The Doctor of Aleppo

by Dan Mayland

  He turned back to Omar. The boy was fourteen years old. Slight and short, like his mother. Gap-toothed. Too young to have more than a hint of facial hair. One of his bare arms indeed was misshapen—likely a break of the humerus, Sami guessed—and his right foot lay at an angle that suggested trauma. Blood had seeped through his jeans, but it was the runny nose that worried Sami.

  He dipped his index finger into the clear fluid that was dripping out of Omar’s nostrils then brought his finger to his tongue. The texture of the liquid was thin, the taste metallic and salty. Not mucus, he determined. Cerebrospinal fluid.

  He took the boy’s pulse. It was rapid and terribly weak. The brain fighting for oxygen.

  “Can you fix his arm?” asked Aya.

  “Yes.”

  She sighed, relieved.

  Sami unbuttoned the boy’s shirt and examined his chest and ribs; seeing no signs of trauma that would impede breathing, he turned to the head. Near the back was bruising, matted blood, and a sunken area of sponginess where the skull had fractured. He imagined the swing of a club, the club connecting with the skull, the pressure inside the skull rising, the cerebrospinal fluid breaching the dura mater.

  But the arm was far more noticeable. That would have been what Aya’s eyes had been drawn to. She didn’t know. She didn’t know what a mess this was.

  Knowing the psychological pain he was about to inflict, Sami paused, then placed a hand on Aya’s forearm and said, “Omar is showing signs of traumatic brain injury.”

  “Auzubillah,” she said turning from him. I take refuge in God.

  “Which means he should be put on a ventilator—immediately—because that will help him breathe, and his brain needs all the oxygen it can get. And we may need to relieve the pressure in his skull. You must bring him to the emergency room. I cannot treat him here. Not properly.”

  He examined Omar’s eyes. There was no sign of blood seeping into the tissue beneath them, but it was too early for that.

  “The emergency room?” asked Aya, incredulous.

  “I know.”

  “But you know what they will do to him there! You have to fix him here!”

  “You must tell them he was in a car accident.”

  “They will not believe it. They will know.”

  “But you at least have oxygen at your clinic, no?” asked Tahira. “You can give him that?”

  “He needs more than oxygen, Tahira!”

  He needed a lumbar drain to take pressure off his brain and steroids to decrease the swelling and a CAT scan to determine the nature of the injury—there was a scanner at the university hospital, but only one—and an intracranial pressure monitor, and—

  “Do either of you have a car?” Sami demanded.

  Tahira did. But it was parked outside the alleys of the old city. She said she could run to get it though, and she would park at the factory’s narrow loading dock.

  It would be faster than calling for an ambulance, Sami calculated, and less dangerous. If they were lucky, no one would see them moving Omar. He resolved to do what he could for the boy at his clinic. And hope that would be enough, and that no one would question Aya in the days to come.

  “Go.” said Sami. “Go!”

  Tahira ran off.

  “I need something we can lay him on,” Sami told Aya. “A cot, or—”

  He remembered the tall hand trucks that were used to move boxes of soap that had been packed for shipping. Though they were not long enough to accommodate an adult, Omar was short and lithe. Aya brought him one, and he lay it upside down on the ground. The lip at its base caused it to settle at an angle, which Sami thought would work well because it would be better for Omar’s head to be raised.

  “I will need you to help me move him,” he told Aya. “We must do it carefully. Very carefully.”

  But at that point, Omar’s body stiffened slightly, and his head, arms, and fingers began to tremble. His brown eyes cracked halfway open. Spittle drooled out of the corner of his mouth.

  Aya cried out. She grasped her son’s hand and asked what was happening.

  Sami tried to stabilize the boy’s head, to angle it slightly to the side in case he vomited. “Perhaps a small seizure.”

  “Is that okay?”

  “It is . . . not uncommon,” said Sami.

  “Can you stop it?”

  “No.”

  The trembling quickly became less pronounced, as though the boy were tiring. Sami noted that the cerebral spinal fluid draining out of his nephew’s snub nose had increased to a small trickle. He took the boy’s wrist again.

  What had been a weak pulse was now nonexistent.

  “Omar!” Sami said. “Omar!”

  “What is it?” asked Aya.

  Sami stuck his fingers in Omar’s mouth and inspected his airway to make sure he hadn’t choked on vomit.

  “What is it?” Aya demanded again.

  As he felt for a femoral pulse on Omar’s upper thigh near the groin, Sami also bent his cheek to Omar’s mouth, feeling for breath.

  There was no pulse. No sign of respiration.

  Kneeling over the boy, Sami placed the palm of his right hand in the center of Omar’s chest and intertwined the fingers of his left hand with those of his right. He thrust down sharply and rapidly on Omar’s chest, again and again. Omar’s ribs cracked, but he kept going. After counting thirty compressions, he pinched Omar’s nose and blew two lungfuls of air into the boy.

  His nephew’s lips were smooth, his cheeks bare save for a few barely visible wisps of downy blond hairs.

  Aya grabbed her son’s hand and brought it to her cheek, and she began to wail.

  chapter 2

  The next day

  Tucked away as it was at the end of an exceptionally narrow hall on the second floor of a shabby two-story, cash-only hotel, there was little to recommend the tiny room.

  Its tile floor was cracked, its ceiling low, and even though an air conditioner mounted up near the ceiling was rumbling like a diesel truck and madly dripping water into a plastic bucket underneath it, the air was stale and hot.

  Still, twenty-four-year-old American Hannah Johnson was relieved to be in it.

  She flopped down, fully clothed, on the twin bed that took up half the room. Oskar Lång, her Swedish boyfriend, joined her. Because he was a tall man, his feet extended past the edge of the mattress. They were both sweating.

  “It’s not so bad,” she said. By which she meant it wasn’t so bad considering it was only a five-minute walk away from the auto repair shop where they’d left their car. “Don’t you think?”

  The bed sagged, and a spring was poking into her back, but she was encouraged by the clean smell of the sheets beneath her. And the one window afforded a magnificent view of the Citadel, a medieval hilltop fortress that loomed over central Aleppo.

  “Could be worse,” he allowed.

  “You won’t miss your flight. We’ll hire a driver if we have to.”

  “I’m not worried.”

  “Yes, you are.”

  The early evening summer sun had dipped to a point in the sky so that it was streaming through a gap between the faded lace curtains and the window. They lay in the sun’s glare for a minute, then Hannah sat up, rolled over, and straddled Oskar.

  “We just have to roll with it,” she said, gently poking him in the chest as he pretended to fight her off. “We’re stuck here for the night whether we”—she snuck in another poke—“like it or not. Which means”—she bent down and he flinched, but instead of poking him she kissed his upper lip—“we may as well enjoy ourselves.”

  “You make a fair point,” he said, and then he kissed her back.

  Even though she suspected he was still thinking about the broken transmission on their car and the flight he had to catch tomorrow, she felt him stirring beneath her
.

  Then the chanting started. Voices in Arabic, not far away.

  Get out, Bashar! Get out, Bashar!

  Hannah exchanged a look with Oskar. He cursed; she climbed off him and approached the window.

  From behind the dusty curtains, she watched as hundreds of protesters poured into a busy intersection just down the street. Some held the flag of Syrian independence. Others clutched signs in English and Arabic that read Bashar the Butcher and Revolution Until Freedom. Most of the protesters were young men, but Hannah’s eyes fixed on three women wearing homemade dresses fashioned out of green, white, and red fabric. The word freedom had been scrawled in magic marker on headbands they wore over their hijabs and they were holding their arms high as they marched, flashing the V for victory sign and chanting with the crowd.

  Hannah cracked the window so she could hear the protesters better. Oskar climbed out of bed.

  “Don’t even think it,” he said as he wrapped his arms around her and pressed his rough stubble against her cheek.

  Hannah scanned the crowd again, and this time noticed two women on the periphery. Both wore their hair uncovered. One was in tight jeans and heels. Another wore big, pink sunglasses more suggestive of an attempt at fashion than a disguise.

  She guessed they were university students, around her age.

  “I don’t see any police,” she said.

  “Hannah.”

  “I know,” she said.

  Their supervisor at the Brussels-based development organization they worked for—Hannah as a community liaison officer, Oskar as a field engineer—had warned them against getting involved in political demonstrations.

  “But still,” she added.

  Hannah had been working in Aleppo for nearly two years—at first living in the city, and then when the protests had started to heat up, commuting every other day from a satellite office in Turkey. In that time, she had grown to detest the regime and she knew Oskar had too.

  Without waiting for him to try to stop her, she grabbed her sunglasses, slipped out the door to their room, and ran down a flight of tiled steps.

  “Miss!” cried the receptionist as she left. “I would not go out there!”

  “I’ll just be a minute!”

  The parade of people at the end of the street had swelled and come to a stop at an intersection where a bearded man with a megaphone had climbed on top of the roof of a car and was leading the crowd in a song-like call and response.

  Get out, Bashar!

  Get out, Bashar!

  The blood of the martyrs isn’t cheap. Pack your things and get out! Get out, Bashar!

  Get out, Bashar!

  You are nothing but a thief!

  Hannah began to chant with the crowd, which was filling in so quickly behind her that soon she was no longer confined to the periphery, as she’d intended, but in the thick of it.

  In front of her, a woman covered head to toe in black had affixed an oversized photo of a boy to a mop handle and was pumping it up and down. The name at the bottom of the photo read Omar Seif; someone who’d been killed by the regime, Hannah assumed. To her right, a man with Elvis-style sideburns held a banner that read Down with the Little Dictator.

  The volume of the chanting rose as the crowd continued to swell. To her right a group of gangly teenage boys, still dressed in their school uniforms, shook their fists in the air.

  The Syrian people will not be humiliated! Get out Bashar!

  And yet every day there were new humiliations. Police barging into homes and businesses. Young men stopped on the street for no reason, and God help them if they had forgotten their state IDs—unless they had connections or money. Just last week, a Syrian friend of Hannah’s had been jailed and beaten simply because she had dared to sign a petition demanding the regime hold local elections that were truly free.

  “Get out, Bashar!” she yelled with the crowd. “Get out!”

  When she felt a hand on her waist, she startled momentarily, but then she saw Oskar standing behind her, his shock of wavy brown hair rising far above the crowd. She smiled at him, and he smiled back.

  “Get out, Bashar!” he yelled.

  Minutes later, when the pop-pop-pop of automatic gunfire sounded from somewhere behind her, the chanting stopped, the screaming and cursing started, and the crowd surged forward. Hannah was shoved into the woman in front of her. To her left a girl’s long hair got caught in the zipper of a man’s jacket, and as the force of the crowd pulled the two apart, a clump of the girl’s hair was ripped from her scalp.

  “Oskar!” called Hannah. She tried to swivel her head to look for him but was being jostled on all sides and almost lost her balance when she stepped on someone who’d fallen.

  The crowd swept her into the intersection where the man with the megaphone had been. The bodies thinned out. Not far away, she observed an open-walled, khaki-colored tent standing next to a small cemetery. A larger-than-life photograph of a smiling, gap-toothed boy named Omar Seif had been hung from the cemetery fence.

  Hannah cursed.

  Of all the protests, the ones centered around funerals for fallen protesters were the most dangerous because the Mukhabarat—the regime’s secret police—could anticipate when and where they’d take place.

  And indeed, hordes of Mukhabarat were piling in, as though they’d been lying in wait. They were clad in black and armed with batons and AK-47s. Some wore helmets with visors. Over by the funeral tent, they were smashing folding chairs, sending shattered fragments of plastic seats skidding across the pavement. One pummeled a veiled woman over the head with a baton.

  Head down, Hannah sprinted away as tear gas canisters were fired, enveloping her and everyone who was running with her in a white cloud.

  She covered her mouth with her shirt and tried not to breathe in the gas, but she was too panicked to hold her breath for long. Everything burned—her eyes, her nose, even the skin on her face. Stumbling on the curb, she fell to the pavement and scraped her hand and smashed her sunglasses. Sparks flew off a nearby metal trash bin as bullets pinged off it.

  Someone grabbed her elbow and hauled her up to her knees. She thought it might be Oskar, but when she turned, she saw a young man using a homemade flag of independence as a mask. He motioned her to the edge of the cloud of tear gas.

  “Run!” he cried.

  She did. Down one block, and then another, until her lungs were bursting, and she could go no more. Doubled over and moaning, she rested her hands on her knees. Her eyes were blinking uncontrollably and tearing so much she could barely see. Her nose felt as though someone had stuffed hot coals up into her sinuses.

  Someone thrust a piece of onion into her hand and told her to rub it underneath her nose. She started to, but it did nothing for the pain, and she threw it away when the smell began to make her sick.

  Bleary-eyed, she half ran, half staggered away from the sound of renewed gunfire, all the while calling out for Oskar. Fifteen minutes later she’d finally managed to loop nearly all the way back to her hotel.

  Crouched behind a silver, cat-infested dumpster, she eyed the street in front of the hotel. It appeared to be deserted, as did the intersection where she’d first joined the protest. Rusted steel roll doors had been yanked down over storefronts, as though it were the middle of night. The table outside the general store next to her hotel had been overturned, and loofah sponges and toilet plungers now littered the street. On the sidewalk, a watermelon vendor had abandoned his cart; melons lay smashed on the pavement. A butcher’s refrigerated display case had been shattered, exposing the beef sides within to the hot air.

  The smell of tear gas, acrid and bleachy, lingered.

  Sporadic gunfire still sounded in the distance, but she saw no sign of the Mukhabarat or protesters. And the entrance to the hotel, which lay behind a waist-high wrought iron fence topped with spiked tips, appeared t
o be undisturbed.

  She sprinted to it, but the door was locked.

  “Let me in!” she cried, as she pounded on the door. There had been only one key, and Oskar had taken it when they’d checked in. “I’m a guest!”

  Although her eyes were still blinking uncontrollably, she saw something move on the periphery of her vision. Glancing down the street, she observed a single Mukhabarat officer patrolling the intersection. He wore a helmet with a tinted visor; she couldn’t tell whether he was looking at her or not.

  She flattened herself against the door.

  “Let me in!” she whispered as she rattled the handle.

  When the door opened, she nearly fell to her knees, but Oskar caught her.

  “One of them is out there!” she cried as she pushed past him.

  Oskar slammed the door shut and locked it. Hannah leaned against the cracked stucco wall in the shabby reception room and began to cough uncontrollably. She felt Oskar’s hand on her shoulder.

  He was just as blinking and bleary-eyed as she was, and his tight black jeans were ripped, exposing his left shin.

  The receptionist, a woman of perhaps sixty with painted nails and bright red lipstick, stared at them for a moment, then disappeared into a back room without saying anything. Moments later, she returned with a can of Coke.

  “For the face,” she whispered.

  “For the face?” asked Oskar.

  “It helps stop the pain of the gas.”

  Hannah’s face still burned, and the stink of the tear gas on her clothes was making her throat convulse, so once in the room, she immediately stripped off her clothes and opened the cold-water valve in the shower all the way.

  Oskar joined her moments later. Naked, they cracked open the cold can of Coke and poured it in each other’s hands and scrubbed their faces with it. Whether it was the soda neutralizing the lingering effects of the tear gas, the cold water, or simply the passage of time, Hannah found she could breathe normally again. After holding her eyes open and rinsing them with water, the pain and blinking began to abate.