Abundance Read online

  Across the road was the large white sign of the Liberian Rubber Corporation, which in blue letters announced that this plantation was a collaboration between the Republic of Liberia and the people of the United States, but Julia knew that wasn’t true anymore. American-owned once. Chinese-owned now. The sign certainly didn’t fool the Liberians, who knew it was owned and run by foreigners, who were all the same, present but not meaningful. Foreigners were people who lived in a different world, a tolerated burden living in their midst, living on their backs; nothing you could talk about but nothing that was ever going away.

  The crossing gate, a thin yellow pole with black stripes, was in pieces on the road, where someone had smashed through and then run over it. The pickup ran over it as well.

  The pickup sped down the plantation’s main road. The road was paved and the going was smooth, so the gun barrel jammed under Julia’s ribs didn’t jab her in new ways. Yellow Bandanna and the driver and the boy near the window kept their eyes on the road and didn’t look at Julia. Their faces were young faces, but their eyes were bloodshot and fixed.

  The road was lined with rubber trees in perfect sixty-foot-tall rows. Each tree had a spiraling groove cut into its bark. The collection cups hanging at the bottom of the grooves were tipped askew, as if someone had forgotten them, and then forgot the rubber trees altogether.

  The drive to The Club was longer than she remembered. The blacktop was still good, better by far than the red dirt roads of the county. The trees had been cut down in places and the stumps burned, the ground left empty and charred. There was a red barn on a hillside off to the right, a red barn that looked like it belonged in Vermont. Once upon a time, the rubber workers raised their own beef on the plantation, and there was a school for their children and a company doctor who visited each settlement of shacks once a week. Once upon a time.

  That farm was nothing like the farm where Kim Terrell ended up, and the road through the plantation was nothing like the road Julia drove to try to rescue Kim.

  Kim Terrell was a medical student from Iowa, a farm girl, big and strong and also blond and uncomplicated. University of Iowa, straight out of public school. She had shown up one Sunday morning in April the year before, in for two months, in a car she had hired at the airport, a beat-up old Suzuki taxi. No guard. She had written Merlin six months before to set up the clerkship, but the doctor she had written to, a family practitioner named Suki Thompson, was long gone. No one remembered Kim was coming, and no one knew what to do with her at first. God loves children, medical students, and fools, though Kim was only one of those. Perhaps, as it turned out, two.

  They needed the help, so Julia put her to work right away. Kim wrote notes while they were on work rounds. Before long she was running the ward during the day while Julia was out in the villages. Some days when Zig’s OR load was light and he felt like he could run the ward alone Julia took her along with her to the village health centers. Julia also let Kim make some village trips with Sister Martha when the village was close by, as long as there was cell phone service in that village so Kim could call in case of trouble. Good experience for her. Kim was always looking for more experience and for more responsibility. She hung out in the Emergency Department at night, helping the PA’s work up new admissions. No one thought much about that. There was no better place for a medical student to hang out than in the Emergency Department and to see what came in from the villages at night, because everything came in—women in labor who had ruptured their membranes a week ago and had gone septic, kids with asthma, young men in comas from brain tumors or meningitis, women with ruptured ectopics who were bleeding out, people presenting for the first time with HIV, TB, malaria, typhoid—you name it, they saw it in that ED.

  No one was that surprised when July came and Kim said how much she loved working at the hospital and put off her departure for six months. She got a leave from medical school, she said. She was learning more in Buchanan than she’d ever learn doing fourth-year electives. Everyone at home supported her decision. No one was surprised, but no one thought she was thinking very clearly, even then.

  They knew Kim had been eating lunch at the hospital instead of in the compound. They just didn’t know why.

  There was a PA Kim worked with when she hung out in the Emergency Department at night, a smooth guy named Alex who was from a community about twenty miles out, from out toward Maryland County along the coast. Sometimes Kim ate her lunch with Alex. They would sit on a hillside near the hospital kitchen and talk. No one thought anything about that either.

  Alex always had a story. When he presented his cases on morning rounds he presented them backwards, starting with the diagnosis and then detailing the history of present illness and the physical examination, as if he decided what the diagnosis was going to be first, and then chose details or made up findings to fit the diagnosis he wanted to give. That he was wrong more than he was right was one problem. That he started the wrong treatment more often than not and killed people by waiting when he needed to act was a more serious problem yet. You had to be kind and patient, because he was a Liberian PA, and they had too few Liberian clinical staff who were likely to stay. But most of rounds were devoted to fixing what Alex and the others had gotten wrong. A good day was the day that Julia and Zig could fix the mess in time, before the patient died.

  One morning in October Kim didn’t show for hospital rounds. They started on the surgical ward.

  “The first patient is a seventeen-year-old woman from Buchanan who had presented in the middle of the night with vomiting and abdominal pain of four days duration and right lower quadrant tenderness,” said Tiffany, the PA on duty the night before. “No recent vaginal bleeding. The temperature is 99.8. The blood pressure is 86 over 52. The pulse is 110. There is no rebound tenderness and the white blood count is normal. She is admitted to the surgical ward to rule out appendicitis.”

  The patient, a young woman, was thin and dark-skinned. The sheets on the bed were tan from washing and age and were wrinkled. The patient wore a thin light blue hospital gown and her hair was braided into tight beaded corn rows that hung to her shoulders and were scattered on both sides of her head as she lay sweating on her pillow. She looked scared and got more scared when the six people in jeans, tee shirts, and white coats surrounded her bed.

  “Pregnancy test?” Zig said, as he walked to an orange ten-gallon water jug that sat on a table nearby and pressed the spigot at the bottom so he could wash his hands. There was a moment of silence.

  “LMP?” Zig said.

  Another moment of silence. Tiffany spoke to the young woman in Bassa. Zig put his hands on the young woman’s abdomen, and she flinched. She twisted away as Zig pressed his fingers deep into her soft belly, and then she flinched again as he suddenly let go. He placed his left hand on the young woman’s abdomen, without pushing, and tapped his third finger with the second and third finger of his right hand, moving his left hand as he tapped it. The young woman flinched again. Then Zig put his right hand on the girl’s upper abdomen and pressed in with his second and third fingers, first on the left and then on the right.

  “Tell her to take a deep breath,” he said, and he pressed in deeper on the right as Tiffany translated and the girl breathed in deeply.

  “The patient is not certain of the LMP. Four or five weeks. Not one or two,” Tiffany said.

  “Shit,” Zig said. “Kim, get me a sterile prep kit and a sterile 20 cc syringe with a two-inch 18-gauge needle please.”

  The people on rounds looked at one another for a moment. Julia walked to the end of the ward, and brought back a package wrapped in green cloth, a syringe wrapped in plastic, and a brown bottle.

  “We’re in luck,” Julia said. “No Kim, but it’s a Betadine day.”

  “You’re in luck,” Zig said. “I’m on my way to the OR, where this kid should have been six or seven hours ago.” He unwrapped the green cloth package on a table, spread out a green cloth sheet that was inside it, and opened the sy
ringe package so the syringe fell on the cloth sheet. Then he scooped up and put on a pair of surgical gloves and with his gloved right hand held out a few gauze pads to Julia, who squeezed some of the brown liquid in the brown plastic bottle she was still holding into the gauze. Zig turned and wiped the girl’s right side with the brown liquid, moving the gauze in an expanding circle, moving quickly.

  “Lay her on the right side,” Zig said. “Tell her this will hurt but only for a minute.”

  Tiffany translated and the girl turned to her right. Zig uncapped the syringe and put his left hand on the girl’s abdomen, his thumb and first finger spread apart, marking a target. Then he slowly inserted the needle into the girl’s abdomen, advanced it, and pulled back on the plunger with the thumb of his right hand as it advanced. After a moment, a spurt of thin red-pink fluid came into the syringe. Zig waited until the syringe was about one-third full. He pulled it out of the girl’s belly and held it to the light.

  The fluid was red tinged. Pink-red not blood-red. Watery, not thick and opaque.

  Pink-red. Not blood. Zig swirled the syringe and waited.

  “It’s not clotting,” Zig said. “Non-clotting blood in paracentesis fluid in a young woman with abdominal pain who missed her period and is getting shocky is a ruptured ectopic. She’s got a tubal pregnancy that has burst open her fallopian tube and now she is bleeding into her belly. She’ll bleed out if we don’t get this fixed now. In Boston, you’d have a quantitative beta subunit HCG, an ultrasound, and maybe a laparoscopy, but it would take you two hours to get that done and another hour to have her in the OR. All I have is a healthy index of suspicion, a head on my shoulders, an 18-gauge needle, and a strong arm. We’ve got a ruptured ectopic. We can be in the OR in ten minutes. Wide open IV saline please, type her, see if you can find me a little blood to cross match, and let’s get her to the OR. Now. Perhaps we can snatch one tiny victory out of the cold fingers of defeat.”

  “I’ll do rounds,” Julia said.

  “Tiffany and Alex, you assist,” Zig said. “Alex, you’ll pass the gas. Tiffany, scrub with me. Julia, you take Kim today.”

  “Kim’s not here,” Julia said.

  Zig looked around.

  “I can round on my own,” Julia said. “You take the others.”

  “Anyone know anything about Kim?” Zig said.

  “Kim is not well today,” Alex said.

  “What do you know about Kim’s health and well-being?” Zig said to Alex. Zig looked at Julia as he took his gloves off.

  “Kim is not well today,” Alex said.

  Zig jerked the sterile drape off the table. He threw it into a bin for laundry, and then he flung his used gloves into a garbage pail.

  “Perhaps Kim will return when her morning sickness improves,” said Tiffany.

  “We’ll take care of Kim tomorrow,” Julia said. “Get this kid to the OR now.”

  Julia went to Alex’s village a week later.

  The village was east and south of Buchanan, about five miles off the main road to Maryland County, close to the sea. The land was low and open, mostly grasslands and wetlands, with salt ponds and lime green grasses in the estuary that swayed in the least breeze and moved with the currents. Malarial country, Julia thought. Low and hot, though maybe the sea breezes kept the mosquitoes from settling and biting. I hope she is using a damn bed net, Julia thought. I hope she learned that much from us before she came here.

  Kim was bent over, hoeing a garden plot with a girl of about fourteen. There were other women working in the village, one grinding a white paste in a wooden trough, one standing at a fire in the cooking hut, and one sitting on the ground, working with her hands. Five or six children were scattered about the village near the pump and in the garden. One old man slept on a bench in the kitchen hut, and two more men squatted in front of one of the huts. A few scrawny chickens darted from place to place, pecking once, twice, three times, and then running across the yard to stay near a hut or a tree in the shade.

  The women heard the truck and turned to look when Julia’s door thumped shut. “Stay here,” Julia said. Torwon turned off the engine. Charles opened his window to catch the breeze and to listen for trouble.

  Kim stood and put a hand to her forehead to shield her eyes from the sun. A short, round, plump, dark woman in a yellow and green lapa came to the door of the hut nearest to Kim, and then came out of the hut so that she stood between Julia and Kim.

  “Good day,” Julia said. “Hey Kim.”

  “G’day,” said the plump woman.

  “Hey, “said Kim.

  Kim’s hair was braided now and hung all to one side. She was wearing an orange tee shirt and a sky-blue lapa and black sandals made from the rubber of old tires. Her face was puffy, and her body had just begun to swell, so she was five months, maybe more. So much for the story about morning sickness. The pregnancy must have started early, just after she arrived, long before anyone noticed that she was spending any time with Alex. That vulture, Julia thought. Alex hit on her right away, before Kim had a chance to get her bearings. You never know where it’s coming from next. Alex always has an angle. I should have watched more closely. You can never turn your back, not for one single second.

  “Kim, is there anything you need?” Julia said.

  “Kim ga. Kim okay,” the plump woman said. Kim is good. Kim is okay.

  “Let’s walk together. Show me around the village,” Julia said.

  “Wait na. We walkabout da fa,” the plump woman said. Wait. We can explore the farm together.

  “I’d like to walk with Kim. Just me and Kim. To talk together,” Julia said. “Alone.”

  “We can walk. It’s a white thing,” Kim said, but she looked at the plump woman, not at Julia when she spoke.

  “Okay-okay,” the plump woman said. “Quick-quick wa.” It’s okay to take a quick walk.

  But the plump woman didn’t move from between Kim and Julia. She put her hands on her hips and remained standing in the bright hot sun. Kim leaned her hoe against a fence made from branches and walked behind the plump woman toward the cooking tent. Julia met her there. Then they walked to the Land Cruiser.

  “It’s a village” Kim said. “Alex’s farm. A good place. Not really much to show. I’ve helped keep the garden in shape. That’s Mallie, Alex’s head wife. She looks out when Alex is in Buchanan.”

  “You want to talk about it?” Julia said.

  “There’s nothing to talk about. This is my life now,” Kim said.

  “And your family back home, medical school and residency, and everything else?” Julia said. “You’re ready to write all that off? All that hard work?”

  “All that hard work, which were preparing me for more hard work?” Kim said. “Always feeling like I don’t know enough. Always feeling like I’m never good enough. I never felt the way Alex makes me feel. He makes me feel smart. He even makes me feel beautiful. Mallie makes me feel like I belong here. I’m going to have a baby. That baby will belong here. At home if I want to have a baby I have to beg for time off from work and apologize for taking the time. Then I’m supposed to act like I want to be back in a hurry. And then I have a baby and am a doctor at the same time, always rushing to be everything to everybody, no time to think. No one’s rushing me here. I can breathe.”

  “You know that women in Liberia are valued mostly for their ability to produce children,” Julia said.

  “I can produce children!” Kim said. “Solid Iowa farming stock. Good teeth and a strong back. Maybe I can have fifteen.”

  “That’s not what I mean,” Julia said. “Alex will have other women. You know how it goes in Liberia. Women he’s married to. Women he’s not. Some women have other men.”

  “I know about that,” Kim said. “Doesn’t matter. Alex makes me feel alive. Liberia makes me feel alive. I’m part of something here. At home you are always alone. At home they make you feel like property, like you are only good for taking tests, getting grades, and maybe someday earning money. To sh
ow the neighbors.”

  “Are you safe? No one’s forcing you? There isn’t anyone here you can call in the middle of the night. Remember you still have options. We can get into that Land Cruiser, have you back in Buchanan in an hour and to Monrovia by nightfall. Back in Iowa on Thursday,” Julia said.

  “My own free will,” Kim said. “This is my choice. I’m here for the duration. Mallie isn’t standing there to force me to stay. She’s there to make sure you don’t try to force me to leave. I know you are looking out for me too. But I’m an adult, and I can make my own decisions. So thanks for coming. I’ll pass on that ride back to town.”

  “Alex isn’t our most trusted or reliable PA,” Julia said.

  “I know who Alex is. And who he isn’t,” Kim said.

  “You get to big belly clinic then. You take your vitamins. Use a bed net. You know the drill. We can always get you home if anything changes. You take care of that baby, you hear?” Julia said.

  Julia leaned against the car door most of the way home, her head on the window.

  “Talk sweet to her. Right thin,” Torwon said. You were kind to her. That was the right thing to do.

  “Alex yona boy,” Charles said. “He rascal. She comes home soon sorry on one-cent car.” Alex is just a street peddler. Kim will come walking back in a bad way.

  “Wait now ad stink moot,” Torwon said. Don’t talk badly about these people.

  Julia shook her head and didn’t speak.

  Kim was right and wrong at the same time. She was an adult, responsible for her own choices, and she had talked herself into this one, big time. But Charles was also right. Nothing good could come of this. Julia should have made Kim get into the car with her and she should have taken her home. She should have been tougher, more in control. Or gotten Torwon and Charles to pick Kim up and just put her in the car. You don’t let people who are insane make their own choices. And love, or whatever this was, was making Kim insane. The average life expectancy in Liberia is about forty. Kim didn’t have the life skills you need to survive. Julia hadn’t been tough enough. She let everyone down.