The end of another universe

2017-11-18 09.20.55 2.jpg

Not very long ago, I wrote about how, as doctors, we will get to see the end of so many little universes around us and yet, still be able to sit comfortably in our rooms, sipping on a cup of freshly brewed coffee. Little did I know that soon enough – as a medical elective student – I’d get to see a tragic such end

*Sarah was a twenty-three-year-old young woman. Having delivered her second son – after a gap of twelve months only – just ten days ago, she was brought to the ER with complaints of headaches, drowsiness, and vomiting. The MRI revealed a left MCA, ACA infarct that had damaged an alarming 80% of her left brain; a possible result of Pregnancy Induced Hypertension. She was on the ventilator when I saw her in the I.C.U. the next day. Needless to say, things did not look good. They were not good. An E.E.G. – a quick test done to determine the brain’s activity – confirmed what every medical personnel in the I.C.U. already knew; Sarah was dead.

As I stood there, watching her pale face dim away from the life that she had just brought into this world, my heart ached for this young woman.

That young girl could easily have been me. Or you.

Instead of heaving a grateful sigh at my promotion to the fourth year of medical school – a privilege that not many are blessed with – I could have been Sarah, lying there comatose, oblivious to the hungry wails of her newborn, and the empty, searching eyes of her eldest. Instead of having a father who is my biggest support system, I could have had a father who found himself helpless in the face of abominable society rules that did not even allow him to take important decisions regarding his daughter’s health, but dictated that he waits for her husband and father-in-law to do so, who sadly, blamed it all on black magic, delaying medical help. Instead of a life that has granted me my basic rights, I could have had a life of non-existence, much like that of so many of my fellow countrywomen.

In those moments of watching a mother’s warmth die away, I said a small prayer – more as an act of resolution than as a cry for Divine help – for all the Sarahs of our world: may our women learn to prioritise their health, may our women not raise helpless sons like Sarah’s father, may our women not be wives of uneducated men like Sarah’s husband. I hope you, too, breathed an ‘amen’ to that.

And then I went home and had my evening tea and carried on with the mundanity of what life had to offer to a medical student. Winters were approaching. The ground was a blanket of orange and yellow leaves, all dry and withering. Like Sarah’s motionless body.

* Name has been changed for reasons of privacy.


A doctor’s heart



Hurried steps from one ward to another. Long working hours at a stretch. Difficult night duties when on call. That is the real life of a doctor. I knew this, of course. But they very rightly say that experience is truly the best teacher. There’s something very powerful about experiences and empathy that takes our understanding to the next level, or the right one, let’s say. That is one of the many things that working as an elective student taught me. And for good.

It’s very easy to imagine that the life of a doctor is that of prestige and wealth. That may be very true. But what we very conveniently forget is what goes behind all this grandeur.
Imagine having to wake up every morning and rush to the hospital to attend to ailing bodies, often missing out on your son’s parent-teacher meeting, or your daughter’s sports day at school, or your own mother’s appointment with the doctor. Imagine having to miss out on attending your best friend’s wedding, or a night out with your cousins because you have a night-shift that may stretch into a 12-hour post-call. Imagine having to be on your feet all day, your wits intact, as your back aches and your feet shout for a rest. Imagine having to make important, life-saving decisions on empty stomachs and full bladders. Imagine losing a patient in the face of the complexity that the human body boasts of, and not blaming yourself for what was predestined. Imagine breezing through life as you watch little tragedies and big miracles every day.
Yes. That is a small window into what the real deal is.

Perhaps, it’s in these larger than life paradoxes that the simple secret of life lies in.
Seconds melt into hours and days into years. Between one summer and one winter, more than a few showers of rain grace this soil, either washing away fragile homes of mud-bricks and straw roofs or watering a healthy rice field. Someone, somewhere, crushes the autumn leaves. Someone, somewhere sings the songs of spring. And a doctor, a messiah, does all of that in the heartbeat of a moment.


2017-11-15 08-1425650451..jpg


It’s such a strange world, isn’t it? The marriage of profundity with the seemingly mundane is not celebrated as it should be. And that’s sad because that’s missing out on what makes this gift of life so beautiful – the significance of the apparently insignificant.

Every morning when I head to work, I squeeze in a few extra minutes in my schedule to celebrate what truly marvels me: the quiet chirping of the birds, the cool breeze hugging the trees, the orange-yellow hues announcing autumn; all of this creating a magical, almost mythical, atmosphere as I sit on the freshly cleaned benches and pour out gratitude and paint heartbeats on to a sheet of papyrus, for Him. It’s in the solitude of these little moments that I reflect on what memories I wish to be looking back on when I’m breathing my last. It’s in the solitude of these moments that I am able to appreciate the gorgeous asymmetry of life as a comfortable sense of chrysalism descends upon the tranquillity of my being. It’s in the solitude of these moments that I am able to appreciate the courtship of medicine and literature – of human suffering and relief that resuscitates the sensitivity within the men and women of words, inspiring us to produce poetry that mirrors the ions within us, the lyrics to the songs which the angels dance to. It’s in the solitude of these moments that you realise, my friend, where the centre of your universe lies.

Empty Beds

2017-11-04 10-1645535249..jpg

We all labour against our own cure; for death is the cure of all diseases.
– Thomas Browne; Religio Medici, 1642

For a doctor, hospital beds more than often become living, breathing humans, and humans become the bed numbers. So when one of these hospital bed ‘dies’, or when a human becomes ‘empty’, how do you react? Do you mourn the loss of another life lost? Do you let those fixed, dilated pupils remind you that there is much that you can not do in the face of Nature’s game? Do you acknowledge your own fragile limitations? Do you push aside your busy schedule and utter a small prayer that is meant more for yourself than for the departed soul? Do you take out a moment to simply offer compassion and empathy to the grieving family standing in front of you? Or do you carelessly, insensitively throw out a command that is supposed to ensure that the hospital dues are cleared before the body is taken home, before moving on to make a politically incorrect joke with a bored colleague?

These empty beds where once someone’s dear one lay, are more than that, really. And what exactly it is, that is for us to feel. – empowering our female doctors

There is no real secret ingredient to a life of happiness and contentment, except, perhaps, learning how to strike a balance. And that is a real cause of concern for the majority of our female doctors. While priorities vary and each to his own, it is a huge waste of resources and intelligence when these qualified female doctors are prevented from practising – either by choice or compulsion – in fears of neglecting their families.
In a society that holds dear some very rigid gender roles, it is necessary to acknowledge and appreciate any effort made in the face of these unfortunate norms; Sehat Kahani is one such drop in the ocean, helping innumerous female doctors achieve this happy balance. A one-of-its-kind telehealth platform connecting the ‘at home-out of work’ female doctors to the lesser privileged patients in inaccessible areas, Sehat Kahani deserves all the help and encouragement that they can get. And with that in mind, I am very excited and happy to have interviewed Dr Iffat Zafar Aga (co-founder and Chief Development Officer at Sehat Kahani) for the Ziauddin University Atlas.

The Ziauddin University Atlas Blog


Currently constituting a network of 14 E-Health Hubs across Pakistan (Sindh, Punjab, KPK and Karachi) and serving more than 440,000 patients directly and indirectly through its digital healthcare services, Sehat Kahani works with the will to create an all-female health provider network to ensure quality healthcare solutions for communities where health access, quality, and affordability of healthcare are still a dream, using cost-effective ICT enabled solutions. 
In the following interview, Dr Iffat Zafar Aga, a proud Ziauddin alumnus, and co-founder and Chief Development Officer at Sehat Kahani talks about her journey and explains what Sehat Khani is about. 

This interview has been lightly edited for length and clarity.

Tell us something about yourself. What inspired you to start Sehat Kahani?

I am a doctor, an entrepreneur, and a mother of a little 4-year-old. I graduated from Ziauddin from the 7th batch and we…

View original post 1,746 more words

These little universes



At the end of this year’s clinical rotations as a medical student, I realise that as future physicians we will soon be moving around hospital corridors, checking up on our patients; their records maintained meticulously by the hospital paramedics. How many of us will look beyond terms inscribed on boards like the one in the picture – ‘Bed No.’, ‘Patient’s Name’, ‘Consultant’s Name’, ‘Ref #’, ‘Company / Private’, ‘Age’, ‘Diet’, etc, etc – and think of the stories that each one of these people walked into our clinics with? How many of us will be healers and not just mere physicians?

So many of us want to see things. We want to see the future, we want to see how the universe ends, we want to glimpse the edges of time and space. So many of us want to see all of that and still be able to have coffee at home in the morning. So many of us want to live a thousand, thousand lives. And still be able to have a cup of coffee in the morning.
And as doctors, witnessing the end of a universe will be an everyday occurrence for us. You know how?
When you will tell a bereaved son that the father who sold his ancestral home to get him through college, is dying, you will see the end of a universe.
When you will tell a devoted husband that he just lost the love of his life, you will see the end of a universe.
When you will see a pair of young parents cradling a small coffin, you will see the end of a universe.
When you will see a loyal friend cry as he sees his friend lose the battle of life, you will be seeing the end of a universe.
Those are all tragic ends to what was a universe of its own, because, after all, as Rumi said, “We are the universe in ecstatic motion”, and as Sagan reminds us, we’re “made of star stuff”, aren’t we?
You’ll witness the end of those universes, and you’ll still be able to have coffee in the morning, in your own universe.

These people around us, struggling to make ends meet. The lonely kid at the school cafeteria wanting to share his mom’s sandwiches. The tired girl treasuring the silence of the night. The sick, old mother waiting for her son. These are all the salt and pepper, an entire cosmos of hidden emotions and beating hearts. And watching these universes disperse with a light that almost blinds your heart, is what makes Time so cruel, doesn’t it? It’s what I call the ‘Twenty-fifth Hour’ – that very intangible moment in the vastness of Time that will not be sorry for its existence as it will alter your perception of life, and love, and loss.

Smiling on the wall sits the ancient clock,
Chiming away – tick, tock, tick, tock –
The day attends to your curiosity
And the night courts your dreams
And between the hours on the clock
walk our insensibilities.
The Hand of the Seconds laughs at you,
And my mind spins a tale that is beyond
The imagination of the elves
And my heart beckons to the minutes
To explain the happening miracle,
And as we slide away on the island of existence,
Our gaze looks afar, into the infinite,
Towards the twenty-fifth hour.


Good bye, Forensics! 


As the sixth semester of medical school draws to an end, I realise that my initial interest in the subject waned into pure disgust and never have I despised a subject as much as I have despised forensic medicine; in simpler words, it is “the application of science to criminal and civil laws, mainly on the criminal side during criminal investigation, as governed by the legal standards of admissible evidence and criminal procedure.” In even simpler words, it is the realisation that the human mind can be a diabolic powerhouse of wrecking smiles and joys through acts of ‘homicide’ and ‘murder’ that may lead to ‘asphyxia’ (a condition arising when the body is deprived of oxygen, causing unconsciousness or death; suffocation). It is the realisation that I’m alive only because my soul has an undeniable relationship with my body and when they divorce, all that will be left will be my soul for the body will be ‘putrefied‘. It is the realisation that while I can not save my body from being the food of rodents and ants, I can save my soul from being victimised by greed, lust, lack of empathy, arrogance, wantonness, miserliness, ostentation, hatred, iniquity, and envy. It is the realisation that I must invest in my soul. It is the realisation that the glamour of this world will end with the end of the last note of my heartbeat, and that could be at the hands of another mortal or even by its natural course, but it will end and what then? That. What then

In the blink of an eye, three years have flown by. Before I know it, I will be breathing my last. So, whatever little time we have left on this huge ball of water and soil, we must spend it with love because there’s so much love in there, buried deep within, for everyone. We’re all in the same boat. All of us. All of us trying to be happy, trying to find ourselves – mind and soul – and not get lost in the maze of what seems to be buzzing around, and to have an identity of our own, one that is not lost in the crowd, one that sets us all apart. 

So, I guess all those hours of sitting through gross depictions of what ‘death’ really looks like paid off: the seconds between this breath and the next is what the ancient phenomenon of time really is, and if it’s all that is left, then I’d rather live it to combat hate with love, apathy with kindness, pessimism with optimism. 

Moms and Dads 


This post first appeared here:





During your clinical years, you come across numerous patients, and each one of them brings out a different you – introducing yourself to the you that you thought never existed, preparing yourself for the absolute worst, helping you empathise with people you have usually always never thought about.


Taking down histories during your clinical rotations is really that; behind sentences heavy with medical jargon that describe ‘presenting complaints’, lies the real presenting complain. These medical histories are life stories, laden with broken hearts and unshared pain. And this is what I realised as I noted down ‘G5P1+3’ while taking down the history of a pregnant lady. Her first child – a son – had drowned in a water tank. She had three miscarriages after that. And now she was pregnant again. A precious pregnancy. And what affected me the most was the way she was holding up; her coping mechanism.


Having now seen several patients with histories of miscarriages, it just makes me wonder what the parents go through after each one of them. Especially the mothers; to carry a part of you and your husband inside you, to feel the feel of life growing inside you, to understand that God wants you to bring a new life and hence, a new generation into this world – a new Einstein or a new Shakespeare or a new Neil Armstrong or a new Sadequain or a new Rumi – to know that your life will be responsible for another life; and then suddenly, it’s not there anymore. It’s gone. As magically as it came, it’s gone. And a void is left behind, the kind that no other daughter or son can fill. How do you mourn the death of someone you can’t even lower in a grave? How do you mourn the death of someone you haven’t laid your eyes on? But you’ve felt their feel, you’ve felt their existence because the news of their arrival – expected arrival – had you jumping with a special kind of joy that only super-humans called parents are familiar with, and your heart seemed bigger than before and the tinkling in your spine was the kind that only your spouse felt because it was his and yours. How do they do that? When they are asked how many children do you have, what do they say? How do they feel looking at other children, even their own? Do they forever question why it happened? How does it feel to miss a child you only felt, but never saw? Do you still shed silent tears? Doesn’t it forever tear their heart apart? The mere thought of it is so devastating, so painful. It breaks your heart, doesn’t it? Because while your mind may acknowledge the medical explanation for a ‘miscarriage’, your heart cannot accept why your little love was taken away from you.


But you know what, Moms and Dads? You are not alone. You are never never were. Your baby is up there, smiling down at you, asking God to keep you away from thorns. And one day, one fine day, you’ll get to embrace them in the warmth of the love that is only, and only theirs! You will.

 Make A Difference 

FMHC, Ziauddin University Hospital, Clifton.

It’s nothing aesthetic. And you’ve seen boxes like these so many times, in so many places – hospitals, shops, supermarkets, at the chemist’s. Boxes like these – awaiting your donations – are sometimes, the only difference between life and death, between health and sickness.
Money is a necessity for some, a luxury for others, and an unconscious obsession for everyone. And charity? Either a religious obligation or an easy road towards a good reputation.
Economizing is an art, a skill.
When we’re busy having fun eating delicacies and buying clothes not worth the exorbitant price, let us not forget to remind ourselves that as the privileged, we owe something to the underprivileged – let us give out charity, not for God’s reward or the world’s applause, but because it’s our responsibility. Let us give out charity so that nobody avoids going to the doctor out of fear of not being able to afford the treatment.

“It’s not how much we give but how much love we put into giving.” – Mother Teresa

Let us give out charity so that everyone can be happy – they can be happy, you can be happy.

“A bone to the dog is not charity. Charity is the bone shared with the dog, when you are just as hungry as the dog.” – Jack London

Sometimes, your patients help you more than you help them


FMHC, Ziauddin University Hospital


“Sister, will you get me some juice?” the boy thrust a hundred rupee note towards the third year medical student.
“Juice? But there’s no canteen here. Where do I get you a juice from?”
“Son, come here. I’ll buy you a juice later,” his mother intervened.
She turned towards the amused student.
“Doctor, he is bugging me for this since morning. I’ll buy him some on our way back,” she was embarrassed.
“There’s actually no canteen here otherwise I would have bought him some,” it was her turn to be embarrassed.
The medical student got busy taking histories of the patients lined up in the waiting room of the Family Medicine Clinic. Schizophrenia, vaccinations, diarrhea; amidst the more grave pathologies of the human body, the student simply forget the little boy whose only problem seemed to be an unfulfilled craving for juice. But not for long. As she turned away from her last patient, she saw him again. This time, he was sitting with a pack of crisps and sipping on mango juice.
“Got your juice?” she smiled at him.
“Yesss!” he nodded his head with a firmness that was nothing but joyful. Simple, little joys.
His mother looked at him fondly.
The student smiled and gave him a thumbs-up.
Sometimes, your patients help you more than you help them.