Ravi fusses after the patient is under anesthesia, asking first for a bigger sandbag between the shoulder blades to throw her neck forward, and for the foot of the table to be lowered further to help the engorged neck veins drain better. “Small things make a big difference, Digby. God is in the small things.”
Soon after they start, the operative field is cluttered with hemostats and they pause to tie off all the bleeders. As Ravi predicted, Aavudainayaki’s goiter extends down into the chest; not even his long fingers can retrieve it. “Ravichandran’s Spoon, please,” he says, turning to the scrub nurse. The long instrument she produces is new to Digby. Ravi eases it under the breastbone. Blind, by feel alone, he levers the lower pole of the goiter out of the chest. “You recognize my instrument, Digby? It’s the spoon that slides through the side slots of my tiffin carrier and bolts the stacked dishes together. My mother blames the driver for losing our spoons. Truly it is multi-purposeful, is it not? Eating fish curry or fishing out goiter!” When they’re done, Ravi is concerned. “The first night is the most dangerous. Essential to have a tracheostomy tray and a nurse at the bedside, please.” There’s reason to worry: the cartilage rings of the trachea normally prop the airway open, but Aavudainayaki’s are thinned out from long-standing pressure from her goiter. Postoperative swelling presents a real danger of the rings collapsing.
Digby has a full day of clinic and rounds at Longmere. But after dinner, he cycles to General Hospital again. Aavudainayaki’s smile has greeted him each morning for weeks now. For all her faith in Jigiby Doctor, he’s terrified of it ending badly.
At night all hospitals become hushed, sepulchral, the silence punctuated by a few coughs or moans. Digby’s footsteps echo in the hallways as he passes the open wards. A nurse sitting under a dim lamp looks up, surprised; she smiles shyly. Her smile stays with him. He feels a longing to be close to a woman.
Aavudainayaki sleeps comfortably, a tracheostomy kit at her bedside, but no nurse is to be seen. A sluggish, slovenly probationer returns after an hour, startled to see Digby. He dismisses her. He’ll keep vigil himself. To pass time he tries to depict the stages of the operation in his sketchbook.
Digby wakes to a high-pitched mewling noise and the sight of a desperate Aavudainayaki laboring to pull in air. That frightening sound—stridor—signals airway obstruction. He leaps to her side, ashamed that he fell asleep. Her terror-stricken face shows no joy at seeing Jigiby Doctor; she senses her imminent death. Digby tears open the tracheostomy tray while yelling for help. This is his worst nightmare: a tracheostomy in bad lighting with a struggling patient. He slashes through her dressings and is stunned to find her neck no longer flaccid as it had been after surgery—but swollen as though the goiter has returned with a vengeance! He cuts away three skin sutures and a huge blood clot slithers out past his fingers onto the bedsheet, a leering, jellylike blob. Aavudainayaki’s distress eases at once. Others arrive and flashlights shine onto the wound, which shows no active bleeding. The trachea is exposed and he could easily do a tracheostomy. But he sees no fresh bleeding and Aavudainayaki’s breathing is steady, her face calm. She even tries to smile.
He should take her back to the theater and under anesthesia explore the wound, find the bleeder if it’s still oozing. But it’s four in the morning. For an outsider to get the theater up at that hour will require an act of God. He’s loath to phone Ravi. He lets the skin flap back down without suturing it, just covering it loosely with gauze. If there’s the slightest sign of fresh blood, I’ll take her back.
In the morning, the surgical team arrives for rounds, Ravi at its head. He eyes the large liquefying clot in the basin. Aavudainayaki’s smile is back, but Dr. V. V. Ravichandran is unsmiling. He examines the wound. The entourage of interns and assistant surgeons shift their feet nervously. “Which one of you checked this patient in the night?” Silence. “Good thing you were here, Digby. But when that clot came out, she belonged in the theater. You should have called me at once.”
“Her breathing improved. If—”
“No ifs, buts, and baingan bhartas!” Ravi says sharply, cutting him off. “In the interest of a patient you may wake me and Jesus Christ himself. To wake the anesthetist, you will need divine assistance. But take patient to theater. No discussion!” He glowers at Digby for a few seconds, then his expression softens. He picks up Digby’s open sketchbook. “Aah, nice only. Those surgical atlases never bleed, do they?”
As Ravi and the surgical crew are about to exit the ward, he stops and turns around so suddenly, his retinue pile into one another. His voice fills the ward. “Dr. Kilgour. Good surgeons can do any operation. Great surgeons take care of their own complications.”
Digby colors with the praise.
CHAPTER 15
A Fine Catch
1934, Madras
“Aa’ never seen so many uniforms in the city,” Honorine says. She and Digby are in the New Elphinstone Theater, taking refuge from a blazing sun. The Saturday matinee crowd is a sea of regulation haircuts and khaki. “Here I was hoping Longmere would be me last posting. If it’s war again, they’ll drag we from the Civil Branch to the military. Of course, I’ll do me part. But the world’s gone mental, if you ask me. Japan invading China? What if they decide India’s next? Not to mention them Germans, the new chancellor. I don’t trust him, me.”
“It feels inevitable when you read the papers—war, I mean.” Digby was astonished to learn that a million Indian soldiers had fought in the Great War, and as many as one hundred thousand had died. Editorials opine that if Indians are to be conscripted into the British Indian Army to fight again, they won’t settle for anything less than freedom in return.
“Inevitable? God, na divven’t say that!” She scrabbles in her large wicker bag. She gives up, then snatches the kerchief Digby proffers and dabs her eyes. “I lost my older brothers in that war. It was the death of me poor mam. These politicians? They’re all gadgies, Digby,” she says bitterly. “If women were in power, you’d not see us sending lads to their death.”
If there’s war, Digby will be posted to a military unit. He recalls Professor Alan Elder in Glasgow saying that war was the only proper school for surgeons. It’s not a thought Digby will share with Honorine.
The triple feature ends with City Lights. Chaplin’s physical comedy has them convulsing in laughter. The wistful sweetness of the story—a tramp who falls in love with a blind girl and raises money for an operation to restore her sight—is the ideal antidote for the talk of war.
They emerge after what seems a lifetime. Though it is dusk, it is blisteringly hot, the air still. Instantly, Digby feels sweat beading on his lip and his brow. Despite the smells of frying vada from a roadside stall, the heat has erased his appetite.
“Marina Beach,” Honorine says decisively to a jatka driver whose long, betel-nut-stained teeth resemble those of his nag; neither man nor horse is enthusiastic about moving.
“Chaplin redeems all men,” Honorine says, her mood improved. “True love wins the day. I’d take him back to mine if I could.”
“Not much of a conversationalist though, is he?”
“And that’d be the blessing of it and all!” Honorine says.