Rivals, by eminent neurologist and cricket columnist Saad Shafqat, is the follow-up to his thriller Breath of Death. As with the latter, the former is set in the fictitious world of the country’s prestigious Avicenna University hospital, which bears a striking resemblance to the author’s real-life alma mater, the Aga Khan University Hospital.

However, while Breath of Death had its doctor protagonists trying to figure out a mysterious brain illness sweeping through Karachi, the plot of Rivals revolves around the professional rivalry between two exceptional surgeons for a coveted job at the institution.

The position of the chair of surgery has become vacant following seasoned veteran and “Avicenna fixture” Afzal Idrees’s decision to resign for greener pastures abroad. In the wake of his resignation, the most likely candidates for the position appear to be two outstanding surgeons — Tanya Shah and Hammad Baig — who, as it happens, have been long-standing rivals ever since they were classmates at medical school.

However, readers would not know that until they reach the halfway mark of this 300-page novel. Shafqat takes his time in getting to the crux of the story and the first half of the novel gives us an intimate, albeit at times superfluous, peek into the lives of the two protagonists, along with a host of other characters whose relevance to the plot never becomes clear.

Towards the beginning of the book there is a suicide bombing at Empress Market that sets the stage for the drama to unravel. Since it is implied that bomb blasts are a frequent occurrence in the Karachi of this story, I assumed the book was set during the decade of the 2010s. However, later on in the novel, a scene opens with Donald Trump being announced as the new president of the United States. I found this confusing in terms of the timeline during which the story is set.

In Saad Shafqat’s vibrant and page-turner medical drama, two surgeons find themselves pitted against each other for the top job at a prestigious hospital in Karachi

Both the two competing surgeons belong to the upper echelons of Karachi’s social class. Hammad Baig is married, has three children and is a complacent ophthalmologist and associate professor at Avicenna Hospital. He prefers his lifestyle to set him apart from the crowd and is not averse to engaging in underhanded political manoeuvres to maintain, or enhance, his standing in medical circles.

He is also a dyed-in-the-wool womaniser and, during a trip abroad, has a dalliance with a human resources representative of a pharmaceutical company he works with. Oddly enough, while the prelude to this entire sequence is delineated in painstaking detail, it does not serve any larger purpose in the story and it seems as though the intent was merely to make the prose risqué and provocative.

Tanya Shah, meanwhile, is a determined and ambitious trauma surgeon, serving as chief of the department of trauma surgery at Avicenna with an aim to train an entire cadre of trauma experts. The latest of these is her newest recruit, Zarak Afridi, a young general surgeon from Peshawar. Tanya and Zarak’s equation serves a pivotal role later on in the book, as Hammad tries to use it to sabotage Tanya’s reputation and tip the scales in his favour.

Despite being a thorough professional, though, Tanya falters when it comes to being tactful and is prone to temper tantrums — which is in sharp contrast to Hammad, who is a maestro at maintaining the perfect public image.

The complete spectrum of reactions can also be found in Avicenna. You have the tut-tutters and pragmatists; the get-on, move-on, shoulder-shruggers; the philosophical, peripatetic analysts; the distraught and emotionally paralysed; the insanely angry; the glib know-it-alls. News of the bombing is discussed in all corners. Chatter progresses to argument, which progresses — occasionally — to heat and fury. — Excerpt from the book

Now pitted against each other for the top level position, their “mutual acrimony” comes to a head. Given the clash not just between the two surgeons, but also between their own individual personal and professional demeanours, it is really anyone’s game, although Hammad — the more immoral of the two — is prepared to leave no stone unturned in his pursuit for the top job.

For people familiar with Karachi, there are several trenchant observations regarding the socio-political landscape of the city. However, the narration barely scratches the surface when it comes to providing a comprehensive view, as it only gives us insight into the trials and tribulations of the upper-class. Getting stuck in long commutes and frequent traffic jams are the only predicament shared by all characters in the book, irrespective of their social class.

Also, since the protagonists embody the upper class of the social circuit, we get to learn plenty about the lives of the elite, but it is regrettable that some small characters are side-lined in the narrative. For instance, Shakoor — an ambulance driver who plays a crucial role in the plot — had an interesting backstory with a potential to develop that remained untapped. In that vein, none of the characters implicated in the Empress Market bombing get a sufficient plotline, which would have added gravitas to the story set in an infamously volatile city.

The highlight of the book is the comprehensive insight given to the workings of a medical institution where the stakes are high every day, since human lives are on the line. The glimpse into the bureaucratic hierarchy and power dynamics between medical professionals and the administration also makes for an engaging read.

Postcolonial inferiority complexes are also highlighted as being a major component of this power play. Avicenna’s chief executive officer Peter Kraus, and head of human resources Grace Wilson, for instance, are shown to be able to display disparaging behaviour towards their subordinates without any repercussions, on account of them being white. At one point, Grace even notes how she “discovered early that her European skin was an incredible asset in this setting. She could throw her weight around and get away with it.”

The premise, that of the drama of the business of medicine against the backdrop of a city as tumultuous as Karachi, is a tall order to fill for anyone. However, Rivals definitely inhabits a niche and untapped genre of its own in Pakistani literature at the moment, and it is one I am looking forward to exploring.

The reviewer is a Karachi-based book critic writing for several international publications

Published in Dawn, Books & Authors, December 12th, 2021