The Hanafi Space-Time Continuum

kr’s note:  The following is the result of class and discussion with Shaykh Amin yesterday, so most of the insights–well, all of them, who am I kidding–are to his credit. We were reading from kitab al-hajj in Hidayah, a section detailing the step-by-step rites of Hajj, when the following discussion took place.

The Hanafis were given the title “ahl ‘l-ra’i”, the people of opinion and conjecture,  and this title was often used with a sense of sarcasm by some of the other schools for they often sought to bring in logic and reason in determining the Law. Abu Hanifah (may Allah have mercy on him) was called “al-Qayyas” (an ism mubalaghah form), meaning “one who constantly and exceedingly uses analogical reasoning.” What these same people overlooked, of course, is that Abu Hanifah and his students were concerned primarily with the nass (text) as foundational evidence, and logic as a secondary and supplemental source at best. The authority of the nass was always paramount, and when rulings deviated from the nass, another nass had to exist along with clear and logical reasoning to allow for such movement away from the hukm (mandated Law).

The above is necessary background in order to understand the Hanafi position–and the subsequent revelation–when it comes to the Day of Arafat, specifically looking at the order and manner in which the prayers are to be performed. It is well known that the pilgrims are to combine the Zuhr and Asr prayers at the time of Zuhr, but the Hanafis say that combining prayers is not allowed (unless of course one makes jama` suwari, which is a discussion for another day, but basically means delaying Zuhr until the end of its time and then praying Asr right as its time comes in).  But, on the Day of Arafat, the Hanafis allow for combining these prayers, yet the nass would indicate that this should not be allowed, specifically due to two verses: 4:103 which explicitly states that prayer has prescribed times, and 2:238 which further says to especially guard the middle prayer (which the dominant opinion says refers to the Asr prayer).  Obviously, one can explain why these prayers are combined because the Prophet (salallahu `alayhi wa sallam) did so when he performed Hajj, and he only did Hajj once in his lifetime, so there is a nass allows for this exception. But reason is necessary to  stipulate how and why the nass can be over-ridden, so the Hanafis say that certain conditions have to be met (such as one being in Ihram, one being in Arafat, etc) in order to move away from the nass.

This is where it gets interesting… because the idea here is that once these conditions are met, the principle of preserving “time” is also maintained because these conditions essentially bring the time of Asr “forward”, relatively, to those who are in Arafat, so they maintain the first nass as well. In other words, their Asr prayer, which the `aql (intellect) may say is before its time and thus not “prescribed” yet (as per the nass), is actually prescribed because the time is brought forward.

Then it gets even juicier… because when sunset happens, one is not allowed to pray Maghrib in Arafat, one has to wait until he reaches Muzdalifah, then he prays Maghrib and Isha together… yet this Maghrib is not considered to be qadah, even if the time for Maghrib has elapsed (even going by the liberal Hanafi 90 minute Maghrib rule) by the time he reaches Muzdalifah. So this presents a conundrum, because in the previous example, we brought the time forward, yet now we are essentially pushing the “time” back, saying that the time for one’s Maghrib–despite one’s `aql observing the sun set–hasn’t started.  To understand this, one looks at the hadith (which is in both Bukhari and Muslim by the way, even Ibn Hajar al-Asqalani (may Allah have mercy on him), a card carrying member of Shafi’i madhab, agrees in his Dirayah commentary), wherein the Prophet (salallahu `alayhi wa sallam) says to Jabir (may Allah be pleased with him), when the latter was about to pray Maghrib in the road while en route from Arafat to Muzdalifah, “As-salātu amāmak, ” (The prayer is in front of you), which is interpreted that as-salatu actually stands for “waqtu ‘l-salāti amāmak” (the time of the prayer is in front of you). In other words, the Prophet said that the time for Maghrib, even though outwardly it may have seemed it was dark, would not start for them until they physically reached Muzadalifah.  Even more amazing is that this “start” time is relative for each pilgrim, only occuring when he/she physically enters Muzdalifah.

This hadith is fascinating because it establishes a link between time and space. Einstein became famous for saying that time was so powerful that it could physically curve and alter the very fabric of space. Here, we are saying that the blessed plain of `Arafat is so powerful that it is not only unaltered by time, but instead, this space physically curves and bends time… and it is so powerful that it pushes time in both directions, bringing the time for one prayer forward, and delaying the time for the other. Thus, the famous hadith of “Al-hajju `arafah” (The Hajj is Arafat), no longer remains majazi (allegorical), but takes on a higher degree of haqiqah (outwardly literal) meaning, because of the power contained in this blessed plain. 

For the pilgrim, the paradox is to use his `aql to understand and appreciate this reasoning, and then to simultaneously understand the weakness of his `aql that tells him it is time or not time to pray–to embrace the power of the `aql on one hand, while understanding its shortcomings on the other.  This is the true test of the pilgrim, to appreciate that his Divinely-given `aql is useful for certain things, but completely useless for others, and instead he has to have faith in Divine Providence in such matters. This complete submission is the spirit of Hajj that is started with the chants of labbayk that declares, “Here I am O Lord at Thy service”, wherein the pilgrim realizes that he is nothing, and God is everything.

It is for this reason that the same Hanafis differ with their Maliki brethren; the latter say that the talbiyah (chanting of labbayk) is to be stopped after the day of Arafat, but the Hanafis (and even the Shafi’is here) say that one is to continue this chant until the stoning of the devils.  In the context of the above, wherein one has to abandon one’s notion of time and accept Divine Time, it serves as a perfect reason to continue this chant, because the only way one can appreciate this travel through this space-time continuum that happens on this day is to be in complete submission to the One who is above time itself.

Einstein ain’t got nothin’ on Abu Hanifah.

A Rambling Diatribe of Inauguration Ruminations

kr’s note: as the title suggests, this isn’t a structured or perhaps even grammatically correct post that you may be normally accustomed to reading from yours truly… but rather, it’s a stream-of-consciousness amalgamation of thoughts that I needed to jot down before I lost them.

“Na`am nahnu nastati`u”

Whenever I listen to Obama’s speeches (or to be precise, the 27 year old dude who writes them at Starbucks… how’s that for symbollism) and the power contained therein, and it always brings to mind the famous Prophetic hadith: Inna min’al-bayaani la-sihrah (Indeed in eloquent speech there is magic)… it sounds great on paper, but I’m not sold until I see something positive happen (OK, so Bush flying away in the helicopter was pretty positive). Yesterday was a uniquely historic day, but it was not the day of fath-e-Makkah repeated either, as some Muslims were making it out to be (it was much warmer on the day of fath-e-Makkah).  I’m not expecting drastic changes in areas like foreign policy (the zionist lobby is too powerful, so anyone expecting things to “change” in the Middle East is at best naive), but I do expect changes in economy, healthcare (esp as a doctor with malpractice), environment, etc. may happen in the next several year.  As I mentioned in a previous post, politics is the epitome of all that is secular, and it surprises me that Muslims always have to view politics with the religiously rose-colored glasses to analyze everything… that to me is the peak of irony, because politics never claimed itself to anything but secular, and yet we conflate our religious goals and values into it, and cry foul when politics and religion don’t rhyme (kinda like that poem yesterday), which they were never really meant to do anyway. I was amazed at how many Muslims were all rah rah rah about the inauguration (wow, 2 million people yesterday, was that the American hajj with black wool topcoats being the new ihram?), acting like either Obama (aka Hussain Bhai) was the Mahdi or the Dajjal, depending on who you spoke to… instead of just appreciating the history quietly (and also the boo-birds ripping mercilessly into Bush), and not allowing ourselves to be suckered into buying the hype like we did with the infamous 2000 Muslim block vote for Bush (for which we should continue to make tawbah for, I believe, myself included), which ironically was on the platform that he would solve the same Palestine crisis that served as the perfect cresecendo ending to his failed symphony of a presidency (as Don King said: “Only in America!”). I voted for Obama too, don’t get me wrong, but I mainly did so because the alternative was far worse (I didn’t like “that one”). Maybe I’m a cynic, but our Hadith prophecies tell us that things will get worse as time goes on–it has to, or else the real Mahdi will never come–so to believe that ‘yes we can’ make all these wonderful changes happen, I think, in some way, is incompatible with believing in these same prophecies about the end of time. At the end of the day, our formula remains the same: our lives are to focus on making sure we maintain our elligibility for salvation (everything else, especially all types of activism is simply garnish at best) and wait… because in the end, when it’s all said and done, despite the efforts against us, we win. At this point in time, that’s the only thing that comforts me.

The Du’a of the Wounded

kr’s note: In the light of all that’s going on, this Prophetic du’a uttered by a wounded Beloved of Allah (may His peace and blessings be upon him) in a vineyard has been on my mind lately:

Oh, Allah, I appeal to you for the weakness in my strength,  and my limited power,
and the treatment of contempt and humiliation from people.
(I appeal) to you, the most Merciful of all the Merciful ones,
You are the Lord of the oppressed, and You are my Lord

Under whose care are You leaving me to?
To a distant person who receives me with hostility?
Or to an enemy to whom You have granted authority over my affair?

If You are not angry with me, then I will forever be content.
However, Your Favor is a more expansive relief for me.

I seek refuge in the Divine Light of Thy Countenance
by which all darknesses are dispelled and every affair of this universe and the next is set aright,
(seeking refuge) lest Your Anger or Your Displeasure falls upon me

To You alone is the supplication until You are pleased,
and there is no force or power except by You.

Muslim Syndromes

kr’s note: Over the years, I’ve often alluded to and referenced several “Muslim Syndromes” in speeches that highlight cultural peculiarities and social idiosyncrasies displayed by the American Muslim community. Several of you have asked me to describe these syndromes in greater detail–this post below is the result.

The term “syndrome” is often used in reference to a collection of notably recognizable clinical phenomena, signs, symptoms, and occurrences that often run together.  In fact, the word syndrome is derived from a Greek root and itself literally means “to run together.” Syndromes are aptly named so that the clinician may identify a salient symptom and in turn recognize the existence of others.

Syndromes manifest in different ways depending on a given time-space within the American Muslim community. Some are innocuously funny, while others approach the downright pathological. One’s observations may lead one to identify and diagnose these phenomena when they occur. While the cures are many–and perhaps best dealt with in another post–the first step to curing a disease is to identify it. What follows are several of my diagnoses of a chosen few syndromes that afflict the American Muslim community.

1. ISNA Saturday Night Syndrome (ISNS): This syndrome is marked by an intense zeal and enthusiasm shown after a lecture or conference by attendees, classically seen after the Saturday night main session at the annual ISNA convention for which this syndrome is eponymously named. Subjects feel overwhelmingly hyped up after a session, but when questioned about, for example, what exactly Shaykh Hamza Yusuf said in the talk, subjects often only remember a few buzz words, or more often, remember nothing at all. All they feel is that a lecture was  “the greatest ever”, but then when asked what they plan to do as a result of listening to such an inspirational talk, they often have no idea or goal as to where the aforementioned hype should be directed towards. Oftentimes, subjects state that they can’t wait till the next conference so they can be hyped up again.

2. MSA Caliphate Syndrome (MCS): A common syndrome in many campuses throughout North America, this syndrome results when MSA members, especially leadership, begin to think that the MSA is a mini-Islamic state or pseudo-caliphate on campus. They give themselves cute titles like “Ameer” and “Ameera” and salivate over the faux-power they now wield. MCS often causes subjects to fight over essentially meaningless positions and topics that then lead to division amongst MSA members. The MSA Qadi variant of MCS (like how there is a Miller-Fisher variant to Guillain-Barre Syndrome) often goes hand in hand, wherein MSA leadership feels they have the right to excommunicate members they disagree with, demand that members follow their specific version of Islam, or seek to impose rulings (and even punishments, in rare cases) that only a real Qadi in an Islamic state may mandate. MCS often alienates the vast majority of campus Muslim students away from the MSA as a result of either not feeling welcome in the MSA, or experiencing extreme nausea as a result of MSA drama.

3. Crowded Iftar Plate Syndrome (CIPS): This syndrome draws its name from an outward phenomenon of a common practice in Ramadan, overloading one’s iftar plate in the buffet line with food (as if this is the first time one has ever seen a samosa), which denotes an inner reality for many Muslims who have too much on their plate in terms of self-imposed roles and responsibilities. CIPS is notably seen on campuses or one of the possible sequelae of ISNS wherein a desire to accomplish many goals quickly is followed by spreading one’s self thin in fulfilling the obligatory responsibilities in one’s religious, familial, and personal life, usually resulting in failing to meet said obligations. Like the crowded iftar plate that often gets discarded with half the food still on the plate, CIPS results in many tasks unfulfilled. Treatment for CIPS begins with the patient “biting off only that which he can chew”, and returning for more later.

4. Irrelevant Prophet Syndrome (IPS): In this syndrome, patients are convinced that the Prophet (may God’s peace and blessings be upon him) and the early communities were mythical figures whose lives bear little or no resemblance to their own. As a result, drawing inspiration and devising practical solutions to one’s current challenges in the light of this blessed history becomes a lost art as it is deemed no longer relevant to modern times. In the Madinah Legend variant (yes, a tongue-in-cheek reference to my previous post for those of you paying attention at home), the seerah remains a legend that is told around campfires and only has entertainment value at best. It is to be told only at meetings and conferences (sometimes leading to ISNS) and has little practical value outside of these settings.

5. Muslim-centric Universe Syndrome (MUS): A syndrome that afflicts much of the Muslim world too, this syndrome is marked by the unwavering belief that because Muslims are “the best of communities that has been raised up for mankind,” that they are therefore entitled to exclusive perks and benefits. This syndrome is especially defined by the idea that the universe should revolve around the affairs of the Muslims, and that because they are God’s chosen people, they should be protected from the trials and tribulations of the world. Some have facetiously asked: “How many Muslims does it take to change a lightbulb?”, to which the answer is, “One. He holds up the bulb and expects the universe to revolve around him.” This syndrome arises when patients forget that the world runs according to the Will of Allah alone, and not according to theirs, and that despite what occurs in the world, the world is still under His control, and that trials and tribulations are ” the Tradition of God, and you will find no change in the Tradition of God“. Oftentimes, MCUS is a sequela of IPS as the patient fails to realize that no matter how bad one’s situation may get, the Prophet (may Allah’s perpetual peace and best of blessings be upon him and his family) and his Companions (may Allah be pleased with them) went through far worse, and they were far more beloved.

6. Sunday School Panacea Syndrome (SSPS): Like the red sulphur sought by mystics of the past which was said to treat all diseases (similar to the elixir of life, the philosopher’s stone, and other such themes in various cultures’ histories) and grant immortality, this syndrome results when American Muslim parents drop their kids off to Sunday school for two hours each week and expect that this is sufficient into making them all-star Muslims that have learned everything there is to know about Islam and are protected from any temptation in the future. Oftentimes, these parents drop their kids off, go watch a Bollywood movie at the theater, and come pick them up after the movie ends, leaving with their children before the Zuhr congregation prayer. Patients become convinced that they need not themselves teach their kids or follow-up what was taught on Sunday because the Sunday School should a cure-all for everything.

7. Cultural Convenience Syndrome (CCS): This syndrome results when patients selectively pick and choose aspects of culture according to their convenience. The irony in most situations is oftentimes, Muslims choose from a culture they bash and denigrate when it suits them. A classic example is Pakistani Muslims who hate on Hindus (and often hate on their Indian Muslim brethren because of this as well), but then conveniently adopt Hindu customs, such as mehendis and dholkis, as their own.

8. Muslim Ghetto Syndrome (MGS): This disease state occurs when Muslims living in the West willfully isolate themselves from “the kafirs” and remain esconced in their little enclaves and communities that essentially becomes ghettos in the larger landscape. As a result, the patient no longer feels the need to communicate with his American brethren and convey his Prophet’s message to them. As he imagines himself to be living in an Islamic country (or in cases where MCS never resolves, a pseudo-Islamic mini-state), he becomes completely irrelevant and marginalized, and then begins to complain when his rights are trampled upon (it is not uncommon to find patients simultaneously affilcted with MGS and MCUS), ignoring the fact he has done nothing to validate himself (or his heritage) in the eyes of the American people around him.

9. Halal and Hilal Syndrome (HHS): This syndrome is unique as it strikes across ethnic, gender, and economic spheres as patients are wont to discuss the two burning issues that American Muslims feel must be discussed at all times–usually to the extent that more serious issues pertaining to salvation are ignored. Patients are often convinced they are the “shaykh al-Islam” of the time and speak with boisterous authority regarding the unquestionable authority of their opinions and the indisputable error in the opinions of those who disagree with them.

10. Muslim Empire Building Syndrome (MEBS): MEBS occurs when a group of patients, often as a result of being hyped up and/or afflicted with ISNS, engage in a long, passionate discussion about the best ways and methods to change the state of the Muslim ummah. The mode of conversation may range from healthy opinion-sharing to fierce diatribe that may seem to require physical confrontation to resolve–after all, Rome wasn’t built in a day either. Such discussions may last hours and days, fascinating ideas may be elucidated, and many cups of coffee imbibed, but usually such discussions end without a clear objective of what to do or how to accomplish it, instead resulting in everyone feeling happy they have accomplished something and at least agreeing on one item for the evening: to use someone’s iPhone to find out when the last showing of Quantum of Solace will be that night.

The Legend of Jeddah Legend

Once in a while, you’re privileged (or perhaps unfortunate) to witness something that is so bizarre that it cannot simply be written off; rather, its sheer ridiculousness (ironically enough) merits for it to be analyzed in order to understand what is really going on. It is a wonder of the times that it is not the lofty or even mundane that have this ability–but rather it is the outlandish that possesses this remarkable characteristics. The above video is perhaps the latest example of such a phenomenon.

When I first saw this video, I had no idea what to make of it. I thought it was a joke, one of those spoof videos that go viral on the internet from time to time (which is another wonder of our times, for the record). I thought it was a satirical attempt by a bunch of guys playing around to mock the idiosyncrasies of the Middle East (and what better example to pick than a wedding) by using the medium of rap–and I’m not talking about new age rap or even the 90′s gangsta rap of Tupac and Biggie… no, this was using the old school 80′s I’m-going-to-tell-a-story-and-keep-it-clean rap genre that tragically died out way too quickly.

But then it dawned on me: this wasn’t a joke. It was real, these guys were really trying to fuse together Arab culture (evident in old boy singing classical Arabic voice-inflection melodies as an introduction) and hip-hop, which of course, is  the epitome of irony in all its forms. I did some research, consulting the grand Shaykh of our times, Shaykh Waki`-Badie* and found the following article to be quite remarkable: (http://en.wikipedia.org/wiki/Middle_Eastern_hip_hop)

(*interlude: it is yet another sign of our times that while the illustrious scholars of our past like Imam al-Shafi`i had luminaries like his teacher, Waki`, to consult when they had problems, we  turn to the grand Shaykh of our times, Shaykh Waki` Badie,  when we have questions).

And the resulting ridiculousness? Not to Muslims in the Middle East (and across the world), who have not only failed to recognize the complete lack of talent that has been packaged together and labeled as music, but have actually embraced and bought into all the hype–and trust me, if there was ever hype, this is it.  In today’s times, lacking any perceivable talent actually helps you to sell albums, and this phenomenon too, is found now in the Middle East.

There are many themes that one can analyze from this video. Perhaps the most evident (and most troublesome) theme is that of the complete lack of identity for Muslims in the Middle East. A great historical legacy that was the identity of Muslims for generations now has been lost, replaced with new legends like Jeddah Legend. This new legend attempts to tap into the past while incorporating facets of Western society that have the least relevance to people living in the Middle East. As one example, the same dude singing classical Arabic to start the song appears in urban gear (as if he’s from the ghetto, no less) halfway through, and many backup singers (or posse members if you will… oh wait, I guess that’s like the new `asab) appears in thobes/scarves in one scene and Dwayne Wade jerseys with caps tipped to the right side in other scenes. Of course, they have no understanding what these symbols mean (some of them can get you killed if you display them in the wrong places) and instead garb themselves like complete buffoons in the clothing of a people with whom they share little in common.

This of course is even more ironic when we see examples of what facets of Muslim culture are still “important” to this new culture, such as making sure there is a “zabihah buffet” for the wedding and incorporating Arabic maxims such as “faragh ba`dah saa`ah” (play comes after work) into the midst of all this. Whether this is an effort to cling to the past or legitimize–legally or culturally–this social revolution remains a debatable issue. It is clear, however, that such phenomenon occur when we fail to “remember who we are.” (yes, shameless plug for a previous post with that title).

There’s much more I could have brought out from this video, but hopefully this serves as a starting point. Keep all this in mind and perhaps watch the video again… it will change your life.

Servants of the Prophet

kr’s note: By request, the following is a story and its lessons that I had narrated at the recent Sacred Time Project conference.

It is mentioned in our traditions that the son of `Umar (may Allah be pleased with him) and the sons of `Alī (may Allah be pleased with him) were friends ever since childhood. It so happened one day that `Abdullāh b. `Umar (may Allah be pleased with him) got into an argument with Ḥasan and Ḥusayn (may Allah be pleased with them both) over some trivial matter, as young boys are wont to do. History does not record the exact reason or the cause for the argument, but only that Ḥasan and Ḥusayn, in a moment of childhood anger, said to `Abdullāh b. `Umar: “Your father is nothing more than a servant of our grandfather.”

Ibn `Umar came home crying and told his father what happened. Upon hearing this, `Umar immediately got up, took hold of his son, and set off with all haste towards the house of `Alī.

He knocked on the door, and when `Alī opened it, `Umar strode in after greeting him with discernible purpose. `Alī began to worry, for this was the same man that the Prophet (salallahu `alayhi wa sallam) had said that even Shayṭān feared him so much that he would take another path if `Umar took one path.

`Umar said to `Alī: “Bring your two sons here.”

`Alī called for his sons, and they entered trembling noticeably, fearful of what reprise might await them for insulting Ibn `Umar in such a manner.

`Umar asked the two young boys: “What did you say to my son?”

They told him what they had said earlier, and began to apologize for their comment said out of haste and anger.

`Umar did not hear them, and instead he asked that paper and pen be brought before the immediately. When it was brought, he instructed them to write what they had just said.

Still trembling, the two cubs of the Lion of God wrote: “Your father is nothing more than a servant of our grandfather.” Even the Lion himself was fearful of what would happen next.

When they had finished, `Umar took the paper, read it and clutched it to his breast. He handed it to `Alī and said to him:

“When I die, please have this paper buried with me so that it may bear witness that I was a servant of their grandfather.”

The greatest possible title that any human being can achieve is to be a Slave of Allah. Perhaps just as fitting, or perhaps as a component of that Slavehood, is the necessity for us to understand, embrace, and actualize servanthood of the Prophet (salallhu `alayhi wa sallam). His Companions (may Allah be pleased with all of them) understood the power and the dignity of such a title, and strove to achieve in every aspect of their lives. While we were not blessed with physical companionship of the Prophet (salallahu `alayhi wa sallam), the opportunity to be servants of his legacy still exists. The role of the servant is to know what the master likes and dislikes, what pleases and displeases the master, and to work to ensure the master is pleased with the servant. The servant must first learn these specific wishes of the master and then must accordingly act upon that knowledge. The Companions understood this, and recognized their glory lay in being such a servant.

Alas, if only we could be true servants of their grandfather…

Medical School Burnout

kr’s note: wow, I can definitely relate, though having been through it and now finally working, it seems like it wasn’t that bad, that it was a necessary trial by fire that one had to go through in order to be prepared for what drudgery and insanity that one often sees everyday as a physician. Thank God I’m doing ophthalmology =).

—-

Taken from the New York Times

October 31, 2008

Doctor and Patient

Medical Student Burnout and the Challenge to Patient Care

By PAULINE W. CHEN, M.D.

Not too long ago, I read a paper titled “Burnout and Suicidal Ideation Among U.S. Medical Students” in The Annals of Internal Medicine. It brought back a flood of memories.

Medical school was not easy for me. I knew that I wanted to become a doctor to help people, but I had given little thought to the process. I was poorly prepared for many things: the pressure to excel in ways that seemed so far from caring for people; rapidly mounting debts I signed off on every semester; a roller coaster existence from chronic lack of sleep; hazing from the more experienced students and residents; and the realities of patient suffering despite my best efforts.

Even surgical residency, despite the relentlessly long hours, seemed so much closer to what I wanted to do.

Some of my professors tried to “humanize” the process. They invited us to dinner in their homes, supported our extracurricular efforts to set up health screening clinics in low-income neighborhoods, and tried to make our basic science courses more relevant to working with patients. But sitting where I am now, as someone who teaches medical students and who loves helping others as a doctor, I can understand the challenge they faced. Given the fire hose of information medical students must learn in just four years, how does one ever gently take a sip?

Despite my teachers’ efforts, I was about as miserable in medical school as I had ever been. I felt alone. Neither I nor my classmates could admit to failure, and the last thing I wanted to do was to let anyone but my closest friends know just how unhappy I was. Success in medical school was the first step to a future of helping others, and I was not about to jeopardize that.

Last week I had dinner with two former classmates from that time. We had not seen each other in over a decade, and after catching up on personal news and reminiscing about gross anatomy lab and our first nights on call, one of them said quietly, “I hated med school. I wanted to quit.” The elephant in our collective memories had broken free.

With that elephant now running loose, and the three of us more comfortable with our own professional accomplishments, the conversation grew more honest. “If you look over my entire lifetime,” my other friend said, “those four years were the lowest point in terms of self esteem.” He held his hand out in the air, plotting an imaginary line that dropped precipitously to his knees.

It took nearly 20 years for the three of us to learn that we had each been miserable as medical students. It has taken even longer for researchers to discover the extent to which such feelings exist among American medical students.

In 2006, Dr. Liselotte N. Dyrbye and her colleagues at the Mayo Clinic found that nearly half of the 545 medical students they surveyed suffered from burnout, which they defined as professional distress in three domains: emotional exhaustion, depersonalization and low sense of personal accomplishment. Moreover, the researchers found that each successive year of schooling increased the chances students would experience burnout, despite the fact that they had entered medical school with mental health profiles similar to those of their peers who chose other career paths.

More recently, in the paper on burnout that had first caught my eye, Dr. Dyrbye and her colleagues widened the scope of their research, analyzing survey responses from 2,248 medical students at seven medical schools across the country. Again, nearly half of the students surveyed met the criteria for burnout. But the investigators discovered an even more ominous finding: 11 percent of all the students surveyed also reported having suicidal thoughts in the past year.

Dr. Dyrbye notes that we are just starting to learn about the high levels of distress in medical students. “It’s incredibly disconcerting,” she said. “What are the causes? And what can we do as educators to facilitate their well-being? We need a better understanding of the causes of stress to design interventions that will help improve student wellness. Students, just like doctors, need to take care of themselves in order to take care of their patients.”

Medical schools have more recently recognized the importance of this issue. For example, the Liaison Committee on Medical Education, the accrediting authority for medical schools in the United States, now mandates that all schools have a program for student wellness in place that includes “an effective system of personal counseling for its students.”

But beyond the personal implications, what are the ramifications of medical student burnout for patients?

In a third study, Dr. Dyrbye found that when tested for empathy, medical students at baseline generally scored higher than their nonmedical peers. But, as medical students experienced more burnout, there was a corresponding drop in the level of empathy toward patients.

“What do they really need to know before graduating from medical school, and how could they most efficiently learn?” Dr. Drybye asked, reflecting on one of the central challenges of medical education. “All the information we want to share with them is not necessarily what they really need to learn.”

By the time my dinner with my former classmates last week had ended, we had made plans to stay in touch and to do something I had never been sure I would ever do: return to my medical school in two years’ time to celebrate our 20th reunion. Over the course of our dinner conversation I felt strangely connected and nostalgic about medical school; I was deeply moved by what my two classmates had chosen to do with their education. One is a well-loved community obstetrician/gynecologist; the other is a psychiatrist devoted to teaching, working in a county medical clinic and caring for severely traumatized Hmong refugees. And both love their work as doctors.

As I listened to them talk about their work, I was reminded of one other thing Dr. Dyrbye had told me. “We need to change things,” she had said, “because maybe the students who are most vulnerable are the ones who are most empathic.”

So Where Are You Going?

So apparently there was an election last week, and an African American man with the middle name of Hussein—the same as the Prophet’s grandson and also the now-deceased dictator of Iraq, how’s that for the definition of irony—will now be the leader of these United States.

Historically, this is an amazing event, one that was unimaginable for much of American history, unthinkable for African Americans and minorities who have seen the worst sides of racism and pure hatred… yet, ironically, an accomplishment that is undeniably American as well. We are privileged to have seen such a fascinating historical event, and the significance of this cannot be overstated.

But what does this mean exactly? I have read the opinions of many American Muslims and seen their reactions encompassing the full gamut from pure joy to sheer dread—and everything in between. There are those who are hailing him as the messiah or the Mahdi, come at last to restore goodness to the world; and then there are those who are declaring him to be predecessor to the Antichrist himself.

The bigger realization that American Muslims must quickly accept and embrace is to understand this election as being historically significant—and nothing more. We didn’t win anything. Why are we so giddy? We can feel proud to witness history, but let us not make the mistake of feeling proud that we had anything to do with this or can share in this accomplishment (unless of course you are African American and Muslim as well, then you can feel proud for the African-American-ness of all this).

What I don’t understand is why elections always have to have religious significance for us—why something that is the epitome of secularism has to somehow relate to religion, and when it doesn’t jive with the spiritual (of course not, how could it, it would be an oxymoron to expect it to do so!), we condemn this secular thing for being secular—as if it deceived us all this time. To relate an event like a presidential election to religion speaks volumes about our own insecurity as a people, or worse yet, our own arrogance (borne from ignorance) about the way the world works—newsflash: the world does not revolve around us, and thank God it doesn’t.

President-Elect Obama is not the messiah, nor is he the antichrist; he is a charming politician that has potential to accomplish great things, but let us not be so deluded to think or expect that he is the answer to the world’s problems—let alone the problems and challenges faced by the American Muslim community. He certainly seems better than what we had before—then again, the standard was set so low these past eight years than it wasn’t much of a challenge to outshine that—but time will tell how much of the melodious rhetoric will become reality. The Prophet (may Allah’s peace and blessings be upon him) said: “Indeed (some speeches) from amongst speeches are pure magic”… Indeed, indeed.

We’ve seen this story before, just eight years ago when we were promised peace in the Middle East and believed it. It’s time we looked at politics, something that is purely secular, and began to see how it can benefit our secular side—the “American” side from American-Muslim. It’s time we learned that we should put aside our “Muslim” side in politics and not have any expectations with certain areas that will never change, such as foreign policy, but instead, as Americans, we should demand fulfillment of promises made in areas that affect us as Americans, such as the economy, healthcare reform, education, and the environment. Paradoxically (and this is subtle, so pay attention), only by doing so will we find ourselves benefiting as Americans, which will benefit us as Muslims as well.

The bigger issue is to ask ourselves that same rhetorical question that God asks us in the Qur’an: “So where are you going?” I was amazed to see so many Muslims get so energized about the Obama campaign and the elections—which is great, but if we’re able to generate that sort of energy for the secular, where is that energy when it comes time for the religious? Where is that hype when it comes time for people to come to Friday prayers? Where is that same joy when it comes time to mobilize ourselves to help out the latest area in the world that has been hit with flood/famine/civil war/insert disaster of choice here. Where is that energy when it comes time to get excited about making it to the masjid for taraweeh for 30 nights? I mean, we’re able to generate energy, so it’s not an issue of being unable to do it—it’s an issue of being able to direct that energy towards loftier purposes as well as the mundane.

So where are we going? Regardless of who won the election, we are still going towards where we were always headed: our appointed meeting with our Lord. Nothing has changed, and nothing will ever change that. We generated a lot of energy these past few months—either in support of or against a candidate or the election in general.

Now the election is over, and the future awaits. Choosing a Cabinet is Obama’s first order of business, whereas separating and prioritizing our goals as American and as Muslims is ours.

We need to figure out where we are going as Americans and where we are going as Muslims—and act accordingly if we plan on getting there.

Remember who you are…

In the famous Disney movie, The Lion King, there is a climactic scene wherein Simba, the wrongfully ousted protagonist, has a vision of Mufassa, his deceased father. At this point in the movie, Simba has run away from his rightful place as ruler of the pridelands, and instead sought out a non-descript and carefree life, ashamed at his heritage and ancestry, and content to wallow in luxury and entertainment. It is exactly at this point that Mufassa visits Simba and shames him when he tells him: “Remember who you are…”

It is perhaps useful to bear the above in mind when considering the plight of the Muslim community in the world to be quite similar to Simba’s situation in the movie. And just like Simba, it is becoming unfortunately more and more common for Muslims to feel ashamed of their identity, values and history and to attempt to seek out something altogether different. Of course, this is not withstanding the fact that it is quite comical to see a brown person (note that I’m generically using “brown” to refer to non-white, not simply desi) attempt to be something or someone that they aren’t.

It is imperative for Muslims to not only be content with who they are and where they have come from, but also to make no apologies and to feel proud about their legacy and identity. Certainly, this is difficult given the socio-political climate that we find ourselves—but perhaps this is why, maybe even more than any other period of Muslim history, it’s necessary for Muslims to reflect, to feel comfortable, and to feel honored with their status as being from the Ummah of the Prophet (may Allah’s everlasting peace and blessings be upon him).

Keeping this goal in mind, I’m presenting a section from Tanbīh al-Ghāfilīn (The Awakening of the Heedless) by the famous scholar, mystic, and jurist, Abū Layth Nadr b. Muhammad al-Samarqandī, specifically from the chapter titled “The Chapter Concerning the Virtue of the Community of Muhammad (salallahu `alayhi wa sallam).” The text is in Arabic and has not been translated yet, so the English translation below is mine; any corrections or suggestions for improvement are welcome.

Hopefully, this helps us to remember who we are.

—–

The jurist (Abū Layth) said: My father narrated to me on the authority of Abū `Abd Allah Muhammad b. Janāh….on the authority of Maqātil b. Sulaymān that Musa (upon him be peace) said: “O my Lord, indeed I find mention in the Tablets of a nation who will be intercessors and interceded upon, so make them to be my nation”.

He (exalted is He) said: “They are the nation of Muhammad.”

Musa continued: “O my Lord, I find mention in the Tablets of a nation whose expiation of their sins will be in the five daily prayers, so make them to be my nation.”

He (exalted is He) said: “They are the nation of Muhammad.”

Musa continued: “O my Lord, I find mention in the Tablets of a nation who will fight the people of misguidedness until they even fight the vanguard of the Antichrist, so make them to be my nation.”

He (exalted is He) said: “They are the nation of Muhammad.”

Musa continued: “O my Lord, I find mention in the Tablets of a nation whose purification is accomplished with both water and dust, so make them to be my nation.”

He (exalted is He) said: “They are the nation of Muhammad.”

Musa continued: “O my Lord, I find mention in the Tablets of a nation such that if any one of them were to intend a work of righteousness but not perform it, one measure of reward will be written for him. And if he were to do it, then ten measures will be written for him, doubling until 700 or even more. And if one of them were to intend an evil act, nothing would be written against him. And if one of them were to do it, then only one evil act will be written against him, so make them to be my nation.”

He (exalted is He) said: “They are the nation of Muhammad.”

Musa continued: “O my Lord, I find mention in the Tablets of a nation that seventy thousand of them will enter paradise without any account, so make them to be my nation.”

He (exalted is He) said: “They are the nation of Muhammad.”

(The narration continues under a different chain as follows, on the authority of Qatādah)

Musa continued: “O my Lord, I find mention in the Tablets of a nation that is the best of nations, enjoining goodness and forbidding evil, so make them to be my nation.”

He (exalted is He) said: “They are the nation of Muhammad.”

Musa continued: “O my Lord, I find mention in the Tablets of a nation: they will be the last such that they will be the first on the Day of Judgment, so make them to be my nation.”

He (exalted is He) said: “They are the nation of Muhammad.”

Musa continued: “O my Lord, I find mention in the Tablets whose gospel will be in their hearts and they will recited it (also) looking at it, so make them to be my nation.”

He (exalted is He) said: “They are the nation of Muhammad.”

This continued until Musa himself wished that he too could be from amongst the nation of Muhammad, and then Allah revealed to him: “O Musa, indeed I have chosen you over all mankind by virtue of My Message and My Speech, so take what I have given you and be amongst the grateful (7:144).” Also, “And from the people of Musa there will be a community that guides towards truth and is just (7:159)”… so then Musa became content.

As part of a longer narration, the gist of the first part being an argument arising between a follower of Musa and `Umar (may Allah be pleased with him) over the Prophet being chosen above other Prophets… it continues:

The Jewish man said: “Indeed `Umar alleges that Allah chose you over all men, and I alleged that Allah did not choose you over all men, so he raised his hand and struck me.”

The Prophet said: “…Nay, indeed Adam was the chosen of Allah, and Ibrahīm was the intimate companion of Allah, and Musa was the Prophet of Allah and Isā was the Spirit of Allah and I am the Beloved of Allah. Nay, O Jew, two Names from the Names of Allah the Exalted have been used to name my Nation: He named Himself “al-Salām” and my Nation was named “al-Muslimīn” (being a derivative of salām), and He named Himself “al-Mu’min” and my Nation was named “al-Mu’minīn.” … Nay, O Jew, you were the first peoples and we are the last peoples yet the first to arrive at the Day of Judgment (for reward). Nay, O Jew, indeed Paradise is prohibited upon the Prophets until I enter it and it is prohibited upon all other nations until my nation enters it.”

Ka`b al-Ahbār narrates: Indeed Allah the Exalted honored this nation with three things that He honored His Prophets with. The first is that each Prophet was made to be a witness over his people, and this nation will be a witness over all mankind. (The second) is that He said to the Messengers: “O ye Messengers, eat from the pure things and work righteousness (23:51),” and He said to this nation: “Eat from the pure things We have provided you (2:172).” (The third) is that every Prophet’s dua is accepted, and He said to this nation: “Call upon Me, I will answer you (40:60).”

It is said that Allah honored this nation with five favors:

The first: they were created weak so that they would not become arrogant in the land.

The second: they were created small in size (compared to previous nations) so that they would not become desirous of much food and drink and their clothes would be few (ie, they would not have to consume much food and drink, or require more cloth for their clothes and thus have to give account for all this)

The third: their lives were made short so that their sins would also be less

The fourth: they were made poor so that their reckoning on the Day of Judgment would be less.

The fifth: they were made to be the last nation so that their remaining in the grave would be the least.

And it is mentioned that Adam said: Indeed Allah the Exalted gave the Nation of Muhammad four favors that even I was not given:

The first: The acceptance of my repentance was only in Makkah, whereas the nation of Muhammad may make tawbah in any place and Allah will accept their repentance.

The second: I used to be clothed, but when I sinned (in paradise), I was made naked; but the nation of Muhammad, even if they sin unclothed, Allah will clothe them.

The third: Indeed when I disobeyed, my wife and I were separated (and reunited much later); but the nation of Muhammad, even if they disobey, He does not separate them from their spouses.

The fourth: Indeed when I disobeyed, He removed me from paradise; but the nation of Muhammad, they disobey outside of paradise but by repentance, they will indeed enter it.

The House of God

The House of God is a novel written about an intern’s experiences during his residency in the early 1970′s. It is an uncensored (yet quite exaggerated at times) look at residency, namely at the psychological trauma faced by residents every day at the hospital. But it also deals with other lesser known truths about medicine that persist to this day: that most patients don’t belong in the hospital; that attendings often unnecessarily keep patients in the hospital to make money; that you feel helpless that for many patients you really don’t do much; and that you see the same patients–frequent flyers–in and out of the hospital for the same problems.

The book is a must-read for anyone involved in medicine, and even for those who are not, as it vividly portrays the above.  They made us read a lot of books in medical school, but no book was as influential, entertaining, and educational as this one.

The book is based on the thirteen “Laws of the House of God”, thirteen maxims taught to the intern-protagonist by his senior resident (the only sane and human person left in the entire hospital). These rules help him to survive the ordeal of internship.

Four months into my own internship, I’ve decided to add a few addendums to the original laws based on my experiences thus far. As the year continues, perhaps I’ll have more, but if anyone wants to add their own laws, please feel free.

Laws of the House of God (from the novel)

1. GOMERS DON’T DIE.
2. GOMERS GO TO GROUND.
3. AT A CARDIAC ARREST, THE FIRST PROCEDURE IS TO TAKE YOUR OWN PULSE.
4. THE PATIENT IS THE ONE WITH THE DISEASE.
5. PLACEMENT COMES FIRST.
6. THERE IS NO BODY CAVITY THAT CANNOT BE REACHED WITH A #14 NEEDLE AND A GOOD STRONG ARM.
7. AGE + BUN = LASIX DOSE.
8. THEY CAN ALWAYS HURT YOU MORE.
9. THE ONLY GOOD ADMISSION IS A DEAD ADMISSION.
10. IF YOU DON’T TAKE A TEMPERATURE, YOU CAN’T FIND A FEVER.
11. SHOW ME A BMS (Best Medical Student, a student at the Best Medical School) WHO ONLY TRIPLES MY WORK AND I WILL KISS HIS FEET.
12. IF THE RADIOLOGY RESIDENT AND THE MEDICAL STUDENT BOTH SEE A LESION ON THE CHEST X-RAY, THERE CAN BE NO LESION THERE.
13. THE DELIVERY OF GOOD MEDICAL CARE IS TO DO AS MUCH NOTHING AS POSSIBLE.

Addendums to the Laws of the House of God

 

1. All women ages 10-65 are pregnant until proven otherwise.
2. Everyone needs IV fluids.
3. If the patient can chew gum, he is not in respiratory distress.
4. The 5 minutes you don’t spend on seeing the patient can be used towards writing a more impressive SOAP note.
5. The hospital has a CT machine; don’t be afraid to use it.
6. If the patient asks for a specific dose of Vicodin, he doesn’t really need pain meds
7. When a chronic pain patient says he wants benadryl + dilaudid + phenergan IV push as opposed to slow mix, don’t knock it till you try it.
8. (number of allergies x number of problems in past medical history)/(age) = the Riaz constant for how many times you will get called in the middle of the night to deal with the patient.
9. Even if you have no plan for an albatross* patient, order a CBC and BMP for the morning anyway to make it look like you do.
10. Dermatology consult: If it’s dry, wet it. If it’s wet, dry it. If not, use steroids and antifungal creams. If still no improvement, biopsy.
11. If you must get an orthopedics consult, you must first get an MRI.
12. Repeated EGDs and colonoscopies will eventually help you find the bleed.
13. ID consult: vancomycin + aztreonam + metronidazole. Add acyclovir and fluconazole depending on the day of the week. If that doesn’t work, write a case report.
14. If a malingering patient keeps asking for pain meds, replace potassium through a peripheral IV line, order an NG tube, foley catheter, and rectal exam. Consider ordering restraints and bowel prep for colonscopy.

*an albatross patient refers to a patient that like the bird, just hangs around forever