Open Heart

by A. B. Yehoshua

  The pill was so effective that Lazar had to shake me several times before he succeeded in rousing me, and his wife, who was busy cleaning the kitchen as industriously as if it were a friend’s borrowed apartment, flashed me a look which seemed to express astonishment at my voracious capacity for sleep. “I didn’t sleep all night,” I explained spreading out my hands apologetically to them, but Lazar wasn’t interested in apologies, he wanted rapid organization. Three swollen suitcases stood ready—two older bags and one new one, which had swallowed up their daughter’s sleeping bag, backpack, and other possessions. Einat herself was sitting on a chair outside, very pale, wearing the simple flowered dress and red cloth hat that her mother had brought from Israel—a sad and pensive tourist, carrying away only the hepatitis B virus, testimony to the fact that her independent backpacking trip to the stormy, colorful subcontinent had ended in failure, requiring an emergency rescue by Mommy and Daddy. Without examining her again before leaving, I hurriedly dressed and ate the sandwiches prepared by Lazar’s wife, who for a moment also seemed uncertain of the wisdom of starting off on the return journey so soon. But at this point the rickshaw driver in the white turban arrived, and when he saw me he came hurrying up to shake my hand enthusiastically, adding a little bow to express his satisfaction at my safe return from Calcutta. This time he had brought a bigger rickshaw, which easily took the four of us and our luggage aboard, and transported us rapidly to the dirty little airport in Gaya, which the light of day stripped of its mystery.

  The flight from Gaya to Varanasi was not long, and the plane did not climb to any great altitude; nevertheless, a spurt of blood burst out of Einat’s nose again. I was absorbed in the window, sleepily watching, with a mixture of depression and admiration, a silvery flash apparently emanating from our plane, which streaked ahead of us, gliding over the fields and roads, vanishing into woods and canals and little lakes, then unexpectedly appearing again, darting quick and silver over another part of the landscape. Lazar’s wife was sitting in a window seat two rows in front of me, and during the flight I noticed her bun unraveling. Suddenly Lazar rose from his seat, a blood-soaked towel in his hand. I jumped up, but when he saw me he signaled me to sit down again. I ignored him and hurried over to them. Einat was lying with her head on her mother’s lap. “It’s stopped,” Lazar announced immediately, as if to send me away, but his wife looked uncertain. Her automatic smile had vanished. “What is it?” she asked me in real anxiety. “It’s probably weakness from the hepatitis,” I said without thinking, “and maybe a result of the change in atmospheric pressure too. Let’s change places for a minute,” I suggested to Lazar, sitting down in the seat next to his wife and looking straight into Einat’s eyes. She raised her head to me; she seemed a little pale, but mainly unhappy. In spite of the inconvenience to Lazar, I insisted on remaining next to the two women until the landing, which from the window was spectacular and startlingly beautiful. The plane circled over the two banks of the Ganges, the deserted east bank and the swarming west one; then it began gliding past, temple after temple, ghat after ghat, rocking in the air over the tiny black figures as if it too wished to bathe in the holiness of the golden river. I began talking to Einat, to distract her. Had she ever been in Varanasi? I asked her. She shook her head. “It’s a pity your father’s in such a hurry,” I said, “otherwise we could have squeezed in another day here. The little we saw when we were here only whetted my appetite for more,” and I smiled at her with the automatic smile of her mother, whose eyes were fixed on my face in profound concern.

  It reminded me of those times in the operating room when we noticed that the glint of irony usually present in Professor Hishin’s eyes had vanished. We had to stop; it was my responsibility. This new thought began to torture me as we sat with our suitcases and knapsack in a dirty corner of the Varanasi airport, surrounded by Indian children who had come to stare at me and my patient, leaning against me with her eyes closed, too exhausted even to look at the big basket a few feet away, from which rose the alert head of a large snake. We had three hours to kill before the flight to New Delhi, and although Lazar and his wife had brought sandwiches and bottles of soft drinks from Bodhgaya, they made their usual tour of the shops, returning from these expeditions with a relatively clean-looking pastry or a glass of hot tea. I took my patient’s hand in mine to feel her pulse. It was rapid, a hundred per minute, and then, in the absurd despair of a doctor whom nobody believes, I found myself praying that she would begin bleeding again, because this was my only chance of asserting my authority and putting a stop to the dangerous journey, which Lazar and his wife were conducting with such feverish zeal. “Do you feel nauseous?” I asked. She thought a little and then nodded her head. “Then come along with me and let’s get it up.” I helped her to stand and led her into a corner, where I held her shoulders and gently pressed on her abdomen. She didn’t vomit much, but blood was evident. Wherever it was coming from, there was no doubt that the damage to the clotting factors was exacerbating the bleeding. I led Einat back to her seat and told her to lie down across my seat, after which I went to stand guard over her vomit, to make sure that nobody effaced the telltale signs until her parents returned and saw with their own eyes. At that point I was finally able to confront them quietly but firmly: “I’m sorry, but it’s impossible to continue to New Delhi. She has to have a blood transfusion immediately. You’re in too much of a hurry to get home, and you’re putting her at risk unnecessarily.”

  Lazar was flabbergasted. But I stood my ground, and in the quiet, firm tone that has powerful effects on patients and their families, I insisted that we could not continue our flight, that we had to reach some decent hotel—perhaps the Ganges, where we had almost stayed last time—and there, in a quiet atmosphere and hygienic conditions, I would give Einat a blood transfusion, which would require complete bed rest for twenty-four hours for proper recovery. “Of course,” I continued, “we could put her in a local hospital. But even without the problem of dirty needles and contaminated blood supplies you’d have to be insane to hospitalize anyone in this ‘Eternal City,’ where nobody cares about anything but reincarnation and cremation.” Lazar still tried to protest. “Let’s go as far as New Delhi, at least,” he begged. “It’s only a two-hour flight. We can stop there—because who knows when we’ll be able to get onto another flight, and traveling sixteen hours by train will be more dangerous for her than postponing the blood transfusion for a few hours.”

  “No,” I stated quietly, “it would be more dangerous to postpone the blood transfusion,” and I looked directly at his wife. But when she remained silent, as if unwilling to come out on my side, I raised my hands in a dramatic gesture, as if a hidden pistol were pointing at my head, and, closely surrounded by a ring of Indians who had gathered to see the little drama taking place in their midst, I burst out a tone of pain and grievance which surprised even me with its intensity, “Okay, she’s your daughter, but just explain one thing to me—why did you drag me here with you?”

  Perhaps it was these words that defeated Lazar’s wife, who now threw her weight decisively onto my side, until Lazar too gave in and immediately began organizing the postponement of our flight, looking for porters, and thinking about a suitable hotel. And then Einat fainted and fell to the ground, and for the first time I was overwhelmed by a real fear that she was going to slip out of our hands. Passersby helped to lift her up; the characteristic Indian expertise in carrying the sick and dying soon proved most helpful as we were provided with a stretcher improvised from a blanket and two bamboo poles, and with a great hullabaloo we were led out of the airport building. A ramshackle minibus took us on board and with un-Indian speed covered the twelve miles between the airport and the town. We soon reached the Ganges Hotel, and although Einat had already recovered from her faint, the managers apparently thought it best to isolate us from the other guests, and instead of showing us into the hotel itself, they led us to an annex in the rear, a kind of pilgrims’ lodge, where they installed
us in two simple but very clean rooms furnished with wicker furniture lacquered a bright purple. After washing my hands and face and taking the extra precaution of putting on a little surgical mask, I turned quickly to my medical kit to collect everything I would need for the blood transfusion, which I had decided to perform as an emergency procedure, as described in the first aid manuals of the Magen-David-Adom station where I had worked night shifts while I was in medical school. In other words, a direct transfusion, where I would have to approximate the amount. I asked Lazar to push two beds together and lay the two women side by side, and Lazar helped me to take off their shoes and undo their belts. I measured their blood pressures, which were good, both about 130 over 80, and asked Lazar’s wife, who was studying me with a rather ironic expression, to take off her glasses. “Why?” she asked in surprise. “It’s not important,” I said in embarrassment. “I just thought you might be more comfortable that way,” and without insisting I found the vein for the intravenous line on Einat’s slender wrist and connected it to the small infusion set. When the needle went in she let out a sharp cry of pain, and I immediately stroked her head and apologized, even though I knew that with the thinness of her arm and the irritated state of her skin the pain was unavoidable. I passed the tube over the table lamp standing between the two beds and began looking for her mother’s vein, which was buried in the plumpness of her flesh. I tied a rubber tube around her upper arm, and since I felt no fear emanating from her, I found it easy to plunge my syringe quickly and painlessly deep into the vein. As the blood began slowly pumping out and I noted the time on my watch, she smiled at me and began joking lightheartedly. I asked Lazar, who was prowling around me not like the head of a hospital in which complicated operations were performed day and night but like a frightened husband and father, to raise his wife a little and prop her back against the pillow, to allow the blood to flow unimpeded between her arm and her daughter’s according to the law of equilibrium. His wife’s hair had come loose and partly covered her face. She tried to encourage her daughter, who was lying with her eyes closed and an expression of pain on her face, as if the blood flowing into her hurt her. Now there was a long silence. Lazar was still examining my actions with a mixture of anxiety and suspicion. Was I keeping an eye on the amount of blood? he suddenly asked in a whisper. I nodded my head. I knew that everything I did here was being registered in his sharp mind, down to the last detail, and that when we got home he would waste no time in asking Hishin and the rest of “his” professors if it had really been necessary to perform the blood transfusion so urgently and to cancel the flight. But I was calm and sure of myself, ready not only to justify the urgent transfusion to all the professors in the hospital but also to demand the respect due to me for my diagnosis and ingenuity in a medical emergency. They had wanted the ideal man for the trip—I suddenly felt a surge of elation—and they had found him!

  After the transfusion of approximately 450 cc’s of blood, according to my estimation, I removed the intravenous line from Lazar’s wife’s vein, applied alcohol to the spot, and gently folded her arm. Again she smiled sweetly at me. If not for Lazar’s needless haste in catching the tube, not a single drop of blood would have been spilled in vain, but he was careless, and a bit of his wife’s blood splashed onto my clothes. “Never mind,” I said, and disconnected the tube from the infusion line in the wrist of my patient, who had calmed down and slipped into a doze, which I wanted to turn into a real sleep. I therefore took a Hartman’s infusion bag, hung it from a nail in the wall, connected it to the infusion line which had just been thirstily and efficiently drinking in the blood, and went over to the window to draw the curtain and darken the room. But before I did so I stood still for a moment and relished the golden moment to the full. “And now we all need a rest,” I said, facing them, “especially you, Dori,” and I blushed, for this was the first time since the beginning of the trip that I had addressed her directly by her husband’s pet name for her. But they both smiled at me affectionately, and Lazar put his arm around me in a conciliatory gesture. “You need a rest too,” he said, but I was as alert and full of vitality as if I myself had received a blood transfusion. I packed the instruments in the knapsack and put it in the other room, and since I knew that the pair of them were perpetually hungry, I offered to look after our patient while they went to have lunch, and then, if everything seemed to be going smoothly, I would go down to eat myself, and perhaps have a look at a nearby museum.

  But I knew that I wouldn’t be going to look at any museum. It was the Ganges River and the swarming steps leading down to it and the vast, mysterious, dark brown temples which I hadn’t managed to see before that called me. After eating a late lunch by myself in the hotel restaurant, encouraged by the clear signs of recovery in Einat—who, after absorbing the entire contents of the infusion bag, woke up and even tasted a bit of the food her parents brought her—I allowed myself to go out to the river before darkness fell. A warm, fine rain sifted through the air, and a stench rose from the town like incense. Who could have guessed that I would return here, I mused, as once more I made my way through the narrow alleys and the tireless, endless crowd until I reached the riverbank, which in spite of the rain was full of bathers. I hired a boat by myself and asked the boatman to row me to the southern ghats, so that I could view the great temples from the heart of the river. The dusky air merged with the river and the boat glided calmly over the water, but I did not succeed in drinking in the mystery. I was still preoccupied with all that had just passed: the argument at the airport with Lazar, the sudden faint, and especially the successful blood transfusion, which had been so elegantly performed. The smile that had gleamed from his wife’s eyes as I took her blood now floated pleasantly through my thoughts. It seemed that I had succeeded in impressing them, and when we returned to Israel, as the cunning Hishin had hinted, Lazar might be able to help me stay on at the hospital. But I soon realized that it wasn’t Lazar I was thinking of but his wife, who couldn’t stay by herself. And in the final analysis, I thought with satisfaction, it was a good thing she had joined us; how would I have found a suitable donor in the eternal crowd? And who would have helped me persuade Lazar to interrupt the journey?

  As illuminated launches sailed past us and our little boat rocked in their wake, I began thinking affectionately of Einat too. How sad for it to end like this, a trip that perhaps was intended to be more than just a trip, a little rebellion or an escape. And in bringing me along, hadn’t Lazar and his wife had some hidden intention to put her in touch with a young doctor, an “ideal man”? She was only four years younger than I was, but she seemed a little bit of a lost soul; why hadn’t she even finished her B.A.? The oarsman called out to me to look at the ghats we were passing. Sensitively he had noticed that I was preoccupied with irrelevant thoughts. I smiled my thanks and raised my eyes to the brown stone temples. Vishvanath, I said softly, getting the name right this time, Vishvanath, and the oarsman’s face lit up and he immediately put his hands together in a gesture of acknowledgment. But the magic had somehow been dispelled, and at the end of the tour of the ghats, when we returned to the bank, I did not linger but hurried back to the hotel, stopping on the way at a small telephone booth, next to which a number of backpackers were clustered. To my surprise I got through right away to my parents, who were overjoyed to be awakened from their sleep by the sound of my voice. We’re already on our way back, I announced, and everything’s going well. And I told them briefly about the day’s events.

  Outside the door to our rooms I heard loud voices, and when I entered I found the two parents sitting on the purple wicker chairs and arguing with my patient, who was sitting up in bed, very yellow and scratching but wide awake. Lazar was in high spirits, having succeeded after strenuous efforts in getting four tickets on the plane to New Delhi the next night. He still hoped to be able to change the flight from New Delhi to Rome that we had missed because of the stop in Varanasi for one the day after, so that we would be in time for the El Al
flight home on Friday. I had finally learned the reason for his haste. He had an important meeting with a delegation of big donors from abroad, whom he had persuaded to devote their Sunday morning to our hospital. “You wanted a twenty-four-hour recovery period, and now you’ve got thirty hours until the flight,” he said aggressively, as if the recovery were meant for me instead of his daughter. But I only smiled. His face was very gray, his little eyes were sunken, and if I had been as close to him as Hishin was, I would have hospitalized him for a few days in the internal medicine department for a comprehensive checkup. But his wife was apparently used to the grayish hue of his face, as were the many doctors with whom he came into daily contact. It was still early for bed, and for a moment I was loath to part from them; I didn’t know if they intended to move the patient into my room, or if Lazar intended to move in with me for the night. In the end Lazar asked me to help him move one of the beds from my room into theirs. What did you think, I said to myself with an inner smile, that his wife would agree to spend a night without him?