Open Heart (15 page)

Is it time to speak of falling in love? For the lover is not yet aware of his state, although in the middle of the night it steals in and clutches his heart and he wakes up stirred to the depths, as if falling in love is only a new dominance and not also a servitude which is liable to drag anyone who persists in it to his doom. Already he can’t go back to sleep, and in his happiness he has to get out of bed, still not believing that it has actually happened to him, and, dazed and heavy, he propels his agitated being through the dark rooms of the house, trying to understand what it is that has shattered his sleep. And there in the kitchen, next to the dining table, he discovers her—a strange little girl, left in his house without his knowledge by one of the neighbors, or perhaps the cleaning lady, and forgotten there. Still wearing her school uniform, with a simple childish badge pinned to her chest with a safety pin, she bends over her books in the faint light of the moon and a streetlight, merging and filtering together through the window bars, and does her homework. He whispers to
himself
, somewhat ironically, It can’t be possible that this has really happened to me, that I’ve simply fallen in love; I know hardly anything about her. But he goes on advancing soundlessly toward the back of the girl, who has been waiting in his heart and who now ignores him and continues bending over an old, ink-stained atlas, a chewed-up pencil between her teeth. And
already
he is gazing breathlessly at the back of her neck, which is pure and stalklike but also rich in mature delights as it descends into the school-uniform shirt, which after a long day of study is still sweet and fresh. Only when he clenches his fists, careful not to touch her, does she turn to look at him, and with a brisk, simple movement she tosses her curly head, and her serious,
beautiful face shows no surprise at the stealthy approach of the silent intruder with the knife twisting in his heart.

Even as the pain stuns his heart he tries to reassure himself. It isn’t serious, it’s a midnight madness, it will pass, it’s already passing, it’s a bizarre, absurd, superfluous, almost criminal, and also hopeless infatuation, in a minute someone will come and take her away. But the little girl gives him a frank, open smile that does not suit her tender years, as if in the few seconds he stood behind her and lusted after her neck she grew up and
understood
—understood so much that he panics and tries to cover up his sudden infatuation. He bends coolly over the open atlas, leafs through an exercise book, and asks in pretend irritation, “Haven’t you finished yet? Do you have any problems? It’s late. Why don’t you leave it now?” Her pure face grows even purer, and she places her little hand freely on his pajama sleeve and says, “Shh … he’s here.” And in the long corridor between the dark rooms of the house, the funny old glasses glitter on the nose of the mystery, that skinny, humorless mental patient who is still stubbornly seeking people and events that came to an end long ago.

Still without touching her, judging only by the way she lay limply curled on the gray sheet in the corner of the room, I concluded that the young woman’s clinical condition was not good and that she may, in Hishin’s words, have “managed to do herself real liver damage.” I had already noticed how she was hugging
herself
with both arms, and how with weak but incessant movement she kept scratching and rubbing herself, a classic symptom of accumulated bile salts penetrating the skin. But I smiled, trying not to reveal to her parents, who were standing right behind me, any sign of anxiety or panic. I knew too that there was no point in undressing her now, in front of her parents and the Japanese backpackers, and trying to auscultate her heart and lungs.
Obviously
I had to perform a blood count and sedimentation rate quickly and obtain the exact bilirubin and glucose levels and liver functions. I had to see the color of her urine and have it tested right away. In the meantime I bent over her on my knees and covered her forehead lightly with my hand to feel her
temperature
,
which seemed worryingly high, and I put my other hand onto her cropped blond head, wondering momentarily whom she had inherited this blondness from, for both Lazar and his wife had dark hair. Then I slid my hand down to her nape and her neck, to feel if there was any swelling in the neck or the thyroid gland, and at the same time I asked her the kinds of meaningless routine questions I usually asked patients in order to gain their confidence and encourage them to reveal, even if unintentionally, additional truths about themselves.

I was glad to see that despite her weakness she seemed eager to cooperate with me, for my main fear when I had begun this trip had been that I would find her so far gone in that she would be completely apathetic, or even resist my efforts to arrive at an exact diagnosis of her condition and take the right steps to bring her home quickly. In contrast to the resistance she seemed to show toward her parents, she answered my questions willingly, if hesitantly, and recalled how it had all begun and what she had felt and where it had hurt most, and she was even able to
describe
the changing color of her urine since then, and of course what hurt her now, apart from this itchiness that was driving her crazy—for which I was prepared, because after Hishin had
forgotten
to bring me the articles he had promised, I had managed to read up on the disease in an old English medical encyclopedia I found in my parents’ house the night before we left, where the itch was particularly vividly described. “Apart from the itch, what is giving you pain?” I pressed her to go on complaining to her heart’s content, and she did so, and although I noticed that she was confusing symptoms associated with the disease with independent symptoms, such as pains in her legs and a heavy feeling in her back, I said nothing and just nodded my head in agreement with everything she said, still stroking her neck, where I felt a slight swelling in the trachea. Perhaps, I thought, the swelling was natural to her, and I dropped my hand in order not to confuse myself with superfluous speculations before I obtained the results of the crucial tests, which had to be given and rushed to the hospital in Gaya immediately. But I couldn’t forget the remark made by the Indian doctor in the train, about the
unreliability
of the laboratory in the Gaya hospital. It was a pity we’d met him, I reflected bitterly, because if we had to start checking up on how reliabile the Indian laboratories were, we would never
finish. But I immediately suppressed this idle thought. Even if Hishin had exaggerated my qualities greatly, mainly in order to get his friends off his back, he was well acquainted with my scrupulous thoroughness, and he had trusted it to guide me
without
making any mistakes that might eventually be discovered in the hospital in Tel Aviv, where malicious professors and
sycophantic
doctors would lick their lips over them. I was only too familiar with the fact that in medicine everybody always has to have the last word: what should have been done, what shouldn’t have been done, and what did more harm than good.

But I knew that here I was in sole charge, and I had to make an immediate decision. Even though it seemed strange to me for a moment that the director of a big, modern hospital, with the best medical minds at his disposal, should be standing here anxiously with his wife in a dark little chamber in a Buddhist monastery at the end of the world, completely dependent on the professional opinion of an inexperienced young resident, who had not yet examined the patient properly but only touched her lightly on the forehead to feel her temperature and felt her neck a little, I stood up to announce my decision.

“We have to perform some essential tests immediately,” I
explained
, “so we’ll know where we are and where we’re going. Even though her condition’s not great, she can be moved. But before that we have to find out a few things, such as the bilirubin and glucose levels, in order to learn how much damage has
already
been done to the liver. But there’s no need to return her to the hospital; we can obtain the samples on the spot and take them to Gaya. In the meantime, I suggest we find a better room and move her into it. She shouldn’t be left in this squalor.”

A smile now hovered on Lazar’s wife’s face—not the familiar smile, which still confused me by its ready appearance, but a more inward and personal smile, as if she were wondering at the authoritative tone I had suddenly adopted (which, to tell the truth, originated with Professor Hishin, who always used the first-person plural when he came across a patient or the relative of a patient who appealed to him particularly). The two Japanese girls came out of their corner, bent over the gas burner, and offered us some of the pale tea they had brewed. Lazar’s wife hesitated, but Lazar declined the offer, in a hurry to rush off and obey my orders by finding a decent place for us to stay. “You can
all wait for me here,” he announced. His wife seemed upset by his urge to depart, quickly stiffened, and said, “Just a minute,” and Lazar said, “What’s the matter?” and she replied, “Perhaps I should come with you.”

“But why?” asked Lazar. “There’s no need.”

But she insisted: “No, I think I should come along to help you.” She was already bending over her daughter to kiss her, and promising, “We’ll be back soon.” Then she turned to me and said, “You stay with her, and if possible start your tests, and we’ll be back right away.” So saying, she went off with her
husband
, evidently unable to remain alone not only with me but even with her daughter.

Einat was still lying hugging herself with both arms, scratching and rubbing, sending me a quiet look from eyes as yellow as a tiger’s or a hyena’s. But in spite of her obviously poor physical condition, I felt no pessimism, for I knew that I had already gained her confidence by the way I laid my hand on her head and felt her nape and neck. From the minute Hishin told me about her, I had harbored the suspicion that I was being sent to an apathetic patient who had lost the will to recover and might even resist my efforts to help her. But it didn’t look as if the young woman lying here would be able to mobilize any resistance; she was too absorbed in her frenzied scratching, and she was eager too for strange hands to touch her and even to take part
indirectly
in the frantic scratching. But I didn’t want to hurry to work yet, and although it was beginning to get dark, I first drank the bitter, scalding tea offered by the Japanese girls and asked them to tell me about themselves. They told me that they had arrived in Bodhgaya two days before, directly from Japan, to take an advanced course in meditation in the nearby Japanese monastery, and since there had been no room there they had come here and been given a place to sleep with the sick girl, on condition that they look after her a little. They had tried to take care of her needs without getting infected, and wore cloth masks when they touched her. Yesterday they had taken her into the inner garden of the monastery and fed her the rice gruel that they had cooked for her. But her itch was severe, and the ointments the monks had given her didn’t help, and had I brought some good medicine with me? they asked, as if I had come all the way from Israel to treat an itch. “Maybe,” I said, “we’ll see,” and I
opened the knapsack and began emptying its contents onto the blanket they spread out for me, angry with Lazar’s wife for not staying to help me undress her daughter. But the Japanese girls were very helpful; they brought me a big flashlight to supplement the dim light of the bulb, and then they sat Einat up and helped me take off her stained white robe, and supported her thin white back while I knelt and passed the stethoscope inch by inch over her back and chest to auscultate her lungs and see if they were clear and free of liquids, and of course to listen to her heartbeat, which was completely regular. The two girls watched my
examination
, pleased that somebody had come to relieve them of the responsibility for the patient, who had been entrusted to their charge maybe as a kind of religious test imposed by the monks. I nodded my head in satisfaction and said to my patient, “
Everything
sounds fine, Einati,” adopting the pet name used by her parents, and then I laid her slowly on her back to feel her
abdomen
, which was hard and covered with red marks from her
incessant
scratching. To my surprise, her inflamed liver, which should have been enlarged, appeared to have shrunk so much that it was difficult to palpate in the flat, hard abdomen, as if it had already begun to degenerate. At first I was alarmed, but I immediately said to myself that degeneration couldn’t possibly have occurred only two months after the outbreak of the disease. The gall bladder did seem enlarged, and was apparently also
inflamed
, for the slightest pressure from my fingers was enough to make Einat scream so loudly that the Japanese girls averted their faces. Footsteps were quickly audible in the corridor, and a shaven-headed monk in a robe the color of the setting sun came hurrying up to discover the cause of the scream, which had
echoed
through the quiet monastery. He spoke no English, and I asked the Japanese girls to explain that I was a doctor from Israel who had come with the girl’s parents to take her home.