E18: Caring for the fasting patient

What happens when life-saving care collides with deeply held faith?

As Ramadan begins this month, millions of patients around the world will be fasting—and many of them will still come to the emergency department sick, unstable, and in need of urgent care. In this episode of EMERGE, we dive into the real-world challenges of caring for the fasting patient, from hypotension and sepsis to IV fluids, medications, and shared decision-making in high-acuity settings.

Joined by Dr. Laila Abubshait, we unpack common myths, high-stakes cases, and practical strategies for clinicians navigating faith, culture, and emergency medicine—without compromising resuscitation or trust. This conversation builds on our ALiEM article “Caring for the Fasting Patient” and translates it into bedside wisdom every resuscitationist and clinician can use.

This isn’t just about Ramadan. It’s about seeing the whole patient, asking better questions, and recognizing that sometimes the most powerful intervention in the ED is curiosity, humility, and listening first.

👉 Read the companion article: https://www.aliem.com/caring-for-the-fasting-pt/

🎙️ We want to hear from you—share your experiences, questions, and reflections as we continue this essential conversation.

Transcript

Dr. Mohamed Hagahmed: 0:00

Welcome to another episode of Emerge. In this episode, we explore caring for fasting patients during the month of Ramadan, navigating faith in emergency medicine and pre-hospital care, and how listening first can reshape outcomes for patients and clinicians alike. This is a timely conversation as Ramadan is expected to begin around February 16th or 17th of this year, and continue through mid-March of 2026 pending on the sighting of the moon. For resuscitationists and all clinicians working in high acuity settings, understanding the fasting patient is essential to providing effective, respectful, and trust centered care. I'd love to hear your experiences, questions, and reflections, so please feel free to share your thoughts and help move these conversation forward. We have a special guest today. She has been doing, uh, great work in the city of Philadelphia, the city of Brotherly Love, Dr. Laila Abubshait tell us more about you.

Dr. Layla Abubshait: 1:01

Yeah. Um, thank you Mohamed for having me. I'm very glad to be on your platform. Um, I'm currently an associate program director at Jefferson Einstein Montgomery. I've been at this job for about five years. And the main focus of my education has always been around health equity. And I found this area under health equity that I've been attracted to, which is how to intersect patient's culture, patient's religion to medicine. And I found it very interesting. So that's where the majority of my work has been.

Dr. Mohamed Hagahmed: 1:32

Layla, I've been following your work and you bring up very interesting topics that impact emergency medicine regarding patient population that we often don't think about. I can't say that we ignore, but we just don't think about very much. And one of the main reasons why I want to bring you here is to discuss the topic of the fasting patient in the ed. And uh, by the time we release this episode, it's gonna be a very special month in the Islamic calendar is the month of Ramadan when millions of people fast from sun up to sundown. This month, to me, as someone who grew up practicing the fasting tradition and fasting Ramadan, I think to me is like, brings up a lot of nostalgia. But also the discussions that I had with some of my colleagues. There have been a lot of unknowns, and what can we do better to ensure that these patients who are fasting in the month of Ramadan actually feel seen and feel heard and not simply neglected because of because of their practice. So I'm just gonna step back a little bit and just give us a global view of Ramadan from a cultural and a religious standpoint.

Dr. Layla Abubshait: 2:52

Yeah, absolutely. I'm glad we're having this discussion. Ramadan is one of the most anticipated month for Muslims across the globe, and it's a perfect example of how we can look at the intersection between faith and medicine and how that applies specifically in the setting of the emergency department.

Dr. Mohamed Hagahmed: 3:11

Can you just give the audience some, some details about the month, what it entails. Just maybe give us an idea of the typical day of a fasting patient in the month of Ramadan.

Dr. Layla Abubshait: 3:21

It's very different across cultures. The culture of Ramadan, every country is different. Um, yes, there. Combined by faith, but the way they practice Ramadan can be very different from one culture to another. To me, when I think of Ramadan, I think of my days back at home. I am from Saudi Arabia. I was born and raised there, so I think of Ramadan as family time. Now in Saudi Arabia, a lot of the stores and the places are closed during the day in Ramadan and everything lights up in the evening after we have broken our fast. So it always reminds me of those times where we walk in the market, where we're outside or when we're with the family breaking our fast. So to me it reminds me of that family time, uh, the time that I get to try different kinds of food. Obviously Ramadan is a little bit different since I moved to the US, but I always take it as a good time to remind me of my family. I know during the month of ramadan for a lot of people, the fasting itself is not just fasting from food or water, but it's also fasting from things that tends to be not so good. Um, so we fast from lying, I would say is one example, and then it's a time for people to remember the less fortunate population who do not have access to food three times or more than three times a day. And the most beautiful part of Ramadan to me is the end of it where we celebrate Eid. It's one day that unifies everyone. Everyone celebrates it. They've done it, they've made it. They fasted the whole month, and this is the time to celebrate and the time to give back to the community. With charity and donation.

Dr. Mohamed Hagahmed: 4:57

I hear you saying all these beautiful things and I just can't help myself but think of home, but just for our audience, I think you bring up a very important point. Ramadan is not just a religious tradition, it's also a cultural practice. So it's very important to bring this point to the audience because everybody is different. Depends on where they're from and how they practice Ramadan. That's a very important point to keep reemphasizing during our talk today, because someone, let's say from like my country, I'm from Sudan in East Africa, we. We fast, and some people sometimes take Ramadan and the practice of fasting very seriously and very

Dr. Layla Abubshait: 5:40

Yeah. Yeah,

Dr. Mohamed Hagahmed: 5:41

Like it doesn't matter what happens, I'm going to complete my fasting because I would like to be honored by god's good deeds, right? So it doesn't matter whether I have diabetes, whether I have heart failure, whether I have other medical issues that can maybe compromise my fasting, I'm still completing this religious practice, no matter what happens today, because at the end of the day, you and I working in the acute care setting, we are hyper focused on fixing the problem. But sometimes if we step back a little bit and just understand or maybe attempt at understanding where they come from, maybe they might feel heard and maybe their minds might be changed depending on the situation. And what I'd like to do today, maybe discuss some cases. Is that okay with you?

Dr. Layla Abubshait: 6:31

Absolutely.

Dr. Mohamed Hagahmed: 6:33

So the first case that I have, not too long ago was a patient who called 9 1 1 because their wife was having GI symptoms: nausea, vomiting, diarrhea for the past few days, and that was in the midst of Ramadan. That was last year. And when the husband called 9 1 1, the request was just take my wife to the hospital. And as you know, we practice EMS in the United States. EMS does things. EMS provides care, right? So they get some vital signs and the patient is somewhat hypotensive. With a high Shock Index, uh, she was tachycardic in the 120s. Systolic blood pressure in the nineties. She was in obviously stress holding her belly, so EMS does what EMS does best, right? Is IV,O2,monitor assessment, examination, and try to provide some IV fluid to correct that number. So I think that was the point of confusion. Because the husband told EMS that both of them are fasting. So he would like her not get any type of IV fluid. And of course, this whole discussion resulted in a little bit of hostility, maybe I would say. Uh, there was maybe confusion about like why the husband is, you know, doing all the talking, the wife is quiet, she's in obviously stress. Was there any type of abuse situation going on? So, you know, the clinicians were concerned, genuinely concerned about this patient. But by the time she got to the hospital, everybody was mad, upset. You know, the husband was mad. I told them she's fasting. They never heard us. They never listened. They just kept doing what they do. And, and again, they did it out of, uh, good conscious and that's what I believe. So walk me through this situation, right? Someone who's fasting has some abnormal vital signs yet has capacity to determine what care that they wanna receive, and the family never felt heard. So how can you go through this? This is now your patient. In your department, Layla, and you're now dealing with the situation, how would you approach that?

Dr. Layla Abubshait: 8:38

I think in your example, it was great that the patient gave you the history and told you that they were fasting. The cases we often see, they don't tell us exactly that they were fasting, and then when they refuse the care or they refuse the fluids, we wonder why they're refusing. So I think because we're not asking the question. That's how we miss these opportunities. We're often trained, just like how, the example you gave me about the EMS providers is that we are trained to look at the pathology, treat the pathology, move on, but we don't try to pause and understand what's the context of why this is happening. So I think now that we are bringing up the month of Ramadan and trying to educate a lot of our healthcare providers on the month of Ramadan, it is time that we start thinking and slowing down. So that's the first thing I would do is I'll slow myself down before looking at the vital signs, before doing all my exam and ask a few questions. I will ask the patient like, how long you've been fasting? Are you fasting? Have you had any fluids at all? When was the last time you had anything to drink? Have you ever experienced these symptoms? In the Ramadans before, is this the first time? And then most importantly, does the patient have any chronic conditions, because that would make their fasting even more riskier. Asking these questions does help me distinguish what's, what I need to fix right away. But at the same time, the patient feels heard because I've acknowledged their fasting. I've acknowledged that I understand what Ramadan is. I've acknowledged that this is something they've done before, and I will have a better communication between me and the patient.

Dr. Mohamed Hagahmed: 10:21

So people ask me before when to ask someone whether they're fasting or not. The common understanding is that Muslims fast only during Ramadan, but as you and I know, people do fast outside of Ramadan. So I struggle when to question patients, uh, whether they're fasting or not. So how do you approach that?

Dr. Layla Abubshait: 10:44

That's a very good question. I was asked that question before. I think the easiest way is to say, when was the last time you had anything to eat or drink? And then if the patient gives you a time, we know as fasting you should be, it is before sunrise. And so if they said that, that is normally a clue to me that okay, they meant they were fasting. And so then I follow that with a question, have you been fasting? That usually helps get the answer that I'm looking for.

Dr. Mohamed Hagahmed: 11:12

In these current times, how can you bring up the question of asking without your patients feeling judged or targeted because of what's happening right now?

Dr. Layla Abubshait: 11:24

I think it's all in your body language and your tone of voice, how you are asking that question. If they felt you're being judgmental in the way you asked the question, they may not be truthful or forward with their answers. There is a concept I like to use, I call it informed curiosity. So whenever I meet somebody who's from a different culture, a different religion, and I felt that they're doing something that I don't expect most of the people do, I ask them in a very genuine question if this is, has anything to do with their religion or their culture. And I often get the answer I'm looking for because of the way I'm asking. Maybe if we start like genuinely being curious rather than judgemental in our questions. I think we will get something there.

Dr. Mohamed Hagahmed: 12:08

So I am curious about your fasting. Tell me more. And also, I'm curious about your wellbeing and I know that your creator, God, Allah, the Almighty is also looking out for your wellbeing and your health, and he does not want harm to come to your body. God wants ease for you and not hardship. So again, like it, it comes down to having a conversation, you know, and I know it's like, it's hard, right? I mean, it's, it's easier said than done because you and I work in a high acuity setting that we have to always just keep doing things and move things faster so we can facilitate disposition and be able to see more patients. So in terms of taking time to listen, to understand and be curious, how can we make this process more efficient, yet respectful, and yet creates trust building and feeling respected.

Dr. Layla Abubshait: 13:08

Yeah, I think the answer to this might contain a lot of layers. It can start all the way from the hospital administration down to us, but me and you are in the field of emergency medicine. We do a lot of education around the topic, so as we get closer to the month of Ramadan, it's a good time to start spreading the word, educating people at work, whether they're your residents, your students, the nurses, other faculty members. That is something I try to do around the month of Ramadan where we send an email out to everyone that keep this in mind. This is the time where people will come in fasting. These are some questions that you can ask that are appropriate. Uh, these are some greetings. We also say that like how you greet somebody in the month of Ramadan. So it is tough. I mean, there are times in our practice where yes, we say we don't have the time, but we, if you wanna really provide good care for your patient and you wanna build their trust, the only way to do it is to spend an additional minute or two and calm yourself down and ask them the question in a very respectful way. And I think you will build that trust and you'll be able to get to them the way you are hoping you can.

Dr. Mohamed Hagahmed: 14:21

That makes a lot of sense. Thank you. So let's get back to this situation specifically. So that patient hypotensive, tachycardic, has some upper and lower GI symptoms. How would you manage them in the department?

Dr. Layla Abubshait: 14:36

Yeah, obviously from the everything that you've just told me, I already set my mind that this is somebody who needs IV fluids and needs IV medications. But I also know the downside to this is that the patient might wonder if I am trying to jeopardize their fast and trying to break their fast. So this is where it's important that I recognize. That I understand that you are fasting and I understand that you are trying to be close to Allah and it's important in Islam that you maintain your fast. However, it's also important that you take care of your body and I understand that in Islam, like preserving your health is a priority and so sometimes we do need to break our fast for medical treatment and it is allowed. Islam does not encourage you to hurt yourself. It actually encourages you to take care of yourself, take care of your body. And then when it, when we look at IV fluids and IV medications, there are different interpretations to that within the religion of Islam, many Muslims are told by the scholars that they are allowed to get IV fluids and IV medication'cause it's, it doesn't provide nutrition and they can still maintain their fast. So you will notice majority of the Muslims will be okay with this. There are some that would not be okay with it, and that's when you start recognizing and informing them about how important it is to take care of themselves, how fasting is not supposed to be such a burden, and hopefully with that conversation that they'll be okay with you providing them the treatment they need.

Dr. Mohamed Hagahmed: 16:06

Besides involving the family in this discussion, and you and I know, I hope by then they're gonna be family there at bedside. Is there someone at. Else that also needs to be in the picture.

Dr. Layla Abubshait: 16:19

I know some hospitals do provide, imams who can, whether you can call and they can come to the hospital and speak to your patients. Some hospitals don't have them, but a lot of hospitals do, and so I would encourage that in your hospital setting, if you have an imam to call them and have them be at the bedside. Some families go to certain mosques and certain mosque have their own imam or the religious person or this scholar and I would ask them to call the mosque and ask for that imam to speak with them over the phone. Sometimes just getting a permission from the imam telling them, yes, we should allow the doctor to do what they do to save your lives, can ease things for them.

Dr. Mohamed Hagahmed: 16:57

Have you seen these cases a lot in the hospital? Like where people like just coming in acutely ill and they don't want to break their fast. Is this something very common in Saudi Arabia?

Dr. Layla Abubshait: 17:08

It is very common, and it's often common with the older generation. They, and it's unfortunate because as you mature, as you get older, fasting becomes even tougher on your body especially if there is a chronic illness underneath that. So yes, we did face this often. Family are involved. Families sometimes try their best to convince, and we've had the Sheikh or the Imam be at the bedside as well, so we try different things. But yes, it is common in everywhere in the world, really.

Dr. Mohamed Hagahmed: 17:36

I remember growing up in Sudan, some people do elect to fast on Mondays and Thursdays, I'm sure the same thing in Saudi Arabia as well, right? This is a common practice to just to do weekly fasting practices on Mondays and Thursdays. And actually sometimes I do that just for my own cleansing intention, which, aligns me and makes me feel more pure in so many ways. And by the way, also, just to make this more generalized fasting doesn't have to be for Muslims, right? Do other population group also fast?

Dr. Layla Abubshait: 18:10

Oh, absolutely. Yeah. There are many religions where, I'm sure you've heard of Lent and all the other, there are so many religions that practice fasting. They do it in a different way. Some religion allows them to drink during their fast, like drink water, et cetera. And then I know a lot of. There are a lot of health gurus out there that also talk about fasting, whether it's 12 hours, 18 hours, et cetera. That's good for your health. So yeah, it's not just specific for Muslims.

Dr. Mohamed Hagahmed: 18:36

and you brought up medications and things that we can do and give in the emergency department without breaking their fast. This is gonna bridge this case. So the next case is another young female, she's in her twenties. That is found to have acute pyelonephritis. So she came in with nausea, vomiting, some flank pain, burning urination. And the ED workup showed acute pylo and obviously she needs management, including IV antibiotics. She was not yet well appearing to be discharged on PO antibiotics or oral antibiotics. So the clinician at that time decided to say, you know what? I'm gonna admit you. We'll make sure your symptoms are managed, and this was during her fasting month. So she was fasting Ramadan, and she asked the question, doctor is this gonna break my fast?

Dr. Layla Abubshait: 19:30

Yeah, it's interesting you brought up this example per se.'cause we had the same example few years ago and my resident went in to see the patient and he came out and he was clueless. He had no idea what to say. He did not expect this at all. Luckily, I was the attending on for that pod, so I said, okay. We he genuinely cared. Like he was very worried about her'cause the vials were not good and he was at the same time frustrated because he wants to take care of her. He wants to give her the medicines, but she hit him with this question that he has no answer to. So we had a quick like debrief at the station before we went in. I explained to him how important it is for Muslims to maintain their fast. And then we went in together. And so I, I remember when I approached this patient, the first thing I asked her was what does fasting mean to her and how important it is when I have to compare her health to the need for fast, which comes first. And I was surprised that she was actually open to getting treatments. She understood that in Islam your health still comes first before fast, and she understood that part. So actually that conversation went much more calmer and easier than what my residents and I prepared for. And when we explained to her that I told her I'm a Muslim and in Islam giving you IV antibiotics, will still maintain your fast. And she was very happy to know that. And she actually told us, look, if you have to break my fast, you can break my fast. That's okay. But we maintained her fast by giving her IV fluids and IV antibiotics, and she was grateful for it. It was actually only few hours before it was time to break her fast anyways, and so we did the IV antibiotics, waited a little bit, and then followed that with fluids once the sunset happened.

Dr. Mohamed Hagahmed: 21:16

I'm glad that she had you there and I'm glad that resident also had you there to provide this, huge learning opportunity.'Cause I'm sure that also impacted, their training and their perception of managing fasting patients. That's awesome. I wish all of us would have someone like you.

Dr. Layla Abubshait: 21:33

This example actually is what prompted me to reach out to you and put that post together. It's interesting'cause I know it happens. I know cases like this happened, but I never thought that it's gonna happen as common. And so when this example happened, and there were a few other examples that were brought up during one of our meetings, I thought it was important that we put something together like a mini guide for people.

Dr. Mohamed Hagahmed: 21:57

And for the audience, we co-wrote an article for ALiEM, so that's Academic Life in Emergency Medicine. And I will include the link to that post in this podcast and also on social media so people can have access to it. A question that came up, and I remember when I talked about this topic in our residency program someone asked me on the side was like, your name is Mohamed. You're a Muslim. You are cool, approachable, dude, I am not. I'm just a white person that has no idea about Islam. How can I create the same magic? That you show to these people, how can I actually be this understanding and show them that I care? So how would, what would you respond to that?

Dr. Layla Abubshait: 22:43

Oh my gosh, that is so tough. I I don't know how I'm gonna answer that. But I always tell them I still go back to that concept of informed curiosity. Maybe you're not meeting a Muslim person, maybe you're meeting a Jewish person. And they happen to have appendicitis, they need an appendix surgery done. It's, and it's on Sabbath. And they can't have surgery. So how are you gonna approach that? I think they need to stop thinking about how you appear, your skin color or how you talk, but it's all about how you approach them and how you speak to them. And the tone of voice your patients can feel when you respect them and when you don't and when you make them feel bad or make them feel guilty, they can definitely feel that. That would be my advice to that residents.

Dr. Mohamed Hagahmed: 23:27

Layla would say the same things that you are saying. Empathy, caring, taking the time to sit down and listen and understand and approach things with curiosity. It's the same things. Work for every single patient, whether they're Muslims, Christians, Jews. It's the same idea of simple human connection that, Hey, I am here and I care about you, and I want you to get. Best care possible that also aligns with your principles, beliefs your moral principles, whatever that is. I'm here to support that. And I think that was my response to to, to that person. When he asked me that question, I was like, first of all, thank you for telling me that I have magic.'Cause I don't know if I have that magic number two, this is what you need. If you can just simply listen and approach their concerns with humility and curiosity. I think a lot of the times things will work out for that patient. I think a lot of times people will end up changing their minds because now they're realizing that this person in front of me, Layla, that resident, that intern, that nurse, that pa, whoever that is, they actually care about me.

Dr. Layla Abubshait: 24:44

Yeah, exactly.

Dr. Mohamed Hagahmed: 24:45

Going back the same theme when it comes to medications. I know in the article that we co-wrote, we listed some medications that can be given without breaking the fast. And that includes, nitroglycerin inhaled abuterol, like a puff inhaler. You can also give oxygen ointments, creams, lotions. Vaccinations and I hope that people will start getting vaccinated again. That's my

Dr. Layla Abubshait: 25:12

That's a topic for another day.

Dr. Mohamed Hagahmed: 25:14

Or another podcast. But what about procedures? Can we get the scans? Can we get an MRI CT scans? Those things.

Dr. Layla Abubshait: 25:21

yeah. Oh yeah. Those are all absolutely, yes. You can definitely get your ultrasounds, your x-rays, your CAT scans, whether it's with or without contrast. Again the interpretation that as long as it's not providing nutrition, then it counts toward keeping you fasting. And I think use that. As a guide. Now, will you meet some Muslims who will still refuse it? Absolutely. But the majority will be okay with it.

Dr. Mohamed Hagahmed: 25:46

I would like to end this segment by going over some myths and realities. So the first myth that I heard is this is something we discussed already, fasting patients cannot receive any treatment.

Dr. Layla Abubshait: 26:00

Obviously this is false, and I hope that after everybody listened to this podcast, you guys know that is false. There are ways to provide the same treatment in different routes. IM, for example, patches, like you said, the ointments and iv, as long as it's nothing given PO

Dr. Mohamed Hagahmed: 26:19

Myth number two, IV fluids or injections automatically break the fast. We talked about this also already.

Dr. Layla Abubshait: 26:26

Yes. So yeah, obviously that's a myth. Nope, it does not break your fast.

Dr. Mohamed Hagahmed: 26:30

And myth number three, patients who fast are being non-compliant or reckless.

Dr. Layla Abubshait: 26:37

Yeah, so it's, this is tough because the example I gave you about that patient who came in with pylo. Like I can tell from the, how my resident came to me that they were upset that, how is she was actually diabetic too, so how is she diabetic and has an infection and decided to fast. It's not that she did it on purpose, that she wanted to hurt herself on purpose. So this is something that we have to recognize and honor their religion, that they're doing it not to, they wanna hurt themself, but it's a disciplined practice to them. It keeps them close to Allah. It it's part of their religion. So I think if. If you make the patient feel seen, feel respected, feel like they're willing to engage in the shared decision making, you'll feel less about them being non-compliant or reckless. It's all about changing the way we think, really.

Dr. Mohamed Hagahmed: 27:30

Absolutely. All of these things that we talked about, I keep reemphasizing just approaching these patients with a sense of cultural Humility, that will go a long way.

Dr. Layla Abubshait: 27:38

Yeah.

Dr. Mohamed Hagahmed: 27:39

The last myth is my favorite. So clinicians need to be religious or experts in Islam to manage these fasting Muslim patients.

Dr. Layla Abubshait: 27:49

No. It's interesting because being a Muslim, practicing Muslim, I'm not an expert. So it's not about being a religious scholar, it's really going back to being curious, being humble. Being kind. You don't really have to know every single detail of what the Islamic practice is. Really you. All you need to know is to ask the questions, listen to them, and then try to work with your patients rather than around their beliefs.

Dr. Mohamed Hagahmed: 28:18

And also get help, right? Like you said, get help from family, support, from family from religious leaders. Like you said, imams, if you have access to one. If you don't, then I would strongly encourage that you get access through your hospital system and maybe encourage your department chief or your chair to help you with that. That's definitely a really good resource that would help create, trust between that community and your healthcare system. One thing that came up also is patients with chronic conditions, let's say like the one you mentioned with diabetes. What is one thing that we can do to optimize their treatment while they're in the hospital? Like what one thing that we can do to, let's say, optimize their diabetic medications, things like that.

Dr. Layla Abubshait: 29:05

Yeah, I think there are definitely a lot of guides out there. There are articles and guides for treating patients with diabetes and how you can adjust their insulin from home, et cetera. And if there are any primary practice physicians who are listening to this podcast, I would say work on that early before Ramadan hits. You know that your patient is gonna be fasting during Ramadan, have that discussion with them before and help them navigate their insulin, et cetera, before, before the thing happened. Like prevention is more important than cure.

Dr. Mohamed Hagahmed: 29:38

We work and live in a different healthcare system than other healthcare systems in the Middle East Africa, Europe. I know you know the issue with actually having access to primary care, right? I know in Saudi Arabia in my country, sometimes people already have an understanding what their doses will be like before going to Ramadan. Like things will be adjusted because maybe there is better access to primary care. So I think one thing we can do in the ED is, pick up the phone and call that friendly primary care doctor who can help us with managing these patients. Do you have any resource like this in Philadelphia?

Dr. Layla Abubshait: 30:15

Fortunately we are well connected with primary care doctors. We also have endocrinologists that are on call. So if we're ever, if we're thinking, for example, this patient is gonna be discharged and. They may not see their primary doctor until a week or two. We just pick up the phone, speak with the on-call endocrinologist, explain the situation to them, and they're often very happy to provide suggestions to how we can adjust their medications. In insulin and diabetes is one example, but hypertension is another. So for, we had a patient actually, who was incarcerated. So he came from one of the prisons and he came because he was severely hypertensive. And the reason is that his blood pressure medicines were given during the time of the day where he is fasting. And because he refused to take the medicine they did not give him his blood pressure medicine without understanding why he didn't want his medicine at that time. So when he came to us, I had the discussion with him. He was excited and happy that I understood why he wasn't taking his medicine during the day. I picked up the phone called the physician or the NP who was on in prison and explained it to them and said, it is okay to let him take his blood pressure medicine after he broke his fast. It doesn't have to be exactly on the same time every day. And they got the okay for me. They felt comfortable and he got discharged was. With just a minor adjustment to his blood pressure medicine.

Dr. Mohamed Hagahmed: 31:38

That is so awesome. That really emphasized the point of that what we do in the emergency department just doesn't stop there. We can go above and beyond and make sure that while they. Practicing the fasting during Ramadan, that actually the chronic conditions can be well managed. This is the beauty that we have here in a department that we can call a friendly person who can help us through those nuanced conditions is awesome. Now I know one thing I have to just, a lot of people don't know this, people who fast and had to break their fast. Do they have ways of making those days up?

Dr. Layla Abubshait: 32:16

Yeah, absolutely. Good question. Yes, they do. So they can make those days up after the month of Ramadan has ended, and if they're still unable to fast after that, they can donate. For the amount of the days that they did in fast, they can donate in the sense of food or money to people of need. And that is the beauty of Islam, right? And is, that's the beauty of the practice. So if you know this, you can use that to have that discussion with your patients and tell them, look, I know. That even if you're unable to keep your fast, there are options. There are things that you can do, and it will definitely make that shared decision making process much easier.

Dr. Mohamed Hagahmed: 32:56

And hopefully that is another useful tool that you can use while maintaining cultural humility, understanding, curiosity, and tell them, Hey, you know what? This is not the end of the day. You can still make this day up later. When you're much better and able physically and mentally to make up for your fast. This has been great discussion, Layla, and I really appreciate you for joining me. Having this conversation with you brought me back to a lot of great memories back home. The beautiful scents of food, the aroma the community, the people, and most importantly, how we've used to visit each other and just take care of each other, so you remember like my mom was always the one in the kitchen cooking for the neighbor the other one we used to visit our elder. I really miss that community in so many ways. So I hope that you get the opportunity to celebrate Ramadan with your family while, maintaining I know a difficult schedule at work like myself, but it's always nice to have these discussions and I hope that we can get more questions later from the audience about Ramadan and fasting and how we can as a community build this trust, that we so desperately need these days and be able to have just this safe environment where we can just like, have a conversation and look at each other from like a human lens and just that we care. I think that's the simple principle of this episode is that curiosity, caring, humanity, that would help build connection.

Dr. Layla Abubshait: 34:32

Absolutely. Yes. And yeah, thank you so much for having me here with you today. Obviously this is a topic that is very close to my heart, being a Muslim and a Muslim physician, and I care for patients who are fasting, and it's important for the, for everybody who's listening to understand that when your patient come to the emergency department, they come with their whole selves, right? They bring their faith with them, they bring their Culture, their fears, their devotions. So it's important that we honor that, and it's not just about treating the abnormal vital signs or treating the pathology itself, but it's also about providing care that affirms dignity, right? And that's what we do best in emergency.

Dr. Mohamed Hagahmed: 35:14

last but not least, we have to tell the audience how they can wish someone's a good Ramadan fasting. How can you say this in different languages.

Dr. Layla Abubshait: 35:27

You can say Ramadan mubarak, ramadan Kareem, or Happy Ramadan.

Dr. Mohamed Hagahmed: 35:32

That's easy. Ramadan Mubarak and Ramadan Kareem. Obviously you don't have to say the same way that I'm saying in my accent. You can say Ramadan, Kareem, Ramadan, Mubarak and Happy Ramadan. I love it. Thank you so much, Layla, for sharing your kindness and knowledge with us, and I appreciate you. Hopefully we can have another discussion again in the future.

Dr. Layla Abubshait: 35:50

I hope so too. Looking forward to it.