Leonore Williams was the last patient on the morning schedule. The 78-year-old woman had been referred from a downtown free clinic. Dr. Sid Narayan reviewed the chart and radiological studies prior to the consultation. The clinic progress notes recorded that in the last three months, she went from spry agility to a cane, and then a walker. The brain scan showed a large vascular tumor in the cerebellum, pressing against her brain stem.
As Narayan reviewed the brain scan, he recalled how almost forty years ago, at the beginning of medical school, he had dissected a cadaver brain along with his classmates, pulling apart each cerebral convolution, down the falx, and past the tentorium to reach behind the brain stem and split the arbor vitae, the leafy divisions of the cerebellum. He remembered that initial wonder. The universe was all that existed, but those pale lobules and leaves contained even more, all that could be imagined. If a single blossom in the garden was a marvel, then those branches, so strangely beautiful, were beyond comprehension — truly miracles. But now, all that mattered for this elderly woman was to lift the hind bone safely off the major veins without injury and then to find the margin between tumor and brain stem. Thoughts about the origin of mind were best kept to a safe library.
Narayan introduced himself at the waiting room door and walked alongside Leonore down the corridor. Her front-wheeled walker clattered with each wobbly step she took. She plopped down in a chair by the sink in the examination room as if exhausted by the short walk. Narayan faced her on a chair by the large mahogany desk. Through the partially opened window blinds, sunlight glittered across the bay and lit up the eastern hills. The noon heat had dissipated the earlier mist.
“What nationality are you?” was her first question. The question was not unusual, but it still surprised him. Patients could read the diplomas on the wall, and they had been referred based on his qualifications and surgical results; but some patients seemed to need additional assurance that he was on their side.
“I’m American but my family was originally from India,” Narayan explained. “I was born in Africa.”
“A regular United Nations,” she said, sarcasm dripping in her tone. Narayan doubted that she approved of the organization.
She thinks her pale skin makes her belong while others do not, Narayan thought. “There are so many immigrants in America,” he said. “It’s best to view people as individuals, not members of an ethnic group.”
Leonore seemed to ignore what Narayan said. “I’m sure glad you isn’t Arab.” She stressed a long A.
“Why do you say that?” Narayan asked, but then soon regretted requesting an explanation. While he wished she could see him as a fellow American rather than as a foreigner who happened to live in America, he had realized that racism ran deep in some people. No assurances from his end were going to make this conversation easy.
“You got to be real careful what you say around them Arabs. They could kill you for anything.” She lowered her voice and turned her head around as if someone in the corridor might hear.
“Maybe you should not use exceptions to stereotype an entire group.” Somehow, he had to extricate from this line of conversation but he was not sure if logic would do the trick. He tried changing the topic.
“I’m glad you isn’t Mexican either. You got to be so careful with your cash and credit cards.” Her voice was steady and calm as if this was a normal discussion for new acquaintances to have, the perceived faults of various ethnic groups. Narayan was dismayed by her xenophobia but knew that he had to focus on her brain tumor irrespective of her outlandish opinions.
“Let’s concentrate on the reason you are here,” he said, trying to steer the conversation back to what they needed to talk about during this clinic visit. Maybe an appeal to her self-interest could redirect her.
Leonore kept on talking as though she hadn’t heard him. “I’m truly happy you isn’t Chinese. You got to be careful with your dogs and cats. Them Chinese eat everything in sight. Look at all them viruses and what-not came over from the markets in China.”
Did the tumor cause her to perseverate, to continue with one line of thought beyond what was reasonable? Narayan knew that he could not be confused for someone Chinese. At her age, she could have pre-existing senile dementia and additionally, on the scan there was early hydrocephalus, a buildup of fluid in her brain ventricles.
Narayan dispensed with details of her medical history and went directly to the neurological examination. On each side, when he asked her to touch her nose and then his index finger, she overshot his finger and touched the side of her nose rather than the tip. She had nystagmus: her eyes beat with an oscillating rhythm when he asked her to follow his index finger horizontally and upward. Narayan explained the surgery and the possible complications. Leonore readily consented and asked to be scheduled as soon as possible.
“Doc,” she said. “I trust you.”
“Thank you,” Narayan said. “The whole team will work hard to deserve your trust.”
Narayan walked with Leonore towards the waiting room. At the front desk, she asked: “What about the fishyitis.”
“What?” Narayan asked incredulously. He had no idea what she was talking about now.
“The fishyitis! The pain and swelling in my feet.”
“Oh. The plantar fasciitis.”
“My feet are killing me.”
“We can refer you to a podiatrist but for now, Leonore, we should focus on the more important issues like the tumor in your brain.”
“Sure, Doc. You’re the best.”
Dr. Narayan had lunch alone in his office as he reviewed emails. He had packed leftover grilled vegetables and saffron rice from last night’s dinner. Leonore Williams’s xenophobic tirade triggered Narayan to reflect on his family’s journey through four continents.
He had been in America for many years and considered himself an American. However, his family had fled Uganda in 1972 after the 90-day notice from Idi Amin that expelled the thriving Asians. In the United States, it was the year of the Watergate scandal. At the Munich Olympics, eleven Israeli athletes were murdered by Arab terrorists. The Godfather movie epic premiered in New York City. For Narayan’s family, 1972 was the year for choosing sides.
Narayan was ten years old at the time and his younger sister, Priya, was four years younger. Their father was a tailor, and their mother helped in the shop on Kampala Street. Their parents did well enough to open a second shop and own a red tiled villa overlooking Lake Victoria, a new Fiat Sedan, and a television. At night, they lay on straw mats on the veranda so that the breeze up from the lake kept them cool. The balmy air gently vibrated with the sounds of water rippling through the reeds and the sharp tone of crickets.
In the mornings, Sid and Priya stood at a corner of the veranda and imagined that they were at the prow of a great ship that could power out of the lake at the center of Africa, down the Nile River, and even further across the open ocean to distant lands. From where they stood, sunlight glinted on the lateen rigged sails of the dhows, and they heard the distant muezzin call to prayer. An open-air market was at the bottom of the hill and merchants set up colorful umbrellas that protected piles of pineapple, melons, and sugar cane from the blistering sun. At the pier, fishermen unloaded their long wooden boats with freshly caught perch and tilapia.
In hindsight, they did keep too much to themselves. The Asians had their own schools and temples. They ate their own foods with recipes passed from mother to daughter over the generations. Outside the house, they always spoke English. They understood but did not speak Swahili let alone the local Bantu and Nilotic languages. None of their many cousins had intermarried with black Africans. The Asians had a rigid code of conduct based on honor and reputation. In the final week, mobs had thrown rocks through the windows of Indian merchants.
They had taken just what they could carry and been transported in a relief flight to London. At the end of one year, they made their way to California to join relatives in San Francisco. Their mother’s cousin worked as a nurse at the Veteran’s Hospital, and they initially shared a rented apartment with her in the outer Sunset District. They ate rice with lentils for most dinners along with cut vegetables or fruits that were in season. Bit by bit, they pooled enough money to buy a duplex. Their parents stressed that in America if you worked hard and got a good education, then you could do anything. You were not limited like in India or Africa by your father’s station in life.
In middle school, Narayan was the only recent immigrant. Once, an older boy bumped into him in the hallway.
“Are you black or white?” he demanded.
“Neither, I’m a golden shade of brown.”
“Like chocolate, right?”
“More like caramel.”
“Or like shit?”
“Like caramel. Dulce de leche is my favorite ice cream flavor. What’s yours?”
“So, you’re Mexican,” he concluded. “Do you also like tacos, Paco?”
“No, I’m not Mexican, but I do like tacos, enchiladas, and most every Mexican food. So delicious. I’m getting hungry.”
“You must be half and half like milk chocolate.”
“No. Pure caramel.”
“Are you Arab?” He also stressed a long A just like Leonore. “Where’s the rag for your head?”
“No. I’m not Arab. Anyway, most Arabs don’t wear the rags. They call it a keffiyeh.”
“You think you’re smarter than me, don’t you?”
“I don’t know you.”
“Are you a faggot, caramel boy?”
“No. I like girls but that’s not your business.”
Just then, Narayan was able to dart into English class. He stuck out his tongue and the older boy made a fist. They were reading Lord of the Flies in class. He wondered if he would turn out like Ralph, Simon, or Piggy. Maybe he had just met Jack.
One day, a history teacher asked him to stand up during a current events discussion.
“Did your family take sides in the Indo-Pak war?” the teacher asked.
“My family was originally from India, but I was born in Africa.”
The teacher’s question seemed quite ridiculous at the time. They were in America now and hoped to become citizens. Why would he be thinking about India and the war? Why did they have to choose sides in distant foreign wars?
“But whose side were you on?” the teacher insisted.
“I believe we favor India. Just like American Jews favor Israel over the Arabs.”
“Where’s your turban?” a classmate asked. Several classmates sniggered.
“Sikhs wear turbans. We are not Sikh.” Narayan had thought the discussion was about the war, but it was really about him then.
“Does your mother have a red dot on her forehead?” another classmate asked.
“Sometimes she wears a bindi. The red dot is called a bindi and represents honor and love to Hindus. But we do respect all religions.”
“I think bindis and saris are pretty,” offered one girl with freckles on her cheeks and the tip of her nose. That was nice of her, Narayan thought. There was more sniggering from the others.
“Do you have an elephant?” asked another classmate.
Narayan sighed.
“I ride her to school each day. She waits for me in the parking lot. Sorry about the dung.”
During his school years, Narayan never lost sight of his duty. His role was to star in class and establish his family’s success in the new country. Now, when remembering this past, he did not look back on those years as a grind because he enjoyed his studies. There was a satisfaction in unfolding the logic of the Periodic table or the Krebs cycle. There was pleasure in the discovery of new words and their connotations in the assigned poetry and novels. Initially, he approached each body of knowledge with an enthusiasm that did not make distinctions between what was useful and what was luxury. In college, he attended each class punctually, worked at the library front desk for two hours each afternoon as part of his financial aid package, and then studied until about midnight. By the end of college, he focused on medicine as a realm of knowledge that was not only interesting to study but also vital to the lives of individual people.
By the third year of medical school, Narayan dedicated himself to a career in surgery. With surgery, the results were immediate, and success or failure apparent when you laid down the knife. The skills of surgery became a part of who you were, and you could take pride in each aspect — making a precise incision, controlling the bleeding, removing the tumor or hemorrhage, and leaving a neat scar when you closed. From his youthful vantage point, neurosurgery seemed the pinnacle of medical achievement, one human being using their own brain power and surgical skill to actually operate on the brain of another. His path was clear.
On the bookshelf across from his desk, there were framed family photographs and anatomic models interspersed between the thick medical texts. On the topmost shelf, the most recent picture was of Narayan’s eldest daughter, Radha, holding Maya, the first grandchild. Next to her and with an arm around both of them was his wife. The family photograph was flanked on one side by a skull model. The cranial vault was attached with a brass clasp like a treasure chest that when opened revealed the convolutions of the brain.
During the middle of his surgical internship year, Narayan came home on a rare free weekend to have dinner with his parents. Priya was away at college. His mother had prepared butter chicken curry, cauliflower dal, and biryani with nuts and dates. She waited until Narayan filled his plate and sampled each dish. He smiled gratefully at her and continued eating.
“There’s a lot more to life than studies and work,” his mother began and nudged the bowls of food towards him. Her hair was pulled up in an efficient high bun and she wore a casual cobalt blue salwar kameez, an Indian outfit with loose pants and a flowing long shirt.
“I know that,” Narayan nodded. He had endured similar conversations several times.
“You should have a stable relationship with a good young woman,” his father said. Narayan remembered when his father towered high above him. Now Narayan was four inches taller. His father used a cane due to the arthritis in his hips and knees.
“I’ve had relationships,” he said, recalling that neither of those had been genuinely accepted.
“A good relationship,” his father reiterated. “Permanent and the foundation of a family. A marriage with a nice Indian girl,” he emphasized.
“So, you are at it again? Indian has nothing to do with it. When I fall in love and marry a girl, she might not be Indian.”
“Love is only part of it,” his mother said serenely. She seemed more confident than in prior such conversations, Narayan thought, and this was disconcerting. “There are families involved,” she continued. “Love can happen over time.”
“We are getting on in years,” his father added. “We want to see our only son settled. There should be children playing and laughing in this house again. Once you are settled, then we can focus on Priya.”
“We don’t have to be settled like potted plants. We both want to marry for love. If you’re trying to arrange a marriage for me again, then please get that idea out of your mind. I will never agree to that. It’s archaic and idiotic.” Narayan felt harassed again and tried not to raise his voice.
“There’s no need to call names,” Narayan’s father responded calmly but his bushy grey eyebrows came together as he frowned.
His mother and father worked in precise tandem, Narayan thought. They prepared this game plan to gang up on him.
“We could die any day now,” his mother interjected.
“You’re perfectly healthy and there is no hurry for me to get married,” Narayan insisted.
His mother got to the point. She did not want Narayan to get up from the table and isolate himself in his room. “Anika Aunty met a beautiful young nurse who just finished her degree and will start work at the trauma center. Here is her picture.” She placed a passport-size picture on the table between the dal and the biryani.
Narayan looked and turned back to his food but then had to glance back. His mother smiled triumphantly. She knew that she finally held the royal flush in her hands. She had revealed the queen trump card.
His mother had tried the photograph trick from Anika Aunty before. Anika Aunty sponsored them years ago when they emigrated from Uganda, and Narayan respected her. But he had never given the pictures a second look before. This girl was different. In fact, he thought, she might be the prettiest girl he had ever seen. He had to admit that he had not had the best luck in dating relationships. His one-time romance with his college girlfriend hadn’t worked out. She had moved back to Connecticut and the long-distance relationship fizzled out soon after.
“So, would you like to meet Kamala?” his mother asked.
“One meeting would be alright. Don’t get your hopes up.”
His mother actually giggled. Narayan still remembered how irritated he had been at the time.
“Sure, son,” his mother said with another chortle. “We only hope for what is best for you. Kamala’s parents will bring her over for dinner tomorrow. Of course, Anika Aunty will come to help with the introductions.”
Thirty-four years later, their daughter Radha had Kamala’s sloe eyes and raven tresses. Their son, Mohan, had her slender build. Now that their two children had grown up and left their own homes, the large house echoed like a sepulchral chamber until the grandchildren visited. In the garden, the corners were marked by an idle hammock, an empty kennel, and a silent basketball hoop. The garden flickered with memories of children playing hide and seek or tag until night fell and their mother called, leaning on the parapet of the balcony, her long black hair unfurled like a flag. Last autumn, Narayan and Kamala bought two plots at the local cemetery. There was a view of the bay and the city. They would eventually lie side by side forever, where on the marble stones, the grandchildren could place flowers that the deer might eat.
Over the last few years, Narayan had seen more immigrant families in the clinic. Some were likely refugees, but he did not ask. Many were Mexican, Chinese, or Arab — all the nationalities of Leonore Williams’s tirade. Some left Muslim countries and the women wore hijabs or chadors. A few even bore the facial scarifications of the Nile tribes that he had seen in Kampala so many years ago. Unless they asked, he did not reveal his family’s immigration story, since that was irrelevant to his task of healing them. They did not know that when he heard their flowing cadences, he recalled the lake at the heart of Africa, the lateen-rigged dhows, and the distant muezzin call to prayer. They knew he belonged to a different tribe. Eventually, everyone chose sides.
After lunch, Dr. Narayan joined the neurosurgical team on a surgical case already in progress in the OR. Mathew Trujillo, the chief neurosurgical resident, had already performed the craniotomy and elevated the bone flap to reveal the midline tumor. The tumor abutted the sagittal sinus, the main venous outflow of the brain that ran from front to back. Trujillo, a graduating resident soon, was fully competent now and could do the case by himself. Narayan was careful not to take over the case since the residents had to learn. He cored out the central part of the tumor with an ultrasonic aspirator and peeled the medial aspect off the sinus. He left the rest of the tumor removal and the closure to the resident, though still under his watchful eyes. All these years in this career, and it remained a marvel to him that a patient could undergo such an extensive exposure of the brain and remain neurologically intact afterwards.
Narayan and Kamala spent the evening at their daughter’s house. Radha was in her sixth year of graduate studies in chemical engineering and did most of her thesis writing from home. After dinner, Narayan turned the pages of picture books for his granddaughter Maya who was five years old. Through the window shades, the pale moonlight streaked the wooden floor.
“Have you been to the moon, Grandfather?” Maya asked.
In the child’s café latte colored skin and the gray shadings in her eyes Narayan could see the future. Radha had married a white graduate student six months after she graduated from college. Michael was an assistant professor in the department of molecular biology and was working late.
“No. Only a few brave astronauts in their rocket ships have gone to the moon.”
“Is it very far, Grandfather?” Maya’s ambiguous beige complexion was so common in the bay area. Narayan hoped that his granddaughter would not have to choose sides as he had been expected to do in school.
“Yes. Too far for ordinary travel.”
“You could do it. Can you take me?”
“Sure. Why don’t we go to Mars while we’re at it?”
“Mars, what’s that?”
“A planet. There are eight planets that revolve around the sun. The earth we live on is one planet.” That delighted Maya and she clapped her hands.
“Did God make the planets?” she asked.
Narayan was uncertain about the answer to that question.
“Busy God,” Maya continued. “Maybe many Gods for many planets.”
“I don’t know about that,” Narayan said.
Kamala interjected to help him out. “We don’t have to go to other planets to see amazing places,” she said. “There are so many beautiful places on this planet that we could visit.” She still had a slim figure and dark lively eyes. There were fine wrinkles below her eyes and at the edges of her lips.
“Where should we go?” Maya was overjoyed.
“We could go to Africa to see the wild lions and elephants,” Narayan suggested.
“Oh, no. The lions might eat me.” Maya’s smile disappeared.
“I see. Then, we could go visit the Grand Canyon, a huge canyon carved by a great river over millions of years.”
“Is it very big?”
“Yes, enormous and about one mile deep.”
“Oh, no. I might fall in.” She looked downcast and frowned.
“Then, if you are scared of wild animals and deep canyons, maybe we should stay closer to home.”
“Where should we go?” She was happy again and laughed.
“How about the beach?” Kamala suggested.
“When can we go, Grandfather?”
“Maybe in the morning.”
Radha joined them from the kitchen. “You must be tired after reading so many books,” she said.
“Grandfather is taking me to the beach tomorrow,” Maya shrieked happily.
“That’s a great idea,” Radha said. “But you must go to sleep now. You must get up early and not stay in bed in the morning if you want to go to the beach.”
“I’ll go to sleep,” Maya agreed without the usual fuss. She gave her grandparents each a hug and a kiss before running upstairs ahead of her mother.
Narayan wished this warm contentment could go on forever, until the galaxies cooled into a dark and endless silence. But he knew that such blissful harmony was transitory, at least in this life. Providence itself grew bitter. Beneath each moment of happiness, there was the memory of the lands and people he had lost and the premonition of what he would yet lose. Perhaps, there could be no happiness without such knowledge. Narayan found consolation in the knowledge that after a voyage across four continents, he had found his home. He was beyond choosing sides. His tribe was right here and not in a distant ancestral homeland. He wished he could record his thoughts in stories for his grandchildren if only he could find the right words. There should be libraries of stories from each stop along the voyage and in each twist and turn convolution of the body.