1 July 2003
I expect my mother to sob at the departure gate but instead she leans stoically against Kerry’s mum and waves goodbye, as though the two of us are off to war, not India.
There’ve been so many times in the last weeks when I’ve wanted to cancel: to go back to the Northumbrian cottage hospital I originally picked, where I could have observed day-cases, taken long walks in clear air, and tried to gain a handle on the parts of this year’s curriculum that are a blur, like stations passed on an intercity train.
But this trip is no longer only about me. It’s about us.
I promised Kerry an adventure, a thank you for all the support she’s given me so far.
‘Make sure you always sleep under your nets and don’t pet any dogs; they all have rabies. And watch out for people who might have SARS,’ Mum calls out, when we’re about to go through security. We found a charity that gives grants for short-term respite care, so Mum will be properly looked after while I’m gone. I wave one last time and turn away.
‘I need to stock up on vodka,’ Kerry announces as soon as our cabin bags have been X-rayed. Mine has been packed and repacked countless times over the last month. I have a change of underwear, a small mosquito net, sunscreen, repellent, painkillers, my vaccination record, hydrocortisone cream and alcohol gel in my little bag of liquids.
Kerry packed this morning: a Stephen King paperback as thick as a brick, a T-shirt and shorts to change into as soon as we land, sunglasses and a bottle of her favourite shampoo, because it’s the only one that tames my mad hair. Oh, and the iPod her control-room buddies bought her; barely bigger than a cigarette packet, with 4,000 tracks loaded onto it.
She didn’t think her boss would agree to a month’s unpaid sabbatical, but she’s wasted in that job and he’s clearly willing to do what it takes to keep her.
As am I.
‘I’m proud of you, Tim,’ she says, once we’re settled into our cramped mid-row seats on the plane. ‘You’re pushing yourself beyond your comfort zone.’
‘You know me, Kerry. Adventure is my middle name.’ We both laugh.
Wilcox and his mates are off to high-end hospitals in exciting places, ideally by the beach. They’ll stay with doctor mates of their doctor parents in desirable condos. They’ll scrub-in to assist surgeons on cutting-edge procedures, in between trips to Niagara Falls or Ayers Rock.
The ones without the right pedigree – like Laura – are aiming to max out hands-on experience in remote African villages. A few have stayed home, mostly the GPs-in-waiting who get turned on taking blood pressures.
India is somewhere in the middle. I’ve picked one of the least deprived states, Kerala, with beaches where Kerry can sip chai and find herself, and a well-equipped hospital where I can observe without having to treat actual patients.
Even so, I keep asking myself what I have done. I haven’t flown anywhere since I was six, and that was only to Marbella when Dad was still around. I like things to stay the same. Just as the body is desperate for homeostasis, people need external stability, too.
Or, at least, I do.
But there’s one enormous positive. India is 5,000 miles from Joel and his supplies and that smug look he gets whenever I buy from him. Cold turkey scares me but it’s the only way, especially as I can’t rely on Joel anyway. I think he might be sampling the wares. Perhaps he’ll disappear into that underworld, so Kerry and I can live happily ever after.
Maybe spending these four weeks together will help me feel more secure. Lately, everything she does has seemed like a sign she’s about to leave me, from the eyebrow raises when I ask her how she is, to the moans about how frustrating her job has become, and the dangerous charity stunts she’s started to do in her spare time rather than spending it with me. Does jumping out of a plane mean she wants to jump out of our relationship? Does the cliff abseil mean she’s desperate to escape?
‘Penny for them?’ Kerry asks.
‘I can’t believe it’s really happening.’
‘I know! Hopefully you’ll find your specialty at long last.’
Most of my cohort already have plans for the future, but I’m paralysed by indecision. Not for the first time. However hard I try to forget it, my failure that night on the Lawns seems to follow me like a ghost.
Pathology is one option: I loved lab work at school, and samples are hard to kill. But to qualify, I’ll still have to go through the grim F1 and 2 foundation years, right at the bottom of the medical pile. On one placement, I met a Senior House Officer only three years my senior who was meant to care for fifty surgical patients overnight. I don’t know that I’ll ever be ready . . .
Do all med students feel like this, deep down? Certainly, we can’t admit to nerves.
The pills have been the only thing to mute my self-doubt, but I need to change that.
Kerry is waiting for a reply. I laugh and say, ‘I’ve already decided what to do. I’m going to run away and join the circus.’
She nods. ‘So, we’re talking animal bites, spinal injuries, eye trauma from juggling balls, allergic reaction to clown paint? I’d say that makes you an emergency medicine doctor.’
That’s the most terrifying specialty of all. ‘Yeah, that’s me, Brighton’s answer to George Clooney.’
But as the plane taxis, I can’t help thinking that A & E or even a circus ring teeming with tigers might be preferable to what lies ahead at the end of the flight. I’ve spent years clinging on to the status quo. What the hell have I signed up for?
We step out of the airport into hot, multicoloured chaos. Kerry slept on the flight, but I didn’t, which is adding to my trance-like state. My body floats on waves of soggy warmth as we step between people and cars and cows and potholes full of rainwater the colour of strong tea.
Monsoon season.
The hospital has arranged a driver, so we follow him to his car, and Kerry sits in the front, chatting away. I pretend to sleep in the back, shivering from the fierce air-con in here.
Yet I can’t keep my eyes closed: there is too much to see. I had feared I would hate it but instead, the world beyond the cab window fills me with an unfamiliar feeling. Excitement. Everything is unknown, and so am I. Perhaps this can really be a fresh start.
Energy pulses through me, as powerful as any drug. For the last few years, I’ve thought that I needed to take pills because I was burning out. But what if the opposite is true? That I needed drugs not because I was overwhelmed by life, but because I need more of it than Brighton and Hazelmere Crescent and my mother’s bluebell-scented living room have to offer?
‘What exactly are you doing here?’ the surgical director asks, peering over his spectacles.
Jetlag means I can’t quite process the question.
‘Sorry, I thought we had an appointment?’ I compare my watch to the clock on the wall, wondering if I got the time zones wrong, but they both say ten o’clock.
Mr Mukherjee shakes his head impatiently. ‘No. What are you hoping to achieve at our hospital?’ He is a small, plump man with incongruously long and slender fingers. Surgeon’s hands. I wonder if this physiological advantage sits somewhere on the same DNA strand as the icy egotism most surgeons possess.
‘A different perspective on healthcare?’ I blurt out, feeling sweat blooming under my arms.
‘And your first impressions of our hospital suggest it will be very different from the NHS?’
It feels like a trick question. ‘I don’t like to judge anything on first impressions.’
‘Hmm.’ His eyebrows arch above his glasses. ‘We don’t need unqualified British students to save our patients’ lives.’ His accent has traces of Manchester vowels – I read his bio and he worked there for a decade before returning to India.
‘Of course not, I never—’
He talks over me. ‘And if you wanted the chance to live out your saviour fantasies, you should have gone somewhere a lot less developed.’
I almost want to tell him that I came here in an attempt to prove to my girlfriend that I am interesting and adventurous. ‘This isn’t poverty tourism. I promise that’s not why I’m here.’
‘That is something. Although I note that on your application, you don’t even have a specialty in mind yet.’
Should I invent an enthusiasm or vocation? My mind has gone blank. I cast around the room, looking for something I could latch on to: as my eyes race over the spines of the books on his shelf, I notice a desk calendar with the image of beaming schoolchildren playing on a beach.
He’s shaking his head. ‘It’s irrelevant anyway, Tim Palmer. The electives were organized by a colleague who left and the last thing I need is an underwhelming British medical student who can’t even string a—’
‘Public health!’ I blurt out. The desk calendar has been sponsored by the public health department.
Mr Mukherjee raises his eyebrows. ‘So you applied for a surgical elective in a teaching hospital because your interest lies in public health?’
‘It’s a recent development.’
He is about to call me out on the lie. As I wait to be put in my place, I wonder if it is a lie. Public health has barely been mentioned in my training, but isn’t it about analysis and logic?
‘This hospital is the wrong place for you, young man.’
I go to rise from my chair, wondering how I am going to tell Kerry we’ve flown halfway around the world to be told I’m not wanted.
‘But . . . I do have an idea. A former colleague has a project a little north of here, involving maternal and child health in rural areas. You might be able to do something useful.’ He sounds sceptical. ‘There is one caveat, however. How do you feel about working in a conflict zone?’
It takes a week to sort, a week in which the doctors deign to let me watch a few minor surgeries while Kerry goes to the beach on local buses and comes back sunburned and full of stories. She makes friends with families in the relatives’ block where we’re staying, plays cricket with the kids in the corridor, and we share their meals in the evening: freshly made curries loaded with coconut and spice. I develop a taste for the heat. It helps to conceal the metallic taste in my mouth that I suspect is caused by drug withdrawal.
Some nights I sleep badly, too, but I know I must see this through.
‘You’ve changed, Kerry,’ I say, as we queue in the local medical centre to be given the extra jabs we need for a rural placement. ‘When we were at school, you would never have chatted to all those strangers.’
‘True. My job has cured me of being shy.’ She smiles. ‘But you’re exactly the same as you were then.’
Ouch. ‘Come on. Would the old Tim be preparing for a dangerous mission in the jungle?’
She laughs but we both know I’d have been on the next plane home if she hadn’t been here. She makes me a better, braver person. But what do I do for her? ‘I’m not thrilled at the opportunity to get murdered in a tribal conflict I’ve never heard of.’
‘It can’t be that dangerous or no one would go there,’ she says, ‘and as for the jungle, I bet they’re exaggerating . . .’
It is the jungle. It feels dangerous. And far from being ‘a little north’ as Mr Mukherjee suggested, our new base is a five-hour flight and a railway journey to the nearest town, then a couple more hours in a battered jeep.
Everything here is red or green: dry earth and dense forest. The heat and humidity are as intense as Kerala, though judging from the parched-looking bamboo and teak trees, the monsoon hasn’t yet arrived.
We pass villages and rice paddies, women in short saris and sometimes children running after our jeep and waving. Kerry suggests stopping to hand out some of the pens and stickers we brought as gifts, but the driver shakes his head.
‘Not here.’
I start to see the signs that this is not a peaceful place. Our driver stops twice when commanded to by baby-faced soldiers, younger than Kerry and me. They ask questions, rifles hanging from their shoulders, and seem bemused by our decision to come here. I can’t imagine theirs is a desirable posting. I never realized there were conflicts like this in India.
When we arrive, the hospital doesn’t resemble any I’ve ever visited before, though a modern block would have seemed bizarre at the end of a rough track that’s fighting a losing battle with nature. Instead, it’s more like a large village. Inside a perimeter fence are dozens of buildings, some grander than others, with rendered mustard-coloured walls and tiled roofs. Other structures are simpler huts. Staff and patients walk between the buildings or sit on verandas, listless in the heat. Signs in English and another script point to the out-patients and the pharmacy.
We get a guarded welcome from Siya, the postgrad who has been given the job of settling us in. She’s our age, dressed in a T-shirt and long combats, and is beautiful enough to be the fifth member of All Saints.
‘Someone pulled strings to get you in here,’ she says. ‘We’re mostly Indian-staffed and we don’t welcome foreigners gawping at our patients.’
She leads us past a refectory. ‘Vegetarian food only, and there’s no smoking or drinking here, plus you will help with manual labour to keep the campus clean.’
I imagine Wilcox’s reaction if he were in my shoes.
‘And as for your girlfriend –’ she turns to Kerry – ‘I hope you have a good book with you because there is nothing for an unqualified person to do here.’
I glance at Kerry and see an expression I know too well: determination. The last thing she intends to do here is read.
Before I get the chance to settle into the dorm room in our cottage, Siya wants to take me to meet the Boss.
‘Can’t I shower?’
She doesn’t even bother to answer.
‘What’s the Boss’s name? Is he scary?’
‘Her name,’ Siya snaps. ‘It’s Dr Murty but everyone calls her the Boss.’
The Boss scrutinizes me as I step into her office, the fan whirring above her desk. She is wiry but powerful, with thick tortoiseshell glasses that obscure any sense of her age. ‘You’re here because you are interested in discovering more about public health, but what can you do for us?’ she asks, without preamble. ‘We don’t need average people. What is the one thing you are better at than anybody else?’
Even if I weren’t exhausted and sweatier than I’ve ever been in my life, I’d struggle to answer. When I was a kid, it was easy: physics, first aid, talking my mum into getting up even when she felt there was no point anymore . . .
‘I’m quite proficient at basic patient care. Feeding. Bathing.’
‘That is what families do here. Come on, boy. You are studying medicine. You must be made of something more than your appearance suggests.’
As I did in Mr Mukherjee’s office, I look around for inspiration but the space is almost monastic.
On the Boss’s desk, I see a pile of unused, headed stationery. I read the upside-down title: RURAL MEDICINE CAMPUS AND RESEARCH CENTRE.
Research.
‘I am logical. I see patterns in data. I like Excel.’
‘Interesting.’ The Boss’s mouth twitches: not quite a smile, something closer to the expression of a wolf who’s caught sight of Little Red Riding Hood. ‘How hands-on do you wish to be while you’re here? If you are in any doubt about the correct answer, let me give you a clue. There will be very few opportunities to treat patients, I value them and our reputation too much to hand them over to a clumsy boy.’
‘I . . . I am happy to help wherever you think I might be most useful.’
‘And that is the right answer.’ She stands up and sweeps out of the office, her buoyant sari adding to my feeling of being pulled along in the slipstream of a speedboat. ‘Let me introduce you to our resident computer genius. You two might be able to make the most beautiful formulae together.’