*
Bed 15’s patient was leaning up against it rather than lying atop. It was a woman with infant twins, one in each arm, and a tree branch stuck inside her vagina, an (obviously) desperate and (so far) failed attempt to terminate a pregnancy. After her, there was a boy younger than Poppy—than Claude—with a snakebite that looked poisonous, had to be poisonous, came from one of eight venomous snakes he’d seen near his home and casually but proudly ticked off on his fingers like he was naming cartoon characters, but then, miraculously, the swelling went down and it wasn’t poisonous. There was a baby with infantile beriberi, which Rosie had only a vague recollection of ever having studied. There was a man who claimed to be fifty but looked eighty with colonic tuberculosis, a diagnosis that seemed jaw-droppingly rare to Rosie and jaw-yawningly common to the nurse helping her translate. A case of Ludwig’s angina had gone so long without the simple antibiotics needed to stop the infection that the patient needed a tracheotomy.
But mostly that first day, as every day before, as every day to come, there was diarrhea, diarrhea and fevers and patients who were dehydrated and emaciated and exhausted. It wasn’t that Rosie didn’t see such symptoms in family practice. It was that here they were worse enough to seem something else altogether, and they were. Here, they were a portrait of what happened when avoidable things occurred instead and then festered, when the treatable went untreated, when the affordable could not be afforded, when the ambiguous got misread, mislabeled, misdiagnosed, misaligned. Here, fever wasn’t caused by that flu that was going around, nor exhaustion by the SATs coming up and college applications coming due and a field hockey coach with unreasonable demands. Here, they were caused by dim, insomniac mosquitos. Here, they were caused by water that was dirty or food that was infested or not having shoes. They were caused by lack of aid or aid diverted or aid misspent or aid ambiguous. Here, they were causing each other. Malnutrition left the body too weak to fight off bacteria. Diarrhea stripped muscle and flesh and reserves. Fever rendered patients unable to eat. So what made any given patient so thin and sick and tired? Who could say?
In the first week, she saw twenty-one different presentations of malaria. She saw what land mines did to tiny hands that picked up something shiny in the grass and what those hands looked like after walking three days through jungle to reach the clinic. She saw more upper-respiratory infections than she had in her entire career thus far. And she saw what she always saw, what she had always seen—what sick children did to their parents, what aged parents did to their kids, how worry and fear and lack of options finished off what mosquitos and land mines and bacteria began. She did not have a facility and a staff she knew like her own kitchen. She did not have an ER with all the comforts of home—CT scanners and MRI machines and a blessed echocardiogram. But she possessed those most important of skills: reflex without panic, action without alarm, cool head and cool hands, mild grace under extreme pressure.
Bed 26 on day one slept a family of seven, the youngest of whom had run through the ashes of the apparently but not actually dead fire that burned every night in front of her home. The ashes looked like the snow she’d seen in a picture book that had come as part of a first-aid and family-support package. The child had second-and third-degree burns and an infection, a lot of pain, a long recovery ahead, but it wasn’t her Rosie was worried about.
The father spoke a surprising amount of English, the most of any patient she saw all day. Rosie explained carefully how to keep the burns clean, apply the salves, change the bandages. She asked if he had any questions. “Yes,” he said. “Where I make mistake?”
“What do you mean?”
“If I do not light fire every night, mosquitos come, bring malaria. If I do not go to fields every morning, first light, I cannot feed family. If I bring daughter to fields with me, she do not learn, run, play. If I do not let her have book, she never get better life. But book make her see ashes is snow. Fire to keep away mosquito and disease no matter if she burn. I make mistake. Where?”
Rosie went back over his story, but she couldn’t see it either. “No mistake,” she told him, which in fact was more horrifying than what had happened to his daughter as a result.
“Must,” he said.
At the end of this first day, Rosie was spinning herself, trying to reckon, to accept what this father had to balance and account for. “Parenthood is like that.” She tried to be doctorly. “The harder the choice, the less likely any of the options are good ones.”