The Somber Side of a Scientific Mind. Christian Tyoder
to have overcome grief and distress. The boys were doing better in school, and Nabeela had regained her normal weight. Still longing for her mother, she cried off and on. But overall, she became more manageable to Omira, who gave her the best maternal care one could imagine. By now Mrs. Rasulov had been in confinement for just over a year.
On one evening of that hot and humid summer, Dr. Faisal sorted out his mail as usual after a long working day. He was astonished to receive a letter from the office of the medical director of Kabul City Hospital. He read the letter twice to be sure that he understood correctly its content. The sender’s note informed him that all the three initial cultures of gastric lavages taken from Mrs. Rasulov over a year ago, first kept incubated in the hospital lab, then subsequently sent to London for confirmation, as well as repeated cultures after the nine-month treatment period remained “negative for Mycobacterium tuberculosis” and that the case was under review. Dr. Faisal was invited to attend a conference convened a week later at the hospital to discuss the case of Mrs. Rasulov. The participants included the hospital administrator, a young radiologist trained at the University College London, Whittington Hospital, United Kingdom, the hospital-based internist, the hospital chief of lab, and the medical director of Charikar Sanatorium. In those days, the diagnosis of tuberculosis was strongly suspected if the patient had a chronic cough, night sweats, blood-tinged sputum, and weight loss. To minimize the risk of spreading this lethal disease, the patient must be isolated as soon as possible in a sanatorium, pending the results of initial cultures. Often the radiologist was relying too much on the appearance of the x-ray films to report as “suggestive” of TB if the patient didn’t have all the above elements of symptomatology. The meeting was held in the hospital radiology department. The internist was asked as usual to quickly go over the patient’s medical record, starting with present illness, going through past history, physical and lab findings, etc., to end up with the family socioeconomic status. He pointed out that Mrs. Rasulov had only a chronic cough, some sweating, and a mild weight loss but no other cardinal symptoms. The radiologist, replacing the one who initially read her x-ray films and recently retired, placed all these films chronologically and side by side on the view box; he then took the hand-held magnifying glass out of his white coat pocket and then meticulously went over each of these negatives.
He turned around, looking straight at the internist’s eyes and then at the hospital administrator. “Very interesting case indeed. I have seen no more than three cases like this when I was still in training in London.”
“What is it?” the administrator anxiously asked.
“We are dealing with a case of mycoplasma pulmonary infection mimicking tuberculosis on x-ray.” Pointing his finger to the semicircular shadow on the initial film that was read as “possible cavitation,” and then to the one taken three weeks ago, he continued, “Now you can see. That round shadow was not there anymore on the most recent film which appears almost normal except for a few small white streaks near the left hilum.” Then within the same breath, he added, “TB leaves a permanent scarring, which can be readily seen on x-ray and fairly characteristic in appearance. Mycoplasma pneumonia infection also results in scars of the parenchymal tissue, but these clear up usually within six to twelve months if prompt treatment was instituted.”
The internist interjected, “This germ is still very sensitive to tetracycline, and we currently use this drug to treat community-acquired walking pneumonia, which is predominantly caused by mycoplasma species.” In the meantime, he scrutinized the patient’s chart once again and read the following sentence from the Charikar Sanatorium nurse’s note: “Mrs. Rasulov has been here barely two weeks and she already recovered her appetite, gained two and a half kilograms, and seems to have more energy.” Abruptly his facial expression changed, and then he added, “In my opinion, this nurse’s observation note supports your contention that we are dealing with an unusual case of walking pneumonia. This patient couldn’t get better so fast if she had overt TB, but one question remains to be answered. Why is Mrs. Rasulov still not infected with TB after staying over a year at the sanatorium? It is possible that the three-drug regimen used for her therapy has prevented her from getting infected with TB. The reading of Mrs. Rasulov’s TB skin test last year as reactive or positive could be explained as a false positive or a cross-reactivity with other nonhuman mycobacteria species, and it should not be taken into account. Repeated negative cultures are the real proof that she did not have human tuberculosis.”
While listening attentively to the discussion, the sanatorium director, quiet until now, asked, “I surmise that the two doctors have come to the conclusion that Mrs. Rasulov has no TB after all. So, could she be discharged tomorrow?”
Almost simultaneously the internist and the radiologist responded, “Yes.”
The hospital administrator looked at the two practicing physicians, saying, “Without your expertise, we wouldn’t be able to come up with such a clear-cut diagnosis. Thank you very much.” He then turned to Dr. Faisal. “Did you hear that, Doctor?”
The conference was adjourned around 3:00 p.m. The next evening Uncle Faisal arrived to Bamyan to announce the good news. The day after, around noon, Abd’s father, on pony back, came to Charikar Sanatorium with a mule to bring his wife home. One could imagine the children’s joy upon their mother’s return. Abd said a thanksgiving prayer to God then said to himself, “The mighty God is looking after my family and always miraculously transforms suffering into a happy ending, simply because he loves all of us so much.”
Abd’s life also took a new turn. He became happier and more relaxed. Visits after school to neighbors became almost a routine for Abd and his twin brothers, Ali and Aamir. Even though he hadn’t grown much in height, Abd’s interest in the opposite sex was noted by his parents and his sister Omira. After all, he turned twelve three months earlier, and a sparse fuzz, precursor of sideburns, was visible at a close look. One late spring Sunday afternoon, Omira was looking for Abd to help her milking the goats. She went to all three neighbors’ sheds trying to find him. One of the ladies among them was Mrs. Rasulov’s aunt, who told Omira that Abd was having a conversation with her daughter, Elaha, a few minutes earlier in her shed’s living room. But neither of the two was anywhere to be found when Omira stopped in, looking for him. She went outside, circled the mouth with her two palms, and then called loudly, “Abdulai! Abdulai!” There was no human response, only mountain echoes to her call. Omira proceeded to walk in the direction of denser bushes interspersed between tall rocks. The whole surrounding was tranquil and peaceful. Suddenly she heard noise of dried leaves generated by a tiny crawling lizard in front of a large red rock to which she directed her attention. “Here you are. We were searching for you the last hour or so.”
Abd was standing with his back against the rock while holding the little girl Elaha with his arms and hands encircling her waist. The young couple was shivering at the mountain breeze. Omira scrutinized them from head to toes then uttered, “You two should go home now. It’s getting late, and the goats are waiting for your daily visit, Abd.”
All three left the isolated site, heading toward the conglomerated dwellings down in the valley. Elaha was brought back to her mother’s home. The lady was told that the two children were found in an intensive discussion while walking in the direction of the elementary school. Before getting into their shed, Abd said to Omira, “Please don’t tell Dad and Mom that you saw Elaha and me together. Otherwise, I will reveal to them the incident of dispersing goats that happened almost two years ago. Is it a deal between us?”
“You are a clever guy. I will keep both incidents as our own secrets for life.” It was customary to the Afghan Buddhist society that physical contacts between boys and girls were not permitted until they reached the age of fifteen. Afghan parents considered the violation of this rule shameful to the whole family.
During the next several months, Omira frequently reminded Abd that he must never violate the agreement between them. Probably she wanted to be assured that Abd’s parents would never know anything about the runaway goats’ incident, for she hoped that the trust and confidence the senior Rasulovs had in her remained unaltered. In Afghanistan, it was customary for an adopted female child to grow up with barely an elementary education, if lucky, while assuming all the routine household chores, no matter how hard or numerous these were. As a result of this devotion