The Covenant of Water

1971, Madras

She has no hope of seeing Lenin again unless it’s in prison or a morgue, and still her feelings for him grow. She must hide her feelings, brine them away like the preserves under the ara. But ghosts abound in such places, and what’s bottled can erupt.

In the second week of her posting in L&D—Labour and ­Delivery—she awakes feeling nausea. It recurs on successive mornings. She struggles to bathe, dress, and climb into Gopal’s rickshaw. He eyes her with concern. He’s perceptive, but discreet, and he won’t speak unless she breaks the silence. She’s hired him for the month to take her to Gosha Hospital and bring her back each evening.

Gosha is two miles from the hostel, just off Marina Beach. The only morning sounds are the squeak of the pedals, the squawk of seagulls, and the murmur of waves. At this hour it’s cool. Soon, the sun will be a flame-white disc glaring off the water, and the macadam road will be hot enough to fry an egg. Gopal turns at the Madras Ice House. At one time, giant bars of ice from the Great Lakes were packed in sawdust, brought by American ships, and stored here to provide the British relief from the heat. The salt air carries scents of dried fish. It tests her stomach. In the distance, fishermen who set out in the dark now return. Their bobbing matchstick heads and the synchronous flash of wooden oars remind her of an upended insect thrashing in the water.

On the beach of a faraway land, she imagines waves keeping the exact same rhythm, sounding the same rustle and pop as they withdraw. In a place that’s a mirror image of this one, another Mariamma lives, but free of this terrible apprehension. That other Mariamma is married to a Lenin who isn’t a Naxalite; that doting Lenin will have tea ready for Mariamma when she returns from L&D. In her room in the hostel, she still has Lenin’s Guide to the Skies that he forgot at Parambil. Now it sits with the precious 1920s Gray’s Anatomy that was her mother’s, an edition that isn’t for studying but for treasuring. The books are her talismans, her good luck charms. But if this is what good luck feels like, then she’d hate to experience bad luck.

Her pulse rises at the sight of the bougainvillea bursting over the limestone walls of Gosha. The blossoms are placental red. Not a soul waters these plants; she believes their roots feed on a distillate from the drains of L&D, an aqua vitae richer than water and cow dung. The smiling Gurkha at the gate salutes—she’s never seen him frown. The fading plaque reads THE ROYAL VICTORIA HOSPITAL FOR CASTE AND GOSHA WOMEN 1885. But it has always been “Gosha Hospital” to one and all, “gosha” being synonymous with “burqa” or “purdah.” The British built it for high-caste Hindu women (who would not enter a hospital with untouchables) and for the Muslim women of neighboring Triplicane, who are sequestered indoors and when they emerge are covered from head to foot. She’s heard stories of Muslim women in obstructed labor who barricaded themselves in their bedrooms to prevent their husbands from taking them to a hospital where a white male obstetrician might touch them. Death was preferable. Times have changed. Obstetrics is no longer an all-male specialty in India. Mariamma’s male classmates rotating through L&D complain they feel like pariahs because women rule. Luck has Mariamma posted at Gosha instead of Maternity Hospital in Egmore, a blessing because only Gosha can claim Staff Nurse Akila.

Outside L&D, a pale, pregnant woman paces, supported by her mother and husband. Her swollen belly exaggerates her lumbar curve as she waddles. Her contractions aren’t frequent enough, so she’s been ordered to walk. Mariamma sees this sight every morning and sometimes she imagines it’s the same groaning woman in the same coarse white hospital sari and the absurd full-sleeved blouse. This British modification of the Victorian jacket and bodice is ill-suited for stifling heat. Now that the colonizers are long gone, why continue to wear this uniform? The woman looks right through Mariamma; the only thing on her mind is getting the baby out. “Better out than in” is the rule Staff Akila preaches. The Five-F Rule: “Flatus, Fluid, Feces, Foreign Body, and Fetus are all better out than in.”

Lord, will that be me in eight months? My symptoms are unmistakable. She can confide in no one, not even her roommate, Anita.

Passing through the swinging doors of L&D, she enters a furnace; the ripe, sweetish scent smacks her in the face like a steaming wet rag. This morning, one woman’s screams and curses have dominion over all the others; her husband is spared hearing her abuse because he’s seated with others of the male tribe in the shade of the rain tree in the courtyard. The woman’s rant is cut short by a smack like a rifle volley, followed by a nurse’s shrill voice saying, “Stop it, woman! You should have cursed him nine months ago. Why bother now? Mukku, mukku!” Push, push! “Mukku” is the magic word, the “open sesame” of L&D, the chant on the staff’s tongues all day and night. Mukku!

The daily tide of babies gives the medical students abundant experience—Mariamma reached her required twenty normal deliveries in the first four days. “Normal” labor is of no interest to the “PGs,” the postgraduate trainees in obstetrics who slouch in colorful saris around the chipped wooden desk, overcoming their inertia only when things are not normal.

At the white pulpit, Senior Staff Nurse Akila, a short, dark, trim woman with angular features, is unruffled, writing up the medication indent, her face smoothed with powder. Her winged cap stands out against shiny black hair. Over her white uniform is a robin’s-egg-blue, ironed apron, so stiff with starch that it can deflect bullets. Her tongue can scald anyone whose work she thinks sloppy, but she’s a loving, nurturing soul. For Mariamma, she somehow evokes Big Ammachi, though they couldn’t have been more different. The prayers to Parvati, Allah, and Jesus; the screams bouncing off tiled walls and rattling frosted windows; the miasma of blood, urine, and amniotic fluid vaporizing off sticky floors, permeating nostrils, sari, skin, hair, and brain; the labor pallets along each wall; the lime-green curtains that are always tied back, making the most private experience communal—what would her grandmother make of all this? Big Ammachi was strong and would have handled it. As for Mariamma, she simply loves it!

The L&D chalkboard resembles the board in Central Station, but with notations such as “G3P2 PROM” (third gravida, or pregnancy; second para, or live birth; and premature rupture of membranes). Mariamma approaches from behind Akila, but Staff has eyes in the back of her cap. “Listen up, ladies!” Staff shouts. “Doctor Mariamma’s here! Don’t hold back anymore, all right? MUKKU-MUKKU!” Akila hoots at her own joke. No one pays any attention except Mariamma, who thrills to hear “Doctor” before her name.

“Hello, Staff,” Mariamma says, placing a length of jasmine on the pulpit. Mariamma patronizes an old woman near the hostel who spends her days attaching buds to a yarn, tying lightning-quick two-finger knots that would shame any surgeon. Her face and body are covered with disfiguring bumps under the skin, some the size of marbles, others the size of plums. The condition is called neurofibromatosis, or von Recklinghausen’s disease; the benign fibrous tumors grow off cutaneous nerves below the skin. The famous Elephant Man, Joseph Merrick, was thought to have had a variant of neurofibromatosis.

“Ayo! Who has time for jasmine here?” Staff says, bringing it to her nose. But she’s grinning. “Go check on three. She’s a forceps I’m saving for you only.” Then she yells, “LISTEN, EVERYONE! WE’LL BE BUSY TODAY. I’M FEELING IT IN MY BONES.” There’s never been a day that hasn’t been busy, or that Staff hasn’t felt it in her bones.

The Malayali woman on pallet three has an orange mackintosh sheet underneath her buttocks and hanging over the edge. The sheet has a permanent gentian-violet stain from the innumerable women who’ve preceded her. When Mariamma spreads her gloved index and middle finger in a V inside the birth canal her fingers barely touch the sides of the cervix: the woman is fully dilated. The chalkboard says she has been in labor for seven hours, yet the baby’s head hasn’t budged past the pelvic floor. Mariamma applies the funnel-­like stethoscope—the fetoscope—to the distended belly. Even with pin-drop silence, it’s hard to hear the fetus. Akila says she must “imagine the baby’s heart” to hear it separate from the mother’s. Imagine! Suddenly she hears it, sounding like a woodpecker with a dull beak. Less than eighty is cause for alarm—this baby comes in at sixty. Now Mariamma’s heart is racing.

“Staff!” she calls out, but Akila has already sent over the trolley. The forceps, fresh out of the sterilizer, have steam rising off them. The strings of the plastic apron Mariamma grabs are still wet from the previous user. She numbs the vulval skin with novocaine to one side of the midline and cuts. Tiny, pulsating gushes of blood follow the track of the angled episiotomy scissors. She’s only used forceps once before. The paired forceps are like curved serving spoons with long, slim handles; when the spoons (or “blades”) are positioned correctly, cupping the baby’s head, the handles can be brought together and locked. But by the time one needs forceps, the baby’s head is a soggy, swollen affair, with the landmarks hard to find. Using her index and middle fingers as a guide, she slides the left blade in and over the baby’s head, then does the same on the right. She prays they’re gripping skull, not squishing the face. But try as she might, she can’t get the two handles to come together. To force it might crush the skull. Just when she despairs, the hand of the Goddess Akila appears over her shoulder, makes a small adjustment to one blade, and now the handles articulate and lock. Staff disappears.

But the traction rod Mariamma tries to affix to the handle doesn’t match! She should have checked before she started. Once again, Goddess Akila’s hand reaches over Mariamma’s shoulder and completes the assembly despite the mismatch. Mariamma plants her feet on the floor, ready to heave. Akila positions the probationer behind Mariamma just in case she falls back when the head delivers. Mariamma tugs with the next contraction. “Ayo, you call that pulling, Doctor?” Akila shouts from the other side of the room without looking. “The baby will drag you back inside, slippers and all, if you can’t do better.” Mariamma squats and gives it everything she has. The baby’s head has run aground on the promontory of the sacrum. “Staff!” she cries through gritted teeth. “It’ll be fine, ma,” Akila shouts from the pulpit, then yells at someone else: “Doctor, by the time you finish sewing up episiotomy, the baby will be walking only!”

And it is fine, because suddenly the head emerges. But for the backstop of the probationer, Mariamma and the baby would be sprawled on the wet floor. The limp blue creature suffers the indignity of an egg-shaped head thanks to the forceps. She frantically works the bulb of the mucus sucker in the mouth to no avail. She blows gently into the face. Nothing. The mother looks on with horror. One of Goddess Akila’s ten hands reaches over and slaps the baby’s bottom, and with a jerk it lets out a shrill cry. “Better, ma?” Akila says, grinning cheekily, the Feels-Better-Out-Than-In implied but not spoken. Mariamma is so happy she feels like bawling. The tiny fists are raised in the air . . . She thinks suddenly of Lenin and tears threaten. “Hello, Mariamma Madam!” Staff yells, now from near the autoclave. “If you won’t cut the cord, kindly give the scissors to the baby. Stop daydreaming!” All-seeing Akila can even read minds. Mariamma cuts the cord and sets to work repairing the episiotomy. As soon as I’m done today, I’ll confess to Akila. I’ll tell her all. I can’t bear this alone.

Hours later, at the end of their shift, she asks Akila if she can walk out with her. Hesitantly, she spills her secret. Akila bursts out laughing.

“Ma, every medical student who comes through L&D thinks they’re pregnant. Even some foolish boys! Pseudocyesis, it’s called. But I say to them, how can you be a virgin and be pregnant?” Akila cracks up again.

“Staff . . . ? I’m not a virgin,” Mariamma says quietly.

Akila regards her with new interest. She takes Mariamma’s chin and turns her face one way and then the other. “Ma, I’m working L&D before you born. Akila is knowing when a woman is pregnant. I’m knowing before God is knowing, before mother is knowing. Husbands are idiots, knowing nothing, so forget about husbands. But never is Akila wrong. Body is telling me. Cheeks, color, ithu-athu. I’m promising you’re not pregnant. Do you believe me? Of course not! So, we’ll do test, but only so you are not worrying, understood?”

In the blood bank, Akila draws the specimen herself. “I’ll give to lab using some other name. But it will be normal, ma. Pregnancy in head, not in uterus.” She stops for emphasis. “This time. Next time could be uterus. So, use head next time.”