But my father didn’t know that at the time and became very depressed. ‘Do whatever you think,’ he said. ‘You’re the doctor.’
The next few hours were a wait-and-see time, the nurses monitoring my heartbeat and vital signs. Occasionally I made a low grunt and moved my hand or fluttered my eyes. Then Maryam would say, ‘Malala, Malala.’ Once my eyes completely opened. ‘I never noticed before how beautiful her eyes are,’ said Maryam. I was restless and kept trying to get the monitor off my finger. ‘Don’t do that,’ Maryam said.
‘Miss, don’t tell me off,’ I whispered as if we were at school. Madam Maryam was a strict headmistress.
Late in the evening my mother came with Atal. They had made the four-hour journey by road, driven by my father’s friend Mohammad Farooq. Before she arrived Maryam had called to warn her, ‘When you see Malala don’t cry or shout. She can hear you even if you think she can’t.’ My father also called her and told her to prepare for the worst. He wanted to protect her.
When my mother arrived they hugged and held back tears. ‘Here is Atal,’ she told me. ‘He has come to see you.’
Atal was overwhelmed and cried a lot. ‘Mama,’ he wept, ‘Malala is hurt so badly.’
My mother was in a state of shock and could not understand why the doctors were not operating to remove the bullet. ‘My brave daughter, my beautiful daughter,’ she cried. Atal was making so much noise that eventually an orderly took them to the hospital’s military hostel, where they were being put up.
My father was bewildered by all the people gathered outside – politicians, government dignitaries, provincial ministers – who had come to show their sympathy. Even the governor was there; he gave my father 100,000 rupees for my treatment. In our society if someone dies, you feel very honoured if one dignitary comes to your home. But now he was irritated. He felt all these people were just waiting for me to die when they had done nothing to protect me.
Later, while they were eating, Atal turned on the TV. My father immediately turned it off. He couldn’t face seeing news of my attack at that moment.When he left the room Maryam switched it back on. Every channel was showing footage of me with a commentary of prayers and moving poems as if I had died. ‘My Malala, my Malala,’ my mother wailed and Maryam joined her.
Around midnight Colonel Junaid asked to meet my father outside the ICU. ‘Ziauddin, Malala’s brain is swelling.’ My father didn’t understand what this meant. The doctor told him I had started to deteriorate; my consciousness was fading, and I had again been vomiting blood. Colonel Junaid ordered a third CT scan. This showed that my brain was swelling dangerously.
‘But I thought the bullet hadn’t entered her brain,’ said my father.
Colonel Junaid explained that a bone had fractured and splinters had gone into my brain, creating a shock and causing it to swell. He needed to remove some of my skull to give the brain space to expand, otherwise the pressure would become unbearable. ‘We need to operate now to give her a chance,’ he said. ‘If we don’t, she may die. I don’t want you to look back and regret not taking action.’
Cutting away some of my skull sounded very drastic to my father. ‘Will she survive?’ he asked desperately, but was given little reassurance at that stage.
It was a brave decision by Colonel Junaid, whose superiors were not convinced and were being told by other people that I should be sent abroad. It was a decision that would save my life. My father told him to go ahead, and Colonel Junaid said he would bring in Dr Mumtaz to help. My father’s hand shook as he signed the consent papers. There in black and white were the words ‘the patient may die’.
They started the operation around 1.30 a.m. My mother and father sat outside the operating theatre. ‘O God, please make Malala well,’ prayed my father. He made bargains with God. ‘Even if I have to live in the deserts of the Sahara, I need her eyes open; I won’t be able to live without her. O God, let me give the rest of my life to her; I have lived enough. Even if she is injured, just let her survive.’
Eventually my mother interrupted him. ‘God is not a miser,’ she said. ‘He will give me back my daughter as she was.’ She began praying with the Holy Quran in her hand, standing facing the wall, reciting verses over and over for hours.
‘I had never seen someone praying like her,’ said Madam Maryam. ‘I was sure God would answer such prayers.’
My father tried not to think about the past and whether he had been wrong to encourage me to speak out and campaign.
Inside the theatre Colonel Junaid used a saw to remove an eight-to-ten-centimetre square from the upper-left part of my skull so my brain had the space to swell. He then cut into the subcutaneous tissue on the left of my stomach and placed the piece of bone inside to preserve it. Then he did a tracheotomy as he was worried the swelling was blocking my airway. He also removed clots from my brain and the bullet from my shoulder blade. After all these procedures I was put on a ventilator. The operation took almost five hours.
Despite my mother’s prayers, my father thought ninety per cent of the people waiting outside were just waiting for the news of my death. Some of them, his friends and sympathisers, were very upset, but he felt that others were jealous of our high profile and believed we had got what was coming to us.
My father was taking a short break from the intensity of the operating theatre and was standing outside when a nurse approached him. ‘Are you Malala’s father?’ Once again my father’s heart sank. The nurse took him into a room.
He thought she was going to say, ‘We’re sorry, I’m afraid we have lost her.’ But once inside he was told, ‘We need someone to get blood from the blood bank.’ He was relieved but baffled. Am I the only person who can fetch it? he wondered. One of his friends went instead.
It was about 5.30 a.m. when the surgeons came out. Among other things, they told my father that they had removed a piece of skull and put it in my abdomen. In our culture doctors don’t explain things to patients or relatives, and my father asked humbly, ‘If you don’t mind, I have a stupid question. Will she survive – what do you think?’
‘In medicine two plus two does not always make four,’ replied Colonel Junaid. ‘We did our job – we removed the piece of skull. Now we must wait.’
‘I have another stupid question,’ said my father. ‘What about this bone? What will you do with it?’
‘After three months we will put it back,’ replied Dr Mumtaz. ‘It’s very simple, just like this.’ He clapped his hands.
The next morning the news was good. I had moved my arms. Then three top surgeons from the province came to examine me. They said Colonel Junaid and Dr Mumtaz had done a splendid job, and the operation had gone very well, but I should now be put into an induced coma because if I regained consciousness there would be pressure on the brain.
While I was hovering between life and death, the Taliban issued a statement assuming responsibility for shooting me but denying it was because of my campaign for education. ‘We carried out this attack, and anybody who speaks against us will be attacked in the same way,’ said Ehsanullah Ehsan, a spokesman for the TTP. ‘Malala has been targeted because of her pioneer role in preaching secularism… She was young but she was promoting Western culture in Pashtun areas. She was pro-West; she was speaking against the Taliban; she was calling President Obama her idol.’
My father knew what he was referring to. After I won the National Peace Prize the year before, I had done many TV interviews and in one of them I had been asked to name my favourite politicians. I had chosen Khan Abdul Ghaffar Khan, Benazir Bhutto and President Barack Obama. I had read about Obama and admired him because as a young black man from a struggling family he had achieved his ambitions and dreams. But the image of America in Pakistan had become of one of drones, secret raids on our territory and Raymond Davis.
A Taliban spokesman said that Fazlullah had ordered the attack at a meeting two months earlier. ‘Anyone who sides with the government against us will die at our hands,’ he said. ‘You w
ill see. Other important people will soon become victims.’ He added they had used two local Swati men who had collected information about me and my route to school and had deliberately carried out the attack near an army checkpoint to show they could strike anywhere.
That first morning, just a few hours after my operation, there was suddenly a flurry of activity, people neatening their uniforms and clearing up. Then General Kayani, the army chief, swept in. ‘The nation’s prayers are with you and your daughter,’ he told my father. I had met General Kayani when he came to Swat for a big meeting at the end of 2009 after the campaign against the Taliban.
‘I am happy you did a splendid job,’ I had said at that meeting. ‘Now you just need to catch Fazlullah.’ The hall filled with applause and General Kayani came over and put his hand on my head like a father.
Colonel Junaid gave the general a briefing on the surgery and the proposed treatment plan, and General Kayani told him he should send the CT scans abroad to the best experts for advice. After his visit no one else was allowed at my bedside because of the risk of infection. But many kept coming: Imran Khan, the cricketer-turned-politician; Mian Iftikhar Hussein, the provincial information minister and outspoken critic of the Taliban, whose only son had been shot dead by them; and the chief minister of our province, Haider Hoti, with whom I had appeared on talk-show discussions. None of them was allowed in.
‘Rest assured Malala will not die,’ Hoti told people. ‘She still has lots to do.’
Then around 3 p.m. in the afternoon two British doctors arrived by helicopter from Rawalpindi. Dr Javid Kayani and Dr Fiona Reynolds were from hospitals in Birmingham and happened to be in Pakistan advising the army on how to set up the country’s first liver transplant programme. Our country is full of shocking statistics, not just on education, and one of them is that one in seven children in Pakistan gets hepatitis, largely because of dirty needles, and many die of liver disease. General Kayani was determined to change this, and the army had once again stepped in where the civilians had failed. He had asked the doctors to brief him on their progress before flying home, which happened to be the morning after I had been shot. When they went in to see him he had two televisions on, one tuned to a local channel in Urdu and the other to Sky News in English, with news of my shooting.
The army chief and the doctor were not related despite sharing a surname but knew each other well so the general told Dr Javid he was worried about the conflicting reports he was receiving and asked him to assess me before flying back to the UK. Dr Javid, who is an emergency care consultant at Queen Elizabeth Hospital, agreed, but asked to take Dr Fiona as she is from Birmingham Children’s Hospital and a specialist in children’s intensive care. She was nervous about going to Peshawar, which has become a no-go area for foreigners, but when she heard that I was a campaigner for girls’ education she was happy to help as she herself had been lucky to go to a good school and train to become a doctor.
Colonel Junaid and the hospital director were not pleased to see them. There was some argument until Dr Javid made it clear who had sent them. The British doctors were not happy with what they found. First they turned on a tap to wash their hands and discovered there was no water. Then Dr Fiona checked the machines and levels and muttered something to Dr Javid. She asked when my blood pressure had last been checked. ‘Two hours ago,’ came the reply. She said it needed to be checked all the time and asked a nurse why there was no arterial line. She also complained that my carbon dioxide level was far too low.
My father was glad he didn’t hear what she had told Dr Javid. She had said I was ‘salvageable’ – I had had the right surgery at the right time – but my chances of recovery were now being compromised by the aftercare. After neurosurgery it is essential to monitor breathing and gas exchange, and CO2 levels are supposed to be kept in the normal range. That’s what all the tubes and machines were monitoring. Dr Javid said it was ‘like flying an aircraft – you can only do it using the right instruments’, and even if the hospital had them they weren’t being used properly. Then they left in their helicopter because it is dangerous to be in Peshawar after dark.
Among the visitors who came and were not allowed in was Rehman Malik, the interior minister. He had brought with him a passport for me. My father thanked him but he was very upset. That night when he went back to the army hostel, he took the passport from his pocket and gave it to my mother. ‘This is Malala’s, but I don’t know whether it’s to go abroad or to the heavens,’ he said. They both cried. In their bubble inside the hospital they did not realise that my story had travelled all round the world and that people were calling for me to be sent abroad for treatment.
My condition was deteriorating and my father now rarely picked up his calls. One of the few he took was from the parents of Arfa Karim, a child computer genius from Punjab with whom I had spoken during forums. She had become the youngest Microsoft-certified professional in the world at the age of nine for her skill at programming and had even been invited to meet Bill Gates in Silicon Valley. But tragically she had died that January of a heart attack following an epileptic fit. She was just sixteen, one year older than me. When her father called, my father cried. ‘Tell me how can one live without daughters,’ he sobbed.
22
Journey into the Unknown
I WAS SHOT ON a Tuesday at lunchtime. By Thursday morning my father was so convinced that I would die that he told my uncle Faiz Mohammad that the village should start preparing for my funeral. I had been put into an induced coma, my vital signs were deteriorating, my face and body were swollen and my kidneys and lungs failing. My father later told me that it was terrifying to see me connected to all the tubes in that small glass cubicle. As far as he could see, I was medically dead. He was devastated. ‘It’s too early, she’s only 15,’ he kept thinking. ‘Is her life to be so short?’
My mother was still praying – she had barely slept. Faiz Mohammad had told her she should recite the Surah of the Haj, the chapter of the Quran about pilgrimage, and she recited over and over again the same twelve verses (58–70) about the all-powerfulness of God. She told my father she felt I would live but he could not see how.
When Colonel Junaid came to check on me, my father again asked him, ‘Will she survive?’
‘Do you believe in God?’ the doctor asked him.
‘Yes,’ said my father. Colonel Junaid seemed to be a man of great spiritual depth. His advice was to appeal to God and that He would answer our prayers.
Late on Wednesday night two military doctors who were intensive care specialists had arrived by road from Islamabad. They had been sent by General Kayani after the British doctors had reported back to him that if I was left in Peshawar I would suffer brain damage or might even die because of the quality of the care and the high risk of infection. They wanted to move me but suggested that in the meantime a top doctor be brought in. But it seemed they were too late.
The hospital staff had made none of the changes Dr Fiona had recommended, and my condition had deteriorated as the night went on. Infection had set in. On Thursday morning one of the specialists, Brigadier Aslam, called Dr Fiona. ‘Malala is now very sick,’ he told her. I had developed something called disseminated intravascular coagulation (DIC), which meant my blood was not clotting, my blood pressure was very low and my blood acid had risen. I wasn’t passing urine any more so my kidneys were failing and my lactate levels had risen. It seemed that everything that could go wrong, had. Dr Fiona was about to leave for the airport to fly back to Birmingham – her bags were already at the airport – but when she heard the news, she offered to help and two nurses from her hospital in Birmingham stayed on with her.
She arrived back in Peshawar at lunchtime on Thursday. She told my father that I was to be airlifted to an army hospital in Rawalpindi which had the best intensive care. He couldn’t see how a child so sick could fly, but Dr Fiona assured him that she did this all the time so not to worry. He asked her if there was any hope for me. ‘Had there bee
n no hope I would not be here,’ she replied. My father says that in that moment he could not hold back his tears.
Later that day a nurse came and put drops in my eyes. ‘Look, Khaista,’ said my mother. ‘Dr Fiona is right because the nurses put eye drops in Malala’s eyes. They wouldn’t put drops in if there was no chance.’ One of the other girls who had been shot, Shazia, had been moved to the same hospital and Fiona went to check on her. She told my father that Shazia was fine and had begged her, ‘Look after Malala!’
We were taken to the helipad by ambulance under high security with motorcycle outriders and flashing blue lights.The helicopter flight was one hour and fifteen minutes. Dr Fiona hardly sat down; she was so busy the whole way with all the different equipment that it looked to my father as if she was fighting with it. She was doing what she had been doing for years. Half her work in the UK was moving critically ill children, the other half was treating them in intensive care. But she had never been in a situation quite like this. Not only was Peshawar dangerous for Westerners but after googling me she realised this was no ordinary case. ‘If anything had happened to her it would have been blamed on the white woman,’ she said afterwards. ‘If she’d died I would have killed Pakistan’s Mother Teresa.’
As soon as we landed in Rawalpindi we were taken by ambulance with another military escort to a hospital called the Armed Forces Institute of Cardiology. My father was alarmed – how would they know how to deal with head wounds? But Dr Fiona assured him it had the best intensive care in Pakistan with state-of-the-art equipment and British-trained doctors. Her own nurses from Birmingham were there waiting and had explained to the cardiology nurses the specific procedures for dealing with head injuries.They spent the next three hours with me, swapping my antibiotics and my blood lines as I seemed to be reacting badly to the blood transfusions. Finally they said I was stable.
I Am Malala Page 22