Mid-March 2020

Madiha

Morning rounds in the hospital were starting to look a lot different lately. My patient list had 30 patients on it, every other one had COVID. Chicago was still not as bad as New York where the National Guard (a branch of the US military that is activated in times of federal emergencies) had been called in to set up extra tent hospitals. On March 11, the World Health Organization (WHO) had finally declared this to be a COVID pandemic.

There was palpable fear in the air as we made our rounds. We were running out of isolation rooms, and had abandoned trying to put all COVID patients into such rooms. For now only patients on a ventilator or needing a breathing treatment that would result in release of a large number of viral particles in the air, were being put into these special isolation rooms. The rest of the patients were in regular rooms, which increased the risk of spread of this virus to the rest of the hospital staff and non-COVID patients.

While the intern presented the updates on his patient, I checked my phone again to see if Omar had left a message or texted. There was nothing.

Given his research expertise in the area of respiratory viruses he had started to work with a virologist in her lab to understand how the SARS-CoV-2 virus was infecting the lung tissue. But that was volunteer work, after he did his regular shifts in the hospital. Which meant that he was literally working 18 hours a day, and had no time to do anything else...including texting or calling me!

We had chatted off and on at noon conferences and grabbed coffee a couple of times last week but then this week the city of Chicago went into lockdown. All meetings were moved online, including our noon conferences. Everyone not involved in direct patient care were asked to work from home. Even some of those physicians who were taking care of patients were asked to do it remotely via telemedicine. Those of us who did come into the hospital were asked to leave promptly after our shifts.

For a couple that depended on casual run ins, because dating wasn't acceptable in our culture and religion...a lockdown meant zero chances of meeting in-person unless we worked together.

Or lived together...after marriage

Omar had told me that the conversation with his parents was on hold because an emergency had happened at their surgical equipment factory the day he had planned to talk to them about us. Following that, his father had jetted out of the country again. At the time I was disappointed at the delay in us finally being together. But since then the pandemic had moved so quickly across the US and things were changing on a daily basis, that marriage was the last thing on my mind.

I still wished I could communicate with Omar more frequently. He had been my source of calmness in the past, and now with all the rapid changes my anxiety was worse not knowing where he was and what he was doing.

Hopefully, he doesn't think I will become one of those nagging wives who don't give space to their husbands...but I need to know he is safe

I tried to not be the kind of woman who purposely remains an enigma. If I needed something I usually asked for it. And right now, I needed to know that despite the chaos around us, Omar and I still had something special.

Fine if he won't text me, I'll text him.

'What are your plans for the day? Telemedicine clinic again or are you in the hospital? Please stay safe whatever you do'

I went back to paying attention to the intern's new patient who was admitted last night with a stroke due to a blood clot in his brain. We had placed the 51 year old man in a non-COVID section of the general ward initially, but quickly realized that while he did not have the typical COVID symptoms his wife had recently been admitted to the hospital with COVID. And sure enough his own test came back positive as well.

"I have never seen a viral infection cause a stroke in a relatively younger, otherwise healthy patient. This is insane...I don't know what this virus is doing, it's not behaving like we would expect most other respiratory viruses to", my attending shook his head as the intern showed him a paper on brain complications from COVID, that was recently published by a group in Italy.

This wasn't our first patient with those symptoms either so I chimed in, "We tried to put our last patient on blood thinners for the stroke, and he ended up bleeding from his lungs...its like this virus affects so many organ systems at the same time, you don't know what to fix and what to leave alone"

"Good thing the death rate is still only like 1-2%...", the intern noted.

But the attending immediately dampened his optimism, "Yes, but at the rate its spreading even a death rate of 1-2% means millions of deaths if we can't control it soon. It is simple maths"

While the attending went in to see the patient, I answered a few pages from the ER. Similar to the half a dozen pages I had already received that morning, more patients with presumed COVID were on their way up to us. I had no idea where these patients' would all go. We were running out of beds in the hospital.

As I was about to join the team, I heard my phone's text notification sound and I couldn't help but break out into a big smile.

Finally Omar!

But alas, the message wasn't from him. It was actually from Faraz, Maliha's brother-in-law, who I had met only a few times after our initial meeting at her wedding.

'Hi Madi. This is Faraz. Could you give me a call when you are free...no rush. I have a pandemic-related proposition I was hoping to get your input on'

Pandemic-related proposition?

I figured it was probably related to a tech-based solution to the pandemic. We were at the stage where everyone was willing to use whatever tools they had to help medical professionals and scientists to figure out a way to stop the spread of this virus. So, I told him that I would call him back in the evening and joined the rounds again.

It wasn't till I was gathering my stuff at the end of my work day when I finally received a reply from Omar.

'Sorry Madi, the day just got away from me. Had back to back telemedicine patients, but going into the lab now. Hoping that the virus has grown in the cells I infected yesterday. Need to start doing some experiments soon. Stay safe'

No love you, or miss you, or can we see each other soon?

He had told me that he loved me one time, and only that one time...a few weeks ago. I was dying to hear those words from him again, especially this week. But I also understood and appreciated him holding back, it wasn't easy being in this weird holding pattern and trying to maintain our boundaries. Besides, I had been too shy to say those words to him so I probably should not be expecting anything from him either.

But then something occurred to me. There was no reason why we couldn't share a simple meal at his lab, or outside the lab...in the open, as just colleagues. We both would have to eat at some point, and I could just order some take-out. With all the restaurants having to shut down their dining spaces, it would actually be a good deed to help the nearby halal eateries with maintaining their revenue flow.

So, I ordered halal Indian-Chinese food and decided to wait outside the main entrance for the food to be delivered. This was Chicago, so the weather was still relatively cold, but with a jacket on it was actually quite comfortable.

And, I can call Faraz back. Wonder what ideas he has...

Omar

I looked at Madi's text message again, and it made me want to punch something. Not because of the message itself, but because I knew I was not worthy of the sentiments that it was sent with. Yet, I craved it, and her...and any other indication that she was still interested in me.

I hated lying to her, but I had no choice. There was no way I was going to break her heart, and tell her the truth about the conversation with my parents. I had told her that I would never let anyone dim her light, but every word that my parents had uttered on that phone call would shatter her.

I could never do that to her. I had to protect her from feeling anything less than the incredible woman she was, and so I lied to her.

They were my family, and I had to fix their mess before I told her the truth. And I had spent everyday of the last week trying to do that. I had tried to talk to my parents again, but they had refused to even pick up the phone. I had talked to my sister, but my parents had refused to talk to her on this topic as well. A relatively open-minded uncle on my dad's side had promised to talk to my parents, but he couldn't convince them either.

Finally, I had messaged them, begging them to accept Madi in return for me giving up my medical career and getting involved in dad's business full-time. He had always wanted me to do that, and not doing medicine was a small price to pay for a lifetime with the woman I was desperately in love with. But there was no response.

So, I booked a flight to Karachi hoping to talk to them face-to-face. But then WHO declared the COVID outbreak to be a pandemic, and with that international borders started to shut down and flight after flight was cancelled...leaving me completely out of options.

Except one, we could just get married without any support from my parents. But that would require telling her the truth. A truth that would confirm her fears and probably convince her that we had never made sense together, even if I had tried to convince her otherwise. And then she would run, like she had before.

I would lose her...no matter what I did from here onwards, I risked losing her. And that would destroy me, so I did what I do best. I buried myself in work.

Working two jobs everyday gave me an excuse to not face her, and it kept my mind off the disaster my life was. And maybe some of the research work I was doing would actually help identify a cure or a vaccine against this virus and help in controlling this pandemic, so that I could travel to Pakistan.

"Hi Omar...", Dr Emily Sanders, the virus expert at our institution, called out to me as I entered the biosafety level 3 (BSL3) lab.

The area where we conducted the experiments was walled off with floor to ceiling glass, and had a special ventilation system that kept all the viruses from escaping that area. In order to get into the BSL3 area we had to wear special bodysuits that covered us head-to-toe. The headgear was hooked on to an oxygen supply so that anyone who was working in that space was protected from the contaminated air.

"Looks like there is plenty of virus growing now, and we just got a fresh set of respiratory cells from people who had mild or severe infections. So you should be all set to do your experiment now", Dr Sanders updated me, just before she headed home.

The experiment she was talking about, essentially included infecting the respiratory cells with the SARS-CoV-2 virus and then looking to see what kind of immune reaction those cells had. We hypothesized that the cells from patients with mild disease would react differently than those from patients with severe disease. If our hypothesis was true, it would mean that the severity of illness was due to a person's own immune reaction to the virus and not the so much the virus itself. And that would be the first step in identifying effective therapies for COVID.

I had just stepped into the BSL3 area and was setting up my all my lab equipment when I heard a voice over the intercom.

"Omar...?"

I could feel my pulse quicken even before I looked up to see her through the glass walls. But when I did see her I had to catch my breath too. Her hair was pulled back in a loose bun with strands of curly hair around her face. While the lower part of her face was covered by a mask, it made her beautiful eyes even more prominent.

I have got to stop reacting to her like this everytime I see her...

She pointed to a brown paper bag that looked like it contained take-out food. Then she spoke through the intercom again.

"I ordered some dinner...if you have time to eat..."

Every brain cell was telling me that I should make up an excuse to stay away from her till I figured out what to do about my parents. But she was standing there, asking me to have dinner with her in that sweet, innocent voice of hers and I had missed her so much over the last few days...my brain's logic didn't stand a chance.

A few minutes later I had taken off my protective gear and had decontaminated myself before wearing my regular mask. Our hospital required masking in all indoor areas now.

"What are you doing here?"

"Well...I thought you might be hungry. You've been working such crazy hours. I'm sorry...I didn't mean to interrupt your work", she replied.

"Don't be sorry at all...I have been living on Maggi noodles so an actual meal sounds like heaven"

Especially, if I get to share it with you

We stepped out of the building, so we could take our masks off and walked to the main courtyard between the biomedical research buildings. Usually this area was teeming with students and researchers. Now it was completely deserted.

I put down the food Madi had bought on an empty table and we sat across each other. It was cold outside, but the chicken corn soup which was still piping hot felt amazing. Over hakka noodles and chicken chowmein we talked about the pandemic and how it was affecting the hospital operations around the country, including our own hospital.

At some point her phone pinged multiple times in a row, and I asked her if her parents were getting concerned about her.

Looking at her phone, she replied, "No, it is not my parents, I am staying at a hotel nearby. I didn't feel comfortable going home and potentially spreading the virus to my parents. The older population seems to be getting affected the most. These texts are actually from Faraz"

I had to stop eating and ask, "Who the hell is Faraz? And why is he texting you?"

I wasn't ever going to tell her who she can and cannot talk to, but a desi-sounding guy, who I had never heard of before was texting her multiple times outside of regular work hours. So I needed to know...sorry, not sorry!

"Are you jealous?", she replied with a amused smile.

"Depends on what he wants...and whether or not he is married!"

"So I am not allowed to text unmarried men?", she laughed, ignoring the first part of my answer, "Does that rule apply to you too?"

I pretended to frown at her, "No! I don't count since I will be getting married to you..."

"And Omar, when might that be?", she asked.

I thought we were still joking around, rather I hoped that we were still joking, because I was no closer to figuring out how to get us there than I was last week. But when I looked at her, the serious expression on her face said otherwise.

"Now that international travel is almost shut down, has your dad returned to Pakistan yet?", she pushed further.

I was gazing at her, but I had no idea what to say. My brain stopped functioning altogether in that moment. Do I tell her the truth and risk her pulling away from me, or do I keep lying and pray to God that this pandemic was contained quickly so I could try to go to Pakistan?

My inner debate and subsequent loss of words were enough to make her suspicious, "Omar, is there something you're not telling me?"

She deserves the truth...however, painful that might be

No, no...I am not ready for this. I am not ready to lose her...not yet...

"Madi...I...uh...", I tried to say something, but had not been able to decide yet exactly what and how to tell her.

"Omar, just tell me the truth...", she looked at me with moisture building in her eyes.

I couldn't bring myself to say the words, but she had already understood what my silence meant.

With her lips quivering, she whispered, "They said no...didn't they?"

I reached out to hold her hand, but she pulled it back and asked me, "Is it that architect girl? They want you to marry her?"

Madi deserved the truth. It would have been easier to just blame this on a friend's daughter's rishta, but that was not the whole truth. And I couldn't keep deceiving her any longer.

So I shook my head, "It's not her..."

Madi's eyes darkened and a defiant look came over her face as she nodded slowly, "Then it's me...they don't want you to get married to me because of who I am..."

"No Madi...it's them. You are perfect...", I tried to tell her.

But I could already see her closing herself off to me. I saw it in the way she got up from the table and backed away from me, and the glazed look she had in her eyes as she looked away from me.

"What is it...about me that they didn't approve of?", she asked me with a flat tone.

I got up from the table to walk closer to her, but she only back away more, "Don't come near me...and don't you dare patronize me Omar. I want the truth...at least have the decency to be honest with me..."

"Madi...I am so sorry...the only truth you need to know is that I will fix this, I will find a way for us to be together. Please...just trust me...I will make my family change their minds", my voice cracked as I begged her to give me a chance to figure things out.

But she was in no mood to give in to me, and replied in a raised voice that I knew was only a cover for the panic she was feeling inside, "I did trust you...Omar, I trusted you when you told me that your family would accept me. But where has that gotten me?"

I tried to calm her, but she lowered her tone and asked again, "If you have any respect for me, Omar, you will stop lying and tell me exactly why your parents' didn't think I was suitable for you. I guarantee you it wouldn't be anything I haven't heard before..."

I did respect her, and if she wanted the truth I felt obligated to give it to her. And so I told her the milder version of everything my parents had said...including that they hired a private investigator. She was smart enough to have figured that out herself.

She had absolutely no expression on her face, there was no anger, no disgust, not even regret...she just stared into space as I talked.

I told her repeatedly that I was so sorry, and that I loved her and would find a way for us to be together. But it was like she was in a soundproof glass room, like the BSL3 area but without any intercom. I could see her, but I couldn't reach her either mentally or physically. Everytime I took a step towards her, she took two backwards, until she just turned and ran towards the parking lot.

"Madi...listen...please just stop and listen to me", I called out as I caught up with her.

She did stop and turned to look at me with icy, emotionless eyes, "I already heard you...I heard every word of what you said back there. And I need you to stay away from me right now...I just need space..."

With that she turned and started walking towards the main road that led back to the hospital. I thought about following her, but she was so hurt and probably disgusted by me, that nothing I would have said or done at that time would have helped.