by Joan Arakkal
I watched the senior trainees apply the plaster and work tiny, twisted club feet under the watchful eyes of Dr Vishwanathan, taking precautions to avoid an overenthusiastic correction. I knew I would have to wait my turn before I was allowed to embark on this delicate procedure. I was thrilled when Dr Vishwanathan eventually suggested I perform the next casting. As the mother hovered over her precious baby on the plaster table, Mr Nair reached over to the top of the shelf and brought out the neatly packaged, factory-made, plaster of Paris rolls. I dipped them in water and savoured their even texture as they rolled over the cotton padding around the baby’s leg and foot. I marvelled at how the rolls did not feel squishy, unlike the ones we prepared with long lengths of gauze. As I rolled the bandage with just the right tension, constantly smoothing it with my palms, I felt like a sculptor at work. As the months passed, I watched with delight as the foot slowly untwisted and the mother’s smile widened as the serial casting did its work.
Some babies were not so lucky. The muscles and tendons around their foot were too tight and they needed extra help to release the tightness. With the child under anaesthesia, Dr Vishwanathan demonstrated how we could lengthen the tendon through a small incision, always looking out for nerves and blood vessels that could be caught in the distortion. We quickly realised that the skill and diligence required for this seemingly simple procedure was not trivial.
We saw many happy feet return for their yearly review. Each time, a bashful smile and a hint of paternal pride flitted across Dr Vishwanathan’s face.
SUGAR IN MILK
The Parsis were a beleaguered band of religious refugees who travelled from Persia to India in their junks in the eighth century. The local king, Jadi Rana, received the refugees with a gesture. Motioning to a vessel filled to the brim with milk, he indicated that there was no room for the refugees. At that moment, so the story goes, the Zoroastrian priest added a pinch of sugar to the milk. The message was clear: the new arrivals would sweeten the lives of the local citizens without causing the vessel to overflow. The Parsis stayed and became invaluable citizens of India. Over generations, they assimilated until only their sharp Achaemenian features and distinctive surnames identified them. The occupations of their forefathers could be deduced from surnames such as Merchant, Engineer and Teacher. The first Parsi doctor I met was called Dr Doctor. Determination and tenacity lurk beneath the gentle appearance of the people from the land that evoked in me images of exquisitely hand-woven silk carpets, muskmelons, dates and the aromatic smells of soft, yellow saffron rice.
Jamsetji Tata, one of the better known Parsis, became the father of Indian industry. When he set up an iron and steel plant in the Indian state of Bihar, a bustling metropolis grew around it. The town came to be called Jamshedpur, after the founder of the plant. In keeping with the Parsi ethos of improving the quality of lives of the communities they served, the Tata family built the state-of-the-art Tata Main Hospital to provide good healthcare for their employees and their families.
I finished my postgraduate training at Calicut and completed a stint in the reconstructive surgery department of the Schiefflin Leprosy Research and Training Centre in Vellore. I now wanted to join Tata Main Hospital. The hospital had advertised for junior orthopaedic doctors. It was a long way away from my hometown. My brother accompanied me to the interview. For the first time we would travel in an aeroplane. Our excitement mounted as we caught our first flight to Madras. Before we could fully savour the thrill of being in the air, the one-hour journey came to an end. We caught a train to Jamshedpur and made it just in time for the interview. The panel, pleased with my responses to their questions and the references from my training days, employed me.
I joined the unit headed by the young and charismatic surgeon, Mr PK Banerji. I was thrilled to work in a hospital that had excellent operating theatres. In addition to his Indian training, PKB – as we came to call him – had also trained and qualified in England. He was a good teacher, always willing to share his knowledge.
One of my first procedures at Jamshedpur still stands out in my memory. I stepped carefully through the pre-procedure rituals. I scrubbed my hand and nails thoroughly, until the bristles of the hard brush left my skin smarting. An obliging staff member poured warm saline over my hands and forearms. As a final preparation, I donned the theatre gown and sterile gloves. I was ready to start. Except for one problem. The patient on the operating table was wide awake.
I had not previously met the senior doctor who was to anaesthetise the patient. He looked enquiringly at me and my apparent readiness to start.
‘Where is the surgeon?’ he asked.
I introduced myself and said I was the surgeon. He responded by walking out to find the man in charge. He interrupted an operation in the adjacent theatre and asked the senior surgeon if I was old enough and qualified enough to perform the surgery. He came back, not entirely reassured. Throughout the entire procedure, I was acutely aware of his watchful, sceptical eyes.
Gradually, he relaxed. When I had closed the wound, applied the last dressing and peeled the size six gloves off my hands, he smiled at me. In future, he said, he would be happy to anaesthetise my patients.
My days at Tata Main Hospital allowed me to learn Bengali, taste my first lychees, savour mishti dohi (sweetened curd set in clay pots) and make new friends. A gentle Parsi doctor, Sharook, befriended me and shared his love of music. I was introduced to seventies pop melodies by performers like Lobo, the Bee Gees and Kenny Rogers. Even today, listening to the strains of Shadow and the haunting melodies of Bread, I can see Sharook’s gentle face. I wonder if that dear friend of mine found the love that I could not reciprocate.
When Anwar Baba broke his hip, his son brought him to Tata Main Hospital. I was assigned to operate on his broken femur. The procedure involved driving a large screw into the broken femoral neck, then holding it in place with a steel plate that was firmly attached with smaller screws to the femur’s shaft. Throughout the procedure, an X-ray technician took images so I could ensure the screws were correctly placed. The final image showed the operation had been a success.
In the post-operative period, I developed an unusual bond with this gentle, bearded man. I called on him regularly, checking his condition and listening to his stories. Three days later, he took a turn for the worse. His heart was failing and the attending cardiologists did not seem to be winning. Feeling somehow responsible for him, I was not prepared for his gentle voice addressing me as I stood at his bedside. He looked at me lovingly and said, ‘Hum thumko dhua dhe rehe hai’ – ‘I give you my blessings’. Tears welled in my eyes. During the night, Anwar Baba’s heart stopped beating. When I arrived on the ward the next morning, his empty bed left me with a desolate feeling. I also felt privileged to have cared for this kind man who left me his blessings.
Another death that affected me strongly was one away from the orthopaedic wards. It was 3 March 1989 and the Tata Iron and Steel Company was celebrating the 150th birthday of its founder, Jamshedji Tata. The ceremony was a spectacular one, attended by the elite of Jamshedpur and their families. Eight-year-old Shruthi and her ten-year-old brother were among the excited throng. Also in the VIP stalls was my colleague, the beautiful Dr Heera, whose vibrant personality brightened up the hospital corridors. A popular Parsi obstetrician, she may have delivered many of the children who sat excitedly waiting for the festivities to begin.
When a fire broke out in the VIP stalls, an announcement urged the audience to remain seated. When it appeared that the fire was spreading, mayhem broke loose and the panicked crowd jostled for the exit. Amidst raging flames and collapsing tents, lives were rewritten and happy families were destroyed forever. Two hundred people were trapped. The fire demanded a heavy sacrifice as the numbers of the dead rose to fifty. There was little left in the charred remains to remind us of Dr Heera. Although she left no biological descendants, Jamshedpur was studded with babies she had lovingly delivered.
When Shruthi’s parents had re
cently found themselves unexpectedly pregnant with their third child, they had looked to Dr Heera for counsel. They already had Shruti and her brother and did not want a third child. Dr Heera had gently convinced them to continue the pregnancy. Tragically, Shruthi and her brother were caught in the flames. When I visited them in their hospital beds and saw their beautiful, untouched faces, it was hard to imagine the mutilation to the bottom halves of their bodies that the bandages covered. Of the nearly 200 people who arrived in the overburdened hospital, Shruthi was the one I gravitated towards. She looked forward to my visits and smiled at me, taking her eyes away from the TV screen that kept her distracted from her pain. I regaled her with stories to keep her mind away from her festering third-degree burns and struggled to accept that her young life was slipping away.
As the days turned into weeks, Shruthi’s chirpy greetings were replaced by feeble acknowledgements. When she finally passed away, a few days after her brother, it was hard for me to fathom the grief of their parents. Their only solace came in the form of a tiny bundle delivered to them a few months later. I pictured Dr Heera’s smiling face hovering over the healing family.
I settled into my work, feeling more and more comfortable about conducting my duties, especially the privileged duty of operating on patients. More than halfway through the year, Mr Banerji broached the idea of my going to the UK for further training. A dual sponsorship program would exempt me from the suggestively acronymed PLAB (Professional Linguistic Assessment Board) examination – a long and tedious licensing exam in undergraduate medical subjects and English language proficiency that allows overseas doctors to work in the UK. Under this arrangement, I could go directly to a UK hospital under his sponsorship. This was an opportunity that most doctors would have given their operating arm for. However, my first reaction was to decline. Going overseas was never part of my plan. Mr Banerji persisted. It would do me good to expand my horizons and gain more experience in the UK. He assured me that I could come back to Tata Main Hospital after I’d been in the UK for a few years.
Shortly after this conversation, I met the man who was to become my husband. He was happy that this opportunity had come my way, especially as he was contemplating doing a master’s course at the University of Newcastle. I decided to take up the offer. Armed with Anwar Baba’s blessings and a spirit of adventure I set out on the journey ahead.
MARRIAGE AND ENGLAND
I was keen to meet a man, fall in love and get married, but brief romances and fleeting infatuations remained just that. My family was keener; however, despite their best efforts to find me a match, the ‘suitable boy’ remained elusive. I was introduced to many young men, but never one I wanted to spend the rest of my life with. As I entered my mid-twenties, the list of men my parents presented to me kept growing.
Where ‘arranged marriages’ occur in middle-class families, education forms the scaffold on which the search is structured. Family background, including religion, language and caste, and habits like smoking and drinking are also considered. If these criteria are satisfied, the couple are introduced to each other. The first few meetings allow them to assess each other’s personality and appearance. Chemistry and mutual attraction come into play as they talk about their plans and aspirations for the future. If all goes well and the marriage is to take place, the couple hand over the rest of the arrangements to their families. In India, a marriage is the union of two families. The vexations about ‘in-laws’ are often replaced with gratitude when the extended families step in to help the couple as they establish their own families. Grandparents arrive on the scene, sometimes having flown thousands of miles to different countries where the diasporic Indians have set up homes, to greet their newborn grandchildren. They stay on until the young mother gets back on her feet, and form lifelong bonds with the next generation.
By the time I was working in Jamshedpur, I had already met a few potential suitors. Physicians, engineers, university lecturers and naval officers came and went. By the time I was preparing to go to the UK, my parents were getting increasingly worried about me leaving alone for a new world. More suitors were introduced, with no success. That is, until a marine engineer walked in along with his beautiful mother. His disarming and forthright personality had my parents and brother charmed and I was attracted to his easy laugh and the breadth of his knowledge. The attraction was mutual. Francis regaled me with stories of his travels. He promised he would make me laugh more than he would make me cry. His irreverence towards existing norms and customs was disturbing yet curiously fascinating.
The traditional banns were read in the Catholic church over three weeks. No-one objected to the union between the Arakkal boy and the Perumpanani girl. A month later, dressed in a creamy white sari with a gold border, a bunch of orchids in my hand, I arrived at the small church where my father handed me over to my future husband. My paternal uncle, who was a Catholic priest, blessed our marriage. I was now officially Mrs Arakkal.
We honeymooned at an army guesthouse in Mussoorie, a hill station that boasts the snow-clad Himalayas as a backdrop and is known as ‘the queen of the hills’. I had heard a lot of its picturesque beauty from the Appus who had previously lived and worked there. I was keen to explore the place. It was December and we arrived in the middle of a cold snap. We walked along Mussoorie’s famous mall and ate warm gulab jamuns, milk dumplings bobbing in sweet syrup served from the stoves of the street vendors, then doused the sweetness with steaming katchoris and hot, spicy samosas. The bitter cold did little to keep people indoors. The mall roads, where the British Raj had once hung signs stating ‘Indians and Dogs Not Allowed’, were studded with people wrapped in colourful shawls. Cycle rickshaws carried people across the town. Tourists could be seen sipping sweet tea, standing at the lookouts over the Doon Valley and shopping for Tibetan prayer wheels.
In the guesthouse, huddled around the fire that did little to warm my cold feet, Francis told me this experience of freezing temperatures would serve us well in the UK. He had spent his early childhood in England when his father was posted there in the diplomatic services. He told me stories of his primary school days in Finchley, where he was the lone brown boy. He spoke fondly of his friend, Tim, who had stood by him when he was bullied in the schoolyard, and the teacher who recognised his vast general knowledge. He reminisced about regular trips with his father to the British Museum. He recalled the Sunday mornings when his father’s recitation of Shakespeare’s plays and Sanskrit verses had sent him running for cover. His father died unexpectedly when Francis was eleven, leaving a void in his life. He wished his father could have met me and was certain that he would have liked me. I, too, wished I could have met him.
I was now ready to embark on a new life as a married woman in a new land.
We arrived in the UK in May. Driving down the motorway, the picture-postcard countryside left me in total awe. The green slopes studded with rolled bales of hay were exactly as I had imagined them as a teenager, tucked into a corner devouring Thomas Hardy. But there was no madding crowd and I was very far from home. Wordsworth’s dancing daffodils fascinated me, as did the woodland wildflowers.
From London, we travelled to the north-east town of Hartlepool by bus and then climbed into a taxi and asked to be taken to the hospital where I was to start work in a few weeks. The taxi driver’s pleasantries left me confused. I could not understand one word of his Geordie-accented English, and he could not understand me. The Queen’s subjects, I was discovering, did not all speak like her.
A few weeks later, I was resting in the comfy chairs of the doctors’ tearoom during a break. As a new arrival, I was eager to meet people and make new friends. Whenever I managed to make eye contact with another doctor, I smiled weakly as they acknowledged my presence. A young doctor in the chair beside me opened a packet of crisps from the vending machine. I longed to taste them, and I was surprised to realise it was not the custom here to offer food around. I had a pang of nostalgia for the tiffin-box lids of my school days, l
oaded with flavours and friendship. Eating and working alone was a new phenomenon that I had to learn to accept. Over the years, I watched many competitive medical practices keep their money chests full and their souls empty.
Not long after we arrived, the short-lived English summer gave way to autumn. The north wind chilled my bones. Later, when the snow fell, I watched in fascination as each unique snowflake floated down silently to become part of an amorphous heap. I trundled to work through crunchy mounds of snow, dressed in wool and fleece and longing for the sunny cotton days of home. I arrived at the hospital before the sun rose and left after it had set and began to understand the true meaning of Seasonal Affective Disorder. Its acronym perfectly expressed my feelings.
I settled into the work and slowly got to know the people, their language and customs. I learnt about the iconic corner shops that stud England and found an Asian one close to the hospital that catered to some of my hankerings. The shop and its friendly owner became indispensable. One cold, frosty morning, I pushed open the door with its tinkling bell and was greeted from behind the counter by Mr Patel.
‘Cold morning, eh?’
‘Yes Patelji. I wish I could have a few days of Indian summer right now.’
‘I would swap some of the sunny Kampala days for these bleak and chilly ones.’
Mr Patel had left Uganda eighteen years ago, seeking refuge in the UK after the rise of Idi Amin. He had left his teaching job behind and arrived in England with his young family. A few years later, he had set up a tiny corner shop. The shop earned a decent living and opened up opportunities for his family. After I had made my purchase I enquired after his son, Sanjay, who was studying medicine at Oxford.
‘He wants to specialise in cardiac surgery,’ Mr Patel said. ‘What do you think of that?’