In a remote Indian village, a murdered family of three walks into a rural clinic asking a surgeon for help. If he can mend the wounds of the dead before sunrise, the family will live again. Stunned, surgeon Saheb takes on the challenge nonetheless—just like doctors do in everyday life, not knowing what they may face. Night Theater (Catapult), released in the United States earlier this year, traverses the ever limited and muddy waters of healthcare and the dilemmas physicians face.
Medical Bag spoke to Paralkar, an oncologist and assistant professor at the University of Pennsylvania, and asked about his inspiration for the book and his thoughts about life, death and the liminal space in between where doctors find themselves as they face the often-insurmountable challenges of medicine.
What was your inspiration for the book?
As a final-year student at the Seth G. S. Medical College in Mumbai, I had to do a rotation at a rural clinic. The day after I got there, the clinic’s doctor took a three-week vacation, leaving me, still a student, alone in the middle of nowhere. That night, as the village grew dark I sat at the clinic’s steps looking at the stars, wondering what would I do if I faced a dangerously ill person. In India especially, people tend to look at doctors as gods who can do divine things, but in reality we are limited by the tools available to us. Luckily, all went well, but I wanted to recreate the same isolated setting in the book, except I made my protagonist an experienced surgeon who faces a greater challenge—operating on the already dead without an ICU or any sophisticated equipment.
Operating on the dead is different than operating on the living. You describe how the three ghosts don’t bleed and don’t need oxygen or anesthesia. How does a medical doctor imagine such non-realities?
When science fiction writers imagine transporting people through space to stars, they think about the mechanics of the vehicles and the types of fuel and supplies. So, once I decided that my three characters would be victims of a violent crime who came to the surgeon for help, my task became similar to that. I thought of the injuries that the surgeon could tackle over the course of one night while balancing the descriptions with the literary momentum. I didn’t want the book to be a catalogue of stiches and incisions—the story had to have conversations, revelations and philosophical digressions.
Despite the otherworldly premise, you managed to make the surgeries read very realistic and believable. How did you do that?
It was important for me that surgeons would read the book and find no medical holes. While I’m not a surgeon, I trained at surgery in medical school. I also consulted my father, a retired surgeon, about what would or wouldn’t be feasible in a tiny remote Indian village clinic. I wanted to give my characters—the teacher, his pregnant wife and their eight-year-old son—three very different injuries with different levels of difficulty to fix. That would give them three different prospects for survival, adding to the literary tension.
I chose to give a splenic injury to the boy, because it’s easy to fix—a surgeon can remove the spleen and the individual can survive. The teacher was stabbed in the ribs, making it challenging for the surgeon to tell whether the knife punctured the heart or a big blood vessel or something minor. And I chose to give his wife an injury that would be impossible for the surgeon to fix—she had her throat cut—leaving the reader wondering if the surgeon could save the life of her unborn child.
In writing this book, did you contemplate the greater mysteries of life and death that medical science doesn’t yet fully understand—and which doctors still have to face?
Absolutely! Doctors constantly find themselves in this liminal space. As an oncologist who treats acute leukemia, I see patients who felt ill for a couple of days, did a blood test—and then were admitted to the hospital within hours, needing high dose chemotherapy. Serving these patients during such catastrophic times is an immense privilege, yet despite all the advances we have made, acute leukemia is fatal in about 70 percent of cases. And just look at our most recent challenge. Typically, doctors are pretty good at treating respiratory infections, but Covid overwhelmed hospitals worldwide. And yet the doctors did not flee from these challenges, they continued to face them. For a doctor, it’s impossible not to think about life, death, what it means to be alive and what we can do to remain alive. Those thoughts have been circulating in my brain ever since medical school and they inevitably found their way into my writing.