War Hospital

by Sheri Fink

  “No, this one.” The professor indicates the patient.

  “I understand why he is shaking,” Ilijaz points to the patient, “but why is the professor shaking? Here, move your legs here.”

  Daylight from the top story windows illuminates the patient. The operating room faces west, away from Serbia, toward the rest of Bosnia, toward the city of Tuzla.

  With practiced hands, a nurse snaps open a glass ampoule and the professor draws its contents into a syringe.

  Suddenly the routine is broken. Someone rushes into the operating room to tell them that a man’s been injured in a landmine explosion. The current patient is swept off the operating table, and the nurses wait with Ilijaz for the new patient to arrive.

  Less than fifteen minutes later, just after 11 in the morning, a group pushes through the glass double doors carrying the injured patient on a stretcher. A tiny woman in a white coat holds up a bag of IV solution and a short man in a sweatsuit holds aloft what remains of the patient’s right leg, which ends in a gauze-wrapped stump where his ankle should be.

  The patient, naked except for his blue briefs, winces. Dried blood stains his chest, his arms, and his other leg. The group maneuvers to the side of the operating table and the man wriggles onto it. Then stretcherbearers duck out of the way and the nurses and the man cupping the patient’s calf step up to the table.

  The “professor” quickly runs through the checklist on the anesthesia record form.

  “When did you last drink something?” he asks.

  The patient mumbles a reply.

  “On the stretcher? Your wife brought something?” This will make anesthesia riskier. The patient could regurgitate and choke while they’re trying to place the breathing tube.

  “Move your head over here.”

  The professor turns the patient’s head toward the large bank of windows, exposing his left neck. He rubs it with disinfectant-soaked gauze and holds a needle above the skin while pulling the patient’s necklace out of the way. The patient squeezes his eyes shut and grits his teeth. The professor pokes into the external jugular vein on his first try. The other anesthetist tapes the catheter into place while the professor screws an intravenous fluid line into its end.

  “Muha, give me one big compress,” the professor directs a nurse. “How much do you weigh?” he asks the patient.

  “Eighty-two.”

  “Eighty-two, good.”

  The other anesthetist, who’s just taken the pulse, normal at eightyfour, marks down eighty-two kilograms—180 pounds.

  “OK. Do you smoke?… You don’t smoke.”

  The professor inspects the man’s neck, putting his fingers beneath the chin to estimate its length, which roughly correlates with the ease of intubation.

  The injured man is thirty-two years old and hails from a neighboring village. He’s been in good health until today, with kidney stones his only medical problem. He’s only gone under the knife once in his life—for a tonsillectomy. He hasn’t had a tetanus shot. He is the first patient in nearly half a year to arrive in the hospital with a serious mine injury.

  When all is ready, at 11:30 A.M., the anesthetists hold an oxygen mask over the patient’s face and put him under with a rapid sequence of painkillers, ketamine anesthetic, tranquilizers, and muscle-paralyzing agents. They give his lungs some pumps of oxygen. The drugs have rendered the patient unconscious and paralyzed—he can no longer breathe on his own nor protect his airway if he regurgitates. The anesthetists can only pump oxygen through a mask temporarily, as the air will just as easily go into his stomach. They lift the mask. They have a precious few minutes to insert a plastic breathing tube into his mouth, position it correctly in his windpipe—his trachea—with the guidance of a lighted metal tongue blade, and re-start the flow of oxygen before brain cells begin to die. Some patients are easy to intubate. Others—especially those who are heavy-set, have short necks or have experienced trauma to the face—can be difficult, even impossible.

  This patient is easy, and the number eight endotracheal tube slips right into his airway. The anesthetists remain behind the head of the bed to monitor the patient throughout surgery, while the rest of the operating room staff turn their attention to the patient’s injury. A tourniquet has been tied around his leg to reduce bleeding, the timing of its placement noted to avoid leaving it on too long and damaging healthy tissue.

  Ilijaz stands at the foot of the bed as a nurse cuts the gauze off and holds the leg up for him to see. The foot has been blown off completely. The stump looks clean, with healthy red muscle, white bone and pink skin. It contrasts with the putrid, worm-filled wounds Ilijaz used to see early in the war, when it took men days to travel from the field to the hospital and their legs had taken on the bluish, mottled, swollen look of gangrene. Even so, the ragged end of this wound will necessitate further amputation for control of bleeding and so that the stump will close nicely and the patient can eventually be fitted with a prosthesis.

  It’s one of the last days of Dr. Neak’s MSF rotation in Srebrenica, and he joins Ilijaz by the operating table, pointing to the leg with a gloved finger. He, too, wears a creased white sterile paper gown over his scrubs, but his white mask nearly covers the entirety of his small face, and his large, wire-rimmed glasses hang over it. The two doctors take their places across from one another at the operating table. The stump is now wrapped neatly in blue sterile towels, the leg has been shaved and cleaned between the knee and the ankle, and the rest of the patient’s body is covered with a blue sterile sheet clipped to two poles on either side of his head.

  Ilijaz points to the place where he plans to cut, drawing his forefinger across the top of the shin, asking a silent question of Neak, standing across the table.

  “A little to the right,” Neak says.

  “What?” Ilijaz asks, and someone translates the surgeon’s words into Bosnian.

  Neak spreads his hands wide on the leg—one on either side of Ilijaz’s. A beam of light from the adjustable silver operating lamp is focused on the patient’s shin. The instrument nurse hands Ilijaz the scalpel, which he takes in his right hand like a pencil. The thumb and forefinger of Neak’s left hand form an L that frames the area where Ilijaz should cut.

  At 11:38 A.M., Ilijaz incises the skin with a firm, confident stroke of the blade. Neak lifts his hand and dabs at the incision. Then, using a second scalpel, he extends the incision toward his side of the table.

  Ilijaz slowly deepens his incision, cutting with the scalpel and daubing with gauze to keep the operating field visible. With a facile hand, he clips hemostats to the edges of the skin incision when he encounters a tiny blood vessel, a “bleeder.” Neak plugs a plastic, pencil-shaped “bovie”—an electric device for cauterizing blood vessels—into a humming generator. Ilijaz holds up the scissors-like handle of a hemostat and Neak touches its lower portion with the metal tip of the bovie. Then, with a hiss, crackle, and puff of smoke, Ilijaz lifts off the hemostat. The bleeding has stopped.

  With feather-like strokes, Ilijaz extends his incision longer and deeper. A large vessel comes into view: the anterior tibial artery. Neak threads bent-tipped scissors beneath it to isolate it. Each man clips one side of the vessel with a hemostat, cutting off the blood flow. Only then do they cut it.

  The rest of the surgery goes smoothly. By its end, in the summer heat, Ilijaz’s white mask is wet and clinging to his nose, and the hair below his cap on the back of his neck is stringy and dripping with sweat. He looks intently at the operating field, his hands working slowly, like a novice’s, but with the delicate touch of a natural.

  * * *

  GOING-AWAY PARTIES for MSF staff are fancy affairs, often held at the Domavija Hotel. Long tables are covered with white cloths and laced with silver platters heavy with food brought from Belgrade by MSF and whipped into delicacies by the local chef. Late in the night, white plates with partly eaten salads and cake are scattered between half-drunk glasses of wine, clear vases filled with colorful flowers, and open
cartons of cigarettes.

  Dr. Ejub Alić holds a cigarette between two thick fingers and leans toward Ilijaz. Ilijaz leans in, too, and the two lift their glasses, giving glassyeyed grins to a camera as its flash bulb goes off. The two—thin Ilijaz in a white shirt with blue stripes, neatly buttoned up high; round Ejub in a white shirt open lower, showing chest and a snatch of undershirt—are inseparable at parties. Ejub loves to eat and drink and relies on Ilijaz as his “inhibitor.”

  Ilijaz knows that it can take two hours of nagging to get Ejub out the door of a party. He marvels at the fact that Ejub can still walk after imbibing a liter or two of plum brandy. Ilijaz is sure that he would die if he drank half that much. Ilijaz, Neak, and many others of the hospital staff marvel, too, at the fact that no matter how drunk Ejub becomes, he still talks only about his wife.

  “I miss my wife,” he says over and over again.

  Neak likes to tease him. There’s a war going on, he says, and your wife is far away—why are you thinking about her? But even in his most besotted state, nobody can get Ejub to so much as talk about cheating on his wife. How unusual he is. In Srebrenica, married men who sent their families away before the war remarry. As Fatima—a keen observer of the phenomenon—explains it, men don’t want to die alone. To not cheat on an absent wife is the deviant behavior.

  Fatima loves the Doctors Without Borders parties and enjoys dressing up for them. When she arrived in Srebrenica she had nothing much to wear besides second-hand donations from an aunt with daughters around her age. None of it felt like hers, and none of it would do for parties. Fortunately, a shopkeeper relative who departed Srebrenica before the war left some silky cloth behind. Fatima cut the cloth by hand to flatter her figure and stitched it, using a sewing machine that she cranked for power and any color thread she could find, into blouses and flaring, knee-length skirts. Her hems were straight, and she affixed tiny gold buttons for decoration.

  To this party, she wears a shimmery turquoise top with a plunging v-neck. Part of her dark-brown hair is pulled up in a white band at the top of her head, showing off her long earrings, and the rest of her hair cascades over her shoulders. Her face is radiant, nose and cheeks pink as if she’s recently had some sun, and the eyebrows above her made-up eyes are thin and carefully shaped.

  The photographer gathers the medical staff for another picture. Fatima comes up beside Ilijaz and cranes her body toward him with a big smile. Ilijaz sits stiffly, lips pursed and arms crossed, leaning slightly away from her. A dozen other hospital and MSF staff gather around them, all smiling. One raises his glass. The flash goes off.

  * * *

  FOR A WHILE NOW, Ilijaz has been romantically involved with someone else. Ironically, it was Fatima who first drew his attention to her, a surgical nurse from the operating room team named Hajra. One day, Fatima jealously insisted that the woman had a crush on him. The next time Ilijaz saw Hajra, he took a better look at the slender, dark-haired woman, who cast youthful smiles in his direction. She reminded him of an old girlfriend. He started to like her. She liked him, too.

  Since the day that Fatima discovered and confronted him about the “affair” that is refreshing him, their relationship has been fraught with conflict. They argue every day. Fatima talks about Ilijaz with others, galling him. He accuses her of having a “long tongue.”

  “Leave him to do what he wants, and he’ll come back,” Ilijaz’s brother-in-law tells Fatima. “Keep your tongue in your mouth. We could stretch it from Srebrenica to Tuzla and walk right across it.”

  Fatima tries to move the nurse out of the surgery department, and Ilijaz snaps at Fatima in the green room, telling her that while she is in charge of gynecology and obstetrics, he is in charge of the operating room. He feels her eyes following him in the hospital, checking to see where he’s spending his time.

  Despite their arguments, Fatima is still a good friend and a support to Ilijaz. They are both prepared to help one another at any time, even late at night when an emergency comes into the hospital. Sometimes Ilijaz is even romantic with Fatima. He doesn’t see why this might confuse her.

  As Ilijaz draws away from Fatima, he grows closer to a group of male friends. They meet every late afternoon beneath the heart-shaped, sawtoothed leaves of the linden trees in the center of town. When Ilijaz cannot be found at the hospital, everyone knows to look for him here among the small circle of about ten men whom Ilijaz likes to think of as the town’s “intellectuals.” While those in charge of the town are not well educated, Ilijaz’s group boasts lawyers, engineers, and former professors. He didn’t know them before, but the war has forged close friendships between the similarly aged men.

  Now, in the early summer, the broad linden branches are laden with stalks of small spicy flowers.

  Lindens are blooming

  Everything is as it was before

  Only your heart and my heart

  Are not in love anymore….

  So goes a popular Yugoslav song from the 1980s. The men talk and laugh and sing and, for a time every evening, they nearly forget where they are.

  The klatch develops rituals. Whoever is last to arrive under the linden tree is the butt of jokes for the evening. Everyone tries to avoid being the last, but someone has to be, and often, when the hospital is busy, it’s Ilijaz. No excuses! When he walks up and sees their smiles, he knows it’s him.

  The group gathers for parties, singing sevdalinke, traditional Bosnian love songs, until late at night, long past curfew. Whoever is the most drunk is named the zmaj, or dragon, the main character in Ilijaz’s favorite song, Vjerna Ljuba, “Loyal Love,” a sad rhyme about a nineteenth-century military captain, nicknamed “the Dragon of Bosnia,” who fought for Bosnian autonomy during the days of the Ottoman Empire. The captain rides away to his last battle. His wife prays and waits for the “the lord of her heart” to return. A messenger arrives to give her the news that her husband has died: “Go wed, white princess, your captain is not coming back.” Her heart breaks and she, too, dies, for she will not marry another. The mujezin chants from the minaret, hawks screech, and sad music can be heard all the way to Istanbul, emanating from the walls of the deserted white fortress. The war has made Ilijaz identify with the song and its themes of true love, youth, and the fight for Bosnia.

  Anyone who misses “linden tree” parties has to have a good reason or he is sure to be chastised the next day. Ilijaz always has a good reason—his work. On the nights when he fails to appear, the linden tree members pour out of whatever apartment they’ve gathered in and stumble down the street arm in arm, singing all the way to the hospital. Then they stand under its windows and belt out Ilijaz’s favorite, “Loyal Love.”

  The group talks of serious things, too, such as the fact that the main occupation in town is “do-nothingness.” They decide to restart the high school, using the former professionals as volunteer teachers. They also establish a club in Srebrenica’s cultural center, which dozens of men and women join, including many hospital staff members.

  That’s when the local authorities—Srebrenica’s former military heroes—get nervous. The new club represents a challenge to their uncontested power. Most Srebrenicans shrink from criticizing the authorities, but Ilijaz, Fatima, and a few other club members are growing more vocal in their condemnation of the crime and unsavory black market activities sanctioned by some local leaders.

  One day an authority comes to the hospital and warns Fatima to be careful or she could end up dead or in jail. Armed men sometimes burst into the hospital, yelling and cursing at the hospital staff. But Ilijaz, aware that he has become irreplaceable, feels fairly secure in expressing his mind. He charges the authorities with selling donated humanitarian aid on the black market at the same time they regularly deny requests for a portion of the donated food, shoes, and clothing to be distributed to the hospital workers.

  “Nobody is above the law,” he tells some military officers. “Just because you did some great things during the war and were great soldi
ers and fighters doesn’t mean you can do whatever you want to do now…. Even commanders have to obey the law.”

  Ilijaz begins flexing his muscles. His attitude toward authority has typically been friendly and deferential, with little or no conscious desire for power himself. One morning on rounds, he discharges three soldiers who have been convalescing after being injured by mines. There is no longer any medical reason for them to stay in the hospital, but one of the soldiers refuses to go home. An hour or so later, Srebrenica’s commander, Naser Orić, barrels into the hospital, striding upstairs with his weapons strung across his broad shoulders. He confronts Ilijaz in the operating suite, where he is preparing for surgery.

  “Why are you expelling my guys from the hospital?” he demands and orders Ilijaz to keep them.

  “You’re commander when you leave this building, but not here,” Ilijaz explodes. “As long as you’re under this roof, I’m the commander!… Now one of us has to leave this building, you or me,” he continues, mustering all of the authority that his position as Srebrenica’s sole local surgeon lends him. “If I leave, I’ll never come back and you’ll have to answer for the consequences.”

  Silence. Everyone in the room has stopped moving, paralyzed by fear, Ilijaz imagines, or shocked to hear these words issuing from his usually polite mouth.

  The commander stands still for a moment, too, looking at Ilijaz with wide-eyed surprise. Then he gathers his men and leaves. After this, whenever Ilijaz meets Naser on the street, he feels the commander greets him with a little bit more respect. After a while the two men even laugh about the incident.

  Ilijaz’s ability to improve life for his fellow Srebrenicans—as a doctor and moral leader—has grown enormously in the past year, but he barely realizes his own influence. Through bizarre twists of fate, an unassuming villager with no great career ambitions has become, though it surprises even him, one of the most powerful and respected men in Srebrenica.