CHAPTER TWELVE

THE WAITING ROOM at outpatients was suffocating. Paul Roberts had looked in, stepped over a body on the floor, felt the press of women holding babies, old men with bandages, the decidedly unpleasant smells, and retreated. Outside the gate half a dozen women were sitting under a truck to shelter from the sun. The asphalt was broken. Some had children with them. The truck itself seemed to have driven out of the forties without ever being cleaned.

Paul paced up and down. The clinic was marked by a white panel with a red cross. There was a dirty red wall, a wooden gate. He watched a woman at an upper window cleaning her teeth over the street, a boy flying a kite from the roof above, a pig rooting through filth in the gutter. It was Old Delhi, by the railway, and everything was filthy. The boy’s kite tangled with power lines. Then a beggar was pestering. ‘Hello, sir.’ It was a girl, a child, tugging at his trousers. ‘Please, sir.’

Paul’s normal strategy was to walk briskly away, but this morning he was determined to be at the outpatients’ door when Helen James arrived. He was growing increasingly frustrated. The girl clutched at his wrist now. ‘Sir!’ Paul found two rupees to shoo her off and at the same moment Helen stepped out of an autorickshaw.

‘It makes no sense giving to beggars,’ she told him and was already past and inside the clinic. At once there was a clamour of voices. ‘Hello! Hello, madam!’

Paul tried to keep up with the crowd as she turned right down a long corridor. ‘What is it you’re afraid I will say in this book?’ he called. ‘Can’t you think again?’

Standing with her back to him, Helen produced a key for the door to her surgery. She was wearing a light green dress. ‘You have no right to harass me,’ she told him.

‘Please, one good talk,’ he said, ‘then I’m leaving Delhi. You can hardly call that harassment.’

Removing her shoes on the threshold, the widow looked up. Her face was severe, but weary too, and suddenly vulnerable. Beyond her, Paul could see into a bare room with a table, a washbasin, a metal cupboard, posters in Hindi. For one second she let him look in her eyes. ‘Why are you insisting?’

‘Mrs James, please, if we could just …’

She turned away and took a white coat from a hook. ‘Come back tomorrow afternoon around five.’ Her voice was brusque. Already people were jostling to be first through the door. ‘And I’ll explain why your project is a bad idea. Please, everybody!’ she raised her voice. ‘In order of arrival, please. Except in cases of emergency.’

As it turned out there was an emergency that morning, but the child’s mother was not aware of it and as a result Helen didn’t see the girl until after twelve: a four-year-old with violent earache, her face dramatically swollen, skin burning and dry.

‘How long has this been going on?’ Helen spoke in basic Hindi.

‘Two weeks.’ The woman seemed doubtful. ‘Maybe three. I work a great deal, Doctor.’ She had five children, she said. Her husband was away. She lived out of town to the south.

The little girl screamed when she was touched. Her name was Shruti. A local doctor had given her some pills, but she hadn’t got better. No, the mother didn’t know what kind of pills. They were white, so big they had to be cut in half to swallow. Helen went to the phone and spoke to the ward supervisor. ‘Then you’ll have to put her on a mat somewhere,’ she told the man firmly. ‘I’d say three or four days, if it isn’t meningitis already.’

The mother was anxious about leaving the girl alone, anxious about losing her job if she stayed. Helen was firm. ‘The medicine must be given constantly, in the hospital, with a drip. You must take this paper to the supervisor.’ It was pointless trying to explain the idea of a drip. ‘Along the corridor and to the right. Ask for Shobha Devi.’

The mother’s head was wobbling with perplexity. The girl whimpered in a daze of fever. Helen smiled. ‘Shruti can get better, Mrs Ram, but only if you leave her here. Do you understand? You must leave Shruti with us. She is very ill. She could die.’

By two o’clock Helen had seen more than fifty patients. When the last was gone, she sat for a few minutes on her own. It was a relief to have recovered a little concentration and energy after those impossible days in January. Yet the more the time passed the more it was clear that things were not as they had been before Albert’s death. One must accept, she had always thought, that work of this kind will be tiring and routine, even when dealing at every moment with life and death. And often discouraging. One must accept that there is little time for pleasantry or self-congratulation. You get on with it. She had always been dogged. Why did Albert’s absence make it so much harder?

In truth, in the past, Helen had rarely been discouraged. As a rule, the patients responded rapidly to drugs and recovered quickly, which was gratifying; or alternatively they were soon dead. You forgot about them. You got used to it. Some left their beds without being discharged. You would never know what had happened to them. Many of the outpatients went off with their medicines and didn’t come back to be checked up. ‘What you’ve done,’ Albert had once suggested, ‘is turn the competitive spirit you learned at home against an opponent who will never relent: sickness. And in the Third World at that.’ It was like fighting the ocean, he protested, or a river in flood. ‘Always an easier enemy than my mum and dad,’ Helen had laughed. ‘Or my dreadful brother.’

Washing her hands now, she looked in the mirror. ‘Albert,’ she mouthed. ‘Albert.’ Perhaps she had chosen him as a husband because she knew he would never compete; Albert would never hurt her, and he always refused to be hurt on the many occasions when she had hurt him. He was my spectator, she said to herself rather unexpectedly. Now I’ve only got the mirror.

Looking into the grey-green of her irises, the enigma of the pupils, Helen experienced a moment of vertigo. She was so intensely present to herself she almost fainted. She had to turn away and put a hand over her eyes.

Helen ate in the clinic’s small canteen with a young Dutch doctor who had come on voluntary service. She explained the options here for dealing with a long-term cancer patient.

‘You mean, I accept that I can do nothing?’ he asked gravely.

He was a handsome young man, the kind who until five or ten years ago would invariably have made a pass at her.

‘I look at it in a more positive way,’ Helen smiled. ‘We never throw resources at a lost cause.’

Late afternoon, she visited the hospitalised patients assigned to her. Two drips feeding the limp stick of her arm, little Shruti lay on a pile of mats fast asleep. Her temperature was down somewhat but the skin still burned. Tomorrow they would know if her mother had brought her in time.

Helen returned to her surgery to pick up her outdoor shoes. Then it was as she was locking the door to go home that she saw the boy. He came stumbling round the corner of the corridor from the right, followed by the ward sister.

‘I found this rascal, he was skulking by the kitchen door!’ the woman complained. ‘The little thief.’ She was trying to shoo the boy out of the building. ‘He cannot speak a word of Hindi, or English!’

Helen recognised the comically protruding ears at once, the exhausted, calculating eyes. ‘He’s been here before,’ she told the sister.

The boy began a fit of coughing. It seemed he could barely stand up. ‘Cover your mouth!’ The ward sister shook her head. ‘I think he’s acting, Dr James. He was trying to steal food and now he’s pretending to be ill. Outpatients is closed,’ she scolded. ‘You will have to wait till tomorrow, if that’s what you want.’

‘I’ll see him, Meena.’ Helen said. ‘He’s been here before.’ Helen went to the boy, put a hand on his shoulder and led him to her surgery door.

Perhaps sixteen years old, the boy had appeared some time the previous autumn. October, or early November. He’d come alone. Helen remembered because it had been quite impossible to communicate with him. He knew not a word of any language she tried. She had called a nurse, then the supervisor. They could get no change out of him. He coughed, wiped a hand across his forehead, put his fingers on his chest and panted, opening his eyes wide. But they had already understood he was suffering from TB. Helen could smell it.

By chance it was one of the days when Albert had stopped by the clinic. Albert was always attracted by the people there and nothing interested him more than a communication challenge. He had sat with the boy for hours while he was waiting to do his various tests.

‘He is Burmese,’ Albert informed the ward supervisor. ‘His name is Than-Htay, or Maung Than-Htay, he has a father and two sisters. His father was a teacher in his village. His mother was killed by soldiers and they came to Delhi as refugees. He was living and working in a silk factory, but when he started coughing they told him to leave. He couldn’t find his father. He is alone now, begging and eating at the Sikh temples.’

It was standard procedure with a case like this to phone a specialised TB clinic, but after some toing and froing it turned out there were problems with the boy being Burmese. State money allocated to indigent patients could not go to foreigners, even if they did have refugee status, which in the boy’s case wasn’t certain. So they had kept him in the clinic to get his treatment started, then let him out when he was no longer infectious.

Unimpressed by his illness, Albert had been fascinated with the boy’s unusual gestures and facial expressions, in particular a strange way he had of turning his head when he spoke. It was partly to do with his being Burmese and partly, Albert thought, because he was slightly deaf. Every movement, every smile, frown, grimace, was theatrically exaggerated. No doubt that was why he was not picking up Hindi, he concluded. Helen remembered that Albert had made a video of the boy. Then when he left the hospital she promptly forgot about him. He was no longer her responsibility.

Without a word, she sat him on a chair leaning forward, pulled up a dirty tee-shirt and pressed her stethoscope against his back. There was a wheezing as of bubbles through sludge. Probably he had stopped taking the antibiotics the moment he was discharged. Now something more powerful would be required.

She went to sit opposite him. The boy looked patiently into space from between his huge ears. She couldn’t remember his name. Exotic names always escaped her. There was an unhappy curl to his upper lip, his nose was slightly flattened, the eyes were shrewd beneath drooping lids. It was the clinic’s policy not to readmit those who had failed to follow through an initial period of treatment. This was a rule they made clear to every patient on discharge. And Helen knew that there were already more than thirty in the 25-bed ward. She sighed. The boy smiled wanly and said something. Helen didn’t understand. His voice was full of catarrh. ‘A-bet?’ It was a question. There followed a few incomprehensible syllables and then again on this sick boy’s lips the familiar name was repeated. ‘A-bet?’