Exiles

by Cary Groner

  “Apparently everyone did but me,” Peter replied. “Is this a smaller town than it seems?”

  Franz turned on the coffee. “It’s like anywhere,” he said. “You become acquainted with one or two of the right people and you can find out most of what you need to know.”

  “Such as where I live, apparently.”

  “Oh, all kinds of things,” Franz said, and smiled.

  Franz was a thickset Austrian in his fifties with short white hair surrounding a shiny bald pate. His English was nearly flawless. He had a bull neck and a strong jaw, his face softened only by a slight middle-aged dewlap and by his small, octagonal rimless glasses. He wore a blue canvas shirt with old, wrinkled khakis and brown Rockports. His arms and hands were thick and sinewed, but for all his obvious physical strength he seemed imbued with an air of reticence or regret. When they’d shaken hands his grip was soft, the touch tentative and probing. Peter had seen this combination before.

  “Orthopedic surgeon?” he ventured.

  “And you’re a psychic, I guess. Not nearly enough of those in Nepal.” He seemed jovial, more or less, but with an edge worth noting.

  Phwoof was in a modest two-story house on a side street about a half hour’s walk from Peter’s place. Franz’s office was painted bright yellow and had windows on three sides. Milk crates full of medical texts were stacked against the walls. The open window brought a warm breeze and the scent of flowers.

  “Not a lot of American cardiologists come over here,” Franz said. “Forgive me for being blunt, but any malpractice issues I should know about?”

  “All my patients die,” Peter said. “Eventually.”

  Franz chuckled. When the coffee was ready, he poured them each a cup. The men sat in the office’s squeaky, tattered chairs.

  “Thanks for sending Sangita,” said Peter, “even though it was a little creepy to find her there.”

  “It’s politically incorrect to say this, but you may as well know: Sangita is industrious and she doesn’t steal, which sets her apart from most didis. She’s Tibetan, even though she wears a bindi and pretends to be Nepali.”

  “Why would she pretend?”

  “She’ll tell you if she wants to,” Franz said. It was a subtle but distinctly anti-imperialist remark, Peter thought, respectful of Sangita’s privacy and informative of Peter’s place in the pecking order, just in case this was required. “And by the way, don’t expect subservience. She’ll give you an honest day’s work, but she won’t kowtow.”

  “I’m figuring that out,” Peter said. “It’s a relief.”

  Franz nodded approvingly, sipped his coffee, and fixed Peter with an oddly penetrating gaze. “We generally get three kinds here: missionaries, misfits, and malcontents,” he said. “Mind my asking which one you are?”

  “Jesus, this really is a job interview, isn’t it? Suppose I ask why there’s an opening on the staff?”

  Franz shrugged. “We often need doctors because I don’t mind firing them,” he said. “We had a Belgian in here last month who was so afraid of catching something that he’d barely touch the patients.” Franz raised his hand and brought it down on the desk like a hatchet onto a block.

  “Well,” said Peter, “I’m definitely not a missionary.”

  “Good,” Franz said. “Misfits and malcontents I can work with. You’ll get the salary of a fry cook and an education in a variety of compelling and terrifying diseases you’d rarely cross paths with at home. What do you think?”

  As much as Peter disliked being cornered, the alternative was giving up and catching a plane home. “What do you get out of it?” he asked.

  “A chance to keep the place open,” Franz said. Phwoof clinics, it seemed, were sponsored by a loose-knit consortium involving the WHO and a couple of international NGOs. Most of the money had lately been redirected to Darfur, Somalia, Iraq, and Afghanistan. The Nepali government had stepped in, but they would commit for only a year.

  “Six months from now, if they decide they don’t like us, that’s it,” Franz said. “I’ll go back home and eat kaisersemmel and sausage, I guess.”

  “Are you sure a cardiologist is the best choice?”

  “Our patients walk everywhere, eat too little, and die young of something else,” he said. “But there are some heart problems I’m not used to seeing. You might understand something about them; if so, I’d like to know.”

  Peter told him what he knew: that Nepalis and Indians were four times more likely to have coronary artery disease and heart attacks than Caucasians, that half the attacks happened before age fifty and a quarter before age forty.

  “Do you know why?” Franz asked.

  “Something to do with how lipoprotein is processed,” Peter said. “When they get prosperous they get away from traditional dietary fats, and that’s when the trouble starts.”

  Franz rubbed his forehead. “Big Indian community where you live?”

  “We wouldn’t have enough engineers without them.”

  “I didn’t know about any of what you just said, but it wouldn’t look bad in a grant proposal. If we actually did something for the prosperous once in a while, it might help us.”

  “So what am I going to be dealing with?”

  “I mainly treat TB, conjunctivitis, dysentery, miscellaneous infections, and bullet wounds,” Franz said. “Tapeworms and flukes and protozoa. Occasionally there’s a mountaineer with a compound fracture, thank God. It keeps my hand in.”

  “Bullet wounds?”

  Franz regarded him, surprised. “You should read the papers, Yank,” he said. “You’ve enlisted for service in a civil war.”

  Peter shifted in his seat. “I thought the whole Maoist thing was mainly out in the countryside,” he said.

  Franz replied simply, “It was.”

  | | |

  “So we’re staying,” Alex said. She sounded almost relieved, but not quite.

  “If you’re miserable three months from now, we’ll negotiate.”

  They walked over to the Bhat-bhateni Supermarket, which occupied five floors on a half acre of land and was surrounded on the outside by stalls selling fresh fruits and vegetables. The building also contained a hair salon, a dry cleaner, a shop with bright ground spices in wooden bins, and a dozen other stores. Alex’s face lit up, taking it all in. She stopped dead in the street and was immediately nudged from behind by a goat on a leash. Its owner spoke to it, then gently led it around her.

  Inside, they each took a cart. Peter picked out electric heaters for the bedrooms and a big kerosene beast for downstairs. Alex found Rice Krispies, which made her nearly ecstatic. She bought toilet paper, tampons, milk, rice milk, yogurt, Wheat Chex, and Toasties. He bought eggs, flour, chicken, steak, hamburger, lettuce, cabbage, beans, chocolate-chip cookies in a giant paper bag, charcoal and lighter fluid, and, just for good measure, a purple Frisbee. On another floor he found sheets, pillowcases, and down comforters.

  When they arrived at the checkout line, Alex eyed her father’s cart. “I thought you hated to shop,” she said.

  “I hate to shop in America. Here, they need us.”

  “Oh, you’re a philanthropist now.”

  A grin tugged at the corners of her mouth, but part of the game was giving as good as he got. He scowled. “I’m going to be glad in a few years, when you become pleasant,” he said.

  She patted his stomach. “If you’re nice to me, you might live long enough to see it.”

  On the way home, crammed into a cab with their plunder, he watched her as she looked dreamily out. When they were stuck in traffic and the huge, broad face of an ox suddenly appeared at her window, she jumped, startled, and then laughed.

  “Hello, ox,” she said. “Are you as strong as yourself?” She giggled self-consciously at her own dumb joke, and Peter knew she’d have to find friends soon.

  FOUR

  “What on earth are you doing?” said a voice.

  Peter turned away from the patient—a girl about Alex’s age—and
saw the woman staring at him.

  “You must be Mina,” he said. Franz had warned him about the Nepali RN who’d help him learn the ropes. Poised in the doorway, slender in a shiny, mottled blouse, with her intently focused eyes and sharp nose, she looked like a snake about to strike. Apparently her father was a retired colonel in the Royal Nepalese Army, and she’d gotten some of the genes.

  “The question stands,” she said.

  “What on earth I’m doing is trying to get a leech out of this girl’s nose without pulling her whole septum out with it,” he answered, briefly grateful that his patient didn’t speak English. He had a hemostat on the slimy thing, but it wouldn’t budge, and he was pulling so hard the girl had begun to weep. She was his third patient, and he was already flailing, but clearly he couldn’t leave a fat, thumb-sized leech in there.

  Mina hissed with exasperation and went to the sink. She filled a glass with water, then brought it over and held it under the girl’s nose. She stared at Peter with unsettling calm; he stepped back and tried to pay attention to the leech, but it was hard not to notice Mina’s eyes. They were wide-set and such a deep brown that they were almost black. Peter felt a surge of energy pass from her to him—there was hostility, to be sure, but there was something more, something confusing. Her eyes were stunning; in fact, she was stunning, though it hadn’t been clear at first. It was as if for just a moment, tending the girl, she let down her scaly armor and revealed an aspect of herself that was genuine and warm.

  But then, as if aware of this unintended revelation, she averted her eyes. Once again she looked like an ordinary woman, and an irritated one at that. Even so, Peter couldn’t completely shake the sense of a hidden life, as if she guarded herself from the world because she had something of great value to protect.

  The leech let go and plopped into the glass.

  “When they’re engorged, they just want to get back into the pond,” Mina said. “So we bring the pond to them.” She set the glass on the counter. The leech sunk to the bottom, wiggling.

  The girl’s nose started bleeding profusely. Peter grabbed some gauze and put pressure on it.

  “It’ll stop in a little while,” Mina said. “Where did you go to medical school, for heaven’s sake?”

  “I’m a cardiologist, not an ENT.”

  “Then presumably you’ve heard of heparin.”

  “What about it?”

  “Leeches invented it; that’s why she’s bleeding. When you can’t get any heparin and you have a patient with thrombosis, remember this and maybe he won’t lose his leg.”

  Peter huffed. “Great,” he said. “Let’s also get some maggots for debriding wounds.”

  “I’ve tried them, and they work pretty well. But that’s not the sort of thing they teach you at Stanford.”

  “How did you know I went to Stanford?”

  “There’s this thing called the Internet, Doctor. Check it out sometime.”

  “But if you knew, why did you ask?”

  “It was a rhetorical question,” she said. “Perhaps you’ve heard of those too.” She picked up the glass with the leech and left.

  The girl in the chair stared at him, wide-eyed. He took a couple of breaths to calm himself down and spoke gently to her. “It’s okay,” he said, figuring she’d get the tone even if she didn’t understand the words. “You’ll be out of here in a bit.”

  He wished he spoke Nepali so he could find out how she’d gotten a leech up her nose in the first place, but Mina had disappeared and there was no one to translate. He showed the girl how to apply the pressure, left her holding the gauze, and walked down to Franz’s office.

  “Any chance I could work with someone else?” he asked.

  “Someone other than Mina?” said Franz, smiling. “Oh, no. She’s a necessary terror. Remember the Belgian?”

  “What about him?”

  “She threw a book of practice guidelines at his head. A thick book. Said if he wouldn’t read it, perhaps it could make an impression some other way.”

  “And how long after that did you fire him?”

  “Within the week, as I recall.” Franz was practically humming with pleasure at the memory of it.

  “So it was him or her, and that was your choice.”

  “Oh, absolutely,” said Franz. “Best to keep it in mind.”

  | | |

  Peter had fled one cage, seeking freedom, and now to his chagrin he found himself in a different one in another part of the world, and a dirtier cage at that. How had everything gotten screwed up so quickly? He had come here to deliver his daughter from a nasty situation, and now she was indignant and he was lost in a maze of frustration and bafflement. She didn’t appreciate anything he tried to do for her, but then everything he attempted seemed to fall apart before his eyes. He had patients to attend to here in the clinic, but mainly he felt like bolting for the door, disappearing down some street until he was as ragged as a beggar. His skin raised up in prickly welts under his shirt, as if something had infested him and begun to bite.

  “Ankhaa,” said the boy, pointing. He was not crying at the moment, but he had tear tracks, outlined with dust, on his cheeks.

  “Your eyes.”

  “Ankhaa.”

  “Okay, let’s have a look.”

  Peter forced himself to focus. The boy was about fourteen, shirtless and bony. His mother, also thin, rested a hand on his arm. She looked fifty, so Peter figured, based on what was now four days of experience, that she was in her late thirties. She wore a clean but threadbare sari, and like her son she was shoeless, with thick calluses on the bottoms of her feet. They’d walked to the clinic from one of the sprawling refugee camps that surrounded the city, shantytowns filled with villagers driven from the mountains by fighting between the RNA and the communist rebels.

  Mina leaned calmly against the counter, legs crossed at the ankles, arms folded over her chest, watching and translating as needed. Her eyes retained their cool, unnerving gaze. Peter felt those eyes on him, persistent and relentlessly acute. Already he couldn’t stand to be in the same room with her, for reasons far more complex and troubling than simple loathing (though loathing was certainly part of the mix). She seemed equally ill at ease.

  He shone a light into the boy’s eye and pulled down the lid while the boy looked up, to the left, down, to the right. The pupil dilated normally and there was no obvious inflammation, but his cornea didn’t look right. Peter peeled back the upper lid, then checked the other eye. He’d read about this in med school but had never seen a case. He looked at Mina.

  “Much trachoma in the camps?” he asked.

  “There you go, Doctor.”

  The infection had scarred the undersides of the boy’s eyelids. The scar tissue, in turn, pulled the lashes under so that they raked the cornea every time he blinked. The boy must have felt like he had sandpaper glued under his lids.

  “Ask her how long he’s been like this.”

  Mina spoke to the mother and then translated. “Off and on for two or three years.”

  “Years?”

  “That’s how things are here, I’m afraid.”

  “What’s your luck with antibiotics?”

  “They’re better for a while, then they usually get it again,” Mina said. “The flies spread it. How well the cornea heals depends on how strong the child is, how much he gets to eat, all the usual things. If he wants to keep his eyesight, he probably ought to have the surgery.”

  “Can they do it at the teaching hospital, or at Kanti?”

  Mina’s lips pulled into a thin smile. “This woman has no money for a hospital, Doctor.”

  “It’s not something I’m trained to do,” he said impatiently, as if she ought to know this.

  “I think if you watch me two or three times, you’ll have it.”

  Peter looked at her. The smile remained on her lips, though it had compressed just slightly in the middle and begun to look smug. “You can do it?” he asked.

  “Of course.”r />
  Of course, he thought. He almost wanted her to fail, then felt ashamed for having the thought. They took the boy to the room with the tilt chair and brought in a seat for his mother. Mina and Peter scrubbed up and put on gloves, then she talked soothingly to the boy as they rolled in the stools, one on each side. Peter was surprised, again, by her sudden gentleness, but this time he deliberately avoided her eyes.

  “Numb him up, will you?” she said.

  “Outer lid?”

  She nodded. But when the boy looked over and saw the needle headed toward his eye, the eyeball rolled up and he passed out cold. The mother came to her feet, apparently fearing the worst, but Mina reassured her.

  “Well, go ahead and do it now, while he’s out,” she said to Peter.

  Peter gave him a small injection in each lid, then Mina broke an ammonia capsule under his nose and he came to.

  “Aama,” he said. His mother spoke to him, and he settled down.

  “Next time we see one of these, which should be in a few days, come over the top and pull the lid up so the child doesn’t see the needle,” Mina said, a little more patiently. “It requires a certain amount of stealth.”

  She pulled the right lid up, reached in with the scalpel, and made an incision the length of the lid’s underside. She lifted the side with the lashes outward so it would be placed correctly, then removed the scar tissue with a few more strokes.

  “Hold this with a clamp,” she said.

  Peter reached in and did as she asked. She wielded the scalpel with calm, steady hands. She stitched the lid closed so the lashes stayed where they should, then moved to the next eye. In all, it took less than half an hour.

  Peter was impressed enough that he felt a little conciliatory in spite of himself. “You learned that at UCSF?” he asked.

  “You’ve discovered the Internet.”

  “No, I just went into Franz’s office and read your file.”