“I’ll be your silent advisor, nothing more. Here’s what you do, Mariamma. First, don’t waste your time asking the board anything. Aadariyumo angaadi vaanibham?” Does the goat understand the butcher’s trade? “Just make a list of medicines and supplies you need. I’ll send the order to T.N.T. Wholesale Medical in Kottayam in your name, with instructions to invoice the bishop. Second, your watchman, Raghavan, is a good fellow. I only got him that job. You give him a stack of blank paper. Have him ask every person he turns away from the gate to write something, even if it is one or two lines, and sign at the bottom with their address. If they can’t write, just sign. We’ll mail the letters to the Metropolitan. It won’t take more than ten or twenty letters before the bishop feels some pain. Lastly, I’m glad you told me about the plaque. I know where they will order it and I will find out how much it might cost. I’ll call the bishop’s secretary pretending to be a journalist. I’ll ask, ‘Is it true a child almost died of asthma because you couldn’t buy ten rupees’ worth of medicine, but you are spending twenty thousand rupees on a plaque?’ ”
“Master, in one minute you accomplish more than I could in a month,” Mariamma says. “We need you.”
“It’s nothing,” he says, but he’s pleased. “Do you know, I only coined the name ‘Mar Thoma Medical Mission Hospital’? It flows like honey off the tongue, does it not? But before the foundation was poured, people shortened it to ‘Yem-Yem-Yem Hospital.’ ” Mariamma thinks it understandable: “M” on the Malayali tongue can come out as “Yem.” And Malayalis love acronyms. “Then they began calling it ‘Triple Yem Hospital’! Can you imagine? So vulgar, Triple Yem! Like some ointment for piles!” She doesn’t admit to him that Triple Yem has caught on—she’s as guilty as all the others.
When he leaves, he says, “By the way, when the bishop questions you about the T.N.T. invoice, you just say that since he was ordering hair oil, Cuticura powder, and vitamins for himself and listing them as ‘essential supplies,’ you didn’t think he’d mind if you added a few essentials to save lives.”
With Uplift Master working behind the scenes, the part of Triple Yem she needs to function is taking shape, with electricians assembling equipment and the ground floor becoming furnished. One room at the front of the Triple Yem becomes Casualty. A large room at the back, with a waiting area outside, becomes the outpatient department. They have four hospital beds set up on a “ward” for emergencies alone. The operating theater is complete and has a state-of-the-art surgical light with so many bulbs it looks like an insect’s eye. But the selection of surgical instruments—all donated—is bizarre: everything one needs for cataract surgery and for dental work, but the bare minimum for abdominal surgery. Mariamma has a night nurse, a day nurse, and a compounder presiding over a small dispensary.
The one commodity that’s been abundant from the outset is patients.
When the outpatient department opens, entire families dressed in their finest come on excursions to Triple Yem, just as they might attend the Maramon Convention. One morning, a kochamma sits smiling and silent on the stool before Mariamma after waiting an hour in line. When asked why she’s come, she makes a twisting gesture with her wrist, “Oh, chuma!” Just like that! “Son and wife were coming, so I thought, What’s there? Why not I come too? Aah. Since I’m here, why not give me that orange injection?”
Mariamma is forced to inaugurate the operating room before she’s ready, performing an emergency caesarean section at midnight for a baby in distress. Her night nurse gets weak-kneed the moment they enter the theater and has to sit in a corner. Mariamma turns to Joppan (who is there because Raghavan has standing orders to fetch him anytime he summons the doctor after dark or risk his wrath). With minimal instruction, Joppan calmly and competently drops ether on the gauze mask. Mariamma, operating alone, hauls the baby out. Only when she hears its shrill cry does her tension vanish. The night nurse is at least capable of receiving the baby in her lap. Mariamma closes the uterus, then muscle and skin. Joppan’s awestruck expression has changed to a silly grin by the time she’s put in the last stitch. “You breathe more of that ether,” she says with mock severity, “and Ammini will think you were at the toddy shop.” He’s still euphoric as he escorts her back. “Molay, what you just did . . . I have no words for it. Imagine if Podi had stayed in school. Or if I had stayed. We were smart, but we weren’t smart enough to understand how important it was to study, were we?”
“Don’t say that. You’re what makes Parambil thrive. You put our relatives to shame. And Podi and her husband are making good money—”
He shakes his head. “Not the same thing. Anyway, I’m so proud of you, molay.”
She’s still glowing from his words when her head hits the pillow.
But every visit to the theater is nerve-racking; there’s no senior surgeon to turn to and no one competent to assist. One night, for a patient who was stabbed in the belly, she promotes Raghavan to ether-mask duties, and Joppan becomes her scrub nurse and assistant. From watching her, Joppan has already picked up the basics of sterility. Now she shows him how to scrub, then don gloves and gown and stand ready, across from her. The sight of the open belly doesn’t faze him. He hands her hemostat, forceps, scissors, and ligature when asked, and pulls on the retractor for her. He soon anticipates her needs. When they’re done, he’s elated. “Molay, whenever you need my help, please call me. In the daytime too. My assistants Yakov and Ousep can spare me for a few hours.”
She’d rather have Joppan’s help than anyone else’s. He’s quick to grasp her explanations of the physiology involved and how a disease has altered it. She’s found him studying her surgical manual while he waits for her, his lips moving as he deciphers the English words.
Six months in, the outpatient routine wears her down with its monotony. Most complaints are trivial—body aches, pains, coughs, colds—or else they’re chronic, like asthma, or the tropical leg ulcers that need to be dressed daily. The tedium is interrupted now and then by a medical or surgical emergency. Mariamma refuses to do elective surgery till she has an anesthetist and more nurses. The dream of a referral hospital with specialists is still far away, but with Uplift Master working behind the scenes and Mariamma as his amanuensis, there’s more momentum. His masterful touches are hard to hide. When the bishop (pressed by the Metropolitan) breaks down and begs Uplift Master to intercede to release equipment stuck in customs, Master is officially back in the fold.
After her years in Madras with its many diversions, Mariamma’s evenings and weekends at Parambil might have felt tedious if she didn’t have a project that kept her busy: she’s fleshing out every node and branch of the Water Tree. She especially wants to learn about the women who married and moved away and whose fate was never recorded. Her relatives—even sweet Dolly Kochamma—are reluctant to talk about the Condition or admit it exists. A breakthrough comes from an unexpected source.
Every afternoon, Cherian sends over a “special” tea and butter biscuits for “Doctor Madam” in the outpatient department. But he refuses payment. Early one morning, she watches him prop up the thatch awning with poles, unlock the wooden barrier, and systematically unbutton his stall for business. She walks over to thank him. Cherian insists she have a coffee. The arc of steaming liquid flies back and forth between his two mixing receptacles before it lands with a flourish in the glass that he hands to her. Her “thank you” makes him incredibly shy. She sips her coffee, and they stand awkwardly together, staring at Triple Yem as if it has just landed there and Martians might emerge. Big Ammachi once said to Mariamma, “You can confide in quiet people. They make way for one’s thoughts.” But Ammachi, when they don’t utter a word, how do you begin?
She’s leaving when Cherian says, “My sister drowned.” She stops and stares at him. Did he speak or is she hallucinating?
“Also, my grandfather’s brother. Drowned. My brother’s daughters both hate water.” What prompted Cherian to volunteer this? Is it common knowledge that the Parambil family has the Condition? “My poor sister had to work in the flooded paddy fields, she had no choice. When a bund broke, she was knocked off her feet and drowned in shallow water.”
“Cherian, you obviously know that our family has the same . . . condition. Do you think we are related?”