by Lucie Wilk
His mother listens to the story. He waits for her smile, for pride to break through her face like it used to do for lesser accomplishments. Instead she clicks her tongue and turns away. “This isn’t right, Jakob,” she says. “You are toying with God’s plans. God organized this woman to be alone in that ward. You meddled.”
“But Ma. She wasn’t alone. Nurses were there. And they looked away. They left her.”
“They are Sisters. And they knew God’s plans.” His mother fumbles for his hand. And weak as she is, she manages to clutch him hard. “You are aliyense to me, Jakob, but you can’t be aliyense to everyone. Only God is that.” She crosses herself, says nothing more. So Jakob gets up off her bed and returns to his work. Despite his mother’s words, he feels that this job, his world here at the hospital is growing out and filling in like a lush green garden. Each day feels bigger, more elaborate and robust, more like the future he had imagined this place would bring.
*
Jakob moves his mop beneath the bed. An enormous clot of dust comes back with the wet strings. Also insect carcasses and plastic wrappers. An empty syringe. He lifts the mop with the debris clinging to it over to the pail and dunks it in. He presses the mop into the wringer and squeezes the water out. The trickle of water into the pail disappears into the other sounds in the room: the repetitive hiss of the breathing machine, the regular beep which is accompanied by a green dance of light on the screen above the bed: the patient’s heartbeat, represented in sounds and patterns, so that the nurse at the desk on the other side of the room need only raise her eyes to confirm that the patient’s heartbeat has slowed down or sped up or stopped.
The woman whom Dr. Bryce saved lies in this bed. There have been a parade of visitors into this room: a husband, parents, aunts, uncles, children—six of them ranging from toddler to teen, two of them still taking from the breast. They all come to the bedside, touch her hand or arm, then recoil as though surprised to find her skin warm. They watch her chest rise and fall with the bellows beside her bed. They study the clear tape that holds her eyelids closed, how her lashes are pressed down and fan out over her cheeks. They stare at the circles of milk that darken the sheets over her breasts. They frown at her hands because they look different, swollen with the fluid that snakes into her from plastic pouches that hang over her like pregnant flags. Through all this their faces are flat, but Jakob knows what they are thinking. They are wondering if they should mourn. The children know, though. The children cry while the adults stand respectfully aside.
*
“We should pull the plug.”
This is Dr. Ellison, the one who took Jakob’s mother’s foot. The two doctors—Dr. Bryce and Dr. Ellison—stand beside the bed of this woman in the ICU. It is a one-bed ICU. There is only one machine to give breath, only one machine to watch the heartbeat, to record the pulse, to measure the oxygen in her blood.
Dr. Bryce just stares at the green pattern moving on the screen above her. It is a regular pattern of peaks and waves that repeats itself over and over again. Jakob finds it comforting. The nurse sitting at the desk in the corner—Neva—glares at him; he has not managed to coax a smile out of her, not even with the biscuits he brought her from the doctor’s lounge. He looks away and resumes his work organizing the supplies cupboard.
“Bryce. Listen. If we knew what it was, if we knew what to fix, it would be a different story. Have you seen her lungs? A mess. And she keeps coming back culture-negative.”
“It’s a simple pneumonia. She just needs time.”
“You saw the x-ray. Total white-out. It’s ARDS. And we don’t have the resources.”
Dr. Bryce uses the suction to suck up some liquid in the woman’s throat, does not speak.
“What’s her HIV status?”
“Negative.”
Dr. Ellison purses his lips and frowns as though a ready excuse has been stolen from him.
“What if we need the ventilator? For something temporary, something reversible. Someone we could actually help.”
“ ‘Actually.’ ” Dr. Bryce barks out an ugly laugh. “I’ve always hated that word.”
“You know by now, Bryce, that practising medicine here has nothing to do with heroics. It’s the exact opposite of heroics.”
Jakob can hear the doctor’s sigh across the room. He looks over. Dr. Bryce has placed a hand on the woman’s swollen leg and stares down at it. He says, “What a fucking mess.”
*
Jakob remembers as if it was yesterday, as if it was now: when they turned the machines off, the family was there. They stood too far away in an respectful huddle. Jakob can still see his own arms moving down then up, from box to shelf as he listened. He did it over and over; he must have filled two shelves with clean syringes. He can still hear the crinkle of the plastic wrapping, although he tried to be silent, he tried to be invisible. He felt as though it could have just as easily been his hand that pushed the button to turn off the breath machine.
He heard the bellows stop, half-compressed. Her lungs half-filled with air. And then he heard death arrive. Her delicate heartbeats—those dancing green lights—were stilled to a single line of sound. To hear aloud the very moment her heart stopped. To know her death in this way—broadcast through the room like this—such an angry sound. It should have been silent and mysterious and greater than a straight green line. It should have been a secret, passing between only the woman and God. It should have been allowed to be beautiful—as beautiful as birth.
The sound was turned off and the silence moved in. The silence was thick and full of wanting—wanting her to move, wanting her chest to rise—but then the strong grieving women pushed it aside with their wails and when Jakob turned around, he could see that the women had finally closed the gap; they were hugging her body, grasping her arms, stroking her hair. The buckles on their grief had been unclasped.
But the children stood back. The children watched with empty faces and dry eyes and silent mouths.
Hands shaking, Jakob stood up and placed another package on the shelf. It slipped off and fell to the floor and he did not pick it up. He closed the cupboard and left the room. As he left he realized that he never learned the woman’s name. And, not knowing her name, he didn’t know how he would ever be able to apologize to her spirit for meddling. If it weren’t for his intervention, she would never have been brought to the ICU and the doctor would never have said, with his hand on her leg and loud enough for her sleeping ears to hear: what a fucking mess.
Outside and behind the hospital, the men’s laughter comes loud and raucous from around the corner. They are smoking and spitting and chewing tobacco leaves. They are scratching themselves and criticizing their boss and arguing about the nurses’ bottoms, and who has the nicest. These are the real men of the hospital: they do all the heavy lifting and deal with terrible things like the corpses and the used-up needles, the body fluids and the blood-stained bandages. These are the men who can truly laugh—a full, belly-shaking laugh—and Jakob thinks it is because of their job, and how they must live in this sadness of the hospital full-time and how this is their only escape.
“Eh, here’s the Robin Hood.”
The men turn, smiling at him.
“Robin Hood—steal from the doctors to win over the nurses, eh? I’ve seen you pass them those biscuits.”
The men break out in another chorus of laughs, this time at his expense. Jakob’s face gets hot, but he doesn’t really mind. Soon, he finds himself laughing along. Soon, he can’t stop. His belly aches. His eyes are wet. He slaps his legs, pushes away the joking prods from the men.
And now, after laughing a real laugh that comes out of the exact place that his tears came earlier, he feels it again as he wipes dry the corners of his eyes: some sort of weightless peace that he tries not to hold on to. He knows this feeling is like a bird; the instant you try to catch it, it is gone in a flash of feathers.<
br />
*
Juma still smiles when Henry comes around. Still looks up with reverence. Points to the paint smears on Henry’ hands and laughs out loud: a strange sound in the ward. When he laughs, it feels like the ward is empty.
Henry arrives at Juma’s bedside one day to find a woman kneeling beside his bed. Her head rests on his abdomen, and she holds one of his hands. Henry stops a few feet away and looks over at Iris who pushes the cart silently behind him.
“His mother. She comes every day, usually when you are not here.” Iris rearranges vials on her cart as she speaks. “She worries because he is not improving.”
The woman lifts her head off her son and unfolds herself to stand beside Juma’s bed. She maintains her grip on Juma’s hand. Now standing stiffly, she directs her gaze to somewhere over Henry’s right shoulder, something Iris used to do when she had to speak with him. He interprets it as evidence of disrespect, and dislike. Iris, thank God, no longer does this. She regards him directly with her hard gaze, and at least now she makes him feel like she wants to be here, working with him.
Juma’s mother says something in Chichewa and Juma looks away. Iris steps a foot closer. “She asks why her son is getting worse. She says he is rotting in this bed. She says nothing is being done to help him.”
The woman looks directly at Henry now, which means she is giving him an opportunity to prove himself. It is his job to reassure, and so he tries, knowing that, even though she will not understand the words, she will detect the real truth in the tone. He can see the look in her eye as he talks. He hears Iris translating his words behind him. Her tone is better, more solid and comforting, but it will not help.
Henry watches Juma’s mother as she listens to Iris’s translation. He looks at her face: intelligent, angry. Something has been destroyed in this culture, amongst this people. The injury has started here, and will become severe enough to affect them all. It is only a matter of time.
He has stopped speaking and Iris has stopped speaking and there is silence. And then Juma’s mother speaks.
“She wants to take him to a traditional healer. She wants to take him out of the hospital.” Iris says this quietly beside him. Juma looks at him calmly, knowing what he will say. Knowing Henry will rise up with the authoritative protection of a medical institution. Flash his badge of Western authority, spread a protective wing around his charge.
He looks at Juma and feels the exquisite pain of love overwhelm him. So unexpected, to feel it here. In this place. For this young boy. And here, right now, his love will be tested. My God, the resolve this will require, the mind- and heart-steeling resolve. He almost grinds his teeth with the effort of it.
“Take him to a healer. Take him home.” And before the wound in Juma’s eyes can infect him with doubt or regret, he moves on to the next patient.
“You don’t know what it’s like to lose a child.” This is Iris’s voice. She is speaking Juma’s mother’s words in his ear.
Even before Henry turns around to see her, he knows Juma’s mother is shaking her fist. Not at him. At the world. At God.
He goes back to Juma’s mother. He looks at her as one parent to another.
“Yes I do.”
*
Henry can tell from across the ward that the new patient has meningitis. The arched back, the neck that is so rigid that the upper body pushes up off the gurney in a stiff bowstring. The struggle; God, the struggle that Henry can see from here, eight rows of beds away, the sweat and agony of it. A few months ago, this textbook scenario would have moved him; he would have felt his heart pound faster at the idea of seeing such a classic presentation. Because he would have known what to do. Lumbar puncture. Send the fluid off to the lab. Cover with broad spectrum antibiotics, cover every bug, just in case. Modify the antibiotics when the cultures came back. But here. But now. Something clenches tight inside him at the sight of the man, wheeled in fresh from the streets. He pushes the thought away. He pushes the thought behind him as he makes his way over to him. When he examines him, he tries not to look for evidence of HIV, and when he finds it—in this case, a small, blue patch of Kaposi’s sarcoma on his right ankle—he tries to be surprised, he tries to muster some sympathy in the gaze that he exchanges with the woman who clutches the man’s hand—his wife? his sister?—and she looks back at him briefly, with a flatness that says it all.
*
When Henry was choosing his field of practice he never considered his mother’s work. Pathology. The pure dichotomy
of that world depressed him. There, the truth was bared and unembellished. The impossible conflict of cellular wisdom and selfish genetics. It was much easier to float above this simple wisdom in the world of the whole organism where one could live by ideals so complicated they could never be proven wrong, or right. Here, one could set his sights on manipulating the unseen world so that blood pressure could be controlled and body fluids could be balanced, cholesterol could be measured, the risk of disease could be reduced. The considered and worthy goals of your typical doctor.
Now he understands his mother’s choice. At least in her work there was peace. At least there was no sense of futility. There was no roller coaster of hope and disappointment. And there was quiet, deep in the stillness of those rooms. Peace and quiet. What we all want, ultimately.
*
Jakob had thought what Dr. Bryce had done for the woman in the ICU was a miracle. But what happened afterward—the warm body already emptied of the person it housed—was much less than a miracle. And somehow they all ended up paying for it, for interfering.
The button on the ventilator was a plastic square and it lit up with a dim red light when the machine was turned on and when it was turned off, the red light went out. It didn’t seem right that this button—any button—was so direct a link to death. And Jakob is now sure that it wasn’t. He is certain that in the last few days they had all fallen under the spell of a masterful hoax spun by the Western machines. Death did not happen with the press of this button after all. It happened that day in the ward while Dr. Bryce was pushing on her chest and making her body lift and fall, squeeze and expand, when her blood flowed only because Dr. Bryce forced it with his pushes, and air moved only because the machine insisted on it. That’s when death happened, and all the rest that followed was just a story. An invented story about a life that had already passed.
*
“You’ll get used to it.”
These were the worst words Henry heard the first day he’d worked here. It was a pronouncement made by the pharmacist, a Dutch woman who has since left and gone back home to the Netherlands. She had said it in reply to his angry shock over the antibiotic supplies. “Only Penicillin.” He’d said just before: “That’s it? What do I do for a gram negative infection?” He’d asked this, thinking of the four or so patients right then in the ward who were harbouring this. And her answer had been: you’ll get used to it.
The worst part about it was that it was true. He is used to it now. He doesn’t even pause to consider his lack of choice. It doesn’t even register as lack anymore, it’s just the narrow confines of the space he is working within. Adaptation is the death of progress, he thinks. Getting used to something is the reverse of evolution, it is devolution, it is our undoing. Here he has adapted, and he no longer despises the system, or the lack. He doesn’t need change anymore, and so will not force it. And things will stay the way they are.
Chapter 9
Oh-oh-oh.” Solomon, one of the orderlies, elbows Jakob. He speaks more quietly than his usual loud, boastful talk. “Over there, under the tree.”
A few yards away in the shade of a tree, Dr. Bryce is eating a sandwich. His usual lunchtime ritual. But now the sandwich lies forgotten in his lap because he is looking at a boy who stands before him, just a few feet away. The boy is a few years younger than Jakob—maybe twelve or thirteen years old. Old enough to hold dangerous thin
gs, like the sharp-edged rocks he grips in both hands. And he is old enough to feel dangerous things—like anger, hurt, hate. All this Jakob can see in the boy’s eyes.
And now, looking up at the boy, Dr. Bryce does the worst thing he can do: he smiles at him. But surely the doctor must see what he and Solomon can see all the way from here. He must see how fiercely the boy clenches the rocks, and his arms: how spring-like they are, two bows pulled taut. Surely he must see what the boy needs to do, where his anger must go.
The doctor doesn’t know how it feels to have your rage answered with a smile.
Jakob now begins to feel the same anger; it burns in his throat and he feels his hands clench along with the boy’s hands. He stares at the rocks and wills his own boiling energy into those hands, that they may release enough power to hit hard, strike bone, draw blood. The boy draws back one arm, the energy of so much hate tied up in a single, tight limb.
“Hey!”
All at once it is gone. With the shout, a flock of birds has lifted out of the tree and now dissolves into the blue sky. And the boy has released a rock but it only tumbles weakly to its target, rolling and then stopping a foot away from where Dr. Bryce sits. Solomon is walking over to the boy, gesturing angrily with his arms, telling the boy off. “He is a doctor, you stupid kid, a doctor!” He hears Solomon’s words in Chichewa, aimed at the boy. Aimed also at him. Jakob looks down at his own clenched fists and opens them up, feels the cool air dry the sweat off his palms. It cools off his anger, too. It cools him down until all he feels is the low simmer of shame deep inside.