Omar

I had meant what I said to Madi. When I had entered Noor's room, I did not know Salman was going to be there. But my initial relief at seeing him, and concern for what he must be going through, had quickly changed to resentment when he spoke rudely to Madi. All she had done the entire day was run around trying to take care of Noor, while also somehow managing more than a dozen other patients. I had no doubt that she was exhausted, even if she was trying to hide it behind her cool, calm exterior.

But I also could have told Salman to watch his tone, and stopped there. I had regretted saying more, but words once said can seldom be taken back. So I knew I had to do what I was about to do, even if it meant confronting a man I had spent the better half of last year blaming for my woes.

"Salman..."

His face was buried in his hands. When I called out, he looked up at me with bloodshot eyes, but instead of anger I saw remorse and fear on his face. I know men don't often sympathize with other men, or have sentimental conversations. We are supposed to be factual and non-emotional. To be honest even I have found it a lot easier to pat my male friends on a back and say 'everything will be ok', without delving into any further details.

But I had just spent the last several hours feeling as if a part of me was about to disappear, and Noor wasn't even bound to me by love, or marriage or a new life that hadn't yet entered this world. Looking at him I realized that everything I felt must be a hundred times worse for him, and he was all alone, next to his wife and their baby.

"What do you want?", he asked in an expressionless tone.

I had to come to this room to apologize but also make a point that if he had to leave her maybe he should have had someone check up on her earlier. But it was obvious, that he did not need my opinions and probably didn't care for my apology either, at that time.

"I just came to check on Noor, and...uh...see how you were doing?"

He stared at me for a few seconds, clearly surprised by the latter part of what I had said. But then just looked down and stayed quiet. So I went over Noor's blood pressure, heart rate and oxygen levels that the nurse had charted over the last few hours. Her heart rate had gone up slightly, but the rest of the numbers were stable. The obstetricians had placed a monitor on Noor's abdomen which was constantly monitoring her baby's heart rate. Thankfully, that too looked good to me.

Salman still hadn't said anything but when I was about to leave the room, he spoke in such a regretful tone I had to stop and turn to face him again.

"I should not have left her alone...not when I knew that she had been exposed to the flu virus because we had to emergently intubate our flu positive patient, and she had rushed into his room without wearing the proper protective gear. She was doing her job, but I should have done mine as her husband..."

Never in a million years did I think I would have to comfort Noor's husband one day, but in that moment I found myself responding to him without hesitation.

"There is no way you can know for sure that she caught the virus from that patient. Flu is everywhere these days, she could have caught it while doing grocery shopping..."

"We were on the cardiology service together, it was so busy we hadn't been anywhere other than work and home", he paused, then added, "Besides I should have never chosen my family over her...they are not worth it"

I had no idea what problems he had with his family, but this was not the time to inquire further.

"Salman...I don't know you, but I do know Noor very well...", I started to speak but he immediately he shot me an angry look.

"You used to know her...she is my wife now"

I knew that she was his wife...I had spent the last year agonizing over that fact. But again, this was not the time to tell him to stop rubbing salt in my wounds. So, I put aside my irritation at him and finished what I was trying to say.

"What I was going to say was that she would not want to you to ever think this was your fault...she would want you to just be with her...and pray for her"

His facial expression softened slightly, and he nodded at me. He didn't say anything to me but looked at his wife and sighed.

"I didn't even get a chance to reply to her. She texted me to say to say that she was going home early, but I was talking to my dad's cardiologist at that time, and I had to take him for some more tests after that, and then my sister and her family came over to see him in the hospital. And I just lost track of time...by the time I called her back it was 10 pm, and she didn't pick up. I tried a few more times after that and initially I thought she was probably just sleeping but then I paged her just to make sure that she was ok, and she didn't reply to that either"

Salman looked at me again, "She has never ever not replied to a page. Her pager is always on her bedside table at night, and she always wakes up. That's when I knew something was very wrong..."

He took a deep breath, and I could see tears starting to pool in his eyes, "I guess...I was right..."

I had no idea what to say to him then. But he wasn't done yet...so I kept listening.

"I didn't even tell her how much I love her...and that she means the world to me...she, and our baby...", he took a deep breath, and reached out to touch his wife's hand, "I have no idea what I would do without them"

He was obviously trying to keep himself together. It was so painful to watch him, I couldn't even imagine how much agony he must be feeling. But I could tell that he loved her, more than anything else in the world. And I couldn't help but feel guilty, because all this time he had been the villain in my story. In that moment I realized that he was the man who loved Noor in a way no one else ever could, not even me.

The door to the room slid open, pulling me out of my thoughts. Madi walked in, and looked at both of us with a mixture of confusion and relief.

Did she really think we would be fighting right now?

"Sorry to interrupt, but some of Noor's tests came back. And she is flu positive, but there is something else as well...her blood is growing the MRSA (methicillin resistant staph aureus) bacteria, that we were worried about"

"She has flu and MRSA?", Salman looked at her aghast.

"Unfortunately, yes. But Omar had bought up that possibility on rounds so we already started her on the antibiotics that would treat MRSA, and she is also on the anti-flu medicine. I am hoping that saved us some valuable time and she will get better, faster"

Salman turned towards me and said, "Thanks man..."

I nodded back, "Just doing my job..."

Madi and I went over some of Noor's other test results with Salman and then the two of us left the room. When we were at a little distance from the room, she turned towards me with a troubled expression.

"I didn't say this in there, but I am really worried about her. Her heart rate has trended upwards ever since she got to the ICU despite us giving her extra fluids, so I know she is not dehydrated. I hope she doesn't end up in heart failure"

I had noted her higher heart rate but didn't think too much of it because her blood pressure was still normal without any extra medications to help her heart pump. But Madi was right, her heart was pumping faster in order to keep up with the extra demand her body had right now as it fought two different infections. Not to mention that her heart was also pumping extra blood and oxygen for her baby.

The problem was that the heart can only pump that fast for so long, before it starts to fail. Noor was a healthy, young woman before her illness, so maybe she would be able to keep up with the extra demands of her body. But that was not a guarantee.

"Shouldn't we tell Salman?", I asked Madi.

"I don't think he can take any more bad news. But I also don't think he can do anything for her right now, and he wasn't feeling great himself this morning...", she paused to look at her watch, before continuing again.

"You know what...I am going to tell him to go home for a bit. Its 1 pm, you and I are here for another 4 hours and we can keep a close eye on her. I would rather that he stays in her room in the evening when there is only one ICU team"

That made sense to me, so while Madi went back to Noor's room I went to the residents room to update the obstetrician about the increasing heart rate that we had noted.

Madi popped her head into the residents room to let me know that she had been able to convince Salman to take a break and go home, but she left before I could respond. And I was again amazed by how she was always two steps ahead of everyone else. I wondered, though, how she herself was doing during what was probably the hardest day of her residency.

Has she eaten anything the whole day?

We had been so busy that we had missed noon conference and the free lunch that day, and even my stomach was growling. I texted her to ask if she wanted some lunch, but when she didn't reply for a while I decided to just grab something for her myself.

The hospital cafeteria had a lot of options and I wasn't sure what Madi preferred so I picked up a tuna sandwich, a veggie wrap and a shrimp salad, and then also a variety of energy bars in case she didn't want a whole meal. As I stood in the checkout line I saw the coffee station, so I decided to get a large cup of coffee as well.

I wasn't a coffee drinker, but a fellow resident had once offered to get Madi coffee, and she had told her that she liked her coffee with a bit of cream.

"Put just enough cream that the coffee matches the color of my skin", she had instructed this resident.

So, I did just that too.

Back in the residents room Madi was at her work station and looked up at me when I put down all the food on a table near her.

"Planning to feed an army?", she asked with a small chuckle.

"Actually...I got these for you. I don't know if you saw my text, but I figured you might be hungry..."

She paused typing and looked at me then the food on the table, her lips slightly apart, as if she was surprised at that gesture.

"My sister keeps texting, so I put my phone on silence, but Omar, this is...uh...really sweet of you. You didn't have to..., she said in a soft voice.

"Yes, I did Madi. You've been running around the whole day, this is the least I could do", I replied, as she walked over to the food table. Honestly, any other intern would have done the same for her. And I would have done it for any other senior resident.

It's not like I am treating her any differently!

"Take whatever you want, and I'll keep the rest, and the coffee is for you too...I'm going to go check on Noor"

"Thanks Omar...especially for the coffee, which is perfect...", Madi said taking a sip, "How did you know how I like my coffee?"

It felt weird telling her that I overheard her conversation, or that I was picturing her face when I got that coffee for her. She had a really attractive face, but that's an opinion I would rather keep to myself!

So, I just smiled at her and said, "I guessed... and you are very welcome!" then walked out of the room.

And it was a good thing I went to Noor's room then because the nurse, Amber, was standing outside with a nervous expression on her face.

"Doc, good you are here, I was just about to page you...I don't like the way our patient is looking"

Oh no!

The thing you need to know about Amber is that she had been an ICU nurse for the last 20 years. She had seen things and done things that surpassed Madi and mine, and maybe even the fellow's combined experience. I had learned very early on in my ICU rotation, that when nurse Amber tells you something is not right with her patient, she is almost always on the mark.

Which is why when she told me that Noor didn't look good, I immediately went into her room. And she was right, Noor's heart rate was higher than before. But now her hands and feet were also cold, another sign that her heart was struggling to pump blood effectively to all parts of her body.

"Ok, lets give her a fluid bolus and I am going to page the team and the obstetrician"

The fluid would increase the volume of blood so that there is more for the heart to pump, but unfortunately that would also dilute the oxygen carrying red blood cells which meant less oxygen being delivered to the baby. So, it was only a temporary solution. In a non-pregnant person, we could give medicines to help the heart pump better, but in her those medicines could cut off blood to the baby.

In short, we were quickly running out of options...

When the team gathered, we started to discuss the pros and cons of all the available treatment options, one of which was to do a c-section and deliver the baby so that Noor's heart wasn't pumping for two.

"Madi, we need to get Salman on the phone", I whispered to her as the attendings stood around discussing the next steps, "He needs to be a part of this discussion..."

"Agreed...", she replied as she dialed his number on her cell.

By now the neonatologist, pediatricians who have specialty training in taking care of premature infants, had also joined our team. And as soon as Madi caught up Salman and the rest of the team on change of events that had happened over the last half hour, we started to discuss our options again.

"No matter what we do from here on, the baby is at risk of getting hurt in the process...", our attending started speaking.

"And that is why I think that we should do a c-section and get the baby out now...it sure beats having to do a crash c-section while you guys are trying to resuscitate the mom", the obstetrician added.

The mom has a name...

I don't know why that thought came into my mind, but it did. She meant something to those in her life.

Salman interrupted over the phone and asked the neonatologist what she thought about the chances of the baby's survival.

"Sal, you're a pediatrician so you know from the time you rotated with us, every day and week counts at this age. However, your baby would be about 29-30 weeks and while each baby is different, we do know that with the right support many of these babies do well. I guess...what I am saying is that I don't know if the benefit of continuing the pregnancy for the baby's sake, is worth the risk to mom"

No one had put this in words so far, but we all knew the question we were facing at that point: Whose life is more valuable? Noor or her baby?

And the silence in that group was evidence that the decision on how to answer that question lay squarely on Salman's shoulders. Even I could barely breathe under the weight of that decision, for him to have to answer it knowing that the two people who mattered most to him would be affected no matter what he said was unimaginable.

Finally, he replied. His voice was slow and deliberate, the sorrow in his voice was obvious, "Do whatever you need to, to save Noor's life, I know we have one of the best neonatology teams in the country...I trust them to take the best care of my baby"

We all nodded, knowing what we needed to do. The neonatologist asked her team to get their infant resuscitation kit and come to our ICU and the obstetrician's team got the c-section supplies ready. Salman had texted Madi that he was waiting to catch an Uber since his car was still at the rest stop along the highway.

We had every intention of waiting for him to get to the hospital, but just then several alarms starting beeping in Noor's room. Her blood pressure had dropped significantly and so did the oxygen levels.

"We are out of time...", the ICU attending declared, as several people rushed in to the room.

Madi and I adjusted the settings on the ventilator and the oxygen levels started rising again, but we both knew this was not going to last long.

"If you are not going to be involved in the c-section, please clear out the room immediately", the obstetrician called out as she gowned up quickly and prepared to deliver the baby.

Outside the room, Madi looked more tense that I had ever seen her before.

"This is not good...this is horrible...I just wheeled her up here this morning...", she said to no one in particular.

But she was right...it was only a little after 3 pm right now. It was 6 am that morning when we had first heard about her being in the ER. So much had changed in the last 9 hours...

Through the ICU room's glass door we all watched in an anxious silence. You could still here the alarms beeping in the room, but everyone had a singular focus right now...deliver the baby as safely as possible, so that we could treat Noor appropriately.

I looked at my watch, even if Salman had gotten on the Uber at the moment he had texted Madi, he would still be about 10 minutes away.

He should be here with her...she would want that!

But then something occurred to me.

"Madi...is there any evidence that sedated patients are able to hear people?"

She gave me a confused look, but answered anyway, "It seems like it...there are a few studies that showed sedated patients benefiting emotionally and maybe even medically from verbal communication...why?"

I paused for a second but then started to wear the mask, gloves and gowns I would need to in order to enter Noor's room.

"I have to do something...", I told her.

"Do what? Omar...its a sterile field in that room, you can't just enter it", Madi furiously whispered to me.

I knew the c-section was being done in a sterile field, the obstetrician had basically converted the ICU room in to an OR. But that's why I was getting myself ready. Besides it wasn't the c-section that I had wanted to be a part of. I had wanted to tell Noor something, even if she was sedated, on the off chance that she may actually hear it.

No one bothered looking at me when I entered the room and made my way to the head end of the bed and leaned in just enough so that she might hear my voice. Then I said something that I never thought I could bring myself to say to her, but I hoped that some subconscious part of her would hear those words and it would make a difference.

"Noor...this is Omar, your friend. Listen...Salman is on his way, but he wanted you to know that he loves you very, very much....and that he needs you to fight for him and your child...ok? Please don't give up...Noor, your family needs you. Hang in there...you need to get better for them"

Then I said a silent prayer and walked out of that room and stood next to Madi again who was looking at me as if I had grown horns.

"What did you say to her?"

"That her husband loves her and needs her to fight for their family...", I replied without looking at her.

Maybe I didn't have any right to interfere in her life at all, or speak on behalf of Salman. But before everything she was my friend and I could never stop caring about her. And as her friend I thought she would benefit from being reminded what she had to live for.

Madi was still looking at me with a surprised expression, and then I realized why

"I thought you were going to tell her that you were in love with her..."

What?