Tuesday, July 10, 2007

The Child That Lived

(This is part of a medblogging fiction project conceived by Maria who asked bloggers to write a medically-related story about the picture below.)

It started as an itching in the feet. One day I was fine and the next it was as if my soles were on fire. An angry red eczema had spread over the surface of both feet scorching through the skin. It was all I could do to rush back from the clinic, rip off my shoes and socks and rub some calamine lotion into the rash to ease its pain. The agony was unbearable.

I was working, at the time, in a small village in Tamil Nadu. It was a sleepy South Indian hamlet with wide skies and fields of undulant green that spread out to the horizon. Small clumps of coconut groves broke up the view and in the evening the tops of the trees could be seen jousting with children’s kites in the slow spill of dusk. I stayed in the doctors’ quarters, a scattering of huts set at a small remove from the primary care clinic where we trained, and in the evening we would sometimes sit outside, watching the shepherds bring their flocks home in the twilight.

It was a beautiful place and I was glad to be there. It afforded the perfect opportunity for my troubled mind which, newly released from medical school, couldn’t settle on what field of specialization to pursue. I had trained in a big urban hospital, thick with chaos and unending streams of impoverished patients whose only understanding of disease meant the brief period before death. Their apathy, and the apathy of the system towards them, had borne down on me until I too, like my colleagues, absorbed and relayed the gestures of diagnosis and treatment with anesthetic kindness, observing a mute sympathy through the mechanics of delivering care and then going home to not weep. It was not what I wanted, not what I had gone to medical school for, and insidiously it began to choke me until I felt I had to escape.

This small village, with its bucolic charms and simple patients, was the perfect antidote to that madness and, had it not been for my excoriating case of dermatitis, life would have been bliss. I was sitting outside the doctors’ quarters one evening ruminating on this minor tragedy when Sam Verghese joined me. Sam was one of the family medicine trainees, a jovial and easygoing doctor whose ambient attitude to life was a perennial source of admiration for me.

“Hey, doc!” he said as he walked up. “How does it look?”

“Ugly,” I replied. “But I think I’ll live.”

“I suppose you’ll have to. I need you to help me with some revision. Malathi called.”

Malathi was Sam’s fiancée. I had met her once, a stern and studious girl with a sharp temper for incompetence. How she put up with Sam’s antics was beyond me but that the two were madly in love there could be no doubt. All night long I could hear him cooing and purring into his cellphone through the thin walls of our joint quarters.

“Yeah, she asked me about cri-du-chat syndrome,” Sam went on. “How the hell am I supposed to know what that is! Do you know?”

“It’s a chromosomal disorder. Breakage in chromosome 5. The baby sounds like a cat,” I rattled off like a parrot.

“Damn! How am I supposed to know that!” he complained. “You know what their problem is?”


“Wimmin’s!” he said in exasperation. “They think too much.”

“Maybe you just need to study harder for your boards. Malathi’s serious about this stuff.”

“Yeah, I will but still, she needs to takes it easy.” Apparently he’d been told off quite bad.

“She works hard and expects . . . hey, what’s that noise?” A thin mewling sound scratched through the air.

“Probably a cat,” Sam said dismissively. “So what if she works hard? Don’t I work hard too?”

“No, it sounds like a baby,” I said, trying not to answer the question. The sound was growing insistently louder.

“What?! Now you’re going to tell me it’s cri-du-chat!” He was irritated.

“Let’s go see.”

“No, you sit here. I’ll go see this phantom cat. Or baby.”

He got up and walked out of the compound, returning a few moments later with a small baby wrapped up in a thin towel. A large black nevus scalloped the right side of its face. One hand gripped a grimy ten-rupee note.

“You were right,” he said. “It was a baby. An unwanted baby.”

“What do you mean unwanted?”

He pointed to the money. “It was abandoned.”

I stared stupidly at this realization.

“Thank God it wasn’t a girl,” Sam said softly.

“What do you mean?”

“If it was a girl she would have been killed.”

“What?” Did he just say killed?

“I said that if she was a girl and she looked like this she would have been murdered by her family.”

“That’s impossible. These things don’t happen in this day and age.”

Sam looked at me as if I was an idiot.

“Where do you live?" he said incredulously. "This region has one of the highest rates of female infanticide in the country. Go talk to the nurses. They will tell you stories that will make your skin curl.”

“I don’t believe that.”

“Oh really? Let’s ask Sister Karuthamma. Excuse me, Sister!” he shouted calling one of the senior nurses over to where we were sitting. “Could you please come here?” Sister Karuthamma had been with the clinic for almost two decades and knew personally almost all the patients who came there.

“We have a gift for you,” Sam said, handing her the child and its money.

“Oh, poor baby,” the nurse said tenderly. “Where did you find it?”

“Outside the gate.”

“Thank God it wasn’t a girl,” she said automatically.

“What?” I repeated, still in persistent denial. Sam looked vindicated.

“If it was a girl, she would be dead,” Sister Karuthamma said plainly. “They kill female children here. They’ve been doing it for ages.”

“That’s illegal!”

She smiled grimly at my outburst. “This is a small village and it’s an open secret. When the police constable himself made his wife mix poison into their daughters’ milk, who will you complain to.”

I couldn’t say anything.

“Sometimes it’s poison, sometimes sleeping pills. Some mothers feed the baby a spoonful of castor oil with a single husk of rice which slits its throat as it passes down. Others just strangle the girl.”

“But why!” I could hear, in my mind, the sickening click as the tiny bones were pressed and crushed.

“It’s the dowry system. Girls are expensive, a permanent burden on their families. Boys on the other hand are believed to bring prosperity into a house. Of course, not all boys,” she said sadly, looking at the baby in her lap.

“Why doesn’t the government do anything?”

“They are trying to but the practice is embedded in the culture. It will take a lot of dedication, a lot of young blood to bring about that revolution. And some doctors can’t seem to decide what to do with their lives,” she said wryly, looking me straight in the face.

I saw what she was trying to say and felt an embarrassment burn inside me. “Let me hold him,” I asked.

She passed the child into my arms. It had fallen asleep as we were speaking, comforted by the maternal warmth of Sister Karuthamma’s lap. I felt its head rest against my shoulder, the perfect contours of its shame snug against the curve of my neck.

“Let me go and get some milk,” Sister Karuthamma got up to leave. “I hope you’ll think about what I just said.”

She was looking straight at me again with a penetrating clear-sighted gaze that could only have been earned through a career of unflinching dedication.

“I don’t think I can ever forget,” I told her, suddenly clear about the years ahead. "Thank you."



1. While this is a work of fiction, the details about female infanticide are all true and have been derived from Gita Aravamudan's stunning analysis Disappearing Daughters.

2. The use of Sister as a designation for nurses is a common practice in the sub-continent and probably dates back to a time when the nursing care was delivered by nuns.

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