Chapter 3
The steady, rhythmic beep of the monitor becomes a countdown.
Each note is sharp and cruel, measuring the seconds Maryam has left.
Her pulse is faint, a whisper beneath the chaos surrounding us.
The air is heavy with the smell of blood—hot, metallic, and inescapable.
It permeates the sheets, the floor, and my gloves.
I watch helplessly as her stats continue to drop—heart rate, blood pressure, oxygen saturation—her life slipping like sand through my fingers. “Come on, Maryam,” I whisper, pressing my fingers against her wrist. “Stay with me.”
Maryam’s eyelids flutter in response. Her lips are pale, and her skin is clammy. She moans softly, her left hand momentarily rubbing over her swollen belly before falling weakly to her side.
“I’ve got him!” A voice cuts through my thoughts, sharp and hopeful. I look up. One of the nurses is leaning over the front desk, flailing the phone clutched in her hand. “I’ve got her husband.”
My breath catches as I push from Maryam’s bedside. “Rafi!” I bark, tearing off my gloves. “What are you waiting for? Let’s go!”
We reach the nurses’ station, and Rafi’s hand trembles as he takes the handset to the old landline. I punch the button to put the call on speaker, and a deep, static-laced voice crackles through the phone.
Rafi’s throat bobs as he switches between languages.
Nudging his arm, I urgently—but steadily—insist, “Tell him that his wife is losing a lot of blood. She needs surgery immediately to save both her and the baby.”
His voice tight, Rafi translates. When the man on the other end responds, Rafi’s lips curl downward as his brows furrow.
“What did he say?”
“No… He said… no.”
My chest is so tight that the thin fabric of my scrubs feels like a rubber band wrapped around my lungs, restricting my breath. This can’t be happening. “Explain it again.” Maybe he didn’t comprehend the severity. “Make him understand how serious this is.”
Rafi does. His tone changes, and even though I don’t understand, I can tell that he is pleading this time. The phone falls silent, save for the faint staticky crackle, before we receive another answer. His shoulders slump in defeat. “He still says no.”
“What the hell do you mean, no?” I shout, my voice reverberating off the chipped plaster walls. “She’s going to die if we don’t do something.”
“I understand,” Maryam’s husband responds flatly. His accent is thick, but his English is perfect. “And it is God’s will.”
Is he fucking serious right now?
“God’s will?” My voice cracks as I choke on my disdain for the complete lack of empathy from the man on the other end. “Are you fucking kidding me? You’re just going to let your wife and baby die?”
“I have other wives.” Each word is so cold and precise that a chill runs down my spine. “Ones who give me sons.”
“Please. You do—”
Click.
I stare at the speaker in complete disbelief, unable to hear anything but the rush of rage-fueled blood pulsing in my ears.
BEEEEEEEEP.
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 to think—no time to ask permission—much less debate the antiquated patriarchal norms we’re expected to uphold while we’re here. There is only now.
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. I will do 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. With the 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 to have 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.
Just me, doing what I came here to do. When I step from the surgical room, I’m surprised to find Rafi waiting 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.
The thought crackles through my thoughts like static.
He wouldn’t answer the call when she was dying. Didn’t give a damn when her blood was soaking through the sheets. But now? Now he’ll be outraged—furious—because I saved her life. Because I touched her. Because she lived without his consent.
I squeeze my eyes shut, and my jaw tightens as I swallow my unease.
“Let him come,” I whisper to no one.
I did the right thing… even if a man said it was wrong.