As I wheeled Chris off the elevator, he was quieter than the day before, definitely not in the mood for pranks. He didn’t complain—my husband never complained—yet he clearly wasn’t feeling as well.

Two steps forward, one step back: that still qualified as progress.

Rolling through the hospital hallways, following signs for Radiology, we passed several women wearing nasal cannulas and pulling oxygen-cylinder carts. The sight wasn’t remarkable in that the National Institutes of Health runs clinical trials on virtually every ailment—from the common to the rare, the treatable to the terminal. What was surprising was seeing a cohort of patients similarly afflicted, all female and relatively young.

At least they were ambulatory. When Chris’s doctor ordered a scan this morning, his nurse ordered a wheelchair.

During his first few days after readmission, Chris’s condition fell somewhere between depleted and God-awful depending on the degree of his sawtoothing fever. As his treatments—withdrawal of anti-rejection meds included—began to take effect, however, I’d sometimes arrive to find him sitting up in bed, looking comfortable and alert, like a patient soon to be released.

Towards the end of the week, his humor kicked in. After opening a colleague’s get-well card to find a droll reference to their firm’s new management—a buyout of the Rouse Company was but two weeks away—Chris reached for the bedside phone. When a recording advised him to leave a message, he deepened his voice and pretended to be the CEO. “This is John B—,” he said gruffly. “It’s come to my attention that you have a poor attitude about the merger.”

To me, the spoof was proof of recovery. To his friend, who didn’t recognize Chris in disguise, it was cause to call the head of security: Someone was impersonating the chief executive.

Come Friday, Chris remained frail despite signs of improvement. His nurse took me up on my offer to drive him to his appointment.

In the Radiology waiting room, we found two more women on oxygen therapy. After positioning Chris at the end of a row of seats, I took the one beside him. If silence had been a preference en route, now it was a prescription. No one spoke or made eye contact. No one leafed through magazines, for there were none. No one asked the time or glanced at their watch. It was as if chronic illness had instilled a monkish composure. Or torpor.

I was the only non-patient in the room, the Lucky One. As the others sat alone with their thoughts, I wondered what those might be. That three back-to-back tests followed? That with sick leave exhausted, the boss had to be told? That scrambled eggs might stay down? That last time the shadow had shrunk, so this time, well, don’t get too hopeful?

Or were they trying to avoid thinking, instead imagining doing something—anything—more agreeable? Strolling through the hill town of Assisi. Watching a Coen brothers film. Defending an IRS audit.

One of the women on oxygen finally had enough. Silence wasn’t a chance to grab a shot of mindfulness; silence was a looming endgame. By talking, she could ward off quietus. But she needed a partner.

“What brings you here?” she asked me, in a tone so warm and genuine that she might have been a greeter in a small-town visitors bureau.

She looked about forty, or a little older, but it was hard to tell; illness can age a person faster than a Broadway makeup artist. Although her appearance was middling in every respect—from her height and build to her facial features and shade of brown hair—her spirit was striking. Whether the vivacity was innate or cultivated for survival, she offered me what she desperately needed: a deep breath of fresh air.

“My husband needs an X-ray.” I glanced at Chris. He showed no sign of wanting to engage. Under the circumstances, it felt unfriendly, even hurtful, to not offer more. “He had a kidney transplant a few months ago,” I added. “Now he has mono.”

Immediately, another patient stood and left. Perhaps she went to the restroom, or realized she’d left her purse in the car. More likely, mononucleosis spooked her—even though it’s not an airborne infection.

I paused, realizing that my interlocutor might want to leave, too. She didn’t budge. “How about you?” I asked. In deference to patient privacy, I avoided the politeness of trading names.

“I need a double-lung transplant. There’s a group of us here who have the same disease. We get together every year.” She chuckled. “It’s like a reunion!”

Lymphangioleiomyomatosis, or LAM, is a rare condition that primarily affects women ages twenty to forty. Abnormal cells invade the lungs, as well as lymph nodes and kidneys, leading to reduced pulmonary function and respiratory failure. Treatments, including transplantation, can enhance the quality and duration of life but the disease is incurable. After diagnosis, life expectancy is usually ten to twenty years.[1]

Her disclosure was stunning. Not long ago, I wouldn’t have grasped the challenges she faced, merely to delay the inevitable. No longer.

One day she would lie in an OR, as we recently had. But unlike Chris, whose kidneys were allowed to fail in place, with one of mine nested beneath them, she would have both lungs removed to accommodate her grafts. No matter how damaged and inadequate, those lungs were infusing her blood with oxygen, ridding it of carbon dioxide, maintaining life. Temporarily, she might require a heart-lung machine and a ventilator; ultimately, she’d either breathe though the new air sacs or wouldn’t . . . breathe. If her grafts failed, there was no recourse like dialysis to sustain her.

In short, she would perform a death-defying, net-free launch from a trapeze with no turning back once she let go of the fly bar. Her odds of surviving even five years after transplantation were not much better than one in two.[2]

And that was if she got lucky. With the chronic shortage of deceased-donor organs, lungs might not become available in time. Although living donation was possible, she’d need two Good Samaritans, each providing the lower lobe of a lung.^⁠ They’d face a riskier surgery and longer recovery than kidney donors, which meant friends and relatives were less likely to volunteer.

A radiology assistant called Chris’s name. Together, they disappeared through a door leading to the imaging machines. Moments later, the woman was called, as well.

She’d shared no details about her personal life. She’d only spoken of her illness, which, understandably, had come to define her—from what lung-healthy products she could buy to how she should dress, walk, or perform daily chores, such as unpacking groceries, to minimize exertion. If she seemed compelled to tell me she had LAM, it was not because she sought sympathy; she struck me as someone devoid of self-pity. What she wanted was to be heard. To be heard is to be remembered.

In no time, Chris was back and we were retracing our route through the cold fluorescence of the corridors. As we entered an empty elevator, he said, “You shouldn’t have mentioned I have mono.”

“Why?”

“You saw the woman leave.”

“But she had a right to know. I’d want to know.”

I hadn’t meant to embarrass him. For that I was sorry. But I was as disappointed in him as he was in me. Chris was still “chesting” his health cards, as if this were a hand of bridge, with nothing but his pride at stake.

No doubt a gender difference was at work, a primal XY-chromosome trait, which he’d exhibited many times before: Never show weakness lest a contender seize the advantage—be that your mate, your kill, or your year-end bonus. According to such logic, illness fell between failing and fatal flaw.

A strategy suitable for the savanna or a boardroom, however, is counterproductive in a medical setting where any debility you don’t reveal is one that isn’t treated. The woman I’d just met understood the importance of communication, on every front, regarding her health. I was sorry that my husband didn’t.

And hadn’t.

At the same time, I was grateful. As we made our way back to his room, my mind unspooled a skein of “at leasts.” At least he isn’t suffocating to death. At least he can fall back on dialysis. At least he isn’t alone while undergoing treatment. At least his graft shows no sign of rejection. At least I haven’t had to kiss him goodbye outside an OR and wonder if he would return. At least both of us were able to presume we would return.

Counting blessings was my luxury, not Chris’s. Sick as hell, he was entitled to feel however he felt, unthankful included, with no obligation to parse his advantages relative to others.

Later that night, Chris’s doctor called me at home. He’d had Chris moved to intensive care. He spoke so calmly and matter-of-factly that I didn’t panic. In fact, the thought never occurred to me that every “at least” would soon count for nothing.

[1] National Heart, Lung, and Blood Institute, “Health Topics: LAM,” http://www.nhlbi.nih.gov/health/health-topics/topics/lam (accessed February 1, 2019).

[2] Organ Procurement and Transplantation Network, “National Data: Lung Kaplan-Meier Patient Survival Rates For Transplants Performed, 2008 – 2015; Survival by Single vs. Double Lung (Lung Only),” https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/# (accessed February 2, 2019).

East and West. Maybe it is not easy to draw straight lines where these two are clearly separated, and yet everyone has a conceptualization of what is meant when this distinction is proposed. While some circles try to delineate the differences and polarize societies on the basis of “us vs. them,” there are others who prefer to highlight commonalities, shared pains and joys, the benefits of interaction, and an inevitable future of less separation and more coexistence.

One dynamic of our shared society that will shape such a future is migration. Migration is a reality of the human condition. Throughout history, migrations, be they mass or individual movements, have not only shaped our societies, national borders, languages, religious traditions, and of course, identities, but have also been a major catalyst for disputes and conflicts. Hence, for the last several years, the US has been debating whether a wall should be built across the Mexican border; we continue to watch the heart-breaking tragedy of thousands of refugees rowing across the Mediterranean; the ongoing plight of Syrians fleeing their country’s violence; and more recently, the forced migration of teachers, doctors, and civil servants affiliated with the Hizmet Movement from Turkey, their homeland, where they have suffered persecution for the last few years. Due to many reasons, including geographical, historical, and colonial ties, Europe has been one of the major destinations for those seeking freedom and a life of security, especially for many Muslims. Akbar Ahmed’s book Journey into Europe: Islam, Immigration and Identity (2018) is one of the most comprehensive researches into this very complex social phenomenon. In this issue, Behzad Fatmi from India reviews Ahmed’s book and explains how the author dissects the fundamental character of European society vis-à-vis the place of Muslim communities in the continent.

Learning theoretically about diseases is surely important. But having a first-hand experience, or at least spending time with those who suffer from a disease, teaches much more than what one can learn from books. Ceyda Sablak shares her experience with some patients who told what they have been through with Amyotrophic Lateral Sclerosis (ALS). She writes how important it is to have an accurate and concrete diagnosis, even if it turns out to be a terminal illness. While it is painful to go through such an illness, it is no less of a burden on the shoulders of doctors and the family who have to be present next to their loved ones and do as much as they can to continue to care for them.

Life, illness, and death are basic human conditions. But at the same time, it is a very individual decision which specific meaning you ascribe to these elements. These meanings also affect the behavior patterns of our life and its consequences. Ascriptions of meaning can – considered without any judgment – be of religious, nationalist, pluralist, and atheistic nature, or be supported from the symbiosis of several ways of thinking.

In the training of health care professionals and in public lectures, the author of this article noticed that illness has a very negative image: the color which stands for physical and mental discomfort is a deep black, while shiny white is the color of health. Consequently, modern medicine therapies have been developed that do not necessarily try to diagnose the causes of diseases, but most of all combat the declared enemy. For this purpose, high-dose drugs, radiation and other weapons are out in the field, according to the motto: attack is the best defense.

The doctors make every effort to win the battle, but there is a risk that the emotional state of the ill person falls into despair – because it is taught to him that his new physical condition is an unnatural, undesirable condition. Thus, a melancholy forms, which reduces the quality of life dramatically. The patient regards the illness as invincible.

In the following, I will present some perspectives that renowned scholar Said Nursi (d. 1960) demonstrated decades ago. They are still powerful today. In my opinion, they harbor the potential to raise the quality of life not only of the ill, but also of healthy people.

In his treatise “The Twenty-fifth Gleam: 25 Remedies for the Sick”¹ Said Nursi throws 25 views (Turkish: Deva² ) on the phenomenon of illness. His outlook could assist in transforming the negative picture of illness into a positive one.

What makes a shift in perspective so important?

Anyone who prepares himself while he or she is a healthy person, if they later catch a more serious illness, will benefit from this text. Nursi’s thoughts on the meaning of illness and potential remedies can play an important role in preparation. Those who internalize his message can help prevent the emotional fall into depression and may instead hope for a cure.

Said Nursi’s first view presents its readers with the understanding that illness should not be seen as a problem that brings bitterness into life, but that you can also draw strength out of it. There may, as said before, be different ascriptions of meaning to human life, but ultimately all people agree that life is something precious and offers a variety of opportunities. The direction of our lives depends on which use we make of these opportunities.

Those who consider illness as something negative will experience every illness as a curse. Such an attitude has a negative impact on the patient and their environment and turns them very pessimistic. They might castigate themselves, and ask questions like: “Why is it me of all people who has ​​this disease?” In extreme cases, this can lead the patient to become delusional and withdraw from society. A shift in perspective, however, can release positive energy and let sorrow and pain melt away.

Those who recognize the opportunities offered by life and appreciate the efforts and labors of everyday life as something positive will concede that even diseases have a meaningful function – for themselves and humanity as a whole.

Nursi says that ill people perceive time differently, which enables them to observe their environment from a more passive perspective. This passivity is supposed to tear modern, urbanized people from the hustle and bustle of everyday life and move them to a pause. It decelerates the lives of those affected and leads them to horizons healthy people find difficulty to access.

Nursi’s second view goes to the role of prayer which he defines in two forms: positive and negative prayers. He refers to prayers like ritual worship, fasting, supplication, and other forms of remembrance as “positive” (müspet) prayers. “Negative” (menfi) prayer on the other hand is attaining awareness and knowledge of one’s own vulnerability and mortality – which is more likely to arise in moments of illness rather than any other time – as a result of which one turns to God in praise of His ultimate power and infinity. Nursi signifies these positive and negative prayers as the second remedy.

The insight into our own transience, which is the third remedy, allows the ill person to recall their past mistakes, many of which might have been forgotten, and allows them to reconcile with themselves and their fellow humans. According to Nursi, this allows a person to realize they are not as perfect and as infallible as they thought. Illness makes people honest: honest with themselves and with others. The confession of the own fallibility is tantamount to an admission of human weakness and mortality.

Viewed from this perspective, the question arises as to whether illness itself is a cure for mankind. It conveys us new views and leads us to reconsider our previous positions. The ill person becomes an observer, and he finally has time to start thinking. As said by Nursi, he realizes that mankind may be considered the crown of creation. But man’s frailty, his aging, and also the health problems of other people make him realize that life on earth is not all there is – a realization that opens his eyes and takes him out of the darkness into the light. Becoming aware of one’s mortality takes away any thoughtlessness. It causes a person to shed laziness and reflect on their obligations.

If the patient manages to do so, they will feel gratitude and be patient, not least in dealing with physical ailments. This gratitude and patience is what Nursi refers to as the fourth remedy. For Nursi, the body is not the property of man, but rather a loan, which he may not dispose of freely. Suffering is to be endured, since it can do some good, too. Nursi characterizes it as a kind of bonus, which God the ultimate owner of our body grants to us, and we should not protest against it.

Chronic diseases or disabilities, which are seen very negatively in today’s society, can be reinterpreted positively in this way because, as Nursi asserts, they bring a gain in knowledge compared that we cannot achieve when healthy. As a result of their illness, they understand new things that healthy people cannot, just as blind, deaf, or dumb people perceive their environment differently, and sometimes more sharply, than people without physical limitations.

Each person strives for well-being, mercy, and forgiveness, and every sorrow and misfortune also harbors rays of mercy in it. From behind the veil of the illness many quite pleasant insights can emerge. A new consciousness arises, and thus many people gain the courage to take risks and reposition oneself in life.

This maturity Nursi describes as the fifth remedy and it can be observed especially in young ill people. Because of their illness, and in contrast to their peers, they have to cope with issues that seem to contradict their youth. They do not fall into the typical noise of youth and are relieved of thoughtlessness and of the pressures of everyday life.

From this point of view, health, for some people, can be even a calamity that can make their heads spin and blind, and lets them lose sight of the fact that their life does not last forever.

Conclusion

Even these first 5 of 25 views on the subject of illness show that not everything, which is interpreted as negative, is actually negative. A shift in perspective can often work wonders.

Nevertheless, such a shift in perspective appears quite disconcerting initially in our modern society in which health equals to a gift and illness to a disaster. If we have considered diseases as the enemy for so long, why should we suddenly welcome disease? A notion that a disease may also enrich the patient and their friends and family is a useful approach. Surely, the thought that positive thinking can influence the illness (coping), and even contribute to the healing process, is quite common. However, the angle shift described by Said Nursi goes much further. And in my eyes, there is no doubt that it is able to significantly improve the quality of a patient’s life and environment.

Illness allows ill persons to pull out from everyday life, at least for some time. Thereby, it gives them new insights and opens doors that probably would have remained closed if they had stayed healthy. Illness allows a refocusing of which we can benefit from as individuals and communities.

Erdogan Karakaya is pursuing a master’s degree in history in Heidelberg, Germany.

Footnotes

1. Nursi, Said. 2009. 25 Remedies for the Sick, the Twenty-fifth Gleam, NJ: Tughra Books.
2. Deva in Turkish actually means cure, resort, and solution. In this article it is also understood as view or view angle.

“Food safety” and “food terrorism” are two significant terms in the food health research. While the former stands for the unintentional contamination of a food product, the latter refers to its intentional contamination, thus a crime.

“From farm to fork” defines the entire process of food defense strategies in the protection of the food supply. It is even more critical in today’s environment, where productivity has a heightened sense of urgency. Many contamination problems that have occurred in growing numbers recent years are in fact preventable unintentional problems; nevertheless, an intentional problem, whose nature and scope are not well known, is not unlikely.

Harmful agents are easily dispersed via food, because factors like strong flavors, strong odors, various textures, or intense colors make the harmful agents invisible. There are hundreds of biological pathogens, toxins, heavy metals, parasites, radioisotopes that naturally occur, as well as many genetically-engineered organisms in addition to 80,000 chemicals that can cause illnesses in their proper concentration. Due to multiple points of accessibility during the manufacturing process and its distribution across great distances, foodborne illness have the potential for widespread impact, which necessitates preventive actions.

Food terrorism is defined by the World Health Organization (2008) as “an act or threat of deliberate contamination of food for human consumption with chemical, biological or radio nuclear agents for the purpose of causing injury or death to civilian populations and/or disruption of social, economic or political stability.” Food terrorism brings unique challenges. Increased food inspection, disease surveillance, laboratory capacity, and awareness among health professionals and the general public are required to assure food safety.

Warring armies targeted civilian food supplies in the past in order to intimidate the enemy. The first known bioterrorist attack happened in 1984 in the USA by members of a religious cult who contaminated salad bars in Oregon, USA with Salmonella typhimurium, causing 751 cases of Salmonellosis. This initial attack was a trial run for a more extensive attack intended to disrupt local elections.

Another case took place in 1996 in Texas, in which an unsatisfied laboratory worker contaminated bakery goods with Shigella dysenteria type 2, causing illness in 12 people.

Although few incidents of food terrorism have been documented, it is prudent to consider basic countermeasures. We can estimate the potential impact of the deliberate sabotage of food by extrapolating from the many documented examples of unintentional outbreaks of foodborne disease. As recorded in the WHO 2008 report, the most well-known incidents include the following:

– Shanghai, China. 1991. Probably the largest foodborne disease incident in history, this was an outbreak of hepatitis A that was associated with consumption of clams. Nearly 300,000 people were affected.

– United States. 1984. 224,000 people in 41 states were affected from an outbreak of S. enteritidis infection from contaminated pasteurized liquid ice cream that was transported as a pre-mix in tanker trucks.

– Japan. 1996. 8,000 children, some of whom died eventually, became ill with Escherichia coli O157:H7 infection from contaminated radish sprouts served in school lunches.

– Turkey. 2004. 96 people in Afyon, Turkey, became ill with Salmonella typhimurium and Shigella dysenteria.

Potential effects of food terrorism

It goes without saying that a deliberate attack with a dangerous agent can be devastating, if one kind of food can infect as many people as in the figures given above. The impact of such an attack will obviously be on the public health, economy, and may even cause political destabilization. Under such an attack, public health services are likely to halt, as they are not prepared to respond effectively in many countries, for their emergency plans do not usually cover food terrorism, and this may lead to errors in diagnosis and in the identification of the infected food.

Economy is also one of the major targets in food terrorism. Large-scale economic loss and disruption of trade with major impact on tourism are some of the most likely objectives of attacks. An example to a domestic-food related health issue becoming a global economic issue is the infamous mad cow disease, or bovine spongiform encephalopathy (BSE), which caused public reaction and the refusal of importing USA beef in Europe and Japan in 2003. 10 thousand tons of frozen ground beef was in recalled in the USA in 2007 because of E. coli O157:H7 contamination. The USA and Canada banned the import of Chilean fruit in 1989 on the grounds that Chilean grapes were allegedly contaminated with cyanide. This ban resulted in a damage of several hundred million dollars, loss of jobs, and bankruptcy involved in this trade.

Another goal behind food terrorism is to generate panic and disrupt civil order. The anthrax attack through the mailing of an envelope showed that the dissemination of biological agents, however simple the means may be, can still cause public anxiety reducing confidence in the political system and government.

According to Dr. Richard Lee, there are only a few methods to weaponize food:

To contaminate, to adulterate, or to take it away. Chemicals or infectious pathogens can be added at various points along the food path, including using water as the vehicle. The longer the distance between the gourmet and the point of adulteration, the more specialized the adulterant must be in order to be viable or to be toxic when eaten by the consumer.

The figure below adapted from “Food as a Weapon” by Richard Lee et al. shows the possible ways of food contamination/adulteration, which can be a road map for us to take in preventive actions in each step of food production.

In order to reduce the burden of foodborne diseases, the food safety systems in many countries are intended to ensure the safety of the food supply, and thus reduce the burden of foodborne diseases. These often include safety management programs for food production, processing and distribution, which can be modified to incorporate basic consideration of food sabotage. The food industry has the primary responsibility for assuring the safety of the food they produce; government agencies, working with the private sector, have regulatory and advisory responsibilities in promoting safe food practices by industry, such as good agricultural and manufacturing practices.

With the globalization of the world’s food supply, an attack on one country’s food supply cannot be viewed in isolation. Thus, governments must work together against food terrorism with the support of agencies like World Health Organization. Developed countries have various levels of food safety infrastructure and alert and response systems, and they will likely require strengthening to meet the new threat of food terrorism. In its review Terrorist Threats to Food WHO suggests that whether a food safety management program, such as HACCP (Hazard Analysis and Critical Control Points), “is rudimentary or well developed, further elaboration should focus on the nature and extent of the threat. When suspected or adulterated food reaches the consumer, the potential consequences to public health, the economy and social or political stability must be managed by an effective, rapid emergency response system. In most cases, existing systems for surveillance, preparedness and emergency response will need to be strengthened to increase their ability to address food terrorism. Without such improved systems, a food safety incident is more likely to escalate, or be perceived to escalate, into a food safety emergency” (p. 20, 11).

It should be kept in mind that food safety is not only the government’s job but each individual’s responsibility. Everyone should be careful to obey and enforce the regulations for food safety. Since it is not possible to monitor each individual all the time, it is important to educate individuals to use their conscience/spiritual/humanistic attributes to maintain food safety at every phase of production. In a saying of God’s messenger, “The believers are those, from whose tongues and hands others are safe and sound.” We should digest and promote this principle to create a society of trust committed to living in peace and comfort.

Hayriye Cetin Karaca is Graduate Research Assistant at Animal and Food Sciences, University of Kentucky.

References

Centers for Disease Control and Prevention. http://www.bt.cdc.gov.

Demirdal T, Demirtürk N, Aktepe OC. “Bir universitede saptanan besin zehirlenmesinin incelenmesi”. Trakya Universitesi Tip Fakultesi Dergisi. 2007; 24(3):205-8.

Lee, Richard V., Harbison, Raymond D., Draughon, F. Ann. “Food as a Weapon.” Food Protection Trends. 2003; 23(8):664-674.

Tauxe RV. “Emerging foodborne diseases: an evolving public health challenge”. Emerging Infectious Diseases. 1997; 3:425-434.

U.S. Department of Agriculture Food Safety and Inspection Service. Food Safety and Security: What consumers need to know. http://www.fsis.usda.gov/OA/topics/foodsec_cons.pdf.

U.S. Department of Health and Human Services, Terrorism and the Food Supply. 2005.

U.S. Food and Drug Administration. FDA introduces new technology to improve food security, 2003. http://www.fda.gov/bbs/topics/NEWS/2003/NEW00960.html.

World Health Organization (WHO), Department of Food Safety. Terrorist Threats to Food. 2008.

Walking into patients’ rooms during random visits always demands courage, self-esteem, and a positive outlook, together with a strong sense of spirituality. But chaplains learn early on to overcome a fear of rejection when they initiate a visit, enter a hospital room and experience a patient who opens their heart in a slow but sincere manner.

Some people think it is about religion. But I found that people accept or reject a chaplain’s visit for a variety of reasons. Religion often never enters the conversation. Chaplains are, in most cases, expected to leave that part to the patients. We just carry them wherever they want to go. Sometimes people respond that they are “Okay that way,” which I interpreted as having their own way of meeting their spiritual or emotional needs. For many, loneliness was one of the main reasons to accept, and anger, the main reason to reject a visit from a chaplain.

In the emergency room, when doctors put forth their greatest efforts to save a patient’s life, death is oh so near. How this death, which we always imagine as being a million miles away from us, so close at that moment? I reflect; “Am I in the same room with the angel of death at this very moment?” The reality of death removes all blocks between the chaplain and the patient; it brings us back to our humanness and our primordial state in front of God.

I encounter lonely, elderly men. These were once tough men, brave men; men who fought in our country’s wars. They were hard workers, often at menial jobs done sacrificially to provide for their families. Most never knew how to express their emotions. Many of them, shattered by the horrors from fighting in wars and suffering family tragedies, needed to be heard. It is a privilege to be the one listening to their stories and moved by a compassion that was never before experienced.

It is not often that any of us witness older men shedding tears. In the privacy of our visit, they voiced their doubt, fear and anger. “No one should ever have to see what I saw, what I was involved in. God – where was God then?” My heart would be crying out to God, “How do I respond? What do I say?” They were asking difficult questions that deserved more than a glib reply. I did not possess the words or the compassion in my own strength. I needed to increasingly rely on God in my encounters. I too wondered “why” and felt their fear and frustration. I listened. I know “God works all things for the good for those who love him” (Romans 8:28). Yet, meeting these men and women, voicing their prayers and concerns to God with them, I grieved.

A life-threatening illness grants a saint’s wisdom to the most vulgar person. Not an automatic or an easy transition, but it cultivates the soul gradually, inch by inch. Since the time Albert learned about his cancer, he has been seeing through a different lens; “All my accomplishments, my goals and ambitions meant nothing for me in seconds when I learned that I had cancer.” Lost is the pleasure of health, and the reality of life and death are finally under daylight. The sick person has the longest time in the world to reflect on this.

Anxious and distressed, an old lady complains that the young do not understand the suffering that old age brings. “Why does God, whom we know as merciful and compassionate, let us suffer?” is a common question among the sick. Some patients are angry with God. Their inner struggle covers up the beauty behind the illness. Yet, it is not ours to correct anything too fast. Their feelings are precious. Acceptance of God’s will can eventually follow the anguish, uneasiness and questioning in the beginning of illness.

To say that life sometimes hurts and is often unfair is an understatement. And it does not satisfy the “why” questions. Facing what is a major fear of all people, the loss of all we hold dear – abilities, youth, dreams, beauty, wealth, pride, fame, life itself – we can only listen.

They see with the eye of certainty and I come to understand with them, that our bodies are prone to separation and death; and the pleasures of this world do not continue. This warning is very bitter and painful at first, yet then it becomes beautiful. We should remember that we are mortal; we have a duty in life and we should prepare well for the next life. It is said that a good friend is harsh but honest. So is illness, it seems.

Sometimes being around patients’ sadness, fear and hopelessness day after day is depressing. But the most draining encounters are with the ones who have turned completely away from God. I honestly grieved for those, who in their times of terrible tragedy, seemed to feel no need for God.

Amidst the dark thoughts, I hear a patient reminding me that life is not only about sickness, but it is a reflection of God’s beautiful Names in miscellaneous ways. I happen to see only the sad part of patients’ life stories, as a chaplain, but that is not all. “Just as, through hunger, you learn of His Name, the All-Providing, so too through your illness, you come to know His Name, the All-Healing.” Thoughtful as he is, Jack says: “I might have cancer now, but I appreciate life in general; there is so much that I am thankful for. Just one big thing that I learned from my sickness: I never thought that I took life for granted. But now, I understand that I did.”

Arthur Frank, a former cancer patient and the author of At the Will of the Body, says there is a problem with the view that physical recovery is the ideal ending of illnesses. He asks “if recovery is taken to be the ideal, how is it possible to find value in the experience of an illness that either lingers on as chronic or ends in death?” Along the way of a health problem, there is the opportunity for spiritual transformation and renewal. This renewal, as a result of physical illness, is the ideal. Either an illness ends with death or not, but one should be aware that there is more than pain that one can receive from illness. From Job we learn, “Shall we accept good from God, and not trouble?” (Job 2:10).

I feel that this man who became poor-looking and weak in the hands of his illness was one of the fortunate ones, as he benefited from this gift of his serious illness. While some of his fellows become neglectful and forget God Almighty through the calamity of good health, this man’s long talk was only about God’s beautiful Names. His illness is good health while for some of his peers good health is a sickness.

Listening to patients is the most valuable gift that one can offer them. Asking questions to make patients talk is one major task of a chaplain, and preaching is not a way to reach out to them without truly understanding their problems. Who would care to listen to any advice without given the right of being heard? As I listen to the words of wisdom pour out of this very old man, he reprimands me and says “You’re the one who should be preaching to me, but here I am preaching to you.” Yet I smile at these words of comfort about God’s love and our need for Him. And I remember the verse: “Those who say when afflicted by calamity: “To God do we belong and to Him is our return” (Qur’an, 2:156).

Lucinda Miller is ordained in the Free Methodist denomination and is now serving as a hospice chaplain. Gulsum Kucuksari is in the process of completing her PhD in Islamic Studies at the University of Arizona.

Notes

1. Said Nursi. The Gleams, Twenty-Fifth Gleam, NJ: The Light, Inc., 2008, p. 292.
2. Ibid.
3. Ibid. p. 293.

Bediuzzaman Said Nursi reveals the beauty and purposes behind these seemingly ugly events in the “twenty-fifth flash”¹ with twenty-five remedies. Almost every remedy starts with a warning sentence advising “patience and thankfulness”; the reason for this is that a person who tries to understand everything without a strong belief in God and in the Hereafter feels impatient and will often complain. At first sight, the statement “An illness is not a malady; it is a cure” strikes almost everyone as paradoxical. Life is the most important asset that one has in this life, and it has a purpose. Life will pass very quickly in ease and heedlessness without bearing any fruit; illnesses and calamities slow time down, and give room for life to yield its fruit. This helps prevent us from wasting our lives.

To show a given situation in all its clarity Nursi considers all possible aspects of it. When we are ill or struck by a calamity we implicitly assume that a right has been taken from us; yet it is at this difficult time that we are asked to be patient and think of the positive side of what has happened. However, this is not all. When the situation is considered from a more fundamental point of view, it becomes clear that a person has no right to complain if they truly understand that they are not even the owner of their own selves:

“It is your duty not to complain, but to offer thanks and be patient. For your body, organs, and faculties are not your property. You did not make them and you did not buy them from other workshops. That means they are the property of another. Their owner has disposal over His property as He wishes.”

The purpose of the above statement is not to close the matter at this point, leaving no room for further discussion, but to make it clear that, there is no justification for any complaint and the All-Compassionate God will reward those moments of illness and tragedy lived in tranquility and patience, as Nursi states:

“Through the calamity of good health, some of your fellows become neglectful, giving up the five daily prayers, not thinking of the grave, and forgetting God Almighty. For the superficial pleasure of a brief hour of this worldly life, they shake and damage a never-ending, eternal life, even destroying it. Through illness you see the grave, which you will, in any event, enter, and the dwellings of the Hereafter beyond it, and you act in accordance with these. That means that for you, illness is good health, while for some of your peers good health is an illness…”

Ironically, the passing of pain is a pleasure, and the passing of pleasures is a discomfort, a constant sorrow left in the spirit. Even some pleasures that only last a day or a few minutes will sometimes cause a suffering that lasts years. It is not difficult to find an example of this; the use of drugs is an obvious parallel. The purpose in this life is to know our Creator and to prepare ourselves for an Eternal Hereafter, yet there are many distractions on the path. Illness gives us a warning: “Your body is not composed of stone and iron; it is made up of various materials which are always inclined to decay. Stop being proud, understand your impotence, recognize your Owner, know your duties, and learn why you came to this world!” This is what is secretly declared to the heart.

Everything is understood by its opposite. Light would not be known if there was no darkness. “If there was no thirst, there would be no pleasure in drinking water.” And as for illness, Nursi gives the following beautiful comparison: “If there was not this illness in your head, or in your hand, or stomach, would you have perceived the pleasurable and enjoyable Divine bounty of the good health of your head, hand, or stomach, and offered thanks? For sure, not only would you not have offered thanks for it, you would not have even thought of it! You would have unconsciously spent that good health on heedlessness, and perhaps even on dissipation.”

The All-Compassionate God from His mercy forgives the sins of the ill believer; this can be found in a authentic hadith: “As ripe fruit falls from the tree that is shaken, so too do the sins of a believer fall with his shaking in illness.”² What can be better news for a believer than this? With patience and by not complaining, one can transform a passing illness into everlasting health. Said Nursi gives the most fundamental and important cure: “Thus, the first thing you have to do is to search for the cure of belief, which is a healing remedy that is sure for the innumerable illnesses of that infinitely wounded and ill, yet extensive immaterial being of yours; you have to correct your beliefs, and the shortest way of finding such a cure is to recognize the power and mercy of the All-Powerful One of Glory by means of the window of your weakness and impotence; this has been shown you from behind the curtain of heedlessness, rent by your physical illness.”

Death plays the main role in causing pain, fear, and anxiety, as this is where illness may lead. Hear Said Nursi as he warns: “So know firstly and believe firmly that the appointed hour is determined and does not change. Those weeping beside the grievously ill and those in perfect health have died, while the grievously ill have been cured.” Moreover, for a believer, death is not a terrifying end; rather, as clearly shown through magnificent analogies in Nursi’s other masterpiece The Words, death is: “…to be discharged from the burdensome duties of life. And for them it is a rest from worship, which is the instruction and training in the arena of trial of this world. It is also a means rejoining friends and relations, ninety-nine out of a hundred of whom have already departed for the next world.”

The fifteenth remedy is of special importance, because it takes the whole issue to a different platform and shifts the perspective from being focused on merely being “patient and thankful” to establishing the social status of those who are ill and in hardship. The following hadith illustrates this: “Those afflicted with the severest trials are the prophets, then the saints and those like them.”³ That is, “Those most afflicted with tribulations and difficulties are the best of men, the most perfect.” In the same remedy, Nursi also mentions that some illnesses that cause death are a type of martyrdom.

The duty of the people around those who are ill is to look after them with compassion, and to visit them without being a burden. These hard times not only produce all the rewards mentioned above for the person who lives through them, but for the believer around them if they know their responsibilities: “To please an ill person’s heart and console him is like giving alms. Fortunate is the person who pleases the easily touched hearts of the father and mother at the time of illness, and who receives their prayer.”

All the remedies that Said Nursi proposes are focused around one issue, which is a strong belief in God, and the Hereafter. This belief shows its effect when one carries out one’s religious obligations as much as possible. This is a belief that will save a person from heedlessness and ignorance, and that will prepare them for the appointed time, which is a door to the eternal life; a belief that will transform the ugly faces of illnesses and calamities to the beautiful faces of eternal life in the gardens of Paradise.

Footnotes

1. The quotes are taken from, The Flashes Collection by Bediuzzaman Said Nursi, Sozler Publication, Istanbul 1995, pg 266-285
2. Bukhari, Mardha 1,2,13; Muslim, Birr 45, Darimi Riqaq 57.
3. Bukhari, Mardha 3; Tirmidhi, Zuhd 57

Yes, illness utters this warning to us: “Your body is not composed of stone and iron, but of various materials that are always disposed to parting. Leave your pride, understand your impotence, recognize your Owner, know your duties, learn why you came into this world!” It declares this secretly in the heart’s ear.

Moreover, since the pleasures and enjoyment of this world do not continue, particularly if they are illicit, they are fleeting, full of pain, and sinful. Do not weep on the pretext of illness because you have lost those pleasures. On the contrary, think of the aspects of worship and reward in the Hereafter to be found in illness, and try to receive pleasure from those.

The disease affects otherwise healthy individuals, usually young adults, with multiple lesions of the central nervous system. These lesions result in problems with co-ordination, slurred speech (dysarthria), numbness, paralysis, urinary incontinence and blindness. Sufferers often do not know which part of the body it will attack next.

Although humankind have made great advances in many areas, they have made little progress in understanding the brain and its operations. The starting point for understanding multiple sclerosis or any other neurological illness is an examination of the smallest unit of the brain, namely the nerve cell or neuron. The neuron is made up of a cell body (called a soma) and one or more long processes – a single axon and dendrites. The structure resembles tree trunks growing from a frizzle of roots (see diagram).

The roots, called dendrites, serve mainly to receive incoming messages from other neurons. The trunks, known as axons, transmit the messages and are covered with fatty insulating sheaths. These myelin sheaths are the focus of research into MS. The myelin contains a protein referred to as myelin base protein (MBP). Deterioration of this myelin sheath, particularly the MBP, is characteristic of multiple sclerosis. The myelin ensures that the electro-chemical charges communicated by the neurons are transmitted efficiently. If the sheath is damaged, signals ‘leak out’ causing the slurred speech, numbness, etc., associated with MS.

There are several approaches to dealing with MS. We can try to understand why the sheath becomes damaged in order to work out how to repair it. We can experiment with animals (typically rats), in whom MS-like symptoms have been induced, and search for a vaccine. Also, we can look to the body’s own healing system and try to understand why (for example) children do not normally get MS and whether the body can reverse the process ‘naturally’.

Whatever approach we take, we will never find a permanent cure unless we understand the complexities of the brain. So far, we have come nowhere near even a partial understanding of this marvel of creation. Fortunately, understanding all of creation is not a pre-requisite of searching for a cure.

One approach, as we noted, concentrates on finding ways of repairing the myelin sheath. This idea would have been unthinkable even a few years ago. However, in 1993, Charles French-Constant, at the Centre for Brain Research, identified re-myelination, that is, a reversal of the process, in newly formed lesions of sufferers experiencing the early stages of the disease. It appears that the body tries to regenerate itself but, with most MS sufferers, it is unable to do so fully. The basis of French-Constant’s research is that this regeneration might be enhanced if a chemical trigger could he found to improve the limited capacity for healing. His work starts by looking at the natural healing processes. Repairing even only 5% of the damaged nerve fibres would bring considerable relief to a large percentage of MS sufferers. For example, it could eliminate most bladder malfunctions related to MS. In effect, the disease would appear to he ‘contained’.

Humans are born with all the brain and nerve cells they are likely to need during their lifetimes. Throughout the life of living organisms, nerve cells die. If the cells which lead to the sheathing of the nerve cells could be found in an inactivated state in MS sufferers, and then encouraged to migrate, proliferate and repair the damage caused by the degeneration of the myelin, the processes of remyelination could be encouraged. The body would heal itself.

Research to identify the origin of the cells which end up insulating the axons began in the l98Os on rats. This work with rats suggests that these cells may still be present in fully developed adults, However, optimism must be cautious. As with other experiments, early results with cats have shown that scaling-up results is not always straightforward.

Even if the right cells can be found in the body, creating the correct chemical environment for regeneration is still going to be difficult. Another problem is that even if remyelination can be encouraged, this does not necessarily mean that de-myelination has been halted. The disease has to he attacked from both directions.

The new ‘vaccine’ about to be tried in America was developed by David Topham of St Jude’s Hospital in Memphis, Tennessee. Instead of trying to support the regeneration of the myelin, he attempts to stop the process that attacks the myelin sheath.

The body’s immune system, primarily in the form of T cells, naturally attacks antigens from viruses and bacteria which are seen as foreign organisms. In multiple sclerosis, the protein of the myelin sheath (MBP) is mistakenly attacked in the same way as an antigen might be.

In the early l980s, researchers found that they could reduce the number of cells which attack the myelin in a MS type illness in rats by inoculating them with inactivated T cells. In 1993, Jingwa Zhang managed to demonstrate a similar pattern in six humans using their own weakened auto- reactive T cells (Science, 261, p.145l). This was based on ‘naturally occurring cells’.

Bill Blackmore, at the Cambridge Centre for Brain Research, has been attempting to culture cells from donors. Others at the Centre have taken cells from patients in the early stages of re-myelination, cultured them in a laboratory and, after a severe attack, reintroduced them along with the necessary growth factor into the damaged area. This has the advantage that rejection is less likely.

A more controversial approach uses post-natal tissue. Cultured fetal tissue has been used in Sweden and America in an attempt to treat Parkinson’s disease. But this procedure raises a number of serious ethical questions.

Any significant breakthrough in the treatment of MS is likely to have implications for the treatment of arthritis. This is what is hoped for with the latest attempt to find a cure. Earlier this year, 300 Americans suffering from severe rheumatoid arthritis were treated with a drug which aimed to ‘re-educate’ the T cells. It was hoped that this would result in them protecting the relevant cells rather than destroying them. The manufacturers claimed that four people were completely cured of the illness. The results were encouraging. A peptide produced by Topham, the developer of the latest vaccine, has already been used on joint tissue by other research groups.

These attempts to ‘cure’ MS may produce results, but all the researchers will admit that the central problem is lack of knowledge about how the brain operates. Much of the nervous system is still a complete mystery. The search for a cure will continue to go on. There is a cure and we have to search for it, for we have been assured that ‘for every illness there is a cure’.

I once asked an Austrian friend of mine who had just qualified as a doctor where he went when he was sick. The surprising answer was that he and most of his colleagues went to a homeopath. He reminded me of our family G. P. who didn’t believe in medicines. I was told ‘just take your son home and make sure he eats well’.

My friend’s preferring a homeopath to one of his fellow professionals, was as I later found out, a rejection of what he had learned during his many years of study. He felt that he had been taught a set of beliefs, which, in his words, ‘did more harm than good’. He believed that he had been trained to ‘manage symptoms using chemicals’ and that his profession had nothing to do with looking for cures or curing people. He told me that he felt dirty when he had finished his shift and that he wasn’t being ‘true to himself’.

My friend may be an exception and is probably frowned upon and dismissed as a crank by other doctors, but, his views raise many interesting issues relevant to professionals and non-professionals alike.

There is an increasing interest in alternative approaches to health. The rise in health shops and alternative clinics show that the world of commerce is cashing in on this fact. Most bookshops stock books on acupuncture, homeopathy and other forms of Eastern medicines. However, the West’s search for an alternative has overlooked the medicine of the Muslim world, sometimes referred to as al Tibb al Nabawi, the medicine of the Prophet or Islamic medicine.

At Tibb al Nabawi

The name al Tibb at Nabawi literally means prophetic medicine. It is based upon the sayings of Muhammad, upon him be peace. However, it encompasses much more than the relatively small number of prophetic sayings. It incorporated Greek and Indian philosophy and practice wherever they were found to be in accordance with the general principles of Islam. The sayings of the Prophet set down general guidelines and principles which later led to the great discoveries and observations of the likes of Ibn Sina and other Muslim thinkers.

This series of articles will be an introduction to some of these principles.

Illness

The word illness, mard, is used in the Qur’an in two different ways. ‘It is no fault in the blind nor in one born lame, nor in one afflicted with illness (mard)’ (Al-Nur, 24.61). This example and the verses like it give special licenses to one who is sick. These licenses include delaying the compulsory fast and not having to fight during wartime. Verses such as ‘and any of you who is ill or has an ailment in his scalp should in compensation either fast or feed the poor’ (Al-Baqara, 2.196) which refer to the sick pilgrim not having to shave or cut his or her hair, led Muslim scholars to attempt to find a legal definition of the word mard illness.

The jurists set out the basis for practical diagnosis. They identified the means by which one could judge illness which included irregularities in the blood, urine, stool, and semen; imbalance in patterns of sleep, eating and drinking and the appearance of wind, sneezing and vomit.

Illness was defined as being ‘out of balance’. This encompassed both physical and mental states. The mental or emotional state is the second usage of the word mard in the Qur’an. ‘In their hearts is a disease (maid)’ (Al-Baqara, 2.15) The heart (qalb), here, refers to ‘the seat of the emotions’, Physically, one is considered to have an illness if one is ‘out of balance’. Likewise, one is emotionally sick if one is out of the natural and pure state that we were created in.

Doctors are needed for some of these emotional and physical illnesses; for others they are not. Tiredness is a symptom of being ‘out of balance’ which can be rectified simply by sleeping.

Islam sees the ultimate curer of these states to be the One who created them. He sent doctors to His creation such as Jesus who cured the leper as well as those suffering from pride and inflated egos. The last of these great doctors was Muhammad, upon him be peace, who, through his advice and practice, set out principles for curing both types of illness.

The state of balance

Common to many systems of alternative medicines is the concept of ‘balance/imbalance’. One’s natural healthy state is a balance between the four qualities of dryness/wetness and hot/cold. The reason a person may have left this state can be either ‘material’ or ‘consequential’. Material sickness is where a substance has entered the body and has caused its balance to shift in one of the several directions. Once the substance is gone the body will return to its natural mizaj, the model of balance.

A ‘consequential’ illness is where the effect of a substance in the body remains after it has left the body. The body is left with an excess of heat/cold or dryness/moisture.

Prophetic medicines sees illness as being caused by either this state of imbalance or damage to an organ or to the natural weakening caused by old age. The doctor’s first job is to discover the cause of illness, consider its cause, think what might encourage it to return it to its correct state act upon that and then depend on the Creator.

SOME BASIC PRINCIPLES

Preparation of medicines

Most medicines in al Tibb al Nabawi are based on the dietary advice of the Messenger, upon him be peace. A simple illness requires a simple medicine. The cure for imbalance leaning towards heat would be something cold. The classic example is the fever. The Prophet said ‘fever is from the hell, put it out with water.’ (Bukhari and Muslim)

A complex illness e.g. one leaning to hot-dry would require a complex mixture, in our example a cold-dry cure.

Every illness has a cure

The Prophet, upon him be peace, said ‘for every illness there is cure. If the cure matches the illness, improvement will take place by the permission of God.’ (related by Jabir in Muslim) and ‘God did not send down an illness except that He sent down a cure (Bukhari).

The above sayings establish there important principles. Firstly, they encourage the administration of medicines. There is agreement among the majority of Muslim scholars that it is a must. Secondly, they imply that, if administering medicine is a compulsion, then searching for a cure must also be a compulsion. Finally, they emphasise the dependence on God. In this modern age of ours we tend to depend on the medicines and not on the True Curer. It is interesting to look at how few remember God in illness until they realise their illness is terminal and that there is no hope for a cure. My own experience is that it is extremely upsetting and often devastating for both patient and doctor when the limitations of modern medicine dawns on them.

Cure may include spiritual as well as physical medicine

Muhammad, upon him be peace, described specific cures which included the likes of honey for the chest and liver. He also described procedures and principles, e.g. ‘emptying the stomach and putting out the fever with water’. In addition, he prescribed prayers and supplications for things like headaches and general sickness. These can be found in the books of hadith, traditions, as well as in the various books of prayers of the Prophet.’

Diet is the key to good health

Himya meaning both precaution and diet. Himya, with both of these meanings is the central pillar of Islamic medicine. The principle is found in the Qur’an which permits the use of sand in place of water in ablution and washing, if the latter is found to be detrimental to health. There was an occasion when the Prophet came with his cousin, Ali, to the house of Um al Mandari bint Qays al Ansari. They began to eat when Muhammad, upon him be peace, stopped and said to Ali ‘you are recovering.’ He took some barley and chard and gave it to him saying ‘this is better for you (related by Ibn Majah)’ The incident is an explanation of the principle of himya in its fullest sense.

Harith, described as the doctor of the Arabs, said ‘himya is the source of every cure, the stomach is the home of every illness.’ The Messenger said: ‘The stomach is the well of the body and the veins drink from it. If it is healthy, the veins pass on good health, if it is sick the veins pass on poison’.

Dietary precaution himya, can be used in three stages.

1. As a cure

2. To keep the body healthy.

3. To aid recovery

Based on the model of Ibn al Qayyim, hakims and traditional doctors have developed a sophisticated system of dietary medicine.

General behaviour and basic hygiene

The Messenger came to perfect behaviour. He taught not only us what foods we should eat hut how they should be prepared. Things like covering food, washing hands before eating and boiling food thoroughly when cooking were all stressed by the Prophet. The same is true of the etiquette of eating. The Messenger taught us to sit in such a manner that our stomach can be filled only to a third of its capacity.

Dieatry advice

The Messenger, upon him he peace, mentioned over seventy specific foods which he considered healthy. Modern science has confirmed that he was right. Among the foods mentioned were honey, dates, vinegar, fish and ginger.

*This article was based on Al Tibb Al Nabawi which is the final section of the book Zad al Ma’d of Ibn al Qayyim al Jawzi. It will be followed by a series of articles expanding on some of the points mentioned above.

References 

1. AL BUKARI (1980) Jami al Sahih
2. AL HAKIM (1965) Majmu’ Zawaid
3. IBN AL QAYYIM (1987) Al Tibb al Nabawi al Taiba
4. MUSLIM (1965) Jami al Sahih