Asymmetry

by Lisa Halliday

  Cortisol is required for normal endocrine activity, regulating growth, metabolism, tissue function, sleep patterns, and mood. Untreated, a cortisol deficiency can be fatal, causing hypoglycemia, dehydration, weight loss, dizziness, low blood pressure, even cardiovascular collapse. Also problematic are the symptoms arising from the thwarted cortisol precursors, which include an excess of androgens, otherwise known as the male sex hormones. As a result, a three-year-old boy affected by CAH could develop hair under his arms and acne as bad as his babysitter’s. Likewise, a little girl with it could also exhibit masculine features from an early age: body hair, a growth spurt, even a preference for trucks and tractors over teacups and dolls. When she reaches the normal age of puberty, her voice might deepen, her chest might remain flat, and she might menstruate very lightly, if at all. In theory, few cases should reach this stage of virilization, because earlier signs would have prompted a trip to the doctor, who in turn would have prescribed synthetic steroids to lower the androgen levels in the system.

  Sometimes, the problem is even apparent at birth. Instead of having a normal-sized clitoris, a baby having two X chromosomes might be born with an enlarged clitoris that looks like a tiny penis. Her urethra and vagina might have merged toward a single opening and the labia may have fused entirely, resembling a scrotum. Yet an ultrasound will reveal that, inside, she has a perfectly normal uterus, fallopian tubes, ovaries, and a cervix. In fact, were she to have external reconstructive surgery, she would have everything she needs (save someone else’s sperm, of course) in order one day to conceive. My little Arab friend had been born with ambiguous genitalia, but not so ambiguous that her parents, nor an obstetrician back in Syria, had seen fit at the time to call her anything but a girl. More recently, however, certain other signs, including the increasingly phallic anomaly between her legs, had raised eyebrows at home and she was brought in. Indisputably, her cortisol levels needed to be regulated. But there remained the question of what to do about her gender. Her doctors were of the opinion that she should be given hormone-replacement therapy and perhaps also a genitoplasty and carry on as a girl. Her mother was inclined to agree. But her father had a different perspective. Where he was from, a boy is superior. A boy is prestige. A boy brings you pride. Where he was from, one might even say: Better an infertile man than a fertile woman. In fact, said the father, I always thought she was a boy. It was a mistake from the beginning. She looks like a boy. She acts like a boy. Her life would be so much easier if she were a boy. He’s a boy.

  There’s no cure for CAH. It’s a genetic condition whereby the double helix inherits two copies of a faulty gene, one copy from each parent. Usually, the gene is recessive to a dominant counterpart. But if both parents are carriers, there’s a 25 percent chance their child will inherit both faulty genes and express the condition. This leaves a 50 percent chance the child will inherit only one faulty gene (and become another carrier), and a 25 percent chance the child will inherit only normal genes, and be unaffected. Owing to the probability that two partners will have inherited the same mutant gene from a common ancestor, autosomal recessive disorders are especially common among the offspring of consanguineous couples. The closer the relationship, the greater the proportion of shared genes. The greater the proportion of shared genes, the greater the risk their offspring will be homozygous for the shared gene. In other words, autosomal recessive disorders are especially common in certain cultures in which, for enduring tribal reasons—to strengthen family ties, maintain a woman’s status within the hierarchy, facilitate the finding of suitable partners, and preserve a family’s traditions, values, property, and wealth—it is not only acceptable but standard and even encouraged to marry your first cousin.

  IN DECEMBER OF 2003, approximately seven months after Bush declared his mission accomplished and the UN lifted a majority of its sanctions against Iraq, I saw my brother again for the first time in thirteen years. I was living in West Hollywood, three semesters into my economics PhD, and I had flown from LAX to Paris to Amman, at which point a driver was supposed to pick me up at the airport and take me to the hotel where my parents, who had traveled from Bay Ridge, were waiting for me to meet them. From Amman we would be driven across the desert to Baghdad, a journey that takes some ten hours. Before sanctions, and then the invasion, one could fly from Amman to Baghdad in less than one hour, such that reaching Amman meant you were almost there. Now, it meant you were only about halfway there.

  When I got to the airport, there was no driver. Or rather, there were plenty of drivers, all of them keen for my custom, but none holding a sign bearing my name. At some point I realized that the address of the hotel in which my parents were staying was written in a notebook I’d left in the facing seat back of my flight to Charles de Gaulle. After about an hour, I gave up trying to find our arranged liaison and, via a series of leery interviews, identified a man willing to take me to up to five different hotels for a flat fare of 250,000 dinars, or about eighty dollars.

  In the car, when this man heard that I was ultimately destined for Baghdad, he became delirious with ambition. I take you! I take you right now! Be there by morning!

  Quite possibly, this was an offer made with the intention of selling me to kidnappers in the desert. I thanked the man and explained politely that I wanted to rest a little at my hotel before continuing my journey. At this the driver looked not only undaunted but delighted. Yes! Perfect. You rest, and I’ll come back later and take you in the morning. He might as well have said: Even better. I’ll just make some arrangements to sell you in the desert and then we’ll be ready to go.

  My parents were at the third hotel. When I approached the front desk, the receptionist was on the phone. After a moment he placed the receiver on his shoulder and I asked if a Mr. Ala Jaafari and his wife were among his guests. And you are? Their son. The receptionist’s eyebrows went up. He pointed at the receiver on his shoulder. This is your driver. He wants to know where you are. Where is he? I asked. At the airport, said the receptionist. No, I said. I’ve just come from the airport, and I swear it to you: he wasn’t there. The receptionist nodded, inspecting me kindly, then returned the receiver to his ear and communicated my message into the phone. A muffled string of invective ensued, making both of us wince. Then the receptionist gave me another long look, as if he were listening to someone describe me—as one describes a wallet or a watch that has been lost—and, as the voice on the other end continued to chew him out, he hung up.

  You know what? said the receptionist, shaking his head. I know this guy. He wasn’t there.

  When my mother opened the door she was wearing a head scarf. Typically she did not wear one in Bay Ridge and for the first time I thought the hard black oval around her face gave unflattering emphasis to her jowls. She had also, owing to her age, taken to walking at a slight forward angle, as if leaning in the right direction might preserve or even generate momentum. Lately, when I called home and spoke to my father, he would answer questions as to how he and my mother were doing with a report on how well or badly my mother had slept the night before. It was like a poltergeist, her insomnia and its effects, and my father warned me of its presence the way he used to warn me approximately once a month that Fatima is not herself today. Now, in Amman, even as she beamed maternally on my arrival, I could tell that my mother needed sleep, and I hoped she’d be able to get some rest in the car. I hoped I’d be able to get some rest in the car. But shortly after we’d embraced my father took me to one side and said that while it was all right for my mother to sleep one of us would have to remain awake at all times. We were leaving in the middle of the night, in order to reach Iraq around dawn; moreover, night or day most of the journey would be monotonous—mile after mile of scrubland and dunes—so it was equally important that we be on alert that our driver should not nod off, or, in my father’s words, pull something funny.

  This was the same driver who’d been supposed to meet me at the airport, and who greeted me now with an air of superior and char
itably suppressed exasperation. His armored Chevy Suburban, with its tinted windows and long boxy rear, looked like a hearse. I could not have slept if I’d tried. Every uptake in speed made me start. Every pair of headlights advancing toward us seemed to push through the dark with an ominous stealth. Our driver gripped his steering wheel tightly, with both hands, bouncing his unoccupied knee and chewing his lip. He was a smoker, obviously; the car stank of it, and every spare compartment had been stuffed with cigarettes—dozens of Marlboro boxes marked CHINA DUTY FREE wedged over the visors and into the pockets behind the seats—but before we’d set off my father had asked if he wouldn’t mind abstaining. Much of the first hour of our ride I spent silently debating the pros and cons of this request. If our escort needed nicotine to deliver us safely into Baghdad, let him have it. We would not die of secondhand smoke in ten hours. On the other hand, my father, who had only recently given up tobacco himself, had paid dearly for this service: three and a half thousand dollars. Why shouldn’t he have his way?

  We arrived at the border a little before four. Slowing, our driver opened the glove compartment and removed a billfold of American twenties, which, after powering down his window, he began peeling off and passing out to the border patrol officers as though they were the standard toll. Any foreigners? one of the officers asked, in Arabic.

  Our driver shook his head. All Iraqis.

  Now he was handing out Marlboros: two packets per officer. Then he powered the window back up and it seemed we would be waved through until one of the officers standing in the road turned around and held up a hand.

  The window went back down and two more packets of cigarettes were offered through and pocketed unceremoniously. Then the officer said something about Baghdad. Our driver nodded. The officer walked away.

  Sitting in one of the SUV’s middle seats, I turned around to face my father inquiringly. My mother, with her dark eyes and snug headwear, looked like an owl.

  What’s happening?

  They want us to take someone to Baghdad.

  An officer?

  Our driver nodded.

  An Iraqi intelligence officer?

  Jiggling his leg, our driver ducked to peer under the rearview mirror and didn’t answer.

  What should we do? asked my father.

  Please, said the driver. Pretend to sleep. Do not speak.

  I have to go to the bathroom, my mother said quietly.

  I am sorry, our driver said urgently, turning around to face us now. We cannot stop unless he says to stop. You must be quiet. Your accent will discover you. I will try to take you quickly, quickly as possible, but please: do not speak.

  By now a large man with a beard and gray army fatigues was approaching. Our driver unlocked the SUV and the officer opened the passenger-side door and sat down in front of me, causing the vehicle to cant. Sabah al-khair, said the officer. Sabah al-noor, our driver replied. Good morning. We Jaafaris said nothing. Our driver relocked the Suburban, put it into gear, and resumed driving, waved off by the officers in the road. Our new passenger adjusted and readjusted his seat, reducing my own legroom by half. Then he reached up above the visor, removed a pack of Marlboros, peeled the cellophane away, drew out a cigarette, and did not stop smoking for the next six hours.

  • • •

  My grandmother’s house was smaller than I’d remembered it, whereas my brother was larger. Not fatter. Not softer and wider, as some of us become when we age, but bigger all over, in a solid and proportionate sort of way, as though to save space my mind had shrunk him down by 20 percent.

  He was also handsomer than I’d remembered: ruddier in the cheeks and readier with a smile, sprouting long lines around his eyes. When at last my parents and I entered our grandmother’s living room, Sami stood, put his hands on his hips, and grinned at me for a long moment, as if he knew my preconceptions were in the process of being dashed. And what had my preconceptions been? That he would be both more and less the Sami I’d remembered. More boyish. Less boyish. Going a little gray behind the ears. He was going a little gray behind the ears, but this was less uncanny than the ways in which he seemed almost exactly the same. The squareness of his hairline. The singular shadows around his mouth. They unnerved me, these animated relics, but in an oddly pleasant sort of way—as it can be oddly pleasant to pass a stranger on the street and catch a whiff of your high school chemistry teacher’s shampoo for the first time in twelve years. We think we have evolved, we think the dross of consciousness is shed, and then all it takes to splice in a frame from 1992 is a noseful of Prell.

  One afternoon we sat out in the garden and while Sami smoked a cigarette he plucked an orange off the grass and tossed it to me for peeling. He’d graduated from medical school a few years earlier and was now a junior doctor at al-Wasati, the hospital for corrective surgery. Prior to the war, the majority of his cases had been nose jobs, breast jobs, liposuction, and hip replacements; now he spent his days staunching rocket wounds, tweezing shrapnel, and swaddling burns. There’d been talk of the Health Ministry funding ear replacements for the men who’d had one or both of their own cut off for deserting Saddam’s army in the nineties, and my brother seemed to look forward to this. After all, he said, if he were reconstructing ears instead of staunching rocket wounds, it would mean the fighting had died down a little. Wouldn’t it?

  We were quiet for a while, and then I mentioned the little boy I’d known at the children’s hospital in London, born with what looked like a butter bean for an ear. Putting his cigarette out in the grass, my brother responded wryly: I wish we had only nature’s mistakes to fix.

  And yet he seemed mostly serene. Not with the situation, of course, but with his choices in life. Certainly no one could accuse him of doing a job that did not matter. After the invasion, and despite the presence of overwhelmed American troops patrolling the city, al-Wasati had been the only public hospital in Baghdad not plundered to the point of incapacitation. Nine months later, it was still undersupplied and understaffed, as an increasing number of doctors refused to make the commute into town or had fled the country altogether. The day my father and I went to see my brother at work, a drive that in peacetime would have taken twenty-five minutes took us an hour and a half. Somewhere, a tanker had exploded, bottlenecking traffic and burdening the hospital with a fresh influx of casualties. Outside the entrance, a man sobbed as the body of another was loaded onto a gurney. The sobbing man covered his face with his hands. Then he lifted his arms to the sky and cried, Why? Why? Why are they doing this? What do they want? Is it money? Why? Just inside the entrance, another gurney contained a child of about ten, his legs wrapped in blood-soaked gauze and his eyes blinking with an otherworldly sort of resignation. No one appeared to be with him, and as my father and I waited to one side, looking for Sami, a doctor came over to us and pointed at the boy.

  Who is dealing with him?

  We don’t know, my father replied.

  The doctor turned to the rest of the lobby and shouted into the rabble of people milling, weeping, praying:

  Who is dealing with him?!

  Waleed! someone shouted back.

  While the doctor continued frowning at the child in a way that suggested only minimal satisfaction, a nurse led us off to the staff mess, where an Arabic soap opera was playing on a television in the corner and my brother presently appeared wearing scrubs. A young man who’d been hit by shrapnel the evening before was waiting for him in the operating theater. My father asked if we could watch.

  This happened yesterday? Sami asked the man on the operating table.

  The man nodded. At sundown. I was just going out for some bread.

  Sami gouged two holes in the man’s torso, just under his arms, to drain the blood from his lungs. The man screamed. He’d been given a small dose of anesthesia, but because anesthesia was one of the things the hospital had too little of, no one gave him more.

  Allahu Akbar! cried the man.

  Give me more light, said Sami.

  An a
ssistant changed the angle of the lamp over the man’s body while two more men, one on either side of him, held him down. My brother fed tubes into the holes under his arms and then adjusted their position so that the man’s skin was drawn away from his rib cage this way and that, like Silly Putty.

  No Muslim would do this to another Muslim! cried the man. My son, he is two, his face was blown off! Why are they doing this? Why?

  Sami sunk a syringe into the man’s abdomen. When he began digging around in the intubated holes again, I closed my eyes and turned to leave. About half an hour later, when I looked back into the operating theater, it was empty. In the doctors’ mess, the television had been turned off and two men waiting for a kettle to boil were arguing over whether Saddam’s capture of four days earlier was real or a lie propagated by the Americans for publicity. I found my father and brother back in the lobby, standing over the boy with the bloody legs, my father with his arms folded as if he were cold and my brother smoking. Another doctor stood beside Sami, also smoking. Waleed, I guessed. On the other side of the gurney stood three more men, two in dishdashas and the third in a red-and-white keffiyeh knotted under a thick black beard. We found him on Wathiq, one of the men was saying. Says he lives in Zayouna. Says his name is Mustafa. Says he hasn’t seen his parents since last week. It wasn’t until that point that I looked more closely at the men standing over the boy—who even as he was being discussed continued his preternatural blinking at the wall—and saw that the one with the very black beard and the red-and-white scarf tied around his neck was Alastair.