The Covenant of Water

1922, Cochin

Rune locks up the clinic at midnight. He started seeing outpatients late that evening because of two back-to-back emergency operations. It has been ten years since Mrs. Eleanor Shaw changed his fortunes. On his ambling walk home along the rocky shoreline of Fort Cochin, usually with a book under his arm, it is his custom, weather permitting, to smoke one last pipe on a cement bench that looks out over the sea, and to savor the breeze. The waves celebrate their long voyage with a final splash on the rocks. The moon hangs low like a lantern, illuminating the angular scaffolding of the Chinese fishing nets, more than a dozen of them along the water’s edge. The poles crane out over the water like long-necked shore birds, while the netting billows like the sails of dhows.

Rune considers himself happy. Each day is different. He lacks for nothing, has good friends and many interests outside of medicine. Why then, many a night when he sits on this bench, does he feel restive? The unsettledness comes as unfailingly as the old Musulman who appears at the end of the month, carrying his tattered rent-collection ledger and his so-sorry-to-disturb-you mien. But this restlessness isn’t the kind that took him from port to port until he found a home in Cochin—it’s not about geography. He is where he is meant to be. What then?

A tapping sound gets louder. Rune sees a shape shuffling along, a staff in one hand, silhouetted by moonlight. The flattened profile, the absent nose are immediately recognizable: a leprous facies. Stumps, not fingers, clutch the staff. Coins rattle in a tin cup dangling from the neck. The figure chants in a low voice, a devotional perhaps, the face tilted up to the heavens and swaying from side to side, scanning the unseen sky. The specter stops, his head ceasing its pendulum swing as though he has sensed the low-hanging moon. He’s a statue, unmoving but for the rise and fall of the shoulders with each breath.

In a dizzying shift of perspective, Rune suddenly feels he has become the leper: it’s Rune who looks out through scarred, opaque corneas; Rune who sees cloudy, smeared images with no edges; Rune who discerns light and shadow but remembers what it was like to have moonlight fall on his face; those are Rune’s misshapen, ulcerated feet wrapped in bloodied gunnysack that is secured with coir rope . . . The moment passes. He has no explanation for what just happened, the sense of being momentarily embodied in another.

The figure departs, swallowed by the night, the tap of staff against stone receding. In a rush of clarity Rune sees all the things the leper could not: the distant horizon where sea meets sky, the sky that suspends the moon, and the moon with the shawl of stars draped around it . . . He feels himself disappear in the capaciousness of the universe. He has become the sagging net, the blind leper who must sleep under the stars . . . In the immensity of the cosmos, Rune feels he himself is nothing, an illusion. The difference between him and the leper is no difference at all, they are just manifestations of the universal consciousness.

In this new awareness, the restless chattering in his head abruptly ceases. Just as the ocean manifests as a wave or surf, but neither wave nor surf is the ocean, so also the Creator—God or Brahma—generates an impression of a universe that takes the form of a Swedish doctor, or a blind leper. Rune is real. The leper is real. The fishing net is real. Yet it is all maya, their separateness an illusion. All is one. The universe is nothing but a speck of foam on a limitless ocean that is the Creator. He feels euphoric and ­unburdened—the peace of God, which passeth all understanding.

In the early hours of morning, his worried watchman comes looking for him. In times past he has pulled his master out of the toddy shop, where the good doctor is slumped over the table. But on this night he finds the doctor rapt as a sadhu, gazing out through unfocused eyes. The watchman shakes him gently. Rune, smiling, reenters the illusion that is the world.

By the end of that week, he has given away all his furniture and stored his instruments and sterilizer in the godown of Salomon Halevi, the Jewish merchant and banker. Cochin now has many doctors, fresh graduates of the medical schools in Madras or Hyderabad, and it has an expanded public hospital system. He will miss his patients, but they’ll manage without him.

Two weeks later, without formal goodbyes, he heads to Bethel Ashram in Travancore. This monastic retreat was founded by a priest, BeeYay Achen, who is guided by the writings of Saint Basil on the pursuit of manual labor, silence, and prayer in order to become closer to the Creator. He was one of the first priests to get a BA, and no one knows him by any other name than BeeYay Achen. He encourages Rune by quiet example: service, prayer, and silence. After seven months, a leaner, almost unrecognizable Rune emerges like a butterfly from its chrysalis, sure of its destination, even if its flight is erratic. The beard, the joy, and the belly laugh are intact, but he is burning with a mystical sense of purpose. BeeYay blesses Rune when he leaves. “I believe God brought you here and revealed to you your life mission. But the important thing is you accepted. Remember, God didn’t speak just to Isaiah, but to everyone, when he said, ‘Whom shall I send? Who will go for us?’ Isaiah said, ‘Here I am. Send me!’ ”

Rune cajoles the enterprising boatman who supplies the monastery with fish, kerosene, candles, and other provisions to take him to his journey’s end. “Where? There? What! Why?” the boatman says, incredulous. “Did you forget something at that place?” When he realizes Rune is serious, he says, “Who knows if my boat can pass? Who knows if the canals are dry? Who knows if anything remains there anymore?”

The two of them set off at dawn into the backwaters, the white man dwarfing his dark companion. The canoe slides through a succession of canals whose sides are built with rock and mud. In the afternoon they cross a vast lake and pass into another narrow channel, which should lead to their destination. They call out to a toddy tapper aloft in a palm tree, who gives them final directions. “Go straight—don’t look left or right! In a furlong a canal will join. Cut in there. Then you’ll see ten or a hundred steps up.”

The “ten or a hundred steps” are fourteen, and so overgrown with moss that they nearly miss them. The boatman helps carry Rune’s sacks to a back gate that has rusted off its hinge, but he declines to go in further. “One more favor,” Rune says, counting out more notes than the boatman has seen at one time. “Sell me this boat.”

His first night alone is spent in the only one of the six crumbling redbrick buildings that has two intact walls and a sliver of thatch overhead. As the sun goes down, he sees a stone move—a snake was sunning itself there. Flat on his back, listening to the scurrying of mice, he looks up at the starscape and questions his sanity. The word “lazaretto” used to refer to a quarantine station where infectious patients could be isolated, but over time it came to mean a leprosy hospital. This lazaretto is tucked away on the furthest inland reach of the backwaters. It was built and abandoned by the Portuguese, rebuilt and abandoned by the Dutch, rebuilt again by a Scottish Protestant mission. The stigma of the unfortunates once housed here is so strong that in the decades since the last mission pulled out, no squatter has claimed the land.

The next morning, a stout staff in hand, Rune explores the large property. He charts the perimeter, explores each ruined building, sounds the well, and examines the intact but rusted front gate. Stepping outside, he finds a well-maintained gravel road that passes directly in front of the lazaretto; in one direction it leads back to the huts and houses of a small village whose canal side he traveled the previous day when they encountered the tapper. In the other direction the road runs as straight as a hair-parting through the vast dusty plain, before rising slightly, then abruptly snaking back and forth to become a ghat road, looking like a sinuous scar at the base of the ghostly, distant, mammoth, mist-shrouded mountains: the Western Ghats.

Rune’s spirits sink as he comes back into the compound and digests the task ahead. “Reality is always messy, Rune,” he says aloud. “Once you open the belly, it’s never as neat as the textbook suggested.”

Near the front gate, a flash of white catches his eye. Hidden by tall grass are the bleached bones of a human skeleton, strewn around by animals. The skull and pelvis are relatively intact, sutured to the ground by creepers. A woman, judging by the pelvis, and clearly a leper, based on the erosions over the cheekbones. He has a vision of her coming to this place, weak, perhaps feverish, hoping for relief and instead finding rubble. She lay down unattended, without food or water. She died. The shiny bones make him terribly sad. “This is a sign, isn’t it, Lord?”

That night he dreams of Sister Birgitta at the orphanage in Malmö, where he was raised. He used to feel sorry for her, dedicating her life to a place that he couldn’t wait to leave. Now he understands. In the dream Sister Birgitta is knitting, seated close to the lamp, which gets brighter and brighter, blinding his eyes.

He awakes to see two terrifying faces, inches from his, their features exaggerated by the candle flame held under their chins. He screams. They pull back, yelling. The two frightened shapes retreat to a corner. Rune lights his lamp. “I didn’t mean to scare you,” Rune says in Malayalam, compounding their shock.

“We thought you were dead,” says a man with a hole for a nose. His name is Sankar, and the woman’s is Bhava. They are returning from a temple festival. Such events are where they seek alms. “It’s a long walk here,” Sankar says, “but there are walls and a roof under which to sleep.”

“Just two walls and not much of a roof,” Rune says.

“Better than out in the open, where wild dogs come at us,” Bhava says, making a sibilant sound as she takes her next breath. Rune guesses that her larynx is riddled with leprous lesions. “People won’t even let us lean against a cattle shed.”

“You don’t have leprosy,” Sankar observes. “Why are you here?”

“The well is silted up,” Rune says. “We must fix that first. Then we will restore the rest, bit by bit.” He gestures at the untended land, the rubble heaps that once were buildings.

“You and who else?” Sankar inquires.

Rune points up to the star-blazing sky.

The next morning, the two lepers wish Rune well and shuffle away in the cool of dawn. The battered tin vessels dangling from their necks that are to hold food or coins are filled with the coffee Rune brewed for them.

An hour later, as Rune stacks usable bricks from the rubble, he sees them hobbling back.

“We decided you could use help,” Sankar says. He shows Rune his hands and laughs. “I used to be a carpenter.” He is short two fingers on the right and the rest are clawed. The flesh of the palm is wasted, giving the hand a simian appearance. The left has all its fingers, but the index and middle stick out in a gesture of papal benediction. Still, he scoops up and squeezes a brick to his body. Bhava, whose hands are in only slightly better shape, does the same. These two, Rune realizes, are angels sent his way. Thus the heavens and the earth were completed in all their vast array.

That evening, Rune cooks rice and lentils for them and hears their tales. Sankar was a new father when he noticed a welt on his face, then more over the ensuing months. His hands turned numb. “I couldn’t hold my carpenter’s pencil. My wife’s brother threw me out. The whole village threw stones at me. My wife watched.” The emotion in Sankar’s voice belies his face, frozen forever into a snarl. Bhava’s face became gradually thickened, unnaturally smooth, and she lost her eyebrows. Her husband made her stay indoors. “ ‘Even the dogs run away from you,’ my husband said. Aah, but it didn’t stop him climbing on me at night. ‘You’re still pretty in the dark,’ he said.” When her fingers curled to her palm, her husband chased her out before she could say goodbye to her children. She cackles at this memory, a solitary tooth flashing in her mouth like a lone tree in a cemetery. Sankar joins in.

Rune puzzles over their strange laughter. The mind must get scarred from being rejected in this manner. These two have died to their loved ones and to society, and that wound is greater than the collapsing nose, the hideous face, or the loss of fingers. Leprosy deadens the nerves and is therefore painless; the real wound of leprosy, and the only pain they feel, is that of exile.

That’s the purpose of a lazaretto, Rune thinks. A home at the end of the world. A place where the dead can live with their own kind and where the spirit might rise. He stares at his blistered hands. The thumb alone would prove the existence of God. A working hand is a miracle; his are capable of removing a kidney or stacking bricks. Lord, what if I lose my use of them? Rune was taught that leprosy is rarely contagious. The causative bacterium lives in the environment, more so in unclean settings, but only those with unique susceptibility get the disease. He recalls Professor Mehr in Malmö dressing leprous wounds with impunity, saying, “Worry about other diseases you might get from your patients, not leprosy.” Indeed, Rune lost one classmate to tuberculosis, and another to sepsis from a scalpel cut. In his head Rune now debates Professor Mehr. What about Father Damien, serving all those years with lepers on Molokai? He caught it and died from it! He imagines Mehr’s response: But think of Sister Marianne, who nursed Father Damien. Think of all the other nuns who served on Molokai—they were fine. Rune decides he will simply not worry about contagion. Lean not on your own understanding. Let God worry.

In a month, there is a signboard in two languages on the gate: SAINT BRIDGET’S LEPROSARIUM. The name honors his beloved Sister Birgitta of his Malmö orphanage. It happens to be the name of Sweden’s patron saint, and perhaps it will help in getting support from a Swedish mission. They restore two buildings and desilt the well. Rune buys provisions from the Mudalali’s store in the village. Mathachen, the toddy tapper who gave his boatman directions, is an efficient middleman, dropping off other purchases—thatch, lumber, tools, coir—outside the front gate or on the steps on the canal side. If the villagers have qualms about Rune’s work, they have no objections to his money. He soon has a bicycle in addition to the boat. ­Thambi, Esau, Mohan, Rahel, Ahmed, Nambiar, Nair, and Pathros join his two angels. Like a teak forest with underground roots, the lepers have a network; word of the lazaretto’s resurrection travels fast.

Half a mile down the road from Saint Bridget’s is a walled property where a traditional thatch house with carved gables and wooden walls has been tastefully fused onto a larger, modern house with whitewashed walls, a red tile roof, tall windows, a broad wrap-around verandah, a porte cochere extending well out from the front entrance with a car sitting under it, and a brick-lined gravel driveway. The inset on the stone pillar of the gate reads THETANATT—the house name—and below that, the owner’s name, T. CHANDY. Once, when riding past on his bicycle, Rune caught a glimpse of a heavy-lidded man smoking on a verandah bench-swing, a gold watch on his wrist. On another occasion he saw him drive past Saint Bridget’s gates, a woman at his side, just as Rune emerged. Rune waved, and the couple smiled and waved back. Each time he rode past the house, he wanted to drop in, but for the first time in his career, his kind of doctoring could make people uneasy. Mathachen, the tapper, tells him that Chandy had been a contractor for the British Army in Aden—“minting money.” When he returned, Chandy purchased an estate of several thousand acres up in the distant mountains that Rune can see from Saint Bridget’s. During the week, Chandy stays up in the estate bungalow, overseeing the planting and harvesting; on weekends he drives back down, a three-hour journey, to his ancestral home, where his wife and her aging mother live.

Three months after Rune’s arrival at the lazaretto, there is a commotion at the gate—someone yelling, “Doctor-ay! Doctor-ay!” The agitated servant from the Thetanatt house stands ten feet from the gate with a message: Chandy’s wife begs him to come at once because Mr. Chandy has collapsed. Rune races over on his bicycle. On the verandah, a pair of men’s slippers sits askew. Smoke curls lazily from an ashtray beside a tin of State Express 555s. From inside, he hears the clattering of furniture. He sees Chandy thrashing on the floor, his mundu askew, his large feet kicking. The terrified wife leans over the prone figure. She’s in a sari, with glittering earrings and bangles on both hands—the couple looks dressed to go out.

Rune kneels, checking Chandy’s airway and feeling his pulse, which is strong and bounding. “What happened? Tell me.”

“Thank you, Doctor,” the tearful woman says in English. “He was behaving different today. He wouldn’t permit me to take him to hospital. Then just now he gave a cry, then he fell like that on the floor. Then he was stiff—very stiff—and unconscious. Driver is not here. I didn’t know what to do. I sent our boy to you. Just now he started shaking, shaking.”

Out of the corner of his eye, Rune sees an old woman in chatta and mundu, and enormous gold spikes in her ears, looking pale, her hands bloodless as she stands gripping the doorframe, her lower lip trembling. He calls out to her in Malayalam. “Ammachi, don’t be afraid, it’s just a fit and he’ll recover momentarily.” Even as he speaks, the thrashing subsides. “But I want you to sit down because if you faint it won’t help.” She obeys.

Rune registers Chandy’s swollen parotid glands, his red palms, his womanly chest, and the burst of new blood vessels on chest and cheeks. He has a feeling that Chandy has spilled more liquor than most men will ever drink. An ammoniacal odor of urine precedes the yellow stain that blossoms on the pristine white mundu.

“Has this happened before?” he asks.

“Never! He was as usual when he came back from the estate last night. Tired from driving from our estate.” She has switched to Malayalam.

“No, he wasn’t as usual,” the old lady says, finding her voice. “It was like an ant was biting him. Aah, fighting with everyone.” The embarrassed wife glares at her but she holds her ground. “Molay, it’s the truth and doctor must know.”

“He always gets irritable at the start of Lent,” the wife acknowledges.

“Ah,” Rune says. “He gives up his whisky for forty days?”

“Fifty days. Yes. Gives up his brandy. He does it for me,” she says, shyly. “He took a vow, the first year after we married.”

Lent began the previous day. Chandy’s sudden abstention probably precipitated a “rum fit,” an alcohol-withdrawal seizure. Rune stands. “Don’t worry.” Chandy is breathing noisily but regularly. “He’ll wake up shortly, but he will be very confused. I’ll be back right away with medicine.”

Mathachen, the tapper, also brews illicit arrack—not the anise-flavored arak of North Africa that Rune knows, but a tasteless distillate that Rune uses as an antiseptic. Back at Saint Bridget’s, Rune compounds a tincture of opium, arrack, lemon, and sugar into an apothecary bottle and heads back.

Chandy is on the floor, but awake, a pillow under his head, the soiled mundu replaced. He’s confused, but like a child he obediently swallows the medicine.

“Give him a tablespoon four more times before midnight,” Rune says to Leelamma—that is Mrs. Chandy’s name. “Tomorrow, three times a day. Then the day after, two times a day, and then once a day. I wrote it down.”

He calls again in the evening, by which time Chandy has come to his senses, though he is sleepy. Rune tells them that in the future, Chandy will need to taper his brandy consumption heading into Ash Wednesday.

A week later, a car honks at the gate. Chandy drives in. Other than Rune himself, he is the first non-leper to enter the property in Rune’s time there. Chandy, now that he is upright and recovered, proves to be a stocky man with a barrel chest and powerful forearms, and carrying excess weight around his waist. He is the rare Malayali without a mustache, his hair parted in the middle and slicked back. In his yellow silk juba and off-white mundu, he looks like a man at ease anywhere, even Saint Bridget’s. His gratitude takes the form of a bottle of Johnnie Walker whisky. He says, “We would be honored if you join us on Easter Sunday for a late lunch. We’d invite you sooner, but Leelamma doesn’t want to serve you rice and green beans. And I’d like to be able to offer you a drink.” Rune accepts.

Chandy’s gaze takes in what he sees with interest; he is unruffled by the curious residents who emerge. Rune offers a tour and Chandy readily accepts. They walk through the buildings that are being restored. Rune had hoped to reuse wooden beams from one of the old buildings, but Sankar thinks there’s termite damage. Chandy squats to carefully examine the beam, then says, “I agree with your man. Termites and also flood damage. See how the color is different halfway up?” Chandy is knowledgeable about concrete and varieties of roof tile. In the fields, Chandy stoops down several times to gather soil and crumble it in his fingers. “I hope one day we can make the place self-sufficient,” Rune says. Chandy makes no comment, but a few days later he’s back with his driver in a car whose back seats have been removed; it also has a platform welded to the rear. The driver unloads pots of mango, plum, and plantain seedlings, as well as gunnysacks of bone and manure mix. Chandy unfolds a hand-drawn schematic of the grounds, on which he has marked his recommendations for the best spot to clear for an orchard. A low-lying, damper area near the canal is ideal for plantain. “This fertilizer, by the way, is for your existing coconut and date palms. Doesn’t look like anyone has done that for years. This land in between these coconut palms keep free for grazing; it will support two cows. A chicken coop would be good too.”

Easter at the Thetanatt house marks the beginning of a lasting friendship. Rune becomes a regular dinner guest at the Thetanatt home on Sundays, enjoying Leelamma’s lavish spreads and Chandy’s brandy. In summer, when the heat is oppressive, the family decamps to the estate bungalow for two months. They invite Rune to visit the mountains and stay with them in the bungalow some weekends.

Salomon Halevi ships Rune his stored surgical instruments, and now he has a clinic and a rudimentary theater. He can do more than dress wounds and drain abscesses. He operates selectively on hands, trying to preserve function or to restore it by releasing contractures. To raise money, Rune writes many letters. The Paradesi Jews fund the brick kiln, while a Lutheran mission in Malmö pays for the sawmill and a small carpentry workshop. At Christmas, the same Lutheran mission commits to an annuity for the leprosarium; Rune’s chatty letters in Swedish are printed in their newsletter. Mr. Shaw, whose wife Eleanor was Rune’s patient, arranges the gift of two dairy cows and a stack of lumber.

Fifty years after Armauer Hansen discovered, under the microscope, the rodlike bacilli in the tissue of lepers—mycobacterium leprae—there is still no medicine to cure leprosy. Rune provides a home and meaningful work, but he’s frustrated that he can do little to prevent the progressive damage to the hands and feet. The day after they open the sawmill, he discovers a severed finger in the shavings. The owner, still working, doesn’t notice the missing digit until Rune points out the bleeding stump. That leads Rune to hold a weekly catechism on preventing injuries. He pairs the residents off for daily inspections of their partners’ hands and feet; he dresses fresh injuries. He is quick to put a finger or a foot into a cast to prevent further damage and to allow the wound to heal. Every tool at Saint Bridget’s carries a padded strap, to make up for fingers that can’t grip, and to protect the skin. Buckets and wheelbarrows have harnesses that go around the neck.

In the lazaretto’s first year, a grinning newcomer walks in, blissfully unaware that his ankle is grotesquely dislocated, with bone sticking through skin. Anyone but a leper would be shrieking in pain, while this garrulous fellow is proud to have walked all day to the new lazaretto. Rune has noted in his residents this same perverse pride: their “advantage” over those who rejected them is that they can walk forever; and they can also stand like statues for hours, having no need to shift weight from one foot to the other because they have no discomfort. The cumulative trauma of walking on injured feet, and of prolonged standing, inflames, stretches, and ultimately ruptures the ligaments that hold the bones of the foot together. When the talus—the saddle-shaped bone under the tibia that transfers body weight to the heel—finally collapses, the arch of the foot becomes as flat as an appam, then convex, like the bottom of a rocking chair. The body weight is no longer spread over the entire foot but concentrated on one spot, and a pressure-ulcer results. If neglected, the ulcer grows and turns gangrenous, forcing Rune to amputate. But it never hurts.