Cutting for Stone (20 page)

“I don't think
I
knew I loved Melly until he was dying. I was so young. Easiest thing in the world is to love a dying man.”

“Did he love you?”

“He must have. You see he died trying to save me.” Her eyes welled up. “It was in
1935.
I'd just arrived in the country, and I couldn't have picked a worse time. The Emperor fled the city as the Italians were about to march in. The looters went to town, pillaging, raping. John Melly commandeered a truck from the British Legation to come and get me. You see, I was volunteering at what is now Missing. He stopped to help a wounded person on the street, and a looter shot him. For absolutely no reason.” She shuddered. “I nursed him for ten days, and then he died. One day I'll tell you all about it.” Then, uncontrollably, she had to sit down, her head in her hands, weeping. “I'm all right, Ghosh. Just give me a minute.”

She was mourning not Melly as much as the passage of the years. She'd come to Addis Ababa from England after getting restless teaching in a convent school and running the student infirmary; she'd accepted a post with Sudan Interior Mission to work in Harrar, Ethiopia. In Addis, she found her orders were canceled because the Italians had attacked, and so she had simply attached herself to a small hospital all but abandoned by the American Protestants. During that first year she'd watched as soldiers—some of the young men buried here—as well as Italian civilians poured in to populate the new colony: carpenters, masons, technicians. The peasant Florino became Don Florino when he crossed the Suez. The ambulance driver reinvented himself as a physician. She had carried on, just as the Indian shopkeepers, the Armenian merchants, the Greek hoteliers, the Levantine traders had carried on during the occu pation. Matron was still there in
1941,
when the Axis's fortunes turned in North Africa and in Europe. From the Hotel Bella Napoli's balcony, Matron watched Wingate and his British troops parade into town, escorting Emperor Haile Selassie, who was returning after six years of exile. Matron had never set eyes on the diminutive Emperor. The little man seemed astonished by the transformation of his capital, his head swiveling this way and that to take in the cinemas, hotels, shops, neon lights, multistory apartment buildings, paved avenues lined with trees … Matron said to the Reuters correspondent standing beside her that perhaps the Emperor wished he'd stayed in exile a little longer. To her chagrin, she was quoted verbatim (but fortunately as an “anonymous observer”) in every foreign paper. She smiled at that memory.

She rose, brushed away her tears. The two of them trudged on.

They walked down the path between one row of graves, then back up another.

“No,” Matron said abruptly. “This'll never do. I can't imagine leaving our cherished daughter in this place.”

Only when they broke out into the sunlight did Matron feel she could breathe.

“Ghosh, if you bury me in Gulele, I'll never forgive you,” she said. Ghosh decided silence was the best strategy. “We Christians believe that in the Lord's Second Coming the dead will be raised from the grave.”

Ghosh was raised a Christian, a fact that Matron never seemed to remember.

“Matron, do you sometimes doubt?”

She noticed that his voice was hoarse. His eyelids sagged. She was reminded again that this was not her grief alone.

“Doubt is a first cousin to faith, Ghosh. To have faith, you have to suspend your disbelief. Our beloved Sister believed … I worry that in a place as damp and disconsolate as Gulele, even Sister will find it hard to rise when the time comes.”

“What then? Cremation?”

One of the Indian barbers doubled as a
pujari
and arranged cremations for Hindus who died in Addis Ababa.

“Of course not!” She wondered if Ghosh was being willfully dense. “
Burial.
I think I might know just the place,” Matron said.

THEY PARKED AT
Ghosh's bungalow and walked to the rear of Missing, where the bottlebrush was so laden with flowers that it looked as if it had caught fire. The property edge was marked by the acacias, their flat tops forming a jagged line against the sky. Missing's far west corner was a promontory looking over a vast valley. That acreage as far as the eye could see belonged to a
ras
—a duke—who was a relative of His Majesty Haile Selassie.

A brook, hidden by boulders, burbled; sheep grazed under the eye of a boy who sat polishing his teeth with a twig, his staff near by. He squinted at Matron and Ghosh and then waved. Just as in the days of David, he carried a slingshot. It was a goatherd like him, centuries before, who had noticed how frisky his animals became after chewing a particular red berry. From that serendipitous discovery, the coffee habit and trade spread to Yemen, Amsterdam, the Caribbean, South America, and the world, but it had all begun in Ethiopia, in a field like this.

An unused bore well occupied this corner of Missing. Five years before, one of the Missing dogs had fallen into the well. Koochooloo's desperate yelps brought Gebrew. He fished her out by dangling a noose around her, almost lynching her in the process. The well needed to be sealed over. In supervising that task, Matron found used prophylactics and cigarette butts around the rock wall; she'd decided the area was in need of redemption. Coolies cleared the brush and planted native grass seedlings. In two months a beautiful green carpet surrounded the well. Gebrew tended to this lawn, squatting, crab walking, grabbing a fistful of grass with his left hand and sweeping under it with the sickle in his right hand.

It was Sister Mary Joseph Praise who identified the wild coffee bush by the well. But for Gebrew's regularly nipping the top buds, it would have grown out of reach. With a few old outpatient benches brought to this lawn it became a place where even Thomas Stone temporarily abandoned his cares. Cigarette in hand, mind adrift, hed smoke and watch while Sister Mary Joseph Praise and Matron fussed with their plants. But before too long he would grind his cigarette into the grass (a practice which Matron thought vulgar) and march off as if to some urgent summons.

Matron prayed silently.
Dear God, only You know what will become of Missing now. Two of ours are gone. A child is a miracle, and we have two of those. But for Mr. Harris and his people, it wont be that.
For them it would be shameful, scandalous, a reason to pull out. Missing had no income to speak of from patients. It relied on donations. Its modest expansion of the last few years came because of Harris and a few other donors. Matron had no rainy-day fund. It was against her conscience to hold back money when money allowed her to cure trachoma and to prevent blindness, or give penicillin and cure syphilis—the list was endless. What was she to do?

Matron studied the view in every direction. She wasn't registering what she saw because her thoughts were turned inward. But gradually, the valley, the scent of laurel, the vivid green colors, the gentle breeze, the way light fell on the far slope, the gash left by the stream, and above all this the sweep of sky with clouds pushed to one side—it had its effect on her. For the first time since Sister Mary Joseph Praise's death, Matron felt a sense of peace, a sense of certainty where there had been none. She was certain that this was the spot—this was where the long voyage of Sister Mary Joseph Praise would end. She remembered, too, how in her first days in Addis, when things had looked so bleak, so terrifying, so tragic with Melly's death—it was at those moments that God's grace came, and that God's plan was revealed, though it was revealed in His time. “I can't see it Lord, but I know You can,” she said.

CHAPTER 13
Praise in the Arms of Jesus

T
HE BAREFOOT COOLIES
were jovial men. Told by Ghosh what their task would be, they made clucking sounds of condolence. The big fellow with the prognathic jaw shed his fraying coat; his shorter companion pulled off his tattered sweater. They spat on their palms, hefted the pickaxes, and set to it;
happened-had-happened
and
be-will-be
as far as they were concerned, and though it was a grave they were digging, it guaranteed the night's bottle of
tej
or
talla
and perhaps a bed and a willing woman. Sweat oiled their shoulders and foreheads and dampened their patchwork shirts.

The sky had started off bluffing, convoys of gray clouds scurrying across like sheep to market. But by afternoon a perfect blue canopy stretched from horizon to horizon.

GHOSH, SUMMONED
to the casualty room by Matron, spotted a lean and very pale white man waiting by a pillar. Ghosh kept his head down, certain this was Eli Harris, and thankful that the man's back was to him.

Inside, Adam pointed to a curtain. Ghosh heard regular grunting, coming with each breath and in the rhythm of a locomotive. He found four Ethiopian men standing there, three in sports coats and one in a burly jacket. They were gathered around the stretcher, as if in prayer. All four had spit-shined brown shoes. As they squeezed out to make room for Ghosh, he glimpsed a burgundy holster under a coat.

“Doctor,” the man lying on the table said, offering his hand and trying to rise, but wincing with the effort. “Mebratu is my name. Thank you for seeing me.” He was in his thirties, his English excellent. A thin mustache arched over a strong mouth. Pain had given him a peaked expression, but it was nevertheless an extraordinary, handsome face, the broken nose adding to its character. He looked familiar, but Ghosh couldn't place him. Unlike his companions, he seemed stoic, not fearful, even though he was the one in pain.

“I tell you, I have never hurt like this.” He grinned from ear to ear as if to say, A man is going along when out of the blue comes a banana peel, a cosmic joke that leaves you upended and clutching your belly. A wave of pain made him wince.

I can't possibly see you today. Beloved Sister has died and any minute I expect someone to tell me they have found Dr. Thomas Stone's body. For God's sake go to the military hospital. That was what Ghosh wanted to say, but in the face of such suffering he waited.

Ghosh took the proffered hand and while supporting it he felt for the radial artery. The pulse was bounding at one hundred and twelve per minute. Ghosh's equivalent of perfect pitch was to be able to tell the heart rate without a watch.

“When did this start?” he heard himself say, taking in the swollen abdomen that was so incongruent on this lean, muscled man. “Begin at the beginning …”

“Yesterday morning. I was trying to … move my bowels.” The patient looked embarrassed. “And suddenly I had pain here.” He pointed to his lower abdomen.

“While you were still sitting on the toilet?”

“Squatting, yes. Within seconds I could feel swelling … and tightening. It came on like a bolt of lightning.”

The assonance caught Ghosh's ear. In his mind's eye he could see Sir Zachary Cope's little book,
The Diagnosis of the Acute Abdomen in Rhyme.
He'd found that treasure on the dusty shelf of a secondhand bookstore in Madras. The book was a revelation. Who knew that a medical text could be full of cartoon illustrations, be so playful, and yet provide serious instruction? Cope's lines regarding sudden blockage of the normal passage through the intestine came to him:

… rapid onset of distention
Will certainly attract your keen attention.

He asked the next question, even though he knew the answer. There were times like this when the diagnosis was written on the patient's forehead. Or else they gave it away in their first sentence. Or it was announced by an odor before one even saw the patient.

“Yesterday morning,” Mebratu replied. “Just before the pain began. Since then no stool, no gas, no nothing.”

Sometimes a bowel-coil gets out of place
By twisting round upon a narrow base …

“And how many enemas did you try?”

Mebratu let out a short sharp laugh. “You knew, huh? Two. But they did nothing.”

He wasn't just constipated but obstipated—not even gas could pass. The bowel was completely obstructed.

Outside the cubicle the men seemed to be arguing.

Mebratu's tongue was dry, brown, and furred. He was dehydrated, but not anemic. Ghosh exposed the grotesquely distended abdomen. The belly didn't push out when Mebratu took a breath. In fact it moved hardly at all. This is my work, Ghosh thought to himself as he pulled out his stethoscope. This is my grave-digging equivalent. Day in and day out. Bellies, chests, flesh.

In place of the normal gurgling bowel sounds, what he heard with his stethoscope was a cascade of high-pitched notes, like water dripping onto a zinc plate. In the background he heard the steady drum of the heartbeat. Astonishing how well fluid-filled loops of bowel transmitted heart sounds. It was an observation he'd never seen in a textbook.

“You have a volvulus,” Ghosh said, pulling his stethoscope off his ears. His voice came from a distance, and it didn't sound like it belonged to him. “A loop of the large bowel, the colon, twists on itself like this—” He used the tubing of his stethoscope to demonstrate first the formation of a loop, then the twist forming at the base. “It's common here. Ethiopians have long and mobile colons. That and something about the diet predisposes to volvulus, we think.”

Mebratu tried to reconcile his symptoms with Ghosh's explanation. His mouth turned up; he was laughing.

“You knew what I had as soon as I told you, right, Doctor? Before you did all these … other things.”

“I suppose I did.”

“So … will this twist untwist by itself?”

“No. It has to be untwisted. Surgically.”

“It's common, you say. My countrymen who get this … what happens to them?”

At that moment, Ghosh connected the face with a scene he wished he could forget.

“Without surgery? They die. You see, the blood supply at the base of the loop of bowel is also twisted off. It's doubly dangerous. There's no blood going in or out. The bowel will turn gangrenous.”

“Look, Doctor. This is a terrible time for this to happen.”

“Yes, it
is
a terrible time,” Ghosh burst out, startling Mebratu. “Why here, if I may ask? Why Missing? Why not the military hospital?”

“What else have you understood about me?”

“I know you're an officer.”

“Those clowns,” he said, nodding his chin in the direction of his friends outside. “We don't do a good job of dressing as civilians,” Mebratu said, wryly. “If their shoes aren't spit polished they feel naked.”

“It's more than that, actually. Years ago, shortly after I arrived here, I saw you conduct an execution. I'll never forget that.”

“Eight years and two months ago. July the fifth. I remember it, too. You were there?”

“Not intentionally.” A simple drive into the city had turned into something else when a large crowd on the road had forced him and Hema into being spectators.

“Please understand, it was the most painful order I ever carried out,” Mebratu said. “Those were my friends.”

“I sensed that,” Ghosh said, recalling the strange dignity of both the executioner and the condemned.

Another wave of pain traveled over Mebratu's face and they both waited till it passed.
“This
is a different kind of pain,” he said, trying to smile.

“You should know,” Ghosh said, “that earlier today the palace called. They asked Matron to inform them if a military person came here for treatment.”

“What?”
Mebratu swore and tried to sit up, but the movement made him yell in pain. His companions rushed in. “Did Matron tell the palace?” he managed to ask.

“No. Matron told me she wouldn't turn you away knowing that you had nowhere else to go.”

The patient relaxed now. His friends had a quick discussion, and then they remained in the room.

“Thank you. Thank Matron for me. I am Colonel Mebratu, of the Imperial Bodyguard. You see we had plans, a few of us, to meet on this date in Addis. I came from Gondar. When I got here I found the meeting had to be called off. We feared we were … compromised. But I didn't get the message till I was already here. Before I left Gondar, yesterday, my pain began. I saw a physician there. Like you, he must have known what I had, but he told me nothing. He told me to come back and see him in the morning and that he wanted to check me again. He must have told the palace, or else why would they call the hospitals in Addis? Hanging will also be my fate if I am discovered in Addis. You must treat me. I can't be seen at the military hospital today.”

“There is another problem,” Ghosh said. “Our surgeon has … he has left.”

“We heard about your … loss. I am sorry. If Dr. Stone can't do it, then you have to.”

“But I can't—”

“Doctor, I have no other options. If you don't do it, I die.”

One of the men stepped forward. With his light beard, he looked more like an academic than a military man. “What if your life depended on it? Could you do it?”

Colonel Mebratu put his hand on Ghosh's sleeve. “Forgive my brother,” he said, then smiled at Ghosh as if to say,
You see what I have to do to keep peace?
Out loud he said: “If something should happen, you can say in good faith that you knew nothing about me, Dr. Ghosh. It's true. All you know about me are all the things you guessed.”

GHOSH DIALED
Hema's quarters. It occurred to him that Colonel Mebratu and his men must have been plotting some kind of a coup. What else could the secret meeting in Addis have been about? Ghosh was faced with a conundrum: How did one treat a soldier, an executioner, who now was engaged in treason against the Emperor? But of course, as a physician, his obligation was to the patient. He felt no dislike for the Colonel, though he could do without the brother. It was difficult to dislike a man who bravely suffered physical pain and managed to retain his manners.

Over the hum of the receiver, Ghosh could hear the blood rushing into his ear with every heartbeat.

Hema's brusque “Hello” told him she was scowling. “It's me,” he said. “Do you know who I have here tonight?” He told her the story. She interrupted before he could finish: “Why are you telling me this?”

“Hema, did you hear what I just said? We have to operate. It's our duty.”

She wasn't impressed.

He added, “They're desperate. They have nowhere else to go. They have guns.”

“If they are so desperate, they can open the belly themselves. I am an obstetrician-gynecologist. Tell them I just had twins and I'm in no condition to operate.”

“Hema!” He was so mad that words would not come out. At least in the business of patient care, she was supposed to be on his side.

“Are you minimizing what I have on my hands?” she said. “What I've gone through just yesterday? You weren't there, Ghosh. So now these children's every breath is my responsibility.”

“Hema, I'm not saying …”

“
You
operate, man. You've assisted him with volvulus, haven't you? I've never operated on volvulus.” By “him” she meant Stone.

The silence was punctuated only by the sound of her breathing. Does she not care if I get shot? Why take this attitude with me? As if I'm the enemy. As if I caused the disaster she walked into when she returned. Did I invite the Colonel here?

“What if I have to resect and anastomose large bowel, Hema? Or do a colostomy? …”

“I'm postpartum. Indisposed. Out of station. Not here today!”

“Hema, we have an obligation, to the patient … the Hippocratic oath—”

She laughed, a bitter, cutting sound. “The Hippocratic oath is if you are sitting in London and drinking tea. No such oaths here in the jungle. I know my obligations. The patient is lucky to have you, that's all I can say. It's better than nothing.” She hung up.

GHOSH WAS
an internal medicine specialist through and through. Heart failure, pneumonia, bizarre neurological illness, strange fevers, rashes, unexplained symptoms—those were his métier. He could diagnose common surgical conditions, but he wasn't trained to fix them in the operating theater.

In Missing's better days, whenever Ghosh popped his head into the theater, Stone would have him scrub and assist. It allowed Sister Mary Joseph Praise to relax, and for Ghosh, being the first assistant to Stone was a fun change from his routine. Ghosh's presence transformed the cathedral hush of Theater
3
to a carnival racket, and somehow Stone didn't seem to mind. Ghosh asked questions left and right, cajoling Stone into talking, instructing, even reminiscing. At night, Ghosh sometimes assisted Hema when she did an emergency C-section. Rarely, Hema sent for him when she performed an extensive resection for an ovarian or uterine cancer.

But now he found himself alone, standing in Stone's place, on the patient's right, scalpel in hand. It was a spot he hadn't occupied for many years. The last time he stood on the right was during his internship when, as a reward for good service, they let him operate on a hydrocele while the staff surgeon stood across and took him through each step.

On his instruction the circulating nurse passed a rectal tube into the anus, guiding it up as high as it would go.

“We better start,” he said to the probationer who was scrubbed, gowned, and gloved on the other side of the table, ready to assist him. Her faint pockmarks were hidden by cap and gown. Even though her lids were puffy, she had beautiful eyes. “We can't finish if we don't start so we better start if we're to finish, yes?”

A very large incision should be made
—of small ones in such cases be afraid—
The coil brought out, untwisted by a turn
—a clockwise turn as you will quite soon learn—
And then a rectal tube is upward passed—
Thereon there issues forth a gaseous blast …