On the day of my diagnosis in Kalamazoo, they whisked me away from my mother’s unrelenting hands on a wheelchair, even though I felt perfectly capable of walking. I did not know at the time that the wheelchair would constitute a more significant part of my experience with cancer only much later. A handsome attendant rolled me toward my uncle’s SUV. When I had settled into the passenger seat, he said with some emotion in his voice and some pity in his eyes, “Best of luck to you.”

I rode in the passenger seat next to Qamar Mamoo, whom I despised at the time. Our relationship reminded me of the one I had with my father. In an ideal world, it should have been my father driving me to the hospital, but he was thousands of miles away, unaware of what had befallen the family he had momentarily abandoned in the Midwest. For now, for all intents and purposes, my uncle was my father. He was on the phone trying to ascertain which hospital could take my case: Borgess or Bronson. They both sounded the same and equally dreadful. I was a complicated case, I gathered in the few moments I broke free from my catatonia and listened to the words being exchanged on his cell phone. Having turned eighteen in November, I was legally an adult, but I was still young enough to not be suitable for adult leukemia treatment. It would have to be pediatric oncology.

I might have even chuckled a little under my breath upon hearing this. For other kids, the coveted age of eighteen augured the transition to adulthood. My cancer had seemingly relegated me, for at least the next three years, to an extended age of the pediatric.

We made it to Bronson and I was assigned my room, its walls a ghastly green, and I was asked to change into an equally ghastly pistachio-green gown. They hooked me up to the first of many machines that my body would be intimate with in the coming years. It was a big, white box of a thing, a little bigger than a mini fridge with tubes coming in and out of it.

I was to undergo leukacytapheresis, a procedure in which my blood was drawn, fed into the machine and—after those thousands of cancerous white blood cells were painstakingly filtered out—returned to my body, spick and span. The mini fridge droned on, trying against all odds to preserve a substance that had seemed to somehow survive beyond its expiration date.

They inserted a cannula into a vein on the dorsal side of my left hand and covered it with medical tape, the blood circulating in mechanical whirrs into and out of my body. But this situation was only temporary. For future drawings of blood and the subsequent infusion of a whole pharmacy of drugs, they were going to surgically install a port in the center of my chest. That port would be my constant companion for the next three years, initiating my transition to cyborg-hood. To my sister, an avid consumer of the Marvel cinematic universe that was just in its fledgling days at the time, the port was my own “arc reactor.” Iron Man 2 had just come out the year before, in which Tony Stark learns that the palladium core of the arc reactor, which on the one hand is the source of his superpower, is also poisoning him slowly and surreptitiously. That wouldn’t have been too far from my own situation, given that my port was a doorway to substances that were both cure and poison.

Also called a portacath—a portmanteau of the steel or titanium “port” in the chest and the “catheter” connecting the port to a large vein near the heart—the port was installed under my skin just a little to the left of my sternum. I don’t believe that the surgery took that long, and I was obviously under anesthesia. But when I came to, I could distinctly feel a heavy protrusion, a foreign body of iron next to my heart.

Mine was a “double port” because it had two apertures one on top of the other, a little like the narrowed eyes of a power outlet. Often the hospital nurse assigned to me on a particular day or night, upon discovering the two little flesh-colored holes in my chest, would express emotions ranging from marvel and awe to unbridled excitement. Some exclaimed something to the effect of: “A double port! Haven’t seen one of these in a while,” as if that in itself were some kind of notable achievement. They proceeded to clean the area with icy alcohol swabs and then pierced the holes with PowerLoc needles. While the insertion of the needle did not sting like the usual pokes in the elbow or the hand—after all, that was one of the reasons for the port, to minimize the number of uncomfortable pricks—this other kind of insertion was somehow even more jarring: one feels not metal piercing human flesh, but the grating of metal against metal against human bone.

The nurse covered the needle with a transparent sticker whose adhesive glue often persisted even days after the sticker was painfully removed like a waxing strip (having taken with it the few hairs that had diffidently appeared on my chest). But I often took some perverse pleasure in the ASMR of the diaphanous adhesive coverings being removed by gloved hands. The sticker kept the needle in place yet allowed anyone to look through to make sure nothing was wrong with the connection. And while the port itself was metallic, the surface of its apertures was of a self-sealing rubber septum that, as its name suggests, closed back upon itself when the needle was removed. I would sometimes think that the port-needle-sticker assemblage, with its metallic interior and self-sealing septum held together by a transparent film, was the perfect allegory of the cancer patient: sturdy but delicate, sealed but open, broken but able to make themself whole again.

The next step involved “flushing” the port with saline—or heparin, in case the port had not been used for infusions in a while. Flushing with saline was probably my favorite part of the entire ritual. Many other cancer patients hated the sharp tang of brine on their tongues as the salt water permeated their bodies, but I rather enjoyed it, perhaps because it reminded me of the ocean. The flushing complete, the needle was connected to whatever chemo drug or painkiller  was suspended from the IV pole. The port became a portal, not just between my body’s ecosystem and the outside world, but also one between different states of consciousness and, as we shall see, between states of national belonging across the oceans.

Ports are not conducive to sleep, and not just because of the nurses coming into the hospital room at every hour of every night to draw labs or to hang up another drug or to silence the interminable beeping of the IV pole. Having your chest hooked up to a multitude of tubes severely limits your mobility in bed, especially for a restless sleeper like me. I usually fidget and turn countless times before finally, ineluctably, electing to sleep on my stomach. But that favorite position of mine was no longer available, what with the protruding needle and port in my chest.

When I was discharged from the hospital after three months, I was sent home with numerous bags of TPN—total parenteral nutrition, a creamy white liquid with all the necessary nutrients that I was not getting due to my nausea-induced hunger strike. They were administering the TPN to me in the hospital as well, and when I was told I was being discharged, I rejoiced at the possibility of never having to deal with anything hooked up to my port ever again. It meant that I could sleep in whatever position I wanted and move around unimpeded. I was soon disabused of this illusion, much to my chagrin and even rage-filled tears. I was to be hooked up to an IV pole at home as well and my simple wish to sleep on my stomach would be denied for the foreseeable future.

I found a solution in the torn little foam travel pillow that I had worn on my flight from Karachi to Chicago. I had been using that from the day I was diagnosed, in fact, because my neck began to feel tender from the first rounds of chemo pushed into my nervous system (on the scale of low, intermediate, and high risk in acute leukemia, I was intermediate, which meant that they had found a few cancer cells in the central nervous system). I can even be seen wearing the travel pillow in the picture taken the day after I was diagnosed and admitted, where I am surrounded by my new friends at the Kalamazoo Area Math and Science Center, and a whole zoo of stuffed animals.

In due course, that little travel pillow would support not my neck, but my chest. At home, after my brother had diligently hooked me up to the TPN whose CADD pump slowly and laboriously pushed the liquid food into my veins, making little churning noises with each thrust of sustenance, I arranged the pillow around my port and needle, cushioning them enough so that I could finally sleep on my belly and take a flight of dreams back to my hometown, Karachi.

*

It only occurred to me much after the fact what a meaningful and coincidental tableau that was, of my using a travel pillow to cushion my port. This is, after all, a narrative of migration and illness, and the travel pillow became a sort of talisman facilitating the transition from one nation-state to another, or from a state of health to a state of illness and back again. I couldn’t help but be reminded of Susan Sontag’s famous opening lines in Illness as Metaphor: “Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.” While Sontag’s use of “citizenship” and “passport” was a metaphorical flourish, for me these terms denoted an experience that was all too immediate, material, and literal.

Even as the travel pillow began to acquire different meanings, so did the port in the center of my chest. It was a pass-port that gave me, in Sontag’s terms, a dual citizenship in the kingdoms of the well and sick, just as I now hold dual nationalities: American and Pakistani. The portacath—with its oddly pleasurable saline flushes—and the ports of ocean and air travel became one and the same, inextricably entangled in meaning and history.

“Port” comes from the old Latin portus and Middle French port, with its first meaning being a harbor or haven, or more specifically in the nautical sense, a place on a coast where a boat shelters from storms, as in the common idiom “a port in a storm.” In this sense, perhaps, my portacath was a port in the storm of malignancy, a conduit for healing elixirs and potions. But like Tony Stark’s arc reactor, my port was also the entryway of all kinds of poisons that, while administered for a cure, were, in the last instance—and as that familiar cliché of cancer has it—even worse than the disease they sought to treat. So much so that the doctors, nurses, and even my family had to wear yellow crepe paper-like protective gear when handling my bodily fluids, now rendered chemically toxic. In French philosopher Jacques Derrida’s words, the port is a pharmakon, both poison and cure, both danger and refuge.

Ports of call—maritime harbors of the past and the airports of today—are similarly pharmakons: they are not just havens but are also the openings to plagues and pandemics. In the wake of COVID-19, we are primed to think more of airports rather than seaports. My port as a symbol of illness and migration brings to mind Karachi’s earlier days as a seaport when Indian seamen called “lascars” (from the Persian lashkar, meaning army) boarded British merchant ships and made their way to the New World, often even absconding and starting new lives in Baltimore, New York, or New Orleans. But my port’s significance as a toxic conduit reminded me especially of Karachi between the years 1897 and 1900, when it became the door to a bubonic plague epidemic emerging in Bombay and Hong Kong. In fact, it was in a Karachi hotel in 1898 that the French physician Paul-Louis Simond, affiliated with the Pasteur Institute, would conduct a series of experiments to conclusively prove that the rat flea was the vector in the transmission of bubonic plague. Eventually, the city port would also become the source of the plague’s dissemination westward through ships taking Muslim pilgrims to Mecca, much to other European empires’ fear and disgust who reprimanded the British for their poor quarantine regulations.

Significantly, many lascars succumbed to bubonic plague on ships bound for Europe or the Americas. These Asian sailors were subsequently often demonized as essentially parasitic or infectious, embodying the risk of contagion. For instance, in 1897 the Philadelphia Inquirer reported from Plymouth, England, that “three soldiers and two Lascars died [of bubonic plague] while on their way home” on the SS Nubia, a passenger-cargo steamer of the P&O Steam Navigation Company which was the largest employer of lascar crews. Interestingly, the journalist refers to both the English soldiers and the Indian lascars as traveling “home,” as if the lascars had officially absconded and had made Plymouth their new home, just like I had made Kalamazoo mine.

Lascars were also spotted in ports of the United States like New York and Baltimore and were often an object of fascination among American reporters. The Brooklyn Times reported in 1897 a story from a few years before about “A Hunt for Lascars in Brooklyn.” A clipper ship named the N. B. Palmer, engaged in the lucrative China trade, made its way from Shanghai to New York and had about forty-six lascars on its crew. The reporter describes them as follows: “With fine forms, intelligent heads and possessing white men’s characteristics as far as their figures are concerned these men, Capt. Steele told me, were skillful and daring soldiers. Their skin is jet black; hair, the same color, perfectly straight; teeth pearly white with no evidence of decay; intensely black penetrating eyes; small of stature, of light and active figures.” Eventually, “eleven of these blacks” deserted into the streets of Brooklyn and only with the assistance of a US Deputy Marshal were they “captured” and returned to the N. B. Palmer.

Perhaps these lascars were friends of those described by historian Vivek Bald in his book Bengali Harlem, in which he shows how merchants, seamen, and other travelers of South Asian descent illegally settled in America and forged relationships and communities with African Americans, particularly in Harlem and New Orleans. Bald shows how, well before the 1965 Hart-Celler Act allowed Asian professionals to legally migrate to the United States, many had already made their homes here despite the rampant legislation codifying “Asian Exclusion” throughout the country. It is curious, then, how the Brooklyn Times reporter describes my antecedents, rather paradoxically, as possessing both “white men’s characteristics” and “jet black” skin. The South Asian lascar was, ostensibly, often inscrutable to the white American whose worldview was constituted in Black-and-White terms. And that inscrutability would persist well into the twentieth century, until 9/11 finally launched us into America’s dubious popular imagination.

*

My brother experienced the effects of this imagination firsthand when we first landed in Chicago in 2010. His immigration process had already been fraught with uncertainty—when my family first received our immigrant visas in Karachi, my brother’s was noticeably absent. This was because he had been just on the cusp of turning twenty-one, an age that would disqualify him from being considered a “minor,” which my sister and I were and could therefore accompany my mother, the person in question sponsored by a blood relative. My mother was in hysterics, vowing that we would not make the move if my brother was not with us. Fortunately, upon appeal, his immigrant visa was eventually approved as he had technically not turned twenty-one before the cutoff date.

But at O’Hare Airport, my mother’s histrionics would—quite justifiably—resume. As we went through customs and immigration, my brother was pulled aside by security. In hindsight, there was something strangely familiar about the way Mom frantically held on to my brother before he was taken away, a little like how she would, six months later, tenaciously hold on to me before the medical attendant rolled me away in a wheelchair. As my brother tells me, they had him wait in a row with a handful of other young brown men. Someone yelled out their last names and they were, by turns, taken somewhere in the back to be interrogated. My brother waited for about ten minutes until finally someone called out “SIDIKI,” but unlike the others he wasn’t taken to the back but simply handed a file and told that he was good to go. In his words, my brother almost “pissed himself,” and the relief was nothing short of ecstatic, albeit tinged with a little survivor’s guilt. When he returned to us, he vividly remembers Mom clicking away at her tasbeeh, the relief in her eyes even more fervent than in his own.

If the lascars of the nineteenth century embodied the threat of infectious epidemics at America’s seaports, their descendants haunt today’s airports as harbingers not of infection, but of terror. Scholar Anjuli Raza Kolb makes just that very argument in her book Epidemic Empire, wherein she examines the trope of “terror epidemics” that routinely conflates “Islam” and “terrorism” with “plague,” “outbreak,” “contagion,” and even, most appropriately for me, “cancer.” Indeed, it is notable, as Raza Kolb too reminds us, that Donald Rumsfeld in his briefing on Operation Enduring Freedom stated that “terrorism is a cancer on the human condition and we intend to oppose it wherever it is.”    

Raza Kolb, therefore, could not have chosen a more appropriate illustration to grace the cover of her book: an 1883 cartoon from Puck magazine personifying cholera as a skeletal scythe-wielding figure in distinctly Oriental grab, complete with a fez and a lunghi. The sinister figure rides the prow of a British marine vessel approaching the fort of Castle Garden in New York’s harbor, where “board of health” officials stand at the ready to repel the choleric invader with bottles of carbolic acid. Given the figure’s attire and that he arrives on a British vessel, it is very likely that the illustrator has the figure of the diseased lascar in mind. The cartoon is captioned: “The Kind of ‘Assisted Emigrant’ We Can Not Afford to Admit.”

But admit they did. When I look back at pictures of myself from the time of my diagnosis—especially that horrid yearbook photo they took of me at the high school in Kalamazoo a mere weeks before we knew—I cannot help but see a little of myself in Puck’s Eastern grim reaper: the wasting away, the forced grin revealing cheekbones that in any other context would have been beautiful. But while the fez-wearing infectious lascar sails into the port of New York, a port had somehow sailed into the center of my chest.

I was no longer traversing through conduits; I was one. No other corporeal condition could have better exemplified the sheer indeterminacy of being a migrant.