Burkett’s first surgical case is a man in his late thirties whose left foot is swollen to the size of a melon. He walks with a crutch, his massive foot wrapped in a grimy bandage.
‘He was your brother’s patient,’ Abu says.
‘Does he know I’m not my brother?’ He has to ask now that several patients have made the mistake.
‘Yes,’ Abu says. ‘He knows what happened and offers his sympathy.’
Burkett looks at the man’s bloodshot eyes, the skin prematurely wrinkled, and opens the manila folder that serves as a patient record. He recognizes his brother’s barely legible handwriting. A single line, dated two weeks ago: OR 5/4 for L BKA. Below-the-knee amputation, scheduled for two days after Owen’s murder.
The patient unclasps a clothes pin so that Burkett, wearing rubber gloves, can remove the encrusted swaddle. He holds his breath – for the cloud of skin flakes more than the foul odor. He stands and changes gloves, if only as a pretext to let the scurf settle to the floor. He tries in vain to feel a pulse through the shell of warts and scabs. The nub-like toes twitch in response to his prodding, but there is no evidence of pain or active inflammation. No doubt the underlying bones are involved, perhaps destroyed.
This is mycetoma pedis – or Madura foot. Burkett has never seen a case, but it couldn’t be anything else.
‘How long has it been like this?’ he asks.
The man listens to Abu’s interpretation and then thinks for a moment before speaking.
‘Too long,’ Abu interprets. ‘The foot has enlarged over so many years that he hardly remembers a time when it was normal.’
‘Did it start with an injury?’ Burkett asks. ‘Did he hurt his foot while working outside?’
‘He doesn’t recall an injury,’ Abu says over the man’s voice, ‘but many years ago, before the – it got bigger?’
‘The swelling.’
‘Before the swelling, there were painful sores with blood and pus.’
While the patient waits, Burkett attempts an online search, but the internet service is too slow for anything more than email. In the clinic’s small library, he manages to find an entry for Madura foot in a book called Tropical Medicine for Nurses. It occurs to him that his brother likely read the same entry in the same book.
Back in the examining room, Burkett makes a chopping motion with his hand. ‘We’ll have to cut it off.’
The patient was told the very same thing by an identical surgeon three weeks ago, but still he places a hand to his chest and dips his head in gratitude and relief. Burkett can see the emotion in the man’s face – his yearning to be rid of the foot.
‘Tell him we’re sorry for the delay in surgery. We appreciate his patience.’ Burkett understands how a man will build up hope, even if three weeks seem short for a problem lasting decades.
It is an operation better suited to an orthopedic surgeon. Burkett was a medical student the last time he scrubbed in for an amputation. There was no shortage of diabetic toes at Emory, but those cases fell under the purview of orthopedic surgery. He reminds himself that Owen wasn’t trained in orthopedics either.
‘He just wants it gone,’ Abu says, while the patient wraps his foot back up.
‘Tell him to come in on Tuesday,’ Burkett says. ‘We’ll do it then.’
The patient rises and shakes Abu’s hand, then Burkett’s, all the while bowing and mumbling his thanks with tears in his eyes.
‘See you Tuesday,’ Burkett says.
When Nick travels to the capital for supplies, Burkett walks with Abu and Beth to a crowded market in the center of town. Beth wears a headscarf but even still she draws malevolent stares. A gruff bodyguard, who follows in a tieless suit, is presumably returning some of that malevolence. The children begging for money (Abu and Beth have brought coins for this very purpose) instinctively know not to bother with the bodyguard.
A black flag hangs from one of the stalls, signifying that vendor’s refusal to sell to westerners, or perhaps just Americans, although in Burkett’s judgment few Americans would even know what to do with the variety of bark and roots on display. According to Beth, this discriminatory vendor – an old man in a turban and mirror sunglasses – went blind decades ago when a member of a rival family threw acid on his face. It was one of many reprisals in a feud that lasted until the majority of both families had been killed.
As it happens, the old man became something of a milestone in Nick’s endeavor to learn Arabic. When he felt he’d reached a certain level of fluency, he tried to pass for native by purchasing a vial of ylang ylang oil at the forbidden booth. Afterward Nick was so pleased by the old man’s friendliness that Beth almost refrained from telling him when she uncorked the vial to the stench of urine.
Burkett waits while Beth haggles with a teenager over the price of apples. A younger boy in the adjacent stall swats a dog when it veers too close to a bucket of crabs. A large tuna hangs from a hook, slabs of its flesh cut away, its fins removed. The boy, when he sees Burkett watching, smiles and gestures toward the fish.
‘No thanks,’ Burkett says.
Nearby a young man in a white tunic seems to be staring at him, perhaps mistaking him for Owen, but as Burkett passes, the man’s eyes remain fixed on some distant point. Burkett experiences a twitch of recognition, but surely he would remember if he’d seen this man as a patient in the clinic.
He risks another glance: the man is walking now, his arms rigid and upper body stiff, like a wooden effigy attached to mechanical legs. There is a sheen of sweat on his face. All at once Burkett understands: it is the look of intoxication – probably opiates. Perhaps he should ask him where a foreigner might buy scheduled pharmaceuticals in this town. But when he looks again the man has disappeared among the stalls.
With her bag of fresh apples, Beth conducts him to the edge of a crowd bidding on livestock. They watch as an American in military fatigues outbids a Khandari tribesman for a horse. This is Mark Rich, Beth explains, an air force captain embedded at the local base. After the final round of bids, they find Captain Rich at the stables waiting for his new horse.
‘I’m sorry about your brother,’ Rich says as they shake hands. ‘We were trying to start a wrestling school.’
‘You were a wrestler?’
‘Four years at the Academy,’ he says.
The captain’s interpreter, a white-haired Arab in camouflage fatigues, stares at the bodyguard, whose gray suit and bulging sidearm mark him as one of Walari’s men. The aide’s fleeting scowl is a reminder of the tense equilibrium between the national army and provincial warlords, former enemies who have found common cause against the Islamic separatists.
‘What weight did you wrestle?’ Burkett asks.
‘One-fifty-eight.’
‘Same,’ Burkett says.
‘Wow,’ says the captain, more polite than amazed: it’s not as much of a coincidence as it might seem. Of the ten weight classes, those around one-fifty tend to be the most highly populated. The two men stare at each other. For former wrestlers in the same weight class, it’s only natural to wonder who was better then and who is better now. Burkett can’t remember a single All-American from the Air Force Academy.
‘How about helping me get this school off the ground?’ the captain asks. ‘It gives the boys a sense of purpose. There’s a long tradition of wrestling in Khandaros, especially among the natives.’
‘No thanks,’ Burkett says. ‘I’m done with all that.’
Burkett envisions them wrestling, his brother and the captain. He resists asking if such a bout occurred. He prefers to think of himself as his brother’s final opponent, even if he hasn’t wrestled in years – not since medical school, when he tried to get back in shape by working out with the team at Georgia State. The coach there was glad to have him – at the time the Burkett twins had a reputation in wrestling circles – but in a single practice he sprained his knee and vomited from sheer exertion.
The captain excuses himself when his new horse emerges from the stables. The handler accepts an envelope from the captain’s aide before handing over the reins. The piebald horse whickers and tugs against the hackamore while the captain whispers in its ear and pats its neck.
‘The wrestling clinic was your brother’s idea,’ says Beth. ‘But Captain Rich wanted to use it for tactical purposes.’
‘Tactical purposes?’
‘He saw the wrestling clinic as a means of recruiting young men as informants.’
‘I thought the American troops were here only as advisors.’ He watches as Rich and his aide guide the horse through the crowd.
‘Officially,’ she says, ‘they’re here to teach people the art of using drones.’
‘I see,’ Burkett says. ‘And drones aren’t much use if you don’t know where to send them.’
Burkett notices the man he saw earlier, the drug addict, striding past the stalls. The man’s eyes, no longer dazed, are locked on the captain. His hands fumble in the baggy sleeves of his tunic. A feeling of dread comes over Burkett as the young man cries, ‘Allahu Akbar!’ and drops to his knees. Burkett shouts but his voice seems to reverse course, as if shoved back into his mouth by a wave of heat.
When he looks again, his ears ringing, a cloud of smoke has replaced the bomber. The captain’s horse staggers on three legs – the fourth reduced to shredded pulp and shards of bone – before collapsing amid the flaming debris. Blood from the horse spreads toward a smoking shoe which – it takes him a moment to realize – contains an amputated foot, presumably the bomber’s.
He sees Captain Rich hurrying toward an SUV, his aide trailing close behind. Beth, apparently stunned, kneels amid bits of puckering flame to pick up her apples.
Even though it is a Saturday, they leave open the clinic’s gates, expecting injuries from the blast, but it seems the only casualties were the horse and the bomber himself. The military closes all roads in and out of town, forcing Nick to spend the night in the capital. Burkett had planned on grilling strips of lamb for dinner, but now feels nauseated by the idea of meat. Instead they eat rice, flatbread, and apples. If Abu and his nephew Karim are disappointed by the meal, they are too polite to say so.
‘It must have been a front-loaded vest,’ Abu says. ‘He was facing the horse when he blew up.’
‘Who has to clean up the horse?’ Burkett asks.
‘People will collect the meat and eat it.’
Burkett can tell from Abu’s face that this isn’t a joke. ‘Wouldn’t it be contaminated,’ he asks, ‘with pieces – of, I don’t know, the bomber?’
‘Once you cook it and pick out the – the metal balls?’ Abu says.
‘Ball bearings,’ says Beth.
‘Once you pick out the ball bearings,’ he says, ‘you can’t tell the difference.’
Abu interprets for his nephew Karim, who expresses revulsion at the notion of eating the horse. He likes horsemeat well enough, but he happens to have known the suicide bomber from childhood.
‘They were schoolmates,’ Abu says. ‘How is it that my nephew could become a successful driver and find a good wife, while his friend would come to this? Isn’t it strange how God works?’
When Karim and Abu have gone home for the night, and Burkett is finishing the dishes, Beth emerges from the storage closet with a bottle of wine.
‘There’s a surprise,’ he says.
‘An IMO rep left it as a gift. We thought it might come in handy some day as a payoff.’
‘I can’t speak for your local warlords, but that happens to be my currency of choice.’
Since the explosion he has felt an almost celebratory impulse. Perhaps it is nothing more than the relief of survival. He thought he was alone in this, but the wine would suggest she feels the same. Or else her sudden urge to drink stems merely from the absence of her teetotaler husband. Whatever the case, he decides not to risk changing her mind by asking for an explanation.
The wine alone isn’t enough to affect him, not till a couple of pills have melted into his nervous system. He can see the pinpoint pupils of the suicide bomber. Burkett’s idiotic notion to ask the man about drugs might well have gotten him killed. After such a close brush with death he should probably be trying to catch the next flight home, and maybe tomorrow he’ll wake up and start making calls, but for now he’s overcome by a kind of tranquil satisfaction, a feeling of near invincibility, as if he’s survived an ordeal through strength and wits rather than sheer luck.
He and Beth sit on the concrete steps behind the clinic, drinking from coffee mugs. His brother seems to occupy the silence between them. Burkett all but holds his breath, listening for some hint of another presence. A distant gunshot breaks his reverie – the soldiers shooting at dogs.
‘Did my brother have any kind of – romance?’
She shrugs. ‘He didn’t have many options here.’
He almost asks: What about you? It would be too direct, too forward, but it’s likely his brother, with so few options, would have felt drawn to her. Perhaps she felt something for him as well.
‘Did he ever talk about old girlfriends?’ Burkett asks.
She purses her lips, gazes upward – almost like an actor’s representation of the act of trying to remember – and says, ‘I don’t think so.’
‘So no old flames?’ he asks. ‘No past regrets?’
She shakes her head. He isn’t sure he believes her. The name he’s circling is Amanda Grey, a name like an iron splinter in his gut. But why would Owen still pine for a woman he’d loved more than fifteen years ago? He should have forgotten her after so long, or at least forgiven his brother for stealing her. Burkett always meant to bring it up – to end their years of silence on that particular subject. Owen probably would have laughed: you’re still hung up on that? But now it’s a conversation they can never have, another layer of regret.
Beth’s phone jingles – Nick checking in, telling her he’s safely ensconced in some hotel. His voice is audible from where Burkett sits. He wants to make sure she locked the gate and the side door, that she double-checked the gas level in the generator. Of course she did: she seems increasingly annoyed with the interrogation. She interrupts him with a peremptory ‘Love you’ and hangs up.
‘Does he always give you the third degree?’
‘We complement each other,’ she says. ‘He’s the idealist and I’m the pragmatist.’
‘He’s just so – dogmatic.’
After a pause, she says, ‘They say true saints are hard to live with.’
In this she seems to be siding against her husband, so he pushes further: ‘Is he a true saint?’
‘As close as any I’ve ever met. He devotes himself completely to easing the suffering of others.’
‘Not everyone,’ he says.
‘What do you mean?’
‘Those who live with him – you said saints are hard to live with.’
She shrugs.
He’s pleased by this trap of logic, but if he were sober, would he still feel like he’d scored a point? Would he still be pursuing this course? A voice tells him: Leave it at that, change the subject.
But he goes on: ‘I’m sure my brother was the same way. So rigid. Always spouting aphorisms. God has a plan, whatever.’
He reaches for her hand, but she pulls it away.
‘I’m sorry,’ she says.
The last of the wine he drinks alone. A scenario forms in his mind: Owen slept with Beth, so Nick killed him, or paid someone to kill him. He almost wishes for it to be true, an easy fiction. As grounds for murder, sexual jealousy is more plausible than religion. At least then he’d understand the reasons behind his brother’s death.
He takes another pill to help him sleep, not bothering to check if it’s Xanax or Valium. Lying in the dark he tries to summon his brother, but no image comes.
Xanax and Valium, his drugs of choice. Xanax has a stronger, more immediate effect, while Valium works as a kind of baseline stabilizer. Classed as benzodiazepines, or anxiolytics, these drugs are designed for the treatment of anxiety. Shortness of breath, rapid heart rate, dry mouth, and insomnia. The tremulous flutter in his belly. Given such similar symptoms, one would expect the benzos to work just as well for shame and grief, but that doesn’t seem to be the case.
The pharmacy here has a small stock of alprazolam, generic Xanax, locked in a glass case, along with several narcotics. The key lies in the top drawer of the desk, in a built-in pencil trough. The drugs are easily accessible. There’s no record of access, no need for a forged prescription.
It is so dark that he sees no difference between opening and closing his eyes. Has he in fact succeeded in conjuring his brother? Is this the very darkness in which his brother now finds himself?
Perhaps he should light a candle. A vision comes to him – flickering lights across a dark landscape, beacons for all the dead. But almost immediately he realizes it isn’t a landscape. What he sees is a much smaller space: the market in the town square. These lights aren’t candles either, but the sputtering flames of exploded bits of flesh.
In the morning he and Beth work together in the clinic. Perhaps too casually he says, ‘Sorry about last night, I drank too much.’
She gives him a curious look before turning back to her patient. Is she feigning confusion, or could she be so naïve that she didn’t notice his desire for her? He doubts it. She wasn’t a married missionary all her life. Whatever the case, he understands all too well. They’ll act as if nothing passed between them. It is a role he’s played before.