By the time I was finished it was dark outside. Iganga asked, “Do you want to look in on Ann’s last operation?” Ann Collins was the Irish volunteer I was replacing.
“Definitely.” I’d watched a few operations performed here, on video back in Sydney, but no VR scenarios had been available for proper “hands on” rehearsals, and Collins would only be around to supervise me for a few more days. It was a painful irony: foreign surgeons were always going to be inexperienced, but no one else had so much time on their hands. Ugandan medical students had to pay a small fortune in fees — the World Bank had put an end to the new government’s brief flirtation with state-subsidised training — and it looked like there’d be a shortage of qualified specialists for at least another decade.
We donned masks and gowns. The operating theatre was like everything else, clean but outdated. Iganga introduced me to Collins, the anaesthetist Eriya Okwera, and the trainee surgeon Balaki Masika.
The patient, a middle-aged man, was covered in orange Betadine-soaked surgical drapes, arranged around a long abdominal incision. I stood beside Collins and watched, entranced. Growing within the muscular wall of the small intestine was a grey mass the size of my fist, distending the peritoneum, the organ’s translucent “skin,” almost to bursting point. It would certainly have been blocking the passage of food; the patient must have been on liquids for months.
The tumour was very loose, almost like a giant discoloured blood clot; the hardest thing would be to avoid dislodging any cancerous cells in the process of removing it, sending them back into circulation to seed another tumour. Before making a single cut in the intestinal wall, Collins used a laser to cauterise all the blood vessels around the growth, and she didn’t lay a finger on the tumour itself at any time. Once it was free, she lifted it away with clamps attached to the surrounding tissue, as fastidiously as if she was removing a leaky bag full of some fatal poison. Maybe other tumours were already growing unseen in other parts of the body, but doing the best possible job, here and now, might still add three or four years to this man’s life.
Masika began stitching the severed ends of the intestine together. Collins led me aside and showed me the patient’s X-rays on a light-box. “This is the site of origin.” There was a cavity clearly visible in the right lung, about half the size of the tumour she’d just removed. Ordinary cancers grew in a single location first, and then a few mutant cells in the primary tumour escaped to seed growths in the rest of the body. With Yeyuka, there were no “primary tumours”; the virus itself uprooted the cells it infected, breaking down the normal molecular adhesives that kept them in place, until the infected organ seemed to be melting away. That was the origin of the name: yeyuka, to melt. Once set loose into the bloodstream, many of the cells died of natural causes, but a few ended up lodged in small capillaries — physically trapped, despite their lack of stickiness — where they could remain undisturbed long enough to grow into sizable tumours.
After the operation, I was invited out to a welcoming dinner in a restaurant down in the city. The place specialised in Italian food, which was apparently hugely popular, at least in Kampala. Iganga, Collins and Okwera, old colleagues by now, unwound noisily; Okwera, a solid man in his forties, grew mildly but volubly intoxicated and told medical horror stories from his time in the army. Masika, the trainee surgeon, was very softly spoken and reserved. I was something of a zombie from jet lag myself, and didn’t contribute much to the conversation, but the warm reception put me at ease.
I still felt like an impostor, here only because I hadn’t had the courage to back out, but no one was going to interrogate me about my motives. No one cared. It wouldn’t make the slightest difference whether I’d volunteered out of genuine compassion, or just a kind of moral insecurity brought on by fears of obsolescence. Either way, I’d brought a pair of hands and enough general surgical experience to be useful. If you’d ever had to be a saint to heal someone, medicine would have been doomed from the start.
I was nervous as I cut into my first Yeyuka patient, but by the end of the operation, with a growth the size of an orange successfully removed from the right lung, I felt much more confident. Later the same day, I was introduced to some of the hospital’s permanent surgical staff — a reminder that even when Collins left, I’d hardly be working in isolation. I fell asleep on the second night exhausted, but reassured. I could do this, it wasn’t beyond me. I hadn’t set myself an impossible task.
I drank too much at the farewell dinner for Collins, but the HealthGuard magicked the effects away. My first day solo was anticlimactic; everything went smoothly, and Okwera, with no high-tech hangover cure, was unusually subdued, while Masika was as quietly attentive as ever.
Six days a week, the world shrank to my room, the campus, the ward, the operating theatre. I ate in the guest house, and usually fell asleep an hour or two after the evening meal; with the sun diving straight below the horizon, by eight o’clock it felt like midnight. I tried to call Lisa every night, though I often finished in the theatre too late to catch her before she left for work, and I hated leaving messages, or talking to her while she was driving.
Okwera and his wife invited me to lunch the first Sunday, Masika and his girlfriend the next. Both couples were genuinely hospitable, but I felt like I was intruding on their one day together. The third Sunday, I met up with Iganga in a restaurant, then we wandered through the city on an impromptu tour.
There were some beautiful buildings in Kampala, many of them clearly war-scarred but lovingly repaired. I tried to relax and take in the sights, but I kept thinking of the routine — six operations, six days a week — stretching out ahead of me until the end of my stay. When I mentioned this to Iganga, she laughed. “All right. You want something more than assembly-line work? I’ll line up a trip to Mubende for you. They have patients there who are too sick to be moved. Multiple tumours, all nearly terminal.”
“Okay.” Me and my big mouth; I knew I hadn’t been seeing the worst cases, but I hadn’t given much thought to where they all were.
We were standing outside the Sikh temple, beside a plaque describing Idi Amin’s expulsion of Uganda’s Asian community in 1972. Kampala was dotted with memorials to atrocities — and though Amin’s reign had ended more than forty years ago, it had been a long path back to normality. It seemed unjust beyond belief that even now, in an era of relative political stability, so many lives were being ruined by Yeyuka. No more refugees marching across the countryside, no more forced expulsions — but cells cast adrift could bring just as much suffering.
I asked Iganga, “So why did you go into medicine?”
“Family expectations. It was either that or the law. Medicine seemed less arbitrary; nothing in the body can be overturned by an appeal to the High Court. What about you?”
I said, “I wanted to be in on the revolution. The one that was going to banish all disease.”
“Ah, that one.”
“I picked the wrong job, of course. I should have been a molecular biologist.”
“Or a software engineer.”