For our meeting with the director of the Pakistan Nursing Council, we arrived punctually at a small ­two-­room office tucked away in a corner of the National Institute of Health’s campus in Islamabad. In the center of one room was a table covered with a flowered plastic tablecloth, as if awaiting a picnic. Resting on it were a pencil holder, some writing materials, and a telephone. On one side of the table was a rather ornate chair, and on the wall behind it was a framed photograph of Muhammad Ali Jinnah, the man credited with creating Pakistan, in his signature oval cap and a severe black sherwani, a formal ­knee-­length coat. Four rickety chairs, a bit dusty, lined the other side of the table. In the adjoining room were more rickety chairs and another table, on which an elaborate tea service was arranged. A small man wearing stained clothes sat on a stool by the door, and mumbled something as he rubbed sleep deposits from his ­eyes.

“She’s what?” I heard my companion ask in a ­panic-­stricken tone. “Dead! Oh, my God, do you hear that?” she said to me. “The director of the nursing council is dead.” She stood still for a minute, as if paying her respects. “How did she die?” she said, again turning to the ­fellow.

The man looked offended at our misapprehension. “Late. Mrs. S.,” he said. Ah, Mrs. S. wasn’t dead. She would be ­late.

My companion, a Canadian, was new to this part of the world and understandably confused by the way Urdu, the national language, is translated into English, the “official” language, especially by people who have minimal schooling. Mrs. S. had gone from merely being late to being “the late Mrs. S.” In a way, this slip of the ­tongue—­or of the ear?—was quite symbolic. For in its efforts to make any effective contribution to the changing needs of the health care system, the Pakistan Nursing ­Council—­the federal institution that oversees nursing and all related ­professions—­might as well have been ­dead.