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Kashmir shaken again. Let us invoke Mercy of Allah

By : MS Khuroo         Dated : 01/04/2016

KASHMIR EARTHQUAKE 2015- REMINISCENCES OF 2005 DISASTER
 Once more, we were rocked by a powerfulearthquake (Max. intensity V1-Strong)which shook north India, northern Pakistan and Afghanistan on Oct 26th 2015 at 2.39 PM. Hundreds of people rushed out of their houses in panic. Few unfortunate susceptible succumbed to cardiac arrests. Even the VVIPs were thrown out of protected indoors. All were worried about their loved one’s especially children. Unfortunately, phone lines including the mobile services, a lifeline at such crucial momentsagain ditched us (as during the recent floods) to leave people clueless about safety of their kith and kin.  In no time the US Geological survey registered earthquake of 7.7 Mw (later readjusted to 7.5 Mw) on the Richtermagnitude scale, centered 82 km southeast of Feyzabad (45 km north of Alaqahdari-ye Kiran wa Munjan) in the remote area of Afghanistan in the Hindu Kush mountain range, 212.5 km (132 miles) deep [epicenter 36.4410 N 70.7170 E]. I along with my family and grandchildren stood together in the lawn reciting the Quranic verses, watching the electric pole in the compound making a death dance and feeling the underneath earth shaking and reaching near to tearing off.  Loss of human lives and property is being continuously evaluated and as of today has caused 387 deaths with 2422 injured. 
While these moments were evolving I had reminiscences of massive earthquake of October 8th 2005. One day earlier (October 7th 2005) I was to run a very busy afternoon outpatient clinic. My first encounter was with a pleasant elderly woman who wanted a consult for abdominal pain. Her daughter, a physician, accompanied her and she narrated her story. This woman had developed lower abdominal pain with altered bowel habits for last 2 weeks and her daughter arranged an abdominal computed tomography scan (CT scan) which revealed thickening and mass-like appearance of right colon. I quickly did a physical and reviewed the hard copies of the scan. I spoke to the radiologist on phone and discussed the CT scan findings reported by him. While I was doing all that, the daughter requested that a colonoscopy (video-endoscopic examination of large intestines) be done tomorrow morning as she has been doing bowel preparation of her mother for colonoscopy for last 2 days and is ready to have a procedure tomorrow.  The nurse was waiting for me to write the order for colonoscopy and told me that she has already booked a slot for the procedure in the next day morning session.   Things could not have been smoother for a colonoscopy procedure. However, I was feeling very uncomfortable and did not want to do this procedure. I quickly reviewed the need for the procedure and felt it was strongly indicated. Then I questioned myself why I do not want to do it. I did not know the answer. While these thoughts were passing through my mind, the nurse withdrew the “colonoscopy order sheet” which I had already signed. During remaining time, I was in the clinic, that evening and throughout that night I was most uncomfortable with the thought of doing this procedure and did not know the answer. Thoughts came to my mind that I should cancel this procedure and I tried to control these with the explanation that this is one of the thousands of colonoscopies I have done and is strongly indicated. I could not sleep that night and felt uncomfortable with these ideas and controlled these with explanations of having some unusual evil thoughts which needed be brushed out.
Next morning, I woke up and life was normal as usual. I reached my clinic at 8AM and after the morning meeting arrived in the endoscopy lab sometimes around 9AM. Endoscopy team (4 committed nurses and an anaesthetist consultant) were to greet me and all was set for what should have been a busy day. Staff nurse showed me a signed “Endoscopy Protocol Check List” that all was OK. Patient whose colonoscopy was ordered last evening was on endoscopy couch with IV line placed and we were ready to start the procedure. Anaesthetist sedated her with cocktail medication including IV propofol, an ideal medication for doing the procedure smoothly. I quickly traversed several regions of colon (rectum, sigmoid, and left colon). A change in body position (needed for passing colonoscope through bends and loops) and a small push across the splenic flexure and I entered the transverse colon. It took a few minutes to reach the hepatic flexure and till that time all was so well. I wanted to change the patient’s body position again to enter the right colon, the site of abnormality seen on CT scan. At this moment patient starting to scream loudly and these screams made me very uncomfortable. Endoscopy nurse told me that she is not distended (distension with gas is the commonest cause of patient’s discomfort during colonoscopy). I looked at the colonoscope length in and it was only 60 cm (looping is second common cause of discomfort and can be picked up by the length colonoscope is inside colon). As we did not understand the cause for her screaming, anaesthetist deepened her sedation by a bolus of propofol IV and she calmed down immediately and went to deep sleep.   At this moment I saw one of the assistant nurse faint and fall down on floor. Along with 2 other junior nurses starting screaming loudly and rushed out of the endoscopy theatre. A male employee entered the room and helped the nurse who had fainted out of the theatre. I was involved in waiting for the patient’s change in body posture and endoscopic push to reach right colon. While so much was happening around me, anaesthetist softly told me that there is an earthquake and it seems to be strong one. I suddenly woke up from where I was with the procedure and looked around. I saw the whole building shaking and everything including endoscopy light source and theatre instruments moving hay-way. The endoscopy couch was shaking in all directions and the hanging bulb on the roof was swaying around 180 degrees. I looked at the walls and saw these bending down to touch our heads. I felt I was losing the grip on the floor as it was moving in all directions. The building starting making cracking noises and I quickly understood all was set for the ultimate scene.  
At this moment (as ever) I heard the loud distant voice of my Molvi Sahib (Late Aziz sahib) who would come to my home in Sopore during my early childhood and made me to recite Al-Quran correctly, remember and translate the Quranic verses and amongst these included the Sura Al-Zalzala, which read as: When the earth is shaken with its [final] earthquake and the earth discharges its burdens and man says, "What is [wrong] with it?" That Day, it will report her chronicles, because your Lord has commanded it. That Day, the people will depart separated [into categories] to be shown [the result of] their deeds. So whoever does an atom's weight of good will see it, and whoever does an atom's weight of evil will see it (Al-Quran; Sura Al-Zalzala, 99:1-8).I remembered that I had taken several attempts to recite and remember this Quranic verse correctly and finally to do so the right way I had received a slap from the Molvi Aziz Sahib on my right cheek which led to my right ear-drum perforation (which I carry with me even today). At this moment I appreciated that I was not only told to recite this verse correctly but also warned to remember this in letter and spirit, as a time shall come when earth shall throw open all good and bad deeds of everybody.  Thoughts came to my mind that this is the time when it is all going to happen and prayed God for forgiveness. 
While the earthquake was on, we gave option to the attending staff nurse to move out for safety. She declined the offer and decided to be with the patient and do what is needed of her. I felt it was ultimate sense of commitment (putting one’s life at risk) by a young nurse towards patient care and for this nursing profession is known all over the world.  I slowly withdrew the colonoscope from the patient and propofol infusion was discontinued. We moved the patient (on the couch) and ourselves to safer place near the pillar of the endoscopy room. We stayed still waiting till the earthquake settled in intensity (this period at that time seemed to last for ages). Soon the patient became conscious and did not need any life support. Time had come to move out along with the patient on the couch. Outside endoscopy room, whole clinic building was barren without any staff.   Outside the clinic building we saw a huge commotion and all were visibly shaken. We waited at the clinic gate along with the patient and appreciated several lighter shocks.  
During this time, I spoke to the anaesthetist that I believe this episode must have consumed more than 100,000 lives. I felt he did not take this comment seriously and wanted me to stay calm. However, over the next few days and weeks it came out that this earthquake was rated as the 14th deadliest earthquake of all times, with magnitude of 7.8 on Richter magnitude scale and had caused over 80,000 fatalities, left over 10, 6000 injured and 3.5 million people homeless and came to be known as “The 2005 Kashmir Earthquake or The South Asian earthquake or The Great Pakistan earthquake” in history. Even the house of the anaesthetist who took my comments lightly had collapsed and raised to ground and his family members had a lucky narrow escape. 
I always wondered why I had the intuition of something bad as of this magnitude to happen during this procedure and felt strongly to cancel or defer this procedure. I believe there is always more to than what meets the eye and that what we cannot see but appreciate is what keeps this universe to run and govern. Also through this episode I came close to know what the end of this world (Qayamat) shall be like and finally how “Day of Judgement” shall open our deeds (good and bad) and shall segregate us on basis of our virtues.  
Prof. Mohammad Sultan Khuroo, MD, DM, FRCP (Edin), FACP, Master American College of Physicians (MACP, Emeritus), Former Director, Chairman Dep’t. Medicine, Professor and Head Gastroenterology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India; Former Consultant and Head Gastroenterology, Hepatology and Liver transplantation, King Faisal Specialist Hospital& Research Centre, Riyadh, Saudi Arabia; Director, Digestive Diseases Centre, Dr. Khuroo Medical Clinic, Srinagar, Kashmir, India. E-mail: khuroo@yahoo.com; website: www.drkhuroo.comTwitter:Mohammad Khuroo @mskhuroo