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He was going to die and there was nothing she could do to stop it.
Five presses, one breath.
Even knowing that it was over, she continued the chest compressions on his frail and bloated body. Five presses, one breath.
All around her the nurses shook their heads, their expressions sad but accepting. Five presses, one breath. His mother looked on with hopeless eyes. Five presses, one breath.
Outside, the howling wind stopped as if the very desert itself was holding its breath as it sensed him slipping away.
Five presses, one breath.
But she couldn't let him go. His eyes had implored her when he first came into the clinic so many hours ago. She couldn't just let him die of the ache in his belly. Not when everything inside her raged at the unfairness of allowing a six-year-old child to slip away, when all of her training taught her to fight harder and longer. After all, malnutrition could be countered, as could starvation and most of the diseases found here.
But it was too late for Mabulu. Too late for high-protein drinks from the States, too late for peanut-butter sandwiches or fresh bananas. Too late for the vitamins and shots that could so easily have saved him a few weeks before.
Sometimes it felt as if everything she did in this godforsaken country was too little, too late.
Five presses, one breath. it was time to stop. Her intellect knew it, but her heart was already so cracked that she feared one more loss might shatter it forever. So she continued pressing down on his small chest, long past the time her medical experience told her to stop.
Sweat ran down her face, and her arms trembled from the strain.
Five presses, one breath.
Tears blurred her eyesan appalling lack of professionalism she could do nothing about.
Hundreds of thousands of deaths she could do nothing about.
She railed at the unfairness of it, at the complete and utter hopelessness of this battle she had been fighting for eleven years now. What good was a medical degree if she couldn't save anyone?
Five presses, one breath.
"Time of death11:42 a.m." The deep voice boomed across the impromptu operating room, and Amanda Jacobs glanced up, startled, into the face of Jack Alexanderhead doctor of this particular clinic and a close personal friend since they'd done their first year of medical school together fifteen years before.
"He's my patient," she said, continuing CPR. "I say when he's dead."
"How long has he been down?"
She bit her lip, knowing that the answer would damn Mabuluand herself. "Twenty-seven minutes."
Jack's eyes cut to hers, narrowed in disbelief. "Stop the CPRnow," he roared when she ignored him.
Her hands trembled and her shoulders slumped as she slowly let her arms drop away from her patient. He had been a beautiful little boy, even with his belly bloated and his bones all but sticking through his skin. His eyes had been bright, inquisitive, and his ongoing stoicism made her own sudden emotional instability even more humiliating.
Sobs choked her and she could barely stop the scalding tears from falling.
"Call it," Jack ordered.
Her gaze met his. "You already"
"Call it." His voice was implacable, his look compassionate as he stared her down. "As you said, he was your patient."
She glanced at the clock, then cleared away the lump in her throat. "Time of death11:44." Her breath hitched and she feltactually felther heart break wide open. She'd been right. Mabulu's death had been one too many, Somalia one country too many in a list so long she'd learned years ago to stop counting.
"I want to speak with you in my office," Jack said, his voice uncompromising.
"My patient" Their eyes locked in a battle of wills she didn't have the strength to winat least not today.
"Nola will take care of him." He nodded toward the head nurse, then turned, without waiting to see if Amanda would follow, confident of his power and leadership even here, in this hospital composed of a series of olive-green tents and overstressed generators in the middle of the desert.
Amanda followed slowly, trying to steady herself for the confrontation she knew was coming. Her behavior was growing more and more erratic, her inability to let Mabulu go just the latest in a series of bad judgment calls. She was exhausted, overemotional, burned out. She knew the symptoms well, had witnessed them in others time and again in the past decade.
She'd simply never expected it to happen to her. Then again, she could say that about so many of the things in her life lately.
"What exactly was that?" Jack asked, closing the curtain on his makeshift office.
Her spine stiffened at his strident tone. "That was me trying to save my patient's life."
"That was you completely out of control, Amanda, and we both know it."
"That's not true," she protested, but her voice wasn't as solid as she would have liked.
"Yes, it is. I've worked with you off and on for fifteen years and I've never seen anything like that from you.
"It was a rough one." She triedand failedto shrug off the incident. "I'll be okay."
He studied her, and she knew his blue eyes were taking in the strain around her mouth and the cloudiness of her usually clear gray eyes. Telltale signs she'd noticed herself. "I'm not so sure about that."
She stiffened. "What's that supposed to mean?"
Sighing, he gestured to one of the two chairs in the room. "Sit down, Mandy
"Are you firing me, Jack?" If so, she would prefer to stand.
"Of course not," he snorted. "You know more about practicing medicine in these conditions than most of my staff put together. But I do want to examine you." He put his stethoscope in his ears and motioned her to sit.
"I'm not arguing with you about this. Before you go back on duty, I'm going to make damn sure you're all right."
She started to protest more vehemently, to tell him her health was none of his business. But she had enough self-preservation to realize that doing so would only reinforce his beliefs about her fitness for the job.
Plus, for the first time in her life, she just couldn't summon up the effort to fight.
"I told you I'm fine," she said as she sank into the chair reluctantly, but she could hear the shakiness in her voice.
"Which is obviously a falsehood." He put the stethoscope to her chest. "Take a deep breath."
Amanda sucked in air as loudly as possible, before letting it out slowly. "I'm just tired. We all are."
"But we're not all in tears when one of our patients dies."
"Sometimes it gets to me. You know what it's like."
He reached for her wrist to check her pulse. "Sometimes it does," he agreed. "But this isn't you, Mandy. Tired or not."
"Well, who is it, then?" She laughed bitterly. "Please, tell me. If this isn't my life, whose hellish existence is it? Believe me, I'd love to give it back to her."
Jack didn't respond and she regretted the words as soon as they were spoken. "I didn't mean that the way it sounded."
"I think you did." He checked her reflexes and she took a childish delight at the involuntary kick that landed in the middle of his shin. "You need a break."
"Yes, now. You've been going hell-for-leather for eighteen months straightmore if you count everything that happened before you came back here. Is it any wonder that you're burned out? You need to get away from here for a while and remember that there's more to life than suffering."
"I can't." She stood and walked over to the crude window near his desk. "We're understaffed as it is."
"We'll manage. We always do."
"I'm overtired. A couple of nights' sleep and I'll be fine."
His smile was sad. "Not this time. You need to step back for a while, go home, live a normal life for at least a year."
"A year?" She whirled to face him. "You can't be serious."
"I'm very serious. You're the best doctor I've got, one of the best I've ever worked with, but even you can't keep going at this pace indefinitely. You're strung out, stressed-out and you're going to make yourself sick."
He paused, stared at her for a long minute as if debating with himself. Finally he quietly commented, "You can't hide from what happened to Gabrielle, Amanda. And you can't bring her back."
The words hit her like an out-of-control freight train, had her fists clenching and her blood pounding even as they flattened her completely. "You think I don't know that?" she demanded, unable to look at him. "You think I don't wake up every morning, wishing that my daughter was alive?"
"I think you do." His tone was compassionate, his voice matter-of-fact. "Which is part of the problem. It's been a year and a half, and you haven't even begun to deal with what happened."
"I deal with it every day."
"No, you hide from it every day. Here, and in Uganda. In Mozambique. You've been running from the truth since the funeral, and all it's gotten you is one step away from a nervous breakdown."
"Is that your professional opinion, Doctor?" She sounded like a sulky four-year-old, but couldn't help herself. If he kept pushing, the emptiness yawning inside of her would completely overwhelm her.
"It is." He sighed, then reached out to cover her hand with his. "I know what I'm asking of you, Amanda."
Her laugh was bitter. "You couldn't possibly know, Jack. If you did, you wouldn't have the nerve to ask."
He squeezed her hand, letting the silence build until her eyesonce againmet his. "You can't save her. No matter how many children you help, no matter how much you punish yourself, you still can't bring her back."
"It's my job to save these children." She yanked her hand away, then ran it carelessly through her short, dark hair. Her fingers snagged in one of the many curls, but she barely felt the pain. These days, she rarely allowed herself to feel anything at all. "They became my responsibility the day I signed up to come here."
"I know." His voice was soothing.
"This has nothing to do with Gabrielle," she insisted. But her voice broke and Amanda rubbed the heels of her hands over her eyes as the tears began to flow. "It's about there never being enough. Enough food, enough medicine, enough doctors. Enough time. Nowhere on this whole damned continent is there enough of anything."
She gave a watery, sarcastic laugh, then corrected herself. "Except the bad stuff. There's plenty of that. Corruption. Famine, drought, poverty."
Glancing out the screened-in window, she watched a trio of vultures circle above the camp, impatient to get their claws into Mabulu's frail, bloated body. She wouldn't let that happen.