The Year's Best SF 11 # 1993

by Gardner Dozois (ed)

  Surely, at the end of a long day with the lepers, tired out of his mind, even Albert Schweitzer sat on his cot among his chickens and goats and wondered how he had managed to so thoroughly screw up his life.

  * * *

  Terry, Megan, and I are at the clinic by 8:00 A.M. We are medical practitioners, MPs. I hope to go to medical school when I get back to the States and become an MD. I thought that coming to China would give me practical experience, and that it would be a chance to travel. A once-in-a-lifetime chance. Maybe, like Dr. Schweitzer, I would find my calling.

  My third patient this morning is a boy about sixteen, whose name is Zhao Lianfeng. Small-boned, with tiny beautiful hard brown hands, dirt ingrained in the knuckles. He has a fever, difficulty breathing, anxiety, and he tells Xiao Cao he hears voices whispering in his blood. Entotic Illusory Disease (EID) means illusions in the ear. Zhao Lianfeng is lucid, despite the whispering he hears. Patients often are. No one has ever been able to explain the whispers, despite all the mumbo-jumbo we rattle off about fever and R-brains and induced dream states.

  “What do the voices say?” I ask. I ask a lot of my patients that. I get some strange answers.

  “They are whispering in a foreign language,” Xiao Cao translates.

  Sometimes they are whispering too quietly for the patient to make out the words.

  I stroke his forehead, and he looks up at me. The Chinese don’t touch much across genders. Boyfriend and girlfriend don’t hold hands in public, although a couple of boys can walk down the street with their arms around each other’s shoulders and nobody pays any attention. But I touch my patients a lot. Sick people need comforting.

  I can’t do a lot else for Zhao Lianfeng. The only things I can give him are fluids for dehydration, broad-spectrum antibiotics against secondary infections, and something for his breathing. He will either live or die. So I hold his hand, while his mother, a middle-aged woman with a perm that lays precisely as the rollers were placed in her hair, watches me. After a moment, the inhaler has helped his breathing. “Shi hao ma?” I ask, “You good?” in the local version of Mandarin.

  He smiles for me. “Shi haode,” he says. “Good.” His hand is calloused. Peasant boys have calloused hands. In Shandong, peasant isn’t a description of what you do for a living. This boy doesn’t farm, he works in a village factory. He helps make parts for motor scooters. But he is still a peasant, because he wears quilted navy-blue cotton jackets and pants. Because he lives in a village. Because, at sixteen, he has finished school and says shi haode instead of hen hao, the way a city boy would. Like saying “ain’t,” or “pitcher” for “picture.”

  I smile at Zhao Lianfeng, and I smile at his mother.

  His mother doesn’t smile. She isn’t fooled, she knows my remedies are temporary. For my records, I ask for a history. Has he had a history of illness? I check bronchitis without bothering to ask; here everybody has bronchitis in the winter. How about his family? Xiao Cao translates: the boy’s father is dead of EID, which the Chinese around here call the Whispers, his mother had it but recovered, twelve years ago. His sister had it as a child, but survived. Anyone else? His mother shakes her head.

  “Didi,” the boy says, “little brother.”

  The mother turns her head away.

  I press her through Xiao Cao: what happened to the little brother?

  “Baixuebing.” Xiao Cao finally translates, “White blood sickness.”

  Leukemia. The leukemia rate among children in China is one of the highest in the world, the result of years of toxics being dumped into the air, the land, and the water. I put my forms in his folder. At the end of the month, I’ll tabulate it all, send my report to someone in Geneva at the World Health Organization. It’s all entered into a data file, but nobody pays much attention to the results. There’s no pattern, or rather, no particularly surprising pattern. EID is virulently contagious, spread by contact, endemic. It is particularly bad among the impoverished, who are, of course, susceptible because of poor nutrition and health and overcrowding. Although, since EID has killed over a billion-and-a-half people world wide, over-crowding in places like Bangladesh and Mexico City is much less of a problem than it used to be.

  I survived because I am an American, and, as a child, I was among the first to get it. I got it in 1996, when hospital care was available that wasn’t available a year later, when medical services were completely overwhelmed by the number of cases. My father got it early, too, but died despite great medical care. My mother didn’t get it until three years later, when medical care was nearly non-existent, but she survived anyway. Like Zhao Lianfeng’s mother survived it.

  Zhao Lianfeng does not want to let go of my hand, but I have other patients, so he must. If his mother had brought him in for a vaccination two years ago, he might not be sick now. The disease can lie dormant for years, though, so if he’d had it already, but was asymptomatic, the vaccine might have activated the virus too.

  Sometimes they live, I think. And then there’s the next patient, there’s always a next patient.

  Usually part of me is numb. I’m tired all the time from my chest cold, and the number of patients is overwhelming. Patients are all frightened; some are brave, some aren’t. I treat toddlers, I treat old people. A lot of them die. A lot of them don’t even die of EID; China doesn’t need EID to find a way to kill you. Just breathe coal dust all winter, or drink yourself to death on 150 proof sorghum liquor, or die of untreated diabetes, or heart disease, or the astounding cancer rate, or pneumonia. Or get run over by a coal truck out in the country, and die because there’s no medical aid at all for most of the villages.

  * * *

  When I come back to the clinic the next morning, Zhao Lianfeng’s fever has spiked to 41 degrees Celsius during the night, about 105 Fahrenheit. Now it is down around 39 degrees. His mother has spent the night with him. When I come by his bed, she watches me without reproach. Without much hope, either.

  “Daifu,” Lianfeng says when I lean over him. “Doctor.” I sit down for a moment and hold his calloused, dry-hot hand.

  Their faces are the pinched angular faces of country people. Square-jawed. For all their differences of race, they are like the faces in the black-and-white photos of people from places with names like Jackson Hollow and Stinking Creek. Or like the Dust Bowl faces of Okies.

  I have the strange urge to lean over and kiss Zhao Lianfeng’s cheek. It comes over me with patients sometimes; I never tell anyone. It is not an Albert Schweitzer love-of-all-mankind urge, it is just an urge to touch that young and shining skin, those hectic red cheeks. Even dried by fever.

  He says something, and I recognize eryu, “whisper.” They are whispering. “Ssss ssss ssss,” he says, trying to mimic the sibilance he hears.

  I hold his hand and rub his forehead.

  “Kate,” Xiao Cao says. Patients waiting. Triage, ignore the dying boy I can do nothing for, concentrate on finding the ones I can help.

  Xiao Cao doesn’t have that pinched look. He is thin, a beanpole of a young man, but he is a city boy. He graduated from the Foreign Languages department in Tai’an Teacher’s College, his father is a professor. I like Xiao Cao, he is open and trusting and naïve. Chinese young people seem younger than their peers in the States. Maybe that is simply because he is less sophisticated in my culture than he is in his own. Maybe I seem simpler, unsophisticated, to him.

  He is also a tremendous help in the clinic. He has been vaccinated against EID, and is happy to be a model of the efficacy of the vaccine. He preaches western medicine to the patients, thinks of us as the Americans who have developed the vaccine, who will save everyone if they will just come and let us.

  I worry about what he tells people; his ideas are a weird mix of what we tell him and local speculation. One day he announced to me that the reason we foreigners get so many colds is that we wear flat shoes. Colds come from the ground, up through your feet, he told me. Wear heels and get your feet off the ground, and there is less surface f
or the colds to get through.

  I wonder what kind of life it is for a young man like him, working with Americans and sick people.

  The morning is the usual parade. Most people do not come to us unless they are very sick. We refer some on to the hospital in Tai’an, but most don’t go. In China, your health care is paid for by your work unit, that is, your factory or employer. But the peasants don’t have work units, and they have to pay for their own health care, up front. If a dying man walks into a Chinese hospital without cash, he dies in the waiting room. I palpitate a man’s stomach, find a mass. I tell him he needs to see a doctor in Tai’an, give him a prescription for pain, and he goes home to die.

  A woman with tuberculosis I can treat. I start her on a course of antibiotics, tell her to send the rest of the family to be tested in case they have caught it from her.

  We stop accepting patients at 11:30; lunch is at noon.

  “Daifu,” Zhao Lianfeng says. His fever is up to 40 degrees Celsius. I take his hot hand. I used to want to clean them up, the rings of dirt on their collars distressed me, but dirt doesn’t really hurt or help him now. I sit a moment, give him a new IV bag, go on to lunch.

  Lunch is hot and spicy cabbage, clear soup, and rice. It’s one of my favorite lunches, but Terry doesn’t really care for cabbage.

  “You know what I’m really hungry for,” Terry says.

  It’s a game, a kind of torture we inflict on ourselves. Sometimes I’ve played with tears in my eyes, but one of the unwritten rules is to pretend it’s only a game.

  Terry’s meal is pizza, a big tossed salad with ranch dressing, a two liter bottle of Coke. He swipes his kinky blond hair out of his eyes and throws in a Steelers-Oilers game. Tall, fair Terry is so foreign-looking that I’ve seen him cause bicycle accidents; most of the locals have never seen a foreigner, and when they see us, they stare. As we walk down the street, the whispers follow us, “Weiguoren, weiguoren.” Foreigner, foreigner.

  Megan’s meal is steak, baked potato, broccoli with cheese sauce, and apple pie.

  My meal is skillet-fried chicken, mashed potatoes with milk gravy, and green beans. My mother’s, but I don’t say that. I’ll write it in my next letter. Thinking of my mother makes me think of Zhao Lianfeng’s mother, sitting next to her son at the clinic. I bet I know Zhao Lianfeng’s favorite meal—Chinese dumplings, potstickers.

  I don’t want to go back to work. I want to go home.

  * * *

  The next morning, I am surprised: Zhao Lianfeng is still holding on. He does not say daifu when I sit down, but he opens his eyes. I take his hand, smile at him. “Hold on, little brother,” I say in English.

  He closes his eyes.

  Xiao Cao comes to tell me I have patients, and Zhao Lianfeng opens his eyes. He says something to the air, to no one in particular.

  “They are whispering,” Xiao Cao translates.

  “What are they whispering?” I ask.

  For a long moment, Zhao Lianfeng does not answer. Then he says something “… shi haode.”

  “They say, hold on, you’re good, you’re okay,” Xiao Cao translates.

  I smile and nod. “Shi haode,” I agree, “you’re good.”

  Zhao Lianfeng doesn’t seem to care, he just closes his eyes.

  I check on him on and off during the day. We have twenty-seven beds, all filled. Zhao Lianfeng’s temperature is back up between 40 and 41 degrees, somewhere around 104 degrees Fahrenheit. He is not really conscious. It is really only a matter of time.

  I am hoping that when I come to work the next morning, the bed will simply be empty. But the next morning, Zhao Lianfeng is still there, still suspended between consciousness and unconsciousness, still running a fever that must, by now, be causing brain damage. There are no facilities here for rehabilitation, so if he is brain damaged, he will go back to his village and his mother will take care of him. Or not take care of him.

  So I begin to hope that he will die. Maybe I am terrible, maybe Albert Schweitzer would feel differently. I know that there is sanctity in all human life and that I took an oath—even medical practitioners take an oath—but there is sanctity in death, too.

  Zhao Lianfeng doesn’t die. Not that whole long day.

  Nor the next day, although the fever is wasting him nearly down to the bone. I force myself to sit down, to take his hand and brush his hair off his forehead, but long black hairs come away in my hand.

  His mother sleeps sitting on the floor, her back to the wall, or wakes and waits.

  After three days, I am thinking the unthinkable. There are lots of things I could add to his IV bag and Zhao Lianfeng would slide gently away. I’ve never done it. Doctors, real full-degree MD doctors do it, although usually not officially. I think Megan has done it, although she says she hasn’t. Terry never would. Terry might be from the suburbs of Chicago, but he comes from a conservative family. Terry brought his Bible to China with him, belongs to a Bible Study group at home. Terry really believes in the sanctity of human life and lets God make all the calls on the quality of life.

  Albert Schweitzer would leave it to God. Kate Lambert of Lexington, Kentucky doesn’t trust leaving things to God, or to other men, either. Maybe we’re supposed to make that decision, maybe that’s part of being a healer.

  But I don’t do it because I can’t do it in front of his mother. Not that she would know, necessarily; I put antibiotics in his drip, how could she know this is different? But she would be watching and I just can’t see myself doing it under her eyes. What if I were wrong? It’s not likely that he has a chance of recovery, nothing in my experience indicates that Zhao Lianfeng will ever go back to the little sweatshop run by his village and make parts for motor scooters again. Most likely he will die without my help or, at worst, he will recover from EID and go home to his village with cerebral palsy, or aphasia or paralysis, maybe end up tied in a bed and fed with a spoon.

  Most likely, I tell myself, he will die. Eventually I’ll forget about him, forget about feeling guilty. Eventually I’ll go home to Lexington, Kentucky, and eat skillet-fried chicken and mashed potatoes with milk gravy.

  * * *

  After five days, Zhao Lianfeng’s fever begins to drop. It drops to 39 degrees Celsius, spikes 41 again, drops again to 39 by the sixth day. By the seventh day, it is below normal, which is common after a fever. He isn’t conscious, although his eyes are slightly open.

  His aunt sits next to the bed; his mother has gone home to rest a few days. I keep an IV of glucose going, and antibiotics, of course, and otherwise avoid the bed.

  Two days later, he is still not conscious, not truly. His aunt can prop him up in bed, and he’ll even take broth, but he’s in a vegetative state. Which may be permanent. When he closes his eyes, he looks angelic, his wrists as thin as a child’s. I stop to look one afternoon, and he is curled up on his side with his thumb in his mouth.

  After that, I ask Megan to take over. She doesn’t ask for any explanation; once in a while we just trade patients.

  We are done with him, and his family comes with a truck borrowed from the headman of their village, bundles him into quilts, and takes him home.

  That weekend, Terry decides that I need R&R. What he really means is that it is his and my turn to spend a weekend in Beijing going to foreign motels in our cheap Chinese coats, looking like the missionaries who come down from the hills to buy supplies. We take the train to Jinan, and then six more hours to Beijing, and eat lasagna at the Jianguo Hotel coffee shop. It’s a bland concoction of cheese and meat. So many Chinese are lactose intolerant that they don’t eat cheese (which has never explained the popularity of ice cream, but it’s true), and every time we go it’s been so long since I’ve eaten western food that it makes me sick, but it’s still wonderful. Even in the evening, jagged out on Cokes and crying in the bathroom with the water running so Terry won’t hear.

  Two days of hot running water, heated rooms, Cokes, and candy bars. It costs half my monthly stipend, but there’s not a l
ot else to spend my monthly stipend on, so I can’t really get upset. I use the hotel long distance phones to call home, “How are you, Mom?” “It’s eight o’clock in the evening here, what time is it there?” “How are you, how’s your cold?” “The cold is doing great, Mom, but I feel terrible, ha ha.”

  And then, Sunday night, we take the train, soft sleeper berths, back into China. My backpack is stuffed with Cokes and Snickers Bars and two buckets of Kentucky Fried Chicken to share with Megan for manning the store. Hell of a dinner we’ll have, Kentucky Fried Chicken and Qingdao beer.

  It’s all incredible luxury; my monthly stipend is 1600 yuan, less than $400 US. Making parts for motor scooters, Zhao Lianfeng probably made around 200 yuan a month. Good money in China, but it doesn’t buy many cans of Coke at 4 yuan a pop.

  Just because Zhao Lianfeng can’t afford it, does that mean I should forego it all myself? I don’t know what Albert Schweitzer’s view was on going native, but I suspect he’d find my existence decadent.

  * * *

  “Daifu,” he says, beaming. It’s March, six weeks after Zhao Lianfeng left the clinic, bundled in cotton quilts. The weather is warmer, but he is still bundled up, still painfully thin. His mother has his arm, steadying him. His coordination has been affected by the fever. Still he smiles at me. “Daifu,” he says.

  His mother explains through Xiao Cao that he has been after her to come see the daifu. He seems delighted and childlike, a bit simple. He smiles and smiles, eyes squinched in the sunlight.

  “Come in, let me look you over,” I say.

  Underneath his cotton shirt, his collar bones rise like wings, but he seems basically healthy. His chest is clear, his ears and eyes good. His blood pressure is low, but not drastically, his heart sounds strong.

  His mother explains that he was like a baby at first, but that he has been “growing up.”

  “Daifu,” he says, and then, in Chinese I can barely follow, “Doctor, they tell me, tell you, it’s good.”