- This Is How It Always Is
“Here and everywhere,” Claude said without looking up. For some reason, he felt worse with his mom than he did in his classroom. He knew she was just trying to help him, but maybe he had more in common with his little students. He knew she loved him more than anything for seven thousand miles in any direction, but somehow that just made him cry harder.
She softened her tone. “Should we go home?”
He looked up at her at once, the worry turned sharply to panic. “No. Mom, no. We can’t go home.” Like their ancestral land was set upon by marauding hordes. Like their intergalactic space pod had crashed on landing.
This was unforeseen.
But accounting for the unforeseen was one of Rosie’s particular talents. At home this manifested as never having to go to the grocery store. She would look at a pantry that contained only the dregs of boxes of four different kinds of pasta, half a bag of brown rice, four cans of kidney beans, three of tuna fish, and a bag of expired sun-dried tomatoes and concoct dinner. She would be missing two-thirds of the ingredients in a recipe, and by subbing skim milk for cream and olive oil for butter and lentils for beef and frozen broccoli for fresh spinach and red pepper flakes for mushrooms and nothing for fresh sage leaves (because really, what dish actually hinged on fresh sage leaves?), she could achieve lasagna béchamel without leaving the house.
And it turned out it was this skill—not her years of ER experience, not her advanced training, not the decade and a half she’d spent in a teaching hospital—that made her so valuable at the clinic. What the recipe called for, they did not have on hand. What a Google search, not to mention said years of experience and her not-inconsiderable medical intuition, suggested as a viable substitution was not available either. But what Rosie could do was look at a yawning supply closet with its paltry stock, at moldy equipment and unreliable drug supplies, and figure out something that would work.
She made a wound sequestration area out of palm fronds and coconut husk. She made an inhaler out of a plastic soda bottle. She prescribed drugs in all sorts of ways the FDA never allowed themselves to imagine.
It had been week two before someone came in with a broken bone, odd because fractures were so common, there and everywhere, and at first Rosie had been relieved. The woman was very pregnant and in a wheelbarrow, both she and her husband, who was pushing, flushed and out of breath, and Rosie had at first thought it would be something much worse. Whereas labor and delivery had tended, in her previous medical experience, to be the most triumphant rotation, here most people gave birth at home, and only came in when there was a complication, often only after it was too late or became too late during the journey. Rosie came to greet the sight of mounded belly with sinking dread. This patient grasped her domed front, shook her head, and assured K, who assured Rosie, “Baby stay. Ankle go.” It was then Rosie noticed her propped leg, purple and blue, her ankle swollen to the size of her thigh. “Fall off water buffalo,” K explained. “Hard to balance with such big…” The woman grinned then grimaced then grasped her belly again.
Rosie checked her pupils and her pulses, listened to her heart and the baby’s, had the woman endeavor to wiggle toes on both feet. “Let’s get you up to X-ray.” It was out of her mouth before she realized that at least the “up” was entirely erroneous. The X-ray too? Surely they had some kind of antiquated-but-better-than-nothing X-ray machine. How could they run the place without one? That said, she’d been there every day for two weeks and never seen one, heard one mentioned, located a building where one might have been. Maybe it had just never come up.
“K? I’m afraid to ask but … X-ray?”
K’s particular talents had proven to stretch further even than from auto repair to midwifery. K was her medic. That’s how the clinic director had introduced her on day two: “This is your medic, K,” as if Rosie had not already saved a truck, lost a patient, and delivered a baby with the woman. Rosie had not been aware she got or needed a medic or what a medic in a clinic like this one even was per se. It turned out the medic was everything except for what Rosie was. And sometimes she was what Rosie was too. K did injections. She did the vomit and the blood and the feces, which was saying something because there was a lot of all of the above. She did wound-care work and handholding work and being patient with patients work. She did the translating work of explaining prognoses and which drugs to take when and how to clean abrasions and stanch blood and how to rehydrate babies and when to let fevers run their course versus when to seek medical care. She translated English into Thai and Northern Thai and a variety of Thai dialects and Burmese and Karen, and she translated Rosie’s stern and complicated Doctor into kind and reassuring Nurse, instructions clear enough to follow precisely, gentle enough to inspire confidence and calm. Rosie assumed K had gone to nursing school at least, but K could not get into nursing school because K had never finished high school.
K was also her physical therapist and her social worker and her security detail. When a child came into the clinic with her father but then her father died, K knew how to comfort the little girl and find her someplace to stay and something to wear and enroll her in school. When a teacher came in to complain that his leg fit incorrectly so that he could walk, yes, but he could not stand for long periods of time in front of his classroom, K worked with the prosthetics department to fashion him a leg that stood as well as perambulated and with the patient to think about exerting discipline on small children from a seated position. When the injuries one woman claimed came from falling off a water cistern proved instead to have come from a husband incensed to find her pregnant again, K had him removed and found beds for all seven of his children. But K had never been to physical-therapy school or social-work school. K had never even taken a martial-arts class. What K knew, and it was a stunning, encyclopedic amount, she had learned from the doctors who’d come before Rosie, from the doctors who came and stayed for weeks or months or years, from watching, from experience, and from necessity. Rosie found herself asking K’s advice more often than the other way around. Rosie had more formal training, but it wasn’t training for this environment. K knew quite a bit more about worms and snakebites and what, based on your symptoms, probably laid eggs in you than had been covered by the University of Wisconsin’s medical school program. And of course she maintained Sorry Ralph, never mind the fact that her functional, sensitive, callus-free hands were precious as palladium. It took a while, longer than it should have maybe, but Rosie gradually realized the many versions of K layered atop one another like sediment. And like that striated earth, what remained of K after the buffeting of wind and wear and time was solid as rock.