PART II
9
ANIL SAT IN THE OFFICE OF THE RESIDENCY PROGRAM DIRECTOR, Casper O’Brien, studying the family photo on his desk: a tanned O’Brien with a sunny-haired wife and two adolescent boys on the beach, framed by palm trees—everything appeared perfect, even the rough-and-tumble way the two boys were holding each other, as if pausing from a friendly wrestling match to smile for the camera. On the shelves behind the desk, interspersed with the usual medical books and hospital-issued binders, sat a basketball on a stand, and a framed photo of O’Brien, hanging from the rim of a hoop. The kind of life suggested by these images—professional success, athleticism, the model family—was so unattainable, so distant from his own reality, Anil couldn’t take his eyes from them.
The door swung open and O’Brien strode over to his desk and sat down. “You left us in a very difficult position, Patel. Our patients count on us. We count on you. Do you understand the impact on this program when an intern leaves for two weeks without notice? December is our busiest time. Do you have any idea what your peers had to do to compensate for your absence?”
Anil shook his head, unwilling to risk speaking, knowing the words would not come out as he intended, if at all.
“I’m sorry about your father. We’d have given you a few bereavement days if you’d told us. But disappearing for two weeks and just leaving a voice mail.” O’Brien shook his head. “We couldn’t even reach you on your pager.” He leaned forward over his enormous desk. “Look, bad things happen in life, but we have to keep working through them. That’s the nature of the medical profession, and you’d better get used to it.” He rocked back in his brown leather chair, the springs squeaking with the movement. “I feel compelled to remind you, Anil, the internship year is a probationary period. It’s a time for us to figure out if you can make it in this residency program, in this profession. You should think about that too. Because from what I’ve seen so far”—he pointed vaguely at some papers on his desk, probably Anil’s monthly evaluations—“it’s not at all clear. You’ll have to prove it to me.”
ANIL RETURNED to work with a renewed sense of purpose. He did not want to go home, and he certainly didn’t want to go home a failure. He owed it to Papa to make good on their tacit agreement, now even more than before. Anil knew, even if no one else did, what Papa wanted most was for him to see this lifelong effort through, for Anil to fulfill his dream of becoming a doctor. With each day marked off on his Krishna calendar, and each passing week, Anil’s resolve hardened. He was the first one to rounds in the morning, followed up on every patient before the end of his shift, ran down each lab result and consult before collapsing in one of the empty call rooms at the hospital. Despite so little free time, grief was his constant companion, filling up the small pockets of his day with fond remembrances and sudden longings that caused an ache under his ribs.
He still joined Charlie at the diner a few evenings a week, but only to study. The meatloaf platter without meatloaf had lost its appeal, as had many other simple pleasures. One evening, Charlie ordered slices of pie for both of them. Anil enjoyed two bites of the tart-sweet berries before pushing his plate away. He jammed his hand into his pocket for the inhaler he’d been carrying around for weeks. It would have been such a small thing to box it up and ship it off to India the first time he’d heard Papa short of breath on the phone. It wouldn’t have prevented his fatal myocardial infarction, but it would have been something—something to make his father more comfortable, something to let him know his son was thinking of him across the oceans. Anil slid the hard plastic edge of the inhaler under his fingernail and pressed down on it until he felt pain, which brought him a satisfaction sweet berries in his mouth could not.
Charlie drummed his fingers on the newspaper sitting on the table. “Hey, did you hear about Miami? Twenty-eight cases of dengue fever this year. First cases reported in the US in over two hundred years. Isn’t that crazy?”
Anil craned his neck to see the article. Dengue, a mosquito-borne illness, was prevalent in India. He’d treated many patients with it in Ahmadabad, but not a single one in Dallas.
“They think it’s because of global warming that these tropical diseases are spreading to new geographies.” Charlie flipped the newspaper over. “Isn’t it fascinating—the way viruses move across the world, the constant race to find the right vaccine?”
“Maybe you should think about infectious disease as a specialty,” Anil said. “You can do a research project to feel it out.”
“Yeah, that’s not a bad idea,” Charlie said. “People are starting to form research teams. I wasn’t even going to think about it until second year, but apparently some of our eager classmates are already petitioning for sponsors at the hospital.”
“How about something with MRSA?” Anil suggested. Every hospital in America was concerned about the resistant strain of staph bacteria appearing in their facilities, creating publicity and legal troubles. “I read that several hospitals have been doing small-scale studies to reduce risk factors. Maybe you could collect them all and do a retrospective study. You could put together a list of proven steps hospitals could follow.”
“Yeah, I like it.” Charlie tapped the end of his pencil against the table. “And they’ll love it at Parkview. Free research that also solves a PR problem. What do you say, mate? Want to work on it together? We’d make a great team.”
Infectious disease wasn’t really Anil’s area of interest: it reminded him too much of India and he’d rather work on first-world medical problems. But Charlie looked so keen, and it would be fun to work together. “Sure, let’s do it,” Anil said.
ANIL’S PAGER buzzed against his hip, displaying a number he didn’t recognize. When he called from the nearest hospital phone, the ward nurse who answered told him Dr. Mehta wanted to see him. Anil took the elevator to the sixth floor and waited in the ward staff room, drumming his fingers against his knee.
“Patel,” Sonia said, entering the room. “You’re back. How was India?”
“Uh . . . it, uh, was okay.” Anil stumbled for words. How had the news traveled through the hospital ranks?
“Casper give you heat?” she asked.
“Uh, Dr. O’Brien? Yeah.”
“Well,” she said, pouring herself coffee, “for what it’s worth, I think you did the right thing.”
Anil cleared his throat and nodded. This whole conversation was putting him off balance.
“It can feel like Parkview’s the whole world, but it’s not, of course,” Sonia said. “I’m sure it took guts and O’Brien will make you pay for it, but you absolutely made the right call to go home.” She flashed him a brief smile.
“Uh . . . thanks,” Anil said. This couldn’t be why Sonia had paged him?
“Anyway, I wanted to let you know the department’s chosen Jason Calhoun’s case for the next M&M conference. You know what that means?”
It was a rhetorical question, since every intern knew and feared being called in front of the M&M. The morbidity and mortality conference, open to all physicians and residents, was intended to be a nonpunitive forum to review medical errors, with the goal of improving learning and patient care. Senior residents referred to it as the firing squad.
Sonia explained that she and Anil would present their case and be subjected to inquiry from their peers about the complications and errors that had led to the patient’s death. “We should probably get together once or twice to review the chart, make sure we have everything covered.” They agreed to meet up again toward the end of the week. Despite Sonia’s assurances that everything would be fine, Anil left the staff room with an anxious energy coursing through his body.
THE SHARED MANGO TREE
AFTER THIRTY-SIX HOURS STRAIGHT AT THE HOSPITAL, ANIL was relieved to find no one home when he returned, but the phone began ringing soon after he entered the apartment.
“Oh, Anil, thank God. I’ve been calling for half an hour,” Ma said when he answered. “We chose this time, no?
Are you ready, son? Everyone is gathered here, waiting for you.”
Anil sank onto his bed. Before leaving India, he’d agreed to hold an arbitration session by phone every month or so, to be scheduled on his days off and to last no more than an hour. He’d have preferred to hand off the role to someone else, but Papa’s death and his own disappointment had left him on the shores of the Ganges feeling he owed something to his father’s memory and his family. Now, after his reprimand from Casper O’Brien and the looming specter of Jason Calhoun, he didn’t have much confidence in his own judgment. “Ma, is it important or can it wait?” he said, summoning the triage skills that now defined his daily routine.
“Just talk to Manoj Uncle,” Ma whispered. “He and your cousin have been fighting over that mango tree on their property line. Manoj Uncle’s dog left his pile outside your cousin’s house, and he’s threatening to retaliate. You know your cousin has a temper. I’m worried he’ll do something violent.”
THE MANGO tree had been there for years, decades even, without causing any problems between the neighbors. Manoj Uncle, not technically an uncle but a family friend, had lived on the same plot of land for as long as Anil could remember. He and his brothers had played there, along with their cousins, who lived in the neighboring house. As boys, they would climb up to pick the unripe mangos, still green and hard as rocks, using them as balls in their cricket games. In the summer, when the golden fruit ripened on the tree, they shook the branches and enjoyed the spoils. They tore off the stems and squeezed the fruit pulp from the skin right into their mouths, competing to see who could consume the most. When they’d had their fill, the boys gathered up the remaining mangos from the ground and pelted them at each other until they were covered in sticky sweetness and flies began to swarm. They were wasteful, Anil was ashamed to remember, the way children can be with things they have in abundance. Only when something was precious did it become valuable. Mangos. Sleep. Approval.
The mango tree had grown mature in recent years and now produced two or three crates of fruit every week. Since its roots were on one property and its branches on the other, both parties claimed ownership, and tempers rose along with the price of mangos during the last drought. Anil listened to Manoj Uncle describe how his neighbor snuck outside early in the morning to collect the fruit and squirrel it away inside his home. “Like a thief, he creeps out there, I tell you—very careful not to make a sound. He knows he’s stealing from me.”
Anil’s cousin complained that Manoj Uncle had neglected the tree for years, never taking any responsibility for pruning or watering it, but now acted as if he were its sole and rightful owner. “I’m the one who groomed that tree, Anil,” his cousin said. “I nursed it back to health. Last month, I even removed a wasp nest from its branches, and got so many stings for my trouble. Why shouldn’t that fruit belong to me? Without me, that tree would still be small and weak, producing nothing.”
Anil’s eyelids threatened to close. He imagined the fragrance of the mangos, the tangy-sweet flesh smooth on his tongue. What he would give for one of those mangos now, just one small bit of pleasure. He rolled over and glanced at the clock radio, glaring at him with its red eyes, and mentally calculated the REM cycles left before the alarm would sound. Were they really fighting over a fruit tree?
“You both deserve praise for nurturing such a productive tree,” Anil said. “But two or three crates of mangos are too much for either of your families, no? They will spoil if either of you keeps them, and it would be a shame to waste such delicious fruit. So here is my advice: every morning you meet at the tree at ten o’clock to collect and divide the mangos equally. Manoj Uncle, as I remember correctly, Auntie makes wonderful kulfi, does she not? Cousin, perhaps you can have your mother make her spicy mango pickle, and the two of you can exchange your gifts.”
There was silence on the other end of the line, which Anil took for agreement. Then his mother came back on. “Thank you, son. I’ll handle the rest; we’ll do it another time. And, Anil?”
“Hmm?” he murmured as he turned off the light and pulled the covers over him.
“Please don’t forget your prayers.”
Anil had not uttered a word of prayer since Papa’s death. Ma would be disturbed to know how infrequently religion entered his thoughts. In the ICU, when he’d taken Mrs. Calhoun to see her husband’s body, draped with a white sheet, he’d stood to the side with the social worker as the new widow stepped tentatively toward the table and stroked her husband’s head. She kissed him gently on the forehead and smiled before her face crumpled and she fell onto his chest with a heart-piercing wail that Anil could hear echoing even after he left the room to pace the corridor outside. When he returned, a priest was holding a rosary and blessing the body. The wife’s expression was pained, her eyes searching every inch of her husband’s corpse for an explanation.
Anil was grateful for the presence of the priest and social worker to help shoulder the woman’s grief. But was God there in that cold room filled with metal machines and halogen lights? It seemed unlikely. Anil was used to the idea of a capricious God, a spiritual order in which death often came to the undeserving. He’d seen the destructive hand of Shiva in the earthquake devastation of Gujarat, and in the slow death of a disease-ridden body. It wasn’t that Anil thought God merciless for taking Calhoun at fifty-seven, leaving behind a widow and three fatherless children. He simply didn’t sense God’s presence there at all. The man had suffered a ruptured aneurysm because of Anil’s oversight. His death was caused by a catheter tip and human error. The whole concept of God had been irrelevant.
10
BEFORE SHE GOT MARRIED, LEENA’S MOTHER WARNED HER THE first year would be the hardest. Leena kept this in mind when her new life was not what she expected: the dilapidated house, the untended lands, the ceaseless toil. She worked hard in the hope that things would get better. Yet, no matter how quickly or carefully she worked, her sister-in-law and mother-in-law were always displeased. They always found some corner unswept or some shirt stain uncleaned. Even as Leena’s cooking improved and she overheard the men around the table complimenting her dishes, Rekha grew more spiteful.
Girish acknowledged her only when he wanted something; otherwise, it was as if she didn’t exist. If he didn’t like the way she folded his clothes or something she said, or if he had too much to drink, he pushed her up against the wall. Leena learned to tilt her chin down right before he did this, so the back of her head did not get slammed against the concrete. If he wanted to get her attention as she walked by, he grabbed her wrist so tightly she could see the impression of his fingers on her skin afterward.
At night, in bed, he did the same thing, clamping her hands above her head while he moved on top of her. His eyes were often closed but Leena kept hers open. She wanted him to know, when he opened his eyes, that she was still there, she was watching.
Leena couldn’t understand why he would want to be close to her if he despised her so. Perhaps it was like the way he oversweetened his chai, using too much sugar because he couldn’t tolerate the natural bitterness of the tea leaves. When he was finished with her, he turned away and told her to get out. Leena would go to the washroom and clean herself quietly with cold water. Only when she heard his snoring did she return to the bedroom. She was terrified of becoming pregnant and kept a careful count of her cycles, as her mother had taught her to do before the wedding, telling Girish it was her womanly time of the month when she needed to keep him away.
One evening, Leena was returning the clean, folded clothes to her in-laws’ bedroom when she noticed something had fallen underneath the cupboard. She bent down to pick it up: a white handkerchief embroidered with a beautiful peacock in tiny, even stitches she immediately recognized as her mother’s. It was dusty from the floor but held its perfect square creases. Leena clutched the kerchief and ran to find her husband. She was hungry for news of her parents. She had not seen them since the wedding and had had only a few short phone conversations under
the watchful eye of her mother-in-law.
She found Girish in the parlor, playing cards with his brothers and two other men. Normally, she would not have disturbed their game, knowing how easily he was angered, but this time she could not help herself. She rushed in, waving the handkerchief. “Where did this come from?” she asked. “Did you see her, my mother?”
The men’s laughter and conversation halted, and their eyes turned to Girish. Slowly, her husband looked up at her, his face darkening. He stared at her for a moment, jerked his head in the direction of the door, and turned back to his cards.
Leena stood there, wanting an answer. Wanting her mother. “Tell me,” she pleaded so softly she could barely hear her own voice.
Without glancing her way, Girish waved her out of the room. “Deal the cards,” he snapped at one of his friends.
Amid the noise of the men resuming their game, Leena backed out of the room and closed the door behind her. She returned to their cramped bedroom and crawled onto the bed, clutching the handkerchief to her face, breathing in the sandalwood scent that reminded her of her mother. She didn’t know what had happened, where or why or who had seen her parents, but she knew this: her mother had sent her love. Lying in the shelter of her bedroom, Leena could hear her brother-in-law in the next room yelling at Rekha—a string of names and meaningless insults she tried to block out. Leena slept in the same position all night long, and the next morning, she tucked the handkerchief into her sari blouse and carried it with her all day, pulling it out periodically to inhale its fragrance. It gave her the strength she needed as the situation in her husband’s house grew worse.
In the kitchen, Rekha swapped out the thin rolling pin for the thicker one and carried it with her at all times. If Leena didn’t work quickly enough, she snapped the rolling pin against her forearm or shoulder. Leena began to wear a sweater over her sari, even on the warmest days, to cover up the bruises on her arms and to protect herself.