In the Land of Invisible Women

by Qanta Ahmed

  Saraway offered me the front seat but as usual I declined. To the sound of Craig David's British R&B we sped off into the night traffic, Imad racing quickly to over a hundred miles per hour. I was shocked both at his recklessness and his taste in music! He didn't wear his seat belt either until finally he gave in to my insistence. (One of my perpetual anxieties in Riyadh as a permanent passenger was injury of whomever was driving me—in recent months my worries were approaching a neurosis.)

  “Please, Imad, this is so dangerous.” I stopped looking out of the passenger window, which revealed our lightning progress in comparison to the other vehicles on the road. We were passing everyone. He responded with a self-satisfied chuckle. I couldn't wait to get out. I triple checked my seat belt.

  In this strange adolescent behavior, Imad revealed yet another male Saudi side of himself—the male appetite for speeding. The expression of his unarticulated masculinity in rubber burn and his evident pleasure at navigating the busy highways in this dangerous manner without regard for the very plain fear of his passengers was juvenile. Unfortunately, this was a commonly expressed characteristic of the bored young men in Riyadh and, I was discovering tonight, not the exclusive provenance of the uneducated.

  Imad couldn't have been any other way, despite a long exposure to the West; his culture was simply too strong. Though his guise was extremely Western—German cars, French ties, Swiss watches, Caucasian skin, Italian footwear—it couldn't blot a very Middle Eastern mentality: entitled male authority and sexual boredom compressed in a perpetually trapped playground. This was the Saudi Zhivago I had chosen.

  AN EYE FOR AN EYE

  IHAD RETURNED FROM A brief interlude in New York, arriving only two days earlier into the Kingdom. I couldn't believe what I was hearing. I went immediately to the bedside of the extraordinary patient Imran had just described.

  Juliette, one of my favorite Filipina nurses, was busy cleaning him. She paused, visibly perspiring under the weight of the flaccid, dead flesh. Gently, she released the fat buttock that she had been dressing, where a wet pressure sore had developed already. Like a flank of refrigerated meat, the hip slapped heavily onto the bed.

  “Doctora! Good evening! Welcome back!” Juliette was eternally pleasant. Her warmth was genuine. I wondered how she remained so graceful even in the most revolting of situations. I answered her pleasantries and then asked her about the patient.

  “What's the story, Juliette?”

  “He is, I mean, he was fourteen. This is day four of his ICU stay. He arrived after a penetrating stab wound to the heart. After open cardiac massage, they got him beating again. He was pulseless for at least fifty-five minutes. We don't know how long he was out cold after he was stabbed. His brain was already swollen on the first CT scan of the head right after that. We knew he would have anoxic brain injury. He never recovered brain reflexes. He has been declared clinically brain dead for days now. He has never been sedated. They haven't discussed withdrawing life support or the usual assessments for organ harvesting. We can't believe it, Doctora.”

  Neither could I. I stared at the body. The glossy shock of thick, unruly hair remained the sole, rude reminder that the patient had been a vigorous adolescent until only a few days ago.

  The obese teen was in suspended animation, machinery performing all of his bodily functions while the essence of his being, the seat of his consciousness, was already dead. I looked at the patient. His face was swollen to the size of a football. Eyes were sealed shut forever under edematous lids. Protective lubricant conferred a sheen of tears as though he wept for his own fate. A respirator connected to a fresh tracheostomy site was pushing air in and out of dead lungs.

  “But this is ridiculous. Why are we doing all this, Juliette? This is medical futility… it's completely unethical.”

  Huffing with irritation, I resolved to talk to Dr. Faris in the morning. Perhaps there was something I didn't know. Ignoring the ethical maelstrom, Juliette addressed more pragmatic matters.

  “Doctora, what do you want to do about Fouad's blood sodium?” She pushed some results into view. I glanced at them. His brain had stopped controlling sodium along with many other minerals in his blood stream. Correcting this would make no difference to the patient's outcome, which had already been decided, and it seemed organ donation wasn't even a consideration (something that would mandate careful control of the serum levels of sodium). I walked away, leaving Juliette with the data. I had no help to give.

  “How can you justify this situation continuing?” I challenged Dr. Faris in his office the next morning. Faris shifted uncomfortably in his chair, and finally, exhaling a sigh of contained exasperation, he began to explain the bizarre circumstances.

  “Qanta, you must know Sharia law in Saudi Arabia carries the death penalty for all murderers?” I nodded impatiently, wondering how this could be possibly relevant. Faris was often circuitous in his explanations. Aching from a long night on call, I hardly had the energy for another one of his shaggy dog stories.

  “Well, this patient was stabbed by another child, a Saudi boy who was also fourteen. They were outside their school. We don't know what the argument was about but the boy who stabbed him—the assaulter—swears he had no intention to kill. If we withdraw care, Fouad will be declared dead and the boy will be convicted for murder. A teenager faces the same consequences as an adult in our country.” I looked at him incredulous. There was more.

  “So the assailant's family has offered blood money, by way of damages for the wounded child. It is up to Fouad's family to decide if they will forgive the transgression, but so far they are refusing. They want the other child to be executed in retribution. So of course, in desperation, the transgressor's family has appealed to the King himself. There is a delicate discussion going on at the highest levels. So you see, Qanta, while this is all being decided we cannot disconnect care because we do not want to be responsible for bringing a youngster to the death penalty. That is a matter for the higher authorities, for the Sharia courts. And so last week we had instruction, by Royal decree, to continue all care. By order of the King, we cannot discontinue our efforts. Do you understand? It is very important you are clear on this matter, Qanta. There must be no confusion.”

  He looked at me sharply. I understood perfectly. Sharia law played a huge and very foreboding role in all aspects of life and death in the Kingdom. This was not a matter of medical ethics at all. This was a case for Islamic jurisprudence as interpreted by the Wahabi clerics in Riyadh.

  “I understand your dilemma very well, Qanta,” he went on. “Like you I was also trained in North America. I withdrew care on many patients who needed that at Hamilton where I trained.” He referred to his fellowship years in Ontario. “I understand the end-of-life decision-making and the consequences of brain death very clearly, but this matter is much more serious. It contains consequences that are much broader than the immediate patient. If Fouad is pronounced dead, this could affect an entire family and could result in the death of another teen.”

  He became pensive, leaving me in a puzzled silence. Medical futility was not the only ethical dilemma in this case. The King had interceded by issuing a royal decree to prevent death from being declared in the hope that clemency would be forthcoming from the victim's family. Even the King couldn't offer clemency on behalf of the parents of a murdered child. That was a decision only the family could make. No one else, not even a monarch, had the right to determine justice on their behalf. What the King had done, however, was buy the families more time, in the hope that hearts would soften and mercy would ensue.

  “I hope the victim accepts the diyya (compensation) from Fouad's family,” Faris began, referring to the Quranic teaching that the families bereaved as victims of intentional death should seek diyya rather than qisas (retaliation) in the way of equivalent punishment.23 Faris began to explain. As usual he had identified my near-habitual confusion at more sophisticated Islamic principles and sought to teach me.

  “You know Is
lam teaches compassion in every situation, don't you, Qanta?” I nodded an affirmative. I very much believed this.

  “Well, the principle of an eye for an eye is indeed present in Islam, because above all Islam is justice. Islam believes in equality and in infinite justice. The following verse reminds us of this,” and Faris quoted the Quran from memory. After he had spoken in Arabic, he translated for me.

  “We have prescribed for thee therein a life for a life, and an eye for an eye, and a nose for a nose, and an ear for an ear, and a tooth for a tooth, and for wounds retaliation; but whoso remits it, it is an expiation (atonement) for him, but he whoso will not judge by what God has revealed, these be the unjust.”

  He went on to explain Islam bestows permission for Muslims to exact justice in very precise and equivalent terms, but never beyond these precisely specified terms. A Muslim cannot punish one crime with a greater crime. Islam discourages vindictive behavior, endorsing only the meting of precise justice. But as Muslims we are also given the option of relief from exacting justice. Instead, retribution is actually preferred to retaliation. In the Kingdom there are even set rules about this. For instance, the death of a Muslim man must be compensated by a fine of SR 100,000, about $26,000. If the immediate family of the murderer does not have money, any extended family may offer it, even any member of the tribe. Sometimes members of the royal family will ease these difficulties. But this compensation is required. It is up to the family of the victim to accept this in lieu of qisas. I listened to the complex explanation carefully, but there was still the fundamental youth of the assailant which disturbed me.

  “But in this case the murderer is a teenager! Can he face decapitation?”

  “Unfortunately, Qanta,” Faris explained, “once the boy has become an adult, with developed secondary sexual characteristics, he is considered adult in the eyes of the law. Committing an adult crime requires an adult punishment.

  “I am afraid that is the way, but even until the last moment the family can forgive him and he will be spared. We pray they show mercy.” Faris fell silent. I understood the conversation to be over. I excused myself and left the room, closing the door softly behind me.

  I walked through the ICU to exit. I paused by Fouad's room. Fouad, or rather Fouad's body, was still heaving with each shuddering breath of the respirator. His vital signs were more or less normal. Juliette had finished her night shift and now Vicky, a Zulu South African, was tending to his dressings. She sang a ballad softly under her breath, perfectly occupied. Fouad looked like any other patient in the ICU. From this vantage, the illusion of life was maintained in perfect order but easing him into a dignified and final death would be much more difficult. It was not our decision, nor apparently his Maker's. The Sharia courts, the families, and his Monarch would decide. In the meantime we must tinker on, effectively ministering to a cadaver. Deeply disturbed, I left the unit.

  The next day I decided to call my friend Jane for more information. I was still troubled by the brain dead patient. Jane, a Kiwi from Auckland, was a physiotherapist and a long-time veteran of expatriate living in the Kingdom. She knew the answers about a lot of things here.

  “Oh yes, Qanta, the blood money thing; it's very common here. Everyone who drives a car, all the men I mean,” she paused, “have to have car insurance in case they need to pay out blood money. Think of it a bit like life insurance. Interestingly, if an expat is killed, his death is not usually legally required to be compensated in blood money, but lo and behold if you run over a Saudi, you better have that blood money ready.” I wasn't sure this was entirely accurate, so I went back to Faris.

  We sat in his office, sharing tea while he explained to me the principles of accountability and compensation. As usual I listened in silence, amazed both at the extent of his knowledge and my ignorance.

  Any accident in the Kingdom found to be the responsibility of another warrants diyya, compensation, irrespective of Saudi nationality. The usual amount for the death of an adult Saudi male is SR 100,000, around $26,000, but for a female, the compensation is less, usually half the amount, because in the Kingdom few women are breadwinners. If the responsible parties cannot pay the blood money, others can step in to meet these costs.

  I knew that Faris was correct in this. There were some tremendous examples of unexpected generosity in the Kingdom. Articles were often published in the Arab News, the daily national paper. Saraway and Iman had told me about the story, which I now remembered.

  “Listen to this Qanta, in the Arab News yesterday!” Saraway began partially quoting an article to me over the telephone.

  The article described a Saudi man entering a courtroom in Hail, a town in the north of the country. There he publically offered SR 50,000 ($13,000) to the family of an Indian worker who had been killed in a motor vehicle accident partly caused by a Sri Lankan whose family could not afford the compensation. Fortunately, the driver had survived, but still the court ordered blood money to be paid to the Sri Lankan family who had lost their only breadwinner.

  Until payment of compensation, the surviving driver, who was partly responsible for the accident (along with the deceased), remained incarcerated. The Arab News reported his consulate had appealed to the local Indian community to help raise funds, but no help had been forthcoming. Somehow the anonymous Saudi man learned about the case, not knowing either the driver or the deceased, and wished to relieve the distress of both the driver's family and the victim's widow. He disbursed the monies completely unexpectedly. They were given to the Sri Lankan consulate to be wired to the widow at once.

  “Wow, that is generous, Qanta!” Saraway gushed, as he read from the paper. “And they never revealed who donated the money.” Saraway paused.

  “Why did he do it, Saraway? Did it say anything about the donor?”

  “Let me see… yes, here at the end it mentions the donor wanted to give because while he didn't expect any reward in this life, he knew Allah is bountiful and will reward him in the next. That's all it says. He must be one rich guy.”

  “And a generous one, Saraway.” I repeated the tale to Jane later in the evening. Her cynicism was partly alleviated.

  “I had never heard of that before, but it does make sense. I have to say the Arabic reputation for generosity is legendary. And for good reason. You know I go to the Palace to do physiotherapy on the Crown Prince and one of his wives? They both have pretty bad osteoarthritis of the knee. Anyway, while I am on my knees working on the Princess, bending down doing the range-of-motion stuff, the courtiers are usually bustling about bringing requests from their subjects to their attention. I think they actually take them seriously. Once in a while she stops me in the middle of our exercises to make a decision. I have heard some even get to have an audience with the CP himself.”

  I looked at her blankly. “Crown Prince,” she explained. “I guess think of it as town hall meetings. The princes meet with their local ‘constituencies’ as it were (can't think of a better term, Qanta), and they hold a weekly Majlis, which means a kind of conference, literally a place of sitting. People tell him their troubles. The Prince helps solve them. Sometimes he mediates disputes over the amounts of diyya demanding which seem to be climbing to astronomical levels here.24 People come to the Prince as a final court of appeal. The monarchy is very alive here, Qanta, and very involved with their people, make no mistake!”

  Ultimately the heaving adolescent cadaver was transferred out of the ICU to a chronic respiratory ward where his body continued to be supported by artificial means. He remained suspended there for some time until finally even artificial life support could not keep his organs functioning. After the death of the teenager his family, with careful persuasion from local elders and the encouragement of their Monarch, accepted blood money in lieu of the death penalty. The juvenile assaulter got to live.

  So, while it was Fouad who was condemned at the moment of the stabbing in this life, the surviving teen lived to be condemned in the next.

  PRINCES, POLYGA
MISTS,

  AND PAUPERS

  JANE HAD MADE ME THINK about monarchy more deeply. As a British citizen I understood the unique affection a subject can have for a monarch, particularly one who has ruled for more than half a century. But in Saudi Arabia the monarch and his monarchy were not as remote from everyday Kingdom life as perhaps might be so in other countries. Working in a hospital, it was not uncommon for them to minister to the sick or to open a building. Sometimes they came to the hospital for their own treatment, though often they chose to receive care at international institutions of renowned status. Other times they came for private fly-by-night visits on business that I could not fully understand.

  On one such an evening, I had just finished assessing the patients in the ICU. It was close to midnight. As I closed a heavy file, the charge nurse reminded me that a senior member of the royal family might appear in the ICU. I disregarded the nurse's fussing. Everyone was making their patient space even tidier than usual. Emma, a gorgeous Filipina, was once again applying her already-perfect lipstick. I caught her checking her enviable ruby pout in a pocket mirror. She fixed a stray hair into place. An excitement was in the air and just at that moment the automated steel door of the ICU flung open.

  A tiny figure, veiled in an abbayah, entered the ICU. About ten steps behind her, I recognized one of the hospital administrators looking very much the worse for wear, being up so late at night. Evidently he was escorting our much anticipated royal guest. All the nurses stood up, acknowledging the dignitary. They paused in their work for a moment, before continuing in their duties. Mark, the night ICU manager, sidled up to me explaining who she was.