Jack Coughlin: Running the Maze

FIVE-MINUTE BREAK. DR. JOEY Ledford sat on the shaky remnants of a wooden chair, smoking a Marlboro and sweating while monsoon rains slammed the tin roof of the makeshift medical clinic of United Nations Refugee Camp Five. Somewhere, doctors and nurses were performing surgeries in antiseptic, air-conditioned rooms that were packed with every conceivable device of the medical arts, with storage areas nearby bulging with vital, lifesaving medicines. They were listening to Bach or Norah Jones or Latin jazz as they performed meticulous cuts and closed wounds with care, taking all the time they needed to do it right. Somewhere, the magical art of medicine was a smooth choreography conducted by well-educated professionals in offices and clinics and hospitals. Somewhere, but not here.

Ledford exhaled, and twin streams of cigarette smoke flowed from his nostrils. The rain was not a gentle and sweet thundershower like back in Iowa. Instead of giving life to crops, this was unrelenting and fell in great sheets, as if some angry demon had ripped open the bellies of the fat black clouds. He looked out at the sprawl of the camp, where thousands of people were hiding under whatever shelter they could find. Armed guards were at the clinic door to keep them out. They had been driven out of their homes by overflowing rivers and leaking dams and were still being pursued by water. Poor creatures, Ledford thought. Poor, damned souls.

Sweat caked his T-shirt and khakis, and when he dropped the cigarette and ground it out, he noticed the bloodstains on his black rubber boots had become deep, splotchy layers during the day, and he could not recall the individual patients from which the blood had come. He would wash it off later. Break over, Ledford ducked back into the tent, back into the world of misery.

He sloshed his hands in a basin, slid gloves on, and put on a surgical mask and a fresh apron, then walked over to what once had been someone’s kitchen table but now served a higher purpose as an operating room surface. It was covered by squares of disposable white paper on which a baby girl lay screaming as a nurse inserted an IV needle in her arm to start a drip. The mother shrieked nearby, echoing and amplifying the suffering of her one surviving child.

“It looks like another cholera,” a nurse replied. “Once you set the broken arm, we will begin the antibiotics.”

Ledford nodded. “We have any patient history or X-rays for her?”

“No. She’s about six months old, has a one-oh-one fever and coughing. Cries are weak. The mother just arrived this morning and said a big rock banged into the child during a mudslide two days ago.”

The doctor wasted no time complaining about what they didn’t have, because they could only work with what was available. He was thirty-one, an even six feet tall, had longish dark hair that reached his collar, and possessed impeccable credentials: University of Iowa for premed, then the Carver College of Medicine there, followed by a three-year internal medicine residency at the Mayo Clinic in Minnesota. He’d been ready for the next step toward a successful career when he decided to take a holiday from his studies and go see the world. He did not like what he found out there. He had a rugged, handsome face, but the eyes were those of a combat veteran, for he had seen horror after horror in refugee camps from Haiti to Africa. The emergency calls for help from Pakistan when the floods struck had come as he was wrapping up an assignment in Bangladesh, and he did not hesitate. This was who he was now, at least for as long as he could stand it.

“OK,” Ledford nodded to the anesthesiologist, David Foley, an irreverent Canadian from Ottawa. “Let’s put the kid to sleep so we can move her on down the assembly line. We’ve got a lot of other customers waiting. Raining like hell and the drinking water is filthy because we can’t store it. No excuse for waterborne diseases here.”

There was a soft hiss in a plastic mask over the baby’s mouth and nose, and she immediately began to calm. “Hey, Joey?” asked the gas-passer.

“What, David?”

“Five years from now you will be doing nip-and-tucks for rich ladies in your own fancy clinic. I will be driving a red convertible. We will tweet and play Fantasy Football and date supermodels.” He looked at his instruments. All good. “OK. She’s down.”

Ledford let his fingers gently probe the left arm of the infant and explore the fracture. “Stay focused, Dr. Foley.”

“Joey?”

“Be quiet. I’m trying to concentrate.” He found the break and tried to picture in his mind how it looked. With luck and a few years, if the child beat the odds and lived that long, her limbs might one day be strong again. Babies are resilient.

“Doc Yao says we can have some time off. Sort of.”

Ledford’s hands were working smoothly now, and the nurse stayed with him, putting another damaged little human being back together. He let her do as much of the work as possible to improve her skills. “What’s the catch?”

“We go up north and visit some of the flooded villages where the water is receding. Pick a site for a new UN facility upcountry. I think we can carve out some serious downtime in the process. Actually get some rest. We about done with this kid?”

“Just a few more minutes.” As the nurse finished the bandaging, he gave the rest of the body a quick examination. No other breaks, but she was malnourished from being sick and unable to feed. He could clearly see the rib cage. He gently pinched, and the skin did not quickly resume its shape. “The arm will be fine, but the cholera is going to kick her little butt.” He made a note to admit the child as a patient and try to get her cleaned up, inside and outside. If she survived all of that, then all she would have to worry about would be measles and malaria and land mines and machine guns and mortars and a long menu of infectious diseases and the questionable privilege of growing up in a third-world country in which women were second-class citizens. Thankfully, Ledford thought, the strict Islamic religious zealots had not invaded the camp yet, or he would not have been allowed to touch or even look at the naked female baby.

“What did you tell Dr. Yao?”

“I volunteered us.”

“Humph,” Ledford grunted. Might be interesting.

The team of nine medical workers headed out the following morning, in a convoy of three United Nations trucks, carrying just enough supplies to establish a base camp that could expand rapidly to help meet the flood emergency. Fifteen hours later, after grinding through brutal, washed-out roads, they reached a camp that was run by Doctors Without Borders, where they spent the night before pushing on deeper into the wasteland in the dusty gold of the new dawn.

“My ass is completely broken,” complained David Foley by radio as the sun reached its zenith. He was in the third truck, and Ledford was riding as the only passenger in the lead vehicle.

“Take two aspirin, put it in a sling, and call me in the morning,” Ledford joked.

“Better idea would be to just stop and have some lunch. Get our bearings,” Foley replied.

Ledford thought that was a good idea, for the road had smoothed out a bit for the last few kilometers as it moved through some small hills. A side road branched off to the right and downward, and he told the driver to follow it to a spot where they could have a break. In a moment, they were on the back side of the hills and following an old road that sloped down into a valley, edging onto a flat plateau. “Here,” he said. The trucks pulled up, nose to tailgate, and the team got out and stretched.