Medical Investigations

Comment on my last note made me think a bit more about investigations some of which are unpleasant, others even painful etc. We, as physicians do not see what the patient is going thru as we feel it is a justifiable procedure. I am not going to relate stories of how some procedures or investigations have caused damage or such unwanted results, because there are some others in which 'good' does result (Like you are doing Ultrasound of the belly for something and you discover a relatively non-symptomatizing lesion of great significance)
I will give my personal impressions as follows. (Iss kay parrnay say buhton ka bhala hoga.)
First--Medicare experience. Retired and depend upon medicare as well as other insurance to cover medical expenses (and now realize what a difference it is when paying for ordinary tests)
Anyway, I personally always saw medicare patients whatever they could pay because it was against my philosophy to reject them. After all somebody has to help those eldrly people. Now that I myself am in that category, I find 'rejection' by a physician (that "our doctor does not see medicare patients; Medicare has very restricted payment schedule.) very painful and I wonder that this physician is going to do when one day he himself will be in that category; what will he do then?
Yes I may have suffered some monetary losses but I was paid by others well. That is not what I am writing however, my purpose is to make you understand how I felt at the time of rejection. felt 'degraded' and small.
Second, when an investigative procedure is performed on me I feel the discomfort and then I rememeber what I did when I was performing, say for example a cerebral angiogram or the most dreaded pneumo-encephalogram (Fortunately it is not done any more since the advent of CT scanning.)
Thirdly, the injections, whenever I needed, or blood drawing or other needle pricking procedures, again I feel (I am pretty stoic and these procedures dont really bother me much but I do feel, to be truthful).
I did have some procedures when I was younger and working myself (Nurses would know me and would be more polite with me then) but now these things do matter.
This therefore is not necessarily a pleasant experience

"Mirgee" in my school

It was hot and humid morning when we all started the "Dua".
D. B. (District Board) Midle school Kakrali was about a mile from my village and for miles and miles around there was no other school of that standard so many boys would walk for two three or more miles every morning to the school. We were only one mile away, lucky.
Groups of students would take the ways "Pugdandi" to Kakrali laughing Joking and keeping the pace with our 'satchles' (Bags or just a piece of sturdy cloth containg books, all tied up) either on heads or on the arms/shoulders.
Might as well tell you some jokes that were popular with us
"O! My master come come come
Goday goday Water meinh chhum chhum
Sir per Basta gir parray hum
Es liyay fidwi did not come."
This one with more Punjabi in it
"I am nay chori keetay punj satt gannay
Farmer nay ask keeta why did you phannay
I am nay jawab ditta, O dear Kisan
Punjan Sattan Ganniyan nal what is your nuqsan"
Well as I said we all stood according to classes in a U-Shaped manner and the two students facing us standing in the middle started the "Dua" (Hymn)
" Kaun-o-makan main dekhi jalwa numai teri
Tabay hay teray maula sari khudai teri.
................."
My class (eighth) was located in the center of the U I remember clearly on that humid sunny morning. Herbans Lal, my classmate coming from Subaur (about two miles) got late but we were still standing in Dua so he joined in my line. Then all of a sudden he screamed and fell to the ground. All students and teachers watching and trying to help him (without any knowledge) with horror and sympathy.
I saw his face, it turned bluish, twitching to one side and he was convulsing.
"Mirgee ay" (Epileptic attack) was the prompt diagnosis and the treatment
"Jutti sunghao onnhuN" (Let him smell a shoe) and sure enough the sole of a shoe was placed near his nose by somebody. (expecting a cure!!)
He got up after a while (short post epileptic stupor with tongue bitten and small amount of saliva at the corner of his mouth), dazed, what happened to him. He was a quiet person any way,
was sent back home by the master for that day.
I dont remember what happened after that for the poor fellow.
That was the very first epileptic attack I had witnessed. Little did I know that I will be seeing so many in the rest of my life (I had no idea at that time what neurology was or that I was to adopt that specialty in my future life) but that attack is still vivid in my memory.

Sunday Surkhi-painkillers

This is the physician's window.
About a decade or so ago a new "vital sign" was added,
The PAIN
From one to ten, the level of pain must be recorded, (along with the usual pulse, temp. and BP). Never mind the fact that it is the patient's statement you are recording and not, like pulse or BP, that you have measured with some instrument. There was a 'circular' that pain treatment should be directed towards relief no matter what (or so, I understood) Not that I was not treating pain before but I had a 'built-in' hesitation to prescribe nacotics for chronic pain. I am not talking about acute pain syndromes where there is usually no problem for the physicianto prescribe a narcotic for a limited period of time.
A patient who has suffered from , say, low back pain (extremely common pain in human beings--some price to pay for being upright, speaking from evolution point of view) for years and who is demanding nacotics because Tylenal, Nsaids etc. are all like 'candy' to him/her. So what would you do, prescribe narcotics?
You sit down and talk to the patient about all the side effects and addiction and whatnot about their use (and he knows it all as so many previous physicians have explained to him already) Says yes I know doc but i am hurting and cannot work, have lost my job and my family is suffering. So you succumb to these 'requests'.
It is not any easier if you know the patient because he has known you too so he can convince you one way or the other and you end up taking care of that prescription which you try to limit for one or two weeks rather than a month at a time.
You feel 'guilty' when you prescribe (am I making him an addict?) and you feel guilty because you do not prescribe (I have not helped my patient)
There is a report in the Sunday paper today of increased death rates from use of Methadone, which is an excellent pain killer as well as adictive and also used for treating addiction as you can place the drug on easy stepwise reducing dosage scale. etc. etc.
Report indicates that many physicians are not aware of the possibility of toxicity as the drug has a tendency to accumulate and a small dose over a certain period of time may become lethal. However when you prescribe a narcotic like methadone or morphine or dilaudid and give one week or two weeks supply to the patient you have no idea what dose the patinet will actually take. There is always that risk the the patient will take more than the prescibed dose,(because smaller dose did not help)
I am just reminding everybody how difficult it is to treat chronic pain syndrome with or without the existence of pathology. It is very easy to 'blame' the doctor, as was the case when Elvis died (I was in NC at that time. I forget the whole detail of all the medications he was taking and it may not be painkillers).
I guess these are "professional hazards". Many patients come to my mind whom I have prescribed narcotics in my life, rightly or wrongly--hard to judge and I have refrained from relating my experiences for ethical and moral reasons.

Jum'ah Journal-haircut and beard

I know this is not a favorite title for most of you but I may have some interesting information for you, just hear me out please.
I moved into a small village in Punjab about when I was in my Middle School. In my eighth class my teacher, May Allah forgive him and place him in Paradise, was a strict Muslim.
Because he wore a beard he was known as Maulvi saheb and he said he had recieved some teaching from my father who (Allah unki Qabar thandi rakkhay) was actually a deoband graduate (so he had some sort of 'respect' for me.)
Maulvi Saheb felt that boys should have "tind" (meaning that the haircut should be like Yul Brynner or Andre Aggassi or--well these days many young men have clean head shaves anyway). That in Punjabi is called a 'tind'. The reason he gave was that "Angrezi boday" (That was his term for English haircut which is the normal one with closer cut around the ears and nape of the neck and more hair on top) are un-Islamic because of resemblance with the English.
Now, dont misunderstand me. He had many good points and was good teacher and all. He, for instance taught us namaz and post namaz astaghfars and other duaiyah kalimaat etc. but all the Muslim boys (Not the Hindus or Sikhs, I am talking about pre-partition days-- O! I still remember he used to scold my classmate by the name of "Bishamber Das when ever he made a mistake, Maulvi saheb will begin like this ' Oay Bishamber Das tera sattya nas....") in his class must have tind or older boys can have "chhattay ball" (Like you see in all the maulvis and maulanas).
I was in a fix. My family especially my sisters were deadly against 'tind' because I will look ugly, so I could not get my 'tind' but in the school I had no choice but to face the music from Maulvi saheb. He thought my family was "maulvi" so I should have had it from the beginning anyway. He would make me stand in the class and say all kind of things but one I remember:
"cho kufr az k'aba berkhaizad kuja manad musalmani"
(If Kufr starts from the k'aba itself, where would 'Islam' be)
Our barber (saipy naai-- villages have barbers do the job without cash payments but they are paid in money or grain on occasions of the family or the land owners give out grains at the time when grains are ready each year.) had been given instructions not to make my 'tind'
One day when it became impossible for me to face the scolding and humiliations by my teacher I threatened my barber that I'll cut my heair with my own scissors if he does not do it. He liked me and did'nt want me to look too stupid and ugly, so he reluctantly shaved my head and sure, from that day on my days in the school were 'normal' again. As for my sisters they teased me for a while but they soon stopped, they loved me too (and al-hamdulillah they still do, one younger and one older than me. They were the ones who teased me most)

Dress and its fashions

Long time ago when I was working in a VA Hospital, there was a sign by the elevators saying
"Visitors wearing only undershirts and nickers will not be allowed in the hospital"
Or something like that. In those days only the vacationers wore undershirts and "nickers"(Half pants). Of course many other changes have been observed from old days in the dress of man and woman young and old.
Strangely
The man's dress has always been shirt and neck tie + trousers and when needed a jacket (and a felt hat or hat for men) and women's dress has always been open neck with variable view of her "beauty below the neck" (This part has not changed over the centuries.)
(Islam has curbed the neck and below the neck open-ness.) Here I have a story about women's dress, please bear with me.

I was in England when Sir Francis Chichester was knighted by Queen Elizabeth II, after he completed his (single-handed) record breaking round the world tour in his boat (called Gipsy Moth IV). There was a great welcome for him when he landed in July 1967 at Plymouth and then he was knighted with the same sword which was used by Queen Elizabeth I to knight the 16th century well-known navigator Sir Francis Drake. Now this was a very special occasion and Mrs. Francis Chichester was there also to be presented to the Queen and guess what, she was wearing a 'Pant-coat suit' (believe it or not).
The newspapers made a lot of noise, I remember," What? pants on a woman with a situation like that? Never heard of such audacity".

Man's trousers have been undergoing recent changes from full pants to half pants or even less and below the knee coverage up to 3/4 th pants also (for lack of better descriptive language)
I see Muslim boys coming into masjid and those who are familiar with the subject I find them trying to unsuccessfully cover the knees with the "higher pants" when 'sitting' in prayer. I have not observed too many "torn" jeens at the knees. Adults, I see in the masjid many a times with half sleeve 'undershirts' pretty loose and extra-large variety, which is frequently being worn these days as an alternative to the real shirt with collar etc. Well, I dare not say too much in case I am ousted from blogosphere.
Most objectionable aspect of dressing in women (from Islamic point of view) is that the shirts or its equivalents are too tight and same is true about the trousers, but gnerally I see Muslim women keep the shirts and trousers loose and do take care of their "satar".
May Allah forgive those with changes in dress for men and women among the Muslims that do not conform to His restrictions.

More on Hijab

In all there are seven ayat that you should look at completely thoroughly and they are:
S. Noor, 24th sura, ayat 30 and 31
Sura Ahzab, 33rd sura, Ayat, 32, 33, 53, 55 and 59.
I mentioned in my previous note about "exempt" for which I am sorry as I did not know what better way I could adopt without going into detail.
What it meant was that male persons at home like father brother,male children, male servants are people that come and go in the house including where women are located and women are allowed to observe only the "satar" and not wear a "burqua" or Jalbab (which is used for perdah when women go out of home). So if she has face and hands and feet open it is OK in front of these persons (I have not given complete list)
Now that must be understood that "satar" has always been compulsory for men and women
Man: covering from navel to knees ( inclusive of them)
Woman: whole body except hands and face (and according to some feet also)
Coming back to hijab or perda, there is no doubt that segregation of sexes and keeping at home or wearing Jalbab when going out, keeping a curtain from unknown men are all forms of hijab. At present it seems that head-cover (called Khimar with plural khumur) combined with ordinary clothes (Not gaudy or flashy or showy) serves the same purpose, as long as it covers the whole body including the head and neck and bosom(which the women tend to show off particularly in the western way of dressing) and clothes are not tight or thin.
Staying at home and only going out when needed is a good suggestion. It is only, that now-a-days women need to go out more often ( because of the changes in life style.) But to enforce staying at home to the extent that it affcts the health is taking it too far, just as going out for no reason may be too far in the other direction). To go out with all the make up and wearing perfume and showy clothes for show-off only is just as bad.
Voice of women is "closed" as perdah which is stretching the meaning of those words of aya 32 of sura ahzab. What is being said that ".../ be not complaisant of speech, lest one whose heart is a disease, be moved to with a desire, but speak ye a speech (that is) just" Clearly here the way of speech is being told and not that you should not speak at all because the voice is under perdah"

My thinking is over but I wish to refer to two things. One which M.Maudoodi has discussed at length in his book on "perdah" and that is "ghoongat" which is in the translation of aya 59 of 33rd sura. All others like M. Junagadhi, M. Shafi, Usmani they all call it" chader ka pallu chehray per latka liya karain" (meaning ghunghat), when they go out.
Allama Yusuf Ali and Assad mention that they should cover their body with chader (jalbab).
I shall quote Assad, you may not agree with him (for those who dont know him, he is the Jew who was trained in Hebrew scripture, also bible and then studied Quran after learning Arabic, eventually accepting Islam): (Noor, 31--Illa ma zdahara minha)
"...what may (decently) be apparant thereof...."
Then in discussion he says, ".... several of the earliest Islamic scholars, and particularly by Al-Qiffal (quoted by Razi), as "that which a human being may openl;y show in accordance with the prevailing custom (al-A'dataljariyah), although the traditional exponents of Islamic law have for centuries been inclined to restrict the definition of "what may (decently) appear thereof"to a woman's face, hands and feet and sometimes even less than that. We may safely assume that the meaning of "Illa ma zahara minha" is much wider and that the deliberate vagueness of this phrase is meant to allow for all the time bound changes that are necessary for man's moral and social growth. The pivotal clause in the above injunction is the demand addressed in identical terms to men aa well as women to lower their gaze....."
As for the translation of 59th aya of 33rd sura he says, "......that they should draw over themselves some of their outer garments (when in public)......."
Yusufali also says, ".... they should cast their outer garments over their person (when abroad)......" And Farooq-e-Azam Malik also says draw the outer garment on their person.
Ibn-e-Katheer (I have Urdu translation) also mentions covering of face. They all mention about one Muslim (who did not meet the prophet during his life) that hedemontrated the outer garment covering the whole body and face except one eye with which to see.
Then there is discussion about free women and slave women.
I have great respect for Mauddodi but sometimes during discussion he uses extremely strong words which worry me. However I'll quote one last word from him, at the end of discussion of "commandments of Perdah" After quoting the propher PBUH
"Ask for the verdict of your conscience and discard what pricks"
"That is why Islam cannot be properly followed without knowledge. It is a rational law and to follow it rightly one needs to exercise reason and understanding at every step"
That is so true.
So If you are living in the west and customary thing is to wear dress that covers the body without showing curves and cover head also, it appears that it shows you care about the injubnctions of perdah. Secondly if not covering the head and hair is felt by you it is customary these dyas, you may not wear hijab, though I personally am in favor of head cover because of this being "satar", but I would not brand you being "indecent" if you are not wearing it. You can be a good Mulim without hijab also.
I have more to say about dress of men IA next time.

Jum'ah Journal--late Plus Sunday Surkhi

I may end up doing this "combining" on occasion for when I get short on time.
Being 4th of July there were all important visitors for me here--Musa-Issa and company. They have learnt so many new words and phrases that it all seems worthwhile having spent so much on fine-tuning of my acoustic 'powers' Playing with water (they enjoy so much) Musa says' "My God 'I'm all wet". They have a vast world to explore written words spoken words and the electronic words of various types. (and of course the multiple gadgetry of today)
Anyway, I wanted to say some thing about Perdah or Hijab. The meanings are more comprehensive though these days only the "head-cover" part has carried away the lime-light.
Basically all the ayat are meant to teach the men as well as the women "modesty" both in dress and 'decoration'. Because the women are entitled to "lot of embellishment" to look prettier, more attractive etc. the instructions are more extensive for them and the men of the family and relations from whom they are "exempt" (still maintaining dignity and decor) are enumerated ( Like in Ahzaab, A.55 or Noor, A.31).
Instructions in 24th sura (Noor) do the same. It boils down to the fact that the fashions and regional or cultural differences are ignored by the Exalted Author (purposely). So you are free to use shalwar -Qameez and dupatta or head scarf and Jalbab or Abaya or indeed coat and trousers or long skirts etc. (forgive me for not going into what type of trousers at present)
Bosom cover is mentioned for women very clearly because rest of the clothes worn by women (of all cultures and times) will cover the rest of the body anyway
The other word mentioned is "....except what (must ordinarily) appear thereof...." (Please see the discussions of this part by various mufassirin who are more knowledgeable). This part is interpreted in a variety of ways and I think the purpose it serves is clear in the background of "modesty". My own feeling is with one interpratation that what remains uncovered of the body, like hands or face or feet. The question of head-cover brings up the discussion of "hair" although it is only mentioned in Ahadeeth or discussions of Mufassireen or Ulama etc. as they all consider that hair must be covered "because they fall in the 'beautiful' group". I personally feel uncomfortable with that explanation. There may be some other more convincing explanation for that, because as many ulama mention the face is "beauty" also and that it should be covered (the argument for wearing 'naqaab').
Will continue discussion later as my time is going to be short today and
' Waqt kotaah-o-qissa toolani' wala m'amla hay. (Time is short and story is long)

Hijab and women

Having read blogs of Ayesha (my daughter), my friend I A Bhopal and more so (my niece) Koonj
I thought of writing myself some more, so here is my research. Bear with me while I state FACTS.
First the meaning of hijab---Arabic Dictionary says---cover, wrap, curtain, woman's veil, partition, screen, foldingscreen, barrier, bar, diaphragm
Urdu dictionary (Feerozesons)--- Perdah, ote, naqaab and Haya, sharm, lihaz
Urdu-English dictionary--Veil, Curtain, modesty, bashfulness, shame, night (Feerozsons).
It may appear therefore that hijab is cover or wrap etc. fitting more for the Chader or "tent-type" burqa and also for "naqaab", in addition to "screen"
It seems that present day understanding of this word has limited itself to headcover, plus covering of neck and chest, (while rest of the body is covered with other clothes).
Now there are seven Places in the Qur'an Majeed where this word appears, (you will see the meanings with each situation):
1. S.VII, (Al-'Araaf), A. 46, "Between them shall be a veil......." That is between the people of fire or people of Garden and these people on "heights"('Araaf)

2. S.XVII (Bani Israeel), A.45, "When thou dost recite the Qur'an, We put bwteen thee and those who believe not in the hereafter, a veil invisible".

3. S. XIX, (Maryam), A. 17, "She placed a screen (to screen herself) from them....." That is Maryam PBUH screened herself from the public (for devotion and worship)

4. S. XXXIII (Ahzaab), A. 53, ".... And when ye ask (his ladies) for anything ye want, ask them from before a screen:......." Sahaba are being given instruction from Allah SWT to observe that respect for Ummahat-ul-momineen, the real 'purdah' or hijab. Here the meaning is more clear because of the situation and I would like you to ponder over the rest of the aya, " that makes for greater purity for your hearts AND FOR THEIRS" (I have capitalized this part for your consideration of this aspect)

5. S. XXXVIII (Saad), A. 32, "............, until (the sun) was hidden in the veil (of night)." This is about prophet Sulaiman AS.

6. S. XLI, (Hameem-as-sajdah), A. 5, ".......and in our ears is a deafness, and between us and thee is a screen:....."

7. S. XLII (Ash-Shoora), A. 51, "It is not fitting for a man that Allah should speak to him except by inspiration or from behind a veil....."

The real aya for hijab or perdah of our subject is therefore the # 4 above. In fact all the ayat regarding "perdah" and behavior of women and men including the Pure wives of the prophet and general Momin women, are to be found in S. Al-Ahzaab. Please look at them and study all at one time:
Ayat 28 thru 34, and also Ayat 50 to 52 (all for Ummahatul Monineen)
For the Mominat : Aya 49, 55, 59. (This aya has, "they should cast their outer garments over their person- Jalabeeb)
In addition you all know about the ayat of S. XXIV (Noor), #30, 31 (this aya contains that word Khumur which has been translated as veil also, "draw their veils over their bosoms". A chader, a dupatta or a head scarf large enough serves this purpose . This is for all Muslim women.
I shall make some discussion about some of the words used here and their applicability in our times and in the Western countries. A thorough understanding of the ayat first , then their application in the current times.
I know all of you have had these discussions with some Aalim or scholar which I am not. I am at your level and indeed I feel that too much has been already said about this (Like Ayesha says) but often the feministic opinions get mixed up with real understanding (I am not feminist either)