Should've Worn the Mask

The temperatures in Mumbai (formerly known as Bombay) routinely reach into the high nineties and low hundreds. While in India, I, as an inexperienced and overly cautious traveler, made every effort to fit in with the local people. For my first week and a half in India this included wearing long pants and button up shirts no matter how hot it was outside, no matter how long I'd be crammed into a small cab with four other people, and no matter how long that cab was going to be stuck in traffic. I've encountered few situations that have left me more uncomfortable than the cab rides to and from Indian hospitals and clinics in the early weeks of June, prior to the arrival of the monsoon. In times like these, anywhere other than the cab seemed like Heaven, even a tuberculosis hospital.

Ramesh Premchand T.B. Hospital was built in 1941. It is a large concrete structure whose appearance from the outside suggests that little maintenance, in terms of painting and such, has been conducted since the day it opened its doors to the incredible numbers of Indians suffering from tuberculosis. This, of course, was not what I was thinking while standing underneath the front canopy waiting to be led inside. I was, after all, out of that cab and in the shade.

The inside of the hospital was not lit, nor was their any air conditioning. The only source of ventilation existed in the form of open windows and ceiling fans that worked as long as there was no city-wide power outage, which was usually a good part of the day. The lack of ventilation scared some members of my group, as they dawned their T.B. masked even before stepping into the hospital. I was a little less cautious than them because I hated wearing a mask. It was uncomfortable and it probably made some of the patients feel alienated. Besides, no one else working at the hospital was wearing a mask. Actually, the first thing that Vigay, the doctor we were meeting with, said to us was that our masks were unnecessary. This put my mind at ease, though Pat and Kedar opted to leave their masks on.

Vigay was a soft-spoken middle-aged Indian man with a small frame and tired eyes. He spoke with the accent that you would expect from an Indian. If you don't know what is to be expected, think Apu from The Simpsons and you'll get the idea. He appeared to be a very kind and likeable guy during the first 15 minutes of our meeting during which time he filled us in on the basics regarding tuberculosis diagnosis and treatment. But he seemed to change a bit as soon as the patients started coming in.

I already felt somewhat awkward as the first patients started rolling in. This was mainly due to the fact that I, along with Vigay and the other four members of my group, were seated behind a long wooden table at the back of the room while patients spoke to the doctor from a distance of about 20 ft. I guess this was simply a preventive measure, a type of space barrier between us and the patients, to ensure that none of us would get sick, at least those of us not wearing a mask. But Vigay made the situation a bit more difficult to swallow when he started asking us questions between his incomprehensible Hindi conversations with patients.

It wasn't that our limited medical knowledge prevented us from correctly answering his questions, or that the patients wouldn't quit staring at the sweaty Americans in glowing white coats, it was that Vigay spoke far too softly for any of us to hear what he was actually saying. This is when things started to get a little strange and I quit jotting down notes about T.B. and just started writing down all the weird crap Vigay was saying.

"Can you please talk a little louder, I'm having difficulty hearing what you are saying, " Pat asks.

"No, I speak softly. Come closer," is how Vigay responded, not even looking up from the notebook in which he was writing.

Pat made a couple scoots forward in an attempt to satisfy the doctor's request, but Vigay wasn't satisfied. "No," he repeated in a somewhat frustrated tone, "you have to come closer." Pat obliged and Vigay's preaching began.

"You cannot just listen to my words, you have to be close that you can hear what is in my heart, you have to listen to what is in my heart."

I think that it is actually a pretty deep statement, and had I been alone with Vigay I may have actually stopped a second to ponder the thought, but laughter is even more contagious than the tuberculosis bacilli that were circulating all throughout that room. As soon as I heard Pat's slight giggle I was unable to prevent the huge grin from forming across my unmasked face. I looked at Pat, who continued to listen to the doctor with any trace of amusement hidden behind his T.B. filter. Still, at this point the thought of putting on my mask had not come to mind. Anyways, we were now on to the next patient.

She was a beautiful young Muslim woman, probably in her mid-20's. She had been on antibiotics for 7 months now and wanted to know if it was safe for her to get married. Her family wanted her to hurry up and "git 'er done," as she was well on her way to becoming an old maid (People marry very young in India. The subject of marriage often came up in my conversations with other Indians and they were always very surprised to learn that I was unmarried. I'm 22.) The doctor turned the question over to us. We told Vigay that she was nearly done with her course of antibiotics and that it was safe for her to marry. Vigay then spoke to her in Hindi and told the nurse to bring in the next patient. We had to ask him what his final word was on her marriage.

"I don't discuss things like marriage. I don't believe in marriage. The only true marriage will come when you are in Heaven," was how Vigay began. His face seemed to gloss over and his voice adopted a rather dreamy tone as he continued. "True love does not exist on Earth. What we experience here on Earth is mere attraction. True love only comes in Heaven."

Again, bits of laughter leak out from behind Pat's mask and float over to me. The result is the same, only now I am looking directly at Vigay, and he's speaking directly to me. He can see the huge grin on my face, though I try to disguise it as me being totally enthralled in these words of wisdom that he is sharing with us, you know, as if I am delighted to be in the presence of such greatness. This would have been an excellent time for me to put on my mask because then I wouldn't have had to suffer the guilt of putting it on right after Vigay informed us on the history of T.B. and the unimportance of our masks.

Vigay began with a general background of the disease and then talked to us about the philosophical side of infectious disease and how we have all lost faith in our bodies' natural defenses against disease, or, as he put it, how "Man has lost faith in Man."

From this statement came Vigay's idea on why we get sick. "Disease only comes if we want it to come," is his theory. "I cannot be dependent on the mask. I have my own lymphocytes, my own antibodies."

O.K., so now I am getting a little worried. Was this man, who, when I entered, instructed me that a mask was unnecessary basing his entire rational on his assumption that I will not be infected with disease simply because I don't want to be infected? Vigay, are you telling me that when the woman infected with T.B. came worried about the fact that her family might catch it, asking why the disease relentlessly takes children, went home with an answer similar to, "Your family will only be infected if they let themselves be infected and children are infected because they want to be infected."? Yeah, now I put on my mask.

Vigay continued to confuse the hell out of me. To further his "Man has lost faith in Man" argument he referred to the water. "No one even drinks the water here, everyone drinks bottled water."

To that Pat asks, "Do you drink the water?"

"No. The water here is very impure."

O.K. Vigay, but your lymphocytes, your antibodies? And if all of what Vigay wasn't enough to scare us already, he decided to spend our last 5 minutes together telling us something that went like this:

"You have all been infected with tuberculosis. The myobacterium has entered your bodies and is interacting with your cells. Just because you are infected does not mean you will develop the illness. If you have a healthy immune system, your body will fight the disease and you will not become ill." He then went on and explained, in a stepwise fashion, what exactly to expect if our immune systems are not in shape to fight off the infection, a scenario with a 5-10% chance of actually being played out.

Well, at least I now had my mask on. The only problem was that now none of us were laughing.