by Qanta Ahmed
THE MAKING OF A FEMALE
SAUDI SURGEON
REEM'S REPUTATION PRECEDED HER. SHE was beloved by nurses, widely respected by her Saudi and Western colleagues, and clearly held in awe by the sprawling sandaled troops of male Saudi surgeons (many of whom were military officers in the Saudi Arabian National Guard) whom she trained in her role as senior surgical resident. They followed her on rounds very much like chicks following a mother hen. Deferent, they waited for her to opine and reveal her knowledge to them. They hung on her every soft-spoken word, carefully drawn maps, and detailed instruction as she gently taught them the science of surgery both within the operating room and outside it. She executed all of her duties without ever wavering from Islamic ideals.
She was already a familiar sight at the National Guard Hospital as she scurried from patient to patient whether long before dawn or late into the lonely night. Her hair was never exposed, even by accident, because she always secured her headscarf with small safety pins, tucking the ends into her V-necked, green surgical scrubs which themselves were covered by a white coat buttoned up to the throat. She moved through her work effortlessly and unencumbered by her restrictions required of her expression of Islam.
Whenever I saw her I knew she must have been uncomfortably hot even within the air-conditioned marble wards and hallways of the ICU, surgical wards, or the sterile finality of the operating room. She would sweat with effort at securing a line, finishing meticulous sutures, or cleansing a purulent wound, yet still she did everything with grace, patience, and evident pleasure. Sometimes she emerged from the operating room sprayed with blood, but always her gown closed, her hair covered, and her soft voice gently reassuring the worried families who had been awaiting the outcome. She was a paragon of the female Muslim professional. Reem was the archetypal Saudi female surgeon.
Even in crises or when she had reason to be provoked, she never raised her voice, she never displayed her frustrations. I had been watching her for some time, noticing her go about her duties whenever she entered the ICU to write surgical orders on my patients. As she moved silently and efficiently she often cast a pleasant smile in my direction.
Yet for a time she remained an enigma to me. I was inhibited by her decorous behavior, which somehow spotlighted the deficiencies in my own conduct. While I could see I was crashing into fury and anger several times a day, unable to navigate conflicts with even remote diplomacy, Reem remained perfectly in control of herself. With so much turmoil in my own behavior and such tranquility in hers, I was deeply puzzled and suddenly shy to know such a woman. How did she glide through her life when I was forever stumbling? I wanted to know more about her.
I already knew that the salient qualities of an ideal Muslim are encompassed in valuing self-control—control of one's actions, one's body, one's tongue and ultimately one's soul. As Muslims age and engage in the practice of Islam with greater understanding and insight through their lifetimes, their ultimate goal of emulating the Prophet Muhammad (PBUH) in excellence of compassionate behaviors drives them to seek to become more God-like. They strive toward tolerance and patience and perseverance. These are perhaps the finest aspirations Muslims can express and to me, it seemed that at thirty-one, Reem had virtually arrived at this stage already. I couldn't be further removed from these ideals with my mouthy New York City aphorisms that dropped from me at the slightest irritation. I was ugly; she was pure. Against the turbulent backdrop of the fast-paced, high-octane ICU, Reem shimmered, a lake of tranquility. She was unaffected by pandemonium surrounding her, whether required to attend several traumas at once or to seek resolution among an arguing cabal of clinicians competing to impose their self-important opinions. She seemed angelic. I was just pondering this very thought yet again, when Reem marched directly toward me.
“Dr. Ahmed, I am the senior surgical resident, Reem Jumma.” It seemed she didn't realize I knew who she was. “I wanted to let you know I have written the transfer orders for the patient in bed nine. He can go to the ward anytime you choose.” Quietly, she waited for me to respond.
“Thank you, Dr. Jumma.” Without pausing, I found myself spilling my tirade. “I have been calling for these orders all morning. It's unbelievable it has taken so long to get them done! So frustrating!” I noted her patient eyes calmly absorbing my irritation. I was somewhat subdued by her gaze. “Well,” I continued, “it's very kind of you to come and write them, but can you tell me how to avoid these delays in the future? The ER is constantly calling to move patients from their holding area here, and until I have orders, I can't transfer patients out to make room for new admissions.” I had begun to sound lame, as though I was still complaining at the delay in orders that Reem had just resolved.
Unperturbed she responded, “I am very sorry that my residents caused you to wait. I will address the matter myself but in the future please just call me. I will be happy to assist.” I was firmly but gently defused. She was offering her services above and beyond the call of duty and seemed not the least bit bothered by my plaintive bleating. Just as she turned around to leave the ICU, I touched her arm.
“Reem, it would be lovely to meet when we are not at work. Let me give you my numbers.” She burst into an unrestrained and very wide smile revealing small, even teeth. Her grin briefly rectified the asymmetrical plainness of her face that somehow accorded her the pathos that struck me as her hallmark. Her voice rose in excitement as she confirmed our plans to meet, displaying raw emotion for the first time. As she scribbled her numbers on a scrap of paper, her eyes twinkled joyfully. In that moment I knew we had commenced a friendship that would last well beyond my time in the Kingdom.
We met a few weeks later. After an evening of window-shopping we settled in a favorite café.
“Tell me, Reem, how did you decide to pursue surgery as your career? How does a woman become a surgeon in the Kingdom, a Saudi woman at that? What are your plans after residency here?”
Reem stirred the crystallized-sugar swizzle stick in her foamy café latte. We were at a table at Jawad's coffeehouse on Thalia Street, one of my favorite spots in Riyadh. We had found a secure place behind a screened section for women. Reem had undone her scarf, allowing me to see her luscious, thick, black hair. The glossy locks transformed her from a surgical nun to a very attractive woman. I wondered if Reem knew how beautiful she was. Even though she was continually devoid of makeup and her eyebrows were ungroomed, she was lovely looking. The plainness of her open features merely added to her charm.
“Well, Qanta, I am from a very educated family. My father is a professor of economics. He lectures at a university in Jeddah. He always believed it was very important I get an education, and we all agreed medicine was a noble and fine career choice. Alhumdullilah, I was able to find a place at the King Abdul Aziz Medical School in Riyadh and I won a National Guard scholarship to sponsor my residency in surgery. That's when I switched to our hospital at the National Guard. I have been there four years. This is my last year.”
“What are you planning on next, Reem?” She released a clumsy gale of high-spirited peals. I was surprised by the volume of her laughter. She seemed suddenly and totally uninhibited.
“Oh Qanta, I want to be a vascular surgeon! That's my passion. I can't tell you how much I love repairing the circulation and watching limbs re-perfuse again. That's my greatest joy. My dream is to have a vascular surgery practice. I am working toward that.”
I was astonished; vascular surgery is one of the most bloodsucking, soul-destroying, pride-swallowing surgical areas to pursue. One needs the patience of a saint to be a good vascular surgeon, to constantly rebuild and bypass clogged arteries and dying veins only to see one's painstaking handiwork destroyed by a patient's addiction to tobacco or the inexorable course of diabetes. The surgeries are invariably long, backbreaking, and infinitely humbling exercises in surgical fortitude. What an interesting choice for Reem. She was a glutton for punishment in my estimation, but perhaps her preference spoke to her evident talents f
or resilience, compassion, and tolerance.
“Will your fellowship be here, Reem? I didn't know they had a vascular surgery fellowship in Riyadh.”
“Well, Qanta, they don't have a fellowship yet, but Inshallah they will someday soon. In the meantime, my mentor Dr. Saud al-Turki is encouraging me to apply for fellowship in vascular surgery at the University of Toronto.”
I had to interrupt, “Toronto, Reem? That's incredible news. You must go. How exciting Reem!” She gave in to her own excitement in another smile and spilled her coffee while she allowed herself another full-throttled laugh of pure pleasure.
“Well, Dr. al-Turki has been amazing, Qanta. He is such an incredible mentor. He is always encouraging me. He treats me and the other female residents with incredible respect and consideration. He is the perfect Saudi gentleman, and he really does believe women are worthy of pursuing the most advanced studies available. Plus he allows me opportunities to publish and speak; he helped me prepare my first case report as a second-year resident. He even encouraged my parents to think about allowing me to move to Toronto. I couldn't ask for a better teacher.” Her voice deepened with sincerity at the dedication of her teacher who sounded to me like a model mentor.
“Do you think you are influenced by Dr. al-Turki? I mean, because he is so compassionate and such an elegant and intelligent Muslim. Do you think that's why you want to do vascular? Perhaps your aspiration is to somehow become him?” Reem paused to give this some thought.
I knew from my own experience the relationship between academic mentor and the mentored could be a heady mix of nurturing, idealism, and unquestionably (if the relationship is rewarding) a lasting, deep love. Perhaps she had found the same experience too.
“It is quite possible, Qanta.” She cocked her head to one side trying to focus on a deeper answer. “I do wish to succeed and I have no doubt that I am drawn to his specialty because, of all the surgeons in the OR, he was the one who taught me with real compassion and dignity. The others did what they could, but I often felt they didn't believe I should be in the operating room with so many men there. Dr. al-Turki made me feel only like a surgeon. It was immaterial to him whether I was male or female. We just had a common goal, to perform surgery in the best way. And I think that's why I naturally gravitated toward emulating him.”
She paused and sipped her coffee. “It is possible, Qanta. Perhaps he has really influenced me in the choice of specialty I wish to cultivate for my own career. I agree, I must concede you that, at least.”
She stopped speaking, following her own train of thought in silence. Among everything else I was also startled at her flawless command of English. Like most of my Saudi colleagues, she had schooled within the Kingdom yet learned the Queen's English. Even so, she spoke perfect colloquial Arabic, could discuss and prescribe medicine in English and Arabic, and had enough command of her native tongue to understand the exalted classical Arabic in which the Quran is written. I soon discovered in Reem a repository of knowledge in matters of Islamic jurisprudence. Whether I wanted an explanation of Islamic teachings on divorce or inheritance or the Islamic ideals of observing Ramadan, Reem seemed to have acquired enormous knowledge beyond medicine.
I asked about her astonishing knowledge of Islam.
“Well, Qanta, I went to school in Jeddah at a state school. Islamic studies were mandatory. We took classes for five years in several disciplines. Quranic studies, the history of Islam, Islamic jurisprudence, the life of the Prophet, and also Islamic theology. Every child who goes to school in the Kingdom has to attend these classes. But the reality is my father is an incredible scholar, so anything especially difficult we could always go and ask him. My mother, too, is very learned, though she has never worked outside of the home. They love poetry and the history of Islam and my father also knows Farsi, so we have also read a great deal about the Persian culture.
“All of us children were raised in the Kingdom. This is my country, our home. I do understand that to be a vascular surgeon—the first woman vascular surgeon in the Kingdom—would help my countrymen a lot, Qanta. There are women who have ischemic leg ulcers and do not want to seek treatment because all the physicians and surgeons are usually male. They need the skills of women like me.” She studied me earnestly, checking to see if I had absorbed the full import of her commitment.
I had met this sincere commitment to improving the Kingdom time and time again, whether issuing from curved, moustached lips of aristocratic Saudi academics, or the bare, unglossed lips of earnest Saudi female clinicians. They revealed an affection for their nation of enormous and very sincere dimensions. I had no doubt that doctors like Reem, al-Turki, and Mu'ayyad were very much driven by a deep desire to improve medicine for the average Saudi national. I was struck by Reem's altruism and searched for signs of the same within myself. I wasn't sure when I had lost my ideals of serving the needy and seamlessly replaced them with an insatiable hunger for reward. I had definitely lost something along the way that Reem, like so many of the pioneering Saudi clinicians I knew, clearly had not.
They worked not only for the patients in their immediate charge but, through these actions and choices, by striving for a role of public service in their country, also for the wider community. There was no doubt in their minds that what they chose to do and how they exercised their skills and privilege was moving their country forward in tiny degrees; like a bloated oil tanker changing direction, every miniscule and unseen effort helped moved the behemoth Kingdom toward modernity and advancement. Reem, like many of the Saudis I met, was a die-hard idealist, willing to direct her career to serve that calling. Like all of her Saudi colleagues, she had the credentials and clout to pursue a fine medical career outside of the Kingdom, but instead she wished to invest her expertise within her native land.
We were finishing our coffee that had since grown cold. Outside, Thalia Street was illuminated with glossy boutique stores selling precious dates, fine culinary items, and the ubiquitous, exclusive jewelry. We noticed that our driver had appeared, waiting to take us both back to the compound. As a single working woman, like me, Reem had an identical apartment on compound where she preferred to live rather than stay as a perpetual houseguest at her sister's married home, which was also in Riyadh. Reem's family trusted her implicitly and allowed her an unusual degree of independence.
In so many ways, Reem thought, acted, and lived exactly like me. Within this Kingdom I was discovering some very liberated, independent, powerful, and highly intellectual women. Interestingly, I was beginning to discern the glimmers of a new insight. I began that evening to realize most of these extraordinary women had arrived in these circumstances by dint of progressive fathers and nurturing male mentors. In the Kingdom, women were gaining their opportunities with the encouragement and often unabashed support of their male Saudi counterparts. This was a complex tapestry of inter-gender cooperation that was finally coming into view, antithetical to the rabid preachings of the state-sponsored Wahabi clergy who wished women voiceless, invisible, and socially inert.
After months of feeling, seeing, and experiencing male supremacy, I was discovering the most fervent supporters and enablers of women's liberation in the Kingdom often came in the form of enlightened men, whether through fatherhood, marriages, or professional mentorships. The Saudi male was much more than I had realized, and Reem, without discounting her own personal efforts or minimizing her own determination and appetite for development, was a product of exactly these forces. I felt myself warming to the Saudi male. I had sorely underestimated him. But there was more to Reem than met the eye. A week later she called me for an evening of conversation.
“Qanta, I have news!” Reem's voice was pressured and tense with excitement.
“What is it?” I asked, rousing myself from the void of a nap that had found me painfully curled up on my eternally lumpy sofa. I patted around to find my eyeglasses that I had cast off in a foggy doze some hours earlier. Reem was jabbering at high speed. It took me a while t
o understand exactly what she was telling me.
“I got accepted! University of Toronto! I have the fellowship! I can't believe it, Qanta! I am going to be a vascular surgeon!”
“Congratulations, Reem, when did you hear? Mashallah that is terrific. You will be the first female vascular surgeon in the Kingdom! I am so proud of you. You deserve this. Quickly, I want to know first, what did Dr. al-Turki say when you told him?”
“Oh Qanta, he told me! He was ecstatic. He called me at home and then he called my parents to congratulate them. He heard from the program director in Toronto that I matched. I am so excited, I cannot tell you. This is a dream come true for me. It's hard to believe it is actually happening.” She released a gale of laughter which I couldn't help sharing. We giggled for a while, clutching our telephones.
Still holding the phone, I slipped my feet into slippers and started to open the windows in the apartment, hoping for the evening breeze to sweep through the musty apartment. Reem was rattling off more news, without pausing even for breath. As I listened to her animated voice, I poured myself some water. The day had been unusually hot and, as the top apartment of the block, my apartment took hours for the superheated ceilings to cool down. Outside, the Maghreb (evening) Azaan sounded. A scraggly flock of pigeons rose into the air, startled by a stray cat.
“When do you leave, Reem?” I asked, thinking already how much I would miss my lovely friend and colleague. In the past months we had solved so many clinical problems together. I had discovered she was a brilliant clinician and she often helped me turn over difficult problems in the patients we shared.
“Well, Qanta the fellowship starts in July, like all programs over there.” I already knew this but still waited to hear her plans. “But I need permission from my father first. You know I can't travel without his consent and it's going to be difficult for my family…” she trailed off. I detected the first tones of uncertainty.