Washington Report on Middle East Affairs, October/November 1997, PAGE 74

Mahjabeen's Musings: A Muslim Traveler Along the American Way

It Can Be Hell on the Other Side of the Doctor-Patient Relationship

By Mahjabeen Islam-Husain

I felt as though I had been slapped real hard—like the girl in the movie "The Exorcist" whose head was spinning 360 degrees. I stared benumbed at the fax, which coldly said "Malignant Melanoma." It just would not sink in that the apparently harmless-looking mole that I had excised from a patient's shoulder was malignant. She said that she had noticed it a year or so ago and that over the last two months it had changed color somewhat.

This is by far the worst part of being a physician—having to be the one to tell patients that they have cancer or a terminal condition. Countless times I have been able to "turf it," so to speak, and have some other doctor tell the patient—the surgeon, the oncologist, etc. This time I was really stuck. I had taken off the mole, and no one else was involved. Gosh! It had to happen to the nicest patients! After many prayers and much trepidation, I broke the news to her—she was too stunned to react and I was grateful for that, as my emotions at that point were enough for me to handle, something she would have picked up on had she not been so overwhelmed.

Little did I know at that point that another stunner was yet to come. It was with an awful sinking feeling that I remembered that I too had a mole—coincidentally on the same spot as the patient. My lesion was larger and had grown, however indolently, over the past two years. I had lately been bothered with a lump in the armpit also. As soon as I made the connection between the two, my anxiety-propelled imagination took a speed-of-light blast-off.

I was dead in five years max, leaving behind 16-, 15- and 12-year-old daughters. My physician husband, after a token period, remarried, and also acquired many more and faster computers than the collection that presently claims much of his time at home. My daughters were left to deal with their memories of me and their fractured defense mechanisms. They have a doting and empathetic father, but surely the new wife and those new computers would be too time-consuming for him to help them deal with all of the good and bad cards that life doles out.

Nothing in the world like a mother, I thought, again and again. My mind in a flash of a few seconds had visualized my death and the following 10 years. I did not care for what I saw, and my anxiety reached its apogee.

Wait a minute, wait a minute. I thought you had a lot of faith in God. What happened to that? Easy to theorize. Shall we—or better, can we—practice? My stabler self tried to wrestle my anxiety back down to earth. After further mental gymnastics and much anguish I concluded that my main concern was the children and not a fear of death itself. This was a relief, for it is vital for a believing Muslim not to fear the inevitability of death. That is a door to the Day of Judgment, belief in which is one of the fundamentals of our faith.

I thought I was pretty empathetic, but this was an unanticipated refresher course.

Sheikh Fadhlallah Haeri in his book Decree and Destiny eloquently explains this concept of the Will of God and how it interfaces with the discretion of humans. Orientalists and pseudo-scholars of Islam have sought to reduce Islam to cult-like status by depicting Muslims as shackled, inert fatalists. Dr. Haeri explains the facts about the qadariyyah, who believed that Man had the power solely to chart his course, and the jabariyah, who believed that God pre-ordained Man's actions and that Man was entirely powerless.

God has made it clear in the Qur'an that the physical laws that He has made will apply and that Man, being the most superior of His creations, has been given the discretion to choose his course and the ability to differentiate right from wrong. This is in the larger framework of the Will of Allah. The fact that Allah has knowledge of all things past, present and future, as well as what choice in a situation any human being will make, does not detract from Man's power to choose.

Because Islam is a complete way of life I found it necessary to extrapolate the above to my situation so as to come to terms with this new challenge and deal with it. In my disbelief-denial state I was still able to figure out that I could not blame myself for this lesion, and that I had to simply deal with the consequences. Slowly my mind settled down, as I tried to steel myself for the worst.

The plastic surgeon's office did not seem to understand the urgency of removing a mole within the next two days. I had to wait a week if I wanted excision on the same day as the office appointment.

It was a long week. The permutations in my mind were endless. I had been a survivor in the death of my brothers and father. I could not understand how this time I could be the "deathee," leaving three young children to survive me. I knew that the real suffering in the loss of my father and brothers had been mine. God in His infinite mercy would forgive me my transgressions, and in death I would be relieved of the great effort that life is. And yet I would be one restless soul, hovering over my children, worrying about a multitude of things.

Straws to Cling To

The day arrived, and at the plastic surgeon's office my husband made light of the situation and told the nurse that he had come for a nose job. Her quizzical look made me laugh. It was amazing to me how I hung on to every word and every expression of the surgeon for the smallest of straws to cling to. The hell of being on the other side of the doctor-patient relationship hit me with great force. Realization of the power that physicians command on the daily life and peace of mind of patients came to me with eye-opening intensity. I thought I was pretty empathetic, but this was indeed an unanticipated big-time refresher course.

"Kiddo, it appears benign but we should take it out since it has grown in size." He was crisp and professional, probably unaware of the mess my mind was in. "Call me in three days for the result of the biopsy."

We all must face our inevitable mortality, especially when the machine which is our body is bound to break down intermittently due to sheer wear and tear. We're never quite ready to have it stall, though, and it's much worse when it dies with forewarning. Sudden deaths are great. You just die once! In those 10 days of waiting I died time and again, in varied ways.

When patients await biopsy or test results, I always tell them to "cross the bridge when you come to it...Wait till we tell you to worry." How flippant it suddenly sounded to me!

Now, the waiting is finished. My patient's melanoma has not spread, she just needs a wider excision, and her five-year survival chances are 90 percent. My lesion was benign.

Muslims believe in the concept of maslihat or a Divine reason for everything that occurs. I now understand the maslihat in this situation. It painfully illustrated to me the terrible powerlessness that patients feel when confronted with a serious diagnosis. Death itself is not as much a problem as the emotionally protracted nature of the terminal state, the associated loss of control and the fallout on the survivors. It humbled me in immense gratitude to the Beneficent, for another lease on life. I cannot verbalize this gratitude other than to say, alhamdolillah!