When Sheikh Abdulla Ibrahim Al Ansari, one of my favorite patients died, I cried and published a sad poem about him. My father cried more when he read my poem. In this essay, I shall quote excerpts from the poem, which I have translated from Arabic to English. Regrettably, much of the flavor and nuance of poetry are lost in translation.
I began with an introduction: “With great sorrow that Sheikh Abdulla whom I cared for, for the last ten years, has gone. What I gave, has gone with him, but what he gave will stay with us for ever.”
Then I started the poem:
I tried to save you, I did not quit,
Medical science is not disgraced if I admit,
My medicine did not save you,
My thoughts did not fit.
God knows how much I tried,
Death is inevitable, I cried.
It is pity, it is sad
Every one dies, except God.
I closely supervised Sheikh Abdulla’s cardiac care in the last decade of his life, not only as a cardiologist but also as a son. He was like a brother to my father and like a father to me. Therefore, I cannot narrate Sheikh Abdulla’s medical story without touching on the social, religious, and historical influences that shaped my career and relationship with patients in our small society. I cannot separate my own personal history from the history of those who have influenced my life or taught me some lessons.
The first time I met Sheikh Abdulla Al Ansari was during my summer vacation in 1959 when I accompanied my father who was visiting him. I was only about 15 years old, a junior high school student, not in Qatar, but in Kuwait then.
My father used to have his living room open daily to visitors, two hours before sunset. He encouraged me to join him in the living room and listen to the conversations. I remember how Sheikh Abdulla made me participate by asking my opinion about some topics. I would tell the grown-up men the news I heard from the radio or from my friends. This pleased my father because, in our society, it is not appropriate for a father to ask his young son to talk while older guests are present. As children, we were taught that a child should not walk in front of or enter a door or take a drink before an older person. A child must not take the liberty of talking, if not asked, while adult guests are present unless they were relatives or close family friends. What could a child contribute to grown-up conversations? But if a guest, like Sheikh Abdulla, asked me to talk, then my father would be relieved. My father also used to take me with him when he visited friends. This is how boys learn about the norms and the fabric of their society. We learn a lot by osmosis.
In that same summer, I had the opportunity to go to Rumailah hospital with my father to visit Sheikh Ibrahim, the father of Sheikh Abdullah. Sheikh Ibrahim appeared to be over 80 years old. He was hospitalized for diabetes and urological problem and was under the care of Dr. Prendeville, an Australian general surgeon who operated on any part of the body. For example, he operated on my father's hemorrhoids, my tonsil, my cousins’ intestine, and performed circumcision on my brother. If Dr. Prendeville was not the “man for all seasons” in Qatar, he was certainly “the surgeon of all organs” then.
The old man, Sheikh Abdulla’s father, was in bed when we entered his room but he insisted to join the guests who were seated on the floor. It was, and still is, not appropriate for a person to sit at a level higher than where the guests are sitting. Of course, a sick person is an exception to this rule. The old man felt, however, that he was not sick enough to stay in bed.
A dozen visitors, including his son Sheikh Abdulla, my father, and I were sitting on a red wool Persian carpet covering the floor. Around the carpet were large white cotton pillows resting on the wall for the guests to lean on. Two large thermoses filled with coffee and tea, with coffee cups and teacups, were on a tray in the corner of the room. Plates of summer fruits -watermelon, cantaloupe, and fresh dates, from Sheikh Abdulla’s farm – were served to us on the floor in a large, round, shiny aluminum dish. The old man ate a lot of watermelons. I overheard Sheikh Abdulla whispering in my father’s ear that doctors had told the old man that he should not eat too much watermelon because of his diabetes but he does not follow their advice. He loves watermelon.
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After the fruits, Arabic coffee then tea was served. Patients and their families used to bring to the hospital carpets, fruits, sweets, and other food items. Traditional hospitality at home was extended to the hospital room. Serving visitors with coffee, tea, fruits, and sweets in patients’ rooms was normal social practice in Qatar hospitals until we banned that custom in 1982.
The old man, his son Sheikh Abdulla, and my father were respected Islamic theology scholars. Even though religion was the dominating theme of discussion during that evening, they also discussed the news of the town, history, and literature.
Sheikh Abdulla and my father shared the same beliefs; both studied theology in Saudi Arabia. My father was an expert on Islamic laws, Qur'an, the prophet sayings, Islamic and Arab history, and Arabic language. He was an Islamic judge. But my father was useless when it came to technical or other such fields. He depended on his friend to buy or arrange things for him. Sheikh Abdulla had a broader knowledge of the affairs of daily life. He preached in the mosque but also drove his car, looked after his farm, actively moved around the villages and calculated the Arabic lunar calendar for Qatar. He included in his annual calendar prayer times, weather expectation, time of planting crops, and entertaining pieces of poetry or proverbs. When my father decided to build a house in 1959 he turned to Sheikh Abdulla for advice, who took it seriously. He contacted an engineer and builders. He made the agreements and checked on the execution as if he were building his own house. I was too young to help then, but 20 years later, I was responsible for building a more modern house for my father. Houses have short life spans in the Arabian Gulf!
Sheikh Abdulla narrated to us a heroic action by Dr. Prendeville who saved his father’s life, years before. The old man stopped breathing while recovering from anesthesia post operation. Dr. Prendiville succeeded in getting him breathing again. In gratitude, Sh. Abdulla gave the surgeon a golden Rolex watch. Swiss watches were the most popular gifts that rich Qatari patients gave to doctors in appreciation of their care. I have more to say about the Australian surgeon Dr. Prendevile in a future article because I convinced him to come back to practice in Qatar again in the 1980s and he, my old doctor, became my patient.
My friends are amazed by how I remember details about health care when I was only a kid. The secret is that I wanted to be a physician since the age of seven when I saw a doctor with a white coat and stethoscope for the first time. That doctor was Dr. Abdullatif Al Mannai, who came to our house to treat my mother in Ras Al Khaimah (now part of UAE). My mother was about 25 years old, then, and complained of “heart pain”. Dr. Al Mannai had just returned from India where he had completed his training. Even though Dr. Al Mannai and my mother were relatives and belonged to the same Arab tribe (Mannai), she was shy to see him. He carried out his “physical examination” standing on one side of the door while my mother stood on the other side. He did not see her or touched her. My job was to put his stethoscope over her heart for him to listen. I enjoyed being the assistant doctor then. It seemed to me that there was something great and magical about physicians and medicine. How smart they were to understand what was wrong with a sick patient from a distance and behind a door, using only a magical tool, the stethoscope. I dreamed of carrying that stethoscope. That doctor and that incident influenced my life and my choice of career.
Dr. Al Mannai had some tablets in his pocket. He gave them to my mother as a gift. Much later, I learned from him that he gave her vitamins. It did help her for a few months. But she complained of “heart pain” for the next 30 years. She never had a cardiac problem. Her problem was severe iron deficiency anima that caused palpitation and some discomfort relieved with vitamins and iron. My mother’s complaints of “heart pain”, however, influenced me, the child, to become a cardiologist as an adult in order to help her.
There was no hospital or clinic in Ras Al Khaimah then for the young Al Mannai doctor to work. He migrated to Qatar where he had the opportunity to work in Rumailah hospital.
Eight years later, during the same summer when I met Sheikh Abdulla and his father, I also met the man who inspired me, Dr. Al Mannai, in the same hospital in Doha. He was working in the dental clinic. He was neither a physician nor a dentist. Mr. Al Mannai donned a white coat, but he was only a dental technician.
Only now, do I realize that I was inspired to be a physician by the wrong person and influenced to be a cardiologist for the wrong reason!
In 1961 when I started high (secondary) school in Doha, Sheikh Abdulla was a principal of a government school, but during the summer vacation, he becomes the acting director of the Department of Education, which became the Ministry of Education a decade later.
When I started the first year class of secondary school, my school principal told me that I should go to a class one year lower because my school certificate from Kuwait was not stamped by the government of Kuwait. I refused to accept his plan and I argued that my grades were the highest in the class. I was very angry. I called Sheikh Abdulla and complained about the principal. He reacted kindly and assured me that there was no such requirement. He told me to wait for him by the school door. He came with his distinguished head cover, driving a Volkswagen (Beatle) to my school. He picked me up and took me to the Director of Education. He scolded the director for what his principal was doing to me. Sheikh Abdulla was well-respected in the country by the people and the government. The director called the principal of my school and ordered him to keep me in the higher class. Sheikh Abdulla then took me back to school. The memory of that day and the kindness of Sheikh Abdulla has engraved my memory with appreciation forever.
In 1979, one year after my return to work as a cardiologist at home, Sheikh Abdulla whose medical problems then consisted of adult onset diabetes mellitus and osteoarthritis complained of typical angina symptoms. We had no cardiac catheterization laboratory nor cardiac surgery in Qatar then. I treated him with propranolol and oral nitrates. His symptoms were controlled with that therapy. He was satisfied and thankful. But I arranged for him to travel to London for cardiac catheterization. He agreed. In London, while waiting for the catheterization he had cardiac arrest following a massive anterior myocardial infarction. He recovered fairly well to undergo catheterization a few days later. He was advised to have surgery but he did not agree. He called me for advice while I was preparing to travel to the USA.
I stopped over in London to visit Sheikh Abdulla. I met with his British cardiologist and the cardiac surgeon. Both were friendly, skillful, and more senior than I was. We reviewed the cineangiogram together. He had severe lesions in the left anterior descending coronary artery and in two large obtuse marginals with aneurysmal dilatation of the anterior wall as I could recall. I convinced Sheikh Abdulla to accept surgery, which he did. He had a smooth course post CABG. He was not taking any cardiac medication when he returned to Doha.
One night, at 2 AM in 1980, the telephone woke me up from sleep. Sheikh Abdulla’s family rang me. The Sheikh wanted to see me urgently because he had the difficulty of breathing. I picked up my emergency bag and ran to my car. Fortunately, his house was only 4 minutes away by car from my house then. I found Sheikh Abdulla in distress, sitting in bed. He was wheezing, with some basal rales that he did not have a week earlier when I saw him in the clinic. He improved a few minutes after I gave him 40mg of Lasix intravenously. He told me that a couple of nights earlier he had a similar episode but milder. The shortness of breath improved when he sat up.
I reevaluated him in the clinic in the morning. He had no signs and symptoms of heart failure. He did not tolerate oral diuretic because of frequent urination. Subsequently, I had to make two more trips to see him between 2 to 3 AM for acute congestive heart failure. I admitted him selectively to the CCU in Rumailah hospital for 2 days' monitoring to rule out arrhythmia or ischemia as a cause of these occasional episodes of heart failure. No arrhythmia was detected, but he had an episode of acute wheezing without much rales. I convinced him then to be on Lasix daily. He slept well without paroxysmal nocturnal dyspnea while on Lasix for the next 6 years. In 1986 his cardiac condition was stable but he developed severe left temporo-occular pain with nausea, which was diagnosed as 3rd nerve palsy. He went to London for treatment. This problem resolved spontaneously in a few weeks.
When I needed a well-known religious leader to join me in a public seminar on smoking, I approached Sheikh Abdulla for that purpose. He agreed to talk about smoking and Islam. We were a good team. He told me to start first. I remember some of what he said: “My son, Dr. Hajar, has told you how smoking causes diseases and kills people. Since God forbids a Muslim to kill himself, then God forbids smoking. The Prophet Mohammed, peace be on his soul, said that you should not eat onion or garlic before going to the Mosque so that the smell does not disturb other Muslims. The smell of cigarette is worse”. He concluded that based on Islamic principles, smoking is forbidden.
In March 1989, Sheikh Abdulla was admitted to the CCU with inferior myocardial infarction, 10 years after his first heart attack and bypass surgery. He was stable for 3 days, but then he had a massive re-infarction or extension of his infarction. He deteriorated with progressive heart failure. His echocardiogram revealed akinetic apex and anterior wall and dilated poorly contracting left ventricle. Stabilizing him was difficult and we could not wean him from the inotropic support. His family, under intense pressure from the public, requested that he be sent abroad for treatment. The patient did not agree with his family’s request to travel abroad. He told me: “You are my physician all these years, I will not find a better doctor to take care of me. If God wants me to live, I will survive whether in Doha or in London. If he wants me to die, then that is my fate; nobody could delay it.” I referred to that in the poem:
"If death is God’s wish and desire,
Neither medicine could delay it, nor fire."
I was not capable of telling Sheikh Abdulla that we were reaching the end of our rope, so to speak, as to our ability to treat his condition. I took the social aspects and the wish of the family into consideration and said to him:
"Oh Sheikh, God said in the Qur'an, ‘Over everyone with knowledge, there is someone with more knowledge’. I am sure that there are many doctors abroad with more knowledge and experience than I. You should go for opinion and I will be calling you and the doctors abroad frequently”. The Sheikh then said: “The decision is yours.”
I called the cardiologist in London who took care of him last time and briefed him about the Sheikh’s condition. He was willing to accept him.
My father rushed to visit Sheikh Abdulla in the hospital and said farewell to him. I told my father that he might not see Sheikh Abdulla again. He was transported with a medical escort, resuscitation equipment, drugs, and nasal oxygen. His cardiac drugs continued during the flight (IV Dobutamine, Nitroglycerin, Lasix and oral captopril and Hydrochlorothiazide).
He made it safely to London. In London, he was reasonably stable with recurrent atrial fibrillations. On his fifth day of hospitalization in London, the British cardiologist called me about midday in Doha to inform me of Sheikh Abdulla’s death. He told me that the Sheikh told him during rounds that morning that he would die that day. The patient, however, was stable and there were no clinical changes. He reassured the patient and left. He was therefore shocked when the nurse called him later in the day to tell him that the Sheikh was dead.
I called one of Sheikh Abdulla’s sons in London. He confirmed the story and added: “My father told us: ‘I want to say farewell to you. Today is the last day of my life. Death is God’s way; everybody will go through it. Do not cry too much after my death’. He then asked us to bathe him. He wanted to meet God clean. After the bath, he prayed. Then he asked us to help him sit up.'I want to meet God sitting, not lying down', he said. We sat him up. He prayed and then suddenly expelled his last breath.”
I described that incident in my Arabic poem:
Your children cried and kissed your hand
When you said: “Farewell”, with a clear mind,
“This is my last day over the ground.”
Your physician was puzzled,
He did not understand.
You were so wise,
You were so kind, Until your last minute over the sand.
Sheikh Abdulla Al Ansari in his farm Photographed by the Author, 1960