THE FRACTURE
by Judy Goldstein Botello

Rosa Navarro was 82 years old, frail as a sparrow, but she could still impress my teenage son with her vigorous sit-ups. She had spent her childhood in Zacatecas, a small city in central Mexico, during the turbulent and romantic years of the Mexican Revolution; her eyes still flashed when she told of watching from behind her mother's skirts as Pancho Villa swept into town with his men. By the time she had graduated from Normal School, the fighting had abated, and she served the new revolutionary government of Mexico as an itinerant teacher, traveling by burro to remote villages, bringing literacy and hope to the peasants. Twenty years after her retirement, she was still addressed respectfully as Maestra, and the local children still came to her door for a cup of chocolate and a reading lesson. Decades before the women's movement, she had embraced single motherhood, raising my husband and his brother alone, with dignity and pride.

Like some migratory bird, she flew north each spring from her home near Mexico City to spend a few months with us in California. While here, she would amuse herself knitting woolen slippers for every member of the family or preparing herbal remedies for my occasional attacks of the blues, which Rosa cheerfully called "los nervios." But she was happiest on those occasions when we would take her to see the San Diego Padres play baseball. Then she would rise to her full five feet and sing the national anthem proudly, in a fine vibrato, although the words she sang were all of her own invention.

The day she broke her hip, she was en route to us, but had stopped to visit a sister in Ensenada, seventy miles south of the San Diego-Tijuana border. The phone call came from Ensenada one bright June morning while I was at my office in one of San Diego's large medical centers. In a frightened voice, my husband's cousin Sara poured out a jumbled message. Rosa had fallen, they took her to the hospital, the doctors were talking surgery, we must come right away. Images flooded my mind: Rosa puttering happily in my kitchen, cooking the best albondigas in the world; Rosa guiding me through the colorful mazes of a market in Mexico; and a future image of Rosa diminished, moving painfully from bed to bathroom with a walker, as I had seen so many elderly patients do. My voice was shaking as I reassured Sara that we would be there as soon as possible.

The hospital in Ensenada is an old one story structure huddled between a paint store and a taco stand. We found Rosa in a narrow manual-crank hospital bed which occupied virtually the entire cubicle allotted to her. Her left leg was supported by Mexican-style traction consisting of a sheet wrapped around the ankle and looped over a metal bar, then weighted by means of a plastic gallon water bottle filled with water. Although there was no room in the cubicle for even one chair, her bed was ringed with chattering family: sister, brother-in-law, niece, two small grand-nephews. The bed itself was strewn with the fragrant remains of tacos and burritos and fresh chile sauce. Rosa looked small and pale but serene in the warm glow of family and food.

Having spent twenty years as a pediatrician, I had forgotten most of what little orthopedics I ever learned. But I remembered enough to know that time was of the essence in pinning a fractured hip, and I asked the nurse who came to greet us if we could speak to the orthopedic surgeon.

"Ah, señora," the nurse told me, "regrettably the orthopedic surgeon is away in Guadalajara, but he should be back in a week or two." I must have blanched, because she hastened to add, "but, if you wish, you can speak to the intern who is on duty here tomorrow. He, too, is an orthopedic doctor." I felt only marginally reassured, but the conversation was clearly over: the nurse was busy plumping up Rosa's pillow and smoothing back the hair from her brow.

Dr. Garcia, the intern, looked frighteningly young to me, but he exuded energy and confidence. Yes, he could certainly perform the required surgery--he knew the procedure well. All he needed were the necessary surgical instruments; he would order them from Mexico City immediately. They should arrive within ten days. Ten days! Didn't this man realize that if Rosa were in a U.S. hospital she would already be on her first post-op day by now, up and moving? Gently, patiently, the young doctor pointed out to me that this was not a U.S. hospital, but was, rather, a small hospital in a small town in a poor country. High tech surgical instruments were hard to come by. But perhaps--and his face lit up--perhaps the Señora and her husband could purchase the instruments in California and bring them to Ensenada? He looked eager, a child peering through a shop window at a shiny toy.

After a wild drive north and hours of frantic searching, we finally located the appropriate surgical set in a medical supply store in San Diego. The salesman astounded me by offering to buy back any unused instruments after the surgery. Nothing in my medical training had prepared me for any part of this experience. Feeling like Alice in a weird wonderland, I paid the man, and we raced back south across the border with our sterile cargo. Dr. Garcia caressed the package with undisguised love: he could hardly wait to wrap his fingers around the smooth metal. Mañana, he promised. Tomorrow he would operate--provided, of course, that there was an operating room available, that there were enough nurses in the hospital, that our family had supplied enough blood . . . He disappeared with the surgical pack, smiling happily. I began to understand dimly that I was, indeed, moving through a world whose rules were utterly different than those of the crisp, efficient medical world I knew. Here was a world incomprehensibly poor in material resources, but vastly rich in humanity; and everything here depended on people: their ingenuity, their generosity, their love.

Of course, there were plenty of willing blood donors among the family members. My husband and I phoned the hospital director at his home in the evening to request his personal help in securing an operating room. We made the call from a small shop whose owner had opened after hours, especially for us, when Rosa's nurse sent us out to buy a surgical drain they would need. Finally, when Rosa was prepped and ready, and lying on the gurney, my husband had to run to the corner store for nail polish remover to clean her manicured nails before she could go to the O.R. The nurse who wheeled her down the hall to surgery held her hand, murmuring endearments like a mother to a small child.

Rosa survived the surgery, and eventually returned to her home outside of Mexico City. But she never again walked without fear, and her spirit slowly withered away like a wild bird in captivity. She died almost two years later, on Easter Sunday, el domingo de la resurección. Now, whenever we visit the family in Mexico, we visit Rosa too, under the pepper tree where she lies with her parents and a brother who went before her. And there, on sunny afternoons, a lone swallow swoops and dives among the leaves, its wings humming with a fine vibrato.

In these turbulent times for our own health care system, beset as it is by shrinking resources and rising human need, I often think of the little hospital room in Ensenada where pain and hope mingled with the fragrance of fresh tortillas, and where Rosa held us beneath her wings in an unbroken circle of love.