Michael Ondaatje - Anil's Ghost

Gamini worked in the base hospital at Polonnaruwa during his last year in the northeast. This was where the serious casualties from all over the Eastern Province, Trincomalee to Ampara, were brought. Family murders, outbreaks of typhoid, grenade injuries, attempted assassinations by one side or another. The wards were always in turmoil-outpatients in General Surgery, floor patients in the corridors, technicians arriving from a radio store to fix the electrocardiogram unit.

The only cool place was the blood bank, where the plasma was refrigerated. The only silent place was Rheumatology, where a man slowly and quietly turned a giant wheel to exercise his shoulders and arms, which had been broken in an accident a few months earlier, and where a solitary woman sat with her arthritic hand in a basin of warm wax. But in the corridors, the walls mildewed with dampness, men would be rolling giant cylinders of oxygen noisily off the carts. Oxygen was the essential river, hissed into neonatal wards where incubators sheltered babies. Outside this room of infants, and beyond the shell of the hospital building, was a garrisoned country. The rebel guerrillas controlled all roads after dark, so even the army didn’t move at night. In the children’s ward Janaka and Suriya circled their patients-one had a heart murmur, another suffered from fits-but if there was bombing or a village attack they too became part of the hospital ‘Flying Squad,’ and even those in the neonatal ward worked the triage and operating room. They left an intern behind.

The specialists who came north seldom worked only in their specific area of knowledge. They were in Pediatrics one day, but might spend the rest of the week helping to contain an outbreak of cholera in the village settlements. If cholera drugs were not available, they did what doctors in another era had done-dissolved a teaspoon of potassium permanganate in a pint of water and poured it into every well or standing pool. The past was always useful. At one time Gamini tried to keep an infant alive for four days. The girl could hold nothing down, not her mother’s milk, not even water, and she was dehydrating. He remembered something and got hold of a pomegranate and fed the child the juice. It stayed down. Something he’d heard about pomegranates in a song his ayah had sung… It was legendary that every Tamil home on Jaffna peninsula had three trees in the garden. A mango, a murunga, and the pomegranate. Murunga leaves were cooked in crab curries to neutralize poisons, pomegranate leaves were soaked in water for the care of eyes and the fruit eaten to aid digestion. The mango was for pleasure.

Gamini was working with Janaka Fonseka in children’s surgery when they began hearing news in the corridors that a village had been attacked. In front of him on the operating table was a small boy, naked except for white shorts, a huge mask over his tiny face. The two doctors had been preparing for the operation all week; neither of them had attempted it before, they had been reading the text of the procedure in Kirklan’s Cardiac Surgery over and over. They had to cool the boy’s body down to twenty-five degrees Celsius by running cold blood into him, reducing his temperature until the heart stopped. Then they would operate. As they began cutting, the wounded started coming into the halls and they were aware of the Flying Squad in action around them.

He and Fonseka stayed with the boy, keeping just one nurse. A heart the size of a guava. They opened the right atrium. This was as close to magic as the two of them got in their days there. They talked frantically back and forth to be certain of what they were doing. They could hear the carts carrying equipment or bodies, they couldn’t tell which, racing down the halls. There’d been a massacre, they now heard, a village thirty miles away had been pretty well wiped out. Somebody had to be sent there to see if any were still alive. The child in front of them had a congenital abnormality, a beautiful kid, Gamini kept wanting to take the mask off and see his face again. Wanted to look at the boy’s dark black eyes, which had been full of trust, which had looked up at him as he gave the needle that had put him into uncontrolled sleep.

Fallot’s tetralogy. Four things wrong with the heart, so he would live perhaps only into his early teens if they didn’t operate now. A beautiful boy. Gamini was not going to leave him alone, betray him in his sleep. He kept Fonseka with him, not letting him go to the others as Fonseka thought he should. ‘I have to leave, they keep calling out my name.’ ‘I know. This is just one boy.’ ‘Fuck, that’s not what I mean.’ ‘You have to stay.’

The operation took six hours and all that time Gamini stayed with the boy. He let Fonseka go after three hours. The nurse would have to help him reverse the bypass. He knew her as a starting intern, the Tamil wife of one of the staff. She and her husband had come to the peripheral hospital in the last month. Gamini stood by the boy and explained what they had to do. The boy would have to be rewarmed with blood at a higher temperature, and at the key moment the bypass had to be removed. Fallot’s tetralogy. No one had ever performed the procedure in this country.

So in the fifth hour Gamini and the nurse reversed the process that he and Fonseka had set up. The young nurse watching him for any sign that what she was doing might be wrong. But she was faultless, faultless, calmer, it seemed, than he was. ‘This one?’ ‘Yes. I need you to cut a shallow three-inch line there. No, to the left.’ She cut into the boy’s body. ‘Don’t remain a nurse. You’ll be a good doctor.’ She was smiling under the mask.

As soon as the boy was in Recovery, Gamini left him with her. There was no one else he could trust. He got two beepers and told her to contact him if something seemed wrong. He washed up and then went into the chaos of the triage. There was blood on everyone except him.

It took a few more hours to deal with the crisis. In surgery they wore white rubber boots and all the doors had to be closed. Sometimes if a doctor had heat exhaustion he slipped into the refrigerated blood bank for a few minutes among the plasma and pack cells. Gamini took over in surgery. There was a small Buddha lit with a low-watt bulb in nearly every ward, and there was one in surgery as well.

All the survivors had been brought in by now. The killings had happened at two in the morning in a small village beside the main road to Batticaloa. They had brought him nine-month-old twins, each shot in the palms and one bullet each in their right legs-so it was no accident, a close-range job and intentional, left to die; the mother had been killed. In a couple of weeks those two children were peaceful things, full of light. You thought, What did they do to deserve this, and then, What did they do to survive this? Their wounds, in reality quite minor, stayed with him. It was the formal evil of the act perhaps, he didn’t know. Thirty people had been massacred that morning.

Lakdasa drove to the village and did the postmortems, otherwise relatives would not receive compensation. For everyone in the region was poor as grass. In those villages the father of a family of seven earned one hundred rupees a day working in a wood shop. That meant each of them could have a five-rupee meal a day. For that you could buy a toffee. When political entourages came up to the provinces and received tea and lunch, the visit cost forty thousand rupees.

The doctors were coping with injuries from all political sides and there was just one operating table. When a patient was lifted off, blood was soaked up with newspaper, the surface swabbed with Dettol, and the next patient laid down. The real problem was water, and in the larger hospitals, because of frequent power failures, vaccines and other drugs were being thrown away constantly. Doctors needed to scavenge the countryside for equipment-buckets, Rinso soap powder, a washing machine. ‘Surgical clamps for us were like gold for a woman.’