The Strength of Bone

by Lucie Wilk

  “We isolate people. At home.” As soon as Henry says this, he knows how it sounds. Of course Kumwembe knows. Kumwembe trained in England, attended medical school in Cambridge on scholarship, then completed residency in Internal Medicine in London. Kumwembe knows about respiratory isolation. He knows about the masks, gowns, goggles and gloves: the uniform for the Western hospital. Kumwembe continues to look at Henry, nodding slowly.

  “Yes,” is all he says.

  *

  Henry can see that Iris has spotted him and now her low and sturdy figure wades through the beds and bodies, over to where he stands fiddling with his lab coat, mustering up the energy to begin his rounds.

  “Juma.”

  “Yes? Yes, Sister Iris?”

  “Juma is still sick.”

  Henry studies Iris’s face, as implacable as ever. She would be less plain, he thinks, if she did not frown quite so much. The tightness of her mouth further thins her lips. Her eyes, already tucked deep beneath her brow, darken and disappear with these looks she carries around with her and inflicts on them all, doctors and patients alike. But he trusts her. Her mood may be permanently sour but her intelligence shines through her observations and her pointed, perfunctory statements.

  And now she is telling him that Juma has not improved. But the malaria smear had been positive. He had seen it himself, the ring-like organisms squatting in Juma’s red blood cells, two or three to a cell. The malaria here is not drug-resistant; he should be improving. By now, his symptoms should be resolved. He goes to Juma’s bedside and picks up his chart. The fevers are still there, the messy little x’s scattered on the graph above the line indicating 38 degrees. He looks down at Juma who lies with his eyes closed. He sucks in and pushes the air through widened nostrils—long, languorous breaths.

  “Juma.”

  Juma opens his eyes to Henry, widens his mouth in his usual broad grin.

  “How are you feeling?”

  “Better.” He shrugs his narrow shoulders. “But not so good.” He moves his arm—bones wrapped in papery brown skin. “Here.” He points a long finger to his abdomen.

  “He still vomits,” offers Iris from the side.

  Henry palpates Juma’s abdomen. He feels the folds of bowel shift under his fingers. He taps over Juma’s belly, one finger over another: tap, tap, tap, testing it like a drum. Hollow, except over his liver, which is as expected. Henry moves the blanket around, exposing first one long meatless leg, then the other. His puppy feet, still too large, are stuck awkwardly to the ends of his legs. A few dark, male hairs sprout from the skin of his lower legs and across the tops of Juma’s feet, matching those above his lip and over his chin: evidence of his adolescence making way for adulthood. Henry places his hands across the tops of Juma’s feet to feel his pulses and then sees the rash. Just a few bumps on the sides of the feet—small, barely there. Round swellings coalescing together with their dimpled centres. Molluscum contagiosum. Suggestive of an immuno-compromised host. In these parts, synonymous with HIV.

  Christ.

  Henry moves his gaze to a point above and beyond Juma’s beatific face. Over to the back of the ward, with its green walls and open windows. To the red earth fields beyond it. To the baobab trees beyond those. To the horizon which bends away from him, pulling him with it, taking him away from this place.

  He looks at Juma, there on the bed, gazing at him, confidence coming through in the smoothness of his face. So damn young. Although he is not surprised to discover another HIV diagnosis in these beds, he had hoped for Juma. There’s where he went wrong.

  Henry pats him on the shoulder. “We’ll get this sorted out.” He feels the chafing scrutiny of Iris to his right as he scribbles orders on the chart: stool for culture, HIV serology. He places the chart back on the hook at the end of Juma’s bed and moves away, to someplace else.

  *

  Ellison claps a hand on Henry’s shoulder: firm and warm. Together, they walk down the corridors, traverse the foyer and push out and through the heavy doors. Were there patients lining the corridors they walked? Women wrapped in blankets, boys clinging to IV poles, mothers nursing babies? For the first time, Henry is not sure. He did not look.

  Outside, the world is darkening and the streets are emptying. Vendors are packing up, people are receding from the city like a tide. After the frenzied bustle of the hospital, this progressive quiet leaves Henry with a sense of dread. The slow emptying of the future.

  But Ellison is too solid and animated, even in silence, for Henry to feel this way for long. They walk to a favourite watering hole of Ellison’s. A bar with a single counter and a collection of mostly Carlsberg bottles in the fridge behind it. The place is lit with a single bulb and filled with a few tables and chairs. There are drunks on the inside and hookers on the outside and once they go in and encounter the smell of the place—the yeasty warm smell of beer and people drinking it—Henry feels oddly buoyant. He clasps the cold and sweaty bottle passed to him at the bar and doesn’t bother pouring it into a glass, just holds it to his lips and takes a long pull. When he places it down it is three quarters empty. Ellison laughs and claps him once again on the back and says how well he’d fit in in Oz. He is on to his next bottle before they take their seats at a small, round, plastic table that wobbles. Henry folds up his paper napkin and places it under one of the legs. He leans both elbows on the table and pulls his hands through his hair, massages his neck. Ellison regards him with a knowing smile and leans back.

  “Looks like this is overdue.”

  “Yep.”

  Behind Ellison a television is mounted on a shelf bracketed precariously to the wall behind the bar. Metal girders wrap around the top and bottom of the TV, holding it in place and posing a challenge to any who might consider taking it. The screen bulges heavily from the frame and loud, large-pixel colour images flash across it. The man on the screen is familiar. The US president. He is standing on a patch of green lawn saying something to a group of journalists. Then he stops talking and takes a swing with his nine iron. Everyone but the camera follows the ball down the green. There is a smattering of applause. The President leans on his nine iron and looks back at the journalists with an aw-shucks sort of grin then continues his talk on more serious matters.

  A red ribbon of newsfeed scrolls across the bottom of the screen. It alerts in white text of recent troubling events. Iraq has invaded Kuwait. President Bush, that man on the green, plans to send troops. Now the television blasts images of war-torn deserts, of cities devastated by floods and quakes in sharp, sudden bursts. They move and change and Henry who sips beer here in this bar in Blantyre watches. The images, or what they reflect, are too close. The scenes flash before him as if they are projections from his own memory, as if he has just been there, as if this is where he will always be.

  He looks back down at his second empty bottle and feels his thirst acutely, as though just outside this bar is the endless blowing sand of a desert. The drops running down the outside of the bottle and pooling on the table tempt him further. He rises and goes to the bar for another.

  When he returns, Ellison is eyeing a woman’s round backside, a woman dressed in a very short and tight skirt. She stands beside their table and chats with another woman similarly dressed. Her buttocks are amazingly round and full and when Henry takes his seat he is so close to her body he could easily reach over and caress one soft cheek or slip a hand beneath her skirt. He is stunned by the pull, the need to touch a woman. He catches himself trying to smell her and when he comes up from another long swallow of his beer he sees Ellison leering at him.

  “Hot.”

  Henry nods.

  “The sex’ll blow your mind but you have to be careful.”

  “Clearly.”

  “So you wanna say hello?”

  “No thanks.”

  “It’ll do you good.”

  “I’m already good.�
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  “You don’t look it.”

  At this, both men look away. Finally, Ellison speaks again. “So you going to talk about it?”

  “What.”

  “Whatever it is. Whatever drove you here. Whatever’s driving you now.”

  Henry pauses. Taps his finger on the bottle. “I just want to help.”

  “Bullshit.”

  Henry feels something strange rising in him. Something like relief.

  “If you don’t want to be honest with me, at least be honest with yourself.” Ellison pauses and gives him some kind of look. Henry can tell, from that look, that Ellison has never lost what he’s lost. Maybe because he never got attached in the first place. It all comes so easy to him. “Whatever it is, you’re here now. You need to learn some ground rules. Some rules of survival.”

  Henry raises his eyebrows.

  Ellison ticks off fingers. “One. Don’t be a perfectionist. It might have gotten you your medical degree but it’s no good here. Two. Don’t count. Don’t count successes and don’t count failures. Three. Don’t think too much. Your instincts are better than your mind. Four. Don’t compare. Here to there, I mean.” Ellison inclines his head toward the television, presumably to the first-world country from which the news is being broadcast. “Five. Don’t work too hard. A corollary to that is do drink too hard, occasionally.” He lifts his beer and tips it toward Henry. “And indulge a little. Once in a while. And always use a condom.”

  He grins. Henry notices, for the first time, the large gap between his front teeth. A thick space that Ellison could probably whistle through. He is probably a good whistler. Probably whistles in the shower. Henry feels his thoughts slipping slowly over to that pleasantly vague place populated with non sequiturs and hyperbole. He watches the television again and when the woman with the gorgeous rear end positions it firmly on his lap he feels himself respond, he feels his body respond, while his mind slips steadily away, over to a place like those scenes still flickering on the television: remote, irrelevant.

  *

  Shouts and excited chatter have replaced the usual oppressive quiet in the ward, and a small crowd gathers in one corner, most of them standing with their hands in their pockets: the casual posture of curious sidewalk loiterers. Sister Iris’s white hat floats among them, dipping down out of sight for a moment, and then rising up, shifting over, tossed in this storm that has blown

  into the ward. Chakudya choyikidwa chiphe. Kapena ululu. Ayi! The chatter is thick around them when Dr. Kumwembe and Henry push their way into the clot of onlookers. Iris glances up at them as she tries to wrap a blood pressure cuff around the arm of a man who thrashes in a gurney. She says nothing as Henry grabs hold of one arm so she can place the cuff. Kumwembe shoos away the group of onlookers and then joins Henry and Iris at the gurney. The man is slick with sweat and Henry has trouble holding him firmly for a blood pressure reading. Henry takes the man’s pulse as he holds him down: 140 beats per minute. His blood pressure is likewise elevated. Iris mutters the reading, then rips off the cuff and looks at Kumwembe who is rummaging through the medication cart.

  Kumwembe hands Henry an intravenous needle and he removes the cap with his teeth, holding the man’s arm with one hand and the needle with the other. He searches for a site—not too difficult—the man’s veins bulge with effort. Henry pierces the skin with the needle and the blood flashes back. He slides the IV tubing into place and steps aside, gives Iris some room to fix it into place with tape. Kumwembe moves in with an ampule of medication drawn up in a syringe. He holds the man’s arm down against the gurney, pushes the needle into his IV line, and then plunges the liquid through. Within seconds, the man begins to breathe more easily. He closes his eyes.

  Kumwembe indicates to Iris where in the ward she should place the man. There are no beds left; he will have a spot on the floor. She starts to wheel the gurney away. The crowd of onlookers has thinned, and they stare at the man, exchange opinions in Chichewa. Henry walks over to Kumwembe and they both watch the man’s chest rise and fall with large, hungry breaths.

  Kumwembe speaks before Henry can ask.

  “OP poisoning.”

  “OP?”

  “Organophosphate. A pesticide used on local crops. A popular way to do people in here. They slip it into a bottle of soda. Odourless and tasteless. We get a few of these a year. Even if they survive, the neurotoxicity can be devastating.” He looks over to the floor where the man has been transferred. He lies still, taking deep breaths, looking at the ceiling. Thinking, perhaps, of the perpetrator. Kumwembe continues. “That one will do fine. He was lucky.” He gathers up the debris: empty syringe, needle caps, vial of medication. “We keep some atropine on hand for this sort of thing.” He walks over to the nearest bin, tosses in the rubbish, and rejoins Henry.

  The two of them stand at the front of the ward, their hands on their hips, surveying the room. Dim quiet has returned to the place. Henry can feel how taut he is becoming, strung like a bow, still unprepared for all this. He pulls himself tighter, day by day. Eventually, there will be no more give and then, with the slightest pluck, he will snap and recoil, frayed and twisted ends will be all that is left of him.

  Kumwembe does not look at him when he speaks.

  “There is a lot of fighting here. That is all we know. If we don’t fight disease or poverty or drought, we fight each other.”

  “I’m not much of a fighter.” Henry looks out at the ward. “That’s why I’m a doctor.”

  Kumwembe turns to Henry, his eyes the same calm brown-black liquid. “If you are not able to fight, I’m sorry to say you will suffer, Dr. Bryce. This place is not for the weak of spirit. A strong mind is not enough.”

  Henry looks away. “There are other ways.”

  “The other way is to leave.”

  Kumwembe goes to the patient who has been gesturing for him from where he sits on the edge of his cot. The patient shows Kumwembe a tissue containing his sputum: thin lines of blood in the yellow. Kumwembe places one hand on the man’s shoulder and points with his other arm in the direction of the TB ward. The patient looks where Kumwembe points and Henry can see him take a large breath, can see the acceptance in his sigh.

  Henry’s mother, a doctor herself, taught him how to be a doctor. She taught him about resolve and she taught him about silence and she taught him about love. All these in no particular order, a cycling and recycling of these teachings in the time he had with her. But right now he isn’t doing it quite right and he knows it. Right now he is applying his resolve to obstinately ploughing through each day, love and silence existing only in the wake he leaves behind himself, all those gathered moments rippling backward and Henry too busy to look, or listen.

  Chapter 2

  Jakob rises from where he had been sitting, helping to shell peas in a group of his aunties. It is women’s work, but he enjoys it. He likes listening to the women talk and sing. He easily moves from groups of men to women, boys to girls, children to adults. His foot buys him entry. If he is honest with himself, he will admit to exaggerating the limp as he approaches a group of girls, he will bask in their sympathetic sounds. With the boys, he hides the limp, walks as smoothly and normally as possible with a foot that is like a clenched fist, on a leg that is too short. He has a foot like a horse, he has been told. But he keeps up, or nearly does. He runs on it, even kicks a football around with it. And the boys respond in as supportive a way as they can: they allow him to stay.

  He walks over from the group of aunties to where his mother sits, looking drawn and tired, massaging her lower leg with her thumb. She has positioned herself near the well, and Jakob knows this means she wants him to fetch some water. He nods at the people he passes along the way and receives broad smiles in return.

  Jakob’s foot may be like a horse but his face resembles something less earthbound. His aunties used to hold him by the chin, turn his face this way an
d that, try to isolate the angelic ingredient. “It’s not that he’s handsome, exactly,” they would say, “but there’s something honest about it. Open and honest. Clear like a lake.” And then they would let him go, watch him wend his way through the community, nearly an orphan (God knew his mother was on her way to join Him soon) yet such a part of everyone, and everyone wanting a part of him, somehow.

  His mother calls him aliyense for this. Everyone. He is everyone to her: son, brother, daughter, sister. He has to be, for he, like no one else he knows, has no siblings and no father. His mother lost her womb after delivering him. She delivered him and then a river of blood that wouldn’t stop flowing. Eventually, she had to be taken to the hospital on the hill where they cut the bleeding womb out of her. They stitched her up and sent her home with her newborn, her only child with his strange and twisted foot. Soon after this Jakob’s father died from an illness of the blood, though the sing’anga had another opinion. And since then Jakob has tried to fill those roles, as many roles as stars in the sky, it sometimes seems.

  Now he crouches down over his mother’s foot and unwraps the bandage around it. The odour of the wound grows as he uncovers the flesh, the mangy bandage soaked with fluid from the wound and coloured milky yellow, brown, and green. The wounded area has been expanding and the flesh itself is looking more chewed up each time he uncovers it to cleanse it. It looks like a beast has been gnawing on it. And the smell is getting worse. He dabs at it with a wet cloth, wipes off the thick substance collected within it. Underneath there is a clean, pure white spot. He tries not to look at that spot; seeing the skeleton of a person still alive seems a bad omen. He takes a clean cloth and wraps it up again.