First, Do No Harm

When the men first took him, Conrad was sure his end was near. The three of them emerged out of the black sedan that had cut across his path. Ski masks covered their features, and two held automatic rifles pointed at his chest. For a panicked moment, Conrad thought about running, before his common sense kicked in -- there was nowhere to run on the narrow street, and all he would accomplish was to endanger the other passers-by. The third man approached him and held out a pair of handcuffs. He did not speak; there was no need. With trembling hands, knowing that he might well be signing his own death sentence, Conrad put them on. The man slipped behind him and tied a blindfold in place, then a gag. Within seconds, Conrad found himself in the backseat of the car, one man on either side while the third took the passenger's seat next to the driver. The muzzle of a rifle dug painfully into his side as the door slammed.

The entire affair took less than five minutes, and he could have laughed at the ease with which it was accomplished. There had been no fuss, from him or from others on the street. Not one word had been exchanged between any of his captors or himself. Yet his entire world had altered to the cramped, darkened interior of the vehicle, to the sound of soft breathing from the men beside him.

The car wound its way through the twisting streets of the residential neighborhoods. The muffled shouts of children playing penetrated the thick glass, but they faded as the ride continued and dusk settled over the city. A bump and the sudden smoothness beneath the wheels told Conrad that they had left behind the cobblestones and intersected with a larger road. His heart beat a fierce staccatto of fear and hope. Numerous security checkpoints guarded the streets; the car was bound to have to pass through at least one. Sweat gathered on his forehead, slid down, and vanished into the fabric of the blindfold.

Within a few minutes, he felt the car slow, heard the sound of a window being lowered, the crunch of approaching boots, and the rough demand for papers and passes. He heard the man in the passenger's seat lean forward, the murmur of low voices, then a grating chuckle from the guard outside, echoed by those in the car. His heart seemed to stop as the car lurched forward and the window rolled up again. He made a strangled noise of protest, but it was already too late. One of the men poked him with the barrel of his gun, then spoke quickly to the others. Harsh laughter filled the car as it picked up speed, and suddenly Conrad understood. They had planted the guard, or had bribed him to allow them to pass. There would be no reprieve from that quarter.

Twice more the performance repeated itself, and each time with similar results. If only our side could be as organized, Conrad thought, the humor oddly incongruous with his surroundings. After the last checkpoint, a change came over the atmosphere of the car -- an easing back and a barely noticeable sigh from one of the men. The sounds from outside faded and then ceased, and the road became more uneven, the occassional pothole rocking the car. With a jolt, Conrad realized that they had left the city and were travelling through the sparsely populated countryside. Unless by chance a night patrol found them, there would be no help that could reach him now.

For the first time since the sudan had pulled in front of him, Conrad thought of his family back home. His wife, his daughter, and the infant son whom he had been planning on meeting for the first time in two months, when his next leave was due. The memories seemed vague and unreal, a completely separate existence from the dark world in which he lived now, so much so that he had trouble concentrating on them.

Eventually, lulled by the bouncing of the car and worn out by the strain of the unnatural ride, Conrad drifted into a fitful doze. He had the indistinct impression of travelling for a great distance, a brief stop followed by the smell of gasoline, and coarse speech mixed with the clucking of chickens outside the window before the car started again.

A sharp prod in his ribs brought him awake. He groaned softly, his neck stiff and his shoulders sore. The man to his right poked him again, harder, and cursed at him impatiently. Conrad realized that the car had stopped, and the weight on his left was gone. He shifted in that direction, and a rough hand grabbed his arm and hauled him out of the car. The calls of night insects filled the air, and Conrad shivered as a chill wind touched him. A dog barked nearby. A brusque command, and his captors steered him after their leader. Conrad felt the subtle change in the air as they entered a dwelling. The smell of woodsmoke and sweat filled his nostrils as his boots touched on a floor of compacted dirt.

They passed into a different room, and a soft glow appeared. Unexpectedly, a hand grabbed the blindfold and ripped it away, and Conrad gasped as tears started into his eyes from the sudden brightness. He squinted his eyes shut as someone untied his gag. The kerosene lamp on the table gave off an uncertain light, seeming not so much to illuminate the room as emphasize its shadows. A grunted command, and the man behind him began a search, running his hands down Conrad's sides and along each of his legs. His wallet hit the table with a soft thump, followed by his keys and the official pass that allowed him to move unhindered in the city. The man who seemed to be in charge flipped open the wallet and glanced at the ID within. He had removed his ski mask, though the others still wore theirs, and his face looked young and unlined in the light.

A sudden knocking disturbed the stillness. The men stiffened, but relaxed a moment later when another man entered. He too, carried a rifle, but his was strapped across his back. He spared Conrad a glance, then addressed the younger man, who answered, handing over the wallet. The newcomer peered from the ID to Conrad and back again, as if to ascertain his identity, then gave a brusque nod. He issued a short order. The younger man's eyes widened, and he protested in a rapid stream of Arabic. The other man cut him off with an impatient gesture and approached Conrad. His face appeared older than that of his companion, perhaps in his mid-thirties or so. A black mustache decorated his upper lip, and a flowing, white turban covered his head. When he spoke, his accent was so thick that he had to repeat himself before Conrad could understand.

"You. Doctor. Ya?"

Conrad nodded. The man grunted in satisfaction, turning to his companion again and pointing at Conrad's hands. Begrudgingly, the other produced a key and unlocked the cuffs.

"Come."

Conrad hesitated a brief moment, then followed the man. He heard the others close in behind him. They came out of the squat, adobe house and crossed the lone road of the village to another dwelling. As soon as they entered, Conrad could smell the sweet, cloying scent of blood. A young man, hardly more than a boy, lay on a low bed in the inner room, the bandages on his chest soaked a dark crimson, his breathing labored. His head turned to stare listlessly at the newcomers, blood loss making even the fear and pain in his eyes appear dim and dull.

"You help him."

Conrad approached the pallet and knelt. Dark eyes gazed into his own as he unwrapped the gauze and padding. He sucked in a breath at the wound. The man had been shot, and from the low whistling sound, Conrad knew that the bullet had penetrated a lung. He turned to the man standing beside him.

"I need a scapel, tweezers, gloves, more gauze..."

The man held up a hand, confusion evident in his face. "Too fast. English bad," he said.

Conrad felt a moment's hot frustration. He forced himself to take a deep breath and repeated his request, slower, and with accompanying hand gestures. The man's frown smoothed, and he vanished from the room to reappear a moment later bearing a battered case. He opened it to display the contents. Conrad stared at them and his heart sank. He picked up a pair of tweezers from the jumbled mess within, noting the rust that discolored the tip. With an effort, he kept his voice even. "This needs to be cleaned, or he'll die of infection. Do you have any antibiotics?" He sighed at the man's ambiguous shrug. Beside them, the boy writhed and groaned slightly. Conrad's hand clenched around the tweezers. "Alright then. Looks like we'll have to improvise."

For the next half-hour, while the boy lay panting for breath, Conrad heated water and boiled the tools he needed. Once the men caught on to his intentions, they helped with a will, keeping the fire hot and fetching more wood for the stove. For a miracle, Conrad discovered a packet of unopened gauze at the bottom of the case, along with a clean roll of bandages. He wrapped a length of it around his mouth and nostrils in a makeshift mask, and the mustached man followed his example. In the absence of gloves, they both scrubbed their hands over and over again with rough soap. Finally, when he could think of nothing else, Conrad motioned for the men to carry the injured boy out to the main room, where he would have more space to work, then sent them for more lamps.

Anaesthetic was out of the question, so the others held down the patient's arms while he made the first cut with a scapel that needed sharpening. Besides a weak moan, it drew no other response. After that, time seemed like a fluid, irrelevant concept, as, without surgical clamps, without sterile sponges, without any type of suction, he worked frantically to stem the blood flow and locate the bullet still lodged in the man's chest. His captor-turned-assistant held the light steady and wiped away the excess blood.

Conrad lost himself in the operation, his hands stained scarlet to the wrists. His world focused to the pulsing pink tissues under his hands. He barely paused when he finally extracted the bullet and dropped it with a metallic clink into a waiting bowl. He sutured the wound closed with a sewing needle, the twine still damp from the boiling pot. As he tied the last knot, the other man handed him a small glass bottle. Conrad stared at the penicillin, then gave an exhausted chuckle. He drew it up and injected it with the lone syringe he had found, feeling absurdly grateful that needles at least were plentiful.

The boy was deathly pale, his eyes closed. Conrad wiped his forehead against his shoulder and hoped that his patient's color was simply a result of his ordeal. Only now, after he had finished, did the full impact of what he had done dawn on him. A gunshot wound. The boy was an insurgent. He had just performed life-saving surgery on one of the enemy. Conrad pondered that thought for a moment, then dismissed it with a weary shrug. There are no enemies when it comes to death.

He turned away from the table, and suddenly staggered, almost falling. One of the men caught his arm, and another muttered something that drew a ripple of coarse laughter from the others, but there was a note of respect beneath the humor. The mustached man removed his mask and spoke, and Conrad let himself be led out of the house.

The sky to the east showed signs of lightening, and a fuzzy corner of Conrad's brain registered that, with his double shift at the hospital, he had gone almost without sleep for over twenty-four hours. They entered the building where he had initially been taken, and as he collapsed into bed, he could hear the tolling of bells, calling the men to the first of their five daily prayers.

***

Conrad woke and lay blinking in the light, wondering where he was. Then the past day rushed back to him and he rolled over with a groan. His room was barren save for his lumpy mattress, but he found a washstand full of tepid water in the main room. At first he felt surprised by the lack of guards, then he snorted. As though they needed to post a guard in the house when he was surrounded by an entire village and had no idea where he was. He bent to splash water on his face.

The door flew open with a heart-stopping crash. Conrad whirled, but too late to ward off the blow from the rifle butt. He landed on his hands and knees with a grunt, stars bursting across the field of his vision. His assailant screamed something, and kicked him in the side. Conrad fell against the washstand, overturning it and sending a cascade of water over himself. Distantly, he heard the soft click as the rifle's safety lock was flipped, and knew that the next instant would be his last.

The shot didn't come. Instead, with a roar, someone tackled the figure pointing the gun at his head, wrestling the weapon away. Conrad blinked up into the scowling countenance of the man from the night before, his mustache bristling. He shouted something at the boy, whom Conrad thought could not be more than fifteen at most. The boy shouted back, his face contorted. His eyes flicked to Conrad and suddenly he gasped and darted forward, one hand snatching at the pendant around Conrad's neck. The thong snapped. The boy waved the small silver cross at the man, his words a blur of Arabic. Conrad caught something that sounded like "unbeliever". In answer, the man struck the boy a backhanded blow, sending him reeling. For a moment, the boy glared hatred at them both, then he dashed out the door and was gone. The cross hit the floor with a metallic ring. The man spat after the boy before turning to Conrad, still lying in a puddle on the floor.

"Him hurt you?"

Conrad shook his head silently, pulling himself up into a sitting position. His head throbbed. "I'll live," he muttered. He glanced at the door. "Who... uh, who is he?"

The anger seemed to drain out of the man at the question. He sighed, and slung the boy's rifle across his shoulders. "Azhar. Brother die." He mimicked the shot and kickback of a gun with his hand. "Soldiers. Now him always mad." He shrugged and an unexpected grin flashed across his face. "You lucky him not shoot first, then hit."

"Yeah, I'm thanking my lucky stars right now," Conrad said with a sour grimace as he stood.

The man dismissed his ill humor with a wave. He tapped his chest. "Fakhir."

"Conrad."

Fakhir grunted and made a beckoning motion at the door. A young man entered, limping and leaning heavily on a crude crutch. Fakhir slapped a hand on his shoulder. "Abdul-Salam," he said, by way of introduction. "Son of my sister. Him no fight now, so him help you, ya?"

A pair of large, black eyes regarded him with calm solemnity. Conrad's heart gave a funny skip. So they planned to let him keep treating their wounded, and had even assigned him an assistant. He didn't know if he wanted to laugh or cry.

"Come," Fakhir said, interrupting his thoughts. "More need doctor."

***

Conrad stared at the blank sheet of paper in front of him and rubbed one hand over his eyes. The past week and a half had passed in a confused blur, and at times he wasn't sure whether he was awake or asleep as he dragged himself through each day. Always, there were more wounded. A large tent had been set aside for them at the edge of the village, and day or night, they lay on filthy pallets in the heat, tormented by flies as they awaited his care. Sometimes, it was no more than a laceration that needed stitching. Sometimes, he had to perform field surgery using the most primitive tools. And sometimes, he could do nothing at all except shake his head and move on to the next bed. The village's stock of penicillin had dwindled to a dangerous low, and bandages had to be recycled from one case to the next. There were times, when the screaming threatened to overwhelm his reason, when he would have traded his soul for a tablet of morphine.

Once, he had collapsed from the pace of never getting more than a couple of hours of sleep a night. It had been near the end of an operation, and he had learned later that Abdul-Salam had finished the suturing on his own. The men had carried him to the house that had become his, and allowed him to sleep for five blessed hours. When he woke, he could hear Abdul-Salam arguing with someone outside, saying that the doctor needed more rest. Conrad had risen and gone back to work.

Yesterday, he had confronted Fakhir about the lack of supplies. The man had nodded thoughtfully, then given him a pencil and a sheet of paper. "What you need, write down."

The tired chuckle didn't quite make it out of Conrad's throat. The man sounded as though he planned to get the items at a grocery store. Perhaps the insurgents were better organized than he thought. Maybe they had a central supply depot where they could acquire some essentials. He put the pencil to the paper and made a list.

The next day, Fakhir and some others left as usual on an excursion. Abdul-Salam told him during lunch that they had taken the list with them.

"I hope they manage to find a Wal-Mart," Conrad muttered. He shook his head ruefully at his assistant's puzzled frown.

They were in the midst of an amputation when the men returned. Three nearly-recovered fighters held the patient down while Conrad cut. The man's voicebox was already ruined, so only a faint rasp emerged. Conrad felt almost grateful.

Fakhir slapped him on the shoulder as soon as he finished. A triumphant grin split his swarthy complexion. He gestured to the entrance of the tent, where several crates stood stacked. "What you need, ya?" He left, chuckling contentedly.

Conrad approached the boxes as though in a dream. He pried one open to find cases of glass vials, full of powdered antibiotics. Another of painkillers. Staring at it, he began to shiver. The words "Zahir-Wadi" were stenciled in black across the front. He had worked at Zahir-Wadi Hospital once, on a transfer request. They had attacked a hospital to get him these supplies. A moan sounded behind him. Conrad put the case down and turned back to the wounded.

***

Tension pneumothorax can occur at any time in patients with penetrating chest wounds, justifying the need for 24-hour surveillance. Close monitoring of lung function is required to prevent morbidity and mortality.

The words ran like a refrain through Conrad's head. There had to be something more, some vital detail that he had overlooked or forgotten. He pressed the heels of his hands to his eyes as, once again, he tried to recall the relevant chapter from his medical manual. Somewhere, buried amid the closely typed text, lay the clue that would tell him what had gone wrong and how it could have been prevented.

The door opened and closed; footsteps approached. Conrad lifted his head and stared listlessly at a pair of military boots.

"Vacation, doctor?" Fakhir asked with a cheerful grin, looking down at him where he sat against the foot of the wall, knees drawn up. A distant corner of Conrad's mind noted for the first time how much the man's English had improved; he almost never had to strain to understand anymore. "No pay here if you no work!"

Conrad looked away. "Abdul-Salam..."

"Ya, ya, Abdul-Salam, him good kid," agreed Fakhir, a note of pride in his voice. "But can't do everything."

"Neither can I."

"Ah." Fakhir lowered himself to sit crosslegged on the floor facing him. "This morning, ya? Very bad wound."

Conrad shrugged, wishing the other man would leave. But Fakhir, with the patience typical of his people, merely regarded him in silence. Finally, "It shouldn't have happened. I... There should've been something I could do." He sighed and leaned his head back against the wall. Now that he had said it out loud, he didn't need Fakhir's nod to continue. "Tension pneumothorax. Build up of pressure in the chest cavity," he said, not caring whether the other man understood or not. "I remember studying it during my residency program." His eyes dropped to his hands. "Not enough, apparently."

The situation had deteriorated more quickly than he could have imagined. One minute, the patient had been fairly stable; the next, he had started having trouble breathing, complaining of an intense pain in his chest. Conrad had tried to relieve the pressure within with a needle first, then an incision when that didn't work. It was a procedure he had only ever heard about, never seen or performed, and he did not know whether it was his lack of experience or the condition itself that finally killed the man. In the end, it didn't really matter.

A rough hand squeezed his shoulder. Fakhir grunted at his surprised look. "Everyone die, ya? Everyday, someone die. But with you, maybe they live, ya?" He shook his head to forestall Conrad's response. "You think maybe you killed him, ya? But many others you save. Some die, some live. Is fair trade, ya?"

"That's not how it works," Conrad protested weakly.

Fakhir pushed himself upright and shrugged. "Could be worse," he said with undaunted practicality. "Is better than more dying than living." He eyed Conrad critically. "Is tough fight. You giving up?"

Conrad ground his teeth as he climbed to his feet as well. "Like hell."

***

The pounding on the door came as Conrad tried to scrape away the dirty blond stubble that marked his chin. He abandoned the task and pulled open the door, ready to head to work once more. He was surprised to see Fakhir. "Hurry." They jogged for the tent together.

"What happened?" Conrad demanded as he stared at the remains of a once-healthy leg. He joined Abdul-Salam in readying the tools they would need.

"Bomb. Not well made. Went too soon. No dead."

It took a moment for the words to sink in, and another before their full meaning burst upon Conrad. This one had been a suicide bomber, but the device had not been made correctly and had gone off before it should have. Fakhir was disppointed that no one had died. Conrad swallowed his nausea. He glanced reluctantly at the mangled body and gasped. Though he had only seen the boy briefly since their first encounter, there was no mistaking the eyes wide open in pain and shock. "Azhar..."

"Is ready?" Abdul-Salam asked, unable to understand his hesitation.

All at once the significance of his work crashed over Conrad. He remembered the IEDs, the roadside bombs, and all the other horrors that he had witnessed at the city's hospitals. It had been easy to forget what these people were, to treat their wounds without thinking about what they did, what they believed. Conrad shuddered. It was possible that one of the people whose life he had saved had been the one to plant a bullet in his brother's leg, or buried the bomb that had killed his cousin.

"Doctor?" Abdul-Salam sounded alarmed.

Conrad struggled for breath. He could refuse to treat the boy, to treat any more wounded. He could walk away. They would likely shoot him, but his life wasn't worth much at the moment in any case.

Azhar gave a choked scream and thrashed, his hands clenching the fabric of the cot.

I will apply, for the benefit of the sick, all measures that are required... A drop of sweat rolled down Conrad's face as he recalled the words he had spoken with such confidence when he had finally graduated medical school. The bright optimism of that time seemed almost unreal now.

"That leg's going to have to come off," he managed. He pulled on a pair of gloves and drew up a vial of morphine. If his hand shook, he had steadied it by the time he injected the shot. "Get someone to hold him down."

***

Conrad first thought the sounds were thunder, and they had puzzled him because the day was bright and clear. Then he looked up into Abdul-Salam's wide eyes as the screaming began. A nearby blast threw them to the ground. The staccato strains of gunfire sounded in the distance as shouting filled the air.

Before he could so much as scramble upright, the street filled with running, shouting figures. The scene resembled complete chaos, but after a moment, he realized there was a sense of organization behind it, as men took up pre-arranged positions and women and children vanished from sight as if by magic. It's almost like triage, he thought, bemused.

Then Abdul-Salam hauled him to his feet, pulling him into the lee of an adjecent house. Sweat beaded his face. "Soldiers," he gasped.

Afterwads, Conrad could never recall the next two hours with any clarity. They moved by in a haze, with only snatches of lucidity like a slideshow in his mind. Running in a low crouch as the fighting escalated around them. The glint of a rifle barrel on a house top. The itch that developed between his shoulderblades with gunfire going off so close. And the men who fought and died, some in houses, others in the street.

The prolonged shootout from one house in particular, where Fakhir and several other men made their last stand, and the bomb that finally silenced their guns.

The sight of Azhar lying in the street, his crutch broken beside him, his empty eyes staring off into the heavens, one hand still on his weapon.

Abdul-Salam, shoving him into an abandoned house, and the two insurgents who came upon them a minute later. One had pointed a gun at Conrad, his face contorted, but before he could pull the trigger, a stray bullet from outside dropped him without a sound. The other had died only seconds later.

An eerie moment of silence followed, like the calm in the midst of a storm. Then the door burst open from a strong kick and soldiers flooded into the room.

"Don't move! Get your hands up in the air! Now!"

Abdul-Salam froze in his tracks at the sight of the soldiers, his eyes wide and terrified. For one eternal second, everyone seemed turned to stone, so still was the scene. Then time resumed its normal flow. Abdul-Salam's eyes flickered ever so briefly to one of the fallen weapons on the floor.

"No!" Conrad shouted, seeing the direction of the younger man's gaze. Too late. With a desperate lunge, Abdul-Salam dove for the gun. In slow motion Conrad watched the soldier turn, his head bent as he followed the other's motion along the muzzle of his rifle. The rat-tat-tat of gunfire filled the room.

Conrad collapsed to his knees beside the young man. He ignored the orders the soldier shouted, ignored the rifle now pointed at himself. But even as the blood stained his hands red and soaked into his trousers, he knew it was hopeless, that the wounds were fatal. Abdul-Salam's hands grasped his, stopping his attempts to staunch the flow. They were already slippery with blood. A twitch of the lips that might have been a smile, a final squeeze, and the light dimmed in his eyes.

"No... God..."

Rough hands pulled at him, hauled him unresisting to his feet. "You speak English?" Someone shook him until he nodded.

"Who are you?"

"Conrad... Conrad Ashton. I... I used to work in the city..."

"Ashton..." The voice paused. "Waitaminute! You're that surgeon that disappeared a few months back! There was a huge search..."

Conrad shook his head, suddenly too tired to listen anymore. He did not protest when they led him from the house, nor when they escorted him to a hummer and posted two guards. Shooting still sounded somewhere amid the small village of adobe huts. Something dug into the seat of his pants. He reached behind him, to his back pocket, and pulled out the battered silver cross on its broken thong. It lay small and almost weightless in his palm, smeared with blood from his hands. Conrad stared at it for a long time, until it grew blurred through the tears gathering in his eyes.

Fakhir, with his prideful mustache and the smile of a predatory cat -- he had provided the roughest, most honest counselling Conrad had ever received whenever he sank into despondency. The man had stopped the boys of the village from harrassing him, obtained medical supplies, and set up the tent for the wounded. And he had finally, just a day ago, introduced Conrad to his wife and daughter.

Then there was Azhar, the would-be soldier of God, who had hated Conrad with such a passion when he first arrived, and who had gone a week without speaking after his operation. In the end, he had gotten what he wished for most, to die in the service of God, a martyr for his beliefs.

And Abdul-Salam, the boy with the quiet, serious eyes and thougtful smile, with an uncommon gift for learning. His English had gone from minimal to fairly good during his tenure as surgeon's assistant, and he had begun suturing patients within a week of their acquaintance. And just the other day, in a moment of rare openness, he had told Conrad that perhaps he would study at the city when things returned to normal, so that someday he could be a doctor too.

Wailing rose on the air as tears slid down Conrad's face; they seemed an echo of his own anguish. One of the guards who had been left behind said something, his voice pitched to a reassuring murmur as his hand patted Conrad on the shoulder. His words lacked all meaning -- just a string of nonsense sounds. After eliciting no response, he went back to his comrade. Conrad watched them as though through a great distance, watched the alert eyes scanning for any sign of danger and the readiness with which they conducted themselves. They shared an air of surety and purpose, confident in themselves and their goals. And as the tears continued to fall, Conrad wondered whether he would ever find that confidence himself again.