The sight of barefoot peasants carrying impossible head loads and horse-drawn gharries plying the roads maintained the aura and mystique of this ancient kingdom that almost justified the fabulous tales of Prester John, who wrote in medieval times of a magical Christian kingdom surrounded by Muslim lands. Yes, it might be the era of the kidney transplant in America and a vaccine for polio due to arrive even in India, but here Hema felt she'd tricked time; with her twentieth-century knowledge she had traveled back to an earlier epoch. The power filtered down from His Majesty to the Rases, the Dejazmaches, and the lesser nobility and then to the vassals and peons. Her skills were so rare, so needed for the poorest of the poor, and even at times in the royal palace, that she felt valued. Wasn't that the definition of home? Not where you are from, but where you are wanted?
AT ABOUT TWO in the afternoon, her taxi pulled up to the chukker-brown gates of Missing, a world unto itself.
The rock wall enclosed the hospital grounds and hid the buildings. Eucalyptus towered over the wall, and where there was no eucalyptus there were firs and jacaranda and acacia. Green bottle shards poked up from the mortar at the top of the wall to dissuade intruders—robbery and petty theft were rampant in Addis—though the sight of roses lapping over the wall softened this deterrent. The wrought-iron gate covered with sheet metal was normally kept closed, and pedestrians were admitted through the smaller, hinged door in the gate. But now the big gate was wide open, as was the pedestrian flap.
Inside, Hema saw that Gebrew's sentry hut door and shutter were also open, and when they crested the hill, she could see that every visible window and door in Missing's outpatient building was open, too; in fact, she could see Gebrew, the watchman (who happened to be a priest), in the process of propping open the woodshed door with a rock.
Spotting the taxi, he came running, his army surplus overcoat flapping, his white priest's turban dwarfing his small face, his fly wand, cross, and beads clutched in one hand. He seemed to be trying to shoo the taxi away. Gebrew was a nervous chap given to rapid speech and jerky movements, but he was far more agitated than was his norm. He looked stunned to see her, as if he'd never expected her to come back.
“Praise-God-for-bringing-you-safely, welcome-back-madam, how-are-you-are-you-well? God-answered-our-prayers,” he said in Amharic. She matched him bow for bow as best she could, but he wouldn't stop until she said, “Gebrew!”
She held out a five-birr note. “Take bowl to Sheba Bar and fetch please doro-wot,” she said, naming the delectable red chicken curry cooked in Ethiopian peppers—berbere. Her Amharic was crude, and she could only speak in the present tense, but doro-wot was a term she'd mastered early. And doro-wot had occupied her dreams her last few nights in Madras, after so many days of a pure vegetarian diet. The wot came poured onto the soft crepelike injera and there would be more rolls of injera which Hema would use to scoop up the meat. The curry would have soaked into the injera that lined the bowl by the time Gebrew brought it. Her mouth watered just thinking of the dish.
“Indeed-I-will-madam, Sheba-is-best, blessed-is-their-cook, Sheba-is—”
“Tell me, Gebrew, why be doors and windows open?” Now she noticed his nails and fingers were bloody, and his sleeves had feathers sticking to them, and feathers were caught up in his fly swish.
It was then that Gebrew said, “Oh, madam! This is what I have been trying to tell you. Baby is stuck! The baby. And Sister! And the baby!”
She did not understand. She'd never seen him so worked up. She smiled and waited.
“Madam! Sister is borning! She is not borning well!”
“What? Say again?” Perhaps being away and not hearing Amharic had made her misunderstand.
“Sister, madam,” Gebrew said, alarmed that he didn't seem to be getting through, and thinking volume and pitch might help, though what came out was a squeak.
“Sister” in Missing always referred to Sister Mary Joseph Praise, for the only other nun there was Matron Hirst, who went by Matron, while all the other nurses were addressed as Nurse Almaz or Nurse Esther, and not Sister.
To Hema's astonishment, Gebrew was crying, and his voice turned shrill. “Passage is closed! I tried everything. I opened all the doors and windows. I split open a chicken!”
He clutched his belly and strained in a bizarre imitation of parturition. He tried English. “Baby! Baby? Madam, baby?”
What he tried to convey was clear enough; there was no mistaking it. But it would have been difficult for Hema to believe it in any language.
CHAPTER 7
Fetor Terribilis
THE DOORS TO THE OPERATING THEATER burst open. The probationer shrieked. Matron clutched her chest at the sight of the sari-clad woman standing there, hands on her hips, bosom heaving, nostrils flaring.
They froze. How were they to know if this was their very own Hema, or an apparition? It seemed taller and fuller than Hema, and it had the bloodshot eyes of a dragon. Only when it opened its mouth and said, “What bloody nonsense is Gebrew talking? In God's name, what is going on?” did their doubts vanish.
“It's a miracle,” Matron said, referring to the fact of Hema's arrival, but this only further confused Hema. The probationer, her face flushed and her pockmarks shining like sunken nailheads, added, “Amen.”
Stone stood and unfurrowed his brows at the sight of Hema. Though he didn't say a word, his expression was that of a man who, having fallen into a crevasse, spotted the bowline lowered from the heavens.
Hema, recalling this event many years later, said to me, “My saliva turned to cement, son. A sweat broke out over my face and neck, even though it was freezing in there. You see, even before I digested the medi cal facts, I'd already registered that smell.”
“What smell?”
“You won't find it any textbooks, Marion, so don't bother looking. But it's etched here,” she said, tapping her head. “If I chose to write a textbook, not that I have any interest in that kind of thing, I'd have a chapter on nothing but obstetric odors.” The smell was both astringent and saccharine, these two contrary characteristics coming together in what she'd come to think of as fetor terribilis. “It always means a labor room catastrophe. Dead mothers, or dead babies, or homicidal husbands. Or all the above.”
She couldn't believe the amount of blood on the floor. The sight of instruments lying helter-skelter—on the patient, next to the patient, on the operating table—assaulted her senses. But most of all—and shed been resisting this—she couldn't accept the fact that Sister Mary Joseph Praise, sweet Sister, who should have been standing, gowned, masked, and scrubbed, a beacon of calm in this calamity instead lay all but lifeless on the table, her skin porcelain white and her lips drained of all color.
Hema's thoughts became dissociated, as if they were no longer hers but instead were elegant copperplate scrolling before her in a dream. Sister Mary Joseph Praise's left hand lying supine on the table drew Hema's eye. The fingers were curled, the index finger less so, as if she'd been pointing, when sleep or coma overcame her. It was a posture of repose that one rarely associated with Sister Mary Joseph Praise. Hema's eyes would be drawn to that hand repeatedly as the hour unfolded.
The sight of Thomas Stone brought her back to her senses and galvanized her. Seeing Stone in the hallowed place between a woman's legs that was reserved for the obstetrician rankled Hema. That was her spot, her domain. She shouldered him aside, and in his haste he knocked the stool over. He tried to explain what had happened: finding Sister, their discovery of her pregnancy and then her obstructed labor, the shock, the bleeding that never stopped—
“Ayoh, what is this?” she said, cutting him off, her eyes round with alarm, brows shooting up and her mouth a perfect O. She pointed at the bloody trephine and the open textbook resting by Sister Mary Joseph Praise's belly. “Books and whatnots?” She swiped them aside, and they clattered to the floor, the sound reverberating off the walls.
The probationer's heart hammered against her breast like a moth in a lamp. Not
knowing where to put her hands, she stuffed them in her pockets. She reassured herself that she had no part in the books and whatnots. Her failure (and she was beginning to see this) was a failure of Sound Nursing Sense; she'd missed the gravity of Sister Mary Joseph Praise's condition when she delivered Stone's message. She'd assumed that others would look in on Sister Mary Joseph Praise. No one had been aware that Sister Mary Joseph Praise was that ill, and no one had told Matron.
SISTER MARY JOSEPH PRAISE moved her head, and Matron believed that she was at least transiently aware that Matron held her hand. But so relentless was her pain that Sister couldn't acknowledge Matron's kindness.
In his hands I saw a large golden spear and at its iron tip there seemed to be a point of fire.
Matron's guess from the fragments she could understand was that Sister Mary Joseph Praise's mumbled words were perhaps the words of St. Teresa that they both knew so well.
I felt as if he plunged it into my heart several times, so that it penetrated all the way to my entrails. When he drew it out, he seemed to draw them out, and left me inflamed with a great love for God. The pain was so severe, it made me moan several times. The sweetness of this intense pain is so extreme, there is no wanting it to end, and the soul is not satisfied with anything less than God.
But unlike St. Teresa of Avila, Sister Mary Joseph Praise surely did want the pain to end, and just then, Matron said, the pain seemed to loosen its grip on her belly, and Sister sighed and clearly said, “I marvel, Lord, at your mercy. It is not something I deserve.”
A brief period of lucidity with roving eye movements followed, along with more attempts at speech, but it was unintelligible. Light splashed into the room, and Matron said it was as if a shroud that had formed in front of her face melted away. In that moment, as Sister Mary Joseph Praise looked around OT3—her operating theater for all these years— Matron thought the young nun realized that she was now the patient to be operated on and that the odds were against her.
“Perhaps she felt she deserved to die,” Matron said, guessing at my mother's thoughts. “If faith and grace were meant to balance the sinful nature of all humans, hers had been insufficient, and so what she felt was shame. Still she must have believed, even with all her imperfections, that God loved her and forgiveness awaited her in His abode, if not on earth.”
Matron wondered if it scared my mother that she might die in Africa, a continent away from her birthplace. Perhaps deep in her— perhaps deep in every being—there lingers a desire to bring the circle of life back to its starting point, which in her case was Cochin.
Then Matron heard my mother clearly whisper “Miserere mei, Deus” before sound left her. Matron carried her through the rest of the psalm in Latin, serving as her voice box while Sister Mary Joseph Praise's lips moved: “… Behold, I was shapen in iniquity; and in sin did my mother conceive me … Purge me with hyssop, and I shall be clean: wash me, and I shall be whiter than snow …”
When she finished, Matron said the shroud was back. The light was slipping away from her world.
“PICK UP THE STOOL, Stone,” Hema barked. “And you,” Hema said, snapping her fingers at the probationer, “get your hands out of your pockets.”
Stone set the stool upright just as Hemlatha eased down onto it. The key bunch Hema had fished out to open her house was now tucked into the waist of her sari, and it jingled as she settled herself. Under the theater lights the diamond in her nose sparkled. Strands of loose hair fell over her ears and in front of her eyes; through pursed lips she blew these wayward locks aside. She squared her shoulders, squared them to the horror and the unloveliness of what was before her. In that gesture she slipped off the mantle of the traveler and put on that of the obstetrician. The task ahead, however difficult, dangerous, or unpleasant, was hers and hers alone.
Hema felt herself gasping for air. Her lungs would need a week to acclimatize. Shed come from sea level in Madras to an operating room 8,202 feet above sea level, not counting the stool on which she sat. Her nostrils flared with each inhalation, like a thoroughbred after the quarter mile.
But her breathlessness came also from what was before her eyes. Gebrew hadn't lost his mind or imbibed too much talla; hed been telling the truth. The everyday miracle of conception had taken place in the one place it should not have: in Sister Mary Joseph Praise's womb. Yes, Sister Mary Joseph Praise was pregnant, had been for months before Hema left for India! And not just pregnant, but now in extremis. And the father?
Who else? She glanced at Stone's gray face.
But why not? she thought. Why should I be surprised? “The incidence of cancer of the cervix,” she remembered her professor saying, “is highest in prostitutes, and almost zero in nuns. Why almost zero and not zero? Because nuns are not born nuns! Because not all nuns were chaste before they became nuns! Because not all nuns are celibate!” That's neither here nor there, Hema admonished herself, while she thrust her hands into gloves that Matron produced.
The probationer recorded in the chart the arrival of Dr. Hemlatha. She chastised herself for not thinking of the gloves.
Hemlatha spread her own legs. Her feet were swollen from the long flight. She flexed her toes against the straps of her sandals and pawed the ground to get good purchase on the bloody floor. With the fingers of her left hand she spread the labia. Then, with a motion made simple by countless repetitions, her right hand pulled down on the posterior rim, opening the birth canal to view.
“Rama, Rama, this is a bloody Stone Age utensil,” Hemlatha shouted as she carefully disengaged first one half and then the other half of the skull crusher, slipping them over and then off the baby's ears. When the bloody instrument was free, she looked at it with distaste and flung it aside.
Matron felt relief. Whatever happened, at least now a real obstetrician was in charge. She couldn't help but note how Hemlatha and Stone had reversed roles: Hema was now the shouter and the flinger.
Matron offered the history that Sister Mary Joseph Praise had been in severe pain, great spasms of it, and then the pains had suddenly ceased and she'd seemed almost lucid, talking … but now she had deteriorated again.
“My God,” Hema said, knowing that in nature pains don't cease till a baby is out, “it sounds like a uterine rupture.” It would explain all the blood on the floor. Placenta previa—a placenta plastered over the exit to the womb—was another possibility. Neither possibility was good. “When did you stop hearing the fetal heart sounds?” No one replied.
“Pressure?”
“Sixty by palpation,” the nurse anesthetist said, after a pause, as if she expected someone else to volunteer the number that she was responsible for.
Hema peered around Sister Mary Joseph Praise's swollen belly to fix Nurse Asqual with a withering look. “Are you waiting for it to get to zero before you breathe for her? Put in a tracheal tube. Connect it to the hand bellows. If she wakes, give her some intravenous pethidine. Tell me when you're done. Where's Ghosh? Have you sent for him?” Nurse Asqual busied herself, grateful for step-by-step instruction because her mind had seized.
“And who has gone for blood? What! Nobody? Am I dealing with idiots here? Go! Run! Run!” Two people charged for the door. “Round up anyone and everyone to give blood. We need lots of blood!”
Hema insinuated two fingers of her right hand around the fetal skull. With her other hand she pushed down on Sister Mary Joseph Praise's belly. She peeked over the rise of the abdomen at Sister's face; it had gone gray, grayer than Stone's.
Nurse Asqual, her hands shaking, managed to insert the tracheal tube. With every squeeze of the air bag, Sister's engorged breasts heaved up.
Hema's hands were like extensions of her eyes as she explored the space that she thought of as the portal to her work; fingers inside took their soundings, helped by the hand on the outside. She closed her eyes, the better to receive what her fingertips conveyed about the pelvic width, the baby's position. “What have we here … ?” she said aloud. Indeed, the baby was h
ead down, but what was this? Another skull?
“Good God, Stone?” Hemlatha said, snatching her hand out as if she'd touched a hot coal.
Stone looked on, not understanding, but afraid to ask. She fixed her gaze on Stone, her face taut, waiting for a reply, any reply, and prepared to shout it down when it came.
“Better out than in?” Stone mumbled, thinking she meant his skull-crushing attempts.
“Damn it, Thomas Stone, don't quote me your idiot book. Do you think this is a joke?” Stone, who didn't at all see this as a joke, who in fact saw that everything Hema was doing was something he could have and should have done, turned crimson. Hema turned back to probe once more that calamitous space in Sister Mary Joseph Praise's body where two lives were in jeopardy. Her words were like body blows directed at Stone.
“One prenatal visit? Could you have let me see her for at least one prenatal visit? I'd have canceled my trip. Look at the soup we are in! Miracle, my foot. Completely avoidable … completely avoidable“ the last two words delivered like lashes.
Stone stood as if in front of the headmistress. Hema seemed to expect him to speak and so he stammered, “I didn't know!”
Hemlatha's jaw dropped. She stared at him. There was a part of her that was incredulous at the idea of Stone impregnating Sister Mary Joseph Praise—who could imagine that? But the cynicism of the obstetrician who has seen everything crept back in. “You're thinking virgin birth, Dr. Stone? Immaculate conception?” She came around the table. “In that case, guess what, Mr. Expedient Operator? This is better than the manger in Bethlehem. This virgin is having twins!” She paused to let it sink in. “For goodness’ sake, couldn't you have done a Cesarean section?” Her singsong intonation rose at the end, leaving the words “Cesarean section” hanging over Stone's head.