The taxi ride to the
Mayor’s office took me through the center of town. The driver at first
performed some sort of monologue. He
spoke in Quechua, and he was probably explaining the region’s history, the
brief unhappy lives of local patriots, the aborted attempts at paving the dirt
road on which we traveled. Probably, too,
he mentioned the unusual size of their orchids, the fun-loving nature of the
giant otter and the distinctive flavor of the passion fruit.
These people, I thought, don’t have too much to brag about.
And there it was:
after only a few minutes my driver fell into a dark silence.
He interrupted it only once for the rest of the trip, to shout curses at
some beggars who’d slowed our snail-like progress through the broken street.
I slouched low in my
seat, eyes shut. Concentrating for a
moment on a convincing argument for my stomach to settle itself, to find
something to do instead of bothering me with all its complaining. I thought of it as a temperamental teenager:
sulking quietly one minute, worked into a screaming rage the next, all
the time wanting to be noticed or left alone, it could never decide which.
played my game. The one where I asked:
if this town were a human being, what disease would it have?
for example, was gray, struggling in the thin air. It had tuberculosis. The new
kind, the kind that eats the lungs in big fast bites like a child spooning up
Paulo had been sick with an indefinite malaise, neurasthenic like an old lady or
the way an infant can be when we say it fails to thrive.
Unemployment was high, drug abuse rampant. The people there went about their business with empty stares and
unconvincing smiles. All of them waiting
for the next bad thing.
Angeles was the worst. Burned, gutted, its downtown empty, the shops and malls mostly
deserted. Alzheimer’s, of course.
An easy diagnosis, especially in those days:
the city was an old man half-dressed, wandering the highway, his
unbarbered yellow-white hair hanging limp around his shoulders.
Waiting for someone to tell him—excuse me mister, you are dead, so
please lie down and act appropriately.
This little town—Pulcapoto
it was called—did not lend itself to a speedy examination.
This was partly because in every respect it was the same as the other
towns I’d already passed through on this trip, and the others, the villages
and settlements I’d seen in other impoverished countries:
a single dirt road, open toilets, laundry hanging from the windows of
one-story shacks fabricated from broken crates and rusted sheet metal.
The superheated air stale and stagnant, filled with eye-stinging brown
haze from a few badly maintained autos, the cooking fires, the piles of burning
eucalyptus and plastic. The bleating of
goats. The endless wailing of hungry
was different from these other towns in one respect only, and this difference
too was in the air. It was over to the north, near the upper jungle where smoke
made a greasy charcoal stain in the gray sky, and its smell was most distinct.
It cut through the town stench, which was after all just the smell of the
what did this town have? I wondered, and then I was thrown against the near door
of the taxi and flung back against the other. The
driver cursed again, swung us across the road and only just avoided a collision
with a scrawny goat and her kid.
I couldn’t come to
a conclusion on the matter. Perhaps what
I needed was a consultation, but that hardly was realistic.
Colleagues were scarce in those parts. Peer
review and grand rounds, they didn’t happen too often.
And also the quality of the professionals left something to be desired. A
year earlier I’d had a chance meeting with a CARE physician, a morphine addict
who spoke in long, slurred sentences and fell asleep at the table before he’d
finished his first beer.
was stumped temporarily, but that was all right, I had great faith in my
diagnostic abilities. One time in medical
school we had a patient, a man with chronic anemia and nosebleeds.
The Chief Resident admitted he knew nothing for certain.
Something tropical, he thought, because this man had once worked in
Haiti. I’d smiled.
A diagnosis can be elusive. The
doctor needs to be open-minded, critical, and diligent like a detective, but in
this case they hadn’t even looked at the patient’s fingernails.
“How long,” I asked him, “have you been picking your nose?”
Chief Resident had been annoyed, but at the end of the day they tossed the
patient on the street because health insurance only covered exotic tropical
diseases and other sexy maladies.
We arrived at our
destination and my stomach settled, thank God. It
had at least ceased its kicking and screaming, apparently having fallen into one
of those deep recuperative sleeps, exhausted from all the energy it had expended
to maintain its anger. It would be angry
again when it awoke, true, but respite was all I sought, a cure being unlikely.
taxi stopped outside the Mayor’s office, a one-story structure of wood and
plaster, and before I could lift my bags, a small, thin fellow scurried out from
the building and shook my hand with great energy.
He introduced himself, I think, and then abruptly let go of my hand,
seized both of my bags and began dragging them back along the dirt toward the
entered the office, and the man—who proved to be the Mayor himself—deposited
my belongings on the floor, then sat down in a leather chair just behind the
desk, beneath a large overhead fan that turned in a slow, sporadic rhythm,
pulsing I suppose in accordance with the uneven supply of electrical power.
Mayor was dressed in long camouflage pants with ragged cuffs, and a faded jacket
missing all of its buttons but one, with a shiny lapel and a hole at each elbow.
I imagined how the jacket might have looked when it first left the
tailor: on the back of a young man
playing third cello in the Berlin Philharmonic. Or
perhaps adorning some fine fellow dancing a waltz with his mistress on the roof
of the Ritz Carlton Hotel in Boston,
Doctor,” the Mayor said. He gestured to
a cane chair on the opposite side of the desk and nodded in encouragement as I
made to sit down. He opened a drawer and
removed a large wooden box.
“I can’t tell
you how excited I am,” he said. “We’ve
been anticipating your arrival for some weeks.”
He opened the box, took out two large cigars.
“Will you have one?” he asked. “These
are the last, until next month.”
you, Mr. Mayor,” I said, and for a short while we smoked, exchanged some
social remarks, and discussed the local wines, about which the Mayor proved
should tell you,” he said, “I’m not exactly a mayor. I was not elected nor was there any sort of formal appointment.
Enverado. More like a
chief.” He grinned and leaned back in
was a handsome man of about fifty. Handsome
for those parts, anyway. His teeth were
remarkably good, straight and white. He
had thick eyebrows and a mustache that was jet black and well-trimmed.
It had been designed, I suspected, to display to best advantage those
I call you ‘Mayor’ just the same?” I asked.
I drew on the cigar. “Or do you
prefer something else?”
is fine,” he said. “I rather like the
sound of it.”
leaned forward, rubbed the tip of my cigar against the rim of the coffee can he’d
placed on his desk. The glowing ember, as I had hoped, caught on the metal edge of the
can, and this allowed the cigar to go out without attracting the attention of my
host, who otherwise would have hastened, I am sure, to light it again.
hadn’t smoked a good cigar in some time. This
one was horribly bad, just abominable. There
was something in the tobacco—rubber, perhaps, or tar—it caught at the back
of my throat and seemed to stick there.
understand you have a medical emergency,” I said. I cleared my throat. “Some
sort of infectious disease, I was told. A high mortality rate.”
The Mayor smiled. “I don’t know about infectious.”
shifted in the cane chair. The calls had
been recorded, I’d listened to them. Severe
bleeding and diarrhea, mucocutaneous lesions. Maybe
Dengue hemorrhagic fever, or cholera, and that was okay—good luck to them.
But maybe the Speckled Monster, and they might have known:
at least one doctor would come, probably a whole team.
what is it, Mr. Mayor?” I asked. “The
worry about that.” He knocked the ash from his cigar. “Let me describe the symptoms, then you decide.”
fine.” I took out my cell phone, placed
it on his desk. “I have to call in
Mayor nodded. “A good policy.”
then the fan above us groaned to a stop, and the air immediately became thick
with smoke from the Mayor’s stinking cigar. He
smiled in apology and waved his hand between us.
“The power is sporadic.” He
held up his cigar. “I can put this out
if you like.”
I balanced my own cigar on the edge of the desk and removed a notebook
from one of my bags. “Let’s talk
about the symptoms.”
Mayor said. “There is a bloating of the
stomach. That’s the first thing.
A loss of appetite. Sleeplessness.” He frowned, looked up at the fan. “After that, vomiting, dizziness. The victim goes into seizures. Death
follows within three days, sometimes four or five.”
there much bleeding?”
I forgot to mention that.”
you have any ideas yourself? What this
no doctor,” the Mayor said. “But we
have newspapers, a medical text. Smallpox,
eh? Like Los Angeles.”
shook my head. “That wasn’t smallpox.”
He smoothed his mustache with his finger.
“The newspaper said smallpox.”
cleared my throat. “What was the age of the victims?”
some were only months old. Others, eight,
where are they? I’ll want to take a look.”
We placed them in a pit a few miles from here.
Covered them over with dirt.”
meant the living ones, Mr. Mayor.”
He puffed away on his cigar, drawing on it until it emitted a thick wave
of smoke. Then he shrugged.
“It was two months ago, wasn’t it? When
we first asked for your help.”
lot of people ask for our help,” I said. And
then the thing in my gut woke up. It did
a kick turn and sent a wave of acid sloshing against the delicate lining of my
you okay?” the Mayor asked.
I rubbed the heels of my hands against my face.
Tried to work the fatigue from my eyes. “I’m not aware of any diseases that present themselves in this
Mayor squinted at me through the smoke. “I’m
I see a great deal of that.” I watched
his face as I spoke. “Influenza,
measles. The symptoms you describe aren’t
consistent with any of those.”
shrugged. “Burning the dead is useless,
that shouldn’t have helped.”
Mayor leaned forward, his face red. “I
should apologize because we have something you don’t recognize?
Maybe not virulent enough?”
at all.” I tried to smile.
“I’m here to help.”
was close to eighty percent, I’d say that’s pretty virulent.”
He picked up something. Some sort
of paper opener, I think. He held it
lengthwise, bending it. “Like nothing I’ve
ever seen,” he said. The paper opener
snapped in half, and he dropped the pieces onto his desk.
“One second.” He ducked his
head and opened the drawer of his desk.
“You should know,”
the Mayor said as he rummaged in his desk, “we’ve been uncooperative with
certain of the Communist factions. Perhaps this is one of those monster strains.
The Russians develop that; maybe they sent it over.”
nodded and made an entry in my notebook. Thirty
percent was virulent—pretty much a show-stopper.
Forget about eighty.
Mayor straightened, held out a photograph in a silver frame and handed it to me.
“My aunt,” he said.
held the picture, saw it was old, cracked. A
portrait of a pretty young girl. “Very
nice,” I said.
he nodded, “very nice,” and just then his tone became terse, impatient.
Whereas a moment before he had been deferential and phony. “She’s got some kind of bug, Doctor,” he said.
“You know, a river bug.”
sorry to hear that.”
Of course you are. That’s why we’re
all so happy to have you.” He reached
over, waggled his fingers and I handed him back the portrait.
“Perhaps you can examine her. That
bug, the book says, is not so bad. Here,
it’s blindness and death. But in the
States, it’s not an issue, is that true?”
depends, I suppose, upon the bug.”
started to say something, ask another question, but I shook my head, grasped the
arms of the cane chair and levered myself into a standing position.
“I don’t feel well, I’m afraid. Is
there a place, someplace where I could be alone for a moment?”
The Mayor dropped
the stub of his cigar into the coffee can and stood, his thick eyebrows raised
high on his forehead in a show of concern. “I’m
so sorry, Doctor, of course. Let me walk
with you.” He led me out of the office,
and for the first time I saw some of the other people who worked there.
They were standing around. Watching.
the Mayor said, pointing. “That’s the
He touched my
shoulder as I started toward the door. He handed me the cell phone. “In
case you want to make a call.”
of his people drove me out to the mass grave. He
stopped almost a quarter of a mile away and said by way of apology that he had a
problem with his lungs.
bad coughing,” he said, and he seized up all at once in a paroxysm of wheezing
and hacking, as if to prove his case.
could have waited for the helicopters.
They’d have had the special suits and decontamination units, but from
what I’d learned, this thing was dormant or had run its course.
People were starving, sure, and there was malaria, measles and whooping
cough. One fifth of their babies would
die before the age of four, and two years earlier gastroenteritis had killed a
third of the village. The Mayor’s man
likely had some sort of fungal infestation in his lungs.
But that wasn’t plague, that was business as usual.
soaked my handkerchief in after-shave and wrapped it around my face, and then I
followed the trail through the jungle. The
grave was a smoking mound of dirt surrounded by barrels of oil and discarded
clothing, and in spite of the circumstances, I found myself smiling.
Burn the bodies and burn the clothes, that was our mantra, and they often
did just fine with the bodies. The
clothes were a problem everywhere, because no one wanted to waste.
circled the mound for a long while. I
poked at the corpses lying beneath their thin cover of soil, using the long
metal pole the Mayor had found for me. I
counted almost a hundred bodies. Mostly
adults, some smaller shapes that I took to be children.
A few others with narrow skulls and sharp teeth.
They were just
bones, all of them. Encased in their
charred skin like one of those trout dishes baked in papyrus.
Even the animals had left the area alone.
I returned to the Jeep, I asked my driver if his family had lost anyone to the
plague, and he said no, he had three kids, all healthy, thank God.
The thing with his lungs though, maybe I could help, he was up all night
with the coughing.
might have something for that,” I told him, and he smiled.
for everything,” he said. He turned the
Jeep around and hummed to himself as he drove us back to town.
family was very lucky,” I said.
He laughed. “I finally save
enough to buy a blender, you know? So my
wife can make baby food. And guess what,
now the power goes out, sometimes a week or more.”
meant about the plague.”
I understand what you meant.” Then he
coughed and coughed, and for a moment I thought he’d drive us right into the
jungle. “I’m with the Rondas Campesinas,” he said when his
coughing finally subsided. The Peasant
nodded as if his comment made sense, but it didn’t, at least not at the time.
helicopters came. We worked for weeks distributing food and treating the sick, and I
never once heard anyone—medic, pilot, frontline staff or senior officer—complain
about how the town of Pulcapoto was not infected with variola major.
We did our interviews, of course, collected tissue samples from the
gravesite and analyzed them as best we could. But
the mysterious disease was never identified.
“I have to leave
now,” I told the Mayor. He looked up
and smiled, and then he came around from his desk and grasped my hand.
you so much, Doctor,” he said. “You
have done many wonderful things here. And
sick yourself the whole time.”
He must have seen it in my face because I’d only just told the Captain
that morning. “I’m sure I’ll be
The Mayor smiled.
“You would be very welcome. My
aunt says you’re special. Not quite a
saint, because your Spanish is so bad.” He
laughed, showing me his bright teeth. “But
I thought your work here was complete?”
complete. Not entirely.”
He took a cigar from the box and lit it. “The
plague.” He drew on the cigar until the
ash glowed. “You’ll figure that out.”
He nodded, clapped me on the shoulder. “I
might help, if I could ask a few more questions.”
wondered about the sound, a humming noise that filled the room.
I looked up. It was the fan, spinning away at high speed, dissipating the
foul-smelling smoke from the Mayor’s cigar.
the dogs?” I asked.
burned the dogs.”
Mayor raised his big eyebrows. “That’s
a medical question. Zoonotics, right?” He puffed on his cigar. “A
theological question, too: why God
chooses to harm dumb animals. And guess
what? I’m neither a priest nor a
doctor.” He smiled.
“Lucky for me.”
walked to the door, and this time he made no attempt to help with my bags.
“Although you should know, Doctor, these weren’t German Shepherds or
Golden Retrievers. More like coyotes.”
He dropped his cigar on the floor and stepped on it.
“Barking, right?” He made his
hands into pincers, opened and closed them: “Barking,
stared at me. “Others?”
were they? Indios?
Shining Path sympathizers?”
Mayor reached into his tuxedo jacket and took out another cigar.
“As I said. The ones God has
chosen.” He lit the cigar and let the
smoke drift out from his mouth. “It’s
true, isn’t it? You had your heart set
on the smallpox.”
wasn’t until the ride back to the helicopter that I thought of my unfinished
game. What disease does this town have?
was a famous case, we studied it in school many years ago, that was called a
factitious disorder: the mother, it was
believed, had injected her little boy with feces. Just to get some attention. His
fever, she’d told the doctors, it scares me when it gets so high.
rather be in Los Angeles,” I said to the driver, and he smiled and pointed out
was a purple orchid, right there by the road. Easily
the biggest I’d ever seen, and very beautiful.
© 2003 John Tisdale