Lipstick in Afghanistan

by Roberta Gately

  “Squeeze the damn heart,” the surgeon barked. “You’re the pump! Squeeze harder!” Elsa held her breath and squeezed as the surgeon worked, willing herself to memorize every detail of the dramatic procedure. She exhaled only when the patient was rushed into the operating room. The following day, Elsa learned he’d survive.

  She knew that she would too.

  Slowly but surely, she found that she loved the adventure of the ER, the adrenaline rush of saving lives. Sometimes she’d run alongside the stretcher holding a flimsy piece of gauze over a gaping wound to staunch the flow of blood. She learned to insert intravenous lines as though she were gliding a piece of silk over someone’s arm, and she learned to place nasogastric tubes as though she were dropping a fishing line. She learned to deliver screaming babies and to wrap the dead.

  And the next time a chest needed to be opened, the surgeon had shouted, “Get Elsa! I need her next to me!” She’d pushed through the crowd and hurriedly tried to insert an intravenous line, but the patient’s veins had collapsed. “Forget that,” the surgeon said as he inserted the rib spreader into the incision and cracked the chest open. Blood sprayed everywhere. Elsa felt it drench her own scrubs, but she stood perfectly still, only her hands moving as she reached for a surgical drape.

  “Here.” The surgeon pointed to a small laceration in the heart. “Put your finger there. Don’t move.” Elsa reached out, her hands steady, and jammed her finger into the tiny hole.

  She watched as he searched for the aorta; every vessel looked the same.

  “There,” he said. “Where’s the clamp?” Out of the corner of her eye she watched as an intern handed the instrument to the surgeon. With steady hands, he clamped the vessel. Instinctively, Elsa called out. “Note the time,” she heard herself shout, glancing up at the wall clock. “Start the timer.” She inhaled deeply through her surgical mask. She felt as though she was watching someone else, someone calm who knew exactly what to do.

  When the bags of universal donor replacement blood arrived, she placed them under her arms to warm them, just as Maureen had taught her.

  “Let that intern warm that blood,” the surgeon told her. “Now suction that out for me.” She passed the blood and took the suction tube, placing it right into the chest cavity, vacuuming out the blood so the surgeon could see the heart. She watched as he placed a tiny suture into the young man’s right ventricle.

  “Get an atrial line in, Elsa,” the surgeon said, directing her. Her hands trembled.

  “Here?” she asked, glad for the face mask that muffled her shaky voice. When he nodded, she inserted the intravenous catheter into the man’s heart and connected it to the blood tubing.

  The flaccid heart had quivered before it began to beat—stronger and stronger—until Elsa could hear her own heart pounding in her chest. She covered the gaping wound with moist pads and the surgeon and his interns pulled at the stretcher, heading to the OR.

  “You’re at nine minutes,” she said, placing the timer on the stretcher. “You have eleven minutes left to get that aorta unclamped.”

  “I knew you had it in you, Elsa,” the surgeon said, patting her on the back as he hurried by.

  Maureen had watched it all from the doorway. “Well done, Elsa. I’m so proud!”

  “My God, I was so nervous. You couldn’t tell?”

  “No, honey. All I saw was an ER nurse. Now, back to work. You’ve got a line of patients waiting.”

  The floor was slick with the patient’s blood as Elsa tossed her surgical gloves and mask on the floor, which was already littered with syringes, medical debris, and discarded latex gloves. She switched off the monitors and paused, looking around. It didn’t look much different from the day Diana had died, but everything had changed. Everything. She was an ER nurse now. If she could do this, she could do anything.

  She turned and flicked on the intercom. “Housekeeping to Trauma One,” she said as she stepped over the debris and headed back to triage.

  Before long, it was Elsa who was calling, “Arrest team to Trauma One.” She almost couldn’t believe how far she’d come, how her confidence and her skills had grown, and she knew, with each passing day, she was closer to her goal.

  Elsa went back to the library where she’d spent so much time and began to research relief agencies. There was one agency she’d seen profiled on CNN—Aide du Monde—with headquarters in New York City. But when she contacted them, they politely informed her that she’d need at least a year of experience, preferably in an emergency room, before they would be able to consider her for a nursing position. She’d only been in the ER for six months, so she swallowed her disappointment and promised to call them when she’d reached that milestone.

  The day her year was up—and not a minute later—Elsa called Aide du Monde, commonly known as ADM, to make an appointment to visit their New York office. This time, she got one.

  With her lips colored a daring red for confidence, she arrived there one afternoon in the spring of 2001. Days of interviews followed.

  “So please tell us why we should choose you. How can you help?” a tall, bespectacled man had asked.

  She took a deep breath. She knew her answer had to be perfect. “It’s all about making yourself try harder,” she said, her voice calm as she told them about learning how to open chests and save lives in the ER. “I know I can help,” she said, finishing. “I absolutely know I can.” The two men who interviewed her smiled then and nodded—signaling approval, Elsa hoped.

  She was asked to submit what seemed like a glut of references and had to write a personal essay explaining her reasons for wanting to become part of their team. It seemed more difficult to join ADM than to get into Harvard. But finally, she called Maureen with the news.

  “I’m in,” she said breathlessly into the phone. “They said they’d call when they have an assignment for me.” There was a brief silence and Elsa wondered if they’d been cut off.

  “That’s wonderful, honey,” Maureen said finally, and the connection made it seem as if there was something in her throat. “I’m so proud of you.”

  Elsa rang off and went to apply for a passport. Over the next few days, she got more vaccines than she’d received in her entire lifetime. Then she returned to Boston and waited for the call.

  It took a long time, but her phone finally rang late one morning in early September. A man named Jean-Claude, his voice a lilting French accent, offered her a post in Afghanistan. Thrilled that ADM finally had a place for her, Elsa eagerly accepted, and Jean-Claude promised to call back soon with more details.

  Hanging up the phone, she crawled back under the covers. She had one more night to go on the night shift, and, still exhausted, she hoped to get some more sleep.

  But her mind was racing.

  Make a list, decide what to pack… who to tell… bills to pay.

  Maybe I should let go of the apartment, she thought. Maybe I could sublet.

  Surrendering to the inevitable, she got out of bed and dragged herself to her desk. She tried to focus, to make a list of things she’d need, but fatigue overcame her and she could only think of one thing to take. At the top of the page, she wrote out LIPSTICK in capital letters and underlined it.

  Pen and paper still in hand, Elsa fell asleep.

  Elsa woke that evening with a feeling of lightness. She was almost giddy. Her life was about to change.

  She worked through the night shift and kept her secret to herself. She wanted Maureen to be the first to know and planned to tell her on Tuesday morning at the change of shift, but the ER was too busy and Elsa was too exhausted to hang around until things quieted. So she dragged herself home, took a long, hot shower, and pulled on her nightgown, then settled in for a cup of tea and the morning news.

  She clicked the television on, expecting to see the newscaster chatting about the weather or the morning traffic. Instead of the usual smiling faces, however, a somber reporter’s voice was shaking.

  “A plane has just crashed into t
he World Trade Center in New York City,” he said. Stunned, Elsa sat back and watched the live report. Suddenly, there on the screen, a second plane appeared and flew into the second tower.

  Elsa’s hands flew to her mouth.

  She stood and moved closer to the television.

  Flames, horrific flames, burst from the gaping holes where the planes had pierced the buildings.

  People inside were trapped, the reporter announced, and some—desperate to escape—had jumped from the highest floors. The cameras caught it all, the specks of bodies hurtling through the air to the concrete below.

  Her hands trembling, Elsa was seized by a feeling of dread, but she couldn’t pull herself away from the terrible images. She was still watching when the towers crumpled and collapsed, sending thousands of people to their deaths. Reporters said that it was a terrorist attack, and the planes had come from Boston.

  The morning was sunny, and despite her closed shades, bright light was leaking in around the edges. Elsa ran to her front window and pulled the blinds open. People were still walking, cars were still moving, drivers were still yelling and honking their horns. It seemed like an ordinary day.

  Except it wasn’t.

  Suddenly, she didn’t want to be alone. If the world was ending, she needed to get out of there. She picked up the phone and called Maureen at the hospital.

  “Have you seen it?”

  “We’re watching it now. It’s just awful.” Maureen sounded defeated somehow.

  “Do you want me to come back? Do you know anything? God, it’s terrible. And the planes came from Boston.” Her words came out in a rush.

  “I don’t know, honey. A Phase One disaster has been called here and we’re on alert, but no one knows what will happen. Stay home, get some sleep. I’ll call if we need you.”

  But Elsa didn’t sleep. She stayed in front of the television and watched as the details of the attack were revealed. In the evening, she called the telephone number mentioned in a news story and tried to volunteer at the World Trade Center site.

  “I’m an emergency room nurse,” she said. “I can help.” A harried official took her name and telephone number and said they’d be in touch.

  She dialed ADM but there was no answer.

  Her world had suddenly turned as gray as the ash that covered Lower Manhattan. Elsa had never felt more isolated. She kept the television on all day and into the night, needing the hum of voices to lull her to sleep.

  When her alarm clock buzzed, she was already up and showering.

  Relieved to go to work and to be back on the day shift, Elsa heaved a sigh as she walked through the ER’s doors. At least there were people there. The staff and the patients were gathered in the waiting room, glued to the television.

  Maureen was still there; she’d stayed all night, just in case.

  “How are you, honey?” she asked as she gave Elsa a hug. She turned back to the television. “I never thought I’d see anything like this, such evil. It gives me the chills.”

  She turned and looked at Elsa. “I hate to think of you all alone in that apartment,” she said, continuing. “Do you want to stay with me and Jack till this is over? You know we’d love to have you.”

  “Thanks for the offer, but I’m okay. You’re the one who should get some sleep. Go home to Jack. We’ll call if we need you.”

  For the rest of the day, a crowd kept vigil in the waiting room and though the faces changed, the numbers in front of the television never diminished.

  When the terrorists were connected to Afghanistan, Elsa wondered what the effect would be on her assignment. Sure enough, before the week was out, her mission was canceled and all international aid workers were evacuated.

  Jean-Claude reassured her when he called with the news. “Not to worry. We will have another assignment for you soon,” he said, and then he paused. “If we reopen our programs in Afghanistan, would you still go?”

  Elsa answered without hesitation.

  “Oh yes. I’ll go. I’ll go anywhere.”

  In early October, CNN reported that the U.S. and coalition forces had started bombing Afghanistan.

  At work and on the streets, people cheered.

  Elsa held her breath.

  What next?

  4

  A persistent ringing jarred Elsa out of a sound sleep. She fumbled for the phone, her eyes still closed, as the bright sunlight seeped through her tightly shut blinds.

  “Hello,” she groaned into the receiver.

  “Hello, hello, Elsa.” A faintly familiar French accent greeted her. “It is Jean-Claude calling from Aide du Monde in New York.”

  “Oh, hello,” she answered, suddenly awake. She hadn’t heard from ADM in over five months.

  “I am sorry we have taken so long,” Jean-Claude continued, “but I am happy to say that, finally, we have a posting for you.”

  “That’s wonderful,” she said quickly. “Where is it?”

  “We still need you in Afghanistan, in a place called Bamiyan,” he replied. “The home of the famous Buddha statues. Well, there are no Buddhas now of course, thanks to the Taliban, but there in Bamiyan, we have a clinic and hospital. The mission will be for one year. You can go, yes?”

  A year, she thought, pushing aside her fears.

  “Yes, of course. When will I leave?” she asked.

  “Probably in a few weeks. We just wanted to be sure you would accept the post. Thank you for saying yes. I will call you later this week with details. Until then, good-bye.”

  “Good-bye,” Elsa replied. She hung up the phone with trembling fingers.

  It was really going to happen—she was going to Afghanistan. She almost couldn’t believe it.

  It was a cold, gray morning in early March when Maureen drove her to the airport and said a tearful good-bye.

  “I’m so proud of you, Elsa. Promise me you’ll be careful,” Maureen said, her voice straining with emotion. “Just come back to us safe.”

  Only later, when Elsa stood in the long line that led through the security maze at Logan airport, did she feel the first real threads of worry about Afghanistan. But the arrangements had all been made; it was too late to back out now, not that she wanted to anyway. This trip was everything she’d ever wanted. She tried to shake off her anxiety, but tears gathered in her eyes as she boarded the plane and sat peering out of the scratchy little window at the blurred runway. It would be her last look at Boston for a long time.

  The first leg of her journey took her to the ADM offices in Paris to pick up medicines and some of the supplies she would need in Bamiyan. It was the first time she’d been outside of the United States, and she yearned to see some of the famous City of Lights, but there was no time.

  There were no commercial flights into Afghanistan, so she was booked on a flight to Peshawar in northern Pakistan, the tribal, frontier city that was the point of entry for all the aid going into Afghanistan. Peshawar was a crumbling old city teeming with refugees, freedom fighters, aid workers, intrigue, and centuries of history.

  Elsa landed in Peshawar in the late morning, and the instant she emerged from the plane, she was hit by the full sun and murky heat of the day. She stood in the plane’s doorway at the top of the metal stairs and looked out, the scents and sounds full upon her, and paused.

  “You!”

  She jumped as a soldier barked at her and motioned brusquely with his machine gun. Her palms were sweating—along with just about every other part of her body—as she descended the staircase and stepped onto the cracked and steaming tarmac. The soldier frowned and pointed the way to the arrival terminal. Elsa fell in behind the other passengers.

  The terminal, a squat two-story building, was teeming with activity. Turbaned men in oversized pajama suits and women in loose dresses and veils filled every available space. Elsa hesitated, looked at her own jeans and cotton shirt, and felt conspicuously out of place in the heaving, exotic crowd.

  Suddenly she realized she’d lost sight of the line of pa
ssengers, who’d somehow blended into the crowd. She stood there alone and tried to read the signs. Panic began to grip her when she realized none of them were in English.

  A flash of movement caught her eye and there, at what seemed to be the entrance to the terminal, she saw a young man waving a sign with her name on it. Relief flooded through her, and she hurried to his side.

  “Come, come,” he said. “My name is Ajmal, and I am here to help you with the rest of your travels. Follow me, please.” He took her passport and visa and guided her through the long lines and confusing maze of Immigration and Customs, and then he collected her lone suitcase and a bulky carton of supplies she’d gathered in Paris. He lifted the carton onto one shoulder and lifted her suitcase with his free hand.

  Finally, he paused.

  “You are from Amrika, yes?”

  “Yes, yes, I’m Elsa. Well, you know that, I guess,” she said, grinning. “After all, you have the sign.” As he smiled back, some of her nervousness melted away.

  “I am from Afghanistan.” He put his hand over his heart. “It is the place of my birth and where my heart resides. You are here to help my people?”