POCKET CHANGE
by Sharon R.

Chapter Four
Of Sailboats, Sunsets and Pocket Change

When Luka and Carter arrived at the doors of the clinic early the next morning, they already had patients waiting. A large group of villagers appeared to have camped out directly in front of the building. As the doctors exited the Jeep, Luka hung back and asked Joseph to stay behind. He didn't want to have to call him back to transport a patient so soon after leaving.

Inside, Agunda had already made the patient, a very old, frail looking man, comfortable in a bed. "He is a very important tribal elder." Agunda respectfully spoke in hushed tones, even though the man did not understand English. "They have heard that the white doctors traveled from far away and believe that you came just for him."

Luka and Carter had a heavy load on their shoulders, neither wanting to be the God that failed! They gave each other identical looks of trepidation making the choice of physician a toss up, until Carter glanced over at the doorway to the exam room and saw the little girl and her father from the day before. He and Chibon headed into the front room to check on her progress.

The old man was fragile to the bone. Agunda had a hard time hearing his faint voice made even feebler by his shortness of breath. Luka checked his heart and lungs, and palpated his sunken abdomen. Upon completing his initial assessment, he used his stethoscope a second time to hear the man's heart and breathing. As he feared, the man was most likely suffering from CHF - congestive heart failure.

He stood by the man's bedside and spoke to him through Agunda. "You have a very sick heart inside your chest. There is little I can do for you here." Luka sat down on a chair and scooted it closer to the dying elder, resting his hand on the patient's shoulder . "You have to go to the big hospital in Kinshasa. They may be able to get you the right medicine to make you more comfortable."

Agunda translated, then paused after listening to his faint but resolute request. "He wants to know if he will die from this illness." Luka's eyes said it all, but he answered anyway with a single nod. No translation required.

The old man motioned his wishes with a shake of his head and wave of his hands. Luka stood and, recognizing the look of acquiescence and acceptance in the elder's eyes, signaled Joseph away, freeing him to go back home.

Chibon undressed the girl, this time for a more thorough examination. She was still quite feverish; the glands in her neck were inflamed now and she had become lethargic. Although it had only been fourteen hours since her initial visit, Carter was concerned that she hadn't responded at all to the penicillin and, in fact, had gotten worse. He had Chibon obtain a urine sample to check for red cells and infection and walked back into the infirmary to consult with Luka.

Carter drew back the curtain and walked into a crowd that had surrounded the old man's bed. Pulling up tight next to Luka he whispered, "How'd you do? Will we be toasted or just toast?"

"CHF"

"Hmmm. Toast." Carter was optimistic. "Can't we turf him down to the hospital?"

Luka moved away from Carter and walked to the back office. Carter followed hoping to talk to him about his patient. "The man doesn't want to leave the jungle. His people are very wary of modern civilization."

"Not much we can do for him here." Carter poured coffee for the two of them.

Luka went to the doorway to keep his eye on the group while he drank his coffee. "Nope. He wants to go back to his village to die. Euthanasia by default."

"That girl is back from yesterday. The one from the end of the day. She's worse on Penicillin." Carter was scratching his head hoping it was just dirt up there. "We really don't have much else to give her here that would be stronger. Maybe IV Kefzol. She needs labs."

"Let's take a look." Luka headed back into the infirmary where the villagers were getting the man out of bed. They all filed quietly out of the clinic but stopped in order for the man to thank Luka, with a kind smile.

Luka's exam of the girl was of no benefit to Carter. Her urine was concentrated somewhat but free of infection or red blood cells. One mention to the father of the possibility that she may have to be transported to the city sent him into a verbal rage with Chibon. Evidently they were of the same opinion of the outside world as the old man and there would be no way to convince them to leave with Joseph.

They broke out the Kefzol and diluted it into the piggy back IV solution. For good measure they also hung a 500 cc bag of normal saline and dextrose to boost her hydration. In the infirmary she was tucked into a bed, her father never leaving her side. She didn't even flinch or make a sound when they established the IV.

"If this is what I think it is," Carter wondered out loud, "the only thing that will touch it is Vancomycin."

"Not a chance." Luka was one step ahead of Carter. "I checked the list of available meds. Vancomycin is gold on the black market. It would be too risky to get up here."

They were screwed. Catch-22.

The doctors observed her through the day and made plans to stay the evening. The father was nervous and restless about not returning to the village and insisted they remove the IV catheter so that they could go home. It took some talking, in more than one language, but Carter at least got them to stay long enough for Joseph's arrival at the end of the day. Just before leaving they drew the girl's blood for a culture and placed it in their small cooler. Joseph would drop them at the house before taking the culture over to the hospital. Two to three days is what it would take to get results.

It had been a long day and the doctors were feeling it. Joseph made two trips up the hill that day to transport patients. They came in a steady pace not giving much time for putting the feet up. Paper work, well, there really wasn't much to do. Not like at County. Chart reviews, rounds, M & M – if they happened it was around the coffee pot between patients. A word here and there, notes scratched on wrappers taken from first aid supplies. The patients that were kept over in the infirmary waiting for transport to the city had charts and the doctors made do with the documentation that they could offer. But the charts were nothing more than treatment diaries. No pink sheets from the lab, or blue from cardiology. Stickers for charges were non existent. Just check marks and hand scratch.

Carter and Luka pulled up to Joseph's home late in the day. Toomay had some food waiting which they heartily gobbled up. They looked forward to the cuisine now, and wondered what they would do when they got back home to Chicago. While Luka easily slid into and became part of the nightly dinner conversation telling stories, laughing and exchanging inside jokes with Joseph, Carter was a polite spectator. They were tired, exhausted and in need of putting their feet up. Luka always made a point of thanking Toomay, and Carter noticed with a smile.

That night after dinner they walked outside with a bottle of whiskey Joseph had rustled up for them. There wasn't much in it, but enough to numb what little they had left of their nerves. Luka poured for the both of them and quickly downed the first shot. Carter took his glass and stared through the pungent liquor. Just holding the glass calmed him and he gave it back to Luka knowing in himself that he wasn't going to let that day drag him back into substance abuse. He just wanted to make a difference somewhere, somehow. The difference he could make while inebriated was not why he was there.

Luka looked longingly at the children playing in the distance. Their voices were far off but close enough, sweet enough to trigger memories of his childhood. "My family didn't have much money, so I would help out by delivering groceries for my uncle in the summertime in Rovinj. Have you ever heard of it?"

"No, actually, I think the closest I've been to Croatia has been Italy." Carter felt uncomfortable, almost as though he was prying where he didn't belong.

"Rovinj is very close to Italy. They call it the Croatian Tuscany. A very old world town, cobblestone streets…" Luka wished he had pictures to share with Carter. "When I was done with deliveries I would go down to the seaside and take my sailboat onto the water. It wasn't a real sailboat." Luka got a good chuckle at himself and didn't care if Carter was listening or not. "It was more like old boards crudely hammered together. But it would get me far enough off shore to drop a line and attempt to get enough fish for our dinner table. No matter what I caught my aunt made a big deal of it. The tiniest fish became fine cuisine at the dinner table."

He closed his eyes and Carter could tell that his Croatian colleague was in a far away land, focused, and he wondered if his own absence would be noticed if he quietly slipped away. But for all the inner whining Carter created within himself, he couldn't quite walk away from Luka's picturesque memories and family yarns.

Luka inhaled deeply through his nose as if to take in the warm, salty sea air of the Adriatic and let his head fall back so as to catch what little sunlight there was left to the day on his tired face. "I didn't get a long ways away from land, but it didn't matter to me. I would hunker down in that little boat so I could no longer see anything but the sky and feel the roll of the sea under me. And I would make believe that I was all alone in the middle of the sea, on my way to America." He opened his eyes and came back to earth, smiling. "I would stay there until the sun set. Lying there, taking in the magnificent colors on the horizon. I figured if I could see that every day, I had it all. It got harder as I grew up. I sure didn't fit anymore inside that little boat, but I can still see the sunset. And the ability to dream like that…" His voice trailed off and he stood to walk away from the conversation. "How about you, Carter? What did you do to entertain yourself when you were a child?"

Carter had to rearrange his train of thought and dig deep to find these memories. "Well, there were polo tournaments. And sporting events at prep school. Dressage, showmanship. At home, … um… lawn parties."

Luka was puzzled by this as he squinted into the far off sleepy sun. "Lawn parties?"

Carter never had to explain this before. "Outdoor picnics. Somewhat formal. White was the color of the day and we played tennis, badmitten, croquet. I guess you didn't have lawn parties."

"We didn't have lawns." Luka wanted to dig deeper. "I mean what did you do to entertain yourself? What did you do when you were dreaming?"

If Carter was taken by surprise by Luka's questions, this particular one not only threw him way off course, it found him speechless. Not because he was searching for the right words, but for the mere reason that he just didn't have an answer. Luka watched Carter look around his surroundings. His eyes traveled slowly from tree to tree, from the ground to the horizon. He made an attempt or two to speak, but failed resorting instead to a shrug of his shoulders. "I don't know," he stammered, surrendering to his lack of memory.

"Come on Carter," Luka primed him, "you lived in a mansion; you had your grandparents, and parents. Siblings. Servants. You had everything."

Carter shook his head as the realization of what little money did for him finally hit home. He turned and looked Luka in the face as he walked straight to him. "I guess I had nothing," he told him with succinct words so that there would be no misunderstanding.

He turned away from Luka this time and spoke as he took steps to distance himself. "Ever since we got here you have talked about nothing but your childhood and your beloved Croatia. If it was so great, why aren't you still there?"

Luka poured himself another drink and sat down in the half broken chair. "It got to the point where there was nobody left. My mother, she died when I was twelve. Then, my wife and children were killed in the war. My grandparents, they too died during the war. Of natural causes, but still, it was a great loss for me."

"And your father?" Carter was counting relations.

"He had his work and his art," Luka said. "That was his passion. I lost mine and by that time there was little work for me. At least that's what I thought." Luka scuffed his feet back and forth in the dirt making neat tracks as he spoke. "I guess I ran away."

By this time Carter was sitting opposite Luka. He no longer scanned the countryside looking for himself. He focused on that bottle of whiskey Luka was finishing and thought of Abby. "How about you," Luka asked. "Why are you here?"

Carter was watching Luka's feet while thinking about Abby, about his mother and father and his cousin. It wasn't exactly a group of people that conjured up memories that would sell on the retail market for top dollar. He knew exactly why he was there, but instead of putting a cap on this discussion by defining his life in 10 words or less, he simply shook his head and walked away.

"Look out at that." Luka pointed at the sunset behind the hills. The vast brilliance of gold and orange swirled among the incoming cloud cover creating a dazzling illumination above and behind the backdrop of the green jungle . The bright mixture of warm colors was hard to miss, especially as they reflected off the swirl of booze in his glass. "Carter, how can you not see that?" Carter turned just his head to look, squinting but not taking in the glory of the moment.

"You look past it, don't you?" Luka queried, hoping to gain some bit of understanding. Carter said nothing, averting his gaze down to his feet instead, eventually walking back into the house leaving Luka to take in the sunset by himself.

The breeze was picking up and dark clouds formed in the distance. It would be time for more rain so Luka decided to stay outside until the moonlight was taken from him and substituted with hard rain. To his left, beyond the roof tops, was the edge of the jungle. To his right, Joseph's house and the other village homes.

The feeling of isolation was conflicting to Luka knowing that he was in an unstable country with unstable weather and, frankly, a seemingly unaffected, immature colleague he was just getting to know. Yet, he was at peace with the people, happy to give of his time and experience. Back on the pendulum of emotions he longed to find a purpose to his life and wondered what else he could possibly do to make him feel …. just feel.

"Not much time before you get drenched!" Luka was startled to find Joseph standing beside him, drink in hand. "I'm sorry, my friend," Joseph remarked, "I just wanted to see how your day was. The tribal elder die?"

"He went home with his people." The days were extraordinarily long but Luka was grateful to get back early enough this night to relax and get some sleep. Luka was finding Joseph to be a good friend in this strange country. Didn't know why, maybe familiar circumstances surrounding their home countries. They both sat down facing the sunset, quickly fading into a dark, starless night.

Joseph took his last drink and asked, "Dr. Carter is a man of few words." That was stating the obvious! "Is he not happy with my family?"

Luka wasn't surprised at this question but understood Carter's lack of comfort. "I think Carter is very happy with your family. He just doesn't know it." They shared a chuckle as delighted sounds of noisy children came from the house. In among those voices was Carter's, possibly, making animal noises and the women shooing the little ones off to bed.

"John Carter is a complex character." Luka shook his head as if to search for an explanation that was hard to come by. "He has had some losses lately. Grew up in a very privileged home but went his own way." Joseph stood up and turned his chair to face Luka. "I think," Luka paused to speak slower, hoping to get it right, "I think he always sees himself as being on the outside looking in."

Joseph leaned forward and gave Luka a tap on his knee. "And you're not?"

Luka was caught off guard with this one. "Not what?"

"On the outside looking in." Luka shook his head, humoring his friend. "Luka, I've been doing this for a long time. I've seen a lot of doctors come and go. I see it with you and Dr. Carter."

"See what? Joseph – you worry me. Too much exhaust from that beat up truck of yours." A gust of wind pushed in and the two grabbed the small patio table as it was lifted up and toppled.

Joseph connected well with Luka and took the opportunity to share his experience with him. "Doctors come here looking for themselves. They seem to think that living in the third world and making do in the clinic with few supplies is roughing it. And that somehow getting back to nature will solve all of their problems and give them their ultimate ticket to St. Peter's gate when the time comes."

Luka didn't know whether he should laugh at this statement or cry. "You are a smart man, Joseph." The small drops of rain came down, slow at first, like at home in Chicago. He closed his eyes and leaned his head back to catch the droplets as they hit his face, wanting to know more about this man. "Well, I would guess that with your service to this organization and your people you already have your ticket to that gate."

Joseph rose to start back to the house. "You don't have to earn your way into heaven, my friend. Everybody is born with a ticket in their pocket. Just make sure you don't lose it among all that loose change."

The wind picked up, and the two men called it a night. Luka wanted to ask Joseph something personal that was gnawing at him. "Why do you do what you do? You have a family, you have proven yourself time and again. But you still risk your life every time you drive through those check points."

Joseph was a proud man. "I went to University. Got my engineering degree, speak four languages." The two stacked the chairs and turned the small table upside down on top of them. "I could have left and gone anywhere. I could be teaching in the big cities. But this is my homeland – my people. My children deserve to see that helping their people as opposed to oppressing them is the only solution to the suffering."

Luka was both puzzled and amazed at his friend's selflessness. "Aren't you afraid of the danger? For your family?"

They stopped just outside the open kitchen door and Joseph put his hand on Luka's shoulder. "I think of that every day. But my children are proud of me. My wife supports me. And most important, my son and daughters will always have good hearts because they know how it feels to sacrifice, and that is humanity."

Joseph lowered his voice so as not to bring the rest of the household into the discussion. "I don't feel the need to define my life by the mountains I have taken. To me, I measure my personal credibility by what I have not done, instead of what I have accomplished. There are people out there who need my help. I can leave here and hope that Sean finds someone else to do the job. That would be easy. But I feel that would serve one purpose – and that would be to make the hole in my pocket open up just a little." He gave Luka a pat on the back as he went off to join his wife in bed.

The household had quieted with the children in bed. Luka stepped in past the doorway and saw Carter at the kitchen table, who had obviously caught the end of the conversation. They both pretended that it didn't happen, exchanged evening niceties and went off to bed.