an itinerant observer

~ 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 ...

I know my patterns but I don't know my words, mom. I know what to add in my tea but I forgot to heat it up, mom. I know I'm thirteen but I can’t act my age, mom. I can create, I can draw, but I really can't read mom. I know tuition centers are the norm, but I need YOUR help, mom. I want to learn, play and make friends, but my behavior wasn't accepted in special school, mom. I was improving, I was learning, I was understanding, but it all fell apart. You chose two month long family weddings over my therapy, mom. -- -- When I met Alishba*, she was wrapped up in layers of clothes (since the temperature had dropped below ten degrees Celsius after the rain in Lahore). She walked with a spring in her step, and didn’t need help sitting in the chair in front of her psychologist, but she just sat with her mouth half open; waiting to be told what to do next. We asked her to write her name, she wrote down jumbled up alphabets in a pattern. She created ...

It started again last week. Noori excitedly came home with a huge card stuffed in her bag. She shoved it into my hands, gave me a hug, planted a kiss on my nose, and asked, “ Baba , will you be my Valentine?”   I could’ve said yes, no, or I don’t know. Several options. But, how does one really answer that question? I could’ve asked her what that meant to her. First impulse was that she was giving in to her kindergarten peer pressure and that had led to the ‘inquisition’. My mind generated alternative scenarios as to what would happen if I were to ‘discuss’ this more with her. Based on my past performances of forgetting love demonstration situations (birthdays, anniversaries, and the like), I have been taken to task frequently. I have been told that I don’t love or care enough. That is an absurd thought to me. You either love or care or you don’t: in my (simplistic, maybe?) mind there’s no gradation of love. Thus, doing more (or not) or saying more (or not) should not necess...

Mr. Teddy Graham came home for the weekend. This had been much anticipated and discussed ad nauseum since the beginning of the school year. Noori was really excited. Mr. Graham’s heavy ‘suitcase’(a bag pack really) stuffed with odds and ends, was a treasure trove for my little one. Mr. Graham is likely the most essential, most peripatetic, and most photographed (think paparazzi), kindergartner that has ever existed. He gets to travel to each kid’s home for the weekend. He gets dressed in different outfits and then enjoys different places (parks, restaurants, movie theaters, malls, to name just a few) and gets his  photos taken in those settings. A letter is written by the student about that weekend spent with Mr. Graham and along with photographs, the ‘compilation’ is filed away and thus a legacy is created. Upon first introduction, what struck me as a bit odd was that Mr. Graham was very comfortable in a dress. Unlike his name, he appeared to be a hot pink ballerina. ...

The Biscuit, although the name is reminiscent of all things British, cannot be dunked into your Earl Grey tea that you sip for breakfast. Nor can he be eaten with your breakfast grits, as he is not the small piece of bread with a firm browned crust, available all across America. The biscuit that I am referring to is a two month old puppy in Karachi, Pakistan. He is ¾ Labrador and ¼ Golden Retriever, presumably with an impeccable pedigree. When you see him you might agree, but don’t ask me to produce a birth certificate or other document that vouches for nobility in his ancestry, because I have none to show. Does it matter? When your child, Rayaan my son, as in this case, is ecstatic to finally obtain his doggie-pup as compensation for moving across the globe to Karachi, from his birthplace and primary home, Houston, then confirming purity of the dog’s gene pool becomes unnecessary. Why is Biscuit called The Biscuit, you might be wondering? I was hesitant to call him that, given ...

Noori the first grader was excited. She had received a golden star for her poster titled “all about my hero”. When she showed me her award winning entry I was quite pleased. Her hero happened to be me, her father.   Her poster was composed of photographs of me – at various places and in various poses, unbeknownst to me. She had highlighted a few facts about me and what I did. There were captions such as, “the best dad ever!” , “my hero fixes children”, “my dad dances salsa” , and so on.   I tried my best not to let that hero worshiping go to my head.   “Who’s my hero?” I asked myself, instead. I’m like that – a lot of clarity comes from seeking answers within. The likely heroes are the usual suspects Over the course of four decades that I have been living on this earth, roughly equal amounts were spent in two very distinct cultures.   For long stretches I’ve either lived in Karachi, Pakistan or Houston, Texas. If I go per cultural or societal specificat...

“Avery is dead, Baba . My friend told me”, said Noori, my 5-year-old kindergartner, when I picked her up from school that day. I had known that ‘fact’ since it was on CNN. Avery wasn’t quite 5-months-old. Avery was the only baby I had known with a bucket list . “Baby Avery”, as she was fondly called, became a household name after the blog written by her dad went ‘viral’. Avery was recently diagnosed with spinal muscular atrophy (SMA), a devastating neuro-genetic disorder with poor outcome. Although I am a pediatrician, I must remind myself that everything becomes ‘recent’ when you are just 5-months-old. Avery was very special for a number of reasons. I got to know the baby entirely through Noori and the baby’s mother, Laura. Laura is a kindergarten teacher….no… THE kindergarten teacher who taught Noori. She is the kind of kindergarten teacher that I never had the privilege to be taught by when I was Noori’s age. Laura and her kindergarten classroom were the inspiration for Noo...

“Baba, my friends were saying that little kids died in ‘Conticut’ !” Noori, the 1 st grader, was quite charged when she related that to me. I, as usual, was oblivious to that factoid although I work in mainstream America. I mostly work night shifts so when I picked Noori up from school it was technically bedtime for me. Some blame could be laid on the 3 rd flu-like illness I was suffering through in a 5 week period. Being an ER doc in a busy children’s hospital, the frequent colds were the necessary evil I was exposed to. I had loaded myself up on multiple medications to control my symptoms partly in an attempt to survive that night‘s shift in the ER. The 1 st query that arose in the dazed and drugged mind of mine was: “Noori, what or where is Conticut?” The massacre of the children took a back seat for the moment. “I don’t know! But there were lots of guns and blood – Ella said so”. Ella was Noori’s equally excitable and worldly friend. It was then that my mind gained s...