Cutting For Stone Part 1

Cutting for Stone.

A novel.

Abraham Verghese.

For George and Mariam Verghese.

Scribere jussit amor.

And because I love this life.

I know I shall love death as well.

The child cries out when.

From the right breast the mother.

Takes it away, in the very next moment.

To find in the left one.

Its consolation.

-Rabindranath Tagore, from Gitanjali.

PROLOGUE.

The Coming.

AFTER EIGHT MONTHS spent in the obscurity of our mother's womb, my brother, Shiva, and I came into the world in the late afternoon of the twentieth of September in the year of grace 1954. We took our first breaths at an elevation of eight thousand feet in the thin air of Addis Ababa, capital city of Ethiopia.

The miracle of our birth took place in Missing Hospital's Operating Theater 3, the very room where our mother, Sister Mary Joseph Praise, spent most of her working hours, and in which she had been most fulfilled.

When our mother, a nun of the Diocesan Carmelite Order of Madras, unexpectedly went into labor that September morning, the big rain in Ethiopia had ended, its rattle on the corrugated tin roofs of Missing ceasing abruptly like a chatterbox cut off in midsentence. Over night, in that hushed silence, the meskel flowers bloomed, turning the hillsides of Addis Ababa into gold. In the meadows around Missing the sedge won its battle over mud, and a brilliant carpet now swept right up to the paved threshold of the hospital, holding forth the promise of something more substantial than cricket, croquet, or shuttlec.o.c.k.

Missing sat on a verdant rise, the irregular cl.u.s.ter of whitewashed one- and two-story buildings looking as if they were pushed up from the ground in the same geologic rumble that created the Entoto Mountains. Troughlike flower beds, fed by the runoff from the roof gutters, surrounded the squat buildings like a moat. Matron Hirst's roses overtook the walls, the crimson blooms framing every window and reaching to the roof. So fertile was that loamy soil that Matron-Missing Hospital's wise and sensible leader-cautioned us against stepping into it barefoot lest we sprout new toes.

Five trails flanked by shoulder-high bushes ran away from the main hospital buildings like spokes of a wheel, leading to five thatched-roof bungalows that were all but hidden by copse, by hedgerows, by wild eucalyptus and pine. It was Matron's intent that Missing resemble an arboretum, or a corner of Kensington Gardens (where, before she came to Africa, she used to walk as a young nun), or Eden before the Fall.

Missing was really Mission Hospital, a word that on the Ethiopian tongue came out with a hiss so it sounded like "Missing." A clerk in the Ministry of Health who was a fresh high-school graduate had typed out THE MISSING HOSPITAL on the license, a phonetically correct spelling as far as he was concerned. A reporter for the Ethiopian Herald perpetuated this misspelling. When Matron Hirst had approached the clerk in the ministry to correct this, he pulled out his original typescript. "See for yourself, madam. Quod erat demonstrandum it is Missing," he said, as if hed proved Pythagoras s theorem, the sun's central position in the solar system, the roundness of the earth, and Missing's precise location at its imagined corner. And so Missing it was.

NOT A CRY or a groan escaped from Sister Mary Joseph Praise while in the throes of her cataclysmic labor. But just beyond the swinging door in the room adjoining Operating Theater 3, the oversize autoclave (donated by the Lutheran church in Zurich) bellowed and wept for my mother while its scalding steam sterilized the surgical instruments and towels that would be used on her. After all, it was in the corner of the autoclave room, right next to that stainless-steel behemoth, that my mother kept a sanctuary for herself during the seven years she spent at Missing before our rude arrival. Her one-piece desk-and-chair, rescued from a defunct mission school, and bearing the gouged frustration of many a pupil, faced the wall. Her white cardigan, which I am told she often slipped over her shoulders when she was between operations, lay over the back of the chair.

On the plaster above the desk my mother had tacked up a calendar print of Bernini's famous sculpture of St. Teresa of Avila. The figure of St. Teresa lies limp, as if in a faint, her lips parted in ecstasy, her eyes unfocused, lids half closed. On either side of her, a voyeuristic chorus peers down from the prie-dieux. With a faint smile and a body more muscular than befits his youthful face, a boy angel stands over the saintly, voluptuous sister. The fingertips of his left hand lift the edge of the cloth covering her bosom. In his right hand he holds an arrow as delicately as a violinist holds a bow.

Why this picture? Why St. Teresa, Mother?

As a little boy of four, I took myself away to this windowless room to study the image. Courage alone could not get me past that heavy door, but my sense that she was there, my obsession to know the nun who was my mother, gave me strength. I sat next to the autoclave which rumbled and hissed like a waking dragon, as if the hammering of my heart had roused the beast. Gradually, as I sat at my mother's desk, a peace would come over me, a sense of communion with her.

I learned later that no one had dared remove her cardigan from where it sat draped on the chair. It was a sacred object. But for a four-year-old, everything is sacred and ordinary. I pulled that Cuticura-scented garment around my shoulders. I rimmed the dried-out inkpot with my nail, tracing a path her fingers had taken. Gazing up at the calendar print just as she must have while sitting there in that windowless room, I was transfixed by that image. Years later, I learned that St. Teresa's recurrent vision of the angel was called the transverberation, which the dictionary said was the soul "inflamed" by the love of G.o.d, and the heart "pierced" by divine love; the metaphors of her faith were also the metaphors of medicine. At four years of age, I didn't need words like "transverberation" to feel reverence for that image. Without photographs of her to go by, I couldn't help but imagine that the woman in the picture was my mother, threatened and about to be ravished by the spear-wielding boy-angel. "When are you coming, Mama?" I would ask, my small voice echoing off the cold tile. When are you coming?

I would whisper my answer: "By G.o.d!" That was all I had to go by: Dr. Ghosh's declaration the time I'd first wandered in there and he'd come looking for me and had stared at the picture of St. Teresa over my shoulders; he lifted me in his strong arms and said in that voice of his that was every bit a match for the autoclave: "She is c.u.m-MING, by G.o.d!"

FORTY-SIX AND FOUR YEARS have pa.s.sed since my birth, and miraculously I have the opportunity to return to that room. I find I am too large for that chair now, and the cardigan sits atop my shoulders like the lace amice of a priest. But chair, cardigan, and calendar print of transverberation are still there. I, Marion Stone, have changed, but little else has. Being in that unaltered room propels a thumbing back through time and memory. The unfading print of Bernini's statue of St. Teresa (now framed and under gla.s.s to preserve what my mother tacked up) seems to demand this. I am forced to render some order to the events of my life, to say it began here, and then because of this, that happened, and this is how the end connects to the beginning, and so here I am.

WE COME UNBIDDEN into this life, and if we are lucky we find a purpose beyond starvation, misery, and early death which, lest we forget, is the common lot. I grew up and I found my purpose and it was to become a physician. My intent wasn't to save the world as much as to heal myself. Few doctors will admit this, certainly not young ones, but subconsciously, in entering the profession, we must believe that ministering to others will heal our woundedness. And it can. But it can also deepen the wound.

I chose the specialty of surgery because of Matron, that steady presence during my boyhood and adolescence. "What is the hardest thing you can possibly do?" she said when I went to her for advice on the darkest day of the first half of my life.

I squirmed. How easily Matron probed the gap between ambition and expediency. "Why must I do what is hardest?"

"Because, Marion, you are an instrument of G.o.d. Don't leave the instrument sitting in its case, my son. Play! Leave no part of your instrument unexplored. Why settle for 'Three Blind Mice' when you can play the 'Gloria'?"

How unfair of Matron to evoke that soaring chorale which always made me feel that I stood with every mortal creature looking up to the heavens in dumb wonder. She understood my unformed character.

"But, Matron, I can't dream of playing Bach, the 'Gloria' ...," I said under my breath. I'd never played a string or wind instrument. I couldn't read music.

"No, Marion," she said, her gaze soft, reaching for me, her gnarled hands rough on my cheeks. "No, not Bach's 'Gloria.' Yours! Your 'Gloria' lives within you. The greatest sin is not finding it, ignoring what G.o.d made possible in you."

I was temperamentally better suited to a cognitive discipline, to an introspective field-internal medicine, or perhaps psychiatry. The sight of the operating theater made me sweat. The idea of holding a scalpel caused coils to form in my belly. (It still does.) Surgery was the most difficult thing I could imagine.

And so I became a surgeon.

Thirty years later, I am not known for speed, or daring, or technical genius. Call me steady, call me plodding; say I adopt the style and technique that suits the patient and the particular situation and I'll consider that high praise. I take heart from my fellow physicians who come to me when they themselves must suffer the knife. They know that Marion Stone will be as involved after the surgery as before and during. They know I have no use for surgical aphorisms such as "When in doubt, cut it out" or "Why wait when you can operate" other than for how reliably they reveal the shallowest intellects in our field. My father, for whose skills as a surgeon I have the deepest respect, says, "The operation with the best outcome is the one you decide not to do." Knowing when not to operate, knowing when I am in over my head, knowing when to call for the a.s.sistance of a surgeon of my father's caliber-that kind of talent, that kind of "brilliance," goes unheralded.

On one occasion with a patient in grave peril, I begged my father to operate. He stood silent at the bedside, his fingers lingering on the patient's pulse long after he had registered the heart rate, as if he needed the touch of skin, the thready signal in the radial artery to catalyze his decision. In his taut expression I saw complete concentration. I imagined I could see the cogs turning in his head; I imagined I saw the shimmer of tears in his eyes. With utmost care he weighed one option against another. At last, he shook his head, and turned away.

I followed. "Dr. Stone," I said, using his t.i.tle though I longed to cry out, Father! "An operation is his only chance," I said. In my heart I knew the chance was infinitesimally small, and the first whiff of anesthesia might end it all. My father put his hand on my shoulder. He spoke to me gently, as if to a junior colleague rather than his son. "Marion, remember the Eleventh Commandment," he said. "Thou shall not operate on the day of a patient's death."

I remember his words on full-moon nights in Addis Ababa when knives are flashing and rocks and bullets are flying, and when I feel as if I am standing in an abattoir and not in Operating Theater 3, my skin flecked with the grist and blood of strangers. I remember. But you don't always know the answers before you operate. One operates in the now. Later, the retrospectoscope, that handy tool of the wags and pundits, the conveners of the farce we call M&M-morbidity and mortality conference-will p.r.o.nounce your decision right or wrong. Life, too, is like that. You live it forward, but understand it backward. It is only when you stop and look to the rear that you see the corpse caught under your wheel.

Now, in my fiftieth year, I venerate the sight of the abdomen or chest laid open. I'm ashamed of our human capacity to hurt and maim one another, to desecrate the body. Yet it allows me to see the cabalistic harmony of heart peeking out behind lung, of liver and spleen consulting each other under the dome of the diaphragm-these things leave me speechless. My fingers "run the bowel" looking for holes that a blade or bullet might have created, coil after glistening coil, twenty-three feet of it compacted into such a small s.p.a.ce. The gut that has slithered past my fingers like this in the African night would by now reach the Cape of Good Hope, and I have yet to see the serpent's head. But I do see the ordinary miracles under skin and rib and muscle, visions concealed from their owner. Is there a greater privilege on earth?

At such moments I remember to thank my twin brother, Shiva- Dr. Shiva Praise Stone-to seek him out, to find his reflection in the gla.s.s panel that separates the two operating theaters, and to nod my thanks because he allows me to be what I am today. A surgeon.

According to Shiva, life is in the end about fixing holes. Shiva didn't speak in metaphors. Fixing holes is precisely what he did. Still, it's an apt metaphor for our profession. But there's another kind of hole, and that is the wound that divides family. Sometimes this wound occurs at the moment of birth, sometimes it happens later. We are all fixing what is broken. It is the task of a lifetime. We'll leave much unfinished for the next generation.

Born in Africa, living in exile in America, then returning at last to Africa, I am proof that geography is destiny. Destiny has brought me back to the precise coordinates of my birth, to the very same operating theater where I was born. My gloved hands share the s.p.a.ce above the table in Operating Theater 3 that my mother and father's hands once occupied.

Some nights the crickets cry zaa-zee, zaa-zee, thousands of them drowning out the coughs and grunts of the hyenas in the hillsides. Suddenly, nature turns quiet. It is as if roll call is over and it is time now in the darkness to find your mate and retreat. In the ensuing vacuum of silence, I hear the high-pitched humming of the stars and I feel exultant, thankful for my insignificant place in the galaxy. It is at such times that I feel my indebtedness to Shiva.

Twin brothers, we slept in the same bed till our teens, our heads touching, our legs and torsos angled away. We outgrew that intimacy, but I still long for it, for the proximity of his skull. When I wake to the gift of yet another sunrise, my first thought is to rouse him and say, I owe you the sight of morning.

What I owe Shiva most is this: to tell the story. It is one my mother, Sister Mary Joseph Praise, did not reveal and my fearless father, Thomas Stone, ran from, and which I had to piece together. Only the telling can heal the rift that separates my brother and me. Yes, I have infinite faith in the craft of surgery, but no surgeon can heal the kind of wound that divides two brothers. Where silk and steel fail, story must succeed. To begin at the beginning ...

PART ONE.

... for the secret of the care of the patient

is in caring for the patient.

Francis W. Peabody, October 21, 1925.

CHAPTER 1.

The Typhoid State Revisited.

SISTER MARY JOSEPH PRAISE had come to Missing Hospital from India, seven years before our birth. She and Sister Anjali were the first novitiates of the Carmelite Order of Madras to also go through the arduous nursing diploma course at the Government General Hospital, Madras. On graduation day my mother and Anjali received their nursing pins and that evening took their final vows of poverty celibacy, and obedience. Instead of answering to "Probationer" (in the hospital) and "Novitiate" (in the convent), they could now be addressed in both places as "Sister." Their aged and saintly abbess, Shessy Geevarughese, affectionately called Saintly Amma, had wasted no time in giving the two young nurse-nuns her blessing, and her surprising a.s.signment: Africa.

On the day they were to sail, all the novitiates rode from the convent in a caravan of cycle-rickshaws to the harbor to send off their two sisters. In my mind's eye I can see the novitiates lining the quay, chattering and trembling with excitement and emotion, their white habits flapping in the breeze, the seagulls hopping around their sandaled feet.

I have so often wondered what went through my mother's mind as she and Sister Anjali, both just nineteen years old, took their last steps on Indian soil and boarded the Calangute. She would have heard stifled sobs and "G.o.d be with you" follow her up the gangway. Was she fearful? Did she have second thoughts? Once before, when she entered the convent, she'd torn herself away from her biological family in Cochin forever and moved to Madras, which was a day and a night's train ride from her home. As far as her parents were concerned, it might just as well have been halfway across the world, for they would never see her again. And now, after three years in Madras, she was tearing herself away from the family of her faith, this time to cross an ocean. Once again, there was no going back.

A few years before sitting down to write this, I traveled to Madras in search of my mother's story. In the archived papers of the Carmelites, I found nothing of hers, but I did find Saintly Amma's diaries in which the abbess recorded the pa.s.sing days. When the Calangute slipped its mooring, Saintly Amma raised her hand like a traffic policeman and, "using my sermon voice which I am told belies my age," intoned the words, "Leave your land for my sake," because Genesis was her favorite book. Saintly Amma had given this mission great thought: True, India had unfathomable needs. But that would never change and was no excuse; the two young nuns-her brightest and fairest-were to be the torch-bearers: Indians carrying Christ's love to darkest Africa-that was her grand ambition. In her papers, she reveals her thinking: Just as the English missionaries discovered when they came to India, there was no better way to carry Christ's love than through stupes and poultices, liniments and dressings, cleansing and comfort. What better ministry than the ministry of healing? Her two young nuns would cross the ocean, and then the Madras Discalced Carmelite Mission to Africa would begin.

As the good abbess watched the two waving figures on the ship's rail recede to white dots, she felt a twinge of apprehension. What if by their blind obedience to her grand scheme they were being condemned to a horrible fate? "The English missionaries have the almighty Empire behind them ... but what of my girls?" She wrote that the seagulls' shrill quarreling and the splatter of bird excreta had marred the grand send-off she had envisioned. She was distracted by the overpowering scent of rotten fish, and rotted wood, and by the bare-chested stevedores whose betel-nut-stained mouths drooled b.l.o.o.d.y lechery at the sight of her brood of virgins.

"Father, we consign our sisters to You for safekeeping," Saintly Amma said, putting it on His shoulders. She stopped waving, and her hands found shelter in her sleeves. "We beseech You for mercy and for Your protection in this outreach of the Discalced Carmelites ..."

It was 1947, and the British were finally leaving India; the Quit India Movement had made the impossible come about. Saintly Amma slowly let the air out of her lungs. It was a new world, and bold action was called for, or so she believed.

THE BLACK-AND-RED FLOATING PACKET of misery that called itself a ship steamed across the Indian Ocean toward its destination, Aden. In its hold the Calangute carried crate upon crate of spun cotton, rice, silk, G.o.drej lockers, Tata filing cabinets, as well as thirty-one Royal Enfield Bullet motorcycles, the engines wrapped in oilcloth. The ship wasn't meant to carry pa.s.sengers, but the Greek captain did just that by housing "paying guests." There were many who would travel on a cargo ship to save on pa.s.sage, and he was there to oblige by skimping on crew. So on this trip he carried two Madras nuns, three Cochin Jews, a Gujarati family, three suspicious-looking Malays, and a few Europeans, including two French sailors rejoining their ship in Aden.

The Calangute had a vast expanse of deck-more land than one ever expected at sea. At one end, like a gnat on an elephant's backside, sat the three-story superstructure which housed the crew and pa.s.sengers, the top floor of which was the bridge.

My mother, Sister Mary Joseph Praise, was a Malayali from Cochin, in the state of Kerala. Malayali Christians traced their faith back to St. Thomas's arrival in India from Damascus in A.D. 52. "Doubting" Thomas built his first churches in Kerala well before St. Peter got to Rome. My mother was G.o.d-fearing and churchgoing; in high school she came under the influence of a charismatic Carmelite nun who worked with the poor. My mother's hometown is a city of five islands set like jewels on a ring, facing the Arabian Sea. Spice traders have sailed to Cochin for centuries for cardamom and cloves, including a certain Vasco de Gama in 1498. The Portuguese clawed out a colonial seat in Goa, torturing the Hindu population into Catholic converts. Catholic priests and nuns eventually reached Kerala, as if they didn't know that St. Thomas had brought Christ's uncorrupted vision to Kerala a thousand years before them. To her parents' chagrin, my mother became a Carmelite nun, abandoning the ancient Syrian Christian tradition of St. Thomas to embrace (in her parents' view) this Johnny-come-lately pope-worshipping sect. They couldn't have been more disappointed had she become a Muslim or a Hindu. It was a good thing her parents didn't know that she was also a nurse, which to them would mean that she soiled her hands like an untouchable.

My mother grew up at the ocean's edge, in sight of the ancient Chinese fishing nets cantilevered from long bamboo poles and dangling over the water like giant cobwebs. The sea was the proverbial "breadbasket" of her people, provider of prawns and fish. But now on the deck of the Calangute, without the Cochin sh.o.r.e to frame her view, she did not recognize the breadbasket. She wondered if at its center the ocean had always been this way: smoking, malevolent, and restless. It tormented the Calangute, making it pitch and yaw and creak, wanting nothing more than to swallow it whole.

She and Sister Anjali secluded themselves in their cabin, bolting the door against men and sea. Anjali's ejaculatory prayers startled my mother. The ritualized reading of the Gospel of Luke was Sister Anjali's idea; she said it would give wings to the soul and discipline to the body. The two nuns subjected each letter, each word, line, and phrase to dilata-tio, elevatio, and excessus-contemplation, elevation, and ecstasy. Richard of St. Victor's ancient monastic practice proved useful for an interminable ocean crossing. By the second night, after ten hours of such close and meditative reading, Sister Mary Joseph Praise suddenly felt print and page dissolve; the boundaries between G.o.d and self disintegrated. Reading had brought this: a joyous surrender of her body to the sacred, the eternal, and the infinite.

At vespers on the sixth night (for they were determined to carry the routine of the convent with them no matter what) they finished a hymn, two psalms, and their antiphons, then the doxology, and were singing the Magnificat when a piercing, splintering sound brought them to earth. They grabbed life jackets and rushed out. They were met by the sight of a segment of the deck that had buckled and pushed up into a pyramid, almost, it seemed to Sister Mary Joseph Praise, as if the Calangute were made of corrugated cardboard. The captain kept his pipe lit and his smirk suggested his pa.s.sengers had overreacted.

On the ninth night, four of the sixteen pa.s.sengers and one of the crew came down with a fever whose flesh signs were rose spots that appeared on the second febrile day and that arranged themselves like a Chinese puzzle on the chest and abdomen. Sister Anjali suffered grievously, her skin burning to the touch. By the second day of illness she was raging in feverish delirium.

Among the Calangutes pa.s.sengers was a young surgeon-a hawk -eyed Englishman who was leaving the Indian Medical Service for better pastures. He was tall and strong, and his rugged features made him look hungry, yet he avoided the dining room. Sister Mary Joseph Praise had run into him, literally, on the second day of the voyage when she lost her footing on the wet metal stairs leading up from their quarters to the common room. The Englishman coming up behind her seized her where he could, in the region of her coccyx and her left rib cage. He righted her as if she were a little child. When she stuttered her thanks, he turned beet red; he was more fl.u.s.tered than she by this unexpected intimacy. She felt a bruising coming on where his hands had clutched her, but there was a quality to this discomfort that she did not mind. For days thereafter, she didn't see the Englishman.

Now, seeking medical help, Sister Mary Joseph Praise gathered her courage to knock on his cabin. A faint voice bid her to enter. A bilious, acetone odor greeted her. "It is me," she called out. "It is Sister Mary Joseph Praise." The doctor lay on his side in his bunk, his skin the same shade as his khaki shorts, his eyes screwed shut. "Doctor," she said, hesitating, "are you also with fever?"

When he tried to look at her, his eyeb.a.l.l.s rolled like marbles on a tilting plate. He turned and retched over a fire-bucket, missed it, which didn't matter, as the bucket was full to the brim. Sister Mary Joseph Praise rushed forward and felt his brow. It was cold and clammy, not at all feverish. His cheeks were hollowed, and his body looked as if it had shrunk to fit the tiny cabin. None of the pa.s.sengers had been spared seasickness, but the Englishman's affliction was severe.

"Doctor, I am wanting to report a fever that has affected five patients. It comes with rash, chills, and sweats, a slow pulse and loss of appet.i.te. All are stable except for Sister Anjali. Doctor, I am most worried about Anjali ..."

She felt better once it was off her chest, even though other than letting out a moan the Englishman made no response. Her eyes fell on a catgut ligature that was looped around a bed rail near his hands and that displayed knot thrown on top of knot, ten-score of them. The knots were so plentiful that the thread stood up like a gnarled flagpole. This was how he had logged the hours, or kept track of his bouts of emesis.

She rinsed out the bucket and put it back within his reach. She mopped the mess on the floor with a towel, then she rinsed the towel out and hung it up to dry. She brought water to his side. She withdrew, wondering how many days it had been since he'd eaten anything.

By evening he was worse. Sister Mary Joseph Praise brought sheets, towels, and broth. Kneeling, she tried to feed him, but the smell of food triggered dry heaves. His eyeb.a.l.l.s had sunk into their orbits. His shriveled tongue looked like that of a parrot. She recognized the room's fruity odor as the scent of starvation. When she pinched up a skin fold at the back of his arm and let go, it stayed up like a tent, like the buckled deck. The bucket was half full of clear fluid. He babbled about green fields and was unaware of her presence. Could seasickness be fatal, she wondered. Or could he have a forme fruste of the fever that afflicted Sister Anjali? There was so much she did not know about medicine. In the middle of that ocean surrounded by the sick, she felt the weight of her ignorance.

But she knew how to nurse. And she knew how to pray. So, praying, she eased off his shirt which was stiff with bile and spit, and she slid down his shorts. As she gave him a bed bath, she was self-conscious, for shed never ministered to a white man, or to a doctor for that matter. His skin displayed a wave of goose b.u.mps at the touch of her cloth. But the skin was free of the rash shed seen on the four pa.s.sengers and the one cabin boy who had come down with fever. The sinewy muscles of his arms bunched together fiercely at his shoulder. Only now did she notice that his left chest was smaller than his right; the hollow above his collarbone on the left could have held a half cup of water, while that on the right only a teaspoon. And just beyond and below his left nipple, extending into the armpit, she saw a deep depression. The skin over this crater was shiny and puckered. She touched there and gasped as her fingers fell in, not meeting bony resistance. Indeed, it appeared as if two or perhaps three adjacent ribs were missing. Within that depression his heart tapped firmly against her fingers with only a thin layer of hide intervening. When she pulled her fingers away, she could see the thrust of his ventricle against his skin.

The fine, translucent coat of hair on his chest and abdomen looked as if it had drifted up from the mother lode of hair at his pubis. She dispa.s.sionately cleaned his uncirc.u.mcised member, then flopped it to one side and attended to the wrinkled and helpless-looking sac beneath. She washed his feet and cried while she did, thinking inevitably of her Sweet Lord and His last earthly night with His disciples.

In his steamer trunks she found books dealing with surgery. He had penned names and dates in the margins, and only later did it occur to her that these were patients' names, both Indian and British, mementos to a disease hed first seen in a Peabody, or a Krishnan. A cross next to the name she took as a sign the patient had succ.u.mbed. She found eleven notebooks filled with an economical handwriting with slashing down-strokes, the text dancing just above the lines and obeying no margin save for the edge of the page. For an outwardly silent man, his writing reflected an unexpected volubility.

Eventually she found a clean undershirt and shorts. What did it say when a man had fewer clothes than books? Turning him first this way and then that, she changed the sheets beneath him and then dressed him.

She knew his name was Thomas Stone because it was inscribed inside the surgical textbook hed placed at his bedside. In the book she found little about fever with rash, and nothing about seasickness.

That night Sister Mary Joseph Praise negotiated the heaving pa.s.sageways, hurrying from one sickbed to the next. The mound where the deck had buckled resembled a shrouded figure and she averted her eyes. Once she saw a black mountain of a wave, several stories high, and the Calangute looked poised to fall into a hole. Sheets of water smashed over the bow, the noise more terrifying than the sight.

In the middle of the tempestuous ocean, groggy from lack of sleep, facing a terrible medical crisis, her world had become simplified. It was divided into those with fever, those with seasickness, and those without. And it was possible that none of these distinctions mattered, for very soon they might all drown.

She awoke from where she must have drifted off next to Anjali. In what seemed like the next instant she awoke again, but this time in the Englishman's cabin where she'd fallen asleep kneeling by his bed, her head lolling on his chest, his arm resting on her shoulder. In the time it took her to recognize this, she was asleep again, waking at daybreak finding herself on the bunk, but on its very edge, pressed against Thomas Stone. She hurried back to Anjali to find her worse, her respirations now sighing and rapid. There were large confluent purple patches showing on Anjali's skin.