Woman of God

  I looked at the ultrasound.

  “There’s no blood in his stomach. That’s one good thing, anyway,” I said to our head nurse. “Maybe the only good thing.”

  Sabeena clucked her tongue and shook her head. Then she hung a bag of blood and threaded an IV needle into the boy’s vein while I considered what to do.

  It was my call. It was all up to me.

  I had recently finished my residency at Johns Hopkins and had volunteered with Kind Hands thinking, like almost everyone here, that I knew what to expect. But the books and documentaries that had inspired me to come here had given me only the slightest inkling of the reality of South Sudan.

  Since 1983, the normally dire, antithetical-to-life conditions had gotten worse, with the country now divided and its people and their villages, families, and livelihoods shredded by genocide.

  The number of displaced persons in South Sudan continued to swell. Food shortages, a lack of potable water and medicine, contagious disease, killing floods, and droughts had been compounded by gangs of murderous teenage boys and actual army militias doling out unspeakable violence.

  And now I stood in an operating room that was bare to the bone. We had two standard operating tables, six beds, a few shelves of expired medical supplies. Instruments were sterilized in pots of boiling water hanging from bicycle handlebars positioned over the fire pit outside the back door. Along with the car battery, we had a small, noisy generator.

  We made medical equipment with tire pumps, duct tape, and cotton jersey. I could do a lot with an empty coffee can and a length of plastic tubing.

  This was it, the real hell on earth.

  Everything here was desperate and chaotic. Except that right now, the radio was plugged into the generator. The Red Sox and Yankees were playing at Fenway. David Ortiz was stepping to the plate with two outs in the bottom of the ninth. The score was tied, 3–3. If Ortiz could somehow get hold of one, maybe Nuru, too, could go deep.

  I had hope.

  Chapter 2

  ONLY MINUTES had passed since I met my young patient, Nuru. Sabeena was bagging the child, and I had determined my course of action, when my colleague, Colin, came up from behind, saying, “Step aside, Brigid. This kid could drown in his blood.”

  Dr. Colin Whitehead was a late thirty-something, tireless, bright, frequently cranky surgeon who had left his practice in Manchester, England, to come here.

  Why? It was commonly believed that we were all running away from something, whether we knew it or not.

  Colin had ten years on me and was in his fourth month of doing what he called meatball surgery. Nuru was my patient, but I handed the scalpel to Colin. It was always exciting to learn from this man.

  Colin held a penlight between his teeth and made his incision on the right side of Nuru’s chest. He followed up the incision by using a hand retractor to spread open a space between the boy’s ribs. Then he put in a tube to drain the blood that just kept coming.

  I saw what Colin saw: plenty of blood and no clear source of the bleeding. And so Colin reached into Nuru’s chest and twisted the child’s lung, a brilliant move that I understood might temporarily stanch the flow.

  I had clamps in hand and was ready to take Colin’s direction when we were interrupted by the awful clamor of people charging into the O.R.

  Our settlement was poorly guarded, and outlaw gangs constantly roamed outside the fences. Everyone on the medical staff had been given a death sentence by the outlaws. Our pictures were posted in the nearby villages. Colin wore a T-shirt under his gown with a target on the front and back.

  He had a very black sense of humor, my mentor, Colin Whitehead.

  Maybe that darkness in him was what brought him here, and maybe it was why he stayed. Colin didn’t look up. He shouted over his shoulder at the intruders.

  “If you’re here to kill us, get it over with. Otherwise, get the hell out of my surgery!”

  A man called out, “Help, Doctor. My daughter is dying.”

  Just then, Nuru’s mother tugged on my arm. To her, I was still her son’s doctor. I was the one in charge.

  I said to her, “Mother, please. Nuru is getting the best care. He’ll be okay.”

  I turned back to little Nuru as Colin threw his scalpel into a metal bowl and stripped off his gloves.

  That quickly, Nuru had stopped breathing.

  The little boy was gone.

  Chapter 3

  COLIN SAID, “Well, that’s it, then,” and headed off to the new patient on the second table.

  Nuru’s mother screamed, “Noooooooooo!”

  Her days-old infant wailed. Her little boy was dead, and already flies were circling. Sabeena started to cover him with a scrap of a sheet, but I just couldn’t stand to lose another child.

  I said, “Nope, stop right there, Sabeena. I’m not done here. I’m opening his left side.”

  Sabeena looked at me like, Yeah, right.

  I said, “Can’t hurt, could help, get me?”

  “Yes, I do, Doctor, dear. Better hurry.”

  “Berna, Rafi. Someone take care of Mommy and the baby. Please.”

  The procedure Colin had performed is called a limited or anterior lateral thoracotomy, a cut into the chest cavity through the side of the rib cage. Colin had opened Nuru’s right side. And now, although it was highly unlikely that I would find a torn artery in the side of the chest opposite the bullet hole, we hadn’t found the leak. And there had to be one.

  Meanwhile, Nuru wasn’t breathing, and his heart had stopped. The technical term for this is “dead.”

  But in my mind, he wasn’t too dead.

  “Stay with me, Nuru. I know you can hear me.”

  I made my incision on his left side and used the hand retractor, and as Sabeena held a penlight for me, I peered inside. The heart wasn’t beating, but blood was still filling the chest cavity from the force of gravity.

  Where was the leak? Where?

  Sabeena wasn’t looking at me, and I knew why.

  One of the things that you started to get after a week or two in this place was that you could not save everyone. Not even close. Fifty percent was a good score, and then half those patients died in recovery.

  Still, Nuru was my patient.

  My responsibility.

  As the flies descended on her child’s face, Nuru’s mother howled and crowded back up to the table, crying out, “No, no, you said, Doctor. You said.”

  Normally, it would be insane to have parents in the O.R., but here, it was necessary for the closest kin to see what we did, the decisions we made, even to help us make the decisions. So Nuru’s mom had to be here, but I needed every one of the seconds that were racing by.

  “Please give me room, Mother,” I said. “I’m sorry, but you’re in my light.”

  She did what I asked. She stepped back but stood at my right arm, crying and praying, the sound of her voice cutting into my ability to concentrate like a machete to my forehead. Other people were screaming, too. Colin yelled at his patient, who was shrieking in agony. He blasted the patient’s father and cursed at our poor orderly, who had been working for a day and a half straight. I had to block it all out.

  I focused my attention on the little boy and began sponging down his still-oozing left lung.

  “Where is your leak, little man? Help me out.”

  And that was when I felt something with my fingertips. Something hard. I pinched and extracted a scrap of metal from the child’s lung—and now it made sense. The bullet must have hit the fence and fractured before it ricocheted into Nuru. The core of the bullet had gone through and through, but a bit of the copper jacket had taken a hard left once inside Nuru’s chest.

  Sabeena said, “Well done, Brigid. Damned good catch.”

  If only. If only we had found it ten minutes before. Nuru’s mother was pleading, “You must save him. You must.”

  The heart wasn’t beating, but I wasn’t letting that stop me. I sutured the tear in the lung, opened the pericar
dium, and began direct cardiac massage. And then, I felt it—the flutter of Nuru’s heart as it started to catch. Oh, God, thank you.

  But what can a pump do when there’s no fuel in the tank?

  I had an idea, a desperate one.

  The IV drip was still in Nuru’s arm. I took the needle and inserted it directly into his ventricle. Blood was now filling his empty heart, priming the pump.

  Sabeena was whispering in her native Hindi. I was talking to God in my mind. Nuru’s mother had her hands on her son’s forehead, and she was speaking to him, asking him to come back.

  And then, the little boy moved. He tried to speak.

  “Mother” screamed. And Colin was back at the table.

  “Jesus Christ.”

  “Amen,” I said, giving him a sidelong grin.

  Nuru’s mother grabbed for me, and then she simply swooned. Sabeena caught her and her baby before they hit the floor. When they were lying safely on a bed, Sabeena gave me the highest of fives.

  “Oh, my God, Brigid. That was kind of a miracle, you know?”

  “Meatball-surgery-variety miracle,” Colin growled as he finished closing Nuru’s wounds. “But, still. Very good job.”

  That was another high five, but even without the actual hand slap, it felt good. I respected the hell out of Colin and was a little bit crazy about him, too. Sometimes I thought he might be a little bit crazy about me.

  I said, “Thanks, Doc.”

  I ripped off my mask and cap, handmade out of a T-shirt, and tuned back into the radio. All I could hear was a staticky roar many thousands of miles away.

  Then, the voice of the announcer: “Well, he did it, Red Sox fans. David Ortiz just launched an Andrew Miller slider into the stunned Yankee bull pen. The Sox have just swept the series, and the Yankees are retreating to the Bronx.”

  Jemilla, my little gal pal, grabbed me around the waist, and we did a funny little dance, part native to Sudan, part cha-cha slide—which was sharply interrupted by the loud chatter of automatic gunfire at the gates.

  Oh, God. It was starting again.

  Chapter 4

  ATTACKS OFTEN happened at this time, just before dawn, when people were sleeping, when the marauders still had the cover of night.

  Now the call to battle stations came as a wordless siren over the P.A. system. The men and boys with weapons went to the walls, the fences, the front gates. At the same time, a handful of boys, none older than twelve, took up posts outside the hospital compound.

  Jemilla pushed a handgun at me, and I took it reluctantly, stuck it into the waistband of my trousers.

  This little darling was twelve. She’d been gang-raped, had had an ear sliced off by an attacker, and she’d seen her parents murdered when her village had fallen to the gang of thugs. She walked for a week to get here, by herself, and we “adopted” her at Kind Hands. She would live here for as long as we remained, but the thing was, this was not a permanent hospital. We survived here on charity, and we were vulnerable to terror attacks. We could get orders to pack up and leave at any time.

  What would happen to Jemilla then? How would she survive?

  “I’m not going to be able to kill anyone,” I said to this brave and irrepressible young girl. She grabbed my hands and said quite seriously, “You can, Dr. Brigid. If you have to, you can. There’s no such a thing as a warning shot.”

  Outside the O.R., men were shouting as they raced up the dirt track that ran between our compound and the tukuls, the round, thatched huts where the refugees lived.

  Colin clicked off his walkie-talkie, saying to all of us, “We’re needed at the gate.”

  Surgeons Pete Bailey, Jimmy “Flyboy” Wuster, and Jup Vander armed themselves and followed Colin out to his vehicle and into the lethal, crackling predawn.

  With help from nurses Sabeena and Toni, I shoved the patients in their beds into the center of the floor, stubbing the wheels on the buckling planks, and I tucked little Nuru, now bandaged in clean cloth and duct tape, into a laundry basket. Nurse Berna administered knockout anesthesia to the patient who’d been moaning since she came in, and gave a gun to the patient’s father. Nurse Toni chucked our instruments into boiling water, and I shut down the generator.

  And then we sat in the dark with our backs against the beds. And some of us prayed.

  I visualized our attackers. They were known as the Gray Army because when those men were cattle herders, they rubbed gray clay into their skin to ward off insects. Now, as a rampaging militia, they dressed in camouflage with bloodred head scarves. Their ghostly skin added another layer of terror to their attacks.

  We were in the massacre zone of a long-standing dispute in Sudan and South Sudan that had roots along ethnic, geographic, and religious lines. After the autonomy of South Sudan was official, internal fighting began between the Gamba and the Gray Army rebels. The fighting defined the expression “take no prisoners.”

  The Grays, as they were also known, re-formed into a rogue militia avenging those deaths, the work of the Gamba. And within weeks, thousands more were dead, and the living had fled. Now, 1.8 million people were displaced, and, although the Gamba had been decimated, the Gray Army, twenty-five to fifty-thousand strong, and drunk with bloodlust and power, kept crossing and recrossing the country, their only objective to destroy it in wave after murderous wave.

  Colonel Dage Zuberi was the head of the Grays.

  The atrocities this evil man had left behind him in Darfur have all been documented. The mass killing of the men and rape of the women, the torture and looting, the kidnapping of young girls, and the total obliteration of villages all form part of his legacy. And now he had turned to South Sudan.

  Throughout this period, IDPs had only one option, the Kind Hands settlement located outside Nimule, though by now, our hands were full. Ironically, just when it seemed completely hopeless, as we were weighing scrapping our mission, a message was relayed by an ambulance driver. He said that twenty thousand volunteer soldiers—all military veterans—were on the way to protect us.

  Was this true? And, if true, would they arrive in time?

  As I sat against a bed pondering all of this, Aziza, another of our little orphan runners, burst breathlessly into the O.R.

  “They’re here, Dr. Brigid. Our army has arrived, and they’re shooting at the Grays.”

  “You’re sure, darling?”

  “Oh, yes. It’s true.”

  Oh, thank you, God.

  But Aziza hadn’t finished her report.

  “The Grays have so many. Our new army is too…too small.”

  “How many?” I asked, although I knew full well that Aziza could not count.

  “Like, three cups full of pebbles. The Grays are shooting them as they try to save us.”

  Chapter 5

  SABEENA FLEW through the operating-room door, running directly to me as my patient was being removed from my table.

  “We’ve got incoming. Some of our new fighters have been shot. Brigid. They’re all black.”

  “Say that again?”

  “Our new army. They’re all black. Men and women. Europeans and Americans, too. Dr. Jimmy is bringing in a boy from New Jersey. He’s conscious but bleeding profusely from a head wound.”

  The ambulance and other vehicles roared up to the O.R., and as our volunteers unloaded the patients, I did triage, sending those with bullets that could be dug out with a knife tip to Maternity.

  We kept the rest.

  Our instruments had been sterilized before the shooting began, but we had no place for the wounded except on empty grain sacks laid out on the floor.

  We had to work faster and more efficiently than ever. The generator was back on, charging up our mini X-ray and ultrasound machines. Runners carried blood samples to our so-called lab for typing. Sabeena and I marked treatment notes on dressings and directly on the patients’ bodies. And throughout it all, the gunfire continued.

  Dr. Jimmy Wuster was working feverishly on the volunteer soldier from
New Jersey. As Sabeena had said, the young man was bleeding profusely. He had gunshot wounds to his head and chest, and we didn’t have enough blood to perfuse him. Of course, Dr. Jimmy still tried to keep the boy alive, until Jup pulled him away from the body.

  Jimmy yelled, “Fuck! Get away from me.”

  Jup persisted until Jimmy stormed out of the O.R. I followed him and found the reed-thin thoracic surgeon leaning against a parched tree, his chest heaving.

  He said to me, “That kid is from West Orange. I grew up there. I told him I would keep him alive.”

  “We all do that, Jimmy. What else can you do?”

  “He’s wearing a dog tag. His name is Henry Webb. His unit is called BLM.”

  “What does it mean?”

  “Black Like Me. A solidarity movement, I suppose. Damn it.”

  “I’m sorry,” I said.

  “Do you have a cigarette?”

  I shook my head no.

  He said, “I stink like rat shit in a meatpacking plant, but I need a hug.”

  I needed one, too. I took him into my arms.

  He was sobbing when Colin’s Land Rover returned from the gates and our aides unloaded the freshly wounded. I squeezed Jimmy’s hand, and then we went back to the O.R. I helped Colin do a bloody leg amputation with a Gigli saw, but after our patient endured the surgery, he died from cardiac arrest.

  Colin walked to the sink and put his head under the trickle of cold water. I handed him a dry rag, and when he looked at me, he saw the blank shock on my face.

  “Brigid. Surgery here is life-or-death. We’re not going to have miracles every day. Get used to it.”

  “I won’t. I’m not like you.”

  Colin reached into his pants pocket and pulled out a nut-and-grain bar laced with chocolate. He handed it to me.

  “Take this before I change my mind. And don’t give it to anyone. Stand right there so I can watch you.”

  My hands were shaking so hard, I couldn’t tear the wrapper. Colin pulled the cellophane apart and watched me eat and cry at the same time.