June 2020
Omar
I stood in the immigration line at Jinnah International Airport in Karachi, clutching my passport with a valid visa and my negative COVID test result in one hand. My carry on bag in the other.
"What was your purpose of returning to Pakistan?" the immigration officer asked me.
"I was visiting family. I am a doctor-in-training an my father wasn't feeling well," I replied.
And somehow ended up getting married to the most incredible woman in the world, I wanted to shout out loud for the world to hear. Barely able to contain myself at the thought of her waiting for me, and so very thankful for the mask I wore, I let a wide grin spread onto my face.
It totally skipped my mind that immigration officials ask you to take your mask off as well, for identification purposes. "Mask utarein," the man asked.
I obliged. The grin, unfortunately, persisted.
The officer raised an eyebrow, "Abu ki tabiyat kharaab thi tou itna muskaraa kyun rahein hai?" (If your father wasn't well, why are you smiling?)
Oops. I swallowed the joy, and stuttered a reply. "Umm...ji...woh sahi ho gayein hain ab." (He is fine now.)"
"Ajeeb doctor hain aap," the man grumbled, but stamped my passport anyway and let me go. Now I just prayed I wasn't 'randomly' selected for further questioning when I entered US.
Twenty minutes later I was standing in the mithai shop just outside the departure lounge. That was probably, something I should have done before but between making sure Abu had everything he needed, and trying to stuff all the clothes and jewelry Ami had bought for Madi in a suitcase, I just didn't get the time.
Yet, mithai was the only gift Madi had asked for. So stale or not, airport mithai it would have to be. But what shall I get? I wondered. From red, white and pink mithai shaped in little balls, to brown squares that resembled fudge there were a surprising number of options even in this unassuming little shop.
I texted her.
Me: At the mithai shop in airport. What sweet stuff do you want from here?'
She replied almost immediately.
Madi: Only you 💖
I chuckled thinking of how she must have smiled while biting her lower lip and typing that message.
Me: Stop flirting with me Mrs. Madi A. Omar and answer my question!
Her reply made me laugh out loud.
Madi: I won't stop flirting! I can do whatever I want with you now 😏
Fiesty! My sweet, innocent wife it seemed may not be as inhibited as I thought she would be. But any further thoughts of testing her innocence immediately fizzled out when a man cleared his throat loudly.
"Ji janaab, kuch lein ge bhi ya idhar kharai ho ke sirf haste rahein ge?" the mithai shop man asked with an amused look in his eyes. (Sir, are you going to buy something or just stand here laughing?)
That jolted me back to reality, diverting my thoughts from the untimely, albeit now appropriate, visions of being with my wife. Quickly, I purchased the mithai I knew she enjoyed – gulab jamun, habshi halwa, and barfi – along with some extras for my in-laws. Then, I got the hell out of that mithai shop, before the shopkeeper could give me anymore weird looks.
Which was a good thing, because soon my phone pinged again.
Madi: Sorry about that last text 😳
And, my shy Madi is back!
Me: You never have to be embarrassed in front of me. And yes, I am yours to do whatever you want 🤭
Two minutes later she texted again.
Madi: In that case, I really want to... 🙈 🙈🙈
My fingers were already flying over my phone's screen.
Me: Really want to what??? Madi A. Omar you've got to start finishing your sentences!!
Madi: Come home to me first Omar Khan. Then I'll finish it.
Torture. That is what this was. An exquisite form of torture, to be bound to the woman of your dreams in holy matrimony yet experience the ache of yearning, to feel her words caress your skin yet not be able to feel her.
After finally reaching the gate my plane was supposed to take off from, I asked the lone gate agent, "How much longer till the plane takes off?"
He raised an eyebrow, everyone seemed to be doing that today. "Bhai sahaab, abhi tou boarding ko teen ghante baaki hain. Aap airport bohat jaldi aagayein hain." (Oh brother, there are still 3 hours left till boarding. You've reached the airport early.)
"Fite mun," I muttered and sunk into a nearby seat.
Madiha
Several hours had passed since the exchange of text messages, yet as I lay in bed that morning, a lingering warmth in my cheeks betrayed the aftermath. Try as I might, I could not stop imaging how his hands would feel on my skin, igniting every inch of me with his heated touch. The taste of his mouth, the caress of his lips on mine - these thoughts consumed me. I may not be the prettiest woman out there, but he made me feel seen and desirable, which made me crave his presence even more.
What's happening to me? I closed my eyes and took a deep breath. It felt as if a floodgate had burst open, unleashing every desire I had suppressed over the past six months all at once.
Yet, there were 10 hours remaining until his arrival at Chicago O'Hare, during which I still had a job to do on the inpatient service.
Dragging myself out of bed, the only solace I found was that 1) this marked my final day as a resident, and 2) I had an entire week off ahead. But once again, in the early morning stillness, my thoughts veered into the realm of late-night fantasies - images of warm embraces and sensual caresses.
"Oh, come on, Madi. Pull yourself together," I scolded, splashing water on my face.
There was even a Rukhsati to attend before nightfall.
*******
Maliha: Ami wants to call the next door neighbor as well. She promises its the last family she'll invite.
Maliha's text made me want to pull my hair out in the middle of rounds. In classic desi fashion, my parents initially planned a guest list for 20 people, but it ballooned to three times that number. I almost declined to participate in my own Rukhsati, considering the COVID situation, but the spacious open air setting at one of the botanical gardens saved the day. With the help of my 'girl squad' and the men in their lives plus my brother, tables were once again placed strategically to ensure each family could sit separately, maintaining a safe social distance.
We were playing with fire, though. There was more and more data coming out that the even open air spaces were not safe. I couldn't imagine the embarrassment if someone caught COVID at the wedding of two doctors.
Me: Ok. But make her keep her promise otherwise I will disown all of you.
I put my phone away and tried to focus on what Jake was presenting about our sickest patient.
Fortunately, I was assigned to the non-COVID inpatient unit this week, and our patient load was manageable. While the acuity of the patients was higher, none were severe enough to warrant ICU admission, except for one individual who appeared to be heading in that direction.
"62 year old woman, with a history of diabetes, was bought to the ER earlier this morning by her husband with high fever, and complaint of severe headache. She had no respiratory symptoms. COVID test is negative, and her blood sugars are only mildly elevated so these symptoms are not due to her underlying diabetes. Since being admitted she also seems to have become more and more disoriented and confused."
"She is maintaining her airway and breathing without difficulty right now, but if her mental status changes anymore she'll need to move to the ICU. I'll give them a heads up about her," I offered. The ICUs were still full of COVID patients and finding a bed for anyone else had been a significant challenge.
Jake went over some of the testing we had done so far, "The head CT scan suggests that there is inflammation of her entire brain. And the brain fluid that we obtained through a spinal tap looked like maybe she has a viral infection."
Several typical viruses are capable of causing brain infections, often accompanied by cold or respiratory symptoms. Even COVID has been linked to this type of infection. However, she displayed no symptoms other than those affecting her brain.
"Any known drug use?" the attending asked.
"None, her husband swears," I reported.
"Did she travel somewhere?" he asked.
I had also pondered that question, as there are arboviruses, a group of viruses, that can lead to such symptoms. However, these viruses are typically transmitted by mosquitoes, requiring exposure to mosquito-prone areas outdoors for infection to occur.
"This woman has not left her house since March this year according to her husband. She works from home and even gets all her grocery delivered to her apartment. She has an extreme anxiety disorder, so I think she is literally afraid of leaving her house during this pandemic. They live on the 40th floor of a high-rise building and the most she has done in the last 4 months is stepped out on to her balcony," the intern noted.
A second thought crossed my mind. As they say 'never say never', and rare as it may be, her symptoms fit with arboviral infection fairly well.
"Let's go ahead and run a test for the arboviruses, even though I doubt it would yield a positive result," I conveyed to the team my thought process.
We explained all that to the patient's husband and were moving on to the next one when my pager buzzed. It was a message from the hospital's front desk receptionist, asking me to call her back.
"Dr Ahmed? Someone is here to see you," she said as soon as she picked up the phone.
"Who is it? I am not expecting anyone."
"Oh he walked away, he said he'll meet you in the foyer. But girl..." she chuckled, "if those roses he's carrying are for you, you are one hell of a lucky thing."
My pulse quickened. "What does he look like?"
"Tall, dark and handsome," she promptly replied.
Omar? I was so convinced it was him, I ran to Jake asking him to continue rounds without me. We only had one fairly stable patient to see anyway.
"Where are you going?" he asked.
"My husband's here..." my voice trailed off, and I ignored Jake's gaping expression. My mind was already weaving a narrative: he knew how much I missed him, he must have taken an earlier flight, his text messages were sent from Dubai not Karachi, he was coming straight from the airport only stopping to pick up the roses.
At no point, as I repeatedly stabbed the elevator's down button, did it occur to me that the man waiting for me could be anyone else but my husband. If it had, I might not have had to suppress the urge to throw punches the moment he turned around as I got off the elevator.
"Faraz?" I frowned, glancing around, convinced it must be a mistake.
Yet, it wasn't. He was the man who had asked for me. The large bouquet of red roses in his hand made any other conclusion seem improbable. With the initial thrill of a surprise from my husband evaporating as swiftly as a drop of water on a naked flame, revulsion swiftly replaced confusion.
"Hi Madi," he replied, his dark eyes boring into mine, arrogantly as always.
If I hadn't been in the bustling foyer of a hospital, and if my masked face could conceal my identity, I would have shouted at him to leave and never to show his face again. Instead, with lips pursed I didn't bother to hide my irritation, when I asked, "What do you want?"
"Well, I can't say 'you' anymore," he mocked.
I took a few steps closer, dropped my voice but didn't mince my words. "Listen to me, Faraz. And listen well, because I am not going to repeat myself. I was never yours, never will be. I am Omar's wife, and if you try to play anymore games with me, I swear to God I will get a restraining order on you."
Yet, backing down had never been in that man's dictionary. He stepped even closer, forcing me to back up, "Look at you," he whispered. "Such an intelligent, independent woman already losing her identity. He'll leave you as nothing but Omar's wife."
"That's not what I -"
"Which is such a shame because you could have been so much more with me." His voice, low almost menacing, sent a shiver down my spine. His proximity made me want to shove him back, instead of yielding more space to him. My silence was filled with indignation, it was a simple attempt to not give him the satisfaction of riling me up. Instead, he took it as regret.
"In case you're wondering, I believe in giving second chances. But for now, here," he thrust the roses into my arms and took out a smaller box wrapped in pretty silver paper, placing it on top of the bouquet. "A gift for your new marriage. When its over, come find me."
That was the breaking point, the final straw. I no longer cared about any onlookers; anger surged uncontrollably, erasing every trace of restraint. I hurled the flowers and gift back at him.
"That's not very nice -" he was saying, when I shoved him back as well.
"What's not nice is you harassing a married woman, so get the hell out of my face," I yelled, people turned towards me. I didn't care. The security guard at the entrance of the hospital was already looking at us when I beckoned him closer. "Sir, this man is harassing me. Please ask him to leave."
It took only a moment for the guard to lay hands on Faraz, who stepped back, insisting, "No need to threaten me, Madi. I was already leaving." He wrested his arm free from the guard's grasp but made no approach toward me. Instead he just stood there. If I didn't hate him with a vengeance right then, I might even have noticed his shoulders slump when he spoke.
"In fact, I am leaving the country. Abu is putting me in-charge of our company's operations in the Middle East."
But I had already turned to head back to the elevators. "Go jump off a cliff, for all I care," I said and walked into the open elevator without bothering to look up when he called out my name.
Or when I heard him say, "I am sorry," just as the doors closed.
He never held any significance for me anyway. Just a contemptible person, easily erased from memory, destined never to cross my path again - in his own words, he was leaving the country.
*******
Luckily, I didn't even have time to dwell on my encounter with that despicable man. As soon as I reached the floor, I found Jake pacing the residents room.
"Hey, so our patient with the mystery neurologic illness, is barely replying to questions now. She only briefly opens her eyes on painful stimulus. Though, she is still breathing on her own."
Differential diagnosis and next steps played themselves out in my mind. "Did you do a spinal tap and send the cerebrospinal fluid for analysis?"
Jake nodded, pulling up her records on the computer, "The fluid shows there is inflammation in her brain. But that is so non-specific."
"She is already on broad spectrum antibiotics, right?"
"Yes," he confirmed.
"Ok, then we sit tight and wait to see what the bacterial and viral testing show."
As unsatisfying as that plan was, sometimes you have to wait and see how signs and symptoms evolve in order to make an accurate diagnosis. Time, reveals its hidden secrets when it wants. There is no way to hurry it up.
Time, crawling by at a sluggish pace, I thought to myself looking at my watch. There were still 5 hours left for Omar's plane to land. The excitement that had been electrifying my nerves all morning, now felt tainted by the unsavory memories of a certain man. q
*******
With 2 hours left till Omar's plane landed, I was feeling very proud of myself for having completed almost every task on my list, while holding an impromptu teaching session for interns, making sure all our patients had their medications/lab tests ordered, and taking a break with my fellow senior residents to celebrate our last day of training.
"Heard you wacked a guy in the hospital foyer today," Kylie smirked as the two of us stood outside, with our masks off momentarily, sipping on the last cup of coffee we would be having as residents. That bittersweet moment instantly overshadowed by disgust.
"He had it coming," I told her, wishing I had punched him in the face as well.
"What's his problem anyway?"
"He doesn't like to lose. It's peak male entitlement."
"Yeah," Kylie shook her head. "Are you going to tell Omar?"
That was a question I had been asking myself too. It would be so much easier to not tell him, let him think that he had already seen the last of Faraz. But did I really want to start my married life by keeping things from my husband?
"He will flip out, but I think I have to tell him."
Kylie was nodding slowly, when my pager went off. Dreading a repeat of the morning, I peaked at it. It was another unexpected message. But this time it was sent by the intern.
Jake: Patient with headache and fever has West Nile Virus in her CSF!!!
Wait, what? How? The fluid around our patient's brain (CSF-cerebrospinal fluid) had one of the arboviruses transmitted by a mosquito. But she hadn't left her apartment, on the 40th floor, for four months.
I told the Kylie the whole story. "How high can mosquitoes fly?" she asked. I had no idea, but we found Jake Googling the same question in the residents room.
"Apparently, not very high. They only typically fly 25 feet or so above the ground," he told us.
"So how did it get to the 40th floor?"
Jake was on it again. "Elevators can collect rainwater," he said after clicking through a websites.
"And its the rainy season in Chicago these days", Kylie noted.
The rest of the mystery was easy to solve, "Any collection of water is a breeding ground for mosquitoes. So mosquitoes were probably transported up and down that building in an elevator. One just happened to get out on the 40th floor and entered the apartment through her front door."
"Poor woman," Kylie exclaimed. "She doesn't leave her house for fear of one virus, but destiny delivered a mosquito infected with another virus to her house, in an elevator."
While the other two marveled at the improbability of it all, my mind dwelled on the limited control humans have over their destinies. Our nature compels us to believe we can shape our futures, but predicting what fate holds is nearly impossible. The most we can achieve is learning to adapt while steadfastly pursuing our dreams.
But the life lesson a mosquito had just taught me, had to be quickly put aside when Jake's pager buzzed with a urgent message from our patient's nurse.
"Mrs. Smith is having altered breathing now," a panicked nurse called out as soon as we arrived at the room. "I've started her on Oxygen but I think she should be intubated."
My assessment wasn't any different. The patient was taking short, rapid breaths alternating with periods of not taking any breaths at all.
"Call a code blue," I asked Jake, who ran out. Soon, I knew, this room would be flooded with the resucitaion team. Yet, every minute counted. It was clear her brain was not getting any oxygen, and while her heart rate was still strong it was only a matter of minutes before it would stop functioning too.
"Kylie help me intubate her."
My co-resident was on it. Every monitor in that room seemed to be beeping when I took my place at the head end of the bed and she positioned the red crash cart next to us. Seconds later I had tilted the patient's head back and could visualize the cords.
"Sedative is in, paralytic going in now," the nurse reported.
We were doing what is called the rapid sequence intubation because our patient still had a gag reflex. The sedative was necessary to calm her down, the paralytic agent to prevent her throat from reflexively constricting when I put the tube down.
"ET tube," I held out a hand to Kylie, never leaving sight of the exposed vocal cords through which I would insert the breathing tube. It went in, first try.
"Great job. I'll take over," Kylie said as she attached the manual ventilator bag to the exposed end of the ET tube. Then she started squeezing the bag, giving each breath over a second, with 10-12 breaths/min.
The ICU team had just arrived. Jake relayed the patient's history, I filled in the gaps where I needed. The attending stood in the corner, simply observing. I was one day away from being an attending myself, there was no need for her to intervene.
I knew exactly what I was doing.
While the ICU's respiratory therapist hooked up a ventilator to the patient's breathing tube, my phone alarm started ringing, making me close my eyes and take a deep breath. It was time for me to leave for the airport.
Except, I couldn't leave for the airport.
Not with my patient still in the process of getting stabilized, and discussions about where to take her since the ICU was full. Every fiber of my being was begging to leave. One look at the room in front of me, and my conscience refused to oblige.
"Can you move any of your ICU patients to the step-down unit?" I asked the fellow instead.
"There might be one, but we'll need some time to move them."
"That's ok. I can stay with the patient. We need to do a chest CT anyway, just to make sure there isn't anything going on in her chest. I can accompany her down to radiology."
"Sounds good. Thanks Madi. You're awesome," were the fellow's last words as he and the rest of the ICU team walked out.
"Do you want me to take over?" Kylie asked, which was nice of her, but she was covering the rest of my team while I took off early. With a steady stream of new admits, asking her to cover a sick patient wasn't just unreasonable, it was downright dangerous.
"No," I told her, hoping the disappointment wasn't evident. "Omar will just have to wait."
And wait is what he did, patiently and lovingly, while I kept replaying our conversation in my head - during my patient's CT scan, while I helped wheel her up to the floor and then the ICU and finally as I rushed to my car.
"I am so sorry, Omar. I am a horrible wife," I had told him, as soon as he texted me that he had landed.
He let out a soft chuckle, "You will always be an amazing wife, Madi. Right now, you're also an exceptional physician. So go save lives, I'll wait. I don't have anywhere else to be."
See, that is why Faraz was so wrong. By all standards today had been a successful day for me as a physician. I had made a diagnosis that seemed improbable, I taught grateful interns things no one else had taught them, I even intubated a patient saving her life.
Yet, as the day concluded, the significance of these successes paled in comparison to the absence of a warmth and comfort that only my husband could provide. Regardless of my professional accomplishments, I am, and forever will be, Omar's wife. For he was the home my heart longed for.
Almost a half later, I had fought the early evening traffic on Chicago highways, parked in the garage opposite the international terminal at O'Hare airport and was standing on the sidewalk scanning all the passengers pouring out of the exit doors across the road.
Then I saw him. Standing there in his black jeans and a light grey polo shirt, his tousled hair begging me to run my fingers through it. His scruffy jaw dropped open just a bit as his gaze locked onto me, unwavering and intense, making me forget that I was standing at the arrival terminal of one of the busiest airports in the world. In that moment, there was no one else there, it was just him and I - husband and wife, two souls destined to be together - just separated now by a single lane, one way street and a pedestrian walk light that was still red.
*******
The patient story is true (name changed for privacy)! We were all stunned when we found their result to be positive. Just goes to show that whatever has to happen will happen, despite all our efforts. She recovered quite well.
But Omar and Madi finally meet as husband and wife! More on that in the next chapter.
Until next time....Thanks for reading! Don't forget to vote and let me know your thoughts about this chapter 🙂