Vikram Seth - A Suitable Boy

Mrs Rupa Mehra sat silently in a chair, and Lata stood behind her, an arm on her shoulder. Mrs Rupa Mehra did not say anything to Lata. Concern for Pran had pushed other matters to the side.

Savita looked sometimes at her husband, sometimes at Imtiaz’s long, fair, appraising face. There was a small mole on his cheek which drew her attention in particular, though she could not have said why. At the moment Imtiaz was feeling Pran’s liver — which seemed an unusual proceeding after an asthmatic attack.

To Dr Kishen Chand Seth he said: ‘Status asthmaticus, of course. It should be self-limiting, but if it doesn’t go away in a little while I’ll administer some adrenaline subcutaneously. If I can, though, I’d prefer to avoid it. I wonder if you could arrange for the ECG machine to be brought in tomorrow?’

At the word ‘ECG’ not only Dr Seth but everyone else started.

‘What do you need that for?’ said Dr Seth sharply. There was only one ECG machine in Brahmpur, and it was at the medical college hospital.

‘Well, I’d like to take a reading. I would not like Pran to be moved at all, so I wonder if you could arrange for it to be brought here. If I ask for it, they’ll just think I’m a young man with newfangled ideas who doesn’t know how to treat asthma.’

That was exactly what Dr Kishen Chand Seth himself was thinking. Was Imtiaz implying that he, Dr Seth, had oldfangled ideas? But something in Imtiaz’s confident manner of examining the patient had impressed him. He said he would make the necessary arrangements. He knew that institutions with ECG machines guarded them like gold.

Lucknow had a single such machine, and there were none in Banaras at the time. The medical college hospital at Brahmpur was extremely proud and possessive of its recent acquisition. But Dr Seth was a force to be reckoned with there, as elsewhere. The next day the ECG machine was brought in.

Pran, who had stabilized after another traumatic hour of wheezing, and had then collapsed into an exhausted sleep, woke up to find Imtiaz and the machine in his bedroom.

‘Where’s Savita?’ he asked.

‘She’s resting on the sofa in the other room. Doctor’s orders. She’s fine.’

‘What’s that?’ Pran asked.

‘The ECG machine.’

‘It’s not very big,’ said Pran, rather unimpressed.

‘Nor are viruses,’ said Imtiaz with a laugh. ‘How did you sleep?’

‘Fine.’ Pran’s voice was clear; there was no wheezing.

‘How do you feel?’

‘A little weak. Really, Imtiaz, what’s the purpose of an ECG? That’s for the heart, and my problem is my lungs.’

‘Why don’t you leave that for me to decide. You may well be right, but there’s no harm in checking. I suspect that this time a cardiogram may help. I believe that it may not be a simple asthmatic attack.’

Imtiaz knew that he could not lull Pran to peace in a soothing hammock of ignorance, and felt that he should take him into his confidence.

But ‘Oh’ was all Pran said. He was still sleepy.

After a while, Imtiaz asked him for some other details of his medical history, and added, ‘I’m going to ask you to move as little as possible.’

‘But my lectures—’

‘Out of the question,’ said Imtiaz cheerfully.

‘And my committees?’

Imtiaz laughed. ‘Forget them. Firoz tells me you loathe them anyway.’

Pran lay back on the pillows. ‘You always were a bully, Imtiaz,’ he said. ‘Anyway, it’s clear what kind of friend you are. You pop up at Holi, get me into trouble, and then only come to visit me when I’m ill.’

Imtiaz yawned.

‘I suppose your excuse is that you work too hard.’

‘I do,’ said Imtiaz. ‘Dr Khan, despite his youth, or perhaps because of it, is one of the most sought-after doctors in Brahmpur. His devotion to his profession is exemplary. And he exacts obedience to his decrees from even the most rebellious of his patients.’

‘All right, all right,’ said Pran, and submitted to the reading. ‘So, when do I expect you next?’

‘In a day. Remember, you’re not to move out of the house and, preferably, not out of bed.’

‘Please, Sir, may I go to the bathroom?’

‘Yes.’

‘And may I accept visitors?’

‘Yes.’

At Imtiaz’s next visit, he looked grave. He had examined the ECG reading, and told Pran, without beating about the bush:

‘Well, I was right, this time it was not asthma alone, but heart. You have what we like to call “severe right ventricular strain”. I am recommending three weeks of complete rest, and I’m going to put you in hospital for a little while. Don’t get alarmed. But lectures are out. And committee work and so on.’

‘But the baby—’

‘Oh, the baby? Are there problems there?’

‘Do you mean the baby will be born when I’m in the hospital myself?’

‘I suppose that’s up to the baby. As far as I am concerned, you are to rest for three weeks, starting now. The baby is none of my concern,’ said Imtiaz heartlessly. Then he added: ‘You’ve done what you needed to in the creation of the baby. The rest is up to Savita. If you insist on endangering yourself further, it won’t be good for her — or for the baby either.’

Pran accepted the justice of this argument. He closed his eyes, but the moment he did so a wave of nameless anxieties washed over him.

He quickly opened his eyes again, and said: ‘Imtiaz, please tell me what this thing is — this ventricular strain you mentioned. Don’t tell me I don’t need to know. Have I had a heart attack or something?’ He recalled Firoz’s remark: ‘The heart and the lungs are two quite different things, young man, two quite different things,’ and, despite himself, began to smile.

Imtiaz looked at him with the same grave expression that seemed so atypical of him, and said: ‘Well, I can see that the idea of a heart attack amuses you. It’s good you’ve never had one, and — well — you aren’t likely to, exactly. But since you’ve asked, let me explain things to you as clearly as I can.’ He paused, thought a little about how to put it, then continued: ‘There’s an intimate connection between the heart and the lungs; they share the same cavity, and the right side of the heart supplies stale blood to the lungs for it to freshen, to oxygenate, as we say. So when the lungs don’t do their job properly — for instance because of not getting enough air when the air-tubes to the lungs seize up asthmatically — the heart is affected. It tries to supply more blood to the lungs to make up for the bad oxygen exchange, and this causes its own supplying chamber to fill up with blood, to become congested and distended. Do you understand?’

‘Yes. You explain things very well,’ Pran said sadly.

‘Now because of this congestion and distension, the heart loses its efficiency as a pump, and that is what we like to call “congestive cardiac failure”. It’s got nothing to do with what laymen understand by the term “heart failure”. To them that means a heart attack. Well, as I said, you are not in danger of that.’

‘Then why must I stay in bed for three weeks? It seems a terribly long time. What will happen to my work?’

‘Well, you can do a bit of light work in bed,’ said Imtiaz. ‘And later, you can go for walks. But cricket is out for a while.’

‘Out?’

‘I’m afraid so. Now as for medicine. Here are two sets of white tablets. You are to take these three times a day, and these once a day for the first week. Then I’ll probably cut down a bit on the digoxin, depending on your pulse rate. But you’ll keep on with the aminophylline for a few months. If necessary I might have to give you an injection of penicillin.’

‘You sound serious, doctor,’ said Pran, attempting to add a touch of lightness to the conversation. This Imtiaz was very different from the one who had helped duck Professor Mishra in the tub.