Cutting for Stone

1. The Typhoid State Revisited

SISTER MARY JOSEPH PRAISE had come to Missing Hospital from India, seven years before our birth. She and Sister Anjali were the first novitiates of the Carmelite Order of Madras to also go through the arduous nursing diploma course at the Government General Hospital, Madras. On graduation day my mother and Anjali received their nursing pins and that evening took their final vows of poverty celibacy, and obedience. Instead of answering to “Probationer” (in the hospital) and “Novitiate” (in the convent), they could now be addressed in both places as “Sister.” Their aged and saintly abbess, Shessy Geevarughese, affectionately called Saintly Amma, had wasted no time in giving the two young nurse-nuns her blessing, and her surprising assignment: Africa.

On the day they were to sail, all the novitiates rode from the convent in a caravan of cycle-rickshaws to the harbor to send off their two sisters. In my mind's eye I can see the novitiates lining the quay, chattering and trembling with excitement and emotion, their white habits flapping in the breeze, the seagulls hopping around their sandaled feet.

I have so often wondered what went through my mother's mind as she and Sister Anjali, both just nineteen years old, took their last steps on Indian soil and boarded the Calangute. She would have heard stifled sobs and “God be with you” follow her up the gangway. Was she fearful? Did she have second thoughts? Once before, when she entered the convent, she'd torn herself away from her biological family in Cochin forever and moved to Madras, which was a day and a night's train ride from her home. As far as her parents were concerned, it might just as well have been halfway across the world, for they would never see her again. And now, after three years in Madras, she was tearing herself away from the family of her faith, this time to cross an ocean. Once again, there was no going back.

A few years before sitting down to write this, I traveled to Madras in search of my mother's story. In the archived papers of the Carmelites, I found nothing of hers, but I did find Saintly Amma's diaries in which the abbess recorded the passing days. When the Calangute slipped its mooring, Saintly Amma raised her hand like a traffic policeman and, “using my sermon voice which I am told belies my age,” intoned the words, “Leave your land for my sake,” because Genesis was her favorite book. Saintly Amma had given this mission great thought: True, India had unfathomable needs. But that would never change and was no excuse; the two young nuns—her brightest and fairest—were to be the torch-bearers: Indians carrying Christ's love to darkest Africa—that was her grand ambition. In her papers, she reveals her thinking: Just as the English missionaries discovered when they came to India, there was no better way to carry Christ's love than through stupes and poultices, liniments and dressings, cleansing and comfort. What better ministry than the ministry of healing? Her two young nuns would cross the ocean, and then the Madras Discalced Carmelite Mission to Africa would begin.

As the good abbess watched the two waving figures on the ship's rail recede to white dots, she felt a twinge of apprehension. What if by their blind obedience to her grand scheme they were being condemned to a horrible fate? “The English missionaries have the almighty Empire behind them … but what of my girls?” She wrote that the seagulls’ shrill quarreling and the splatter of bird excreta had marred the grand send-off she had envisioned. She was distracted by the overpowering scent of rotten fish, and rotted wood, and by the bare-chested stevedores whose betel-nut-stained mouths drooled bloody lechery at the sight of her brood of virgins.

“Father, we consign our sisters to You for safekeeping,” Saintly Amma said, putting it on His shoulders. She stopped waving, and her hands found shelter in her sleeves. “We beseech You for mercy and for Your protection in this outreach of the Discalced Carmelites …”

It was 1947, and the British were finally leaving India; the Quit India Movement had made the impossible come about. Saintly Amma slowly let the air out of her lungs. It was a new world, and bold action was called for, or so she believed.

THE BLACK-AND-RED FLOATING PACKET of misery that called itself a ship steamed across the Indian Ocean toward its destination, Aden. In its hold the Calangute carried crate upon crate of spun cotton, rice, silk, Godrej lockers, Tata filing cabinets, as well as thirty-one Royal Enfield Bullet motorcycles, the engines wrapped in oilcloth. The ship wasn't meant to carry passengers, but the Greek captain did just that by housing “paying guests.” There were many who would travel on a cargo ship to save on passage, and he was there to oblige by skimping on crew. So on this trip he carried two Madras nuns, three Cochin Jews, a Gujarati family, three suspicious-looking Malays, and a few Europeans, including two French sailors rejoining their ship in Aden.

The Calangute had a vast expanse of deck—more land than one ever expected at sea. At one end, like a gnat on an elephant's backside, sat the three-story superstructure which housed the crew and passengers, the top floor of which was the bridge.

My mother, Sister Mary Joseph Praise, was a Malayali from Cochin, in the state of Kerala. Malayali Christians traced their faith back to St. Thomas's arrival in India from Damascus in A.D. 52. “Doubting” Thomas built his first churches in Kerala well before St. Peter got to Rome. My mother was God-fearing and churchgoing; in high school she came under the influence of a charismatic Carmelite nun who worked with the poor. My mother's hometown is a city of five islands set like jewels on a ring, facing the Arabian Sea. Spice traders have sailed to Cochin for centuries for cardamom and cloves, including a certain Vasco de Gama in 1498. The Portuguese clawed out a colonial seat in Goa, torturing the Hindu population into Catholic converts. Catholic priests and nuns eventually reached Kerala, as if they didn't know that St. Thomas had brought Christ's uncorrupted vision to Kerala a thousand years before them. To her parents’ chagrin, my mother became a Carmelite nun, abandoning the ancient Syrian Christian tradition of St. Thomas to embrace (in her parents’ view) this Johnny-come-lately pope-worshipping sect. They couldn't have been more disappointed had she become a Muslim or a Hindu. It was a good thing her parents didn't know that she was also a nurse, which to them would mean that she soiled her hands like an untouchable.

My mother grew up at the ocean's edge, in sight of the ancient Chinese fishing nets cantilevered from long bamboo poles and dangling over the water like giant cobwebs. The sea was the proverbial “breadbasket” of her people, provider of prawns and fish. But now on the deck of the Calangute, without the Cochin shore to frame her view, she did not recognize the breadbasket. She wondered if at its center the ocean had always been this way: smoking, malevolent, and restless. It tormented the Calangute, making it pitch and yaw and creak, wanting nothing more than to swallow it whole.

She and Sister Anjali secluded themselves in their cabin, bolting the door against men and sea. Anjali's ejaculatory prayers startled my mother. The ritualized reading of the Gospel of Luke was Sister Anjali's idea; she said it would give wings to the soul and discipline to the body. The two nuns subjected each letter, each word, line, and phrase to dilata-tio, elevatio, and excessus—contemplation, elevation, and ecstasy. Richard of St. Victor's ancient monastic practice proved useful for an interminable ocean crossing. By the second night, after ten hours of such close and meditative reading, Sister Mary Joseph Praise suddenly felt print and page dissolve; the boundaries between God and self disintegrated. Reading had brought this: a joyous surrender of her body to the sacred, the eternal, and the infinite.

At vespers on the sixth night (for they were determined to carry the routine of the convent with them no matter what) they finished a hymn, two psalms, and their antiphons, then the doxology, and were singing the Magnificat when a piercing, splintering sound brought them to earth. They grabbed life jackets and rushed out. They were met by the sight of a segment of the deck that had buckled and pushed up into a pyramid, almost, it seemed to Sister Mary Joseph Praise, as if the Calangute were made of corrugated cardboard. The captain kept his pipe lit and his smirk suggested his passengers had overreacted.

On the ninth night, four of the sixteen passengers and one of the crew came down with a fever whose flesh signs were rose spots that appeared on the second febrile day and that arranged themselves like a Chinese puzzle on the chest and abdomen. Sister Anjali suffered grievously, her skin burning to the touch. By the second day of illness she was raging in feverish delirium.

Among the Calangutes passengers was a young surgeon—a hawk -eyed Englishman who was leaving the Indian Medical Service for better pastures. He was tall and strong, and his rugged features made him look hungry, yet he avoided the dining room. Sister Mary Joseph Praise had run into him, literally, on the second day of the voyage when she lost her footing on the wet metal stairs leading up from their quarters to the common room. The Englishman coming up behind her seized her where he could, in the region of her coccyx and her left rib cage. He righted her as if she were a little child. When she stuttered her thanks, he turned beet red; he was more flustered than she by this unexpected intimacy. She felt a bruising coming on where his hands had clutched her, but there was a quality to this discomfort that she did not mind. For days thereafter, she didn't see the Englishman.

Now, seeking medical help, Sister Mary Joseph Praise gathered her courage to knock on his cabin. A faint voice bid her to enter. A bilious, acetone odor greeted her. “It is me,” she called out. “It is Sister Mary Joseph Praise.” The doctor lay on his side in his bunk, his skin the same shade as his khaki shorts, his eyes screwed shut. “Doctor,” she said, hesitating, “are you also with fever?”

When he tried to look at her, his eyeballs rolled like marbles on a tilting plate. He turned and retched over a fire-bucket, missed it, which didn't matter, as the bucket was full to the brim. Sister Mary Joseph Praise rushed forward and felt his brow. It was cold and clammy, not at all feverish. His cheeks were hollowed, and his body looked as if it had shrunk to fit the tiny cabin. None of the passengers had been spared seasickness, but the Englishman's affliction was severe.

“Doctor, I am wanting to report a fever that has affected five patients. It comes with rash, chills, and sweats, a slow pulse and loss of appetite. All are stable except for Sister Anjali. Doctor, I am most worried about Anjali …”

She felt better once it was off her chest, even though other than letting out a moan the Englishman made no response. Her eyes fell on a catgut ligature that was looped around a bed rail near his hands and that displayed knot thrown on top of knot, ten-score of them. The knots were so plentiful that the thread stood up like a gnarled flagpole. This was how he had logged the hours, or kept track of his bouts of emesis.

She rinsed out the bucket and put it back within his reach. She mopped the mess on the floor with a towel, then she rinsed the towel out and hung it up to dry. She brought water to his side. She withdrew, wondering how many days it had been since he'd eaten anything.

By evening he was worse. Sister Mary Joseph Praise brought sheets, towels, and broth. Kneeling, she tried to feed him, but the smell of food triggered dry heaves. His eyeballs had sunk into their orbits. His shriveled tongue looked like that of a parrot. She recognized the room's fruity odor as the scent of starvation. When she pinched up a skin fold at the back of his arm and let go, it stayed up like a tent, like the buckled deck. The bucket was half full of clear fluid. He babbled about green fields and was unaware of her presence. Could seasickness be fatal, she wondered. Or could he have a forme fruste of the fever that afflicted Sister Anjali? There was so much she did not know about medicine. In the middle of that ocean surrounded by the sick, she felt the weight of her ignorance.

But she knew how to nurse. And she knew how to pray. So, praying, she eased off his shirt which was stiff with bile and spit, and she slid down his shorts. As she gave him a bed bath, she was self-conscious, for shed never ministered to a white man, or to a doctor for that matter. His skin displayed a wave of goose bumps at the touch of her cloth. But the skin was free of the rash shed seen on the four passengers and the one cabin boy who had come down with fever. The sinewy muscles of his arms bunched together fiercely at his shoulder. Only now did she notice that his left chest was smaller than his right; the hollow above his collarbone on the left could have held a half cup of water, while that on the right only a teaspoon. And just beyond and below his left nipple, extending into the armpit, she saw a deep depression. The skin over this crater was shiny and puckered. She touched there and gasped as her fingers fell in, not meeting bony resistance. Indeed, it appeared as if two or perhaps three adjacent ribs were missing. Within that depression his heart tapped firmly against her fingers with only a thin layer of hide intervening. When she pulled her fingers away, she could see the thrust of his ventricle against his skin.

The fine, translucent coat of hair on his chest and abdomen looked as if it had drifted up from the mother lode of hair at his pubis. She dispassionately cleaned his uncircumcised member, then flopped it to one side and attended to the wrinkled and helpless-looking sac beneath. She washed his feet and cried while she did, thinking inevitably of her Sweet Lord and His last earthly night with His disciples.

In his steamer trunks she found books dealing with surgery. He had penned names and dates in the margins, and only later did it occur to her that these were patients’ names, both Indian and British, mementos to a disease hed first seen in a Peabody, or a Krishnan. A cross next to the name she took as a sign the patient had succumbed. She found eleven notebooks filled with an economical handwriting with slashing down-strokes, the text dancing just above the lines and obeying no margin save for the edge of the page. For an outwardly silent man, his writing reflected an unexpected volubility.

Eventually she found a clean undershirt and shorts. What did it say when a man had fewer clothes than books? Turning him first this way and then that, she changed the sheets beneath him and then dressed him.

She knew his name was Thomas Stone because it was inscribed inside the surgical textbook hed placed at his bedside. In the book she found little about fever with rash, and nothing about seasickness.

That night Sister Mary Joseph Praise negotiated the heaving passageways, hurrying from one sickbed to the next. The mound where the deck had buckled resembled a shrouded figure and she averted her eyes. Once she saw a black mountain of a wave, several stories high, and the Calangute looked poised to fall into a hole. Sheets of water smashed over the bow, the noise more terrifying than the sight.

In the middle of the tempestuous ocean, groggy from lack of sleep, facing a terrible medical crisis, her world had become simplified. It was divided into those with fever, those with seasickness, and those without. And it was possible that none of these distinctions mattered, for very soon they might all drown.

She awoke from where she must have drifted off next to Anjali. In what seemed like the next instant she awoke again, but this time in the Englishman's cabin where she'd fallen asleep kneeling by his bed, her head lolling on his chest, his arm resting on her shoulder. In the time it took her to recognize this, she was asleep again, waking at daybreak finding herself on the bunk, but on its very edge, pressed against Thomas Stone. She hurried back to Anjali to find her worse, her respirations now sighing and rapid. There were large confluent purple patches showing on Anjali's skin.

The anxious faces of the sleepless crew and the fact that one fellow had knelt before her and said “Sister, forgive my sins!” told her that the ship was still in danger. The crew ignored her pleas for help.

Frantic and frustrated, Sister Mary Joseph Praise retrieved a hammock from the common room because of a vision she had in that fugue state between wakefulness and sleep. She strung it in his cabin between porthole and bedpost.

Dr. Stone was a dead weight and only the intercession of St. Catherine allowed her to drag him from bunk to floor, then feed him, one body part at a time, onto the hammock. Answering more to gravity than to the roll of the ship, the hammock found the true horizontal. She knelt beside him and prayed, pouring her heart out to Jesus, completing the Magnificat which had been interrupted the night the deck had buckled.

Color returned first to Stone's neck, then his cheeks. She fed him teaspoons of water. In an hour he held down broth. His eyes were open now, the light coming back into them, and the eyeballs tracking her every movement. Then, when she brought the spoon up, sturdy fingers encircled her wrist to guide the food to his mouth. She remembered the line shed sung moments before: “He hath filled the hungry with good things, and the rich He hath sent empty away.”

God had heard her prayers.

A pale and unsteady Thomas Stone came with Sister Mary Joseph Praise to where Sister Anjali lay. He gasped at the sight of the wide-eyed and delirious nun, her face pinched and anxious, her nose sharp as a pen, the nostrils flaring with each breath, seemingly awake and yet completely oblivious to her visitors.

He knelt over her, but Anjali's glassy gaze passed right through him. Sister Mary Joseph Praise watched the practiced way he pulled down Anjali's lids to examine her conjunctivae, and the way he swung the flashlight in front of her pupils. His movements were smooth and flowing as he bent Anjali's head toward her chest to check for neck stiffness, as he felt for lymph nodes, moved her limbs, and as he tapped her patel-lar tendon using his cocked finger in lieu of a reflex hammer. The awkwardness Sister Mary Joseph Praise had sensed in him when she had seen him as a passenger and then as a patient was gone.

He stripped off Anjali's clothes, unaware of Sister Mary Joseph Praise's assistance as he dispassionately studied the patient's back, thighs, and buttocks. The long sculpted fingers that probed Anjali's belly for the spleen and liver seemed to have been created for this purpose— she couldn't imagine them doing anything else. Not having his stethoscope, he applied his ear to Sister Anjali's heart, then her belly. Then he turned her to one side and pressed his ear against her ribs to listen to the lungs. He took stock, then muttered, “Breath sounds are diminished on the right … parotids enlarged … she has neck glands—why? … Pulse is feeble and rapid—”

“It was a slow pulse when the fever started,” Sister Mary Joseph Praise offered.

“So you mentioned,” he said sharply. “How slow?” He didn't look up.

“Forty-five to fifty, Doctor.”

She felt he had forgotten his illness, forgotten even that he was on a ship. He had become one with Sister Anjali's body, it was his text, and he sounded it for the enemy within. She felt such confidence in his being that her fear for Anjali vanished. Kneeling by his side, she was euphoric, as if she had only at that moment come of age as a nurse because this was the first time she had encountered a physician like him. She bit her tongue because she wanted so much to say all this and more to him.

“Coma vigil,” he said, and Sister Mary Joseph Praise assumed he was instructing her. “See how her eyes keep roving as if she's waiting for something? A grave sign. And look at the way she picks at the bedclothes—that's called carphology and those little muscle twitches are subsultus tendinum. This is the ‘typhoid state.’ You'll see it in the late stages of many kinds of blood poisoning, not just typhoid … But mind you”—and he looked up at her with a little smile that belied what he said next—”I am a surgeon, not a medical man. What do I know of medical matters? Except to know that this is not a surgical illness.”

His presence had done more than reassure Sister Mary Joseph Praise; it calmed the seas. The sun, which had been hiding, was suddenly at their back. The crew's drunken celebration indicated how grave the situation had been just hours before.

But though Sister Mary Joseph Praise did not want to believe this, there was little Stone could do for Sister Anjali, and in any case, nothing to do it with. The first-aid box in the galley held a desiccated cockroach— its contents had been pawned by one of the crew at the last port. The medicine chest which the captain used as a seat in his cabin seemed to have been left over from the Dark Ages. A pair of scissors, a bone knife, and crude forceps were the only things of use within that ornate box. What was a surgeon like Stone to do with poultices, or tiny containers of wormwood, thyme, and sage? Stone laughed at the label of something called oleum philosophorum (and this was the first time Sister Mary Joseph Praise heard that happy sound even if in its dying echo there was something hard-edged). “Listen to this,” he said, reading: “ ‘containing old tilestones and brickebats for chronic costiveness’!” That done, he heaved the box overboard. He'd removed only the dull instruments and an amber bottle of laudanum opiatum paracelsi. A spoonful of that ancient remedy seemed to ease Sister Anjali's terrible air hunger, to “disconnect her lungs from her brain,” as Thomas Stone explained to Sister Mary Joseph Praise.

The captain came by, sleepless, apoplectic, spraying saliva and brandy as he spoke: “How dare you dispose of shipboard property?”

Stone leaped to his feet, and at that moment he reminded Sister Mary Joseph Praise of a schoolboy spoiling for a fight. Stone fixed the captain with a glare that made the man swallow and take a step back. “Tossing that box was better for mankind and worse for the fish. One more word out of you and I'll report you for taking on passengers without any medical supplies.”

“You got a bargain.”

“And you will make a killing,” Stone said, pointing to Anjali.

The captain's face lost its armature, the eyebrows, eyelids, nose, and lips all running together like a waterfall.

Thomas Stone took charge now, setting up camp at Anjali's bedside, but venturing out to examine every person on board, whether they consented to such probing or not. He segregated those with fever from those without. He took copious notes; he drew a map of the Calangutés quarters, putting an X where every fever case had occurred. He insisted on smoke fumigation of all the cabins. The way he ordered the healthy crew and passengers around infuriated the sulking captain, but if Thomas Stone was aware of this he paid no attention. For the next twenty-four hours he didn't sleep, reexamining Sister Anjali at intervals, checking on the others: keeping vigil. An older couple was also quite ill. Sister Mary Joseph Praise never left his side.

Two weeks after they left Cochin, the Calangute limped into the port of Aden. The Greek captain had the Madagascar seaman hoist the Portuguese flag under which the ship was registered, but because of the shipboard fever the Calangute was promptly quarantined, Portuguese flag or no Portuguese flag. She was anchored at a distance, where, like a banished leper, she could only gaze at the city. Stone bullied the Scottish harbormaster who had pulled up alongside, telling him that if he didn't bring a doctor's kit, bottles of lactated Ringer's solution for intravenous administration, as well as sulfa, then he, Thomas Stone, would hold him responsible for the death of all Commonwealth citizens on board. Sister Mary Joseph Praise marveled at his outspokenness, and yet he was speaking for her. It was as if Stone had replaced Anjali as her only ally and friend on this ill-fated voyage.

When the supplies came, Stone went first to Sister Anjali. Making do with the crudest of antisepsis, with one scalpel stroke he exposed the greater saphenous vein where it ran just inside Sister Anjali's ankle. He threaded a needle into the collapsed vessel that should have been the width of a pencil. He secured the needle in place with ligatures, his hands a blur as he pushed one knot down over another. Despite the intravenous drip of Ringer's lactate and the sulfa, Anjali didn't make a drop of urine or show any signs of reviving. Later that evening, she died in a final dreadful paroxysm, as did two others, an old man and old woman, all within a few hours of one another. For Sister Mary Joseph Praise the deaths were stunning, and unforeseen. The euphoria she felt when Thomas Stone had risen and come to see Anjali had blinded her. She shivered uncontrollably.

At twilight, Sister Mary Joseph Praise and Thomas Stone slipped the shrouded bodies over the rail, with no help from the superstitious crew who wouldn't even look their way.

Sister Mary Joseph Praise was inconsolable, the brave front she'd put up shattering as her friend's body splashed into the water. Stone stood beside her, unsure of himself. His face was dark with anger and shame because he had not been able to save Sister Anjali.

“How I envy her,” Sister Mary Joseph Praise said at last through tears, her fatigue and sleeplessness combining to release custody of her tongue. “She's with our Lord. Surely that is a better place than this.”

Stone bit off a laugh. To him such a sentiment was a symptom of impending delirium. He took her by the arm and led her back to his room, lay her down on his bunk, and told her she was to rest, doctor's orders. He sat on the hammock and watched as life's only sure blessing—sleep—came to her, and then he hurried off to reexamine the crew and all passengers. Dr. Thomas Stone, surgeon, did not need sleep.

TWO DAYS LATER, with no more new cases of fever, they were finally allowed off the Calangute. Thomas Stone sought out Sister Mary Joseph Praise before disembarking. He found her red-eyed in the cabin she'd shared with Sister Anjali. Her face and the rosary she clutched were wet. With a start he registered what he had failed to before: that she was extraordinarily beautiful, her eyes big and soulful and more expressive than eyes had a right to be. His face grew warm and his tongue wouldn't unstick itself from the floor of his mouth. He shifted his gaze to the floor, to her travel bag. When he finally spoke it was to say, “Typhus.” He'd looked in his books and given the matter a great deal of thought. Seeing her puzzlement, he said, “Indubitably typhus.” He had expected the word, the diagnosis, would make her feel better, but instead it seemed to fill her eyes with fresh tears. “Most likely typhus—of course a serum test could have confirmed it,” he stammered.

He shuffled his feet, crossed and uncrossed his hands. “I don't know where you're going, Sister, but I'm heading to Addis Ababa … it's in Ethiopia,” he said, mumbling into his chin. “To a hospital … that would value your services if you were to come.” He looked at her and blushed again, because the fact was he knew nothing about the hospital he was going to or whether it could use her services, and because he felt those moist dark eyes could read his every thought.

But it was her own thoughts that kept Sister Mary Joseph Praise silent. She remembered how shed prayed for him and for Anjali, and how God had answered just one of her prayers. Stone, risen like Lazarus, then brought his entire being into understanding the fever. Hed barged into the crew's quarters, run roughshod over the captain, and bullied and threatened. Doing the wrong thing, as Sister Mary Joseph Praise saw it, but in pursuit of the right thing. His fierce passion had been a revelation to her. At the medical college hospital in Madras where she trained as a nurse, the civil surgeons (who at the time were mostly Englishmen) had floated around serene and removed from the patients, with the assistant civil surgeons and junior and senior house surgeons (who were all Indian) trailing behind like ducklings. At times it seemed to her they were so focused on disease that patients and suffering were incidental to their work. Thomas Stone was different.

She felt his invitation to join him in Ethiopia hadn't been rehearsed. The words had slipped out before he'd been able to stop them. What was she to do? Saintly Amma had identified a Belgian nun who had broken away from her order, and who had made a most tenuous foothold in Yemen, in Aden, a foothold that was in jeopardy because of the nun's ill health. Saintly Amma's plan was for Sister Anjali and Sister Mary Joseph Praise to start there, perched above the African continent, and to learn everything they could from the Belgian nun about operating in hostile climates. From there, after correspondence with Amma, the sister-sisters would head south, not to the Congo (which the French and Belgians had covered), not to Kenya, Tanganyika, Uganda, or Nigeria (the Anglicans had their fingers all over those souls and disliked competition), but perhaps to Ghana or Cameroon. Sister Mary Joseph Praise wondered what Saintly Amma might say to Ethiopia.

Saintly Amma's vision now felt like a pipe dream, a vicarious evange lism so ill informed that Sister Mary Joseph Praise was embarrassed to mention it to Thomas Stone. Instead she said in a breaking, hopeless voice, “I have orders to Aden, Doctor. But I thank you. Thank you for all you did for Sister Anjali.” He protested that he'd done nothing.

“You did more than any human being could do,” she said and took his hand in both of hers and held it. She looked into his eyes. “God be with you and bless you.”

He could feel the rosary still entwined in her fingers, and the softness of her skin and the wetness from her tears. He recalled her hands on him, washing his body, dressing him, even holding his head when he retched. He had a memory of her face turned to the heavens, singing, praying for his recovery. His neck grew warm and he knew his color was betraying him a third time. Her eyes showed pain, and a cry escaped her lips, and only then did he know that he was squeezing her hands, grinding the rosary against her knuckles. He let go at once. His lips parted, but he didn't say anything. He abruptly walked away.

Sister Mary Joseph Praise couldn't move. She saw that her hands were red and beginning to throb. The pain felt like a gift, a blessing so palpable that it rose up her forearms and into her chest. What she couldn't bear was the feeling that something vital had been plucked out and uprooted from her chest when he walked away. She'd wanted to cling to him, to cry out to him not to leave. She had thought her life in the service of the Lord was complete. There was, she saw now, a void in her life that she'd never known existed.

THE MOMENT she stepped off the Calangute onto the soil of Yemen, Sister Mary Joseph Praise wished she'd never disembarked. How absurd it had been for her to have pined to come ashore all those days they'd been quarantined. Aden, Aden, Aden—she'd known nothing about it before this voyage, and even now it was no more than an exotic name. But from the sailors on the Calangute, she gathered that one could hardly go anywhere in the world without stopping in Aden. The port's strategic location had served the British military. Now its duty-free status made it the place to both shop and find one's next ship. Aden was gateway to Africa; from Africa it was gateway to Europe. To Sister Mary Joseph Praise it looked like the gateway to hell.

The city was at once dead and yet in continuous motion, like a blanket of maggots animating a rotting corpse. She fled the main street and the stultifying heat for the shade of narrow alleyways. The buildings looked hewn from volcanic rock. Pushcarts loaded impossibly high with bananas, with bricks, with melons, and even one carrying two lepers weaved through the pedestrian traffic. A veiled, stooped old woman walked by with a smoldering charcoal stove on her head. No one glanced at this strange sight, saving their stares instead for the brown-skinned nun walking in their midst. Her uncovered face made her feel stark naked.

After an hour during which she felt her skin puffing up like dough in an oven, after being directed this way and that, Sister Mary Joseph Praise arrived before a tiny door at the end of a slitlike passage. On the rock wall was a pale outline of a signboard recently removed. She offered a silent prayer, took a deep breath, and knocked. A man yelled in a hoarse voice, and Sister Mary Joseph Praise interpreted the sound as invitation to enter.

Seated on the floor next to a shiny balancing scale, she saw a shirtless Arab. All around him, reaching to the ceiling, were great bales of bundled leaves.

The hothouse scent stifled her breathing. It was a new scent for her, this scent of khat: partly cut grass, yet with something spicier behind it.

The Arab's beard was so red with henna she thought hed bled into it. His eyes were lined like a woman's, reminding her of depictions of Salahuddin, who'd kept the Crusaders from taking the Holy Land. His gaze took in the young face imprisoned in the white wimple, and then those hooded eyes fell to the Gladstone bag in her hand. A heave of his body produced a vulgar laugh through gold-trimmed teeth, a laugh which he cut off when he saw the nun was about to collapse. He sat her down, sent for water and tea. Later, in a mixture of sign language and bastardized English, he communicated to her that the Belgian nun who'd lived there had died suddenly. When he said that, Sister Mary Joseph Praise began shivering again, and she felt a deep foreboding, as if she could hear death's footsteps rustling the leaves in that hothouse. She carried a picture of Sister Beatrice in her Bible, and she could see that face in her mind's eye, now metamorphosing into a death mask, and then to Anjali's face. She forced herself to meet the man's gaze, to challenge what he said. Of what? Who asks “of what” in Aden? One day you are well, your debts are paid, your wives are happy, praise Allah, and the next day the fever gets you, and if it opens your skin up to the heat which your skin has fought off all these years, you die. Of what? Of what doesn't matter. Of bad skin! Of pestilence! Of bad luck, if you like. Of good luck, even.

The building was his. Green khat stalks flashed in his mouth as he spoke. The old nun's God had been unable to save her, he said, looking up to the ceiling and pointing, as if He were still crouching there. Sister Mary Joseph Praise's eyes involuntarily followed his gaze, before she caught herself. Meanwhile, his muddy eyes dropped from the ceiling to her face, to her lips, and to her bosom.

IF I KNOW THIS MUCH about my mother's voyage, it's because it came from her lips to the ears of others and then to mine. But her tale stopped in Aden. It came to an abrupt halt in that hothouse.

What is clear is that she embarked on her journey with faith that God approved of her mission and would provide for and protect her. But in Aden, something happened to her. No one knew what exactly. But it was there that she understood that her God was also a vengeful and harsh God and could be so even to His faithful. The Devil had shown himself in Sister Anjali's purple, contorted death mask, but God had allowed that. She considered Aden an evil city, where God used Satan to show her how fragile and fragmented the world was, how delicate the balance between evil and good, and how naïve she was in her faith. Her father used to say, “If you want to make God laugh, tell him your plans.” She felt pity for Saintly Amma, whose dream of enlightenment for Africa was vanity that cost Anjali's life.

For the longest time all I knew was this: after an unknown period of time that could have been months or even a year, my mother, aged nineteen, somehow escaped Yemen, then crossed the Gulf of Aden, then went overland perhaps to the walled and ancient city of Harrar in Ethiopia, or perhaps to Djibouti, then from there by train she entered Ethiopia via Dire Dawa and then on to Addis Ababa.

I know the story once she arrived at Missing Hospital. There were three spaced knocks on the door to Matron's office. “Come in,” Matron said, and with those two words Missing was on a course different than anyone could have imagined. It was at the start of the short rains, when Addis was stunned into wet submission, and when after hours and days of the sound and sight of water, one began hearing and seeing things. Matron wondered if that explained this vision of a beautiful, brown-skinned nun, standing, but just barely, in the doorway.

The young woman's recessed, unblinking brown eyes felt like warm hands on Matron's face. The pupils were dilated, as though, Matron would think later, the horror of the journey was still fresh. Her lower lip was ripe, as if it might burst at the touch. Her wimple, cinched at the chin, imprisoned her features in its oval, but no cloth could restrain the fervor in that face, or conceal the hurt and confusion. Her gray-brown habit must have once been white. But, as Matron's eyes traveled down the figure, she saw a fresh bloodstain where the legs came together.

The apparition was painfully thin, swaying, but resolute, and it seemed a miracle that it was capable of speech, when it said in a voice heavy with fatigue and sadness: “I desire to begin the time of discernment, the time of listening to God as He speaks in and through the Community. I ask for your prayers that I may spend the rest of my life in His Eucharistic Presence and prepare my soul for the great day of union between bride and Bridegroom.”

Matron recognized the litany of a postulant entering the order, words she herself had uttered so many years ago. Matron replied automatically, just as her Mother Superior had done, “Enter into the joy of the Lord.”

It was only when the stranger slumped against the doorpost that Matron came out of her trance, running around her desk to grab her. Hunger? Exhaustion? Menstrual blood loss? What was this? Sister Mary Joseph Praise weighed nothing in Matron's arms. They took the stranger to a bed. Under the veil, the wimple, and habit they found a delicate wicker-basket chest and a scooped out belly. A girl! Not a woman. Yes, a girl whod only just bid good-bye to childhood. A girl with hair that was not cut short like that of most nuns but long and thick. A girl with (and how could they not notice?) a precocious bosom.

Every maternal instinct in Matron came alive, and she kept vigil. She was there when the young nun woke up in the night, terrified, delirious, clinging to Matron once she knew she was in a safe place. “Child, child, what happened to you? It is all right. You are safe now.” With such soothing words, Matron comforted her, but it was a week before the young nun slept alone and another week before the color returned to her face.

When the short rains ended, and when the sun turned its face to the city as if to kiss and make up and say it was after all its favorite city for which it had reserved its most blessed, cloud-free light, Matron led Sister Mary Joseph Praise outdoors. She was to introduce her to the Missing People. The two of them entered Operating Theater 3 for the first time, and an astonished Matron watched as the stern and serious expression of her new surgeon, Thomas Stone, crumbled into something akin to happiness at the sight of Sister Mary Joseph Praise. He was blushing, taking her hand in his and crushing it till tears came to the young nun's eyes.

My mother must have known then that she would stay in Addis Ababa forever, stay in Missing Hospital and in the presence of this surgeon. To work for him, for his patients, to be his skilled assistant, was sufficient ambition, and it was an ambition without hubris, and God willing, it was something she could reasonably do. A return journey to India through Aden was too difficult to contemplate.

In the ensuing seven years that she lived and worked at Missing Hospital, Sister Mary Joseph Praise rarely spoke about her voyage and never about her time in Aden. “Whenever I brought up Aden,” Matron said, “your mother would glance over her shoulder, as if Aden or whatever it was she left behind had caught up with her. The dread and terror on her face made me loath to ask again. But it scared me, I'll tell you. All she said was, ‘It was God's will that I come here, Matron. His reasons are unknowable to us.’ There was nothing disrespectful about that answer, mind you. She believed that her job was to make her life something beautiful for God. He had led her to Missing.”

Such a crucial gap in the history, especially that of a short life, calls attention to itself. A biographer, or a son, must dig deep. Perhaps she knew that the side effect of such a quest was that I'd learn medicine, or that I would find Thomas Stone.

SISTER MARY JOSEPH PRAISE began the task of the rest of her days when she entered Operating Theater 3. She scrubbed and gloved and gowned and stood across the table from Dr. Stone as his first assistant, pulling on the small retractor when he needed exposure, cutting the suture when he presented the ends to her, and anticipating his need for irrigation or suction. A few weeks later, when the scrub nurse couldn't be there, my mother filled in as scrub nurse and first assistant. Who knew better than a first assistant when Stone wanted a scalpel for sharp dissection, or when gauze wrapped around his finger would do. It was as if she had a bicameral mind, allowing one half to be scrub nurse, shuttling instruments from the tray to his fingers, while the other side served as Stone's third arm, lifting up the liver, or holding aside the omentum, the fatty apron that protected the bowels, or with a fingertip pushing down edematous tissue just enough for Stone to see where his needle was to take a bite.

Matron would peek in to watch. “Pure ballet, my dear Marion. A heavenly pair. Totally silent,” Matron said. “No asking for instruments or saying ‘Wipe,’ ‘Cut,’ or ‘Suction.’ She and Stone … You never saw anything quicker. I suspect that we slowed them down because we couldn't get people off and on the table quickly enough.”

For seven years Stone and Sister Mary Joseph Praise kept the same schedule. When he operated late into the night and into the morning, she was across from him, more constant than his own shadow, dutiful, competent, uncomplaining, and never absent. Until, that is, the day when my brother and I announced our presence in her womb and our unstoppable desire to trade the nourishment of the placenta for the succor of her breasts.

2. The Missing Finger

THOMAS STONE HAD a reputation at Missing for being outwardly quiet but intense and even mysterious, though Dr. Ghosh, the hospital's internal medicine specialist and jack-of-all-trades, disputed that last label, saying, “When a man is a mystery to himself you can hardly call him mysterious.” His associates had learned not to read too much into Stone's demeanor, which a stranger might think was surly when in fact he was painfully shy. Lost and clumsy outside it, inside Operating Theater 3 he was focused and fluid, as if it was only in the theater that body and soul came together, and where the activity within his head matched the terrain outside.

As a surgeon, Stone was famous for his speed, his courage, his daring, his boldness, his inventiveness, the economy of his movements, and his calmness under duress. These were skills that he'd honed on a trusting and uncomplaining population, briefly in India, and then in Ethiopia. But when Sister Mary Joseph Praise, his assistant for seven years, went into labor, all these qualities vanished.

On the day of our birth, Thomas Stone had been standing over a young boy whose belly he was about to open. He held his hand out, palm up, fingers extended to receive the scalpel in that timeless gesture that would forever be the measure of his days as a surgeon. But for the first time in seven years, steel had not slapped into his palm the instant his fingers opened; indeed, the diffident tap told him someone other than Sister Mary Joseph Praise stood across from him. “Impossible,” he said when a contrite voice explained that Sister Mary Joseph Praise was indisposed. In the preceding seven years there hadn't been a time when he'd stood there without her. Her absence was as distracting and maddening as a bead of sweat about to fall into his eye when he was operating.

Stone didn't look up as he made his keyhole incision. Skin. Fat. Fascia. Split the muscle. Then, using blunt dissection, he exposed the glistening peritoneum, which he incised. His finger slithered into the abdominal cavity through this portal and rooted for the appendix. Still, with each step, he had to wait for a fraction of a second, or wave off the proffered instrument in favor of another. He worried about Sister Mary Joseph Praise even if he was unaware that he was worrying, or unwilling to admit it.

He summoned the probationer, a young, nervous Eritrean girl. He asked her to seek out Sister Mary Joseph Praise and remind her that doctors and nurses couldn't afford the luxury of being ill. “Ask her”— the terrified probationer's lips were moving as she tried to by-heart his message—”kindly ask her, if …” His eyes were free to look at the probationer, since his finger was now sounding the boy's insides better than any pair of eyes. “… if she recalls that I returned to the operating theater the very next day after performing a ray amputation on my own finger?”

That event took place five years before and was an important milestone in Stone's life. His own curved needle on a holder had nicked the pulp of his right index finger while he worked in a pus-filled belly. He'd immediately stripped off his glove, and with a hypodermic needle, he had injected acriflavine, precisely one milliliter of a solution diluted 1:500, down the tiny track the errant needle had traveled. Then he'd infiltrated the fluid into the surrounding tissue as well. The orange dye transformed the digit into an oversize lollipop. But despite these measures, in just hours a creeping red wave extended down from the fingertip and into the tendon sheath in the palm. Despite oral sulfatriad tablets and, later, at Ghosh's insistence, injection of precious penicillin into his buttocks, scarlet streaks (which were the hallmark of streptococcal infection) showed at his wrist, and the epitrochlear lymph node behind the elbow became as big as a golf ball. The rigors had made his teeth chatter and the bed shake. (This later became an aphorism in his famous textbook, a Stonism as readers called it: “If the teeth chatter it is a chill, but if the bed shakes it is a true rigor.”) He had made a quick decision: to amputate his own finger before the infection spread farther, and to do the operation himself.

The probationer waited for the rest of his message, while Stone drew the wormlike appendix out of the incision and straightened up like a fisherman who'd reeled his quarry onto the deck. The few bleeders Stone snapped off with hemostats, like a marksman firing at pop-up ducks, while also clamping off the blood vessels to the appendix. He tied these off with catgut, his hands a blur, until all the dangling hemostats were removed.

Stone held up his right hand for the probationer's inspection. Five years after the amputation, the hand looked deceptively normal, though on closer study the index finger was missing. The key to this aesthetically pleasing result was that the metacarpal head—the knuckle of the missing finger—had been cut away, too, so that no stump was visible in the V between thumb and middle finger. It was as if the fingers had simply moved over one notch. Four-fingered custom gloves added to the illusion of normalcy. Far from being a disadvantage, his hand could negotiate crevices and tissue planes that others could not, and his middle finger had developed the dexterity of an index finger. That, together with the fact that his middle finger was longer than his former index finger, meant he could tease an appendix out from its hiding place behind a cecum (the beginning of the large bowel) better than any surgeon alive. He could secure a knot in the deepest recess of the liver bed with just his fingers, where other surgeons might resort to a needle holder. In later years, in Boston, he famously punctuated his admonishment to his interns of “Semper per rectum, per anum salutem, if you don't put your finger in it, you'll put your foot in it,” by holding up the former middle finger, now elevated to the status of index finger.

Those who trained with Stone never overlooked the rectal exam on their patient, not just because Stone had drilled into their heads that most colon cancers are in the rectum or sigmoid, many within reach of the examining finger, but also because they knew they'd be fired for this omission. Years later in America, a story circulated about one of Stone's trainees, a man named Blessing, who, after examining a drunk in the emergency room and taking care of whatever the problem was, returned to his call room. As he was about to sleep, he remembered that he hadn't done a rectal exam. Guilt and fear that his chief would somehow discover his lapse moved him to get up and go out into the night. Blessing tracked the patient down to a bar, where for the price of a beer the man agreed to drop his pants and be digitally examined—be “blessed” as the event came to be described—and only then was the young doctor's conscience eased.

THE PROBATIONER IN Operating Theater 3 on the day of Sister Mary Joseph Praise's labor and our birth was a pretty—no, a beautiful— young Eritrean girl. Sadly, her humorless intensity, the dedication she showed to her training, made people forget her youth and her looks.

The probationer hurried off to find my mother, not pausing to question the propriety of the message she carried to Sister Mary Joseph Praise. Stone, of course, would never have imagined the message might be hurtful. As is so often the case with shy yet talented people, Stone was generally forgiven what Dr. Ghosh called his social retardation. The glaring gaps that in a bowel repair could have been fatal were overlooked when they occurred in such a personality; they weren't an impediment to him, only an irritation to others.

At the time of our birth the probationer was not yet eighteen, with a tendency to confuse penmanship and keeping a neat medical record (and thereby pleasing Matron) with the actual care of patients.

Being seniormost of the five probationers in Missing's nursing school had been a matter of pride for her, and most days she managed to push to the back of her mind the fact that her seniority was only because she was repeating her year, or, as Dr. Ghosh put it, because she was “on the long-term plan.”

Orphaned as a child by smallpox, which had also left a faint lunar landscape on her cheeks, the probationer had from a young age addressed her self-consciousness by becoming excessively studious, a trait encouraged by the Italian nuns, the Sisters of the Nigrizia (Africa), who raised her in the orphanage in Asmara. The young probationer displayed her studiousness as if it were not merely a virtue but a God-given gift, like a beauty spot or a supernumerary toe. What promise she'd shown in those early years, sailing through church school in Asmara, skipping grades, speaking fluent official Italian (as opposed to the bar-and-cinema version spoken by many Ethiopians, in which prepositions and pronouns were dispensed with altogether), and able to recite even her nineteen-times table.

You could say the probationer's presence at Missing was an accident of history. Her hometown of Asmara was the capital city of Eritrea, a country which had been an Italian colony from as far back as 1885. The Italians under Mussolini invaded Ethiopia from Eritrea in 1935, with the world powers unwilling to intercede. When Mussolini threw his lot in with Hitler, his fate was sealed, and by 1941, Colonel Wingate's Gideon Force had defeated the Italians and liberated Ethiopia. The Allies gave Emperor Haile Selassie of Ethiopia a most unusual gift: they tacked on the very old Italian colony of Eritrea as a protectorate of newly liberated Ethiopia. The Emperor had lobbied hard for just this, so that his landlocked country could have the seaport of Massawa, not to mention the lovely city of Asmara. The British perhaps wanted to punish the Eritreans for their long collaboration with the Italians; Eritrean askaris, thousands of them, were part of the Italian army and had fought their black neighbors and died alongside their white masters.

For the Eritreans to have their lands handed to Ethiopia was an unimaginable wound, akin to giving liberated France to England merely because the people of both countries were white and ate cabbage. When, a few years later, the Emperor annexed the land, the Eritreans at once began a guerrilla war for their liberation.

But there were some advantages to Eritrea being part of Ethiopia: the probationer won a scholarship to the country's only nursing school in Addis Ababa, at Missing Hospital, the first young person from Eritrea to be so rewarded. The trajectory of her scholastic progress to that point was spectacular and unprecedented, a model for all youth; it was also an invitation to fate to stick a foot out and trip her.

Yet it wasn't fate that stymied the probationer when she came to her clinical years, and it wasn't her clumsiness with the Amharic language, or with English, since she soon overcame these obstacles and became fluent. She discovered that memorization (“by-hearting,” as Matron called it) was of no help to her at the bedside, where she struggled to distinguish the trivial from the life threatening. Oh yes, she could and did recite the names of the cranial nerves as a mantra to calm her own nerves. She could rattle off the composition of mistura carminativa (one gm of soda bicarb, two ml each of spirit of ammonia and tincture cardamom, point six ml of tincture of ginger, one ml of spirit of chloroform, topped off with peppermint water to thirty ml) for dyspepsia. But what she couldn't do, and it annoyed her to see how effortlessly her fellow probationers could, was develop the one skill Matron said she lacked: Sound Nursing Sense. The only reference to this in her textbook was a statement so cryptic, more so after she memorized it, that she'd begun to think it was put there to antagonize her:

Sound Nursing Sense is more important than knowledge, though knowledge only enhances it. Sound Nursing Sense is a quality that cannot be defined, yet is invaluable when present and noticeable when absent. To paraphrase Osler, a nurse with book knowledge but without Sound Nursing Sense is like a sailor at sea in a seaworthy vessel but without map, sextant, or compass. (Of course, the nurse without book knowledge has not gone to sea at all!)

The probationer had at least gone to sea—she was sure of that. She was determined to prove that she did have map and compass, and so she would regard every assignment as a test of her skills, an opportunity to display Sound Nursing Sense (or to hide the lack of it).

SHE RAN AS IF jinn were chasing her, through the sheltered walkway between the theater and the rest of the hospital. Patients and relatives of those being operated on that day were squatting or sitting cross-legged on either side of her path. A barefoot man, his wife, and two small children shared a meal, dipping fingers into a bowl lined with injera on which a lentil curry had been poured, while an infant, all but hidden by the mother's shama, suckled at the breast. The family turned in alarm as she ran by, and it made her feel important. Across the yard she could see women in white shamas and bright red and orange head scarves crowding the outpatient benches, looking at that distance like hens in a chicken coop.

In the nurses’ quarters she ran up the stairs to my mother's room. When she knocked there was no answer, but the door was unlocked. In the darkened room she saw Sister Mary Joseph Praise under the covers, her face turned toward the wall. “Sister?” she called softly, and when my mother moaned, the probationer took that to mean she was awake. “Dr. Stone sent me to tell you …” She felt relieved to have remembered all the parts of the message. She waited for a response, and when my mother didn't volunteer one, the probationer imagined that my mother might be annoyed with her. “I only came because Dr. Stone sent me. I'm sorry to disturb you. I hope you feel better. Do you need anything?” She waited dutifully, and after a while, she eased out of the room. Since there was no return message for Dr. Stone, and since her pediatric nursing class was about to start, she did not return to Theater 3.

IT WAS EARLY AFTERNOON by the time Stone went to the nurses’ quarters. He had finished the appendectomy, then two gastro-jejunostomies for peptic ulcer, three hernia repairs, one hydrocele, a subtotal thyroid resection, and a skin graft, but by his standards it had been tortuously slow. An ordeal. With knitted brow he ascended the stairs. He understood that his swiftness as a surgeon depended to a large degree—more than hed ever imagined—on the skills of Sister Mary Joseph Praise … Why did he have to think about these things? Where was she? That was the point. And when would she be back?

There was no answer when he knocked. It was the corner room on the second floor. The compounder's wife came charging up to protest this trespass by a male. Though Matron and Sister Mary Joseph Praise were the only nuns at Missing, the compounder's wife acted as if she had been denied her true calling. With a sash low over her brow and a crucifix as big as a revolver, she looked like a nun. She considered herself a quasi warden of the nurses’ hostel, the keeper of the Missing virgins. She had a spider's sense for a male footstep, an incursion into her territory. But now, seeing who it was, she backed away.

Stone had never been inside Sister Mary Joseph Praise's room. When she typed or worked on the illustrations for his manuscripts, she came to his quarters or to his office adjoining the clinic.

He turned the handle, calling out, “Sister? Sister!” He was met by a miasma at once familiar and alarming, but he couldn't place it.

He groped for the switch and swore when it eluded him. He stumbled to the window, bumping into a chest of drawers. He swung the glass-paned portion of the window in, and then pushed back the wooden shutters. Daylight flooded the narrow room.

On top of the chest of drawers was a heavy mason jar that drew the sun's rays. The amber fluid within reached all the way to the chunky lid which was sealed with wax. At first he thought the jar might hold a relic, an icon. A carpet of gooseflesh swept down his arms, as if recognition came to his body before it came to his brain. There, suspended in the fluid, the nail delicately pivoting on the glass bottom like a ballerina on tiptoe, was his finger. The skin below the nail was the texture of old parchment, while the underbelly displayed the purple discoloration of infection. He felt a longing, an emptiness, and an itch in his right palm which only that missing finger could relieve.

“I didn't know—” he said turning to her bed, but what he saw made him forget what he was going to say.

Sister Mary Joseph Praise lay in agony on her narrow cot. Her lips were blue. Her lusterless eyes were focused beyond his face. She was deathly pale. He reached for her pulse, which was rapid and feeble. An uninvited memory from the Calangute voyage of seven years before came flooding over him: he recalled the feverish and comatose Sister Anjali. A cold sensation spread from his belly to his chest. He was overcome by an emotion that as a surgeon he had rarely experienced: fear.

His legs could no longer support him.

He fell to his knees by her bed. “Mary?” he said. He could do nothing but repeat her name. From his lips, Sister Mary Joseph Praise's name sounded like an interrogation, then an endearment, then a confession of love spun out of one word. Mary? Mary, Mary! She did not, could not, answer.

An old man's palsy overtook his hands as they reached for her face. He kissed her forehead. In that extraordinary and unstoppable act he realized, not without a twinge of pride, that he loved her, and that he, Thomas Stone, was not only capable of love, but that he had loved her for seven years. If he'd been blind to his love, perhaps it was because it had happened as soon as he met her on those slippery stairs, it had happened when she had nursed him, bathed him, tried to revive him on the Calangute. It had happened when she'd held him in her arms and wrestled and dragged his dead weight to a hammock and then spoon-fed life back into him. It had happened as they crouched over Sister Anjali's body. But love reached its apogee when Sister Mary Joseph Praise came to work alongside him in Ethiopia, and then it had never wavered. Love so strong, without ebb and flow or crests and troughs, indeed lacking any sort of motion so that it had become invisible to him these seven years, part of the order of things outside his head which he had taken for granted.

Did Mary love him? Yes. Of this he felt certain. She had loved him, but following his cue—always following his cue—she'd said nothing. And what had he done all these years? Only taken her for granted. Mary, Mary, Mary. Even the sound of her name was a revelation to him since he'd never called her anything but Sister. He was sobbing, terrified of losing her, but that, too, he saw was his selfishness, his need for her manifesting itself again. Would he have the chance to make amends? How stupid could a man be?

Sister Mary Joseph Praise barely registered his touch. Her cheek was hot against his. He lifted the sheet. A generous swelling of her belly met his eyes.

It was an axiom of his that any swelling in a woman's abdomen was a pregnancy until proven otherwise. But his mind overrode that thought, refusing to consider it—this was a nun, after all. Instead he came to a snap diagnosis of bowel obstruction … or free fluid in the peritoneal cavity … or hemorrhagic pancreatitis … some sort of abdominal catastrophe …

Maneuvering through the door frame, then trying not to bump her feet on the banister, his sobs changing to grunts of effort, he carried her out from her quarters, and then down the path to the operating theater. She felt heavier to Stone than she had a right to be.

There was a question the chief examiner had posed to him when he appeared for the Royal College of Surgeons viva voce after passing his written examinations in Edinburgh: “What first-aid treatment in shock is administered by ear?” His answer “Words of comfort!” had won the day. But now, in place of reassuring and soothing words that would have been humane and therapeutic, Stone yelled for help at the top of his voice.

His shouts, taken up by the keeper of the virgins, brought everyone including Gebrew the watchman, who came running from the front gate, along with Koochooloo and two other unnamed dogs at her heels.

The sight of the blubbering, helpless Stone shocked Matron just as much as the sight of Sister Mary Joseph Praise's terrible state.

Lord, he's done it again, was Matron's first thought.

It was a well-kept secret that Stone had on three or four occasions since his arrival at Missing gone on a drunken binge. For a man who rarely drank, who loved his work, who found sleep a distraction, who had to be reminded to go to bed, these episodes were mystifying. They came with the suddenness of influenza and the terror of possession. The first patient on the morning list would be on the table, ready to be put under, but there'd be no sign of Stone. When they went looking for him the first time they found a babbling, disheveled white man, pacing in his quarters. During these episodes he did not sleep or eat, slipping out in the dead of night to replenish his supplies of rum. On the last occasion this creature had climbed the tree outside its window and perched there for hours, muttering like a cross hen. A fall from that height would have cracked its skull. Matron, when she had seen those bloodshot, mongoose eyes staring down at her, fled, leaving Sister Mary Joseph Praise and Ghosh to keep vigil and to try to talk him down, get him to eat, to stop drinking.

As abruptly as it started, in two days, no more than three, the spell would be over, and after a very long sleep Stone would be back at work as if nothing had happened, never making any reference to how he'd inconvenienced the hospital, the memory of it erased. No one ever brought it up to him because the other Stone, the one who rarely drank, would have been hurt and insulted by such inquiry or accusation. The other Stone was as productive as three full-time surgeons, and so these episodes were a small price to pay

Matron came closer. Stone's eyes were not bloodshot and he didn't reek of spirits. No, he was unhinged by Sister Mary Joseph Praise's condition, and rightly so. As Matron turned her attention from Stone to Sister Mary Joseph Praise, she nevertheless felt a ghost of satisfaction: at last the man had bared his soul, displayed his feelings for his assistant.

Matron ignored Stone's ramblings about volvulus or ileus or pancreatitis or tuberculous peritonitis. “Let's go to the theater,” she said, and when they were there, she said, “Lay her on the operating table.”

He set her down and Matron saw a sight she had seen seven years before: blood soaked Sister Mary Joseph Praise's dress in the region of her pubis. Matron's mind raced back to Sister Mary Joseph Praise's first arrival from Aden, and how blood on her habit then had caused similar concern. Matron had never asked the nineteen-year-old, point-blank, what caused the bleeding. The irregularity of the stain on that occasion had invited the observer to read meaning in its shape. Matron's imagination had constructed so many scenarios to explain that mystery. In the ensuing years, memory had changed the event from mysterious to mystical.

Which was why Matron now glanced at Sister Mary Joseph Praise's palms and breast as Stone laid her down, as if she half expected to see bleeding stigmata, as if that first mystery had grown into this second mystery. But no, the only blood was at the vulva. Lots of blood. With dark clots. And bright red rivulets that ran down the thighs. Matron had no doubt, as blood dripped to the floor: this time it was secular bleeding.

Matron seated herself between Sister Mary Joseph Praise's legs, willfully ignoring the stomach swelling that loomed in front of her. The labia were engorged and blue, and when Matron slid her gloved finger in, she found the cervix fully dilated.

Of blood there was much too much. She swabbed and dabbed and pulled down on the posterior vaginal wall for a better view. When a piteous sigh emerged from her patient's lungs, Matron almost dropped the speculum. Matron's chest was pounding, her hands shaking. She leaned forward, tilted her head again to peer in. There, like a rock at the bottom of a mud pit, a stone of the heart, was a baby's head.

“Lord, she's,” Matron said, when she could finally speak, gasping at the sacrilegious word that threatened to choke her and which her mouth could no longer contain, “pregnant.”

Every observer I later talked to remembers this moment in Theater 3, when the air stood still, when the loud clock across from the table froze and a long, silent pause followed.

“Impossible!” said Stone, for the second time that day, and even though it was incorrect and hardly the thing to say, it allowed them all to breathe again.

But Matron knew she was right.

She would have to deliver this baby. Dr. K. Hemlatha—Hema to all of them—was out of station.

Matron had delivered hundreds of babies. She reminded herself of this now to try and keep herself from panic.

But how was she to push away not just her qualms but her confusion? One of her own, a bride of Christ—pregnant! It was unthinkable. Her mind refused to digest this. And yet the evidence—an infant's skull— was there, right before her eyes.

The same thought distracted the scrub nurse, the barefoot orderly, and Sister Asqual, who was the nurse anesthetist. It caused them to trip over one another and knock down an intravenous drip as they scurried around the table, readying the patient. Only the probationer, who was mortified that she had failed that morning to recognize this crisis when she visited Sister Mary Joseph Praise, didn't stop to wonder how Sister Mary Joseph Praise got pregnant.

Matron's heart felt as if it might gallop right out of her chest. “Lord, what worse circumstance can you construct for a delivery? A pregnancy that's a mortal sin. A mother-to-be who is like my own daughter. Massive bleeding, ghostly pallor …” And all this when Hema, Missing's only gynecologist, not only the best in the country, but the best Matron had ever seen, was away.

Bachelli up in the Piazza was marginally competent in obstetrics but unreliable after two in the afternoon, and his Eritrean mistress was deeply suspicious of him leaving on “house calls.” Jean Tran, the half-French, half-Vietnamese fellow in Casa Popolare, did a bit of everything and smiled a lot. But assuming they could be reached, it would still be a while before either man would come.

No, Matron had to do this herself. She had to forget the implications of the pregnancy. She had to breathe, concentrate. She had to conduct a normal delivery.

But that afternoon and evening, normal would elude them.

STONE STOOD BY, his mouth open, looking to Matron for direction, while Matron sat facing the vulva, waiting for the baby to descend. Stone alternately crossed his hands in front of him and then dropped them by his sides. He could see Sister Mary Joseph Praise's pallor increasing. And when Nurse Asqual in a panicked voice called out the blood pressure— “systolic of eighty palpable”—Stone wobbled as if he might faint.

Despite uterine contractions which Matron could feel through the belly and see in Sister Mary Joseph Praise's contorted face, and despite the fact that the cervix was wide open, nothing happened. A baby's head high up in the birth canal with the cervix flattened like a gasket around it always reminded Matron of the shaved scalp of a bishop. But this bishop was staying put. And meanwhile, such bleeding! A dark and messy pool had formed on the table and tidal eddies of blood came out of the vagina. Blood was to delivery rooms and operating theaters what feces were to tripe factories, but even so it seemed to Matron that this was a lot of blood coming out.

“Dr. Stone,” Matron said, her lips quivering. A bewildered Stone wondered why she was calling on him.

“Dr. Stone,” she said again. For Matron, Sound Nursing Sense meant a nurse knowing her limits. For God's sake, she needs a Cesarean section. But she didn't say those words because with Stone it could have the opposite effect. Instead, her voice low, her head drooping, Matron pushed down on her thighs to bring herself to her feet and to vacate her spot between Sister Mary Joseph Praise's legs.

“Dr. Stone. Your patient,” she said to the man who everyone believed to be my father, putting in his hands not only the life of a woman that he chose to love, but our two lives—mine and my brother's—which he chose to hate.

3. The Gate of Tears

WHEN SISTER MARY JOSEPH PRAISE felt the herald cramps of labor, Dr. Kalpana Hemlatha, the woman I would come to call my mother, was five hundred miles away and ten thousand feet in the air. Off the starboard wing of the plane Hema had a beautiful view of Bab al-Mandab—the Gate of Tears—so named because of the innumerable ships that had wrecked in that narrow strait that separated Yemen and the rest of Arabia from Africa. At this latitude, Africa was just the Horn: Ethiopia, Djibouti, and Somalia. Hema traced the Gate of Tears as it widened from a hairline crack to become the Red Sea, spooling north to the horizon.

As a schoolgirl studying geography in Madras, India, Hema had to mark where coal and wool were produced on a map of the British Isles. Africa figured in the curriculum as a playground for Portugal, Britain, and France, and a place for Livingstone to find the spectacular falls he named after Queen Victoria, and for Stanley to find Livingstone. In future years, as my brother, Shiva, and I made the journey with Hema, she would teach us the practical geography she had taught herself. She'd point down to the Red Sea and say, “Imagine that ribbon of water running up like a slit in a skirt, separating Saudi Arabia from Sudan, then farther up keeping Jordan away from Egypt. I think God meant to snap the Arabian Peninsula free of Africa. And why not? What do the people on this side have in common with the people on the other side?”

At the very top of the slit a narrow isthmus, the Sinai, thwarted God's intention and kept Egypt and Israel connected. The man-made Suez Canal finished the cut and allowed the Red Sea to connect with the Mediterranean, saving ships the long journey around the Cape. Hema would always tell us that it was over the Gate of Tears that she had the awakening that would change her life. “I heard a call when I was in that plane. When I think back, I know it was you.” That rattling, airborne tin can always seemed an improbable place for her epiphany.

HEMA SAT ON THE WOODEN BENCH SEATS that ran lengthwise on both sides of the ribbed fuselage of the DC-3. She was unaware of how badly her services were needed just then at Missing, the hospital where she had worked for the last eight years. The drone of the twin engines was so loud and unrelenting that half an hour into the flight she felt as if the sound inhabited her body. The hard bench and choppy ride were raising blisters on her behind. Whenever she closed her eyes, she felt as if she were being hauled across a rutted landscape in the back of a bullock cart.

Her fellow travelers on this flight from Aden to Addis Ababa were Gujaratis, Malayalis, French, Armenians, Greeks, Yemenis, and a few others whose dress and speech did not as clearly reveal their origins. As for her, she wore a white cotton sari, a sleeveless off-white blouse, and a diamond in her left nostril. Her hair was parted in the middle and gathered with a clip at the back, and loosely braided below.

She sat sideways looking out. She saw a gray dart below—the shadow cast by the plane on the ocean. A giant fish she imagined was swimming just below the surface of the sea, keeping pace with her. The water looked cool and inviting, unlike the interior of the DC-3, which had grown less steamy but was still thick with the mingled scents of the human freight. The Arabs had the dry, musty smell of a grain cellar; the Asians contributed the ginger and garlic; and from the whites came the odor of a milk-soaked bib.

Through the half-open curtain to the cockpit she could see the pilot's profile. Whenever he turned to glance at his cargo, his bottle-green sunglasses seemed to swallow his face, only his nose poking through. The glasses had been perched up on his forehead when she boarded, and Hema had noted then that his eyes were red like a rodent's. The odor of juniper berry on his breath advertised his fondness for gin. She'd developed an aversion to him even before he opened his mouth to herd his passengers onto the plane, snapping at them—“Allez!”—as if they were subhuman. She bit her tongue then, because this was the man about to take them aloft.

His face and jug ears resembled a figure a child might draw with crayon on butcher paper. But the details were beyond a child: the fine arbor of blood vessels on his cheeks; muttonchop sideburns dyed bootpolish black; the white ring of arcus senilis around his pupils; gray eyebrows that betrayed his pretense at youthfulness. She wondered how a man could look in the mirror and not see the absurdity of his own appearance.

She studied her own reflection in the porthole. Hers was a round face, too, the eyes widely spaced with a doll's pert nose. The red pottu in the center of her forehead stood out. Her cheeks had a Martian tint cast on them by the cobalt-blue water below, and the hint of green in her eyes—unusual for an Indian—was accentuated. “Your gaze encompasses all men, makes your most ordinary glance seem intimate, carnal,” Dr. Ghosh had told her, “as though you are ravishing me with your eyes!” Ghosh was a tease and forgot what he said as soon as the words rolled off his tongue. But this statement of his lingered with her. She thought of Ghosh's fur-covered limbs and shuddered. Body hair was one of her pet dislikes, or so she'd believed. She knew it was a fatal prejudice for an Indian woman. His was like a gorilla coat, the chest tendrils poking out through his vest and peeking up above his shirt collar. “Ravishing? You wish, you lecher,” she said now, smiling as if Ghosh were sitting across from her.

She had to give him this much: if she stared fractionally too long at a man, she attracted more attention than she intended. It was partly why she used spectacles with large wire frames, because she thought they made her eyes seem closer together. She liked the exaggerated Cupid's bow of her upper lip, but not her cheeks, which she felt were too chubby. What to do? She was a big woman. Not fat, but big … Well, maybe a bit fat, and she'd certainly put on a kilo or two or three in India, but how could she help that in the face of a mother's astonishing cooking? Because of my height, I get away with it, she told herself. Wearing a sari helps, of course.

She grunted, remembering how Dr. Ghosh had invented a special term for her: magnified. Years later, when Hindi movies with their song and dance became all the rage in Africa, the ward boys in Addis Ababa would call her Mother India, not in mockery, but in reverence for the tearjerker of the same name starring Nargis. Mother India had run for three straight months at the Empire Theater and then moved to the Cinema Adowa; that, too, without the benefit of subtitles. The ward boys could be heard singing “Duniya Mein Hum Aaye Hain”—”We've Arrived in This World”—though they didn't understand a word of Hindustani.

“And if I'm magnified, what term shall we apply to you?” she said, carrying on the imaginary conversation, surveying her old friend from head to foot. He was not a conventionally good-looking man. “How about ‘alien’? I mean it as a compliment. I say ‘alien,’ Ghosh, because you are so unaware of yourself, of your looks. There's a seduction in that for others. Alien becomes beauty. I'm saying this to you because you're not here. To be around someone whose self-confidence is more than what our first glance led us to expect is seductive.”

Mysteriously, during her holidays, Ghosh's name kept popping up in her conversations with her mother. Despite Hema's lack of interest in marriage, her mother was terrified that her daughter would end up with a non-Brahmin, someone like Ghosh. And yet as Hema neared thirty her mother had begun to feel that any husband was better than no husband at all.

“You say he's not handsome? Does he have good color?”

“Ma, he's fair … fairer than me, and he has brown eyes. Bengali, Parsi, and God knows what other influences in those eyes.”

“What is he?”

“He calls himself high-caste Madras mongrel,” she said, giggling. Her mother's frown threatened to swallow her nose, and so Hema had changed the subject.

Besides, it was impossible to construct a Ghosh for someone who'd never met him. She could say that his hair was combed flat and parted in the middle, looking sleek and smart for about ten minutes in the morning, but after that, the hairs broke loose like rioting children. She could say how at any time of the day, even after he had just shaved, black stubble showed under his jaw. She could say that his neck was nonexistent, squashed down by a head shaped like a jackfruit. She could say he just looked short because of a slight belly whose size was exaggerated in the way he leaned back and swayed from side to side as he walked, which drew the eye away from the vertical. Then there was his voice, unmodulated and startling, as if the volume knob had frozen on its highest setting. How could she convey to her mother that the sum total of all this made him not ugly, but strangely beautiful.

Despite the rash on the backs of his hands—a burn, really—his fingers were sensual. The ancient X-ray machine, a Kelley-Koett, had caused the rash. Just thinking of the “Koot” made Hema's blood boil. In 1909, Emperor Menelik had imported an electric chair, having heard the invention would efficiently get rid of his enemies. When he discovered it needed electricity, he simply used it as a throne. Similarly, the big Kelley-Koett had come in the 1930s with an eager American mission group that soon realized that, even though electricity had arrived in Addis Ababa, it was intermittent and the voltage insufficient for such a temperamental beast. When the mission folded, the precious unpacked machine had been simply left behind. Missing lacked an X-ray machine, and so Ghosh reassembled the unit and matched it to a transformer.

No one but Ghosh dared touch the Koot. Cables ran from its giant rectifier to the Coolidge tube, which sat on a rail and could be moved this way and that. He worked the dials and voltage levers until a spark leaped across the two brass conductors, producing a thunderclap. The fiery display had caused one paralyzed patient to leap off the stretcher and run for his life; Ghosh called that the Sturm und Drang cure. He was the Koot's keeper, repairing it, babying it so that three decades after the company went under, the Koot was still operational. Using the fluo-roscopy screen, he studied the dancing heart, or else he defined exactly where a cavity in the lung resided. By pushing on the belly he could establish whether a tumor was fixed to the bowel or abutted on the spleen. In the early years he hadn't bothered with the lead-lined gloves, or a lead apron for that matter. The skin of his probing, intelligent hands paid a visible price.

HEMA TRIED TO IMAGINE Ghosh telling his family about her. She's twenty-nine. Yes, we were classmates at Madras Medical School, but she's a few years younger. I don't know why she never married. I didn't get to know her well till we were interns in the septic ward. She's an obstetrician. A Brahmin. Yes, from Madras. An expatriate, living and working in Ethiopia these eight years. Those were the labels that defined Hema, and yet they revealed little, explained nothing. The past recedes from a traveler, she thought.

Sitting in the plane, Hema closed her eyes and pictured her schoolgirl self with the twin ponytails, the long white skirt, and white blouse under the purple half sari. All Mrs. Hood Secondary School girls in Mylapore had to wear that half sari, really nothing more than a rectangle of cloth to coil around the skirt once and pin on the shoulder. Shed hated it, because one was neither child nor adult but half woman. Her teachers wore full saris while the venerable headmistress, Mrs. Hood, wore a skirt. Hema's protests triggered a lecture by her father: Do you not know how fortunate you are to be in a school with a British headmistress? Do you not know how many hundreds have tried to get in there, offered ten times the money, but were turned down by Miz-Iz-Ood. She goes by merit only. Would you prefer the Madras corporation school? And so, each day she put on the hated uniform, feeling half dressed, and feeling as if she were selling a piece of her soul.

Velu, the neighbor's son whod once been her best friend, but who had turned insufferable at ten, liked to perch on the dividing wall and tease her:

The girls who come from Miz-Iz-Ood, parlez-vous?

The girls who come from Miz-Iz-Ood, parlez-vous?

The girls who come from Miz-Iz-Ood,

Haven't grown their womanhood,

Inky Pinky parlez-vous!

She ignored him. Velu, who was as dark-skinned as she was light, said, “So proud you are of being fair. Monkeys will nibble your sweet flesh thinking it is jackfruit on a jackfruit tree, mind you me!” There she was, eleven years old, setting off for school, dwarfed by her Raleigh bicycle, trading barbs with Velu. Her books were in a tasseled sanji slung over her shoulder, the strap running between her breasts. Already in her posture and in her steady pedal strokes there were signs of a certain immutability.

The bicycle, once so tall and perilous, soon shrunk beneath her. Her breasts thrust out on either side of that sanji strap, and hair sprouted between her legs. (If that was what Velu had meant about not growing her womanhood, she had proved him wrong.) She was a good student, a captain in net ball, a senior prefect, and showing promise in Bharat-natyam, finding in herself a talent for recapitulating a most intricate dance sequence after being shown it just once.

She felt neither an obligation to join the herd nor any urge to try to stand out from it. When a close friend told her she always looked cross, she was surprised and a little thrilled that she could pull off such mis direction. In medical school (in full sari and now riding the bus) this quality grew stronger—not crossness, but independence and misdirection. Some classmates considered her arrogant. She drew others to her like aco lytes only for them to discover she wasn't recruiting. The men needed pliancy in their women friends, and she couldn't bring herself to act coy or silly for their sakes. The couples who huddled in the library behind oversize anatomy atlases and whispered themselves into the notions of love amused her.

I had no time for such silliness. But she did have time for trashy novels set in castles and country houses with heroines named Bernadette. She fantasized about the dashing men of Chillingforest and Lockingwood and Knottypine. That was her trouble then—she dreamed of a greater kind of love than the kind displayed in the library But she was also filled with a nameless ambition that had nothing to do with love. What exactly did she want? It was an ambition that wouldn't let her compete for or seek the same things others sought.

When, as a student at Madras Medical College, Hema had found herself admiring her professor of therapeutics (the lone Indian in a school where, even as independence approached, most of the full professors were British), when she found herself moved by his humanity his mastery of his subject (Face it, Hema; it was a crush), when she found herself wishing to be his understudy and found him encouraging, she deliberately chose another path. She was loath to give anyone that kind of power. She chose obstetrics and gynecology instead of his field, internal medicine. If the professor's field was limitless, requiring a breadth of knowledge that extended from heart failure to poliomyelitis and myriad conditions in between, she chose a field that had some boundaries and a mechanical component—operations. Of these there was a limited repertoire: C-sections, hysterectomies, prolapse repair.

She'd discovered in herself a talent for manipulative obstetrics, becoming expert at divining just how the baby was hung up in the pelvis. What other obstetricians perhaps dreaded, she relished. Blindfolded, she could distinguish the left from the right forceps and apply each in her sleep. She could see in her mind's eye the geometry of each patient's pelvic curve and match that to the curvature of the baby's skull as she slid the forceps in, articulating the two handles and confidently extracting the baby.

She went overseas on a whim. But it broke her heart to leave Madras. She still cried some evenings, picturing her parents taking their chairs outdoors to wait for the sea breeze which, even on the hottest and stillest of days, blew in at dusk. She left because gynecology, at least in Madras, remained a man's domain, and, even on the eve of independence, a British domain, and she had no chance at all for a civil service appointment to the government teaching hospital. It was strange and yet it pleased her to think that she, Ghosh, Stone, and Sister Mary Joseph Praise had all at one time or another trained or worked at the Government General Hospital in Madras. A thousand five hundred beds and twice that number under the beds, between the beds—it was a city by itself. In it Sister Mary Joseph Praise had been a budding novitiate and probationer; perhaps theyd even walked past each other. And incredibly, Thomas Stone, too, had a brief tenure at Government General Hospital, though since the maternity section was quite separate, thered been no reason for his path to cross with Hema's.

Shed left behind Madras, left behind labels of caste, gone so far away that the word “Brahmin” meant nothing. Working in Ethiopia, she tried to make a visit home every third or fourth year. She was returning after her second such visit. Seated in the noisy airplane, she found herself rethinking her choices. In the last few years shed come close to defining the nameless ambition that had pushed her this far: to avoid the sheep life at all costs.

Missing had felt familiar when she first arrived there, not unlike the Government General Hospital in India, but on a much smaller scale: people waiting in line, the families camping out under trees, waiting with the infinite patience of those who have little choice but to wait. Shed been kept busy from her first day. If the truth be known, she secretly relished the emergencies, the situations where her heart was in her mouth, where the seconds ticked off, where a mother's life hung in the balance, or a baby in the womb, deprived of oxygen, needed a heroic rescue. In those moments she did not have existential doubts. Life became sharply focused, meaningful just when she wasn't thinking of meaning. A mother, a wife, a daughter, was suddenly none of these things, boiled down to a human being in great danger. Hema herself was reduced to the instrument required to treat them.

But of late she felt the huge remove between her practice in Africa and the frontiers of scientific medicine epitomized by England and America. C. Walton Lillehei in Minneapolis had just that year begun an era of heart surgery by finding a way to pump blood while the heart was stopped. A vaccine for polio had been developed, though it had yet to make its way to Africa. At Harvard in Massachusetts, a Dr. Joseph Murray had performed the first successful human kidney transplant from one sibling to another. The picture of him in Time showed an ordinary-looking chap, unpretentious. The portrait had surprised Hema, made her imagine that such discoveries were within every doctor's reach, within her reach.

She'd always loved the story of Pasteur's discovery of microbes, or Lister's experiments with antisepsis. Every Indian schoolchild dreamed of being like Sir C. V. Raman, whose simple experiments with light led to a Nobel Prize. But now she lived in a country that few people could find on the map. (“The Horn of Africa, on the upper half, on the eastern coast—the part that looks like a rhino's head and points at India,” she'd explain.) And fewer still knew of Emperor Haile Selassie, or if they remembered him for being Time magazine's Man of the Year in 1935, they didn't remember the country whose cause he pleaded at the League of Nations.

If asked, Hema would have said, Yes, I'm doing what I intended to do; I'm satisfied. But what else could one say? When she read her Surgery, Gynecology & Obstetrics (each month's volume arriving by sea mail weeks after publication, bruised and stained in its brown wrapping), the innovations read like fiction. It was exciting yet deflating, because it was already old news. She told herself that her work, her yeoman contribution in Africa, was somehow connected to the advances described in SG&O. But in her heart she knew that it wasn't.

A NEW SOUND REGISTERED. It was the scrape and rattle of wood on metal. The tail of the plane was packed with two giant wooden crates and stacks of smaller square tea chests, banded with tin strips stamped LONGLEITH ESTATES, S. INDIA. Netting hooked to skeletal struts restrained the cargo from falling on the passengers, but not from sliding around. Her feet and those of her fellow passengers rested on bulging jute sacks. Fading military logos were stenciled on the floor and on the silver fuselage. American troops in North Africa once sat here and contemplated their fate. Patton himself perhaps sat on this plane. Or perhaps this was a relic from the French colonies in Somalia and Djibouti. The carrying of passengers felt like an afterthought for this new airline with its hand-me-down planes and ancient pilots. She could see the pilot arguing into the microphone, gesticulating, pausing to listen to the reply, then barking again. The passengers who were close to the cockpit frowned.

Once again Hema craned her neck to see if her crate with the Grundig was visible, but it wasn't. Every time she thought about her extravagant purchase she felt a pang of guilt. But buying the radio-cum–record player had made the night she spent in Aden almost tolerable. A city built on top of a dormant volcanic crater, hell on earth, that was Aden, but at least it was duty-free. Oh yes, and Rimbaud had once lived there—and never wrote another line of poetry.

Shed picked out the spot for the Grundig in her living room. Most definitely it would have to be under the framed black-and-white print of Gandhi spinning cotton. Shed have to hunt for a quieter location for the Mahatma.

She imagined Ghosh nursing his brandy, and Matron, Thomas Stone, and Sister Mary Joseph Praise drinking sherry or coffee. She pictured Ghosh leaping to his feet as the dazzling opening chords of “Take the ‘A’ Train” poured from the Grundig. Then came the cheeky melody—the last tune in the world that youd have predicted to follow. Those opening chords, though … how they stayed with her. And how she resisted them! She resented the chauvinism of Indians who could only admire things foreign. And yet, she heard those chords in her sleep, found herself humming them during her ablutions. She heard them now in the plane. Strange dissonant notes thrown together, wanting resolution, and somehow they captured America and Science and all that was bold and brash and daring and exciting about America (or at least the way she imagined America to be). Notes pouring out of the skull of a black man whose name was Billy Strayhorn. Stray … horn!

Ghosh had introduced her to jazz and to “Take the ‘A’ Train.” “Wait … watch! See?” he said, the first time she heard the melody after the chords. “You have to smile. You can't help it!” And he was right, the tune was so catchy and upbeat—how fortunate she was that her first introduction to serious Western music should be that tune. Still, shed come to think of it as her song, her invention, and it annoyed her that hed been the one to bring her to it. She laughed at the strangeness of liking Ghosh so much, when she wanted so much to dislike him.

BUT JUST AT THE MOMENT she was thinking these thoughts, anticipating her arrival in Addis Ababa … she found herself suddenly invoking Lord Shiva's name: the plane, the DC-3, the trustworthy camel of the frontier sky, was shuddering as if mortally wounded.

She looked out. The propeller on her side fluttered to a stop, and a puff of smoke came out of the beefy engine cowling.

The plane pitched to starboard and she found herself plastered against the window. All around her passengers screamed, and a thermos flask bounced on the cabin wall, spilling tea as it clattered away. She clutched around for a handhold, but then the plane righted itself and seemed to stop in midair, before beginning a steep descent. No, not a descent, her stomach corrected her—this was a fall. Gravity reached its tentacles out and grabbed the silver cylinder with its cantilevered wings. Gravity promised a water landing. Or, since the plane had wheels, not floats, a water smashing. The pilot was shouting, not in panic, but in anger, and she had no time to think how strange this was.

When, years later, shed look back at this moment of change, look at it clinically (“Milk the history! Exactly when and exactly how did it start? Onset is everything! In the anamnesis is the diagnosis!” as her professor would say), she would see that her transformation actually took place over many months. However, it was only as she was falling out of the sky over the Bab al-Mandab that she understood that change had come.

A LITTLE INDIAN BOY fell on her bosom. He was the son of the only Malayali couple on board—teachers in Ethiopia, no doubt; she could tell that in a single glance. This knock-kneed fellow, five, maybe six, years old in oversize shorts, had clutched a wooden plane in his hand from the moment he came on board, protecting it as if it were made of gold. His foot had become wedged between two jute sacks, and when the plane righted itself, he fell onto Hema.

She held him. His puzzled look collapsed into one of fear and pain. Hema spotted the curve in his shin—like bending a green stick, the bone too young to snap clean. She took all this in even as her body registered that they were plunging, losing altitude.

A young Armenian, bless his practicality scrambled to free the leg. Incredibly, the Armenian was smiling. He tried to tell her something— a reassurance of sorts. She was shocked to see someone calmer than herself when all around the cries of passengers made the situation worse.

She lifted the little boy to her lap. Her thoughts were both clear and disconnected. The leg is already straightening but there is no doubt that it is fractured and the plane is going down. She stopped his stunned parents with an outstretched palm and clamped a hand on the mouth of the wailing mother. She felt the familiar calmness of an emergency, but she understood the falseness of that feeling, now that it was her life at stake.

“Let him be with me,” she said, removing her hand from the woman's face. “Trust me, I'm a doctor.”

“Yes, we know,” the father said.

They squeezed in next to her on the bench. The boy didn't cry; he only whimpered. His face was pale—he was in shock—and he clung to her, his cheek against her bosom.

Trust me, I'm a doctor. She thought it ironic that these would be her last words.

Through the porthole Hemlatha saw the white crests getting closer, looking less and less like lace on a blue cloth. She had always assumed that she would have years to sort out the meaning of life. Now, it seemed she would only have a few seconds, and in that realization came her epiphany.

As she bent over the child she realized that the tragedy of death had to do entirely with what was left unfulfilled. She was ashamed that such a simple insight should have eluded her all these years. Make something beautiful of your life. Wasn't that the adage Sister Mary Joseph Praise lived by? Hema's second thought was that she, deliverer of countless babies, she who'd rejected the kind of marriage her parents wanted for her, she who felt there were too many children in the world and felt no pressure to add to that number, understood for the first time that having a child was about cheating death. Children were the foot wedged in the closing door, the glimmer of hope that in reincarnation there would be some house to go to, even if one came back as a dog, or a mouse, or a flea that lived on the bodies of men. If, as Matron and Sister Mary Joseph Praise believed, there was a raising of the dead, then a child would be sure to see that its parents were awakened. Provided, of course, the child didn't die with you in a plane crash.

Make something beautiful of your life—this whimpering little fellow with his shiny eyes and long eyelashes, his oversize head and the puppy-dog scent of his unruly hair … he was about the most beautiful thing one could make.

Her fellow passengers looked as terrified as she felt. Only the Armenian shook his head at her, and smiled as if to say, This isn't what you think it is.

What an idiot, Hema thought.

An older Armenian—his father perhaps—was impassive, staring straight ahead. The older man had looked morose on boarding and his mood now was no better, and no worse. Hema found herself amazed that she should notice such trivial details at a time like this when, instead of deconstructing faces, she should be bracing for the moment of impact.

As the sea rushed up to meet the plane, she thought of Ghosh. She was shocked when a flood of tender feelings for him overcame her, as if he were about to die in a plane crash, as if his grand adventure in medicine and his carefree days were ending and with it any chance of his achieving the thing he wanted most: to marry Hema.

4. The Five-F Rule

YOUR PATIENT, DR. STONE,” Matron said again, vacating the stool between Sister Mary Joseph Praise's legs. Seeing his face, she wondered if he was about to throw something.

Thomas Stone was an occasional flinger of instruments, though never in front of Matron. It was rare that Sister Mary Joseph Praise ever handed him the wrong implement, but from time to time, a hemostat failed to release with light counterpressure, or a Metzenbaum didn't cut at its tip. He had good aim; one spot on the wall of Operating Theater 3, just above the light switch and perilously close to the glass instrument cabinet, was his usual target.

No one but Sister Mary Joseph Praise took it personally—she would be crestfallen, even though she tested every instrument before she put it in the autoclave. Matron insisted the throwing was a good thing. “Feed him a ratchetless hemostat from time to time,” she said to Sister Mary Joseph Praise. “Otherwise he'll keep it bottled up till it comes oozing out of his ears and we'll have a right mess then.”

The plaster above the light switch had stellate pits and scratches as if a firecracker had gone off there. The strike on the wall occurred after the word “COMPLETELY” and before the word “USELESS!” left his mouth. Once in a great while he exploded at Nurse Asqual, the anesthetist, if the patient were too lightly under or had been given too little curare so that the belly muscles clamped down like a vice on his wrists as he fished inside the abdomen. More than one etherized patient had woken in holy terror hearing Stone bellow, “I'll need a pickax if you can't give me more relaxation down here!”

But at this moment, with Sister Mary Joseph Praise's lips ashen, her breathing shallow, her eyes seeing past him, her unrelenting bleeding, and then with Matron having passed the baton to him, Stone was speechless. He was experiencing the helplessness that patients’ relatives must feel, and he didn't like it in the least bit. His lips trembled and he felt shame at how his wet face displayed his emotions. But more than that he felt fear, and an astonishing paralysis of thought which only shamed him further.

When he finally spoke it was to say in a quavering voice, “Where is Hemlatha? Why isn't she back? We need her,” which was an act of uncharacteristic humility.

He swiped at his eyes using the back of his forearm, a childlike gesture. Matron watched in disbelief: instead of taking the stool she offered, he retreated. Stone walked to the wall that bore the marks of his anger. He struck his head on the plastered surface, a head butt worthy of a mountain goat. His legs wobbled. He clung to the glass cabinet. Matron felt obliged to murmur “Completely useless” on the off chance that if his violence had meaning, God forbid it should fail for lack of its accompanying mantra.

True, Stone could have done a Cesarean section, though, strangely for a tropical surgeon, it was one of the few operations he hadn't done. “See One, Do One, Teach One” was a chapter heading in his textbook, The Expedient Operator: A Short Practice of Tropical Surgery. But what his readers didn't know, and what I learned only many years later, was that he had an aversion to anything gynecological (not to mention anything obstetrical). It stemmed from his final year of medical school, when he did what was unheard of: he bought his very own cadaver so that he could master the anatomy he had already learned so well on a shared cadaver in his first year of medical school. The male poorhouse specimen of his first-year anatomy class had been ancient and shriveled with ghostly muscles and tendons, such being the common tender of Edinburgh anatomy theaters. He'd shared that body with five other students. But he lucked out with the cadaver he purchased in his final year: a well-fed, middle-aged female, a type he associated with the linoleum factories in Fife. Stone's dissection of the hand was so elegant (with just the tendon sheath exposed on the middle finger, while on the ring finger he carried it further to lay open the sheath and show the tendons of flexor sublimis like the wires of a suspension bridge, the profundus tendon coursing between them) that the anatomy professor preserved it to show the first-year students. For weeks Thomas Stone toiled over his cadaver, spending more time with her than he had with any other female save his mother. He felt an ease with her, a fluency that came from intimate knowledge. On one side, he had filleted her cheek to the ear, tying the flap back with sutures to expose the parotid gland and the facial nerve passing through, its branches splayed out like a goose's foot, hence the name pes anserinus. On the other side of the face hed removed all subcutaneous tissue and fat to reveal the myriad muscles of expression whose concerted movements in life had conveyed her sorrow, joy, and every emotion in between. He didn't think of her as a person. She was simply knowledge embodied, embalmed, and personified. Every evening he folded back the muscles and then the skin flaps dangling on narrow hinges, and then he spread the formalin-soaked rags over her to ensheathe her. Sometimes when he fastened the rubber sheet around her and tucked the edges in, it reminded him of his mother's ritual of putting him to bed. Back in his room, his solitude and loneliness always felt more acute.

On the day he removed the bowel to expose the aorta and kidneys, he saw her womb. It wasn't the shriveled purse he expected to find, sunk into the bowl of the pelvis. Instead, it peeked above the pelvic brim. A few days later he turned to the pelvis, his Cunningham's dissection manual open to the new section. He proceeded step by step, marveling at the book's genius as it unpeeled and unroofed and taught as it went. Cunningham's dictated a vertical slice through the front of the uterus and then the operator was to gently pry the uterus open. He did, and out fell a fetus, its head a little bigger than a grape, eyes tightly shut, limbs folded in like an insect. It dangled on the umbilical cord like an obscene talisman on a headhunter's belt. He could see the mother's cervix destroyed and black, from infection or gangrene. The catastrophe that befell this woman was memorialized in formalin.

Stone barely made it to the sink before his dinner came up. He felt betrayed, as if someone had been spying on him. All this time he'd imagined he and she were alone. He couldn't go on. He couldn't even look at her, or fold her back up or cover her. The next day he asked the puzzled attendant to dispose of the cadaver even though the dissection of the pelvis was incomplete and the lower limbs were untouched. But Thomas Stone was done.

At Missing Hospital, because of Hema, Stone never had to venture into the territory of the female reproductive organs. That area he conceded (and it was atypical for him to concede anything) to her.

He and Hemlatha were civil, collegial, and even friendly outside the operating theater. After all, Missing only had three physicians—Hema, Stone, and Ghosh—and it would've been awkward if they didn't get along. But in Operating Theater 3, Hema and Stone managed to provoke each other. Hema's style was precise and careful—a living example, Matron thought, of why more women should be surgeons. Matron sometimes believed she saw Hemlatha listening and then thinking when with a patient in the clinic, rather than trying to do both things at once. Hema was a surgeon who would throw four casts to her knots where others might be content with three. She never left the operating room until her patient awoke from anesthesia. Her surgical field was as neat and tidy as an anatomical demonstration with vulnerable structures carefully identified and moved out of harm's way and with bleeding meticulously controlled. To Matron the field looked static, yet alive, like a painting by Titian or da Vinci. “How can a surgeon know where she is,” Hema was fond of saying, “unless she knows where she has been?”

For Stone, minimal handling of tissue was what counted the most, and he had no time for the aesthetic of the surgical field. “Hema, if you want pretty, dissect cadavers,” he once told her. “Stone, if you want bloody, become a meat cutter,” she said. So vast was his experience and the practice that he put into his craft that his nine fingers could find their way in a bloody field in which no landmarks were visible to others; his movements were economical and precise, and his results were excellent.

On those rare occasions when a woman with the mud of the field still fresh on her feet was brought in with a bull-gore wound that extended into the pelvis, or when a bar girl came with a knife or bullet wound near the uterus, Hemlatha and Stone would scrub together and enter the abdomen à deux, fussing at each other, bumping heads, and at times rapping each other's knuckles with the handle of the hemostat. Matron said she kept a register of which surgeon had stood on the right side at the last joint exploration, and she made sure they took turns. While Hemlatha meticulously resected uterus or repaired a bladder tear, Stone, who could not carry a tune, nevertheless whistled “God Save the Queen,” which riled Hema. If Stone went first, Hemlatha would talk about the famous surgeons of years past—Cooper, Halsted, Cushing—and what a shame it was that tropical surgeons showed no sign of that great surgical legacy.

Stone didn't believe in glorifying surgeons or operations. “Surgery is surgery is surgery,” he liked to say, and on principle he would no more look up to a neurosurgeon than down on a podiatrist. “A good surgeon needs courage for which a good pair of balls is a prerequisite,” he had even written in the manuscript of his textbook, knowing fully well that his editor in England would take it out, but enjoying the experience of putting those words on paper. Stone had found a volubility a combative-ness and forcefulness, in his writing that he didn't show in his speech. “Courage? What's this you write about ‘courage’?” Hema asked. “Is it your life you are risking?”

A Cesarean section was technically not beyond Stone's abilities. But on that fateful day, the thought of taking scalpel to Sister Mary Joseph Praise—his surgical assistant, his closest confidante, his typist, his muse, and the woman he realized he loved—terrified him. She was already in appalling shape, pale and clammy, her pulse so thready that he believed anything he did would send her over the precipice. On a stranger, he might not have hesitated to try a Cesarean section. “The doctor who treats himself has a fool for a patient” was an adage he knew well. But what about a doctor who performed an unfamiliar operation on a loved one? Was there an adage for that?

Increasingly, since the publication of his textbook, Stone had taken to quoting from it, as if his own written word had greater legitimacy than his unpublished (and heretofore unspoken) thoughts. He'd written, “The doctor who treats himself has a fool for a patient, but there are circumstances when he has no recourse …“ He had gone on to chronicle the tale of his own ray amputation, how he'd performed a nerve block on his right elbow, and then, with Sister Mary Joseph Praise “helping,” he had made the incision into his flesh, his left hand doing some of the work while Sister Mary Joseph Praise stood in for his right. He realized as he watched her make the bone cuts that she could do much more than assist if she chose to. It was the anecdote of the amputation, together with his picture in the frontispiece, his fingers—all nine of them—forming a steeple in front of his chin, which had made the book so successful. There were so many extant surgery texts that it was surprising how popular The Expedient Operator (or A Short Practice, as it was known in some countries) had become. For a tropical surgery book, most of its sales took place in nontropical countries. Perhaps it was its quirkiness, its biting tenor, and the often sharp and unintended humor. He drew only on his experience or his careful interpretation of the experience of others. Readers pictured him as a revolutionary, but one who operated on the poor instead of preaching land reform. Students wrote him adoring letters, and when his dutiful responses (penned by Sister Mary Joseph Praise) didn't match the gushy, confessional tone of their letters, they pouted.

The illustrations in the textbook (all drawn and lettered by Sister Mary Joseph Praise) had a simple quality as if done on a napkin; no attempt was made at getting proportion or perspective right, but they were models of clarity. The book was translated into Portuguese, Spanish, and French.

Daring operations performed in darkest Africa—that was how the publisher had described the book on the back cover. The reader, knowing nothing about the “dark continent,” filled in the blanks, pictured Stone in a tent, a kerosene lamp held up by a Hottentot providing the only light, elephants stampeding outside while the good doctor recited Cicero and excised a part of himself as blithely as if he were cutting for stone on the body of another. What neither the reader nor Stone would accept was that his self-amputation was as much an act of conceit as it was an act of heroism.

“YOUR PATIENT, Dr. Stone,” Matron said for the third time.

Stone took the spot between Sister Mary Joseph Praise's legs that Matron vacated, though, after all that, Matron seemed reluctant to let him by, as if she didn't want him to sit there any more than he wanted to sit. It wasn't a vantage point that he was accustomed to, at least not often with a woman. With men, he sat there to repair a watering-can scrotum, and in both sexes he might be seated to drain rectal abscesses, or to ligate and excise hemorrhoids or fistula-in-ano. But otherwise, he was a surgeon who was rarely seated.

When Stone clumsily parted the labia, blood poured out. He adjusted the gooseneck lamp and then his own neck to sight up the birth canal.

He tried to remember the citrus rule from his student days. What was it? Lime, lemon, orange, and grapefruit corresponded to four, six, eight, and ten centimeters of dilation of the cervix. Or was it two, four, six, and eight? And was there a grape or plum involved?

What he saw made him turn pale: the cervix was past grapefruit, on its way to melon. And there, as if at the bottom of a bloody well, was a baby's head, the tissues around it flattened. The fine wet black hair on the skull reflected the theater lights.

At that moment it was as if someone who'd lain dormant within Stone took over.

If there was a connection between him and the poor infant within, it was something that Stone didn't see. Instead, the sight of that skull agitated him. Fear was driven out by anger, and anger had its own perverted reasoning: What cheek this invader had to put Mary's life in jeopardy! It was as if he'd spotted the corpse of a burrowing mole that had attacked Mary's body, and the only way he could bring her relief was to extract it. The sight of that bright scalp wrought no tenderness from Thomas Stone, only revulsion. And it gave him an idea.

“Find the enemy and win the firefight” was a saying of his.

He had found the enemy.

“ Flatus, Fluid, Feces, Foreign Body, and Fetus feel better out than in,” he said aloud, as if he'd just invented the phrase. In his book he had called it the Five-F rule. He drove himself to his terrible decision. Far better, he decided, to drill a hole in the skull of the mole—he'd already stopped thinking of it as a baby—than to experiment on Sister Mary Joseph Praise by doing a Cesarean, an operation that was both unfamiliar and one that he feared would kill her in her fragile state. The enemy was more a foreign body, a cancer, than it was a fetus. No doubt the creature was dead. Yes, he would tap that skull, empty its contents, crush it just as if he were crushing a bladder stone, and then he'd pull out the deflated head which was the part that was hung up in the pelvis. If need be, he'd use scissors on its collarbones, scalpel on ribs; he would grab, slash, slit, and smash whatever fetal part obstructed delivery, because only by getting it out could Mary be out of her misery and the bleeding cease. Yes, yes—better out than in.

Within the boundaries of his irrational logic, this was a rational decision. Doing the wrong thing to do the right thing, as Sister Mary Joseph Praise might have said.

To a shocked and horrified Matron, the man who sat between Sister Mary Joseph Praise's legs didn't resemble their fierce, shy, and exceedingly competent Thomas Stone. This man had nothing in common with Thomas Stone, FRCS, author of The Expedient Operator. His place had been taken by this desperate, agitated fellow who did not look like a Fellow of the Royal College of Surgeons, but rather someone for whom the letters FRCS could mean (as Dr. Ghosh often claimed they did) “Farting Round the Country-Side.”

Stone, animated now, consumed by a sense of mission, propped Munro Kerr's Operative Obstetrics open, cookery-book fashion, on the down slope of Sister Mary Joseph Praise's protuberant belly. “Damn it, Hemlatha, you picked a hell of a time to be away,” he said aloud, feeling his courage return.

Two blasphemies, Matron noted. “Custody of the tongue,” she murmured under her breath. She took her own pulse because despite her faith in the Lord she was anxious about the heart flutter that had turned up in the last year like a surprise guest. Her heart was skipping beats now and she felt faint.

The strange instruments that Stone had requested and that Matron dug up from an old supply closet refused to be tamed by his hands. “Where the devil is Ghosh?” he shouted, because Ghosh often pitched in to help Hema with abortions and tubal ligations, and, as a jack-of-all-trades, he had more experience with a women's reproductive anatomy than Stone. Matron once again sent a runner over to Ghosh's bungalow, more to placate Stone than with any faith that Ghosh was back. Perhaps she would have done better to send the maid to inquire at the Blue Nile Bar or its vicinity for the banya doctor. But even an inebriated Ghosh could counsel Stone that what he was about to do was not the act of an expedient surgeon but an idiotic one, and that his decision was wrong, his logic illogical. Matron felt this pregnancy, this birth, was somehow her fault—some inattention on her part had resulted in this. Still, she also assumed in the face of torrential bleeding that the child was long dead. Had she believed for a moment that the child was alive (she knew nothing about twins), she would have intervened.

Stone cocked his head from side to side, trying to match Munro Kerr's illustrations of instruments—Smellie scissors, Braun's cranioclast, Jar-dine's cephalotribe—with the objects he juggled in his hand. His tools were distant cousins of the ones depicted in the book, but clearly designed for the same sinister purpose.

With two Jacobs clamps, he grabbed the oval of my brother's scalp. “I see you in the depths, burrowing creature! Damn you for torturing Mary,” he muttered. Then, using scissors, he cut the skin between the two clamps and gave the intruder its first introduction to pain.

His next move was to try to put the cephalotribe—the skull crusher— on the head. This awkward medieval instrument had three separate pieces. The middle was a spear meant to go deep into the brain, cutting a big opening in the skull as it did so. Flanking it were two forcepslike structures to clamp to the outside of the skull. Once all three pieces were in place, their stems interlocked to form a single handle with convenient finger indentations. Stone would be able to crush and grip the skull so it wouldn't slide away. Out would come the intruder.

It was cool in the operating theater, but sweat from his brow trickled into his eyes and wet his mask.

He tried to drive the spear in.

(The child, my brother, Shiva, sheltered for eight months and already hurting from the cut of scissors on his scalp, cried out in the womb. I pulled him to safety as the spear slid over the skull.)

Stone decided it would be easier if he first applied the outer two blades of the cephalotribe, then dragged the head within reach, and then inserted the spear. His hands were clumsy in this awkward space. Matron shuddered at the damage he might be doing to Sister Mary Joseph Praise's tissues and to the baby as he jammed each piece past an ear until, finally, he had the skull in his grasp, or thought he did.

Matron was close to dropping. “It is the duty of the nurse to assist and anticipate the doctor's every need.” Wasn't this what she herself preached to her probationers? But it was all wrong, all wrong, and she didn't know how to begin to turn it around. She was sorry she ever dug out the instruments. A humane obstetrician invented these instruments for mothers with the most desperate needs, not for desperate physicians. A fool with a tool is still a fool. In Stone's hands the instruments had taken over, and they were doing the thinking for him. Matron knew that nothing good could ever come out of that.

5. Last Moments

AT THE VERY LAST SECOND, just as she braced for the plane to smash into the water, Dr. Hemlatha saw the ocean give way to dry scrubland.

And before she could digest this, the plane flared to a touchdown over shimmering asphalt, squealing its tires, wiggling its tail, and, when it bled off its speed, scampering down the runway like a dog unleashed.

The passengers’ relief turned to bewilderment and embarrassment, for the most godless among them had prayed for divine intervention.

The plane stopped, but the pilot continued arguing with the tower while dragging on a cigarette, even though he had made a big point of turning on the NO SMOKING light after they landed.

The little boy whimpered, and Hema rocked him with an adeptness she didn't know she possessed. “I'm going to put a tiny, tiny bandage on your leg, okay? Then the hurt will be all gone.” The young Armenian somehow found a cane, and the two of them fashioned a splint.

When the throb of the engine ceased, Hema felt the silence within the cabin press on her eardrums. The pilot looked around, a smirk on his face, as if he were curious to see how his passengers had held up. Almost as an afterthought, he said, “We are stopping to pick up some bagg-aje and some Very Important People. This is Djibouti!” He smiled and showed his bad teeth. “They did not give me permission to land unless it is emergency. So I make an engine failure.” He shrugged as if modesty prevented him from accepting their accolades.

Hemlatha was startled to hear her own voice shatter the silence.

“Baggage? You bloody mercenary. What do you think we are? Goats? You just shut down an engine and drop out of the sky like that and stop in Djibouti? No warning? Nothing?”

Perhaps she should have been grateful to him, happy to be alive, but in the hierarchy of her emotions, anger was always trumps.

“Bloody?” the pilot said, turning red. “Bloody?” he said, clambering out of the cockpit, white knees knocking under his safari shorts, as he struggled free.

He stood before her, huffing from the effort. He seemed to take far more exception to “bloody” than “mercenary.” His contempt for this Indian woman was greater than his anger. But he had raised his hand. “I will offload you here, insolent woman, if you don't like it.” Later he would claim that he had raised his hand merely as a gesture, with no intent to strike her—God forbid that he, a gentleman, a Frenchman, would strike a woman.

But it was too late, because Hemlatha felt her limbs move as if by their own volition, fueled by anger and indignation. She felt as if she were observing the actions of a stranger, of a Hemlatha who had not previously existed. The new Hemlatha, whose license on life had just been renewed and its purpose defined, came to her feet. She was as tall as the pilot. She could see the tiny feeder vessel in the starburst on his left cheek. She pushed her glasses up on her forehead and met him eyeball to eyeball.

The man squirmed. He saw she was beautiful. He fancied himself a lady's man, and he wondered if he'd blown the opportunity to have drinks with her at the Ghion Hotel that evening. Only now did he notice the people huddled over the whimpering boy. Only now did he notice the father's rage, and the clenched fists of some of the other passengers who had lined up behind her.

What a specimen, Hema thought as she studied him. Spider angiomas all over his exposed skin. Eyes tinged with jaundice. No doubt his breasts are enlarged, his armpits hairless, and his testes shriveled to the size of walnuts—all because his liver no longer detoxifies the estrogen a male normally produces. And the stale juniper-berry breath. Ah yes, she thought, coming to a diagnosis beyond cirrhosis: a gin-soaked colonial resisting the reality of postcolonial Africa. If in India they still are cowed by all of you, it is from long habit. But there are no such rules on an Ethiopian plane.

She felt her rage boil over, and it was directed not just at him but at all men, every man who in the Government General Hospital in India had pushed her around, taken her for granted, punished her for being a woman, played with her hours and her schedule, transferred her here and there without so much as a please or by-your-leave.

Her proximity to him, her encroachment of sacred bawana space, rattled him, distracted him. But his hand was still up there. And now, as if he just noticed it, he moved the hand, not to strike her, he would claim, but as if to determine whether it really was his hand and to see if it still answered to his commands.

The upraised hand was insult enough, but when Hema saw it start to move, she reacted in a manner that made her blush when she recalled it later.

Hemlatha's fingers shot up the pilot's shorts and locked around his testicles, only his underwear intervening. There was an ease to her movements which surprised her, and an ease to the way the gap between her thumbs and index fingers allowed passage for the spermatic cords that connected balls to body. Years later she would think that what she did was conditioned by her surroundings, by the propensity in East Africa for shiftas and other criminals to lop off their victims’ testicles. When in Rome…

Her eyes burned like a martyr's. Sweat changed the pottu on her forehead from a dot to an exclamation mark. She had worn a cotton sari for the heat, and earlier, when she had been seated, she had hiked it to her knees—modesty be damned—and now that she was standing it stayed that way, outlining her thighs. Sweat glistened on her upper lip as she squeezed to extract the same measure of distress and fear the Frenchman had caused her.

“Listen, sweetie,” she said (deciding that there was indeed testicular atrophy and also trying to recall tunica albugineae, and tunica something else, and vas deferens, of course, and that craggy thingy at the back, whatsitcalled … epididymis!). She saw his shoulders sag and the color drain out of his face as if she'd opened the spigot below. Dampness quite different from sweat appeared on his forehead. “At least your syphilis isn't far advanced because you can feel testicular pain, huh?” His upraised hand came floating down and then hesitantly, almost lovingly rested on her forearm, pleading with her not to increase the pressure. A cathedral of silence descended on the plane.

“Are you listening now?” she said (thinking that she didn't really want to know a man's anatomy this way). “Are we talking as equals? … My life in your hands and now your family jewels in mine? You think you can terrify people like that? That little boy broke his leg because of your stunt.”

She turned her head toward the other passengers but, keeping her eye on Frenchie's face, said, “Anybody have a sharp knife? Or a Gillette?”

The rustle she heard might just have been the cremaster muscles of all the males on board involuntarily reeling their dangling sperm factories back up to shelter.

“We were unauthorized … I had to …,” the pilot wheezed.

“Take your wallet out right now and pay for this child,” Hema said, because she didn't believe in IOUs.

When he fumbled with the notes, the young Armenian grabbed the wallet and handed it to the boy's father.

One of the Yemenis, finding his voice, let out a stream of profanities, wagging his finger in the pilot's face.

Hema said, “Now, you refund the plane tickets for the boy and his parents. And you get us back in the air very soon, … otherwise, you will not only be a eunuch, but I will personally petition the Emperor to make sure that even a job as a camel driver, let alone flying khat, will be much too good for you.”

They heard the cargo door open and sharp exclamations from the coolies milling around outside.

The Frenchman, his eyeballs sinking in their sockets, nodded mutely. France had colonized Djibouti and parts of Somalia, and they had even jockeyed with the English in India before settling for a foothold in Pon di cherry But on this steamy afternoon, one brown soul who would never be the same again, and who had Malayalis, Armenians, Greeks, and Yemenis backing her, showed she was free.

“Well, how can one be sane in hot weather?” Hemlatha said to no one in particular, letting go and making for the outside to wash her hands, stifling her laughter.

6. My Abyssinia

HEMA FIXED HER EYES on the ground below, watching for the transition of brown scrub and desert into steep escarpment announcing the lush, mountainous plateau of Ethiopia. Yes, she thought. This is my home now. My Abyssinia, which sounded to her so much more romantic than “Ethiopia.”

The country was in essence a mountain massif that rose from the three deserts of Somaliland, Danakil, and Sudan. Even now Hema felt a bit like a David Livingstone or an Evelyn Waugh exploring this ancient civilization, this stronghold of Christianity which, until Mussolini's invasion in ‘35, was the only African nation never to be colonized. Waugh, in his dispatches to the London Times and in his book, referred to His Majesty Haile Selassie the First as “Highly Salacious,” seeing cowardice in the Emperor's leaving the country in the face of Mussolini's advance. Hema's reading of Waugh was that he couldn't accept the notion of African royalty. He couldn't accept that the bloodlines of Emperor Haile Selassie, extending back as they did to the Queen of Sheba and King Solomon, made the Windsors or the Romanovs look like carpetbaggers. She didn't think much of Waugh or his book.

The new passengers who climbed aboard at Djibouti were Somalis or Djiboutians (and really, she thought, what difference was there between the two, other than a line drawn on a map by some Western cartographer). They chewed khat and smoked 555s and despite their doleful, muddy eyes they were happy. Crammed into the plane, which by now was altogether too familiar to Hema, was khat, great bales of it being hauled back to Addis Ababa. It was all very strange, since khat usually traveled in the opposite direction: grown in Ethiopia, around Harrar, and exported by rail to Djibouti and then by air to Aden. That lucrative khat trade route was responsible for the birth of Ethiopian Airlines. She overheard that some problem with the railway and road transport, as well as the urgent need for large quantities of khat for a wedding, prompted this reverse export and the unscheduled stop. Khat had to be chewed within a day or so of its harvest, or else it lost its potency Hema pictured the Somali, Yemeni, and Sudanese merchants in the tiny souks that anchored every street and byway, and the owners of the bigger shops of the Merkato in Addis Ababa, eyeing their Tissot watches, snapping at their shop boys as they waited for this shipment. She pictured the wedding guests with mouths too parched to spit, but spitting and cursing all the same, telling one another that the bride was uglier than they remembered, and the big mole on her neck must mean shed also inherited the miserliness of her father.

Hema imagined telling her mother about the pilot business. It made Hema laugh, which made the Somali sitting opposite her, one of the newcomers, smile.

Madras had been hot and humid for the three weeks that Hema was there, but it was heaven compared with Aden. Her parents’ three-room house in the neighborhood of Mylapore, very near the temple, had seemed spacious to her as a girl, but on this visit if felt claustrophobic. Though she regularly sent her parents bank drafts, shed been dismayed to find no improvements in the house since her last visit. The interior paint had peeled to form abstract patterns while the kitchen, blackened with smoke, resembled a darkroom. The narrow street outside which rarely saw a car was now a noisy thoroughfare, and the compound wall showed no trace of whitewash but instead was the color of the earth on which it stood. Only the garden had benefited from the passage of time with the bougainvillea hiding the house from the street. The two mango trees had become huge and heavy with fruit. One was an Alphonso and the other a hybrid with flesh that felt rubbery at first bite but then melted in the mouth like ice cream.

The sole decoration in the living room was, as it had always been, the Glaxo powdered-milk calendar hanging on a nail. The overfed blue-eyed Caucasian baby had never grown up. The caption read “Glaxo Builds Bonny Babies.” It was enough to make any breast-feeding mother feel guilty that she was starving her infant. As a child Hema had barely registered the Glaxo baby. Now the calendar drew her eye and her ire. What an insidious presence that brat had been in her life. An interloper with a false message. Hema took down the calendar, but the pale rectangle on the wall called attention to itself in a way the baby never had. No doubt once Hema left, another Glaxo baby would find its way back there.

During her brief vacation, Hema had the house painted and ceiling fans installed. Sathyamurthy, the father of her old childhood nemesis, Velu, peered over the fence as workmen carried in a Western-style commode to be cemented over the footpads of the Indian toilet. He sniggered and shook his head. “It's not for me, you old coot,” Hema said in English. “My mother's hips are bad.” And Sathyamurthy answered in the only English phrase he knew, “Goddamn China, kiss me Eisenhower!” He smiled and waved, and she waved back.

THE SOMALI ACROSS FROM HER wore a shiny blue polyester shirt and a gold watch that swung on his stick wrist. His toes, protruding from sandals, glowed like polished ebony. He looked familiar to Hema. Now, he bowed, grinned, and displayed his fingers as if bidding at an auction as he said, “Three kids, two shots, one night!”

She remembered. His name was Adid. “I say, are you still doing double duty these days?”

His ivory teeth lit up the plane's dim interior. He said something to his friends. They smiled and nodded sagely. Such strong teeth they have, Hemlatha thought. She admired his blackness, a color so pure that there was a purple tinge to it. The headmistress at her school, Mrs. Hood, had been porcelain white, and the schoolgirls believed that if they touched her, their fingers would come away white; with Adid, she imagined they would come away black. Adid's regal manner, the slow play of expressions on his face, each thought matched by a lip-eyebrow combo, gave Hema the bizarre idea that she'd like to suck his index finger.

She'd last seen Adid in a headdress and flowing robes in the casualty room at Missing, unflappable, even though his pregnant wife was convulsing. When Hemlatha unwrapped the shrouds of cotton she found a young, pale, anemic girl. Her blood pressure was sky-high. This was eclampsia. While Hemlatha was in Theater 3 delivering this wife of her firstborn by Cesarean section, Adid disappeared and returned with an older wife, also in labor, who proceeded to deliver in the horse-drawn gharry beside the outpatient steps. Hemlatha ran out in time to cut the cord. She pushed on the wife's belly, but instead of the afterbirth, a twin popped out. Adid's smile when he saw the second child, the third total, reached from ear to ear. Hema suggested he wear a banner across his chest that said ONE NIGHT, TWO SHOTS, THREE KIDS. Adid had laughed like a man whod never heard the word “worry.”

“Yes, yes,” he said now, raising his voice to be heard over the drone of the engines. He had the clipped, French-accented diction of a Djiboutian. “A man is only as rich as the number of children he fathers. After all, what else do we leave behind in this world, Doctor?”

Hema, who'd been thinking along similar lines just minutes before, decided she was a pauper by that yardstick. She said, “Amen. You must be a millionaire many times over then.”

An impish expression stole across his face, and with waggling brows and using just his eyes he pointed down the bench to a woman veiled and swathed in red-and-orange cotton robes. A very pale, henna-painted foot showed. Hemlatha guessed her to be a Yemeni. Or else a Muslim from Pakistan or India.

“And she is … ?” Hema said, hoping it would not be impolite to ask about her nationality.

Adid nodded vigorously. “Three more months at least. And one more expecting at home!”

“I tell you what,” Hema said, looking pointedly at Adid's groin, “I'll ask Dr. Ghosh to give you a special rate on a vasectomy, two for one. It will be cheaper than doing a tubal ligation on all the begums.”

The Gujarati couple across from her looked up scowling at Adid's thigh-slapping laughter.

“Why don't you bring the wives to the antenatal clinic?” Hema asked. “A smart man like you shouldn't wait till they get into trouble. You don't want them to suffer.”

“It's not my choice. You know how these women are. They won't come until they are unconscious,” he said simply.

True enough, Hemlatha thought. Years before, an Arab woman in the Merkato was in labor for days, and the husband, a rich merchant, brought Dr. Bachelli to see her. But rather than allow a male doctor to see her, she wedged her body behind the bedroom door so that any attempt to open it would crush her. The woman died alone, behind that door, an act much admired by her peers.

Because Hema was hungry, and to annoy the Gujaratis further, she accepted some leaves of khat from Adid and tucked them into her cheek. It was something she'd never have dreamed of doing before, but events of the last few hours had changed things.

The khat was bitter at first, but then the pulpy mass became almost sweet and not unpleasant. “Wonder of wonders,” she said aloud, as her face took on the chipmunk bulge and her jaw fell into the lazy, slewing rhythm of the thousands of khat chewers she had seen in her lifetime. Like a pro, she used her handbag as an elbow bolster and she brought her feet up to the bench, one knee flat, the other under her chin. She leaned toward Adid, who was surprisingly chatty.

“… and we spend most of the rainy season away from Addis, in Aweyde, which is near Harrar.”

“I know all about Aweyde,” Hema said, which wasn't true. Shed driven there years before on a holiday to see the old walled city of Harrar. What she remembered about Aweyde was that the entire town seemed nothing more than a khat market. The houses were hopelessly plain, not a trace of whitewash. “I know all about Aweyde,” she said again, and the khat made her feel that she actually did. “The people there are rich enough to each drive a Mercedes, but they won't spend a cent to paint their front door. Am I right?”

“Doctor, how could you know these things?” Adid said, astonished.

Hema smiled, as if to say, Very little escapes me, my dear man. And then she was thinking of the Frenchman's balls, of rugaeform folds, of the median raphe that separated one bollock from the other, of the dartos muscle, the cells of Sertoli. Her mind was racing, hyperaware.

The cabin was no longer hot, and it felt good to be heading home. She wanted to say to Adid: When I was a medical student, we had to do this test on patients to check for visceral pain. Visceral pain is different from when you bump your knee, for example. Visceral pain comes from the inside, from the body's organs. It's a pain that is tough to characterize, poorly localized, but painful all the same. Anyway, as students we had to squeeze the testes to check for intact visceral pain, because diseases like syphilis can cause the loss of visceral pain sensations. One day, at the bedside of a patient with syphilis, the professor picked on me to demonstrate visceral pain. The men in our group were snickering. I was bold then—I didn't hesitate. I exposed the balls— the testes, excuse me. The patient had advanced syphilis. When I squeezed, the man just smiled at me. Nothing. No pain. No reaction. So I squeezed harder—really hard. Still nothing. But one of my male classmates fainted!

Adid grinned, as if she had told him this story.

THE PLANE DESCENDED, slipping into and out of the scattered clouds over Addis Ababa. The dense forests of eucalyptus trees at first concealed the city. Emperor Menelik had imported eucalyptus years before from Madagascar, not for its oil, but as firewood, the lack of which had almost made him abandon his capital city. Eucalyptus had thrived in the Ethiopian soil, and it grew rapidly—twelve meters in five years, and twenty meters in twelve years. Menelik had planted it by the hectare. It was indestructible, always returning in strength wherever it was cut down, and proving ideal for framing houses.

The trees revealed clearings with circular, thatch-roofed tukuls and a thorn enclosure to keep the animals penned in. Then, at the edge of the city, she saw corrugated-tin-roofed houses, abundant and closer to gether. A church with a short spire came into view, and then the city proper. There was Churchill Road starting at the railway station and making a steep rise to the Piazza, with a handful of cars and buses plying its slope. This glimpse of the city center, which looked so modern, made her think of Emperor Haile Selassie. Hed brought about more change in his reign than the country had undergone in three centuries. Down at street level, his portrait—the hook nose, the thin lips, the high brow— would be in every house. Hema's father was the Emperor's biggest fan because just before World War II, as Mussolini stood ready to invade, Emperor Haile Selassie warned the world of the price of standing by and allowing Italy to invade a sovereign country like Ethiopia; such inaction, he said, would fuel the territorial ambitions of not just Italy but Germany. “God and history will remember your judgment,” he said famously before the League of Nations, and they did. It made him the symbol of the little guy whod stood up to the bully (and lost).

“You see Missing Hospital, madam?” This from Adid who peered over her shoulder.

“Missing is missing,” she said.

Near the airport an entire hillside had turned to a flaming orange from the blooming of the meskel flower which told her that the rainy season must have ended. Another hillside was covered with lean-tos and shacks of corrugated tin, the colors rust brown or a darker corrosive hue. Each shack shared a wall with its neighbor, so that collectively they looked like long irregular railway carriages that snaked across the hill, sending buds and offshoots in all directions.

THE FRENCHMAN BUZZED low over the strip so that the customs agent could get on his bicycle and shoo stray cows from the runway He circled and landed.

Cars and vans in the bile-green colors of the Ethiopian police raced up to the plane, along with every functionary of the Ethiopian Airlines staff. The cargo door was yanked open, and frantic hands rushed to unload the khat. They tossed the bundles into a VW Kombi, then into a three-wheeler van, and when those were full, they stuffed the police cars, and they all raced off, sirens sounding. Only then were the passengers allowed to disembark.

The engine of the blue-and-white Fiat Seicento whined as the six-hundred milliliter engine, which gave it its name, strained to carry Hemlatha and her Grundig. Shed personally supervised the loading of the big crate onto the roof rack.

It was a perfect sunny afternoon in Addis, and it made her forget that she was more than two days overdue at Missing. The light at this altitude was so different from Madras, suffusing what it graced rather than glaring off every surface. There was no hint in the breeze of rain, though that could change in an instant. She caught the woody, medicinal odor of eucalyptus, a scent that would never do in a perfume but was invigorating when it was in the air. She smelled frankincense, which every household threw onto the charcoal stove. She was glad to be alive, and glad to be back in Addis, but she didn't know what to make of the wave of nostalgia that overcame her, an unfulfilled longing that she could not define.

With the end of the rains, makeshift stalls had popped up selling red and green chilies, lemons, and roasted maize. A man with a bleating sheep draped around his neck like a cape struggled to see the road in front of him. A woman sold bundles of eucalyptus leaves used as cooking fuel for making injera—the pancakelike food made from a grain, tef. Farther on Hema saw a little girl pour batter on a huge flat griddle which sat on three bricks with a fire underneath. When the Injera was ready, it would be peeled off like a tablecloth, then folded once, twice, and once more, and stored in a basket.

An old woman in the black clothes of mourning stopped to assist a mother sling her baby onto her back in a pouch made out of her shama— the white cotton cloth that men and women alike wrapped around their shoulders.

A man with withered legs that were folded into his chest swung stiff armed along the dirt sidewalk. He had blocks of wood with a handle in each hand, which he planted on the ground, and then he swung his bottom forward. He moved surprisingly well, like the letter M marching down the road. Her brief absence made these sights a novelty again.

A herd of mules overladen with firewood trotted along, their expressions docile and angelic in the face of the whipping they were getting from the barefoot owner who ran with them. The taxi driver leaned on his horn. Despite the high whine of the engine, the taxi managed only to crawl along like another overburdened beast.

A lorry carrying sheep, the poor animals so crowded together they could hardly blink, overtook them. These were the lucky animals being carried to slaughter. Before Meskel, the feast celebrating the finding of Christ's cross, huge herds of sheep would arrive in the capital, the animals wobbly from exhaustion, barely surviving this march to the feast table. Then, in the days after Meskel, one neither heard nor saw any sheep. Instead the skin traders walked the streets and alleys shouting, “Ye beg koda alle!”—”The sheep's hide whoever has!” A household would hail him, and after some haggling, he'd drape another skin over the ones that he was already shouldering and resume his cry.

Suddenly Hemlatha noticed children everywhere as if they'd been invisible all these years. Two boys were racing their crude metal hoops, using a stick to guide and push, weaving this way and that and making motorcar noises. A toddler with railroad tracks of snot connecting nose to lip watched with envy. Its head had been shaved to leave a traffic-island tuft in front; Hema was told when she first came to Ethiopia that this strange haircut was so that if God chose to take that child (and He took so many), the tuft gave Him a handle by which to lift it to heaven.

The child's mother stood outlined by the bead curtain of a buna-bet— coffeehouse—though it was really a bar, offering things more potent than coffee. At night the bar would glow within from the tube lights, painted green, yellow, and red, and the woman, transformed by that hour, would offer drinks and her company. An espresso machine on a zinc bar established the class of an establishment—this was a legacy of the Italian occupation. The woman's flat eyes fell on the cab, then on Hema, and her expression hardened as if she had seen a competitor. She lifted her gaze to the strange container on the taxi's roof, and then she looked nonchalantly away as if to say, I'm not the least bit impressed. She might be an Amhara, Hema thought, with that walnut skin, the high cheekbones. She is so pretty. Probably a friend of Ghosh. A comb was stuck in her hair as if she were taking a break from teasing it into shape. Her legs shone from Nivea. She might even swallow a dab or two of Nivea now and then, in the belief it lightened the complexion. “For all I know, it works,” Hema said, though she shuddered at the thought.

Between the newer cinder-block buildings were huts, the wattle walls unpainted and revealing their sticks, straw, and mud. All it took was a pole stuck in the ground with an empty can inverted over the top to say, This, too, is a buna-bet, and though we don't have an espresso machine, and though we sell homebrewed tej and talla instead of bottled St. George beer, we offer the same services as the other.

The oldest profession in the world raised no eyebrows, even with Hema. Shed learned it was futile to object—it would have been like taking exception to oxygen. But the consequences of such tolerance were evident to her: tubal and ovarian abscesses, infertility from gonorrhea, stillbirths, and babies with congenital syphilis.

On the main road Hema saw a work crew of grinning, dark-skinned, big-boned Gurages supervised by a laughing Italian overseer. The Gur -age were southerners with a well-deserved reputation for being hardworking and willing to take on what the locals wouldn't. Gebrew, when he needed extra hands at Missing, would simply step out of the front gate and yell “Gurage!” though of late, that could be seen as insulting, so it was safer to shout “Coolie!”

The crew was barefoot but for the overseer and one man who had squeezed into ill-fitting plastic shoes, having cut holes in them for his big toes. By all rights Hema should have been incensed by this sight of black laborers and a white overseer, and she wondered why she wasn't; maybe it was because the Italians who stayed behind in Ethiopia after it was liberated were so easygoing, so ready to mock themselves, that they were hard to resent. Life for the Italians was what it was, no more and no less, an interlude between meals. Or maybe that was just the way of being that they found worked best in their circumstance. Hema saw the laborers stand still as soon as the overseer turned away. A snail's pace, but nevertheless, schools, offices, a grand post office, a national bank, were coming up to match the grandeur of Trinity Cathedral, the Parliament Building, and the Jubilee Palace. The Emperor's vision of his European-style African capital was taking shape.

PERHAPS IT WAS BECAUSE the Emperor was still on her mind, and because her taxi was at the intersection where, in place of the string of shops, there once stood a gallows, but suddenly Hema was thinking about a scene that haunted her.

It was at this very spot in 1946 that she and Ghosh, in their first months in Addis, had come upon a crowd blocking the road. Standing on the running board of Ghosh's Volkswagen, Hema had seen a crudely constructed frame and the three dangling nooses. A modified Trenta Quattro with military markings had pulled up. Three handcuffed Ethio pian prisoners on the flatbed were hauled to their feet. The men were coatless, but otherwise, in their shirts, shoes, and pants, they looked as if theyd been interrupted while having dinner.

An Ethiopian officer in Imperial Bodyguard uniform read from a piece of paper and tossed it aside. Hema watched, fascinated, as he put the noose over each head and positioned the knot to one side, behind the ear. The condemned seemed resigned to their fate, which was in itself a form of extreme bravery. The bearing of a tall older man made Hema certain the prisoners were military. This graying but upright prisoner spoke to the Imperial Bodyguard officer who inclined his head to listen. He nodded, and removed the noose. The prisoner then leaned over the truck and held his handcuffed wrists out to a weeping woman. She removed a ring from his finger and kissed his hand. The prisoner stepped back, looked down like an actor searching for his mark onstage, then bowed to this executioner, who returned the gesture and replaced the noose with the delicacy of a husband garlanding his new bride.

Hema didn't understand what she was seeing, not then anyway. She half believed it to be a form of theater. The violence of what followed— the truck roaring away, the thrashing forms, the awkward and impossible angle of head on chest, the mad rush of onlookers to tear off the dead men's shoes—was less disturbing than the idea that she was living in a country where such things could take place. Sure, she'd seen brutality cruelty, in Madras, but they took the form of neglect and indifference to suffering, or they took the form of corruption.

The event left Hema sick for days. She contemplated leaving Ethio pia. There'd been nothing about it in the Ethiopian Herald, no comment the government wished to make. The men had been planning revolution, so people said, and this was the Emperor's response. He was keeping a fragile country on course.

Hema had never forgotten the reluctant executioner, a handsome man, his temples forming a sharp angle with his brow so his head was shaped like a hatchet. His nose was flattened at its base as if from an old fracture. She remembered his stately bow to the condemned before he carried out his orders. Shed felt pity and even respect for him. The conflict between his duty and his compassion was revealed by that gesture. Had he refused to follow orders, his neck would have been stretched. Hema was sure he'd acted against his conscience.

Maybe this is what keeps me in Addis all these years, Hema thought, this juxtaposition of culture and brutality, this molding of the new out of the crucible of primeval mud. The city is evolving, and I feel part of that evolution, unlike in Madras, where the city seems to have been completed centuries before I was born. Did anyone but my parents notice that I left? “Why don't you stay in India? There are so many poor women who die needlessly here in Madras,” her father had said halfheartedly on this visit. “You want me to give free service to the poor from this house?” she said. “If not, then get me a job. Let the City Corporation hire me, or the Government Medical Service. If my country needs me, why is it that they don't take me?” They both knew the answer: jobs went to those willing to grease palms. She sighed, causing the taxi driver to look over. She was reliving the pain of saying good-bye to her parents yet again.

The sight of barefoot peasants carrying impossible head loads and horse-drawn gharries plying the roads maintained the aura and mystique of this ancient kingdom that almost justified the fabulous tales of Prester John, who wrote in medieval times of a magical Christian kingdom surrounded by Muslim lands. Yes, it might be the era of the kidney transplant in America and a vaccine for polio due to arrive even in India, but here Hema felt she'd tricked time; with her twentieth-century knowledge she had traveled back to an earlier epoch. The power filtered down from His Majesty to the Rases, the Dejazmaches, and the lesser nobility and then to the vassals and peons. Her skills were so rare, so needed for the poorest of the poor, and even at times in the royal palace, that she felt valued. Wasn't that the definition of home? Not where you are from, but where you are wanted?

AT ABOUT TWO in the afternoon, her taxi pulled up to the chukker-brown gates of Missing, a world unto itself.

The rock wall enclosed the hospital grounds and hid the buildings. Eucalyptus towered over the wall, and where there was no eucalyptus there were firs and jacaranda and acacia. Green bottle shards poked up from the mortar at the top of the wall to dissuade intruders—robbery and petty theft were rampant in Addis—though the sight of roses lapping over the wall softened this deterrent. The wrought-iron gate covered with sheet metal was normally kept closed, and pedestrians were admitted through the smaller, hinged door in the gate. But now the big gate was wide open, as was the pedestrian flap.

Inside, Hema saw that Gebrew's sentry hut door and shutter were also open, and when they crested the hill, she could see that every visible window and door in Missing's outpatient building was open, too; in fact, she could see Gebrew, the watchman (who happened to be a priest), in the process of propping open the woodshed door with a rock.

Spotting the taxi, he came running, his army surplus overcoat flapping, his white priest's turban dwarfing his small face, his fly wand, cross, and beads clutched in one hand. He seemed to be trying to shoo the taxi away. Gebrew was a nervous chap given to rapid speech and jerky movements, but he was far more agitated than was his norm. He looked stunned to see her, as if he'd never expected her to come back.

“Praise-God-for-bringing-you-safely, welcome-back-madam, how-are-you-are-you-well? God-answered-our-prayers,” he said in Amharic. She matched him bow for bow as best she could, but he wouldn't stop until she said, “Gebrew!”

She held out a five-birr note. “Take bowl to Sheba Bar and fetch please doro-wot,” she said, naming the delectable red chicken curry cooked in Ethiopian peppers—berbere. Her Amharic was crude, and she could only speak in the present tense, but doro-wot was a term she'd mastered early. And doro-wot had occupied her dreams her last few nights in Madras, after so many days of a pure vegetarian diet. The wot came poured onto the soft crepelike injera and there would be more rolls of injera which Hema would use to scoop up the meat. The curry would have soaked into the injera that lined the bowl by the time Gebrew brought it. Her mouth watered just thinking of the dish.

“Indeed-I-will-madam, Sheba-is-best, blessed-is-their-cook, Sheba-is—”

“Tell me, Gebrew, why be doors and windows open?” Now she noticed his nails and fingers were bloody, and his sleeves had feathers sticking to them, and feathers were caught up in his fly swish.

It was then that Gebrew said, “Oh, madam! This is what I have been trying to tell you. Baby is stuck! The baby. And Sister! And the baby!”

She did not understand. She'd never seen him so worked up. She smiled and waited.

“Madam! Sister is borning! She is not borning well!”

“What? Say again?” Perhaps being away and not hearing Amharic had made her misunderstand.

“Sister, madam,” Gebrew said, alarmed that he didn't seem to be getting through, and thinking volume and pitch might help, though what came out was a squeak.

“Sister” in Missing always referred to Sister Mary Joseph Praise, for the only other nun there was Matron Hirst, who went by Matron, while all the other nurses were addressed as Nurse Almaz or Nurse Esther, and not Sister.

To Hema's astonishment, Gebrew was crying, and his voice turned shrill. “Passage is closed! I tried everything. I opened all the doors and windows. I split open a chicken!”

He clutched his belly and strained in a bizarre imitation of parturition. He tried English. “Baby! Baby? Madam, baby?”

What he tried to convey was clear enough; there was no mistaking it. But it would have been difficult for Hema to believe it in any language.

7. Fetor Terribilis

THE DOORS TO THE OPERATING THEATER burst open. The probationer shrieked. Matron clutched her chest at the sight of the sari-clad woman standing there, hands on her hips, bosom heaving, nostrils flaring.

They froze. How were they to know if this was their very own Hema, or an apparition? It seemed taller and fuller than Hema, and it had the bloodshot eyes of a dragon. Only when it opened its mouth and said, “What bloody nonsense is Gebrew talking? In God's name, what is going on?” did their doubts vanish.

“It's a miracle,” Matron said, referring to the fact of Hema's arrival, but this only further confused Hema. The probationer, her face flushed and her pockmarks shining like sunken nailheads, added, “Amen.”

Stone stood and unfurrowed his brows at the sight of Hema. Though he didn't say a word, his expression was that of a man who, having fallen into a crevasse, spotted the bowline lowered from the heavens.

Hema, recalling this event many years later, said to me, “My saliva turned to cement, son. A sweat broke out over my face and neck, even though it was freezing in there. You see, even before I digested the medi cal facts, I'd already registered that smell.”

“What smell?”

“You won't find it any textbooks, Marion, so don't bother looking. But it's etched here,” she said, tapping her head. “If I chose to write a textbook, not that I have any interest in that kind of thing, I'd have a chapter on nothing but obstetric odors.” The smell was both astringent and saccharine, these two contrary characteristics coming together in what she'd come to think of as fetor terribilis. “It always means a labor room catastrophe. Dead mothers, or dead babies, or homicidal husbands. Or all the above.”

She couldn't believe the amount of blood on the floor. The sight of instruments lying helter-skelter—on the patient, next to the patient, on the operating table—assaulted her senses. But most of all—and shed been resisting this—she couldn't accept the fact that Sister Mary Joseph Praise, sweet Sister, who should have been standing, gowned, masked, and scrubbed, a beacon of calm in this calamity instead lay all but lifeless on the table, her skin porcelain white and her lips drained of all color.

Hema's thoughts became dissociated, as if they were no longer hers but instead were elegant copperplate scrolling before her in a dream. Sister Mary Joseph Praise's left hand lying supine on the table drew Hema's eye. The fingers were curled, the index finger less so, as if she'd been pointing, when sleep or coma overcame her. It was a posture of repose that one rarely associated with Sister Mary Joseph Praise. Hema's eyes would be drawn to that hand repeatedly as the hour unfolded.

The sight of Thomas Stone brought her back to her senses and galvanized her. Seeing Stone in the hallowed place between a woman's legs that was reserved for the obstetrician rankled Hema. That was her spot, her domain. She shouldered him aside, and in his haste he knocked the stool over. He tried to explain what had happened: finding Sister, their discovery of her pregnancy and then her obstructed labor, the shock, the bleeding that never stopped—

“Ayoh, what is this?” she said, cutting him off, her eyes round with alarm, brows shooting up and her mouth a perfect O. She pointed at the bloody trephine and the open textbook resting by Sister Mary Joseph Praise's belly. “Books and whatnots?” She swiped them aside, and they clattered to the floor, the sound reverberating off the walls.

The probationer's heart hammered against her breast like a moth in a lamp. Not knowing where to put her hands, she stuffed them in her pockets. She reassured herself that she had no part in the books and whatnots. Her failure (and she was beginning to see this) was a failure of Sound Nursing Sense; she'd missed the gravity of Sister Mary Joseph Praise's condition when she delivered Stone's message. She'd assumed that others would look in on Sister Mary Joseph Praise. No one had been aware that Sister Mary Joseph Praise was that ill, and no one had told Matron.

SISTER MARY JOSEPH PRAISE moved her head, and Matron believed that she was at least transiently aware that Matron held her hand. But so relentless was her pain that Sister couldn't acknowledge Matron's kindness.

In his hands I saw a large golden spear and at its iron tip there seemed to be a point of fire.

Matron's guess from the fragments she could understand was that Sister Mary Joseph Praise's mumbled words were perhaps the words of St. Teresa that they both knew so well.

I felt as if he plunged it into my heart several times, so that it penetrated all the way to my entrails. When he drew it out, he seemed to draw them out, and left me inflamed with a great love for God. The pain was so severe, it made me moan several times. The sweetness of this intense pain is so extreme, there is no wanting it to end, and the soul is not satisfied with anything less than God.

But unlike St. Teresa of Avila, Sister Mary Joseph Praise surely did want the pain to end, and just then, Matron said, the pain seemed to loosen its grip on her belly, and Sister sighed and clearly said, “I marvel, Lord, at your mercy. It is not something I deserve.”

A brief period of lucidity with roving eye movements followed, along with more attempts at speech, but it was unintelligible. Light splashed into the room, and Matron said it was as if a shroud that had formed in front of her face melted away. In that moment, as Sister Mary Joseph Praise looked around OT3—her operating theater for all these years— Matron thought the young nun realized that she was now the patient to be operated on and that the odds were against her.

“Perhaps she felt she deserved to die,” Matron said, guessing at my mother's thoughts. “If faith and grace were meant to balance the sinful nature of all humans, hers had been insufficient, and so what she felt was shame. Still she must have believed, even with all her imperfections, that God loved her and forgiveness awaited her in His abode, if not on earth.”

Matron wondered if it scared my mother that she might die in Africa, a continent away from her birthplace. Perhaps deep in her— perhaps deep in every being—there lingers a desire to bring the circle of life back to its starting point, which in her case was Cochin.

Then Matron heard my mother clearly whisper “Miserere mei, Deus” before sound left her. Matron carried her through the rest of the psalm in Latin, serving as her voice box while Sister Mary Joseph Praise's lips moved: “… Behold, I was shapen in iniquity; and in sin did my mother conceive me … Purge me with hyssop, and I shall be clean: wash me, and I shall be whiter than snow …”

When she finished, Matron said the shroud was back. The light was slipping away from her world.

“PICK UP THE STOOL, Stone,” Hema barked. “And you,” Hema said, snapping her fingers at the probationer, “get your hands out of your pockets.”

Stone set the stool upright just as Hemlatha eased down onto it. The key bunch Hema had fished out to open her house was now tucked into the waist of her sari, and it jingled as she settled herself. Under the theater lights the diamond in her nose sparkled. Strands of loose hair fell over her ears and in front of her eyes; through pursed lips she blew these wayward locks aside. She squared her shoulders, squared them to the horror and the unloveliness of what was before her. In that gesture she slipped off the mantle of the traveler and put on that of the obstetrician. The task ahead, however difficult, dangerous, or unpleasant, was hers and hers alone.

Hema felt herself gasping for air. Her lungs would need a week to acclimatize. Shed come from sea level in Madras to an operating room 8,202 feet above sea level, not counting the stool on which she sat. Her nostrils flared with each inhalation, like a thoroughbred after the quarter mile.

But her breathlessness came also from what was before her eyes. Gebrew hadn't lost his mind or imbibed too much talla; hed been telling the truth. The everyday miracle of conception had taken place in the one place it should not have: in Sister Mary Joseph Praise's womb. Yes, Sister Mary Joseph Praise was pregnant, had been for months before Hema left for India! And not just pregnant, but now in extremis. And the father?

Who else? She glanced at Stone's gray face.

But why not? she thought. Why should I be surprised? “The incidence of cancer of the cervix,” she remembered her professor saying, “is highest in prostitutes, and almost zero in nuns. Why almost zero and not zero? Because nuns are not born nuns! Because not all nuns were chaste before they became nuns! Because not all nuns are celibate!” That's neither here nor there, Hema admonished herself, while she thrust her hands into gloves that Matron produced.

The probationer recorded in the chart the arrival of Dr. Hemlatha. She chastised herself for not thinking of the gloves.

Hemlatha spread her own legs. Her feet were swollen from the long flight. She flexed her toes against the straps of her sandals and pawed the ground to get good purchase on the bloody floor. With the fingers of her left hand she spread the labia. Then, with a motion made simple by countless repetitions, her right hand pulled down on the posterior rim, opening the birth canal to view.

“Rama, Rama, this is a bloody Stone Age utensil,” Hemlatha shouted as she carefully disengaged first one half and then the other half of the skull crusher, slipping them over and then off the baby's ears. When the bloody instrument was free, she looked at it with distaste and flung it aside.

Matron felt relief. Whatever happened, at least now a real obstetrician was in charge. She couldn't help but note how Hemlatha and Stone had reversed roles: Hema was now the shouter and the flinger.

Matron offered the history that Sister Mary Joseph Praise had been in severe pain, great spasms of it, and then the pains had suddenly ceased and she'd seemed almost lucid, talking … but now she had deteriorated again.

“My God,” Hema said, knowing that in nature pains don't cease till a baby is out, “it sounds like a uterine rupture.” It would explain all the blood on the floor. Placenta previa—a placenta plastered over the exit to the womb—was another possibility. Neither possibility was good. “When did you stop hearing the fetal heart sounds?” No one replied.

“Pressure?”

“Sixty by palpation,” the nurse anesthetist said, after a pause, as if she expected someone else to volunteer the number that she was responsible for.

Hema peered around Sister Mary Joseph Praise's swollen belly to fix Nurse Asqual with a withering look. “Are you waiting for it to get to zero before you breathe for her? Put in a tracheal tube. Connect it to the hand bellows. If she wakes, give her some intravenous pethidine. Tell me when you're done. Where's Ghosh? Have you sent for him?” Nurse Asqual busied herself, grateful for step-by-step instruction because her mind had seized.

“And who has gone for blood? What! Nobody? Am I dealing with idiots here? Go! Run! Run!” Two people charged for the door. “Round up anyone and everyone to give blood. We need lots of blood!”

Hema insinuated two fingers of her right hand around the fetal skull. With her other hand she pushed down on Sister Mary Joseph Praise's belly. She peeked over the rise of the abdomen at Sister's face; it had gone gray, grayer than Stone's.

Nurse Asqual, her hands shaking, managed to insert the tracheal tube. With every squeeze of the air bag, Sister's engorged breasts heaved up.

Hema's hands were like extensions of her eyes as she explored the space that she thought of as the portal to her work; fingers inside took their soundings, helped by the hand on the outside. She closed her eyes, the better to receive what her fingertips conveyed about the pelvic width, the baby's position. “What have we here … ?” she said aloud. Indeed, the baby was head down, but what was this? Another skull?

“Good God, Stone?” Hemlatha said, snatching her hand out as if she'd touched a hot coal.

Stone looked on, not understanding, but afraid to ask. She fixed her gaze on Stone, her face taut, waiting for a reply, any reply, and prepared to shout it down when it came.

“Better out than in?” Stone mumbled, thinking she meant his skull-crushing attempts.

“Damn it, Thomas Stone, don't quote me your idiot book. Do you think this is a joke?” Stone, who didn't at all see this as a joke, who in fact saw that everything Hema was doing was something he could have and should have done, turned crimson. Hema turned back to probe once more that calamitous space in Sister Mary Joseph Praise's body where two lives were in jeopardy. Her words were like body blows directed at Stone.

“One prenatal visit? Could you have let me see her for at least one prenatal visit? I'd have canceled my trip. Look at the soup we are in! Miracle, my foot. Completely avoidable … completely avoidable“ the last two words delivered like lashes.

Stone stood as if in front of the headmistress. Hema seemed to expect him to speak and so he stammered, “I didn't know!”

Hemlatha's jaw dropped. She stared at him. There was a part of her that was incredulous at the idea of Stone impregnating Sister Mary Joseph Praise—who could imagine that? But the cynicism of the obstetrician who has seen everything crept back in. “You're thinking virgin birth, Dr. Stone? Immaculate conception?” She came around the table. “In that case, guess what, Mr. Expedient Operator? This is better than the manger in Bethlehem. This virgin is having twins!” She paused to let it sink in. “For goodness’ sake, couldn't you have done a Cesarean section?” Her singsong intonation rose at the end, leaving the words “Cesarean section” hanging over Stone's head.

“Gloves and gown, quick!” Hemlatha shouted. “C-section tray here. Wake up, all of you! Do you not want to save her? Hurry! Hurry! Hurry!” She repeated this in Amharic—“Tolo, tolo, tolo!”—in case English wasn't getting through.

The authority of her words kept them from retreating into the shock that had paralyzed them. “And you nurses standing around all starched and useless,” Hemlatha said, as she pulled on a sterile gown and donned fresh gloves (there wasn't time to wash), “couldn't you have said something to him? Matron?” Matron looked to the floor.

“How long ago did the fetal heart sounds stop? What was the fetal heart rate?”

“It happened too quickly. We—”

“Oh, shut up, Stone. One of you give me a straight answer. Otherwise all of you shut up. Pressure now?”

“Barely sixty.”

“Where's the blood? Am I dealing with deaf as well as dumb people? Answer me?”

The hospital had no blood bank, just a pint or two if one were lucky, kept in a refrigerator. Patients’ families were reluctant to give blood. Hema once pressed a husband to give blood for his wife, and he'd refused outright. When she suggested that his wife would surely give blood for him if the tables were turned, he said, “You don't know my wife. She's waiting for me to die to take my cows and property.” Time and again, she and Ghosh and Stone and Matron would donate their own blood and prevail on some of the nurses to do the same. At least once a year Ghosh would take his car and round up members of his cricket team to give blood.

“Has no one thought about blood?” Hema said again. “All of you who aren't needed here, go at once and give blood. This is one of our own, for God's sake. Go, now. No, not you Stone! Get gloved, man, for goodness’ sake. Make yourself useful. What was the fetal heart rate?”

The probationer kept her eyes focused on the chart, terrified at the idea of giving blood and not daring to look up. And she knew that no one had listened for a fetal heart. They'd been too preoccupied with the mother. The probationer drew a line through her “C-section indicated” entry, sensing that it reflected badly on Matron. It was no consolation to see Dr. Stone standing frozen, eyes downcast, like a dog who'd disobeyed its master, every instinct telling it to slink away but knowing that the slightest movement would only bring more punishment.

Hema saw that Sister Mary Joseph's Praise's face was losing all color, the eyelids lowered to quarter mast, the hooded gaze now unfocused, a look that was so often a precursor to death.

“Pressure?”

“Can't find it …”

“Doesn't matter, pour in blood, splash some iodine here, let's go!” With that she ripped open the sterile tray, grabbed the scalpel, and slashed through the skin—no time for sterility even—a vertical cut below the navel. Hema still couldn't believe what she was doing, or whom she was cutting.

She half expected Sister Mary Joseph Praise to sit up in protest.

Instead she heard the thud of a body falling and turned in time to see Matron crumpled on the floor.

8. Missing People

CUSTODY OF THE BODY” was the first thing out of Matron's mouth when she revived. She'd passed out for probably fewer than five seconds; everyone was in the same position, but now staring down at her. The probationer ran over to help. Despite Hema's protests, Matron clawed and kneed her way onto the anesthetist's stool, shouting, “I'm not leaving!” They were too busy to argue.

She sat near the board that tethered Sister Mary Joseph Praise's arm, blood finally running from a bottle into a vein. Matron reached for that hand, bending over it, studying Sister Mary Joseph Praise's fingers. She didn't want to look at what the doctors were doing, their red gloves reaching in Sister's belly. Matron still felt light-headed.

As she massaged Sister's fingers to still the shaking in her own, the words came to Matron unbidden: “Instruments of God.” Sister Mary Joseph Praise had beautiful fingers, slender and soft, each a delicate sculpture. Even at rest they spoke of fine motor skills. Matron's by contrast were doughy white, the knuckles large and red as if someone had taken a ruler to them; the knobby excrescencies on the fingers spoke of nothing but age and toil and the caustic soaps and scrubbings which were the first tools of her profession; the fire burst of wrinkles on her palms spoke of her love for the Ethiopian soil and her willingness to plant and weed and dig alongside Gebrew. He was guard, gardener, odd-job man, and priest, and he believed Matron had no business dirtying her hands.

Matron felt her body shaking. Lord, you can take me, she thought. But wait till they're done because I don't want to distract them again. How she longed for a cup of coffee made from their own plant grown on Missing soil. She loved the gritty feel of the stone-ground bean against her teeth, and the way it rolled down the throat like lead shot. The Italians had left behind their passion for macchiato and espresso so that every café in Addis served these beverages. Matron had no use for any of that. Missing coffee, brewed traditionally, that's what sustained her through the day, and what she needed right now.

Tears tracked down into the crevices at the angles of her mouth. One of my Cherished Own, she thought; the daughter I can never have, now with child … So many times at Missing, Matron had become privy to an unspeakable secret revealed by catastrophic illness. Impending death had a way of unexpectedly unearthing the past so that it came together with the present in an unholy coupling. But Lord, she cried out silently, You could have spared us this. Spared her!

As she stroked the younger woman's skin, Matron thought of the impulse that had made Sister Mary Joseph Praise choose to hide her body under a nun's habit or under scrub suit and mask. It hadn't worked; her covering exaggerated what little flesh was exposed. When a face was so lovely, lips so full, even a veil couldn't block its sensuality.

A few years after Sister Mary Joseph Praise's arrival, Matron thought that the two of them should give up the white habit. The Ethiopian government had closed down an American mission school in Debre Zeit for proselytizing. Matron was in the business of running a hospital, not converting souls; she decided it might be politically smart to forgo nun's habit. But when she'd seen Sister Mary Joseph Praise leaving Operating Theater 3 in a skirt and blouse, Matron wanted to run out and cover her with a sheet. W. W. Gonafer, Missing's laboratory technician, standing next to Matron, had also seen Sister Mary Joseph Praise walk by in mufti. He'd frozen like a setter pointing to quail, a flush creeping from his collar to the roots of his hair, as if lust were a companion fluid to blood. Matron had decided then that nuns at Missing should remain in habit.

A sudden exclamation that could have been from Hema or from Thomas Stone startled Matron, brought her back to the present. She jerked her head up, and before she could stop herself, she looked … What she saw made her shudder and feel as if she'd keel over again. She dropped her head down between her shoulders, closed her eyes, and forced her mind to find another focus …

Matron had no saint whom she modeled herself after, someone to call on at these times. To think of St. Catherine of Siena drinking the pus of invalids—oh! how that disgusted her. Matron thought of such displays as a particular Continental weakness, and she was impatient with celestial billing and cooing, bleeding palms and stigmata. And as for St. Teresa of Avila … why, she didn't have anything against Teresa. She didn't grudge Sister Mary Joseph Praise her adulation of Teresa. But secretly she agreed with Dr. Ghosh, the internal medicine physician at Missing, that St. Teresa's famous visions and ecstasies were probably nothing but forms of hysteria. Ghosh had shown Matron photographs that Charcot, the famous French neurologist, had taken of his patients with hysteria at the Salpêtrière hospital in Paris. Charcot believed that these delusions sprung from a woman's uterus—hystera in Greek. His patients, who were all women, stood in smiling poses—provocative poses, Matron thought—that Charcot had labeled “Crucifixion” and “Beatitude.” How could anyone smile in the face of paralysis or blindness? La belle indifférence was what Charcot called this phenomenon.

If Sister Mary Joseph Praise had visions, she wasn't one to speak about them. Some mornings, Sister Mary Joseph Praise had looked sleepless, her bright cheeks, her floating carriage, suggesting her feet strained to remain earthbound. Perhaps that explained her equanimity while working shoulder to shoulder with Thomas Stone, a man who for all his talents gave little encouragement to those who labored with him.

Matron's faith was more pragmatic. She'd found in herself a calling to help. Who needed help more than the sick and the suffering, more so here than in Yorkshire? That was why she came to Ethiopia a lifetime ago. The few photographs, mementos, books, and certificates Matron brought with her had over the years been pilfered or mislaid. She never worried over this—one Bible, after all, would do just as well as the next. The essentials were also easily replaceable: her sewing kit, her water-colors, her clothes.

But she'd come to value the intangibles: the position she had grown to in the city where she was “Matron” to everyone, even to herself; the resourcefulness she'd discovered that allowed her to make a cozy hospital—an East African Eden, as she thought of it—grow out of a disorganized jumble of rudimentary buildings; and the core group of doctors whom she'd recruited and who by long association had evolved into her Cherished Own. The umbilical cord that had connected her to the Society of Holy Child Order, to the Sudan Interior Mission, had shriveled and fallen off. They were all now self-exiled prisoners at Missing— she and her Cherished Own.

Missing Hospital wasn't its name, of course, and now and then Matron tried to correct people, teach them to say “Mi-shun” instead of “Missing.” But in truth that year it wasn't even Missing; it was either Basel Memorial or Baden Memorial—she had to consult the paper taped to her desk to be sure—named after a generous church in either Switzerland or Germany. The Baptists of Houston were big donors, but they weren't at all concerned about naming the hospital. Dr. Ghosh liked to say that the hospital had as many forms as a Hindu god. “On any given day, only Matron knows which hospital we work in, and if we are walking into the Tennessee Baptist outpatient clinic, or the Texas Methodist outpatient clinic, so how can you blame me for being late— I have to get out of bed and go find my place of work. Oh, Matron, there you are!” Prisoners they all were, Matron thought, smiling despite herself; Missing People who could hardly choose their cell mates. But even for Ghosh, who was without doubt one of the strangest of God's creations, Matron felt a maternal affection. And the parallel anxiety that comes with such an impish child.

MATRON SIGHED and was surprised to hear words tumble out of her mouth, and she felt the others in the operating theater staring at her. Only then did she realize that her lips had been busy shaping prayers. Since turning fifty, Matron had noticed such dissonances and disconnections between her thought and action; they were becoming common. For example, at inopportune moments her mind busied itself pasting images into a mental scrapbook. Why? When would she ever have occasion to recall all these memories? At a testimonial dinner? On her deathbed? At the pearly gates? She'd long ago stopped thinking literally about such matters. Her father, a miner who had lost himself in alcohol and the darkness of the tunnels, had loved the words “pearly gates.” On his tongue it sounded like the name of a blowsy woman, one of many that had come between him and his conjugal duties.

Still, Matron was sure of one thing: the image she witnessed when she'd inadvertently looked up a short while before, that was one she'd never ever forget. What happened was this: the sun had suddenly freed itself from behind a cloud, and by some accident of elevation and season presented itself directly on the ground-glass window of Operating Theater 3. Lambent and white, it had bounced off the walls, reflected off glass, metal, and tile, and there it was just when Hema or Stone or whoever it was made a loud exclamation, which was what had made Matron look up. That was when Matron saw them all bent over like hyenas over carrion, peering into Sister Mary Joseph Praise's open abdomen and its scandalous contents. She saw the light nosing its way between elbow and hip. Then the sunbeam fell directly on Sister Mary Joseph Praise's gravid uterus, which bulged out of the bloody wound like an obscenity on a saint's tongue. A blue-black collection of blood—a hematoma— stretched the broad ligament of the uterus, and it glowed in the light like the Host. Matron felt that this had been the sun's intent all along— to find the unborn. We have seen each other anew. We are unmasked. Yes, it was the kind of event that might be termed a “miracle”—except that nothing happened; the laws of nature weren't suspended (which Matron felt was the sine qua non for miracles). But it was as if the twins’ place in the firmament as well as in the earthly order of things had been secured for them even before they were born; she knew that nothing—not even the familiar scent of eucalyptus, or the sight of its leaves thrust into a nostril, or the drumroll of rain on corrugated tin roof, or the visceral odor of a freshly opened abdomen—could ever be the same again.

9. Where Duty Lies

HEMA WIELDED HER SCALPEL like a woman on fire. No time to tie off bleeders, and, in any case, very little bleeding along the way—not a good sign. She opened the glistening peritoneum and quickly positioned retractors to hold the wound edges back. The uterus bulged out of the wound. Then, before her eyes, it seemed to swell and turn luminous … She stood frozen, until she realized it was because the sun had suddenly struck the frosted window and lit up the table. In all her years operating at Missing, she couldn't remember that happening before.

Just as Hema feared, there was a lateral tear in the uterus. Blood had filled the broad ligament on one side. That meant that once she got the babies out, shed have to do an emergency hysterectomy, no easy task in pregnancy, what with the uterine arteries being tortuous, thickened, and carrying half a liter of blood a minute. Not to mention the massive blood clot shimmering in the light, growing before her eyes and gloating at her like a smiling Buddha, as if to say, Hema, I have completely distorted the anatomy, dissection is going to be bloody difficult, and your landmarks will all be gone. But come on in anyway, why don't you?

Hema believed in numerology; next to one's name, nothing was as important as numbers. What is it about this day? she asked herself. It's the twentieth day of the ninth month. No fours or sevens in there … Airplane almost crashes, a child breaks his leg … I crack a Frenchman's nuts … What more, I say, what more?

She rapped Stone's knuckles with a scissors. “Stop!” He was fumbling with an oozing vessel when she needed him to retract.

She incised the uterus and tried to deliver the twin who sat higher in the uterus but was nevertheless head down, upside down. This twin would have been the second to come out had delivery proceeded through the birth canal, but now it would be the firstborn. But strangely, this twin, hand jammed against its cheek, wouldn't budge.

She extended the uterine wound.

She suctioned the infant's mouth.

She drew a sharp breath that inverted her mask against her lips because she could see the problem.

The babies were joined at the head. A short, fleshy tube passed from the crown of one to the other, a tube that was narrower and of a darker hue than the umbilical cords. They were tethered together, but there was a fatal tear in this stalk, a jagged opening caused no doubt by Stone's fishing with the basiotribe. And from this rent, what little blood the two infants possessed was pumping out.

Please God, she thought, let this be only a blood vessel, and a minor one at that. Let there be no brain or meninges or ventricle or cerebral artery or cerebrospinal fluid or whatnot in it. She spoke aloud to Stone now, to the room, to God, and to the twins whose lives, if they survived, might be irrevocably affected by this decision: “They could have seizures the minute I cut this. One twin could bleed out and the other overfill with blood. They could get meningitis …”

This was a technique surgeons used when difficult decisions had to be made: think aloud for your assistant because it might help clarify the issues for yourself. And theoretically it gave the assistant time to point out her faulty reasoning, though she wasn't about to take an opinion from the man responsible for this blunder. A careful decision was needed so as not to blunder again. It was often the second mistake that came in the haste to correct the first mistake that did the patient in.

“No choice,” she said. “I have to cut.” She put clamps across the stalk where it emerged from each infant's scalp. She invoked Lord Shiva's name, held her breath, and cut above each clamp, bracing herself for something terrible.

Nothing happened.

She tied off the stumps. She cut the umbilical cord and easily pulled out the first infant, a male. She handed it to the gowned and gloved probationer who stood nearby. This baby had been spared his father's probings. Then she pulled out the other infant—again a boy, an identical twin, whose scalp was bloodied from Stone's knife and whose skull would have been crushed had she not arrived.

Both infants were tiny, three pounds at best. Clearly less than full term. A month premature, perhaps more. Neither infant cried.

Distracted now by heavy oozing from Sister Mary Joseph Praise's soggy, friable uterus, Hema turned back from infants to the mother.

“What is her BP?” Hema asked, peering over the drapes, first at Nurse Asqual, and then at Sister Mary Joseph Praise's face. The anesthetist, the whites of her eyes showing like saucers, shook her head. Beautiful Sister Mary Joseph Praise's face now looked bloated and lifeless. “More blood! For God's sake. Pour it in!” Hema shouted.

As she toiled in the now deflated cavity of the belly, Hemlatha remembered that when she'd handed over the second baby to the probationer, she had been surprised to find the probationer still standing there, holding the first, a blank look on her face. But Hema had no time to worry about that. Once the babies were out, her duty as an obstetrician was to turn completely to Sister Mary Joseph Praise; her duty was to the mother.

10. Dance of Shiva

WE TWO UNNAMED BABIES, newly arrived, were without breath. If most newborns meet life outside the womb with a V V shrill, piercing wail, ours was the saddest of all songs: the stillborn's song of silence. Our arms weren't clamped to our breasts; our hands did not make fists. Instead, we were limp and floppy like two wounded flounders.

The legend of our birth is this: identical twins born of a nun who died in childbirth, father unknown, possibly yet inconceivably Thomas Stone. The legend grew, ripened with age, and, in the retelling, new details came to light. But looking back after fifty years, I see that there are still particulars missing.

After labor stalled, I dragged my brother back into the womb and out of harm's way as lances and spears came at him through our only natural exit. The attack ceased. Then I remember—and I believe I do—the muffled voices, the tugging and sawing outside. As the rescuers neared us, I recall the blinding glare and strong fingers pulling at me. The shattering of the darkness and the silence, the deafening racket outside was so great that I almost missed the moment when we were physically separated, when the cord connecting my head to Shiva's fell away. The shock of that parting lingers. Even now, what I think about the most isn't that I lay there without breathing, immobile in the copper basin, born to the world, yet not alive—instead, I recall only the parting from Shiva. But, to return to the legend:

The probationer unloaded the two stillborns into a copper basin used to hold placentas. She carried the basin to the window. She made a notation in the delivery chart: Japanese twins connected by the head but now disconnected. In her eagerness to be useful, she completely forgot her ABC's: Airway, Breathing, and Circulation. Instead, she thought of what she had read the previous night about jaundice of the newborn and the helpful role of sunlight. Shed memorized that passage. She wished she had read about Japanese twins (the word “Siamese” eluded her) or asphyxiated babies, but the fact was she hadn't; shed read about jaundice. But then, as she set the basin down, she realized that for sunlight to work, the babies had to be alive, which these weren't. Her sorrow and shame made her confusion worse. She turned away.

The twins lay face-to-face, feeling the basin's galvanic touch against their skin. In the chart the probationer used the words “white asphyxia” to describe their deathly pallor.

The sun, which had stage-lit the room moments before, now honed in on the basin.

The copper glowed orange. Its molecules became agitated. Its prana rose into the infants’ translucent skin and passed into their doughy flesh.

HEMLATHA DISSECTED the broad ligaments, then clamped the uter ine arteries, praying that she wouldn't accidentally clamp the ureters and shut down the kidneys in that bloody mess. “Quick, quick, quick!” She was tempted to smack Stone on the forehead instead of on the knuckles. “Retract properly, man!”

She followed his gaze to Sister Mary Joseph Praise's head, which bobbed like a rag doll's as the anesthetist tugged at her arm to find another vein. Matron, teary and lost in her grief, stroked Sister Mary Joseph Praise's other hand.

When Hema finally delivered the uterus, clamps and all, into a basin, she saw no pulsations in the abdominal aorta. Her hands, steady till now, shook as she loaded a syringe with Adrenalin and attached a three-and-a-half-inch needle to it. She lifted Sister Mary Joseph Praise's left breast, hesitated for a moment, invoked God's name again, then plunged the needle between the ribs and into the heart. She pulled the plunger back, and a mushroom of heart blood appeared in the syringe. Whenever I've had to resort to adrenaline to the heart it has never worked, Hema said to herself. Not once. Maybe I do it as a way to signal to myself that the patient is dead. But surely it must have worked, somewhere, with someone. Why else was it taught to us?

Hemlatha prided herself on being methodical in an emergency, keeping her cool. But she stifled a sob now as she waited, her right hand buried in Sister Mary Joseph Praise's abdomen, palm down, just over the spine, waiting for a throb in the aorta, a slap to register in her fingers. She couldn't forget that this was dear Sister's heart she was trying to jump-start, and whose life was slipping away. They'd shared the bond of two Indian women in a foreign land. The bond extended back to the Government General Hospital in Madras, India, even though they hadn't known each other there. To share a geography and a landscape of memory made them sisters, a family. And Hema could see her sister's hands turning blue, the nail beds dusky, and the skin turning dull. It was the hand of a corpse, and holding it was Matron, her head bowed as if she were asleep.

Hema waited longer than she might have under normal circumstances. It was some time before she could bring herself to say, her voice breaking, “No more. We have lost her.”

IT WAS DURING this hiatus of activity in the room that the firstborn, the one who'd been spared a skull puncture, signaled its presence. It rapped its hands on the copper basin. It brought its left heel down to produce a muffled gong. Now that it had come wholly forth from a dying womb, it reached both arms skyward and then to its right, to its brother. Here I be, it announced. Forget the shoulds and coulds and might haves and hows and whys. I am sympathetic to the situation, the circumstance, and in due course we can explore the details, and, in any case, Birth and Copulation, and Death—that's all the facts when you come down to brass tacks … I've been born, and once is enough. Help my brother. Look! Here! Come at once! Help him.

Hemlatha ran over at this summons, saying “Shiva, Shiva,” invoking the name of her personal deity, the God whom others thought of as the Destroyer, but who she believed was also the Transformer, the one who could make something good come out of something terrible. Later she would say that she'd assumed the worst about the twins. One of them had his head bloodied, and then there was the matter of her dividing the fleshy tube that connected them, and God knows how much distress they'd been in before she cut them free of the womb. But she'd also assumed that Matron or the probationer or both would be reviving the infants while she worked on the mother, though she recalled seeing Matron seated and immobile.

The probationer was mortified at the sound of a baby that had come alive right behind her back, confounding her most basic clinical assumptions. The child was no longer white, but pink, and not jaundiced. The other infant was a robin's egg blue, and it was still and unmoving as if it were the discarded chrysalis from which the crying baby had emerged. Matron, hearing that newborn cry, jumped off her stool. Her glance let the probationer know she was a hopeless case. Hemlatha went to work on the twin that was unmoving while Matron hastened to clean up the living one.

THE BREATHING TWIN gazed out from the copper vessel. Its puffy newborn eyes surveyed the room, trying to make sense of its surroundings.

There stood the man everyone took to be the father, a tall, sinewy white man, looking lost in his own theater. The father's hands were preternaturally pale from the talc that lingered on them after he'd stripped off his gloves. His fingers were clasped together in a posture shared by surgeons, priests, and penitents. His blue eyes were set deep in the orbits under a ledge of a brow which could make him look intense, but on this day made him look dull. From the shadows sprung the great ax blade of a nose, a nose that was sharp, in keeping with his profession. His lips were thin and straight as if drawn with a ruler. Indeed, the face was all straight lines and sharp angles, coming to a point in a lancet shaped chin, as if it had all been carved out of a single square of granite. His hair was parted on the right, a furrow that originated in boyhood with every follicle tamed by the comb to know exactly which direction it was to tilt. The top was cut unevenly, as if after saying, “A short back and sides,” he'd risen from the chair when that was accomplished, despite the barber's protests. It was the kind of obstinate, determined face that with a spyglass held to the eye and a ponytail wouldn't have been out of place on the deck of an English man-of-war. Except, of course, for the tears rolling freely down the cheeks.

And from that tear-stained face, a voice emerged: “What about Mary?” startling everyone because it had been silent for so long. The measured syllables had the quality of a slow fuse.

“I'm sorry, Thomas. It is too late,” said Hemlatha as she suctioned the infant's pharynx, then pushed air into the baby's lungs, her movements speedy and almost frantic. The irritation with Stone was gone from her voice, and pity had taken its place. She stole a glance at him over her shoulder.

A wrenching noise emerged from Stone's mouth, the cry of an unsound mind. Hed been a passive observer and a worthless assistant ever since Hema's arrival. Now he leaped forward and grabbed a scalpel from the tray. He placed a hand on Sister Mary Joseph Praise's chest. Hemlatha thought of restraining him and then decided it wasn't prudent to approach a man wielding a knife.

Stone lifted Sister Mary Joseph Praise's breast. The motto of those pioneers of resuscitation, the Royal Humane Society, resounded in his ears: Lateat scintillula forsan—a small spark may perhaps be hidden.

He pushed the breast up and out of the way, and under his knife a red gash appeared between the fourth and fifth ribs. He drew the knife over the wound again, and yet again till he was through muscle. If he was clumsy earlier, his movements now were those of a man incapable of tentative strokes. He cut the cartilages that connected the two ribs to the breastbone. He spread the ribs and watched in disbelief as his ungloved hand slid out of sight and into the still warm cavity of her chest. The spongy lung he pushed away. And there, under his fingers like a dead fish in a wicker basket, was Sister Mary Joseph Praise's heart. He squeezed, surprised at its size, barely able to encircle it. Meanwhile, he exhorted the nurse anesthetist to keep pushing air into her lungs, not to stop.

His right hand was buried within her thorax, but his eyes were on Sister Mary's engorged left breast, which he held out of the way with his left hand. The breast felt firm, unlike the slippery, soft heart. He saw blotchy blue shadows creep into her face, a hue that her brown skin shouldn't have been capable of. Her abdomen had collapsed, its surface crinkled like an airless balloon, its two halves splayed open like a book whose spine had given way.

“God? God? God?” Stone cried with every squeeze, calling on a God he had renounced once and didn't believe in. But Sister Mary believed, rising before dawn to pray, and lingering in prayer at night before she slept. Every beat of her life and each day of her calendar had been filled with God events, and no morsel of food entered her mouth without God's blessing. Make your life something beautiful for God. If Thomas Stone never understood it, he respected it, because it was the same quality she brought to the operating theater, and to the textbook she'd helped him with. That was why he called out God's name now, because if there was a God, God bloody well owed His devoted servant, Sister Mary Joseph Praise, a miracle. Otherwise, God was the shameless fraud Stone had always found Him to be. “If you want me to believe, God, I'll give you another chance.”

The theater doors swung open.

All eyes turned to the figure that entered.

But it was only wide-eyed Gebrew, priest, servant of God, and watchman. The covered bowl he carried held the injera and wot, and their scent was added to that of placenta, blood, amniotic fluid, and meco-nium. Gebrew had hesitated to come into this sanctum sanctorum. He held the food container in front of him, unsure if it were the ingredient that might save the day. His eyes almost popped out of their sockets when he saw, on the altar of this hallowed place, Sister Mary Joseph Praise opened like a sacrificial lamb with Stone's hand in her chest. He started to shake. He put the food on the floor, squatted down against a wall, pulled out his beads, and swayed in prayer.

Stone redoubled his efforts. “I demand a miracle and I want it right now,” he said, his body rocking back and forth. He kept it up even when the heart had turned mushy in his hand, and he was shouting now. “The bloody loaves and fishes … Lazarus … the lepers … Moses and the Red Sea …” Gebrew's chanting in ancient Geez matched Stone, call and response, as if Gebrew were translating because in this hemisphere God didn't know English.

Stone looked up to the ceiling, prepared for the tiles to part and for an angel to intercede where surgeons and priests had failed. All he saw was a black spider hanging down from its web, with its compound eyes taking in the scene of human misery below. Stone's shoulders slumped, and though his hand was still in Sister Mary's thorax, he was now merely caressing her heart, no longer squeezing. His chest heaved, tears falling onto the body of Sister Mary Joseph Praise. His head fell forward so it rested on his arms, which rested on Sister's chest. No one dared approach. They were transfixed by the sight of their surgeon so defeated, so destroyed.

AT LONG LAST he looked up, seeing as if for the first time the green tile going halfway up the wall, the swinging green door to the autoclave room, the glass instrument case, the bloody uterus with its necklace of hemostats lying in the green towel, the blue-black placenta right next to it on the specimen table, and the jade-colored ground-glass windows through which sunlight filtered. How did these things dare to exist if Mary did not?

That was when his eyes fell on the twins, no longer in their copper throne; that was when he saw the orange halo of light that surrounded the two boys. Somehow both children were alive, bright-eyed, one of them seeming to study him, the second one now as pink as the first.

“Oh no, no, no,” he said in a pitiful voice. “No. That was not the miracle I asked for!” When he withdrew his hand from Mary's body it made a gurgling sound. He left the theater.

He came back with a long broom. He brushed the spider off the ceiling, and then, with his heel, he ground it into the tile.

Matron understood he was intent on blasphemy; in case the arachnid was God, he was killing God.

“Thomas,” Hemlatha said, using his first name, which sounded strange on her tongue in Operating Theater 3, because they were always formal here. By this time both babies were in Hema's arms, wiped off and suctioned and swaddled in receiving blankets. The one in whose skull Stone had tried to drill a hole had aspirated some amniotic fluid but now seemed recovered; there was a big pressure dressing in place over the head wound. The other child showed only the stump of the flesh-bridge that had connected him to his brother, a stump now tied off with umbilical cord suture.

Hemlatha had established that the boys could move their limbs, neither of them was cockeyed, and they seemed to hear and to see. “Thomas,” she said, approaching, but he cringed. He turned away. He would not look.

This man she thought she knew well, seven years a colleague, now stood bent as if hed been gutted.

That, she said to herself, is visceral pain. As angry as shed been with him, the depth of his grief and his shame moved her. All these years, she thought, it should have been clear to us that he and Sister were a perfect match; maybe if wed encouraged them it could have been something more. How often did I see Sister assisting him in surgery, working on his manuscripts, taking notes for him in the outpatient department? Why did I assume that was all there was to it? I should have reached over and smacked him at my dinner table. I should have shouted at him, Don't be blind. See what you have in this woman! See how she loves you. Propose to her! Marry her. Get her to discard her habit, renege on her vows. It's clear her first vow is to you. But no, Thomas, I didn't do it because we all assumed that you were incapable of anything more. Who knew that this much feeling was hidden in your heart? I see it now. Yes, now we have these two as proof of what was in your hearts.

The two bundles in her arms propelled her forward, because they were, after all, his, and even as she thought that, she was still fighting her own disbelief. Surely he wouldn't try to deny that fact. She couldn't back away from this moment; she had to force the issue—who else could speak for these children? Stone was a fool who lost the one woman in the world fated for him. But now he had gained two sons. And Missing would rally round these infants. He'd have lots of help.

She moved closer.

“What shall we name these babies?” She could sense the uncertainty in her voice.

He appeared not to hear. After a pause, she repeated the question.

Stone thrust his chin at her, as if to say she could name them whatever she wanted. “Please get them out of my sight,” he said very softly.

He kept his back turned on the infants to gaze once more at Sister Mary Joseph Praise. Which was why he missed the way his words fell on Hema like hot oil; he didn't see the flames of anger shooting out of her eyes. Hema would misread his intentions, and he hers.

Stone wanted to run away, but not from the children or from responsibility. It was the mystery, the impossibility of their existence that made him turn his back on the infants. He could only think of Sister Mary Joseph Praise. He could only think of how she'd concealed this pregnancy, waiting, who knows for what. In response to Hema's question, it would have been a simple thing for Stone to say, Why ask me? I know no more than you do about this. Except for the certainty that sat like a spike in his gut that it was somehow his doing, even though he had no recollection how or where or when.

Sister Mary Joseph Praise lay lifeless and unburdened of the two lives she had carried, as if that had been her sole earthly purpose. Matron had pulled down Sister Mary Joseph Praise's eyelids, but they would not stay closed. The half-mast eyelids, the unseeing gaze, hammered in the reality of her death.

Stone took one last look. He wanted to remember her not as Sister, not as his assistant, but as the woman he should have declared his love for, the woman he should have cared for, the woman he should have wed. He wanted the ghoulish image of her corpse burned into his brain. He had negotiated his way through life by work, and work, and more work. It was the only arena in which he felt complete and the only thing he had to give Sister Mary Joseph Praise. But at this moment work had failed him.

The sight of her wounds shamed him. Thered be no healing, no scars to form, harden, and fade on her body. He would bear the scar, he would carry it from the room. Hed known only one way of being, and it cost him. But he would have been willing to change for her had she only asked. He would have. If only she could have known. What did it matter now?

He turned to leave again, glancing around as if to seal in his memory this place in which hed polished and elevated his art, this place that hed furnished to suit his needs and that he thought was his real home. He took it all in because he knew hed never ever return. He was surprised to find Hema still standing behind him, and again the sight of the bundles she carried made him recoil.

“Stone, think about this,” Hema said. “Turn your back on me if you want, because I'll have no use for you. But don't turn your back on these children. I won't ask you again.”

Hema held her living burden and waited on Stone. He was on the verge of speaking to her honestly, of telling her all. In his eyes she saw pain and puzzlement. What she didn't see was any recognition of the infants as being connected to him. He spoke like a man who'd just been hit on the head. “Hema, I don't understand who … why they are here … why Mary is dead.”

She waited. He was circling around a truth that might emerge if she waited. She wanted to grab his ears and shake it out of him.

At last he met her gaze, refusing to look down at the infants, and what he said wasn't what she wanted to hear. “Hema, I don't want to set eyes on them, ever.”

The last of Hema's restraint fell away. She was livid for the children, furious that he seemed to think this was just his loss.

“What did you say, Thomas?”

He must have known a battle line had just been drawn.

“They killed her,” he said. “I don't want to set eyes on them.”

So this is how it will be, Hema thought, this is how we shall pass from each other's lives. The twins mewled in her arms.

“Whose are they, then? Aren't they yours? So didn't you kill her, too?”

His mouth opened in pain. He had no answer, so he turned to leave.

“You heard me, Stone, you killed her,” Hema said, raising her voice so that she drowned out every other sound. He flinched as the words lashed into him. It pleased her. She felt no pity. Not for a man who wouldn't claim his children. He pushed the swinging door so hard it shrieked in protest.

“Stone, you killed her,” she shouted after him. “These are your children.”

THE PROBATIONER BROKE the ensuing silence. She was trying to anticipate, so she opened a circumcision tray and pulled on gloves. The one thing Matron allowed her to do without supervision was to use the foreskin guillotine.

But instead of praising her, Hema pounced on her. “My goodness, girl, don't you think these children have had quite enough? They're preemies! They are not out of danger. Want them to be chip-cock-Charlies on top of all this? … And you? What have you been doing all the time, eh? You should've been worrying about their swallowing ends, not their watering cans.”

HEMA ROCKED THE TWINS, thrilled by their breathing selves, by their peaceful smiles, the opposite of the usual anxious, panicked face of a newborn. Their mother lay dead in the same room, their father had run, but they knew nothing of that.

Matron, Gebrew, the nurse anesthetist, and others who had gathered were weeping around Sister's body. Word had spread to the maids and housekeepers. Now a funeral wail, a piercing lululululululu ripped through the heart of Missing. The ululations would continue for the next few hours.

Even the probationer began to show the first inkling of Sound Nursing Sense. Instead of struggling to appear to be something she was not, she wept for Sister, who was the only nurse who really understood her. For the first time the probationer saw the children not as “fetuses” or “neonates” but instead as motherless children, like herself, children to be pitied. Her tears poured out. Her body slumped as if the starch had vanished not just from her clothes but from her bones. To her amazement, Matron came and put an arm around her. She saw not just sadness but fear in Matron's face. How could Missing go on without Sister? Or without Stone? For surely he was never coming back, that she could see.

Hemlatha shut out the sobbing around her as she rocked the babies, and then she began to croon, her anklets jingling faintly like castanets as she shifted weight from one foot to the other. She felt the loss of Sister Mary Joseph Praise as acutely as anyone, and yet she felt guided— perhaps this was Sister's doing—to give her all at this moment to the two infants. The twins were breathing quietly; their fingers fanned over their cheeks. They belonged in her arms. How beautiful and horrible life is, Hema thought; too horrible to simply call tragic. Life is worse than tragic. Sister Mary, bride of Christ, now gone from the world into which she just brought two children.

Hema thought of Shiva, her personal deity, and how the only sensible response to the madness of life in this her thirtieth year was to cultivate a kind of madness within, to perform the mad dance of Shiva, to mimic the rigid masking smile of Shiva, to rock and sway and flap six arms and six legs to an inner tune, a tabla beat. Thim-thaga-thaga, thim-thaga-thim, thim-thaga … Hema moved gently, knees flexing, tapping her heels, then her forefoot in time to the music in her head.

The bit players in Theater 3 regarded her as if she were mad, but she danced on even as they tidied the corpse, she danced as if her minimalist gestures were shorthand for a much larger, fuller, reckless dance, one that held the whole world together, kept it from extinction.

Ridiculous, the thoughts that came to her as she danced: her new Grundig, Adid's lips and his long fingers, the thump of Matron falling over, the revolting feel of the Frenchman's balls but the satisfaction in seeing the color flee his face, Gebrew with chicken feathers stuck to him. What a journey … what a day … what madness, so much worse than tragic! What to do except dance, dance, only dance …

She was surprisingly graceful and light on her feet, the neck and head and shoulder gestures of Bharatnatyam automatic for her, eyebrows shooting up and down, eyeballs flitting to the edges of their sockets, feet moving, a rigid smile on her face, and all this while holding the babies in her arms.

Outside the hospital, as the light faded, the lions in the cages near the Sidist Kilo Monument, anticipating the slabs of meat the keeper would fling through the bars, roared with hunger and impatience; in the foothills of Entoto, the hyenas heard and paused as they neared the edge of the city three steps forward and one back, cowardly and opportunistic; the Emperor in his palace made plans for a state visit to Bulgaria and perhaps to Jamaica, where he had followers—Rastas—who took their name from his precoronation name of Ras Teferi and who thought he was God (an idea he didn't mind his own people believing, but when it came from so far away and for reasons that he didn't understand, made him wary).

THE LAST FORTY-EIGHT hours had irrevocably altered Hema's life. She had two infants squinting up at her from time to time as if to confirm their arrival, their good fortune.

Hema felt light-headed, giddy. I won the lottery without buying a ticket, she thought. These two babies plugged a hole in my heart that I didn't know I had until now.

But there was danger in the analogy: shed heard of a railway porter at Madras Central Station who won lakhs and lakhs of rupees, only to have his life fall apart so that he soon returned to the platform. When you win, you often lose, that's just a fact. There's no currency to straighten a warped spirit, or open a closed heart, a selfish heart—she was thinking of Stone.

Stone had prayed for a miracle. The silly man didn't see that these newborns were miracles. They were obstetric miracles for surviving his assault. Hema decided to name the first twin to breathe Marion. Marion Sims, she would tell me later, was a simple practitioner in Alabama, USA, who had revolutionized women's surgery. He was considered the father of obstetrics and gynecology, the patron saint; in naming me for him, she was both honoring him and giving thanks.

“And Shiva, for Shiva,” she said, naming the child with the circular hole in his scalp, the last to breathe, the child she had labored over, a child all but dead until she had invoked Lord Shiva's name, at which point he took his first gasp.

“Yes, Marion and Shiva.”

She tacked on “Praise” to both names, after their mother.

And finally, reluctantly, almost as an afterthought, but because you cannot escape your destiny, and so that he wouldn't walk away scot-free, she added our surname, the name of the man who had left the room: Stone.