Fasting for Ramadan and being the on-call orthopedic trauma resident

A patient groans in agony lying atop a rigid spine board, carried by paramedics into the ER, his neck in a protective collar. The paramedics shout a summary of the accident. Monitors are attached to the man, flashing and beeping the cadence of vital signs. Nurses and physicians swarm. Gloved hands comb through brown hair for bumps or lacerations. They remove his clothes, feeling for pulses in the neck and limbs. They press his belly, strap a blood pressure cuff to his arm and ask him to move fingers and toes. IV fluids are given, X-rays are taken and calm reassurances are repeated. I press along his arms and legs, noting obvious deformities to his forearm and shin. I don’t need X-rays to know they are fractured. I call the orthopedic tech, emphasizing the urgency and what splints we need. This all occurs in rapid succession, a chaotic yet well-versed sequence that is all too common at a large trauma center.

I glance at the digital clock in the trauma bay — 8:10 p.m. I smile. Only a few minutes until iftar, the evening time to break the fast.

Ramadan is the Islamic fasting month when adherents abstain from food and drink during daylight. Fasting is mandatory for healthy adult Muslims; but if one is ill, older, medication-dependent, pregnant or traveling, they are pardoned. Muslims believe that during this month, the Quran and other religious texts like the Torah, Psalms, and Gospels, were revealed by God to His prophets. Thus, in addition to forgoing food from sunrise to sunset, one is encouraged to increase charity and prayer, and abstain from sexual relations, impolite speech, etc. Naturally, food plays a large part in the spirit of Ramadan. Sharing iftar is common, varying by culture. For me, this means dates, spicy samosas, kabobs, juicy mangos, and a yogurt drink called lassi. And right about now — standing in the trauma bay with my green scrubs caked with white splinting plaster — the sheer thought of food is invigorating.

Yet I know better than to hope for any grand meal tonight: I’m the on-call orthopedic trauma resident. There are already three patients in the ER waiting for me. I had only spared quick glances at their charts and X-rays when I was interrupted and rushed here.

The familiar vibration had gone off at my right waistband, followed a second later by the inexorable “beep-beep” of the pager clipped to my pants. I thumbed the button, silencing the cacophony. The screen flashed a short phrase: “TRAUMA ALERT / MCC / 40M / ETA 5 AIR.” Translation: A 40-year-old male was in a motorcycle accident with serious injuries, arriving in five minutes via helicopter for complete trauma evaluation.

Now in the trauma bay, I think back to those three ER patients and create quick mental plans. 1. Wrist fracture, displaced: needs reduction and splint. 2. Open ankle fracture/dislocation: needs reduction, splint, antibiotics, added to surgery schedule. 3. Deep hand laceration: needs neurovascular exam, possible surgery.

My pager goes off again, ending my orthopedic reverie. A four-digit extension blinks on the screen. I also hear the chime of unopened text messages on my phone (hopefully device reps confirming the correct implants for the morning’s surgeries).

Needless to say, the orthopedic department at a large trauma center is busy. With 20 or more such patient consultations a night, one must be sharp mentally and physically. And it’s Ramadan.

So how do I fulfill the religious obligation to fast without hindering patient care? How do I reconcile religious belief with the ancient oath of Hippocrates, a promise to place patients first?

People are curious whether one can maintain focus while abstaining from food. They have asked, “Is it safe?” “Does it compromise ability?” Studies assessing physiologic effects of fasting illustrate many health benefits such as enhanced neurogenesis, improved cognition and decreased impulsivity, decreased TNF-alpha and C-reactive protein levels, improved insulin sensitivity, and increased human growth hormone production. There is also evidence that fasting during Ramadan improves liver function, decreases total cholesterol, and leads to weight loss and decreased fat mass by preferentially burning fat as fuel.

One must further realize that Muslims who fast throughout Ramadan, like myself, have done it yearly since before they were teenagers. The self-discipline of Ramadan teaches me perseverance, patience, and toughness. For me, these are translatable traits, and of themselves integral to becoming a skilled and empathic surgeon.

The daytime restrictions on food and drink can undoubtedly cause fatigue without adequate preparation. So I plan ahead. Before sunrise, I eat a full meal, called Suhoor, ensuring adequate nutrition throughout the day. Eggs, yogurt, fruits and plenty of water. Additionally, before every night of call, I pack full iftar and suhoor meals. I carry these unabashedly in my oversized red lunchbox, stashed in the surgeons’ lounge fridge, ready to break fast and then eat again before sunrise. I chose the medical profession and orthopedic surgery specifically to help patients conquer injuries and climb the ladder of recovery to regain quality of life. It would be a disservice if I didn’t ensure that I was as mentally and physically sharp as possible to give them my best.

So I stand in the trauma bay, watching the digital clock. “Another motorcycle?” The orthopedic tech arrives at the trauma bay with the splinting material. “You know it. Night’s just getting started. Let’s do it,” I respond.

Once we finish, I promptly jog to the surgeons’ lounge, fling open the fridge and extract my ridiculously large red lunchbox. I quickly pray, raise the Styrofoam cup to my lips and gulp down the water. I scarf down carrots, hummus, a samosa and grab an apple for the walk to the ER. Yet I barely pass the lounge door when that all-too-familiar vibration hits my right hip, followed by the pager’s “beep-beep” like a one-two punch.


Here we go again.

Adil Shahzad Ahmed is an orthopedic surgery resident.

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