But I knew that here I was in sole charge, and I had to make an immediate decision. Even though it seemed strange to me for a moment that the director of a big, modern hospital, with the best medical minds at his disposal, should be standing here anxiously with his wife in a dark little chamber in a Buddhist monastery at the end of the world, completely dependent on the professional opinion of an inexperienced young resident, who had not yet examined the patient properly but only touched her lightly on the forehead to feel her temperature and felt her neck a little, I stood up to announce my decision.
“We have to perform some essential tests immediately,” I explained, “so we’ll know where we are and where we’re going. Even though her condition’s not great, she can be moved. But before that we have to find out a few things, such as the bilirubin and glucose levels, in order to learn how much damage has already been done to the liver. But there’s no need to return her to the hospital; we can obtain the samples on the spot and take them to Gaya. In the meantime, I suggest we find a better room and move her into it. She shouldn’t be left in this squalor.”
A smile now hovered on Lazar’s wife’s face — not the familiar smile, which still confused me by its ready appearance, but a more inward and personal smile, as if she were wondering at the authoritative tone I had suddenly adopted (which, to tell the truth, originated with Professor Hishin, who always used the first-person plural when he came across a patient or the relative of a patient who appealed to him particularly). The two Japanese girls came out of their corner, bent over the gas burner, and offered us some of the pale tea they had brewed. Lazar’s wife hesitated, but Lazar declined the offer, in a hurry to rush off and obey my orders by finding a decent place for us to stay. “You can all wait for me here,” he announced. His wife seemed upset by his urge to depart, quickly stiffened, and said, “Just a minute,” and Lazar said, “What’s the matter?” and she replied, “Perhaps I should come with you.”
“But why?” asked Lazar. “There’s no need.”
But she insisted: “No, I think I should come along to help you.” She was already bending over her daughter to kiss her, and promising, “We’ll be back soon.” Then she turned to me and said, “You stay with her, and if possible start your tests, and we’ll be back right away.” So saying, she went off with her husband, evidently unable to remain alone not only with me but even with her daughter.
Einat was still lying hugging herself with both arms, scratching and rubbing, sending me a quiet look from eyes as yellow as a tiger’s or a hyena’s. But in spite of her obviously poor physical condition, I felt no pessimism, for I knew that I had already gained her confidence by the way I laid my hand on her head and felt her nape and neck. From the minute Hishin told me about her, I had harbored the suspicion that I was being sent to an apathetic patient who had lost the will to recover and might even resist my efforts to help her. But it didn’t look as if the young woman lying here would be able to mobilize any resistance; she was too absorbed in her frenzied scratching, and she was eager too for strange hands to touch her and even to take part indirectly in the frantic scratching. But I didn’t want to hurry to work yet, and although it was beginning to get dark, I first drank the bitter, scalding tea offered by the Japanese girls and asked them to tell me about themselves. They told me that they had arrived in Bodhgaya two days before, directly from Japan, to take an advanced course in meditation in the nearby Japanese monastery, and since there had been no room there they had come here and been given a place to sleep with the sick girl, on condition that they look after her a little. They had tried to take care of her needs without getting infected, and wore cloth masks when they touched her. Yesterday they had taken her into the inner garden of the monastery and fed her the rice gruel that they had cooked for her. But her itch was severe, and the ointments the monks had given her didn’t help, and had I brought some good medicine with me? they asked, as if I had come all the way from Israel to treat an itch. “Maybe,” I said, “we’ll see,” and I opened the knapsack and began emptying its contents onto the blanket they spread out for me, angry with Lazar’s wife for not staying to help me undress her daughter. But the Japanese girls were very helpful; they brought me a big flashlight to supplement the dim light of the bulb, and then they sat Einat up and helped me take off her stained white robe, and supported her thin white back while I knelt and passed the stethoscope inch by inch over her back and chest to auscultate her lungs and see if they were clear and free of liquids, and of course to listen to her heartbeat, which was completely regular. The two girls watched my examination, pleased that somebody had come to relieve them of the responsibility for the patient, who had been entrusted to their charge maybe as a kind of religious test imposed by the monks. I nodded my head in satisfaction and said to my patient, “Everything sounds fine, Einati,” adopting the pet name used by her parents, and then I laid her slowly on her back to feel her abdomen, which was hard and covered with red marks from her incessant scratching. To my surprise, her inflamed liver, which should have been enlarged, appeared to have shrunk so much that it was difficult to palpate in the flat, hard abdomen, as if it had already begun to degenerate. At first I was alarmed, but I immediately said to myself that degeneration couldn’t possibly have occurred only two months after the outbreak of the disease. The gall bladder did seem enlarged, and was apparently also inflamed, for the slightest pressure from my fingers was enough to make Einat scream so loudly that the Japanese girls averted their faces. Footsteps were quickly audible in the corridor, and a shaven-headed monk in a robe the color of the setting sun came hurrying up to discover the cause of the scream, which had echoed through the quiet monastery. He spoke no English, and I asked the Japanese girls to explain that I was a doctor from Israel who had come with the girl’s parents to take her home.
But the monk remained standing in the doorway, as if he were unable to grasp the connection between my words and the scream of pain uttered by the woman lying half naked on the floor. I felt suddenly disheartened at the possibility of losing my patient’s confidence, and rage at Lazar’s wife’s desertion welled up in me for her. I decided to interrupt my clinical examination and postpone the palpation of the spleen and kidneys to another time. I would have plenty of opportunities later, I said to myself, and so I changed the dressing on the wound on Einat’s leg, which seemed to me infected but not serious. I put her stained white robe back on and tried to reassure her. “Don’t worry, it’s only an inflamed gall bladder, which is quite natural in hepatitis.” Among the medications I found a tube of cortisone ointment, which was supposed to relieve the itching, and allowed her to rub it on her arms and abdomen herself, warning her not to expect anything more than temporary relief, since the unexcreted bile salts accumulated under the skin and the itching could be relieved only from inside. But she thanked me gratefully. While she smeared herself with the ointment, assisted by the Japanese girls, I asked one of them to bring the flashlight closer and prepared to draw blood. I have to admit that it gave me a kick to see them all, including the Buddhist monk, frozen in their places as I tightened the rubber tube around Einat’s thin arm, looked for a vein, and gently and slowly extracted a syringe full of blood. Not content with one, I took another one and filled it too. As long as she’s lying here quietly, I thought to myself, I might as well get two — who knows, a test tube can break or become infected; the blood’s flowing now, and who can tell what might happen tomorrow?