said when she came on the line. “I ate injera for the first time in well over a year.” She was miffed to learn that Ghosh had a message for Stone—I read that in the fact that she said nothing. When I told her just what Ghosh had wanted me to say to Stone, I heard a vigorous honk on her kerchief. The message said more about Ghosh and his selflessness than it did about Thomas Stone. I asked if she knew about the bookmark or a letter that accompanied it. She didn't.
“Maybe Shiva knows,” I said. “Can I speak to him?”
She called out his name, a summons I had heard so many times since I was a child. I heard Shiva's reply, and could judge from its echo that it had come from our childhood room. While I waited, I heard Hema asking Matron about the bookmark; her “No!” told me it was news to her.
THE TELEPHONE WAS NEVER a comfortable instrument in Shiva's hands. He was fine, the fistula work was going very well, and no, he knew nothing about any missing letter.
“Do you remember the bookmark, Shiva, and the reference to a letter?” I asked.
“Yes.”
“But you're saying there was no letter in the book?”
“No letter.”
“How did you get the book, Shiva?”
“Ghosh gave it to me.”
“When?”
“When he was dying. He wanted to talk with me about many things. This was one. He said he'd taken the book from Thomas Stone's quarters on the day we were born. He had kept it. He wanted me to have it.”
“Was that the first time you'd seen the textbook or seen a picture of Thomas Stone?”
“Yes.”
“Did Ghosh mention a letter from Sister Mary—our mother—to Stone?”
“No, he didn't.”
“Did he say why he wanted you to have the book?”
“No.”
“When you saw the bookmark and the reference to the letter, did you go back and ask him?”
“No.”
I sighed. I could have stopped there, but I had come this far. “Why not?” I asked.
“If he wanted me to have the letter, he would have given it to me.”
“Why did you give me the book, Shiva?”
“I wanted you to have it.”
There was no annoyance in Shiva's voice; his tone was no different than when we began—I wondered if he'd picked up the irritation in mine. Shiva was right: there either was no letter, or Ghosh had the letter and had his reasons for destroying it.
I was about to say good-bye. I knew better than to expect my brother to ask about my health or my welfare. But he took me aback by saying, “How are your operating theaters?” He wanted to know about the layout, how far away the autoclave and the locker rooms were, and was there a sink outside each room, or one common scrubbing area. I gave him a detailed picture. When I was done, I waited. Once again, he surprised me: “When are you coming home, Marion?”
“Well, Shiva … I have four more years of residency.”
Was this his way of saying he was sorry for everything that had happened? That he missed me? Did I want that from him? I wasn't sure, so all I added was, “I don't know if it is safe for me to come, but if it is, I'd love to come a year or so from now … Why don't you come visit here?”
“Will I be able to see your operating theaters?”
“Sure. We call them operating rooms here, not theaters. But I can arrange for you to see them.”
“Okay. I'll be there.”
Hema came back on the line. She was in a chatty mood, reluctant to let me go. Listening to her lilting voice, I was transported back to Missing Mean Time, as if I were sitting by the phone under Nehru's photograph and looking across the room at the portrait of Ghosh which consecrated the spot where he spent so many hours listening to the Grundig.
When I hung up I felt despair: I was back in the Bronx, my walls bare but for the framed Ecstasy of St. Teresa. My beeper, silent till then, went off. In answering its summons, I slipped the yoke back around my neck; indeed, I welcomed my slavish existence as a surgical resident, the never-ending work, the crises that kept me in the present, the immersion in blood, pus, and tears—the fluids in which one dissolved all traces of self In working myself ragged, I felt integrated, I felt American, and I rarely had time to think of home. Then in four weeks, it was time to dial Missing again. Were these phone calls just as difficult for Hema? I wondered.
In a letter after our call, Hema said that shed checked with Bachelli, Almaz, and even W. W. Gonad to see if they had heard of Ghosh or Sister leaving a letter behind, but no one had. She told me that Shiva's application for an exit visa to come visit me was held up by the government; he was asked to provide affidavits to show he had no debts in Ethiopia, and moreover that I had no debts for which he might be responsible. She said she would remind Shiva to work on the visa. Reading between the lines, I knew and she knew that Shiva had lost interest.
I wrote to Thomas Stone to let him know that the whereabouts of Sister Mary Joseph Praise's letter remained a mystery. He never wrote back to me thanking me for my troubles.
OVER THE NEXT FOUR YEARS, I saw Thomas Stone now and then when he came to conduct conferences or bedside teaching rounds; he was impressive, as I knew he would be, masterful, serious, and in command of his subject. He had the kind of perspective that could only come from careful study of the literature of surgery and from living it for many years. I much preferred being around him in that fashion than having a dinner with him. Perhaps he felt the same way, because he didn't call or visit again.
I went up to Boston for three separate, month-long rotations: plastic surgery, urology, and transplant, and the work was engrossing, challenging, so that each time my anxieties about being there and near him were forgotten. I worked with him in that last rotation, which was busier than I'd ever imagined. He suggested once during that time that we have a meal, but I begged off because my work in the transplant intensive care unit simply did not allow me to get away before nine in the evening, even on my nights off. I think he was relieved.
By 1986 I had finished my year as Chief Resident, which was also my fifth year of training, and I stayed on as an assistant to Deepak as I prepared to take my board exam. Grudgingly, Id come to admire the long, arduous American system of surgical training; it was easier to admire when you were about done with it. I felt technically competent to do all the major operations of general surgery, and I knew my limits. There wasn't much I hadn't seen at Our Lady. More important, I was confident about caring for patients before and after surgery, and in the intensive care settings.
ALSO IN 1986, my brother became famous; it was Deepak who showed me the feature article in the New York Times. What a shock it was to see Shiva's picture, to see in it my reflection, but with shorter hair, almost a crew cut, and without the gray that had completely taken over my sideburns and temples. The image brought immediate bitterness, the recollection of the pain of betrayal. And yes, envy. Shiva had taken the first and only girl I loved and spoiled her for me. Now, he was making headlines in my backyard, in my newspaper. I'd followed all the rules, and tried to do the right thing while he ignored all the rules, and here we were. Could an equitable God have allowed such a thing? I confess, it was a while before I could read the article.
According to the Times, Shiva was the world's expert and the leading advocate for women with vaginal fistula. He was the genius behind a WHO fistula-prevention campaign that was a “far cry from the usual Western approach to these issues.” The Times reproduced the colorful “Five Failings That Lead to Fistula” poster: it showed a hand, the fingers splayed out. Peering at the photograph, I could see that it was Shiva's hand. In the palm was a seated woman in a posture of dejection—was the model the Staff Probationer?
The poster was distributed all over Africa and Asia and printed in forty languages. Village midwives were taught to count off on one hand the Five Failings. The first was being married off too young, child brides; the second was nonexistent prenatal care; the third was waiting too long to admit that labor had stalled (by which time the baby's head was jammed halfway down the birth passage and doing its damage) and a Cesarean section was needed; the fourth failing was too few and too distant health centers where a C-section could be done. Presuming the mother lived (the baby never did), the final failing was that of the husband and in-laws who cast out the woman because of the dribbling, odiferous fistula from bladder to vagina, or from rectum to vagina, or both. Suicide was a common ending to such a story.
“Somehow women with fistula find their way to Shiva Praise Stone,” the article said. “They come by bus, as far as they can before the other passengers kick them off. They come on foot, or by donkey. They come often with a piece of paper in their hand that simply says in Amharic, ‘MISSING’ or ‘FISTULA HOSPITAL’ or ‘CUTTING FOR STONE.’”
Shiva Stone was not a physician, “but a skilled layperson, initiated into this field by his gynecologist mother.”
When I next spoke to Hema, I asked her to congratulate Shiva for me. “Ma,” I said, “you should have gotten more recognition in that story. Without you, Shiva couldn't be doing what he does.”
“No, Marion. This is really all his doing. Fistula surgery wasn't something I relished. It suits someone as single-minded as Shiva. It needs constant attention, before, during, and after surgery. You should see the hours he spends thinking over each case, anticipating every problem. He can see the fistula in three dimensions.” Shiva had fashioned new instruments in his workshop and invented new techniques. The article had mentioned Matron's fund-raising efforts and the desperate needs, and the article brought donations pouring in. Matron had in mind a new Missing building devoted to women with fistula. “Shiva has had the plans drawn out for years. It will be in the shape of a V with the wings converging on Operating Theater 3.” Theater 3 was to be overhauled and remodeled, making two operating rooms with a shared scrub area in the middle.
I reread the Times article late that night. I felt a hollow sensation in my belly this time as I went through it again. The writer's unabashed admiration for Shiva came through, and one sensed she had abandoned her reserve, her usual dispassionate tone, because the man more than the subject so moved her. She ended with a quote from my brother: “What I do is simple. I repair holes,” said Shiva Praise Stone.
Yes, but you make them, too, Shiva.
I HAD MY OWN SUCCESS, albeit a quieter one: I passed the written exam of the American Board of Surgery. A few months after that, I was assigned to take my oral exams in Boston at the Copley Plaza Hotel. After a grueling hour and a half in front of two examiners, I was done. I knew I did well.
Outside, the day was glorious. The monolith of gray stone that was the Church of Christian Scientists stood serene at the end of a long reflecting pool and framed against a blue sky. For five years I had spent my nights and days in the hospital, not seeing the sky, not feeling the sun on my face. I felt the urge to wade through the water fully clothed, or to let out a victory whoop. I contented myself instead with an ice-cream cone, which I enjoyed while sitting by the reflecting pool.
I planned to head to the airport, take the shuttle back to New York. But seeing that my driver was so obviously Ethiopian, and having greeted him in our language, I had another idea. Yes, of course he knew the Queen of Sheba's in Roxbury, and it would be an honor for him to take me there.
“My name is Mesfin,” he said, grinning at me in the rearview mirror. “Who are you? What do you do?”
“My name is Stone,” I said, putting my seat belt on, although I wasn't worried; nothing bad could happen to me on this day. “I'm a surgeon.”
THE STREET HAD A JUNKYARD at the corner with high walls and barbed wire so reminiscent of Kerchele Prison. A massive dog, chained and asleep, was visible through the gate. Then came a string of vacant lots where ashes and soot outlined whatever had stood there. Mesfin seemed to be pointing the cab to the sole house at the end of the street that survived the blight that had felled the others. Its driveway began in the middle of the road, as if the paving machine had run out of asphalt when it got this far and so the owner took things into her own hands. The split-level house had yellow shingles. The steps, the railings, the pillars, the doors, the decks, and even the drains were painted the same canary yellow. A column of (unpainted) wheel hubs shored up a corner of the sagging front veranda. There were four taxis parked outside, all yellow.
The smell of fermenting honey elicited a Pavlovian response from my taste buds. A dour Somali met us at the door and led us to a dining room six steps down from the front landing. We found a half-dozen men eating at the picnic tables and benches, with room for a dozen more. The wooden floor was strewn with freshly cut grass, just as it would have been if this were a home or restaurant in Addis.
We washed our hands and took our seats, and at once a buxom woman arrived, bowing, wishing us good health, and placing water and two small flasks of golden yellow tej before us. The cornea of her left eye was milky white. Mesfin said her name was Tayitu. Behind her, a younger woman brought a tray of injera, on which were generous servings of lamb, lentils, and chicken.
“You see?” Mesfin said, looking at his watch. “I can eat here quicker than I can pump gas in my car. It's cheaper, too.” I ate as if I had lived through a famine. The waitress in New York who first told me about the Queen of Sheba's had been right. This was the real thing.
Later, through a side window that looked out onto a sloping yard, I saw a white Corvette slide up. A shapely leg in heels emerged, the skin a café au lait color, with a shade of nail polish that B. C. Gandhi called “fuck-me red.” A baby goat appeared from nowhere and danced around those elegant feet.
Soon a lovely Ethiopian lady came cautiously down the stairs, careful not to snag her heels. She said over her shoulder to the Somali, “Why is that silly boy letting the baby goat out at this hour? One of these days I'll run over it.” Her golden-brown hair had red streaks, and it was cut in a perky, asymmetrical style that revealed her neck. She wore a maroon pinstriped blazer over a white blouse and skirt.
The Queen, for there was little doubt that this was she, bowed in our direction while continuing on to an office next to the kitchen. She stopped abruptly. She turned as if she had seen a vision and she stared. I was in my suit, my tie loosened—did I look that out of place? Within the confines of Our Lady of Perpetual Succour, all the tribes of Abraham were represented and I felt no more foreign than my patients or the staff. Now, as I attracted her attention, and that of the others there, I felt like a ferengi again.
“Praise God, praise His Son,” the Queen said, her hands on her cheeks. She shifted her tinted glasses to her forehead, revealing eyes that were wide open in astonishment. I looked behind me; could she be talking to someone else? Her expression, at first quizzical, now turned joyous, showing brilliant white and perfect teeth. “Child, do you not know me?” she said, coming close, her rose-scented attar preceding her.
I came to my feet, still puzzled.
“I pray for you every day,” she said in Amharic. “Don't tell me that I have changed that much?”
I towered over her. I was tongue-tied. She had been a mother and I a boy when I first met her.
“Tsige?” I said at last.
She lunged toward me, kissed my cheeks, held me at arm's length to better examine me, then pulled me to her to bump cheeks again and again. “My God, Blessed Mary and all the saints, how are you? Is it you? Endemenneh? Dehna ne woy? How are you? Can this be you? Praise God that you are here …”
After six years in America, it was only at that moment, standing in that yellow house, in her arms, cut grass under my feet, that I felt at ease in this land, felt my guard come down and the muscles in my belly and neck relax. Here was someone from my past, from my very street, someone whom I liked and with whom I had always felt a bond. I kissed her cheeks as vigorously as she kissed mine: Who would stop first? Not I.
Tayitu peered in from the kitchen. Two other women looked over the upstairs rail. Our fellow diners stopped to watch. They were displaced people, just like us, and they understood all too well these kinds of reunions, these moments when a piece of your old house comes floating by in the river.
“What are you doing here?” Tsige said. “You mean you didn't come to see me?”
“I came to eat. I had no idea! I've been living in New York for six years. I'm here just for the day. I'm a doctor now. A surgeon.”
“A surgeon!” She gasped, falling back, clasping her hands to her heart. Then she kissed the back of my wrists, first one, then the other. “A surgeon. You brave, brave child.” She turned to our audience and in the tones of a cantor she continued, still in Amharic, “Listen, all you unbelievers, when he was a little boy, and when my baby was dying, who took me to the right place in the hospital? It was he. Who called the doctor, who was his father, to see my child? He did. Then who was it who stayed with me as my baby fought for life? No one but him. He was the only one by my side when my little baby died. No one else was there for me, if only you knew …” The tears streamed down her face, and in an instant the mood in the room went from the joy of reunion to profound sadness, as if those two emotions were invariably linked. I heard sympathetic clucks and tsks from the men, and Tayitu blew her nose and dabbed at her good eye, while the other two women wept freely. Tsige was unable to speak, head bowed—she was overcome for a moment. At last she straightened her shoulders, raised her head, the lips parted to smile bravely, and she declared, “I never ever forgot his kindness. Even today, when I go to sleep, I pray for my baby's soul, then I pray for this boy. I lived across the street. I watched him grow up, become a man, go to medical school. Now he is a surgeon. Tayitu, give everyone their money back, for today is a feast day. Our brother has come home. Tell me, ye of little faith, does any one of you need some other proof that there is a God?” Her eyes glittered like diamonds; her hands, palms up, reached for the ceiling.
For the next few minutes I solemnly shook the hand of every person in the house.
LATER I SAT WITH TSIGE on a sofa in a living room upstairs. She had kicked off her heels and tucked her feet up under her. Still holding my hand, she touched my cheek often to exclaim how happy she was to see me.
I had plans to return to New York that afternoon, but Tsige insisted on sending Mesfin away. “You can take a later flight,” she said.
“Are you sure I can find a taxi here?” I said, pretending to be serious.
After a beat, she threw her head back and laughed. “See, you have changed! You used to be so shy.”
Through the window I saw six or seven baby goats in a large wire enclosure. Behind that was a chicken coop. A dreamy-looking boy with a long narrow head sat stroking one of the goats. “He's my cousin,” Tsige said. “You can see the forceps marks on his forehead. He has some problems. But he loves to take care of the animals. You should come here when we celebrate Meskel on Meskerem Day. We slaughter the goats and cook outdoors. You will see not just taxis, but police cars. They come from the Roxbury and South End stations to eat.”
Tsige said she left Addis a few months after me. A patron of the bar, a corporal in the army, had wanted to marry her. “He was nobody. But in the revolution, even the privates became powerful.” When she declined his advances, she was falsely accused of imperialist activities and imprisoned. “I bought my way out after two weeks. In the time I was in Kerchele, they confiscated my house. He came to see me, pretending he had nothing to do with my arrest. If I married him, he said, everything would come back to us. The country was being run by dogs like him. I had money hidden away. I never looked back. I left.
“In Khartoum, I waited a month for asylum from the American Embassy. I worked as a servant for the Hankins, a British family. They were nice. I learned English by taking care of their children. That was the only good thing that came out of Khartoum. I don't mind the cold in Boston because every cold day reminds me how good it is to be out of Khartoum.
“I worked hard here, Marion. Quick-Mart—often I did two shifts. Then five nights I worked at a parking garage. I saved and saved. I became the first Ethiopian woman to drive a taxi in Boston. I learned the city. I found work for Ethiopians. Stock boy, parking attendant, taxi driver, or counter girl at the hotel gift shop. I lent money on interest to Ethiopians. Tayitu used to work for me in the bar, so when she came, I rented this house. She cooked. Then I bought the house. Now, my God, there is much to be done: grind tef, make injera, clean chicken, make wot, sweep the house. It takes three or four people. Ethiopians arrive at my door like newborn lambs, everything they have tied up in bedsheets, their X-rays still in their hands. I try to help them.”
“You really are the Queen of Sheba.”
There was an impish grin on her face. She switched to English, a language I had never heard her speak. “Marion, you know what I had to do to feed my baby in Addis. Then in Sudan, I was even lower than that— I was no better than a bariya,” she said, using the slang word for “slave.” “In America they said you can be anything. I believed it. I worked hard. So when they say, ‘Queen of Sheba,’ I think to myself, Yes, from bariya to queen.”
I told Tsige about seeing her on the day I left Addis so hastily, seeing her getting out of her Fiat 850. “Today, what do I see before I see your face? Your beautiful leg getting out of a car. The last glimpse of you in Addis was also your beautiful leg coming out of a car. I wanted to say good-bye to you then. But I couldn't.”
She laughed, and self-consciously pulled her skirt down. “I knew you disappeared right after Genet,” Tsige said. “No one knew if you were part of the hijacking.”
“Really? People thought I was an Eritrean guerrilla?”
She shrugged. “I didn't think you had anything to do with it. But when I saw Genet, she never said anything one way or the other.”
I was puzzled. “How could you have seen Genet? She left the same day I left. That's why I had to go—did you see her in Khartoum?”
“No, Marion. I saw her here.”
“You saw Genet in America?”
“I saw her here. In this house … Oh my God. You didn't know?”
I felt the air leave my lungs. A sinkhole opened up under me. “Genet? Isn't she still fighting with the Eritreans?”
“No, no, no. That girl came here as a refugee, just like the rest of us. Someone brought her here. She had her baby in her arms. She acted as if she didn't recognize me at first. I had to remind her.” Tsige s face turned hard. “You know, Marion, once we come here, we are all the same. Eritrean, Amhara, Oromo, big shot, bariya, whatever status you had in Addis it means nothing. In America you begin at zero. The ones who do the best here are those who were zero there. But Genet came here thinking she was special, not like the rest of us—”
“When was this?”
“Two, maybe three years ago. She said she'd lost touch with you. She didn't know where you went. She acted as if she didn't know you had escaped from Addis.”
“What? She was lying,” I said. “It was the Eritreans who helped me escape. She was their star … their big heroine. She must have known.”
“Maybe she didn't trust me, Marion. I never knew her the way I knew you, never exchanged two words with her. People change, you know. When you leave your country, you are like a plant taken out of soil. Some people turn hard, they can't flower again. I remember she told me she got sick in the field. She got sick of the fighting, too, I think. She had the baby. Some women she knew in New York had a job for her and offered to help take care of the baby boy. So I didn't really have to do anything for her.”
“My God,” I said, sinking back into the sofa. I was glad I didn't know of this before, glad I didn't know she was in New York. “Is she still there?”
“No.” Tsige hesitated, as if she wasn't sure whether to tell me the rest. “There were lots of rumors. What I heard is … she met a man and they got married. Something happened. She almost killed him. I don't know exactly why or how. All I know is that she's in prison. Her baby was given up for adoption …” Tsige saw the shock on my face. “I'm sorry. I thought you knew all this … I could find out if she is still in jail.”
“No!” I shook my head. “You don't understand. I don't want to ever see her again,” I said. I don't want to see her other than to spit in her face, I thought.
“But she was your own sister.”
“No! Don't say that,” I said sharply.
We sat there in silence. If Tsige found my reaction unexpected, I couldn't blame her. I had to wait a few minutes for the turmoil in me to subside.
“Tsige,” I said, at last, reaching for her hand. “I'm sorry. I must explain. You see, Genet was not my sister. She was the love of my life.”
Tsige was shocked. “You were in love with your own sister?”
“She's not my sister!”
“I am sorry. Of course.”
“What does it matter, Tsige? If she was my sister or not my sister, either way I was in love with her. I couldn't change what I felt for her. We were going to marry after we finished medical school …”
“What happened?”
“My own brother betrayed me. She betrayed me.” This was so hard to say. “They were pillows for each other,” I said, using an Amharic expression.
I realized Id just told Tsige what I'd never told anyone else, not even Hema. I'd come close to telling Thomas Stone in the restaurant, but I hadn't. There was such relief now in the telling. I left nothing out—my being falsely accused, Genet's genital mutilation, Rosina's death, Hema's suspicion that I was responsible. In six years at Our Lady of Perpetual Succour, with all the close friends I had made—Deepak, B.C., various medical students—not one of them had I told this tale.
Tsige s hand was over her mouth, her eyes showing her astonishment and empathy. After a while, she put her hand down and shook her head sadly. “Your brother wanted to sleep with me,” Tsige said. She grinned when she saw my jaw drop. “Oh, yes. You both were young then, fourteen or fifteen. Not too young, though. Shiva was so direct. ‘How much to sleep with you?’ “
She laughed at the audacity of this, gazing out of the window, her mind conjuring up that faraway time.
“Did he?” I said at last, my throat so dry that the words could have set fire to the tejin my stomach. She had no idea how important her answer was to me.
“Did he what?”
“Sleep with you?”
“Oh, you sweet thing. No!” She pinched my cheek. “You should see your expression. No, no.” I let out the breath I had been holding. “Don't you know that if it had been you, it would have been different? If you'd ever asked … I owe you, Marion. I still owe you.”
I was sure I was blushing. As quickly as Genet had appeared in my head, she had disappeared. “You don't owe me anything, Tsige. And I'm sorry, I never should've asked you that—it's personal, your business.”
“Marion, you must have lots of girlfriends. A surgeon in New York! How many nurses share your pillow, eh? Where are you going? Why are you standing? What's the matter?”
“Tsige, it is late, I'd better—”
She pulled me firmly down, so that I landed almost on top of her. She held me. The scent of her body and of her perfume had shot up my nostrils. My eyes were on her throat, her chin, her bosom. I had thought of her many a night in the house-staff quarters at Our Lady of Perpetual Succour, never imagining that I might really touch her. I was a board-certified general surgeon, but now I felt like a pimply adolescent.
“You are turning so red! Are you all right? Oh, bless me, Mary … blessed Gabriel and the saints … you are still a virgin, aren't you?”
I nodded sheepishly “Why are you crying?” I asked.
She would only shake her head, studying my face while swiping at her eyes. At last, holding my cheeks in her hands, she said, “I am crying because it's so beautiful.”
“It isn't beautiful, Tsige. It's stupid.”
“No, it's not,” she said.
“I saved myself for Genet. Yes, I know—ridiculous. But then when she and Shiva … I threw myself into my studies. The worst part is I still loved her. Shiva didn't. I loved her. I felt responsible when she almost died. Can you believe that? Shiva slept with her, and I felt responsible? Then, when she and her friends stole that plane, she betrayed me again. She never worried what might happen to me or Hema or Shiva. But at least at that moment, on the day I left Ethiopia, I was free of her. When I came here, I tried to forget her. I hoped she was dead in that stupid war—her damn war. Now I find she's here. Maybe I should leave the country, Tsige. Go to Brazil. Or India. I don't want to be on the same continent as that woman.”
“Stop it, Marion. Don't talk foolishly. How much tej did you drink? This is a big country and you're a big man. Forget about her! Look where you are and look where she is. She's in jail, for God's sake!” She touched my hair, and then she pulled me to her bosom. “You are the kind of man that women dream about.”
I was aroused. There was nothing about my life that I could hide from her, even if I wanted to. Not my shame, not my secrets, not my embarrassment.
She kissed me on my lips, a brief exploratory brush first, then a leisurely probing kiss. I could feel the adrenaline pouring out of me, the reserves of unused, stockpiled testosterone announcing their availability. So this is how it is going to happen, I thought. On the day I pass my surgical boards. How fitting. My hands reached for her.
She sighed and pulled back, pushing me upright, then straightening her hair. Her expression was serious, like that of a clinician making a pronouncement after the detailed physical exam.
“Wait, my Marion. You've saved yourself all these years. That is not a small thing. I want you to go home. After you have thought about it, if you want me, I will be here. You can come back here or we can go away, go on a trip together. Or I will come to New York and we will take a beautiful hotel room.” She read the disappointment on my face, the rejection. “Don't be sad. I am doing this out of love for you. When you have something this precious, you must think carefully how you give it away. I'll understand if you don't give it to me. If you choose me, I will be honored, and I will honor you. Now, I'll get a taxi to take you. Go, my sweet man. Go with God. There is no one else like you.”
This is my life, I thought, as my taxi slogged through heavy traffic and inched through the tunnel to Logan Airport. I have excised the cancer from my past, cut it out; I have crossed the high plains, descended into the desert, traversed oceans, and planted my feet in new soil; I have been the apprentice, paid my dues, and have just become master of my ship. But when I look down, why do I see the ancient, tarred, mud-stained slippers that I buried at the start of the journey still stuck to my feet?
NOW THAT I HAD the income of an attending surgeon, I bought a duplex at one end of a row of such units in Queens. The roofline above the dormer window on one side was peaked like an eyebrow, and it cast a proprietary gaze over an overgrown wedge of land, thick with maples. In summer, I put my jasmine pots on the little patio and I grew salad staples in a tiny garden. In winter, I brought the jasmine indoors while the empty wire cages outside stood as memorials to the succulent, blood-red tomatoes the earth had given up. I painted walls; I repaired roof shingles; I installed bookshelves. Uprooted from Africa, I was satisfying a nesting impulse. I'd found my version of happiness in America. Six years had gone by, and though I should have visited Ethiopia, somehow I could never quite break free.
One day, when coming out of an ice-cream shop, a tall elegantly dressed black woman, her leather coat dancing above her ankles, brushed past me. I held the door for her, and as she slid past, an intense disquiet came over me. She turned back to look at me, smiling. Another evening, while driving back through Manhattan from a trauma conference in New Jersey, a streetwalker caught my eye as she stepped out from under an awning near the Holland Tunnel. She was ghost lit by car headlamps and reflections off the puddles. She tit-flashed me in the rain. Or I imagined she did. I felt the disquiet again, like the hint of something afire, but one doesn't know where. I circled the block, but she was gone.
At home, I prepared for the next day's work. I could have gone into private practice when I finished my five-year residency, or else I could have gone to some other teaching institution. But I felt a great loyalty to Our Lady. And now, Brooke Army Medical Center in San Antonio and Walter Reed in Washington were sending us a few of their senior surgical residents. In peacetime, we provided the closest thing to a war zone, a place where they could hone their skills. I was Our Lady's Head of Trauma; we were blessed with new resources and more personnel. There was no reason for me to be unhappy. But that night, with a fire going in the grate, I felt restless, as if a paralysis would soon set in if I didn't take certain measures.
That weekend, I decided my life needed a dimension that did not involve work. I looked over the Times for events, readings, openings, plays, lectures, and other matters of interest. I forced myself to leave the house on Saturday and again on Sunday.
THE FOLLOWING FRIDAY, I came home after work and deposited my briefcase and the mail in my library. In the kitchen, I lit the candle, set the table, and warmed up the last portion of a chicken casserole that I had cooked the previous Sunday from a Times recipe.
There was a knock on the door.
I panicked.
Had I invited someone over for dinner and forgotten? Other than Deepak coming over once, no one had ever been here. Could it be that Tsige from Boston had decided to take matters into her own hands, since I had failed to call her? I'd picked up the receiver a dozen times, and then lost courage. Or could this be Thomas Stone knocking? I hadn't told him where I lived, but he could have found out easily from Deepak.
I looked through the peephole.
In that convex fish-eye image, I saw eyes, a nose, cheekbones, lips … My brain tried to juggle and rearrange the parts to come up with a face and a name.
It wasn't Stone or Deepak or Tsige.
There was no mistaking who it was.
She turned to leave, went down the two steps.
I could have watched her walk away.
I opened the door. She stood frozen, her body facing the street, her face turned back to the door. She was taller than I recalled, or perhaps it was that she was thinner. She looked to see that it was me, then she dropped her gaze to a spot near my left elbow. This allowed me to study her at will, to decide whether to slam the door on her.
Her hair was straightened, lank, without benefit of ribbons or bows or even a good combing. The cheekbones were intact, more prominent than ever, as if to better buttress those oval, slanting eyes which were her prettiest feature. Even without makeup, hers would always be a stunning face. Although it was summer, she wore a long wool coat tied tight around the waist, and she hugged herself as if she were cold. She stood there motionless, like a small animal caught invading the territory of a predator, paralyzed and unable to move.
I came down my steps. I reached my hand out and tilted her face up. Her eyeballs and lids rolled down just like the eyes of the dolls she used to play with. Her skin was cold to my touch. The vertical scars at the outer edges of her eyes were now seasoned lines, though I recalled the day Rosina's blade gave birth to them, and how they had been raw and choked with dark blood. I jerked her chin farther up. Still she wouldn't meet my gaze. I wanted her to see the scars on my body, one from her betrayal of me with Shiva and another from her becoming more Eritrean than any Eritrean, resulting in the hijacking that drove me out of my country. I wanted her to see my rage through my outer calm. I wanted her to feel the blood surge in my muscles, to see the way my fingers curled and coiled and itched for her windpipe. It was good she didn't look, because if she'd so much as blinked, I would have bit into her jugular, I would have consumed her, bones, teeth, and hair, leaving nothing of her on the street.
I took her by the elbow and led her inside. She came like a woman going to the gallows. In the foyer as I bolted the door, she stood rooted to the mat. I led her to my library—a dining room that I had transformed—and I pushed her down on the ottoman. She perched on its edge. I stared down at her; she didn't move. Then she coughed, a spasm that took fifteen seconds to pass. She brought a crumpled tissue to her lips. I looked at her for a long time. I was about to speak when the cough commenced again.
I went to the kitchen. I boiled water for tea, leaning my head against the refrigerator as I waited. Why was I doing this? One minute homicide, the next minute tea?
She had not changed her position. When she took the cup from me, I saw her unvarnished, chipped fingernails and the wrinkled washerwoman's skin. She pulled one sleeve down, passed the cup over, and repeated the process with the other, so as to hide her hands. Tears streamed down her face, her lips pulled back into a grimace.
I had hoped that my heart would be hardened to such displays.
“Sorry. I work in a kitchen,” she whispered.
“After all you have done to me, you're sorry about the state of your hands?”
She blinked, said nothing.
“How did you find me?”
“Tsige sent me.”
“Why?”
“I called her when I got out of jail. I needed … help.”
“Didn't she tell you that I didn't want to see you?”
“Yes. But she insisted I see you before she would help me.” She glanced directly at me for the very first time. “And I wanted to see you.”
“Why?”
“To tell you I'm sorry.” She averted her gaze after a few seconds.
“Is that something you learn in prison? Avoiding eye contact?”
She laughed, and in that moment I wondered if, with all she had seen and done, she was beyond being touched by anger. She said, “I was stabbed once for looking.” She pointed down with her chin to her left side. “They took out my spleen.”
“Where were you in prison?”
“Albany.”
“And now?”
“I'm paroled. I have to see my probation officer every week.”
She put her cup down.
“What else did Tsige say?”
“That you're a surgeon.” She looked around the library, the shelves full of books. “That you're doing well.”
“I'm only here because I was forced to run. Forced to leave in the night like a thief. You know who did that to me? To Hema? It was someone who was to our family … like a daughter.”
She rocked back and forth. “Go on,” she said, straightening her back. “I deserve it.”
“Still playing the martyr? I heard you hid a gun in your hair when you got on that plane. An Afro! You were the Angela Davis of the Eritrean cause, right?”
She shook her head. After a long while she said, “I don't know what I was. I don't know who I was. The person I was felt she had to do something great.” She spat out the last word. “Something spectacular. For Zemui. For me. They promised me that you and our family would not be harmed. As soon as the hijack was over, I realized how stupid it was. Nothing about it was great. I was a great fool, that's all.”
She drank her tea. She stood up. “Forgive me, if you can. You deserved better.”
“Shut up and sit down,” I said. She obeyed. “You think that does it? You say sorry and then leave?”
She shook her head.
“You had a baby?” I said. “A field baby.”
“The contraceptives they gave us didn't work.”
“Why did you go to jail?”
“Must I tell you everything?”
She began coughing again. When the spasm was over, she shivered, although the room was warm and I was sweating.
“What happened to your baby?”
Her face crumpled. Her lips stretched out. Her shoulders shook. “They took my baby away from me. Gave him away for adoption. I curse the man who put me in that position. Curse that man.” She looked up. “I was a good mother, Marion—”
“A good mother!” I laughed. “If you were a good mother you might be carrying my child.”
She smiled through her tears as if I were being funny—as if shed just remembered my fantasy of our getting married and populating Missing with our children. Then she began to shake, and at first I thought she was crying or laughing, but I heard her teeth chatter. I had rehearsed my lines in my head as I walked out of Asmara, walked all the way to the Sudan; Id rehearsed them so many times since. I imagined every excuse she might offer if I ever met her. I had my barbs ready. But this quaking, silent adversary was not what Id envisioned. I reached over and felt her pulse. One hundred forty beats per minute. Her skin, cool just a while ago, was burning to the touch.
“I … must … go,” she said, rising but swaying.
“No, you will stay.”
She was clearly unwell. I gave her three aspirin. I led her into the master bath and ran the shower. When it was steaming, I helped her undress. If earlier I had seen her as an animal in the predator's lair, now I felt like a father disrobing his child. Once she was in the shower, I tossed her underwear and shirt into the washer and ran the load. I helped her out of the shower. She was on glass legs. I dried her off and sat her on the edge of the bed. I put a pair of my winter flannels on her and tucked her in. I made her eat a few spoons of casserole and drink more tea. I put Vicks on her throat and on her chest and the soles of her feet, just as Hema would do with us. She was asleep before I slid the woolen socks over her toes.
What was I feeling? This was a Pyrrhic victory. A pyrexic victory— the thermometer I slid under her armpit read one hundred three degrees. While she slept, I moved her wet clothes to the dryer and stuck her jeans in the washer. I put away the casserole. Then I sat in the library by myself, trying to read. Perhaps I dozed. Hours later, I heard the sound of a toilet being flushed. She was on the bed, covers thrown to the side, pajamas and socks off, wrapped in a towel and wiping her brow with a washcloth. Her fever had broken. She moved over to make room for me.
“Do you want me to leave now?” she said.
In that question, I felt that she was taking control because there was only one possible answer: “You're sleeping here.”
“I'm burning up,” she said.
I changed into my boxers and T-shirt in the bathroom, took a blanket from the wardrobe, and headed for the library.
“Stay with me?” she said. “Please?”
I had no reply planned for that.
I climbed into my bed. When I reached for the light, she said, “Please leave it on.”
No sooner had I lain down than she pressed against me, smelling of my deodorant, my shampoo, and Vicks. She raised my arm and huddled in the crook of my shoulder, her damp body against me. Her fingers touched my face, very gingerly, as if she worried that I might bite. I remembered that night so many years ago when I had found her naked in the pantry.
“What's that sound?” she said, startled.
“It's the dryer alarm. I washed your clothes.”
I heard her sniffle. Then sob. “You deserved better,” she said, looking up.
“Yes, I did.”
I stared at her eyes, remembering the little fleck in the right iris, and the puff of gray around it, where a spark had penetrated. Yes, it was still there, darker now, looking like a blemish she was born with. I traced her lips. Her nose. She shut her lids at my touch. Tears were sliding underneath them. She smiled a smile from our days of innocence. I took my hand away. She opened her lids, her eyes glistening. Hesitantly she kissed my lips.
No, I hadn't forgotten. At that moment, my anger wasn't so much with her as it was with the passage of time. Time had robbed me of such wonderful illusions, taken them away far too soon. But right then I wanted the illusion that she was mine.
She kissed me again, and I tasted the salt of her tears. Was she feeling sorry for me? I couldn't take that, ever. Suddenly I was on top of her, tearing away the sheet, tearing away her towel, clumsy but determined. She was startled, the muscles of her neck taut like cables. I grabbed her head and kissed her.
“Wait,” she whispered, “shouldn't you … ?”
But I was already inside her.
She winced.
“Shouldn't I what, Genet?” I said as I bucked, my pelvis possessing some intrinsic knowledge of the movements needed. “This is my first time …,” I managed to say. “I wouldn't know what I should or shouldn't do.”
Her pupils dilated. Was she pleased to learn this about me?
Now she knew.
Now she knew that there were people in this world who kept their promises. Ghosh, whose deathbed she never had the time to visit, was one such person. I wanted the knowledge to shame her, to terrify her. When it was over, I stayed on top of her.
“My first time, Genet …,” I said, softly. “Don't think that's because I was waiting for you. It's because you fucked my life up. You could have counted on me. Money in the bank, as they say here. And what did you do? You turned it all into shit. I wanted to make life beautiful for you. I don't understand it really, Genet. You had Hema and Ghosh. You had Missing. You had me who loved you more than you will ever love yourself.”
She wept under me. After a long time, she gently caressed my head, tried to kiss me. She said, “I need to go to the bathroom.”
I ignored her. I was aroused again. I began to move inside her once more.
“Please, Marion,” she said.
Without removing myself from within her, I rolled onto my back, holding her, flipping her, and setting her on top of me, her breasts hovering over me.
“You need to pee? Go ahead,” I said, my breath coming quick. “You've done that before, too.”
I grabbed her shoulders and pulled her to me hard. I smelled her fever, and the scent of blood and sex and urine. I came again.
Then I let go. I let her slide off.
I WOKE LATE ON SATURDAY MORNING to find her back in the crook of my arm, staring at me. I took her again—I couldn't imagine how I had denied myself this pleasure for so long.
When I awoke it was 2:00 p.m. and I could hear her in the kitchen. I went to the bathroom. It was when I returned to the bed that I saw the blood on the sheets. I stripped the bed and took the sheets to the washing machine.
She brought two cups of coffee, a serving of the casserole and two spoons to me. She was getting feverish again, the dressing gown not warm enough, her teeth chattering, and with spasms of a dry cough. I took the coffee from her. Her dressing gown came apart. She watched me remake the bed.
“Sorry,” she said. “I am bleeding because the scars … I always bleed with … intercourse. Rosina's gift to me. So that I will always think of her when—”
“Is it painful?”
“At first. And if it's been a long time.”
“What about this fever, how long have you been this way? Have you had an X-ray?”
“I'll be fine,” she said. “It's a bad cold. Hope I don't give it to you. I took some Advil I found in your cabinet.”
“Genet, you should—”
“Really, I'll be fine, Doctor.”
“Tell me why you went to prison.”
Her smile disappeared. She shook her head. “Please, Marion. Don't.”
I knew then it was a story that would do me no good. I knew I had to hear it. Later, when the two of us were seated in my library, I insisted.
HE WAS AN INTELLECTUAL, a firebrand, an Eritrean who like her had left the cause. He shall remain nameless—it's painful enough already. Suffice it to say he won the heart of her baby. (The baby's father had died in the struggle.) And then he won her heart—all this in New York, after her arrival. She felt her life was just beginning. They married. In a year she was pregnant with his child. She began to suspect that he was cheating on her. She found the whereabouts of the woman, the flat where they conducted their tryst. She broke in and hid in the woman's clothes closet and waited there for half a day till the couple arrived in the late afternoon. When her husband and his white lover were on her bed, seeking carnal knowledge of each other in a noisy, effortful way, Genet debated whether to announce her presence.
“Marion,” she said, “as I stood in that closet, with this woman's belts in baskets like snakes at my feet, it all came back to me. Everything I had been through from the time of Zemui's death till then.
“I somehow came to America, and what did I do? For the first time in my life, for the one person who deserved it the least, I gave my love completely. I loved him—what is it you said earlier?—more than I loved myself. I gave it all up for this useless man. Standing in the closet, I knew that if I tried to get vengeance, I had to be willing to lose my life. There has only been one man in my life worthy of such a sacrifice, Marion, and it was you. I was too stupid to know that when I was young. I was too stupid.
“He wasn't worth it, but now I couldn't stop myself. You see, in loving him, it had happened again, Marion—I wanted to be great. I thought he was destined for greatness as an academic, as an intellectual, and my greatness would be in being with him.
“For the first time I understood who was the proletariat. The proletariat was me, the proletariat had always been me, and now I needed to act for the proletariat. I had my straight razor in my hand.
“I began to sing in my softest voice. They could not see me though I could see them.
“I opened the door of the closet with one intention for him: to slit his thew, slit it like a stalk of henna. You can only do that when you have loved someone so completely that you have held nothing back and there is nothing left of you—it has all been used. Do you understand?” I understood all too well. “Otherwise, I'd have said to her, Take him and keep him. Good riddance. Instead, I jumped on them.
“I cut them, but not as badly as I had in mind. They escaped. I waited for the police. I felt as if I had taken off handcuffs that had been on my wrists the whole time. I had been looking for greatness, and I found it then. I was free at the very moment when my freedom would end.”
She saw my expression as I followed the story, and she smiled.
“Genet died in prison, Marion. Genet is no more. When they take your living child away, you die, and the child growing inside you dies, too. All the things that matter are gone, and so I am dead.”
There was a tiny part of me that wanted to say, You have me, Genet. But for once, I stopped to consider myself, to save myself
I felt compassion for her of a sort that I hadn't felt before: it was a feeling better than love, because it released me, it set me free of her. Marion, I said to myself, she found her greatness, at last, found it in her suffering. Once you have greatness, who needs anything else?
IN RETROSPECT, my illness began that Sunday morning in the crystalline moment of waking to a silent house in which I knew I was alone and she was gone. Forty-three days later, the first shudder of nausea arrived, an ocean surge as if a distant Vesuvius had collapsed into the sea. Next an ancient fog, an Entoto mist full of shifting shapes and animal sounds descended on me, and by the forty-ninth day I had lost consciousness.
How remarkable that a life should turn on such a small thing as a decision to open a door or not. I ushered Genet in on a Friday. She let herself out two days later without a good-bye, and nothing would be the same again. She placed a pinwheel cross at the center of the dining table, a gift for me, I presumed. That St. Bridget's medallion she wore on a necklace had been her father's, and it had belonged to a Canadian soldier named Darwin before that.
The tale of her ex-husband lingered like a nasty flu. I'd insisted on hearing the story. I discovered that Genet was capable of selfless love— just not with me. Still, in my home I'd found a momentary equilibrium with her, or the illusion of it, as if we were again like children playing house, playing doctor.
I HURRIED HOME each night after work, hoping to find her waiting on my stoop. My heart would sink when I glimpsed the yellow sticky I had left for her inside the screen door, telling her the key was with my good neighbor, Holmes, and to feel at home. Once inside, I felt compelled to retrieve my note, checking to be sure I had, in fact, written on it. I confess, I even left a stub of a pencil by the door in case she felt inclined to compose a reply.
By Friday, a week after I first dragged her into my home, the sight of that yellow square of paper screamed, FOOL! The stubby pencil said, FOOL OF THE HIGHEST ORDER. I tore up the paper and flung the pencil stub into the street.
I wasn't angry with Genet. She was consistent, if nothing else. I was angry with myself because I still loved her, or at least I loved that dream of our togetherness. My feelings were unreasonable, irrational, and I couldn't change them. That hurt.
Sitting in my library that night, having done more damage to a bottle of Pinch in four hours than I had in the year since I bought it, I replayed our last exchange. She'd been curled up in the chair I now sat in, wearing my dressing gown, the gown that I now wore. I came to her with tea— that signature move of fools, one of the stigmata by which you shall know us.
“Marion,” she said, for she had been gazing at my library, my eclectic little collection. “Your father's apartment in Boston, the way you described it … it sounds so much like this.”
“Don't be ridiculous,” I said. “I built these bookcases myself. Half the books here have nothing to do with surgery. Surgery isn't my life.”
She didn't argue. We sat quietly. At one point I saw her gaze flit to the rug on the floor between us—there was an intruder sitting naked on those synthetic fibers, a dark silent man with razor cuts to his body. His presence put a damper on our conversation.
When I announced I was going to go to bed, she said she'd be right along. She smiled. I didn't believe her. I thought I'd never see her again. But I was wrong. She joined me under the covers. We made love. It was tender and slow. It was the very moment when I thought, At last, she is going to stay, but in fact it was her good-bye.
TWO WEEKS AFTER SHE LEFT, I felt at odds with my house. I found my library oppressive. In the kitchen, I took out my dinner, which was a foil packet labeled FRIDAY in my handwriting; it was the last of what I had cooked, frozen, and packed in aliquots many weekends ago. Now I saw this categorizing of my freezer food as a sign of the true chaos inside my head.
Thank God for my good neighbor, Sonny Holmes. He heard me raging, he heard me bang my head against the fridge. Sonny Holmes had an inherent curiosity an honest, all-American nosiness that came with crossing one's seventieth year and that did not try to conceal itself. Hed been aware of the coming of my guest—such a rare event—and he'd heard the headboard music and then the long silence.
“You need to hire a security firm,” he said, coming to a quick diagnosis before I had even finished my story. Sonny believed in the ennea-gram, that Jesuit-invented classification of people into personality types. He was a One, willful and confident and certain. He had me pegged as a Three or a Four, or was it a Two? Whatever it was, it was a number that did not argue with Ones.
“I need a what?” I said.
“A private detective.”
“Sonny, for what? I don't want to see her again.”
“Perhaps so. But you need closure. What if she's in jail or in a hospital? What if she's trying desperately to get back to you, but can't?”
A noble motive, that was all a Two needed to continue an obsession. I latched on to that.
East Coast Investigations of Flushing turned out to be an earnest, blond youth by the name of Appleby, son of Holmes's late sister-in-law. Appleby quickly established that Genet had not returned to her halfway house. She hadn't gone to Nathan's restaurant, where she washed dishes. She had not checked in with her probation officer and she had not called Tsige. He learned these facts in no time. He even knew that Genet had been diagnosed with tuberculosis while in prison. She began medications, but then failed to report for her DOT—Directly Observed Therapy—after she was released. The cough, the fever, in all likelihood were her tuberculosis coming back. The disconcerting news was that if she ever materialized, I'd be third in line after the state health department and her probation officer. She would be headed back to jail. Apple by s source in jail could get his hand on her complete medical records if we wished, and Appleby said he'd taken the liberty of telling the man to proceed. I was concerned about violating her confidentiality. “Knowledge is power in these kinds of situations,” Appleby added, and with that he won me over; any man who would use a quote that Ghosh loved was a man to trust. “You are paying to know,” he added, “and I think we're obliged to know more.”
“So what now?” I asked Appleby. I wasn't asking him about exposure to tuberculosis. I could handle that.
Appleby avoided my eyes. His cheeks and the tip of his nose were covered with twitchy blood vessels, ready to flush at the least provocation. His condition was acne rosacea, not to be confused with the pedestrian acne vulgaris, the bane of many teenagers. Appleby's nose would one day be burgundy and bulbous, the cheeks a meaty red. Already shy, his problems would get worse because strangers would assume incorrectly that his appearance was a result of drink. Here I knew about his future while paying him to tell me mine.
“Well, Dr. Stone,” Appleby said, clearing his throat, his nose starting to redden, a sure indication that I would not like what he had to say, “Respectfully, I would say to check your silverware. Inventory your belongings. Make sure nothing is missing.”
I looked at him for a long while. “But, Mr. Appleby, the only thing that matters to me is precisely the one thing that is missing.”
“Yes, of course,” he said.
The compassion in his voice told me he had known my kind of pain. There are legions of us.
AS FAR AS THE EVENTS of the next few weeks, I recall one night waking to the shrill ring of the telephone. Receiver in hand, I was lost, uncertain whether I was at Our Lady or back at Missing. I was the backup trauma consultant. But I couldn't decipher what the resident at the other end wanted. This isn't uncommon for the first ten seconds of a middle-of-the-night conversation. The caller understands. But, as we kept talking, the fog in my brain refused to lift. I hung up. I pulled the phone from its moorings. The next morning, my mind felt clear, but my body wouldn't rise off the bed. I was weak. The thought of food turned my stomach. I rolled over and went back to sleep.
Perhaps that same day, perhaps a few days later, a man was on the edge of my bed. He took my pulse, called my name. It was my former Chief Resident and now my colleague at Our Lady, Deepak Jesudass. I desperately held his hand and asked him not to leave—I must have recognized the danger of my situation.
“I'm not leaving,” he said. “Just pulling back the curtain.” My memory is that I told him everything that had transpired. He examined me as I spoke. He pulled down my eyelids, interrupting me only to ask that I look down at my feet, or say “Ah!” At one point he inquired if I had a stethoscope in the house. I said, “Are you kidding? I'm a surgeon,” and we laughed together, a strange sound that had been missing from my home. I said “Ouch” when he probed just under my ribs on the right. I found this funny. I heard him murmuring on the telephone. All the while, I did not let go of his hand.
Three men whose faces I knew arrived with a stretcher. They wrapped me in a flannel cocoon, carried me out to the curb, and lifted me up into their ambulance. I remember wanting to say something about the beauty of their motion, the inherent grace, and how incredible it was, this baby-kangaroo-in-pouch feeling. I apologized for not having appreciated their skill all these years.
Deepak rode with me. At Our Lady, he walked alongside my gurney past the shocked faces of the staff we encountered in the halls and elevator. He wheeled me into the Intensive Care Unit of Our Lady of Perpetual Succour. My eyes glowed yellow under the harsh fluorescent lights, but I didn't know it. My skin, too. I bled wildly from every needle stick. Too late, the nurses tried to hide the ominous tea-colored urine in my catheter bag from me, but I saw. For the first time, I was very, very scared.
The increasing swelling in my brain made me desperately sleepy. I held on to consciousness long enough to ask Deepak to come near. “Whatever happens,” I whispered, “don't take me from Our Lady. If I must die and can't die at Missing, I want to die here.”
At some point I was aware that Thomas Stone came to my bedside and was studying me, but not with the concern of a clinician. It was the petrified look I knew so well, the look of a parent whose child had suffered some misfortune. It was at about this time that I lost consciousness.
AS I LEARNED LATER, the cable to Hema read: COME AT ONCE STOP MARION CRITICALLY ILL STOP THOMAS STONE STOP P.S. DO NOT DELAY STOP—and she did not. Hema called in her favor with the Comrade President-for-Life's wife, who understood all too well Hema's need to be at her son's sickbed. The American Embassy readily provided visas, and by day's end, Hema and Shiva were on their way to Frankfurt via Cairo. Then, still on Lufthansa, they crossed the Atlantic. Hema pulled out the telegram more than once, studying the letters, looking for a hopeful anagram. Over Greenland, she said to Shiva, “Perhaps this means Thomas Stone is near death, not Marion.”
Shiva said with absolute certainty, “No, Ma. It's Marion. I can feel it.”
At ten in the night New York time, they floated into the Intensive Care Unit, a graying woman in a maroon sari, the face striking despite the raccoon rings around her eyes. With her was a tall youthful man who was so obviously her son and my identical twin.
They slowed outside my glass cubicle, weary Old World travelers peering into the glow of a New World hospital room. There I was, the son who went to the States for higher studies, who became a practitioner of the artful, lavish, disposable-everything, lucrative, and incredibly effective American brand of medicine, with no prices on the menu, so different in style and substance from what they did at Missing; only now it must have appeared to them as if the American medicine had turned on me, like the tiger turning on its trainer, so that I lay moored to a blue-gray ventilator, chained to moni tors on the consoles behind my bed, comatose and invaded by plastic tubing, by catheters and wires. There was even a stiff wire like a nail poking up from my skull.
They saw Thomas Stone seated on the side of my room closest to the window, his head resting awkwardly against the bed's safety rail, his eyes closed as if in sleep. In the seventy-two hours since he sent the telegram, my condition had worsened. Thomas Stone opened his eyes, suddenly aware of them. He stood up, bedraggled, stiff, and somewhat shrunken in his borrowed scrubs, relieved but apprehensive. Worry lines ran into his eyes, and his face was drawn and pale under his shock of white hair.
The two old colleagues and combatants had last seen each other in a delivery room, moments after my birth and our mother's death. That was also when Stone had last seen Shiva: in Operating Theater 3, held tight in Hema's arms.
The bedside table and the ventilator blocked Hema's approach to the near side of the bed. She circled to where Stone stood, her eyes on me.
“He is ‘critically ill’ from what, Thomas?” Hema said, referring to the two words in the telegram that had most frustrated her. Her tone was professional, as if she were asking a colleague about a patient; it allowed her the pretense of being calm when inside she was quaking.
“It's hepatic coma,” Thomas said, responding in the same manner, grateful that she'd elected to converse in the language of disease, a fallback which allowed even their son to be reduced to a diagnosis. “He has a fulminant hepatitis. The ammonia level is very high and the liver hardly functioning.”
“What from?”
“Viral hepatitis. Hepatitis B.”
Stone let down the bed rail and the two of them stood over me. Hema's hand reached behind her for the tail end of her sari, the part that went over her shoulder. She brought it to her mouth.
“He looks anemic, not just icteric,” she managed to say at last, clinging to the idiom of medicine to describe my pallor and jaundice. “What's his hemoglobin?”
“Nine, after four units of blood. He's bleeding from his gut. His platelets are down and he isn't making clotting factors. The biliru-bin is twelve, and his creatinine just today is four, rising from three yesterday …”
“What's this, please?” Shiva said, pointing at my skull. He stood across from Thomas Stone, the bed between them.
“An intracranial pressure monitor. Goes into the ventricle. He has cerebral edema. They're giving him mannitol and adjusting the ventilator settings to keep the pressure down.”
Shiva looked skeptical. “It goes through his skull, through brain into the ventricle just to measure? It does not treat?”
Thomas Stone nodded.
“How did this begin?” Hema asked.
As Thomas Stone recounted the sequence of events, Shiva freed the bedside table and found slack between the bed and ventilator. He let down the bed rail on his side. Moving with the slow efficiency of a contortionist, he slid under the tubes and wires. Deepak entered in time to see Shiva lying on his side next to me, his head touching mine. His being there looked both precarious and entirely natural. All Deepak could do was stare, noting, however, that my intracranial pressure tracing, which had done nothing but go up for three days, went down.
No sooner had Deepak introduced himself than Vinu Mehta, the gastroenterologist, filled the doorway, panting from taking the stairs. Vinu had been an internal medicine resident at Our Lady when I was a surgery resident. After specializing in gastroenterology he'd joined a lucrative practice in Westchester but wasn't happy and had returned to the salaried staff of Our Lady.
“Vinu Mehta, Dr. Madam,” he said, putting his palms together in a ñamaste before grasping Hema's hand with both of his. “And this must be Shiva,” he said, unfazed at seeing Shiva in my bed. “I know this only because I am certain the other gentleman is Marion.” He turned back to Hema. “What a shock this must be, madam. For everyone here, too. Our whole world is upside down! Marion is one of us.” This sudden switch to the vernacular of feelings made Hema's lips tremble.
One look at Vinu and you knew the stories about him buying groceries for patients he discharged were probably true. Id seen him extend a patient's stay to insulate her from some madness at home. He was the best friend to everyone on the staff and regularly baked cakes and cookies for me. I always sent him a card on Mother's Day, which pleased him no end.
“I was called the minute that Marion was brought here, Dr. Madam,” Vinu went on. “Hepatology, the liver, that is my field. Hepatitis B swims around here. Lots of carriers, intravenous drug addicts and people who acquire it from their mothers at birth—very common in immigrants from the Far East. Madam, we see no end of silent cirrhosis and even liver cancer from this virus. But acute fulminant hepatitis B? In my career I have seen only two other patients quite this severe.”
“Vinu, tell me the truth,” Hema said, taking on a no-nonsense, Mother India tone with this young doctor who was all too ready to play the role of nephew. “Is my son a drinker?”
I suppose it was a fair question. I hadn't seen her in more than seven years. She knew it was in my genes. What did she really know of who or what I had become?
“Madam, categorically no!” Vinu responded. “No, no. A gem of a son you have.”
Hema's stern expression softened.
“Although, madam,” Vinu continued, “in the past few weeks, madam—don't take this wrongly—by the report of his neighbor, Marion had been troubled and drinking.”
Deepak had found a new prescription in my house for isoniazid, a drug used to prevent tuberculosis. Isoniazid was also famous for causing severe liver inflammation. It was routine to check liver enzymes two weeks after starting treatment so the drug could be discontinued if there was any sign of liver damage.
“My hypothesis, madam, is that Marion-bhaiya started isoniazid on his own. The prescription is a month old. He probably didn't get his blood drawn to check liver functions the way he was supposed to. He is a surgeon after all, poor fellow. What does he know about these fine matters? If he'd only consulted me! I would have been honored to take care of him. After all, Marion-bhaiya took care of my hernia so lovingly.
“In any case, madam, I personally went to Manhattan, to Mount Sinai, and I chauffeured over the world's best liver man, the man who trained me in this specialty. I said, ‘Professor, this is a not a case of hepatitis, but a case of my own brother.’ He is in agreement that the alcohol and the isoniazid might be contributory, but there is no doubt that what we are dealing with here first and foremost is hepatitis B.”
“What is the prognosis?” Hema said. “Will someone tell me that?” It was the most basic thing a mother wanted to know. “Will he get better?”
Vinu looked to Deepak and Thomas Stone, but neither man was willing to speak. The disease was, after all, Vinu's area of expertise.
“Just tell me. Will he live?” Hema spat out.
“It is undoubtedly very grave,” Vinu said, and the fact that he was fighting back tears told her everything.
“Come on!” Hema said, annoyed by this and turning to Thomas Stone, and then to Deepak. “It's hepatitis. I understand hepatitis. We see the damage it does in Africa. But … here, America! In this wealthy place, this rich hospital”—she swept her hands at all the machinery— “surely here in America you can do more for hepatitis than to wring your hands and say it is very grave.“
They must have winced when she said “rich.” Compared with the state-of-the-art ICUs in the money hospitals, such as Thomas Stone's institution in Boston, ours was bare-bones.
“We tried everything, madam,” Deepak said now in a more subdued tone. “Plasma exchange. Whatever anyone in the world can do for this disease, we are doing that here.”
Hema looked skeptical.
“And praying, madam,” Vinu added. “The sisters have a prayer chain going around the clock for two days now. Honestly, we need that kind of a miracle.”
Shiva had quietly followed every word from where he lay.
Hema stood looking down at my unconscious form, stroking my hand and shaking her head.
Vinu convinced the two of them to retire to a room readied for them in the house-staff building; he'd even arranged for a light dinner of cha-patti and dal. Hema was too tired to argue.
THE NEXT MORNING, Hema appeared in an orange sari, looking rested, yet as if she had aged a few years in the course of the night.
Thomas Stone was exactly where she had left him. He looked past her in the doorway, as if expecting Shiva, but Shiva wasn't there.
She stood by my bed again, anxious to see me in daylight. The previous night she'd found it all too unreal, as if it were not me on the bed but some extension of all the noisy machinery which had taken the form of flesh. But now she could see me, see the rise and fall of my chest, the puffiness of my eyes, my lips contorted by the breathing tube. It was real. She couldn't help herself, and began to weep silently, forgetting Thomas Stone was there, or not caring one way or the other. She was only conscious of him when he tentatively offered a handkerchief. She snatched it from him, as if he'd been slow to offer it.
“It feels as if this is happening because of me,” Hema said. She blew her nose. “I know that sounds selfish, but to lose Ghosh, then to see Marion like this … You don't understand, it feels as if I have failed them all, that I let this befall Marion.”
Had she turned, she might have seen Thomas Stone stir, seen him rub his knuckles against his temples, as if trying to erase himself. He spoke, his voice hoarse. “You … you and Ghosh never failed them. I did. I failed all of you.”
There it was, Hema must have thought; it was both the sorry and the thank-you that was so long overdue, and the funny thing was that at this moment, she didn't care. It no longer mattered. She didn't even look his way.
SHIVA ENTERED, and if he saw Thomas Stone, he didn't acknowledge his presence. He had eyes only for me, his brother.
“Where were you?” Hema said. “Did you sleep at all?”
“In the library upstairs. I took a nap there.” Shiva surveyed me, then he studied the settings on the ventilator, and then the labels on the fluid-containing bags hanging over my bed.
“There is one thing I didn't ask Vinu,” Hema said to Stone. “How did Marion get hepatitis B?”
Thomas shook his head as if to say he did not know. But since she wasn't looking his way, he had to speak. “It … was probably during surgery. Nicking himself. It's an occupational hazard for surgeons.”
“It can also be acquired by sexual intercourse,” Shiva said, addressing Thomas Stone. Thomas Stone stammered assent. Hema glared at Shiva, one hand on her hip. She didn't get a chance to speak, because Shiva had more to say: “Genet was at Marion's house, Ma. She showed up there six weeks ago. She was sick. She stayed for two nights and then disappeared.”
“Genet … ?” Hema said.
“There are two people in the waiting room you need to meet. One is an Ethiopian lady, Tsige. She used to live opposite Missing. Ghosh took care of her infant years ago. Marion met her again in Boston. The other is Mr. Holmes—he is Marion's neighbor. They want to speak to you.”
BY MIDMORNING, Hema knew the whole story. Genet had been ill with TB. But Appleby had his hands on the prison health records and they showed what we had not known before: Genet was also a silent carrier of hepatitis B. She contracted it (or so the prison doctor postulated) from an improperly sterilized needle or a transfusion or a tattoo when she was in the field in Eritrea; she could also have acquired it sexually. Genet had bled readily when we slept together, and I had been generously exposed to her blood and thereby to the virus. The incubation period of hepatitis B fit Shiva's hypothesis: it was six weeks from her visit to my falling ill.
Hema paced the waiting room, cursing Genet and bemoaning my stupidity in letting Genet get close to me again after everything she had put us through. Had Genet appeared just then, I would have feared for her life.
WHEN DEEPAK AND VINU made rounds together that afternoon they shared the latest lab results: my kidneys were failing; my liver, normally the source of clotting factors, wasn't producing any. If there were any viable liver cells left, they were showing no signs of recovering. There was not a bit of good news they could convey. They withdrew, Shiva following them. Thomas Stone and Hema stayed, silent around my immobile form. Now it was a watching game, a vigil to the end. There was no hope. The two of them as physicians knew it all too well, but if anything, experience made it even less palatable.
AT NOON, an ICU nurse paged both Deepak and Vinu to a Stone family conference. They came to find Hema and Shiva seated across from Thomas Stone in the small meeting room.
Hema, weary, head in her hands and elbows on the table, gazed up at the two young doctors in white coats, her son's peers. “You wanted to see us?” she said impatiently to Vinu and Deepak.
Deepak looked puzzled. “I didn't call this meeting.” He turned to Vinu, who shook his head.
“I did,” Shiva said. He had a stack of photocopied papers in front of him. A yellow legal pad was covered with notations in his careful script. Hema noticed an authority to his voice, a sense of action and energy and initiative that no one else seemed capable of displaying in the face of my terrible prognosis. “I called the meeting because I want to talk about a liver transplant.”
Deepak, who found it difficult to sit face-to-face with Shiva and not feel he was speaking to me, said, “We considered a transplant early on, Shiva. In fact, Dr. Stone and I talked about transferring Marion to Mecc—I mean to Boston General, Dr. Stone's hospital. Dr. Stone's team does more transplants than anyone on the East Coast. But we decided against it for two reasons. First of all, transplants are notoriously unsuccessful when the liver is being destroyed by fulminant hepatitis B. Even if we found a cadaver liver of the right blood group and size and we did the transplant successfully, we would have to use massive doses of steroids and other drugs that suppress the immune system to prevent rejection of the new liver. That would give the hepatitis B virus a field day and the new liver would be destroyed and we would be back to exactly where we are now.”
“Yes, I know,” Shiva said. “But what if the transplant is a perfect match? Not just the same blood group, but all six HLA antigens and other antigens you don't even measure—what if they all matched? Then no immune-suppressing drugs would be needed? Right? None. No steroids, no cyclosporine, nothing. Would you agree?”
“Theoretically, yes, but …,” Deepak said.
“A perfect match is what you would have if you took the liver from me,” Shiva said. “His body would see it as self, not as foreign in any way.”
The air had been sucked out of the room. No one spoke for a few seconds. Seeing Hema's expression, Shiva quickly explained, “I mean take a part of my liver, Ma. Leaving enough for me and taking out a lobe to give to Marion.”
“Shiva …” It was on Hema's lips to apologize for Shiva—this clearly was not his field, or hers for that matter. But then she changed her mind. She knew something about his tenacity when it came to medical situations that others thought impossible. “But, Shiva, has that ever been done—transplanting part of a liver?”
Shiva slid one of the articles over to her. “This is from last year. A review by Deepak Jesudass and Thomas Stone on the prospects for live donor liver transplant. It hasn't been done in humans, Ma, but before you say anything, read page three where I have underlined. They say, ‘Technically, the success in almost one hundred dogs, the ability to sustain life in the recipient and not jeopardize life in the donor, suggests that we are ready to perform this operation on humans. The risks to a healthy donor present a significant ethical obstacle, but we believe the critical shortage of cadaver organs obliges us to move forward. The time has come. Live donor transplant will overcome both the problem of organ shortage and the problem of cadaver livers that are damaged because it has taken too long to get consent and too long to remove the organ and get it to where it needs to be. Live donor liver transplant is the inevitable and necessary next step.’ “
Shiva wasn't reading, but reciting word for word from memory. It didn't surprise Hema, but it astonishmed the other physicians at the table. Hema felt proud of Shiva. She was reminded how often she took Shiva's eidetic gift for granted. She knew he could draw the page he was reciting from, reproduce it on a blank piece of paper, beginning and ending each line just as it was on the original, down to the punctuation, the page number, and the staple marks and photocopy smudges.
Shiva, sensing that he had quieted Hema for the moment, addressed Thomas Stone and Deepak, the two surgeons: “May I remind you that the first successful kidney transplant by Joseph Murray involved a dying twin who received a healthy kidney from his identical twin brother?”
Deepak spoke, because it appeared that Thomas Stone was in a state of shock, “Shiva, we also state in the paper,” Deepak said, “that there are ethical and legal implications—”
Shiva interrupted. “Yes, I know. But you also say ‘in all likelihood the first donors will be a parent or sibling, because such a donor has a pure motive and takes on the risk willingly’ “
Deepak and Thomas Stone looked like defendants whose alibi had just been shot down by a surprise witness. The prosecutor was moving in for the kill.
But the attack came from another quarter. Hema said, “Thomas, tell me the truth: in the last four days, given that this is your area of interest”—she tapped the paper, her fingers bunched together—”seeing Shiva lie next to his twin, did the thought of this live donor operation not cross your mind?”
If she expected him to squirm and swallow hard, she was in for a surprise: Stone looked steadily at Hema, and after a beat, he nodded almost imperceptibly. “I thought of the Murray twins, yes. I thought of it. But then thinking of all the hazards … I dismissed it. This is much, much harder than removing a kidney. It's never been done.”
“ I never thought of it!” Vinu Mehta said quietly. “Madam, I should have thought of it. Shiva, I thank you. In anyone else with acute hepatitis B, a liver transplant would simply feed the virus. But with a perfect match … Of course, Shiva, the issue is really the risk to you.”
My brother was ready, and he spoke without glancing at his notes, addressing his comments largely to Thomas Stone even though Vinu had asked the question. “Your estimate, Dr. Stone, based on cutting out one or more lobes from patients with liver trauma, is that the risk of death should be less than five percent for me, the donor. The risk of serious complications, such as bile leaks and hemorrhage, you said should be no more than twenty percent in an otherwise healthy donor.” Shiva pushed a single sheet to Deepak and Thomas Stone. “I had my blood drawn last night. All my liver functions came back normal. As you can see, I am not a carrier of hepatitis B or anything like that. I don't drink or take drugs that might damage the liver. I never have.” Shiva waited for Thomas Stone.
“You know that paper of ours better than I do, son,” Stone said. “Unfortunately, those were estimates, a pure guess.” He put his hands on the table. “We don't know how it might really work in humans.”
“And if we fail,” Deepak added gently, since Thomas Stone was finished, “we lose you who walked in here healthy and we lose Marion. Not to mention that we won't have a leg to stand on or that our careers could be over. Even if we succeed, we will be heavily criticized.”
If they thought Shiva was done, they didn't know my brother. Hema was seeing her son anew. “I understand your reluctance. I wouldn't think much of you as surgeons if you agreed at once. However, if you can do this operation and if it has a reasonable chance, even a ten percent chance of saving Marion's life, and a less than ten percent chance of ending my life, and if you choose not to do the operation, then in my opinion, you would have failed Marion, failed Hema and me, failed medical science, failed yourselves. You would have failed my brother not only as his physicians, but as his friend, and as his father. If you did the operation and succeeded, you would not only save my brother, but you would have advanced surgery by a decade. The time is now.” He looked his father and then Deepak in the eye. “You may never get a chance like this again. If your rivals at Pittsburgh were facing this situation, what would they do? Would they not be bold?”
The prosecution rested. It was time for the other side of the table to respond.
“Bold, yes,” Stone said, breaking the long silence, and speaking in an undertone as if only for himself, “but they wouldn't be operating on their own sons. I'm sorry, Shiva, I can't imagine this.” He pushed back from the table, put his hands on the arms of his chair as if he were thinking of leaving.
“Thomas Stone!” Hema's voice was sharp as a Bard-Parker blade and it nailed him in his seat. “Once before I asked you for something, Thomas,” she said. “It had to do with these boys. You walked away then. But this time if you walk away, neither I nor Ghosh can help these boys.” Stone turned pale. He sat back in the chair. Hema's voice broke. “Thomas, do you think I would want to subject Shiva to a risk he couldn't surmount? Do you think I want to lose my sons?”
When she had composed herself, and after blowing noisily on her kerchief, she said, “Thomas, please dismiss from your head the idea that they are your sons. This is a surgical problem and you are in the best position to help them, precisely because they were never your sons. They never held you back, they never slowed your research, your career.” There was no rancor in her voice. “Dr. Stone, these are my sons. They are a gift given to me. The pain, the heartbreak, if there is to be heartbreak, are all mine—that comes with the gift. I am their mother. Please hear what I say. This has nothing to do with your sons. Make your decision by deciding what you must do for your patient.”
After an eternity, Deepak dragged the yellow pad from Shiva's side of the table and turned to a fresh page. He uncapped his pen and said to Shiva, “Tell me, why are you willing to subject yourself to such a risk?”
Shiva, for once, did not have a ready reply. He closed his eyes and made a steeple of his fingers, as if to shut out their faces. It worried Hema to see him this way. When he opened his eyes, he seemed for the first time since his arrival to be sad. He said, “Marion always thought that I never looked back. He saw me as always acting only for myself. He was right. He would be surprised if I were to risk my life to donate part of my liver. It isn't rational. But … seeing that my brother might die, I have looked back. I have regrets.
“If I was dying, if there was a chance he could save me, Marion would have pushed you to operate. That was his way. I never understood it before because it's irrational. But I understand it now.” He glanced at Hema, then shouldered on.
“I had no reason to think about all this till I got here. But at his bedside … I realized if something happens to him, it happens to me, too. If I love myself, I love him, for we are one. That makes it a risk worth taking for me—it wouldn't be for anyone else, unless they loved him. I am the only one who is a perfect match. I want to do this. I couldn't live with myself if I didn't do this, and I think you wouldn't be able to live with yourselves if you didn't try. This is my destiny. My privilege. And yours.”
Hema, composed till then, pulled Shiva to her and kissed him on the forehead.
Deepak, pen poised, had yet to write a word. He put the pen down.
At that moment it sunk in that they were going to go ahead with what had never been done before.
Shiva said to Deepak, “You said there was a second reason you had initially dismissed the idea of a transplant. What was it?”
Deepak said, “Before he lost consciousness, Marion made me promise not to transfer him. This hospital was special to him. It was more than a place for us foreign medical graduates to train. It welcomed us when other places did not. This is our home.”
Hema sighed and dropped her head into her hands. Just when they had come this far, another obstacle.
“We can do it here,” Thomas Stone said softly. He had listened to Shiva without moving a muscle, and those blue and steady eyes were now shiny and bright. He pushed his chair back and stood up, his movements purposeful. “Surgery is surgery is surgery. We can do it here as well as anywhere if we have the tools and the people. Fortunately, the world's expert in splitting the liver is sitting right next to me,” he said, putting a hand on Deepak's shoulder, “and the tools, many of which he designed, are also here and will need to be sterilized at once. We have a lot to get ready. Hema, at any time if you or Shiva have a change of heart, all you need to do is say so. Shiva, please don't eat or drink anything from this moment on.”
As he walked past Shiva's chair, he clamped his hand on my brother's shoulder, squeezed hard, and then he was gone.
AHELICOPTER FROM BOSTON GENERAL landed on Our Lady of Perpetual Succour's helipad during the night. It brought special instruments and the key personnel from Boston General's well-oiled liver transplant program. The corridor outside Our Lady's operating suites, normally a desolate stretch where one might find an empty stretcher or a portable X-ray machine parked while the tech took a cigarette break, was now like battalion headquarters at the start of a military campaign. Two large blackboards had been set up, one labeled DONOR and the other RECIPIENT, each listing what had to be accomplished with a check box next to the task. Our Lady of Perpetual Succour's team with Deepak as lead surgeon would handle the donor (Shiva's) operation, and the Boston General crew with Thomas Stone as lead surgeon would staff the recipient (my) surgery. The Our Lady team wore blue scrubs, while the Boston General crew wore white, and just to be certain, the former had a big D (for “donor”) marked on their hats and scrub shirts with a black marker, whereas the latter had an R. The adrenaline flow kept these disparate teams in good spirits; one Bronx wag even suggested to his Dorchester counterpart that they could call the teams Crackers and Homeboys. Only Thomas Stone and Deepak Jesudass would be common to both teams, each man assisting the other.
A dry run at midnight with dummy patients in both operating rooms had uncovered a few critical glitches: anesthesia from Boston General needed a better orientation to the setup at Our Lady, and there was need to anoint a “ringmaster” whose job was to be timekeeper, to keep abreast of the activities of both teams, and who was the only person authorized to carry and, most important, record all messages from Team R to Team D and vice versa. Two new blackboards were brought in to be placed inside each theater, and tasks to be ticked off written on these. Our Lady of Perpetual Succour was put on diversion, with trauma being rerouted to other hospitals in neighboring boroughs. By 4:00 a.m. it was time for the real thing.
Thomas Stone threw up in the surgeons’ locker room. The Our Lady crew saw this as a bad omen, but the Boston General crew assured their counterparts that a pale, diaphoretic Stone augured a good outcome (though in truth, they had never seen him quite so pale and weak, lying prostrate on the bench, a puke basin at his side).
With so many people from two hospitals involved, it would have been difficult to keep the operation a secret. There were two television crews parked outside Our Lady. Newspaper editors were past the deadline for the morning paper, but they were preparing to weigh in on the ethics of this historic transplant, and now they could wait to see how it went before committing themselves.
Making history or keeping it a secret was the last thing on the surgeons’ minds. Deepak, sitting on a bench separated by a row of lockers from where Stone suffered, tried to block out the sickening sound of his colleague's retching by reviewing a liver atlas.
At 4:22 a.m. Shiva was given diazepam and then pentothal, and a tube was passed into his trachea. The donor operation had begun. Thomas Stone and Deepak expected it to take anywhere from four to six hours.
IF THE BEATING HEART is pure theater, a playful, moody, extroverted organ cavorting in the chest, then the liver, sitting under the diaphragm, is a figurative painting, stolid and silent. The liver produces bile, without which fats are not digested, and the liver stores excess glucose in the form of glycogen. In silence and without outward signs, it detoxifies drugs and chemicals, it manufactures proteins for clotting and for transport, and it clears the body of ammonia, a waste product of metabolism.
The liver's smooth and shiny outer surface is monotonous and unexciting, and apart from a median furrow dividing it into a large right lobe and a smaller left, it has no visible cleavage planes. It is a surprise to find surgeons speak about its eight anatomical “segments”—as if they are discrete, as if they are like sections of an orange. Try pulling these segments apart and you'll have raw surfaces oozing blood and bile and a very dead patient. Still, the idea of segments allows the surgeon to define areas of liver that have a full complement of blood and bile conduits and that are therefore semiautonomous units, subfactories within the factory.
Four families of vessels enter or leave the liver. First, the portal vein, which carries all the venous blood leaving the gut and hauls it to the liver, blood that after a meal is rich in fats and other nutrients for the factory to process. The hepatic artery brings oxygen-rich blood to the liver from the heart via the aorta. The hepatic veins have the task of taking all the spent blood that has filtered through the liver and returning it to the heart via the vena cava. The bile formed by each liver cell gathers in tiny bile tributaries that merge and grow and eventually form the common bile duct that then empties into the duodenum. Excess bile is stored in the gallbladder, which is nothing more than a balloonlike offshoot of the bile duct. In keeping with the liver's chaste and understated demeanor, the gallbladder is tucked out of sight, just under the overhang of the liver.
DEEPAK, STANDING ON THE RIGHT, made the incision. The first step was to remove Shiva's gallbladder. Then, turning his attention to the stalk of vessels entering the liver (the porta hepatis), he dissected out the right hepatic artery, then the right branch of the portal vein and the right biliary duct. To get the right lobe free, he also had to cut through liver tissue and disconnect the hepatic veins at the back where they joined the vena cava—the dark side of the liver, the place where the surgeon might “see God” if there was bleeding. In removing a lobe of the liver for cancer, it is possible to control bleeding by pinching off the stalk of blood vessels in the porta hepatis—the Pringle maneuver. But this wasn't an option for Deepak, because it would compromise the function of the lobe they were removing, choke it half to death before giving it to me. There are now ultrasonic and even radio-frequency “dissectors” that make cutting through the liver easier, less bloody. But Deepak, with Thomas Stone as his assistant, had to resort to clamp crushing and “finger fracturing” to break through the liver tissue while avoiding the major blood vessels or bile ducts. Deepak worried about his senior partner: Thomas Stone's mind seemed to wander, something Deepak had never encountered before. Little did Deepak know that Stone was struggling to keep away the image and the memory of his futile efforts to save Sister Mary Joseph Praise, and his dangerous attempts at crushing a baby's skull.
The donor operation went without a hitch. At 9:00 a.m., I was wheeled into the operating room, and at 9:30 a.m., just as Shiva's right lobe was coming free, the Boston General team, without Thomas Stone, made a long incision across my middle, below my rib cage but above my belly button. They began mobilizing my liver, cutting away its ligaments and trusses.
Thomas Stone took Shiva's freed right lobe to a side table, where, with hands that were steadier than his insides, he flushed the portal vein with University of Wisconsin solution. Deepak, meanwhile, ensured that there were no bile leaks in the raw edge of what remained of Shiva's liver, which was largely his left lobe. He looked all around for any overlooked bleeders, repeated the sponge and instrument count twice, and then he closed Shiva's belly. In a month, Shiva's liver would regenerate to its previous size.
Now, Thomas Stone and Deepak donned fresh gowns and gloves and came to me to complete the removal of my liver. Because my clotting functions were poor, there were lots of tiny bleeders, particularly behind my liver as they freed it from the diaphragm. I required many units of blood as well as platelets. They carefully identified and preserved my bile duct, the hepatic artery, and the portal vein. It was one in the afternoon when my four-and-a-half-pound companion, which I had sheltered under my rib cage all these years, left me. A gaping cavity under the dome of my right diaphragm, an unnatural void, remained.
Connecting Shiva's liver, or rather his right lobe, was a laborious process. Bleeding had to be meticulously controlled in order to see clearly and for Thomas Stone, with Deepak's assistance, to suture artery to artery, bile duct to bile duct, and vein to vein. The scissors and needle holders were specially designed for microsurgery. Both surgeons wore headlights and magnifying loupes as they manipulated sutures that were finer than a human hair. One advantage of Deepak's decision to give me Shiva's right lobe was that it fit more naturally under the dome of my diaphragm, and its hilum—the place where the vessels entered—was oriented more naturally toward the vena cava. It made the surgeons’ jobs a little easier.
The remnants of the D team took Shiva to the recovery room and then waited in the locker room. Their mood unexpectedly became somber. It was now out of their hands, and that made the tension almost unbearable.
An anxious Hema, with Vinu at her side, watched the clock in the waiting room. At first, she was thankful for her chatty companion, but then even he could not distract her. She kept thinking of Ghosh and wondering if he would have chastised her for letting Shiva take such a risk. A stone in hand … or was it “bird”? Grass is greener … he would have a maxim for the situation.
Word came from the operating room via the Ringmaster—he called at each stage of the operation—and Hema now wished he wouldn't, because the shrill ring never failed to startle her and made her imagine the worst, only to be told “They have begun” or “The portal vessels have been isolated” when what she wanted to hear is that they were done with Shiva. At last, she did hear those words, and soon she saw Shiva, awake but groggy in the recovery room and wincing in pain. She was giddy with joy, stroking Shiva's hair, and she knew that wherever he was, whatever form his reincarnation had taken, Ghosh, too, was relieved.
Shiva's eyes, coming into focus, asked the question. “Yes,” Hema said. “They're putting your liver lobe into Marion right now. Deepak said the part you donated looked magnificent.”
She wasn't allowed to stay long. Instead of returning to the waiting room, she decided to slip away to the chapel. A solitary stained-glass window allowed in very little light. When the heavy door closed behind her, she had to seek the pew with her hand and ease into the velvet-covered bench. She covered her head respectfully with the tail of her sari. As her eyes adjusted, she got the fright of her life, seeing a figure on its knees near the altar. An apparition! she thought. Then she remembered the prayer chain for Marion, the round-the-clock vigil in this chapel. As her pulse recovered, Hema settled back and observed the veiled head, the scapular falling back, stiff and separate from the pleated tunic. Hema realized that in importuning every deity she could think of, she had somehow neglected to appeal to Sister Mary Joseph Praise. The oversight caused a fierce and silly panic, blood surging up her neck. Oh, please don't let that be a reason to punish my son. She wrung her hands, squirmed and chastised herself for forgetting. Forgive me, Sister, but if you only know how stressful this has been, and if it is not too late, please watch over Marion, please see him through.
She felt the response arrive as distinctly as if it were a voice or a touch: first, a lightness in her forehead, then a calmness in her chest that said she had been heard. Thank you, thank you, Hema said. I promise to keep you updated.
She returned to the waiting room. She was so exhausted that she could only wonder how Stone and Deepak managed to stay upright. From the waiting room window the earth looked as if it were mostly sky and concrete—no real earth to speak of, no manifestation of nature on the ground other than the sun setting in that direction. It was so odd, and yet this was the view her son had known for the last six years.
At 7:00 p.m., Thomas Stone was at her side. He nodded, then smiled, an expression so rare that she knew it had gone well. He said nothing, and she, too, was speechless, tears running down her cheeks. In studying Stone's face, grooved where his magnifying spectacles and lamp had sat, and grooved also from worry and work, she realized with a start how old he had become, how old they had both become, and how if they had nothing else in common, they had this: that they were both still standing after all these years, and that her sons (his, too, at some level, she had to admit) were both alive.
Thomas Stone sat down, or rather fell into the sofa, and he didn't protest when she forced juice and a sandwich on him from Vinu's ice chest of goodies. Stone washed the juice down with a bottle of water and started on a second before life seemed to stir within him. His gaunt face filled out. “Technically, everything has gone well,” he said. “Marion's new liver, Shiva's old lobe, was already making bile before we had even finished the anastomosis.” He smiled again, a shy twist of the corners of his mouth, pride in his voice. The bile, he said, was an excellent sign.
“We had a scare,” he added. “There was a moment when Marion's blood pressure dropped precipitously. No explanation for it. We were ahead on fluid and blood, but still his heart raced to one hundred and eighty beats a minute. We poured fluid in, tried this and that … and just as suddenly, the pressure came back up.” She was about to ask him precisely what time that was, but then she didn't bother, because she knew. She closed her eyes and thanked Sister for her intercession. When she opened them, Thomas Stone was staring at her as if he understood. She felt so close to him, so grateful. She couldn't go so far as to hug him, but she did reach for his hand.
“So, I must leave now,” he said to Hema after a minute. “It will be touch-and-go for a while for Marion, given how sick he was when we started. But at least he has a working liver. His kidneys are still not functioning, and he needs dialysis, but I trust it is just hepatorenal syndrome and the new liver will fix that.” He was holding things back from her. He didn't tell her how, when things had looked so dire in the operating room, hed looked up at the ceiling and prayed not to a God or to spiders, but to Sister Mary Joseph Praise, asking to be redeemed for a lifetime of mistakes.
THERE WAS REJOICING in the hospital, first that one of its own who had been near death was still alive, and second that Our Lady had made history. The Mass of Gratitude in the chapel was packed, Hema and Vinu in the front pew and the crowd spilling out to the cloisters.
Outside Our Lady of Perpetual Succour, the news vans were lined up—international as well as national. Every previous liver transplant in the world had its origins in a corpse-to-be, in someone who was brain-dead. A living donor—and an identical twin who had given half his liver to his brother—that was big news. The media didn't quite get that this technical breakthrough would be most meaningful to babies born with congenital biliary atresia—lack of bile ducts. Adult organs from people dying of trauma were scarce enough; a child donor was exceedingly rare. Stone and Deepak opened the way for a parent to donate part of his or her liver to save their infant.
By the second day, the ferreting journalists had connected Shiva to his fame as the fistula surgeon—”fixing holes is what I do”—and by the third day, they'd labeled Thomas Stone the “estranged father.” It was perhaps only a matter of time before they discovered the story of Sister Mary Joseph Praise, though it would probably necessitate a reporter traveling to Addis to unearth that tidbit.
I CAME AWAKE on the fifth day. My first memory is that of floating up from the ocean bottom, my eyes still waterlogged and with what felt like scuba gear stuffed in my mouth and throat—I couldn't speak. As I broke to the surface, I understood that I was still in the ICU at Our Lady, but I heard nothing of what anybody said. I saw Hema and Stone and I looked for Shiva. He's decided not to come from Addis, I remember thinking, and I was disappointed.
Twelve hours later, in the late evening of the fifth day (though it was perpetual twilight in the ICU), I surfaced for good, relieved to see that Hema was there, and that I hadn't imagined her presence.
She stayed by my side, holding my hand. I craved her touch, fearful I might sink back into the abyss where it was all dark and from which there was no promise of return. But I would drift off into light sleep for short periods. Night turned to day, bringing with it a new bustle and energy and more traffic through our room.
On the seventh day, I was awake long enough for Hema to make the fantastic statement that half of Shiva's liver was in me. Sick patients need to have everything explained at least twice, because you can presume they will not have heard half of what you said. Hema repeated herself at least ten times, and it was only when she showed me the Times, and the picture of me and of Shiva, that I believed.
“Shiva is recovering,” Hema said. “He's fine. But you've developed pneumonia and there is fluid collecting around your right lung. That's why you are still on the ventilator. But it's getting better, so Deepak says you will be off the ventilator tomorrow. Your new liver is functioning well, and your kidneys have bounced back.” This was not the reunion I had imagined with Hema, but the expression on her face, her joy, her relief, were priceless. She rarely left my side.
I saw Deepak and Stone for the first time later that same day. I struggled with my emotions. I know I was supposed to feel gratitude. Sometimes I think we surgeons wear masks to conceal our desires, to hide our willingness to violate the body of another. Only the guarantee of amnesia, the fact that the patient will remember nothing but the anesthetist's saying “Sweet dreams,” allows us to be surgeons. They stood before me, these perpetrators of organized violence on my body. The fact that both men were shy and unassuming seemed almost deceitful given the ambition, the hubris, that had allowed them to risk Shiva's life for mine. It was the only time I was thankful for that evil tube going down my throat and between my vocal cords, because what I would have said to them would have sounded ungrateful: It's a good thing Shiva made it, otherwise I'd be after your hides.
When I awoke sometime later, I forgot about the tube and tried to speak, which made me feel I was choking, which made me panic. My struggles triggered the ventilator alarm, and now I was terrified that the nurse would decide I was “fighting the ventilator,” which could bring an order for intravenous curare. That drug, derived from the poison darts of Amazon tribes, paralyzes all the muscles, leaving you still as death, so that the ventilator can do its work unimpeded. But God help you if you aren't given a strong sedative along with it, because then you are awake, alert, but unable to twitch or even blink. The thought of being in that paralyzed, locked-in state had always horrified me, even as I blithely ordered curare (andsedation) for hundreds of patients. Now that I was a patient, my curse was that I knew too much.
With Hema's help, her soothing voice, I did my best to calm down, to let the machine push air into me, and the nurse retreated. When I felt better I wrote, How is Shiva?
She didn't have to reply, because just then my other half came in, led by Thomas Stone.
My brother, whom I had not seen for seven years, looked haggard, not at all like the picture in the Times. I felt vertigo in seeing my reflection moving independently of me. Shiva wore a hospital gown, one palm resting carefully on his belly, the other hand pushing his intravenous pole ahead of him, and using it as a walking stick. My brother wasn't given to laughing and most jokes were wasted on him, but when he saw me, he grinned like the chimp who'd locked up the zookeeper.
You monkey, you, I wanted to say, and I reached hungrily for his hand, our fingers interlocking. You should laugh more, it suits you: see how the furrows around your brow vanish and your ears ease back? I felt fluid running down my temples, and his eyes were full, too. I squeezed his fingers, a Morse code to convey what was in my heart. He nodded—You don't have to tell me anything is what he was saying. He bent forward gingerly, and I wondered what he was up to, surely not a kiss … He clinked his skull against mine. It was such an unexpected, jarring, and surprising act, a throwback to being little boys, the softest of testas, that it made me laugh, which made that horrible tube scratch the inside of my throat, and so I had to stop.
I pointed to Shiva's belly. He pulled aside his gown and I could see some of the incision, though a gauze pad with a drain passing through it hid the remainder. I raised my eyebrows at him, asking if it hurt. And he said, Only when I breathe, and we both laughed and both had to cut that off because of the pain. Stone stood looking on at this silent dialogue, amazed, a strange expression on his face.
Little did I know that Shiva's recovery had been complicated by a bile infection requiring antibiotics. Or that he had developed a blood clot in the vein in his right arm through which he'd been getting fluids. He was on a blood thinner, and the clot was resolving.
I held his hand for a long time, content to look at him, to thank him with my fingers, but he kept shrugging off my thanks. I reached for my pen, and Hema pushed the pad in front of me and I wrote, Greater love hath no man—
He didn't let me finish. He held my pen. He said, You would have done the same. I had my doubts, but he nodded. Yes, you would.
That evening, Deepak drained fluid from around my right lung, and my breath expanded in that direction. Then he took the wretched tube out of my throat. My first words were “Thank you,” and when that ugly blue machine left my room, I fell into a deep sleep.
The next morning was full of small miracles: being able to turn and gaze at the window and see sky, being able to say “Ouch” when the movement pulled on my incision. Hema wasn't around. The ICU was quiet. My nurse, Amelia, was unnaturally cheery. I assumed it was still early morning. “We have an X-ray to do downstairs,” she said, unhooking me from the tethers, and readying my bed to roll.
In Radiology I was lifted into the doughnut for a CAT scan, but oddly, it was of my head and not my belly. Surely it was a mistake. But no, the order was from Deepak, and it read, “CAT scan of the head with and without contrast.”
Back in my room and by noon, still no sign of Hema, or Stone, or Shiva. Amelia said they would be along presently.
The physical therapist helped me stand beside my bed for a few seconds. My legs felt like Jell-O sticks. I took a few steps with assistance, then sat in the chair, exhausted, woozy, as if I had run a marathon. I dozed there, ate what little I could. After lunch, I took a few more steps, and even peed upright. The nurses helped me back to bed. In retrospect, they seemed pleased to get out of my room.
IT WAS 2:00 P.M. when Thomas Stone appeared at my door. There were dark circles around his eyes. He sat self-consciously on the edge of the bed. He touched my hand. His lips parted.
“Wait,” I said. “Don't say anything yet.” I looked out of the window at the clouds, at distant smokestacks. The world was intact now, but I knew once he spoke it wouldn't be so.
“Okay,” I said. “What happened to Shiva?”
“He had a massive bleed in his brain,” he said, his voice hoarse. “It happened last night, about an hour after we left your room. Hema was with him. He suddenly clutched his head in pain … Then, in a matter of seconds, he was … unconscious.”
“Is he gone?”
Thomas Stone shook his head. “He bled from an arteriovenous malformation, a cavernous tangle of blood vessels in the cortex. He has probably had it all along … He was on anticoagulants for the blood clot in his arm … In a week we would have stopped.”
“Where is he?”
“Here. In the ICU. On a ventilator. Two neurosurgeons have seen him.” He shook his head. “It isn't feasible to evacuate the bleed. They think it's too late. And that he's brain-dead.”
I didn't register much of what he said after that. I remember he said that my CAT scan showed a similar but smaller spider knot of vessels, but mine wasn't bleeding, a miracle of sorts, I suppose, since I'd bled from everywhere till I got Shiva's liver.
A few minutes later, Hema, Deepak, and Vinu came into the room. I understood now that Stone had been delegated to break the news.
Poor Hema. I should have tried to comfort her, but I was too full of grief and guilt. I felt so very tired. They sat around my bed, Hema weeping, bent over, resting her head on my thigh. I wanted them to leave. I closed my eyes for a moment. I woke up when a nurse came in to silence one of the intravenous pumps. There was no one else in the room. I had her walk me to the bathroom and then I sat in the armchair. I wanted my strength back.
WHEN I AWOKE, Thomas Stone was by my chair. “He can't breathe on his own, and there are no pupillary or other reflexes,” he said in response to my silent query. “He's brain-dead now.”
I said I wanted to see him.
My father wheeled me down the hall where Shiva lay. Hema was with him, her eyes puffy and red, and when she turned to me, I felt ashamed to be alive, ashamed to be the cause of her sorrow.
Shiva looked asleep. It was his turn to sport the spike coming out of his skull—the intracranial pressure monitor. The endotracheal tube skewed his lips, angling his chin up unnaturally. The rise and fall of his chest from the ventilator offered a spot on which to rest my eyes, and my ifs were coming in that rhythm: If I hadn't come to America. If I hadn't seen Tsige. If I hadn't opened the door for Genet …
HEMA WHEELED ME BACK to my room, helped me back in bed.
I said to her, “It would have been better if you and Shiva had buried me. Youd be on your way to Missing now with your favorite son.”
It was a stupid, churlish thing to say, a primitive and subconscious urge to wound her so as to assuage my pain and guilt. But if I expected her to strike back, she didn't. There is a point when grief exceeds the human capacity to emote, and as a result one is strangely composed—she had reached that point.
“Marion, I know you think I favored Shiva … And maybe I did. What can I say but that I'm sorry. A mother loves her children equally … but sometimes one child needs more help, more attention, to get by in the world. Shiva needed that.
“Marion, I have to apologize to you for more than that. I thought you were responsible for Genet being mutilated, circumcised, and all that followed. I held that against you. When we came here, Shiva told me everything. My son, I hope you can forgive me. I'm a stupid mother.”
I was speechless at this news. What else had gone on when I was unconscious?
Outside a siren drew closer and closer, an ambulance coming to Our Lady.
“They want to discontinue the ventilator on Shiva,” Hema said. “I can't bear for them to do that. As long as he is breathing, even if it is the ventilator breathing for him, he's alive for me.”
The next morning, after the nurse seated me in the shower and helped me with my first bath, I put on a fresh gown and I asked to be wheeled to Shiva's room.
“Stop here,” I said, well before his room, because I saw through the half-open door that Thomas Stone was seated by Shiva's bed, just as I was told he had sat by mine. His fingers rested on Shiva's wrist, feeling the pulse. His hand lingered there long after he had registered the heart rate. I wondered what he was thinking. I watched him for a full ten minutes before he stood up and came out, his eyes haunted and red. He didn't see me as he walked off in the other direction.
I rolled my chair after him. “Dr. Stone,” I said. Every fiber of my being wanted to cry out, Father!
He came to me. “Dr. Stone,” I said. “Surely an operation … is his only chance. Can't the neurosurgeons go in, tie off the tangled vessels, and evacuate the clot in his brain? So what if it's a long shot? It's his only shot.”
He considered this for a while.
“Son, they say the tissue in there is—sorry to say this—the consistency of wet toilet paper. Blood mixed with brain. The pressure's so high, if they so much as touch him, they tell me it'll only make him bleed further.”
I didn't want to accept that. “Can't you do it? You and Deepak? You've done burr holes. I've done burr holes. What's there to lose? Please? Let's give him that chance.”
He waited so long that even I could hear the fallacy of what I was suggesting. My father put his hand on my shoulder. He spoke to me gently, as to a junior colleague, not to his son. “Marion, remember the Eleventh Commandment,” he said. “Thou shall not operate on the day of a patient's death.”
When I was back in my room, Thomas Stone brought up Shiva's CAT scan. I was shocked to see the huge white splotch—which is how blood looks on a CAT scan—involving both hemispheres and spilling into the ventricles. It compressed the brain within the rigid confines of the skull. I knew then that it was hopeless.
BECAUSE OF THE ANEURYSM or tangled vessel malformation in his brain, Shiva was not a potential donor for heart or kidneys, for fear there might be similar changes in those organs.
Hema didn't want to be there when the ventilator was discontinued. I said I'd be with him. I asked to be alone with Shiva when he passed.
Hema said her good-bye first.
I was outside the room when Vinu escorted her out. It was a heartbreaking sight to see my mother, the tail end of her sari draped over her head, her shoulders slumped, leave her still-breathing child. It must have felt to her as if she were abandoning him. Every eye in the unit was on her, and not one was dry, as her shimmering, sari-clad form floated down the hall on her way to the Quiet Room.
With Deepak's assistance I climbed onto Shiva's bed. It was eight in the evening. I settled myself next to him. Everything but his breathing tube and an intravenous line had been removed. Deepak peeled away the tape that held the tracheal tube to Shiva's cheeks. Then, with a nod from me, he injected morphine through Shiva's intravenous tubing. If any part of Shiva's brain was alive, we didn't want it to sense pain, or fear, or suffocation. Deepak turned off the ventilator, silenced its immediate shrill protest, slid the endotracheal tube from Shiva's mouth, and then he left the room.
I LAY THERE, my head against Shiva's, a finger resting on his carotid pulse. His body was warm. He never took a breath after the tube came out. His facial expression never changed. His pulse stayed regular for almost a minute, then it paused, as if it had just realized its lifelong partner—the lungs—had quit. His heart sped up, became faint, and then, with a final throb under my fingers, it was gone. I thought of Ghosh. Of all the pulse types, this was both the rarest and the most common, a Janus quality that every pulse possesses: the potential to be absent.
I closed my eyes and clung to Shiva. I cradled him, his skull buttressed against mine and now wet with my tears. I felt physically vulnerable in a way I'd never felt when we were a continent apart, as if with his death my own biology was now altered. The heat was rapidly leaving his body.
I rocked Shiva, wedging my head against his, remembering how for so long I was unable to sleep except like this. I felt despair. I didn't want to leave this bed. Chang and Eng had died within hours of each other, because when the healthy one was offered the opportunity to be freed from the dead one, he declined. I understood so well. Let Deepak give me a lethal dose of morphine and let my life end this way, let my respiration cease, my pulse fade and then disappear. Let my brother and me leave the world in the same embrace with which we began in the womb.
I PICTURED SHIVA getting the telegram, his coming to me, then putting himself at risk to save me. Would I have done the same for him? Perhaps when he saw me, he'd felt the way I did now: that it didn't matter what might have transpired between us, but life would not be worth living and would end soon if something happened to the other.
His body continued to lose heat in my arms as if I were drawing it away, siphoning it over. I remembered the two of us running up the hill in a relay, carrying a lifeless and cold child to Casualty, the parents trailing behind us. He was now that lifeless child.
The minutes passed.
Ultimately it was the rude coldness of Shiva's skin, the terrible separation it delineated of the living and the dead, the disarticulation of our bound flesh, that forced me to a new understanding, a new way of seeing us in the face of such rapid attrition, and this is what I came to:
Shiva and I were one being—ShivaMarion.
Even when an ocean separated us, even when we thought we were two, we were ShivaMarion.
He was the rake and I the erstwhile virgin, he the genius who acquired knowledge effortlessly while I toiled into the night for the same mastery; he the famous fistula surgeon and I just another trauma surgeon. Had we switched roles, it wouldn't have mattered one bit to the universe.
Fate and Genet had conspired to kill my liver, but Shiva had a role in Genet's fate, and hence my fate. Every action of ours turned out to be dependent on the other. But now by a brilliant and daring rearrangement of organs, ShivaMarion had readjusted. Four legs, four arms, four kidneys, and so on, but instead of two livers, we had downsized to one. Then karma and bad luck took us even further, forced further concessions: we lost ground on his side, a few organs died. Okay—just about everything on his side died, but we retained half his liver, and it was thriving. What we had to do now was economize further, go halves again, tough measures for tough times: two legs sufficed, so also with eyes, kidneys. We'd go with half a liver, one heart, one pancreas, two arms … but we were still ShivaMarion.
Shiva lives in me.
Call it a far-fetched scheme that I conjured up to allow me to go on … Well then, it allowed me to go on. It gave me comfort. It dried my tears, helped me untwine my arms and legs from the body that we were discarding. In the eerie quiet of that room, so primed for machines but with the machines all silent, the blinds closed, and with an icy corpse next to me, I felt Shiva was instructing me. He had rowed over from the sinking ship and he was telling me to think this way, and it was just Shiva's kind of logic. One being at birth, rudely separated, we are one again.
THEY WERE ASSEMBLED outside, a ghoulish receiving line was what I thought at first. But they couldn't know what had just transpired, and so I didn't blame them. Their hearts were in the right place. Thomas Stone, Deepak, Vinu, and so many of my nurses and nursing assistants— my friends, my Our Lady family before they became my caregivers. I shook each hand, and thanked them for the two of us. I believe they will tell you my manner was composed, far different from what they expected. I left Thomas Stone for last. After I shook his hand, I followed an irrational instinct—Shiva's, I believe, certainly not mine—which told me to hug him, not to get but to give. To let him know that as a father it turns out hed done what he was meant to do; he lived on in us and we lived because of his skills. The way he clung to me, held me as if he were drowning, told me Id made the right choice, or Shiva had, awkward as it was.
I walked slowly down the hall to our Quiet Room, a euphemism for the place we chose to give bad news, a place with chairs, a table, a sofa, a big picture window, a cross on the wall, but no TV, no magazines, only a solid and soundproof door. How many times had I made this walk as a trauma surgeon? So often I had lingered outside the door, conscious of the devastation my news would be bringing. Had I honored the feelings and the dignity of those who waited in that room, the parents, siblings, spouses, and children, even if what I had to say dashed all their prayers? I could remember every such encounter; I could recall each face as it turned in hope and apprehension when the door opened.
I FOUND HEMA, hands crossed in front of her, gazing out of the window at the lights of the Battleship housing project that abutted our house-staff quarters, and the distant outline of the bridge beyond. Her back was to me. She saw my reflection in the glass before she saw me, but unlike every single person I had ever come to see in this room, she did not spin around. Instead, she stood like a statue, staring at my reflection in the window. I stopped where I was, holding the door open. I saw in that glass her eyes widen, the eyebrows rise. She held my gaze for the longest time. Her face showed surprise … as if who she saw wasn't the person she had expected to see.
“Here we are, Ma,” I said.
She cocked her head at my voice. She brought one hand up to her chin, her fingers aligned and locked together and resting contemplatively along her cheek, her movements exaggerated. She studied my face, my reflection, just like a village girl who is surprised in the act of drawing water at the well, and who must now read the intentions of the tall, smiling avatar whom she sees standing behind her.
Then, in slow motion, as if this were a dance, and both of us dancers, she turned and faced me.
I moved to her. “Here we are,” I said again, my arms extending toward her. “We can go home now, Ma.”
It must have seemed to her a very strange thing, even the wrong thing, to say. To live purely in the here and now, to look forward but never to the past—that was vintage Shiva. “Here we are,” I said.
She came into my arms.
We held her tight.
ON A BEAUTIFUL MORNING, just three weeks after Shiva's transference, Hema and I took leave of Our Lady of Perpetual Succour. Thomas Stone insisted on being our escort. We stepped outside into air so crisp I felt a cough or a sneeze would shatter it like glass. The brick façade of Our Lady of Perpetual Succour glistened with dew as we said our good-byes. The hospital's recent turn in the limelight had brought in special city funds and sparked emergency repairs; as a result, the monsignor in the fountain was no longer tilting, his swizzle stick was gone, as was his crusting of bird droppings. Polished and sanguine, he looked emasculated and alien to the place where I had spent the last seven years of my life.
Our yellow cab sped across the Whitestone Bridge to Kennedy Airport. The sun had barely come up, and yet the freeway was thick with cars, the solitary drivers insulated from one another in wafer-thin metal, which at these speeds offered only the illusion of protection. We merged like wingmen rejoining the formation. Hema looked out meditatively just as I had when I arrived seven years before. I wondered if she could hear the hum of the überconsciousness, the superorganism who kept this from descending into chaos.
The year 1986 was a disaster for our family. Hema believed that it had something to do with the number, because it had birth in the 1 and destiny in the 8. Nineteen eighty-six had started off terribly with the Challenger spacecraft exploding on January 28 (which was month 1, and there was the number 8 again). Then the Chernobyl tragedy was exactly eighty-eight days after the Challenger disaster. On that scale, the death of one twin—on the eighteenth of the month—hardly registered.
There was yet another death eight days later that had bearing on us: my neighbor Holmes came with Appleby of the detective agency to let me know that Genet had passed away in a prison hospital in Galveston just as I was regaining my strength. Genet's son had been adopted by a family in Texas, and she had gone in search of him. Shed been living hand-to-mouth in a cardboard lean-to a few blocks from the seawall when she was picked up. She was a mere skeleton and survived just two days in the prison infirmary. She had supposedly died of adrenal failure caused by tuberculosis. I knew better. She had died chasing greatness and never saw it each time it was in her hand, so she kept seeking it elsewhere, but never understood the work required to get it or to keep it. I'm ashamed to say I felt relief when the word came; only her death could ensure that we didn't keep tearing each other apart for what remained of our lives.
IN THE INTERNATIONAL DEPARTURE HALL, I heard snatches of Bengali, Arabic, and Tagalog. A man bound for Lagos protested in screeching pidgin about the unfairness of British Airways, because there was no way he was four pounds over. In this setting, Thomas Stone, without his white coat or scrubs, looked like the newly arrived foreigner.
“Will you be back, Marion?” he asked when it was time for saying good-bye.
All I knew was that I wanted to be with Hema when she interred Shiva's ashes between Ghosh and Sister Mary Joseph Praise. The grotto by Missing's back wall and in earshot of the little creek was rapidly becoming the family burial plot. I was going back also to see Matron, Almaz, and Gebrew. I knew that my presence would help console them. Beyond that, I hadn't given great thought to my future.
“Of course I'll be back,” I said. “I still have my house, the car, my job …”
“Be careful what you eat, drink …,” he said. It was his way of telling me to protect his handiwork.
I felt better than well. Other transplant patients had to fight to keep their bodies from rejecting the lifesaving organ. The cortisone they took led to cataracts, diabetes, hip fractures, and other side effects. I was blessed not to have to swallow a single pill. I felt no pain if you didn't count the twinges under my ribs, which I considered promising and not painful; they were the sign of Shiva's half liver growing to fully occupy its new home.
“How about you?” I had yet to find a comfortable way to address my father; it was “Dr. Stone” in the hospital and nothing at times like this. “Will you have a job to go back to?” I teased. He hadn't seen Boston since I fell ill.
His slow smile only exaggerated the sadness in his face. He took Shiva's death personally, as if fate had never forgotten that he'd once attempted to destroy Shiva, and so when he had operated to save Shiva, his original intent had betrayed him.
My father made no attempt to shake my hand. Our one hug after Shiva's passing was good for a lifetime. We parted with a nod.
Hema, however, took Thomas Stone's hand in both of hers. I had missed their reunion at my bedside. Now, I watched like a nosy child.
“Thomas, stop this at once!” Hema said, chiding him for his melancholic expression. “You did everything you could, do you hear me? You did your best for your sons. No one else in the world could have done what you did. Thomas, if Ghosh were here, he'd say the same thing. He'd have been so proud of you and he'd say, ‘Go on with your work because it is so important.’ “ She released his hand, after patting it one last time, then she turned and walked away.
Later, as our plane banked over Queens and headed for open water, I thought about Hema's parting words to Stone. Buried in there had been her apology for having fashioned him into a monster in her mind for all these years. In patting his hand and walking away, she was releasing herself.
Alitalia took us to Rome. Mechanical problems on the connecting flight had the agent projecting a fourteen-hour layover. It gave me an idea. In no time Hema and I were once again in a taxi on a freeway, but this time we were heading to downtown Rome. We were like children playing hooky from school.
Hema had needed little convincing. We went to a first-class hotel, the Hassler, Rome's best, I was once told. It was a grand building that overlooked the Spanish Steps. From the rooftop at dusk the sky's red hue outlined the dome of St. Peter's in the distance.
Each morning we set out for the briefest sightseeing. We returned to our hotel for lunch and a long afternoon nap. The evenings we wandered down the streets and alleyways beneath the Spanish Steps. Eventually we'd pick an outdoor café for dinner. “It's so familiar, isn't it?” Hema said. “These menus, typed out and mimeographed, minestrone and pasta fagl-oli, the waiters with white shirts, black pants, white aprons …” I knew what she meant. The Italians had brought it all to Ethiopia, right down to the umbrellas that hung over the little Formica-topped round tables. Hema's face at dinner was as tranquil as Id seen it since I became conscious of her at my bedside at Our Lady. “I wish Ghosh could have been with us. How he would have enjoyed this,” she said, smiling.
ON THE FOURTH MORNING, we let the concierge talk us into a private tour with a guide from our hotel. What did we want to see? Surprise us, we said. Take us off the cow path. Places where there isn't too much walking or waiting in line.
He began with the Santa Maria della Vittoria, a ten-minute ride from our hotel. It was a homely church, sitting right on the street, cars passing by, the elaborate façade looking as if it had been slapped on to the front of an unadorned stone box. Our guide said it was built about 1624, first dedicated to St. Paul, and later to the Virgin Mary. The interior was small—tiny when compared with St. Peter's—with a short nave under a low vault. Off to the side, Corinthian pillars flattened into the wall demarcated three “chapels” which were nothing more than recesses, each with a rail for private prayer and a place to light candles. As we came to the end of the nave, our guide turned to the left and pointed. “This is the Cornaro Chapel. It is what I wanted you to see,” he said.
It took a few seconds for my eyes to relay the sight to my brain, and longer still for my brain to believe. The blue marble sculpture floating before me was Bernini's Ecstasy of St. Teresa. I wanted to silence our guide and say, Stop, I know this sculpture. But in truth what I knew was only a print that found its way onto a calendar which my mother had then thumbtacked to the wall of the autoclave room. It had been up for perhaps thirty years before Ghosh had taken that aging piece of paper and framed it for me, to protect it from further deterioration. The print meant the world to me, yet it had never seemed at ease on my walls in America, where it looked like the cheapest kind of tourist gewgaw. I'd packed it with me on this journey, planning to restore it to the one place where I knew it was at home, the autoclave room.
I looked over to Hema. Her face was aglow. She understood. What providence had brought us to this spot? Surely this was Ghosh announcing his presence, because Ghosh was the sort of man who could be counted on to know that Bernini's Ecstasy of St. Teresa was minutes from our hotel, even if he'd never been to Rome before. Ghosh had brought us here, led us to this spot, not to see St. Teresa in marble, but to see Sister Mary Joseph Praise in the flesh, for that is what the figure was to me. I have come, Mother.
WE LIT CANDLES. Hema fell to her knees, the flame throwing a flickering light on her face. Her lips moved. She believed in every kind of deity and in reincarnation and resurrection—she knew no contradictions in these areas. How I admired her faith, her lack of self-consciousness—a Hindu lighting candles to a Carmelite nun in a Catholic church.
I knelt, too. I addressed God and Sister Mary Joseph Praise and Shiva and Ghosh—all the beings I carried with me in the flesh and in spirit. Thank you for letting me be alive, letting me see this marble dream. I felt a great peace, a sense that coming to this spot had completed the circuit, and now a blocked current would flow and I could rest. If “ecstasy” meant the sudden intrusion of the sacred into the ordinary, then it had just happened to me.
My mother had spoken.
What I didn't know then was that she had more to say.
IT WAS DUSK when we landed. I had been away from Addis for seven years. The white buildings of Missing looked rounded at the edges, worn down, as if theyd been excavated in an archaeological dig but not restored.
When the taxi reached Shiva's toolshed I had the driver let me out. I told Hema to go on because I wanted to walk the rest of the way.
I stood listening once the car pulled away; the dry rustle of the leaves was like a child's hand sifting through a box of coins. The sound had lost all its menace for me. I found that dented and bent curb, which had stopped a motorcycle but not its rider. I looked down into the trees and the shadows where he fell. The spot no longer generated any dread for me. All my ghosts had vanished; the retribution that they sought had been exacted. I had nothing more to give, and nothing to fear. I looked out over trees to the city. The sky was a mad painter's canvas, as if halfway through the artist had decided against azure and had instead splashed ochre and crimson and black on the palette. The city was alight, glowing, but here and there it was obscured by great puffs of mist which smudged my view, like the smoke of many small battles.
I walked up the hill to the house, a thousand memories now of Shiva and me doing our three-legged race to be in time for dinner, or the two of us and Genet walking back with our school books, of Zemui coming up with his motorcycle and then coasting the last hundred yards. Up ahead I could see the figures huddled around our taxi and around Hema. Then Matron, Gebrew, and Almaz separated from the vehicle, silhouetted against the last embers of the sky, and they waited for me.
I'D BEEN BACK just three days when Matron summoned me to Casualty. A young girl with a bull-gore wound to the abdomen was exsanguinating before our eyes. The child would have died if wed tried to send her elsewhere. I took her to Operating Theater 3 at once, and found the bleeder. What followed next—cutting out damaged bowel, washing out the peritoneal cavity, fashioning a colostomy, was routine, but its effect on me was anything but. I felt I was on consecrated soil, standing on the same spot where Thomas Stone, Ghosh, and Shiva had stood, each with scalpel in hand. At the end of the surgery, when I turned to leave, weaving around the bucket and wires on the floor, I looked up and saw Shiva in the new glass that separated Theater 3 from its spanking-new mate, Theater 4. The sight took my breath away. I remembered Shiva's first words when the killing of Koochooloo's puppies prompted him to break years of silence: Will you forget if someone kills me or Marion?
No, Shiva, we'll never forget you, I said to my reflection. In saying that I think I decided my future.
AMONG SHIVA'S BELONGINGS in his room, I found a key on a key-holder shaped like the Congo. In Shiva's toolshed was a strange-looking motorcycle, with bright red, stubby fenders, a teardrop-shaped red fuel tank, handlebars that would have been called ape hangers in America, and lovely chrome wheels. Hema said that Shiva had bought the bike secondhand a few years back and that he kept tinkering with it. She said he had only ridden it late at night when there was no traffic. The udderlike engine looked very familiar, and its low rumble when I kick-started it gave away its true identity.
I operated three days a week, and when my return ticket to New York was about to expire, I did nothing.
Shiva's liver functioned beautifully in me year after year. The shots of hepatitis B immunoglobulin helped. The virus became so dormant that my blood tests showed I wasn't a carrier, and that I couldn't infect anyone. Matron insisted it was a miracle, and I had to agree.
In 1991, five years after my return, I stood by the gates of Missing just as I had when I was a child, and I watched the forces of the Tigre People's Liberation Front and other freedom fighters make their way into the city. They were dressed in the same functional shirts, shorts, and sandals of the guerrillas I had seen in Eritrea, bandoliers crisscrossing their chests, rifles in their hands. They didn't march in formation, yet their faces showed the discipline and confidence of men who believed in their cause. There was no looting, no mayhem. The only looting was by the Comrade President-for-Life, who emptied the Treasury and flew with his loot to Zimbabwe, where his fellow looter, Mugabe, gave him refuge. Mengistu was a despised figure, a blight on the nation, a man about whom to this day no one can find a good word to say Almaz said that the souls of all those he murdered were assembled in a stadium, waiting to give him a reception on his way to hell.
EVERY EVENING I checked on Matron before I went to bed. She was so tremulous and bent over with age, but her joy in life was unchanged. We would have a cup of cocoa together. Her only LP—Bach—played in the background on the small gramophone I had bought for her. She never tired of the “Gloria,” which I will always associate with her. As Id sit with her, she would look over and smile as if she always knew Id come back to the land I had once disowned. It had been Matron's wish that God might call her either during her prayers or her sleep, and He obliged. It was 1991, a few months after the President-for-Life fled; I found her in her chair, the record still spinning on her gramophone. Just the previous morning she had been supervising the planting of a new cultivar, the Rosa rubiginosa Shiva, which she had officialy registered with the Royal Society. To me it looked as if the whole city, rich and poor, turned out for her funeral. Almaz said that the streets to heaven were lined by the souls of those who were grateful to Matron, and that her throne was next to Mary's.
Almaz and Gebrew were retired and ensconced in new, comfortable quarters built for them at Missing, free to spend their time in any way they chose. I suppose it should not have surprised me that they would spend it in fasting and prayer.
The Shiva Stone Institute for Fistula Surgery with Hema as its titular head grew, as did its funding. Hema worked every day, and zealous young gynecologists from within the country, but also from other African nations, came to train and take up the cause. The Staff Probationer, whose room I had visited so many years ago, had become a skilled assistant under Shiva's tutelage, and now, with Hema's encouragement, she was a confident surgeon on her own, well suited to the painstaking task of training the young doctors who came to learn how to treat this one condition. I insisted on learning her real name, and reluctantly she told me it was Naeema. But it was not a name she ever used; she had become the Staff Probationer even to herself.
In going through Matron's papers, I discovered that the anonymous donor who had modestly funded Shiva's work for so many years was none other than Thomas Stone. Now he worked to direct other donors and foundations to support Missing.
I HAD TO WAIT till 2004 for Sister Mary Joseph Praise's message to reach me. It happened just after New Year's on the Western calendar, a time when the mimosa trees that surrounded the outpatient building had sprung their violet and yellow blooms and Missing was enveloped in the scent of vanilla.
I'd gone into the autoclave room between patients. The framed print of Bernini's Ecstasy of St. Teresa looked slightly askew. In straightening it, I found the hook was loose. When I took the frame down to tighten the hook, I noticed the thick paper backing had come unglued at one edge. The room stayed humid because of the autoclave, and it appeared to have weakened the glue. On trying to get the backing to stick again, I spied a gossamer-thin letter paper folded and ensconced behind that backing, the lines of blue writing showing through.
I fished it out.
I slumped back into my chair. My hands never tremble, but for some reason that delicate slip of paper shook.
The letter looked discolored by age, almost transparent, in danger of crumbling into dust. Like Ghosh, I had a moment to decide whether to read a private letter that was meant for another. I was certain that this was the letter my mother had penned just before I was born. Then it was in Ghosh's possession. When I was twenty-five years old, the letter came to me. I had carried it to America, then I had brought it back. For twenty-five years I was unaware that I had it. Until today. “When are you coming, Mama?” I used to ask when I was a small boy gazing up at the picture. She had come at last.
September 19
Dear Thomas,
Last night, God told me I must confess to you what I have never confessed, even to God. Years ago, in Aden, I turned from God as He turned from me. Something happened to me there that should not happen to any woman. I could not forgive the man who harmed me. I could not forgive God. Death would have been better than what I endured. But I came here, to Missing. I came in the dress of a nun to hide my bitterness and shame from the world.
In Jeremiah 17 it is written, “The heart is deceitful above all things and beyond cure, and who can understand it?” I came to Ethiopia in deceit.
But our work changed me. I would have been your assistant till my last breath. Now, things have changed again.
A few months ago, you were like a man possessed, and I tried to comfort you. Now I am with child. Do not blame yourself.
It was difficult to hide my body from Matron and the others. Many times I thought of telling you. I could never find a way. But now I am frightened. My time is short. Last night the movements became strong. It made me think, What if Thomas wishes me to stay? I should not leave in the way I came to Missing and to you, hiding and in deceit. That is why I write.
I must flee Missing to spare it my shame just as I once fled to it to hide my shame. If you come to me when you get this letter, I will know that you wish me to be with you. But whatever you do, my love will always be the same.
Mary
It took such concentration to finish my last surgical case—a routine vagotomy and gastrojejunostomy for a duodenal ulcer—and not let my mind wander. At last, with that letter in hand, I walked back to my quarters, feeling as if I had never come up this path before.
She loved him. She loved him so much she ran to him from Aden. The bloodstains with which she came to Missing told me what she could not. She made her way to the doctor—the man—she had met on that ship out of India. And then, years later, she loved him so much she was ready to leave him. At the eleventh hour she decided to write and tell him. Then she waited for him to come, or not.
But Thomas Stone did come. Surely she would have registered his arrival. As he picked her up, carried her, ran with her, every tear that fell from his eyes onto her face she would have interpreted as affirmations of his love. He came not because of the letter: he never got it. He came because some part of him knew what he had done, and what he had to do: some part of him knew what he felt.
I pictured Ghosh visiting Thomas Stone's quarters after my mother's death, searching for him. He would have seen on Stone's desk the new textbook and bookmark, and on top of them, conspicuously perhaps, this letter. Thomas Stone never saw the book or the letter because he spent the previous night sleeping in the lounge chair in his Missing office, as he often did, and then after my mother's death he never returned to his quarters. Why hadn't Ghosh simply mailed the letter directly to Thomas Stone? Thomas never wrote or communicated; Ghosh had no address at first. But as the years went by, Ghosh could probably have found Stone's whereabouts. After all, Eli Harris had always known them. But perhaps by then Ghosh was hurt by Stone's silence and his willingness to forget his old friend and leave him caring for his children as he ran from his past. As more years went by, Ghosh might have pondered the effect of the letter on Stone—perhaps it would in fact be a disservice to send it to him. It might have precipitated another meltdown, or, as Hema had always feared, Stone might have returned to claim the children. And perhaps Stone wouldn't understand—or believe—anything the letter said.
Then, as death approached, it must have worked on Ghosh's conscience to be the keeper of this letter. What if the contents could save Stone, put his heart at ease? What if it made Stone do, even belatedly, the right thing by his sons? By this time all Ghosh's resentment for Stone, if he ever had any, had vanished.
So ultimately Ghosh gave the textbook and bookmark to Shiva, and the letter to me, but hidden from me. I marveled at the foresight of a dying man who would entomb a letter within a framed picture. He would leave it to fate—how like Ghosh this was! When would I find Thomas Stone? When would I find the letter? If and when I found it, would I give the letter to its intended recipient? Ghosh trusted me to do whatever it is I would choose to do. That, too, is love. Hed been dead more than a quarter century and he was still teaching me about the trust that comes only from true love.
“Shiva,” I said, looking up at the sky where the stars were warming up for their nightly show while I recalled the night I fled Missing in haste, and how Shiva had thrust at me my father's book—A Short Practice, that bookmark inside. The few words on the bookmark penned by my mother were the only way any of us knew a letter even existed. Years ago, over the telephone, I had asked him, “Shiva, what made you give me the book?” He didn't know. “I wanted you to have it” was all he could say. The world turns on our every action, and our every omission, whether we know it or not.
WHEN I REACHED MY QUARTERS, I sat down and spread the letter on my lap, and with shaky hands I dialed Thomas Stone's number. My father was well past eighty now, an emeritus professor. Deepak said the old man's eyes were fading, but his touch was so good he could have operated in the dark. Still, he rarely operated anymore, though he would often assist. Thomas Stone was once known for The Expedient Operator: A Short Practice of Tropical Surgery. Now he was famous for pioneering a breakthrough transplant procedure. I was proof that the operation worked, but Shiva's death was proof of the attendant risks. Surgeons around the world had learned to do the operation, and many infants born without a working bile-drainage system had been saved by a parent's gift of a part of his or her liver.
IN MY EARPIECE I heard the hush of the void that hangs over the earth, and then out of that ether, the sound of the phone ringing far away, its high-pitched summons so brisk and efficient, so different from the lackadaisical analog clicks and the coarse ring when I dialed an Addis Ababa number. I pictured the phone trill and echo in the apartment that I had visited once, and which I had left open like a sardine can so that Thomas Stone would know that his son had arrived in his world.
I thought of my mother writing this letter, her whole life compressed on one side of this parchment. She had probably delivered it (and the book with bookmark) in the late afternoon when the pains hit her. She had worsened in the night, slowly slipping into shock, and then the next day she died. But not before Thomas Stone came to her. It was the sign she had waited for. He did the right thing, and yet for the last half century, he was unaware that he had done so.
Thomas Stone answered after the first ring. It made me wonder if he were wide awake even though it was the middle of the night in Boston.
“Yes?” My father's voice was crisp and alert, as if he expected this intrusion, as if he were ready for the story of trauma or massive brain bleed that made an organ available, or ready to hear of a child, one in ten thousand, born with biliary atresia who would die without a liver transplant. The voice I heard was that of someone who would bring all the skill and experience he carried in his nine fingers to the rescue of a fellow human being, and who would pass on that legacy to another generation of interns and residents—it was what he was born to do; he knew nothing else. “Stone here,” he said, his voice sounding so very close, as if he were there with me, as if nothing at all separated our two worlds.