He had been sick for a few days, and it suddenly became much worse. What started out as "the flu" was rapidly turning into a life-threatening illness. His cough was becoming severe; his fevers were very high, up to 105; his lungs looked and sounded terrible. Even though he was already in the hospital and receiving appropriate treatment, his condition worsened. His breathing became more rapid and shallow. His blood pressure began to fall quite rapidly, progressing to shock. His mental alertness, previously quite normal, began to quickly deteriorate.

He was transferred to the intensive care unit (ICU), and soon afterwards required a breathing tube to be inserted into his throat to help him breathe. Fluids were being given rapidly to try to increase his plummeting blood pressure, but it was not enough. He required powerful medications to support his blood pressure, so that his most vital organs, the brain and heart, could receive life-saving blood flow. His kidneys were shutting down, and the specter of dialysis (a machine which does the job of the kidneys) loomed large. It was not looking good.

All of this happened so quickly, and it simply overwhelmed his shocked and bewildered family. One minute, he was in bed talking and laughing with them - albeit in pain - and the next minute he was on a ventilator, with all sorts of tubes going into his body, fighting for his life in the ICU.

This is not the story of just one patient. I have combined the details from several cases here, but as a critical care doctor, I’ve seen this scenario many times. The families look to the doctor to provide answers, to explain why and how this could happen. Sometimes the doctor has a clear answer; many times, however, the answer as to "why" is elusive, and this was no different. This is very difficult for many people who are not in the medical field to understand: disease does not always follow the rules laid out in the medical textbook.

Many times, the patient may be suffering from the ravages of the systemic effects of an infection, but the precise cause of the infection remains unknown. It may take time for the offending bacteria, fungus, or parasite to grow on a culture plate, so we can identify and properly treat it. Often times, it may never grow at all. Or, it may not be an infection at all, even though we treat for infection. It may be some sort of deranged inflammatory process that looks a lot like an infection. Other times, we know exactly what sort of infection the patient has and treat it appropriately, but the reaction of the body can be so severe that it, and not the infection, is liable to kill the patient.

This makes sense to us, the medical professionals, but to a family not well-versed in the minutiae of medicine, it is nothing short of madness. So, all that is left for a family to do is - hope. They hope that their loved one will make it; they hope the treatments will work and their husband, son, brother, and father will walk out of the ICU; they hope the tubes that have violated the dignity of their loved one will be removed once and for all. All that is left is hope - in other words, all that is left is Ashura.

Ashura is the tenth day of the first month of the Islamic calendar. In Shi'i Islam, it is perhaps the most important day of the year, when Shi'i Muslims gather and commemorate - some by self-flagellation and injury - the brutal murder of the Prophet Muhammad's grandson, Hussein. For the rest of the Muslim world, however, Ashura is a day of fasting and reflection, a commemoration of the Exodus of the Children of Israel out of Egypt. In a sense, Ashura is the "Muslim Passover."

So, what does someone's terrible illness have to do with Ashura? Does the day of Ashura have some sort of healing process? No. Ashura, which is the story of the Exodus, is a story of hope. Just as the boots of the Egyptian taskmasters were brutal and bitter, so too can be the ravages of disease. It can, in fact, be as enslaving as the Egyptians were to the Hebrews. Just as it seemed almost impossible that the greatest empire on earth, Egypt, would yield to two men coming out of the desert, to free slaves that had been chattel for centuries, sometimes people can be so sick that the thought of recovery seems so far and remote.

Yet, with God, all is possible. With God, the Children of Israel were freed from centuries of bondage and the greatest force on earth was utterly defeated. The same is true with critical illness. There have been patients who have been so sick, that I thought for sure, death would overtake them. Yet, death never came. They gradually recovered and walked out of the ICU. Praise be to God. It is what I love about critical care medicine: it always keeps you honest, and it always reminds me that life and death is not in my hands, and I am quite happy and proud to admit that.

To mark Ashura, Muslims are encouraged to fast that day along with the day before or the day after. When I fast for Ashura it’s a big deal because, I really love my morning coffee, and it is hard to part with it outside of Ramadan. Yet, fasting to commemorate the Exodus is no problem at all, because the story of the escape of the Children of Israel is a happy one for me. Besides, fasting for my man Moses is the least I could do to honor his prophethood.

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