an itinerant observer

The morning after Karachi drowned, I did something I do not usually do. At 0700, I walked into Zahid’s room. He lay unresponsive, frothing at the mouth. Twenty-five years old, once trained patiently by my mother and later woven into the daily fabric of my household. Reliable yet often clueless, a boy who grew into a young man - always present, always willing. Now limp in my arms, his breath shallow. He had likely just seized. What if I had not gone? The question shadows everything that followed. The floodwaters of a climate-changed Karachi had receded just enough. The rain had stopped. The roads were empty, strangely permissive. Had they still been blocked; this story could have been another one entirely. Security guards from the neighboring house helped me carry him to the car. My sister-in-law hurriedly drove us to AKU Clifton ER , where competence was ready to act. My former residents, now instructors and SMOs, stepped forward with calm assurance. Nurses and staff I had once ...

~ Act II ~   A Letter to the Father Who Returned   Dear Father, You came back to the ER yesterday. Alone. Your eyes searched for the place where your children had been, as though the walls might still hold their shadows. You wandered, lost, and when the tears came, they came quietly at first; grief without sound, until they could no longer be contained. I stood there, silent, because what can you say in the face of such loss? Your grief took me back to 2019, when another father arrived; with his five children, also victims of phosphine poisoning. They had come to Karachi from Quetta on a short vacation, staying in a modest guesthouse. No one knew that a cheap fumigant, silently seeping through the rooms, had already marked them. They were Dead On Arrival (DOA in our lingo). Five small bodies laid side by side, from the youngest, a baby, to the oldest, a teenager. I remember the starched white sheets, how they barely moved as we covered those bodies. I remember dr...

Prologue I thought I’d prepared myself. My last shift in the ER, after 13 years, landed on Friday the 13th - the most infamous day on the calendar. It felt like a joke the universe was playing, so I leaned into it. I imagined the absurdities, the chaos, the dark humor that define life in a pediatric ER. I even wrote about it preemptively, anticipating the madness. But the universe had more to offer. What I thought would be a final hurrah of irrationality turned into something far heavier. A father, a family, a tragedy that echoed through time. This is my farewell to the ER in two acts. Act I – The chaos I expected. Act II – The weight I couldn’t see coming.   ~ Act I ~ 13 Years, Friday the 13th, and the Madness of the ER Coincidence or predestiny? After nearly 13 years of adrenaline-fueled chaos, sleepless nights, and a steady diet of chai and calamity, my last ER call lands squarely on the unluckiest day of the calendar. I could’ve chosen to laugh, but ...

“ Should we resume the monoclonal antibodies that help her heal or preserve the fragile calm we’ve found in their absence?” The question looms, heavy and unrelenting. My mother, the matriarch, now stands at a delicate crossroads. These past two months without medication infusions have brought a surprising lightness to her days. She moves with more ease, takes joy in simple tasks—cooking, cleaning, even making those sugary desserts again. One evening, as she kneads dough for chapatis , she pauses and looks me in the eye. “Do you think I can get through this without more treatments?” She asks. I don’t know how to answer—but in that moment, her strength reminds me that this is her battle, and I am only there to support her. It’s a reprieve that feels both precious and precarious, shadowed by the uncertainty of what lies ahead. Another day, the warm aroma of cardamom wafts through the kitchen as she prepares our favorite halwa , her hands moving with a rhythm that feels both f...

I am the parent. Scared and uninformed, I sit beside my sick child in the ER, hoping she will be okay. I am worried. Is this the last time that I get to spend with my daughter? Will our lives ever be the same? Or is this just something we will smile about years down the road. I don’t fully understand what’s wrong, and I cannot see far beyond the weakened state of my child. In this blooming, buzzing confusion of medicines, readings, numbers, and smells I sit powerless, with my whole life in the hands of a set of scrubs. But I cannot stay silent, so I look to the meticulous practitioner in front of me and ask “ Will my child be okay ?” I notice the doctor flinch and reassure me without eye contact. It’s imperfect reassurance, but this is all that matters to me right now. If the doctor says it will be fine, it will be. Why would he say it otherwise?  I do wish to have information; I do wish to know the state of the medical situation. I do wish to understand my child’s c...

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...