“Perhaps because they are close to the surface they are more susceptible to impact damage,” Dr. Buultgens surmised.
Paul nodded. It was possible. Only time would tell if her hypothesis was right.
Paul studied the cadaver more closely, trying to get a better idea of which muscles could be repurposed surgically to take over for those that were paralyzed. He took a series of photographs of the exposed nerves. By then it was time to suture the body and take it to be cremated on a funeral pyre, as was the Hindu custom.
After gathering all the specimen jars and surgical instruments, a tired Paul and his two assistants headed for the gate of the leprosarium. They then woke up their driver and headed back to Vellore.
Back at the hospital at Vellore, Paul sent the nerve samples from the autopsy to the pathology department, where Dr. Gault and his staff set to work analyzing them under the microscope. The process was long and slow. Being a thorough researcher, Paul waited patiently for the conclusions.
Over the next few months, Paul and his team performed seven more autopsies on leprosy cadavers, though none was as harrowing as the first autopsy in Chingleput. In each case they found the same nerve swellings in the same places in the bodies they autopsied. This was evidence to Paul that he was on to a breakthrough in understanding the way leprosy affected nerves. Paul just didn’t know how to interpret the evidence. Why did the nerves swell at the particular places they did? What could possibly be the cause?
Paul received permission to keep several amputated hands to study, which he stored in the family freezer at home. At night he would often thaw out a hand and begin pulling the muscles and tendons in various directions with various intensities, trying to work out which muscles and tendons controlled what movements and which ones he could substitute for others.
Margaret did not tell the family cook what the objects wrapped up in the freezer were for fear he would run away. Sometimes the cook would ask if he could use the meat wrapped in the freezer, but Margaret told him they were keeping it for something special. The children, on the other hand, knew what Paul was up to and were delighted to sit beside him at the table while he described to them and demonstrated the marvels of the human hand.
Although Paul was busy with his regular hospital rounds and surgeries, he kept focused on his quest to discover just how leprosy debilitated the bodies of those it ravaged. Sometimes he experienced setbacks that made him question whether he would ever make significant progress. One of these setbacks occurred with John (as Krishnamurthy now called himself) some time after he had been released from the hospital. The day John was released had been a great day of celebration for Paul and the team of nurses and physical therapists who had worked with him. After his release from the hospital, John had returned to his family, shown them his working hands, and looked for a job to support himself. Sadly, things did not go as he had hoped.
One day, about two months after he had been released from the hospital, John returned to Vellore looking thin and forlorn. He held out his hands to Paul. “Sahib doctor,” he said, using a term of respect, “these are bad hands. They are not good hands.”
Paul felt his heart racing. How could the operation have gone wrong after such a long time? “What do you mean?” he asked, noting the tears in John’s eyes.
“Bad begging hands, Sahib. Before, when I would beg, people would throw me money, but now they look at me and think I could work. But I cannot. No one will give me a job. People do not pity me, but they will not employ me either. It is because of my bad hands.”
Paul was aghast. Why hadn’t he thought about this before now? He recalled seeing another leprosy patient unbandaging himself and picking at his wounds, making it impossible for his hands to heal. Had that patient been worried about “bad begging hands” as well?
John interrupted his thoughts. “What should I do?”
The question hung in the air. What should he do? Paul did not have an answer, but he realized that unless he came up with one soon, all of his research would be pointless. If leprosy patients did not want to be healed because it gave them bad begging hands, then he might as well stop now.
As he thought about the dilemma, Paul decided that what was needed was a place where leprosy patients could earn a living right in Vellore. In an instant he could see it all: a small village with huts where those who had undergone surgery on their hands could live while they recovered. Physical therapists could observe the movements of their hands and guide them toward a trade suited to the kind of movement they had. Skilled instructors would train them in that trade. When they reached proficiency, the patients could return to their village and set up a small business.
It all seemed so simple and straightforward, and Paul wondered why he hadn’t thought of it sooner. There was just one problem: it was difficult enough paying for the limited amount of research he was doing, and Paul wondered where the money for such a rehabilitation center would come from.
Chapter 12
Nava Jeeva Nilayam
A few days after coming up with the idea of a leprosy rehabilitation village, Paul was making his hospital rounds when one of his patients called him over. Mother Eaton, as the woman was affectionately known, was an eighty-four-year-old American missionary suffering from rheumatoid arthritis. She had come to Vellore hoping to get some relief from her pain, but there was little that could be done for her. Mother Eaton did not let the excruciating pain stop her from taking an active interest in what was happening at the hospital.
“Do you remember how yesterday you were telling me about your idea for a village for your leprosy patients?” she asked Paul.
“Yes,” he replied.
“I couldn’t sleep last night because of the pain, and I lay awake thinking about what a wonderful difference your idea could make in those boys’ lives. I’m not a rich woman. I have only about five hundred pounds in the bank, but I kept thinking, how would I explain to my Lord why I left that money idle? I want you to take it and use it.”
Paul felt tears fill his eyes. “Are you sure?” he asked.
Mother Eaton waved her hand. “Yes! I don’t have long to live; we both know that. I want the money to go to build some small huts and a shed where those boys can learn a trade. In a year or two, they can go home and become self-sufficient, and other boys can come. What are you going to call the place?”
Paul took Mother Eaton’s hands. “If you are sure this is what you want to do, we’ll start right away. The need is great. I was thinking of calling it Nava Jeeva Nilayam.”
“Perfect!” Mother Eaton responded enthusiastically. “New Life Center. I will pray for you every day.”
Paul soon found out that he needed every one of Mother Eaton’s prayers. Even those who Paul thought would enthusiastically support his plan were reticent. Among them was Dr. Cochrane, who pointed out to Paul that the new Schieffelin Leprosy Research Sanatorium was being planned for Vellore. Why not wait for it to be completed? Paul pointed out that he needed something now, and the site for the new research sanatorium had lain idle for over two years.
When Paul sought permission to build the rehabilitation village in the corner of the two-hundred-acre lot on which the medical college stood, many doctors at the hospital questioned such a move. They argued that it was unwise to put medical students and leprosy patients in such close proximity to each other. Nonetheless, Paul persevered. He was granted permission to build the village on the condition that it be cordoned off with a barbed-wire fence and that none of the inhabitants of the village cross the fence and enter the medical college campus.
Paul accepted these conditions and set to work. Soon he was busier than ever, designing and building the New Life Center. He still had his hospital work to do during the day and was regularly on call during nights at the hospital. He also continued to spend his weekends at Chingleput. And somewhere between dusk and bedtime each night he pored over the plans for the simple village. For the first time he marveled at how his years as a builder were now helping him with his work.
Meanwhile, the Brand family continued to grow. On February 25, 1950, Margaret gave birth to a third daughter, Estelle. Soon afterward the first group of six young men were situated in the whitewashed, mud-walled huts at the New Life Center. Because leprosy did not respect social or caste boundaries, it was an interesting group of men from both upper and lower castes. Also, the men possessed a broad range of educational abilities. One of the residents was an engineer, another had a bachelor of science degree, and still another had been a chartered accountant. Yet all of them had been afflicted with leprosy. And all of them living together in the village as they did was unique in India, a society deeply divided along caste and social lines.
At first Paul played the role of both doctor and instructor. Drawing on experience from his apprenticeship as a builder, he began teaching the young men how to work with wood—how to use the various tools to shape and mold the wood into beautiful and useful objects that could be sold for profit. The men started by making wooden toys and branched out from there. They also planted and tended a village garden where they learned to grow and cultivate a variety of vegetables to eat.
While the village was devoted to rehabilitation and teaching new trades to those who had regained the use of their hands through surgery, Paul had another reason for working so hard to make the New Life Center a reality. The village would provide him with a group of patients whom he could monitor and observe every day, unlike those patients at the leprosarium in Chingleput whom he saw only once a week.
By paying close attention to this small group, Paul hoped to unravel the mystery of why the fingers and toes of leprosy patients wasted away. As soon as the six men were settled in the New Life Center, he set out to find answers. With the help of Dr. Buultgens, now Paul’s full-time research assistant, and several others, each patient’s hands were inspected every evening, and any minute changes were recorded. That, however, was not the procedure that led to a major breakthrough.
The breakthrough came when one of the residents, a ten-year-old boy, offered to turn a key in a rusty lock for Paul. Paul was trying to unlock the padlock on a small storage room at the New Life Center, but the lock had rusted, and he could not manage to get the key to turn. That was when the ten-year-old boy came along and said, “Sahib doctor, let me try. I can do it.”
The young boy grasped the key between his thumb and forefinger, and with a quick flick of his wrist, turned the key and undid the lock. “There, Sahib,” the boy said with a grin, adding jokingly, “Are you a weakling?”
The boy’s action was amazing to Paul, who had used all the force he could muster to turn that key until his fingers hurt. But this boy had done the seemingly impossible, turning the key in a lock that an adult could not turn. As he looked at the boy, Paul noticed several drops of blood falling to the floor. “Let me see your hand,” he said.
As the boy held out his hand, Paul could see that in the process of turning the key he had applied so much pressure that he had cut his finger open to the bone. Yet because of the lack of feeling in his fingers, the boy was totally unaware of the damage he had done to himself.
Paul was amazed when he became aware that the men were probably damaging themselves in many ways every day without ever realizing it. It all made sense! When those wounds healed, they would leave behind scar tissue. And as that scar tissue built up over time under the skin, the blood vessels and fat tissue receded and created the shortening of the fingers that occurred in leprosy patients.
With this understanding, Paul began to spend his evenings and any spare time watching the men at the New Life Center work. Just as he thought, the men were constantly injuring their fingers without even noticing. Paul began to work with the men to make them more watchful for injuries. He redesigned many of the tools the men were using. He made sure that the tools had large, smooth handles with no sharp edges so that if they were gripped too hard, they would not cause lacerations of the fingers.
