Summary
Mariamma begins medical school, aided in her studies by her unique ability to accurately imagine body systems based on limited visual data, such as the cadavers she dissects and the illustrations in her textbooks. She quickly becomes one of the university's top students and regularly exchanges emotionally intimate letters with Lenin, who is struggling with his faith and calling. During her viva voce, Mariamma is left alone with the examiner, Brijee Sakar, who threatens to fail her if she does not touch him sexually. Confused and scared, Mariamma reaches into his pocket; she remembers other examples of sexual harassment and is seized by fury and survival instinct. Screaming, she crushes his groin, causing him to have a heart attack; she is injured in the process. Mariamma passes her exam and testifies against Brijee, who is suspended; however, the emotional scars of the experience remain with her, and she does not tell her family what happened.
Soon after the assault, Lenin visits Mariamma. His appearance has changed, including a scar marring his face. The two visit Mahabalipuram, and Mariamma swims in the ocean for the first time, feeling renewed and reckless. They miss the last bus to the city and decide to stay the night in an inn. There, Lenin tells Mariamma a harrowing story of how he left the seminary to engage in Communist protests, which turned unexpectedly violent. After receiving a beating and seeing his mentor shot, he explains, he decided to join the Naxalites, an insurgent group reclaiming land by killing landowners. Now that he is a fugitive, Lenin knows he has no hope for an ordinary life. Knowing this may be the last time they see each other, Mariamma realizes she loves Lenin, and the two sleep together. The next morning, Lenin asks Mariamma to marry him and join his political movement; Mariamma is offended, pointing out that Lenin is asking her to sacrifice her dreams for his. They part sorrowfully, Lenin insisting that if he had known of Mariamma's affections, he would never have joined the Naxalites.
Mariamma's feelings for Lenin grow during their time apart. She works at a labor and delivery ward at Gosha Hospital and starts to believe she is pregnant. After assisting in a harrowing delivery, Mariamma confides her suspicions with Nurse Akila, who orders a blood test, confirming that Mariamma is not pregnant. Relieved, Mariamma returns to Parambil for her school holidays, though she keeps her struggles secret from her father. She also learns that Joppan, a devout member of the Communist Party, lost his barge business after attempting to break up a worker's strike. Philipose offers Joppan a similar position to the one he offered after Shamuel's death, though with the land allotment and salary reduced, which Joppan begrudgingly accepts, and discovers he enjoys caring for the estate. To grapple with the changes, Mariamma visits the Stone Woman, the nest, and bathes in the river.
Much-admired Doctor Uma Ramasamy offers Mariamma a research position dissecting the limbs of people with leprosy. Mariamma enthusiastically accepts, as she sees Doctor Ramasamy as a surrogate mother and leprosy was the reason she decided to go into medicine in the first place. With her excellent motor skills and ability to imagine the body, Mariamma is able to cleanly dissect nerve samples.
Meanwhile, Philipose visits Willingdon Island to conduct research for an Ordinary Man article. At his hotel, he sees a catalog for an art auction; one of the sculptures, attributed to an unknown artist, is a replica of Elise's Stone Woman. Realizing that Elsie might not have drowned, Philipose books a train to Madras to make amends, though he fears returning to the city. As the train crosses over the water, the bridge collapses. Remembering what Shamuel taught him, Philipose swims to the surface and opens his eyes. However, he sees a child calling for its father; he swims to rescue the child and drowns in the process.
Mariamma and Doctor Ramasamy visit the morgue to identify Philipose's body, where Mariamma asks her mentor to perform an autopsy on Philipose's body to discover the source of the Condition. After Philipose's funeral, Doctor Ramasamy shows Mariamma her father's brain, which has two small tumors, causing vertigo, hearing loss, and the myriad other symptoms exhibited by members of her family. The two conclude that this genetic condition makes it impossible to orient oneself in space while suspended in water, causing an increased likelihood of drowning. Though relieved to have a name and scientific cause for the condition, Mariamma is frustrated that no cure exists. She decides to focus on neurosurgery and is awarded a scholarship to train in this field after volunteering with a mission hospital near Parambil.
Analysis
When Mariamma first arrives at school, the narrator describes the campus using eerie, gothic terms to highlight the strangeness of medical school, particularly the macabre necessity of dissecting human corpses. For example, one school building "sits apart from the rest of the medical school like the scary relative hidden in the attic." Mariamma's anatomy professor reminds her of a gargoyle, and the "mosque-like turrets" of a crumbling building remind her of the Hunchback of Notre Dame.
As she is immersed in anatomy classes, Mariamma starts to understand herself in medical imagery, a motif established earlier in the text. In her embryology class, she is disturbed to consider that she once was an embryo, "a cell from Philipose and a cell from Elsie. The two became one and then divided." This comparison helps Mariamma understand her parents' strange relationship. Mariamma's entire reality begins to be shaped by her studies; for example, she experiences a sensual dream where a lover touches and names her "ginglymoarthrodial joint," naming the body part in clinical terms. This experience recalls the connection between sensuality and clinical vocabulary that Digby used during his encounters with Celeste. Mariamma's use of medical terminology takes a dark turn when her examiner attempts to sexually assault her. In a panic, Mariamma attempts to make sense of the situation with anatomical terms and knowledge, which are dredged up alongside countless memories of harassment. Once she works through her shock, Mariamma reacts swiftly, fighting her assailant and causing maximum damage to his anatomy.
The theme of faith and superstition surfaces as Mariamma and her classmates prepare for exams, another example of the novel blurring the lines between belief and medicine. Though scientifically minded, the medical students develop bizarre treatments and rituals, such as sleeping with the lights on, eating fish brains, and learning while sleeping, to better prepare for their exams. These examples recall one of Philipose's stories about a collector of wart-cures. The thesis of the story is that belief itself is a cure. Mariamma extends this blurring of faith and medicine during her internship at the labor ward. One of the nurses, a skilled midwife who reminds Mariamma of Big Ammachi, is nicknamed "Goddess Akila." This title indicates that to Mariamma and the other staff, Akila possesses an almost supernatural skill for delivering babies that cannot be learned or developed.
When Mariamma and Lenin leave Madras, Mariamma decides to swim in the ocean, ignoring Lenin's discomfort and warnings about the Condition. After surviving the assault, Mariamma feels "entitled to be reckless." Mariamma enjoys the ocean's power, and emerges from the water feeling powerful and reborn; the symbolic cleansing gives her the bravery to accept her feelings for Lenin and stand up for her future and dreams when he proposes to her. Later, when Mariamma returns to Parambil, she bathes in the canal, noting that though it is technically the same swimming spot she visited throughout her childhood, "time and water move on relentlessly," meaning that neither she nor the canal are the same as when she last visited.
Mariamma and Lenin's discussion of marriage inverts Elsie and Philipose's. Like Mariamma, Elsie had clear dreams, wanting to become a famous artist. However, Elsie recognized how limited her opportunities were as a woman in her community, and thought marrying Philipose would provide the support she needed to follow her dreams. Elsie did not reciprocate Philipose's love but prioritized herself by marrying him. Mariamma exhibits her mother's determination, but because of Big Ammachi's influence and the opportunities afforded her generation, she does not need the support of a marriage. Mariamma loves Lenin passionately but rejects him, knowing he will take away her dreams. The mother and daughter's experiences are both parallel and inverse; initially, Elsie did not love Philipose, but loved the life he could provide her. Conversely, Mariamma loves Lenin, but understands that he cannot provide her with a happy or stable future.
The difficult delivery in which Mariamma assists is reminiscent of Elsie's dangerous labor. Mariamma has the support of a medical staff and extensive training, but nearly damages the baby and mother during the delivery. By contrast, Big Ammachi did not have training or formal education, but her intuition as a healer helped her deliver Mariamma. Like Nurse Akila, Big Ammachi had the uncanny ability to recognize pregnancy just by looking at a woman. This parallel demonstrates Mariamma's role as a successor to Big Ammachi and invites the reader to question what Big Ammachi could have achieved if afforded the opportunities her father intended for her. Furthermore, Mariamma attends a college lecture about immune responses. As her professor explains, "in essence, the veterans clone their younger selves" to fight off diseases. Big Ammachi's main goal in life was to figure out a way to cure the Condition; because of the limitations imposed on her, she was unable to obtain the necessary skills and education to address the Condition herself. However, Big Ammachi pours all her love, energy, and support into Mariamma, her namesake, who continues Big Ammachi's mission and eventually discovers the cause and cure of the Condition. Like white blood cells in a body system, Mariamma inherits Big Ammachi's skills and goals, healing her family.
Lenin and Mariamma's intimate and harrowing conversation demonstrates the darker side of the theme of secrets. As Lenin shares his dangerous, violent story, he and Mariamma realize that if they had shared their feelings for one another, Lenin would have not joined the Naxalites, and their futures would have been different. As she returns to her medical training, Mariamma's feelings for Lenin grow, and she struggles to process the assault. She senses a distance between herself and her family, but recognizes that "it's her secrets that create the distance."
Mariamma explores different types of healing, continuing and expanding on the traditions of her predecessors. For example, Digby and Rune worked at Saint Bridget's to help people with leprosy access the healing power of community and regain functionality in their hands to continue activities that give their lives purpose. Contrasting with this project, Mariamma takes on the equally important task of contributing to medical research in Doctor Ramasamy's lab. The physicians all work on hands, which provides a clear point of contrast to analyze their practice. Mariamma and Doctor Ramasamy excise and study nerves to find patterns and develop life-saving treatments. Saint Bridget's addresses the present realities of people suffering from leprosy, and Doctor Ramasamy's lab looks to the future to prevent the disease. Though Mariamma, Rune, and Digby all view their patients differently, their efforts work in conjunction to help improve the lives of people suffering from leprosy.
Philipose's death is highly ironic. After years of fearful seclusion at Parambil, Philipose decides to visit Madras to make amends with Elsie. However, the train he picks derails, the bridge collapses beneath, and he plunges into the water. Adding to the irony, Philipose survives the crash, only to drown rescuing a child. Additionally, the accident was the first time Philipose violated his agreement with Big Ammachi and swam alone. Though tragic, Philipose's death also contains an element of healing and redemption. Throughout his entire marriage, Philipose prioritized his anxiety over Elsie's needs, refusing to even consider leaving the home to support her. Emotionally healed and accepting his past, Philipose rushes to find Elsie without hesitation. Though he had wanted Mariamma to be a reincarnation of Ninan to redeem him, Philipose ultimately redeems himself by saving a child and sacrificing his own life.
The motif of conceptualizing human beings through anatomy is resolved when Mariamma views Philipose's brain. Throughout the novel, characters compartmentalize others into anatomical categories to cope with the complexity of human relationships and traumatic experiences, like when Digby paints organs on Celeste's body to subdue his grief or when Mariamma focuses on Brijee's anatomy to fight his assault. When Mariamma sees Philipose's brain, however, she is unable to compartmentalize his anatomy and his personhood. Though "her father's brain looks like any other brain," Mariamma considers how this piece of his body "held his unique memories, every story he wrote, and the ones he might have written." Mariamma adds an emotional, spiritual aspect to the brain as she notes that the organ "held the love he had for her" and "the mystery of why he came to Madras."
