Reading the research letter published in the Lancet 1412-1414, Vol365 April 16, 2005 about Inadequate anaesthesia in lethal injection for execution (₁)

(A study conceived by LG Koniaris and JP Sheldon ). I was amazed by the concept that had always proven correct,

(Reach for a taken for granted agreeable theorem and think about it, Challenge it and you are on your way to surprise the world.)

Here is a mean of execution in the USA that I had always thought of as most human if compared to the violent Electric chair, Hanging, Gas Champers, or Shooting.

DR Koniaris challenged that agreeable concept and researched it to find almost 40% of people executed that way were possibly aware of the horrible feeling of being paralysed and unable to wink, hypoxic and feeling the burning sensation of potassium shot injected into them.

It was also revival of the logical debate, Should Doctors be part of execution when we all sworn to maintain life and cause no harm.

Or should a doctor who knows so much about reducing human suffering by pharmacological means, Sets on his backside watching Somebody been hanged , shoot or electrocuted, With the scenery of Sadam Hussein not to far back in our memory .

Moslem scholars are in agreement about executing the murder and cutting the hand of the violent rubber and dismembering those who spread evil community destructions, Are all just and deterring and by reducing crimes that would establish God kingdom on earth, That had never appealed to westerners, Although some see the logic of it.

I personally heard of a highly regarded Islamic Scholar (₂) that people by enlarge tends to sympathise with the victims of execution, But they never think how did these victims mange to get to such mischief in the first place , That would make any state determined to want to punish them, Whom did he or she had killed, rapped or violated, True I thought.

Back in the hot summer of Al madinna Almunwara (Hejaz, Saudi Arabia)1985 Late afternoon on a Wednesday and following a busy day in the operating theatres,(₃

I was called by the hospital director who had given my name as the Anaesthetist who will accompany the ambulance on the next Friday to attend Qesas after Friday mass prayer near by Prophet Mohamed PBUH masjed A yard known as Narring (Qessas) Area,( Where Islamic law punishments were implemented) Oh no not again I nearly shouted with visions of a mans head flying of his body, Brought back as a living memory, It was of a man who had killed his brother 16 years back. And an event that I had witnessed among thousands others not a long time back then.

Do you really need an Anaesthetist for that? I asked. And The Director said a senior doctor had to accompany the ambulance for resuscitation should that be necessary,

Sir what resuscitation when the head fly away and both Carotids drain like a fountain of blood all over the ground? I so that once and never hoped to ever see it again.

No he said it is hands only this time. And I f you care to come to my office I would explain the matter in more details, Well I will be with you shortly.

I was a bit excited somehow as I wondered how this going to be and what do I need to take with me who else would be there. I also wondered where would I be on the day of this coming Qesas ? Would I have to be so close to those ? And what they might be looking like?

As I changed OR cloths and had my lab coat on heading to the director office some more questions came to my head How I wonder the hand would be shopped off? How the Prisoner would takes that? What if he fainted before cutting his hands? What if dies of syncope? Could he bleed to death as the ambulance drive back to the hospital?

Now what is all this about I asked as I greeted the Director in his office, and he pressed the button on his desk to order a glass of tea for me. I sat down and he said Dr Hamalawy this is just a routine

You are our best Anaesthetist and I believe the doctor who would attend this don’t usually have to do much, You would have the Ambulance service man with you who had witnessed this matter before.

The hospital have to be ready to operate on these guys’ after their hands shopped off, Yes I remarked some surgery would be necessary I am sure.

The calm director continued some trimming and suturing would be done immediately as they come to the hospital hence we arranged Two theatres to be ready. Why Two I interrupted?

So you didn’t know that there will be hand cutting of two people. I started sipping the Tea and Visualising my self in the heart of the incident and wouldn’t like to miss being there

I must get some resuscitation stuff with me, I better start thinking of what I must take in the rescue bag and arrange for an extra resident Anaesthetist to be available on Friday afternoon in OR.

Well If you need any thing then let me know, commented the director . I thanked him for explaining the matter and back to my office I returned.

On a blank sheet I started writing what would I possibly need Laryngoscope several Endotracheal tubes Ampu bag Syringes and needles Adhesive plaster, Bandages, Sphygmo manometer, Stethoscope and Drugs.

Adrenalin Atropine Calcium Sodium Bicarbonate and Lignocaine. Lignocaine No I crossed that off then wrote it again and crossed it off again and stopped and wondered for a while why not?

Well It is obvious that these people are keen on preserving the criminals life, With all the arrangement Ambulance Operating rooms Surgeons and nurses. And me why?

Well if they are keen on their life and on immediate treatment of any fainting why let them faint in the first place? I wondered

I reached for the Phone and began to feel privileged to have to be assigned for this task, Now I was already told you are our best Anaesthetist and the child in me was overjoyed. I called the Ambulance services office to enquire about what they would have in the Van on the day and who would answer It was him the very man who would accompany me on Friday. He sounded rather experienced and apparently had been involved in similar episodes , and he was proud that none of the punished prisoners who came under his care had died following their hand chop . You only have to insert a cannula in their left arm and I will put a dressing and loos tourniquet over their right upper arm to be tightened immediately following the cutting.

Would you have Oxygen in the Van? I asked. Of course he replied don’t worry, I thanked him and asked to be picked on Friday 11:00 AM from King Fahad Hospital main loopy.

The question that kept burning in my head was why Should those people feel the pain of their hands chopped off ?.Isn’t going to be a lost hand for the rest of their life A just reminder of their robbery, Isn’t their communal insult when thousands of people see them punished enough?

I wakeup at crack of dawn on Friday with the call for Fagar prayer loud and clear repeating that Prayer was better than sleep, After prayer it was clear that I have some homework to be done.

I had just completed my own little Islamic literature home library, Mainly with free books as a gift (₄) and some selected important books that I bought from book shops near Haram Shareef. I went through the books of hadeeth searching for something to agree or deny the prisoners the right to have painless punishment. I wasn’t sure where I might find an answer, But I kept reading through relevant matters.

God almighty (Rauoof Rheem) Most merciful and compassionate, Well then it was the moment I ,thought I made my mind up, Let them suffer no pain.

I know now what they were going to have done

I spent most of Thursday finding out, It is going to be a kind of Disarticulation at the right wrest

And I could help these guys and it seems that their is no obvious Islamic doctorin against it and it is a blessing and compassionate act to help these two not to suffer any pain.

Ten O’clock Friday morning I went to the hospital made couple of phone calls and made sure that Anaesthetist as well as theatre would be on a standby ready to receive these Two guys when they arrive to the hospital, I went to check my box that I prepare from Wednesday to make sure that everything was there.

A lignocaine 1% plain 100 mills vial was there sealed staring at me , I almost snatched that with punch of spirit swabs and few 20 mills, Syringes and needles, I stuffed it all in my box and called an assistant to take my box to the hospital main loopy.

The Grey head Ambulance Palestinian had arrived with an expressionless face, Went to the receptionist asking for the Consultant Anaesthetist who would accompany him.

I went straight to him and my assistant walk behind me with the box. The ambulance man gave a surprising laugh yelling where you people think you going, For Heart Transplant Ha,

I greeted him and asked if I keep that box in the van with us? Yes, he answered politely and I was thrilled. He looked in the direction of my assistant in a way that indicated that there is no need for him to come, and I agreed. After all this Ambulance man had been there before on similar occasions and knew what he was talking about.

Off we went in the Ambulance in the direction of Haram shareef (₅) Where Exactly near Haram we going to be? I asked

Well the gentleman replied in the big square in front of the (Mezzallat Area by Bab Al salam,)(₆)

The Ambulance man again briefed me on the details of what we going to see, The van was approaching Haram when few crowds had gathered near that area mentioned above, A traffic policeman waved and directed the Ambulance man as to where exactly he should bark the van.

There was a massive queer looking blue Van with Bars and side door slided open and the Ambulance barked next to it. The ambulance man barked the car and looked his door and went straight to the back of the ambulance and brought his bag .turned to my side and said here all what you may need,

Never mind I still think I need my box as near as possible to where the chopping will take place,

Off I went out of the ambulance and he took my box and placed by the open door of the prison van

I reached for my box took my stethoscope round my neck and sphygmomanometer and asked the ambulance man to check there Blood pressure if he may..Well he said with a tone of appreciation asking where was I trained and I answered UK and he said no wonder, I t is the first time I come with an organised fellow Doc, Thank you I said.

I looked inside the prison Van to see two black guys chained from their legs to the Van seats

They were neither pleasant nor friendly looking , I introduced my self and told them that I am asked to examine them briefly and insert a cannula and have some fluid running in their veins to stop them having any mishaps. They were almost a carbon copy of each other early thirties or late Twenties at the youngest guess. They did not say much and it was understandable how miserable they must feel

There Hearts and Chests were free of major illnesses Their Blood pressure Were also normal as the ambulance man informed me.

I let you feel no pain as you go through what you are expecting, One suddenly stared at me with a Yah sign, The other reluctantly said do what you must do, Obviously he was in no mode to listen.

My feelings of sympathy to these guys had grown tremendously and I went on saying one or two scratches and you will fell absolutely nothing, I reached for my lignocaine vial and draw two syringes of about 25 mills each of the lignocaine, I got to the more arrogant one first and asked him to stretch his right hand I infiltrated subcutaneously around his wrest and went Intra articular and put about 15 cc of the stuff. I turned to the other one and did exactly the same and the first guy said with a funny grin on his face It feels different.

I checked them again and the Ambulance man rapped Cotton wool around their Right upper arm Bandages around it, Ready to tie it hard after the chopping and put some gauze bandage over it. By that time both these guys had the right wrest blocked their left arm cannulated and the right forearm tourniquet as mentioned. The prisoners would take a quick glimpse at one another but not a spoken word, I don’t think they were all that carless but they seemed that way.

Time must have been running fast I stepped out of the Van and realized that we had already missed the Prayer, That made me feel awful Yet anxious to what is coming . A Saudi man approached with a sophisticated piece of rob about 6o cm long as a 40 cm single part and about 20 cm where it was singled into 3 thinner ones, The 3 thin branches went around the Thumb , 2ed,3ed and 4^th,5^th fingers. The single thick end of the robe had a ring of the same material apparently for handling it.

Prayers now finished, people Dashed out of the masjed and placed themselves silently in a huge big rectangle and I realised that here we are in the middle of it all There were two more GMC Vans not too far from where we were but within this prosecution field. Two policemen approached us but stood about ten meters away and of one of the cars came a civilian in Plain Saudi cloths with his Files

The first prisoner was unchained when one of the policemen reached for the prison van and was brought some 2 meters away from us in the direction of the man with the paper who was then

accompanied with the man who brought the robe. The crowd were able to get very clear view in the bright sunny day and the man with the files took his papers out and started reading the court order for Chopping the mans hand, I don’t think it is appropriate to mention their names here but they were relatives perhaps cousins.

My mind was focusing on the moment where the chopping would take place, But couldn’t help hearing what had proceeded the court order, These 2 guys had been rubbing Gold stores repeatedly they were imprisoned before several times warned several times fined several times, then the chopping was over due, I don’t think many would be very sympathetic with them because t was obvious that they themselves had defiantly hurt so many people.

The man read the sentence loud and clear and within 2 minutes a policeman were at the prisoner head standing behind him ,the Ambulance man on the prisoner left hand side ready with more bandages my elf to the right hand side of the prisoner and the man with the robe apparently was the Executer himself, the prisoner kneeled down on the ground , The policeman grasped his shoulders back, The executer got his Peculiar knife out of his pocket and had it flicked open in his right hand and with his left hand grape the ring at the end of the robe, An assistant to the executer appeared in a split second he grape the right arm real tight pulled it real hard backward and the executer pulled the ring with a mighty strong pull. Just before the knife reached the wrest I could see the arm looks at least few cm longer they had dislocated that wrest completely , The double edged sharp blade went into the rest once forward then backward , The slashed hand were tied to the robe and left high up by the executer left hand obviously for the crowds to see.

The ambulance man gazed at me with a surprise on his face, Indicated that it is our turn he rapped tight a bandage around the one he had on the prisoner right forearm earlier , I ran the IV drip of lactated ringer and I got the prisoner up on his feet and walked him 2 meters to the back of the ambulance escorted by the police man.

The Executer with his assistant had by then applied exactly a similar robe on the other prisoner Right hand, And the Ambulance man called me back to the seen and the exact same thing repeated on the second prisoner and few minutes later another robe and another hand went high up .Tourniquet was placed and drip running and the second man was in the ambulance. They were hand cuffed

together by both left hands and the ambulance man indicated to me to hope into the van next to him and he drove fast to reach the hospital.

In a way I had a sense of achievement but still sceptical of what may happen next,, I was glade the whole thing was over and Although I believe in the Just of Islamic Shareea law, I wascertain that I would be reluctant to ever attend that again.

Saturday afternoon I had the director of health authority in Madina region on the phone asking for me and said what on earth happened yesterday, I am here with judges from the Madina court who are also are the Imams of the prophets’ masjed, They are wondering why these prisoner did not even wink when their hands were chopped,

And quickly I answered in a way that would help presenting my idea as humble and polite as I possibly could, Sir what do you think ?was that kind enough you think, There were no chance for these prisoner to faint or had any further complications, His voice went away from the phone and he came back asking what happened, I said in a very clear tone DO YOU WANT ME TO COME AND SEE OUR MAWLANNA AND BRIEF THEM ON THE DETAILS, Again his voice went away for a minute or two and then came back and was laughing no that is not necessary, Thank you and good luck.

Now I look back and wonder did I make history that day? OR has any body done that before in the history of the Islamic Judicial system.

These hands were hanged up on a stretched high robe near by Al slam door of Alharam Alshareef.

As we went for Maghreb prayer at Sunset neither the robe nor the hands were there any more.

If I was the first man to Anaesthetise the wrest before it is chopped off, then let every man hear that story that: I AM STILL VERY PROUD OF MY HUMBLE CONTRIBUTION.