It’s April 13, 2021. I can hear the alarm in the background. I open my eyes and look at the clock. It’s 4 a.m. It took a few seconds to realize it’s the first day of Ramadan, and it’s time for the pre-dawn meal, or suhur. I am currently living alone in Boston, Massachusetts, doing my second year of the Acute Care Surgery and Trauma Fellowship at Massachusetts General Hospital with all my family back home in Saudi Arabia. I have around 45 minutes before the fast begins. As I heat the food that I prepared the night before, I call my wife and son on Facetime to see how their first day is going. They are in the middle of their day, as there is a seven-hour time difference. I see the typical, organized chaos of home. I miss the rush of cooking the food for the evening and making the lists of things that need to be picked up from the store. In the background, I can hear lots of laughter and feel the overwhelming sense of joy that warms me and makes me homesick. The energy from that call is more than enough to put a smile on my face and prepare me for a long day-in-the life as a trauma fellow. Charged for the day, I take a quick shower and head straight to the hospital.
In Islamic culture, Ramadan is the ninth month of the Islamic lunar calendar. It is a time when Muslims focus on their spirituality and self-improvement. Besides making an effort to be more patient and charitable in their daily lives, Muslims are also expected to abstain from eating or drinking anything, including water or gum, from sunrise to sunset. Fasting for the 29-30 days of Ramadan serves to teach and practice self-discipline, self-control, sacrifice and empathy for those who are less fortunate.
Fasting is mandatory for healthy, adult Muslims, but if one is ill, older, medication-dependent, pregnant or traveling, they are considered exempt. For me, fasting was the toughest during my surgical internship year a few years ago. Working long hours as a surgical resident takes its toll when you are eating three regular meals a day and staying hydrated; it becomes much more grueling when one is fasting. I was able to overcome the challenge, not only with the understanding and support that I had from my senior residents, but also through the camaraderie of my co-intern, who was also Muslim. We used to exchange tips and would give each other snacks for when we would break our fast (iftar).
I still find the most meaningful description of being a physician who observes Ramadan as it was written in a 2013 piece by Muslim physician Dr. Ahmed Zaafran, which I read many years ago when I moved to the United States for residency. He wrote, “Ramadan is the best time to showcase the beauty of our religion and its focus on self-control. For example, how many times, in any occupational platform, have people come up to you, after finding out that you are fasting from food AND water (for some reason, they are always impressed with the water part), to inquire more about your fast and your faith? This is the perfect time to explain to them what fasting during Ramadan means, that abstaining from our material desires, including food, sexual relations, backbiting and slander, are only the physical vehicles that allow the spiritual self a viable platform to elevate itself. People in the health care industry understand what it means to make sacrifices. It might sound like clockwork to you, but for many of your colleagues, it is the most profound thing they will ever hear.”
Ramadan is a time for personal growth and family. Everyone gathers around each night at sunset for iftar, which reinforces the importance and commitment to family. With my family being so far away, I was not able to have the same experience as I had most years before. The Muslim community will often have social gatherings at iftar for those with who are unable to spend time with their families. This was the case at the hospital where I worked, and we set a place to meet each evening to break fast and pray together. It was a wonderful feeling. When far away from family, the sense of community and belonging I had from these evenings has been comforting. I do not feel alone and got the chance to meet new people. These gatherings serve to create new, lasting friendships. Unfortunately, COVID-19 and restrictions on social gatherings have made this last month even harder for me and those who are far away from their families. The pandemic has been very tough, but it has been even worse during Ramadan when we usually recharge with our family and community ties through iftar.
Even when there is not an ongoing pandemic, residency or fellowship during Ramadan can be challenging. I remind the senior residents to keep in mind the fasting residents and provide any extra support. During residency and fellowship, I only experienced care and support from my senior residents and leadership, and it has meant so much to my family and me. Overall, fasting during Ramadan has a tremendously positive effect on the body and soul. People who have been fasting all their lives and can no longer do it often miss it. It is a reminder that the body is a gift of God, and we have to treat it with care.
Hassan Mashbari, MD, DABS
Trauma, Acute Care Surgery and Surgical Critical Care
Massachusetts General Hospital & Harvard Medical School