Brother''s Keeper

  ‘You were arrested?’ Burkett asks.

  ‘I went to a meeting,’ Abu says, holding up his index finger. ‘For one meeting I spent ten months in prison.’

  ‘But it turned out to be a blessing,’ Nick says.

  Abu nods, but offers no explanation, so Burkett asks, ‘How was it a blessing?’

  ‘It was in prison that I met Isa,’ Abu says.

  ‘Jesus,’ Nick interprets. He glances back as if to check Burkett’s face for skepticism.

  ‘It sounds like you made the best of the situation,’ Burkett says in a neutral voice.

  Abu explains that he had a recurring dream while in prison – a clear vision of a bearded man all in white, standing in a meadow beside a running stream. Abu never heard the man speak, but somehow he under­stood that it was Jesus, and somehow he knew, simply from the man’s gaze, that he was being invited to drink from the stream. He stopped having the dream after his release, but for years afterward he envisioned this man during his prayers. Now he supports his wife and two small granddaughters on a salary of about thirty dollars a month. Not even the other employees of the clinic know of his conversion and baptism. He and the twenty or so other Christians in Mejidi-al-Alam gather in secret for fellowship and worship.

  ‘Like the earliest apostles,’ Nick says.

  It seems unwise for Abu to discuss matters of faith with a man he has only just met. Or maybe it’s that same fallacy encountered all too often by identical twins – the assumption of identical beliefs. When Burkett agreed to work at the clinic, he failed to consider the mild irritation of being mis­taken for his brother. Perhaps he should ask Nick to spread word of his religious apathy.

  ‘My wife is an enemy of the faith,’ Abu is saying. ‘She calls me a great sinner, but she would never betray me. If I die, all my property goes to the nearest male relation. A cousin she hates, a terrible man. She and our granddaughters would have nothing.’

  To Burkett he looks far too young for grandchildren, no older than forty. But he suspects this is what happens in a poor, overly religious culture. People marry too early, have too many children. Perhaps Burkett should serve as a different sort of missionary – an evangelist not of faith but of progress.

  They pull off the road at a roofless, one-room hut of mud brick and go inside to urinate. They face the wall and keep their distance from a corner used by some previous traveler for defecation.

  Burkett lingers inside while Abu and Nick return to the car. He opens his flask and takes a drink only to be startled by a sound in the window. An elderly farmer with shells in his beard stares at Burkett. A pair of oxen wait behind him. Burkett stuffs the flask in his pocket and looks away.

  The SUV pulls through an open gate into a small, otherwise empty lot. The cluster of buildings is surrounded on three sides by a twenty-foot wall of unpainted cinderblock. Plastic tarps divide the courtyard into separ­ate waiting areas for men and women. Among the men, Burkett spots a goiter, a case of jaundice, and a swollen toe – probably gout.

  In Nick’s absence, a nurse named Hassad has managed the male side of the clinic. He wears a prayer cap, bright red vest, and baggy pants a few inches above the ankles. They follow him into the anteroom used for triage – a new addition of plywood and corrugated steel that, like the cinder-block wall and portable modules, seems incongruous next to the stone and crumbling brick of the original house at the center of the complex.

  It is perhaps another byproduct of Nick’s absence that the task of running triage has fallen to a teenager. The boy, about fourteen, sits at a desk and types on a laptop while listening to an elderly tribesman. Posters tacked to the walls feature instructive cartoons on clean water and vaccination. A white woman emerges from a door behind the desk. She’s attractive, around forty, with a scarf draped over a blonde pony-tail.

  ‘My wife Beth,’ says Nick, as she and Burkett shake hands. ‘She’s in charge of our women’s health and vaccination programs.’

  ‘Welcome,’ she says with a smile. ‘Now that you’re here, we have one doctor for every fifty thousand people in the province.’

  ‘What was it yesterday?’

  ‘One in a hundred thousand,’ she says.

  Out the window, Burkett can see the section of the courtyard desig­nated for women. The burqas make it impossible to guess their ailments. Fully covered even when sick, he thinks. Nick explains that Burkett won’t see any female patients except in cases of surgical emergency. Beth, who has training as both a midwife and a family nurse practitioner, can handle most of the issues in the women’s clinic.

  ‘What’s to keep the separatists from attacking this place?’ Burkett asks.

  ‘We pay a tribal leader for protection,’ Nick says. ‘A shady character named Walari.’

  ‘He’s something of a warlord,’ Beth says without sarcasm.

  ‘Ex-warlord,’ Nick corrects her. ‘He’s more of a businessman.’

  She begins to speak but catches herself. Perhaps she fears reopening an ongoing dispute, or drawing attention to her husband’s recalcitrance, that quality of certainty bordering on arrogance. Burkett could tell her not to worry. He’s spent enough time in operating rooms not to be bothered by a personality like her husband’s. Among health workers it’s typically the surgeon who plays the part of dominant asshole, but this soldier turned nurse resides far from the hierarchy of any hospital.

  ‘A piece of advice,’ she says, opening the door to a simple examining room. ‘With the people here, we have different views of God, but our word for him is the same. God in English is Allah in Arabic. Don’t be afraid to use those terms interchangeably.’

  He stares, trying to imagine a context in which this would have rele­vance. Perhaps it is evidence of Owen’s religious fervor that no one can imagine his twin would not have an identical vocation.

  ‘Something to remember,’ she goes on, ‘is that Muslims do believe in the virgin birth. Most are interested in discussing the person Jesus, but it’s counterproductive to try to persuade anyone through apologetics.’

  ‘I don’t expect to do much persuading,’ he says.

  ‘Beth,’ says her husband, ‘he’s not a believer.’

  A look of vexation crosses her face. Burkett sees that she’s well aware of his unbelief. No doubt she and Nick have discussed at length the ques­tion of whether a non-believer should be allowed to work in the clinic – whether his surgical skills outweigh his spiritual shortcomings. So why would she speak to him in such a way? Was her ‘advice’ on evange­lism itself a form of evangelism? A paradoxical strategy of coaxing the agnostic twin? Her husband either missed the point altogether or simply recognized the futility of it.

  Burkett places the pocket notepad and canister of ashes on the small wooden desk. His brother inhabited this same room, approximately ten feet by five, equipped with a small sink of stainless steel and a narrow bed that doubles as a desk chair. He opens the single drawer in the desk – a blank legal pad, some loose paper clips, a toothpick, and one of those microfiber rags used for cleaning glasses.

  How did Owen live here more than a year without leaving the slightest mark? Burkett scans the walls, but he doesn’t know what he’s looking for. His brother wasn’t the sort to carve some prosaic memorial to his own presence. Owen was here.

  Burkett might have thought by coming here he’d better understand why his brother gave up his career. Why he turned his back on whatever prestige he might have enjoyed as a surgeon in the States. In any Ameri­can city, he could have found ample poverty and secular misery on which to train his evangelical sights.

  It seems unthinkable that a surgeon of Owen’s caliber would have chosen to live like this. How could a man so driven in the pursuit of success end up in such bleak obscurity?

  As a wrestler, Owen was known for his relentless desire to win. Of course Burkett too wanted to win, but he lacked his brother’s obsession.
Mad obsession – the only way to explain the undefeated final season, the NCAA championship, when Burkett, despite identical genes and an identical training regimen, managed to win just a few more matches than he lost. Owen always gave the credit to God, spouting clichés on faith and hard work that annoyed Burkett but inspired church groups and teenage members of the Fellowship of Christian Athletes.

  But did Jesus not exhort his followers against vanity and worldly ambi­tion? Owen must have seen the obvious contradiction in the idea of a Christian seeking worldly glory. How would an NCAA champion and Harvard-trained surgeon reconcile his success with his faith? Or was it that very success which drove him to this island, this Spartan cell?

  In a cardboard box under the bed he finds wadded surgical scrubs and an old Penn State tee shirt. He puts on the tee shirt and lies on the bed with his arms at his sides. His brother’s bed, his brother’s clothes: surely this is an exact repetition of some past moment. He lifts the collar of the tee shirt over his nose and breathes in the faint odor of dried sweat. Perhaps something of his brother, his spirit, resides in the odor. If only he could believe in such things. The odor takes him back to the Penn State wrest­ling room: he and Owen, grasping each other by the neck. He imagines the smell of the tee shirt entering his body and being transformed, and when he exhales, his breath takes the form of his brother’s name. Not even a whisper, little more than a modulation of air: Owen.

  Owen was here. Where is he now? Is he some kind of spirit or ghost? Does his soul or some version of his consciousness exist at this particular moment, here or elsewhere? Even if Burkett became a so-called believer, he wouldn’t buy into the sort of afterlife preached to children – not some sunlit family reunion. How much joy could such a place offer, anyway? How could the dead bring themselves to celebrate while the living still grieve?

  In reality, what is Owen now but tiny bursts of electricity in the brains of those who knew him? Like an afterimage that follows a flash of light.

  That night sleep comes to him only in fits, despite the additional Valium, which on top of the Xanax and alcohol could be dangerous for even the most desensitized patient. Maybe he’s testing his limits, explor­ing the boundaries of death. Maybe he wants to die. He doubts he would even be missed, except perhaps by his father, in a rare moment of lucidity.

  He lies in the dark waiting for a bright light with floating angels – or endless writhing bodies in a barren desert, the armies of the dead. What he sees instead is the face of his brother underwater – his eyes replaced by black ovals, hair wafting in the current. The strength of the current leads Burkett to think they’re in the ocean or a strong river. They wrestle as they sink deeper, but shouldn’t they be helping each other swim back to the surface? Burkett realizes the effort of their wrestling is entirely his own, the stiffness in his brother’s limbs an effect of rigor mortis. So how is it that he can’t seem to gain an advantage? They come to a gentle landing, and silt rises in an enveloping cloud of black. He’s held his breath till now, but this ash-tasting blackness turns out to be something he can breathe.

  The taste of it lingers when he wakes. The clock reads 3:32 a. m. It is the sound of his own name that woke him, his brother calling, Ryan. He gets up and opens the squeaking door of his module. The night breeze carries a hint of ocean salt. From beyond the wall of the compound comes his name: Ryan. Now it sounds less like the voice of his brother than that of a woman or child. He pads barefoot to the gate and stares out at the street and when the voice comes again he realizes it’s not a human voice at all, but merely the wail of some animal in pain. He goes back to his room, but the shrieks rise in volume and frequency. The animal, perhaps a dog, must be closer now, just outside the wall of the compound. No sooner has he put on his jeans and shoes and gone back outside than the noise stops altogether. The animal must have died.

  He stands listening, waiting, but for what he has no idea – some agonal whimper from the dying animal, or some chirp or distant howl to bring an end to the silence. All of a sudden he has the sense that he isn’t alone, as if the silence itself were imbued with consciousness and waiting for some sound from him.

  ‘Owen,’ he whispers.

  As though in response, a muffled thud comes from the module Nick and Beth share – something dropped, perhaps, or one of them stumbling in the darkness. Or perhaps a stray sound in the throes of passion. He’s had only a glimpse of their chamber through the open door, the layout no different from his, so small as to seem crammed despite the modesty of furnishing. In his mind’s eye he sees Beth lying beneath her husband, her eyes closed and lips parted in pleasure, but the image doesn’t hold: it is more caricature than reality. He listens further, but there is only silence. Did his brother ever have such thoughts of Beth? No, even in the deepest recesses of his mind, surely Owen, so honorable and gallant, would have respected the privacy of his friends’ marriage. How unfortunate, then, if he were forced in death, through some binding of spirits, to endure the lusts of his brother, the very thoughts he shunned in life.

  5

  Until the arrival of the portable operating room, Burkett and Nick divide the work of seeing patients on the male side of the clinic. Burkett func­tions as what amounts to a family practitioner, though not a very good one. After five years of general surgery, and almost two more in plastics, he’s hardly qualified in the art of physical diagnosis.

  He’s most at ease treating the minor burns and chronic wounds that happen to pass through his examining room. To a man complaining of urinary frequency, he offers a week’s worth of ciprofloxacin. He pre­scribes the exact same dose to a teenager with what seems to be a middle ear infection, though he can’t be sure with the earwax blocking his view of the tympanic membrane. At this rate he’s going to deplete the clinic’s limited supply of antibiotics.

  Several patients with abdominal pain leave him wondering if he missed a case of ruptured diverticulitis or cholecystitis. In his surgical residency, every patient with abdominal pain had a CT scan, but the clinic’s capa­bilities are limited – totally inadequate by the standards of the level one trauma center where he has spent the last ten years. It forces him to hone his skills in physical diagnosis – to try to practice medicine in the old way. For years he’s wielded a stethoscope, but he doesn’t remember the last time he truly listened to the sounds of the heart and lungs. It was always an ECG that informed him of an arrhythmia, an x-ray of pneumonia.

  If all had gone as planned, he would have been content to spend the rest of his career at Emory. He’d been on probation after his second drunk-driving offense, but what ended his tenure as a fellow in plastic surgery was his refusal one night at two a. m. to drive to the hospital. Emergencies in plastic surgery being relatively uncommon, extremely rare in fact, he’d decided not to let the possibility of one ruin every third evening.

  That night he happened to be extremely drunk. He was asked to eval­uate an obese female trauma victim whose antecubital vein had ruptured during a CT scan. The injected contrast material, rather than entering her bloodstream, had infiltrated the soft tissues of her hand. Normally this requires nothing more than ice and elevation – Burkett had never heard of a severe complication – but in this particular case, the swelling and inflammation cut off the blood supply. A smarter intern would have con­sulted vascular surgery straight away rather than wasting time on plastics. Whatever the case, he had no excuse, he refused to see the patient, and within days, a portion of the woman’s little finger had to be amputated. Burkett, for his part, has no recollection of receiving any call that night, but two nurses backed up the intern’s account of slurred speech, his insis­tent repetition of that phrase ice and elevation.

  All along his brother questioned his decision to specialize in plastic surgery. Burkett remembers an argument over Thanksgiving dinner in their third or fourth year of residency. His brother refused to see beyond the breast implants and face lifts. There was a kind of irony in Owen’s view
of plastic surgery, the fixation on its surface flaws. What about repairing a child’s cleft palate, or reconstructing the face of a trauma victim? But for Owen, a single cosmetic operation on a healthy patient would negate a thousand acts of medical necessity.

  Near the end of his first week at the clinic, he wakes one night to the sound of gunshots. His first thought is that the separatists are attacking the clinic, but the shots are too far away. Perhaps it is the nearby military base that is under attack. He wonders if the clinic has weapons. He reminds himself of Nick’s military experience but takes little comfort in it.

  He dresses and walks into the courtyard and checks the lock on the front gate. He stands listening. The gunshots seem to have died, but then comes another series of bursts. Are they closer now than before?

  The modules are small enough that Nick can open the door without getting out of bed. He is shirtless, and the tattoos covering his torso resem­ble a map of some non-existent geography. Behind him Beth rises on an elbow, looks at Burkett, and sinks back into the heap of blankets and pillows.

  ‘I hear gunshots,’ Burkett says.

  ‘It’s just the soldiers at the base.’

  ‘Are they fighting someone?’

  ‘No,’ he says, laughing. ‘When there’s a full moon they like to shoot stray dogs in the air field.’

  The door closes and Burkett stands in the dark of the courtyard. He senses movement and turns just as a shadow drifts over the wall of the compound. He realizes he’s just seen a surveillance drone – probably the same type he saw from the window of his hotel in the capital. The other day he read online that for surveillance the Khandarian military favors a model called the Phantom. In the photographs it has a distinctly piscine shape, with a snub nose, tapering empennage, and propeller mounts that resemble fins.

  It reminds him of a story he heard in the capital: a teenage girl from the provinces was bragging about late night visits from the shark god himself. The girl’s father, a Khandari tribesman, was uneducated but by no means stupid, so when he heard this he grew suspicious and started keeping watch. One night around midnight he saw an object hovering at her window. It turned out there was some pervert in military intelligence.