JULIA COULD NOT SEE WHAT WAS LEFT BEHIND WHEN THEY DROVE PAST THE VILLAGES. BUT she could hear. She heard automatic rifle fire and the taunts and the boasts of the boys in the back of the truck. She heard muffled voices calling out and screaming, which faded as they sped away.
Julia saw the mud-walled huts. In one village they were just building a hut. There was a beautiful latticework of poles where the walls and roof would be, as if someone commanding the power of history had reached into the bush, found a collection of perfectly straight poles, and then assembled them, carving a safe space for human life out of air and elements.
One moment she had been on the roof of their Land Cruiser, lowering a tire and getting a kiddo dying of malaria moved into Buchanan the quickest and best way she could manage. The next moment she watched Carl’s car drive north with Sister Martha, the child, and its mother. Then she saw a pickup on the road from District #4 Health Center. They heard the rumbling bass of a stereo from the blue pickup. You could see that there were people in the back of the pickup as it came closer to the main road, but you couldn’t see their faces or hear the sound of the pickup or their voices. Only the sexy grind of the music pulsing into the country air. The pickup turned right and climbed the small hill that was between the road it had come from and the hill they were on.
Julia had looked away, thinking to sit on the side of the road and wait for the relief truck from Buchanan. Then the pickup was on them. There were three boys in the front and five or six in the bed. The boy on the passenger side leaned out the window with a gun and began firing.
“No weapons!” Julia shouted, but all she could hear was the ripping and rattling of gunfire.
“Oh blessed God!” Torwon screamed. Blood burst from the right side of his head. He covered his face with his hands. Then he staggered to the side of the road and fell.
The boy in front kept firing until the blue pickup was next to their truck. The music from the pickup sizzled and whomped.
Charles, who had been squatting next to the rear wheel, stood as a line of redness crossed his belly and chest, and then he groaned and fell slowly into the road, face down.
Then the boys in the back started firing into the Land Cruiser. The bullets crunched and rang in the metal and the glass. The shattered windows collapsed, the shards hissing as they fell into the skeleton of the truck. Then there was a bright yellow flare, a roar, a hot wave, and then thick black smoke as the gas tank exploded. Suddenly there was acid in Julia’s eyes. She felt her eyebrows sizzle and turn to ash. The stink of burning rubber choked her. Julia’s throat closed. All she could see was orange and black, and all she could feel was burning. She bent under the smoke and backed away to find air she could breathe as her hair started to burn.
The boys in the back of the truck laughed and hooted. Then they jumped from the truck and surrounded her, all touching her at once. They touched Julia’s breasts and butt and neck and crotch and face.
“Get the fuck off me,” she said. “Who the fuck do you think you are?”
She stepped forward, swatting their hands with her hands. Someone grabbed her from behind, a sweaty arm around her neck, and sets of hands grabbed her thighs. They lifted her into the air as they spread her thighs apart. It felt like they were ripping her body in two.
Then one who was wearing a yellow bandanna and whose bare chest was crisscrossed by ammunition belts came and swatted the others away with the butt of his gun. They lowered her so she was standing. The man-boy wearing the yellow bandanna couldn’t have been more than seventeen. He had dark skin, small red eyes, and a dark, humped up scar that ran from the right side of his face half way through his right nostril.
One of the others, off to Julia’s right, shoved a gun barrel against her temple. And then the man-boy in the yellow bandanna slowly reached his hand behind Julia’s neck, pulled her to him, and pushed his mouth and then his tongue into hers.
Then he jumped back, hit Julia across the face with the back of his hand, and put his hand on his bleeding tongue.
“Fock you!” he said. He swatted her away and yelled something in Kpelle that she didn’t understand. He hit her face with the back of one hand again and punched her with the other, one-two. Julia’s head snapped backward, the bones of her neck crunching together, and her nose began to bleed.
They bound her hands with a bloody rag and shoved her into the cab next to the driver, with two others—the one with the yellow bandanna right next to her, his gun resting on her thigh and pelvis, the steel from the stock pressing into her flank and its barrel under her breast. The beat of the music throbbed in the air, shaking Julia’s thighs and back and keeping her from thinking.
She wasn’t dead, and she hadn’t been raped. Charles and Torwon were dead. They hadn’t shot her when it would have been easy to, and they hadn’t raped her right there in the road beside the truck.
Two blue police Land Cruisers were waiting for them at a road junction a mile or two toward Buchanan, where a road came in from the east. The truck carrying Julia slowed. One of the thin men-boys in the uniforms, who had RPGs standing in the red dust next to their dusty but pale blue vehicles, half lifted a rifle onto his shoulder, but it was not a serious threat or challenge. The driver stopped and the men talked in Kpelle, not Kreyol. Then some of the men-boys got into their Land Cruiser, and one of the Land Cruisers followed the pickup south.
The cold barrel of the gun jutted into the soft part of Julia’s belly, just under her ribs. It jammed into her flesh and bone every time they hit a rut or the truck swerved, and it hurt her every time she took a breath. Carl will see the burning truck, Julia thought. He’ll be back from Godeh soon. He’ll see the truck on fire and see Charles and Torwon dead on the road in the dirt. Whatever was true or not true about who we are to each other, Carl will get help.
But there wasn’t going to be any help. Carl would hit this checkpoint. Then Carl would also die. They carried no weapons. Carl and the kiddo and Sister Martha and Carl’s driver and the mother and the mother’s mother. They would all die. And there was nothing Julia could do to stop it. And then it would be hours or days before anyone knew that Charles and Torwon were dead and that Julia was gone.
The pickup turned onto a road that ran east and north. So they weren’t going to Buchanan. They were taking her somewhere but not back to the hospital. To a place she didn’t know. Where no one would ever be able to find her.
There is no privacy for NGO expats in Buchanan, so Carl and Julia met at Sparks Hotel. For a drink and dinner.
It was a Lebanese place that was trying to look American, so they had hung football jerseys on the walls. It had a jukebox that didn’t take money that played disco and top ten music from the ’80s and ’90s, over and over. The rest of NGO life reminded Julia of the world of graduate students in a university town, where everyone goes to potlucks and drones on and on about their professors, their work, and about who is sleeping with whom. In Buchanan NGO staff ate at one another’s compounds most nights. They had Liberian housekeepers and cooks to make the food and clean up afterward, but each NGO made a great show of using food they grew in the compound garden, of cooking together and helping to clean up, and of recycling the paper and the organic waste. The bedrooms in the compound houses were like dorm rooms at college only the walls were thinner, so you could hear the person in the next room as they walked, snored, or turned over in bed. In each bathroom were sheets of neatly typed rules about cleaning up after use and about the disposal of feminine hygiene products. The sheets of rules sat inside clear plastic envelopes and hung from the mirrors. The rules had lots of capital letters and exclamation points for emphasis.
They met at Sparks after the evening rain. They had their drivers drop them at the hotel. The drivers went back to the compounds and would return when they were texted. They could have come over in the same van, but they came separately, and the plan was for them to return separately, each to their own compound.
It was a hotel and restaurant. The customers were mostly white and Middle Eastern but anyone was welcome. Near the little harbor. The white South Africans and Rhodesians (because that was how they still thought of themselves, as Rhodesians, and not Zimbabweans) came with their girls or picked up Liberian girls at the bar—girls who made themselves up and sometimes dyed their hair blond or green or pink and sat on the laps of the white men while the fake jukebox cranked out the same music, over and over. Those white men looked like rugby players, stocky and blond, although there were also Ukrainians and Poles and Bulgarians—thin, very pale men in cheap suits who often brought made-up white women with big blond or platinum hair and bigger eyelashes.
Carl bought the first round. “Glad you could come,” he said. “I wanted a place where we could talk.”
“Thank you for asking,” Julia said. “You never get a moment to yourself here.”
“We can talk about Rhode Island,” Carl said.
“Little place,” Julia said. “Not much to say.”
“Wait, I’m from there,” Carl said.
“And I spent four years there. I still have friends there. My mentor is there. My car is there. Like I said, not much to say. I didn’t like it much. I like you, though.”
“You want to talk about your work?”
“Not really. Does your work matter?”
“It matters some. We get clean water to about one village a week. Keeps people from getting cholera and other dread diseases. Gets one person in each village a job. It matters more than anything I could do at home. Does anything in the U.S. matter?” Carl said.
“Not much. How many of your pumps are still working five years out?” Julia said.
“Not many, unless we swing by to check on them once a month. Supportive participatory development. Participatory development doesn’t work. People aren’t ready. Incremental cultural development. New development model. Whatever all that means,” Carl said. “You take care of these cool little kids. Fun, no?”
“The kids are fun, yes,” Julia said. “I love being in charge, being the one person who can fix it. Sounds strange, but I even love it when they call me in at 2:00 a.m. for a kid with a fever who needs a spinal tap. This won’t mean anything to you, but I love being able to prance in half asleep, look at a baby, roll the kid over, and do a quick spinal tap. There is nothing quite like the feeling you get when you put a needle into the spine between the vertebrae at exactly the right place, feel the membrane around the spinal cord ‘pop’ as the needle goes through that membrane, and then see drops of crystal clear fluid come out through the hub of the needle. And then I start the kid on antibiotics, and sometimes I even get to save a life. At home, I might do two spinal taps a year, and then the kid goes to the Pediatric Mobile Intensive Care Unit, and I never see that kid again. Here, I do two or three taps a day. I do the tap, start the antibiotic, see the kid on rounds every day, get to know the mother and her sisters, and sometimes even the father and the other kids, and then I get to see the kid when she’s better, when I’m out in the bush doing clinics at the health centers. As long as the kiddo doesn’t die. So not very often, to tell the truth.”
“So you do the bush as well,” Carl said. “The bush is different. People at home will never understand it.”
“I love the bush, the country places far away, where they need everything,” Julia said. “You’re right. No one in the U.S. knows or understands what goes on out there—the women with twenty children, all those complex relationships, different fathers, different mothers, kinship, the sharing and the control and the violence, the rituals, and the secret societies. Women in the bush die in childbirth all the time. That almost never happens at home.”
“You miss being home?” Carl said.
“Naw,” Julia said. “I don’t miss the self-important fluffery. We have these great important lives in which nothing else matters besides work, while most of what we actually do is work ten hours a day, watch TV, wait in line, and fill out one stupid form after the next. I do miss having people I know and who know me to talk to. Don’t get me wrong. I like my colleagues and all that. But talking to people about medicine and even the countries they come from is different. It’s not personal. No one here knows anything about Stanley’s Burgers in Central Falls or Ray’s Pizza on Sixth Avenue in the Village or the Talking Heads or Will.i.am, and I’m betting you know all that stuff without even thinking about it. I miss people to talk to and people to be with. See? You can tell. I’m talking too much.”
She wanted him to say, no, you’re not, or something, but instead he just shrugged. She drained her gin and mostly tonic. “So what about you? You miss home?”
“It’s different for me,” Carl said. “I fit in here. Sort of. I’m not from here, but nobody knows that instantly just by looking at me. I miss Stanley’s a little but not so much. Home is a hard place for me. Tough history. I can’t see that ever changing. Here no one will ever know who I am, but at least here not everyone has already decided that I am who I’m not. I can make my own life here. Yeah, it’s a little lonely from time to time, but things here will change. Have to change. No place to go but up.”
“You—we—won’t change things here, though,” Julia said. “People have to want to change it, and they don’t. At least not yet. They could learn how to make their world safer and cleaner, but they don’t want to. They live the only life they know, and in its own way, it works for them. They live hard, and they die young, but they don’t worry the way we worry, and they don’t ever feel worthless or struggle with self-doubt. I’m trying to keep kids alive one at a time, when I can, but the odds are tiny, and it’s a huge uphill battle. I could save a lot more kids if their mothers brought them in as soon as they got sick. Hell, I could save even more if everyone slept under a bed net. But I lose a lot of kids, and that’s all on me. It really sucks to lose even one. I guess I hope to keep a few of these kids alive long enough so that they can grow up and change things. Bill Levin, my friend and teacher in Providence, has all this stuff about if you save one life, you save the world, about how each life brings the lost light back to the world. My work is nothing like that. Not much light. Too many kids dying in the bush. Sometimes we get lucky, that’s all.”
Julia put her hand on Carl’s hand, which was holding his glass.
“You want dinner?” Carl said.
“Not necessarily. We can eat any time.”
“I’m getting a room,” Carl said, and he ran the inside of his calf against the inside of Julia’s calf as he stood up.
One of the white Rhodesian guys sat down in Carl’s chair as soon as he was out of sight. He must have been six foot three and 250 pounds. He had blond curls that hung down the back of his neck.
“You look lonely,” the Rhodesian guy said.
“That chair is taken,” Julia said.
“Pleased to make your acquaintance,” the Rhodesian guy said. And he stood up and went away.
The room was a cheap room that claimed to have a view of the harbor. It had a bed with a mattress that sagged in the middle and a desk next to the window that had a chair in front of it and a bureau that didn’t match on a far wall, a ceiling fixture with a bare bulb, and no television. The window had a blind but no curtains. An air-conditioner in the window rumbled and hummed. It produced a moist breeze but no cold air. Out the window you could see the floodlights from the steel plant floating over the blackness where the sea likely was and the headlights from occasional cars but nothing else.
Carl put his hands on Julia’s hips as he kissed her after they came into the room. They were standing just at the point where the narrow entryway opened before the bed, and Carl hadn’t closed the window blind yet. He knew how to kiss, and Julia discovered that she did too. She thought she had forgotten, but it was like remembering something she had never really known. He knew how to unbutton her. Carl was strong and he smelled like burnt orange—strong and sweet.
He undressed her in the light. She sat down on the bed. “Wait,” she said.
“I can’t wait,” Carl said.
“We have to wait,” Julia said. “I’m a doctor, remember? Always ready. Though maybe that makes me a marine.” She reached for her shoulder bag and rummaged in it. Carl, sensing what she was about, reached for the wallet in his pants.
“I have one as well,” Carl said. He took her hand and pulled her up and off the bed so he could pull off the bedspread and they could have cool sheets for their bodies. “And that puts you in the coast guard not that marines. Semper paratus. Always ready. The marines are semper fi, semper fidelis, always faithful, which does not appear the subject of our discussion of the moment.”
He knew how to fuck too. As well. Better than that. Long and slow. Then deep, hot, everlasting, and explosive.
They made love a second time. Then they lay together side by side as they caught their breath.
“It doesn’t get much better than that,” Julia said. “Kind of a grand slam.”
“A grand slam is four runs, three men on,” Carl said. “That was just batting practice. Wake me in a few minutes if you’re still awake.” And he fell asleep.
Julia lay awake, staring at the ceiling. She hadn’t fucked anyone in a long time, and this was better than she expected. He was sweet, and he was smart, and he was good in bed. Damn, she thought, I’m falling for this guy. Not good. He would find out, over time, how little she had to offer, how vapid and boring she was, and he would move on to someone hotter, or smarter, or richer, or famous. It had happened before.
She closed her eyes, looking for sleep. And it found her.
He woke her with an embrace, and they made love again. It was later, but how late there was no way to tell. He got up to look for his watch, but she pulled him back into bed.
“Hey,” Julia said. “Talk to me.”
“Oh, now you want to talk,” Carl said. “What do you want to talk about? You probably also want dinner in a nice restaurant. And wine. Probably a fancy California Chardonnay.”
“Stop. Just talk,” Julia said. “Tell me stories about growing up. And I like good French wine not California crap. California wine is for Californians. Which I was, once. Now it’s Côtes du Rhône. Dry, deep, and full of body.”
“Stories about my youth,” Carl said. “Back home in little Rhody, hot summer days, getting up when the rooster crows, feeding the cows before breakfast, working hard all day in the hayfields, fishin’ in the fishin’ hole, swimming in the swimming hole, that kind of stuff?” Carl lay flat on his back, looking at the ceiling.
“That kind of stuff,” Julia said.
“It wasn’t like that,” Carl said. “I’m looking forward, not back. How about you?”
“How about me what? You’re ducking the question.”
“Not ducking. Just skillfully evading,” Carl said. “My life is the opposite of an open book. Closed, sealed, and put away. What’s past is past. That’s a quote from a great ancient sage of my people.”
“You are misquoting,” Julia said. “What selfsame ancient sage said was, ‘The past can hurt. You can either run from it or learn from it.’”
“Oooh,” Carl said. “Your knowledge of ancient literature is deep and extensive. Getting a little personal, aren’t we? The residency was pediatrics, yes? And not psychiatry.”
“Residencies. Pediatrics and Emergency Medicine, if you please,” Julia said. “And you are still ducking the question.”
“You really don’t want the details. I just don’t go there anymore,” Carl said, and he rolled on his side and began to caress the small of Julia’s back, her butt, then he ran his hand deep inside her inner thigh.
“That’s good,” Julia said. “Very good. But it doesn’t get you off the hook. So you were born in Rhode Island?”
“I was born in Rhode Island. In Pawtucket, Rhode Island, in a neighborhood called Fairlawn, which had no people of color then, other than in the housing projects closer to downtown. It gets pretty messy after that.”
“You have siblings? Sisters and brothers?”
“One sister. Eighteen months younger. She’s still in Rhode Island.”
“And?”
“No ifs, ands, or buts, other than the very nice butt in my hand as we speak. That’s all there is. More than enough.”
“And your parents?”
“I had a mother and a father. My mother was from Martinique. Very Creole. Very dark and very beautiful. You just don’t want to know all this. We have better things to talk about and better things to do,” Carl said, and he pulled her to him.
“Ummm,” Julia said. “Sweet. Very sweet. Tempting to be sure. Exceptionally tempting. But it still doesn’t get you off the hook. What about your father?”
“Look, can you let it alone? I like fucking you. I like you. But my life is my life. Do what you want with my cock. Just leave my family out of it,” Carl said.
“No push,” Julia said. “I’m just interested. Sounds like your father wasn’t easy.”
“My father was a Jewish guy from Boston, all right? Very political. Pretty isolated. He got weird after we moved to West Virginia. This is all pretty messy. You just don’t want to know,” Carl said.
“I do want to know,” Julia said. “How old were you when you moved to West Virginia?”
“I was five. My sister was three. We lived there for seven years. Then we came back to Pawtucket. Satisfied?” Carl said.
“What brought you all to West Virginia?” Julia said.
“The car. It was a Chevy. I don’t know,” Carl said. “My father was trying a back-to-the-land thing. He bought a cabin on a dirt road in the mountains. We grew our own food. He went hunting for meat, and he thought he could make living writing articles for left-wing newspapers and magazines about life off the grid. He had a little family money. My mother was a speech pathologist. She worked in the schools. We lived off her income.”
“Sounds nice,” Julia said.
“It wasn’t nice,” Carl said. “I was a black kid from the North in a white place, and I had a family that didn’t get being black in America. So I looked a little black, but for sure black enough to make me black in West Virginia, and I thought white, which meant I didn’t get how to go along and get along. And my father was convinced that the John Birch Society and the Ku Klux Klan were about to take over America, and that we had to be ready, so we could hold out until the Russians came. Crazy stuff. Crazy-crazy. He was probably schizophrenic. We were alone, back in the woods, where no one could see or hear.”
“Yikes. What kept you sane?” Julia said.
“Who says I’m sane?” Carl said. “I found a black church, or they found me. Little place by the side of the road. Weirton, West Virginia. We lived about five miles out of town on a dirt road in the woods. Old steel town. There were a couple of old steelworkers, the guys who worked the coke ovens. Their families prayed together. I started hanging out there on Sundays. Rode my bike. I told my father I was fishing.”
“And?” Julia said.
“No and …” Carl said. “My cover got blown in the weirdest way. There was also a little synagogue in Weirton. A couple of the store-owners and some of the doctors were Jewish, but by the time I was growing up, that community was in decline. Most of the families had come as immigrant peddlers a generation before. Their kids all moved to Pittsburgh, New York, Boston, Cleveland, or DC. My father, crazy as he was, would take us to that synagogue on the Jewish Holidays, and as much as we felt like outcasts every day, we felt really weird in that place. Anyway, the synagogue caretaker went to Bethel AME. I started talking to him at the synagogue, and my father got suspicious. My old man followed me the next Sunday. That was that. I got grounded for Sundays. We moved away about six months later.”
“Where are your parents now?”
“My mother died before we left West Virginia. My father’s in jail in Massachusetts. Long story.”
“Your sister?”
“She’s okay. She lives in Rhode Island. She went to Princeton, and she could have lived anywhere, but she’s back home now. We talk. We’re close. She’s okay.”
“Sounds complicated.”
“It is complicated. Was complicated. Not complicated anymore.”
“You want to talk about it?” Julia said, and she reached over and put her hand on Carl’s cheek.
“I’ve talked way too much,” Carl said. He took Julia’s hand off his cheek and put it on the bed, away from him. He rolled over onto his side, his back to her.
He’s angry, Julia thought.
He turned around again. “It’s okay. You’re okay,” Carl said. “I haven’t talked this much about myself in years. Pretty boring. Sorry I rambled on.”
She’s even smarter than she looks, Carl thought. Why am I talking so much? Got to be careful now.
“I’m sorry,” Julia said.
“Nothing to be sorry about. The past is just the past.” Then he fell asleep.
Julia lay quiet for a few minutes. I shouldn’t have gone there, she thought. I fucked up again. Who is this guy? What the hell has happened in his life? Why do I like being here so much? Why does wanting hurt, every time? The ache in her shoulders, the strange sensation that was part pain, part rapid heartbeat returned.
Julia stood, went to pee, turned off the light, and came back to bed. She lay on her back, her eyes open.
The air-conditioner hummed. There was no light from behind the blinds yet. The nurses would be making middle of the night rounds at the hospital.
She woke just after dawn. Carl was gone.
A hard left turn. The lean of the truck shifted the gun barrel that was jammed into Julia’s side, and she took a quick breath while she had the chance. The radio was pounding so loud she couldn’t hear or think, so loud it hurt. Julia was sweating, but she couldn’t wipe the sweat from her brow. It dripped into her eyes, and she had to squint so she could see. Sweat, not tears. They could all go fuck themselves. They might make her scream, but they wouldn’t make her cry. The oily sweat of the man-boys on both sides of her smelled like spoiled butter and old leather, and she felt the grit on their slippery skin as the pickup swayed and jolted, taking them deeper into the middle of nowhere.
Yellow Bandanna yelled something in Kpelle, and the two others in the cab whooped. Julia jammed her elbows into the ribs of the driver and Yellow Bandanna. She twisted her wrists inside the cloth that bound them, but she couldn’t tear free. The driver whooped and jabbed her with his elbow, hard and deep under her ribs. Yellow Bandanna let go of the stock of the gun, grabbed Julia’s wrists in his hand, and twisted them, hard. They were young boys, but they were strong, and Yellow Bandanna’s hand was big enough to hold both Julia’s wrists at once.
“Fuck you,” Julia said.
Yellow Bandanna laughed and said something in Kpelle. The boy next to the passenger door said something, and then the driver said something. Yellow Bandanna humped the air, rocking his pelvis in time with the blaring radio beat, jamming the gun barrel into Julia’s ribs with each thrust.
“Goddamn it,” Julia said. “Please go fuck yourself.”
Yellow Bandanna looked at Julia for the first time.
“Stink-mouh! Na focked,” he said. “Ya plenty-plenty fock-o,” Listen to the mouth on the woman! I’m not fucked. You are completely fucked, though.
The pickup turned right, and the lean drove the gun barrel into Julia’s chest. When the truck evened out, Julia saw the plantation sign and the guardhouse. She recognized the road. She knew where they were. It was the road to the clubhouse. They were going to The Club.
The Club sat on a hill from which you could see for miles; all the way, it seemed, to Sierra Leone, to Ivory Coast and Guinea, to the borders where there were iron and diamond mines and a railroad that in quiet times brought iron ore to a huge smelter that was perched on a harbor near the sea. Once Julia even saw a train.
Toward the end of day while the sun was still strong and bright and the hills were green and blue, you could see the clouds forming below the mountains, and you could see the thunderstorms in the distance—purple blue patches against the green of the mountainsides. As evening came, you could see the sky flaming orange and red. The wise deep light of the end of the day.
There was a TV over the bar, and the men at the bar cheered whenever someone on the television scored a goal—black men and white men cheering together, something Julia never saw anywhere else in Africa. But women never sat at the bar.
The expats gathered at The Club on Sunday afternoons. The hospital people came after brief work rounds. The NGO people came earlier and stayed later than the hospital people and spent most of their time talking politics. Julia wasn’t sure that any of them did real work. The hospital people, on the other hand, worked. They worked hard—endlessly, incredibly hard. The hospital people were there to get a break from seeing people who were sicker than it was possible for human beings to be sick, and from losing little kids and young women, day in and day out, to get a break from living through hell and heartbreak all day long, every single day of the year.
The hustlers who usually hung out at the bar at the Sparks Hotel came to sit at the bar of The Club on Sundays. They never looked at the view. They watched soccer on the television and made a big noise when a goal was scored. The NGO people and hospital people sat together on the porch behind the club near a swimming pool with pale blue water, and together they watched the evening storms roll in. They watched the weaver birds making their colonies, which looked like apartment houses in the ironwood trees. The surgeons from the hospital who came from Ethiopia, Nigeria, and Slovenia played ping-pong, while the others drank beer and talked about the news from America, Europe, and the Middle East. About poverty. About social class and social chaos and the great divide between rich and poor. About the abundance they had left behind. And about Africa, where you see what happens to the lives of the poor in a world where everyone lives off his neighbor, and the poor and rich are always at war.
Looking out like that, sitting in a place that seemed like it was at the top of the world, with waiters to bring you drinks and a swimming pool at your feet and being with smart accomplished people, in a place and in a way where there was nothing pressing, no immediate anxiety, you could understand how colonists lived. You were living on someone else’s land, living on someone else’s back, the pain and the fear of the lives of others invisible to you, and yet while you were sitting in The Club it felt like you owned all of the known world, which existed only because you had built it and was real only because you were looking at it.
One Sunday in early April, late in the afternoon and soon after she had arrived in Liberia from Rwanda, Julia sat in that circle of people, in lawn chairs, watching the red sun setting over Sierra Leone.
Julia kept to herself. She had just lost another eighteen-month-old to meningitis—kid sick three days, the easiest spinal tap she had ever done; just roll the kid on his side, find the space between two vertebrae, insert the needle, and then pop, right into the spinal canal, and the beautiful clear fluid flowed freely from the hub of the needle, crystal clear drop after crystal clear drop. They had a good vein and had the antibiotic they needed and they got it started right away, but the kiddo died anyway in the middle of the night. No one called her. There was just an empty basinet in the morning when she made rounds. At home, the kid would have been in the PICU, and a whole team would have worked on him all night long. The whole bit. Here, just an empty basinet in the morning. Didn’t matter now. What’s done is done. Water under bridge.
Zig, the Ethiopian surgeon was there. So was Katy from Hampstead Heath who ran the Buchanan branch of Merlin. Sister Martha was there, and so was Grace, the Rwandan hydrologist who brought a new guy, a tall, tan-skinned American. The American sat next to Julia. He had just arrived from Sierra Leone.
Julia turned to talk to the new guy, who told her his name was Carl, and then turned away before she could introduce herself. He was more interested in listening to the others. The United States had just invaded Iraq after the shock and awe bombing of Baghdad. They were talking about Iraq, which was a continent away—but there was nothing any of them could do about Iraq. Bill Levin was probably worked up about it, and he was probably right, but he got worked up about every world crisis, real or imagined, and none of his demonstrations ever stopped even one little war. Julia was sitting in Liberia where there were people dying in the bush from preventable diseases all day long. These people just liked hearing themselves talk.
A bunch of white Irish and Zimbabwean guys were clustered around a football match on the television over the bar, and you could hear them shouting from time to time at a reversal or a goal. It was hard for Julia to listen to any of it.
The new guy signaled a waiter for a drink. He had a New England accent, hardly black at all. “That’s the paradox of development,” he was saying. “You do have to live to love. But to live you have to want, and have, and be willing to work to have, and compete to have, and separate yourself in the interest of having. And then you can’t love. Families and the communities here create a place, a context in which people can love. Our job is to help families and communities change or to try to keep individuals alive while communities change. Good stuff, but few of us have that much unselfishness in us. And then look at what happens. Development brings more stuff, more goods, and more guns. More wanting. Wanting brings war. War is the triumph of having over loving. Our work gives people the tools they need to go to war with one another.”
Huh? Julia didn’t know what to say or think. I’m a lightweight, she thought—one more white woman doctor, one more idealist, head in the sky, feet in Africa, doesn’t stay in one place for more than a year or two. This new guy Carl was apparently not so new after all. Julia heard something she liked in that voice—energy, intelligence, experience, pain, and recovery. The substance I don’t have, she thought.
The talk moved on to other topics. Keynesian economics. Phenomenology. The Pedagogy of the Oppressed. The new guy seemed to know about all of it, and even so he was quiet when others were talking and always kept something in reserve. All Julia knew was how to match three medicines to four diseases and hope for the best.
The calling of the birds became louder, and there were now long whistles, interspaced between the calls. Carl, the new guy, spoke well. He knew who he was. I’d take a little of that, she thought. Not that he even noticed her. Julia was nothing. Nobody.
And then there was a long cheer from the bar, and the others went inside for the television and a beer, and Carl and Julia were left alone.
“Game?” Julia said, for the surgeons had abandoned the ping-pong table for soccer and beer with the rest. It was a weak hope.
“Sure,” Carl said.
The daylight was fading. Julia put on the electric lights.
Carl had a strong forehand and an unstoppable slam, but no backhand and almost no serve. They traded points at first, feeling out each other’s strengths and weaknesses.
And then they had a long volley. The white ball went faster and slower, popping and clicking like the clatter of horses’ hooves on a cobblestone street, swinging from one side of the table to the other as they each danced alone behind the table. Julia could feel where Carl was going to hit the ball and was ready for it. Carl’s arms were longer, but Julia was quicker. As the volley went on, they each bounced from side to side, seeing only the ball and one another.
Julia changed pace. She fed a simple but slow shot into Carl’s backhand that he easily reached, and his return put a slow looping ball exactly where Julia wanted it, about three-quarters of the way down the table, with a moderately high bounce, right in her sweet spot. He couldn’t know about her slam, which she had kept hidden from him.
She hit the ball hard. She nailed it. She barely looked as the ball flew across the table, fast and hard enough to be barely visible and bouncing far back on the table, landing at the very last moment, exactly where she wanted it to go.
But somehow Carl reached it, and the ball came back high and slow and so long it looked like the ball would certainly miss Julia’s end of the table. But somehow the ball came down, and touched the table’s edge.
The game was over. And Carl came around the table like a good sportsman, prepared to shake her hand. Then Julia did something she had never done before. She reached up and touched the cheek of this man she had just met. Then, on tiptoes, she kissed his cheek.
“I’m Julia,” she said.
There was a dead black man in a green uniform that was too big for him slumped over the desk of the plantation guardhouse. His neck was red with blood, his silly policeman’s hat lying at a strange angle on the table in front of him, leaning against his chest.
The guardhouse windows had been smashed, and there were jagged edges of glass hanging from the window frames, distorting the reflected light. The glass was spattered and streaked red, as if someone had started to paint the inside and then shook the excess paint off the brush.
Across the road was the large white sign of the Liberian Rubber Corporation, which in blue letters announced that this plantation was a collaboration between the Republic of Liberia and the people of the United States, but Julia knew that wasn’t true anymore. American-owned once. Chinese-owned now. The sign certainly didn’t fool the Liberians, who knew it was owned and run by foreigners, who were all the same, present but not meaningful. Foreigners were people who lived in a different world, a tolerated burden living in their midst, living on their backs; nothing you could talk about but nothing that was ever going away.
The crossing gate, a thin yellow pole with black stripes, was in pieces on the road, where someone had smashed through and then run over it. The pickup ran over it as well.
The pickup sped down the plantation’s main road. The road was paved and the going was smooth, so the gun barrel jammed under Julia’s ribs didn’t jab her in new ways. Yellow Bandanna and the driver and the boy near the window kept their eyes on the road and didn’t look at Julia. Their faces were young faces, but their eyes were bloodshot and fixed.
The road was lined with rubber trees in perfect sixty-foot-tall rows. Each tree had a spiraling groove cut into its bark. The collection cups hanging at the bottom of the grooves were tipped askew, as if someone had forgotten them, and then forgot the rubber trees altogether.
The drive to The Club was longer than she remembered. The blacktop was still good, better by far than the red dirt roads of the county. The trees had been cut down in places and the stumps burned, the ground left empty and charred. There was a red barn on a hillside off to the right, a red barn that looked like it belonged in Vermont. Once upon a time, the rubber workers raised their own beef on the plantation, and there was a school for their children and a company doctor who visited each settlement of shacks once a week. Once upon a time.
That farm was nothing like the farm where Kim Terrell ended up, and the road through the plantation was nothing like the road Julia drove to try to rescue Kim.
Kim Terrell was a medical student from Iowa, a farm girl, big and strong and also blond and uncomplicated. University of Iowa, straight out of public school. She had shown up one Sunday morning in April the year before, in for two months, in a car she had hired at the airport, a beat-up old Suzuki taxi. No guard. She had written Merlin six months before to set up the clerkship, but the doctor she had written to, a family practitioner named Suki Thompson, was long gone. No one remembered Kim was coming, and no one knew what to do with her at first. God loves children, medical students, and fools, though Kim was only one of those. Perhaps, as it turned out, two.
They needed the help, so Julia put her to work right away. Kim wrote notes while they were on work rounds. Before long she was running the ward during the day while Julia was out in the villages. Some days when Zig’s OR load was light and he felt like he could run the ward alone Julia took her along with her to the village health centers. Julia also let Kim make some village trips with Sister Martha when the village was close by, as long as there was cell phone service in that village so Kim could call in case of trouble. Good experience for her. Kim was always looking for more experience and for more responsibility. She hung out in the Emergency Department at night, helping the PA’s work up new admissions. No one thought much about that. There was no better place for a medical student to hang out than in the Emergency Department and to see what came in from the villages at night, because everything came in—women in labor who had ruptured their membranes a week ago and had gone septic, kids with asthma, young men in comas from brain tumors or meningitis, women with ruptured ectopics who were bleeding out, people presenting for the first time with HIV, TB, malaria, typhoid—you name it, they saw it in that ED.
No one was that surprised when July came and Kim said how much she loved working at the hospital and put off her departure for six months. She got a leave from medical school, she said. She was learning more in Buchanan than she’d ever learn doing fourth-year electives. Everyone at home supported her decision. No one was surprised, but no one thought she was thinking very clearly, even then.
They knew Kim had been eating lunch at the hospital instead of in the compound. They just didn’t know why.
There was a PA Kim worked with when she hung out in the Emergency Department at night, a smooth guy named Alex who was from a community about twenty miles out, from out toward Maryland County along the coast. Sometimes Kim ate her lunch with Alex. They would sit on a hillside near the hospital kitchen and talk. No one thought anything about that either.
Alex always had a story. When he presented his cases on morning rounds he presented them backwards, starting with the diagnosis and then detailing the history of present illness and the physical examination, as if he decided what the diagnosis was going to be first, and then chose details or made up findings to fit the diagnosis he wanted to give. That he was wrong more than he was right was one problem. That he started the wrong treatment more often than not and killed people by waiting when he needed to act was a more serious problem yet. You had to be kind and patient, because he was a Liberian PA, and they had too few Liberian clinical staff who were likely to stay. But most of rounds were devoted to fixing what Alex and the others had gotten wrong. A good day was the day that Julia and Zig could fix the mess in time, before the patient died.
One morning in October Kim didn’t show for hospital rounds. They started on the surgical ward.
“The first patient is a seventeen-year-old woman from Buchanan who had presented in the middle of the night with vomiting and abdominal pain of four days duration and right lower quadrant tenderness,” said Tiffany, the PA on duty the night before. “No recent vaginal bleeding. The temperature is 99.8. The blood pressure is 86 over 52. The pulse is 110. There is no rebound tenderness and the white blood count is normal. She is admitted to the surgical ward to rule out appendicitis.”
The patient, a young woman, was thin and dark-skinned. The sheets on the bed were tan from washing and age and were wrinkled. The patient wore a thin light blue hospital gown and her hair was braided into tight beaded corn rows that hung to her shoulders and were scattered on both sides of her head as she lay sweating on her pillow. She looked scared and got more scared when the six people in jeans, tee shirts, and white coats surrounded her bed.
“Pregnancy test?” Zig said, as he walked to an orange ten-gallon water jug that sat on a table nearby and pressed the spigot at the bottom so he could wash his hands. There was a moment of silence.
“LMP?” Zig said.
Another moment of silence. Tiffany spoke to the young woman in Bassa. Zig put his hands on the young woman’s abdomen, and she flinched. She twisted away as Zig pressed his fingers deep into her soft belly, and then she flinched again as he suddenly let go. He placed his left hand on the young woman’s abdomen, without pushing, and tapped his third finger with the second and third finger of his right hand, moving his left hand as he tapped it. The young woman flinched again. Then Zig put his right hand on the girl’s upper abdomen and pressed in with his second and third fingers, first on the left and then on the right.
“Tell her to take a deep breath,” he said, and he pressed in deeper on the right as Tiffany translated and the girl breathed in deeply.
“The patient is not certain of the LMP. Four or five weeks. Not one or two,” Tiffany said.
“Shit,” Zig said. “Kim, get me a sterile prep kit and a sterile 20 cc syringe with a two-inch 18-gauge needle please.”
The people on rounds looked at one another for a moment. Julia walked to the end of the ward, and brought back a package wrapped in green cloth, a syringe wrapped in plastic, and a brown bottle.
“We’re in luck,” Julia said. “No Kim, but it’s a Betadine day.”
“You’re in luck,” Zig said. “I’m on my way to the OR, where this kid should have been six or seven hours ago.” He unwrapped the green cloth package on a table, spread out a green cloth sheet that was inside it, and opened the syringe package so the syringe fell on the cloth sheet. Then he scooped up and put on a pair of surgical gloves and with his gloved right hand held out a few gauze pads to Julia, who squeezed some of the brown liquid in the brown plastic bottle she was still holding into the gauze. Zig turned and wiped the girl’s right side with the brown liquid, moving the gauze in an expanding circle, moving quickly.
“Lay her on the right side,” Zig said. “Tell her this will hurt but only for a minute.”
Tiffany translated and the girl turned to her right. Zig uncapped the syringe and put his left hand on the girl’s abdomen, his thumb and first finger spread apart, marking a target. Then he slowly inserted the needle into the girl’s abdomen, advanced it, and pulled back on the plunger with the thumb of his right hand as it advanced. After a moment, a spurt of thin red-pink fluid came into the syringe. Zig waited until the syringe was about one-third full. He pulled it out of the girl’s belly and held it to the light.
The fluid was red tinged. Pink-red not blood-red. Watery, not thick and opaque.
Pink-red. Not blood. Zig swirled the syringe and waited.
“It’s not clotting,” Zig said. “Non-clotting blood in paracentesis fluid in a young woman with abdominal pain who missed her period and is getting shocky is a ruptured ectopic. She’s got a tubal pregnancy that has burst open her fallopian tube and now she is bleeding into her belly. She’ll bleed out if we don’t get this fixed now. In Boston, you’d have a quantitative beta subunit HCG, an ultrasound, and maybe a laparoscopy, but it would take you two hours to get that done and another hour to have her in the OR. All I have is a healthy index of suspicion, a head on my shoulders, an 18-gauge needle, and a strong arm. We’ve got a ruptured ectopic. We can be in the OR in ten minutes. Wide open IV saline please, type her, see if you can find me a little blood to cross match, and let’s get her to the OR. Now. Perhaps we can snatch one tiny victory out of the cold fingers of defeat.”
“I’ll do rounds,” Julia said.
“Tiffany and Alex, you assist,” Zig said. “Alex, you’ll pass the gas. Tiffany, scrub with me. Julia, you take Kim today.”
“Kim’s not here,” Julia said.
Zig looked around.
“I can round on my own,” Julia said. “You take the others.”
“Anyone know anything about Kim?” Zig said.
“Kim is not well today,” Alex said.
“What do you know about Kim’s health and well-being?” Zig said to Alex. Zig looked at Julia as he took his gloves off.
“Kim is not well today,” Alex said.
Zig jerked the sterile drape off the table. He threw it into a bin for laundry, and then he flung his used gloves into a garbage pail.
“Perhaps Kim will return when her morning sickness improves,” said Tiffany.
“We’ll take care of Kim tomorrow,” Julia said. “Get this kid to the OR now.”
Julia went to Alex’s village a week later.
The village was east and south of Buchanan, about five miles off the main road to Maryland County, close to the sea. The land was low and open, mostly grasslands and wetlands, with salt ponds and lime green grasses in the estuary that swayed in the least breeze and moved with the currents. Malarial country, Julia thought. Low and hot, though maybe the sea breezes kept the mosquitoes from settling and biting. I hope she is using a damn bed net, Julia thought. I hope she learned that much from us before she came here.
Kim was bent over, hoeing a garden plot with a girl of about fourteen. There were other women working in the village, one grinding a white paste in a wooden trough, one standing at a fire in the cooking hut, and one sitting on the ground, working with her hands. Five or six children were scattered about the village near the pump and in the garden. One old man slept on a bench in the kitchen hut, and two more men squatted in front of one of the huts. A few scrawny chickens darted from place to place, pecking once, twice, three times, and then running across the yard to stay near a hut or a tree in the shade.
The women heard the truck and turned to look when Julia’s door thumped shut. “Stay here,” Julia said. Torwon turned off the engine. Charles opened his window to catch the breeze and to listen for trouble.
Kim stood and put a hand to her forehead to shield her eyes from the sun. A short, round, plump, dark woman in a yellow and green lapa came to the door of the hut nearest to Kim, and then came out of the hut so that she stood between Julia and Kim.
“Good day,” Julia said. “Hey Kim.”
“G’day,” said the plump woman.
“Hey, “said Kim.
Kim’s hair was braided now and hung all to one side. She was wearing an orange tee shirt and a sky-blue lapa and black sandals made from the rubber of old tires. Her face was puffy, and her body had just begun to swell, so she was five months, maybe more. So much for the story about morning sickness. The pregnancy must have started early, just after she arrived, long before anyone noticed that she was spending any time with Alex. That vulture, Julia thought. Alex hit on her right away, before Kim had a chance to get her bearings. You never know where it’s coming from next. Alex always has an angle. I should have watched more closely. You can never turn your back, not for one single second.
“Kim, is there anything you need?” Julia said.
“Kim ga. Kim okay,” the plump woman said. Kim is good. Kim is okay.
“Let’s walk together. Show me around the village,” Julia said.
“Wait na. We walkabout da fa,” the plump woman said. Wait. We can explore the farm together.
“I’d like to walk with Kim. Just me and Kim. To talk together,” Julia said. “Alone.”
“We can walk. It’s a white thing,” Kim said, but she looked at the plump woman, not at Julia when she spoke.
“Okay-okay,” the plump woman said. “Quick-quick wa.” It’s okay to take a quick walk.
But the plump woman didn’t move from between Kim and Julia. She put her hands on her hips and remained standing in the bright hot sun. Kim leaned her hoe against a fence made from branches and walked behind the plump woman toward the cooking tent. Julia met her there. Then they walked to the Land Cruiser.
“It’s a village” Kim said. “Alex’s farm. A good place. Not really much to show. I’ve helped keep the garden in shape. That’s Mallie, Alex’s head wife. She looks out when Alex is in Buchanan.”
“You want to talk about it?” Julia said.
“There’s nothing to talk about. This is my life now,” Kim said.
“And your family back home, medical school and residency, and everything else?” Julia said. “You’re ready to write all that off? All that hard work?”
“All that hard work, which were preparing me for more hard work?” Kim said. “Always feeling like I don’t know enough. Always feeling like I’m never good enough. I never felt the way Alex makes me feel. He makes me feel smart. He even makes me feel beautiful. Mallie makes me feel like I belong here. I’m going to have a baby. That baby will belong here. At home if I want to have a baby I have to beg for time off from work and apologize for taking the time. Then I’m supposed to act like I want to be back in a hurry. And then I have a baby and am a doctor at the same time, always rushing to be everything to everybody, no time to think. No one’s rushing me here. I can breathe.”
“You know that women in Liberia are valued mostly for their ability to produce children,” Julia said.
“I can produce children!” Kim said. “Solid Iowa farming stock. Good teeth and a strong back. Maybe I can have fifteen.”
“That’s not what I mean,” Julia said. “Alex will have other women. You know how it goes in Liberia. Women he’s married to. Women he’s not. Some women have other men.”
“I know about that,” Kim said. “Doesn’t matter. Alex makes me feel alive. Liberia makes me feel alive. I’m part of something here. At home you are always alone. At home they make you feel like property, like you are only good for taking tests, getting grades, and maybe someday earning money. To show the neighbors.”
“Are you safe? No one’s forcing you? There isn’t anyone here you can call in the middle of the night. Remember you still have options. We can get into that Land Cruiser, have you back in Buchanan in an hour and to Monrovia by nightfall. Back in Iowa on Thursday,” Julia said.
“My own free will,” Kim said. “This is my choice. I’m here for the duration. Mallie isn’t standing there to force me to stay. She’s there to make sure you don’t try to force me to leave. I know you are looking out for me too. But I’m an adult, and I can make my own decisions. So thanks for coming. I’ll pass on that ride back to town.”
“Alex isn’t our most trusted or reliable PA,” Julia said.
“I know who Alex is. And who he isn’t,” Kim said.
“You get to big belly clinic then. You take your vitamins. Use a bed net. You know the drill. We can always get you home if anything changes. You take care of that baby, you hear?” Julia said.
Julia leaned against the car door most of the way home, her head on the window.
“Talk sweet to her. Right thin,” Torwon said. You were kind to her. That was the right thing to do.
“Alex yona boy,” Charles said. “He rascal. She comes home soon sorry on one-cent car.” Alex is just a street peddler. Kim will come walking back in a bad way.
“Wait now ad stink moot,” Torwon said. Don’t talk badly about these people.
Julia shook her head and didn’t speak.
Kim was right and wrong at the same time. She was an adult, responsible for her own choices, and she had talked herself into this one, big time. But Charles was also right. Nothing good could come of this. Julia should have made Kim get into the car with her and she should have taken her home. She should have been tougher, more in control. Or gotten Torwon and Charles to pick Kim up and just put her in the car. You don’t let people who are insane make their own choices. And love, or whatever this was, was making Kim insane. The average life expectancy in Liberia is about forty. Kim didn’t have the life skills you need to survive. Julia hadn’t been tough enough. She let everyone down.
But maybe it would be okay. Maybe Kim knew what she was doing and it was Julia who was confused.
Then two weeks later Julia heard one of the community health workers say that she had been out to Alex’s village, that Kim’s face was black and blue. And that Kim was talking to the traditional midwives, and not doing big belly clinic at all.
So Julia asked Carl to go out and take Zig with him. Maybe Carl could do for Kim what Julia had failed to do. Perhaps Carl was the person Julia wasn’t.
They went out, and they came back. They took four men from Carl’s team just in case. Julia had been clear. Get her back. Don’t take no for an answer. Just put her in the car and bring her home. And then we’ll ship her back to Iowa for safekeeping.
Julia was doing the ward and she saw the Land Cruiser pull into the courtyard of hospital compound where the hospital cars parked at the end of the day, and she went out to meet them.
Zig got out of the back. Carl was sitting in the front seat. He pulled down his window when Julia walked down the ramp from the ward.
No Kim.
“Where is she?” Julia said.
“She’s in the bush,” Zig said. “She isn’t going anywhere.”
“I thought we said you would just put her in the car,” Julia said.
“She was gone. They must have known we were coming,” Carl said. “Alex works here. News travels fast. She wasn’t there.”
“Did you look?” Julia said.
“There isn’t much to see. You’ve been there. Four or five huts, a cooking hut, and a garden. No we didn’t walk into every hut. We didn’t exactly have a warrant for her arrest. They didn’t want us there. That woman you met, Alex’s head wife, she was there. She said Kim’s not here. She made it pretty plain we weren’t welcome,” Carl said.
“So you didn’t see her,” Julia said.
“No we didn’t see her,” Zig said.
“You should have checked the huts,” Julia said. She turned her head away.
“Julia you are over the top on this,” Carl said. “She’s of age. Maybe not thinking straight but of age. You don’t go marching into people’s houses, regardless of how right you think you are. This is a place with its own culture and its own rules. We have to respect that. You want to find her, you come with us next time, and you do the dirty work. Even then I don’t think we can bring her back against her will.”
“She’s going to die out there. This is suicide. She’s all alone,” Julia said.
“Then she’s no different than a hundred thousand Liberian women. No different than African women from any of the fifty-plus nations. Everyone lives this life,” Zig said. “People make their own choices, even when they make choices that they can’t survive.”
“You can’t make different choices if you’re dead. We’re going back,” Julia said. “I’m going with you. We can’t leave her out there alone.”
“Let it settle for a few weeks,” Carl said. “Then maybe we’ll all go back together. But I don’t think she’s coming in. This is the life she wants.”
“You didn’t do what you needed to do,” Julia said. “I’m going to try to find someone else to go. The church people might go. They know what they believe.”
“Suit yourself,” Carl said. “You are way over your skis. And there ain’t no snow on this ground, and there ain’t going to be snow in Liberia anytime soon.”
Later, back in her room, Julia threw a book against the wall. Carl was not the man she wanted him to be. Kim was lost. Julia was not the person she needed to be.
Three weeks later, Julia was awakened by a car honking in the middle of the night, and a few minutes later there was a loud knock on her door. There was a pregnant woman in labor. In trouble. Big-big trouble.
It was Kim. Her face was waxy, blue-white, and wet. Her braids were pulled back behind her head so her forehead and features stood out. Her eyes had glazed over. She was breathing in big, deep agonal breaths. Sister Martha was there. So was Alex.
“Vitals?” Julia said, as she put her hands on Kim’s belly.
“Sixty over palp,” Sister Martha said. “Pulse 140 and thready.”
There was a horizontal blue line on the upper part of the abdomen. The abdomen was tense. There was no uterine fundus, no smooth firm dome, and no capsule to hold and protect the baby. Fetal parts were easily palpable beneath the skin. Julia felt a flexed leg, then a bent arm, a shoulder and the child’s nose and mouth just beneath the cool white skin of Kim’s belly. There was no fetal movement. The baby wasn’t moving. The child was dead.
“She’s in shock. She’s ruptured her uterus. Get the OR ready. Get Zig. Get the lab. Get me two 18-gauge catheters and two bags of normal saline and as much blood as we can find. Type-specific to start. Cross-matched if we get that far. Was she in labor?” Julia said. She walked over to a treatment table and pulled two wrapped catheters from a jar.
“The patient commenced labor at zero three hundred hours three days ago,” Alex said. “She failed to progress.”
“Fuck you,” Julia said. Then she scooped a few wet white gauze pads from a metal tin, turned back to Kim’s side, wiped the skin on the back of Kim’s hand with gauze, opened one of the catheters and slipped it under Kim’s skin. Sister Martha connected tubing to a bottle of IV fluid, ran the fluid through the line, and handed the end of the tubing to Julia as she probed with the catheter until a spot of blood showed in the hub of the catheter. Then Julia pulled the metal stylus, the needle, out of the catheter and connected the tubing.
“Open it wide. Run it as fast as it will run. We’re on borrowed time,” Julia said, and she walked around the foot of the gurney, slapped the back of Kim’s other hand, wiped the back of it, and jerked off the plastic and paper covering of the second catheter.
“Zig’s scrubbing,” Sister Martha said.
“Who was managing her labor?” Julia said as she inserted the catheter under the skin of Kim’s left hand. “And let’s get an intubation set up please. I’m going to tube her as soon as the IVs are running, on her way to the OR.”
Kim’s breathing grew suddenly shallower. Julia looked at Kim’s face and shook her head.
“We don’t have much time. Not any time. Let’s move people,” Julia said.
“The patient was attended by a traditional midwife,” Sister Martha said. She punctured a second bottle of IV fluid and began to run it through the tubing. “She ruptured her membranes three days ago. When her labor failed to progress, the midwife placed a wooden plank on the uterine fundus and pressed on the plank with both hands, hoping to expel the fetus through the cervix and vagina and deliver the child naturally. When the labor still failed to progress, the midwife stood on the plank, one foot on each side.”
“So somebody put a board on the belly of a pregnant woman in labor and stood on it?” Julia said.
Then Kim’s breathing stopped.
“The respirations have ceased,” Alex said.
“Fuck you, Alex. Fuck, fuck, fuck you. I need that tube right now!” Julia screamed. She left the catheter under the skin of Kim’s left hand and moved around the gurney so she stood over Kim’s head.”
“There is no pulse,” Sister Martha said.
“Get Zig, Alex. Tell him to break scrub. Tell him I need him now,” Julia said. “Sister Martha, start chest compressions. I’m going to tube Kim now,” Julia said, and she picked up a laryngoscope from a table and snapped its head open so the tiny light went on.
“There is no tube,” Sister Martha said.
“Give me a seven,” Julia said. “A six and a half will do if that’s all you have.”
“There is no need to tube,” Sister Martha said. “There is exsanguination. There is no blood to transfuse. There is no operation to repair the damage now. The baby has died. The girl has died. We will pray for these souls and ask for their forgiveness,” Sister Martha said.
“A seven and a half then,” Julia said. “Please give me a tube.”
Kim lay on the gurney, blue-white and still, her waxy eyes still open but without life in them, a sheet over her big still belly, and an IV catheter in the back of each hand.
When Zig came in, Julia was standing over Kim, the laryngoscope in her hand, its tiny light still on.
Zig took the laryngoscope form Julia and closed it. The light went off when the blade snapped shut. Then Zig reached over and closed Kim’s eyes.
They passed a small lake that lay next to a hill. The steel stitch in Julia’s side hurt less. Yellow Bandanna was awake, but his face was flatter and his eyes were dull, and he must have relaxed his grip on the gun. They were moving fast, fifty, perhaps sixty miles an hour, and there was a stiff breeze on Julia’s face from the open windows. The stereo was still booming, BOOMCHA BOOMCHA BOOMCHA, the bass shaking Julia in her seat. It would have rattled windows in buildings along the side of the road if there had been windows or buildings.
The road ran between the lakeshore and a grove of rubber trees that were tall enough for the angled grooves in the pale green bark and the towering darker green leafy tops to be reflected in the water.
Still water. No waves.
One Sunday in the dry season they went to Roberts Beach. It was hard for Julia to believe that there can be places as beautiful as Roberts Beach in a country as bereft as Liberia.
The beach was a little more than a sand bar curling into the ocean with a cliff on one end that boys use for diving and a spine of palm trees on a low hill with ocean with surf beyond the hill. There was a good breeze off the ocean and a crashing surf.
Six of them went for an outing in two cars—Julia, Zig, Carl, Grace, and Rashid, the community health guy from Pakistan, as well as two visitors, both women from Britain, who rode with Carl and Grace.
They sat at a rickety refreshment stand made out of odd-sized boards and driftwood painted bright yellow and bright green and white, in the shade of a patio made of poles and thatched with banana leaves. A thin wizened man with a white three-day beard brought them drinks. They sat and watched the surf breaking and watched the white and green Ghanaian boats, pirogues, fishing a few hundred yards offshore. Bent signs near the water said you shouldn’t swim because of the riptide, but there were people, mostly boys from town, standing in water as high as their chests.
They sat in the shade and talked about the foolish police, who wore hot uniforms and big blue-visored hats that didn’t fit and ran checkpoints that existed only to extract payoffs. They laughed about the castoff four-wheel drive pickups and SUVs imported from the U.S. that roared through the streets of Buchanan without mufflers, their exhaust noise shaking the windows, so loud that you’d look for a semi or freight train and all you’d see was a little red Honda CRV. They talked about the signs on the back of taxis or in the small shops: Lord’s Blessing Taxi; God have Mercy and Kindness Car Service; God’s Blessing Tailor; God is in Control Business Center; All Thanks to God Medicine Shop; We Are Here to Serve God Shoes Doctor. Then they talked about the news, about the rumors of Charles Taylor getting indicted in Sierra Leone, about the rebel group in Loma County and how the British were behind them, about 9/11 and the Israelis and the Palestinians and the war in Iraq and the looting of Baghdad.
How wonderful was that day for Julia, who didn’t think much about the news, to be sitting on a beautiful beach and to hear the perspective of people from other places. Julia believed that people from around the world hated the U.S., and through that hatred those people also hated her and burned our flag and our president in effigy every chance they got. But that was not what these people thought. They did not think Julia was the enemy, or even an enemy. They seemed to like the U.S., to respect it, and even to like and respect Julia and her work. They were puzzled about our choices. Respectful of our power. Curious about our democracy. And hopeful that we’d eventually get it right, after trying all the other options.
Carl, the other American, was listening and looking out to sea when he got bored. They were still not an item. They had been together twice. That was good, really good. She throbbed when he left. Ached. And thought too much about him later.
But Carl acted like he barely knew she existed. Days and sometimes a week would go by without her hearing from him. He didn’t stop by or come to the hospital to see her. They had chance meetings. Dinner at Zig’s. They’d see one another at the Bong County Road crossing in the morning, when her crew and Carl’s crew were on their way to the bush. She saw him at The Club on Sunday afternoons.
She was a lightweight and Carl knew it. No theory. No Marx, Marcuse, Friere, Habermas, Foucault, Rawls, or even Paul Farmer. She tried to listen sometimes, but none of it had any weight, any reality. There were little kids in the bush dying of measles and malaria and of simple dehydration after diarrhea and that was about all Julia knew. Carl needed someone who could think like he thought, who could understand the big picture, who could quote the Old Testament and Shakespeare and was also good in bed.
That wasn’t her. Julia was just not that much about being an item anyway. She was about her work. Kiddos dying in the bush. Good prenatal care. Bed nets. She was awkward and she wasn’t good at relationships and she wasn’t really that smart. And she’d be gone in a few months, so what was the point? It was good while it lasted. What little there was of it. Just between them. Two consenting adults.
While the others talked Julia went alone into the surf. The furious tide crashed around her legs and belly and tried to suck her legs out from under her as she walked into deeper water. When she bodysurfed, the waves twisted and turned her and beat her up good until she fought back and ached with the exhilaration of being alive. The hell with Carl. The hell with Africa. The surf was as good as it gets. She swam until she started to get cold, swam hard, across the waves, and then she bodysurfed back to shore. She let the riptide twist her and toss her and roll her into the pebbles, seaweed, and sand.
Then Carl walked into the surf to where Julia was, half kneeling, half floating in water that was not quite waist deep where a wave had dumped her, still a little short of breath, after a long rough ride, and he held out his hand and arm for Julia to hold as she stood. It was a strong hand.
Then a wave hit them, and Carl reached around Julia’s waist so he could hold her, his feet spread wide apart and planted in the sand. Carl and the wave together lifted Julia, so her feet floated toward shore, and the wave poured over her neck and chest and back and abdomen, but Carl’s arm kept her head out of the water, and she held her side and chest tightly against him, against his chest and flank, which was warm and strong. The next wave knocked them both over. The next wave after that sent Julia twisting toward shore, spinning her about so she didn’t know which way was up.
Then the surf paused. Julia had enough time to plant her feet and turn around and look for Carl.
And suddenly the tide reversed, and sucked her back under and out to sea, sucking her out fast and hard. Her body twisted in the current. She felt the exhilaration of force and speed at first. Then everything was out of control. The shore was suddenly distant, the little refreshment stand just a speck of color on the beach. Her arms ached.
And she was way too far out. She swam hard across the current but she couldn’t break the rip. She swam harder. Suddenly she felt fear. Can’t panic, she thought. But maybe I really can’t. Can’t swim. That far. Alone.
Then there wasn’t enough air. Julia was swimming with everything she had in her arms and upper body and legs. But struggling. Tired and short of breath. Then cold. Then very short of breath.
And then Julia felt herself dying.
It was a strange, sad sensation. Carl was far away. The world was far away. Julia’s life was not her own. It had never been her life. Now it was vanishing. She was glad for having lived. But so sad to lose the world that would now never be hers.
There wasn’t much breath left. Weak, she thrashed about with her elbows and arms, watching the sky disappear. There was only a cold chill and the water around her.
And then Carl was there. He put his arm around Julia’s waist. She threw both arms around his neck. Her head came out of the water and she took a deep breath. And then another deep breath. And then the world came back, and she was holding onto Carl, whose body was still warm and strong.
“Go limp,” Carl said. “Hold my chest, not my neck. I’ll swim for both of us.”
Julia molded herself to Carl’s body. She began to shiver, even to shake, and the only way she could get warm was to fold herself into him. She wrapped her arms around his chest.
Carl started swimming at right angles to the current. The current continued to carry them out to sea but Carl swam to where the water wasn’t moving so fast. And then he swam a little further, to a place where the waves broke but the water was quiet between the waves. And then he stopped swimming and rose out of the water.
“You can stand,” he said. “Sand bar.”
Julia was shivering and breathless, but she stood, her legs weak and her body shaking. She wrapped her arms around Carl, and pushed her chest into his to stop the shivering and the dying. But it was more than not dying. Julia felt something she had never felt before. Carl was the body part Julia lacked. The missing piece had been found. Julia had never been whole before.
No one on shore could see or would know. They had gone for a swim. But had come back different. Really different.
“Oh man,” Julia said. “You just …”
“Shhh,” Carl said. “You gotta do what the sign says. You can’t go swimming here alone.”
He kissed her forehead first, and then he kissed her closed eyes and kissed her cheeks and nose and mouth, and he held her to him, and he didn’t let her go.
But they were still not an item. Not yet.