Tom piped up; his voice a mere whisper. “Steff will be elated. All the more for her.” His sense of humor was clearly intact, even if it fell flat with everyone but me.
Later that morning, the call came that an appointment had opened up for a CT scan. We piled into the ambulance, squeezing close around Tom on his gurney. The CT clinic occupied a space in what amounted to a small commercial strip mall, and the surrounding hubbub reminded me of similar scenes during our many trips to India. Swarms of people bustled around. A teenager on a bent bicycle swerved around the ambulance. Several women strode past, carrying pots of vegetables on their heads and children in slings across their hips. Across the street, a man hacked at a goat carcass that hung upside down in the doorway of a halal butcher.
At the doorway to the CT clinic a queue of people waited, pacing and smoking. The line wound around a litter of kittens that suckled their mother’s dry teats on the doorstep. The mother cat hissed as she was forced to make room for Tom’s gurney, carried inside by six men, with me and Dr. Busiri in tow. Inside, the waiting room was crammed full of wobbly plastic chairs; on every seat was a woman in a black hijab. Several glared at us, and I could understand why. It looked like we were jumping the queue. What they couldn’t know is that we had been waiting standby at the clinic for the call to come. I looked at them apologetically as Tom’s gurney was pushed into the back room, but there was no way to explain.
No way to explain. That was quickly becoming the defining sense of foreboding that I couldn’t shake. There was no way to explain any of this, no way to get a handle on it. What had begun as a seemingly routine run-in with food poisoning was turning out to be something quite different—and disturbing. Everything about this was disorienting. Tom was a supremely hardy guy; he’d been fine—and then suddenly he wasn’t. In the barely thirty-six hours since Tom had fallen ill, every step forward—from the ship to the clinic to the diagnosis of pancreatitis—seemed to be a step back, spiraling us only deeper into this medical crisis, not out of it. Every step took us further from any expertise I had that could even remotely help Tom. It felt like we were channeling Apophys, the god of chaos.
6
THE COLONEL FROM AL-SHABAAB
Later that day, as we dozed side by side in the operating room, Tom on his gurney, me on mine, Khalid appeared to tell me that I had a visitor: an officer from the tourist police. What now? Was getting sick in Egypt a crime? He assured me it wasn’t, but any incident involving a foreigner needed to be investigated.
I was ushered into a small cubicle in the clinic while Khalid stood quietly in the corner, observing. Officer Aziz sat before me, chain-smoking Camels while absently toying with his bushy black mustache. A portly, middle-aged man, he wore an ordinary khaki uniform in typical military style. At his side, I noted calmly, a gun poked out prominently from his holster, admittedly not something you’d expect in a medical clinic. But right now, the truth was that his inquiry and the power he held to stall our effort to leave felt more threatening than the gun. With a full head of black hair and thick eyebrows, his expression seemed imposing, even menacing. Or maybe I was imagining that. Tom had often described how the mind works to make sense of sensory input—what we see or hear, for instance—but may also filter our perceptions through implicit biases of our own making.
This was central in his decades of work with schizophrenics, but it plays out for any of us in everyday circumstances, shaping our perceptions, our behavior, even our dreams. So I tried to quiet my fears, be calm, and think objectively about our situation.
In broken English, he asked me a series of questions, which included whether or not we had been attacked, robbed, or poisoned by an Egyptian. I assured him we had not. In fact, I stated emphatically, we were being taken care of with the utmost care and respect. Officer Aziz beamed at my remark and sucked hard on his Camel, flicking the long ash onto the floor. Pointing, he asked me to sign an affidavit. It was several pages, the paper was so thin that you could see through it, and it was all in Arabic.
“But I can’t read Arabic. Do you have an English version?” I said in the most polite tone I could muster, pushing it back toward him.
“You must sign,” he replied, pushing it back.
When I refused again, Khalid crept from the corner and explained my discomfort to the officer. They discussed the matter for several minutes before Khalid finally relented. He picked up the pages and looked them over quickly.
“It is okay,” he said. “You should sign.” More quietly, he whispered, “They just don’t want a bad scene in the paper where tourists are complaining of being attacked or injured.” I signed the form and handed it to him, worried that I’d live to regret it, but I was more worried about Tom and whether he’d live at all if we didn’t get to a hospital equipped to treat him.
Officer Aziz smiled thinly, folded the document and pocketed it, hoisted his pants and gun belt up, and strode out the door. Khalid walked with me back toward Tom’s gurney. He explained that he had been summoned back to Cairo, but would leave me in the capable hands of a local tour company that would help with anything we needed. He went to shake my hand, but I gave him a hug instead. As I watched him walk away, I blinked back tears. Suddenly, I felt terribly alone.
Over the next forty-eight hours, despite getting IV antibiotics, Tom’s condition continued to worsen, and I spent hours on the phone with reps from the travel insurance company, basically begging them to get us out of there. After speaking to several of their medical personnel, I learned that for Tom to be medevacked I needed to prove that he required a “higher level of care.” This was delicate, since I didn’t want to insult the medical staff of the clinic, who were doing the best they could with what they had. But by now, Tom’s condition was clearly deteriorating. He could no longer get up and walk to the bathroom, even with help from me and a nurse. The nasogastric tube continued to siphon off copious amounts of greenish-yellow fluid. His breathing had become ragged, and one of the nurses had fitted him with a face mask so he could receive oxygen.
Originally, Dr. Busiri had appeared convinced that his clinic could handle Tom’s care, but after the radiologist’s reading from the CT finally arrived, Dr. Busiri’s confident tone shifted, too.
“There is no obstruction,” he said slowly. “However, there is a high probability of complications, which would likely occur within the next twenty-four to forty-eight hours.”
“What kinds of complications?” I asked him. But his phone rang and, appearing visibly relieved at the opportunity to exit, he hurried off.
Left to my own thoughts, I tried to shrug off my growing sense of panic and the image of some invisible monster waiting in the wings, growing stronger by the moment as we fiddled with clumsy human efforts to see it revealed in shadowy scans and blood tests. When I’d texted Chip about the pancreatitis diagnosis, he called me right back, and he wasn’t as relieved as I’d thought he’d be. Although he was satisfied that the clinic doctors had prescribed an antibiotic regimen he would have prescribed himself, pancreatitis was serious, and he felt certain there was something more going on. He just didn’t know what or whether the clinic had the resources to tackle whatever turned out to be the cause. That was worrisome. Chip had been a well-known leader in HIV/AIDS research in the eighties, when I was just starting in the field, and I’d met him first in his published research, which was groundbreaking and, at times, visionary. He’d told me once that he was drawn to the big challenges—that when things got comfortable, he got bored. We were kindred spirits in that regard, and I respected his zeal for tackling medical mysteries, but right now I wanted Tom’s case to be blessedly boring.
Unlike Tom, I could eat and needed to. I left the clinic to grab a bite and ship some of our luggage home. The travel insurance agent, Carol, had told me that on a medevac flight, we would be allowed only one duffel bag each on the small plane. It’s surprising how much stuff you realize you don’t need when the only carry-on you really care about is the irreplaceable man on
the gurney.
Barely through the clinic front door, I could hear Tom bellowing as I approached his room. There, on the floor beside his bed, was a pool of urine, and he was in an uproar.
“Tell them I need a bedpan! They don’t understand me!”
I turned to one of the nurses, who was standing there flustered.
“Bedpan?” I said. “For urine…” I motioned to Tom’s privates. The nurse waved her hands in dismay.
“La! La! No! No!” she uttered, backing away, and then launched into a tirade in Arabic.
With a start, I realized that she thought I was asking her to touch or see Tom’s genitals, a major taboo. At the same time, Tom thrust a piece of paper toward me; he had attempted to draw her a picture of a bean-shaped kidney in an effort to explain his request. At any other time, I would have laughed uproariously at ourselves and so would Tom, but at the moment, this was no laughing matter.
Suddenly, one of the doctors appeared, having been summoned by a nurse. I recognized him as one of the doctors who had arrived to meet us the first night. Dr. Abboud, a thirty-something man, balding, a few wisps of hair swept across his forehead, matching his weary demeanor. The clothes beneath his white coat looked unkempt, like he had been sleeping. I explained to him that Tom had been requesting a bedpan unsuccessfully for the last few hours and as a result, there was now a puddle on the floor.
“I told them to use Google Translate!” he exclaimed, throwing his hands up in disgust.
“It didn’t translate properly!” Tom barked back.
Dr. Abboud translated for the nurse, who disappeared and then reappeared with a bedpan. It was the only one in the clinic, but it was hopelessly cracked.
Just then, my cell phone trilled. It was Carol from the travel insurance company calling back. I filled her in on the morning’s drama; I could hear her typing furiously on the other end. She asked to speak to the doctor, and he disappeared down the hall with my cell phone. A half hour later he returned and handed the phone back to me. Carol was still on the line.
“The doctor says your husband is psychotic,” she told me.
“What? That’s ridiculous,” I exclaimed, turning my back so Tom couldn’t hear. He would be outraged. Tom was clearly disoriented. But psychotic? No.
“Let me speak to him,” she ordered. As Tom spoke to Carol, I listened to his side of the conversation, trying to get a sense of what she was trying to find out. Tom was mostly answering yes or no. As he tried to get more comfortable so he could hold the phone more easily, I saw him gasp in pain. “I don’t remember,” he told Carol in response to a question I couldn’t hear. Then he turned to me. “She wants to know when I was last given pain meds.”
I looked at the wall clock: ten a.m. “Sometime last night,” I told him, and he repeated it back to her. I could hear Carol’s voice get louder on his end of the phone. He handed it to me. “She wants to talk to the doctor again.”
I went to look for Dr. Abboud and found him in a back room, which was furnished with a small cot that was covered with a blanket and a pillow. He grabbed the phone from me, exasperated, shooed me away, and shut the door in my face. A few minutes later he emerged and almost threw the phone at me in sheer frustration. I retreated back to the operating theater, hoping that my phone battery would last a little longer. Carol was livid, and after venting for a moment shifted into administrative sotto voce to declare her verdict: “I have now confirmed that your husband’s pain is not being managed sufficiently, and that the medical equipment in the clinic is insufficient for his needs.”
Bad news had never sounded so good. This gave her exactly what she needed to justify the airlift, and unfortunately it was true. All there was left to do was wait. Carol’s team needed to process the medevac order, get their medical director’s permission, identify the hospital that would take Tom—the short list was London, Istanbul, or Frankfurt—and finally arrange for the plane to transport him.
The next hours ticked by so slowly that I thought the clock on the wall was broken. Antibiotics were still being given as a just-in-case measure, much as they are prescribed so routinely back home, to prevent a possible infection. But if the antibiotics had had any effect, it seemed negligible. Typically, if antibiotics are what’s needed, they kick in within a few days, but there was no sign of it for Tom. His pain was unremitting, and the murky fluid from his stomach continued to drain through the tube in his nose into the collection bag that hung by the bed. Nobody knew what was causing the inflammation in his pancreas.
At least I heard good news from Chip. He knew the chief of medicine at one of the top hospitals in Frankfurt, and also had colleagues who could help if we ended up in London. As I waited bedside to give Tom the details, I repacked our belongings so they were ready to go. Our duffel bags were still too heavy, so I left the Vogue magazine for the young fashion-conscious nurses, along with some toiletries I hoped would find their way to someone who could use them.
The travel insurance company had emailed me several pages that needed to be signed and faxed or emailed back, but there was no fax or scanner in the clinic. It took several hours to find a hotel that could help me with this task. Every obstacle or inconvenience reminded me how resourceful the local people had to be, day in and day out.
Thankfully, Tom slept while I was gone, but his sleep was fitful. And fearful, as I could see from his expression, even as he slept, when I returned and sat bedside. When he woke, he motioned me closer. His eyes were wide and his pupils dilated.
“They’re experimenting on me,” he whispered. “That doctor—he tried to blow hookah smoke inside my oxygen mask!” I looked at Tom incredulously. He glared at me. “You don’t believe me,” he said in an accusatory tone.
He was right, I didn’t. But admitting to that would only alienate him further. Perhaps the doctor had been right after all; Tom was becoming psychotic. What would the sane Tom say if he were dealing with one of the schizophrenic patients in his studies?
“Honey,” I began, using a tone as calm as I could muster. “It doesn’t matter what I believe; it matters what you believe. So, if you believe that the doctor is blowing hookah smoke into your oxygen mask, you’ll be anxious and won’t rest. I’ll stay beside you and make sure no one does anything to you, okay? We are getting medevacked in the morning. This is our last night here, so just hang in there with me.” That seemed to appease him. I dug out his noise-canceling headphones from the duffel and put them over his ears. He closed his eyes and slept.
Twelve hours after Carol and I had hung up, my phone rang. The details were confirmed. Two doctors would arrive the next morning to determine if Tom was fit to fly, and with any luck, we would be whisked off to a hospital in Frankfurt in a small Lear jet equipped for medical transport. I texted Chip with the update, and Tom’s daughters, too.
I’d barely closed my eyes when Tom woke me in a panic.
“Steff, Steff, wake up!” He looked anxiously around the room to see if anyone else was with us in the operating theater, but we were alone. “The colonel is coming! They’re going to kill me! We have to get out of here!”
“What the hell are you talking about? What colonel?” Was this paranoia? Or was he hallucinating?
“The colonel from Al-Shabaab!” Tom screamed.
All right then: there was no doubt about it. My husband was now psychotic. What should I do? Over the next half hour, we spoke in hushed tones to one another. Tom was getting more and more agitated. I could tell he was feverish; sometimes he asked that the air-conditioning be put on, other times he was shivering. He insisted that while I was sleeping, one of the nurses had come to warn him that the colonel was coming and that he should run.
“But honey, the nurses only speak Arabic, remember?” I pointed out to him quietly, praying that this would convince him to give up this fantastic claim. Tom blinked and lay on his back, looking at the ceiling, thinking.
“OK. You’re right,” he finally said. “But I am sure about the hookah pipe. Totally, tota
lly certain.” A minute passed and Tom was still looking at the ceiling. “My God, am I losing my mind? I can’t even trust myself!” he started to whimper. This was another shocker. I had only seen Tom cry once before, when his dad died.
“You can trust me,” I told him fiercely. “I will protect you.” I realized how preposterous this sounded—nothing seemed further from the truth. I was overwhelmed and about as clueless as I’d ever felt in my life. Like the hissing mother cat on the steps of the CT clinic, my protective instinct was in overdrive, but with no resources to back it up.
Besides, Tom was always the one to protect me, instead of the other way around. But hearing me say this calmed him down and he drifted back to sleep. And I was hopeful.
The next morning, Tom was weaker and more feverish. Once in a while he would ask me what time it was and whether the plane had arrived yet, but he seemed to have lost track of whether it was day or night. I watched the clock nervously. Finally, just before noon, the operating theater doors burst open and two women strode in. Both were over six feet tall and wearing Doc Martens boots that further established their commanding presence. They carried black backpacks full of medical equipment. In clipped German accents, they introduced themselves, first names only, as Anneke and Inge, physicians from the medevac company that had been contracted to fly us to Frankfurt. As they took Tom’s vitals, they spoke German to one another, while two nurses and Dr. Abboud watched silently.
“When was his blood sugar last taken?” Inge asked Dr. Abboud sternly, in English.
He rifled through the pages of the medical chart and replied, “Last evening.”
Inge and Anneke exchanged glances. Anneke was wearing electric blue eyeliner straight out of the 1980s, which made her eyes widen and look even more alarmed. Tom’s blood sugar level was seventy-five, which was dangerously low. “His blood sugar should be tested every four hours under these circumstances!” she snapped. “He could end up in a diabetic coma!”
The Perfect Predator Page 5
