Thirst for Justice
A Novel
David R. Boyd
Contents
Dedication
Epigraph
Part I
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Part II
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
Chapter 21
Chapter 22
Chapter 23
Chapter 24
Chapter 25
Chapter 26
Chapter 27
Chapter 28
Chapter 29
Chapter 30
Chapter 31
Chapter 32
Part III
Chapter 33
Chapter 34
Chapter 35
Chapter 36
Chapter 37
Chapter 38
Chapter 39
Chapter 40
Chapter 41
Chapter 42
Chapter 43
Chapter 44
Chapter 45
Chapter 46
Chapter 47
Chapter 48
Chapter 49
Acknowledgments
About the Author
Copyright
Dedication
This book is dedicated to Médecins Sans Frontières.
A portion of the author’s royalties will be donated to MSF.
Epigraph
“A man does not have to be an angel in order to be a saint.”
—Albert Schweitzer
“It has long been recognized that among the public utilities, water supply facilities offer a particularly vulnerable point of attack to the foreign agent, due to the strategic position they occupy in keeping the wheels of industry turning and in preserving the health and morale of the American populace.”
—J. Edgar Hoover, Director of the FBI
“Individuals have duties which transcend the national obligations of obedience. Therefore individual citizens have the duty to violate domestic laws to prevent crimes against peace and humanity.”
—Nuremberg War Crimes Tribunal
Part I
The Attack
Chapter 1
Michael took a deep breath before turning to his next patient. She was the size of a two-year-old American toddler, although her head was disproportionately large. Big brown eyes, but vacant. Skin stretched over bones. Legs like two sticks hinged, with a golf ball in the middle. He looked at the chart. Kapinga Kabobo was seven years old. Nineteen pounds. She should have weighed at least forty. The latest cholera outbreak had tripled the number of people seeking medical attention at the International Medical Assistance Foundation field hospital in Goma.
Michael had quickly become a staff favorite, his quiet confidence and warmth revealed in a broad smile and the crow’s feet at the corners of his eyes. He opened the girl’s mouth gently and used a tongue depressor to take a quick look. “Let’s get this girl on a rehydration program. If she can’t swallow, then use intravenous glucose and electrolytes.” Perhaps startled by the foreign sound of Michael’s voice, the girl defecated onto the dirt floor of the medical tent. The watery diarrhea contained flecks of mucous and epithelial cells the size of rice grains, a telltale sign of cholera.
“We also need some metronidazole. Add it to the IV drip please.” He scrawled instructions onto the chart.
The girl’s listless eyes fluttered and closed. She was fading fast.
“Come on, sweetheart, don’t give up on us now,” Michael pleaded, unwilling to admit that she was probably too far gone. He checked her pulse. Rapid, way faster than it should have been. He took her blood pressure. Low and falling. There was nothing he could do. He held her hand and stroked her cheek, trying to offer some small comfort as he heard the last, rattling breath. Biting back grief and frustration, Michael closed her eyes. Back in Seattle he could have saved her life. Then again, back in the U.S. he’d never seen a case of cholera and probably never would.
He knew that it wasn’t really the disease that had killed her. It was the fact that she had no clean water to drink, and no latrine for going to the bathroom. There were no parents or other relatives to notify; the girl was an orphan and a refugee. Michael would fill out the death certificate later. There were living, breathing, laughing, crying children needing his help.
“I’m going to step outside,” he said to no one in particular. “Back in five.”
He walked slowly out of the operating tent, stripping off his mask, hairnet, gloves, all drenched in sweat. He suppressed the urge to scream, cry, tear out his hair, curl up on the ground in the fetal position. In his third month in the Congo, Michael desperately wanted a hot bath, the feeling of his wife Maria’s skin against his, even two mindless hours in an air-conditioned movie theater distracted by Hollywood flash and glitter. None of these luxuries were available. Instead, inside the secure compound, he circled past the bile-green rehydration and recovery tent and stopped to fill a red plastic cup at one of the faucets on the giant bladder flown in from Europe. Clean water poured into his cup.
Michael walked around the perimeter of the compound with deliberate slowness, stretching every moment of his break. The night was young and the casualties were endless. To the north, despite the lights of the city he could still see the glowing cauldron of Mount Nyiragongo, one of the world’s most active volcanoes, smoldering away. To the south it was much darker, thanks to Lake Kivu.
A piercing shriek from inside the medical tent interrupted the night. Michael ran back inside to see an agitated woman burst into the cordoned-off surgery, oblivious to the orderly’s restraining hand. She carried a bloody bundle of rags and raced forward to thrust it into Michael’s hands, screaming and gesticulating wildly. Behind her trailed a wizened man, looking at the ground. He murmured quietly and nodded, as though embarrassed by all of the commotion but compelled to confirm her story.
The orderlies were shouting apologies to Michael and trying unsuccessfully to restrain the woman. Michael joined the din, yelling, “What’s she saying?” as he cautiously peeled back the rags. He’d picked up some French during his months in the Congo but remained flummoxed by the myriad local languages and dialects.
“She says she had six children but this is the last one alive. She is begging you to please save her child.” Daniel, one of the local Congolese who worked as a nurse’s assistant, translated from Kiswahili, the lingua franca of the Great Lakes region.
The rags contained a young boy of indeterminate age. He was either sleeping or unconscious, and he was missing his right hand. Machete or land mine? Machetes made a clean cut, although sometimes the blade was deliberately smeared with shit to increase the odds of an infection. Land mines, in contrast, tended to rip and tear, leaving jagged wounds. Severed body parts were shockingly common, usually hands or feet, occasionally ears or even lips and tongue. Michael was tired of the amputations. He himself had removed so many limbs that he felt a lurking complicity, as if
he was becoming a silent partner in the atrocities inflicted by the warring factions—Hutu ex-militia, the Congolese army, outlaw Mai Mai, and child soldiers from the Lord’s Resistance Army. Every day he dealt with the aftermath, the evidence of evil that corroded his belief in the goodness of human beings.
What kind of person could hit a child with a machete? As there were no satisfactory answers to this kind of question, Michael tried to avoid dwelling on them. He cast a quick glance at the woman. She looked back at him, her eyes making it clear that he was her last hope. She herself was in terrible shape, painfully thin and covered in sores.
One look at Michael’s solemn face and she collapsed onto the ground, clawing the dirt and hitting her head with bony fists. From somewhere deep inside her came a powerful ululation, incongruously melodic. The man also fell to the ground, struggling to wrap her tiny figure in his arms.
Jesus H. Christ, thought Michael. Children. The kids could pierce his emotional armor. He lifted the child toward his face and sniffed like a drug-seeking customs dog. The smell was a relief. It wasn’t exactly pleasant, but there was no sign of the putrid and inimitable odor of rotting flesh. Michael looked up. “Hakuna matata,” he said to the woman, exhausting his Kiswahili vocabulary with a phrase from Disney’s The Lion King. No problem.
“This kid has lost a lot of blood. He needs a transfusion, stat. Get me at least 500 ccs of O negative, and let’s get the intravenous rehydration running too. Daniel, I want his name and any medical history you can gather.”
Daniel rattled off several quick questions and passed the information on to Michael. “His name is Étienne Tshisekedi. He is in his eighth year. His hand was amputated by soldiers near Bunia when he refused to join them.”
“Michael?” Anna, the young Danish nurse, came into the tent. She was striking despite trying to look nondescript to avoid unwanted attention. She dyed her blond hair brown and kept it short. But even a bad haircut, an ill-fitting T-shirt, and the inevitably disheveled condition produced by eighty-hour work weeks couldn’t disguise her beauty. With the high adrenaline and the long shifts together, it was easy to sit too close in the lounge, to slide into the casual contact that opened the door to more. But Michael had sensed himself on the precipice and had pulled back to cool professionalism in the OR and nothing more friendly than a game of cards after a shift.
“Yes?”
“The fridge is empty. We’re out of blood.”
“You’ve gotta be kidding!”
“No. I’m so sorry. Jean-Claude says that the next shipment should arrive on Thursday.”
Normally JC worked miracles keeping the facility stocked with essential supplies, from antibiotics to vaccines. Michael wondered how the only remaining surgical facility in the entire city could run out of blood. “This kid isn’t going to make it through the night without a transfusion, never mind surviving forty-eight hours until Thursday. Hook up one of the locals with blood type O neg for a direct transfusion.”
Anna cringed. “We cannot do that.”
“This kid is dying!”
“Yes, but some of the people here might be HIV positive. Giving the child blood from one of them would be like playing Russian roulette.” Anna held her hands out, palms up, as if to say there’s nothing we can do.
She was right. Michael looked at Anna, then the boy, and finally his eyes came to rest on the mother, now sitting on the floor watching him intently. They had little in common, the American doctor and the Congolese refugee, but an understanding passed between them.
“Okay then, hook me up. My blood’s O neg and it’s clean. It’s almost the end of my shift anyway.” Michael would have twelve hours to recuperate before his next shift. It was breaking most of the rules, and it would push Michael closer to, or possibly over, the edge of exhaustion. On the other hand, it was the only hope the child had. Anna knew from experience that there was no point in arguing with him when he decided to do something.
“Is that needle new?” Michael asked.
“Of course! I just unwrapped it myself.”
Anna squeezed Michael’s arm, found a vein, and inserted the needle. Soon blood was flowing through the one-way shunt. Anna used Michael’s phone to record the moment. In seven years as a nurse, she’d never seen a doctor take such a step.
Michael opened and closed his fist. “Okay, let’s go. We need a full amputation kit, bactericidal solution, a local anesthetic, and something strong to sedate him—ketamine or diazepam. Daniel, secure the patient.” The boy was nearly catatonic from shock but he would start thrashing when the operation began unless he was sedated and restrained.
Michael stood up, tubes still attached to his arm, and hunched over the boy, visualizing the operation, the steps he needed to take. Although amputations were grueling, Michael excelled at them, quarterbacking his small team. He was pleasantly surprised at the lack of infection in the boy’s arm. It looked like the machete had been sharp, and the assailant strong.
“We’ll cut it back here,” he said, quietly talking through the procedure. He marked the incision midway up the boy’s forearm, leaving as long a stump as possible while removing the damaged tissue to minimize the risk of infection.
Anna and Daniel gathered the equipment, unfazed by the oppressive heat and humidity. Michael cleaned the wound and used a piece of surgical tubing to fashion a makeshift tourniquet, minimizing further blood loss. “Anna, be ready with clamps and suction. Here we go. Bear with me, Étienne!” He used a scalpel to cut quickly through the skin, muscle, and other soft tissue. Anna rotated the boy’s wrist and Michael made a similar incision on the anterior side of the arm. Crimson gushers spurted from the radial and ulnar arteries but were quickly arrested as the blood vessels and nerves were ligated.
“Saw, please.”
Daniel passed Michael the oscillating surgical saw. It whined when Michael clicked it on. He carefully sliced through the two bones in the boy’s lower forearm. Michael then used the saw to bevel the edges of the bones, preventing sharp edges that could cut through the skin during the healing process or as the boy grew. He performed a myoplasty to connect the transected muscles to the bone, necessary to prevent atrophy and allow the forearm muscles to maintain function. The whole procedure took about thirty minutes, and Michael was soon using absorbable sutures to sew the two flaps of skin back together. He inserted a small drain, closed the wound, packed the area with gauze, and then pulled a sterilized stocking over the stump. The operation was complete.
“Brilliant!” Anna said.
“Thanks. Great team effort. I’m wiped out.” Michael’s green surgical gown was drenched in sweat and spattered with blood. He smiled and laugh lines appeared at the sides of his mouth and around his eyes. His face was too long and thin and his ears too large to be described as handsome, but Maria always told him he had kind eyes. “Any sign of Henri?”
“He’s already here,” Anna replied, “checking patients in the supplemental feeding tent.”
“Good. Tell Henri to keep a close eye on Étienne, and call me if anything goes wrong with him. I’ll see you tomorrow.” For now, the boy’s vital signs were weak but stable.
Michael undid the intravenous hookup, put a bandage on his own arm, changed out of his filthy scrubs, and washed up. He walked out of the tent into the darkness.
Chapter 2
The following day was a field day. Laurent, a young Congolese who’d become one of Michael’s friends, drove him and Anna northwest of Goma to medical outpatient clinics scattered across a series of villages in Masisi province. They traveled in an aging Toyota Land Cruiser with bald tires, no windshield wipers, and one reliable headlight. A Cadillac by local standards. On the door were two faded decals, the Red Cross sign and a red circle around a Kalashnikov assault rifle with a red line through it, intended to emphasize that the vehicle was not carrying any weapons.
The villages were all within a 100-kilome
ter range of Goma but the drive could take up to five hours because the roads were cratered moonscapes, unrepaired since the Belgians withdrew in 1960. There were always people walking along the roadside, carrying bags, bundles, bananas, corn, onions, blankets, mattresses, saucepans, wood, jerry cans, and clothing. Refugees flowed like rivers, their homes destroyed, fields burned, families torn apart by rape, assault, murder, and forced recruitment into militias and gangs. They moved into tent cities of wretched squalor, living under sticks and strips of plastic. In some places, you could still see remnants of the beautiful countryside, once speckled with small farms, forests, and tea plantations. Occasionally they passed skeletons at the side of the road, bodies and vehicles picked clean by different kinds of vultures.
It had been a long day. Michael had conducted almost one hundred exams. Without blood tests or x-rays, his diagnostic abilities were limited but he did what he could, listening carefully to each individual’s story, handing out antibiotics, and even stitching up a few cuts and gashes. Anna met dozens of women, offering them vitamins, contraceptives, and AIDS-prevention advice. The villagers whom they visited were kind and disarmingly generous, offering to share their meager food with the team. Laurent translated, chatting with people he met for the first time as if they were old friends, discussing the ever-shifting political landscape, the loyalties that changed direction as effortlessly and as often as the carrion eaters riding the thermals above them. They kept going until all the vaccines, infant formula, nutritional supplements, and medicines in the Toyota had been dispensed.
As they drove back to Goma, Michael and Anna argued about his decision to donate blood to Étienne. Michael leaned forward from the back seat to argue his case.
“I still think it was the right move. I’d do it again.”
“It was impulsive, and it put you in danger. Worse, it put the boy in danger too!”
“How?”
“The operation went smoothly and yet you were completely exhausted by the end. I saw your hands beginning to shake. What if there were complications? You could have hit a wall.”
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