Hijab

Prologue

My name is Guru. That is not my given name. Yet, that is how I’m addressed by my friends, my co-workers, and my patients. I do have a first, middle and last name. I live in a small town called Amoka in the state of Minnesota, working as an emergency physician in the only hospital in town.

Nobody here can pronounce my full name. They inevitably call me Guru, and I, instinctively respond to it. Don’t go looking for Amoka, Minnesota on Google Earth or Google Maps. You’ll never find it.

I am also a writer. I’ve written a few short stories and novels in Kannada.

This is one story that I feel compelled to tell.

In a town like Amoka which is right in the American heartland, you see a few Indian doctors like Radhika and me and many Sanghaali immigrants like Fadhuma, Rukiya, Abdhi and Kuki—sometimes more than you would expect.

Again, don’t go looking for Sanghaala on Google Maps either. You will not find this country on it. Sanghaala could be any country in Africa—like Sudan, Ethiopia, Kenya or Uganda. It really should not matter much when all the immigrants from these countries look the same, eat alike and speak alike.

There are many Sanghaali immigrants in Minnesota. In fact, according to a census report from the United Nations, the highest number of Sanghaalis outside Sanghaala live in Minnesota. Many of them speak little to no English!

They all came to America for the same reason.

Their homelands failed them.

This story is about them.

This story is about us.

Where shall we start? We can start anywhere. Let’s begin with Fadhuma’s incident.

PART 1

Two Years Ago…

1. Fadhuma

‘Name?’

‘Fadhuma Hassan.’

‘How far along are you in this pregnancy? How many kids do you have?’

‘Fourth month…three babies.’

‘Do you speak English?’

‘No.’

‘What language do you speak?’

‘Sanghaali.’

‘Does your belly hurt?’

‘No.’

‘Any bleeding?’

Fadhuma shook her head. She looked like she was about twenty-four or twenty-five years old, with dark skin, a glowing face, and sparkling eyes. She had applied her eyeliner with utmost care, almost like an artwork, without any smudges or overflows, eyelashes nicely groomed with mascara and her eyebrows shaped like an arch. A Hijab covered her head, with no glimpse of even a single strand of hair. Even in this touch screen age, she carried an old-fashioned flip phone with its slim ear-piece tucked into her Hijab. Her lips were lightly painted. The colour of her lips and the mascara paled against the brightness of the eyeliner and the Hijab, which had an odd brownish purple colour. The mobile phone’s speaker was on and her husband Hassan was at the other end of the line. He interpreted my questions in English into Sanghaali language for her.

I asked her, ‘Fadhuma, what brings you to the hospital?’

‘I’ve been vomiting all day and my belly hurts.’

‘Are you hurting right now?’

She shook her head.

‘Not this belly, but this one,’ she showed her protruding abdomen.

‘I have to examine you to find out what’s wrong.’

‘No, not possible. I want a lady doctor. Interpreter, interpreter,’ she screamed with impatience. The operator had paged the hospital’s Sanghaali interpreter as soon as Fadhuma arrived but she hadn’t arrived yet.

‘Fadhuma, there are no female…sorry, lady doctors here today. I am the only doctor here who can examine you. I’ll not look down there. I’ll check if the baby is alright. If I sense that there is a problem, we can get Dr Radhika. Were your first three deliveries normal or did you have cesarean sections?’

Fadhuma did not respond to my question right away.

The husband and wife conversed in Sanghaali for five minutes. I continued with my examination. It was a full-term pregnancy. On her lower abdomen there were horizontal surgical scars. I suspected that her previous deliveries were all done by C-sections. I held the probe soaked in gooey gel against her abdomen and looked at the baby on the ultrasound monitor. The baby was breech—its head was up. Fadhuma’s contractions were very unsettling for the baby. I figured that the chances of a normal delivery were slim.

Fadhuma had not replied to my question yet. She was still talking to her husband.

I asked again, emphasizing each word, ‘the…first three… deliveries…were by…cesarean section…right?’

She spoke with her husband again for a few minutes. I didn’t understand any part of their conversation.

‘No,’ Fadhuma’s husband spoke cautiously over the mobile.

‘What?’ I asked, a little surprised at the delayed response.

‘The first three children were delivered normally. No surgeries.’

Fadhuma made a futile attempt to conceal the scars on her lower abdomen.

‘This one?’ I pointed at the scar.

Fadhuma was embarrassed. Her husband intervened quickly, ‘That…that…there was a growth in her tummy and that mark is from when they took out the growth.’

I decided not to say any more. I called Radhika, the hospital’s obstetrician, on her mobile and gave her a quick summary of what had transpired so far.

‘Let me guess, the husband and wife are refusing cesarean section, right?’

‘I briefly raised the possibility of a C-section. I didn’t say it was one hundred per cent necessary. I think the baby is breech. I also think that her previous deliveries were all by cesarean sections. But both the husband and the wife deny this. They insist that the children were delivered normally. Fadhuma’s husband is not here in the hospital. She does not speak any English. He is interpreting everything over a speaker-phone. I am waiting for the hospital’s interpreter. She should be here anytime. Fadhuma is demanding a female doctor. She says that if we cannot provide that service, she will leave against medical advice.’

‘Welcome to my world. This is what I have to deal with every day. This has been these people’s jig-and-dance now-a-days. No matter what, they insist that they will not get a cesarean done. Apparently, cutting the belly open and taking the baby out is against their cultural beliefs. There was another Sanghaali patient of mine who complained that we do unnecessary surgeries all the time, only to make money! None of them have health insurance. Neither the hospital nor I make a single penny by treating them. And if something goes wrong, I have to deal with these Human Rights and Patient Rights groups. They come chasing you at the drop of a hat. Guru, don’t try to be a hero. I will come and take over.’ Her tone made it clear that she was getting a bit antsy.

‘Hurry up, Radhika. What if Fadhuma starts to deliver here in the emergency room?’

‘Don’t worry. If she delivers normally, all you have to do is watch. If she needs a cesarean section, no one can convince her to have one, not even her good Lord Allah!’

‘Why?’

‘Trust me on this, I have no idea. Just hold the fort. I will be there as soon as possible,’ she hung up.

2. The Land of Ten Thousand Lakes

The State of Minnesota is well-known as the ‘Land of Ten Thousand Lakes’. The state is dotted with lakes. The land is luscious green as far as one can see. Those who visit the state in the months of July or August are so enthralled by its tall maple trees, the fawns that stray onto the backyards, the clear blue sky and the lakes and streams along its many walking trails, that they easily forget the ‘10 below’ temperature and piles of snow in the winter that follows. We too were enticed by this weather. The fresh verdure of Minnesota was a welcome change for people like us moving from a concrete jungle like New York.

Situated in its Fair Blue County is the small town of Amoka, with a population of ten thousand. In the town’s only hospital, three Kannadiga doctors—I, Radhika, and Srikantha—served as the chief of medical staff, chairman of the department of obstetrics and chairman of the department of medicine, respectively. We didn’t earn these professional titles at the young age of thirty-two because America recognized exceptional leadership potential in us. And neither was it sheer serendipity. According to Minnesota State’s Gazetteer, Amoka was a medically underserved town. A recent census had reported that the ratio of patients to physicians was highly disproportionate—for the town’s population of ten thousand, thirty doctors were just not enough. Amoka barely held on to the new world order with its free Wi-Fi zones, two huge satellite dishes, mobile phones and a single two-lane road. No wonder that ‘American’ doctors, regardless of the perks offered, didn’t want to move to this ‘metropolis’. It was on folks like Srikantha, Radhika and me who were on J-1 visas and waiting for their green cards that the American government set its sights. We were their back-up, contingency ‘just-in-case’ MDs.

The J-1 visa is one of its kind. A foreign-born physician needs to do three years of residency to practice Medicine in America. Specialty practice needed further training. Doctors, scientists, pharmacists and other professionals can come to America on this visa. One can stay for a total of seven years. Getting a green card while on J-1 visa is extremely difficult. One cannot work other than in the enrolled training program. After seven years, these professionals are required to return to their home countries, live there for two years, and then find another job on a work visa again to return to America. Then, they are eligible to apply for their green cards. At times when America changed its foreign policy with countries like Pakistan, Iran and Syria almost daily, no residency trained doctor from these countries wanted to go back to their homeland. J-1 visa waiver program is the only saviour for most of us. Radhika, Srikantha and I were no exceptions.

Under this visa waiver program, doctors on a J-1 visa could stay if they served in government-declared underserved areas like Amoka for three to five years. That would get them their green cards expeditiously. Hence, Amoka had doctors from countries like India, Pakistan, Mexico, Columbia and the Dominican Republic.

Radhika, Srikantha and I came to America together. We did our residency training in the same hospital in New York. As we were about to complete our residency, we saw an advertisement for three jobs in this remote town. So remote, we had noticed that we didn’t have access to any mobile network when we visited the town for the first time for our interviews. This did not stop us from accepting the jobs, and within ten days of finishing our residency we started working without any qualms.

Thirty years ago, Dr Smith, an obstetrician, founded the Amoka General Hospital. He still practices here with Radhika. Amoka, like any other small Midwestern town, had transformed and developed significantly when people from countries like Sanghaala, Mexico and Cambodia started immigrating. Development here really meant the coming up of a multiplex cinema, a mall and a couple of Starbucks look-alike mom and pop coffee houses. The joy of Muskie fishing and snowmobiling or ice skating hardly had enticed US citizen doctors. Apart from Smith and a few other native Amokans, all other physicians were from foreign countries.

Radhika used to joke, ‘If thirty to 10,000 physician to patient ratio is considered medically underserved, then by that definition, except for Bengaluru, all other towns in Karnataka are underserved.’ She always had thought that Amoka was underserved because of the surge of Sanghaali refugees and Mexican minorities who had none to minimum health insurance. According to her, ‘If you are uninsured or underinsured you are always underserved.’

Srikantha and I had decided to share a house. We were delighted when we found a four-bedroom house for a mere five hundred dollars rent. Radhika had rented a small apartment for herself.

That didn’t last very long. Apparently, she was freaked out by the eerie silence of the nights where she couldn’t hear even the buzz of fruit flies. One day, she showed up at our house and said, ‘Guys, I am moving in. I will cook for you if I must. Why do you need this big house, anyway? Are you worried about how a single sexy girl like me could live with studs like you? I’m sure you are not scarier than these lonely nights. Moreover, neither of you is sexier than my Giridhar! I am taking the master bedroom.’ She had moved in without so much as waiting for our consent.

Radhika was engaged to a boy from Mysuru who worked for Intel in Austin, Texas. They lived on the opposite poles of the country. The lovebirds communicated on Skype and Facetime. Giridhar already had his green card. Radhika had thought that she could apply for hers as Giri’s dependent if they got married soon. But she had learnt after talking to an immigration attorney that since she was on a J-1 visa, she had to work in a place like Amoka for five years before she could apply for her green card even if she married an American citizen. She was frustrated and lamented, ‘Coming here on this visa is like doing time. There’s no way out. Instead of getting stuck in this shit hole for five years, had we been to Bengaluru and worked at the Central Jail for a couple of years, and applied for our green cards, we could have got it by now. At the very least we would have had the satisfaction of living in Bengaluru for two years.’

Her sweetheart Giridhar had visited us at Amoka once. This past Christmas, he had taken a flight from Austin to Minneapolis. On his way from the Minneapolis airport, he was caught in a severe snow storm. Roads were closed, and he was forced to stay in a motel right outside Amoka. He could see the town but couldn’t get on the only highway to Amoka which was dangerously icy. Apparently, Radhika had requested the Highway patrol guys to drop her off at his motel. The patrol guys had declined. ‘Ooo…she is coming hard you know. She is a tough one.’ Radhika was stumped. She had no idea that Minnesotans personify their cars, snowstorms, and tornadoes as she. The Skype connection was down, and the lovebirds had to settle for their smartphones. Emojis and succinct LOL, TTYL texts had served as poor substitutes for an encounter and they bid adieu over their mobiles alternately sobbing and exchanging greetings for a Happy New Year. Since that visit, Giridhar had never ventured into another trip to Amoka. Radhika used to visit him at Austin.

Even at thirty-two, Srikantha was single like me. When asked about the reason, he always had the excuse that his parents hadn’t found the right girl yet. He relied on his parents to find him a match. A Mysuru native like Giridhar, he grew up in Birmingham, England. His father had moved to England when he was twelve years old and they had stayed there for the next ten years. He completed his college and subsequently went to medical school at Birmingham. After their retirement, his parents had returned to Mysuru for good. Apparently, they had hoped their son would stay back in England. Srikantha had realized very soon that he would be a staff grade doctor at best, always sucking up to the English physicians, no matter how long he worked in England. He had pondered over returning to Mysuru and practicing medicine there. His parents had advised him not to return. He had ignored their advice and had moved to Mysuru, worked there for about six months in a medical school, and had realized that the medical practice in India was not as easy as he had imagined. He had gone back to England. He had realized soon that he didn’t belong there either. The answer out of this limbo was America. But his MRCP from England hadn’t given him any advantage over us. He too had come to America on this ‘Doing Time’ visa.

Srikantha was nothing like what I had imagined him to be. My initial impression of him was that of an English bloke who had grown up in Birmingham eating Fish and Chips and drinking Lighthouse beer. My clichéd stereotype was soon found to be wrong when we saw him doing the Trikala Sandhyavandhyanam, the traditional three-times-daily prayers, and having conventional Indian breakfast like gojjavalakki with mosaru-spiced ground rice flakes with yogurt. His mom would often WhatsApp him traditional Indian recipes from Mysuru and he would cook for everyone. Radhika hadn’t cooked for a single day.

Srikantha used to thank all the gods for his fortunes, after drinking a couple of Kingfishers: ‘Man, we should all be thankful for what we have. Thanks to Amoka and the comforts it has offered us! We can amble to work at nine in the morning and still no one will question us. We can go home for lunch in the afternoon and pinch a round of golf before getting back to work. We can come home in the evening and have another cup of coffee or a mug of beer. Thanks to you Guru, no need to stress about going back to the hospital at night. You guys at the emergency room will take care of everything, true nocturnists you are—saving lives when the rest of the world sleeps. God bless you. Not bad for doing time, huh!’ This had made me think that we need to get him out of Amoka as soon as possible. Otherwise, instead of a Mysuru girl he would end up finding someone here and settling down as ‘The Indian Doctor’.

There is a popular saying in Kannada: haaloorige ulidavane gowda. ‘In a deserted town, the lone survivor will himself be the chieftain.’ In a similar sort of way, I was promoted to be the chief of emergency medicine and later, the chief of medical staff for the Amoka General Hospital within two years of my joining the job. I still had to work full time in the emergency department. We had eight full time physicians. All of us worked three twelve-hour shifts a week. Thanks to a highway passing through the town and a few skiing resorts in the vicinity that attracted a lot of people, the emergency department was busier than what I had expected it to be. Even after a forty-hour work week, I had three days off in a week. In a town like Amoka, since there was nothing else to do except play golf, I had accepted the chief of medical staff position.

The chief’s main duty was to oversee that the hospital staff followed the guidelines laid down by the state’s medical board and to sit down in monthly meetings with other department chiefs to talk about important sounding stuff, such as a five-year road map to make us a state-of-the-art facility in the state of Minnesota. The ‘overseeing’ part was more about working with Carla, the chief of patient services—a sixty-five-year-old Administrative Assistant who had memorized every by-law of the hospital. My job was to sign all the papers at places the stickered post-it arrows pointed.

The department of obstetrics and gynecology had three doctors: Radhika, Smith and a Pakistani by the name of Abdul Razak. Razak also had come to Amoka just like us, seeking a green card. He too had completed his residency along with us in New York. After doing their residencies in family medicine, Radhika and Razak had gone on to do a one-year fellowship to learn how to perform C-sections. Since this training licensed them to do Cesarean sections on their own, they both functioned as OBGYN specialists. Radhika was the town’s only female obstetrician. With Smith’s retirement around the corner, she was the uncrowned queen of that department.

Razak was married to Zeba, a very pretty Karachi girl. Srikantha used to tease them, ‘Razak, when I heard that you guys were from Pakistan, I had expected your wife to look like any other Begum. Nice catch, buddy. And Zeba, you have a fine taste for selection of your outfits. You remind me of Zulfiqar Ali Bhutto’s wife when she was young. Watch out, guys. Your Mullahs will order a Fatwa if they see you walking around, without a burqa.’ Razak and Zeba had a two-year-old girl, Reshma.

Razak had absolutely no interest in hospital administration. He mostly kept to himself and lived comfortably with his wife and daughter. His only complaint was that no halal meat was available in Amoka. He was surprised that despite the presence of so many Sanghaalis, there was no one selling it here.

The prospect of a green card looming large, added to the fact that we landed these ‘chief’ positions within two years of completing our Residency meant that we were having a good time. In terms of rank I was the boss to both Radhika and Srikantha. In meetings—when I used management jargon like ‘Healthcare Reform’, ‘Strategic Planning’, ‘Creative Destruction’ or ‘Affordable Care Act’—Radhika would joke with me, ‘Guru, we will be getting our green cards in a couple of years. You look like you are getting comfortable here. Listen to me, if your mom pairs you up with a nice-looking girl, just get married. Think of an exit plan from Amoka. Keep New York and Chicago in mind when you try to settle down permanently. You look like you are never going to leave this place.’

Those were happy times. We were cruising along, like a ship sailing on a calm sea, like an aircraft flying at thirty thousand feet.

3. The Original Sin

Fadhuma’s pain had worsened. I had ordered for some blood work and asked the nurse to give her four milligrams of morphine and was anxiously waiting for Radhika’s arrival. I was a bit nervous about my expected actions as an emergency physician if Fadhuma were to deliver in the emergency department. I remembered Radhika’s words—‘Things will go just fine if it were to be a normal vaginal delivery. Normal babies will pop out like slippery blobs with or without your help.’ However, I had an intuition that Fadhuma’s case wouldn’t be ‘normal’.

Dr Carlos Alvarez, another immigrant physician from Mexico was working the shift with me. It suddenly occurred to me that this was a good time to respond to Human Resource’s emails. I asked Carlos if he would mind keeping an eye on Fadhuma as she was my only patient. I told him, ‘She is thirty-nine weeks into her pregnancy. She has mild lower abdominal pain, these could be labour pains. She had a few contractions when she came in, but nothing now. The baby is doing fine. I have paged Radhika. She is on her way. There are some emails that I must respond to. I will be in my office. Call me if you need anything.’ I was surprised at my own voice when I signed my patient out to him. The breech presentation and Fadhuma’s obstinate opposition to C-section had conveniently slipped out of my mind. I went into my office before he could ask any questions. Perks of being the boss, I chuckled to myself.

I went inside my so-called office, which was only a wee-bit bigger than a fifty-six-inch TV box, and started going over my e-mails. I was a bit uneasy about delegating Fadhuma’s case to Carlos at a crucial moment. I consoled myself, since Carlos loves delivering babies, he might be better suited than me for this job.

One email caught my attention. It was from a certain address Abdhi.Abu-Bakr@yahoo.com and was forwarded to me by the hospital’s human resources department. Abdhi had complained against Radhika to the hospital. The email that started with the salutation ‘To whom it may concern’ could be paraphrased as: ‘My wife Rukhiya Abu-Bakr was admitted for delivery to the Amoka General Hospital on 20 June. This was our first baby. We were as excited about this delivery as we were anxious. Our family physician, Dr Mohammad Mohammad had told us all along the pregnancy that we had nothing to be concerned about. We were skeptical about having our first baby delivered in a small hospital like yours. But, at the end we had no choice as Rukhiya’s labour pains were so bad that driving to Minneapolis was impossible. As luck would have it, I wasn’t in town at that time. A few of our relatives had accompanied Rukhiya to the hospital. None of them could speak English. Apparently, Dr Radhika insisted on doing a C-section right away. The baby was delivered by C-section within fifteen minutes of Rukhiya’s arrival at the hospital. We feel that we were given no other options. As there were no interpreters around, we could not make out who said what to whom and when. Later, we spoke with Dr Mohammad Mohammad and he told us very clearly that this was an unnecessary surgery. Our culture does not support cutting the belly open and taking the baby out. If either the mother’s or the baby’s life is in danger, as the baby’s father I should be the one to make the call