Dressed in a worn-out, shapeless pink T-shirt and track pants, rubber slippers on my feet, hair tousled, I present a shabby picture on the wheelchair. The sterilized green linoleum and the spotless white walls of the hospital offer a stark contrast. I am smiling in the photo, happy to go back home to my son, my dogs, but I also know that the smile is to push back tears forming on the edges of my eyes. The intern, who stands beside me in the photo, is a tall girl, earnest, you can see it in the way she holds her hands together, her face jutting out above her neck. The shy nurse stands on my right.
It was a heart attack. The shy nurse in the photo was on duty that night at the coronary intensive care. She was one of the two nurses who had stanched the wound from where the stent was inserted, thus sealing my body from the episode with only bluish-black gashes as evidence of the invasions. I must have looked anxious that night, trying to avert my eyes from the rapid peaks and troughs of the red and blue lines of the monitor by my bedside and unable to ignore its hooting sounds. How was I to know if these weren’t signs of a heart in distress? The heart, which until that morning of the heart attack, was inside me, invisible, had somehow been transposed flat on the machine and now seemed to reside there, undecipherable. This shy nurse, whom I suspected was a fresh recruit and new to the city— knew what it was to be afraid. — She had reassured me, unbidden, “You are doing good. Don’t worry.”
My friend must have taken the photo; she is not in the picture. She had flown down to my city, the city of Hyderabad, as shocked as I was by the news of my heart attack. She would come to depart after my discharge from the hospital, with a promise to look me up during my month’s break from work, as advised by my cardiologist and the Head of the Department at the Health City, which is the name by which my hospital goes.
Twenty-eight months back, my son and I had discovered “The Health City” by the giant billboard in teal and white colours, on a short walk from our new home. As we clambered up the hill, winding through a crowded marketplace, the tree-lined Health City emerged into view, and I told my teenage son, “Another bonus for the new house. A hospital so close.” Since my move to Hyderabad a month before on work, I had been doing this—validating my choice of our new home. But my son’s attention was on the food bandis on carts, the sizzling oil and the billowing aroma of spices that invited him in.
The Health City is set apart from the non-health city by a stone wall and its overall functional aesthetics. At the entrance leading to the Emergency Care on the right is a flex display board with a happy family, smiling and bound together in wellness, oblivious to the ominous hospital helpline numbers listed below. No pain or disease has ever touched them; they are beautiful, dressed in the colours of The City, which, as I said earlier, are teal and white.
I would come to visit The City for the second time more than two years later, and the taxi driver ferrying me would turn left from the entrance, a mistake that we would not catch on time because I would be busy detailing instructions to my son on who should he call if “this discomfort” turned out to be an emergency. We would not know on arrival at the Emergency that I had had a heart attack. And neither of us would smile like the family on the display board.
But I am jumping ahead. Let me lay out the cheerful provenance of our first visit to The City. When I was not sick. Yet.
We had decided to check out the bakery at the Café-Theatre—prominently detailed on the map of the Health City next to the giant billboard—but a sudden rain put paid our plans. Looking for cover, we took a wrong turn to find ourselves back in the marketplace where there wasn’t a tree to shelter from the rain except one straggly lone gulmohur that struggled to steady itself on the concrete road, and we had run back to The City. At a point where the gradient of the road was steep, the road had developed a deep crack and my son shouted to me, “Watch out.” He halted under the thick canopy of a banyan tree—Uff! he said— his head bent, and his long arms stretched along his legs. My heart was pounding too, notwithstanding the hours spent every week at the gym, and I had squatted on my haunches under the tree. Few miles from where I squatted, a stream of laterite flowed down the cracks of a jagged hill like a blood river in a spate. Since our shift to the new house, I had come to get used to the faint, incessant sound of drilling of rocks on that hill, the sound coalescing into another sound with an origin deep inside my body, beyond the ear, deeper in my womb, a thrumming presence since the onset of menopause. When the skies cleared up, the drilling, paused due to the rain, started up once again, and I walked back to my house, safe for now.
Twenty-eight months after that visit to the City, I would come to hear the drilling again from the two-bed coronary intensive care room where I was admitted after a heart attack. I enquire about the drilling from the nurse on duty, who answers me bluntly—a manner that is typical of Hyderabad but one I had come to find oddly endearing—about the inescapable necessity of drilling in a rocky terrain, “patharan na. drilling hona kethe”. The sun has set, and it is already dark outside to make out the view, but I quickly gather that it would not be of the under-drilling hill after all.
Next day brings glorious sunshine that my friend has brought from Delhi. Her shirt is bright yellow with large green flowers, worn loose over grey track pants. When she pulls the window curtains open, I can see only large blue water tanks which dot every building in this water-starved region. From her multi-coloured sling bag with pink zips— which I recognize because she had gifted me a similar one—my friend takes out two hard-bound books that she places on my table. One is a very personal gift, autographed by a much-loved author, Elizabeth Strout, that she had bought on a visit to the U.S.
The daily visit of the cardiologist is scheduled at 11:00 a.m. “Right coronary artery, completely cut-off, madam,” Dr. B. smiles, his cherubic face reflecting satisfaction from having executed a successful stent. Mine would have been one of the many procedures that he must conduct daily, and I find it comforting, that for him, each stent is a unique achievement.
His touch is gentle when he leans over to place the stethoscope on my chest to listen to my heartbeat while his eyes scan the monitor beside me. He proceeds to inform me that with a 100% block in the coronary artery, I had been in grave danger, on the brink of plummeting down an arterial tunnel, from where the stent procedure had saved me despite my son, who, he laughs, “was wasting precious time on google.” Although I am uncomfortable that he has dragged my son into this, I am in no condition to protest— stented, stunted—and I attempt a wan but grateful smile.
“Any pain, madam?” Dr. B asks, “any discomfort?” I shake my head in a no.
“Your other vessels are ectatic,” he reads from the papers clipped on a board strung to the rails of my chrome bed with a blue wire.
“Ecstatic?” Until now uncommunicative, I am all ears.
“Ectatic. Like this,” a junior doctor who stands deferentially behind Dr.B., moves his fingers in and out like a wave, stopping at where the fingers are the widest to indicate distended vessels. I notice yellow stains on his nails. Nicotine? Aha, a smoker.
Dr. B continues to detail the ways in which my body had failed me and ends the monologue with a mocking indictment, “Going to the gym every day, madam?”
My friend, who writes a blog on weight training, asks, “She can resume normal life, light exercises? After 2-3 months?” Her enthusiasm is out of place here; although hers is not a question, I can see she is seeking an affirmation for my sake and hers, that over time, the heart attack would be behind me, and my life would get back to its ordinary routine.
Dr. B doesn’t look at her. His gaze is on me, his index finger wagging. “Madam, don’t get me wrong. No more exercising.” I notice a yellow smear on the edge of his right eye. A small part of his pink tongue smacks on the lower lip. As he continues, my eyes are entranced by a strand of saliva stretched vertically between his jaws.
My friend follows Dr. B as he leaves the room, dragging her shoes, which she hasn’t fully slipped on. She is reassuring on her return: “Just one more day and you will be back home.” I slip back on the bed, pull the cover over my head and shut my eyes. From the edges of my half-shut eyes, I watch her leave the room. I don’t open my eyes after she goes, but I don’t sleep either.
What was once a source of joy, my fitness that is, has now become a matter of shame. This seems to be the other bubble that the stent burst when it blasted through my choked artery. Prior to the heart attack, I would gloat about my fitness. The gym I would frequent had put out a video of my pull-ups on social media with the caption: “Age is just a number.” I would preach to unsuspecting colleagues about fitness, even to the young in their 20s/30s already bursting with good health.
But it also seems to me that Dr. B views aging women who devote themselves to exercise, or just women in particular, as vain and indulgent. In fact, he demands a surrender of my body as a receptacle for medicines and surgical intervention on which I would henceforth have no say. To own my body or act upon it would seem to him an act of transgression. By falling ill, I had ceded that right to him. I imagine that his strategy with the obese may be of a different kind, but shaming, nevertheless, which would lay the ground for the passage of one’s sick body, its heart, into the hands of the cardiologist, forever. Because once stented, the body enters that liminal zone of well-but not-well, buoyed above the swirling dark waters below with life-long medication. (My discharge summary later that week says, “Importance of diet control and weight reduction is highly stressed. Nine medicines in all prescribed, including two statins when my cholesterol levels aren’t high at all. No matter that I have a BMI of 21, weight reduction is highly stressed. A standard format for a standard protocol of shaming)
My friend is back by the time lunch is served. Grilled chicken and sautéed vegetables and a small heap of herbed rice served on a square plastic plate. “Fancy!” she says but refuses my offer to share the lunch and instead peels a banana she has brought in her sling bag. She leans back on her chair and asks “Hey, do you hear that drilling sound?”
“Maybe from neurology. They are drilling a cranium. Is it crania in plural?”
She laughs. “Brain Wellness Clinic. At least get the name right.” While I had rested, she had gone around The City and is now familiar with its nomenclature codes.
Later that long night, at 3:00 a.m., a nurse comes for a blood sample. This 3:00 a.m. routine, which I have come to gather in the last two days, is like an ancient ritual to propitiate the cardiac gods, which the nurses can’t change at the whim of patients like me. A young man follows the nurse into my room to plead with her to convince the doctors to discharge him the next day, a plea that is only met with silence, and he returns to his bed, his blue paper gown parted on his backside, his bare cheeks on display.
My veins are thin, accuses the frail nurse, so she calls another who looks like the supervisor—a banyan of a woman with a thin moustache—who orders a puncture on my arm, leaving behind a bluish-black patch that will remind me of her well after my return home.
By falling ill, I had created a crisis at home. In the week following the heart attack (and after my friend returns to Delhi), I watch my teenage son struggle with the new demands. With me in bed, we need a cook and a housekeeper. But the colleagues to whom I reach out are distracted, busy with a sports fest, and I feel side-lined at the very moment I needed help.
When a neighbour, a friend of another friend I know only through a WhatsApp group, brings me home-cooked food, undertaking to do so until I find a cook (which we do four days thereafter), I break down. This is the first time I am meeting her but I sob sitting on the edge of the sofa next to her, as she whispers, “Oh, please, don’t put yourself through this…” My son helplessly stands in attention to her, embarrassed, but she falls into a familiar pattern, “I have gone through such a phase. Once…” she relates a story when she was left similarly helpless, one that I can’t focus on because I am mourning for what I have lost—not just health, agency and as it seems, everything I foolishly prided upon, including the independence that I had since my divorce more than a year back. I also realise that the kind lady has dressed this story to make me feel that the helplessness I feel is commonplace, not one to be shameful about, just like the way we women often re-assure each other.
Ostensibly, culture seems to allow sick men to prioritize their recovery in a way it doesn’t permit its women. A decade-old memory of a superior at work resurfaces in my mind. After a heart attack, this man had come to acquire a halo of martyrdom with his wife as a sentinel beside him. A man with a stent will lean on a woman who will make it her business to cradle him and nurse his heart back to health. Around this woman, an entire curative ecosystem often develops, at home and at the workplace, to cosset him for the rest of his life. As it happened with my superior. What, I now wonder, would have happened if his wife had fallen ill instead?
Few days later, my son returns from school to find that the new cook, having come an hour late, has just begun cooking lunch. He sits by my bedside and says, “I know that you can’t cook or work, but you can at least ensure that lunch is cooked on time.” To my mind, my son is now hungry because of the cook, who, taking advantage of my illness, undermines me by being tardy at work. By directing my ire at the cook, I am, in fact, trying to forgive my son and justify, if only to myself, that he is traumatized by witnessing, first-hand, his mother’s heart attack and now wishes it away so that life can be once again back to old times, in retrospect an unblemished life of health and carefree provision of his basic needs. Later that evening, he helpfully shows me medical sites on google that recommends only a week’s rest after a heart attack. “It is not such a big deal in the West,” he says.
Two weeks after, we find a new cook. My son reads the discharge summary aloud: “The patient reported to the hospital with acute angina. Isn’t angina the chest pain before a heart attack? When did you have that, mama?”
My memory of the morning of the heart attack is only of extreme fatigue. Giving uncharacteristic attention to the fatigue, I had gone to a local dispensary, where the physician had checked my blood pressure and, on finding it high, had advised me rest. I also mentioned to the physician, a dull earache extending to the jaw. He had prescribed a painkiller for the ache. In retrospect, these symptoms should have alerted the experienced physician to a heart attack. But they did not.
By that time, it was 9:30 a.m., but the traffic was not as heavy as it would have been at this hour. I remember leaning out of the car window to read a banner for an upcoming Rockathon to push for heritage status for twenty iconic rock formations of Hyderabad. The weekend before, I had spent over an hour at a popular spot from where a vista opens of the rocky terrain, which they say, has weathered like an onion peel for over 2500 million years to form unique balancing forms that are now the pride of Hyderabad. I had wanted to commit this view to memory—the way I often do in this historic city that is now an IT hub—preparing for a time when these riches would remain only a memory if, without the protection of a heritage tag, the rocks might be flattened, one by one, in the course of the city’s unceasing development.
On my return home from the dispensary that morning, I gave up my plan to cook lunch and, instead, lay down only to wake up soon, dizzy and in sweat. I had called out to my teenage son, who thought it was a joke. When I walked down the stairs of my double-storey house disregarding his banter, my son followed me into the car.
On the way to the hospital in the car, I kept trying to raise my hands. I did this almost instinctively, drawing on a cherished memory. At Kavil Bhavan, a naturopathy centre I had visited more than a year back, the adorable 94-year-old Raman Mashu had pooh-poohed heart surgeries as: “A racket by the engleesh medicine!” Setting aside a sling that he had designed with an ordinary towel to cure shoulder pains, he had shown me the exercise: “If you ever feel chest pain, raise your hands. Like this. It will pass.” His eyes were glazed with cataract, but his freshly bathed skin glowed in the sunlight framing him, a touch of pink close to his temples–and that smile!
But when faced with an actual heart attack in the car headed to the hospital, my faith in Raman Mashu was waning with each attempt to raise my hands, an act which my son imitated with me laughing, “Hallelujah! Praise the Lord.” I too had laughed; ridiculing the pastors seemed to steady my dizzy, weightless head.
“Then how could I take you seriously, eh?” my son asked a fortnight later when we recount the events leading to the heart attack. But we both agree on one point. I was breathless, but I had no angina on admission, as recorded in my discharge summary.
My heart attack was so asymptomatic that even a physician had failed to see it coming an hour before the attack. Later, I came to understand that a woman’s heart attack is atypical (because the typical is the way the men experience it). Could this be a reason why heart attacks are the number one killer among women? In the movies, a man gasps, clutches his chest and falls to the ground. But a woman’s experience is far less dramatic. She can experience a heart attack without any chest pain. Instead, she may experience shortness of breath, dizziness, light-headedness, or extreme fatigue. Like I did.
The differences across sexes go beyond symptoms. And it turns out, female bodies differ from that of men across all our organs including the heart, demanding different diagnostic tools. My older son, who is home after quitting his job as he waits to join a university for an MS in Munich, shares this unique etiology of heart disease in women. That word makes him happy: “etiology,” he says reverentially.
What he is not happy with is my daily routine of staying in bed all day and reading. “You need to step out, Woman!” This was how, my son explained, Jesus addressed his mother on the way to Calvary. He is feeling pious on his return from the Rockathon, the banner for which I had seen on the day of my heart attack.
Next morning, my son and I relax on a bench after a walk in the neighbourhood park. A peacock approaches the bench to peck at the half-eaten apple in my hand. The solace this moment of intimacy provides is only momentary because I repeat, as if on an automatic winding machine, Dr. B’s words: “Only slow walks, madam.”
“No, no,” my son says, wagging his finger to repeat the words, this time spraying spit with each word, as we laugh. No matter that he hasn’t met Dr. B as yet.
One month after the heart attack, I return to Dr. B for a review. This time, Dr. B is unhappy with the cholesterol results. “LDL 110, no, no, it must be at 70. Below is even better. Hmm… so I am putting you on a higher dosage. If this doesn’t work…”
On our way home, my older son suggests, “Why don’t we try another doctor? In a government hospital?”
“There aren’t any. There is only The City here. When corporate-run Cities come up, government withers.”
The reality is that Government hospitals, few and starved of funds or stewardship, are the last resort for even the poor. “It is like a conjurer’s old trick of soap bubbles within bubbles,” I tell him, “The City comes up within a city and then it grows, but slowly, the outer city dissipates, and one day, poof, it is go-oo-ne.”
My son shakes his head. “Anyway, mama, don’t bother about Dr. B. You have friends! Some of us don’t even have real friends.” That makes me uncomfortable; does he not have real friends?
Even if that is not his point, I do have friends with whom I could be real if that is what he meant. And they have real ways to express that friendship. My friend, on her return to Delhi, has launched into research on heart attacks, sharing her findings with me, none of which I pay any heed to. More important than the information she shares is that she is on a quest to restore my health. Other friends and colleagues visit me despite their hectic schedules.
Though in readiness for these visits, I spike my ears and stiffen my body in a way only my dogs understand. This is how I brace myself to acquiesce, if only for their sake, and accept the faults that brought this upon me. Friends find my home—my dogs, my boys, our palatial house—so chaotic that it isn’t at all a surprise that this happened. With them, I feel naked and held up for derision. Others give me homilies as if hoping for a change in my chemistry to balance my body’s humors and keep such shocks away. Which, I assume, is to assuage their fears and to reassure themselves that since they, their lives are free of such fault lines, this wouldn’t happen to them.
“Don’t get me wrong, but you barely eat. And all that exercise,” says a colleague. After he leaves, I feast on the oranges he brought me and allow the juice to drip on my red shirt that I had carefully selected for his visit, chosen in part to bring colour to my pale, bloodless face.
“You think too much. Even on trivial stuff, you get emotional,” one visiting colleague says. I had shared with her the perils of a transferable job in the Indian civil service, moving every three years and falling ill in a city you are not entirely familiar with. I wish that she acknowledges that I had come to this pass because I had been repeatedly asked to manage extraordinary and hence, stressful projects. (At this time, I was presiding over the division of men and materials of a bigger office to smaller constituent offices and their physical shifting. At best of times, the partition of men and assets is a messy business) Instead, she smiles, “I drove to the hospital myself after a miscarriage, literally bled into the car.”
“You are so brave,” I say admiringly, even though she has stolen my thunder with an account of her greater misery.
Between me and the once-familiar world—of my friends and colleagues—lies a chasm because I have now been physically shifted to another island, what Susan Sontag calls the “kingdom of the sick.” And I can’t bridge that chasm, even with my friend from Delhi, because I have no language for what I feel. My capacity for feeling, in general, seems to sit on its edge. I am no longer legible to myself. Dr. B, whom I rail against, is merely the visible part of a larger, unacknowledged spectre in my life— the disconnect with the world. As if penned inside a glass wall, unable to see my reflection.
Some days later, following a sleepless night spent worrying over a dull chest pain, I make an unscheduled visit to Dr. B. The examination reveals nothing alarming. He prescribes me Clonazepam, “To calm you. Take for a month.”
A school friend who is a psychiatrist in the U.S. informs me that cardiac rehabilitation is an integral part of post-heart attack treatment. But the Health City has a different package for psychiatric help. The business verticals are to diversify; the total solutions have not yet put the patient in the heart of the business. The receptionist’s slow, practiced voice parrots, “Allow me to make a separate appointment with Psychiatry.”
As advised, I returned to The City for a follow-up after three days. Dr. B wants a further investigation, which will help rule out any underlying issues for the dull chest pain I had experienced earlier in the week. While he scribbles the detailed advice and the room falls silent except for the sound of pen on paper, I ask Dr. B, “That hill has been finally flattened? I didn’t realize, the drilling has stopped.” He ignores me, but I continue, “Do you know what the shape of the hill was?” I wonder if this hill, too, had a distinguishing feature, like Hyderabad’s other iconic rock formations.
Dr. B laughs. “I am no poet, madam. One rock looks like another.”
Just like patients, I think.
On the way to Pathology, the assistant tells me, “Madam, they say that the rock looked like a toad with its mouth open. A flat rock jutted out from its mouth like a tongue.”
I am excited. “Have you seen it?”
“Oh no, no. By the time I joined, the drilling had started.”
When my car pulls out of the parking of The City, it begins to rain. I hear the driver mutter, “What is the point in this drizzle? Just makes it more humid.” But as we drive by The City’s Theatre-Café, the rain gathers strength. Sheets of water thump on the windshield, and the driver, blinded in the rivulets of water and the murk ahead, pulls up under the porch of the Café. And we wait. A downpour like this one will flood the roads because old channels that once conveyed rainwaters to the river lie choked, buried under the frenetic construction, the drilling, and the debris from the rocks. The torrent may take away a part of the road, trees, but eventually, the water will drain off, wasted into the ground, and then the cycle of water, the cycle of progress, will resume in this city parched for drinking water.
An ambulance painted yellow and red turns around the corner towards the Emergency. The ambulance has slowed down, but it doesn’t stop; its red hooting siren pierces through the pounding rain. But we wait for the rain to run its course. We are lucky to have found that spot to take cover.