LIFE IS AN UNFINISHED NOVEL: CHAPT 2: MY FATHER AND THE NEW ENGLAND JOURNAL OF MEDICINE

“He died when he was alone………..the police had to breakdown the door to enter”

We are traveling to North Carolina for D’s funeral and his family is describing what happened.

As the car sped across the highways of South Carolina the road disappears into my mental fog, thank God I am not driving. I no longer see the highway. What emerges from the fog outside is a page from the mental archives of my past. A similar event that took place may years ago in Pakistan where my father died alone…………… and introduced us to the new member of our family: Grief.

 

Is December and Christmas décor is up. I pull into the garage of a friends house and her husband comes out visibly upset “Where have you been? Your brother is looking for you?”

Both questions are unusual, coming from this man who is usually very reserved, polite and soft spoken.

The era of the cell phone has not arrived.  I rush home to call my brother who lives up north. “Abijan died” two words……………and an ocean of unfulfilled moments contained within it. He too had died alone with all but one of his children in America and the one local one away at a tour of duty. The sands of time had run out while we were looking the other way.

Back to medical school days………….

The summer of our graduation was hot, and add the white coat to it which carried every possible gadget in its pockets layered over 100 degree heat changed us into a blazing furnace. In addition Karachi was blessed with few trees and high humidity but if that is what you have know all your life, you don’t complain, you just go home and shower and put on fresh fine cotton clothes.

The college was rife with politics with an air of festivity. Since my brother was running for an office in the College Union, we worked long hours after school to make banners:

These were the politically rife years in Pakistan where change was incited by the young

Sweat was pouring down my back as we exited the medical school and headed towards the bus stop.

The man who promised to mend bones without X-rays or operations sat under the tree away from the entrance, His sign advertised “Bones set with no pain” no one bothered with him yet few disappointed patients still believed him.

Old Bunder Road parallel to Dow Medical College courtesy: http://www.thedowdays.com/wp/2013/11/20/dow-medical-college-neighborhood-by-amin-h-karim-md/

We took a left and started the suicidal crossing of what was then called “Bunder Road” The cars, buses, rickshaws, donkey carts, bicycles, came careening down the road and in order to cross this road one had to rely on the blessing of a traffic jam.

MY friend and I zigzagged between the front of the bus, the side of the rickshaw and brushed the high mounted bumper of the decorated trucks from Afghanistan to reach the other side.

Once on the other side we were on the sidewalk. The bus stop now was only a block away. I asked my friend “ Would you like to ride with my father?”

“No No! she said, knowing well that we would have to wait two hours albeit in an air-conditioned office till he finished and closed shop to take us home.

“I have to be home for visitors”  she said with a grin, I smiled, she was being “visited” at her home with families of her suitors galore. I did not envy her public bus ride filled with sweaty laborers this time of day.

“ Ok” I laughed at the thought of what awaited her and she turned to the packed bus stop which was located  below and on the opposite side of the boys hostel of the engineering college. Right at that moment as we looked up a boy leaned out of the hostel window and blew us a kiss . “Idiot” she said . I smiled as I turned away to step into the traffic again to cross over. I waved to her and headed towards the British Council Library which lay a block away. The British Council Library where when you entered the dim cool interior you would step into Jane Austen’s land and time and the sweaty laborers on the bus would recede into the English countryside.

I still had to fight traffic while I crossed the Pakistan Chowk roundabout to reach my fathers office.

The offices were old, no they were ancient but the part of town was premium as nothing new was being built in the area. The shop next to my fathers office printed wedding cards, I paused at the window and looked at the ornate wedding cards and somehow felt deep in my bones that this shop would not be printing my wedding cards.

The yellow stone of the office was the same as the Medical College and at the entrance the sign had his name in italic Calligraphy followed by numerous initials of the many diplomas and postgraduate degrees he had obtained overseas. Below his name was the name of his International research Journal and press.

I walked into the entrance and felt the light cool ness like a caress to my overheated face. On the right was a desk that once was occupied by an assistant. bookshelves with numerous journals adorned the left side of the room. The next door took me into his inner sanctum.

The room was peaceful though by no stretch of imagination was it neat. There were humongous piles of documents, The bookshelves held first printings of medical books as well as his published novels and medical text. The newest medical journals were in the bin on the left side of his desk.

My father looked up as I made my salaam on entering his room and asked him if I could ride home with him. He nodded.

“May I?” I asked as I picked up the newest issue of “The new England Journal of Medicine”

“Sure”, he said and continued in a firm voice” as long as you put it back and not take it with you”

“Of course” I said feeling a little miffed. What was so special about these issues. Why was he so protective of them, I was not a child, but a final year medical student.

I sat down in the cool slightly dark interior lighted by a weak fluorescent light as he worked on some papers. I opened the first page of the NEJM and was transported to a faraway land where new frontiers of medicine were being reached. “New England” how romantic it sounded, and how exciting for it to be the hub of research.

I then perused through the British Journal of Medicine which seemed like cliff notes compared to the NEJM. I read some through Lancet but it was boringly British.

“Are you ready?” he said breaking the silence.  I closed the journals and placed them back in the bin and stood up.

I a humble medical student from Karachi riding the public buses with laborers and working class people everyday had found a treasure trove in my fathers office . It contained a time machine which transported me from hot, dusty, concrete Karachi to the halls of academia where research was done in an intriguingly romantic place called “new England”.

Medical Journals were sent to him free of charge from all over the world in the hope that his international Journal would publish a positive review of at least some articles in them.

I often wonder if those dark quiet cool afternoons in my fathers office sowed the seeds to propel me into becoming a reviewer for some of the most prestigious journals in the USA?

We rode home in silence. I in my dreams of New England and he concentrating on his driving, silent as always.

I graduated in the top ten in my class and was awarded a paid house job for training in Pediatrics while others had to volunteer to get the same training . It was mandatory to train for 6 months in medicine/pediatrics and six months in surgery to get the basic license to practice medicine.

I was ecstatic. I had gotten an internship/house job in pediatrics with the charismatic chairman who had told me that 25% of the population of Pakistan was under the age of 12 and that Pediatricians were the wave of the future and will always be needed and valued and becoming a Pediatrician will make a difference in the lives of children.

Six months of Pediatrics in Civil Hospital were a documentary on the state of poverty, and witness to the levels of famine  despite the affluent society of Karachi, where children died of dehydration, and succumbed to fatal infectious diseases due to the ignorance about preventive health  and inadequate facilities and overcrowding of the free hospitals where I worked. Fortunately thanks to my classmates care and resources have improved by leaps and bounds.

At night I did an average of 11-22 lumbar punctures on children coming in with meningitis and many dying due to lack of antibiotics,

Many times I would find myself running to the surgery ward climbing two steps at a time hoping to find one of my friends worked in surgery and begging for the life of a child ” Please ……..please can I borrow the antibiotics, I will replace them as soon as our monthly stock comes in……..” Sometimes I could and sometimes the cupboard was bare and the children were freed to become angels.

Pediatrics always ran out of supplies of antibiotics and IV bags early in the month as children, especially babies came in droves with meningitis and dehydration and many died before I could do a cut down to find a vein to push the life giving liquids that their body had been starved for.

One evening while I am visiting my father in his large and sprawling house in the posh part of town. I decided to ask his opinion about a job offer I had received from a colleague to whom I had complained about the desperate state of the wards.

“ Abijan………..today I got offered a job in a private clinic with a pay of 60,000 Rs per month”

He turned and looked at me, his face aghast and then his expression turning to stone, almost as if I had said I got offered a job to be a hooker.

I was being paid Rs 200 per month for my paid house job, I lived at home and it seemed like a lot of money as I did not have much to spend it on except Chinese dinners with my cousins and tuck shop teas.

“what do you have to do to make that kind of money” his asked his voice was steel.

“ I would write prescriptions for B12 shots and sell colored water with diluted vitamins as the magic drug for “taaqat ki dawa” (medicine for strength)”

He did not say anything but turned away.

“ I refused it………” I said to his back.

I saw the tentative smile play around his lips.

“But…………….” I paused

“ This made me realize that I want to go abroad and specialize, otherwise I will have to do general practice like this guy who made this offer”

He nodded.

“I want to specialize in Pediatrics” He remained silent. Almost a disapproving silence.

“Healthy children are the future of the world, aren’t they?” I asked sensing his disapproval.

He looked at me his eyes softened.

“ Where do you want to go?

“America”

“ He turned to face me ………” No no ! The American diploma is not recognized in Pakistan, you will work so hard and no one will accept it here”

Echoes of his past were in the passion of his words. He had specialized in England at the request of his hospital in Lahore with a contract for him to return to as chief.

The Hospital on his return breached his contract and had hired a crony of the Minister who did not want to vacate the promised position for my father despite his additional qualifications.

“Your father sticks to his principles” My mother had once confided in a tone that was tinged with anything but a compliment.

As a result of his principles He had turned down the lower position that the hospital in Lahore offered him on return from specializing in Ob GY. He left not only the Hospital but the historic city of Lahore for the urban sprawl of Karachi to dabble unsuccessfully in private practice and eventually start an internationally renowned Medical Journal.

Only Allah knows the ache in his heart at being rejected but we have all in some way at some time walked that path and have been guided to something better. Walking towards whatever was going to fulfill our Qada wal Qadar.

“ Go to England to specialize” He said adamantly.

“ Abijan I have been reading most of the major research journals in your office and do you know which is the best ?”

He looked at me amused……….not patronizing but genuinely curious.

“The best is the New England Journal of medicine”

Hmmm……..yes that is so in some things” he said

“ I want to go to New England to specialize “ I said.

He went to the corner revolving bookcase and pulled out a folded map which was almost yellow with age.

He brought it to the black glass table and unfolded the map of the United States of America. As we both bent down poring over it, searching for “New England” we both came to the realization together as raised our heads from the map that there was no “New England” on the map of the United States of America……..

Without consciously realizing it I had taken the plunge off the cliff with no knowledge or preparation for the future. I had not recognized that my Qadaa wal Qadar was calling me to “New England”………………

New England of course was breathtaking in the fall: