by C. E. Smith
The bulbous, encrusted foot – perhaps even more grotesque with the sheen of betadine – lies on a cushion of sterile blue drapes. A loose tourniquet encircles the thigh, not yet inflated. Burkett finds the pulses of the arteries: popliteal, anterior and posterior tibial, and peroneal. With a felt marker, he outlines the path of his incision.
‘Aren’t you getting a bit close to the induration?’ Beth asks.
‘It’s fine,’ he says without looking at her.
Her question – which she probably wouldn’t have asked if the surgeon were Owen – is all the more annoying for touching on his own doubts, his discomfort with an operation he’s never actually performed. But he resists the urge to explain the basic principles, that for whatever length of bone he wants to preserve, he’ll need an even longer flap of skin to cover it.
He makes a circumferential incision. Blood seeps despite the pneumatic tourniquet, so he singes the edges of the wound with electrocautery. He uses a blunt probe to tear free the skin, exposing the moist tissue underneath. He begins plucking away the fibrous layer covering the greater and lesser saphenous veins, which cling like vines to the surface of the gastrocnemius muscle.
‘Light,’ he says, prompting Beth to adjust the lamp.
It’s taking him far too long to locate the tiny sural nerve, especially when compared to the expert in the video who found it in no time at all. He’s tempted to abandon the search, to simply amputate the nerve along with the rest of the leg, but as a sensory nerve it could cause chronic pain, so he presses on till he finds it, and when he does he cuts it as close to the knee as possible, high above where he plans the stump.
He notices the trembling of his hands, the first sign that he needs his pills. As if his hands were sentinels, the first warning of a progressive tremor – a tremor that will spread through his nervous system, from the outside in, till it reaches his brain and renders him frantic with anxiety. In less than an hour, he’ll be able to think of nothing but the pills.
This morning he took a single Valium instead of his usual two. He skipped the dose of short-acting Xanax. He thought he needed his mind clear for this unfamiliar operation, but now he sees that he made a mistake.
‘You all right?’ It is Nick, standing across from him in a matching gown and mask. With a wad of gauze he pats the surgical field. Beth sits on a wheeled stool, easing Fentanyl through the patient’s intravenous line.
‘I need a bathroom break,’ he says, tearing off his gown and gloves in a single motion.
Nick and Beth stare in surprise. The patient sleeps, the prongs of a cannula resting in his nostrils.
Burkett hurries back to his room, where he takes another Valium, along with a Xanax and a shot of siddique. He is aware that his craving is worse now than during his fellowship just a year ago, when he could last eight hours on a single Valium. This depressing thought is eased by the taste of the sid, the knowledge of those pills dissolving in his stomach.
Nick, Beth, and the patient remain exactly as he left them. On the blue-draped table, Beth has placed a new sterile gown and pair of gloves on top of the forceps, probes, needle-drivers, clamps, and retractors. Only after he snaps on his gloves and knots his gown does he realize that he does in fact need to urinate.
An amputation below the knee. It seems simple enough: cut the tissues, control the bleeding, and cover the stump with a flap. But even the simplest procedures have nuances that can only be learned through experience. By merely watching a video, he couldn’t possibly prepare for every contingency, but the hands of that anonymous surgeon seem almost interchangeable with his own as he ties off the vessels and saws through the tibia and fibula, smelling even through his mask the crisp, dry bone dust. After cutting the last strand of muscle, he nudges the severed foot off the table and it strikes the floor with a thud.
9
He seems to have overslept. Last night he finished the siddique from the capital, so if he wants his usual shot he’ll have to settle for what he bought from the apothecary. He uncaps one of the bottles, but the fluid inside seems more turbid than he remembers. He’s heard stories of siddique causing blindness, a side effect of methanol contamination. Maybe before drinking it he should test it on one of the stray dogs.
The sink runs dry, as it often does, so he uses bottled water to wash down his pills. He swipes his armpits with a stick of deodorant and puts on the Penn State tee shirt and a pair of scrubs.
He had a dream he can’t recall – only that it was suffused with bitterness, as if the dream had no content other than a disconnected feeling. If this dream featured characters, landscapes, or sounds, he has no memory of them now. All that remains is the aftertaste.
Pausing at the door, he reconsiders the siddique. He opens the bottle and brings it to his lips. It tastes no different from the previous batch. A local word comes to mind: inshallah. As God wills. It is the shrug of fatalism, the nearly comical resignation of so many of his patients. If he goes blind, so be it. He follows the first small sip with a larger one.
He crosses the courtyard toward triage, thinking he needs to check Sabib’s wound and send him home. In the two days since the amputation, the patient has been sleeping on an air mattress in the clinic. After Burkett leaves at the end of the week – he’s arranged for his trip back to Atlanta two days from now – Nick will have to visit Sabib’s home to remove the skin staples.
The clinic is unusually quiet, at least for this hour of the morning. It might be a Muslim holiday. Normally a line of patients would be waiting outside the door, but the only patient he sees is an old man at the gate limping away from the clinic. Even from a distance Burkett can make out the open sore on his leg. The bandage meant to cover it is wadded in his hand, as if he’d left in such a hurry there was no time for putting it on.
He is running from something, Burkett realizes. The other patients must have fled as well.
The parking lot is empty but for a spavined American station wagon, parked in such a way that he doesn’t see it till he turns the corner at the entrance to triage. The roof of the station wagon has been sawed open to accommodate a mounted machine gun. The driver’s door squeaks open to reveal a teenager in a police uniform. A Kalashnikov, pointed skyward, rests in the crook of his elbow as he gestures with his free hand for Burkett’s phone. The boy must be too young for policework – fifteen or sixteen at the most – but perhaps age limits are waived when a militant switches sides. Or maybe the boy simply stole the uniform.
He pockets Burkett’s phone and conducts him into the clinic’s small anteroom, where Beth and Hassad face another gunman. This one wears a police uniform too, but with a red turban and full beard. Burkett’s eyes fall to the man’s flip-flops and thick, discolored toe-nails. Toe-nails like horse’s teeth: a severe case of onychomycosis, a chronic fungal infection.
‘Weapons aren’t allowed here,’ Beth says, jabbing her finger toward the gunman’s face. Hassad doesn’t bother interpreting, and his silence seems like a comment on the pointlessness of her statement.
The man aims his rifle at Burkett and barks a question.
Burkett stares. Was it you who killed my brother? Do you look at me and wonder how Owen came back from the dead?
His Kalashnikov is indistinguishable from the boy’s, at least to Burkett’s eye. Worse than dying by the same gun would be to die by the same gun and not know it. If only he could be granted the satisfaction of that final symmetry. But if these were Owen’s killers, surely they would betray some reaction, some flicker of recognition on seeing the twin brother.
‘He asks if you’re here to spread Christianity,’ Hassad says.
‘Absolutely not,’ Burkett says. ‘Tell him we’re doctors, we’re here to give medicine —’
The man thrusts the gun barrel against his chest. He staggers backward, reeling with pain. He rubs his sternum, half expecting an unnatural depression or loosening of bone. An imag
e flashes before him: a textbook skeleton labeled in elegant calligraphy. The segments of the sternum are called manubrium and gladiolus, handle and sword. He always appreciated the use of metaphor in anatomic names, but for the first time finds himself wondering about the incorporation of weaponry. Did the early anatomists, when considering the bone closest to the heart, have more in mind than its vague resemblance to a sword?
‘He wants to know where are the Bibles,’ Hassad says.
‘We don’t have any Bibles,’ Burkett says.
Abu told them, no doubt, and why shouldn’t he? This is the way it is with torture, Burkett imagines. You tell them what they want to hear, whatever you can say to stop the pain. Surely Abu would have told them about the hidden compartment under the floor of the supply closet. Did they force him to renounce his faith as well? On that one issue perhaps he refused to yield.
The man in the red scarf is speaking directly to Hassad. Burkett recognizes the word Amrikee, American.
Hassad nods toward Burkett and says, ‘Tabib, na’am.’ Doctor, yes.
Another policeman, also in flip-flops, emerges from the back room, pharmaceutical packages loaded in the front of his shirt. Burkett recognizes the sky blue label of Xanax. He feels a twitch of shame, but now that the worthless pills are in the hands of jihadists, he dares to wonder if some good might come of his ruse. Perhaps some suicide bomber will come up short on the dose needed to blunt the fear of death.
‘He can’t take those,’ Beth says. ‘That’s medicine for our patients.’
After a brief exchange, Hassad says, ‘It’s the religious tax.’
‘Religious tax?’ Burkett asks.
‘The government provides uniforms and guns,’ Beth explains, ‘but no paycheck till they’ve been vetted by Khandari special forces. That could take up to a year, so in the meantime they collect a “religious tax” to support themselves.’
He hears the sound of another car in the driveway, probably Nick returning from his rounds.
‘Please tell me he went out with one of Walari’s men.’
‘What do you think?’ She is pinching the front of her tee shirt, or perhaps the cross she wears tucked behind it.
By the time Nick steps into the clinic, he has somehow managed to keep his phone from the boy, but the gunman in the red scarf pries it away and strikes him in the abdomen with the butt of his rifle. Despite the awkwardness of the blow, Nick grunts and bends at the waist and lowers himself to the floor.
Beth kneels beside him. Nick has his eyes closed, his head bowed as if praying, but Burkett realizes he is actually listening to the conversation among the spurious policemen.
‘What are they saying?’ he asks.
‘We’re going to be all right,’ Nick says. ‘They only want us for ransom.’
‘Ransom? We’re being kidnapped?’
‘As soon as we’re gone,’ Nick says to his wife, ‘call Mark Rich, describe the car.’
‘I’m going with you,’ she says.
‘Unlikely,’ he says. ‘They’d see it as shameful to take a woman.’
Before she can object, he says, ‘Once you’ve talked to Mark, call Pierre at IMO.’
She nods. ‘Where will they take you?’
‘South, probably.’
At gunpoint they are led outside. The boy stands in the back of the station wagon and sights them with the mounted machine gun, but it seems like an empty threat since his compatriots too would fall in the line of fire. The one in the red scarf walks to the edge of the lot and surveys the road.
‘They want us – to lie in the back of the vehicle,’ Hassad says, clearly wishing the us were a you.
‘I’m sorry about this,’ Nick says to Burkett. ‘It’s not what you signed up for, and just two days before you’re scheduled to leave.’
‘Maybe we’ll get it resolved by then.’
‘Maybe.’
But the doubt in his voice reminds Burkett of kidnappings that have lasted weeks or even months. He can’t help but smile wryly at the absurdity of it. The word that comes to mind is ‘godforsaken’: a word for himself and his brother and this entire island.
Strange that he isn’t more afraid. Curiously enough, his heart rate would suggest a state of panic, but he feels abstracted from himself – the way he felt the second time he was arrested for drunk driving, when his cuffed wrists seemed to belong to someone else. He isn’t drunk at the moment, not even close. But if he hadn’t taken the pills and the shot of siddique, he’d probably now be begging for his life.
‘Make sure they see you crying,’ Nick mumbles to his wife. ‘Cry like you’ve never cried before.’
Her weeping seems authentic as she embraces him under the watchful gaze of the jihadist policemen.
‘Why do you want her to cry?’ Burkett asks.
‘They’d be less inclined to kill a man supporting a family.’
‘Can she cry enough for the three of us?’
He meant it as a joke, but of course no one is laughing. Beth, seeming to take it to heart, drops to her knees with her fists clenched and face contorted as she howls in wordless entreaty. The display seems unnatural – like an American trying to imitate the funereal ululations of the local women – but she carries on even as Burkett, Hassad, and Nick climb into the back of the station wagon.
The vehicle lacks any kind of back seat, so they have to make use of the wood planks on either side of the mounted machine gun. Their captors force them to lie down in order not to be seen through the windows. As the car passes through town, Burkett can see the tops of cinderblock and mud brick walls, the occasional tree. Brown dust rises when they leave the paved road. The legs of the gun jab into his back as the car bumps over the uneven surface. He is relieved when they finally come to a stop.
‘Where are we?’ he asks after they’ve climbed out.
‘South of town,’ Nick says.
Their captors drape the station wagon in camouflage mesh. Two women, fully covered in burqas, are plastering the walls of a hovel with what looks like a mixture of mud and straw. A cow stands tethered in the yard, dipping its snout in a bucket. Out of the hovel limps an old man with seashells braided into his long beard. He speaks to the gunmen, while the boy walks to the far side of the building and starts the engine of a decrepit Buick sedan.
‘Shouldn’t we make a run for it?’ Burkett whispers.
‘Beth’s calling in the cavalry,’ Nick says, shaking his head and looking toward the sky for some sign of military or perhaps heavenly rescue.
‘I agree with Dr Burkett,’ Hassad says. ‘I have an uncle who lives nearby.’
The two older gunmen follow the bearded man into the hovel. From the Buick the radio blares as the boy searches for reception.
‘This is as good a chance as we’re likely to get,’ Hassad says. ‘This is the time to run.’
‘Look at the terrain around here,’ Nick says, sweeping a hand across the empty fields. ‘We’d be sitting ducks.’
Hassad locks eyes with Nick. ‘A white man would bring a high ransom,’ he says, ‘but me, a Khandari from a poor family, they will kill me first.’
‘The best way to get yourself killed is to run.’
But Hassad turns and sprints into the stretch of scrub and stone, toward a copse of trees in the distance. Burkett looks at Nick, who glances back toward the hovel. It is a question of risk, a window of opportunity – and perhaps for Nick a concern for his ministry, a fear of being perceived as a coward – but Burkett has already made his decision, and he is glad when Nick starts running as well.
Behind them now the boy is shouting, honking the horn of the Buick. Hassad is still at least twenty yards ahead of them when they hear the first gunshots.
Burkett feels in his ear a change in pressure, the hum and press of what can only be a passing bullet, and that very instant a cloud bur
sting from a nearby rock showers particles into his face and eyes. All he sees is black and he wonders if the bullet in fact has penetrated his skull and severed his optic nerves, but when he drops to the ground he finds his vision again in the flood of burning tears.
The sharp cracks in the air seem to grow ever closer, but then there is a pause in the gunfire, and from somewhere off to his left he hears Nick shouting in Arabic. Burkett risks a glance over his shielding rock. Nick is walking toward their pursuers with his hands raised. Perhaps he is trying to create time for the others to escape. Burkett wonders if he should make a run for it, but when he looks again, that red turban is only a few feet away.
The boy guards Burkett and Nick while the others pursue Hassad. They sit in the back seat of the sweltering Buick, irritated as much by the safety mechanism that blocks the windows from fully opening, as by the boy outside who circles the vehicle and occasionally taunts them with his Kalashnikov for no reason beyond the pleasure of startling them, or perhaps imagining what it would be like to strafe the glass and metal and flesh inside.
Nick regrets running – ‘Stupid, stupid,’ he says – but it might have given Hassad the extra seconds he needed. And if someone heard the gunshots and called the authorities, then maybe at this very moment the hovel and the Buick are pictured on a screen in some military control center. It seems to Burkett that every minute of delay should improve their chances of rescue. But there are no helicopters or special forces, only the boy and his gun, and the old man who emerges from the hovel to give them all a drink from a canteen of water. It is less than an hour before the jihadists return. Hassad is nowhere in sight – which could mean either death or escape – but Burkett can tell from their downcast expressions that they haven’t found him.
Within minutes they are driving south in the Buick. Burkett and Nick are given scarves to cover their heads – disguise enough for the casual observer. Burkett sits in the middle of the back row, Nick in the front passenger seat, both of them staring straight ahead in silence as they travel deeper into the barren country. They turn off the main thoroughfare and continue on a dirt road. Mountains loom in the distance ahead but never seem to get any closer. Near sundown they pull off in the scrub. The jihadists unfurl rugs and pray while Burkett and Nick walk a short distance to a rock outcropping.