Just Here Trying to Save a Few Lives

by Pamela Grim

  “All right,” he said, “all right, all right.” He turned to the man with the machine gun (security guard? out-of-uniform soldier? heavily armed passerby?). “Ward C,” he said; he turned on his heel and retreated back up the steps.

  “Ward C,” the nurses echoed.

  “Okay,” I said. “Where the hell is that?”

  It was across the street but the hospital had no stretcher. We carried the tetanus patient by holding on to his clothes. One of the nurses led the way. “What now, what now, what now?” I chanted to myself.

  Ward C was Quonset-hut shape, vintage World War II temporary housing. It was one of four or five long, narrow buildings found a hundred yards from the intake office. We crossed the street and hurried up the short walkway littered with trash that led to the entrance of Ward C. The doors were open, letting a rhomboid of sunlight into a long, darkly hot room. Two women sat at desks. There were two rows of beds, maybe fifteen beds on each side of the room. The ward was in no better shape than the intake office. The floors were grimy, windows blankly screenless. No light except for what came through the windows, no curtains on the windows, no curtains between the beds. No mattresses on the beds, just bare bedsprings, and no patients—or rather two patients. One on the right near a desk and the other halfway down the row of beds on the left.

  Neither of the women at the desks had moved. They both stared at us as if we were some type of unearthly vision. “Are they nurses?” I asked Simon, who shrugged noncommittally.

  “Where is the tetanus ward?” I asked them.

  Wordlessly, one of the women pointed to the far end of the room.

  We carried the tetanus patient down the row of beds. At the other end of the ward there was a room or, rather, a closet. Inside was wedged a single bed with bare springs. We laid the patient on that bed.

  The tetanus ward—this was it. I looked around, thinking of the injunctions: the patient must be in a dark, quiet room. Well, it was dark here and quiet. It was deathly quiet, and only the steel gray threads of cobwebs caught what little light there was.

  There was nothing here. Nothing, nothing, nothing.

  I knelt down next to the man and put my hand on his shoulder. He was far away now, eyes wide and staring, foam still bubbling from between his lips. His arms hung loosely at his sides, but his thoracic muscles were twitching like mad. I realized then that this man wouldn't get better and there was nothing I was going to do about it. It didn't matter where I brought him or what medicine I gave him. None of this mattered. I could pray all I wanted. I could give him all the medicine I had; this man was dying a terrible death of a preventable disease in a joke of a hospital in a country that floats on oil. And there was nothing I could do about it.

  The tetanus hospital, I thought, what a joke, a mirage.

  The old feeling, the feeling that I was the only one who could help this man, washed over me again. I cannot let this man die, I thought. I cannot, cannot, cannot. I am all he has. I racked my brains. What had I missed? Where was his wound? Why wouldn't the penicillin work?

  But I knew I had lost him. I was all this man had and I was letting him die. What if I had demanded more of that doctor or had known a better hospital? Maybe it would be better to take him back to the meningitis camp, I thought, and then I remembered the ride with the man jammed into the back of that car.

  There was no way he would survive the ride back. And even then, what else could we do for him? What else was left?

  “Doctor,” Simon said. He put his hand on my shoulder. “You must go.”

  I stood up. I found I was clutching at the medications we had brought, 100 mg of Valium and several ampules of penicillin. Simon took them from me. “I will wait here and give these to the brothers when they come.” He bowed his head. “Otherwise the nurses will steal them.”

  “We'll bring more tomorrow,” I told him. “Tell them we'll come back in the morning.”

  “Yes,” Simon said. “Yes, we will.”

  I understood then what the doctor in the yard was trying to tell me, although for whatever reason, he could not come out and say it: we have nothing for this man. We have no medicines, nowhere for him to rest, no nurses, no doctors, no equipment.

  All that I had accomplished after that mad ride was to find a place for this man to die.

  The next day Simon went up to the tetanus hospital with more Valium. There he found, miraculously, that the tetanus patient was still alive. The three brothers gathered around him watching him as he lay there rigid, bathed in sweat, struggling to catch each breath. By then his chest wall muscles were constantly clenched; they were slowly smothering him. Simon tried more Valium, but it seemed to have no effect. The patient died, finally, about the time of afternoon prayers. Without expression, his brothers wrapped him in the blanket that had been with him since the beginning of his illness. They thanked Simon and told him they had no money to pay him. Then they picked their brother up, walked down the road we had driven up so frantically, and disappeared into the city.

  A few days after the tetanus patient died, the first of the monsoon rains appeared as a morning shower. Jean-Paul had predicted this would be the end of the epidemic and it was. Whatever climatic conditions had made the meningitis epidemic possible left with the first rain. My tent population of sixty dwindled to thirty, twenty and then ten. There were no corpses waiting for us when we started morning clinic; the people we saw were moderately ill and after a while barely ill at all. It was time to go home.

  The night before I left I dreamed that I went home and found my hospital had been closed down. No one was there. The parking lots were empty; all the doors were padlocked shut. I tried them all in succession. I couldn't get in until I walked around to the emergency entrance. The emergency department door swung open magically when I approached. I walked in past an unmanned security office, then a vacant triage desk, and continued down the empty hallway past empty rooms. The place had an air of everyone having left for a moment intending to come right back. Charts were on the desk, the computer screens were lit, doors to the rooms were open, gowns and sheets lay rumpled on the gurneys. All those signs of life, but there was no one there. I realized then that nothing at home would be the same as when I left it; then I awoke in that dank room with the understanding that nothing here would be different when I went home.

  I sat up in bed, wide awake now. I felt for a moment as if someone had handed me a pair of special glasses. Suddenly, I could see this epidemic with epic clarity.

  In front of me I could see the faces of my patients, all the ones I had gotten to know on my daily rounds—the patients who survived and moved on; the ones who died while we tried to start IVs and get antibiotics into their systems; the patients already dead by the time I saw them. The only answer I had to the humanitarian aid paradox was in the particular. We came here trying to save individual lives: the policeman's son, the bus driver's daughter, the young man with the tribal tattoos, the elderly woman who, while she was sick, nursed her even sicker granddaughter. The blind woman, the old man with the ebony cane. These few people are alive because we were here. We have received their blessings and their thanks for what we have done—although it required a pact with the devil to do it. Though it has really been so little compared to what needed to be done.

  What Nigeria needed here was a revolution. Some heroes to smash the gates of Abacha's palace and liberate it for the people. Nationalize Shell Oil. Destroy Lagos. Destroy this city, hotel included. Save themselves. Save their children. Save me if they had a chance.

  I was packing late one afternoon with the door open for light. The porter appeared and leaned against the doorstep. Behind him the rain splashed on relentlessly. It had been raining since early that morning.

  “You are checking out?” he asked. “Do you want your bags carried?”

  “Please.”

  “Did you enjoy your stay in Nigeria?”

  “Yes, very much.”

  “Was it a pleasant vacation?”

&nb
sp; “It was a wonderful vacation.”

  “You go back to America?”

  “Eventually.”

  The porter clutched at his shirt pocket, then brought something out to show me. It was a ballpoint pen with a blue hub. “This pen,” he said with a touch of awe, “was made in America.”

  “Excellent,” I said and then turned my head away so that he could not see me smiling.

  He started off with my bags, wheeling my suitcase through the mud. I looked around the room for anything that I had missed. That's when I found a copy of the Koran, covered in dust, in the drawer of the bedside table. I did not disturb it.

  13

  STATELESS

  Stateless: [f. STATE n. + LESS.] 1. Without a state or political community. Also, destitute of state or ceremonial dignity. [OED]

  “Today's ceasefires and armistices are imposed on lesser powers by multilateral agreement—not to avoid great power competition but for essentially disinterested and indeed frivolous motives, such as television audiences' revulsion at harrowing scenes of war.”

  —Edward N. Luttwak, Foreign Affairs magazine, July/August 1999

  IN MAY 1999 I CAME TO MACEDONIA with Doctors of the World to work in a camp for Kosovar refugees. There, on a good day—or rather a bad day—and they were all bad—each doctor saw at least one hundred patients during a twelve-hour shift. Most of the patients had minor complaints in the clinic—things that served as a pretext for the real reason they were there: anxiety, depression, despair. After a while I stopped asking questions about the patients' symptoms and just started asking what had happened to the man or woman sitting opposite me. Then I would just sit back and listen to the stories. All these stories. Women giving birth in the woods, old men walking for days over the mountains, diabetics without insulin, children with unattended broken bones. None of the stories were any better or worse than any other—they were each horrible in their own way—but some stories were harder to forget…like the story of the deaf girl.

  She was about ten years old and had been deaf since she was six months old from a bout of meningitis. Late in April, the Serb paramilitary forces entered her town and broke into her family's house. There they found the family cowering upstairs. One of the paramilitary (they are called just that, no one graces the term with the explanatory “soldiers”) lined the father and the mother next to each other up against a wall, the mother holding their six-week-old baby. The Serb then asked the husband, “Who do you want me to kill? You or your wife and child?” As he said this, the deaf girl started screaming, screaming at the top of her lungs. “The loudest scream I have ever heard,” the mother told me. The soldier turned around, and at that moment the family could see that the soldier had changed his mind; he was not going to kill any of them. He shouldered his Kalishnikov and as he did, the little girl began laughing, a laugh almost as loud as the scream. It took them several hours before they got her calmed down enough to stop this insane laughter. Ever since then, though, every morning in the camp, the little girl would wake up laughing the very same way. She would laugh and laugh until her mother would shake her and slap her. No one knew what the girl was thinking—or dreaming—that made her wake up with laughter; she couldn't speak at all because of her deafness. Every morning, though, it was the same thing: laughter and slaps, slaps and laughter.

  Everyone had a story about what happened to them at the border—where they crossed, what the Serbs did there, what the sheltering country's border guards did. The refugees we saw had fled to Macedonia. Given the dramatic urgency of the situation, it wasn't surprising that the Macedonian method of dealing with refugees was initially ad hoc, at best. But over the course of weeks and hundreds of thousands of displaced persons, there did develop an informal method of “processing” refugees at Blace. This was the main transit point for most of the refugees attempting to enter Macedonia.

  Essentially, if the Serbs were in a giving mood, they would allow the refugees to cross through the Serb border onto about a mile-long strip of pavement into no-man's-land. No-man's-land itself ran as a swath of heavily mined territory between Kosovo and Macedonia. This land, while a subject of dispute between the neighboring countries, also served as a buffer zone. In no-man's-land the refugees would wait, sometimes for hours, usually for days, to see if the Macedonian officials would let them through to safety and relative freedom. Those that got across were interned initially at Blace Camp itself, a hellhole land of mud and tarpaulins strung between trees. After this, everyone was bussed by the Macedonian authorities to one of the main refugee camps. Camps like Stankovac I, Stankovac II, Cegrane, had, at times, held over thirty thousand refugees apiece.

  On the other hand, if the Macedonians decided to close the border, the refugees were sent back into Kosovo and into the arms of the Serbian military and paramilitary forces. The Serbs would get rid of them by beating them away with sticks.

  In the camp clinics we were heartbreakingly busy. We slept, ate, drank, and dreamed about patients and the camp, about the things we saw and the things we heard. In the morning, every relief worker would sit at breakfast and swap dreams. I dreamed that Milosovic had come to our house to dinner and we tried to poison him, but, Rasputin-like, he refused to die. Alan dreamed that our house was bombed by NATO (foreseeable). Paul dreamed that we all went to an Orthodox monastery and found the dining room filled with howitzer-packing Mafia dons. Even awake, though, there was a hallucinatory aspect to the world around us. NATO jets flew overhead nonstop; the sky was pinstriped with jet streams. At our camp we lived in a sun-bleached world of white tents and white gravel, a well-organized desert. At night, the camp inhabitants moved like shadowy specters in the harsh halogen vapor lights that lit the camp perpetually.

  One night I was sleeping, dreaming of demons, then suddenly found myself awake, sitting upright in the backseat of a Land Rover as it bounced from pothole to pothole. “Where are we going?” I asked the back of the driver's head.

  He turned his face so that I could see it in profile in the oncoming light of a passing NATO convoy. “Blace,” he told me. It was Dini.

  “Is the border open?”

  “Serbia side, yes. Macedonia, nobody knows. There are refugees in between. They are waiting.”

  “How many?”

  “Many, many.”

  “Why are we going there?”

  “Because you are a doctor.”

  Bafti, my translator, sat slumped next to me, chin down, arms folded, head nodding with each bump in the road. He was sound asleep. Bafti was sixteen and had learned his nearly flawless English from watching TV. Like most of the people we worked with, he was as much a refugee as the patients we saw. His family had crossed over a month before. “It wasn't too bad,” Bafti told me. “The first day of the bombing we were hiding at my grandmothers's house until they started burning the village. Then we ran into the woods. They were shooting at us the whole time, bullets going over our heads, my little sister crying. Then we walked and walked with nothing to eat for three days. But we were okay. Other people did worse.”

  Bafti had a moon face, open and innocent, that matched his gentle spirit. He translated everything for me, the young woman who might be pregnant, the old man with gangrene of the foot, the KLA soldier tortured by the Serbs, the little girl who saw her mother and father killed. All the stories. The tortured, the maimed, the starved, the dying, all talked to Bafti, who passed them on to me. I only saw him cry once; Bafti had a special knife—a gift from an American friend—and someone stole it.

  We went through sleeping Skopje, an ancient town with now a purely Soviet cement-block aspect. Most of the old town had been destroyed by an earthquake in the 1960s. We passed by the old radio station where the clock tower, still standing, read perpetually 6:42, the precise moment the quake began.

  I awoke again to find myself standing in front of an exhausted-looking English woman, the only doctor at Blace Camp. I was yawning. “I'm sorry,” I told her. “I've put in a fourteen-hour shift already toda
y.”

  She yawned herself. “This is my second twenty-four hours in a row.”

  Relief-work rivalry.

  I looked around the medical tent, and my eye caught my name on a posted piece of paper. The title was “Coverage for Blace Border Crossing During Urgent Situations” and then opposite Thursday was my name. I had never seen this schedule before.

  “How many refugees?” I asked her.

  “They say almost ten thousand in no-man's-land. The Serbs let them in past the Serb border crossing at—let's see—about nine tonight. And another twenty thousand still in Kosovo. But of course, it doesn't make any difference what the Serbs do if the Macedonians keep their side closed.”

  “Is there any word?”

  She shrugged. “No, of course not. That would make it easy.”

  The medical tent was actually essentially empty except for a woman with a squalling child who had managed to make it alone across the Kosovar border through mine-ridden no-man's-land. One of the aid workers found her shivering by the side of the road and brought her here. The baby was about six months old. He had lost all his baby fat but wasn't frankly starving yet. He had obviously been wrapped in wet clothing for a long time, though. His entire body was one giant, macerated, lobster-red open sore, the sore extending even up into his face—a whole-body diaper rash. Otherwise he was one angry baby. He squalled vehemently while the nurse peeled off the plastic triangle that had served as his diaper for God knows how long. His mother had kept him wrapped in a piece of plastic shower curtain.

  I looked around…missing something. Then I realized it was Dini.

  “Where is he?” I demanded of Bafti, who was sleeping in the corner. Without opening his eyes, he lifted his hand to point outside.

  “Well, wake up. We've got to get moving.”

  Dini was dozing in the Jeep outside. Poor Dini. Dini got roped into everything. He drove, he translated, he held people's hands, he carried the wounded, he counseled the stricken. There is no part of my stay in Macedonia that does not have Dini's infinitely weary, infinitely patient face imprinted on every memory. He was always there, always ready to shrug, “Yes, why not,” to every request, always with a lit cigarette, no matter where. I had worked with him for a month before I found out that he had finished medical school in Bulgaria and had come back to Pristina to continue his studies. “Why don't you work with us as a doctor?” I asked him. He shrugged and shook his head. “He's given up,” Bafti told me and refused to say any more. “Ask Dini,” he told me when I pressed him.