Saad Shafqat’s sophomore novel Rivals is a fast-paced potboiler set, like his debut novel, in a milieu he knows well as a practising doctor — the world of medicine and healthcare practitioners. At its centre are two highly ambitious doctors, a man and a woman, both working at Karachi’s upmarket Avicenna Hospital, and both out to achieve fame and fortune for themselves. Eos presents an exclusive excerpt from the book, the events of which take place after a bomb blast in the city...

Inside

It’s been a wrenching period for Nyla and Nasreen. Having spent the previous night in the recovery area adjoining the OR, Nyla was shifted early this morning to the step-down unit. A couple of hours later, Dr Zarak had rounded on her and — to Nasreen’s intense relief — found everything in order. Nyla was still groggy — presumably from the anesthetic, thought Nasreen. Dr Zarak had reassured her that Nyla was recovering well. There was no need for worry.

Later in the day, they had propped her beautiful little girl up in bed. The bed itself was huge and her darling girl seemed frail and tiny lying upon it, awkward and out of place. Two nurses were fussing over her. One wiped her face and forehead clean. Another checked on her IV line, removed her urinary catheter, and gently fed her sips of clear apple juice from a teaspoon. They chatted with Nasreen and joined her in prayers of gratitude to Allah, the most merciful and most beneficent.

She wanted to stay longer but visitors — even mothers of 10-year-olds — to the surgical step-down unit were strictly regulated. The area comprised six beds and was staffed by two nurses, each supported by a nursing aide. It was an intermediate facility, with a level of care about halfway between the ICU and the general ward.

All the patients in here were hooked up to cardiac monitors and subjected to vigilant nursing. Family members were permitted inside only two or three times in 24 hours, and that too for just a few brief minutes each time. This is where patients were typically transferred after surgery — unless they needed to be on a ventilator, in which case they were sent to the ICU.

Nasreen had lingered at Nyla’s bedside, craving to catch a smile, even a weak one. It didn’t happen. She had stood by the side of the bed, cradling her daughter’s delicate arm. She stroked the little girl’s fingers, massaged her hand and playfully squeezed the wrist. Then she moved to the foot of the bed, unfurled the white hospital sheets from the edge and toyed with her daughter’s toes. Ever since she was a baby, Nyla had always found that gesture affectionate and ticklish, and never failed to squeal with delight. This time it was different. She briefly fluttered her eyes, but nothing more. Nasreen couldn’t hide her dismay. It was all those pain medications making her drowsy, one of the nurses explained.

That was six — no, make that seven — long hours ago. Seven hours of nothing other than quiet and anxious waiting. Nasreen is tired. She hasn’t slept in almost two days. She’s been through an emotional tornado. She has tried to suppress all thought of the bomb blast, yet the images keep flooding back. The rattled window panes, the helter-skelter as she rushed out of her apartment building, the sight of Nyla caked with dust and flattened to the ground amid her scattered school books.

And that dismembered limb. Who did it belong to? Why did it land on her roof, of all places? Was it some kind of sign? Nasreen finds it weird that the thought of that torn-off arm does not revolt or nauseate her. It doesn’t fill her with disgust or dread. It just sets off a deep sadness and a sense of crushing loss for the person to whom it had once been attached.

A black Karachi crow, as much a native of the city as any other living being, flaps down and settles on the far end of the bench. Nasreen is startled. She looks at the bird bobbing its hideous head and poking its sharp, tapering beak between its grimy feathers. She finds herself focusing on the crow, trying to imagine its life, a life spent flying and foraging — with no apparent purpose other than day-to-day survival.

She is not sure why she does this, but the musing comes readily. Indeed, she welcomes it. She does not want to think about what happened to Nyla’s friend and what nearly happened to Nyla herself. She does not want to imagine her own life without Nyla — a life that would surely be reduced to drifting and foraging, with no apparent purpose other than day-to-day survival.

No, she doesn’t want to imagine any of that. She would rather try and think about this crow, hoping for an escape — even a brief one — from the fragility of her own life and its brittle circumstances.

Suddenly, the crow takes flight and Nasreen is startled once again. She feels her heart thumping like a piston and wants it to settle. She adjusts her dupatta and shifts position. Her eyes scan the main hospital courtyard, at whose edge she is quietly seated. The place is full of people, trees, wheelchairs, stretchers. But it is all a blur to Nasreen. She watches but doesn’t really look. She can hear the sounds — people chatting, children laughing and yelling, leaves rustling, crows cawing — but she isn’t really listening.

Dusk approaches. The maghrib prayer call will soon follow. The duty to pray tugs at her conscience, but how can she? She hasn’t showered or washed. She hasn’t even changed the shalwar qameez she has been wearing since ... how does one even refer to something like this? The incident. Yes, certainly an incident.

Her husband had joined her at the hospital while Nyla was undergoing surgery. He spent the night with her, stretched out on the same bench where Nasreen now sits alone. Shortly after daybreak, her sister arrived. Then, later in the morning, there was a hefty assembly of neighbours, friends, relatives and acquaintances.

Nasreen sent them all away. They had come with good intentions, most of them. But their words of comfort were little solace to her. Even her husband was sent off; he needed to rest and report back tomorrow at the bank where he was a junior audit officer. Her sister offered to stay, but Nasreen insisted on being left alone. Your household needs you more than I do, she told her sister. Both women knew she was right.

That was around the time when she had last been able to see Nyla. Remembering the feel of her daughter’s hand in her own ignited a wave of delight in Nasreen. She had made three more attempts to visit Nyla in the surgical step-down, each without success.

Twice a nurse came out and assured her all was well with Nyla but there were other sick patients inside and allowing visitors would cause unwanted interference. The third time no one answered the door. She knocked several times and repeatedly buzzed the intercom by the door. A security guard gently came up and politely advised her to check again later.

“Behen ji, is it you?” asks a friendly masculine voice from behind. The tone is gentle, almost lyrical. Nasreen feels her neck soften, her nerves soothed. The man’s face is familiar, though she doesn’t place it right away.

“You are Nasreen, right?” asks Shakoor. He has just come in on another ambulance run to Avicenna. After handing his patient — an elderly female with a suspected urinary tract infection — over to the ER staff, he has stepped out for a smoke. Noticing the vacant expression on Nasreen’s face, he points at his name tag and the KIH logo above it. “From the ambulance, Behen ji. Yesterday.”

“Shakoor bhai! From the ambulance!” Nasreen blurts out. “I’m sorry I didn’t recognise you.” She feels suddenly roused. She barely knows this man, yet he seems a friend, something about him conveying promise and trust.

“How is your daughter?” Shakoor politely enquires.

“She had an operation,” replies Nasreen. “The doctors ... they say she’s going to be okay.”

As soon as she utters these words, Nasreen loses composure. Her face gets twisted and thick tears stream down her cheeks. Shakoor stands still and silent, unsure what to do. Within seconds, Nasreen has completely broken down, burying her face in her dupatta and sobbing convulsively. Shakoor steps forward and places a light hand on her shoulder. Questions are flooding his mind, but instinct tells him not to rush it.

“What is it, Behen ji?,” he asks finally, articulating the words with softness and warmth. Smoking is a deep enjoyment for Shakoor and his cigarette is only half consumed, yet he flicks it onto the ground and stubs it with his toe. “Tell me,” he continues. “Maybe I can help.”

Nasreen allows Shakoor’s hand to remain on her shoulder. After a minute or so, her sobbing ceases. She looks up and inhales deeply, wiping away the tears. Emboldened, Shakoor sits down on the bench beside her.

“Shakoor bhai, I don’t know how my daughter is,”

Nasreen sighs.

“How is that possible?”

“They’re not letting me see her.”

Shakoor listens patiently as Nasreen explains her predicament. He feels livid. These elite private hospitals, he knows all about their snobbish ways. He brought Nyla here because he knew this is where she would get the best medical care. It was obvious that Nyla’s family won’t be able to afford Avicenna prices, but Shakoor was confident the hospital’s welfare budget for indigent patients would kick in.

Unfortunately, that also meant that Nyla would get identified as a recipient of financial assistance and not be accorded the same respect as the patients and families who paid in full. If you were rich and connected, you were handled well at Avicenna. If you were on welfare, you were tolerated. How unfair. How insane.

Shakoor takes a long look at Nasreen as she sits on this hospital bench with the posture of the needy, her clothes mussed up and rumpled, her hair untidy, her face belonging to the margins. Appearance, manner, speech and smell — these are easily and instantly profiled in Karachi. Yesterday, when he was transporting Nasreen and her injured daughter in his ambulance, Shakoor had felt a social and emotional kinship with this woman. They had hardly spoken; they hadn’t needed to. She was a fellow struggler in Karachi’s brutal sea of disadvantages.

Shakoor simmers at the thought of Nasreen getting overlooked and ignored by the Avicenna staff. The affinity he had felt with her yesterday becomes intensified manifold. He wants to help her and he wants to do it right. He doesn’t wish to be a nuisance; he wants a strategy that will bring results. He knows that simply accompanying Nasreen to the ward won’t be enough. Much better to try and involve someone higher up the chain of influence. Clever and weathered, Shakoor knows that these situations can be tricky. Despite the best intentions, things can backfire. He wants to be deliberate and careful. He doesn’t want to end up adding to the damage.

Lifting the flap on his shirt pocket, Shakoor extracts a fresh cigarette. “Let me think,” he says, as he stands up and steps away. With the most practised and fluid motion, a match is struck and the cigarette gets lit. Shakoor draws on it deeply.

He scans his surroundings. Night has fallen. The courtyard is still a busy place, although the crowd is starting to thin. Shakoor thinks of approaching a security guard, but decides there’s little point. An Avicenna security man won’t be much higher up the influence ladder than a uniformed KIH ambulance driver such as himself.

Slipping a hand into his trouser pocket, he pulls out his phone and fingers the keypad thinking of whom to call. Wrapped in thought, he steps out of the courtyard and starts pacing along the driveway leading in from the hospital’s main entrance. His eyes take stock up and down the brightly-lit road. Cars — SUVs and expensive models, mostly — are pulling up on one side, dropping or picking up patients. On the other side, the media vans with their satellite dishes and colourful important logos are still parked, waiting for any scrap of news related to victims of the Empress Market bombing.

In a flash, it hits him, and Shakoor snaps his fingers. Another cigarette, half consumed, is flung to the ground and stubbed out once again, this time militantly.

Quickly crossing the driveway, Shakoor begins scuttling along the row of media vans. The first two are empty but in the third one, belonging to Premier News, he finds a driver slumped at the wheel, taking a snooze. Shakoor shakes him awake, demanding attention.

Within minutes, a reporter and a cameraman are at Shakoor’s side. They’ve been thirsty for an interview, a nugget, a quick feature, anything. But there’s been no luck all day. The hospital isn’t releasing the identities of the injured. Nor have they provided much by way of medical updates. The media teams have been under pressure from their head offices, their bosses hungry for content to fill the evening broadcasts.

The reporter senses something useful here, perhaps even a scoop. Yet he is careful not to get carried away. He must be certain about the details. He tells Shakoor to relax. He wants to take his time calming this man down.

“This woman you’re telling us about. You say she’s the mother of a bombing victim? From yesterday’s blast at Empress Market?” the reporter asks.

“Yes, yes,” replies Shakoor. He is excited to be talking to a television news team, but also frustrated that the reporter is making him repeat things.

It was obvious that Nyla’s family won’t be able to afford Avicenna prices, but Shakoor was confident the hospital’s welfare budget for indigent patients would kick in. Unfortunately, that also meant that Nyla would get identified as a recipient of financial assistance and not be accorded the same respect as the patients and families who paid in full.

“And she’s not being allowed to see her daughter?”

“No, she’s not. Correct.”

“And you’re saying there’s no fresh information on how the patient is doing?”

“No, there isn’t. I already told you!”

The reporter ignores Shakoor’s irritation. “Let me clear it with my producer,” he says. Flipping out his phone, he walks off a few feet to make the call. It doesn’t take much to persuade the producer. Within seconds, the reporter is back.

“Let’s go,” he says, with an air of command. “We’ll interview the mother first. Then we go with her to the ward, where she’ll make an attempt to see her daughter. Keep the camera rolling throughout. Got it?”

The cameraman hoists the camera on to his shoulder, adjusting the lens and flipping a switch. He gives a sharp nod. “Ready,” he says.

The three men head off towards the courtyard. They spot Nasreen and begin marching in her direction. Even from a distance, they are easy to identify. With a determined stride, Shakoor leads the pack. The reporter is right beside him, clothed in a sky blue zipper-jacket with the Premier News logo loud and prominent at the back, a microphone thrust out in front of him like a threatening dagger. A step behind these two is the cameraman, looking all officious and important. Everybody notices.

At first, Nasreen is reluctant to cooperate. She feels uncertain about getting mixed up with TV news. But the reporter tells her to think about her daughter, and she doesn’t need any further prodding.

From across the courtyard, a security man has been watching this gaggle closely. His nervousness mounts as their movements become more and more purposeful by the second. An intrusive media team is always a red flag that must be communicated up the chain of command. He gets on his walkie-talkie and alerts the night-shift supervisor. Avicenna is an image-conscious institution. A series of rapid steps are set in motion.

By the time the group reaches the entrance to the surgical step-down unit, a small crowd has assembled to greet them. There are uniformed supervisors from security and nursing. The on-call surgical resident has arrived, looking overworked in a set of crumpled OR scrubs. A representative from Avicenna’s media relations is also on hand.

The nursing supervisor, a 50-year-old experienced Avicenna figure with a classic matronly demeanour, takes charge. She can tell the camera is rolling. Any wrong move and the situation will quickly blow up. The reporter is hostile from the outset. He accuses Avicenna of having spoiled Nasreen’s daughter’s case. “Why are you not letting her see the patient?” he barks. “What are you hiding?”

The nursing supervisor tries to maintain an outward calm. “Let me see what the situation is,” she says. Her brow is furrowed, though she has managed to hold on to her smile. After a brief word with Nasreen, she turns around and punches in the entrance passcode on the ward’s security keypad. Sharp, short beeps punctuate the air as each button is pressed. Finally, a burst of rapid beeps is sounded as the electronic lock opens. The nursing supervisor pushes through the door and steps into the five-bedded step-down unit.

Nasreen cranes her neck, trying desperately to peer inside. The cameraman repositions himself, hoping for an angle into the interior. “Stop this cover-up!” the reporter yells, as the nursing supervisor disappears inside and the door shuts.

Within seconds, the door reopens. The nursing supervisor motions to the group, inviting them inside. Her brow is now smooth, her smile now genuine and beaming. Nasreen rushes to the side of Nyla’s bed; Shakoor follows. The reporter and his cameraman position themselves in the middle of the doorway. Nyla is sitting up and looking fresh and relaxed. On seeing Nasreen, her face breaks into a grin and she stretches out her arms. Mother and daughter lock into a fervent embrace. Nasreen, tears of relief streaming down her eyes, showers her little girl with kisses.

The reporter is unable to hide his disappointment. Evidently, he had hoped to find something more newsworthy than simply a tearful mother-daughter hugfest. “Cut it,” he says to the cameraman, poking him with an elbow. Both men quietly walk across the unit to join Nasreen and Shakoor near the bed.

The nursing supervisor adjusts her hair and straightens her uniform. She runs a commanding gaze across the unit, taking a quick survey. Fleeting eye contact is made with the newsman, at whom she flashes a radiant smile. Her manner conveys authority and control. She appears a woman who enjoys the taste of attention, though on her terms.

“I must offer an apology on behalf of the unit,” she says, her voice calm and confident. “It’s been extremely busy in here today, but things have finally settled. We were just about to call Nasreen in for a visit. As you can see, her daughter is well cared for.”

The small gathering turns its collective eyes towards the surgical resident, anticipating a more technical update. “She’s post-op day one,” he says. “Wound’s clean, no fever, minimal pain.”

“Doctor,” Nasreen says with urgency and intensity. “She’s fine na? She’s going to be okay na?”

“Yes,” replies the resident. He looks down at his electronic tablet, tracking the various tasks — the wound dressings, procedure schedulings, emergency room assessments, family meetings, clinical note-writing — that have already been done and that are still to be done. Wrapped deep in thought, he turns around and walks off.

The reporter steps forward to exchange pleasantries with Nyla. Placing a paternal hand on her head, he looks up above her bed. There is a white plastic nameplate with clear black lettering. Name: Nyla Rehman. MR no. 0706399. Attending: Dr Tanya Shah.

“Where’s Dr Tanya?” he asks. When no one responds, he turns towards the nursing supervisor and repeats his query. He is told that Dr Shah isn’t in the hospital at the moment, but can be contacted if needed.

“Have you met Dr Tanya?” the reporter asks Nasreen.

She shakes her head. “The doctor I’ve met was a man,” she says. “I think he’s called Dr Zarak.”

The reporter asks the nursing supervisor if he can speak with Dr Tanya, but is told there’s no need as the patient is doing well. He asks for Dr Tanya’s cell number and receives a polite no. With that, the reporter and the cameraman thank the nursing supervisor and shake hands with Shakoor.

The reporter gently pats Nyla’s head once again. Avicenna’s media representative greets them at the door as the two Premier News employees exit the ward and step outside. They are leaving the scene empty handed, shoulders slumped, nursing a sense of defeat. Their producer won’t be pleased.

Back in the courtyard, the reporter pursues a hunch. He is a shrewd and perceptive man who has covered Avicenna before. He knows a thing or two about how the place is arranged and organised. Pulling out his smartphone, he composes an email to tanya.shah@avicenna.org, guessing the address based on prior communications with other Avicenna personnel. He has barely hit ‘send’ when his phone pings with a reply. “Out of office …” the header reads.

“We’ve got our story,” says the reporter.

Excerpted with permission.

Rivals is published by Bloomsbury.

The author is a cricket columnist, novelist and professor of neurology. He tweets @_saadshafqat

Published in Dawn, EOS, November 28th, 2021