“Tomorrow we’ll go to Grozny,” Sonja announced as she strode through the canteen doorway, stopping at the counter to inspect the scalpels he’d boiled.

“Did Deshi tell you that?” he asked, unable to mask the panic building behind his eyes. “I was only kidding. Of course I’d use the plane ticket to go somewhere else. Tbilisi, even Istanbul.”

“You boiled these for ten minutes?”

“You’re joking, right?”

She gestured toward him with the scalpel blade, a little too casually for Akhmed’s comfort. “About ten minutes in boiling water? I’ve never been more serious.”

“No, about Grozny.”

“Did you or did you not boil these for ten minutes?”

“Yes, but are we going to Grozny?”

She frowned, seeming to think he was the one talking in circles. “You don’t get to ask any more questions,” she said. “A question mark in your mouth is a dangerous weapon.”

“So are we?”

She gave a defeated sigh. “Yes.”

“Why?”

She pulled a cigarette lighter from her pocket. “Do you smoke?”

“I am an excellent cigarette smoker.” It had been seven weeks since his most recent cigarette, and two months more since the one before that, and technically those had been papirosi, capped with a filterless cardboard tube and jammed with coarse tobacco that left him violently nauseous for the rest of the day.

Perhaps inspired by his earlier display of professionalism, she waited until they reached the parking lot before lighting up. She passed him the square pack. He knew the Latin alphabet, but hadn’t used it in years. “Duh …”

“Dunhill,” she said.

He selected one from the two erect rows and leaned it into Sonja’s lighter. The first drag slid into his lungs without the paint-scraper harshness of his two most recent cigarettes, and he stared at the slowly burning ember, admiring the quality of the tobacco and the quality of the flame, pleasantly surprised that he didn’t feel ill. “Where did you get these?” he asked.

“Grozny.”

“We’re going there to get cigarettes?”

She smiled. “I can’t believe you’d really use that plane ticket to go there.”

“I’ve never been.”

“It’s something else.”

“So why are we going?”

Farther down the street the side of a building had crushed all the cars in a parking lot. He was thirty-nine years old and had hoped to own a car by this age.

“I go once a month to pick up supplies,” Sonja said. “Not just cigarettes. About everything in the hospital comes through a man I know in Grozny with connections to the outside. I also call a friend of mine who lives in London and updates me on what’s been going on in the world.”

“What’s happening out there?” he asked. By now the wider world was no more than a rumor, a mirage beginning at the borders. Thirty-two years earlier, in the rancid air of his primary school — built on a block bookended by a sewage treatment facility and a lumberjack brothel — his geography teacher had expected him to believe that the world was the same shape as a soccer ball. He had been the first of his classmates to accept it, not because he knew anything about gravity, but because the air was more nauseating than usual that afternoon, and he wanted to leave. For the rest of her career that geography teacher would pride herself on being the first to recognize Akhmed’s aptitude for the sciences.

“Last month he told me that George Bush had been reelected,” Sonja said.

“Who’s that?”

“The American president,” Sonja said, looking away.

“I thought Ronald McDonald was president.”

“You can’t be serious.” There it was again, condescension thick enough to spread with a butter knife. His mother was the only other woman to have spoken to him like that, and only when he was a child — and only when he wouldn’t eat his cucumbers.

“Wasn’t it Ronald McDonald who told Gorbachev to tear down the wall?”

“You’re thinking of Ronald Reagan.”

“English names all sound the same.”

“That was fifteen years ago.”

“So? Brezhnev was General Secretary for eighteen.”

“It doesn’t work like that over there,” she explained. “They have elections every few years. If the president doesn’t win, someone else becomes president.”

“That’s ridiculous.” The wind lifted the ash from his cigarette and scattered it across the empty parking lot.

“And you can only be president for ten years,” she added.

“And then what? You become prime minister for a bit and then run for president again?”

“I think you just step down.”

“You mean Ronald just stepped down after ten years?” he asked. She had to be putting him on.

“He just stepped down and George Bush became president.”

“And then George Bush shot Ronald Reagan to prevent him seizing power?”

“No,” she said. “I think they were friends.”

“Friends?” he asked. “It makes me wonder how we lost the Cold War.”

“Good point.”

“And so George Bush has been president since Ronald Reagan?”

“There was another guy in there. Clinton.”

“The philanderer. I remember him,” he said, pleased. “And then George Bush became president again?”

“No, the George Bush who is president now is the first George Bush’s son.”

“Ah, so that’s why they don’t shoot the previous president. They’re all related. Like the Romanovs.”

“Something like that,” she said distractedly.

“Then who is Ronald McDonald?”

“You know, Akhmed,” she said, looking to him for the first time in several minutes. “I’m beginning to like you.”

“I’m not an idiot.”

“You used the word, not me.”

A blast rippled from the east, a long wave breaking across the sky.

“A land mine,” she said, as if it were no more than a cough. “We should get going.”

He dropped his cigarette without finishing it, the first time he’d done so in six years, and was careful to avoid the glass shards as he followed her back to the entranceway.

“Sew the pockets of your trousers before you come in tomorrow,” she advised. “We’ll pass a dozen checkpoints to reach Grozny and with that beard you look like a fundamentalist. I don’t want the soldiers to plant anything on you.”

Akhmed looked to the clouds before following her into the corridor. It wouldn’t matter even if he had found a plane ticket. Ten and a half years had passed since he had last seen commercial aircraft in the sky.

The man dragged into the waiting room wasn’t the first land-mine victim Akhmed had ever seen, not the first he’d seen accompanied by an incomprehensible woman, not even the first he’d seen dragged on a tarpaulin along a slick scarlet trail; he wasn’t the first man Akhmed had seen writhing like a lone noodle in a pot of boiling water, not the first he’d seen with half his shin hanging by a hinge of sinew. But when Akhmed saw this man it was like seeing the first man for the first time: he couldn’t think, couldn’t act, could only stand in shock as the air where the man’s leg should have been filled the floor and the room and his open mouth. The woman tugging at the corner of the tarpaulin spoke a language of shouts and gasps and looked at him as if he could possibly understand her. What a volume her chest produced. The true color of her dress was indistinguishable for the blood. When he finally remembered how to use his feet, he walked right past the woman and the writhing man, to the corner chair, where he draped a white lab coat over Havaa’s head.

Then the man’s pulse was a haphazard exertion against his finger. The woman was asking one question after the next. Her dress was showing the curves of her legs. Her breath was on his left cheek. An artery was severed. His face was pale yellow. Sonja was there. She was strapping a rubber tourniquet below the knee. She was rolling him on a gurney and into the hall. The gurney was turning into the operating theater and Deshi was taking the man’s blood pressure. “Sixty over forty,” she was calling out. The blood pressure meter was velcroed to the young man’s arm. The bulb was swinging above the gurney wheel. The wound was wet with saline.