Christopher Reich - Rules of Betrayal

“It’s all right to tell me if it hurts,” said Jonathan.

“A man does not howl,” said Sultan Haq.

“It will help me localize the problem.”

“Surely you can discover the problem yourself.”

Jonathan took the old man’s blood pressure, temperature, and pulse. All readings were well above normal.

“What is the matter with my father?” asked Sultan Haq.

“Without an X-ray, it’s impossible to be sure. My guess is that he’s suffering from an acute abdomen caused by a peritoneal abscess. That means there’s a tear in his colon or stomach that has allowed bacteria to escape into the abdominal cavity. Normally, if it goes untreated this long, it kills you. Since he isn’t dead, it means that his system has walled off the infection.”

“He is a strong man.”

“Yes, he is. But he has a big pocket of pus in there that needs to get out. And I mean now.” Jonathan looked at Abdul Haq and did his best to offer a comforting smile. The old warrior scowled in return, his eyes wishing Jonathan a long and painful death.

“What can you do?” asked Haq.

“We need to take him to a hospital in Kabul. The sooner, the better.”

“That’s not a possibility,” responded Haq. “I ask you again, what can you do?”

Jonathan sat back on his haunches, running a hand over his mouth. “I don’t have the equipment to perform that kind of surgery. Look around you. These aren’t exactly sanitary conditions.”

“I didn’t bring you up the mountain to do nothing.”

“Take him to a hospital and he’ll be better in two days.”

“You will heal him here, now.”

“I will not harm your father,” said Jonathan. “He needs proper medical care.”

“Then I will have to kill you and your friend.” Haq barked a command, and one of the guards grabbed Hamid and put a knife to his throat, drawing blood.

“Stop!” shouted Jonathan, jumping to his feet. “All right. I’ll do it. Let Hamid go.”

Haq waved away the guard and Hamid slumped to the ground, gingerly exploring the wound on his neck.

“But the best I can do is open him up and drain the pus,” Jonathan continued. “That will relieve the pain, but it won’t solve the underlying problem. Even if I find a perforation, I doubt I can close it. I don’t have the tools.”

Haq held Jonathan’s eyes. “You will cure my father or you will not walk out of this cave.”

Jonathan gazed down at the old man lying on the bed of colorful blankets. As he did, he observed a large black centipede scurrying beneath the pillows. He looked around the room for a table or some firm surface he could lay the man down on. There was nothing.

“I’m going to need water,” said Jonathan. “Lots of it, boiled and sterile. Hamid, put a bandage on your throat, then get me two syringes of lidocaine. I’ll need gauze, scalpel, forceps-that should do it.”

He turned to Haq. “Your father won’t feel anything, but you and your men”-he pointed at the guards standing nearby-“you’re not going to like it. I suggest you wait outside.”

“They’re used to blood,” said Haq.

“I’m not talking about blood.”

“We will stay,” said Sultan Haq.

Jonathan injected three cc’s of lidocaine into the area around the infection. He waited several minutes, then made a five-centimeter incision and with his fingers separated the fascia. “Mosquito.”

Hamid inserted the mosquito, a small rake-shaped clamp, to hold the incision open. Jonathan injected another cc of lidocaine directly into the fascia. Already he could feel the pressure from the abscess throbbing against the muscle.

“You guys might want to back off,” he said, eyeing the guards, who stood with the barrels of their AK-47s aimed at his back.

The guards looked at Haq. Haq shook his head sternly.

“Don’t say I didn’t warn you.” Jonathan cut through the last layer of fascia. A jet of pus erupted, shooting vertically out of the abdomen and striking one of the men squarely in the face. The man cried out, frantically wiping away the warm liquid.

“Be still,” commanded Haq.

Jonathan widened the incision and glimpsed a large mass of yellow pus. Officially the pus was termed a “fibrous, proteinaceous exudate.” As a resident in general surgery, he’d preferred to call it what it actually was: “gross nastiness.”

Inserting his fingers, he pulled out a wad of pus and wiped it on the gauze. It was then that the odor wafted from the wound, and the first guard bent double and retched. A second guard turned his head, his eyes watering.

Nothing on earth smelled as awful as a long-festering anaerobic infection. The smell was worse than a Lagos latrine on a 100-degree day. Worse than a three-day dead rat plumped with maggots. Worse than anything Jonathan had ever experienced.

“Like that, eh? There’s more. Don’t worry.” Reaching back into the abdominal cavity, he retrieved a second, larger wad, this one the size of a Coke can. The guards covered their mouths and rushed out of the room. Even Haq jumped to his feet and charged the door. Only Hamid remained rock-steady, unflinching.

“What do you think got to them?” asked Jonathan.

“No idea,” said Hamid. “Guess the sight of blood makes them squeamish.”

“Guess so,” said Jonathan. “Now, let’s clean this out.”

For the next few minutes he pumped syringe after syringe of sterile boiled water into the cavity. Leaving behind even a trace of bacteria would result in a second infection. Abdul Haq might be Public Enemy No. 1, but for the moment he was a patient in grave danger, and Jonathan did his best to save him.

Satisfied that the infection had been cleaned, he tacked the muscle together. To allow any residual pus to escape, he fashioned a Penrose drain from a short length of rubber tourniquet and inserted it like a candle wick into the cavity. Ten stitches closed the incision.

Jonathan looked at the doorway, where Haq remained, his face a curious shade of yellow. “We’re done.”

“Will he live?” asked Haq.

“That’s up to you. He needs to recover in a clean environment. If the infection comes back, I wouldn’t count on him making it through a second time. He’s tough, but not that tough.”

Abdul Haq probed the stitches gingerly. “I am all right?” he asked in Pashto.

“Yes,” said Jonathan. “You’re going to be fine.”

Suddenly the old man was beaming. Free of the crippling pain that had plagued him for weeks, he grabbed Jonathan’s hand and held it to his chest. “God sent you. Blessings upon your house. You are a great man.”

Sultan Haq touched Jonathan’s shoulder. “I thank you for saving my father’s life.”

“You’re welcome,” said Jonathan. “But if you really want to thank me, let those soldiers go.”

“They’re my enemies,” said Haq. “They have killed many of my men. They know where we live.”

“So do we.” Hamid kneeled beside Abdul Haq to apply a sterile bandage to his abdomen.

“Did I speak to you?” thundered Haq, looking down at the slight assistant.

“Well?” asked Jonathan.

“You are welcome to stay,” said Haq with forced kindness. “You say you came to my country to help its people. You may help us.”

“Is that an invitation or an order?” Hamid stood, and Jonathan thought he appeared taller, no longer so timid.

Drawn by the sound of the raised voices, one of the guards poked his head back into the room.

“Hold it, Hamid,” said Jonathan. “Finish putting on the bandage. Okay?”

“Your work is done, Jonathan,” continued Hamid. “Now it’s my turn.”

Jonathan looked hard at Hamid. It was the first time the assistant had ever called him by his Christian name. He could feel the tension ratcheting up, everyone looking at everyone else too expectantly.