As a veteran emergency room physician at Hollywood Presbyterian Medical Center, Dr. Mahmoud Nouh has seen it all.
From serious nosebleeds to shooting and heart attack victims, the devout Muslim often treats 20 to 30 patients a shift, working up to 12 hours at a time. As a "golden hour" doctor who is the first to treat an ER patient in those critical moments after an injury, the La Canada Flintridge resident knows the work he does can literally be a matter of life and death.
Yet once the holy month of Ramadan begins Monday night, Nouh will strictly fast from the break of dawn to sunset for the entire month, all while mostly sticking to that rigorous work schedule in which he needs full concentration to help save lives.
He dismisses the idea that hunger pangs would affect his critical work.
"A human being can actually live three days without water and seven days without food...so when God tells you to fast for 12 hours without food or water, it's not cruel. It's tolerable," the affable Egyptian-American, husband and father of five said Monday during a break from the hospital's chaotic ER. "Many people in our country live hungry and sleep hungry so it makes you more compassionate."
While it's not uncommon to get headaches and feel tired the first few days of Ramadan, he said, the body usually adjusts to the new routine and stabilizes itself.
Muslims throughout the world -- including an estimated 300,00 to 500,000 in the greater Los Angeles area -- will abstain from food, drink and sex during daylight hours of Islam's holiest month, as their religion requires. It's a time in which God is said to have revealed the Islamic faith's holy book, the Quran, to the Prophet Muhammad. Some Muslims such as Nouh have the added challenge of having physically demanding jobs, including those who will be working or training outdoors while they fast.
Ramadan rotates throughout the four seasons based on the Islamic lunar calendar. This year the fasting month falls in the middle of a near-record hot summer, meaning they'll also have to contend with the season's unforgiving, triple-digit temperatures.
Los Angeles County Sheriff's Deputy Matt Ahrari of the West Hollywood station, who rides in a patrol vehicle responding to crime and car crashes, will be among those fasting during Ramadan.
The San Bernardino County resident helps his wife in the morning take care of their two young boys before he starts his 10-hour patrol shift at 4 p.m. But the Afghan-born Ahrari said he's unfazed by the challenge of fasting this year because for him, it's largely mind over matter.
"It's self-discipline," Ahrari said. "Last year, when I was fasting, it was very hot and it didn't bother me a lot. It's the power that God gives you. It's a test. I believe God helps you to go through it."
Ahrari will be working when he breaks the daily fast sometime after 8 p.m. but his superiors, he said, do allow him to go back to the station to pray and eat.
"If I have time, I'll eat; if not, I'll eat whenever I can," the seven-year Sheriff's veteran said. "I have all night to eat whenever I want to."
Ahrari, 37, has fasted in much more rugged scenarios. As a civilian consultant for U.S. soldiers during Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom, he said he fasted in 100-plus degree weather on three different occasions while working in hostile conditions.
"It was hot. I was kind of feeling the thirst more than being hungry but again it's all about how you discipline yourself," Ahrari said. "Part of the fasting month is to feel how underprivileged people feel if they don't have food to eat or water to drink, to discipline yourself to be thankful for what you have and for what God has granted you."
Usrah Hamzie, who works with Dr. Nouh as a clinical supervisor at the emergency department of Hollywood Presbyterian, has been fasting for Ramadan since she was seven years old. Her three sons, ages 25, 19 and 13, will also be fasting. While it can be challenging at times, especially while doing errands outside in the heat, Hamzie said she looks forward to the month each year.
"It's a pride to say I'm fasting; I'm making a sacrifice for God," said Hamzie, a Santa Clarita resident originally from Sierra Leone. "You feel like God does a lot for you. He created you. He's giving you everything you have...So what can you do in return? You fast to show your gratitude."
With time, Hamzie has learned what and when to eat to help her get through the fast. Eating too much at night makes her tired the next day. While some people eat one or two meals between sunset and the break of dawn, others eat continuously throughout the night, something the nurse with an easy laugh said would make her ill.
"Usually if you eat too much after you break your fast, it's hard to pray because that prayer is long," Hamzie said, referring to the special prayers recited each night during Ramadan called Taraweeh, in which long portions of the Quran are recited. "You're either standing too much or sitting too much and you tend to fall asleep so you have to gauge yourself."
Since women are not allowed to fast while menstruating, many will start fasting a few days before the start of the Islamic month and continue fasting a few days later to get in their 30 days, Hamzie said.
While fasting during Ramadan is one of the five pillars of Islam, those who are sick, breast-feeding, traveling or pregnant are not required to fast that month, though they can make up the days at a later time, Dr. Nouh said. It's also customary to give charity during Ramadan and to break the fast at night with family and friends.
Sports nutritionist Rehan Jalali of Beverly Hills suggests that fasting Muslims eat plenty of "hydrating foods" like dates, figs and watermelon and avoid high sodium or dehydrating foods such as soups, breads, sauces, canned meats and condiments.
"And most importantly, do not overeat when it's time to break the fast -- hard to do when your starvin' like Marvin but overeating at this time can cause issues," Jalali wrote in an email interview.
For those who will be working or training outside and fasting during Ramadan, Jalali recommends drinking plenty of water at night and before beginning the fast in the morning and then taking breaks throughout the day when possible. Taking a solid multi-vitamin to lower any chances of nutritional deficiency is also helpful, he said.
The Zeenni family of Arcadia has three children who will be fasting for Ramadan this year while training for college or high school sports.
Kareem Zeenni, 16, a junior at St. Francis High School in La Canada Flintridge, said his varsity football team's practice this year coincides with Ramadan. Zeenni has been practicing from 6 to 9 a.m. Monday through Friday and also has physical therapy sessions twice a week for hip flexor and quad injuries. Zeenni said he was unsure how much his coaches would want him to participate during his fast or how he would fare with all the activity during these long summer days.
"I talked to my mom about that; I was saying, 'I'm so scared. I have to do physical therapy too...how am I going to be able to get through these days?'" he said. "It's a little scary, I guess, but at the end of the day, it's an exciting thing, Ramadan. You see all your friends and family at night. It's fun with a little bit of hard work."
Zeenni's brother Omar, 20, who plays on the University of California Davis men's soccer team, is also practicing twice a day with an Orange County-based league while he's home for the summer. Their sister, Natalie, 19, plays with the women's soccer team at Cal State Long Beach. As they've done in past years, both siblings have practice during Ramadan and plan to fast and train at the same time.
"When one of us feels like we have to give up or give in, we look to each other for strength," Omar Zeenni said of his sister. "I was a goalkeeper, but my sister was a field player. I told myself if she's doing it, I need to do it. It's that family competitiveness." ___