by Pamela Grim
Our first patient was a frightened tow-headed boy, a little on the thin side but otherwise healthy. I was more worried about his mother, a tubercular-looking woman with a bad cough and a mouth full of rotting teeth. She handed over the child's passport with a nervous flutter of her hands. Vaccination information was kept in passports in Bosnia—otherwise the passports were considered useless. Her shoulders trembled as she tried to hold her son still while I listened to his chest. His lungs were clear, heart okay. I made a notation on his card and sent him on to the anteroom, where the paramedic was waiting to inject the appropriate vaccine. Upon entering the anteroom the child immediately began to scream. I could hear his mother speaking sternly to him in Bosnian and then the sound of a slap, which made the child wail all the more. The next child, whom I had begun to examine, heard the screaming, rolled his eyes and looked at me. I could see myself momentarily as he saw me, the embodiment of all the evil in the world, a monster in a white coat. He let out a scream, and since his mother was holding his hands down, tried to fight me off with his feet. He, too, was physically in pretty good shape.
Next.
A little girl and her younger sister, both thumb suckers; one clung to an elderly rag doll. Next, a set of twins, mirror images, who both were somehow sporting matching Bart Simpson sweaters. Another little boy showed us where he had cut his finger. The nurse kissed it and then I kissed it too. At that point he burst into tears.
Obviously, despite the war, babies were still being made, children were growing. The next generation of Muslims was there already and growing, a generation that so far had known only war. The children were for the most part surprisingly healthy. I wondered how much food and clothing the parents had forgone to keep them this way. They were also well scrubbed and dressed neatly. But there were some disasters here. A little girl with a heart murmur that sounded like a sewing machine, classic for ventricular septal defect—a hole in the heart. In the States this could be repaired; here she would die young. Another with a cleft lip and palate, a serious-looking little boy led in by his five-year-old sister, who asked me to fix his lip. A child with a hand laceration, unattended and now festering. A child severely underweight and with a cough. Tuberculosis? Parasites?
All was chaos, but in a good-natured way. I had Amir teach me Bosnian for “beautiful baby,” krasno bebe. “Krasno bebe!” I would exclaim to the mothers. “Beautiful child!” There were teething problems, problems with cradle cap and ringworm. As the morning wore on, women brought in tiny babies, one a month old and another only six or seven days. New mothers handled the children as if they were fine porcelain. Experienced mothers, the ones with three or four kids in tow, handled the babies as if they were a sack of potatoes. They'd fling them over their arms while they delivered a swat to the other kids.
One father, in uniform, brought his daughter in. He squatted down to comfort her, a beautiful little girl with hair so blond it was really white. She stood safely in his shadow as he pulled her to his chest and patted her back to reassure her. “It's all right,” he kept saying. “It's all right; it's all right.”
I compared these children in my mind with the kids I knew from the city of Zenica itself. There the kids were street scamps, tough kids, mean. Those kids acted like miniature gangsters; they played real war. One would follow you with the barrel of his Y-shaped stick-cum-machine gun, or bomb you with acorns from the branches of a tall tree. Some would shadow you wherever you walked and rush you every so often to make sure you hadn't changed your mind about giving out some spare change. Not all the children were like this. There was, for example, the little girl in a pink pinafore with pink ribbons in her hair (a triumph in these circumstances) holding her mother's hand as they went to market. There were neatly dressed children going quietly to the Orthodox church or to their mosque. Also, on the outskirts of town, there were children working: carrying water, hauling stacks of firewood, minding the occasional goat. They seemed mute and solemn and like little old men.
In town the children who begged were mostly Gypsy children, I was told. They certainly begged like professionals. They created a diversionary scene in front of you, with at least twenty ten-year-old boys chanting, “Deutsche marks, deutsche marks, deutsche marks,” while the twenty-first went after your wallet from behind. By then there was no Bosnian currency; all transactions were in German marks. If you tried to give the children Bosnian coins, they just gave them back with a look of total disgust. However, if you gave a single pfennig to one of them, you would have the entire pack stuck to you like glue wherever you walked. Crying, wailing, hands lifted, and, if that didn't work, getting down on their knees, pleading. These kids can spot a foreigner a block away—just like the old days under communism when any American in an Eastern bloc country stood out like scarlet. Those kids had flawless eyes.
On my first night in Zenica, after I had locked up and gone to my room, I heard a bang, bang, bang downstairs. Someone was pounding on the door. I found my flashlight and went back down the stairs. The bottom half of the door was textured glass and I could see through it the moon shadow of a child.
“What?” I asked.
More pounding on the door.
“What do you want?”
There was a plaintive, tinny whisper on the other side of the door. “Deutsche marks,” the child moaned.
“Go away.”
He continued to bang on the door. “Deutsche marks, deutsche marks…”
“Go away.”
The banging stopped, then started again. I switched off the light and stumbled back upstairs. Behind me, I could hear the voice, disembodied, there probably long after the child has gone, that tinny, whispering voice: “Deutsche marks, deutsche marks, deutsche marks.”
At noon the nurse locked the doors and restirred the fire for coffee. I went out to the Land Cruiser and brought in a box of biscuits I had managed to find in Zenica. The paramedic came back in accompanied by a tall man of about thirty-five wearing a baggy sweater. Disheveled hair.
“Dr. Pamela. This is Dr. Yassar.”
As I stood up to shake his hand, someone called him back out to the ward. When I sat down again, Amir whispered in my ear, “That man is a hero to these people.”
I looked at Amir. “How come?”
“He was with the men that came up over the pass, the men who broke the siege of Old Vetiz. He built this hospital here and was the surgeon—the only doctor—these people had. He did everything. Everything. He is a good man.”
“Where did he do his surgery?” I had an image of amputations done with a buzz saw by a campfire.
“Right in there.” Amir pointed. “Go look.”
There was a door on the north side of the room. I opened it and peeked inside. It was a small room that obviously was used as a full-service operating room. In the center was a wooden table, something like an old kitchen table with an extension at one end. There was a tall, modern surgical light pulled over against the side wall. In one corner there was an old bookcase that served as storage for medical supplies—gloves, instrument kits. Against the other wall was the oldest anesthesia machine I had ever seen, a big metal box surrounded by a hodgepodge of rubber tubing and copper and glass containers. Next to it on the floor was a suction machine with a foot pump to drive it.
I tried to imagine bringing that anesthesia machine, with its glass containers, that suction pump, those instruments, over a mountain pass in the dead of winter. But it was very simple. I couldn't.
At four the parade was stopped again, and everyone gathered in the anteroom for more coffee. The practical nurse brought in an enormous cheese pie for all of us. Forks were laid out. We ate directly from the tray because, Amir whispered to me, there were no plates.
The surgeon came back in from the ward room. I asked about his anesthesia. “Do you use much ketamine?”
“Yes, all the time. Very good drug. I use it for all my amputations.”
Ketamine is an odd drug. It is an excellent “field anesthetic” for use in war zones. Bu
t it does have one major drawback…
“Do you find that people hallucinate as they wake up?”
“Oh,” he said, waving a fork. “Always. And it can really be terrible. We need four or five people to hold some raving soldiers down.”
I wanted to ask the surgeon more but Amir said no. “Not now. He has to see patients. We'll finish with the children and go for coffee afterward.”
In the afternoon we vaccinated even more children. By midafternoon we had seen over three hundred. I had to stop examining any but the sickest. They all began to blur into one another. At last, though, the door was closed. The stragglers were sent away with “Come back next time.” I went out to the anteroom, where I found the used contents of the WHO vaccine kit scattered everywhere—syringes on the windowsills, needles on the floor, the box upended and empty. The instructions were wadded up by the sink. So much for the WHO kit.
We closed up shop, the paramedic, Amir and I. The doctor met us out by the truck. “We're going for beers,” Amir told me as we piled into the car. I tried to figure out where in the hinterlands of Bosnia we would find beer.
The doctor and I, with Amir translating, talked medical shop. Have you had much experience with these new drugs, cephalosporins? Do you use staples for skin closures? What is your specialty?
He couldn't really understand me when I told him I specialized in emergency medicine. “You only take care of accidents? How can you only take care of accidents?” He was a humorous-looking guy, tall, long-faced, with a three-day growth of beard. He had the air of being a happy man, with overtones of thoughtfulness. He seemed like a man who, even in the most difficult of times, was satisfied with life.
We drove for about twenty minutes—bouncing along a little rutted gravel road. Unexpectedly the gravel turned into pavement, badly scarred but recognizable. We rounded a corner and there was a parking lot—with not a single bomb crater. A parking lot. Over a little bridge at the far end of the lot was a low-built, rough-timbered rambling building looking out over the stream and beyond a small pond.
“What the hell is that?”
“It's a hotel,” Amir told me.
“A hotel?”
“From before the war.”
“Here?”
“Oh, yes. People come up here to fish. Used to come up.”
“And now?”
“Oh,” Amir said, pointing. “The soldiers stay here to relax, you know, after bad times on the front.”
The paramedic looked around. “They bombarded everything around here. Everything. But for some reason most of this place survived.”
We went inside. There was a large lobby that clearly had once had furniture. The front desk was to the right and empty; the whole place seemed empty until we walked into the large dining room. There three or four tables still stood, and at one a couple of military officers sat idly. They were being served by a lanky waiter dressed in a tuxedo jacket and shirt but no tie. He beckoned us toward a table that overlooked a pond.
“Nice job he has,” the surgeon commented.
We ordered a round of beer and talk turned immediately to the war.
“What was the siege of Old Vetiz like?”
“Well,” the paramedic said, warming up, “the Croats attacked us at Vetiz, but we held the line and the Croats couldn't get through. We used everything we had as a weapon. Everything. Like fire extinguishers, for example. You take a fire extinguisher and fill it up with explosives and then you put it in a metal tube with a little gunpowder—and you point it at the Croatians and—well, it works pretty good. After that the Croats were losing ground, so they bring in a special unit with helicopter and special soldiers. And we Bosnians ask ourselves: if we don't have real weapons, how shall we make them think we have real weapons? So we got a submachine gun and we mounted it on top of this big metal drum so it would have a bigger noise. When we fired it, it sounded like—like an antiaircraft gun. That kept the helicopter away; we scared the pilot. So the Croats brought in the Croat special forces. They were going to have a surprise attack. But the Bosnians knew that the special forces were there, so the Bosnians let them creep up. We let the Croat special forces move closer in, closer, closer. We held our fire until the Croats got so close, you know, that they were really on Bosnian territory, then the Bosnian soldiers crept around behind them and boom-boom. No more Croatian special forces.”
The paramedic looked up at the rafters. “Sixty Bosnian people died in four months.”
“How?”
He shrugged. “The usual way. Snipers mostly.”
The waiter returned with beers and bowed over the surgeon as he poured his beer into a glass. The surgeon sat gazing at it thoughtfully and then looked up at me, a glint in his eyes. “I think everyone in America has this idea that all Muslims of Bosnia are fanatical extremists—all the women are in purdah and all men want to die in a jihad. But we are not like that at all.”
I thought of a poll I had seen before I left: only 40 percent of Americans could identify the Serbs as the ethnic group that was fighting against the Bosnian government.
“What was the fighting like here?” I asked him in return.
The paramedic slapped the surgeon on his back and said, “Go ahead, tell her.”
The surgeon came over the mountain with the Bosnian army. Their mission was to break through to Old Vetiz, to provide relief and advance the front. They built a makeshift road through the forest and made it to a small valley, this valley, about three kilometers from Old Vetiz. The surgeon set up a hospital in the old four-room school house. He used that ancient ventilator for anesthesia (and plenty of ketamine). Rudimentary supplies were provided by the army—medication, suture material, surgical equipment, all brought over the pass. “You know what we saw most of?” he asked. “Head injury—we couldn't do much for those sorry bastards—penetrating wounds to the neck, chest and abdomen. I had three cases of hemothorax in the chest, and I hadn't enough new blood to transfuse so I used the blood from the chest, what do you call that? Yes, auto-transfusion. Well, I didn't explore them, I couldn't because we were being shelled. And all three survived. Three patients! I could probably publish it as a case report, don't you think?”
The paramedic leaned toward me. “This surgeon did all this five hundred meters from the front. Constant bombardment and sniper fire.”
“I saw things I would never forget,” the surgeon continued. “Never, never.”
“Like…” I said. I immediately felt ashamed for asking. But I didn't stop him.
“Like an old man up on that ridge right there. He took his grandson—the Croats usually just ignored the kids that were underfoot—so the grandfather wrapped up explosive around his grandson and set the detonator and sent him down to play where the Croats were in the valley. Then, BOOM. Dead five soldiers and one grandchild.”
“How could anyone…”
“We have to stop them some way,” he said to me, suddenly fierce. “You see, we have no weapons, the Serbs and the Croats have all the weapons. We have no helicopters, no missiles, nothing but what we can scrape together ourselves. But we must fight them or they will kill all the Muslims. Believe me. They will line us up before our own graves and shoot every one of us. They'll destroy even the memory of us. They will murder us all.”
We drove back home in silence, Amir and I, through the blighted landscape. At the offices we counted through the forms. We had vaccinated nearly five hundred children. Still I knew there were many more.
I was late for my evening shift in the ER. It was quiet when I got there, no major traumas all day. My first patient was a woman with a sprained ankle, another everyday event in the midst of war. I sent her over for an x-ray. The radiology tech sent her back, telling her, “We don't waste radiology film on ankle sprains.”
An old woman, gnarled and worn, had an infected wound on her arm. She had fled with her family over the hills a few weeks before. She was the only one of the family to survive and she still seemed completely bewildered. She wa
nted to tell me her story. Maybe if she told a doctor her story it would make more sense. But she didn't have a chance; there was another patient.
The patient was a slender, very nervous-appearing young man dressed in blue jeans meant for someone twice his size. He was complaining of headache, a swollen neck, chest pressure, problems with his kidneys and weight loss.
Through Yasha, my translator, I asked the obvious question. “Are you in the army?”
Yasha and the patient talked for several minutes until Yasha raised his hand to stop him and said to me, “He's in the Black Swan battalion.”
“What's that?”
“It's a very, very…tense group. They are the advanced troops, always on the front line, always in bad places. In America I think you call them the Green Berets.”
The young man in front of me did not look like suitable material for the Green Berets. But where to start? This man was complaining of everything. “Has he ever seen a doctor for these complaints?”
“Yes.”
“What did the doctor say?”
“He said he was mad.”
“Mad?”
“Yes,” Yasha said. “Like crazy.”
“Crazy how?”
Eventually we got the full story. The patient had been very close to a grenade that exploded about six months before. Most of his platoon was killed. Since then he had been terrified of the war, of dying. One night in his barracks he thought his platoon mates were trying to murder him. He leaped out of bed, grabbed his gun and began firing at random. Fortunately no one was hurt.
He was then placed in jail where he was told he was mad—crazy—but not crazy enough to be discharged from the army. He was on leave now but was supposed to report back tomorrow morning.
I checked him over. Other than the weight loss—which I believed because of his baggy pants—there was nothing abnormal on his exam.
“We can check his urine…We can check…”
Yasha explained this to him and then turned back to me. “He doesn't want any tests.”
“He doesn't want tests?”