Abundance, page 1
For my mother,
Ashraf Banu Lakhani
Contents
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Epilogue
Acknowledgments
1
The early hours in Florida were early evening in Rawalpindi, where Ramzan had grown up in the same building as Sakeena, but where he had not felt compelled to visit in the forty years since he’d left. In a way of staving off loneliness, or of keeping up, in some small manner, with the times, he enjoyed the daily exchange of messages from back home—from a faraway part of his life—forwarded videos and images from his brother and sister-in-law, but also from old friends, acquaintances whose sole role in Ramzan’s life at this point was wishing Eid Mubarak with a video of stars twinkling around a new moon, or Happy Siblings Day, or International Daughters Day, sometimes holidays Ramzan wasn’t even aware of but was happy to act upon, forwarding the lovely animation to Fareen in New York or to Kawal just a few miles away. On his phone were also texts from the morning employee at their Dunkin’ about ingredients that needed reordering, a batch fryer that needed servicing. The messages pulled at Ramzan’s attention as they always did, a task he felt satisfaction in completing, if only to clear away the numbered badge at the corner of an app, but today, he consciously set the phone aside. Something felt off with Sakeena. All night she had been agitated. Lost in a dream, she’d turned restlessly, struggling, it felt, before finally murmuring, Adnan ku kya? What has happened to Adnan? They had not seen Adnan, their youngest, in three years, a concern for Ramzan, too, but it was unusual for Sakeena to suffer dreams like these.
After helping Sakeena out of bed, an hour past their usual waking time, and guiding her in her drowsy state to the kitchen table, Ramzan tried to recall how to make masala chai. Despite all these years in the U.S., they held on to traditional roles at home, Sakeena the expert in the kitchen, Ramzan the happy helper; at Dunkin’, Ramzan was the stress bearer of the turbulence in managing a small business, Sakeena the gentle hand of reassurance. Envisioning Sakeena’s steps now for chai, Ramzan filled the small pot with water before setting it over a flame. He scooped in loose tea, added cardamom pods, then poured in condensed milk just as it all came to a slow boil. As he observed Sakeena do so many times, he let the creamy mixture rise but not spill, lifting the small pot off the flame, repeating this three times to give the chai strength, before pouring it through a strainer into two steel cups. The children for many years poked fun at these cups—Why would you drink hot tea from a steel cup?—but it was simply their custom, holding the cup comfortably by its lip and sipping, how they best enjoyed the taste of tea. In his case, Ramzan could get by if need be with Lipton made in the microwave, or coffee from their Dunkin’—but Sakeena, even after these many years, could not bring herself to drink tea any other way.
Chal, Adnan, Sakeena had said in her dream. Come. The time has come—our plane will leave. Come! Have you sent in all the suitcases?
To Ramzan’s disappointment, Adnan had several times over the past three years cancelled plans to visit, always claiming some urgency with his shoes business, but at least he video called Sakeena each week, from Monaco, or Sardinia, or Kinshasa, wherever he was at the moment, calling sometimes three times before Sakeena answered. Sakeena was never likely to have her phone handy, or charged, even. Occasionally, after Ramzan heard Sakeena’s phone ring multiple times, he would receive a call from Adnan on his own phone, which Ramzan gladly answered, even knowing that he was a second preference, that Adnan would politely make conversation before asking if Sakeena was around. Ramzan did not resent Sakeena’s closeness with Adnan, but rather loved the pleasure he observed in Sakeena’s eyes when she finally saw Adnan’s face on the screen. What worried Ramzan, though, was that it had been three weeks since Adnan’s last call, with no response as yet to five or six attempts to reach him.
Sakeena, Ramzan whispered that morning in bed, his vision blurry without his glasses. He’d touched his hand softly to her stomach. This was a position of great intimacy for them, one of his arms beneath her head, the other wrapped loosely around her, how they’d fallen asleep each night for over thirty years. Sakeena, where are you going on this plane?
Arey, Bombay, she murmured, frustrated. Like Ramzan was asking an unintelligent question. Bombay, then going by train to Rawalpindi.
She had not returned to Rawalpindi in eighteen years, having gone back for the funerals of each of her parents, only three years apart. Ramzan was not able to go for either of his parents’ deaths—finances especially tight at those times, plus his older brother Tabreez was there to manage arrangements.
There is still some time, no? Ramzan said to Sakeena in her sleep.
Sakeena moaned in response: There is not even one bit of time—
After her first sips of chai Sakeena grew more alert, though sleep and confusion still weighed over the thin lines of her face. Even after poor sleep, Sakeena appeared to Ramzan somewhat composed, her hair falling elegantly past her cheeks, resting in neat layers high against her back. Somehow her hair had never gone gray; it retained the same shine that aunties used to remark upon when they were teenagers exchanging glances in the dirt lanes of the colony. At the kitchen table, Sakeena fixed her gaze outside, searching for one moment in the branches of the old mango tree that they planted before the twins were born, their first weeks in Miami, this mature tree now crowding against the wall of their small townhouse, while on the other side it leaned over the drainage canal, beautifully ripe mangos often going wasted into the water.
You made it perfectly, Sakeena said about his chai, while she dipped a corner of her toast in the steel cup, letting it soak a few moments.
Ramzan sliced onions and chilis and broke eggs in a bowl for the breakfast dish he vaguely knew—unda piaz ka saak. Scrambling the mixture, Ramzan intermittently confirmed the recipe with Sakeena, who appeared tired again, her head slumped toward the table. Cook on slow heat, she murmured. Cut onions fine, allow them to soften before adding eggs. Sakeena had left a stack of chapatti in the fridge and Ramzan reheated a few on the tawa pan, coating each with a bit of ghee.
When Ramzan set the plate of unda piaz before her, Sakeena was awake—this much he remembered. She responded to the smell of food. Right away she tore off a piece of warm chapatti, pinched the first bite of egg and onion into her mouth. She closed her eyes while she chewed. When she opened them, she looked out toward the mossy rocks at the edge of the canal, at a few ducks swimming by. The texture of his unda piaz was dry but she did not complain; she registered no distaste, no deviation from their normal routine, as if she were eating the same food, made by her hand, that they had been eating their whole life.
It was then, while Ramzan went to the counter to grab the salt, his back to Sakeena, that he heard a spilling sound. Ramzan turned. At the table, Sakeena’s elbow was bent; she was holding the steel cup close to her lips. But it was tilted. Her eyes were shut. Slowly, the chai spilled, first onto her plate and then directly onto Sakeena’s lap.
Jaanu! Ramzan called, running. He took hold of the cup, still warm, by its base. Sakeena did not react, not to the alarm in his voice, not to the chai soaking through her nightgown. Ramzan pressed at her legs with a towel, but she seemed to feel nothing.
Bhothe thakgayi, she only said—I’m so exhausted—before she tucked her head down and let her arms sink to her sides.
Ramzan called Fareen, their eldest, in New York, but got no answer, only to find her a few minutes later on her work phone—on a Sunday.
She what? Fareen said. You have to call 9-1-1, Daddy. Right now. Don’t worry about the cost—
But Sakeena simply seemed to be sleeping, sleeping in the midst of being awake, sleeping while he carefully dabbed at the spilled chai in her lap. Worry struck him, yes, but not until he heard the alarm in Fareen’s voice did it occur to him to go to the hospital. Only he could not put Sakeena in an ambulance. What if they did not allow him to accompany her? At home, if he guided Sakeena she followed, even in her drowsiness, so Ramzan, one limb at a time, helped her change clothes, then sat her in the front seat of the car. On the drive to Jackson Memorial, he phoned Kawal—the only one of their three children who had stayed in Miami. Ramzan explained first that Sakeena was not feeling well, trying to protect Kawal from worrying, especially in her new pregnancy, but asked her to come meet them at the hospital, and to please try once again to get a hold of Adnan.
Inside the Jackson ER, in a curtained cubicle where the beeping of machines and children crying filled the too-crowded air, a nurse rolled Sakeena from one side to another, changing her out of the simple pants and blouse that Ramzan chose and into a hospital gown. An unshaven doctor took charge, drawing her blood while Sakeena slept. Her ammonia is dangerously high—your wife is at risk of an encephalopathic coma, the doctor soon made clear, while moving IV lines and wires away from the bedside. You need to stand back, he said. Back from Sakeena? Ramzan could not. Instead he crouched beside her while the doctor raised Sakeena’s legs, examining her underside in a way that Ramzan could not bear to watch. We have to administer an enema, the doctor said—the only way to release the ammonia. While he said this Sakeena remained asleep, her calm expression interrupted only by winces from needles and prods. You will be fine, jaanu, Ramzan said, blindly, because Sakeena valued reassurance. Naseeb meh hai tho kya karsakthe? she would say. If something is in your naseeb—destined for you—then what can you do?
Sakeena released a painful scream when the doctor inserted the enema. She remained in near sleep, her delicate face pinching and contorting with the passing of stool. Ammonia had built in her blood to dangerous levels, her liver possibly not filtering it as it should. An enema was a temporary solution, the doctor explained. The toxins would almost certainly build again. But for now it worked. Within an hour—an hour in which the nurse very sweetly cleaned Sakeena with foaming soap and wet towels—Sakeena was more alert, asking Ramzan: Jaani, why are we here in the hospital?
After Kawal arrived, twenty-five weeks pregnant and strained with worry, and after hours of tests in the third-floor biopsy unit, after which Sakeena was admitted to a comfortable room on the fourteenth floor, Sakeena appeared completely normal, in great spirits in fact after Kawal’s husband, Hussain, brought two-year-old Zul into the room. The nurse immediately came to warn them that children were forbidden on this floor—a hazard to the suppressed immune systems of transplant patients—but after just one minute with Zul, whom Sakeena cared for most weekdays, Sakeena transformed. Aya mara Jully, she cooed—My Jully has come—using her pet name for him, as well as her habit still present from India, thirty-four years removed, of conflating Z and J. Zul matched Sakeena’s enthusiasm, not noticing the beeping machines and small IV needle inserted into the back of her hand but, rather, climbing all over Sakeena, to her great pleasure.
A portly young doctor greeted Sakeena as he entered the room. He wore a neat checkered shirt beneath a white coat reading at the breast: University of Miami Hepatology Unit. Stitched opposite was Dr. Hitesh Gupta, an Indian name that reassured Ramzan—it could have been Gujarati, like their name, though it appeared from his fair skin and confident English that he came from a more educated class than theirs.
Mrs. Bharwani, Dr. Gupta smiled. Is it true that you have not visited a GP in more than ten years?
GP means doctor? Sakeena turned to Ramzan, alert, no more encephalopathy, and speaking, too, for the first time in weeks in English. Ramzan knew from their troubles years ago, in trying to conceive, how much Sakeena hated visiting a doctor. She turned to Gupta now: If I am feeling healthy then why am I to see a doctor?
Ah, but you are not healthy, my dear. You gave your family here a real scare today.
My children scare me every day, Sakeena quipped. Not this one, she corrected, touching Kawal’s hand. But my son has not come to see me in more than three years.
Doctor Sahib, Ramzan interjected, using the formal title, how they were raised to address any physician. Ramzan found himself turning his head side to side, an honest plea, body language from back home. Gupta seemed sympathetic, mirroring Ramzan’s gesture. Please, Doctor. What is happening with her?
Gupta’s smile faded. Mrs. Bharwani, I am deputy head of the hepatology unit here at Jackson. For the last few hours I’ve been studying your case—the tests and blood work, plus the liver biopsy I ordered. The reason I am concerned that you have not visited a GP in years is that perhaps we could have learned sooner that you are suffering from an advanced case of cirrhosis of the liver. This is often found in patients with severe alcoholism, though I’m aware you don’t drink. Gupta might have interpreted this from their Muslim name, if not from the forms Ramzan had completed. Your case appears to be autoimmune—the body is naturally breaking down its own liver, for no reason other than bad luck. His voice turned softer now. Mrs. Bharwani, your liver is functioning at just 10 percent of normal. Your body is losing its ability to filter poisons—even digestive poisons, like ammonia or bile—from your blood.
Kawal drew herself closer to Ramzan. Ten percent? she said. This while Ramzan felt that the world was beginning to spin too quickly. He felt like something was being taken from him. In his mind he saw Sakeena—Sakeena from their youth—hanging clothes on the balcony of her parents’ flat. He saw himself waiting at the colony gates in drizzling rain—the monsoon was their favorite season—as he hoped to slip a carefully written letter into Sakeena’s school bag. He pictured himself late at night sitting on a stool behind the counter of a gas station in Tampa, listening to mice fornicate beneath the deli case. For six lonely years he saved to bring Sakeena to the U.S. Finally, he could remember flashes of raising the children—Sakeena’s hand resting in his as they witnessed Fareen’s fifth-grade trumpet solo, Sakeena meeting his eyes when she saw how deeply moved he felt.
Doctor Sahib—what is implication of this low function?
If we did nothing it would mean end of life, Gupta said. Her MELD score is twenty-one. You understand a healthy person’s MELD is six. Patients in this state of cirrhosis, at age sixty, are unlikely to live longer than nine months. But we can list her for a transplant. As she gets sicker her score will rise. Transplants are being allotted to patients right now with MELD scores in the high twenties.
The word transplant gave Ramzan hope. There was a system in place here, someone—Gupta, the health insurance company, University of Miami researchers—available to help them, hope that at that exact moment someone was dying from an unfortunate car accident and that that person’s organs were being harvested to save another life. Sakeena’s situation felt fixable—they needed only to undergo this procedure, in the way that some people have a heart attack and receive a stent, and then they are fine. Procedures made sense to Ramzan. He placed his faith in them as Sakeena placed hers in naseeb. His way had always served them well. When after their sixth year together in this country, running their farm-road store in Bartow, they still had not been able to conceive, Ramzan convinced Sakeena that they should spend their savings on a fertilization procedure—against her will, Sakeena optimistic that their luck would turn—and after that intervention they were blessed with Fareen in their seventh year of marriage.
Jo hai to hai, Sakeena said now. What is, is. She sounded almost as if she were joking—a stubbornness Ramzan recognized, a tone she took when she felt her instincts were being ignored. If this sickness is in our blood then what can we do?
What—what else can be done? Kawal asked, a kind of focus coming over her. I mean—if there’s anything we can do to get more time, Doctor, we’ll do it, you know?
There is one thing, Dr. Gupta said. Control the diet. Mrs. Bharwani, I need you to avoid red meat—this is very important. We must reduce foods that create significant ammonia. A little fish or soy protein is fine—but no red meat. You are slightly diabetic as well. I need you to avoid white rice and white bread, too. Those amino acids will also build ammonia.
At this Sakeena laughed. She was actually laughing. Tell me, doctor, you are from India?
Yes, of course.
And being from India, have you gone one day of your life not eating white rice?
Gupta smiled. Brown rice is nice, too, Mrs. Bharwani. Or how about quinoa? Have you tried quinoa?
Sakeena simply looked out the hospital window. You people are all crazy, she said. Completely crazy.
In order to list Sakeena for a transplant, Ramzan learned that they needed to complete a workup, including a heart examination, colonoscopy, ob-gyn clearance, even a dental exam, all in the interest of avoiding infection after receiving a new organ. But first they needed Sakeena to agree to a transplant; so far, she had only consented to some liquid medication that Gupta prescribed. This was what Ramzan was mulling over as they prepared to be discharged from the hospital the next morning, just as Fareen called from New York. She had been calling every few hours, asking once, twice, fifty times what level of urgency this was. Should she jump on a plane right away—take time away from her Wall Street work—or could her visit wait until the following weekend? Was Mom at urgent risk? If not, Fareen could come Thursday night, stay until Monday morning, and if it was possible to wait these four days it might make a difference for her because it was November, year-end was near, reviews were underway, and Fareen was being considered for a promotion to managing director. It is not too urgent, Ramzan half lied, not wanting to alarm Fareen. It was nine months they had left, not nine days. Plus, there was the likelihood of a transplant. What felt important, too, was that Ramzan did not want to stand in the way of Fareen’s promotion, which he understood was rare, to earn the title of managing director at age twenty-eight. The magnitude of opportunity available to Fareen had become clear over her six years working at Goldman Sachs, from hurried phone calls home—sometimes every few days, sometimes weeks apart—usually late at night while she sat in the back of a car shuttling her home to Brooklyn from the office. Take your time, beta, Ramzan said. Mumma will get better. I have faith in Dr. Gupta already.
