Brotherhood Dharma, Destiny and the American Dream (17 page)

Although we had been aware of each other from early childhood, it took very sad circumstances for us to move closer. I was still in medical school. I came through the hospital wards on rounds one day to see a very sick woman with Rita sitting by her bedside. This was her aunt, I learned, who had been admitted with a serious lung condition that turned out to be untreatable. It took a year before she passed away in the hospital, going through stages of degeneration that robbed her of speech and eventually of breath. Rita came regularly to visit during that year, and we began to talk.

The heart was discreetly given space to grow. We talked but didn’t touch. She brought up the Beatles, who were no longer alien to me. They had followed a guru to India in 1968. The Beatles stayed only briefly, in Rishikesh far to the north, where many spiritual luminaries had their ashrams, but once the world saw photos of them with Maharishi Mahesh Yogi, it made him instantly famous. The West suddenly turned its gaze on India; the country had been put on the map. Maharishi wore white robes and a long beard, already turning from gray to white. There was always a rose in his hand. He had laughing eyes and a radiant smile. When he greeted someone, he held his hands together in the gesture of
Namaste,
with a faint bow of the head, and murmured “
Jai Guru Dev,
” a salutation to his own teacher. (The phrase entered into the lyrics of a Beatles song, “Across the Universe,” and one reads in various accounts that their
stay in India was very productive. Music was more on their minds than enlightenment.) None of this felt exotic to me—for one thing, I had visited yogis with my uncle—but the hint of charisma around Maharishi made me remember those wire-service photographs.

As infrequently as Rita and I had met in the past, one encounter sticks out. I was at St. Columba’s, waiting for the bus in front of the girls’ convent school. It began pouring rain, and a car pulled up. Rita’s mother called out, offering me a lift, and as I gratefully climbed into the backseat, I found Rita beside me. It was a romantic shock for teenagers to sit so close. I didn’t forget it. This encounter, along with one other, was enough to start whispers of a romance. I was half of the two-man debating team that my medical school sponsored, and we happened to stage a debate at Lady Shri Ram College, the women’s college in Delhi where Rita was studying English literature. Rita showed up and, more to the point, she sat in the front row, right at my feet. I’m sure I was nervous and that I tried to stick out my chest. Debating had gotten me noticed. Not just by Rita. A man came up after our team won a contest and told me that I had a good voice for radio. That had crossed my mind, but very soon I was reading the late-night news for an overseas broadcast that reached Indians in other countries, especially in Africa.

It was heartbreaking for Rita to watch as her aunt got worse and no one could help. (This was the aunt who died just before our wedding, adding the only note of somberness to the day.) I found myself discovering reasons to be on the ward when I knew Rita would be there. At that time private telephones were very difficult to get in India. There was a two-year waiting list, and even then getting one often meant paying a hefty bribe. So the only opportunity we had to be together was when Rita visited the hospital.

We didn’t date, but because our families had known each other for so long, we were permitted to socialize. Two years and several turning points passed before the wedding. I graduated without distinction from medical school thanks to the debacle with the outside examiner. With my father’s encouragement I decided to go to America for my advanced training; London had been the place to go when
he was young, but no longer. The Americans went from triumph to triumph in medical research.

India didn’t want its best graduates to flee to the West, so it had banned the test that the United States required before foreign-trained doctors could enter the country. I had to fly to Ceylon to take this exam, which was only minimal. Once I arrived in America, I would still have to pass the same state medical boards as any native-born doctor. While I was in Ceylon I was walking through the bazaar, and a beautiful necklace caught my fancy. I brought it home with me, and when I saw Rita I gave it to her and asked her to marry me. She said yes and burst into tears. When we told our mothers, they were so excited that they kept frantically trying to call each other and getting busy signals for several hours.

With the help of an American foundation that supplied foreign doctors for community hospitals and even paid their airfare, I landed an internship in Plainfield, New Jersey, at Muhlenberg Hospital. It was a private facility, very well equipped, with four hundred beds. Newly married, our trip to America was also our honeymoon, with eight dollars for travel expenses, all that the Indian government allowed citizens to take out of the country. Fortunately my uncle Narendra, who was an admiral in the Indian navy, had been a naval cadet in England. He still had the equivalent of a hundred dollars stashed overseas, which he gave us as a belated wedding present. The number one hundred is propitious, which added to the kind gesture.

After landing at JFK, Rita and I found ourselves checking into a motel somewhere in the wilds of New Jersey. We were exhausted but too excited to sleep. I flipped from channel to channel, fascinated with color TV, which neither of us had ever seen. I landed on coverage of tennis from Wimbledon, which was interrupted by a local news bulletin. During an attempted robbery, two people had been shot. The victims were being wheeled on stretchers into an emergency room. My stomach churned, and I half collapsed onto the bed.

“My God,” I exclaimed. “They’re taking them to my hospital.”

For the first time in my medical career I felt frightened. I had no preparation to deal with patients in an immediate life-and-death situation.
I’d never even seen a gunshot wound. I perched on the edge of the bed staring at the phone, afraid that I’d be called into the ER. Thankfully the phone didn’t ring.

I began working the next night. I was in charge of the entire ER on the overnight shift. On strict instruction I was not to wake up the chief resident unless it was absolutely necessary. Even then he would not look fondly on being called by a nervous intern in the middle of the night. I was determined not to let that happen. Everything was under control, because it had to be.

Our time in Plainfield lasted a year, beginning in July 1970. When I walked into the ER for my first shift, the doctors who showed me my locker and gave me a tour of the acute care facilities were not Americans. There was one German, but the rest had Asian faces like mine, from India, Pakistan, the Philippines, and Korea. The nurses, who included some in training at the adjacent nursing school, were local girls, often with Italian last names. What had brought so many foreign doctors together was the Vietnam War. A severe doctor shortage had arisen as the army drained away medical school graduates while other young men, who might have wanted to become doctors, were drafted to fight.

For all my nervousness, there was no one to treat on my first shift. This wasn’t like an inner-city ER with its constant flow of patients from the streets. Toward the end of a listless night, one of the duty nurses appeared, saying that I was needed for an expiration. I’d never heard the term before, but I didn’t want to embarrass myself, so I didn’t ask. She led me down an abandoned corridor into a hospital room where the patient was lying in bed, staring with fixed eyes at the ceiling. Ah, that’s what expiration meant.

“What do you expect me to do?” I asked. “He’s dead.”

“A doctor has to pronounce before we can move him,” she said.

This nurse must have introduced a good many foreign doctors to American lingo. I checked the body for a pulse; there wasn’t one. I hadn’t brought a medical flashlight to examine the man’s eyes; if his pupils didn’t react to light, it was one of the critical signs of death.

“I forgot my torch,” I said. “Do you have one?”

“We want you to pronounce him, not cremate him!”

That an Indian would use the British term for a flashlight wasn’t part of her experience, apparently. There was nothing more I could do, so I started to leave, but the nurse stopped me. The man’s relatives, who were gathered in the waiting room, needed to be told. It was my responsibility to deliver the news. In India this wouldn’t be anyone’s job since the patient’s family is always in the room with him.

Reluctantly I went where I was told to go. Maybe eight people were in the waiting room. They got to their feet when I walked in, wearing silent, solemn expressions. I started to speak when I realized that I didn’t know the dead man’s name. His relatives waited expectantly, and I found the only words that came to mind.

“I’m sorry, but we’ve had an expiration.”

Some of the family burst out crying. One man pumped my hand, profusely thanking me for everything I’d done. I nodded, trying to preserve my dignity, and fled. A feeling of complete helplessness lingered, and I thought, how strange to be in a country where a sick man is connected to a battery of machines and disconnected from his family, whom he needs the most.

Acute care became a public crusade in Plainfield after a serious train wreck with multiple victims. This was just at the beginning of trauma medicine as a specialty—another field where America was far in the lead—and I learned to work at a furious pace. The local crime rate was high by my standards, even in the suburbs. Guns were easy to obtain, and every Friday night saw the arrival of at least two or three ambulances with young males, generally black or Italian, who had taken a bullet in the chest. The time pressure was intense.

I prided myself on turning into a doctor machine as the victims rolled in. With an assist from an ER nurse, our team tried to keep the victims from passing out and to extract a story from them about what had happened. Getting a useful medical history was practically impossible. Meanwhile I, the newbie doctor, examined their wounds, took their vital signs, hooked them up to a cardiac monitor, IV drip, and oxygen tube, probed for critical damage to the major
arteries, heart sac, and spleen (locations of quick fatalities if we didn’t get there first), made sure that the patient wasn’t bleeding out internally, started transfusing saline solution and the first pints of blood if needed, removed the bullet, closed the wound, called for a surgical consult if the damage was especially horrendous, and filled out my notes as the groaning, half-conscious patient was wheeled off to his next stop in the wards. There was a likelihood that these same young males would show up down the road with another gunshot wound, but we worked at a life-and-death pace without thinking about that.

It wasn’t all trauma associated with violence. I found myself treating the sudden medical emergencies of everyday life: drunks who had fallen down and gashed their heads, children with high fevers, a woman who began hemorrhaging as she was trying to perform a self-abortion, a professional man having a heart attack. Often an incident implied a story that the person was too embarrassed to reveal. One of the other interns saved a collection of X-rays to pull out at the height of doctor-and-nurse parties. The X-rays revealed some of the amazing and wonderful things people lost in unlikely orifices.

The breaks between emergencies were a dead time. I had been reading Mario Puzo’s
The Godfather,
and asked one of the local nurses about the rumors that the Mafia had a sizable influence in that area of New Jersey and that it even had a financial stake in our hospital. She gave me a smile I couldn’t read.

“Let’s just say that if my father knew I was dating a Korean doctor, they’d have something to pull out of the river tomorrow.”

After two months I felt totally in charge when a night’s calm broke into organized frenzy for half an hour. I don’t know if my cockiness was out of bounds for my surroundings. I was so exhausted pulling long shifts, driving my red VW Bug home at dawn in a state of terminal bleariness, that I couldn’t think of what was coming next for me. Then one night an ambulance brought in a young man who was dead on arrival, and I called the county medical examiner. It was after midnight.

“I don’t have to come in,” the medical examiner told me on the phone. “Just sign off on cause of death.”

“There’s a problem,” I said. “I don’t see anything wrong with him—no wounds, no obvious marks.”

“Right. So put down heart attack.”

I was taken aback. The DOA was just a kid, maybe twenty-three at most. Virtually no one that age dies of a heart attack.

“Don’t you want to do an autopsy?” I asked. I had already told the medical examiner how young the dead man was. Maybe he had been poisoned or was the victim of a dangerous disease that might be contagious. What about the risk to his family and friends? I thought.

The voice at the other end grew sharper. “Who do you think you are? Put down heart attack.”

There was a moment’s tense silence, and then I refused. The next morning I was called on the carpet by one of the attending physicians who was my supervisor.

“Whatever the medical examiner tells you to do, you do it” was the clear message I received. It was a matter of obeying the rules, not finding out the truth. The dead man was poor; no trouble would be made over how he died. But my insolence couldn’t be dismissed that easily. Our attending physicians were all Americans. They typically didn’t consider anyone trained in Asia to be a real doctor. Even the single American intern on staff, who had gone to medical school in Bologna, Italy, was suspect. The more tactful attendings tried to conceal their prejudices, but the implication was never far away.

My supervisor began talking more pointedly. He reminded me that I needed this job, what with a young wife at home and a baby on the way. I knew what was good for me, didn’t I? We wouldn’t want anything to go wrong. (Troubling images from
The Godfather
flickered in my head.) Toward the end, however, his tone softened. He put his hand on my shoulder.

“Hey, if you do a really good job here, who knows? Maybe you can get to Boston.”