Malakoot

فَسُبۡحَـٰنَ ٱلَّذِى بِيَدِهِۦ مَلَكُوتُ كُلِّ شَىۡءٍ۬ وَإِلَيۡهِ تُرۡجَعُونَ
Therefore glory be to Him in Whose hand is the dominion over all things! Unto Him ye will be brought back. (Qur'an 36:83)

My little brother Ali's heart was attacked by a raging virus. We all thought it was a flu but it turned out to be a case of fulminant myocarditis, which inflamed his heart muscle so severely that it put him into cardiac arrest less than 72 hours after the onset of his relatively mild symptoms. Less than 4 days after that, his heart was pumping with such diminished capacity that he began going into organ failure, and was immediately scheduled for emergency surgery to install biventricular assist devices (BiVAD's) to pump his blood for him. Out for two days, he awoke slowly from anesthesia and is now facing the possibility of a heart transplant.

He went to the hospital Sunday. Three days earlier he was perfectly healthy. He is 25 years old.

His brush with death - twice - has made all of us close to him think a lot about mortality. For me in particular, about how little we actually control. Scratch that. We don't control anything.

In order for Ali to have the fighting chance he now has - quite literally a new lease on life - there were many factors that had to play out perfectly, in exactly the right way, and at exactly the right time.

Saturday night Ali was at our house, knocked out on Sudafed. I was tired after the late night, but for some reason I could not fall asleep. So I went downstairs to watch TV. Around 2:30 am I heard a loud thud from upstairs. I ran into the guestroom and Ali was on the floor, kind of out of it, but conscious, and saying he was trying to go to the bathroom but didn't make it. I thought it was his flu acting up, he was nauseous, so I told him to yak. He couldn't. How could I have known that he was less than 3 hours away from cardiac arrest, and that, for all intents and purposes, he was having a heart attack before my very eyes?

He took a shower to help him relax but felt worse than before as he came out. He was on the floor and Rabiah and I were telling him he had to go to the hospital. When he raised his head finally, ostensibly to try to go downstairs to get in the car, I saw his face, and it was white. No color. I remember how his black hair and black beard stood out all the more. And then the thought crossed my mind to call 911.

The paramedics arrived, no one really taking it seriously because Ali is a healthy 25 year old. He had been complaining about the flu, after all. How could anyone have suspected a rare disease that affects roughly one in a million patients? But they got him to the hospital.

The nurses, upon seeing him, did what they could to warm him, and I think they all realized that something much more serious was the matter. The ER physician wasted no time, and within 15 minutes declared Ali had had a heart attack, and not a minor one. Realizing how little time he had, Ali was airlifted to Inova Fairfax, a premier cardiovascular institute. En route, in the chopper, he went into cardiac arrest, flatlining for 90 seconds, his first brush with death. But he came back, as Ali, with no brain damage.

As the virus ravaged his heart over the next two days, and he began to go into organ failure, the emergency surgery was ordered and the BiVAD's installed. Such treatment is not available at all hospitals. The team of nurses and doctors, calling the shots and thinking quickly, all operated to seamlessly prepare him for a successful surgey when their best estimates had given Ali 24 more hours to live. His second brush with death.

There is a long way to go. InshaAllah his heart will be able to recover on its own, given time, rest, and treatment.

But who inflicted me with insomnia the night Ali's heart began to fail him? Who put the thought in my head to call 911? Who made it all happen in the wee hours of the morning so that the ambulance arrived in only 10 minutes? Who chose the venue of northern Virginia, where he could be airlifted to a facility wherein he would receive the best medical care available? Who gave Ali the strength to explain his symptom of chest pain to the ER team, and who put the thought it their head to not part with standard procedure and do an EKG which led to the discovery of something much more serious?

It makes you think about Allah's dominion - malakoot - over all things. What has happened to Ali is a complex sequence of events. It seems that he has overcome incredible odds, and had a lot of "luck" to be where he is now. But it's not luck. It was just Allah's plan. It couldn't have happened any other way. And he may have had two brushes with death. Now this avid snowboarder, weightlifter, and financial advisor par excellence is lying up in a hospital bed, fighting for his life.

But the fact is - we're ALL precisely as far away from death as he is.