September 2019
Omar
It was towards the end of September but our medical ICU was already filled with patients admitted for respiratory issues, thanks to an early flu season that had hit our region. The of-th-chart census of our ICU though meant that whatever awkwardness happened between Madi and me was swiftly forgotten.
We were back to being the uber-competent senior resident, and the ever-eager-to-learn intern. That was a very comfortable space to be in, and one that I had no intention of stepping out of ever again.
Sleep deprived with a protein bar in hand I walked in to the hospital at 6:30 am and coincidentally ran into Madi at the entrance of the hospital. With a large coffee mug in her hand and despite her eyes still hidden behind sun glasses, I could tell she was frowning at her phone.
"Everything ok?", I asked her, ready to tell her exactly what I thought of her douchebag fiancé if he had upset her again.
But she just said, "Its nothing. I was trying to reach a friend and she isn't picking up", and put her phone away before giving me an update on the patient in 1502 who I had intubated yesterday. And that reminded me of something I had wondered all of this month.
"Madi, how do you remain so calm in a high stakes situation? Even the attendings sometimes get flustered. But you are just laser focused, doing what needs to be done. I mean, it is really impressive"
Maybe I saw her cheeks flush a bit, or maybe it was the lighting in the elevator that we had just gotten into, but I ignored all that. Just focusing on her words instead. I was just her intern.
"Well, for one I've had a poster of the poem 'If' by Rudyard Kipling up on my bedroom wall ever since I was a teen. Look it up when you get a chance, you'll know why I like to recite it in my head when things are going south, especially the first stanza. And secondly, my mom taught us to be like ducks", she said with a smile.
I made a mental note to look up that poem, and figure out what the heck a 'stanza' was. But I had expected her to explain that duck part more. Instead, she stopped talking and went back to sipping on her coffee. So I said the first thing that popped in my head.
"That's weird, I have never heard you quack before"
She burst out laughing, almost choking on her coffee, surprising me. I quickly gave her a napkin from my backpack and apologized, "I uh - I am sorry, I didn't mean to make you choke. But I am genuinely curious how and why your mom taught you to be like a duck"
She doubled over with laughter for a few more seconds, but eventually caught her breath enough to answer my question.
"Omar, gosh - you are better at waking me up than any coffee", she chuckled and wiped her eyes before continuing.
"What I meant to say was that she taught us to be calm and unruffled on the surface, even as your mind is thinking through a hundred scenarios at the same time. Kind of like how a duck looks so calm above the surface and glides smoothly across the water, all the while paddling like crazy below the surface"
I looked at her, took in her sparkling eyes, and simply nodded.
We had reached the resident's room by now. She put her bag down, and sat on a nearby workstation. I should have followed her and done the same. Any other intern would have.
Yet, I could only stand still. Enchanted by her lips that had molded into a joyful smile and the sweet-sounding melody she hummed while typing on the keyboard. I had no idea whether it was a song that she sang or a tune she had just made up. All I knew was that it seemed to come straight from within her.
And I had no choice but to stand there, letting my soul capture the music of her heart.
A snickering in my ear jolted me back to reality, "Your Madi seems happy today", I nearly swung around and knocked down my co-intern. He ducked just in time.
"Shut up, Jake. She's my senior resident", I hissed at him and walked all the way to the other side of the room, to take up a workstation furthest from said resident.
Who I respected more than anything else.
And who was engaged - to a douchebag.
*******
"You guys ready for sign out?", Jake asked me and Madi when the clock struck 7 am. That was when his overnight shift would be officially over.
While the three of us settled down at the round table in the middle of the room and waited for his resident, he whispered to me on the side, "Dude, I am so sick and tired of Liam. I swear its either going to be me or him in this rotation"
"What did he do now?"
"We had a new patient admitted last night. Liam was no where to be found, so I did everything for this patient by myself. And when he finally showed up, he yelled at me for not finishing my notes on time, in front of the attending"
"You should have told the attending that Liam disappeared"
Jake sighed, "I tried. The attending didn't believe me"
Of course I believed him. He may have a tendency to fluster me with his unreasonable insinuations but he was a good guy at heart. I had seen him with his patients and at our teaching conferences. To me it had always been obvious that Jake was not the problem in their toxic resident-intern relationship. It was Liam.
Speaking of the devil, the door of our work room opened and a scowling Liam walked in and headed towards our table. Jake took a deep breath and launched into the sign out. Of the 15 patients on our team, 4 had required certain interventions overnight, but the rest had remained stable. Which was especially reassuring when the senior resident apparently went missing in the middle of his shift.
We were about to adjourn when Liam finally decided to speak up in his gruff irritated voice, "There's a new patient the ER just called me about"
He rolled his eyes at Jake, as he spoke to Madi, "She'll go to your team, as long as you don't run crying to HR about one extra patient"
What is this jerk's problem? I frowned, in fact I felt like punching him.
"Liam, we know how to work hard and not blame everything on others like you do. Stop being mean to your intern and tell us about the patient", Madi retorted immediately, and I laughed internally at her tenaciousness.
Madi 1, Liam 0
"Fine", his scowl deepened, Jake's smile widened, "Its a 26 year old, almost 7 month pregnant woman, who was brought in to the ER about an hour ago with breathing difficulty, high fever, and changes in her mental status. ER said that she wasn't really able to answer questions or follow any commands. They are thinking she has either some infection or pregnancy related issues"
"Okay. We'll go see her in the ER if she doesn't come up to the ICU soon", Madi told him, and we started to get up from the table for a second time.
"Oh one more thing", Liam added, "Apparently she is a peds resident or something"
I froze.
So did Madi.
We both knew a pediatric resident who was pregnant.
I seemed to have lost my voice, but Madi spoke up, "Peds resident? From our medical center? What's her name?"
Liam shrugged, and started to walk away, "How the fuck am I supposed to know. I didn't write it down"
Suddenly, I couldn't contain the feeling of absolute dread that was threatening to explode out. I went after him.
"Liam, what the hell is her name?"
That really ticked him off. He aggressively shoved my shoulder, "Stop shouting asshole. It was Nora - or Noor - or something. Who the fuck cares anyway. She is just a patient"
No, no, that can't be, I wanted to shout out, instead I felt myself lunging at him.
"I fucking care", I yelled as Liam's body slammed against the table behind him, and I could feel my fist clench, ready to punch him in the face.
In retrospect I have no idea what made me do that, perhaps it was easier to target the resident idiot rather than face the terror I was feeling right then. Or maybe I just needed an excuse to punch him given how arrogant he was.
Either ways Madi was having none of it.
I felt her yank my hand back, and whisper harshly, "Omar get off him"
"And Liam", she thrust her finger in his chest, "Touch Omar again and see what I do to you"
The next moment she grabbed my hand and dragged me out of the room into the corridor, before turning towards me, "What the hell has gotten into you? Even if this is the Noor we know, in this ICU you are a physician. You expect the unexpected, and you never ever start throwing punches"
Her deep brown eyes hooded and glared at me through her thick lashes. I couldn't tell if she was angry or worried. Whatever it was, the look in her eyes was enough to bring me back to my senses - partially.
Madi was right. We didn't know for sure that the pregnant patient was the Noor we knew. But I think we both understood that the chances of it being someone else were very, very slim. How many other pregnant, pediatric residents named Noor could there be in Chicago?
Virtually none.
"I am going down to the ER without you. Check up on the other patients and wait for me here. Do you understand?", Madi looked at me sternly.
I heard her, but every muscle in my body had become paralyzed. Whatever the reason for her condition, a pregnant woman in the ICU was bad news for both mom and baby. I knew she wasn't mine anymore, but Noor was still the woman I had once loved, and still deeply cared for.
And now she was sick and coming to the ICU, on my team. How much more messed up could life get?
"Do you understand Omar?", Madi repeated through gritted teeth, "Otherwise, I will not hesitate to send you home and call for backup"
I took a ragged breath, "Yes. Fine. I understand"
She started to walk away, but I stepped in front of her, "If it is Noor, you call me right away, do you understand?"
She looked at me for a couple of seconds before nodding, and I let her go.
Back in the resident room, thankfully both Liam and Jake had left already, so I focused on the patient list in front of me and repeated to myself what Madi had said; in this ICU, I was a physician, and I needed to behave like one. Even if Noor was admitted to my team, she would be 1 of 16 patients on my service. The other 15 patients still needed to be taken care of.
I thought about Madi's warning to send me home, and for a moment wondered if it was even right of me to be involved in Noor's care. There was a reason that physicians were discouraged from taking care of their own family, friends and loved ones. It was very easy to lose focus and objectivity, when emotions are involved. But then I remembered that for Noor, I was neither family, nor friend, and certainly not a loved one.
So I might as well be her physician.
Madiha
Breaking up fist fights between grown men was not part of my job description. Though, I could understand why Omar had reacted the way he did. I just hoped he would be able to remain calm through the rest of the day. I knew Liam would not dare to report him, because he was the one who had assaulted Omar first. But if he tried to pull something like this on someone else, even I would not be able to protect him.
When I reached the ER any hope I had that our new patient was not my friend, was dashed the minute I saw several senior faculty from the Pediatric Department crowd outside the room our patient was supposed to be in.
"Oh hi Madi, this is breaking my heart", the ER attending said to me as soon as she saw me, "Her oxygen levels were becoming really low, so we had to put her on the ventilator. The baby is fine for now, but we're just getting ready to transfer her upstairs to the ICU"
I shook my head, "I was supposed to check in on her this morning, but she never picked up her phone", I told the attending, trying to keep my own feelings of guilt at bay. I wasn't sure I would be able to function if I listened to the voice within me, telling me that I should have called her last night, instead of dealing with my own drama.
Just then Kim, one of Noor's co-residents stepped out of her room and saw me.
"Madi, oh my God. I can't believe this happening", she was almost on the verge of tears. Apparently, it was Kim who had found Noor passed out in her living room that morning when she went to pick her up before work.
The ER team was still trying to piece the story together, but it had seemed that Noor had a slight cold for a couple of days. Then yesterday, during morning rounds, she started having chills and a headache. The attending on service at that time had sent her home, and asked her to rest.
"I met Noor just before she left the hospital and she looked fine to me. In fact, she wanted to drink some water and get back to work, but Salman had insisted that she take the day off", Kim added.
"So how did she go from walking out of the hospital yesterday, to being on a ventilator today?", I asked, because that timeline didn't make any sense.
"Well, that is what is confusing us too", the ER attending admitted.
"Has anyone gotten in touch with Salman?", I asked them.
Kim shook her head solemnly, "We can't get a hold of him"
Salman is missing? My heart sank. But once again this was not the time to let myself feel. This was a moment for objectivity. To be a physician, and ignore the angst within me. And repeat the words that had hung on my bedroom's wall for eons.
If you can keep your head when all about you
Are losing theirs and blaming it on you,
If you can trust yourself when all men doubt you,
But make allowance for their doubting too;
.
.
.
If you can fill the unforgiving minute
With sixty seconds' worth of distance run,
Yours is the Earth and everything that's in it,
And—which is more—you'll be a Man, my son!
I placed my hand on Kim's shoulder, "Don't worry, everything will be ok", and I willed myself to believe it.
"Thanks Madi", her chest heaved, "She's my best friend. I never imagined something like this would happen to her"
"She is my best friend too", I replied but didn't wait for her to answer.
"Alright guys, let's move her to the ICU. We can send more tests upstairs and try to figure out what is going on", I instructed the ER nurses, and told Kim to let me know if she hears anything from Salman.
On the way to the elevator, I was already on the phone with the Obstetrician on-call, "I have a 26 year old G1P0, who was found unresponsive at home by her friend. Chest xray shows a bilateral pneumonia. She is in septic shock requiring several fluid boluses"
"How's the baby?", Dr Roberta asked.
"Fetal heart rate is strong for now"
"Is the mother on pressors?"
"Not yet. But I am not sure how long she'll maintain her blood pressure"
"I am on my way", the doctor replied and hung up.
Her tense voice told me exactly what I was most afraid of. If Noor got sicker, and we had to use heart medicines to maintain her blood pressure, her baby would have to come out.
She was only 7 months pregnant.
As I helped maneuver Noor's bed and the attached ventilator onto the elevator, I remembered the promise I had made to Omar. Every part of me resisted making that call to him. I even debated just sending him home. But a promise is a promise, so I took my phone out and dialed his number.
"Omar, could you meet us in room 1545. And...uh...I am so sorry"
*******
So many questions...Where is Salman? What happened to Noor (there is actually a hint in the first bonus chapter of Clash of Cultures!)? Will Omar and Salman meet?
Thanks for reading! Don't forget to vote and let me know your thoughts about this chapter 🙂