Omar

Of course I like Madi...everyone likes Madi!

As I walked to work that morning, I pondered on why that thought had unsettled me yesterday. It should not be a surprise to me that I liked her. You just had to look around the ICU to know that everyone probably felt the same way about her as I did. I was just lucky to be on her team. Unlike my co-intern, Jake whose senior resident Liam was back to his toxic self. The two had been on call last night, and I wondered if Jake managed to survive it.

Our ICU census had been off the charts the whole week. It was towards the end of September but our medical ICU was already filled with patients admitted for respiratory issues, thanks to an early flu season that had hit our region.

The health department of Illinois had been caught off-guard too, because they had planned the flu vaccine drives for the end of September to beginning of October, as was usual practice. But with the early rise in cases they as well as the regional hospitals were scrambling to procure and then distribute the flu vaccines as soon as possible. I knew the vaccine would not completely stop the flu from spreading, but it should significantly decrease the hospitalization rates, and certainly the need for ICU admissions and flu-related deaths.

Hopefully, that decrease in ICU admissions would happen quickly, because while there were 4 teams covering the ICU during the day, overnight calls were usually covered by only one team; the intern, senior resident, ICU fellow and attending. Another team was on back-up call if needed. But there was this weird obsession among physicians, where not calling for the back-up team even when things were absolutely insane in the ICU, was considered a badge of honor.

We are an odd breed of humans, for sure.

Madi, of course, was the exception. When this topic had come up in our resident room once she had said without any hesitation,

"When the quality of patient care suffers, because it is humanly impossible for a physician to be in 5 different patient rooms at the same time, I have no problem putting my ego aside and asking for help!"

That was the thing about her, she was brilliant, but also humble. The world would be a better place with more people like her.

Coincidentally, I met Madi at the entrance of the hospital, and we walked in together. She was holding her large cup of coffee as usual, and I could tell even she was feeling the effect of sleepless nights.

"The lack of sleep catching up?"

"Yes, but also there is a lot of family drama going on...you don't want to know", she replied, looking ahead.

Oh! I wonder why she keeps telling me about her personal news, are we actually friends?

But that did give me an opportunity to ask her something that I was a tad bit curious about.

"Sorry to hear that...umm...are you and your fiancé doing ok?"

"Not really to be honest, I am not sure I want him as my fiancé anymore. But my sister is getting married so my issues are not my family's priority right now"

That doesn't make any sense

"So you're staying engaged to him because this is not a convenient time to break it off?", I could feel a frown forming on my forehead.

I had been on the receiving end of that breakup and was still dealing with the hurt and feeling of betrayal. To hear Madi speak as if there are no consequences to stringing along someone for the heck of it, just did not sit right with me.

Madi must have realized what was going on in my mind because she stopped in the middle of the hallway to face me, "Oh Omar, I am sorry. I didn't mean to bring up memories of you and Noor. I get your point, but for now let's just focus on getting through this day...ok?"

I nodded politely, but was also kind of annoyed that she would bring up Noor.

I did not need to be reminded of her yet again.

Little did I know at that time that Madi's mention of ex-fiancée would be the least of my problems during the rest of that day.

"You guys ready for sign out?", Jake asked as soon as Madi and I entered the resident room.

He then whispered to me separately, "I swear...I am taking this up with HR, it is going to be either Liam, or me in this rotation. I have had enough!"

Poor guy...but I am not giving up Madi!

We put our stuff down, and joined Jake at a table in the resident room. A few minutes later we were also joined by a scowling Liam who had just gotten off the phone. During signout, as is customary for the intern, Jake started telling us about any overnight events that had happened to the patients on our team. Of the 15 patients we had, 4 had required certain interventions, but the rest had remained stable. All in all, not bad for an ICU team.

"You guys have the most stable patients in the ICU right now so you should take the new patient that the ER just called me about', Liam said, then rolled his eyes at Jake and added, "As long as you're not going to run crying to HR about an extra patient..."

What is this jerk's problem? If I was Jake, I would have punched him by now.

"Liam, we know how to work hard and not blame everything on others like you do. Just tell us about the patient", Madi retorted immediately, and I laughed internally at her tenaciousness.

Madi 1, Liam 0

"Fine...its a 26 year old, almost 7 month pregnant woman, who was brought in to the ER about an hour ago with breathing difficulty, high fever, and changes in her mental status. ER said that she wasn't really able to answer questions or follow any commands. They are thinking she has either some infection or pregnancy related issues"

"OK...we'll go see her in the ER if she doesn't come up to the ICU soon", Madi told him, and we started to get up from the table.

"Oh one more thing...apparently she is a peds resident or something"

I froze...and so did Madi. We both knew a peds resident who was pregnant.

I seemed to have lost my voice, but Madi spoke up, "Peds resident? From our medical center? What's her name?"

Liam shrugged, "How the fuck am I supposed to know...I didn't write it down"

How could he be so nonchalant about this?

Suddenly, I couldn't contain the feeling of absolute dread that was threatening to explode out of me.

"Liam...what the hell is her name?", I shouted at him.

That must have really ticked him off, because he stood up from the table and aggressively shoved my shoulder, "Stop shouting asshole...it was Nora...or Noor something...who the fuck cares anyway"

It can't be...I just saw her last week...she was fine

"I care...", I heard myself shout again before lunging at him.

In retrospect I have no idea what made me do that, perhaps it was easier to target the resident idiot rather than face the terror I was feeling right then. Or maybe I just needed an excuse to punch him given how arrogant he was.

Liam's body slammed against the table behind him, and I could feel my fist clench, ready to punch him in the face. But then Madi's voice broke through my anger and shock, and I felt someone yank my hand back, "Omar get off him...and Liam, touch Omar again and see what I do to you!"

She grabbed my hand and dragged me out of the room and into the corridor, before turning to me, "What the hell has gotten into you? Even if this is the Noor we know, in this ICU you are a physician. You have to expect the unexpected, and not start throwing punches just because you feel like it"

She was right, we didn't know for sure that the pregnant patient was the Noor we knew. But I think we both understood that the chances of it being someone else were very, very slim. How many other pregnant, pediatric residents named Noor could there be in Chicago? Virtually none.

"I am going down to the ER...without you. Check up on the other patients and wait for me here. Do you understand?", Madi looked at me sternly.

I heard her, but every muscle in my body had become paralyzed. Whatever the reason for her condition, a pregnant woman in the ICU was bad news for both mom and baby. I knew she wasn't mine anymore, but she was still the woman I had once loved, and maybe part of me still did. And now she was sick and coming to the ICU, on my team.

How much more fucked up could life get?

And then something else occurred to me.

Had Noor's misfortune been the result of all of my mom's cursing and hatred of her. Did I somehow will this into happening, because I wasn't man enough to tell my parents to stop blaming her for everything that had gone wrong in my life? Or did I want her to suffer because she made me suffer?

"Do you understand Omar?", Madi repeated through gritted teeth, "Otherwise, I will not hesitate to send you home and call for backup"

"Yes...fine...I understand"

She started to walk away, but I reached out to grab her arm, "If it is her, you call me right away, do you understand?"

She looked at me for a couple of seconds before nodding, and I let go of her.

Back in the resident room, thankfully both Liam and Jake had left already, so I focused on the patient list in front of me. Madi was right, in this ICU, I was a physician, and I needed to behave like one. Even if Noor was admitted to my team, she would be 1 of 16 patients on my service. The other 15 patients still needed to be taken care of.

I thought about Madi's warning to send me home, and for a moment wondered if it was even right of me to be involved in Noor's care. There was a reason that physicians were discouraged from taking care of their own family, friends and loved ones. It was very easy to lose focus and objectivity, when emotions are involved. But then I remembered that for Noor, I was neither family, nor friend, and certainly not a loved one.

So I might as well be her physician.

Madiha

Breaking up fist fights between grown men was not part of my job description. Part of me could understand why Omar had reacted the way he did. I just hoped he would be able to remain objective through the day. I knew Liam would not dare to report him, because he was the one who had assaulted Omar first. But if he tries to pull something like this on someone else, even I would not be able to protect him.

If this patient is the Noor we know, would this be the first time Omar and Salman would be meeting, after Noor broke her engagement?

Oh boy

Any hope I had that our new patient was not my friend, was dashed the minute I saw several senior faculty from the Pediatric Department crowd outside the room our patient was supposed to be in.

"Oh hi Madi, this is breaking my heart...such an unfortunate case", the ER attending said to me as soon as she saw me, "Her oxygen levels were becoming really low, so we had to put her on the ventilator. The baby is fine for now, but we're just getting ready to transfer her upstairs to the ICU"

I sighed, this was unbelievable. Omar would be devastated, and I didn't even know how her husband was holding up. Salman wasn't in her room, but I was sure he was around there somewhere.

"What happened?", I asked the attending, as Kim, one of Noor's co-residents, also joined us.

They were still trying to piece the story together, but it had seemed that Noor had a slight cold for a couple of days but yesterday during morning rounds she started having chills, and a headache. The attending on service at that time had sent her home, and asked her to rest. But no one heard anything from her after that.

"I met Noor just before she left the hospital and she looked fine to me. In fact, she wanted to just drink some water and get back to work, but the attending had insisted that she take the day off", Kim added.

"So wait...how did she go from walking out of the hospital yesterday, to being on a ventilator today?", I asked, because that timeline didn't make any sense.

And why hadn't I seen Salman in the ER yet?

"Well, that is what is confusing us too", the ER attending admitted, "She was apparently alone at home, and Kim found her this morning barely conscious and struggling to breathe"

"Wait...where is her husband?", I had to ask.

"We can't get a hold of him", Kim replied, tearing up as she related what she knew, "All I know is that he had to go to Kentucky, and then this morning when I woke up I had 5 missed calls from him overnight. He never calls me in the middle of the night, so I called him back and it went straight to voicemail. Then I called Noor and she never picked up her phone either. So I went to check on her before going to work. She didn't open the door and I had a bad feeling so I called the police. And well...then we found her"

Salman is missing?

"It's ok Kim, we'll take good care of her upstairs. Don't worry about her", I told Kim, and gave her a quick hug.

"Thanks Madi. She's my best friend. I just never imagined something like this would happen to her"

Noor was my best friend too, but I couldn't think of that right now.

Right now, I needed to keep my head straight and think like a physician, not a friend.

And I was starting to get really worried about Salman, because there was no way he would ever leave his wife like this. Kim reassured me that the Pediatric Department was trying to use all the resources they had, to figure out where he was.

So for now, I decided to let someone else worry about him and focus only on my patient instead. I went over her medical chart again. Her Chest X-ray showed obvious signs of severe pneumonia, but with the help of the ventilator she was maintaining the oxygen levels in her blood. Her blood pressure too was stable but on the lower end of normal.

"If it goes any lower than that, it will affect the baby. We have alerted the obstetrician as well, just in case...", the ER attending's voice trailed off.

I knew what she meant, though. Just in case Noor's condition worsened, we would have to deliver the baby immediately, 2 months prematurely.

"Alright guys, let's move her to the ICU. We can send more tests upstairs and try to figure out what is going on", I instructed the ER nurses, and then told Kim to let me know if she hears anything from Salman.

As I helped guide Noor's bed and the attached ventilator into the elevator, I remembered the promise I had made to Omar.

I really do not want to be the one telling him this.

But a promise is a promise, so I took my phone out and called him, "Omar, could you meet us in room 1545. And...uh...I am so sorry"

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