The Shortest Way Home (3 page)

That hadn’t happened to him in over a year, though, and after a moment he realized it didn’t feel as if he were being gazed upon lovingly. It felt like surveillance. He snapped his head up and looked around quickly. There in the doorway stood the dog, just staring at him.

CHAPTER 2

A
fter twenty-four hours of travel, at least it felt good to lie flat. His back had been hurting for months, maybe longer, though he couldn’t really be certain. His days at the small hospital near Bukavu, Democratic Republic of Congo, had been filled with patients whose bodies were so battered that paying attention to his own discomfort seemed absurdly weak. Most of them were victims of brutal tribal warfare, women and children who were relatively lucky enough to have made it to the hospital before their wounds prevented them from walking.

Sean’s pain came and went. Sometimes he thought it was improving, and then a simple action—bending to lift an emaciated patient from her cot, perhaps—would bring it on with a vengeance. The sensation was like an unhitching of something that surely ought to have stayed connected, and then the compensatory clenching of the surrounding muscles to keep the unhitched pieces from separating altogether. He should have been able to evaluate exactly what was going wrong. But all he could do when it came over him was squeeze his eyes shut and mutter,
“Jesussufferingchrist,”
against clenched teeth.

It had gotten pretty bad toward the end of his time in Bukavu. It was a wonder he’d stayed so long. He supposed he’d been waiting for that time-to-move-on feeling that settled on him reliably every several years or so, but it never came.

Usually he would hear of something—military attacks on native Indians in Guatemala, for instance. He had gone there right out of nursing school and stayed for a few years, learning the dialect and suturing wounds, staying far enough away from the politics to be ignored.

And then he’d heard of a clinic in the Dominican Republic tending to the slaves of the sugar industry, with an infant mortality rate that rivaled that of the Dark Ages. From there he’d gone to Kenya. In 2001 there had been a devastating earthquake in India, and he had thought to go for a month or two and help out, but stayed for several years. Then the tsunami in the Indian Ocean hit, and there was such widespread need for medical care, it took him a few days to figure out which country to head for and which relief agency to offer himself to. He wrote Aunt Vivvy for travel funds to Sri Lanka. She never said no. She never said yes, either. She just wired the money without a word of interest in his plans or news from home.

Bukavu hadn’t been his first stint in Africa. The first had been in a little clinic outside of Bomete, Kenya. He’d loved it there. The staff had been great—hardworking and friendly—almost like a family. It was fourteen years ago, now, but Sean could still see it clearly. Lying there in his long-gone father’s bed, it was a relief to focus on the unambiguous past rather than on his throbbing back and undefined future. . . .

* * *

H
e’d only been in Kenya a month, so his Swahili was just slightly better than that of Dr. Yasmin Chaudhry, a newly arrived OB/GYN he was working with.

“She says she feels . . . full of air?” Sean struggled to translate.

“Does that mean she’s breathing well, or having trouble?” asked Dr. Chaudhry.

“Imevimba,”
insisted the girl, and blew her cheeks up like small, coffee-colored balloons.

“Swollen!” said Sean.

“Bloody hell,” muttered Dr. Chaudhry. “Of course, she’s
swollen
. She looks about ten months pregnant.”

Slowly, Sean reached out and took the girl’s hand. In the six years since graduating from nursing school, he’d learned that no matter how good his intentions, a tall freckled white man was an oddity in developing countries, and sudden moves didn’t do anything to instill trust. He gently pressed his forefinger onto the back of her hand, creating a depression that took several moments to disappear. It was a sign of preeclampsia, a potentially deadly pregnancy complication that could only be remedied by delivery of the baby.

Dr. Chaudhry met his gaze. “Ah,” she said, nodding. “Check her blood pressure.”

It wasn’t only his patients Sean had to prove himself to. He stifled a smile, secretly enjoying the challenge of establishing credibility with a new medical team. It always made coming to a new place just that much more interesting.

The girl’s name was Amali, and she was
kumi na sita
, which was either sixteen or seventeen—the two numbers sounded alike, and Sean couldn’t remember which was which. It was enough to know she was quite young, though he’d treated pregnant twelve-year-olds in Guatemala and the Dominican Republic. This was Amali’s third pregnancy. She and her husband had traveled more than forty miles to the hospital on foot—she wearing a pair of battered bedroom slippers, the soles all but worn through, and he with no shoes at all.

“Your children?” said Sean.
“Watoto?”

She shook her head and looked away.

Stillborn
, he guessed. Sean had delivered as many dead babies as live ones. Most women didn’t come to a hospital unless something had gone terribly wrong, and by then it was often too late. Any small complication—even something as common as a breech birth—could trap the baby in the birth canal, causing death. Cervical necrosis could set in, sterilizing or even killing the bereaved mother. Sometimes Sean wondered which was worse. Children were often the only joy desperately poor women had—and the only thing they could offer a prospective husband, without which they lived in the double jeopardy of being female and having no protector.

Amali’s preeclampsia was confirmed by high blood pressure and a dipstick urine test indicating an overabundance of protein. Dr. Chaudhry ordered an induction, instructing Sean to manually strip Amali’s cervical membrane, and if that didn’t kick-start labor, to break the amniotic sac. She hurried off to see another patient, whose terrified screams reverberated throughout the curtained labor and delivery area. Amali’s eyes went wide with fear.

Oh, great
, thought Sean.
And now a white guy’s going to stick his hand in your vagina
.
Not quite the day you bargained
for
.

In halting Swahili, liberally mixed with English and an entire ballet of interpretive gesturing, Sean explained the plan to Amali. Her expressive face changed with every new piece of successfully transmitted information. Skepticism, mild disgust, deep concern as her eyes flicked toward the direction of the ward door, beyond which her husband waited.

He doesn’t have to know
, Sean wanted to say.
He’ll just be happy you’re alive
.

Amali looked at him, her face pinched in anxiety.
You really have to do this?
she seemed to be saying with those enormous dark eyes.
Seriously?

Sean took her hand and pressed his thumb into the bloated skin, showing her the dimple it made.
“Mbaya,”
he said. “Bad for you,” pointing to her, “and for the baby,” indicating her belly.

She gave the tiniest of nods, turned her head away, and parted her knees. Sean averted his own gaze to give the illusion of some small bit of privacy. As he slid gloved fingers toward her cervix he prayed silently, a habit he’d gotten into back in nursing school. For women he usually said a Hail Mary, but today he heard the Gloria in his head.
Glory to God in the highest, and peace to His people on earth
. He began the painful procedure of irritating her cervix into dilation.
Lord God, heavenly King, almighty God and Father, we worship You, we give You thanks, we praise You for Your glory. . . .
When he’d finished, he pulled the sheet back over her legs and left without a word, knowing eye contact would only compound her embarrassment.

He came back later to check on her and there were no contractions, so he talk-mimed the need to break the amniotic sac. This time he used what looked like his sister Deirdre’s plastic crochet hook. During his brief visit home a month before, she’d been crocheting a 1960s-era vest as a costume. He slid the amnio hook into Amali’s vagina. The image of Deirdre, whose main worry was whether she’d get the lead in her high school play, was weirdly incongruous as he broke the water of a girl of approximately the same age, who’d already buried two children.
Lord God, Lamb of God, You take away the sin of the world: have mercy on us. . . .

* * *

T
he induction failed. Amali’s contractions were weak, and the hospital carried no Pitocin to chemically force them. Dr. Chaudhry looked tired, and Sean felt himself in that crystallized state of sleep deprivation where objects take on an added glimmer when they move. As they began the Cesarean section, the doctor’s face went into a fixed blank state, suggesting intense concentration . . . or that her mind had wandered far away from the understaffed, underequipped hospital on the outskirts of a small Kenyan town.

After anesthesia had been successfully applied, and just before the incision, Amali’s blood pressure skyrocketed, and she began to hyperventilate.

“Hold her still,” commanded Dr. Chaudhry.

Sean threw himself across the young girl’s heaving body and the scalpel was applied. He waited for the duckling squawk of a newborn and felt his own pulse race, adrenaline rushing into all the cracks of his fear. Two young lives would be lost or saved in these moments. And though he knew the final outcome was in God’s hands, he felt the rightness of his being there to help. In moments like these, Sean experienced a surge of gratitude for having been guided so clearly to his life’s work. And despite everything, he felt immensely lucky.

A baby girl was soon released from the confines of her mother’s body. After tending to the baby, Sean went out to tell the father, who had waited all night at the hospital door. The young man shook his hand vigorously and came in to see the baby while his wife was being stitched up in recovery. Slipping his newborn daughter into his shirt to keep her extra warm, he sang quietly to her. Sean had never seen an African father take such an active role in a baby’s care. Generally this was considered the sole province of women. He felt an unexpected hopefulness for the future of a baby with such a devoted father, despite their profound poverty.

In the glory of God the Father, amen
.

* * *

S
ean soon learned that Dr. Yasmin Chaudhry wasn’t as young as she looked. He was twenty-nine, and she had a solid decade on him. An Englishwoman of Pakistani descent, she was well trained and had a fortitude that Sean came to admire greatly as their friendship grew.

She was also quite clear about her lack of interest in any kind of romantic entanglement. She had a way of physically holding herself apart without seeming cold. Her eye contact was direct but not inviting. This was a relief to Sean, who was generally agreeable if one of the transient health care workers was interested in a casual interaction. He’d had a vasectomy years before and was careful about protection. But he tended to stay away from longer-term staff and older women—not because he wasn’t attracted to them, but because they were more likely to hope for an actual relationship.

One evening Sean was walking down the deeply pocked road by the doctors’ quarters—small cement bungalows clustered together near the hospital. Yasmin’s tiny yard was overgrown with weeds and flowers. She worked too many hours, she said, to trim plants that would only grow back again. It was a warm night and she was sitting in her window and spotted him.

“Come in for a glass of something,” she called to him. And he was happy to sit with his friend at the little table by the window and feel the breeze and smell the tangle of roses that sprawled against the house. They drank Rocamar red wine out of scratched glasses, conversation ambling through current patients, wish lists of supplies they would never see, and the various peculiarities and suspected motivations of their coworkers.

She questioned him in her guileless way about how he had come to Kenya, and he found himself talking about his mother’s death from Huntington’s, an incurable disease passed from generation to generation, characterized by mental and physical deterioration and early death. Symptoms often came on by the victim’s early forties. His mother had died at thirty-five when he was fifteen, giving him a 50 percent chance of inheriting the disease himself.

“I’ve heard about that,” Yasmin said. “Isn’t there a test for it now?”

“Some people take it, some don’t.”

She studied him for a moment, her hand resting around her glass. “And you haven’t.”

He shrugged. “My brother and sister don’t want to know, either.”

“Why on earth wouldn’t you want to know?”

Sean gazed out the window, the hum of insects seeming to grow louder in the silence. It was always so hard to explain it to people. “Put yourself in my shoes,” he said. “If I were to tell you that I could say
for certain
when and how you’d die, and that you could linger for years, becoming an enormous burden to your family . . . would you still jump at the chance?”

Yasmin’s night-black eyes went vague for a moment as she envisioned his dilemma. Her focus returned and she said, “There’s just as good of a chance you’ll find out you
don’t
have it. You’d be free to marry and have a family. You obviously enjoy the company of women.”

He raised his eyebrows at her.

“It’s clear as crystal,” she said flatly. “No one mistakes you for homosexual.”

He laughed at her forthrightness. “Anyway . . .” he said. “For me the trade-off works. Not having to deal with definitive bad news is worth not settling down and working in some small-town American hospital, bandaging lacrosse lacerations. I’m happier than most people,” he said, taking another sip of his Rocamar.

And he was.

CHAPTER 3

T
welve years later, Sean had returned to Africa, this time to Bukavu, Democratic Republic of Congo. It had been an entirely different story. The staff had worked just as hard—harder, maybe—but the civil war that raged around them caused a level senselessness to their patients’ afflictions that was nearly impossible to bear. Of course, the whole planet throbbed with suffering, but it was hard to out-suffer the women and children who clustered around the hospital, malnourished and homeless, severed from their families and any place in their culture by the unspeakable indecency of their “war wounds.”