The next day, the shit hit the fan.

“The twins died last night,” Idris said when Isobel arrived at the hospital. He was on the stairs, smoking, looking tired.

“Merde.” They had delivered them the day before, by C-section, and they had been horribly small. “How’s the mother?” she asked.

“Her family came to get her.” He let out smoke, stared into the distance. “Do you feel it?” he asked after a while.

Isobel nodded. It was there, an unease, palpable in the air. A new silence, a low pressure, an absence of sound. A foreboding that something was about to happen.

“Some of the staff have disappeared,” he said, taking another drag.

That was often how it started. The locals were the first to know. A rumor, spreading quickly during morning prayers. Men, secretly arming themselves. Women, seeking shelter for themselves and their children.

She followed Idris into the hospital, wondering where Marius could be. It was warmer than before, and she slapped her neck. Was it her imagination, or were the insects biting even harder today?

“We have a lot of patients,” Idris said as he washed his hands. He clutched his notepad. “I need to go back to ICU. Can you look into this?”

He gave her a handwritten note.

“What is it?”

“They came in this morning. Boy. Two years old. Trouble breathing. They’ve walked for days.”

“So far? Where from?”

“The desert. His blood count isn’t good.” Idris shook his head. “They should’ve brought him much earlier.”

“I’ll take it.”

Idris disappeared, and Isobel left to find the family. She quickly greeted the father, Muhammed, a tall, serious man with a tattoo of a bird’s footprint on the entire left side of his face. The mother, Halima, who didn’t look a day older than fifteen, sat with the boy in her arms.

“What’s his name?” Isobel asked softly as she glanced at her patient.

“Ahmed,” Halima whispered. She was dressed in a piece of colorful fabric, dusty with sand. She had a tattoo similar to her husband’s on her cheek.

As Isobel examined the boy, he was silent. That was never a good sign. A child who cried, protested, or screamed was a child who still wanted to live. When Isobel tried to give him an injection, he was so dehydrated she couldn’t get the needle in.

“Medicine,” the father snapped. “My son needs medicine.”

Yes, Ahmed needed medicine. And nourishment. If only they had been able to get him here earlier.

She filled a pipette with a nutrient solution and gave the parents what she hoped was a reassuring and confident smile.

“Give him this. A drop at a time until it’s finished,” she told them, hoping it would be enough.

“Where are you going?” the father asked, blocking her way. “You’re the doctor—you have to stay. Help my son.”

“I will come back. Give him the drops. I need to see my other patients. I’ll be back as soon as I can, I promise.”

Muhammed stared at her, but then moved out of the way. Isobel smiled encouragingly at Halima, who had already started to give Ahmed the solution. She moved on to her next patient. And then the next. She met with mothers and grandmothers, fathers and siblings, and of course with sick children. Listened to their hearts and lungs. Prescribed medicine, injections, and oxygen. Gave instructions to nurses and tried to have a smile for every tiny child she met, an encouraging word for every parent. Coming to a hospital run by Westerners took a great deal of courage, and she acknowledged that fact. Being a young mother, daring to seek Western medicine for your child instead of going to the local medicine man was an act of bravery.

“Hello, Fatime,” she said to a young mother in her twenties. Fatime had clever eyes, looked tired but resolute, and had her own mother in tow. Fatime had a two-year-old in her lap.

“My daughter, Zara,” she said.

Isobel examined the petite Zara. She was two years old but weighed less than a one year old. Her complexion was pale and she was coughing, but she gave Isobel an angry stare when Isobel measured her upper arm. Isobel smiled. An angry child meant there still was hope.

“Your daughter is strong,” she said.

Fatime nodded and smiled faintly. “Very,” she agreed.

“How many children do you have?”

“Four.”

Isobel didn’t ask, knowing that if Fatime had four living children she’d probably buried as many. She listened to Zara’s lungs. Prescribed medicine for her. “She has a fever, and she is underweight. We need to keep her here, for observation.”

Fatime nodded in agreement, and relief rushed through Isobel. Sometimes it was difficult to get them to stay. But Fatime seemed intelligent and strong-willed. Maybe this little girl would survive.

“I will come back. Please, eat something. You have to be strong. For your daughter.”

Fatime nodded regally. “Thank you, Doctor, I will.” Their eyes met in one of those wordless connections. Two women, born in different parts of the world but with the same determination to keep this little girl alive, to make a change.

Isobel left the family and continued on with her work as the scorching Chadian sun climbed the sky.

When Isobel came back to baby Ahmed and his family, the little boy did actually seem slightly more lively. This time she managed to get the needle into a vein, and she set up a drip. Maybe little Ahmed would make it after all. She stroked his head, nodded to his parents, trying to instill some hope, and then left again. This was a frustrating aspect of her work, that she never had time to stay, that the overwhelming stream of patients forced her to be hard, made her seem uncaring, when in reality it was all about trying to be there for as many patients as possible. She worked without break all day; the hospital was completely full, and there were two small patients in almost every bed.

Next time she came back to Ahmed and the family, it was already afternoon. She had seen over a hundred patients, hadn’t had time to eat, barely had time to drink, and was covered with dust and sand. Ahmed was wrapped up in a foil blanket.

“How is he?” she asked the nurse, who slowly shook her head.

His breathing was hoarse, and she prescribed oxygen for him, profoundly thankful that the last of their machines still worked properly. She checked the small boy’s pulse and temperature. Listened to his faintly beating heart. Shone a light in his eyes, finding no reaction. There was nothing more she could do, not here in Chad anyway. Had she been at home, she knew she could have saved this child. But now, despite the drip, despite the blanket, even though she’d done all she could, the baby had started to disappear. Slowly and silently he was slipping away, dying before their eyes. His tiny head fell to his chest, which was no longer moving. She listened with her stethoscope, though she already knew it was over.

She laid a hand on his little body, felt the warmth slowly vanishing, before she braced herself and turned around to face the parents. She looked first Muhammed and then Halima in the eye, and shook her head.

Halima put a hand to her mouth and started to sob silently.

Isobel felt the tears well up in her own eyes. It was so horribly unfair.

“He was doing better before we came,” said Muhammed. His voice was taught, his face drawn. They were a proud people, Chadians, but this father was on the verge of crying.

“He was very ill,” Isobel said gently, wishing she had some way of easing the brutal blow of losing a child.

Muhammed took a step toward her. It was a sudden movement, but she wasn’t scared. Not yet anyway.

“He died when we came here,” he said through clenched teeth. Anger flashed in his eyes.

“Your son was very sick,” she said.

He took another step toward her and suddenly there was a knife in his hand. Isobel froze. Weapons were forbidden in the hospital, but it must have been hidden in his clothes. He held it up to Isobel’s face.

“I’m sorry,” she said, trying not to flinch, to sound calm. Could anyone hear them?

“You killed him. With your medicine.”

She started to move toward the curtain, hoped someone would get there before the situation got even more out of hand.

“Please, put down the knife. I did everything I could. He got the right medicine, but he was weak. His heart couldn’t cope.”

She had been in threatening situations before, but you never got used to having a knife waved in your face.

Muhammed’s eyes narrowed, and she wondered whether she would have time to push him away before he managed to stab her. Goddamn it, he was too close. Merde, merde, merde. She didn’t dare look at Halima. How could they have missed the knife? Everyone carried knives here, but the hospital had guards—it was their job to guarantee safety.

“Docteur!”

Marius. “No, Marius. Go,” she said.

Muhammed turned his head toward Marius. Waved the knife, said something in Arabic. Isobel didn’t dare to move, afraid now for Marius more than anything. “Don’t hurt him,” she pleaded.

Suddenly, the curtain moved back and Idris came into the room.

“Enough,” he said calmly. He moved his considerable frame between Isobel and Muhammed. “She’s a good doctor. She did all she could. Your son was ill. He is with Allah now.”

Muhammed gave her a look so full of hatred she actually shuddered, but he slowly lowered the knife. She nodded to Marius and he turned on his heel, disappearing again. Thank God he was safe.

Idris held out his arms as though to protect her. “Go on, Isobel, I have this.”

“Are you sure?”

“Go.”

Isobel backed out of the room and walked on shaky legs to the office, where she slumped into a chair. She took out her water bottle, drank, and closed her eyes. The sun was setting, she realized, and at that very moment she heard Hugo’s voice.

“Docteur? We must leave. The streets are not safe tonight.” He sounded stressed, and his eyes darted.

“Is it that late already?” She hadn’t even had time to eat today.

He gave her an urgent look. “Come.”

She stood. Caught sight of a shadow from the corner of her eye. It was Marius; he stared at her with wide, frightened eyes. Jesus, he’d just been threatened with a knife. He must be scared. Where would he go tonight?

“Docteur,” the driver repeated.

She hesitated.

Idris came into the room. “They left. Go home now, sleep,” he said calmly.

Isobel glanced around for Marius, but he had vanished into thin air and was nowhere to be seen. She gave up. With a heavy heart, she climbed into the car.

When she got back to the house, she took out her cell and headed for the corner where the Wi-Fi was strongest. Miraculously she had a signal. A satellite must have just passed over. She called Leila.

“Did you hear anything?”

“No, what’s going on?”

“I don’t know. But it feels unstable. Could you check with the State Department? And with the security company?”

Leila promised to get back to her, and Isobel hung up, completely drained. When you went on trips for MSF, there was a huge safety apparatus behind you, but Medpax was small and she had to trust her own experience and whatever Leila could do from home. Unease crept through her.

The cook came over and placed a bowl of stew in front of her. “Merci,” said Isobel.

She switched on her laptop. Opened Skype.

Alexander must have been waiting for her to appear, because he called immediately.

“And how are things in Chad?” he asked with a wide grin.

Isobel blinked rapidly, fighting the tears that were welling up. She had hoped to put her feelings to one side, not give in to them until she went to bed and could cry in solitude. But now they just bubbled up, like a physical reaction. It wasn’t something she could control, and from one second to the next, something within her just snapped. She couldn’t utter a single word as her tears fell uncontrollably.

“Isobel,” he whispered softly from the other side of the world. “What’s happened? Are you okay?”

She wiped her eyes, but the tears continued to roll down her cheeks and she couldn’t do anything about it.

He stayed silent as she cried. She grieved for the lives she hadn’t saved, cried for the little boy who’d died, those lives she wasn’t able to change. The abandoned and constantly frightened Marius. Her fear with the knife pointed at her. The poverty that made people do desperate things.

“Life is just so hideously unfair,” she sobbed.

“Yes.”

She dried her tears, tried to compose herself.

“Sorry,” she sniffed.

He held out a hand. It looked as though he was stroking the screen, as though he was trying to touch her. She placed her hand close to his.

“Thanks,” she said. “Thanks for calling.” He had no idea how much it meant that he just let her cry, that he didn’t try to soothe. That he just was there, steady, calm.

“Do you want to talk about it?” he asked.

She shook her head. “Not today. It’s too fresh.”

“If you knew what a hero I think you are.”

“No, don’t say that word. I hate it.” She was no hero, she was just an inadequate doctor.

“Okay,” said Alexander.

“I’m so tired.”

“Go to bed. I’ll call tomorrow at the same time.”

She sniffed again. “Thanks.”

Isobel had trouble sleeping. She lay awake, listening through her mosquito net, imagining she heard things, whispers in the night, drums in the distance.

When she came down in the morning, it was dead silent, no sign of the cook. Neither Skype nor her cell would work, so she sat down and sent Leila an e-mail instead.

How the hell had people managed before the Internet, she asked herself as she waited for an answer. It came almost at once.

Preparedness has increased. The situation is seen as unstable. You should start to think about heading home.

Isobel read those short few lines. When had the situation in Chad ever been anything but unstable? She didn’t want to leave. It might even be over by tomorrow.

I want to stay.

She hit SEND, closed the computer, and went out to see if Hugo had arrived. When he approached, his face looked haggard and, as she climbed into the front seat next to him, she could sense the stress in the vehicle.

“Thanks for coming,” she said.

“It’s dangerous now,” he clipped out.

They had traveled this road every day for over a week and never been stopped.

Today, the road was blocked. A cart stopped them from passing. Two men, armed with automatic weapons, waited alongside it.

Hugo swore and pulled over.

Isobel studied the roadblock, feeling her pulse skyrocket.

Dangerous, so terrifyingly dangerous.

She didn’t dare look at Hugo as the two armed men, no more than teenagers, came toward them. One stopped in front of the car and the other came over to the window. He stuck his head in and looked around.

Isobel averted her eyes, made herself as invisible and unthreatening as she could, let Hugo do the talking.

“Where are you going?”

“The hospital.”

“Who is she?”

“Doctor.”

She held her breath. Counted the seconds in her head, conscious of the smell of fear and adrenaline.

“You can go,” the man eventually said, and motioned for his friend to move the cart. They drove slowly past, and Isobel could barely breathe.

But they left without incident, and when Hugo stepped on the gas, the pedal to the floor, she leaned back in her seat and breathed out.

When she looked at Hugo, she saw that his knuckles were white.

“Bonjour, Docteur.”

One of the hospital’s anesthetic nurses came out to meet Isobel when the car stopped and she climbed out.

Hugo rushed off so quickly, she didn’t even have time to say good-bye.

“We didn’t think you would come today. Have you heard about the fighting in the neighboring village? People have been killed. We’ve already received casualties.”

“Here?”

“They don’t care that we’re a pediatric hospital. But Doctor Idris will be pleased you are here.”

Fighting.

Isobel knew what that meant, had seen it far too many times. Raped women. Wounded men. Terrible wounds from machetes and guns. Injured children.

“We’ll have to put them in the hallways,” said Isobel. “Do we have blankets?”

Side by side with those of the staff who hadn’t fled, she dressed wounds, put splints on legs, and stitched up injuries. She had no time to think of anything but her next patient, no time to be afraid. She just worked, methodically, washing blood, sewing, trying to be a beacon of strength in the stormy sea of blood, trauma, and chaos.

When the sun began to set and Hugo failed to appear with the car, it was an easy decision to stay in the hospital overnight, although it was against all safety regulations. Isobel and the rest of the staff took turns sleeping a few hours every now and then. The stream of injured people petered out toward dawn, but the hospital was so full that there was barely room to move between the patients. The stench from bad wounds and the screams from the patients were a blanket of anguish over the hospital.

“We need to start to discharge the people who can leave on their own,” Isobel said, forcing her voice to be steady, refusing to give in to fear and worry.

Idris nodded. His face was gray. He was sneezing.

“Are you ill?” she asked. He looked awful.

But then so did she probably.

“I’ll start to discharge people. Do you think we can hope the worst is over?”

“Hope is free.”

“Docteur Isobel?”

She turned toward the voice; it came from one of the local staff. “Oui?”

“You have a message in the office.”

Isobel headed over.

Knew what she was about to hear before she even sat down. She picked up the satellite phone.

“Hi, Leila, how are things?”

“You’re coming home tonight. I’ve managed to talk my way into getting you an empty seat on one of the Red Cross planes.”

Shit, I don’t want to go.

“That’s an order,” Leila said, as though she had read Isobel’s thoughts. “Not negotiable in any goddamn way. You’re coming home. Don’t even think about arguing with me.”

Idris had come into the office, and he gave her a questioning look. It wasn’t so strange. Leila had shouted so loudly across the line that Isobel’s ears rang. She placed a hand over the mouthpiece.

“She wants to send me home.”

“I thought so. She’s right. You’re White, Western. And a woman. It’s too dangerous. Go. We’ll cope.”

“But the patients?”

Just give me a sign, any sign, and I’ll stay.

“Non, Isobel,” he said firmly. “It’s time.”

He stood up and held out his hand. She did the same and gave it a firm shake. Long.

“Au revoir.”

See you again.

She hoped he was right.

Today Hugo was waiting outside the hospital as though nothing had happened. She didn’t dare ask why he hadn’t come the day before. Didn’t ask how he knew she would be leaving today. She just sat in the car and allowed herself to be driven back to the village. The feeling of defeat was like a bad taste in her mouth.

There were no roadblocks this time.

The road was empty, as though there had never been any teenagers with automatic weapons and empty eyes, and they arrived in Massakory without incident.

Isobel went into the building, gathered her bags, left as much money as she could for the cook, if she were to come back, and then stopped. She thought of Marius. If things were different … But it made no difference how unfair life was, how much it hurt. There was nothing she could do for him now. He was one more in an agonizing line of children she’d had no choice but to abandon. She left the chocolate bars behind, went out, and got back into the car. Ten minutes later, she and Hugo were on their way to N’Djamena and the airport.

Alexander couldn’t sleep. Isobel hadn’t answered on Skype the day before. Leila had talked about unrest. It was as though his body wanted to turn itself inside out with worry. He had spent hours Googling field doctors and conflict, but he’d had to force himself to stop.

Now he just stared out of the window.

Waited.

The phone rang. It was Leila.

“Yes?”

“I’m bringing her home. The rebels tried to take the neighboring village.”

“Where is she now?”

His mouth was so dry he had trouble talking.

“Wait,” Leila said, and disappeared.

He waited. Focused on breathing. On not freaking out. He pressed the phone to his ear, tried to force Leila to hurry, to tell him what was going on.

The rebels tried to take the village.

What the hell did that mean? Was there a war going on? It was surreal.

“Hello?” Leila returned.

“What’s going on?”

“Isobel is on her way back. I just got confirmation. She’s traveling with the Red Cross from N’Djamena; they had a plane to Paris, and she got on at the last minute. There was a bit of chaos, but it seems to have calmed down now. I talked to Doctor Idris Toko. The hospital is secure. It was some kind of power battle between two clans. It’s over now.”

“But Isobel is still coming home?”

“Yes. Definitely. She’s spending the night in Paris and gets to Arlanda Airport the day after tomorrow.”

Alexander hung up.

And then he started to pack.