His morning prayer begins before dawn. The young father, his lips effortlessly forming sounds of the words he knows so well, feels the coldness of the earth through the worn strands of his prayer rug and notices how the scent of morning dampness mixes with the dust in his light gray clothing. He covers his face with his hands in the way his people have always done. This time, as he feels the rough skin of his hands, his thoughts drift to the heaviness of the morning. Soaring like a raven, the man in gray imagines his village from above. He looks down on the small patchwork of houses blending with the drab color of the surrounding soil. Rows of plants cultivated in small courtyards add stark contrast to the muted landscape. White and gray linens drying between the inner walls cast a calm fluidity over the scene. A thin ribbon of white smoke rises in the still air. He sharpens his focus, and in his mind, he reluctantly places a small figure, wearing the same gray clothing as his own, on a wall in the center of the village. He painfully recalls the event as it was told to him: The small child had run along the top of the inner wall, a smooth, worn, elevated path, to the end of the courtyard. There he met another wall that signals the border of the village. A few feet higher, the cured mud on top of this outer wall is studded with rows of broken glass bottles for security. The child carefully climbed up and slowly began to navigate the gaps between the jagged green and clear class. Though he has been warned not to climb on the outer walls, the child had become skilled at taking small shortcuts on these forbidden bridges, and he was shocked at the hot stab of pain as his heel slid down onto a long spike of glass.
Snapping his focus back to the prayer, the man in gray diligently rocks forward, placing his head on the ground again. As the prayer continues, his mind wanders again to the hours that followed the fall. With deep, burdensome anguish, he remembers abandoning the plans for the day’s harvest as he lay next to his son to comfort him as he wept with pain and sadness. He remembers how the village elder had come, bringing tea, to look at his injured son. The father had lifted the cloth to show the elder how his son’s bones had penetrated the skin and drastically deformed his leg. Later, with their tea, they had sat in silence outside the small house, looking off to the distance. The old man had finally spoken. “You helped to build these houses. If your neighbor’s house were to crumble in the rains of spring, you would help to rebuild it by the following winter. Your son may die. All of us will help to build your family again. You must be strong.” He remembers returning to the house to speak with the boy’s mother and his feeling of helpless guilt as she silently wept in his arms.
Later, the broken-hearted father had walked to the edge of the village and climbed the hill his own father had climbed with him in his earliest memories. He had sat on top of the hill, looking out at the purplish-gray haze that marked the horizon and thought how similar the sky and ground appeared, and how he could not discern the exact point where the two met. He thought of this as he realized how close life may be to death for his son and wondered if he would be able to recognize the crossover. His heart grew heavier and heavier, and he was certain he could hear it beating as he sat silently. The beating became louder and louder as the ground began to shake with slow, persistent thuds. The father trembled as the giant bird from foreign lands flew directly over him and off to the distant mountains near the great river.
Stationed deep in the mountains of Afghanistan, a member of a military team wakes in the evening to make use of the dusty, open-air gym built of weathered plywood benches and steel plates. His work dictates that most days begin in the evening and end in the early hours of the morning. The setting sun’s reflection bleeds yellow and orange streams into the braided river below, creating a dreamlike feeling. The man stares at the illusion and takes a few long, deep breaths, allowing his mind to drift homeward. During lengthy deployments to the region, he has found that this time of day allows a rare period of reflection, and he thinks about his young daughter, a world away, who at this hour might be drifting off to sleep. Under his breath he says a small prayer that her dreams will be good. As he begins his workout, the faint melody of the evening call to prayer echoes in the distance. He thinks about the rituals of those who call this place home. He thinks of the long hours spent flying over small villages and wonders what the villagers below must feel as the thunderous noise from the helicopter passes overhead. His mind shifts to his role on the team and how he’s grown to care for each of its members. He thinks about his responsibilities at home and examines them against his responsibilities in this place so far from home. With a nervous laugh, he mutters something about tomorrow, Wednesday, the day of the clinic. For him the clinic is the most anticipated part of the week.
His unique role for the team is the ability to quickly provide lifesaving attention to those in need of care. He feels confident when performing the immediate action necessary to treat trauma-related injuries, but has enormous concerns about the clinic he runs for the local villagers each Wednesday. He feels deeply the pain and anguish of those he meets each week. For those he can help, his heart feels tremendous gratitude, but the ones he cannot help tear at his soul. Each week, patients line up next to a door along the fence that separates the small outpost from the adjacent village. Young men with crutches made from olive branches, small children with burns to their legs, and many villagers with persistent infections form a line that starts early in the morning and builds throughout the day. Using an interpreter, the man examines one patient at a time. Each Wednesday he discovers new problems or long-term ailments that he has never seen before. He records the symptoms, takes pictures of the affected areas, and journals each patient’s condition. In whatever spare time he has throughout the week, he thumbs through medical books, sends emails, and consults online with specialists. He receives advice from doctors who routinely treat similar illnesses, and he learns who he can and cannot help the following week. He wrestles with these thoughts as he weighs the value of his efforts against the pain caused by false hope.
Thoughts like these swirl as the man punctuates his evening routine by running to the top of a small hill behind the outpost. He stands and catches his breath looking out at the dry landscape as it gradually descends into the valley and eventually off into the flatlands. The scene looks absent of life, but the haunting, slow and deliberate melody of the call to prayer reminds him of the life that has existed in this place for so long. He thinks for the first time how beautiful the sound is, and as he does, his eye catches a small hint of dust moving slowly closer across the barren desert.
As the sun rises on a Wednesday morning in the high mountains of Afghanistan, a military medic prepares his small clinic for the treatment of local villagers. He places clean blankets on the three exam tables made from pieces of discarded construction material. He inspects the instruments and supplies he will use throughout the day and prepares the camera and notepad he will use to record his findings. Tape, bandages, splints, medications, and ointments are organized for efficient access. His notes from the previous week are reviewed, and treatment recommendations from various sources scribbled next to the appropriate patient’s information. As the final preparations are accomplished, the man hears a faint noise from outside the clinic walls. He believes it may be the dull groan of a small motorcycle as the sound grows very close and abruptly stops. Curious to see if an early visitor might have arrived, the medic unlocks the steel door that separates the clinic from the village beyond. He opens the door to find a man carrying a small boy toward the clinic. From behind a dusty cloth wrapped many times around the head, neck, and shoulders, the man carrying the child looks up at the man in the clinic. The medic takes the father and his son into the clinic and motions to the father to place the boy on one of the tables. The medic, the boy, and the father work in silence to carefully remove the clothing and wraps that hide the boy’s leg. As the leg is exposed, the boy lets his head ease back onto a pillow and begins to cry quietly.
Though soft, the cry reveals depth and complexity: the sorrow of disappointment, his own, and that of his father, and the fear of the strange place where he finds himself after traveling in agony through the night. He also cries for hope, the blind hope that this strange man in this strange room might somehow heal his leg and return him to his home. Having never before left his village, he now gives himself to the potential of this far-off place and breathes his tears to an end. The father cautiously shares his son’s blind hope. He has heard stories of great healers from foreign lands, but he also knows the brutal consequence of misplaced trust. He studies the face of the man from foreign lands and patiently waits to learn what might be done.
The medic examines the boy’s leg and begins to think through several options. He has seen this kind of wound many times in the context of an emergency but must now force himself beyond the instinct to stabilize, transport, and deliver. He must think about the days, weeks, and months that lie ahead. The medic imagines success and also imagines possible failure. He thinks about the infections that may result from an environment almost impossible to sterilize. For an hour the medic cleans the skin around the open wound. He places moist, sterile dressings on the protruding bone ends and gently irrigates the tissue. With nods and facial expressions, he communicates with the boy and begins to assess the viability of the leg. As he proceeds to work, he notices the father’s posture becomes more relaxed and yielding. At this moment the medic realizes that trust has been established, and there is no turning back. He must do all he can for the boy. He continues his assessment, learning that the lower leg and foot are still receiving adequate blood flow and the nerve is still intact. Nervousness turns to hopefulness as he begins to develop a new plan for the morning.
As the interpreter walks into the clinic, the medic begins to put his plan into action. Some staff are recruited to help clean and prepare the table for the operation. Others are tasked with informing the other patients that the clinic will not be open and begin inquiring about living arrangements for the boy and his father for a month. The leadership of the outpost are asked to communicate a change to the team’s schedule for the day, as a new objective begins to crystalize. All efforts of this small, remote base are rerouted to assist the work of the clinic. Medical instruments are boiled in water, and one section of the clinic is sterilized as much as possible. Lighting is creatively suspended from a metal bar above the bed. Emergency life-support supplies are prepared, and the team receives a full briefing of the sequence to follow. A scribe is appointed to take notes and provide inputs if something doesn’t look right. At noon, the boy, his father, the interpreter, and the medic have a conversation. The medic explains the plan and discusses the chance of things going wrong. He tells the father of his own daughter at home and shows him a picture. He explains how he would feel in this situation, and the father places his hand on the man’s shoulder. With this signal of trust and understanding, the man calls his team together to prepare for the work at hand.
With an anesthetic, the medic begins by blocking sensation to the entire leg and commences to deeply clean the exposed tissue and lightly agitate crucial points to promote blood flow. His team begins to pull slowly on the traction device connected to the leg, and great care is taken to approximate the ends of the bones. The compartments inside the leg are attended to with internal sutures and cleaned again before a drain is inserted and the hole in the skin is mostly closed with external sutures. The splint is reinforced and wrapped loosely as the team continues to monitor the lower leg for signs of blood flow. During the hours that follow the operation, the boy is fed soup and given antibiotics. His father is told of the outcome, and a plan is made for the boy to remain in the clinic for two days to be monitored and to accomplish the final closure of the wound. The boy and his father will spend the next month in the village, visit the clinic weekly to have the sutures removed, and eventually have a cast placed on the leg.
As the sun begins to set, the medic leaves the boy and the father in the clinic and walks slowly back to the top of the hill behind the outpost. He sits on the ground and stares out into the distance just as the evening call to prayer begins. The events of the day rush through his mind and he puts his hands over his face and cries. He cries for relief and for gratitude. He cries with empathy and compassion for the humanitarian consequence of war. He cries for the family he misses so much. He closes his eyes and mumbles a prayer that they will be safe.