Forty-One Months

William McGrath, 2014 BLR Nonfiction Prize Winner

Thato is a small sad boy who has come to stay at the safe home in Lesotho, up in the cloudvoid in the eastern mountains of Mokhotlong district. His mother is dead and his father is off working somewhere, possibly South Africa. His grandmother has struggled to care for him but is unable. Thato is severely malnourished and HIV-positive, three-and-a-half years old, with a tiny skeleton’s body and mournful eyes that swivel in their sockets as they silently scan the room, taking in foreign surroundings, trying to interpret this newest confusion, this latest question-with-no-answer.

Thato makes ten now at the safe home. But what separates Thato from the other children is that, on some level, he knows what has happened. Most of the babies—weeks old, months old—are too young to process their current circumstances. They don’t understand that their mother is dead, or their father by necessity works in another country. They don’t realize that their uncle the drunk won’t take them in, or their aunt doesn’t have enough money for food, or their cousin is in jail, or their sister is nine and doesn’t know how to treat abdominal tuberculosis. All they know is that suddenly they are being fed five times a day. Perhaps for the first time in their lives they feel healthy—getting meds exact to the minute—or at least the absence of pain.

But Thato knows, understands more than any child should.

It is his second day in the safe home. I am in the bedroom, playing with the babies before they turn in for the night. I take my baseball cap and put it on each of the kids’ heads, let the brim slip over their eyes, lights out. Each one clamors to wear the hat.

Thato is sitting across the room, away from everyone, staring at me. I motion for him to come over and he looks away. After a minute, I scoot a few inches closer, then hold my hat out toward him. Nka, I tell him conversationally, take it. He recoils. I move back to the other kids and keep the game going. Every few minutes I try to draw him in. Every few minutes he looks away.

Soon it is time for the kids to get into bed. Thato sees me getting up and breaks down. I am one more heading for the door. He wails, holds his arms out to me, begging, sobbing. He tries to crawl toward me but is too malnourished to drag his bony frame across the floor.

I pick him up and he grabs onto me, a featherweight jumble of ulna, radius, femur, tibia. He digs his tiny iron fingers into my clothing, buries his face in my armpit. His body is shaking. I can feel the notches of his spine, my fingers fit between them as between the laces of a football.

His tiny bones are kindling.

Doctors have come and gone. Thato has started antiretroviral meds now but seems sicker each day.

Sometimes I take him in my arms and we walk outside. He stares with infinite sadness at the cars and trees and clouds and birds. We listen to the river as it lightly cuts down through the mountain. A multitude of local beasts—cattle, sheep, goats, donkeys, horses, mongrel dogs—moves slowly past us, an animate freight train.

Thato raises his matchstick arm, points at the mass of animals, and says something I cannot hear, in a language I cannot understand.

Thato stops eating.

Our medical support is limited in these distant mountains, so we begin feeding Thato through a nasogastric tube. This arouses a passionate hatred in his tiny heart, a rare spark of life. He tries to pull it out every chance he gets.
After a few days, he grows resigned to the fact of the tube.

His eyes are veiled now, clouded over.

Thato spends two days in the hospital, a small cluster of understaffed and semi-deserted buildings near the safe home. Lesotho has no medical school, no doctors of its own, so the staff come from other countries, refugees from Zimbabwe and the Congo mostly.

Thato’s eyelids are swollen half-shut, but his mournful eyes still roam and swivel in their sockets, full of unwanted knowledge. His grandmother is here in the hospital room now, sitting silently beside him.

Someone has gotten word to her out in some distant village, where all word makes its way, eventually.

My wife Ellen and I are about to sit down to dinner when a deep foreboding takes hold of me, so we leave our food on the burner and head over to the hospital. We arrive right before the end of visiting hours.

Earlier in the day, Nyamatukwa—a kind and talented Zimbabwean doctor who works with us frequently—told us what to expect with Thato’s treatment: what should be happening with his IV, his meds, his NG tube. Nyamatukwa repeats the orders he has given the nurses on duty.

We arrive and ask to see Thato. A fat nurse eating cheese curls points toward a room, then redirects her attention to a soap opera.

We find Thato’s bed. His grandmother is sitting silently beside him, staring at the wall. None of Nyamatukwa’s orders have been followed. The IV stands next to Thato’s bed, disconnected; he is getting no nutrients, no hydration. The fat cheese curl-eating nurse has told the grandmother to administer Thato’s antiretroviral meds herself, but the grandmother has no idea how or when to attend to this task.

The grandmother’s silence in the face of this assignment—the highly-specialized care of her dying grandson while medical staff sit nearby watching TV—strikes me as a strange and terrifying passivity. My mind struggles to formulate a question that begins How can… but there is no proper ending to the question, only cultural forces beyond my understanding at work, issues of class or education or etiquette or power or fear.

Or maybe it is simpler than that: a grandmother confronting in silence that which has no proper analog in language.

I leave the room and tell the nurse to follow me right this second. Ellen shows her the valve on the NG tube that is draining the medicine from Thato’s stomach before his body can absorb it. The nurse turns the valve to the correct position and then returns to her station. It is apparent to me now that Nyamatukwa feared this exact scenario, although it would have been impossible for him to tell us this.

Visiting hours for non-family have ended. We make it clear that we are not leaving until the nurses do their jobs, until the IV is hooked up, until the meds come. We bring the full force of our white privilege to bear on the situation, and we feel—what exactly? It is hard to know. As Nyamatukwa taught me, there are some things that cannot be put so directly.

We sit beside Thato’s grandmother—this sphinx, this cipher—as her gaze silently floats to Thato, then to us, then back to the wall. It is impossible to know what she thinks of our presence here.

Thato’s mournful eyes roll and roam. I take his hand and he weakly wraps his fingers around mine.

After dark we watch heat lightning far off over the mountains, pulsing and rolling in strange silent sheets. The horizon is alive with electromagnetic ghosts, dancing ethereal shades of purple, orange, and yellow. We are sitting outside with some friends from town. The immense spiral arm of the Milky Way is bright overhead, a broad arcing smear of starlight.

The moon rises and charts its flagrant path across the sky. It bathes the road in cool light and awakens secret life in the willow tree that hangs over the turn in the river. Everything around us is still.

Look just there, someone says, that blur beside the spiral arm? That is another galaxy. Another entire galaxy visible to the human eye.

Something about the tangible sense of space—this galaxy beyond our galaxy—is intensely disorienting. Feet rooted on rock, gaze pulling elastically outward.

We’re so tiny, someone else says, so insignificant.

But that sense of cosmic desolation rings false to me, feels like puny cliché in the face of such grandeur. Something about the abyss embraces, something about the absence is intensely present, some strange fullness in the engulfing emptiness.

Thato dies that next morning. He had been alive for forty-one months.
As best I know, Thato spent those entire forty-one months in some degree of pain or privation. I can only hope that we gave him some small measure of comfort in his final weeks. I can only hope that we did not somehow increase his life’s accumulated suffering.

As the afternoon lengthens, an impermeable fog seeps over the mountains, something I have never seen in the year I’ve lived here in Lesotho, in this land of blank skies. The peaks surrounding Mokhotlong become hazy and insubstantial, a shadowy outline against the sky. By evening, the mountains have dissolved completely. Disintegrated.

Where are the platitudes we fall back on when someone dies, those battered bromides we deploy in consolation?

We tell ourselves not to mourn the death, but celebrate the life. We exhort ourselves to bask in those golden memories accrued over decades, to reflect on the joy that was increased over a lifetime.

But what joy has accrued over those forty-one months? What is to be celebrated here—besides the fleeting and guilty acknowledgement that Thato’s life of continual suffering has come to an end?

Several months later, we meet Thato’s father. We are staying overnight at the rustic alpine lodge at Sani Pass, near the border, where the mountains of eastern Lesotho fall away precipitously into South African pastureland. The terrain here is cataclysmic, dropping three thousand feet across the border.

Ellen tells me she recognizes this man—who is helping us carry our bags inside—as Thato’s father, a chance encounter that is not chance at all, but a fundamental part of Lesotho’s recursively looping nature, where all paths must cross eventually.
It is snowing now, the wind tearing over the edge of the mountains and into the drop. Once we are inside, we talk briefly with Thato’s father. When we tell him who we are, he begins smiling, the kind of smile that is an immediate response to pain.
“Oh,” he tells us, “thank you.”

“Yes, you are welcome,” we say, a response so absurd and unnerving that I feel myself drifting up and into the wind and off away over the edge and down.

One of the great and perverse joys of working at the safe home is seeing children come in ravaged with illness, devastated by hunger, eyes and veins sapped of vitality—and knowing that they will survive, knowing that they will prosper, knowing that they will grow fat and joyous and will one day throw a tantrum because a puzzle piece doesn’t fit properly. It has happened so many times this way. That is how I consoled myself with Thato when I held him—the brittle pencils of his bones, the pleading mournfulness of his gaze—I thought about how surprised he would be one day to discover himself fat and comfortable and annoyed that someone took away his ball.

What a great luxury—to have that mentality, to have the certainty of knowing that the house never wins, that the odds can always be beaten.

Some weeks later I see Nyamatukwa out at the public bars. We are both very drunk. His eyes are impossibly red, his smile as wide as the sky. We talk and talk and talk all night about soccer.

Mokete was once like Thato, maybe worse. His stomach dense and bloated, his limbs shrunken and skeletal, his only decorations those delicate curls of ringworm along his scalp, and his spine, running like a string of pearls.

But Mokete is here by my side now, this curious three-year-old, cheeks fat like two golf balls, a smile around the corner of his mouth like he’s about to whisper a dirty joke. He is wearing his red-and-white striped beret, his talisman over these last weeks. The beret was donated to the safe home and Mokete now becomes desperate when he cannot locate it. Today I find him lolling on his back in the nursery, one leg crossed over the other, hands behind his head, the beret pulled down over his eyes like a cartoon Parisian sleeping off his wine.

I steal him from the safe home, take him up to our rondavel after they tell me that Thato died this morning.

Mokete is watching me straighten the rondavel. He is sitting on the bed with a half-raised eyebrow. Now he toddles around the room as I fold laundry. Now he examines a small jade figurine of a hippo. He is content to be out of the nursery for a change, but occasionally he looks over at me, trying to puzzle out why I’ve brought him up here to do nothing.

We sit together in silence. We are beyond words.

I am standing alone in the full dark, staring up at the mountain. I am thinking about the baby that is growing inside Ellen, the silent galaxy of cells that will soon enough be a little blonde boy.

A light misting of rain springs swirling through the air. Suddenly—from somewhere above, up the mountain where there is nothing—a snippet of an American pop song comes drifting down. I can’t make out the words but they are achingly familiar.
Then the wind catches them and everything is silent again.