Slice Girls

by Joan Arakkal

  My father’s unusually progressive attitude towards education began with his siblings. His enterprise and entrepreneurship got him into the air force and took him across the length and breadth of the country. As a young airman, all his daily requirements were provided, allowing him to send his salary, right down to the last rupee, back to his family. Often, he did even better by selling the cigarettes he received every month as part of his standard issue. In this way, he ensured his brothers and sister were educated. They all graduated from university, much to his pride and satisfaction.

  When my father sought out a bride, he was looking for a spark that would set her apart from others. He found that spark in my mother. She had a thirst for knowledge and she could not have had a better partner to foster her desire. After completing year ten, she had done a year of teacher’s training. Upon discovering his new wife’s keenness to study, he was delighted to help her through a university education that he had not been able to access himself. Every effort was made to ensure my mother could attend university. I saw nothing amiss in my father cooking us a special meal on Sundays while my mother was lost in her books. On examination days, he made her strong cups of coffee, cooked nourishing meals and escorted her to the examination hall. He waited outside the hall for the entire duration of the exam, eager to know how it went and whether the questions were as expected. If my mother was concerned about her performance, he made light of her worries and encouraged her on.

  My mother, Abe and I regularly sat around the table doing our assignments while my father read the newspaper. We lived in each other’s worlds and shared our successes and worries. Our joys were doubled and our troubles halved. In the solipsistic way of childhood, I had no reason to think this was anything but the norm.

  When it was clear to my father that I wanted to be a doctor, he silently went about the task of helping me get there. To enter medicine, I would have to do well in physics, chemistry and biology. Laboratories were fascinating places. We weighed, balanced, pipetted, titrated and peered through microscopes but the highlight of my biology classes was dissecting immobilised frogs that had been pinned grotesquely to wooden boards. Their small amphibious hearts pulsating on the boards filled me with awe. Carefully, I teased out one of the creature’s blood vessels, eventually laying out the whole circulatory system in a marvellous and enthralling tableau. But frogs were rationed at school and if I was going to master dissection, I needed more of them. My father came to the rescue. He rode his bicycle to a mysterious location where he procured more frogs in a large bottle, and he came up with the essential chloroform that would settle them before they were pithed. I owe a huge debt of gratitude to these creatures who gave their lives to advance my surgical skills.

  In a country where the feminine has always been worshipped, I saw nothing unusual in my father’s role in educating his wife and daughter to any level they aspired. My brother was expected to follow his older sister. Endowed with a more analytical intellect, he saw the folly of this blind adherence, but disobeying our parents was just not something we did. He went along with it until he had a chance to voice with kind humour his disapproval at the hierarchy and the folly of my ways. His sentiment was noted, but there was no change to the delegation of our roles.

  Our family dynamic was obviously a positive and effective one. Other parents wanted to know the secret of our success. Back then, I did not think there was any special element. Today, I know the secret was the untiring efforts of a father whose respect for education knew no bounds, and who saw the need to educate women as much, if not more, than men. Years later, when I brought home a gold medal for surgery, what meant more to me than the medal was the joy and pride I saw in my father’s face. If the pithed frogs had paid the ultimate price, my father had truly won the prize.

  EMERGENCY

  In 1966, the world’s largest democracy elected its first female prime minister – well before other industrialised nations could even conceive of a woman holding such a high office. As a supporter of minorities and an upholder of women, the poor and the Dalits, who were at the bottom of the hierarchical caste system, Indira Priyadarshini Gandhi’s visions mirrored those of her father, Nehru. He had been imprisoned for his role in India’s freedom struggle. His love and vision for his daughter reached out from behind prison bars through letters urging her to look at the world, its cultures and its civilisations and view history with sympathy, and human beings as different yet the same in their virtues and failings. Nehru was a statesman, an historian and a lawyer but, above all, a dedicated father. He loved his daughter and gave her roots and then wings to soar as high as she chose.

  In 1975, sensing ‘imminent danger to the security of India being threatened by internal disturbances’, she declared a controversial national emergency. Fundamental rights were suspended and the media was censored. The government wielded unconstitutional power in an attempt to curb unrest. Horror stories of compulsory sterilisation to control population, unlawful incarceration and deaths in custody echoed throughout the next twenty-one months. On the brighter side, a program was rolled out to increase agricultural and industrial productivity and set the nation on a path towards economic progress. The legacy of the emergency continues to be debated forty years on. There were winners – and I was one of them – and there were losers.

  Prior to the emergency being declared, political leaders placed party and communal ideologies before those of the nation. Anarchy, black markets and corruption thrived. Party leaders held sway over students and institutions. Admissions to coveted professional courses, like medicine, were hijacked by politicians and their minions. Public institutions were run like private kitchens where the cook decided the menu and doled out food in proportions they saw fit, to whomever they pleased. Money spoke loudly, as did the men with influence. It was more important to know the right people than it was to do the right thing.

  At the age of sixteen, I graduated from school with excellent grades. Thanks to the emergency, the men who could have thwarted my entry into medicine had been thwarted themselves. When I applied to be admitted to medicine at Madras University in Tamil Nadu, selection into the course was streamlined and academic merit became the sole arbiter of entry into medical school. I was lucky to be one of the entrants. Hands were not greased (we could not have afforded the grease at any rate), influence was not bought and castes were not engineered.

  The much-maligned Indian caste system was initially conceived as a welfare system. Every child born into the society was assured of a trade – goldsmith, blacksmith, carpenter, tree climber, healer, Veda reciter, street cleaner. From midwives to corpse burners, no aspect of life was unattended. But the system gradually morphed into the ugly monster that we know today. In the early phase of its conception, shifting between castes was acceptable and no job was seen as unworthy. If the apprentice cloth weaver wished to become a barber, he could do so. Contrary to modern assumptions of the caste system, identities were not set in stone and boundaries were ill-defined.

  In precolonial India, caste was one of the many aspects of an individual’s identity, which included religion and creed, profession and province. However, with the passage of time and the arrival of colonial rule, ethnographic classification using a census was established. Value judgements were made and previously unheard-of communities – such as ‘criminal tribes’ – were invented. Taxonomically classified people were boxed into spaces that they could not move out of. Sudras remained Sudras, and Brahmins were exalted.

  Preferential treatment and positions in the British Raj resulted in the Veda readers occupying the highest rung on the caste ladder. The previously meritocratic society based on multiple identities with fuzzy borders was organised into the rigid one-dimensional system that India has today. The lower castes internalised the prejudice that saw them as inferior of castes, and the upper castes grew in confidence. Added to this was a mixture of poverty and illiteracy. The restructured caste system was an ugly baby that India was left holding when Britain’s
taxonomists and eugenicists left, and it continues to rile and embarrass right-thinking Indians.

  India became a sovereign and democratic republic in 1950. The communities, which had been separated both socially and psychologically, demanded self-governance. The ‘backward’ classes rose in numbers and affirmative actions to uplift them were encouraged. To alleviate generational iniquities that resulted from illiteracy and poverty, dedicated positions – along with lower requirements of entry into educational institutions – were established. This positive discrimination resulted in the privileged communities – now called ‘forward’ – having access to fewer places and having to meet more stringent requirements for entry into professional education. This included the Brahmins. As a Syrian Christian, with roots supposedly traceable to the conversion of Brahmin families by St Thomas around CE 52, I was in the ‘forward’ group. Many sects of Christians who converted after the arrival of Vasco de Gama and missionaries from the imperial worlds were in the ‘backward’ group.

  When admission into professional colleges was on the agenda, every ‘forward’ student wished they were ‘backward’. For those who had parents with money, enterprise and few scruples, this wish could become a reality. When I joined the medical school, three of my distant relatives were already in their senior years. They had walked in through the ‘backward’ door. Their conversion took place on paper with a tiny drop of ink and a not-so-tiny amount of ill-gotten money. They had escaped the stringent scrutiny that had been executed through the months of emergency rule and emerged as Latin Christians, their Syrian and Antiochian roots now shoved aside for the more practical and prestigious pursuit of medicine.

  The emergency served me well. It let me enter the world of medicine I had dreamt of, with no machinations. But before I could heal the living, I had to learn from the dead.

  THE GRAMMAR OF MEDICINE

  Entering the anatomy dissecting hall in my long white coat, I joined the throng of the excited, young medical students setting out to do their first dissection. The long, narrow, steel table held a human-shaped mound covered by a plastic sheet. The group of eight that would work and dissect together was decided for us. Our tutor arrived at our table and we gingerly took our positions on the steel stools along its edges.

  When the professor of anatomy arrived, a hush settled over the excited babble in the high-ceilinged expanse of the anatomy theatre. He welcomed us to the department and told us about the journey we were embarking upon. He reminded us that each of the mounds on our table was once a person who lived and breathed. In their death, they had provided us with the gift of their body so we could learn to serve the living. His message to always honour the mortal remains entrusted to us was later sometimes forgotten as we competed to see whose dissection would look most like the artistic illustrations displayed in Cunningham’s Manual of Practical Anatomy.

  As we hesitantly lifted the plastic cover, the expressions around the table ranged from poorly concealed disgust to pure awe. A wizened man lay frozen and mummified before us. Embalming fluids and alcohol had lent a leathery texture to his skin. In his veins, where blood once flowed, there was now formalin. The barely human appearance of the dead man helped us overcome our diffidence in wielding our brand-new scalpel on his extremities. As we supported a colleague who had a fainting spell, we knew we had to forge a bond to help us all survive the eighteen months of cutting and slicing that lay ahead.

  As the days went by, we eased into our dissecting roles. With the smell of preserved death hanging on our white coats, we relaxed and bonded over the greasy dissection manuals and scattered tissues. We dug deeper into the grey flesh and bare bones to which the muscles cleverly clung. We bandied about the Latin names that we were painstakingly memorising: ‘abductor digiti quinti minimi brevis’, ‘levator labii superioris alaeque nasi’ and ‘flexor digitordum profundus’ all rolled off our tongues with ease as time went by. ‘Caddy’, as we had come to affectionately call the cadaver on our table, was slowly taken apart. His upper and lower limbs were shredded down to milk-white bones, and as the months went on we ventured into his abdomen and then his pelvis. Later, we sawed through his chest and ribs and exposed his still heart, the lungs lying deflated on either side. The head and neck were challenging – I can still see one of the students in my group being fascinated by the waves and undulations of the solidified brain. Today, when I hear of his neurosurgical skills, I am not surprised. The seeds of our surgical interest were sown in those early days when Caddy laid his body bare to us.

  Osteology, the study of bones, was both fun and tedious. Macabre as it may sound, each of us acquired an entire dismantled skeleton. Some of us, including me, inherited them from senior students who had finished with anatomy. Others bought theirs from sources that remain a mystery. A cardboard box sitting under my bed held my deconstructed skeleton. Its bones ranged from the longest femur down to the smallest pea-shaped wrist bone, the pisiform.

  As exams approached, we entered a last-minute frenzy of memorising every part of the bones: the tiny holes where blood vessels entered to feed the marrow, the pits and fovea where ligaments attached, and the roughened surfaces where muscles held on. We knew the growing ends of the bones and the difference between the spongy and cortical textures. As the Latin names rolled off our tongues ever more effortlessly, our droopy eyes closed and our heads rested on the voluminous hard-bound covers of Gray’s Anatomy. One day I was woken by the gentle laughter of my mother. She had come into my room and found me fast asleep, curled up like a cat amidst the scattered bones. Today I think of that ghoulish scene and marvel at the ease with which the household adapted to my life as a medical student.

  Many years later, when I entered orthopaedic training, Caddy and those dead bones came to life. As I was taught to expose a fracture site with carefully laid incisions to avoid important nerves and blood vessels, I longed for Caddy. He had been so forgiving, even when we slashed through his vital arteries. The bones I knew so well from my studies were barely recognisable underneath plump, reddish-purple muscles that pulsated with life. Blood congealed at the fracture site, where nature had rushed in to heal the breach. As I carefully reduced the splintered ends of the bone into alignment and drilled the long Kirschner wire to bridge the broken ends, I realised anatomy was indeed the grammar of medicine. Without it, I could not have made sense of the blood and gore that lay before me.

  HEALING TOUCH

  The completion of Caddy’s dismemberment set the stage for us to leave cadavers behind and move into the more animated world of the living.

  Each day we arrived early at the crowded outpatient clinics. We learnt to differentiate acute illnesses from chronic ones, who needed immediate attention from who could wait, and the patients who only needed a prescription of vitamin C to be healed from those who would never heal. Patients swarmed the corridors and left gratefully with a hastily scribbled script. Many of them insisted on painful injections that they believed would cure them more quickly. Two hours later, we moved on from the crowded outpatient clinics to the wards.

  Good unit chiefs made bedside learning a pleasure, and Dr Padmanabhan was one of them. His intellect matched his debonair personality. Medical students posted to his unit had the advantage not only of his excellent bedside clinical sessions, but also his well turned out persona.

  Dr Padmanabhan arrived on the ward in his crisp white coat. The nurses in starched uniforms picked up their pads, and the intern and postgraduate trainees gathered around him. At the bottom of the pecking order were the medical students, so we joined the back of the retinue that moved slowly across the open ward. We listened as the nervous intern presented each patient, describing their progress, the latest investigations and the treatment plan. We watched in awe as Dr Padmanabhan asked difficult questions of the postgraduate trainees, containing our glee when they fumbled with the responses. These trainees had ‘ragged’ us when we entered the medical school. ‘Ragging’ was the term used to describe the traditional bullying of fre
sh medical students. We had been forced to propose to students we had barely met, made to wear ridiculous clothes and told to repeat lewd lyrics that made us blush with embarrassment. Some senior students carried the initiation ceremony too far and the passing of the years had done little to erase the memories or temper our dislike of the perpetrators. Now it was our turn to rejoice when our bullies were left squirming and fumbling, unable to answer the questions posed to them.

  As the team moved from one bed to the other, the patients who were well enough to sit up on their beds would fold their hands in a namaste gesture, simultaneously greeting and supplicating the man-god who held the solution for their ailments. He smiled, spoke to them gently, felt their pulse, listened to their chests, answered their timid queries and moved from bed to bed.

  When morning ward rounds came to an end some two hours later, our pocket notebooks had more nuggets of clinical wisdom added to their pages. We rushed to a local tea shop for the morning break, settling our rumbling stomachs with spicy lentil vadas and dousing the chilli with milky sweet chai. Before we knew it, it was time to return to the tuberculosis ward.

  Carrying our Hutchison’s Clinical Methods, we gathered around the bed of a middle-aged man. The cloth screen around his bed did not stop our questions or his answers from being overheard by other patients. Our detailed history-taking included his social and family background, his smoking and drinking habits, and his possible exposure to venereal disease or tuberculosis. It went on until his whole life was laid before us – and the patients in the adjacent beds, if they chose to listen in.