Twelve Patients: Life and Death at Bellevue Hospital (40 page)

The cops guarding his door didn’t know what to make of it. Would he die? Would that be a good thing? Or a bad thing? Would they catch chickenpox, on top of everything else he was offering them?

“WTF?” they asked me as I came out of Beltrán’s room later that morning.

“Excuse me?” I couldn’t make out what they said.

“What The Fuck? Doc, WTF?”

“He should be okay,” I said. I wasn’t sure if they were relieved.
“Though this can be really serious. The timing of his HIV treatment is tricky. I know it sounds bizarre, but when you treat TB and AIDS, the patient’s crippled immune system starts to work again.” I felt like I was teaching in school. They all looked at me intently. “I mean when we put Beltrán on HIV medications, his immune system started to recover, the T cells rebounded and started to attack his infection—and his body did an overshoot. It looks like his TB is active again, but it’s not.”

The looks on their faces made me realize why we needed physicians who really knew these diseases in all their granularity. Every case had a unique twist. Textbook cases were cartoons, averages, generalities. They were not substitutes for real-life experience. The disease had escaped my internist capabilities some time ago. It was like an oncologist’s job now, teasing out regimens, side effects, testing and rebalancing and keeping up with an avalanche of new drugs and treatment regimens. Studies were ongoing for a morning-after sex pill and for a daily preventive pill. Plan B for HIV disease from your local pharmacist, like oral contraceptives. If you had HIV and access to HAART (highly active anti-retroviral therapy) or the comprehensive treatment regimens, your life expectancy was normal. In twenty years it had become a manageable, chronic disease. The
if you had access
piece was the big variable.

“Doc, you mean you treat the guy, he gets better and then gets worse?” The chief of detectives looked at me and then his entourage.

“Yes, Detective. Precisely. We call it IRIS, immune reconstitution inflammatory syndrome, a mouthful, I know. It is strange. But it means he is getting better. His immune system is healed and exploding. We will watch him carefully and treat the syndrome.” The detectives and officers were listening and trying to figure this out. It was counterintuitive, like a lot of what we did in medicine. Less is more. More is less, and on and on. Revisited in every generation.

After a week, it was clear Beltrán had survived that setback. I came by regularly while he sweated and moaned away. Now he wanted company. Chickenpox got him to talk about what his life had been like and how he had ended up in a seventh-floor room on a locked tuberculosis
unit in a city hospital in custody of the U.S. justice system. A pause for some reflection on the meaning of it all?

“Have you heard of the Kaibiles?” he asked me a few days later, after his temperature came down.

“
If I advance, follow me. If I stop, push me. If I retreat, kill me.
Those Kaibiles?” I responded, my ears now wide open at the mention of Guatemalan military, special ops. Ruthless.

Beltrán repeated in Spanish, “
Si avanzo, sigueme, si me detengo… Apremiame…, si retrocedo… Mátame
.”

“My wife and I took a trip up the Usumacinta River from Yaxchilan in Mexico near Palenque in the Yucatán. We were traveling to Tikal in the late 1980s. Not the regular tourist flights from Guatemala City or overland from Belize. We were stopped at a checkpoint at a military camp that might have been
El Infierno
, Hades. Los Kaibiles had their ‘motto’ prominently displayed on a wooden sign:
Bienvenidos. Si Avanzo… Sigueme. Si me detengo… Apremiame… Si retrocedo… Mátame.
After that introduction, how could I not have heard more about them?” I asked him back. Diana and I had actually stumbled on a black-ops training camp deep in the jungles of the Petén, the large Guatemalan province that juts northward into the Yucatán Peninsula. The recruits were young men trained to be killing machines through psychological and physical deprivation and brutality. A fourteen-or fifteen-year-old with a machine gun pointed at our faces had stopped our dugout canoe.

As Diana and I sat for hours on a wooden bench waiting for our passports to be returned (and our guide to resurface), we could see young boys, fifteen or so years old, beat one another to a pulp while older men surrounded them in a circle, cheering and taunting them. Young Kaibiles in training. We drank a Coke under ads and calendars graced by beautiful blond women and children and wondered if we’d ever see our kids again. During the thirty-plus-year civil war in Guatemala that “ended” in 1996 with the “Peace Accords,” many Kaibiles left as mercenaries seeking other “opportunities” or were decommissioned into civilian life. Over 250,000 civilians were dead in a war that left the country in a collective state of post-traumatic stress. The perps
were granted immunity. I wondered where he was going with Los Kaibiles. I was feeling uneasy at this point.

“I was twenty years old and had no skills and no future. The civil war had decimated the Highlands. Family was turned against family, friends against friends. I decided to enlist. Just like the guys your age who enlisted to go to Vietnam from the poor barrios of New York.” He threw that in gratuitously. By this time we were not wearing masks anymore, literally and figuratively. He was non-infectious, having completed several weeks of TB therapy. He would need a full six to nine months to finish the complex four-drug regimen ensuring that all of the slow-growing bacilli were moribund.

“So you joined the elite of the elites? The Navy SEALs of Guatemala?” I asked him if they really bit off the heads of live chickens, and drank pulque, the local fermented alcohol, out of recently fired mortar shells. And I asked if he had CIA advisers in his years of training.

“
Jefe
”—he must still have had his military reflexes since he called me “chief”—“we did a lot of weird and stupid things. Part of the harassment and way they break you down. You ever see the movies about Jason Bourne?” He loved the movies, evidently a Kaibil fascination. I smiled, some of my favorite action movies of all time. The protagonist is so destroyed in becoming a killing machine that he doesn’t know who he is or what he has become except through short flashbacks. “I would have thought you were a
Terminator
fan.” The pirated CDs littered the markets of every Latin American town.

“I left when the Guatemalan Peace Accords went down in ’96. A lot of us left at that point. It was a poisonous time for the military and particularly the ‘elites’ as you call us. The Truth Commission was putting a report out and it wasn’t clear who would be sacrificed, except that it wasn’t going to be the top commanders for sure. The United States was pulling dollars out of its intelligence operations. You couldn’t trust anyone.” I reflected on the concept of trust for an ex-black-ops guy suddenly cut loose from the decades-long fratricidal killing rampage.

“So what did you do then?” I felt like the psychiatrist from
The Sopranos
. Short questions, non-judgmental. Psychopathic killer sitting opposite with charm and a sense of humor.

“There was another game that had been developing in Guatemala and spilling over from Mexico and El Salvador. Narcotics. If you were ex-military and weren’t freelancing, there was only one thing you were capable of doing and that was the security service industry that was growing around everything like a
matapalos
.” The
matapalos
were killer vines in the jungle. They started innocently climbing a tree and ended up strangling it—killer vines, like the Guatemalan military.

I remembered a long conversation with our driver from Guatemala City to Rabinal through the back gravel roads winding our way over mountains and through small pueblos. His previous career had been in private security as a driver and guard. After a few cycles of layoffs, Rafael ended up chauffeuring an ever-diminishing tourist trade. For unemployed security employees, there was only one other option to have a steady income. The narco trade was the growth industry and the networks were all ex-military and ex-security, almost one and the same. “The government tolerates a high rate of crime so there are not more unemployed security personnel on the street,” he told me. You could drive through the Zonas or neighborhoods in Guatemala City and not see a soul. Barred windows and doors gave the impression of prison cells without roofs. Rabinal was a cluster of white buildings between two rivers in the distance as we zigzagged down the clear-cut mountainsides, the few remaining trees hugging the steepest banks and arroyos like their life depended on it.

“What is freelancing for ex-Kaibiles?” I asked straight back.

“Like the Zetas,” he said, referring to the elite units of the Mexican military that had defected around that time and taken up positions as the paramilitary enforcers of the Gulf Cartel before freelancing in the narco business. They were notorious for their cruelty and their creation of new forms of barbarity. Narco-messaging was an art form. They communicated using corpses and body parts they left hanging from lampposts or overhead bridges. They mutilated the decapitated bodies beyond recognition.
Posole
, corn soup, was a concoction of vats of acid where they melted bodies to the consistency of stew. Heads stitched to look like soccer balls were left on playgrounds.

“Like Zetas, like Kaibiles and the Colombian paramilitaries. Some
common buddy system across international lines?” I pushed a little further.

“We all worked together all the time. Remember, our commanders trained in Panama and then Fort Benning at the School of the Americas run by your government,
amigo
. They all knew one another and developed close ties between countries, like classmates from college. What do you call it, a fraternity,
una cofradía
. The borders were porous.”
Esponjoso
, spongy, was the word he used. “We helped one another all the time. Collaboration. I think the Fortune 500 call it teamwork.” He was having a good time with me.

“And Las Maras, just how did they fit in?” The puzzle was starting to fit together.

“Las Maras came into Guatemala across the border from El Salvador. They networked right up to the frontier with Mexico and extended a spiderweb north into the heartland of the United States. Remember, Los Angeles is their ancestral land. During a civil war, their parents fled Central America to California. The kids were born north of the border before they were sent back to El Salvador. But now as pretty hardened gang members to survive the tough turf battles and life without jobs. Many sent back did not even
hablar
the Spanish. They were distributors, independents, human traffickers,
sicarios
(guns for hire), and Mafia, all in one, not specialists. They couldn’t become an independent cartel in Mexico. The Mexican cartels were too powerful and well established, so they worked in the spaces between the major cartels and worked with the cartels. There is always room for some independent contracting. This is a very advanced form of capitalism.”

He smiled broadly at his political message to me. We were talking in codes, but there was truth in his throwaway line. There was plenty of money being made on the War on Drugs north and south of the border. The United States had recently signed a multibillion-dollar “Plan Merida” of “assistance” to the Mexican government. This would go to U.S. contractors to service the border, providing armaments, motion detectors, and drones. What U.S. congressman could object to that list of familiar requests? These weren’t earmarks, after all.

Two converging lines brought the drug cartels into open and
brutal competition—violence that has left a body count approaching fifty thousand in the few years since President Calderón of Mexico announced a military operation against the major cartels. The first was the loss of elections by the long-term single governing party in Mexico, the PRI, to Vicente Fox, the former Coca-Cola executive, in 2000. The loss of the near-dictatorial rule of the PRI, which had managed the country with a form of distributive payments for votes and compliance, combined with the closure of Florida as a transshipment zone for South American cocaine, left the traditional areas of the Mexican drug trade now awash in unlimited sums of money and zero government “cacique” or strongman controls over the “plazas,” the local drug distribution centers.

The second converging phenomenon was the North American Free Trade Agreement or NAFTA concluded in 1994. The net effect of the treaty was a time bomb for Mexico. It devastated the agricultural sector, pushing millions of peasants into the cities and sending them in a northward migration as agricultural subsidies for corn were withdrawn in Mexico and the distributive land or
ejidos
(unsalable) from the revolution was revoked. Millions of people lost their means of livelihood. The maquiladora phenomenon on the border—zones of businesses that assembled refrigerators and televisions for U.S. consumption—was eroded by lower Chinese labor costs and created the phenomenon of “nini”: “
Ni empleo, ni estudios
.” Neither work nor studies (education). Generations of unemployed, uneducated young Mexicans with nothing to do and increasingly nowhere to go. The U.S. post-9/11 militarized the border and increased the border patrol from four thousand to over twenty thousand members, with drones and temperature-sensitive detectors. The most insidious was the criminalization of immigration. Crimigration. The creation of a vast new industry of privatized detention centers run by Immigration and Customs Enforcement, part of Homeland Security, has placed over four hundred thousand immigrants in its centers.

Undocumented immigrants are summarily convicted of a misdemeanor and deported or spend a few months in detention. The next offense is a felony with up to twenty years in prison. As the United
States is facing a prison crisis domestically while state budgets reel from the loss of tax receipts from an enduring recession and it can no longer afford to keep 2.5 million under lock and key, a parallel private detention system is growing in hundreds of sites in rural America, competing for jobs and political favors, off the radar screen for most Americans. Tough justice for complex socioeconomic problems that are not amenable to tough-justice solutions. Just as the War on Drugs has not solved the “drug problem” and has ignited a reign of violence in our neighbors to the south. Here I was talking to one of the warriors.