A Change in Altitude

by Anita Shreve

  They had moved to the house-sit in Karen, unnerved at first by its size: something between the Big House, which had been sold to the Kenyan minister of transportation, and their cottage. The new home was furnished with antiques and Orientals and came with a house servant named Moses. Moses did for Patrick and Margaret what James had done for Diana and Arthur, and it had been made clear to Patrick and Margaret that there was no not having Moses. The owners, a couple from Australia, considered him a fixture in their lives and wanted to ensure that he would be there when they returned in six months’ time.

  Moses was a good cook and would greet Margaret each morning with a list for the day’s shopping for her to approve: garam masala, king prawns, ghee, Kiwi Kleen Bowl. He had an extensive repertoire of main dishes, and she hadn’t yet come up with a meal he couldn’t figure out how to make. He had an easy disposition as well and smiled often; Margaret liked him. But whenever she was with him, she couldn’t shake the sensation that she was a fraud, living a life she hadn’t been bred to and hadn’t earned. Giving instructions to Moses, she was an actor in a play someone British had written for a previous generation.

  Apart from his convivial presence, which lent the household a positive ambience, Moses served as a kind of buffer between Patrick and Margaret. Knowing that Moses was just around the corner kept their dialogue civil, even pleasant. Most of all, it kept them talking. The perception that they ate their meals in silence was one neither of them wanted to convey. It was as though they rose to their best behavior when Moses was in the house. Still, Margaret was hard put to treat the man as a servant. She wanted to invite him to sit with them at dinner. This was an entirely American idea, Patrick explained.

  Periodically, either Patrick or Margaret would “make an effort” to break through the clot that was thickening just below the surface of their civility and pleasantries. In February, a month after the climb, Margaret had had Moses prepare an extravagant dinner, with champagne cocktails to be had first in the drawing room. Moses had lit the fire and retired to the kitchen, and Margaret had placed candles on the mantel and side tables. When Patrick came through the front door, doctor bag in one hand, briefcase in the other, and she called to him, she could see his surprise in his raised eyebrows. She had bought another surprise she intended to reveal later: a white silk nightgown.

  “What’s this about?” he asked.

  “Nothing,” Margaret said. “Just us. Thought we needed a lift.” She was wearing a long blue dashiki with a V-neck and slits at the sides of the skirt.

  At first Patrick sat on the sofa as if he might not be staying.

  “You don’t like this?” she asked.

  “No, it’s just that… I don’t know…”

  “Should we still be in mourning?”

  “I don’t know. I guess not. I never thought about it, really.”

  “It’s just a drink and dinner.”

  “Just a drink and dinner with caviar and champagne?”

  Margaret turned away and looked steadily into the fireplace, and Patrick must have sensed he’d gone one comment too far. He touched her arm and signaled to her to snuggle up against him. He opened the champagne and poured them each a glass. They didn’t toast; nothing seemed suitable. They drank the champagne and ate the caviar and laughed, something they hadn’t done since before the Mount Kenya climb. When they left the drawing room, having polished off the champagne, there was at least a hint of real intimacy between them.

  But something happened in the dining room—with its perfect place settings, candles lit, Moses serving—that flattened whatever brief stab of happiness they’d managed to create just moments earlier. Too late, Margaret realized they’d have been better off eating on trays by the fire. Or sending Moses home early after he had cooked the meal, with promises that they would do the washing up. By the time dinner was over, any joy they’d managed to produce had evaporated like the champagne bubbles they’d had earlier. Patrick rose to go to the study to review papers about equatorial medicine. Margaret went upstairs and removed the white nightgown from its impudent toss across the bed.

  “You brought your camera?” Patrick asked Margaret on the tarmac.

  “Thought I’d give it a whirl. If they insist, I’ll take it back to the car.”

  Just then, the stench hit her, assaulting her nose and throat and stomach. “Patrick,” she gasped.

  In the car, Patrick had been civil, even animated, trying to prepare Margaret for the hospital. As they had passed the slums of Mathari, she’d glimpsed cardboard roofs covering the shanties. The huts had seemed piled one upon the other until all the ground was swallowed up.

  “This was cleaned out during Mau Mau,” Patrick began. “It was thought to be a hotbed of rebellion. After independence, the people returned and built houses, if you can call them that, of thin wood or of mud. They make their income hiring out rooms or brewing a maize beer called bazaa to sell to customers, mostly men, who flood the slums in the evenings and on weekends.”

  “Have you ever tried it?” Margaret asked. “The bazaa?”

  “Awful stuff. Really.”

  Below them, she could see no roads, merely miles and miles of cardboard and tin rooftops.

  “No water, no electricity, no drains, no way of disposing of garbage,” Patrick continued. “Every once in a while, the police come along and bulldoze a hundred or so huts. I’m all for it. Diseases spread fast in the slums. Cholera. Typhoid. Tuberculosis.”

  “What happens to the people whose houses are destroyed?” she asked, thinking of Adhiambo.

  “They move in with relatives. Eventually everything the government has bulldozed grows back. Like a weed.”

  On the tarmac, Margaret felt blinded. When her eyes adjusted, she could see masses of hot-pink and orange blossoms covering blue and white buildings. Several men in green cotton uniforms were working on cars under a corrugated tin roof. An attendant in a white coat walked slowly with a woman in a green shift. The scene struck Margaret as a normal one. It was only seconds later, when she saw that the woman’s head had been shaved; that an adolescent boy, flailing in the hot sun, was strapped into a high chair; and that every window in the long string of buildings was barred, that she understood that the men working on the cars were really very sick.

  “The place is woefully understaffed,” Patrick said as they walked to the entrance. “All I’m doing here is trying to separate out the organic diseases, which would require different treatment, from the strictly psychiatric diseases. In return for being allowed into the hospital to do my research, I run a clinic whenever I come.”

  Margaret brought her straw hat farther down on her brow to ward off the glare. Short of wearing a mask, there was nothing she could do about the smell.

  “There are seventeen hundred patients, eight hundred of which are incarcerated,” Patrick explained. “For those eight hundred, there are eight doctors. You do the math. Everyone here has been brought by family or police because his or her behavior was deemed either criminal or suicidal. The men’s wards are on the other side of that fence. We’ll just see the women’s wards today.”

  Margaret saw women lying on the paved courtyard, some alone, some in pairs. She felt bludgeoned by the sun and couldn’t imagine how hot and uncomfortable the tarmac must have been for them. As Margaret and Patrick passed, they caused a commotion. The women ran to Patrick and chattered in languages Margaret couldn’t identify. He talked encouragingly in Swahili to them, scolded others. Margaret knew enough Swahili to understand some of Patrick’s admonitions. Eat well. Drink a lot of water. Drink the milk they offer you. Take the medicine. Rest in the shade if you can. He turned and introduced Margaret. The women touched her, and she knew not to shrink away. The women’s hands were filthy, and, up close, the stench made Margaret’s eyes water. The women especially wanted to touch her hair, with its sun-bleached streaks. With their fingers, they reached out toward her head and then hissed, as if their fingers had been singed.

  “Everyone here is
thought to be psychotic,” Patrick explained.

  “Are they not allowed baths?” Margaret asked.

  “The overall stench is because of the plumbing,” Patrick said.

  They were greeted by the senior nursing officer, Mr. Jesani, an Asian with a thick beard that covered the bottom half of his round face, a heavy head of black hair, and thick glasses. He would be the tour guide. Margaret asked if she could use her camera. He said no. Then maybe. Then that he would signal her when a picture could be taken. Margaret took four that day. One was taken through bars to an outdoor courtyard where the women, in cotton dresses, milled around one another. A second was of a woman with a shaved head, lying on the dirt next to a wire fence, a picture she managed to snap without permission. Another was of a similar woman, her new hair growth gray, making a basket with a long piece of straw. A fourth, staged for Margaret, was of a female nurse in starched white, teaching a group of women gathered at a table how to read.

  A wire fence surrounded one ward. Yellow doors and yellow bars, along with the green shifts of the women, provided a touch of color in an otherwise bleak scene. For the most part, the women were in courtyards, some alone, some huddled in pairs, some contentedly weaving baskets. In the center of the first courtyard, a woman named Wanjui, six months pregnant, was drinking a Tetra Pak of milk, her extra ration. When her baby was born, Mr. Jesani said, it would go to Dr. Bernard’s Home, an orphanage. Mathari Hospital, it was explained, was no place for babies.

  Wanjui’s child to come would be her second. The first was staying with her husband’s family while she was in the hospital. It was doubtful that Wanjui would be allowed to care for either child again. Her parents had always regarded Wanjui as a strange girl, given to long, sullen crying spells and fits of bad temper. When she married, the parents felt better, for she immediately became pregnant, had a baby, and began to care for that child in a way they deemed appropriate. One day, however, her husband arrived home and found Wanjui trying to drown her baby in a tub of water. Wanjui could not explain what she was doing. Sometimes she couldn’t even remember the incident. Sometimes she wasn’t able to remember that she had a child at all.

  “Psychotic,” Mr. Jesani pronounced.

  Many of the women suffered from hallucinations and delusions, while others could not control their bodies. The latter were the patients Patrick was interested in. Why couldn’t they control their bodies? Patrick was convinced that some of these women, if correctly diagnosed, could be treated with conventional medicines and sent on their way.

  On the grass were women lying so motionless that the flies didn’t even bother to buzz around them; they simply rested on the brown flesh. From a long corridor Margaret could hear a woman moaning. Mr. Jesani explained that she had had to be locked in her room because she “couldn’t control herself,” again a loose reference to what might or might not be an organic disease. In a corner by a fence, an older woman cradled a younger woman in her arms as a mother would a baby. A gregarious patient followed Margaret, asking questions she couldn’t understand, continually touching her and wanting to be touched back.

  “Don’t,” Patrick whispered to Margaret.

  They moved from ward to ward until they came to the final locked door. There was some discussion as to whether or not Margaret should be allowed in. Mr. Jesani was worried about the chaos that might ensue if there was an upset in routine. White women seldom visited, Margaret was told. She argued that if there was a problem, she would leave at once. The nurse unlocked the door to the female criminal ward.

  Tall, thick stone walls surrounded the women. The building was damp and airless, the smell terrible, the atmosphere gloomy. The women approached Patrick and Margaret aggressively. They demanded her bracelet. They wanted money. They pulled her hair. When bananas were served in the dark courtyard, they fought for their share. They laughed at Margaret and pursued her relentlessly down the long corridor of locked doors, behind which lay women in solitary confinement. At times it was so dark in the criminal ward, Margaret couldn’t see her hands. Mr. Jesani communicated with the patients, chiding and scolding if necessary. From time to time, Patrick would ask to examine a patient. On their way out, they passed by an open door. Inside sat a lovely elderly Masai woman, in regal splendor, finishing an enormous basket, ten feet in diameter. The fact that she had become incontinent and incapable of caring for herself did not diminish the grace with which she came to the bars in her window and held out her hand in greeting.

  “Karibu,” the woman said. Welcome.

  “You have seen the worst,” Mr. Jesani said.

  * * *

  Margaret couldn’t drink the tea that was served to them in the director’s office. Patrick had two cups and two sandwiches to match. He glanced at Margaret from time to time. At one point, she thought he was trying to tell her, “It could be a long afternoon. You might want to eat something.”

  After lunch, she followed Patrick to the place where he was to hold his clinic, a damp stone corridor with a window just behind him to enhance the light from the single bulb overhead. He asked Margaret to give the waiting women cups of water and the tray of biscuits the director had held out to them when they’d left his office. Margaret thought that the promise of the biscuits may have been the draw of the clinic; that, or the handsome young doctor who waited to treat the women. When she had distributed the water and the food, she sat in a chair in the corner and observed her husband.

  He resembled the Patrick she’d known before the climb: focused, but quick with a joke; searching for the problem, but not immune to a sudden hug; pulling a young woman who was crying to his shoulder. He palpated glands, looked down throats, felt for lumps that had been shyly pointed to. He gave orders to an attending nurse in a calm voice that clearly communicated urgency. He dispensed pills. He wrote notes the entire time in a shorthand only he could read. When the clinic was over, Margaret knew, he would meet with the top physician at the compound and review the records of the eighty patients he was following for his research. She watched him, his dark hair haloed by the bright midday light beyond the window, his face backlit.

  “Patrick, Patrick, Patrick,” she said silently to herself.

  * * *

  Shortly after the day at Mathari Hospital, a colleague of Patrick’s named Munira and his wife, Naomi, invited Patrick and Margaret to visit Munira’s family shamba in Limuru, a village north of Nairobi in Kikuyu territory. Munira drove. While still in the car on the way to Limuru, Margaret was overtaken by a soporific lassitude, one brought on by the seemingly endless panoramas of red dirt and carved green terraces, of mango trees and banana plantations, of seas of red coffee beans. She thought it must be the saturated color, too many bright hues overwhelming the senses. Or perhaps it was the fact that Naomi and Munira spoke English with a musical and mesmerizing Kikuyu lilt.

  When the four arrived in the town, Munira announced that he and Naomi first had to pay their respects to Naomi’s father, who was an advocate and had an office there. Patrick and Margaret took cups of tea they’d ordered at a tea shop to an outdoor terrace. Below them lay a maze of red and green, punctuated by grass huts.

  “This is too beautiful,” Margaret said. “It makes me feel alive and yet dreamy at the same time. I just want to close my eyes.”

  “It’s the altitude.”

  “You don’t think it’s beautiful?”

  “I do. But it’s the altitude.”

  “Okay.”

  “Did you know Munira’s grandfather fought during Mau Mau?” Patrick asked.

  “Where?”

  “Right here.”

  “You mean right here, in this town?” Margaret asked, taking another sip of the sweet tea.

  “And in the countryside. It’s like sitting at the site of a Civil War battle twenty years after it happened.” He paused and then asked, “Are you okay?”

  Margaret met his eyes. “I’m trying,” she said.

  Anger begets anger, she wanted to say. Distrust begets distrust
.

  They could hear their friends and Naomi’s father approaching.

  “My father-in-law wants to give you a drink from the bar of his friend,” Munira said.

  Margaret checked her watch. It was eleven in the morning.

  “We’d love a drink,” Patrick answered. He smiled and shook hands with Naomi’s father.

  They followed the man to a cement box of a bar, where they were greeted with much enthusiasm by Naomi’s father’s friends, all Kikuyu men of varying ages and builds, all with a distinct Bantu likeness. They were ushered into a back room, where Patrick was offered chang’aa. Not far from the bar was the actual grave site of Munira’s grandfather, which they visited. While Margaret snapped pictures of Munira, Naomi, the grave site, and the surrounding countryside, Munira spoke about his grandfather’s sacrifice.

  “He was a very brave man,” he said. “He killed eight of the British troops with his panga alone.”

  “How did he die?” Patrick asked.

  “He was executed,” Munira said. “A bullet to the back of the head.”

  Margaret tried to imagine the beautiful terraces as a bloody battleground. The prize had been freedom, as flawed and as difficult as that had turned out to be.

  “I think it is time we are eating,” Munira said.

  He drove Patrick and Margaret to his family’s shamba, a mud-and-wattle hut with a grass roof—Munira’s home when he was a boy. From that hut, he had gone to grammar school, high school, university in the UK, and then medical school in Nairobi. Now he worked as a physician at Nairobi Hospital. Naomi was a banker. She had on an electric-blue suit that hugged every curve of her body. From time to time, she settled her hands on her belly and sighed with contentment. Munira announced that Naomi was pregnant.