I leaned against her. When we could breathe, we stood and walked home.
Two months later, we packed our bags and boarded a plane with our American passports. We spent the next four years in three different countries, with side excursions on different continents. In the moments when my heart opened to God, I thanked Him for designing this way for me to disappear and exist, this chance to become an American without living under an American microscope.
My world had swerved from beautiful to punishing and back again.
I have run along the turquoise Bosphorus and with my back to the snowcapped Dolomites. I have circled the Mitad del Mundo and explored the streets of Cairo. It was on the banks of the Nile, realizing that a river must flow in one direction if it wants to reunite with the sea, that I decided I would leave my old name and my old world behind me.
I run because of all I have seen. I run despite all I have seen. I run against the wind, and sometimes I run with it. I run planned and unplanned routes. I measure my distance and run full miles, whether four or five or eight, never leaving a fraction on the ground.
I check my phone once more. No messages, which means the woman I operated on today is doing well—as well as can be expected for a kindergarten teacher whose body has become home to a cancer.
When we reviewed her imaging, swirling shapes and patterns on a black-and-white screen, she was trying hard not to appear overwhelmed.
This is a lot to take in. What are you most worried about? I asked, as I always do.
She hesitated, looking down before she asked what had been roiling in her mind.
I can still have kids, right? I mean, down the road. At some point.
We spent twenty minutes discussing fertility options. We did not discuss the chances of her being alive in five years.
I hope we won’t one day sit here for that other conversation, the one in which I admit that anything more I do is just as likely to harm as it is to help. Those discussions are like handing someone a ball of brown clay and telling them they are free to shape it to their liking. Some people stare at the lump a good long while because they don’t know what to make of it. Others can’t seem to pinch or pull the ball in any way that gets it at all close to what they’ve imagined. Eventually, everyone realizes the clay is actually a ball of excrement that will never turn into something they want to hold in their hands.
I want to fight, some say. That means I cut wider, deeper, taking bigger risks to keep them alive for one last visit from a sister coming from their homeland, for the birth of a first grandchild, or maybe just one more Super Bowl. Finish lines are arbitrary inventions. Others listen to the options I offer, thank me for my time, and ask their misty-eyed children or spouses to take them home.
Just as I slip my phone into my armband, I hear a chime. It’s a text message.
It’s been three days, Aryana. Please say yes. I promise it won’t even be the biggest decision you’ll make today.
My fingers hover over the screen. I want to reply, but I can’t think of what I want to say. And that’s the problem. I tuck the phone back into my armband and begin to jog. The evening air is still, making hardly a whisper as it slips through the leaves.
I know it’s been three days.
I reach the half-mile marker. The signs are small red squares nailed into the wood post fence. Green would have been a better choice. It’s so basic that even preschoolers know it. Green means go. Red means stop.
Go.
Stop.
If life came with road signs or mile markers, Adam would have his answer by now and I could run without these thoughts knocking around in my head.
But life doesn’t come with road signs or mile markers.
I reach the one-mile mark and pull my ponytail tighter. I don’t deliberate in the operating room, even in the hairiest of situations. There’s a fine line between being cautious and being hesitant. Caution means I’ve done my homework but hesitation means I haven’t.
Adam’s cousin issued a late invitation to her wedding, which is just a couple of weeks from now. It is the week I’ve planned to spend at a lake house, surrounded by trees stripped of leaves and catching the magic of moonlight on water. Adam thinks we should reschedule and join the family in celebrating at a restaurant in Connecticut.
I don’t know how to tell him that I’ve had an uneasiness lately, something I haven’t felt in a while. It makes me seek out quiet spaces and comforting rhythms until this wave passes.
I run my second, third, and fourth miles as dusk gives way to night. Headlights cut through the ring of trees that surround the path, casting eerie shadows on the ground. But I run at night because that’s when it becomes impossible to tell if the salt on my face is from tears or sweat. Because that’s when I confirm that I am no longer cowed by what might be lurking in the bushes. I don’t look over my shoulder. I just run faster, harder.
Eager to prove myself to the dark.
Chapter 34
The team is turning over the room for the next patient so I pour myself a cup of coffee in the empty physician lounge where, for once, the television is not set to a twenty-four-hour news channel.
How do you do it? the talk show host asks her guest, a rock singer I’ve never heard of who suffered horrific physical abuse at the hands of his father growing up. His father took great care to strike only the parts of his body that would be covered by clothes. Even after his father died, he kept the years of abuse a secret.
I fall into an office chair and whirl myself to face the television.
After surviving something so ugly, how do you manage to wake up every day and create music? How do you step on a stage?
He bows his head.
I just keep all that in a box, I suppose. Don’t let it get in the way of more important stuff.
I give my coffee a stir. Clumps of creamer refuse to dissolve.
Some of your fans might be survivors as well. Some might be wondering how you cope with the trauma.
He talks about the nonprofit he has started to foster healing through art programs. Not everyone can do that, of course. Some people can barely open a bottle of Klonopin.
Do you get nightmares or flashbacks? the host asks, and the musician draws a long sip of water from his glass.
My pager buzzes on my hip before he can answer. My patient, the kindergarten teacher, has been moved to the recovery unit.
She is still asleep and hooked up to monitors, but within the next half hour the sedation will wear off and I can tell her the good news, that her operation went well and her wound will heal without much scarring.
When she has had time to recover, I will tell her the bad news.
The mass I removed from her gallbladder is on its way to the pathology lab, where it will be sliced thin, stained, and examined under a microscope. In a few days, I’ll get a report from a pathologist confirming my suspicion that the tumor has already sent tentacles into an otherwise healthy liver.
“How are you feeling?” I ask her later in the day, when I stop by the recovery room. She is pale and bleary-eyed from the anesthesia.
“Tired,” she says, though she manages a smile. “Like I just ran a marathon.”
Her mother is at her side now. She flew in from Chicago and looks duly grateful that her daughter can find lightness in the moment. I leave them to the inimitable comfort they bring each other. They’ll need me more later.
I leave the hospital and take the train to Manhattan to meet Mom for dinner. She is in town for a luncheon. I can’t recall which of her many causes this one is for, or which of her many connected friends invited her. I check my watch and hop on a train to Midtown to meet her at her favorite Indian restaurant. Mom is craving spice tonight.
“Hey, sugar!” Mom says, the door chime ringing in my wake as I enter the restaurant. We hug, and she gives my hand a squeeze, like I’m still a little girl.
“Have you been here long?” I ask.
“Just got in, but I ordered us some pakora to start. Figur
ed you’d be hungry.”
“You figured right. I’m famished.”
Mom dotes on me with the same precision and focus she always brought to her work.
“How’s Dayo? I haven’t heard you talk about her in a while,” Mom says. She’s always relieved to know I’m spending time with my best friend. She’s waited a long time to see me with people in my life. And apart from Mom, Dayo is the only person who knows anything about my past.
“She’s good, thanks. Busy as ever. How was the luncheon?” I ask once we place our orders. When the pakoras arrive, we waste no time digging into them.
“Mmm,” she says, dabbing a napkin to her lips to catch the tamarind sauce. “Remarkable. The vaccination program has been very successful in parts of rural Pakistan.”
Normally, I wouldn’t let the mention of Pakistan dredge up the past for me. But today, breathing in the cumin-infused air of the restaurant, I drift to those wild days with Tilly.
“Pakistan,” I repeat.
Mom looks up at me. She raises an eyebrow and waits.
“I can’t believe it’s been thirty years since Pakistan,” I say, fully recognizing how cliché I sound marveling at the passage of time.
“It is hard to believe,” Mom says. She sets her napkin on her lap. “Tilly would have been so proud to see all you’ve done since then.”
Tilly. I can’t imagine what Mom went through from the moment she discovered that we’d left with Indigo and his van full of travelers to the moment she got the phone call from Washington that Tilly had stopped breathing. Though they’d shuttled her directly from the tarmac to the hospital, she hadn’t survived. She’d been diagnosed with cancer a few months before she went to Afghanistan, Mom told me when I was in high school.
Once I started to think back on those days with Tilly, I realized I’d known she wasn’t well even then.
It wasn’t until my third year of medical school, when I spent more time in the hospital than anywhere else, that I learned how many diseases have their own distinct smells. I also learned that I had the rare ability to sense them. Some were obvious, overwhelming even, like the rancid fish smell of bacterial vaginosis. Others, like the fruity ketones of diabetic breath, were more subtle. I had detected a handful of pregnancies, in patients and nurses, well before bellies had rounded. I would sniff urine samples before they went to the lab and stand an extra moment at a patient’s bedside to hone my skills.
I was an intern taking care of a patient who had just had a broken foot casted when I smelled something organic and slightly spoiled, a mixture of moss and mildew. I only needed to check that her toes were pink and perfused, but I asked her if I could do a more thorough examination instead.
Rolling her eyes, she’d taken deep breaths so I could assess her lungs. Go ahead, she’d said. But be careful with my ankle or you’ll owe me an extra dose of morphine.
Moments later, my fingers rolled across a small knot on the underbelly of her left breast. I felt again, to be sure.
A flash of understanding passed between us.
I’m getting married in three months, she’d said, as if in protest.
I hadn’t yet learned the right combination of words to use in those heavy moments.
The ticking of the clock is constant, but time has an elasticity too. The short weeks I spent with Tilly were a lifetime of songs, solidarity, and regrets.
“I think about Tilly a lot,” I say. “I wish I could have done something to help her.”
“There’s nothing you could have done. You know very well how serious meningitis is.”
The crash on the mountain on our way to Jalalabad.
The runny nose Tilly had in Islamabad.
I was in my first year of medical school, learning the anatomy of the head and neck, when I put the clues together. Tilly must have sustained a skull fracture in the car accident, opening a tiny crack in the wall meant to keep microbes out. While we hid in the embassy vault, surrounded by flames, those microbes were setting fire to the lining surrounding Tilly’s brain and spine. She must have felt awful long before we boarded the plane to leave Pakistan.
I’d been afraid to tell Mom my theory because I’d thought I’d break her heart all over again but she’d been relieved. But I know unanswered questions about those we love can torment us and sometimes get in the way of good grieving.
Antonia had been frantic from the moment she’d heard about the riot in the Islamabad embassy. She’d been about to board a bus to meet us there when she learned of the evacuation plans. She’d come home and, while arranging Tilly’s funeral, had also tracked me down.
“She shouldn’t have been on that road,” I say.
“Aryana,” she says, a chastising edge to her voice. “Mom and I were adults. We each made decisions. Mom wanted to get you out of the country. It was almost as much for her as it was for you. And if she hadn’t gotten on that plane with you, God knows how long it would have taken me to get you out of Pakistan, even with my contacts.”
Mom purses her lips.
“You looked like you were going to jump,” she says softly. “When I walked into that room and saw you standing at an open window, I was terrified. And that woman, nice as she seemed, was just fussing around her kitchen with a cup of coffee. A goddamned cup of coffee.”
I flinch at the memory.
“We all end up where we were always meant to be, Aryana,” she says.
On that day, I hadn’t heard the door open. Antonia had managed to slip her arms around me before I realized she was there. I fell backward, into her embrace. I don’t know how long we stayed on the floor of that room or if Janet stuck around to watch.
It had taken two whole days for Antonia to have me placed with her. Janet and Everett had protested after they learned that Antonia was unmarried but were quick to let me go.
I had been with Mom for a month before I went to her crying, begging her to bring Gabriel and Shawna to live with us. She thought I missed them at first, until I managed to tell her what had happened in that house. I remember the long interval before her face went slack with understanding. She didn’t bring them to live with us, but she did raise hell with the foster care system and made sure they were removed from Janet and Everett’s home. It wasn’t until years later that it occurred to me that there was no real guarantee that Shawna and Gabriel had ultimately wound up in a better place.
“It still haunts me to think,” Mom says, her voice thin as a butterfly’s wing, “what was going through your mind while you were standing there that day.”
Even now I’m not sure. I know I craved escape—from that room and that house and maybe even from the dark cave my head had become. I’d wanted to fly, to feel weightless in the infinite sky, even if only for an instant.
Chapter 35
Adam pauses to admire a passing French Bulldog as we walk down a transformed street in my neighborhood. Since I moved in, much has happened here. The thrift shop is now a juice bar with wheatgrass growing in pots on a marble countertop. Two women took over the corner bodega and turned it into a yoga studio, where women in pink camo leggings salute the sun. The Jamaican restaurant has given way to a coffee shop outfitted with a fireplace, free Wi-Fi, and a water bowl for thirsty dogs.
Adam knows I miss the feel of the old neighborhood. The thrift shop felt like an old-world bazaar, its shelves mixed with necessities and handcrafts. Every time I entered the bodega, the owner called out, Doctora! and clutched his chest in mock pain. I went into his shop more often than I needed to, but not enough to make his lease affordable.
Adam and I have settled into this new world order, though, and decided that the coffee shop is our favorite addition to the block, especially when the two armchairs by the front window are up for grabs.
I’ve been dating Adam for almost a year, but we live on opposite ends of the city and work the kind of hours that don’t leave much time for play, so a year is not really a year. Adam is in finance, having followed in his father’s footsteps. I find his
admiration for his dad endearing. Their conversations remind me of my father sharing his work with me as if I were a young apprentice.
I met Adam at an airport bookstore in Chicago. I was standing with a beach read in one hand and an exposé of Big Pharma in the other when he approached me.
The pimps of the medical world, he said, tapping on the orange pill bottle on the book’s cover.
I turned to meet his eye.
Well, then. I cringe to think of what that makes me.
Adam let his hands drop to his sides then. He closed his eyes for a beat and then looked at me, head tilted.
You wouldn’t happen to be a—
Forgiving person?
I was going to say surgeon. See, he said, pointing to his mouth, I’ve got this foot I need removed.
He asked what time my flight was and if I had time for him to buy me a cup of coffee. I said no, but later saw him standing at my gate. We were boarding the same flight, both of us headed home to New York City. Adam was returning from a college reunion, and I had just given a presentation at a conference.
Adam made easy conversation. He was smart and witty. He made me laugh and seemed genuinely embarrassed about the bookstore comment. He was impressed with my job but didn’t feel the need to tell me he could’ve gotten into medical school if he’d wanted to or talk up the rigors of his profession. He seemed comfortable.
We boarded the plane, and Adam took his seat five rows behind me. I could feel his eyes on the back of my head. Just before the doors closed, Adam walked up the aisle and asked the man seated next to me if he would mind switching seats.
We’re old classmates and haven’t seen each other in years, he said to the man, who shrugged and accepted Adam’s aisle seat. Adam and I sat shoulder to shoulder, thousands of feet above the ground, chatting about our favorite places in New York City, the sorry state of health care, and the likelihood of finding life on other planets in the next few decades.
Aryana, he said as we walked through the passageways of LaGuardia Airport, got any other trips coming up?
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