understanding that Tibet's on the Mexican time plan. Around here you have to be
ready for lots and lots of mañana.'
'So now the climb begins,' Abe said.
'Abe,' said Daniel, and he suddenly sounded cold sober, 'the climb began a long time
before we ever got here. But you know that.'
Abe glanced at him quickly. The words were cryptic, the smile was not. But Daniel
had no intention of explaining himself. Already he was looking away, reveling in the
chaos with his cocked white grin.
A sharp light, a dark voice, someone's hand – Abe's sleep blew to pieces.
'Doctor, sir.' It was a Sherpa crouching at the far bright end of a headlamp. His voice
was solemn, not so different from the wind.
'Nima,' Abe registered. Something was wrong. Someone was ill. He knew this ugly
rousing and blinding light and voices soft and solemn. They needed him.
'One man,' the Sherpa said. 'Very sick.'
'Now?' Abe pleaded. He was so warm in his cocoon of goose down and the night was
so cold. He resented it a little that Nima had just woken him from a shoreline of white
sand and bare flesh and lime green tequila. Abe squinted and shielded his eyes. He
had a headache and craved glacier water.
'This man very sick,' Nima repeated. 'Please you coming now.' There was demand
behind his calm. The calm was Sherpa, the demand was not, not to a white employer.
Abe paid more attention.
'Bring him here then.'
'Not possible, sir.'
'I'll look at him. But I want to do it here. All my equipment is here.' There was some
truth to that. Mostly he didn't want to go out into the wind.
Nima was adamant. 'Not possible.'
'What's wrong with him?'
'Very, very sick.' Berry, berry sick. 'Maybe dying now. This way, sir.' He was
pointing away from camp, but at this hour there was nothing that way except night
and more night. Still Nima was not the sort to cry wolf.
'Yes, okay.' Abe heaved himself to sitting. There was never a dignified way to rise
from sleeping on the ground, and he felt doubly awkward under the beam of Nima's
light. He dressed quickly, then thought to check the time. It was three-thirty.
Abe rooted through the open boxes lining his tent wall and located some of the
basics. He stuffed a stethoscope, a BP cuff, and a penlight into his parka pocket, then
laid out some medicines on the sleeping bag. A bottle of injectible lidocaine and a 3-cc
syringe for local anesthesia, plus a few packs of silk and needles. A number 15 scalpel.
Scissors. A Betadine scrub brush. Gloves. Bandages. Cipro for general infection,
though that was expensive and not so plentiful. Percodan for pain. Benadryl for
inflammation. He glanced through the mechanisms and chemicals and, satisfied,
tossed it all into his little day-pack. He trailed Nima out into the cold blackness.
Abe splashed white light through the silent camp, then swung it outward in Nima's
direction. There was only darkness. Almost until they reached Mallory's Tomb, Abe
could not figure out where he was being led.
Now he saw that someone – the Sherpas or the herders – had lashed old tent fabric
on top of the listing walls for a roof. Yesterday the hut had been an empty shell. The
raggedy improvement actually made the building appear less habitable and more
inconspicuous. By the light of Abe's headlamp, the hut had achieved a look of eerie
corruption befitting its nickname.
At the hut door, Abe paused and silently wished for a mug of hot tea and hoped this
was blood or bones, not some disease. He was good with trauma. With trauma, the
problem was often obvious, and better yet, it usually responded to touch. It healed
and you could see it heal. But with disease, the body hid its problems. It impeached
whatever you thought you knew and made you suffer for the suffering.
Abe took a deep breath and slipped through the ripped tentage posing as a front
door. He was unprepared for the primitive scene. The hut was lit with two headlamps
hung from pegs in the wall. Thick incense choked the air and it was impossible to see
how many people were crowded inside. Their eyes glowed white in the gloom.
The patient was lying in an expedition sleeping bag on top of three or four
brand-new air pads, a luxury even Jorgens would not have allowed himself. The
extraordinary because Abe had seen no love lost between the Sherpas and the
yakkies. Nima roughly ordered the herders to make room, and they scuttled
backward.
The patient was a young man, probably still in his teens, and his hair was cropped
close. Underneath a layer of grime and blue wood smoke, the boy's face was
handsome, more round than long, and yet slighter than most of the Tibetan faces Abe
had seen. Under his dark sepia pigmentation, the boy's big Mongolian cheeks were
flushed and rosy. He was unconscious and his respiration was labored, yet he looked
healthy enough, even robust. Abe hadn't noticed the boy among the yakkies and
concluded he'd arrived in the night, maybe herding strays.
'Hold my light,' Abe told Nima.
He knelt in the cold dirt. Overhead, the nylon ceiling rustled in the wind. The
incense drifted like fog, gray and aquatic. Everything in the room had an aspect of
slippery illusion. Abe peeled back the edge of the sleeping bag.
Then Nima moved the light or the fog shifted and suddenly the left side of the man's
face leapt into view. It was completely different from the healthy face of a moment
before. From his lips to left ear, the jaw was contused, purplish and swollen, a fighter's
mask. Very obviously the boy had been beaten. Abe had heard how violent these
Tibetans got when they drank, but if this was the result of a brawl, then it was an old
one. The bruises were too mature, days old, maybe older.
Abe made a mental note to check for facial fractures and loose teeth, then moved on.
Vitals first, he told himself. Then head to toe. Keep in order.
The boy's throat was hot under Abe's fingertips, the pulse fast and thready. His
blood pressure was high, but then everyone was running high BPs because of the
altitude. Abe pressed back the eyelids. The pupils looked unequal, one blown, one
pinpoint. That could mean an epidural hematoma: arterial bleeding within the
cranium. This far from a hospital that would spell certain death. Abe leaned in closer
to the boy, determined to prove himself wrong.
He ran his fingers around the back of the boy's skull, searching for lumps or blood.
The boy's hair was stubbly in Abe's palms. He handled the skull carefully, almost
sacramentally. No matter how many times he held a victim's head, it never ceased to
astonish him that a lifetime of memories and thoughts could weigh so little, and yet at
the same time that a mere two handfuls of bone and water could weigh so much.
With an epidural hematoma, most patients died within eight hours. And yet the
discoloration on this man's jaw – which might coincide with any possible skull fracture
– looked a week or more old. There were no goose eggs. No blood or fluid in his ears.
What then, Abe silently demanded. Head injury or not? And then Nima moved the
light again and suddenly the
pupils evened out. Now they looked equal in size. Abe
was baffled but relieved. He moved south from the troublesome head.
'Let's see what else,' he said to Nima. Together they unzipped the sleeping bag and
exposed the boy to view. He was dressed in yak skins and a pair of quilted pants. Abe
smelled old vomit and there were bloodstains on his shirt. Whoever had laid him here
hadn't gotten around to removing the Chinese sneakers from his wide feet. Abe
opened the hide jacket and lifted up the bloody shirt. And halted.
In the first instance Abe thought it was measles. A dozen or more circular wounds
splashed across the boy's barrel chest, each the size of a pencil eraser. But they were
grouped – oddly – around his nipples. Abe revised his guess. The pustules might be
the infected bites of some large parasite. Then he reverted to disease theory and
conjectured it might be some sort of Asian plague. That could explain the fever and
coma. But it might not.
Mystified, Abe looked up at Nima. 'What happened to this boy?' he asked.
Nima shrugged helplessly.
'He was beaten,' Abe said, and clenched his fist for illustration.
'Yes sir.'
'Who did this?' Abe asked. Then he amended his question. 'When?'
'This man, very good man,' the Sherpa said.
All right, Abe thought. Let's talk about the man. 'Who is he? Where's he come from?'
Nima shook his open palm in the air to show uncertainty. 'I don't know, sir. Some
guy.'
'Is he a yakherder?' Abe tried.
'Yes.' Nima's eyes shifted away. 'Yok hoda.' Nima knew more than he was saying.
Abe didn't know why, nor did he ask. That was a different pursuit.
'Did this happen on the trail?'
'Yes.'
'What happened, Nima?'
'I don't know, sir.'
'Nima, please...'
Nima thought about it. 'Not possible.'
'You can't tell me? Or you don't know?'
'Yes sir.'
Abe sighed. 'Ask his friends, Nima.'
Nima barked a question at the yakkies, then turned back to Abe. 'They say, this
man falling down. Shaking, shaking. I don't know.'
There was the suggestion of malaria again, but Abe discounted it. He would have to
look it up later in the big Physician's Desk Reference in his tent, but this just didn't
seem like malaria.
'Anything else?'
'No sir.'
Abe glanced up and around at the stark white eyes glowing in the smoke and gloom.
The shadows were too thick to show the stone walls and their dark faces were
invisible. But their eyes leapt out of the murkiness, peering and cryptic. Their
curiosity went beyond the ordinary voyeurism that attends any accident. These
yakkies had awe and fear written on them – it showed in their multitude at this early
hour and it sounded in their hushed murmurs and repetitious mumbles. Prayers, Abe
decided. Some of them were praying, and praying hard, non-stop. But why? He looked
down at his patient, and all he saw was 'some guy,' a creature like himself except for
the strange markings and hot delirium.
'Nima,' he started again, then gave it up. Abe admonished himself. It wasn't up to
Nima to provide answers. It was up to him, Abraham, their pretend-physician, to
solve the greater mystery of why this man lay unconscious and stretched out on the
ground. Always before, Abe had known his patients would move into the care of men
and women who knew more than he did and had technology he didn't. Once he
packaged and delivered them to the emergency room, his patients disappeared, and
he could quit thinking about them. But there was no other place for this Tibetan boy
to go, and no higher authority than Abe himself.
At the same time it touched him, Abe was also annoyed that these yakkies – indeed,
all of the men and women now gathered in the lap of this mountain – needed him, or
might need him, which was the same thing. He was not their answer to pain and
sickness, risk and death. He was just one more of them, a wanderer bearing his own
question mark.
They called him Doc for their own peace of mind and because they thought it would
flatter him, but Abe was embarrassed because he knew real physicians considered his
type wanabees and shake-and-bake messiahs. He was good at what he did, but a
paramedic is never a doctor, only at best the cowboy who first reaches the car wreck
or cardiac arrest or climbing victim and lays on the hands and manipulates the horror
and fear. Abe had saved people. He had been saving them most of his adult life,
sometimes even bringing them back from clinical death. But he no longer trusted his
motives, because at bottom what he did fed upon human beings at their most
vulnerable. He was needed by people who could not help but need him.
Abe had thought these thoughts too often to let them distract him. They came to
him as second nature, and he handled them with the same ease as he now handled the
boy's limp arms, palpating for fractures. He had a talent for treating his doubts as
background noise and getting done what needed doing.
He moved quickly, feeling for broken ribs, for deformities along the lower spine, for
pelvic fractures. The light shifted again, this time revealing yellowing bruises on the
boy's belly. But there were no distended areas, no unusual lumps or masses, not to
Abe's touch.
The rule was to assume spinal injuries with an unconscious patient. He hoped the
story of this boy collapsing on the trail was true, because anyone with cord injuries
might just as well die as be evacuated back across the Pang La and the corrugated
Tibetan roads.
Gently Abe pulled off the boy's shoes – he had no socks – and scratched his bare
soles with a pebble off the floor. To Abe's relief, each foot twitched. Abe got a distal
pulse behind each Achilles tendon and that meant there was circulation, more good
news.
Abe ran his hands down the bones of each leg, hip to toe: no gross fractures, no
dislocations. Then, with Nima's help, he slid off the Tibetan's quilted pants. His first
glance showed nothing out of the ordinary, but then the light – or shadows – revealed
more damage and once again he was scowling in puzzlement.
The flesh of both lower legs was ripped and torn and contused. Some of the wounds
appeared to have a pattern, some overlaid other wounds. His legs were like a canvas
of bad paints. Some of the marks were fresh and dark blue. Others showed green or
yellow, a month old. The overall effect was gruesome.
The yakherders against the wall muttered at the sight. Nima reacted, too. Abe could
feel the Sherpa withdrawing into himself. Nima still knelt beside him and held the
light. But his poise was gone, replaced by shock or fear or loathing. Something. For
whatever reason, his sense of command had drained off. Curiously, Abe felt himself
gaining strength from Nima's unnerving.
Abe took the light and bent close to the mysterious trauma on the boy's legs. He
pried open some of the lacerations for a cursory look and prodded at the terrible
bruises, investigating the clues. Abe had rescued – and when they were beyond
rescue, had bodybagged – climbers who had fallen from great heights and gotten torn
and shredded by th
eir descent. Some of this boy's tissue injuries were consistent with
that, a bad tangle with old-fashioned gravity.
But some of these wounds were different.
'Damn,' Abe swore and pulled away, shocked.
His reaction alarmed Nima, who said, 'Sir? Sir?'
'These are animal bites.'
'No sir.' Nima categorically rejected the notion. 'Not possible.'
Abe didn't know what kind of animal, but he definitely recognized the puncture
wounds and lacerations.
'What's going on here?' Abe demanded. This was no ordinary camp accident. He
tried to piece together the injuries. Had the boy fallen off the trail and lain unconscious
while animals chewed at him? Or had animals attacked and driven him off some cliff?
Stranger things had happened.
'Very bad,' Nima murmured. 'Very bad.' Nima rocked back on his heels. He wouldn't
meet Abe's eyes.
Abe felt defeated, completely lost, like a traveler who wakes up in a dark forest. Abe
wanted a story to go with these wounds, as if that would somehow locate him in this
wilderness. But that was just laziness speaking. It was up to him to create the story
with a diagnosis. Wound by wound, he had to put in order this poor body.
Abe sighed. He was about to begin at the top again, with the boy's head, when
suddenly the body stiffened under his hands. The muscles seized and shuddered and
the boy gave an inhuman cry as if to answer all of Abe's questions.
Naked to the world, the body released its momentary tension, then spasmed again,
and the boy commenced to jerk and moan, gripped in the throes of a violent grand mal
seizure. Abe had seen epileptic fits before and knew what was happening. But the
yakherders were terrified by the monstrous sight, this human pinned and writhing
upon the cold dirt. Shouting, they scrambled backward against the wall and those by
the door darted out into the black wind.
Abe didn't hesitate. Still on his knees, he swept away the loose rocks and slid the
bunched sleeping bag under the boy's skull to prevent his braining himself. All the
while, the boy's hard fists and elbows flailed against Abe. Even though unconscious, he
seemed to be doing battle with some terrible enemy.
Abe hunched against the blows, but a sudden flurry caught him square in the face
and he shouted with pain and surprise. Blood flew from his nose and then another