Taxonomy of Grief, Part 2

(Page 2 of 2)

It's late. I check my watch again by candlelight but can't see more than a shadow. Outside, the night is as black as before. I look around for Pierre but he must still be at the measles ward, so I walk up to the pharmacy to try to find something to drink. There is no moon. The trees carry their giant canopy of leaves like great black clouds boiling overhead. The air is close; the wind has died down. There is a touch of dampness in the air. Perfect weather for an epidemic.

I fish out my key to unlock the pharmacy door. Everything here has to be locked up and guarded; the pilfering is unending. There are some Cokes hidden behind a stack of saline bags. I pull one out and root around, candle held high, for the bottle opener. How long has it been since I've used a bottle opener in America? I find it, go back out and sit on the front steps where it's cooler. The stars are all out, all brilliant. Out of habit I search for the Big Dipper, the Little Dipper, Cassiopeia, but nothing I see looks familiar.

Why am I in Nigeria? I wonder this for the hundredth time as I look up at the stars. There is the thin arc of a comet up above one of the trees. The answer is simple burnout. I am here so I won't be there. So I won't be back at home and in the ER. A crisis of faith brought me here to Nigeria. I had been thinking more and more that I might not want to spend the rest of my medical career wide awake at three a.m. attending some screaming drunk shackled to the bed while someone in the next bed over vomits copiously into a metal basin. It was beginning to get to me in ways I really didn't understand. Or ways I understood too well. It didn't take a genius to figure it out. The fact is that I have just seen too many cases of child abuse, sexual abuse, assaults, bad mothers and worse fathers, disastrous car wrecks, people dying who shouldn't die, people alive only by some whim of God's. I was turning into someone I didn't recognize, someone I didn't particularly like.

I have, when I go back home, some career decisions before me—a potential for a whole new life. I have been offered a chance to do a completely different kind of medicine. It involves—don't laugh—hair transplants. A friend of mine, a family practice physician, has offered me a partnership in her practice. She specializes in what charitably may be described as boutique medicine. Hair transplants, electrolysis, skin peels, that sort of thing. She is making a fortune as she sits, day in, day out, planting sproutlets of hair onto bald domes. "Just think," she told me, "no insurance hassles! No nights or weekends or holidays. You even have background music while you work."

"New Age?" I asked her doubtfully.

"Anything you want," she told me.

What do I want?

Perched on that step, a warm Coke in my hand, I contemplate an image of myself sitting in a quiet room performing one simple task at a time with pleasant music in the background, surrounded by polite professional nurses, and patients who don't vomit on my shoes. The image seems comforting in a way. I even think of a slogan for myself: "Stop doing good and start doing great!"

Simon appears out of the darkness, looking grim. "There is a child here," he tells me. "Very, very sick. Could you please come?"

I sigh and get up. Candle aloft, I light my way back down the path following Simon.

In the last tent a father is sitting on a mat with his child in his arms—a boy—maybe seven or eight. I kneel down beside them and lift up the candle in order to see. The child's head lolls back—his eyes are open and glazed yellow from jaundice. I look up and my eyes meet the father's eyes. His expression is unreadable.

I pull the child from his father's lap onto the matted floor. Automatically I reach for the IVs I keep in my bush jacket pocket. An 18-gauge is all I can find. I need something smaller. The child lies motionless; his matchstick limbs collapse away from him, completely flaccid. His face is sunken, hollow. He is clearly septic and desperately dehydrated.

"Simon," I whisper fiercely. "Quick, quick, get me some IVs and some ampicillin." Simon stays rooted to his spot, though, staring down at the child. I look again and then grope for a pulse. I try the wrist but there is nothing there. I fumble, trying to feel for the carotid.

Nothing. The child is dead.

"I see," I say to Simon, who must have known before I did. "Never mind."

Simon kneels to tell the father. The father looks down at the child. He hasn't known before this either, I realize. There was still hope. Now the hope is gone.

"How long has he been here?" I ask Simon fiercely.

"Since just after you left for dinner."

I thump the ground before the child. "Was the child alive when they got here?"

Simon leans over and speaks to the father softly in Hausa. They stop. Simon shrugs. "The father says, yes, he was alive."

"When did this child die?" It suddenly seemed important to know. I glance at my watch. It is now eleven and I left at six p.m. The father must have been here almost five hours, and during that time his son died in his arms here while he waited for the doctor. Would he have held his son in his arms until morning if I hadn't been here to round? How many hours had he been protecting something no longer his child but a corpse?

"I'm sorry," I say to the man. I don't dare touch him. Here women do not touch men.

He bows his head.

From out of the shadows comes a woman. She must have been sitting just outside the tent. The man looks up at her and says something. She, too, bows her head.

"It was Allah's will," I say in Hausa. Who knows if they understand me.

The mother kneels beside her son and lifts him up. She holds him for a moment gazing down at him, a Madonna in chiaroscuro, face as grave, solemn and still as if she were painted by some old master. Then she bends over, and with her husband's help she slips the child onto her back and steadies him. She takes the long winding sheet of broadcloth that all Nigerian women use to wrap their children into place on their backs. She wraps him close to her for the last time. Again his head lolls back drunkenly. The husband touches the wife's hand and they look down at me. The wind gutters the candle so I can't see well, but they seem to be blessing me, thanking me even, though they say nothing. Simon whispers something in Hausa and they look around dazed, like sleepwalkers. This is their grief. The man lifts his hand to me, a gesture of farewell, and they turn and vanish into the dark, noiselessly, as if they were never there.

There's a beat. Simon squats down next to me. "That was a bad one," he says.

I just sit there looking after them.

After a moment there is some rustling to the right of Simon. It is one of the other mothers, motioning to her sleeping daughter. The daughter has a rash on her face, and the mother holds her hands out toward the rash as if she is trying to sell us something valuable at a market. Staph infection, I think, then I look more closely. The rash is more like a wound and has a purplish hue, like nothing I have ever seen before. I wonder how many things I miss, mistreat, misunderstand, here in the tropics. A world of strange diseases. How many patients . . .

I realize I can't look again at another festering wound. I have reached my limit. "Tomorrow," I tell Simon. "I'll look at it tomorrow." I stumble out of the tent.

The trees, the stars, the night that had so charmed me a short time ago, now seem sinister and oppressive. I kick some IV tubing off the path. There are IV needles on the ground, used IV bags, waste everywhere. I am thinking of something I read somewhere. All grief is alike, someone had once written. Clearly, he didn't know grief; he hadn't seen it every day, day after day, the way I have. There is a taxonomy of grief; it is not one human feeling, one set of human actions. I try not to think of the grief I've seen expressed, but images come flooding back anyway. The young woman in America, one who had just lost her mother, wailing, beating on the walls, shrieking. The husband whose wife had just died in a freak auto accident. He just sat there in stunned disbelief. "But this really can't be . . . ," he kept murmuring. An old woman, crying after I told her that her husband of sixty-seven years was now dead. "I'm sorry," she kept saying to me, as she cried. "Please forgive me, I know you all did your best." She seemed more worried about me than about herself.

I have, in my memory, a whole catalogue of grief. Each entry differs as the human face differs.

And now this. African grief, Hausa grief, Islamic grief. All silence and darkness, no voice, no gesture, just a gathering up and heading out into the night. Did those parents love that boy any less than any other parents in the world? Did they suffer less? Did they see his death as I did—something absolutely unnecessary, useless, a chance encounter between two pieces of bad luck, one involving politics and the other the natural history of a disease?

I shake my head. Of course they don't see it that way. Thank God, thank God.

I find my warm Coke still out on the front steps. I sit back down and look around at the night, the darkness. All this death.

I think: You can't save everyone in the world. You must save yourself first.

I remember a snatch of a poem by—was it Auden?

But here and now,
Our oath is to the living world.

I turn the bottle opener over and over in my hand. W. H. Auden. What did he call death, "the cosmocrat"? Why is it that some poets understand death better than doctors do? I remember another set of lines:

. . . I have seen
the just and the unjust die in the day,
all, willing or not, and some were willing.

I look down and notice my hands are wet. Stupidly I look up at the sky, but there is only the canopy of leaves. Then I realize I am crying, real tears. The funny thing is, I think, as I wipe the tears out of my eyes, I don't feel sad. In fact I really don't feel anything. And that, it occurs to me, is the problem. I never feel anything anymore. The death of a child—I shrug it off. A bad car crash where people come in dying or dead—nothing; it feels like nothing to me. It's not as if I don't care. I'm sure I do care or I wouldn't be here. But I'm not sure anymore what caring really feels like. It doesn't exist for me as an emotion. In fact, I think, as I turn the bottle cap over and over again, nothing exists for me as an emotion anymore. I try to remember the last time I felt sad or upset, worried or lonely or confused or even happy. The only emotion that seems to have remained a friend is anger. I still know how it is to be angry. All the other emotions just get in the way of being a doctor, of working in the ER, of working in Nigeria.

I can no longer feel things, I think, because I couldn't survive if I did. I can't mourn everyone who needs mourning; I can't grieve at every death. I can't feel outraged at a rape or at a child abused. I can't afford these feelings. What could I do with them except to pile them higher and higher? But what have I become? An automaton? A person who shrugs off the death of a child and all the other tragedies?

And with these thoughts it feels as if I have redeemed another feeling, but not the one I could ever have expected. I am flooded, suddenly, not with sorrow for that child or those parents or the woman in the bed next to the policeman's son, I am flooded by a kind of wistfulness about myself. Here I sit, as detached as ever, another tragedy under my belt. My youth is gone, spent haunting hospital corridors at all hours of the night, and now my middle age is spent in some washed-out back corner of a country where I have come to make some decisions about my life and have ended up, once again, awestruck by the suffering God can inflict.

Just as suddenly as that feeling of wistfulness came, I feel laughter rising up. I'm feeling sorry for myself, I think, smiling as I wipe the tears out of my eyes. The first true feeling I have had in a long time and what would that be? Self-pity, of course. I look out on the night. Everything is as still as death, as still as that child. I put my face down into my hands and draw a deep breath. I would rather feel anything else in the world, self-pity—anything—than feel the death of that child.

As I sit there, images from the ER come flooding back. I see them all, the crazy patients, the nurses, the cops, the paramedics. I hear the banshee wail of the ambulance in the night. Another trauma, another disaster. What I miss most, I realize, is the feel of the instruments, the snap you make with the latex sleeve when you put on a pair of sterile gloves. I miss peeling open the suture package and wrapping the suture around the index and middle finger of my left hand. Putting my hands over the hands of the residents and trying to make them make the right moves for suturing, for starting central lines.

I remember the last evening that I worked, the last ER shift before I left. It was a quiet night. I was reading a magazine in the nurses' station when the deadpan voice of Mark, the security guard, came crackling over the intercom:

"Attention, triage," he said wearily. "There's a full arrest in the parking lot."

A full arrest in the parking lot, I think, shaking my head. And I realize, as I wipe more tears out of my eyes, I am smiling.

Could I miss the ER? Could that really be home for me?

I stop myself. I am in Africa. A child has just died. What does the ER have to do with this? But I don't stop thinking about it. I can't. Do I miss it? I don't know, I can't tell. What would it take to have feelings again?

I think of hair transplants and that beautiful office, those professional nurses, the sober patients worried about nothing more than their hair. Kenny G playing softly in the background. What a nice life that could be. As I think of this, though, I can feel the tethering, the sense of being anchored and drawn down, back down, again and again, to those dark places, the places where children die and monsters are born. Probably, I can never go completely back to the surface again, where the bright sunlight is, where most people live. I remain entwined by the memories of days and nights in the ER, and those memories would never let me go, not even if I were drowning.

An owl flies overhead and beyond, down to the tents. The first tent is lit from within; the nurses are making their rounds. The light is amber through the canvas of the tent, the color of old gold. I have emptied my mind out—there is nothing left for me to think. I stand up, dust my pants off and lock up the pharmacy again. My candle has gone out, so I make my way back slowly down the path shuffling in the dark. It must be midnight, I think. Late, late. A few hours from now, not long at all, the world will begin to fill with light and from every minaret and mosque rooftop the crackling sound of some old loudspeaker will echo and reecho the muezzin, the Muslim call to prayer.