southern-status-anxiety-by-adrian-blevins.html Storyscape Journal - Issue 20 - The Hand by Zekana Shuff
The Hand
Zekana Shuff

Navy Captain and medical doctor Ed Blassingham was six months into a year tour as the commanding officer of the Honduran mission that was both humanitarian and military. He did not have to go. He wanted to go. He had muscled his way into it, in fact, after two years of commanding a combat support hospital in Camp Arijifan in Kuwait City. He told himself he needed to help people outside a war situation, to see it all and feel it all and know what was out there, to show people what a caring man was really like.

The base was a few hours from the Mosquito Coast and several rural villages of the Honduran interior. Most days, US Army Black Hawks and Chinooks would take him and his unit to various villages where they would provide medical care, safe water systems, satellite links, and also, incidentally, reconnaissance of the Nicaraguan border.

Each evening, the unit would return by air to the base where at the cantina they would gather and clap each other on the shoulders and share beers. “Where are the men?” Captain Blassingham once asked the local marines who accompanied them on their missions to translate and protect. “In these villages. It’s women and children. Old men sometimes.”

One Honduran marine said, “United States. Working for money. Remesa.”

“Narcos,” said a different marine, and sipped his beer. He glanced at the medic. “Your bag. Do you keep narcos in?”

“Yeah,” said the medic, “and I’m saving them for myself in case something drastic happens to me in the field.”

“— or me,” said the Captain and grinned his boyish smile. “Shit.”

The unit arrived in the village of Patuca which lay next to the widest point of the Patuca River. The locals called it “The River of Souls” because a steady threat of stingrays, piranhas, bacterial infections, or parasites thrived beneath the water’s seemingly placid surface.

While the seamen set up their makeshift medical tent, a square-faced Patucan villager named Pascal demonstrated the pride of the village to the doctor. It was a yuca root slicer. Yucas were a staple food for the Honduran poor. Yuca stew, mashed yuca, yuca rolls and crispy yuca croquettes. This starchy root was low on flavor and full of zero nutritional punch. But it filled stomachs.

Pascal had rigged the slicing machine together from sundry parts they’d collected over the years, including a large hubcap and a hand crank fashioned out of an old Big Wheel pedal that turned the flywheel. Each tuberous vegetable sluiced through the throat of the machine and spouted out the other side as usable chunks or circles. The creaky racket of the gears was muted by the sucking juicy sound the fruit made as it went through. “Swup, swup, swup.”

The Captain watched as a teenage girl placed yucas into the hopper from a basket, one by one so as not to bruise the root by careless mass pouring. The square bib of the girl’s spotless dress was sun yellow, and her blouse looked as white as if they had modern appliances and bleach instead of just the river. As the girl’s arm transferred the fruit, it moved as fluidly as a sash in a breeze until the machine jammed, “sw, sw, sw.” A yuca was stuck, and she pushed that one through with her hand.

“It’s ready,” said the ranking seaman to the Captain.

The Captain smacked his hands together and said, “All set.”

Then, as the head seamen reassembled his men to work on a large-scale water purification system with a pump, the villagers lined up at the makeshift medical tent. “Ah,” said a boy when matched with lenses that happened to be set in bright purple women’s frames. He ran to join his friends, kicking a deflated soccer ball in a dirt field. The Captain watched as the boy clenched his hand in a fist when he kicked a hard shot and then pushed up his new glasses with his middle finger as reflexively as if he’d done it all his life.

It was at the end of the day when the Captain told an aged Honduran, “Open your mouth.” The man’s spine was staggeringly curved, and he stood on one leg due to an old fracture that healed in a perpendicular position. When the man opened his mouth, the doctor doubled over at the odor. “Get these teeth out,” he said but, before he could see the next patient, a breathless medic ran into the tent.

“Captain,” he said. “We need you.”

The Captain hurried behind him to where the girl he remembered from the yuca machine lay folded over her arm. Her teeth chattered, and she intermittently heaved. Blood spewed from her wrist and soaked into the bright yellow of her dress, creating a growing blotch of red across her chest. “Ayudarla! Ayudarla!” screamed her mother and looked at the Captain with wicked eyes. She flailed her hands and shot out Spanish phrases — loud, rapid, distinct. Unintelligible to the Captain other than the girl’s name, “Felina.”

“Crush injury,” said the medic. “With the machine.”

The girl’s hand hung from her wrist like a pocketbook, connected only by strings of sinew and vessel and nerve. The Captain and the medic worked quickly to place a tourniquet.

The Captain knew what he had to do to save her, but had no idea how he would muddle through the actual procedure. He’d done trauma rotations during his medical training, but he was an allergy doctor back home. Cut and sew, he told himself, cut and sew.

“What do we have that is sharp?” said the Captain.

“Only the 7-blade scalpel in my bag. Nothing that would cut through this.”

“The blade on the yuca machine?” said the Captain. “How sharp? How big?”

“Big and sharp,” said the medic, “But connected to the machine.”

“Unconnect it,” said the Captain.

“That could take hours,” said the medic. “And we don’t have many tools.”

The villagers and the unit had gathered around. “Sir,” said the Black Hawk pilot, “It’s getting time. We have orders to go tomorrow, sir,” he said, “Our orders are to fly from base camp to Puerto Lempira.”

The medic stood in a circle with their Honduran colleagues and Pascal. After their conversation, the medic pulled the Captain aside. He quietly whispered, “Sir, they need that machine. To eat. For food. Every day. If we break it, well —”

“Well so you’re saying it’s all the villagers or the girl,” said the Captain. He nodded his head in agreement with the medic, and then, he said loud enough for all within earshot, “If she does not get this hand off, she will die. Even if the bleeding stops, it will get infected, and she will die.”

“Sir,” said the pilot, “With all due respect, sir, people die here every day.” The nurse looked over from where she was trying to calm the mother, who was still wailing. She stroked the woman’s head.

“Not in front of Americans in uniform,” the Captain told the pilot. “We are doing this for us as much as for them,” he said. “You leave and return for me tomorrow. I will work tonight. I will be here in the morning, CWO.”

“Sir,” the pilot said, “we are not 9-1-1 to the world.”

“While you are here, on this mission, with me, Navy or Army, we are United States military. I am your commanding officer. You take your orders from me.”

The pilots left behind what water was left in their aircraft and a spotlight. Soon the Captain heard the Black Hawk fly out. The nurse and medic stayed with him.

Pascal protested the disassembly of the machine until he was pulled away. The medic wrestled with the slicer but could not get the blade loose.

The mother mumbled softly now because they’d sedated her. The klink of metal against metal grew louder. The girl lay catatonic on a stretcher, her cheek in a pool of her vomit.

The Captain applied pressure to the wound until he said, “Trade me,” and switched jobs with the medic until, miraculously, the blade broke off with a pop. “Shit,” he yelled and jerked his arm back. It had nicked his hand. He used his Swiss army knife to flick off odd shapes of gunk from the blade, nasty and teeming as petri dishes, and filed the metal edge smooth of rust with an oil stone until it shone.

The girl had been drugged — at least they’d had enough supplies for that. He had lidocaine that he injected into nerves along each side of the arm to numb it. But back in the States, he knew, she’d have already been typed and crossed and received two units by now. She would also be in the able hands of a surgeon. Here, the best she had was him, a guy who once saw an amputation performed in med school from the second row behind the operating table, looking over the shoulder of a senior medical trainee who retracted and cut when instructed. The hand surgeon had moved comfortably about the OR, his own hands whipping through the procedure. A few mere blood spatters dotted his surgeon’s robe. Above and below him, the venue was antiseptic and completely controlled, the patient’s body a long anonymous bulge under the sterile dressing. Afterwards, when Blassingham found himself breaking scrub alongside the doctor, he said, “You made that amputation look so easy.”

The surgeon removed his sterile gown in one smooth peel, the latex gloves popped off with a snap. “That was easy,” the surgeon said. “That’s the easiest thing I do.”

It was then that Ed Blassingham decided he did not want to be a surgeon.

Cut and sew, he now told himself, cut and sew.

The nurse held the girl, Felina, down while the Captain used the blade of the yuca cutter to saw through bone, nerve, tendon, and other strings of flesh. “Move the light,” said the Captain indicating with his eyes for the medic to shine the light higher on the forearm as he worked. Once the hand was off, he ligated to prevent bleeding, then dissected up the arm to cut back the bone to be shorter than the skin. He needed enough loose flesh to form a flap over the edges of the arm bones. If he had to stretch it, it wouldn’t heal. The humid night was in the mid- nineties. A rivulet of sweat seared his eye. He blinked at the sting, but he was getting dry. It was hard to make tears. The nurse lifted a cloth and said, “May I?” as she wiped his forehead.

He hoped he was doing it right. He sewed up the slack skin at the tip of the arm.

When he finished, he left a container of antibiotics for the mother and instructed her to give them three times daily to the girl. He held up three fingers and popped his hand to his mouth as if taking a pill.

Between them on the ground sprawled the hand. Red-tinged whitish bone and sinews spilled gloomily out from a lifeless pocket of skin and meat. He scooped it into a medical rag which he folded into a neat square. Using the light and some kitchen utensils, he dug a hole in the packed clay earth behind the shanty and buried it, smoothing the dirt back over top it with his boot.

Back inside, he noticed the medic, pale and haggard. His eyes weren’t focused, and the Captain checked his pulse and his blood pressure. “You’re dehydrated,” he said to the medic, and he started an IV and gave him one of the two last bags of fluid from their supplies. He cut a hole in the other one with his Army knife and gave it to the nurse to drink.

She choked up between briny swills. Halfway through, she held out the bag and said, “Drink?” Hot and sweat-soaked, a strand of her hair stuck to her forehead and hung down over her eye, fluttering each time that she blinked.

“No thanks,” he said, and brushed the hair away from her eye with his filthy hand. When she had finished the drink, he said, “You’re pretty good at that. In there.”

“I’m an O-R nurse back home.”

“You could’ve helped with the surgery. Shit. You could’ve done it.”

“You did a good job,” she said.

Finally, it was time for him to rest. The Captain leaned upright against the wall of the shanty home and tried to get some sleep in the eerie, unelectric Honduran night. He kept an ear out for the sound of the Black Hawk. They will return, he assured himself.

He had barely dozed off when the rotor wash shook them awake. On the flight, the Captain slept and dreamed of a great big glass of sweet tea, with ice, and of one with water and Gatorade and Tang after that — all of these with drippy squeezes of lemon.

The first thing he did at the base camp was drink more water. Then he showered, ate at the dining hall and drank more. That night, he skipped the cantina and went to bed early. The next days were filled with muddy river towns to the Mosquito Coast, same as most days before. Vitamins, infections, snake bites, teeth extractions, and finally the Captain returned to normal, relieved of the heaviness he had felt after the amputation.

The seamen needed to complete Patuca’s water system, and so, six months later, the mission returned.

At the cantina, the Captain asked a local about the girl with the hand injury.

“Mano?” he said.

“Eh?” said the local. One of the Honduran marines overheard and stepped in to help. He had a quick conversation with the local, and the local looked at the doctor and said, “Ah, amputada.”

They walked past the offender, the yuca machine. Its parts fanned out on a table like a poker hand. A young man used the blade manually.

“Pascal?” Captain Blassingham asked, but the young man’s oblong face went wan and his lips parted. He shook his head and looked back to Pascal’s homemade machine.

The blade, still shiny from the oil stone, gleamed in the sun. Blassingham had to look away. “It’s hot,” he said.

The local knocked on the door of a hut, spoke some Spanish and entered after someone from inside said, “Vale.”

The mother looked different, her face in repose compared to its fervor before, and focused intensely at her task of sweeping the dirt floor. A pot over her wood-burning stove bubbled. She transferred the water from the metal pot into a cistern. She wiped her hands on her apron. When she faced the Captain and smiled, he recognized the dark wicked eyes but noticed something new about her, something he had not seen or noticed before. She had large, beautiful teeth, shiny white and lined up as uniformly as soldiers at attention, their luster rare and out of place.

The mother said something in Spanish to the Captain.

The marine translated, “She thanks you, important American Captain,” and made quotes with his hands.

“Where’s Felina?” the Captain said.

The marine covered his mouth with his finger and shook his head, no, as if to say, don’t ask.

“Pascal?” the Captain said, and the marine returned the question with the same gesture and said, “Sir, they, have their ways of dealing with things here.”

The one-room shanty was furnished with straw mattresses on the dirt floor, with one chair behind a small round table sufficient enough to hold one place setting, about the size of a TV tray in the Captain’s home. The mother pulled out the chair and pointed for the Captain to sit. He did so rigidly with his palms flat on his thighs, back as erect as a flagpole. She crushed some coffee beans with a pestle and placed them in a strainer, poured water from the cistern into an aluminum cup and steeped the coffee in it.

She placed the cup in front of him and stood staring at him. When he didn’t drink, she nodded proudly for him to.

The marine said, “It’s —”

“I know,” said the Captain, and he took small sips from the meager cup in order to show appreciation for her gesture. On a shelf in the kitchen, he saw the full container of antimicrobial pills he had given her. As he left, the girl’s mother stood at the door of her hut, her eyebrows lifted; her lips pressed together, telling nothing. She placed her hand flat on her sternum. Was it, of all things, a gesture of gratitude because he had helped? He couldn’t guess.

On their way back to the copter, they passed a group of children. They kicked the deflated ball back and forth. A giggling girl caught the Captain’s eye as she played, completely off guard. She wore a yellow bibbed dress, a faded blood stain crossing its front and side. She never looked away from her game. She had two legs and two arms. Two hands. It was not Felina.

When the kids noticed the Americans passing, one held the ball. They craned their heads to watch as the Americans made their way to the Black Hawk.

Mission complete.

“The slicer,” the Captain said to the nurse, “Did you see the pieces of the slicing machine?”

“You were saving a life,” said the nurse. “To hell with the slicer.”

“Mission over,” then she displayed her paper orders. “I leave tomorrow,” she said. “You?”

“Same,” he said.

She stepped back, held her hand in a salute and said, “Sir, it has been a pleasure.”

He returned the salute and said, “Shit,” then broke salute. “Likewise.”

For now he was going home. And the villagers stood to watch the copter depart, the thatched roofs flapping up from the rotor wind.

“Look,” said the nurse, nodding, and pointed to where Felina’s mother stood among them, staring, the same way as she had back at her hut, her eyes as dark as ever, one hand in a loose fist at her thigh, the other flush over her chest bone.

Zekana Shuff has an M.D. & an M.F.A. She has been lucky enough in her life and work to have acquired friends like Navy Captain Dr. Jack Edward Riggs (whose essay, “This Little Girl Dies Today” appeared in the Annals of Internal Medicine) and nurse Donna Potter (a Presbyterian minister’s daughter who spent her teenage years in South America where her father was a missionary) who helped bring this piece to life by helping the author to understand the ways, the people, and the imagery of the locale. The author works as a physician and lives in beautiful West Virginia with her husband (a plastic & hand surgeon), their two kids, their dog, and their cat. Her poetry, fiction, and non-fiction have appeared in literary journals in print and online.