The Covenant of Water

At Longmere Hospital, Digby encounters Aavudainayaki, a woman with a massive goiter (enlargement of the thyroid gland) that distorts her neck. Potassium iodide eases her symptoms but does not reduce the swelling. She refuses referral elsewhere and insists Digby alone must operate. Recognizing his inexperience, Matron Honorine arranges for him to train with Dr. Ravichandran, the first Indian professor of surgery at Madras Medical College. Ravi welcomes Digby, and Digby begins assisting him in complex operations, including stomach resections for cancer.

Five weeks later, Digby brings Aavudainayaki in for surgery. Ravi examines her and confirms the goiter extends into her chest. Together, they remove it, using a long instrument Ravi designed himself. He warns that swelling could obstruct her airway during recovery and orders a tracheostomy tray kept at her bedside. That night, Digby returns to find Aavudainayaki struggling to breathe. He opens her incision and removes a large blood clot, which immediately eases her breathing. By morning, Ravi inspects the patient and reprimands Digby for not taking her back to surgery after removing the clot. Before leaving, Ravi tells him, “Good surgeons can do any operation. Great surgeons take care of their own complications.”