CHAPTER 25
Opening her jacket, Grace dug in the breast pocket for the tiny notepad and pencil stub Brenna had given her. Since she was here, she might as well work. Maybe she could still salvage the documentary.
She stepped into the hallway and nearly collided with two porters dragging the corpse of a white-haired man in a black coat.
The body trailed a foot-wide swath of bright red blood.
The porters curved toward the bank of plastic-covered window openings and parked the body on its side, facing the base of the wall.
Following the porters back through the swinging yellow doors to the emergency area, she stepped into pandemonium.
On one side, men gestured wildly, their voices raised by the adrenaline of danger.
Away from them, shadow-eyed families and friends huddled together, intently watching the medical teams working behind the nurses’ station.
The less critically-injured, sitting silently on the short-legged canvas litters, leaned against the stained walls, pressing wadded gauze against bleeding injuries, waiting their turns.
Brenna was moving through the chaos with feline grace, peering through the viewfinder with somber concentration.
The entrance doors burst open. Two blood-sprayed men, hands locked together to form a seat, carried in a woman whose right foot dangled by ropes of dirt-encrusted tissue.
The triage nurse led them to Mariana. She spoke briefly to the patient, examined the foot, and called out in a loud voice.
Porters appeared beside her and shook their heads in response to her questions.
Her eyes scanned the room and landed on Grace.
“Can you stand the sight of blood?”
She nodded. Her Dad was a surgeon and Grace had often sat in the viewing gallery, observing him work.
“I need help.”
She pocketed her notepad. “Tell me what to do.”
“Follow me.”
With her hip hurting, Grace struggled to keep up with Mariana as she wove through the crowded room, issuing orders and answering questions along the way.
“I have a thirty-five-year-old female who stepped on a land mine while she was picking dandelions for dinner. I need someone to hold her down while I amputate her foot.”
Why did the patient have to be held down? “Dear God in heaven,” she said, horrified. “You’re cutting off her foot without anesthesia?”
“I have to,” Mariana said, pushing open the staircase door. “She’s bleeding out.”
What have I gotten myself into?
“Without electricity, there is no refrigeration,” Mariana continued. “Without refrigeration, there is no blood bank. The best I can do for her is stop the flow. I’m hoping Brenna was able to get us the antibiotics. This woman’s got half the road in the wound.”
At the basement landing, Mariana opened the door to a dark hallway lit by a single lantern hanging at the midpoint.
At the far end, Grace glimpsed extra-wide double doors. “The aid agencies say they’re moving tons of supplies into the city. Aren’t you receiving them?”
“Every crook, every blockade the supplies move past, shaves a percentage. We get thirty percent of what we need. And often, what we get is unusable. Expired meds, unlabelled, labeled in a foreign language, spoiled during transit. We’re getting World War II stuff dumped on us.
And cases of plaster tapes from 1961. I got a shipment of Dapsone the other day. Dapsone! Leprosy treatment. Do I get anesthetics? Antibiotics? Insulin? Cardiac meds?”
Mariana pushed open a door with the international symbol for Do Not Enter and walked ahead of her into the surgical area.
Grace stopped, scarcely able to see through the gloom.
Without natural light, the basement was pitch black.
Only three small tea light candles combated complete obscurity.
As her eyes grew accustomed to the gloom, she made out two shadowed figures. OR Nurses.
“Take off your jacket and throw it over a chair. I’ll see if I can find you a gown and gloves.” She departed, murmuring to the nurses.
One of the entry doors swung open. The porters entered, carrying the woman with the macerated foot on a stretcher.
She came past her at waist level, her eyes wide with fear, the rags on her foot soaked with blood.
An intravenous needle and tubing was taped to the back of her left hand and a bag of clear fluid lay beside her on the stretcher.
Grace held her gaze until the porters entered the operating suite.
“Word of advice?” Mariana said, handing her a filthy gown, a clean-ish face mask, and a used pair of gloves.
“Keep some emotional distance. Empathy makes it harder, especially once the patient starts screaming. If you pass out, you are no use to her. Keep this in mind: Taking the foot will save her life.”
Grace nodded, feeling the pit of her stomach drop out.
“The gown ties in the back. Suit up, and go on in. I’ll be in to cut in a moment.”
The windowless operating room was dark except for the bright circle of light cast onto the patient by a lantern hanging from an IV pole.
The woman lay on a narrow operating table with no rails.
Two nurses, one on each side of the patient, tightened a broad strap around her hips.
Moving with wordless teamwork, never taking their hands off the patient, they threaded a second strap under her arms and secured it.
They lifted the patient’s arms off her belly onto the two hinged wings of the table and strapped them down.
Finally, the wings swung perpendicularly out from the body, locking into place, completing the macabre crucifixion-like tableau.
Mariana bumped the door behind Grace and entered the room back first, hands in air. “Come closer,” she said, walking to the operating table.
Grace joined her, elbow to elbow, not daring to touch anything—though the patient was so filthy, sterility seemed impossible. The woman’s intact leg, she now saw, was tied tightly at the calf, but her injured leg, painted with orangey-brown disinfectant, was free to allow manipulation.
A shiver ran up her spine.
The nurse at the foot of the table rolled an instrument tray closer.
Some of the instruments were familiar: hemostats, surgical brushes, curved needles and silk, a scalpel.
And a hand saw. Over to one side of the tray, a lit can of Sterno sat a bit apart, with thin metal rods the length of a crochet hook glowing red at the tips.
“What’re those?” she asked.
Mariana followed her gaze to the blue flame.
“For cauterization. Stops bleeding in the smaller blood vessels.”
She pulled on a pair of surgical gloves.
“I need help manipulating the leg while I amputate the foot. When I tell you to hold her, immobilize her. She’s going to panic, kick hard. It’s going to take force to keep her still. You will bruise her. It can’t be helped.”
Grace nodded, jaw muscles tight with tension.
Mariana switched from English to check if the nurses were ready. The nurse at the patient’s head gave a one-word reply that the nurse at the lower extremities echoed.
“Okay,” Mariana said. “Let us begin.”
Grace grasped the woman’s leg.
Mariana nodded, and the nurse pulled off the blood-soaked padding.
The patient cried out. Her leg jumped with unexpected force. Grace tightened, too late to keep her immobile.
Mariana caught her eye. “And that’s nothing,” she said, picking up the scalpel. “Try bracing your hip against the table. Bear down.”
Grace pressed her sore hip into the table and pushed down so hard on the woman’s leg she feared snapping the bone.
“More,” Mariana said, grasping the right leg as if she were preparing to slice a loaf of French bread. The patient jumped, crying out, but the leg did not move. “Good. Let’s do it.” She lowered the scalpel.
Grace held the patient with barbaric force. “Jesus,” she muttered, her stomach sour. “Dear Jesus help us all.”
Mariana cut quickly, working seamlessly with the nurses, who anticipated every need, quickly handing her hemostats, cauterizing rods, and other instruments.
On the periphery of her consciousness, Grace saw Brenna come in. Moving silently, she taped the surgery, her face a grimace behind the lens.
Mariana worked efficiently, her concentration absolute. Finished with the scalpel, she handed it back to the nurse and held her hand out.
The nurse placed the saw in her waiting hand.
Grace flinched reflexively, inadvertently nudging Mariana’s shoulder.
She paused, saw hovering over the shattered bone. “Grace. What kind of information do you need for your interview?”
The unexpected question jarred her. “What? Oh. Um…” It came to her, what Mariana was doing: Distracting her. Okay. “Well, um, tell me about your patients.”
“Eighty percent are civilians,” she said, positioning the saw over the bone.
“Most of the wounds we treat are from shells and bullets.”
Her voice was calm and clinical as she started sawing.
“As you can see, massive tissue destruction is characteristic. Even with debridement the wounds always get infected because foreign material gets sucked in behind the shrapnel.”
Grace closed her eyes and turned her head away, concentrating on Mariana’s voice, forcing herself to tune out the screams, the patient’s frenzied thrashing, the rhythmic sound of the saw. All she wanted was to run out of this chamber, this city of horrors.
When the surgery was over and the patient taken to the recovery area, Grace stood, dazed, in the circle of lantern light, grateful for the silence. At some point, Brenna had left, but she didn’t know when.
Mariana spread her hands on the blood-drenched edge of the operating table, stepped back to stretch, and hung her head with exhaustion.
She does this every day. Grace couldn’t imagine how she survived this life.
Mariana straightened, peeled off her gloves and tossed them in the stainless steel bucket that now held the amputated foot. “You did well,” she said. “Most people would have ended up on the floor.”
“For a minute there, I thought I would,” she admitted. “Thanks for the distraction.”
The corner of her mouth twitched. “Do you remember anything I said?”
“Honestly?”
The doctor turned serious. “And you? What do you have for your pain?”
She shouldn’t have been surprised that Mariana had noticed. “Pills. In my jacket.”
“I’ll get you some water.”
Grace stripped off the gown, mask, and gloves.
Mariana returned with a small cup of water and Grace took her pain killers and antibiotics.
“I’ll lead you back upstairs.”
“Actually, I need a few minutes. I don’t suppose there’s someplace quiet where I can—” Fall apart.
“The back staircase. No one uses it now that the northern wing has been destroyed. I sit there sometimes myself.”
She took a candle and led her through the rear exit of the surgical unit to the ground level of the staircase.
“Right here. It’s private. One flight up, the door exits at the end of the hallway where the stockroom is.”
“If you see Brenna, would you tell her where I am?”