Ya Ayyuhal Walad........ [ Oh My Dear Son ]

 Oh My Dear Son,

You ask Papa what do we do next? We are now beyond 'Puasa Enam'

Well, my dear son,

At you relative young age, you still have long to go. If you continue the fervour you did the last 10 days of Ramadan, you will end sooner than later a 'burnt out' chap.

I advise to 'DE-ESCALATE' ie if for example you are doing, like Papa, the al-Ghazali's weekly wirid in a day, say at 500x each quantum, de-escalate to say a hundred time each, or 200 each , over the whole day.

Maintain your obligatory prayers as before and try to at least do it once a day at our local mosque, say, Magrib, Isya' or Subuh

Try to maintain contact with the mosque as it is not for prayers, it serve as your contact and centre to ILM.

In short, my dear son, choose whatever wirid you like, spread it out over day but start with CASH early in the morning, well before Subuh prayer, if you are a wee bit lazy, give a longer post Subuh wirid.       Add a wee bit of daily quran, this is best!!                                                                                                   If you guys want to be permanently head damaged like Papa  at your age[ phd}, go to my library and start reading Hamka's Tafsir al-Azhar, 2 to 3 pages a day.

Whatever you do, the accent is ISTIQAMAH.                                                                                             Berdikit dikit dulu, but amplify the volume with the coming years.

At Papa's age , and people Papa's age, when the 'house is already saying goodbye, goodbye,... and the grave is welcoming' , we have no choice but to 'ESCALATE'

I would still do my al-Ghazali wirid full: the weekly plan complete in one day, no longer to be coubted as you go by the minutes and hours.

Still wake up say one hour or one hour and a half before Subuh, and inter-sperse the tahajud prayers  and tasbih prayer with the wirid, probably covering half of the wirid before Subuh, and the rest between breakfast time and lunch, at every nooks and corners available during Papa's morning hours at the hospital.. No more need to count, just go by feeling and time.

THe rest of the day, I have the other favourite such as Nabi Yunus's doa and wirid; some favourite asma al-husna....and the greatest zikr of all :

" La ila Ha illa hu wahdahu Laashari kala' lahul mulku wala hul hamdu wahuwa ala kulli shai in qadir "

etc etc etc..........tengok keadaan. Papa could easily do a thousand in the pool at KGNS.

Mixing the profane and the sublime , so to speak. You will find you will like the profane [ the exercise ] because you got addicted to the sublime [ the wirid  ]

The Haj people mostly recite just this at the field of Arafah during their Wukuf time.

There is a well known hadith which alluded to this wirid being 'the tress and beautiful plants that you plant in heaven.

" ....your estate in Jannah is a vast open plain, stretches far beyond the horizon. A cool place. This wirid will be the trees that you plant for your garden in Jannah...", or some thing to that effect. I could not recall the hadith exactly, but off the cuff , it alludes to that/

Please do check the authenticity of the hadith. Papa  has wild imagination oftentimes. I read to much during your age. 

At school in KB in the 60's, papa used to cycle from Jalan Teliput into down town KB to visit Carnegie Library,  to read philosophical works of Scopenhaur, Jung, Freud., of which Papa that time could not comprehend a thing Even read the works of evangelicals like Dr Norman Vincent Peale..

Then after having my morning fill, cycle back to prepare for afternoon school session at the world famous Sultan Ismail College. Papa probably was in form 2 or form 3, then. at MCKK, I was introduced to Bertrand Russel.

In later life graduated to al-Ghazali, Abdal Qadir al-Jilani, etc and etc.  & not forgetting Hamka's Tafsir al-Azhar.

So now , all those years of  'junks' are just creeping out!!

Enjoy. your life to the fullest my son, but, always, always, always, the BILLAH & LILLAH, must be there in the background and foreground.

LIFE IS FRAGILE,  at all ages, even at your ages!

5 Best Things To Do On Laylatul Qadr | Dr. Omar Suleiman....................

Ru, Sha , Jo, Nina & Yazman,

This last 10 days oF Ramadan is Laylatul Qadr territory. If you are in Makkah now, it would be impossible to enter the Haram even if you arrive 2 hours before Magrib. One can say what one likes with respect to the Arabs in general, but Laylatul Qadr is very serious  'business' in the Arab world.

They know their Quran.

As the good Shaykh Suleiman above mentioned in passing, in the last 10 days you do the same as what you have been doing everyday : Solat, Zikr & Quran. But just increase the volume.

Papa will add, but x10 more in term of volume, and do it mostly in between Magrib & Subuh.

If you have to sleep, sleep very little. Try sleeping just after the Terawik prayer before 9.30, then wake up at 12 and start work!! Of course the best is to iktikaf fully in the masjid the last 10 days.

But we all work

That remains a reality  nowadays. We work.

Papa's personal modus operandi has now changed a wee bit from what Papa advised you guys some 5 years back. I have adopted Imam al-Ghazali's recommended weekly schedule, UNTRUNCATED, AND COMPRESSED,  into half a night, as my daily zikr.

Starting at 11 pm, or on the dot at 12 am, on waking up, take ablution, and do his 1st zikr:

1...." ya Allah, ya Allah, ya Allah..." [ or Allah, Allah, Allah...]     x1000  .....less than 20 minutes

2...." La ila haillallah "       x1000   ........approx 24 minutes

One cycle of 2 rakaat Tahajjud prayer.

3...." ya Hayyu ya Qayyum "    x1000      ......less than 20 minutes

4...." La haw la wala quwwata illa billah "    x1000     ....approx 22 minutes

2nd cycle of Tahajjud prayer.

5...." Allah humma solli ala Muhammad  wa ala ahli Muhammad " , or interspersed with slightly elongated versions, occasionally, if you like,             x1000      ......approx 25 to 35 minutes, if you intersperse with the elongated version, and longer if you do like the one in the last rakaat of our solat.

6...." Astagfirullah, astagfirullah, astagfirullah "   x1000      ...... only 14 minutes

[ but I usually do the whole, longer personal version taught to me by an Indonesian Shaykh, Shaykh al-Mendalingi, [ from Mendaling, Sumatera ] given ijazah by the Saudis to teach in the Haram in Bahasa Indonesia., Papa met al- Mendalingi in the Haram while leading the Medical Haj Mission in 1984 :

" astagfirullah hal Azim allazi la ila ha illa huwal hayyul qayyum wa atu bu ila'  rabbir firli waliwa liddaya wal mukmini wal mukminat ".

Tak sampai hati Papa tak berdoa UNTUK kedua orang tua Papa. Itu saja Papa boleh doakan dan buat kepada kedua yang tersayang buat masa ini.  This addition does not take long anyway....Allahualam.

Kalau betul ilmu yang di-perturunkan olih the good old shaykh itu , betul lah. Kalau tak betul, tak rugi..

Ini Papa punya philosophy. , 

Tak perlu debat dengan sesiapa benda amalan seperti ini.

Dalam hal ugama, children, please avoid those 'tok gurus' with blinkers.

Just too many of them around nowadays.

They will take away the sweetness of berugama, especially in your later lives.

Followed by 3rd cycle of 2 rakaat Tahajjud prayer.

7...." Subhanallah wa biham dihih subhanallah hil Azim "       x1000      ....approx 30 minutes.

Followed by 4 rakaat of Solatul Tasbih dalam 2 salam. [ 20 minutes ]

Between 5 to 5.30, when you guys joins Papa for Sahur, I listen to al-Basit on the net with direct transliteration by Pickthal [ excellent video ]. Or read the Quran. I love listening.

Between 630 am to 830 m, try to get a short nap before going to work in SJMC Hospital.

Another short nap after Zohor.

In between Asar and Berbuka,

8.... " La ila haillallah hu wahdahu la sharikallah lahul mulku wa lahul hamdu yuhyi wayumit wahuwa ala kulli shai in Qadir "       x1000        ........approx  70 minutes,

&

A potpourri of other short wirid, in between 'nook and corners' while at work, and while waiting for Berbuka :

1. Rabbana atina fiddunya...

2. Allahuma innaka affuwun...

3. Doa dan wirid Nabi Yunus

4. Some favourite asma al Husna, esp " ya Latiff ", " ya Salam "

5. " Hasbunallah wani' mal Wakeel "

6. " Subhanallah wa bi hamdih astagfirullah wa atu bu ilaik "

Pokoknya children, dont leave any " space " unfilled this last 10 days of Ramadan.

IT IS NOT JUST ABOUT THE 1000 BULAN. 

IT IS ABOUT BEING CLOSE TO HIM.

Papa view the annual Ramadan month as a great OPEN UNIVERSITY for all humanity.

The last 10 days is Allah's gift to Mukmin.

And after the Ramadan, we will certainly percolate downhill  a lot with our zikr volume almost certainly, to just a mere fraction of what we are doing now, ...it is very OK.

With a lot of istiqamah, Insyaallah, we go up a couple of  planes higher in our relationship with HIM, from previous years. It is stepwise like climbing a staircase.

Next year up another staircase, until constant  zikrullah, in your ripe old age no longer becomes work.

It will be pleasure, insyaallah.

ITU SAJA MEANING HIDUP INI.

WE WANT TO BE CLOSE TO HIM.

We dont want to remain static, like a man running on a threadmill, year in and year out, not going any where.

Ru, Sha, Jo Nina & Yazman,

LAYLATUL QADR IS DOWABLE,

GRAB IT.

Case History 23 : " ...Doc, I don't Want Bypass Surgery "

 CML, a 64 year old Indian gentleman, saw me some  16 years ago in ER, SJMC, at 2 am in the context of an acutely developing anterior wall myocardial infacrtion [ heart attack involving total,100 % blockage of the Left Anterior Descending Artery ].

He was duly admitted right straight to the Cath Lab, where the occluded artery was duly 'openned' with balloon angioplasty and drug eluting  stent implanted.

At the same sitting the proximal  Right Coronary Artery , that had 75 % stenosis [ significant, critical- flow blockage ] was also ballooned up and stented. He had 2 stents implanted that wee hours of the morning.

He was lost to my clinic follow up for years following Covid epidemic, until last week, he presented at my outpatient clinic with ? GERD pain., pain in the epigastric region moving up to the chest , like a heartburn type of discomfort.

A blood test  for 'Trop T sensitive' was taken and I gingerly put him on the threadmill.

His resting ECG was normal looking but hardly 3 minutes when he started  walking, the ECG showed evidence of myocardial ischemia. The Stress test was duly stopped.

Back in the clinic, his 'Trop T sensitive' result proved positive. He has ACUTE CORONARY SYNDROME.. He was duly admitted and planned for coronary angiogram the next day.

" Doc, whatever your finding, by hook or by crook, I don't want Bypass Surgery! ". When patients like CML, give this kind of 'preemptive' decision, interventional cardiologists like me have a wee bit of 'heart-burn' because doing an angiogram on people like CML, with chronic, badly controlled lipid level, with clinic f/u which at best are irregular, etc etc and etc, it is like going to have breakfast at Manhattan Fish Market : we dont know what is going to be the 'fish  on the plate' for that morning.

If the lesions turn out to be complex, ad-hoc angioplasty and stenting, there and then, straight on the table without prior detailed discussion with or without his spouse or partner being present, can be wee bit stressful to the interventional cardiologist. We want to discuss further with patients and family but the " Doc, I dont want surgery, full-stop ", is usually a stiff order.

BUT AN ORDER IS AN ORDER.........he was very specific with what he wanted, and his wife was present, at the initial discussion.

I proceed.

Video 1

This was his Right Coronary angiogram. Alhamdullillah, the proximal stent in the Right Coronary Artery is still very patent despite 15 years plus, albeit with minimal 'in-stent restenosis' [ renarrowing ], about 20-25 %  of diameter of stented part. In the distal RCA are two tandem lesions, about 90 to 95 % each. Critical. The RCA, at this point and the distal run-off, overall looks good for either angioplasty and stenting and also good for the surgeon.

Video 2

The Left Anterior Descending Artery cine showed a critical 90 % stenosis before the fully patent stent implanted 15 years ago, to the ostium of the Left Main Stem artery. They was no adequate landing zone for any stent implantation, if one is planning to stent this artery without encroachment in the Left Main Stem Artery. Infact the ostial LAD disease seems to spread into the distal LMS vessel, given a luminal narrowing of about 50 % at the distal LMS. This is a surgical option...

Video 3

A " spider cine view of the LMS lesion,  50 % narrowing here and subtending into the ostial LAD vessel with 90 % narrowing.

....

Video 4

A  AP-Cranial cine view of the left arterial system highlighting the 90 % narrowing. At this juncture Ipointed to Mr CML:

" Sir, You have a very tight right coronary blockage, 2 narrowings in the distal Right, about 95% both of them, and a tight lesion in your proximal LAD before your old stent. Your left and right stents seemed to be holding very well despite 15 years with little, non significant re-narrowing....the left narrowing involved the Left Main Stem......the 1st option is CABG since , at present time, the available data seems to point to a better long term result. I will stop here and discuss  the cine with you again tomorrow with your wife present, and give you time to consider a surgical option "

" Doc, is my disease dowable with angioplasty and stent.?  What is the risk and how long will it take for me to get back to work. I have an oversea trip coming up a week's time. I dont want surgery."

" The ball-park figure for risk of mortality for chaps like you with this good looking lesions and distal vessels run-off, and normal left ventricular ejection fraction of normal 62 %, I think in my estimation around less than 1 %.  You can begin work tomorrow evening. Your oversea trip next week , insyaallah, can proceed.... "

Video 5

I gingerly and carefully passed an 18/1000 inch BMW stainless steel guide-wire with a soft end into the Right Coronary Artery with Xray guidance. With the guide wire in place, I passed a small balloon,a semi compliant balloon, 2.5mm diameter and 15 in length over the guidewire going thru the artery gliding in the artery in a monorail fashion.

Video 6

The two tight lesions were dilated several times with the balloon in placed at that spot of constriction with pressures around 8 to 11 atmospheres.

Video 7

Having satisfactorily pre-dilated the lesion, I remove the 1st predilatation balloon , and with still the guide-wire in the right coronary, I passed and glided another balloon over the lesion. This time a 3.0mm x 26 mm in lenght balloon with a drug eluting stent of that lenght, factory-crimped on the balloon.

Deployed the balloon and stent twice at pressures 8 atm, & 12 atm respectively.

Video 8

Final result of the Right Coronary lesions  after further high pressure dilatation, and removal of balloon and guide-wire. Looks satisfactory.

The distal narrowing in the small branch , I leave alone.

Video 9

Now it is on to the left system.

I passed another new BMW guide-into the un-diseased Left Circumflex Artery as an 'insurance policy' while we are to do work on the Left Anterior Descending Artery, as oftentimes, this vessel can close while we are doing work on it's partner branch of the Left Main.

I passed another guide-wire into the the culprit artery where we will be working ie. The Left Main Stem, and the Left Anterior Descending Artery., a Sonne Blue 18/1000 inch diameter wire also with soft ends.. Gingerly , I glided predilatation, semi-compliant balloon , 3.0mm diameter x 15 mm length,over the Sonne Blue guidewire, and placed the balloon just at the tight LAD lesion, and deploy at 8 to 10 atm, in sequential fashion, all along the lesion lenght.

Video 10

After satisfactorily predilated the LMS- Ostial LAD lesion with the predilatation balloon, I removed the balloon and re-introduce another balloon, the stent balloon ie 3.0mm in diameter and 26mm in lenght to satisfacttorily cover the whole lenght of the LMS and the ostial lesion in the LAD artery.

at this juncture it is important to get accurate placement of the stent to cover all the diseased portion of the artery, and cine from several views are usuaaly done.

In this video, it is showing the 'spider view' ' [ AP-caudal view ] of the LMS and the Left Anterior Descending Artery

Video 11

When it ws deemed the stent balloon had been accurtely positioned, only then was the balloon deployed at twice at pressures 10atm to 12 atm respectively.

As an interventional cardiologist for over 3 and a half decades onw, when I am in a Left Main Stem with balloon and stent fully deployed , I still have my adrenaline rush.

Mashallah, in this kind of work, things can always go southward in the best of cases, and this has benn my practice now for over decade that at the beginning of any angioplasty I asked my patient to say his favourite prayer or incantation continously while I say mine..

1 % mortality may not sound very much to you and me but if you happened to be that 1 %, it is 100 % for you !!!

Video 12

After satisfactorily deploying the stent across LMS- LAD, I take off the stent balloon and deploy a short high pressure 3.0mm x 8 mm high pressure non compliant balloon deploying it in the tent at 18 atm sequentiially.

Video 13

Then do a POT in the Left Main Stem with a high pressure , non compliant short balloon 4.0 mm x 8 mm lenght at 22 atm sequentially, and 25 atm at the ostium [ opening ] of the LMS with the aorta.

After this procedure I can sense the whole Cath lab staff, scrub nurses, technician and radiographer, there was a collective sense of relief and sigh.

Angioplasty and stenting, at whatever level of difficulty, is a total team effort. I am there acting just as conductor of the orchestra! 

For me it is like music, occasionally just keroncong but oftentimes , like this case, it went on to Bach or Beethovan.

Video 14

This is the final result of the LMS-Ostial LAD stenting.

" CML, you are an excellent patient throughout the procedure, soo calm and composed...what yogic chant were you doing this 1 and hour hour?.....Is it OOOOOMM all the way? "

" Doc, who come you know ?......I was doing that, yes..!! "

" Well, CML, I was doing ..'Allaah ..Allaah..Allaah ' so I assume you must doing Oooooomm..Ooooomh..Ooooomm .......you looked so composed...you never once disturb our work.....you are a rare patient "