Voices of Islam (154 page)

1. ‘‘Islamic physicians saw the body of man as but an extension of his soul and closely related to both the spirit and the soul
   ...
   . They envisaged the subject of medicine, namely man, to be related both inwardly through the soul and the spirit, and ‘outwardly’ through the grades of the macrocosmic hierarchy to the principle of cosmic manifestation itself. Whatever may have been the historical origins of Islamic Medicine, its principles cannot be understood save in the light of Islamic metaphysical and cosmological sciences.’’ Seyyid Hossein Nasr,
   Islamic Science
   (London, U.K.: World of Islam Festival Publishing Co. Ltd, 1976), 159.
   

2. According to Islamic belief, there is an angel on either shoulder who records one’s good and bad deeds.
   

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‌

C
ARING FOR THE
I
LL IN
I
SLAM

•

Kristin Zahra Sands

God will say on the Day of Resurrection, ‘‘Oh child of Adam, I was sick but you did not visit me.’’ [The child of Adam] says, ‘‘My Lord, how could I visit you when you are the Lord of all beings?’’ God says, ‘‘But didn’t you know that my servant so-and-so was sick and yet you did not visit him? Did you not know that if you had visited him, you would have found me present with him? Oh son of Adam, I asked you for food but you did not feed me.’’ [The child of Adam] says, ‘‘My Lord, how could I feed you when you are the Lord of all beings?’’ God says, ‘‘Didn’t you know that my servant so-and-so asked you for food and you did not feed him? If you had given him food, you would have found that in my presence. Oh son of Adam, I was thirsty but you did not give me water.’’ [The child of Adam] says, ‘‘My Lord, how could I give you water when you are the Lord of all beings?’’ He says, ‘‘My servant so-and-so asked you for water but you did not give it to him. If you had given him water, you would have found that in my presence.’’
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This dialogue between God and the human race, recorded in a divine saying or
hadith qudsi,
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can be read—and should be read—as an urgent reminder of our obligation to respond to the needs of others. However, the wording of the hadith hints at deeper issues and broader possibilities than conventional notions of duty. What happens at moments when we are called upon by others? Why do we often turn away from those in need of us? Sometimes, there is irritation at the interruption or fear of one’s own dependencies. There is the fatigue that sets in when one is asked to give again and again. Alternatively, there is the self-satisfied pride that follows some small sacrifice, the patting of oneself on the back for what was not at all difficult to give. What does it mean to say that God is present with the ill, the hungry, and the thirsty, and that one could find that presence in responding to those in need?

My approach to this question draws upon two sources: the textual sources of Islam and personal experience. The primary textual sources I am relying on are the Qur’an and selections from the literature of Sufism, also referred to as mystical Islam.
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The literature of classical Sufism is characterized not only by

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Voices of Life: Family, Home, and Society

its references to contemporaneous exegetical, theological, and legal discus- sions but also by its use of anecdotes and poems that express an ethical and emotional sensibility that is particularly suited to the topic at hand. This is
not
a chapter surveying practices of caring for the ill in Muslim societies. Instead, it is very much situated in my particular experience within a privi- leged middle-class and secular environment in North America. I care, along with my husband, for a daughter with spina bifi hydrocephalus, and epilepsy, conditions that have led to a broad range of chronic, pervasive, and diffi lt challenges as well as acute emergencies. Our experiences, although profoundly personal, have also necessarily involved repeated in- depth encounters with the services of outside professionals and private and public institutions. These encounters have led me to question the relation- ship between private beliefs and the organizational structures of a commu- nity, particularly the secular assumption that beliefs and institutions can be separated. The issues addressed here, then, are as much about private faith as they are about the relationship between that faith and action in the world.
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THE SHOCK

We hurl truth against falsehood and it smashes out its brains; suddenly, falsehood is nothing.

(Qur’an 21:18)
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The usual resting state of my consciousness consists of a carefully maintained bubble, within which a sense of entitlement to comfort and ease exists in tension with a gnawing fear of loss. One of these imagined ‘‘losses’’ materialized six months into my second pregnancy, when a sonogram uncovered the fact that the child I was carrying had a signifi disability. The first idol to fall was the one that had assured me that I could predict and control events, if only I was willing to follow the rules—in this case, those of the healthy living required for a healthy pregnancy. Finding myself in the uncomfortable situation of needing help from strangers, I entered the foreign and complicated world of specialists in the medical profession, start- ing with a superior physician in a prestigious medical center. As I lay in his examining room experiencing my fi t internal sonogram, he stared at the image of my daughter’s spine on the screen and exclaimed with excitement, ‘‘It’s a very large defect!’’ Then he called in what seemed to be an entire class of medical students from the university to see it. No matter the indignities, I reassured myself—we were fortunate to be receiving the best medical care in the world. Sitting afterward in his offi e, the physician gave us a well- written, thorough report on his fi Then he abruptly mentioned the stress that children with disabilities have on families and handed us a small

Caring for the Ill in Islam
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piece of paper with the name of someone who would perform what would have been an illegal abortion at that late date in the pregnancy. This was the first lesson of many for me that the qualities that support the long and arduous development of excellent physicians are not necessarily the same those one longs for in a highly fragile state. This is not to say that there are no doctors who combine rigorously practiced medicine with sensitivity to their patients. However, many do not combine these qualities.

The second idol to fall was my sense of entitlement to be treated in a cer- tain way. Whatever slights I had suffered up to this point paled in comparison to this new kind of vulnerability. Having been raised to be as independent as possible, I found the task of petitioning others acutely painful to me. I had very few tools at my disposal for coping with the indignities of asking others for help, a situation many face far more frequently than I do, with far fewer resources. Visible to me now in the waiting rooms of medical offices and in hospital wards, these are the (mostly) women who fi on a daily basis on behalf of their children and other family members, demonstrating extraordi- nary levels of courage, intelligence, patience, and persistence, all of which frequently goes unrecognized. However, from my position of privilege, the events of my daughter’s birth were shattering.

A madman in Baghdad throws a stone into a shop selling glasses and all the glasses shatter with a great crash. When people ask him why he caused such damage, he answers: ‘‘I so enjoyed the crash and the tinkling sound! Whether it causes damage or is of any use to others, that has nothing to do with me as a madman.’’

(Farid al-Din ‘Attar d. 1220
CE
)
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CALLING FOR HELP

Oh humanity! An example has been made, so listen to it carefully. Those whom you call upon beside God are not even able to create a single fly, even if they were to join together to do it. And if a fly steals something from them, they cannot get it back. How feeble are both the seeker and the sought!

(Qur’an 22:73)

There are many false gods to call upon, some more obviously fake than others and more easily exposed. Belief in the omniscience and omnipotence of modern medicine is sustainable only by those who have had very limited interactions with the medical profession and its institutions. Many of the doctors I have worked with have expressed their awareness of the limits of their prescriptions, tests, and interventions, and my confidence in them is in direct proportion to their humility. However, what has been even harder to

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bear than the limits of knowledge in the medical profession and its institu- tions are the limits in its ability to provide comfort; one could say that I have searched for a personal and caring god here without success. One arrives in an emergency room with the expectation that all will be taken care of. Instead, obtaining necessary care in today’s medical system is more often than not a sustained struggle that requires tactical skills. Although a bewildering array of people provide services in emergency rooms and hospitals, they are empowered to act only in carefully demarcated areas. In New York State, hospitals are required to post and give patients a copy of the ‘‘Patients’ Bill of Rights.’’ Among the rights given to patients is the right to ‘‘know the names, positions, and functions of any hospital staff involved in your care

and refuse their treatment, examination or observation.’’
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Everyone who

cares for patients in hospitals must understand this right along with the other rights of patients. Once, I sat in an emergency room perched on the edge of a gurney for three hours before finally being told by a kind worker that there was no one available that evening who had the authority to examine a child beyond the initial triage.

To return to the ‘‘Patients’ Bill of Rights,’’ the language used here is signifi nt: it is the language of legal ethics, not the ethics of medical care. What is odd about this is that one is certainly not looking to pick a fight in a hospital or an emergency room, yet a strategic, rational analysis of the system followed by assertive and sometimes aggressive action is frequently necessary to get needed care. It is extremely important for a patient to under- stand who has the power to do what in the hierarchical structure of hospitals. It is also important to understand that the primary task of the hospital is to care for the body, not the person or the soul that inhabits the person. The responsibility for attempting to relieve the fear, grief, boredom, and exhaustion that patients and caretakers experience comes under the rubric of auxiliary services: the social workers, chaplains, and recreational therapists who are entrusted with the power to soothe and help patients within limited parameters. So, although the hospital is invaluable in its rationing out of resources for keeping the body functioning as well as possible, it makes for a very poor god.

Second only to the fear for the well-being of one’s child is the fear of how one will be able to pay for extraordinary medical costs. It has been suggested by some scholars that the concept of God’s providence has been replaced in modern societies by a belief in the providence of the state and the economic structures that are tied to it.
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The safety net for expensive medical costs in the United States is insurance, provided by and partially paid for by employ- ers, privately purchased, or, as a last resort, provided by the state. Although the reimbursement guidelines for these organizations are relatively clear, anyone with extensive medical bills knows that getting all of the bills paid appropriately requires an endurance marathon of phone calls and e-mails if