Exiles (7 page)

In the mornings he girded himself emotionally for the skirmishes at work. There was Mina, of course, and Franz too, since he’d taken her side. There were the two other nurses, who were clearly too cowed by Mina to risk affiliation with anyone else. And then the patients, in their abject poverty and their calm acceptance of their fates. He knew the poverty wasn’t their fault and acceptance was almost certainly a virtue, but this didn’t stop him from feeling frustrated with them. He felt petty and ugly for having such thoughts, and this fouled his mood even further. In any case, their only alternative would have been futile railing against the heavens, which was more in Peter’s line.

Mainly, Peter felt rage against the filth of the city and the plagues that flourished in it, bacteria and viruses and protozoa and spirochetes that infected anyone they could, the living expression of the world’s immense talent for creating and destroying life. These tiny bugs were just like Peter himself, of course, just like anyone or anything that had ever lived. They were programmed by their DNA to survive, and that was all they demanded of the universe—to live and pass that life along to their descendants. The
viruses—the hepatitis, dengue, HIV, and the rest—weren’t even alive, strictly speaking, but they displayed the same relentless and avaricious drive to reproduce, doing so using the cells of others instead of their own. It was this commonality of purpose that chilled Peter the most—the knowledge that he would be hard pressed to distinguish what he wanted from what they wanted, if they could be said to want (and he believed, for complicated reasons, that they could). Malaria was a parasite in the body of a human, and humans were a parasite on the body of the earth, all of them fighting for dominance, reproducing and dying in droves.

One morning, as Peter toiled away in this sunny mood, a spindly old fellow came in. He had a bad cough and blood in his sputum, and he smelled like sweat and goats. Mina checked his lymph nodes, which were swollen.

“Masks on,” she said.

Peter donned his mask, reflecting on another paradox—that though he was frequently annoyed by patients as an abstract mob, each time he met one alone in the exam room he felt genuine fondness, even tenderness, and wanted to do his best to deliver them from whatever was ravaging their bodies. He didn’t understand this dichotomy, which occurred at such a deep emotional level that it seemed to defy explanation.

He asked the man, through Mina, if he’d ever been diagnosed with TB. The old fellow rambled on at length, and when he’d finished, Mina translated.

“Eight or nine years ago,” she said. “They gave him a drug, he doesn’t remember what. He took it for a while, but then it ran out, so he stopped.”

Peter watched her. She seemed tired, less ready for battle. He was glad; it meant he could let down his guard a little. “Anything since?”

She spoke to the man. “He says no. He says he got a little better, then in the past year it came back. He’s losing weight and coughing a lot. He says he’s very weak.”

“And it feels like it felt before, when he had it.”

“Yes.”

TB was the primeval, archetypal guerrilla warrior, a terrorist whose very body was an explosive device. Endemic in the population, quick to seize advantage of weakness, deftly mutating into drug-resistant forms, impossible to eradicate, merciless and deadly. It always made Peter nervous, from fear not only of getting it himself but of giving it to Alex. The months-long antibiotic treatments were hard enough, but if you got a multi-drug-resistant strain, you were finished as a physician and very possibly dead. Cardiologists usually didn’t have to deal with much in the way of infectious disease, so as promised, this place was turning out to be an education all its own. He was gaining more sympathy for the Belgian.

“We probably don’t need an X ray,” he said.

Mina nodded. “We’re almost out of film, anyway, and it’s going to be three weeks before we get any more.” There was no record of what the man had been given the last time around, but she was pretty sure it would have been isoniazid.

“Alone or with other drugs?” Peter asked.

“Most likely alone.”

“That might be a good thing, if there’s resistance. Any way to do a sputum culture or DST?”

“Not without sending him to the hospital, which he can’t afford.”

“Right.” You could be the best doctor on earth, but if you found yourself practicing in the Stone Age, you were going to be reduced to decoctions of roots and berries, just like everybody else. “What other TB drugs do we have?” he asked.

“Rifampicin and pyrazinamide.”

“Anything second-line?”

“Not at the moment.”

“Can we give him both, then?”

“If you want to,” she said. She spoke to the man and told Peter that he lived in a crate in the camp over in Bhaktapur, on the other side of the river. It had taken him five hours to walk to the clinic. She thought it unlikely they’d see him again, or that anyone would
take the trouble to find him. If he stopped taking the drugs, they’d just be creating one more resistant strain of the disease, contributing to a potential disaster no one wanted to contemplate.

“Ask him, if I give him a lot of medicine, will he take it all, just as we say, until it’s finished six months from now? And then come back?”

She asked, and the old man nodded agreeably. Peter could tell that Mina didn’t believe him. He’d already seen five cases like this, and for every one he saw there were probably twenty or thirty people out there living with the disease and making do. The clinic was always low on drugs, always digging up a supply just at the last minute, through pharma company write-offs or the WHO or whatever else they could scrape together.

After the old man left, Mina took off her mask and opened the window. She headed for the door, and as she passed Peter she met his eyes, just for a moment. He couldn’t tell what the look conveyed. It unnerved him, because her sudden proximity seemed both aggressive and sensual. There was something in the lightness and ease of her movements, and in the mutual physical danger of the situations they faced, that put him on edge in ways so confusing that it spurred his desire to flee even more than the open conflict did.

|   |   |

Peter bought a little red Hero for getting around. He’d ridden a Kawasaki 750 when he was younger, and compared to that, the motorbike accelerated like a concrete block in mud, but
ke garne
? For Kathmandu it was enough; he didn’t want to go faster than thirty-five, anyway, because he figured either he’d run into something (a dog, a person, a cow) or something would run into him (a
tempo
, an ox, a bus). He rode with a bicycle helmet and a surgical mask, because the smog was returning after the monsoon. Otherwise, with all the diesel and other soot in the air, he’d come home looking as though he’d been snorting ink. He understood now why everyone in the city had a cough.

As he rode home one day, he saw two teenage girls walking ahead of him, hand in hand. The hand-holding was common enough; what got his attention was that one of the girls looked like Alex. He pulled alongside and saw that she
was
Alex, in fact. The other girl was even taller and wore a T-shirt and jeans.

Alex had continued to plow through her homeschooling, and given her academic proclivities, she didn’t need any prodding. So even though Peter was relieved that she’d made a friend, he wasn’t sure how she’d managed it. It made him realize he had no clear picture of how she’d been spending her days. She was hitting the books, but she also had a healthy desire to get out and explore the city.

In any case, acculturation was apparently under way on both sides. He pulled down his sunglasses.

“Is that you?” he asked.

She looked at the Hero and smiled. “I don’t know,” she said. “Is that you?” She let go of the girl’s hand and made a sort of formal introductory gesture. “This is Devi. Sangita’s daughter.”

“Oh, right.” He stuck out his hand, and they shook. Devi was a striking beauty with wide, dark eyes. As she gave his hand a strong shake, she smiled and said, “Pleased to meet you,” with only the slightest of accents.

“We’re on our way home,” said Alex. “See you there?”

Polite code for “Get lost,” he figured. “Sure,” he said. “I’ve got to get groceries. You want anything?”

“Rice Krispies,” she said. “She’s never had them, and we’re almost out.”

|   |   |

Sangita and the girls were in the kitchen, drinking tea, when he returned. Sangita helped him unpack the bags while she selected what she wanted for dinner and started chopping.

“Devi’s going to teach me Nepali and maybe Tibetan too,” Alex said.

Peter handed her the cereal. “Does she know she’s dealing with a know-it-all?”

Alex rolled her eyes. “She’s brilliant, Dad. And don’t worry, Sangita said we can spend as long as we want if she doesn’t get behind on her homework.”

Peter looked at them both. They seemed a little giddy. Devi had a peculiarly intense gaze and a delicate scar cutting diagonally across her nose. Peter wanted to ask some sort of question, but he wasn’t sure what that question might be.

“Great,” he said. “That’s great.” He looked at Sangita, who was rinsing out a pot and smiling her enigmatic smile.

|   |   |

After dinner the girls went up to Alex’s room and turned on some music. Peter helped Sangita carry the plates to the sink.

She held up two fingers, side by side. “Just met yesterday and already they like
this
,” she said.

“You saw it coming?”

Sangita nodded as she ran hot water into the sink.

“Is this okay with you?” he asked. “I mean, Alex doesn’t have a lot of friends, but I know how she is with the chosen few. You and Sonam might start missing your daughter.”

“Devi eighteen, very strong,” she said. “Will like mule, worse even than me.
Ke garne?
”

“She speaks English very well.”

Sangita smiled. “She smart, got scholarship to international school. Son gone, we figure, better educate daughter!”

She’d mentioned the boy before. “Where is your son, anyway?” Peter asked.

She hesitated, then finished washing a plate and put it in the dish rack. “Maybe better not much saying,” she said.

“Well, is he alive? Is he okay?”

“We not know,” she replied, and it was clear from her tone—a mix of anxiety and resignation and emotional gristle—that that was all she was going to say about it.

Franz slouched behind his desk, holding his head dejectedly. A half-empty bottle of pink Pepto-Bismol sat beside a jam jar full of pens. Mina sat bolt upright on one of the chairs at the front of the desk. Peter slumped on the other chair. It was the end of the day, and although the light was fading, Franz hadn’t turned on his desk lamp. The room had a dank, autumnal air, like a cornfield about to be attacked by crows.

Franz spoke quietly, without looking up. “If we don’t get our funding we’ll all be gone in a few months, so this may not matter,” he said. “But in the meantime I don’t care if you hate each other; I just care that it shows. I can’t have this kind of thing going on.”

Mina crossed her arms over her chest. “He’s just like the Belgian,” she said.

“I never even met the Belgian,” Peter retorted. “For all I know, you
invented
the Belgian. Are we still in high school here? I merely asked whether ampicillin was the best choice for that kid’s infection. In America I’d have used Cefzil.”

The brief, fragile détente had been broken; perhaps it had been an illusion, anyway. Franz spoke again, but his words were barely audible, his voice rumbling like an ancient, discouraged oracle. They both leaned forward to hear.

“First, Mina, he’s a much better doctor than the Belgian, and you know it,” Franz said. She huffed dismissively in response, as if this were irrelevant. “And Peter, you should know by now that we don’t have access to antibiotics that cost five dollars a pill. You’ve got to learn to trust Mina’s judgment.”

“He doesn’t seem to be able to learn anything, so why should he learn that?”

Franz sighed. “Please,” he said. “I will give you a special bag of cat treats, which one of my patients paid me with today.”