Madiha

"Hello", a hesitant, but familiar voice had spoken on the phone.

Omar?

My heart had raced at the sound of his voice. Mama had messaged saying that Papa was in the ER at the community hospital near our house with chest pain. My first thought was a heart attack, given his age, even though he was in reasonable health overall. In the panic that ensued after that I had called my father looking for more details, as I tried to locate my attending so I could leave work early. My father didn't know all the details so I had asked to speak to his physician.

But I stopped dead in my tracks when I heard his voice. I didn't know he was rotating in the ER all the way out in the suburbs. I hadn't seen him at noon conference for a few weeks and I had just assumed that he was travelling across the country, interviewing for his surgery residency positions. Hearing his voice calmly explain what was going on with my father, and then reassuring me that he'll take care of him had meant so much at that time. I trusted him as a physician, but more than that I trusted him to give me the truth about my father. So when he said, "I think he just has heartburn", I believed him.

I had debated taking off early anyway, but just then a whole family had been brought in by the paramedics with exposure to carbon monoxide from a faulty gas heater, and I knew the ER team would need all hands on deck to treat them quickly. So as much as I would have liked to have been the person to pick up my father from the ER, and meet Omar, I told my sister to pick him up instead.

Maybe, I should have thought twice about that though, because Maliha had left me an excited message on the phone soon after she picked up Papa.

"Madiii...I know who he is, the guy who dropped you off in a Porsche. And I approve!! Even Papa said he had great bedside manners"

Of course my family would like him, it was difficult not to, with his thoughtful and compassionate personality. But even those personality traits had a limit. And though some of that softness had returned in his voice when we had spoken on the phone yesterday, I wasn't sure if we would ever get to the point before my ridiculous meltdown in the residents room.

There was heavy snowfall today so my commute had been a nightmare, but when I finally made it to the ER for my 8 am shift, I wondered if I should just reach out to Omar. If he truly hated me, he wouldn't have said 'it was nice talking to you'...would he?

I walked into the physician's work room, but before I could put my bag down I heard that low-pitched, deep voice that had given me goosebumps yesterday.

"Hi Madi"

For a moment I thought I was just imagining things. He wasn't supposed to be here. He was supposed be working at another ER miles away from me.

But then he said, "The snowstorm outside is insane", making me swing around to look at him.

He was standing at the entrance of the work room, with his backpack slung over one shoulder and the other hand tucked into the pocket of his winter coat. Snowflakes littered across his thick wavy hair, and a few damp locks fell across his forehead. He gazed at me with his lips slightly parted and an expression that I had not seen before. Almost like he was stunned, or couldn't find words.

What is he doing here?

Before I could say anything, he strode past me and put his bag down. With a slight smile, he said,

"You changed your hair", his voice still in that low tone, as if he was a sharing a secret just between us.

He noticed!

I had recently gotten a haircut, in an effort to get myself out of the slump I felt like I was in. But that morning I did not have time to straighten my naturally curled hair, so I just blow dried them lightly and pinned them back. If I had known he would be here I would have put some more effort into my appearance.

"It looks really nice", he said, as his eyes wandered across my face.

Or maybe it's good I left my curls as they were

His smile widened as he said, "Looks like we are working together today "

That is when I realized that I hadn't said a word to him since he entered the room. I had not even put my bag down, and had just been staring at him awkwardly.

Come on Madi, get yourself together...since when have men left you speechless?

"Yes! It looks like we are...", I smiled back at him, hoping he wouldn't notice the heat in my cheeks.

I wasn't exactly sure how that had happened, but I wasn't going to question it. I figured one of the other interns was probably out sick, there had been a viral infection going around the hospital staff and we had been very short staffed recently.

"How is your dad doing? Hopefully, his chest pain resolved completely", Omar asked as I finally put my bag down and pulled out my stethoscope.

"He is much better, as long as you ignore his bruised ego from Mama's lecture after he reached home yesterday"

That made him laugh, and I couldn't help but grin at that. It was almost like us being back in the ICU. Back when I felt I could just be myself around him, without him judging me or expecting anything from me.

But as much as I wanted to just stand there chatting with him, and laughing, I was still a senior resident and he an intern, and we both had jobs to do.

"Come on, I'll introduce you to the ER team", I told him as we left the workroom.

Given the size of our ER, we had three ER teams, A, B and C. Omar and I were scheduled to work on team A today so I introduced him to the attending, Dr Lopez, the head nurse, Fen Wang, and the other intern Elijah Jayden.

Interestingly, our team today comprised only of people of color. Which should not be a surprised given how diverse Chicago was, and hence our hospital staff. Even though all my colleagues were great, I always felt a different kind of camaraderie with colleagues who were people of color, especially given the racially charged and anti-immigrant environment we lived in these days.

"Good morning Omar and Madi, this promises to be a doozy of a shift, and not in a good way. The storm outside will inadvertently lead to accidents, so be prepared for anything", Dr Lopez said, as we gathered around him.

Fen Wang, our head nurse, spoke up as well, "Thanks Dr Lopez, if things start to get bad, we will initiate incident command at which point I and the charge nurse will decide where each patient goes. Interns, your job will be to assess the patients quickly as a first pass, you guys let Madi know about the severity of illness or trauma, and Madi will decide the order in which these patients are cared for. And obviously, Dr Lopez will supervise everything"

The incident command system, is a standardized command, control and coordination system in response to an emergency, which aims to create a hierarchy within the medical system so that things works in a focused, efficient way instead of everyone working in parallel. We all nodded in near unison before walking to our individual workstations.

"Sounds like our ICU rotation all over again", Omar said, as he logged into the computer next to mine.

"Yeah, it does...but somehow we still managed to do a pretty good job", I replied. And our individual evaluations had reflected that.

"We make a good team...", he smiled at me warmly.

"We do, don't we...", I looked at Omar who held my gaze for a few seconds before looking at his computer again.

Madi, do it now. Apologize again for your meltdown and set things straight with him...now

"Omar, I am so sorry about my meltdown in the ICU"

He smiled at me again, "It's ok Madi, we both said things we shouldn't have", but then he became more serious and lowered his voice, "What happened to you, though? You were like a different person altogether"

I was...am...falling for you

But I could never really tell him how I actually felt, so all I said was, "It was nothing, I was just having a moment"

I am pretty sure that he did not buy that explanation because he looked like he was going to question me more, but thankfully Fen came over then and handed Omar some paperwork for our first patient, a 52 year old with a history of kidney stones who was having intense back pain again.

Whew! Saved by Fen...

Elijah then went in to see a 20 year old who was brought in by ambulance after a possible overdose, and I went into see a pregnant woman who was having pain on urination.

After Noor, pregnant women scared to my core, so I was adamant to run every test on this patient to make sure that we would not miss anything. Turned out, she only had a urinary tract infection, and I discharged her with some antibiotics and told her to follow up with her obstetrician.

But that reminded me to check up on Noor. I had been meaning to call her but just hadn't had time recently , and maybe part of me still felt guilty about nearly causing her harm because of the disappearing stunt I had pulled in the ICU. So I quickly texted her, asking her how she and Ayah were, and went to in to see my next patient.

The first hour of our ER shift went by smoothly. But then as the morning traffic started to backup on the highways which were rapidly accumulating snow, our ER started to fill up triggering incident command and we went into an assess-prioritize-act mode. Both Elijah and Omar were among the best interns I had worked with and our team seemed to work effortlessly as they rapidly assessed the injuries of patients that were sent to them by Fen and the charge nurses. Once they had done the assessment, they would report to me and I would either work with the interns to stabilize and manage the patient if they had minor injuries or quickly escalate care to the attending and the surgical trauma team if the injuries were life threatening or disabling.

We had managed more than a dozen patients using that strategy when a new patient was wheeled into an empty ER room. He seemed to be a younger man, perhaps in his mid-twenties, was covered with tattoos, and was shouting profanities as Fen followed him into the room. She came out soon after, red in the face, and on the verge of tears.

"Fen, what happened?", I hurried up to her.

"That douche bag only has minor injuries from what I can tell, but he is covered with Nazi symbols and said that he only wants to be treated by a White, male physician. I told him we didn't have anyone on our team that identifies as White only, so he threw the bedpan at me and told me to stay away because he didn't want to get the China virus from me", she relayed her experience to me.

"I think you should let Dr Lopez to handle this, he may be a Latino but as the attending he would know how to handle the idiot in Room 5", she advised.

But Dr Lopez was busy in the trauma room stabilizing a patient that had come in with multiple fractures and glass shard that had penetrated his abdomen.

That would leave Elijah, who was an African-American and no way was I going to throw him under the bus with a white supremacist. Then there was Omar, who was also a brown-skinned man, and as his senior resident I needed to protect him too.

"Dr Lopez is busy, and I am not bringing the interns into this mess, so I'll take care of him myself...Fen, could you alert security, just in case something happens"

"Madi, are you sure..."

"I am..."

The upside of having to live with dark skin was that there wasn't much else someone could say to me that I hadn't already heard, and learned to ignore. As unpleasant as this experience may be, at least his hateful words would be from a deranged stranger who was shun by society for the most part. His words could never hurt me the way the words of close relatives and people from my own background did.

I'll be fine...I can take it

I was just starting to look through the medical chart of this new patient, Mr Spencer, when I saw Omar getting ready to enter his room.

"Hey Omar", I quickly walked over to Room 5 before he could enter, "Listen, I'll take care of this patient...why don't you take the next one"

"Why?", he asked me with a confused look.

"I know Mr Spencer, from before. I took care of him in the hospital and I thought he could use a friendly face", I told him, hoping that he would buy my excuse. There was no point in explaining the real reason to him.

"Ok, I'll see if Elijah needs help...", he shrugged and turned to walk away, but then stopped and looked at me again, "Madi, how are you doing? I feel like you've been running around non-stop since this shift started"

I don't know why, but that just made me want to hug him. In a world full of men like Mr Spencer and others that were perhaps not so outrightly racist or misogynistic, there were also men like Omar, who were concerned about their colleague running around when they themselves had been doing the same.

I took a deep breath, and smiled at him, "I am ok Omar, thanks for asking...are you doing ok?"

He nodded, and smiled back at me, "I am, but if you need anything with Mr Spencer...just ask"

With that he left to find his co-intern, but I stood there for a few more seconds. I loved working with him, not because of whatever feelings I was developing for him, but because he saw me as a person, not just as a physician who was there to do a job. And even if we never had a future together, I would always appreciate moments like this.

Ok, stop daydreaming...time to face the music

I straightened my white coat, and stethoscope and put on the most confident look that I could muster, and stepped into Mr Spencer's room.

"Good afternoon Mr Spencer, I hear your car was in a pile up on Lakeshore Drive. What exactly is hurting right now?"

"What the fuck? I specifically asked that Chinese woman to get me a White, male doctor. You are neither! Get out of here...", he snarled at me.

"I am sorry Mr Spencer, but we do not honor requests like that here. Now I need to take a look at that wound on your arm", as much as I wanted to scream at him, I answered him in a calm, even tone.

But that triggered him even more, and he pushed my hand away aggressively when I tried to reach out take a look at a deep gash on his heavily tattooed arm.

"Get me a fucking white doctor, otherwise get out of my face. I have had enough of you uneducated dirty immigrants who are taking all our jobs", he yelled out.

"Keep your voice down Mr Spencer, don't make me call security", I replied to him in a stern voice. There was nothing I could do if he did not want to get treated, he was free to leave, but I would not tolerate being yelled at in my ER.

But then something else occurred to me. I normally would not push back against the ridiculous beliefs of my patients, that was not my place as their physician. But this patient had said something that just irked me in the wrong way.

"I have to apologize Mr Spencer, I did not realize that you had gone to medical school"

As I had expected, he gave me a perplexed look and said, "I have not gone to medical school...if I had, I wouldn't be here..."

"Oh ok, I thought you did, because you implied that I as a second generation immigrant physician had take your spot in the job market...", I replied to him with a straight face.

That seemed to have gotten the point across to him enough that while he still refused to let me examine him properly, he didn't object to me looking at the gash in his arm again and washing it with saline (saltwater). It was a deep one and would need to be stitched in two layers, so I stepped out to get a suturing kit. But I had only taken a few steps when I heard his monitors start to beep.

I rushed back into the room to see that his oxygen level had suddenly dropped from 99% to 89%, and he was having difficulty breathing.

"What happened Mr Spencer?", I asked, listening to his lungs.

"I...I...don't...know...can't breathe", he struggled to get his words out.

When I listened to his chest using my stethoscope I could barely hear any breath sounds on the right side, so I asked for a stat chest xray.

As the xray technician rushed in with the portable xray machine so did Omar and the attending. Both balked at the Nazi symbols tattooed on the man's arms and neck, but recovered quickly enough to look at his chest xray with me.

This is what we do...patient care above our own feelings, always, even if it sucks sometimes

"He has a broken rib on the right side, that is probably what punctured his lung", Dr Lopez said

The punctured lung would have leaked air into the space between the lung and the chest wall making it difficult for that lung to expand.

I grabbed the needle decompression kit, and told our patient what was happening, "Mr Spencer, I have to stick this needle into your chest to let the air out"

His oxygen level was at 85% and he was in obvious distress, yet he frowned and said in a voice that was barely audible, "Get...away...you...dirty...bitch..."

God help this man, if he can't even let his hatred go when he was getting sicker by the minute.

I hoped that no one else had heard that, and I decided to ignore his cussing and stick the needle into the top of the right side of the chest letting that air out and allowing the lung to expand again.

Unfortunately, Omar did hear it and he said loudly, "What did this man just call you?"

"Omar its ok, just ignore him...", I told him.

Dr Lopez moved towards Omar and whispered something in his ear, which seemed to calm him down. A few minutes passed, and the patient's oxygen levels started to come up again and soon normalized. The attending got called away, but Omar stayed which made me a bit nervous because it was only a matter of time before this patient's racism would be on full display again. And sure enough, as I was listening to Mr Spencer's lungs he aggressively shoved my arm away.

"Did you not hear me...dirty bitch, I have a right to be treated by a doctor who doesn't have a low IQ, like you filthy dark-skinned people", He scowled at me.

"Hey!...Watch your mouth, she is one of the most brilliant physicians you....", Omar yelled back at my patient.

Before he could finish, I grabbed his arm and pulled him out of the room.

"Omar...quit it, ok? Just ignore the guy, as soon as I am done treating him I am going to call the patient relations team and they can handle him. But let me do my job, without agitating the man"

"Madi...he has no right to call you such despicable names...", he replied angrily.

"I've been called worse...it's not a big deal. Let me handle this my way..."

"What do you mean you've been called worse?", Omar asked, frowning.

"Let it go Omar...", I turned and left him standing near the workstations.

I wasn't in the mood to let it go that easily with the patient, though, so I asked a security guard to accompany me. From then on, the Caucasian, burly, security guard stood in the room, as I sutured up my patient's arm and asked for the orthopedic surgeon to take a look at the man's ribs to see if he needed surgery.

Had he allowed me to take a look at his chest earlier, we could have prevented his lung from getting punctured and possibly avoided a surgery. But his hatred for me and others like me cost him the medical care he should have received.