Omar

"Where the hell is her husband?", I could feel the anger building up inside me as Madi related what she knew so far about Noor's condition.

"How could that SOB leave his pregnant and sick wife alone at home and just disappear?"

"I don't know Omar. I've seen these two together. I can't imagine him ever leaving her alone if he knew how sick she was", Madi tried to placate me, outside Noor's room.

"Listen, we need to focus on her right now. It doesn't matter where Salman is or how she ended up so sick. She is here and we need to figure out what the heck is going on...", Madi's stern facial expression was back, "Can you do that Omar? Can you focus on her as a physician, or do I need to take you off her case?"

"I'll focus on her", I told her, though I still couldn't let go of the fact that she was alone at home and her husband was somewhere off in Kentucky, "And I do hope her husband is fine, but if I find out that she is here because of him..."

Madi shot me a look of disapproval, "Stop right there, Omar. You do not want to finish that sentence. I know you that you are hurting, but I know you are not the kind of person who would think ill of her husband just because you have feelings for her. For all we know he is sick with whatever she has, and we can't even locate him"

I hadn't considered that, and it did make me feel slightly guilty that my first instinct was to blame him for Noor's illness, when he himself may be sick too.

"Fine, let's look over her chart and the labs she has gotten so far", I said, as I pulled her information on the computer.

Soon after we were joined by the attending and ICU fellow as well. We went over the brief information we had received from the ER, she had what sounded like just cold symptoms initially, but rapidly deteriorated over the next few hours. We all wondered why she didn't call someone when she started to feel sicker, she was a physician and should have known better.

"Knowing her, she probably thought she could just sleep it off", I offered.

Physician or not, every young person's first instinct is to 'sleep it off'. Given how hardworking and dedicated Noor was to her job, I would have expected her to try and power through any symptoms.

Madi must have agreed with me, because she nodded before talking about what could have caused Noor to get so sick.

"Given the terrible flu season we are having I am going to guess that her cold symptoms were likely because of the flu virus. She had just gotten vaccinated, so there probably wasn't enough time for her to develop a protective antibody response. We did send the flu test, and it should be back in a few hours"

The ICU fellow agreed with her, but then added that it still wouldn't explain the timeline of her getting sick.

"What if she has a secondary bacterial process going on, on top of the flu? The chest xray certainly looks bad enough for this to not be a viral process alone. The ER had started her on antibiotics but maybe we should broaden that to cover bacteria that are known to cause secondary infections in patients with flu. Bacteria such as MRSA (methicillin resistant staph aureus)?", I replied, remembering some of the work I had done as part of my PhD in respiratory viral infections.

The attending, Dr Muller, nodded, "Actually, that's a great idea Omar. Many healthcare workers carry MRSA on their skin and upper respiratory tract just because this is such a common bacteria in hospital settings. I wouldn't be surprised if the flu virus damaged her lung tissue, and that allowed the MRSA to invade the lungs and from their spread to her organs via the blood. And by the time she was found she was in full blown septic shock"

I knew that septic shock was a severe drop in blood pressure in response to widespread infection, that resulted in problems with how the body's cells worked and produced energy. That had probably affected her brain function as well.

This is a nightmare for her, and we haven't even talked about the baby yet.

"Dr Muller, what about the baby?", I asked.

"So we have to think about the patient's body as two compartments, one is the womb and the other the rest of the body....", the attending went on to describe how the baby is somewhat protected because the barrier between mom and baby is incredibly effective at keeping bacteria and toxins out of the womb. But that is not a fail-safe mechanism to protect the baby, and we still had to keep a very close eye on the fetus.

But somewhere in that discussion, I felt my mind wandering off to another thought. Noor was not a just a body with two compartments. Even if I put aside what she meant to me, she was someone's wife, daughter, sister, friend and...hopefully a mother. So many people cared about her and loved her. Up until this moment, she had led a full life, complete with love, and warmth, and ambition, and dreams. How was I then supposed to think of her as just two bodily compartments?

That's when I realized that the hardest part of being a physician wasn't the sleepless nights, and long hours, it was maintaining the humanity of our patients while also thinking about them objectively enough so that we can actually help them.

"Omar?", Madi's voice called out.

"Yes? Sorry...what were you saying?"

"We were just discussing about giving Noor steroids...", the ICU fellow started speaking.

"Wait, isn't that dangerous for her?", I immediately interrupted him, "She already has a low immune system because of pregnancy and the steroids will suppress her immune system even more...in what world does that make sense?"

I hadn't meant to question the fellow so aggressively, he obviously knew a lot more than me. But this wasn't just any patient. Suppressing her immune system when we she may be dying from an infection just did not make sense.

This guy better not mess up her care, otherwise I will raise hell!

Madi must have noticed the edge in my voice, because she gently placed a hand on my shoulder and said, "Omar, let him finish...there is a reason for giving her steroids"

The fellow gave me an annoyed look, but then continued, "We all know that maintaining a pregnancy when the mother is on a ventilator is difficult, and more often than not the baby has to be delivered prematurely. In preparation for that possibility, we need to give Noor steroids, which will her make her baby's lungs develop more quickly. Without the steroids the baby could have significant breathing problems. But Omar is right, we do need to keep in mind that her own condition may worsen"

"Do we know where her husband is yet?", the attending asked Madi, "I usually like to involve family in situations like this where there is no right answer. We can't ask her opinion obviously, but it would be good to ask someone who knows her well about she would want to do"

Madi reported that the only update she had was that the Pediatric Department had officially asked Chicago Police Department to assist in locating Salman.

But then she looked at me, and hesitantly asked, "Omar, you've known her for a long time. Do you...umm...know what she would want to do?"

I did, without a doubt. Whatever had happened between us would never erase the years where we had grown up together. I knew her almost as well as I knew myself.

I hated that I said what I did next, because to me Noor's life meant everything. But that is not what she would have said, if she could speak.

"She would do anything for her unborn child, even if it meant giving up her own life"

Madi nodded, even she knew Noor well enough to know that I was right about her. So as reluctant as I was, I had to agree with the rest of the team when they made the decision to give her the steroids, but also broaden her antibiotics to treat a possible MRSA bacterial infection, and give her an anti-viral medicine to treat possible flu.

By that point I was actually starting to get worried about her husband as well. I didn't know him at all, but I knew her. If she loved him as much as everyone said she did, he must be worthy of that love. The woman I knew never did anything half-heartedly...well, except get engaged to me.

He should be here and have a say in the medical decisions we are making for her. That was not my place.

I was not her husband, Salman was.

Madiha

While we waited for her test results we started Noor on all the therapies that we had discussed on rounds to cover every possible reason for her illness. In other words we did what we in medicine call 'throwing the kitchen sink'. Its not the best approach, but sometimes its the only approach.

Of our 16 patients, including Noor, a couple of others had required escalation of treatment. One was put on the ventilator by the attending, while the fellow and I continued rounds. And another needed to be rushed off for emergent heart surgery. But after that rounds went quickly, and we were heading back to the resident room when my sister sent me a text.

'Call quickly...need help!'

I was working in the ICU, and had seen the sickest of the sick patients over the last 2+ weeks. So of course, my mind immediately went to someone in my family falling seriously ill. But when I called her back she wanted to know which designer perfume she should buy for her fiancé, whose birthday it was that day.

Is she kidding? How is that even a problem she needs help with?

But then reminding myself that she was my little sister, and that I should be honored that she wants to involve me in her happiness, I responded, "Maliha, do you really think he needs material things from you? The guy has everything he wants, and if he doesn't he can afford to buy it himself. Why not focus on an experience that the two of you can share?"

"Oh Madi, that is an excellent idea! Maybe I'll ask his secretary to clear his morning schedule and I can take him to breakfast at this quaint little restaurant on Lake Michigan, that he mentioned he had wanted to go to. Thanks Madi...you're the best sister, ever!", Maliha exclaimed excitedly and hung up.

Of course I am! But she wants to take him out for breakfast? What time is it?

I checked my phone and saw that it wasn't even 9 am yet. It felt like we had done an entire day's worth of work already, but then again we had started the day at 6 am. Besides, I was convinced that the ICU existed in a time dimension that was separate from the rest of the world.

Omar had remained quiet since his mini-outburst on rounds, but I could see how tense he was. When we finally reached the residents room, he sat down at the work station off to the corner, obviously not wanting to chat with anyone else like he usually did. I had told him that I would take care of Noor's admit note. He should not have to be bogged down with her paperwork at such an emotional time. Yet, I noticed that he kept refreshing her chart, looking for any new results as soon as the lab released them.

He had also asked me a few times if I had heard anything about Salman, not that I expected anything else from him. The thought that Noor's husband was in trouble himself was a greater possibility the longer he remained missing. Kim's only update had been that they were able to reach his mother in Kentucky and according to her he had abruptly left their house around midnight. They had assumed he was driving back to Chicago, but hadn't heard anything from him either.

Maybe he hadn't heard from Noor, got worried and then decided to drive back to Chicago. But if he did, the drive from Kentucky to Chicago is about 5 hours, he left his parent's house 9 hours ago. Where the hell is he?

I didn't know what else to do to help find him, so I scrolled through the news looking for anything about a car accident along the highway that links Kentucky to Chicago. I hadn't found anything, which was somewhat reassuring. Sometimes, no news is good news.

Feeling completely helpless, I started to work on Noor's admit note when Jake walked in to the residents room looking disheveled, like someone had sucked the life out of him.

Well, I can at least help someone...

"Hey Jake", I motioned for him to follow me out of the residents room, "Let's go grab some coffee"

It was ridiculous that he, as an intern, had to put up with so much from his senior resident and no one had supported him as he had tried to find a solution. That included his attending, who I knew was the old-school type. His motto was, 'I went through hell during my training, and so shall every subsequent generation'.

Which is the stupidest thing ever, and is the number one cause of the toxic environment in medical training.

"Jake, there are rules and regulations now to protect trainees", I explained to him, "You just need to know who to contact"

We then made a plan where he would write up everything that had happened to him, and I would corroborate some of what he reported because I had witnessed it first hand. And I was going to ask Kylie, the other female senior resident this month to also add her comments.

"Madi...why are you helping me? No one else seems to care around here", he asked me with a dejected look on his face.

"Because you are a good physician Jake, and I would hate to see you drop out of residency because of loud, inconsiderate people who think the world revolves around them"

The look of relief on Jake's face was worth any backlash I would get for helping him. But I had built enough of a reputation in this residency program that I knew my word carried weight...not to toot my own horn. But it was time to put that reputation to good use.

Then, almost as if I was being rewarded for a good deed, I got a text from Kim.

'Good news! Highway Patrol found Salman, he is 30 mins away from the hospital. I told him to call you directly when he gets there'

I immediately called Kim for more details.

"I don't have all the details yet, but from what I know...he was found asleep in his car at a rest station about 2 hours away from Chicago. His phone had died so he didn't realize how long he had slept. It does sound like he may have whatever viral infection that Noor has, because he had a really high fever and was dehydrated when the cops found him. The paramedics checked him out in the ambulance and he seemed to get much better with IV fluids and an anti-fever medicine, so they are driving him here"

"Oh my God, what a harrowing situation for both of them. Does he know how sick Noor is?", I asked, trying to mentally prepare myself.

"Umm...not exactly. I didn't want him to be alone when he found out she was intubated in the ICU. He just knows that she is in the hospital", Kim replied.

"OK...thanks for letting me know. I am glad that he decided to stop at the rest station, things could be so much worse if he had kept driving and dozed off or something"

I would have done exactly what Kim did, but that meant that I would have to be the one to break the news to Salman.

First Omar, now Salman...why am I cursed with being the bearer of bad news?

And as I had expected when Salman did reach the hospital and I bought him to his wife's room, he completely broke down. Its difficult to see anyone with a tube down their throat, hooked up to dozens of lines and completely unresponsive. I couldn't even imagine what it would have felt like to see your young, beautiful, pregnant wife like that.

I could feel the lump grow in my throat as I watched him sit next to her and gently hold her hand, bringing it to his lips, as tears streamed down his face uncontrollably, his body almost shaking with the shock of seeing his wife. He sat like that for a while, as I looked through her electronic chart again to make sure we hadn't missed anything. I wanted to be there for him but also give him the privacy he needed, so once I logged off the computer I started to walk towards the door. Just then he called out to me and asked me to give him the details of what her tests had shown so far.

"Salman, I will tell you if you really want to know them, but you don't have to be her husband and her physician. We have a great team here"

But he insisted, so I updated him on everything we knew so far. Her blood oxygen levels had remained stable, she had briefly received medications to help normalize her blood pressure in the ER but not since she had come up to the ICU. Putting her on the ventilator seemed to have helped stop the progression of her illness for now. His baby's heartbeat was strong and the obstetrician was keeping a very close eye on any signs of distress in the baby.

He was nodding along as I told him everything, but then I heard the door of Noor's room slide open and from the corner of my eye, saw a figure enter the room. Salman looked up to see this new occupant of his wife's room and immediately froze. But only for a moment. After which I saw his disbelief quickly morph into anger.

Oh crap...maybe I should have led with updating him on the members of his wife's ICU team.

"What the fuck is he doing here?", Salman's voice boomed across the room.

"Oh...Salman, this is Omar, the intern on Noor's ICU team...and Omar, this is Salman, Noor's husband"

"Madi...I didn't ask who he is, I asked why the hell is he in my wife's room?", Salman replied to me curtly.

Omar who had been quiet till then, immediately spoke up with a frown on his face, "Stop talking to her like that...she isn't the one who left his wife alone when she was 7 months pregnant...to do God knows what, all the way in Kentucky!"

"My father had a heart attack. I was only gone for two days...", Salman retorted.

"Clearly, that was enough time for Noor to end up like this...", Omar interrupted, and nodded in her direction.

"Stop taking her name", Salman raised his voice again.

Oh God, I can't have these two fighting in here

"Both of you, stop it! The two of you clearly have a lot of issues to resolve, but right now we need to focus on her...stop making it about yourself", I knew I sounded like my mother right now, but these two grown men were acting like kids.

"Omar step outside please and wait for me...I need to talk to Salman", when he continued to stand there scowling, I repeated, "Now!"

After he left, I turned towards Salman. I wasn't going to tell him how Omar felt about Noor, but they had a long history together and he clearly cared for her.

Before I could say anything, Salman started speaking, "Madi...I am going to ask you again, why in the world is he here? I don't trust the man at all. I want him off her physician team"

"Salman, I am so sorry that you are going through this, and please know that we are all here for you, but Omar is on her ICU team and he has done everything he can to help her since she came in. I know this is not an ideal situation, but it is also not fair to take this out on him. If you just take a moment and think, Omar is a really good physician and he cares about her more than any other intern ever would...wouldn't you want that for your wife?"

"He doesn't need to care about her. I can do that all by myself. She doesn't need him...". he sat down next to Noor's bed.

I knew he was in agony right now, but I honestly thought that on our ICU team, no one was more invested in Noor's health than Omar. But perhaps this was not the time to try to convince her husband about that fact.