Medical College, Gwalior.
The bad trip. Some years before everything else.
The Man in Bed Seven
The man in bed seven had been at GCS 3 to 4 for three days.
On the Glasgow Coma Scale, 3 is the floor. Eyes do not open. No verbal response. Motor response at its most primitive — the body present and the person who inhabited the body elsewhere, or nowhere, or somewhere without an address. For three days the residents had checked the pupils with their torches and written unchanged in the notes, which is the handwriting of doctors who are writing for the record rather than for the patient. The family sat at the bedside in shifts. The ceiling of the male ward did not change. The institution continued its business around bed seven the way water continues around a stone.
On the third day the decision was made to intubate and transfer. The equipment here was insufficient. The higher centre had what was needed. To move him by air the airway had to be secured. Standard. Protocol. The young registrar had done this before — the laryngoscope, the blade, the visualisation of the cords, the tube passed through. He was not nervous. He was prepared. He was, in the way of young doctors who have learned their procedures and not yet learned what procedures cannot account for, confident.
He had not done this on a patient whose coma was, at that precise moment, ending.
The Fumble
The laryngoscope blade went in. The pharynx — that most ancient and unthinking part of the airway, the part that does not wait for cortical permission before it acts, the part that has been defending itself since before there were opinions or intentions or case notes — responded as it responds. The gag reflex. The oldest defence in the repertoire.
And the man in bed seven, who had been at GCS 3 for three days, opened his eyes.
The registrar stopped moving entirely. Behind him, the nurse who had been assisting also stopped moving. The ward around them continued its ambient noise — the trolley in the corridor, the murmur from the next bay, the institutional sounds that do not pause for miracles — but at bed seven everything was still.
The patient looked at the laryngoscope blade. Then at the registrar who was holding it. Then at the ceiling. Then at the family member at the bedside who had gone the colour of someone receiving news too large to immediately process. Then back at the registrar.
His expression was the expression of a man who has been deeply and rudely awakened and is assembling the available evidence before delivering his verdict.
“What,” said the patient, in a voice that had not been used in three days and showed it, “are you doing?”
The registrar removed the laryngoscope. He straightened up. He looked at the patient who was now at GCS 15 — the maximum, fully conscious, the entire distance from absent to present covered in the time it had taken to make one movement in one direction.
The family member began to cry. The nurse made a sound that was not quite a word. The registrar stood very still with the laryngoscope in his hand and understood that the official explanation — spontaneous recovery, concussion had settled, neurological improvement consistent with natural history — was both true and entirely insufficient. The concussion had settled. This was accurate. It had settled in response to a laryngoscope blade introduced by a registrar who had been attempting something else entirely, and the pharynx had done the work that three days of medication and observation had not.
Shaking an old radio sometimes makes it work. The principle is the same. The fumble is sometimes the point.
He left the patient with the nurses. He went to the bathroom.
The Slum
The bathroom in the male ward of Medical College Gwalior was a functional room. Tile. Tap. A mirror in which he looked at his own face for a moment — the face of a young registrar who had just done something he could not explain and would not be able to explain and would carry as a private knowledge for a very long time. He turned to leave.
The door did not open onto the corridor.
The door opened onto a slum.
Not metaphorically. Not the slum of exhaustion or the slum of the overworked young doctor’s mental state. An actual slum — narrow lanes, corrugated iron and tarpaulin, the architecture of incremental necessity, the specific density of a place where many people have organised their lives in a small amount of space with the efficiency that small space requires. Cooking smells. A child running. A goat standing in the lane with the philosophical equanimity of an animal that has made its peace with improbable surroundings.
The registrar stood in the doorway. Behind him, the bathroom, the tap, the mirror. In front of him, the slum. He checked his pockets from instinct. His hands found, in the left pocket, what they always found in the left pocket: his name tag, his identity card, his registration number, the papers of a person assembled and ready. In the right pocket, money. Sufficient. Appropriate.
He was always arriving prepared. This was the condition of the eternal — to find in the pocket exactly what the present situation required, to arrive in each new configuration of the world already equipped for it. He had arrived at Somnath in 1026 with the qualities the priest needed in a carrier. He had arrived at the Satpura patrol with the instinct to throw before thinking. He had arrived in Gwalior with a degree and a laryngoscope and the specific fumble that the man in bed seven required. He always had the papers.
He looked at the papers. On the other side of those papers was the same life he had just come from — the ward, the rounds, the declining practice of an alcoholic doctor whose fumbles were not always miraculous. The papers led back to that. They were accurate. They were his. He put them back in his pocket.
He looked at the slum.
In the slum, the people moving through the lane were nameless until they decided to don a persona. This was the slum’s great gift and the thing about it that the official world of wards and case notes and registration numbers could not replicate. Nobody here was yet the thing they were going to become. The degree was in the pocket but the name tag was not on the chest. He was, for the moment, a man standing in a doorway, which was unremarkable. People stood in doorways here. The doorway was where the inside and the outside negotiated.
The Small Shop
He found a small shop at the end of the lane. The size of a large cupboard, which is the correct size for a small Indian shop — the precise minimum necessary for commerce, calculated so that transactions require at least one party to sit, which removes the hierarchy of the standing person over the sitting one and puts both parties at the same level. The man running it looked at him without alarm or curiosity.
“What do you need?” Not: who are you. Not: where did you come from. Not: why is there a hospital bathroom behind you. Simply: what do you need.
“A place to sit,” he said. “For a while.”
The man moved slightly to the left. He sat.
Above the shop were stairs — narrow, steep, more vertical than horizontal because horizontal space had not been available when they were built. At the top was a room in which you could lie down or sit. Those were the two options the room offered. If you wanted to pace you went up to the roof, which was the largest room in the building because the sky had not been rationed. Below, the clinic next door had set itself up in a space smaller than the shop. Four people in it at any time. Nobody stood. The doctor crouched at the level of the patients, which was perhaps the best configuration for understanding what was actually wrong with them, the level that the teaching hospitals with their grand rounds and their vertical authority had not managed to achieve by design but that this clinic had achieved by the simple fact of insufficient space.
He sat in the shop and watched the lane. People came for tea, for a biscuit, for the small transaction that is also a moment of being seen by another person, which is what small shops have always actually sold alongside the biscuits. Nobody asked him anything further. He was present. That was enough.
He thought about bed seven. About the man who had been nowhere for three days and had come back when the pharynx was irritated. About the official case notes and the truth that ran alongside them. About the Varaha, who did not descend into the primordial flood with a careful plan. Who descended because the earth had sunk and someone had to go down, and the going down was itself the action regardless of whether it was executed correctly, and what came back up was what needed to come back up because that was the nature of the descent.
The fumble is sometimes the point.
He stayed in the shop until he was ready. Then he went up the stairs and lay down in the room that permitted only lying down or sitting, and looked at the rectangle of sky through the single window, and when he was sufficiently rested he went back through the door he had come from, which opened, as doors do when you are ready to go back through them, onto the corridor of the male ward of Medical College Gwalior.
The nurse at the station looked up. “Doctor. The family of bed seven is asking for you.”
He went. The man in bed seven was sitting up, eating dal from a steel tray, with the appetite of someone who has not eaten in three days and has a great deal of catching up to do. He looked at the registrar with recognition and something approaching amusement.
“So,” the patient said, between spoonfuls. “Did it work?”
The registrar looked at him. “Yes,” he said. “It worked.”
The patient nodded. He took another spoonful of dal. Then, without looking up, with the casualness of someone stating a fact that requires no particular emphasis: “There are many eternals around.”
The registrar said nothing. He pulled up the chair beside the bed and sat down. Outside, the ward continued its business. The trolley went past. The institution did not pause. The dal was getting cold and the patient was eating it anyway and the afternoon light came through the window at the angle it always came through at this hour in this ward in this city.
Two eternals. A steel tray. The ordinary afternoon.
Eternal Bopa Rai smiled.
— ★ —