It Is 10 Dollars If You Come Here to Die

Monrovia at night

‘Hi!’ Jess says when she opens the hotel room door.

She smiles each time when she opens the door and sees that it is me returning from work. She smiles like she has not seen me in a long time and then she sort of tilts her head and bends one knee almost in a strange half-curtsy. I find that I have come to anticipate it - the smile and the wonderfully awkward half-curtsy - so that it taps the reward center of my brain to produce a shot of dopamine each time. It makes coming home to her an even finer thing.

‘I’m not well,’ I say to her on this day and her lovely wide smile quickly turns to concern.

I have been out of work all week and this is my first day back and I feel awful.

‘My throat is bad,’ I say as I come in and put down my messenger bag.

‘You probably need antibiotics,’ she said. ‘Let’s go to the hospital now.’

‘No,’ I say stubbornly.

‘Come on,’ she urges.

‘Let’s go tomorrow morning during work hours,’ I say. ‘I’m sick because of the apartment that they put us in!’

I know how I sound and I feel lousy about myself for sounding that way and for feeling the way I sound, but I made a good contribution at work today and now the chip is on my shoulder when I think about the mistreatment that I have received.

Jess urges again that we go to the hospital but I am a stubborn baby just now.

We eat and it hurts to swallow so that I am twice as slow as the absurdly slow eater that I normally am. Then we get into bed - actually we had eaten in bed because there is no table or chairs in our hotel room and we do not want to eat in the common area. Later, at night, we put the lights out and I lay there and I feel bad. The adrenaline from the activity of the day abandons me and I feel my sore throat close and breathing becomes difficult.

‘Jess,’ I say into the darkness, knowing that she is still awake because neither of us have learned to sleep sound or well here yet.

‘Yes?’ she says from beside me.

‘I think I need to go to the hospital.’

We walk the five blocks to the John F Kennedy Hospital because I will not let Jess call for a car-taxi and I refuse to ride on the back of a motorcycle-taxi. Also, I feel that the walking builds the adrenaline up in my system so that I do not feel so bad as when I lay in bed shallowly breathing. The security guards stop us at the gate but they let us through when Jessica explains why we have come.

‘Do they think we are here to steal something?’ I say because I feel bad and I forget that it does not make me feel better to spit venom at others.

‘Look at this field in front of the hospital,’ I say. ‘I could die here and no one would find me until the rain washes my decayed, MOLDY corpse to the street.’

‘Come on, Negative Nancy,’ Jess says.

Earlier in the day I called myself a ‘Negative Nancy’ because I got into a foul mood talking about the moldy apartment that has made me sick. Jess likes the label and now she is calling me ‘Negative Nancy’ intermittently as we walk to the emergency department.

‘If I die,’ I say, ‘you tell my mother that I died bravely. No whimpering or sniveling, ok?’

‘OK, Negative Nancy. Hang on. We’re almost there.’

‘On second thought, I’m feeling a lot better,’ I say as we approach the dreadful looking reception room of the emergency department. ‘I think we should go home and we’ll visit the SOS clinic in the morning.’

‘Come on. We’re already here, Negative Nancy,’ she says.

Then she tries to think what would be the opposite label so that she can be more encouraging.

‘Don’t be a Negative Nancy,’ she says. ‘Be a Positive Pauliana.’

‘Pauliana?’ I say. ‘Positive Peter or Pauline would be better.’

‘I like Pauliana,’ Jess says and then she says, ‘Be a Positive Pauliana,’ again as though to make it stick.

On the wall beside the entrance is a plaque that says Emergency Department and the door is open to the night air. The reception area is lit by a compact florescent bulb that hangs naked from the ceiling. The walls are bare except where printed papers with poorly written instructions hang by scotch tape.

'US$10 (ten dollars) charge for the pronouncement of death'

‘That one says it is 10 dollars if you come here to die,’ Jess whispers as we enter. She is referencing the processing fee for delivering a dead body to the Emergency Department.

Cobwebs, dust, and mold fill where the walls meet the ceiling and along the exposed rafters and unused light fixtures. There are two boys behind the reception desk and Jess goes over to register me. I sit in a plastic chair beside a pregnant young woman whose mother comes in shortly with the 700 Liberian dollars to pay the registration fee. After the mother pays, the nurse wraps the girl's arm to take her blood pressure and then the young boy who is a nurse’s assistant takes her to an examination room.

‘What is your problem?’ the nurse asks me.

‘My throat is infected,’ I say.

The nurse looks at me and sighs. I feel sick and put out but I think about not spitting venom. ‘She won’t kiss me when my throat is infected,’ I say, gesturing to Jessica who has come to sit beside me after paying the registration fee.

The nurse smiles as though for the first time tonight and I feel proud of myself for not spitting venom back at her. Then the nurse directs the boy to take my blood pressure. I am 120 over 70.

‘He will take you for the tests,’ the nurse says.

‘What tests?’ I ask.

‘Blood and urine,’ she says.

The face of patient care in Liberia

‘I have a throat infection,’ I say, ‘Can we do a throat swab instead?’

‘No,’ she says.

I get up to follow the boy.

‘Do you want me to come, love?’ Jess says.

‘Fuck yes I do. Don’t you leave me here,’ I say threateningly.

We follow the boy through a series of poorly lit hallways where the smell of mold and filth is heavy in the air. As we walk, the boy tries to solicit a job from me.

‘You see, we must work for 12 hours at a time so there is no time to study,’ he says. ‘Maybe your company has a job for me. It’s OK if your company does not work in health,’ he continues as though anticipating my response. ‘I can do any job. It’s just so I can study, you see. I will get your mobile number before you go.’

We wait outside the laboratory for twenty minutes and then I am called in. Another young boy who wears a lab coat pricks my finger and smears the blood on a microscope slate. Then he hands me a cup and the other boy leads me back through the corridors to a bathroom by the reception area where I fill the cup and then we walk back to the laboratory.

When we return, Jess is trying to take pictures indiscreetly but her iPhone lacks a flash and it is too dark here to take a picture without one.

‘I peed in a cup,’ I tell her.

‘Good for you, love,’ she says in mock condescension.

The Emergency Department pharmacy is behind the bars

‘I’m not well,’ I say to Jess because there is only us there as there is only us everywhere we go together.

‘You have an infection, Negative Nancy,’ Jess says.

The man in the white coat writes me a prescription for Cipro and an antihistamine and throat lozenges. The hospital pharmacy is closed and the Emergency Department pharmacy, which is a nook enclosed by metal bars in the hallway beside the reception area, does not have the prescribed items.

‘The pharmacy across the street will have it,’ the pharmacist behind the metal prison bars says, handing the prescription back to Jess. ‘Lucky Pharmacy is the one on the corner.’

‘You know, I've read studies that found that more than half the drugs in Africa are counterfeit,’ I say.

‘Come on, Negative Nancy. Let’s get your counterfeit drugs,’ Jess says.

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