Malawi Dictation: Outing with the Lighthouse HIV/AIDS Clinic 's home-based care doctors

The home-care doctors say they've saved the most critically ill patient for last. We bump over the potholes in the dust road primarily used for foot traffic, watching villages appear and subside out the window. I notice awareness of me arrive in every person’s eyes as if it’s a wind that reaches everyone in turn. The eyebrows of women, men, children jump up as they catch a glimpse of me, and stay up, their faces locked on mine. The faces of the children come to life with true grins. To see such happiness on anyone’s face is a gift, but I feel left out—I don’t know what the happiness is, there’s something here I cannot see. I laugh anyway. I would like to share something with them, with anyone, but I can’t find a place where our thoughts can cross.

We pass a few dry empty fields, and then stop in the road. To our left is a track in the field leading to a small square mud house, with an open doorway that reveals only black. I step out of the car and enter the world outside my window.

It’s quiet and the air is warm and full of soft dust. Five kids stand 10 feet away from me, looking at me solemnly, as if not sure what I’ll do now that I’ve broken out of the car. I look at them quietly a moment, then deploy my widest grin. The answering volley of grins is so instant and bright that mine is stuck on my face, trying to stretch wider until it begins to hurt. Finally I’m desperate to relax my face muscles and space out my grins with periods of no smile at all. Each time I grin again their grins reappear with full wattage.

The doctor is ready, and gestures that I should start down the narrow track. A gentle seriousness has settled on all the contours of his face in the time it took him to gather his tools. We walk through the quiet of the field. I don’t see the patient until my foot has already touched the dirt step in front of his house, but he’s been sitting on a chair outside the door the whole time, watching us approach.

He doesn’t move his head to face the doctor when they greet each other, which I think is odd until it's time to proceed into the house. I understand then that he is only pooling and conserving his remaining energy, and every movement comes at a cost. We wait for him to complete his long journey to his bed, respectfully looking away. The room is very dark, but the shafts of light that angle in from gaps in the tin roof are beautiful. They look solid enough to hold. A great rainbow of pills is scattered in bags or trays all over the room; sherbet orange and white striped tablets, cherry red lozenges, periwinkle ovals. The doctor and patient begin a sotto voce duet of questions and answers. When taking measurements, the doctor is impossibly graceful as he loops the tape measure around arms that never grow wider than the wrists, and legs that never grow wider than the ankles.

I spend most of the visit staring at the patient's t-shirt. It’s a black shirt gone gray from time, and there is an even coat of dust worked into the cotton weave. Still, behind these obscuring veils an image of a haunted house presses through to be seen. A mummy, a werewolf and some suited creature with the traits of both Frankenstein and a vampire slouch insolently in the door frame. Bordering the image are red ballooned letters meant to look like congealed blood: I ESCAPED THE HOUSE OF HORRORS. I look at the residents of the haunted house. I notice that each has a power hold on the others. The werewolf stands at the back, clamping the entire circumference of the other monsters heads with one gigantic paw. The mummy has slyly wrapped a loose end of his bandage around the feet of his companions. Vampenstein flexes his fangs at the neck of the werewolf, and is prepared to strike the mummy with a spare bolt, a replica of the one through his head. All together it creates a system of immobility.

It's hard to believe escape from such a place could be more than a mirage, that it would ever cease to wield invisible holds on you. It’s even harder to believe after I notice that the trapped despair in the monsters eyes is reproduced perfectly in the eyes of the patient.

The visit is ending. The patient asks the doctor one last question, and the answer is my name. Suddenly there are great vibrations of energy from the patients bed; his limbs skitter around as he rallies himself to rise. He accomplishes standing, and in a great waste of energy reaches out his hand for mine, saying bleakly, “Thank you, Mr. Ellen.”

I return to my place behind the car windows again, carrying a thank you that does not belong to me. I wish I could give it to the doctor. I let my eyes look out the window without seeing as we drive home, so that I can remember the sick man.

Hello, Suffering, I say silently. So, now I have met yet another of your many faces.

I hollow out my mind to listen for a reply, but none comes. I’m not surprised. Not on any of its faces has Suffering moved its lips for me.