25 Dhul Qa’dah 1438 AH • 18 August 2017

Patient Always have Rights

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Madinah. The City of Peace, Tranquillity and Light. Hajj was still a few weeks away and most of the pilgrims who arrived early that year were bathing in the serenity of the Prophet’s City. She was on her first Hajj and was excited about the journey. She was young and accompanied by her husband and, just like all normal couples, divided their days between visiting the Prophet’s Mosque for the five daily prayers, acquainting themselves with the history of religion by actually visiting historical sites, and exploring the wonderful eccentricities of the numerous shopping areas.

They were childless and she had a difficult time prior to Hajj. Now however she was radiant and content. Their Creator was smiling on them, blessed them with the gift of the journey of Hajj. When she consulted me in Madinah, she and her husband reiterated their happiness with life. As we chatted it became evident that something was bothering her. All was not well. Hesitantly she explained that she was pregnant.

I smiled and congratulated them. ‘Pregnancy is not a disease, it is part of normal life!’ I said. We discussed travel in pregnancy and I expanded in detail about how, with normal every day precautions, pregnancy should not be an impediment whilst on this holy journey. In fact Islam demands respect for all mothers and mothers to be. She seemed uncertain still and I tried reassuring her about all the efforts the Saudi regime puts in place for pregnant ladies. There are hospitals dedicated to maternity matters staffed by world class specialists. The facilities provided are state of the art.

There is annually great excitement about the first child born on Mina on the first day of Hajj, and especially for the first child born on Arafat, with newspapers clamouring to publish this news. Boys born on the day of Wuqoof are inevitably named Arafat. We discussed how Asma’ bint ‘Umays, the wife of Abu Bakr, gave birth at Dhu’l-Hulayfah just outside Madinah and was instructed to put on her Ihram for Hajj as they were on their way to Makkah.

The worried tone persistent in her voice and her demeanour showed that she was definitely not at ease. ‘Is something worrying you?’ I asked directly. She replied with a degree of hesitance. ‘Yes. I am bleeding. There is spotting occurring at the moment and that is worrying me,’ she at last admitted. I took a detailed and in depth history of her medical issues and advised strict bedrest until we had her seen to by a gynaecologist at the hospital. I explained to her that spotting can occur during pregnancy and that we needed to find out the cause of her bleeding and the course of action to take. She was comfortable in seeing a gynaecologist as the Saudi hospitals are manned by lady gynaecologists. However, when I added that the doctors would in all likelihood do an ultrasound scan, she immediately and very firmly said: ‘No, no scan is to be done.’

I was taken aback. I explained to her and her husband that the scan would show us how developed their baby would be, whether there were any abnormal features, and possibly indicate the reason for the bleeding. The doctors would then be in a good position to know what to do. The scans are generally regarded as being harmless to both mother and baby whilst simultaneously providing a wealth of information. We were not dealing with a case here where the establishment of the baby’s gender was being determined. Nor were we looking for abnormalities in the baby in order to advise medical intervention.

Many doctors believe scans should not be done unless the pregnancy is not progressing normally. We often counsel older pregnant ladies who are advised to do tests to exclude Down’s Syndrome which occurs more frequently in that group. Some would reply that it does not matter whether their baby is going to be normal or not; they would never intervene and would wait to give birth and do not want any tests. Others would say that knowing that the child may be abnormal would prepare them and want to do the tests. Some would want to know if the baby was normal, insist on the tests and act upon abnormal results.

‘No scan,’ she again emphasised. I politely tried to explain its potential benefits but realised that there was no ways that she was going to be persuaded otherwise. Intrigued, I asked her why she was so against a standard medical procedure. ‘My Sheigh said I must not have a scan,’ she explained. From what I surmised, her previous problems have been linked to her having had scans. I was in a position that I do not like to be in as the medical profession has the utmost respect for the learned religious scholars. In fact, we often ask for the persuasive knowledgeable assistance of the family Sheigh when we deal with difficult cases and it is very seldom that there is opposing advice given. We were in Madinah, where our beloved Prophet (SAW) advised of his companions to consult medically trained compatriots for ailments.

We had a South African gynaecologist in our group who was also on her Hajj journey and I asked her opinion about this situation. This lady doctor was a bit despondent but, like me, would not act against the wishes of the patient. We had no issue in calling the Sheigh, who was not in Saudi Arabia, and explaining the need to do the procedures, but could not obtain his details. We referred her to hospital to which she willingly went and was attended to by an empathetic, kind and considerate lady.

All went well until the issue of the scan was raised. Again, despite the attempts of the specialists, she refused to have it done. The hospital staff obliged with her wishes and discharged her with some medication, emphasising that their treatment is in effect a shot in the dark as they could not make a proper diagnosis.

I saw her again a few days later. The bleeding did not stop and it was clear that the medication dispensed to her did not help. ‘Everything is in the hands of our Creator,’ someone said. Perhaps her problems would stop spontaneously in the next hour, perhaps she would inevitably deteriorate. Western trained, disease treating and result orientated doctors like myself often feel agitated that our advice falls on deaf ears.

Some of us would feel aggrieved that a Sheigh could dictate about a procedure that he may have no knowledge about. This was one of the occasions where refuge in the Prophet’s Mosque brought an immense sense of relief. I somehow found a spot in the Rawdul Jannah and settled down, making duaa for her and her unborn child. We are not always right. The patient always has rights.

This forms part of a series by hajj doctor Dr Salim Parker.  More hajj stories can be found at www.hajjdoctor.co.za 

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