Truth, by Omission Read online

  A month ago we started taking turns staying all night, one of us climbing into the hospital bed and gently cuddling our little princess. But there was no sleep on those nights for either of us. When I was at home alone in bed I worried, I doubted, I prayed to gods I didn’t believe in, just in case. I wallowed in pity. And the nights I was at the hospital I lay awake, trying not to move lest I jerk one of the drip lines feeding into her delicate little veins, willing a miracle with all my might.

  Several times we were lulled into false hopes. Stephanie would tell us the pain was gone. She wanted to go home. Could we play a game with her? She wanted to walk to the playroom down the hall where she could hear the other kids. For these brief moments she had more energy than either of us, than both of us.

  When Anna and I met up at the hospital these mornings I didn’t need her to tell me that she’d had as little sleep as I’d had. Her movements were slow, her eyes dull, her hair had no sheen, and her fingernails began to crack. The life was draining from all three of us. The nurses at the hospital began to treat us like copatients. They brought us water and snacks when we stopped bothering to even pick up takeout.

  Eventually, we both insisted on staying, refusing to leave. On the fifth night of this, Anna’s parents stayed late at the hospital as well, waiting outside in the hall. Her brother and his wife and two boys were staying at our house. We wanted to be alone in the room with her. She hadn’t opened her eyes for hours. I knew she wasn’t sleeping. She was in a fitful coma, but we pretended between us, without saying it, that she had slipped into peaceful dreams. That’s what we wanted for her. But I had seen many deaths and I knew they seldom came peacefully.

  Steph no longer breathed, she gulped in bits of air at irregular intervals and expelled them in long slow bellows. I could hear it all in my dozing state midway between half sleep and total exhaustion. My eyes popped open when the next gulp of air didn’t happen. I squeezed Anna’s hand, and she woke in the chair beside me. She bent over the bedside and cuddled the frail skeleton of our daughter, her previously effulgent caramel skin now a pallid beige, her springy curls long ago fallen out, leaving a tiny bald orb easily cradled in one palm.

  We cried without making a sound, my tears running off my cheeks, sponging into Anna’s already matted blond hair, now tucked beneath my chin. Her tears rolled even more copiously, drenching the single sheet that covered Steph. We sat like this for a long time, neither of us with any will to do anything save hold our baby, hold each other.

  Dutifully taking the advice of the counselors, we had already made all the funeral arrangements but there was still a lot to do. Anna’s family helped out immensely. They’ve been a rock to us since her parents embraced me as a second son. Anna and I muddled through four days of condolences from extended family, friends, colleagues, and remote acquaintances.

  Two things stand out as especially touching to me—Stephanie’s school friends and my own patients. Every single child in Steph’s class, all twenty-six of them, and their parents made it out to the wake and the funeral, and a few of her closest friends and their parents even made the two-hour drive to the interment at the small plot on Anna’s old family farmstead in Colorado Springs. For most of them it was their first experience with death. I wondered what they thought. How will death affect them throughout the rest of their lives? They’ll all soon enough lose relatives, a parent, a grandparent, a sibling. Some of them will witness violence and accidents. Some may become policemen or firefighters or soldiers and have to see more than their share of death. I only hope that none will have to experience all the deaths I’ve known.

  My patients, many of whom I really didn’t even know all that well, came out in numbers that I would have never expected. I was touched by how they wanted to give back some healing now that I was in need. They turned the tables on me, asking about my family and my well-being. And I was grateful to them all. It helped reaffirm what I believe to be one of the basic truisms of medicine—that compassion and empathy go a long way in the healing process.

  But now we’re alone here, Anna and I. Alone for the first time in nearly ten years, and we are empty and exhausted. Side by side on Stephanie’s bed, tears puddling and spilling over, we take in all of what used to be Stephanie’s—a constellation of glow-in-the-dark moons and stars stuck to the ceiling; National Geographic animal posters; photos of her school friends; a collection of stuffed animals, from the ratty little dinosaur that she used to suck on in her crib to a giant panda that her grandpa won for her just this last summer at the fair; an i am africa poster. We are surrounded by a mix of things that tell us our little baby girl was turning into a young lady. But now we will never see her giddy with her first love, or graduate, or learn to drive, or go to the prom, or get engaged, or have her own children.

  I know we’ve been lying here for a while because through the window I’ve watched the sky go from cloudy gray to indigo purple. Anna has finally fallen asleep, but she holds my hand with her fingers twined into mine. She’s always been a good sleeper. She can sleep anywhere, any time of day. We’ve had a lot of jokes between us about that over the years.

  I, on the other hand, want desperately for more sleep. For years my sleep was sparse and haunted by the atrocities I’d seen. There was a brief time, during my years in France, when Anna and I first met, where I enjoyed long, blissful sleeps. I was lost in Anna’s newly cast spell and we spent time in bed together, totally oblivious to the rest of the world, to any past demons. We gaily lounged through whole weekends without ever getting dressed and hardly leaving the bed. But life overtook us, as it does all new lovers, and those carefree days are now relegated to memories and yearnings.

  All the years of med school and residency helped to banish my recurring nightmares. I didn’t have time for such distractions, but I had little time for sleep, either. When I could grab a few winks, I was in such a bone-weary state that even my sleep couldn’t be distracted. Then my first few years of practicing medicine were as a trauma doctor, usually as junior man on the night shift, in the emergency department at St. Joe’s in Denver. It’s only been in the last few years again, now that I’ve joined a group practice, that I’ve been able to keep more regular hours and get a bit more steady sleep.

  But no one can sleep like Anna. And it’s not just how much she sleeps, it’s the way she sleeps. She’s totally peaceful and calm. She hardly breathes, she rarely moves—on the couch, the bed, upright in an airplane or bus, on a chaise by a crowded pool. And she always sleeps with a smile, always that is, until Steph got sick. Since then it’s been different. She is sleeping less and fitfully. When I look over at her now her brow is furrowed and her face twitches. Her grip on my hand is alternating from a hard clasp to a flaccid touch, and she makes noises, like she is thinking in her sleep.

  I start to selfishly mull over that she is all I have left. I’ve only ever really, truly loved so few people in my life, and three of these are now gone. Why shouldn’t I have been the one to go instead of any of them? How sad for me to be left to grieve, to be burdened with the weight of their deaths. But how can I even think like this? How deplorable, how pathetic am I to think of myself now. Yet it’s in me to wallow in this stuff. I’ve done it all my life. I hate it. I don’t want to do it, but it sloshes around inside me. I’ve felt it before, dark inky purple, swirling, building force into a whirlpool, grabbing, pulling me along, taking me down.

  Vincent

  Istood atop the battered van while our driver handed bags up to me. We’d be eight in this little van with all the luggage packed up top in the welded-pipe rack. Vincent had wrapped both of his suitcases and my small one each inside its own plastic green garbage bag. This was as much to keep the dust out as to keep the rain off. The rainy season was just letting up, and Vincent had judged that the roads should be passable without too much trouble. We were leaving what had been home to both of us for the past four years, the Nkwenda refugee camp. It was a bittersweet dep
arture. This squalid place had reformed me, proved to me that humanity existed, and inspired some sense of hopefulness out of the despair that was my life. But most of what we were leaving held few pleasant memories for me.

  The camp had been built four years earlier by the United Nations Assistance Mission for Rwanda to house the masses fleeing the civil war. It was a noble project on behalf of the world, an attempt to stave off starvation and death and provide housing for up to five thousand refugees. But within two years the population of the camp had swelled to more than fifty thousand. I was among that number, and Dr. Vincent Bergeron was one of two doctors who futilely, desperately treated us. By the time I left, most of the other fifty thousand had already moved out, and many others were buried or cremated downwind of the camp. The original service tents, emblazoned on the roofs with the large UN logo in hopes of preventing “friendly fire” from one of the several militaries operating in the area, were now threadbare and blackened by the mold that crept over them continuously during the nine-month rainy seasons. A few thousand other tents, or more accurately, tarps pulled over sticks, remained and housed those still too fearful to return to their homes and villages. But they’d have to leave soon; the Tanzanian government was expelling all those who were left, and the UN was wrapping up its mission.

  From my vantage on the roof of the van I could see the whole of the camp—what was once the camp. The single main road that remained ran straight down the center and was rutted deep. It was almost impassable, with potholes like artillery craters. On either side lay acres and acres of mud. There was no longer any semblance of paths or roads left in these fields, just garbage strewn everywhere. In a few areas the garbage was piled up in small hills. These were the neighborhoods in the camp where some local leader had the foresight and strength of character to convince the inhabitants to organize themselves into a community of sorts. But most of the camp was just acres of garbage, ankle- and knee-deep, trampled into the mud.

  On the outskirts of the camp the forest had been completely cut down for miles to provide families with small amounts of firewood for cooking, warmth, and camaraderie. I had watched the camp swell time and again, each time thinking that surely it had reached its limits, only to see thousands more drift in and expand it further. Each new wave of migrants would dig out the tree roots left by the previous settlers’ harvest of wood. These roots became their own first stash of firewood as they settled their families in and covered them with whatever they had carried on their backs or wheeled in their barrows. Every few months the UN convoys arrived with a new truckload of blue tents, all exactly the same, and the camp dwellers would line up, waiting their turn to be handed a new home to pitch in place of the cardboard and rags that they had been using. This was how the camp grew, expanding out concentrically, gobbling the forest ahead of it.

  On the day we packed up to leave, the immense African sun burned down on the mud and garbage, cooking it, fermenting it. But I had long since become immune to the stench of human waste mixed with death and refuse. Actually, it was a pleasure to see the sun reaching all the way to the ground since, during most of my past four years at the camp, sunlight was rarely able to filter through the yellow-gray haze that pressed constantly down on us. As a little bit of haze would blow or burn away, it was immediately replenished by the smoke from thousands of small fires that smoldered, many days augmented by the funeral pyres that were required for quicker cleanup of the camp.

  Our van held the last of the UN personnel to vacate, and Vincent had arranged for me to ride with them since I would be accompanying him back to France—thanks to my recently granted refugee status. At one time the UN contingent here numbered as high as forty but over the past few months they had gradually been called away. I knew everyone who would be traveling with us, the UN people had been a tight and cohesive group, and they had accepted me as a useful, if not important, part of their workforce. Along with our driver, a Tanzanian national, two of the six traveling with us were logistics coordinators, one was a clerk and accountant, one was the mission lead, another was there as a nurse—also through Médecins Sans Frontières, the same group that Vincent volunteered with. In his late thirties, Vincent had already been through this a few times before, always leaving behind what would never really be a completed job in Africa. Never able to wholly satisfy the demand for the healing and compassion he brought with him.

  The land portion of our trip was to take us first to Dodoma, the capital of Tanzania, where the UN had a small permanent office. The office had sent word that my French refugee papers had finally arrived, and they were holding them for us. From Dodoma we would be able to take the highway to Dar es Salaam. And after that we would fly, my first ever time on an airplane, through Zurich and on to Paris.

  I lashed the gear tight and slid down from atop the van. Some of the camp dwellers who were still left had come to see us off. Those of us leaving tried to downplay our buoyant feelings, while those left behind forced themselves to offer us pleasant tidings. One of them stepped forward from the small crowd and extended his right arm as if to shake my hand. By the time I noticed there was no hand to shake, rather just a stump at the wrist, Idi Mbuyamba had grabbed my biceps with his left hand and pulled me close. He held me firmly and froze me stiff with his eyes, removing any thoughts of fondness that I was having for the camp.

  I was twenty and feeling every bit a man. Idi was fifteen years my senior and certainly no bigger or stronger than I, but locked for these few seconds in his glare I was reverted to a child, mesmerized, intimidated, insecure, beholden. I had known Idi long before we both showed up in the camp and this was how he had made me feel for years. But before I could contemplate what was happening his face broke into a large toothy grin and the spell was broken. “You’ve done well to find a way out. You won’t forget me, will you?” he said and stepped back into the throng.

  As we packed ourselves into the van, I despised how once again Idi had found a way to spoil what should have been a moment of achievement for me. The joy of embarking on a new phase in my life was tainted.

  Vincent sat in the front seat with the driver, three more on the middle bench, and the last three of us in the back row. As the driver began his navigation of the potholes, I twisted around in the seat, looking through the back window, wanting to say my own goodbye to the camp, but all I could see was Idi waving his handless stump at me.

  We headed north and east to Bukoba, on the shore of Lake Victoria. Africa’s greatest and the world’s third-largest lake, Victoria spills out and becomes the Nile, traveling north for another four thousand miles. We stopped for a few hours to marvel at the vastness of the lake, an ocean to us. Perhaps even more impressive was the freshness of the air that blew off the lake and cleansed our lungs. All eight of us had forgotten the smell of freshness, and we sucked in as much of it as we could. Vincent thought we’d do well if we could make it another three hours due south to Biharamulo, and I was more than happy to put any extra mileage behind us.

  The hotel in Biharamulo was a game lodge, out of season at the time and empty. They were glad to have our business, and the porters quickly erected tents for us on wooden platforms. Vincent and I shared a tent, each getting a cot. We sat alone on the porch in front of our tent relishing the quiet. Four years in the camp, there was never quiet. Tents were pitched so close to each other that there was no prospect of privacy. All the sounds of humanity not meant for broadcast were inescapable in the camp, grunts and snorts and farts, spousal squabbles, copulation, childbirth, child death, all day long, every night. Vincent and I sat for a long time in peace, just basking in the silence. Eventually he pulled out his diary and made his entries, just as he’d done every single night we were in the Nkwenda camp. After he’d finished writing down his thoughts he broke the silence.

  “Will you miss the camp, Alfred?”

  “In some ways … maybe.” I tried to sound positive but was unable to escape the stare, then smirk and dep
arting words from Idi.

  “What is it you’ll miss?” Vincent tried to coax conversation from me.

  I thought about this before replying. There were lots of things I surely wouldn’t miss, but for the sake of conversation, I finally settled on, “Being needed. Since I started helping you I feel like I have a purpose, like I’m needed.”

  “A basic human requirement, to be needed,” he said. “Medicine would make a good profession for you. You’ll be needed—more than you’ll want sometimes.”

  “What about you, Vincent? What’ll you miss about Nkwenda?”

  “I’ll miss making a difference. Every day, every hour I spent in that cursed camp I knew I was making a difference. Now, I’m going to go back to fill out forms and requisitions and fight the politics of a big-city hospital, and I’ll go home most nights having not made a damn bit of difference.”

  “Is that why you stayed so long?” I asked. Most doctors did a six-month stint then retreated to the comforts of the first world. Vincent had been there four years, returning home to France only once for about two months to tend to his mother when she was dying.