Ann Patchett - State of Wonder

Marina put her hand on her teacher’s arm but Dr. Swenson shook her off. “Go on,” Dr. Swenson said. “Try.”

Marina put the scope in her ears, ran the drum across Dr. Swenson’s belly, trying one spot and then another and then another.

“There’s nothing there,” Dr. Swenson said.

“No,” Marina said. She took her blood pressure then and then took it again to make sure her reading was correct. “One seventy-two over one fifteen.”

Dr. Swenson nodded. “I have preeclampsia. There is no Pitocin. There is a syrup the locals use to bring about labor in these circumstances, a boiled-down extract of crickets or some such thing but for the time being I am finished with my own human experimentation. I don’t think I’d survive labor anyway. So the bad news is you will have to do the section and the good news is you won’t have to wait two months to do it. Mr. Fox will leave tomorrow with the proof he needs that the drug is viable, and that in itself will buy us a great deal of time. If you could stay here just a little while after the surgery to make sure there are no complications I would appreciate it. Later I’ll have Easter and the Saturns take you back to Manaus in the pontoon. Can you do that?”

“I can put you on that boat in the morning and we can go to a real hospital with real medicine and a sterile surgical room and an anesthesiologist. I’m not going to operate on you with a syringe full of Ketamine.”

Dr. Swenson waved her hand. “Don’t be ridiculous. We have bags of Versed for special occasions.”

There were things to say about that but Marina let them go. “These are serious circumstances. I know it isn’t what you want but you have got to think like a medical doctor and not an ethnobotanist. If you go with Milton and Mr. Fox you’ll be there in half the time. You could be there tonight, which, considering your blood pressure, is what you should be doing anyway. You’d never put this off if it were someone else.”

“Listen to what I’m saying the first time, Dr. Singh. I don’t have the energy to keep repeating myself. I’m not going anywhere tonight, so if I die before you have the chance to save me the onus will be completely my own. You can’t have Mr. Fox take me to the hospital. Then all of his dreams will be shattered and subsequently my dreams will be shattered as well. I will not sacrifice a potential malaria vaccine for a hospital bed in Manaus. I am asking you to do this surgery as a way of saving myself from having Alan Saturn do it. I don’t know that I have asked you for so much in the past that you would find this single request something you are unable to grant.”

Marina waited, considering the horror of it all. In the end she could do no better than a nod of the head.

“There is of course every reason to think that this will kill me in the end.” She opened her eyes and looked at Marina. “It’s difficult to say if this is an outcome of the drug or the circumstances of age. Whether or not I am finished remains to be seen, but I want you to know that the drug is finished, at least the fertility aspect. Mr. Fox can go and cry in his cups. With a little luck we’ll be able to keep that news from him for a few more years while he finances a malaria vaccine.”

Marina shook her head. She wrote it off to the circumstances. In a couple of months when all of this was behind her Dr. Swenson would feel differently. “You shouldn’t say that. You’ve worked on it for too many years to let it go.”

“And how shall we test it further? I’ve been eating this bark for years. I’ve seen my own menstruation return at sixty. I’ve lived through the pimples and the cramps and I will tell you there was nothing there to enjoy. I did not need to see that aspect of my youth again.”

“That’s why they have NHV, normal healthy volunteers. No one expects that you should do all of this yourself.”

“We would have to find a great many childless seventy-three-year-old women who were willing to be impregnated in order to evaluate safety. Chances are we would kill the lion’s share of them in the course of the drug trials.”

“Chances are,” Marina said. She brushed down the insane wires of Dr. Swenson’s hair with her hand.

“Don’t be tender, Dr. Singh. We’re fine the way we are. I only tell you this because I want you to know that if anything happens to me now, anything, it is not your fault. I’ve brought this on myself in the interest of science and I don’t regret any of it. Do you understand that? This has all been to the positive. We are very close to securing a vaccine, and in addition to that we know what the body has told us all along, postmenopausal women aren’t meant to be pregnant. That is what we had to learn.”

“It might not work at seventy-three. That doesn’t mean it couldn’t work at fifty. This isn’t the time to throw everything away.”

“Let the fifty-year-olds console themselves with in vitro as they have in the past. I have no intention of unleashing this misery on the world because I trust women to stop trying at a sensible age.” She shook her head. “So it’s good then,” she said, “it’s good. I’m going to go to sleep now. I want you to get some sleep, too. We’ll do this tomorrow in the afternoon when everyone has left and there’s plenty of light. Do your best to get them off early. Milton and Barbara would swim out of here, I feel sure of it, but Mr. Fox may try to linger. Once you get them on the boat, go and ask Dr. Budi to assist you. There’s no sense in telling her tonight.”

“Alright,” Marina said. She pulled the mosquito netting down over the bed. She turned down the flame in the lantern but she couldn’t seem to make herself go.

“You’re still here,” Dr. Swenson said finally.

“I thought I’d wait until you fell asleep.”

“I know how to sleep, Dr. Singh. I don’t need you to watch me unless it is something you are trying to learn to do yourself.”

When Marina got back to the lab, Dr. Nancy Saturn was explaining the relationship between the Martin trees and the purple martinets to Mr. Fox, and Thomas Nkomo was showing him the charts of pregnancies, birth weights, live births, and they were all lying to him in everything they chose not to tell. Milton and Barbara made sandwiches out of the store-bought bread they had brought with them. Everyone was helpful. Everyone was getting along.

“Have you seen all of this?” Mr. Fox said to Marina when she came over to them.

“I have,” she said. “I’ve been here a long time.”

“It’s remarkable work. Truly remarkable work.” He was smiling at her now without the slightest trace of collusion. He was simply happy. The drug would soon be in hand, the stock would exceed expectations, his risk would be lauded by generations of board members to come.

Dr. Budi handed her a sandwich on a plate, potted chicken after so many weeks of potted ham. “Dr. Swenson?” she asked.

“Her blood pressure is high,” Marina said.

Mr. Fox looked up and Marina shook her head. “She’s tired. She just needs rest, that’s all. There should be as little stress as possible.” It was a line of dialogue she remembered from meeting with patients years ago. It always comforted them. Anyone could embrace the idea that the answer was rest.

“We’ll leave in the morning,” Milton said.

“After we’ve seen the trees,” Mr. Fox said.

Marina waited another minute for old time’s sake. Mr. Fox bent back over the data and she wanted very much to put her hand on the crown of his head. It was probably better that he didn’t look at her, that he didn’t take her aside and whisper his true plan in her ear. If he loved her now, it would only be sadder later on when he realized that she had lied to him along with all the others. He would leave her once the whole thing fell apart. It might be years, but once he understood that he was holding a malaria vaccine instead of a drug for fertility and that she had known it and done nothing to stop it, nothing to save him, he would break with her in every possible way. That loss would be infinitely harder to take if he had ever loved her. “Let’s go to bed now,” she said quietly. Then he did raise his head, looking at her as if to say that surely he misunderstood.