Anthony Marra - A Constellation of Vital Phenomena

“I’m sorry,” she repeated.

“The Feds weren’t looking for Dokka alone,” he said quietly, glancing to the girl.

“What would they want with her?” she asked.

“What do they want with anyone?” His urgent self-importance was familiar; she’d seen it on the faces of so many husbands, and brothers, and fathers, and sons, and was glad she could see it here, on the face of a stranger, and not feel moved. “Please let her stay,” he said.

“She can’t.” It was the right decision, the responsible one. Caring for the dying overwhelmed her. She couldn’t be expected to care for the living as well.

The man looked to his feet with a disappointed frown that inexplicably resurrected the memory of b) electrophilic aromatic substitution , the answer to the only question on her university organic chemistry exam she’d gotten wrong. “How many doctors are here?” he asked, apparently deciding to try a different tack.

“One.”

“To run an entire hospital?”

She shrugged. What did he expect? Those with advanced degrees, personal savings, and the foresight to flee had done so. “Deshi runs it. I just work here.”

“I was a GP. Not a surgeon or specialist, but I was licensed.” He raised his hand to his beard. A crumb fell out. “The girl will stay with you and I will work here until a home is found for her.”

“No one will take her.”

“Then I will keep working here. I graduated medical school in the top tenth of my class.”

Already this man’s habit of converting entreaty to command annoyed her. She had returned from England with her full name eight years earlier and still received the respect that had so surprised her when she first arrived in London to study medicine. It didn’t matter that she was both a woman and an ethnic Russian; as the only surgeon in Volchansk, she was revered, honored and cherished in war as she never would be in peace. And this peasant doctor, this man so thin she could have pushed against his stomach and felt his spine, he expected her acquiescence? Even more than his tone of voice she resented the accuracy of his appraisal. As the last of a staff of five hundred, she was engulfed by the burden of care. She lived on amphetamines and sweetened condensed milk, had regular hallucinations, had difficulty empathizing with her patients, and had seen enough cases of secondary traumatic stress disorder to recognize herself among them. At the end of the hall, through the partially opened waiting-room door, she saw the hemline of a black dress, the gray of once-white tennis shoes, and a green hijab that, rather than covering the long black hair, held the broken arm of a young woman who was made of bird bones and calcium deficiency, who believed this to be her twenty-second broken bone, when in fact it was merely her twenty-first.

“The top tenth percent?” Sonja asked with no small amount of skepticism.

Akhmed nodded eagerly. “Ninety-sixth percentile to be precise.”

“Then tell me, what would you do with an unresponsive patient?”

“Well, hmm, let’s see,” Akhmed stammered. “First I would have him fill out a questionnaire to get a sense of his medical history along with any conditions or diseases that might run in his family.”

“You would give an unconscious, unresponsive patient a questionnaire?”

“Oh, no. Don’t be silly,” he said, hesitating. “I would give the questionnaire to the patient’s wife instead.”

Sonja closed her eyes, hoping that when she opened them, this idiot doctor and his ward would have vanished. No luck. “Do you want to know what I would do?” she asked. “I would check the airway, then check for breathing, then check for a pulse, then stabilize the cervical spine. Nine times out of ten, I’d be concentrating on hemostasis. I’d be cutting off the patient’s clothes to inspect the entire body for wounds.”

“Well, yes,” Akhmed said. “I would do all of that while the patient’s wife was filling out the questionnaire.”

“Let’s try something closer to your level. What is this?” she asked, raising her thumb.

“I believe that is a thumb.”

“No,” she said. “It is the first digit composed of the metacarpal, the proximal phalange, and the distal phalange.”

“That’s another way of saying it.”

“And this?” she asked, pointing to her left eye. “What can you say about this besides the fact that it is my eye, and it is brown and used for seeing?”

He frowned, uncertain what he could add. “Dilated pupils,” he said at last.

“And did they bother teaching the top tenth percent what dilated pupils are symptomatic of?”

“Head injuries, drug use, or sexual arousal.”

“Or more likely because the hallway is poorly lit.” She tapped a small scar on her temple. No one knew where it had come from. “And this?”

He smiled. “I have no idea what’s going on in there.”

She bit her lip and nodded. “Okay,” she said. “We need someone to wash dirty sheets anyway. She can stay if you work.” The girl stood behind Akhmed. In her palm a yellow bug lounged in a pool of melting ice. Sonja already regretted her consent. “What’s your name?” she asked in Chechen.

“Havaa,” Akhmed said. He gently pushed the girl toward her. The girl leaned against his palm, afraid to venture beyond its reach.

A year earlier, when Natasha had disappeared for the second and final time, Sonja’s one- and two-night stays in the trauma ward had lengthened into weeks. After five weeks had passed since she’d last slid the key into the double lock, she had given up on the idea of ever going back. The twelve blocks to her flat might as well have been the Sahara. Waiting for her there was a silence more terrible than anything she heard on the operating table. Years before that, she had posed with her hand pressed against a distant Big Ben, so that in the photograph her fiancé had taken, she appeared to be holding up the clock tower. He had taken it on the eighth of their seventeen-day engagement. The photograph was taped above the desk in her bedroom, but not even its rescue was enough to lure her home. Living in the trauma ward wasn’t much of a change. She’d already been spending seventeen of her eighteen waking hours in the ward. She knew the bodies she opened, fixed, and closed more intimately than their spouses or parents did, and that intimacy came as near to creation as the breath of God’s first word.

So when she offered to let the girl stay with her, she meant here at the hospital; but the girl already knew that as she followed Sonja to her room.

“This is where we’ll sleep, all right?” she said, setting the girl’s suitcase by the stacked mattresses. The girl still held the bug. “Is there something in your hand?” Sonja asked tentatively.

“A dead bug,” the girl said.

Sonja sighed, grateful, at least, to know she wasn’t imagining it. “Why?”

“Because I found it in the forest and brought it with me.”

“Again, why?”

“Because it needs to be buried facing Mecca.”

She closed her eyes. She couldn’t begin with this now. Even as a child she had hated children; she still did. “I’ll be back later,” she said, and returned to the corridor.

If nothing else, Akhmed was quick to undress. In the time it took her to show the girl to her room, he had changed into white scrubs. She found him preening before the hallway mirror.

“This is a hospital, not a ballroom,” she said.

“I’ve never worn scrubs before.” He turned from her, but the mirror held his blush.

“How could you go through a residency without wearing scrubs?”

He closed his eyes and his blush deepened. “My professors didn’t have much faith in me. I never had, exactly, what you would call a residency.”