POCKET CHANGE
by Sharon R.
Chapter Five
Fed-Ex: Congo Style
The night heat was unbearable as the two doctors tried in vain to get comfortable in their cots surrounded by mosquito netting. The atmosphere was still with thick, humid clamminess. Turning over and over in their cots was the only way of creating some sort of movement of air. Usually the noise from the jungle creatures could be soothing as they had a rhythm of their own; keeping a pulse-like tempo that one could easily fall asleep to. This night was different. The racket started and stopped unpredictably. Carter and Luka were just as easily awakened by the lack of noise as they were by the suddenness of the clatter. There was an eerie sense that night, almost one of foreboding.
The sticky, almost waxy film that masqueraded as his skin gave no relief from the warm and humid breeze that briefly invaded the porch through the screens. Once a man who wore fine clothes and exuded GQ cleanliness and quality, Carter now found comfort and relief in a simple pot of warm water and an old rag. He felt like an old rag too. He used the unsettled night to contemplate his life - his being. In the Congo he was far from the security blanket of Chicago. Unsettling, it put him in a place that made him the pilot of his own ship for once, but even this once far off dream found him with few tools within himself - no idea how to fly the plane. And in his effort to use the experience to better himself or even to fit in, he had been a miserable jackass and found himself sounding more and more like his father. The DNA doesn't fall far from the tree. He was determined to at least do as much for his patients as he possibly could. But at the moment, making frequent changes in position on the old cot was the only way to cool himself off.
Luka cat napped and fell into deep but brief bits of sleep only to be woken by the dead silence. His beard, long neglected since his arrival, was now an irritant and he promised himself to shave in the morning. The bugs had gotten the best of him and with the Calamine lotion used up, he was relegated to using a homemade concoction Agunda had whipped up for him. It had a foul stench at first but after a while blended with his own natural smells. He was ripe but at least his scratching was kept at bay. He was in his element at the jungle clinic and it felt good to get away from County General, from the paperwork, the people and most of all, his own expectations of himself. He just wished that Carter could find something of use in his experience. Closing his eyes again he thought of his wife, turned on his side and reached out to her, touching…. the mosquito netting.
"Luka." Joseph shook his shoulder trying to wake him up. Through the veil of the netting, Luka was startled awake as the moment he was dreaming of, far from the Congo, was infiltrated by the reality of the heat, the noises and his friend's face just inches from his. "Luka," Joseph whispered, "the nurses are on the short wave."
Joseph cleared away the netting to allow Luka to get up, explaining that the nurses were back at the clinic with the little girl. She had taken a turn for the worse and the women needed instructions.
The creaking of the floor boards woke Carter. He rubbed his eyes of the day's dirt and grime that had accumulated and set up during his short bursts of sleep. Joseph and Luka were whispering in French as they walked out of the porch bedroom. Being alone didn't bother Carter. But the loneliness he felt while even in a crowd of colleagues punctuated his deep emotions, though it was a feeling he had long accommodated: another family trait. He had surrendered to Joseph and Luka's friendship and, as a result, buried himself in his work. At that point, Mother Nature called and Carter followed the pair into the house finding them at the short wave radio. Luka was talking to Agunda.
"What's going on?" Carter was hushed by Luka's waving hand, but he continued. "What's wrong?"
"Stop!" Luka was trying to hear Agunda on the static radio. They had a few more French exchanges as Carter stood by impatiently and then Luka finally turned around to face him. "The little girl is back with her father. He found the nurses at their homes and begged them for help." The women were now at the clinic and found themselves in over their heads.
"Joseph, can you get me up there now?" Carter ran his hand through his hair trying to think of a way to help the girl with the few supplies they had.
Joseph refused, it was too dangerous. "It doesn't feel right tonight. Even in the best of conditions, a nighttime drive is too risky." He had been more concerned lately about the drive to the clinic. Checkpoints were fewer, but the militia and rebels were no longer on foot. They frequently packed the beds of Toyota pickup trucks – they were looking for faster getaways.
The doctors agreed to wait until just before first light and relayed information to the nurses. They would establish a new IV line and work to get the girl's temperature down. Carter checked in on them regularly as the minutes ticked away. No change. Joseph returned to the arms of his wife, Luka tried to sleep but Carter's pacing was annoying enough to keep even the flies at bay. By the time Joseph roused himself for a second time, the obscurity of the dark skies was lifting and the creatures of the deep night gave way to the early morning critters. All three walked briskly to the Jeep not wanting to miss a moment of time. Carter noticed as Luka and Joseph traded words with each other in French. Joseph almost seemed short with Luka.
For the first time in over a week there were no rebels or soldiers on the road. Nobody. It was almost a blessing that their tensions were not kept inside that vehicle together for more than they had to be. Before Joseph came to a complete stop Carter was out half walking, half running to the clinic doors.
Chibon and Agunda were at the girl's bedside, cooling her off, doing what little they could for her fever. Luka spoke with the nurses in their native French to save time, ordering what additional meds he could. More NSAIDs, more fluid. Her output was still good - her kidneys still functioning, and not over hydrated, yet. The father spoke to Carter as if they were of the same language. The man was beyond emotional repair as Carter tried to console him, putting his hand on his shoulder, doing what he does so well. Hearing the commotion, Joseph walked in and spied the father obliviously talking Carter into a corner. He stepped in between the two and backed Carter away to give himself his own room. Joseph had a way of talking. He could make anyone feel comfortable in the worst situations. He translated for the two men - letting the father know that the doctors were doing all they could without having the facilities of a larger hospital. The man still refused to leave the mountain. "His son died from Cholera last year. His wife in childbirth last month." Joseph spoke quietly to Carter even though the father could not understand the words. But he knew the meaning of the translation, and that was Joseph's way - his comforting - and his way of bridging the gap between desperate father and doctor. "The girl is all he has left." Carter gave the father an understanding nod and empathetic hand to the shoulder.
Joseph left the clinic before Carter had a chance to thank him. He sat at the girl's side taking her vitals and looking at her sweet face. There was nothing left to do. Agunda came to help Carter, pausing to look at both faces. "I think she knows," Carter shared with her.
"Knows what, Dr. Carter?" Her calm voice and nice smile hid her own trepidations.
"That there's nothing more we can do." Carter spoke with no hesitation, but with a reserving sense of surrender as he smiled down at the girl and stroked her face.
"She knows that you care, and that's what is important." Bless Agunda and Chibon, thought Carter. They had been amazing in their abilities to deal with the retches of the conditions inherited from the government and non-governmental disasters over the decades. And they did this every day of the year. She put her own hand on Carter's shoulder as she walked away and Carter reached up to pat it in thanks.
He stood and stretched his very sore back, turning to gaze out the window. It was beginning to rain again. Out by the Jeep he saw Joseph and Luka in deep conversation. Lots of head shaking, talking with the hands. Much going on, but in a way that even puzzled Carter.
A couple hours later Carter saw Luka walk back in the clinic office with the satellite phone in his hand. "I thought we were only to use it in an emergency?"
"It is, sort of." Luka slipped the phone back in the desk drawer and walked briskly past Carter into the infirmary. "I couldn't get the short wave to work and we need some supplies."
Carter walked over to the radio and flicked on the switch. All the lights were on, all parts working. Arms folded, Carter leaned against the desk, peering out at Luka talking to Chibon at the other end of the infirmary. Talking to Joseph on the sly and now Sean.
They couldn't wait any longer for the culture results and decided to get a sample of the girl's spinal fluid on their own, the two doctors working together to do the lumbar puncture. It took the entire staff of four to convince the father that the procedure was necessary, that it wasn't some sort of witchcraft.
Carter sat at the table adjusting the ancient microscope. It had to be dusted off, a light carefully aimed at the mirror. Scooting on his stool he looked through the eyepiece focusing the view with his left hand and moving the slide around ever so slightly with his right. And there it was.
"Do you see it?" Luka was standing behind him, waiting his turn.
Carter stood to let him see for himself. "Yep. The cocci are right there. Enterococci"
Almost overlapping Carter's diagnosis, Luka spoke up. "Meningitis."
"And she's resistant." Carter didn't have to mention it, but it gave credibility to himself to say it out loud. They had taken precautionary measures to protect themselves, but the little girl would not make it another couple of days. Stuffing his hands in the pockets of his khakis, he shrugged his shoulders at Luka and walked back to the girl.
As the noon hour approached, the fact that no other patients came to the clinic that day yet had not been lost on the staff. In fact, it was quiet, too quiet. Luka walked back in to find Carter asleep but sitting up at the little girl's bedside. He gave Carter a poke to wake him up. "How's she doing?" Carter wiped his eyes and stretched his arms, looking around almost as if to verify that he wasn't stuck in a dream state.
"Her fever is high and consistent. Fluid is beginning to accumulate in her lungs." Carter gave a run down.
Luka guessed that sepsis was not far off. "Carter, there is nothing more we can do. She's non-responsive to the antibiotics we've given her." They walked to the back of the clinic, but within eye site of the girl.
"If we could just get Vancomycin she'd have a chance." Carter was reaching for anything to keep his mind off the eventuality of the child's death.
"We tried getting it, you know that." Luka backed him into the wall forcing him to listen. "There are people out there who would kill you to get it and we can't risk depleting what little there is with Sean." Carter looked past Luka to the slight girl dwarfed by the big bed. So young, but so easily treated had she been in Chicago.
He was annoyed by Luka's seeming lack of concern. "How can you just stand there and watch her die, Luka?" Carter's voice rose, pitching his anger at the boiling point as he slowly backed Luka away from him. "You of all people in that ER fight for your patients. You demand the best and stick by them, and speak for them. I have watched you run a code for 45 minutes knowing that it was beyond impossible. And now you are content with being just adequate? Well, I'm sorry, but that's not good enough."
Enraged, Carter shoved the already brittle chair with his foot so hard it smashed into the metal file cabinet, falling into pieces. When Luka could finally get between Carter and his rage he grabbed him from behind and pinned him against the desk, face down. "Are you done?" he screamed from behind his clenched jaw. "Because there is a whole jungle out there to conquer. But it still won't change anything." He let go of Carter and sunk into one of the remaining chairs. They were both exhausted and grasping for straws.
Maybe Carter was right. Luka knew, he knew that he had become complacent not only with his life, but as a doctor as well. The once fearless health care provider had become a by-the-book, county salaried, nine-to-five physician. Gone was the man who took chances and risks to advocate for his patients.
The two were worn out by circumstance and each other. Carter leaned against the side of the window, calm now, but surrendered to the situation. He was not used to talking, especially to Luka. But with almost an involuntary slight, he let his feelings known as he stared out the window.
"I remember a time at County, in my training, when I compared myself to God. I thought I was the healer sent down to serve my people." He spoke in a hushed tone, almost to himself. "It didn't take long to see that the 15 minutes or so we spend with a patient before we turf them to surgery or ICU or street them, is such a miniscule amount of time compared to the millions of minutes of their lifetime. Yet in those few moments we can literally change their fate."
Carter paused to look at the dying girl at the far end of the building and turned to Luka. He didn't know how to form these words of despair. Would Luka even understand? He continued, "I look at these kids, the old people here, women who are destined to die in childbirth. They suffer and die because of little things, diseases that can be treated and prevented. An infection that we would treat and street with a prescription for a ten dollar bottle of antibiotics." The young doctor struggled to maintain his composure. "I come all this way to tell them that there is nothing I can do because I don't have what I need?"
Luka stood and walked behind Carter who turned his back in shame. "It's not that I don't care." Luka pulled from deep within himself to try to bring some sort of understanding to the needless situation. "I have lived this before. This is the real world, here, right here. I know what it's like to go without, both as a doctor and a father. We can only do what we can with what we've got. It's not about you, Carter. It's about them. We are to them what CT scans, nuclear medicine, organ transplantation and micro surgeons are to us in the ER. If they can just get to us they know they have done their best. What little we can sometimes do for them is enough for them to go on. Even if we fail. And you have to accept that. Because those 15 minutes to them are a lifetime."
Carter was worn out, spent and stuck on blending his family life with his professional one. "Well I can't fail." He was talking to himself more than to Luka. "I failed my cousin, I failed my brother, my parents, even Abby. I tried everything, there was no fixing her." He clung to the metal chicken wire grate that separated the office from the infirmary beds and stared at the girl and her now sleeping father with all his might. "I can't fail that little girl." With his fingers still grasping the wire he turned his head to bring his attention back to Luka. "Do you know how that feels?" Carter was convinced that this was the anvil of the conversation, that Luka had no choice but to concede.
Luka gently, but firmly put his hand on Carter's shoulder. "I've failed. I've failed plenty." He was not about to let Carter get away without getting a snoot full of pride thrown back at him. "I failed my wife and two children when I couldn't perform CPR and surgery at the same time on all three during a bombing raid." Carter looked incredulously at Luka. "And I failed myself by not taking charge of my life this past year. I lost my drive to maintain my courage. You've been at rock bottom before, Carter, and you have pulled yourself out of it. I know failure like you never will, and it's not something to be taken lightly."
"I've never pulled myself out of any hole before." This part of Carter seemed to be a new discovery. "I'm not even sure where I would start. See, there has always been somebody else to rescue me from my failures – to bring me back to my proper Carter-ness." The sun was hitting him directly in the face now. He had to squint to see Luka through the dust particles swirling in the haze before him. "I am a thirty-two year old man who doesn't even know what it feels like to make a significant difference in somebody's life based on who I am instead of what I am. I don't even know if I have any courage. Maybe that's my dream." Carter pushed Luka away from him and walked to the opposite side of the room.
Luka wouldn't let him swill in the self pity he was so good at producing. "I will never, ever get over losing my family the way I did, of not being able to save them even though I had the skill and training." He pointed to the little girl in the bed. "That little girl needs all we can give her and although we may not have the best the world has to offer, we are the best that she can get at the moment. You can't quit, Carter. Not on her. Just don't quit. I haven't."
Carter walked back into the infirmary, but stopped short to leave Luka with one last thought. "I guess adequate is better than the alternative."
Through the door of the exam room a group of villagers shouted for help. Carter was first to reach them, carrying a young man who was bleeding. He opened the curtain and directed them to the back of the infirmary where Luka was clearing the debris off of the make shift surgical table. One of the nurses rushed to turn on the generator instinctively knowing that the bright surgical light hanging above would be needed. The villagers laid the man on the table and briskly stepped back to let the doctors examine him. Dressed only in shorts, it was explained to them that he had been in the jungle with other family members collecting food when gunfire broke out nearby.
He had one gunshot wound to his abdomen with no exit. He was bleeding from the wound and was obviously terrified, but was at least conscious and breathing on his own. "Chibon, call Joseph on the radio," Luka shouted above the din of voices, "tell him we need a transport right away." Carter looked up from the man, briefly, to shoot a look through Luka. Broken radio, huh? The look wasn't lost on Luka at all.
With the light focused on the patient's belly, they worked to assess his condition while Agunda gave them frequent vitals. No x-ray to call, no labs, no CT. The best Luka could do was to stick his pinky finger straight into the wound and route around inside to see if the bullet had entered the peritoneal cavity. The man strained to keep his composure as Agunda sat near his head talking to him. "It's gone through," Luka told Carter, "but how far?"
Carter finished getting the IV started and palpated the abdomen. It was not distended or rigid. The bleeding was obvious but the question was, where was it coming from? "Should we wait?" Carter was ready to hone his few and rusty surgical skills. When breathing became more difficult for the man, they struggled to put in a chest tube, draining away blood that accumulated in his chest.
As time passed they contemplated doing surgery. "We can't open him up here unless he starts to decompensate dramatically." Luka really didn't want to risk infection unless he absolutely had to. They waited. It would take about twenty minutes at top speed for Joseph to reach them, and the rains were coming down hard. The man's blood pressure began falling, slowly. There was bleeding going on somewhere, a slow leak. Lots of hands helped get him onto the stretcher as Joseph got to the door.
The Jeep was covered in mud. "Almost didn't make it, but getting down should be alright. I'm more worried about getting back up today." Joseph was speaking to both of them but looking at Luka with a great sense of urgency.
"I'll go. Carter should stay back with the girl." Luka got in the Jeep and straightened out the stretcher laying across the back.
The man began getting agitated and Joseph put his head close to his to hear him speak. "He says it's hard to breath again. And he has shoulder pain." Luka moved to adjust the chest tube. More blood drained away and the man was able to breath more comfortably once again.
Carter told them to wait as he got an intubation kit and ambu bag. He got up into the Jeep, but kept the kit to himself. "He may have torn his diaphragm. You can't hold onto him and intubate at the same time."
Luka did not want Carter along and told him it was too dangerous and the girl needed him at the clinic. "You can't come, Carter."
"You said yourself there was nothing more we could do for her. I'll come right back. You can't do this alone, you know it, Luka." Carter was not moving.
Luka turned to Joseph and gave him a look. They took off for Joseph's village skirting around downed tree limbs, batches of palm leaves piled in the road and potholes of gargantuan proportions. They were filthy as they turned into Joseph's house, the first off the road. Carter was surprised to see Sean walk out of the house as the two doctors transported the patient into another waiting truck with staff from the hospital.
"Carter," Luka mentioned, walking towards Sean, "go fill the hospital people in on his condition. Check his breathing again."
He didn't need to be told. Carter was suspicious as he approached the truck, looking back at Luka, Joseph and Sean talking quietly amongst themselves. He gave the nurse in charge the details of the man's injuries and the treatment he received at the clinic. The man's breathing was still difficult but it could wait a few more minutes until they got to the better equipped and staffed hospital.
Carter took a moment to go back in the house to grab his rain poncho. A cheap, blue deal Abby had gotten him at Wal-Mart before he left. Stuffed at the bottom of his bag, he'd forgotten about it. He was sick of getting wet and changed into a dry t-shirt before heading back outside with his slicker.
Sean got a kick out of the blue cloaked Carter. "You're looking like a razzer these days, Dr. Carter." Sean smiled, shaking his head in amazement, his Irish brogue in true form. "You have a might big stash of lee-a-roady to go into the jungle dressed like that." Carter tossed a puzzling look Joseph's way, getting only a shrug in return.
"Hey," Carter tossed out, "it's all about function," and laughed at himself.
Once again, Luka tried talking Carter out of making the journey with them. He told Carter that he might as well stay at Joseph's house until the next day. "You're tired, Carter. You need some sleep. I'll stay with the girl and tomorrow you can take my place."
And once again, Carter was not going to accept Luka's excuses. "How about I go back and you stay?"
Joseph and Luka shrugged their shoulders and took their places in the Jeep with Carter. The weather and waiting patient at the clinic gave them a sense of urgency to get moving but the driver deferred to his wife for a few more moments as she approached the vehicle. Toomay gently caressed Joseph's cheek and whispered into his ear as he started the engine. A soft kiss between the married couple and the three men were off yet again, leaving Toomay and Sean in the distance.
The men had to hold on tight as Joseph worked hard to get the Jeep up and around all of the debris and mud in the road. They were fighting the rain and losing as the Jeep finally got stuck half way up the hill. All three got out, Luka grabbing the medical bag of supplies Sean had delivered. They had to talk above the sound of the rain smacking against the palm leaves and splashing into the standing water. They made their way to the banks of the creek and began walking upstream. Carter stopped when he noticed he was alone. Turning around he saw Joseph and Luka standing side by side, both staring at him.
"We should tell him," Luka shouted at Joseph. "He should know."
Carter walked back to the men hoping this was not some sort of inside joke. They looked serious, and they were speaking English. "What's going on?"
Luka and Joseph exchanged glances before Luka finally spoke up. "Sean brought us the Vancomycin."
"What?" Carter was incensed. "And you decided to make this a little secret?"
Luka explained that he was hoping to keep Carter out of it for his own protection. "The soldiers and rebels here, they don't like you as much as me." He gave Carter a little grin as he looked down at his feet.
Joseph spoke up to fill in the blanks. "We felt that if the rebels found you with the Vancomycin they would be more likely to kill you than Luka. Please understand, Dr. Carter. Luka did it for you."
The three men gazed at each other uncomfortably as Carter finally exhaled and broke a soft smile. "Yeah, I guess I haven't been the most diplomatic tourist." Carter grabbed the bag and rummaged through it. "You know, Luka," he tossed in with a sarcastic wink, "I can think for myself sometimes. But, ah, thanks for getting the stuff." He pulled out the zipped baggie of Vancomycin vials and a wrapped Ace bandage. Taking the safety pin off of the bandage he turned around, his back to Luka. "Here, pin the baggie inside the top back collar of my shirt." How many times had they seen the gang-banger drug dealers back home come into the ER with the drugs creatively attached to them? Drugs the cops had missed in their searches.
"No, Carter that's stupid. They'll find it." Luka was having no part of this.
Joseph took the baggie and pin from Carter and reached up under his poncho and shirt. "He's right, Luka. If we get stopped, they'll look through our supply bag and find it. They'll frisk both of us and do a half-assed job with Dr. Carter. It's unlikely they'll find it."
Luka put his hands on his hips, sighing a breath of resignation. The three men continued on their journey, stumbling up and over rocks, dipping their feet many times into the cold water to avoid a more treacherous route away from the creek. Suddenly without even a hint of sound, a large group of rebels came upon them from nowhere. They quizzed Joseph in his native tongue. They spoke to Luka in French. At least they were recognized. It appeared to Carter as though Joseph was successfully talking his way out of the ambush, until the medical bag was grabbed and the men were searched. All three patted down, but as Joseph had guessed, they didn't give Carter much thought as the young man searching him passed right over the vials under his shirt and poncho. Knowing the three men were medical professionals, just as likely to help them as they were their enemy, they let them go - giving them their black bag back and walking away. The younger man stayed back watching Joseph, Carter and Luka as they continued on walking upstream.
Luka and Joseph had a few legs up on Carter when the young man's voice brought Carter to a stop. He turned, apprehensively, to see the young man, rifle casually slung over his shoulder, pointing to the ground. He was smiling and walking towards the item, picking up what the doctor had dropped, reaching his arm out to Carter giving it back to him. Carter played the game, smiling back at him, thanking him, even giving him a lame bow. Surprisingly the bow was returned and that's when the young man saw what was in Carter's hands. A bag with vials of Vancomycin, safety pin haphazardly attached. Something that hadn't been seen in the first inspection. Something they had tried to hide. Before Carter could turn to run, the man yelled to his fellow rebels, who were by now out of sight, well into the trees. It was just seconds as the two connected eyes. Carter lunged forward knocking the man to the ground smashing his head with his fist, but not before he got a shot off into the air.
Luka had raced back grabbing the man from behind, putting him in a head lock, choking the breath out of him, silencing him. Falling to the ground with the man, Luka established that he was breathing, just unconscious. Carter stood by staring in a silent panic. Joseph had backtracked to the pair motioning for them to run. Luka grabbed the baggie, throwing it into Joseph's hands. "You go, Joseph. GO. You know your way better. You can get there first."
Joseph took the baggie and started upstream, full speed. "I can make it, Luka. I can make it."
Luka gave Carter a shove as they both took off after Joseph, paying close attention to the terrain while keeping their ears wide open this time. They ran fast, stumbled often on the slick rocks and leaves, and got up just as quickly. The branches of the thick brush and rough bark of the scattered trees left marks on them as they ran into them, not feeling the pain of the abrasions. Carter took the lead at one point as Luka fell, lodging his foot in a tangled mess of tree roots.
"Go, Carter." Luka waived his arm in the air while trying in vain to free himself. "Get out of here."
Carter stopped and leaned down to help Luka. He wasn't leaving Luka behind. It took both of them, but they finally got Luka's foot out. They were on their way again, clawing their way back up the muddy embankment, but not before they heard the familiar voices of the rebels in back of them, to their left and in front of them. This time their guns were drawn.