Dr Surendran’s OP room was spacious. Apart from the two chairs across, and the massive desk in front, two plush couches and a study table occupied the room. The latest Filmfare and Cine Blitz lay on the glass-top table. An enormous pane of glass separated the room from the spectacular lobby of the New World Hospital, which looked like the reception of a five-star hotel. Cosy seats dotted the floor, and expensive chandeliers hung from the ceiling. Smartly uniformed young girls flitted to and fro, looking neat and efficient. Dr Surendran was sophistication personified. Trim, and tall, with thick black hair slicked back with hair gel, he was forty-two, though he looked thirty-five. Surendran’s father, Jayapalan, was a businessman. But Surendran had wanted to do Medicine.
Jayapalan asked him why. It was a fair question, but Surendran could not pin-point the reason behind his wish. He had always been an ambitious young man. The white coat and the stethoscope had attracted him like they must have attracted scores of adolescents. The lure of prestige was real. And some doctors did make money. But Surendran was not naïve enough to believe that Medicine was an efficient way of making it, just through professional practice. Hospitals fascinated him. Whenever he had to visit one, while his companions sat around bored, he roamed around the place. He studied the economy of space and the efficiency of the personnel. He watched the OPDs and the scan centres. A hospital had to generate goodwill, otherwise people would not come. Healthcare was a refined and sophisticated business. He saw the challenges it offered.
“I could send you to Devonkary Medical School,” said Jayapalan, since Surendran couldn’t clear the entrance exam. “They are asking for thirty lakh.”
“Your three elder brothers would have to agree.”
Surendran stared at his father. He had some idea about what he needed to do: forgo his inheritance, which would have amounted to so much. He was at an age when ambition mattered more than money.
He did his MD from Sri Ramprasad Institute at Chennai. It cost him fifty lakh. His father made no fuss, even though he was a consummate businessman. Surendran was grateful. He had hoped that he would get some help from the old man after his MD, as he had some further plans. But Jayapalan died during his final year at Chennai.
Dr Surendran focused his attention on the mousy man who sat opposite him. He was the marketing manager at the New World Hospitals.
“Yes, sir, I am quite sure of the figures,” he said nervously. “The past six months show a slight drop in the number of patients. But the income, and the number of procedures, have remained stable.”
Surendran frowned. “What is the use of that?” he said. “What does James say?”
James was one of the administrative staff at Damayanthi’s Nursing Home. He was also secretly on New World’s payroll, as a corporate spy.
“He says there has been an increase in the number of patients there. They had an initial drop, but that was temporary.”
“Fine. You can go.”
The phone rang. It was P Raghavan, the district congress committee president and a former MLA. He had called an hour back to take an appointment for Nitheesh, the son of the revenue minister.
“Hello. Raghavan here, Doctor Sa’ab,” the politician’s deep voice penetrated Surendran’s ear.
Surendran was on very good terms with the local politicians. It was a crucial skill in running any business. Power did not always come naturally with money. It had to be carefully cultivated.
“Hello, Raghavan ji,” Surendran smiled. “You know, we are ready to take the red carpet out for Nitheesh. When does he want to come?”
“I called about that, Doctor Sa’ab. The minister and his son want to consult Dr Damayanthi first. I was the one who suggested your name. But it seems some of the minister’s relatives are Damayanthi’s patients. She is very famous. You know that, don’t you? After all, she was the first gynaecologist here, at the district hospital. But they might come to you later. I will call you.”
Surendran felt strangely unsettled. If only he could have bought Damayanthi’s nursing home. That would have solved a lot of problems. It would have ended the only competition, and doubled his number of patients. It would also have made him free to raise the charges to double of what he was charging now. The woman’s old district hospital-style rates were ridiculous. She did not have to bother about the heavy EMIs others like him were burdened with. She had built up her practice gradually over the years. He, on the other hand, stood on the edge of a scalpel.
Surendran knew Damayanthi’s only daughter was in the States. Her husband had died of a heart attack many years ago. Surendran had hinted at wanting to buy the place many times, but she wouldn’t hear of it. She must be nearly seventy, he reflected. Didn’t she want to retire?
He felt his frustration mounting.
Mr Nitheesh Nair leafed through the cheap pornographic magazine with his left hand, simultaneously trying to massage his reluctant member to erection with his right. It was tricky. The lowered trousers and rolled down underwear revealed a tight band around his upper thighs. Sweat accumulated on his forehead. The room was hot, dark, and humid. He was in the collection room at Damayanthi’s Nursing Home and Infertility Centre. He looked at the white plastic vial on the table before him, hungry for its share of hot and fresh semen, and felt disgusted with himself. Now, touching forty, and amidst these unpleasant and sterile surroundings, he found it very difficult to perform the task that was demanded of him.
It was the eighth year of treatment now, spread over six specialists in four cities, as he had flitted from one software job to another. They had come to this city – his home town, mostly for the treatment. His influential father had insisted on it. A varicocele in his scrotum had been excised a month back, to increase his sperm count. Today, he was undergoing the test to know if the surgery had helped. He thought about all the gynaecologists he and his wife had met. Then he shifted his focus to the task at hand, and berated himself. This was not the way to do it. He had to concentrate. Again, he leafed through the magazine.
Dr Damayanthi was sitting at her table. The semen analysis report was in front of her. She looked at Mr Nitheesh Nair, and his wife, seated on chairs opposite her. The wife had a careworn, but hopeful look. Nitheesh had a tinge of hostility in his demeanour. It was natural in a man who had gone through a series investigations and therapy he considered degrading.
Damayanthi could see it, and began softly and a trifle apologetically. “The report, Mr Nitheesh, is not very encouraging.”
“Are there any viable sperms at all?” Nitheesh asked, hesitating.
“Very few. There’s hardly any improvement.”
“Why did you advise the surgery then? Why did you make me go through that, Doctor? I want to know.” Nitheesh spoke with suppressed rage.
“No smoking, no drinking, no tight underwear, no bike riding…”
He was becoming increasingly agitated, and his wife put a calming hand over his forearm perfunctorily.
“We have to try, Nitheesh.” Damayanthi’s voice was kind. “We can only do whatever is possible, and pray. I explained it to you before the surgery. I am sorry. I understand your feelings, but…”
“What should we do now, Doctor? Can we try in-vitro? Test tube baby … like you explained last time?” Nitheesh was mellow now.
“Since you don’t have any viable sperms, it is not really possible, unless…” Damayanthi paused. She had to put it delicately. “…Shobha, your wife, can provide the eggs. We could arrange –”
“A donor! No, we don’t want that!”
Nitheesh had raised his voice, but he did not sound very convincing. He and Shobha were aware of all the options they had. Shobha was not averse to the idea of a donor. Rather than adopt a child, who was completely unrelated to them, this would be one that was biologically half theirs. No, hers.
Nitheesh found it intolerable.
“No, Doctor, that is not an option for us. What about micro testicular sperm extraction? I have read it is a useful technique. Can’t you do that?”
Damayanthi was faintly surprised, but realized that it was common for patients to be well-read nowadays. And it was true that in some cases it was useful, but she did not have the sophisticated, and expensive, lab facilities required for that – yet. Personally, she felt it was still too experimental; nothing had been proved properly. And it was certainly useless in this particular case.
“Well, Mr Nair, I can tell you that it may not be useful for you. But I don’t know enough about it. We don’t do it here yet.”
“Then we will go to the New World centre, Doctor. They are sure to have it.” Nitheesh sounded dissatisfied.
“Sure. I will give a referral with all the details. I wish you all the best. Please contact me if you need any help,” Damayanthi sighed. She was about to lose a very important patient. But that couldn’t be helped. She had stopped refusing the ten thousand-rupee commission that followed referrals to New World. Maybe one could live only by referring all infertility patients there, Damayanthi reflected.
Dr Surendran regarded the couple seated opposite him. His manner exuded kindness, gentleness, and quiet confidence. The minister had called him the previous day.
“You are very knowledgeable, Mr Nair,” he said. “Even many doctors don’t know about micro testicular sperm extraction. I assure you that you have come to the right place. We have all the facilities, of course. As you know, we are the best in the world.”
Nitheesh was effusive in his praise for New World. His corporate brain had noted the cool efficiency at the front desk, and compared it to the impression of amateurism at Damayanthi’s.
“I knew we could count on you, Doctor. I have seen your advertisements on TV, and many people recommended you, but we were a little late.”
“Don’t worry, we will take care of your problem. I will ask the PRO to escort you and arrange for everything. But you should realize that … um … it is not an easy procedure. Chances of failure are quite high. We have to induce your wife to produce multiple eggs, and procure them with laparoscopy. We will take the sperms from you, and keep the lab ready. There is a chance that we may fail, but it will still cost you around two lakh.” Surendran believed in making the monetary aspects clear at the outset.
“We are with you, Doctor.” Nitheesh reiterated. “We are aware of all that.”
“All right then.” Surendran leaned back on his chair with satisfaction. He relaxed a little bit.
Three years ago, this hospital used to be Cherian’s Nursing Home. Surendran had joined it after his stint in France. He had become a popular doctor, and had a lot of patients. Dr Varghese Cherian, the owner, had called him one day. Surendran remembered that meeting vividly. It was a life-changing moment.
“I have to sell this hospital, Surendran. It is running at a loss.” Dr Cherian said.
As a key employee there, Surendran was well aware of the hospital’s woes. Many doctors thought that if they were given the charge, they could manage a hospital better than its owners. Surendran was definitely one of them. This was the chance he had been looking for. But where was the money? Only his house and the surrounding land was his own.
“How much?” he asked.
One advantage of being born into a family of businessmen was that even if you did not have enough money, you had something more important – contacts. A private financier had agreed to give a loan. Surendran had moved with his family to a rented house after selling off his own. He had kept Dr Varghese Cherian on as the medical superintendent.
By afternoon, the OP patients were done with. Surendran was just going to leave, when Dr Cherian walked in with a somewhat stern expression on his face.
“Yes, sir?” Surendran was slightly defensive. Recently Dr Cherian had been acting rather difficult.
“Surendran, it is about this Nair couple. You know, the minister’s…”
“Yes?” He did not like the older man’s brusque tone.
Dr Cherian sat down now, facing him. “You know we don’t have the lab fully equipped for micro testicular extraction yet.”
“It is ready enough,” Surendran replied stiffly. “And the chief embryologist is ready to do the biopsy. They came here for that. You want us to refuse such a crucial client? Surely, you realize, sir, that money is the last thing on my mind in this particular case?”
“But the reagents are not standardized yet. And if he has azoospermia … we may not get any sperms,” Dr Cherian persisted. He knew he was stepping on quicksand.
Surendran leaned forward. His eyes had narrowed. They looked straight into the other man’s. “These technical details are best left to me, Dr Cherian. You had better stick to administrative work. Thank you for expressing your concern.”
“Then I cannot continue here, Surendran.”
“In that case, I accept your resignation, sir,” said Surendran. “I was thinking you might like to enjoy retirement at this age anyway. You could relax with your grandchildren now. I am, of course, sorry to lose you.”
The elder doctor got up slowly, and left the room.
A month later, an anxious Nitheesh and wife Shobha were ushered into Dr Surendran’s opulent room. He watched as both of them settled down in their chairs. Nitheesh shifted uneasily. They looked at him expectantly.
“We could get a few sperms from the biopsy specimen. But the intracytoplasmic sperm injection did not succeed. It was not completely unexpected, Mr Nair. I told you there was a chance of failure.” Surendran spoke clearly, and looked at Nitheesh.
Nitheesh’s face registered anger as well as despair, but slowly became resigned.
“I am sorry,” Surendran continued. “But … you have already paid the full amount for in-vitro. The eggs are ready in the refrigerator. The lab is ready. Additional charges will be minimal for you. If you want … we could…” he paused.
“What are you implying, Doctor? Can we do something?” Nitheesh cheered up a bit.
“Well, we can always arrange for donor sperms, at a moment’s notice. They are well-screened individuals. We have met all the accreditation requirements, I assure you. We could start the procedure tomorrow, or even today.”
“No,” Nitheesh protested.
His wife started crying softly by his side. “Nitheesh, please, let us get it over and done with,” she sobbed. “I cannot stand it anymore.”
“We don’t want that. I thought we already discussed that before. Damayanthi offered us that,” Nitheesh said firmly. He refused to look at his weeping wife.
Surendran kept quiet. His plan had not worked. Usually, the last-minute pressure tactic worked. In this case, it had produced the desired effect on the woman, but the man was adamant. Surendran felt a dull throb of anger at Nitheesh. What was the problem with a donor? Didn’t he realize he had no other option? The intracytoplasmic sperm injection was given with suboptimal cells. It was bound to fail.
He found it unthinkable to give up on this couple. It was crucial that he succeeded. Nitheesh was a very important person. Establishments thrived on such mileage. “In that case,” he said softly after a pause, “we can try once again.”
“Oh, is that possible, Doctor?” Hope had made a comeback to Nitheesh’s face. His wife stopped crying.
Actually, that was what doctors did, thought Surendran. They packaged and peddled bundles of hope to people.
“Yes, of course. Some more sperms are bound to be there in the specimen. We could repeat the ICSI. We may be lucky this time. Usually, people are reluctant … the added expense and all that. In your case, we will do it for free. You have nothing to lose.”
“Thank you, Doctor,” Nitheesh said gratefully.
After the couple left, the phone rang.
“Hello, Sura.” It was Surendran’s cousin, Satheesh. “Payal delivered this morning. I have a daughter, man.”
“Congratulations,” Surendran replied. “She was in Sahridaya, at Palakkad, wasn’t she?”
“Oh, no. She was here, at Damayanthi’s. I suggested New World, but her mother insisted on it.”
“That’s okay,” Surendran replied casually, but he was troubled. The gynaecologist in him was okay with his cousin choosing Damayanthi. Patients were free to choose their doctor. But he was the owner of a hospital. He could not afford to just let it go. It was not in his nature, as an entrepreneur, to have such a philosophical outlook on life. He had not come this far by being laid-back. Ignoring competition was not the path to corporate greatness.
It is time to meet Damayanthi again, Surendran said to himself, and reached for the bell, to summon the office boy.
The previous month, Damayanthi’s house had had an income-tax raid. There had also been an anonymous complaint that hospital wastes were being dumped from her nursing home, without proper treatment. The DMO had ordered an inquiry. Surendran had a lot of influence among the local officials. It turned out that there was very little substance in both the cases. But the local TV channels gave a lot of importance to them. The journalists were Surendran’s closest friends.
“Yes, Surendran,” Damayanthi smiled, “why the visit? I heard you are very busy.”
“Oh, I came to discuss the State OBG meet we are organizing jointly. The venue hasn’t been decided. Would Hotel Presidency be fine with you?”
For the next ten minutes the two gynaecologists discussed the upcoming state meet.
“Your daughter is an intern, isn’t she?” asked Surendran, after a while. “Doesn’t she want to learn to manage a hospital?”
Damayanthi laughed. “She wants to continue in the US. Her husband is an architect there.”
“Have you thought about the future of your hospital? Maybe I could buy some shares, and we could run it together. We could be a big name.”
“Oh … no, Surendran. Right now it is going well. Why should I change anything? I can run it on my own terms, as long as I am healthy. I don’t know about the future. I am at an age when I am taking one day at a time.”
She had become slightly uneasy. Surendran noted this and rose to leave. She was a tough old bird.
I am at the age when I have to think far ahead, he thought.
Surendran’s depression was lifted the next week by a stroke of luck. The second ICSI was successful. It was implanted, and Shobha became pregnant. There was a proper celebration at New World Hospital. A lunch was organized by Nitheesh’s father for the entire staff.
“Thank you, Doctor,” the minister said to Surendran on the phone. “You are a great man. Your services will not be forgotten by the people of the state.”
Everything seemed to be turning out in Surendran’s favour. After two or three months, there was a death at Damayanthi’s Nursing Home. A mother died of post–partum haemorrhage. Mohammed Usman, a prominent opposition leader who sought political mileage in this occurrence, blew it up into a big issue. Then he approached Dr Damayanthi for money as a bribe to help resolve it. She refused. It became a chronic problem for her nursing home. Surendran loved it.
But the joy was short-lived. Shobha’s baby had an intra-uterine death, following some bleeding. Surendran was on vacation at a resort, and had kept his mobile phone switched off. The minister could not reach him. VIPs are important patients to have. But they are also temperamental. Instead of coming to New World, and be looked after by Surendran’s juniors, he took the woman to Damayanthi’s for an abortion. After Surendran came back, he called the minister’s secretary, but the minister refused to speak to him.
The advantage he had so painstakingly obtained, seemed to be slipping from his grasp. Somehow, he held Damayanthi personally responsible for the entire episode. He hated her. Her style of practice irritated him. The trust people had in her abilities frightened him.
He had reliable weapons. Muhammed Usman was also a friend of his. A tussle sparked in his mind, between a fair professional and a ruthless businessman. Until now he had maintained a façade of business ethics. Holding on to the true spirit of ethics was perhaps not practical. The cash flow determined his future. Nobody gave him any leeway, he thought. Maybe he should see Muhammed after all.
“She refused to cough up the money, the old bitch,” Muhammed said. “And, imagine, a poor girl died!”
Surendran could not help smiling. “Muhammed, you should organize an attack on the nursing home,” he suggested. “No stone pelting from a kilometre away. The damage should be real. And then you should block the hospital exit for at least a month. A series of daily demonstrations will be enough. You have my full support.”
“What do you mean?” Muhammed sputtered. “A month! Organizing that won’t be that easy. What is the use of your support?”
“By support,” Surendran said pointedly, “I meant monetary support. Full monetary support. You understand?”
Muhammed understood well.
A month later, Surendran felt that the time was ripe for an important meeting with Damayanthi again. He went to her house. As he was allowed inside, he looked at her face to detect signs of stress and weariness, but could find none. She greeted the young gynaecologist cordially.
“I am tired, Surendran,” she said conversationally. “My daughter is in the States … yes, you know that. The second grandchild is on the way. And, well … she wants me there. I don’t know how I can go.” She laughed wistfully.
“Well, I have a proposition for you.” Surendran did not believe in creating an elaborate background. “I could buy the hospital, Madam, if you agree. I could offer you fifty crore. A ten-crore advance will be handed over to you next week. The rest a month later.”
“Fifty! I mean … Surendran? I don’t know … are you serious?”
“Two lakh in cash every month, just as a goodwill gesture – as long as you live.”
Damayanthi was silent. Surendran felt somewhat disconcerted. She seemed to be slightly amused.
“In case you don’t want to retire, you could continue as the medical superintendent, on a salary.” He was rather desperate now. “It would be better for you. The problems won’t die down unless you decide upon something drastic. After sometime, you may not find a buyer for your hospital. I could be your last chance.”
It seemed to him the woman had a delusion of infallibility. She needed to be realistic. The stress of recent events could have pushed her into dementia. She didn’t seem to be fully aware of the situation.
Damayanthi did not say anything for some time. The lines on her face showed age, but the chin and high cheekbones conveyed confidence and strength. Her hair, Surendran noticed, was fully white. He had wondered many times in the past why she did not dye her hair. Her eyes were keen, and far from senile.
Finally, she said, “You know Muhammed, don’t you?”
There was no anger in her voice.
“I … I know him,” Surendran stammered. “What difference does it make?”
“You are clever, Surendran. Very clever.” Damayanthi smiled. “The problem is – you think you are the only one.”
“What is that supposed to mean?”
“You know Shobha. You know she had her abortion here. I kept the foetus in the freezer, instead of disposing of it.”
“That is illegal! Did you have their consent?” Surendran cried.
“No. But I am touched by your concern for ethics. I can see the indignation of a conscientious doctor.” There was mild sarcasm in her tone. “I had already preserved Nitheesh’s sperms in the lab. We keep the samples for six months.” She smiled again.
Surendran’s insides felt like they had instantly been transported to Antarctica.
“Even though the sperms were abnormal, as you know, they were enough to provide a sample of DNA. I sent the cells from the foetus, and the sperms, to CCMB, Hyderabad. Of course, you know the result. They did not match. It was not Nitheesh’s child.”
Surendran had stood up now. Why, he did not know. Maybe he wanted to walk to the door. There was nothing else for him to do.
“Sit down, Surendran. We need to talk,” Damayanthi said calmly.
As Surendran rose to address the crowd of employees at New World Hospital, a silence fell. There was a rumour that he was about to impart important news. The staff, who knew him well, thought he looked tired and gaunt, as if he had not slept for many days.
“Good evening, ladies and gentlemen. First, I would like to announce the return of Dr Varghese Cherian to our hospital. He is a valuable doctor, and an able administrator. We are delighted to have him back.” He looked down solemnly for a few seconds, and then resumed his speech. “Dr Damayanthi has acquired fifty-five per cent of the shares of New World Hospital. She now has the controlling share. As you know, she is a very popular and able doctor. It heralds a new era for all those associated with our establishment. The financial details have already been worked out between us.” He glanced at the finance manager, who looked mystified. “I want to tell you that the work will go on as usual. I believe we will progress faster with this change. The reasons for this are purely personal and unavoidable. I resign as the director of New World right away. It’s the Brave New World from now on.”
He tried to smile bravely, and somewhat succeeded. As he rose to leave, a babble of voices erupted behind him.
“Damayanthi is good!” Surendran heard someone comment.
He had to agree.