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Kamala

Published:December 30, 2020DOI:https://doi.org/10.1016/j.amjmed.2020.11.027
      My mother used to eat Welch's Grape Jelly by the spoonful straight out of the jar while she studied for the licensing exam for foreign medical graduates. She could not believe the abundance in this country—the food, the cars, the cosmetics, the frilly dresses for her children.
      At age 7, I could just reach the counter where her snapping makeup kit sat. The box contained 20 shades of eyeshadow, 5 rouges, and a mirror in the lid. Every morning my mother outlined her eyes in dramatic black before securing her tidy bun with squiggly legged hairpins and draping her sari to perfection. She was beautiful, praying in front of the small altar as she was leaving the house. With her white coat, gold earrings, and bindi, she looked to me like a doctor princess. It was maddening when people did not treat her well. She insisted on saying “please” and “thank you,” even when salespeople demanded 3 forms of identification to use a credit card, even when a waitress complained rather volubly that she could not understand my mother's accent, even when she was randomly stopped by Border Patrol agents for simply driving on I-19 in southern Arizona.
      She had completed a pathology residency at Vanderbilt before we moved. Then she worked and worked. Her days were spent at the hospital, and she came home smelling of something I could not exactly name. Her nights and weekends were spent cooking, doing laundry, and driving. She somehow made the time to speak to my science club about the immune system, arriving early with her slide carousel perfectly organized.
      My father, ever the dreamer, invested in a failing business, and my parents declared bankruptcy. My mother had been practicing for 7 years when she started hiding cash under her mattress. I knew she was doing it, and I knew how much shame she felt at having to shop at warehouse stores and grocery outlets. I saw the longing when she encountered wealthy people. In a moment of desperate inspiration, she suggested to my father that they open a plasma center. He agreed, and they made it a success, allowing them to climb out of the financial hole.
      My mother had been in the United States for 13 years when she surrendered her green card and became a citizen. My sister and I did so at the same time, and we were all asked a series of questions on American history. We answered with ease, but my mother was the one who had taken the time to really study.
      When the business stabilized and we kids were out of the house, my father decided to embark on a round-the-world trip of self-discovery. He made plans to visit all the places he had seen on PBS – Machu Picchu, the Amazon, the Red Sea (or the Dead Sea, we could never remember which). He left my mother to run the business by herself while she continued to work at the hospital and worry about all of us. When I would return home on weekends and ask her to sit with me, she always said something that roughly translated means, “Nothing will be accomplished if I don't keep moving.”
      I remember when my mother came to visit me at the University of Arizona College of Medicine's multidisciplinary lab for basic science. My frustration with the wooden box of histology slides must have been evident when she suggested that we look at them together through the multi-headed microscope. A few classmates trickled in to join us at the scope, and we sat for almost 3 hours while my mother patiently pointed out plasma cells and histiocytes. The following week a classmate asked when my mother might be coming to visit next.
      It was 2 years later during my third-year clerkship that I had recurring upper respiratory infections leading to a nasopharyngeal biopsy. The biopsy was read by the pathologist as “suspicious for lymphoma of mucosa associated lymphoid tissue,” and a surgery was scheduled. My mother of course ordered the slides so she could see for herself. She snorted into the phone as she told me it was clearly just reactive tissue and not a lymphoma at all. After the surgery, she drove me the seventy miles home to recover. The opioid pain medication made me so sick that I vomited into her hair as she was bringing me tea. We soon got the call that the excised mass was just reactive tissue. No lymphoma.
      We attended a skin pathology conference together when I was studying for boards. I was proud, familiar with all the material and disease processes, barely looking at the speaker. I noticed my mother sitting, rapt and straight backed as a schoolgirl. Looking directly forward, she was taking notes in her neat Indian-style cursive. My mother had been practicing general pathology for over 20 years, and she was the director of a regional pathology lab and blood bank. Yet she was still paying attention.
      On September 11, 2001, my mother called me from their new home on the east coast. Her voice was clipped and strained. She was a devastated American. She told me she was going to buy a flag for the front yard.
      I was 33 years old before I thought to ask my mother why the whole family called her Nandini when her name was Kamala. She was named Nandini at birth, a simple country name. Her family would not have been called poor, but no one wore shoes when she was young. Her parents, both teachers in rural colonial India, kept the family fed and clothed. They all wove cotton “homespun” when Gandhi called for the boycott of British cloth. In Kerala, India, of the 1940s, matriculation into grade school was the time in life when one's name was formally put on paper and made official. My mother somehow knew this at age 5. She declared that her name was Kamala Devi and registered for school as such.
      When my mother told me she had acute myelocytic leukemia she did not want me to tell my sister or her younger sister (so they would not worry). We talked about her treatment. She began planning things to cook and freeze for my father. She fought each relapse, vomiting, shedding, and then eagerly trying the next regimen. At the end of her life, she began to resemble a small bird. Her lovely prominent nose became more stark and beaklike, her skin feathered with ashy scale. She was shrunken and depressed about 2017 America. Her memory remained perfect. She was able to recite the exact dates of her first episode of thrombocytopenia, chemo induction, port placement, each relapse, every transfusion, and various noncontributory medical incidents each time she met a new provider. Sadly, she was completely lucid until she began actively dying. Her last terrified words to me were “Am I dying now?”
      On November 7, 2020, Kamala Devi Harris stands at the lectern dressed in white. I am crying for my mother, and for all of the women before us who strove for excellence and toiled with such grace.