Just Here Trying to Save a Few Lives: Tales of Life and Death from the ER (29 page)

It was a four-room schoolhouse. We had entered a sort of anteroom that served as the triage area: a ten-foot-by-ten-foot cubicle with a desk, a sink and a couple of chairs. To the right, through two blankets that served as doors, was the hospital “ward.” Amir pulled a blanket aside and I peeked in. There were four beds, neat as pins, two of which were occupied by dozing soldiers with bandaged heads. We walked beyond the anteroom into a larger room, which appeared to be the rest of the hospital. There were two examining tables and off in the corner an oversized ceramic stove. An ancient gentleman with a luxurious, snow-white mustache looked up from where he was stirring the fire. A woman standing by one of the examining tables lifted her arms and enveloped each of us in turn in an enormous embrace that smelled of peppermint. Introductions were made. The peppermint lady proved to be a practical nurse. The man by the stove was called Asur. His sole function seemed to be to feed the stove with firewood. A tall, gawky young man with acne was introduced as the paramedic. He would actually administer the vaccines. I was to perform a quick physical exam.

These were refugee children we would be seeing. Most of them were two to three years or more behind on their vaccinations, if they had received any at all. Already there were rumored to be several cases of German measles in the refugees from Bihac.

But first, of course, was coffee. This was made and served up while the nurse, the paramedic and the old man looked on, kibitzing all the while. It was good dark Turkish coffee but I really didn't want to drink it. There seemed so little here—five small cups and they used a metal medical-instrument tray to serve them on. The sugar bowl was passed from hand to hand, the precise amount titrated on a little spoon before it was slowly stirred in. The sugar bowl was almost empty.

As we all sat drinking silently, I heard a faint hum outside—like the muted noise of traffic or a rushing river. I listened for a moment before I realized it was the sound of children—many children.

“How many kids are we going to see?”

“I don't know. Maybe a hundred.”

“Croatians and Muslims both?”

Amir glared at me. “This is a Muslim clinic.”

“Why is it so far out of town?”

“Muslims don't go into town. There are Croats in town.”

“But town is still a part of Bosnia.”

“Muslims don't go to Croat clinic.”

“Why is that? Because they can't?”

“No, because they are Muslim.”

Suitably unenlightened, I examined one of the vaccination kits while I finished my coffee. It was supplied by the World Health Organization and was rather ingenious. Needles and syringes were packed in a box, the box doubling as a waste container as the syringes were used. You attached a plastic syringe to the metal needle using a spring-loaded device. After use, the needles were to be inserted into a small plastic cup and the syringes put back into the box container. When the kit was finished, the box, now filled with flammable syringes, could be burned, leaving just some ash. The only medical waste was the small plastic container with the needles, which could then be buried. Even more ingenious was the fact that all the information about how to use the box was relayed using pictures only—no words. A universal medical device.

I tried to imagine a world with a hundred diseases just like AIDS—diseases that could savage a whole generation in a heartbeat or two—in which no one had the power to stop them, nothing worked. That was life before vaccines. Polio, measles, rubella—killers all—and in just one generation we have forgotten them. To many doctors, myself included, many of these diseases are almost theoretical. I, for example, have never seen a case of diphtheria or pertussis. The two cases of tetanus I have seen were both in intravenous drug abusers, the only safe harbor for the disease remaining in the U.S. In one the diagnosis was made not by me but by a Filipino nurse, who said she had seen hundreds of cases back in the Philippines. Here in Bosnia I had already seen several cases of rheumatic fever and a case we thought was miliary tuberculosis, diseases now rare in America. It was sobering to think that the mundane process of vaccinating these children might ultimately save more lives than any UN-brokered peace treaty. At least I told myself that.

Finally the time came to open the side door that led outside. By now the faint roar of children had turned into a tidal wave of sound. When the door opened, the crush outside was so bad that one child fell immediately onto the floor while two others spilled over on top of him.

Our first patient was a frightened tow-headed boy, a little on the thin side but otherwise healthy. I was more worried about his mother, a tubercular-looking woman with a bad cough and a mouth full of rotting teeth. She handed over the child's passport with a nervous flutter of her hands. Vaccination information was kept in passports in Bosnia—otherwise the passports were considered useless. Her shoulders trembled as she tried to hold her son still while I listened to his chest. His lungs were clear, heart okay. I made a notation on his card and sent him on to the anteroom, where the paramedic was waiting to inject the appropriate vaccine. Upon entering the anteroom the child immediately began to scream. I could hear his mother speaking sternly to him in Bosnian and then the sound of a slap, which made the child wail all the more. The next child, whom I had begun to examine, heard the screaming, rolled his eyes and looked at me. I could see myself momentarily as he saw me, the embodiment of all the evil in the world, a monster in a white coat. He let out a scream, and since his mother was holding his hands down, tried to fight me off with his feet. He, too, was physically in pretty good shape.

Next.

A little girl and her younger sister, both thumb suckers; one clung to an elderly rag doll. Next, a set of twins, mirror images, who both were somehow sporting matching Bart Simpson sweaters. Another little boy showed us where he had cut his finger. The nurse kissed it and then I kissed it too. At that point he burst into tears.

Obviously, despite the war, babies were still being made, children were growing. The next generation of Muslims was there already and growing, a generation that so far had known only war. The children were for the most part surprisingly healthy. I wondered how much food and clothing the parents had forgone to keep them this way. They were also well scrubbed and dressed neatly. But there were some disasters here. A little girl with a heart murmur that sounded like a sewing machine, classic for ventricular septal defect—a hole in the heart. In the States this could be repaired; here she would die young. Another with a cleft lip and palate, a serious-looking little boy led in by his five-year-old sister, who asked me to fix his lip. A child with a hand laceration, unattended and now festering. A child severely underweight and with a cough. Tuberculosis? Parasites?

All was chaos, but in a good-natured way. I had Amir teach me Bosnian for “beautiful baby,”
krasno bebe. “Krasno bebe!”
I would exclaim to the mothers. “Beautiful child!” There were teething problems, problems with cradle cap and ringworm. As the morning wore on, women brought in tiny babies, one a month old and another only six or seven days. New mothers handled the children as if they were fine porcelain. Experienced mothers, the ones with three or four kids in tow, handled the babies as if they were a sack of potatoes. They'd fling them over their arms while they delivered a swat to the other kids.

One father, in uniform, brought his daughter in. He squatted down to comfort her, a beautiful little girl with hair so blond it was really white. She stood safely in his shadow as he pulled her to his chest and patted her back to reassure her. “It's all right,” he kept saying. “It's all right; it's all right.”

I compared these children in my mind with the kids I knew from the city of Zenica itself. There the kids were street scamps, tough kids, mean. Those kids acted like miniature gangsters; they played real war. One would follow you with the barrel of his Y-shaped stick-cum-machine gun, or bomb you with acorns from the branches of a tall tree. Some would shadow you wherever you walked and rush you every so often to make sure you hadn't changed your mind about giving out some spare change. Not all the children were like this. There was, for example, the little girl in a pink pinafore with pink ribbons in her hair (a triumph in these circumstances) holding her mother's hand as they went to market. There were neatly dressed children going quietly to the Orthodox church or to their mosque. Also, on the outskirts of town, there were children working: carrying water, hauling stacks of firewood, minding the occasional goat. They seemed mute and solemn and like little old men.

In town the children who begged were mostly Gypsy children, I was told. They certainly begged like professionals. They created a diversionary scene in front of you, with at least twenty ten-year-old boys chanting, “Deutsche marks, deutsche marks, deutsche marks,” while the twenty-first went after your wallet from behind. By then there was no Bosnian currency; all transactions were in German marks. If you tried to give the children Bosnian coins, they just gave them back with a look of total disgust. However, if you gave a single pfennig to one of them, you would have the entire pack stuck to you like glue wherever you walked. Crying, wailing, hands lifted, and, if that didn't work, getting down on their knees, pleading. These kids can spot a foreigner a block away—just like the old days under communism when any American in an Eastern bloc country stood out like scarlet. Those kids had flawless eyes.

On my first night in Zenica, after I had locked up and gone to my room, I heard a bang, bang, bang downstairs. Someone was pounding on the door. I found my flashlight and went back down the stairs. The bottom half of the door was textured glass and I could see through it the moon shadow of a child.

“What?” I asked.

More pounding on the door.

“What do you want?”

There was a plaintive, tinny whisper on the other side of the door. “Deutsche marks,” the child moaned.

“Go away.”

He continued to bang on the door. “Deutsche marks, deutsche marks…”

“Go away.”

The banging stopped, then started again. I switched off the light and stumbled back upstairs. Behind me, I could hear the voice, disembodied, there probably long after the child has gone, that tinny, whispering voice: “Deutsche marks, deutsche marks, deutsche marks.”

At noon the nurse locked the doors and restirred the fire for coffee. I went out to the Land Cruiser and brought in a box of biscuits I had managed to find in Zenica. The paramedic came back in accompanied by a tall man of about thirty-five wearing a baggy sweater. Disheveled hair.

“Dr. Pamela. This is Dr. Yassar.”

As I stood up to shake his hand, someone called him back out to the ward. When I sat down again, Amir whispered in my ear, “That man is a hero to these people.”

I looked at Amir. “How come?”

“He was with the men that came up over the pass, the men who broke the siege of Old Vetiz. He built this hospital here and was the surgeon—the only doctor—these people had. He did everything. Everything. He is a good man.”

“Where did he do his surgery?” I had an image of amputations done with a buzz saw by a campfire.

“Right in there.” Amir pointed. “Go look.”

There was a door on the north side of the room. I opened it and peeked inside. It was a small room that obviously was used as a full-service operating room. In the center was a wooden table, something like an old kitchen table with an extension at one end. There was a tall, modern surgical light pulled over against the side wall. In one corner there was an old bookcase that served as storage for medical supplies—gloves, instrument kits. Against the other wall was the oldest anesthesia machine I had ever seen, a big metal box surrounded by a hodgepodge of rubber tubing and copper and glass containers. Next to it on the floor was a suction machine with a foot pump to drive it.

I tried to imagine bringing that anesthesia machine, with its glass containers, that suction pump, those instruments, over a mountain pass in the dead of winter. But it was very simple. I couldn't.

At four the parade was stopped again, and everyone gathered in the anteroom for more coffee. The practical nurse brought in an enormous cheese pie for all of us. Forks were laid out. We ate directly from the tray because, Amir whispered to me, there were no plates.

The surgeon came back in from the ward room. I asked about his anesthesia. “Do you use much ketamine?”

“Yes, all the time. Very good drug. I use it for all my amputations.”

Ketamine is an odd drug. It is an excellent “field anesthetic” for use in war zones. But it does have one major drawback…

“Do you find that people hallucinate as they wake up?”

“Oh,” he said, waving a fork. “Always. And it can really be terrible. We need four or five people to hold some raving soldiers down.”

I wanted to ask the surgeon more but Amir said no. “Not now. He has to see patients. We'll finish with the children and go for coffee afterward.”

In the afternoon we vaccinated even more children. By midafternoon we had seen over three hundred. I had to stop examining any but the sickest. They all began to blur into one another. At last, though, the door was closed. The stragglers were sent away with “Come back next time.” I went out to the anteroom, where I found the used contents of the WHO vaccine kit scattered everywhere—syringes on the windowsills, needles on the floor, the box upended and empty. The instructions were wadded up by the sink. So much for the WHO kit.

We closed up shop, the paramedic, Amir and I. The doctor met us out by the truck. “We're going for beers,” Amir told me as we piled into the car. I tried to figure out where in the hinterlands of Bosnia we would find beer.

The doctor and I, with Amir translating, talked medical shop. Have you had much experience with these new drugs, cephalosporins? Do you use staples for skin closures? What is your specialty?

He couldn't really understand me when I told him I specialized in emergency medicine. “You only take care of accidents? How can you only take care of accidents?” He was a humorous-looking guy, tall, long-faced, with a three-day growth of beard. He had the air of being a happy man, with overtones of thoughtfulness. He seemed like a man who, even in the most difficult of times, was satisfied with life.