Sleepless nights

The other night I was in the ward when one of our patients fell ill after the surgery. In such cases we are supposed to do bedside duties to take care of the patients.Most of the time the condition of the patients will be stable by the time they are shifted to the ward and for the resident doctor it is just a matter of utilizing the time to sit and read comfortably.

Bed No. 10 is notorious for patients who stay in the ward for long duration.We usually joke when a patient gets admitted to that bed commenting how unlucky he or she is. The bed is strategically placed to be just in front of where we resident doctors sit so that we could have a quick access to the patient in case of emergency.I have seen the condition of normal patients worsening unexpectedly in that bed.

A middle aged old man who underwent a neck surgery was admitted there.His removed disease was very close to his vessels and hence he was a potential candidate for artery rupture on the 8 to 10th day of the surgery which was a very dangerous situation.We used to consider them as mobile time-bombs in the ward. I was tired after fasting and found it difficult to concentrate in the book I was reading. My eyes wandered off to the patient in bed No. 10, even though I was doing bed side duty for another patient. The man had a big bandage covering his entire neck which made his chin to be be raised up.His position reminded me of the verse in the Holy Quran which mentions people who don't listen to the Truth, 'and verily there were iron collars to their neck lifting their chin which made their heads lift up " .He was sitting in his bed.The intra venous line was connected to an antibiotic infusion.He was looking at the bottle, me and at the medicine flowing to his vein by holding the regulator of the infusion. There were roughly 3 or 4 drops left in the bottle which prevented him from sleeping. The drip had somehow stopped. He was trying his best to make these last drops fall by checking the infusion regulator, massaging his veins and squeezing the bottle,but those drops refused to obey him. I wondered why he was so adamant to get the last drops of medicine.Was it because he wanted full utilisation of his money or was he fully confident of the medicine. I knew that those last drops would not cause much difference in his case. He was not complaining to the nurse as most of the patients do. I went to him and removed the intra venous line. He just thanked me and laid in his bed for a much awaited sleep. But I was quite sure with the large bandage compressing his neck a good sleep was a far possibility for him. He did not have any relative around because we usually send them out to reduce the rush in the ward and to prevent the contagion. I closed my unread book and went to bed.

My friends used to complain to me about the state of my room. Busy schedule and my careless and lazy attitude leave my room so shabby that I sometimes prefer to sleep in the duty room. My bed consists of a pile of books and all I do is to push them aside and sleep on the other end.I remember what my sister used to say quoting her mother in law's comments about her son or my brother in law that even if a tigress gives birth in his bed he would just push it to the other end and sleep rather than cleaning it up. No wonder I have a bad backache on getting up due to my innocuous sleeping position which my friends used to call as my football kicking position.It takes at least 30 minutes for me to straighten my stiffened back . I rarely get a 6 hours sound sleep after joining the medical profession.

Seeing this patient I thought that after all at the end of the day what we all is badly in need of is a sound slumber which neither myself nor the patient is getting. May be this is life's way of teaching me that regardless of our status or position we long for the same thing.

By the eldest son

Helpless...

Cancer is the most dreaded disease I have ever come across . The mere mention of the disease weakens my spirits. As a doctor I am not supposed to have such a feeling and should remain positive to carry on . But this disease invades my good spirit day by day . The most striking feature of the disease is that once it starts growing , it wages a war against the body , weakens its system, attacks its vital centers , suppresses the morale of the patient and sends spies to all parts of the body to ensure that even if the main center is destroyed by the doctor , the deployed troops from distant sites in the body regroup and attack .It is a master disguiser sometimes and a silent killer as well . If God gives me permission to eradicate one disease, I will not think twice to answer . Such is the burden of the disease and the pitiable end the patient is afflicted with. Don't get the idea that all cancers are so . Some of them if detected in early stages can be resected or treated . This is not a documentary on the disease. I would just like to share some of my encounters with this ailment.

As an ENT resident in one of the prime institutes in India , our out patient department is really hectic . Patients crowding around the single door of our consultation room in a steaming summer the last place on earth you would like to be . I would confidently say that more than 50 % of the patients attending the clinic will be suffering from some or other type of cancer . A middle aged lady came from in between the queue claiming that she was an ayurvedic medical practitioner from Uttar Pradesh and she wanted to show one of her patients personally . Usually I hate people who upset the order of the queue and deal with them very harshly . As she personally came to see her patient get the right treatment I appreciated her good will and asked her to bring her patient . It was a middle aged lady with a neck swelling so large that she couldn't move her neck and breath properly . Such large thyroid ( a gland in the neck) cancers are not uncommon in this part of the world but when I asked the doctor what she was thinking of when she was treating I could understand why she personally brought the patient . With a bit of guilt on her face she told me that she had advised the patient to go to higher center long before . I asked her what she expected us to do then . She had no answer . But I appreciated her care and sincerity to bring the patient herself . I took the patient to my professor who right away asked them the same question, what they were doing the whole time . He asked me to get the investigations done at the earliest and proceed . About 60 % of patients with end stage cancer who come to us were already treated by quacks , alternative medicine practitioners and even allopathy doctors . When they reach an advanced stage they resort to us and then we will be left with palliative treatment only.

I always like Sardarjis ( sikh men of Punjab) . It may be because during my childhood ,I had a Major Singh uncle as our neighbour when we lived in Qatar . Steady turban and long beard always humble me with respect . One day a sardarji in his thirties with a smiling face came to my room complaining of an ulcer in the mouth . He told me it was a minor trouble for him but nevertheless wanted to show it. Seeing the ulcer I was quite sure that it was a cancer but of an early stage . I promptly explained the case to him and took special personal interest in working him up early since getting investigations done is a very long process here . In 10 days time he was fully worked up and I took him to the professor for dating for surgery hoping I could persuade him to give an early date . I was heart broken when I saw my professors diary of dates . He just helplessly looked at me and told me if I could show him a slot he would do it . He was right . His dates were full for 4 months and he was going on leave for 1 month in between . He told me to call the patient after 1 month to be listed in another consultants list . Then it was my role to explain to the patient the time lag . As I had already explained to him the investigations should be done on emergency basis , I found it very difficult to tell him to wait for another month . Contrary to my expectations he was a very understanding man and appreciating the efforts I made for him the readily obliged . But his parting question really shook me when he asked me , " doctor Saab , ithne din me ye bad tho nahi ho jayenge " ( Doctor , won't this disease advance by one month ) . Knowing very well the rapidly advancing nature of the disease , I could just tell him , " Let us hope for the best " . Fortunately after one month the disease not only did not advance much , but according to the patient, was the swelling shrank and he was even asking me whether the surgery was necessary or not . I told him that he was just lucky and not to spoil his luck by acting foolishly. I took him to the consultant and by God's graciousness he got operated the next week .

We have a tumour clinic wherein every Friday we discuss difficult cancer cases with radiotherapist , plastic surgeon and other faculties to reach a perfect decision . We take cases in turns . The patient allotted to me was a middle aged man already operated for cancer . We had removed his right eyes and cheek . He had also received maximum dose of radiation therapy and his type of cancer will not respond to chemotherapy . The discussion concluded quickly. He had developed a chest metastasis .The decision was to explain to the patient that we had no options left with us . So all we could provide him with was palliation . In other words ,he was to go home and wait for his end . As the resident in charge of the patient it was my responsibility to explain this to the patient . I was searching for appropriate words to tell him to go home and was nothing else we could do for him. The sad patient kept imploring me to do something . Seeing my dilemma my Senior came to my rescue . She told the patient , " Babaji , Hum bagwan nahi he "( Uncle , We are not Gods) . The patient left silently . She was right . Who are we to prescribe cure for patients when it is God who disposes

During one of our morning rounds my senior complained of mild abdomen pain . She asked me to complete her dressings she was doing in the ward as she was not feeling well . I obliged with no hesitation as she was one of my favourite seniors who taught me the basics of ENT . Next day she left the operation theatre early not feeling well again . During work up she was found to have a cyst in the abdomen either in the mesentry or the ovary . We joked with saying her that the surgeons would say it was from the ovary and the gynaecologist would call it a mesenteric cyst as both of want to evade case . Any way cysts are benign or harmless . After two days in the operation theatre I could not hear the news. It was found she had raised levels of a particular protein in her blood which is usually raised in cancers . It was a big blow to all of us . The usual joyful mood was transformed into melancholic . No one wanted to discuss the matter or to ask for details . Later she was diagnosed to have a borderline .May God help her to overcome her difficulties . Even though we learn , see and explain to people regarding diseases , it was only when someone close to us undergoes trial we really feel the gravity of the disease .

May God help all these people and help me to be of some help in their lives.

By the eldest son

Confession

Nicholar D Kristof is an American journalist, author, columnist and winner of two Pulitzer Prizes. He is widely known for exposing human rights abuses around the world. He is one of few journalists who have travelled twice to Iran. He recently travelled to West Bank and was teargassed by Israeli Security Forces.

I was touched by his article on the eve of Fathers day entitled " My father's gift to me" that appeared in the International Herald Tribune in which he recounts how his father an Armenian hailing from a noble family was imprisoned by Nazis and how he managed to escape to the United States where he learned English, earned his Doctorate at the University of Chicago and began his career as Political Science Professor. He quotes the following statement of his father " War, want, concentration camps, exile from home and homeland, these have made me hate strife but they have not made me loose faith in the future of humanity. If a man has been able to create arts, sciences and material civilisation, why should he be judged powerless to create justice, fraternity and peace".

The author laments that he feels fatherless on Fathers day as his father had died a few days ago at the age of 91 after leaving " a story book life " to his only child. He opines that we should celebrate the bequest of fatherhood with some thing simpler, deeper than artificial verse on store brought card. "Speak and hug from heart and soul while there is still time".

Another columnist - I don't remember his name- was explaining in one of his articles how much he missed his late father when he visited a particular spot together with his mother and how his mother sobbed adding that they would return to the same location next year when his father would be waiting there for them .
These are words of true love, affection and appreciation. I was with my parents during the last days of their lives . It was a golden opportunity to ask them to pardon my misbehaviour and misdeeds but I was too shy to do so. Now when some one misbehaves to me I rationalise it presuming that God is punishing me for mistreating my parents especially my father as I always had a soft corner for my mother. When I say mistreat I mean my arguments and disagreements with my father and my failure to rationalize their behaviour and nothing beyond that.
16 years have elapsed since my father left this world for good. Here in Doha when my friends call me Saidukka or Saidbhai or said , they in fact help me sustain my memories about my father . Whenever I visit my parents' graves while I am at home, I feel their proximity as if they are alive. Irrespective of his financial status, my father tried to educate me even if it involved knocking at doors he had never approached. I learned from him the principle of contentment and therefore I learned not to cherish any higher aspirations. He was very eager to preserve our dignity and was never ready to compromise on this matter. I used to go Edakkazhiyoor lower primary school, then known as Mannan School with our neighbours like Late Mohamed S/O Kader Musliyar, Velan etc. Mohamed had a very nice school bag in which once I put my books and carried it based on his request. I was not mature enough to realize the implications of such an act. I have to confess that I still act recklessly at many crucial issues. When my father caught me doing so, he did not scold me in front of my friends but when I returned from the school, he asked me not repeat it. Once Latheef's paternal uncle, the famous muezzin of Edakkazhiyur mosque, Mohamedkka, censured me for running here and there in the mosque while I was learning there. I obeyed him but did not forget to complain as usual to my father about him. My father went to question him but the poor man who commanded respect and reverence from our villagers due to his simple life and, his unique voice which pierced not only through the ears but touched the hearts of our villagers when he was calling for prayer, apologised saying that his purpose was not to harm me in any way but to teach me how to respect the sanctity of the mosque. When my father told me how he had questioned him and what his response was, I felt deeply disturbed and sorry and thought I should not have lodged any complaint with my father . May Allah forgive me for harming such a person.

By the father

Paradoxes

The distance between Dar Al Tawheed Intercontinental Hotel, Makka and the Haram seems to be around 500 Meters. The sound system at the holy Kaaba is electronically connected to the hotel rooms whereby the guests can hear the call for prayer in their rooms . What one has to do if he or she does not want his sound sleep during the sojourn not to be interrupted is to switch off the the button of the electronic device beside his bed. When one steps out of the hotel and walks towards the Haram, he or she meets African and local children, youths and women carrying small of packets of tissue paper or polythene bags and imploring you to buy them at any price. It is evident that theirs is an advanced form of begging. Once when a small girl  aged around  five years ran after us holding a small packet of tissue paper in the midst of the Pilgrims, I don't know why I felt pity on her and began to pat on her head, my fingers touching her soft, curly brown hair and her countenance cooling my mind. When one member of our group gave her a fifty Riyal currency note , I thought she was too  small to hold it and that currency would fly away from her hand. Then I was told that my fears were unwarranted as her mother was watching her closely and that she had been well trained for such a task.

These children are lucky when compared to their counter parts in India and some other Asian countries where they are abducted, mutilated and used for begging business. When I tried to visualize a situation in which a parent comes across his missing child maimed and mutilated among a group of beggars, a shock wave runs through my body, my hand shivers and my pulse rate increases. I sat looking at the photo of a couple whose child went missing while he was playing in the vicinity of their house in a news paper that carried this news item.

One can use the food grains in the hands of these children to invite pigeons and enjoy feeding them as many pilgrims do around the Haram. Some times I walked in the midst of these birds enjoying an ineffable pleasure while they ate food grains and moved like bashful brides, the shining feathers around their necks resembling gem studded necklaces. They revived nostalgic memories of my childhood when I had attempted in vain to catch and tame at least one of them

The area in front of Makka Hilton Towers and Dar Al Tawheed Intercontinental seems to represent the paradoxes and contradictions of this worldly life. On the one hand you meet affluent Muslims enjoying all types comforts and pleasures even while performing Omra or Hajj whereas on the other hand you come across human beings struggling to earn their bread and butter under the scorching heat of the sun or biting cold in front of their eyes.

I don't remember the author who said " Taj Mahal is the worst structure ever erected by mankind ....Marble conceives a multitude of sins etc..." .The white marble around the Haram has a different story to tell. A number of Saudi Youths could be seen waiting eagerly in front of the hotels , looking tired and their hands resting on wheel chairs". They ask the pilgrims coming out of the hotels around the Haram whether they need them to help the aged and physically weak persons to perform Haj or Omra rites especially the strenuous task of Tawaf around the Kaaba and the Saa'yu between Safa and Marwa mountains. The pilgrims are required just to sit on the wheel chairs pulled by these youths and the rest will be done by them. Despite the fact that they are prepared to bear this burden physically and mentally for pea nuts, some of the pilgrims who stay in Five star hotels could be seen bargaining with them. These jobless youths swallow their grievances and continue their struggle for existence. The white marble around the Haram will bear witness to their plight in the Hereafter.

By the father

P.S: Please share your thoughts on this  and other posts you have read.
My email: binsaed@hotmail.com