Where There Is No Doctor

My friend Kris and I play a game. It’s called “Should I eat it?” and it’s not complicated. When, in our endless desperate American quest to feed ourselves after an eleven-hour workday, we encounter food of questionable freshness in the fridge, we text each other and ask, “Should I eat it?” Actually it’s not so much a game as it is a running joke, because the answer, from both of us, is always “Yes.”

On the rare occasion in which the situation is really up for grabs, we’ll attach a picture or provide a detailed description. “The bacon is expired by a few days. It smells fine,” I say. “But it’s a little slimy. The internet says don’t eat slimy bacon.” I feel stupid typing that. Because it’s, um, bacon. Cured. It barely requires refrigeration to begin with. And the internet is overly cautious when it comes to expired food. But the slime gives her pause. “Hmmm.”

Then we reminisce about some of the things we’ve eaten. The street meat, which we always chose to identify as goat, purchased from a rotisserie located right next to an open sewer. The strips of raw beef we bought from market stalls, hanging in the sun, covered in flies, shimmering fluorescent green with the foreshadowing of rot. We both believe if you cook pretty much anything long enough it will be safe to eat. So her answer is, eventually, “Yes.” And I cook the bacon, a little crispier than I normally would, and eat it. And I’m fine. Just fine.

Kris and I were Peace Corps volunteers in Chad, in central Africa, in the early nineties. We should never have been there, it was a failed state, wildly unsafe, I heard machine guns and artillery fire on the regular the entire two and a half years I was there. But the real threat wasn’t violence, it was hunger and disease. According to the World Health Organization, fifty-eight percent of the Chadian population was suffering from malnutrition at the time. That statistic is obviously bad, but the on-the-ground view of it, of the impact it had on things like infant and child mortality; well, I still think about it almost every day.

When we entered our service we were given a book called Where There Is No Doctor. The title is self-explanatory. It was filled with instructions for how to manage a series of medical crises in the absence of help from any actual medical professionals — possibly even in the absence of any other humans. It provided diagrams showing you how to splint your own broken leg, for example. More relevant to our day-to-day, the book also contained the details necessary to self-diagnose a number of gastro-intestinal complaints — how to make crucial distinctions that would define the urgency of your treatment. If your shit is yellow and smells of sulfur, you’ve got giardia. If it’s black and tarry, you’ve got amoebas — the discoloration is the dried blood from your ravaged intestines. You have to address those situations, obviously, but no need to be really concerned, to alert Peace Corps through the two-way radio at the Catholic Mission in the neighboring town, unless you have dysentery — defined during training as diarrhea six or more times a day, that will not abate. That was rare. The only other exception, the time to hit the panic button, is if your shit looks like rice. If it looks like rice, you have cholera, and you are well and truly fucked.

Cholera is easily treated, actually. It’s vanquished by tetracycline, which I thought of as an acne drug until I got to Chad. The problem with cholera is that the evacuation of fluids from your body is so rapid and severe that it will send you into organ failure. Untreated, it kills at least half the people who get it. During our health training in Chad, we were told that if we had shit that looked like rice, we were to hydrate constantly. That if we vomited we were to drink (boiled, clean) water immediately after. That every minute, possibly even while we were shitting, we should be drinking water. That no matter how acute our suffering, no matter how desperately we wanted to stop taking in fluid, to stop the ingress in order to stop the egress, we should never pause drinking water as long as we were conscious. It was the only way.

I’m telling you all this by way of explaining that I’m well-educated and terrifically blasé about diarrhea. It’s hard to alarm me, so hard that I didn’t react even when I got it during the coronavirus lockdown. I was just puzzled. As a matter of routine I analyze the color, texture, and odor of my shit. This time it has a high, sweet smell, a fruity top note; something I encountered both in Chad and here at home. And so I know, for certain, that whatever I have now I’ve had before, many times, and thus it isn’t Covid-19. I’m not sure what it is, though. It’s nothing like giardia, which is so foul-smelling it refuses to be misdiagnosed. There’s no bloody tar from amoebas, and obviously it’s not cholera. Since the internet is worthless in this situation, and never gives me the kind of useful information I got from Where There Is No Doctor, I don’t waste time googling my symptoms. I do, in a moment of anxiety, google Covid-19 testing sites, but after about twenty minutes of fear I get it together, decide not to waste my time or the state’s money. It’s not that.

So, I wait. And I work. At some point along the way, during my re-entry from Chad back into American life, I mistranslate what it means to have dysentery. I no longer interpret it as the trigger to seek urgent medical care, but as the threshold for calling off work. Since I never reach that threshold — I have diarrhea, but not more than six times a day — I never take time off, even though I feel like hell.

I’m fortunate enough to be able to work from home during lockdown, inhabiting my Zoom meetings for hours a day, and one afternoon I almost pass out — from fever, from physical weakness, from stupidity. When it happens, I tell my co-workers that if I go down, drop out of view of the camera, they should call our colleague Casey, who’s not in this meeting. Casey and I have mutual friends outside of work, I say, he’ll know who to call to come get my dog. I’m joking, sort of, also I’m not. They laugh uncomfortably. I mention it to Casey later and he gives me a look. “You know, if you go down, the number I’ll call is 911.”

So I alarm and annoy my coworkers until my illness passes, and eventually I get a call from Wegmans. It was the peaches. I used my loyalty card so they know to call me and tell me I bought peaches contaminated with salmonella. Obviously, I didn’t wash or peel them well enough to make them safe. And of course, I hadn’t cooked them.

Tom, who lives next door to me, works at Wegmans. He’s a night manager, oversees re-stocking the shelves, a whole new challenge in the time of Covid-19. He’s a good, old-fashioned neighbor, and he looks out for me. He knows I missed the rush on hand-sanitizer and bleach wipes early in the pandemic, and as the weeks progress and the supply chain fitfully comes back online, he ferries me the things I need, as soon as he can, before they can be sold out. He does it for all of us, filling in gaps for all of his neighbors, and though he’s mentioned Fox News to me a couple of times, I can’t help but notice he doesn’t discriminate when it comes to helping out. He shares his resources and his time with all of us, white and black.

Tom seems very center, belonging neither to the MAGA right nor a woo-woo fragment of the left, so I’m surprised when he tells me he’ll refuse a vaccine for Covid-19 when it becomes available. We’re having a socially-distant conversation, from one porch to another, when he says he won’t do it. I dissociate immediately — I feel anger before the conversation even really begins, and later I remember the whole thing as if I’m floating near the roof, looking down at the two of us. But I manage to feign calm.

“Why not?” I ask.

It’s not proven, it’s an experiment, they don’t know, they’re rushing it. He has many excuses, and they all lead up to “And you know, vaccines give kids that disease…”

I say nothing, stare blankly.

“You know…I can’t think of the name of it.”

I still stare.

“What is it?” he asks.

I know perfectly well he’s trying to think of the word “autism.” But I refuse to supply it. I won’t provide the word for the thing children won’t get if we all get a coronavirus vaccine.

“No idea,” I say. “I’m getting the vaccine.”

“Not me.”

I lose my temper then. I say, I lived in a country with no vaccines, where measles killed children every day, killed a sweet little boy I knew, actually, a boy I lived with. I say I lived in a country where the survivors of polio dragged themselves around on their hands, made wheelchairs out of salvaged bicycle wheels, begged me for money.

I say Americans are ungrateful. I say I’m getting the vaccine.

I don’t say that even if the bullshit he is spouting was true, I’d rather be autistic than dead. That there’s no comparison, that being on the autism spectrum beats death, hands down. That I have friends on the spectrum and they have great lives, what the fuck are you trying to imply? I don’t say any of it, because I’m still refusing to say “autism.” I don’t want to give any oxygen to the lie.

He’s staring at me in surprise. I feel like a card sharp, like the hand I just played wasn’t drawn from the same deck as his. He can’t possibly win when I’ve made this about polio and dead babies. But then, why should he? Those things are real.

To my surprise, my good old-fashioned neighbor holds no grudge. After that argument, he continues to look out for me. He’s a great cook and all summer long he grills, and he offers me short ribs and barbecued pork loin, and he’s generous and kind. For his own sake, when the time comes, I just want him to get the vaccine.

In August, a derecho hits the state of Iowa. Wind speeds in the range of a hundred to a hundred-and-thirty miles-per-hour. The next day, I get a text from Kris.

“Should I eat it?”

“Yes,” I reply.

She doesn’t elaborate and about an hour later, I have to prompt.

“Should you eat what?”

“Everything in my freezer and fridge. Power’s out.”

The damage is surreal, millions of acres of crops destroyed, hundreds of thousands without power. Kris’s home and family are safe, and her power comes back on quickly, she says she feels lucky. But traumatized. It’s one more thing on top of the raging plague.

Lucky. But traumatized. It’s how I felt when I returned from Chad. It’s how I feel now, too, though I’ve been trying to deny it. I’m a born hermit, in this six-months-of-isolation-and-counting I’ve only really wanted to leave my house a handful of times. Not only can I make a living from a laptop, I’ve been given an inarguable, life-or-death excuse for turning down every social invitation that comes my way. And I’m learning. I’ve learned that eliminating my commute hasn’t changed my life as much as I always thought it would; my house is still a mess. I’ve learned that a fruity top note on the odor of my shit means salmonella. I’ve learned that apparently I have mild food poisoning often enough — that sweet smell is so familiar — that I might be applying the rules of my game with Kris a little too enthusiastically.

When people ask me how I am, these are the things I say, and they’re true.

What I’m not saying is that I am wounded, I am so hurt, by what’s happening in my country. And it’s not a mortal wound, but it will never, ever heal. As I write this, the coronavirus death toll here is nearing two-hundred-thousand. It’s expected to reach four-hundred-thousand in December. The worst in the world. And I’m pointing the finger at Trump, of course I am, his failure of leadership is so grand, so fantastic, it’s the one way in which he really has outstripped all previous U.S. Presidents. But it’s not just him, it’s the rest of us too.

I went to the McDonald’s drive-thru today. All the workers were wearing masks; they’re required to. But none of the drivers I saw pull up to the window bothered to put one on. Almost as if they think their lives are more important than the life of someone working in a drive thru. I’m feeling jagged and five hours later I’m still fantasizing about jumping out of my car and walking thru the line banging on windshields and yelling at people to PUT ON A FUCKING MASK, because otherwise you might kill a McDonald’s employee. Or make someone who doesn’t have health insurance or paid time off very, very sick. This is not hard. This should not be so hard. We should be better than this.

When I lived in Chad I was at some personal risk, but really, I was a voyeur. I had a plane ticket in my back pocket, I could always come home. I knew even then that my country wasn’t perfect. But I also knew, I thought I would always know, I was smug in my conviction, that here, home, the United States, was safer and forever would be. We have clean water, we have antibiotics and a cold chain. We have hospitals and the internet, we don’t need books like Where There Is No Doctor. Jonas Salk was an American.

Just now, in my house, writing this essay, I try Combat Breathing. I want my blood pressure to drop. It’s one thing to be alone all the time and calm, quite another to be alone all the time and enraged. I count to four as I inhale; as I hold my breath; as I exhale. I visualize the numbers. I remind myself that at the end of August, the continent of Africa was declared free of the wild polio virus. The United States is not the yardstick for human progress. My lifetime is not a yardstick for human progress. I have to take a longer view, look at history as though I’m not in it. Consider how long it’s taken to subdue polio; consider that six months of coronavirus is nothing. Consider the whole world.

We are moving forward. We are.