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Question Du Jour
By Dr. Mahjabeen Islam
Toledo, Ohio
I have been appointed Palliative Care Medical Director at a local hospital and in that capacity had to present a talk on “Communicating Bad News”. Palliative care is the care of patients whose cure is no longer possible. The organizers of that conference had a tall expectation of people’s concentration for the talk and it was marked out for one-and-a- half hours.
A few weeks earlier there was another conference regarding Advanced Directives and in the accompanying syllabus there was nothing regarding the cultural and religious perspectives of Muslims. With Dr. Islam in the audience though there were many questions, which I tried my best to answer.
With this as a backdrop and the fact that I had been given an hour-and-a-half for one subject generated the brain wave that I could perhaps tackle two topics in an hour-and-a half: Communicating Bad News and also Cultural and Religious Practices of Muslims as related to Health Care. And thus at the inception of the talk I solicited questions that people might have about all things Islamic as related to health care. They could mull them over, I said and ask at the end.
With the first subject one of the slides illustrated how physicians from the West versus the East communicated bad news. I used that as a springboard to deal with the difference in which patients from the different cultures receive bad news. With the first few patients in the United States that I had broken bad news to, I was stunned to see the patient just take a tissue and sniff a little and in the case of a patient that cried, the crying was interspersed with profuse apologies for the display of emotion. The audience was very amused when I contrasted this staid and controlled grief display to the emotional and often loud burst of emotion when people from the East receive bad news.
It is apparently bad manners to impose your emotional outburst on another, but to me that is just freedom of expression and I thought America was a haven for that. How could a person who had been told he/she might have a year to live, be expected to just sniff with a tissue to the eyes a couple times?
There is a difference also in which the news of the death of a loved one is received amongst the cultures. As a house officer in Civil Hospital in Karachi I remember that though the crying was unbridled, the acceptance was complete and almost invariably the family would verbalize that this was the Will of God. The point was also made that Muslim patients are easy to deal with in the sense that they believe in “dua and dawa”, prayer and medical treatment, for there are some evangelical Christian sects where the patient refuses treatment saying, “I will pray over it”. Additionally, the vital teaching of Islam that this life is short and the next one eternal was underscored.
The talk continued rather well and several questions were asked about palliative care and I began to entertain thoughts of going into academia. And it appeared that it was all over, until a little old nun in the back said that she had a question: “What do you feel about suicide bombing” (!)
I flinched inwardly but went on to explain that suicide was a ticket to hell by Islam and that Islam was a deeds-based religion and on the day of judgment there would be a scale and if your good deeds outweighed the bad you would go to heaven and if the opposite applied to hell you went, but for the Grace of God. I explained that Muslims are advised to count on their deeds, even though God is Oft-Forgiving Most Merciful.
Surah Maidah, verse 32 states, “We ordained for the children of Israel that if anyone killed one person it was as though he had killed all of humanity and if anyone saved one person it was as though he had saved all of humanity”. By extrapolation of the scales system, if one had killed all of humanity the bad deeds scale would be awfully weighed down.
My first slide had said “A method to the madness” and here I took them back to it. An attempt was made to underscore the legitimate right of the Palestinians to a homeland with the method of achievement of that homeland as a major issue. “And how many virgins does one get for jihad?” I asked and a man in the audience promptly said seventy. Funny I explained that a person such as myself, who is so into reading about my religion, does not know that the reward for suicide bombing is seventy virgins in the next life. Simply because nowhere in the Qur’an or the Hadith does it say so. Islam forbids the killing of non-combatants and the greater emphasis is on killing only in self-defense.
A brief explanation of jihad not meaning holy war but the control of one’s base desires was received with surprise, but understanding. We all agreed on the behemoth power of the media, as well as the abuse of Islam by its fanatical adherents.
It was a rewarding though adrenaline filled experience. A couple of weeks later there was a seminar on “Death and Dying” and I had shared my experience with the Muslim physician that was to present at this conference. There were to be Hindu, Jewish, Catholic and Muslim presentations. Dr. Iman Mohammed did an outstanding job explaining Islam’s perspective on death and dying, and did all of us more than proud. At the question and answer segment the first question to her was: “What does Islam say about martyrdom?”. “You want to ask about suicide bombing, don’t you?” she replied testily. Dr. Mohammed explained that martyrdom was to die in the way of God and she quoted Surah Maidah as well. And then she suddenly turns to the Rabbi and says, “If someone comes to my home and kills my children, I will not turn my face, I will kill them, I will kill them”
Whilst I had (boringly) explained the Palestinian struggle for a homeland and the modus operandi, Dr. Mohammed said it all in one sentence. It’s the Question Du Jour Muslims beware.
Mahjabeen Islam is a physician practicing in Toledo Ohio, mahjabeenislam@hotmail.com
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