In the Land of Invisible Women

by Qanta Ahmed

  “Mrs. Tarfa has made an amazing recovery, Haydar,” I began, remarking on a Saudi woman who had survived a horrific fire at a wedding party some months earlier. Haydar had just replaced two of her heart valves.

  Haydar replied, “Thank you, Qanta, Alhumdullilah, looking after that woman really affected me. It makes me feel worthwhile here to help patients like her.”

  With the incredibly advanced care we could provide here and thanks to aggressive surgeons like Haydar and Mu'ayyad, she was actually going to live and perhaps even eventually be well enough for prosthetic limbs.

  “So, do you yearn for Canada, or are you settled here now, Haydar?” I asked, curious to see if his answer would merge with Ghadah's.

  “Alhumdullilah, Qanta, we have returned to the Kingdom at a very good time. We are grateful the mood here is changing, and things are becoming more open. The radical clerics are weakening, and our country is finally moving ahead in the right direction. The National Guard Hospital is very progressive, Qanta. Soon we will be performing the Kingdom's leading transplant program. Mashallah, the Crown Prince Abdullah himself is very, very supportive to us here. We are fortunate because he is heavily invested in progress and development. None of this would really be possible without his patronage and his actions. He diverts a lot of funding to us here at the National Guard. That's why we are the premier center in the Kingdom. And we will soon be training our own surgeons right here, instead of constantly sending them to Canada or the States. It's why I came back.”

  “Don't you miss Canada, Haydar?” I asked, comfortable addressing him by his first name. “Ghadah seems to very much.”

  He smiled at his wife who, true to form, had just stubbed her toe on the credenza.

  “Careful, Habibti,” he told her, leaping up to take the heavy tray from his pregnant wife. He caressed her arm gently and pulled her down toward the sofa near him. Clearly they were still very much in love. Haydar poured me my tea while Ghadah and I watched, equally enchanted by this marvelous Saudi man.

  “Sure, I miss Canada. I had great mentors there. The clinical experience was incredible, but to be honest we see more pathology here. There are fewer heart surgeons here so of course I get a very broad surgical experience. It's good for me to be here, and I am sure you have talked to Mu'ayyad. I just feel I have to do this for my country. The least I can do is return to serve my people.”

  As I watched Haydar's clear, green eyes burning with commitment, a light radiated from his beautiful face. There was nothing contrived or insincere about his feelings for his country. This wasn't the immature nationalism of an angry young man. Haydar was a member of the intellectual glitterati who really wanted to enable change. All over the Kingdom, couples like Ghadah and Haydar raised progressive families while they pursued the very real task of developing their nation, which found itself strangling in the suffocating slick of extraordinary wealth that had paralyzed so many. Haydar and Ghadah were the New Generation of Saudis: the idealists, the community activists, the servants of the masses, the intellectual gluttons, the progressives, the liberals.

  “Here, Qanta, my album!” Ghadah pushed the heavy, leather-bound volume onto my knee, turning the pages herself.

  “Oh, Qanta, you will be here another three hours! My wife loves to show her photographs.” Haydar watched her fondly as she showed me the beginning of their story.

  “And this one was taken in Thailand, where we went on our honeymoon.” Shyly Ghadah pointed out a picture of her with her husband obviously on the way to a special dinner. He was dressed in slacks and a white shirt, she in a lace, long-sleeved dress which revealed surprisingly stumpy ankles! Like many Saudis, they veiled only in Riyadh for social propriety, not for orthodox attachments to more extreme beliefs. Ghadah was still very modestly dressed, revealing only her ankles, but her husband's relaxed posture toward her both in the picture and now as they looked at it together with me years later belied progressive Muslims who were more attached to actions than appearances. Ghadah was completely absorbed in her album, showing me the images of her marriage, complete with the archetypal wedding thrones that had graced the late-night wedding I had attended last week. In many ways, Ghadah and Haydar were bread-and-butter Saudi and in other ways completely alternative.

  As I watched them talk about their future, as I saw Haydar intently listening to Ghadah about her plans to enroll in a PhD program in London after the birth of her third child, and saw him beaming with pride at her academic dreams (dreams that she did indeed fulfill several years later), I realized I had significantly underestimated the Saudis I was working with. They didn't work to pass time, though certainly a number of them truly did not need the salary in the way that I did. Rather, they preferred to work to accomplish change. They worked as a team in their very forward and healthy marriages, which in turn influenced the circles around them and their society overall.

  Ghadah was far from a desperate housewife, even if her home already looked like it was straight off the ABC set. Instead, Ghadah was a fulfilled woman with ambitious goals and the unwavering support of an equally brilliant husband, one who took enormous pride in the progress of his wife and daughters and in that of his country. Realizing that he had married Ghadah at nineteen when he was in his mid-twenties, I did agree that Haydar was perhaps as influential in her life as her broad-minded father. Ghadah was the product of nurturing men, whether in her childhood home or in the marital home. A woman like Ghadah would not be possible were it not for the confident, loving, supportive, and empathic men surrounding her.

  I had a lot to learn from Ghadah and Haydar. Their relationship was a microcosm of all the good that was unfolding in the Kingdom, just like this, inside family homes, in the soft, safe recesses of loving marriages, in the indulgent connections of fathers to their daughters, and finally in the hopes that confident, valued mothers pinned on their children. The Kingdom of Loss was becoming one of beauty.

  THE GLORIA STEINEM OF ARABIA

  I FOUND MYSELF IN THE neonatal ICU early one afternoon. On Dr. Fahad's recommendation, I was seeking out Dr. Maha al-Muneef. Incubators, full of premature babies in varying stages of growth, hummed in unison. A primal current of life surged through the unit, dense with young beginnings of future Saudis. Nurses worked intently on their tiny patients, reaching toward frail limbs still covered in a glossy pelage of lanugo. Giant latexed fingers pushed through the Perspex hatches, tending to the delicate needs of the youngest patients at the National Guard Hospital. Through a glass pane, a veiled Saudi mother, clearly limping from the pain of recent childbirth, scanned the scene until her visored gaze spied her baby. She gazed at the neonate through an opaque cloud of blackness.

  Maha was conducting rounds. She was dressed in a disposable sterile gown, the yellow paper cloth covering her doctor's coat which dwarfed a tiny frame. She looked no more than five feet tall. On her head she wore a black scarf which constantly slipped backward, sometimes exposing the crown of her hair, occasionally exposing a fraction of her neck. Her dynamic gestures and the energy that inhabited her made for an annoyingly mobile veil that she tolerated without irritation. She stood in a flurry of gesticulations, holding court amid her Saudi residents and Western nurses, explaining her decision-making with patience and precision.

  In the midst of prescribing and teaching, she adjusted her scarf constantly, covering unruly hair. She made eye contact with everyone around her to determine their level of understanding. Satisfied the issues were resolved, she briskly stripped off her gloves with a snap, casting them into the receptacle, and moved to the next patient. Periodically, she laughed with her colleagues, emitting an audible peal that was surprisingly infectious. In turn, her colleagues laughed with her, evidently comfortable with their female Saudi senior. She was a woman very much at ease within herself. Her confident body language unextinguished even by a mandated headscarf, a relaxed candor, and a natural authority belied a powerful, secure woman.

  Catching my eye, she smiled a wide, toothy grin, flashing
her gorgeous teeth. Her cheeks dimpled in sincerity and the smile infused her almond-shaped, hazel eyes framed by a ray of crow's feet. Without makeup, dressed in the sterile yellow gown, her beauty remained unquashed. I studied her for a time, searching for the source of familiarity in my attraction to ineluctable good looks. After a few moments, I found it: the squared-off jaw leading to a subtly cleft chin; the perfectly symmetrical nasolabial folds, deep lines stretched across full, high cheeks flanking the wide, warm smile; and finally, the endearing yet slightly imperfect alignment between her incisors peeping between wide bow-shaped lips were all very familiar. She was a Saudi Gloria Steinem.

  She finished her last assessment and at once came to greet me, holding a tiny outstretched hand in greeting.

  “Salaam alaikum, Dr. Qanta! Dr. Fahad mentioned you would visit me!” She gripped my hand in a surprisingly steely handshake. I found myself smiling at her vigor.

  “Wa alaikum Salaam, Dr. al-Muneef! I am delighted to meet with you. Dr. Fahad mentioned you would be a wonderful guide for me. I want to hear all about your work.” We walked out of the ICU together to return to her office.

  Maha was a pediatric infectious disease specialist and the Deputy Chairman of the Department of Pediatrics. She consulted in the hospital on all varieties of infectious diseases. A widely published academic, she was trained at Ivy League programs in the U.S. I also was beginning to recognize that Maha was very busy as an activist. She was a proponent of human rights for women and children in the Kingdom.

  “Please, come in, make yourself comfortable, Qanta.” Closing the door, she removed her scarf from her hair. Without it she was even more beautiful, and her softly colored hair curled up above her shoulders in a very stylishly cut bob. Under the light, subtle highlights warmed her thick head of hair with flecks of burgundy.

  Her office was in the basement of the administration buildings. Small, high windows shielded with Venetian blinds that remained closed still allowed sunlight into the room without affording a view of the interior, a contrast from Faris's office, which was walled with thick panes of glass looking out over lush swathes of manicured lawns; or Dr. Fahad's office, which revealed pretty dappled sunlight filtering through the young plane trees outside the window. Maha, as a woman, couldn't allow herself a clear view of the outside, even if she wasn't in a basement office, because women must not be seen in Saudi Arabia. Women spent lifetimes incarcerated in guarded privacy and secrecy. A woman working at her desk in clear view of a large window would be unacceptable in this society which wasn't yet ready to receive women in the public arena.

  She settled herself in a giant swivel chair that only magnified her petite frame. Her desk was cluttered in a corner of the room and was mainly occupied by a tall CPU that dwarfed its user. On top of the CPU a yellow silken prayer mat, much worn from use, was casually folded up, obviously placed there since the noon prayer that took place earlier that day. Pinned on the notice board were candid snaps of her children, daughters and sons, who were dressed in casual clothing, relaxing in a garden. A photocopied newspaper article in Arabic was taped to the window. A Nokia Sidekick intermittently vibrated with missed calls and new emails. A bookshelf was filled to the brim with texts and journals and the occasional framed photograph. She took me at once to a framed picture that was perched in pride of place at the top of the shelf. It was a picture of Maha with Barbara Walters.

  “You may have seen this interview in New York while you were there recently. Barbara Walters came here with her 20/20 team and asked to interview me.30 They followed me around at work and at home to learn about professional Saudi women. It was fantastic, Qanta. She is a great lady.” She looked at the picture with affection, before placing it carefully on the top-most shelf.

  “Gosh, Maha, that's a picture I would keep on my desk for everyone to see!” I gushed, impressed.

  “No, Qanta, it's not like that here. You can see my relaxed scarf on my head there, and of course not everyone here is a fan of this famous American journalist. It's better to keep this picture somewhere where people can't see it unless I show them. Unfortunately in my society people are limited and not always open to my position on matters.” I looked at her, pressing for her to reveal more.

  “You know, Qanta, you probably already are aware our society does not like outspoken persons, whether men or women.”

  I was immediately reminded of a conversation I had already shared with Imad, when I was surprised to see as a man, he had made the exact same observation. I was learning that it wasn't only women who were oppressed by the puritanical dictates that determined life in the Kingdom; the autonomy of moderate men was shackled too. Even someone as powerful as our CEO, Dr. Fahad, had to constantly fend off pressures from the Wahabi clergy, for instance, in seeking to justify his employment policies. I suddenly remembered him crumpling up faxed fatwas from the Mutawaeen, threatening him for employing so many women, women like myself and Maha. At the time I wasn't sure if I was more shocked at the fatwas which included one forbidding women from wearing seat belts because of the resulting defined cleavage, or the fact that the clergy had fax machines. Rabid orthodoxy was a lot more high tech than I had ever imagined. Maha continued unaware of the racing thoughts she had triggered inside me,

  “As a Saudi woman who has chosen to speak out for the weakest in society, the children and women, I face a lot of pressure. I have to be very careful to try and be a model citizen, while I work for progress in a private and professional manner. This is a complex society where there are many rules and rituals and cultural expectations. I have learned how to accomplish things here, within our framework which can be restrictive. I have learned how to accomplish a lot, Alhumdullilah, but much work needs to be done.”

  Over the next several hours she began to explain her work and her passion in the Kingdom with an energy that blazed through her small frame. I was entranced to hear Maha talk about the progress she was making in exposing child abuse and protecting battered women throughout the Kingdom. I knew there was a need for this work from several patients either I or my friends had attended in months past. Two children in particular stood out in mind.

  It was winter in Riyadh, and this had been an especially long week of difficult admissions. The ICU nurses and many among our physician ranks were demoralized. We had lost several young patients despite our best efforts. I had started my evening on call a little deflated.

  “Dr. Qanta!” It was chirpy Juliette. “The emergency room on the phone, they want to know do you have a bed for acute respiratory failure?” Without taking any details, I nodded assent. Juliette relayed the information into the phone. “We are getting an admission,” she announced after a few moments. “A vent,” indicating the patient was on a respirator, which was doing the breathing for the patient.

  “Fine, just page me when the patient arrives,” I called out and continued writing.

  Some time later, I received the relevant call and arrived to see my new patient. As I entered the patient cubicle, buttoning up my coat and reaching for fresh gloves, I gently pushed the flurry of nurses to one side in order to reach the bedside. I found the nurses clustering around a tiny body.

  “This is my patient?” I asked, flummoxed at the sight of a child. “We are not a pediatric ICU. I have no pediatric critical care training! Why are we receiving him?” Annoyed, I failed to recall it was my fault for not inquiring of the details of the patient.

  “Doctora, he is an adult, here. Any child who displays even one pubic hair is classified as adult here. We have to receive him. He is to be admitted here.” And, while she was inserting a Foley catheter to drain the patient's bladder and measure the urine output, Nurse Rita pulled back the patient's gown to show me the offending wisp of pubic hair that accompanied the penis of a child. The child was clearly Tanner stage 1, the first step of pubertal development.

  “How old is he?”

  “Nine, Doctora, last month,”

  “And his weight?”

  “Forty-eigh
t pounds, Doctora. He seems really underweight. I would guess he is perhaps four feet tall. I don't know, we have to measure.”

  I studied the thin frame, examining my tiny patient. His ribs were showing through his sallow skin. His hands were wizened, without the normal fullness of youth. His eyes were sunken hollows, closed under the deep sedation administered in the emergency room. They were studded with gorgeous, long, lush lashes that touched his joyless cheeks. His thick, tousled hair was dirty and had not been washed in days, possibly weeks. The nurses covered his head with a surgical hat, keeping it apart from our peering heads to avoid the inadvertent transmission of lice, which could be a potential risk. Later they would shampoo and brush his hair, after I had finished my assessment.

  I examined his heart, beating rapidly and easily audible through his thin rib cage despite the rushing wind of mechanical breaths underneath. His lungs were clear. His belly was scaphoid and hollow and sank into the narrow pelvis of a child. Little legs were underweight and lay flaccid in their knock-kneed stance typical of many children at this age. I noticed a healing scab from when he must have fallen playing. His feet were caked in dirt and roughened already with young callous. Perhaps he was one of the boys who kicked a dusty soccer ball around in the vacant lots awaiting development. His hands were flaccid and open-palmed. I noticed the fingernails were bitten to the quick and some of the hangnails recently bloody. His crumpled thobe, stained and worn, lay soiled on the floor. A smell of stale urine pervaded the air and then my eyes finally saw the precipitant of admission.

  As I moved in to examine the head and review the airway, his thin T-shirt, torn and now partly cut by the nurses in order to attach EKG leads, fell from his throat. A series of ringed marks appeared at the front of his neck, like the coiling of something tight. They encircled his small throat. The bruises were easily visible once I moved the cloth away. I adjusted an angle poise lamp on the wall to eliminate the shadow cast under his small chin. I was sure; these were ligature marks.