by Cary Groner
One morning, as Peter toiled away in this sunny mood, a spindly old fellow came in. He had a bad cough and blood in his sputum, and he smelled like sweat and goats. Mina checked his lymph nodes, which were swollen.
“Masks on,” she said.
Peter donned his mask, reflecting on another paradox—that though he was frequently annoyed by patients as an abstract mob, each time he met one alone in the exam room he felt genuine fondness, even tenderness, and wanted to do his best to deliver them from whatever was ravaging their bodies. He didn’t understand this dichotomy, which occurred at such a deep emotional level that it seemed to defy explanation.
He asked the man, through Mina, if he’d ever been diagnosed with TB. The old fellow rambled on at length, and when he’d finished, Mina translated.
“Eight or nine years ago,” she said. “They gave him a drug, he doesn’t remember what. He took it for a while, but then it ran out, so he stopped.”
Peter watched her. She seemed tired, less ready for battle. He was glad; it meant he could let down his guard a little. “Anything since?”
She spoke to the man. “He says no. He says he got a little better, then in the past year it came back. He’s losing weight and coughing a lot. He says he’s very weak.”
“And it feels like it felt before, when he had it.”
“Yes.”
TB was the primeval, archetypal guerrilla warrior, a terrorist whose very body was an explosive device. Endemic in the population, quick to seize advantage of weakness, deftly mutating into drug-resistant forms, impossible to eradicate, merciless and deadly. It always made Peter nervous, from fear not only of getting it himself but of giving it to Alex. The months-long antibiotic treatments were hard enough, but if you got a multi-drug-resistant strain, you were finished as a physician and very possibly dead. Cardiologists usually didn’t have to deal with much in the way of infectious disease, so as promised, this place was turning out to be an education all its own. He was gaining more sympathy for the Belgian.
“We probably don’t need an X ray,” he said.
Mina nodded. “We’re almost out of film, anyway, and it’s going to be three weeks before we get any more.” There was no record of what the man had been given the last time around, but she was pretty sure it would have been isoniazid.
“Alone or with other drugs?” Peter asked.
“Most likely alone.”
“That might be a good thing, if there’s resistance. Any way to do a sputum culture or DST?”
“Not without sending him to the hospital, which he can’t afford.”
“Right.” You could be the best doctor on earth, but if you found yourself practicing in the Stone Age, you were going to be reduced to decoctions of roots and berries, just like everybody else. “What other TB drugs do we have?” he asked.
“Rifampicin and pyrazinamide.”
“Anything second-line?”
“Not at the moment.”
“Can we give him both, then?”
“If you want to,” she said. She spoke to the man and told Peter that he lived in a crate in the camp over in Bhaktapur, on the other side of the river. It had taken him five hours to walk to the clinic. She thought it unlikely they’d see him again, or that anyone would take the trouble to find him. If he stopped taking the drugs, they’d just be creating one more resistant strain of the disease, contributing to a potential disaster no one wanted to contemplate.
“Ask him, if I give him a lot of medicine, will he take it all, just as we say, until it’s finished six months from now? And then come back?”
She asked, and the old man nodded agreeably. Peter could tell that Mina didn’t believe him. He’d already seen five cases like this, and for every one he saw there were probably twenty or thirty people out there living with the disease and making do. The clinic was always low on drugs, always digging up a supply just at the last minute, through pharma company write-offs or the WHO or whatever else they could scrape together.
After the old man left, Mina took off her mask and opened the window. She headed for the door, and as she passed Peter she met his eyes, just for a moment. He couldn’t tell what the look conveyed. It unnerved him, because her sudden proximity seemed both aggressive and sensual. There was something in the lightness and ease of her movements, and in the mutual physical danger of the situations they faced, that put him on edge in ways so confusing that it spurred his desire to flee even more than the open conflict did.
| | |
Peter bought a little red Hero for getting around. He’d ridden a Kawasaki 750 when he was younger, and compared to that, the motorbike accelerated like a concrete block in mud, but ke garne? For Kathmandu it was enough; he didn’t want to go faster than thirty-five, anyway, because he figured either he’d run into something (a dog, a person, a cow) or something would run into him (a tempo, an ox, a bus). He rode with a bicycle helmet and a surgical mask, because the smog was returning after the monsoon. Otherwise, with all the diesel and other soot in the air, he’d come home looking as though he’d been snorting ink. He understood now why everyone in the city had a cough.
As he rode home one day, he saw two teenage girls walking ahead of him, hand in hand. The hand-holding was common enough; what got his attention was that one of the girls looked like Alex. He pulled alongside and saw that she was Alex, in fact. The other girl was even taller and wore a T-shirt and jeans.
Alex had continued to plow through her homeschooling, and given her academic proclivities, she didn’t need any prodding. So even though Peter was relieved that she’d made a friend, he wasn’t sure how she’d managed it. It made him realize he had no clear picture of how she’d been spending her days. She was hitting the books, but she also had a healthy desire to get out and explore the city.
In any case, acculturation was apparently under way on both sides. He pulled down his sunglasses.
“Is that you?” he asked.
She looked at the Hero and smiled. “I don’t know,” she said. “Is that you?” She let go of the girl’s hand and made a sort of formal introductory gesture. “This is Devi. Sangita’s daughter.”
“Oh, right.” He stuck out his hand, and they shook. Devi was a striking beauty with wide, dark eyes. As she gave his hand a strong shake, she smiled and said, “Pleased to meet you,” with only the slightest of accents.
“We’re on our way home,” said Alex. “See you there?”
Polite code for “Get lost,” he figured. “Sure,” he said. “I’ve got to get groceries. You want anything?”
“Rice Krispies,” she said. “She’s never had them, and we’re almost out.”
| | |
Sangita and the girls were in the kitchen, drinking tea, when he returned. Sangita helped him unpack the bags while she selected what she wanted for dinner and started chopping.
“Devi’s going to teach me Nepali and maybe Tibetan too,” Alex said.
Peter handed her the cereal. “Does she know she’s dealing with a know-it-all?”
Alex rolled her eyes. “She’s brilliant, Dad. And don’t worry, Sangita said we can spend as long as we want if she doesn’t get behind on her homework.”
Peter looked at them both. They seemed a little giddy. Devi had a peculiarly intense gaze and a delicate scar cutting diagonally across her nose. Peter wanted to ask some sort of question, but he wasn’t sure what that question might be.
“Great,” he said. “That’s great.” He looked at Sangita, who was rinsing out a pot and smiling her enigmatic smile.
| | |
After dinner the girls went up to Alex’s room and turned on some music. Peter helped Sangita carry the plates to the sink.
She held up two fingers, side by side. “Just met yesterday and already they like this,” she said.
“You saw it coming?”
Sangita nodded as she ran hot water into the sink.
“Is this okay with you?” he asked. “I mean, Alex doesn’t have a lot of friends, but I know how she is
with the chosen few. You and Sonam might start missing your daughter.”
“Devi eighteen, very strong,” she said. “Will like mule, worse even than me. Ke garne?”
“She speaks English very well.”
Sangita smiled. “She smart, got scholarship to international school. Son gone, we figure, better educate daughter!”
She’d mentioned the boy before. “Where is your son, anyway?” Peter asked.
She hesitated, then finished washing a plate and put it in the dish rack. “Maybe better not much saying,” she said.
“Well, is he alive? Is he okay?”
“We not know,” she replied, and it was clear from her tone—a mix of anxiety and resignation and emotional gristle—that that was all she was going to say about it.
SEVEN
Franz slouched behind his desk, holding his head dejectedly. A half-empty bottle of pink Pepto-Bismol sat beside a jam jar full of pens. Mina sat bolt upright on one of the chairs at the front of the desk. Peter slumped on the other chair. It was the end of the day, and although the light was fading, Franz hadn’t turned on his desk lamp. The room had a dank, autumnal air, like a cornfield about to be attacked by crows.
Franz spoke quietly, without looking up. “If we don’t get our funding we’ll all be gone in a few months, so this may not matter,” he said. “But in the meantime I don’t care if you hate each other; I just care that it shows. I can’t have this kind of thing going on.”
Mina crossed her arms over her chest. “He’s just like the Belgian,” she said.
“I never even met the Belgian,” Peter retorted. “For all I know, you invented the Belgian. Are we still in high school here? I merely asked whether ampicillin was the best choice for that kid’s infection. In America I’d have used Cefzil.”
The brief, fragile détente had been broken; perhaps it had been an illusion, anyway. Franz spoke again, but his words were barely audible, his voice rumbling like an ancient, discouraged oracle. They both leaned forward to hear.
“First, Mina, he’s a much better doctor than the Belgian, and you know it,” Franz said. She huffed dismissively in response, as if this were irrelevant. “And Peter, you should know by now that we don’t have access to antibiotics that cost five dollars a pill. You’ve got to learn to trust Mina’s judgment.”
“He doesn’t seem to be able to learn anything, so why should he learn that?”
Franz sighed. “Please,” he said. “I will give you a special bag of cat treats, which one of my patients paid me with today.”
“Where on earth did they get cat treats?” she asked.
“He works for an English lady, and she gave them to him as a tip,” Franz said. “They’ve probably been in circulation for years, like fruitcake.”
“I’ll take them,” said Mina.
“Cats,” Peter said. “It figures. You probably live with fifty cats.”
Mina turned to him, her gaze cool and level. “If you lived with fifty cats, they’d all be dead within a week.”
“I don’t pride myself on veterinary skills, like some people.”
“If you paid attention you’d see by now that I know what I’m doing.”
“Since half the time I don’t know what I’m doing, how the hell would I know about you?”
“Well,” she said, “at least you admit it.”
Franz cleared his throat. “Glad to see we’re getting somewhere,” he said. He finally looked up, just barely. “Now, what’s this about your daughter?”
“I just asked Mina how she’d feel about having Alex volunteer,” Peter said. “Instead of welcoming the opportunity, she seemed to take it as a threat.”
“As if I’d be threatened by some teenager,” Mina snapped. “You’re just more interested in building your daughter’s character than in treating patients.”
“There are ethical issues, Peter,” Franz pointed out. “What if she catches TB?”
“It’s a minimal risk, and she’s aware of it,” Peter said.
“But what if she does?” Mina asked. “Are you willing to take that responsibility?”
Peter stared at her. It hadn’t occurred to him that she might actually be concerned about Alex’s well-being.
“Of course I will,” he said, but he faltered. “I’d have to take her home, though, I guess.”
“I rest my case about tourist doctors,” Mina said.
Franz waved his hand like a white flag from a trench. “Mina, please,” he said. “I couldn’t keep this clinic open without you, you know that.”
She tossed her head triumphantly. “I know that very well,” she said.
“And I can’t keep it open without him, also,” Franz continued.
Encouraged by the praise, they both leaned slightly in toward the desk. Franz raised himself smoothly, the way a cobra does when its prey has finally stumbled into striking distance.
“If Alex wants to help us out, she will be at your disposal, Mina. If you want to get rid of her, you can. Peter will not be angry about it, will you, Peter?”
Peter shot Mina a look. “As long as you give her a fair chance,” he said. “If you ax her over some trumped-up BS, I’ll be in your face.”
“Just be sure she knows why she’s here,” said Mina.
“She’ll know,” Peter replied.
“Hallelujah!” said Franz, his hands upraised. “Everyone is happy now!”
| | |
Peter stalked through the door, took off his helmet and mask, and tossed them on the table. Alex and Devi were sprawled on the couch together as Devi quizzed Alex on vocabulary.
“Ke cha, Papaji?” asked his daughter.
“The good news is you’re in,” he said. “The bad news is you’ll be working with a psychopath.” He went to the fridge and pulled out a beer. “You might actually be right about going home.”
Alex glanced at Devi. “I’ve been rethinking that.”
Peter looked at his daughter. He fell into his chair by the couch and took a swig of beer. “Care to elaborate?”
“Well, the clinic might be a broadening-experience kind of thing,” she replied. “Plus, I have seventeen years of practice with a psychopath.”
“Bear in mind that broadening experiences are often unpleasant.”
“Would you care to elaborate?”
“On today’s menu we had multiple forms of respiratory distress due to lives spent breathing smoke from ox-dung fires,” he said. “Three cases of extensive scabies, given Kwell. A probable case of TB.”
“TB or not TB?”
“That is the question,” he said, and they briefly beamed at each other. “Let’s see … a kid with complications from measles who’s now in the hospital. TB, TB, and TB yet again. Assorted infections, many in the eyes. Two streps, one with a side of staph—patient may die depending on antibiotic-resistance profile. Oh, and I ran over a fresh pile of cow shit on the way home and sprayed it all over my scooter. We don’t have a hose, so now it’s covered with shit and flies.”
“Oh,” she said.
“And I know we’ve talked about this, but bear in mind that if you work there, you’ll be exposing yourself to some serious microbial risk.”
“You do it every day, right?”
“I have to. You don’t.”
“If you can do it, I can.”
He appreciated her grit, but it still worried him. “If I die, at least I won’t die young,” he said cautiously.
“No, you’ll just leave me orphaned at seventeen in a strange country.”
“Hmm, good point.”
“Whereas if I die, you’d ship me home in a box and get on with your life. You can have all the kids you want, but I only get one shot at having a dad.”
“Oh, right,” he said. “I expect I’d immediately forget all about you and just start happily procreating with the first woman I met.”
“Well, why wouldn’t you? I would if I were you.”
“You two are extremely, upsettingly bizarre,” said Devi.
>
“See?” said Alex. “The girl’s got vocabulary.”
Peter took a breath; all the cheery banter about mortality was making him uneasy, and he craved some sort of segue. “So ke cha with you two, anyway?” he asked.
Alex smirked at Devi. “Multiple forms of intellectual distress due to the nutty way these people speak.”
“Hey,” said Devi.
“Nepali actually turns out to be pretty straightforward, but Tibetan is unbelievably hard. They end their sentences with verbs, but that’s the least of my problems.”
“That’s for sure,” said Devi.
“Hey yourself,” said Alex.
Peter watched them and remembered Sangita’s remark. They did seem unusually comfortable together for such new friends.
“How do you like the international school, Devi?” he asked.
“It’s difficult,” she answered. “I like physics and philosophy, though.”
“Good combination,” said Peter. He sipped his beer. “This Gorkha’s pretty good. Have you tried it?”
Alex laughed. “You know we have. I’ve seen you count the bottles.”
“I only count the bottles to know when we need more.”
“I certainly believe that, Papaji.”
“Your daughter memorized forty more words today,” said Devi, in an apparent flanking maneuver. “She is a genius, I think.”
“Of course she’s a genius, but don’t tell her so.”
Alex air-kissed him. “Ma teamelai maya garchu,” she said.
“That better be as nice as it sounds.”
“Sure it is, if you allow for sarcasm.”
EIGHT
The two of them faced off like boxers sizing each other up in the ring. Alex was taller and still growing, but Mina, though thin, had the contained, intimidating bearing of a lioness poised to defend her territory.