The tiny, clenched hand looks intact, uninjured. The mother, in her twenties, lies on the table, conscious—quite alert, in fact. She’s striking, with curly black hair framing a fair, oval face. Her blouse is green, and her sari and silky underskirt white. This is no estate laborer. The small pendant at her throat—a leaf with raised dots forming a crucifix—marks her as a Saint Thomas Christian. Her face is hauntingly familiar, beautiful in a generic way, Digby thinks. Perhaps it’s her resemblance to the calendar image of Lakshmi so ubiquitous in the laborers’ quarters and in shops, a print of a Raja Ravi Varma painting. His mind can’t help registering these details: the wedding ring, the dark circles of fatigue around her eyes, and her admirable composure, as though she’s wise enough to know the alternative is not helpful. Behind that fa?ade, this lovely woman is terrified. And embarrassed.
The skin over her pregnant belly is stretched taut. The two-inch incision is slanted just to the left of the navel, too neat to have come about except by a knife or a scalpel. Blood trickles slowly from one edge; she’s not in danger of exsanguinating. Digby pictures the blade passing through skin, then the rectus muscle . . . and then straight into the uterus, which, since she is close to term, has grown out of the pelvis, pushing bowel and bladder back and out of its way as it reaches the ribs, completely occupying the abdomen. It’s the only reason she will have been spared torn intestines: the blade simply pierced the abdominal skin and muscle and encountered a bigger, thicker, and stronger muscle: the uterus. It made a slit, a porthole in the womb, and the baby reacted like any prisoner: it reached for daylight.
The infant’s fingers are curled into a fist, the gossamer nails shining like glass. Digby swabs the wound and the fist with antiseptic while making these observations. The iodine stings the mother but doesn’t seem to bother the baby. Had she presented to a hospital, they’d certainly have done a caesarean. In theory, Digby could do one. He has chloroform stored somewhere, if it hasn’t evaporated. But lacking good abdominal retractors and with no capable assistant, a caesarean in his hands could easily endanger mother as well as baby.
He ponders his options. But he’s distracted by a compost-heap, cheap-tobacco stink that reminds him of the Gaiety in Glasgow, a memory better buried. He turns to see Skaria at the window ledge, the vile cheroot on his lips. The man knows better than to smoke indoors or around Digby. But the flustered compounder couldn’t help reaching for the soggy stick, like a baby seeking a nipple.
Digby’s left hand, now his dominant one, moves with the precision of a pickpocket on the Saint Enoch railway platform. He snatches the cheroot from Skaria’s lips and—
—in the same sweep, brings its glowing end to those infant knuckles, the red-hot tip a tenth of an inch from its skin.
The universe teeters in indecision. Then the tiny fist makes a slithery retreat into its watery world, snatched back in response to the noxious insult. The space where the fist hovered is now just shimmering air, charged by what’s no longer there. In Digby’s brief surgical career he’s seen round worms crawl out of gallbladders; seen germline tumors containing hair, teeth, and rudimentary ears; but never anything like this.
Digby flicks the cheroot in Skaria’s direction and grabs a sterile bandage, pressing it down onto the wound. “Custody of the hands,” he says aloud, addressing the fetus. (He imagines the bairn raging in the womb, blowing on singed knuckles, cursing Digby and plotting revolution.) Custody of the hands. In his Glasgow schooldays, Sister Evangeline punctuated those words with a ruler to the knuckles.
“That baby’s fist will get it into trouble one day,” Digby mutters. Skaria has fled, and so he takes the mother’s hand and places it over the bandage, has her apply pressure.
Outside he hears a man groaning, muttering, then letting out a bloody yell; whoever that is sounds drunk or delirious. He hears Cromwell intervening.
Digby mounts the curved needle and suture on a long holder, and signals for the mother to remove her hand from the wound, praying the baby doesn’t try another escape. He spreads the wound edges just enough to see the uterine wall pressing up. Thankfully, the uterus, with its visceral nerve supply, isn’t sensitive like skin. As quickly as he can he passes the needle through the wall of the womb on one side of the rent, and then through the other side, ties the knot and cuts the thread. The mother doesn’t flinch. He puts in two more uterine stiches. Now the baby’s only way out is the front door. He closes the skin with two stitches. She winces once but says nothing. If he used local anesthetic for every skin laceration he sutured he’d use up his precious tetracaine in a week.
“Right, then. All done,” he says, looking around for Cromwell to translate. The mother is pale, exhausted, but still calm.
“Thank you so much, Doctor,” she says, in English, startling him. He studies her anew: the gold earrings, the carefully trimmed fingernails. He asks for her name. Lizzi. He introduces himself.
“Are you having any contractions, Lizzi?” She shakes her head. “How far along are you?”
“I think I’m having two more weeks.”
“Good. I hope you’ll deliver normally. But best to be in a hospital when labor starts, all right?” She signals yes with an earnest, childlike movement of her chin. The shouting outside is distracting. Who can be drunk this early? “For now, stay here. It could be a few days before the road opens.”
He turns to prepare the dressing. “Doctor,” she says. “It was an accident.”
How many women have said that before? And how many doctors, policemen, nurses, and children have heard those words and known differently? It’s a mystery why a woman would protect a man so unworthy of it. Celeste’s face flashes before him.
“That’s my husband. His name is Kora,” she says, pointing in the direction of the racket. “He is an estate writer.” Such men are brokers who contract with the village headman down in the plains for estate labor; the appellation comes from the broker’s act of writing each laborer’s name in a ledger. Unscrupulous headmen often sign with several writers, leaving an estate high and dry when the season starts. Digby is lucky to have workers who return faithfully every year, because he’s taken pains to ensure they have the best quarters, medical care, a one-room school, and a nursery for infants. “My husband lost his mind suddenly last night, Doctor. He thought I was the devil.”
“You mean he was fine before that?”
“Yes. But having severe asthma only. Here in mountains his asthma is very bad. He takes asthma cigarettes usually, but three days it didn’t help. Yesterday he ate one cigarette. Maybe ate more. His eyes became big. He cannot sit down, hearing voices. Devils are coming to get him, he says. When I brought him food, he was hiding behind the door and attacked me. Then he is very sorry.”
Digby’s grandmother smoked pre-rolled stramonium cigarettes. In India he knows asthmatics roll their own using dried stramonium or datura leaves. The atropine in the leaves dilates the bronchi; but in excess it produces a characteristic poisoning with dilated pupils, dry mouth and skin, fever, and agitation. Every medical student knows the aide-mémoire to recall the signs: “Blind as a bat, hot as a hare, dry as a bone, red as a beet, and mad as a wet hen.”
“It could be atropine poisoning. I’ll take a look. He should get better as it wears off. Are you from around here?”
The question seems to make her sad. “No. We are from central Travancore. We used to have a house and property and loving family. But he . . . we lost it all. He borrowed from dangerous people. Much trouble. He ran away. I could have stayed. Sometimes I wish I had.”
This is more information than Digby sought. He forgets that she views him not as a planter but as a physician, someone she can confide in. After her ordeal, talking about it is cathartic for her. It’s no effort for him to stand there and gaze at her classical features, the idealized Malayali beauty.