After Kilimanjaro Read online

  When the blue-haired lady coded, her EKG showed the classic evolution of a heart attack: elevated ST segments, flipped T’s, then V-tach. They took turns at chest compressions, shocked her again and again, but could not get a rhythm back. Sarah wished the sweet little old lady would hurry up and die.

  Her advisor told her not to feel guilty for such thoughts. It was burn-out, an increasingly common problem among physicians. “It’s not just the long hours, the life and death situations. It’s depersonalization, loss of autonomy in this complex health care system—electronic records, more and more regulation. Taking care of patients can seem like shift work.” She prescribed stress reduction and schedule decompression. As if Sarah had any control over her life.

  David had a brilliant solution. He wanted to climb Kilimanjaro. “I could get a grant to work on that malaria vaccine project. We could spend a whole year in Africa.”

  “Kilimanjaro? Sounds extreme.”

  “It’s not that hard. No technical rock climbing or anything that dangerous—just a long hike up the world’s tallest free-standing mountain. Imagine the view from the top: three hundred and sixty degrees.”

  The concept of a break year was appealing. But she did not want to sit around idly during the hours that David devoted to saving humanity from a dreaded disease, so she scoured the internet for something constructive to do. Nothing seemed to fit, until she happened onto a statement that took her breath away.

  PREGNANCY SHOULD NOT BE A FATAL ILLNESS

  This was the vision statement of the Stanford Foundation, a non-profit agency waging war against the mortality of childbirth in sub-Saharan Africa. The website was replete with sad stories of women who suffered grievously in childbirth, preventable deaths, and disabling complications. There were heart-breaking photos of hollow-eyed orphans. The foundation sponsored scholarships for young American doctors to spend a year learning first-hand about women’s health care in Africa. Each fellow was provided funds for a research project and encouraged to “think outside the box” for innovative solutions.

  It resonated with her—a chance to re-ignite her compassion, to remind her of why she went to medical school in the first place. She did not feel qualified for the position—no training in obstetrics beyond medical school. But she submitted her application anyway and crossed her fingers.

  She was stunned to receive an invitation for an interview. On a bright sunny day, she took a train down to DC and Ubered to a brownstone in Georgetown. The CEO, perched on a taupe velvet loveseat, reviewed the mission of the foundation. “Normally we sponsor young obstetricians. But Mrs. Stanford was very impressed with the passion in your essay. And she believes, as a surgeon, you could provide a fresh perspective. Will you accept the position?”

  IT WAS A magnificent plan. She and David would be off on a grand adventure in an exotic locale, making the world a better place.

  It was too good to be true.

  Literally.

  David didn’t get funded for the malaria project.

  He got the bad e-mail one night as they sat at the kitchen table. He slammed his laptop shut. “We’ll just have to wait to go to Africa … someday when we’re rich doctors.”

  “I can’t back out now. I got all those references, the schedule is changed—”

  “But … you wouldn’t go without me, would you?”

  “Can’t you just come along with me?”

  “What?” He scoffed. “Just goof off for a year?”

  “I would have gone with you.” And she would have. She would have followed him anywhere.

  CHAPTER FOUR

  THE MOUNTAIN

  One would expect Kilimanjaro to be clearly visible from a place called the Kibo View Lodge. But when the sun came up, there was no sign of the mountain. Sarah wandered around the grounds, peering over trees and hedges and scanning the overcast horizon in vain. When her taxi arrived, she asked the driver to point out the mountain. He smiled and shrugged. “Kibo very shy today.”

  The road to the hospital seemed barely wide enough to accommodate two vehicles, but somehow it functioned as a multi-lane thoroughfare. Tiny three-wheeled transports trolled for passengers along the shoulders, and motorcycles streamed along anywhere they could squeeze through. The dominant vehicles were Dala-dala minibuses, each with a young man hanging out the door to recruit customers and a driver who felt completely entitled to claim the right of way at all times.

  The taxi wove back and forth to avoid potholes, people, and goats. Small shops, vegetable stands, beauty shops, and bars lined the roadsides. Large displays of brightly colored cooking gas containers were arranged in splashes of orange, blue, and yellow. The air was saturated with the aromas of fish and corn roasting over charcoal. A small white coffin lined in pink satin sat in the dirt yard in front of one shop.

  Children ambled alongside the road, clustered in groups of color-matched school uniforms, chattering, laughing, and somehow managing to avoid being struck by traffic. The most popular color was royal blue, but forest green was a close second, and there were smatterings of rust, maroon, and mustard. Each uniform, inexplicably, included a pullover sweater that could not be comfortable in this tropical climate.

  SARAH’S HOUSE WAS like all the others in the doctors’ compound: cream-colored stucco walls, red tile roof, and battered green garage doors. Built in the ’60s, the homes had not been that well maintained. The linoleum on the kitchen floor was disintegrating and stains on the ceiling provided evidence of a leaky roof. But the house was spacious and clean. Large screened windows transmitted sunlight and jasmine-scented breezes.

  Irene, the housing manager, pointed out the large sink near the kitchen door. “The housekeeper, Rosie, will wash your clothes here. You must buy washing powder. And she will i-ron your clothes.”

  “My clothes don’t need ironing. They’re wrinkle-free.”

  “You must i-ron the clothes. When the clothes are drying on the line, flies will lay eggs. You i-ron to kill the eggs. If you don’t, they will hatch on your skin.”

  Sarah fought back the urge to scratch herself.

  Irene gestured to a large electric kettle sitting on the counter. “You boil water for five minutes. Then you can drink it. Or you can buy bottled water.” She inspected the kettle and clucked her tongue. “The cord is frayed. You must buy a new one.” She gestured to a switch on the wall. “That is for the hot water heater. You turn it on for one hour, then you have hot water. But it uses much power. You give Rosie money for the power. Then she will go and pay it for you. And you must buy a tank of gas for this cooker.”

  Beyond the kitchen was a large room with sitting and dining areas. The veranda overlooked a large and lush but unkempt garden bordered by a hedge of brightly blooming bougainvillea. There were flame trees with crimson flowers, lavender laden jacarandas, and a family of monkeys rustled the branches of a mango tree. A privet hedge that wanted pruning encircled a large birdbath. The lawn was overgrown with knee-high weeds. Irene said a gardener would cut the grass.

  “Can you see the mountain from here?”

  Irene waved her arm northward. “The mountain is there.”

  “I don’t see it.”

  “Too many clouds. Maybe this evening.”

  In the bedroom, a mosquito net dangled from the ceiling, tied in a loose knot. Irene shook her head. “This has net has many holes. You must buy a new one”

  Information overload. It was a relief when the housing manager left. Sarah turned to the daunting task of unpacking and worked steadily, until she heard a loud squawk from outside. A weird green bird about the size of a turkey perched in the crook of a white-blossomed tree near her bedroom window. It was ugly and awkward, with a long, curved beak that gaped widely with each obnoxious squawk. She was captivated. She snapped a quick picture with her cellphone, then rummaged in her backpack for her camera. David had given her a telephoto lens as a bon voyage gift. There was an ulterior motive. He was coming for a visit in September and wanted to get some good closeup s
hots on a safari. By the time she had the lens connected and the camera poised for the shot, the bird had flown away.

  So much for nature photography. Time to go to the hospital and meet with her supervisor.

  She followed a red dirt path to the hospital, between fields of corn, beans, and sunflowers. The ground was peppered with little holes, as though some madman with a drill had declared war on the baked earth. The openings were portals to an underground termite network that periodically erupted into phallic mounds, five to seven feet high.

  A tunnel of jacaranda trees led to the back of the hospital. There were two rear entrances. One was marked Mortuary. Not Morgue. A small group of people loaded a coffin into a pick-up truck festooned with purple ribbons and a wreath. The truck pulled slowly away, followed by a procession of mourners, singing a melancholy chant.

  She took the other entrance and headed for the maternity clinic.

  CHAPTER FIVE

  ORIENTATION

  The OB clinic waiting room was hot and stuffy, saturated with baby and body odors, even though the outer wall was a latticework of brick that should have allowed ample circulation. The crowd of patients far exceeded seating capacity, with most of the women and their children resting on the floor or leaning against the walls.

  A receptionist led Sarah down a dark hallway to the office of Dr. Obaye, the chairman of the OB Department. A portrait of the Tanzanian president hung on the wall behind a large mahogany desk cluttered with stacks of papers and journals. The stern-faced man glanced up but did not rise from his seat. He just waved a large hand toward an empty chair. “Karibu, Doctor Sarah. Please be seated. You must be tired from your journey.” He launched into a description of the maternity service. “Our facilities are not as modern as what you have in the states. But we work hard. We do much with little.” He leaned forward, folded his hands. “You will see patients in the clinic and take call in labor and delivery.”

  “Uh … what about your research program?” Her position description included “some clinical activity,” but she hadn’t signed on for a full burden of direct patient care. She had expected the year to be a respite from such stress.

  He raised his eyebrows. “Research?”

  “Yes, I have a grant to complete a research project.”

  “What do you propose to study?”

  She squirmed, recalled ideas she had listed in her application. “I’m interested in prenatal nutrition. Maybe looking at pre-conception weight, vitamins …”

  He smiled thinly, and his eyes glazed over. “You are trained as a surgeon, not an obstetrician. You need some experience first. Then some good research question may come to you. Meanwhile, you can work with our chief resident, Dr. Ameera Zaheer.” He cleared his throat. “A few years ago, we developed protocols for managing the three main causes of obstetrical death: infection, bleeding, and eclampsia. Dr. Ameera is reviewing our results.” He stood up, tapped softly on his desk. “Let me show you the clinic.”

  It should not have been a shock. After all, this was a third-world country. But she wasn’t expecting the peeling paint and the cracked concrete floor. The long narrow room was divided by curtains into six exam cubicles. Not a single computer in sight. Patient records were sheafs of pastelcolored papers, with dog eared corners and hand-written notes, laid out on a chipped Formica covered desk.

  Dr. Ameera Zaheer was slender and petite, of Indian descent, her head was covered with a scarf. She bowed slightly. “Karibu. We have a busy clinic today.”

  The first patient was accompanied by a toddler in a pink organdy dress and sparkly blue plastic shoes. The child fixed her huge brown eyes on Sarah’s smile for a millisecond, then ducked her head and covered her face. Ameera crouched over the mother’s bulging abdomen with a fetal stethoscope, searching for the heartbeat. She found the sweet spot and handed the scope to Sarah. The fluttering heart sounds were so different from the whooshes of a doppler, the electronic sensor they always used back in Philadelphia. A small hand touched Sarah’s arm and she looked down at the sparkly plastic shoes next to her own sandals. She put the earpieces in the little girl’s ears. The child gasped softly and reached up to touch her mother’s belly.

  The next patient handed her two-week-old infant to Sarah before climbing onto the exam table. Ameera smiled as she read from the chart. “This baby is sero-negative.”

  “You mean, she doesn’t have HIV? Does her mother have AIDS?”

  “Yes, but she received medication during pregnancy. So she didn’t pass it to the baby.”

  Sarah admired the perfect tiny fingernails and rosebud lips, hoping the mother would survive to care for this baby. Her cell phone went off—David’s signature alert—but she couldn’t answer, not with the baby in her arms. She tried to call him back later, but only heard his voice mail message.

  THE GARDENER WAS attacking the lawn when she returned to her house. He made it look easy, one arm casually on his hip, right arm wielding a curved machete like a pendulum, back and forth, precisely decapitating weeds at an inch above the ground. He bundled a huge mass of the cuttings, four feet tall and at least six feet wide, onto the back of his bicycle. He waved and smiled at Sarah, then pointed to his cargo. “Foodie for my goat.”

  He hopped on the bike and wobbled off, with Sarah wondering how on earth he managed to keep his balance.

  Tea would have been nice, if the cord on the kettle had not been frayed. And she couldn’t boil water on the stove because she still had no gas canister. A hot shower sounded good, but when she switched on the hot water heater, she realized there was no power. A neighbor said it was not unusual. Power routinely went out one or two times a week, rarely more than a couple of hours. Maintenance work. Good thing her laptop was charged up. She decided to conserve that battery and settled down on the sofa to read a book. Soon she was fast asleep.

  HER PHONE RANG several times before she found it under a cushion.

  “Hey, Sam. I was afraid you weren’t going to answer. Again.”

  David always called her Sam. Family nickname. Allegedly, her little sister could not pronounce “Sarah.”

  “Sorry. I’m really zonked out.”

  “You should stay up until at least ten tonight. That’s the best way to change time zones. Just like jumping into a cold swimming pool.”

  “I thought I’d never hear from you. Didn’t you get my text messages?”

  “I did.”

  “I thought they didn’t go through. I was afraid you’d be worried about me.”

  “I knew you had to be alright. If your plane had crashed, it would’ve been in the news.”

  “What if I got abducted from the airport?”

  “Uh … well … sorry. Really sorry. I should have called sooner.”

  “That’s okay.” Sarah’s constant refrain of conflict avoidance. Never admit annoyance. “It’s nice to hear your voice. But hang up, and I’ll call you back on Skype. Then we can see each other, too.”

  “So your house has internet?”

  “No, but I got a wireless hot spot. They sell them at a tent in front of the hospital. And I got a neat little cellphone for local calls. I can even use it to pay for stuff. They have this system called m-pesa.”

  David appeared on her computer screen, with his dark brown eyes and pouty smile. “There you are,” she gushed. “Across an ocean, a continent, and the equator.”

  “Yeah, thanks to true love and technology. But we’re not really gazing into each other’s eyes. We’re both looking into a camera, so on the screen it looks like we’re looking somewhere else.”

  “Let’s take turns looking at the camera. First you.” She watched as his eyes rotated. “Now me.”

  David laughed. “We just had fake eye contact. What’s next?”

  “You can let me know if a cheetah is sneaking up on me.”

  “Cheetahs don’t sneak! They’re the fastest mammals. A leopard would be more likely to stalk you. I have a wild animal here who wants to see you.” He scooped up Sarah’s
cat, Whiskers, and raised one of his paws in a kitty wave. “Say hi to Mommy.”

  “He looks well.”

  “That’s because I took him off wet food. He’s on the wagon. Dry food only.”

  “The vet says wet food is good for him!”

  “I don’t buy that. More importantly, wet food stinks. What about Kilimanjaro? Is it as beautiful as the pictures?”

  “I haven’t seen it yet. The weather’s not cooperating. How are things going for you?”

  “The usual. Rounds every morning at seven, then clinic. Call every fourth night. The lab takes up most nights and weekends.” He droned on about his experiments in great technical detail. Sarah was fading and had trouble concentrating on his tales of gels and primers.

  David shouted, “Hey, wake up!”

  Sarah yawned and stretched, struggling to keep her eyes open. “Sorry.”

  “I’m boring you.”

  “No, no, it’s just—”

  “I understand. Jet lag.” He made his puppy dog face. “I miss you way too much. I think I’m gonna go nuts while you’re gone.”

  It was going to be a long year.

  CHAPTER SIX

  FORKS IN THE ROADS

  Mothers normally do all the real work in childbirth. After successive contractions, the baby suddenly pops out, slithering and slimy. All that remains is to cut the cord and deliver the placenta. Simple and natural. As long as nothing goes wrong.

  Sarah examined the young woman one last time, and then nodded at the medical student. “Okay, tell her to push.”

  George barked a command in Swahili, a bit too loudly. He was certainly enthusiastic, but his bedside manner left something to be desired. This was his first delivery and his eyes glowed with wonder as the baby slipped into his waiting hands. Sarah handed him the clamps and scissors. “Tell me how long we should wait before cutting the cord.”