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The Hanoudi Letter

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Chapter Three: There Was No Miracle

Who among us has not, in moments of despair?

Has not dreamt of the miracle.

Charles Baudelaire


We arrived in Michigan on the 14th of November 2007, we have been given the chance to resettle in the united states because we have suffered as a result of their presence in our country, we were received by three young men from the Lutheran social services of Michigan who were to help us with the problems of resettling in the united states and our son Samer who was our sponsor.

The Lutheran Social Services of Michigan is a charity affiliated with the Evangelical Lutheran Church in America and is the largest faith based non-profit human service organization in the state. Motivated to serve others as an expression of the love of Christ, the Lutherans help those in need regardless of religion, race, color, national origin, sexual orientation, marital status, height, weight, age or unrelated handicap.

We were greatly helped to resettle in the United States by this organization, they assigned a case officer to help us with the plethora of problems which are associated with settling in the  completely different environment of our new home, in Michigan our case officer was a very nice Iraqi young woman herself a

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refugee who used to live in the good  old days near my daughter’s house in Baghdad, she was a great help, we still see her occasionally. After staying from the Nov. 14 in the big Detroit hospital to which my son was taken on arrival in Chicago, the boy was sent to the Greenfield rehab and nursing home on the Nov. 23 where he stayed when he was not in Beaumont hospital.

Greenfield rehab and nursing home;

Greenfield rehab and nursing home is an intermediate care facility and like all nursing homes  is a place of residence for people who require constant nursing care and have significant deficiencies interfering with their  daily living. Its residents were a mixture of elderly and younger adults with physical or mental disabilities. Its services were provided by skilled nurses and nurses’ aides who were available 24 hours a day. The facility is located in Greenfield road in Royal Oak /Michigan midway between 12 and 13 mile roads and it was to this residence that my son was referred to after he was discharged from the Detroit hospital where he was since arriving in Michigan on November 14. We were to stay there until Nov. 11, 2011 when he was taken from there to Beaumont hospital for the last time.

Our first year in Greenfield Nursing Home was very bad, few days after we went there it was bought by two families an Iraqi one and an Indian, the previous owner were having difficulties with its running and the standard of the care they were providing and they were in trouble, they have also neglected the needs of the building which was about 50 years old and was showing signs of very serious deterioration and decline. The previous owners left the facility in a very bad shape pretty chaotic with a pretty   second-rate  administration , one of the new owners the wife of one of the partners  who

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would ultimately manage the place was still six months away from taking control  take charge of the place and in the interim period  the facility  was  in a really bad shape , but we had to cope with the situation in spite of our serious disappointments and frustrations  we were in no position to do anything about it , but things started to improve albeit very slowly in the beginning when the new administrator took over.

Few days before Christmas 2008 our friend Jacki Lyden visited us for few days at our house in greenfield road which we have chosen because it was very near to the nursing home , she stayed with us and during her stay she interviewed us and on the 25th of January 2009 NPR aired the interview of which I  am inserting a transcript below,

She said, For Iraqi Family, 14 Minutes Means Life of Sacrifice,

I met the Hanoudi family when I was a war correspondent in Iraq in 2003. Dr. Najeeb Hanoudi was a practicing ophthalmologist in Baghdad. Instant friends, we drove all over the country together. Now I visit him in a Detroit suburb, and we can go no more than five blocks — just up the street to the nursing home and back.

Nearly five years ago, Hanoudi's son Nazar was traveling to work at a Baghdad checkpoint when he was shot by a U.S. soldier who thought he was an intruder. The Americans took the unusual step of sending Nazar to a U.S. hospital in the Green Zone, but as his conditioned worsened and he was being transferred to another facility, his heart stopped for 14 minutes.

Since those 14 minutes, Nazar's parents have rarely left his side. After enduring years of the worst of Baghdad's violence, the Hanoudi family emigrated and ended up in Michigan, living in a modest two-story apartment in the city of

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Berkley. Caring for Nazar keeps them closely tethered, and they rarely see one another outside of the small nursing home down the road.

Nazar, 40, now spends his days stretched out on a small twin bed, with an Arabic TV channel providing a constant murmur. He is "minimally conscious" and needs the assistance of a breathing machine. Hanoudi stresses that the facility is not an intensive care unit. There is no 24-hour nurse to make sure Nazar doesn't choke on the phlegm that builds up in his throat several times an hour. His parents are there when that happens — afraid all their painstaking care will unravel if they miss a moment, and that in that one second, they will lose Nazar.

They adjust his feeding tube, wipe his spit or suction his throat. They talk to him like a child, wait for him to blink back what could be — could be — a yes or no. Hanoudi's wife, Firyal, takes up most of the burden, and always takes the night shift. In the late afternoon after leaving dinner for her husband, she gathers up some meat, bread and cheese for her own supper and heads to the nursing home a few blocks away. When she comes back through the door, at 10 or 11 in the morning, her husband leaves for his turn by the hospital bed. They have another son, Samer, who recently lost his job at a nearby gas station and also takes also takes a turn.

Hanoudi says, "I'm doing it because I have to do it. This is why we are here. And we are prepared to stay beside him because he is our responsibility, for the next few months, for the next few years, even for the next few centuries."

The new manager to the Greenfield facility was a nurse herself and has been working in nursing homes for many years, she knew what was involved in the job and what needed doing, she is an extremely capable administrator, well

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experienced , a very hard worker  and very clever and was able very slowly within few months to bring thing under control which was not very easy , there were major changes amongst the staff, a very serious attention was paid to the building and its components, but slowly things started to get better and we stayed there until the end which was not always very pleasant but it also had  many pleasant experiences and honest friendships which I afraid I cannot talk about all of them in spite my great indebtedness to them for their kindnesses and love , I will never forget them , I am going to talk about some of them a bit later , but I would like to end my talk about greenfield with few notes about an  absolutely terrific and wonderful young lady, Dr. Vian Misho. I met this young doctor for the first few weeks we have settled in the greenfield nursing home, I was standing at the door were my son was staying when a young very good looking doctor approached and said I have started working here recently and I am trying to find myself around the place, could you please tell where is Nazar Hana’s room, I have to check on him and his condition, I said it is this one I am his father please go ahead. She went into the room but I stayed outside but kept watching her when she was examining my son, I was greatly impressed by the way she was doing her job, she was patient, quiet and unobtrusive and patiently trying to communicate with him which was immensely difficult because of the nature of his condition. It took her about ten minutes to finish and when she came out she was visibly touched and some tears in her eyes she said I am sorry sir but I have no words to express my feelings of sadness but also my admiration to you and your family who have been living with this terrible nightmare, it would be honor to help in whatever way I can. At that moment she was trying to change her position when her name appeared on the identity badge she was carrying, Dr. Vian Misho,I was really surprised and

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said I used to have a colleague in Baghdad and his name is Fawzi Misho, she said he is my father and now I was more than surprised, but at that moment she was looking very hardly into my face as if trying to remember something but she said who are you sir and I said my name is Najeeb Najeeb Hanoudi, I lived more than fifty years ago next door to your father’s family , we were at the medical  school in Baghdad during the fifties but we went into different specialties  your father into radiology and me into ophthalmology.

During that short dissertation she was absolutely speechless and then suddenly said professor Najeeb and now it was me who was dumbstruck and couldn’t envision what was happening but she said I have learned a lot about disease of the eye when I attended your clinic in medical city when I was a fifth year medical student in 1986 and that was when a great friendship was born which would mature during the next five years into an absolutely beautiful and friendly , she is now our doctor our friend and our second daughter.

Dr. Misho is a graduate from the same medical school in Baghdad the one I graduated from myself, she graduated in 1987, worked or few years in Baghdad, she immigrated to the united states 12 years ago and went through the long and tiresome process of acquiring the license  to be able  to practice in this country which lasted for almost 8 years, which was very difficult but she managed , she was married and had three young kids to raise in addition to a very serious problem in her family.

When she was finally granted the license to practice here she started to work with a primary care center the one we were attached to, in their responsibility was a number of patients who were residing in the Greenfield rehab center where we met her for the first time when she was there one afternoon looking at my son who was there at that time and from then on she was a constant and

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an absolutely indispensable help. She was seeing our son almost every day whether he was in Greenfield or in the hospital and always with great compassion and love. I am going to go back to this very good doctor and very treasured friend towards the end of this work.

We stayed in the Greenfield rehab and Nursing Home from Nov. 23, 2007 until Nov. 11, 2011 when he was taken from there for the last time to Beaumont hospital in Royal Oak which is the oldest and largest hospitals which belong to

the Beaumont Health System.

The Beaumont Health System is a nonprofit regional community medical organization in the Detroit Metropolitan area, its headquarters are in Royal Oak.  It is a healthcare provider that includes three hospitals, 57 medical centers which are located throughout the area, nursing homes, rehabilitation facilities and hundreds of doctors' offices. Ninety-one medical and surgical specialties are represented on the Beaumont medical staffs of more than 3,700 physicians. It opened on Jan. 24, 1955, as a 238-bed community hospital in Royal Oak, Mich.

Today, the Royal Oak hospital is a 1,070-bed major academic and referral center with Level I trauma status. It was Michigan’s first Magnet-designated hospital for nursing excellence and it is an associate member of the National Association of Children’s Hospitals and Related Institutions.

A second Beaumont hospital opened in Troy in 1977 as a 200-bed acute care community teaching hospital. It is now among the nation’s busiest community hospitals with 406 beds. In October 2007, Beaumont became a regional health provider when it acquired a third community hospital with 250 beds in Grosse Pointe.

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The Royal Oak, the largest hospital is located at 3601 W Thirteen Mile Road in Royal Oak, Michigan near Woodward Avenue, it is a very big entity which is made of three parts each one is a hospital by its own rights, it houses 1,070 inpatient beds, it has 15,000 employee, 500 doctors employed and 2,600 in private practice, five thousand nurses and nurse assistants, technicians, chaplains and administrators and every other job imaginable which is needed in the running of a hospital. It is built around three towers, the east, the central, and the south, these structures contain the treatment centers [medical and surgical] and other units which are directly related to patients care, each of the three towers is entered from its own entry point  and near each of these entry points there is a parking lot big enough for several thousand cars. The largest tower the central is the one we visited most, it contains several medical units, the eight centers, the six, and the fourth. On the sixth floor there is also a hospice which belongs to the hospital to which my son was taken to 12 days before the end. The facility includes cancer, renal, vascular, heart and neuroscience centers, two very big ICU units one for the medical problems and the other for the surgical cases, the hospital contains a research institute and a medical building with private practices and other Beaumont services.

Beaumont is a major teaching facility; it has 37 accredited residency and fellowship programs with more than 400 residents and fellows and partnered with Oakland University to establish the Oakland University William Beaumont School of Medicine in 2011. For undergraduate training, the hospital is affiliated with the University of Michigan and Wayne State University schools of medicine. Beaumont also has nursing affiliations with area schools, including a top-ranked certified registered nurse anesthetist school. The System offers

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residency and fellowship programs for physicians, and research opportunities through the Research Institute.

The Royal Oak hospital was built 60 years ago, its ground breaking was done in 1953; it opened its doors on Jan. 24, 1955 with 238 beds it was founded through the efforts of groups of citizens who recognized the need for a hospital to serve the growing suburban population in south Oakland County. By early 1957 Beaumont was bursting at the seams and was expanded to 700 beds and ten stories in 1966. Then in the seventies the hospital added a north tower taking it to 940 beds in response to growing patient demand. Beaumont’s expansion has continued through the years through hospital additions community medical building and outpatient buildings on the Royal Oak campus such as a cancer center imaging center and a research institute. and their mission is to rank among the nation’s leading institutions in the provision of health care services with the patient always at the center of everything they do.

During the last four years of our son’s struggle when we were we living near Detroit in September 2004 we took our son for 36 times to Beaumont hospital because of the various medical emergencies to which because of his condition he was very prone. The first time we took him there was on the 21st of January 2008 for a clogged NG tube. In the beginning our visits were for every two or three months, but with the slow deterioration of his condition we were taking him more regularly, most of these visits to the hospital were to have his NG tube changed, for chest infections and problems of his Trach, but increasingly for intestinal obstruction episodes which resulted from an increasing damage to his intestinal muscles which is called paralytic ileus. Sometimes the problems we took him to the hospital for were dealt with in the emergency

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room and then he was returned to the nursing home but on more frequent occasions he was admitted to the hospital. I don’t think that I can talk about all those visits now but to make things a bit clearer I have selected six months from the year 2011 march, June , July ,August ,September ,  October and finally November which was the last visit before the end and  during all those months we took there once or sometimes twice with a total of a hundred and six days  And every time we were there which was happening with increasing frequency towards the end we were treated very kindly and efficiently by the various members of the staff who were involved in his care.

This piece of my work is not a dissertation on the clinical management of vegetative states, it is about a small number of the hospital employees who were exceptionally kind and helpful with whom and during my increasing recurrent  visits to the hospital I became very friendly with them. I have not forgotten the help and compassion of the others and I would like to apologize to them but I cannot talk about every one now because of the guidelines imposed by the size of this work.

I have selected, a doctor, and four nurses from amongst the dozens I have met to talk about today, I  have selected those not only because of my friendship  and  admiration I feel towards them , but because their lives provided a source of  tremendous moral and psychological help to me during the long years of the Hanoudi tragedy.

The Doctor, Paul Bove, is a senior surgeon in the vascular unit, a male aged 49 with 20 years of medical experience and practices in Surgery and Surgical Critical Care and Vascular Surgery.  He is currently the Medical Director of the Peripheral Vascular Diagnostic Center at William Beaumont Hospital, Royal Oak, Michigan and a member of the hospital’s ethic committee. A Phi Beta

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Kappa graduate of Wayne State University, he received his M.D. from the University Of Michigan School Of Medicine in 1988. His postgraduate medical training included a General Surgery Residency at William Beaumont Hospital and a Residency in Vascular Surgery at the Cleveland Clinic Foundation.

Dr. Bove has presented papers on vascular surgery, critical care, and other topics at more than 20 medical conferences, including the 6th World Congress on Intensive and Critical Care in Medicine held in Madrid, Spain. His clinical research has resulted in the publication of 14 articles in medical journals, including a pioneering procedure for treating aneurysms by placing thoracic and aortic stents simultaneously.

He was involved in the care of my son from the start because the boy was prone to have infections of his fingers and his toes as result of the damage his brain has sustained, these infections could be life threatening if not treated properly and my son had them on more than a dozen times which were dealt with by this doctor except on two occasions when the infection was so bad it required getting rid of two toes. On the whole this specialist must have seen our son on at least two dozen times, and every single one of those visits was done in a very friendly mood and in perfect professional capacity. I am greatly impressed by his medical skills and his capacity to give as best as he can and wish him all the best in his life and his career.

The first nurse is in fact a senior nurse administrator, Deidre Grazioli, she is a wonderful care giver and a very capable administrator and a very treasured friend, she is in her early forties, she has been married for twenty years and has an 18 years old daughter who is in Chicago working for a degree in international finances and a son who is two years away from college.

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Deirdre was planning after high school to go to university for a marketing degree and then she changed her mind and went into a nursing school, she was greatly influenced into making this decision by what she calls her legacy to mankind, she is very kind and always ready to give especially to people who are in pain and suffering and thought that in a nursing career she could realize her hopes and expectations, her mother was a nurse which was another very important factor in her decision , so she went in 1994 to study nursing in  for five years during which she was working as a nurse assistant in Beaumont Royal Oak, and at the end of her years at university she returned as a registered nurse [RN] in the same hospital, when she worked in the beginning in various medical units including the progressive care unit and then to some administrative jobs and finally back to the progressive to which she was made the nursing administrator in 2008.

She has been very happy in Beaumont; she says it is a great place which is striving to provide the best medical care to meet the needs of the community. The system is supporting a huge program of research in the many aspects of medicine, a wide ranging program which is financed by the surplus of the revenue the system makes after paying the operational expenses. The Beaumont system is a nonprofit organization.

We met this truly remarkable woman when we took my son from the nursing home around the end of march 2008 when he had a very serious case of chest infection a condition which is always very serious in cases like my son’s and for that reason the boy was admitted to the progressive care unit on the 4th floor in the central tower to which our friend was recently made the nursing administrator. I was immediately captivated by her professionalism, by the

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meaning she attaches to her work and the depth of the concern she showed in her patients anguish and their suffering.

Deirdre was greatly touched by our ordeal and the desperate struggle and suffering of our son. She was always there to help and make sure that the boy was receiving the best care and getting everything he needed every time we went to the 4th.

She is very intelligent, a good reader and greatly interested in ancient history like myself, she in the old Egyptian civilization and me in the history of Mesopotamia which are usually referred to as the twin civilizations. We became very good friends, a boundless friendship which I greatly treasure and Venerate.

The first nurse Gail Garvenstreter is 54, married, she has five kids, two girls and three boys one them died in a motor cycle accidents four years ago when he was 21.  They are a very well knit family and very religious, the boys are active missionaries one of them spent two years in South Korea some time ago, and the other has been recently in Argentina on a similar mission.  She has a degree in the liberal arts, and another one in holistic nutrition in addition to her nursing degree, she is smart and very friendly, she love books of which she had a lot of them  at home, she is greatly interested in history she enjoys the company of her colleagues and her patients. We met shortly after we arrived here and we hit it immediately, she is intelligent, friendly and highly professional, but what most attracted me to her was her faith, she had a great faith in the word because if you have faith in the word you would have faith in humanity and the purposefulness of life, also the tragic death of her son and our son’s misfortune strengthened and cemented our friendship. This woman is a wonderful person, intelligent, witty and very friendly, I have been greatly

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honored and blessed by her friendship, and her religiousness and deep faith were impressive and very inspiring.

The second nurse Karishma Puga is a very nice  34  years old naturalized American who was born in India but has been living in this country from a very early age, her father was an engineer who immigrated to the united states more than quarter of a century ago.  She finished her early school years here and had a degree in nursing as an RN and started working in Beaumont four years ago in the progressive care unit which is a higher acuity unit something between a regular floor and an ICU , she is recently married to an American lawyer and has one infant daughter. She has recently finished studying for a practitioner nursing degree and is returning to Beaumont to join the rapid response team. I met her in the hospital around the middle of October 2012; and I wrote the following short notes after meeting her.

She is very happy working for her hospital because it is a non-profit organization and its employees work from their hearts, they love their hospital and they love working for people,

She said she was very actively involved in the care of my son on the many occasions he was in her unit; she said she felt so sorry for his suffering. He always had a very thick tracheal secretions, frequent coughing which caused his whole body to convulse, he became very skinny; you could easily see all his bones and feel his abdominal organs. She said all the staff of the unit always strived to keep him nice and clean, shaved his beard regularly and always treated him with respect and dignity. She said his family was very supportive of him; his mother, his father and his brother were constantly by his side.

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The Third nurse, the fifth member in this fascinating group ,Christina Hahn  is a 28 years old nurse, who was involved in the care of my son from our earliest visits to Beaumont, she was and is still working in the eight center which we frequently visited during my son’s recurring stays in the hospital and during those visits I developed a marvelous friendship with her, she is extremely clever, very efficient and totally dedicated to her profession and the welfare of her patients, she enjoys a good book, again like her older colleague she loved reading and talking about history, this time modern European history, she is from a family whom came from there, her mother is British.

She decided to become a nurse when she was 17 years old and she never regretted that decision. She thought that she could see herself fitting very nicely in a nursing career, in that kind of role, she had also looked up at a very close friend of her family who was a nurse who had encouraged her to go ahead.

She went to Oakland University which is a community university in the Detroit area, she spent four years there and graduated with a bachelor degree in the sciences with a focus in nursing, she started working in Beaumont hospital as a registered nurse [RN] in 2007 when she was 21. She started working in the medical unit in the eight floor of the central tower all her time, she was recently promoted to the job of an assistant manager of the unit. She is very happy there, she enjoys her work, she loves her patients and strives to help them always and tries to educate them about their medical problems and relish the challenges the great variety of the problems she had to deal with constantly.

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She was always very kind to my son , very attentive to his needs even when he was not under her care, few days ago I was talking to her about my book and asked her about our tragedy and the ordeal of my unfortunate son, she said;

In life sometimes people can make choices and decisions about the path they want to go.

There are the times in life when significant events happen that may forever change that.