outskirts of St. Ives.
It was there that he had sought to rebuild his life. He had saved well over the years, a lesson learned from his impoverished youth, and although the divorce cost him a great deal, he was left with enough to start over. But earning a place in the hearts and minds of Cornwall’s residents was nearly impossible, particularly for a foreigner. The community was close-knit and quick to lash out at unwelcome visitors, especially those seeking to make a home on the coast. Although he had hung on for nearly two years, trying to earn their trust, his practice simply wasn’t bringing in enough patients. Finally, the bitterness began to sink in. Once he realized that he no longer cared about winning them over, he knew it was time to return to the only other home he had ever known.
That was in the winter of 2006. He could still remember the sense of personal failure that had consumed him when he first stepped off the British Airways plane in Islamabad, the realization that he had squandered the best— and perhaps only—opportunity of his life. Even now, years later, he deeply resented many of the choices and mistakes he’d made, but he had come to accept them. He had replicated his Cornish home in his native land, but otherwise, he had relegated England to the past. Admittedly, his life in Pakistan could have been worse. There was no shortage of patients in Sialkot. Many of them could not afford the state-run hospitals, so naturally, they turned to him for help. These were people who held his English medical degree in high regard. People who appreciated his lenient nature, reasonable rates, and kind manner, and he valued them in return. Sometimes he wondered if he would have been happier in Pakistan all along. At least, that was how he had felt until the day he had met Benazir Mengal. Unlike Naveed Jilani, whom he had never met, Qureshi had not made the effort to form an alliance with the famed Pakistani general. In fact, it was the other way round. He had first encountered Mengal on a warm fall afternoon the previous year. Mengal had sent one of his men to collect him at Cafe 24 on the Kashmir Road, where Qureshi took his afternoon tea. He had been frightened at first, reluctant to leave without knowing the final destination. It was clear he wasn’t going to be given a choice, though, and in the end he’d agreed. He was blindfolded and driven to a flat, where he was shown a young man, a soldier, from the look of it, who had been shot twice in the right arm. The wounds were superficial—no major arteries were hit, and neither bullet was still inside the limb—but it had still been a challenge to repair the damage, given the limited tools he was provided with. Mengal had watched with interest the entire time, and when Qureshi was done, the general had quietly congratulated him before slipping an envelope into his jacket pocket. It wasn’t until he was back at the cafe that he opened the envelope to examine the contents. Inside he found 120,000 rupees—nearly $2000 American—
and a handwritten note from Mengal, cordially thanking him for his services.
Over the next several months, Mengal called on him twice more. Qureshi was able to repair the damage on both occasions, and in the strained, anticipatory lull that followed the surgeries, the general began to open up. He told Qureshi of his service in the Northwestern Frontier Province, as well as hinting at his involvement with ISI, and he expressed sympathy when the doctor explained his misfortune in England. Qureshi had no idea what happened from that point forward, but his list of patients doubled virtually overnight. He assumed the general must have spread the word to people in high places. In any case, he was grateful, and he said as much the next time he encountered Mengal. He wasn’t able to save the patient on that occasion—the bleeding was just too severe—but the general seemed to understand.
Qureshi never asked why these men weren’t being treated by army surgeons, partly because the answer was clear. Whatever they were doing—whatever Mengal had involved them in—was not related to the military and, in all likelihood, was highly illegal. So Qureshi kept his mouth shut, and as the years passed, the relationship continued to bloom. Night had fallen an hour earlier. A harsh wind sweeping down the foothills swayed the Chinar saplings outside and rattled the sturdy windows on the ground floor. Said Qureshi stood before a deep ceramic sink, his outline barely visible in the dim light from the hall. He lifted a scalpel from the steel tray by his elbow, then held it under the hot water, turning the light handle between his fingers in order to rinse the blade clean. He watched absently as blood swirled down the drain, but he wasn’t really seeing it. Nor could he hear the elevated voices in the next room. All he could think about was the surgery he had just performed. More specifically, he was thinking about the person on whom he had worked.
Mengal’s men had arrived earlier that evening, shortly after Qureshi had seen to his last patient of the day. From the moment he had opened the front door, Qureshi knew exactly who they had brought him. It had been all over the news, of course, but it was the look in their eyes that said it all. It was a shared look of desperation—not fear, but desperation—and when Qureshi had reached down to pull the blanket away from the woman’s face, he had shared in their desperation, but also the fear. . . . He replaced the scalpel on the sterile gauze and reached for a hemostat. As he subjected the surgical clamp to the scalding water, he saw that his hand was shaking. It was a delayed reaction, and the one thing he could take pride in. Throughout the procedure he had known the stakes. He had been all too aware that if she died, if she bled out on his table, ultimately, he would be blamed. Mengal’s wrath would be nothing compared to that of the Americans if they discovered his involvement; he might as well have staged the attack himself. And yet, throughout the surgery, he had remained stoic. He had kept his composure. His hand had been steady the whole time, and if she died, he could console himself with the knowledge that he had done everything in his power to save her life. It was a small comfort, but a comfort nonetheless. From the next room came another shout, then the sound of a door banging shut. There were heavy footsteps in the hallway, and then he sensed a presence behind him. He turned to face the other man, who was half concealed in the shadows.
“Will the woman live?”
Qureshi lifted his hands in a noncommittal gesture. The general had spoken in Urdu, and he replied in kind. “It is too early to tell. I’ve done all I can. If her injuries were any more severe, she would not have survived the trip.”
“Said, I am aware of how fortunate we are,” Mengal responded tersely. “Tell me, will our luck continue to hold? Based on your experience, what do you believe?”
Qureshi shifted uneasily. “It is hard to say.
“I don’t understand,” Mengal said slowly. He was clearly speaking to himself. “My men described the entire attack. She was fine when they pulled her out of the vehicle. She was talking, struggling. . . .”
“She was bleeding internally. She is
“Bleeding internally?” Mengal’s voice was sharp and accusing.
“Why haven’t you fixed it?”
Qureshi pushed down his rising impatience. Like so many soldiers who fought on the front lines, Benazir Mengal saw only the obvious signs of physical injury, the things he could fix immediately. The intricacies of the human body were completely lost on him.
“General, the woman has sustained severe injuries. The armor plating on her vehicle saved her from further injury, as did the fact that she was in the backseat, but she is still very fortunate to have survived. First, she suffered a pneumothorax of the left lung, most likely a result of blunt trauma. This means her lung was collapsed. I’ve already relieved the pressure and inserted a chest tube, but it must stay in for two days at the least, perhaps three. By that time, the excess air should be fully removed from the pleural cavity, and the tube can be removed safely.”
Mengal’s brow creased in annoyed confusion. “You said there was bleeding—”
“The bleeding,” Qureshi continued, “is a result of a hemopericardium, or tearing inside the membrane that surrounds the heart. That injury was also caused by blunt trauma, but it could be more severe than the pneumothorax. Perhaps much more severe. There is no way of knowing for certain until I operate.”
“How did you determine the cause of the bleeding?”
“There was no puncture wound, admittedly, but all the signs of cardiac tamponade are present. She regained consciousness shortly after you arrived. I asked her to lie flat, but she said it only made the pain worse. She complained of discomfort in her chest, and the veins in her neck were slightly distended, indicating a backup of blood in the veins.”
Qureshi paused, thinking about the best way to phrase it. “The heart, General, when surrounded by excess fluid, cannot beat efficiently. That is why she did not want to lie down. When her body was upright, the blood collected in the bottom of the pericardial sac, relieving the pressure. Her blood pressure was ninety over forty, low for a healthy woman in her late forties, and the EKG revealed J-waves, which are yet another indication of the injury
