Cutting for Stone (45 page)

Fistulas have been described since antiquity. But it wasn't till
1849
in Montgomery, Alabama, that Dr. Marion Sims, my namesake, first succeeded in repairing a vaginal fistula. His first patients were Anarcha, Betsy, and Lucy, three slave women who had been cast out by their families and their owners because of this condition. Sims operated on them—willing subjects we are told—in an attempt to cure the fistula. Ether had just been discovered but wasn't in widespread use, so his patients were wide awake. Sims closed the gaping hole between bladder and vagina with silk and thought he had cured them. But a week later, he found pinhole openings along the line of his repair through which urine was leaking. He kept trying. He operated on Anarcha some thirty times. He learned from each failure, modified his technique until he ultimately got it right.

When Hema operated on the girl wed seen, she used the principles of repair established by Marion Sims. She first put a catheter through the urethra into the bladder to divert the urine away from the fistula to allow the wet, macerated tissues to dry and heal. A week later, Hema operated vaginally using the bent pewter spoon the Alabama surgeon had fashioned—the Sims speculum, we now call it—which allowed for good exposure and made vaginal surgery possible. She had to carefully dissect out the edges of the fistula, trying to find what had once been discrete layers of bladder lining, bladder wall, then vaginal wall and vaginal lining. Once she had trimmed the edges, she made her repair, layer by layer. Sims, after many failures, had a jeweler fashion a thin silver wire which he used to close the surgical wound. Silver elicited the least inflammatory reaction from the tissues, inflammation being the reason a repair would break down. Hema used chromic catgut.

At dinner, a month after Id learned of Ghosh's blood disorder, Hema shared with us that she and Shiva had operated on fifteen successive fistula patients with not one recurrence. “I owe this to Shiva,” she said. “He convinced me to take more time preparing the women for surgery. So now, we admit the patients and feed them eggs, meat, milk, and vitamins for two weeks. We treat with antibiotics till the urine is clear and use zinc oxide paste on their thighs and vulva. It was Shiva's idea to deworm them and correct iron deficiency anemia before surgery. We work on strengthening their legs, getting them moving.” She looked at Shiva with pride. “I am embarrassed to say, he's seen and understood their needs better than I have after all these years. Like the idea of physical therapy—”

“Can't get them to walk after surgery if they won't walk before,” Shiva said.

On four of their patients the hole into the bladder was so large, so scarred down and shrunk back, that it was impossible to pull the edges together. In these patients, Hema and Shiva had learned to expose a narrow but thick “steak” of flesh under the labia and, while keeping it connected at one end to its blood supply, tunnel its free end up and pull it into the vagina and use it as a live patch in the fistula.

“Matron has a donor who wants to support nothing but fistula surgery,” Shiva said. “We're getting one thousand American dollars every month.” I found it difficult to look at him, let alone congratulate him.

I STOPPED FRETTING
over Genet. When she failed two of the four courses the first year and had to repeat both semesters, I was too distracted by Ghosh's illness to care. She wasn't having a good time and living it up. Instead she'd lost her desire, lost sight of her target if she'd ever had one. All it took was one week of not studying, missing class, to get impossibly behind, so hectic was the pace of the first year of medical school.

Halfway through my second year, I learned that Genet had again missed a few anatomy lab sessions. I felt obliged to check on her.

At Mekane Yesus Hostel, the door to her room was open. Her visitor's back was to me; neither of them saw me at first. Genet shared the room with another girl who wasn't there. The tiny room which had once been so neat was now cluttered and messy. The room held a bunk bed and a small table for two. When he was alive, Genet acted as if Zemui annoyed her. Her brave and loyal father had died in a hail of bullets, and now she had his picture on the ceiling, inches from her face when she lay on the top bunk.

Her visitor's coarse features and his gruff manner made him stand out. I knew him as a student firebrand, organizing others for curricular reform, or collecting signatures to oust an unpopular warden. But he was Eritrean first, just like Genet. The liberation of Eritrea was almost certainly his most important cause, but it was the one he'd have to keep secret. He was speaking to Genet in Tigrinya, but I heard a few English words: “hegemony” and “proletariat.” He stopped in midsentence when he sensed me in the doorway. His bovine eyes gave me a look that said,
You will never be one of us.

I deliberately spoke to Genet in Amharic, so her guest would see that I spoke it better than he did. He muttered something to her in Tigrinya and stalked off.

“Who are these radical friends of yours, Genet?”

“What radicals? I'm just hanging around with Eritreans.”

“The secret police have informers on this floor,” I said. “They'll link you with the Eritrean People's Liberation Front.”

She shrugged. “Do you know the EPLF is making great gains, Marion? You can't know that. It's not in the
Ethiopian Herald.
But I doubt you're here to discuss politics?”

In the past I might have been wounded by her manner. “Hema says hello. And Ghosh says he wants to see you for dinner one of these evenings … Genet, I'm worried about your dissections. There is no one to do your labs for you this year. If you don't show, you'll fail, no matter what.
Come on,
Genet.”

Her face, so interested and animated when the other man was there, had now become sullen.

“Thank you,” she said icily.

I wanted badly to tell her that Ghosh was ill, to shake her out of her self-absorption. And yet I sat there feeling the witchcraft of her presence. It kept me coming after her and it made me tell myself I still loved her, no matter how she acted, even when our lives were so clearly drifting apart.

IN MY FINAL YEAR
of medical school, during my surgery rotations, Ghosh's volcano erupted. I came home to a look on Hema's face that told me she knew. I steeled myself for her tirade. She hugged me instead.

Ghosh had thrown up blood, and also developed a major nosebleed. He'd tried to conceal it but failed. He was resting comfortably in the bedroom. I peeked in on him, then came out and sat with Hema at the dining table. Almaz, red-eyed, brought me tea.

“I suppose I'm glad he didn't tell me,” Hema said. I could see from her swollen eyelids that she'd spent the afternoon crying. “Particularly when there's nothing to do for it. I've been able to enjoy the best of him. Such perfect days, without knowing any of this.” She fingered the diamond ring on her finger, a present that he'd given her the last time they renewed their yearly vows. “Had I known … maybe we could have taken a trip to America. I asked him about that. He said he preferred to be here. The first sight of me every morning is all he wants!
Ayoh,
he is such a romantic chap, even now. It's funny, but a few months ago, I actually felt that things were so good that something bad had to happen. The signs were all in front of me. But I wasn't paying attention.”

“Me, too,” I said.

I found Almaz weeping in the kitchen, and Gebrew, tears in his eyes, his tiny Bible in his hand, rocking and reciting verses to console her. When they saw me, Gebrew said, “We shall fast for him. Our prayers have been lacking.”

Almaz nodded, and though she let me hug her and try to reassure her, she was agitated. “We have not been prayerful,” she said. “That is why such a thing comes on us.”

I ASKED GEBREW
if hed seen Shiva, and he said Shiva had been gone all day, but if he was back, he might be in his workshop. Gebrew walked down with me to the toolshed.

“Are you still wearing your scroll?” Gebrew asked, referring to the thin strip of sheep's hide on which he'd drawn an eye, an eight-pointed star, a ring, and a queen and copied a verse in fine script. He had rolled the scroll tight and eased it into an empty bullet casing. On the metal he scratched out a cross and my name.

“Yes, it's always with me,” I said, which was sort of true because I carried this phylactery in my briefcase.

“I should have made one for Dr. Ghosh and perhaps this would not happen.”

I marveled at my faithful friend. To become a priest in Ethiopia, it was enough for the archbishop in Addis Ababa to blow his breath into a cloth bag which was then carried to the provinces and opened in a church yard, allowing for the mass ordination of hundreds. The more priests the merrier, from the standpoint of the Ethiopian Orthodox Church.

But having thousands and thousands of priests had its problems for God-fearing people like Almaz. A small number of these men were drunkards and cadgers for whom priesthood was a means of avoiding starvation while satisfying their other appetites. The worst reprobate priest who held out his cross obliged Almaz to stop and kiss its four points. I met her one day looking distressed, her clothes in disarray. She told me she'd beaten off a priest's advances with her umbrella, and others had come to her assistance and pummeled the man. “Marion, when I'm dying, go to the Merkato and get me
two
priests,” she said to me then. “That way, just like Christ, I can die with a thief on either side of me.”

But Gebrew was different. Almaz was sure God approved of Gebrew. He spent hours with his nose buried in his prayer books, leaning on his
makaturia—
his praying stick—beads clicking through his fingers. Even when he shed his priest garb to cut the grass, to run errands, to be Missing's watchman and gatekeeper, his turban stayed on and his lips never stopped moving. “Please make Ghosh a scroll,” I said to Gebrew. “Have faith. Maybe it is not too late.”

SHIVA HAD JUST COME BACK.
I hadn't been in that toolshed for ages, and I was unprepared for the extreme clutter. Parts of engines and electrical boxes covered the floor. The narrowest of paths led to where his tank and welding equipment stood along with scraps of metal. Shiva had shored up the walls and ceiling of the shed with a welded metal scaffold, and from this his tools hung on wire holsters. He was hidden at his desk behind a mountain of books and papers. I made my way there. He was sketching a design for a frame of some kind, an apparatus he said would allow better exposure during fistula surgery. He put his pencil down and waited. Hed known nothing about what had transpired in the bungalow earlier. I told him the truth about Ghosh.

He listened but said nothing. Though he turned a little pale, his face otherwise gave away very little. He closed his eyes. He had climbed into his tree house and pulled up the ladder. He had no questions. I waited. Not even this news could break down the walls between us, I saw.

I needed him. I had carried Ghosh's secret alone, and now I was ready to spread the burden. I needed his strength for the days that were to come, but I didn't want to admit it. What was Shiva thinking? Did he feel anything at all? I left after a while, disgusted that those eyes would not open, convinced I couldn't count on him.

But Shiva surprised me. That night and for two more nights Shiva slept in the corridor outside Ghosh and Hema's bedroom with just a blanket wrapped under and over him. It was his way of expressing his love for Ghosh, of staying close. Ghosh was moved to tears seeing Shiva curled up there the next morning. I felt something around my heart break down and shatter when Hema told me. On the fourth night, as Ghosh's condition worsened, I decided to leave Ghosh's old bungalow and return to the bed I used to share with Shiva. I convinced Shiva not to sleep on the floor in the corridor. We slept awkwardly, on the edges of the mattress, getting up several times in the night to check on Ghosh. By morning, our heads were touching.

SHIVA AND I HAD
the same blood group as Ghosh. With Adam's help, I'd been stockpiling my blood for this moment. Now, Shiva gave his. But blood was no longer sufficient, and it had caused a dangerous iron overload. Ghosh's platelets weren't working; he was oozing from his gums as well as losing blood in his bowel. He became progressively weaker.

Ghosh didn't want to move to the hospital. Soon the anemia left him short of breath, and he could no longer lie flat. We moved him from his marital bed of more than twenty years to his favorite armchair in the living room, his legs up on the footstool.

Quietly, systematically, he sought time with everyone he loved. He sent for Babu, Adid, Evangeline, and Mrs. Reddy and the other bridge players; I heard them laughing and reminiscing, though it wasn't all laughter. His cricket team surprised him when they arrived dressed in their whites to honor their captain. They regaled him with exaggerated stories of his past exploits.

Then it reached the point that he was breathing oxygen through a face mask that sat loosely over his chin. It was my turn to have
the
conversation with Ghosh. I'd been dreading the moment, resisting its implication.