Summary
Mariamma begins working with patients at Parambil but is frustrated by the hospital board's refusal to complete construction on the hospital and secure essential supplies. She reaches out to Uplift Master for help, though he is afraid to challenge the board directly after an embezzlement scandal involving one of his employees ruined his reputation. Still, Uplift Master provides several ingenious suggestions for working with the board and the bishop, and soon resumes his position as an intermediary with bureaucracy, allowing Mariamma to perform emergency surgeries and provide treatment for the entire village.
In her free time, Mariamma studies the family tree and tries to fill in missing entries of women who married out as well as distant cousins. She contacts Broker Aniyan for additional information, as he has an encyclopedic knowledge of all Saint Thomas Christians in Kerala. Mariamma also seeks answers in her father's journals, believing the Condition causes eccentricity that she can identify in his writing, and contacts Philipose's publisher, who decides to write an article about the Condition, asking families with a similar history to contact Mariamma. Meanwhile, Joppan volunteers to work as Miaramma's scrub nurse and proves so competent that he becomes her surgical assistant.
One morning, Cromwell and Digby arrive at the hospital and ask Mariamma to accompany them to Saint Bridget's, explaining on the way that Lenin, remembering his mother's stories of Digby intervening during his birth, arrived at Gwendolyn Gardens gravely ill and asking for Mariamma. When they arrive, Lenin is unconscious, and Digby is awed by Mariamma's comprehensive exam and thoughtful diagnosis. She explains that the Condition has caused a buildup of fluid at Lenin's brain stem, which they need to drain before he can be taken to the hospital. Knowing that Lenin is wanted by the law for his Naxaltie activities, they decide to perform the operation there. Together, Digby and Mariamma operate, and Lenin regains consciousness.
Mariamma, emotionally overwhelmed and physically exhausted, faints, waking later in Digby's study. She examines his photographs, including one of his mother, who has a distinctive "piebald" streak in her hair, similar to Mariamma's own. As she and Digby return to check on Lenin, Mariamma passes a woman with leprosy standing unnaturally still; this sight reminds her of the Stone Woman sculpture at Parambil. In his brief waking moments, Lenin explains his feelings for Mariamma and his disillusionment with the revolution. He is reticent to go to the hospital, but when he succumbs to a seizure, Mariamma makes the decision to bring him to the hospital several hours away, regardless of the consequences.
At the hospital, Lenin is examined at length and brought in for life-saving surgery. Digby calls and advises Mariamma to reach out to the newspaper to publish an article explaining the behavioral effects of the Condition so Lenin's sentence will be reduced. Relatives of patients pray with Mariamma, who meets with Lenin's surgeon, who is also her future boss. As Lenin recovers, he and Mariamma reconnect, discussing their potential future together after he is released from prison and agreeing to meet again at the hotel where they were first intimate. When Lenin is sufficiently recovered, a police officer arrives to escort him to prison, though the medical staff warn the officer about mistreating their patient.
Back at Parambil, Mariamma is despondent and unable to sleep. She comforts herself by reading her father's journals, drawn to an unusual entry about her. In the entry, Philipose takes responsibility for his opium addiction, Ninan's death, and Elsie's departure. He also expresses that Mariamma is his purpose in life and allowed him to become the person he was meant to be. He also briefly mentions that when Elsie returned to Parambil twenty-five years before, she was already pregnant with Mariamma. Even though Philipose knew he was not biologically her father, he proudly assumed the role. Mariamma is shaken by the discovery that she has no blood ties to Parambil, her father, or her grandmother. When considering who her father might be, Mariamma realizes that her "piebald streak," a distinctive feature that no one in her family shares, is the clue.
Analysis
As Mariamma's scrub nurse, Joppan's willingness and competence contrast with Philipose's squeamishness when he helped perform surgery for Digby. Joppan is earnest in his efforts and thrilled by his new role, which extends beyond what he imagined possible for himself. Joppan's narrative arc explores how inequality can determine and influence fate. Joppan's nontraditional entry into the medical field demonstrates that a person's fate can be fulfilled at unexpected times and places. Joppan always longed for an education and to elevate himself, but was consistently denied opportunities, often violently. When he tried to follow other paths that were built to exclude him, like the formal education system and the business world, he consistently failed. However, by letting go of these oppressive systems and working with Mariamma to build a new, equitable future, Joppan contributes to a vision of the future he wanted to build as a member of the Communist Party.
As Mariamma uncovers information about the Condition, she realizes that the disease is part of an inheritance that intersects with faith. As explored throughout the novel, medicine and belief intersect at the root of the Condition, as all the families that share the Condition are Saint Thomas Christians. The community is bonded not only by shared ancestry and culture but also by pain and loss. Mariamma's discovery is also ironic, as the Saint Thomas Christians believe that baptism is an essential ritual for salvation; baptism involves submerging a person in water to signify their rebirth as part of the Christian faith. Submerging in water disorients people afflicted by the Condition, and sometimes results in their death by drowning.
Mariamma also considers a theory that the tumors that cause the Condition might also cause a "tumor of thought," essentially, an eccentric or erratic personality. As Mariamma searches for evidence of the "tumor of thought," she introduces ethical questions about accountability and disability. For example, Mariamma wonders if Lenin's extreme political views are a consequence of the tumors, hoping that publishing her findings will reduce his sentence. However, Mariamma also recognizes that Lenin's personality was developed before the tumors created physiological deficits, like loss of balance, and fears that discounting Lenin's responsibility for his actions will also diminish his personhood and agency. In this ethical and philosophical question, the novel invites the reader to consider the limits of compartmentalizing personality, anatomy, and disability.
Mariamma's unique ability to extrapolate and fill in the gaps of limited data shapes her medical practice. For example, Mariamma completes the Parambil family tree, finding unusual yet essential sources of data like Broker Aniyan and her father's journals. Unlike her predecessors, Mariamma suspects that healing the Condition also involves bringing secrets to light and forging human connections that supplement clinical research. For example, Mariamma recognizes that the women who married out of the Parambil family likely suffered from the Condition, and tracks down stories of disregarded women to complete her understanding of the family tree. Beyond the benefits to her research, Mariamma's imagination helps her imagine completeness in her patients. For example, when she visits Saint Bridget's, she sees past missing limbs and features, responding "automatically, barely registering" that a woman with a missing hand's "'namaste' must be imagined to be complete." Mariamma's uncanny imagination takes on a symbolic layer when she sees a woman standing unnaturally still, and regards her as a work of art, until the woman's sari moves and "the object she took to be lifeless came alive." Mariamma's intuitive understanding of the woman's connection to art and sculpture foreshadows the revelation that Elsie is alive.
The theme of family intersects with the theme of secrets when Mariamma interviews Broker Aniyan and reads Philipose's journals. Broker Aniyan maintains an expansive knowledge of all the Saint Thomas Christian families in Kerala, including their histories and secrets. This knowledge gives Broker Aniyan the credibility to suggest that "all families have secrets, but not all secrets are meant to deceive," and that what "defines a family is not blood, but the secrets they share." This cryptic message foreshadows Mariamma's discovery that Philipose is not her biological father but was her father by choice, a responsibility that changed him forever and saved his life. The secret of Mariamma's paternity bonded Philipose, Big Ammachi, and Mariamma into an authentic family, and helped Philipose and Big Ammachi interrogate what it means to be a family. This secret was not meant to deceive others, as Broker Aniyan suggests, but to protect Mariamma's sense of self, which was tied to Parambil.
Part Nine investigates different types of inheritance. For example, Lenin relates that during his time hiding from the authorities, the indigenous tribal leaders helped him survive by sharing survival skills, such as knot tying. Lenin remarks that this knowledge is a form of inheritance "that is not land or money," but that is often more significant. Referencing the idea that families are defined by the secrets they share, the tribal leaders who helped Lenin essentially invited him into kinship by sharing their secrets and knowledge. When Mariamma performs her examination and surgery on Digby, he realizes that Mariamma's inheritance includes her innate surgical talent and the body of medical knowledge they both share. As physicians, Mariamma and Digby "inherit" the research and ideas of medical professionals who came before them. For example, Mariamma references the "Cushing Response," a concept Digby remembers from his time in Glasgow, suggesting that those who participate in the sacred vocation of medicine are connected across time, space, and culture.
As Mariamma waits for Lenin at the hospital, the theme of healing expands to acknowledge the intense pain of seeing a loved one suffer illness and injury. Mariamma and the other people waiting for their loved ones create ways to heal their fear and the feeling that "there's nothing emptier than a hospital bed to which a loved one might not return." They spontaneously create methods of healing one another, praying together and encouraging one another, regardless of how effective their efforts are on the outcome of the surgery.
