First read: Namita Gokhale’s ambitious saga intertwining women, history and the Himalayas

‘The stories of my life and my grandmother’s and my great-grandmothers, says the writer of her new novel.

Life changed for Tilottama too, that year, without her ever realising it. On the first day of Chaitra, in the new Samvatsar, her husband was to set off from Almora to rejoin work at the headquarters of the Trigonometrical Survey of India in Dehra Doon, two days’ journey away from Almora.

Nain Chand Joshi was distantly related to the line of the famous pundits who had travelled as spies to track the path to the roof of the world, and helped map and locate Lhasa. His mother’s cousin, the legendary Nain Singh Rawat of Milam, had single-mindedly trudged across the length of the Himalayan arc to help the British sarkar fill in the blanks in the mountain atlas.

It was this lineage that had got him his coveted and well-paid post with the Trigonometrical Survey. It was an inexplicable aberration for a high-born Brahmin to have ties with a clan that inter-dined with Tibetans and wore leather boots, but a renegade uncle had taken a cousin of Nain Singh as his second wife.

The weather was uncertain when Nain Chand received the note from Colonel Walker, summoning him back to the headquarters. The March winds were racing with habitual abandon, flailing the red rhododendron blossoms. It was cold and bright, and unsure clouds broke the sunshine only to wander off again.

Tilottama had persuaded him to wear the thick, woollen Tibetan socks he had brought back from his last journey into the high mountains. “They don’t look silly at all,” she had protested, against his assertions to the contrary.

The thin cotton dhoti draped ankle length around his muscular calves was an absurd protection against the cold, anyone would argue, but the multicoloured harlequin design on the Tibetan knee socks only served to further highlight this inadequacy. He left the house feeling foolish, imposed upon and slightly forlorn.

This sky was the colour of lapis lazuli. It was a relief to be away from Tilottama’s overpowering presence, to return to his work and to the rational order of the Trigonometrical Survey. Tilottama overwhelmed him. Yes, he had hit a six, but he had been bullied into marrying her by Saruli, who was distantly related to him through her mother’s family.

Tilottama had always been intimidating, for she had a temperament that well understood the tricks of power.

She managed her Almora cousins, as she had ruled her aged uncle and aunt, with a whimsical brand of tyranny. And she was still testing tactics with her husband, although his relative equanimity continued to baffle her.

Nain Chand was a traveller, and in his wanderings he had encountered many women. He was not a sensualist, but he had his needs and had perforce taken his pleasures in many places, discreetly and with temperance. He had known the sweet passions of many a Kathmandu brothel and the cold comfort of a long liaison with a certain lady of Lhasa.

Her name was Lobsang Rampa. She was tall and of stately bearing and wore an exquisite necklace of lapis lazuli interwoven with amber beads. She wore lapis in her ears as well – long earrings which she took off before they embarked on their lovemaking – and a lapis lazuli ring, set in gold, which she declared she would never remove from her person, not until she died.

He had known passion with whores and been generous with them, and also cautious, for he was on a secret mission, and it was in places like this that men let down their guard and usually lived to repent it, if they lived to tell the tale.

But Lobsang Rampa had been different.

There was something in her gently hooded eyes – her black, opaque eyes which seldom blinked – before which he had surrendered, yielded some part of his carefully constructed defences. She was proud and self-sufficient, yet dexterous and gentle between the sheets. She never submitted to him, held back a quiet and unmoving part of herself. There had been something between them, between him and Lobsang Rampa, which he could not define, which he had never left behind.

He remembered her now because the colour of the sky reminded him of her creamy neck and the lapis lazuli necklace which draped it and which she always wore except when they were naked together, the cast-iron bukhari struggling to warm the small room while the cold air whistled in from the cracks in the window. He thought of Lobsang Rampa standing straight and tall before a carved doorway when he had last said goodbye to her and the prayer flags waving in the breeze in a sky the colour of the sky today.

And he thought then of his wife, of her strangeness, her awkwardness, her pitiable lack of grace. Tilottama was not like a woman, somehow – she had a core of brute strength surrounded by an almost endearing naivety, as though the gods had mixed up the ingredients while she was forming in her widowed mother’s womb. But he was away, back on his journeys, and she would learn in time to grow up, to become more like a woman.

Tilottama watched Nain Chand leave with very little feeling.

Her eyes followed his departure down the hill until the very last turn in the winding road. Then she returned to the dark, smoky kitchen and made herself a cup of strong banar leaf tea. She stoked the straggling embers in the hearth, blowing into them through the long iron flue pipe until she felt her lungs would burst.

The flames came to life, and she let the milk and water boil in the copper kettle. To this she added a lump of jaggery and let it boil some more. Although her husband was not a noisy man, she relished the silence of his absence.

“Tilottama,” she murmured reflectively. “Now what sort of name is that? Wife of Meghnad‚ the son of King Ravana who was the abductor of Sita devi. Now why couldn’t I have been married to Ravana? He was a fine man, I’m sure…”

“Or I should have been born a man,” she continued, twirling an imaginary moustache, “a son for my mother. She might not have drowned herself then. She might have been alive still, had I been a son rather than a daughter. I would have taught you a thing or two then, Nain Chand Joshi! Had I not been born a mere woman…”

“What’s wrong with daughters?” Tilottama wondered aloud next. “I intend to bear you many, many daughters. So watch out, Mister Nain Chand Joshi!”

She wandered into his study, picking over his things carelessly. Nain Chand was a meticulous man and in the habit of diligently checking the temperature on the hour. Tilottama admired this practice, for it seemed a grand sort of thing to do.

An overseas visitor to the Trigonometrical Survey had gifted her husband an expensive modern barometer with a built-in thermometer, a Schatz Precision model in chromed brass, which occupied pride of place on a table in the veranda. Her husband had forbidden her from ever handling it. “This is a scientific instrument, not a toy,” he had explained reproachfully, when she had ventured to pick it up.

Nain Chand’s logbook lay beside the barometer, with painstaking notings to keep track of diurnal variations, maintained in his small, meticulous handwriting. She studied the logbook with intense concentration, struggling to make sense of Nain Chand’s handiwork. The curlicued F, to indicate Fahrenheit, was a particular favourite. It was a triumph to decode the notings, as she would learn to do. Until then, it was satisfying to even guess and pretend.

Satisfied with her efforts, Tilottama got down to drinking her banar tea, appreciating the smoky flavour with each sip. She felt giddy with unfulfilled purpose. She ran on an impulse to the fireplace and extracted a still-warm wood coal, flinging it upon the stone-flagged floor to cool.

Then she searched for her husband’s shaving mirror, which he kept on the far corner of the windowsill, and propped it up on the table. She admired herself critically, a look of deep concentration settling upon her face. Her hair was much too curly, she decided. The eyes were large, a deep brown colour she was entirely satisfied with. A small, inquisitive nose, with a habitual twitch aggravated by excitement and a golden nose ring glittering provocatively on its edge. The lips full and red, encircling a perfect set of strong, sparkling teeth.

She smiled critically at herself and then drew a large, full moustache against her fair upper lip with the charred coal.

It looked very black against her pale skin. Dissatisfied with the effect, she got to work again and sketched in a thick pair of sideburns on her cheeks and then, heady with excitement, a full, curly beard.

She pulled out a tin trunk from under the bed and unpacked it. Swiftly throwing off her woollen Pahari-style plaid skirt, Tilottama slipped into Nain Chand’s spare pair of trousers, bequeathed to him by Colonel Walker. Her husband’s pants were too long for her, but she rolled them up carefully from below in two neat folds. Her waist was too slender to hold them up, so she took a length of thick black cord and wound it around her until the trousers were shaped into compliance around her well-formed hips.

She didn’t bother with the shirt and jumped impatiently into the woollen coat and buttoned it up. There was no full-length mirror in the house, so she had to content herself with the hand mirror, which she held up at various angles to build up a composite image of how she looked. The artist in her discovered a flaw, and she tucked her unruly braid under a feathered alpine hat, another precious gift from Colonel Walker.

“So you see, Nain Chand Joshi, you silly cuckoo, that’s the kind of man I wanted to marry!” she exclaimed aloud, then tittered at her own audacity.

Not satisfied with her transformation, Tilottama rooted through a wooden box where Nain Chand Joshi kept his papers. She knew he sometimes hid a pack of bidis or a cheroot there, which he would light only on the sly, behind the outdoor privy, out of respect for his wife’s sentiments.

She found a cheroot and lit it on the kitchen fire, then inhaled experimentally. It made her choke at first, but very soon she got the feel of it and settled herself on the floor for a long, satisfying smoke.

Excerpted with permission from Things To Leave Behind, Namita Gokhale, Penguin Viking.

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What hospitals can do to drive entrepreneurship and enhance patient experience

Hospitals can perform better by partnering with entrepreneurs and encouraging a culture of intrapreneurship focused on customer centricity.

At the Emory University Hospital in Atlanta, visitors don’t have to worry about navigating their way across the complex hospital premises. All they need to do is download wayfinding tools from the installed digital signage onto their smartphone and get step by step directions. Other hospitals have digital signage in surgical waiting rooms that share surgery updates with the anxious families waiting outside, or offer general information to visitors in waiting rooms. Many others use digital registration tools to reduce check-in time or have Smart TVs in patient rooms that serve educational and anxiety alleviating content.

Most of these tech enabled solutions have emerged as hospitals look for better ways to enhance patient experience – one of the top criteria in evaluating hospital performance. Patient experience accounts for 25% of a hospital’s Value-Based Purchasing (VBP) score as per the US government’s Centres for Medicare and Mediaid Services (CMS) programme. As a Mckinsey report says, hospitals need to break down a patient’s journey into various aspects, clinical and non-clinical, and seek ways of improving every touch point in the journey. As hospitals also need to focus on delivering quality healthcare, they are increasingly collaborating with entrepreneurs who offer such patient centric solutions or encouraging innovative intrapreneurship within the organization.

At the Hospital Leadership Summit hosted by Abbott, some of the speakers from diverse industry backgrounds brought up the role of entrepreneurship in order to deliver on patient experience.

Getting the best from collaborations

Speakers such as Dr Naresh Trehan, Chairman and Managing Director - Medanta Hospitals, and Meena Ganesh, CEO and MD - Portea Medical, who spoke at the panel discussion on “Are we fit for the world of new consumers?”, highlighted the importance of collaborating with entrepreneurs to fill the gaps in the patient experience eco system. As Dr Trehan says, “As healthcare service providers we are too steeped in our own work. So even though we may realize there are gaps in customer experience delivery, we don’t want to get distracted from our core job, which is healthcare delivery. We would rather leave the job of filling those gaps to an outsider who can do it well.”

Meena Ganesh shares a similar view when she says that entrepreneurs offer an outsider’s fresh perspective on the existing gaps in healthcare. They are therefore better equipped to offer disruptive technology solutions that put the customer right at the center. Her own venture, Portea Medical, was born out of a need in the hitherto unaddressed area of patient experience – quality home care.

There are enough examples of hospitals that have gained significantly by partnering with or investing in such ventures. For example, the Children’s Medical Centre in Dallas actively invests in tech startups to offer better care to its patients. One such startup produces sensors smaller than a grain of sand, that can be embedded in pills to alert caregivers if a medication has been taken or not. Another app delivers care givers at customers’ door step for check-ups. Providence St Joseph’s Health, that has medical centres across the U.S., has invested in a range of startups that address different patient needs – from patient feedback and wearable monitoring devices to remote video interpretation and surgical blood loss monitoring. UNC Hospital in North Carolina uses a change management platform developed by a startup in order to improve patient experience at its Emergency and Dermatology departments. The platform essentially comes with a friendly and non-intrusive way to gather patient feedback.

When intrapreneurship can lead to patient centric innovation

Hospitals can also encourage a culture of intrapreneurship within the organization. According to Meena Ganesh, this would mean building a ‘listening organization’ because as she says, listening and being open to new ideas leads to innovation. Santosh Desai, MD& CEO - Future Brands Ltd, who was also part of the panel discussion, feels that most innovations are a result of looking at “large cultural shifts, outside the frame of narrow business”. So hospitals will need to encourage enterprising professionals in the organization to observe behavior trends as part of the ideation process. Also, as Dr Ram Narain, Executive Director, Kokilaben Dhirubhai Ambani Hospital, points out, they will need to tell the employees who have the potential to drive innovative initiatives, “Do not fail, but if you fail, we still back you.” Innovative companies such as Google actively follow this practice, allowing employees to pick projects they are passionate about and work on them to deliver fresh solutions.

Realizing the need to encourage new ideas among employees to enhance patient experience, many healthcare enterprises are instituting innovative strategies. Henry Ford System, for example, began a system of rewarding great employee ideas. One internal contest was around clinical applications for wearable technology. The incentive was particularly attractive – a cash prize of $ 10,000 to the winners. Not surprisingly, the employees came up with some very innovative ideas that included: a system to record mobility of acute care patients through wearable trackers, health reminder system for elderly patients and mobile game interface with activity trackers to encourage children towards exercising. The employees admitted later that the exercise was so interesting that they would have participated in it even without a cash prize incentive.

Another example is Penn Medicine in Philadelphia which launched an ‘innovation tournament’ across the organization as part of its efforts to improve patient care. Participants worked with professors from Wharton Business School to prepare for the ideas challenge. More than 1,750 ideas were submitted by 1,400 participants, out of which 10 were selected. The focus was on getting ideas around the front end and some of the submitted ideas included:

  • Check-out management: Exclusive waiting rooms with TV, Internet and other facilities for patients waiting to be discharged so as to reduce space congestion and make their waiting time more comfortable.
  • Space for emotional privacy: An exclusive and friendly space for individuals and families to mourn the loss of dear ones in private.
  • Online patient organizer: A web based app that helps first time patients prepare better for their appointment by providing check lists for documents, medicines, etc to be carried and giving information regarding the hospital navigation, the consulting doctor etc.
  • Help for non-English speakers: Iconography cards to help non-English speaking patients express themselves and seek help in case of emergencies or other situations.

As Arlen Meyers, MD, President and CEO of the Society of Physician Entrepreneurs, says in a report, although many good ideas come from the front line, physicians must also be encouraged to think innovatively about patient experience. An academic study also builds a strong case to encourage intrapreneurship among nurses. Given they comprise a large part of the front-line staff for healthcare delivery, nurses should also be given the freedom to create and design innovative systems for improving patient experience.

According to a Harvard Business Review article quoted in a university study, employees who have the potential to be intrapreneurs, show some marked characteristics. These include a sense of ownership, perseverance, emotional intelligence and the ability to look at the big picture along with the desire, and ideas, to improve it. But trust and support of the management is essential to bringing out and taking the ideas forward.

Creating an environment conducive to innovation is the first step to bringing about innovation-driven outcomes. These were just some of the insights on healthcare management gleaned from the Hospital Leadership Summit hosted by Abbott. In over 150 countries, Abbott, which is among the top 100 global innovator companies, is working with hospitals and healthcare professionals to improve the quality of health services.

To read more content on best practices for hospital leaders, visit Abbott’s Bringing Health to Life portal here.

This article was produced on behalf of Abbott by the marketing team and not by the editorial staff.