My problem was the opposite: I saw AIDS everywhere in the fabric of the town; I wanted to pick up a megaphone as I stood in a checkout line and say, “ATTENTION K-MART SHOPPERS: JOHNSON CITY IS A PART OF AMERICA AND, YES, WE DO HAVE AIDS HERE.”
My ubiquitous stack of index cards floated in front of my face at night. I could rattle off precisely where each person was in the downhill trajectory that was the natural history of HIV infection. The integers and the units of measurement—“liters,” “cells per cubic millimeter,” “grams per deciliter”—sometimes inhabited my dreams in a peculiar “dream-work” routine, as if I was on the eve of a math exam, a Cambridge tripos, truly a nightmare for one so disinclined toward mathematics as I.
When I awoke I would make calculations: If I had twenty patients and they were the tip of the iceberg, then how many others did the town have? Two hundred? Four hundred? Could one in every five hundred persons in town be infected with the virus?
At times I was angry with the town—how could I be in this landscape of death, the unholy minister to a flock of dying people, while Johnson City went on with business as usual? While I was awake, everything I did—be it with hamsters or with humans—seemed to be a way of marking time while waiting for the next HIV case or the next opportunistic infection in my old HIV patients. Would there come a point where AIDS would grow until no one could ignore it? Where every church member, every person in the mall would have this knowledge rise to their consciousness? Where every doctor, every nurse would have the disease drop onto their plate the way it had been dropped onto mine?
As I entered my house through the kitchen, more than twelve hours after I had left it, I took a deep breath. I decided I would not think about AIDS for a while.
STEVEN CAME RACING around the corner in response to the squeak and slam of the screen door. I barely had time to rid myself of my briefcase and the mail before he came flying into my arms. My mother and father were visiting us and would stay with us till their second grandchild arrived. My mother had clearly been hard at work in the kitchen. There was the rich aroma of cardamom and ginger and green chilies; every ring on the stove held a pot. A mound of papads sat in a sieve on the counter. The food made me feel famished: I remembered that I had not eaten lunch and only the one chocolate-glazed doughnut had sustained me all day.
I loosened my tie and, still carrying Steven, pushed through the swinging doors into the dining room and greeted my parents. Rajani was upstairs having a bath. I poured a Scotch for myself and a sherry for my mother. I poured ginger ale into a wineglass for Steven, who preened with self-importance. We toasted each other until Steven had his fill of clinking glasses. Ever so gradually, I felt the shackles of work slip from me.
Just before dinner, as we waited for Rajani to come down from her bath, my father, mother, Steven and I went out to the front porch where Steven wanted to see the fireflies. My father asked me about work. I told him about Scotty Daws, my silent myna bird in the ICU. And about the clinic. Here I was, despite my promise to myself, talking about AIDS.
“Do you wear gloves when you touch them?” my dad asked.
“Them?” I was on the defensive. “No. Not unless I’m going to draw blood or do a rectal or something.”
“You mean you don’t wear gloves when you touch their skin?”
“No. Dad, you can’t get it from touching the skin.”
My mother shuddered.
“Still,” my dad said. “I think you should wear gloves. Why don’t you? You have a young child at home. A baby coming. Don’t take chances.”
I kept quiet. On several previous nights I had heard myself justify to my parents what I was doing—the AIDS work—telling them how much satisfaction I was getting from it. What I didn’t mention was how stressed I felt some days, how alienated I felt from other physicians, from friends, and even from my wife. By God, if what I was doing was noble, why did it feel like something . . . something shameful?
I remembered Scotty Daws’s nurse, the green eyes over the surgical mask. Why are we going on? And now my father’s Do you wear gloves when you touch them? I seemed to be living in a separate world which those who had not been touched by the disease could not enter. I felt alone at my own table, alone and unclean, chastened by my father’s attitude. I thought at that moment of the gay men I had met during the last months. I thought of how often they had felt alone at the table among family and friends.
During dinner, Steven fell asleep in his grandfather’s arms and I carried him up to bed. When I returned, the others were sitting around the dining table, eating coffee cake. The chandelier was dimmed and light came from the candle-shaped fixtures on either side of the china cabinet. I had turned off the air conditioners and opened the door to the front porch to let the evening in. The chirping of the crickets came through, a reassuring sound. Through the black living room window we could see the fireflies zigzag across the lawn, and behind them, occasionally, the headlights of a car tracking through Mountain Home.
My mother was telling Rajani a tale from my childhood in Ethiopia. Some escapade of mine that with each telling seemed to be embellished. It was amazing how this yarn brought a smile to my father’s face. At the time it happened, I had been punished: an ear grabbed and twisted, or a stick to the seat of my pants—I don’t remember. In any case, the event was no longer mine. It had gone from fact to anecdote; it was the property of my mother.
Listening to my mother’s voice, I felt as if I was on the outside, looking in: the four of us around the dining table, bathed in the soft saffron light, a family tableau, Indians in east Tennessee. The perfect family—well fed, safe from danger.
Rajani sat still, a distracted, faraway look on her face as my mother talked. My wife’s expression revealed nothing. Occasionally she smiled pleasantly, laughed on cue. But it was as if she responded without truly hearing anything. Still she was beautiful in the soft light. Her beauty was what had drawn me to her when I saw her at a cousin’s wedding in India. Of course I wanted to possess it, wanted it to adorn my vanity. When we met, I was on the eve of graduating from medical school in India, on the eve of coming back to the United States. I had no intention of getting married. She had finished her bachelor’s degree in English literature and a postgraduate degree in mass communications and was working for a large advertising agency. She was very eligible, and her parents were looking to get her married—an arranged marriage. Despite her education, she was not a woman who would have considered rebelling against this custom.
The arranged marriage system, primitive as it sometimes sounds, is nothing more than an elaborate form of the dating system. Good girls, by definition, are difficult to meet because they stay at home. When they sally out, they are carefully chaperoned. I saw them around, tantalizing, but quite unapproachable. I got to chat with interesting women in the medical school or in the hospital—but it was rare that they agreed to go out. Much of that is changing, but even with the modern Indian girl, the parental voice echoes strong in her mind and keeps her from being too adventurous. So how does an Indian male meet a woman and get married if women are so cloistered? When you are ready to marry, your parents might say something to you like, “Do you know so and so’s daughter? Why don’t you go see her? Go for a movie or something. Get to know her. They will be expecting you.” Two movies and three lunches might be the limit before you have to commit yourself. Or bail out.
Rajani had been approached in this fashion by several suitors, and the stories she told me of these meetings were comical. But I could understand how a man could become tongue-tied in her presence—it happened to me. She and I went out a few times without her parents’ knowledge—a dangerous thing to ask of her, the sort of thing that could ruin a girl’s reputation. I began to feel that if I wanted to be with this gorgeous and intelligent woman, if I wanted to solve the mystery of her reserve, of her imperturbability, I needed to make my move at once; otherwise she would soon be married. I had no time to waste.
I proposed on our third
date, by which time I was quite infatuated with her. She accepted reluctantly; she really did not want to leave India, but of all the suitors I had proven, at the very least, the most tenacious. We went to our respective parents and suggested they arrange our marriage.
Those first years of marriage were exciting stages of discovery that perhaps Western couples go through when they are dating, well before they marry. Now, after seven years of marriage, I felt I was still getting to know her, still unraveling the Gordian knot, still unsure what was on Rajani’s mind. If I tended to be the extrovert, Rajani was the opposite. She could hold a thought for months or years. She had a black-and-white sense of wrong and right, good and bad—quite the opposite of the chameleonlike instincts I had accrued from being a lifelong expatriate. What I saw as relative, she saw as absolute. If she was calm and even-tempered, my personality was much more cyclothymic, the downs in particular could be prolonged and could try the patience of anyone around me. And my practice, particularly now with AIDS, was making me more emotional, less able to hold back my feelings and less tolerant of anything I saw as hypocritical.
I often felt as if I had failed her, as if she would have preferred the privileged life she led in India—maids, chauffeurs, an exclusive and entitled circle of mannered friends, the society of tea planters, estate owners, and tea brokers that characterized the small hillside resort town she grew up in—to the rough-and-tumble existence we had led through my years of training.
With the press of time and the demands of one child and a second on the way, we rarely debated the gray zones that separated us anymore. We loved Steven; he made it even easier to sidestep these issues, delude ourselves into feeling that to be together with him was to be communicating with each other.
Forewarned with the knowledge of what Rajani approved or disapproved of, I spared myself her disapproval. I spared her any angst. My time with my wilder friends like Allen was more likely to be spent outside the house or at his house than in mine. I could sit in the back room of his gas station and shoot the breeze and taste his moonshine, and bathe in his cigarette smoke, but it was something I would never dream of asking Rajani to do. I had a cadre of friends who I knew would probably be ill at ease at our house, less inclined to be themselves. And her small circle of friends and their interests I found difficult to relate to.
My work with AIDS in the community fell into this chasm between us. AIDS was like another wild friend, a friend from a different social stratum, a friend I indulged but no longer brought to the house or even discussed with her.
RAJANI NOW HEAVED herself up from the dining table and went to the kitchen even before my mother came to the punch line of the story. From the kitchen, Rajani beckoned me.
“The baby has stopped moving,” she said.
The little kicks and punches had been virtually incessant till then. Now, for twenty minutes, while we were sitting at the table, she said she had felt nothing.
I shook off the torpor of the evening. I was fully alert. Rajani was looking to me to see if this was something serious. I didn’t know! New life—birth—was not my area of expertise.
I called our obstetrician, Dr. Dunkelberger. He told us to go right away to the Miracle Center so that Rajani could be hooked up to a fetal monitor. We left my stunned parents behind, the coffee cake half-eaten, my mother’s anecdote still incomplete, hanging in the air. At the doorway, Rajani gave hasty instructions to my parents on what to do if Steven woke up.
By the time the fetal heart monitor was hooked up, Dr. Dunkelberger was by our side. The tracing showed that the baby was alive but its heart rate was erratic. It was in distress. A cesarean—at once!
As Dr. Dunkelberger was making preparations for the cesarean, the baby’s heart rate normalized. Perhaps the cord had got kinked from the baby’s wriggling into an awkward position. And perhaps, in the process of examining Rajani, Dr. Dunkelberger had managed to shift the baby into a better position. In any case, the crisis had abated for now.
Dr. Dunkelberger elected to induce labor; it would take a couple of hours. We settled back to wait for the first contraction.
L&D, Labor and Delivery, was in the bowels of the Miracle Center: there were no windows, only the contrast of fluorescent daylight in the corridors outside with the soft light from the table lamps of the birthing suite which looked like an Ethan Allen showroom. All sense of time disappeared. It was a strange feeling to be in this hospital as an observer, awaiting the birth of a child. Upstairs, a young man on a respirator had his every breath and sigh controlled by me; a young girl inhaled an antibiotic I had prescribed. Elsewhere, in other rooms, my handwriting was on many a chart. But in this room my function was simply to wait.
Rajani’s contractions began. They were widely spaced. I waited at the bedside. Periodically, Dr. Dunkelberger would materialize, scan the fetal heart monitor, smile at me, say a few words of encouragement to Rajani, and then withdraw as quietly as he appeared. I was in awe of his alertness. I felt punch-drunk from lack of sleep.
Next door, the faint sounds of “Push, push, push” had given way to a “Stat” call for a pediatrician crackling on the overhead speakers and echoing in the hallway, rupturing the silence. There was the clatter of running footsteps and agitated expressions on the faces that passed our door. Running is ominous in a hospital. It can only mean trouble.
I slipped out into the hallway, curious. A medical student, looking ashen, told me that the baby in the next room had been born with exomphalos: the abdominal wall was missing and the intestinal organs were retained only by a thin membrane. If the baby survived, it faced many operations to reconstruct the abdominal wall.
I said nothing to Rajani. But my anxiety for our new baby increased.
MY BEEPER WENT OFF at two in the morning: my father was paging me. Steven had woken up and had gone to our bedroom and was terrified to find us gone. He had walked around the house looking for us. My parents had heard the pit-pat of his feet on the wooden floor below as he ran from living room to dining room to kitchen in search of us. They called to him. Much as he loved his grandparents, he was frightened and inconsolable, my father said. He had been pacified only when my father told him he was going to telephone me. I could hear him sniffling in the background. I talked to him on the phone. “Daddy, come here,” he said.
“Daddy’ll be right there,” I said.
I sped home and found my little two-year-old in the living room—he had refused to go upstairs. He was sitting on the edge of the sofa, between his grandparents, holding back his tears with pouting lips, his eyes glued on the door. When I picked him up he put his little hands around my neck, wrapped his legs around me and cried angry tears—“how could you leave me?” he seemed to be asking. The tears diminished and finally ended with a big sigh.
I sang “Puff the Magic Dragon,” his favorite sleepy-time song, and soon I could hear his breath, soft and regular against my neck, an occasional involuntary sob like a hiccup shaking his body. I took him upstairs and laid him down in our bed, his hands still locked around my neck, the fingers grasping my hair. Like a contortionist, I extricated myself from his grip, patting his bottom all the while in time to my singing. I tiptoed back out of the room, wishing the floorboards of this old house would not creak so, humming while I retreated. I held my breath on the stairs, hoping I would not hear an anguished sob that would mean I would have to start all over again.
Downstairs, I asked my parents to sleep in our bed with Steven—the simplest way to keep him from roaming. I promised to call when the baby came. I headed back for the hospital.
The night air was thick and the pollen tickled my nose. There was no mist. It was instead a still, summer night. I felt tense. I had no control of what would happen in the next few hours. I was totally at the mercy of God or nature. Would that this birth be uneventful. Given all that I had seen recently, all the suffering, all the sadness, an easy uncomplicated birth seemed almost too much to hope for. As a reflex, I prayed.
A driving bl
ues number was playing on the radio. The song brought back memories of my first year of medical school in Ethiopia when, for a while, I had played bass guitar in a band. I didn’t need the money, and I couldn’t afford the time, but there had been benefits: looks of interest from the girls, the exhilaration when a number spun out perfectly. At the time, I couldn’t imagine giving it up. In the haze of smoke and the press of dancers of all races and colors against the stage—this was the East Africa of the early 1970s, East Africa in the first cataclysms of a subcontinent about to fall—I had stayed close to my amp, next to the drummer, watching his bass pedal, he and I solely responsible for keeping the skeleton of the song intact. Some undefined melancholy for which I never found a reason had justified my being high every night—the beer was free, and between sets there was always a joint making the rounds. Yet, I lived for a special moment that came every night, an instant of absolute clarity, a tungsten light that washed away all the fuzziness (and stayed with me long after I left the club and was still with me in the early hours of the morning when I propped open my Gray’s Anatomy). It came in a twelve-bar blues like the one I was listening to now. It was the number with which we closed our second and final set, a blues with a driving, funky rhythm that set heads nodding and feet tapping from its first bar. When we came around to the climactic eleventh and twelfth bars, a point in the song where the musical tension was so high that you could be tone deaf and still know that a resolution had to take place, we would go silent. We let the climax happen in thin air, in people’s minds, punctuating just the ghost of these remaining bars with single beats from my thumb against the string. By the twelfth bar, the crowd would go wild, spilling into our song, threatening to mess us up altogether, drowning out the sound of the lead guitar, the drums and the organ kicking back in. While the strobe lights spun and the dance floor became a lunar landscape in which ghostly figures held poses, the drummer, Solomon, would look at me and I at him. Solomon would call across the void that separated us, “Steady, Abe! Steady!”
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