At the hospital, Paul opened a foot clinic and was astounded when overnight it became the busiest clinic. The majority of the cases he saw at the clinic were clubfoot, a condition with which Paul had some experience. Paul had worked at Great Ormond Street Hospital in London with Dr. Denis Browne, a world expert in surgically correcting clubfoot in babies. Paul had noticed during his time at Great Ormond Street Hospital that such surgery created a lot of scar tissue, which in turn became a problem as the child grew. Nonetheless, surgically correcting clubfoot was the accepted procedure, and Paul decided to use it, despite its drawbacks.
Many of the patients coming to the clinic were clubfooted adults. Paul had never seen this in England, since clubfoot was corrected in infancy. It was disconcerting for Paul to see an adult walking on the side or top of his or her curled-under foot.
As he examined a young man of nineteen with clubfoot, Paul was amazed at how supple the man’s foot tissue was. The foot had none of the hard scar tissue that came from surgical correction. Paul decided to try a different approach in treating the young man. He bent the foot around until the young man felt pain, at which point he set the foot in a cast. After a week he removed the cast and repeated the procedure of bending the foot until it hurt and putting it back in a cast. Over the next several weeks, as the procedure was repeated, Paul was able to restore the young man’s foot to a normal position.
Paul was nearly as surprised as the young man at the outcome of the treatment. Soon this became the accepted procedure for treating clubfoot at the hospital. Instead of radical surgery to correct the deformity in one hit, Paul used a gradual approach that produced the same result with no later problems.
One day, during the steamy hot season, Dr. Cochrane sought Paul out. “How about coming over to Chingleput and having lunch with me?” he asked.
“I’d like that,” Paul replied, thinking that it would be good to talk with Dr. Cochrane about the possibility of his staying long-term at the hospital in Vellore. As it would turn out, the two men ended up having quite a different conversation.
Later that week Paul was able to find the time to make the seventy-five-mile trip east to Chingleput, where Dr. Cochrane, the head of the medical school at Vellore, was the superintendent of the Lady Willingdon Leprosy Sanatorium. As he entered the gates of the sanatorium, Paul glanced at his watch. He had made good time from the train station and was a little early. Dr. Cochrane greeted him warmly and said, “Let’s go for a walk before lunch. You’ve been in India for a while now, but since you’re not assigned to any of the mobile clinics, I don’t suppose you’ve seen many cases of leprosy.”
Paul nodded. It was true. He had hardly seen or thought about leprosy since arriving at Vellore. He knew a little about the skin disease—that it was caused by the same bacteria seen in tuberculosis, that about 95 percent of people were naturally immune and could not catch the disease, and that those who did catch it were completely cut off from their previous world. This was true even in the hospital at Vellore, where lepers were left untreated for fear that treatment would cause rioting in the wards. That was about all Paul knew or felt he needed to know about the disease. After all, he was now an orthopedic surgeon, interested in bones, not skin.
Soon Paul was walking around the thousand-patient facility at Chingleput, admiring the way the staff worked with the patients. Dr. Cochrane told him that patients had been trained to give injections to each other, grow their own food, weave cloth for clothing and bandages, and even bind their own books.
“I like the way things are set up here,” Paul commented. “It’s well thought out and gives the lepers dignity. I have to admit, it’s not at all like I imagined a leprous asylum to be.”
“It’s a hospital, not an asylum,” Dr. Cochrane snapped. “And don’t call them lepers. What comes to mind when you say the word leper?”
Paul’s mind flashed back to when he was seven years old living in the Kolli Hills and the three lepers had come to the house seeking help. He recalled how his father had worn gloves, how his mother had burned the basket they touched, and how he and Connie had been warned never to go near the spot where the lepers had stood.
Apparently Dr. Cochrane was not expecting an answer to his question, because he continued, “Whatever it is you thought of, that’s the stigma these people have to live with every day. They’re not defiled or unclean, they have a disease—just like any other disease.”
Paul nodded and mumbled an apology. He had hit a nerve with Dr. Cochrane. He reminded himself not to use the words leper or asylum again.
The two men continued their tour and were soon standing in a courtyard where many patients were sitting. Some of the people were blind, many had bandages on their hands and feet, and the chins and noses of some looked like they had been eaten away.
“Look at the skin nodule on this leg,” Dr. Cochrane said, pointing to one patient, “and the discoloration of the skin around the cheeks,” he added, pointing to another.
Paul felt depressed, especially when he thought about how these people would never get better. Their best hope was that a new class of sulfone drugs would slow the progress of their disease.
Paul’s stomach growled, and he hoped the tour would soon be over. While he appreciated that Dr. Cochrane was a world expert on leprosy, skin diseases had never interested Paul. Besides, it was time for lunch. Suddenly, however, it was as if a fog had lifted and Paul was seeing the scene in front of him from an entirely different point of view. It almost made him gasp. He was no longer looking at pitiful people with an incurable skin disease. He was looking at people with hands—horribly deformed hands. Some of the hands looked like mittens, with all of the fingers gone, while other hands were set in a claw position or were raw and ulcerated. Never before had Paul seen so many people in one place with hand problems.
“I’m not interested in skin,” Paul said to Dr. Cochrane. “I operate on hands. Tell me about these hands I’m seeing. What is wrong with them? How did they get that way? How are you treating them?”
Dr. Cochrane turned to Paul with a strange look on his face. “I’m sorry, Paul,” he said. “I can’t answer any of those questions.”
“Why?”
“Because I don’t know.”
Paul studied the doctor’s face. Was he joking? Dr. Robert Cochrane was a world-renowned expert on leprosy, and here in front of him were hundreds of lepers, most of whom had some kind of deformity in their hands—and their feet, for that matter—and the doctor did not seem to know anything about it!
“What do you mean you don’t know? Isn’t it your job to know?” Paul asked.
“My job?” Dr. Cochrane challenged. “My job? Paul, I am doing all I can. I am a skin man. I study their skin. It would take a bone man, an orthopedic surgeon, to figure out what is happening to their hands and feet. You’re one of those. Tell me, is it your fault or mine that we don’t yet know what’s going on?”
“Surely someone has done studies, if not here, then somewhere. There must be papers in medical journals on such things as the deformed hands of leprosy sufferers,” Paul exclaimed.
Dr. Cochrane shook his head sadly. “There are at least ten million leprosy patients in the world, and most of them have deformed hands. If this were any other disease, of course that would be the case—it would have been the object of multiple studies. But as I said, this is leprosy, and people, even doctors, recoil when they see it.”
Paul felt himself turning red. Had Dr. Cochrane seen the fear on his face when he recalled the three lepers from his childhood? “But still,” Paul went on, unable to believe his fellow doctor, “someone, somewhere must have looked at the problem.”
Dr. Cochrane again shook his head, and the two men walked in silence. As they walked, Paul noticed directly in front of them a teenage boy struggling to unbuckle his sandals with clawlike hands. Paul stopped.
“Nerve damage,” Dr. Cochrane said. “That’s about all I can tell you. Nerve damage, paralysis, and complete anesthesia.”
“You mean he can’t feel anything with his hands?” Paul asked.
“That’s right. Numbing of the skin is one of the classic signs of leprosy. You could stick a pin into that hand and he wouldn’t flinch. Some of them do it, a kind of grotesque party trick, if you will.”
Paul drew in a deep breath and bent down. It was time to take a closer look. “May I see your hands?” he asked in Tamil.
“Yes,” the teenager replied as he scrambled to his feet.
Paul took the boy’s right hand. It was the first time he had ever touched a leprosy patient. He stroked the palm and then the fingers, which were stiff and inflexible. “Can you feel this?” he asked as he pressed down hard on one of the young man’s knuckles.
“No,” the teenager replied.
“Or this?” Paul said, choosing a different part of the boy’s hand on which to apply pressure.
“No, I can’t feel anything with my hands.”
A wave of incredible sadness washed over Paul. This young man could not feel anything in his hands. It was as if his hands were lumps of meat at the end of his arms. And at least ten million other people in the world were suffering in the same way. It seemed impossible that Paul had not noticed it before.
Suddenly Paul realized that not all of the muscles could be paralyzed. Hadn’t the boy been able to grasp the sandal strap? Paul put his hand into the boy’s palm once again. “Squeeze my hand as hard as you can,” he instructed.
A jolt of intense pain shot up Paul’s arm. The boy had a vice-like grip, as strong as any person’s grip. Paul felt a surge of hope. The hand had working muscles! Strong muscles.
Paul thanked the boy and moved on, peppering Dr. Cochrane with questions: At what stage of the disease did the fingers fall off? Did the doctor have any unattached fingers Paul could study? Had Dr. Cochrane noticed any patterns in numbing on the skin? Did all leprosy patients get ulcers and sores, and what caused them? Had anyone operated on clawed hands or traced the nerves to see which ones might be responsible for the lack of feeling?
Dr. Cochrane did not have any answers to Paul’s questions and kept insisting that no one else did either. Paul found this impossible to believe.
Even as Paul ate vegetable curry for lunch and chatted more with Dr. Cochrane, his mind was moving a million miles an hour. There had to be answers in the hospital research library back in Vellore, and he was going to find them.
Chapter 10
New Hope
Paul worked ten hours a day operating on patients and teaching medical students, and he was on call every third night, but now he had another mission. He spent every spare moment in the hospital library running down all the leads he could find on leprosy. His drive to know more was infectious. Soon other doctors at the hospital were giving up their own off-hours to cover for Paul so that he could continue his research in the library.
After three months Paul had to conclude that Dr. Cochrane had been right: no one had studied the deterioration of the hands or feet of leprosy patients. The only references Paul could find in all of the medical journals were related to how to amputate the arms and legs of a leprosy sufferer once the limbs had become too infected and ulcerated. Thousands of orthopedic surgeons around the world operated regularly on patients with hand problems caused by polio, birth defects, and accidents, but not one of them had ever operated on the hands of a leprosy patient. Paul found this hard to comprehend, since there were more leprosy patients with hand problems than all of the other patients with hand problems combined.
Like an annoying stone in his shoe, Paul could not ignore the mystery of leprosy. Somebody had to solve the riddle of what was happening to the hands of leprosy sufferers and why. Eventually Paul came to the conclusion that this was the reason God had put him at Vellore—to be the person who took on the task of helping leprosy patients keep or regain the use of their hands.
