Atrio of monkeys frolicked in front of me as I drove back into the dusty sanatorium compound. They leapt nimbly from treetop to treetop, then onto the tiled roof of an open-sided patient ward, their chattering and scuffling breaking the quiet of the afternoon siesta time. The mischievous trio landed with a thump on the roof of my office just as I pulled the ambulance, our main form of transportation, to a stop. The vehicle, a shiny, cream-colored thing of beauty, bore on its side in bold, red letters the legend "Wanless Tuberculosis Sanatorium." It had been a gift from the Presbyterian Board of Foreign Missions and looked completely out of place in its drab surroundings.

As I wearily got out of the ambulance, I watched the monkeys scampering down the road toward the bungalow where my wife, Marilyn, and I lived with our two small children—who would surely be delighted to see the hyperactive creatures. But I was hot and tired and thus annoyed rather than amused by the monkeys. I had just returned from the general hospital in Miraj, two miles away, where I'd held a clinic and assisted a colleague in the OR. A pile of paperwork awaited me back at the sanatorium, and I'd just settled down at my desk to attack it when Manohar Mane, the achondroplastic dwarf who was my secretary and interpreter, came in carrying an x-ray film and looking worried.

"Saheb," he said, using a Marathi variation of "Sahib," a polite form of address in India, "we are having an emergency."

"What's up, Manohar?"

"A man from Ichalkaranji is swallowing a railroad tie."

"Manohar, that's impossible. A railroad tie is bigger than you are."

"The iron thing that ties the rail to the wood. You can see it for yourself, right here." He held up the x-ray.

"You mean a railroad spike. My God, how did he ever get that huge thing down his gullet?"

"He is trying to kill himself, Saheb. Everyone is knowing the story."

"Okay, so tell me."

"The father is head man of the panchayat [a village's five-member governing body] in Ichalkaranji. He is having two sons. One of them is a TB patient here in Wanlesswadi. The other is falling in love with a Christian girl. The father is forbidding him to see the girl, so the son doesn't want to live any more. But no one is expecting him to do this!"

"This is unbelievable! How crazy can someone get? Well, tell the OR people to get ready. We'll have to esophagoscope him. Maybe we can shove the spike down into his stomach with the scope. It would be a lot easier to take it out through his abdomen than his chest. Where is the patient? What's his name?"

"Shivaji, Saheb. He's in x-ray—no, here they come now."

A small, black Hindustani auto came around the corner and drew to a stop. Five men were somehow squeezed into it. One of them—wearing a purple turban and a gray-white dhoti (a length of cloth wrapped around the wearer's body and brought up between the legs, typical villager's garb)—extricated himself from the car and planted himself in front of me. "Is my son going to die?" he demanded.

"No, I don't think so. I think we can get the spike out. He should be okay." This exchange took place with Manohar interpreting.