For eight and a half months he cared for her with paternal devotion. But each morning as he set the teacup on the nightstand, he wondered if physical deprivation might revive her ailing mind, and so, ten days before Dokka lost his fingers, Akhmed left her teacup in the kitchen. As the day wore on she called his name in cries more confused and desperate with each iteration, until his name was no longer his but a word of absolute anguish. Unable to stand the call of his name, he stayed with Dokka’s wife and daughter for three nights. On the fourth morning he returned and found her on the bedroom floor. The beginnings of bedsores reddened her shoulder blades. In that moment he came to understand that he would spend the rest of his life atoning for the past three days, and that the rest of his life wouldn’t be long enough. He lifted her from the floor and set her beneath the sheets. He took her a glass of water from the kitchen, then five more. “You never have to get up again,” he promised her. He laid his head on her chest and her heart pattered against his temple. “Akhmed,” she said. “Akhmed.” His name was now a lullaby.
He never again tried to coerce Ula into health. It would end. Everything did. But when he emptied the bedpan in the backyard, or brushed her teeth despite her protestations, the afterglow of resentment still smoldered. She was gone but still there, the phantom of the wife the war had amputated from him, and unable to properly mourn or love her, he cared for and begrudged her. And so the previous day, when he had offered to work at the hospital until other accommodations could be found for Havaa, he had hoped Sonja would agree for his sake as much as the girl’s. That morning, when he left Ula alone with four glasses of water and a bowl of lukewarm rice on the nightstand, he double-locked the door and entered the dawn chill with the confidence that Havaa’s future meant more than his wife’s, and he trudged eleven kilometers through a broken obligation that only a child’s life could justify.
When he folded the last sheet he ducked beneath the clotheslines and opened the cupboard. His trousers lay folded on the bottom shelf. Along the left leg inseam he found a familiar bulge in the stitching. If he were to die away from home, he hoped a kinder soul than Deshi would find him.
“Tomorrow we’ll go to Grozny,” Sonja announced as she strode through the canteen doorway, stopping at the counter to inspect the scalpels he’d boiled.
“Did Deshi tell you that?” he asked, unable to mask the panic building behind his eyes. “I was only kidding. Of course I’d use the plane ticket to go somewhere else. Tbilisi, even Istanbul.”
“You boiled these for ten minutes?”
“You’re joking, right?”
She gestured toward him with the scalpel blade, a little too casually for Akhmed’s comfort. “About ten minutes in boiling water? I’ve never been more serious.”
“No, about Grozny.”
“Did you or did you not boil these for ten minutes?”
“Yes, but are we going to Grozny?”
She frowned, seeming to think he was the one talking in circles. “You don’t get to ask any more questions,” she said. “A question mark in your mouth is a dangerous weapon.”
“So are we?”
She gave a defeated sigh. “Yes.”
“Why?”
She pulled a cigarette lighter from her pocket. “Do you smoke?”
“I am an excellent cigarette smoker.” It had been seven weeks since his most recent cigarette, and two months more since the one before that, and technically those had been papirosi, capped with a filterless cardboard tube and jammed with coarse tobacco that left him violently nauseous for the rest of the day.
Perhaps inspired by his earlier display of professionalism, she waited until they reached the parking lot before lighting up. She passed him the square pack. He knew the Latin alphabet, but hadn’t used it in years. “Duh …”
“Dunhill,” she said.
He selected one from the two erect rows and leaned it into Sonja’s lighter. The first drag slid into his lungs without the paint-scraper harshness of his two most recent cigarettes, and he stared at the slowly burning ember, admiring the quality of the tobacco and the quality of the flame, pleasantly surprised that he didn’t feel ill. “Where did you get these?” he asked.
“Grozny.”
“We’re going there to get cigarettes?”
She smiled. “I can’t believe you’d really use that plane ticket to go there.”
“I’ve never been.”
“It’s something else.”
“So why are we going?”
Farther down the street the side of a building had crushed all the cars in a parking lot. He was thirty-nine years old and had hoped to own a car by this age.
“I go once a month to pick up supplies,” Sonja said. “Not just cigarettes. About everything in the hospital comes through a man I know in Grozny with connections to the outside. I also call a friend of mine who lives in London and updates me on what’s been going on in the world.”
“What’s happening out there?” he asked. By now the wider world was no more than a rumor, a mirage beginning at the borders. Thirty-two years earlier, in the rancid air of his primary school—built on a block bookended by a sewage treatment facility and a lumberjack brothel—his geography teacher had expected him to believe that the world was the same shape as a soccer ball. He had been the first of his classmates to accept it, not because he knew anything about gravity, but because the air was more nauseating than usual that afternoon, and he wanted to leave. For the rest of her career that geography teacher would pride herself on being the first to recognize Akhmed’s aptitude for the sciences.
“Last month he told me that George Bush had been reelected,” Sonja said.
“Who’s that?”
“The American president,” Sonja said, looking away.
“I thought Ronald McDonald was president.”
“You can’t be serious.” There it was again, condescension thick enough to spread with a butter knife. His mother was the only other woman to have spoken to him like that, and only when he was a child—and only when he wouldn’t eat his cucumbers.
“Wasn’t it Ronald McDonald who told Gorbachev to tear down the wall?”
“You’re thinking of Ronald Reagan.”
“English names all sound the same.”
“That was fifteen years ago.”
“So? Brezhnev was General Secretary for eighteen.”
“It doesn’t work like that over there,” she explained. “They have elections every few years. If the president doesn’t win, someone else becomes president.”
“That’s ridiculous.” The wind lifted the ash from his cigarette and scattered it across the empty parking lot.
“And you can only be president for ten years,” she added.
“And then what? You become prime minister for a bit and then run for president again?”
“I think you just step down.”
“You mean Ronald just stepped down after ten years?” he asked. She had to be putting him on.
“He just stepped down and George Bush became president.”
“And then George Bush shot Ronald Reagan to prevent him seizing power?”
“No,” she said. “I think they were friends.”
“Friends?” he asked. “It makes me wonder how we lost the Cold War.”
“Good point.”
“And so George Bush has been president since Ronald Reagan?”
“There was another guy in there. Clinton.”
“The philanderer. I remember him,” he said, pleased. “And then George Bush became president again?”
“No, the George Bush who is president now is the first George Bush’s son.”
“Ah, so that’s why they don’t shoot the previous president. They’re all related. Like the Romanovs.”
“Something like that,” she said distractedly.
“Then who is Ronald McDonald?”
“You know, Akhmed,” she said, looking to him for the first time in several minutes. “I’m beginning to like y
ou.”
“I’m not an idiot.”
“You used the word, not me.”
A blast rippled from the east, a long wave breaking across the sky.
“A land mine,” she said, as if it were no more than a cough. “We should get going.”
He dropped his cigarette without finishing it, the first time he’d done so in six years, and was careful to avoid the glass shards as he followed her back to the entranceway.
“Sew the pockets of your trousers before you come in tomorrow,” she advised. “We’ll pass a dozen checkpoints to reach Grozny and with that beard you look like a fundamentalist. I don’t want the soldiers to plant anything on you.”
Akhmed looked to the clouds before following her into the corridor. It wouldn’t matter even if he had found a plane ticket. Ten and a half years had passed since he had last seen commercial aircraft in the sky.
The man dragged into the waiting room wasn’t the first land-mine victim Akhmed had ever seen, not the first he’d seen accompanied by an incomprehensible woman, not even the first he’d seen dragged on a tarpaulin along a slick scarlet trail; he wasn’t the first man Akhmed had seen writhing like a lone noodle in a pot of boiling water, not the first he’d seen with half his shin hanging by a hinge of sinew. But when Akhmed saw this man it was like seeing the first man for the first time: he couldn’t think, couldn’t act, could only stand in shock as the air where the man’s leg should have been filled the floor and the room and his open mouth. The woman tugging at the corner of the tarpaulin spoke a language of shouts and gasps and looked at him as if he could possibly understand her. What a volume her chest produced. The true color of her dress was indistinguishable for the blood. When he finally remembered how to use his feet, he walked right past the woman and the writhing man, to the corner chair, where he draped a white lab coat over Havaa’s head.
Then the man’s pulse was a haphazard exertion against his finger. The woman was asking one question after the next. Her dress was showing the curves of her legs. Her breath was on his left cheek. An artery was severed. His face was pale yellow. Sonja was there. She was strapping a rubber tourniquet below the knee. She was rolling him on a gurney and into the hall. The gurney was turning into the operating theater and Deshi was taking the man’s blood pressure. “Sixty over forty,” she was calling out. The blood pressure meter was velcroed to the young man’s arm. The bulb was swinging above the gurney wheel. The wound was wet with saline.
With swift, well-rehearsed movements, Sonja inserted IVs of glucose and Polyglukin into the man’s arms. She pulled a surgical saw from the cabinet and disinfected the blade as Deshi called out blood-pressure readings. At seventy over fifty, she injected Lidocaine just above the tourniquet. Deshi anticipated her requests, and the clamps he’d boiled were in her reach before she asked. She worked without looking at the man’s face or hearing his cries as though her patient were no more than his most grievous wound. Blood reached her elbows but her scrubs remained white. The man, and he was a man, it was so easy to forget that with all his insides leaking out, had graduated from architecture school and had been searching for employment when the first bombs fell. When the land mine took his leg, he had already spent nine years searching for his first architectural commission. Another six and three-quarter years would pass before he got that first commission, at the age of thirty-eight. With only twenty percent of the city still standing, he would never be without work again.
“Come here,” Sonja called. Akhmed looked over his shoulder to summon a more capable ghost from the Brezhnev-beige wall. “Akhmed, come here,” she repeated. He stepped forward, wiggling his toes in his boots. One step and then the next, with an immense gratitude for each. The skin was peeled back toward the knee. The calf muscle, cut away. The bone wasn’t wider than a chair leg.
She gestured with her scalpel. “For a below-the-knee amputation, you want to keep in mind that stumps close to the knee joint will be difficult to fit for a prosthesis. Long stumps are also difficult to fit and can lead to circulation issues. First, you’ll need to make a fish-mouth incision superior to the point of amputation. You want a posterior flap long enough to cover the padded stump and to ensure a tensionless closure when sutured.” She described how to isolate the anterior, lateral, and posterior muscular compartments in dissection. She showed him how she had ligated the tibial, peroneal, and saphenous veins, and noted that the blood pressure always rose after the peroneal artery was tied off. She transected the sural nerve above the amputation line and let it retract into the soft-tissue bed to reduce the phantom limb sensation. With a clean scalpel she incised the dense periosteum. She gave directions in the flat, bored tone of a carpenter teaching a child to measure and cut wood, and Akhmed heard her without listening. All her Latin words and surgical jargon couldn’t mitigate the helplessness he felt while watching her finish what the land mine had begun.
“Leg amputations are normal business here,” she said, and handed him the saw. He held it, expecting her to ask for it back. She looked to it and nodded. No, she couldn’t be serious. She didn’t expect him to do that, did she? She barely trusted him to fold bedsheets properly. “You should get comfortable with this procedure as soon as possible.”
He gazed from the blade to the bone. The bone was a disconcerting shade of reddish gray; he’d expected it to be white. He had been six years old when he first realized that the drumstick he slurped the grease from was, in principle, the same as the bone that allowed him to walk, run, and win after-school soccer matches. He hadn’t eaten meat again for two years, so great and implacable was his fear that another carnivore would consume his own leg in reprisal. “I’m not qualified for this,” he stammered.
“This is the deal,” she said calmly. She reached for his hand. That grip held more of her compassion than the past two days combined, and then it was gone, replaced by hard pragmatism, and her fingers wrapped his around the foam grip. “This is what we do. This is what it means for you to work here.”
His hands shook and hers steadied them. The last leg surgery he had performed had been after the zachistka, on a boy named Akim. He had tried his best, he really had, but he couldn’t be faulted for his lack of supplies and experience, for the lack of blood in the boy’s body and the great abundance drenching the floor, for the bullet he didn’t shoot, or for the war he had no say in; if anyone had bothered to ask his opinion, he would have happily told them that war was, generally speaking, a bad thing, to be avoided, and he would have advised them against it, because had he known that not one but two wars were coming, he would have dropped out of medical school in his first year, his reputation be damned, and gone to art school instead; had he known a domineering, cold-hearted Russian surgeon would one day ask him to cut off this poor man’s leg, he would have studied still-life portraiture, landscape oil painting, sculpture and ceramics, he would have sacrificed his brief celebrity within the village, if only to safeguard himself from this man’s leg.
“There’s only one amputation now, but what about next time?” Sonja said. “There could be five, ten.”
He exhaled. Sweat pasted his surgical mask to his cheeks. Sonja pushed his hand forward. The blade grated against the bone. The vibration of each thrust ran up the blade, through the handle, to his hand, and into his bones. The name of the bone was tibia and it was connected to fibula and patella. He had studied the names that morning, but what he knew wouldn’t push the saw.
“Press harder,” she instructed, steadying the bone for him. “This isn’t a delicate operation.”
Halfway through, the blade unexpectedly went red with marrow. He stopped sawing.
“What’s wrong?” Sonja asked.
He could have answered that question several different ways, but he shook his head, and kept sawing. “I didn’t know human bone marrow is red. I thought it would be golden. Like a cow’s.”
“The marrow of a living bone is filled with red blood cells. If we were to shake a little salt and pepper on this bone and ro
ast it in the oven, the marrow would turn golden in about fifteen minutes,” she said.
He feared he might vomit.
“Fine work,” she said, as he sliced through the tibia. “Just one more bone to go.”
He set the blade on the fibula and his quick hard saw-strokes spat into the air a fine white bone dust that drifted toward him, drawn by his breath, eventually dissolving into his damp surgical mask. Sonja’s dark eyes leered at him in his periphery, and he pushed the saw harder, faster, wanting Sonja to see in him more than his helplessness, wanting to finish before he fainted. A dozen strokes later the foot dropped to the table. He held the remnant by the ankle, and without pause or consideration, he flipped it on its end, and blood and marrow coated his fingers as he counted six shards of glass glinting in what was left of the man’s sole.
“Set that aside,” she said. “We’ll wrap it in plastic and give it to the family for burial.” She showed him how to round off the amputated bone and pad it with muscle. She pulled the posterior flap over the muscle-padded stump, trimmed the excess skin, and sutured it with black surgical thread.
When they finished, he peeled off his latex gloves and massaged the pink soreness of his right palm, where the skin between his thumb and forefinger had swollen from the handle’s pinch. Sonja noticed, smiled, and when she raised her right hand he wanted to be back in bed with Ula, where he could pull the covers over their heads and in the humidity of their stale breaths hold the one person who believed he was knowing, capable, and strong.
A Constellation of Vital Phenomena Page 7
