In the Land of Invisible Women Read online

  © 2008 by Qanta Ahmed

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  Cover photos © iStockphoto.com/Naci Yavus, iStockphoto.com/Klass Linbeek-van

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  This book is a memoir. It reflects the author's present recollections of her experiences over a period of years. Some names and characteristics have been changed, some events have been compressed, and some dialogue has been re-created.

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  Library of Congress Cataloging-in-Publication Data

  Ahmed, Qanta.

  In the land of invisible women : a female doctor's journey in the Saudi Kingdom / Qanta A. Ahmed.

  p. cm. ISBN-13:978-1-4022-2002-9

  Includes bibliographical references.

  1. Ahmed, Qanta. 2. Women physicians—Islamic countries—Biography. 3. Women in medicine—Islamic countries—Biography. 4. Muslim physicians—Islamic countries— Biography. I. Title.

  R692.A346 2008

  610.82092—dc22

  [B]

  2008009548

  Printed and bound in the United States of America.

  VP 10 9 8 7 6 5 4 3 2 1

  For my parents, who gave me my Islam and my love of words.

  And for Joan Kirschenbaum Cohn, who shows me how to live,

  as a better woman, as a better Muslim.

  CONTENTS

  Chapter 1: The Bedouin Bedside

  Chapter 2: A Time to Leave America

  Chapter 3: My New Home, a Military Compound

  Chapter 4: Abbayah Shopping

  Chapter 5: Invisible and Safe

  Chapter 6: Saudi Women Who Dance Alone

  Chapter 7: Veiled Doctors

  Chapter 8: The Lost Boys of the Kingdom

  Chapter 9: A Father's Grieving

  Chapter 10: An Invitation to God

  Chapter 11: The Epicenter of Islam

  Chapter 12: Into the Light

  Chapter 13: The Child of God

  Chapter 14: The Million-Man Wheel

  Chapter 15: Committing Haram

  Chapter 16: Calling Doctora

  Chapter 17: Daughters of the Desert

  Chapter 18: Next Stop: Absolution

  Chapter 19: Prayer under the Stars

  Chapter 20: Between the Devil and the Red Sea

  Chapter 21: Mutawaeen: The Men in Brown

  Chapter 22: Single Saudi Male

  Chapter 23: The Calm before the Storm

  Chapter 24: Wahabi Wrath

  Chapter 25: Doctor Zhivago of Arabia

  Chapter 26: Love in the Kingdom

  Chapter 27: Show Me Your Marriage License!

  Chapter 28: An Eye for an Eye

  Chapter 29: Princes, Polygamists, and Paupers

  Chapter 30: Divorce, Saudi-Style

  Chapter 31: The Saudi Divorcée

  Chapter 32: Desperate Housewives

  Chapter 33: The Making of a Female Saudi Surgeon

  Chapter 34: The Hot Mamma

  Chapter 35: The Gloria Steinem of Arabia

  Chapter 36: Champion of Children

  Chapter 37: 9/11 in Saudi Arabia

  Chapter 38: Final Moments, Final Days

  Afterword: Rugged Glory

  Endnotes

  Bibliography

  Reading Group Guide

  Acknowledgments

  THE BEDOUIN BEDSIDE

  SEEKING RESPITE FROM THE INTENSITY of medicine, I trained my eye on the world without. Already, the midmorning heat rippled with fury, as sprinklers scattered wet jewels onto sunburned grass. Fluttering petals waved in the Shamaal wind, strongest this time of day.

  In a pool of shade cast by a hedge, a laborer sought shelter from the sun. An awkward bundle of desiccated limbs, the Bengali lunched from a tiffin. His shemagh cloth was piled into a sodden turban, meager relief from the high heat. Beyond, a hundred-thousand-dollar Benz growled, tearing up a dust storm in its steely wake. Behind my mask, I smiled at my reflection. Suspended between plate glass, a woman in a white coat gazed back. Externally, I was unchanged from the doctor I had been in New York City, yet now everything was different.

  I returned to Khalaa al-Otaibi, my first patient in the Kingdom. She was a Bedouin Saudi well into her seventies, though no one could be sure of her age (female births were not certified in Saudi Arabia when she had been born). She was on a respirator for a pneumonia which had been slow to resolve. Comatose, she was oblivious to my studying gaze. A colleague prepared her for the placement of a central line (a major intravenous line into a deep vein).

  Her torso was uncovered in preparation. Another physician sterilized the berry-brown skin with swathes of iodine. A mundane procedure I had performed countless times, in Saudi Arabia it made for a startling scene. I looked up from the sterilized field which was quickly submerging the Bedouin body under a disposable sea of blue. Her face remained enshrouded in a black scarf, as if she was out in a market scurrying through a crowd of loitering men. I was astounded.

  The scraggy veil concealed her every feature. From the midst of a black nylon well sinking into an edentulous mouth, plastic tubes snaked up and away from her purdah (the Islamic custom of concealing female beauty). One tube connected her ventilator securely into her lungs, and the other delivered feed to her belly. Now and again, the veil-and-tubing ensemble shuddered, sometimes with a sigh, sometimes with a cough. Each rasp reminded me that underneath this mask was a critically ill patient. Through the black nylon I could just discern protective eye patches placed over her closed eyelids. Gently, the nurse lifted the corner of the veil to allow the physician to finish cleansing. In my fascination, I had forgotten all about the procedure.

  From the depths of this black nylon limpness, a larger corrugated plastic tube emerged, the main ventilator circuit. It snaked her breaths away, swishing, swinging, with each machine-made respiration. Without a face at the end of the airway, the tubing disappeared into a void, as though ventilating a veil and not a woman. Even when critically ill, I learned, hiding her face was of paramount importance. I watched, entranced at the clash of technology and religion, my religion, some version of my religion. I heard an agitated rustling from close by.

  Behind the curtain, a family member hovered, the dutiful son. Intermittently, he peered in at us. He was obviously worrying, I decided, as I watched his slim brown fingers rapidly manipulating a rosary. He was probably concerned about the insertion of the central line, I thought, just like any other caring relative.

  Every now and again, he burst into vigorous rapid Arabic, instructing the nurse. I wondered what he was asking about. Everything was going smoothly; in fact, soon the jugular would be cannulated. We were almost finished. What could be troubling him?

  Through my dullness, eventually, I noticed a clue. Each time the physician's sleeve touched the patient's veil, and the veil slipped, the
son burst out in a flurry of anxiety. Perhaps all of nineteen, the son was demanding the nurse cover the patient's face, all the while painfully averting his uninitiated gaze away from his mother's fully exposed torso, revealing possibly the first breasts he may have seen.

  Each staccato command was accompanied by the soggy mumblings of Arabic emerging from behind the physician's mask, asking the nurse to follow suit and fix the veil. The physician sounded unconcerned, yet the son was suspended in an agonizing web of discomfort. He paced in anxiety about his mother's health, anxiety about her dignity, and anxiety about her responsibilities to God. The critically ill, veiled face and her bared breasts, pendulous with age, posed an incredible sight. I was as bewildered as the Saudi son.

  I gazed at the patient, completely exposed, except for her veiled face, and her fragile son supervising (why not a daughter, I thought). The veiling, even when her face slept, deeply comatose from sedation, was disturbing. Surely God would not require such extreme lengths to conceal her features from her doctors who needed to inspect her body? Did an unconscious sickly Muslim have the same responsibilities as a conscious, able-bodied one? Although a Muslim woman myself, I had never faced such questions before. My debate was internal and solitary; those around me were quite clear of their obligations. The patient was a woman and needed to be veiled. The physician was instructing the Filipina nurse throughout to comply with the son's concerns. The Filipina was obviously inured to the whole spectacle. The son knew his duties to his mother. Only I remained locked in confusion.

  I studied her more closely, trying to understand more. Thin arms lay flaccid at the side of her supine body, palms upwards, pools of lax flesh puddling under feeble triceps. She seemed very short, perhaps four and a half feet tall at most. On each palm, in the center, I could see bluish stigmata. These were the dark, circular marks of tribal tattoos. The nurse removed the veil to attend to the airway, suctioning out the frothing saliva which had collected in the last half hour.

  Now that the limp black nylon was lifted, I could finally see Mrs. al-Otaibi. Her weathered, leathery face was in pain. Congealed tears streaked from under the taped eyelids. I called to the nurse for some pain relief, following the silent tears as they wound to her receding jaw. They pooled into deep wells in a face made ancient by sun-lashed desert winds. Proud cheek bones climbed high above hollows where her teeth should have been. Her chin met in a defiant point, conferring a determined, dour look. I wondered what she was like when awake.

  Her facial markings belied a woman of status. Now I could see complicated blue tattoos in cross-like formation. They centered on the exact middle of her cheeks, much like marks delineating fields of radiation in a cancer patient, but bigger. She had similar marks on her brow, centrally placed above her balding eyebrows, perfectly symmetrical. All this painful decoration only to remain concealed behind a veil? Wondering what the marks could mean, I asked my Arab colleagues. She turned out to be a senior elder in her tribe, the tattoos on her face defining her rank, they explained, already bored by my curiosity. Obviously, they had seen many such tattooed Bedouin women. To them there was nothing remarkable about Mrs. al-Otaibi.

  Small brown hands were clenched in a sleeping fist. I unpeeled them and looked at the stubby, anemic, orange-tipped nails. This color I knew to be henna. I looked at my own hands grasping hers, my glossy, noired nails contrasting against her orange manicure. Mine were Western, hers Eastern, so different but both seeking the same folly: to change the color of our nails.

  I smiled in silence at the first similarity I could draw between us. Saudi Bedouin women would wear this cosmetic coloring often, placing a viscid blob of the dark green henna in the palm of their hand and then holding it tight in a fist, burying the tips of their nails into the pool of thick dye. The women would often sleep like this, securing their hands with string, to wake later with orange-tipped fingernails. This is what Mrs. al-Otaibi must have done, some weeks earlier, when she had been well. I looked up at her straggly, sweaty hair and saw the streaks of henna there too, slowly losing the battle against a burgeoning mass of white roots.

  On her rotund belly, several inexplicable scars, small, puckered, and paler than the surrounding skin, peppered the surface. They were evenly distributed over the right upper quadrant of her abdomen. They were in the wrong place for laparoscopic surgery but I knew of no other tool that left such marks. I looked up at my colleague, puzzled.

  “She went to the shaman, the Bedou healer. They all do that. We often see these marks on our liver patients.” He went on, “The shaman uses a branding iron to treat pain which the patient probably had months ago.”

  Later I would observe that many patients carried these same marks, often seeking relief from the pain of enlarging, inflamed livers. Hepatitis is common in Saudi Arabia and indeed my new workplace, the King Fahad National Guard Hospital in Riyadh, was a center of excellence for treating liver disease. There we saw hundreds of patients with liver failure. The poorer patients had avoided the many public health centers in the Kingdom, instead choosing traditional healers; by the time they came to us, their diseases were often too advanced.

  So, in the midst of the familiar, shiny, high-tech intensive care environment in which I was so at home, I encountered the unfamiliar. I was deeply perplexed by the active ancient practices which this woman's body disclosed. Even more disturbing, what role did shaman and other pagan healers have in a world which subscribed to Islam, a religion which enshrines the advancement of knowledge?

  I wondered about the lengths to which the son continued to veil his mother, even when she was gravely ill. Couldn't he see it was the least important thing for her now at this time, when her life could ebb away at any point? Didn't he know God was merciful, tolerant, and understanding, and would never quibble over the wearing of a veil in such circumstances or, I doubted, any circumstances?

  Somehow I assumed the veil was mandated by the son, but perhaps I was wrong about that too. Already, I was finding myself wildly ignorant in this country. Perhaps the patient herself would be furious if her modesty was unveiled when she was powerless to resist. Nothing was clear to me other than veiling was essential, inescapable, even for a dying woman. This was the way of the new world in which I was now confined. For now, and the next two years, I would see many things I couldn't understand. Even though I was a Muslim, here I found myself a stranger in the Kingdom.

  A TIME TO LEAVE AMERICA

  I RECALLED THE COLD NIGHT of my departure only a few weeks earlier. Black rain glistened on liquid streets. Squinting between raindrops, I peered into the red river of brake lights. A blurred boa of traffic oozed ahead. I motored onto the Belt for a final time. A grim weight bore downward upon me, grinding me deeper into the creaking leather seat. Would I ever again call this country home? My flight to Riyadh, the capital of Saudi Arabia, would depart Kennedy at nine. My recent past rushed by in the rearview mirror of a migrant's regret. It was time to leave America.

  Denied visa renewal, the magic spell of my U.S. immigration was at an end. After a final appeal to revert my status had failed, I had decided to take my medical credentials to the Middle East where U.S. medicine was widely practiced. It had been a spur of the moment decision and with it I became once more an outcast in motion.

  During my years in New York City, I had completed a residency and fellowship, gaining certifications in internal medicine, pulmonary disease, and critical care medicine. I had also finished a fellowship in sleep disorders medicine in which I would also soon be certified. My short years here had been productive, and within a few weeks of learning I could not stay in the U.S. any longer, I had been head hunted by a hospital in Saudi Arabia. After allaying my initial hesitations, I had accepted the job, lured by free accommodation and a fat salary. As a Muslim woman, I believed myself well-acquainted with the ways of an Islamic Kingdom, feeling no apprehension about life in Saudi Arabia. I dismissed the cautions of concerned friends at my sudden decision and thought no more of it.

 
Accelerating the silent Lexus, wipers beat metronomically to my sorrow. I wondered when I would next be at the wheel of a car. I knew already that it is illegal for a woman to drive in Saudi Arabia. In Riyadh, I would be licensed to operate procedures on critically ill patients, yet never to drive a motor vehicle. Only men could enjoy that privilege.

  I felt the car purring under me as I drove myself to the airport. I already missed the primal thrill of pedal and power, the visceral surge uniting me with machine. Soon my car keys would be gone. Atlantic winds ruffled my thick hair, caressing ripples of my femininity. Soon my hair would be covered, banishing such playful breezes. Legislation would stipulate my head be veiled in the Kingdom. Everything would be different.

  I return in my memory to the rainy surroundings. Arriving at Kennedy, the airport was empty. These were the halcyon, forever-lost days before 9/11. Check-in was completed in minutes. The contents of my apartment were to remain in storage in New York, a casual decision. My car was to be retrieved by a friend who would keep it for me until my return. Intuitively, I knew I was embarking on a stage of transience.

  “What's a year?” I remembered thinking to myself, as I had signed the contract recklessly, flicking through pages, ignoring bold capitals announcing the death penalty. In a thoughtless flourish I found myself now subject to the laws of Saudi Arabia, decapitation included.

  I waited alone at the gate, making calls on a dying cell phone. I kept up a banter fueled on bravado, while I studied the passengers gathering for my flight.

  My prior sightings of Saudis had been rare, clusters of them at the Cleveland Clinic awaiting consultation, a sprinkling of Saudi figures bustling at the Dior counter in Harrods, and the odd exotic Saudi traveler connecting at Heathrow. Tonight there were dozens of them. Everywhere I looked, Saudi men and women were seated apart, cordoned by invisible barriers. I caught some murmuring Arabic. A knot of Saudis caught my eye. I watched.