The Smoker

 

 

 

 

 

 

 

 

 

 

 

 

 

A young man approached my seat to greet me. He asked me if I knew him. I said no. He told me that his father had told him how I saved his life.

“Who is your father”? I asked.“Mohammed Juma.” he said. “Of course I knew your father. Peace is on his soul. I used to see your father on social occasions and as a patient until he died in 1989.”

“How old were you when your father had his first heart attack?” I asked. The young man seemed puzzled. “When was his heart attack ?” He asked. “It was in the summer of 1979.” I replied, “I was only three years old then.” He said. The above conversation took place in an airplane flight from Europe to Doha in the Autumn of 1999.

 

On June 20, 1979, before starting my morning round, I was informed that an unconscious patient was admitted. He was a relatively young man with ECG evidence of acute inferior myocardial infarction and 2:1 AV block. The police found him unconscious and brought him to Rumaillah hospital. While we were examining him, he went into ventricular fibrillation. We started CPR with our newly trained CPR team. I told the nurse to charge the defibrillator next to the patient’s bed to 300J. At that time, most of our CCU patients were monitored with a defibrillator screen because we had no wall mounted ECG monitors yet. This was very convenient for rescuing this patient.

A house officer jumped with the Ambu bag to the head of the bed. Another doctor thumped the patient on the chest, but he was too gentle to have any effect. I grabbed the defibrillator paddles, asked the team to clear off the bed, and administered the shock. The patient went back to sinus rhythm. All these did not take more than 75 seconds but it seemed very long at the time. Perception of accurate time under stress is difficult. His vital signs became stable. Xylocaine infusion was started after a bolus. He required mechanical ventilation after the CPR. Procainamide infusion was added to the Xylocaine. His pupils were reactive to light and he had spontaneous movement of his extremities.

We did not know the name of the patient or his medical history. The police brought him from the street as “unknown”. A relative of another patient who watched us resuscitate the patient heard us wondering about his identity. He came to me and told me that he had seen a man who looked like our patient in the Amiri Diwan. He was sitting in the office of Y. N. I called Mr. Y.N. at the Amir’s office and requested him to come to the CCU to see if he could identify the unknown patient. He came and told us that the patient’s name was Mohammed Juma and that he worked at the Amiri Diwan. His family was then informed.

During that morning, Mohammed went into ventricular fibrillation five times. He required full CPR once but simple defibrillation was adequate to revert him to sinus rhythm the rest of the time. The following day his mental status improved dramatically and he had no further episodes of fibrillation. He was weaned from the respirator. His vital signs were stable.

On the third day, he was fully conscious, oriented, and smiling. He told us that he was a heavy smoker and had no medical illness before. He could not remember how he lost consciousness while walking in the street.

On the fourth day, I saw Mohammed smiling when he saw me coming toward him. His wife was asking him to tell me something, but he was reluctant.

“You tell him.” He told her. His wife then told me: “A few weeks ago, while Mohammed was smoking, he saw you on TV talking about the dangers of smoking. He shouted, “Go to h. . .” Then, he turned off the TV and continued smoking his cigarette.” I asked Mohammed: “How about now? Do you believe me?”

“I will never smoke again, not after all this”. He said. Then he pointed to his wife and told me while laughing: “If she gets me another son I will call him Hajar”.

On the 5th day, we transferred him from the CCU to the medical ward. Mohammed was very entertaining. He had a good sense of humor. He made jokes about the medical and nursing staff. He told me that he frequently entertains the head of the state with his humor. He was discharged asymptomatic, on propranolol only. He came for follow-up once, and then he disappeared.

One year later I saw him in the Amiri Diwan in the office of Mr. Y.N. He came to greet me and kissed me. He told me that he was in Lebanon recently. He had a medical checkup while in Lebanon and was told that he was in perfect health. He was no longer taking any medication.

“Mohammed is smoking again”, Mr. Y.N. whispered in my ear. Mohammed immediately sensed that his “crime” was exposed.

“Do not believe them; they are trouble makers.” He said. The other people in the office laughed, and said to me: “Look in his pocket.” I put my hand in Mohammed’s pocket while he was laughing and denying having any cigarettes with him. I pulled out a pack of cigarette from his pocket. He told me that they were not his – they belonged to a friend. He admitted then that he smoked only occasionally.

I reminded him that he had several cardiac arrests one year earlier and that he almost died. The cigarette was very dangerous to his health. He agreed with me. He thanked me for my concern and promised to stop smoking again.

On my frequent visits to the Amiri Office, I used to see Mohammed. I heard that he continued to smoke. He used to quickly empty his pocket as soon as he heard that I was coming to the office. I gave up on him.

Seven years later, Mohammed was admitted to the hospital with a commuted fracture of the left humerus due to a road traffic accident. Cardiology consultation was requested because of his old history of myocardial infarction. He had no symptoms related to the cardiovascular system. He was on no medication. His BP was 170/110 on admission. He had cardiomegaly on CXR. The Amiri Diwan sent him to London for fracture treatment. He did well. I saw him two weeks later with a sling around his arm. After his arm was completely healed he fell from a ladder at home a year later while he was trying to change a light bulb. He was brought to the emergency room complaining of severe pain in the left lower ribs. He had tenderness at left 9th to 12th rib. No fracture was seen on x-ray. He was sent home on analgesics.

Ten years after his myocardial infarction, he was admitted to the CCU at HGH for moderately severe congestive heart failure. He improved on diuretics and ACE inhibitor. I presented him for the ground round as the longest post CPR survival in Qatar. I reviewed his history from the days of Rumaillah hospital in 1979.

Before his discharge, I told him that he was an important patient for the history of cardiology in Qatar. I asked him to give me his picture to keep for the department. I told him that I would write his story in the history of the department.

He smiled and said: “You want me to go to a studio for a picture! You do not want to spend money on me? Let the hospital photographer take my picture for you.”

I called Public Relations and arranged for him to go to the photography room on the third floor.

As I was leaving, he stopped me, and told me while smiling: “I am sure that you will be fair when you write about me after my death. You are the son of a Motawa (religious shaikh). Ask God for mercy on my soul and do not say anything bad about me. I am sure you will praise me. You will say that Mohammed Juma was a good man.”

Mohammed died on April 5, 1989, with acute myocardial infarction and congestive heart failure at the age of 55. Yes, he was a good man. O’ God have mercy on his soul.

© 2019 by Dr. Hajar