old colleagues by now, unwound noisily; Okwera, a solid man in his forties, grew mildly but volubly intoxicated and told medical horror stories from his time in the army. Masika, the trainee surgeon, was very softly spoken and reserved. I was something of a zombie from jet lag myself, and didn’t contribute much to the conversation, but the warm reception put me at ease.
I still felt like an impostor, here only because I hadn’t had the courage to back out, but no one was going to interrogate me about my motives. No one cared. It wouldn’t make the slightest difference whether I’d volunteered out of genuine compassion, or just a kind of moral insecurity brought on by fears of obsolescence. Either way, I’d brought a pair of hands and enough general surgical experience to be useful. If you’d ever had to be a saint to heal someone, medicine would have been doomed from the start.
I was nervous as I cut into my first Yeyuka patient, but by the end of the operation, with a growth the size of an orange successfully removed from the right lung, I felt much more confident. Later the same day, I was introduced to some of the hospital’s permanent surgical staff — a reminder that even when Collins left, I’d hardly be working in isolation. I fell asleep on the second night exhausted, but reassured. I could do this, it wasn’t beyond me. I hadn’t set myself an impossible task.
I drank too much at the farewell dinner for Collins, but the HealthGuard magicked the effects away. My first day solo was anticlimactic; everything went smoothly, and Okwera, with no high-tech hangover cure, was unusually subdued, while Masika was as quietly attentive as ever.
Six days a week, the world shrank to my room, the campus, the ward, the operating theatre. I ate in the guest house, and usually fell asleep an hour or two after the evening meal; with the sun diving straight below the horizon, by eight o’clock it felt like midnight. I tried to call Lisa every night, though I often finished in the theatre too late to catch her before she left for work, and I hated leaving messages, or talking to her while she was driving.
Okwera and his wife invited me to lunch the first Sunday, Masika and his girlfriend the next. Both couples were genuinely hospitable, but I felt like I was intruding on their one day together. The third Sunday, I met up with Iganga in a restaurant, then we wandered through the city on an impromptu tour.
There were some beautiful buildings in Kampala, many of them clearly war-scarred but lovingly repaired. I tried to relax and take in the sights, but I kept thinking of the routine — six operations, six days a week — stretching out ahead of me until the end of my stay. When I mentioned this to Iganga, she laughed. “All right. You want something more than assembly-line work? I’ll line up a trip to Mubende for you. They have patients there who are too sick to be moved. Multiple tumours, all nearly terminal.”
“Okay.” Me and my big mouth; I knew I hadn’t been seeing the worst cases, but I hadn’t given much thought to where they all were.
We were standing outside the Sikh temple, beside a plaque describing Idi Amin’s expulsion of Uganda’s Asian community in 1972. Kampala was dotted with memorials to atrocities — and though Amin’s reign had ended more than forty years ago, it had been a long path back to normality. It seemed unjust beyond belief that even now, in an era of relative political stability, so many lives were being ruined by Yeyuka. No more refugees marching across the countryside, no more forced expulsions — but cells cast adrift could bring just as much suffering.
I asked Iganga, “So why did you go into medicine?”
“Family expectations. It was either that or the law. Medicine seemed less arbitrary; nothing in the body can be overturned by an appeal to the High Court. What about you?”
I said, “I wanted to be in on the revolution. The one that was going to banish all disease.”
“Ah, that one.”
“I picked the wrong job, of course. I should have been a molecular biologist.”
“Or a software engineer.”
“Yeah. If I’d seen the HealthGuard coming fifteen years ago, I might have been right at the heart of the changes. And I’d have never looked back. Let alone sideways.”
Iganga nodded sympathetically, quite unfazed by the notion that molecular technology might capture the attention so thoroughly that little things like Yeyuka epidemics would vanish from sight altogether. “I can imagine. Seven years ago, I was all set to make my fortune in one of the private clinics in Dar es Salaam. Rich businessmen with prostate cancer, that kind of thing. I was lucky in a way; before that market vanished completely, the Yeyuka fanatics were nagging me, bullying me, making little deals.” She laughed. “I’ve lost count of the number of times I was promised I’d be coauthor of a ground-breaking paper in
“But now Yeyuka feels like your true vocation?”
She rolled her eyes. “Spare me. My ambition now is to retire to a highly paid consulting position in Nairobi or Geneva.”
“I’m not sure I believe you.”
“You should.” She shrugged. “Sure, what I’m doing now is a hundred times more useful than any desk job, but that doesn’t make it any easier. You know as well as I do that the warm inner glow doesn’t last for a thousand patients; if you fought for everyone of them as if they were your own family or friends, you’d go insane…so they become a series of clinical problems, which just happen to be wrapped in human flesh. And it’s a struggle to keep working on the same problems, over and over, even if you’re convinced that it’s the most worthwhile job in the world.”
“So why are you in Kampala right now, instead of Nairobi or Geneva?”
Iganga smiled. “Don’t worry, I’m working on it. I don’t have a date on my ticket out of here, like you do, but when the chance comes, believe me, I’ll grab it just as fast as I can.”
It wasn’t until my sixth week, and my two-hundred-and-fourth operation, that I finally screwed up.
The patient was a teenaged girl with multiple infestations of colon cells in her liver. A substantial portion of the organ’s left lobe would have to be removed, but her prognosis seemed relatively good; the right lobe appeared to be completely clean, and it was not beyond hope that the liver, directly downstream from the colon, had filtered all the infected cells from the blood before they could reach any other part of the body.
Trying to clamp the left branch of the portal vein, I slipped, and the clamp closed tightly on a swollen cyst at the base of the liver, full of grey-white colon cells. It didn’t burst open, but it might have been better if it had; I couldn’t literally see where the contents was squirted, but I could imagine the route very clearly: back as far as the Y-junction of the vein, where the blood flow would carry cancerous cells into the previously unaffected right lobe.
I swore for ten seconds, enraged by my own helplessness. I had none of the emergency tools I was used to: there was no drug I could inject to kill off the spilt cells while they were still more vulnerable than an established tumour, no vaccine on hand to stimulate the immune system into attacking them.
Okwera said, “Tell the parents you found evidence of leakage, so she’ll need to have regular follow-up examinations.”
I glanced at Masika, but he was silent.
“I can’t do that.”
“You don’t want to cause trouble.”
“It was an accident!”
“Don’t tell her, and don’t tell her family.” Okwera regarded me sternly, as if I was contemplating something both dangerous and self-indulgent. “It won’t help anyone if you dive into the shit for this. Not her, not you. Not the hospital. Not the volunteer program.”
The girl’s mother spoke English. I told her there were signs that the cancer might have spread. She wept, and thanked me for my good work.
Masika didn’t say a word about the incident, but by the end of the day I could hardly bear to look at him. When Okwera departed, leaving the two of us alone in the locker room, I said, “In three or four years there’ll be a vaccine. Or even HealthGuard software. It won’t be like this forever.”
He shrugged, embarrassed. “Sure.”
“I’ll raise funds for the research when I get home. Champagne dinners with slides of photogenic patients, if that’s what it takes.” I knew I was making a fool of myself, but I couldn’t shut up. “This isn’t the nineteenth
