The Doctor of Aleppo

by Dan Mayland

  He called Tahira. “Get the children inside. Lock both doors.”

  She had already done it. She could hear the explosions perfectly well, she informed him, adding, “Now they will pay for what they did to Omar.”

  Sami hoped she was right, but he cringed to hear her speak in such a fashion on the phone. He hoped that the rebels and government alike would be hesitant to take the fight inside the old walled city, where his house lay and which had been designated a world heritage site. Surely there was a shared interest in protecting a shared heritage.

  Tahira wanted to know when he was coming home.

  “Not tonight. Maybe tomorrow.”

  “Treat none of them,” she said. “Those thieves deserve nothing.”

  “Tahira,” he said. “Please.”

  “They will not be around much longer to worry about anyway,” she added.

  Sami hung up. Maybe she was right and maybe not, but for now, it still was not safe to talk that way.

  Many of the doctors and nurses abandoned their posts. Farrah al-Mahmoud, a middle-aged nurse who had been assigned to the orthopedic recovery wing that evening, was one of them.

  Sami found out during his rounds, when the American woman named Hannah tracked him down in the hall to tell him that her boyfriend Oskar hadn’t been given his final course of intravenous antibiotics. She knew everyone was busy, and she had heard about the fighting, but could he please, please give Oskar his antibiotics? Immediately, if possible?

  Always it was something with this woman, always charging toward him, as though her forehead were a battering ram. A constant river of words spilling out of her mouth—and she was not even the patient!

  But after checking the medical administration record affixed to Oskar’s chart, he conceded that she did have a point.

  “I know you are short-staffed,” she said. “And I can hear what is going on outside. If there is anything I can do to help, I will.”

  “There is nothing you can do.”

  He would likely have to give the other patient in the room his medications, too, Sami realized. And check on all the rest of the patients this nurse had abandoned . . .

  Had the medicines even been delivered from the pharmacy?

  He rubbed his head, thinking he could not do it all, that someone had to find another nurse for the floor. Minutes later, he retrieved two saline bags, a vial of cefazolin, and a vial of ciprofloxacin from the medicine cabinet at the nurses’ station. Back in Oskar’s room, he double-checked the medication administration record, then reconstituted the cefazolin with 10 cc of saline, added it to the saline bag, and set up a drip. That done, he checked Adel’s medication administration record, reconstituted the dry ciprofloxacin, and set up Adel’s drip. The cipro would not have been his choice, Sami thought, but given that other alternatives were in short supply, he supposed it was a reasonable decision on the part of Dr. Issa.

  chapter 11

  Hannah had gotten in the habit of checking to make sure that whatever was going into Oskar was what was supposed to be going into him because over the past five days, she’d learned from experience that mistakes were often made: the wrong dosage of morphine, almost doubling up on an anticoagulant medicine, forgetting to mark down when Tylenol had been given and then offering new pills too soon.

  So, while she hadn’t wanted to imply that her trust was less than absolute when Dr. Hasan had been in the room, she had no compunction about pulling the medicine vials out of the garbage after had left. And she noticed the mix-up right away. Both bottles had originally been labeled in Cyrillic, but the pharmacy had covered up the Cyrillic labels with new labels in Arabic. By looking through the back of the vials, though, she could see the original labels. And because she had learned to distinguish between the Cyrillic words for cefazolin and ciprofloxacin, she saw that the Arabic label for ciprofloxacin had gone on the cefazolin bottle, and the Arabic label for the cefazolin on the ciprofloxacin.

  “What’s wrong?” demanded Oskar, as he observed her holding the empty vials up to the light to inspect them.

  “Nothing you have to worry about,” she said, not wanting to feed his anxiety any more than he appeared to be feeding it himself. Besides, she knew ciprofloxacin was just another antibiotic, so she wasn’t that worried. At least Oskar and Adel were both getting something.

  She ducked her head around the privacy curtain and that was when she noticed that, for the first time she could recall, no one was sitting with Adel. At a glance the boy seemed okay.

  “We need to think about getting out of here, Hannah!” Oskar called after her as she left to try to catch Dr. Hasan.

  He could hear the fighting. Everyone could.

  “I am thinking about it, Oskar,” she called over her shoulder.

  Dr. Hasan wasn’t in any of the adjacent rooms, and the nurses’ station at the end of the hall was empty, but twenty minutes later, in the next hall over, she nearly ran into Farrah—the very same night-shift nurse who’d supposedly left earlier in the evening.

  Around the age of her own mother, she was wearing banana-yellow scrubs and a black headscarf. Between that and her pear-shaped body, Hannah thought she looked a bit like a bumblebee. Hannah was particularly well-disposed to her, though, because she’d helped Oskar get to the toilet twice.

  “Oh,” said Hannah, surprised to see her. “I thought you had gone home?”

  She explained that she had, but her adult daughter had left Aleppo to stay with her extended family outside the city, so she had come back.

  When Hannah told her about the mix-up her eyes widened. “Ya Allah,” she said as she clutched her throat.

  “Is it unsafe?” Hannah asked.

  “Not for your boyfriend. But for the other boy . . . Oh, I must fix this immediately.”

  “Wonderful,” said Oskar, upon learning that he’d received Adel’s medications and that Adel had received his. “That’s just wonderful.”

  “Hey,” said Hannah, putting a hand on his shoulder. “What’s wrong? You’re not acting like yourself.”

  “What’s wrong is that doctor gave me the wrong meds. He would never make it in Europe. Never.”

  “Actually, I think he’s pretty good,” said Hannah. The truth was, she liked Dr. Hasan. All her research suggested that up until today, he’d done exactly what he should have done to treat Oskar. And while he might have just mixed up the medications, it was really the pharmacy’s fault for mislabeling them. Besides, Dr. Hasan was a surgeon, not a nurse, and at least he hadn’t panicked and run when the explosions had started up. He was doing his best. “He’s just stressed. I would be, too, if I had his job.”

  “He’s an asshole even when he’s not stressed,” said Oskar, with uncharacteristic venom. “I’ve seen the way he treats you.”

  “He treats me fine,” said Hannah.

  chapter 12

  Hannah tried calling several private ambulance companies. None would transport Oskar to Turkey while there was still fighting going on in and around Aleppo. She tried her Syrian acquaintances, hoping to find someone willing to drive her and Oskar to the border. Most didn’t answer their phones. The few who did didn’t have cars and didn’t know anyone who would be willing to loan or lease one to her.

  Maybe when the fighting let up, they said.

  She tried calling the airport and was told that even if Oskar were physically capable of boarding a plane, all the outbound flights were booked, and no inbound flights were coming in—which meant soon there wouldn’t be any outbound flights at all.

  Around the hospital, the taxi drivers had either gone home to avoid getting caught in the fighting or were already ferrying other people out of the city. When she finally found one outside the Pullman, a modern seven-story hotel just north of the hospital, the driver refused to take her and Oskar into Turkey out of fear the border crossing would be shut and he wouldn’t be let back
in.

  Around midnight, though, an EDS colleague in Turkey called her back with an offer—if Hannah could get Oskar to the border, this colleague would drive them the rest of the way back to Antakya.

  “Done,” Hannah said.

  She’d hire a taxi at the Pullman to take them to the border, and they’d cross on foot—Oskar would just have to suck it up and use crutches.

  Oskar said he was game.

  “I can’t thank you enough,” he said. He took her hand in his.

  She kissed him on the lips. “Don’t thank me yet. The ride to Antakya is going to be awful.”

  “I mean for everything. For staying here and looking out for me. I’ve been a pain in the ass, I know. I’ll never forget it.”

  “I’ll call you when I get a taxi. Then we’ll get you back to Sweden. We’ll figure this out.”

  Hannah jogged back to the Pullman. The taxi that had been there earlier was gone, but the concierge said it was expected back soon from the airport.

  Two hours later it still hadn’t arrived. Explosions sporadically brightened the night sky, and the sound of gunfire just to the south of her was relentless. Military trucks roared by every few minutes.

  At three thirty in the morning, four hotel guests climbed out of the taxi in question, having just returned from the airport where their flight had been canceled.

  For five times the normal fare, the driver—an ill-tempered older man with a Saddam Hussein mustache—reluctantly agreed to bring her to the border. Hannah used the ATM inside the hotel to take out extra money on her credit card.

  From the back of the taxi, she tried to call Oskar, to let him know she’d be there soon, but the call wouldn’t go through. While she was sending him a text, the taxi pulled to a stop in front of a haphazardly erected barrier made of corrugated steel roofing panels and adorned with Syrian flags. Government soldiers, dressed in camouflage uniforms and wielding assault rifles, stood in front of it.

  The driver cursed.

  “Checkpoint,” he said, adding, “It was not here twenty minutes ago.”

  “Will they let us through?”

  He tapped his steering wheel, looking antsy and nervous. “Inshallah. How much money do you have?”

  “How much do I need?”

  The driver tapped the steering wheel again, peered through the windshield, then said, “Maybe one thousand.”

  Hannah slipped a thousand Syrian pounds—the equivalent of about fifteen dollars—into her US passport. Moments later, the driver handed his Syrian ID and Hannah’s passport to a soldier.

  They let the driver through but not before they told him fighting had broken out at the border crossings north and west of Aleppo and that it was not safe to go anywhere near them.

  Hannah, her bribe notwithstanding, was detained.

  chapter 13

  “Dr. Hasan! Dr. Hasan!”

  Sami heard the nurse but kept walking. Having just operated on a woman who had been hiding under her bed when a stray bullet had shattered her tibia, he was now needed to help stabilize a patient who had been shot in the hip. Meanwhile, the emergency room was filling with patients faster than they could be treated.

  “Dr. Hasan, I must speak with you!” said the nurse, trying to catch up. “It concerns one of your patients.”

  “So speak,” said Sami, still not breaking stride.

  “It is about a matter that would best be discussed privately.”

  “I do not have time”—Sami stepped out of the way, his back to the wall, to avoid colliding with a bed-bound patient being wheeled down the hall at race-car speed—“for a private discussion.”

  “Dr. Hasan, I beg of you!”

  The nurse—Farrah was her name, Sami recalled—leaned closer.

  “One of your patients has died,” she whispered. “The one in room 142.”

  “The Swede?”

  “No, no—the other one.”

  Sami took a moment to process the information.

  “I am sorry,” said the nurse.

  “Adel Suleiman,” said Sami.

  “Yes.”

  “Thank you for telling me.” Sami began walking again.

  “Doctor, that is not all. The reason I am here is because the pharmacy distributed the wrong . . .”

  The nurse had lowered her voice to the point where Sami could not hear what had been said.

  “The pharmacy distributed the wrong what?”

  Sami stopped walking. The nurse stepped in close.

  “The wrong medication. There was a mix-up. Between the medicine for the boy and the Swede.”

  “No. I checked the labels,” Sami said. “And the MAR,” he added, referring to the medication administration record.

  “Of course you did, Dr. Hasan. And yet, with the war in the south, we have been low on the usual medications, and some replacements have come in from Russia. The pharmacy relabels them, but this time there was an error. The American girl, she noticed it and told me. I fixed it, but it was too late. The boy had a reaction—”

  Sami raised his eyes and clucked his tongue. “No.”

  “—to the cefazolin,” said the nurse. “A bad reaction, he was allergic.”

  “I knew he was allergic to cefazolin,” snapped Sami. “I read the MAR. And besides, I helped operate on him. He threw a rash when administered cefazolin, became hypertensive. Dr. Issa ordered the switch to cipro.”

  “He had a worse reaction this time, Doctor. Much worse.”

  Sami leaned back against the wall and took two deep breaths. He knew what cefazolin and ciprofloxacin looked like when spelled out in Cyrillic. He would have been able to tell the difference if he had been as careful as he should have been. There was no excuse for not checking; no good excuse at least. The nurse knew it, too, but she was simply allowing him to save face by placing all the blame on the pharmacist. “You administered epinephrine?”

  “It was too late.”

  Sami lifted his head. It was possible—unlikely, but possible—the nurse had misjudged the situation.

  “Get me a .5 milliliter dose of epinephrine, meet me in the room!”

  Moments later, Sami, slightly out of breath, ran to Adel Suleiman’s hospital bed. He felt for a pulse, but the second he picked up the boy’s hand and felt how cold it was, he knew. The computer monitor, which displayed the boy’s vital signs—or rather, lack thereof—confirmed it.

  He slumped into a bedside chair and cradled his head in his hands, his confidence shaken. He had been distracted. Worried about Tahira and his children. But that was no excuse.

  Still, the odds of the boy going into anaphylactic shock and dying instead of just breaking out in a rash were incredibly low! In surgery, he had become hypertensive, yes, but when the medication was changed, his blood pressure had returned to normal and his flushing had receded.

  Stop it, Sami admonished himself. He cradled his head in his hands again. The odds were irrelevant. There were always outliers. The boy’s body had been under stress. It would not have taken much to kill him. Maybe a second hypertensive incident had led to a stroke. The boy had, after all, suffered a concussion.

  “The epinephrine you requested, Dr. Hasan,” said the nurse. “Shall I administer it?”

  “No.” From where Sami sat, he could see Adel’s toes. They were pale. He touched them. They were already cold. “You were right. Has the patient’s family been informed?”

  “Not yet. I thought it best to speak to you first.”

  “We should call them. Now.” He checked the time on his phone; the woman with a bullet in her hip was waiting for him in the emergency room. “This is not news that will get better with time.” Sami considered what his reaction would be if one of his children had landed in the hospital, and some pharmacist and an absentminded doctor had accidentally killed him. He would be devastated. And furiou
s.

  Sorry was not nearly enough.

  “I can look up the phone number for the parents,” offered the nurse.

  “Bring it to me in the emergency wing. Have you informed the pharmacist?”

  “She left not long after the fighting broke out. This would have been one of the last scripts she filled. The nurses that remain are filling their own scripts.”

  “I see.”

  Sami stood. It was then he noticed that the Swede—and all the Swede’s belongings—were gone. Even though he had not been discharged.

  “But I was wondering . . .” said the nurse, as Sami stared at Oskar’s empty bed.

  “Wondering what?”

  “Wondering what the use would be of telling the family about the medicine issue.”

  Turning to the nurse, Sami said, “They deserve to be told the truth.”

  “And you believe they would want to know it?”

  “You think I should lie to them?” Sami posed the question as an accusation—even though he knew that most doctors at the hospital would lie. To admit an error was to admit weakness, and while such an admission might be looked upon admirably in the hospitals of Paris and London, it would not be here.

  Sami had been fighting against that attitude for years now. Arguing at staff meetings for better reporting standards. If no one admitted their errors, how could future ones be prevented?

  “All I am saying, Doctor, is that the family might be better off not knowing that the boy died as a result of something that could have been prevented.” Lowering her voice, she added, “We must also consider that the patient’s father is Mukhabarat and will likely think more kindly of you, and me, if he believes his son died as a result of an act of God. An embolism, perhaps.”

  Sami stood perfectly still for a moment. The Mukhabarat—a catchall name that could apply to any of Syria’s myriad domestic intelligence services—were not to be trifled with. Most likely it was the Mukhabarat who had killed Omar. He had not realized Adel Suleiman’s father was one of them. He further considered that, with the possibility that Aya could be detained and questioned by the Mukhabarat, his situation was already exceptionally precarious.