March 2020
Madiha
March 24: Who Should Be Saved First? Experts Offer Ethical Guidance (New York Times)
With hospital beds and ventilators predicted to be in short supply for the expected numbers of COVID-19 patients, experts say that clinicians will be confronted with having to ration care, as doctors in Italy have already had to do. To make such difficult decisions, many ethicists recommend using a utilitarian approach, in which care would be directed toward those most likely to benefit the most from it, according to this article by Austin Frakt, senior research scientist in the Department of Health Policy and Management.
I sat at our breakfast table early in the morning reading the NYT articles that had been the rounds on social media. Physicians were trained to save every life, every time. None of us went into medicine thinking that one day we would have to decide which life is worth saving more than the other. But that was exactly the dilemma facing so many of my colleagues around the world.
Morning rounds at our own hospital were starting to look a lot different too. That entire week we had on average 30 patients on our team's list, every other one had COVID. Chicago was still not as bad as New York where the National Guard (a branch of the US military that is activated in times of federal emergencies) had been called in to set up extra tent hospitals, and morgues were running out of place.
Yet, all week I could feel palpable fear in the air as soon as I stepped into the hospital. The situation with our isolation rooms was especially dire, forcing us to use them only for patients on the ventilator or those receiving breathing treatments that could result in the release of a large number of viral particles in the air. The remaining patients found themselves in standard rooms, a situation that heightened the risk of the virus spreading to hospital staff and non-COVID patients.
I so desperately wanted to talk to Omar about all of this but with Chicago in lockdown all meetings were moved online, including our noon conferences. Everyone not involved in direct patient care was asked to work from home. Even some of those physicians who were taking care of patients were asked to do it remotely via telemedicine. Those of us who did come into the hospital stayed in our designated areas and promptly left after our shift ended.
For a couple that depended on casual run ins, because dating wasn't acceptable in our culture and religion, a lockdown meant zero chances of meeting in-person unless we worked together.
Or lived together...after marriage, an impatient voice reminded me.
I had started to text him, when I heard Abu come down the stairs. "Assalam Alaikum Abu. You're up early. Is everything ok?" I asked him, noticing the worried expression on his face.
"Walaikum Asalaam Madi beta. I was just on the phone with Naeem bhai," he sighed. "I am very worried for him."
I poured a cup of chai and served it to him before taking a seat at the opposite end of the table, six feet away, "What do you mean?"
"He was fired from his job and now the whole country is in lockdown," he shook his head sadly. "Pata nahi kesai guzaara hoi ga un ka. Bhabi's diabetes is out of control and the insulin is so expensive. Plus his youngest is still in school." (I don't know how he will manage everything)
"I am sorry to hear that," I commiserated.
Though, truth be told I had never paid much attention to Abu's side of the family. We never visited Pakistan growing up, never had the funds to. And their financial situation was worse than ours. It was only in the past few years with smartphones and social media, that Abu had fully connected with his family again giving rise to regrets I knew he felt for leaving them behind.
"Was Naeem Tayaa laid off because of the pandemic?"
Anger unexpectedly pooled in Abu's usually calm eyes. He frowned, "No, he was humiliated, insulted and kicked out of that factory like a dog, after giving them almost 20 years of his life."
"Which factory?"
He pursed his lips, "Surgilab. They make surgical equipment. Have you heard of it?"
Omar
"I present to you your mystery texter..." Sehr presented to drum roll on video call. I vowed to pinch her the next time I saw her, pregnant or not, she was still the world's most irritating sibling.
"Yaar get to the point, I have to get to work. Who is it?" I asked, stifling a yawn.
"Shadab bhai. The snake himself. He changed his phone number recently, probably trying to hide from all the people who want him dead."
Cousin Shadab, the eldest son of Abu's eldest brother was the darkest moral stain on our not-so-morally clean family. My uncle had passed away a few years ago from a heart attack, since then Shadab bhai had taken over their family business of several sugar mills in Punjab. And when I say take over, I mean a hostile take over in which he made enough enemies for ten lifetimes.
"How did you find out this was his number?"
"I had a hunch, and Saima's lawyer confirmed it. You know, she won the case against her brother."
"Of course, I know. I am not that out of touch with our family," I rolled my eyes, even though I had spent the better part of the last two weeks wishing that I could just walk away from all of them.
Saima was Shadab bhai's younger sister who was just a couple of years older than us, and had all her inheritance usurped by her brother. She had promptly sued him for it. Thankfully, the court had sided with her. Saima and Sehr were best friends for a reason. Both were the kind of women who could hold their own even against the worst humanity had to offer.
The kind of women that Madi would have loved to hang out with, I thought bitterly.
"Shadab must be pissed?" I asked to distract myself from the impossible situation I was in.
"He sure is. And his income has taken quite a hit too. Sooo he needs a new source..." She raised her eyebrows, and looked into her camera as if she was expecting me to respond.
Wait.
I sat up. It all made sense now. "He's trying to take over Abu's company. That's why he sent that text message. With Abu effectively sidelining me, he is free to manipulate Abu into making him a partner or something."
"Finally the man wakes up to smell the dirty family politics," she exclaimed. "So what are you going to do about it?"
"Nothing at all. I am done with all of them."
"Omar- "
"No, Sehr. I know we have to respect Ami and Abu, but you should have heard what they said about Madi and her family. It was disgusting. And they are not even willing to talk about it anymore."
She sighed. "Have you told Madi?"
Of course, I hadn't. The mere thought of what she would feel if she found out the truth sent shivers down my spine. I couldn't knowingly cause her pain. So, I concocted an excuse about the pandemic wreaking havoc in the factory, and Abu having to deal with one thing after another. It was a flimsy excuse, and deep down, I knew it. If she weren't consumed by her relentless inpatient-service responsibilities and her transition to the chief resident position, she would have seen right through the façade.
Yet, for now the uncertainties of a pandemic offered a temporary respite from the grim prospects that loomed in my personal life.
"How long do you plan on keeping this from her? Sooner or later, she's going to get suspicious," Sehr cautioned.
"I'm aware, but for now, I can continue pretending that there's a future with her."
"Have faith in yourself, Omar. You're an amazing person. She's fortunate to have you," my sister reassured me.
"That's what you said about Noor," I muttered, and the heaviness in my chest came bearing down again. A familiar sense of déjà vu washed over me. The haunting fear of losing her flooded my mind, gradually and painfully consuming me from within.
I survived losing a fiancé. But she was a friend who filled a void in my lonely life.
Madi was life.
Madiha
Later that Day
I snuck a peak at my phone.
Me: What are your plans for the day? Telemedicine clinic again or are you in the hospital? Please stay safe whatever you do.
That was the last message I had sent this morning, without so much as a single word reply from Omar. The sinking feeling in the pit of my stomach worsened. Questions swirled, possible answers stung.
His silence was so uncharacteristic.
At first I thought he was just busy. Given his research expertise in the area of respiratory viruses he had started to work with a virologist in her lab to understand how the SARS-CoV-2 virus was infecting lung tissue. But that was volunteer work, after he did his regular shifts in the hospital. Which meant that he was literally working 18 hours a day.
Naeeem Tayaa's revelation had me on edge, as another possible explanation for Omar's aloofness emerged. Was it possible that he or had parents had made the connection between me and my Tayaa? I wondered, but dismissed the idea quickly. I had never even met him in-person.
However, this wasn't the right time or place to contemplate it. Doing so would only lead me further into the depths of despair, a place I couldn't afford to be in at such a crucial time.
I went back to paying attention to the intern's new patient who was admitted last night with a stroke due to a blood clot in his brain. We had placed the 51 year old man in a non-COVID section of the general ward initially, but quickly realized that while he did not have the typical COVID symptoms his wife had recently been admitted to the hospital with COVID. And sure enough his own test came back positive as well.
"I have never seen a viral infection cause a stroke in a relatively younger, otherwise healthy patient. This is insane...I don't know what this virus is doing, it's not behaving like we would expect most other respiratory viruses to," my attending shook his head as the intern showed him a paper on brain complications from COVID, that was recently published by a group in Italy.
This wasn't our first patient with those symptoms either so I chimed in, "We tried to put our last patient on blood thinners for the stroke, and he ended up bleeding from his lungs. This virus affects so many organ systems at the same time, you don't know what to fix and what to leave alone."
"Good thing the death rate is still only like 1-2%..." the intern noted.
But the attending immediately dampened his optimism, "Yes, but at the rate its spreading even a death rate of 1-2% means millions of deaths if we can't control it soon. It is simple math."
While the attending went in to see the patient, I answered a few pages from the ER. Similar to the half a dozen pages I had already received that morning, more patients with presumed COVID were on their way up to us. I had no idea where these patients' would all go. We were running out of beds in the hospital.
As I was about to join the team, I heard my phone's text notification sound and I couldn't help but break out into a big smile.
Finally Omar!
But alas, the message wasn't from him. It was from Dr Patel regarding a topic that had piqued my interest lately, and seemed to be the perfect global solution to a global pandemic.
Dr Patel: There is a tech company looking to partner with us on setting up an international teleconsulting portal connecting physicians from the US with those in developing countries. We're meeting next week. Interested in joining?
Interested? I was all in. Using modern tech to connect physicians from urban centers to those working in rural ones and from the US to other developing countries, in this era of smart phones and widespread internet had seemed like the best way for exchange of knowledge and expertise even before the pandemic. Now, I was beginning to realize it was also the most efficient way to spread knowledge.
Me: Absolutely. Which company is this?
Dr Patel: Cyber Gateway. Its a local company.
Cyber Gateway. Why does that sound familiar? I couldn't quite place the name, but my pager went off again and the attending and intern walked out of the room at the same time as a nurse called out to me. As the chaos continued I forgot about the Dr Patel's text message, and ignored the little alarm bell that had gone off in my mind.
After all, every professional was using whatever tools they had to counter a problem of an unimaginable scale. How could anyone think of using this tragedy for personal gains, right?
*******
I didn't get a text message from the man I was desperately waiting to hear from all day till I was packing my bag to leave the hospital. Unfortunately, it didn't do anything to placate my angst.
Omar: Sorry Madi, the day just got away from me. Had back to back telemedicine patients, but going into the lab now. Hoping that the virus has grown in the cells I infected yesterday. Need to start doing some experiments soon. Stay safe.
No love you, or miss you, or can we see each other soon? I sighed.
I longed to hear those words from him, especially this week. Yet, I also recognized and valued his restraint, if that is what this was and not his family's rejection of me. Navigating this peculiar holding pattern we were in, while maintaining our boundaries wasn't simple. Besides, I had been too timid to express those feelings to him, it wasn't fair to expect him to do it either.
Yet, as I stood at the entrance of the typically bustling hospital, now eerily quiet save for a handful of hurried figures with masked faces, the idea of returning home without seeing him filled me with dread. With so much chaos unfolding around me, the uncertainty and despair were overwhelming. I needed him and the sukoon of his presence more than anything else in that moment.
Then go to him, my heart murmured. My mind came up with more valid excuses; we were colleagues too, both of us would have to eat at some point, ordering take-out would help the struggling eateries, maybe I could even bring up my Tayaa and see if something could be done about his job.
I gave in to my heart's desire, and took out my phone. I hope Omar likes halal Indian-Chinese food, I thought as I ordered a few dishes online. By few I mean, I mean 5 dishes, for 2 people. But I didn't care about the excess food. Just like I didn't care that I was smiling like an idiot under my mask or that it was still quite chilly outside as I walked over to his lab.
I couldn't wait to meet my favorite person in the whole world.
I should have waited, though.
Omar
I looked at Madi's text message again, and it made me want to punch something. Not because of the message itself, but because I knew I was not worthy of the sentiments that it was sent with. Yet, I craved it, and her, and any other indication that she was still interested in me.
I hated lying to her, but I had to protect her from feeling anything less than the incredible woman she was. And so I buried myself in work, using it as a cover to avoid the truth, till I figured out a way to fix my family.
Its not like I hadn't spent everyday of the last week trying to do that. I had tried to talk to my parents again. They refused to even pick up the phone.
I messaged them, begging them to accept Madi in return for me giving up my medical career and getting involved in Abu's business full-time. They never responded.
I started booking flights to Pakistan. But all flights were cancelled.
I called up my Mamoo, one of the only sane heads in the family. He couldn't convince my parents either.
There was only one option. We could just get married without any support from my parents. But that would require telling her the truth, and I couldn't do that to her.
So I worked, and worked, and worked.
*******
"Hi Omar," Dr Emily Sanders, the virus expert at our institution, called out to me as I got ready to enter the biosafety level 3 (BSL3) lab. The experiment area was enclosed by floor-to-ceiling glass and equipped with a specialized ventilation system to prevent virus escape. Access to the BSL3 area required wearing head-to-toe bodysuits with attached oxygen-supplied headgear for protection against contaminated air.
"Hi Dr Sanders."
She raised an eyebrow, "I wasn't expecting you to back in the lab this evening. Didn't you just get done with clinic?"
I put on a brave smile, "I did, but I am really excited about this project and honestly any data we can get is bound to make a huge impact. So why waste time?"
She shrugged, "Well, pace yourself. But looks like there is plenty of virus growing now. We also just got a fresh set of respiratory cells from people with mild or severe infections. So, you should be all set to do your experiment."
The 'experiment' involved infecting respiratory cells with SARS-CoV-2 to observe their immune response. We hypothesized that cells from mild and severe cases would react to the infecting virus differently. If true, it would suggest that illness severity is largely determined by one's immune response, rather than the virus itself. That, in turn, could lead to more effective COVID therapies.
"That's great. I'll get right on it."
She left to go home soon after, and while the rest of the lab members also followed suit, I did what I knew how to do best; avoid my problems by working. And I would have succeeded at that too, had it not been for a soft voice that came over the intercom.
"Omar?"
My pulse raced as I glanced up and saw her through the glass walls. When our eyes met, I couldn't help but catch my breath too. Her hair was casually gathered in a loose bun, with a few curly strands framing her face. Although her mask concealed the lower part of her face, it accentuated her captivating eyes even more.
She pointed to a brown paper bag, and leaned towards the intercom again, "I ordered some dinner...if you have time to eat."
Despite every rational thought urging me to come up with an excuse and keep my distance until I sorted out my parents' situation, there she stood, inviting me to dinner with that sweet, innocent voice of hers. I had missed her so much over the last few days, my brain's logic didn't stand a chance.
Just a few minutes later I had taken off my protective gear and decontaminated myself before wearing my regular mask. "What are you doing here?" I asked.
"Sorry, I didn't mean to interrupt your work. I just thought you might be hungry. You've been working such crazy hours," she replied.
"Don't be sorry at all. I have been living on Maggi noodles so an actual meal sounds like heaven," I told her, silently admitting to myself that I would have eaten rocks if it meant spending time with her.
We stepped out of the building, so we could take our masks off and walked to the main courtyard between the biomedical research buildings. Usually this area was teeming with students and researchers. Now it was completely deserted.
It was cold outside, but the piping hot chicken corn soup felt amazing. Over hakka noodles, chicken chowmein, crispy lamb and vegetable fried rice we talked about anything and everything like we always had. At ease with each other, finishing each others sentences, laughing at the humor of everyday life despite the world around us. We are us, in our element and I cherished every second of it, knowing it might be our last.
That moment of reckoning came without warning.
"I have to tell you something, Omar," she said quietly during a lull in our conversation.
"Tell me what, Madi?"
"My Tayaa dedicated over two decades to Surgilab. He was recently fired, through no fault of his own, and it's weighing on Abu heavily," she shared, avoiding my gaze. "I haven't mentioned that your family owns Surgilab, and given how guilty he already feels about leaving his brothers behind in Pakistan, I'm afraid of how he might react when he finds out."
She knew about her Tayaa? That caught me by surprise, and my brain responded without thinking.
"Naeem sahaab stole 50 lakh from the safe in Abu's office."
"Abu said Tayaa was asked by someone else to open that safe and take the money out," she immediately responded. If I hadn't been so preoccupied with parsing her words, I might have detected the bitterness creeping into her expression.
"Did he give you a name?" I pressed her.
"No. But he said it was your father's nephew."
Shadab bhai, my jaw clenched as realization hit. Sehr was right, that snake of a man was siphoning off money from Abu while he worked his way into the company itself. Unfortunately, a realization had washed over Madi too.
"If you know about Naeem Tayaa, that means you've talked to your father..." she straightened up her gaze fixed on me. "Did you talk to him about us?"
I was looking into her dark orbs, utterly lost for words. My mind seemed to stall entirely, unable to decide between revealing the truth, risking her distance, or continuing the charade while hoping fervently for a swift resolution to this pandemic so I could attempt to go to Pakistan and fix my family.
My inner debate and loss of words were enough to make her suspicious, "Omar, is there something you're not telling me?" she asked again.
She deserves the truth, a voice said. However, painful that might be.
No, no. I am not ready for the consequences. My heart begged.
"Madi...I...uh..." I tried to say something. Nothing substantial came out.
"Just tell me the truth," she looked at me with moisture building in her eyes. I couldn't bring myself to say the words, but she had already understood what my silence meant.
With her lips quivering, she whispered, "They said no. Didn't they?"
I reached out to hold her hand, but she pulled it back and asked me, "Is it that architect girl? They want you to marry her?"
It would have been so much easier to blame it on a family friend's rishta. But the more I looked at the woman in front of me, her quiet strength mesmerizing me as always, the more I felt obligated to reply in all honesty.
I shook my head, and dropped my gaze, but forced the words out. "It's not her."
"Then it's me," her voice hitched, I hated myself, "they don't want you to get married to me because of who I am."
"No Madi, it's them. You are perfect," I tried to tell her.
But I could already see her closing herself off to me. I saw it in the glazed look she had in her eyes as she looked away from me. And the way she clasped her hands between her knees.
"What is it...about me that they didn't approve of?" she asked me with a flat tone.
I tried to move closer, she jolted back. "Just tell me," she breathed out.
"I can't," I whispered. I could never.
She squared her shoulders, "Then allow me. My family is middle-class and doesn't fit in with yours. My parents are not educated enough, or have fancy jobs. Our family name means nothing, in fact now I am associated with a alleged thief. I am too dark. I am too ugly. I have no business getting married to their handsome rich son-"
"Madi, please stop. None of that is true," I implored, but my words fell on deaf ears.
"I told you this would happen, Omar, didn't I? We were never going to work out." She spoke with an unsettling detachment, devoid of anger, disgust, or even regret. Just an eerie calmness.
I repeated my apologies, professing my love and promising to find a way for us to be together. Yet, it was as if she was encased in a soundproof chamber, like the BSL3 area without an intercom. I could see her, but I couldn't bridge the gap, neither mentally nor physically.
I knew then, this was it.
This is what it felt like to loose everything in the world in an instant. To be completely and utterly hopeless, and question your very existence. To have your soul shattered and your future ripped from your hands. To sit in the cold, in an empty courtyard, and helplessly watch your dreams melt away. To have lungs but not breathe, to have a heart that does not beat.
To see your life, but be unable to live.
I had a voice, but I couldn't speak. Barely a whimper escaped.
"Are you going to leave me?"
Madiha
I heard the gut-wrenching anguish in his voice before I even glimpsed the salty trails on his cheeks, hastily wiped away in a frail attempt to conceal his shattered soul. As I looked on, forgetting my own pain for a moment, I saw the fear in his eyes.
My life's course had made me quite familiar with feelings of disappointment, regret, agony, loathing, anger, betrayal. Yet, never in my life had I felt the fear of someone else. That too the fear of losing me.
The longer I gazed into those deep, chocolate brown eyes of his, so full of agony, the more I realized it was love that fueled that fear. It was such an overwhelming love that, suddenly, the hatred stung less, and words, though acknowledged, held less sway. It compelled me to turn inward and reflect; what was I willing to give up, just to save face in front of our families?
My truth revealed itself. The answer was obvious.
I had a million reasons to run from him and the life he offered. One to stay.
The words spoke themselves.
"I love you."
Three simple words. Yet for me they held a far deeper meaning. "I don't love your family wealth. I don't love your Porsche. I don't love that you can afford to eat at fancy restaurants. I don't love that you never have to think twice about buying something. I certainly don't love that your family thinks so lowly of mine. I absolutely don't love that your father maligned my uncle. I could never love being degraded because of how Allah created me, but..." I paused to catch my breath.
"Omar, I love you."
He looked stunned, his voice cracked. "Are you sure?" he asked hesitantly, quite unbelievingly.
I felt my cheeks heat up as the weight of what I had blurted out sunk in. I nodded to him, because every word was true. I loved him with all my heart, and he loved me back the way I dreamt of being loved. In this fucked up, messy world (excuse my language), where your worth was determined by the house your were born in, and the number of melanocytes* in your skin, he gave me everything that mattered.
"I am. A wise woman once said, when you find that one person who brings you true happiness, you hang on to them like your life depends on it. So, here I am, hanging on to you with everything I have."
His smile was like sunshine peeking through stormy clouds. "I am never letting you go," he said in a hushed voice.
"Its not going to be easy, though" I cautioned.
"I promise, it'll be worth it," he replied.
It wasn't easy. That evening we had simply taken the first few steps, together. But he was worth every agonizing, harrowing moment that was yet to come as we navigated a raging pandemic, egotistical families, deception and misunderstandings.
Yet, he was worth fighting for, with all my heart - even when he almost gave up.
*******
*Melanocytes are cells that produce melanin, a dark pigment that gives skin and hair their color.
Be honest, how many of you thought Madi would abandon him? Haha...
Maybe the emotional drama was unnecessary in the end. But I really just wanted to show the depth of feelings these two have for each other. Because that is exactly what their story is: they found someone whose love matched the depths of their own.
I hope you liked Madi's explicit confession, finally! They still have a ways to go in convincing both sets of parents in the midst of a pandemic. But at least they are together.
Thanks for reading! Don't forget to vote and let me know your thoughts 🙂
P.s. There will be COVID related info weaved into this story, because I wrote it initially as a way to remember what we all went through. If you find those parts boring, feel free to skip 🙂