The Strength of Bone Read online

  The Strength of Bone

  Lucie Wilk

  a John Metcalf book

  BIBLIOASIS

  Windsor, Ontario

  Copyright © Lucie Wilk, 2013

  All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher or a licence from The Canadian Copyright Licensing Agency (Access Copyright). For an Access Copyright licence, visit www.accesscopyright.ca or call toll free to 1-800-893-5777.

  first edition

  Library and Archives Canada Cataloguing in Publication

  Wilk, Lucie, 1972-

  The strength of bone [electronic resource] / Lucie Wilk.

  Electronic monograph in ebook format.

  Issued also in print format.

  ISBN 978-1-927428-40-5

  I. Title.

  PS8645.I434S77 2013 C813’.6 C2013-902004-7

  Edited by John Metcalf

  Typeset by Chris Andrechek

  Cover Designed by Kate Hargreaves

  Biblioasis acknowledges the ongoing financial support of the Government of Canada through the Canada Council for the Arts, Canadian Heritage, the Canada Book Fund; and the Government of Ontario through the Ontario Arts Council.

  For

  Eric,

  Amber &

  Aidan

  The way of love is not

  a subtle argument.

  The door there is devastation.

  Birds make great sky-circles

  of their freedom.

  How do they learn it?

  They fall, and falling,

  they’re given wings.

  Rumi

  The sky was milky blue. It seemed wet and somehow stained. Beneath it the ground was dry and untended. Nothing moved. It was winter.

  Inside, a young girl lay on a bed in the dark in a room that was filled with the sound of her breath. In and out. In and out. The air was saturated with her breath just as her lungs were sopped in fluid, semi-submerged. Her chest lifted and fell. In. Out.

  The visitors who came tried not to share the air. They breathed short and shallow. They tried to be as unaware of their own breath as they were before they entered the room. Because noticing it somehow created lack and just for a moment, they knew suffocation. That is why after a short while they left.

  The girl once held her breath. Maybe a year ago she did this. Just an inch under the bath water, her small body still, muscles relaxed, face serene. After what became too long, her mother reached under the water, grabbed her under her arms and pulled her up and when the girl emerged into the air she was triumphant with her discovery. That she could control these sorts of things. She could stop breath like this. On a whim.

  Her right arm was folded across her stomach and exaggerated the lift of her chest—a barometer of breath. Her legs were askew, scissor-like. Her skin was sallow but warm. The angle where her neck met her jaw fluttered twice with each pause of her heart. Her lips were dry. Her eyes were closed. Because she was sleeping.

  Night or day, the room was kept dark. Because letting the sun in might have been too hopeful. Because hope at this stage was irresponsible.

  Around her and inside the room were objects still animated by her presence. A doll, a hairbrush with six brown hairs entwined, a box of colouring pencils of different lengths, two parents, one hunched forward, the other leaning back. Their meaning existed because she did, because the girl who held them or hugged them or regarded them with a precise, thoughtful intention still lay sleeping nearby.

  She slept because she was tired. She was tired because she was ill. She was ill because—and this was where the chain broke. There was no because. There was no reasonable answer. There was no reason.

  May 12, 1995

  He waited in Lilongwe airport for an hour. He sat on a chair in the near empty single room, contemplated buying something from the little stand where food was on offer. This consisted mainly of fresh fruit—bananas and tangerines. Hard-boiled eggs. Clawed chicken feet, deep-fried and glistening with nails still intact. Sleep deprivation and strange airplane air clogged his thoughts. He struggled to sort it all out. He was here. He wouldn’t be there (Toronto) for months, maybe years. Who knew? And this—that he didn’t know, exactly, what his plan was. There were two more steps on the bulleted list folded up in his dossier next to his passport (- find apartment, - go to hospital) and then the plan that had seemed so detailed, so well-laid from his apartment in Toronto was complete. The details, he now understood, were in the preparations—what to bring, what to put into storage, when to shut off his phone line, his utilities, immunizations, flight times. But what came after was unplanned, undetermined, a white space beneath the printed list. Sitting in that airport he was hard-pressed to believe this was what he really wanted. There was a rising sense that what propelled him onto the plane and out of Toronto was something as unreal as what faced him here. It could follow him.

  He sat there looking at the food and at the vendor who ignored him pointedly for countless minutes. Then he somehow knew (did someone tell him, was there an announcement) that he needed to get up and join the short queue for another plane, a twin-prop that crouched on the runway while passengers climbed into the cavern of it. The plane doors were pulled closed and they were taxiing along the red earth.

  Red. Burnt, ferrous red of old blood. This was the colour of the place. Along with the yellow of tall grasses. Yellow-brown thatch of village roofs from the air. And as they approached Blantyre there were corrugated metal roofs that sent sunlight upwards in sharp sudden flashes.

  They touched down in Blantyre, his second and final stop in Malawi. The wings fought the wind and the plane gradually slowed, its wheels bumping tentatively then more certainly along the ground. Red earth tumbled up and blew past his window. It obscured his view. When he climbed out of the plane the ground was still agitated, dust swirling up as he clambered down. He rubbed his eyes. It settled on his travel-weary clothes and skin as a fine grit.

  In the Blantyre airport he found a man who would drive him (possibly a taxi driver, probably not), fumbled for the address somewhere in his pocket, found his assigned apartment on a hillside, met the sullen man who would be guarding against intruders, found his bedroom and his bed with a dirty tangle of netting above it, and fell asleep.

  When he wakes it is dark and the flickering bulb dangling from the ceiling casts a sepia glow on his quarters, shows him that they are as he recalled in his dreams. His watch indicates that it is 5 am, local time. He washes in a bathroom still damp with someone else’s (the last doctor’s?) shower. A lone gecko up on a wall near the ceiling doesn’t budge its splayed round toes. He dresses and sits at the table in the kitchen in the rising grey light. When it matches then exceeds the lamplight, he goes outside where he finds the sullen guard having a smoke. He asks him where the hospital is and the man points down the road and up the hill.

  In his room his backpack still leans against the wall where he dropped it uncounted hours ago. He opens it and finds his stethoscope coiled between T-shirts. He pulls it out and feels more certain. It reminds him of something. A remote urge. A quiet desire. The sense of something being possible. It reminds him of hope.

  Part I

  Out beyond ideas of wrongdoing and rightdoing

  Chapter 1

  Dust returns to the land in the mornings. It settles in a thick layer and smothers the early light so that the colour is soft, a blush on the horizon. The effect is calming, far differe
nt from the experience of living with the dust itself. When he first arrived in Malawi, Henry would swing at the dust, cough it up, rub it out of his eyes, find pale grains in his tears. The dust, combined with the heat and the diesel exhaust, made the air feel thick and stifling. He choked on every breath.

  He walks across the land with less resistance now, with less fight in him. He is willing to accept certain things about the place, things he cannot change, like the dust, or the heat, or the geckos that scurry across the walls. But there are things he is still unwilling to accept, and he senses that the land, this place, feels the same way about him. There are things that it just won’t compromise on. And so, to him, it remains round and hard like a bone, blanched and chafed from centuries of sun and drifting dust. He sees the convexity of the surface on which he walks, how it arches and bends away from him. Always, no matter where he is, he can see the curve to the horizon—out there where the baobab trees show their root-like branches to the amber sky.

  He climbs the hill, keeps a steady pace. Henry can see the hospital now. At home in Toronto the hospitals are neat white boxes, packaged like takeout containers, compartmentalized and sterile. The stink of illness is swept clean and the suffering is tucked into bed with the curtains drawn. Here in Blantyre, bodies are wet with the sweat of prolonged struggle and the air is thick with the sour odour of a losing battle. For the first few weeks it seemed to Henry that most people went there to die.

  Henry reaches the hospital and pulls open the heavy door with effort. He feels himself move like an old man, as if he has already lived a full lifetime. But he is only thirty-five, and just two months older than he was when he arrived here, in the spring of 1995, brimming with piss and vinegar and idealism—the particular blend unique to a doctor who has been Canadian-trained, and who has travelled through life with pale skin, and red hair, and blue eyes. He has never been more aware of these unchangeable aspects of himself since arriving here, where he is reminded of the immense significance of his appearance constantly, wherever he goes, to whomever he speaks. The gaze is just as prolonged and considered no matter who it is considering him.

  He steps into the dim foyer and moves down one of the hallways. Sunlight from open windows struggles through the interior shadows, brightening no more than a few feet. He walks past the windows and sucks in the outdoor air —dusty, but odourless. Blankets hang from clotheslines outside, in the hospital courtyard. Blankets, sheets, and hundreds of gloves—ghostly wisps of hands waving from the line. Even sterile gloves are recycled.

  Henry enters an office off the main medical ward and slips on his lab coat. He nods to the nurse seated at the desk. Sister Iris Mwachilale regards him briefly with hooded eyes, and then returns to her charting. Henry takes his stethoscope out of the pocket of his lab coat and hangs it around his neck. He pauses as Sister Iris flips another page, head down. It is too early in the morning to contend with one of her moods, but he proceeds anyway.

  “Any action on the wards last night?”

  Iris lifts her eyes and looks at his nose. “One of the TB patients,” she says, “respiratory failure.”

  “No bed in the ICU?”

  Iris shrugs.

  “You should have called me,” he says, “I could have tried. To intubate, or resuscitate.”

  Iris lifts her head, meeting him more squarely. Her eyes tighten a little. Her jaw juts sideways. More effort has been put into this last non-verbal exchange. The tumult of possible meaning kaleidoscopes in front of him. It would have been futile. Or, perhaps, it is invasive, a cruel intervention from the Western tradition. Or even, he’s more my brother than yours. And finally: it is not your right.

  But it is! Henry feels like yelling, although she has said nothing to him at all. I have knowledge. I have skill. I have the desire. To do what? He wonders this, stuck for a moment in the quagmire of wants, needs and frustrations that slop about messily in his mind.

  Instead, he mutters, “I’ll start on rounds.” And exits the room, leaving Sister Iris to flip another page and watch his departure in the same viscous silence.

  Henry enters the general medical ward, feels its damp breath on his skin and wonders why it is always so dark in this place. Despite the bulbs hanging from the ceiling, the long wall of open windows, why is the light so meagre? Beds are lined up, a foot or two apart, in row upon row. There are bundles of blanket and cloth under and between the beds and angular limbs jut out of them—another tier of patients waiting for care. Henry sees Dr. Kumwembe a few rows down, clipboard in hand, interviewing a patient, frowning and looking studious as usual.

  Henry moves to one of the beds in the front row. A new patient lies on it with his arm draped across his forehead. Jutting up from the bed, each rib is well-defined and evenly spaced, like struts in a house. Henry rests his hand on his shoulder. “Sir?” he asks and then waits. The patient’s mouth spreads into a wide smile. Despite his illness, he savours the rare pleasure of a white doctor calling him sir.

  Henry picks up the clipboard hanging off a hook at the end of the bed. The patient’s vital signs are scrawled across the top of the page: temp: 39.5. A fever. Ubiquitous here. Blood pressure: 75 over 40. In his boots. Heart rate: 120. Racing to keep up. All in all, likely septic. Probably malaria but there are so many other possibilities. Henry glances at the name on the chart: Juma. And his age: based on the date of birth, he is just 16. A child. Just old enough to have outgrown the paediatric ward. Henry now notices the soft growth of fuzz on Juma’s chin.

  Henry takes Juma’s hand and searches for the radial artery that is strung along the ropes of tendons in his wrist. Juma’s pulse is bounding, his arteries wide open, flooding his extremities, making them hot and dry. Septic. Henry reaches for the IV bag to check its contents, expecting one to be there like there always is at home, but there is nothing, not even a pole. He looks around the ward for the recognizable white sail of a nurse’s hat drifting somewhere in the sea of bodies but sees only a few scattered visitors, crouching over a bed or squatting beside a prostrate figure on the floor, and Dr. Kumwembe, even farther away now, many rows ahead.

  Henry returns his attention to Juma who has reached out to touch his lab coat, fingering it like rare silk. Not knowing how much English the boy understands, Henry explains, “I need to find an IV bag. Some fluids for you. So your heart doesn’t have to work so hard.”

  Juma places his hand over the left side of his chest and Henry sees the vigorous efforts of his heart transmitting through his hand. “My heart works hard all my life.” Juma says. “Strong.”

  Henry smiles. “Yes.” He turns and sees Sister Iris a few feet away with a pushcart of medications and supplies. Watching them with an empty face.

  “Is there an IV pole around? I need a bag of normal saline.” Iris turns and walks away from them and Henry can only hope that she has gone to collect the supplies.

  Iris returns within a few minutes and passes the requested plastic bag of intravenous fluid to Henry, pushes the IV pole over to Juma’s side. Henry accepts the bag, “Thank you, Sister.” As he crouches over Juma’s arm and pushes a large-bore IV needle into the largest vein he can find, he feels her behind him, moored to the concrete floor. “Shouldn’t you be heading home now?” He asks this as the needle reaches a vein and Juma’s blood flashes back, dark purple-red in the tube.

  “Sister Josephine is sick today,” she replies.

  Henry fixes the IV tubing onto Juma’s arm with some tape. He stands up and adjusts the drip of the IV so it flows in quickly. Snaps off his gloves. Iris has been working for over 12 hours now; she had just been on night shift, overseeing the ward. Satisfied with the drip, Henry turns to Iris. Her hat is still in place; Henry has never seen her without it. But wiry strands of hair have sprung loose from under it, released from their knot.

  “Maybe you should head home,” he says, “get some sleep.”

  Iris shakes her head, tightens her lips an
d squeezes the pushcart handles, stares at Juma as if expecting him to argue alongside Henry. But Juma is watching his arm where the doctor has thrust the plastic tube, where he can feel the cool fluid enter his body. He looks at it as though he knows that this is where the cure will begin to take effect.

  Henry sighs. “We’ll need blood cultures and a malaria smear on this one,” he says and then steps a few feet past Juma to crouch down to his next patient: a tangle of blanket and limbs on the floor. Iris follows, nudges the pushcart over and quickly smoothes her hair back into place under her hat.

  *

  Henry observes the top of Dr. Kumwembe’s head with its compact spirals of hair as he bends over his plate and eats quickly, his fingers wet with food. The man had apologized once, many meals ago, for leaving his fork at the side of the plate. “When I’m at home, I do what comes most naturally,” he’d said with a shrug.

  Henry lifts a forkful of rice to his mouth, chews it slowly, swallows it down. Kumwembe wipes his hands and face with a napkin, rolls his tongue over his teeth. His eyes settle on Henry’s respiratory mask sitting on the table beside his plate. It is becoming discoloured and worn.

  “How many of those did you bring?” Kumwembe inclines his head toward the mask.

  “A few.”

  He had packed a box full of the masks. Upon first entering the TB ward, Henry felt vertiginous with the thought of a room full of millions of TB particles, colliding in the air, spinning toward him in an invisible, chaotic cloud. He moves his hand over to the mask and fingers the green elastic bands. Kumwembe watches him with his moist brown eyes. It is futile, wearing the mask in the TB wards. Unless he is willing to wear the mask all day long and everywhere, he will inevitably be exposed, it is only a matter of time. Despite this, he knows he will go back to his apartment tonight, pull out a fresh mask from the box and bring it to work tomorrow.