Afternoon Heat

Vishwas R. Gaitonde

When I saw him after ten years, I surprised myself by instantly remembering who he was. In a busy general medical practice in an Indian metropolis, it is common to see a hundred patients a day, six or seven days a week. To remember one of them, whom I had seen only once, after ten years no less, made me respect the human brain anew.

But I had forgotten his name.

“Rangan, sir,” he said, and his astonished eyes seemed to ask: how could you have forgotten my name?

Ten years ago, I had a thriving medical practice in the Elephant Gate subdivision of Madras, as Chennai was called then. After the British converted Madras from a fishing village into a town, it was repeatedly raided by the neighboring local rulers, so the British built a fortified wall along the perimeter. The wall had many gates—Hospital Gate, Chuckler’s Gate, Ennore Gate, Pully Gate, Elephant Gate, to name a few. The wall had long since crumbled, not from the cannons of the invaders, but from the explosion of the growing city. Today, Elephant Gate was a run-down part of town where shabby residential blocks were entangled with dingy commercial establishments. The city’s main railroad station lay south of Elephant Gate. The soot that spewed out from the coal locomotives mixed freely in the sky with yellow industrial fumes from the factories in the north. Those who were content with their lot were happy to disclose Elephant Gate as their address. Those who aspired to move up were more circumspect.

I was just starting my medical practice then, and worked long, hard days. When I arrived home late in the night, my infant son would be asleep and my wife would be fighting to keep her eyes open. I wondered, sometimes sadly, whether I was married to my wife or to my practice.

When Rangan first came into my little clinic, I thought maybe I had seen him in a movie. He was the most dashing, debonair man I had ever set my eyes on. He was all of twenty years old, with a striking face and sharp, handsome features, smooth unblemished skin, and thick, black hair that was slightly tousled. And he was raven dark. In a country where most people would kill to have a lighter complexion, his swarthy appearance would have given any movie studio second thoughts.

He walked in with a slight swagger and told me that he wanted no interruptions during the consultation. I sent my clinic boy out and asked him not to let anybody in.

“Now what is this all about?” I asked.

Without a word, Rangan undid his trousers and let them fall to his ankles. He jerked down his underwear, gingerly lifted his penis and held it up to me. I saw it immediately, the small, lonely, oval sore on the tip. I switched on my pocket flashlight to inspect it closely. In the glare of the light, the sore seemed to shrink.

“Sometimes urine leaks out.” Rangan’s voice mixed disgust with reproach.

“The watery fluid you see is not urine,” I informed him soberly. I knew what it was, having seen similar cases as a medical student and a house officer. But how could I tell that to this young man who had innocently, or more likely, ignorantly, assumed it was a hole that leaked urine? How could I tell him about the corkscrew bacteria within, that, in the end, brought about nothing but lamentation?

I slipped on a pair of gloves, debating whether to slip on a second pair. The sore could be highly infectious, with the delicate but lethal spiral bacteria lurking in its depths. I remembered one of my professors informing us that in the early days, when little was known about syphilis, the English physician Hunter had deliberately inoculated himself with the bacteria in order to study the disease firsthand—a noble sacrifice for medicine, for science, in the true spirit of a mind eager to discover and learn.

“That’s what they say,” a student had scoffed. “But we know how he really got the disease, don’t we, sir?”

I needed to be careful, I thought. What if I contracted syphilis from him? But the second glove refused to fit over the first one so I gave up. First, I gently pressed Rangan’s groins and felt firm lumps—enlarged lymph nodes—as I had expected. The difficult part was to determine if the ulcer’s edges were hard or soft. Brief palpation showed that the tissue was firm.

“There’s no pain whatsoever,” Rangan volunteered, more at ease now than when he’d first come in.

I discarded the gloves. How was I to break the news? “Are you married?” I asked.

“No, not yet.”

“Who is the woman, then?”

“What do you mean, doctor?” He was clearly on the defensive.

“You have syphilis.” I was surprised that I said it straight out, plainly.

“No!” It was a whimper that almost rose to a shout. “It cannot be—not possible!”

“But it is,” I said.

Rangan’s face crumpled up, just like the glove I had discarded.

“I’m sorry,” I added, trying to sound gentle.

Rangan wrapped his face in his hands, his fingers tearing at the curls that had slipped on to his forehead. When he finally looked up, his countenance was bloodless; all the swagger had disappeared. His vulnerable side, which we all possess but keep corked and bottled up, was now showing. He softly said that he couldn’t have syphilis because he never had any dalliance with a prostitute, had never visited a brothel in his life.

“I had sex, yes,” he said. “A man has his needs, and has to give in sometimes. She lives next door. She is a married woman, a respectable woman. Not a whore who picks up and spreads diseases.”

I said nothing, but with my eyes I urged him to continue his story.

Rangan worked as a shop assistant in a cut-piece store, a store that sold remnants of fabrics obtained from wholesalers at a low price. The cloth was of good quality but came in uneven sizes. Enterprising shopkeepers could use them for odds and ends. Women liked to stitch blouses with the pieces to wear with their saris, and, quite apart from his duties in the shop, Rangan would ride down the lanes on his bicycle, selling fabric pieces, knocking on doors. Women could not resist the handsome man, and Rangan always made his sales. But a woman could only buy so many cut pieces, so Rangan also began to sell colorful lungis, the garments worn by men that extended from waist to ankle. He bought these in bulk from the merchants in Thambu Chetty Street and Angappa Naicken Street. The women happily bought them for their husbands, brothers, and sons, and asked their favorite salesman to keep calling.

The sections between the main roads in Elephant Gate were an intricate mesh of dusty by-ways and weathered buildings, sprawling glomeruli of human dwellings pulsating with life. The alleys were paved with broken brick or crumbling asphalt or, in some cases, were just dirt tracks. Rangan lived on the ground floor of a four-story apartment building in one such alley. Directly across the way was a three-storied building with balconies on the upper floors abutting into the alley. Anyone standing on the lower of these balconies could look directly into Rangan’s tiny room.

The city had gone through a series of sweltering days, the high humidity sucking the moisture out of everybody. After making one of his sales rounds, Rangan had decided to rest for awhile in his room before going back to the shop. He peeled off the damp shirt that clung to his skin; his trousers followed. He lay face down on his bed, stripped to his underwear, his smooth muscular body flecked with sweat in the afternoon heat. A power outage had rendered the fan nothing more than a rusty metal fixture on the ceiling. He opened the window for ventilation, though the hot air hung still, as though it was too tired to circulate. A few minutes later he had the uncomfortable feeling that he was being observed. He shifted the position of his head, swiveling his eyes to look out of the window.

She stood on the balcony, gazing directly at him with a roguish smile. She wore fresh jasmine in her hair, and a bright yellow nylon sari with a purple floral design, the semi-transparent kind imported from Singapore. He saw that she had dabbed talcum powder on her face but it was already glistening in places. Her make-up could not mask her age; she was many years his senior. When she noticed that he was looking at her, her smile broadened and a cheek dimpled.

The heat surged through his body. He had to get it out of his system; a shower would not do. Water might cool his skin, but it could do nothing to cure the heat within. That kind of heat, his friends had told him, could only be relieved by letting out his seed. Now as he felt the heat pass through him like a wave, the woman lowered her gaze, then looked up again.

“A respectable woman, doctor,” Rangan repeated. “Not a loose woman, not a whore.”

“But if she went to bed with you,” I said dryly, “she could have gone to bed with just about anybody.”

The young man looked thunderstruck at the thought. I asked him to dress; he had been sitting through all of the exchange on a wooden stool, with his trousers and underwear around his ankles. I explained that the condition was treatable with penicillin—that this was not as big an issue as whether he could control his urges. Rangan sounded confident, saying he had succumbed only once when his will power had supinely given in. He had learnt his lesson.

When I suggested that Rangan go to the Government General Hospital for treatment, he refused. “No, doctor,” he said. “They’ll put me on display there. When I went there for an ordinary chest infection, you have no idea how many students examined me—and the kinds of comments they made—and that was only about slime in the chest. I have no wish to be publicly humiliated, and before all the ladies too.”

“I’ll give you a prescription for penicillin,” I told him. “You’ll have to get it from a drug store and come here daily for ten days—I’ll give you an oosi each day. You mustn’t miss these injections. If this disease is untreated, it can affect your heart, your mind, your brain. It can….”

I stopped when I saw Rangan’s expression; it was cruel to flog a half-dead horse. Besides, he would more likely comply if he himself bought the drug, thereby paying in advance for the full course.

“I think you should get married soon,” I suggested. “Why, with your good looks, you are going to have a line of girls, all with their nets out to catch you.” His face opened into a weak grin.

“It was something serious, wasn’t it?” my clinic boy asked, after Rangan had left. When I did not reply, the clinic boy said, “That man skipped his turn twice, each time asking me to send other patients in, even those who had come in after him. Nobody does that unless something is really wrong.”

Now ten years later, Rangan was in my clinic again—my new clinic. In the intervening years I had moved my practice to Adyar, an upscale section of the city. My patients were mostly from the affluent middle class, and occasionally I saw a rich one from the posh seaside suburbs of Besant Nagar and Injambakkam.

It turned out that Rangan had also recently opened his own store near Adyar, a small shop that sold cut-piece fabrics, saris, and lungis. He had left Elephant Gate, too. He had passed by my clinic once, and apparently had made a mental note to drop in and say hello. Even though he did not come as a patient, I was glad to see him. He brought back so many memories of those old days. They were hard days, days of struggle, but it took the passage of years for me to see how essential they were in shaping me both as a physician and a person. My patients then were from the struggling working class, but they were open and unpretentious. I could explain to them in their language exactly what was wrong and what we could do about it.

Here in Adyar, many of my patients were somewhat familiar with scientific information through their discombobulated education as well as frequent and haphazard forays onto the Internet.

“Oh, so from what you say, it looks as though I am heading for a bout of gallbladder pleurisy, am I not, doctor?” one patient asked last week.

She looked at me as though I had to agree with her self-diagnosis; if I said anything else, she would eye me with grim suspicion and doubt. If it was indeed a gallbladder problem and I began to explain the condition to her, she would cast, instead, a bored “I-know-all-this, Doc; can-we-get-it-over-with” look. If I assumed that she did know it all and therefore did not explain, as I normally would have, and, in fact, she didn’t actually know it all, then she would not have vital information, and of course, I would be held responsible. My Adyar practice had certainly padded my bank account—but oh, for my simple Elephant Gate patients! Rangan’s sudden appearance made me momentarily wonder whether being in Adyar was even good for me, at all.

Some people are likeable; you take to them from the first time you meet them. Rangan was like that—and so it was not just because he opened my memory gates that I was glad to see him. Moreover, this time he had not come by himself. He had brought his wife along to introduce her to me. I looked at her with surprise, for she was small and petite compared to the broad-shouldered Rangan. She was like a delicate china doll displayed in a showcase in the living room. Rangan told me, in a surprisingly shy manner, that they were expecting their first child soon.

“That’s great. My congratulations.” I pumped his hand warmly. We talked more as my clinic boy chafed, no doubt at the crowd swelling in the waiting room. But old acquaintances seldom drop by. In any case, most of those waiting were hypochondriacs, and the rest had no life-threatening conditions. So we talked more, and when Rangan and his wife left, I told them they could call again whenever they wanted.

The intense heat during the peak of summer—known as the kathiri days—can also be erratic. The heat scorches the earth during the day, but with sundown, one expects the heat to dissipate. And it does—but sometimes its remnants linger into the late evening and even the night, catching people unawares. I have never forgotten how I went for an evening walk one Sunday, along the beach, enjoying the refreshing sea breeze dancing on my face. When I sat on a low stone wall to rest and regain my breath, I jumped up quickly. The wall had absorbed—and now was radiating the afternoon heat fiercely, even though the stars were bright in the sky.

Summer sapped the energy out of us all, the patients in the waiting room under a whirring fan and I in my consulting room. On one such summer day, Rangan came to my clinic again. I was shocked to see him. Gone was the new, confident Rangan; he looked as whipped as he did in my old clinic ten years earlier when I had told him he had syphilis. He held a manila folder in his trembling hands.

I made him sit down. It took me some time to coax him to speak. When he finally did, the story came out in a flood. His wife had delivered a boy, but the baby had been underweight and sickly from birth. The doctors and nurses had performed all kinds of tests on his son and discovered that he was HIV positive. Then they had tested Rangan and his wife, and both of them were harboring the virus.

Rangan handed me the manila folder. It contained copies of the laboratory reports, the implications clear at first glance, but I could pretend to scrutinize them carefully while I gathered together the my fragmented thoughts. Many years of medical practice had still not honed my skills on how to console a shattered patient. I often wondered if I would ever master this art in a lifetime of practice. I nonetheless had to make an attempt. I reasoned that parents of a first-child would be the most disconsolate about their infant, so I tried to give him a glimmer of reassurance about the baby.

“I don’t think the doctors can say with certainty that your baby has the infection, Rangan. The test they have done—ELISA test—detects antibodies, substances that the body makes to fight the invading germ. These antibodies circulate in the blood, and what was detected in your baby’s blood could have come from his mother. When your baby is one and a half years old, and if the antibodies are no longer there, then we can be sure that the child is not infected.”

“The lady doctor told us the same thing,” Rangan said, referring to the obstetrician. “But she also said that the baby was showing other signs—skin rashes, sores in the mouth, not gaining weight—she said all of these were no good at all.”

He looked into my eyes steadily. It was I who had to lower my gaze as he continued to speak. I thought of my son, in elementary school now. I still did not spend as much time with him as I would have liked. But at least he was healthy, a blessing that would be denied to Rangan’s son.

Rangan’s words interrupted my thoughts. He said the obstetrician had had a long talk with him, and when she learned that he still had contact with the doctor who had treated him for syphilis, she urged him to see that doctor once more.

“The doctor thinks my family has been infected because of me. She seems sure I got it through sex, not through any of the other means. And I think she was doubtful whether I would be open with her about…about other women, because she asked me if this previous doctor of mine was a man.”

So he had been sent here for a man-to-man talk about his sexual escapades, I thought.

“Rangan, after that syphilis episode, you promised me you would never go for such things again.” I tried to keep my voice neutral, without any indication of reproach.

“But I didn’t!” His eyes looked glazed and his voice had a shrill edge, but it also had the ring of truth. “That was the one and only time before I got married.”

“Then how…” My voice trailed off as the situation crystallized in my mind. In that one encounter in Elephant Gate, Rangan had become infected with two organisms—the bacterium of syphilis and the virus of AIDS. The syphilis bacteria had revealed its true colors immediately, but the virus had not.

Years ago, I had been able to help Rangan with his syphilis. We had penicillin, the king of antibiotics then. But there was no such rescue from this virus. What was passing through Rangan’s mind as he looked at me? That I, the doctor, was staring at a living corpse?

Rangan could never afford anti-retroviral treatment. Even as a super salesman, he must have needed a loan from a bank to open a shop in Adyar in so short a time. The expensive anti-retroviral drugs needed to be taken life-long, however long or short that life might be. Not just Rangan, but also his wife, and the child, assuming that he survived infancy, what with cholera, typhoid, dysentery, pneumonia, and the other portentous ailments lurking in the alleys of the city. And without medicines, Rangan would have to quickly accept the idea that he was going to die, as would his wife and his newborn child. But nobody could know in which order they would go.

Suddenly my practice of medicine had opened up like a precipice on a mountainside, and I was filled with vertigo and fear. My practice now stretched beyond the recording of symptoms and the prescription of remedies, beyond elixirs and radiation and cutting and suturing—it had expanded into something breathtaking, indeed terrifying, diabolic. One little slip, one human miscalculation on a hot summer afternoon, and a life was destroyed, a family destroyed. If it happened often enough and widespread enough, a nation could be destroyed.

I knew that I would be forever haunted by this vision of a dark and handsome young man lying on his bed stripped to his underwear, his smooth muscular body flecked with perspiration, his eyes locked with those of the woman across the street who beckoned to him in the afternoon heat.