Right of Thirst (11 page)

When I was finished, and when I had cleaned myself as best I could, and washed my shoes in the stream, I found all of them waiting: Elise, and Rai, the girl on the blanket, the whispering villagers. As I approached, the child's mother said something, and then the young man took his sister's arm and helped her stand. He bent, she leaned forward and put her arms around his neck, and then he stood. It was the only moment of tenderness I'd seen that day.

Just then, as I rejoined the others, a man pushed his way through the crowd and made his way up to us. He was old, walking with a stick, and I didn't recognize him until he was reaching for my hands, and bowing his head repeatedly, and calling out. I took a step back, even as I let him take my hand in both of his.

“His is thanking you,” Rai said. “He is thanking God for sending you.”

It was the man with the bad heart.

“It is amazing,” Elise said, smiling with delight. And it was—he could walk unassisted, the fluid in his legs had melted away, the blue of his lips had receded, and he could speak without pausing between each word to breathe. I watched him, and my stomach felt like a stone.

“He won't be better for long,” I managed, looking at Elise. “The diuretics bought him a little bit of time, but that's it.”

“Still,” she said, her smile faltering only a little, “he is better now.”

I did my best to smile at the man, and for a moment I de
bated trying to explain what the future held for him, that as soon as the diuretics were gone the fluid would return, that even with them he would probably be dead before the year was out. But then I looked at Rai, and the crowd around us, and the girl clinging to her brother's back, and chose to say nothing.

Perhaps I should have done it that afternoon. But I wanted a few hours to gather myself, to read and plan. My stomach, also. And so I let her spend a night in the medical tent, on the cot with her foot propped up on pillows and a bag of donated antibiotics flowing into her little dark stick of an arm. Her brother slept beside her. Her mother remained in the village below.

I had most of what I needed—the sterile drapes and fluids, the sutures and needles and all the rest. I didn't have a bone saw, though. I would have to make do with the saw on the tool Eric had given me. The saw itself was perhaps three inches long, sufficient for the girl, though I would need to boil it in the morning.

The question, of course, was whether I had the nerve. I had the nerve to scrub the foot raw, and pluck out the dead tissue and fragments of bone, and get it all bleeding again—I was certain of that. I'd done such things before. But taking off her foot was something else entirely. She was not the old man. For her, it truly was a lifetime in the balance, and that night I felt the full weight of her future on my shoulders. It was what I had asked for, after all, and finally there it was.

For her I cannot imagine what it must have been like. Even though she was a child, she was old enough, surely, to compre
hend something so stark. I checked on her before dinner to make sure the heater was working properly and her brother was comfortable beside her and that the antibiotics had gone in. I considered sleeping in the medical tent as well, but her brother was there, and I could see no reason to disturb her further. So I left her with her brother, and the hiss of the kerosene heater, on the green canvas cot made up tight with probably the first clean sheets she had ever slept on in her life. I debated bathing her, also, but thought better of it. I did not feed her, because I wanted her stomach to be empty in the morning.

We were mostly quiet at dinner, though the three of us ate together as usual. Through it all I could feel her presence in the medical tent just a few feet away. We ate our canned stew, and dipped in the crackers, and drank our instant lemonade as Ali came and went with the dishes. Outside the sun fell, as it always did, abruptly, casting the tent in shadow, and Captain Rai lit the lantern hanging from the center pole.

“I'll need some help tomorrow,” I said to Elise. “I'll need an extra pair of hands.”

She made a wry face, which Rai noticed because I saw him begin to smile.

“How will you put her under?” Rai asked, with interest.

“I'm going to use a drug that puts you out, but you breathe on your own. You are awake and not awake at the same time.”

Rai looked intrigued.

“Will she feel any pain?”

I shook my head. “She shouldn't,” I replied. “I'll just have to give her enough. It's one of the things I'll need help with. And I'll need someone to hand me instruments.”

“Of course,” Rai said, in a professional tone.

I could have shared my fears, I suppose. I could have told him that I had never done such a thing in my life before. I could have
told him that I was only marginally more prepared to do this than he was. But I knew that I couldn't confess those things.

Usually I lingered after dinner, but that night I said my good nights and left them together, and if they noticed my change of mood they said nothing.

It was light enough to see the cliffs as I walked back to my tent. I hardly glanced at them. Instead, I did what I expected of myself—I looked through the surgical textbook by the light of my headlamp again and again, tossing and turning on the hard ground. For hours, later, I lay there, looking up through the fly at the veil of the Milky Way.

She lay there also, just a few meters from my tent, a dark slip, a shivering little figure, and though I listened carefully as the hours passed, and the air was still, I never heard a sound.

Early the next morning, after a few hours of fitful sleep, I dressed quickly, and made my way to the dining tent just as the sun began to flood the valley. Elise and Rai slept on, but Ali and his nephew were awake preparing breakfast. As I waited beside the heater, and sipped the first cup of tea, I wished with a sudden passion that I'd never come. In some ways the stakes were low—whatever the outcome, nothing would happen to me. But in other ways the stakes were enormous, because even then I knew that I would carry her with me forever.

“Omelet?” Ali asked, in his usual way. I shook my head, which puzzled him, and then I waved him off. It took him a moment or two to realize that I wanted him to go. Finally he retreated, leaving me with my mug of tea.

Alone in the tent, I might have given in to my fears. But instead, as I waited for Elise and Rai, I felt a sudden wave of exhilaration, the source of which mystified me completely. But it was there, and I could feel it, as the wind gusted, and the band of sunlight flowed across the cold earth and dark shadowy stones. It came over me like recklessness, and gave no warning at all. Tremulousness, weakness—these things I understood and expected of myself. But the
cold bath of confidence, of sudden ruthless conviction, caught me entirely by surprise.

Elise and Rai arrived. He was smiling, rubbing his hands together, and her cheeks were red and flushed in the cold, her eyes a piercing blue.

“Well, Doctor,” he said, pointedly. “Are you ready?”

“Yes,” I said, and met his eye.

“Good,” he said. “When is the operation?”

“I'd like to do it soon. Now, even, if that's okay with you.”

“Before breakfast?”

“The earlier, the better,” I said, or rather found myself saying. Elise was looking at me.

“Very well,” he said, formally, then glanced at her.

“Good,” I said. “Let's go.”

The girl and her brother were both awake. How much they knew I could not say. The girl lay there on the cot in the center of the tent just as she had the night before, her foot propped up on pillows and wrapped in plain white gauze. Her brother, the young man who had started all of this, sat beside her on the floor where he'd slept. The tent itself was warm, because the heater was working well—it was warm enough for shirtsleeves. The girl had cast off her blankets during the night, but now she drew them up again as we entered the tent, announcing our presence through Captain Rai's voice at the door.

Aside from the cot, the heater, a table, and several folding chairs, there was nothing in the medical tent but the piles of supplies, much of them wrapped in plastic.

The first order of business was to boil water on the table, and in a few minutes I had the little propane stove hissing away at a pan of it. Then, carefully, I took out Eric's gift, the all-purpose tool, and opened all the blades, the corkscrew and bottle opener and file, before dropping it carefully into the pot.

It would have to be the table. Perhaps I should have set it up the night before—in any case I hadn't, and during the next few minutes I lay out the packages of drapes, and placed the table in the brilliant square of sunlight flooding in through the open door. The water came to a boil and began to knock. The girl lay in the corner, watching us. It took quite a while; I needed to be sure I had everything in reach—the blue paper gown to be used only once, the drug, the needles and syringes, the liter bottles of sterile saline flown in from the other side of the world.

As I worked, Elise went over to the girl and knelt beside the cot, then reached out and took her hand. The girl did not resist, but neither did she respond. She looked to her brother. The expression on her face was that of terror.

Elise spoke to Captain Rai.

“Tell her it will be all right,” she said to him. “Tell her we need to make her foot better.”

The brother was standing now, a few feet back from the cot, taking it all in.

Rai surprised me then. He knelt down beside Elise and spoke with unmistakable tenderness to the girl. His voice was low and soft. For a moment it was the three of them—Elise and Rai on their knees beside the cot, and the girl, lit up in the sun through the doorway. Then I turned away, and finished with the drapes and the instruments and drew up the drug in my clear plastic syringe.

“Tell her,” I said, “that I may have to amputate her foot. She needs to know that.”

Rai looked at Elise, then back to me.

“She is afraid,” he said, “and she is only a child.”

“Does her brother understand?”

“I don't know,” he said.

“Then we at least need to tell him,” I said. “The family needs to understand this.”

Captain Rai moved his head in that particular native way, as if it slipped out of him. But then he spoke to the brother, and asked us to step outside.

We stopped a few paces away, out of earshot. Elise remained with the girl.

“Tell him,” I said, “that I may need to cut off her foot. Her foot is very bad.”

Rai translated. The man stood looking down at his feet, murmuring his answers.

“He understands,” Rai said.

“Tell him I won't unless I have to.”

They murmured.

“He says that he is grateful that God has sent you to help his sister.”

I've heard the sentiment before, of course, many times. As well as I know anything, I know it to be nonsense, to be empty. God had also sent the stone, and the teeming microbes after it, and the poverty to do nothing. Did he thank Him for that as well?

“Tell him there are risks,” I said instead, and turned away.

There was no need to delay any further. I was as ready as I could hope to be, and the book was open, and through it all, I knew, the girl's foot pounded away with her pulse as if it had just been boiled.

I gave her the drug before I moved her. I gave her a good dose, quickly, before I could do any more thinking. No one understands such things—the overwhelming absence, the roving eyes and emptiness and steady breath no matter what is done. Just her eyes, drifting back and forth, with nothing to remember or forget.

We watched her intently, and just then she was gone; her limbs relaxed, her half-open eyes began their unearthly wandering. There was no transition that I could see—just here, then there. I waited a few more seconds to be sure.

“Is she out?” Rai asked, fascinated.

“I think so,” I said. “Let's move her.”

She weighed hardly anything, and I carried her easily to the table. Then I undressed her, quickly, and covered her in a blanket, until only her head and her entire left leg protruded from them. An odor, as her ragged dress came off—unwashed, vague. She was still a child. Her brother turned his head away, without speaking, and left the tent.

She breathed steadily, and her pulse beneath my finger was regular and slow and reassuring. For the first time I had the chance to see exactly what was there.

Her thigh, the little dark knot of her knee—all normal, but then, just above the ankle the skin went doughy and soft beneath my hands. Her foot was black, twice the size of the other. When I lifted it a trickle of pus began oozing from the deep, jagged, scabbed-over wound. I could see dirt ground into it, shiny flecks of gravel. The bones of her ankle were loose, also, and I felt them shift and grind together. The foot bent unnaturally, dangling to one side as I lifted her leg.

Elise took a breath behind me.

“It's very bad,” she said.

The girl's eyes went back and forth in silence.

I knew then that there was nothing else for it, whatever I had hoped for.

I looked at her then—the little girl, suspended somewhere else, and a sudden wave of anger filled me. This worthless girl, so complete in her misery, and they in their complicity—the villagers, her brother, Captain Rai, the lot of them. Myself, also,
standing above her full of inadequacy, in my gown and gloves, with my boiling water and steel tools, my age like a weight on my back. I was full of the anger of weakness, of the inadequate when they are forced to see themselves for what they are, and action is required.

“What are you going to do?” Rai asked, eagerly.

“I have to amputate her foot,” I said, my voice harsh and foreign even to me. “What do you think?”

An amputation is a simple thing. But I'd never done one, and had only the dimmest memory, across a gulf of over thirty years, as a medical student, of standing beside a draped figure while the leg was lifted free and carried away. I could remember nothing more than that.

In a child, the incision is made some six or seven centimeters below the knee. Dissect down to the tibia, then laterally, to the fibula. Identify the neurovascular bundle that runs between the bones along the membrane between them. Tie off the vessels, above and below. Cut them between the knots. Cauterize the smaller vessels. Run the blade around the back of the calf, down toward the Achilles tendon, so that a flap of muscle will hang. Then the bone saw, up at the top of the wound, close to the knee. First through the tibia, then the fibula. Peel the bone free of the hanging muscle. File the sharp edges of the bone smooth. Then fold the hanging muscle of the calf forward, trimming as necessary. Stitch it up like a pillow beneath the bone ends. Elevate the leg. On the tenth day, remove the stitches. Nothing for a surgeon, but for me it was a foreign land.

I'd read it over and over until I was certain that I knew the steps. The difficulty lay in finding the vessels—the arteries and veins supplying the lower leg. If they got loose she might bleed a great deal. But again and again I told myself it was something I could manage. It should take only a few minutes—her leg
was hardly bigger than my wrist. I thought of the past, of how surgeons were measured by the speed of their amputations, and how they timed themselves, with hourglasses, and drank bloody-handed toasts to the winner.

We step outside ourselves sometimes. Eric's birth, for example, when I drove home with him for the first time, or the day at the office when I first heard Rachel's news, which she told me in the most matter-of-fact of tones on the telephone. At the first bite of the scalpel, the drag on the blade as the brown skin spread like clay, her blood rose in points from the capillaries, and the sun shone, and she gave no sign at all.

I had a battery-operated cautery device, a thick white pen, and I watched myself touch it, one by one, to the points between the tiny yellow globes of fat. Each time, a crackle, a wisp of smoke rising in the sunlight from the red-hot tip, and on I went—the blade into the muscles of her calf, the muscle parting like strands of warm red rope, irregular slices, bleeding now, as I dabbed at it with squares of gauze. I carved a long ellipse from the back of her leg, down to the bone, and I clipped the white rubber of her Achilles tendon free from her heel with a pair of scissors. The end of the muscle was ragged, uneven, but it couldn't be helped, and as I watched the blood began to clot and go blue. Her leg was warm, and her blood cooled on my slick, gloved hands.

I was down to the bones of her lower leg—the tibia and fibula. It was a shocking sight—the gash, circling around and down her calf, the muscle hanging loose and dripping, then several inches of perfectly exposed white bone, and finally, below it, her dead black foot, which I'd wrapped in plastic to prevent it from contaminating the rest.

Then, finally, the saw, gummy on the bone for the first few strokes before biting. The sound of it, like someone brushing
their teeth very slowly, and the rasp of it in my hands, the silver bar of the blade up and down, bloody and glistening from the bone ends, until, right before the saw went through, I stopped, and took the bone in my hands, and cracked it, gently, like green wood. I did the same for each, and finally only the blood vessels and the membrane between them connected the girl to her foot.

But I could see them, even without the guidance of the book, I could see the vessels, her pulse regular and slow within them, and then—I think this was the only time my hands shook—I tied them off with fine sutures, throwing in far more stitches than were necessary. The long half-moon of the needle, around them and through them again, above, and below. Then I cut them quickly, between the knots, with the smallest pair of scissors I had, and her lower leg was free, and I could hardly believe what came loose in my hands. It felt malevolent, like a dead snake, or a gun, and I covered it quickly with a towel.

I turned to the stump. I filed the bone ends as smooth as I could, running my thumbs across them over and over again. I thrust the needle in and out of the dangling calf, then pulled it by the hanging sutures beneath the exposed bones to pad the stump. I sewed it all to the front of her shin, trimmed the fat and dead tissue, smeared antibiotic ointment on the wound, and then I wrapped the stump until it was a cap of white gauze.

Later, I could not remember those minutes well. Just as I'd started, I'd given her another dose of the drug, to be absolutely certain, and it was as if the drug had found its way across her bleeding flesh into my hands and into my body as well. But somewhere in that brilliant square of sunlight and soapy foam from all the washing, I'd managed it, and though I'm sure a surgeon would have cast a critical eye upon it, even then I knew it was good enough.

We cleaned her up, and I took her leg and the bloody drapes
and stuffed them in a plastic bag. I threw the bag in the corner. We moved the table back to its position, and then we moved the girl, finally, back to her cot and out of the sunlight pouring in through the door.

Suddenly I was back again, soaked with sweat beneath my gown, light-headed in the heat. I murmured something to Elise and Captain Rai, and then I left the tent. The cold air struck me like a physical force, as if I'd stepped out of a shower.

Her brother was there, crouching down on his haunches on the gravel just outside the door. He looked up at me with his yellow-brown eyes, and then leapt to his feet.