And because I love this life I know I shall love death as well. The child cries out when From the right breast the mother Takes it away, in the very next moment To find in the left one Its consolation.--Rabindranath Tagore, from Gitanjali PROLOGUE The Coming AFTER EIGHT MONTHS spent in the obscurity of our mother's womb, my brother, Shiva, and I came into the world in the late afternoon of the twentieth of September in the year of grace 1954. We took our first breaths at an elevation of eight thousand feet in the thin air of Addis Ababa, capital city of Ethiopia.The miracle of our birth took place in Missing Hospital's Operating Theater 3, the very room where our mother, Sister Mary Joseph Praise, spent most of her working hours, and in which she had been most fulfilled.When our mother, a nun of the Diocesan Carmelite Order of Madras, unexpectedly went into labor that September morning, the big rain in Ethiopia had ended, its rattle on the corrugated tin roofs of Missing ceasing abruptly like a chatterbox cut off in midsentence. Over night, in that hushed silence, the meskel flowers bloomed, turning the hillsides of Addis Ababa into gold. In the meadows around Missing the sedge won its battle over mud, and a brilliant carpet now swept right up to the paved threshold of the hospital, holding forth the promise of something more substantial than cricket, croquet, or shuttlecock.Missing sat on a verdant rise, the irregular cluster of whitewashed one- and two-story buildings looking as if they were pushed up from the ground in the same geologic rumble that created the Entoto Mountains. Troughlike flower beds, fed by the runoff from the roof gutters, surrounded the squat buildings like a moat. Matron Hirst's roses overtook the walls, the crimson blooms framing every window and reaching to the roof. So fertile was that loamy soil that Matron--Missing Hospital's wise and sensible leader--cautioned us against stepping into it barefoot lest we sprout new toes.Five trails flanked by shoulder-high bushes ran away from the main hospital buildings like spokes of a wheel, leading to five thatched-roof bungalows that were all but hidden by copse, by hedgerows, by wild eucalyptus and pine. It was Matron's intent that Missing resemble an arboretum, or a corner of Kensington Gardens (where, before she came to Africa, she used to walk as a young nun), or Eden before the Fall.Missing was really Mission Hospital, a word that on the Ethiopian tongue came out with a hiss so it sounded like "Missing." A clerk in the Ministry of Health who was a fresh high-school graduate had typed out THE MISSING HOSPITAL on the license, a phonetically correct spelling as far as he was concerned. A reporter for the Ethiopian Herald perpetuated this misspelling. When Matron Hirst had approached the clerk in the ministry to correct this, he pulled out his original typescript. "See for yourself, madam. Quod erat demonstrandum it is Missing," he said, as if hed proved Pythagoras s theorem, the sun's central position in the solar system, the roundness of the earth, and Missing's precise location at its imagined corner. And so Missing it was.NOT A CRY or a groan escaped from Sister Mary Joseph Praise while in the throes of her cataclysmic labor. But just beyond the swinging door in the room adjoining Operating Theater 3, the oversize autoclave (donated by the Lutheran church in Zurich) bellowed and wept for my mother while its scalding steam sterilized the surgical instruments and towels that would be used on her. After all, it was in the corner of the autoclave room, right next to that stainless-steel behemoth, that my mother kept a sanctuary for herself during the seven years she spent at Missing before our rude arrival. Her one-piece desk-and-chair, rescued from a defunct mission school, and bearing the gouged frustration of many a pupil, faced the wall. Her white cardigan, which I am told she often slipped over her shoulders when she was between operations, lay over the back of the chair.On the plaster above the desk my mother had tacked up a calendar print of Bernini's famous sculpture of St. Teresa of Avila. The figure of St. Teresa lies limp, as if in a faint, her lips parted in ecstasy, her eyes unfocused, lids half closed. On either side of her, a voyeuristic chorus peers down from the prie-dieux. With a faint smile and a body more muscular than befits his youthful face, a boy angel stands over the saintly, voluptuous sister. The fingertips of his left hand lift the edge of the cloth covering her bosom. In his right hand he holds an arrow as delicately as a violinist holds a bow.Why this picture? Why St. Teresa, Mother?As a little boy of four, I took myself away to this windowless room to study the image. Courage alone could not get me past that heavy door, but my sense that she was there, my obsession to know the nun who was my mother, gave me strength. I sat next to the autoclave which rumbled and hissed like a waking dragon, as if the hammering of my heart had roused the beast. Gradually, as I sat at my mother's desk, a peace would come over me, a sense of communion with her.I learned later that no one had dared remove her cardigan from where it sat draped on the chair. It was a sacred object. But for a four-year-old, everything is sacred and ordinary. I pulled that Cuticura-scented garment around my shoulders. I rimmed the dried-out inkpot with my nail, tracing a path her fingers had taken. Gazing up at the calendar print just as she must have while sitting there in that windowless room, I was transfixed by that image. Years later, I learned that St. Teresa's recurrent vision of the angel was called the transverberation, which the dictionary said was the soul "inflamed" by the love of God, and the heart "pierced" by divine love; the metaphors of her faith were also the metaphors of medicine. At four years of age, I didn't need words like "transverberation" to feel reverence for that image. Without photographs of her to go by, I couldn't help but imagine that the woman in the picture was my mother, threatened and about to be ravished by the spear-wielding boy-angel. "When are you coming, Mama?" I would ask, my small voice echoing off the cold tile. When are you coming?I would whisper my answer: "By God!" That was all I had to go by: Dr. Ghosh's declaration the time I'd first wandered in there and he'd come looking for me and had stared at the picture of St. Teresa over my shoulders; he lifted me in his strong arms and said in that voice of his that was every bit a match for the autoclave: "She is CUM-MING, by God!"FORTY-SIX AND FOUR YEARS have passed since my birth, and miraculously I have the opportunity to return to that room. I find I am too large for that chair now, and the cardigan sits atop my shoulders like the lace amice of a priest. But chair, cardigan, and calendar print of transverberation are still there. I, Marion Stone, have changed, but little else has. Being in that unaltered room propels a thumbing back through time and memory. The unfading print of Bernini's statue of St. Teresa (now framed and under glass to preserve what my mother tacked up) seems to demand this. I am forced to render some order to the events of my life, to say it began here, and then because of this, that happened, and this is how the end connects to the beginning, and so here I am.WE COME UNBIDDEN into this life, and if we are lucky we find a purpose beyond starvation, misery, and early death which, lest we forget, is the common lot. I grew up and I found my purpose and it was to become a physician. My intent wasn't to save the world as much as to heal myself. Few doctors will admit this, certainly not young ones, but subconsciously, in entering the profession, we must believe that ministering to others will heal our woundedness. And it can. But it can also deepen the wound.I chose the specialty of surgery because of Matron, that steady presence during my boyhood and adolescence. "What is the hardest thing you can possibly do?" she said when I went to her for advice on the darkest day of the first half of my life.I squirmed. How easily Matron probed the gap between ambition and expediency. "Why must I do what is hardest?""Because, Marion, you are an instrument of God. Don't leave the instrument sitting in its case, my son. Play! Leave no part of your instrument unexplored. Why settle for 'Three Blind Mice' when you can play the 'Gloria'?"How unfair of Matron to evoke that soaring chorale which always made me feel that I stood with every mortal creature looking up to the heavens in dumb wonder. She understood my unformed character."But, Matron, I can't dream of playing Bach, the 'Gloria' ...," I said under my breath. I'd never played a string or wind instrument. I couldn't read music."No, Marion," she said, her gaze soft, reaching for me, her gnarled hands rough on my cheeks. "No, not Bach's 'Gloria.' Yours! Your 'Gloria' lives within you. The greatest sin is not finding it, ignoring what God made possible in you."I was temperamentally better suited to a cognitive discipline, to an introspective field--internal medicine, or perhaps psychiatry. The sight of the operating theater made me sweat. The idea of holding a scalpel caused coils to form in my belly. (It still does.) Surgery was the most difficult thing I could imagine.And so I became a surgeon.Thirty years later, I am not known for speed, or daring, or technical genius. Call me steady, call me plodding; say I adopt the style and technique that suits the patient and the particular situation and I'll consider that high praise. I take heart from my fellow physicians who come to me when they themselves must suffer the knife. They know that Marion Stone will be as involved after the surgery as before and during. They know I have no use for surgical aphorisms such as "When in doubt, cut it out" or "Why wait when you can operate" other than for how reliably they reveal the shallowest intellects in our field. My father, for whose skills as a surgeon I have the deepest respect, says, "The operation with the best outcome is the one you decide not to do." Knowing when not to operate, knowing when I am in over my head, knowing when to call for the assistance of a surgeon of my father's caliber--that kind of talent, that kind of "brilliance," goes unheralded.On one occasion with a patient in grave peril, I begged my father to operate. He stood silent at the bedside, his fingers lingering on the patient's pulse long after he had registered the heart rate, as if he needed the touch of skin, the thready signal in the radial artery to catalyze his decision. In his taut expression I saw complete concentration. I imagined I could see the cogs turning in his head; I imagined I saw the shimmer of tears in his eyes. With utmost care he weighed one option against another. At last, he shook his head, and turned away.I followed. "Dr. Stone," I said, using his title though I longed to cry out, Father! "An operation is his only chance," I said. In my heart I knew the chance was infinitesimally small, and the first whiff of anesthesia might end it all. My father put his hand on my shoulder. He spoke to me gently, as if to a junior colleague rather than his son. "Marion, remember the Eleventh Commandment," he said. "Thou shall not operate on the day of a patient's death."I remember his words on full-moon nights in Addis Ababa when knives are flashing and rocks and bullets are flying, and when I feel as if I am standing in an abattoir and not in Operating Theater 3, my skin flecked with the grist and blood of strangers. I remember. But you don't always know the answers before you operate. One operates in the now. Later, the retrospectoscope, that handy tool of the wags and pundits, the conveners of the farce we call M&M--morbidity and mortality conference--will pronounce your decision right or wrong. Life, too, is like that. You live it forward, but understand it backward. It is only when you stop and look to the rear that you see the corpse caught under your wheel.Now, in my fiftieth year, I venerate the sight of the abdomen or chest laid open. I'm ashamed of our human capacity to hurt and maim one another, to desecrate the body. Yet it allows me to see the cabalistic harmony of heart peeking out behind lung, of liver and spleen consulting each other under the dome of the diaphragm--these things leave me speechless. My fingers "run the bowel" looking for holes that a blade or bullet might have created, coil after glistening coil, twenty-three feet of it compacted into such a small space. The gut that has slithered past my fingers like this in the African night would by now reach the Cape of Good Hope, and I have yet to see the serpent's head. But I do see the ordinary miracles under skin and rib and muscle, visions concealed from their owner. Is there a greater privilege on earth?At such moments I remember to thank my twin brother, Shiva-- Dr. Shiva Praise Stone--to seek him out, to find his reflection in the glass panel that separates the two operating theaters, and to nod my thanks because he allows me to be what I am today. A surgeon.According to Shiva, life is in the end about fixing holes. Shiva didn't speak in metaphors. Fixing holes is precisely what he did. Still, it's an apt metaphor for our profession. But there's another kind of hole, and that is the wound that divides family. Sometimes this wound occurs at the moment of birth, sometimes it happens later. We are all fixing what is broken. It is the task of a lifetime. We'll leave much unfinished for the next generation.Born in Africa, living in exile in America, then returning at last to Africa, I am proof that geography is destiny. Destiny has brought me back to the precise coordinates of my birth, to the very same operating theater where I was born. My gloved hands share the space above the table in Operating Theater 3 that my mother and father's hands once occupied.Some nights the crickets cry zaa-zee, zaa-zee, thousands of them drowning out the coughs and grunts of the hyenas in the hillsides. Suddenly, nature turns quiet. It is as if roll call is over and it is time now in the darkness to find your mate and retreat. In the ensuing vacuum of silence, I hear the high-pitched humming of the stars and I feel exultant, thankful for my insignificant place in the galaxy. It is at such times that I feel my indebtedness to Shiva.Twin brothers, we slept in the same bed till our teens, our heads touching, our legs and torsos angled away. We outgrew that intimacy, but I still long for it, for the proximity of his skull. When I wake to the gift of yet another sunrise, my first thought is to rouse him and say, I owe you the sight of morning.What I owe Shiva most is this: to tell the story. It is one my mother, Sister Mary Joseph Praise, did not reveal and my fearless father, Thomas Stone, ran from, and which I had to piece together. Only the telling can heal the rift that separates my brother and me. Yes, I have infinite faith in the craft of surgery, but no surgeon can heal the kind of wound that divides two brothers. Where silk and steel fail, story must succeed. To begin at the beginning ... PART ONE... for the secret of the care of the patient is in caring for the patient.Francis W. Peabody, October 21, 1925 CHAPTER 1 The Typhoid State Revisited SISTER MARY JOSEPH PRAISE had come to Missing Hospital from India, seven years before our birth. She and Sister Anjali were the first novitiates of the Carmelite Order of Madras to also go through the arduous nursing diploma course at the Government General Hospital, Madras. On graduation day my mother and Anjali received their nursing pins and that evening took their final vows of poverty celibacy, and obedience. Instead of answering to "Probationer" (in the hospital) and "Novitiate" (in the convent), they could now be addressed in both places as "Sister." Their aged and saintly abbess, Shessy Geevarughese, affectionately called Saintly Amma, had wasted no time in giving the two young nurse-nuns her blessing, and her surprising assignment: Africa. On the day they were to sail, all the novitiates rode from the convent in a caravan of cycle-rickshaws to the harbor to send off their two sisters. In my mind's eye I can see the novitiates lining the quay, chattering and trembling with excitement and emotion, their white habits flapping in the breeze, the seagulls hopping around their sandaled feet. I have so often wondered what went through my mother's mind as she and Sister Anjali, both just nineteen years old, took their last steps on Indian soil and boarded the Calangute. She would have heard stifled sobs and "God be with you" follow her up the gangway. Was she fearful? Did she have second thoughts? Once before, when she entered the convent, she'd torn herself away from her biological family in Cochin forever and moved to Madras, which was a day and a night's train ride from her home. As far as her parents were concerned, it might just as well have been halfway across the world, for they would never see her again. And now, after three years in Madras, she was tearing herself away from the family of her faith, this time to cross an ocean. Once again, there was no going back. A few years before sitting down to write this, I traveled to Madras in search of my mother's story. In the archived papers of the Carmelites, I found nothing of hers, but I did find Saintly Amma's diaries in which the abbess recorded the passing days. When the Calangute slipped its mooring, Saintly Amma raised her hand like a traffic policeman and, "using my sermon voice which I am told belies my age," intoned the words, "Leave your land for my sake," because Genesis was her favorite book. Saintly Amma had given this mission great thought: True, India had unfathomable needs. But that would never change and was no excuse; the two young nuns--her brightest and fairest--were to be the torch-bearers: Indians carrying Christ's love to darkest Africa--that was her grand ambition. In her papers, she reveals her thinking: Just as the English missionaries discovered when they came to India, there was no better way to carry Christ's love than through stupes and poultices, liniments and dressings, cleansing and comfort. What better ministry than the ministry of healing? Her two young nuns would cross the ocean, and then the Madras Discalced Carmelite Mission to Africa would begin. As the good abbess watched the two waving figures on the ship's rail recede to white dots, she felt a twinge of apprehension. What if by their blind obedience to her grand scheme they were being condemned to a horrible fate? "The English missionaries have the almighty Empire behind them ... but what of my girls?" She wrote that the seagulls' shrill quarreling and the splatter of bird excreta had marred the grand send-off she had envisioned. She was distracted by the overpowering scent of rotten fish, and rotted wood, and by the bare-chested stevedores whose betel-nut-stained mouths drooled bloody lechery at the sight of her brood of virgins. "Father, we consign our sisters to You for safekeeping," Saintly Amma said, putting it on His shoulders. She stopped waving, and her hands found shelter in her sleeves. "We beseech You for mercy and for Your protection in this outreach of the Discalced Carmelites ..." It was 1947, and the British were finally leaving India; the Quit India Movement had made the impossible come about. Saintly Amma slowly let the air out of her lungs. It was a new world, and bold action was called for, or so she believed. THE BLACK-AND-RED FLOATING PACKET of misery that called itself a ship steamed across the Indian Ocean toward its destination, Aden. In its hold the Calangute carried crate upon crate of spun cotton, rice, silk, Godrej lockers, Tata filing cabinets, as well as thirty-one Royal Enfield Bullet motorcycles, the engines wrapped in oilcloth. The ship wasn't meant to carry passengers, but the Greek captain did just that by housing "paying guests." There were many who would travel on a cargo ship to save on passage, and he was there to oblige by skimping on crew. So on this trip he carried two Madras nuns, three Cochin Jews, a Gujarati family, three suspicious-looking Malays, and a few Europeans, including two French sailors rejoining their ship in Aden. The Calangute had a vast expanse of deck--more land than one ever expected at sea. At one end, like a gnat on an elephant's backside, sat the three-story superstructure which housed the crew and passengers, the top floor of which was the bridge. My mother, Sister Mary Joseph Praise, was a Malayali from Cochin, in the state of Kerala. Malayali Christians traced their faith back to St. Thomas's arrival in India from Damascus in A.D. 52. "Doubting" Thomas built his first churches in Kerala well before St. Peter got to Rome. My mother was God-fearing and churchgoing; in high school she came under the influence of a charismatic Carmelite nun who worked with the poor. My mother's hometown is a city of five islands set like jewels on a ring, facing the Arabian Sea. Spice traders have sailed to Cochin for centuries for cardamom and cloves, including a certain Vasco de Gama in 1498. The Portuguese clawed out a colonial seat in Goa, torturing the Hindu population into Catholic converts. Catholic priests and nuns eventually reached Kerala, as if they didn't know that St. Thomas had brought Christ's uncorrupted vision to Kerala a thousand years before them. To her parents' chagrin, my mother became a Carmelite nun, abandoning the ancient Syrian Christian tradition of St. Thomas to embrace (in her parents' view) this Johnny-come-lately pope-worshipping sect. They couldn't have been more disappointed had she become a Muslim or a Hindu. It was a good thing her parents didn't know that she was also a nurse, which to them would mean that she soiled her hands like an untouchable. My mother grew up at the ocean's edge, in sight of the ancient Chinese fishing nets cantilevered from long bamboo poles and dangling over the water like giant cobwebs. The sea was the proverbial "breadbasket" of her people, provider of prawns and fish. But now on the deck of the Calangute, without the Cochin shore to frame her view, she did not recognize the breadbasket. She wondered if at its center the ocean had always been this way: smoking, malevolent, and restless. It tormented the Calangute, making it pitch and yaw and creak, wanting nothing more than to swallow it whole. She and Sister Anjali secluded themselves in their cabin, bolting the door against men and sea. Anjali's ejaculatory prayers startled my mother. The ritualized reading of the Gospel of Luke was Sister Anjali's idea; she said it would give wings to the soul and discipline to the body. The two nuns subjected each letter, each word, line, and phrase to dilata-tio, elevatio, and excessus--contemplation, elevation, and ecstasy. Richard of St. Victor's ancient monastic practice proved useful for an interminable ocean crossing. By the second night, after ten hours of such close and meditative reading, Sister Mary Joseph Praise suddenly felt print and page dissolve; the boundaries between God and self disintegrated. Reading had brought this: a joyous surrender of her body to the sacred, the eternal, and the infinite. At vespers on the sixth night (for they were determined to carry the routine of the convent with them no matter what) they finished a hymn, two psalms, and their antiphons, then the doxology, and were singing the Magnificat when a piercing, splintering sound brought them to earth. They grabbed life jackets and rushed out. They were met by the sight of a segment of the deck that had buckled and pushed up into a pyramid, almost, it seemed to Sister Mary Joseph Praise, as if the Calangute were made of corrugated cardboard. The captain kept his pipe lit and his smirk suggested his passengers had overreacted. On the ninth night, four of the sixteen passengers and one of the crew came down with a fever whose flesh signs were rose spots that appeared on the second febrile day and that arranged themselves like a Chinese puzzle on the chest and abdomen. Sister Anjali suffered grievously, her skin burning to the touch. By the second day of illness she was raging in feverish delirium. Among the Calangutes passengers was a young surgeon--a hawk -eyed Englishman who was leaving the Indian Medical Service for better pastures. He was tall and strong, and his rugged features made him look hungry, yet he avoided the dining room. Sister Mary Joseph Praise had run into him, literally, on the second day of the voyage when she lost her footing on the wet metal stairs leading up from their quarters to the common room. The Englishman coming up behind her seized her where he could, in the region of her coccyx and her left rib cage. He righted her as if she were a little child. When she stuttered her thanks, he turned beet red; he was more flustered than she by this unexpected intimacy. She felt a bruising coming on where his hands had clutched her, but there was a quality to this discomfort that she did not mind. For days thereafter, she didn't see the Englishman. Now, seeking medical help, Sister Mary Joseph Praise gathered her courage to knock on his cabin. A faint voice bid her to enter. A bilious, acetone odor greeted her. "It is me," she called out. "It is Sister Mary Joseph Praise." The doctor lay on his side in his bunk, his skin the same shade as his khaki shorts, his eyes screwed shut. "Doctor," she said, hesitating, "are you also with fever?" When he tried to look at her, his eyeballs rolled like marbles on a tilting plate. He turned and retched over a fire-bucket, missed it, which didn't matter, as the bucket was full to the brim. Sister Mary Joseph Praise rushed forward and felt his brow. It was cold and clammy, not at all feverish. His cheeks were hollowed, and his body looked as if it had shrunk to fit the tiny cabin. None of the passengers had been spared seasickness, but the Englishman's affliction was severe. "Doctor, I am wanting to report a fever that has affected five patients. It comes with rash, chills, and sweats, a slow pulse and loss of appetite. All are stable except for Sister Anjali. Doctor, I am most worried about Anjali ..." She felt better once it was off her chest, even though other than letting out a moan the Englishman made no response. Her eyes fell on a catgut ligature that was looped around a bed rail near his hands and that displayed knot thrown on top of knot, ten-score of them. The knots were so plentiful that the thread stood up like a gnarled flagpole. This was how he had logged the hours, or kept track of his bouts of emesis. She rinsed out the bucket and put it back within his reach. She mopped the mess on the floor with a towel, then she rinsed the towel out and hung it up to dry. She brought water to his side. She withdrew, wondering how many days it had been since he'd eaten anything. By evening he was worse. Sister Mary Joseph Praise brought sheets, towels, and broth. Kneeling, she tried to feed him, but the smell of food triggered dry heaves. His eyeballs had sunk into their orbits. His shriveled tongue looked like that of a parrot. She recognized the room's fruity odor as the scent of starvation. When she pinched up a skin fold at the back of his arm and let go, it stayed up like a tent, like the buckled deck. The bucket was half full of clear fluid. He babbled about green fields and was unaware of her presence. Could seasickness be fatal, she wondered. Or could he have a forme fruste of the fever that afflicted Sister Anjali? There was so much she did not know about medicine. In the middle of that ocean surrounded by the sick, she felt the weight of her ignorance. But she knew how to nurse. And she knew how to pray. So, praying, she eased off his shirt which was stiff with bile and spit, and she slid down his shorts. As she gave him a bed bath, she was self-conscious, for shed never ministered to a white man, or to a doctor for that matter. His skin displayed a wave of goose bumps at the touch of her cloth. But the skin was free of the rash shed seen on the four passengers and the one cabin boy who had come down with fever. The sinewy muscles of his arms bunched together fiercely at his shoulder. Only now did she notice that his left chest was smaller than his right; the hollow above his collarbone on the left could have held a half cup of water, while that on the right only a teaspoon. And just beyond and below his left nipple, extending into the armpit, she saw a deep depression. The skin over this crater was shiny and puckered. She touched there and gasped as her fingers fell in, not meeting bony resistance. Indeed, it appeared as if two or perhaps three adjacent ribs were missing. Within that depression his heart tapped firmly against her fingers with only a thin layer of hide intervening. When she pulled her fingers away, she could see the thrust of his ventricle against his skin. The fine, translucent coat of hair on his chest and abdomen looked as if it had drifted up from the mother lode of hair at his pubis. She dispassionately cleaned his uncircumcised member, then flopped it to one side and attended to the wrinkled and helpless-looking sac beneath. She washed his feet and cried while she did, thinking inevitably of her Sweet Lord and His last earthly night with His disciples. In his steamer trunks she found books dealing with surgery. He had penned names and dates in the margins, and only later did it occur to her that these were patients' names, both Indian and British, mementos to a disease hed first seen in a Peabody, or a Krishnan. A cross next to the name she took as a sign the patient had succumbed. She found eleven notebooks filled with an economical handwriting with slashing down-strokes, the text dancing just above the lines and obeying no margin save for the edge of the page. For an outwardly silent man, his writing reflected an unexpected volubility. Eventually she found a clean undershirt and shorts. What did it say when a man had fewer clothes than books? Turning him first this way and then that, she changed the sheets beneath him and then dressed him. She knew his name was Thomas Stone because it was inscribed inside the surgical textbook hed placed at his bedside. In the book she found little about fever with rash, and nothing about seasickness. That night Sister Mary Joseph Praise negotiated the heaving passageways, hurrying from one sickbed to the next. The mound where the deck had buckled resembled a shrouded figure and she averted her eyes. Once she saw a black mountain of a wave, several stories high, and the Calangute looked poised to fall into a hole. Sheets of water smashed over the bow, the noise more terrifying than the sight. In the middle of the tempestuous ocean, groggy from lack of sleep, facing a terrible medical crisis, her world had become simplified. It was divided into those with fever, those with seasickness, and those without. And it was possible that none of these distinctions mattered, for very soon they might all drown. She awoke from where she must have drifted off next to Anjali. In what seemed like the next instant she awoke again, but this time in the Englishman's cabin where she'd fallen asleep kneeling by his bed, her head lolling on his chest, his arm resting on her shoulder. In the time it took her to recognize this, she was asleep again, waking at daybreak finding herself on the bunk, but on its very edge, pressed against Thomas Stone. She hurried back to Anjali to find her worse, her respirations now sighing and rapid. There were large confluent purple patches showing on Anjali's skin. The anxious faces of the sleepless crew and the fact that one fellow had knelt before her and said "Sister, forgive my sins!" told her that the ship was still in danger. The crew ignored her pleas for help. Frantic and frustrated, Sister Mary Joseph Praise retrieved a hammock from the common room because of a vision she had in that fugue state between wakefulness and sleep. She strung it in his cabin between porthole and bedpost. Dr. Stone was a dead weight and only the intercession of St. Catherine allowed her to drag him from bunk to floor, then feed him, one body part at a time, onto the hammock. Answering more to gravity than to the roll of the ship, the hammock found the true horizontal. She knelt beside him and prayed, pouring her heart out to Jesus, completing the Magnificat which had been interrupted the night the deck had buckled. Color returned first to Stone's neck, then his cheeks. She fed him teaspoons of water. In an hour he held down broth. His eyes were open now, the light coming back into them, and the eyeballs tracking her every movement. Then, when she brought the spoon up, sturdy fingers encircled her wrist to guide the food to his mouth. She remembered the line shed sung moments before: "He hath filled the hungry with good things, and the rich He hath sent empty away." God had heard her prayers. A pale and unsteady Thomas Stone came with Sister Mary Joseph Praise to where Sister Anjali lay. He gasped at the sight of the wide-eyed and delirious nun, her face pinched and anxious, her nose sharp as a pen, the nostrils flaring with each breath, seemingly awake and yet completely oblivious to her visitors. He knelt over her, but Anjali's glassy gaze passed right through him. Sister Mary Joseph Praise watched the practiced way he pulled down Anjali's lids to examine her conjunctivae, and the way he swung the flashlight in front of her pupils. His movements were smooth and flowing as he bent Anjali's head toward her chest to check for neck stiffness, as he felt for lymph nodes, moved her limbs, and as he tapped her patel-lar tendon using his cocked finger in lieu of a reflex hammer. The awkwardness Sister Mary Joseph Praise had sensed in him when she had seen him as a passenger and then as a patient was gone. He stripped off Anjali's clothes, unaware of Sister Mary Joseph Praise's assistance as he dispassionately studied the patient's back, thighs, and buttocks. The long sculpted fingers that probed Anjali's belly for the spleen and liver seemed to have been created for this purpose-- she couldn't imagine them doing anything else. Not having his stethoscope, he applied his ear to Sister Anjali's heart, then her belly. Then he turned her to one side and pressed his ear against her ribs to listen to the lungs. He took stock, then muttered, "Breath sounds are diminished on the right ... parotids enlarged ... she has neck glands--why? ... Pulse is feeble and rapid--" "It was a slow pulse when the fever started," Sister Mary Joseph Praise offered. "So you mentioned," he said sharply. "How slow?" He didn't look up. "Forty-five to fifty, Doctor." She felt he had forgotten his illness, forgotten even that he was on a ship. He had become one with Sister Anjali's body, it was his text, and he sounded it for the enemy within. She felt such confidence in his being that her fear for Anjali vanished. Kneeling by his side, she was euphoric, as if she had only at that moment come of age as a nurse because this was the first time she had encountered a physician like him. She bit her tongue because she wanted so much to say all this and more to him. "Coma vigil," he said, and Sister Mary Joseph Praise assumed he was instructing her. "See how her eyes keep roving as if she's waiting for something? A grave sign. And look at the way she picks at the bedclothes--that's called carphology and those little muscle twitches are subsultus tendinum. This is the 'typhoid state.' You'll see it in the late stages of many kinds of blood poisoning, not just typhoid ... But mind you"--and he looked up at her with a little smile that belied what he said next--"I am a surgeon, not a medical man. What do I know of medical matters? Except to know that this is not a surgical illness." His presence had done more than reassure Sister Mary Joseph Praise; it calmed the seas. The sun, which had been hiding, was suddenly at their back. The crew's drunken celebration indicated how grave the situation had been just hours before. But though Sister Mary Joseph Praise did not want to believe this, there was little Stone could do for Sister Anjali, and in any case, nothing to do it with. The first-aid box in the galley held a desiccated cockroach-- its contents had been pawned by one of the crew at the last port. The medicine chest which the captain used as a seat in his cabin seemed to have been left over from the Dark Ages. A pair of scissors, a bone knife, and crude forceps were the only things of use within that ornate box. What was a surgeon like Stone to do with poultices, or tiny containers of wormwood, thyme, and sage? Stone laughed at the label of something called oleum philosophorum (and this was the first time Sister Mary Joseph Praise heard that happy sound even if in its dying echo there was something hard-edged). "Listen to this," he said, reading: " 'containing old tilestones and brickebats for chronic costiveness'!" That done, he heaved the box overboard. He'd removed only the dull instruments and an amber bottle of laudanum opiatum paracelsi. A spoonful of that ancient remedy seemed to ease Sister Anjali's terrible air hunger, to "disconnect her lungs from her brain," as Thomas Stone explained to Sister Mary Joseph Praise. The captain came by, sleepless, apoplectic, spraying saliva and brandy as he spoke: "How dare you dispose of shipboard property?" Stone leaped to his feet, and at that moment he reminded Sister Mary Joseph Praise of a schoolboy spoiling for a fight. Stone fixed the captain with a glare that made the man swallow and take a step back. "Tossing that box was better for mankind and worse for the fish. One more word out of you and I'll report you for taking on passengers without any medical supplies." "You got a bargain." "And you will make a killing," Stone said, pointing to Anjali. The captain's face lost its armature, the eyebrows, eyelids, nose, and lips all running together like a waterfall. Thomas Stone took charge now, setting up camp at Anjali's bedside, but venturing out to examine every person on board, whether they consented to such probing or not. He segregated those with fever from those without. He took copious notes; he drew a map of the Calangutes quarters, putting an X where every fever case had occurred. He insisted on smoke fumigation of all the cabins. The way he ordered the healthy crew and passengers around infuriated the sulking captain, but if Thomas Stone was aware of this he paid no attention. For the next twenty-four hours he didn't sleep, reexamining Sister Anjali at intervals, checking on the others: keeping vigil. An older couple was also quite ill. Sister Mary Joseph Praise never left his side. Two weeks after they left Cochin, the Calangute limped into the port of Aden. The Greek captain had the Madagascar seaman hoist the Portuguese flag under which the ship was registered, but because of the shipboard fever the Calangute was promptly quarantined, Portuguese flag or no Portuguese flag. She was anchored at a distance, where, like a banished leper, she could only gaze at the city. Stone bullied the Scottish harbormaster who had pulled up alongside, telling him that if he didn't bring a doctor's kit, bottles of lactated Ringer's solution for intravenous administration, as well as sulfa, then he, Thomas Stone, would hold him responsible for the death of all Commonwealth citizens on board. Sister Mary Joseph Praise marveled at his outspokenness, and yet he was speaking for her. It was as if Stone had replaced Anjali as her only ally and friend on this ill-fated voyage. When the supplies came, Stone went first to Sister Anjali. Making do with the crudest of antisepsis, with one scalpel stroke he exposed the greater saphenous vein where it ran just inside Sister Anjali's ankle. He threaded a needle into the collapsed vessel that should have been the width of a pencil. He secured the needle in place with ligatures, his hands a blur as he pushed one knot down over another. Despite the intravenous drip of Ringer's lactate and the sulfa, Anjali didn't make a drop of urine or show any signs of reviving. Later that evening, she died in a final dreadful paroxysm, as did two others, an old man and old woman, all within a few hours of one another. For Sister Mary Joseph Praise the deaths were stunning, and unforeseen. The euphoria she felt when Thomas Stone had risen and come to see Anjali had blinded her. She shivered uncontrollably. At twilight, Sister Mary Joseph Praise and Thomas Stone slipped the shrouded bodies over the rail, with no help from the superstitious crew who wouldn't even look their way. Sister Mary Joseph Praise was inconsolable, the brave front she'd put up shattering as her friend's body splashed into the water. Stone stood beside her, unsure of himself. His face was dark with anger and shame because he had not been able to save Sister Anjali. "How I envy her," Sister Mary Joseph Praise said at last through tears, her fatigue and sleeplessness combining to release custody of her tongue. "She's with our Lord. Surely that is a better place than this." Stone bit off a laugh. To him such a sentiment was a symptom of impending delirium. He took her by the arm and led her back to his room, lay her down on his bunk, and told her she was to rest, doctor's orders. He sat on the hammock and watched as life's only sure blessing--sleep--came to her, and then he hurried off to reexamine the crew and all passengers. Dr. Thomas Stone, surgeon, did not need sleep. TWO DAYS LATER, with no more new cases of fever, they were finally allowed off the Calangute. Thomas Stone sought out Sister Mary Joseph Praise before disembarking. He found her red-eyed in the cabin she'd shared with Sister Anjali. Her face and the rosary she clutched were wet. With a start he registered what he had failed to before: that she was extraordinarily beautiful, her eyes big and soulful and more expressive than eyes had a right to be. His face grew warm and his tongue wouldn't unstick itself from the floor of his mouth. He shifted his gaze to the floor, to her travel bag. When he finally spoke it was to say, "Typhus." He'd looked in his books and given the matter a great deal of thought. Seeing her puzzlement, he said, "Indubitably typhus." He had expected the word, the diagnosis, would make her feel better, but instead it seemed to fill her eyes with fresh tears. "Most likely typhus--of course a serum test could have confirmed it," he stammered. He shuffled his feet, crossed and uncrossed his hands. "I don't know where you're going, Sister, but I'm heading to Addis Ababa ... it's in Ethiopia," he said, mumbling into his chin. "To a hospital ... that would value your services if you were to come." He looked at her and blushed again, because the fact was he knew nothing about the hospital he was going to or whether it could use her services, and because he felt those moist dark eyes could read his every thought. But it was her own thoughts that kept Sister Mary Joseph Praise silent. She remembered how shed prayed for him and for Anjali, and how God had answered just one of her prayers. Stone, risen like Lazarus, then brought his entire being into understanding the fever. Hed barged into the crew's quarters, run roughshod over the captain, and bullied and threatened. Doing the wrong thing, as Sister Mary Joseph Praise saw it, but in pursuit of the right thing. His fierce passion had been a revelation to her. At the medical college hospital in Madras where she trained as a nurse, the civil surgeons (who at the time were mostly Englishmen) had floated around serene and removed from the patients, with the assistant civil surgeons and junior and senior house surgeons (who were all Indian) trailing behind like ducklings. At times it seemed to her they were so focused on disease that patients and suffering were incidental to their work. Thomas Stone was different. She felt his invitation to join him in Ethiopia hadn't been rehearsed. The words had slipped out before he'd been able to stop them. What was she to do? Saintly Amma had identified a Belgian nun who had broken away from her order, and who had made a most tenuous foothold in Yemen, in Aden, a foothold that was in jeopardy because of the nun's ill health. Saintly Amma's plan was for Sister Anjali and Sister Mary Joseph Praise to start there, perched above the African continent, and to learn everything they could from the Belgian nun about operating in hostile climates. From there, after correspondence with Amma, the sister-sisters would head south, not to the Congo (which the French and Belgians had covered), not to Kenya, Tanganyika, Uganda, or Nigeria (the Anglicans had their fingers all over those souls and disliked competition), but perhaps to Ghana or Cameroon. Sister Mary Joseph Praise wondered what Saintly Amma might say to Ethiopia. Saintly Amma's vision now felt like a pipe dream, a vicarious evange lism so ill informed that Sister Mary Joseph Praise was embarrassed to mention it to Thomas Stone. Instead she said in a breaking, hopeless voice, "I have orders to Aden, Doctor. But I thank you. Thank you for all you did for Sister Anjali." He protested that he'd done nothing. "You did more than any human being could do," she said and took his hand in both of hers and held it. She looked into his eyes. "God be with you and bless you." He could feel the rosary still entwined in her fingers, and the softness of her skin and the wetness from her tears. He recalled her hands on him, washing his body, dressing him, even holding his head when he retched. He had a memory of her face turned to the heavens, singing, praying for his recovery. His neck grew warm and he knew his color was betraying him a third time. Her eyes showed pain, and a cry escaped her lips, and only then did he know that he was squeezing her hands, grinding the rosary against her knuckles. He let go at once. His lips parted, but he didn't say anything. He abruptly walked away. Sister Mary Joseph Praise couldn't move. She saw that her hands were red and beginning to throb. The pain felt like a gift, a blessing so palpable that it rose up her forearms and into her chest. What she couldn't bear was the feeling that something vital had been plucked out and uprooted from her chest when he walked away. She'd wanted to cling to him, to cry out to him not to leave. She had thought her life in the service of the Lord was complete. There was, she saw now, a void in her life that she'd never known existed. THE MOMENT she stepped off the Calangute onto the soil of Yemen, Sister Mary Joseph Praise wished she'd never disembarked. How absurd it had been for her to have pined to come ashore all those days they'd been quarantined. Aden, Aden, Aden--she'd known nothing about it before this voyage, and even now it was no more than an exotic name. But from the sailors on the Calangute, she gathered that one could hardly go anywhere in the world without stopping in Aden. The port's strategic location had served the British military. Now its duty-free status made it the place to both shop and find one's next ship. Aden was gateway to Africa; from Africa it was gateway to Europe. To Sister Mary Joseph Praise it looked like the gateway to hell. The city was at once dead and yet in continuous motion, like a blanket of maggots animating a rotting corpse. She fled the main street and the stultifying heat for the shade of narrow alleyways. The buildings looked hewn from volcanic rock. Pushcarts loaded impossibly high with bananas, with bricks, with melons, and even one carrying two lepers weaved through the pedestrian traffic. A veiled, stooped old woman walked by with a smoldering charcoal stove on her head. No one glanced at this strange sight, saving their stares instead for the brown-skinned nun walking in their midst. Her uncovered face made her feel stark naked. After an hour during which she felt her skin puffing up like dough in an oven, after being directed this way and that, Sister Mary Joseph Praise arrived before a tiny door at the end of a slitlike passage. On the rock wall was a pale outline of a signboard recently removed. She offered a silent prayer, took a deep breath, and knocked. A man yelled in a hoarse voice, and Sister Mary Joseph Praise interpreted the sound as invitation to enter. Seated on the floor next to a shiny balancing scale, she saw a shirtless Arab. All around him, reaching to the ceiling, were great bales of bundled leaves. The hothouse scent stifled her breathing. It was a new scent for her, this scent of khat: partly cut grass, yet with something spicier behind it. The Arab's beard was so red with henna she thought hed bled into it. His eyes were lined like a woman's, reminding her of depictions of Salahuddin, who'd kept the Crusaders from taking the Holy Land. His gaze took in the young face imprisoned in the white wimple, and then those hooded eyes fell to the Gladstone bag in her hand. A heave of his body produced a vulgar laugh through gold-trimmed teeth, a laugh which he cut off when he saw the nun was about to collapse. He sat her down, sent for water and tea. Later, in a mixture of sign language and bastardized English, he communicated to her that the Belgian nun who'd lived there had died suddenly. When he said that, Sister Mary Joseph Praise began shivering again, and she felt a deep foreboding, as if she could hear death's footsteps rustling the leaves in that hothouse. She carried a picture of Sister Beatrice in her Bible, and she could see that face in her mind's eye, now metamorphosing into a death mask, and then to Anjali's face. She forced herself to meet the man's gaze, to challenge what he said. Of what? Who asks "of what" in Aden? One day you are well, your debts are paid, your wives are happy, praise Allah, and the next day the fever gets you, and if it opens your skin up to the heat which your skin has fought off all these years, you die. Of what? Of what doesn't matter. Of bad skin! Of pestilence! Of bad luck, if you like. Of good luck, even. The building was his. Green khat stalks flashed in his mouth as he spoke. The old nun's God had been unable to save her, he said, looking up to the ceiling and pointing, as if He were still crouching there. Sister Mary Joseph Praise's eyes involuntarily followed his gaze, before she caught herself. Meanwhile, his muddy eyes dropped from the ceiling to her face, to her lips, and to her bosom. IF I KNOW THIS MUCH about my mother's voyage, it's because it came from her lips to the ears of others and then to mine. But her tale stopped in Aden. It came to an abrupt halt in that hothouse. What is clear is that she embarked on her journey with faith that God approved of her mission and would provide for and protect her. But in Aden, something happened to her. No one knew what exactly. But it was there that she understood that her God was also a vengeful and harsh God and could be so even to His faithful. The Devil had shown himself in Sister Anjali's purple, contorted death mask, but God had allowed that. She considered Aden an evil city, where God used Satan to show her how fragile and fragmented the world was, how delicate the balance between evil and good, and how naive she was in her faith. Her father used to say, "If you want to make God laugh, tell him your plans." She felt pity for Saintly Amma, whose dream of enlightenment for Africa was vanity that cost Anjali's life. For the longest time all I knew was this: after an unknown period of time that could have been months or even a year, my mother, aged nineteen, somehow escaped Yemen, then crossed the Gulf of Aden, then went overland perhaps to the walled and ancient city of Harrar in Ethiopia, or perhaps to Djibouti, then from there by train she entered Ethiopia via Dire Dawa and then on to Addis Ababa. I know the story once she arrived at Missing Hospital. There were three spaced knocks on the door to Matron's office. "Come in," Matron said, and with those two words Missing was on a course different than anyone could have imagined. It was at the start of the short rains, when Addis was stunned into wet submission, and when after hours and days of the sound and sight of water, one began hearing and seeing things. Matron wondered if that explained this vision of a beautiful, brown-skinned nun, standing, but just barely, in the doorway. The young woman's recessed, unblinking brown eyes felt like warm hands on Matron's face. The pupils were dilated, as though, Matron would think later, the horror of the journey was still fresh. Her lower lip was ripe, as if it might burst at the touch. Her wimple, cinched at the chin, imprisoned her features in its oval, but no cloth could restrain the fervor in that face, or conceal the hurt and confusion. Her gray-brown habit must have once been white. But, as Matron's eyes traveled down the figure, she saw a fresh bloodstain where the legs came together. The apparition was painfully thin, swaying, but resolute, and it seemed a miracle that it was capable of speech, when it said in a voice heavy with fatigue and sadness: "I desire to begin the time of discernment, the time of listening to God as He speaks in and through the Community. I ask for your prayers that I may spend the rest of my life in His Eucharistic Presence and prepare my soul for the great day of union between bride and Bridegroom." Matron recognized the litany of a postulant entering the order, words she herself had uttered so many years ago. Matron replied automatically, just as her Mother Superior had done, "Enter into the joy of the Lord." It was only when the stranger slumped against the doorpost that Matron came out of her trance, running around her desk to grab her. Hunger? Exhaustion? Menstrual blood loss? What was this? Sister Mary Joseph Praise weighed nothing in Matron's arms. They took the stranger to a bed. Under the veil, the wimple, and habit they found a delicate wicker-basket chest and a scooped out belly. A girl! Not a woman. Yes, a girl whod only just bid good-bye to childhood. A girl with hair that was not cut short like that of most nuns but long and thick. A girl with (and how could they not notice?) a precocious bosom. Every maternal instinct in Matron came alive, and she kept vigil. She was there when the young nun woke up in the night, terrified, delirious, clinging to Matron once she knew she was in a safe place. "Child, child, what happened to you? It is all right. You are safe now." With such soothing words, Matron comforted her, but it was a week before the young nun slept alone and another week before the color returned to her face. When the short rains ended, and when the sun turned its face to the city as if to kiss and make up and say it was after all its favorite city for which it had reserved its most blessed, cloud-free light, Matron led Sister Mary Joseph Praise outdoors. She was to introduce her to the Missing People. The two of them entered Operating Theater 3 for the first time, and an astonished Matron watched as the stern and serious expression of her new surgeon, Thomas Stone, crumbled into something akin to happiness at the sight of Sister Mary Joseph Praise. He was blushing, taking her hand in his and crushing it till tears came to the young nun's eyes. My mother must have known then that she would stay in Addis Ababa forever, stay in Missing Hospital and in the presence of this surgeon. To work for him, for his patients, to be his skilled assistant, was sufficient ambition, and it was an ambition without hubris, and God willing, it was something she could reasonably do. A return journey to India through Aden was too difficult to contemplate. In the ensuing seven years that she lived and worked at Missing Hospital, Sister Mary Joseph Praise rarely spoke about her voyage and never about her time in Aden. "Whenever I brought up Aden," Matron said, "your mother would glance over her shoulder, as if Aden or whatever it was she left behind had caught up with her. The dread and terror on her face made me loath to ask again. But it scared me, I'll tell you. All she said was, 'It was God's will that I come here, Matron. His reasons are unknowable to us.' There was nothing disrespectful about that answer, mind you. She believed that her job was to make her life something beautiful for God. He had led her to Missing." Such a crucial gap in the history, especially that of a short life, calls attention to itself. A biographer, or a son, must dig deep. Perhaps she knew that the side effect of such a quest was that I'd learn medicine, or that I would find Thomas Stone. SISTER MARY JOSEPH PRAISE began the task of the rest of her days when she entered Operating Theater 3. She scrubbed and gloved and gowned and stood across the table from Dr. Stone as his first assistant, pulling on the small retractor when he needed exposure, cutting the suture when he presented the ends to her, and anticipating his need for irrigation or suction. A few weeks later, when the scrub nurse couldn't be there, my mother filled in as scrub nurse and first assistant. Who knew better than a first assistant when Stone wanted a scalpel for sharp dissection, or when gauze wrapped around his finger would do. It was as if she had a bicameral mind, allowing one half to be scrub nurse, shuttling instruments from the tray to his fingers, while the other side served as Stone's third arm, lifting up the liver, or holding aside the omentum, the fatty apron that protected the bowels, or with a fingertip pushing down edematous tissue just enough for Stone to see where his needle was to take a bite. Matron would peek in to watch. "Pure ballet, my dear Marion. A heavenly pair. Totally silent," Matron said. "No asking for instruments or saying 'Wipe,' 'Cut,' or 'Suction.' She and Stone ... You never saw anything quicker. I suspect that we slowed them down because we couldn't get people off and on the table quickly enough." For seven years Stone and Sister Mary Joseph Praise kept the same schedule. When he operated late into the night and into the morning, she was across from him, more constant than his own shadow, dutiful, competent, uncomplaining, and never absent. Until, that is, the day when my brother and I announced our presence in her womb and our unstoppable desire to trade the nourishment of the placenta for the succor of her breasts. CHAPTER 2 The Missing Finger THOMAS STONE HAD a reputation at Missing for being outwardly quiet but intense and even mysterious, though Dr. Ghosh, the hospital's internal medicine specialist and jack-of-all-trades, disputed that last label, saying, "When a man is a mystery to himself you can hardly call him mysterious." His associates had learned not to read too much into Stone's demeanor, which a stranger might think was surly when in fact he was painfully shy. Lost and clumsy outside it, inside Operating Theater 3 he was focused and fluid, as if it was only in the theater that body and soul came together, and where the activity within his head matched the terrain outside. As a surgeon, Stone was famous for his speed, his courage, his daring, his boldness, his inventiveness, the economy of his movements, and his calmness under duress. These were skills that he'd honed on a trusting and uncomplaining population, briefly in India, and then in Ethiopia. But when Sister Mary Joseph Praise, his assistant for seven years, went into labor, all these qualities vanished. On the day of our birth, Thomas Stone had been standing over a young boy whose belly he was about to open. He held his hand out, palm up, fingers extended to receive the scalpel in that timeless gesture that would forever be the measure of his days as a surgeon. But for the first time in seven years, steel had not slapped into his palm the instant his fingers opened; indeed, the diffident tap told him someone other than Sister Mary Joseph Praise stood across from him. "Impossible," he said when a contrite voice explained that Sister Mary Joseph Praise was indisposed. In the preceding seven years there hadn't been a time when he'd stood there without her. Her absence was as distracting and maddening as a bead of sweat about to fall into his eye when he was operating. Stone didn't look up as he made his keyhole incision. Skin. Fat. Fascia. Split the muscle. Then, using blunt dissection, he exposed the glistening peritoneum, which he incised. His finger slithered into the abdominal cavity through this portal and rooted for the appendix. Still, with each step, he had to wait for a fraction of a second, or wave off the proffered instrument in favor of another. He worried about Sister Mary Joseph Praise even if he was unaware that he was worrying, or unwilling to admit it. He summoned the probationer, a young, nervous Eritrean girl. He asked her to seek out Sister Mary Joseph Praise and remind her that doctors and nurses couldn't afford the luxury of being ill. "Ask her"-- the terrified probationer's lips were moving as she tried to by-heart his message--"kindly ask her, if ..." His eyes were free to look at the probationer, since his finger was now sounding the boy's insides better than any pair of eyes. "... if she recalls that I returned to the operating theater the very next day after performing a ray amputation on my own finger?" That event took place five years before and was an important milestone in Stone's life. His own curved needle on a holder had nicked the pulp of his right index finger while he worked in a pus-filled belly. He'd immediately stripped off his glove, and with a hypodermic needle, he had injected acriflavine, precisely one milliliter of a solution diluted 1: 500, down the tiny track the errant needle had traveled. Then he'd infiltrated the fluid into the surrounding tissue as well. The orange dye transformed the digit into an oversize lollipop. But despite these measures, in just hours a creeping red wave extended down from the fingertip and into the tendon sheath in the palm. Despite oral sulfatriad tablets and, later, at Ghosh's insistence, injection of precious penicillin into his buttocks, scarlet streaks (which were the hallmark of streptococcal infection) showed at his wrist, and the epitrochlear lymph node behind the elbow became as big as a golf ball. The rigors had made his teeth chatter and the bed shake. (This later became an aphorism in his famous textbook, a Stonism as readers called it: "If the teeth chatter it is a chill, but if the bed shakes it is a true rigor.") He had made a quick decision: to amputate his own finger before the infection spread farther, and to do the operation himself. The probationer waited for the rest of his message, while Stone drew the wormlike appendix out of the incision and straightened up like a fisherman who'd reeled his quarry onto the deck. The few bleeders Stone snapped off with hemostats, like a marksman firing at pop-up ducks, while also clamping off the blood vessels to the appendix. He tied these off with catgut, his hands a blur, until all the dangling hemostats were removed. Stone held up his right hand for the probationer's inspection. Five years after the amputation, the hand looked deceptively normal, though on closer study the index finger was missing. The key to this aesthetically pleasing result was that the metacarpal head--the knuckle of the missing finger--had been cut away, too, so that no stump was visible in the V between thumb and middle finger. It was as if the fingers had simply moved over one notch. Four-fingered custom gloves added to the illusion of normalcy. Far from being a disadvantage, his hand could negotiate crevices and tissue planes that others could not, and his middle finger had developed the dexterity of an index finger. That, together with the fact that his middle finger was longer than his former index finger, meant he could tease an appendix out from its hiding place behind a cecum (the beginning of the large bowel) better than any surgeon alive. He could secure a knot in the deepest recess of the liver bed with just his fingers, where other surgeons might resort to a needle holder. In later years, in Boston, he famously punctuated his admonishment to his interns of "Semper per rectum, per anum salutem, if you don't put your finger in it, you'll put your foot in it," by holding up the former middle finger, now elevated to the status of index finger. Those who trained with Stone never overlooked the rectal exam on their patient, not just because Stone had drilled into their heads that most colon cancers are in the rectum or sigmoid, many within reach of the examining finger, but also because they knew they'd be fired for this omission. Years later in America, a story circulated about one of Stone's trainees, a man named Blessing, who, after examining a drunk in the emergency room and taking care of whatever the problem was, returned to his call room. As he was about to sleep, he remembered that he hadn't done a rectal exam. Guilt and fear that his chief would somehow discover his lapse moved him to get up and go out into the night. Blessing tracked the patient down to a bar, where for the price of a beer the man agreed to drop his pants and be digitally examined--be "blessed" as the event came to be described--and only then was the young doctor's conscience eased. THE PROBATIONER IN Operating Theater 3 on the day of Sister Mary Joseph Praise's labor and our birth was a pretty--no, a beautiful-- young Eritrean girl. Sadly, her humorless intensity, the dedication she showed to her training, made people forget her youth and her looks. The probationer hurried off to find my mother, not pausing to question the propriety of the message she carried to Sister Mary Joseph Praise. Stone, of course, would never have imagined the message might be hurtful. As is so often the case with shy yet talented people, Stone was generally forgiven what Dr. Ghosh called his social retardation. The glaring gaps that in a bowel repair could have been fatal were overlooked when they occurred in such a personality; they weren't an impediment to him, only an irritation to others. At the time of our birth the probationer was not yet eighteen, with a tendency to confuse penmanship and keeping a neat medical record (and thereby pleasing Matron) with the actual care of patients. Being seniormost of the five probationers in Missing's nursing school had been a matter of pride for her, and most days she managed to push to the back of her mind the fact that her seniority was only because she was repeating her year, or, as Dr. Ghosh put it, because she was "on the long-term plan." Orphaned as a child by smallpox, which had also left a faint lunar landscape on her cheeks, the probationer had from a young age addressed her self-consciousness by becoming excessively studious, a trait encouraged by the Italian nuns, the Sisters of the Nigrizia (Africa), who raised her in the orphanage in Asmara. The young probationer displayed her studiousness as if it were not merely a virtue but a God-given gift, like a beauty spot or a supernumerary toe. What promise she'd shown in those early years, sailing through church school in Asmara, skipping grades, speaking fluent official Italian (as opposed to the bar-and-cinema version spoken by many Ethiopians, in which prepositions and pronouns were dispensed with altogether), and able to recite even her nineteen-times table. You could say the probationer's presence at Missing was an accident of history. Her hometown of Asmara was the capital city of Eritrea, a country which had been an Italian colony from as far back as 1885. The Italians under Mussolini invaded Ethiopia from Eritrea in 1935, with the world powers unwilling to intercede. When Mussolini threw his lot in with Hitler, his fate was sealed, and by 1941, Colonel Wingate's Gideon Force had defeated the Italians and liberated Ethiopia. The Allies gave Emperor Haile Selassie of Ethiopia a most unusual gift: they tacked on the very old Italian colony of Eritrea as a protectorate of newly liberated Ethiopia. The Emperor had lobbied hard for just this, so that his landlocked country could have the seaport of Massawa, not to mention the lovely city of Asmara. The British perhaps wanted to punish the Eritre-ans for their long collaboration with the Italians; Eritrean askaris, thousands of them, were part of the Italian army and had fought their black neighbors and died alongside their white masters. For the Eritreans to have their lands handed to Ethiopia was an unimaginable wound, akin to giving liberated France to England merely because the people of both countries were white and ate cabbage. When, a few years later, the Emperor annexed the land, the Eritreans at once began a guerrilla war for their liberation. But there were some advantages to Eritrea being part of Ethiopia: the probationer won a scholarship to the country's only nursing school in Addis Ababa, at Missing Hospital, the first young person from Eritrea to be so rewarded. The trajectory of her scholastic progress to that point was spectacular and unprecedented, a model for all youth; it was also an invitation to fate to stick a foot out and trip her. Yet it wasn't fate that stymied the probationer when she came to her clinical years, and it wasn't her clumsiness with the Amharic language, or with English, since she soon overcame these obstacles and became fluent. She discovered that memorization ("by-hearting," as Matron called it) was of no help to her at the bedside, where she struggled to distinguish the trivial from the life threatening. Oh yes, she could and did recite the names of the cranial nerves as a mantra to calm her own nerves. She could rattle off the composition of mistura carminativa (one gm of soda bicarb, two ml each of spirit of ammonia and tincture car damom, point six ml of tincture of ginger, one ml of spirit of chloroform, topped off with peppermint water to thirty ml) for dyspepsia. But what she couldn't do, and it annoyed her to see how effortlessly her fellow probationers could, was develop the one skill Matron said she lacked: Sound Nursing Sense. The only reference to this in her textbook was a statement so cryptic, more so after she memorized it, that she'd begun to think it was put there to antagonize her: Sound Nursing Sense is more important than knowledge, though knowledge only enhances it. Sound Nursing Sense is a quality that cannot be defined, yet is invaluable when present and noticeable when absent. To paraphrase Osler, a nurse with book knowledge but without Sound Nursing Sense is like a sailor at sea in a seaworthy vessel but without map, sextant, or compass. (Of course, the nurse without book knowledge has not gone to sea at all!) The probationer had at least gone to sea--she was sure of that. She was determined to prove that she did have map and compass, and so she would regard every assignment as a test of her skills, an opportunity to display Sound Nursing Sense (or to hide the lack of it). SHE RAN AS IFjinn were chasing her, through the sheltered walkway between the theater and the rest of the hospital. Patients and relatives of those being operated on that day were squatting or sitting cross-legged on either side of her path. A barefoot man, his wife, and two small children shared a meal, dipping fingers into a bowl lined with injera on which a lentil curry had been poured, while an infant, all but hidden by the mother's shama, suckled at the breast. The family turned in alarm as she ran by, and it made her feel important. Across the yard she could see women in white shamas and bright red and orange head scarves crowding the outpatient benches, looking at that distance like hens in a chicken coop. In the nurses' quarters she ran up the stairs to my mother's room. When she knocked there was no answer, but the door was unlocked. In the darkened room she saw Sister Mary Joseph Praise under the covers, her face turned toward the wall. "Sister?" she called softly, and when my mother moaned, the probationer took that to mean she was awake. "Dr. Stone sent me to tell you ..." She felt relieved to have remembered all the parts of the message. She waited for a response, and when my mother didn't volunteer one, the probationer imagined that my mother might be annoyed with her. "I only came because Dr. Stone sent me. I'm sorry to disturb you. I hope you feel better. Do you need anything?" She waited dutifully, and after a while, she eased out of the room. Since there was no return message for Dr. Stone, and since her pediatric nursing class was about to start, she did not return to Theater 3. IT WAS EARLY AFTERNOON by the time Stone went to the nurses' quarters. He had finished the appendectomy, then two gastro-jejunostomies for peptic ulcer, three hernia repairs, one hydrocele, a subtotal thyroid resection, and a skin graft, but by his standards it had been tortuously slow. An ordeal. With knitted brow he ascended the stairs. He understood that his swiftness as a surgeon depended to a large degree--more than hed ever imagined--on the skills of Sister Mary Joseph Praise ... Why did he have to think about these things? Where was she? That was the point. And when would she be back? There was no answer when he knocked. It was the corner room on the second floor. The compounder's wife came charging up to protest this trespass by a male. Though Matron and Sister Mary Joseph Praise were the only nuns at Missing, the compounder's wife acted as if she had been denied her true calling. With a sash low over her brow and a crucifix as big as a revolver, she looked like a nun. She considered herself a quasi warden of the nurses' hostel, the keeper of the Missing virgins. She had a spider's sense for a male footstep, an incursion into her territory. But now, seeing who it was, she backed away. Stone had never been inside Sister Mary Joseph Praise's room. When she typed or worked on the illustrations for his manuscripts, she came to his quarters or to his office adjoining the clinic. He turned the handle, calling out, "Sister? Sister!" He was met by a miasma at once familiar and alarming, but he couldn't place it. He groped for the switch and swore when it eluded him. He stumbled to the window, bumping into a chest of drawers. He swung the glass-paned portion of the window in, and then pushed back the wooden shutters. Daylight flooded the narrow room. On top of the chest of drawers was a heavy mason jar that drew the sun's rays. The amber fluid within reached all the way to the chunky lid which was sealed with wax. At first he thought the jar might hold a relic, an icon. A carpet of gooseflesh swept down his arms, as if recognition came to his body before it came to his brain. There, suspended in the fluid, the nail delicately pivoting on the glass bottom like a ballerina on tiptoe, was his finger. The skin below the nail was the texture of old parchment, while the underbelly displayed the purple discoloration of infection. He felt a longing, an emptiness, and an itch in his right palm which only that missing finger could relieve. "I didn't know--" he said turning to her bed, but what he saw made him forget what he was going to say. Sister Mary Joseph Praise lay in agony on her narrow cot. Her lips were blue. Her lusterless eyes were focused beyond his face. She was deathly pale. He reached for her pulse, which was rapid and feeble. An uninvited memory from the Calangute voyage of seven years before came flooding over him: he recalled the feverish and comatose Sister Anjali. A cold sensation spread from his belly to his chest. He was overcome by an emotion that as a surgeon he had rarely experienced: fear. His legs could no longer support him. He fell to his knees by her bed. "Mary?" he said. He could do nothing but repeat her name. From his lips, Sister Mary Joseph Praise's name sounded like an interrogation, then an endearment, then a confession of love spun out of one word. Mary? Mary, Mary! She did not, could not, answer. An old man's palsy overtook his hands as they reached for her face. He kissed her forehead. In that extraordinary and unstoppable act he realized, not without a twinge of pride, that he loved her, and that he, Thomas Stone, was not only capable of love, but that he had loved her for seven years. If he'd been blind to his love, perhaps it was because it had happened as soon as he met her on those slippery stairs, it had happened when she had nursed him, bathed him, tried to revive him on the Calangute. It had happened when she'd held him in her arms and wrestled and dragged his dead weight to a hammock and then spoon-fed life back into him. It had happened as they crouched over Sister Anjali's body. But love reached its apogee when Sister Mary Joseph Praise came to work alongside him in Ethiopia, and then it had never wavered. Love so strong, without ebb and flow or crests and troughs, indeed lacking any sort of motion so that it had become invisible to him these seven years, part of the order of things outside his head which he had taken for granted. Did Mary love him? Yes. Of this he felt certain. She had loved him, but following his cue--always following his cue--she'd said nothing. And what had he done all these years? Only taken her for granted. Mary, Mary, Mary. Even the sound of her name was a revelation to him since he'd never called her anything but Sister. He was sobbing, terrified of losing her, but that, too, he saw was his selfishness, his need for her manifesting itself again. Would he have the chance to make amends? How stupid could a man be? Sister Mary Joseph Praise barely registered his touch. Her cheek was hot against his. He lifted the sheet. A generous swelling of her belly met his eyes. It was an axiom of his that any swelling in a woman's abdomen was a pregnancy until proven otherwise. But his mind overrode that thought, refusing to consider it--this was a nun, after all. Instead he came to a snap diagnosis of bowel obstruction ... or free fluid in the peritoneal cavity ... or hemorrhagic pancreatitis ... some sort of abdominal catastrophe ... Maneuvering through the door frame, then trying not to bump her feet on the banister, his sobs changing to grunts of effort, he carried her out from her quarters, and then down the path to the operating theater. She felt heavier to Stone than she had a right to be. There was a question the chief examiner had posed to him when he appeared for the Royal College of Surgeons viva voce after passing his written examinations in Edinburgh: "What first-aid treatment in shock is administered by ear?" His answer "Words of comfort!" had won the day. But now, in place of reassuring and soothing words that would have been humane and therapeutic, Stone yelled for help at the top of his voice. His shouts, taken up by the keeper of the virgins, brought everyone including Gebrew the watchman, who came running from the front gate, along with Koochooloo and two other unnamed dogs at her heels. The sight of the blubbering, helpless Stone shocked Matron just as much as the sight of Sister Mary Joseph Praise's terrible state. Lord, he's done it again, was Matron's first thought. It was a well-kept secret that Stone had on three or four occasions since his arrival at Missing gone on a drunken binge. For a man who rarely drank, who loved his work, who found sleep a distraction, who had to be reminded to go to bed, these episodes were mystifying. They came with the suddenness of influenza and the terror of possession. The first patient on the morning list would be on the table, ready to be put under, but there'd be no sign of Stone. When they went looking for him the first time they found a babbling, disheveled white man, pacing in his quarters. During these episodes he did not sleep or eat, slipping out in the dead of night to replenish his supplies of rum. On the last occasion this creature had climbed the tree outside its window and perched there for hours, muttering like a cross hen. A fall from that height would have cracked its skull. Matron, when she had seen those bloodshot, mongoose eyes staring down at her, fled, leaving Sister Mary Joseph Praise and Ghosh to keep vigil and to try to talk him down, get him to eat, to stop drinking. As abruptly as it started, in two days, no more than three, the spell would be over, and after a very long sleep Stone would be back at work as if nothing had happened, never making any reference to how he'd inconvenienced the hospital, the memory of it erased. No one ever brought it up to him because the other Stone, the one who rarely drank, would have been hurt and insulted by such inquiry or accusation. The other Stone was as productive as three full-time surgeons, and so these episodes were a small price to pay Matron came closer. Stone's eyes were not bloodshot and he didn't reek of spirits. No, he was unhinged by Sister Mary Joseph Praise's condition, and rightly so. As Matron turned her attention from Stone to Sister Mary Joseph Praise, she nevertheless felt a ghost of satisfaction: at last the man had bared his soul, displayed his feelings for his assistant. Matron ignored Stone's ramblings about volvulus or ileus or pancreatitis or tuberculous peritonitis. "Let's go to the theater," she said, and when they were there, she said, "Lay her on the operating table." He set her down and Matron saw a sight she had seen seven years before: blood soaked Sister Mary Joseph Praise's dress in the region of her pubis. Matron's mind raced back to Sister Mary Joseph Praise's first arrival from Aden, and how blood on her habit then had caused similar concern. Matron had never asked the nineteen-year-old, point-blank, what caused the bleeding. The irregularity of the stain on that occasion had invited the observer to read meaning in its shape. Matron's imagination had constructed so many scenarios to explain that mystery. In the ensuing years, memory had changed the event from mysterious to mystical. Which was why Matron now glanced at Sister Mary Joseph Praise's palms and breast as Stone laid her down, as if she half expected to see bleeding stigmata, as if that first mystery had grown into this second mystery. But no, the only blood was at the vulva. Lots of blood. With dark clots. And bright red rivulets that ran down the thighs. Matron had no doubt, as blood dripped to the floor: this time it was secular bleeding. Matron seated herself between Sister Mary Joseph Praise's legs, willfully ignoring the stomach swelling that loomed in front of her. The labia were engorged and blue, and when Matron slid her gloved finger in, she found the cervix fully dilated. Of blood there was much too much. She swabbed and dabbed and pulled down on the posterior vaginal wall for a better view. When a piteous sigh emerged from her patient's lungs, Matron almost dropped the speculum. Matron's chest was pounding, her hands shaking. She leaned forward, tilted her head again to peer in. There, like a rock at the bottom of a mud pit, a stone of the heart, was a baby's head. "Lord, she's," Matron said, when she could finally speak, gasping at the sacrilegious word that threatened to choke her and which her mouth could no longer contain, "pregnant." Every observer I later talked to remembers this moment in Theater 3, when the air stood still, when the loud clock across from the table froze and a long, silent pause followed. "Impossible!" said Stone, for the second time that day, and even though it was incorrect and hardly the thing to say, it allowed them all to breathe again. But Matron knew she was right. She would have to deliver this baby. Dr. K. Hemlatha--Hema to all of them--was out of station. Matron had delivered hundreds of babies. She reminded herself of this now to try and keep herself from panic. But how was she to push away not just her qualms but her confusion? One of her own, a bride of Christ--pregnant! It was unthinkable. Her mind refused to digest this. And yet the evidence--an infant's skull-- was there, right before her eyes. The same thought distracted the scrub nurse, the barefoot orderly, and Sister Asqual, who was the nurse anesthetist. It caused them to trip over one another and knock down an intravenous drip as they scurried around the table, readying the patient. Only the probationer, who was mortified that she had failed that morning to recognize this crisis when she visited Sister Mary Joseph Praise, didn't stop to wonder how Sister Mary Joseph Praise got pregnant. Matron's heart felt as if it might gallop right out of her chest. "Lord, what worse circumstance can you construct for a delivery? A pregnancy that's a mortal sin. A mother-to-be who is like my own daughter. Massive bleeding, ghostly pallor ..." And all this when Hema, Missing's only gynecologist, not only the best in the country, but the best Matron had ever seen, was away. Bachelli up in the Piazza was marginally competent in obstetrics but unreliable after two in the afternoon, and his Eritrean mistress was deeply suspicious of him leaving on "house calls." Jean Tran, the half-French, half-Vietnamese fellow in Casa Popolare, did a bit of everything and smiled a lot. But assuming they could be reached, it would still be a while before either man would come. No, Matron had to do this herself. She had to forget the implications of the pregnancy. She had to breathe, concentrate. She had to conduct a normal delivery. But that afternoon and evening, normal would elude them. STONE STOOD BY, his mouth open, looking to Matron for direction, while Matron sat facing the vulva, waiting for the baby to descend. Stone alternately crossed his hands in front of him and then dropped them by his sides. He could see Sister Mary Joseph Praise's pallor increasing. And when Nurse Asqual in a panicked voice called out the blood pressure-- "systolic of eighty palpable"--Stone wobbled as if he might faint. Despite uterine contractions which Matron could feel through the belly and see in Sister Mary Joseph Praise's contorted face, and despite the fact that the cervix was wide open, nothing happened. A baby's head high up in the birth canal with the cervix flattened like a gasket around it always reminded Matron of the shaved scalp of a bishop. But this bishop was staying put. And meanwhile, such bleeding! A dark and messy pool had formed on the table and tidal eddies of blood came out of the vagina. Blood was to delivery rooms and operating theaters what feces were to tripe factories, but even so it seemed to Matron that this was a lot of blood coming out. "Dr. Stone," Matron said, her lips quivering. A bewildered Stone wondered why she was calling on him. "Dr. Stone," she said again. For Matron, Sound Nursing Sense meant a nurse knowing her limits. For God's sake, she needs a Cesarean section. But she didn't say those words because with Stone it could have the opposite effect. Instead, her voice low, her head drooping, Matron pushed down on her thighs to bring herself to her feet and to vacate her spot between Sister Mary Joseph Praise's legs. "Dr. Stone. Your patient," she said to the man who everyone believed to be my father, putting in his hands not only the life of a woman that he chose to love, but our two lives--mine and my brother's--which he chose to hate. CHAPTER 3 The Gate of Tears WHEN SISTER MARY JOSEPH PRAISE felt the herald cramps of labor, Dr. Kalpana Hemlatha, the woman I would come to call my mother, was five hundred miles away and ten thousand feet in the air. Off the starboard wing of the plane Hema had a beautiful view of Bab al-Mandab--the Gate of Tears--so named because of the innumerable ships that had wrecked in that narrow strait that separated Yemen and the rest of Arabia from Africa. At this latitude, Africa was just the Horn: Ethiopia, Djibouti, and Somalia. Hema traced the Gate of Tears as it widened from a hairline crack to become the Red Sea, spooling north to the horizon. As a schoolgirl studying geography in Madras, India, Hema had to mark where coal and wool were produced on a map of the British Isles. Africa figured in the curriculum as a playground for Portugal, Britain, and France, and a place for Livingstone to find the spectacular falls he named after Queen Victoria, and for Stanley to find Livingstone. In future years, as my brother, Shiva, and I made the journey with Hema, she would teach us the practical geography she had taught herself. She'd point down to the Red Sea and say, "Imagine that ribbon of water running up like a slit in a skirt, separating Saudi Arabia from Sudan, then farther up keeping Jordan away from Egypt. I think God meant to snap the Arabian Peninsula free of Africa. And why not? What do the people on this side have in common with the people on the other side?" At the very top of the slit a narrow isthmus, the Sinai, thwarted God's intention and kept Egypt and Israel connected. The man-made Suez Canal finished the cut and allowed the Red Sea to connect with the Mediterranean, saving ships the long journey around the Cape. Hema would always tell us that it was over the Gate of Tears that she had the awakening that would change her life. "I heard a call when I was in that plane. When I think back, I know it was you." That rattling, airborne tin can always seemed an improbable place for her epiphany. HEMA SAT ON THE WOODEN BENCH SEATS that ran lengthwise on both sides of the ribbed fuselage of the DC- 3. She was unaware of how badly her services were needed just then at Missing, the hospital where she had worked for the last eight years. The drone of the twin engines was so loud and unrelenting that half an hour into the flight she felt as if the sound inhabited her body. The hard bench and choppy ride were raising blisters on her behind. Whenever she closed her eyes, she felt as if she were being hauled across a rutted landscape in the back of a bullock cart. Her fellow travelers on this flight from Aden to Addis Ababa were Gujaratis, Malayalis, French, Armenians, Greeks, Yemenis, and a few others whose dress and speech did not as clearly reveal their origins. As for her, she wore a white cotton sari, a sleeveless off-white blouse, and a diamond in her left nostril. Her hair was parted in the middle and gathered with a clip at the back, and loosely braided below. She sat sideways looking out. She saw a gray dart below--the shadow cast by the plane on the ocean. A giant fish she imagined was swimming just below the surface of the sea, keeping pace with her. The water looked cool and inviting, unlike the interior of the DC-3, which had grown less steamy but was still thick with the mingled scents of the human freight. The Arabs had the dry, musty smell of a grain cellar; the Asians contributed the ginger and garlic; and from the whites came the odor of a milk-soaked bib. Through the half-open curtain to the cockpit she could see the pilot's profile. Whenever he turned to glance at his cargo, his bottle-green sunglasses seemed to swallow his face, only his nose poking through. The glasses had been perched up on his forehead when she boarded, and Hema had noted then that his eyes were red like a rodent's. The odor of juniper berry on his breath advertised his fondness for gin. She'd developed an aversion to him even before he opened his mouth to herd his passengers onto the plane, snapping at them--"Allez!"--as if they were subhuman. She bit her tongue then, because this was the man about to take them aloft. His face and jug ears resembled a figure a child might draw with crayon on butcher paper. But the details were beyond a child: the fine arbor of blood vessels on his cheeks; muttonchop sideburns dyed bootpolish black; the white ring of arcus senilis around his pupils; gray eyebrows that betrayed his pretense at youthfulness. She wondered how a man could look in the mirror and not see the absurdity of his own appearance. She studied her own reflection in the porthole. Hers was a round face, too, the eyes widely spaced with a doll's pert nose. The red pottu in the center of her forehead stood out. Her cheeks had a Martian tint cast on them by the cobalt-blue water below, and the hint of green in her eyes--unusual for an Indian--was accentuated. "Your gaze encompasses all men, makes your most ordinary glance seem intimate, carnal," Dr. Ghosh had told her, "as though you are ravishing me with your eyes!" Ghosh was a tease and forgot what he said as soon as the words rolled off his tongue. But this statement of his lingered with her. She thought of Ghosh's fur-covered limbs and shuddered. Body hair was one of her pet dislikes, or so she'd believed. She knew it was a fatal prejudice for an Indian woman. His was like a gorilla coat, the chest tendrils poking out through his vest and peeking up above his shirt collar. "Ravishing? You wish, you lecher," she said now, smiling as if Ghosh were sitting across from her. She had to give him this much: if she stared fractionally too long at a man, she attracted more attention than she intended. It was partly why she used spectacles with large wire frames, because she thought they made her eyes seem closer together. She liked the exaggerated Cupid's bow of her upper lip, but not her cheeks, which she felt were too chubby. What to do? She was a big woman. Not fat, but big ... Well, maybe a bit fat, and she'd certainly put on a kilo or two or three in India, but how could she help that in the face of a mother's astonishing cooking? Because of my height, I get away with it, she told herself. Wearing a sari helps, of course. She grunted, remembering how Dr. Ghosh had invented a special term for her: magnified. Years later, when Hindi movies with their song and dance became all the rage in Africa, the ward boys in Addis Ababa would call her Mother India, not in mockery, but in reverence for the tearjerker of the same name starring Nargis. Mother India had run for three straight months at the Empire Theater and then moved to the Cinema Adowa; that, too, without the benefit of subtitles. The ward boys could be heard singing "Duniya Mein Hum Aaye Hain"--"We've Arrived in This World"--though they didn't understand a word of Hindustani. "And if I'm magnified, what term shall we apply to you?" she said, carrying on the imaginary conversation, surveying her old friend from head to foot. He was not a conventionally good-looking man. "How about 'alien'? I mean it as a compliment. I say 'alien,' Ghosh, because you are so unaware of yourself, of your looks. There's a seduction in that for others. Alien becomes beauty. I'm saying this to you because you're not here. To be around someone whose self-confidence is more than what our first glance led us to expect is seductive." Mysteriously, during her holidays, Ghosh's name kept popping up in her conversations with her mother. Despite Hema's lack of interest in marriage, her mother was terrified that her daughter would end up with a non-Brahmin, someone like Ghosh. And yet as Hema neared thirty her mother had begun to feel that any husband was better than no husband at all. "You say he's not handsome? Does he have good color?" "Ma, he's fair ... fairer than me, and he has brown eyes. Bengali, Parsi, and God knows what other influences in those eyes." "What is he?" "He calls himself high-caste Madras mongrel," she said, giggling. Her mother's frown threatened to swallow her nose, and so Hema had changed the subject. Besides, it was impossible to construct a Ghosh for someone who'd never met him. She could say that his hair was combed flat and parted in the middle, looking sleek and smart for about ten minutes in the morning, but after that, the hairs broke loose like rioting children. She could say how at any time of the day, even after he had just shaved, black stubble showed under his jaw. She could say that his neck was nonexistent, squashed down by a head shaped like a jackfruit. She could say he just looked short because of a slight belly whose size was exaggerated in the way he leaned back and swayed from side to side as he walked, which drew the eye away from the vertical. Then there was his voice, unmodulated and startling, as if the volume knob had frozen on its highest setting. How could she convey to her mother that the sum total of all this made him not ugly, but strangely beautiful. Despite the rash on the backs of his hands--a burn, really--his fingers were sensual. The ancient X-ray machine, a Kelley-Koett, had caused the rash. Just thinking of the "Koot" made Hema's blood boil. In 1909, Emperor Menelik had imported an electric chair, having heard the invention would efficiently get rid of his enemies. When he discovered it needed electricity, he simply used it as a throne. Similarly, the big Kelley-Koett had come in the 1930s with an eager American mission group that soon realized that, even though electricity had arrived in Addis Ababa, it was intermittent and the voltage insufficient for such a temperamental beast. When the mission folded, the precious unpacked machine had been simply left behind. Missing lacked an X-ray machine, and so Ghosh reassembled the unit and matched it to a transformer. No one but Ghosh dared touch the Koot. Cables ran from its giant rectifier to the Coolidge tube, which sat on a rail and could be moved this way and that. He worked the dials and voltage levers until a spark leaped across the two brass conductors, producing a thunderclap. The fiery display had caused one paralyzed patient to leap off the stretcher and run for his life; Ghosh called that the Sturm und Drang cure. He was the Koot's keeper, repairing it, babying it so that three decades after the company went under, the Koot was still operational. Using the fluo-roscopy screen, he studied the dancing heart, or else he defined exactly where a cavity in the lung resided. By pushing on the belly he could establish whether a tumor was fixed to the bowel or abutted on the spleen. In the early years he hadn't bothered with the lead-lined gloves, or a lead apron for that matter. The skin of his probing, intelligent hands paid a visible price. HEMA TRIED TO IMAGINE Ghosh telling his family about her. She's twenty-nine. Yes, we were classmates at Madras Medical School, but she's a few years younger. I don't know why she never married. I didn't get to know her well till we were interns in the septic ward. She's an obstetrician. A Brahmin. Yes, from Madras. An expatriate, living and working in Ethiopia these eight years. Those were the labels that defined Hema, and yet they revealed little, explained nothing. The past recedes from a traveler, she thought. Sitting in the plane, Hema closed her eyes and pictured her schoolgirl self with the twin ponytails, the long white skirt, and white blouse under the purple half sari. All Mrs. Hood Secondary School girls in Mylapore had to wear that half sari, really nothing more than a rectangle of cloth to coil around the skirt once and pin on the shoulder. Shed hated it, because one was neither child nor adult but half woman. Her teachers wore full saris while the venerable headmistress, Mrs. Hood, wore a skirt. Hema's protests triggered a lecture by her father: Do you not know how fortunate you are to be in a school with a British headmistress? Doyou not know how many hundreds have tried to get in there, offered ten times the money, but were turned down by Miz-Iz-Ood. She goes by merit only. Would you prefer the Madras corporation school? And so, each day she put on the hated uniform, feeling half dressed, and feeling as if she were selling a piece of her...
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