3:26 PM | 12 July 2020

For the past three months, I have seen patriarchy at its peak. I’ve seen women being exploited in the name of religion. I have seen painful births and tearful miscarriages. I have seen couples struggling to become parents and couples seeking secret abortions. I have seen bruises smelling of domestic violence and I have counselled new mothers for post-partam depression. I have begged women to take their pre-natal supplements on time and I have also eaten the *mithai distributed by proud grandparents. From being unable to name their child to being denied the right to decide how many children they want to bear, I have seen our kinswomen withering away in the stench of stolen rights.

I have seen women requesting BTL (bilateral tubal ligation: a surgical contraceptive procedure) and I’ve seen women on the operating table for the fourth time and, yet, refusing to acknowledge that another C-section could be detrimental for their health. I have seen women unprepared for motherhood conceiving under the pressure of “Shadi ko chheh maheenay ho gaeye, abhi tak koi good news kyun nahin hai?” (“It’s been six months to your marriage, why isn’t there any good news?”) and I have seen women bearing the brunt of male infertility. And I see humanity rusting away.

You know what’s really sad, in fact, disgusting? That it’s women themselves who play a huge role in providing fodder for this life-threatening cycle – by keeping silent in the face of these inhumane injustices, by seeking revenge from the next of their kin and subjecting their daughters-in-law to the same customs, and by teaching their own daughters to accept these injustices as customs that are “zamanay ka dastoor” (norms of the society).

Is there anything at all that we can do? Maybe not much except counsel each and every one of them – the mothers, the fathers, and the mothers of these mothers and fathers. It’s not an easy task, yes. But the thought that being privileged enough to be able to call myself a doctor is more of a responsibility than a badge of honour that I can show-off; that I am here to ‘heal’, not ‘cure’; that my faith and religion tell me that I will be questioned on how I used my skills and education – both His blessings – to help His people; that as a doctor, I can not only change the course of a disease but also the future of many generations to come – this is enough to ease this difficult task. So I continue to do what I can: talk to these women and all the women around me. And I urge you to do the same – with your househelps, your patients, your friends, the women around you. But most importantly, with the woman within you.


unprepared mothers

8:00 PM | 29 June 2020

Sitting on the other side of that plastic screen, I see more than a few pregnant women every day, each one of them recounting a different tale of how patriarchy has strangled the notion of even basic human rights.

95% of these women hail from families where making ends meet is a struggle but where bringing a child into this world is like going out for grocery: that’s the amount of thought these people – who make up a good chunk of our population – put into something completely life-changing.

Deciding how many children their malnourished bodies can bear is a right unheard of. These are women who need their husband’s permission before they can even get – in layman’s terms – injectable iron to correct their anaemic state. These are women whose primary doctor is chosen by their mothers-in-law, or their aunts-in-law, or some other lady relative. Anyone but herself. When does she have the next kid? That also gets to be decided by the other women in her family. These are women who have to beg their husbands to ‘allow’ them a C-section because they can’t bear the labour pains or because it’s technically not possible.

I see the helplessness in their eyes and I wonder what their childhood was like; if anyone asked them ever what they would like to be when they grew up? I wonder what they would say… Had anyone ever actually asked them that?
I see how the lack of control over their lives feeds their hidden demons, the same demons that viciously come out when it’s their turn to give their place to another woman, just like their mothers-in-law. It’s a cycle, one that will never stop. Not unless we educate these women and solve the problems that have made them who they are.
How can a woman who can not even stand up for herself protect and nourish a child? Food and water and clothes are never the only things that a child needs; they need kind love, care, and compassion for their intellectual, moral, and spiritual growth; all of these being part of the ‘*rizq‘ that is supposed to come with this little human.

I remember looking at one of these women rather closely today. Her doe-like eyes carried an unheard tale. The eight-month-old in her lap testifying to how unprepared his mother was for another baby. A haemoglobin level of 7.2, her refusal to get further tests done, and a husband who was sleeping at home did nothing to confute my views.

I see these women waiting to welcome a new life into this world and I do the only thing I can – speak to these parents about the huge blessing that they’re being bestowed with, that a mother’s responsibility is more than just to birth this child and the father’s responsibility is more than just to facilitate and finance that birth. And I say a little prayer for them: may every child born into this world find the warmth of a loving home, the kindness of those we call our own, the miracle of humanity, and the power of faith and true love. Amen.

*rizq: provision

Dr Ziauddin Memorial Hospital, Gole Market, Nazimabad.

A letter for her (XXXII) – a few disconnected thoughts

I think as difficult as this time is, I’m going to miss living it. Even the uncertainties seem to have warmed my heart and I’m nothing but surprised; surprised at how far we’ve come, surprised at the light sneaking out from that haunted house; how the hospital beds have nestled hopeful dreams and difficult patients no longer make you anxious. But COVID-19 and patients who lie still do.

“Farz chhorr k nafl kar rahi houn!” (Its like I’m leaving my real job to offer voluntary services!)
These are physician mothers who have not met their kids for months since the pandemic.

I can’t wait for a tomorrow that is peaceful, less frightening, and that will finally see the end to a journey of patience that has lasted for as long as I can remember. Because getting exhausted is the very proof that you need to believe that you’re a human, too.

Its amazing how life unfolds and you get answers for questions long forgotten. Almost like tumbling across a 1000-rupee note in the pocket of your old jeans. Or finding your favourite chocolates at the back of the fridge. But despite this all, some emotions linger on, the subconcious plays it’s game and tricks and corners it’s questions and queries about the the little universe within its own self, just like these disconnected thoughts. That’s life.

And sometimes I can’t distinguish between breathing and breathing from behind the tight-fitting N-95.
Is it the same struggle?

A letter for her (XXXI) – Al-Baatin

11:00 AM | 11 May 2020

It’s very rare – and very fascinating – to see the child that has grown within someone you call your grandmother because when you’re a kid, you think all grown ups were always all grown up.

You loved making sandcastles. The way your slender fingers would expertly build another home is a fond memory etched over the papyrus of time now. You’d place a chair on the shoreline and go and sit there, letting the waves sink the plastic chair deeper into the moist floor, the salty water playing with the seams of your saree. And you’d sit there and smile beautifully and gaze back at the sun, your sunglasses making you look like a diva. You were gorgeous!

Life has become pretty much like the waves you’d sit with. One after another, rushing in; leaving no time for the first wave of a new realisation to engage with the brain before sweeping in another extraordinary feeling that I have to struggle to recognise. I really can’t decide whether to laugh at that or to continue to be surprised. Or why not both?

I don’t have answers to any of the questions. I don’t even have questions anymore. I wanted to climb the highest peak of Tawakkal. I wanted what Hazrat Umar wanted: “Oh, Allah! Make us of your few servants!” And this is mighty difficult, Nani Jaan. You used to say, “Allah Mian bohat piyaray hain! (God is lovely!)” He really is. I don’t know anything at all except theΒ fact that He makes me take out my phone and open up the dua, “Allah alone is sufficient for us, and He is the best disposer of affairs for us.” (Quran 3:173) when my boss is creating a difficult situation for me in an OPD swamped with more than thirty patients. All I know is that He relieves my anxiety when my brain – more than my heart – tells me that no power is bigger than God and what will only happen is what only He wills. All I know is that these last fourteen days passed by without cough and fever and in the line of duty because He is the Omnipotent, and there’s work threaded in the lines of my palms only. All I know is that if He’s giving enough strength to the two people who brought me into this world to also send me out on this new battlefield, then only He can turn the Impossible into Possible. All I know is that if I find myself calling out to Him for help when I’m stuck in the restroom with no water or when I find myself whispering to Him to grant me the motivation to drop another few extra pounds on the weighing scale or when I make a quick dua for my favourite food, I’m free from the chains of human dependency and unfulfilled expectations. All I know is that when I find myself writing unsent letters that have no address, my soul is testifying to the power of duas made long ago, to His promise of not returning us empty-handed, to the very special heartbeat that He has hidden inside me. All I know is that when lost in the blurriness of this cacophony, the only lantern I am able to hold is that of istikhara; for every tangled knot, for every aching breath, for every dark alley. All I know is that ever since I’ve started playing this game of Tawakkal, He is increasing not only the level of difficulty, but also my bonus points, my resilience, my Love for Him, and how somehow, I know we’ll be able to fill in this crossword puzzle. Because He is our secret inner companion, after all.

And all of this because of your magical duas. I see them protecting me, making me stronger, happier. Little by little, every day. The dewdrops falling on me, calming the storms within, now comfortable with patience, waiting for and amused at the unknown path, but the known heartbeat.

Thank you, Nani Jaan.

A letter for her (XXX) – hearts are prettier when they’re thankful

2:18 PM | 6 May 2020

There are two things that define those miraculous six months we spent together preparing to say goodbye to you: unconditional, unquestionable faith in God, and unconditional gratitude.

Two years down the lane, and can you believe who I am now? It’s an addiction now, Nani Jaan. I am addicted to being grateful to Him. What pain? What loneliness? What of anything at all? This ‘Alhamdullilah’ is unveiling itself with full force. Every time I feel the kheyr in a difficult situation, I feel my body dancing on the lightness of happiness. It’s such a strange kind of happiness! It’s like my heart is heavy with the lightness of nothing. It’s overwhelmed by how nothing ‘right’ that is happening is making me happy. I really don’t get how this science works, Nani Jaan. I’m beginning to think that this was the secret you referred to that day. Remember that day when we were all gathered in your room – a daily routine then – and you said, “Arfa knows everything”? There was awkwardness and confusion on everyone’s face. You just looked at me – everyone else an irrelevant entity – and repeated the words that now bring me so much comfort: “She knows, she knows everything!”

I miss you. I love you. I’m really happy that you’re in a much, much better place and even though I can’t wait to join you, I’m not prepared, yet. I’m preparing.

I love this cloud, Nani Jaan. It’s the softest. It’s the stardust I’d always wanted, the dream I thought I didn’t deserve. “Becoming bros with Him!” How did you know this would happen? How did you know this would happen like this? How did you know that laughing at pain would sound so melodious? How did you know that the peace that will marry this happiness will be so loyal? You knew it all along. It was our special secret all along.

This pandemic has broken the old frame that was keeping together this picture. It’s a crazy world right now. The toxic workplace, the political manipulation, the exposure, the sick friends and colleagues, being directly exposed, family safety – all of this has faded into the background of His ‘Kun Faya Kun’, His mercy, and my heart bearing witness to the fact that He’s taking care of us all and there’s absolutely nothing to be afraid of if only I trust Him with Love: there’s coal-black, and ash-grey, and neon-yellow, and navy-blue, and deep red, and emerald-green on the canvas. There’s a roughness to it that feels gritty against the palm, hiding the smoothness of the good that is to come. Why can’t they see it, too?

Alhamdullillah. Alhamdullillah. Alhamdullillah.

“And which of the flavours of your Lord will you deny?”

Ziauddin surgery team, thank you for handing down all the worthy lessons!

25 January 2020 – 16 April 2020

Starting off my house job journey with the surgery rotation, I had a lot of doubts in my mind – from the rotation itself to the team I’d be working with. But what initially began as a struggle to stay afloat turned into a very timely realisation that makes me recall the wise words of Mawlana Rumi: “What you seek is seeking you”.

Beginning this new professional phase of my life in hopes of learning so much more than medicine, I did learn all that has now set a very helpful precedent for all ways I’ll steer my gear towards: I saw how good intentions turn away malice. I learnt what respect does and does not look like, how we ought to and ought not to treat our juniors, the various angles of what patient safety looks like; the various shades that professional ethics cloaks in, and the very basic traits of human nature that make us all so, so vulnerable.
When this journey jumped from learning about pre and post-operative patient management to subconsciously gaining a better insight into how we messiahs live and breathe, I do not know. And just like that, amidst the cries of COVID-19 and easily (read: annoyingly) being the most vocal member on the WhatsApp group of the “Ziauddin Surgery Team”, the days rolled by and now it’s time to say good-bye!

All’s well that ends well, eh?

Ziauddin surgery team, thank you for handing down all the worthy lessons and quite a few memories!


From the ER, with love

The picture is classic and openly welcomes you to the new horror: the pungent stench of the disinfectant, the brown pyodine bottles ready to court any kind of bruise and wounds, and the slow beeping sound of the mechanical sphygmomanometer setting the background music to all conversations playing in the emergency department of this hospital.

Hanging in the air – besides traces of what-must-not-be-named – is fear, incredulity, danger, and the unmasked urgency that science attributes to an adrenaline rush. Behind gowned human bodies are artists, writers, debaters, dreamers. Behind these masked faces are the worried hearts of mothers, fathers, daughters, brothers, sons, and husbands, and wives who have loved ones waiting at home. Behind these smiling faces consoling the scared patients being asked to get tested for COVID-19, are dutiful minds and healthy consciences that are struggling to keep their patients safe, both from the disease and the anxiety and fear that come with it.

How do we measure time here now? In the number of minutes it takes us to take off each piece of this protective layering, the number of hours we take it off after to grab a bite or use the restroom.

We’re not doing anyone a favour here. We do not want a round of applause from anyone, either. What do we want?
We just want to be safe while we take care of you. We just want your honesty when you share (or hide) your travel or contact histories while we take care of you. We just want you to act responsible and stay home. We just want the world to heal quickly so we all can breathe in without the fear of a painful death. We just want to be able to laugh and smile with our patients and give them a pat on the back or a warm handshake to shoo away their worries. We just want to be able to be near our families with peace of mind and soul, like we used to, once upon a time.

That’s all. Please help us help you. Please let us.

our hearts are little rays of sunshine

This poetic vignette is inspired by the song, ‘Waqt ki baatein’ by Dream Note.

11:05 PM | 13 April 2020

someone, somewhere is listening to this music,
to the words of this quill,
to the empyrean secrets whirling with the royal emissaries.

an old palace is this heart, and time is trying to tell us how the seconds in it are slipping away,
and youth is rustling away.

the night is dark, the lips are sealed;
there’s so much in their hearts, but nowhere to be seen.
tears are unseen, the agony melancholy; forever and ever.

the sound of broken dreams: the clouds
falling from the rooftop of longings,
far and near;
“i’ve missed you all my life!” you said.

it’s not a bad life, it’s just a bad, long day.
the heart is the same, the soul remains –
ours, and ours,
and ours.

our hearts are little rays of sunshine,
let’s let them live, let’s give them wings.
this poor, old heart of mine
wants to fly, wants to fly high.

the city lights are blazing, dusty memories and
urdu words sitting in the candlelight
with emotions new and hurting.
where are you? where am i?

Voluntary e-medical consultation

I, Dr. Arfa Masihuddin, would like to volunteer my services as a doctor if anyone here needs any guidance regarding their medical complaints.

Please DO NOT visit hospitals for your minor ailments, regular health checkups, stomach aches, headaches or minor pains anywhere. Your blood test reports, kid’s poor nutritional habits, 15-year-old backache and other OPD based cases can wait.

Hospitals are infected in one way or the other. Please stay safe as you might become the source of transmission of the virus to your friends and family.

If you need any medical help, you can reach out to me on E-mail/Messenger/Instagram for all types of medical consultations.

I’ll try to get back to you as soon as I can, with the best of my knowledge. If I’m unable to assist you, I will refer you to a specialist who can.

If you do reach out, please send in your medical queries in the following format:

πŸ’Š Your name and gender:
πŸ’Š Your age:
πŸ’Š Any pre-existing medical conditions / health issues you regularly take medicines for:
πŸ’Š Your symptoms / current medical issue:
πŸ’Š Duration of your symptoms:

🦸 Stay at home and play your part in saving the world.

πŸ“§ E-mail: walkingthoughts.am@gmail.com
☎️ Contact number: +92 306 0984838
πŸ“· IG: @drarfamasihuddin


A special feature on the Subcontinenttimes

The following was a special feature on the page Subcontinenttimes.

β€’ β€’ β€’ β€’ β€’

β€œ’Donning’ and ‘doffing’ every alternate day as I gear up to tend to patients in the ER of a tertiary care hospital in Karachi; that’s how we are observing quarantine for you.
It’s true that the shiny pictures popping up on my newsfeed arouse a strange sense of envy – and even fear – and then a lot of guilt at that envy. But then I remind myself to be grateful to these people staying at home, enjoying their safe time. It is, after all, the only way this quarantine can rescue the world.
Every time we receive a patient and take a quick history, and the alarm bell goes off, we gulp down another gloomy thought and joke amongst ourselves if this one is going to finally get us, like that senior colleague we heard about the other day on the news. It’s the new normal, you see.

An unprotected CPR on a suspected COVID-19 patient – now dead – or meagre, insufficient PPE, or another X-RAY of an asymptomatic patient revealing infiltrates on both sides of the lungs, or just a young man nervously hiding his travel history: it’s how we count the hours here.
No textbook had prepared us for this. No exam had tested us on how to navigate through an unprecedented global emergency while struggling to do no harm, to protect everyone, to be kind to our scared patients, to fight off poor administrative policies, and not be used as a frontline human shield. Nothing.

Every time I step out, I fight off the fear of exposing my brave family. The unconditional love of my mother never leaving my side as I see her blowing duas over me as I step out of the car, knowing that she’d rather have her girl home, safe and sound, but also knowing that it’s the bigger battle that needs to be won. It’s also the slow, startling realization that humanity always comes first, that no amount of wealth or social status can win over the power of the Unseen, and that at the end of the day, nothing really matters, you know? Except peace of heart and freedom from the self-imposed rules of our society. After all, the world is managing fine without all it’s fanciful desires, isn’t it? But, thankfully, once I manage to get past these, I jump from being a doctor to the writer that always consoles me: there’s words, and heartbeats, and poetry, and letters, and books, and chai, and Ammi-k-haath-ka-khana. A little happiness, a little peace, and lots of lovely memories.”

Dr. Arfa, @drarfamasihuddin
Karachi, Pakistan

Link to the original articles: Part 1 |Part 2