Lady doctor

March 2009

The patient had hobbled in an hour earlier with a shrapnel injury that had become infected. The wound gaped. Pus oozed out. The leg was dead, everything black and liquefying.

This is a very bad case, the doctor said. It must be amputated.

Mahindan closed his eyes to summon a happy memory of Chithra, but she refused to oblige. He tried to muster up a mantra, the sound of Rama chanting, the fragrance of incense, but again there was nothing. Only this man and his putrefying leg.

In January, Mullaitivu had fallen and they had all moved here to Puthukkudiyiruppu, a small farming town eleven miles inland. The two-ward dispensary was already overrun, so the doctors had commandeered the school as a secondary hospital. The operating room was set up in one of the smaller classrooms. Four desks had been pushed together with a plastic sheet thrown on top. The patient was now lying on this improvised bed with his trouser leg cut off.

The doctor used the sink in the corner to wash her hands. She wore a paper mask and plastic goggles and pulled a yellow gown over her head to cover her cotton sari. Supplies were scarce and Mahindan and the other volunteer wore the same soiled gowns all day. They had taken what they could from the hospital in Mullaitivu; doctors, nurses, and ordinary people all working together to load equipment into wheelbarrows and patients onto bullock carts. Even the retreating cadres had pitched in, pushing the injured on their stretchers down the A35. A rare day of unity, everyone co-operating like a team.

In the hallway outside, patients moaned and gurney wheels rolled past. The lucky ones shared beds. Others were laid out on mats on the floor. There were five doctors and a dozen nurses in this improvised hospital, but most of the helpers were ordinary people like Mahindan, civilians who volunteered to escape the alternative. Every day, more and more people were conscripted into service by the LTTE, digging trenches, collecting weapons from dead bodies, or worse. Mahindan was thankful Sellian was only five, that near starvation had stunted his growth so he appeared even younger. Rumour had it they were taking children as young as nine.

There was a big green chalkboard set up on a wooden easel and children’s paintings clipped to a laundry line along the back wall. Sunlight streamed in through the naked windows. It made Mahindan’s skin crawl to be here.

The doctor had a small metal table on wheels where she laid out all her equipment. The doctor’s hair was hidden under a shower cap. Yellow ducks swam in a line across her forehead. Mahindan and another volunteer stood on either side of the patient. The man was breathing hard. Sweat dampened his moustache. The infection bubbled away, corroding his leg. The smell was rancid. It burned in Mahindan’s nose; his eyes watered.

He looked at the patient and tried to find something to hate – even disgust would make this easier – but all Mahindan saw was his own potential fate, how easily it could be him on this table, tomorrow or the next day, with no anaesthetic and no consolation.

You must be brave, the doctor said.

The doctor said the patient’s name often. She put her hand on his shoulder and focused on his eyes when she spoke. Mahindan tried not to learn anyone’s names.

Have one of you a belt? the doctor asked.

The other volunteer undid his buckle and the patient clamped the belt between his teeth.

Keep him from moving, the doctor said. Please, sir, try to stay still.

The doctor held a scalpel; her attention was focused. The patient trembled and whimpered, lips folded into each other. Mahindan had one hand on the man’s chest and the other on his arm. He ignored the queasy waver in his gut, the lightness in his head. He must not lose his dignity in front of the lady doctor.

She pressed the scalpel down, tip first. Drops of blood beaded up where blade met skin, a bright red line. Mahindan turned his head. The world lay flat, pinned to the wall. Sri Lanka was a teardrop in India’s shadow. America was green and, above it, Canada was orange. Large, unknowable countries oceans away.

The patient’s head jerked off the table when he screamed. The belt clattered loose to the floor. Mahindan and the other volunteer moved quickly to press his shoulders down. When he muffled the man’s shrieks with his hand, Mahindan felt spit and breath dampen his palm. The man’s eyes squeezed closed. His wail was primal. Mahindan gritted his teeth as a memory assaulted him. Chithra gripped his hand and keened.

Ammmmmmma! the patient yelled.

Tears prickled Mahindan’s eyes. He sniffed and bit down hard on his own tongue.

The incision was complete. The doctor peeled the skin back slowly, exposing muscle and sinew underneath. Rotten flesh fell away in clumps. The patient breathed in hot, hard bursts. Outside, a meal was being served. The smell wafted in – oats or gruel, something watery and insubstantial.

The doctor’s gown was splashed with pus and blackened flesh. There was less blood than Mahindan had expected. He caught a whiff of something sweet and oddly familiar. A pile of bananas rotting in the sun, the smell of the body fermenting.

The doctor turned on the saw. Its blade whirred and vibrated. The man whimpered. His eyes were open again, wide with terror. Mahindan saw his pupils roll up toward his forehead. The body under his restraining hands went slack.

Fainted, the other volunteer said.

For the best, the doctor said, and bent over her work. The noise was a high-pitched whine.

—

The body, in death, was heavy and stiff. It took three men to lower it into a wheelbarrow. Mahindan struggled with the head, trying to rest it as gently as possible.

He’s dead now, one of the volunteers said impatiently. Let’s just finish this quickly. He shook his head and clucked his tongue against his teeth. Poor bugger. Who deserves this?

The other two went ahead with the shovels and Mahindan was left to ferry the dead man through the hallways. He tried not to see the stump and its jagged stitches. Patients languishing on gurneys stared with blank eyes. The corridor to the back door was empty. An LTTE flag hung across the threshold. A yellow tiger burst out from a circle of bullets, its gaze following him.

Student artwork decorated the walls, a class project for Martyrs’ Day. The students who had made these drawings were probably all dead. Mahindan could hear the sounds of the makeshift hospital around him – the clicks and clangs of moving equipment, the babble of voices as if from far away, and the wheel of the barrow rolling on the floor. The man’s head was torqued, tucked against one shoulder. His intact leg dangled out.

He had grown feverish overnight, Mahindan was told. There were no medicines to give and nothing to do except let him shake and sweat, muttering gibberish. It had been hours before anyone realized he was dead. A complete and utter waste.

At the door, he stopped and set down the handles. After a furtive scan, he squatted beside the body and reached his hand into the man’s pocket. The man wore jeans, which were stiff. It was a tight fit. Mahindan struggled to pull out a billfold. He caught sight of a five-hundred-rupee note before stuffing the money away. There was something else. An identity card, slimy but intact. He pocketed that too without glancing at the name, then stood, picked up the handles of the barrow, and walked forward with purpose out into the sunshine.