Chapter 18
The Long Headache
She went to ground in a room at the end of the world.
It was in Najjera, on the edge of Kampala, where the tarmac ran out and the hills began, a single room at the back of a half-built house, with a tin door and a hole for a window. She had found it by chance, from a hand-lettered card in a shop. ROOM TO LET. CHEAP. NO QUESTIONS. It cost thirty thousand shillings. The landlord, a deaf old man in a woollen hat, who spent his days sitting on a pile of bricks watching his chickens, took her money without lifting his head.
She told nobody.
She did it carefully. She switched off the old phone, and took out the battery, and dropped them both down the latrine. She did not go back to the room in Kisenyi. She left the green exercise book, and the Virgin, and the plastic bag with the sock, under the bed, for whoever came. She took only her suitcase, and her father's watch. At the stage, she told a boda man that she was going to Mbarara. She got off at the next junction. She walked the rest of the way, with her bag on her head, by an unmade road, in the dusk, and told herself that she was going to be a person who did not exist.
It was easier than she had thought.
That was the horror. A city is a very large place. It has room in it for a thousand ghosts. She had only to stand at the side of the road, in a plain brown dress, with a scarf over her hair and her eyes lowered, and a hundred people would pass her without looking, as one passes a post. Nobody asked. Nobody saw. For the first time in her life, she was perfectly, absolutely alone.
She had thought it would feel like freedom.
The first weeks were quiet.
She slept, and ate a little, and swept the floor. She did not have a cough. She did not have a fever. She woke at dawn, with the cocks, and sat on the step in the cold grey light with a cup of tea, and watched the mist lift off the hills, and was astonished at how well she felt. It was the old trick. It was the medicine, lingering. For a month, six weeks, she was almost herself.
She found work, of a kind. A woman at the stage sold fried cassava from a basin, and needed someone to peel. She sat on a stool in the back of the stall, with a pile of roots, and a knife, and scraped, and scraped, and said nothing. She was paid in cassava, and a little money. She got thinner. She did not notice. She told herself it was the heat.
She did not think about the tablet.
That was the trick of it. She had put it away in the same place in her mind where she kept the stage, and the lies, and the sack on the hotel floor. A small bright room with a shut door. She walked past it, every day, with her eyes down. It was not that she had decided to die. She would have been horrified. It was only that she could not, for the life of her, find the strength to turn the handle.
Tomorrow, she thought. When I'm stronger.
When it has all died down.
It is a phrase that has killed a great many people.
The headache began in the second week of September.
It started quietly, at the back of her head, a faint pressure, like a thumb. She thought it was the sun. She thought it was the peeling, which hurt her neck. She took a tablet from a strip she had bought at a kiosk, and it went away, and came back. By the weekend it had grown. It sat behind her eyes, a dull heavy ache, that throbbed when she bent down, and when she coughed, and in the middle of the night.
She did not think of it.
She did not think of anything. She told herself it was malaria, and bought a packet of the pink tablets, and swallowed four. It did not help. It got worse. By the end of the month it had become a living thing. It was a wet cloth, drawn tight round her skull, a band of iron. She woke at three, in the black of the room, with her whole head pounding, and lay with her hands pressed against her temples, rocking, her teeth clenched. It did not stop. It did not stop for a minute.
It's only a headache, she told herself.
She said it fourteen times.
She stopped being able to look at the light.
It was a curious thing. She had been sitting on the step, in the morning, with her tea, as she always did, when the sun came over the hill and struck her in the eyes. It was a thin gold ray. It was no brighter than any other day. But it went through her like a nail. She cried out, and covered her face, and sat doubled over on the step with the cup spilled in her lap. She had to be helped inside by the cassava woman, a big kind person named Mama Gertrude, who put a cloth over her eyes and drew the door shut and said, "You are sick, my child."
"It's only the sun."
"You are sick. You must see a doctor."
"I'll be all right."
"You will not." She was standing in the dark, in the doorway, a huge outline against the light. "I have seen this. My brother had it. It is the head. I know a clinic."
"No."
"My sister..."
"No." She heard her own voice, high and sharp. "Please. Please. Leave me. I only want to sleep."
The woman said nothing. She stood there for a long time. Then she sighed, a great slow breath, and went out, and left the door ajar.
She lay in the dark with her hands over her eyes.
Don't let them come.
Don't let anybody come.
She began to lose the days.
It happened gradually. She would sit down on the bed in the morning, with the thought that she would get up in a minute, and find that it was evening. She would reach for a cup, and discover that she was holding a spoon. Once, she was walking back from the stage with a bag of cassava, and stopped, in the middle of the road, and could not remember which way to go. She stood there for what seemed a very long time. A boda man shouted. A woman took her arm, and said, "Madam? Madam? Are you drunk?"
"No."
"You are in the road."
"I'm sorry. I..." She looked at the woman's face. It was very large. It had a mole. "I'm looking for my mother."
"Where is she?"
"In the village."
"Which village?"
She opened her mouth. Her mind was a white page. A small panicked voice said, Kisaana. Kisaana-Nabbale. Lwengo. She could see it. She could see the hill, and the banana grove, and the red road. She could not, for her life, bring the word to her lips.
"I don't know," she said, and began to cry.
They took her home. She did not remember how. She woke on the bed, in the dark, with a wet cloth on her forehead and the headache like a wolf. She was shaking. She was sick. She turned to the wall and vomited into a basin, and the room tilted, and swung. A voice in the corner was saying something. It was her father's. It was very low. It said, Look after the garden. The coffee will want pruning in March.
"Taata?"
Tell Nabirye.
"I'm here."
Do not let Kizito's cough go on.
"It's me, Taata. I'm Nabirye."
He did not answer. He was sitting on the stool, by the door, a long thin shape in a dark suit, with his hands on his knees. She could not see his face. It was in the shadow. But she knew the shape of the ears. She knew the voice. She felt such a wave of love and terror and relief that she cried out, and held out her arms.
"Don't go," she said.
I would rather go quiet.
"No. No, Taata. Don't. It's not right. You were wrong." She was weeping. "You were wrong. You should have gone. They would have helped. Maama would have carried you." She could hear her own voice, high and childish and cracked. "I'm sorry. I'm so sorry. I should have gone. I should have gone to the clinic. I knew. I knew. I..."
The shape on the stool stirred.
He lifted his head.
There was nothing there. It was a coat on a nail.
She lay with her arms out, in the dark, shaking.
Ibra found her on the first of October.
It was a Wednesday. It was a clear bright morning, with a high blue sky, and a thin breeze off the hills. He had come in a taxi, with a carrier bag, from the hospital, in a clean white coat, with his glasses pushed up on his forehead and his face set in a hard, tight, careful line. It had taken him eleven weeks. He had gone to the Blue Door. He had gone to the room in Kisenyi, and found the green book, and a Virgin, and a sock with a single pill. He had gone to every taxi park, every stage, every clinic between Entebbe and Mukono. He had asked in markets. He had put up cards. He had found a woman at a stall in Najjera who said, "A thin one? With a bag? She is at the old man's. At the back. She is very ill."
He knocked.
There was no answer.
"Nabirye?" He pushed the tin door. It swung inward, with a long squeal. "Nabirye, it's Ibra."
The room was dim. It smelled of old sweat and vomit and damp. There was a bed, and a stool, and a basin. A thin shape lay on the bed, curled on its side, with its face to the wall, covered with a blanket. A hand was visible, on the pillow, small and brown and stiff, with the fingers curled.
He stood very still.
Please.
He crossed the floor in three steps. He knelt. He put one hand, gently, on the thin shoulder under the blanket, and turned her.
Her eyes were open.
They were enormous. They were dull and unfocused and strangely bright, with the pupils pinpricks, staring at the ceiling. Her face was grey. Her lips were cracked. The skin on her cheekbones had a papery sheen, like wax. She was breathing very fast, in small shallow gasps, and in her throat there was a faint dry click.
"Nabirye."
She did not look at him.
"It's me. It's Ibra. Can you hear me?"
"The light," she whispered.
"I'll shut the door."
"It hurts."
"I know." He got up. He shut it. The room went dark, a thick yellow gloom, striped by a bar of sunlight through the hole. He came back and knelt. "Can you tell me your name?"
"Nabirye Kibirige."
"Good. And what day is it?"
"I don't know."
"Where are you?"
"In the village." She smiled faintly. "My mother's... my mother's coming. She's got a sack."
"Nabirye."
"I'm going to be a nurse."
"I know."
"I'm going to build a place where..." She stopped. Her eyes rolled. A shudder went through her whole body, from her feet to her head, and her hands clenched. A thin high whining sound came out of her throat.
He had taken her face between his hands.
He felt, with his fingers, under her jaw, the hot dry skin. He touched the glands of her neck. He bent her chin gently toward her chest, and she cried out, and her back arched, rigid as a bow. He let go. His hands were shaking. He was a laboratory technician, not a doctor. But he had stood for four years on the edge of a ward, and he knew, as he knew his own name, what a stiff neck was.
Oh, God.
"It's all right," said Ibra. "It's all right. It's all right. I'm going to get you to hospital."
"No."
"Yes."
"I can't."
"You can."
"They'll know. They will look at me. They'll say..."
"I don't care what they say." His voice cracked. "I don't care who looks. I don't care if the whole world sees. I'm not leaving you in this room."
"Ibra..."
"I have been looking for you for eleven weeks!" It tore out of him. He was crying. It ran down his face, onto his white coat, unashamed. "I've gone to every... I thought you were dead. I thought you were in a ditch. And you are here, in a room, with a goat in the yard, and you're burning up, and you ask me not to..." He broke off. He pressed the back of his hand against his mouth. "I'm sorry. I'm so sorry. I'll be quiet. I will be quiet in a minute."
She was looking at him.
For the first time since he had come in, she was looking at him, with a clear, steady, conscious look, as one looks out of a window after a long fever. Her eyes were very large and dark. They were wet. She lifted one hand, with great effort, and laid it on his cheek.
"You came," she said.
"Of course I came."
"I didn't think anyone would."
"I know." He covered her hand with his. "That is what's wrong with you. You never think anyone will."
The ambulance came in twenty minutes. He had rung from the hospital, in the taxi, and a driver he knew had done him a favour. It came up the unmade road in a cloud of dust, with its siren off, and two men in blue coats, who lifted her onto a stretcher with practised, impersonal gentleness, and carried her out.
The deaf landlord was standing in the yard, in his woollen hat, with a chicken under his arm. He watched them go by. He did not say a word. As they passed, he lifted his free hand, in a small slow benediction, and Nabirye, turning her head on the pillow, saw that his eyes were full of tears.
"God bless you," he said, in a cracked old voice. "I did not know."
She closed her eyes.
The Accident and Emergency department of Mulago Hospital at noon on a Wednesday is a sight that no one forgets.
It is a vast low shed, with a hundred beds, and nine hundred people. They lie on trolleys, on benches, on mats on the floor. They are carried in on doors. They are brought in on bicycles, on the backs of lorries, in the arms of weeping relatives. A woman is giving birth in a corner behind a sheet. A boy with a broken leg is sitting patiently on a stool, whistling. A man is shouting. A nurse is running, with a drip stand. And over it all, a roaring, steady, human noise, like the sea, of groans and prayers and orders and the ring of telephones, rises to the corrugated roof.
They found her a space in a corner.
It was a metal trolley, with a thin mattress, against a wall. A doctor came in forty minutes. He was a tall, tired, grave young man called Dr. Atim, with a beard and spectacles, who had been on duty for twenty-six hours. He listened to Ibra's rapid, low-voiced account. He looked at her eyes. He lifted her arm, and let it fall. He bent her neck, and she cried out.
"Positive HIV?"
"Yes. On treatment. She defaulted. About three months."
"CD4?"
"Last was sixty-one. In December."
"Right." He did not say any more. He straightened up. "I need an LP. Now. I want opening pressure. Can you hold her?"
"Yes."
"Good man."
They turned her on her side. She felt it, dimly, from a great distance. Hands. A cold swab on the small of her back. A voice, saying, This will be a little pinch. A sudden, enormous, grinding pain, in a place she could not name, that went up her spine into her skull like a bolt of white fire. She screamed. It was a long raw unrecognisable sound.
"Hold her!"
"I've got her."
"Nearly there. Nearly. Breathe, my dear. Breathe."
"Pressure's high," said a voice, calm. "Thirty-eight."
"It's cloudy."
"Send it."
It went on for a very long time.
The result came back at three.
It came to Dr. Atim on a slip of paper, brought by a boy on a bicycle from the laboratory. He read it standing in the corridor, among the trolleys, with the noise of the ward at his back. He read it once. He closed his eyes.
"Cryptococcal antigen," he said. "Positive. Titre one in two thousand and forty-eight."
"Cryptococcal meningitis," said Ibra.
"Yes."
"Oh, God."
"It's what I thought." The young doctor took off his spectacles and pressed his thumb and finger into the bridge of his nose. "Her CD4 will be in the teens. She has been off treatment for about three months. It's a fungus. It lives in the soil. We all breathe it in. A healthy person's immune system deals with it and never thinks of it again. When the system has been taken apart..." He did not finish. "It goes to the brain."
"What do we do?"
"Amphotericin. A drip, for a week. Flucytosine, if we have it. We will need to drain the fluid, the pressure, every day, as many days as it takes. It's very painful. It does not always work." He put the glasses back. "And we have to wait to restart the HIV drugs. Four to six weeks. If we start too soon, the immune system wakes up and it kills her."
"You mean... she has to go without?"
"We have to treat the fungus first." He looked at Ibra, with a steady, grave, exhausted, not unkind look. "I'm going to be honest with you. You work in the laboratory. You can read the numbers. It is a very, very serious infection. She has come in late. There is about a one in three chance that she won't leave this building."
Ibra said nothing.
A trolley went past. A man was calling for a nurse. Beyond the double doors, out in the sun, someone was playing a radio, and a high sweet voice was singing about rain.
"And two in three?" he said.
"She goes home."
"Then that's what we do."
"Yes." The young doctor smiled, wearily, for the first time. "That is what we do."
She was moved to a ward at six.
It was the long green one on the second floor, with the iron beds and the yellow bulb. She was laid in the fourth bed from the end. A drip was put in her hand. A bag of amber fluid, bright as tea, was hung on a stand, and the tube was taped, and a nurse came and said, "There you are, sister," and drew the sheet up to her chin. It smelled of bleach. Along the row, a man was coughing, slow and tired. A woman was praying, in a low voice with no hope in it.
She knew it. She had been in it. It was the ward at St. Veronica's, in its twin, with the same smell and the same light. She lay with her eyes shut and her head splitting, and heard it, and thought, distinctly, in a calm voice, So this is where it ends.
Where I started.
It's a circle.
Ibra was sitting by the bed.
He had not gone home. He sat on a plastic chair, with his coat off, and his elbows on his knees, watching her face. He had a notebook. He did not write in it. He held a pencil, in one hand, and turned it over and over, like a man saying a rosary.
"Ibra," she said.
"I'm here."
"Is it bad?"
"It is not good."
"Tell me."
He told her.
He did it plainly, in a low voice, as one gives a patient the facts. He did not lie. He did not smooth. When he had finished, there was a very long silence, and she lay with her eyes on the ceiling, and a tear ran sideways out of the corner of one, and into her hair.
"I could die," she said.
"You could."
"I'm so frightened."
"I know."
"I don't want my mother to know."
He did not answer.
"I mean it." She turned her head. Her eyes were very bright. "I can't. She thinks... she thinks I am a nurse. She thinks I'm well. She thinks it's all a mistake. I told her it was a mistake." Her voice cracked. "I lied to her, Ibra. On the phone. She asked me straight. And I said no."
"I know."
"You know?"
"She told me."
She stared at him.
"She came to see me." He said it very quietly, looking at the pencil. "In August. At the hospital. She did not tell you. She sat for four hours on a bench in the yard, outside the laboratory, with a sack. She had walked from the stage." He swallowed. "She said, I do not want you to tell her I came. But I think she's in trouble. And you are the only one I know in this city."
"Maama came?"
"She asked me to find you."
"What did you say?"
"I said I would." His voice shook. "I did not tell her where you were. I did not know. I told her I'd try. She said..." He stopped.
"What?"
"She said, When you find her, do not tell her I know. Let her tell me. Let her come home in her own time." He wiped his eyes. "She said, I will be waiting. I have always been waiting. It is the thing I'm good at."
Nabirye made a sound.
It was not a sob. It was lower than that, more deeply wrenched, a sound that began somewhere in the bottom of her ribs and tore its way up. She put her hand over her mouth. Her whole body arched. The drip stand shook.
"She knows," she said.
"I think she has known for a long time."
"She knew on the phone."
"Yes."
"And she let me..."
"She let you say it. Because she thought you needed to." He leaned forward. He took her free hand, in both of his, and held it hard. "Nabirye. Listen to me. I am going to say the one thing I came to say, and then I'll stop. I want to ring her."
"No."
"I'm going to ring her."
"You can't."
"I have to."
"Ibra, please..."
"I'm not asking." He was crying, and his voice was perfectly steady. "You said you were afraid. You said it, in that room. You said, They will look at me. And I said I did not care. That I would stand between you and the whole world." He raised her hand to his mouth, and pressed it, and held it there. "I will. I swear. For as long as I'm alive. But I cannot stand between you and her. It is not my place. She's your mother. She has the right."
"I can't let her see."
"See what?"
"Me." She was sobbing. "Like this. After everything. After the sack. After the hotel. I turned my head, Ibra. I turned away. She was standing on the lawn, and I turned away."
"I know."
"How can I look at her?"
"You don't," said Ibra. "She'll look at you."
She stared at him through a blur.
"And I promise you," he said, "it will not be what you think."
The bulb above them flickered. Down the ward, a baby began to cry. A nurse came, and took her temperature, and wrote something on a chart. In the next bed, the praying woman had fallen silent, and was staring at the ceiling with wide, dry, quiet eyes.
She was so tired. She was too tired to argue. She lay back on the thin pillow, with the drip in her hand and her friend's hand over hers, and listened to her own breath.
Maama.
A sack, and a green gomesi.
I don't deserve her.
"Ring her," she whispered.
He did not move for a moment. Then he lifted his head. His whole face, in the yellow light, was naked and wet and young.
"Thank you," said Ibra.
He took out his phone. He stood up, and walked out of the ward, into the corridor, and she heard his voice go away down it, low and urgent, among the noise.
"Hello? Mama Nalubega? It is Ibra Sekitoleko. Yes. I'm sorry to ring so late. I have found her."