Triage

The cramping began two days later than the village doctor in Duala town said it would. Mercy Boh had woken with a jolt, her eyes registering the familiar rusty streaks of the tin corrugated roof above her mattress; her flank the familiar solid warmth of George and Sipo, now 14 months and 2 years old, nestled to the left and right of her sleeping softly.  At least they were undisturbed.  She had thought maybe she had been startled awake by the dream of her falling in a vat palm oil—the moment right before Mercy’s head went under-- but then she realized that she was still holding her breath and tensing her abdomen long after the image.

By this time, blood had soaked then seeped around the oily rag stuffed in her undergarments to hold in the herbs and small stone that the village doctor had inserted.  Mercy registered the metallic almost sweet scent emanating from her privates before she understood the sticky wet running down her legs.  Mercy reached down instinctively to her inner upper thigh and confirmed with the lift of her first three fingers the dark red fluid oozing from her insides.  She rubbed the slippery grit in a circular fashion as if she were examining soil and winced.

Of course she had wanted to keep the pregnancy.  What mother wouldn’t.  But with Thomas not around and three mouths to feed, the math after a day of selling peanuts, Guinean onions and Lonestar cell-phone cards was too easy to figure out.  Two dollars Mercy earned on a good day.  Bulgur wheat cost twenty cents, one piece of chicken a dollar, thirty cents for tomatoes and a clove of garlic, potato greens from behind the house, and two dollars a week for coal and Mercy would be lucky to have fifty Liberian extra at weeks end.  It’s not like Mercy was projecting extra hardship.  She had no time or luxury to contemplate the opposite.  Who wouldn’t think it was persistently disgusting to toilet in the river where everyone else in the village shat and pissed.  Whose sleep in Duala was not interrupted by the rampant swarms of mosquitos born of stagnant bathing and cooking water strewn onto the narrow paths between the town’s tightly positioned huts? 

 

Mercy awoke daily at 4:30.  After combing her hair back and washing her face with water from the yellow Jerry can next to the door stop, she swept the floor, washed the clothes, started the fire, cooked the Bulgur wheat, woke the kids, fed them, dressed them, took them to aunty May’s and then was off to the market before the 7:30 commuter rush.  At the market if she were lucky, the day would be interrupted by a fantastic joke, a garrulous customer, a cool breeze, one quarter of Mercy’s product’s sold before noon.  Otherwise the market was the usual cacophony of cars, music and shouts; the usual cloud of dirt, heat and road exhaust; the usual chant of the product line initially uttered with enthusiasm then increasingly in monotone as if the vendors were falling sick. 

As quickly as the work day started, fifteen minutes before sunset at 7:30, Mercy would stand up from her haunches, extend her arms and with one fell swoop collapse the shampoo, the flip flops, the pencils, the counterfeit Hello Kitty sock packages and warm bottles of water towards the wheel barrel’s center in a synchronous clunk.  Roughly, as if waiting to uproot, she’d pick up the handles and start the day's end roll along the edges of the market garbage pile, down Quarrel’s Lane, up Honey Suckle path, past Brother Tom’s six bedraggled chickens, to Aunty May’s house, giving her what usually amounted to a quarter of the day’s take for her services.  The boys on seeing Mercy smiled and laughed.  At home, Mercy would position George and Sipo on the mattress with their three toys and one plastic spoon, which George preferred, while she lighted the coal, prepared the rice and pepper soup, fed the family, cleaned up, and bathed the children, swinging them towards the sky before putting them to bed.  By herself, however, tired she was, Mercy made it a rule to read the bible for fifteen minutes under candlelight before sleep.  Mercy’s bible began on the third page of genesis after the line “Adam and his wife were naked but felt no shame” because of a torn cover at the mouth of Sipo.  Mercy’s favorite book was that of Job’s.  She could not fathom how a human could be so tested.

In the hush of any serious conversation spoken in a slum, Mercy had gotten the idea of aborting her pregnancy from Theresa, the owner of the convenience shop across the way from the community center, from whom Mercy restocked her Lonestar cards and to whom she sold one pound of salted peanuts every other week or so.  Theresa confirmed to Mercy that there was a village doctor Theresa’s own half-sister had gone to a few years back.   For twenty U.S., the equivalent of 10 days of work, this person could “get rid of one’s belly” which Mercy had been able to hide to this point with loosely wrapped Lapa skirt and ill-fitting blouse.  Mercy had asked Theresa what exactly the village doctor would do to get rid of her belly but Theresa had remained silent while rummaging through a stack of papers as if this level of detail was irrelevant.  Of course this level of detail was exactly what Mercy wanted. Mercy wasn’t particularly squeamish after having and caring for two children.  How could she be.

When Mercy was a girl, one of her fondest memories was the afternoon of unlimited fried chicken and plums.  She and her sisters had eaten slowly but plentifully.  After they swam in the river then warmed on the sandy banks with their eyes shut and arms positioned by their sides, as if in attention to the luck of their lives.  Mercy thought of this particular day when after arriving at the village doctor’s hut a few weeks following her conversation with Theresa, it had started to rain; when after the short doctor came to the door she was led in silence to a darkened side room; when she was asked to lie on a dusty mat on the floor that wasn’t even long enough to contain her feet; when she passed payment for the procedure at the same time she arched her back to remove her underwear. I am still an innocent girl.  Mercy mouthed this fact as she heard the rustle of a paper bag, the clink of instrumentation, the smell of a stricken match, the rub of stirred poultice, the sudden awareness of a stranger’s coarse hands between her legs. 

This is going to hurt. Mercy closed her eyes tight while looking up.  She concentrated on the large moving purple blob in her gaze, wondering if this was what it was like to be crippled and blind.  She was thankful for the blessings in her life but now she felt a cold smooth object rising within her, rising higher still, slowly, sickening her, then finally to a threatening pierce.  Mercy curled the edges of the straw mat under with her fists, her knuckles scraping into the hard stone floor.  She bit down hard enough to break teeth. Beads of sweat formed on her forehead dropping down her temples in numerous rivelets.  Mercy was not a screamer but her moan evoked a mix of sadness and agony.  In retrospect a hum.

The worst was over.  Mercy told herself this and the village doctor confirmed.  She was numb completely up and down now, but sensed a packing of her insides.  A smelly salve.  The pressing of cloth.  The fullness of a round stone?  She was exhausted as if she had just run a race on her knees.  What had been done?  What did it look like down there? Mercy thought of her mom greeting her and her sister with hugs at the river.

For the next couple of days, Mercy continued her life pattern only at a slower pace and minor limp.  She now woke at 4:45, arrived to market by 8:00, picked up the kids by 7:15, was in bed by 10:00.  She splurged on daily bottle of orange juice. But what started as malaise on Monday soon developed into vomiting and diarrhea by Tuesday.  Wednesday she was doubled over like a prize fighter after sudden punches to the gut.  Thursday she was febrile and shook at night in the cruel irony of Liberia’s hot.

Friday Mercy knew that she had to go to the local hospital.   The bleeding was heavier now.   The village doctor had stopped answering her phone.  Fever clouded Mercy’s thinking and it was now a effort to walk and eat.  Redemption was certainly the better hospital of the choices around: JFK was considered by the townspeople as short for “Just for Killing”.  Best not to go there.  At ELWA, the doctors acted like priests.  Yet the towns people had said that Ebola had scared away most of Redemption staff.  Who was left following Dr. Manteau’s death and the looting of the patient wards? Mercy had once brought George to Redemption’s outpatient clinic to be vaccinated and it was true that they did a good job once they managed to get through the back door.  Sure the process took six hours but the shots were free.  That’s what the nurse said.  

When Mercy walked through the metal door at the Hospital front after having her temperature taken by a guard with a device resembling a gun and the bottoms of her soles sprayed by a man in plastic suit, goggles and mask, she was met by three nurses standing behind a two meter wooden barrier who asked her why she was there.  Mercy told the story about going to the village doctor four days prior.  In return for a payment, she’d been given a vaginal exam, which resulted in a piercing and two pills which 12 hours after swallowing then resulted in cramps, bleeding and pain.  The only reason she had come to the hospital actually was because of the fever and vomiting.  These symptoms had been going on now for 30 hours and with all the sweating and inability to keep down fluids, Mercy could no longer walk without the room spinning.

Whether the nurses acknowledged her accounting of events was debatable.  Any expression of compassion was not.  Instead they asked if she had been around anyone in the past 21 days who had been sick or had died.  Mercy told the truth: no on the death question but yes, her son Sipo had  a stubborn cold.  This fact produced stern looks.  As for the bleeding, no it was not unexplained, but yes she was bleeding. 

Why was she bleeding?  Was she also bleeding from her eyes or gums?  The nurses seemed to have not heard Mercy's story, instead asking the same details again confusing Mercy as to how to speak to people who don't listen.  She decided on the third time around to target her explanation to the taller of the nurses who seemed the most compassionate of the three.  Mercy thought for some reason her silence or the fact that she rarely blinked gave her a chance.

By now blood was running down Mercy’s left leg spotting the cement floor much like a slow consistent pipe leak on dry dirt or the trickle of a new spring rain.  This seemed to annoy the middle nurse, who announced that she was bleeding into the triage area and now no one else could come in.  The door must be closed said the smallest nurse to no one in particular since it was obvious that none of the nurses would be coming out from behind the wooden barrier below the Welcome sign.  Mercy as patient was certainly not going to close it.  

"I don’t have Ebola," Mercy finally exclaimed.  She regretted her outburst immediately.   Mercy had been answering questions for forty five minutes and there didn't seem to be much progress in this process.  She was tired and becoming desperate.  The cramping was vicious and the blood now coming down generously. 

“Oo owe,” said the middle nurse, “you are a doctor? You come here to tell us what you do are do not have? This is not your house.”

Over the next two hours, Mercy would abort her fetus in the triage area while the nurses and a steady stream of other professionals, some “white” debated what to do.  Mercy never would have imagined things could turn worse than the direction they were already heading.  She wondered if she would die there.  She wondered if anyone might bring her a glass of water or a towel to absorb the pool on the plastic chair.  She wondered why the white doctors didn't help her if her own people wouldn't.  She wondered who were her people.  She wondered about George and Sipo and how they are behaving with Aunty May.  They are good children she whispered.