April 2020
Madiha
April 30: FDA authorizes emergency use of remdesivir (abcNEWS)
While the data for remdesivir looks promising, and hydroxychloroquine less so, experts warn data so far is limited, and right now there's no silver bullet cure for COVID-19. "In this pandemic, the field is changing rapidly. What we know now is changing from what we knew three months ago -- most fields don't change that rapidly," said Dr. Neera Ahuja, division chief of hospital medicine at the Stanford School of Medicine. "We have to keep reevaluating as we go along. What drug looks good right now might not be the best looking one in two weeks."
It was late afternoon as I sat at my newly assigned desk in the Chief Resident's office trying to focus on learning more about the drug remdesivir that had provided a glimmer of hope to the world with its modest impact on COVID mortality. Yet, all I could think about were the words 'You, Madi. Just you'. Whispered mere inches from my face they still sent a shiver down my spine.
For a woman who went through one rejected rishta after another, this was not a position I ever thought I would find myself in; basking in the pure love of one man and confused by the unexpected obsession of another.
My phone rang, it was my sister.
"Maliha, did you talk to your mother-in-law?" I blurted out even before greeting her.
"Yes Madi, I did. I told her that you were interested in someone else and that Faraz bhai's behavior was not acceptable," I could hear the edge in her voice, and I hoped to God she would had gotten into trouble with her new in-laws because of me. Yet, I had no choice but to reach out to her. My own parents brushed away my concerns, and I vowed never to talk to Faraz again. Having Maliha be the voice of reason was my only option.
"Was Sakina Aunty upset? I hope she wasn't mean to you."
"She wasn't. She was actually quite appalled herself at Faraz bhai, and had no idea about you and Omar bhai. But Madi..." she paused, the edge in her voice was replaced by a solemn pledge. "I am your sister. You've been my shield God knows how many times. Rest assured, I will be no less protective of you. If my new family tries to force you into something, they'll have to go through me."
I couldn't help chuckling at the sweet determination in her voice, "Bohat bari ho gayi ho." (You've grown up quite a lot)
She laughed, "Choti tou abhi bhi houn, I just asked myself WWMD." (I am still young)
What would Madi do, was her mantra when things got tough. She had told me that on the day of her wedding. Today I could safely I wasn't just impressed at her maturity, I sought comfort in her voice and words. I didn't have to bear the burden of a big sister alone. I had a younger one who had my back even when I wasn't looking.
Omar
Today was my day 'off'.
Though 'off' in my world these days meant that I spent that time in Dr Sanders lab trying to make a mark, as insignificant as it may be, on the growing body of evidence that the severity of COVID was related to the immune response triggered by the virus more than the virus itself.
"You're back again? I asked you take the day off, son," Dr Sanders looked over her reading glasses at me.
"There is so much to do," I replied. And so little to do at home, I thought.
"The techs are working on it."
"Yes, but they don't have a PhD in respiratory viruses, Dr Sanders. I do. So I might as well put it to use."
She took her glasses off and put them to the side. I couldn't read her facial expression well because of her mask, but didn't doubt her sincerity one bit when she asked, "Omar, do you like coming here because you're lonely at home?"
It wasn't a casual remark, nor was it laced with any trace of condescension or pity. Instead, it bore the weight of genuine concern, a reflection of her deep understanding of the challenges I was facing.
From one healthcare worker to another, in unprecedented times, she understood the loneliness of my solitary existence and how much I relied on interactions with my colleagues for my own mental sanity. Even if done through N95 masks and goggles while wearing plastic gowns and gloves, those moments served as a vital antidote to the anxious thoughts about Madi and the bleakness of our future. Coming into work was the sole means by which I could stave off the surging anger I felt whenever I thought about my parents and society at large.
'You could say that," I admitted.
She quietly nodded, "Then you're always welcome. But only if you promise me that if your loneliness turns into something more, you will come straight to me."
The sincerity in her eyes mirrored the gravity of her offer. She was in her late 50s and I had only known her for a couple of months. But right then she wasn't just a mentor, but a source of solace in these turbulent times. Her words were an invitation that resonated deep within, a lifeline extended in the unspoken language of empathy.
All things I wished from my parents. The two people who had raised me, yet refused to acknowledge my existence.
"I promise," my voice perked up unexpectedly. I might not have parents that cared. But I had people who cared.
Soon I would realize, my sister and younger cousin were among those people too.
*******
"What video?" I asked Sehr as I drove towards the COVID field hospital where I was volunteering for the night shift.
"The one of Naeem sahab taking the bag of money out of Abu's safe. Saima was able to get a hold of it."
"And how is that supposed to help prove that Shadab bhai was behind all of this?"
"Omar, Naeem sahab had a piece of paper with the code written on it. You can clearly see him reading off it. That means someone gave it to him. Its not like he went and broke into the safe or something."
I understood my sister's enthusiasm. She wasn't kidding when she said she was on my side. But jaded by all my past interactions with Abu, who was no fool I might add, a piece of paper wasn't the evidence that would convince him that Madi's uncle wasn't a thief.
"Its not enough, Sehr. Abu will just say he had gotten the code off some document or email and written it down for himself."
"I am sending you the video. Just look for yourself. He seems so relaxed like he was in no rush at all. Saima confirmed that Abu was in the building at the time. If Naeem sahab was really stealing something wouldn't he be rushing?"
"Maybe, but Abu will just say that he knew he would be preoccupied with something else."
I heard her sigh, "Well, take a look anyway. You'll know what I am talking about."
"I will. And listen, thanks for doing this. Tell that to Saima too," I told her as I pulled up outside the field hospital.
"Thanks for what, bro?", she chuckled. "We're just doing what sisters do best. Meddle in our useless brother's life."
"Haha...very funny." I made a face even though she couldn't see me.
Yet, no matter how much I made fun of her, or pretended that she irritated me to no end, she had always been the undeterred solid support I needed. I didn't tell her this enough, but she was one of the best parts of my life.
I still didn't tell her. What kind of a brother gets all emotional in front of their sister anyway? If I was with her, I would have pulled her hair and called her donkey, but I wasn't so I expressed my appreciation in another way.
"I bet your child is thinking, kis pagal ma se palaa parha hai." (what crazy mother have I encountered)
"Chup karo," she squealed. "The only thing he is thinking is, why is his Mamoo so stupid?" (Be quiet)
She started laughing, "Are you wearing a mask right now?"
"Of course, I am."
"Good, your patients don't need to see your ugly face."
I rolled my eyes. "Go away, I am hanging up"
"No, no wait. I have another joke..."
I stood alone at the entrance of the domed tent that had been set up by the National Guard (a branch of the US Army) to take care of COVID patients who couldn't find a bed in the overflowing hospitals o the city. I should have been dreading my shift, bracing for another wave of death and despair. Instead, I found myself laughing at my sister and her silliness. In that moment, when I needed it most, she was the spark of brightness in the darkness of my reality.
I loved my sister. I would never utter those words though.
"What are you craving these days?"
"Chocolate covered almonds. Why?"
"Nothing, I have to go. I don't have time for your stupid jokes."
"Oh I know you love them. They are stupid just like you."
"I hate you."
She chuckled, "I hate you more."
I hung up, but didn't put my phone away. Instead, I opened the Amazon app, and selected the biggest bag of 5-star rated chocolate almonds I could find and put in Sehr's address in the 'deliver to' section.
After all, I hated my sister.
Madiha
When I took charge of scheduling the resident and intern hospital shifts, I had not realized how much work it would be. It was almost 10 pm and I was still sitting in our chief resident's office trying to figure how best to make sure that the tougher weeks in the COVID units were evenly divided and that no one went over the 80 hrs per week rule.
No one else was in the residency office at that time which is why I nearly jumped out of my skin when I heard footsteps running down the hallway, and a sharp knock on the door.
What the...
Before I could get too worried, Dr Patel stuck his head into the office. He seemed breathless. "Oh good. Madi, you're still here. I need you to come with me quickly..." And then he ran back out again.
What in the world is going on?
I grabbed my purse and shoved my laptop into it before running out of the office as well and followed his footsteps. He and a couple of other senior administrators, and the Chairman of Pediatrics were gathered near the elevators, talking in hushed tones.
"Looks like Southern Michigan Hospital didn't need that shipment of gloves and gowns so they rejected it in favor of the masks. We have plenty of masks, but only have enough gloves and gowns to last the hospital 3 more days," one of the administrators was saying. "I say we reach out to the PPE company asap and get what we can."
"I also just spoke to the representative of the company we've been buying COVID tests kits from. They confirmed they have 500 kits on their truck right now, and are willing to meet us somewhere along the I-90 highway to make a deal. If they agree, that stuff is ours" the second administrator chimed in.
The Chairman of Pediatrics, who was a formidable character usually, was now standing there in a pair of old, worn out jeans and Nike sweatshirt. He looked like he had rolled out of bed, put a mask on and rushed here.
I still had no clue what was happening. But it seemed intense.
"Ok, great," the Chairman gave instructions to the two administrators and then looked at us, "Harish and Madiha, you two go and meet the COVID testing company. I believe they are on their way to Iowa, so intercept them and see if they if they'll sell us the kits without us going bankrupt. I'll be in my office talking to both companies so they don't bypass us."
Everyone nodded and it seemed like we had some sort of a game plan. Everyone except me, that is. It sounded like we were making drug deals, except we were a freaking hospital.
My confusion must have been evident because the Chairman looked straight at me and frowned. Through clenched teeth he said, "Young lady, welcome to the world of medical supplies covert operations. This is what we have to do to keep you guys safe...all because our fucking government doesn't believe we are in the middle of a fucking pandemic!"
He stormed off into the dark hallway towards his office, leaving me to stare at Dr Patel hoping he would give me more of an explanation.
"Come on Madi. Let's go," he started jogging towards the parking garage.
I followed, but had to ask, "Dr Patel. You'll have to give me a little more detail about what exactly it is that we are doing."
"I'll need an extra set of hands to go through the kits to make sure they are not missing any components," was the only thing he muttered then.
It was during our ride to somewhere in the middle of rural Illinois when he explained how the government had left individual states, cities and hospitals to arrange for their own protective gear, hospital equipment such as ventilators, and COVID testing kits. Instead of there being a centralized, coordinated effort to manage these essential supplies, individual entities were having to make deals directly with the companies themselves.
"That sound like the worst possible way to handle a pandemic."
"Exactly, and it's not just that," Dr Patel went on. "These companies are free to price gouge whenever they want. The supply chains are so fragile right now that you never know when the next shipment of essential goods will come so we pay whatever they ask, and buy the supplies whenever we can...including in the middle of the night on the side of a highway."
"Kind of sounds like hunger games!"
That finally dissipated the perpetual frown lines on the senior physician's forehead, but it wouldn't last for long.
"What? Are you sure about that?" Dr Kumar's panic stricken voice made me focus on the call he had just received.
He turned towards me and said, "The truck bringing the COVID kits stopped for the night in Indiana, because the driver had been driving for 18 hours straight. We could leave it till the morning, but looks like there is another buyer in the area so we may not have anything left for the morning. Are you up for another hour's drive into Indiana?"
"Of course." This was turning into more of an adventure than I could ever have imagined. I took my phone out and opened up my text messages app.
Me: You are never going to believe what I am doing right now.
Omar
"Why are you looking at Madi's schedule?" a familiar, but unexpected, male voice called out to me. I turned to look at the person behind that voice, and sure enough Salman was standing there in full protective gear, with only his eyes visible through the plastic goggles.
"None of your business!" I would have stuck my tongue out at him but like him I too was in full protective gear including an N95 mask.
"What are you doing here anyway? The average age of these patients is several decades more than what you are used to."
"Emergency declaration by the medical licenses department allows pediatricians to take care of adults too. Besides our children's hospital donated several ventilators to this field hospital, so I decided to come along," he shrugged.
I didn't think I could ever trust a pediatrician to take care of a 70 year old patient, anymore than I would trust myself to take care of a 2 year old patient, but these were unprecedented times.
"That explains why my patient's ventilator had teddy bear and giraffe stickers on it," I told him as he took a seat next to me.
It was almost funny how those colorful stickers stood out in stark contrast to the dull drab of the rest of this field hospital that had been set up to take care of the COVID patients overflowing from all the Chicago city hospitals. Children were not as affected, yet, so the pediatric hospitals' resources and personnel were being redirected to adults.
"Nothing wrong with a little bit of pediatric cheer in this place. But back to you," Salman peered over my shoulder. "are you signing up for shifts in this field hospital so that Madi can't?"
How did he figure that out? I silently wondered. It was true, I was trying to keep Madi out of this place by signing up for the shifts when she would have been available to do so. Not only was it insanely busy, this was my first half hour break after 6 hours of being on my feet, but there was also a severe lack of personal protective equipment. We were asked to wear the same protective gear for all our patients since everyone was COVID positive. That might have made sense for the patients, but increased the risk of contaminating ourselves.
Call me unscientific, but I was going to try my best to keep her out of here. Without letting her know of course.
"Good man," Salman patted me on the back. "I would have done the same for Noor"
"Thank you for your approval," I replied sarcastically.
But now that I had run into him, I had questions. "Speaking of Noor, where have you two been? Madi and I have been trying to call you and you never reply. Is there a problem?"
His shoulders slumped, surprising me. "No. We're ok." He mumbled, and started to get up from his seat.
I got up too, "Just ok?" Something in his voice told me things were anything but.
I had inkling on what it might be. The pediatric population may not have been affected in terms of infections, but this pandemic had essentially halted their lives.
Salman shook his head, "All the daycares are closed. I don't want a nanny at home. She would be another non-essential person in the house. So, Noor is taking care of Ayah all by herself. There are days that she is literally doing telemedicine clinic while bouncing Ayah on her lap. Luckily, most of the parents are ok with that, though someone complained about Noor the other day which made quite upset."
I wanted to ask him why Noor was taking care of their daughter 'all by herself'. By all accounts Salman had been one of the most hands-on dads I had ever met. Before I could ask him though, I noticed that my phone had several messages from Madi. It was on silent and I had just taken it out of my pocket.
"What the heck?" I said out loud as I started reading her messages and showed them to Salman as well.
[10:30 pm] You won't believe what I am doing right now. Dr Kumar and I are chasing down a truck with COVID supplies.
[11:00 pm] Almost near near the Illinois border. Making a quick stop for coffee.
[11:20 pm] We just heard that the other interested party is also heading towards the same truck with COVID supplies.
[11:30 pm] Damn...I had no idea Dr Patel could swear like that or drive that fast. It's like a crossover episode of Hunger Games and Fast and Furious.
[11:42 pm] We are at the gas station where the truck was supposed to be, but there is no truck here.
[11:53 pm] Company says that driver was hungry. COVID supplies in an 18-wheeler, are currently in a MacDonald's parking lot somewhere in Indiana
[11:55 pm] Found MacDonald's, heading there now
[11:59 pm] Oh shoot...there is another van behind us, marked Indiana State Hospital. Dr Kumar is gunning it...
That was the last of the messages.
I looked at my watch, it was 12:10 am.
"Call her dude. Did they get the COVID supplies?" Salman asked, excitedly.
I dialed her number, "Madi, what happened? Are you ok?"
"Yes, yes. I am fine. On an adrenal high, but I am fine. Its crazy out here Omar, we managed to make payment and check about half the kits before the other team arrived. They had literally no kits at all, and served one of the poorest cities in Indiana so we left the other half of the kits for them. But listen, I gotta go. Stay safe!"
"You too- " I said quickly but she had already hung up.
"Is this for real?" I asked Salman. "This is our healthcare system? Chasing 18-wheelers across state lines in the middle of the night?"
"It is. And it is so messed up. I read about similar things in New York and California. It's like a disaster preparedness plan doesn't even exist at the highest levels of the government."
"Unbelievable."
*******
The Next Morning
"Unbelievable," I found myself uttering again as I scrolled through Shadab bhai's social media feed filled with evidence of his ostentatious lifestyle. I wasn't even sure what compelled me to pull up his Facebook page when I should have been taking a quick nap after my overnight shift.
I had just seen the video that Sehr had sent. Taken from the surveillance camera in Abu's office, I saw what she meant. Naeem sahab looked completely unfazed as he carefully unfolded the piece of paper and took his reading glasses out from his pocket. He even stopped to answer a phone while in the middle of unlocking the safe. There was no sound on the video, so I couldn't tell who called him. But it was evident that Naeem sahab wasn't feeling rushed at all. He methodically packed a black canvas bag adorned with a BMW logo, carefully filling it with cash before casually walking out of the room.
He was either the most confident criminal in the history of crime, or he didn't think he was a criminal at all.
Suddenly, I stopped scrolling through my elder cousin's Facebook feed and stared at a picture.
It was of him, in his expensive looking business suit with his thinning hair swiped to the side and a slimy smile on his face, leaning against a dark blue car. A BMW.
But that wasn't all. It was what was on the car's bonnet that caught my eye.
A black canvas bag with a BMW logo.
*******
Siblings: the people we would give our kidney to, but refuse to share a cookie with 😂 And we hate them, but always with love.
This was intended to be a lighter chapter because I wanted to show that even when parents are hard-headed and unreasonable, sometimes siblings are the glimmer of hope that is desperately needed. And like Omar's mentor, sometimes strangers become family in foreign lands.
Will Omar's discovery help him and Madi at all? Will Faraz quit pursuing Madi now that his mother knows the truth about her and Omar? Was that a hint of trouble in paradise for Salman and Noor? More to come on all that!
I kind of joked about the lack of access to protective gear in the beginning of the pandemic, but don't want to gloss over the fact how dangerous it was for healthcare workers. I think it was when we were asked to spray bleach on our N95 instead of getting a new one, that I really lost it.
The whole chasing after supplies in the middle of the night might seem made up, but it was inspired by true events in the US! https://www.cbsnews.com/chicago/news/illinois-comptrollers-office-finds-itself-paying-3-5-million-for-ppe-in-mcdonalds-parking-lot-during-coronavirus-crisis/
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