Faryal Hamed
June 2016
Hamed Residence, Halb, Kingdom of Saudi Arabia
Faryal stood in the kitchen on the phone with Mr. Aden. He had just given her updates on having met with some of the victim patients and if she could meet them in-person to deliver their medical records. She had a hand on their marble counter, dressed in a silk blouse, trousers, and heels. She picked up a small tea cup and sipped it as she listened.
That morning, her transplant team had done a CAT scan on her lungs. And her team included Nancy, Amalia, her pulmonary specialists, psychiatrist, nutritionist, and her social worker. Faryal had also been back-and-forth with hospital billing and her health insurance. Her heart transplant could very well cost $1,000,000. It was all too overwhelming.
Faryal and Mr. Aden bid farewells and she hung up the phone. Footsteps sounded down the living room stairs and Naseem walked into the kitchen. It was nighttime and the kitchen lights were spotlights surrounding them.
He asked, "Was that your mom? Have you told her?"
Faryal's jaw pointed outward, "No. I haven't. Stop asking, I'll get to it."
"It's been two weeks, you keep putting it off."
She brought her hands up, "I don't want to talk about this, Nas. I have a lot on my mind obviously." Her heart began to race and felt the initial sweat underneath her eyes, "Don't stress me out, Nas."
He spoke with a calm pace, "I think… That although you are doing a wonderful job following your team's directions, but somewhere in your mind – you haven't really accepted all of this yet."
Faryal's hands were at her sides and her head pointed out, "What haven't I accepted?"
"You haven't limited your hours despite the director allowing you to and you haven't transitioned your patients' care to the other doctors yet. Why haven't you?"
She pointed to herself, "My patients need me. I have appointments booked for the next two months, I can't be gone yet, I have to be there for them. I can't just leave them. And obviously, with this case, not every doctor there is as competent as we'd hope for them to be."
"I remember you telling me earlier, that you were happy. Happy because your parents seemed to be doing better than ever. They had just went on an anniversary trip with your sisters in Paris."
Faryal interrupted with irritation, "What does this have to do with anything?"
He continued regardless, "And I think… that you keeping yourself busy like this…" he took a step closer to her, "Is an excuse, because you don't want to tell your parents that you're sick and in treatment."
Faryal picked up her tea cup where her grasp slipped along the handle – as it fell and broke along the floor. Large pieces shattered into small crumbles that were washed out and ricocheted beneath her heels. She squatted down with a towel and Naseem stopped her.
The two met with level eyes as she explained, "I'm not just ill, Nas. You know what else I have to wait for. I have to wait for," her eyes went back and forth along the spilt tea, "people who are suddenly brain dead, and on life support, and… Who, who don't have cancer… And that they have a heart attack inside the hospital. You know how rare that is. People that die and can become donors is just… Tiny…"
No one else had told her this, but she learned online that 22 people died every day just waiting for an organ donation. And could I be one of them? Why wait and hope just to never make it? Her eyes became lost in the cracked edges of the pieces of the cup.
She turned back to him, with reddened eyes, and a single spilling tear, "… I just don't if I can do all of this…"
He held her cheek in his hands, "Faryal, listen, I think… Because just like when you found out about your dad, and how he cheated, you didn't want to be the one to break your mom and your sister's hearts –"
Faryal stood up, began to turn and walk away when Naseem put a palm to her arm.
She turned back as he continued, "You never told your mom because you didn't want to ruin their happiness. Now, you don't want to be the one to have to give bad news. Because then they'll stop being happy." Faryal's eyes drifted as Naseem calmly held both sides of her arms, "But not telling them is more horrible… Because you're just lying to them all over again…"
Faryal brought a hand to her face as she cried. Naseem brought her head to his chest, and softly stroked her hair.
After taking a moment, Faryal sniffed and wiped her eyes. She took out her phone and brought up mamma's contact.
Naseem took a step away and she looked up, "Can you stay? Please?"
He smiled and brought up a chair from the dining table for her to sit in. Faryal wiped her hand on her blouse as the phone was ringing.
She pressed it to her ear as a sound picked up, "Mamma?"
"Hello, my God Faryal, I've been calling. How have you been?"
She hung her head low, "Mamma…" she looked back up at Naseem's receptive expression and it reassured her, "Mamma, I'm sick."
Faryal held her head in her hands. Naseem stood beside her with a hand on her shoulder, slowly massaging it, as Faryal continued to speak about her diagnosis, treatment, and on her future surgery.
***
Faryal was riding an Uber downtown through afternoon traffic. After her being interviewed, their home being approved, Faryal was officially placed on the region's transplant list for a heart. Sitting on a car driving through desert streets, she couldn't help but feel she was at the last frontier. Literally and metaphorically.
*
Aden Law Firm
The driver lifted the trunk and took out a light office box full of paper-filled folders. Faryal stepped onto a clean courtyard decorated with thin, green trees and walkways which led to glass-walled office buildings. She entered the largest building where she was greeted by Mr. Aden and his associates in the lobby.
Mr. Aden showed his hands, "Let me hold that for you."
Faryal handed him the box and then offered his hand as her eyes admired his suit, "Salam, Misses Hamed, pleasure to finally meet you. These are my associates, Talal, Yasser, and Saahira."
They all shook hands, exchanged salams, and led her to their firm's office, where they offered her a seat at the front of their long, dark-wood conference table.
Faryal took a seat as the attorneys opened legal pads and grasped fancy pens which shined under the florescent lights. Bookshelves of thick, maroon law books of the same sized lined the back wall behind the attorneys. Mr. Aden was an older man with grey side-combed hair and a grey groomed beard.
The receptionist held the conference door open as Mr. Aden looked at Faryal, "Can we get you anything? Coffee? Tea? Water?"
"Oh, no thank you."
The receptionist nodded with a smile and closed the door.
Mr. Aden spoke, "I can tell from your accent, you are not from Saudi. May I ask, where are you from?"
"Byblos, Lebanon."
"Ah! My sister works nearby in Beirut, beautiful city! They call it the Paris of the Middle East," he cleared his throat and looked to his attorneys, "Well, normally in this case, we would be speaking about a referral fee. Such as when an attorney refers a case to a firm, and they are eventually paid a case's awarding sum when it is over. However, because you are not a licensed attorney, referral fees cannot be paid from an attorney to a non-attorney."
Faryal nodded understandingly and motioned her hand, "I understand. The patients and their families deserve the money. And to know what's been done to them."
In truth, the attorneys in front of her were going to take in a bulk of the awarded settlement, but at least reasonable enough compensation would go to those patients. That would be enough for her.
Faryal motioned to the box she had brought, "Those are the hospital's aggregate records which pooled together every patient's services, admissions, bill totals – all under anonymity and summarized with gross totals and averages within the past year."
Under the suit, the firm would be able to subpoena these records, but for now Faryal and Nameera would help them get a head start. The hospital would have unlimited resources to defend themselves, so they were essentially the "little guys" in this fight.
Faryal continued, "I was able to meet with most of the victims in-person and they have agreed to file a class action suit. Also, in the box is all their medical records, they have also agreed for me to release them to you. Their own written authorizations are included."
The associates began passing around folders from the box as they began to skim through them.
Mr. Aden put on reading glasses as he read through his portion, he looked back up to Faryal, "Misses Hamed, would you be able to tell me what this section means?"
It was a constant disappearing act. Faryal went back-and-forth between Mr. Aden, Talal, Yasser, and Saahira as she explained what medical terms meant on patient records, aggregate records, and bill receipts. She was here. There. And then over there. While the attorneys remained statues in their seats.
Mr. Aden's suit hung on the back of his chair. Sleeves were rolled up, ties undone. Water cups appeared and disappeared. They ended up ordering-in takeout meals as leftover plates and cups appeared beside a stack of paper which grew into higher and higher stacks of skyscrapers on the conference table, until they tumbled down and were deconstructed.
Highlighting, yellow, pink, sticky notes, pen marks, copying, stapling, filing, and re-filing. The large office printer ran endlessly beside them. The once empty trash bin was now full. Faryal rose from her seat to help, looking over his shoulder, his shoulder, his shoulder, and then her shoulder. She took a sip from her drink, with a hand on her hip, and held a folder closer for her to read. And then she was called on by someone else for help.
Officially, Faryal would be an anonymous non-practicing 3rd party which acted as the referral for the victims. But her name would never be mentioned on court documents. They found that a good number of patients had visited the hospital's ER and had been billed "Emergency Room, Visit – $7,000" and also "Emergency Department Visit for Very Severe Problem – $600". What constituted the additional charge for severe cases? Faryal explained to the attorneys that their visits were not unlike other cases charged for less.
And these visits lasted no longer than six hours. She had seen much lower costs for much longer stays and more comprehensive tests. It's hard to haggle or refuse services you're convinced could save your life. But even these charges were egregious. And for patients that underwent EKG/ECG tests, they were billed $1,500, when the national average for its costs were $200.
Many ER visits the patients underwent originally cost $10,000 which was billed to the insurance. And the patients, on average, had to pay $3,500 afterwards. This showed that despite having insurance coverage, this was where the upscaling of charges piled up against patients. The hospital made prices 5 times more than normal, and when patients paid deductibles, they ended up paying more than they needed to despite insurance. Hours had passed when they found that higher prices, administrative expenses, and unnecessary medical services accounted for more than half the victim's total bills.
Faryal turned in her executive chair to see the window had suddenly become dark, and a simple meeting turned into a 5-hour consultation.
July 2016
Hamed Residence
Faryal woke up on Monday morning. Her face was pressed against her pillow and she lifted her phone off the bedside table, No new notifications. She got up from the white Egyptian cotton sheets that hugged her bed and stepped onto her temperature-controlled tile flooring. Glass plates surrounded their walk-in shower, there was a white porcelain tub beside it.
She stepped onto her digital display and recorded today's weight on her phone. She put a digital thermometer in her mouth and waited. Typed it on her phone. Then she sat on a wood stool beside the stainless counter and opened a blood test kit. Her tan arm had a lot of needle marks. I look like a drug addict.
Faryal stepped out of the bathroom texting Nancy her blood pressure, total cholesterol, triglycerides, HDL, and LDL for the day. She copied that text and sent it again to Naseem. Faryal stepped onto her hallway and entered her office. Rows and rows of fantasy novels lined a light wood bookshelf behind her desk and chair. And small, 3D models of the human body and its internal organs displayed along the front of the desk.
She took a seat behind her desk and glanced up at the wall opposite her, which hung her medical degree from the American University of Beirut. And on her desk, was a small stack of blank, pearl white stationaries. She grasped a pen, took a sheet, and began writing in elegant cursive.
*
Dear Maleeha,
It is with deep regret that I must take an indefinite leave of absence from King Faisal Medical Clinic due to illness. I have e-mailed you the official forms for Patient Transfer of Care and Consultation. And you will be in the magnificent care of Dr. Javid, who has been a great colleague of mine for the past four years.
I wish you good health and I hope to return to practice soon. I cannot wait to share the good news with you.
Sincerely,
Dr. Faryal Hamed.
*
With pen in hand, she glanced at the old photo framed on the corner of her desk, of her smiling beside her horse Ameerah in the Beirut Equestrian Club. At first, she didn't want to name her daughter after her, because of how she died, it brought bad memories. But then she realized she wanted to remember Ameerah for how she lived, that she was strong and beautiful despite her sensitivities. And how we have to remember a person, or animal, for what they meant to us alive. Because that was more important.
Faryal set the handwritten letter aside and picked up another blank sheet to begin writing again.
*
Faryal was in the adho mukha svanasana yoga pose along the carpet of her living room. Legs and arms slanted creating a mountain peak on her butt. And she had been on a vegetarian diet since her diagnosis. I miss eating meat. And she had stopped drinking caffeine. That was the real stab in the heart.
Faryal would only buy groceries with sodium labels so that she can calculate them throughout her day's intake. She had gotten a routine down. Sodium contained liquids, and the goal was to keep fluid levels down as to decrease her heart failure's progression. Thus, giving her more time to wait for a donor heart.
She bent her knees and stretched out her arms in balasana pose.
August 2016
Hamed Residence
Faryal woke up naturally without the routine disruption of an alarm. She flipped herself to face the bedside table and checked her phone, No new notifications. The hum from their bedroom's A/C vents were different because Naseem and the repairmen put in high efficiency air (HEPA) filters. They were the same ones found in OR's, ICUs, and isolation rooms.
She got up and put on her red silk robe, which matched her red bra, and complemented her black pajama pants. She pulled the corner pulled on the white bed sheets and began to take it off. Her sheets and any high-contact surface such as door knobs needed to be cleaned more than usual. Because any other illness she caught could complicate her getting a transplant. And she never knew when it was around the corner – then a bumbling feeling began to rise in the pit of her chest.
Faryal ran to the bathroom and leaned over the toilet – where vomit erupted from her mouth and she couldn't help but smell the crude, yellow-green mixture. And it made her vomit more. She stayed by the toilet another ten minutes and the nauseous spin within her stomach and her head would not go away. And she groggily stood on her scale to record her weight.
She put the digital thermometer in her mouth and waited. She typed the temperature on her phone. Faryal sat on the wood stool and opened the next blood test kit. Later, she stepped out of the bathroom texting Nancy her blood pressure, total cholesterol, triglycerides, HDL, and LDL for the day. Copied that text and sent it again to Naseem.
Faryal walked slowly into the hallway and passed her office. All of her patients had been transferred to colleagues and she had no existing appointments anymore. She took out her phone and scrolled through her contacts. Abdul Aden. And tapped call. Faryal pressed the phone to her ear as it was ringing.
Mr. Aden picked up, "Salam, Misses Hamed. How are you feeling?"
"Salam, I am well, thank you for asking…"
She stopped by the hallway, beside framed photos of her, Naseem, and Ameerah in front of the Pyramids of Giza.
"What can I do for you?"
Faryal put her hands in the pockets of her silk robe, "I wanted to check and see if you needed more help looking over any of the hospital records you were able to subpoena. I could take a look, even highlight some possible arguments…" She bit the corner of her lip, "I know I can't go over there, but we can perhaps speak on webcam, any terms or medical procedures you –"
"Oh, I'm sorry Misses Hamed, but we have actually hired an outside expert physician on providing testimonies for these records… This is very much in your best interest as well, because if your name were to ever be revealed as the referring third party, I must say, it would… you know, be career suicide. The hospital would let you go and… I would be worried that no hospitals would hire you after that. Because as we've learned, hospitals are essentially a business, and to limit their profits as we hope to do, is bad business for them… I hope you understand."
Faryal nodded with the phone pressed to her ear, biting her lower lip, "No, I completely understand… Thank you…"
"Okay, is there anything else I can do for you, Misses Hamed?"
"No, that's all."
"Well, I wish you good health."
"Thank you, goodbye."
Faryal took the phone away from her ear, pressed her shoulder against the nearest wall, as her lungs deflated. I miss my life. I want to take Ameerah to prayer. I want to go outside, even to buy groceries. But to leave the house for any other reason than going to the hospital meant exposing herself to a possible disease. Faryal took slow steps down the stairs and made her way to the kitchen. She turned on the stove, placed a pan, and put cooking oil on.
She padded the pocket of her robe and felt her phone. Faryal took it out. Check again. She checked, No new notifications. Flipped the phone. Yes, the ringer is on. Pressed the volume button. Yes, it's at max volume. She put down the phone and cracked an egg on the pan. A minute has passed, check again. She checked her phone, No new notifications.
Faryal took a deep breath, shut her eyes tight, and pressed the palms of her hands on the edge of the stovetop. Get it together, Faryal… She reminded herself something Naseem had told her. Your life is worth waiting for.
Not knowing was scary. The future was scary. But for Naseem and Ameerah, she would hang on. No matter how long it took.
*
Faryal sat behind her glass dining table and finished her breakfast omelet. She lifted the glass pitcher of water and poured herself a glass. Beside her plate was a large pill organizer. She opened Monday's and took each pill at random. Digoxin. Helps the heart pump. Diuretics. For kidneys to remove excess fluid. Potassium-sparing diuretics. Helps you retain potassium. Angiotensin-converting enzyme (ACE) inhibitors. To dilate the blood vessels. Beta blockers. Helps the heart pump efficiently.
Each day, each hour, each minute, each second – she was one step closer to a new heart.
*
Faryal checked the time on her tablet, still an hour until Ameerah got home from school. She went on Facebook and onto a group she had joined of other women with the same condition as her. She scrolled along and read the latest post from one of the members.
I feel all the love and strength to battle this. Love everyone that has joined and thank you for keeping me in your prayers. God will save us and has plans for us!
Her tablet was held up by a holder attached to the head of her bed. And angled over Faryal's side of the bed so she wouldn't have to constantly hold it up. At this point, she was just re-watching all her favorite shows. Like finishing the ending to one of her fantasy novels, she had gotten so attached to the characters and the world inside them, it felt like heartbreak to have to let go. But then she would smile because she'd realize it meant you'd move on to something new.
Because everything that you enjoy was once new to you. And having enjoyed something and moving on from it just means you can enjoy something else. Or something brand new. Faryal pressed on her table to turn off the screen. She removed it from its holder and set it aside, then a ding sounded from her phone. She checked to see it was from Naseem, Will be in surgery a few more hours. Don't wait up for me, sweat dreams. I love you.
Faryal brought her phone close to her heart as she curled up. Closed her eyes. And kept a smile.
December 2016
Hamed Residence
Faryal opened her eyes and based on the sun's height through their windows, it was close to noon. Strands of her hair were unfixed along her face as she turned to the bedside table and checked her phone, No new notifications. Naseem walked into the bedroom in sweats and walked over to Faryal's side, which had a wheelchair nearby.
Naseem asked, "Hey, do you want to shower?"
She nodded, flipped the bed sheets off, and reached up to grab the trapeze bar hanging over her.
"How are you feeling?"
She pulled to sit herself up, "Like shit. I'm at a three I think."
Naseem helped her get naked and then dug his arms underneath her. He lifted her up and slowly carried her into the bathroom.
"Well, your three is like a negative thirty for other people."
Naseem carefully placed her in their porcelain tub and turned on the water. The rush that spilled along her legs reminded her of home. Byblos. Beirut. She imagined running across the tan-colored sand with the pale, blue water by her side. With the sun basking in the sea and she was with Naseem and Ameerah. And it would be after she was wheeled out of the ICU with Naseem by her side, mamma, her sisters, and Ameerah. Celebrating her new heart.
She held onto his arm, "The moment I'm better, I want go to the beach."
"Byblos? We can stay at your parent's house."
Faryal looked into his eyes longingly, "Please take us back."
He had a carefree smile, "I promise."
Her husband helped scrub her with soap, clean her hair, wash her clean, drain the tub, then dried her. Naseem helped her into clean pajamas, brought the wheelchair over, and carried her on it. He took her temperature and tested her blood with a new kit. And even after her surgery, Faryal would need physical therapy to relearn how to walk again.
He pushed her back into the bathroom where she saw a binder full of color-coded tabs at the foot of his side of the bed.
"I organized your records for you, I couldn't really sleep this morning."
She reached back to massage his arm, "I know you hate paperwork. You're sweet, I love you."
Those were all her visit summaries, any correspondence with her transplant team members, bills, medications, insurance correspondence, and consent forms. Faryal had been kept 1A priority due to a high risk of infections complicating her health. And Naseem would apply at the end of every month to maintain her status so that she would not become 1B – lowering her priority on the wait list.
Naseem pushed her down the hallway and stopped at the top of the stairs. He carried her out of the wheelchair and on to the diagonal stairlift, where it slowly brought her down, and then detached her. He carried her onto the downstairs wheelchair and pushed her to the kitchen. Faryal had learned that the lawsuit would be filing for a collective $30 million as the case had grown to 120 affected patients. But Mr. Aden explained that cases like this took time and that the patients and families would likely not receive their compensation for years even.
*
Faryal lay in bed with the moonlight shining through the window that faced her side of the bed. Naseem took late-hour shifts so that he could take care of her in the mornings. She wished she could make love to her husband, but because of her feeling weak and her medications, she had stopped feeling aroused altogether.
She laid flat on her bed and looked down the middle of her chest, drawing a line with her finger of where her surgical scar would be when the time came. It would look ugly. The last time they made love, she had given him oral, and even then, she could feel he was not as hard. And he came on her breasts. If your loved one couldn't make love anymore, would you have less love for them?
She turned her head over to Naseem's side of the bed and brought his pillow next to her face. Please don't lose your love for me.
*
Faryal turned off the screen of her tablet. She had watched everything there was to stream. With the bedroom lamp on, she could see herself on the black mirror screen. Her hair was disheveled, lips naked, and skin pale. Is this it? Is this all there is for me?
She remembered a conversation with her psychiatrist where she recommended writing mock letters to friends and family about their illness, what they have meant to Faryal's life. They were letters to express how she truly felt and didn't have to send them.
Faryal opened the drawer of her bedside table, took out a blank stationery, a notepad, and a pen. She reached up at the trapeze bar and sat herself up along the bed's headboard. Faryal thought about the person most important to her to start off with, then began writing.
*
Mamma,
I miss you and I thank you for calling me every night. My greatest joy is when we talk about Ameerah, and with my illness, she has to do more things on her own. And I never want her to stop being my baby girl. You, Meerah, and Nas are the reasons I hang on, because I don't want Meerah to ever have to live without me in her life. But our calls are always ruined when you want to put pappa on. You don't know this, but I never feel like talking to him.
*
She felt a soft squeezing along her heart. Faryal wiped her eyes and took a deep breath. She set the letter aside and reached for another sheet to begin writing.
*
Pappa,
I think the reason I was so quick to leave with Nas to Saudi was because I couldn't go on living close by with mamma, Zahra, and Fareeda. I couldn't go on seeing you lie and I couldn't bring myself to tell the truth. I wanted them to be happy but I wanted to remove myself from seeing what it
*
Faryal stopped writing. Her phone was ringing. She held her breath and immediately picked it up to answer, "Hello, this is Faryal."
"Hello! This is A-T-Z account management. Are you happy with your current phone service plan?"
It was an automated caller.
Faryal quickly hung up and threw the phone against the middle of her bed, "Fuck!"
She put her hands to her face and took the moment to slow her heart rate.
End of Chapter 4.