Days turned into months.
Time flies really, she thought.
Half of her final year was done and she had taken both her USMLE step 1 and step 2. Even though her scores weren’t that great, just knowing that she won’t have to take the exam again was something.
Her younger sister was starting college this year and she had to help her with applications and paperwork.
Tanya welcomed all the distraction. It helped her deal with the pain. If she hadn’t had her family, she would’ve killed herself. She didn’t want to live after what happened.
That eventful night when her mother brought her home from the beach was one of the darkest moments of her life. Even her father’s death hadn’t affected her like that. She had got out of the car crying violently and had then thrown up the whole night. She had bad abdominal spasms that made her retch and vomit. She was burning in fever for days. She lost track of time and events and was usually delirious.
But she was a strong girl and Asma knew she’d bounce back. She didn’t know how she could make it better for her child but she knew enough to know that Bilal had said no. There was nothing to do now.
The third day Tanya was feeling a little better. Asma brought breakfast for her. She balanced the tray on the small nightstand and then looked around her daughter’s room. Nothing had changed since she had decorated it for her first born 22 years ago. She remembered the day she and her husband Tariq Zaman had brought her home.
She was a preemie and the most beautiful baby. She grew up fast and was an exceptionally intelligent girl. She was talking by eight months and had started having conversational speech by a year. Nothing was hard for her. She was the easiest child. No tantrums, no unreasonable asks of her parents, always the model child.
Asma and Tariq had another daughter after her, then another and then finally had a son.
Tanya was a mentor for her siblings. Tariq had various medical problems and Asma spent a lot of time with her husband. Tanya took over the education and upbringing of her siblings. She was always available to her parents also. Asma and Tanya had philosophical and ideological differences but nothing that was too big. She loved her opinionated, headstrong and strong willed child, a perfect combination of Asma’s natural charm and Tariq’s uprightness.
She heaved a deep sigh. Who could prevent fate? If she had known this would happen, she wouldn’t have sent Tanya to medical school. The vision of her child crying inconsolably, throwing up violently and then spending her days and nights completely out of it was hard for her. Very hard. She hated Bilal. She hated the woman who rejected her precious child without even giving her a chance.
Tanya stirred. She opened her eyes. Her eyes filled with tears as she saw her mother sitting at the bedside.
“Mama! Don’t bring food for me here. This room suffocates me”.
“I won’t bring lunch. But breakfast is here so try to eat some”.
She silently ate breakfast. She didn’t have an appetite but knew she had to eat to get back on her feet.
“This room needs a make over”, Asma said, attempting to make light talk.
Tanya didn’t say anything. Her whole life needed a makeover. This room was her sanctuary until a few days ago. She hid in here to talk to him, text him and send him her pictures. This room held many secrets. Of their love and passion. Of their friendship and alliance. This room had heard them laugh together and kiss each other fervently over the phone together. This room had seen it all.
“Tanya?” Asma called her name gently.
“Yes, Mama, May be, but I don’t find anything wrong with it”, she said, noncommittally.
“Really? Your taste has definitely taken a dive since you’ve been in medical school. Do you like these pink drapes, the white furniture, the fluffy carpet? Doesn’t it look a little too school-girlish?”
Asma saw a flicker of laughter in Tanya’s eyes but it died quickly.
“No, Mama, don’t waste money on me. Or my room. Don’t waste any emotion on me either. I’m not worth it”.
Tears flowed. Like they always did. The heart cried, like it did so often. Her mouth went dry at the prospect of a life without him. She shivered of weakness and grief.
Why did I love him, she asked herself? I didn’t need that problem. I didn’t need to get myself in a mess.
Asma touched her face,
“Never say that. Do you hear me? Never say that. You’re worth the world. The whole world is what you’re worth. He’s unlucky and a coward. I curse the day you met him. But you’re worth much more than him. As God as my witness, I will find a man better than him in every respect. In every sense of the word. I will find a man who will have everything that he didn’t have. And I’ll make him yours. And when I have, I’ll make sure Bilal knows. He’ll regret the day he let you, a gem worth a universe, go. Just wait! As God as my witness”.
Tanya didn’t say anything. No man would ever measure up. No man would ever be Bilal Hussain. No man would ever get close to her like he was. No man could ever touch her like he did.
Final year done! She thought with jubilation as she exited Karachi University where Dow students traditionally took their exams.
The thrill, the excitement, the pride and the overwhelming urge to celebrate were surprisingly not marred by the memory and loss of Bilal. She had waited for this day for so long that she momentarily forgot about the injustices that life had recently ladled in her plate.
She got into her car. She had finally learned to drive upon her sister’s insistence and was now pretty good. It felt good to not depend on their aging driver anymore.
Nothing could ruin this day for her! Nothing! She thought as she drove home. Infidelity, deceit, abandonment, nothing could change the way she felt towards her education and her career. This was her purest labor of love. Bilal couldn’t ruin it either! She thought with mounting pride in herself. That wasn’t bad, she congratulated herself, just about a year out of that dreadful night and look at me not even thinking about him.
Happiness had taken a much different meaning. Thinking of him was happiness this time last year. Now she had a sense of fulfillment in not remembering him as often.
Her mother’s words came back to her,
“Don’t think this was a bad thing. These incidents happen so we learn. Now you’ll always be careful when you trust another man. Now you’ll check him out and make sure he’s worthy of your love. You were too naive, too impressionable. Sometimes women see a guy taking a measly interest in them and think that this is it. This is what they were supposed to have and love. But there are big things in your future. And a much better man. Much much better”.
Tears stained her cheeks as she drove determinedly towards home. Now it was Bilal in her ears,
“Tanya! If ever you even think of another man, I’ll just have to marry you on the spot. So don’t even joke about it. I can’t have you become someone else’s”.
So is he not going to be another woman’s either? She asked the wind.
I was a simple, upright girl. Why did it happen to me? Why did he leave me? Why did his mother say no? Even if she did, why did he accept her no? Why didn’t he try to prove his love for me? He could’ve just taken me like a thief in the night. I would’ve fled with him to a place where people don’t get in the way of harmless, benign love. But he didn’t. He didn’t.
Her car came to a halt, tires screeching. She let out a sigh of relief. A dog was crossing the street. It just about avoided being run over.
She stopped the car. Her head fell forward on the wheel and she cried until the sun set and the stars came out.
“Many options for you, my child, many options”. Her uncle’s pompous voice filled the living room.
Asma looked at Tanya proudly. Tanya looked at her sister, three years younger than her and a total brat. Sarah was making faces and mimicking their uncle while he reeled off the names of all the expensive hospitals where she could apply for a house job.
“And you’ve also completed two of your American licensing exams so just prepare for the third and then leave for residency”.
He had a habit of making everything sound trivial and easy.
Her father’s brother, Asif, was as different from her father as night and day. While her own father was a mellow, kind and quiet physician, her uncle was a boisterous businessman. He had many children of his own, all high-achieving physicians in the United States of America.
“Uncle! I was thinking of completing my house job at Civil Hospital. You know I love working there. That’s my affiliate hospital.”
He was nonplussed at this strange plan. Surely, she could just go to a wealthy people hospital and meet a guy from a good family and make a life for herself. Or even better,
“USA, my child, USA! That’s where you keep your sights. Civil Hospital? Sounds a little ghetto to me”.
“It is ghetto”, Sarah said, rolling her eyes. “She wants to work there because she wants to. If all the good doctors go to all these high profile hospitals then who’s going to go and serve people who need cheap healthcare?”
He dismissed her but was obviously perturbed enough by the insolence of his young niece that ordered her to make tea for him.
Sarah got up scowling and left.
“Uncle! Civil is good for me. I love medical unit 4. The professor there likes me. I had amazing scores in medicine. And for the surgery rotation I’ll go to our other affiliate hospital, Lyari General. I’ve already mapped it all out”.
Asif blinked a few times trying to make sense of what she had said. For someone like him who only spoke in dollars and cars, it was all useless jargon.
“Okay, sweetheart, do what you like. But continue to work on your USMLE also. We want you there. We need you there. America needs you”.
“Why does America need her?” Sarah came back in the living room, no tea in sight.
Asif was again a little bowled over by her but immediately decided to chide her to redirect this whole conversation,
“I don’t see tea, my child. Where’s the tea I asked for?”
“We are out of tea”, Sarah lied.
Asma got up, angrily staring at Sarah. She was the complete opposite of Tanya. Loud, funny, the most handy girl around in terms of cooking and cleaning. Tanya had never had much interest in household chores and Sarah gladly did them in lieu of studies all the time.
“Sarah! Come with me. I’ll show you where the tea is”, Asma took her out.
“Medical unit 4….. medical unit 4”, Asim Zaman strained his memory about where he had heard that. Tanya watched him cautiously. She had come to love her uncle, a little erratic and full of himself but essentially good-natured and doting.
“Oh yeah! My friend Sabir’s son is working there these days. They’re installing the electronic medical record in Civil Hospital. He’s the chief mastermind behind it. Very intelligent guy. What’s his name? What’s his name? Very good looking too. Young, very young, hardly 30 years old but he’s brainy. Always has been”…… he drifted off.
Her mom brought the tea. They had tea and croissants. Her uncle was a good eater and it wasn’t hard to ask him to stay for dinner too.
Dinner was ordered from one of the local barbecues. According to Sarah, their uncle didn’t know what good food was and therefore was always quoting various subpar meal places in New Jersey and New York. She ordered a huge meal and they all sat down to eat.
“Oh yeah I remember! His name is Azhar. Sabir Hussain’s son! He’s the one installing the electronic record in Civil Hospital. Azhar. Azhar. Azhar Hussain. Sabir has four sons but this one! He’s gifted. Knew him since he was a little boy. Brilliant! Brilliant boy. Scholarships all the way to NED. Brilliant! Younger brother? Didn’t amount to much. But this guy? I wouldn’t be surprised if he is the Chief Informatics Officer at a swanky place in the next five years”.
Stars danced in front of her eyes and she felt like the food was choking her . Life chased her even though she had given up. How many times will she lose? How many times will she get up? How many times will life slay her again?
She lay in bed, contemplating her options. There were none. She had always wanted to go to Medicine-4 and she couldn’t let life take another thing from her that she had longed for and waited for.
Hospitals are generally divided into units. There are units based on nursing staff available and sometimes even based on the availability of the physician force. Civil Hospital was a large, inner city hospital, affiliate hospital of Dow Medical College. It was more than a thousand beds, had many residency programs, fellowships, a transplant center and was the primary training hospital for medical students of Dow.
Dow Medical College was her dad’s alumni too. It had become a legacy of sorts. She had pride and a little vanity about it. Dow didn’t take everyone. Only the best.
But somehow the best didn’t then go to Civil Hospital for their one year internship after MBBS. Many went abroad for residency programs and some went to high profile rich hospitals in Karachi for a better experience.
Civil Hospital catered to the heart and soul of Karachi. The people. The blacksmiths and the carpenters. The rich who had friends working in important departments there and could get a plastic procedure for a nominal amount. The transsexuals and the intersex. The prostitutes and society women who had unwanted pregnancies. Civil catered to all. Many skeletons of affluent and powerful people were known by the many residents, house officers, fellows, nurses and ancillary staff there. It all got buried at Civil Hospital eventually. HIPPA…… healthcare information privacy and protection act deterred anyone from passing anything on.
Every June a new crop of house officers came. Young, energetic, bright-eyed and eager. The residents and fellows looked at them as fresh meat in more than one sense. Love affairs, injustice in terms of scut work, extra overnight calls for the ones who fell out of favor, arguments with nurses and the quest to prove themselves to the department head, all started as soon as June started.
June marked the new year at the hospital. June marked the month when the stars conspired. When the tides turned. When a woman entered Azhar’s life. When he realized why it was so hard for Bilal to move on. He saw her, sad and nervous, hanging by the entrance to Medicine-4, and thought she must be someone’s relative, here to see them and tend to them. She didn’t look older than 18.
But Tanya was older. She was 23, soon to be 24. She was wiser and as she saw the stranger peering at her, she quickly moved away from where she was standing and hid herself in the on-call room.
Her friends chattered and laughed, excited and nervous. She sat timidly in the room, reliving the past one more time.
She knew he was Bilal’s brother. He had the same attractive face. Whereas Bilal looked pleasant and friendly, Azhar looked haughty and arrogant.
She felt her legs weaken. Before long she had gotten out of the unit, walking briskly to her car, determined to move mountains to switch her medicine unit to Medicine-5 that was in Lyari General Hospital but right then she just wanted to leave the hospital.
She was sitting in a chair across from the registrar. He was looking at her strangely. Dr. Masood, incidentally had also been her faculty advisor so she felt close to him. He finally asked, perplexed,
“What happened? Any particular reason for switching? You know there are no spots anywhere now. Very few of you actually want to complete house job here anyway and now this? This makes my job very tough”.
“I know….”, She started.
He cut her off before she could finish,
“Tanya! No lies to me. What’s going on? I’m observing you for a few months actually, may be a year. What’s going on? If you weren’t Tariq’s daughter I wouldn’t have asked. But what’s going on?”
He was her father’s best friend and had become a mentor of sorts after his death.
Why did everyone want to know the truth? Like they’d get her Bilal back.
She smiled, holding back tears at the mockery that life had made of her.
“Okay then let me be frank with you but keep it between us. Medical 5 and 6 will be renovated in the fall, three months from now. They’ll be moved to here. So I can’t transfer you there. Now I can move you to Medical 3. Would that work?”
But those two units 3 and 4 are opposite each other. He thinks I don’t like the people in 4. But I don’t like anything. Nothing makes me happy. Her perpetual sadness started creeping in again.
“It’s okay, uncle”, she said dejectedly, standing up and swinging her bag on her shoulder. “I’ll stick to my ward. What’s the point in changing? It’s only six months anyway”.
She left quietly. Dr. Masood watched her leave in amazement. Strange girl! Came to change it and didn’t. Kids these days! He shook his head. Nothing makes them happy.
She walked out in the Karachi summer heat. The problem with trying to live a new life in an old place is that the memories never leave you. They haunt your steps and they scare you wherever you go. She had become scared of Dow and Civil. The two places that felt more like home than home sometimes.
The sun in Karachi is always unforgiving but June is bad. She soon realized that it wasn’t a great idea to walk back and forth between the college and the hospital without a water bottle. The memories made her weaker too. Everything made her cry now. Every man who looked even the slightest bit like him made her stare at him and follow him wherever he went. Every laugh that was like him reverberated in her ears for days. They didn’t have many photos together and whatever selfies they had taken were not revisited by her.
Why are you doing this to me? She asked Allah on her way back to the hospital. Why was my heart breaking once not enough? I know you’re punishing me for letting a man near me. But I didn’t think he was another man. You know that I thought he was a part of me. My soulmate. My one and only. Then why are you punishing me? If I see Azhar everyday then I won’t forget Bilal.
But you weren’t forgetting him anyway, her heart deadpanned.
She laughed. In spite of herself, she laughed. Such irony. Such juxtaposition of her feelings with life’s sorcery. Such pain. Such remorse. She was going through so much that strangers asked after her all the time. But Allah didn’t forgive her. He made his brother a part of her bereft existence
Tanya was an amazing student and was in very high regards with her teachers always. Her dad had known half her teachers as close friends and of course that gave her a vantage point. But she wasn’t a vain girl anyway and therefore was well-liked by everyone.
She was also quiet. She had always been a borderline introvert and had drawn into her shell even more after her failed attempt at love and marriage. She had few close friends before but now she had only one friend, Saima, whom she had known well because they were in the same clinical group during their medical school days but hadn’t always been close. Now they were inseparable.
Saima was a quiet girl too but together they chatted a lot. She told Saima about her parents, siblings and her home. Saima shared some private details with her too. She didn’t tell her about Bilal. That was painful still.
Someday, she would muse, I’ll remember him with love and fondness. Someday. Like Papa’s memory is so pleasant now. Someday his will be too.
She learned quickly that Azhar will be around for at least many months. She was going to be out before the many months were over, she thought with satisfaction. I’m here for only six months, she would remind herself when she felt her mood becoming dark and melancholy at the prospect of seeing Bilal’s brother everyday.
He was as quiet as her. Or may be even more. He was always in Dr. Safdar’s room, working on the computers and the glitches that the medical records program had loads of . He didn’t chat with his team mates even. He talked only as much as required and then busied himself with the complaints and queries that they got thousands of on the daily. This was the most important job of his life and he intended to make something out of his chance at medical informatics.
This, however, hadn’t been his expectation. A dingy office in a government hospital. The stench of illness. The misery of death. The flurry of new people every twelve hours. The cold meals in the subpar cafeteria. Boys and girls who were young but looked like they had nothing going on in life except a rat race for a career that was elusive at best. And they were all skinny. So skinny. He sometimes wondered if medicine made people lose their appetite.
Rates of depression and suicide are high in medical students, he knew. He sometimes wondered if the emaciated looks he saw on some house officers were the result of constant worry for a career or the lack of time to eat. They all seemed short on time. The whole business of medicine seemed to not have enough time.
He watched people running codes and it shocked him how young adults in their early twenties were making life and death decisions. He watched thrashing patients with blood-borne diseases getting blood drawn by a young man without gloves. HIV, and Hepatitis C were rampant but the protective equipment to prevent transfer to doctors and nurses were another planet’s luxuries. The house officers in Civil Hospital worked with the bare minimum and sometimes not even that.
Then what makes them live and love the same arduous routine day after day?
Both his maternal uncles were doctors. His mom and aunts hadn’t been to professional institutions. He had seen his uncles work very hard to build a career. Their kids had all gone to various places for skill-learning and professional education. He wondered if his father was educated he would’ve made more of an effort with Bilal. No one cared about Bilal. He quit his education midway and Ami and Abu both supported it. Abu with the selfish idea of how he’d be helping him with his business. Ami with the ignorance that education doesn’t change nature or nurture and that they were all mutts of their dad’s genes. Bilal was smart. He took a job at a mediocre bank and found respite in friends and girlfriends.
“Azhar”, his colleague interrupted him.
“Huh”, he said, looking up and realizing he didn’t know his name.
“Dr. Safdar would like us to be a part of the rounds everyday. They’re piloting the program on rounds and so they want us there to help them. Also, don’t forget we are starting the orientation for the software tomorrow”.
“I don’t get it”, he said, exasperated that he’d have to stand next to sick patients during rounds and be a part of that miserable process, “why do we need to be there? It’s a violation of the HIPPA code and also, if they encounter a problem can’t they just submit a complaint ticket and we can deal with it later? This isn’t efficient. I can get more work done here in this office”.
Office was a rich word for their workstation. There were two wooden tables that creaked convulsively with even the breeze from the fan, they were so weak. They sat on jute seats, that had the weaving coming undone and therefore they were always uncomfortably shifting positions and trying to find that sweet spot that didn’t make their buttock red and their lower back spasm by the end of the day. Their was a water cooler which was a misnomer because there wasn’t any cold water in it ever. It was usually a tough ask to even get clean water from it. They both sat so close that their legs and feet kept touching each other’s and even though initially they apologized the whole day each time this happened, they soon realized that this was an occupational hazard of working in this slum of an office and had silently curbed the apology ritual.
“My life has never been so professionally fulfilling and hygienically pathetic as it is now”, he thought grimly.
Life never gives everything, his inner wise guy whispered. One thing has to suffer in order for something else to thrive.
He woke up earlier than usual since he had to be on rounds with the physicians. He normally woke up at 9 and got to the hospital at 10 but now he had to get up at 7 and be there by 8. If he didn’t get there the rounds couldn’t happen. He had to show them how to log in and check labs on the new system.
He hadn’t been sleeping with Bilal anymore. Bilal was much better now and he also felt that he probably needed privacy since he was an engaged man now.
But sometimes he caught his brother staring listlessly into space, not responding to people calling his name, then coming to with a shudder, and smiling to convince people that he was okay.
But he wasn’t okay. Azhar knew that. Bilal wasn’t okay. He was pretending and because he had been pretending for so long, he had gotten very good at it.
“Up so early?” Bilal asked as Azhar rushed into his room looking for his blue shirt.
“I have to round with those geeks”, he said huffily.
Bilal laughed. He wondered about if Azhar got married to a doctor. He never spoke any good words about the doctors that he was interacting with. He called them “tech-idiots”, “nerds”, “skinny puppies”. His mind automatically went to Tanya. He didn’t know anything about her life anymore.
She must have graduated this year, he thought.
He didn’t think about her much. Thinking about her made him think of other things. Forbidden, evil things. Thinking about her made him suicidal. Thinking about her made him thirsty for his mother’s blood.
Azhar came out of the bathroom, looking coolly handsome in a blue shirt and khaki pants. He ran a comb through his hair, pulled at a particularly arrogant lock that just won’t tuck under his front hedge of a hair, cursed it, then saw Bilal looking at him in the mirror and both brothers laughed.
“Bilal! If you ever wear my shirts again without losing at least ten pounds, I’m going to beat you up”, He threatened him affectionately and started spraying himself with Bilal’s cologne.
“Don’t beat me up again, man”, Bilal groaned, “You’re like The Hulk. You really hit to kill”.
“I do look like Mark Ruffalo”, he said examining his reflection in the mirror.
“The Hulk as in the monster….. Mark Ruffalo, my ass”, Bilal said, rolling his eyes.
“Don’t be jealous. I’m so good looking, all these doctors are eyeing me all the time. And some are men, mind you”.
Bilal threw a pillow at him. Azhar caught it deftly, threw it back at Bilal who caught it again. They kept throwing the pillow back and forth for a few until Azhar said,
“I gotta go now, kid! Nice playing with you”.
At the threshold he stopped, turned around and asked him casually,
“Good”, Bilal said, noncommittally.
“She’s finishing her masters this year, right?”
“You don’t know?”
“I think she told me”, Bilal said nonchalantly, “It’s hard to know all that’s happening with her. She doesn’t talk that much”.
“But she should talk to you”, Azhar said, wide-eyed.
“Why? Why should she talk to me?”
“Because she’s your fiancé”.
Bilal laughed derisively.
“Azhar! It’s an arranged marriage. We’ve been chosen for each other. She’s not my fiancé and I’m not hers either. She’s my wife-to-be. That’s it. That’s all there is to it.”
“I don’t agree”, Azhar said, pragmatic as ever, “An arranged marriage can be a very loving and wholesome marriage too. There are many around us. Not our parents'”, he added hastily, “But our aunts and uncles. Our cousins. I don’t think arranged marriage is all a dud “.
Bilal was contemplative. He wanted to tell Azhar that he needed more time until the wedding. They were thinking of picking a date and he didn’t feel ready.
Azhar can’t rescue me each time I’m drowning, he decided.
“Okay, bud,” Azhar said, throwing his sunglasses on, “I gotta go now”.
The usual scramble before rounds in a hospital is a sight to behold. The overnight interns and residents trying to get their bearings. The residents who will be on-call taking sign out from their sleep-deprived colleagues. The nurses who tried the entire night to get precarious intravenous lines now guarding their work of art from the morning nurses. Attending physicians, who precept the rounds, having a cup of tea in their office and enjoying their few last minutes of quiet before a three to four hour bedside rounding session. Add to this the arrival of information technology and electronic health records, COWS (computers on wheels) and the associated personnel and it’s complete chaos. Complete and utter chaos.
He had never thought he’d be a part of it but he was a part of the chaos. He stood in a corner where he was told the day before to wait and someone would get him when rounds started.
Civil Hospital despite its shortage of interns and residents works like a well-oiled machine. Rounds are didactic and therefore everyone has to be present throughout the length of the rounds. No exceptions. Everyone listens in about every patient. Everyone is questioned about every patient . Everyone is expected to know about every patient. Ownership of patients is a critical aspect of learning. Nothing is more unbecoming than trainees not owning their patients and their colleagues’ patients. If you want to have the reputation of a doctor who doesn’t care, all you have to do is not know one patient out of the forty or fifty admitted patients in your medical unit. Because during call everyone cross covers others’ patients, it’s imperative that everyone knows every patient and has a general idea of their diagnosis, treatment plan and their labs to follow, imaging to review and code status.
Tanya knew every patient. Not only did she know their disease processes but she also knew their human processes. Who had trouble with childcare. Who couldn’t afford the medicines. Who couldn’t get syringes and bandaids. Government hospitals run out of things really fast. Philanthropy rarely reaches the echelons where it’s needed. She watched outstanding medical decision making with suboptimal outcomes due to resource poverty and it hurt her. She was part of a student organization that worked for patients in regards to arranging medicines, blood, maternity supply. She dedicated a lot of time after hours at the organization, offices of which were located within Dow and Civil. She loved the mission and the selflessness. One of her closest friends who was also her neighbor, Shariq, was the president. Tanya suspected that he never went home and split his life between hospital and organization.
Azhar saw the crowd of physicians and medical students with the charge nurse approaching him and got the EMR (electronic medical record) ready on his computer. Tanya was momentarily frozen when she saw him but there was no need for her to feel any way around him, she had decided. If he identified her she’d play cool and move on. She won’t introduce herself or talk to him unless absolutely necessary.
The human mind and heart are more resilient than we give them credit for. She had thought she’d forever miss Bilal but surprisingly, had found his infidelity a great tool to enable moving on. She had thought she’d be forever his but when he disowned her, her heart went through a transformational change and didn’t think it belonged to him anymore. Seeing Azhar was shocking initially but she had made peace with it. Bilal and his family lived in the same world that she inhabited too. They could run into each other. It was a one in a million chance but it was definitely a possibility.
The first patient was Tanya’s. She got her papers together and went over the labs one more time. She had had a brief orientation on the system when she had started a week ago and was somewhat more comfortable than the rest of her colleagues. This was why people had been asking her how to enter orders, most importantly pharmacy orders. She was always glad to help and had helped everyone put in their orders the day before.
Dr. Safdar was precepting.
“What’s the story?” Rounds were always in English. Medicine is all in English in almost the entire world.
The patient was a middle-aged male who appeared to be pale and slightly uncomfortable-appearing. He was also breathing faster than normal. He overall looked stable.
She noticed Azhar was standing next to her, ready to troubleshoot or explain any bumps that they would face with the new system.
She got over his presence and started,
“60 year old male with a past medical history of hypertension, diabetes and atrial fibrillation. Here with abdominal pain and hematochezia. Labs showed a hemoglobin of 12 slightly lower than two months ago, lactic acid of 6, creatinine of 2. CTA with possible mesenteric ischemia”.
She noticed Azhar following her history on his computer. He had his own laptop to work with.
She narrowed her eyes. What was he frowning at?
Hmph! Look at his idiotic face, she thought haughtily, the entire family is an idiot. Bilal could never get medical terms either. This is the brightest tool in that miserable shed that their sadistic mother created.
“Labs this morning?” Dr. Safdar politely prompted.
“Uh…. yeah yeah”, she quickly regained her composure, “labs show hemoglobin of 11 after four liters of fluids, lactic acid of 1, creatinine improved to 0.9. Abdominal pain resolved with morphine initially and now has been pain-free for six hours. Surgery has seen him. Nothing to do”.
“Is he on blood thinners?” Dr. Safdar asked, frowning at the chart.
“Yes. Coumadin”, she said confidently.
“No bleed on the CTA, right?” He asked again.
“No”, she said.
She’s so young, Azhar thought, how can they let her be in charge? Looks like she doesn’t eat either like the rest of them.
Suddenly he noticed something,
“Excuse me”, he interrupted her.
Everyone turned to look at him. He was already the handsome mystery guy for many women and there was sudden snickering from the team.
He took a deep breath.
“I think you are in the wrong chart”, he continued.
Tanya stared at him blankly.
“What do you mean?” She asked bluntly.
“Look”, he came closer, “he’s Nasir Hashmi. But the chart that you’ve got open is Qadir Hashmi. See?” He showed her the red banner on top of the page, “see this is a name alert banner. Any time you have two same last names, there will be a banner for attention”.
The room started to spin around her. She knew that. But had totally ignored it. She had seen this banner on many patients yesterday and had still put through morning labs and medicines. How many medicines have already been wrongly administered, she panicked.
“Sir!” She said, trying to check her panic, “I made a huge mistake. Please ask everyone to stop giving any medicines or take patients to procedures. We might have entered the wrong orders on many patients”.
There was a flurry of movement and people went in all different directions for damage control.
Tanya was white as a sheet. Dr. Safdar saw her, grabbed her arm and steered her out of the room, signaling Azhar to come after him.
Tanya and Azhar spent the entire morning fixing orders, contacting pharmacy and making sure that the right prescriptions were getting to them, reordering labs and putting in consults again on some patients. Thankfully, there were only ten patients out of the 60 patients on the unit who had same last names and therefore it wasn’t as bad as if the whole unit was wrongly prescribed.
Tanya shuddered many times thinking of what could’ve happened. “Azhar was Bilal’s brother” wasn’t even something that was crossing her mind. She was so focused on the charts and patients that she missed lunch and didn’t know it was dinner time when Azhar entered with two large bags of food.
Even though they had spent the entire morning in the same room, they had barely spoken. There wasn’t much to talk about anyway. She had to redo the orders and he had to make sure that they went through. Her colleagues had come in every now and then to check on her. She looked like she was badly shaken but wasn’t showing it.
Whatever might be said of how mousy-looking she was, the sapiosexual in him couldn’t ignore the fact that her intelligence was very attractive. Sure she had made a huge blunder which could have led to sentinel events but she had also worked extra hard to understand the EMR and had signed up to be a super user. She would teach others as a super user.
Which made his job easy. Very easy. And she didn’t eat. Just like the rest of them, he thought wryly.
He thought of how strange it was to him or Bilal to not count food as the most important part of any day. He was so going to tell him about these food skippers. But then he quickly reminded himself to not share any hospital details with him. He didn’t want him to think about his ex at all.
He got food for her without thinking how she’d receive it. But as he saw her stooped over the computer trying to cross check what others had done with their orders in the morning, he suddenly became nervous. What if she said no?
“Do you want to eat?” He asked, stammering just a little.
Eat? She seethed. Your brother gave me a lifetime of emotions to eat. I eat feelings, you know. And tears. I swallow tears all the time. They constantly nourish my soul by poisoning it. I eat, Bilal’s brother! I eat all the time. Your brother’s memory is my sustenance. And in return, I keep it alive by offering it the flesh off my bones. His touch used to set my desire on fire. Now the memory of his touch drinks from my blood in hopes of immortality .
She threw a glance at him,
“Thank you! I’m good”.
He suddenly felt foolish and like a schoolboy trying to please someone who thought he was beneath them. All their lives their mother had instilled an inferiority complex in them through neglect and disdain. When parents don’t love their kids, kids don’t think they deserve love or can demand for it. They accept that love isn’t for them. Azhar was a much more rounded person compared to his brothers but was still a product of colossal inattentiveness and indifference. He had more vulnerable moments than he cared to admit to himself.
If someone else had been in his place they would have insisted or even taken offense at the rudeness she showed in response to a nice gesture. But not him or his brothers. Their childhood had conditioned them to accept rudeness as par for the course. He sat at a little distance and started eating.
She was almost done. She put a paper next to him on her way out,
“This is my phone number. You can call me before the training. I’ll come over and help you train others”.
He nodded, and wanted to thank her but there was food in his mouth. She didn’t want his thanks anyway. She opened the door and disappeared down the long passageway that led to the parking lot, her dark hair swishing in the dark night.
He watched her walking away. He surreptitiously glanced at the laptop that he was using as his own.
Everything was being built into the electronic records. This included imaging, labs, documents, discharge paperwork. There were some other things also that they had introduced just that morning and people were slowly catching on.
The quality and performance improvement division had already claimed their expertise. They had already built their inclusions and features many months ago and they were far more functional than the other features that they were introducing now that were more patient-related.
One job of the quality and performance division is to take in reports regarding near misses and sentinel events in hospitals. Near misses are medical errors that when caught in time do not lead to a sentinel event but have the potential for it if not caught.
A sentinel event is when an error occurs and causes illness and morbidity for the patient.
There are dedicated hospital departments that monitor system-level issues and due to these practices and procedures hospitals are able to address and understand any system errors that may have led to clinical errors.
He had temporary access to the safety first reports due to the system being new and because he had had to troubleshoot a lot of it already. But overall, not many people reported errors or near misses because the system was new and a paper trail was still considered more reliable. They also hadn’t expanded the education so he was sure that once this feature was completely taught and implemented, they were going to get a lot of reports.
So he was surprised that the inbox for safety first reports was blinking. It blinked when it overflowed but how could it be empty until an hour ago and now brimming over capacity?
He opened it curiously and saw a hundred safety first reports filed against Tanya.
Someone had taken a painstakingly long time to complain separately for each medicine that was wrongly ordered, each test that was inappropriately drawn or performed and each consult that was called for the wrong patient.
He wondered how so many people had logged on at the same time to complain about her. He checked the name on the complaints.
It was the same name, Nyle Ansari.
Whoever he was, he had made all the complaints.
Azhar wondered who would spend so much time complaining about mistakes that were caught in time. He could understand one or two complaints but the amount of work that this individual had put into complaining was astronomical. Frankly, the error that she had committed was the same error across several patients so it didn’t warrant so many documented complaints.
He felt uneasy. He had her phone number sitting in front of her and so he decided to call her,
“Hello”, her cool voice came floating.
“It’s Azhar. We were working together today”.
“Azhar?” She said incredulously.
She was driving towards home. The car swerved a little. What was he calling her for? Did he want to talk about Bilal? May be tell me how he is so innocent and naive. And I should forgive him.
“Yes, Azhar. I’m installing and implementing the electronic health record at your hospital. Can I chat with you real quick about something?”
Her head was spinning.
“Azhar?” She repeated, not completely knowing what to say.
“Err. Yes, Azhar! The IT guy”, he offered helpfully.
“I know you’re the IT guy”, she snapped. “Why’re you calling me?”
“Actually someone has submitted many safety firsts reports about you”, he said cautiously, somewhat aware that she was driving and trying not to drop a huge piece of information on her.
“Standard hospital procedure. What else?” She said shortly.
She’s a mean one, he thought angrily.
“Okay. There are about a hundred so I figured you’d want to know”.
“What?” Her car swerved a second time. She cursed softly.
“Yes a hundred. That’s unusual, right?”
“I’m coming back”. She said and hung up.
Twenty minutes later they were both hunched over the computers trying to figure out who Nyle Ansari was.
“May be he is your class mate?” He suggested.
“May be he’s someone from another department”.
“Or May be he was just someone experimenting with the program and inadvertently submitted so many”.
“I don’t think so!” She said, thinking as she spoke, “Look how elaborate the complaints are. They look thought-out and detailed. It doesn’t look like an error or repeat submission. It looks like he wanted to submit as many as he could”.
Does she have enemies too in this place? He thought, half joking, to himself. With her attitude, I wouldn’t be surprised if a whole army of Oompa Loompas was waiting for her to go down the garbage chute.
She spent the next three hours writing detailed answers to the complaints while he worked efficiently on transferring them to the record and submitting them to the quality improvement division.
By the time they were done it was 3 in the morning. She had briefly spoke with her mother and explained everything. He had texted Bilal. He was the only one who cared anyway.
She rubbed her eyes. They were red and looked swollen. She looked at him gratefully and thought how much he looked like his brother. The same profile, the same voice, the same head of gorgeous hair.
“You have to eat now”, he said abruptly.
She knew she had to. She hadn’t eaten anything since breakfast and was embarrassed to hear her stomach growling ferociously now.
“What did you get?” She asked with mild interest.
“Tomorrow I’ll get something nice. Tonight just eat the gyro I got”.
She smiled. So much like Bilal. But there was something different too. He wasn’t all Bilal. He had a distinct difference and she couldn’t put her finger to it but it was there.
“Thanks for feeding me”, she said after finishing the gyro. “It was delicious”.
“Don’t thank me. It’s a guy across the street. He makes them. I’ve been getting them for everyone for months now. But I dare not tell all the hoity toity people here. They worry more about where food came from than what it tastes like”.
Her smile deepened. The gyro guy across the street was a good friend of hers.
For some reason she said without thinking,
“He’s my friend”.
“The gyro guy?”
“Yes he is. Did you know he isn’t illegally encroaching on someone’s property?”
“Yes, I do”, she said, smiling still.
“But no one buys his stuff because people want something nice”.
“Nice” she said, getting up and putting her papers in her bag, “is a nondescript word, I think. It has no depth and no meaning. It’s like saying “cool” or “wow” or “yay”. It’s without a meaning or a commitment. So when people say they want something nice, ask them to define nice and you’ll see that they don’t know what they want. Someone told them something is nice and they went about in search for it. Nice isn’t what makes the world go round. Delicious and finger licking good is what makes the world go round. Or scrumptious. Or divine. Or anything but nice. Nice is an insulting qualifier”.
He watched her with his mouth open, gobsmacked at how someone could talk so much about the word “nice” and slowly watched her walk out of the room the second time during the same night.
The drive back home was rich with his memories, as always.
How he touched her hair. Tugged at it.
How he held her hands and didn’t let go.
How he was always so eager to kiss her, with complete disregard for their surroundings.
Why did you accept defeat so easily, my love? Tears rolled down her cheeks.
Why didn’t you make a grab for me and hide somewhere in the mountains? We could’ve foraged for food and water.
Why did everything spin out of control so fast? We shouldn’t have told anyone anything and bought more time.
Do you miss me, Bilal? Do you ever think about me? Naked? In your arms? Happy? All yours?
He lay in bed watching the night sky clearing up. He couldn’t sleep again last night. She kept him awake, every night.
Tanya! Tanya! Can you call me sometime? I wanna talk to you and tell you that life has been so unfair since you’ve left.
Do you miss me? Sometimes I think you don’t, I was so horrible to you. May be it’s a good thing that I didn’t get you. Someone who deserves your love should get you.
But do you remember all the times we kissed and touched each other all over? Wasn’t that magical? Didn’t it stay with us for weeks?
Can you just show me your face once? Just once? I won’t ask for anything ever again. I just want to see your face once. Everyone says Maha is beautiful. Then why does she lose all her light when I think about you?
Can you laugh just once in my ear again? I’ll record it and listen to it when the demons start to overpower me.
I want to paint a picture of us, on the beach, hand in hand, soul in soul. I’ll ask Ami to let me make that one picture and then we will take our entire lives painting it. This way Ami will be none the wiser.
Bilal turned on his side restlessly. There was no peace anywhere.
His car was speeding towards home. He had spent eighteen hours at work but surprisingly felt light and fresh. He sang merrily, making his own music, smiling for no reason.
Are you sleeping, Tanya? Don’t miss your rounds today. I’ll wait for you.
I know I’m not as smart as you are but I could listen to you forever.
Did you think about me on the way back home, Tanya? I know I don’t mean much to you but when a selfish woman has raised you, you start to gain trust in humanity by being around honest people. This is why I can’t help thinking about how truthful you are.
I won’t bother you, Tanya, but someday I’ll ask you a question that you probably won’t want to answer but will have to.
Some people say love can happen at first sight. I’ll tell them that love can also happen at a hospital, over a gyro date, while discussing the word “nice”.
And if you would like to come with me, I’ll fight everyone so you can become mine. I’ll smash all the walls. I’ve seen love lose once in our home. It broke us all. Love won’t lose a second time in our home because if it did, we won’t survive it. We will all die. Except the woman who gave birth to me. She’ll live. Like she has always lived victoriously amidst misery and stifled sobs.