“What the hell do you mean, I need aman’spermission?”
The words explode out of me before I can stop them, loud enough to slice through the chaos of the emergency ward. For a second, everyone stills. It falls so silent in the room that the blades of the ceiling fan above us squeal as they limp through another rotation, stirring up dust and sweat, but it gives no relief.
This place is a shit hole of a hospital. Before the war, it was a government building. Now, it’s patched together with mismatched tiles and smears of unfinished plaster. Cracks run like veins along the drywall, and water stains bloom from the ceiling where the rain seeped through the roof last week. Generators rumble outside the window, barely enough power to keep the lights from flickering every few seconds.Well, the lights that actually work.
The smell is unlike any of the hospitals where I completed my training and residency. It has the same overwhelming scent of antiseptic, but it’s the sour undertone of death androt that clings to the blood-stained floors, no matter how much bleach we spread across them.
A glare at Rafi, my translator. His shirt sticks to his torso, a dark patch of sweat radiating from his sternum. He looks at the clipboard in his hand, pretending to read the paperwork, though I know it doesn’t contain the answer to my question.
“Rafi!”
He flinches. “This is how it is here,” he murmurs with a heavy accent, his eyes avoiding mine. “She cannot receive treatment without consent from her husband or tribal elders.”
“You can’t be fucking serious!” I glare at him. “She’spregnant, not property.”
Another contraction tears through her, and the woman lying on the cot between us winces in pain. Her eyes—dark and wide—dart between the two of us as she listens to our tones, not our words.
I tug at the sagging curtain dividing her cot from the one behind, wanting the frayed fabric to give my patient some semblance of privacy. After reaching across her lap, I lift her trembling hand from the long, tiny-flower-pattered dress covering her lap. I cradle it tenderly between mine and softly ask, “What are you here for, Maryam?”
I wait a moment for Rafi to translate, but he doesn’t say a word. Angered, I snap my head toward him, raise my eyebrows, and flatly demand, “Translate.”
He blinks blankly in confusion. “You… want me to askher?”
Myface scrunches, annoyed. “Yes. That’s usually how translation works.”
Rafi mutters something in his native tongue under his breath before letting out a heavy sigh. Turning toward the scared patient between us, he finally translates for me. Maryam hesitates, then pulls her hand from between mine. With trembling fingers, she gathers the fabric of her dress and inches it up to her knees. I suck in a sharp breath; the metallic scent is instant and nauseating.
To help, I grab the fabric in her hands and lift the dress a little higher to find her thighs are slick with blood. The dark crimson has stained her skin and is soaking into the fabric beneath her. I look up to find her staring at me with wide, glassy eyes as she rubs her swollen belly with one hand. The gesture is both heartbreaking and futile.
“Get her vitals,” I bark to the nearest nurse. “BP, heart rate, fetal monitor.”
Zahra, the American nurse who arrived here almost a year before me, moves fast. She’s one of the best here. Her hands are always steady, and from her eyes, it’s clear that she has seen far too much. She wraps the cuff around Maryam’s arm and glances up at me as the gauge continues to fall. The numbers are bad. She doesn’t need to say it.
“You can’t…” Rafi stammers as Zahra wraps the fetal monitor around Maryam’s stomach. “Her husba?—”
“Then fucking call him!” I bark, watching her stats slowly decline with every second that passes.
I move on sheer instinct—ordering Zahra to insert an IV, starting a saline drip, and getting her stats to regulate—before pausing to give thought to the misogynistic rule that our patient needs permission to seek medical care. “Has anyone reached her husband yet?” My eyes dart around to the staff before falling on Rafi.
Sweaty and anxious, he shakes his head. “No answer. I left a message. He hasn’t called back yet.”
“Try again.”
He hesitates and draws in a deep breath. “Dr. Hart, sometimes?—”
“Try again,” I snap. “Please.”
Muttering something I don’t understand, he disappears into the hallway.
When I return my attention to Maryam, her lips move near soundlessly with shallow breaths wafting over them. I don’t understand what she’s saying. It might be a prayer or a plea for help. I take her hand, finding the skin hot and clammy. She squeezes mine gently, as though she knows how helpless I feel.
Unable to do anything else, I hold her hand as the light from the single high window above her gurney shifts from a harsh white to a dull amber from the sinking sun. The color in Maryam’s face is falling as well, matching the steady decline of her pulse. The absorbent pad beneath her hips is now saturated, the deep red seeping into the thin mattress beneath it.
I can’t take it anymore.
“I’ll be right back.” I set her hand on her stomach before storming toward the nurses’ station. The rough woodencounter is littered with clipboards. They rattle when I lean over it. “Did anyone reach the husband?” I demandingly ask.
A nurse looks up, startled. “We just called again, Dr. Hart.”
