Exiles (15 page)

When Peter opened the fridge, though, he could barely believe his eyes. There were the usual antibiotics and painkillers, but there was also a huge supply of second- and third-line TB drugs, better stuff than they’d had at the main clinic in town. He turned to the nurse.

“Banhi, where did these come from?”

She turned to look and made a dismissive gesture. “We getting some things,” she said vaguely.

“Getting how?” Peter asked.

She eyed him coolly. “Just getting,” she said. “Not necessary knowing everything.”

Peter looked at Alex and Devi, who appeared as astonished as he was at this blatant insolence. He felt his temper rising. “In this case, I’d like to know,” he said as evenly as possible.

She responded by closing the ledger, throwing on her coat, and stalking out without even glancing back at him. The steel front door slammed behind her.

“What the hell was that?” Peter asked. “Are we dealing with some sort of Mafia here?”

“I don’t think the Mafia’s too interested in Nepal,” Devi said.

“Well what, then?”

“Don’t have a stroke, Dad.”

“She’s obviously a bitch,” said Devi.

“Probably been talking to Mina about you,” Alex added. She stretched out on the exam table. It was built of plywood and two-by-fours, and had a thin vinyl pad on it that appeared to be stuffed with animal hair, some of which was coming out at the seams. “It’s like lying on a dead goat,” she said.

Peter was still fuming. He sat down on the stool and rested his chin on his hands. “I was one of the best cardiologists in California,” he said.

“Or maybe a dead yak,” Alex said. “A black yak, whacked by the little-known Nepali Cosa Nostra.”

“Smacked in the back by a Mafia hack,” said Devi.

“I was supposed to speak at a colloquium at Stanford last week, in fact,” Peter continued, ignoring them. “I would have become pals with the new dean of the medical school, and as a result you would be starting next fall on a full ride.”

“Dream on, Dad.” She turned to Devi. “I’ve seen this syndrome once or twice before with him. You might want to take a seat.”

Devi sat on the table by Alex’s feet.

“In your first year you would write a memoir of your experiences called
Alexandra on the Farm
, which due to its tastefully suggestive and inspiring content would quickly land you a place on
Oprah
and become an international bestseller,” Peter said.

“The farm?” asked Devi.

“Stanford’s nickname,” said Alex.

“There are animals there?”

“Extremely well-bred ones.”

“The film rights would sell for three million dollars,” Peter continued, ignoring them, “and you would be played by … um … Who would be playing you?”

Alex spoke with only a hint of sarcasm. “Keira Knightley, I expect.”

“Fair enough. Of course, sooner or later Keira would want to meet me. Just, you know, to express her appreciation for what a great job I’d done raising you and all. Dinner and drinks, a long walk on the beach. Nothing fancy.”

Alex looked at him a little askance. “I’m pretty sure Keira Knightley has a boyfriend.”

“She does?”

“God, Dad, don’t you ever read?”

Several Tibetan monasteries had been rebuilt near Boudhanath after the destruction by the Chinese across the border. People still routinely fled from Tibet across the high passes, and Peter was seeing a lot of frostbite. He was usually able to save fingers, but sometimes the refugees’ toes would turn gangrenous and require amputation. For that, he gave them bus fare and sent them into Kathmandu, to Franz.

Alex’s Nepali had become serviceable, and she and Devi worked together with the Tibetans so Alex could get closer to fluency in Tibetan too. Alex and Devi were tireless, putting in ten-hour days every day but Sunday, and soon acquired a devoted following among the children.

One night after work, Devi cooked
momos
, Tibetan dumplings stuffed with ginger, lamb, and garlic. Alex picked up a calendar and realized they’d forgotten Christmas—missed it by five days, in fact. She wanted a tree, but Peter had no idea where to find one without poaching it. They did have a green marker, though, so they drew a tree on an empty rice bag and tacked it to the wall. Peter told them they’d open presents the next night, on New Year’s Eve.

The heater wasn’t really up to the task, given the drafty window and the concrete floor, and they were always cold. Peter found a shop that had a thick rug, big enough to cover the entire floor, with a good pad for underneath.

On New Year’s Eve he brought the rug home. They moved their stuff into the yard, unrolled the rug, then brought everything back in. The girls were delighted and promptly stretched out on it, luxuriating in the thick fibers and cooing their approval. The room felt warmer immediately, just by having their feet shielded from the heat-sucking concrete floor.

Peter decided to give the girls some time to themselves, so he walked down the road and called Franz, who picked up on the second ring.

“Home alone on New Year’s?” Peter asked. “Serves you right for banishing us to the outlands; we could have kept you company.”

“I’m not alone,” said Franz.

“Oh, you’re right, I can hear the cat. I expect that’s the closest you’re getting to pussy tonight, boss.”

“Fuck you, American doctor.”

Peter smiled. “What’s the news at court? Any chance Duke Bahadur will be mollified by spring?”

“I’m taking care of his girls for him, gratis, thanks to you.”

“Well, you old whore.”

“Everyone he touches ends up as some kind of whore, apparently. He has even more connections than I knew.”

“Meaning what, exactly?”

“He’s still pissed at you, so I’ve got a feeling you’re going to find out,” said Franz. “Oh, and by the way, that girl you sprang? She’s already back with him, and she
is
HIV-positive.”

Peter felt the holiday cheer bleed right out of him. “I’m sorry to hear that,” he said feebly.

“Happy New Year, Dr. Do-gooder,” said Franz, then hung up.

Peter had been trying not to think about futility, but it had acquired such multifarious manifestations it had become impossible
to ignore. Recurring trachoma, because you could treat the patient but you could never kill all the flies. Kids dead from diarrhea, because you could give them antibiotics but you couldn’t clean up the rivers. Endemic TB, because for every case you treated there were ten that never came to a clinic, that lived with it and died with it, while the bacteria just kept evolving resistance. For that matter, a kind but stubborn lama who could have had his heart repaired but who preferred to stay at the monastery and meditate. Peter could see why docs burned out here; it was like medical Whac-a-Mole. For every case he hammered, ten more sprang up that he couldn’t do anything about. There was no end to it, no sense of having finished or accomplished anything. It was starting to feel corrosive, as if it might burn its way through his skin and begin consuming him from the inside.

|   |   |

He scheduled visits at a couple of the monasteries up the hill and took stock of his paltry supplies. Stuffed into the old leather doctor’s bag that had belonged to his father was a stethoscope; a thermometer; a Ziploc full of latex gloves; a speculum; a couple of dozen sterile-wrapped syringes; an otoscope; and his favorite reflex hammer, gift of Bollixall Pharma, with its titanium handle and orange rubber head. Medications from the clinic stock—ampicillin, sulfa, Cipro, cortisone (injectable and inhalable, for anything from anaphylactic shock to asthma), albuterol, insulin, and a few other things. And of course the amazing array of TB drugs.

Peter hadn’t thought of his father in a long time, but the bag brought the old curmudgeon to mind. Peter and his sister had grown up in Jackson, Mississippi, where their father was a dermatologist. Even though his father was otherwise embarrassingly conservative, as a young man in the late 1950s he’d raised eyebrows by being one of the first white physicians in town to accept black patients.

“Once you learn something about skin, you’d have to be an
idiot to think it makes any difference between people other than maybe in melanoma,” he told his son, when Peter was about ten. “And if that’s your metric,
they’re
superior to
us
.”

Holding the old leather bag now, Peter felt more fondness for his father than he had in some time, and wondered if his father too had felt his work was futile. Mississippi in those days had almost as much poverty as Nepal did now, and he must have wrestled with some of the same issues.

The jeep had only a canvas top, and the morning they left, it was cold as they careened through the mud on terrible roads. Devi was excited about seeing other Tibetans, though—or as she put it in her blunt way, Tibetans who weren’t afraid to
be
Tibetan, as her mother was.

They drove through the front gate of the monastery and found their liaison, a robust, red-cheeked nun who showed them to a small room where they would treat the other
anis
.

The room, like the whole building, was unheated. It was furnished simply with a cot, a chair, a small writing table, and a shrine with water bowls, lamps, and photos of the Dalai Lama. Down in the valley the days did warm up; it might be thirty degrees in the morning, but it would hit the mid-fifties by afternoon. Up at elevations like this, it stayed cooler. Having a row of butter lamps and three people crammed into the room helped, though. It was more than a matter of comfort; Peter liked his patients to feel safe, and it always seemed that they were more relaxed and talked more easily if they were in a warm place.

Alex and Devi unpacked the various kits. Devi was worried that the
anis
might balk at being examined by a male doctor, but the abbot, Lama Yeshe, had assured the nuns that there was no misconduct in this and encouraged them to keep themselves well.

Soon the first
ani
appeared, a broad-hipped woman in her late thirties. She’d had recurrent diarrhea ever since leaving Tibet. Peter asked about it, and the nun said there was no blood in it, and that between bouts she felt all right, though a little weak. Without access to a real lab, Peter had to treat empirically, so he gave her
Flagyl and figured that would likely take care of whatever she’d picked up.

The second nun was much older, possibly in her seventies, and had a skin rash over her lower back, buttocks, and legs. It wasn’t clear what was causing it, but it didn’t appear to be serious. Peter suggested she try to bathe every day with gentle soap, then gave her a big tube of cortisone cream.

Next came Ani Dawa, a pretty but tough-looking young woman in her twenties. She’d had a hacking cough for three months. Peter did his best to listen through her three or four layers of clothing but finally had to ask, through Devi, if she would mind paring down a bit. Ani Dawa laughed and unwrapped herself, leaving in place just the T-shirt that served as her bottom layer.

When he lifted the shirt in back he noticed the scars. They were eight to ten inches long, slightly curved, red, and shiny. There were about a dozen of them, from mid-shoulder blade to her sacrum. He met Devi’s eyes briefly, then continued with the exam, listening to Ani Dawa’s lungs and then, from the front, to her heart. There was a little bit of a wheeze, but otherwise her lungs sounded clear, and her heart was strong.

“Is this the first time she’s had the cough?” he asked.

Devi spoke to her and said, “No, she says she gets it every winter. This year has been worse than before. Sometimes it keeps her up half the night.”

“Any phlegm or blood?”

“Sometimes phlegm.”

“What color?”

“She says clear or white.”

“Is she weak?”

“She says not so much. Sometimes she gets tired just from all the coughing.”

Peter asked Alex how much of the Tibetan conversation she was able to understand.

“Half, maybe,” she said.

Peter told Devi he wanted Ani Dawa to have a TB test, but he
was pretty sure that wasn’t the problem. They got out the kit and pricked her forearm, then told her what to look for so they’d know what to do when they came back.