Mar 5, 2022
It was a sultry day. The heat of the summer was morphing into the cooler evenings. It was now pleasant to sit under the trees outside the cafeteria and drink tea while munching on hot samosas and pakoras. The breeze was lazy and gently lifted the hair of the almost somnolent couple sitting at the tiny table. Sarah and Tanya were enjoying the evening. It had been a very hectic day for both of them and they were just enjoying the silence punctuated by the sounds of nature around them. An occasional giggle from other students or the sounds of the cafeteria sometimes intruded on their tranquility. But they were happy. Content to be in each other’s company for the evening.
Suddenly Tanya spoke up. “Do you know what day it is tomorrow?”
“Have no clue.” Said Sarah with a lazy smile not wanting to disturb the relaxed mood she was in.
“It’s the 14th Safar (2nd month of the Hijra calendar)”
“And? Am I supposed to know what that is? Do I jump for joy”
Tanya looked at Sarah pointedly. She wanted to be annoyed with her friend. But she thought that she was so cute when she tried to be funny. Emphasis on “tried”,
“It’s the Urs (death anniversary) of Shah Abdul Latif Bhitai. Thousands of people from Sindh come to pay respect to the Sufi saint on the occasion of his urs. Each year, the three-day ceremony begins with poetry marathons, literature conferences and other activities to celebrate the Sufi saint’s poetry. And it lasts for three days.
The main features of the festival are prayers, music, exhibitions, literary conferences, and horse races. Many renowned singers and musicians attend. It’s like an ethnic rock fest!!!”
That sounds interesting. But I doubt that I would get permission to go there. Especially if there will be a massive crowd.” Sarah looked forlorn. Tanya looked at her bowed head with an affectionate smile.
“Would you be allowed to go if you had someone take you there and ensure your safety?”
Sarah looked up with a speculative glint in her eyes. “Tanya! You are a genius! My father comes to these Urs’s every year to recruit men for the army. I am sure he would be there. He could take us if we asked him to!”
Tanya started to laugh. Not a polite gentle laugh but a deep belly laugh that ended with her wiping the tears of mirth from her eyes.
“Sarah, I am a grown up. I don’t need daddy dearest to chaperone me.” She continued to laugh. Sarah looked at her as if she had gone completely mad.
“I mentioned the Urs because I have been asked to monitor it. More and more women attend every year, so having a policewoman instead of a bevy of policemen to look after the women attendees as well as those of the female persuasion who commit petty crimes is supposedly a good idea.” Tanya continued to grin. “I just wanted to ask you if you would like to go with me this year.”
Sarah suddenly understood why Tanya found the situation hilarious. Here she was trying to invite her to the Urs festival, and on the other hand she was thinking of her father. Just like a child. She really had to grow up she thought as she shook her head. She started to laugh along with Tanya.
“But I would still have to let my father know Tanya. If he sees us at the festival he might get upset. I am after all supposed to be chained to my books in the college. Aren’t I?” Sarah gave Tanya a saucy wink.
“Anyway, I would love to go with you. I will apply for three days leave this evening and will also let my father know that we will meet him there.”
Tanya was not very happy that Sarah’s father would also be at the Urs, but she understood her logic. It was better to go with proper permission that to sneak around. Even if they were not doing anything wrong. She looked forward to the three days of color and festivity with Sarah. The lineup of superstars promised to be entertaining. Yes, she did look forward to the festival in more ways than one.
Feb 25, 2022
How different our lives are when we really know what is deeply important to us, and keeping that picture in mind, we manage ourselves each day to be and to do what really matters most ~ Stephen Covey
My life as a doctor has been interesting and varied. I am blessed with a career that I passionately love. I have come a long way from the little four-year-old that dreamt of being a doctor, actually I am extremely lucky that I am one of the few people in the world whose childhood dream had come true. When I go to work, I don’t think of the paycheck, at least not anymore. I love taking care of children, and when they get better and smile at me, it warms my heart. That in itself is thanks enough for me. There have been times when the prognosis of some patients that have caused sorrow and pain and it was heartbreaking to say the least. The death of a patient should never be taken for granted. We lose our humanity that way. Feeling the pain of the parents who lost a child, empathizing with them, and being supportive, makes one a better person… a better human.
If I was given the chance to live my life once again, would I have chosen a different profession? No! Not at all. Being a doctor has always been and will be till the end my ultimate passion. Maybe I might have changed my specialty, become the pediatric surgeon I initially wanted to be, but working with children has always been fulfilling for me.
I digressed from my path for a while by working as a Clinical Research Associate, and then later on as the Head of Public Affairs in the big bad world of pharmaceuticals. That was because they paid well, and I was economically strapped at the time. On the plus side, I did travel nearly all over the world while working with them. Getting trained in media and presentation skills was actually fun. However, there is one thing that I didn’t do…. I never let go of my red Littman stethoscope.
My private practice continued in the evenings, and many times I would be accompanied by my children who loved to play and move around the area. Especially, when there was a chance to get takeout pizza or kababs for dinner when we were about to go home.
One of the things I would like to mention, that brought me great pleasure and, in a sense, spiritual fulfillment. Whenever I went out of town into the country, our ancestral village, or the mountains up north, I would take boxes of basic as well as some vital medicines with me and set up impromptu clinics for the people living there. This happened mostly in areas where medical facilities were sometimes sparse or quite far away. My mother and my children helped me many times with the patients. Mama thought that tea with a shot of whiskey was therapeutic for a chronic cough. It was amusing to see how many patients came back and specifically asked for her medicine instead of mine. Interacting with the people while helping them was a balm to my sometimes-troubled soul. The cheerful banter would create an ambience that drew people into our circle, and at the end of the day, the patient count was usually quite high.
You know, maybe I should work on the idea of having a mobile clinic one day?
One of the most devastating times where we volunteered our medical services was the 2005 earthquake in the north of Pakistan. A relief team from San Diego included my daughter, two sisters in law and myself to help the people, especially the injured victims of that devastating natural disaster. We liaised with the army to set up proper medical camps in one of the most affected areas. If one didn’t look towards the ruined buildings and the smoldering fires, the area was beautiful. We were high in the mountains and the natural scenery could have rivaled Austria or Switzerland. It was so sad to see the devastation. I didn’t know how much it had affected me till I was hit with a wave of PTSD (Post Traumatic Stress Disorder) when I had to make a presentation on a very serious forum, to track the relief donations. While speaking and presenting my data, to my horror, I had tears streaming down my face. Since I was one of only two female senior executives in the company, believe me, it was embarrassing to say the least. I kept hearing derogatory words like “weak” and “hormonal” throughout the evening. Mean men!
We were impressed with the way the relief agencies had pitched tents with their equipment and makeshift clinics on top of a beautiful grassy hill. There was a sort of structured chaos where multiple humanitarian agencies worked together. I was able to commandeer the massive pediatrics tent, and as I remember I had examined and treated over 3500 children with mild, moderate to severe ailments and injuries in the time that I was there. Maintaining discipline and cleanliness was difficult but paying a sweeper to come twice a day to clean the tent and educating the parents to throw their rubbish in the bins provided did make a difference. The then President visited my set up and was impressed with my “ward”. I was asked by the Presidential Team what I needed at the time. Since we had a lot of medical supplies due to the generosity of donor agencies, the only thing I could think of was blankets and a heater for the tent. Even though it was October, the nights were very chilly in the mountains. We received a lot of blankets, so much so that we were able to let the grateful patients take away the ones they were using once they were discharged.
My strongest memory of that time was sleeping in our much smaller tents while the earth rumbled and trembled with the continuous aftershocks. It was like sleeping above a subway. Though it was quite disconcerting, we were glad that the tent was pitched in a field with no structures to fall on us.
Once back in town, I felt that I had to continue my charity work. I knew that there were slum areas in the city where women and children never left their surroundings because they had migrated from villages and were still not savvy to the ways of the city. Keeping that in mind, I visited a mosque situated in a nearby slum area with my maid. She wanted to introduce me to the Mullah there. According to her, he was swamped every day by women who would come to him for prayers and holy talismans for their own and their children’s’ health. There were many conditions that stumped him, and she had incidentally heard him say one day that he wished there was a doctor that would come to help him with his “patients”.
On meeting the Mullah, I realized that he was a kindly old man. He wasn’t one of those fire and brimstone clerics. As a matter of fact, I was surprised that he was well educated and had served as a young man in the army. What endeared me to him was, that when I walked into the mosque, he was teaching a child with Down Syndrome to play Ludo, a board game. The patience that he showed that little girl was quite sweet.
I realized that I could do a lot of good here and started to set up a makeshift clinic within the mosque that I would run once a week. Of course, if anyone needed me before that, they had my phone numbers or I referred them to my colleagues at the Government Hospital nearby. It was unusual and rather funny to see people praying on one side, and on the other side, in my corner, there were women waiting in line to be treated while gossiping and catching up with their families’news. The children with them were quite well behaved and played with board games and toys while they waited their turn. Many of them became my friends, and I still am in touch with them even though I am not in the country anymore.
One strange day, while I was writing a prescription for one of the women, I looked up and saw a tall man with a white beard and sparkling white clothes standing in front of me, smiling gently. He told me that God was very happy with me and what I was doing to help the community. I don’t remember if I said anything or was tongue tied. I just shyly looked down for a second, and when I looked up again, he was gone. I asked the woman who was waiting for her medicines who that man was. Can you imagine? She said that she hadn’t seen or heard anyone! Quite strange, isn’t it?
Due to extenuating circumstances, and the sad breakdown of my marriage, with a heavy heart I decided to leave the country. My work as a pediatrician in my new home has been appreciated and I have become fairly well known. Continuing my work in Reiki, Intuitive Medical Scanning and alternate healing has added to my allopathic skills. I did dabble in Shamanism, but I concluded that it was not for me.
Another one of my passions, teaching and training has also flourished here. I am able to instruct nurses and doctors on various pertinent topics so that they get the requisite annual Continued Medical Education points mandated by the Department of Health. Being trained as a trainer for Basic Life Sciences, I train the staff at the hospital where I work which is definitely a plus point in my favor. (Free CME points without much effort).
Spinning a tale was a learning experience. I can thank my daughter Sharmeen for that. When she was small, we just had to point out someone on the road and wonder why they were happy or sad, and she would spontaneously spin a story around them, telling us in minute detail why they actually existed. I tried to do the same with the cases to make them more interesting and maybe human? I do wish my daughter writes a book one day. Her story telling and imagination is phenomenal. For now, she is a Psychologist and a Theta Healer. But I will keep reminding her that she could and should do it.
My son is also a Theta Healer, courtesy the training he and his wife received from my daughter. He is a spiritual person and has skills in Extra Sensory Perception (ESP) just like his sister and me. My children have been my anchor in hard times, and they have on many occasions calmed me down just by talking to me and applying their healing skills. All three of them are amazing. (I include my daughter in law here as well because she is. Amazing)
My journey as a physician is not over. There are still new cases to examine, new places to see and new adventures to experience. I look forward to seeing what life brings my way. Till my energy wanes, I will do what all typical doctors do. Only give up once my signature red stethoscope wears out.
Old doctors never die, they just lose their patience. (Patients)
Feb 10, 2022
The Irish Connection
I was excited to travel to Ireland. My admission to the Royal College of Physicians and Surgeons in Dublin was confirmed. I was finally going to specialize in Paediatrics!
Leaving my two-year-old with my husband, sister and her paternal grandmother was heartbreaking, but I knew she was well taken care of. And there was always the telephone. My bills were phenomenal, 
but definitely worth it.
The day I landed in Ireland, was a sunny day. From the time I looked out of the plane’s window, till I reached the bedsit where I was staying, I was visually bombarded with eye-soothing shades of green. Yes, this country was more than adequately named the “Emerald Isle”. And I was there! It was to be my home for the next few months. Fáilte romhat go hÉirinn… Welcome to Ireland!
After a quick shower and a chat with my land lady, I thought I would take advantage of the good weather and go for a walk. Coming from a hot country, the mild weather was a balm to my soul, and I definitely relished it. It was a lovely day, and I wanted to think about the days ahead. Maybe this would be the only time I would get to relax before we got busy with our ward lectures and studies at the college.
While walking down one of Dublin’s many pedestrian zones, a little body literally hurled into me. Looking down I saw that it was a little girl who must have been about eight years old. She had a cherubic face that was framed with beautiful red curls and there was a light dusting of freckles over her nose. Her green eyes twinkled at me mischievously. To my dismay, she was dressed in very shabby clothes, and her tennis shoes had holes where the toes were unsuccessfully trying to merrily stick out.
Seeing me make eye contact with her, she started to beg for some money. I looked at her carefully, and noticed that despite her shabby appearance, she looked well-fed and more or less clean. So instead of giving her money, I asked her where her parents were, and she succinctly told me, as if it was a regular occurrence, that they were both in the nearby pub. They needed money to have more drinks, so she was sent by them to beg in the street. Conversationally, so that she wasn’t scared away, I asked whether she had eaten anything that day. On hearing that she hadn’t, I did give her a few coins, but I told her that the money was to buy something to eat for herself and not to give to her parents. Little Kathy snatched the money from my hand, and grinned at me over her shoulder, while she happily made her way to a nearby well-known fast-food restaurant. Poor kid, I thought to myself. Not letting the incident mar my pleasure of the lovely day, I walked on and put all thoughts of her and her predicament out of my mind.
Kathy’s name triggered a thought in my mind… I should try to contact Sister Kathleen Mcguire. She was the one nun in my Convent School that I really liked. I had heard that she had moved back to Ireland and was still with her Order of the Presentation Convent. Okay then, once I was back home, I started to look in the phone book and noted down the numbers of the Orders that I thought were relevant…..Have you any idea how many Kathleen Mcguires there are in this land of intrepid wandering nuns? Sadly, unless I wanted to call each and every one of the two thousand and more Kathleen McGuires in the phone book, I wasn’t destined to meet her again.
True to Ireland’s weather unpredictability, I woke up the next day to a wild hurricane. Now how would I be able to go to the college? Would it even be open in these weather conditions? Just to be sure I phoned them. I didn’t want to be thought tardy on my first day.
“Och! We won’t close the college for such a little drizzle.” I was told by the office secretary.
Therefore, being ill equipped for such weather, borrowing an umbrella from my landlady, I literally ran to the shops nearby. Since we hardly needed coats and umbrellas where I lived, I had planned to go shopping that day after class. But I was not counting on Hurricane Charley. Later on, listening to the news I found out that Hurricane Charley had hit Ireland hard and brought heavy rainfall, strong winds, and widespread flooding. It was responsible for at least 11 deaths. Winds reached 65.2 mph, and rainfall peaked at 280 mm setting a record for the greatest daily rainfall in the country. Wow! Little drizzle? I really thought that I had to take up that issue with the college secretary!
Thankfully the shops were just opening, and I was able to buy a sturdy (hurricane proof) umbrella and a Burberry raincoat. I was lucky that the Irish were friendly, helpful people, and allowed me to shop before they were properly open, otherwise I would have had to slink into class looking like a drowned rat.
Studying in Ireland was different and interesting. The discussions and interactions between the postgraduate students and the professors were exhilarating and eye-opening. There was such a lot to learn. But the most prominent feature that stood out was the attitude of the professors to ante-natal diagnoses of genetic diseases, and the termination of pregnancies even if the unborn foetus had severe or life-threatening deformities. There were many cases documented where the mothers’ health was in jeopardy, with their pregnancies, but the doctors refused to terminate them because of their beliefs. One case was also touted in the newspapers where a 13-year-old was raped and became pregnant. You of course can understand by now what her fate was. She was denied termination by the state and her diocese.
Unbeknownst to me, I brought up the topic in class when we were told that the Celts were genetically more prone to have babies with Spina Bifida or with Down Syndrome. The worrying fact was that children with Spina Bifida have multiple neurological defects ranging from mild to moderate paralysis of the lower limbs to loss of bladder and rectal functions. We noticed that there were sometimes two, or even three children with that condition in the same Irish family. I was puzzled why an antenatal diagnosis wasn’t performed and the mother given the option of a therapeutic abortion rather than let a child come into the world with severe deformities. More often than not they were not able to have a good quality of life or even take basic care of themselves. In addition to that, why weren’t the families properly counseled on family planning if there were risks? To my knowledge, I didn’t say anything new. That was taught in all of the textbooks around the world, so hearing this being refuted in Ireland was puzzling. But why did I feel as if I had said the wrong thing?
The Professor with whom we were discussing these cases stopped talking for a beat, and for a fleeting moment, he might have had a frustrated look on his face. He took a deep breath and told us, a class of predominantly International Students, that Ireland was a Roman Catholic country where family planning and abortion for any reason whatsoever was a crime. Therefore, the average Irish family had six or even eight children. If there was a genetic inclination to any medical condition, it was not uncommon to see the disorders emerging in more than one child in the same family. We were shocked. But of course, no one said anything out loud because we realized it was a sore point here and we did not want to hurt the religious and political sensitivities of the Professor and other Irish citizens. We were guests in their country, and we needed to respect their beliefs and laws.
Recently however, it was all over the news. It is only now, in the 21st century that they have permitted abortions in Ireland. That too only during the first twelve weeks of pregnancy. (And I agree to this wholeheartedly. I do think that abortions performed later in the pregnancy are dangerous for the mother as well as the baby.) The authorities and powers that be in Ireland added a codicil that abortions could also be performed where the pregnant woman’s life or health is at risk. That included also the cases of a fatal or severely debilitating foetal abnormality. This legislation was just implemented on the 1st of January 2019, which had become the law only on the 20th of December 2018. Can you imagine how much heartbreak the families had with their babies till then? It wasn’t unusual to see families in town with more than one sibling having either Down Syndrome or walking on crutches or in wheelchairs due to Spina Bifida.
Let me make it very clear. As a physician, I am an advocate of therapeutic abortions, where either the life of the mothers or the babies are at risk. I would not recommend random abortions, but then that is the prerogative of the person(s) involved. I have no say whatsoever in that matter. Your body, your choice.
Neonatology, a personal favorite, was taught to us at the famous Rotunda Hospital of Dublin. This
ancient historical hospital was built with perfectly round “lying in rooms”. The air vents were placed near the floor for proper circulation. The idea was that if there were no corners in the room, the germs that caused post-partum sepsis or puerperal sepsis couldn’t lurk in the corners. I found that quaint and interesting, since the Rotunda Hospital has occupied its present premises since 1757. The concept of germs was very new in that period of time, so this belief was an innovative way of providing a more or less germ-free environment for the mothers. The idea was commendable.
To study the diseases and conditions of older children, we were rotated through the many hospitals in Dublin. One day, while we were heatedly discussing child-abuse, a sore topic with any pediatrician, we were to my surprise introduced to Little Kathy who I had met on my first day in Ireland.
Our teacher showed us that she had multiple bruises on her legs and her back. She looked quite miserable, the poor little girl. Definitely (at first glance) it seemed as if she had had a severe beating leading to the horrific bruising all over her body. Her mother who had consented to let us examine Kathy, was already aware of her diagnosis. To my dismay there were a few indiscreet students who once again started to talk about physical child abuse as a differential diagnosis in front of the mother. Therefore, while listening to the random discussion, she became inconsolable. She kept saying tearfully that her Kathy had fallen down while playing with her brother in the garden. She said that she would never beat her child so cruelly. Well, thankfully she hadn’t. We reassured her and told her that the reason our lecturer had brought Kathy forward as a clinical case for us to examine, was to show us that everything is not always as it seemed. Kathy had developed condition called Idiopathic Thrombocytopenic Purpura. Due to the lack of platelets in her blood, and most probably due to a past viral infection, just like other children with this condition, Kathy bruised easily. The acute form of this illness often follows an infection and spontaneously resolves within two months. A mistaken diagnosis of child abuse could easily be made in this case. To avoid psychological and traumatic implications on the child and the family, a careful diagnosis always had to be made. Especially in places like Ireland where Child Protective Services were quick to isolate the children from their allegedly abusive parents.
Knowing where I had met Kathy initially, I was aware that even though she might not have been physically abused, she was still being used by her parents to beg for their pub visits.
Kathy had recognized me the moment she stepped into our classroom, and she looked at me with pleading eyes. I understood that she didn’t want me to mention how and where we had met. Giving in to her silent plea, I didn’t say anything because I didn’t want to add to her and her mother’s stress, but I did think about it a lot, and wondered whether I should have said something?
My stay in Ireland, the intense hands on as well as the theoretical studies opened my mind, I felt on top of the world! Finally, I graduated with honors.
On the last day of my exams I was able to pick up my husband and daughter from the airport. We had planned to spend a very nice relaxing month driving through Europe. Stopping when we wanted to and meeting whoever we wanted to.
The food snobbery in France was hilarious and my husband kept telling me to bug the chef by asking for ketchup. I obviously didn’t. I wanted to eat in peace. They were already upset with me because I didn’t sample their wine. My only regret was that I had to cut my visit to the Louvre short because of a cranky toddler… or was it a recalcitrant, (or a not into art) husband?. But on the whole, it was fun and memorable. Meeting my maternal relatives in Switzerland and Austria was also quite enjoyable.
Now the time had come to go home and start serious work. After all, I was now a qualified pediatrician. I was ready to jump in feet first and start looking after the children of the world.
Feb 8, 2022
Another one of Dr. Sarah’s Adventures:
Opium has had a chequered history down the ages. But did you know that it was once upon a time a drug of choice to treat a plethora of ailments in babies and children as well?
Even the Ancient Egyptians would deal with their noisy crying babies by just giving them a draft of opium. It’s interesting to know that it was still the drug of choice in the Victorian era, till it gained notoriety for the dangers of opiates in children and the significant adverse effects on their general health.
Historically we know that in the Victorian era opium was commonly used as a cure-all for coughs, or aches and pains in adults. But it is less well known that restless or teething babies and even very small infants would be given different concoctions that contained opium or morphine (an opium derivative). Attitudes towards the administering of opium to children were often casual, and popular preparations such as laudanum even recommended doses for children and infants on the labels of their bottles.
Opium was at that time period often described as the ‘Poor Child’s Nurse’, due to its ability to stop hungry babies from crying and disturbing the household where their mothers worked. Thankfully, the doctors of the era were convinced that opium was a major cause of infantile death, especially with its use becoming widespread amongst working class families.
Usually on my drive to work, I had to wait at a busy traffic intersection before I could turn into the road where the hospital was situated. The morning rush hour was at times so heavy that the lights changed a few times till I was able to get to the point where I would be able to turn. While sitting in the car there was not much to do, so I would either listen to music, or look around and “people-watch”.
The young girl would be at the crossroads every day. Without fail she would be standing quietly at the same traffic light for months on end. It was as if she had made that junction her home. In the beginning when she was younger, she used to be alone, or accompanied by a stern looking woman who I presumed was her mother. As she grew older, I noticed that she would sometimes be standing in the sweltering heat cradling a small bundle in her arms, that, in the fleeting glimpse I got of it while passing by, wouldn’t move or even give the impression that there was any sign of life.
One day, when the traffic lights took their time to turn green, she tapped on the window of my car and started to beg for alms. She uncovered her baby’s face and said she needed the money to buy milk and medicines because her child was ill. I looked carefully and noticed that the baby, a little girl, did look pale, and somehow her breathing was very shallow. The odd thing was that even though she was fast asleep, she was oblivious to the loud cacophony from the traffic.
Giving the baby a quick glance, I told the girl that since she said the baby was ill, she should bring her to me at the hospital, where I would examine her properly and give her some appropriate medicine. In the short time I had before the light turned green, I quickly threw my card at her and told her to come to the ward on the third floor of the Children’s Hospital as soon as she was able to.
Obviously, she didn’t come to the hospital as was expected, and it dawned on me that she was in fact not at all concerned for the child. She just wanted the money she could get by playing on the sympathies of the motorists who she targeted at the traffic junction. I had felt there was something dispassionate and distant with her attitude towards the baby. I could not feel any maternal vibes coming from her. Was the baby really hers?
The next time I saw her at the traffic lights, I asked her why she hadn’t come to the hospital. I tried to reassure there that the treatment and the medicines were free. She looked furtively around and saw that the woman I thought was her mother, was looking at us with a stern expression. Becoming aware of the woman’s malevolent stare, she suddenly looked scared and didn’t want to talk to me anymore. Giving a quick look at the sleeping baby I once again found it strange that there was no movement or response to any stimuli, whether physical or auditory. Before I drove off, I flippantly asked her what she had given to the child to sleep so soundly, because I couldn’t get my patients to sleep so deeply. Instead of laughing or brushing off my joke, she looked even more frightened and turned away from my car so abruptly that she caught her foot on a stone and tripped falling face first onto the road. The baby obviously also fell from her arms onto the curb. She just moaned slightly and went on sleeping. That was when I became even more suspicious that the child must have been heavily drugged. Not only that, but I also noticed that the baby was not breathing well and looked even more pale than the first time I had seen it.
Looking for a nearby place to park, I tried to find the girl to take her and the baby to the hospital, but by the time I was able to walk back to the intersection, she and the old woman had taken the baby and disappeared. I asked a few passersby and another one of the regular beggars there whether they knew where they had gone, but either no one knew, or they were not saying where they went.
Disappointed and worried I went back to my car and went to work as usual. But the baby’s condition did lay heavy on my conscious. I hoped she was all right and that my suspicions were unfounded….but then, why didn’t the baby cry when it fell down with the mother? Strange thoughts and “what ifs’ were continuously swirling around in my head. I just could not put them out of my mind. Maybe it was a grim premonition? Or was it just that I knew too much about the detrimental effects of drugging babies and was frustrated because I wasn’t able to help them. The question was, did they want to be helped? I guess not since they slipped away once I showed an interest in the health of the baby. I tried to put them out of my mind, and yet I couldn’t do so.
Mentioning my strange encounter of that day to one of my colleagues, she told me that these things were common in a big city. Was she hinting that I was a country hick? Well, I did study in a smaller town, so I took her barb as it was meant, a joke. She also told me a frightening story of gangs who “hired” babies from poor parents for these begging stints. Many times, the “mothers” we saw on the road were only regular beggars with no relationship to the baby at all. These gangs would take the babies along with them and they were usually drugged to the gills. The drug of choice was opium because it was easily available, and in their uninformed minds, it didn’t seem to affect the babies that much. They usually gave the baby an exceedingly small quantity (I was told that it was a bit of opium paste the size of a rice kernel). This ensured that while they were on the streets, the babies wouldn’t cry or demand any feeds, and by the time they took them back to their real mothers, the drug would have started to wear off. My colleague also told me to keep my eyes open and look around the area where I encountered these beggars. There would always be an elderly woman or man sitting or standing nearby keeping an eye on the wretched “working” woman, and many times one could see that they would immediately take the alms away from her as soon as she received them.
The next day, just when I started my ER shift, I was surprised to see “my” beggar there looking very worried indeed. The moment she saw me enter she ran to me and pulled me towards an examination cubicle. She was nearly hysterical, and I could hardly understand what she was trying to tell me. She kept on babbling about not wanting to be a murderer. When I saw the baby lying helplessly there on the examination bed, I understood immediately why she had sought me out. To her I was a somewhat known entity in the frightening and unknown world of the hospital.
Looking at the baby I observed that it was pale as usual, but to my dismay she was unresponsive to any stimuli and had very shallow breathing. Keeping in mind my colleague’s story, I examined her pupils and saw that they were constricted to a pinpoint. There! I found my answer immediately. Just as I was in the middle of examining the baby, she stopped breathing. Immediately a code blue was called, and we started to resuscitate the little one. It was a tedious job and time seemed to have slowed down. The team was working with excellent coordination, but even though only minutes had passed it seemed as if we were working on the baby for hours. We were finally able to resuscitate her as per the Basic Life Sciences (BLS) and Paediatric Advanced Life Support (PALS) guidelines and after giving the antidote for opium, the baby soon responded to our resuscitative efforts and started to cry. Believe me when I say that we were all so relieved! It was as if the baby was reborn!
While we were working on the little baby, my colleague called my friend Chief Inspector Tanya. We had to report the incident since it was a case of accidental poisoning of a forbidden substance.
Seeing Tanya was such a relief. Going against such gangs was dangerous on any given day, but with the support of the police, at least some children could be helped. At least I sincerely hoped so.
Tanya and I asked the girl, whose name was Marvi, what she had given to the baby just to be sure. At first, she tried to lie and said that she hadn’t given the baby anything, she was just sick. I told her that she couldn’t fool a doctor, especially one who had just resuscitated the baby, and I was adamant that she told me the truth. I wanted her to speak out in front of Tanya. Finally, she broke down and told us that her “mother” had given the baby some opium. She said that they usually just gave it a small amount, but today the usual amount didn’t seem to affect the baby, and she kept on crying so on her own volition she gave her a bit more. After a while she saw that the baby was quieter than it usually was, and she realized to her horror that she had overdosed the child. While she panicked, she had an epiphany and remembered that she had pushed the card I had flung at her into her pocket. She literally ran as quickly as she could to the hospital and made her way to the ER showing the card to the staff to ensure that she was in the right place.
Once the baby was stabilized, I handed the now crying baby over to the ER nurses for supportive treatment and possibly for a bottle. In the meantime, we took Marvi to an adjacent seminar room and started to question her about the gang she was involved in. At first, she didn’t want to answer honestly but then I told her that if she had come just a few minutes later the baby would have died, and she would have been in police custody by now. Therefore, if she wanted to be helped, she needed to be honest with us. Tanya assured her that she would be taken care of because she was as much a victim as the baby. Marvi was also told that if she helped the police with information about the gang, many innocent lives would be saved.
As her story unfolded ,we realized that it was sad and horrifying. As we suspected, the baby did not belong to her. As a matter of fact, she had never been married. She was only 17 years old. She didn’t know who her parents were because she was bought by the “Mother” of the gang of girls that she belonged to. This mother would “hire” babies for a day from poor people who needed money, and the girls were told to take them along when they went begging. It wasn’t always necessary that they had the same baby every day. It depended on who was available at the time. This modus operandi was more prevalent at the times of festivals and celebrations because people were supposed to be more generous with their alms at these times. However, in the “quiet” months they stayed in a gypsy camp at the outskirts of the city.
She confirmed that all of the babies “hired” were always fed opium to keep them quiet and complacent during the time they had them. They were easier to handle that way. Also, since they were sleeping most of the time, they weren’t hungry and so they didn’t need the usual feeding paraphernalia that a baby needed. Poor, poor babies. I felt so sorry listening to her tale. What sort of parents rented their babies to such scum? Were they driven by desperation or were they just uncaring?
I asked this of Marvi, and she told me that many families were dysfunctional themselves. It was quite common that the men of the family were drug addicts and the women had to either go to work, or they had so many children that they couldn’t leave them alone in the hovels or gypsy camps where they lived. Their thoughts were that for the safety of the other siblings, wasn’t the sacrifice of one baby justified?
Tanya immediately went with her team and arrested the ring leaders of the gang. They had to follow “Mother” and keep her under surveillance for a few days till they found out where she operated from. To her surprise they didn’t live in the hovels where their beggars lived. The husband-and-wife ringleaders were masquerading as a respectable couple whose children were studying abroad in well-known universities. They lived in the height of luxury in one of the upscale areas of the city and drove around in large cars. That was quite a weird twist in the tale. Her modus operandi was quite simple. A rickety rickshaw would pick up the woman every day every day at the same time after dawn. She would be dressed in rags. Her chosen transport would take her to the ramshackle dwellings of her beggars. The same rickshaw picked her up from there in the evening and dropped her at her house once more.
Through an informer, Tanya found out that corrupt officials would ask the beggars to pay for the choicest corners and intersections in the city. Usually, they were the traffic cops working there. That problem was thankfully noted and handed over to the department of Internal Affairs of the Police.
Anyway, the requisite arrest warrants were procured from the court, and the house was searched. I think someone must have tipped off the media because the next thing we knew was that the story made headline news. From the news video we were able to see stacks of foreign and local currency that was found in a hidden safe under the floor. Jewelry worth millions was also recovered. When that was itemized, Tanya recognized a few expensive pieces that had been reported stolen. Of course, the other jewelry was then also considered stolen or maybe bought with stolen money.
The Husband and wife were quite vocal in implicating their gang members once they were caught, and I am sure that you will agree with me that the long sentence combined with hard manual labor for all of them was well deserved.
We found out that there were 15 girls that were supposedly “employed” by them. All ranging from the ages of 12 to 20. They were relieved to be free from the shackles of the evil couple because they had been told that they would be sold to another gang as prostitutes if they did not bring in a certain amount of money every day. That threat weighed heavily on them, and that was the reason why they were so pushy when they begged.
With the help of a couple of philanthropic groups we were able to accommodate some girls in shelters and some of them were given jobs as domestic help. A few of them even asked to go to school which was quite heartening.
Happily, since that significant raid, the police have been collaborating with the Government and are strictly cracking down on the gangs. Begging was always considered illegal, but with the authorities turning a blind eye, it had become uncontrollable, and gave the gangs leeway to exploit innocent people. Nowadays, there are special police patrols especially designated to pick up beggars and homeless people from the roads to take them to specifically appointed shelters. Those that need help in repatriation to their villages, want to go to school or need jobs are helped. But there are also those habitual transgressors who don’t want to be helped at all. For them, there is nothing one can do about their situation.
Where I am concerned, I am just happy that the number of children with opium poisoning has definitely reduced quite drastically. Overdose cases for that age group has become thankfully rare.
Feb 6, 2022
“The beauty and mystery of this world only emerges through affection, attention, interest and compassion . . . open your eyes wide and actually see this world by attending to its colors, details and irony.” ~ Orhan Pamuk, Name is Red.
When I first met my friend, Dr. Jamal Ara, she was the Chief Resident of the ER. If you saw her, you wouldn’t believe that she was the head honcho of one of the busiest Emergency Rooms in the country. She had a happy disposition, was petite, just five feet and two inches (136.4 cms) tall, and she had her curly hair in two thick braids hanging over her shoulders. She actually looked like a little girl. But her authority and her knowledge commanded respect and she ruled the ER with an iron fist. At the time, she had just married the Chief Resident of Surgery who was also a good friend of mine and one of my mentors. Having a cup of tea together after midnight, or just cracking a joke in passing were normal for us, and our friendship has just grown stronger and has endured many years.
Since the husband and wife were studying to get their post graduate degrees, they put off having children at the time. However, when they were ready, they endured heartbreak many times when one miscarriage after the other weakened Jahan’s spirit and health. The fact that Jahan was diabetic since she was a child, and that she was in her late 30s didn’t seem to help with bringing her pregnancies to term. Anyway, it came to a point that the couple decided that they would try just one more time, and then if it would end in tragedy once again, they would stop and surrender to God’s will. The sorrow they felt every time they lost a baby was too painfully poignant to endure and was taking its toll on both of their mental and physical health.
To their delight, this last time the baby was able to develop to term, and they looked forward to welcoming the new member of their family. There was just one hitch. The gynecologist had said that there was a chance that the baby could be having a condition known as Down Syndrome.
Down syndrome is a disorder in which a person has an extra chromosome. It is also called a ‘trisomy”, so Down syndrome can also be referred to as Trisomy 21. This extra chromosome changes how the baby’s body and brain develop, which can cause both mental and physical challenges for the baby.
Even though people with Down syndrome might act and look physically similar, each person has different abilities. Children with Down syndrome usually have an IQ in the mild-to-moderately low range, and they are slower to speak than others.
To be clear, I would like to let you know that some of the common physical features of Down syndrome, include:
A flattened face, especially the bridge of the nose with almond-shaped eyes that slant upwards. If you look carefully, you can see tiny white spots on the iris of the eye. They have a short neck with small ears, and a tongue that is quite large, so that it tends to stick out of the mouth. The small hands and feet are distinctive, and there is a single line across the palm of the hand (the palmar or simian crease). The small pinky fingers sometimes curve toward the thumb. Poor muscle tone or loose joints give a feeling that the baby is floppy at birth. Ultimately as they grow older, they are shorter in height as compared to other children and adults.
So you can see as I mentioned before, there are so many different abilities and talents that these children can have. But it would take a long time to note down, and obviously this is not a textbook.
The birth of baby Mariam was celebrated with joy and mild trepidation. She was beautiful with a mop of thick black hair and beautiful almond shaped eyes. The parents loved her dearly and Jamal became extremely protective of her beautiful little girl. Mariam’s limbs were like other children with her condition, floppy. That meant that her muscles were soft and not as strong as those of normal children. Therefore, her neck holding, sitting, and walking milestones were delayed. But with the help of her parents, regular physiotherapy, and a baby gym, she was up and about by the time she was 18 months old. She even started to participate in her school’s athletic meets when she was older.
Speaking was on the other hand difficult for her. Just like her skeletal muscles were floppy, it seemed that the smooth muscles of her throat and respiration were also floppy. Despite vigilant speech therapy, she could just enunciate a few easy words. Most of her communication was by grunts, wild gestures, or a crude form of sign language. Being thus handicapped, she gave the impression that she was more intellectually compromised than she actually was. But I am happy to say, she used to do very well when she was tested, and at the age of 16 she had the intellect of a 12-year-old. As she grew older, Mariam became more and more frustrated when she wasn’t able communicate clearly with her teachers, caretakers, or most of all her parents.
The only thing that brought Mariam pleasure was going to her kindergarten, and then later on school. She used to get passionately involved in the arts and crafts class. Looking forward to mess and play around with the paints and colors in the art room were the highlights of her day. Her teachers observed that she would just lose herself while painting, as if she were in a trance, when she sat and worked on one of her canvases.
Seeing her ardent interest in painting, Jamal started to look around for a teacher who would be patient and compassionate while instructing her daughter. After a few hits and misses, she finally found a mild-mannered retired art teacher who immediately bonded with Mariam. It was a joy watching them interact. Under the patient tutelage of Professor Bashir, Mariam learnt about mediums, paints, colors, and most of all painting techniques. Just to see the happiness on her face when she came back from her lessons was priceless.
As she grew older, and the lessons became more advanced, and with the repetitive motion of using the paint brushes, Mariam’s fingers became stronger. As her confidence grew, she started to become more daring and began to paint on larger canvases. The beauty of the colors she melded together along with the abstract lines swirling and dancing on the canvases were her form of communicating with the world. Her mother observed that the colors she chose on any given day were according to her mood. A darker palette when she was angry or sad, and a more colorful one when she was happy. The complexities of the designs and the aesthetic presentation of the paintings were her lifeline and she started to paint even more. Her parents and teachers had to struggle to keep up to provide her with enough art supplies and canvases.
By now, Jamal Ara had finished her specialization studies and was an eminent professor of endocrinology with a stellar reputation amongst her colleagues, students, and patients. So, it was no surprise that one day Jahan had a visitor at her home who happened to own an international art gallery. Hilde von Auerstein was a friend of a friend that happened to be visiting from Germany. Unfortunately, she had eaten something at her hotel that didn’t agree with her. Because, she was not feeling very well, and since she was diabetic Hilde needed to consult an endocrinologist before she took any medication for her gastroenteritis. She needed immediate advice, as she did not want to have an unsteady blood sugar that could have made her even more ill than she already was. Being away from home in a strange country also made her apprehensive, and she wanted to get better as soon as she possibly could. As a special favor to her hosts, she was therefore brought to Jahan’s home instead of her clinic since it that day was a public holiday
After she was examined and given the expert advice she came for, Jamal and the visitors sat down for some refreshments and a chat. Looking around she noticed the unique collection of paintings on the wall of the living room. And just like that the conversation turned towards Mariam’s love of art and painting. Hilde obviously asked to see some more of the artwork. And Jamal, ever the proud Mama brought out some of the larger canvases to show the art gallery owner.
Hilde was extremely impressed with the brushwork and colors that were swirling on the paintings. Looking intensely at the technique and the kaleidoscope of colors, she started to sense a powerful feeling that evoked a cornucopia of emotions in her. Being generally a person who stoically kept her emotions under control, she could not believe the intense reactions and the urge to communicate that literally sprang from the paintings. It seemed as if they were talking to her. She felt a unique energy flowing from the paintings filling her body and mind. She watched as the energy flowed from the paintings like a liquid rainbow swirling gently around her. It was as if she was transported into another world. The abstract paintings were creating pictures in her mind that were telling her their stories of happiness, pain, and most of all the abject frustration at not being heard. As she continued to look at the paintings, her eyes filled with tears, and she became inexplicably emotional. Brushing her tears away and with a determined expression on her face, Hilde resolutely said that she wanted to show the world Mariam’s beautiful, soulful talent that literally poured from the paintings.
After communicating with her for about a month, Jamal finally received a phone call from Hilde. She sounded extremely excited and wanted to know whether Mariam could get enough paintings ready for an exhibition in Frankfurt and another in Washington DC. Since she happily painted most of the time, getting enough canvases together for the exhibitions was no trouble at all. Jamal was ecstatic. Her talented daughter was on her way to getting international acclaim in the art world!
As was expected and predicted, Mariam was feted in Frankfurt and Washington. Her paintings were well received and most of them were sold. As a matter of fact, Jamal had foreseen this and had thankfully brought along more paintings that were requested or agreed upon. It was all very exciting and both of them had a wonderful time, not only at the exhibitions, but also sightseeing. From the excited way she told me about her visit, I think Jamal had more fun than Mariam at Disneyland.
Being part of the international art scene was an eye opener for Jamal and Mariam. It created the catalyst of an idea in Jamal’s mind to finally exhibit the unique paintings at home as well. Since professional endorsement through the international and local press had been given to the paintings, buyers were already clamoring to add a Mariam Original to their collections. Rumors of the feelings of peace and tranquility emanating from the paintings created a keen curiosity amongst art lovers and many flocked to Jamal’s house just to see whether this phenomenon was an actual fact, just fiction or a marketing gimmick created by the media to sell more of the unusual paintings.
It came to a point that there was always a crowd at Jamal’s house. It was now absolutely necessary to have a local art gallery for Mariam’s creations, so that they could finally have peace in their private lives. Rather than making a profit, Jamal wanted Mariam’s paintings to be appreciated and seen by many. She wanted the gallery to be where people came to see them with the option to buy only if and when they fell in love when they looked upon their favorite canvas.
Many venues were explored, and opinions were sought from friends and professionals alike. The final solution was brilliant! There was an empty penthouse hall on top of the National Institute of Child Health (NICH). It had been unoccupied for an awfully long time. Since no one was using it, remodeling the fairly large area into an art gallery full of light and positive energy was the logical solution. The NICH’s director, Professor Afroze Ramzan thought it was a good idea and happily gave the go-ahead. Not only that, but the rent of the place was also extremely nominal. After all, in addition to getting permission for the art gallery, Jahan had also pledged 50% of the sales of the paintings towards the NICHl’s cancer ward.
The art gallery became a reality, and the next step was to plan an inauguration party. And what a grand and well-attended party it was! I helped in planning the soiree and with my media connections, I made it a point to see that many VIPs and media celebrities I were invited. Friends and journalists in the print media ensured that the news about the gallery was splashed all over in the main newspapers. The event even warranted a 20 second newsflash in the evening news with the invited celebrities raving about the paintings. A few days later a well-known TV station came to the gallery to film a short documentary on Mariam, her paintings, and the unique art gallery.
The beauty of Mariam, her creations, and the positive energy that she spread just brought a feeling of peace and happiness that touched the beholder to the core. Where doctors thought that little Mariam would not be able to communicate due to her condition, despite all odds, she had reached out to the hearts of the world and created an sanctuary of happiness with her talents. I am quite happy to say that I was involved from the beginning with Jamal and Mariam, and my contacts and willingness to run around helped to some extent to get the gallery to open. I now own four of her paintings, and they are quite a conversation starter with my visitors.
Feb 5, 2022
I would like to tell you an anecdote about my final surgical oral exam. I had a unique patient. While he was cooperative, there was a moment when I nearly had a heart attack!
The patient, oh I do remember him well, how could I forget him? He was a young man with Buerger’s Disease which is a rare disease of the arteries and veins in the arms and legs. It is also called thromboangiitis obliterans — the blood vessels become inflamed, swollen, and can become blocked with blood clots (thrombi). This eventually damages or destroys skin and the surrounding tissues leading to infection and gangrene. It initially manifests in the hands and feet, but it is possible that it could eventually affect larger areas of the arms and legs.
The significant point to note is that everyone ever diagnosed with Buerger’s Disease smoked or had smoked cigarettes or used other forms of tobacco, such as chewing tobacco. Quitting all forms of tobacco is the only way to stop the progression of Buerger’s Disease. For those who don’t quit the disease progresses to cause gangrene, and sometimes amputation of all or part of a limb becomes necessary.
In my exam case, my patient’s nemesis was chewing tobacco. He had started using it since he was 10 years old when his much older cousin introduced it to him, and he had subsequently become addicted. But as he unfortunately now got to know, the consequences were ultimately grim for him.
Iqbal was a friendly, cooperative man who had already gone through the examination process the day before with another group if exam hopefuls, and still wasn’t (yet) too irritated. I was therefore able to complete his history and detailed examination quite quickly, since the case, despite the misgivings of others, was actually quite straight forward. Thereafter, I just had to wait till the professor’s examination team came to my patient’s bedside to cross examine me about the case.
While I waited for the examiners, I chatted with the patient. He told me stories about his family, how he met his fiancé, and the business he was hoping to start after he was discharged from the hospital. He added that I was the first student that knew what I was doing (with reference to his case). I was relaxed and not at all appalled by his illness. While I had the time, I tried to persuade him to stop chewing tobacco, because that was one of the reasons that he had this disease, inasmuch he should take care of himself because a young man needs his limbs desperately… Of course, he does. Amputation should never be an option if it could be prevented.
Finally, I saw that the professors had entered the far end of the ward and were two beds away, starting the viva voce of one of my friends. But my day wasn’t destined to be smooth, was it? Where was the drama? The fun? What is a perfect day without a routine dose of adrenaline? Well, just as I turned my back to check my notes, I heard a rustling sound and footsteps walking away. I swung around to see that my patient had disappeared!!! Now I was on the verge of a panic attack! I nearly fainted with the effort to slow down my breathing and my racing heart.
Surely, I’ll fail my surgery exam if my patient wasn’t there! Oh God! I’ll be good! Please make my patient come back! I don’t want my professional degree to be delayed because of a minor glitch! These words were just whizzing through my mind, making me even more anxious instead of calming me down.
I tried looking for my patient as discretely as possible, asking the passing nurses and the ward orderlies whether they had seen him. They just shrugged and continued with their jobs. Just when I was nearly at the end of my tether, lo and behold! In the last moment, I saw Iqbal hurrying towards me, weaving in and out in the aisles of the ward, trying not to bump into anyone. In one of his hands, he carried a bowl of ripe, washed grapes and in the other, a bottle of cold water. He succinctly handed them to me saying “You have been on your feet the whole day, and I didn’t see you eat or drink anything! Something suddenly compelled me to get you some food and water before your exam. I do want you to do well as you were talking so kindly to me. I thought that this would help you bring your energy levels up and concentrate on your exams”.
That was enough to render me was speechless for a moment, and of course I was touched! It was also so unprecedented! Actually, to be honest, at the time I was feeling the effects of low blood sugar since I hadn’t had any breakfast that morning, and the fruit did perk me up. Therefore, when it was my turn to be examined by the invigilators, trust me, I was alert, focused and didn’t have my usual exam anxiety. It goes without saying that I happily passed my surgery viva voce with flying colors.
