The Covenant of Water

1933, Madras

The clerk from the hospital who meets him at the port is shocked that Digby has no trunk, just a shabby suitcase. They travel in a rickshaw pulled not by a beast of burden but by a man. The heat and a touch of mal de débarquement leave Digby disoriented, taking in the cow loitering in the middle of the broad avenue, the blur of dark faces on either side, the cobbler at work on the dusty pavement, the low-slung whitewashed buildings with hand-painted signboards, and the cluster of huts on the edge of a stagnant pond of water. They pull up at a bungalow not far from the harbor and close to Longmere Hospital, his new place of employment.

A short man in a white shirt, white trousers, and bare feet slips a jasmine garland over Digby’s head, then bows, his palms held together at chin level. Muthusamy is to be Digby’s cook and housekeeper. For someone who is used to calling a tin of sardines his breakfast, lunch, and dinner, Digby can’t fathom the notion of his own cook, let alone one who garlands him. Muthu’s white teeth are a beacon in his coal-dark face; his forehead has three horizontal streaks of ash—a vibuthi, as Digby learns later, a sacred Hindu marking that Digby will soon observe him apply each morning after lighting camphor and praying before the small icon of a god tucked in a kitchen shelf. Muthu’s salt-and-pepper hair is parted in the middle and oiled back; he radiates kindness. Digby bathes and then sits down to the meal Muthu has prepared: rice with what Muthu says is “chicken korma”—chicken in an orange-colored gravy. Digby is famished and the korma mixed in with the rice is delicious, a riot of completely new flavors on his palate. He finishes most of it before he belatedly notices that his mouth burns and his forehead blossoms with sweat. After dousing the flames with ice water he lays down on his bed under a sluggish ceiling fan. His last waking thought is that he must ask Muthu to tone down the combustible ingredients in his dishes until he is more used to them. He sleeps for eleven straight hours.

The next morning, Assistant Civil Surgeon Digby Kilgour shows up for duty at the cluster of two-story whitewashed buildings that is Longmere Hospital. It is close enough to the harbor for the smells of tar and brine to waft into the wards. He reports to Civil Surgeon Claude Arnold, who he discovers is not one to keep civil hours. One hour passes, with Arnold’s office manager periodically offering the curious phrase “Doctor Arnold is just presently only directly coming now, sir.” The manager, along with the Anglo-Indian secretary and the barefoot peon, smiles at Digby. “Having tea, Doctor? Or taking degree coffee?” “Degree coffee” turns out to be sweet and delicious; it is coffee brewed in hot, frothy milk. It gets its name, he’s told, from the markings on the hydrometer or lactometer used to ensure the milk isn’t too diluted with water.

The ceiling fans rustle the free edges of papers held down by stones. Nothing else stirs. The three employees show languorous skill in the art of not moving a muscle in the stifling heat. The pretty secretary’s eyelids flutter each time he glances her way, a kind of Morse code, Digby thinks. Her lovely arms are dark, but her heavily powdered face is chalky white and stands out against her blood-red lipstick and varnished black hair. She brings to his mind a showgirl under stage lights.

Close to noon, the office staff suddenly shuffle papers; the peon stands. They’ve received a secret signal. Minutes later, a blond Englishman in his forties, in a dapper white linen suit and brown shoes with a mirror finish, materializes in the doorway, the peon grabbing the pith helmet from his extended hand. He registers Digby’s presence with a raised eyebrow. His wide shoulders suggest a former sportsman; he’s good-looking, but his sallow complexion and puffy, bloodshot eyes hint at the dissolute. The small mustache is darker than his hair, and to Digby it seems faintly ridiculous.

Senior Civil Surgeon Claude Arnold takes the measure of his fresh-off-the-boat subordinate: he sees a young man with a widow’s peak marking his thick hair, a strange, irregular dimple on his left cheek, a crumpled blazer over his arm, and woolen trousers that only a masochist would wear in Madras. Digby squirms under this scrutiny. Claude Arnold has the confidence of a public-school boy encountering his social inferior. He studies Digby’s documents, the papers trembling slightly in his hand. He offers a cigarette; the eyebrow goes up again when Digby declines, as though the new man has failed another test. Eventually, after his coffee, Arnold stands and motions for Digby to follow.

“You’ll be responsible for two surgical wards. Under my supervision, of course,” Arnold says over his shoulder. “Both are for natives. For your sins, old fellow. I run the Anglo-Indian and British wards. Two LMPs will be working for you, Peter and Krishnan.” He drags with relish on his cigarette, as if to show Digby what he’s missing. “I don’t care for LMPs. I’d rather have a real doctor than a babu impersonation.” Digby knows that Licentiate Medical Practitioners pass an abbreviated two-year diploma course and can practice medicine. “But it’s India, you know. Can’t do without them, or so they tell us.”

Arnold stops at the male native ward. “Where’s Matron Honorine?” he asks irritably of the brown-skinned nurse who rushes to greet them with a ready smile. Matron is gone to the pharmacy.

Patients occupy the beds on either side of a long, high-­ceilinged room, and others lie on mats between the beds. Outside is a covered porch with more patients on mats. A man with a grotesquely swollen belly, and a hollowed face that emphasizes his cheekbones, sits on the edge of a bed, his stick arms propping him up. Meeting Digby’s gaze, he smiles, but his face is so wasted that he appears to bare his teeth. Digby nods. The sight of suffering is familiar; its language transcends all borders. The native female ward is across the hallway, and it too is full.

Dr. Claude Arnold’s Anglo-Indian ward currently is populated by one patient, plus a lone probationer presiding over him. The other carefully made beds all stand empty. Arnold doesn’t take Digby to the British ward. The latter, he will learn later, is a collection of six private rooms on the upper floor, all unoccupied. British and Anglo-Indian patients in the know choose the General Hospital near the railway station, or else the Royapettah Hospital, for their surgical problems.

On the second floor, two operating theaters lead off from the scrubbing station. “Today is operating day for your wards,” Arnold says. “You get Tuesdays and Fridays. The native side hasn’t had a surgeon for a while. Well, we have the LMPs. They could do some major surgery if I were to let them. But then, before you know it, they’ll set up shop in some small town and call themselves surgeons.” Arnold points to the corkboard. “Take a look,” he says, and then he slips out of sight.

The surgical list for the day is impressive in length: two amputations, a string of hydroceles and hernias, and four I&D’s—incision and drainage for tropical abscesses. But Digby sees no major surgeries posted. Claude Arnold returns with a brightness in his eyes that was absent before. Digby picks up a medicinal odor on the senior civil surgeon.

“So, you’re a surgeon,” Arnold says suddenly, turning to Digby with unexpected charm, almost smiling.

“Well, not quite, Dr. Arnold. I did a total of a year and a—”

“Nonsense! You’re a surgeon! Call me Claude, by the way.” His new congenial tone is that of the captain of the cricket team needing ten runs from the last batsman. “You learn by cutting. Remember, Kilgour, for these people the choice is you or nothing at all. Be bold!” The corners of Claude’s mouth turn up, as though he’s let Digby in on a trade secret, or perhaps a joke. “You might as well plunge in,” Claude says. Then to the waiting theater boy, “Get Doctor Kilgour a locker and whatever else he needs.” There’s to be no further orientation.

Before he knows it, Digby is scrubbed, gowned, and gloved. The redolence of this theater, a continent away from Glasgow, is familiar: ether, chloroform, phenol, and the lingering feculent odor of an abscess recently drained. But the similarity to Glasgow stops there. Digby stares at the most astonishing sight framed by the surgical towels: a scrotum ballooned beyond the size of a watermelon, now reaching the kneecaps. The penis is buried in the swelling like a belly button in an obese abdomen. When he read “hydrocele” on the surgical list, this wasn’t what he pictured. He expected to see a modest collection of fluid in the space enclosed by the tunica vaginalis that covers the testis. He’d operated on a unilateral hydrocele in a child, a straightforward procedure. But that gentle, lemon-sized scrotal swelling of memory has no relationship with this brown, corrugated behemoth. In the adjoining theater, an amputation is in progress. It’ll be a while before the LMP on that side can help. Claude has vanished. And Digby is living the recurring nightmare of every surgeon: the patient under ether, the body cavity open, but the anatomy unrecognizable. His legs feel weak.

The Tamil scrub nurse across from him smiles through her mask.

“It’s . . . a large one,” is all Digby can manage, his gloved hands locked together in the manner of a prelate.

“Aah, yes, Doctor . . . Big only,” the scrub nurse says agreeably, her tone implying that “big only” is something to celebrate, and small isn’t worthy of her theater. Her head movements, like those of Muthu, confuse him: what’s a “no” in Scotland becomes “yes” here, as long as there’s a little yaw and twist with it. “But above the knee only,” the nurse adds, striking a note of slight disappointment. It takes Digby a second to understand that hydroceles (and groin hernias too, he will later learn) are classified here as “above the knee” or “below the knee” and the latter alone are truly deserving of being called “big only.” If the specimen were a fish, she might fling it back in the river.

Digby is pouring sweat. A hand mops his brow before he drips onto the patient—it’s the barefoot orderly who’s also in charge of the ether mask. The scrub nurse uncovers the tray of instruments, waiting for his order.

“Actually, I’ve never seen anything this big,” Digby says, stalling.

“Big only,” she repeats, but with less enthusiasm, puzzled that the doctor doesn’t plunge in. Her grizzled counterparts in Glasgow might have responded with “Aye, it’s a stoater of a scrotum and ye’ve said it twice already, but ye’ll not shrink it by gabbin’, so g’wan and take yer knife to it.”