Juan Peten climbed the mountain, cut the wood with his machete, and hauled it down on his back. He had been doing this, two trips per day, for thirty years. He wore the same slacks, the same shirt, and had no shoes. He didn't know the date, or even how old he was. But often he thought about his daughter. He remembered the stove tipping, flames up the front of her dress engulfing her. The horrible screams. He hadn't made the long trip to see her in the hospital at Santa Ana since the rains had started. In the evenings he plays flor, a card game, with his friends in the Cantina.

Recently he told them:” The American doctors are coming. They will bring a miracle.” “Un milagro,” he would repeat, with his eyes fixed on the cards in his hand. “Un milagro.

“Are you all right?”

I returned to the man sitting next to me, a mestizo, who looked worried. I gave a split-second smile, the kind you give when you don’t feel like talking, and answered, “Yeah, I’m okay.”

I buckled to the belt and sat with a hollow feeling. Then engines roared, the plane pitched ahead and sped down the runway. We lifted off. I looked at the air terminal, built by the army, neat and tidy, with, in big letters, EL Salvador—The Savior, I thought. People were lining the second-level deck, waving. I waved back even though no one was there for me. As we gained height, I could see a prison, with its walls and wires and sentry boxes to keep the prisoners in check. A few of them were milling about the yard. As the plane lifted, I could make out the layout of the land, the soft green mountains pitched up, as if held by tent poles, in the horizon. The flatlands were efficiently checkered, like the Midwest, with fields of sugarcane and cotton. We swept over a mountain near the capital, where, once with enough altitude, we could peek over the rim at its lake with the surrounding houses. We swung around—a few more mountains, then a beautiful panorama of this sad nation. Ahead was Guatemala. I pointed out the window and asked the man next to me, “What’s the name of that mountain?”

“Cerro Nejapa. It is a volcano.”

I held my breath and squinted for a view. Several roads snaked up the sides, going as far as possible before petering out to a virtual jungle or perhaps coffee. The scattered houses, huts, and lean-tos, thinned out as well. Short of the summit, I could see one more house, surely the home of another campesino. Someone, a worker, was still higher. I strained to see if he might be carrying wood on his back like Señor Peten, but it was too far. I arched and felt myself pressing, muscling against the window. I rose up and tried to angle down for a good look. The plane careened away, then the sun produced a horrible glint of silver streaks across the window. The view was gone. I could no longer see the man, the volcano, or even El Savador, and I sat back in my seat. A dark cloud was off to the West with the last bit of sun coming through.

“Are you Salvadoran?” the man asked.

“Me? No. Not at all. American.”

“Tourist?” The man was insistent. I was unfair. He was just being friendly.

“Medical mission. Surgery for the children.”

“That’s wonderful. I’m Salvadoran. Let me shake your hand. A hero.”

A hero, I thought.

He added, “You sacrifice for our por. God bless you.”

The man wanted a martyr. Little did he know. My mission was self-rescue, a validation, not altruism. I could have told about the events that led me here—how I flung a Coke across the room to where my wife sat and she delivered divorce papers the next day. Maybe mention of the scene in Surgical Grand Round where Dr. Wagner pilloried me by announcing I was on probation. Oh I had their blessings for my trip—my wife mentioned malaria and death squads as I slammed the door.

Perhaps the senor deserved to have seen me the night before departure, crushing Colt-45 cans and tossing the critical list of stand-by anesthesiologists in the trash. It was my daughter’s ninth birthday, and all I got was the answering machine.

The explanations were too complicated. He wants to believe I’m a hero—let him. I won’t see him again. I turned to him and gave him a softball, “Well, it wasn’t really a sacrifice. It was a good experience for us.”

“Let me show my family.” He pulled out a photo from his wallet. There he was in a suit, big Tijuana grin, with his arm around his wife, who was also beaming. Two obedient sons, smiling and well-scrubbed, and a daughter.

“That’s nice.” I couldn’t take it. I put my head down, and cupped my hands over my ears. I thought, what did I do wrong? I went over the details.

It was the first day, I was in the evaluation clinic. She was slight and bent or twisted, I wasn’t sure—almost, I don’t know, tubercular or leprotic. Barefoot and alone, clad only in loose hospital-issue shorts which were a light beige revealing nothing underneath, she did what she was told and sat on the table. With aplomb, she seemed to say: Okay, let’s talk, surgery? Fix me.

“¿Dónde vives?”

“En un volcán.”

I turned to the nurse. “Yes, jefe,” she said, “she lives on the volcano.”

“How old are you?”

“Diez.”

Ten? She looked six. But god, all the kids here look a fraction of their real years—stunted by the mix of genes, the sapless food, and the worms squirming through their bodies. “What is this from?” I was pointing to her chest and neck which was covered with a mottled scar, a resplendent scarlet layer, flecked with thick white plaques. It contracted her neck to the point that her chin, drawn by sheets of scar, was flush on her chest. Her head was in a constant tug-of-war to crane up causing her mouth to be spouting, like a gargoyle. I gazed and winced, then whispered, “From a burn?”

“Sí .”

“When?” I said, keeping my Spanish simple and clear.

“El veintiséis de diciembre.”

Well, that’s exact. My limps whispered, Merry Christmas. “And from what?”

“La estufa se arruino.” I could see the war zone, at the waistline, where her shirt had incinerated, that day the stove toppled with the coals spraying on her. I followed the scars—the heat roared up her chest to her throat, where it melted the protein into a glue. Managed in our country this girl could gaze at the stars. The lack of basic burn care from their ignorance, the hapless submission to third-world level of care, had allowed her chin slowly to fuse onto her chest—anger colored my assessment. I put my hand on her sweet head, and with my fingers combed her raven-black hair, twirled the banded tuft gathered on top. I’m an important surgeon from the Estados Unidos; my bag is a magical cornucopia of miracles and promise; from my fingers fall stardust; your little El Salvador rumbles when I walk—do you hear me? That’s what I believed as I rubbed her chin. Her eyes were screwed up and her mouth agape, as she angled for a view. I squatted, bent, and peered at her face. A long code of despair over her face came to a halt and gave away—to a smile. Trust me, Rosita.

I asked myself, “How many more?” and peered out the clinic into the hallway. The activity stopped, and the noise became a hush. A hundred round faces, and dark eyes looked at me and pleaded. Mothers clutched their children. They had made their trek, like a pilgrimage, across El Salvador to seek us, responding to the notices on the radio and in the newspapers. The look of the parents told me that our whim was their only chance. I closed the door and the nurse nodded her head as if to say, welcome to El Salvador.

“Maria, how long has Rosita been in the hospital?”

“Doctor, for six months.”

“Six months. Where are her parents? Why is she alone?”

“Jefe, they live on the mountain. It is very far up. There are no roads. Too much mud,” she said as she threw her hands up. I finished the first patient at ten o’clock and the nurses congratulated me with a warm Coca-Cola. When I drank it in one upward swing and burped, they laughed and got me another. As I was packing, a surgeon from Guatemala, our coordinator, stopped me. “Don, that is sixty-six kids you saw.”

I rubbed my stubbled face in my hand and said, “Not bad, for a lowly resident, huh?” I pulled at my shirt stuck to my chest. “Boy, do I smell. Listen, do you know anything about the assignments, like where I go?”

“Yes, they assigned you with Ted Cavet. I hope you don’t mind.”

“Who’s Cavet? Why would I mind?”

“Oh, he’s not here yet. Ted Cavet. Where do I start? Irascible. Aloof. No, just kidding. I don’t want to scare you off. I met him here last year. He’s an older plastic surgeon, from Sacramento, a real rolling stone. Here now, next thing you know—where’d he go?”

“So, I’m stuck with this weirdo? Great. Ah, what the hell. Listen, do you have a Rosita Morales Peten on your list?”

He pulled out a sheet. “Let’s see. Here she is. Yeah, she’s Ted’s, for the day after tomorrow. Oh yeah, she’s the one with that huge burn. Nobody else wanted that one."

“Why not?”

In his thick accent he explained, “Not like in the U.S. They’re a hell of a lot of work, shaving all that skin off the legs with one of those old dermatomes. Then like doing a jigsaw puzzle, trying to get hundreds of curly shreds of skin to fit together and stick to the wound. The dressing changes are tedious and the kids hate you for all the pain. Sounds like fun, huh?”

Ted Cavet wore corduroys, a light blue shirt, sneakers, and carried a black shoulder satchel. His hair was short, looked choppy like it was lopped with scissors, pure gray and scattered. He had a craggy face that revealed a long exposure to the weather and still withstood, as faces go, with the squint and faraway gaze of some displaced artist, say Paul Bowles. I had this picture of him: leaving behind, untouched on an oak desk in California, his blue chip portfolio—and instead, being jostled and pawed in some sweaty packed San Salvador but station, with his bruised luggage straining at the cinches, and the old familiar skirmish in his bowel. There was no picket fence for this curmudgeon.

“Hello, Ted, I’m Don Rhea. I think we’ll be working together.”

He was more occupied at the moment with his packs of petrolatum gauze than the courtesy of a handshake. Hey old fart, either look up or you can do your own retractions.

“Well Danny, good,” he mumbled, head down, as he was sorting his supplies. “We have the number four OR. Last of the draw. But shit, that’s my lot in life. ”

“Number four, it’s the only one not air-conditioned, and it’s the size of a …”

“A mausoleum,” he said, never looking up. “Say, can you find some more gauze?”

The next day in the hospital, walking through the tropical air of the outside hallways, occasionally distracted by the scampering lizards, I caught a glimpse of a ward, obstetrics and gynecology. I paused and looked in. It was like peeling ways the layers of several decades, gazing into an aged photo like one of those reverently hanging in any Chairman’s office. The room was the size of a warehouse, where from one bed you could look across twenty others. The nurses were like actors on a stage, oblivious to my spying. They had crisp blue dresses, wore caps balanced over prim hairdos, and moved gracefully in total equanimity balancing their pans and pitchers. Behind them the mist was caught by the diagonal shafts of sunlight.

I entered the next ward, pediatrics, carefully stepping through the children gathered in front of a TV with a fuzzy screen and tin foil draped on the ears. Proceeding toward the far side, I scanned, methodically along one wall and across the back. My eyes abruptly stopped at the familiar sight: a bowed head, a red ribbon, and those hospital-urchin shorts—it was Rosita. She was standing by one of the cribs, balanced on one leg with the toes of the other curled on her shin, talking to another girl who had her leg in traction. At that moment, her body softly, shyly, lurched back in a move to look straight ahead, with that sprig of hair pointing skyward. She pivoted, tapped her friend, and pointed with her fork at me. I walked straight over to her. Towering over her, I could sense an obeisance to my stature. We stood like that for seconds gauging each other, then she arched far back, then farther, as if to say: So talk to me.

I leaned over, which wasn’t good enough. I got down on my knees and evened the view. I put her plate down, with the glop of refried beans, and sat on the floor. I met her friend and heard about her dog, named Pancho. Her father, she said, was an intelligent man who brought back wood from the mountain. She told me her favorite place in the hospital, the newborn area. They let her carry the laundry. It was a conversation buoyed by, not content, but smiles and expectation. I jokingly told her she would come with me to the United States. She turned red and buried her head in her friend’s chest. My mind was dancing ahead, envisioning in Connecticut an orchestrated series of operations to return her to full function. I pictured taking this chiquita to see the Nutcracker Suite, the Statue of Liberty, and Lake Winnipesaukee. But here in Santa Ana, we’ll operate, stay within our limits, and pack up.

I delivered the news—tomorrow we operate. When I reached the door, I stopped and turned. Two girls giggled and quickly ducked their heads together.

In a restaurant I was sitting alone at a long wooden table while a Mexican guitarist in black pants with white frills strolled, strumming and cooing another heartbreaker. Ted walked in, making us the first two arrivals for dinner. I wondered if he would sit with me. He did and the guitarist continued to yelp at our back.

“Christ. The air here feels like it’s already been breathed,” I said, trying to start a conversation.

Ted nodded and said, “It has.”

“What’s the deal with malaria here? Are you on chloroquine?”

Ted looked at me and said, “See the waiter there?” He pointed at the slightly built Salvadoran by the door with the silver tray.

I said, “Yeah, I see him.”

“Does he look wracked with fevers?” I nodded no.

“Do you think he’s taking his chloroquine? Do you think he worries about the resistant falciparum?” Again, I nodded.

Ted pointed to his temple and said, “Disease here is a state of mind.”

“Tell that to the kids we saw.” I said.

A man briskly walked in and hugged the owner. I touched Ted on the arm and said, “Look what just slimeballed in.” The man was a bouncy heavyset type, with slick-downed black hair, and sweat rings. He wore tight pants and a polyester shirt that was unbuttoned to expose an inflated hairy chest and two or three gold chains. His wide-mouthed smile appeared pasted on.

I said, “It’s Dr. Victor, I forget his last name. Every time I see him I want to take a soapy shower. ”

Victor saw us and came over. He grabbed my hand, shook it vigorously and then did the same with Ted’s. Ted got up and gave him a quick tug at the shoulder. “What the f are you doing, Ted?” I said, mumbling the question so Victor couldn’t understand.

Victor, unable to speak English, asked us how we were, and then mimicking dancing, said, “¿ Bailando? ¡ Esta noche!”

I told him no and waved him off. “Ted, how can you be friendly to that guy? He’s the biggest scuzzball in El Salvador.”

“He’s the director of the Emergency Room here.”

“Exactly. Which gives you some idea why these countries are in such shambles. Emergency room, what a joke. The guy’s like a tsetse fly, hanging around us. He just wants to meet Mustang Sally.”

“Let him.”

“Ted, c’mon. Ignoring him is one thing, but do you have to act like you guys are war buddies? Don’t encourage him.

“I know what you are saying. But who knows, maybe he’s the real thing.”

“Yeah, real. Like the chains around his neck.”

“Listen, I learned not to look too critical at things. The slimy guys in this business will drive you crazy. Hell, they call me names too.”

I rolled my eyes and said, “You’re aloof. That’s your sin. What do they care?”

“The pediatric organization here worked out a deal with the government, for only cleft lips and palates done. Jesus Christ, I do noses, breasts, ears, even did some guy’s penis. Once, they tried to cancel cases on my schedule. Of course, I wouldn’t let them. So they tried to send me home. I refused that too.”

“Aloof with piss and vinegar. I like that.”

“Careful, you hang around me, you’ll get labeled too.”

“Me? I’ve got more labels than Budweiser. My program sent me here, like it was the Galag.”

“What happened to you?” Ted said.

“I told one of our professors, Dr. Wagner, he was an incompetent hack. He was doing a repair on a six-year old girl, when she bled out. His dictation said aneurysm. I was there, scrubbed in. He nicked the damned aorta. Worst thing was my wife, when I told her, she defended him. She wants me to be like him, wear bow ties with Princeton Tigers and talk like William Buckley. So, he kicked me out and she packed my bags. Here I sit with a misanthrope, a Mexican guitarist, and Victor. Would you believe I was booked for a plastics rotation at the Mayo Clinic? ”

Ted laughed and said, “Dr. Wagner. I like him. Nothing like good old surgical pluck. I’ll pour this one for him. We’ll call him Nick.” He emptied the wine bottle in our glasses.

The next day, between cases, we sat in the supply room, slumped over the make-shift chairs, with a cautious eye on some sandwiches lying out for us. “Jamón y queso, ham and cheese. Hopefully light on the salmonella,” I said as I handed him one. “So tell me, why are you here? You’ve got a wife and kids, a big house in, where, Malibu, Santa Monica?”

“Sacramento.” Ted was half-way through his ham and cheese. He lit up a cigarette and said, “I don’t know why I’m here. The damned surgery.” He took a big bite out of his sandwich and said, “I’ll tell you, if there was some way I didn’t have to fly to these crazy infested countries to do these kinds of cases. I mean these are great cases.”

I rewrapped my sandwich and put it back. “Then you’re not all bad. At least some kids come out of it better off.”

“Hey,” he laughed, aiming his sandwich at the garbage can and slapping my back, “I never looked at it that way.”

Ted slipped on his shoe covers and tied his mask. As he pushed through the swinging doors to head toward the number four OR, trying the back of his cap, I heard him make a muffled sound, but couldn’t make out the words. I could see him through the plexiglass as he strode down the hall, probably pissing and moaning. The little guy had a big stride, and was sure of himself. I thought of him on our nightly post-op rounds, flashlight in hand, meticulously the wounds, and changing the dressings; while I knew the other surgeons were back at the hotel, thumping the bar for more Aguardiente. I got up and reached for my mask and cap, we had our next case.

In the operating room, I was hashing over the Spanish names for things like cautery and forceps, when I was told, “Doctor, your patient is here.”

I found Rosita, in her same attire, in the hall outside the operating theater, her crib resembling a cage. Workers and staff were scurrying around it, as if the contraption didn’t exist. Her mouth was drawn down and the jaw trembled. I slid the side rail down and held her hand, walking alongside as we wheeled her into our operating suite.

When the anesthetist smothered her face with the mask, her fear increased, she took big gulps, and her eyes darted back and forth across the room. I put my hand on her cheek, cradled her head, bent over to her ear and whispered—don’t be afraid. I promised her when she woke up I’d be there.

“What kind of surgery did you do?”

I raised my head and looked at the man next to me. He was eating a snack, airline peanuts with a soda and ice. I looked down at my tray, they had skipped me. He held out the bag of peanuts and said, “Do you want some?”

“No thanks.” I hesitated. “Plastic surgery. That’s what we did. Burns, lips, and stuff.”

“Oh, you guys are great. Really great. I wish you would come back.”

“You do?” On the TV monitor was a movie with Chevy Chase. I closed my eyes, said, “Thanks,” and whispered to myself: now Ted Cavet and I are ready to start the case. We stood in the operating room at the foot of the stretcher, scrubbed, gowned, our hands gloved and held high. I couldn’t take my eyes off anesthesia as he was working with Rosita. He had sedated her and now was trying to intubate her, slide the tube into her trachea. I knew you were supposed to pull the neck into hyperextension, that’s basic. But her neck was locked in flexion, making it impossible to introduce the tube. She was blue. He was frustrated and kept jamming the tube harder, each time with less success and more desperation—the man was clearly lost. I turned to Ted, who was surveying his equipment and said, “Ted, we’ve got a problem here.”

“No, we don’t have a problem, he does,” he said, giving a quick nod to the struggling man at the head of the table. He broke scrub, snapping his gloves off and said, “I have learned to stay out of other’s business. Pablo there doesn’t know what he’s doing. These damn fellas they give us aren’t anesthesiologists. I think they recruit them from the tortilla stands.” He leaned over to my ear and said, “Remember, we’re not anesthesia. Don’t start a war.”

From that point was a blur of images and a shrill of sounds—strident voices blurting out for equipment, beeps and ominous numbers on the monitors, pounding on the child, her body reflexively writhing in response to the assault, and the dreaded dusk-colored lifelessness. I was frozen. At home I would approach the scene like a linebacker. I could split open a chest and never lose a smirk. But there I sponsored no hope. I watched an inept struggle taking place. The skills were abysmal; there was a complete language gridlock, and in the air hung an utter lack of care.

Nobody had claimed any position of authority and everyone continued on, avoiding that final order. So I did it—called an end to the resuscitation. She never had a chance.

People dropped their things and walked out. With everybody gone, the room took on a shaded brown hue, and everything I perceived in my slack state was so slow, so dark and so still. Rosita lay on the table, untormented at last.

A nurse came into the room. I observed her clean the body, in a solder-like fashion. With each long slick stroke on the still warm body, Rosita’s dull brown skin glistened, flawless up to the torn and oozing scars from December twenty-sixth. The hospital-issue shorts, now bloody, were cut off and tossed into a crumple by my feet. I leaned against the doorway, numb, and saw the nurse bind her hands, in a praying posture over her chest. The mouth never closed, but remained like the Munch scream. They pulled a shroud over her. A cord was used to wrap and tie it up. I winced at the thought that I had been leaning over her while the nitrous oxide filled her head, and what I said to her as she slipped away.

There was a hand on my shoulder, then Ted Cavet’s voice. “Hell, she’s probably better off.. These damn kids. I mean what did she have to look forward to, all contracted up in this pisshole country.”

“We didn’t have our anesthesiologist,” I said, thinking about the list I’d thrown into the trash along with the empty Colt 45’s.

“Yeah,” Ted said, “Somebody screwed up.”

I looked up, out the window, then at my shoulder. The Salvadoran’s hand was on my right shoulder. Outside the window, it was almost dark and below us was a blue ocean. He said, “Hey, mister hero. I’m going to get some coffee. Do you want some? Say, are you all right?”