The alarm from the monitor attached to Maryam screams, yanking me back from my haze. I run as the world blurs and nurses shout my name. The curtain around her cot is partially splayed, her body near limp behind it. I tear it open, finding her face ghostly pale. Blood is flowing down her thighs and spilling over the gurney’s mattress onto the floor.
“Hang more fluids!” I yell, grabbing the rails as Zahra follows my command without question. There isn’t time tothink—no time to ask permission—much less debate the antiquated patriarchal norms we’re expected to uphold while we’re here. There is onlynow.
I unlock the brake and rush the gurney toward the double doors that lead into the tiny surgical suite. The tiles underfoot are streaked with dried blood from prior occupants, the sterile field not nearly sterile enough.
Rafi barges into the room. “Dr. Hart! You can’t?—”
“If you aren’t coming to help, you can get the hell out of my OR,” I snarl over my shoulder, pulling on a pair of gloves. He lets out an exasperated sigh and slinks out of the doors. Turning my attention back to Zahra, I soften my tone. “That goes for you, too. If you aren’t comfortable helping, leave now. Iwilldo this on my own.”
Zahra rushes beside me, snapping on surgical gloves and grabbing an operating kit.
“Vitals?”
“Dropping fast,” she quickly exhales. I glance at the monitor. Maryam’s heart rate is barely there, and her pressure is plummeting. The baby is doing no better, with the heartbeat on the Doppler frantic and fading fast.
“Tube her,” I bark, filling a syringe of Propofol and Succinylcholine—hoping my minimal knowledge of anesthesia is correct—before pushing it through the IV port in her arm. Zahra hooks her up to the ventilator as I scrub in fast, adrenaline burning through my veins.
When I lift the scalpel, it feels heavy in my hand. I’ve done plenty of C-sections—and emergency ones at that—but the gravity of this one feels different than all the rest. Withthe blade pressed against her skin, I whisper, “Hold on… both of you.” My incision is clean and well-practiced. The gush of blood is not. The suction whines, red swirling away down the tube. “Scalpel. Clamp. Retractor.” I work fast, pushing aside tissue, opening the uterus as if driven entirely by muscle memory.
My gloved hand wraps around a tiny, slippery body, and I pull her into the world. She’s ungodly still, and my heart drops into my stomach. Zahra aggressively rubs a surgical towel over the baby’s skin, wiping away blood and trying to stimulate her breathing as Zahra and I hold ours. A tiny wail fills the otherwise near-silent room, and I exhale a sigh of relief while Zahra excitedly gasps, “She’s breathing.”
I smile through the sting of sweat in my eyes, knowing it’s far too soon to actually start celebrating this emergency C-section as a win. Blood is still pooling from Maryam’s uterus. Its walls are shredded where the placenta tore away. I try clamping, suturing, and transfusing what little blood we have, but it’s not enough. Every time I think I’ve stopped it, another surge follows.
“Her pressure is crashing again,” Zahra warns.
I look at the ruined tissue, at the gaping wound that refuses to close, and make the call I swore I’d never make—for any woman—without consent.
“Get me the instruments for a partial hysterectomy.”
Zahra freezes. “Doctor Ha?—”
“Now!”Shaking my head, I soften my tone before continuing, “We’ve already done more than we should, Zahra. If we don’t keep going, that little girl isn’t going tohave her mom.” She nods her silent agreement and hands me the instruments I need. With the steady but firm thump of my heart pounding in my ears, I clamp, cut, and work diligently to save the life of the woman on my table.
By the time I finish and step back, my scrubs are practically soaked through with blood, but both of them are alive.
For now…
The first light slips through the small window, painting the room in a pale, dusky gold and illuminating the dust particles in the air as Maryam’s eyelids flutter open. She groans softly, her hand instinctively pressing against her semi-deflated belly, and her lower lip begins to tremble. “You’re okay,” I soothe with a soft smile, although I know she doesn’t quite understand me. Stepping closer, I bring my arms together and rock them as though I were cradling a baby. “And so is your little girl.”
Zahra rises quietly from a stool in the corner, cradling a small bundle wrapped in a mint-green surgical towel. The baby is perfect—round cheeks, dark lashes, and a faint pink blush blotting over her skin. Maryam’s face crumples, and tears fall from her eyes as she reaches out, her trembling fingers brushing against the swaddled fabric. Zahra places the baby in Maryam’s arms, and she clutches the bundle to her chest. With her lips pressed to her daughter’s forehead, she whispers something I can’t understand between happy sobs.
For the first time in weeks, I feel like a doctor again. Not a bystander. Not a foreigner trapped within rules that make no sense. Justme,doing what I came here to do. When I step from the surgical room, I’m surprised to find Rafiwaiting in the hall. “You shouldn’t have done that,” he warns quietly as I pass.
Stopping mid-stride, I turn toward him. “Done what?”
He stares at the floor. “Saved them.”
I blink, stunned. “It’s done.”
He shakes his head. “It’s not. Her husband?—”
Turning on my heel, I don’t give him the opportunity to finish. I stride down the suddenly too-narrow hallways, needing air. Finally, I dart into the stairwell and take the stairs two at a time until I’m pushing open the door to the rooftop.
The air hits like a slap—hot, dry, and alive with wind. From up here, the city sprawls across the horizon in shades of beige and smoke. The morning sun catches on the distant hills, turning the sand to fire. Gunfire cracks in the distance, sporadic, yet so constant it’s nothing more than casual background noise.
With my palms pressed against the rough concrete railing, I suck in a much-needed breath of fresh air, inhaling until my lungs ache and feel like they’re going to explode. The air is thick with dust and diesel, faintly sweet from the smoke of burning trash.
Her husband.
