The Way of Zen
By Steve Watkins
Shankar came to say goodbye the night we left the Alwar hospital, and to bring us food Pushpa had prepared for the journey. It was already dark. David had to carry our backpacks out to a waiting cycle rickshaw. I didn’t know how he managed to get me up into the seat, or down again when we arrived at the Alwar train station. There were no sleeper cars in first class–David doubted I’d be able to handle the usual mass of humanity jammed into third or second–but he was able to get us a private berth with cushioned bench seats, and he helped me lie down on one, hoping I’d sleep. But the lurching of the cars, the clatter of steel wheels on the steel track, the discomfort of my distended abdomen kept me awake. I wanted to apologize. I felt bad about wasting the money on first class.
I spent much of the night propped up in a corner, staring out at moonlit fields and ghost villages, much as I had on my first overnight train trip months before, north from Delhi to Pothankot. I felt years older. All the color had been washed out of the world. Everything was hidden in shadows.
A week since the accident, and I was still chastising myself for having been so careless riding down from Pandupol the morning of the crash, so uncoordinated, and stoned, and stupid. For not having the reflexes to jump free, the way they do in the movies. For not paying enough attention to Alan Watts. “When a cat falls out of a tree, it lets go of itself,” he wrote in The Way of Zen. “The cat becomes completely relaxed, and lands lightly on the ground. But if a cat were about to fall out of a tree and suddenly make up its mind that it didn’t want to fall, it would become tense and rigid, and would be just a bag of broken bones upon landing.
“In the same way, it is the philosophy of the Tao that we are all falling off a tree, at every moment of our lives. As a matter of fact, the moment we were born, we were kicked off a precipice, and we are falling, and there is nothing that can stop it.
“So instead of living in a state of chronic tension, and clinging to all sorts of things that are actually falling with us because the whole world is impermanent, be like a cat.”
Delhi Station was its usual chaos, though it was early morning when we arrived, the platforms swarming with thousands of travelers with their oversized bundles and frightened children and crying babies bound to their mothers. David couldn’t find a porter to help us, and he couldn’t leave me to carry both backpacks out of the station to find a taxi or tuk-tuk or cycle rickshaw. “You have to walk,” he said. “Just off the train and out of the station. Stay close behind me. We’re going to have to fight our way through.”
He charged onto the platform and through the station, pulling me along as well as he could, hauling both our packs, at times swinging mine in front of us to clear a path. I kept my arms wrapped around my torso, as though I needed to hold everything in place as much as to protect myself. Nothing catlike about it. But we made it through, out of the station and into the open air outside the gates.
“American Embassy,” Dave told the driver. He’d sprung for a taxi rather than our usual tuk-tuk. Dave climbed in front. I lay down on the back seat, too weak from the frantic walk through the crowd to sit, bracing myself for an hour crawling through traffic –the thick pollution, the incessant horns, the lurching progress. David reached over the back of the seat and put his hand on my shoulder. Maybe he kept it there to make sure I didn’t roll off the seat, or just to assure me that he was still there, and that we’d get through this together, too.
Dave’s friend Bob Tetro, who worked for the Foreign Agricultural Service at the embassy, had the guards let us into the heavily fortified compound. I had met Bob once before, after we’d returned to New Delhi months earlier from Himachal Pradesh and Kashmir, before Nepal. He greeted us warmly once again, only this time instead of offering us cold beers, he took one look at the shape I was in—gaunt, wasted–and instructed his cook to make us French toast with a dusting of powdered sugar and real American maple syrup from the embassy canteen. I was thrilled, but had to give up after a few bites. I still had no appetite, a week since the accident, and everything I swallowed felt leaden. Dave, who always ate as if he’d been starved, finished off his and mine. Bob, clearly worried, made some calls while we ate and got me an appointment with a physician associated with the embassy.
Another taxi ride later, this time through wide, paved streets in an opulent part of New Delhi, we sat in the doctor’s examination room. He was Indian, trained in England, and spoke with a familiar lilting English flavored with a Hindi accent. I expected all manner of diagnostic equipment, but the room was bare except for an empty exam table. We sat in chairs. He asked me to show him my hand, and I reached forward with my right, the hand with the now-healed scar, in my confused state thinking he wanted to see my one visible wound. He pinched one of my fingers and studied the reaction. It had been pale but still pink. When he pinched it, the end of my finger turned white and stayed that way. I couldn’t feel anything.
“You must go to hospital right away,” he said. “There is significant internal bleeding, from the accident. You cannot delay. You will need surgery immediately. I will call East-West Medical Center and tell them you are coming so they can prepare.”
Things happened quickly after that. I remember them laying me down again in the back seat of a taxi. David urging the taxi-wallah to drive faster through the city. A walled compound across a busy road from what Dave said looked like an overgrown golf course from the days of the Raj. A thick bank of pink bougainvillea. Nurses waiting with a wheelchair at the entrance to a white two-story building. A sign. East-West Medical Center.
I started hemorrhaging shortly after we arrived, thrown back into acute pain worse than in the moment of the accident. I begged them to give me something, anything. I was delirious, desperate, thrashing on the bed. David held me, told me to hold on, hold on, it would be over soon, but it wasn’t true. They had to summon an anesthesiologist. They had to prepare the operating room. They had to find a second surgeon. They needed blood for a transfusion.
They say when pain gets too great you’ll pass out, but that must be a lie, just like the other lie they teach you–that God never gives you more than you can handle. Pain, extreme pain, centers you. Pain reduces you. Pain obliterates you–the ego you, the self-conscious you, the counterfeit you, the caring you.
Finally, past finally, they ran an IV line into a vein and flooded me with anesthesia. There was none of that counting backwards from. There was instantaneous escape. Oblivion. Some people wake up during their surgery, but they still can’t move, can’t speak, can’t communicate. They’re traumatized in their mute and frozen helplessness. They may even suffer pain from the operation, or imagined pain from what they can sense or see is being done to them. But there was none of that for me. I was plunged into merciful nothingness, not knowing if I would ever return from that place, not caring as I was crashing under, only grateful that the pain was subsiding, killed or just temporarily masked, and if the cost was my consciousness, maybe only for a while, maybe forever, I didn’t care about that, either.
Dr. N.P.S. Chawla, the Sikh surgeon who owned the private center, supervised the procedure, as he had supervised and performed hundreds of emergency surgeries before mine. A stern figure in his white dastar and tightly trimmed beard, Dr. Chawla had come to New Delhi from Lahore after partition in 1947, and soon after developed a practice doing emergency rescues. He had dealt with his share of wrecked Westerners, starting with his first case in 1970, when the American ambassador flew him on a private plane to Allahabad in Uttar Pradesh to bring back a tourist from the States who had been electrocuted riding on the roof of a train.
I learned all this later, of course. Realized that David and I had ridden on that same train, a few weeks before my accident, had sat on that same roof.
The incision started just below my sternum in my right quadrant and ran nine inches, almost to my pelvis. After the incision, Dr. Chawla pulled back the skin and cut through several layers of fat and muscle and tissue. Working carefully around a three-inch tear in my liver, he removed two-liters of blood and bile, fibrinous clots, and what in his limited surgical notes he described as “purulent material.” Full records weren’t kept, but he likely used peri-hepatic packing–laparotomy pads he tucked around the lacerated area of the liver in hopes that the pressure would stop any subsequent release of fluids.
Or he may have used the Pringle Manoeuvre–named for the medical researcher who developed it in 1908, not for the saddle-shaped potato chips sold in round cylinders–affixing a clamp on the hepatic artery to temporarily stop the flow of blood to the liver.
Or he may have decided that the laceration had already closed sufficiently on its own so that my body could absorb and dispose of any more blood and bile that continued to leak from the damaged area.
They gave me another blood transfusion, my fourth since the accident–most of it donated by Dave. Dr. Chawla cleaned the wound and the abdominal cavity with a saline solution, then inserted two drainage catheters that clogged immediately and didn’t work, then or ever. Stainless steel sutures with bent prongs were used to close the deep layers of tissue.
The surgery took several hours. My family still didn’t know what had happened, and wouldn’t for another day, when they finally received a State Department cable from the embassy. Dave hadn’t had time to contact them since we arrived in New Delhi, and he was afraid to leave during the procedure. Dr. Chawla had told him I was fortunate to have lived so long without treatment, and that I might not survive the operation.
Dave was waiting when they brought me back from the recovery room, unconscious but alive. Still there when Dr. Chawla came in to check on me hours later. The anesthesia was just beginning to wear off, though not so much that I felt anything. Not yet, anyway. The pain would come later. Dr. Chawla felt my pulse. Checked the thick dressing covering my sutures. The drainage tubes. The IV. My eyes flickered open, and when Dr. Chawla saw, he spoke to me in what I would come to understand was his typical blunt fashion.
“You must thank your friend,” he said. “You would not be here if not for him. He saved your life.”
David took care of me at East-West Medical Center, opening the windows when I was hot, closing them when I was cold, going for the nurses when I got too feverish or when the IV line backed up or when the fluid bag ran out. Putting his own life on hold for weeks, months as it turned out, to help save mine.
They didn’t have me on any monitors–there weren’t any in the hospital–and the nurses from the Catholic training hospital in Goa, as kind as they were, were busy hurrying from recovering patient to recovering patient. My overwhelming feeling, to the extent that I felt anything, had awareness of anything, had it in me to care about anything besides my own suffering, was helplessness.
So it was David who stayed close, sleeping on a cot in my room. David who lifted me onto a bedpan. David who cleaned me afterward. David who was there in the middle of the night when I woke up confused, delirious, crying. David who was with me when they pulled out the drainage tubes that hadn’t worked, leaving me queasy and shaking. David who tried and failed to coax me to eat something, anything. David who held me and talked to me and urged me to breathe, to relax, to let go.
And David who was with me when I hemorrhaged again, three days after the first operation. The reopened laceration sent me writhing in my sweat-soaked bed and screaming from the same deep, crippling pain I had had on the rocks in Sariska. There was no going to the pain this time; it was nowhere and everywhere. Frantic calls were made. Another surgeon, Dr. Kucheria, was summoned. Dave and a surgical assistant were sent on a desperate search across New Delhi to find a blood bank in the middle of the night for yet another transfusion that would hopefully work through yet another operation. Dave had already given me as much of his own blood as they’d let him.
I was only dimly aware in my fragmented consciousness. Dave wrote about it a few days later in his journal:
Stephen having an acute attack of pain and drop in blood pressure, followed by high fever around midnight. Sucking down a pint of O+ after an hour’s search for a vein to plug, and then only able to prick a small one. Also tried other arm for glucose, but no go. The time passes, sometimes quickly, and sometimes hardly at all. Steve in so much pain and confusion. I’m concentrating on him, but the pain lingers and his willpower is quickly drawn away. Breaking out in hot and cold sweat. Losing control. Slinging off sheet, rolling in terror from side to side, taking a shit on bed. Nurses checking temperature and pulse every five minutes.
Young doctor strides in and takes a look and listen, orders a couple of sedatives and says, “You’ll be all right now.” Fifteen minutes later back again and Steve’s still rolling. What to do? Dr. Kucheria appears and things happen. Sends me and the junior doc out for more blood. Standing at the blood bank door. The junior doc afraid to buzz too long. No one comes. I’m not believing. We drive back to get a technician from East-West, an “expert,” so the young doc says. No doubt a capable man, one that can hold his finger on a door bell when someone is in need. Finally, someone answers. Tells us blood not immediately available. We leave the technician to wait for it. Go back to the hospital.
Steve still sweating. Kucheria back in again looking for another vein. No veins for glucose. I feel faint observing the syringe searching for a good vein. I take my seat. Doctor gives up on glucose. Steve slowly drifts away, sweat beading on his brow. Occasional temperature checks bring him up long enough to open his mouth. So far away. Doctor informs me, “Keeping fingers crossed.”
Steve comes around a little. Overwhelmed with fear. “One bombshell after another.” I come down on him. “You’ve come a long way, you know that? You’re awful lucky. You could be dead! You know that too! You have to hold on, you have to take control. Remember ‘Fear is the mind killer.’”
Steve falls out again. Pain, coughing, tossing and turning. “I can’t take this any more.” Tears flowing, crying release, holding each other tight. I’m so run down and tired, feeling hollow inside. At last, technician shows up–in a taxi, with the blood….
Steve finally out of surgery at 5:15, sedated soundly. A repeat of the first operation. Doctor Kucheria explains: “A collection of blood, bile, and large clots equaling 2 liters removed. The oozing must have started the day the tube was pulled. Very toxic fluid, but no pus luckily so the antibodies are working but unable to contain the oozing from the liver wound. When the accident occurred, a blood vessel and biliary tube carrying bile were severed, so when the hemorrhaging started again, the bile also oozed out into the surrounding cavity. There has also been a blood infection….”
I was most of a week coming out of the fog of anesthesia and trauma from the two surgeries, confined to my bed with a urinary catheter and IVs for fluid and nutrition, too weak and unstable to sit up in bed, much less stand. Because of the infection, nurses woke me early every morning to draw blood for tests. I cried every time, though I didn’t know why. The blood draws hurt, but in comparison to the liver laceration and the raw incisions, not so much. Sometimes it took several attempts for them to find a vein that didn’t roll or collapse. I was so depleted, sometimes they couldn’t raise a vein at all.
I spent my days sleeping, feverishly dreaming. David came and went. Mostly he spent the night in the room with me, but once I was no longer in immediate danger, he ventured out to send telegrams to my family, to stay the occasional night at Bob Tetro’s, to eat rich American embassy food, to get high with Peace Corps friends still in the city.
He got letters from Shirim, the sardarni in Alwar. She usually wrote him in Hindi, but tried out her English in a poem that was so simple and sweet it did him in.
I always remember you.
I can never forget you.
Wishing happiness for you.
Not only for a day or two,
Not here and there,
Or now and then,
But over and over and over again.
Dave had his own worries. Should he write her back? Her family would be furious if they knew. But what if they were to continue? What if he decided to stay in India, to marry her?
His dad wrote to tell Dave his mom had fallen in the shower and had to have an operation for her back. He was sure it was because of her drinking.
He got word that his old girlfriend, who had taken up with another guy before he joined the Peace Corps, had gotten married in September–and then divorced two months later.
He had no idea what he should do with his life when he got back to the States. He just knew that after India, he could never again be who he once was.
He was anxious about me. Forced to spend hours applying for visa extensions, negotiating refunds for our flights back to the States, haggling with the East-West business office, talking me down when I woke up yelling, incoherent, out of my mind with night terrors. In lucid moments, I still had that sense of dread, that something worse was going to happen, and that everything that had already happened had led me here to this broken place, the past four months an inevitable stumble, a fall from a high cliff, a spiraling down from a mountain, a dream of falling where your unconscious mind is supposed to wake you up before you land because otherwise you’ll die in your sleep.
They started prescribing me sedatives in the evenings that sent me crashing into dreamless oblivion. I was in constant pain otherwise, but Dr. Chawla, out of concern for the pneumonia and blocked lung, was adamant that I not be given anything that would further compromise my already shallow breathing.
An old school respiratory therapist came in every other afternoon to beat on my chest to loosen the thick phlegm and open my blocked airways–inducing wracking fits of deep coughing that tore at the sutures and sent me into paroxysms of agony. I was terrified the sutures would burst and I would hemorrhage again. I begged him to stop, begged David to make him stop. Wished there was a way to make everything stop.
The days dragged on and on, interminable, with nothing to fill them except this waiting to get better, this hoping to heal. I was back in the desert, two years before, hitchhiking from California to North Carolina but stuck somewhere in Arizona early on, standing for hours in the blistering sun with my thumb out at the top of the on-ramp to I-10, praying no state troopers would come by and kick me off where there would be no chance of a ride whatsoever, not that anybody was showing any signs of stopping as it was. I felt as if I was disappearing, or perhaps I’d already disappeared, or faded so much that I was camouflaged in the dusty landscape. I was in a state of suspended animation, sometimes forgetting to lower my arm even when there weren’t any cars. They say that when you’re hitchhiking you have to trust the road, trust the universe, that no matter how long it takes, how much you despair, if you wait long enough there will always be another ride. I supposed it was true but was having my doubts, looking around for somewhere, anywhere, I might pitch my tent that night if it came to that, and crawl in with my sleeping bag, and try again the next day.
Finally, after several hours, deep into the late afternoon, long after I’d drunk the last of my water, smoked the last of my cigarettes, long after I’d stopped sweating and was well on my way to heat stroke, a slow-moving truck hauling something on a trailer eased its way up and over the rise. He was going so slow I doubt he even needed to use his brakes, just coasted to a stop. On the trailer was a Port-A-Potty. In the truck, the driver had a cooler full of beer and invited me to drink all I wanted. He told me the Port-A-Potty was full and apologized for the smell. “If I go too fast it might fall off, but if I go too slow, with the tailwind, we might get asphyxiated.”
I was four more days on the road before making it back to the East Coast and, finally, home.
It was sort of like that now, at East-West Medical Center, lying there in a state of suspended animation. Hoping somebody would come by and pick me up. Trusting the road or trying to. Waiting for a ride.