September 2019
Omar
8:00 AM
"Where the hell is her husband?", I could feel the anger building inside me as Madi related what she knew so far about Noor's condition.
I was being irrational and childish. I had no right to judge her husband and their relationship. I was supposedly over her, accepted the fact that she chose him and not me. I lost, he won.
I knew of all of that.
Yet, this was Noor.
The girl who would cheer me on from the sidelines when I played cricket in school. The friend who was the first person I ran to when I got accepted to my dream medical college. The woman I used to follow around when she got accepted to the same college, to keep her safe - to keep her mine.
She left me, heartbroken and spirit shattered. What she could never do though, was erase my memories of her and the bond we once shared. That bond was a means to an end for me, it was just part of a journey for her. I understood that. At some point in the last couple of months, I even convinced myself that I didn't love her anymore. Our destinies were always meant to be parallel, never cross.
But I could never not care for her.
And right now, she was in the ICU room in front of me. Pregnant, unconscious and alone. With the man who was supposed to keep her safe was no where to be found. So, I saw no reason to mince my words.
"How could that idiot leave his pregnant and sick wife alone at home and just disappear?"
"I don't know Omar. I've seen these two together. I can't imagine him ever leaving her alone if he knew just how sick she was", Madi tried to placate me outside Noor's room.
"But...", she put a firm hand on my shoulder. Her unflinching gaze anchored mine. Her soft but determined voice enveloped my anxiety in a warm tight embrace.
"We need to focus on her right now. It doesn't matter where Salman is. She is here and we have to do everything we can to keep her and her baby safe. So I am going to ask you again. Can you be her physician and keep your emotions in check? Or do I need to send you home?", she asked slowly, like she was studying me, trying to discern the truth even if I lied.
I swallowed, took a breath, and made a resolution not to let down Noor or Madi.
"I can be her physician", I told my senior resident, with certainty this time.
"Good", she nodded, "Lets look over her chart again and pull up the labs she has gotten so far"
Soon after that we were joined by the rest of our team.
"Given the terrible flu season, her cold symptoms were likely early flu", Madi told the attending, Dr Muller and the fellow, "Her records say she had just gotten vaccinated two days ago"
"That's not enough time to mount an adequate immune response", I noted.
"Yes. But how did she get so sick so quickly? Was it just because she is pregnant?", the fellow asked what was on all our minds.
I remembered a research paper that I had read for my PhD thesis, "What if she has a secondary bacterial process, on top of the flu? The chest x-ray certainly looks bad enough for this not to be a viral process alone"
"That's a great idea Omar. We should broaden her antibiotic coverage", Dr Muller said and Madi immediately ordered the new broader spectrum antibiotics, to add to the anti-Flu medication she was already on.
Pensive silence followed as we looked at the patient in front of us. She meant the world to me, but even for others in our team she was a friend, a colleague, a student, a trainee. In her they probably all saw a part of themselves. And we haven't even talked about the baby yet.
"Dr Muller, what about the baby? Should we be giving Noor steroids?", I asked.
He nodded solemnly, "I think we have no choice"
There was a reason for his reluctant acceptance. Noor's baby was only 32 weeks. If it were born now, its lungs would not be fully developed and it could have breathing problems for life. If the baby survived this newborn period, that is.
Steroids would help the fetus's lungs develop faster. But that came at a cost to Noor. The steroids would also suppress her own immune system at a time when her body was wracked with pathogens and she needed every cell in her body to fight it. Giving her steroids was akin to pushing her into a boxing ring with one hand tied behind her back.
That was not a fair match.
But it was match, I knew, she would willingly fight for the sake of her baby.
Madi must have read my mind because as soon as the attending and fellow went into the room to examine her, she whispered to me, "Balancing the mother and baby's life is always tricky. But with the antibiotics and antiviral treatment on board for Noor, steroids are the best chance of survival for both her and her baby"
"InshaAllah"
Madiha
10:00 AM
The rest of our rounds went faster, but the waiting game we were playing did not ease up. In fact the longer I went without hearing from Salman, despite my numerous texts the more I was worried for him too. Even Osman had asked me multiple times if I had heard from him.
"I am worried for him.", he admitted quietly. A far cry from the abrasive tone he had taken up just a little while ago. His voice, an indication of acceptance of Salman as Noor's husband, soothed something deep inside me.
I didn't even know what it was, but I ignored it. I didn't have time to understand it right now.
Instead I glanced at my phone again. All I had was a text message from Kim saying that the Pediatric Department had officially asked Chicago Police Department to assist in locating Salman. A little while later she texted again. The police had been able to reach Salman's mother in Kentucky. According to her he had abruptly left their house around midnight. They had assumed he was driving back to Chicago, but hadn't heard anything from him either.
"Maybe he hadn't heard from Noor, got worried and then decided to drive back to Chicago. But if he did, the drive from Kentucky to Chicago is about 5 hours, he left his parent's house 9 hours ago. So why isn't he here yet?", Omar remarked when I updated him.
I had no answers for him. The only thing I could do is focus on the task at hand; being the senior resident of an ICU team that was taking care of the sickest of sick patients in the hospital. Summoning my inner duck, calm on the surface paddling like crazy under the water, I started to work on Noor's admit note when my sister sent me a text.
'Call QUICKLY. Need help!'
Of course, my mind immediately went to someone in my family falling seriously ill. That was the fate everyone around me was faced with at the moment. But when I called her back she just wanted some money to buy a present for her new fiancé whose birthday it happened to be that day.
"Are you kidding me, Maliha?", I stared at my phone incredulously, "That is the problem you sent me an SOS for?"
"It is an SOS. This is the first time we're spending his birthday as a couple and Abu gave me $20 to buy him a present", she replied, "Madi tell me, how am I supposed to buy a present for a man worth millions himself, with 20 dollars"
I swear, I was ready to throw my phone off the 15th floor of that building. But when I closed my eyes, out of sheer frustration, I remembered the exhausted look on my father's face when he would come home after driving a taxi for 18 hours straight. And the determination in his eyes when I would hear him tell my mother, mein apne bachoun ko paisay ki kami kabi mehsoos nahi honei dun ga.
(I will never let my children feel the lack of money)
In all my 27 years of life, not once did he go back on his promise. Whenever we wanted something big or small, within reason, somehow he would manage to buy it for us. But he was getting old now, and I knew he was saving up for mine and Maliha's wedding. On the other hand, I understood Maliha's dilemma as well.
It was so obvious Hasan and her were meant for each other. And maybe I should have lectured her on living within her means. But I was the big sister who solved problems. And right now my younger sister had a problem, albeit of her own making. It was a problem, that on this terrible morning when everything was going wrong, I could actually solve.
"I'll zelle* some money to your account. Though, do you really think he needs material things from you? The guy has everything he wants, and if he doesn't he can afford to buy it himself. Why not focus on an experience that the two of you can share?"
"Oh Madi, that is an excellent idea! Maybe I'll ask his secretary to clear his morning schedule and I can take him to breakfast at this quaint little restaurant on Lake Michigan that he mentioned he had wanted to go to. Thank you, thank you, thank you. You're the best sister, ever!", Maliha exclaimed excitedly and hung up.
Breakfast? I checked my phone.
It was barely 10 am. It felt like we had done an entire day's worth of work already, but then again I had started the day at 5:30 am. Besides, I was convinced that the ICU existed in a time warp that was separate from the rest of the world.
*******
11:00 AM
I was in a patient's room talking to a family when my phone buzzed again. There was a 50/50 chance that it was my sister with some new request, or Kim who had an update on Salman. Both were causing me anxiety right now though, so I finished what I was doing and checked my messages.
Kim: Good news! Highway Patrol found Salman, he is 30 mins out from the hospital. I told him to call you directly when he gets there.
I immediately called Kim.
"I don't have all the details yet, but from what I know, he was found asleep in his car at a rest station about 2 hours away from Chicago. His phone had died so he didn't realize how long he had slept. It does sound like he may have whatever viral infection that Noor has, because he had a really high fever and was dehydrated when the cops found him. The paramedics checked him out in the ambulance and he seemed to get much better with IV fluids and an anti-fever medicine, so they are driving him here"
"Oh my God, what a harrowing situation for both of them. Does he know how sick Noor is?", I asked, trying to mentally prepare myself for that conversation.
Kim sighed, "Not exactly. I didn't want him to be alone when he found out she was intubated in the ICU. He just knows that she is in not feeling well and is in the hospital"
I would have done exactly what Kim did, but that also meant that I would have to be the one to break the news to Salman. First Omar, now him, I couldn't help thinking that today I had been cursed with being the bearer of bad news.
Sure enough when he did reach the hospital and I bought him to his wife's room, Salman completely broke down. Its difficult to see anyone with a tube down their throat, hooked up to dozens of lines and completely unresponsive. I couldn't even imagine what it would have felt like to see your young, beautiful, pregnant wife like that.
I could feel the lump grow in my throat as I watched him sit next to her and gently hold her hand, bringing it to his lips, as tears streamed down his face uncontrollably, his body almost shaking with the shock of seeing her. He sat like that for a while, as I looked through her electronic chart again to make sure we hadn't missed anything. I wanted to be there for him but also give him the privacy he needed. So once I logged off the computer and he hadn't said a word I headed towards the door. That's when he stopped me.
"Tell me about every test you've sent and the results so far", he said in a hoarse voice.
"I will tell you, Salman, if you really want to know. But you don't have to be her husband and her physician. We have a great team here"
But he insisted, so I updated him on what we knew so far. Her blood oxygen levels had remained stable, she had briefly received fluid boluses to help normalize her blood pressure in the ER but hadn't required them since she had come up to the ICU. Putting her on the ventilator seemed to have helped stop the progression of her illness, for now. Their baby's heartbeat was strong and the obstetrician was keeping a very close eye on any signs of distress in both mom and baby.
He was nodding along quietly, when I heard the door slide open, and from the corner of my eye saw a figure enter the room. Salman looked up to see this new occupant of his wife's room and immediately froze. But only for a moment, before his disbelief quickly morphed into anger.
Oh God, I had made the cardinal mistake of not introducing the members of his wife's ICU team first.
"What the fuck is he doing here?", Salman's voice boomed across the room.
I kept calm, "Oh, this is Omar, the intern on Noor's ICU team. And Omar, this is Salman, Noor's husband"
"Madi, I didn't ask who he is, I asked why the hell is he in my wife's room?", Salman replied to me curtly.
Omar who had been quiet till then stepped closer to me and immediately spoke up with a frown on his face, "Hey, don't talk to her like that. Besides, I am not the one who abandoned his wife to do God-knows-what in Kentucky"
"My father had a heart attack. I was only gone for two day...", Salman retorted.
"Clearly, that was enough time for Noor to end up like this", Omar interrupted, and nodded in her direction.
"Stop taking her name", Salman raised his voice again.
Has the world literally gone mad today? I watched in horror at the two men ready to tear each other apart.
"Both of you, stop it! The two of you clearly have a lot of issues to resolve, but right now we need to focus on her. So for the love of God, stop making it about yourself", I knew I sounded like my mother right now, but these two grown men were acting like kids.
"Omar step outside please and wait for me. I need to talk to Salman", when he continued to stand there scowling, I repeated, "Now!"
Thankfully, he left even as Salman muttered something under his breath. I knew my friend's husband well enough to know that his outburst had nothing to do with Omar and everything to do with seeing Noor the way she was. Yet, I could not have my patient's family fighting with my intern.
Not on my watch, I steeled my spine and turned to face him.
"Madi, I want him off her physician team", he gestured towards the now closed door.
"You know very well that is not going to happen", I told him, in an even, low voice, "I am so sorry that you are going through this. But we have an excellent ICU team here, and that includes Omar"
"But...", he started to say. I firmly held my hand up.
"I get it. The ex-fiancé and husband dynamic is awkward even in the best of times. But right now one of the smartest interns in this hospital is taking care of your wife. And he is doing it with empathy and the utmost care. Is that not what is in her best interest?"
We may have had a staring competition for the next few seconds. I won.
His shoulders slumped and he sat down again, "He better be as good as you think he is"
"He is", I reassured him. And that was my honest unbiased opinion despite the uneasiness his behavior had elicited within me.
*******
12:00 PM
"You", I pointed to Omar who was standing at the nurse's station just outside the room, "Get in the supply room, right now"
With his head lowered he followed.
"Madi...", he started to say.
"Zip it", I glared at him and he stopped talking. Then I took on the same tone with him that I did with the man who was undoubtedly the villain in his life.
"Salman is hurting, his wife is sick, and contrary to what you keep trying to insinuate he did not leave her by choice. So moving forward, you will let me do the talking. Got it?"
He simply nodded, shuffling his feet uncomfortably.
In the quiet moment that followed, I gave into the uneasiness within me. I shouldn't have. What Omar thought about Noor was none of my business. But I am human too. And as I would realize in the weeks and months to come, the human heart is not an organ that can easily be controlled by the human mind.
He had had started to leave, when I called out to him, "And Omar, whatever romantic feelings you have for Noor - shove them back inside. This is not the time nor the place for them"
His head swung around to face me, "I don't..."
"I don't want to know. Just please do your job while you are an intern in this ICU and do not embarrass me"
The warmth in his chocolate brown eyes that had once inexplicably drawn me to him disappeared. Replaced by quiet indignation and pursed lips as he walked out of that supplies room. I didn't care though. The calmness I exuded was no longer a mark of my competence.
It was the façade that I put up to hide away the turmoil within me. The dam that contained my tears and dampened my sobs.
I solved problems, I managed tempers and soothed nerves. I listened to my parents, not my heart. I could not be the vulnerable one. Ever.
*******
*Zelle is a money transfer app
Super busy chapter. But well this is the ICU, soooo! Add to it complicated feelings all around and things start to get messy.
It is really tough to see your loved one so sick, but trying to be their physician at the same time is that much harder. Salman had been worried about exactly this in Clash of Cultures (the first bonus chapter).
Omar and Salman finally met, probably under the worst of circumstances. Do you think they'll learn to get along with each other?
Lastly, what do you think about Madi? Is she on the verge of burn out? There is so much pressure on her from every where. Is that why she is feeling so uneasy or is it something else?!
Thanks for reading! Don't forget to vote and let me know your thoughts about this chapter 🙂