Wednesday, September 04, 2013

Devils in the Emergency Room

"Men never do evil so completely and cheerfully as when they do it from a religious conviction."

Blaise Pascal

Mr Pascal's Wager himself.

Yesterday night, at the beginning of my graveyard shift in Emergency & Trauma, a trio of police officers frogmarched an 18-year-old Malay young lady into the Yellow Zone. She was clearly in a state of extreme agitation, struggling, kicking and screeching glass-shattering notes at the top of her lungs. Getting the savage screaming girl down onto a bed and restraining her consumed my attention for five whole minutes and by the time I looked around, the policemen were nowhere to be seen. So there I was, left with a very disturbed young woman tied down to a bed who continued to yell abuses at me and I had no idea what transpired, where she came from or who I could contact to find out. Our tax money well-spent right there. Thanks a lot, our boys in blue.

After taking a deep anger-purging breath, I had the medical assistant take her vital signs, shoved an IV cannula into a vein (she tried to bite me in the bid) and took some blood. I turned my back for a minute to run some initial tests on her blood but when I returned, I found two strange portly men wearing songkoks and ankle length robes standing by the patient’s side. 

Must be her family members, I thought. They recited Arabic prayers at her while she barked curses back at them. I rolled my eyes at that and left them to it, thinking I could interview them when they were done – because Muslims in our country can be real explosive when you interfere in anything pertaining to their Religion of Peace™. I didn’t want to make the news. I could already see the headline in my head: ATHEIST DOCTOR FORBIDS MUSLIM FAMILY FROM PRAYING FOR THEIR LOVED ONES IN EMERGENCY ROOM. 

I returned shortly after and found that the men had drawn the curtains all around her bed. A whole lot of commotion and noise were coming from within so I took a peek. One of them was hunched over her at the head of the bed. His hands were clasped around her face and he was shouting angrish at her while she shouted back. He was trying to get her to recite something Arabic but that was to no avail. At one point, he even threatened to murder her (or what he believed was inside her). As he became increasingly more flustered, I saw his fingers pressing harder and harder onto her mastoid processes - those are the bony bumps behind your ears - till his knuckles were white and trembling. The girl started whimpering in pain and cried out, begging him to stop hurting her.

"What is your name?" the man asked again. Eyes screwed up in agony, she said it. He appeared satisfied at her response and lifted his fingers off her mastoids. Then, looking at me and smiling a winning smile, he informed me that everything was under control. He casually gestured at the IV canulla I inserted earlier and said: 

"You can pull that out now. You won’t be needing that anymore."

It takes a lot to surprise me but for I confess that I was stunned for a second by what he was telling me to do.

"Who are you?" I finally asked, my hackles rising. Who the fuck are you?

"I am Ustaz Aladdin and my companion here is Ustaz Ali Baba," the spectating partner of the pair explained in Malay. The names had been changed to minimize my own risk of getting sued. "This young lady here was possessed by an evil spirit. It was a difficult battle but we finally cast it out."

"Oh really?" I remarked acidly as my eyebrows climbed my forehead. "Are you related to her?"

"No, we just wanted to help."

At this point, the girl hulked out again and renewed her commitment to contact space aliens using only the strength of her voice alone. She struggled so violently against her bonds that I was afraid that she was going to dislocate something or worse, damage our expensive bed. Ustaz Ali Baba clamped down on her face again in a hurry with his fingers positioned behind her ears, ready to unleash torture anew. He began murmuring something Quranic.

From right to left: the patient, Ustaz Ali Baba, Ustaz Aladdin, and
the beer gut of the security guard I brought with me to confront them.

"Please unhand my patient," I told him. "You failed. Whatever you did to her is obviously not working."

Also you shamans are not part of hospital personnel and are of no relations to her – how dare you curtained yourselves off alone with her without any chaperones and manhandled her without her or her family’s consent? What you motherfakirs were doing is called assault and battery, and that shit is highly illegal. And who died and made you King of the ER that you deem yourselves to be in any position of authority to order me to remove my acutely psychotic patient's IV cannula? Also, if you claim to represent and speak for Allah, you better have papers bearing his almighty signature to prove it, you goat-bearded wizard-robed balderdashers.

Besides, isn't it haram to touch a non-mahram stranger of the opposite sex based on what the Prophet Muhammad said? These two ustaz (ustazes?) clearly didn't think so.

While I was addressing them, my patient started retching. Ustaz Aladdin cried excitedly, declaring that the young lady was about to cough up the demon possessing her. I ignored him and quickly turned her on her side to prevent her from aspirating her vomitus. When she stopped dry heaving, she - surprise, surprise! - remained aggressive and unruly. I stared daggers at the pair of defeated exorcists and said, "Please leave now."

To calm her down and to prevent her from injuring herself and her caregivers, I gave her 5 milligrams of midazolam. In just a moment, she winked out like a light (something I couldn't have done without an IV cannula).

It must had been a strange sort of ghost, demon, or djinn that can be subdued by a sedative which only affects her brain and not her body. It's almost like her psychotic actions were, gosh, all dictated by her own brain! I wanted to point this out to our Saracenic Tweedledee and Tweedledum but they had already evaporated from the Yellow Zone. Got it under control, they said. Pull out the IV cannula, they said.

When the sedative wore off and she came to an hour later, she was acting normally again.

More than even the belief in superstitions and the insistence on blaming mental illness on demonic possession, I was shocked by the gall and presumptions of the two Muslim clerics - civilians all - who thought that it was okay for them to walk into a restricted area of the Accident and Emergency department without authorisation, impose themselves onto an ill patient whom they do not know, commit assault and battery on her, and then somehow have enough nerve left in them to tell the patient's doctor what to do in regards to her medical treatment. No one, not the security guards, not my colleagues, not even my senior officers dared to reproach them for their highly unethical and unlawful actions towards a patient that was entrusted to our care. It is because they are afraid of offending the religious over-sensitivities which certain people professing to certain faiths wear around themselves like some sort of criticism-proof Kevlar jacket. It is because they afford certain people far more respect that they rightfully deserve, as their deplorable conduct showed.

It is this same misplaced respect and cowardice of standing up for what's right that led to this brutal attack orchestrated by an imam on a poor innocent Muslim woman in the UK, and this fatal exorcism in Belgium conducted by a "sheikh" and his acolytes in Belgium which ended in the death of another Muslimah.

It is high time we point out the painfully obvious fact that these self-professed spokespersons of their respective gods have no fucking clue what they are doing. Two such lowlifes attacked my patient, and I had a responsibility to protect her so I did what's right. Also, mistaking mental illness for demonic possession was something medieval yokels would do, back when trepanation and having holes in the head was still in vogue. Now that we are living in the age of smartphones, the internet and self-flushing toilets, I can't believe that people can still be this stupid.

P.S. When I related this incident to one of my colleagues who witnessed the whole thing, she told me she thinks that my patient might be possessed for real - but she disapproved of what the two ustaz was doing and probably thought that a Christian exorcist would had been more effective given her own beliefs. I just laughed loudly at her face and walked away.

Buster of ghostbusters,
k0k s3n w4i


Niek Beaujean said...

I'm so sorry this crap surrounds you so thickly. It can't be healthy to have no rational people around you.

How can you tell whether you're arrogant or everyone else is insane? Not a pleasant position to be in.

darshan said...

What did you eventually diagnose her ailment? What treatment you gave her? Her condition now? She ran amok? Seems like a psychiatric case to me.

Susie Phang said...

This is what is called ajaran sesat.trying to subdued the demons in her, playing God. High time people wake up and don't repeat the incidence that killed a toddler in Bkt. Minyak. Let the trained professional handled this.luckily this girl was still alive!

Anonymous said...


Anonymous said...

U know nothing about islam...and yet u want to talk about it...wakakak im just laughing n doa that u get hidayah about theoverall about what is islam is...amin

Souhayla NourJannah said...

In ever religion there is a belief of the supernatural, things unseen. I assume you are an atheist but even atheists have to admit that they don't know everything that goes on in the world... including the presence of something that our eyes or other senses cannot definitely perceive. Therefore you cannot be 100% that she is not possessed by a djinn/demon.

Nevertheless, despite what you or I believe in, I agree on your decision to advocate for your patient. InshaAllah, I will be a HO in a few months and would actually react the same way as you did. 

Although I am a muslim, I do not agree with the conduct of the two ustaz as they should have a family member present as she is a non mahram (whatever their status in religion is). To my understanding, even an exorcism such as this require some investigation done on the ustaz's part much like doctors taking a history from patients, though of course less scientific. Heheh. And an exorcism of this degree usually would not be done out of a sudden by strangers even if they are ustaz.

As to your point of the djinn or demon being subdued after administration of sedatives, if there is indeed a djinn in her, it still requires some bodily function of the person being possessed. Easier to control someone who is still moving than an unconscious body. But then again, I am not an ustazah so have very little knowledge in this area. 

k0k s3n w4i said...

Niek Beaujean: I guess I am lucky that I have a sense of humour then ;)

darshan: I have a diagnosis in mind but I had referred her to psychiatric care. The actual diagnosis might be different from mine after their in-depth assessment (I am, after all, working in Emergency and don't always have the luxury of time).

Susie Phang: Yeah, it's the same kind of crazy belief that led to death of an innocent.

Anonymous #1: Thanks?

Anonymous #2: I was not talking about Islam. I was talking about two Muslim holy men who committed assault and battery.

Souhayla NourJannah: I am not saying that I know everything that goes on in the world but unlike other invisible things that are detectable through other means non-visual like how we detect the presence of dark matter by measuring their gravitational influence, the existence of spirits/djinns/demons are not supported by any controlled, unbiased studies and there are no way of detecting their presence except for the words of a some charlatans who claim that they have such abilities. And the phenomenon of possession does not display any systematically observed signs by which we can distinguish them from mental illnesses.

But think about it this way, mental illnesses do exist. We have data on how they present - we have lists of symptoms like any other illnesses of the human body. We have organic evidence like their tendency to run in families and documented neurological abnormalities in these patients. And mental illnesses CAN explain the behaviour of allegedly possessed people - so tell me, doctor-to-be, which explanation holds more water from a rational point of view?

If your house was broken into, which explanation do you think makes more sense: some human burglars did it or a djinn?

As to my point about the alleged entitiy being subdued by a sedative: tell me, Souhayla, what is the mechanism of action of midazolam? You are not an ustazah but you are going to be a member of the medical fraternity soon. Midazolam acts on the brain, not on the body. An outside source controlling her body apart from her own brain should not be affected by midazolam.

"... if there is indeed a djinn in her, it still requires some bodily function of the person being possessed. Easier to control someone who is still moving than an unconscious body."

So your remark above made no sense. The patient's body wasn't weakened. And there is no such thing as an unconscious body. Consciousness is a product of brain activity.

Thus, drawing from the effect of midazolam on her, we can conclude that the patient's behaviour originated from her own brain. And since we know that mental illnesses exist and that her actions clearly came from her own organic brain, why are we even looking at an alternate explanation that has no evidence or rational reason in support of it like djinns or demons?

Did they not teach you in med school that when you hear hoofbeats, think horses and not zebras (or in this case, not unicorns)?

Besides, if possession is indistinguishable from mental illness, how on earth do your ustaz or imam (who have no medical training) know how to differentiate them?

Souhayla NourJannah said...

Yes. I am taught to diagnose according to symptoms and signs and lab results. Which is why I said previously that I would have reacted the same way as you did, if placed in a similar situation.

However, if someone came to me and tell me a posibility of a possession, unlike you, I would keep an open mind. I would not discharge a patient without medical treatment of proper investigation whatever my opinion is (possession or not).

The ustaz was wrong to overstep the line since the patient was in the hospital and under your care. But if the situation was reversed, as in you heard of an exorcism being performed in a home, then by interfering, you are also overstepping the line. If the family of the patient or the patient has consented to an exorcism then doctors have no place to interfere.

Protocols are there for a reason and a good reason. But a person's culture and belief is also there for a good reason. It may differ greatly from yours but should be respected as well. The way you have written about this experience is slightly insulting to people who actually believe these things.

Probably the way of writing that offends and not your opinion, at least that's what I think. It's never wrong to be opinionated but the delivery of one's opinions is important.

I studied medicine from great professors, understood well what I studied and will do my best to treat my patients as I have learned to. But I also believe in the unseen related to my own religion and therefore a respect to other beliefs of other religion even atheists.

Maybe you have not seen anything that defies scientific explanation as you might not have spent time in the rural areas. But in clinics and small hospitals in rural sarawak, I have seen weird things happening.

I bet ur laughing or rolling your eyes. Either ways, I have said my peace.

k0k s3n w4i said...

Souhayla NourJannah: "However, if someone came to me and tell me a posibility of a possession, unlike you, I would keep an open mind."

I resent the suggestion that I do not have an open mind. I just happen to not keep it so open as to let my brains fall out. I will accept any claim that meets at least its own burden of proof. Maybe instead of being Muslim, you should keep an open mind as to the possibility that the Christians are right and that your beliefs are wrong. Or maybe entertain the possibility of Santa Claus' existence while you are at it? Because open mind, yo.

I don't consider the uncritical acceptance of any claims without hard evidence to be open-mindedness. It is naked gullibility disguised as open-mindedness. While I do not readily accept every fairytale presented to me, I at least take the time to think about its plausibility and look up the evidence (if any) - that is how a proper open mind operates. If I reject it without even considering the possibility, then you may call me close-minded.

"But if the situation was reversed, as in you heard of an exorcism being performed in a home, then by interfering, you are also overstepping the line. If the family of the patient or the patient has consented to an exorcism then doctors have no place to interfere."

There are many instances in which courts have taken custody of children from parents that are denying their children proper treatment due to their religious beliefs. Mentally ill patients had been rescued from their abusive exorcisms. You see, demonic/spirit possession is not a real thing and it is not recognised by the court or authorities - because unlike everything else, that phenomenon does not have any bases behind it. That is why when the police took my patient in, they brought her to a hospital instead of a bomoh or an imam. And didn't you read the two news items I shared in the above article on how exorcisms lead to abuse and even injuries and death; based on no credible evidence of such occurences? Did you not hear of the incidence earlier this year in Bukit Minyak when a 2 years and 9 months old toddler was suffocated to death in an exorcism attempt?

These are hard facts: (1) There are no scientific bases to support the phenomenon of demonic possession, (2) There are no consistently documented symptoms by which we can recognise the phenomenon and distinguish it from mental illness, (3) There are no standards of practice in exorcism in that ensures the safety of the practice and prevent abuse by imams, priests, bomohs, etc, (4) Lack of any standards meant that regulation is not possible and there is no way of knowing if anyone is actually skilled or qualified in the art plus the lack of any consistent features meant that these holy men cannot actually tell if a person is possessed or not, there are no "tests" they can perform to verify it, so to speak - they just tell you they do and you just have to take their words for it, (5) There are no published evidence on the efficacy of exorcism, only anecdotes, (6) On the other hand, there are clear evidence of harm from such practices (injuries, death, abuse of victims, etc).

Such practices should be made illegal, period. If any treatment in medicine is this shitty, we would never use it. Why the double standards? I talked about gullible people who gives far too much respect to these self-professed representatives of God, so much so as to allow them to cause bodily and mortal harm to patients with mental conditions - and it seems like you are just another one of those people.

k0k s3n w4i said...

Souhayla NourJannah: "But a person's culture and belief is also there for a good reason. It may differ greatly from yours but should be respected as well."

Don't be ridiculous. That is obviously untrue. Cultures and beliefs can be bad and harmful. To say otherwise is to be in denial. The Etoro people of Papua New Guinea thinks that young boys need to ingest the semen of their elders from 12 to 17 years old in order for them to grow properly. There are no scientific bases for such practices. Tell me, do you then also respect such a culture that enforces homosexual paedophilia amongst its youth? Beliefs and cultural practices should NEVER be accepted and respected just because they are remnants of some older society that knew far less then we do - to do so is to stagnate as a race and maintain the stupidity of medieval people. They should always be assessed critically and good practices should always be separated from bad and harmful ones.

"The way you have written about this experience is slightly insulting to people who actually believe these things."

And people who believe in such things can do no better to defend their beliefs aside from insisting that other people respect their beliefs without producing any evidence supporting their beliefs? This is simply a sign of weak beliefs that cannot withstand scrutiny on their own.

"But I also believe in the unseen related to my own religion and therefore a respect to other beliefs of other religion even atheists."

Atheism is not a religion. It is the opposite of a religion. It is the lack of belief in the existence of God or gods, not the belief that there is no God or gods. And I neither need your respect nor ever demanded it. Of course, your religion is famously hostile towards atheists. I have many friends who came from Muslim families who doesn't believe but still had to pretend to do so because they are afraid of being ostracised or worse, penalised. You call that respect?

"Maybe you have not seen anything that defies scientific explanation as you might not have spent time in the rural areas. But in clinics and small hospitals in rural sarawak, I have seen weird things happening."

Anything that defies scientific explanation doesn't mean it will always defy scientific explanation. People used to think that the sun is magical, but in time, we knew that it is actually a giant fusion reactor. To provisionally say that an unexplained phenomenon is caused by a djinn or ghost - that is pretensions to knowledge that I find incredibly dishonest and such answers are useless because they are not based on evidence.

Just because you are baffled and confused due to your own ignorance and lack of knowledge doesn't mean that others would be impressed with what you saw. Besides, I only have your word for it. Any proof?

And if it is just your words, I too can say that every single so-called supernatural phenomenon I encountered had turned out to be perfectly explainable using mundane means - and only seemed supernatural because people who made that observation already have a tendency to believe in nonsense.

Claims are just hot air until we see evidence and proof. That is the foundation of the practice of science and medicine.

P.S. I had not automatically dismissed your claims but constantly asked you to produce evidence or proof backing them up. This is how you be open-minded without being a gullible idiot.