Salam
- Good morning!
A glum Old Man does not look up. The glare of eyeglasses conceal his eyes. His family brought him in to fix his chaotically beating heart. I do not know who felt bad, the Old Man or the family in their knowledge of the runaway heart. The fix made him worse. He gets water on the lungs making it hard to breathe. His back had to be pierced with a very long needle to reach the area around his lungs where fluid accumulates to relieve the pressure and ease his breathing. The last attempt to discharge him home failed because his heart started beating faster in dialysis to make up for dropping blood pressure.
The Old Man is a very important patient. Several of his family members work at the hospital. He is unassuming. His wants are few: eat, watch TV, sleep. Mostly, he wants to be left in peace. One of his daughters tends to him with the assistance of a hired caregiver who serves him hand and foot, anticipating simple whims exacerbated by the Old Man’s waning memory. It is the family that gives the most grief to doctors and nurses - questioning every medication to suppress nausea, tame the heart rate, and keep the blood pressure up; requesting specialist consultations, turning the earth upside down to manage the numbers on vital sign machines and waves on the strips humming out of electrocardiogram machines. The Caring Daughter’s anguish permeates the air in the Old Man’s room.
“Look at your father? Is he in pain? Is he content?” The Caring Daughter looks at the back of her father finishing lunch and hesitates. He is at peace. “You are in pain and worry about your father. He is not hurting. Go home and pray God grants you peace. We will take care of the rest.” She is half relieved, half teary.
***
-As-salamu alaykum! 1
The Old Man looks up. Our eyes meet for the first time. “Wa ʿalaykumu s-salam!”2 His face lights up, wrinkles fade into a smile. He cannot wait to go home after another round of pulling fluid off his lung. He agreed to the procedure, nudged by the logical parameter management by his Caring Daughter.
When I tell him about thoracentesis, he gets frantic. I cannot insert a word into the loud lament “I GO HOME OR I DIE!” The Old Man gets out of breath. His eyes well up with tears. I recognize myself in him but cannot take that liberty because I do not know him. Is it desperation? Faulty mind of dementia? I stand over him. He begs for mercy. I upset his peace to cure him of what he does not suffer. He is not short of breath when he is left at peace. Two of his daughters are in the room, looking lost. I am the trespasser but they decide their father’s fate. I am the executor.
-I do not know your father. What does he value? What does he want? Was he this way all of his life? Would he agree to it under other circumstances?
The Old Man’s Do Not Resuscitate status vaguely suggests there is intent to die once. Dying is expected or accepted by someone in the family. Who made this decision? Much is concealed during biomedical encounters. I witness quick deliberation between two daughters to reconcile the suffering we all feel we bring onto the Old Man and the unknown number of milliliters of fluid between the layers of the pleura outside of his lungs. “We are upsetting him more by forcing it on him, making his heart and blood pressure worse”, one of the daughters grants mercy onto her father. I silently wonder if suffering caused no effect on the heart rate, would it justify the infliction of good. I lean down to give the Old Man a hug and assure him no harm will come his way if he does not want the procedure done to him. He cries in relief. Salam.3
***
The meaning of “peace” varies in different cultures. The meaning of “peace” varies between men. Receiving a medical treatment has potential to give or destroy peace of a sick man. Approaching death upsets the peace of men who are stewed in the mindset of technological solutions to prevent it. Man decides when to pull the plug on another man, a euphemism for medical killing. Death does not upset the peace of men who dwell in Peace of God. God gives life and death.
God is Peace.
A greeting in Arabic that means "Peace be upon you".
The standard response to the As-salamu alaykum.
An Arabic word that literally means "peace”, but is also used as a colloquial greeting by Muslims.
Beautiful. Your patients are lucky to have you.