CHAPTER ONE

The Patient

She’s waiting out a sudden shower of fifty kilo bags of rice, a gathered clutch of angry chickens flapping like their heads are off. It’s raining rolls of razor wire and wooden crates of tangerines, a blood-red set of luggage for a couple on their honeymoon. The driver honked through eighteen hours of blindly climbing hairpin turns; the bus hit every dog that dared to cross the road from Chandigarh. Mary’s so exhausted she can barely stand among the crowd - she’s praying that her bags are there, the one box in particular. At last she sees her canvas duffel sailing through the mountain air; she waves and yells to get the man to treat her box more carefully. But his ropy muscles flex and stretch across his shirtless arms and back, the sun gleams off the lines of sweat that trickle down his dusty flank. He doesn't look or heed her shout before he drops it to the ground - the box lands in the mud and dust: the sparkling sound of broken glass.

Trying not to get upset, she’s swallowing her rising bile: stupid idiot! she thinks, though not referring to the man. She feels like everything she’s touched has shattered in the past six months; can't even get a goddamn-box of medicines down off a bus. She knows that things are different here, she’s not back home in Baltimore, but seven thousand feet above the plains of Northern India. The sun is beaming overhead, the sky the blue of early May; a soft breeze swings the evergreens, the mountains oh-so-beautiful. But the bus keeps belching diesel smoke and noise so she can't concentrate; three men are shouting in her face, each claiming his hotel is best. She'd like to turn around and leave, go find someplace to sit and cry - she’s desperate for a private place to drop her pants around her knees. She has to shift from foot to foot, she hasn't gone since yesterday; the few times that the driver stopped, there wasn't any ladies room. Every muscle in her back is on the verge of spasming: sudden shooting, stabbing pains enough to take her breath away.

The closest man before her has a cancer growing on his lip; in all her years of practice she has never seen one half as big. Trying not to stare she shouts, "I'm staying at the hospital!" She sees the hope drop from his face, the pearly tumor glistening. The three men turn away as she attempts to gather up her bags; she thought, perhaps, there'd be somebody waiting for her when she came. She feels like she can't focus, like there’s nothing under her control: a nauseating moment when she steps in something soft and dull. A half a dozen porters want to help her with her duffel bag, but all she sees are wasted arms on men who must weigh less than her. She doesn't want to feel this way, she thought that she had come prepared: she read the books and travel guides, the passages on culture shock. But she’s never been so far from home or traveled overseas before; she’s following her husband’s ghost that led her to this wretched town. She makes herself meet one man’s eyes, a porter with a crooked smile, her random choice because his shirt’s the only one not torn with holes.

They are high up in a little town where tourists come to see the snow; the valley walls with peaks of ice are lined with fruiting apple trees. Her map shows that the road ends here, the last real town before the pass - further north are only arid mountains going on and on. But this town’s rimmed by forests filled with evergreen deodar trees that rise up from the duff to try to imitate the mountain peaks. The buildings stand two stories high, their walls are mortared brick and stone; the town is just a couple blocks of alleyways and market stalls. The alley that they're walking down is filled with tourists from the plains: long-haired Western travelers and newlyweds with hennaed hands. The hotel signs are lettered in a half a dozen languages: Stay Here for Your Honeymoon and Best Place for the Hippie Freaks; Hindi, English, French and several others she can't recognize. But Mary doesn't have the time or energy to look about for anything except a place to let her aching bladder down. She'd like a clean, well-lighted place where she could trust them with her bags, a disinfected toilet and a sink to wash her face and hands.

Nothing looks too promising, the storefronts are all dark inside, the sidewalk lined with metal plates on stoves of hissing kerosene. These sizzling grills are saucer-shaped and large enough to sled on snow; she feels the spit of grease from brown samosas fried in smoking oil. She braced herself for beggars, but the impact is still visceral: a woman without legs has propped herself against a crumbling wall. On what’s left of her lap she holds a plump and squirming two year old who vigorously sucks beneath a coarsely woven woolen shawl. This woman looks at Mary so their eyes meet for the briefest time - Mary has to look away or risk another crying jag. The wallahs in their canvas stalls - all shouting at her constantly - demand that she must stop and buy their cabbages and tangerines. And she'd like to pass this holy man, this baba smeared with human ash, who’s blocking half the sidewalk as he browses through the marketplace. His begging bowl is pounded brass, his trident staff is tipped with bone; he hasn't got a stitch of clothes but dreadlocks filled with marigolds. She doesn't try to pass because she'd likely bump him with her bag - afraid she'd have to buy the goat he'd need for cleansing sacrifice. But then she sees a little cafe up another alleyway, a landmark from the photos that she memorized in Baltimore. It was where her husband took his meals, back a dozen years ago, Himalayan Dhaba painted on the sign above the door. It doesn't look much better than the other cafes that she’s seen: built from poorly mortared brick, tiny windows thick with grease.

She motions to the porter that she wants him to wait by the door, signing with her hands, hoping he'll stay and guard her box and bags. She drops her backpack on the ground and feels a wave of urgency; she rushes through the cafe door and almost knocks the waiter down. He’s a short and slender walleyed man dressed neatly in a Nehru suit - she’s shocked to recognize his face, from another photo Richard kept. The picture shows her husband with his arm around this gentleman: Richard has a goofy smile, the waiter’s eyes look here and there. The cafe is so dark inside she has to strain to look around: the room is twenty feet across, the tables don't look very clean. The cafe’s barely half full with a funny mix of clientele; suddenly she’s thinking that she should have looked around some more. Everyone has turned to stare; she feels a dozen sets of eyes: a ragged Western traveler, an Indian in suit and tie. She asks this man her husband knew: please, could she use the ladies room? He bows to her then wags his head, an answer she can't comprehend.

"Méré saath aa-i-yé," he says and gently takes her arm, leads her down the center of this darkly paneled restaurant. The room is close and filled with smoke, she smells the faintest hint of dope; the waiter guides her through the darkness toward the swinging door in back. He points her to a closet that smells like an open septic tank - ripping at her belt she barely gets her pants down fast enough.

The only light comes through a tiny window high up over head, and there isn't any toilet but a hole cut in the concrete floor. She’s focusing on balance, trying to keep her pants up off the ground - horrified she'll tumble over, unsure where she’s supposed to aim. At last her bladder’s letting down, her feet not quite spread wide enough; her passport safe around her waist now jabbing in her pancreas. She'd made a promise to herself she wouldn't cry for two more days; tears have come so quickly ever since the day that Richard died. She feels them running down her cheeks, along the crease beside her nose, dripping from her chin into this hole between her hiking boots. She’s worried that the porter won't be outside when she’s finished here, and worried that she’s never going to find the mission hospital. She’s not sure why she’s doing this, except her husband loved it here - she’s thinking she should turn around for safe and sterile Baltimore. But there’s nothing for her there now that she’s left her home and quit her job, sold her house and practice in a clinic for the very old. She knows she'll find the hospital, it can't be very far away, and if the porter steals her bags she'll buy some other clothes to wear. There isn't any paper so she zippers up her wrinkled pants - doesn't trust the water in the pail to give her hands a wash. She wipes her eyes off with her sleeves, takes a breath of fetid air. She shakes her head and wonders what-the-hell she thinks she’s doing here.

The alley’s paved with graveled rock, the sunlight bouncing off the dust, and Mary has to squint to see, the restaurant was dark as night. The porter is still waiting with her bags beneath the dhaba’s sign; she tells him with her red-rimmed eyes that she’s feeling better than before. Now that she has peed and cried and hasn't lost all her supplies, this tiny village doesn't seem as awful as at first it had. The porter has a friendly face, his eyes are sparkling with life; she shows him once again the name of Doctor Vikram's hospital. She knows it’s likely he can't read, especially her English script; his head moves in a way that Mary can't quite tell is no or yes. So she mimes as if she has a cough, walks like someone with a limp, finally rifles through a bag, pulls out her shiny stethoscope. The porter rolls his eyes and laughs, her destination obvious.

"Achhaa-ji," he says, and picks up Doctor Mary’s dusty bags.

He leads her from the restaurant, it isn't very far at all; he takes her down a winding maze of gravel paths and alleyways. As they walk she’s looking round, a half a world away from home; she watches someone scrub a pot with dirt scraped straight up off the ground. But the sky today is cloudless and she’s almost at her journey’s end, anxious to meet Doctor Vikram, another one of Richard’s friends. She’s having a rare moment of her optimism blossoming: maybe she will like it here, this busy little tourist town. Her husband talked about this place, he worked here when he finished school: spent two months in these mountains just before they met in internship. He'd told her of the hospital, of Doctor Vikram Vargeela, a man from Southern India who runs the place all by himself. Richard called the man a saint, said Vikram had a magic touch - so long as you ignored the surgeon’s tendency to preach too much. Rich said the place was beautiful with lovely terraced valley walls, a temple in the forest and the Himalayas all around. But he didn't mention how it smells, the nasty open-sewer stink, the beggars with their pleading palms and exudative skin disease. This is why she’s come here, though, so useless since her husband’s death: her love cut down in prime of life, a stupid biking accident. She cried herself to sleep for weeks, then made herself go back to work; just couldn't care enough about her aging patients’ chief complaints. Her partners bought her practice for a price that was quite generous; she banked it with the million from the life insurance Richard kept. She contemplated suicide, but wasn't really serious; she tried to think what Rich would do if she had been the one to die. That’s when Vikram’s card came with his yearly Christmas newsletter which hinted for donations for his hospital in India. A way to keep her husband near, it felt like such a good idea: supplies are low, the wards are full, could use a doctor volunteer.

The compound has seen better days, with patchy bits of weeds and grass - she recognizes everything from Richard’s color photographs. The buildings haven't changed at all, with roofs of rusty village tin, the windows glazed with wavy glass, the walls in need of plastering. She thought that this would feel familiar, as if she'd been up here before, but really it was Rich who worked here back a dozen years ago. Like all the buildings in this town, they're brick and rock and wooden beams - a painted sign in English points the way to the X-ray machine. The wards are both two stories high with wooden stairs and balconies, the courtyard beaten free of grass by years of patients’ trampling feet. In the center of the yard there is a stunning, ancient walnut tree: massive trunk and spreading limbs, its canopy blocks out the sky. The porter drops her bags beneath it, speaks to her in Kullui; Mary doesn't know the coins so lets the porter keep the change. The man gives her his crooked smile and brings his hands before his face. Bowing he takes one step back before he turns to take his leave.

The hospital is tiny, with the buildings scattered randomly, dwarfed from east and west by massive Himalayan mountain peaks. She smells the sweet deodar smoke of someone cooking over fire, reminding her of camping in the pines of western Maryland. She wonders where the patients are, the lines that Richard once described - Vikram wrote that there was never time enough to see them all. It is sometime in the afternoon, perhaps the staff has gone to lunch; she set her watch in Delhi, though she could have turned the dial wrong. But someone should be hanging round, she knows they are expecting her; she sent a message yesterday: arriving soon as possible. The last time Vikram wrote he said there’s always so much work to do - the clinic runs four days a week, with surgery the other two. Sunday is his day of rest, he preaches in the little church; she sees the tiny, empty building: a steeple and a crucifix. She tries to think what day it is, she left the States on Saturday; spent one night in the Delhi Hilton’s musty air conditioning. She’s guessing that it’s Tuesday and it must be close to three o'clock - unlikely Doctor Vikram would take off to play a round of golf. So she leaves her bags beneath the tree with leaves the green of early spring, and wanders through the courtyard, through the echoing dispensary. The only sound she hears is someone’s distant whistle off somewhere. She follows it in through a door, a painted sign to Surgery.

The hall is almost black inside, the walls are stacked with limp supplies: boxes with their lids cut off, the dust has never been disturbed. She’s thinking it’s incredible, the storeroom’s loaded with antiques: surgical contraptions no one’s used in half a century. She takes a cloth mask from a bin and holds it to her mouth and nose, then opens up a door that’s marked the entrance to the surgery. It should be draped with braided rope, an old-time surgical museum: an overwhelming ether stink is sickly sweet and volatile. The table has a dozen cranks, a sheet draped over stainless steel; above it hangs an ancient lamp: a giant metal buttercup. Nobody’s there, but still she hears the funny, tuneless whist ling - and then a ringing echoed laugh, a soft and high-pitched giggle. It comes out from a little room, the next door that she opens up; she finds a tiny woman, someone Richard once had talked about.

"Doctor-ji! Namasté!" At last someone expecting her; she sent a photo of herself and Richard the first time she wrote. Padma can't be four feet tall, her body nearly bent in half: Rich had said he liked her best of all the people working there. Mary is amazed at how she looks just like her photograph: tiny little angel face and eyes benignly mischievous. Her spine has got a nasty twist, perhaps a childhood accident, but Mary’s never seen a face as beautiful and radiant. Padma climbs down off a stool, her wrinkled apron stained with red from washing blood off rubber gloves so that they can be used again. She wangs her hands before her face: palms together, fingers straight; a man stands from a wooden bench: he’s the source of all the whistling. She wonders if this could be Vikram - pleasant smile and slender hips - but he hasn't got the features of a man from Southern India. His face is more Tibetan-shaped, his eyes a little wide apart; in very broken English he says Tamding is his given name. Mary only knows a couple phrases of the dialect, studied from a worthless book, a numbing set of language tapes. She’s not sure what his job is but he does what Padma tells him to: he helps her with her bags and shows her to the rooms that she’s to have. They cross the dusty courtyard past the one-room missionary school; Tamding might be speaking English, but she doesn't know for sure. He’s pointing out the landmarks, making jutting gestures with his chin; Mary only smiles and wonders anxiously where Vikram is.

He leads her to a building that could be a mom-and-pop motel: single-story cinderblock with doors all lined up in a row. She’s got the last rooms on the end, the farthest from the hospital; Tamding opens up the door and shows her where she’s going to live. This won't do at all, she thinks, her heart drops down another inch: the walls a shade of green like something growing in a swimming pool. She tries to see her husband here, how Richard thought it wonderful; the bed a musty block of foam, the kitchen doesn't have a stove; she looks into the bathroom: just another hole where she’s to go. Tamding brings her bags inside and stacks them neat against the wall, wangs his hands before his face and goes out backwards through the door. She’s glad, at least, to be alone, to have some time to recompose; her stomach gripped with anxious fear, she thinks this was a bad idea. Richard was the one who dreamed of coming back to India - never was the kind of man who needed to be comfortable. She wants her husband desperately, perhaps she would relax a bit: he'd take her out exploring, wander through the winding market place.

She lies down on the bed but can't relax enough to fall asleep; she wonders if the water in the tap is safe to brush her teeth. The only nice thing in the room is a sunny wooden window seat that overlooks an alley with a glimpse of snowy mountain peak. She pulls the curtains back to let some light into this gloomy space, wanders through the tiny kitchen, sniffs a hint of rat perfume. Then on a table by the bed she finds a letter with her name, held down at one corner with a textbook as a paper weight. She looks first at the massive tome, the English title on the spine: General Practice Guidelines for the Rural District Hospital. She flips through several pages filled with pictures of advanced disease: liver cysts from parasites she’s hoping that she'll never see. She’s thinking she won't be much help with everything so different here - Richard was the surgeon, could have operated anywhere. But Mary is an internist, knows medicines and lab reports: a specialist in geriatrics, treating grandpa’s gout and stroke. She opens up the envelope, her name spelled in a hasty hand; it takes some time to read the words, decipher Vikram’s doctor-scratch.

At first she doesn't understand, she has to guess some of the words; but then it all comes clear why there weren't patients at the hospital. And she thought that she hit bottom when she saw where she’s supposed to live, but now she knows her heart can sink at least another couple feet. She’s thinking now would be the time to quietly just disappear, leave a note for Vikram on the box of shattered medicines. But then she hears the whistling, the flute of Tamding’s puckered lips - he’s knocking nonstop on her door until she starts to open it. Breathlessly he’s talking in a language she can't understand, motions with his hands so that she knows to quickly follow him. With no idea what’s going on, she’s led across the hard dirt yard; she’s running through a list of what might be the worst that she could find. She’s thinking it’s a heart attack, a motorcycle accident - someone with a bleeding cut, an artery that’s gushing blood. They cross beneath the walnut tree, the speckled light of twitching leaves; he leads her to a room that smells of nasty disinfectant spray. But no one’s on the table that is centered in the trauma room, just a woman on a bench, a bundle cradled in her arms. The bundle’s covered with a shawl and Mary’s trying to catch her breath; the woman looks up briefly but then turns her eyes away. The woman’s dressed in local clothes, a pattu made of homespun wool, a scarf ties back her long black hair, silver hoops pierced through her nose.

And Tamding’s somehow disappeared so Mary’s not sure where he’s gone - doesn't even know exactly why he left her standing here. She doesn't have her stethoscope, she isn't in her long white coat; she couldn't even start to ask the questions that a doctor must. She’s trying to imagine what required her so urgently; this woman isn't bleeding, isn't writhing round in agony. Mary tries to guess her age - she could be forty-five years old, she could be half of that but Mary finds it difficult to tell. Right then the woman looks at her, the saddest eyes she’s ever seen; now Mary understands what made them call for her so urgently. Her heart skips several beats at first, a lump forms large inside her throat; she motions to the mother that she'd like to take a closer look. The mother pulls the shawl back so that Mary sees the baby’s face - Mary has to swallow hard to keep her gasp from being heard.

The baby looks a hundred years, with sagging skin across the face: sunken eyes and fontanel, breathing at too slow a rate. She hasn't got a clue what’s wrong: a birth defect or rare disease; she takes the baby from the mom as if she holds a hand grenade. With the baby on the table, she unwraps the musty woolen shawl; the skin hangs down like melted wax: a dying little baby girl. Her eyes are dry and glazed as if she hasn't blinked since she was born; doesn't cry or make a fuss, just stares and slowly gasps for air. In Baltimore there'd be a dozen nurses working frantically: X-ray techs and lab reports and respiratory therapists. All she'd have to do is give the orders to the nursing staff: stand and watch and make sure that the blood gets sent off fast enough. Mary hasn't slept in days, her thinking isn't very clear: this baby is dehydrated, should get some fluids into her. She’s thinking meningitis, maybe H. flu septicemia: spinal tap and blood cultures; X-ray and a white cell count. She needs an IV right away, she'd like to put her on a vent; she puts an ear against her chest to listen to what noise she makes. She wants to know how long it’s been, how old this ancient baby is; she needs to get the baby’s weight to calculate the fluid drip. At last she hears the whistling of Tamding coming back this way; he steps in through the door and rattles something off in Kullui. She asks him for an IV drip; he only shrugs and wags his head. It’s obvious he doesn't understand a word that Doctor Mary says. At last she hears another set of footsteps from across the yard - she sees a floating nurse’s cap come sailing past the window frame.

The nurse who comes in through the door is not a day past seventeen: long black hair done in a braid, a ribbon tied-up in a bow. She says her name is Chidda and she'll try to help the best she can; the other nurses are at home, they weren't expecting her so soon. She says she’s only worked a month, just graduated nursing school - that Doctor Vikram said he thinks that one day she'll be pretty good. But Mary doesn't have the time, this baby is about to die; already diagnosed the nurse’s tendency to rattle on.

"I'm Doctor Mary Davis," she says, cutting off the chattering; starts listing off the things she'll need: an IV and a catheter. She’s calculating in her head the dosages that she should give; she needs antibiotics that will cross the blood/brain barrier. This infant’s running out of time, each breath could be her final gasp, and Mary isn't sure about the doses she’s remembering. The nurse just stands in horror when she sees the withered infant girl, so Mary gets the feeling that this nurse won't do her any good. She starts into the list again, anxious that the work begin - mimes the way she'd try to stick a needle in the baby’s vein. "If you can't help, I understand. Just find somebody else who can!"

The nurse then turns around and leaves, comes back in with an IV tray; puts it down then backs away, not volunteering for the job. Mary hasn't started IVs since she finished Internship; she’s used to having IV techs and nurses with experience. She quickly asks for sterile gloves, a swab or two of Betadine; she'll need a couple culture jars, plus red and purple vacuum tubes. Mary’s nervous she won't find a vein before the baby dies; asks then for a tourniquet to strap around the baby’s thigh. She’s slapping at the leg to see if she can raise a purple vein - baby so lethargic that the slapping doesn't make her cry. She looks up at the nurse to see if she has brought the things she needs; nurse is still just standing staring at the walnut tree outside.

"I'm sorry," Chidda says this time, "but everybody else is gone."

The nurse sounds like she’s going to cry - she says that she is all alone; when Doctor Vikram left he said that they should close the hospital. They can't get any X-rays since the tech has gone to Chandigarh, off to search for parts to fix the broken autoclave machine. They can't do any cultures since they haven't got a micro lab; she thinks the spinal needles are still waiting to be sterilized.

"And we don't have any bata-deen. I'm not sure what it is you need."

Mary’s hands are shaking, thinks this baby can't be three weeks old; the baby doesn't have the strength to keep on gasping any more.

"I need something to clean the skin," and Mary’s also on the verge; she’s slapping at the other leg, still desperate for a decent vein. Chidda brings a cotton ball that’s soaked in something horrible; slowly mops the knee and thigh till Mary knocks her hands away. The baby is so deep in shock her veins have all nearly collapsed; with fingers trembling Mary blindly sticks the IV needle in. She knows that there’s a big vein somewhere near the outside of the shin; after several tries she finds it: tiny flash of something red.

"Damn it! I need tape!" she screams, her patience finally wearing out; she knows this baby’s going to die and everything will be her fault. Vikram’s letter said the staff would help her any way they could; all she needs to do is ask: the nurses are all excellent. And this was what he'd written in the letter underneath the book: that he would keep her in his prayers, that Richard would be proud of her. I'm going home to Kerala. My father's taken gravely ill. I’ll be back in a month or so. The hospital depends on you.

She knows that she’s not up for this, she hasn't got much in reserve - she came this far to find a ghost to hold her hand and comfort her. She looks down at this tiny girl, while Chidda draws the saline push; this dying baby’s face holds all the sadness in the universe. She knows that she will have to stay, if only for a couple days: she'll live but only if I keep this needle safe inside her vein.

Reprinted from Himalayan Dhaba by Craig Danner by permission of Dutton, a member of Penguin Group (USA) Inc. Copyright © Craig Danner, 2003. All rights reserved. This excerpt, or any parts thereof, may not be reproduced without permission.

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