by Kaylie Jones
It was Mick, his blue eyes swimming in a sea of red. He was completely lit, practically falling down as he crashed his way across the kitchen toward me.
“You can’t come in here like this, Mick. My dad’s gone now.”
“I … heard about your dad on the police scanner …” He banged his hip on the corner of the stove. “Shit. Fuck. I … Uh, here … let me give you a hug …” he uttered, coming forward.
I lifted the pistol, sighted down the barrel as my dad had taught me, and shot him twice in the chest. He gazed at me without the slightest surprise, as if he’d been expecting this all of his life.
ANJALI’S AMERICA
BY QANTA AHMED, MD
Garden City
My eyes were gritty. My feet ached in shoes made tight from hours of standing. Palpitations clattered helter-skelter within me, skidding slipshod on waves of caffeine. I was wired with the barren exhaustion with which only a physician is intimate.
It was two a.m. My patient had made it out of the OR. I was hurrying to her in the intensive care unit. A young Pakistani woman, Mrs. Anjali Osmaan, was already the mother of several. This last delivery had nearly killed her. The labor had advanced slowly, and partway through the evening the baby turned, obstructing his own passage. After a brief struggle, the tired uterus ruptured, splitting across an old scar. There was a lot of blood. The EMTs said her mother-in-law had looked on in silent disapproval as the ambulance screamed away. Mrs. Osmaan had arrived in extremis, raced to the hospital by the ashen-faced men. Nobody wants a mother to die.
I prepared to war with young death. As nurses moved her from the gurney, I began gowning, gloving, tying my face mask, focusing my thoughts in the silence of age-old battle rituals. Frank had operated on her. I smiled at my friend. Tearing off his paper hat, he rushed up to fill me in.
“Christ, what a disaster—a complete uterine rupture! I don’t know if she’ll survive the hysterectomy but we had no choice. Baby’s dead. She was peri-arrest half the time, we didn’t think we’d make it out of the OR. Good luck with this, Yasmine. The anastamoses are secure but her coagulation is shot. And her kidneys are dicey. We ran some labs, pending now, should be back any moment. You know the drill. Gotta run, kiddo, an ectopic in the ER.” Thrusting the chart into my hands, he clattered off in his clogs to answer his pager.
With my team of nurses and residents, therapists and orderlies, I began the work of resuscitation. An earnest medical student watched from the corner of the room like a frightened kitten. Seamlessly, the team enacted my terse orders. Ours was a familiar ballet—most of the time it was a dress rehearsal that ended in death; but this was a live performance. We were wrapped in the struggle to win back life.
Within the labyrinth of lines and tubing, Mrs. Osmaan was spectral. Drained of blood, her features were sallow. Arched brows crowned sleeping eyes, lush lashes gleamed moist with Vaseline, as though she’d been crying at her own dismal fate. Her hair was long and unstyled, dull, her premature aging typical of multiparous mothers. This was not a woman with appointments in shrill Long Island salons, who jostled with fur-coated wives. Her nails were unmanicured, but filigree henna patterns ascended both arms, rooted in a deep amber plunge of color at the fingertips. She must have attended a wedding recently. Her pale skin placed her among the elite of Punjab. She was Pakistani, like me. I imagined she had arrived in Long Island after an arranged marriage. I shivered unexpectedly, for hers was a fate I once defied.
I began the examination. She was icy cold, the shock having driven all the blood to her core. Her thready pulse coursed to a furious 160 on jet streams of adrenaline. A firm mouth revealed a determined woman. Chapped lips clasped reflexively around tubing, which shuddered with each mechanical breath. Only the tide of moisture in the tube confirmed the feeble tendrils of life persisting beyond the assault. A clear tube emerged from her nose, ferrying bilious liquid out of the stomach. A tiny stud gleamed in the left nostril of her Mughal nose. In the postoperative nightmare that was now her world, the young Pakistani mother retained her dignity with this glittering decoration, the brave little sparkles escaping the surgical tape overlying it.
The belly wound was dressed, already oozing with thinned blood too weak to clot. Staples gnashed at her anemic flesh, struggling to knit her back to life. Fluids escaped through the futile seams, soaking the dressing. A pristine catheter bag waited for the precious elixir of urine—the first clue of returning life.
Turning her hands over I could see purple flecks speckling her flesh: a very bad sign. Frank was right—after losing her entire blood volume several times over, what circulated was refrigerated blood; her system was badly diluted, distressed, and maybe would never be restored. My patient was punctured, perforated, and powerless to plug the holes. Like sailing a scuppered boat, we were bailing out water as fast as we were taking it in. It was all hands on deck to keep this woman afloat.
Soon we called for more blood products; started antibiotics; added drugs which would drive her heart faster and further; inserted lines to infuse and lines to measure. We dialed up her oxygen and pored over X-rays. We stabbed arteries and cannulated veins. We checked her pupils and emptied her rectum. We pushed and prodded, listened and pondered. Locked in our hive of fervent activity we concealed our worries and fears from each other and ourselves, assuaging our anxieties with yet more intervention. We cross-consulted other physicians, rousing them from fragmented sleep. We wrote orders, dispensed drugs, and finally put her violated body in a clean gown and crisp sheets. Between our many efforts, we suspended the wounded mother in a fragile web of life, wondering if we had built it strong enough to bear her weight.
I settled myself on a swivel chair at the foot of her bed and began the long process of recording the cramped fury that is our work. A silent nurse placed coffee at my elbow. I rubbed the back of my neck to rid it of knots, and pulled my bloodstained gown closer, fending off the special chill of the early hours. Bright lights became dim. The ICU returned to its baseline hum. At last, I allowed myself to uncoil a fraction. Soothed by the unit’s background buzz, I permitted myself a momentary satisfaction, for ours is worthwhile work. From time to time, as I scribbled my thoughts and checked my calculations, I studied this woman, this Muslim woman, this Pakistani woman, whose fate could have been mine.
Anjali Osmaan and I were of the same heritage. Both of us had traveled from East Punjab to Nassau County, she on marriage and its trousseau, I for my training in medicine. I looked at her date of birth—we were only months apart in age, yet in such short years our paths had parted and diverged as if separated by an abyss. Where her family had succeeded in making her marriage a priority, my family had spectacularly failed. Where for her, education had been a means of biding time for the right suitor and increasing her marital market value, for me it had been the breakneck getaway car screeching away in clouds of Punjabi dust. We were from similar backgrounds, of that I was certain, yet while I had escaped in noisy defiance, she had acquiesced in silence.
A buzz at the door announced a visitor. Mrs. Osmaan’s husband was outside. Someone murmured, “He’s an MD.” So, finally he had turned up. I prepared to explain her condition, but before I could greet him, he burst into the room with the misplaced authority typical of a doctor finding himself suddenly a relative to the sick. Striding up to me, he demanded to know what was going on. I was struck by the odd mixture of anger and dispassion in his tone. He extended a fleshy hand in cursory greeting, his tight grip twisting my fingers. I winced in pain. He didn’t apologize. His was an arrogance nurtured on cream supped at the knees of a doting Christian ayah. I knew the type well—a family who could afford schooling at Aitchison but without the pedigree to find themselves accepted. This was a man who would never be admitted to play with the boys at the Lahore Polo Club; his wealth was not welcome, his circles excluded. He harbored bitterness, but also a sense of entitlement to his mother’s money, and a desperate need to conceal his humdrum Punjabi origins. Glancing over my name emblazoned
on my coat, he immediately recognized in it his own background, and, repelled, turned away. Nothing was more loathsome to him than to behold a woman from his discarded world who had made it here too—Pakistani women were to be married or bedded, and always without voice.
Our revulsion was mutual. French cologne masked Budweiser and Marlboros, the preferred armor of the Pakistani male failing to find his place in the massive currents of America. A well-cut suit strained at the seams, his thick neck bulging over the collar. A Bluetooth earpiece flashed rhythmically, underlining his self-importance. Silver hair cut a sharp contrast to his deep-brown pockmarked skin, a legacy of the acne that had surely shamed him in adolescence. It was clear he was wrestling with his gentleman’s disguise. He never took his hands out of his pockets. Something deep inside me turned.
“So she is in hemorrhagic shock? Any DIC yet? How many units of FFP did she get? Have you given her any Vitamin K? Not making urine right now? And you have her on adrenaline and dopamine? What’s her acid base?” From his questions I gathered he was a fellow specialist.
Falling prey to his authority, I responded with facts. He jangled car keys in his pocket. He was dying for a smoke.
“Anyway, as long as she can still have kids after all this is over.” He finally stopped talking, meeting my astonished stare. He paused, gazing coldly at me, the silence heavy with unspoken threat.
“Oh, I am sorry you weren’t informed,” I began, knowing full well my staff had been trying to reach him for hours. “Your wife ruptured her uterus completely. She had an emergency hysterectomy to save her life. She won’t be able to have any more children.” I wondered how I would tell him about the dead baby. Worse, I realized I was wondering if he would even care.
Without saying another word, he turned on his heel and left, stony-faced. The woman had failed him completely, now his barren wife would be a shame and a burden. He brushed off compassionate nurses attempting to stop him, wives and mothers themselves. I turned to my abandoned patient. How desolate must have been her years here. I saw it clearly: an arranged bride; a maladjusted Pakistani expat. Grasping at stability in the confusion of America, he handled it the only way he knew how—by dominating his dispossessed bride, far from her girlhood home.
Hours later, as I drove home in the late morning, I thought about Anjali Osmaan. Mineola was bustling with delivery vans and ambulances. The banks were open, bagels were being toasted, traffic was beginning to snarl. I drove past the Garden City Hotel, its lawns soothed by cascading sprinklers. I followed the tree-lined curving road, always so refreshing after an airless night trapped in fluorescent lights and beeping machines. Passing the most beautiful house on Cathedral Avenue, I slowed the car to take in its symmetry. The colonial columns rose sharp and white from the crisp lawn. The shades were pulled as always, but pretty pink flowers fluttered in the morning breeze. For a thousandth time I wondered about the family within, but as usual the home yielded no clues.
Finally, I reached the hospital housing just at the end of Cathedral Avenue, where the neighborhood changed in a sweeping curve, from Wall Street wealth to working class. I pulled into the garden apartments, one of which was mine. Inside the garage, I switched the engine off and listened for a moment to the tick-tick expansion of the uncoiling motor, beginning to feel my own unfurling. Would my unconscious patient survive to tell me her tale?
Soon I was pulling the cold duvet over my head, obliterating daylight. I savored the precious moments before sleep, perched at the cusp of the deep, dreamless state that follows a night on call. As I slipped off the edge, floating into reverie, I thought of the woman I had left behind in the mechanical orchestra of the intensive care unit, where perhaps she was tumbling through a dreamless sleep of her own. As I drifted down into deeper and darker blue canyons, her turbulent battle to stay with the living continued. Would she swim back up of her own will or would the currents finally pull her down into permanent void?
“Bed five is coding. Code 99! Code 99!”
“No pulse! Rhythm: V-tach. Shock her!”
“Epi!”
“Atropine!”
“Pads!”
“Bag her! Are we charged?”
Charging.
“Stand clear. Stand clear, everyone!”
Paralyzing silence.
“Sinus rhythm. She’s back.”
“Thank you, everyone. Get a gas. Calcium gluconate, please. Get me that EKG. Hang some Mag. Would you? Finish that bolus. Call for blood. And the rapid infuser. Stat. Call the family. It’s not looking good. She could box out anytime.”
I knew her story as if I’d lived it myself. She would be me, had I not made an impulsive dash for my life. With my mind’s eye I looked back over my shoulder and followed the curve of the road disappearing into the dark; I allowed myself a rare pause from my perpetual flight.
It all starts with such hope. Summer is well into its ripeness, though Anjali is yet to blossom. She has just been married-by-proxy, an arrangement approved by her family, who always knows best for their sole daughter, their hopes stoked on the fires of her great beauty. He is from Amreekah! they tell her, choosing wedding fabrics and photographers. “Amreekah!” they shout, repeating it out of sheer disbelief. In the midst of their joy, Anjali is an afterthought. Our daughter will go to Amreekah! A place called Long Island, they tell her, triggering images from The Great Gatsby, one of her mother’s favorite books. She had read it in British India during her Jesuit schooling.
Busy with the end of college, Anjali doesn’t have time or energy to think about protesting. She is joining her new husband in Amreekah. She should be grateful, so few girls get a chance like this. She will be a married woman, the only way to carry her special burden, the woman’s cargo of familial honor. Marriage is the only way forward.
And yet I found a way out. I won a place in residency to study medicine in New York. But I was no brighter than she—just stronger, hungrier, more defiant.
Anjali’s marriage begins as it will continue: she is alone. The plane lands in torrential summer rains, so like monsoon season in Sindh. With precious dollar bills and an address written on crumpled paper torn from a schoolbook, she takes a taxi to her husband’s home. After hours of bumper-to-bumper traffic the cab stops before a large house in a place called Garden City. The neighborhood is glossy and rich. Anjali feels suddenly poor, suddenly small. She hesitates, cowered by her own future.
Entering the house with a newly cut key, she closes the door behind her. The silence is total and in it the weight of her distance from the familiar becomes painfully apparent. Sheets of driving rain are now muted behind heavy glass. There are no cars outside. Even the other houses don’t have lights on. In her first night in her husband’s vast home she searches for food. With a struggle, she opens the American fridge. She has never seen one so big. It unseals with an expensive, icy hiss. She shivers. A few crumbs and some curled cheese greet her in return. The thin clinking of her marriage bangles seems to be the only sound for miles around.
She wanders into the bedroom, the future scene of her abuse. Anjali falls into a fitful, jetlagged sleep, yet still she remains excited at her own boldness. She draws her bridal hopes close to her throat, trying to be warm in the icy air-conditioning. If only she knew how to turn the coldness off. Drifting to sleep, she warms herself with the childish envy of her college friends at home in Lahore. I am so lucky, she thinks, leaving them all behind. And here I am already on the threshold of everything new! Such exciting beginnings: marriage, migration, motherhood. She doesn’t know it yet, but her trust for the stranger she has married is already blind.
She has known him for less than half an hour and already they are in bed. She keeps her eyes closed, sealed shut by a bride’s mixture of shame and reluctant pleasure. He fondles her roughly from behind, running his hands up and down her torso and venturing toward the perilous region between her legs, the place where all the horrors begin. She can’t stop shivering. Adjusting something on his belt, her husband ease
s a long, thin territorial leg over her hip. Too naïve a bride, she fails to notice his expertise. The sinewy leg is surprisingly heavy, pinning her still, impaling her will. Penetration will become their only communication and her husband’s only claim. As he fills with blood and desire, she fills with dread and sudden regret. This must be how all brides feel, she decides.
The act over, she rearranges her shredded fantasies in the face staring back at her in the bathroom mirror. The bedroom light is on. He is stripped off, freshly showered, fragrant, sitting at the edge of the bed. In the bright lights of the room, he looks sated and alien as he picks up the phone to make a call. Anjali goes to join him on the tousled bed, stroking his shin, imagining this to be affection. Her family isn’t a tactile one, so all she knows is what she has learned from movies. He is talking to a woman. His voice is strangely tender, a voice she will soon learn he reserves for his mistress. He is indifferent to Anjali’s caress.
At last, he hangs up. Anjali is still a mess of shyness and awkwardness; of shame and embarrassment; of desire and satisfaction, and under it all she is sour with the rancor of new jealousy. Expressionless, he stands, wearing the towel around his waist, heads to the restroom, and urinates a long, satisfying stream. He is done with Anjali and doesn’t say a word to her as he dresses and departs. This will be the way it is for a long, long time. Eventually, he will degrade her, beat her, berate her; later the margins between marital relations and marital rape will blur. But all things in their appointed time.
Their children are conceived, delivered, and raised; first one, then another, then another, in such rapid succession that her young body doesn’t have time to recover. Finally comes this last baby who is bursting Anjali’s seams to get out. Please God, spare my baby, let the child not be a girl, she prays.
