Prognosis So Done

by Andrews, Amy

  ‘He’d like that.’

  ‘I’ve always kept in close touch with your family, Gill. I just don’t think we should pretend that we’re something we’re not anymore.’

  Their energies would be better spent thinking positive thoughts for a swift recovery. That, at least, she could do...

  CHAPTER SEVEN - 1300 HOURS

  The two surgical teams left the building together and walked across to the medical building. Once a week, providing they weren’t in the middle of surgery, the surgical and medical teams joined together and ran an immunisation clinic.

  Most of the countries MedSurg serviced had very low levels of childhood immunisation. Part of the organisation’s directive was mass vaccination, and they employed people in the field, working in partnership with the World Health Organisation to co-ordinate local vaccination programmes.

  Yellow fever, a potentially fatal mosquito-borne illness, was prevalent in this particular area, and the teams had been tasked to immunise as many locals as was possible during their stay. Thanks to the field operatives, there were usually hundreds of men, women and children lining up for their shots at the weekly clinics. Therefore it was all hands on deck.

  Some of the surgical teams grumbled about it but Harriet quite liked it. It got them out amongst the local people, instead of staying cloistered inside the same sets of walls for two months. They could become very insulated inside and it was nice to think they were doing something proactive for once, instead of reactive.

  The idea of public health had always been attractive to Harriet. Yes, she enjoyed her work, enjoyed being a theatre nurse, but if she was totally honest, Gill had been the reason she’d stuck with it for so long. She’d always loved developing rapport with her patients and, as Harriet walked in the heat, she thought this was an area of nursing she might explore now she was leaving MedSurg.

  Several tents had been set up outside the medical building under the shade of the few remaining trees that existed in the dust bowl that surrounded them. They were big and looked as old as the buildings themselves, and were obviously very hardy to have survived when other greenery had long ago succumbed to the arid heat.

  The clinic was just getting under way as the team arrived.

  ‘So pleased you could join us,’ said Dr Kelly Prentice, grinning eagerly at her recruits as she swatted away the ever-present flies. She was a petite African American woman with a New York twang. ‘Pull up a pew. You know the routine.’

  Between each chair was a small table with a supply of the vaccine and a box of gloves, and on the other side a sharps

  bin. Out of habit Harriet sat down at next to Gill and then spent a moment dithering about whether she should have or not.

  Helmut sat on the other side and smiled at her as he said, ‘Bet I can do more than you.’

  Harriet rolled his eyes and forgot her dithering. ‘This isn’t a race, Helmut.’

  ‘Whatever you say,’ he said on a laugh and greeted his first customer.

  Gill looked up from his work at the teeming mass of humanity waiting patiently in line, an array of colourful fabrics dazzling the eye. The crowd was as big as usual, about six or seven hundred at a guess, but he knew from past experience that with twenty health-care professionals administering the vaccine, it’d be all over in an hour.

  He tried to concentrate on his work. But with thoughts of his grandfather and with Harriet in his peripheral vision, talking and trying to make the children laugh as she worked, he was failing badly. She was a natural with the kids and had their shy, serious expressions erased in a flash, replaced with big white grins.

  He had heard Helmut’s challenge and knew he would win easily because being fast wasn’t Harriet’s style. It wasn’t that she wasn’t efficient, she just thrived on making a connection, taking some time to make her patients feel like individuals.

  She looked up at him and caught him staring. He smiled at her and she smiled back as she flapped at some flies. She was glowing - in her element - despite the heat and the flies, as she turned back to a little girl who was shyly showing her a raggedy old toy that had seen better days.

  Gill continued to work through his line, smiling at every patient, wondering what the hell must be going through their heads. The things these people had lived through and seen. They took their needles stoically - even the children.

  What was one tiny needle compared with a horrific civil war? Compared to having no food in your belly or your house burnt to the ground or your parents killed? Compared to dying from yellow fever, as so many of their countrymen did?

  No. There were no hysterics here. No cajoling kids and bribing them with ice creams and sweets, like back at home.

  Just a resigned silence, a calm acceptance.

  Someone down the line, a woman, began to sing a tribal tune and others joined in, and suddenly the lines were swaying to the rhythm. It was like listening to ancient music being sung by a gospel choir in a foreign tongue and Gill marvelled at the pride and resilience of these people.

  They were standing in the dirt, their feet bare, the sun beating down relentlessly, in a place torn apart by war, and yet they could still sing. They could still rejoice.

  He smiled at a beaming Harriet who was also getting into the groove. There was something indomitable and defiant about these voices raised in song. A message.

  This is our home. We will endure.

  Gill felt a pang hit him in the chest and ripple outwards. Maybe it was his grandfather, maybe it was saying goodbye to Harriet, maybe there was magic in this music, but listening to this tribal tempo which seemed to be coming from the very earth beneath his feet, he had a strong urge to go home.

  To ground himself.

  He turned to look at Harriet as he absently brushed some flies from his face and he felt the ripples intensify. She sat on her chair in her scrubs, talking to a mother while she nursed a baby on her lap. The babe had its head snuggled into Harriet’s breast and tiny fingers wrapped around Harriet’s index finger.

  The two women couldn’t possibly understand each other but there was something universal about babies that crossed language barriers and cultures. Harriet looked radiant and for the first time ever he imagined how it would be to have her holding their baby on her lap. His baby. Watching her belly blossom and her nurturing their baby at her breast.

  A small noise in front of him brought him back to the task at hand. A little boy was looking at him apprehensively with big round eyes. He looked from Gill to the needle he’d been holding poised in the air for too long now and then back at Gill again.

  ‘It’s OK, little mate,’ he said, and ruffled the boy’s hair, giving him a reassuring smile. The boy looked dubious but he took his vaccination without a whimper.

  Gill made a concerted effort to control his scattered thoughts. It was hot and his grandfather was critically ill. And it was his last day here. He was always a little stir-crazy after being away from home for two months.

  So, Harriet was nursing a cute baby. Babies were cute - that’s how they sucked you in. It wasn’t until 2 a.m. feeds, no sex for six months and eating cornflakes for dinner that you realised you’d been conned.

  He liked his life. So had she. He liked dining out most nights, going to the movies, the ballet and the theatre. And making love till the sun rose. And he most definitely liked his cornflakes for breakfast.

  Actually, not even then. Eggs Benedict was a much better breakfast at a dinky little sidewalk café.

  Damn it all — they’d talked about this. She had agreed. After one scare and years of dating women who sooner or later had wanted his babies, Gill had been ecstatic to find one who didn’t. To find a woman who was as concerned as him about the number of neglected children already in the world and the issues with population control. How many times had they discussed all this and decided they didn’t want to contribute to the problem?

  She’d changed the rules, damn it. Not him. Why, Harry? Why? He would have given her anything she’d wanted,
anything. But this? Why did she want the one thing he did not?

  He noticed a big purulent sore on the arm of the next child that the flies were enjoying immensely, and it finally made him put a lid on his rising frustration. He jabbed the boy in the opposite arm and with Theire’s help explained to the mother to go up to the medical facility and get it looked at.

  These clinics were a good opportunity to treat any and all ailments and he’d already sent several patients over to the medical building, suffering from various superficial skin and eye conditions rampant in such a tropical environment. He’d even sent a man across who, he suspected, might have tuberculosis.

  The crowd was at last thinning when he heard a most awful noise. It drove a fist right into his intestines and squeezed hard. It was a sound of deep distress and it was coming from Harriet. He turned to her quickly.

  ‘Gill!’

  She was holding an infant who looked very close to death, flies buzzing around the child’s face like vultures. Her eyes were large with appeal and said it all - help.

  Do something.

  ‘Theire,’ he yelled, keeping his eyes on the child, gently examining the scrap of skin and bones in Harriet’s arms. He glanced at the mother and her look of utter misery and despair was gut-wrenching. He’d seen that look so often in this war, and other wars all round the world, but it never got any easier to witness.

  She was trembling all over and had her hands clasped together as if in prayer. A low keening noise was coming from the back of her throat as if that’s all she was capable of, as if grief had stricken her mute.

  She knew. She knew her child – her son - was dying.

  ‘Gill...’ Harriet said, her voice etched with anguish. ‘I think it’s too late.’

  He knew she was right. The child’s skin had a yellowy-green tinge and the whites of his big brown eyes were also yellowed. Jaundice. The symptom that gave yellow fever its name.

  The child was in liver failure.

  He watched as Harriet flapped a hand back in forth in front of the baby’s face, swatting away the stubborn little black flies that had zeroed in on the exudate from his eyes and the dried blood at the corners of his mouth. She was making growling noises at them, frustrated at their persistence.

  He glanced back at the mother, who was looking down at her

  child, her face cloaked in grief. She looked utterly destroyed, and Gill tried to imagine how he would feel in her position. Not just that his baby was dying but that he hadn’t been able to protect and keep his family safe.

  He never wanted to be in her position.

  ‘Ask her how long her child has been like this,’ said Gill to Theire as she arrived on the scene.

  There was an exchange during which Gill continued to examine the child.

  ‘She says he had a fever and vomiting about a week ago and then got better. He’s been yellow for a couple of days. She has walked for two days to bring him here. He won’t eat or drink.’

  The child could barely hold his head up and keep his eyes open. He was practically unconscious. His fontanelle was very sunken, as were his eyes, and his lips and the mucous membranes of his mouth were cracked and bleeding.

  ‘When did he last pass urine?’ asked Gill.

  There was another brief exchange. ‘Not for over a day now.’

  Renal failure as well. ‘How old is he?’

  Theire repeated the question to the distraught mother. ‘Six

  months,’ she relayed back.

  ‘Why did she wait, Gill?’ whispered a distressed Harriet. ‘She waited at the end of the line. She should have brought him straight up.’

  Gill gave her hand a squeeze. They both knew that it probably wouldn’t have made much difference. ‘Because that’s what these poor people do, they wait.’

  ‘His name, Theire? What’s his name?’ Harriet asked, turning to the interpreter, blinking back tears.

  ‘Nimuk.’

  ‘Stay here and finish up,’ said Gill as he stood, indicating for Theire and the mother to accompany him. ‘We’re nearly done. I’ll take him in to Kelly.’

  ‘Nimuk,’ Harriet said, handing the child over. ‘His name is

  Nimuk.’

  Her eyes burned with a fierce light, boring into his and Gill nodded as he scooped the dying baby from his wife’s arms. ‘Come on, Nimuk,’ he crooned. ‘Let’s get you seen to.’

  He turned away but not before he saw a tear slide down Harriet’s cheek and the resignation in her gaze. Harriet knew Nimuk was dying, too, and there wasn’t a damn thing any of them could do about it.

  CHAPTER EIGHT - 1400 HOURS

  Lunch was a sombre affair. Gill joined them just as they were sitting down to sandwiches and airline fruit juice. Harriet sought his face immediately, searching it for something positive but there was nothing. He shook his head.

  ‘He’s still hanging on. Kelly got an IV in but it’s palliative only.’

  ‘What about choppering him out?’ she asked.

  There was silence in the room as everyone looked at their plates and tried to pretend they weren’t there. They had all seen Nimuk and known how futile any intervention would be.

  They also understood that some patients just got to you.

  They clouded your judgment.

  ‘He’s in multi-organ failure,’ Gill said gently. ‘He has acidosis not compatible with life. His lactate is through the roof.’ He sat down beside her and stroked a finger down her cheek and cupped her face. ‘It’s too late, Harry.’

  She swallowed and squeezed her eyes shut as she nodded. ‘I know.’ Her voice was husky with emotion. ‘I’m sorry...I know.’

  She placed her hand over his and gently pulled it away. ‘I’m okay.’

  Clearing her throat, Harriet waved her hand dismissively. ‘Sorry, guys, ignore me. I’ve always been too emotional.’

  ‘This is true,’ said Helmut.

  Everyone laughed - including Harriet – and, just like that Gill felt the mood lighten and lunch proceeded. There was general conversation about what everyone was going to do in London and how they were going to spend their two months off.

  ‘Have you heard any more about your grandfather?’ Siobhan asked.

  ‘No.’ Gill shook his head. ‘If I don’t hear anything in the next couple of hours, I’ll ring my father.’

  There was a return to a more sombre mood again until Joan spoke up. ‘Come on, guys. Best and worst. It’s our last day. We always play it on our last day.’

  ‘Best and worst?’ asked Benedetto, who was the only one remaining at the table from the other surgical team, much to

  Katya’s chagrin.

  ‘It’s a game our team plays at the end of a mission,’ said

  Katya, her voice leaving him in no doubt that he wasn’t welcome to join in.

  Gill laughed at Katya’s rudeness. ‘Don’t mind Katya. She has no manners. Of course you must join us. In fact, you should go first. You have to tell us what’s been the best part of the mission for you and the worst.’

  Ben smiled. ‘Hah! That is easy. Katya. Dear, sweet Katya with the beautiful face and the shrewish tongue. She has been the best and worst of my time here.’

  People laughed and Katya blushed.

  ‘I shall miss her when I go back to my home on the Amalfi coast...unless she wishes to join me for a little holiday in Positano?’

  ‘I would rather drink bad vodka.’

  There was more general laughter and they moved on. ‘My best has been having Harry back,’ said Joan, and there was a general murmur of agreement.

  ‘Why, thank you, kind lady,’ said Harriet with a smile that touched her eyes and mouth but didn’t linger.

  Gill wondered if she was thinking that this was the last time she’d see these people again?

  ‘Worst...hmm,’ Joan continued, ‘let me see. The food?’

  ‘Oh, hell, yes,’ Helmut agreed, as he ripped the lid off his second juice tub. ‘I’d kill for a beer. A nice cold German beer. That’s my wor
st — no beer. And my best, well, Harry, of course, but also that pneumonectomy we did right at the beginning. That was a fine piece of work, Guillaume.’

  There were more murmurs of agreement. Gill had been really happy with it, too. The lung had been a mess, having taken a chunk of flying metal. The fact that the man had survived at all was a miracle. Gill had had little choice but to completely remove the lung.

  Had he had time and been in a major centre with every machine that went ping and the back-up of thoracic surgeons, he could have attempted to save some of it, but that wasn’t what field medicine was about. The objective of this kind of surgery was to stabilise the patient for transfer to a more major facility.

  They operated with basic equipment, the bare minimum. It was fix and fly. Not try something and see if it worked. There was no time for risky or fancy. No time for lengthy repair procedures. Fix and fly.

  Fix and fly.

  ‘My best is definitely having the whole team back together,’ said Siobhan, grinning at Harriet, ‘and I think I’ll have to agree with Helmut about the worst. What I wouldn’t give for a nice pint of Dublin Guinness.’

  Helmut made gagging noises. He was not a Guinness fan. ‘I would rather drink bad vodka, too,’ he said, and laughter broke out again.

  It was Katya’s turn. ‘Da,’ she said. ‘Having Harriet back has been the best. The very best.’

  ‘OK, stop now, you guys, you’re embarrassing me!’ said Harriet.

  ‘My worst?’ She glared across the table at Ben and Gill laughed.

  Poor Ben. He feigned a wounded expression but Gill could tell that he revelled in her attention. Any attention.

  ‘The bloody flies,’ she said, still looking directly at Ben. ‘Buzz, buzz, buzzing around. Always buzzing.’

  Ben roared with laughter. ‘You are the only person who has ever compared me to a fly.’

  ‘Welcome to the real world, Count,’ she said, her face deadly serious.

  ‘OK, OK,’ Gill interrupted. ‘My turn.’ He felt Harriet tense beside him. ‘Well, let’s see, it’d look pretty bad if I didn’t say Harry as well but, then...’ He grinned. ‘That pneumonectomy was good.’