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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 2008  |  Volume : 19  |  Issue : 6  |  Page : 984-985
Faith and fate in medical practice


Department of Internal Medicine, Security Forces Hospital Program, Riyadh, Saudi Arabia

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How to cite this article:
Al-Harbi A. Faith and fate in medical practice. Saudi J Kidney Dis Transpl 2008;19:984-5

How to cite this URL:
Al-Harbi A. Faith and fate in medical practice. Saudi J Kidney Dis Transpl [serial online] 2008 [cited 2020 Nov 27];19:984-5. Available from: https://www.sjkdt.org/text.asp?2008/19/6/984/43479
To the Editor,

Sarah was an eight-year-old girl born with congenital nephrosis. She was very beautiful and a sibling of one of our hospital employees. She required dialysis a few months after birth and was initially started on peritoneal dialysis (PD); she however developed severe fungal infection from which she recovered following which she was shifted to hemodialysis through a permcath. She was the first child patient on hemodialysis for most of the staff including myself. She used to bring flowers from her family garden for the nurses each time she came for dialysis. She spoke English, Tagalog, and Arabic of course, because she spent most of her life in hospitals with nurses and doctors. She was in the process of learning how to connect herself to dialysis machines too.

Sarah was liked by her parents very much because she did not give them a hard time. She rarely cried and was self dependent in most of her daily needs. She was on top of the list for transplant, but unfortunately no matched kidney was found for her. In 1998, Sarah was brought for dialysis with a non-functioning vascular access. The vascular surgeon was contacted but he could not help. We tried to send her to a higher center with an experienced vascular surgeon but unfortunately met with no success. After three days of struggle we failed to con­vince anybody to give her a chance to live. One of my colleagues advised me to give him a chance to participate in her management decision because he thought I was behaving in an irrational way in blaming our colleagues for not attempting to operate on her to establish a vascular access. What he decided and ex­plained to me was to put her in DNR (DO NOT RESUSCITATE) category, restrict her fluid intake so that she would not die from suffocation and pulmonary edema, and give her food with high potassium content so she had arrhythmia and sudden death. After one week, he just asked me if I would like to see Sarah, who I thought was already dead. We went to see her in the pediatric unit and found her playing and smiling. I hugged her and she smiled to me; I then went directly to my office and called one experienced transplant surgeon. I explained to him about the patient and after a prolonged discussion, he agreed to see her but no promise of success was made. The father and mother drove all the way to another city and patient was seen the same night. Some radiological studies were performed following which she was operated upon and a permcath was inserted into the inferior vena cava. She was dialyzed over there and again on the third day in our hospital. After one week, the family found Sarah dead on her bed. They brought her to the morgue.

After all this, I and my colleagues were left with many unanswered questions!

  • How far should we go to help our patients?
  • When we should stop fighting or begging our surgical colleagues to help our patients?
  • Is it really our responsibility to do all this just to help patients?
  • Are these patients only for the nephro­logists or for all medical staff?
  • Is there an end and limitations for us to stop finding solutions and answers?


I do not have any clue to answer these ques­tions, but it is easier for me not to think about them; but we learned one thing and that is, our faith pushes us to do a lot for our patients but fate is the ultimate, and we ask Allah to smoo­then our faith.

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Correspondence Address:
Ali Al-Harbi
Department of Internal Medicine, Security Forces Hospital Program, Riyadh
Saudi Arabia
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PMID: 18974591

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