Cutting For Stone Part 37

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 blus.h.i.+ng. "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 s.h.i.+va. 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.

CHAPTER 45.

A Matter of Time

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 cras.h.i.+ng around Fort St. George. And he a.s.sumed that all fathers were like his, cras.h.i.+ng 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 demiG.o.ds, 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 p.r.o.nouncements, 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 G.o.d.

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 fas.h.i.+oned 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 was.h.i.+ng 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 G.o.d, 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 rea.s.surance, they did nothing for Thomas. He spoke to his son as if he were addressing mult.i.tudes. 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 Pa.s.sED 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 G.o.d listened and prayer never failed. He prayed constantly, convinced that at the very least the prayers kept her alive.

I know G.o.d 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 alt.i.tude. 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, pus.h.i.+ng up under her blouse. He was embarra.s.sed 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 a.s.sumed 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 wors.h.i.+p 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 rea.s.sured 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 s.p.a.ce that lined the lung, a s.p.a.ce 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 p.r.o.ne, 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 s.p.a.ce 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 s.p.a.ce? 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 p.r.o.nOUNCED 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 guardians.h.i.+p 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 apt.i.tude for two things: sickness and suffering.

In medical school in Edinburgh, he lost himself in his studies, finding a stability and a sanct.i.ty missing before. He had no need to lift his head from his books, no desire to go anywhere but for cla.s.ses 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 cla.s.s 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 b.r.e.a.s.t.s, 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 s.p.a.ce, but in Justifus Stone those messages had been blocked in his spinal cord. His father's stamping, cras.h.i.+ng 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.