State of Wonder

by Ann Patchett

  “Come now,” Dr. Swenson said. “Once you get started with this it can go on for hours. You’ll come home with more bruises than Easter.”

  It took some navigation to get Dr. Swenson down the ladder but there were so many Lakashi waiting for her at the bottom with their arms stretched up that they would have simply caught her had she fallen and borne her aloft all the way back to the lab. She gave herself a few minutes to catch her breath and while they waited a crowd assembled. Clearly the news of their success had spread. The natives made a thick ring around Marina and Dr. Swenson, chattering and clapping their hands together once Dr. Swenson made it clear they were to keep their hands to themselves.

  “Everyone is admiring you,” Dr. Swenson told Marina in a raised voice.

  Marina laughed. There was a woman behind her holding on to her braid, staking out the territory as her own. “You’re just projecting. You have no idea what they’re saying.”

  “I know their happiness. I may not know the details of every sentence but believe me, there are many ways to listen and I’ve been listening to these people for a long time.” The crowd was moving forward and the two doctors moved with them. “They think you will replace me,” Dr. Swenson said to her, “the way I replaced Dr. Rapp. Benoit told them you were the one who killed the snake to save Easter and that you brought the snake back for them. Now they’ve seen you cut out a child and keep the mother alive. That’s a heady business around here.”

  “They didn’t see that,” Marina said.

  “They most certainly did,” Dr. Swenson said, and lifted up her hand towards the sky. “They were in the trees. The entire surgical theater was full.”

  Marina looked around at the faces of all the beaming Lakashi. What would have happened if the woman hadn’t lived? If the child were dead? “I didn’t look up,” she said.

  “Just as well, too much pressure. You did a fine job. I could tell you were a student of mine. You made a classic T-incision. You kept the opening in the uterus small. You have very steady hands, Dr. Singh. You are exactly the person I want when I deliver.”

  What a thought, delivering the child of the person who taught her to deliver children. “I won’t be here when you deliver,” Marina said, and took comfort in the knowledge. “How far along are you?”

  “Just over twenty-six weeks.”

  “No, no,” she said. “That’s not even possible. Who were you planning on delivering the baby?”

  “The midwife. I’ll be honest, I had envisioned an experience as close to the Lakashi’s as possible, but as time goes by I’m thinking more about the need for a section. I’m doubting that my pelvis will spread. Chewing the Martins does nothing to reverse the aging of one’s bones. I’m going to need a section and there’s no one else here I’d trust for that.”

  “Then you’ll go to Manaus.”

  “A woman my age can’t go to the hospital to have a baby. There would be too many questions.”

  “I would have to think a woman your age couldn’t avoid going to the hospital.” Marina looked at Dr. Swenson and seeing that she wasn’t listening began again. “Even if I was going to be here, and trust me, I’m not, you don’t know what kind of complications you might have. You’re breaking ground here, you can’t just expect to have the baby on your desk. You just saw me perform my first surgery in over thirteen years. That hardly qualifies me to deal with anything that could come up.”

  “But you could. I saw you work. At some point I realized I should have made better plans for this inevitability but now you’re here. You’re a surgeon, Dr. Singh, and all the pharmacology in the world isn’t going to change that.” She shook her head. “Pharmacology should be reserved for doctors who have no interpersonal skills or doctors with uncontrolled tremors who are prone to making mistakes. You never did tell me why you changed your course of study.”

  Some members of the crowd around them had begun to sing and some others to tap their tongues against their palates, making a noise of cheerful wailing. The children cleared the path ahead like a pack of hungry goats, snatching up every leaf and twig, ripping out vines, knocking down spider webs with a stick, until the trail was as neat as anything found in a national park. “You never told me why you changed yours,” Marina said.

  “I had no choice. I saw the work that needed to be done and I had to do it myself. You can’t draw the world a map to this place and have everyone come running in, trampling the Rapps, killing off the martinets, displacing the tribe. By the time they understood what they were doing, it would all be dead. The conditions for this particular ecosystem have yet to be replicated. Eventually, yes, but for the time being if it is going to happen it’s going to happen here. For years my study was strictly academic. I wanted to record the role of Martins in fertility. I had no desire to synthesize a compound. I’ve never believed the women of the world are entitled to leave every one of their options open for a lifetime. I believe it less now that I am pregnant. Give me your hand, Dr. Singh, this leg is killing me. Yes. We can walk a little slower than the rest of them.” With that the Lakashi, who had at times an uncanny ability to understand English, cut their pace in half. “But when I discovered the link to malaria all of that changed. No scientist could be on the threshold of a vaccination for malaria and not make an attempt at it. I’ve been very careful about the people I’ve brought here. They are all extremely committed, respectful. I wouldn’t have any of them take out my appendix, but as far as the drug’s development is concerned they have made remarkable progress.”

  “How do you know it works?”

  Dr. Swenson used her free hand to pat her stomach. “In the same way I know the fertility aspects work. I test them. I’ve been regularly exposing myself to malaria for more than thirty years now and I’ve never had it. Dr. Nkomo, Dr. Budi, both of the Saturns, we all have regular exposures. I’ve exposed the Lakashi. I can show you all the data. It’s the combination of the Martin bark and the purple martinets. We know it now. It’s just a matter of replicating it.”

  “And what about Vogel?” Marina asked.

  “Vogel pays for it. I would have said I had been careful in choosing Vogel as well, but Mr. Fox has grown too restless for me. He isn’t interested in what can be accomplished. He only wants to see where the money’s gone. Not that I think some other company would have been better. They all claim to support science without any real understanding of what science entails. Dr. Rapp spent half of his life down here, he did the most important work in the history of his field and he only scratched the surface of the mycology that was available to him. These things take an extraordinary amount of time. They can take lifetimes. You would think they would be grateful that I’ve given them my life, but someone like Jim Fox would be incapable of understanding that. Sending Dr. Eckman here was a disaster for all of us. His death was very bad for morale. For a week or two I thought I might lose all of them. But then you came, Dr. Singh, and as much as I’ve fought the intrusion I can see you have a place here. You get along well with everyone, your health seems excellent, and I think you’ll be able to soothe Mr. Fox, convince him that things are progressing nicely and we’ll just need a little more time.”

  “But why would I do that? I work for Vogel. They’re paying out enormous sums to develop the drug that you brought to them, that you proposed. You haven’t even told them about the malaria vaccine and that seems to be all you’re working on. Why would I want to cover for you?” Marina balanced the weight of Dr. Swenson on her arm. The farther they went the more Dr. Swenson leaned against her.

  “It isn’t a matter of covering anything. This isn’t a lie told in school. The drugs are intertwined. We have not been able to separate them out. Look at me. I am clearly pursuing my work in fertility even if my interests lie in how it relates to malaria. What I’m interested in personally really doesn’t matter when either way we end up in the same place. When we get one drug we’ll have the other, and I don
’t see the harm in making an American pharmaceutical company pay for a vaccination that will have enormous benefits to world health and no financial benefits for company shareholders. The people who need a malarial vaccine will never have the means to pay for it. At the same time I will give them a drug that will, if anything, undermine the health of women and make them a truly obscene fortune. Isn’t that a reasonable exchange? Eight hundred thousand children die every year of malaria. Imagine an extra eight hundred thousand children running around the planet once this vaccine is in place. Perhaps instead of trying to reproduce themselves, these postmenopausal women who want to be mothers could adopt up some of the excess that will surely be available.”

  Marina, as usual, felt that she was five steps behind in the conversation. “It seems you should give Vogel a chance. You may find they’re as interested in the vaccine as you are.”

  “Your trust would be charming if it weren’t so simplistic,” Dr. Swenson said without a trace of rancor in her voice. “Because if you’re wrong, and I am fairly certain you are wrong about an American pharmaceutical company wishing to foot the bill for Third World do-gooding, then we lose everything. That is not a risk you are allowed to take when the outcome of an incorrect assumption amounts to such a significant annual loss of lives.”

  They were back in the village, having picked up a great many more Lakashi on the way. It looked to Marina like almost the entire tribe was assembled.

  “Come to the lab,” Dr. Swenson said, patting the arm that she held with her other hand. “Dr. Nkomo will show you our mosquitoes.”

  “Let me take a swim first,” Marina said. “Get the blood off.”

  Dr. Swenson shook her head. “Use a basin. I’ll have some men bring some buckets of water over for you. No sense getting into the river all covered in blood. You never know who might mistake you for dinner.”

  “I went into the river when I had half an anaconda on me,” Marina said, looking down at her dress which had stiffened as it dried.

  Dr. Swenson nodded her head. “We’re being more careful with you now.”

  When Marina went back to the sleeping porch the sheets on the bed had been straightened and there was a letter lying on top of the pillow. She reached carefully into the netting and took it out. She didn’t want to touch anything until she’d had a bath and still she slid a finger around the edges of the envelope, turning it back into a sheet of paper. All that was there was her name, Karen Eckman, Karen Ellen Eckman, Mrs. Anders Eckman, Karen Smithson, Karen Eckman. The letters were scrawled and uneven. A few times the pen had torn the paper. He had printed the words but his hand was shaking. Maybe he had folded this one up and kept it with him in the bed. Maybe this one he had never even thought to mail.

  Ten

  Every morning Marina extricated herself from the sleeping limbs of the lightly drugged child and took the path to the field of Martins. She didn’t follow the native example and wait for five days to pass. She was thinking it was possible that five days from now she would be out of this place and so she wanted to stuff herself with the bark, to turn herself into medical evidence before she went home. Her goal was to make up for all the bark she hadn’t eaten in the past and anticipate the bark she would never eat in the future. This was her moment, the perfect now. She didn’t mind making the trip deep into the jungle by herself anymore, though there was never a morning when she didn’t run into other women eventually, both Lakashi and the doctors. Dr. Budi said there was scientific precedent for going to chew the trees so often at the beginning. They said they’d had a loading dose as well. Maybe it was just the excitement of the discovery, or maybe it was something the body had been starved for all along. Dr. Budi told Marina that even at this early stage she would be inoculated against malaria and that her window for monthly fertility would be extended from three days to thirteen. Beyond that, Marina had begun to wonder if there wasn’t something mildly addictive in the fenneled bark, something that kept the Lakashi women trudging back to the trees long after they were sick to death of babies, something that kept the doctors at their desks for years after they were ready to go home. Maybe Dr. Rapp had been correct in his original assessment that there was some mild connection between the mushrooms and trees, the smallest touch of narcotic in the bark that kept the women leashed to the forest.

  As for herself, Marina dreamed of Martins. They were there, slim and stately, in front of her eyes before she opened them in the morning, and when she drifted off at night she was walking towards them. It was the thought that she could become addicted to anything in this place that first made her realize it was time to leave the Amazon, though everything was pointing towards departure. In one week she had sewn together the eyelid of a girl who had been bitten by the very monkey she had worn around her neck. It took both of her parents to hold the child down while Marina worked with too heavy a needle and too thick a thread to reassemble the delicate tissue. When she asked Dr. Swenson about getting some human rabies immunoglobulin, Dr. Swenson said she would first need to see a slide of the monkey’s brain. She had removed a six-inch wedge of wood from between the third and fourth toes of a man who was cutting down trees to make boats to ride to Manaus. Three men had dragged him down to the lab without so much as a tourniquet, leaving Marina to do her best to piece together muscles and bones whose names she could no longer remember. The terror of the jungle was now redefined by the work it could dream up for her. While the other doctors, no doubt relieved that they had not been asked to perform the task themselves, praised her to the point of ridiculousness, the Lakashi peered over her porch railing at night and raised up on their toes to sniff her neck whenever they were close. It was clear to Marina that no good was going to come of this. She was tired of her two dresses, tired of waking up in the middle of the night trying to figure out how she could take Easter with her when she left. She was unnerved both by Dr. Swenson’s repeated references to “our” delivery date and by the letters from her dead friend that she found waiting in her bed at night. She wanted out of all of it, but still, it was just now light in this beautiful, singular stand of trees and she cupped her hand around the slender trunk of one of them and leaned in.

  Marina had never seen the rooms where the other doctors lived. There was a small circle of huts behind the lab but the lab was where they worked and ate and stayed to talk in the evenings. She had known for some time that one of the huts contained the mice that were forced into repeated pregnancies, their heavy bellies bumping against their exercise wheels, and now she knew that another hut was full of mosquitoes. Their larvae grew in tepid water inside of plastic trays that stacked into a tall rack of metal shelving. When they were ready to hatch they were transferred into large plastic buckets with a piece of pantyhose stretched across the top that was held in place by a rubber band. From there the mosquitoes were infected with malaria. It might have been because everyone felt so confident in the success of their vaccinations that they could afford to be so sloppy in their protocol, but when Alan Saturn first showed them to Marina she did not feel comfortable with the hundreds of flying insects per bucket banging their minuscule weight against a web of nylon.

  “Feeding time at the zoo,” Alan said, and soaked a large wad of cotton in a cup of sugar syrup. “Go on and give them a taste of what they really want. Breathe on them. Just lean over and exhale.”

  And so she did, and they flung themselves upward in one ineffectual black fist. Marina stepped back.

  “Mammalian breath, that’s what draws them. It’s only the females that bite, you know. The males neither contract nor spread the protozoa.” He dropped the cotton onto the hosiery and the mosquitoes went in like sharks for bloody chum. He watched them for a minute. “They always hold up their end of the bargain.”

  There were two plastic flyswatters tacked to the wall, their wire handles rusted. “How do you test yourself?” she asked, not entirely certain she wanted to know.

  “We take five m
osquitoes out of the infected bucket,” he said, tapping the lip of the bucket she’d just breathed into. “When I first came here you should have seen what we went through. We’d put on hazmat suits, seriously, face masks, gloves. As if every tenth mosquito outside isn’t carrying anyway. Now I just stick a net in there. I know what I’m doing. I put those five in a cup with a piece of nylon over the top, then I hold the cup on my arm, on my leg, it doesn’t matter. When I have five bites I kill the mosquitoes and run them under the microscope on a slide to make sure they were all infected. That’s pretty much it.”

  “That’s it?”

  “Well, then you wait. The malaria will present in ten days. But it doesn’t present. It hasn’t for any of us.”

  “So how can you be certain your mosquitoes are good?”

  “The microscope tells us that, and then from time to time we infect one of the men in the tribe from the same batch. Ten days later, clockwork, he has malaria. We bring in some of the women and the same group of mosquitoes can bite them all day long and it’s nothing.” Alan was leaning over another bucket. He blew in before giving them the cotton.

  “And this man who contracts malaria, how does he agree to this?”

  He stood up and shrugged. “I suppose if this man had a lawyer it could be said that he hadn’t agreed, or that he hadn’t been made fully aware of what he was agreeing to. I’ve got some Cokes in here, I don’t tell Annick that. They love them.”

  “You give them a Coke for getting malaria?”

  “Don’t make this out to be the Tuskegee Institute. Chances are excellent that these men have had malaria before, or that they would have had malaria eventually. The difference is that when they get it in this room we’re also going to cure it. Curing malaria isn’t the problem, you’ll remember; the problem is figuring out a way to vaccinate against it. If they get sick for a couple of days in the name of developing a drug that could protect the entire tribe, the entire world, then I say so be it.”