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Island Hopper-Chapter 17b: Sugar Sickness

Brand new chapter, but out of sequence. Posted 10-16-2020

Previously Chapter 17: Bitter Jamie and Claire have different ideas about what being back together should look like.

ISLAND HOPPER Table of Contents

Back to work, we meet someone important, and an illness leads to an early parting.

“Thirsty. Lukkuun thirsty. Alap awa.”

Perkaj’s mother wiped her son’s forehead with a cool washcloth, looking at me with concern.

“Lukuun kilep. Now, bery skinny.”

A group of children—siblings, cousins, and interested neighborhood kids—crowded around the mat where the little boy lay, feverish and unresponsive. It had taken me several tries to say his name correctly. Finally a patient cousin had grabbed my hand to get my attention. “Him name Purr Gus” the little boy had said clearly, smiling as I repeated it.

My heart had sunk at her first words. Perkaj was thirsty all the time? Just that one word had given me a preliminary diagnosis. I was almost positive it was type I diabetes. And how was a person to manage type one diabetes out on an outer island? Spare insulin needed to be kept at a moderate room temperature. Since it didn’t often get above 85°F in the islands, it wouldn’t have to be refrigerated, but it would last longer if kept cool. And if he ever ran out of it, he could quickly slip into a diabetic coma from high blood sugar.

That was what appeared to be happening right now.

I spread open my black bag—an iconic black leather satchel like the doctor’s bags of olden days. I located the supplies I needed and pulled out the blood sugar monitor from its protective plastic bag, unwrapping a stiff testing strip and slipping it in the slot in the tester, then twisting off the plastic tip of the lancet.

I heard the intake of breath as the children saw the gleam of the sharp lancet tip and sensed them all bending closer as I picked up Perkaj’s small hand and firmly pricked his fingertip.

Watching his face for a response, I was grateful to see a shadow pass over his features at the pain. At least there was a little consciousness still.

Turning back to my task, I squeezed his finger and watched as the burgundy swell of blood appeared on his skin. I gestured with my head toward the tester on the mat, and several pairs of small hands reached for it, one child passing it to me so I could meet the testing tip to the droplet of blood.

A chorus of “ohhhs” was the response as the absorbent testing strip slurped the droplet of blood off Perkaj’s fingertip.

“I need to be able to see,” I said, hoping my voice wasn’t too sharp. I didn’t want to hurt their feelings, but all the little heads were blocking the light from outside.

“Move,” ordered one of the mamas. “Etal,” she added in Marshallese. My little audience backed away reluctantly and I breathed a sigh of relief as a gentle breeze of cooler air from outside swept through the small house.

My fears were confirmed when the tester flashed Perkaj’s current blood sugar level. 615. Six hundred and fifteen? Healthy was under 120. Elevated was anything over 200. Four hundred was seriously high. Six hundred? No wonder the boy, his features slack in unconsciousness, was so feverish. Perkaj had indeed slipped into a diabetic coma.

Although my medical bag held a multitude of items, insulin was not one of them. The small stock of insulin I had was kept in the clinic in a brick enclosure. There may have been no means of refrigeration, but whoever had built the clinic had realized that caves tended to be cooler than the surrounding area and had created—in essence—a small root cellar for storing medicines that were sensitive to temperature.

“I have to go get medicine,” I said, my Marshallese failing me in the moment of stress. “Kottar jiddik—wait a little bit—and I’ll be back.”

Perkaj’s house was in the town of Ine, just a half mile or so from the clinic. I broke into a jog, trying to ignore the sensation of sharp rocks under the thin rubber of my flip-flops. The sooner I got some insulin into him, the sooner Perkaj would recover and the fewer side effects he would suffer.

“I’m not enough,” I panicked as I jogged. “I don’t know enough. I recognize diabetes, but I’m not an endocrinologist. I need a doctor. Perkaj needs the hospital.”

The plans for the coming days swirled in my head. Jamie and John were working on the solar still. John would be leaving on the Jolok boat tomorrow—he needed to be back to Majuro on Thursday. Jamie and I had planned to ride the fishing boat with Kona on Thursday evening, knowing that our flight didn’t leave until Friday. We had scheduled a little time for shopping on Majuro Friday morning. We wouldn’t need a hotel; Jamie had mentioned our need of a place to stay Thursday night to Mr. MacKenzie before he left on the final leg of the field ship voyage, at which Dougal had grinned and said Revka would be happy to sleep at a friend’s house so we could have her room.

I was trotting past the Iroij’s palace when I realized I should call the hospital, remembering that the Iroij had one of the two satellite phones on the island.

I smiled shyly at the man sitting on a chair by the gate into the Iroij’s property. “Is the Iroij here?” I asked. My brain scrambled for the words in Marshallese. “Iroij ijin?”

He nodded toward the house with a low “Ayet, ijo,” and I walked up the white gravel pathway to the Iroij’s door.

I’m not sure why I was surprised when the Iroij himself opened his door, but I smiled at the stocky man with salt-and-pepper hair cropped short, wearing a sarong and an embroidered island shirt, his outfit completed with bare feet.

“Miss Beauchamp!” he exclaimed. “I mean, Mrs. Fraser.” His smile was warm, and he urged me into the large open room lit by electric lights. It was a simple building, but in comparison to most of the dwellings on Arno it was lavish.

“Thank you, Iroi… Sir… Your honor?”

“Call me Mayor Timisen,” he urged at my apparent discomfort. He had gestured for me to sit in one of the chairs in the main room, and he leaned forward once we were both seated, urging me to speak.

I was grateful he spoke such fluent English as I explained to him what seemed to be ailing Perkaj. Although it wasn’t going to cause an instant death, high blood sugar meant that glucose wasn’t getting into the body’s cells, and organ failure was a possible consequence of elevated blood sugar left too long without treatment.

“Perkaj needs to go to the hospital,” I said. “Can we use the satellite phone to contact them and ask what we should do?”

He nodded slowly, then got up and went to his desk, coming back with the chunky black satellite phone. I eyed it with mixed emotions as I watched him dial a number and then hold the phone to his ear. Just seeing the phone brought back a flurry of remembered events that had led to my first satellite call out here—

That dark night after my trip to Matolen with Sharbella, I had ridden with Jamie on his bike back to the clinic… later, lying next to him under our makeshift mosquito-net tent—after he'd said it would be inappropriate to hang out in my apartment after dark —we had been looking up at the stars and talking when I’d accidentally called him Frank…

I remembered the sinking sensation in the pit of my stomach when Jamie pulled away from me, and the deepening discomfort a few days later when Angus confronted me about my behavior towards Jamie, when he told me the engagement ring on my finger was about the only part of me that was engaged…

My heart sank at the memory of the night I took care of baby Maxson when he was sicker than I could deal with in my primitive clinic, waking the next morning to find that the infant was dead.

I remembered the pain of Jamie discovering me on the beach and trying to comfort me, only having to force him away. I could picture him seated on a mat with Rupert and Angus across the gravel-strewn yard at Maxson’s funeral, and I remembered trying to convince Anni and myself that I truly didn’t want him.

I chuckled as I recalled Anni and that crazy midnight run to the fishing dock on the ocean side to see the miracle of the full moon. But that joy was followed by Frank’s letter—familiar handwriting crushing my soul as he told me he didn’t want to wait for me, that he was breaking up with me.

That pain had been followed by the comfort of Jamie’s arms, by tender murmured reassurances and his touch when I went to him in the darkness, desperately needing to not be alone. And later, I had slept in his bed with him, curling in the hollow of his form, reassured by his even breathing, his warmth, and the solid substance of his body behind me.

The comfort of Jamie's kindness was replaced by Angus’s disappointed, bitter voice the next morning, accusing me of sleeping with—not just ‘sleeping with’—Jamie, telling me that since I wouldn’t stay away from the young man on my own, he was going to have to take more drastic measures.

And then I could vividly picture the Iroij standing outside my door, handing me a black phone and telling me the person on the other end was Mr. MacKenzie— that I was being summoned to UniServe headquarters.

Now I looked at the white gold circle on my right hand for a moment and then back at that boxy black phone held by the Iroij and found myself shaking my head, gratefully astonished at how that story had ended; hoping that this sequence of events would have a similarly positive end.

Mr. Timisen held the phone out to me then, lifting me out of my deep deja vu. After taking a breath, I quickly explained the situation to the emergency room physician on the other end of the line.

“We could try to catch the Jolok boat tomorrow,” I said. “I have some insulin. I could administer it and try to monitor his blood sugar, but I’m concerned that if I gave him too much, he could die. And he has a high temperature and is almost unresponsive—he can’t stay at this blood sugar level without doing drastic damage to his organs.”

There was static on the line and I wondered if the connection had been severed, but then the doctor’s calming voice came back on.

“We can’t do much until you get the patient here, unfortunately,” the physician said. “Administer insulin and monitor his blood sugar. Perhaps the Iroij could charter a private flight so you could get here sooner.”

The conversation was loud enough that the Iroij heard the request. He nodded to me reassuringly, reaching for the phone and bidding the physician farewell, then dialing another number and having a brief conversation in Majel. I assumed he was calling the Majuro airport.

“The plane could meet you at the landing strip beyond Jabo. Are you able to transport the patient there by truck?”

I nodded, then told the physician that we could get him to the landing strip within an hour and a half. Mayor Timisen smiled reassuringly at me, going into the hallway and calling out into one of the other rooms. In a few moments, a young man entered. At Mr. Timisen’s terse command, he quickly trotted away, I assumed to go locate the island truck.

“Can you travel with him?” the physician asked me over the phone. “The plane has room for the patient and a parent, but a doctor or nurse should go along as well.”

“Don’t you send a nurse or EMT out on the plane?” I asked.

“Not unless it’s a heart attack or severe injury. We’re understaffed as it is,” he responded.

With a few last directions, the doctor and I hung up, and Mr. Timisen assured me that they would bring the truck to the clinic to pick me up and then take my patient to the air strip on the way towards Arno Arno.

As anxious as I was feeling, I was actually grateful to run the rest of the way home. I felt calmer knowing that I would soon be getting Perkaj to a hospital where he would have the round-the-clock monitoring I was incapable of providing on my own.

After unlocking the clinic, with shaking hands I removed the vials of insulin from the medication locker. Making sure I had syringes and a few glucose packets to counteract the effects of accidentally giving Perkaj too much insulin, I locked up the clinic and entered the apartment.

What was I supposed to take with me? I hadn’t yet packed my big suitcase for Guam, so I threw a few dresses, bras, and pairs of panties in a backpack, along with my conditioner and skincare bag. Then I pulled my larger suitcase from under the bed and loaded it as quickly as I could, though I couldn’t tell if I had what I needed for our trip. I’d been planning on a leisurely evening of packing once I had been done for the day at the clinic. An evening of packing, followed by some more quality time with my husband…

My heart sunk at that thought. My memories of those days of sadness without Jamie had made me long to be close to him again. As I remembered that night when Frank broke up with me, I could almost sense Jamie’s warm comfort next to me in his bed. And today, helplessly looking at Perkaj lying limp and unresponsive on the mat on the floor had brought back those feelings of powerlessness I had felt with baby Maxson. I could feel my need for Jamie in the pit of my stomach, but I steeled myself. This was a time I was going to be strong without him.

But I couldn’t just leave without telling Jamie where I was going. I went out to the side yard where I discovered him and John working, the two men standing in remarkably similar positions with arms crossed, heads cocked to one side, looking in puzzlement at the structure in front of them. It looked a little like a terrarium or sunroom, with a slanting glass roof on top of an enclosed wooden box. As I watched, they each moved a few steps to the right, resuming the same quizzical posture when they stopped. I chuckled at their incidental resemblance, the tall, broad-shouldered, auburn-haired Scot and his slighter, dark-haired Marshallese friend.

“Claire, come see,” Jamie said, ushering me over and pulling me under his arm. “We put an inch or so of well water into the reservoir there,” he explained, drawing me toward the structure and pointing at the shallow pan that stretched the entire length and width of the base of the still. “The water soaks up into the black cloth draped over those blocks, which heat in the sun and then the water evaporates from the fabric, traveling upward as the heat rises.”

“But the sloping glass ceiling traps the moisture inside the still,” John continued as he came close on my other side, “and as the air outside is cooler, it condenses on the inside of the glass.”

“We’re trying to figure out the right angle for the glass,” Jamie said, “so that the water doesn’t drip back into the pan but instead dribbles down the glass and finally into this channel,”—here he pointed at a sloping half-pipe near the lowest part of the glass, cupped upward underneath a line of something that looked like clear caulk, where the droplets of water that had snaked their way down the glass-collecting surface were stopped from sliding further, growing into larger and larger reservoirs until their weight overpowered the surface tension and gravity forced them to fall. I could see a thin stream of water in the bottom of the pipe, slowly flowing toward the place where the pipe exited the still and entered flexible tubing threaded into the top of a large water jug on the ground.

“It looks great babe,” I said, finally grabbing Jamie’s arm to stop him. “But I don’t have time right now. I have to take a plane to the Majuro hospital,” I said quickly, before he could speak.

“What?” he exclaimed with an involuntary squeeze closer to him, looking me up and down as if I were the one injured. “Have ye been hurt?”

“No, it’s Perkaj,” I said. “You’ve mentioned how Rupert said he’s been losing weight the last few months and hasn’t had much energy at school. Well, there’s a reason for it. I’m almost positive he’s diabetic!”

From the look on his face, I could see it hadn’t completely sunk in yet, but when the truck pulled up in front of the house at that very moment, Jamie questioned me again. “Truly? You are leaving now? You are going to Majuro? Today?”

I nodded quickly, slinging the strap of my backpack over one shoulder. “I started packing my suitcase for Christmas, but I’m sure I’ve forgotten something. Can you finish packing for me?

Jamie had his hand around my upper arm, a grip that expressed what he couldn’t seem to be able to say. His forehead was wrinkled, his face clearly communicating that he objected to my departure.

“I’ve gotta go, babe,” I said, beginning to move toward the truck. “I’ll see you tomorrow evening when you get to Majuro on the fish boat?”

Jamie still looked bewildered, but a sudden certainty flooded over his face and he took two quick steps to me and crushed me in his arms.

“Be safe,” he murmured into my hair. “I canna believe I’m losing ye again so soon.”

Gently pushing me out to arm’s length, he met my eyes. “I love ye, hen,” he said, stooping to firmly kiss me on the lips once more before urging me toward the waiting vehicle. John and Jamie followed me as I went to the truck, and Jamie offered a hand as I climbed up into the bed of the pickup.

“I love you too,” I mouthed, blowing him a kiss as the truck drove off nearly before I’d settled myself on the truck bed. He watched, waving until I couldn’t see him anymore.

Once at Perkaj’s house, I waded through the crowd of concerned well-wishers, thankful for Mayor Timisen’s ability to translate and explain to Perkaj’s family what we were doing. The biggest challenge was determining which family member should travel along with the boy. Perkaj’s mother was eliminated as a good option because the boy had several younger siblings, one of which was a nursing infant. I couldn’t follow the entire conversation, but Mr. Timisen also explained to me that Perkaj’s father was out fishing and wouldn’t be back until dark. After some rapid fire conversations in Marshallese, it was determined that his auntie Maria—a lovely girl of around twenty—would come along with Perkaj so he had family to watch over him.

As the family had debated who would travel with Perkaj, I had re-tested his blood sugar. Finding it still over six hundred, I gave him eight units of fast-acting insulin, hoping that each unit would drop his blood sugar by about 50. I knew the ride to the air strip would take a half hour or so, and expected the helicopter ride to Majuro to be about the same. I would continue to monitor Perkaj’s blood sugar level as we traveled, but I could feel my agitation easing at the promise of a more updated facility and an ICU where my young patient’s progress could be closely monitored.

The process of transferring Perkaj to the truck was accomplished by a group of four young men who gripped the corners of the woven pandanus mat on which Perkaj had been sleeping, and using it like a stretcher, carried him out to the truck and unceremoniously slid the mat into the bed of the truck. I had grabbed a blanket from my house so we could cover him and then his auntie and I sat on either side of him to keep him from rolling as the truck drove down the bumpy island road.

When we reached the air strip, I got out of my cramped sitting position. I tested Perkaj’s blood sugar again and was pleased to see that it had dropped, but not with such rapidity that I would have to worry about his sugar level getting dangerously low..

I’d traveled over the air strip several times since my arrival on the island. Each time we’d gone on the Jolok boat, the time I’d heading out on the Field Ship trip, and then returning back home again all necessitated driving through that narrow stretch of the island. But this time it wasn’t as green as I remembered from my first arrival on the island. The grass on either side of the wide-open swath of land was yellowed, a sign of the continuing drought.

Maria smiled at me as I stretched and bent over to touch my toes, preparing for another half hour or more of sitting in a cramped position before arriving in Majuro. She was patting Perkaj’s hand gently, her forehead wrinkling as she looked at his expressionless face.

“He will be okay?” she asked. “Ejjab mej?”

“Ejab malele,” I said sadly, shaking my head. “I really don’t know if he will die. But I hope not.” I tried to smile for her.

By the time we had been loaded onto the plane with Perkaj strapped onto a gurney that was then locked into place, he was moaning. Though it sounded worse, and though his face wrinkled more furiously when I again pricked another finger to test his blood sugar, I was relieved to see the gradual signs of a return to consciousness.

Before we landed at the Majuro airport, Perkaj’s blood sugar had dropped to 420, which although still horrible, was a significant improvement.

There was an ambulance waiting for us on the runway. As we rode the twenty minutes to the hospital, I briefed the EMT on Perkaj’s symptoms. He tested Perkaj’s blood sugar again and I was glad to see it had dropped yet a few more points.

By midnight I was beyond tired. I had sat, holding Perkaj and Maria’s hands, trying to understand the Marshallese explanations given by the medical professionals, trying to reassure the young Marshallese girl that her nephew was going to recover. I was weary but grateful that Perkaj’s blood sugar was at a reasonable level.

“Lass, why dinna you come to our house for the night,” said a familiar voice.

“Mr. MacKenzie?” I asked. This time Dougal seemed completely unsurprised when I stood and hugged him. In fact, he even patted my back gently before releasing me and picking up my backpack. Speaking briefly to Maria, he took me by the hand and led me from the hospital.

I was so exhausted I refused the offers of food made by Moneo. I simply slipped off my sandals, lay down on the couch in the living room, pulled a light blanket over myself and fell asleep.

Something about being on Dougal’s couch brought back such intense memories that all night I dreamed of cuddling next to Jamie the night after we got engaged. One dream-memory was so vivid that it startled me awake.

In the middle of that night after our sudden decision to get married I had found myself tossing and turning on the mat on the floor in Revka’s room. You’re an impulsive idiot, my brain told me. This is a rebound. You don’t really want to marry Jamie—you just didn't want to lose him as a friend.

I had gotten up as quietly as possible and slipped through Revka’s door, standing in the darkened living room trying to let my eyes get used to the darkness.

“What’re ye doin’?” a deep voice murmured from the couch.

“You’re awake?” I asked, moving a few steps forward.

“Canna sleep,” he responded. I could see a faint movement as he scooted over on the couch, and I tiptoed to him, finding his hand reaching out to me to guide me around the coffee table.

“Here,” he said, drawing me down to lie on the edge of the couch in front of him and covering me with the blanket. “Though I dinna ken whether having ye next to me is going to make sleep come any more readily.”

“I’m not out here to make out with you,” I said bluntly. “I’m just… having second thoughts.”

“Ye dinna have to marry me,” he said without hesitation, though his muscles had tensed at my words. “Dinna feel guilty if you’ve thought better of it and have changed your mind.”

“Are you having second thoughts as well?” I asked him.

He hesitated. “No,” he said calmly. I could feel him shaking his head behind me.

I scoffed in disbelief. “Why not?” I asked.

He sighed, and I could feel his chest expand against my back. “Do you believe in providence?” Jamie asked slowly.

“Providence—like a good coincidence?” I asked.

“Not exactly… Providence—as in, an act of God. Something that canna be explained away with logic.”

“Maybe,” I responded. “I’m not sure.”

“In the month before you came to Arno,” he said, his voice a husky rumble in my ear, “I found a letter from my ma. She had tucked it inside the Holy Bible she gave me on my first confirmation.”

“What did it say?” I asked, curious. I knew his mother had passed away when he was a teenager, so I knew her words would matter to him.

“She told me that while I should have in mind the things I wanted in a wife, that I might be surprised at what God provided. But she also told me that she had prayed for the partner of my future, and that I should do the same.”

“And did you?” I asked in surprise, turning my face to look at him over my shoulder.

“I did,” he said simply.

“You started praying for your wife a month before I came to Arno,” I repeated, stunned.

“Aye,” he said. “Every day.” I could see the smile on his face despite it being dark in the living room.

“So I appeared, and you saw an answer to your prayers?” I asked, amusement edging into my voice.

“No, actually. I thought he would choose a local girl for me,” Jamie explained. “When you arrived, I mostly saw a kind nurse who was clueless about island mores and desperately needed a friend.” At that, he leaned in and kissed me on the tip of my nose.

I pushed him away in mock disgust. “You pitied me?"

“Ye didna need to be pitied?” he asked, pulling me closer.

“Well, I was clueless,” I agreed, settling into his arms again, only slightly perturbed at him.

“And engaged,” Jamie added.

“That too,” I said. I felt a sudden ache in the pit of my stomach. “Unavailable, as far as you were concerned.”

“Well…” Jamie continued, “As for that, I wasna exactly convinced.”

I remembered the way he had asked me about Frank on the ocean side dock the day we did laundry together… And how I couldn't answer him, how I couldn't bring myself to say that I loved my fiance.

Jamie caressed my arm, running his fingers lightly from elbow to shoulder to neck. When he brushed my hair aside and leaned forward to press his lips beneath my ear, I shivered.

“Dinna fash,” he said.

“What does that mean?” I had asked, turning to him again.

“Don’t worry yourself,” he answered. “Trust.”

“Trust?” I had asked.

“Providence doesna always make sense, but I believe this has all worked out as it should. And it will continue to work out because He is in it.”

With that reassurance again running through my mind, a ghost of his kiss on my neck, I wrapped myself in my blanket and slept the rest of the night.

Next chapter is officially Chapter 18: Hopping to Guam Jamie loves plane trips about as much as he loves boat trips.

#betweenscenes #Outlander fanfic #Jamie x Claire #Island Hopper #Jimjeran book 2 #Campbell & Carlie #Meet Perkaj (Fergus)#Apart again!!!

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