Saturday, April 23, 2011

High Fever

This is the second sample of my writing posted here in the process of applying for the Writer's Institute. It is the first chapter in my forthcoming book called "Chief Complaint."

“On their faces are their marks, (being) the traces of their prostration.”
From the holy Koran

In the middle of a rainy dark night there was a knock at the door. Didi went to the door to deflect another disturbance to my fitful sleep. It was in the days when I had little choice but to receive emergencies regardless of how many there were in one night. She came back and shook me out of sleep into another physician’s nightmare:
“It sounds serious enough. And it is another house call. You think you could drive or should I drive you?”
I stumbled to the door but had to rub my eyes twice before I could believe who was there. It was a classmate I hadn’t seen since high-school days. Even under the exceptional circumstances I had the presence of mind to make the socially required gesture of asking him into our humble abode: “Tfaddal –honor us and come in!” I blurted after a vigorous hug.
“Not at this hour, thank you. And we need you to come see my father at home right away. You remember my father, old man Abd-el-’Athim – Servant of the Almighty --, don’t you? He is boiling with fever and has started to speak shatt wmaghyabani -- abstract nonsense.”
I got my bag and we were on our way on foot. The house was not far.

We found Abd-el-’Athim at the door of his single room home with his wife and daughter hanging onto his arms as he attempted to escape. And indeed he was speaking shatt, wanting to be let go off so he can fetch something black he needed. None of us understood exactly what that was or where he wanted to go. He was dressed in his standard three-piece outfit of blotchy and tired white shirwal, a gray woolen shirt thoroughly drenched with sweat, and a long lambskin coat, its bedraggled locks heavy with years of accumulated grime. And he looked exactly like I remembered him some fifteen years earlier when he came to see me off as I readied myself for my fateful departure to study medicine; nearly every man in the village attended that occasion, of course. He was a giant of a man, cause enough for his fellow villagers to contract his name simply to ‘Almighty,’ with roughhewn rock head over a short neck and broad sloping bearlike shoulders, red eyes with lash-less lids, a week’s worth of white stubble on his face that seemed to merge imperceptibly into his thick chest hair and around to his ears, and a tuft of thick matted curly graying red hair under an old hand-sewn skullcap. He immediately recognized me and treated me as his guest extending his huge hand in greeting. Despite its bulbous joints and firm locking grip around my hand, his rough hand felt feverish. He asked me in and welcomed me as best as he could, explaining that he was actually preparing to come to my home next to the diwan – classic men-only guesthouse -- of my uncle Salih, his former boss, and that he needed that black ointment from his friend, my father. I tried to explain that I no longer lived at that address and that my parents were both long dead and gone as was my uncle. But he didn’t seem to comprehend. He insisted that as soon as his wife finished making tea “lawajbak -- for your due welcome” and he di his morning two compulsory prostrations to God we would be going to my father’s place. His wife didn’t make tea; she went out the backdoor to the adjoining shed, we heard their cow moo in objection to being disturbed at that hour of night, their donkey responded with sharp braying, then the wife came back with some milk and made us fresh cafĂ© latte on the rekindled embers in the primitive earthen fireplace right next to the couple’s sleeping floor space.

With the help of his son, my classmate, we managed to get Abd-el-’Athim to lie still in a supine position on his sheep’s-wool stuffed mattress. In the faint kerosene lamp’s light, augmented intermittently by the flickering of the revived fire in the hearth, the moss-like white fuzz on his ears and the permanent bemused smile of acceptance with undetermined reservations on his wrinkled face created the eerie impression of being in the presence of a sacrificial lamb, or rather a sacrificial ram. And his face spoke medical history to me: The moonscape, lit up only on one side, betrayed deep creases spreading out from the depth of his eye socket down to his ear, intercepted at right angle by deeper furrows around his toothless mouth, with the entire terrain interspaced with many dark craterlike depressions, the pockmarks of childhood small pox. Two brothers died and one sister went blind but Abd-el-’Athim escaped with only permanent deep scarring.

And there was that darkened fig-size coarse protuberance in the middle of his forehead declaring to the world that he was a practicing good Muslim prostrating himself in private communion with God five times a day. The repeated touching of the forehead to the ground, when done with enough vigor to emphasize devoutness and seriousness of intent, especially when the supplicant’s head is particularly heavy or dropped down with abandon, confirms the prescription in the holy Koran of “simahum fi wujuhihim – On their faces are their marks.” And Abd-el-’Athim had all it takes to cultivate a large and angry identifying sign. A neighbor was known to avoid standing next to Abd-el-’Athim at the Friday noon group prayer because the sudden collapsing style of his prostrating himself and the forceful pounding of his forehead on the mosque’s floor would distract this neighbor from his own focused attention on God in heaven. But then, this neighbor had a questionable commitment to the faith as per his family’s reports of his repeated doubts concerning the validity of the promised rewards in the afterlife for keeping on the straight and narrow path in this one. Especially on cold winter mornings when doing his ablutions with cold water in the open yard and after finishing the washing of his genitalia he would be heard talking to himself: “And what if there is no afterlife?” And when tilling one of his fields in the Battouf Valley he always chose to pray at the southeast corner of the field, leading people to speculate that as he prostrated himself on the ground he would nudge the border demarcation stone a few millimeters into the neighbor’s field.

I did a cursory medical examination in search of the source of Abd-el-’Athim’s 41 centigrade fever. It wasn’t hard to decipher; his leg was red, swollen and tender and his wife confirmed that the chronic pus flow from the open wound in it had lessened for the previous week. I touched his leg. He jerked it away and started hallucinating about needing to visit my father to bring that black ointment for his wound. It now dawned on me what residual memories must be swirling in his head. He must have heard his family discussing the need to call me over and remembered a pertinent incident from our shared past.

I explained, more to his wife, son and daughter than to him, that in my judgment he needed to be in a hospital and promised to visit him in a day or two. They must have already thought about that; they wouldn’t hear of it. “Is he that bad off?” they wanted to know. And if so, they preferred that he die at home. Much as I tried they stood their ground and enlisted the man of the house, in his massively incoherent way, to refuse the suggestion. Some of the best tricks of the medical trade that I had learned at Harvard came from its School of Public Health not Medical School. In the face of the family’s intransigence I recalled the words of Dr. Maurice King on the one occasion that he guest-lectured us on international health and the practice of medicine in developing countries based on his experience in Africa: “If you were to go out in the wild and were given the choice of taking a single medication with you, take an ampoule of Penicillin.” Any prescription of a broad-spectrum antibiotic meant waiting until the morning and a trip to the city. I gave Abd-el-’Athim a massive dose of intramuscular Penicillin and requested to see him in six hours at my clinic. I begged him to drink a lot of water, figuring that in his confusion he was no better than a child who may slip into dehydration. With his rough and redundant flaps it was impossible to judge his state of hydration based on skin elasticity.

The old man showed up only the next evening during my regular clinic hours. His wife explained that he had slept through the morning hours. And he ate a hearty lunch of Mjaddara, the local heavy-sinking near-daily stable dish of cooked bulgur wheat, lentils, olive oil and onions, the consumption of which is considered a testament and a supplement to a peasant’s health and vigor. Abd-el-’Athim’s elephantine appetite was legendary in the village. People claimed that in his youth he came home one moonlit night to find the family tin-plated copper dish on the floor next to the hearth with the moonlight from the chimney striking it at an angle. He mistook the light reflection on the empty dish for the scrumptious shine of homemade yogurt, sprinkled a little salt on it and polished off five loaves of his mother’s homemade bread dipped in the imaginary delicacy. Another account I have heard of his voracious appetite speaks of him in his teenage years. Because of his bulk and the absence of any caution, much less fear, in the way he conducted himself in confrontational circumstances, he once was entrusted with the task of guarding a whole neighborhood in the Christian village of Rama. A dispute had erupted between the Nakhlis and the Khuris, the two prominent clans there. The elders from other Galilee villages were alerted, interfered, separated the two warring parties and left one physically fit peacekeeper in charge of each of the two neighborhoods overnight. ‘The Almighty,’ armed with his hefty nabbout –fighting stick-- was put in charge of protecting the Nakhlis should the Khuris think of attacking them. That evening when he dined with his host family and managed to polish off all the prepared food for a dozen people before they had a chance to start, Jamil Nakhli, the respected head of the family, relieved him of his duty with the admonition that “My enemies, the Khuris, can never be crueler to my family than you!”

In my clinic Abd-el-’Athim was clear as a bell; no hallucinations; he remembered none of the previous night’s events. But he knew what black ointment he thought he still needed:
“You were a little child, not older than two years when those mules dragged you and bashed your head against the stone,” he now confirmed my suspicions. There is no doubt that my seemingly vivid recollection of the traumatic event is the result of having heard the story repeated so many times by my parents and others of their generation, and not a true memory. To this day, and right now as I stop typing and press my finger on the bare spot at the vortex of my scalp, it feels as if it gives way a little. Before I became a doctor and had a chance once to see a scan of my head, I had always assumed that a piece of bone was missing there.

It happened on a hot summer afternoon. My father was having a smoke and a sip of black coffee in the shade of the pomegranate tree at the gate to our compound. We, his two youngest children, were playing with age mates in the village square fronted by the entrance to our compound, with my uncle’s diwan on one side of the road and on the other by the wall of the same uncle Salih’s compound. Then there was the cross street and to its far side the huge round stone with a hole in its center that formed the opening to a communal rainwater cistern usually covered by a metal flap. Such hand-sculpted stone was called kharazi –a bead, because of its shape and next to it a stone trough fom which the work animals drank. A run-away team of two mules of my uncle’s came racing from the east with Abd-el-’Athim shouting, cursing, and running after them. Somehow, I became entangled in their reins. I was swept away by the mules that headed straight to that big stone, one on each side of it, and my head slammed against it causing the rope to snap and me to be released. Abd-el-’Athim abandoned his mule chase, grabbed me and brought me to my father who had seen it all happen and was sapped out of his ability to move at all. He was surprised that I was still alive; scooping a handful of coffee grounds, he pressed it against the gash in my scalp till the bleeding stopped. Others gathered at the scene and someone took a knife to his leather belt and scraped away at it to produce some organic powder to apply to the wound as a supplement to the coffee grounds. In the meantime, the team of wild mules was subdued and Abd-el-’Athim was dispatched on the back of one to Nazareth to bring ‘black ointment,’ a medicated petroleum jelly, from the French Nuns Infirmary there. My survival was taken by relatives to be a proof of my hard-headedness, some even claiming that there was a permanent chip in that kharazi stone. Abd-el-’Athim still remembered the beneficial effects of the black ointment that the nuns had given him gratis.

Abd-el-’Athim came to my clinic for his daily penicillin injection for a couple of weeks. I managed to take care of the acute flare-up but the chronic Osteomyelitis persisted. He lived most of his adult life with that running sore in his leg where he had taken a bullet in the 1936 Palestinian peasant uprising against the British Mandate Government and against the creeping implementation of its Balfour Declaration. Partially because of it he had become a veritable living legend in the Arrabeh of my childhood, a role model of peasant simplicity, ingenuity and steadfastness, stretching all such noble qualities beyond reason and the acceptable. He was reputed, for example, as having once trapped a British army commander and made him the laughing stock of the village and his own company: British soldiers at the time often entered Palestinian homes and reeked havoc with the peasants’ stored food items for their families and animals of flour, grain and olive oil. They would spill it all on the house floor in one pile, mix it together, and leave feeling victorious, all as a punishment for the villagers’ presumed sympathies with the revolt. What Abd-el-‘Athim did was to dig a hole in the floor large enough to house a barrel of olive oil which he covered casually with a strawmat of his own handweaving, all before the army entered the house for their ‘peaceful’ exercise of authority. As the officer exited the house drenched with oil, he was cerenaded by a band of children raining stones over his head.

‘Athim was reputed also to have participated in the two seminal Palestinian resistance movements to British Mandate designs, the 1936 revolt and the 1948 war, armed with nothing more than a gun with no bullets and a dozen disabled hand grenades strung around his waist. Damarjan, a Syrian of Armenian descent who was the commander of the Arab Liberation Army (ALA) in Arrabeh in 1948, tried to train Abd-el-’Athim in the use of hand grenades. When Abd-el-’Athim accidentally struck Demarjan with the defunct grenade in the chest, the latter dropped the attempt and went back to his favorite pastime of the war era, that of lying in his hammock in the shade of the cypress trees at Arrabeh’s school that his troops used as their headquarters with a couple of underlings swinging him in the breeze. Till now, this and other shameful such acts as demanding to be fed and commandeering donkeys from farmers are reported by surviving villagers as typical of the fighting skills, the help and the protection offered us by the ragtag ALA, actions spun by Zionist propagandists into “invasion by the armies of seven Arab countries.”

Abd-el-’Athim is remembered more for his daring and sheer physical strength than for his smarts. In his youth, caught stealing olives from the fields of the neighboring village of Dier Hanna, he was imprisoned in a second-story room. He swore to put all of that village’s farming efforts out of commission. At night he escaped by jumping out of a window while a pursuer broke his leg doing the same. On the way home he carried away a total of seven wooden plows from the village, each usually heavy enough for a mule.

Now, the old worrier related to me when and how he took that bullet. His sentimental reminiscing and the circumstantial details were almost as interesting to me as the clinical case:
“I was still young and used to be a loner, just me and my gun in the mountains harassing the British whenever I had a chance. But I spent most of my time at Ein Natif (the natural spring east of Arrabeh that was once copious enough for the entire village. Now Mekorot, the Israeli Water company, had tapped the source and reduced the spring’s flow to a trickle. To add insult to injury, by now the meager source is most likely contaminated by the settlement of Hararit on the hill above it.) You see, those were hard times and I had fashioned my own boots out of raw cowhide. But it kept drying up and getting tight and crinkly around my toes. So I would go to the spring, sit on the edge of the pool and dangle my feet in it for hours on end to soak those boots of mine. Not much of a fighter, believe me. Still one time they got me in the shin. I managed to hobble away and hide in the bushes where I nearly bled to death.”

Abd-el-’Athim’s ineptitude in the arts of war did not diminish his attachment to his old gun. In 1948 when all of Arrabeh’s men had surrendered what few guns they had, he hid his gun, camouflaging it as another stick in the roof of an abandoned shack in his yard. Next to it he stretched out his broad belt, strung with a supply of live bullets. A few months later, in early winter when the refuse from the pressed olives provided plentiful fuel for it, his wife decided to activate her taboun -- the outside oven -- in the abandoned shack. The very first night, when the temperature reached its peak in the shed, Abd-el-’Athim and most of his neighbors were awakened by volleys of live fire. He immediately tried to come up with another camouflage, this time for the disturbing telltale rapid-fire explosions. He reached for his nabbout -- fighting stick -- and started banging with it on an old corrugated iron sheet by the shed. The few neighbors who had slept through the initial disturbance were now awakened. Someone ratted and Abd-el-’Athim had to surrender his weapon and spend several months in jail.

Some ten years later Abd-el-’Athim had another brush with mortality. If he were not much of a fighter, as he himself admitted, he was not much of a farmer either, as his meager annual agricultural crops from his land proved. Like most of his fellow villagers, he owned a modest share of land mostly in our fertile Battouf Valley. He would let his relatives farm it and, on occasion, when not acting the rebel, would serve as a plowman for big landholders in the village like my uncle Saleh. He was a repository of great muscle power but not of much help in managing and directing that resource. When lining up say with a team of reapers in a wheat field, he would volunteer to “tame the field” by running wild with his sickle changing direction at random from one end to the other and then again crosswise. He claimed that this way the field would be terrorized into submission to fellow reapers as they moved in one organized sweep. His style became known by his name, Abd-el-’Athim’s reaping technique. On one such random venture he came across another unexploded mine left in the fields by the British armed forces and tried to examine it with the tip of his sickle. The explosion was heard clear across the valley but, miraculously, his only injury this time was to the area of his genitalia. News of the accidental explosion reached his wife and she ran down the long road wailing and shouting out Abd-el-’Athim’s name. A cynical old man who had been at the scene gave her the most enigmatic and unsettling news, reassuring her with the assertion that “Abd-el-’Athim will be all right. It is only your share in him that has gone missing.” And, in fact, they never brought into the world any more children other than the one boy (my classmate, who began this chapter by interrupting my sleep) and the one girl whom they already had.

Those two children would one day, so late in the game that many people had forgotten and others had never known Abd-el-’Athim or his wife, bring shame to the remaining traces of good memory of their parents. It all started at the turn of the millennium when the Palestinians in the Occupied Territories were cleverly goaded by Sharon of Sabra and Shatella ill repute, on his way to becoming Israel’s prime minister, into launching their second intifada. The inheritance of the late Abd-el-’Athim and his wife had been settled in favor of their boy as is customary in Galilee Arab families, the girl not only accepting the Shari’a-based half share of the property in preference to a civil court option of an equal share to her brother’s but also signing over her half share to him. Each of the two siblings had started a new family, he in Arrabeh and she in a village in the occupied West Bank. Her husband was another Palestinian illegal worker in Israel who crossed the border in search of livelihood. At first it was forbidden for him to stay in Israel overnight and Abd-el-’Athim hid him in his humble abode as another member of the family, Then it became forbidden for Palestinians from the Occupied Territories to enter Israel altogether and the young man sneaked across in the belly of a five-kilometer-long sewer line wading in the liquid refuse of settlers like a rat. On occasion, a group of occupation soldiers would be waiting at the exit and they would force him to wade back in the sewer line to its Palestinian exit. Then his marriage itself became forbidden on this side so as to temper the Palestinians’ animalistic propensity to reproduction. The newly-wed couple had to escape back toٍ his West Bank village.

The siblings’ relations were normal till the sister lost her husband in the violence of the Al-Aqsa Intifada. Her husband dead, she found herself with a slew of kids and no source of livelihood. That is when she reneged on her former traditional decision and asked to be given back her share of her parents’ land. The brother stonewalled and the two became avowed enemies. Then the brother’s kidneys failed and he needed a transplant. I was now brought again into the family’s saga as a physician and as someone whom both parties could possibly trust. The feud between the two had simmered long enough for most relatives to have taken sides and gained the enmity of one sibling or the other based on factual stand or, more often, on rumored pronouncements on the matter. I tried to seek some form of rapprochement between the two, enough to convince the woman, found to be the most appropriate match, to donate one of her kidneys to her sick brother. I spoke to the man about his sister’s need and dire circumstances and expressed my own conviction that she may have been unfairly pressured by next of kin to sign away her due share to him.
“Whoever heard of a man giving up his father’s land to a stranger? She was married to an outsider, not a relative. And her children are likely to sell the land to the government or to the Jewish Agency. Whoever heard of girls inheriting in Arrabeh? I ask you: Have you ever heard of a farmer agreeing to the sale of his father’s land to strangers, man? Here in Arrabeh, just last year, our neighbor killed his cousin over a disputed border between them. How can I give away my father’s land? It would disgrace his good name and memory as a pious farmer who lived and died by the dctates of his religion and local tradition”
She, in turn, stood her ground: “I never knew what I was signing. Besides, he has proven to be a stranger to me. He is no longer my brother. In fact he is so ugly that he could not have been the true seed of Abd-el-’Athim; he is a bastard. We are so different that my parts could never fit his body regardless what the doctors’ tests show.”

Regardless of his sister’s opinion, in the eyes of most villagers, Abd-el-’Athim’s son was no monster. He simply was acting in the best tradition of Galilee native farmers: To them land was not for sale or trade, not even for a promise of a new hold on life. I remember him making fun of his old man when we were in sixth grade and he reached the height to hold down the wooden plow and be trained in the honorable task of tilling the land:
“My old man drives me crazy. I make it all the way across the patch next to the house until our work team of ox and donkey pulling the plow are half way inside the cactus hedge and he still insists ‘a little further; keep going; a little more!’ Only when the animals refuse to go any further does he permit me to pull up the plow and turn around. And then he gives me the hoe and asks me to turn over the last bits by hand. You would think it is going to grow gold, that land, and not fava beans.”

Little of Abd-el-’Athim’s legendary tales was openly mentioned in my clinic as he came for his daily injections, though it all hung in the atmosphere like a pleasant familiar scent. On the last day, when he offered to make the extra payment for the initial house call, I refused to accept, considering it not only a justified step in the line of my professional duty but also a neighborly visit for the sake of the good old days. Abd-el-’Athim thereupon waxed poetic quoting from the Koran and sayings of the prophet and from the traditional elders of the faith. “They didn’t name you Hatim for nothing,” he ended, referring to the legendary pre-Islamic Christian Arab legendary model of generosity and good deeds with whom no Arab fails to identify the name. “I hope you don’t mind me saying it, but regardless of how hard you try, you will never be more of a friend to me than was your late father. As you know, people in Arrabeh consider me another simpleton who is happy to live from his land and do his required prayers. But your father never gave me that feeling; he always treated me as his equal.”
I don’t know if it worked, but I tried to give him that same feeling through the proper use of local parlance. I said that the course of treatment was now over. Then, to bridge the age gap between us, I added a differential parting endearment, a jovial pat of my hand on his shoulder just as I imagined my father would have done:
“Fargini a’rd ktafak –Show me the width of your shoulders!” I used the lighthearted colloquial way of saying ‘You can leave now.’

Abd-el-’Athim, my classmate’s venerable father, seemed pleased.

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