Open Heart (20 page)

But it was already too late to change anything. Lazar and his wife had come back from Gaya with plane tickets for all of us for the next morning, and Lazar reacted with considerable
annoyance
to the sight of the blood-soaked handkerchief. “What on earth made you go out for a walk?”

“If you want to leave tomorrow morning,” I replied in a tone that I knew contained both complaint and rebuke, “she has to get accustomed to the open air.” But only his wife was aware of the rebuke. Lazar, looking at his daughter, who was beginning to raise her head, was even more determined to leave for home
before
things got worse. “Never mind,” he said, as if he were the expert here, “it’s only a little nosebleed, and it’s already stopped. Let’s go back to the hotel—we have to eat and start packing.” I took my camera out of its case again and snapped the three of them a couple of times. Then I called the Indian girl to join them and I took a photo of the four of them, and after that I asked Lazar to take one of the four of us, but I still wasn’t satisfied. I took the camera again and posed him and his wife opposite the soft sun, and took a picture of the two of them by themselves. “We might as well finish the film,” I said. “The light’s so pretty now and the place is gorgeous, and tomorrow we’ll be on ugly roads.” Lazar looked too tired to take any further part in my sudden lust for photography, but Dori cooperated gladly. It was evident that she liked having her photograph taken. There was suddenly something captivating about this middle-aged
woman—in the way she drew herself up to her full height, crossed her long legs, tried to pull in her protruding stomach, and then looked straight at the camera and shot out smile after smile, even before the button was pressed. And for the first time on this journey I felt a slight pang of regret and longing. I had come so far but seen so little. Would I be able to come back here one day?

Although I guessed that the sudden bleeding was related to Einat’s general weakness, and perhaps also to the onset of her period—as sometimes happens, but usually with young girls—I couldn’t avoid the nagging thought that there might be a small hemorrhage somewhere which refused to stop because of the coagulopathy caused by the viral hepatitis. So I didn’t take my eyes off Einat, who was now leaning on the Indian girl. Lazar’s wife supported her too, and the three of them walked slowly behind Lazar, who hurried in the direction of the hotel. Who could tell what other surprises she had in store for me on the way home? I thought to myself, adopting the cynical tone beloved of Hishin, who sometimes talked about his patients as if they were cunning opponents whose only aim was to trip him up. And while I quickly changed the film in the camera and insisted on snapping one more shot of the four of them outside the entrance to our hotel, which was now suffused in a strange purple-yellow twilight, like a huge bruise remaining after the sun refused to set, I also inquired casually, and without explaining why, about
Lazar’s
and Dori’s blood types. I had guessed right: the only
possible
donor if an emergency arose would be Lazar’s wife.

In the night I tossed and turned in my little room. I was still angry at the decision to leave in the morning. Was it only the insult of not being consulted that was bothering me? Maybe it was the nagging thought that I was about to return home
without
a job, and even though I had spent a whole week,
twenty-four
hours a day, with the administrative director, I still had nothing to show for it, and it was very much in the air that on my return I would have to start looking, without much hope, for a residency in the surgical department of another hospital. When I realized that I wasn’t going to fall asleep, I got out of bed and
began to pack. I switched on the light and started putting the medical equipment back into the knapsack, carefully examining every item as I did so. The pharmacist was a genius; he had thought of everything. And the imagination, precision, and
economy
of his preparations had a particular radiance shining next to me in the silence of the night. I made a mental note to express my appreciation as soon as I got back, as I folded everything up and packed it in the knapsack, trying to remember exactly where each item fit. In the end, even though a red glow was already beginning to appear between the palm and coconut trees, I
decided
to try to snatch a couple of hours of sleep before the
journey,
and from a little glass jar with three words written on its label in the pharmacist’s handwriting—“Effective Sleeping Pill”—I fished out a smooth blue capsule and swallowed it.

The pill was so effective that Lazar had to shake me several times before he succeeded in rousing me, and his wife, who was busy cleaning the kitchen as industriously as if it were a friend’s borrowed apartment, flashed me a look which seemed to express astonishment at my voracious capacity for sleep. “I didn’t sleep all night,” I explained spreading out my hands apologetically to them, but Lazar wasn’t interested in apologies, he wanted rapid organization. Three swollen suitcases stood ready—two older bags and one new one, which had swallowed up their daughter’s sleeping bag, backpack, and other possessions. Einat herself was sitting on a chair outside, very pale, wearing the simple flowered dress and red cloth hat that her mother had brought from Israel—a sad and pensive tourist, carrying away only the
hepatitis
B virus, testimony to the fact that her independent
backpacking
trip to the stormy, colorful subcontinent had ended in failure, requiring an emergency rescue by Mommy and Daddy. Without examining her again before leaving, I hurriedly dressed and ate the sandwiches prepared by Lazar’s wife, who for a moment also seemed uncertain of the wisdom of starting off on the return journey so soon. But at this point the rickshaw driver in the white turban arrived, and when he saw me he came hurrying up to shake my hand enthusiastically, adding a little bow to express his satisfaction at my safe return from Calcutta. This time he had brought a bigger rickshaw, which easily took the four of us and our luggage aboard, and transported us rapidly to the dirty little airport in Gaya, which the light of day stripped of its mystery.

The flight from Gaya to Varanasi was not long, and the plane did not climb to any great altitude; nevertheless, a spurt of blood burst out of Einat’s nose again. I was absorbed in the window, sleepily watching, with a mixture of depression and admiration, a silvery flash apparently emanating from our plane, which streaked ahead of us, gliding over the fields and roads, vanishing into woods and canals and little lakes, then unexpectedly
appearing
again, darting quick and silver over another part of the
landscape
. Lazar’s wife was sitting in a window seat two rows in front of me, and during the flight I noticed her bun unraveling. Suddenly Lazar rose from his seat, a blood-soaked towel in his hand. I jumped up, but when he saw me he signaled me to sit down again. I ignored him and hurried over to them. Einat was lying with her head on her mother’s lap. “It’s stopped,” Lazar announced immediately, as if to send me away, but his wife looked uncertain. Her automatic smile had vanished. “What is it?” she asked me in real anxiety. “It’s probably weakness from the hepatitis,” I said without thinking, “and maybe a result of the change in atmospheric pressure too. Let’s change places for a minute,” I suggested to Lazar, sitting down in the seat next to his wife and looking straight into Einat’s eyes. She raised her head to me; she seemed a little pale, but mainly unhappy. In spite of the inconvenience to Lazar, I insisted on remaining next to the two women until the landing, which from the window was
spectacular
and startlingly beautiful. The plane circled over the two banks of the Ganges, the deserted east bank and the swarming west one; then it began gliding past, temple after temple, ghat after ghat, rocking in the air over the tiny black figures as if it too wished to bathe in the holiness of the golden river. I began
talking
to Einat, to distract her. Had she ever been in Varanasi? I asked her. She shook her head. “It’s a pity your father’s in such a hurry,” I said, “otherwise we could have squeezed in another day here. The little we saw when we were here only whetted my appetite for more,” and I smiled at her with the automatic smile of her mother, whose eyes were fixed on my face in profound concern.

It reminded me of those times in the operating room when we noticed that the glint of irony usually present in Professor Hishin’s eyes had vanished. We had to stop; it was my
responsibility
. This new thought began to torture me as we sat with our
suitcases and knapsack in a dirty corner of the Varanasi airport, surrounded by Indian children who had come to stare at me and my patient, leaning against me with her eyes closed, too
exhausted
even to look at the big basket a few feet away, from which rose the alert head of a large snake. We had three hours to kill before the flight to New Delhi, and although Lazar and his wife had brought sandwiches and bottles of soft drinks from Bodhgaya, they made their usual tour of the shops, returning from these expeditions with a relatively clean-looking pastry or a glass of hot tea. I took my patient’s hand in mine to feel her pulse. It was rapid, a hundred per minute, and then, in the
absurd
despair of a doctor whom nobody believes, I found myself praying that she would begin bleeding again, because this was my only chance of asserting my authority and putting a stop to the dangerous journey, which Lazar and his wife were
conducting
with such feverish zeal. “Do you feel nauseous?” I asked. She thought a little and then nodded her head. “Then come along with me and let’s get it up.” I helped her to stand and led her into a corner, where I held her shoulders and gently pressed on her abdomen. She didn’t vomit much, but blood was evident.
Wherever
it was coming from, there was no doubt that the damage to the clotting factors was exacerbating the bleeding. I led Einat back to her seat and told her to lie down across my seat, after which I went to stand guard over her vomit, to make sure that nobody effaced the telltale signs until her parents returned and saw with their own eyes. At that point I was finally able to
confront
them quietly but firmly: “I’m sorry, but it’s impossible to continue to New Delhi. She has to have a blood transfusion
immediately
. You’re in too much of a hurry to get home, and you’re putting her at risk unnecessarily.”

Lazar was flabbergasted. But I stood my ground, and in the quiet, firm tone that has powerful effects on patients and their families, I insisted that we could not continue our flight, that we had to reach some decent hotel—perhaps the Ganges, where we had almost stayed last time—and there, in a quiet atmosphere and hygienic conditions, I would give Einat a blood transfusion, which would require complete bed rest for twenty-four hours for proper recovery. “Of course,” I continued, “we could put her in a local hospital. But even without the problem of dirty needles and contaminated blood supplies you’d have to be insane to
hospitalize
anyone in this ‘Eternal City,’ where nobody cares about anything but reincarnation and cremation.” Lazar still tried to protest. “Let’s go as far as New Delhi, at least,” he begged. “It’s only a two-hour flight. We can stop there—because who knows when we’ll be able to get onto another flight, and traveling
sixteen
hours by train will be more dangerous for her than
postponing
the blood transfusion for a few hours.”

“No,” I stated quietly, “it would be more dangerous to
postpone
the blood transfusion,” and I looked directly at his wife. But when she remained silent, as if unwilling to come out on my side, I raised my hands in a dramatic gesture, as if a hidden pistol were pointing at my head, and, closely surrounded by a ring of Indians who had gathered to see the little drama taking place in their midst, I burst out a tone of pain and grievance which
surprised
even me with its intensity, “Okay, she’s your daughter, but just explain one thing to me—why did you drag me here with you?”

Perhaps it was these words that defeated Lazar’s wife, who now threw her weight decisively onto my side, until Lazar too gave in and immediately began organizing the postponement of our flight, looking for porters, and thinking about a suitable
hotel
. And then Einat fainted and fell to the ground, and for the first time I was overwhelmed by a real fear that she was going to slip out of our hands. Passersby helped to lift her up; the
characteristic
Indian expertise in carrying the sick and dying soon proved most helpful as we were provided with a stretcher
improvised
from a blanket and two bamboo poles, and with a great hullabaloo we were led out of the airport building. A ramshackle minibus took us on board and with un-Indian speed covered the twelve miles between the airport and the town. We soon reached the Ganges Hotel, and although Einat had already recovered from her faint, the managers apparently thought it best to isolate us from the other guests, and instead of showing us into the hotel itself, they led us to an annex in the rear, a kind of pilgrims’ lodge, where they installed us in two simple but very clean rooms furnished with wicker furniture lacquered a bright purple. After washing my hands and face and taking the extra precaution of putting on a little surgical mask, I turned quickly to my medical kit to collect everything I would need for the blood transfusion, which I had decided to perform as an emergency procedure, as
described in the first aid manuals of the Magen-David-Adom
station
where I had worked night shifts while I was in medical school. In other words, a direct transfusion, where I would have to approximate the amount. I asked Lazar to push two beds together and lay the two women side by side, and Lazar helped me to take off their shoes and undo their belts. I measured their blood pressures, which were good, both about 130 over 80, and asked Lazar’s wife, who was studying me with a rather ironic expression, to take off her glasses. “Why?” she asked in surprise. “It’s not important,” I said in embarrassment. “I just thought you might be more comfortable that way,” and without insisting I found the vein for the intravenous line on Einat’s slender wrist and connected it to the small infusion set. When the needle went in she let out a sharp cry of pain, and I immediately stroked her head and apologized, even though I knew that with the thinness of her arm and the irritated state of her skin the pain was
unavoidable
. I passed the tube over the table lamp standing
between
the two beds and began looking for her mother’s vein, which was buried in the plumpness of her flesh. I tied a rubber tube around her upper arm, and since I felt no fear emanating from her, I found it easy to plunge my syringe quickly and
painlessly
deep into the vein. As the blood began slowly pumping out and I noted the time on my watch, she smiled at me and began joking lightheartedly. I asked Lazar, who was prowling around me not like the head of a hospital in which complicated
operations
were performed day and night but like a frightened
husband
and father, to raise his wife a little and prop her back against the pillow, to allow the blood to flow unimpeded between her arm and her daughter’s according to the law of
equilibrium
. His wife’s hair had come loose and partly covered her face. She tried to encourage her daughter, who was lying with her eyes closed and an expression of pain on her face, as if the blood flowing into her hurt her. Now there was a long silence. Lazar was still examining my actions with a mixture of anxiety and suspicion. Was I keeping an eye on the amount of blood? he suddenly asked in a whisper. I nodded my head. I knew that everything I did here was being registered in his sharp mind, down to the last detail, and that when we got home he would waste no time in asking Hishin and the rest of “his” professors if it had really been necessary to perform the blood transfusion so
urgently and to cancel the flight. But I was calm and sure of myself, ready not only to justify the urgent transfusion to all the professors in the hospital but also to demand the respect due to me for my diagnosis and ingenuity in a medical emergency. They had wanted the ideal man for the trip—I suddenly felt a surge of elation—and they had found him!