Tom looked up. “Please?”
“Yeah, in Vietnamese.”
Tom brushed the hair out of his eyes.
“I’m serious,” David said.
“You know,” Tom admitted, “I don’t know. Never heard anybody use it.”
“Maybe we should find out. It might make our job easier.”
Tom seemed about to argue, but then changed his mind. “Okay …” he said.
Chapter 6
AT THE BEGINNING OF the fourth week, david started to take along more antibiotics. He added tetracycline, erythromycin and one of the newer synthetic penicillins that Sergeant Parker had been able to get for him from the evac hospital at the 70th. He started to hand out the medications himself. When the villagers filed past, he’d make sure those with open sores got penicillin; he gave staphcillin to the ones with abscesses. The erythromycin was used for coughs; and he gave the tetracycline to the villagers who looked chronically ill. Young and old alike received vitamin pills, and the ones who looked anemic, iron.
Tom asked an occasional question about the new antibiotics, why one was better in some cases than the other, but for the most part he ignored the additional medications, though he never challenged taking them along.
It was a very small step from trying to hand out the right pills to feeling a neck or examining a lymph node to see if it might be a tumor or abscessed. Without planning it and not quite realizing what was happening, they were turning the med caps into a mini exam clinic.
Tom had taken his time, but he did finally find out how to say please in Vietnamese. David had not pushed the issue. The truth was he’d found out himself how to say it the day after he had asked Tom, but decided to wait and see if Tom would come up with it. He was about to give in and use it when, a week later after leaving the last village of the day, Tom had turned to him and said, “Lam on. It means ‘please.’”
The word had an almost magical effect. Reluctant villagers seemed to lose their timidness, taking the pills with something close to cheerfulness; often when he’d say please, an old man or woman would lift his or her eyes and look at him as if for the first time.
Tom was not as pleased with the clinics as the Vietnamese were. “A lot of their medicine is putting mud and leaves on cuts. It’s best,” he said, “not to change things too much.”
“We aren’t exactly doing heart surgery, you know,” David answered good-naturedly.
It was their lingering at the villages that bothered Tom most. But he said nothing about the extra time the exams took until David started to bring along a stethoscope. Then he couldn’t control himself any longer. “Doc, all they’re used to are pills.”
They were parked a few meters from the road, eating lunch. Tom had pulled the jeep off into a small ravine where they could be in the shade and still see the road in both directions.
They had taken to eating their lunch on the way back to the 40th. At times it meant holding off till late in the afternoon, but Tom was always more relaxed heading back, and David, too, found that, as in medical school, he was more comfortable eating after all the work was done. Without any discussion, they simply continued to leave their lunches till they were on the flats again, even though with longer visits they were eating later and later.
Tom handed David a tin of chicken and opened his own.
“Pills work better,” David said, “when you know what you’re using them for.”
Tom shook his head. “It ain’t so good to stay at any one place too long.”
David stretched out, resting his foot on the side of the hood. He was enjoying the silence and the sense of a day’s work well done. “I don’t want to get back when it’s dark either.”
David had mentioned Tom’s concerns about the length of the trips to Cramer. “Yes,” Cramer had said, “it’s best to get back by evening,” and then with uncharacteristic candor he’d mentioned that nights in pacified areas were not as safe as they could be. But then he’d added, “Nights weren’t all that safe in certain parts of the States either.”
“It ain’t the dark,” Tom said. “Nights belong to the gooks, ain’t much argument about that. It’s the in-between stuff, the dawn and dusk, that’s confusin’, and when things over here get confusing, you can be in trouble, and real quick.”
“That what Morril thought?” David asked, looking over at Tom, who was eating as mechanically as ever.
Tom shrugged. Meals for him were just something to keep you going; another mouthful meant another quarter-mile. David had seen him in the mess hall, where the food was not as bad at times, and he ate there the same way he did out on the road. “Hard to know what the captain thought,” he said.
“Sergeant Bradford told me the two of you met in the Delta.”
Tom continued to eat. “Yeah,” he answered, digging at the last bit of chicken.
“Bradford told me Morril wouldn’t go unless Thorpe assigned you to him.”
Tom took his empty tin and tossed it into the backseat. “I’m a good shot.” He wiped his hands and looked around the jeep for scraps of food or loose wrappers.
“Oh, really. A good shot, huh.”
“Yeah, a real good shot.”
“And Morril?”
Tom leaned back and stretched before he settled himself back into the seat. “He was special forces.”
“Special forces.” David was surprised.
“He liked jumpin’ out of airplanes … he’d been a skydiver in the States and ran rapids in rubber boats, stuff like that,” Tom added. “Ready?”
“You’re not telling me much.”
Tom turned on the engine. “Some things ain’t worth spendin’ much time on.”
David knew the conversation was over.
Chapter 7
EVERY SATURDAY MORNING, CRAMER went over that week’s med cap missions with David. The major was not concerned with details. In fact, he didn’t want to know anything about the nuts and bolts of what was going on; only the villages visited, the number of Vietnamese seen and the percentages of men, women and children.
But he appeared genuinely pleased when David mentioned that things were getting better with Tom. “If you give them half a chance, they all come around and do what they’re supposed to do. The Army’s okay for these kids,” he said, warming to the topic. “The military teaches them a lot. I’d bet if you asked Griffen you’d find out that before the Army he’d never been more than fifty miles from his hometown. Don’t kid yourself,” he said. “For the poor and uneducated, the Army’s a damn good deal. They see new things, go places they’d never be able to visit. I bet Griffen’s been to Hong Kong and Tokyo on his R and Rs, and there’s the GI Bill when they’re done and the ten percent overseas savings fund. Believe me, a hell of a lot of people are going to come out of this war better off than before it, and that isn’t only the ones with defense contracts. Things aren’t as bad in this army as some people would like others to think.”
Cramer read David’s silence as agreement. They went to lunch together.
Chapter 8
THE VILLAGES DIRECTLY NORTH of the 4oth were the largest they’d visited. Tom looked at the ever-growing lines of Vietnamese with obvious misgivings.
“It’s occurred to me,” David said, responding to Tom’s increasing impatience, “that you haven’t been up here before.”
“What do you mean?”
“When I came here, you and Morril had already been doing med caps for a couple of weeks. Then you and I began all over again, right? Redoing all the villages you’d already visited. Pretty shrewd, I mean for a country boy.”
Tom actually blushed. It was the first time David had seen him looking uncomfortable.
“Don’t worry,” David said, clearly amused. “You’re forgiven.”
“These are damn long trips up here,” Tom answered defensively.
“And I won’t tell anyone either. Just kidding,” David said, “just kidding.”
David had examined a dozen villagers and was listenin
g to an old man’s chest when he called Tom over.
“Come on,” David said good-naturedly. “You know we don’t have all day.” He motioned Tom around to the front of the jeep. “No, no, over here.” He handed Tom the stethoscope. “Listen. Come on, it’s just a stethoscope.” Tom gave both David and the old man and then the stethoscope a wary look. “Well, go on,” David coaxed. “It won’t bite. Take the earpieces.”
David held the bell of the stethoscope against the old man’s chest while Tom slowly bent and put the earpieces in his ears. He listened for no more than a second and then, with a perfunctory nod, started to take the stethoscope out of his ears.
“Not so fast,” David said. “Listen!”
Tom reluctantly bent again. He waited another moment and was about to stand when he hesitated.
“That’s fluid in his lung,” David said softly. He let Tom listen a little longer. “Lungs are really nothing but millions of tiny air sacs wrapped in blood vessels. When you breathe,” he said, “the sacs expand and fill with air, and the oxygen in the air is picked up by the blood. If there’s fluid in those sacs, when air rushes in, the fluid pops as the sacs open. That’s the crackling.” David moved the bell of the stethoscope to the other side of the man’s chest. “See, clear. No crackles. He has a pneumonia, but it’s only in the left lung.”
Tom, bent over, continued to listen, his expression so intense that David found himself embarrassed. Finally he slowly straightened and started to hand back the stethoscope.
“No, no,” David said. “You use it. I’ll give this guy his pills. Why don’t you start with that woman over there. Take my word for it, one person’s lung is like any other. If there’s fluid there, you’ll hear it.” By the time they left, Tom had examined six other villagers.
Tom didn’t say a word on the way back, but it was not his usual silence. There was no distance to it. It was contemplative, more a stillness than a barrier.
“Amazing, huh,” David said after a few minutes.
“Yeah,” Tom admitted softly, strangely subdued. David hadn’t thought about it for years, but he remembered the first time he’d used a stethoscope. It was truly like being able to see through walls. Neither spoke again until they stopped to eat.
“About that first man,” Tom asked, not looking at David, pretending to be preoccupied with his tin of biscuits. “If that fluid had been on both sides, we’d have heard the same crackling all over, right?”
David was amused by the effort Tom was making to act as if nothing had happened. “Yeah,” he answered as if there were nothing unusual about the question. “But most pneumonias occur only in one lung. If you’d heard fluid on both sides, you’d have to think of conditions that affect both lungs, causing the air sacs on both sides to fill. The best bets are heart failure or fluid overload.” David found a small stick and drew an outline of heart and lungs in the dirt. “When the heart fails, the blood backs up here into the lungs, into the blood vessels around the air sacs. The pressure in these vessels builds, and when the pressure gets high enough, the fluid in the vessels gets pushed out into the air sacs. You’d hear the same crackling, or rales, you heard today, only in both lungs. Kidney failure can cause a person to retain too much fluid, and eventually the same thing happens to the blood vessels and the lungs fill up, but when it’s one side it’s probably a pneumonia.”
“Probably?” Tom glanced up at David.
“Well, there are other conditions that, like pneumonia, can affect only one lung. Cancers usually involve only one lung. They can obstruct some of the air sacs so that the airway fills with mucus and sometimes blood. You hear the rales, but those patients are usually coughing up blood by the time you hear the fluid. There are different kinds of pneumonias, too. Some are bacterial; a number are viral; a few are fungal. I assume there’s a lot of TB out here. What you heard today could be tuberculosis.”
“How can you tell the difference? I mean, how can you know which kind of lung infection it is?”
“Out here,” David said as he rubbed out the diagram, “it’s not easy. If we were in the States, we’d do chest X rays, tomograms, white counts, sputum cultures, skin tests for fungal infections, maybe even a lung biopsy. But over here,” he said with a shrug, “it’s penicillin or sulfa and hope that if it is an infection, the organism causing it is sensitive to penicillin.”
“And if it isn’t?”
“If it isn’t,” David said, collecting their tins and wrappers, “we might as well have plastered his chest with the mud and leaves you keep telling me about.”
Tom thought for a moment. “Ain’t so simple, is it?”
“It’s a little harder out here. Come on,” David said, pointing to the ignition. “Time to get back.”
Tom started the engine but kept the clutch in. “How many years of schooling you have?”
It was the first personal question he had asked.
“Counting college?”
“The whole thing,” Tom said.
“Well, four years of college, four years of medical school, a year of internship, and two years of residency—eleven years.”
“Eleven years,” Tom said, impressed. “Damn long time.”
“That’s just the beginning,” David said. “When I’m done here, I’m going back to a research fellowship. That will be another three years—probably the most important three.”
“But you are a doctor, right?”
David laughed. “Yes, I’m a doctor, all right. You’re a doctor the minute you graduate from medical school. You just don’t know very much yet.”
Chapter 9
WITHIN TEN DAYS, THEY were completely off the flats, spending all their time in the hills above the 40th. There were times when they were forced to travel below ridge lines and on occasions across a valley floor. David, despite the effort to keep his attention focused on what they were doing at the villages, couldn’t ignore the difficulties they had negotiating the narrow, winding roads, some no more than ledges cut from the sides of the slopes, or their growing isolation. He hadn’t realized how familiar, almost comfortable, the flats had become.
Tom had his own concerns. “With the jeep we never could hear all that much,” he said as they bumped along. “Now”—he looked up at the hills around them—“we can’t see all that much either.”
The villages in the hills were much the same as those on the flats, only bigger; but the people were different. They were heartier than the peasants on the plateau. There was more water in the hills, the gardens weren’t burned off, and there was even some rice out in the fields. The better land, though, brought with it a greater cautiousness than David had noticed among the villagers on the flats. The peasants would move up to the jeep in groups instead of lining up one by one. They took the pills, but only a few allowed themselves to be examined. There was more than enough to do, though. With the better nutrition, abscesses and pneumonias that had been so routine out on the flats were not as prevalent, but the more specific diseases began to show themselves.
David continued to teach Tom what he could. He showed him how to do a complete cardiac exam, how to palpate an abdomen for masses, and how to tell the difference between nerve and muscle damage. David only had to show Tom once and he’d have it. Soon Tom was picking out signs of disease with a skill almost equal to his own.
Their lunches became lectures. At first, David made an effort to keep his explanations simple, but as they did more exams and found more disease, the effort to restrict his discussions began to tax David’s ingenuity, and out of necessity he started to go into more detail, bringing in general physiology and even pathology. Tom listened, occasionally nodding, but usually saying nothing. When he did ask a question, it was never related to what they were discussing at that moment but to something David had explained the week before. David would be talking about liver disease, and when he was done, Tom would ask a question about a point he’d made when they were discussing meningitis. The questions, though, were always to a point and so ac
ademically sound that David, who back in the States might have been irritated by such sudden changes in topic, found himself so intrigued and challenged that he didn’t have time to be annoyed.
It was during those lunches that Tom would occasionally mention home, though he never really talked about himself. Tom liked his family and would speak with real affection about his parents and their farm, about hunting and fishing with his brothers and uncles.
David asked him once what he planned to do after he got back there, and Tom shrugged it off. “It ain’t so good,” he said, “to decide too much about things till you’re there.”
“You sure about that?” David asked.
“Yeah. Pretty sure anyway.”
The villages became so spread out that they could only visit one a day if they wanted to get back before dark and still do the missions even halfway right. They decided to do only one village a trip, and though Tom still made it clear he was not exactly pleased with being in the hills, the decision stopped him from complaining. He did, though he refused to admit it, begin to enjoy the missions.
More than once David had to restrain himself from laughing as Tom, towering over some tiny Vietnamese, palpated for a mass or cyst with such an intense expression on his face that the villager, growing more anxious by the moment, would slowly back away and Tom, keeping pace, would continue the exam.
“It’s strange, isn’t it,” Tom said late one afternoon while they were packing up. Earlier David had shown him how to evaluate the different muscle groups in the withered leg of a man who’d had polio. “I mean, I always thought all the cripples over here had been hit. I never figured it was something like, well, something like polio.”
“There are a lot of things that can injure and hurt people besides rockets and gunships,” David said, “even over here.”
Chapter 10
DAVID DID SEE BITS and pieces of the war. Twice flights of choppers moved across the horizon east of the hills, and two days in a row he and Tom watched the contrails of flights of B-52s moving in from the coast. But when David finally did find the war, it was not out on the flats or in the hills. It was at the 40th.
Another War, Another Peace Page 4
