R.A. Burrell
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  • West Bank, Israel
    Outside the Dheisheh Refugee Camp

    Dreams tell you what to chase, Nate likes to remind me.  They don't always specify the route.  Funny time to think about it – I've never needed a map more than I do right now.

    Israeli patrols blocked the safe road an hour ago, amidst a driving rain.  An hour during which I've gone from highly trained physician to errand girl, sent down to Hebron for supplies.  Dr. Crenshaw didn't mean it as a punishment; he meant it as a reprieve.

    Fine, I needed it. 

    Our appointments ran late, on a day when nothing went right. My worst-case diagnoses kept turning out to be the correct ones. Patients I've been treating for months just seemed to get sicker.  Despite that, or maybe even because of it, I couldn't shake the feeling the afternoon had been a little too peaceful. That's when Dr. Crenshaw handed me the keys to the medi-van, said he'd handle our remaining patients, and told me to come back with new provisions, in case I was right.  I've got a sense for these things, he says.

    By the time I got to Hebron, reports of sporadic gunfire were pouring in. The alternate route back winds through scrub and foothills, all alike in the dark.  Ahead, the road splits.   One side goes back to the refugee town of Dheisheh; the other, more deeply into Hamas territory and I have no idea which is which. Maybe I do have a sense of impending disaster.  A sense of direction, not so much.

    The local nurse assigned to our mobile unit sits in the passenger seat, wearing her customary scowl.  I turn from the road to face her.  "Do you know which way to go, Jamila?"

    Wizened eyes flit from side to side. "This is why only men should drive."

    Torrents of rain sheet down the windshield.  "If you'd ever driven with my husband, you'd change your mind."

    "Bah." A wobbling Qassam rocket skitters into the rain-swollen clouds, painting a fiery pinwheel across the sky. It explodes harmlessly, five hundred yards to our right. She points left.  "Listen to the signs of Allah, my child.  He says that way."

    "So does common sense."  I tilt the wheel away from the source of the rocket.  Seconds later, a mortar barrage whistles towards the launch site.  "Bastards."

    Mortars follow rockets, rockets follow mortars.  Millennia of eye-for-an-eye and everyone's left blind.  The children of Abraham, fighting in the name of Yahweh, of Allah, never caring they're one and the same.  I used to think it would end one day, and I fell in love with my husband because he told me he wanted to help.  After investing years of his life in the peace process, only to see it blow up yet again, he's still convinced there's a solution.  These days, his dreams keep us both afloat.

    When the mortars start flying, the way they are tonight, I have to fight to keep my skills from taking the hit.  Whistle, boom, shake.  The acrid smell of munitions smoke fills my head long before it fills the air; a faint memory, like burnt garlic mixed with the Fourth of July.  Then it's a sideways glance and a Micah, we're nearly out of bandages. Or a Doctor, why don't you let me finish. Go find his mother instead. Dr. Crenshaw is more understanding about my little blink-outs than he should be. Then again, everyone who works for MSF in the West Bank seems to know why. 

    The girl who nearly died in the Bosnian War, they whisper.  Living proof there's hope for refugees.  If only she'd talk about it more. 

    Their hearts are in the right place, but the 'refugees' would understand why I choose to keep it to myself, even if my fellow aid workers don't.  Besides, if there's hope in this place, I'm not seeing much of it lately.  Both here, in the West Bank, and in Gaza, things have been going to hell for months.

    Skeletal branches of uprooted olive trees cast shadows on a rock face, showing scars from the teeth of a bulldozer.  Two teenage boys stand sentry atop the crags, black checkered keffiyah worn proudly around their necks.  My brother was around their age when he died. 

    Bodies battered or full of holes, they're carried into the clinic, sometimes alive, sometimes not.  Every time, I see Luka's face.  My father couldn't save him.  My father couldn't save himself.  But they saved me, so it's my job to make sure other families survive what mine didn't.

     A rolling explosion thunders off the Judean Hills, echoing in the distance.  I watch the smoke blow north, towards Jerusalem.  "I'd better call Nate, or he's going to freak."

    Jamila tugs her headscarf lower and looks down her nose.  "Doctor, I suggest you get us to safety before you worry about your Yahud."

    To her, he's not my husband, he's 'that Jew'.  Never mind that Nate is the furthest thing from a Zionist, and she's not even Palestinian.  She drives me nuts, but in this case, she's right. 

    Each rut in the muddy road jars my bones.  We've barely gone fifty yards when a man runs into the road, holding a lifeless child in his arms.  Adrenaline hits, reflexes jam on the brakes.  They disappear in front of the van, just as it skids to a stop in the mire. "God, please," I breathe, prying my clenched hands off the wheel.

    When I run out, he's dropped to his knees, cradling the child, a boy about five or six.  "Help, help, please," he sobs in Arabic.

    One look at the boy tells me Dr. Crenshaw's errand will have to wait.  Dressed in fatigue-print sweat pants and a filthy striped t-shirt, the boy's tiny body is a battered mess of fractures, open wounds, and bruises. One of his shoes has come off; both feet are covered in a nasty-looking green slime.

    Still shaking from the near-miss, I motion towards the back of the van.  "What's his name? Are you his father? How did he get hurt?"

    'Efraim' is one of the few words I catch from his rapid-fire reply.  "Slow down, please." Before the war, half the people in my hometown spoke Arabic, but I don't remember that time very well, and after five months here, mine is still lousy.  Jamila does most of the translating.  The back doors of the medi-van swing open and she motions for the man to bring his son inside.

    Fervent, shaking prayers fill the back of the ambulance. The father sets his son on the stretcher, which doubles as a surgical table in this mobile unit.  I race through an assessment. His pulse is thready, and his pressure is dropping. While I’m mentally running through the standard signs and tests, I start an IV. "His airway's open and he's breathing on his own." I pry open his eyelids, watching his pupils react evenly to the light. At least there's no neurological damage. "Tell him that's a good sign." 

    Jamila hands me a central line kit.  "Father is Isa. He says his son was playing on rocks. Fell into cave."

    I start to cut through his clothes, shaking my head at the catheter. "Cordis first, not triple lumen.  Ask him how long ago it happened."

    "Twenty minutes."

    "That's good too."  In this life, I have only two enemies.  Time and infection.  The 'Golden Hour', trauma medics say.  Odds are much better inside it. "He must've landed on his left side.  Distal ulnar fracture, plus at least two ribs on that side."  When I cut through his t-shirt, his abdomen is distended, so I stick in a syringe. All I pull back is blood.

    Not so good.

    I can't drive to the clinic. Even if I knew where we are, even if the assholes at the checkpoints decided not to harass us, it'd take an hour to get to Hebron. He'd bleed out before we got there. For him to have a chance, I'll have to stop the bleeding here.

    "Get a bag of blood going," I say to Jamila. Given the green crap in his other wounds, the time it would take to set up a proper sterile field would be wasted, so I grab a bottle of betadine, squirt a generous amount over my hands and onto Efraim's abdomen.  Some good antibiotics in your IV and we'll all pray for the best, kiddo.

    Jamila hangs a bag, then sets a paralytic agent, trach tube and pediatric laryngoscope on the tray. Frustrated, I push it away. "I can't put him that far under. I have to cut, you have to monitor his vitals and suction. Unless you have three hands, nobody has any left to bag the kid."

    She points at the boy's father, who's still in an awful state, praying, rocking back and forth. I shake her off. "Bad idea." Ignoring her glare, I work out the right level of anesthesia. In thirty seconds, the little one the first dose in his IV. "Watch him close," I warn. "Push a bolus of propofol every five minutes. It wears off fast."

     Massive guilt weighs on every ounce of Isa's undernourished body. While I race through my prep, he scrutinizes every movement, so I struggle to project the image that I do major abdominal surgery in the back of a van every day.

    Life got pretty crazy in Bosnia and my father was a physician who talked me through my first cut at twelve, but there's a good chance I'm over my pay grade here. I could use your help now, Papa. Unfortunately, neither he nor anyone else is around to help, so with what I hope is a reassuring smile for Isa, I set to work.

    Despite the sun-hardened leather of his skin, he looks a few years younger than me, no more than twenty-five.  He too, wears the keffiyah.  Everyone does in this area, one of the island enclaves of Palestinian territory in the West Bank.  "I am sorry, my son," he whispers in Arabic.

    Tears form in his eyes when I bring my scalpel to the boy's abdomen.  "Baba, God made children very strong," I say. "Now it is your turn." 

    His eyes widen when I complete the incision, retract the opening, and stick my hands into the wound. The blood slickens and warms my fingers while I search for the source, palpating slippery bowel and pulsing organs. I don't have the feel yet that an old doc like my father would, but he taught me that with this much blood in the field, my hands are better than my eyes.

    Right below the boy's sternum, I find a warm gush coming from his liver. "Suction here Jamila."

    She does, revealing an inch-long laceration on his liver, probably from a broken rib. Looks like his spleen is mildly bruised too.  I pick up my forceps, open a dissolvable suture pack, and set to work, knowing it's going to take a while. Fixing a liver is like sewing a sponge – it's a real pain in the ass. "It is not so bad.  With time and a few stitches, all this can be fixed."

    More weeping prayers, this time of relief and thanks. Truth be told, I'm feeling better myself. This is one kid I know I can save. And that makes up for the rest of the day.  Heck, a week of bad days.  

    With the EKG beeping a steadier rhythm, the prayers subside. Isa moves closer, intently watching me work.  I motion for Jamila to pull him away.  "Baba, it would be best if you did not see."

    His reply is still in Arabic, but spoken slowly, so I can understand.  "Allah shames those who turn from the hurt they cause.  May he bless you, sister."  At my surprise, his eyes turn toward the gold cross around my neck.  "We are all children of Abraham, are we not?"

    I nod.  "Yes, we are.  God bless you as well."  More heartened than he could possibly imagine, I set back to work. Motioning for Jamila to suction blood from the field, I glance over again.  "Why do you blame yourself for this?"

    "Do you have children, doctor?"

    For various reasons, kids aren't in the cards for us, which I've tried to convince myself is a blessing. I can't ever see myself leaving this job. Nate's just as dedicated to his. When he's working, only two things can get him to stop. Food being the other one.  "No, no kids."

    "If you did, you'd understand."  He brushes a spot of coarse white hair away from the leg of his dripping fatigues.  "We used to have many goats.  Now we have one.  This happened because I was more focused on lost goat than playful boy."

    Blood wells up in the middle of the boy's liver again, so I sigh and set back to work. Isa continues on about his goats, last summer's drought, the Israelis stealing his water.  Hard not to notice the green stain of a tattoo on the inside of his wrist, something I see a lot on dead fighters.  Some are Hezbollah or Islamic Jihad, but in this area, they're usually Hamas. After five months in the crossfire, can't say I'm terribly enamored of either side.  "Does Efraim attend school?" I ask, trying to sound nonchalant.

    "We follow the water," he replies. "Nearest school is often many miles."

    The nearest school, the nearest playground, the nearest hospital.  "Perhaps I could get you some schoolbooks?"

    He gazes at his boy's face. "I think he would like that."

    I smile. "He will have time to read them while he recuperates."

    "Insha Allah. May He be so merciful."

    A quick glance at the dashboard tells me it's already after seven, and there's still a broken arm and all those slime-filled lacerations on his legs and torso to deal with. Isa's much more calm now. Maybe there's something he can do.

    Since my hands are covered in his son's blood, I jerk my head towards a squeeze bottle of sterile water on the tray. "I could use some help cleaning his other wounds. If I talk you through, do you feel up to it?"

    He rubs the inside of his wrist, like he's trying to hide his tattoo. "What must I do?"

    "Use the bottle to irrigate the cuts. Squirt as much water into them as you need to dislodge the slime."

    His mouth thins. "I'm sorry, I cannot. It must stay."

    I put down my needle. "It'll cause an infection."

    He rubs the tattoo again. "God led me to you. We must trust him to heal what you cannot."

    Confused, I stare at Efraim's legs, struggling to figure out what his father isn't telling me. Though the rain washed tracks through the slime, there's a handprint smeared over the deepest gash. "What the hell? You put that stuff on him on purpose?"

    A lump bobs in his throat. "He is my son. I insist you obey my wishes."

    A screech of tires outside sends a chill up my back.  Brakes squeal, soldiers shout. Isa's eyes widen, and he steps protectively towards the table, shoulders tense and drawn.

    The EKG beeps three times before the rear doors fly open, revealing a detachment of Israeli soldiers in full battle dress, their guns trained on us.  The first soldier grabs Jamila's wrist and yanks her out of the van, screaming.  "Hands up," says another.

    I keep stitching, fighting a tremor.  "My hands are busy. Shoot me if you want," I say in Hebrew.  "I can just imagine the headlines."

    With a growl, the soldier edges forward. "Let's go, out of the van."

    A leathery hand grabs the waist of my scrubs, yanking me backwards.  Its mate forms a vise around my other hand, the hand holding a scalpel, and wrests the instrument free.  Angry shouts fill the air.  The sharp edge against my throat silences a scream and stops my struggle.  This can't be happening. "Isa, please, I am your friend. Think of your son."

    "I am," he whispers back.

    A baby-faced soldier clad in bloodied fatigues steps forward.  He appears unhurt, though an embroidered two-stripe insignia patch dangles from a large tear in his uniform, just over his heart.  Keriah, the rending of cloth, a mourner's tradition. The blood, no doubt, is a comrade's. 

    Anger rising against futility, I swallow hard, feeling the blade on my skin.  "You must leave.  This is an operating room.  You have gravely compromised my patient's safety.  Whatever your reason for bursting in here, I must ask you to respect this boy's life."

    "Shut up. This doesn't concern you." He steps toward Isa.  "Take us to where they're hiding the rockets. Then I'll let the doctor finish her surgery."

    The grip on my waist tightens.  "Shaitan whispers in your ear, Yahud." 

    Jamila screams curses at them from outside the ambulance.  I try to steady my voice, knowing things are rapidly spiraling out of control. "Corporal, I beg you…"

    The soldier's weapon stays leveled, his face stoic.  "One boy for a hundred civilians.  A thousand civilians.  I can live with that.  Apparently, so can your friend here. Can you?"

    My stomach flips when Efraim begins to stir on the table. "God please, no." The propofol is wearing off. "Please, he's waking up, can't you see?"

    The scalpel stays against my neck, but one trembling finger slips beneath my crucifix.  An eternity passes while he rubs the chain.  He begins to sob when his son whimpers, eyelids fluttering.  A deep, remorseful breath warms my ear.  "If you believe in God, let the wounds heal as they are," he murmurs.  "Hmaia aqbar injeel. You must find it. See its power for yourself. Protect it from the unworthy. God willed this task to me. Now he wills it to you."

    The edge withdraws.  I turn to see Isa plunge the blade deep into the side of his own neck and drag it across his throat.  My vision dissolves into a crimson haze, over a cacophony of shouts and curses.  Neither his words nor his actions make sense to me, but it's too late to ask. By the time any of us recover our wits, he's dead.

    The EKG beeps five times, over the sound of my own weeping, before I get another dose of sedatives into the now-fatherless boy's IV.  Ten and he's back under, while I still my trembling hands and set back to work with a whispered prayer for Isa's soul, a soul that touched mine for too brief an instant. 

    Uncounted beeps later, I'm nearly finished, ignoring angry whispers and unsympathetic glares. I leave the slime for last. The largest gash should've severed his femoral artery for sure, but there's hardly any blood at all. Which leaves me unsure whether I'm questioning Isa's faith or my own.

    The throng of soldiers parts.  The corporal moves away, to the back of the van, towards a broad-shouldered figure standing in the glare of headlights, cigarette smoke wafting like a wreath round his head. After a brief conversation, the man removes a black leather coat, hands it to the corporal, and steps inside the van. With a pitying look at the unconscious boy, he flashes a blue and white shield that reads 'H. Azuli – Interrogation Division'.

    Oh God, he's Shin Bet.

    At my wide-eyed reaction, he rolls up the sleeves on a well-starched blue shirt. "Come, doctor. I'm not the enemy. Just tell me what you know."