SIALKOT, PAKISTAN
The house was perched atop a small hill in the Gujrat district of Sialkot, reachable only by a rutted driveway bordered on each side by patchy grassland. A number of sheep grazed in the open fields, which were separated from the road by a tangled row of scrawny trees. It was a quiet area just south of the Kashmiri foothills, small homes dotting the landscape. There were no natural wonders, nothing of interest for miles around. For this reason alone, few people would have noticed that the house was unusual for the area—
indeed, for the country itself. It was like something out of the English countryside: thick stone walls that stood up to the hard northern winds, a garden trellis wrapped in jasmine and white orchids on one side, the building itself with a fine slate roof and double-glazed windows. The interior space was just as extraordinary. The living room featured a large stone fireplace, with exposed timber throughout and oil-fired central heating. The second-floor rooms stayed warm even in the coldest winter months, a rare benefit in the impoverished villages of northeastern Pakistan. It had taken Said Qureshi many years to purchase the house. It was easily the most important thing in his life, other than his children, whom he hadn’t seen in years. It also represented the only thing he had salvaged from his time in England: a love of British architecture. His family had immigrated to England when he was fifteen, and though it was hard to admit now, it had been the happiest time of his life. It was what he had secretly wanted from the time he could read and write—to leave Pakistan, to escape the squalor of Saddar Town, where he had spent his youth, and find something better in another land. And he had worked to make the best of the unexpected opportunity. He had shrugged off the callous remarks made by his classmates, most of which related to his skin color, and he’d devoted himself to his studies. His efforts had earned him a place at St. George’s Medical School by the time he was twenty-one. Following graduation, he had worked for nearly a decade at Guy’s Hospital in southeast London, where he specialized in cardiothoracic surgery. He had risen through the ranks with astonishing speed, despite the intense competition. It seemed as if he could do no wrong, until a failed surgery in 2004 resulted in the death of an eleven-yearold boy. It was a small mistake, a nicked blood vessel they had caught too late, but that was all it took. Everything from that point forward had been a downhill slide. He could have argued that stress played a role, that his impending divorce, as well as the inevitable custody battle over his three children, had distracted him from his duties. He could have said that his drinking played a lesser role. There would have been penalties, but alcoholism was better than incompetence, and he might have been forgiven in time. But it wasn’t the truth, and he wasn’t one for making excuses. Instead, he quietly resigned his post—they had given him that option, at least—and moved to the Cornish coast a month later, taking up residence in a small cottage on the 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 Café 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 café 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. If she is given the chance to rest, and if she is cared for by a skilled nurse, then . . . yes, she will pull through. The worst, I believe, is behind us now, but there are no guarantees, and there is still much to be done.”
“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 still bleeding internally. They should not have sedated her. Not all injuries are obvious, General. Sometimes it takes time for the symptoms to manifest.”
“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 I mentioned. She needs a pericardial window, and she needs it soon.”
“To what purpose?”
Qureshi took note of the other man’s voice, which had dropped to a dangerous murmur. Clearly, Mengal did not like being lectured to. Talking down to people was a habit common to many surgeons, and Qureshi knew he shared the affliction. He paused again to check his tone, then continued. “The window will relieve the pressure on the heart by removing the excess fluid. It is a relatively simple procedure, but I need an anesthesiologist to do it properly.”
“You can’t do it with Thorazine and a local anesthetic?”
Qureshi hesitated again, suddenly uncertain; perhaps this man knew more than he was letting on. “Technically, yes, but it is extremely risky. General, you went through a great deal of trouble to get this woman to me as quickly as possible. Why take a chance now? You want her alive, correct?”
“Yes.” Mengal nodded slowly, absently scratching his beard with his left hand. “Yes, I do want her alive. And I agree with your assessment.” He seemed to relax slightly. “As always, Doctor, you are correct. Who is best equipped to handle this?”
“I can handle it here, but I need help.”
“Give me a name.”
Qureshi thought for a moment, trying to disguise his rising panic. He was already well aware that he was involved in something beyond his control, and though he was desperately trying to push the thought aside, he knew he was now expendable. He had seen too much, learned too much, and whoever he brought into this situation would soon find themselves in the same position. He had no wish to subject an innocent person to that fate.
“General, I left my colleagues in England, and I have yet to seek out new ones here.”
“I don’t believe that’s true, Said.” Mengal took a menacing step forward, his short, blocky frame filling the doorway. “But if it is, then I will be forced to turn elsewhere for help. I could, with some effort, find the kind of man you need, but he may not want to work with you. He may prefer his own colleagues. Of course, that would negate the need for your participation.”
The general paused to let this statement sink in, then continued in a voice as dry and hard as the wind sweeping across the Kashmiri foothills. “Said, I value your friendship. I believe we can work together for many years, but you must prove your loyalty now.”
“Sir, I can’t—”
“The name, Doctor. Give me the name of the man you want. I will find him for you.”
“Craig. Randall Craig. He’s a visiting professor from the University of Washington.”
“How do you know him?”
“We used to work together. We’ve stayed in touch. You should be able to find him at a hospital in Lahore. Sheikh Zayed. Do you know it?”
“Yes. What about the supplies? Anesthesia, the machine, the monitoring systems . . . ?”
“I can find the supplies. They can be procured with relative ease in Sialkot, but I need Craig to make them work, and I need him soon. The woman’s symptoms could become worse at any moment.”
“Fine.” Mengal nodded toward the kitchen, where several of his men were waiting. “They will stay and guard the house. Most will patrol outside, but two will remain outside the secretary’s room at all times, even when you are treating her. Is that understood?”
“Yes, of course.” Qureshi hesitated. “And the other one?”
“The Algerian?” Mengal offered a curious smile. “Why do you ask, Said?”
“He watches everything,” Qureshi blurted out. It was something that had been on his mind from the moment they’d arrived, and he could no longer contain his fear. “He never stops smiling. It’s as though he’s waiting for something. He will kill her if you give him the chance . . . I can see it in his eyes. General, I don’t want that to happen here. I don’t want her here.”
Qureshi caught himself and stopped suddenly, searching for some sign of anger in the older man’s face. Mengal merely smiled again. “I understand your concern, Said, but he had the chance to take her life in Rawalpindi, and he didn’t. He stands to benefit only if she lives, my friend. You have nothing to fear from him.”
“But he will stay.”
“Yes, he will.” Mengal took another step forward, the smile fading.
“And you will not. You must acquire the materials you need as soon as possible. Go to Sialkot. Find what you need. One of my men will accompany you. I will find this man Craig and bring him here. Once you fix what is wrong with the woman, we will leave you in peace. Agreed?”
“Yes, General.” Qureshi did not believe a word of it, but he was in an impossible position. All he could do now was try to buy some time. “Agreed.”