an itinerant observer

The manager behind the hotel counter in Lagos looked up, paused for a second, and then flashed her lovely smile. It was not the polite, transactional kind. She remembered me. I remembered her. “Welcome, Dr. Mian. Welcome, Sir!”. There was a familiarity to it now. It had moved beyond routine. Over the next few minutes, between check-in formalities, she told me more of her story. How she had grown into this role. How those early opportunities had come her way - one in particular resonated because the person behind it was well known to me. He also stayed at the same hotel during work trips; during one of which he had quietly opened that door for her to become the manager. She spoke simply about how things had unfolded. These moments had started to matter more to me over time. The repeated trips to Lagos. The same roads from the airport. The congestion curling through the Mainland, Victoria Island, Ikoyi, and Lekki. The faces shifting from familiar to expected. And somewhere alon...

Back in 2020, while COVID-19 was peaking during its first wave, as a front-line emergency physician I was frustrated. It was not just my hectic work routine in one of the busiest emergency departments of the megapolis   of Karachi to blame. The unavailability of my gymming routine because of the pandemic-mediated lockdown was adding to my woes. To keep sane, I, therefore, settled into a nice daily home-based exercise routine: 2.5 km of outdoor running followed by 15 minutes of indoor creative movement (aka Zumba-like dancing, to be precise). The fact that I went overboard with my routine and ended up fracturing my right ankle is a story for another day .  After I had reflected enough on my intra-pandemic/post-fracture predicament and my ankle (with a metal screw inside) had healed enough, I resumed my home-based Zumba routine. But this time I added Salsa steps to it so I could make it a high-intensity/low-intensity workout. Although I became quite happy with my workout, I ...

“Aren’t you glad that you left Houston when you did?” I was asked recently. In the wake of hurricane Henry’s devastation, perhaps that was a valid question - not an insensitive one. However, on further introspection, I realized that I was neither glad that I had left Houston when I did, nor could I wish that I was still there. Au contraire, I was pensive about family, friends and former work colleagues having to deal with this newest water-related calamity of Houston. That Houston is flood-prone is not news to me. During my 15 year-long ‘sojourn’ in Houston, I had to deal with several flash floods and hurricanes. Allison, Katrina, Rita…. I can rattle their names off in my sleep. In June 2001, within a year or two of moving to Houston for graduate school, I confronted Allison, a ‘freak’ tropical storm that dumped so much rain on Houston in just a night that I was flabbergasted. I woke up to find my car flooded and the apartment complex grounds in disarray. At that time, I ...

Dear Karachi, Ptooey ! Did you know that’s an onomatopoeia? A written sound, in other words. Or more precisely, per the Merriam-Webster dictionary :   Definition of  onomatopoeia T he naming of a thing or action by a vocal  imitation  of the sound associated with it (as  buzz, hiss ). Ptooey! That’s the commonest written version of the sound that is presumably made when you spit. Why presumably, you ask. Well because the esteemed composers of the dictionary obviously did not travel to our city prior to drafting that onomatopoeia.      Paan -splattered flowerbed outside the ER where author works Why do I say that? Simple. Have you ever spat on a wall here? You don’t have to. You don’t need to. Simply look around and you will observe several fellow Karachi- wallas spitting away as if participating in a well-orchestrated symphony. And not just on walls, but also on footpaths, roads, grounds, gardens, flowerbeds, schools, col...

I heard about the second floor (T2F) in Karachi before hearing about the person behind it. Prior to relocation to Karachi, my birthplace and the city where I came of age, T2F was described to me as the reason why Karachi was still cooler than Lahore. I recalled the 80s and 90s during my school and medical college years, when there weren’t any spaces like the T2F, where one could go and immerse oneself in thinking, for oneself and for those around you.  After resettling in Karachi, I had the opportunity to visit a few sessions at T2F. It was delightful. The talks and discussions were scintillating, photographic or other exhibits impressive, and the café an oasis. But none of that even came close to the person who ran the show, Sabeen Mahmud. Every time I would see her there, I found her exuding vitality and uber enthusiasm for any cause célèbre that she hosted. She was witty and introspective, an intriguing combination - a real charmer, as they say.   Interesti...

Innovative app wins top prize at AKU’s first-ever Hackathon Four innovative solutions in emergency medicine receive awards Innovators at Pakistan’s first-ever medical hackat​hon at the Aga Khan University have proposed new ways of tackling challenges facing Pakistan’s emergency rooms (ER). HistorER , the winning team at the Hackathon, came up with a unique QR (quick response) code system to address a persistent challenge faced by ER doctors. Patients are often brought to emergency by family members or by bystanders who are not aware of their medical history. In the absence of critical information, doctors face delays in performing life-saving procedures.     The HistorER team has suggested that every person carry a medical card with a QR code with vital details: blood group, allergies, current medication and previous operations. Scanned, the QR code would provide doctors immediate access to information and the ability to ini...

What’s the chance of a bad outcome,lik e death, in Karachi? Based on anecdotes circulated on social media and what you read in the news, you might assume that chances for a series of unfortunate events remain high in this city. This prompted a friend to do some calculations to gauge chance of an unexpected death in Karachi, compared to any major metropolitan city in the U.S. Assuming how the percentages were arrived at was fairly accurate, the bottom line, if true, was intriguing: the likelihood of an untimely, unexpected death was similar in the two places. Delving into death rates in Karachi vs. elsewhere was perhaps meant to be an intellectual discourse following the meaningless death of a colleague’s sister in Karachi. Being gunned down outside a famous restaurant after a meal there is hard to rationalize as an expected outcome of a botched cell phone robbery attempt. But this is Karachi. And such occurrences are unfortunately all too frequently heard and shared. Ev...

Illustration / Photo-credit: Saniya Kamal Imagine yourself as an ER nurse or physician. Then imagine a parent bringing to you their dead child, with the expectation that you will bring her back to life. What do you do? This happened to me, yet again. The overhead page for pediatric resuscitation was met with the routine ‘rapid response team’ deploying itself from the pediatric ward to the ER ‘resus’ room. There we met a distraught father who had brought in Sasha, his 2-year-old daughter. Once I took stock of the situation, I realized this was a no brainer: I was to follow the pulseless and apneic child (that is, neither heart nor lungs functioning) algorithm from the American Heart Association’s Pediatric Advanced Life Support guidelines.  “Dead child -> go directly to Cardio-pulmonary resuscitation (CPR) -> do not pass Go, do not collect $200!” a professor from my residency years would remind us, specifically for that situation.   I im...