Dr. Pankaj Satija dressed for the day in his navy scrubs, but he didn’t know if by the end of it he would be back at his neurology clinic or deported back to his native India.

Satija and his wife, Dr. Monika Ummat, a neurologist specializing in severe pediatric epilepsy at Texas Children’s Hospital, arrived at their attorney’s office around 9 a.m. Thursday, preparing for a high-stakes meeting with U.S. Customs and Border Protection at George Bush Intercontinental Airport that could determine whether they would be removed from the country or granted more time to fix their paperwork.

They were given a one-day notice.

For the two highly specialized, triple-board-certified neurologists, it was among the longest, most uncertain 24 hours of their lives. They started calling patients, cancelling upcoming surgeries, worrying about who would fill the patients’ prescriptions some depended on to survive. They didn’t know what to tell their American children,a seven-year-old son and four-year-old daughter, or what they would do with their dog, Omi, and their fish, Yoda. How does someone prepare to get deported tomorrow? Too overwhelmed to pack up the lives they had spent 15 years building in the United States, Satija and Ummat prepared only their most important immigration documents.

“My biggest worry right now is the patients,” Satija said Thursday morning, preparing to leave for the airport to meet with federal immigration agents. “I do not take care of patients who can wait on their treatment. If those procedures aren’t provided to them, they could land up in the emergency room, or possibly even die.”

By the end of the day Thursday, Customs and Border Protection finally approved a 90-day extension so the couple could remain in the country and renew the travel permit that had expired — but not before agents had changed their minds three different times about the fate of the couple in a matter of 48 hours. At one point, their options aside from deportation were temporary removal from the country or temporary detention while waiting to plead their case to an immigration judge.

Satija and Ummat’s minor paperwork oversight stems from a trip to India to visit Satija’s terminally ill father last fall. Satija and Ummat each legally came to the United States in the early 2000s to complete their doctorate educations and residencies at Baylor College of Medicine, and Ummat also studied at Duke. In 2007, they applied to become permanent legal residents, and Houston Methodist Hospital sponsored Satija’s application. But because of immense backlog and limitations on how many green cards can be issued per year, ten years later, the couple is still waiting.

They have been living with valid work visas instead, allowed to travel out of the country thanks to a travel permit called “advance parole” — and that’s where the paperwork snafu comes in.

They have renewed this document every two years for the past decade, but for some reason it was only valid for one year during the past renewal period, which expired in July 2016. Further confusion arose after returning from a cruise in Mexico in December 2015, when the U.S. Department of Homeland Security stamped their travel permit saying it was valid until June 2017. Not noticing the discrepancy in dates, Satija and Ummat left in a hurry to India in October to see Satija’s father, who had been rushed to the ICU.

When they returned one week later, Customs and Border Protection officials told them their papers weren’t valid, but granted them what’s called a parole extension so the couple had time to renew their travel paperwork. On Wednesday, CBP revoked the extension, telling the couple to come back tomorrow. They would learn whether they would be sent back to India then.

“I can’t put my mind together,” Ummat said, hours before the meeting. “I keep thinking, Why is this happening to us? How are we going to handle it? Our whole life has been here.”

The couple’s attorney, Gordon Quan, said that the government's initial decision to revoke the parole extension appears to be related to the Trump Administration’s February 20 Department of Homeland Security executive-order memo, which said parole should only be granted to “any alien who is an applicant for admission for urgent humanitarian reasons or significant public benefit.” Homeland Security Secretary John Kelly said it should only be granted “sparingly.”

On Wednesday, Customs and Border Protection had said yes, Satija and Ummat would be granted this extension — but then after lunch, officials came back and told the couple never mind, prepare for possible deportation. The next morning, while the couple mulled their options in Quan’s office, CBP called and said deportation wouldn’t be necessary, but the couple would have to leave the country and only return once they had received physical copies of their new advanced parole travel documents, which had been approved by immigration officials March 22. Still, even a one-week trip to India had the couple fearing they did not have enough time to notify patients and make other arrangements for them. The kids worried about their dog and their fish.

Representatives from Homeland Security said they could not comment on the specifics of the couple’s case for privacy reasons.

On the way home from the airport Thursday, after the family was finally in the clear, Ummat sounded cheery, saying she couldn’t wait to get home so she could eat something and finally close her eyes that evening.

The previous night, neither she or her husband slept. They had told the kids they were dealing with an emergency — but the kids were used to it, having parents with complicated patients.

“But my son understood a few things,” Ummat said. “Later at night I see him out of bed, and I say, where is he? I see him praying. He said, ‘I’m just praying that whatever problem you have will be fixed.'”

