Chapter 7: January 2011

Hannah awoke to the sound of a gentle bell and a voice announcing that all passengers should secure their safety belts in preparation for landing. As she shook her head gently from slumber, she quickly realized that the collar of her t-shirt was wet and that the source of her dampness was very likely her own mouth, which had been hanging open as she slept. She quickly looked over to the seat next to her to see that Adam was still sound asleep, mouth closed, undeterred by the overhead announcement. She cautiously raised the window shade.

Warm yellow light poured into her seat, and as she lifted the shade higher she could see the city below getting closer as the plane made its approach. The brilliant blue sea met the white sand which disappeared into a patchwork quilt of rusted tin roofs. Beyond that, the plain whitewashed buildings stretching along the coastline were surrounded by lush gardens. Pastel-shaded yellow, pink, and blue buses and cars moved in the streets between the buildings like multicolored ants. Hannah thoroughly despised most travelogue descriptions of Africa and resented the colonial mindset they fostered, but every time she flew in or out of Ghana she did feel a giddy explorer’s excitement at the colors and sights below.

The plane circled around the airport and touched down on the gray-white concrete runway, finally waking Adam as it did. He shook his head and rubbed his eyes, reorienting himself to his surroundings and reaching over Hannah to look out the window.

“Well, here we are!” she announced.

“Yup,” he replied. “Home sweet home. I guess I should probably call my uncle now that we’re on the ground.”

“Do you think he’ll really take us all the way to the clinic?”

“Well, apparently he has land out there or something anyway, so yeah. And my dad was only willing to let me go if I was ‘closely supervised,’ whatever that means.”

“I assumed it meant that you were to be watched by one of the key medical personnel from the study.” Hannah smiled. “At least that’s what I said when he called me.”

“He called you?”

“Oh yeah. He insisted that I bring a full first aid bag. Apparently your uncle will bring us a defibrillator and bag-mask for resuscitating you, if necessary.”

“I guess you’re not allowed to bring the oxygen tank under my bed on the plane, huh?” remarked Adam.

“We both know that your liver function tests have been normal for months and that you have as good as chance as using it on me as I have on using it on you. I just played along with him as much as possible because, well, I wanted you to come.”

“I’m really surprised he didn’t try to pack his bags himself. If he didn’t have a sales pitch to give to five liver surgeons in Minnesota this week, I’m sure he would have booked himself a seat with us.”

“He’s seen the place himself– he comes every 3 months to visit.”

“Really? That often?”

“You seem surprised,” observed Hannah.

“I dunno. I guess he does just come and go. When I was younger, he’d go to Ghana without telling me and there will be a visiting nurse checking on me while he’s gone; sometimes if there’s a wedding or something and he’s here it’s all he can talk about for weeks beforehand. Sometimes he’ll come home with some complicated biochemical pathway that someone at work gave him and ask me to explain it to him, sometimes I ask him what he’s been doing at work and he just mumbles about financial stuff for a minute and then goes upstairs.”

“When I’ve talked to him about doing our research, I could never get over the impression that he was always trying to plan the next step. When I insisted that Verilife hire local men to do the construction, he kept talking about forming a company to manage the labor for future projects in the area.”

“Yeah… he can be a little mysterious sometimes.”

“At least he’s into local sourcing and indigenous empowerment.”

“Guess so.”Adam shrugged.

The plane had finally taxied to a stop, so Adam and Hannah gathered their bags and moved slowly in a line to the door. Down the metal stair they went onto the tarmac, where the harsh brightness of the late morning sun stung their eyes. Adam had forgotten sunglasses and shielded his face with his bag as they moved into the terminal. Once inside, they waited for their baggage in an area clearly designed for more than the three gates’ worth of passengers that the airport served, which made the airport feel even smaller. The rolling bars of the baggage claim whirred and clicked for several minutes before any bags appeared, giving Adam a few minutes to pace in the corner with a cellphone that his father had given him. Various other passengers were doing the same, milling about the terminal in either immaculate suits or elaborate traditional dress.

Finally, two large black suitcases tied with a yellow ribbon lurched their way down the track, whereupon Adam quickly moved over to the carousel and lifted one in either hand, still balancing the phone between his ear and his shoulder and negotiating something with his uncle in his usual soft-spoken voice. Hannah found herself constantly revising her initial impression of him– months ago when they first met in Solomon’s office, his handshake was limp and he remained slumped in his chair for most of the visit. She had half-expected him to not even try to come along and let his father’s initial protests be an excuse. And yet here they were, moving out past the security station and getting their passports stamped with a bright green, yellow, and red stamp.

“Welcome home!” exclaimed an enormous man wearing in a bright pink dress shirt and khakis just beyond the gate. He was carrying a neatly lettered cardboard sign proclaiming “FREEMAN/WELLS,” which was unnecessary given his overpowering voice and Hannah’s clear distinction of being the only blonde in the airport. As Adam and Hannah approached, he moved closer to the railing and exit gate and Hannah noticed before how much he resembled Kofi– intensely dark skin, narrow eyes, tiny nose, and high forehead. However, where Adam’s father was slow and deliberate in his mannerisms, his uncle was loud and animated. He also stood about six inches taller than Kofi and was at least 100 pounds heavier. He gathered Adam in his arms and hugged him tightly, causing the luggage to drop to the ground, before doing the same to Hannah.

“Uncle Kwame, it’s good to see you again,” said Adam with a warm smile.

“Oh yes, it has been so long,” he replied in his deep, hearty accent. “And Hannah, it is always a pleasure to make your acquaintance. Come, let us be going. You have all your things?”

“Yes, Uncle,” said Adam with a nod. Kwame took both suitcases and heaved them onto either shoulder, shaking his head at the touts who quickly appeared at the sliding door airport exit to offer their services. Adam and Hannah each had a large backpack that they’d carried on slung over their shoulders, which immediately became the locus for sweat in the hot, sticky air outside the airport.

“So what’s in the suitcases?” asked Adam.

“Medical supplies, books for the school, a couple of presents for people here,” responded Hannah nonchalantly.

“Couldn’t those have been locally sourced and indigenously empowered?” joked Adam.

Hannah rolled her eyes. “Oh gosh, sometimes are you are too much. You know none of it could be found here.” Her smile at the end of her sentence let him know that she still appreciated it.

The suitcases were tossed unceremoniously in the back of a midsize red-rusted Peugeot truck whose open back was lined with high wooden rails, each one emblazoned with a colorful Bible verse or Biblically inspired slogan. Hannah could not decide if her favorite was“JOHN 16:33 TAKE HEART I HAVE OVERCOME THE WORLD” or “JESUS IS MY BOSS.” The suitcases rested casually on several bags of concrete, a stack of lumber, and a few crates that Hannah thought she heard clucking from.

They all climbed into the truck’s cab and squeezed in tightly, with Kwame’s large frame occupying just about half of the space while Adam and Hannah shared the rest. Hannah did not particularly mind, and from the way that Adam did not flinch when she let her leg rest against his instead of leaning her body against the door, it seemed to her that he didn’t mind, either.

The truck rumbled northward, quickly leaving the quiet bustle of Accra for the open expanse of the road to the Volta region. They stopped at a roadside cafe and devoured a whole roast chicken with Cokes while Uncle Kwame catching Adam up to speed on a lot of family gossip regarding numerous cousins that he had previously not even aware that he had. They rinsed off the grease from their fingers under a rusty spigot behind the shack and walked back to the truck, but not before Kwame reached into the bed and pulled out a stack of magazines.

“Here’s the latest edition of the Ghanaian Journal of Medicine & Surgery!” he exclaimed with pride. “My company prints it and I thought you might like to read it. I don’t understand half the words but the doctors in Accra cannot get enough! They love having their own journal.”

Hannah, always interested in new medical information no matter how obscure, received the journal gladly. Adam, however, was clearly less enthused but still took his new travel gift with the same humble gratitude that he might receive a necessary needle in his arm. They all piled into the cab again and Hannah began devouring the contents. The first thing that struck her was the generic Verilife advertisement on the inside front page, emblazoned with their stylized logo and their catchphrase.

“A good life is within your grasp,” she said softly, as if she had not read it day after day on various promotional materials that fluttered in and out of the lab.

“My dad never liked that,” said Adam. “He always wanted something about soaring horizons or a brand-new future. But he’s the numbers man. So his motto didn’t get far.”

“Oh, well,” mumbled Hannah. “Does he have a lot of conflicts with the other Verilife bigwigs?”

“If he did, he’d never tell me.”

Hannah returned her attention to the articles. The first article described the effectiveness and side effects of two different vaccines for rotavirus tested in a randomized controlled trial. Unsurprisingly, the vaccine made by the company that sponsored the study was found to prevent more cases of rotavirus while producing fewer side effects. They had also done an interesting cost-comparison analysis, necessary of course because the superior vaccine was also more expensive. In the end, though, comparing the additional costs of treating sick children showed a clear benefit in terms of cost. She noticed that Adam was reading the same study, nodding along.

“Wow, seems like it makes a lot of sense,” he said with a nod.

“Seems like it,” she said. “But they changed one thing. We can’t trust this study.”

“How come?” he asked.

“Well, whenever you read a study that was sponsored by the manufacturer, you have to really ask carefully if they can really defend the claims that they made.”

“Oh?” inquired Adam.

“Don’t say anything too bad about my journal, now!” implored Kwame.

“Oh, it’s not a problem with the journal– it’s the study authors. They might not have even meant it, but they played with the data to make it look better.”

“I don’t get it,” said Adam.

“Look at figure 3,” said Hannah, pointing to a graph comparing the two vaccines. A bright red bar at 30%, representing the clear favorite, looked small next to the blue bar representing its competitor at 50%, which Hannah noted from the introduction had been in use already for five years in Ghana. “First of all, they’re using relative risk reduction, not absolute risk reduction.”

“Oh, so you mean they’re comparing the relative change to make the numbers look better.”

“Yeah. So in the group that didn’t get either vaccine, in 1 year 212 kids out of 780 got rotavirus. That’s 27%. In the group that got the old vaccine, 106 kids out of 733 got rotavirus– that’s 14%–  and in the group that got the new vaccine, 63 kids out of 746 got rotavirus– 8%. So really, the new vaccine is only 6% better than the old one. But the bar graphs here show us the relative risk reduction because they compared only the number of kids who got rotavirus– 106 out of 212 is 50% and 63 is 30%.”

“I see,” said Adam.

“But the big coup is all in the terminology. They only measured cases of rotavirus. They don’t even say how bad it was. It might have been a few loose stools, it might have required admission to the hospital. They say that they tested any stools for the presence of rotavirus. So they didn’t measure anything that’s relevant to the patients.”

“But doesn’t it matter whether or not you have rotavirus?” asked Adam. “Like, regardless of the severity, having the virus in your stool is bad, right?”

“Not if you don’t get sick from it.”

“Guess you have a point there. They teach you that in med school?”

“I wish,” muttered Hannah. “Solomon taught me. Made me read a bunch of studies and critique them before I started working on our paper.”

“Dang,” replied Adam. “He’s pretty serious.”

“Understatement of the year,” said Hannah with boredom, already moving on to devour the next article. “Which do you want to do next? We can do ‘School Performance and Multivitamin Use in Schoolchildren: A Case-Control Study,’ ‘Recurrent Fevers and a Psoriatic Rash,’ or ‘Higher Prevalence of Brain Tumors Among the Akan,’ or ‘Changes in Prevalence of HIV in Urban Areas.’ The multivitamin one sounds most interesting to me, but I’ll let you pick.”

“Are you going to make me figure out what’s wrong with all of these studies? Pretend to be Sol– er, Dr. Bode– for a while?” asked Adam.

“If you want to. Having our own little journal club might be fun. I brought some financial reports on the NGO if you would rather read those.”She winked.

“I might just listen to some music,” he replied. “My dad left all the financial reports on the kitchen table the other night and, whoo, they were just a little too much drama and suspense for my taste.”

“Okay!” she replied cheerily, turning back to her journal as he began to fiddle around in his bag, looking for his iPod. She was studying some of the figures in the multivitamin article when she heard Adam’s low, almost whispering voice again.

“They didn’t blind the people who were reviewing the school records. Or at least they don’t discuss whether or not they blinded them,” he observed thoughtfully.

“Hmmm,” said Hannah, flipping back a page. “I didn’t realize.”

 

***

Jessi looked up from her magazine as the door to the waiting room opened. Standing there was a short, young medical assistant with heavy makeup and a blue-green patterned scrub top, her eye fixed on the chart in her hand.

“Miss Goodson, you can come on back.”

Jessi got up from her chair, abandoning the Essence from last fall that she had been skimming and gathering her bag over shoulder before she followed the medical assistant back out of the waiting room. The small television in the corner had a game show on and the plain white walls were littered with posters in English and Spanish featuring smiling, happy families of various ages and races encouraging readers to get their flu shot or exercise every day (except, of course, for the poster encouraging HIV testing, which portrayed a strong, resilient-looking young black woman by herself looking directly at the camera.) They passed through a door clicked behind them as it locked automatically passing into a gray-white hallway lit by a flickering fluorescent light, with six staid wooden doors on either side of the hallway.

“Please take off your shoes and step on the scale,” said the MA as she loudly chewed her gum. Jessi removed her shoes, set her bag on the ground, and then watched as the scale was adjusted by hand with the counterbalanced weights. Jessi waited with nervous anticipation for the result.

“Two fifty-two,” announced the MA.

“Thank you Jesus,” said Jessi softly. “Down from two fifty-six.”

They next went into the small examining room, where Jessi’s blood pressure, pulse, temperature, and respirations were recorded into the computer. Jessi sat on the examining table, with the computer directly in front of her and the sink adjacent. Again she wondered if her blood pressure would be appropriate, and this time it was 145/78. She silently cursed the bacon she’d eaten for breakfast, thinking that she knew better on the day of her doctor’s appointment.

“The doctor will see you soon,” said the MA, strolling out of the room. She left Jessi to wait next to a conspicuously placed bowl of condoms and a detailed diagram on wall of the female reproductive anatomy provided “as a service by GenSense Pharmaceuticals.” Jessi began to look through a pamphlet next to the condoms entitled “Living with Respiratory Disease.”

She waited for about ten minutes, making it through her first pamphlet and then another about diabetes that recapitulated all that she knew about it when finally the doctor arrived. He seemed young to her– maybe early 30s– with thick, dark hair that he kept brushing out of his eyes. He immediately sat down at the computer and shaking his hand.

“Hi Miss Goodson, my name is Dr. Pollan. It’s good to meet you, how are you today?” His words came out rapidly and seemed rehearsed..

“I’m fine,” she replied. “What happened to Dr. Michaels?”

“Oh, nothing happened to her,” he replied. “She’s still here.”

“Oh,” murmured Jessi. “How come I ain’t seein’ her? She was my doctor that done my pap smear and saw me last time.”

“Hmm,” he replied. “Dunno. Musta been a scheduling thing. You can see her next time. So let’s see, what’s going on with you…” His words trailed off as he looked through her chart on the computer, the only noise in the room coming from the clicks of his mouse.

“Oh, nothin’ much, just tryin’ to get by. You know.”

“Mm-hmm,” he said. “So I see you have diabetes, your last A1C was 8.4%… we gotta get that down. You’ve got some early signs of kidney trouble. And your blood pressure today is still high. Did you take your medicine today?”

“I did.” She spoke softly and deferentially, looking down at her feet and then back up at the doctor. She often could not remember the answer to this question when she was asked, but today she distinctly remembered taking the pills and hoping they’d work their magic in time for the appointment.

“Hmm, well, I think we probably need to increase your medicine, then.”

“Okay,” she said.

“I see you take lisinopril and hydrochlorothiazide… so let’s add on metoprolol, since your pulse is a little high, too. It’s in the 90s. Are you feeling nervous?”

“Oh, you know, I was just worried about what it would be,” she answered. “And my weight, too.”

“Yeah,” he said nonchalantly, “Looks like losing some weight would definitely help with the blood pressure and diabetes too. You know that losing weight and controlling your sugars reduces your risk of having a stroke or a heart attack, right?” He whipped his head around to ask this question.

Jessi nodded vigorously, as if the enthusiasm of her response would make the knowledge more effective. The doctor turned back to his computer.

“Alright, and the Lexapro is working okay for your depression?” he asked, continuing his way down her medication list.

“Yeah,” she replied.

“Okay, we’ll keep that the same, then. It looks like Dr. Michaels increased your diabetes medicine, so I’m not going to change that, but we are gonna check some bloodwork and then decide if maybe you need to be on insulin.”

“Insulin!” exclaimed Jessi. “You know I don’t wanna be gettin’ no needle or anything.”

“Yeah,” replied Dr. Pollan, turning his whole chair around. “I mean, if we can’t get your diabetes under control, we have to start you on insulin.”

“I don’t like needles,” she said softly.

“Well, then, you gotta make sure you take your medicine every day and check your sugars. Did you bring in a record of your blood sugars?”

“Oh, no,” said Jessi. “I’m sorry, I forgot it at home.”

“How often do you check them?” he asked.

“Three times a day,” she lied. “Breakfast, lunch, and dinner.” She decided not to mention the fact that she’d run out a week and a half ago and was only checking them about once a day anyway because she didn’t want to pay another copay on them once a month.

“And what are they, usually?”

“Oh, you know… like 100s in the morning, then 120s to 160s after lunch, usually about 200s after dinner, I guess.”

“Hmmm, well, sounds like you need to be more careful about what you’re eating and exercise regularly,” he advised. He turned back to the computer. “Looks like last time you and Dr. Michaels talked about that, you were walking once a week. We recommend at least 3 times a week, at least half an hour each time.”

“Yeah… I’m still doin’ that, it’s just I get tired after ten minutes or so,” she said.

“Okay, well, you gotta keep going on and keep exercising,” said the doctor. “Keep at it, and you’ll get better. Three times a week.”

“Okay,” said Jessi with another compliant nod.

“Are you still smoking?”

Jessi clenched her hands nervously. “Uh, I been cutting down. I go through maybe a pack every 2 or 3 days.”

The doctor shook his head. “Well, you know that’s not good, either. Raises your risk for kidney disease, heart attacks, all that. You should quit. Have you seen an eye doctor and a foot doctor this year?” he asked.

“Yes,” she said, this time truthfully.

“Good… hmm, I don’t see their notes in here. We need to call and get a copy of their report. Did they tell you anything?”

“Just the same thing as always, no signs of diabetes in my eyes or feet yet,” she reported.

“Okay, good.”

He clicked through a few more boxes, then turned around and put his stethoscope to his ears, listening to her heart and lungs for a few seconds. He sat back down.

“Alright, let me send your prescriptions to the pharmacy with the computer,” he said, clicking away furiously. Jessi noted a few grunts of frustration as he wrestled with the program. “Sorry, the system is just slow today… not sure what’s happening.”

Jessi’s phone buzzed in her purse. She hesitated for a second before taking it out, not wanting to bring further judgment upon herself for being distracted by a text when the doctor’s time was so short.

“Hmmm.” He rubbed his temple, not looking up from the screen. “This just popped up… it looks like we don’t have an HIV test on file for you. We’ll just draw that today.”

“Oh, no thank you,” she said curtly.

“You don’t want an HIV test?”

“Not today.”

“But we don’t have one in the computer. Have you had one before?”

“I dunno, I think so. Maybe a couple of years ago. I ain’t been with a man in ten years, so I don’t think it makes much difference.”

He finally turned to face her. “You used to use drugs, though, didn’t you?”

“That in the computer, too?” Jessi felt her face pinch. She let up a silent prayer for forgiveness and patience, then breathed out as it was answered.

Dr. Pollan nodded. “Well, if you don’t want it, I can’t force it on you.” He hopped up from the chair and shook her hand again. “It was nice to meet you.”

“Nice to meet you, too, sir,” she said.

“Any other questions before I go?” he asked as he moved towards the door.

“Well, uh… my shoulder been hurtin’ me lately,” she said.

“Your shoulder, huh? Which one? Point to where it hurts the most.”

Jessi gestured with her right hand to her left shoulder, right dead center in what she perceived to be her shoulder joint.

“Hmm,” he said, rolling up her shirt sleeve and pushing on it. “Does it hurt when I do this?”

“Nope,” she replied.

“Okay, flex your arm for me,” he said, pulling against her hand. “Now the other way.”

He checked her reflexes and moved the shoulder back and forth a couple of times. “When does it hurt the worst?”

“When I be liftin’ something or carrying something,” she answered.

“Have you tried Tylenol or Motrin for it?” he asked.

“Done both, none of them seemed to do me much good,” she said.

“How about heat or ice?” The questions continued to come rapidly.

“Yeah, I tried the heatin’ pad and that didn’t do no good, neither.”

“Hmmm,” he said. “Well, I’ll get an x-ray and send you to physical therapy. And I’ll give you a script for some Tylenol #3. It’s got codeine in it, which is a stronger painkiller.”

“Okay,” said Jessi. He returned to the computer and again wrangled with it for several minutes before rising again and heading for the door.

“Alright, your orders for labwork and physical therapy are out on the printer, Shanice will get those for you. I sent your prescriptions to the pharmacy, and we’ll call you about your labs. See you in 3 months and don’t forget what I said about losing weight!” He disappeared out the door just as quickly as he had breezed in. Jessi followed him out after easing herself down from the examination table, gathered her papers from the MA, and ambled out the locked door back to the waiting room.

 

***

 

“Adam! Look at it,” implored Hannah.

“Look at what?” asked Adam.

“The hospital!”

In the distance, Adam could make out a drab concrete structure in a clearing surrounded by thick foliage. The last few hours of their journey had felt much slower as the roads they traveled on became smaller and changed from asphalt to gravel to dirt. Leading up to the hospital was a freshly paved stretch of blacktop cutting through the tropical forest and headed east towards the regional capital. A fine mist hung in the air and the trees around them teamed with the sounds of life.

Around the hospital were clusters of smaller buildings, some with painted concrete walls and tin roofs and others that appeared to be constructed of mud with thatched roofs. About half a mile beyond the hospital he could make out the faint outline of the river’s edge with boats and canoes crowded on the shore and the lots of people gathered there. As they drew closer to the river, the plain savanna became dense forest and then jungle with every shade of green imaginable illuminated by the late afternoon sun. A long line of people sat outside of the clinic

The hospital, to Adam’s eyes, did not appear particularly impressive. His father had shown him plenty of pictures as it was being constructed, most of which were as dull as his current view. However, as they drew closer he could appreciate that with its stark concrete-and-glass construction it was by far the largest and sturdiest building in the village and certainly larger than anything that they had seen for many miles. A large crowd of people sat on the ground outside what appeared to be one entrance, many rocking infants in their arms or setting out newspaper to lay their dinners on.

“Yeah, it’s pretty cool,” mumbled Adam.

“I never imagined… I mean, here it is. This was all jungle when I first came. Then we built a one-room clinic, then this. Look at all those people! They’ve been waiting since the morning to be seen, probably. Before this went up, there was just the clinic with the doctor once a week… and now this hospital serves villages for miles and miles.”

“Wow.”

“Yes, it’s been a big deal for everyone,” remarked Kwame. “All the construction brought work for people, and now with people traveling so much here they’ll probably improve the roads even more. Local vendors are setting up shop and the market a few klicks away has never done better.”

“Dang. And that’s… from the government? From Verilife?”

“Most of the construction was funded by Verilife; the government employs the doctor. The day-to-day operating are a mixture of donor funds, Verilife support, and the local health bureau,” explained Hannah.

The truck rolled to a stop just the dirt road began to dissolve into a clearing in front of a small lean-to covered wall-to-wall in prepaid phone cards, phone accessories, and small bags of snacks. The proprietor waved a friendly hello and shouted a greeting to Hannah, who hopped out of the truck and hugged the woman before exchanging some quick words of greeting in a dialect that Adam didn’t completely understand. They kept talking animatedly as Adam turned to Kwame, who nodded towards the back of the truck. They began lifting crates off the back and carrying them past the crowd of people still waiting to see the doctor and into the hospital.

Inside, Adam followed Kwame through another waiting room where a lone nurse was checking vital signs on patient after patient while a doctor saw patients in the next room over. They moved down a short hallway to a wooden door, which Kwame unlocked with a key from his pocket. The room beyond the door was lit by a single sodium bulb in the center of the ceiling that took several minutes to warm up and get to full brightness, casting shadows on what appeared to be all varieties of medical equipment. Some items Adam easily recognized, such as four bedside commodes and what appeared to be a stack of charts, while others he did not, like a device that appeared to be a plastic flashlight with a cone-shaped cover. They set down their crates in one corner.

“What are we bringing here, Uncle?” he asked.

“Oh, just some kind of mouth scope, I think,” replied Kwame. “Some hospital in Accra bought a new one and so we bought the old one for them to use here. The operating room isn’t up and running yet, but when it is we’ll have everything they need!” He grinned wide, exposing a mouthful of bright white and shiny gold teeth.

“And the other crates…”

“Just a few things I’ll be selling while I’m up here, things you can only get in the city,” he replied casually. “Always trying to make the most of these little trips that your father sends me on.”

“Oh,” replied Adam as they walked back out and . “I didn’t realize he kept you so busy.”

Kwame laughed heartily. “Oh, your father has lots for me to do. The printing business is up and down, but Verilife always has things here to be smoothed out… so how is your health? I did not want to ask in case you did not want to talk in front of Hannah.” His long, deep vowels made it sound like he pronounced her name “Honna.”

“Oh, no, it’s fine. She knows everything. She works on Dr. Bode’s protocol. But yeah, my health is fine. Just taking my medicine every day and letting it work.”

“Your father wanted me to keep a very close watch on you. You know he worries so much for your safety.”

“Yeah,” said Adam. “I do know.”

They emerged back outside, where yellow and orange streaks were stretching across the sky from the setting sun and accentuating the darkened tree branches and leaves that rustled in the gentle wind. The crowd in front of the clinic entrance was dying down, but an even larger crowd had gathered around Hannah to exchange hugs and how-are-yous. Babies were being passed to her to hold, little children were gleefully tugging at her legs, and she seemed more at home and settled here than Adam had ever seen her before. He followed his uncle back to the truck, where a slim woman waited to meet them.

“Kwame!” she exclaimed. “So good to see you!”

The two of them embraced, and then she turned to Adam. “And you! My God, the last time I saw you, your head didn’t even reach my waist! So good to see the son of Kofi again after all this time.” She reached out and embraced Adam in an enthusiastic hug. Adam squeezed back gently, trying to remember who she was or if he was even supposed to know. Her skin tone was slightly lighter than his or Kwame, so she was probably not an immediate blood relative– making the guessing game even harder.

“You probably don’t remember me, though… my name is Afua. I just finished nursing school when you were born, and I gave you your first polio shot.” Her accent was not quite as strong as his uncle’s; her words came out fluid and smooth through her pronounced lips.

“Wow!” exclaimed Adam. “So you remember?”

“Of course I remember. I have been coming and going from this place for a long, long time.”

“And I think Hannah mentioned you…”

“Yes!” she replied enthusiastically. Adam noted her large, enthusiastic eyes that grew bigger whenever another point of connection arose between them. She was dressed in a smart blue blouse tucked into an ankle-length khaki skirt out of which her long, slender legs peeked. A stethoscope hung around her neck, tickled by her braids. “Hannah really helped me learn to advocate for myself and advocate for my people. If it wasn’t for her, I’d probably just be another nurse in the big regional hospital… but here I am, administrator of the hospital and field director for Africa Partnership.”

She turned to Kwame. “So you put the endoscope equipment in the storage room?”

“Of course,” he replied.

“Excellent. Well, I don’t know what else you have here, but if any of it is for the hospital…”

“No, I just have a few other things for some of the shops.”

“Hannah mentioned that she has some equipment,” said Adam. “Like, for the OR and stuff.”

“Oh, good!” Afua’s eyes widened again. “I’m so glad. You know, we don’t have the theater up and running yet but when we do it will be so helpful.”

“Yes, let’s get those suitcases down from the truck and to her quarters,” said Kwame. “Hannah can sort them out later. They shall be on the second floor?”

“Yes, yes,” said Afua. “There were two doctors visiting on rotation until yesterday, but now all the rooms are empty.”

Kwame pulled Hannah’s suitcases down from the truck bed and handed them to Adam.

“I’ll show you to your room,” said Afua, walking back towards the hospital. Hannah’s gang of well-wishers had only grown in the last few minutes, so Adam passed them by with a grin on his face. He caught her eye for a moment and watched her smile back before she turned to another exuberant child at her feet.

Afua took Adam around to the other side of the hospital, where a wrought-iron gate stood in front of a stairway jutting out of the wall inside. She shooed away a chicken that was in front of the gate before she unlocked it and began moving up the stairs to the second floor. They passed what appeared to be several small offices in the first part of the hallway, where a few textbooks were scattered on the shelves; one of the rooms had a beat-up old computer sitting alone on a metal desk. They moved past these to a set of four wooden doors, two on either side of the hallway. Between them was a staiway leading down the other side to the inside of the hospital. Each was wide open. Adam could see that the first two each held a single bed and a small desk with a chair, while the second two contained double beds, closets, wicker loveseats, and larger tables pushed against the wall with four chairs around each one.

“Our honored guests get the big rooms, the best for the son of Kofi Freeman!” she exclaimed. “Take your pick.”

“And Uncle Kwame…? I don’t know if he’ll fit in one of those small beds!” joked Adam.

Afua laughed. “Oh, he’ll be fine in the small room. Here are your keys– this one is for the big door downstairs and this one is for your room. The cafeteria is on the other side of the building and you have free meals here while you’re a guest of the hospital.”

Adam strolled into the one on the right, setting down both enormous suitcases. There was a set of heavy doors, also made of wrought iron with heavy frosted glass panes, on the other side of the room. He unlocked the left one and found that it opened onto a small balcony with a simple wooden railing. The balcony connected to the other room shared a side railing with his. From here, he could see the slow, muddy water of the river stretching for miles northward , hemmed in on either side by thick foliage as it disappeared into the darkness of the horizon. The boats and canoes at the riverbank bobbed gracefully in comparison with the frenzied activity of the people gathered near them; the merchants turned on the lightbulbs from their stalls and a few small charcoal fires had started to cook all sorts of food items that they were selling as the sun disappeared behind the forest. Several chickens and a goat tethered to a pole wandered through the grass, bobbing their heads to eat irregularly. The cacophony of their voices just a few hundred feet away mingled with the sounds of birds and insects cawing and whirring, making Adam wonder why his father had never described this.

He unzipped his backpack and began unpacking its contents into the dresser. The simple wooden drawers– undoubtedly made nearby, he thought– slid with some clumsiness, but he managed to get a week’s worth of t-shirts and jeans fit into two drawers and then hang up his collared shirts and khaki pants for church on Sunday. They would clearly need to be ironed first. He made a mental note to ask Hannah or Kwame how he could get this done.

He then moved both suitcases back into Hannah’s room on the left and headed back out of his room and down the plain white hallway. He heard the door slam shut at the bottom of the stairs and seconds later saw Hannah emerge from the stairway.

“Hey there!” she said. “Getting settled in?”

“Yup!” said Adam. “I hope you’re okay with the left side.”

Hannah laughed. “I’ll be fine with anything. Last time I was here, I slept on a patient bed in the clinic, back when that was all that was here.”

She had already moved past Adam and was taking in the same breathtaking view from her own balcony, which shared a side railing with his. He followed behind her, gazing at the orange light dancing on her skin and hair. She almost looked like she was on fire and Adam could not resist reaching out a hand to embrace hers, which was clutching the railing. Her fingers moved gracefully to intertwine with his.

“This is really spectacular,” he said. “I don’t remember it being this beautiful.”

“It finds a new way to stun me every time,” she said.

“That was quite a crowd you gathered out there,” he observed.

“No kidding,” she said. “Everybody wanted to know what was happening with me. The last time I visited was last summer, when they were just starting construction. They were worried that I’d get married and not come back or something. Med school is just not nearly as flexible as college was, and next year I’ll have even less time to come back.”

“Next year?” asked Adam.

“Yeah, I took off a year to do research, but normally you do two preclinical years of all classroom learning and two clinical years in the hospital. There aren’t really any breaks during the clinical years until the very end.” She got quiet and let go of his hand. “But they know that I care, and they know that I’m still working hard, even when I’m not here.”

She turned back into her room. “We should probably be careful about being seen together in certain ways.”

“I understand,” said Adam. “My father tried to give me a pep talk about how village people think. I’m not totally sure what all he meant, but he just kept saying that ‘People can talk.’ ”

A scream suddenly cut through the sounds of the African dusk. Hannah immediately darted towards the stairwell, with Adam following close behind. She hastily unlocked the door at the bottom and rushed around to the clinic entrance. There, a young mother, who from her wet red eyes and tortured expression was clearly the source of the scream, sat with a child at her side and another woman in her arms, flailing her arms. Adam and Hannah watched helplessly as the woman rolled on the ground, her limbs shaking violently with no clear pattern or plan.

“She’s seizing,” muttered Hannah. “Oh God, I don’t know anything about this…”

Afua quickly emerged from behind them and took the seizing woman by the shoulders, laying her flat on the grass. After quickly looking in the woman’s mouth and listening with her stethoscope, she called for Kwame, who rushed to her side. They lifted the woman inside, with Afua asking rapid-fire questions of her companion in a local dialect. The doctor, who had almost finished the last of the day’s patients, met them at the door. Adam, dumbstruck at all the activity happening around him, felt a tug on his collar and he quickly followed Hannah inside. Afua shut the door behind them as Kwame laid the patient on a stretcher in one of the examining rooms.

Kwame gestured to Adam and Hannah to take a seat on the opposite side of the room while the doctor worked with Afua. They sat down, staring in awe as the doctor quickly moved head to toe with just a penlight, a stethoscope, and his hands to examine the young woman, who had stopped seizing. The whole time he continued up the incessant questioning of the other woman, this time in English, who now carried her child in her arms and revealed in between frantic breaths that she was the patient’s sister. The patient had been having headaches for weeks and had been vomiting in the mornings, but had not thought anything of it until tonight, when she began to feel dizzy. She had come to the clinic and began seizing on the lawn. The sister was asked several times about fevers and several times about seizures before. Each time the answer was no.

Afua was hurriedly placing an IV and drawing blood; Adam felt powerless and wished that he could help. His only medical experience had been on the receiving end of these questions and procedures. As he looked over to Hannah with her clenched fists, he was sure that she felt the same way, if not more. The other clinic nurse dashed off down the hallway and returned with several small vials, which she and Afua worked with carefully but quickly to attach to the woman’s IV tubing. The doctor began loudly asking questions of the patient, speaking clearly and slowly.

“Marian! Can you see anything?” he asked gruffly.

The patient groaned..

“Marian, I need you to squeeze my fingers here.” He placed his index and middle fingers squarely in her palms and shook them, as if to help give her a clue as to where they were. Adam could see, even from a distance, that her left hand moved much more easily than her right to squeeze. It was the same with her feet.

“Maybe she has meningitis,” said Hannah.

They watched as the woman was sedated with more IV medication and rolled onto one side. Her sister was led outside and Afua continued to talk to her for several minutes whilst the doctor gowned himself and cleaned the patient’s back. He placed a white drape over her, finally dragging a chair from the waiting room.

“What’s happening?” asked Adam.

“He’s doing an LP.”

“What’s that?”

“Oh, sorry– a lumbar puncture. The needle is going in between her lumbar vertebrae and they’ll run tests on the spinal fluid. Although, gosh, I wonder what tests they can run here? They used to send blood to the hospital in the capital, but I know they have a small lab here.”

Adam watched carefully, fascinated as the long needle carefully penetrated the woman’s back. The doctor had to adjust the needle in and out several times before he got what he wanted: a few small drops of clear fluid that he collected in a small glass tube. He stripped off his gown, pulled the drape off, and carefully took the tubes in his hand. As the patient rolled back and slowly awoke, she began saying something indistinct to the doctor. He gently took her hand and responded to her in a whisper, then left the room. He turned to her sister, still sitting there with silent tears gathering on her cheeks.

“I will be back in just a few minutes to talk to you,” he said calmly. “Your sister is doing fine right now and she is awake. She would love for you to come sit with her.” She nodded in response and slowly gathered her baby in her arms, then slowly walked into the examination room. The doctor gestured to Hannah, who quickly got up and followed him down the hall. Adam tentatively followed behind them.

“I’m Dr. Osege, the staff doctor,” he said as they walked, turning into a small room opposite from the storage room where Adam and Kwame had dropped the crates off earlier.

“Good to meet you, sir. I’m Hannah. I think that we’ve corresponded a few times by e-mail. You’re doing some of the follow-up testing for Hepatolife, aren’t you? This is Adam Freeman.”

“Yes, indeed,” he said. He turned to Adam and looked him up and down, then back to Hannah.  “And yes, I have been the one sending you all those details about the study patients. I know you’re a medical student, so you’ll probably want to see this. I didn’t want to bring you in the room there with the LP because it would get too crowded, but you can take a look under the microscope with me.” The tiny room held a few small machines that Adam did not recognize, as well as a centrifuge and a microscope. The doctor placed his tubes in the centrifuge and turned it on.

“So what’s going on?” asked Hannah.

“She’s had headaches for a while and now she has seizures. Her exam shows signs of mass effect.”

“What’s mass effect?” chimed in Adam.

“There’s a mass in her brain having an effect,” answered the doctor bluntly, gently pouring the contents of one tube out and then spreading what remained onto a slide. The well-worn microscope clicked on, and he spent a few quiet minutes adjusting it. He then dropped a few small solutions onto other slides, letting them sit as he faced Hannah.

“Take a look,” he said to her. “No red blood cells. I’ll do the gram stain here and look for bacteria. Could be an advanced presentation of AIDS, like cryptococcal meningitis or lymphoma, but if I remember this woman properly, she’s had a negative HIV test in the last few years and normal labs with every check. Could be an abscess or parasitic infection. Although it is very strange that she’s had no fevers.”

“Jesus,” muttered Adam. “That’s horrible.”

“She’s stable, at least,” observed Dr. Osege. “We can probably transfer her to the capital where she might be able to get a scan of her head and tell for sure. After that, if it’s something they can take out she might get transferred again to Accra to see a neurosurgeon. We just have to keep her here and give her some steroids to see if the swelling will go down.”

He swapped out another slide, carefully peering through the microscope. “No bacteria on gram stain. We’ll have to check the cultures, of course. See what her other tests show when we run them. The tech will be here in the morning.”

He walked out the door and turned back to Adam.

“Tell your father I send him greetings and thanks,” he said quietly. He then disappeared down the hallway to talk to the patient and her sister. Adam turned to Hannah, who gripped his hand tightly. They silently turned back the other way, walking through the dark hallway until they reached the inside stairs. Up they went, still holding hands the entire way along the dimly lit corridor until they reached the doors to their rooms. Without a word, they each went their own way.

 

***

 

Gainers fiddled with the buttons on his shirt as he tried to dress himself, wondering if perhaps he should go back to a t-shirt for today. His large, stubby fingers were a little swollen today and were giving him extra difficulty with his buttons. He slowly and methodically clenched each one between his thumb and index finger of his right hand, then tugged gently at his shirt with his left hand to hold the hole open. He then guided each button through carefully, one by one with increasing precision. With his shirt buttoned, he could now go upstairs and eat breakfast.

The basement of their house was rather large, though most of it was occupied by piles of old clothes, boxes full of stuff the family had accumulated and never thrown away, and the rather large furnace in one corner. His bed, a rickety metal frame over which a mattress was spread, sat in the opposite corner from the furnace. It had been passed down to him from Tanisha and pulled out of a corner of the basement last year when he moved back in with Jessi. A small television was propped on a TV tray at the foot of the bed and adorned with a single picture of Gainers from when he was in his 20s, defiantly smiling at the camera like he had won the lottery and was going to spend it as he pleased. He may have even had the picture taken after he had won a local numbers game, but he could not remember. A single bulb lit Gainers’ corner of the basement, which he neglected to turn off with the switch at the top of the stairs on his way up.

He opened the cabinet and examined his medication bottles, carefully pouring out his pills onto the counter and then reaching over for a glass to fill with water. He heard the front door open and turned to see Jessi coming back into the house, dressed in her usual neat gray scrubs.

“How ya doin, sis?” he called.

“Oh, Gainers, my shoulder be painin’ me,” she said. “I just don’t know what I’m gonna do. Them pills the doctor gave me ain’t done me no good. Lord, it hurts!”

Gainers turned and walked over into the living room from the kitchen, offering his hand.

“I’m sorry,” he said quietly. “Can I get you somethin’?”

“No,” she replied. “I… just…”

She began to sway and then, before he could realize what was happening, Gainers felt Jessi tumble into him and knock him over. He fell backwards, tumbling into the couch with her fall cushioned by his protuberant belly. He winced in pain as they collapsed.

“Jessi!” he exclaimed. He shook her head roughly, desperate to wake her up. “Jessi!”

He pushed her away and pushed himself upwards off the couch, watching helplessly as she slunk down onto the floor, her right arm caught awkwardly on the coffee table. He rushed to kitchen and hurriedly grabbed the phone from the wall, struggling to dial 911 with his edematous fingers.

“Hello, 911. Police, fire, or medical emergency?” came the operator’s calm but hurried female voice.

“Medical! My sister done passed out!”

“Okay, sir, where are you at?”

“1520 Mc-Mc-Mc-Kean,” he stammered.

“All right, an ambulance is being dispatched right now. Is she breathing?”

“I dunno, lemme check.”

Gainers moved back over and, with some effort, rolled his sister onto her back, so she was half-occupying the kitchen and half the living room. He watched as her chest rose and fell, then  ran back to the phone.

“Yeah, she breathin’,” he reported.

“Does she have a pulse?” asked the operator.

“A what?”

“A pulse, sir. Is her heart beating? You can check with your fingers on her wrist or her neck to feel if there is blood flowing.”

“Oh, uh… okay.” He put down the phone again and walked back over, clumsily running his hands up and down her arms to try to feel a pulse. He remembered that he had done this before with several friends who had overdosed and were unconscious; he could not remember ever being successful in finding a pulse, but he was optimistic that this time might be the one.

“Mmmm…” murmured Jessi.

Gainers turned his head to her face. “Jessi? You there?”

“Mmm… ow, it hurts.”

“Jessi! You okay?”

She only moaned in response. Gainers hurried back to the phone.

“I can’t find no pulse, but she talkin’!” he announced.

“Okay, stay with her. If she becomes unconscious again and you cannot feel a pulse, you can do chest compressions to keep her blood flowing.”

“Gainers, who you talkin’ to?” demanded Jessi, her voice louder but still weak. He watched as she struggled to lift herself up.

“I’m on the phone with 9-1-1!” he shouted back. “You stay right there! Am-bu-lance is comin’!”

He heard the distant wail grow closer, and when he looked up at the window a faint red light began to flash through the curtain. The sound and the light grew more intense, getting closer and closer until there was a sharp knock at the door.

“Thanks, ma’am,” said Gainers quickly, hanging up the phone and rushing to the door. He nearly tripped over Jessi and the coffee table on his way, hurriedly turning the lock and opening the door to see a stern-faced white man with an enormous jaw and a stiff crew cut on his front step. His blue polo shirt had a familiar logo on it; Gainers was fairly certain that this paramedic may have transported him to the hospital once or twice in his career.

“My sister done fell out, and now she’s awake… help her, please!” he implored.

“Alright, just step out of the way, sir,” asked the paramedic. Gainers clumsily shuffled to the other side and stood by the other couch as the paramedics came in. They first pushed the coffee table out of the way, then crouched down next to Jessi.

“What’s your name, ma’am?” he asked.

“Jessi Goodson,” she whispered.

“Ma’am, tell me what happened.”

She took a deep breath. “I was just walkin’ home from work and my shoulder was painin’ me real bad. Then when I got in the house, I was talkin’ to my brother here and I just fell out.”

“Did you feel anything before you passed out?” he asked.

“No, nothin’ but the pain.”

“Are you having any chest pain?” he asked.

“No,” she said.

“Are you feeling lightheaded or dizzy at all?”

“Maybe just a little bit,” she said.

“Does your neck hurt at all?”

She shook her head.

“Anything else bothering you?”

“I feel real nauseous, like I’m gonna throw up.”

“Okay,” he replied, quickly listening with his stethoscope to her chest and then standing up. “Let’s get a backboard!”

His comrades responded quickly, bringing in a bright yellow plastic board with straps dangling from every side in through the front door. They gently laid it next to her, then moved her onto the board, clearly trying to keep her spine straight. Gainers had seen this before. His fingers kept twisting nervously in his lap as he watched carefully, beginning to mouth whispered prayers.

They slid the back of a firm white collar lined by blue padding behind her neck, then snapped it shut over the front of her neck. Straps on either side were tied, pinning her arms and legs to the board. The team of paramedics finally lifted her up and began to carry her out the front door to a waiting stretcher on wheels, which they gently pushed across the sidewalk and into the waiting ambulance. Gainers followed her out.

The team of paramedics lifted her up and began to carry her out the front door to a waiting stretcher on wheels, which they gently pushed across the sidewalk and into the waiting ambulance. Gainers followed them out, barely noticing the few neighbors on the block that were standing on their stoops and watching the scene carefully. As he watched her disappear into the back of the ambulance headfirst, he called out.

“W-wait! Can I ride along?”

“You her brother?” asked the big paramedic.

Gainers nodded. “I ain’t got no ride.”

The paramedic sighed, then turned to one of his female colleagues. They exchanged a knowing glance before turning back to Gainers and mumbling something in the affirmative. Gainers trembled as he climbed into the back of the ambulance and took his sister’s hand. She already had an oxygen mask strapped to her face and one more paramedic was attaching leads to her chest, her scrub top tugged down beyond all modesty.

Gainers took a moment to gaze in awe around the inside of the ambulance, filled on every wall with an apparent treasure trove of medications and equipment. A small monitor attached to Jessi’s leads was already starting the register the familiar green lines representing the electrical impulse of her heart, which Gainers studied carefully as if he were able to interpret the squiggles. The back doors shut decisively and the engine roared to life as the siren turned on again and they lurched down the street.

“Oh shit,” said the female paramedic. “The EKG is reading ST elevations.”

“Alright, we gotta divert to University,” said the driver, picking up his radio and rattling off a series of abbreviations and acronyms that Gainers had no hope of comprehending. The muffled, indistinct voice on the other end of the radio acknowledged that they had received the information and encouraged him to carry on.

“What’s going on?” asked Jessi, the fear apparent in her voice.

“Miss Goodson, we can’t say for sure but it looks like you’re having a heart attack. We’re taking you to the University of Maryland.”

“Oh, my God,” exclaimed Jessi with a sigh. “Oh, oh, oh, help me Jesus.”

Gainers felt her fingers clench his, as if she could somehow draw more life from him if she squeezed tighter. Not knowing what to do, he squeezed back. He had no idea what to say. He was not used to being the one sitting upright while she was surrounded by medical personnel. He simply held on tightly until the fluid was pushed out of his fingers, hoping desperately that his gesture could convey his love for her.

After five minutes of halting, start-and-stop movement the back doors swung open again and the paramedics quickly moved to get Jessi out of the ambulance. Gainers watched as they carefully moved the stretcher out, its thin metal frame extending down to the ground as they did. He tentatively followed behind her, stepping into the blinding light of day fighting with the bright red sign declaring EMERGENCY over the sliding glass doors leading to the ER. A nurse met the stretcher at the door, quickly writing down information onto a thick folding clipboard as it was barked out by the paramedics. Gainers heard a few words in their conversation that he recognized, but most of it was spoken so quickly that he didn’t even try to decode their lingo. They entered a large room with a glass door opened wide; there were already a few people dressed in scrubs and white coats of various lengths waiting for them.

“Miss Goodson, is that right?” asked a young black woman wearing the longest white coat in the room.

“Yes, ma’am,” said Jessi, still strapped firmly to the backboard with her collar snugly attached.

“Okay, I know a lot is happening right now, but I just need you to answer some questions for me. My name is Dr. Polk and I’m the ER attending today. Behind me is my team. I heard that you passed out at home.” She took Jessi’s hand and turned to Gainers. “And you are?”

“Uh, I’m, uh, her brother. Younger brother.”

“And your name is…”

“Gainers. Gainers Goodson,” he answered, not used to being addressed so directly.

“Alright, Gainers, you were there?”

“Yes,” he said.

“Okay, I’m gonna want to hear your side of the story, but first let’s hear it from Jessi. Miss Goodson, what happened today?”

“I worked all night, like I usually do-”

“And what do you do, Miss Goodson?”

“I’m a tech over at Franklin Square Hospital.”

“Okay, keep going.”

“Well, I worked all night and then I rode the bus home. My shoulder been hurtin’—and it was just hurtin’ worse and worse today, and I was feelin’ real tired when I walked home from the bus stop. I went to say hello to my brother and then I done passed out right then and there.”

Nurses on either side of Jessi were putting IVs in her arm.

“Okay, when was the last time you ate or drank anything?” asked the doctor.

“I ate breakfast at the cafeteria before I left work this mornin’,” answered Jessi. “A biscuit, an apple, cuppa coffee, and some sugar-free juice.”

“Alright, so you probably weren’t too dehydrated or anything. Did you feel anything before you passed out?”

“No.”

“Were you having any chest pain?”

“How come everyone keep askin’ me that?” retorted Jessi. “I said the pain be in my shoulder, not in my chest!”

There were a few muffled laughs among the medical team. Dr. Polk smiled. “Honey, it’s because it looks like you’re having a heart attack and that’s why you passed out.”

“So you’re tellin’ me that my pain in my shoulder comin’ from my heart?”

“Probably.” Dr. Polk nodded along with her answer, as if to say that she fully believed her answer but wanted to word her answer so as to not be trapped by her words later. Gainers, having met many emergency personnel, was used to this sort of discourse.

“Sweet Jesus… I’m too young,” muttered Jessi.

“How old are you, sweetie?” asked the doctor.

“Fifty-six.”

“And what other medical problems do you have?”

“Uh, sugar diabetes, blood pressure, high cholesterol, acid reflux.”

“And what medications do you take?”

“Oh, Lord if I can remember… lisinopril, HCTZ, Prevacid, Lexapro, metformin, glipizide, aspirin… I think there’s one or two more, I can’t remember.”

“Do you have any allergies?”

“Just penicillin. I get a rash.”

“And have you ever had any heart problems before?” asked the doctor.

Jessi shook her head. “Done got an EKG every few years says my heart’s good.”

“Oh, and who has those?”

“My primary care doctor.”

“Okay, who’s your primary care?”

“Uh… I’m not really sure who it is, they keep changin’ it around on me. But it’s at the Baltimore Community Family Health Center.”

“Okay, let’s get her to sign a release so we can get those records,” announced the doctor, to no one in particular. However, moments later someone appeared with a clipboard and shoved it in Jessi’s hands for her to sign. She scribbled her signature hastily.

“Now Gainers, you want to tell me what you saw?” asked Dr. Polk.

“Well, uh, I was just at the house getting’ some breakfast when I hear the door open and in comes my sister. She ain’t lookin’ too good, neither, and she be complainin’ ‘bout her shoulder.”

“What do you mean, she ain’t lookin’ too good?” asked Dr. Polk, her eyebrows raised.

“Uh, y’know, she just look all worn-out. I mean, she usually tired when she be workin’ the night shift, but she just don’t look good. All sweaty and mumblin’. I dunno.”

He looked over to see that Jessi’s chest leads were again being attached to a machine that was spitting out a familiar-looking piece of paper with red lines crisscrossing across the page. Several of the other doctors and nurses peered at it before handing it to Dr. Polk, whose eyes darted between the page, Gainers, and Jessi.

“So, uh, then she just fall out and fall into me.”

“You cushioned her fall, then?”

“Uh, yeah, I guess, in a manner of speakin’.” Gainers patted his stomach.

“And then what?”

“And then I try to wake her up, but she not wakin’. So I called 911 right away, and while I was on the phone she came to.”

Dr. Polk turned back to Jessi. “Miss Goodson, do you remember hearing your brother while you were out?”

Jessi shook her head. “It was just black, and I couldn’t hear nothin’ til’ he was on the phone yelling about my pulse.”

“Okay. Well, looking at your EKG here, you’re definitely having a heart attack and I’m going to go call the cardiologist right now to see if there’s anything they can do for you today. If you have a blocked artery, they might be able to go in and open it up.”

“You mean surgery?” asked Jessi abruptly.

“Usually what they try first is going in through a catheter in your leg,” explained the doctor, tapping on Jessi’s thigh. They take a picture of your heart with some dye and then see if they can put a little stent to pop open your artery.”

“Oh,” said Jessi. “Lord have mercy.”

“Let me just listen to you,” said the doctor, taking off her stethoscope and placing the bell on Jessi’s chest. After a few seconds, she moved it around her chest, her face pensive and concerned as she listened. A few of the other doctors took their stethoscopes to listen simultaneously, dancing around one another to examine Jessi.

“Are you having any neck pain?” asked Dr. Polk, her long fingers reaching through the collar to feel the back of Jessi’s neck.

“No, ma’am,” answered Jessi.

“Okay, open your mouth wide,” she ordered. Jessi did so as the doctor peered into the back of her throat with a penlight.

“Okay, we can take this collar off and take her off the backboard after you do a back survey,” announced Dr. Polk. She began to bark out orders. “Mark, put her in for the usual labs and meds. Ginny, teach the students how to do a survey and get that backboard off, then get some more history. I’m gonna call cards and get them down here right away, let’s make this door-to-balloon time less than an hour if we can.”

She took Jessi’s hand again. “Ma’am, right now you are very sick, but we are going to do everything we can to get you better. Any questions?”

Jessi shook her head again, which the team took as a signal to disperse in a flurry of activity. Gainers watched carefully as Jessi’s scrub top was cut off with scissors and one of the doctors taught two of the medical students how to feel along someone’s back for broken bones. Finding none, they slipped the backboard out and allowed Jessi to sit up in bed. They then asked her a few more questions about her medications and medical conditions before scurrying away and pulling a curtain over the door, leaving the two of them finally alone together, like they had been just half an hour ago. Gainers watched the green lines of her EKG monitor dance along the screen, beeping their reassurance of her heart rate at a steady 70 beats per minute.

“Jessi, I… I’m scared,” he said.

“I know you is, Gainers. I’m scared, too,” she replied matter-of-factly.

“It’s just… y’know, you always been there for me. Even when we was gettin’ high together, I always looked up to my big sister. And you took me in again when no one else would, and now…” Tears began to well up in his eyes.

“Gainers, the Lord gonna watch over us. Don’t you be worryin’ about tomorrow’s troubles, today gots enough of its own.”

A nurse appeared at the edge of the curtain, a tiny cup in her hand.

“Hi, I’m Kari and I have your nitroglycerin and aspirin here, Miss Goodson. Take this one by mouth and put this other one under your tongue.” She handed the two pills in her cup to Jessi, who did as she instructed.

“You’ll feel a headache from the nitro, but that’s to be expected.”

“Mmm,” said Jessi right afterwards. “No kidding. But my shoulder finally feels better!”

“Good, glad to hear that. Can you tell me your pain score?” asked the nurse.

“Uh, I dunno… I guess it was an 8 before and now it’s a 2. In my shoulder. Now my head be hurtin’.”

“Okay, great!” said the nurse. “I’ll be back in a few minutes.” She disappeared behind the curtain, only to be replaced seconds with by a tall, skinny white man with no hair on his head. He was flanked by a man of vague Middle Eastern descent who also had no hair, but instead sported a long and impressive black beard.

“I’m Dr. Shpritz, and this is my fellow, Dr. Ahmad,” he announced. “We’re from cardiology. I understand, Miss Goodson, that you have been having some shoulder pain and shortness of breath?”

“Yes,” said Jessi.

“Okay, and this has been going on for a few weeks?” he asked.

“Mm-hmm.”

“Okay, and then you passed out today?”

“Yes.”

“Any chest pain?”

Jessi smiled. “No sir.”

“You feeling short of breath right now?”

“Nope.”

“Okay, let’s take a listen to you.” They both whipped out their stethoscopes and again listened intently to Jessi’s heart and lungs. Standing back, the attending cardiologist nodded to his fellow with the big beard, who hesitantly made his pronouncement.

“Well, I agree with the ER– you’re having an anterior ST-elevation MI and need a heart cath right away.”

“Huh?” replied Jessi.

“Oh, uh, well, that just means that you’re having a heart attack– the ST-elevation just describes part of your EKG where the electrical signal is abnormal because there’s not enough blood flow to one part of your heart. Standard treatment for that is a heart catheterization, where we shoot dye into your heart through a catheter in your leg and see if there are any blocked arteries. If there are blockages, we try to open them.”

“Damn, you can get to her heart through a catheter in your leg?” exclaimed Gainers. “Does it go through, uh, y’know, your p-”

“Gainers!” scolded Jessi. “Don’t you be interruptin’ them.”

“It goes through the femoral artery,” declared the fellow. “Now, obviously, the risks with any procedure include bleeding and infection any time we cut through your skin. We need to use extra blood thinners to prevent more clots when we put any stents in, but we will tape down the area where we put the catheter in very tightly. There’s also some risk of kidney damage from the dye that we use. Your lab tests show some damage already to your kidneys, but we still think that this procedure has the best chance of saving your life and saving your heart muscle.”

“Okay,” said Jessi. “Just do what you think is best.”

The fellow produced another clipboard, drawing an X where Jessi was to sign her consent for the procedure. He had scrawled in the risks and benefits of the procedure above the line. She signed her name carefully in her neatest cursive before handing it back to him.

“Okay, we’ll see you in the cath lab.”

They disappeared behind the curtain again, replaced moments later by a pair of young men in light blue scrubs, their nametags dangling from lanyards.

“We’re here to pick you up and take you to the cath lab, Miss Goodson,” stated one. “State your name and date of birth, please.”

“Jessi Goodson. April 21st, 1955.”

“Okay, sir, you can ask someone to direct you to the waiting area on the third floor.”

“Um, alright,” said Gainers, giving his shoulders a shrug. The bed beneath Jessi made several loud pops as the two transporters released the brakes, pulling her out of the room with little effort. Gainers shuffled behind them out of the room and into the busy ER hallway. Just adjacent to their room was a wide set of double doors activated by a plate on the wall, which one of the transporters swiped his badge over. The doors clanked open as Gainers reached over and squeezed his sister’s hand one more time before she was wheeled away through the doors, which slowly creaked shut and locked themselves with a loud click.

 

***

 

Adam awoke gently, the light and heat in his room slowly building to a crescendo that made sleep uncomfortable with the windows and doors shut. He rolled over and stared at his curtains, the morning sun blazing brightly even through them. His sheets felt heavy with sweat, so he pulled them off and got out of bed, pacing around his room for a few minutes before slipping on a pair of sweatpants and a t-shirt and opening his porch doors. Sunlight spilled into the room along with a gentle breeze coming off the river, refreshing him as it did. He stepped onto the porch, gazing once again at the busy river traffic just ahead.

“Good morning,” came a voice at his left. He turned and noticed Hannah, sitting on her own balcony with a book in hand, smiling ferociously. Her hair was freshly washed and she was dressed in a long, blue dress gathered at her waist. The fabric appeared to have come from someplace around here, although Adam could not be sure.

“Good morning to you, too,” he replied. “How’d you sleep?”

“Eh, the jet lag usually gets me pretty bad. Woke up at 3 and couldn’t get back to sleep. Spent a lot of time just reading. How about you?”

“I’m sorry,” he offered. “I… don’t even remember my head hitting the pillow.”

“Good for you,” said Hannah, still smiling. “It might be another day or two ‘til it catches up with you.”

“We’ll see,” he said with a smirk. “I hope not. What’s on the agenda for today?”

“I’ve got some meetings with Dr. Osege and Afua in the afternoon, but I was thinking we could go up to the market and start asking some people about what their impression of the hospital has been. I’m curious about what folks think and whether or not it’s having a positive impact on the community.”

“Okay, sounds fine,” he said. “Let’s check on that woman, too.”

“She’s doing okay,” reported Hannah. “I already went down and asked this morning. One more small seizure overnight, but the rest of the time she’s awake and talking. Just very sad.”

“I… can imagine,” said Adam wistfully.

Hannah bit her lip gently. “I guess you can.”

Her eyes drifted away from his momentarily, towards the river, and then back. He could not determine what her face could convey about her thoughts– she seemed sad towards him, as if his statement had inspired some strong pity in her. But she also seemed eager, as if she were waiting for him to say more. He was not sure what else to say.

“Yeah,” he mumbled. “But… y’know, I think I like being with you because you know. You can feel it when other people are uncomfortable with your illness. Back when I had more swelling and my eyes were yellow all the time from jaundice, I felt like I could never be normal or anything. And even now, people find out and they can be weird about it sometimes.”

“What kind of weird?”

“I dunno, like.. not like they can catch from you or anything, but like there’s something about me dragging down the party. I wish I could explain it.”

“You don’t have to.”

“I want to. You actually want to know this stuff. My father never had patience for it, my other friends were never really close enough to understand, and everyone else in Solomon’s waiting room is a drunk. But you… you don’t care. You treat me like a person, not like a patient. And you treat my thoughts like they’re interesting.”

“Thanks,” said Hannah, her cheeks slightly blushing. “That’s kind of you to say.”

“I just wish I could figure out why you’re interested in hanging out with me at all.”

Hannah laughed quietly. “Well, if you’re dying to know…”

She let her words hang in the cool morning air for a few moments. Adam could not decide if she was just playing with him or if she was still trying to find the words herself. Worse still, if she didn’t have a reason at all.

“…I’m still trying to figure it out for myself. But you’re so unassuming.”

“You’ll have to clarify that for the people that didn’t get a 38 on their MCAT.”

She giggled. “You just… don’t have any pretensions. No secrets. You’re not desperate to prove yourself with your achievements, you’re not afraid to be vulnerable. And you’ve got a good heart.”

“Well, thanks,” he said, feeling her words spread through his body like a cup of warm coffee, invigorating him as she spoke. He could not help himself from smiling wider, which she reciprocated. She set down her book and brushed his hand gently where it sat on the shared balcony railing, then stood and turned.

“Let’s get some breakfast,” she said, her smile not breaking.

“Whatever you say,” he replied. She moved back inside her room, closing the doors behind her.

Adam stood up to follow her, suddenly noticing a peculiar sensation. As he looked down, he could see that his sweatpants bulged uncomfortably outwards just below his waist, which he immediately tried to cover with his hands in case anyone was watching from below. Somehow, in just the few minutes of talking, that had happened.

“Damn,” he whispered to himself as he went back into his room. He slipped on sandals, waiting for a moment to allow his pants to right themselves before opening his bedroom door. Hannah waited there in the wallway with a small cloth purse slung over her shoulder.

He reached out his hand to take hers, only to be met by her hand movin up his arm to his back. She pulled him close, letting him breathe in the light scent of her flowery perfume. He instinctively reached his arms around her, returning the embrace with enthusiasm as his pants became misaligned yet again. Her fingers ran up and down his shoulder blade, almost as if tickling him. He loved it.

“So, uh, breakfast,” he said.

“Breakfast!” she exclaimed. “Yes, let’s go. Mama Abayang makes delicious omelettes.”

“They have omelettes here?” he asked. They began to walk down the hallway and turned to the stairwell.

“Adam, did you see the chickens running around in the hospital courtyard? Of course there are omelettes!” Hannah unlocked the door outside and they turned left towards the river. At that side of the hospital was a screened porch with several circular tables and white plastic chairs arranged around them. As they walked into the porch through a screen door, they were greeted by a friendly woman behind a counter running the length of the porch. Behind her sat three stoves and more counter space, where a variety of delicious smells emerged.

“Oh, Miss Hannah, it is so good to see you again!” she called out. “What can I get you and Mister Adam?”

“Mama Abayang, so good to see you too! How is your family? Are your children well?”

“Yes, they are well. And your parents, God willing?”

“They are fine, thank you.  We will both have your special omelette.”

“Of course! And Adam, so good to meet you!” Adam was slowly becoming less unnerved by the fact that everyone here knew exactly who he was without ever having to ask. “How is your father? I hope he is well.”

“Yeah, he’s doing great,” answered Hannah. “Kofi sends his greetings!”

“Praise the Lord!” said Mama Abayang with enthusiasm.

Adam watched as Hannah repeated this pattern of conversation with just about everyone in the cafeteria, each person diligently inquiring about the health of the Hannah’s mother and father before sharing their individual joys and griefs since last they had seen her. Each old friend peppered their speech with various religious inflections, mostly Christian but a few Muslim phrases got thrown in as well. The well-worn thin plastic plates were soon filled with warm, salty eggs on a roll, which Adam brought back to the table where Hannah had planted herself. Afua and Kwame were already sitting down, each sipping from a large cup of tea. Hannah poured Adam a cup from a metal kettle as he sat.

“How did you sleep?” asked Afua.

“Just fine,” said Adam. “I was pretty worn out from the journey.”

“I’m sure,” she replied. “It is always exhausting to go from here just to Accra. I can’t imagine flying to Baltimore, too!”

“I’m just glad to be here,” he said. “My father– and now Hannah– have told me so much about this place. And it really is as wonderful as they say.”

“I wish he would have brought you before now,” said Afua. “But I understand we have Dr. Bode to thank for you even being here today.”

“Yeah,” replied Adam. “Do you know him?”

Afua smiled. “We’ve spoken on the phone many times. I have tried so hard to get him to come here and visit Mother Africa, but he refuses. Too busy! Always too busy! He should come see the people who tested his medicine. But I guess he trusts Hannah’s word when she tells him that they are still fit and strong. Myself included!”

“You?” exclaimed Adam.

“Of course!” said Afua. “Hannah and I took the pills on the first day of the study with everyone. Of course our results are not valid for use in the study, but we had to prove that we were willing to take it if they were.”

“That’s pretty bold,” observed Adam.

“You have to do what you have to do,” said Hannah nonchalantly. “We were all pretty invested in getting the trial done right.”

“Well, I certainly appreciate your… enthusiasm and perseverance,” he said with a smile.

“I think I speak for everyone here when I say that we were all very glad that this Hepatolife works and Verilife gets some credit for it,” said Afua. She set her teacup down slowly. “I’ve got to get over to the clinic and start giving some shots. Hannah, I’ll see you at 2pm?”

“Yes, yes,” replied Hannah. “Looking forward to hearing more of the details.”

“Of course!” Afua rose from her chair and hurried off, thanking Mama Abayang before she rushed out the screen door, which closed behind her with a decisive bang. Adam turned back to his omelette, which was peppery and filled with a meat that he did not immediately recognized but reasoned was likely to be goat based on its texture.

They finished their breakfast in relative silence before returning to their rooms upstairs. Adam showered in the tiny bathroom inside his room, dressing himself in a t-shirt and jeans. He stared in the mirror intently before he stepped out of his room.before meeting Hannah down by the river’s edge.

She was staring intently at a small wooden stall with an enormous number of animal parts hanging on the wall in various stages of preservation or decay. In front of the stall was a large table with numerous glass jars stacked in no particular order that Adam could determine, with rows and rows of mostly brown or clear liquids. Some had more official-looking labels, while others just hand-scrawled words across the cork on top. As he drew closer, he was able to appreciate the details of the animal parts more closely, which only added to their horror and intrigue. Shriveled paws, wiry tails, and every imaginable color of fur was on display, some natural and others dyed. Hannah appeared to be having an on-and-off conversation with the vendor as she inquired about various elixirs.

“And what’s this one for?” she asked, holding up an old Coca-Cola bottle with an ill-fashioned cork stuck in it. Inside the dark red liquid swirled around.

“Oh!” exclaimed the vendor, an older man with wild, wiry graying hair resting on a small wooden stool. “This one for blood pressure. Hibiscus. Very good. I brew it myself.”

“That would, uh, explain the Coke bottle,” she said. “And this one?”

She picked up a pink-labeled bottle that read “Fem-Aid.”

“This one for when woman is having baby. Makes mother relaxed.”

Hannah unscrewed the top and sniffed cautiously.

“My God, it smells like whiskey,” she announced. Adam watched as Hannah carefully considered the bottle and it’s contents, murmuring under her breath with growing intensity as she thought about giving it to a pregnant woman. She rather ostentatiously unscrewed the cap and let the brown liquid fall to the ground as she tipped the bottle. A look of shock and outrage rose from the vendor’s face.

“What you think you doing?” he demanded forcefully, rising slowly from his stool.

“You can’t give alcohol to pregnant women!” declared Hannah. “It isn’t safe.”

“Not alcohol!” he retorted.

“You sniff that bottle and tell me it’s not alcohol,” insisted Hannah, her arms now planted firmly on her hips.

The shopkeeper looked down, defeated, and then backed up at Hannah.

“Okay, but you must pay for lost bottle.”

Hannah shook her head. He began to yell loudly in another language, gathering the attention of several others around them. However, the other merchants simply shook their heads, some laughing quietly under their breath. Hannah walked off and away from the near-hysterical shouting, leaving Adam alone with his dramatic herbalist.

“Not fair!” he exclaimed, breaking into what was surely a stream of curses in his mother tongue.

“Shut up! She’s Hannah Wells. She says it’s no good for mamas, you better listen,” called a woman across the way.

“Here, let me buy something from you, to make it better,” offered Adam. The hysterics stopped suddenly.

“Okay, what you buy?”

“Uh, I don’t know… something to make a woman fall in love with me.” He blurted out the first thing that came to mind, deciding half a moment later that it was probably a silly request. He then decided that he would like to see what the vendor did with it.

“Hmmm… very common desire,” he said. “Let me see… aha!”

The shopkeeper pulled out a twisted, hair-covered fetish from the wall. It was dangling from a thin leather strap and appeared to be an animal paw of some kind.

“From monkey. Gives you love. Hide it beneath woman’s pillow and she crazy for you.”

“Sounds like a great way to make a woman throw me out,” quipped Adam. “How much do I owe you?”

“You give me twenty cedi or 10 dollar.”

“Jesus!” exclaimed Adam. “That’s quite a lot. 5 American dollars.” He waved the bill in his hand, which the vendor quickly snatched away. He stuck the fetish in Adam’s hand just as quickly, then shook.

“You go tell that woman stop messing with me,” he ordered, frustration obvious on his face as he pointed at Hannah, who was now a few stalls down laughing with another old friend.

“I can’t tell her to do anything,” said Adam with a small laugh. “Don’t know if I’ll ever try.” He looked and saw that Hannah had turned down further away, closer to the water now. He rushed off to follow her, quickly catching up.

“What was that about?” he asked when he reached her.

“The traditional healer has been a thorn in our side ever since we started things in the village,” answered Hannah. “His potions are worthless and he’s always trying to scam someone. He really didn’t want the clinic to go up in the first place and kept telling people that our vaccines make men impotent.. But since we actually help people and don’t just give whiskey to pregnant women, he’s probably losing business by now.”

“Oh, okay,” said Adam. “Wouldn’t it be better to take Afua or Kwame with you when you did that?”

“I’d prefer for them to not get involved with that sort of thing. They have to be here more often than I do and deal with backlash. People know that sometimes I’ll do things that are unreasonable and they’re willing to forgive.” They had reached the shoreline and Hannah began to untie a small canoe from where it was moored to a sturdy wooden post in the sand.

“Is it really so bad, though? To sell the herbs and stuff to people?”

Hannah looked back at Adam, her face a mixture of surprise and disappointment.

“Is it bad? You’re giving people something that doesn’t work and telling them it will!”

“I dunno. Dr. Chambliss once told me that most antidepressants work by the placebo effect. Is that true?”

Hannah, mildly frustrated, looked up again from her rope. “Well… I don’t know exactly. They taught us about the classes of antidepressants, but I don’t remember ever being told about their efficacy data.”

“Anyway, it’s what she told me. And Dr. Chambliss seems like a smart lady.”

“Well, yeah, she is. So what’s your point? Antidepressants are safety-tested and carefully monitored for side effects.”

“Well, a lot of traditional medicines have been used for years and years, so their side effects are also well-known. And for a lot of the things they supposedly treat– headaches, stress, impotence, whatever– the mind has a lot to do with getting better. I dunno. We talked about this a little in my psychology class. Magic just means a lot to people.”

“But why?” asked Hannah, finally unmooring the canoe and gesturing for Adam to step in.

“Whoa, what are we doing?” he asked.

“We’re going on the river,” she said. “C’mon! The canoe belongs to Afua’s family. She said it was fine.”

“But, uh… you know I can’t swim, right?”

Hannah laughed. “It’s alright. We’re not going to fall in, and if we do I can pull you out. Get in!”

Adam awkwardly did as she ordered and tried to reach one of his long legs from the shore into the canoe, only to watch his foot slip and half his leg drop into the water. Hannah laughed again, then hiked up her skirt higher and did her best to steady the canoe as Adam tried again, more carefully this time. Putting one hand on Hannah’s shoulder, he managed to push himself up above the water and into the canoe, nearly tumbling out the other side as he lurched into his seat. Hannah effortlessly followed him in, lifting her feet nearly to her waist as she held onto the canoe with one hand and her skirt in the other. She handed Adam a paddle from beneath their feet and took one for herself, pushing off a nearby rock and past the other boats clustered in the little harbor.

As the canoe glided slowly out of its port, Hannah began paddling with long, slow strokes on the right side. Adam quickly imitated her, immediately sending the boat into a tailspin.

“Alright, you have to steer– so be careful not to paddle on the same side as I do!” she instructed.

“I don’t know how to steer!” he protested.

“Just paddle a little on the side where you don’t want to go to push us in the right direction,” she said  “It’ll take some time to get used to it, but you’ll get it.”

“Okay…” he started. “I just… y’know…”

“You didn’t answer my question earlier,” she interrupted.

“Which one?”

“Why does magic mean so much to people?

Adam was trying to match Hannah’s strokes, trying to correct the force that she exerted and move them in something resembling a straight line. In this long bend, the current of the river was not exceptionally strong and they easily moved through the dark brown water. His mind wandered as he focused on turning his paddle and pushing hard, so much so that Hannah had to ask again.

“Oh! Uh, sorry. I’m thinking,” he murmured. He decided to stall for time. “I’m not sure what you mean.”

“Well, I usually let it go here, because when you’re just making a living from farming or fishing and a big drought changes your world, it makes more sense to believe in spirits that you pray to in order to get rain. Life is cruel, unpredictable, and short for most people, so feeling like there’s some control you can exercise by buying a shriveled monkey paw isn’t something I’m prepared to judge.”

“But you just destroyed that one guy’s potion,” observed Adam.

“Well, that’s because what he was doing was harming people. That kind of stuff you have to stand up to.”

“Okay, I understood you there. But what about the rest?”

“Well, I think that once someone has been exposed to other things– after you’ve seen the world, see how many different religious perspectives there are, and learn what we know about the natural world– you know there aren’t spirits controlling whether or not you’re fertile. It’s your fibroids, or the mumps you got as a child. No prayer or offering is going to stop your cancer. After you know that, it feels… disingenuous to go back to some pre-modern way of thinking. Things have to be tested, explored, experienced– and religion just shuts all of that up.”

“I don’t think so,” replied Adam. “I mean, sure, there are some religions that shut it down… but I think that, for a lot of people, faith is more than the magic that they use when they’re in trouble. It’s something that… animates their lives. Something that fuels all that exploring and asking questions. And for all our advances, life can still be short, cruel, and unpredictable.”

“Is that how it is for you?” she asked. They stopped paddling and let the boat drift in the middle of the river. A soft breeze rippled through Hannah’s hair as she turned back to look at him.

Adam shook his head. “My dad and I went to church sometimes when we came to the States. But then he got busy and it kinda fell off. I always liked it. I guess I just imagine sometimes that if I had stronger faith, there would be more to the world. Another dimension, another way of looking at things. I like talking to other patients in the waiting room who always see some sort of cosmic struggle going on with their illnesses, like every good day is a victory meant for them by God. They see God working through Dr. Bode, and it’s like every day is magical.”

“I guess there might be something to that,” she said. “I just feel like I know too much for things to be very magical.”

“Just keep that in mind whenever you prescribe an antidepressant,” said Adam with a smile.

“I will,” she replied, smiling back. She gave a long stroke with her paddle to the side, pushing the boat closer to the shore. They drifted into a tiny cove, surrounded on all sides by trees. Their roots ran down the bank and into the water, twisting and turning in the dark brown sand. Hannah reached out for one to steady the boat and pull them a little closer to the shore.

“Let’s go,” she said, deftly hopping out of the boat and onto the rocky beach. She began to throw a rope from inside the boat over the trunk and tie it.

“Where?” asked Adam.

“It’s just up this way a little,” she answered.

“You didn’t answer my question!” he protested, tenuously standing up and trying to wobble his way out of the boat.

“Well, then, have a little faith and let there be a little mystery today!” she commanded. Adam laughed and tripped his way out of the boat, catching himself on the shore with his hands and then pushing himself up. He dusted off his fingers and followed Hannah up the steep embankment to the thick grass above.

They passed through a small clearing full of scrub brush up to a small path in the jungle, which was mostly overgrown with thick foliage. Hannah led the way, pushing vines and branches out of her way and tramping along the ground with Adam following close behind. The only noises they heard for a few minutes were the incessant chirping of birds and the rustle of leaves above as the wind blew through.

They finally reached a small pool, this one full of crystal-clear water fed by a tiny waterfall about ten feet wide and barely taller than them. The white jets of water falling down the slope contrasted with the dark gray rocks beneath. The forest canopy above broke around the stream, sending streaks of light into the clearing and all over the waterfall. Hannah climbed up on top of the rocks and took off her muddy shoes, letting her bare feet rest in the stream above.

“There’s a spring not far from here where the women from the villages nearby come to gather water,” she explained. “But I saw this place and fell in love. This is the sort of magic that I can believe in.”

Adam followed her up and shed his sandals. “What else do you believe in?”

“Hmmm, good question,” said Hannah. “You’re getting better at this!”

“Thanks,” he murmured.

“Well… I never really learned much about God growing up, and most of what I heard didn’t make the concept very appealing. I do believe that people can work together to make their circumstances better. That the forces of greed, racism, and exploitation need to be challenged. I believe that there’s something magical in how we perceive beautiful things, in places like this or in… other people.” Her gaze turned from the scenery to him and her hand extended towards his.

“And that’s not just all the random firings of our synapses and oxytocin and all that shit?” asked Adam with a wry smile. Their fingers began to intertwine.

“Solomon would certainly say so.”

Adam shook his head and laughed again. He moved his bare foot in the water towards her, drawing a heavy toe across her slender foot. “I could probably guess what Solomon would say. But what do you think?”

“I don’t know,” she said. “Let’s try to find out.”

She leaned in suddenly towards him, such so that his first instinct was to try to pull away to keep from tumbling down the waterfall. She seized on him with such force, though, that he couldn’t escape, her arms were around his neck and his lips were pressing on his with such force that he could only react by pushing back. He felt his arms sliding around her in return, clutching her as if holding on for dear life. The same fire in her that he sensed when she talked about her causes and her hospital was just as bright and hot, if not more so.

He sensed movement in her lips and tried to match it with his, clumsily puckering against the onslaught of emotion flowing out of Hannah. Her hair was drifting into his face, her bosom pushing into his chest, her hands clutching his neck and shoulders and pulling him closer. At first he was too overwhelmed to enjoy it, but as the seconds passed he found himself giddy with joy. Her toes now tickled his in the water.

“Wow,” he remarked when she drew back.

She smiled at him radiantly, the sunshine caught in her golden-white hair. She looked almost angelic to him, but he hesitated about voicing that observation for fear that she might find it corny and trite.

“I had wondered what that would feel like… for a long time,” he said finally.

“You’ve never kissed anyone?” she asked coquettishly.

Adam shook his head.

“You aren’t bad for a first-timer,” she observed with a wry grin.

“Thanks,” he mumbled.

“How was it?” she asked.

“It was… magical.”

 

***

 

Jessi laid still on the table and closed her eyes. Her street clothes had been shed and now she wore only a hospital gown, her back bare against the cold paper with a firm vinyl pad beneath it. A sterile paper sheet covered her from the neck down with only a small hole where her thigh met her hip. At that moment, she felt cold liquid wiping right on that exposed area.

“And next we’re just going to stick you. It’ll be a pinch and a burn,” announced the cardiology fellow.

She looked straight up at the dull plastic above her. It was connected to the floor somehow, yet hovering over her while extending a winding adjustable arm out. At the end of that arm was a flat screen twisted at what seemed to her to be a funny angle. Perched above the screen was a small camera, also connected to the hulking plastic shell over her head and from there connected to the screen in the corner. The whole room was darkened except, again, for that one place in her thigh where they were working. The computer monitors glowed faintly.

She felt the needle enter her thigh. As predicted, it pinched and then burned as the local anesthetic quieted the nerves in her leg. The medicine she’d requested for the nerves in her brain was already starting to wear off. There was more movement– the rustling of packages being unwrapped.

She had taken care of a fair number of patients who had had this procedure done and had often asked about the details of post-op care, but she had never bothered to ask them much about this part of their experience. Now she wished that she knew every detail. They were going to find out what was wrong with her heart. Somewhere in there was a coronary artery running between her atria and ventricles where years and years’ worth of cholesterol had built up, narrowing the artery and choking off the muscle beneath from the oxygen it needed. Now some brave soul with a thin balloon was going to try to undo all those cookouts and cigarettes.

She felt an odd pressure as her leg was cut into and briefly saw the catheter wiggle in the air as it was inserted. She overhead bits and pieces of the muffled instructions that the attending doctor gave to his fellow, who had clearly done a few of these before but not enough that there was any ease in the attending’s voice. Jessi sighed as the pressure spread up her back.

Out of the corner of her eye, she watched as the indistinct lines on the screen flashed for a second with clarity. The image repeated suddenly and then paused, controlled by a technician somewhere else in the room that she could see. As she strained with her eyes– being very careful not to move the rest of her body– she saw the faint outline of her heart with all of its blood supply beautifully illuminated in black dye on the angiogram.

“What do you think?” asked the attending.

“90% stenosis of the LAD,” announced the fellow.

“Hmmm… I’d say 99.”

“Okay, 99.” The fellow paused. “Miss Goodson, there’s a big blockage in the main artery that supplies the front of your heart, the LAD. We’re gonna try to see if we can open it up.”

More rustling. More tugging sensations in her groin. More muffled instructions. Jessi breathed in deeply through her nose, trying to suck in more oxygen through the tubing in her nostrils. She tried to follow what was happening on the screen, but she could only see it indistinctly and there was a lot of motion. She struggled to remember her cardiac anatomy from her brief classes years and years ago for her Medical Assistant certification. She wondered how they could thread a catheter into her heart when it was still pumping blood, but decided she would save this question for later.

“Okay, we’re going to have to put a stent in there, and it looks like on the right side you’ll need a stent as well,” stated the cardiologist, as if he were observing a few patches of her living room wall that needed fresh paint.

“Okay,” she said quietly.

“Alright, here goes.” Her heart, projected on the monitor danced merrily in its steady rhythm as she watched a long black tube slide up from the bottom of the screen and worm its way around her aortic arch, sliding gently into a little gray line illuminated down the middle of her heart. She saw appeared to be the problem: a little spot where the gray line narrowed before widening again. For several tense minutes the pressure in her leg continued and the tube flailed around inside her heart. She had only the faintest sensation that it was in her chest at all, much less which artery it was inside.

Finally she watched as the gray line evened out and she heard a sigh of relief emerge from behind her doctors’ masks. Her heart continued its slow, steady dance on the screen as her eyes closed, the dull noises of the catheterization lab and the words spoken behind sterile masks floating by her ears as she drifted into a half-sleep.

 

***

 

Hannah flicked another page past. She looked over at her watch, lying on the simple wooden nightstand. 2AM. She groaned to herself and set the book down, rubbing her eyes and wondering if perhaps she could go back to sleep now. She decided to give it a try and reached over for the lamp on the nightstand.

Duk duk duk came the gentle knock on her wooden door. She rose from bed quickly to answer the door, wondering if perhaps there was some emergency. In the few seconds that it took her to reach the door, she wondered what use she would be in such an emergency with her limited language skills and half-formed medical skills. Perhaps she’d be useful if someone needed a metabolic pathway elucidated in the middle of the night, or a mob formed demanding to know everything there was to know about the intracellular cascade produced by Hepatolife.

She fumbled the door open and found Adam standing there, his hands in his sweatpants pockets and his head hanging subtly, his eyes fixed on the ground until she opened.

“Hey,” she said.

“Hey,” he replied. “I, uh… finished my copy of the journal. And the book that I bought in the airport. I was wondering if you brought any others I could borrow.”

“Sure! Come on in!” She immediately felt the exhaustion of jet lag leave her as she headed towards the stack of books on the floor near her bed. Having Adam in the same room as her was making her feel more and more invigorated as they spent more time together.

“Well, uh… what if Uncle Kwame wakes up and sees me in here? That could be awkward.”

Hannah rolled her eyes. “Adam, do you still have some ammonia rolling around in your brain? Uncle Kwame’s sheets have not been disturbed by his giant frame since we arrived. Have you heard him come in at all?”

“Uh, no, come to think of it,” said Adam, a puzzled look crossing his face. “What’s he doing every… oh.”

The puzzled look turned to concern. “But… he has a wife in the city.”

“A lot of men do. Afua doesn’t mind.”

“Afua?” he remarked, a little too loudly.

“Shhh,” cautioned Hannah.

“Sorry,” he whispered.

“It’s alright. He just put his bag here for show. Probably for you, because I doubt at this point anyone around here doesn’t know.”

“Does my dad…?”

Hannah shrugged. “I don’t know. And if he doesn’t, I certainly won’t be the one to tell him.”

“Okay,” he mumbled. He shuffled into the room, closing the door gently behind him. Hannah lifted her stack of books up and laid them across her bed for Adam to peruse.

“Take your pick,” she said. “Paul Farmer is good for the stuff about health care disparities in different countries. I’ve read most of his other books already. I don’t know much about the travelogues, but those can be hit-or-miss when it’s just a white dude narrating his adventures overseas. Everyone said that I had to read The Corner since I live in Baltimore, but I just finally picked up a copy.”

“This one looks interesting,” he said as he sat down on the bed and picked up a book that had fallen near her pillow. He flipped it open, revealing a plain black cloth-bound cover and neat gilded letters on the spine.

“The Count of Monte Cristo? My dad keeps telling me that I’ll like it. I get about 100 pages in every time that I start and get distracted by something else.”

“What does your dad do?” asked Adam, looking up from the book.

“He’s a high school English teacher. Not quite as exciting as being the CFO of an up-and-coming biotech company, but he at least steered me in the right direction and didn’t try to stop me when I wanted to do something crazy.”

“Did a lot of people try to stop you?”

“Oh, yeah,” said Hannah emphatically. “Teachers told me I was crazy to go back to Africa by myself, the folks who used to send work teams here said I’d never raise enough money to start Africa Partnership, and even the donors who gave me money thought that we’d never have full-time staff or anything.”

“But you showed them,” said Adam with a smile.

“I did. My parents were just what I needed. They gave me a little money and kissed me on the way out the door. Taught me what I needed to know to find out the rest on my own.”

Adam looked puzzled again, as if the concepts that she was articulating were so foreign to him that she was speaking in one of the many languages that they had heard the last two days.

“Not the same for you, huh?” she asked, sitting down next to him. She was only wearing thin athletic shorts and a plain white tank top, exposing more of her than Adam had ever seen before.

“No, not really. My dad wants what’s best for me… he just doesn’t have any idea about what that means. And he moved to America so I could get better medical care, but then all the rest of our family was still here. So he still kind of operates in this very African it-takes-a-village kinda mindset, but without any of the support. I dunno how to describe it. Not like I was a unique little snowflake that got sent out into the world to save it.”

“Hey,” said Hannah sharply, sensing a jab.

“Sorry,” said Adam quickly. “Didn’t mean it like that. Against you, I mean.”

“It’s alright,” she said. “I know… it’s been difficult.”

Her hands began to run through his hair. She noticed his sweatpants moving and watched as he clumsily tried to adjust his position on the bed to hide it. She moved her eyes directly up to his, awaiting his response to her attempt at empathy. She felt burdened by the damage that his illness had done to his teenage years; she didn’t want to treat him like a kid but she also didn’t want to push him too quickly into anything he wasn’t ready for.

“It has been difficult,” he said. “But it’s different now. I try not to think about that. I’m moving past that.”

“Good,” she said, her lips parting in a wide smile. They began to move towards him again. This time, he met her halfway, pushing against her with the energy that he’d been saving up all day, wondering when this would come again. They kissed for a few more seconds before Hannah sat back and picked up The Count of Monte Cristo, dangling it from her fingers.

“This is getting in the way,” she observed.

“Yeah,” he said with a shrug. “I can’t say I was only looking for a book to read when I noticed that your light was on.”

Hannah snorted with laughter and clutched Adam’s hand. “Well, I’m glad you came over.” She swept her leg across the bed decisively, kicking the books to the floor where they remained undisturbed until the morning.

__________________________________________________________________

 

 

 

Maryland Department of Social Services
Baltimore City Division
217 E. Redwood Street
Baltimore, MD 21202

Gainers Jeffrey Goodson
1520 McKean Avenue
Baltimore, MD 21217

 

Dear Mr. Goodson,

We hope this letter finds you well. It has come to the attention of the office of disability benefits that you have recently been gainfully employed at approximately 31 hours per week. As per the Maryland state guidelines for disability income, you no longer qualify for your current disability benefits and these payments will cease after January 1st, 2011. This includes your federal Medicare health coverage. You will be responsible for finding coverage, although you can feel free to contact our Department of Rehabilitation Services (DORS) program for more information about transitional housing or other resources.

Please do not hesitate to call our office if you have any questions or concerns.

 

Sincerely,

Jacqueline Johnston

Benefits Specialist

 

 

Chapter 8 was released on April 1, 2015.

Go to the discussion page.

Creative Commons License
Trousseau Syndrome by Matthew Loftus is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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