Cutting For Stone Part 28

At one point, Hema lifted her head up and said, "The people who did this should all go to jail." It wasn't the first time she'd had to rescue a woman in Genet's situation. She was probably one of the world's experts in treating botched and infected female circ.u.mcisions. But now her face was clamped down in a bitterness I'd never seen before.

It was evening when Genet opened her eyes. She saw me, and she tried to say something. I asked her if she wanted water, and she nodded. I guided a straw to her mouth. She looked around to see if there was anyone else in the room.

"I'm sorry, Marion," she whispered, her eyes swimming with tears.

"Don't talk," I said. "It's all right." It wasn't, but that's what came to my mouth.

"I ... should have waited," she said.

Why didn't you, I wanted to say. I didn't get any of the pleasure, the honor of being your first lover, but I'm getting all the blame.

She moaned when she tried to move, licking her lips. I gave her more water.

"My mother thinks it was you." Her voice was weak.

I nodded, but said nothing.

"When I told her it was Shiva," Genet said, "she slapped me. She kicked me and called me a liar. She didn't believe me. She thinks Shiva is a virgin." She tried to laugh, but grimaced and then coughed. When she could speak, she said, "Listen, I made my mother promise not to tell Hema."

I couldn't resist a sarcastic snicker. "Well, don't worry. She will tell Hema. She's probably telling her right now."

"No. She won't," Genet said. "That was our deal."

"What do you mean?"

"I agreed to let her do this to me, if she wouldn't ... say anything. She's to keep quiet. Not a word to Hema. Not one word. And no more shouting at you."

I slumped back on hearing this. Genet allowed a strange woman to cut her privates with an unsterilized blade, and it was all to protect me? So now I was to blame for the circ.u.mcision? It was so absurd that I wanted to laugh, but I found I couldn't: the guilt had settled on me as if it knew that was its home and it would be welcome.

Shiva came in the evening, his face pale and drawn. "Here, sit here," I said before he could open his mouth. I didn't trust myself near him and I needed a break. "Stay with her till I come back. Hold her hand. She gets restless when I let go." There was nothing else I could say to him, now. I was beyond anger, and he was beyond sorrow.

GENET'S FEVER RAGED for three days. I sat by her bed day and night. Hema, Ghosh, and Matron were in and out all the time.

On the third day, Genet stopped making any urine. Ghosh was very worried, drawing blood himself, then Shiva or I would run to the lab, help W.W. line up our reagents and tubes and measure the blood urea nitrogen level: high, and getting higher.

Genet was never completely unconscious, just sleepy, confused at times, often moaning, and at one point horribly thirsty. She called for her mother once, but Rosina wasn't there. Almaz told me Rosina wouldn't leave her room, which was probably a good thing. The atmo sphere in the hospital room was tense enough without the prospect of Hema attacking Rosina.

On the sixth day, Genet's kidneys began to produce urine, and then they produced it in huge amounts, filling up the catheter bag. Ghosh doubled and tripled her intravenous fluid rates, and encouraged her to drink to keep up with the loss. "Hopefully this means her kidneys are recovering," Ghosh said. "They just aren't able to concentrate the urine too well."

One morning, when I woke up in the chair and saw her face, the texture of the skin, the relaxation around the brow, I knew she was going to make it. She was skinny to begin with, and now the illness had consumed her, burned her down to just bones. Her color was returning; the sword that hung over her had lifted away. My shoulders began to unknot.

That afternoon I went to my room in Ghosh's quarters, and I fell into a black sleep. It was only when I woke up that I turned my attention to Shiva. Did he understand how he shattered my dreams? Did he see how he hurt Genet, hurt us all? I wanted to get through to him. The trouble was that I couldn't think of any other way than to pummel him with my fists until he felt the same degree of pain he had caused in me. I hated my brother. No one could stop me.

No one but Genet.

When she told me about her deal with Rosina, how she had agreed to be circ.u.mcised if Rosina said nothing to Hema, Genet hadn't finished what she had to say. Later that first night, she struggled to consciousness to ask something of me. She had made me swear to it. "Marion," she said, "punish me, but not Shiva. Attack me and cast me away, but leave Shiva alone."

"Why? I can't do that. Why spare him? "

"Marion, I made Shiva do what he did with me that night. I asked him." Her words were like kidney punches. "You know how Shiva is different ... how he thinks in another way? Believe me, if I hadn't asked him, he would have read his book and I wouldn't be here."

Reluctantly, on that first night, I had given Genet my word that I wouldn't confront Shiva. I did so mainly because that night had looked as if it might well have been her last.

I never told Hema what had really happened, leaving her to imagine whatever it was she thought I had done.

Why, you might ask, did I keep my word? Why did I not change my mind when I saw that Genet would survive? Why didn't I tell Hema the truth? You see, I'd learned something about myself and about Genet during her battle to stay alive. I'd come so close to losing her, and it helped me understand that despite everything, I didn't want her to die. I might never forgive her. But I still loved her.

WHEN SHE WAS DISCHARGED from the hospital, I carried Genet from the car to the house. No one objected, and if they had I would have stood my ground. My unceasing vigil at Genet's bedside had earned a grudging acknowledgment from Hema; she didn't dare deny me.

As I carried her daughter into our house through the kitchen, Rosina watched from her doorway. Genet never looked in that direction. It was as if her mother and the room in which she had lived her life no longer existed. Rosina stood there, beseeching with her eyes, pleading for forgiveness. But a child's ability for reprisal is infinite, and can last a lifetime.

I carried Genet to our old room, Shiva's room, which would now be hers.

The plan was that Shiva and I would sleep in Ghosh's old quarters, but separately, he in the living room.

Half an hour later, when I went to get Genet's clothes from Rosina's quarters, she had locked herself in and wouldn't answer despite my knocking. I pushed on the wood in anger, and I could tell from the resistance that she'd barricaded the door or else she was leaning against it. A peculiar silence blanketed the atmosphere. I went to the window. The shutters were bolted, but now, with Almaz helping, I pulled on the flimsy slats till they snapped off. The wardrobe had been used to block the window. I scrambled onto the ledge and tried to shove the wardrobe aside with my hands, but I couldn't. I craned my neck to peer above it. What I saw made me set my back to the window frame, put both feet on the wardrobe, and topple it without a thought to its contents. It hit the ground with a terrific crash, the wood splintering, the mirror shattering, plates smashing. It brought everyone running.

I could see clearly now. We all could see. Hema, Ghosh, Shiva were behind me, and even Genet, hearing the commotion, had dragged herself there.

There is a mathematical precision to that scene as I remember it, but there are no angles in Carr's Geometry or any other text that quite describe the slant of that neck. And no pill in the pharmacopoeia that might erase the memory. Hanging from a rafter, her head tilted on her spine, her mouth open and the tongue looking as if it had been yanked out of her throat, was Rosina.

CHAPTER 35.

One Fever from Another

THE MOSSY STONE WALLS and the ma.s.sive gate of Empress Menen School gave it the look of an ancient fortress. In her white socks, light blue blouse, dark blue skirt, and with no headbands, clips, or earrings, Genet was just one of the girls, blending in. Her only adornment was the St. Bridget's cross hanging from her neck. She didn't want to stand out. Her old vivacious self had died along with the corpse we took down from the rafter and buried in Gulele Cemetery.

My new ritual was to come on Sat.u.r.day evenings to see Genet. She was just up the hill from the palace where General Mebratu (with Zemui at his side) took hostages and tried to bring about a new order.

Genet could have come home on weekends, but she said Missing evoked painful memories. She insisted she was happy at Empress Menen. The Indian teachers were strict but very good. Sheltered from society and from us, she worked very hard.

We entered university together for our premedical course, and the following year we entered medical school. Now out of uniform and in regular clothes, her dress and manner remained reserved and subdued. Each time I went to visit Genet in the Mekane Yesus Hostel opposite the university, I'd pray that this would be the day when the locked door to her heart opened and I might see traces of the old Genet. She was appreciative for the tiffin carrier of food Almaz and Hema sent for her, but the barrier she put up around herself remained.

I still loved her.

I wished I didn't.

We entered the Haile Sela.s.sie the First School of Medicine in 1974- only the third cla.s.s to be admitted. Genet and I were paired as dissection partners on a cadaver, which was fortunate for her. Anyone else would have taken offense at her frequent absences and her failing to carry her load. I didn't think she was lazy. There was no good reason for this; something was brewing, and for once I had no clue.

OUR BASIC SCIENCE TEACHERS were very good, a mix of British and Swiss professors and a few Ethiopian physicians who graduated from the American University of Beirut and then took postgraduate training in England or America. There was one Indian: our own Ghosh. Ghosh had a t.i.tle: not a.s.sistant Professor, or a.s.sociate Professor, or Clinical a.s.sociate Professor (implying an honorary, unpaid designation), but Professor of Medicine and Adjunct Professor of Surgery.

I don't think any of us, not even Hema, realized the extent of Ghosh's scholarship during his twenty-eight years in Ethiopia. But Sir Ian Hill, dean of the new medical school, certainly did. Ghosh had forty-one published papers and a textbook chapter to his name. An initial interest in s.e.xually transmitted illness had given way to major scholarship on relapsing fever, for which he was the world's expert, because the louse-borne variety of this disease was endemic to Ethiopia, and because no living person had observed the disease as closely.

I learned about relapsing fever as a schoolboy when Ali of the souk opposite Missing brought his brother, Saleem, to the hospital and asked me to intercede. Saleem burned with fever and was delirious. Ghosh said later that Saleem's story was typical: He'd arrived in Addis Ababa from his village with his life's belongings in a cloth strung over his shoulder. Ali found his brother a toehold in the seething, swarming docks of the Merkato, where, monsoon or not, he hauled sacks off the trucks and into the G.o.downs. At night he slept cheek by jowl with ten others in a flophouse. In the rainy season, there was little opportunity to wash clothes because they would take days to dry. Saleem's living conditions were unfit for humans, but ideal for lice. While scratching his skin he must have crushed a louse, its blood entering his body through the scratch. Coming from the village, he had no immunity to this urban disease.

In Casualty, Saleem lay on the ground too weak to sit or stand, semiconscious. Adam, our one-eyed compounder, bent over the patient, and with one swift move made the diagnosis.

Years later Ghosh showed me the correspondence he had with the editor of the New England Journal of Medicine, who was about to publish Ghosh's seminal series of cases of relapsing fever. The editor felt "Adam's sign" was pretentious. Ghosh defended the honor of his uneducated compounder at the risk of not being published in that prestigious journal.

Dear Dr. Giles, ... in Ethiopia we cla.s.sify hernias as "below the knee" and "above the knee," not "direct" or "indirect." It's another order of magnitude, sir. Our casualty room often has as many as five patients prostrate on the floor with fever. The clinician asks: Is this malaria? Is it typhoid? Or is it relapsing fever? There is no rash to help sort this out (the "rose spots" of typhoid are invisible in our population), though I will grant you that typhoid causes a bronchitis and a slow pulse, and people with malaria often have giant spleens. I would be remiss in publishing a paper on relapsing fever without providing the clinician a practical way to make the diagnosis, particularly in settings where blood and serum tests are hard to come by. The clinician has only to grab the patient's thigh, squeeze the quadriceps muscle, squeeze it hard: Patients with relapsing fever will jump up because of the otherwise silent muscle inflammation and tenderness that is part of this disease. Not only is this a good diagnostic sign, but it can raise Lazarus. This sign was first noted by Adam, and is deserving of the eponym "Adam's sign."

I could testify to Adam's sign-Saleem yelled and leaped to his feet when Adam mashed. The editor wrote back. He was pleased with all the other revisions but Adam's sign remained a sticking point. Ghosh held his ground.

Dear Dr. Giles, ... there is a Chvostek's sign, a Boas's sign, a Courvoisier's sign, a Quincke's sign-no limit it seems to white men naming things after themselves. Surely, the world is ready for an eponym honoring a humble compounder who has seen more relapsing fever with one eye than you or I will ever see with two.

Ghosh, working in an obscure African hospital, far from the academic mainstream, had his way. The paper was published in the prestigious journal, and no doubt led to his being invited to write a chapter in Harrison's Principles of Internal Medicine, the bible of senior medical students. Now, here he was, a professor. Hema bought our new professor two beautiful pin-striped suits, one black and the other blue. Also a tweed coat with leather elbow patches, as if to put "Professor" in quotes. The bow tie was his idea. In all things, especially when it cost little and did no harm to others, Ghosh was his own man. The bow tie told the world how pleased he was to be alive and how much he celebrated his profession, which he called "my romantic and pa.s.sionate pursuit." The way Ghosh practiced his profession, the way he lived his life, it was all that.

CHAPTER 36.

Prognostic Signs

LIFE IS FULL OF SIGNS. The trick is to know how to read them. Ghosh called this heuristics, a method for solving a problem for which no formula exists.

Red sky in the morning, sailors take warning.

Pus somewhere and Pus nowhere means Pus in the belly.

Low platelets in a woman is lupus until proven otherwise.

Beware of a man with a gla.s.s eye and a big liver ...

Across the outpatient department, Ghosh would spot a breathless young woman, her cheeks flushed, contradicting her general pallor. Hed suspect narrowing of the mitral valve of the heart, though he'd be hard-pressed to explain exactly why. It would make him listen carefully for the soft, rumbling murmur of mitral stenosis, a devilish murmur which, as he said, "you'll only hear if you know it's there," and then it was only audible with the bell of the stethoscope lightly applied over the apex of the heart after exercise.

I'd developed my own heuristics, my mix of reason, intuition, facial appearance, and scent. These were things not in any book. The army soldier who'd tried to steal the motorcycle had an odor at the moment of his demise, and so, too, had Rosina, and the two odors were identical-they spoke of sudden death.

But I didn't trust my nose when I should have, when it picked up signals from Ghosh that put my nerves on edge. I wrote it off as being a function of his new job as a professor, a side effect of his new suits and new environment. When I was around him it was easy to be rea.s.sured. He'd always been upbeat, a happy soul. But now he was even more jovial. He'd found his best self. For a man who prided himself on "the three Ls: Loving, Learning, and Legacy," he'd excelled in all three.

On the anniversary of Hema and Ghosh's marriage, I woke myself at 4:00 a.m. to study. Two hours later, I walked over from Ghosh's old bungalow to the main house. Shiva had moved back to our boyhood room. It was still dark outside. I planned to creep into Shiva's room to see if a shirt I was missing had been laundered and hung in his closet. I came in as Almaz arrived. I hugged her and then waited as she made the sign of the cross on my forehead and murmured a prayer.

Hema was still sleeping. The hallway bathroom door stood open, steam coming out. Ghosh stood in front of the washbasin, a towel around his waist, leaning heavily on the sink. It was early for him. I wondered why he was using this bathroom. So as not to wake Hema? I could hear his labored breathing before I saw him and, certainly, before he saw me. The effort of bathing had winded him. In his reflection in the mirror, I saw his unguarded self. I saw terrible fatigue; I saw sadness and apprehension. Then he saw me. By the time he'd turned around, the mask of joviality which had fallen into the sink had been slapped back on, not a seam showing.

"What's wrong?" I asked. I felt my stomach flutter. The scent was there. It had to be connected to what I just saw.

"Not a thing. Scary, isn't it?" He paused to take a breath. "My beautiful wife is sleeping like an angel. My sons make me so proud ... Tonight I'm going to take my wife dancing and I'll ask her to extend our marriage contract for another year. The only thing wrong is that a sinner like me doesn't deserve such blessings."

Hema came out to the hallway, shaking sleep from her hair. Ghosh flashed me an anxious look.

He turned back to the mirror, whistling as he slapped on cologne. His eyes pleaded with me not to alarm Hema. The effort of holding his arms up made his "Saints Come Marching In" full of staccato notes and pauses. I got my shirt and left.

I had an early morning cla.s.s, an important one. But I followed my instinct, my intuition-my nose. I dressed and then hid myself behind Shiva's toolshed. Soon, the Volkswagen appeared out of the mist, with just Ghosh in it. I followed on foot.

I got to Casualty in time to see him enter Matron's office. Not only was Matron there at this early hour, she was waiting. I stood there considering what this meant, when Adam appeared carrying a bottle of blood. Matron's door opened for him. Adam emerged moments later empty-handed. He was startled to see me, and he tried to close the door behind him, but I had a foot there.

Ghosh was on a lounge chair, his feet up, a pillow behind his head, smiling. Bach's "Gloria" chorus sounded on Matron's ancient phonograph. Matron bent over his arm, taping the needle that carried blood into his vein in place. They looked up, thinking perhaps it was Adam returning for something.

Ghosh's lips moved.

"Son, you know I-"

"Don't bother to lie to me," I said.

He looked to Matron, as if for a cue. She sighed. "This is fate, Ghosh. I always thought Marion should know."

I'll never forget the stillness, the hesitation, and a trace of something I'd never before seen on Ghosh's face: cunning. Then it gave in to resignation and a faraway look. For a moment I saw the world through his eyes, his intellect, his sweeping vision that took in Hippocrates, Pavlov, Freud, and Marie Curie, the discovery of streptomycin and penicillin, Landsteiner's blood groups; a vision that recalled the septic ward where he wooed Hema, and Theater 3 where he was the reluctant surgeon; a vision that recapitulated our birth and looked to the future, looked past his life to the end of mine and beyond. And then and only then did it settle, gather, and focus, on the now, on a moment when the love was so palpable between father and son that the thought that it might end, and this memory be its only legacy, was unacceptable.

"All right, Marion, you budding clinician. What do you think it might be?" He loved the Socratic Method. Only this time, he was the patient, and it was my heuristic I would invoke.

I'd noticed his pallor before, but I'd refused to let it register. Now I remembered that I'd seen bruises on his arms and legs for the past few months-bruises for which he always had explanations. Was it just a week ago he had the paper cut on his finger? It happened in front of my eyes, and it bled for a while; when I saw him a few hours later, the wound was still oozing. How had I managed to dismiss that? I remembered, too, his hours exposed to radiation from the Old Koot, the ancient X-ray machine which, despite everyone's protests, he'd continued to use until Missing finally got a new machine. The Koot was broken apart with hammers and the pieces hauled to the Drowning Soil. There it would keep the army man company, while making his bones glow.

"A blood cancer? A leukemia?" I said, hating the sound of those ugly words on my lips. Ghosh's disease was only born, it only came to life, the moment I named it, and now it couldn't go away.

He beamed, turned to Matron, raising his eyebrows. "Can you believe this, Matron? My son, the clinician."

Then his voice lost its ebullience; he spoke in a manner in which pretense had fallen off like leaves after a frost.

"Whatever happens, Marion, you mustn't let Hema know. I had my slides sent off about two years ago through Eli Harris to Dr. Maxwell Wintrobe in Salt Lake City Utah, USA. He's a fabulous hematolo-gist. I love his textbook. He personally wrote me back. What I have is like an active volcano, rumbling and spitting. Not quite a leukemia, but brewing into one; it's called 'myeloid metaplasia,' " he said, p.r.o.nouncing it carefully as if it were something delicate and exquisitely wrought. "Remember the term, Marion. It's an interesting disease. I still have many years left, I'm sure. The only troublesome symptom I have now is anemia. These blood transfusions are my oil changes. I'm going dancing tonight with Hema. It's our big day, you know. I wanted more gumption."

"Why won't you let Ma know? Why didn't you let me know?"

Ghosh shook his head. "Hema will go crazy ... She'll, she shouldn't, she can't ... Don't look at me that way, my son, I'm not being n.o.ble, I promise you."

"Then I don't understand."

"You didn't know about my diagnosis these last two years, did you? If you had known, it would've changed your relationship with me. Don't you think?" He grinned, and he ruffled my hair. "You know what's given me the greatest pleasure in my life? It's been our bungalow, the normalcy of it, the ordinariness of my waking, Almaz rattling in the kitchen, my work. My cla.s.ses, my rounds with the senior students. Seeing you and Shiva at dinner, then going to sleep with my wife." He stopped there, silent for a long time as he thought of Hema. "I want my days to be that way. I don't want everyone to stop being normal. You know what I mean? To have all that ruined." He smiled. "When things get more severe, if it ever comes to that, I'll tell your ma. I promise."