by Davis Bunn
Amanda heard the tremors echo now in her voice. “Has her blood work ever included a full enzyme test?”
“Why would we be following such a very expensive protocol?”
“Sometimes a pattern of jaundice suggests a causal link to enzymes.”
“Very rare.” Even so, the doctor was nodding. “All right. Tell me.”
She could tell the doctor knew what she was going to say. But she said it anyway. “G-6PD.”
“Impossible,” the doctor said instantly. “This you are also already knowing.”
Nechama broke in with, “What is this you have said?”
“Glucose-6-phosphate dehydrogenase deficiency,” Amanda answered, giving the full medical name. “It’s a hereditary ailment characterized by abnormally low levels of a specific enzyme.”
“It is also exclusively a male illness,” the doctor said. Even so, his hostility was utterly gone. He addressed Amanda as he would any other professional. “And as we both know, Rochele is most definitely a female.”
Amanda lifted her hand, halting Nechama while the office manager was still drawing in her breath. “Actually, there has recently been a change to this perception. Last year scientists made a definite tie between the illness and a defect in the male chromosome.”
The doctor crossed his arms, but not in defense. He adopted the tight tone of a man on a quest. “You are sure of this how? I ask because, as we both know, all patients who suffer from G-6PD are from this part of the world. It is not a disease of the Americas. Caucasians do not suffer this enzyme deficiency.”
“In my hospital in Florida, we almost lost a little girl. One of my last cases. She was in and out of intensive care for the first eighteen months of her life. Her father was Lebanese.” The recollections were so intense and vivid they brought tears to Amanda’s eyes. “She was brought in with a fever that terrified us. As we were fitting the IV she went into spasms so tight we feared she might snap a vertebra. We raced to the ice machine, scooping out handfuls and filling the space around her. We already knew she had an allergy to most analgesics; we couldn’t even administer paracetamol. The mother was held in the corner by an aide and kept screaming for us to do something. I’ve never felt more helpless in my life. But a doctor on our staff had an idea.”
The doctor was nodding with his entire body, rocking so that his thighs came in contact with the examining table. “And what did this doctor say?”
“His name is Henri Beausejour. Dr. Henri is from the Dominican Republic, but his heritage is African. And as you know, G-6PD is the most common hereditary disease in West Africa. He told us of a UN study completed just months before. It proved incontrovertibly a direct link to the male chromosome. And just as male chromosomes are latent in some females, the disease in infant girls almost always remains dormant. Most female carriers of this deficiency will have it their entire lives, and perhaps think they have severe allergic reactions to sulfas or fava beans. Only when the father was a sufferer was the disease shown to become an active threat in daughters.”
The doctor continued rocking. “And you knew that Rochele’s father passed early.”
“From respiratory complications. Which are also a symptom of G-6PD. Yes. Miriam told me.”
“Your patient, the little Lebanese girl, how is she?”
“I don’t . . . I have not heard.”
“You are no longer a nurse?”
Amanda wiped her cheeks. “Not for over a year.”
The doctor took his time settling the pages in the file back into place. “I am thinking this is a very great shame.”
The doctor’s name was Korban. He asked them all to wait, excused himself, departed, then returned and sheepishly apologized for not having introduced himself. The change in his attitude was so total, Nechama actually felt comfortable saying, “I must leave. There is another urgent matter. Probably one of my lawyers has forgotten where he left his yarmulke.”
“I cannot thank you enough for making this happen,” Amanda said.
“What have I done? Nothing, is what. You are the miracle worker.” Nechama waved off Amanda’s protests. “And now you will come and join us for dinner, yes? You can take a taxi from your hotel. Here is my card. Here, the number for my cell phone, which is surgically attached. Here the address of our home in Hebrew. Show this to the taxi driver. Tell him if he charges you the tourist price he will answer to me. Seven o’clock, it is not too late? Good-bye.”
The cubicle seemed to expand somewhat, as though air rushed in to fill the vacuum left by Nechama’s departure. Miriam spoke with Alathea in Hebrew, then said to Amanda, “I should go.”
“Of course.”
“My assistants, they are good-hearted, and the children love them. But they need a firm hand.” She embraced Amanda with the ease of long friends taking leave. “What Nechama says, it is true. This is a day of miracles.”
“I’m glad I could help. Perhaps. We won’t know for certain until—”
“Please. Let an old woman feel the joy of knowing, without doubt, yes? Will I see you again?”
Amanda realized with a start that her work here was done. Either the tests revealed what she suspected and the little one responded to the treatments, or not. Either way she had nothing left to offer. Yet she loathed the idea of saying good-bye to Miriam. “Can you come back to Jerusalem tomorrow? I need to go back to the Wall.”
“After what I have seen here, how not? It is good to touch the stone and pray the words of thanks.” Miriam shut her eyes, lifted her hands, and spoke a soft refrain in Hebrew. Alathea responded with a soft amen, accented such that Amanda did not at first realize what she had just heard.
The curtains did not jerk back this time. Instead they were drawn back slowly, revealing an older gentleman, accompanied by a nurse and Dr. Korban. The senior doctor translated, “I call out to the Lord, and he answers me from his holy mountain. From the Lord comes deliverance.” He gave Amanda a kindly glance. “You recognize these words, perhaps?”
“They are verses in the third Psalm.”
He glanced back at Dr. Korban, then said, “And so a nurse who is no longer a nurse comes to Israel on holiday. This is true?”
“Yes.”
“And how does a tourist from America come to be in Bet Jola? It is not, as you see, a destination for many tourists.”
“Miriam asked me to come. We met at the Wailing Wall. I went there to pray, and Miriam asked me to put a prayer in the stones for her. About Rochele.”
The three Israelis mirrored astonishment. They spoke with Miriam in Hebrew, who shrugged and nodded at the same time. Her tone was matter-of-fact, as was the soft embrace she gave to mother and daughter together. The elder doctor and the nurse and Dr. Korban all watched in silence as Miriam started off, leaning on her cane. The doctor asked her something, to which the old woman gave another abrupt wave. The doctor turned and spoke to the nurse, who hurried out. He said to Amanda, “We will arrange for a car to take her home.”
“Thank you. The walk over was a lot for her.”
“All right, madame. To the business of healing. It has been years since we treated a case of G-6PD. Even here in the Middle East it is very rare. So tell us how you would treat this.”
“The enzyme test, obviously. And. . .”
“Yes? Please speak freely, madame. We are all in accord here. We have cared for Rochele her entire life. I was on duty the night she arrived. Before that I treated her father, and was there with the family to say kaddish. So tell us.”
Amanda had made careful study of the data available on the illness, most of which had to be translated. “The patients with acute symptoms like Rochele follow a fairly steady pattern of improvement and decline. This is tied to the level of healthy blood cells. How long has it been since her last fever?”
Korban returned to the file on the treatment table. “Forty- two days.”
“Which tallies with the jaundiced complexion. She is weakening again. Anything could set her off, probably an a
llergic reaction, since she’s so well cared for. We need to strengthen her immediately.”
“How is this done?”
“A blood transfusion today, followed by regular dialysis. Once a month should do it. When her strength starts to build by not suffering from regular fevers, you can cut back to once every three months.”
He spoke at length with Alathea, who continued to glance at Amanda with something akin to awe. That done, he asked, “Anything more?”
“You need to hold Rochele to a strict diet, building up her weight and strength. Stop keeping her indoors. She needs to begin adjusting to normal life, and that includes accepting the occasional allergy. After six months she needs to be tested for what analgesics she can accept, because there will be fevers, and she will need to be given something to help stabilize the symptoms. Aspirin is usually better for the patient than paracetamol. There are others, more expensive, but still . . .”
Korban said, “We are speaking of an end of treatments that have filled this file. We are speaking of a child brought to life. What is the cost of a few pills?”
“No dried beans of any kind, and no hummus,” Amanda went on. “And no sulfas. Not ever. When I get back to Florida, I can e-mail you my research dossier.”
“Florida, how nice. My grandchildren all beg for a trip to Disney World.” He spoke to Alathea, then to Korban, who replied in English, “It will be done.”
“And now, good woman, we should let you go back to seeing our country.”
Amanda exchanged farewells with Alathea. The mother’s words needed no translation. Rochele gifted her with a tiny embrace. Amanda traced a finger along the child’s face, shared another smile with her mother, then allowed the younger doctor to usher her outside. As they passed through the clinic’s waiting area, the nurse she had seen inside was standing by the reception desk, surrounded by a half dozen other staffers. They all turned and stared as Amanda passed. She smiled a farewell and said to Dr. Korban, “You have a good staff here.”
He pretended to shrug it off, but Amanda knew he was pleased. “I must apologize for my attitude.”
“You are a good doctor. You have done your best by Rochele. If I had been in your position, I would have acted much worse.”
“Not for an instant do I believe that.” He waved to one of the men standing in the alley’s shade. “We have cars for the infirm who must come for treatment. The least we can do is offer you a ride back to your hotel.”
“Thank you.” Amanda had a sudden thought. That first morning when she was trying to find which bus to take, the hotel receptionist had said this village was close to Bethlehem. She asked, “How far is Bethlehem from here?”
“Fifteen kilometers. You wish to go there?”
The desire rose up like a hunger. She had given up the chance to travel there with the tour group when she and Emily had struck out on their own. And tomorrow was her last day. This was her only chance. “Please.”
“The hospital drivers cannot go through the checkpoints. These are official cars leased by the health department. You will have to take a taxi or walk into town. But he can wait and take you back to Jerusalem when you are done.” He waved off her protests. “For the tourist lady who has brought back our child from the grave, what is such a thing? Nothing, that is what.”
Amanda waited while he talked with the driver, then said, “I can’t thank you enough.”
“For what do you thank me? This I am not understanding.”
“Last year I suffered a personal tragedy. I stopped working as a nurse. Now . . . I don’t know what is going to happen when I get home. But I know the child in there is not the only one who has been healed.”
“Madame, it gives me great peace to know we have given something in return for your gift to us.” Dr. Korban bowed over her hand. “I urge you to go help the other little ones in your country, those who cry out in need.”
CHAPTER TWENTY-ONE
The Judean hills above the road Amanda traveled gleamed in the afternoon light. The rocky scrubland had turned to molten gold. The fields of ancient olive trees were burnished with a timeless splendor. Amanda rolled down her window and let the hot desert wind rush over her. The driver smiled at her pleasure and turned on the radio. A woman sang in a tongue she did not understand, spicing the world with more mystery.
As Amanda stood in line at the checkpoint, she talked with a couple from Michigan. When they heard she was on her own, they insisted she join them for the trip into town. Amanda thanked them from the heart, relieved not to be entering this strange town alone.
The tour bus took them through the sprawling outer city. Amanda could see that many of the others were disappointed by what they saw. But for her it was very similar to Bet Jola, just another impoverished town struggling to make ends meet. The tour guide spoke through the loudspeaker, explaining that because they were coming in the afternoon during the Christmas season, the parking lot closest to the Church of the Nativity was already full. They were going to be relegated to a parking area beyond the central market. They would arrange a taxi for anyone who could not walk the half mile.
Amanda loved the market. It was a vibrant tumult, filled with every imaginable sort of person and dress, from Western fashion to dark-robed women who saw the world through tight eye slits. The market sold everything from clothes to meat to refrigerators to parrots. The air was thick with spices and overripe fruit and truck fumes. Birds squawked and radios blared.
And so it was that she arrived at Manger Square that fronted the church. Amanda wiped the sweat from her face and found herself humming. Helping to heal the little one had left her almost giddy with joy. She hoped that there was something in the experience that would last beyond this first moment, that there would be something she could take back with her to Florida, and home, and the hospital, and Chris.
Her companions from the bus were very kind. As they waited in the line that snaked across the baking stones of the plaza, they introduced themselves and talked about where they had been. Amanda let the words wash over her, enjoying their company but not feeling the need to respond with more than a smile and the occasional nod. The market and the plaza were filled with hawkers and children begging for coins. The tour guide employed a very sharp tongue to protect her charges. Amanda felt as though the afternoon was making a special effort to shield her.
They waited almost an hour before they were permitted through the tiny Door of Humility, a portal that forced even children to bend over to enter. Inside the ancient basilica the guide raised her voice to be heard over the babble of hundreds and hundreds of other visitors. The church’s age was hotly disputed, but it was certain that at least some of the chamber where they now stood was set in place within three centuries of the Savior’s death. Most of the others in her adopted group strained to hear above the clamor. Amanda remained on the fringe of the group.
They joined another line, this one leading to the Grotto of the Nativity. The chamber at the base of the narrow stone stairs was cool and much quieter, though the crowd was very dense. A silver star planted in the chamber floor marked the point where Jesus had been born. Amanda watched many of the others move forward to touch the star or kneel and pray at its edge. She allowed the throng to press her back against the side wall, where she found herself standing next to another of their group, an elderly gentleman who read from a pocket-sized New Testament. He noticed her gaze, smiled, and shifted the book over to where she could read with him.
Amanda read the words from Luke: Greetings, you who are highly favored! The Lord is with you.
The grotto was ancient in a manner that Amanda had never imagined might truly exist. The ceiling lamps held electric bulbs now, but they were encased in hand-blown glass, and the oil wicks were still visible. The walls were lined with paintings called icons, all of which were over a thousand years old.
Do not be afraid, Mary, you have found favor with God. You will conceive and give birth to a son, and you are to call him Jesus. He will be great an
d will be called the Son of the Most High.
The chamber was suddenly filled with song. A group from Italy sang a chorale in four-part harmony. The music rang through the chamber, a chant of resounding glory.
The Holy Spirit will come on you, and the power of the Most High will overshadow you. So the holy one to be born will be called the Son of God.
Amanda felt an overwhelming sense of power flow through her. An awakening that sent shivers through her frame, tiny quakes that grew in force until she felt as though she vibrated like a human tuning fork. The words on the page seemed illuminated with a holy fire.
Amanda found herself there in the grotto with Mary. Hearing not the angel, but the young woman’s fears. How tempted she must have been to give into them! The prospect of giving birth to the Holy One, balanced against all the woes of this world and all the pressures of life and tradition. And yet she found the strength not just to respond, but to continue. Amanda lifted her gaze to the polished stones of the grotto’s ceiling. The glory and the agony. Was this not the way of all mothers? The hope and the terrible anxieties?
The perfection of the heavenly gift was balanced against the tremendous burdens of motherhood. It was true for every mother. Emily and Frank with the child they lost, not to mention the crisis they endured with Lucy. Alathea and her two years of sleepless worry over little Rochele. All the little ones Amanda had cared for in the hospital, all the mothers who had sat by the crisis cribs and wept and prayed and begged for their babies to live, to grow, to thrive.
That was why she had not been able to enter the ward that day, Amanda realized. She could not face her own pain, much less the distress of other terrified mothers. She no longer possessed the distance and the balance required to comfort the ones who were brought into her care.
But was it truly gone? Had she not handled herself well with Rochele? Could she not at least try and return to the hospital, and confront her past and her present fears?