He looked at me intently. "You'll keep this a secret? Please? It's what you can do for me. A gift, if you like. Give me as many normal days as I can possibly have. And you mustn't tell your brother either. That might be hardest for you. I know you two have had a ... rift. But you understand Shiva better than anyone. I know you care enough for him to protect him from this news getting to him prematurely."

I gave him my word.

ABOUT THE NEXT FEW MONTHS, I remember very little, except that Ghosh's wisdom was revealed. It had been a blessing not to know for the last two years. Now that I knew, there was no turning back time or erasing that knowledge; it was as if he were back in jail again and, in a way, so was I. I read everything I could about myeloid metaplasia (how I hated that term which he loved). His bone marrow was quiet when I first learned of his diagnosis. But then the disease became more active, the volcano started rumbling, oozing lava, spitting telltale traces of sulfurous gas when the wind was right.

I spent as much time as I could with Ghosh. I wanted every bit of wisdom he could impart to me. All sons should write down every word of what their fathers have to say to them. I tried. Why did it take an illness for me to recognize the value of time with him? It seems we humans never learn. And so we relearn the lesson every generation and then want to write epistles. We proselytize to our friends and shake them by the shoulders and tell them, "Seize the day! What matters is this moment!" Most of us can't go back and make rest.i.tution. We can't do a thing about our should haves and our could haves. But a few lucky men like Ghosh never have such worries; there was no rest.i.tution he needed to make, no moment he failed to seize.

Now and then Ghosh would grin and wink at me across the room. He was teaching me how to die, just as he'd taught me how to live.

SHIVA AND HEMA went about their days ignorant of Ghosh's condition. They were caught up in their own excitement. Shiva had coaxed Hema into a major commitment to treating women with vesiculov.a.g.i.n.al fistula, or "fistula" for short. It wasn't a condition that Hema (or any gynecologic surgeon) relished seeing because it was difficult to cure.

Now I can explain why that little girl whom we'd seen when we were young children-the one who came walking up the hill with her father, her head bowed with shame, dribbling urine at every step, carrying about her an unspeakable odor-had such a profound influence on Shiva's life.

Unbeknownst to Shiva and me, Hema had operated on her three times. The repair broke down the first two times; the last one held. We never got to see her leave Missing, but we had Hema's word that she was cured and had left happy. The mental scars, though, would never heal. We understood little at the time of what ailed her; it wasn't a subject Hema would speak about to us. But now, Shiva and I knew. In all likelihood, perhaps before she was a teen, the girl was married off to a man who could have been as old as her father. The painful consummation of her marriage (more traumatic if circ.u.mcision had left scar tissue at the entrance to the v.a.g.i.n.a for the husband to batter down) would have ter-rifed her. She may even have been too young to connect this act with becoming pregnant, but soon she was swollen with child. When labor began, the baby's head jammed against her pelvic bones, the pelvic inlet already narrowed by rickets. In a developed country or a big city she might have had a Cesarean section as soon as her contractions started. But in a remote village, without the help of anyone but her mother-in-law, she would suffer for days, her uterus trying to do the impossible, but succeeding only in ramming the baby's head against the bladder and the cervix, crushing those tissues against the unyielding bony pelvis. The baby soon died inside the womb and the mother's death would follow shortly, most often due to a ruptured uterus or infection and septicemia. It was the rare family who managed to transport the mother to a health center. There the lifeless fetus could be removed piecemeal, by first crushing the skull and then pulling the rest out.

During her convalescence from that dreadful labor, the dead and gangrenous tissues inside her birth pa.s.sage eventually sloughed off, leaving her with a jagged hole between bladder and v.a.g.i.n.a. Instead of urine pa.s.sing from bladder to urethra to emerge just under the c.l.i.toris (and only when she chose to void), the bladder now constantly leaked its contents directly into the v.a.g.i.n.a and down her legs. She was never dry, her clothes always soaked, and she dribbled all day. The bladder and its urine quickly became infected and foul-smelling. In no time her l.a.b.i.a, her thighs, became wet and macerated and oozed pus. This must have been when her husband cast her off, and her father came to the rescue.

Fistulas have been described since antiquity. But it wasn't till 1849 in Montgomery, Alabama, that Dr. Marion Sims, my namesake, first succeeded in repairing a v.a.g.i.n.al fistula. His first patients were Anarcha, Betsy, and Lucy, three slave women who had been cast out by their families and their owners because of this condition. Sims operated on them-willing subjects we are told-in an attempt to cure the fistula. Ether had just been discovered but wasn't in widespread use, so his patients were wide awake. Sims closed the gaping hole between bladder and v.a.g.i.n.a with silk and thought he had cured them. But a week later, he found pinhole openings along the line of his repair through which urine was leaking. He kept trying. He operated on Anarcha some thirty times. He learned from each failure, modified his technique until he ultimately got it right.

When Hema operated on the girl wed seen, she used the principles of repair established by Marion Sims. She first put a catheter through the urethra into the bladder to divert the urine away from the fistula to allow the wet, macerated tissues to dry and heal. A week later, Hema operated v.a.g.i.n.ally using the bent pewter spoon the Alabama surgeon had fashioned-the Sims speculum, we now call it-which allowed for good exposure and made v.a.g.i.n.al surgery possible. She had to carefully dissect out the edges of the fistula, trying to find what had once been discrete layers of bladder lining, bladder wall, then v.a.g.i.n.al wall and v.a.g.i.n.al lining. Once she had trimmed the edges, she made her repair, layer by layer. Sims, after many failures, had a jeweler fashion a thin silver wire which he used to close the surgical wound. Silver elicited the least inflammatory reaction from the tissues, inflammation being the reason a repair would break down. Hema used chromic catgut.

At dinner, a month after Id learned of Ghosh's blood disorder, Hema shared with us that she and Shiva had operated on fifteen successive fistula patients with not one recurrence. "I owe this to Shiva," she said. "He convinced me to take more time preparing the women for surgery. So now, we admit the patients and feed them eggs, meat, milk, and vitamins for two weeks. We treat with antibiotics till the urine is clear and use zinc oxide paste on their thighs and v.u.l.v.a. It was Shiva's idea to deworm them and correct iron deficiency anemia before surgery. We work on strengthening their legs, getting them moving." She looked at Shiva with pride. "I am embarra.s.sed to say, he's seen and understood their needs better than I have after all these years. Like the idea of physical therapy-"

"Can't get them to walk after surgery if they won't walk before," Shiva said.

On four of their patients the hole into the bladder was so large, so scarred down and shrunk back, that it was impossible to pull the edges together. In these patients, Hema and Shiva had learned to expose a narrow but thick "steak" of flesh under the l.a.b.i.a and, while keeping it connected at one end to its blood supply, tunnel its free end up and pull it into the v.a.g.i.n.a and use it as a live patch in the fistula.

"Matron has a donor who wants to support nothing but fistula surgery," Shiva said. "We're getting one thousand American dollars every month." I found it difficult to look at him, let alone congratulate him.

I STOPPED FRETTING over Genet. When she failed two of the four courses the first year and had to repeat both semesters, I was too distracted by Ghosh's illness to care. She wasn't having a good time and living it up. Instead she'd lost her desire, lost sight of her target if she'd ever had one. All it took was one week of not studying, missing cla.s.s, to get impossibly behind, so hectic was the pace of the first year of medical school.

Halfway through my second year, I learned that Genet had again missed a few anatomy lab sessions. I felt obliged to check on her.

At Mekane Yesus Hostel, the door to her room was open. Her visitor's back was to me; neither of them saw me at first. Genet shared the room with another girl who wasn't there. The tiny room which had once been so neat was now cluttered and messy. The room held a bunk bed and a small table for two. When he was alive, Genet acted as if Zemui annoyed her. Her brave and loyal father had died in a hail of bullets, and now she had his picture on the ceiling, inches from her face when she lay on the top bunk.

Her visitor's coa.r.s.e features and his gruff manner made him stand out. I knew him as a student firebrand, organizing others for curricular reform, or collecting signatures to oust an unpopular warden. But he was Eritrean first, just like Genet. The liberation of Eritrea was almost certainly his most important cause, but it was the one he'd have to keep secret. He was speaking to Genet in Tigrinya, but I heard a few English words: "hegemony" and "proletariat." He stopped in midsentence when he sensed me in the doorway. His bovine eyes gave me a look that said, You will never be one of us.

I deliberately spoke to Genet in Amharic, so her guest would see that I spoke it better than he did. He muttered something to her in Tigrinya and stalked off.

"Who are these radical friends of yours, Genet?"

"What radicals? I'm just hanging around with Eritreans."

"The secret police have informers on this floor," I said. "They'll link you with the Eritrean People's Liberation Front."

She shrugged. "Do you know the EPLF is making great gains, Marion? You can't know that. It's not in the Ethiopian Herald. But I doubt you're here to discuss politics?"

In the past I might have been wounded by her manner. "Hema says h.e.l.lo. And Ghosh says he wants to see you for dinner one of these evenings ... Genet, I'm worried about your dissections. There is no one to do your labs for you this year. If you don't show, you'll fail, no matter what. Come on, Genet."

Her face, so interested and animated when the other man was there, had now become sullen.

"Thank you," she said icily.

I wanted badly to tell her that Ghosh was ill, to shake her out of her self-absorption. And yet I sat there feeling the witchcraft of her presence. It kept me coming after her and it made me tell myself I still loved her, no matter how she acted, even when our lives were so clearly drifting apart.

IN MY FINAL YEAR of medical school, during my surgery rotations, Ghosh's volcano erupted. I came home to a look on Hema's face that told me she knew. I steeled myself for her tirade. She hugged me instead.

Ghosh had thrown up blood, and also developed a major nosebleed. He'd tried to conceal it but failed. He was resting comfortably in the bedroom. I peeked in on him, then came out and sat with Hema at the dining table. Almaz, red-eyed, brought me tea.

"I suppose I'm glad he didn't tell me," Hema said. I could see from her swollen eyelids that she'd spent the afternoon crying. "Particularly when there's nothing to do for it. I've been able to enjoy the best of him. Such perfect days, without knowing any of this." She fingered the diamond ring on her finger, a present that he'd given her the last time they renewed their yearly vows. "Had I known ... maybe we could have taken a trip to America. I asked him about that. He said he preferred to be here. The first sight of me every morning is all he wants! Ayoh, he is such a romantic chap, even now. It's funny, but a few months ago, I actually felt that things were so good that something bad had to happen. The signs were all in front of me. But I wasn't paying attention."

"Me, too," I said.

I found Almaz weeping in the kitchen, and Gebrew, tears in his eyes, his tiny Bible in his hand, rocking and reciting verses to console her. When they saw me, Gebrew said, "We shall fast for him. Our prayers have been lacking."

Almaz nodded, and though she let me hug her and try to rea.s.sure her, she was agitated. "We have not been prayerful," she said. "That is why such a thing comes on us."

I ASKED GEBREW if hed seen Shiva, and he said Shiva had been gone all day, but if he was back, he might be in his workshop. Gebrew walked down with me to the toolshed.

"Are you still wearing your scroll?" Gebrew asked, referring to the thin strip of sheep's hide on which he'd drawn an eye, an eight-pointed star, a ring, and a queen and copied a verse in fine script. He had rolled the scroll tight and eased it into an empty bullet casing. On the metal he scratched out a cross and my name.

"Yes, it's always with me," I said, which was sort of true because I carried this phylactery in my briefcase.

"I should have made one for Dr. Ghosh and perhaps this would not happen."

I marveled at my faithful friend. To become a priest in Ethiopia, it was enough for the archbishop in Addis Ababa to blow his breath into a cloth bag which was then carried to the provinces and opened in a church yard, allowing for the ma.s.s ordination of hundreds. The more priests the merrier, from the standpoint of the Ethiopian Orthodox Church.

But having thousands and thousands of priests had its problems for G.o.d-fearing people like Almaz. A small number of these men were drunkards and cadgers for whom priesthood was a means of avoiding starvation while satisfying their other appet.i.tes. The worst reprobate priest who held out his cross obliged Almaz to stop and kiss its four points. I met her one day looking distressed, her clothes in disarray. She told me she'd beaten off a priest's advances with her umbrella, and others had come to her a.s.sistance and pummeled the man. "Marion, when I'm dying, go to the Merkato and get me two priests," she said to me then. "That way, just like Christ, I can die with a thief on either side of me."

But Gebrew was different. Almaz was sure G.o.d approved of Gebrew. He spent hours with his nose buried in his prayer books, leaning on his makaturia-his praying stick-beads clicking through his fingers. Even when he shed his priest garb to cut the gra.s.s, to run errands, to be Missing's watchman and gatekeeper, his turban stayed on and his lips never stopped moving. "Please make Ghosh a scroll," I said to Gebrew. "Have faith. Maybe it is not too late."

SHIVA HAD JUST COME BACK. I hadn't been in that toolshed for ages, and I was unprepared for the extreme clutter. Parts of engines and electrical boxes covered the floor. The narrowest of paths led to where his tank and welding equipment stood along with sc.r.a.ps of metal. Shiva had sh.o.r.ed up the walls and ceiling of the shed with a welded metal scaffold, and from this his tools hung on wire holsters. He was hidden at his desk behind a mountain of books and papers. I made my way there. He was sketching a design for a frame of some kind, an apparatus he said would allow better exposure during fistula surgery. He put his pencil down and waited. Hed known nothing about what had transpired in the bungalow earlier. I told him the truth about Ghosh.

He listened but said nothing. Though he turned a little pale, his face otherwise gave away very little. He closed his eyes. He had climbed into his tree house and pulled up the ladder. He had no questions. I waited. Not even this news could break down the walls between us, I saw.

I needed him. I had carried Ghosh's secret alone, and now I was ready to spread the burden. I needed his strength for the days that were to come, but I didn't want to admit it. What was Shiva thinking? Did he feel anything at all? I left after a while, disgusted that those eyes would not open, convinced I couldn't count on him.

But Shiva surprised me. That night and for two more nights Shiva slept in the corridor outside Ghosh and Hema's bedroom with just a blanket wrapped under and over him. It was his way of expressing his love for Ghosh, of staying close. Ghosh was moved to tears seeing Shiva curled up there the next morning. I felt something around my heart break down and shatter when Hema told me. On the fourth night, as Ghosh's condition worsened, I decided to leave Ghosh's old bungalow and return to the bed I used to share with Shiva. I convinced Shiva not to sleep on the floor in the corridor. We slept awkwardly, on the edges of the mattress, getting up several times in the night to check on Ghosh. By morning, our heads were touching.

SHIVA AND I HAD the same blood group as Ghosh. With Adam's help, I'd been stockpiling my blood for this moment. Now, Shiva gave his. But blood was no longer sufficient, and it had caused a dangerous iron overload. Ghosh's platelets weren't working; he was oozing from his gums as well as losing blood in his bowel. He became progressively weaker.

Ghosh didn't want to move to the hospital. Soon the anemia left him short of breath, and he could no longer lie flat. We moved him from his marital bed of more than twenty years to his favorite armchair in the living room, his legs up on the footstool.

Quietly, systematically, he sought time with everyone he loved. He sent for Babu, Adid, Evangeline, and Mrs. Reddy and the other bridge players; I heard them laughing and reminiscing, though it wasn't all laughter. His cricket team surprised him when they arrived dressed in their whites to honor their captain. They regaled him with exaggerated stories of his past exploits.

Then it reached the point that he was breathing oxygen through a face mask that sat loosely over his chin. It was my turn to have the conversation with Ghosh. I'd been dreading the moment, resisting its implication.

"You're avoiding me, Marion," he said. "We must start. We can't finish unless we start, right?"

I would never have predicted what he'd say next.

"I don't want you to feel responsible for the entire family. Hema is very capable. Matron, even though she is getting old, is tough and resourceful. I am saying this to you because I want you to take your medi cal career to great heights. Don't feel bound by duty to Shiva or Hema or Matron to stay here. Or to Genet," he added, frowning slightly as he mentioned her name. He leaned forward to grab my hand, to make sure I understood how serious he was. "I wanted to go to America so badly. All these years I've read Harrisons and the other textbooks ... and the things they do, the tests they order ... it's like reading fiction, you know? Money's no object. A menu without prices. But if you get there, it won't be fiction. It'll be true." His eyes turned dreamy as he imagined what it was like.

"We stopped you from going, didn't we? Me and Shiva. Our birth?"

"Don't be silly. Can you imagine me giving up this?" he said sweeping his hand to indicate family, Missing, the home he'd made out of a bungalow. "I've been blessed. My genius was to know long ago that money alone wouldn't make me happy. Or maybe that's my excuse for not leaving you a huge fortune! I certainly could have made more money if that had been my goal. But one thing I won't have is regrets. My VIP patients often regret so many things on their deathbeds. They regret the bitterness they'll leave in people's hearts. They realize that no money, no church service, no eulogy, no funeral procession no matter how elaborate, can remove the legacy of a mean spirit.

"Of course, you and I have seen countless deaths among the poor. Their only regret surely is being born poor, suffering from birth to death. You know, in the Book of Job, Job says to G.o.d, 'You should've taken me straight from the womb to the tomb! Why the in-between part, why life, if it was just to suffer?' Something like that. For the poor, death is at least the end of suffering." He laughed as if he liked what he just said. His fingers automatically went up to his pajama pocket, then to the back of his ear searching for a pen, because the old Ghosh would have jotted that down. But there was no pen and no more need to write anything down.

"I haven't suffered. Well, maybe briefly. Only when my darling Hema made me pursue her for years. That was suffering!" The smile said it was a kind of suffering he wouldn't have traded for fame or fortune.

"Shiva will thrive with Hema. Hema needs him to keep her occupied. Hema's instinct will be to retreat to India. She'll make a lot of noise about that. It won't happen. Shiva will refuse. So she'll stay here in Addis. What I am saying is that it's not your worry. You understand?"

I nodded, without much conviction.

"I do have one small regret," Ghosh said. "But it's something you can help me with. It has to do with your father."

"You're the only father I've ever had," I said quickly. "I wish Thomas Stone had this leukemia instead of you. I wouldn't care one bit if he died!"

He waited before answering, swallowing hard. "Marion, it means everything to me that you consider me your father. I couldn't be prouder of you, of who you've become. But I bring up Thomas Stone for selfish reasons. As I said, it's one of my regrets.

"You see, I was as close a friend to your father as he was capable of having. You have to picture how it was then, Marion. He was the only other male physician here at Missing. We were so different, nothing in common, or so I thought, when I met him. But I found that he loved medicine in the same sort of way that I love medicine. He was dedicated. His pa.s.sion for medicine ... it was as if he came from another planet, my planet. We had a special bond."

His eyes drifted off to the window, perhaps recalling those times. I waited. Eventually he turned to me and squeezed my hand.

"Marion, your father was deeply wounded by something, G.o.d knows what. His parents died when he was a child. We never talked about things like that. But here, working alongside Sister Mary Joseph Praise, all of us working together, he was sheltered. He was as happy as such a man can be. I felt protective of him. He knew surgery well, but he had no understanding of life."

"You mean he was like Shiva?"

He paused to consider this. "No. Very different. Shiva's content! Look at him. Shiva has no need for friendship or social support or approval-Shiva lives in this moment. Thomas Stone wasn't like that; he had all the needs the rest of us have. But he was scared. He denied himself his needs, and he denied himself his past."

"Scared of what?" I found all this hard to swallow. "Matron told me once that he threw instruments when he got upset. She said he had a temper, that he was fearless."

"Oh, fearless in surgery, I suppose. But even that might not be true. A good surgeon must be fearful and he was a good surgeon, the best, never foolhardy, and appropriately fearful. Well ... a few lapses of judgment, but then he was human. But when it came to relationships he was ... terrified. He was frightened that if he got close to anyone they'd hurt him. Or perhaps he'd hurt them."

I was resisting this construction of Stone that was so different from what I'd made up all these years. Finally, I asked, "What do you want from me?"

"Now that my time is coming, Marion ... I want to let Thomas Stone know that whatever happened I always considered myself his friend."

"Why don't you write to him?"

"I can't. I never could. Hema hasn't forgiven him for leaving. She was happy he left-she wanted you two from the moment you were born. But still, she wouldn't forgive him for leaving. And then, once he left, she was terrified-always-that he might come back and claim you. I had to promise her, swear to her, that I wouldn't write him or communicate with him in any form." He looked at me, and said with quiet pride, "I kept my word, Marion."

"Good. I'm glad."

I'd harbored such curiosity about Thomas Stone when I was younger. I had fantasized about his return. Now I resisted Ghosh, and I wasn't quite sure why.

Ghosh went on, "But I fully expected Stone to contact me. I was disappointed as the years went on that he didn't. Marion, he is filled with shame and he a.s.sumes that I have no desire to see him. That I hate him."

"How do you know?"

"I've no way of knowing this for sure. I suspect that to this day he sees himself as an albatross. Call it clinical intuition if you like. The truth is that you were better off with us than with him. Try as he might, I don't know that he could have created what we have here, a family. So I don't want you to hate that man. The cross he carries is huge."

"Why tell me this now?" I said. "I stopped thinking about him after you came out from jail. He was never there when we needed him. Why should I waste my time thinking about him?"

"For my sake. I told you, this is for me. My one regret. It's not about you. But only you can help me."

I said nothing.

"Let me see if I can explain ..." He looked up at the ceiling for a few seconds. "Marion, there'll be something incomplete about my life if I don't let him know that I still consider him a brother." His eyes became wet. "And that whatever his reasons are for being silent all these years, I still ... love him. I can't see him, I can't tell him this. But you can. I won't live to see it, but that's what I want. Do it without hurting Hema's feelings. Do it for me. Complete what is incomplete."

"Are you going to tell Shiva this?"

"If I tell Shiva that it's my dying wish, he'd do it. But Shiva may not know how to do it, how to ... heal him. It requires more than delivering a message." He hesitated. "Speaking of Shiva: what I also need to tell you about Shiva is that whatever he did to you, please forgive him."

He stunned me there. Had he planned to say that? Was it an afterthought? I didn't think Ghosh knew the depths of my hurt, my bitterness toward Shiva, but I'd underestimated him. Still, what happened between me and Shiva wasn't a subject I wanted to bring up with Ghosh; it was too painful, too personal.

"I'll do my best about Thomas Stone. For you. But I can't believe this is what you want. You're forgetting this is the man who caused my mother's death ... A nun's death. A nun he got pregnant. And then he abandoned his children. And to this day no one seems to know how any of it happened."

As my voice rose and quavered, Ghosh said nothing, but looked at me steadily till my shoulders collapsed and I gave in. Id do what he asked.

WHEN THE END CAME a week later he was still in that chair, all of us with him, me and Shiva holding his left hand, Matron holding his right. Almaz, who had become so lean from rigorous fasting, squatted behind his chair with her hand on his shoulder; Hema sat on the arm of the chair, so Ghosh's head could rest against her body. Genet was not to be found. She wasn't in her hostel when Gebrew was sent in a cab to bring her to Missing. Gebrew stood next to Almaz, praying.

Ghosh's breathing was labored, but Hema gave him morphine-he'd taught her that, she said. Morphine "disconnects the head from the brain," so although the breathlessness was unchanging, the anxiety would be gone.

He opened his eyes once, startled. He looked at Hema, then at us. He smiled and closed his eyes. I like to think in that last gaze he saw a tableau of his family, his real flesh and blood, because our blood was now in his veins. I like to think in seeing us he felt his highest purpose was served.

And that is how he pa.s.sed from this life to the next, without fanfare, with characteristic simplicity, fearless, opening his eyes that last time to make sure we were fine before he went on.

When his chest stopped moving, my sorrow was mixed with relief: I'd been matching every breath of his with mine for days. I know Hema felt the same way as she laid her head on his and wept, her arms still cradling him.

WITH GHOSH'S DEATH came a new understanding of the word "loss." I'd lost my birth mother and father, lost the General, lost Zemui, lost Rosina. But I only knew real loss when I lost Ghosh. The hand that patted me and put me to sleep, the lips that trumpeted bedtime songs, the fingers that guided mine to percuss a chest, to feel an enlarged liver or spleen, the heart that coaxed my ears to understand the hearts of others, was now stilled.

At the moment he died I felt the mantle of responsibility pa.s.s from him to me. He'd antic.i.p.ated that. I remembered his advice to wear that mantle lightly. He'd handed me the professional baton, wanted me to be the kind of doctor who would surpa.s.s him, and then pa.s.s on that same knowledge to my children and to their children, a chain. "I shall not break the chain," I said, hoping Ghosh could hear me.

Freud, I knew, wrote that one only became a man the day one's father died.

When Ghosh died, I stopped being a son.

I was a man.

CHAPTER 37.