Brotherhood Dharma, Destiny and the American Dream (20 page)

Everything, as it turned out. At the barbecue our hosts suggested we buy a car.

Buy a car? When we reminded her we had just arrived and had no money, she said something that began to describe America to us.

“You don’t need to have money in this country. You’re both interns and have a guaranteed salary.”

She explained the concept of credit to us. Buy without money? Who ever heard of such a thing? But a few days later Mary drove us to the Volkswagen dealership in Plainfield. In 1972 there was only one car in America that sold for less than two thousand dollars: the Volkswagen Beetle. We got carried away and bought the Super Beetle, which had an AM/FM radio, not just AM, and cost twenty-one hundred dollars. Then we bought a color TV. We had been in America for less than two weeks and we were already in debt—but we felt rich.

I was fascinated by the things that Americans took for granted,
especially McDonald’s. It seemed like there were golden arches on every corner. We were amazed. At that time McDonald’s used to advertise on its signs
OVER EIGHT MILLION SOLD
. Then they said
OVER NINE MILLION SOLD
. Amita and I watched with amazement as the number grew and grew. What is it this week? How many hamburgers did they sell last month? On our budget we would eat at McDonald’s regularly, and I always had the cheeseburger and fries.

There were some things that required making an adjustment. We loved diners. Diners are a totally unique American experience. There was a diner on Route 22, the Scotchplain Diner, where we ate often, especially when we were coming back from driving our new Beetle into New York City. One night we were leaving the diner when we were pulled over by a policeman. I was a careful driver, so I couldn’t imagine what I’d done wrong. We’d just left the diner and I knew I hadn’t been speeding. I knew I’d signaled when I’d merged into traffic. I just couldn’t figure out why he had stopped me.

“Were you drinking beer?” he asked me.

“Nothing at all. Just Coke.”

“You sure you didn’t have a few beers?”

“I haven’t,” I insisted.

“Do you realize you were driving on the wrong side of the road?”

Oh. That. I handed him my license.

“Officer, I’m very sorry, but I grew up in India and we drive on the left side. During the day there are cues. When I see a car coming I know I’m on the wrong side. But I just came out of the diner and there were no cars…”

He was understanding. Not only did he not give me a ticket, but he also offered to escort us home. While we told him that wasn’t necessary, we were impressed. Look at them here, we said to each other. They’re very efficient, but they’re kind as well.

We also had to get accustomed to the weather. India, like much of the world, doesn’t really experience four seasons. There was little air-conditioning. In the summer we would holiday in what are called hill stations, colonial British outposts at high altitudes, to escape the heat. While I had seen snowcapped mountains in India, neither Amita nor
I had ever been in a snowstorm, and we certainly had never experienced the cold of a New Jersey winter. The first time it snowed in the winter of 1972 we stood outside like young children, catching the snowflakes, feeling them land on our hands, faces, and tongues. It was an absolutely enchanting and magical experience. Figuring out how to deal with the bitter cold came later. But we have never lost our appreciation for the beauty of snow. We live in a suburb now, away from the hustle and bustle of the city, and at night, in the depths of winter, moonlight glints off the snow-covered trees. We still remember that first amazing snowfall.

We couldn’t get enough of American culture. Many years later, as I was welcoming new interns to Beth Israel Deaconess Medical Center in Boston, one of them told me he was from New Jersey.

“When my wife and I came to the United States in 1972,” I said, “we were interns at a small hospital affiliated with Rutgers. We have the fondest memories of New Jersey. Every weekend, we would go to see a Broadway show, or go to Chinatown for dinner, or visit the museums…” I went on to tell him all about our life.

“Dr. Chopra, can I ask you a question?”

“Of course.”

“How come all your fondest memories of New Jersey have nothing to do with New Jersey?”

“You’re a bright intern,” I replied. “You’ll do well.” Then I added, “Princeton is charming.”

As someone who had played sports in India, I was immediately interested in learning about the games played in America, especially baseball. One evening I was driving along Route 22 when I noticed a batting cage. I thought, That looks just like cricket. It’ll be easy. I got into the cage and the machine pitched the ball and I swung at it—and missed. And missed again and again. Then I realized that a cricket bat is a flat surface and a baseball bat is a cylinder. Hitting the baseball was more difficult than I had imagined. But I practiced and eventually got pretty good at it.

One day Amita and I went to a picnic where they were playing
a game of softball. When I was asked if I had ever played baseball I replied that I hadn’t, but I’d played a lot of cricket and the essentials of the two games, hitting and catching, were similar. As a competitive person, I wanted to show off my skills, so I got up to bat. This was a bigger ball, thrown softly, and I slammed it. By watching other players I knew what to do: I ran directly to first base—carrying my bat with me as we do in cricket. No, they told me, throw your bat away. I had learned the first rule of baseball. It turned out the only similarities between baseball and cricket were that you hit the ball with a bat. Everything else was different.

As my team got ready to go into the field, a friend offered me a glove. A glove? I smiled and explained that wouldn’t be necessary.

“Cricket players don’t use gloves. We learn as young players to catch the ball with two hands and retract your hands at the instant you catch the ball, which absorbs most of the impact.”

“Doesn’t it hurt?”

“No,” I said. My message was clear: Cricket players are tough. We don’t need big gloves to field. In the end, I fielded very well and everyone was impressed.

But more than anything we could buy, or enjoy, more than the glamour of a Broadway show or the experience of eating at a diner and dropping coins in the jukebox on the table, what immediately impressed both Amita and me about America was the generosity and openness of the American people. The first place we experienced this was in the hospital. A few days after we arrived Dr. Eddie Palmer, a world-famous liver specialist, came to Muhlenberg to teach.

I was in awe. I sat down in the front row to take notes. Sitting a few seats away from me was a medical student who propped his feet up on a chair. I noticed that and thought it was odd. In India that would have been considered extremely disrespectful. No one would have done it. But I also noticed that no one said anything to him about it.

Dr. Palmer gave a marvelous talk, and I dutifully made my notes. At the end of the speech this medical student asked Dr. Palmer a
question and was given a detailed answer. When Dr. Palmer finished, the student looked at him skeptically.

“I don’t buy it.”

This is amazing, I thought. A medical student challenging a legend? A student speaking back to his teacher? Where was the cane? This never happened in India, never. We were taught to respect our teachers, even when we know they’re wrong. What was even more surprising to me was that Dr. Palmer didn’t seem to mind. He simply responded to the comment. I knew right then that there was something fundamentally different about the American spirit that was considerably more profound than how many millions of hamburgers McDonald’s sold.

Amita had a very similar experience. At the end of her first day at Muhlenberg hospital her professor, Dr. Paul Winokur, met with the new interns. When he asked her if she had finished seeing all of her patients she said, “Yes, sir.”

There was a moment of silence, the other interns looking at Amita. Dr. Winokur smiled.

“Dr. Chopra,” he said, “I haven’t been called ‘sir’ since I was in the army.”

What else, she wondered, would be appropriate? He was a teacher and he was older than she was. The level of familiarity that students had with their teachers surprised her. Some of them even addressed Dr. Winokur by his first name, Paul. He’s your professor, she thought. How can you be so disrespectful? But Dr. Winokur didn’t seem to mind it. In fact, he didn’t even seem to notice.

That same night she saw another first-year resident put his feet up on the conference table and lean back in his chair. What audacity, she thought. Doesn’t he understand how insulting that is? But no one objected to that, either.

It wasn’t that we disapproved; we just didn’t know how to deal with this casual attitude. We had no frame of reference for it. Our scale of right and wrong was being challenged. While it seemed disrespectful to us, the people who should have felt disrespected didn’t
object. It took us time to get used to this openness, but we did see the advantages of it. We began to understand that people in America were much less formal—and had their own ways of demonstrating respect.

We were also surprised, and pleased, that Americans showed great respect for working people. In India labor was so cheap that people who did menial work were not respected. We were products of a caste system, and even though it was breaking down, its shadows still existed. We thought it was admirable that Americans seemed to treat everybody equally, that there was little sense of superiority, of class. The doctors in the hospital treated the maintenance workers with as much respect as they treated the other doctors. All those things that were ingrained in us, that young people must follow the wishes of older people and that you are not permitted to speak your mind, it simply took us time to accept that this was not disrespectful at all, but simply the way people dealt with one another in America.

While most of the Americans we met were very friendly and welcoming, we discovered quickly that few of them knew much about the world beyond America’s borders. Perhaps this comes from the fact that America is separated from Europe and Asia by the great oceans. In India it was imperative that we learned everything possible about the people we shared a continent with, as well as the countries of Europe. For so long India was a member of the British Commonwealth and we were impacted by all of England’s battles. Our fate depended on the outcome, so we learned about it.

Many Americans knew little about India. When we told people we were Indian it was as though they expected to see us wearing a feathered headdress. They had no concept of how large, diverse, modern, and prosperous a country India was. At the hospital the majority of the interns were from different parts of India. When we were in the faculty lounge we spoke to one another only in English. When I was asked why we didn’t speak in our native tongue, I explained that we didn’t have one.

“There are a lot of different languages spoken in India. Not just
different dialects but completely different languages. Mine is Punjabi, for example, and his is Bengali. I wouldn’t have any idea what he was saying. English is the only language we have in common.” There were even some people who were surprised that we didn’t speak “Indian.”

There were things that we had difficulty understanding. We’d come from a country where beggars lived in the street and survived on meager handouts of food and a few coins. When we went to a restaurant, or a diner, we were surprised not just by the size of the portions that were served but also how much of it was wasted. We would watch as the waiters carried away plates with one-quarter or more of the food back to the kitchen to be discarded. It was saddening to us to see that waste, knowing the difference that food would have made in so many lives. It took us some time to get used to the reality that Americans were often casual about the abundance here and perhaps didn’t appreciate how different it was in other parts of the world.

I was also uncomfortable about the number of guns in the United States. While we had seen the gunslingers in American Westerns, we hadn’t really expected guns to be so common. I couldn’t think of a single relative, friend, or even a friend of a friend in India who possessed a gun, unless they were hunters. People don’t possess guns to protect themselves there. Instead, they hire guards and install alarm systems. I don’t know, for example, if my parents had kept guns in the house, how the robbery might have turned out. Not well, I suspect. So while I understood the meaning and the importance of the constitutional right to bear arms, I was still surprised at the gun culture of America.

What made us most comfortable when we first arrived was the discovery that modern medicine was practiced pretty much the same way in America as we had learned in India. Our education had prepared us remarkably well, although there was always that degree of doubt. One night a few weeks after I had started my internship at Muhlenberg I was doing a neurology elective. I was working with Dr. Greenberg, a neurologist who had trained at the Massachusetts General Hospital in Boston, and a man I held in great esteem. He
informed me that he had just received a consult, a patient who was very weak. It was suspected that he was suffering from a serious neurological disorder known as myasthenia gravis, in which the patient eventually loses control of his muscles and often needs to be on a ventilator. He asked me to join him in seeing this patient.

The patient had just been admitted, so we hadn’t yet received any lab results. Taking a detailed history, I learned that the man was having profuse, watery diarrhea. He was going to the bathroom ten, even twenty, times a day.

“Okay, then,” I said, remembering my father’s admonition that every patient has a story to tell, if only the doctor is willing to ask the proper questions. “What happens if you don’t eat?”

It made no difference, he said. There were a few days that he’d lost his appetite and had eaten nothing at all—but the bowel movements continued. I made a diagnosis of secretory diarrhea, which doesn’t abate even when the patient is fasting, and wondered if perhaps a tumor might be the cause of his distress. The GI tract is normally an absorptive organ, but a tumor can transform it into a secretory organ, one that just pours out fluid. Some forms of secretory diarrhea can lead to a condition called hypokalemia, a critically low potassium level, so I wanted to know his serum potassium level. We ordered the labs and when the results came back, his serum potassium was dramatically and dangerously low.