Things unforeseen were plaguing Rosie as well. Everyone reported that Claude was great for the school, patient and gentle, an extra set of much-needed hands for the understaffed staff, for the understaffed students who had never imagined anything as exotic and far-flung as her baby. But Rosie was working when Claude was at school, so this poise and grace went unseen. She knew that the clinic’s students must be teaching Claude as much as he was teaching them, for the protected world of even a transgender ten-year-old is awfully small compared to what these kids had seen, foreseen. But Claude was usually asleep by the time she got home from the clinic, so how he was learning or growing or becoming went unwitnessed as well. Instead she got tears over breakfast or, worse, worry that precluded talking about it, that drew his eyebrows together and his mouth toward his shoulders.
She expected heartache and sadness of course. She expected shock: culture shock from being a stranger in a very strange land and gender shock from being a boy again for the first time in five years and general shock from finding oneself, suddenly, a bald English tutor in Thailand. But she had also expected all that would have started to fade, at least a little, now that they’d been here a few weeks. It was so beautiful in Thailand. There was so much wonder. But if Claude was still miserable, maybe it was time to leave already. Maybe bringing him had been a mistake. “Do you hate it here, my love?”
“Here and everywhere,” Claude said without looking up. For some reason, he felt worse with his mom than he did in his classroom. He knew she was just trying to help him, but maybe he had more in common with his little students. He knew she loved him more than anything for seven thousand miles in any direction, but somehow that just made him cry harder.
She softened her tone. “Should we go home?”
He looked up at her at once, the worry turned sharply to panic. “No. Mom, no. We can’t go home.” Like their ancestral land was set upon by marauding hordes. Like their intergalactic space pod had crashed on landing.
This was unforeseen.
But accounting for the unforeseen was one of Rosie’s particular talents. At home this manifested as never having to go to the grocery store. She would look at a pantry that contained only the dregs of boxes of four different kinds of pasta, half a bag of brown rice, four cans of kidney beans, three of tuna fish, and a bag of expired sun-dried tomatoes and concoct dinner. She would be missing two-thirds of the ingredients in a recipe, and by subbing skim milk for cream and olive oil for butter and lentils for beef and frozen broccoli for fresh spinach and red pepper flakes for mushrooms and nothing for fresh sage leaves (because really, what dish actually hinged on fresh sage leaves?), she could achieve lasagna béchamel without leaving the house.
And it turned out it was this skill—not her years of ER experience, not her advanced training, not the decade and a half she’d spent in a teaching hospital—that made her so valuable at the clinic. What the recipe called for, they did not have on hand. What a Google search, not to mention said years of experience and her not-inconsiderable medical intuition, suggested as a viable substitution was not available either. But what Rosie could do was look at a yawning supply closet with its paltry stock, at moldy equipment and unreliable drug supplies, and figure out something that would work.
Sometimes.
She made a wound sequestration area out of palm fronds and coconut husk. She made an inhaler out of a plastic soda bottle. She prescribed drugs in all sorts of ways the FDA never allowed themselves to imagine.
It had been week two before someone came in with a broken bone, odd because fractures were so common, there and everywhere, and at first Rosie had been relieved. The woman was very pregnant and in a wheelbarrow, both she and her husband, who was pushing, flushed and out of breath, and Rosie had at first thought it would be something much worse. Whereas labor and delivery had tended, in her previous medical experience, to be the most triumphant rotation, here most people gave birth at home, and only came in when there was a complication, often only after it was too late or became too late during the journey. Rosie came to greet the sight of mounded belly with sinking dread. This patient grasped her domed front, shook her head, and assured K, who assured Rosie, “Baby stay. Ankle go.” It was then Rosie noticed her propped leg, purple and blue, her ankle swollen to the size of her thigh. “Fall off water buffalo,” K explained. “Hard to balance with such big…” The woman grinned then grimaced then grasped her belly again.
Rosie checked her pupils and her pulses, listened to her heart and the baby’s, had the woman endeavor to wiggle toes on both feet. “Let’s get you up to X-ray.” It was out of her mouth before she realized that at least the “up” was entirely erroneous. The X-ray too? Surely they had some kind of antiquated-but-better-than-nothing X-ray machine. How could they run the place without one? That said, she’d been there every day for two weeks and never seen one, heard one mentioned, located a building where one might have been. Maybe it had just never come up.
“K? I’m afraid to ask but … X-ray?”
K’s particular talents had proven to stretch further even than from auto repair to midwifery. K was her medic. That’s how the clinic director had introduced her on day two: “This is your medic, K,” as if Rosie had not already saved a truck, lost a patient, and delivered a baby with the woman. Rosie had not been aware she got or needed a medic or what a medic in a clinic like this one even was per se. It turned out the medic was everything except for what Rosie was. And sometimes she was what Rosie was too. K did injections. She did the vomit and the blood and the feces, which was saying something because there was a lot of all of the above. She did wound-care work and handholding work and being patient with patients work. She did the translating work of explaining prognoses and which drugs to take when and how to clean abrasions and stanch blood and how to rehydrate babies and when to let fevers run their course versus when to seek medical care. She translated English into Thai and Northern Thai and a variety of Thai dialects and Burmese and Karen, and she translated Rosie’s stern and complicated Doctor into kind and reassuring Nurse, instructions clear enough to follow precisely, gentle enough to inspire confidence and calm. Rosie assumed K had gone to nursing school at least, but K could not get into nursing school because K had never finished high school.
K was also her physical therapist and her social worker and her security detail. When a child came into the clinic with her father but then her father died, K knew how to comfort the little girl and find her someplace to stay and something to wear and enroll her in school. When a teacher came in to complain that his leg fit incorrectly so that he could walk, yes, but he could not stand for long periods of time in front of his classroom, K worked with the prosthetics department to fashion him a leg that stood as well as perambulated and with the patient to think about exerting discipline on small children from a seated position. When the injuries one woman claimed came from falling off a water cistern proved instead to have come from a husband incensed to find her pregnant again, K had him removed and found beds for all seven of his children. But K had never been to physical-therapy school or social-work school. K had never even taken a martial-arts class. What K knew, and it was a stunning, encyclopedic amount, she had learned from the doctors who’d come before Rosie, from the doctors who came and stayed for weeks or months or years, from watching, from experience, and from necessity. Rosie found herself asking K’s advice more often than the other way around. Rosie had more formal training, but it wasn’t training for this environment. K knew quite a bit more about worms and snakebites and what, based on your symptoms, probably laid eggs in you than had been covered by the University of Wisconsin’s medical school program. And of course she maintained Sorry Ralph, never mind the fact that her functional, sensitive, callus-free hands were precious as palladium. It took a while, longer than it should have maybe, but Rosie gradually realized the many versions of K layered atop one another like sediment. And like that striated earth, what remained of K after the buffeting of wind and wear and time was solid as rock.
“No X-ray,” K answered cheerfully. After two weeks of working together, K had grown amused by all Rosie requested as if she were asking if the clinic stocked mind readers.
Rosie eased the patient from wheelbarrow to bed. She remembered the night she’d accidentally X-rayed Poppy—well, Claude, almost-Claude, Claude-in-utero—all those years ago in the ER in Wisconsin. Here, she often found that absent being able to see entirely, insides included, it was better to see not at all. Until Thailand, closing her eyes was not a diagnostic technique she’d reverted to much, but it beat going to the grocery store. Especially since there was no grocery store. She held her hand above the patient’s leg to feel how hot it was. She pressed gently with her fingers, feeling for the break, feeling where it was twisted and misaligned. She pictured the X-ray sketched for her by her gently tracing fingers, the ghostly bones reaching for one another as if through time. It was remarkable, really, how well she could see without seeing. Later, she would detect fractures with the far more advanced technologies of a tuning fork and a stethoscope, but she was a couple weeks away from that trick yet. This first one, fortunately and unfortunately, was broken enough she could feel it easily, displaced enough, maybe from the wheelbarrow ride into the clinic rather than the break itself, that the patient was going to need something more than just a cast.
The art of bone setting is not a modern one. Rosie knew this. She knew that once upon a time, broken bones were treated by barbers and blacksmiths, that physicians felt fractures were beneath them. But she also knew why. You sought a blacksmith because you needed someone strong to realign the bone, to overcome the complete freakout the muscles around it were going to have when you started pulling. You sought a barber because you lived in the Middle Ages and were totally screwed.
K was tending to a patient who’d been carried in on a ladder, so Rosie was on her own. Her patient’s husband spoke no English at all. Rosie steered him by the shoulders and positioned him behind his wife’s head, his arms looped around her shoulders up to his own. Rosie went back to the other end of the wooden pallet and took the woman’s ankle gently into both hands. The patient gasped. This boded ill. She made the patient take five deep, slow breaths. She made the husband take five deep, slow breaths. She took five deep, slow breaths. Then she pulled like hell. The patient screamed. The husband screamed. But the bone realigned. And the baby stayed put. Lacking an intramedullary nail—she knew enough not to even ask for that one, not that she could have placed it without an X-ray anyway—she stabilized the leg with fabric wrap, a section of branch, and plates made of coconut shells. As long as the remedy required was something that grew on a palm tree, you were all set.
The patients in Thailand also knew what to do without what they never knew they were doing without. Absent antibiotic ointment, honey would stop a burn from getting infected. Dried papaya seeds crushed into powder would get rid of intestinal worms. Tea made from corn silk would reduce swelling. It was the way here. It was the only way. So it was this skill Rosie started employing, a few weeks into Thailand, a few weeks into Claude 2.0, not so much looking for remedies on palm trees as looking for them where she hadn’t been looking before.
She wasn’t so naïve as to imagine there was something she could crush up or stir in or scavenge from a plant to help her child live in the world. But if she could doctor without drugs, medical equipment, or sterilized bedding, surely there was another option besides the ones she and Penn had been considering so far. Surgeries, side effects, appropriated choices, and life interrupted on the one hand versus misery, failure to fit, and life disallowed on the other was not a choice any more than dying from dehydration or dying from an enema used to treat dehydration. The trick was neither to make peace with medical intervention nor to eschew it altogether. The trick was to doctor a palm frond to help Poppy and Claude find their way in the world. Rosie didn’t know what that trick was yet, but she was getting a crash course in looking for it.