Monthly Archives: August 2008

“Everyone keeps telling you to move on, to forget. They keep telling you that time heals all wounds and fill your ears with all those cliches. The fact is, when you lose someone you truly love, it leaves a hole in your heart. That hole is in her or his shape and no one can really fit in and fill it except for that one person you have loved and lost.” – Mona Rashed.

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“Are you okay? I’m so sorry. I completely forgot. Please forgive me,” Deema said. “It’s fine. Nothing happened,” I said abruptly. “I swear I’m sorry. I don’t know what’s wrong with me. I just say things without thinking. I didn’t mean to bring it up, believe me,” she kept on apologizing. ‘It’s fine I told you. I just need to go to the bathroom for a minute,” I said and excused myself. “See what you’ve done? You’ve upset her,” I heard someone hissing at Deema as I walked away from the table.

I was having dinner at Shurafa restaurant with some of my friends. Deema is my friend’s cousin. I had met her only a couple of times before. We were talking about our friend’s wedding that took place the last weekend when suddenly Deema turned to me and asked, “Did Amal get married yet? I remember she was engaged the last time we met.” The second she uttered my sister’s name, everyone stopped talking and just glared at her.  She looked confused for a minute as she was trying to figure out why everyone seemed angry with her. She had a look of horror in her eyes when she remembered that Amal has passed away in a car accident just less than a year ago. I knew she did not mean to upset me and that it was an innocent mistake. Still, I could not help feeling hurt. I felt my throat tightening and my eye were starting to tear up. I did not want to cry in front of everyone at the restaurant so I escaped to the bathroom.

I closed the door of one of the stalls on myself and wept like a baby. I did not want to admit it but my tears of sadness mixed with some tears of resentment toward myself. I felt extremely selfish and coldhearted because I got slightly irritated at the mention of my sister. I did not want anyone to remind me of her. Everything around me was doing that and I wanted to enjoy the peace that comes with not having her on my mind if only for a few hours. I did not want to hear her name when I was out with my friends trying to have a little bit of fun, which is something I did not get to do often at the time. I have been struggling ever since she passed away. I have been trying to move on unsuccessfully. Even when a year had passed by, I still cried at night thinking of the many times we slept next to each other although each one of us had her own room. We were as close as sisters could be. We shared everything. I missed her a lot and I still do but back then, I needed to stop missing her just for a little while. Was that so awful?  I felt guilt taking over me.

“Mona, are you alright?” I heard Sara, my best friend, asking me. “Yes, I am,” I said and opened the stall’s door. She did not say anything. She just gave me a quick hug and exclaimed, “You look like a mess! Come on, let’s get you fixed up.” I smiled as she took out a tissue from her purse and wiped the tears off my cheeks then started adjusting my make up. Those of you who do not know her would probably think that is the most superficial thing she could have done when clearly her friend, I, was having an emotional moment. You could not have been more wrong. Sara had been my friend for over ten years and she knew me as well as I knew myself. She could tell that I did not want to talk about Amal then. It was not the time or place to be having a pep talk of any kind. Best thing to do was to pretend nothing has happened and try to enjoy what I had determined on making a nice night out. A good time was what I needed the most.

“Behold everyone, the queen is back. Drinks are on me!” Sara announced loudly as we got back to the table. Everyone laughed because there were no drinks in Saudi Arabia and because Sara would never in her life offer to buy anyone anything! “This night might be salvaged,” I thought.

Early in the morning a couple of days later, I sneaked out of the house to go to the beach with Majed, my boyfriend. My parents were sound asleep when I quietly shut the outer door and got into Majed’s convertible Porsche. “I got you something from Paris. Here you go,” he said and handed me a small teddy bear holding an Eiffel tower. “Thank you. This is so cute,” I said and gave him a kiss on the cheek.

I had met Majed two years ago practically through Facebook, which always made me laugh at myself because I used to think that people who use the messenger and online social networks to hook up with others are desperate geeks who could not meet anyone in real life. That is until I ended up being one of them. He added me as a friend and I accepted because I knew him and his sister remotely from Palms beach, which is a private beach for foreigners that I used to frequent with my friends because it did not allow Saudi guys to enter meaning we could tan and swim freely without being harassed. Every Thursday morning there, Majed was present, often with his sister whom we eventually befriended. However, he and I never spoke directly to one another up until he added me on Facebook. He did not waste time and soon afterwards asked me out. After a few weeks of hesitation, I agreed thinking I had nothing to lose. He seemed like a decent man. He was funny and intelligent He was 28 years old and the vice president of his family’s company. I valued that he was a hard worker. A few dates later, we became an item.

None of my friends liked him. They all admired his good looks but they all warned me about him. “You and him will never make it,” even Sara used to say. They had accepted him at first but when a couple of months had passed, they started wondering why he did not contact my parents and asked for my hand in marriage. I did not understand why they were in such a rush. “You don’t go on marrying someone you had just met a few months ago,” I used to tell them. “It’s just an engagement to make things official. It’s not a life binding commitment yet,” Sara always argued. I did not want to bring the subject up with Majed because I did not want to drive him away. I did not want to come off as needy especially early in the relationship.

When I finally got around to talking to him about it, nearly a year later, he just shrugged and confessed to me that he was simply not ready yet. We had a fight in which I accused him of not loving me. He swore he did but that I should let him take his time. I hung up on him and did not sleep that night. He showed up the next day with a grand apology and a gold bracelet. A few days later, I forgave him and promised him to wait. I had hoped that I could persuade him into making that move with me. I understood that it would be very hard for him to change his lifestyle. He was a workaholic that spent his free weekends and vacations in the beach or travelling abroad.  Perhaps he needed to make more room for me. I promised myself that by the time we complete two years together, I would be 22 by then, and I would give him the choice of either speaking to my parents or breaking up with me.

Of course, Amal snapped at me when I told her of my decision. She kept saying that a year is long enough for anyone to decide whether he wants to be with someone or not. She lectured me on the fact that he was 28 years old. “If he still can’t make such a commitment at his age, he probably never will,” she used to say. Her words always hit sore points with me, which made me mad. I knew what she used to tell me made sense but I could not listen to my mind. She was two years older than I was and I trusted that she was wiser, too. Unfortunately, I loved Majed. I had a couple of boyfriends before him but they were all teenage crushes that never lasted. He was the real deal to me, or so I thought. I believed that he was a man unlike most Saudi guys that were nothing more than foolish boys.

Majed gave the gatekeeper to the Palms beach his American passport and the entrance fee so he waved us in. We found a few of our friends inside, as it is the case on Thursdays. I stared at Majed from afar as he jumped into the water. “His body is amazing,” I found myself thinking. I was lying on a beach seat when I heard Abdul-Majeed Abdullah’s latest song coming from someone’s mobile phone. He was Amal’s favorite singer. I think he is a good singer but she used to have every single song of his. God, she used to annoy me with his music sometimes.

Looking at Majed, I wondered if I could keep that promise I made to myself a year ago. Amal had died just a couple of weeks later. Naturally, I found myself clinging more to Majed. He listened to me when I needed to talk for hours about her and how much I needed her back. He took me out whenever I was feeling down and made me laugh. He hugged me when I cried. He kept me company when I felt alone and abandoned. He gave me a safe haven away from my home, which was filled with memories and polluted with my parents’ voices yelling at one another. I simply could not leave him even if I wanted to. It was much easier said than done. I did not only want him and love him; I needed him in my life.

I was sure that Amal would not approve of this. She would advice me to leave him and go find someone else. Actually, when you think about it, she would probably advice not to date anyone now that she has been buried. She had probably met Malak Almawt, The Angel of Death who took her soul. I immediately brushed the unpleasant thought off my mind. The fact was, I was not a good Muslim. At least, not as good as I wanted to be. Death and judgment were not what I wanted to think about on that beautiful sunny day.

I had gone through the religious phase as most people who lose a close loved one usually do. I started praying all five prayers on time. I did an Umrah. I started wearing Hijab, a veil. I started reading and listening to more Qur’an. I tired to minimize my sins and do more good deeds. I even stopped seeing Majed. He did not like that transformation. He did not say anything at the beginning but then he simply told me that I was taking it too far. After a few weeks and a few arguments, I simply caved in. Perhaps I grew tired of it too and my need for Majed grew everyday.

I could tell that he was changing slowly in the last couple of months. He did not strike me to be as caring and attentive as he once used to be. It could be probably due to the fact that we were advancing in our relationship and that it was normal for him to get that way. I did not know. I did not talk to him about it because I did not want to seem delusional and paranoid because maybe nothing has changed and it was all in my head.

I got back from the beach late afternoon all happy and tanned. If my parents asked, I would tell them I was at Sara’s house because she has a swimming pool. “Mom, Dad, anybody here?” I said loudly as I entered my room. I heard no response, which was weird because my father’s car was parked in the garage and the driver’s car was outside. I went to their room to find my father sitting alone on his desk and that he had been clearly chain-smoking. “Where’s mom?” I asked. “She went to your uncle’s house,” he replied. “Okay,” I said and turned around to leave the room. “Your mother and I left each other,” he said.

“The butterfly effect is basically a theory saying that even a minor change in circumstances can lead to  a major change in outcome. For example, a butterfly flapping its wings may alter the course of a tornado. The flapping itself will not directly affect the tornado but it might set off a chain of events that ultimately modifies the end result.” – Faisal Makki.

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“It is not your fault. How many times do I have to tell you that?” I said with frustration. We were sitting at Second Cup, Tahlia branch, just Yousef and me. I have been trying to convince him for over an hour that he should stop blaming himself for Amal’s death. “It’s been over a month already. Don’t you think that it’s time you let it go?” “How can I let it go? If I can forget about her, I’m sure her family can’t. I shouldn’t even allow myself to forget. I should keep reminding myself of her so that I don’t make a similar mistake again. How can you, out of all people, ask me to leave it behind as if nothing has happened? Don’t you know me at all?” he nearly snapped at me. I shrugged and took a sip from my coffee. “I’m sorry, man. You know very well that I’m not angry at you, just myself,” he apologized immediately.

That was Yousef, constantly seeking perfection, constantly setting his standards higher than everyone else’s and demanding more from himself. He always prided himself on the fact that he was the top student in our class. Ever since we were kids back in elementary school up until the day we graduated from medical school, he scored the first place year after year. “I never make mistakes,” he frequently used to say. As arrogant as that statement was, it was very much true. Yousef never made mistakes. It was annoying and admirable at the same time.  I personally looked up to him because in the unlikely event he did make a mistake; he would be the first one to admit it and beat himself about it. He would punish himself more than any other person would. He never took his mistakes lightly. He would work extremely hard to ensure that they would never happen again. He was like a machine that never stopped running. He had the utmost belief that his destiny is to become an excellent doctor. He was one of the rare few that actually chose medicine so that they can help others. Clichéd as that may sound; he wanted to save lives. Perhaps he had developed a hero complex from all the cartoons he used to watch back when he was a kid. Amal was his first chance to experience his dream in reality. Sadly, it did not go as he once hoped it would and he, in his opinion, has failed miserably. Therefore, I understood why this particular mistake was not easy for him to deal with. Someone has died and that is not something you can make up for or fix.

Yousef is also the type of man who never conceals the way he feels. He wears his emotions out on his sleeve as they say. You can look at his face and you will instantly know if he is happy, angry, disinterested or upset. That is why when I ran into him at the hospital the following day after Amal’s death I knew something was wrong. Of course, Yousef did not wait for me to ask him what is going on because he simply blurted it all out the minute he saw me. I have been trying to get his mind off her for the past month but to no avail. So there we were at Second Cup in another attempt to bring back the usually cheerful Yousef.

“You are a believer, right?” I said looking into his eyes. He nodded his head, “Don’t you think that God would have inspired you with the things to do if she was meant to live? Don’t you think that Mazin would’ve saved her? Don’t you think that the accident wouldn’t have taken place to begin with? There might be a bigger picture that you’re not seeing. God knows best and we are not to question his wisdom. There was nothing you could’ve done to prevent what’s been written,” I said. “Maybe,” he said, clearly not convinced. “Let’s look at it from a different angle. Don’t you think that you’re a good doctor? Didn’t you do all the reading you should have done and more? Don’t you think you have practiced hard and long enough? Well, maybe they didn’t prepare us to deal with such emergent situations. It’s not our fault. It’s the system’s fault,” I said. “And they leave us out alone in the jungle to learn by ourselves as if it’s fine to lose a few victims along the way, collaterals,” he said with spite. “Anyhow, now that you have taken the BLS again and the ACLS, do you think you would have done things much differently?” I asked him. “I don’t know, perhaps not much. I guess it means I need to take the ATLS course too,” he said. I looked at him in a funny way. This guy will never surrender. Yousef will never change. “Listen, Faisal, don’t worry about me. I’ll be fine. You know I will. I just need some time. This is only a mistake if I didn’t learn anything from it. Anyhow, enough about me. How’s Samar?” he said. “She’s fine. She’s still in Switzerland having fun. I miss her but she’ll be back in a couple of weeks so it’s all good.” I said with a smile at the mention of my fiancé.

We stayed at the place for half an hour more before we decided to go home and call it a night. Ever since we started our internships, sleeping early has become a necessity if we wanted to survive the grueling work. “You know what? If I ever got into a car accident and I was injured and rushed into an emergency room, I would want you to be the doctor treating me. How about that?” I said. He laughed and gave me half a hug. “You know I would take good care of you,” he said then paused for a second before continuing, “Thank you.” He waved goodbye and left.

Twenty years later, my son got into a major car accident and was emergently rushed to the hospital. Yousef, a Consultant Trauma Surgeon then, operated on him and literally saved his life. Amal’s death affected Yousef’s life and mine in more ways than we could have imagined back at the time when we were just fresh interns trying to find a meaning in what seemed like a random and tragic loss.

To be continued…

“Our mistakes should neither be forgiven nor forgotten. Otherwise, we’ll make them again.” – Yousef Nabeel.

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“Beep… Beep… Beep“

I woke up to the sound of my pager bleeping. It took me a few seconds to realize where I was, the Emergency Department’s doctors’ room, or lounge as it was officially called. It was a small room that contained nothing except for a single bed and a rusty closet in addition to a plastic table that had a water boiler and a Nescafe jar on top. The room smelled of coffee, every doctor’s best friend. I had just put my head on the pillow and lied down less than ten minutes ago. Every time I think I can escape and get a few minutes of precious sleep, I get awakened by a nurse paging me, hardly ever for an urgent matter. I thought of calling to ask what the matter is but I had lost all hope for sleep that night. I glanced at my watch to see that it is almost five in the morning. I had lost track of time. I was yet to get used to these night shifts. I washed my face and headed to the ER where I was doing my first rotation of the internship year.

“Dr. Yousef, hurry,” said Alice, the head nurse of the ER as she saw me approaching. “What is the problem?” I asked, still sounding sleepy. “RTA victims have just arrived. Man with his wife and two daughters,” she said, jolting back my senses into me. RTA stands for Road Traffic Accident. “Page Dr. Mazin immediately and page the surgical on-call too,” I said as I ran toward the room she pointed at. Unfortunately, I was not prepared to deal with what was inside of it.

“Dr. Yousef Nabeel. What happened?” I said as I entered the room. I was able to hear the wailing even before I came close to the room. The wailing was coming from a lady in her early forties who was crying her heart out. “Ya Allah, Ya Allah,” she kept on saying. A man in his mid fifties was pacing around in his place saying over and over again, “Oh please God, save my daughter. Save her.” There was a young lady in the room too, probably my age. She was sitting on the chair at the distant corner and seemed to be in shock or lost in her own world. The man had a relatively large bruise on his face. The upper part of his thobe was torn apart and he had multiple lacerations on his shoulder, chest and left arm, none seemed particularly dangerous. The two ladies were disheveled but seemed to be fine with the exception of minor bruises and lacerations on whatever showed from their bodies. The reason for their concern was the girl lying on the bed in the middle of the room.

“Doctor, please help my daughter,” the father shrieked at me when he first saw me. She was unmistakably in a bad shape. It was the first trauma case I have ever encountered and I was not prepared. I did not know what to do. I froze in my spot for a couple of seconds before I shook my head and said, “Inshallah khair. We’ll do the best we can. Just keep praying for her.” “Karin, please take the family and check on their vitals and see if they are complaining of anything,” I addressed the nurse that was present. “Please go with the nurse and someone will be there with you shortly to check on you,” I told the father. “We are not going anywhere until we are sure that Amal is fine,” he said, firmly. I turned my attention to the girl because there was no point of arguing with a worried parent.

“ABCDE; Airway, Breathing, Circulation, Disability, Exposure,” I was thinking rapidly in my head as we were taught. She had a neck collar on. Do we do the head-tilt/chin-lift maneuver in this case or not? I wondered. I just opened her mouth and looked to see if there was anything obstructing the airway. I did not see anything. “Okay, good,” I thought. Her chest was rising up and down but on auscultation, her breathing sounds were muffled on the right lung. Her oxygen saturation was decreased. Her blood pressure was very low and I could barely feel her pulse. She had clearly lost a large amount of blood whether it’s from the openly fractured arm of hers or even worse, internally. Her limbs were cold.

“Insert two large bore IV cannulas and give her a 500ml bolus of Ringer. Send for CBC, Type & Cross Match, U & E’s.. umm.. PT and PT too,” I told the nurse then asked the family, “What is her blood type?” “A+,” the mother replied. “Do you have a document that proves that?” I asked her. “Yes, it’s written in her medical ID card,” she replied. “Tell the blood bank to send four units of Packed RBC’s of A+ immediately. Tell them we have an actively bleeding patient,” I ordered the first nurse I spotted outside the room because Karin was busy with the IV lines. “Quickly, please,” I yelled.

“ABCDE,” I repeated it silently. Disability, I did not check for that. I looked at the girl and she was obviously drowsy. “What’s your name?” I asked. She mumbled something incoherent. “Can you lift your arm?” She did not move a muscle. I pinched her left hand and she withdrew it away. “What is her GCS? There is something missing,” I thought to myself. Shit. My mind went blank and I could not remember the details of the scoring system. It did not matter anyway.  “E is for exposure.” I started taking a quick look at her body to see the extent of her injuries. “Her lower limbs suffered only minor abrasions. Her right arm has an open fracture. Her right lung has muffled breathing sounds but the left lung and arm are relatively fine. Her face is bruised but other than that…” My thoughts were halted when I noticed blood oozing from the back of her head. I turned it to the side to see that there was gauze completely draped in blood and soaking. The paramedics must have had put them there. How did I not know there was an injury to the back of her head? Just as I was inspecting it, I heard the vitals monitor’s loud alarming sound.

Her blood pressure and her oxygen saturation were dropping to dangerous levels. “Where is Dr. Mazin?” I yelled. What am I supposed to do? They did not prepare us for any of this back in medical school. I took the Basic Life Support course more than a year ago. What did they tell us? My mind was racing but my body was frozen in its place. “Call a code,” I almost shouted at the nurse that entered the room that moment. She ran out to give the order. “Please leave the room,” I told the panicking family. “I can’t work with you around. Please get out so I can help your daughter better.” They left the room unwillingly and the mother’s wailing became loud again after it has subdued a while ago. “Code Blue. Code Blue. Emergency Room. Adult Code Blue. Emergency Room,” I heard the operator’s voice delivering the message through the overhead speakers. “Where is that blood? Damn it.” I was losing my self control and starting to panic myself. The nurses came with the crash cart. They did not teach us how to use the defibrillator before! I was sweating profusely as the nurses stared at me expecting me to run the code. “Don’t you understand? I don’t know anything,” I wanted to yell at them. Luckily just then, Dr Mazin entered the room.

“What is going on?” he asked. “RTA victim. Open fractured Humerus. Apparently severe injury to the back of head. Muffled breath sounds on her right lung. She was given 1500ml Ringer so far. And as you can see, patient is coding,” I filled him as he was instructing the nurses on what to do. “What is her GSC?” he asked me. “I do not know,” I said. “What about her abdomen? You did not say anything about it.” “I did not check her abdomen. I’m sorry,” I said with shame building up inside of me. How did I forget to examine her abdomen? He gave me a look as if to say, “An apology does not make up for incompetency.”

I stepped aside and watched as he tried to save Amal’s life. Everything switched into slow motion and the sounds mixed together until there was no distinct sound except for that of the vitals monitor. Her heart flat lined. I saw Mazin doing everything that is medically possible to keep Amal alive. I looked at him with admiration and wished in myself that it was me doing all of that. For nearly thirty minutes, he was trying to spare Amal’s family the tragedy of her loss. Unfortunately, there was nothing he could have done. She passed away. “Time of death: 5:41,” he said mournfully then paused for a second before leaving the room. 

“I’m so sorry. We have done all that we could but she was severely injured. We tried to save her but it was her time. I don’t know what to tell you. My sincerest condolences. May Allah grants her entry into His heaven. May Allah grant you the patience and strength to make it through,” I heard Dr. Mazin delivering the horrible news to Amal’s family as I watched from afar. Her mother screamed in a way that I know for a fact that I will never forget in my life. Her father’s eyes were widely opened in disbelief in a clear state of shock. Her sister broke down in tears. I just watched. Her mother and sister could not hold themselves standing anymore so they sat on the ground and continued sobbing. The father tried to hold his composure. “La hawla wla gowat ella bellah,” he started saying over and over again. He had an empty gaze in his eyes and he was looking directly at nothing. He was shaking his head every now and then. I just watched. There is no dignity in death. It strips you down of all that you are and leaves you bare with nothing except for your beliefs. “Rabby Ajerny fy mosebty hazeh, Rabby ajerny fy mosebty hazeh,” he was saying. I wanted to tell them that I was sorry for their loss but I did not.

I just watched from afar like a coward. If I were brave enough I would go to them and tell them that I have failed them and failed their daughter. I should have been more prepared. I should have known what to do. I should have acted quicker. I should have been a better physician. My heart ached for them. I felt my eyes tearing up so I stepped outside the hospital for a moment. Guilt was devouring me and I needed to escape. The walls were closing in on me. Perhaps the air will cool down this fire inside of me. “It is my fault,” I thought to myself. It is my fault. It is my fault.

To be continued…

PS. This is the first chapter of a new story that I am working on. Don’t get excited yet about anything. I’m still not sure that it will evolve into something big but it’s a beginning nonetheless and Layla started as a single chapter one night two years ago. I hope you enjoyed reading this post. As always, comments and feedback are much appreciated. Thank you.