Abundance

by Fine, Michael;

  But maybe it would be okay. Maybe Kim knew what she was doing and it was Julia who was confused.

  Then two weeks later Julia heard one of the community health workers say that she had been out to Alex’s village, that Kim’s face was black and blue. And that Kim was talking to the traditional midwives, and not doing big belly clinic at all.

  So Julia asked Carl to go out and take Zig with him. Maybe Carl could do for Kim what Julia had failed to do. Perhaps Carl was the person Julia wasn’t.

  They went out, and they came back. They took four men from Carl’s team just in case. Julia had been clear. Get her back. Don’t take no for an answer. Just put her in the car and bring her home. And then we’ll ship her back to Iowa for safekeeping.

  Julia was doing the ward and she saw the Land Cruiser pull into the courtyard of hospital compound where the hospital cars parked at the end of the day, and she went out to meet them.

  Zig got out of the back. Carl was sitting in the front seat. He pulled down his window when Julia walked down the ramp from the ward.

  No Kim.

  “Where is she?” Julia said.

  “She’s in the bush,” Zig said. “She isn’t going anywhere.”

  “I thought we said you would just put her in the car,” Julia said.

  “She was gone. They must have known we were coming,” Carl said. “Alex works here. News travels fast. She wasn’t there.”

  “Did you look?” Julia said.

  “There isn’t much to see. You’ve been there. Four or five huts, a cooking hut, and a garden. No we didn’t walk into every hut. We didn’t exactly have a warrant for her arrest. They didn’t want us there. That woman you met, Alex’s head wife, she was there. She said Kim’s not here. She made it pretty plain we weren’t welcome,” Carl said.

  “So you didn’t see her,” Julia said.

  “No we didn’t see her,” Zig said.

  “You should have checked the huts,” Julia said. She turned her head away.

  “Julia you are over the top on this,” Carl said. “She’s of age. Maybe not thinking straight but of age. You don’t go marching into people’s houses, regardless of how right you think you are. This is a place with its own culture and its own rules. We have to respect that. You want to find her, you come with us next time, and you do the dirty work. Even then I don’t think we can bring her back against her will.”

  “She’s going to die out there. This is suicide. She’s all alone,” Julia said.

  “Then she’s no different than a hundred thousand Liberian women. No different than African women from any of the fifty-plus nations. Everyone lives this life,” Zig said. “People make their own choices, even when they make choices that they can’t survive.”

  “You can’t make different choices if you’re dead. We’re going back,” Julia said. “I’m going with you. We can’t leave her out there alone.”

  “Let it settle for a few weeks,” Carl said. “Then maybe we’ll all go back together. But I don’t think she’s coming in. This is the life she wants.”

  “You didn’t do what you needed to do,” Julia said. “I’m going to try to find someone else to go. The church people might go. They know what they believe.”

  “Suit yourself,” Carl said. “You are way over your skis. And there ain’t no snow on this ground, and there ain’t going to be snow in Liberia anytime soon.”

  Later, back in her room, Julia threw a book against the wall. Carl was not the man she wanted him to be. Kim was lost. Julia was not the person she needed to be.

  Three weeks later, Julia was awakened by a car honking in the middle of the night, and a few minutes later there was a loud knock on her door. There was a pregnant woman in labor. In trouble. Big-big trouble.

  It was Kim. Her face was waxy, blue-white, and wet. Her braids were pulled back behind her head so her forehead and features stood out. Her eyes had glazed over. She was breathing in big, deep agonal breaths. Sister Martha was there. So was Alex.

  “Vitals?” Julia said, as she put her hands on Kim’s belly.

  “Sixty over palp,” Sister Martha said. “Pulse 140 and thready.”

  There was a horizontal blue line on the upper part of the abdomen. The abdomen was tense. There was no uterine fundus, no smooth firm dome, and no capsule to hold and protect the baby. Fetal parts were easily palpable beneath the skin. Julia felt a flexed leg, then a bent arm, a shoulder and the child’s nose and mouth just beneath the cool white skin of Kim’s belly. There was no fetal movement. The baby wasn’t moving. The child was dead.

  “She’s in shock. She’s ruptured her uterus. Get the OR ready. Get Zig. Get the lab. Get me two 18-gauge catheters and two bags of normal saline and as much blood as we can find. Type-specific to start. Cross-matched if we get that far. Was she in labor?” Julia said. She walked over to a treatment table and pulled two wrapped catheters from a jar.

  “The patient commenced labor at zero three hundred hours three days ago,” Alex said. “She failed to progress.”

  “Fuck you,” Julia said. Then she scooped a few wet white gauze pads from a metal tin, turned back to Kim’s side, wiped the skin on the back of Kim’s hand with gauze, opened one of the catheters and slipped it under Kim’s skin. Sister Martha connected tubing to a bottle of IV fluid, ran the fluid through the line, and handed the end of the tubing to Julia as she probed with the catheter until a spot of blood showed in the hub of the catheter. Then Julia pulled the metal stylus, the needle, out of the catheter and connected the tubing.

  “Open it wide. Run it as fast as it will run. We’re on borrowed time,” Julia said, and she walked around the foot of the gurney, slapped the back of Kim’s other hand, wiped the back of it, and jerked off the plastic and paper covering of the second catheter.

  “Zig’s scrubbing,” Sister Martha said.

  “Who was managing her labor?” Julia said as she inserted the catheter under the skin of Kim’s left hand. “And let’s get an intubation set up please. I’m going to tube her as soon as the IVs are running, on her way to the OR.”

  Kim’s breathing grew suddenly shallower. Julia looked at Kim’s face and shook her head.

  “We don’t have much time. Not any time. Let’s move people,” Julia said.

  “The patient was attended by a traditional midwife,” Sister Martha said. She punctured a second bottle of IV fluid and began to run it through the tubing. “She ruptured her membranes three days ago. When her labor failed to progress, the midwife placed a wooden plank on the uterine fundus and pressed on the plank with both hands, hoping to expel the fetus through the cervix and vagina and deliver the child naturally. When the labor still failed to progress, the midwife stood on the plank, one foot on each side.”

  “So somebody put a board on the belly of a pregnant woman in labor and stood on it?” Julia said.

  Then Kim’s breathing stopped.

  “The respirations have ceased,” Alex said.

  “Fuck you, Alex. Fuck, fuck, fuck you. I need that tube right now!” Julia screamed. She left the catheter under the skin of Kim’s left hand and moved around the gurney so she stood over Kim’s head.”

  “There is no pulse,” Sister Martha said.

  “Get Zig, Alex. Tell him to break scrub. Tell him I need him now,” Julia said. “Sister Martha, start chest compressions. I’m going to tube Kim now,” Julia said, and she picked up a laryngoscope from a table and snapped its head open so the tiny light went on.

  “There is no tube,” Sister Martha said.

  “Give me a seven,” Julia said. “A six and a half will do if that’s all you have.”

  “There is no need to tube,” Sister Martha said. “There is exsanguination. There is no blood to transfuse. There is no operation to repair the damage now. The baby has died. The girl has died. We will pray for these souls and ask for their forgiveness,” Sister Martha said.

  “A seven and a half then,” Julia said. “Please give me a tube.”

  Kim lay on the gurney, bl
ue-white and still, her waxy eyes still open but without life in them, a sheet over her big still belly, and an IV catheter in the back of each hand.

  When Zig came in, Julia was standing over Kim, the laryngoscope in her hand, its tiny light still on.

  Zig took the laryngoscope form Julia and closed it. The light went off when the blade snapped shut. Then Zig reached over and closed Kim’s eyes.

  They passed a small lake that lay next to a hill. The steel stitch in Julia’s side hurt less. Yellow Bandanna was awake, but his face was flatter and his eyes were dull, and he must have relaxed his grip on the gun. They were moving fast, fifty, perhaps sixty miles an hour, and there was a stiff breeze on Julia’s face from the open windows. The stereo was still booming, BOOMCHA BOOMCHA BOOMCHA, the bass shaking Julia in her seat. It would have rattled windows in buildings along the side of the road if there had been windows or buildings.

  The road ran between the lakeshore and a grove of rubber trees that were tall enough for the angled grooves in the pale green bark and the towering darker green leafy tops to be reflected in the water.

  Still water. No waves.

  One Sunday in the dry season they went to Roberts Beach. It was hard for Julia to believe that there can be places as beautiful as Roberts Beach in a country as bereft as Liberia.

  The beach was a little more than a sand bar curling into the ocean with a cliff on one end that boys use for diving and a spine of palm trees on a low hill with ocean with surf beyond the hill. There was a good breeze off the ocean and a crashing surf.

  Six of them went for an outing in two cars—Julia, Zig, Carl, Grace, and Rashid, the community health guy from Pakistan, as well as two visitors, both women from Britain, who rode with Carl and Grace.

  They sat at a rickety refreshment stand made out of odd-sized boards and driftwood painted bright yellow and bright green and white, in the shade of a patio made of poles and thatched with banana leaves. A thin wizened man with a white three-day beard brought them drinks. They sat and watched the surf breaking and watched the white and green Ghanaian boats, pirogues, fishing a few hundred yards offshore. Bent signs near the water said you shouldn’t swim because of the riptide, but there were people, mostly boys from town, standing in water as high as their chests.

  They sat in the shade and talked about the foolish police, who wore hot uniforms and big blue-visored hats that didn’t fit and ran checkpoints that existed only to extract payoffs. They laughed about the castoff four-wheel drive pickups and SUVs imported from the U.S. that roared through the streets of Buchanan without mufflers, their exhaust noise shaking the windows, so loud that you’d look for a semi or freight train and all you’d see was a little red Honda CRV. They talked about the signs on the back of taxis or in the small shops: Lord’s Blessing Taxi; God have Mercy and Kindness Car Service; God’s Blessing Tailor; God is in Control Business Center; All Thanks to God Medicine Shop; We Are Here to Serve God Shoes Doctor. Then they talked about the news, about the rumors of Charles Taylor getting indicted in Sierra Leone, about the rebel group in Loma County and how the British were behind them, about 9/11 and the Israelis and the Palestinians and the war in Iraq and the looting of Baghdad.

  How wonderful was that day for Julia, who didn’t think much about the news, to be sitting on a beautiful beach and to hear the perspective of people from other places. Julia believed that people from around the world hated the U.S., and through that hatred those people also hated her and burned our flag and our president in effigy every chance they got. But that was not what these people thought. They did not think Julia was the enemy, or even an enemy. They seemed to like the U.S., to respect it, and even to like and respect Julia and her work. They were puzzled about our choices. Respectful of our power. Curious about our democracy. And hopeful that we’d eventually get it right, after trying all the other options.

  Carl, the other American, was listening and looking out to sea when he got bored. They were still not an item. They had been together twice. That was good, really good. She throbbed when he left. Ached. And thought too much about him later.

  But Carl acted like he barely knew she existed. Days and sometimes a week would go by without her hearing from him. He didn’t stop by or come to the hospital to see her. They had chance meetings. Dinner at Zig’s. They’d see one another at the Bong County Road crossing in the morning, when her crew and Carl’s crew were on their way to the bush. She saw him at The Club on Sunday afternoons.

  She was a lightweight and Carl knew it. No theory. No Marx, Marcuse, Friere, Habermas, Foucault, Rawls, or even Paul Farmer. She tried to listen sometimes, but none of it had any weight, any reality. There were little kids in the bush dying of measles and malaria and of simple dehydration after diarrhea and that was about all Julia knew. Carl needed someone who could think like he thought, who could understand the big picture, who could quote the Old Testament and Shakespeare and was also good in bed.

  That wasn’t her. Julia was just not that much about being an item anyway. She was about her work. Kiddos dying in the bush. Good prenatal care. Bed nets. She was awkward and she wasn’t good at relationships and she wasn’t really that smart. And she’d be gone in a few months, so what was the point? It was good while it lasted. What little there was of it. Just between them. Two consenting adults.

  While the others talked Julia went alone into the surf. The furious tide crashed around her legs and belly and tried to suck her legs out from under her as she walked into deeper water. When she bodysurfed, the waves twisted and turned her and beat her up good until she fought back and ached with the exhilaration of being alive. The hell with Carl. The hell with Africa. The surf was as good as it gets. She swam until she started to get cold, swam hard, across the waves, and then she bodysurfed back to shore. She let the riptide twist her and toss her and roll her into the pebbles, seaweed, and sand.

  Then Carl walked into the surf to where Julia was, half kneeling, half floating in water that was not quite waist deep where a wave had dumped her, still a little short of breath, after a long rough ride, and he held out his hand and arm for Julia to hold as she stood. It was a strong hand.

  Then a wave hit them, and Carl reached around Julia’s waist so he could hold her, his feet spread wide apart and planted in the sand. Carl and the wave together lifted Julia, so her feet floated toward shore, and the wave poured over her neck and chest and back and abdomen, but Carl’s arm kept her head out of the water, and she held her side and chest tightly against him, against his chest and flank, which was warm and strong. The next wave knocked them both over. The next wave after that sent Julia twisting toward shore, spinning her about so she didn’t know which way was up.

  Then the surf paused. Julia had enough time to plant her feet and turn around and look for Carl.

  And suddenly the tide reversed, and sucked her back under and out to sea, sucking her out fast and hard. Her body twisted in the current. She felt the exhilaration of force and speed at first. Then everything was out of control. The shore was suddenly distant, the little refreshment stand just a speck of color on the beach. Her arms ached.

  And she was way too far out. She swam hard across the current but she couldn’t break the rip. She swam harder. Suddenly she felt fear. Can’t panic, she thought. But maybe I really can’t. Can’t swim. That far. Alone.

  Then there wasn’t enough air. Julia was swimming with everything she had in her arms and upper body and legs. But struggling. Tired and short of breath. Then cold. Then very short of breath.

  And then Julia felt herself dying.

  It was a strange, sad sensation. Carl was far away. The world was far away. Julia’s life was not her own. It had never been her life. Now it was vanishing. She was glad for having lived. But so sad to lose the world that would now never be hers.

  There wasn’t much breath left. Weak, she thrashed about with her elbows and arms, watching the sky disappear. There was only a cold chill and the water around her.

  And then Carl was there. He
put his arm around Julia’s waist. She threw both arms around his neck. Her head came out of the water and she took a deep breath. And then another deep breath. And then the world came back, and she was holding onto Carl, whose body was still warm and strong.

  “Go limp,” Carl said. “Hold my chest, not my neck. I’ll swim for both of us.”

  Julia molded herself to Carl’s body. She began to shiver, even to shake, and the only way she could get warm was to fold herself into him. She wrapped her arms around his chest.

  Carl started swimming at right angles to the current. The current continued to carry them out to sea but Carl swam to where the water wasn’t moving so fast. And then he swam a little further, to a place where the waves broke but the water was quiet between the waves. And then he stopped swimming and rose out of the water.

  “You can stand,” he said. “Sand bar.”

  Julia was shivering and breathless, but she stood, her legs weak and her body shaking. She wrapped her arms around Carl, and pushed her chest into his to stop the shivering and the dying. But it was more than not dying. Julia felt something she had never felt before. Carl was the body part Julia lacked. The missing piece had been found. Julia had never been whole before.

  No one on shore could see or would know. They had gone for a swim. But had come back different. Really different.

  “Oh man,” Julia said. “You just …”

  “Shhh,” Carl said. “You gotta do what the sign says. You can’t go swimming here alone.”

  He kissed her forehead first, and then he kissed her closed eyes and kissed her cheeks and nose and mouth, and he held her to him, and he didn’t let her go.

  But they were still not an item. Not yet.

  Chapter Five

  Carl Goldman. July 16 to 18, 2003

  FIRST THEY FLEW HIM TO A STAGING AREA IN SENEGAL. THEN THEY FLEW HIM TO Wiesbaden. He landed about 10:00 at night. Carl called Naomi at about 6:00 in the evening, her time. That way he wouldn’t have to wake her when he got to Boston.