In my innocence, I believed that if not married, there is no chance that she could be pregnant. This was the pure naiveté’ of a young man displaced from his nurtured land and its values—the good-natured innocence of a novice.
I had learnt my lesson the hard way.
The first thing that I do now whenever women of any age between thirteen and forty-nine, come to the hospital complaining of abdominal pain is their urine test, especially urine pregnancy test. Many had complained that I suspect every female patient to be pregnant. Once, someone had complained that I had gotten a pregnancy test done for a lesbian woman, the hospital board members had also had a word with me about it.
I blamed my profession for all these missteps. I had argued that it had destroyed my innocence and made me a die¬hard cynic. I had tried to prove myself to my colleagues and administration with examples of women testing positive for pregnancy after they had sworn that there is no way they can be pregnant, even lesbians.
If I were to be observed without the halo of a physician, do I do things differently based on the skin colour? Do my prejudices, values and experiences drive me towards this kind of behaviour? Do I order more and unnecessary tests to Sanghaalis in comparison to white patients? If a white person and a black person are badly injured in a road accident, who would I try to save first?
‘Doc, hey dude. Are you going to give any medicine for my stomach pain? What kind of hospital is this?’
Stephanie came over and helped me out of Fadhuma’s room and asked me, ‘Guru, just order some pain medication for her. It’s not worth it.’
I asked her, ‘Stephanie, you have been working with me for the last five years. May I ask you a question?’
‘Now?’
‘Yes. A very quick question. Am I a racist?’
She thought for a moment and then said, ‘No. Not really. Wait, one moment. Tell me, who isn’t? You are not that kind of racist. Even if so, you are a good racist, an okay racist. You are on the right side.’
I looked at her stunned.
29. A Long Night
Stephanie called me. ‘Doc, come here quickly. We have a full term pregnant Sanghaali woman. This is her tenth pregnancy. The baby is ready to come out anytime. Precipitous delivery. Radhika’s patient.’
Radhika is in Key West. There’s another Fadhuma in the emergency department. And on top of that, I must deliver a baby of a Sanghaali woman with no help from anyone.
For some reason everything felt like déjà vu. Deep inside, my instinct told me that this patient is likely to be Nusrat.
And yes. It turned out to be Nusrat. She made no noise, no loose talk, and no crying. It was obvious that she was in pain. She was wheeled to the room next to Fadhuma’s. I excused myself from Fadhuma saying, ‘Sorry there is another emergency.’ Seeing me leave her room she began to swear, ‘What the fu…’ and then stopped midway upon seeing Nusrat. Nusrat’s mere presence silenced her. ‘Asalaam walekum,’ there was respect laced with fear in her voice.
I did not know Nusrat personally. I introduced myself. I told her that Radhika was not in the hospital today. And that I could only deliver her baby if it was a normal delivery but if there were any complications, I may have to send her to Minneapolis.
Nusrat said, ‘Doctor, this is my tenth baby. Since I had the last three babies by Cesarean section, Dr Radhika had told me that this baby too would most likely be by Cesarean. She has given me her phone number in case I need her. I had called her just a little while ago. She advised me to get to the hospital immediately.’
I decided to examine her. By the time I was ready, the baby was ready to come out with its head crowning. I told Stephanie, ‘We do not have time to move her to the labour ward. Please set everything ready for delivery here in the emergency department.’
My heart was beating fast. Nusrat is not just another average Jane. She is a well-known personality, not just among the Sanghaali community but in all of Minnesota. And she is the mother of the notorious Mohammad Igal! Why in the world did Radhika even agree to deliver her baby?
I asked Nusrat to lie down on the examination table and after placing her feet on stirrups, I examined her. I could feel the soft spot on the baby’s head. The bedside monitor indicated that the baby’s heartbeat was normal. Stephanie started an intravenous infusion.
Nusrat tried to push a couple of times and stopped. ‘I’m not feeling any pain,’ she said when I looked at her. I increased the infusion rate, ‘You have to push only twice.’
She pushed twice and stopped again.
There was no further screaming from Fadhuma in the next room. I was sitting there waiting for Nusrat to deliver her baby. Apparently, her water had broken quite a while ago and I was concerned about infection because of ruptured membranes.
I told Nusrat, ‘If it is ok with you, let me call Radhika.’
Nusrat said, ‘Isn’t it one am for her now?’
‘That should be ok. She is anyway aware of you coming here, isn’t she?’ I called Radhika.
Radhika seemed to have not slept at all. I could hear loud music blazing in the background. I informed her about Nusrat being in the hospital with labour pains and briefed her on what I had done so far.
‘One minute,’ she said and stepped out of the bar. ‘Increase the dose of the infusion some more.’
‘I am at the max already.’
She asked, ‘Where is the baby?’
‘What do you mean?’
‘Tell me the position. I mean the station of the baby in the cervix.’
‘Probably three or four.’
‘Guru, what do you mean by three or four? Is it three or is it four?’
‘Radhika, I don’t know. This is not my expertise, not my job.’
‘Ok. Ok. Never mind. How is Nusrat doing?’
‘She is doing fine.’
‘I’ll come on Facetime. Let’s get that baby out.’
I had no time to think about anything. Nusrat looked at me approvingly.
I took the phone near Nusrat’s bottom, near the baby’s head.
This was a discomforting situation for me, but I really had no choice. Nusrat on her part showed no discomfiture.
Radhika said, ‘Guru, can you put the ultrasound probe on her abdomen. Let me look at the baby.’
I did as directed.
Radhika continued, ‘The baby is too big. Possible shoulder dystocia. Nusrat, your baby’s shoulder is much bigger than its head. Therefore, the baby may not come out easily. If I were to be there, I would take you for a Cesarean section right away. There is no doctor there who can do a Cesarean section now. So, I will walk Guru through the procedure and get the baby out. You have to be patient for a while.’
I asked Radhika, ‘Shall we send her to Minneapolis? I can get the chopper here in ten minutes.’
Radhika said, ‘If we don’t take the baby out in ten minutes, the baby will die. Whatever we need to do, we have to do it now, and we have to do it right here.’
Nusrat’s pain was getting worse. Yet she seemed to be in a world of her own. It looked as if she was not aware that she was delivering a baby. But her pain showed on her face.
Radhika was giving me instructions on the phone. ‘Guru, try some vacuum.’ I immediately applied suction pressure using a vacuum extractor on the baby’s head and tried gentle traction. The baby’s head came out fine, but as Radhika predicted, the shoulder posed a problem. No matter what I tried, the shoulder was stuck. The baby’s face had swollen like a potato and its colour was changing.
I looked at Radhika.
‘Ok Guru. You have only one option now. Fold both of Nusrat’s knees and bring them all the way up—as in a missionary position. Insert both your hands fully inside, and hold the baby by both the shoulders and then pull it out gently but firmly…that is good…now press your thumbs firmly against the baby’s collar bone. Keep in mind that we may have to break the collar bone. That should be ok and that is the only way we can save the baby.’
Nusrat sa
id, ‘Is there no other way?’
‘There is another very difficult procedure. We need to push the baby all the way back into the uterus and then do a Cesarean section. That is very dangerous. And as it is, there are no doctors there who can do a Cesarean now. So, we must do it the way we discussed before. And we must do it right now.’
I was passively following Radhika’s instructions. Both my hands were inside Nusrat and I pressed and held the baby’s shoulders while pressing the collar bone with my thumb. Soon the shoulders loosened enough to touch each other, and the baby folded up almost like a newspaper. I broadened Nusrat and slowly and firmly pulled the baby out.
It was a boy.
The baby was not breathing. Two minutes of ventilation, a couple of injections and a vigorous massage on the base of his feet later, he started crying loudly. It was the robust cry of a healthy baby.
But he didn’t move either of his arms. Radhika was explaining to Nusrat over the phone. ‘Sorry Nusrat, I should have been there. But what is important is that the baby is alive. You don’t have to be concerned. He is not moving his arms probably because of the pain in the collar bone. Another very rare possibility is that pieces of the broken collar bone may be pinching the nerves that control the arm muscles. If it stays that way, the baby’s arms will not work temporarily. If the baby does not move his arms for a long time up to a year or so, then we need to worry about permanent damage. I am almost certain that this is not likely to happen. But if it does, there are lots of treatment options.’
Nusrat picked up the phone next to her, ‘Dr Radhika, thank you for your help. I’ve to sleep now,’ and she went to sleep.
I came out to the break room and poured myself a cup of coffee. I stretched my feet for about half an hour on the recliner. Stephanie knocked on the door and came inside. She gave a quick report of the emergency room status—that Fadhuma had signed herself out against medical advice, Nusrat had been shifted to the labour ward, there were no new patients in the emergency department except for a couple—one person waiting for his CT scan results for his abdominal pain and a child with an allergic reaction for which she had given Benadryl injection.
My phone buzzed. There was a message from Radhika, ‘Turn on CNN.’
I switched on the TV. There was some breaking news.
A twenty-two-year-old young man having links to Al Tewagi was shot dead in a gunfight with the police in the northern Minnesota suburb of Robbinsville. The young man, Mohammad Igal, was from the town of Amoka. He was on the FBI’s ‘Most Wanted’ list. It is believed he was involved in last year’s bomb attacks in Turkey and Paris. Many explosives and firearms were seized from his Robbinsville home. FBI has also seized a laptop and several mobile phones from there. The rest of his family members live in Amoka. Our reporters have tried to contact them many times and have had no success. One point of significance is that Igal’s mother, Nusrat, who is very active in Minnesota’s Sanghaali community had recently organized a Town Hall meeting about ‘Sanghaali mothers fight against terrorism and racial profiling’.
I switched the TV off.
To the north of our Amoka Hospital one can only see the vast expanse of the sky. I was looking out through the window. Everything thus far had unfolded like filmy melodrama. Did Nusrat know about Igal’s death? He was dead before she came here for her delivery. Does that mean she knew about his death before she came here? And despite that, did she check in to deliver the baby?
It was a crazy, almost senseless thought. What other choice did she have? When she starts having labour pains, she does have to come to the hospital, doesn’t she? Had Igal called her? During the shootout, when he was mortally wounded and aware of his imminent death, did he think of calling his mother once?
I suspect I watch too many movies.
There were no patients in the emergency room. The kid with allergic reaction felt better and had gone home. The man with abdominal pain was found to be constipated. He went home happily after having a huge bowel movement, thanks to Stephanie’s enema. I heard him yelling on his way out ‘This is the most expensive crap. You’ve got to do a CT scan to tell me that I haven’t pooped for a week. That’s the reason I came to the hospital. I ain’t paying no fucking two thousand dollars for taking a shit in your ER.’
There were three more hours to go on my shift. I tried to sleep. I could not. I was tossing around on the bed.
I heard a loud brouhaha in the emergency room. Stephanie banged on the door of the call room. I came out. The police had brought a man in handcuffs. He didn’t have even a shred of cloth on him. He was completely naked from head to toe. He had a smooth shiny body with hardly any hair on it.
He yelled at the top of his voice, ‘Motherfuckers! I will do whatever I want in my house. Is that a crime? I know my rights. I’m telling the truth. Someone is spreading fake news about me. They are trying to poison my food. After I ate the muufasos in that Sanghaali restaurant, I could not get up for three days. When I got up this evening and watched the TV news, the FBI had shot dead that Igal from our town. The other day, the muufasos I had was at his mother’s restaurant. God bless our FBI. Yo Igal, go, get lost to the land of seventy-two virgins. Goodbye!’ Fortunately, Nusrat was not in the emergency department.
He looked at me and said, ‘What is your name? Are you the doctor here?’ He was disgustingly rubbing his penis with his cuffed hands. I did not bother to answer.
A child who had come to the emergency department looked at him, ‘Yooo! You are not wearing your clothes. Who are you?’
He answered, ‘I’m god.’
He looked weird. Possibly seventy years old. Strongly built and tall, around six feet four inches. His face was heavily botoxed.
He addressed me again, ‘Where are you from? Bangladesh? Pakistan?’
Stephanie and I looked at the policeman.
The policeman said, ‘Cocaine doc, cocaine. It was all over his house. He was sitting on top of his roof, butt naked in this cold.’ Stephanie made a sign with her finger across her neck in a cutting motion and gestured to me with her eyes not to talk to him or answer any of his questions.
But if I don’t talk to him, how can I even treat him?
I looked at him and said, ‘Hi.’
He ignored me, looked at the child and waved bye with his hands. His hands were disproportionately small compared to the rest of his body. He held his penis with one hand. His penis was so large that when he walked, it dangled up to his knees.
His hair was tousled by the breeze of the corridor fan and it had a strange colour. It was not clear if the colour was natural or fake. It was the colour of pure undiluted saffron or orange. The colour of Baji Rao’s flag.
The police took him to the special room meant to treat psychiatric patients and laid him on the bed there. He was given the hospital’s clothes to wear. He did not so much as even look at them. The walls of that room were padded with soft cotton wool. Even if he does try to bang his head against the wall, he will be safe. More than anything, we will be safe if he tries to attack us. After checking that it is safe to go inside, I entered his room. A security guard from the hospital was sitting there. The orange-haired person was lying naked on the bed. There was a picture of the Washington monument hung on the wall. He was trying to get his manhood straight enough as if to put the tall monument to shame. The seventy-year-old organ curved at the end. He held his handcuffed hands as if he held a camera and took a fake selfie of his erect Willy.
I tried to ask him, ‘What’s happening? Are you doing ok?’
He held his fingers like a gun, pointed at me and said, ‘Dishum.’ Then he looked me in the eye and said, ‘Let’s chase these Mohammads and Ahmeds away. Let us build our own America. Let us make America great again.’
I ignored his shenanigans and examined him. My hands felt something gooey. I felt nauseated.
‘Stephanie, give him ten milligrams of Haloperidol, get him dressed no matter how difficult. If the medicine does not work and if he is still up to
his antics, page the psychiatrist.’
I ran to the restroom. I could not puke properly either. Perhaps because I had too much of coffee, I could only spit out bitter bile. My throat felt bitter. I pissed copiously. I sat on the toilet bowl with my eyes closed.
Om BhoouH,
Om BhuvaHa,
Om SuvaHa,
Om MahaHa,
Om JanaHa,
Om TapaHa,
Om Satyam,
Om Tat Savitur Varenyam
Bhargodevasya Dheemahi,
DheeyoyonaH Prachodayat,
Om Apo Jyotiraso Amrutam Brahma Bhoorbhuvassuvarom
It had been so long since I recited the Pranayama chant. I was not even aware that I still remembered it. I could recall it very well. I continued reciting sitting there.
It is strange that we came to this anonymous town only with the desire of getting our green cards, never to be a part of its history, its social fabric or its cultural identity.
How can a town this small, this modest, hold so many things inside her—anger, love, hate, sacrifice, frustration, suicide, deaths, pregnancies, politics, sympathy, guns, fights, terrorism, Sanghaala, India?
Is this the real America? The melting pot and the land of opportunities? Is this the American dream that we came after? Or is this simply my dream—my sights and sounds— circumscribed by my work at the emergency department, my patients’ diseases and the anger and the frustrations that came with them.
Where had I seen the America beyond my work? I did not have contact with anyone here other than Srikantha, Radhika and Saanvi. I lived in a bubble. Not once had I ever gone to a co-worker’s house. Be it Smith, Rick or Powell, none of them had ever invited me over to their home for a meal. Whenever I have had time, Srikantha and I would go out to the Minneapolis temple. Beyond an odd comment about family, pastime and politics, our social life in America is dotted by our own rituals, and Indian food in the Udupi restaurant in Minneapolis. Our awareness of Amoka is limited to the outer layer of its outer skin.
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