In his hands I saw a large golden spear and at its iron tip there seemed to be a point of fire.

Matron's guess from the fragments she could understand was that Sister Mary Joseph Praise's mumbled words were perhaps the words of St. Teresa that they both knew so well.

I felt as if he plunged it into my heart several times, so that it penetrated all the way to my entrails. When he drew it out, he seemed to draw them out, and left me inflamed with a great love for G.o.d. The pain was so severe, it made me moan several times. The sweetness of this intense pain is so extreme, there is no wanting it to end, and the soul is not satisfied with anything less than G.o.d.

But unlike St. Teresa of Avila, Sister Mary Joseph Praise surely did want the pain to end, and just then, Matron said, the pain seemed to loosen its grip on her belly, and Sister sighed and clearly said, "I marvel, Lord, at your mercy. It is not something I deserve."

A brief period of lucidity with roving eye movements followed, along with more attempts at speech, but it was unintelligible. Light splashed into the room, and Matron said it was as if a shroud that had formed in front of her face melted away. In that moment, as Sister Mary Joseph Praise looked around OT3-her operating theater for all these years- Matron thought the young nun realized that she was now the patient to be operated on and that the odds were against her.

"Perhaps she felt she deserved to die," Matron said, guessing at my mother's thoughts. "If faith and grace were meant to balance the sinful nature of all humans, hers had been insufficient, and so what she felt was shame. Still she must have believed, even with all her imperfections, that G.o.d loved her and forgiveness awaited her in His abode, if not on earth."

Matron wondered if it scared my mother that she might die in Africa, a continent away from her birthplace. Perhaps deep in her- perhaps deep in every being-there lingers a desire to bring the circle of life back to its starting point, which in her case was Cochin.

Then Matron heard my mother clearly whisper "Miserere mei, Deus" before sound left her. Matron carried her through the rest of the psalm in Latin, serving as her voice box while Sister Mary Joseph Praise's lips moved: "... Behold, I was shapen in iniquity; and in sin did my mother conceive me ... Purge me with hyssop, and I shall be clean: wash me, and I shall be whiter than snow ..."

When she finished, Matron said the shroud was back. The light was slipping away from her world.

"PICK UP THE STOOL, Stone," Hema barked. "And you," Hema said, snapping her fingers at the probationer, "get your hands out of your pockets."

Stone set the stool upright just as Hemlatha eased down onto it. The key bunch Hema had fished out to open her house was now tucked into the waist of her sari, and it jingled as she settled herself. Under the theater lights the diamond in her nose sparkled. Strands of loose hair fell over her ears and in front of her eyes; through pursed lips she blew these wayward locks aside. She squared her shoulders, squared them to the horror and the unloveliness of what was before her. In that gesture she slipped off the mantle of the traveler and put on that of the obstetrician. The task ahead, however difficult, dangerous, or unpleasant, was hers and hers alone.

Hema felt herself gasping for air. Her lungs would need a week to acclimatize. Shed come from sea level in Madras to an operating room 8,202 feet above sea level, not counting the stool on which she sat. Her nostrils flared with each inhalation, like a thoroughbred after the quarter mile.

But her breathlessness came also from what was before her eyes. Gebrew hadn't lost his mind or imbibed too much talla; hed been telling the truth. The everyday miracle of conception had taken place in the one place it should not have: in Sister Mary Joseph Praise's womb. Yes, Sister Mary Joseph Praise was pregnant, had been for months before Hema left for India! And not just pregnant, but now in extremis. And the father?

Who else? She glanced at Stone's gray face.

But why not? she thought. Why should I be surprised? "The incidence of cancer of the cervix," she remembered her professor saying, "is highest in prost.i.tutes, and almost zero in nuns. Why almost zero and not zero? Because nuns are not born nuns! Because not all nuns were chaste before they became nuns! Because not all nuns are celibate!" That's neither here nor there, Hema admonished herself, while she thrust her hands into gloves that Matron produced.

The probationer recorded in the chart the arrival of Dr. Hemlatha. She chastised herself for not thinking of the gloves.

Hemlatha spread her own legs. Her feet were swollen from the long flight. She flexed her toes against the straps of her sandals and pawed the ground to get good purchase on the b.l.o.o.d.y floor. With the fingers of her left hand she spread the l.a.b.i.a. Then, with a motion made simple by countless repet.i.tions, her right hand pulled down on the posterior rim, opening the birth ca.n.a.l to view.

"Rama, Rama, this is a b.l.o.o.d.y Stone Age utensil," Hemlatha shouted as she carefully disengaged first one half and then the other half of the skull crusher, slipping them over and then off the baby's ears. When the b.l.o.o.d.y instrument was free, she looked at it with distaste and flung it aside.

Matron felt relief. Whatever happened, at least now a real obstetrician was in charge. She couldn't help but note how Hemlatha and Stone had reversed roles: Hema was now the shouter and the flinger.

Matron offered the history that Sister Mary Joseph Praise had been in severe pain, great spasms of it, and then the pains had suddenly ceased and she'd seemed almost lucid, talking ... but now she had deteriorated again.

"My G.o.d," Hema said, knowing that in nature pains don't cease till a baby is out, "it sounds like a uterine rupture." It would explain all the blood on the floor. Placenta previa-a placenta plastered over the exit to the womb-was another possibility. Neither possibility was good. "When did you stop hearing the fetal heart sounds?" No one replied.

"Pressure?"

"Sixty by palpation," the nurse anesthetist said, after a pause, as if she expected someone else to volunteer the number that she was responsible for.

Hema peered around Sister Mary Joseph Praise's swollen belly to fix Nurse Asqual with a withering look. "Are you waiting for it to get to zero before you breathe for her? Put in a tracheal tube. Connect it to the hand bellows. If she wakes, give her some intravenous pethidine. Tell me when you're done. Where's Ghosh? Have you sent for him?" Nurse Asqual busied herself, grateful for step-by-step instruction because her mind had seized.

"And who has gone for blood? What! n.o.body? Am I dealing with idiots here? Go! Run! Run!" Two people charged for the door. "Round up anyone and everyone to give blood. We need lots of blood!"

Hema insinuated two fingers of her right hand around the fetal skull. With her other hand she pushed down on Sister Mary Joseph Praise's belly. She peeked over the rise of the abdomen at Sister's face; it had gone gray, grayer than Stone's.

Nurse Asqual, her hands shaking, managed to insert the tracheal tube. With every squeeze of the air bag, Sister's engorged b.r.e.a.s.t.s heaved up.

Hema's hands were like extensions of her eyes as she explored the s.p.a.ce that she thought of as the portal to her work; fingers inside took their soundings, helped by the hand on the outside. She closed her eyes, the better to receive what her fingertips conveyed about the pelvic width, the baby's position. "What have we here ... ?" she said aloud. Indeed, the baby was head down, but what was this? Another skull?

"Good G.o.d, Stone?" Hemlatha said, s.n.a.t.c.hing her hand out as if she'd touched a hot coal.

Stone looked on, not understanding, but afraid to ask. She fixed her gaze on Stone, her face taut, waiting for a reply, any reply, and prepared to shout it down when it came.

"Better out than in?" Stone mumbled, thinking she meant his skull-crushing attempts.

"d.a.m.n it, Thomas Stone, don't quote me your idiot book. Do you think this is a joke?" Stone, who didn't at all see this as a joke, who in fact saw that everything Hema was doing was something he could have and should have done, turned crimson. Hema turned back to probe once more that calamitous s.p.a.ce in Sister Mary Joseph Praise's body where two lives were in jeopardy. Her words were like body blows directed at Stone.

"One prenatal visit? Could you have let me see her for at least one prenatal visit? I'd have canceled my trip. Look at the soup we are in! Miracle, my foot. Completely avoidable ... completely avoidable" the last two words delivered like lashes.

Stone stood as if in front of the headmistress. Hema seemed to expect him to speak and so he stammered, "I didn't know!"

Hemlatha's jaw dropped. She stared at him. There was a part of her that was incredulous at the idea of Stone impregnating Sister Mary Joseph Praise-who could imagine that? But the cynicism of the obstetrician who has seen everything crept back in. "You're thinking virgin birth, Dr. Stone? Immaculate conception?" She came around the table. "In that case, guess what, Mr. Expedient Operator? This is better than the manger in Bethlehem. This virgin is having twins!" She paused to let it sink in. "For goodness' sake, couldn't you have done a Cesarean section?" Her singsong intonation rose at the end, leaving the words "Cesarean section" hanging over Stone's head.

"Gloves and gown, quick!" Hemlatha shouted. "C-section tray here. Wake up, all of you! Do you not want to save her? Hurry! Hurry! Hurry!" She repeated this in Amharic-"Tolo, tolo, tolo!"-in case English wasn't getting through.

The authority of her words kept them from retreating into the shock that had paralyzed them. "And you nurses standing around all starched and useless," Hemlatha said, as she pulled on a sterile gown and donned fresh gloves (there wasn't time to wash), "couldn't you have said something to him? Matron?" Matron looked to the floor.

"How long ago did the fetal heart sounds stop? What was the fetal heart rate?"

"It happened too quickly. We-"

"Oh, shut up, Stone. One of you give me a straight answer. Otherwise all of you shut up. Pressure now?"

"Barely sixty."

"Where's the blood? Am I dealing with deaf as well as dumb people? Answer me?"

The hospital had no blood bank, just a pint or two if one were lucky, kept in a refrigerator. Patients' families were reluctant to give blood. Hema once pressed a husband to give blood for his wife, and he'd refused outright. When she suggested that his wife would surely give blood for him if the tables were turned, he said, "You don't know my wife. She's waiting for me to die to take my cows and property." Time and again, she and Ghosh and Stone and Matron would donate their own blood and prevail on some of the nurses to do the same. At least once a year Ghosh would take his car and round up members of his cricket team to give blood.

"Has no one thought about blood?" Hema said again. "All of you who aren't needed here, go at once and give blood. This is one of our own, for G.o.d's sake. Go, now. No, not you Stone! Get gloved, man, for goodness' sake. Make yourself useful. What was the fetal heart rate?"

The probationer kept her eyes focused on the chart, terrified at the idea of giving blood and not daring to look up. And she knew that no one had listened for a fetal heart. They'd been too preoccupied with the mother. The probationer drew a line through her "C-section indicated" entry, sensing that it reflected badly on Matron. It was no consolation to see Dr. Stone standing frozen, eyes downcast, like a dog who'd disobeyed its master, every instinct telling it to slink away but knowing that the slightest movement would only bring more punishment.

Hema saw that Sister Mary Joseph's Praise's face was losing all color, the eyelids lowered to quarter mast, the hooded gaze now unfocused, a look that was so often a precursor to death.

"Pressure?"

"Can't find it ..."

"Doesn't matter, pour in blood, splash some iodine here, let's go!" With that she ripped open the sterile tray, grabbed the scalpel, and slashed through the skin-no time for sterility even-a vertical cut below the navel. Hema still couldn't believe what she was doing, or whom she was cutting.

She half expected Sister Mary Joseph Praise to sit up in protest.

Instead she heard the thud of a body falling and turned in time to see Matron crumpled on the floor.

CHAPTER 8.

Missing People

CUSTODY OF THE BODY" was the first thing out of Matron's mouth when she revived. She'd pa.s.sed out for probably fewer than five seconds; everyone was in the same position, but now staring down at her. The probationer ran over to help. Despite Hema's protests, Matron clawed and kneed her way onto the anesthetist's stool, shouting, "I'm not leaving!" They were too busy to argue.

She sat near the board that tethered Sister Mary Joseph Praise's arm, blood finally running from a bottle into a vein. Matron reached for that hand, bending over it, studying Sister Mary Joseph Praise's fingers. She didn't want to look at what the doctors were doing, their red gloves reaching in Sister's belly. Matron still felt light-headed.

As she ma.s.saged Sister's fingers to still the shaking in her own, the words came to Matron unbidden: "Instruments of G.o.d." Sister Mary Joseph Praise had beautiful fingers, slender and soft, each a delicate sculpture. Even at rest they spoke of fine motor skills. Matron's by contrast were doughy white, the knuckles large and red as if someone had taken a ruler to them; the k.n.o.bby excrescencies on the fingers spoke of nothing but age and toil and the caustic soaps and scrubbings which were the first tools of her profession; the fire burst of wrinkles on her palms spoke of her love for the Ethiopian soil and her willingness to plant and weed and dig alongside Gebrew. He was guard, gardener, odd-job man, and priest, and he believed Matron had no business dirtying her hands.

Matron felt her body shaking. Lord, you can take me, she thought. But wait till they're done because I don't want to distract them again. How she longed for a cup of coffee made from their own plant grown on Missing soil. She loved the gritty feel of the stone-ground bean against her teeth, and the way it rolled down the throat like lead shot. The Italians had left behind their pa.s.sion for macchiato and espresso so that every cafe in Addis served these beverages. Matron had no use for any of that. Missing coffee, brewed traditionally, that's what sustained her through the day, and what she needed right now.

Tears tracked down into the crevices at the angles of her mouth. One of my Cherished Own, she thought; the daughter I can never have, now with child ... So many times at Missing, Matron had become privy to an unspeakable secret revealed by catastrophic illness. Impending death had a way of unexpectedly unearthing the past so that it came together with the present in an unholy coupling. But Lord, she cried out silently, You could have spared us this. Spared her!

As she stroked the younger woman's skin, Matron thought of the impulse that had made Sister Mary Joseph Praise choose to hide her body under a nun's habit or under scrub suit and mask. It hadn't worked; her covering exaggerated what little flesh was exposed. When a face was so lovely, lips so full, even a veil couldn't block its sensuality.

A few years after Sister Mary Joseph Praise's arrival, Matron thought that the two of them should give up the white habit. The Ethiopian government had closed down an American mission school in Debre Zeit for proselytizing. Matron was in the business of running a hospital, not converting souls; she decided it might be politically smart to forgo nun's habit. But when she'd seen Sister Mary Joseph Praise leaving Operating Theater 3 in a skirt and blouse, Matron wanted to run out and cover her with a sheet. W. W. Gonafer, Missing's laboratory technician, standing next to Matron, had also seen Sister Mary Joseph Praise walk by in mufti. He'd frozen like a setter pointing to quail, a flush creeping from his collar to the roots of his hair, as if l.u.s.t were a companion fluid to blood. Matron had decided then that nuns at Missing should remain in habit.

A sudden exclamation that could have been from Hema or from Thomas Stone startled Matron, brought her back to the present. She jerked her head up, and before she could stop herself, she looked ... What she saw made her shudder and feel as if she'd keel over again. She dropped her head down between her shoulders, closed her eyes, and forced her mind to find another focus ...

Matron had no saint whom she modeled herself after, someone to call on at these times. To think of St. Catherine of Siena drinking the pus of invalids-oh! how that disgusted her. Matron thought of such displays as a particular Continental weakness, and she was impatient with celestial billing and cooing, bleeding palms and stigmata. And as for St. Teresa of Avila ... why, she didn't have anything against Teresa. She didn't grudge Sister Mary Joseph Praise her adulation of Teresa. But secretly she agreed with Dr. Ghosh, the internal medicine physician at Missing, that St. Teresa's famous visions and ecstasies were probably nothing but forms of hysteria. Ghosh had shown Matron photographs that Charcot, the famous French neurologist, had taken of his patients with hysteria at the Salptrire hospital in Paris. Charcot believed that these delusions sprung from a woman's uterus-hystera in Greek. His patients, who were all women, stood in smiling poses-provocative poses, Matron thought-that Charcot had labeled "Crucifixion" and "Beat.i.tude." How could anyone smile in the face of paralysis or blindness? La belle indifference was what Charcot called this phenomenon.

If Sister Mary Joseph Praise had visions, she wasn't one to speak about them. Some mornings, Sister Mary Joseph Praise had looked sleepless, her bright cheeks, her floating carriage, suggesting her feet strained to remain earthbound. Perhaps that explained her equanimity while working shoulder to shoulder with Thomas Stone, a man who for all his talents gave little encouragement to those who labored with him.

Matron's faith was more pragmatic. She'd found in herself a calling to help. Who needed help more than the sick and the suffering, more so here than in Yorkshire? That was why she came to Ethiopia a lifetime ago. The few photographs, mementos, books, and certificates Matron brought with her had over the years been pilfered or mislaid. She never worried over this-one Bible, after all, would do just as well as the next. The essentials were also easily replaceable: her sewing kit, her water-colors, her clothes.

But she'd come to value the intangibles: the position she had grown to in the city where she was "Matron" to everyone, even to herself; the resourcefulness she'd discovered that allowed her to make a cozy hospital-an East African Eden, as she thought of it-grow out of a disorganized jumble of rudimentary buildings; and the core group of doctors whom she'd recruited and who by long a.s.sociation had evolved into her Cherished Own. The umbilical cord that had connected her to the Society of Holy Child Order, to the Sudan Interior Mission, had shriveled and fallen off. They were all now self-exiled prisoners at Missing- she and her Cherished Own.

Missing Hospital wasn't its name, of course, and now and then Matron tried to correct people, teach them to say "Mi-shun" instead of "Missing." But in truth that year it wasn't even Missing; it was either Basel Memorial or Baden Memorial-she had to consult the paper taped to her desk to be sure-named after a generous church in either Switzerland or Germany. The Baptists of Houston were big donors, but they weren't at all concerned about naming the hospital. Dr. Ghosh liked to say that the hospital had as many forms as a Hindu G.o.d. "On any given day, only Matron knows which hospital we work in, and if we are walking into the Tennessee Baptist outpatient clinic, or the Texas Methodist outpatient clinic, so how can you blame me for being late- I have to get out of bed and go find my place of work. Oh, Matron, there you are!" Prisoners they all were, Matron thought, smiling despite herself; Missing People who could hardly choose their cell mates. But even for Ghosh, who was without doubt one of the strangest of G.o.d's creations, Matron felt a maternal affection. And the parallel anxiety that comes with such an impish child.

MATRON SIGHED and was surprised to hear words tumble out of her mouth, and she felt the others in the operating theater staring at her. Only then did she realize that her lips had been busy shaping prayers. Since turning fifty, Matron had noticed such dissonances and disconnections between her thought and action; they were becoming common. For example, at inopportune moments her mind busied itself pasting images into a mental sc.r.a.pbook. Why? When would she ever have occasion to recall all these memories? At a testimonial dinner? On her deathbed? At the pearly gates? She'd long ago stopped thinking literally about such matters. Her father, a miner who had lost himself in alcohol and the darkness of the tunnels, had loved the words "pearly gates." On his tongue it sounded like the name of a blowsy woman, one of many that had come between him and his conjugal duties.

Still, Matron was sure of one thing: the image she witnessed when she'd inadvertently looked up a short while before, that was one she'd never ever forget. What happened was this: the sun had suddenly freed itself from behind a cloud, and by some accident of elevation and season presented itself directly on the ground-gla.s.s window of Operating Theater 3. Lambent and white, it had bounced off the walls, reflected off gla.s.s, metal, and tile, and there it was just when Hema or Stone or whoever it was made a loud exclamation, which was what had made Matron look up. That was when Matron saw them all bent over like hyenas over carrion, peering into Sister Mary Joseph Praise's open abdomen and its scandalous contents. She saw the light nosing its way between elbow and hip. Then the sunbeam fell directly on Sister Mary Joseph Praise's gravid uterus, which bulged out of the b.l.o.o.d.y wound like an obscenity on a saint's tongue. A blue-black collection of blood-a hematoma- stretched the broad ligament of the uterus, and it glowed in the light like the Host. Matron felt that this had been the sun's intent all along- to find the unborn. We have seen each other anew. We are unmasked. Yes, it was the kind of event that might be termed a "miracle"-except that nothing happened; the laws of nature weren't suspended (which Matron felt was the sine qua non for miracles). But it was as if the twins' place in the firmament as well as in the earthly order of things had been secured for them even before they were born; she knew that nothing-not even the familiar scent of eucalyptus, or the sight of its leaves thrust into a nostril, or the drumroll of rain on corrugated tin roof, or the visceral odor of a freshly opened abdomen-could ever be the same again.

CHAPTER 9.

Where Duty Lies

HEMA WIELDED HER SCALPEL like a woman on fire. No time to tie off bleeders, and, in any case, very little bleeding along the way-not a good sign. She opened the glistening peritoneum and quickly positioned retractors to hold the wound edges back. The uterus bulged out of the wound. Then, before her eyes, it seemed to swell and turn luminous ... She stood frozen, until she realized it was because the sun had suddenly struck the frosted window and lit up the table. In all her years operating at Missing, she couldn't remember that happening before.

Just as Hema feared, there was a lateral tear in the uterus. Blood had filled the broad ligament on one side. That meant that once she got the babies out, shed have to do an emergency hysterectomy, no easy task in pregnancy, what with the uterine arteries being tortuous, thickened, and carrying half a liter of blood a minute. Not to mention the ma.s.sive blood clot shimmering in the light, growing before her eyes and gloating at her like a smiling Buddha, as if to say, Hema, I have completely distorted the anatomy, dissection is going to be b.l.o.o.d.y difficult, and your landmarks will all be gone. But come on in anyway, why don't you?

Hema believed in numerology; next to one's name, nothing was as important as numbers. What is it about this day? she asked herself. It's the twentieth day of the ninth month. No fours or sevens in there ... Airplane almost crashes, a child breaks his leg ... I crack a Frenchman's nuts ... What more, I say, what more?

She rapped Stone's knuckles with a scissors. "Stop!" He was fumbling with an oozing vessel when she needed him to retract.

She incised the uterus and tried to deliver the twin who sat higher in the uterus but was nevertheless head down, upside down. This twin would have been the second to come out had delivery proceeded through the birth ca.n.a.l, but now it would be the firstborn. But strangely, this twin, hand jammed against its cheek, wouldn't budge.

She extended the uterine wound.

She suctioned the infant's mouth.

She drew a sharp breath that inverted her mask against her lips because she could see the problem.

The babies were joined at the head. A short, fleshy tube pa.s.sed from the crown of one to the other, a tube that was narrower and of a darker hue than the umbilical cords. They were tethered together, but there was a fatal tear in this stalk, a jagged opening caused no doubt by Stone's fishing with the basiotribe. And from this rent, what little blood the two infants possessed was pumping out.

Please G.o.d, she thought, let this be only a blood vessel, and a minor one at that. Let there be no brain or meninges or ventricle or cerebral artery or cerebrospinal fluid or whatnot in it. She spoke aloud to Stone now, to the room, to G.o.d, and to the twins whose lives, if they survived, might be irrevocably affected by this decision: "They could have seizures the minute I cut this. One twin could bleed out and the other overfill with blood. They could get meningitis ..."

This was a technique surgeons used when difficult decisions had to be made: think aloud for your a.s.sistant because it might help clarify the issues for yourself. And theoretically it gave the a.s.sistant time to point out her faulty reasoning, though she wasn't about to take an opinion from the man responsible for this blunder. A careful decision was needed so as not to blunder again. It was often the second mistake that came in the haste to correct the first mistake that did the patient in.

"No choice," she said. "I have to cut." She put clamps across the stalk where it emerged from each infant's scalp. She invoked Lord Shiva's name, held her breath, and cut above each clamp, bracing herself for something terrible.

Nothing happened.

She tied off the stumps. She cut the umbilical cord and easily pulled out the first infant, a male. She handed it to the gowned and gloved probationer who stood nearby. This baby had been spared his father's probings. Then she pulled out the other infant-again a boy, an identical twin, whose scalp was bloodied from Stone's knife and whose skull would have been crushed had she not arrived.

Both infants were tiny, three pounds at best. Clearly less than full term. A month premature, perhaps more. Neither infant cried.

Distracted now by heavy oozing from Sister Mary Joseph Praise's soggy, friable uterus, Hema turned back from infants to the mother.

"What is her BP?" Hema asked, peering over the drapes, first at Nurse Asqual, and then at Sister Mary Joseph Praise's face. The anesthetist, the whites of her eyes showing like saucers, shook her head. Beautiful Sister Mary Joseph Praise's face now looked bloated and lifeless. "More blood! For G.o.d's sake. Pour it in!" Hema shouted.

As she toiled in the now deflated cavity of the belly, Hemlatha remembered that when she'd handed over the second baby to the probationer, she had been surprised to find the probationer still standing there, holding the first, a blank look on her face. But Hema had no time to worry about that. Once the babies were out, her duty as an obstetrician was to turn completely to Sister Mary Joseph Praise; her duty was to the mother.