the boy, as of 9 am this morning, is working to breathe. he is leaning forward, balancing his tiny shoulders over his big belly, trying to increase the space inside his lungs, hoping to pry open even one more tiny alveoli and squeeze some oxygen into it.

the boy, as of 9 am this morning, is working to breathe. he is leaning forward, balancing his tiny shoulders over his big belly, trying to increase the space inside his lungs, hoping to pry open even one more tiny alveoli and squeeze some oxygen into it. last night, we started the hospital generator so we could use the oxygen machine and give him some help. it kept him alive this long.

last night, as he was struggling for breaths, i was struggling to sleep. it is not a new one. years old. decades. as i start to tip, i realize that i am and become glad. the realization wakes me and i find myself in an uncomfortable flat landscape, wind whistling by, the possibility of being struck by a live thought from any side.

...... the boy... did i use humidified oxygen... i did.... what haven't i... no... tomorrow.... figure it out tomorrow..... (yawn) ..... oh, good.... here i go.... sleep... no...... Thursday today..... how many left...... shhhhh..... tired...... quiet..... the event horizon of a black hole...... that's what i want to be..... no thoughts.... nothing in... nothing ou..... silent.... black.....

two days ago, i was walking home in the rain. in the distance, i heard the sound of a siren. oh, i thought, an ambulance. i guess they are on their way to the hospital. wait a minute..... what? ambulance? from where? people arrive on donkeys.

the sound approached, and a white truck with an ambulance stencil on the door flew past, its siren informing only me and a frightened goat of the emergency it held. i suspect that when you are considering becoming the driver of a new ambulance in a land of donkeys, the chance to use the siren is a firm pro.

it was new. from agok. it was the first i had seen of it. the emergency it contained was a woman who had delivered a child eight days ago. in an effort to clean her after, they had doused her perineum in boiling water. she had thick burns around her vagina, on her buttocks. three days ago, she developed diarrhea and the burns were deeply infected. the child had died because she was in too much agony to feed it. she spent eight days in the bush, screaming.

... black..... crowsnest.... i bet i could fall asleep in a crowsnest.... wind... curled up on the wooden planks.... listing back and fort..... clouds above wind... starless.... tilt.... tilt......

yesterday, i was administering medicines in the TB area. developing the program has been a priority for me here. i was cutting foil pill pouches into correct numbers, to make sure taking the correct amounts is as easy as possible. dozens of patients walked in and out, some coughing, others not. i weighed them, talked to them, lauded their commitment, listened to their story. i watched an inpatient, our newest and sickest, leave the recubra where we placed her because of our bursting rooms. she was leaning on a long stick which she would plant in front of her, then catch up with it. in the morning sun, they cut the thinnest of shadows. she slowly picked her way across the field, leaned her back against the wall outside my door, and slid down until her head, hanging between her sharp shoulders, hung between her sharp knees. i finished with the patient in front of me, rose and tapped her shoulder. she is deaf. she stood, shakily, and sat in the chair. i started to cut the foil. as i did, shrill cries came through the window. i knew what they meant. i kept cutting. Margaret came to the window, and pressed her forehead up against the wire mesh.

"you know where that is from, don't you?", she said.

i did. the baby her and i spent three days feeding from a syringe had died because, at some point, we went home to feed ourselves. i finished cutting the pills, and explained through gestures as best as i could how to take them. more wailing. i gestured for the next person.

.... tilting..... a hard, blue iceberg...... take an iceaxe and chip out a chair..... sit..... watch the ocean float a fleet of ice..... sun glancing glinting through cracks..... cold bright light.....

margaret and i walked home from the hospital together. i told her that i see her going through a similar transition that i did. you feel that if you leave the hospital, let your guard down for one second, someone might die. for fear that it will not get done, you take the syringe and feed the child yourself, you hold it, fret over it. it becomes a symbol of your success, the reason why you came in the first place. if you can't save them all, if you can't be there all of the time, at least you can save this one, at least you can be there for this one. so, you try. you keep on looking after him. even in your sleep. you hang on too tightly.

.....cold...........statue.... crawl into the middle....cold brass.... dark....curved..... echoes......

a few years ago i wrote a list of ten things i wanted to do before i die. sleep inside a statue was one. i have no idea why, but i have a strong imagination of how deep the sleep would be there, the sharp smell of brass, only the most insistent rays of light bending around corners, muffled museum echoes. i have eyed the henry moore outside toronto's AGO. it has the right curves, but it is not as deep as my dream.

that tapping mirror bird is at it again. click click click. and me, i am off to the hospital.