by Inderjeet Mani
If there is anything to be admired in the sorry tale of man’s existence, it is his triumph over circumstance. Maman instilled in me the need to make something of myself, to flourish no matter what. How proud she would have been to see me today, a successful doctor invested in humanitarian work, devoted to a cure for cancer, while still keeping up the hobbies that have captivated me since childhood.
Poor Maman! When Father called to say she had fallen sick with severe stomach pains, I was a student in England. I flew to Pondicherry, where I found Father pressing gently on Maman’s stomach, which seemed hard and bloated above her normally roly-poly belly button. She had a thin and jaundiced look and soon after she kissed me, she vomited.
Father spoke to me on the verandah. It had been years since we had last met, and he was even more stiff and formal than usual. I kept my distance, standing two yards away from him.
A pancreatic adenocarcinoma, he said, looking out at our toddy palms whose fronds were now frayed and weather-beaten.
How did you find out? I tried to keep my voice steady, hoping that the cancer hadn’t spread.
I did the needle aspiration myself.
He had obtained a biopsy by sticking a needle into her skin down to the pancreas. I wished I could have done that, but I knew Father was a stickler for rules. I was no stranger to medical procedures, having recently spent long days – and nights – in the dissection room at Addenbrooke’s Hospital in Cambridge. But Father wouldn’t let me help until I completed my medical degree.
Was it her pack a day of Gold Flake? Or staying indoors for two decades?
Hard to say. He shrugged, his thin lips forming into a frown. One can’t discount genetic factors. But then your Maman never talked about her family.
Didn’t Uma have a fatty liver? I remembered all the details of my sister’s illness and death.
He became annoyed at the mention of her name. Steatosis is not a characteristic of pancreatic cancer. Is this what they teach you at Cambridge? Your sister’s fatty liver was a side-effect of her chemotherapy.
So what’s to be done? It was great to see him riled up.
He shrugged. I’ll have to Whipple her.
Is she strong enough for major surgery?
He smiled. Don’t worry, son. Her heart and lungs are in terrific shape.
You’ll do it here?
Of course. Bombay is out. And can you stop that whining? It’s damned irritating.
Father was strict but he was all for education. And the Aurobindo Hospital where Maman was admitted for her operation exemplified Indian medical practice. The walls of the general wards were a dull green, spattered with mould, with the windows kept wide open in the absence of air conditioning or fans. I could barely hear Maman above the moans and shrieks of patients, some of whom were doubled in beds, head-to-feet. The sheets were heavily stained and had cigarette burn marks, and the floor was a mess of spilled liquids and strands of hair. The sweepers mopped at it half-heartedly with a mixture of phenyl and soiled water, ignoring the protests of squatting relatives. The nurses sat in a corner, swatting flies, standing up whenever a doctor approached.
Father gave them a dirty look and wheeled Maman into the operating theatre, which had a backup generator but no air conditioning. A refuge though it was from the hellish conditions outside, Maman kept pleading for mercy until she went under.
I have to say it was a tremendous pleasure to see Father at work. I kept my eyes glued to his enormous and steady fingers as he snipped open a triangular patch above Maman’s navel and exposed the peritoneal cavity. In those days, before CT scans and MRIs had reached India, the surgeon had to rely on his hands to determine the extent to which the cancer had metastasised to neighbouring regions. Father began to palpate the organs, first gently touching, then pressing more firmly. The tissue within was pink and raw like chicken flesh, with strips of pale yellow fatty tissue, except for the chocolate slab of her liver in the upper portion of the cavity. Maman’s colon with its stubbled segments jiggled like a long tentacle in Father’s gloved fingers.
The surgical resident was now lightly cutting tissues, parting thin curtains of skin. He was careful not to nick any blood vessels and steered clear of the vena cava.
Metzenbaums please. A nurse rushed to fetch scissors on a tray.
Father cut the bridge between the colon and stomach, moving the colon from the upper part of the abdomen to the lower, a first step towards exposing the duodenum and the head of the pancreas.
The intestinal lining is remarkable, Father said, pointing to the white and cheesy mucosa. Did you know that it is replaced every two to three days?
Is that right? I said, feigning ignorance.
Single five-o. He was anchoring the lining.
Her gall bladder soon appeared, distended like a purple pear, no doubt due to a tumour having blocked her bile duct.
It was a four-hour operation, and Father worked like a calligrapher, his strokes precise, clean and focused as he cut, divided and stapled. He tucked the gall bladder to one side, while leaving it connected to the duct. Then he carved out a smooth tunnel from the portal vein to the pancreas.
Debakeys. The nurse was clueless, and Father’s eyes started to enlarge.
I said Debakeys, stupid motherchoad!
I went and fetched the forceps myself. I was terrified that he might attack the nurse, armed as he was with sharp surgical instruments. I knew only too well how dangerous they could be, for I had often nicked myself as a child, playing with teasing needles, forceps and T-pins while exploring frogs, birds, and several little mammals in the privacy of my bedroom. Then, at ten, I had my first serious accident, during our afternoon siesta. I was restless as usual, and tiptoeing to the keyhole of Maman’s door, I spotted her with her legs wrapped around the waist of a Southern businessman, his black buttocks clasped by her long fingernails. I still remember that scent of incense, coiling in the pale light that came through the curtains! The visitor was pulling her by the shoulder, forcing her to turn, and now the globes of her posterior came into view, and then they were locked together, their skin glistening, the jambs of arms and legs jumbled in cubist frenzy, and then she turned again, her hair flung on the pillow, her fair legs parted. I felt like clapping as I caught a glimpse of what I had so often attempted to touch, pretending to fumble for her hand when I was huddled next to her in bed. Returning to my room, I prodded at a frog cloaca, and as my attention drifted off, dreaming of Maman, the scalpel slipped, slicing a chunk off my left pinky. The searing pain and subsequent deformity only strengthened my resolve to become a surgeon like my father.
Two-o ties please. Father was ligating a blood vessel near the stomach. When he was done, Father pushed the stomach out of the way to the upper abdomen. He separated the splenic and portal veins from the pancreas before cutting into the latter.
Suction. The nurse’s hand trembled as she mopped up a rush of yellowish-brown juice.
Everything that needed to be removed was now in the right upper quadrant of the abdomen.
Good news. There’s no indication of spread to liver or critical areas.
When he was done with his cutting, Father slid out the extracted organs in one nice connected piece, like pipes fitting together. The head of the pancreas and the duodenum made a beautiful pair, like a purple sausage curled on a testicle. And sitting on top were the gall bladder and common bile duct, as well as a packet of lymph nodes.
Feel it, Father said. Don’t be afraid, son.
I took the lump in my hands and pressed her pancreas, feeling a walnut-sized cancerous mass that rolled like a marble under my fingers. After a last look at the organs, I handed them off to a nurse.
Saline, please irrigate.
In surgery, coming down from the mountain is as important as reaching the top. After a cleanup, Father pointed out to me where the three organs would be connected back up to the intestines: the edge of the pancreas, the common bile duct, and then the stomach. Father was sweating in the mellow light as he went on carefully threading and looping, a master tailor methodically stitching and knotting, weaving Maman back. Cut well, sew well, and usually the patient gets well.
He summoned me as he was scrubbing off.
Son, may I ask something of you?
Yes? I was full of admiration for his skill, though not for him.
Will you be able to stay with your Maman? I’ve got my hands full in Bombay.
Yes, but only for a fortnight. I had exams coming up.
That last week in the hospital went by in a blur. While the nurses dozed and Maman slept, I managed to explore the adjoining room, where I had spotted attendants going in the middle of the night. It was dingy, but my flashlight soon illuminated the gleam of metal buckets, filled with ice.
Grabbing a plastic mug, I started transferring the ice out of one. A face appeared. Flat, and round, with short dark hair. I opened an eye and shining the light close, saw a yellowed iris banded by tache noir.
I scraped the ice away, clawing at it till I could reveal the entire specimen, clad in blue denims and a pink blouse. I noticed, as I lifted her up, how she sagged a bit, for she was on the plump side. I propped her up on my shoulder to get a better look, and then dragged her to floor, carefully positioning the flashlight. I lifted her arms up, stretching the elbows out as rigor was setting in, and, though she would no doubt have protested vigorously had she been alive, slid the blouse off her chest and up over her head. My fingers were tripping up on each other as I unclasped her bra and pulled it off, revealing some dampness on her chest and the smell of sweat, and then those prizes to feast the eyes on, her plump breasts bouncing and jiggling with every touch – though the left breast fell oddly flat – and with firm, dark nipples that reminded me sadly of my childhood, of my sister Uma and those muscadine grapes that I used to roll softly under my tongue.
When she returned home, Maman was looking forward to getting back to her old diet and even asked me to light a cigarette for her. Our old cook Raman was long dead, and his replacement was already showing signs of senile dementia. I took care of Maman's needs, assisted by an unkempt home nurse with greasy fingernails. When she gave Maman her morning shower, I insisted on doing the sponging around her incision myself.
Then India got back to Maman in the form of a UTI.
All the operating equipment had been sterilised, but the hospital nurse who replaced her catheter may not have put on a pair of fresh gloves and I doubt very much if the furniture in her private ward was adequately sanitised. The UTI turned into sepsis, and while we managed to pump fluids and antibiotics into her at home, her kidneys started shutting down. I could have taken her to hospital again for dialysis, but that would involve sailing back into a sea of infection. She was throwing up each time she was fed, so I suggested a nasogastric tube. Father, who was on the phone daily, agreed, and a doctor came home and threaded it through her nose down the oesophagus directly into her stomach.
Maman wept as the tube went in, and blood sprinkled from her nostrils. She started wheezing and gagged a few times, and I could tell that she wanted to scream but couldn’t because of the tube. I was in charge of her nutrition, and instead of continuous feeding, I adjusted the valve so that gavage was performed thrice a day, allowing a warm mash of her favourite comfort food to drop down. I had prepared bor bor, a bland Cambodian congee made of soupy rice, lemongrass, garlic and fish sauce that she had loved while growing up and which continued to be a popular staple, minus most of those ingredients during the Khmer Rouge era. But within a few days, Maman’s kidneys got the better of her and her electrolytes went out of whack. She became confused, short of breath and experienced severe atrial fibrillation, and her condition deteriorated rapidly. She started to gabble about her mother, whom we had not heard from since 1975. Then she called out for Montha, her fellow singer and lover who had been executed, and whose name I inherited.
Attachment to people, I have noticed, survives the dissolution of the mind. She would shout for Montha in her feeble voice for hours on end, so I dressed up in a two-piece suit with a bow-tie and sang Montha’s one major hit, the mournful Khmer ballad ‘Violon Sneha’. Montha was by now little more than a few stray fingers and a skull chip or two lurking in the soil of a killing field, and I had a great time pretending that his bones had been glued back together and were playing an air violin with that over-sentimental portamento that would have had the Khmer audience swooning. It was all for a laugh, but Maman fell for it, dazed, clutching onto the IV tube as she listened with her mouth half-open.
On her last morning, I was surprised to hear her speak clearly, saying that she had found her mother in Battambang. I said yes, Maman, you will meet her there. But now she wanted her other friends to be at the gathering. Where are they, Pierre darling? Where are Montha and Vann? And my lovely Champei? I said they were probably taken by the KR, like everyone else, but that I would find out what happened. She squeezed my hand with her last ebb of strength. Promise, kaun proh.
Her tongue lolled after she said that, its surface mottled with brown patches. Her fingertips were by then rotten and black, with deep pus-filled ridges marking the boundary with healthier skin. She belched, then uttered a pitiful groan, which soon turned into a growl, growing louder, her acetone breath crackling and reptilian, then hoarse and rasping, going on for ten long minutes, at the end of which she shrieked. I put my fingers to my ears, but she carried on with the screaming, until at last her chest jerked up in spasm, her thighs twitching twice. Her fingers were pointing to me, her mouth open in alarm, the pupils aghast as she left us.
I remember precisely the moment when I got Maman’s DNA on file. I did a cheek swab to get a decent quantity of saliva, which she obligingly provided. It wasn’t comfortable for her to have to spit into a test-tube. She was getting prepped for her cremation, and I had only a few minutes alone with her.
When I got home to Rue Romain Rolland after the ceremony, which featured the usual breast-beating and lamentation by expert mourners, not to mention Father’s crocodile tears, I added a little detergent to break open her spit cells, and followed it up with a couple of drops of meat tenderiser, allowing the protease to separate out the proteins. Then I sprinkled in table salt to get it all to clump together. After adding a shot of vodka, I spun it around a couple of times till I got the snotty strands of DNA collecting in the bottom, their coils of chromatin glistening like sperm. I took a few sips, then transferred the sample into a tube, carefully marking her details on the label. I put it away in my old bedroom, next to the mouldering squirrel skulls and the jar of glycerine in which swam that other trophy of Maman’s that I had managed to snip off, those tantalising lower lips surrounded by their strands of waving hair.
Inderjeet Mani’s books include The Imagined Moment, a work on time and narrative theory. His stories have been published in Short Fiction, Storgy, Eclectica, New World Writing, 3:AM Magazine, Apple Valley Review, Drunken Boat, Slow Trains, Nimrod, WIND, Word Riot, Asia Writes, Plum Ruby Review, and other venues. Website: tinyurl.com/inderjeetmani
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