In the Land of Invisible Women

by Qanta Ahmed

  Saudi women are reported to have had a mixed reaction to this. Some orthodox women from very conservative families now newly considered medicine (regarded even by the most vehement mufti as a humane profession) as a possible career choice if she could be guaranteed practicing in an all-female environment; for instance, in a hospital devoted to obstetrics and gynecology. To many women in the Kingdom, however, this was simply another way of their marginalization, this time through limiting work options for professional women. The Arab News reported8 these objections to single-gender hospitals in the words of one woman in particular:

  “I don't think this is a good idea. We all live on one planet so we cannot segregate the genders. If the Holy Mosque in Makkah, which is the holiest place on earth, does not segregate women, then why would the Ministry of Health want to segregate them?” said Maha al-Nuwaisser, 26.

  She also went on to object to the selection of a physician based only on gender and not competence, expressing her disdain as follows: “I prefer doctors who are professional in studying my situation and solving my problem, regardless of whether they are male or female. I cannot imagine a men's hospital without female nurses and doctors, and I also cannot imagine women's hospitals without men playing a role in them,” she added.

  Even though I and the women around me agreed, we knew anything was possible here and were unsurprised when we read the expected response of the Ministry of Health to the Grand Mufti's declaration. Dr. Khaled Mirghalani, official spokesman for the Ministry of Health, did admit the Ministry was considering the formation of such single-gender hospitals, but rapidly added that this had nothing to do with the mufti's recommendation. For now, I found myself in a mixed environment where, whether expatriate women or Saudi citizens, female physicians were a rarity. I looked to my few female colleagues for support and guidance. Perhaps I could learn how to cope in my new environment by studying these women.

  All Saudi female residents were entirely veiled. They would join the rounds covered from head to foot in black abbayahs, over which they would wear cartoonishly long white coats, tailor-made, which were always fully buttoned up to the throat and often closed with round mandarin collars rather than the standard neckline of a jacket. On their heads, black nylon hijabs would brush down to their mid-backs over the stuffy white coats. All features and any suggestion of shape or even weight were obliterated. It was impossible to distinguish one woman from another. Often in corridors, I would be greeted by a woman whom I had taught in the ICU and could not recognize her because of the uniform guise of anonymity required of women in Riyadh.

  On rounds, invariably the women would be glued to the back of the group, standing always to one side, a single invisible organism. Frequently I would try to move each female resident with a gentle but firm guiding hand to their draped elbow or shoulder, encouraging them to move to the fore of the group. Like a phalanx, they moved only in a cohort, afraid to stand alone, sheltering each other in a cumulative shadow of their opacity. They remained silent and respectful during acrimonious exchanges, inscrutable behind their hijabs, rarely tendering any opinion, and certainly never questioning anything that was said. I watched them at this strange nexus of Wahabiism, womanhood, and Western medicine. They shuffled heavily on rubber-soled shoes in their airless mantles of the modified white coats and helmet-hijabs. How hot they must be, even in the air conditioning of the unit.

  From time to time, I would direct them to listen to the patient or examine for a particular sign. I watched as they stuck the rubber ear pieces of their stethoscopes into veiled ears, pushing the ear buds over their fabric masks of blackness which extended, here, even deep into the recesses of the female ear canal. I knew it would be impossible for them to hear a soft diastolic murmur against the deafening (and now acoustically magnified) crunch of itchy polyester.

  When we made rounds visiting our burn patients who were nursed in strict isolation, I knew these stoic women were even more uncomfortable, dressed in the sterile, bright yellow protective garb over shrouds and coats. Isolation masks or orange duckbilled TB masks snapped on over full-face hijabs. Sometimes metal-rimmed eyeglasses perched bizarrely over entirely veiled heads, like so many bespecled puppets. The intensity of veiling even engaged in procedures within the privacy of isolation rooms was astonishing. These women had to be very dedicated and able to withstand uncomfortable conditions, sometimes for hours. They were tough and capable of seemingly enormous tolerance for the intolerable.

  Over time I found myself full of fascination and admiration, while somehow also brimming with enormous pity for these mysterious women. Judging by the miserable rounds we were making, their approach to medicine mimicked what I guessed must be their approach to Islam, mute and unquestioning obedience, always prescribed by a man. As the women rarely spoke to me on rounds, I wouldn't be corrected in my simplistic views until much later, when I befriended more Saudi women. For now, I made my own wretched conclusions and began to wonder how long I really could last in the low-grade hostility I felt at work.

  The rounds at least allowed me an opportunity to observe the Saudis in their workplace. Occasionally, other specialists would visit our patients while we were at the bedside. While presenting a patient for the benefit of Waleed, a young Saudi resident, and his fellow surgeons, I pointed out an important physical sign. I spent a significant amount of time explaining the patient history and nudging him toward the expected findings. Waleed's long moustache drooped into an expression at the intersection of abject boredom, indulgent tedium, and ignorance. I tried harder to animate him. As I focused on striving to unlock his medical imagination, at the periphery of my vision, I slowly became aware of the rustling of crumpled cotton. Mid-auscultation, around me I began to hear greetings in Arabic, followed by the preeminently disturbing and unmistakable sound of kissing! Filled with disquiet, I looked up. The stethoscope slipped from my hand clattering noisily against the bedrail.

  Coteries of male surgeons from the vascular service were greeting Waleed and the other male residents. They had just stepped out of the operating room. Some still had their surgical masks dangling rakishly around stubbled necks. Green clumps of Saudi men dressed in surgical scrubs intermittently disentangled into single green entities. Slowly, methodically, the men were kissing one another on each side of the face: each cheek, twice, thrice, four times, even more, as I lost count. At the same time, they shook hands and embraced in endless combinations of two—a strange, synchronized kissing geometry.

  Nothing could proceed until every Saudi scrub suit had greeted every other Saudi scrub suit. Of course, all women were excluded. The veiled phalanx stood wordlessly, as usual, to one side. For once I joined them in my own silence. I was annoyed at the interruption, but even more flummoxed at the overt lack of concern for my time and the uncovered patient who lay half-examined. Beeping monitors and alarming machines faded into the background. I lost my train of thought in its entirety as I stared at the scene.

  Their greetings were slow, languid, and relaxed, as if we had all the time in the world. Did they know we had critically ill patients to attend? What a contrast from New York City, I thought, imagining all the red-blooded, monogram-cuff-wearing men who had worked with me there; a quick back slap to a male colleague followed by a rapid hand scrub with sanitizers and it was back to work immediately. Nothing could be more alien to this display. “There will be no kissing on my round!” I wanted to scream, but of course, as usual, I bit my tongue and waited for every man to greet each of his compatriots.

  Truthfully, if I looked inside myself, it was disconcerting to see so many men kissing one another. This was the first display of public affection I had ever seen in the Kingdom. Subconsciously perhaps, I had assumed Saudis didn't kiss. Who knew Saudi mouths could make such sounds of tenderness and grace? After all, for months now, I had never seen anyone kiss or hold hands or embrace one another here. Physical contact seemed unthinkable in the Wahabi state.

  Observing the kissing surgeons, I couldn't help th
inking I had wandered into a Halloween party in the West Village by mistake where gay New Yorkers masqueraded as sheikhs, greeting each other girlishly, almost camp displays of affection. The themes of homosexuality seemed strangely near. Nevertheless, I could tell there was a sense of real connection here. The familiarity and physical intimacy with which these men greeted one another was astonishing. Not only did they shake hands, but men continued holding each others' hands in greeting quite some time after the initial pleasantries and salutations, intertwining long slender fingers almost wistfully.

  The actual kiss was in fact a gesture, the pink, full lips rarely contacting skin, but making a quiet sound of lips touching softly. The kiss of a Saudi man was a caress, warmer than a plastic Park Avenue pout, more sophisticated than a clumsy kiss planted on a cheek. This seemingly intimate act was an effeminate and highly choreographed, practiced maneuver: the man closing his eyes as he caressed the air around the recipient's cheek or shoulder, a small quiet gesture of closeness and undeniable elegance, carried over across the ages; an elegance not of my world, not of the West, nor of this time. It made for an arresting dichotomy: the harshness of male supremacy and sometimes visceral misogyny juxtaposed with the intensely tender relations between the men themselves, as if the only sensitivities that could be safely displayed were deeply gender segregated.

  It would take time for me to be accustomed not only to this public courtliness among Saudi men but the far more unsettling sensation which often accompanied it. The fact that perhaps among these men a homosexual was compelled to hide, at risk of the penalty of decapitation, filled me with unease. Did a gay man move comfortably among these men, or was he full of fear? Could men even acknowledge these possibilities among themselves?

  My unease was not homophobic, but at how difficult it was to make sense of anything that I witnessed here. The opacity was overwhelming and blinding; I could see, yet I couldn't. Sometimes I could feel myself literally widening my stare, as if to catch more light to decipher the unintelligible images. How well invisible gay men could blend in, how well-concealed, how protected and ensconced in this male-dominated, severely segregated society. I couldn't distinguish men in any way, the homogeneity was extraordinarily powerful. The feeling of not knowing quite what I was privy to at the moment I was privy to it, and that things were (as usual) not what they appeared to be, never left me in the Kingdom.

  Once again, even the familiar salaams which these men were exchanging, almost the first Arabic words I had learned as a child, were rendered unfamiliar because of the social dance in which they were contained. At the end of this dance, Waleed and his fellow residents reluctantly returned to the round, grudgingly restoring their attention to me. They failed to notice my stony silence as I had waited for them. Mercurially, their moist smiles changed to impassive masks of severity and boredom. The warmth and politesse drained quite suddenly away. We returned to the patient. Mentioning nothing of the intrusion on my round, I continued seamlessly from where I had been interrupted. Invisible or not, I had a job to do.

  THE LOST BOYS OF THE KINGDOM

  I RACED TO THE EMERGENCY ROOM. Arriving, I was immediately sucked into the gravity of crisis. Three bodies were laid on steel trolleys, dead on arrival. An orderly draped them with sheets. A fourth stretcher bore a shorter bundle already shrouded; one of the dead had been a two-year-old, sheets around him purpled with cold blood. In the far corner, a bleeding body lay limp on the final stretcher where a cluster of doctors worked. It was this man whom I had been called to attend.

  I pushed through the anxious mass surrounding the bed. The man's head was split open, the scalp a bisected, bloody coconut. An intense smell of alcohol exuded from clammy skin. He had been drinking, probably Jack Daniels, likely chased down by whole bottles of Finnish vodka, I guessed, by now experienced in the poisons of choice in the Kingdom. Eyes swollen shut, now purple figs, and a trickle of thick blood from the left ear confirmed my suspicion: a basal skull fracture.

  Lush, long lashes revealed the prime of youth. A single mole on his right cheek conferred aristocracy to the young face. A finely manicured beard betrayed a man of vanities and panache.

  His once-aquiline nose was ignominiously collapsed into itself, a “dishpan” fracture indicating enormous impact to his face. Around it, his dreadlocked mane was startlingly lush. His elaborate hair was his private rebellion. The airway had already been protected with a breathing tube, rasping with bloody secretions at each mechanical shudder. His chest was severely bruised. I could feel the sickening give of fractured ribs crumpling like wishbones in roast chicken. A collar bone was wildly displaced. Scanning for the telltale marks, I realized he had been unrestrained. His belly was disturbingly swollen and bruises were beginning to form on his cool flanks. A leg was rotated outwardly at a queasy angle, the swollen thigh pooling with liters of blood. He had fractured at least one hip, perhaps also the pelvis.

  I checked his pulse. His digits were icy. An unpleasant mottling was beginning to show on the palms of his hands. He had already lost liters of blood. As quickly as I could, I placed a line to deliver massive amounts of intravenous fluid. I managed to insert it in his hollow, left groin. Even his femoral artery, normally a booming pulse, was deflated, fluttering like a frightened, dying sparrow.

  Stitching, I noticed the glittering wristwatch on his left hand. The diamond surround of the sapphire dial was flecked with his own blood, the P of Piaget obscured under a mossy clot. I unbuckled the thick crocodile wristband, handing the precious timepiece to the nurse for safekeeping. Studded Vuitton wrist cuffs dressed a broken spirit of stylized angst. Above, where his Gucci flying jacket had been sheared open, his inner arm was a crisscross of fresh track marks, revealing a heavy drug habit. My patient was a privileged man with addictions to alcohol, heroin, and, I suspected, several other substances.

  After intense teamwork, we rescued the falling blood pressure and could safely move him to the CT scanner. I accompanied him to the scanning table, blood transfusions running. Satisfied he was secure, I returned to the ER to finish up.

  A Filipino janitor cleaned the bloody floor where we had been working, smearing the viscid mess across white linoleum. The adult bodies were wheeled away, awaiting identification in the hospital morgue. Parents numbed in their grief prayed over the smallest, still body. The brutal fluorescent lighting stole any semblance of privacy. A nurse whispered the details of the dead child to me as I wrote at the station.

  The child had been their eighth, a youngest son. He had been killed by the Mercedes which had carried the four men returning from a weekend of high jinx in Bahrain. These parents had lost another child in a motor vehicle accident only a year earlier. I listened, unflinching. Months of working in the traumatic environment of critical care in Riyadh had already numbed me. Children were killed every day. I watched the parents weeping and allowed myself to feel nothing. The cruel, tasteless expatriate joke was based on a hideous reality.

  “What do you call a Saudi airbag?”

  “A five-year-old.”

  Follow with black laughter.

  It was common practice for fathers to drive with their sons at the wheel. Often the child, flying unrestrained headlong through windshields, died in the collision while the father lived. A massive effort was underway to teach parents about car seats and seat belts, spearheaded by the National Guard Hospital, yet safety of children in Riyadh was not the neurotic obsession we were familiar with in the West. Often one could see actual children driving, their button noses barely peeking over the steering wheels of American SUVs. Motorists as young as twelve were an unremarkable sight in Riyadh.

  As I finished writing, I looked at a young Saudi man pacing in the area, unable to settle in a chair which had been provided. His thobe was scattered with the blood of others. He must have tried to stem the bleeding of his fellow passengers before help had arrived. In his left hand, he clutched remote entry keys to the now-mangled monster Benz. I realized he was the sole passenger unscathed by
the apocalyptical joy ride. He must know what had happened.

  Before I could approach him, he rushed up to me. He had been watching me treat his brother.

  “Doctora, Doctora, is Tahir going to live? Please, I have to know. God, I can't believe this is happening.” He rushed up to me, then dissolving into sobs, frantic. In his distress, he reached out to grasp my forearm but at the last minute, inhibited by tradition, snatched his hand away. Traces of $185 Creed wafted from his Dunhill thobe, despite the carnage wrought on his clothing. I waited for him to become calm. He wiped away tears of pain with soft, manicured hands. The sharp scent of absinthe on his breath startled me. He had also been drinking it seemed. When he finally spoke, it was slowly and in a British voice, smoke-laced and Eaton-educated. He sounded exactly like Jeremy Irons.

  Yaseer, the brother of the wounded man, described the night I had predicted. They had been returning from a weekend of drinking, coke, and heroin. Tahir had just taken delivery of the monster Mercedes McLaren. They had opened the 5.4L engine full-throttle to see what it could do. They clocked speeds of almost one hundred twenty miles per hour. Tahir had been drinking for hours, trying to “sober up” with lines of cocaine. His brother couldn't persuade him to relinquish the keys, and so the death ride began.