The Memory of Love (11 page)

‘Tell the doctor what brought you here,’ Ileana says.

‘I cut my father. My father brought me here.’

‘Why did you cut your father?’

‘He was sitting on the verandah. It was one night. A bad night. I was afraid. I didn’t cut him.’

‘So why do you say that you did?’

‘I saw the wound.’

Afterwards, as they leave the ward, Adrian asks, ‘What’s his diagnosis?’

‘Psychosis. Drug-induced.’

‘And the drug of choice?’

‘Cannabis mostly. There isn’t much else anyone can afford. There’s a bit of heroin. Brown brown, it’s called here. But that’s a lot more expensive, obviously, and has to come in from elsewhere. Most of them on this ward are the same.’

‘All cannabis?’

‘Yes,’ she replies, turning to meet his gaze as she says the word. And then, ‘He was transferred from the military hospital after Attila intervened. “Wounded in Action.” I think the father sought Attila’s help.’

‘So he saw action?’

‘I believe so, though I’m not sure of the details. You’d have to ask Dr Attila about that. John’s been in and out of here for the best part of a decade. The war began in ’91 and I’m not sure exactly when he was discharged. Certainly the army was where he began to use drugs. It was encouraged among the new recruits. They called it Booster Morale. As far as Dr Attila is concerned, he’s a casualty of war.’

‘So now his answer is to keep the man chained.’

She regards him for a moment in silence, dips her chin and looks at the floor.

‘Looks like you dropped something,’ she says, pointing.

His eye travels to the floor. There is nothing he can see.

‘Where?’

‘Right there.’ She points.

Adrian sees nothing but a patch of lino, curled and broken. He frowns. ‘What is it?’

‘Oh, about two million dollars, I think.’

‘I don’t understand.’

‘What it would cost to put in a proper security system: infrastructure, staff, training.’

They are on the other side of the door. Ileana reaches into her pocket for her cigarettes and lighter. She turns away, trailing smoke.

‘I’m sorry. I just want to know about the treatment methods.’

‘We have a method,’ she says. ‘We call it cold turkey.’

Ileana walks and smokes. Adrian, unsure of his response, walks alongside her, waiting for her to say something more, realising she does not intend to.

‘So why did Dr Attila say …?’

‘Exactly,’ she says, laughs briefly and gives him a humourless smile. ‘Now you get it. You should have been here at the start. But of course you weren’t. Nobody was. You all turn up when it’s over. Shit!’ And throws her butt into a flowerbed.

At her office Ileana unlocks the door with a key she draws from her smock pocket, crosses the room and plugs a kettle into the wall.

‘Back in the 1980s the country was being run into the ground. Attila was already working here by then. On his own. He trained abroad and came back after his studies were over. I think there was a Brit in charge up until that point, but gradually they were leaving and being replaced by Africans. He must have been pretty young to take on such a responsibility. At that time the population he was treating was pretty much the same as anywhere else: schizophrenics, psychotics, depressives. The usual breakdown of nutcases. Then, at some point, that began to change.’

Ileana makes tea in a small silvered pot. Lipton Yellow Label, it takes an age to brew and even then the tea achieves no more than a pale gold.

‘In the early 1980s there was an influx of new admissions; Attila saw it first. He was the one admitting them. They were mostly young men, late teens and early twenties. They came from the city but also from the provinces, either without family or thrown out by their families. All with drug-related disorders. Within a few years, the make-up of his population had inverted. Those who’d once made up no more than a tenth were now the overwhelming majority.’

She pauses to stir and then to pour the tea, hands Adrian a cup. There is no air conditioning in the room, no fridge either. The windows are all closed. What he’d in fact really like is a glass of cold water, but he accepts the tea without complaint. He wants to get over the bad start he seems to have made with Ileana.

‘He wrote to the government, the newspapers. Something was coming. Of course no one took him seriously. The government ministers laughed and said he was as batty as his patients. But he went on, to the World Health Organisation. The government began to get irritated with him. Fuckers. He was trying to warn them. And then in the 1990s. Whoosh!’ She throws both hands dramatically up in the air. ‘Hundreds, thousands of young men, high on drugs and very, very angry. No jobs. No families. No futures. Nothing to lose. The thing that was coming had arrived.’

In the silence Adrian drinks his tea. Ileana fetches a tin from the top of a filing cabinet and offers him a biscuit from a selection. He takes one with jam in the middle, like the ones he used to enjoy as a child, licking out the sticky, synthetic centre. He hasn’t had one in years. Ileana opens a window and a faint trickle of breeze reaches him. On the wall behind her desk a sign reads:
Some days it’s just not worth chewing through the straps
. The conversation picks up and strays on to other subjects. He asks her where she trained, as a way of trying to locate where in Eastern Europe she is from.

‘Tel Aviv.’

‘Ah.’

She smiles for the first time, knowing she has confounded him. ‘My initial training was in Bucharest.’

On the way back to the front gate they pass a building, smaller than the rest, and set slightly apart. Outside it is a washing line upon which are strung several
lappas
, lengths of printed cloth, limp with age and wear. At the back a woman is bent over a cooking fire. The women’s quarters.

‘Can we take a look?’ asks Adrian.

‘Don’t see why not,’ Ileana shrugs, tosses her half-smoked cigarette on to the ground and leads the way, introducing Adrian to the female attendant at the door.

Inside the room the beds are fewer and therefore more widely spaced than inside the men’s ward. The rank odour is less present, possibly because the windows are open. None of the patients is restrained. Some are sitting or lying on their beds, at the far end a woman is folding clothes, nearest the door another sits cross-legged on her bed. She looks up at Adrian and smiles suddenly and warmly; one eye is cloudy, her hand plucks at the bedclothes as she babbles nonsense. They are, Ileana explains, mostly schizophrenics, some personality disorders. Few are violent, though they have to keep an eye on them.

‘With women the families will try to keep them at home, seek treatment through local healers or religious leaders. So there are relatively few of them here.’

‘Do they help? The local methods?’ he asks.

‘It’s just care in the community under another name,’ she replies.

The attendant, who has been shadowing them ever since they entered the room, says something to Ileana, who stops, holds up her hand, signalling for Adrian to wait. She moves forward, stopping a few paces in front of a woman who is standing facing them from the other side of a bed, sullen and motionless, a hairbrush in her hand. Ileana speaks to her for a moment. She turns to Adrian.

‘This one’s not good with men. They had a bit of trouble with her the other day, apparently. I hadn’t heard about it. If you’ve seen enough we may as well go.’

‘Sure.’

Ileana gives instructions regarding the patient’s medication to the attendant. Adrian waits, looking around him. There is a woman lying in one of the beds, curled upon her side, hands under her chin, her eyes open, staring into the middle distance. He takes a step forward and peers at her, but moves no nearer, less concerned with his own safety than subverting Ileana’s authority.

When Ileana joins him again he asks, ‘What do you know about this woman?’ It is her, he is sure of it, the woman who came to see him in the hospital and who approached him later on the street. She had fled then and never returned.

Ileana tilts her head on one side and peers at the woman’s face. ‘I’ve never seen her before, I don’t think. Mostly it’s Attila who deals with the women’s ward.’ She turns to the attendant, speaking the local dialect.

‘She was admitted two days ago.’ She interprets haltingly, her attention given to listening to the attendant. ‘Somebody brought her. She’s not sure who, but it wasn’t a family member. Somebody off the street. She’s confused, apparently.’ A pause. ‘That’s it.’ She is about to continue walking when the attendant speaks again, saying something which causes Ileana to raise her eyebrows and grunt with faint surprise. ‘Every few months or so. She reappears every few months. It’s a regular occurrence, apparently.’

Through the open office door Adrian can see Attila bent over his desk. Thankfully he is alone. Adrian knocks softly on the door. He is suddenly nervous, the memory of the man’s earlier manner and also now the possibility of being refused. There is no reason, after all, for the man to say yes except as a professional courtesy. Adrian’s sliver of hope rests on Attila seeing it that way. At the second knock Attila waves him in without looking up and points at an empty chair. Adrian obeys. Attila signs off on the document in front of him and rises, paper in hand.

‘One moment,’ he says to Adrian. ‘Salia!’

A moment later the nurse glides into view and Attila hands him the document, issuing instructions as he does so. He returns and sits down behind the desk, regarding Adrian with no particular sign of warmth.

‘How may I help you?’

Suddenly Adrian is in two minds whether to ask about the woman at all, but now he is expected to say something.

‘Thanks for letting me look around.’

‘My pleasure,’ replies Attila, and inclines his head without smiling, as though he means nothing of the sort. He leans back with his hands spread out on the desk in front of him and waits for Adrian.

‘There’s a patient on the women’s ward.’ Adrian plunges straight in. ‘She was admitted a few days ago. I’m told not for the first time.’ He describes the woman he has just seen. Attila nods once, yes, he is aware of the patient. Adrian continues, telling Attila how the same woman had been to see him at the hospital. In the moment he decides to omit any mention of the encounter in the street. The psychiatrist listens expressionlessly and without comment until Adrian finishes.

‘So what is it you think I can help you with?’

Adrian takes a breath. ‘I’d like your permission to examine her, if I may.’

‘By all means.’

It had been that easy. Adrian realises he has been holding his breath and exhales, wondering why he’d allowed himself to become so tense.

‘Come back when it suits you. I will inform Salia. Her notes will be made available to you.’

‘Thank you. Thank you very much.’

‘We are,’ says Attila, turning upon Adrian a fathomless look, ‘at your service.’

It is enough for Adrian, who rises to go. By the time he reaches the door, Attila’s attention has shifted back to the paperwork on his desk.

For the second time in the same day and with Ileana’s help, Adrian succeeds in securing a taxi to himself. Despite the heat and the speakers relaying rap music directly behind his head, he luxuriates across the plastic-covered back seat.

For the first time since his arrival he feels a small sense of triumph.

At a T-junction next to a garage a traffic policeman is waving his arms in the air, rotating them like windmills. It seems to be a fashion among the new recruits to develop an individual style, a kind of a semaphoric signature. On three sides the traffic stops and starts in confusion. Inevitably, there is a collision, minor, but chaos ensues as the two drivers get out of their vehicles and a crowd, including the traffic policeman, gathers.

Adrian’s driver exhales huffily, turns up the music and pulls out around the fracas, skirting the cars and people, turning right down a road Adrian has never been before. Suddenly the way ahead of them is clear. Adrian winds down the window and lets in the air, salt and marshy. In between the speed bumps, the driver accelerates. The houses come to an end. There is an expanse of scrub, a view of the sea and a bridge, stretching out ahead of them. As they cross it Adrian sees, to the left, an inlet leading to swampy, open land. To the right, the horizon, a straight blue-grey line. His thoughts are brought back from the mental hospital.

The bridge; he sits up and looks around properly. Over there, the peninsula. And this bridge is the one Elias Cole described. Exactly as he described, Adrian is certain of it.

Julius’s bridge.

CHAPTER 10

It is something Kai enjoys. Keeps his fingers dextrous, like a piano player practising scales. And it entertains children. He holds up the single piece of orange peel, the entire skin of the fruit, so it falls into a natural helix, and hands it to the girl pressed up next to him on the bench. He places a segment of the fruit in his mouth, gives the next one to one of the children, sharing the segments out until the orange is finished. The last piece he hands to the girl next to him. When he stands, she stands alongside him. When he walks, she shadows him, one step behind. Bump, scrape, pushing her bamboo walking frame ahead of her. He turns and squats, pushes a forefinger experimentally into the space between her leg and the plaster.

‘Good?’

A nod.

He moves away. She watches him go, leaning across her frame, like an old woman at the garden gate.

He passes through the children’s ward, still decorated with the remnants of Christmas, tinsel and twists of coloured paper. There’d been presents this time, donated by a Western charity, who sent a photographer along to capture the occasion. The children sat unsmiling, clutching the presents on their knees. The photographer, a middle-aged German, had tried to press them into unwrapping their gifts. The children weepily resisted his encouragements. Finally he had removed – wrenched – the gift from the arms of a five-year-old, and begun to tear the paper away. The child’s distress reached a new pitch, to cease suddenly when the man drew from the box a small wooden house. In moments the room was filled with the sound of tearing paper, scrabbling fingers. The photographer, happy now, clicked away for minutes. Kai stood smiling in a white coat and stethoscope he rarely wore, clapping along with the other staff members.

One parcel contained a plastic gun. A scuffle broke out between two of the boys. One of them, in fact the smaller of the two, wrestled the gun successfully from the other, forced his companion to his knees, hands behind his head, and shot him in the back of the skull. The rhythm of the clapping grew ragged. Mrs Mara stepped forward and removed the weapon, gave the child another toy and resumed her place in the line, the gun held behind her back.

Outside the swing doors of the outpatient department a boy, long-limbed and languid, is sitting in a wheelbarrow. His right knee and lower leg, massively distorted, is bandaged and propped out in front of him. Next to the boy his uncle fans flies away from the leg. Even at this distance the odour reaches Kai, sweet and high like rotted flowers. The amputation would take place in the evening. He pauses in front of the pair, asks the uncle who is to give blood for the operation. The man taps himself on the chest. The boy, feverishly beautiful with cheekbones cut across his face and huge, heavy-lidded eyes, stares into the middle distance, dreamy and preoccupied. He looks otherworldly. It strikes Kai how death, so often ugly, can sometimes arrive in the guise of such beauty.

Diagnosis: Sarcoma. Advanced. Proposed Treatment
. Kai had written on the admission form,
Surgery. Amputation of left leg. ATK. Grounds: Compassionate
.

In the antechamber to the operating theatre he changes his clothes, tossing the used greens into the bin, kicking off his flip-flops and slipping his feet into one of the pairs of rubber clogs. Some of the visiting foreign surgeons have their own pairs, initialled in black marker pen upon the toe. Kai is content with one of the general pairs; they are a luxury, still.

He takes a cap from the shelf and sits down on the bench, flexes his fingers. Sometimes he remains in the changing room for minutes at a time, opening himself for the state to arrive. He read something once, on artists, performers, and their relationship with their work, and recognised himself in the description. One of the writers had commented that it was not so much a matter of waiting for the muse to descend, as opening oneself to receive it. Kai knows that when the sounds around him begin to recede, when the edges of his mind draw in and the horizon comes closer, he is ready to begin. In that state he had learned to work under almost any conditions. As he had for months under flickering lights, a generator roaring in the corner of the room, pausing motionless with his instruments held in the air, like a conductor at the start of an overture, each time the machine broke down and somebody was sent to coax it back into life. As he had when there were no anaesthetists available, when the patients were tied to the table and told to clamp down on a twisted sheet. Kai lost himself amid their screaming, failed to notice when and if they finally fainted. All the time making do with whatever instruments were available, even kitchen utensils.

During emergencies he is rushed, spinning on adrenalin, into the maze, racing down the paths, left and right, trusting his judgement to avoid the dead ends and wrong turnings, searching for those pinpoints of light. Now the hospital has money, some at any rate. The buildings have been renovated, there are doctors on sabbatical from overseas.

Today a letter from Tejani. Kai slips it from his back pocket and smoothes out the creases over his knee. In the computer age, they stick to this old-world form of correspondence. Tejani, he assumes, has a computer at home. But for him it means a trek into town to an Internet café, the long wait for a connection, the ponderous typing of his message – his fingers never having acquired the agility over the keys they possess when handling medical instruments – only to lose it when the server crashes or the electricity cuts out. The blue aerogramme bears a date some two weeks prior. The postal services are erratic, yet this is how they both seem to prefer it.

The anaesthetist puts her head around the door.

‘Ready when you are.’

‘Coming.’ Kai places the letter on top of his clothes, closes the locker door and follows her out.

First thing in the day they deal with the scheduled operations, then perhaps an elective and then whatever emergency has brought in. Keeping busy is the one way he knows to keep things under control. When he is not operating he writes up his notes meticulously and drinks coffee, or volunteers to help in the second theatre where a surgeon is often working alone. Other times he writes to Tejani, details of the procedures he has carried out. He has few friends among the staff. The African staff, who comprise almost all the nurses but only a few of the doctors, all have homes and families. The Western staff live and socialise in their own cliques, arranged by language mostly, sometimes age or ethnicity. Generally they stay only a few months and in that time Kai will extract from them whatever threads of knowledge he can: the Scottish expert in pain who demonstrated how patients felt phantom pains in limbs they no longer possessed, the plastic surgeons who arrived in teams of four and worked around the clock for two weeks, the eye surgeon who rotated between the hospitals in the city and upcountry and who set a stopwatch for each operation to remove cataracts and liked to joke, to relax his patients, that he could perform with his own eyes shut.

And when, finally, Kai can extend his day no longer he will pass outside the staff room, where the doctors gather at the end of the afternoon, and head to the empty apartment, which few know exists. He will lie on the sofa, hating the prospect of sleep, checking the luminous numerals of his watch and counting off the hours of darkness. Sleep, when it comes, arrives in flights, accompanied by a rush of images or sometimes lingering dreams. He wakes, often, bathed in sweat. In the morning he stands beneath the shower waiting to feel restored, then he begins to work again.

Inside the theatre they are ready to start, but for the fly. Now hovering above the lights, now perched upon the window frame. A masked nurse flicks at it with a cloth. Some joker has posted a sign on the OR door:
No Fly Zone
. Kai waits while efforts are made to remove the insect. On the shelves are stacked bottles of saline solution, rolls of cotton, catheters, IV lines, braided silk, needles, polyester suture and boxes of gloves. Unimaginable a few years ago. He thinks of Tejani.

Once, as students, they travelled together to a town upcountry to find a doctor of whom they had heard, who was conducting research into Lassa fever. The man and his work had achieved a mythological status among the student body. The fever affected populations only in rural parts of West Africa, peasants and farmers. No drug companies had ever funded programmes into its cure, though the virus, which was carried in rats’ urine, had been identified in 1969. The infection started with a headache, ended in death, blood pouring from the body orifices. Some claimed the doctor had a world-class reputation. Others that he didn’t exist. They’d hitched up one Saturday morning, Tejani and Kai, chased by the momentum of a late-night drinking session, and a handshake bet. Neither had travelled outside the city for several years, and neither could tell if the other was serious. The roads were appalling, nervous truck drivers insisted by then on travelling in convoy. They arrived after darkness. In the town they searched for a bar in which to relieve their hangovers, the edge of the thrill already blunted, their minds turned to getting back for Monday lectures. Two soldiers, stepping out of the black, asked to see their papers and what their business was in town. Tejani had spoken for both of them, as was the way in their friendship. He was honest, he told the soldiers they were students, of the doctor for whom they had come. There was nowhere in the world where doctors weren’t cherished. The soldiers had led them to him.

They found the doctor still at work, late into the night beneath a lone, insect-spotted, forty-watt bulb. He worked with a single assistant. Tejani and Kai waited in silence until he was ready for them. A small man, who seemed uncomfortable in his skin and baffled by their visit, though gracious enough. Kai remembered seeing a picture of him some time later, at an awards ceremony for his work, wearing an outsize suit and the same expression of bafflement, surrounded by European faces. Two images of him: that one, which came later, and the first, of him working on the other side of the room, handling samples of contaminated matter, wearing a snorkel and mask, and a pair of household rubber gloves.

In those days they had learned to make do. Throughout the whole of their medical training, it had been the same. One would perform a procedure, the others watch. It has become part of him, this lack of need. And there is always a fly. So they decide to proceed, as they always do. Time in the operating theatre is marked out in precious minutes.

The amputation patient is lying on the table, arms outstretched, one arm hooked up to the blood-pressure monitor, the other to a line into which the nurse is pumping ketamine. He is strapped to the table to prevent him moving should he begin to hallucinate. Kai has seen a patient try to stand up in the middle of a procedure, heard another talk to his dead mother. Tejani had written to him of nightclubs in America where people lay in darkened rooms, knocked out on ketamine. During the war commanders had given the drug to child combatants just before they sent them into battle.

In this most recent letter, Kai thinks he detects a new mood of confidence. Tejani’s letters of the first two years have been full of laments. It has been Kai’s job to reassure him. Now, for the first time, something different. Come, Tejani is saying to his old friend.
Come
. The word acts upon him all day, making him restless, like a grain of sand between skin and shirt.

Kai swabs the area where the first incision will be made with a mixture of water, iodine and ampicillin.

Seligmann, the Canadian surgeon whom Kai is assisting, is ready to begin.

‘Cutting now.’

Kai closes his eyes and opens them. He breathes in, lets all the sounds behind him fall away, all except the voices of the team and the sound of the instruments.