And the Mountains Echoed

of phone messages greets him when he enters his office. Prescription-refill requests spill from a basket, awaiting his approval. He has over one hundred and sixty e-mails to sift through, and his voice mail is full. He peruses his schedule on the computer and is dismayed to see overbooks—
squeezes
, as the doctors call them—inserted into his time slots all week. Worse, he will see the dreaded Mrs. Rasmussen that afternoon, a particularly unpleasant, confrontational woman with years of vague symptoms that respond to no treatment. The thought of facing her hostile neediness makes him break into a sweat. And last, one of the voice mails is from his chief, Joan Schaeffer, who tells him that a patient he had diagnosed with pneumonia just before his trip to Kabul turned out to have congestive heart failure instead. The case will be used next week for Peer Review, a monthly video conference watched by all the facilities during which mistakes by physicians, who remain anonymous, are used to illustrate learning points. The anonymity doesn’t go very far, Idris knows. At least half the people in the room will know the culprit.
    He feels the onset of a headache.
    He falls woefully behind schedule that morning. An asthma patient walks in without an appointment and needs respiratorytreatments and close monitoring of his peak flows and oxygen saturation. A middle-aged executive, whom Idris last saw three years before, comes in with an evolving anterior myocardial infarction. Idris cannot start lunch until halfway through the noon hour. In the conference room where the doctors eat, he takes harried bites of a dry turkey sandwich as he tries to catch up with notes. He answers the same questions from his colleagues. Was Kabul safe? What do Afghans there think of the U.S. presence? He gives economical, clipped replies, his mind on Mrs. Rasmussen, on voice mails that need answering, refills he has yet to approve, the three squeezes in his schedule that afternoon, the upcoming Peer Review, the contractors sawing and drilling and banging nails back at the house. Talking about Afghanistan—and he is astonished at how quickly and imperceptibly this has happened—suddenly feels like discussing a recently watched, emotionally drenching film whose effects are beginning to wane.
    The week proves one of the hardest of his professional career. Though he had meant to, he doesn’t find the time to talk to Joan Schaeffer about Roshi. A foul mood takes hold of him all week. He is short with the boys at home, annoyed with the workers streaming in and out of his house and all the noise. His sleep pattern has yet to return to normal. He receives two more e-mails from Amra, more updates on the conditions in Kabul. Rabia Balkhi, the women’s hospital, has reopened. Karzai’s cabinet will allow cable television networks to broadcast programs, challenging the Islamic hard-liners who had opposed it. In a postscript at the end of the second e-mail, she says that Roshi has become withdrawn since he left, and asks again whether he has spoken to his chief. He steps away from the keyboard. He returns to it later, ashamed of how Amra’s note had irritated him, how tempted he had been, for just a moment, to answer her, in capital letters,
I WILL. IN DUE TIME
.
    â€¦
    â€œI hope that went okay for you.”
    Joan Schaeffer sits behind her desk, hands laced in her lap. She is a woman of cheerful energy, with a full face and coarse white hair. She peers at him over the narrow reading glasses perched on the bridge of her nose. “You understand the point was not to impugn you.”
    â€œYes, of course,” Idris says. “I understand.”
    â€œAnd don’t feel bad. It could happen to any of us. CHF and pneumonia on X-ray, sometimes it’s hard to tell.”
    â€œThanks, Joan.” He gets up to go, pauses at the door. “Oh. Something I’ve been meaning to discuss with you.”
    â€œSure. Sure. Sit.”
    He sits down again. He tells her about Roshi, describes the injury, the lack of resources at Wazir Akbar Khan Hospital. He confides in her the commitment he has made to Amra and Roshi. Saying it aloud, he feels weighed down by his promise in a way he had not in Kabul, standing in the hallway with Amra, when she’d kissed his cheek. He is troubled to find that it feels like buyer’s remorse.
    â€œMy God, Idris,” Joan says, shaking her head, “I commend you. But how