1933, Madras
A large white woman bustles in, gnarled fingers pressing the surgical mask to her face, forgoing the ties in her haste. Gray hair shows at the edges of a surgical cap that sits askew. “Aa’m Matron Honorine Charlton. Just missed you on the ward.” She’s out of breath. “Oh dear, I see Claude’s thrust ya right into the fray. Goodness! He could’ve let you get your land legs, mind,” she says, in a thick, familiar accent that marks her at once as a Geordie.
He steps back from the table. “Matron, I . . .” Her blue eyes, framed in a nest of fine wrinkles, take it all in.
She comes around to his side, her voice a whisper. “Is everything all reet, then?”
“Yes, yes! Thank you . . . Well, no . . . I’m in a wee bind,” he whispers back. “I wish I’d examined the patient first. If I’d only had a chance to think about the operation, to review the steps . . . I’ve operated on hydroceles, but Matron, this—I hardly know where to begin.”
“Aye, of course!” she says soothingly. “Peter or Krishnan could have learnt you, but they’re both busy. I’ll tell you what—you divven’t need an assistant, but this being your first day, if you don’t mind, I’ll scrub in myself.”
He could kiss her, but she’s gone. Digby unclasps his hands and re-drapes the towels around the brown melon for want of anything to do. The scrub nurse nods approvingly. Digby’s not used to such deference from the staff. In Glasgow he was bullied by the scrub nurse and was fodder for the senior registrar or the consultant. It had nothing to do with religion, just medical hierarchy, although they weren’t above asking “What school d’ya go tae?” or fishing for his football loyalty with “Who d’ye follow?” He’s ashamed to realize that here in British India, he’s white and that puts him above anyone who is not. The nurse will do nothing to add to his embarrassment.
She asks politely, “Tenelevenfifteen, Doctor?”
“He says he’d like the eleven blade, thank you, Sister,” Matron Honorine says, appearing on the other side just in time to decipher the question, and now speaking in an accent worthy of the BBC.
Honorine grips the scrotum with both hands, as though placing a rugby ball on the goal line. “We have so much filarial infection in Madras. It clogs the lymphatics. The swollen legs—the elephantiasis—gets all the attention, but there’s fifty of these beauties for every big leg.” She squeezes to make the skin taut. “I’d make a longish vertical skin incision here first.” She points just to the right of the median raphe, the dark streak over the septum that divides the scrotum into two compartments.
The skin parts under his blade and blood wells up at the edges. Digby finds his rhythm as he ties off bleeders. His heart rate slows. Order is restored.
On her advice, he wraps gauze around his index finger and pushes the scrotal skin off the tense balloon, working all around until the fluid-filled sac is delivered fully from that half of the scrotum, a shiny, huge Fabergé egg.
“You can drain it now. I’ll get a basin,” she says, turning aside.
But Digby has already stabbed the balloon. A jet of clear yellow fluid hits him in the face before he can jerk his head away. Honorine grabs the scrotum and points the fountain to the basin. “Well, you’ve just been christened, you have there, pet,” she says, laughing. The orderly wipes his eyes for him.
Once the balloon is flaccid, Digby trims the redundant sac off the testes, leaving just a fringe, and then oversews the cut edge. “You could make a bonny bloose out of that,” Honorine says, holding up the shiny excised tissue.
He repeats the procedure on the other side of the scrotum and closes both skin incisions. “Most grateful, Matron. Don’t know what I’d have done without you.”
“Call us Honorine, pet,” she says. “You did famously. It’s the same operation as you did in Scotland, just that the pathology is magnified.”
That word captures Digby’s first impression of India. It’s a term he’ll use often when a familiar disease takes on grotesque proportions in the tropics: “magnified.”
Digby rides a bicycle to work each day because he can’t abide being pulled in a rickshaw when he is able-bodied. This morning, on the small street outside his bungalow he finds a carpet of yellow blossoms from the towering copper pod. He turns onto the dusty macadam thoroughfare and overtakes a dhobi with a huge laundry bundle on his bicycle rack. The banyan tree on Digby’s route is a hive of industry. Already the letter writer is busy, sitting cross-legged with a square of cardboard balanced on his thighs and serving as his desk, as he takes dictation from a woman. A hawker lays his plastic bangles on a sheet on the ground; the earwax remover waits for customers. On the other side of the tree, the saffron-robed fortune-teller fans his deck of cards, warming up for business, his birdcage beside him. Digby has seen previously how the parrot emerges to pick the card that reveals the customer’s destiny; then the bird cocks a wistful glance to the sky before returning to its cage.
Passing a tea stall, Digby notices a customer squinting to see past milky-white corneas. Digby takes in the prominent brow and the collapsed, saddle-shaped nose—the man has congenital syphilis, without a doubt. If Digby had anyone at home to write to, he might catalog these morning sights, describe the small-framed, handsome Tamils with their sharp Roman features, bright glittering eyes, and ready smiles. Next to them he feels pale, blotchy, and much too vulnerable to the sun.
Digby immerses himself in running the native surgical wards. His LMPs, Peter and Krishnan, are masters of the minor operations: hydroceles, circumcisions, amputations, urethral strictures, draining abscesses, removing lipomas and cysts. They pass on their skills to him quite generously. He emulates his LMPs in other ways, drinking gallons of water a day, along with a salt tablet or a salt lassi. The heat and humidity are constant. There is a short rainy season, so he’s told, though most years it hardly merits its name.
Before Digby arrived, native patients needing major surgery—thyroidectomies, mastectomies, surgery for duodenal ulcers, and head and neck tumor resections—were sent on to the Madras Medical College and General Hospital. Now, Digby takes on just a few major operations that he feels comfortable performing; of these, the operation to cure peptic ulcers is the most common. It’s pointless to prescribe daily antacid therapy to a long-suffering patient who barely earns enough for food. During surgery, Digby leaves the ulcer in the scarred duodenum alone and instead removes a chunk of the acid-producing part of the stomach—a partial gastrectomy. Then he connects the remnant of the stomach to a loop of jejunum, thus bypassing the ulcer. He feels Professor Elder’s eyes on him, hears his voice at every step, as Digby sutures bowel: “If it looks all right, it’s too tight. If it looks too loose, it’s all right.” The results are dramatic, with patients quickly pain-free and able to eat. On theater days he’ll speed through three of these operations before he gets to anything else.
One of his peptic ulcer patients on the fourth post-op day hasn’t recovered bowel function. Digby says to Krishnan, “I don’t understand. The surgery went well, and his pulse and temperature are fine, the wound is good. Why are his bowels so silent?”
“Maybe he needs you to reassure him, sir. Say it with full feeling. I will translate.”
A skeptical Digby squats by the bed. “Senthil, we cured the ulcer. Everything looks perfect inside you.” The man’s eyes are on Digby’s lips, ignoring Krishnan, as if the Tamil comes off Digby’s tongue. “Soon you can eat anything.” Senthil looks relieved; his wife tries to touch Digby’s feet. Digby feels quite silly.
At the end of the day, while Digby, Peter, Krishnan, and Honorine take tea in her office, the probationer pokes her head in to say, “Matron! Patient Senthil is passing flatus only!”