madam september 1997ihis hospital no longer treats women," the guard barked. hewas standing at the top of the stairs, looking down icily on thecrowd gathered in front of malalai hospital.

a loud groan rose from the crowd.

"but this is a women's hospital!" a woman shouted behindmariam. cries of approval followed this.

mariam shifted aziza from one arm to the other. with herfree arm, she supported laila, who was moaning, and had herown arm flung around rasheed's neck.

"not anymore," the talib said.

"my wife is having a baby!" a heavyset man yelled. "wouldyou have her give birth here on the street, brother?"mariam had heard the announcement, in january of thatyear, that men and women would be seen in differenthospitals, that all female staff would be discharged from kabul'shospitals and sent to work in one central facility. no one hadbelieved it, and the taliban hadn't enforced the policy. untilnow.

"what about ali abaci hospital?" another man cried.

the guard shook his head.

"wazirakbarkhan?""men only," he said.

"what are we supposed to do?""go to rabia balkhi," the guard said.

a young woman pushed forward, said she had already beenthere. they had no clean water, she said, no oxygen, nomedications, no electricity. "there is nothing there.""that's where you go," the guard said.

there were more groans and cries, an insult or two. someonethrew a rock.

the talib lifted his kalashnikov and fired rounds into the air.

another talib behind him brandished a whip.

the crowd dispersed quickly.

* * *the waiting room at rabia balkhi was teeming with women inburqas and their children. the air stank of sweat andunwashed bodies, of feet, urine, cigarette smoke, and antiseptic.

beneath the idle ceiling fan, children chased each other,hopping over the stretched-out legs of dozing fathers.

mariam helped laila sit against a wall from which patches ofplaster shaped like foreign countries had slid off laila rockedback and forth, hands pressing against her belly.

"i'll get you seen, laila jo. i promise.""be quick," said rasheed.

before the registration window was a horde of women,shoving and pushing against each other. some were still holdingtheir babies. some broke from the mass and charged thedouble doors that led to the treatment rooms. an armed talibguard blocked their way, sent them back.

mariam waded in. she dug in her heels and burrowed againstthe elbows, hips, and shoulder blades of strangers. someoneelbowed her in the ribs, and she elbowed back. a hand madea desperate grab at her face. she swatted it away. to propelherself forward, mariam clawed at necks, at arms and elbows,at hair, and, when a woman nearby hissed, mariam hissedback.

mariam saw now the sacrifices a mother made. decency wasbut one. she thought ruefully of nana, of the sacrifices that shetoo had made. nana, who could have given her away, ortossed her in a ditch somewhere and run. but she hadn't.

instead, nana had endured the shame of bearing aharami, hadshaped her life around the thankless task of raising mariamand, in her own way, of loving her. and, in the end, mariamhad chosen jalil over her. as she fought her way withimpudent resolve to the front of the melee, mariam wished shehad been a better daughter to nana. she wished she'dunderstood then what she understood now aboutmotherhood-she found herself face-to-face with a nurse, whowas covered head to toe in a dirty gray burqa. the nurse wastalking to a young woman, whose burqa headpiece had soakedthrough with a patch of matted blood"my daughter's water broke and the baby won't come,"mariam called.

"i'mtalking to her!" the bloodied young woman cried "waityour turn!"the whole mass of them swayed side to side, like the tallgrass around thekolba when the breeze swept across theclearing. a woman behind mariam was yelling that her girl hadbroken her elbow falling from a tree. another woman criedthat she was passing bloody stools.

"does she have a fever?" the nurse asked. it took mariam amoment to realize she was being spoken to.

"no," mariam said.

bleeding?

"no.""whereis she?"over the covered heads, mariam pointed to where laila wassitting with rasheed.

"we'll get to her," the nurse said"how long?" mariam cried someone had grabbed her by theshoulders and was pulling her back.

"i don't know,"the nurse said. she said they had only twodoctorsand both were operating at the moment.

"she's in pain," mariam said.

"me too!" the woman with the bloodied scalp cried. "waityour turn!"mariam was being dragged back. her view of the nurse wasblocked now by shoulders and the backs of heads. she smelleda baby's milky burp.

"take her for awalk," the nurse yelled. "and wait."* * *it was dark outside when a nurse finally called them in. thedelivery room had eight beds, on which women moaned andtwisted tended to by fully covered nurses. two of the womenwere in the act of delivering. there were no curtains betweenthe beds. laila was given a bed at the far end, beneath awindow that someone had painted black. there was a sinknearby, cracked and dry, and a string over the sink fromwhich hung stained surgical gloves. in the middle of the roommariam saw an aluminum table. the top shelf had asoot-colored blanket on it; the bottom shelf was empty.

one of the women saw mariam looking.

"they put the live ones on the top," she said tiredly.

the doctor, in a dark blue burqa, was a small, harriedwoman with birdlike movements. everything she said came outsounding impatient, urgent.

"first baby." she said it like that, not as a question but as astatement.

"second," mariam said.

laila let out a cry and rolled on her side. her fingers closedagainst mariam's.

"any problems with the first delivery?"'no.

"you're the mother?""yes," mariam said.

the doctor lifted the lower half of her burqa and produced ametallic, cone-shaped instrument- she raised laila's burqa andplaced the wide end of the instrument on her belly, the narrowend to her own ear. she listened foralmost a minute, switched spots, listened again, switched spotsagain.

"i have to feel the baby now,hamshira "she put on one of the gloves hung by a clothespin over thesink. she pushed on laila's belly with one hand and slid theother inside. laila whimpered. when the doctor was done, shegave the glove to a nurse, who rinsed it andpinned it back on the string.

"your daughter needs a caesarian. do you know what that is?

we have to open her womb and take the baby out, because itis in the breech position.""i don't understand," mariam said.

the doctor said the baby was positioned so it wouldn't comeout on its own. "and too much time has passed as is. weneed to go to the operating room now."laila gave a grimacing nod, and her head drooped to oneside.

"thereis something i have to tell you," the doctor said. shemoved closer to mariam, leaned in, and spoke in a lower,more confidential tone. there was a hint of embarrassment inher voice now.

"what is she saying?" laila groaned. "is something wrong withthe baby?""but how will she stand it?" mariam said.

the doctor must have heard accusation in this question,judging by the defensive shift in her tone.

"you think i want it this way?" she said. "what do you wantme to do? they won't give me what i need. i have no x-rayeither, no suction, no oxygen, not even simple antibiotics. whenngos offer money, the taliban turn them away. or they funnelthe money to the places that cater to men.""but, doctor sahib, isn't there something you can give her?"mariam asked.

"what's going on?" laila moaned.

"you can buy the medicine yourself, but-""write the name," mariam said. "you write it down and i'llget it."beneath the burqa, the doctor shook her head curtly. "thereis no time," she said. "for one thing, none of the nearbypharmacies have it. so you'd have to fight through traffic fromone place to the next, maybe all the way across town, withlittle likelihood that you'd ever find it. it's almost eight-thirtynow, so you'll probably get arrested for breaking curfew. evenif you find the medicine, chances are you can't afford it. oryou'll find yourself in a bidding war with someone just asdesperate. there is no time. this baby needs to come outnow.""tell me what's going on!" laila said she had propped herselfup on her elbows.

the doctor took a breath, then told laila that the hospital hadno anesthetic.

"but if we delay, you will lose your baby.""then cut me open," laila said. she dropped back on thebed and drew up her knees. "cut me open and give me mybaby."* * *inside the old, dingy operating room, laila lay on a gurneybed as the doctor scrubbed her hands in a basin. laila wasshivering. she drew in air through her teeth every time thenurse wiped her belly with a cloth soaked in a yellow-brownliquid. another nurse stood at the door. she kept cracking itopen to take a peek outside.

the doctor was out of her burqa now, and mariam saw thatshe had a crest of silvery hair, heavy-lidded eyes, and littlepouches of fatigue at the corners of her mouth.

"they want us to operate in burqa," the doctor explained,motioning with her head to the nurse at the door. "she keepswatch. she sees them coming; i cover."she said this in a pragmatic, almost indifferent, tone, andmariam understood that this was a woman far past outrage.

here was a woman, she thought, who had understood thatshe was lucky to even be working, that there was alwayssomething, something else, that they could take away.

there were two vertical, metallic rods on either side of laila'sshoulders. with clothespins, the nurse who'd cleansed laila'sbelly pinned a sheet to them. it formed a curtain between lailaand the doctor.

mariam positioned herself behind the crown of laila's headand lowered her face so their cheeks touched. she could feellaila's teeth rattling. their hands locked together.

through the curtain, mariam saw the doctor's shadow moveto laila's left, the nurse to the right. laila's lips had stretchedall the way back. spit bubbles formed and popped on thesurface of her clenched teeth. she made quick, little hissingsounds.

the doctor said, "take heart, little sister."she bent over laila.

laila's eyes snapped open. then her mouth opened. she heldlike this, held, held, shivering, the cords in her neck stretched,sweat dripping from her face, her fingers crushing mariam's.

mariam would always admire laila for how much time passedbefore she screamed.