Sex, Drugs, and Public Health

 

The good news was, I would spend the final three months of medical school in exotic South America, studying rare tropical diseases; the bad news? The medical organization there was run by missionaries – no drinking, no smoking, no girls.

So I thought.

“Charlie,” the missionary doctor rasped down at me from his elevated position six and a half feet off the floor, “Get your jacket and Spanish dictionary – we’ve got a house call to make.”

He sucked so hard on his Marlboro that the room’s air whistled as it rushed between his lips.

“Where we going?” I asked, bracing for the toxic cloud of his exhalation.

“Over across the Ruta. We’ll walk.”

The “Ruta” was the major highway that snaked through this sprawling grasslands and remaining islands of hardwood forest. It was “major” only because it was paved. All other roads including the town’s streets were either dirt paths or mud slides, depending on the weather. A depression in the main street remained a puddle for days after a rain, and was home to a large pink sow who moved for no bicycle, motor bike, or truck.

The Ruta was also a steady source of emergency patients to our little hospital. It brought us the chainsaw accident victims and women in labor from miles away where people were clearing the forest to create new lives as farmers. It aimed careless truck drivers and drunk motorcyclists into sudden collisions. Although most were low speed collisions compared with the U.S. variety, they were ugly because motorcycles usually carried entire families at a time.

I could hear the Ruta at night, when the clamor of this frontier town surrounding the hospital ebbed. During brief silences in the cicadas’ songs, it hummed with a low roar that crescendo-decrescendoed as trucks loaded with mahogany logs roared away from the frontier, and trucks loaded food, beer, cigarettes and other essentials of frontier life roared into town. Lacing the edges of this low roar, like embroidery on a dishrag, was a tinkling of loud music, obviously blaring and shrill at its origin, but muted over the distance between the Ruta and us. Aside from the initial drive into town two weeks earlier, I hadn’t been to the Ruta.

“What are we gonna do there?” I asked my mentor as I arose from my after dinner siesta.

“Told ya,” the lanky West Virginia physician said in a cloud of smoke. “House call.” His long bones were so loosely hung on him that he lurched more than walked through the door into the fading light of dusk.

“I didn’t know there were any houses over there,” I trotted to catch up to his ambling silhouette. “Just stores and gas stations and bars, I thought.”

He stopped, turned, and showed me his teeth through a mischievous smile. “Depends on your definition of a ‘house,’ doesn’t it, Charlie? Come on.”

We found a dirt path that wound into the stand of palm trees, reduced now by dusk to shadows against a sky which glowed blue-black from a sliver of moon. Insects buzzed so loudly on either side as we walked that my eardrums hurt. Some bird up above let go with a fusillade of caws like a machine gun. Then I thought: “Snakes” and looked down to find my feet, but they were swallowed into the darkness of the path. I was walking by Braille.

Just as I took a breath to say something, he rasped, “You bring a flashlight, Charlie?”

“No.”

He clicked on his. The path before us materialized from the darkness.

“You should, you know. There are creatures out here at night.”

“Really?” I ran a couple of steps to get closer to the illumination. “Doesn’t bother me.”

“Oh, good,” he laughed. “I like that. To be a doctor around here, best to be macho.”

A glow ahead silhouetted the tree trunks. The distant cacophony of musical notes became louder as we walked. It was connected to the glow, which also intensified as we approached.

When we emerged at the edge of the Ruta, the blaring of tin quality music smothered the droning cicadas. Behind that noise was another: a gasoline generator, driving the turntable and loudspeaker system wired together somewhere. Stark electric light bulbs, bare and swaying in the evening breeze from wires hung at roof edges, were as harsh as the music.

Four small square buildings of crude plank lumber and thatched roofs randomly sprouted at the other side of the Ruta.

“Where we going?” I asked.

“La Mariposa,” he pointed at one of the buildings which had a faint pinkish hue. “The Butterfly.”

“Why?”

“Already told ya.” He started across the road. I followed him into the glaring din. The flashlight was no longer necessary.

Inside the one-room building, the “music” was so loud it was unrecognizable as something produced by instruments. There were four or five small tables of thick wood, about the size of card tables my parents utilized to play bridge in more genteel surroundings. A bare light bulb dangled from the roof above, flooding the center of the room like a stage, and casting the walls into shadow. We sat on crude wooden chairs at the table he chose.

From the shadows, a girl appeared. Short black hair, ebony eyes, skin-tight top low cut to cover half her breasts (until she bent over), and a skirt that ended mid thighs. She was barefoot, I noticed. And her feet were broad – splayed actually – as are those of half the people here who live in such intimate connection with the soil.

“Cerveza,” the missionary requested of her, lighting another cigarette. “Dos.”

She looked at me, smiled – or was it leered? – and said something to him in Spanish too rapid for me to comprehend.

He chuckled. “The joven is a doctor,” he told her. “Recently arrived. Be sure to be — nice — to him.”

She tossed her hair back in a maneuver meant to be sultry, I suppose, and walked away. Wiggled away. Jiggled away.

“Pay attention, Charlie.”

I whipped my head around to face him. “Yea. Sure. Okay. Attention to what?”

“To what you see around you.”

“Been doing that. What did she say?”

“Said she hadn’t seen you before and wanted to know who you were.”

“What did you tell her?”

“The truth. Here’s our beers. Only place we can get beer this time of night. All the stores in town are closed.”

For some reason, it had taken two girls to bring both beers. For some reason, they also brought chairs and joined us.

“We’re not alone,” I said taking a sip from the bottle. I was nervous, trembling a little for some reason.

“You noticed?” he guffawed. The two girls giggled with him.

“Good,” he continued. “You’re paying attention.”

The second girl was more attractive. She was blonde, which is unusual here, and looked older. Wiser. More relaxed and sure of herself. Her eyes, however, were as black as the other girl’s, and burned into me. She said something.

“What’s your name, Charlie?” the Marlboro man said.

“That’s really kind of a dumb question,” I blurted, “for a couple of reasons.”

He guffawed again. This time with a head back, all teeth showing, spontaneous gesture. The girls laughed with him.

“Yeah, I suppose it would be,” he said once he gained control of himself again, “if it were me asking. But I was just translating for you. Margarita asked.”

“Who’s Margarita?”

The blonde smiled broadly and lowered her eyelids demurely at the sound of the name.

“Blondie. Tell her yours.”

“I am called Carlos. Please I am to meet you,” I repeated the phrase I’d memorized best. I had to scream it above the blaring noise.

Then there was more Spanish, half of it drowned by the “music”, the other half too fast for my primitive knowledge of the language. It pinballed among the other three at the table, with occasional sentences aimed at me to which I merely smiled and/or nodded.

At first, my mentor translated a few phrases, but he eventually abandoned English. I had the tone of the conversation by then. It wasn’t deep. It wasn’t philosophical. It was, unfortunately, mostly about me.

“Rosita thinks you’re cute.”

“Cute?”

“Yeah, you know, handsome. Margarita wants to know if you’re married. They want to know what state you come from. Do you have any questions for them? They are asking.”

Half way into beer number two, I became aware that the two girls were no longer sitting across from me and from him. They were on either side of me. They were laughing and tousling my hair. Margarita’s bare thighs were rubbing against my pants. Rosita was blowing big bubbles from her gum and we all laughed as she peeled the pink slime from her face, time after time.

“What are they saying now?” I asked the hospital’s medical director.

He blew out a dense cloud of blue smoke that enveloped his brain-shaped skull.

“They gave you a nickname – ‘Choco Clinudo’ – ‘cause of your brown hair. They think you’re cute.”

“Yeah, yeah. I know. They wouldn’t think I was so cute if I was broke, I betcha.”

“You’re right about that,” he said, taking another swig of beer.

Then, a flurry of fingers in my hair propelled by girlish giggles and squeals. Their brown thighs jumped as they teased me. “Hey, you’re messing me up,” I objected, grabbing their wrists and pulling them off me.

“They like you, Charlie,” he beamed, then threw back his head, laughed and guffawed and bellowed and let loose enjoying himself like I’d never seen him in the hospital where he played the role of American mentor to fledgling Latin interns and the dedicated nurses who actually did the work.

When he finished his laugh, he said something to them. The two got up, shook my hand politely and said the “glad to meet you” phrase in Spanish which I understood. They dissolved again into the peripheral shadows.

“Let’s finish up and get home,” he said swigging the dregs of his beer. “It’s late.”

“What about the girls?”

“We’ll see them again at the clinic,” he said. “Thursday. V.D. check day. We need to test them every month.”

“So they come in once a month?”

“Not always,” he said reassembling his lanky frame into an upright position. “These two have missed a couple of times, but they’ll be there Thursday.”

“How do you know?” I waited for him to finish lighting another cigarette.

“Because,” he flicked off his lighter. “I told them you’d be there. Let’s go.”

We crossed the Ruta, dropped down to the palm tree thicket, and he flicked on the flashlight again. As I followed him down the path, I raked my fingers through my hair to re-comb it, and snagged a wad of bubblegum with my fingernails. My hair was deeply entangled in the thick, sugary wad.

“Shit!” came shooting out. “Hey,” I called up to him, perhaps a little more aggressively than I should have. “What exactly were we doing back there?”

His answer came floating back to me in a cloud of Marlboro smoke:

“Public Health, Charlie. Public Health.”

Pierre calls 911 for an ambulance every week or two during the warm months when he still pans for gold. More often during the lonely winter.

“Chest pain,” he’ll say the magic words. “Like a fart turned sideways.”

Just to seal it, he’ll often add “I can’t drive.”

We wouldn’t want him to. Not any time after eleven A.M. anyway. There are enough drunks on the roads during the night hours causing accidents; we don’t want the steel mining contraptions that fill his rusty Datsun clanging into each other as he drifts, occasionally, into the right lane, then yanks the car back onto its usual trajectory directly into oncoming traffic.

“We’re coming, Pierre,” we always reassure him.

It’s my job to bring the dog food.

Red lights plinking off the pine trees astride the road, siren wailing to warn any meandering deer, Joe, the hospital janitor, weaves around the hills and swoops us down, then up the gullies. Like a needle embroidering the landscape.

As the ambulance strains up the final grade to Pierre’s shack on the hill, transmission slipping, medical equipment sliding to the back of the vehicle, I pull a can opener from the Trauma Kit and start opening the first can. I’ve ruined a few pairs of pants from that splattered grease.

The instant we arrive at the junkyard that surrounds his shack, the ambulance is accosted by a half dozen raucous canines, no two of which look to be even the same species, let alone the same breed, but all of which are seriously mean and, we’re pretty sure, unvaccinated.

I roll down the window. A big black-and-brown with stinking breath and thistle-matted fur lunges his front paws onto the door, almost reaching the window, snarling in a pitch that makes my ears ring.

“Ready?” I yell to Joe.

“Ready.”

I wind up, like back in Little League, and heave the can as far as possible from both ambulance and front door of the shack.

The howling, yelping, baying cacophony streaks after the can. We jump out, run to the back of the ambulance, yank out the gurney, and run for the shack.

“Got the Trauma Kit?” he asks me.

I streak back to the ambulance, grab the kit, then race back toward the shack. The black-and-brown sees me, and comes charging. We burst in, hauling the gurney and Trauma Kit, and slam the door behind us.

“What took ya so long?” he says from somewhere within the junkyard that is the inside of his shack. “My friends are saying nice things about me – I must be ready to die.”

The din of dogs is a muffled tornado beyond the thin walls. We can slow down now, and be methodical.

I check his blood pressure.

“Never mind that. Check my eyes. I don’t wanna go blind from that Immaculate Degeneration, like my brother.”

“I thought you had chest pain,” I retort.

“Yeah. It’s prob’ly from the cigars the doctor said I had.”

“You smoke?” I am surprised. “I thought you just chewed,” I try hard – in vain – not to look at the permanent brown streak of stained skin at the right corner of his mouth.

“Don’t smoke,” he mumbles. “Doctor said the X-ray showed I have cigars on my lungs.”

I listen to him breathe, stethoscope at full distance. I don’t want to inhale too deeply, that close to him.

“There’s some mucus in your lungs. You coughing it out?”

“Can’t. I can get down to my cough, but I can’t get under it. It’s stuck. Take me to the hospital.”

We will, of course. But by the time he’s strapped securely into the gurney and we’re ready, a dozen paws scrape furiously at the door. The incessant caterwauling has enveloped us.

I pull the second can from the Trauma Kit, open it, crack the door just enough, and heave again.

They all wheel and run after it. All but the black-and-brown. He stands there, snarling at me, saliva drooling from his black lips like tobacco juice from an old miner’s mouth. But then he, too, turns to chase the pack, sure of himself that he’ll get the biggest share.

We run for the ambulance, wheels bumping over the irregular earth and the scattered trash.

“Hey, slow down,” Pierre complains. “It feels like you done thrown me in the ore tumbler.”

We shove him in the back and lock the gurney in place. We just make it to our seats before the dogs come back looking for a fight.

“Don’t you feed your dogs?” Joe shouts back to Pierre once we’re safe inside.

The sound of dog claws scraping down the paint and steel of the vehicle reminds me of the blackboard in grade school.

“Sure I feed ‘em, “ he yells up to the driver. “I feed ‘em ambulance guys.”

And he chuckles all the way down the hill as our red light strums the pines that straddle the road.

Jerry was a cool guy for a boss. He wore a beard, which was against the former boss’s rules, spoke fluent Spanish, and had spent a year at the Cordon Bleu school in Paris. A great mix of rebellion, cultural sensitivity, and gastronomic priority setting.

So I was counting on him to see my point of view and support it.

“Chuck, the Ambassador wants you to take one of his officers to Panama for medical care.”

There. He’d delivered the message, like a good politician who hung out occasionally at the U. S. Embassy in Paraguay.

“Well, tell him I can’t. My prime responsibility is to the Peace Corps Volunteers, not to his Embassy staff.”

“Sit down, Chuck. Let me explain something to you.”

So the officer, a diplomat named Jim, and I arrived at Paraguay’s airport on the designated day.

“I know you’ll be needing immediate access to oxygen,” the Paraguayan woman in charge of the Braniff Airlines desk said in perfect English. “In case anything…” she glanced toward Jim, paused, then tried to extricate herself, “In case you… want it, Dr. Mosher. In case you want it. So. We’ve seated you in the very front with an oxygen bottle on the bulkhead.”

She exuded a whole lot more anxiety about this than I had mustered, still fuming and muttering about how politics had hijacked me. Her words were like sharp jabs with a sword called “responsibility”. My mood darkened.

Not Jim’s. “Aw, oxygen, smocks-ygen. It’s nothing. Fly up. Get zapped. Fly back. Do you have cocktails on board?”

The Paraguayan agent smiled, nodded her head, and smoothed an imaginary wrinkle in her uniform. “For the other customers, of course.” She shoved our tickets toward us, and changed her voice to the standard industrial chipper, “Have a good flight!”

“No fuckin’ secrets in this cow country,” Jim mumbled as we walked toward the tarmac. “Oh, sorry,” he jolted. “Do you swear? ‘Cause if not, I’ll try not to.”

It was a short walk across the asphalt to the waiting plane, but a lot of stuff flooded into my head. Stuff I’d tried to set aside so I could fume and mutter. He was in Atrial Fibrillation, due, the Embassy physician believed, to excess alcohol use.

The local physician had refused to perform cardio-version on the alcohol-loving diplomat there in Paraguay, insisting that the nearest “competent” cardiologist with a cardio-version machine was 2,000 miles to the north.

He’d obviously decided that, if the Embassy functionary died in the attempt, the blood would, metaphorically, be on his hands. Even if this simple electrical intervention had taken place in Argentina, Brazil, Venezuela, or Columbia. Let alone his home country of Paraguay.

He was protecting his golden-egg laying chicken called ‘the Embassy of the United States’, and placing the patient, heart still thrashing irregularly, into my hands. Hands so fresh from Med School and internship, that they had very little dexterity with the profession’s skills. All my experience has been in the highly controlled, fully equipped confines of teaching hospitals and emergency rooms.

The Devil advocated all over my brain during the short walk to the portable steps, rolled into place against the plane’s fuselage, on a mercifully un-rainy day: as we climb, the oxygen pressure in the air will drop, stressing his heart; The irregularity could worsen, perhaps speed up to over 200 when blood circulation will drop drastically; Maybe even degenerate into Ventricular Fibrillation with a complete paralysis of the heart; Only C.P.R. and thumping his chest with my fist would offer any hope, 30,000 feet up; I need to be prepared.

“Stewardess,” Jim called once we’d clicked ourselves in. “Could I have a Manhattan, please?”

“Jim, no alcohol,” I whispered in my serious Doctor tone. “Let’s not make things worse.”

“Aw, one won’t hurt.”

“You can have all the drinks you want,” I promised, “once you’re back in Asuncion. None ‘til then.”

He pouted.

“Orders from Gorgas,” I added to heap on more ponderous medical authority. I don’t recall, at this remove of time, whether any physician at Gorgas had said such a thing to me. Or even, whether I’d communicated with them from Paraguay at all. But if I had, I’m certain they would have agreed.

I spent the flight glancing at his red-cheeked and red-nosed face, to confirm that blood was still circulating from his fibrillating heart. I clenched the arm rests with all the anxiety a cardiac arrest in my patient might provoke, doubting whether this long-distance transfer with a fledgling non-cardiologist was, really, in the patient’s best interest. Sure as hell wasn’t in mine.

Jim spent his time commenting on the size of the stewardesses’ breasts and the mobility of their asses. Twice he unbuckled and excused himself to seek out the bathroom. Because that’s awfully close to where they keep those little bottles of vodka and scotch, I accompanied him on both trips.

“You’re my patient,” I said in what I hoped was a jocular tone. “Can’t let you out of my sight.”

Except for when he slid the “occupied” sign from the inside of the little door. He was on his own in there. Limits to this doctor-patient thing do exist.

Hours later we landed. His cheeks were still red and the stewardesses – all three of them – were pretty done with him. The air of Panama, even in the evening, was heavy, thick, wet, and hot. As, I am told, it always is. My glasses steamed up the instant I stepped from the airplane’s door.

We were met on the tarmac by some Embassy driver and were checked into some excessively luxurious hotel.

“Let’s get some dinner!” Jim enthused, his hands rubbing together in anticipation of something. Something within his brain that I suspected he didn’t want me to know about.

“Downstairs is the hotel dining room,” I prescribed. “Then off to bed. It’s an early day for you tomorrow at the hospital.”

The disappointment in his eyes reminded me of my first dog, a sad faced beagle incapable of hiding his thoughts. Or emotions. Or whatever dogs have. Jim’s look also confirmed my fears that he had plans.

I got him through dinner without alcohol and then, into bed. Luckily, we were in the same suite. Unluckily, his Atrial Fibrillation didn’t stifle his snoring.

In the early morning, we were driven to Gorgas. The Embassy vehicle cleaved the Panamanian air, which was hot, wet, heavy and laden with the myriad perfumes of the city and surrounding jungle. I delivered him into the hands of a cardiologist and felt a sudden and complete relief a lot like – (medical metaphor warning) – unburdening a full colon.

I wandered the banks of the famous canal for as long as I could tolerate moving and breathing through the jelly-like mass of the Panamanian atmosphere, then returned to the air conditioned hotel to await news.

“They’re keeping me overnight,” Jim reported by phone. “For observation.”

I smiled, relaxed, enjoyed the feel of the hotel’s air.

“Then they want me to stay at the hotel tomorrow night, too. Just to be sure.”

Crap! I’d hoped I could just get him back to Paraguay immediately upon discharge. Still breathing. “Okay,” I said.

“Man, my chest is sore. That defibrillator packs a punch. See you tomorrow.”
The Embassy took care of plane tickets and another night at the hotel. I wandered outside into the evening to look for a restaurant. But I returned quickly to the hotel to eat. And to breathe.

Next day, Jim was delivered to me at the hotel, all chipper and oblivious, as usual. He insisted on seeing the canal so we ventured out, allowing the environment to drain us of copious sweat and most of our energy. We returned to the hotel at siesta time, removed our sodden shirts and hung them up to dry in the conditioned air, then lay down for siestas.

I awoke near dusk to find his bed empty. I knocked on the bathroom door. No answer. Pulled it open. Empty.

“Jim?” I called into the obviously empty room.

“Jim?!!” louder.

Shit!

I yanked open the door and looked down the hallway. No Jim.

I picked up the phone and hit “O”. Hard.

“Is Mr. ______ from this room down there?”

Of course he wasn’t.

“Did he leave a message?”

Of course he didn’t.

I called Gorgas Hospital. “Is he there?”

“No, Doctor. He’s been discharged. Didn’t you know that? It says he was discharged to your care.”

I scribbled a note: “Jim – When you get back, STAY HERE!!
I’ll be back soon. Doctor’s orders.”

Increasing frantic, I checked out the restaurant, the bar, the pool, the gym (that’s a joke, I thought), and the sidewalk outside the hotel, as far as dusk would allow my eyes to penetrate.

Shit!!

Shit! Shit! Shit!

Back to the room to wait, seething. Like Gorgas said, – – – into my care – – –

He waltzed into the room three hours later, whistling.

In spite of my relief to see a live Embassy officer, I fear that my question to him may have been sharply worded, for his eyes dropped to the floor, his lips pushed into a pout, and I swear he looked exactly like my beagle for a few seconds there.

“I just went out to find a hooker,” he explained in all innocence. “I wasn’t gone that long.”

“Hooker? Are you nuts? You could have been robbed. Murdered.”

“Oh, nonsense,” he shrugged, smiling as naively as an altar boy.

“Didja find one?”

“Oh, yeah! They’re all over. You want one? I know where…”

“Jim!” I jolted him. “Did you have a drink?”

“Well, Jeez. You can’t find hookers in ice cream parlors. What do you think?”

For the remaining twelve hours in Panama, I camped outside the bathroom door when he showered. I laid awake all night, watching the room door, which I had locked and chained. I confirmed that the Embassy car was downstairs, waiting, before I opened the door and we went down.

The Braniff plane for home had, I recall, one of those gaudy paint jobs for which the airline had paid an artist named Calder. All the way south, Jim smiled and jabbered and regaled me with stories about the nurses of Gorgas and the whores of Panama City. I kept feeling his pulse to confirm sinus rhythm. As long as he had a regular pulse, I allowed his enthusiasm to wash over me like Panamanian air.

“There was this nurse in Cardiology. She was just gorgas.”

“She was what?”

“You know, beautiful. She had the most beautiful body.”

“You saw her naked?”

“Of course not. She was wearing a uniform.”

“Then how do you know she had a beautiful body?”

“Her smile.”

Is this part of his job skills as a diplomat? I shook my head.

“If I could paint, like those Italian guys from the Rainy period – ”

“The what period?”

“You know, the 1400’s.”

”Oh. The Rainy-sance?”

“Yeah. That’s it. I could paint all of her just from her eyes. She’d be like the sea-shell lady.”

The joy his face exuded was so intense, that I expected him to spasm his fists up to his mouth, and begin chewing on them, overwhelmed by it all like a five-year-old on Christmas morning.

“How do you like being a diplomat?”

“Oh, it can be boring – parties, dinners, talking, kissing asses that don’t even speak your language. And it can also be scary – say just one wrong word and you’re fucking up things for a whole lot of people.”

A stewardess walked by, distracting him.

“But the world is still fun,” he continued, “wherever you are. Flowers to smell, women to see – sometimes touch, scotch to drink.”

It was pouring in Asuncion when we landed. They swung the plane’s door open and the sound of torrential splashing flooded in. Jim jumped up and charged for the door, but the stewardess intervened.

“We are bringing you umbrellas, Señor Ambassador,” she inadvertently promoted him. Please wait here and remain dry.” Two Paraguayan agents for Braniff, with rain dripping from their hair, ducked onto the plane, opened two umbrellas, and handed them to us. The outside air that snuck in with them was cool and clean smelling.

He stared at me. “I’m going to miss you, buddy. It’s been fun.”

“Sure has,” I replied diplomatically.

“Bad luck.” He grinned and pointed to our open umbrellas within the plane.

And down the steps he went, rain rattling off his umbrella, bound for the Embassy, to resume his unique approach to official U.S. diplomacy.

Actually, I admitted to myself, would be nice if I could be a little less terrified of my responsibility as a doctor and a little more into smelling the flowers – – –

“Naw,” I smiled to his descending back. “Bad luck’s all behind us now.”

– – – is how a colleague mis-pronounced what I’d said.

“Haiti,” I corrected. “I’m going to Haiti.”

They sent us to St. Marc, a city north of Port-au-Prince and beyond the zone of impact from The Earthquake. But tent cities of blue plastic metastasized from the maimed capital, to line the road north, leaking streams of sewage like pus from sores. These clots of densely packed refugees from Mother Nature’s attack remained camped out, waiting. For something. For someone. The parched and stripped Haitian landscape around them gave no hint of where they’d find water.

Our van stopped at a roadside market halfway to St. Marc. The primary items for sale were food and water. The food was the same from every vendor – deep fried something. It looked identical on every platter carried by the competing hawkers. Water was sold in sealed plastic bags the size of your palm. This was the water I’d been warned about on the airplane by a flamboyantly dressed Haitian woman:

“Da water dey sell in bags – don’t you drink it. Bad.”

St. Marc is a densely packed town surrounded by thousands of farmers’ small plots. Our clinics were set up in churches scattered among the farm homes, barefoot kids, free range pigs, and roads as rutted and pitted as horse trails. To get there, we bumped alongside an irrigation canal churning with brown foam, in which naked children played and from which women scooped water.

Throngs of people appeared at the clinic doors from amid this landscape, and grew quickly to a chaos of jabbering Creole voices. We admitted them in a controlled manner, to sit and wait their turn, only to discover that the chaos was now inside, at our elbows.

From this outside squalor and the chaos of waiting people inside, we brought patients, one by one, to our tables:

A thin grandmother wearing a clean and colorful dress stood, in shoes, with two granddaughters flanking her. I was surprised to note that the old farm woman didn’t smell of sweat and mud. Both girls had ribbons braided into their hair and tied in bows. They wore clean Sunday-go-to-church dresses, and they both wore sandals.

“Dis one, she won’t eat, and da other is always tired.”

Intestinal parasites in both; medicine for the two of them.

A six year old boy, on his mother’s lap, wore a suit – dark slacks and matching jacket over a crisp white shirt. His shoes shined like black mirrors. He had a congenital problem that meant he couldn’t control his bowels. “Dey tease him at school,” his mother worried. “He maybe will drop out of school. Den how he get a good job?”

A teenaged girl stood mute by her mother’s side. She wore a clean dress of multi-colored flowers, and smelled of perfumed soap. Her face had no expression.
“She was in Port-au-Prince,” her mother nodded toward her, “when the earthquake hit. I brought her back here because she was so terrified to stay there. She lost her words.”

Lost her words?

“She hasn’t spoken since the earthquake.”

Luckily, we had a French-speaking counselor on our team.

After we’d listened, examined, then prescribed, they each smiled and thanked us effusively for the little we’d done.

“Merci, Doctor, merci.”

One middle-aged woman told me, “You are the first doctor I’ve ever seen.”

On our way back to the airport, weaving thru crowds of people who were barefoot again, incompletely covered by tattered clothes again, it was obvious to me that, while our medicines may have helped a few people for a few days, what the appreciative and classy people of Haiti really need is water which is separated from the sewage.

Real simple concept. Apparently, monumentally difficult in Haiti.

So maybe my colleague was right. The people are powerless to drink anything other than the contaminated water of Hades.

Ticking time bomb.

A thrill electrifies you when the fuse bursts to life.

Before, it’s just a string-like object hanging from the paper-wrapped cylinder. Inert. Unexciting.

You hold the glowing red tip of your punk against it, waiting, waiting, glancing around in the dark, to see if others are fleeing their already lit fuses, still waiting – – –

Suddenly the fuse sparks, enflaming your face. It comes alive, sizzling, crackling, and burns rapidly toward your cylinder, now hiding deep inside a plastic tube, pointed skyward.

Like horseradish in your picnic food, the Thrill includes fear,

You run to where the spectators stand. The sparking fuse and its rattlesnake sound disappear down into the plastic tube.

Waiting – – – waiting – – –

Ba – FOOM !

It launches into the black sky, trailing a faint glow. Higher – – – higher – – – . Until your neck is bent back to where you hear the vertebrae crunch against each other.

At the tip of the climbing streak of sparks, there’s a small flash.

BOOM !

It explodes into glowing embers of phosphorus, strontium, barium, and charcoal that expand outward in all directions, trailing white, red, green, gold. A mini-Universe is born, glows majestically in the vast blackness, and falls slowly toward you, already dying, but doing it with beauty.

Occasional little dead embers land in your hair.

Then you run out to re-load the plastic tube with another Mortar cylinder.

There are at least a couple dozen of us on the night of the 4th, playing Creator of the Universe with our Mortars, Roman Candles, Fountains, and Cakes, while hundreds of others flank us and watch, contributing to the show in the night sky with Spinners and Sparklers .

We – all of us – came to the Indian reservation just at the edge of the County line, where laws about such things change when you cross the street. 40 or 50 fireworks stands sold big stuff – boxes the size of medium sized children, packed with dozens (in one case, 720) explosions of your choice. In the frenzy, tens of thousands of dollars changed hands at a speed approaching that of light.

The designated area is a vast paved field in the industrial seaport section, flanked by looming container cranes on the water side, and railroad tracks on the other. Nothing flammable here but what is in our boxes, and the clothing of small children. Someone has positioned two containers side by side with just a narrow alley between them, 100 yards across the macadam from where we stand.

From the sides of this massive parking lot, people shoot their Mortars skyward at random moments, attacking the night sky with explosions of varying colors and reverberating ignitions while others decorate the earth with Fountains of white sparks, spinning Fireballs that shriek and change colors as they whirl, and air-dancing Sparklers.

A couple next to me hold a flame to the small cake of wax wired beneath a miniature hot-air balloon of paper. Slowly, it inflates with the heat. They release it. It hangs there, glowing blue, round and a couple of feet in size. The breeze drifts it out over the pavement. Slowly it begins to fall toward the ground and it appears destined to crash. But the wax burns on, and the balloon begins to rise. We watch it climb into the black sky as it drifts, glowing blue, toward whatever is out there.

Someone lights a Roman Candle and aims it toward the balloon.

POOM !

A tracer bullet of red arches thru the air, missing the floating balloon to the right.

POOM !

A green one streaks toward the balloon, falling beneath it.

POOM !

This time he misses to the left with a yellow one.

And the happy little balloon, still glowing and inflated, floats further south and higher, up toward where the jets approach Sea-Tac airport.

BA – WHOOM !

The detonation prolongs as an echo of itself, like a kettle drum reverberating to the blow of a drumstick. The penumbra of a large Mortar erupts from behind the container across the field, creating a multi-colored semi-circle above the pavement, its lower half raining down upon whoever dares to run into that alley of fire. They shoot their Mortars, not up, but into the container.

We have so many boxes of stuff that we stay there, lighting fuses, running like hell, and contributing to the chaotic cacophony of color until midnite. Then we pile up the boxes and ignite them, the traditional method of clean-up, apparently, for those who have blown their wad and are heading home.

What do we Americans celebrate on July 4th, I muse as we follow the beams of our headlamps to our cars. Not the Revolution, I shake my head. Even the Roman Candle guy, who got closest to the historical origins of fireworks, probably missed his own symbolism, so long forgotten was that history.

Military might? If that were so, we’d be at some tank-and-marching parade, craning our necks skyward for acrobatic jets, not fireworks.

How about Individualism? The great Lone-Cowboy-on-the-Plains social model we worship perpetually, manifesting here as a day off from work to consume hot dogs, beer, and a pyrotechnic show. If that’s it, we certainly upped the ante: took the fireworks from the hands of professionals and, fueled by beer and pyromania, re-created the unchoreographed terror of war interwoven with the beauty of friendship and color.