Just Here Trying to Save a Few Lives: Tales of Life and Death from the ER (30 page)

We drove for about twenty minutes—bouncing along a little rutted gravel road. Unexpectedly the gravel turned into pavement, badly scarred but recognizable. We rounded a corner and there was a parking lot—with not a single bomb crater. A
parking
lot. Over a little bridge at the far end of the lot was a low-built, rough-timbered rambling building looking out over the stream and beyond a small pond.

“What the hell is that?”

“It's a hotel,” Amir told me.

“A hotel?”

“From before the war.”

“Here?”

“Oh, yes. People come up here to fish. Used to come up.”

“And now?”

“Oh,” Amir said, pointing. “The soldiers stay here to relax, you know, after bad times on the front.”

The paramedic looked around. “They bombarded everything around here. Everything. But for some reason most of this place survived.”

We went inside. There was a large lobby that clearly had once had furniture. The front desk was to the right and empty; the whole place seemed empty until we walked into the large dining room. There three or four tables still stood, and at one a couple of military officers sat idly. They were being served by a lanky waiter dressed in a tuxedo jacket and shirt but no tie. He beckoned us toward a table that overlooked a pond.

“Nice job he has,” the surgeon commented.

We ordered a round of beer and talk turned immediately to the war.

“What was the siege of Old Vetiz like?”

“Well,” the paramedic said, warming up, “the Croats attacked us at Vetiz, but we held the line and the Croats couldn't get through. We used everything we had as a weapon. Everything. Like fire extinguishers, for example. You take a fire extinguisher and fill it up with explosives and then you put it in a metal tube with a little gunpowder—and you point it at the Croatians and—well, it works pretty good. After that the Croats were losing ground, so they bring in a special unit with helicopter and special soldiers. And we Bosnians ask ourselves: if we don't have real weapons, how shall we make them think we have real weapons? So we got a submachine gun and we mounted it on top of this big metal drum so it would have a bigger noise. When we fired it, it sounded like—like an antiaircraft gun. That kept the helicopter away; we scared the pilot. So the Croats brought in the Croat special forces. They were going to have a surprise attack. But the Bosnians knew that the special forces were there, so the Bosnians let them creep up. We let the Croat special forces move closer in, closer, closer. We held our fire until the Croats got so close, you know, that they were really on Bosnian territory, then the Bosnian soldiers crept around behind them and boom-boom. No more Croatian special forces.”

The paramedic looked up at the rafters. “Sixty Bosnian people died in four months.”

“How?”

He shrugged. “The usual way. Snipers mostly.”

The waiter returned with beers and bowed over the surgeon as he poured his beer into a glass. The surgeon sat gazing at it thoughtfully and then looked up at me, a glint in his eyes. “I think everyone in America has this idea that all Muslims of Bosnia are fanatical extremists—all the women are in purdah and all men want to die in a jihad. But we are not like that at all.”

I thought of a poll I had seen before I left: only 40 percent of Americans could identify the Serbs as the ethnic group that was fighting against the Bosnian government.

“What was the fighting like here?” I asked him in return.

The paramedic slapped the surgeon on his back and said, “Go ahead, tell her.”

The surgeon came over the mountain with the Bosnian army. Their mission was to break through to Old Vetiz, to provide relief and advance the front. They built a makeshift road through the forest and made it to a small valley, this valley, about three kilometers from Old Vetiz. The surgeon set up a hospital in the old four-room school house. He used that ancient ventilator for anesthesia (and plenty of ketamine). Rudimentary supplies were provided by the army—medication, suture material, surgical equipment, all brought over the pass. “You know what we saw most of?” he asked. “Head injury—we couldn't do much for those sorry bastards—penetrating wounds to the neck, chest and abdomen. I had three cases of hemothorax in the chest, and I hadn't enough new blood to transfuse so I used the blood from the chest, what do you call that? Yes, auto-transfusion. Well, I didn't explore them, I couldn't because we were being shelled. And all three survived. Three patients! I could probably publish it as a case report, don't you think?”

The paramedic leaned toward me. “This surgeon did all this five hundred meters from the front. Constant bombardment and sniper fire.”

“I saw things I would never forget,” the surgeon continued. “Never, never.”

“Like…” I said. I immediately felt ashamed for asking. But I didn't stop him.

“Like an old man up on that ridge right there. He took his grandson—the Croats usually just ignored the kids that were underfoot—so the grandfather wrapped up explosive around his grandson and set the detonator and sent him down to play where the Croats were in the valley. Then, BOOM. Dead five soldiers and one grandchild.”

“How could anyone…”

“We have to stop them some way,” he said to me, suddenly fierce. “You see, we have no weapons, the Serbs and the Croats have all the weapons. We have no helicopters, no missiles, nothing but what we can scrape together ourselves. But we must fight them or they will kill all the Muslims. Believe me. They will line us up before our own graves and shoot every one of us. They'll destroy even the
memory
of us. They will murder us all.”

We drove back home in silence, Amir and I, through the blighted landscape. At the offices we counted through the forms. We had vaccinated nearly five hundred children. Still I knew there were many more.

I was late for my evening shift in the ER. It was quiet when I got there, no major traumas all day. My first patient was a woman with a sprained ankle, another everyday event in the midst of war. I sent her over for an x-ray. The radiology tech sent her back, telling her, “We don't waste radiology film on ankle sprains.”

An old woman, gnarled and worn, had an infected wound on her arm. She had fled with her family over the hills a few weeks before. She was the only one of the family to survive and she still seemed completely bewildered. She wanted to tell me her story. Maybe if she told a doctor her story it would make more sense. But she didn't have a chance; there was another patient.

The patient was a slender, very nervous-appearing young man dressed in blue jeans meant for someone twice his size. He was complaining of headache, a swollen neck, chest pressure, problems with his kidneys and weight loss.

Through Yasha, my translator, I asked the obvious question. “Are you in the army?”

Yasha and the patient talked for several minutes until Yasha raised his hand to stop him and said to me, “He's in the Black Swan battalion.”

“What's that?”

“It's a very, very…tense group. They are the advanced troops, always on the front line, always in bad places. In America I think you call them the Green Berets.”

The young man in front of me did not look like suitable material for the Green Berets. But where to start? This man was complaining of everything. “Has he ever seen a doctor for these complaints?”

“Yes.”

“What did the doctor say?”

“He said he was mad.”

“Mad?”

“Yes,” Yasha said. “Like crazy.”

“Crazy how?”

Eventually we got the full story. The patient had been very close to a grenade that exploded about six months before. Most of his platoon was killed. Since then he had been terrified of the war, of dying. One night in his barracks he thought his platoon mates were trying to murder him. He leaped out of bed, grabbed his gun and began firing at random. Fortunately no one was hurt.

He was then placed in jail where he was told he was mad—crazy—but not crazy enough to be discharged from the army. He was on leave now but was supposed to report back tomorrow morning.

I checked him over. Other than the weight loss—which I believed because of his baggy pants—there was nothing abnormal on his exam.

“We can check his urine…We can check…”

Yasha explained this to him and then turned back to me. “He doesn't want any tests.”

“He doesn't want tests?”

“No.”

“Does he want medication, is that why he's here?”

More animated conversation. Then: “He doesn't want medication.”

“Then what the hell does he want?”

This time Yasha and the soldier talked for a long time. Finally, Yasha turned to me and said, “He wants a statement that says he's too sick to be in the army and then he wants a visa to leave the country.”

I closed my eyes and pressed them shut to ease the headache. When I opened them again I found Yasha gazing out the window to where a lonely light bobbed in the distance. Yasha had been a medical student before the war. He, too, was desperate to get out.

“Tell him,” I said, “that there is nothing I can do for him. Tell him we don't give out visas in the Emergency Department.” It's just a fact of life.

“He wants to know if we can write him something that would say he was too sick to fight.”

I looked down at this fellow, shivering on the gurney. He looked as fragile as a young girl. He just didn't want to die. What was the matter with that? As a doctor I should understand that. There should never be war.

I put one hand on his shoulder and reached out for his other hand. “I'm sorry,” I said. “He has to go to a military doctor for that. Maybe they can help him. I can't do it.”

There was, ultimately, so little I could do. I stood there asking myself, Am I really making a difference?

Then, I thought, well, vaccination.

Earlier in the afternoon, up in the mountains above Old Vetiz, back when I thought I was making a major contribution to the war effort (these things can turn on a dime), I had gone outside to take a break and sit in the sunshine. I sat on the steps of the schoolhouse and looked around. A dozen men stood talking in the yard, a few in uniform, or as much of a uniform as men wore in Bosnia. The others were dressed for farming. One young soldier flirted with a young girl with long hair. The women stood off near a fence chatting happily. The scene was utterly bucolic. It was then that I realized that these were the former Muslim inhabitants of Old Vetiz—the ones who held the siege as long as they could. They must have finally retreated to the surrounding mountains. I knew this was going on elsewhere. Territory was fought for and then finally abandoned when the townspeople melted into the mountains. This was a short-term solution only. It was only a matter of time before the Serbs or the Croats claimed this land as well.

Amir joined me and we walked up the hill. There was a field in front of us, and then above us stood what looked like an old barracks or stable. And there was some kind of statue, human sized, arms raised in a sort of benediction. “What is that?” I asked Amir.

He looked up. “It's a monument. To the war.”

I looked around at him. “The war?”

“Not this war, the other war. World War Two.”

We walked up the hill through the brush, stepping over mounds of dirty snow.

“That barracks there,” he said pointing, “that was used by the Ustasha during World War Two. A concentration camp. A death camp.” Amir stopped, reached down and plucked a stalk of grass. He chewed its end thoughtfully.

“This is where they killed—what is the word in English—you know, people who fight for freedom?”

“Partisans.”

“Yes, partisans. This is where they killed the partisans and tortured them. It used to be a slaughterhouse, a regular cow slaughterhouse. Then it became a human slaughterhouse. My uncle died here, I think. We don't know for sure.”

We arrived at the top of the hillock. There was a small memorial: a statue of a woman gazing at the ground sorrowfully, arms outstretched. Underneath her on the pedestal “1945” was etched in the granite. There was a coda in Bosnian carved underneath. I didn't ask Amir to translate it. I was afraid that somewhere it would contain that classic memorial phrase, beloved of survivors and those who remember, the ever hopeful

“Never again.”

12

H
OW TO
T
REAT
T
ETANUS

Also a sign for them is that we bear their progeny on the laden ship.

If we will, we drown them,

and there is no helper for them

nor are they saved, unless as a mercy from us…

—The Koran

I
N
N
IGERIA WITH
M
ÉDECINS
S
ANS
F
RONTIÈRES
,
I, the lone American, drove the French crazy in many ways, but one way in particular was by taking photographs. “You are here as a doctor,” Pierre told me as he watched me rack down my camera lens on a child covered with necrotic purpura, “not a tourist.”

“I am also here to bear witness,” I told him, zeroing in with my camera now at a different angle, “to witness what I've seen.”

He had no response to this. But I did. Photographing made me queasy. I felt like a predator, even though, every time I would ask permission (not with words, of course, not with my ten words, max, of Hausa). I would touch the camera with an index finger and then gesture to my potential subjects. They would always nod, yes, but how could they do otherwise? We, who came with everything that saves lives, how could they refuse us? Worse was that after the first day in this land of infectious atrocities, I photographed only the worst of the worst, some terrible confluence of tragedies: the woman dead with cholera found one morning at the edge of the camp—she couldn't make it the last one hundred feet to the clinic; the boy who had lost half his face to meningococcal purpura; the old man dying alone and covered with flies; the baby already dead. There I was, checking different angles, trying to get the correct exposure. “I want others to witness this,” I told my medical colleagues, but my justification was something of a sham and I knew it. I was right, too. Most people back in the States would look through the first few images only, in my book of photographs, and then they would put them aside. Or I would show a couple at a medical lecture, to illustrate a clinical problem. The room would always go very quiet, and there would follow a collective sigh and a few amplified coughs. “Wow,” someone would say. Then we would move on. This was not for them. Nothing they had ever seen could be like this. Ultimately, the only one I really bore witness to was myself. I pasted the photos that meant the most to me into a scrapbook, and I would leaf through the book sometimes, late at night, after a bad shift in the ER, just to remember. There was the kid with purpura that had necrosed his entire right foot. There was
that
woman (me standing beside her wearing a ridiculous grin and a Hemingwayesque safari jacket the clinic staff told me only an American would ever wear) we brought back from the dead, who was now
yaworeke,
cured. Then there was the strangest picture of all, the backseat of a car—a little sedan—where a black man lay, pietà-like, over the laps of two other frightened-looking men, their black faces burned white in the false light of the camera flash. One of the men is holding up a glass bottle of saline, the other grasps at the IV site. The figure on their lap is rigid, stiff, as if he were badly painted, or rather, if you thought of him as a sort of Christ, as I thought of him, he was an immobile Christ of a twelfth century-triptych, no later.