by Dan Mayland
He took another sip of coffee then stripped off his shirt and washed as much as he could under his arms without dripping too much water.
Because he had ten minutes before he had promised to be on the floor, he sat back down on his cot with his coffee in one hand and his cell phone in the other. After signing on to the hospital’s satellite Wi-Fi and checking his email and text messages—nothing he needed to respond to—he opened an online version of Le Monde and quickly read through the headlines: protests had broken out in Istanbul, the economy of Greece was a mess . . .
When explosions sounded not far to the south, he sighed, clicked off his phone, and put on a clean pair of scrubs. Bypassing the aging elevator, he took the staircase up to the third floor, where he checked on a pregnant nineteen-year-old whose lung had been punctured by a piece of shrapnel.
Minutes later, ambulances and private cars announced their collective arrival with repeated beeps on high-pitched horns.
He returned to the ground floor, where the emergency room intake area had been divided into triage zones marked by colors—green for the walking wounded, yellow for those seriously wounded but not in immediate danger of dying, red for the wounded who would die soon without treatment, and black for those still alive but certain to die.
The first patient to arrive had been placed in the yellow zone and was bleeding profusely from a shallow laceration on the back of his head. Sami ushered him into an exam room and had just finished suturing the wound when three men—soldiers, dressed in battle gear—burst in, claiming that the brother of some Colonel Antar had been injured and was in need of immediate treatment.
Sami knew nothing of any Colonel Antar, much less the man’s brother. He eyed the men, noting with dissatisfaction that they were armed. “This colonel’s brother. Why wasn’t he brought to a field hospital?” he demanded.
Sami was a supporter of the Free Syrian Army and had even performed work at their field hospitals during the first few months of the war for Aleppo. But this was a civilian hospital. If the regime saw armed soldiers being treated here, it would encourage them to bomb.
“The doctor at the field hospital sent him here because he was unable to treat him properly. Please, Doctor.”
“First, you will get your weapons out of my hospital,” Sami ordered, remaining seated.
“Doctor—”
“Now.”
Two of the soldiers handed their rifles to the third, who left the room. Sami followed the remaining two soldiers into the triage zone, which was rapidly filling with wounded. Some had been brought in on metal gurneys, others had stumbled in on their own.
“There!” cried one of the soldiers, pointing to a man on a gurney.
Sami was determined to follow triage protocol. The life of a soldier was worth no more or less than the life of a civilian, and in any event, prioritizing the treatment of soldiers over civilians was another good way to put a target on the M2.
But the soldier in question was in the red triage zone and first in line, so Sami knelt beside him. He was maybe twenty years old. Long black hair, long eyelashes that were covered with dust. A prominent hawklike nose. Conscious, but barely.
“What happened?”
“The building collapsed and he was buried from the chest down. We had to dig him out.”
“Bleeding?” Sami asked as he looked for external signs of the same.
“No.”
“What is his name?”
“Abdul.”
“Abdul!” said Sami loudly, as he pinched the nail bed of Abdul’s right index finger and noted that the blood was slow to refill. “How do you feel?”
Moaning, Abdul said his stomach hurt. Sami palpated his skull and began to work his way down the rest of the body, which was colder than it should have been. When he got to the abdominal region just below the ribs, he detected swelling. Abdul winced.
“I need a FAST scan!” Sami called over his shoulder, making eye contact with a nurse’s assistant.
Moments later, she produced a white ultrasound device that was connected to a wall outlet by a twisted extension cord. Along with the ultrasound, she handed him a half-full dispenser of hand sanitizer. “No gel,” she said.
Sami frowned, but then squirted hand sanitizer on top of a probe, which he then used to shoot high-pitched frequencies into Abdul’s abdomen. When, moments later, he observed a thick black stripe in the upper right quadrant, between the kidney and the liver, he said, “Prep the OR. Number two. You, you”—Sami pointed at a nurse, as well as custodian who was helping to lead a child into the green triage zone—“get him on the table.” He hesitated for a moment. Supplies of universal-donor blood were limited, but there was no time to type and crossmatch Abdul’s blood; the last of the rapid-test kits had been used yesterday. “And ready three units of O-negative, more if we can spare it.”
As he was donning his operating robe, Sami’s phone rang. The ringtone was Ravel’s Bolero, which meant it was his wife calling.
He ignored it and began to wash his hands. Then she texted:
call me now!!!!
Sami stared at the four exclamation points then pushed the callback icon and put the phone on speaker as he continued to scrub his hands.
“What is it?” he snapped when his wife picked up.
“We need you.”
For a moment Sami stopped scrubbing. Tahira explained that fighting had broken out in the northern Syrian town of Jarabulus, where she and the children had been taking refuge since fall of the prior year.
“The regime is in Jarabulus?” asked Sami, alarmed. As far as he knew, they had been nowhere near that area of the country.
“No, this is some other group. Rafiq says they are telling people that Jarabulus is now part of a new nation, with new rules.”
“What new nation?”
“The Islamic State of Iraq and al Sham. They frighten me, Sami.”
Sami recognized the name. He took two deep breaths.
“They have been raiding homes,” added Tahira. “Doing terrible things. I—”
“Go to Turkey,” Sami said, interrupting. Jarabulus was a border town. Turkey was only a short walk away. “Get out. Go now.”
Sami had long been comforted by the thought that by moving his family north and out of Aleppo, he had left them in a position to get out of Syria quickly if they ever needed to.
“Rafiq says they have already captured the border crossing and are not letting anyone pass.”
Sami took another deep breath. “Wait for me. I will come as soon as I can.”
Lacking assistants, Sami pushed open the door to the staff washroom with his foot and took care not to touch anything on his way to the operating room.
The patient had been hoisted up onto the operating table, and his clothes had been cut off. The anesthesiologist was sitting with her cart near the head of the table. A nurse was hastily rolling an instrument table into place.
“What am I prepping him for?” she asked.
They were poison, Sami thought, this group that had invaded Jarabulus. Poison to the rebellion, and certainly to his family. He had to leave. Now.
“Doctor?”
“Laparotomy.”
“Is there something wrong, Doctor?”
“No.”
“Your instruments are ready.”
Sami conferred with the anesthesiologist as the nurse arranged surgical drapes over the patient so only his torso was exposed. Upon sterilizing the exposed skin, Sami made an incision from the patient’s upper right quadrant, just below the ribcage, down to his belly button, using a scalpel to cut through the initial layer of skin and fat, but switching to surgical scissors to cut through the fascia and peritoneum.
Upon exposing the inner organs, it became clear that internal bleeding was indeed present. As he focused on finding the source, fear of what might h
appen to his family receded.
chapter 22
Northern Syria, near the border with Turkey
Like the Mohammedans in the seventh century and the Mongols in the thirteenth, they came to conquer the Levant, but instead of horses, they rode pickup trucks. Chevys and Fords, Toyotas and Izuzus. Humvees stolen from the Americans. Kicking up dust and bouncing over ruts in the road, they blitzed up the Euphrates River Valley, taking towns by surprise.
Certainly five-year-old Adam Hasan, son of Dr. Sami Hasan, was surprised to see them when they roared into Jarabulus.
It was just after eight in the morning, the start of summer only a few days away. Adam, being an early riser, had woken at dawn, crept outside, and tried to light bits of newspaper on fire by directing a beam of the morning sun through a magnifying glass. But he had only been outside for a few minutes before his mother had pulled him back into the house told him not to leave the house at all for the whole day.
Which Adam had thought was crazy. He was allowed to play outside every other day, why not today? So, when his mother took her eyes off him to make a phone call, he snuck back outside. The morning sun had not yet crested the privacy wall that surrounded the house in which he was staying, and he did as he had done earlier in the morning—opened the gate and stepped into the road.
The first of the pickup trucks appeared just as his newspaper was beginning to smolder.
He stood to the side as they flew by him, more curious than scared. He counted one, two, three . . . At ten, he stopped counting. Most of the men inside the trucks wore black balaclavas or bandannas. They all carried guns. Some stood on the back of the pickup truck beds, holding onto the roofs. Others sat half in, half out of the windows.
When one of the trucks skidded to a stop in front of him, Adam thought to run back inside to his mother, but he was too mesmerized by the sight of the soldiers and the guns they carried, and the way the whole town suddenly seemed to be buzzing.
The soldier driving the truck that had stopped leaned his head out the window. He wore a patchy, untrimmed beard with no mustache, a floppy hat, and wraparound sunglasses. Unlike the others, his face was not covered with a balaclava.
“You should go back inside,” he said, smiling as he spoke.
Adam nodded but found himself frozen in place.
“We are conducting operations,” the soldier added. Then, when Adam still did not move, he asked, “What is your name?”
“Adam.”
“I have a son, only a few years older than you. My son likes marbles, do you like marbles?”
Adam nodded. The soldier reached behind him, and from a cardboard box produced a small, dirty plastic bag filled with four glass playing marbles. He offered them to Adam.
Adam stared at the bag. One of the marbles was chipped, and something greasy glistened on the outside of the bag.
“Take it,” said the soldier, when Adam hesitated. “It is a gift. And then you go back inside.”
As Adam accepted the marbles, one of the soldiers in the back of the pickup truck extended the black flag that was affixed to the back of the truck. On it, crude white calligraphy had been inscribed above a white circle-like blob, upon which black calligraphy had been inscribed. Adam stared at the flag.
“What does it say?” demanded the soldier.
Although Adam had been able to read since the age of three, the writing on the flag was different than anything he had encountered in his studies.
He shrugged.
“I will give you a hint,” said the soldier who had given him the marbles. “It is the shahada. The shahada,” he repeated, upon observing Adam’s blank expression. “Surely you must know this?” When Adam did not answer, he grew agitated. “There is no god but God, Muhammad is the messenger of God! This is the shahada ! This is what is on our flag!” He pointed to the white blob. “Muhammad. Messenger. God. You have heard this, of course?”
“I think.”
“You think? Are you Christian?”
chapter 23
Rebel-held Aleppo
“We are going to need that transfusion!” said Sami. “What is the delay?”
The anesthesiologist ducked out into the hall to investigate as the remaining nurse began suctioning blood away from the patient’s exposed internal organs. Sami lifted the small intestines out of the patient’s body, quickly inspecting them as he did so, but declining to run each section of the bowel through his fingers as he might have done had the situation not been so critical.
After glancing at the stomach—it appeared to be intact, but he could revisit that assessment if necessary—he slipped his hands under the patient’s ribcage and gently exposed the liver. As he had suspected, it had ruptured and was now swimming in a pool of its own blood.
“More suction!”
Sami grasped the liver with both hands and began to compress it, focusing on the center of the large right lobe where the worst of the rupture appeared to be. After a minute of compression, he felt confident he had at least managed to isolate and contain the hemorrhage.
“For the third time, where is my transfusion?” he demanded, just as a man with two units of O-negative blood burst into the operating room. Sami turned to the nurse, who had put down her suction probe. “You must compress the liver while I pack it.”
She exhaled then nodded.
“Tight enough to keep it from bleeding, but not so tight you cause another rupture. Get your hands in position. “On three . . .”
Sami counted to three.
They made the switch, and as the nurse stood over the patient, and the transfusion of universal-donor blood began, Sami sutured and tied off what bleeding blood vessels he could, then packed the liver in place with absorbent, sterile abdominal pads. When the nurse released the liver, Sami packed in two more pads to maintain compression. Then he sewed a clear plastic bag over the exposed entrails, connecting one side of the incision to the other with the bag. The suture thread he had used was black, and the stitches wide-spaced.
The result was not attractive.
“Bring him to intensive care,” Sami said. “Type and cross-match him for blood, give him at least two more units, and keep him warm. I will finish with him maybe tonight, maybe tomorrow.”
At that, he pulled off his gloves and rushed back to the triage room. Seeing no one waiting in the red section, he announced that he was leaving for the afternoon.
“What?” said the intake nurse. “But—”
“I am sorry,” he said, “it is an emergency.”
After stripping off his scrubs, Sami jogged back over to the pharmacy where threw his stethoscope and a collection of syringes and medications into a cardboard box. As he was racing out through a set of back doors adorned with iron scrollwork, he was almost bowled over by a soldier his size or taller wearing camouflage and a waist belt that held an empty pistol holster and a satellite phone.
The soldier gripped Sami’s shoulders. “Abdul Antar! Do you know where he is?”
As the chief surgeon at the M2, Sami was not used to being manhandled. But because he was dressed in civilian clothes and realized the soldier could not know his position in the hospital, he chose not to make an issue of the affront.
“He is recovering from an operation,” he said, disengaging.
“You have seen him? He is alive?”
“If it is the Abdul I operated on, then yes.”
The soldier’s eyes widened. “You are the doctor?”
“Evidently.”
Sami began to walk away.
“Where is he? I must see him. I am his brother.”
“The intensive care unit. But you may not visit him.”
“I must! And I must talk to you about his condition!” called the soldier, who Sami assumed was Colonel Antar.
“The staff inside will help you,” Sami called back as he reac
hed the street, talking over his shoulder as he bunched his fingertips together and made the sign that patience was called for.
Minutes later, as he was halfway between the hospital and his home, passing through Qinnasrin Gate and into the old city, it occurred to Sami that he probably should have mentioned to Colonel Antar that he intended to perform a second operation on his brother—that he would never leave any patient in such a compromised condition forever. He hoped the nurses would know enough to deliver that message. In any case, it was too late to turn around.
chapter 24
“I asked, are you a Christian?” the soldier in black demanded again, this time with more anger.
Not knowing what a Christian was, Adam did not know how to answer, so he was relieved when, from behind him, he heard his mother say, “Of course he is a Muslim, brother. And who are you?”
“The army of the Prince of the Faithful, of the Caliph of the Muslims. Your liberators.”
“But this town has already been liberated.”
“And now it is being liberated again.”
“Alhamdulillah,” said Adam’s mother. Thank God. With a stern warning never to disobey her again, she grabbed Adam’s hand and pulled him inside the courtyard. The soldier with the patchy beard stared at them for a moment, then sped off.
Inside, Adam was served a breakfast of flatbread with yogurt and fresh cucumbers, as his Aunt Aya paced around the kitchen yelling something about traitors and cowards.
There was shooting outside. Adam knew it was shooting because he had heard plenty of it when he had lived in Aleppo.
When the soldiers in the pickup trucks came back an hour later, it was with megaphones. Everyone was instructed to come to the roundabout near the center of town. His Aunt Aya and mother closed the drapes on all the windows and told everyone to be quiet, but then the soldiers came by on foot, banging on the front door. Attendance was mandatory they said. Everyone must come to the roundabout. Anyone who was found inside their home would be considered an enemy of the Islamic State of Iraq and al Sham.
