Sunday Surkhi-Ahmedis/Mirzaies

 I sometimes look at Dawn news. Most news are dis-heartening. This one was refreshing, a news about prejudice against Ahmedies deplored, mostly by young writers.

 My own take.
 I prefer to call them Mirzaies because strictly speaking we, the ordinary Muslims are better suited for that name-Ahmadi. I believe that Mirza Ghulam Ahmed was schizophrenic or too much of knowledge of Islam got to him. His teachings initially showed he  had correct understanding but within 10 years period he claimed himself to be a prophet on his own accord. He had followers all along and many continued with him and thus a 'religion' was born which was initially a sect of Muslims "Ahmediyya movement in Islam" and by the time in September 1977 they were declared minority (thrown out of the pail of Islam) the hatred that had appeared over the previous 3-4 decades including some bloody clashes (and I was in Lahore at that time), increased.  Fighting was started by Mirzaies from the railway station of Rabwah (which ,BTWwas clearly a mistake of the new Pakistan Government in 1947).
 I personally have had no respect for the Mirziae sect or religion but I am not against the Mirzaies who I do  NOT consider  Anti-Pakistan. They had established themselves well in Pakistan from the times of Sir Muhammad Zafarullah Khan and have been loyal citizens of Pakistan. They deserve the same respect as is given to other non-Muslim citizens if not better. Although they are not considered Muslims now but the Muslims need to approach them like they did before that legislation or even better. I know they made mistakes but such things like expelling a student from a teaching institution because of being Mirzaie is ridiculous and deplorable. I believe that the Government should take action against such activity to restore the full rights of these citizens. The Ulama need to do the same and invite these people to mutual understanding rather than continuing polarization which does not serve any purpose. Many of such Mirzaiees believe in Prophethood of Muhammad (SAWS) as the last prophet. The prejudice against the Mirzaies needs to come to rest and bond of mutual cooperation needs to be developed


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I Doc, Mairajunnabi and Wahi

 I wrote some aspects on these two subjects when discussing Sura Najm (My blog of November 2008)

 Here I'll concern myself with some hearsay, misinterpretation or exaggeration that took hold in the non-Muslim perception. I shall quote just the one instance which prompted this blog. Dostoevski's epilepsy is well-known and studied by neurologists. What was picked up by the non-Muslim writers (mostly non-neurologists) is his clever description of his aura that he sometimes felt"supreme exaltation of emotional subjectivity"-- he goes on to say that "probably it was such an instant that the epileptic Mahomet was speaking when he  said that he had visited all the dwelling places of Allah within a shorter time than it took for his pitcher full of water to empty itself" (Alajouanine, T. Dostoevski's epilepsy, Brain 86: 209-218, 1963). Any Muslim familiar with the details of Mairaj-un-Nabi can see the fallacy and imagination of the poorly and deceptively informed non-physician (some may concede this to an epileptic's 'first-hand' knowledge of the disease). He was not the only one with 'prejudiced' opinion, but the surprise for me was when a more educated professor of neurology made a 'differential diagnosis of the "spells of Muhammad,the prophet of Islam, as recently as 1976 (Freemon,F.R., in 'EPILEPSIA' 17: 423-427). This professor gathered information from the Western writers and therefore could not see the truth at all. Prejudice against the epileptics has existed from the times of Bible as I can tell (Mathew 17:14 goes like "Lord, do have pity on my son, for he is a lunatic and is in a terrible state. he is always falling into fire or into the water. I did bring him to the disciples, but they could not cure him."). There is more to it than just what I am writing but my point here is that in the past epileptics have been considered "possessed, hysterics, malencholic, suffering with 'falling-sickness' etc. etc. and so the prejudiced Western writers delighted in this label without any proof and so did this professor although writing  wearing the cloak of a Neurologist and imparting an air of  "authenticity" by publishing it in the journal named Epilepsia' leaving out all other Neurology Journals.
  Actually I am quoting from my own article that I had published in the journal of Islamic Medical Association (Vol14, pages23-26, 1982), but now to make some observations on the epilepsy and the aura.
'Ecstacy' as aura I personally did not observe in my 30 years experience, there may have been one patient about which I cannot remember much. It is rare but not unknown. Crying-weeping or being sad is more often seen and one patient I studied I remember he would incessantly continue weeping during attack (I recorded continuous epileptic discharge on EEG during his weeping episode) and would not remember it after the attack. I was intrigued because I did not recognize he was in attack when I first saw him in the ER. He was crying and saying something to which I did not pay much attention until after admiting him. There are all kinds of auras known to neurologists, but trying to "explain away" the episodes of Wahi or Nuzool-e-wahi one meets with several difficulties as one might expect.
 If you or others read prof. Freeman's article (quoted above) and are interested, I will be happy to discuss further but for the moment my points are more directed to that Dostoevski problem only.

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iDoc PVS,PVS-like conditions and Muslims

 Enough was written about Persistent or Permanent Vegetative State when Terry Schiavo was in that condition and national News broke out with the case. Briefly I shall place before you other names/terms that physicians/Neurological physicians use for patients who have suffered irepairable neurological dmage resulting in a state in which:
The patient is unable make any or minimal movements which may not be purposeful; paralyzed in all four limbs. Heart and lung function preserved without assistive devices and sleep-wake cycle.
 He/she may be alert, that is eyes may be open but may not respond to verbal stimuli or may appear to respond minimally
He/she may not have ability to eat or drink or take care of the self-hygiene
 This condition may be temporary or permanent depending on the extent and type of brain damage. Common name used is PVS (Well-defined by and accepted by American Neurologic Association and Americal Academy of Neurology).  I have already stated the other name of Brain death is "Irreversible Coma "Some other names for conditions similar to PVS are
 Akinetic Mutism,
Coma Vigilante
Severe Abulia
Appalic Syndrome
Locked-in Syndrome.
    Each condition must be examined in its own perspective by the physician trained in Neurological sciences to make a definite diagnosis and prognosis explained.
      Islamic understanding for PVS is associated with full care (Palliative care) of the patient including maintenance of nutrition and hydration. The question of how long this should be maintained is very difficult and several factors are involved singly or in combination.(This is not necessarily a comprehensive statement covering all situations)
   The patient in this state is unable to discharge any duties of life required of a Muslim and should have a "No Code" label in the hospital. Beyond that a clear statement cannot be made, for instance of the N/G tube or Gastrostomy  or other invasive procedures be considered in the "extraordinary means of life maintenace" or given a separate consideration. If long time has elapsed (many months, a year or more) and recovery is considered hopeless and depending on the location (Hospital, hospice or home) etc. development of complications such as lung or urinary infection, the treatment options need to be discussed by/with the family and appropriate action taken. Islamic teachings have given us two options to choose from:
     Treat with full effort with all means available when recovery is possible/expected
     Leave the patient/disease to take its normal course without treatment when there is no hope.
 The Muslim family has the responsibility to take appropriate actions and decisions should be made after with consultation with Knowledgeable Muslim Physician and Knowledgeable Islamic Scholar (Telephone consultations may not be appropriate). Continuing extraordinary life-support measures on a presumption of a 'miracle' or because somebody said their loved one came out of coma after so many days or weeks or months, is un-Islamic. I understand there is a lot available on the internet which may be confusing and misguiding instead of guiding and helping because each case has its own conditions for consideration.
(Allah knows best)
 
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Brain Death and Muslims

 Ever since first heart Transplant was carried out,in 1967 the question of recognition of brain death surfaced with urgency not only in the scientific and clinical circles but also amongst the lawyers, states, clergy and society in general. Since then Brain death has been recognized as the death of an individual and medically criteria have been established and accepted all over the world. My writing here is specifically for the Muslim Families and Muslim physicians
 Islamic position is that brain death is accepted as death in Shariah, the Ulama signing a document in mid-september 1986 in Amman Jordan. The statement is similar to official position of Islamic Medical asssociation of North America published in their Journal (Vol.29; 1997, Page99)
 It reads:
"A person will be considered dead when one or both conditions given below are met
    1.A physician has determined after standard examination that a person's cardiopulmonary function has come to a permanent stop.
    2. A specialist physician has determined after standard examination that the function of brain including the brainstem has come to a permanent stop even if some organs of the body continue to show some activity (by artificial means)."
  Muslims living in the West are likely to be confronted with a situation (God forbid) where brain death will be diagnosed on one of their loved one and they will have to accept it as most hospitals in most  states will enforce discontinuing the use of artificial means of maintaining life. It therefore behoves on all of us to understand this from Islamic standpoint. The Qur'an states "It is Allah that takes the souls at death and those that die not (He Takes) during their sleep. Those on whom He has passed the decree of death He keeps back (from returning to life) but the rest He sends (to their bodies) for a term appointed....." (Sura 39, Verse 42)
 And also, "Nor can a soul die except by Allah's leave; the term being fixed as by writing........." Sura 3, verse 145.
   Islamically therefore we can say that every living person must die and there is a time fixed, known to Allah and that the soul separates from the body permanently, at the time of death. Physicians do not know exactly where the soul resides in the body. Physicians make the diagnosis of death traditionally when they find heart and lungs have stopped functioning. When lungs and heart functioning is carried out with artificial menas that is  the time when 'brain death' is considered for diagnosing death. In this situation the heart may be functioning with important medications being given and lungs may be functioning because the automatic machines are pumping the lungs and the kidneys may be forming urine etc. these functions can be maintained with machines for prolonged periods, from many hours to many days or weeks. The physicians make a decision of starting and maintaining these life-sustaining equipments function depending upon the cause and disease of the person that resulted in that state. This 'death' is called 'Irreversible coma" in clinical terms and is very different from other comas or coma-like conditions. Only the physicians know these types of comas. It is stated without hesitation that no patient has ever recovered from irreversible coma diagnosed with accuracy. Those cited examples in the media were NOT CORRECTLY DIAGNOSED who recovered. Also the question of Persistent Vegetative State is very different and should not be confused with irreversible coma.
 It must be stated then clearly that physicians decide to continue because they have hope of tiding over this suspended function requiring automatic machines to sustain 'life'. That hope is dependent upon the condition which may or may not be treatable and may or may not be reversible. For example:
 If there has been brain injury (Trauma or loss of oxygen supply to brain for a critical time for whatever reason) which does not result in brain death the physicians will maintain the machines until the brain recovers or dies.
 Coming back to Islamic understanding of body-soul connection, all the functions of the body including the brain function are present with the connection of the body and soul and all functions of the body stop when soul has left he body permanently. So how do we tell the soul has departed-- by the functions of the body. Now all the functions of the body depend on continuous supply of aerated blood which depends on adequate function of heart and lungs If the heart and lung functions are artificially maintained, we would be forced to depend on brain function ( to diagnose death) as it is the brain that runs all the functions of the body including the heart and lungs even though heart and lungs have some limited ability to function for a few seconds to minutes without brain connection. That is not because we feel that the soul resides in the brain but soul commands the function of all organs including the brain, and the brain commands on all the rest of the organs.
  It is thus we as Muslims come to understand the process of death. The Ulama had their sharia supported methods of coming to that statement  of Brain Death the details of which are not known to me but I came to know the results of their meeting/s  that were held in 1976 or so) I as a physician and as a neurologist accept the Brain Death as the death of a person.
 I have tried to simplify as much as I could but I would be very happy to answer any questions by anybody physicians or non-physicians. I have been involved in very emotionally draining situations for some families on such occasions and would like to advise the Muslim physicians to understand and be able to answer the doubts and question of families under such situations, May Allah keep us from such situations by His Grace. I humbly suggest that neither the physicians should make statements to the families concerned without knowledge nor the family members should take the statements of non -physicians during their difficult time.
Also the physician should make clear statements so that the family does not get confusion or doubts.

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Fifty Years ago today

 It was a foggy morning and I arrived at the Karachi Airport (old one) and boarded the PIA plane a  Boing-727 jet. I do not remember seat number (I have a bad habit of remembering funny things). When we reached London by this PIA flight it was around 4pm and beautiful sunny afternoon. By the time I reached Saeed 's hospital  (Chasefarm) in Essex it was 8-9 pm. A week later I wrote down my experience of this very first  (commercial) flight of my life and so it is easy to recall and write now how I felt on that day. It feels like 50 years have just passed in a year or so. Little did I know I'll end up in USA and will not return to Pakistan for living. Please see FB and Twitter  also


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Jum'ah Journal- Drama similar to OJS

 I could easily predict that Dr. Murray will be prosecuted in the end when Michael Jackson died.
 August 16 , 1977, right here in NC Mr. Elvis Presley was visiting when he died at a young age (42).
 So his doctor went through the same thing. It is a "professional hazard" to be 'doctoring' such celebrity
 I would hate to be a doctor for such celebrities, who live on drugs and their lives are consumed with their 'art'. I cannot figure out whether he was really negligent or just did not have enough know-how of how to look after such patients. I would never trust a patient like that with so many drugs lying around him within easy reach. But Dr. Murray's private life has added more spice to the drama than the death of M.J. by itself could do. Wow. He sure is a busy man. I can understand why he demanded 5 million to be doctoring M.J.
 Now the drama is going on reminding me of OJ Simpson's TV drama. When will it end



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