THE CHEESE VENDOR

                                           
      In 1979, I was interviewed on Qatar TV about diet and heart disease. I recommended low fat instead of full fat dairy products. A food salesman, Mr. Jack Sirriah, watched my interview with great interest. He was a fifty years old Lebanese gentleman who worked in Darwish cold store. Darwish cold store was located at the place where the present Ministry Of Foreign Affairs building is located. It was on the seashore before the government claimed more land from the sea.

   Since no store had low fat product in Doha, the Lebanese gentleman came up with a perfect business plan to fill the vacuum. He quickly imported a variety of low fat cheese. As soon as his cheese arrived, he decided to bring me the samples for promotion. On February 19,1980, he came with his low fat cheese samples to our famous wooden portacabin Cardiology Clinic.

   That portacabin was installed originally by a Swiss company for the use of engineers supervising the construction of Rumailah Hospital extension. After completing the project in 1979, the company had no use for the cabin. I requested the Ministry of Health to buy it for Cardiology. It was bought for 120,000 Qatari Riyals (US$32,967). The cabin was located close to our new Coronary Care Unit (CCU) and cardiology in-patient ward. I converted it to a Cardiology Clinic. The establishment of a proper Cardiology Outpatient Service was an important progress in the history of cardiology in Qatar.

   When Mr. Sirriah came to the clinic, he did not know that we had just introduced an appointment system for the cardiology clinic. Patients used to line up starting at 7:00 AM without an appointment to see doctors in the outpatient clinics. Cardiology was the first clinic in Qatar to establish an appointment system. It was a big challenge for me. My colleagues told me, “It is impossible to have an appointment system in Qatar.” They advised me against it, as “patients would not accept such a system.” I did not accept their advice. I was determined to make an appointment system succeed. That was why we were very rigid then, in enforcing the rule that “no patient could be seen without appointment.”

   Mr. Sirriah entered the portacabin, put his plastic bag filled with cheese on the receptionist desk, and asked her with a big smile to let him see me. The clerk told him that she could not let him in because he had no appointment. He insisted that he must see me without appointment.
“I am not a patient”, he screamed at the clerk.
“My instruction is not to let any one in without appointment”, the clerk responded.
“I came only to show the doctor new cheese.” He argued with rage and anger.

   The salesman, while shouting, suddenly collapsed and fell on the floor in the narrow corridor of the clinic. The corridor floor was made of wooden boards raised a meter above the ground. The portacabin shook and the boards bent, if a heavy man walked on them. The floor was covered with a soft carpet. The fall of the salesman shook the portacabin, and made a loud noise because of the vibration of the wood. Fortunately, he did not sustain any injury from his fall. The lucky coincidence was that he fell just next to our new, charged defibrillator and resuscitation cart. There was no better place for a cardiac arrest victim to fall in Doha or anywhere.

   We, doctors and nurses, were all in the examining rooms on both sides of the corridor, and only a few feet away from the patient. The frightened clerk screamed for help. I rushed out of my examination room immediately. Two cardiology residents and the clinic nurses rushed in. Patients in the waiting room came to watch the scene with alarm.

   The victim was supine on the floor, in an ideal position for resuscitation. The wooden floor under him gave a good support, if we needed to compress the chest. He was pale, pulseless, slightly cyanotic, and unconscious. He received an immediate but ineffective thump on his chest. The defibrillator monitor revealed ventricular fibrillation. We shocked him with 300 joules successfully to sinus rhythm. He regained consciousness, but was confused for a few minutes. An intravenous cannula was inserted. Xylocaine bolus was given and drip started. Ten minutes later, we wheeled him to our new CCU in Rumailah hospital extension. He was awake and oriented, with his cheese on the table by his side.

   The CCU was 50 meters away from the clinic. He was thankful to God that he arrested in the cardiology clinic, where trained staff and equipment were available.
“I would have been dead if this happened to me in the cold store”, he said.
“It was my luck; it was my fate”, he added.

   He did not sustain a myocardial infarction, but he had ST-T changes of ischemia. He denied ever having had any cardiac symptoms. Coronary angiography revealed that he had severe three-vessel disease. I performed the coronary angiography in the CCU. We had no cardiac catheterization laboratory at that time. I was using the CCU pressure module and monitor for hemodynamic study and a portable fluoroscopy machine connected to a video recorder for filming. My colleagues and I reserved a room in the CCU with such equipment to use as a temporary cardiac catheterization laboratory. We performed 200 diagnostic procedures in that room until we moved to the newly constructed Hamad General Hospital, which is equipped with a proper Cardiac Catheterization Laboratory.

  We treated Mr. Sirriah medically, as we did not have a cardiac surgery section yet. After discharge, he attended our cardiology clinic regularly. He was kind and friendly to the same clerk with whom he had had an argument on his first visit to the clinic.

Sadly, I learned a few years later that he died in Lebanon.

   Rage and anger caused the cheese vendor who was asymptomatic, to have an episode of cardiac ischemia, which resulted in cardiac arrest – an event that occurred by chance next to our defibrillator. He was right: It was fate, not cheese, that brought him to our clinic, where his coronary artery disease was discovered. He survived the cardiac arrest, but death caught up with him a few years later.

   Zohair ibn Abi-Sulma, our famous pre-Islamic Arab poet, noted for his wisdom said in his old age: “Death is like a blind camel; those it hits will die, and those it misses will live to a ripe, old age.”