Ravi guffaws at his own helplessness. “Ayo, Honorine, those Tanjore patients are still coming two hundred and fifteen miles to see me, though I try to dissuade them!” His professional vanity is strangely charming.
The bearer sets down tea and butter biscuits; the stenographer pushes a stack of forms before Ravi and he signs without looking down. A limping barefoot man in a blue uniform, who Digby learns later is Veerappan, Ravi’s former patient and driver, sets a colossal six-tiered silver tiffin carrier on Ravi’s cluttered desk. He unlocks the frame by sliding the long spoon-bolt out of its rings, then unstacks and displays each dish for Ravi to peer at and sniff before Veerappan reassembles it all and departs, having filled the room with the scent of coriander, cumin, and lentils.
“Some things haven’t changed, I see,” Honorine says. “How’s yer muther, then?”
“My mother is well, thanks be to the Divine,” Ravi says. “Digby, no other hand but my mother’s prepares my food, as I am her one and only issue.” He giggles mischievously. “If she knew that I am giving it away to patients in the septic ward, she would have to destroy the cooking vessels, bathe in the temple thrice a day, and live on barley and ghee for five days. But she is suspicious. When I get home, she’ll ask, ‘How was the bitter gourd?’ knowing fully well there was no bitter gourd! Veerappan has a second tiffin carrier in the car whose existence is unknown to Mother. I eat when I go later for house calls. I give in to my weakness for mutton korma with paratha. Beloved Matron Honorine only was my temptress and corrupter. Her pease pudding with ham—that was how my flesh-eating life began. One day, I will atone by giving away all my possessions—wear saffron robes, go to Benares, and pass from the world.”
All this while, an audience of junior doctors looks on, and an office boy hands Ravi a stack of chits, each of which he manages to scan without losing his train of thought.
“Glasgow, is it? Oh, Digby, so much I wanted to visit. Glasgow! Edinburgh! Hallowed names for surgeons, are they not? How wonderful it would have been to sit for the exams. To put the magical FRCS behind my name . . . Fellow of the Royal College of Surgeons! Ayo, I even had my steamer ticket!”
“What stopped you?” Digby asks hesitantly.
“Three thousand years of history,” Ravi says gravely. “We Brahmins believe the ocean is polluted, and in crossing to a foreign land over water the soul putrefies; one is damned for all time—”
“Tell him the truth, Ravi,” Honorine says. “It was your mother.”
He bursts out laughing. “Correctly only Honorine is telling. Ayo, my saintly mother . . . it would kill her. If I went overseas that would be matricide. Supposing she survived, her only issue would return so polluted that even if he stood out of sight, she could not speak to him ever again. Thus only, I stayed. But tell me, Digby, what made you risk eternal damnation and cross the water? What are you running from? Or to?”
Blood surges around Digby’s scar. Ravichandran’s grinning gaze settles there with curiosity and compassion. Digby searches for words.
“A blushing surgeon is better than the other kind,” Ravi says to Honorine. “I won’t add to the discomfort of a man who is already having Claude Arnold as his superior. Digby, did you know a Rolls-Royce sits in front of Claude’s house? Why he bought it? Because I have one! My Rolls was the first in Madras and has been a splinter under the dermis of your countrymen! ‘The impertinence of this babu!’ ” Ravi says, trying to mimic a posh English accent. His laughter interrupts his narrative. “The governor had to get one. Much later, Claude Arnold too. But Claude’s doesn’t move. It decorates the house like the pottu on my mother’s forehead. Digby, I am unmarried. I work very hard. For the profession I am giving up the necessities, but should I give up the luxuries? In my own land, am I not to come and go as I please?”
Ravi suddenly shouts over Digby’s shoulder at someone in what sounds like coarse and vulgar Tamil, his smile fading. “Impatient people!” he says, the smile slowly returning. “Always rushing. I am so behind that yesterday catches up with tomorrow. Anyway, Digby, if saintly Honorine likes you, then I am liking too. Come. My first case is a stomach resection for a likely gastric cancer. If it’s not too far gone.”
In the theater, Digby assists, anticipating Ravichandran’s movements, yet careful not to get in the way. There’s a rock-hard mass in the antrum, just above the pylorus where the stomach empties, a location where even a small tumor comes quickly to a patient’s attention because they feel full after a few bites. Ravi runs his hand over the surface of the liver, then pulls out the small bowel, all twenty feet of it, feeding it through his hands, looking for metastasis. Then he inspects the pelvis. “No spread. We’ll do a distal gastrectomy. Switch sides. I will be your humble servant.” Digby cuts out half of the stomach. Having Ravichandran as his skilled assistant, subtly improving his view and access, makes Digby feel like a far better surgeon than he really is. When he’s done, they’re left with a stump of the duodenum—into which bile and pancreatic juice pour—and the stump of the stomach remnant.
“What now, my young friend?”
“I’ll sew off the duodenum, leaving a blind stump. Then I’ll connect a loop of jejunum to the remnant of the stomach.” It’s the same familiar procedure he does for peptic ulcers at Longmere.
“A gastrojejunostomy, is it? Why not join the stomach directly to the duodenum? A Billroth One? Why not keeping the normal continuity? And then no duodenal stump to leave behind that might leak.”
Digby clasps his hands together, his gloves bloody past the knuckles, the open belly awaiting his decision. “To be honest,” he stammers, “I’ve done many more gastrojejunostomies at Longmere. For me it would be trickier to connect what’s left of the stomach to the scarred duodenum than to do what I am familiar with and know I can do safely. Yes, it would leave behind a blind duodenal stump, but that has less chance of leaking than if I tried to connect the stomach to the duodenum. In my hands.”
“Good answer! The best possible operation is not the same as the best operation possible! Of course, if the cancer returns, all this is moot. Go ahead.”
Operating weekly with Ravichandran at General Hospital is precisely the surgical education Digby sought when he came to India. He sops up every pearl the brilliant surgeon offers, and lingers to watch Ravi as he operates with others. Meanwhile, Aavudainayaki waits, unwavering in her determination that “Jigiby Doctor” take out her goiter. She earns her keep on the wards by being a willing helper to Matron and the nurses, and a support to new patients. She has become family.
Five weeks after first meeting Ravichandran, Digby takes Aavudainayaki to General Hospital in the early morning in a rickshaw. Ravi greets her graciously in Tamil. After palpating her goiter, he has her raise her arms and keep them up, her biceps bracketing her cheeks. Soon, her face gets dusky colored and congested, and she becomes breathless. “See that, Digby? Call it ‘Ravi’s sign.’ It means this goiter extends into her chest. If we can’t get at it from the top, we’ll be sawing through the sternum. Nothing routine about this, I assure you.”
The anxious patient is eager to convey something in Tamil to Ravi, who reassures her. He says drily to Digby, “I’ve assured her that the white man only is performing the surgery. I am merely assisting the great Jigiby Doctor.”