Just Here Trying to Save a Few Lives: Tales of Life and Death from the ER (34 page)

The man lay limply now, glistening with sweat. He was barely breathing. His eyes were open, staring blindly out at us all. There was froth on his lips.

“I see,” the doctor said. “An advanced case.”

“He's dying,” I said.

The doctor looked at me and I saw him for what he was, a smarmy show-off, interested most in looking good and minimizing his own workload.

“For this advanced a case,” he said, “we just have absolutely no beds.”

“Fine,” I said to him. “If that's the way it is. Simon, take the patient out of the car.”

Simon looked up at me.

“I said, take him out of the car.”

The doctor intervened. “I said, we have no beds.”

“I understand that,” I told him, my face up close to his. “But this man is dying and there is nothing I can do about it. I, personally, am sick of being the one who watches him die. So I'm going to put him out here on the street, and now
you
can watch him die.”

I had an audience now. Simon and Avi, the driver, moved around to one side while the nurses from the intake office gathered around behind the doctor. The doctor looked from the patient over to me. “Don't be insane,” he said almost under his breath.

“Don't be insane?” I shouted. “Don't be insane? That's what you want me to do?”

He looked at me with a half smile on his face. He had me beaten, he thought, and he knew it. He had me beaten because he didn't care. It didn't matter to him what the patient looked like. He wasn't giving in. His pride was at stake.

At that point, perhaps because the noises of our voices were echoing beyond the yard, a man in a dirty jubbah carrying a machine gun rounded the corner and ambled toward us.

“I've told you…” the doctor said again. I knew this technique, just keep repeating the same useless thing over and over again until the irritated foreigner gives up and goes away. Especially effective when backed by artillery.

“I've seen them die,” I said. I surprised myself. I had no idea what I would say next. “I've seen children die. Every day I go to work and I see children that are dying because there is no clean water, because they have worms, malaria, cholera, typhus. And what do you do? You close your clinic at eleven in the morning. No patients, no beds.”

He stood there now, fully revealed in the floodlight of my rage. He wasn't a doctor, he was a bureaucrat. There was nothing compelling about life to him, except perhaps his own. He was master here. When I left this country, it would be he who took care of the patients I left behind.

“And as for you!” he shouted in return. I had finally gotten him angry, this Nigerian doctor. The smarmy superior expression had given way to cold fierceness. He was in my face now, screaming back at me. “Who are you? Someone who comes here to my country and stays for a while and then goes back home. At home you have everything there is to have. How can you judge me? How can you judge my people?”

I stepped back and looked down at my patient. He was still frothing at the mouth, his eyes were wide but sightless and he was nodding his head rhythmically. The clonus was back. We had given him a total of 45 mg of Valium, and he still had spasms.

“This is what matters,” I said, pointing. “I don't care about what I have at home; I don't care about politics or religion or anything. I care about this man. I want this man to live. But I can't do it, so I'm bringing him to you. You tell me you have no beds, and if that is true then he'll have to die out here on the street.”

“He's not my responsibility,” he shouted back at me. Now he was trying to stare me down. Behind him the man with the submachine gun was watching our faces, back and forth as we talked. Clearly he didn't understand a word we were saying.

“You're right,” I shouted in return. “
Nothing
is your responsibility.”

“Look,” the doctor said. He raised his hands, backing away from me. Now he spread his hands out asking for sympathy. “I've been up since five-thirty this morning…”

I came after him. “I don't care when you got up. This man is dying and he's going to do it right here. Simon. Take the man out of the car.”

“No!” the doctor said.

We stood nose to nose, the doctor and I. Both of us hated each other, hated everything about this. The doctor stood there to outwait me. He was going to show me and show the nurses behind him who was boss. Except he wasn't sure how much I was bluffing. I wasn't really sure myself. I knew that if I had to physically drag this man myself to whatever they had for beds in the tetanus hospital, if that's what it would take to save his life, then I would do it. And beyond that. What could I do that was beyond that?

I turned to the man with the machine gun. “You want to shoot me?” I asked. “Go ahead and shoot me. You want to create an international incident out of this, that's fine with me. But I'm going to make sure you take care of this man if it is the last thing I do in this country. And if you want to shoot someone who is trying to save a life, then do it now and get it over with.”

The man with the gun had stopped staring at me and was now staring at the patient in the car. I looked as well. Other than a faint hiccup motion every ten seconds or so, he looked as if he was dead. The man with the gun, an old man I now saw, shook his head slowly. He said something quietly in Hausa to the doctor.

The doctor looked at me, then at the man with the gun and then back at me again. His posture suddenly changed; he looked cornered. He turned to the side and looked down, scratched his neck and kicked at something in the dirt. I didn't hear what he said the first time, and I had to ask him to repeat it.

“All right,” he said, “all right, all right.” He turned to the man with the machine gun (security guard? out-of-uniform soldier? heavily armed passerby?). “Ward C,” he said; he turned on his heel and retreated back up the steps.

“Ward C,” the nurses echoed.

“Okay,” I said. “Where the hell is that?”

It was across the street but the hospital had no stretcher. We carried the tetanus patient by holding on to his clothes. One of the nurses led the way. “What now, what now, what now?” I chanted to myself.

Ward C was Quonset-hut shape, vintage World War II temporary housing. It was one of four or five long, narrow buildings found a hundred yards from the intake office. We crossed the street and hurried up the short walkway littered with trash that led to the entrance of Ward C. The doors were open, letting a rhomboid of sunlight into a long, darkly hot room. Two women sat at desks. There were two rows of beds, maybe fifteen beds on each side of the room. The ward was in no better shape than the intake office. The floors were grimy, windows blankly screenless. No light except for what came through the windows, no curtains on the windows, no curtains between the beds. No mattresses on the beds, just bare bedsprings, and no patients—or rather two patients. One on the right near a desk and the other halfway down the row of beds on the left.

Neither of the women at the desks had moved. They both stared at us as if we were some type of unearthly vision. “Are they nurses?” I asked Simon, who shrugged noncommittally.

“Where is the tetanus ward?” I asked them.

Wordlessly, one of the women pointed to the far end of the room.

We carried the tetanus patient down the row of beds. At the other end of the ward there was a room or, rather, a closet. Inside was wedged a single bed with bare springs. We laid the patient on that bed.

The tetanus ward—this was it. I looked around, thinking of the injunctions: the patient must be in a dark, quiet room. Well, it was dark here and quiet. It was deathly quiet, and only the steel gray threads of cobwebs caught what little light there was.

There was nothing here. Nothing, nothing, nothing.

I knelt down next to the man and put my hand on his shoulder. He was far away now, eyes wide and staring, foam still bubbling from between his lips. His arms hung loosely at his sides, but his thoracic muscles were twitching like mad. I realized then that this man wouldn't get better and there was nothing I was going to do about it. It didn't matter where I brought him or what medicine I gave him. None of this mattered. I could pray all I wanted. I could give him all the medicine I had; this man was dying a terrible death of a preventable disease in a joke of a hospital in a country that floats on oil. And there was nothing I could do about it.

The tetanus hospital, I thought, what a joke, a mirage.

The old feeling, the feeling that I was the only one who could help this man, washed over me again. I cannot let this man die, I thought. I cannot, cannot, cannot. I am all he has. I racked my brains. What had I missed? Where was his wound? Why wouldn't the penicillin work?

But I knew I had lost him. I was all this man had and I was letting him die. What if I had demanded more of that doctor or had known a better hospital? Maybe it would be better to take him back to the meningitis camp, I thought, and then I remembered the ride with the man jammed into the back of that car.

There was no way he would survive the ride back. And even then, what else could we do for him? What else was left?

“Doctor,” Simon said. He put his hand on my shoulder. “You must go.”

I stood up. I found I was clutching at the medications we had brought, 100 mg of Valium and several ampules of penicillin. Simon took them from me. “I will wait here and give these to the brothers when they come.” He bowed his head. “Otherwise the nurses will steal them.”

“We'll bring more tomorrow,” I told him. “Tell them we'll come back in the morning.”

“Yes,” Simon said. “Yes, we will.”

I understood then what the doctor in the yard was trying to tell me, although for whatever reason, he could not come out and say it: we have nothing for this man. We have no medicines, nowhere for him to rest, no nurses, no doctors, no equipment.

All that I had accomplished after that mad ride was to find a place for this man to die.

The next day Simon went up to the tetanus hospital with more Valium. There he found, miraculously, that the tetanus patient was still alive. The three brothers gathered around him watching him as he lay there rigid, bathed in sweat, struggling to catch each breath. By then his chest wall muscles were constantly clenched; they were slowly smothering him. Simon tried more Valium, but it seemed to have no effect. The patient died, finally, about the time of afternoon prayers. Without expression, his brothers wrapped him in the blanket that had been with him since the beginning of his illness. They thanked Simon and told him they had no money to pay him. Then they picked their brother up, walked down the road we had driven up so frantically, and disappeared into the city.

A few days after the tetanus patient died, the first of the monsoon rains appeared as a morning shower. Jean-Paul had predicted this would be the end of the epidemic and it was. Whatever climatic conditions had made the meningitis epidemic possible left with the first rain. My tent population of sixty dwindled to thirty, twenty and then ten. There were no corpses waiting for us when we started morning clinic; the people we saw were moderately ill and after a while barely ill at all. It was time to go home.

The night before I left I dreamed that I went home and found my hospital had been closed down. No one was there. The parking lots were empty; all the doors were padlocked shut. I tried them all in succession. I couldn't get in until I walked around to the emergency entrance. The emergency department door swung open magically when I approached. I walked in past an unmanned security office, then a vacant triage desk, and continued down the empty hallway past empty rooms. The place had an air of everyone having left for a moment intending to come right back. Charts were on the desk, the computer screens were lit, doors to the rooms were open, gowns and sheets lay rumpled on the gurneys. All those signs of life, but there was no one there. I realized then that nothing at home would be the same as when I left it; then I awoke in that dank room with the understanding that nothing here would be different when I went home.

I sat up in bed, wide awake now. I felt for a moment as if someone had handed me a pair of special glasses. Suddenly, I could see this epidemic with epic clarity.

In front of me I could see the faces of my patients, all the ones I had gotten to know on my daily rounds—the patients who survived and moved on; the ones who died while we tried to start IVs and get antibiotics into their systems; the patients already dead by the time I saw them. The only answer I had to the humanitarian aid paradox was in the particular. We came here trying to save individual lives: the policeman's son, the bus driver's daughter, the young man with the tribal tattoos, the elderly woman who, while she was sick, nursed her even sicker granddaughter. The blind woman, the old man with the ebony cane. These few people are alive because we were here. We have received their blessings and their thanks for what we have done—although it required a pact with the devil to do it. Though it has really been so little compared to what needed to be done.

What Nigeria needed here was a revolution. Some heroes to smash the gates of Abacha's palace and liberate it for the people. Nationalize Shell Oil. Destroy Lagos. Destroy this city, hotel included. Save themselves. Save their children. Save me if they had a chance.

I was packing late one afternoon with the door open for light. The porter appeared and leaned against the doorstep. Behind him the rain splashed on relentlessly. It had been raining since early that morning.

“You are checking out?” he asked. “Do you want your bags carried?”

“Please.”

“Did you enjoy your stay in Nigeria?”

“Yes, very much.”

“Was it a pleasant vacation?”

“It was a wonderful vacation.”

“You go back to America?”

“Eventually.”

The porter clutched at his shirt pocket, then brought something out to show me. It was a ballpoint pen with a blue hub. “This pen,” he said with a touch of awe, “was made in America.”

“Excellent,” I said and then turned my head away so that he could not see me smiling.

He started off with my bags, wheeling my suitcase through the mud. I looked around the room for anything that I had missed. That's when I found a copy of the Koran, covered in dust, in the drawer of the bedside table. I did not disturb it.