Reflections of a Father: The  Sudden Death of My Daughter, Bahar Sakha

By Dr G S Sakha 30th March 2013

Spring. My favorite season. Crisp, fresh and renewing. Gently leading us from the darkness and shivers of winter to the warmth, brightness and glow of summer.

Bahar is the name of my daughter. In the language of the heart of the Silk Road it means ‘spring’. It was in the spring of 2013 as the daffodils start appearing on the earthly verges, gardens and parks of London, when my youngest daughter, Bahar suddenly collapsed / passed away and left us shocked, devastated and the hurt. O, the indescribable paternal hurt.

On the 18th December 1989 in Kabul, Afghanistan, my youngest daughter was born, healthy and well. My wife, a secondary school teacher, and I, a Medical Doctor, and the older children had lived happily in our beloved country -Afghanistan. Then, the destruction, ugly chaos and fear caused by war led me and my family to flee to Europe, and one day in 1990 we flew over the white cliffs of Dover and landed on the runways of Heathrow airport in Hounslow.

So far, I had fulfilled my duty as a father and spouse and, by the Grace of God, rescued my family and offered them the opportunity of a good life albeit on a distant land in t he UK.

Apart from an asthma attack , there were no significant medical issues of note. Her childhood asthma rarely bothered her again and her medical, mental and spiritual health as a teenager and young adult were generally very good as far as we knew. On the family side, however, there is a family history of cardiovascular disease, diabetes, cancer and high cholesterol. Bahar preferred a warm cup of green tea with cardamom and almonds, sultanas and walnuts while watching a movie or documentary on her laptop or on the sofa with her family, instead of cigarettes, alcohol and recreational drugs, having always refused them.

She was a much loved, beautiful, bubbly, bright, caring, wonderful girl. She was a t St marks Primary school, The Ellen Wilkinson High School for Girls and completed her Law degree at London Metropolitan university a few weeks ago, having been informed that her graduation ceremony was to be held in October 2013 and had plan to start `master degree

This year. She had bought dresses from Istanbul,Turkey for her sister’s wedding in the autumn, and wanted to change her local landscape and volunteered at the Citizens Advice Bureau in Ealing amongst supporting other good causes. Bahar had grand ambitions to shape the world and contribute positively to global issues such as women’s rights, the right to education for all and the promotion of religious freedom in Europe, democracy and unity in Afghanistan. She was elected the Chairperson of the Afghan Students Association,ASA UK, an online-based platform for promotion of further and higher education to Afghan students in the UK with over a thousand members, and organized educational, religious and cultural events. Bahar had talked many times about moving to Afghanistan to establish an educational charity in Afghanistan, especially promoting girl’s education, her planned future efforts to help victims of the fallout caused by the consequences of war. She said that for every school that was opened, one prison would be shut down, and that if you educate a man you educate an individual, but if you educate one woman you educate a nation, because mothers are the universities for their children.

In more recent weeks, myself, Bahar and youngest son, Baktosh Sakha, were working on a presentation. I was to deliver a talk at the Association of Afghan Healthcare Professionals UK meeting in Finchley North London on Saturday 23rd March, regarding the mental health and drug-narcotics addiction problems Afghans are suffering today. This was following my recent advisory post as Consultant Psychiatrist with the Afghan Ministry of Public Health in Kabul-Afghanistan.

A whizz-kid on her Apple MacBook laptop, she efficiently and skillfully helped me to prepare a Keynote presentation to a high standard. Two days before her death she bought a mountain bike, helmet and registered herself with a local gym. She wanted to stay healthy, be in shape, look good and keep active ahead of her sister’s wedding and following encouragement by her parents.

However, all seemed perfectly routine and normal on Sunday evening 24th March 2013. I had dropped off my eldest daughter and her children to her house and came home and asked my wife “where is Bahar? I would like to borrow her laptop”. My wife said “she was watching TV with us and she went upstairs to her room to rest five minutes ago”. It was 8:30pm.

I went upstairs and experienced something no father should ever go through. I found my daughter unconscious and not breathing, slumped on the side of the bed, her two feet on the ground and head turned to one side as if she was trying to get out of bed and had not managed. She looked extremely pale and her hands were white as snow and cold to the touch. She was completely unresponsive and her eyes were shut. My eldest son,Shafiq Sakha, had already called an ambulance and the local ambulance station was on the same road as our just in Hanwell.

Her mother immediately rushed upstairs when I called her to come to see what happened to Bahar. She come over and had splashed water on her daughter’s young face, and despite the sense of doom, panic, and hysteria - we immediately started chest compressions, rescue breaths and checked and hoped for signs of life.The paramedics arrived very quickly, in fact two ambulance crews had arrived. They used their skills in extended, professional, desperate attempts to save my daughter’s life by Advanced Life Support, Automated External Debrillation, intravenous adrenaline injection, Cardio-Pulmonary resuscitation and subsequently transferred her in the ambulance to Ealing Hospital Accident and Emergency department.

We were not allowed into the treatment area of the casualty ward and sat and waited. Agony. The fear and worry was overwhelming but our love for her meant that we could never lose hope and we would cling on to every last drop of hope. It was now 10.30pm. I cannot describe the emotions, stomach wrenching devastation, the tears, the tears, and shock myself and Bahar’s mother, brother and sisters, Simeen and Kamilia, were feeling. We were all at the hospital including my son-in-law, Turgay, cousin Jamil Burna-Asefi, his mother, Hamida Burna-Asefi and other close family members, uncles and aunts.

At midnight the senior casualty doctor, an oriental gentleman dressed in neat blue scrubs came over to us with a look of despondence and told us privately that they were unable to save my daughter’s life, they had done everything they possibly could but the fact was the Bahar was unfortunately dead. Dead? My Bahar? The period of denial was short, but I could not believe what had just happened. I was in a state of confusion, bewilderment, shock and devastated and thought about the ‘hows’ and ‘whys’?

We had not idea why my daughter, healthy, fit and well with her whole life ahead of her, suddenly left us so suddenly without saying goodbye. She was in the sanctuary of her parent’s house in her own room. Why? Why? Why now? Why Bahar? This was an enormous, gigantic tsunami of loss for our family.

Due to the sudden and unexpected nature of her death, the coroner’s office had ordered a post Mortem investigation to reveal the real cause of her death.

The waiting and not knowing was hard and my mind went on overdrive. Did she suffer a massive heart attack? Was it a pulmonary embolism? Was there a head injury involved - had she fallen off her bike without her helmet on and not told us?

A silent Killer:

Four days later, the Coroner for Greater London (Western) in Uxbridge had conducted their investigations and emailed Ealing Council through whom we found out that the cause of her death was a ‘subarachnoid haemorrhage due to a ruptured berry aneurism.’

The Oxford Clinical Handbook of Medicine describes subarachnoid haemorrhage as: ‘spontaneous bleeding into the subarachnoid space, which is a sudden and frequently catastrophic event. Incidence of subarachnoid haemorrage is that it happens to 15 out of every 100,000 people of the UK population. Typical age: 35-65 yrs. Cause: rupture of a ‘berry aneurism’ is the commonest cause (70%) with arterial-venous malformations 15%).

 Berry aneurisms: commonest sites: junction of the Posterior communicating with the internal carotid artery/junction of the anterior communicating with the anterior Cerebral/bifurcation of the middle cerebral artery. A genetic influence has been suggested.

The patient: sudden (within a few seconds) devastating headache. Collapse and loss of consciousness often follow. The patient may remain comatose or drowsy for days. Mortality in subarachnoid haemorrhage: almost all of the mortality occurs in the first month, of those who survive the first month (risks of re-bleeding and vasospasm), 90% survive a year or more

(References:Ostergaard 1990 BMJ ii 190, WT Longstretch 1994 Ann Int Med, J van Gijn 1997 Lancet 249 1491)’

The coroner’s report provided  the answers as to the biological mechanisms and medical events that led to my beautiful daughters sudden death. She never complained of any symptoms like headaches or pain anywhere in her body, not  had to visit her GP for a few years. Her mother said “ Just five or ten minutes  ago she went upstair she and I were laughing together, she took her laptop and went to her room. I was not aware it was her last laugh forever...” Her mother mentioned through her incessant tears, so continuous, that they could water all the flowers in our garden.

It is a hard reality that we may never fully recover from this loss of our youngest daughter and sister. But seeing the death of my daughter will strength our faith and our strength as a family, in time. Though sharing in the grief and family visits, so many family and friends who have come to pay their respects have let go of personal grudges and family politics and squabbles have melted and evaporated away - a manifestation of love and mercy from God for our suffering. It is said that The Most Merciful only send the hardest tests to those He loves the most and when they are ready and strong enough to handle it.

The human experience of acute bereavement and grief is well documented and touches everyone at some point. Without doubt, the emotional, physical and spiritual support offered by regular visits of family and friends and neighbours of all backgrounds and religions has softened the hurt and strengthened us. Flower, food, cards, hugs, shared tears and condolences and messages on the phone, email, text message, via Facebook, Twitter from all over the world has been a comfort to us.

My wife’s bereavement has been especially severe and we called her GP to make a home visit and she was prescribed medication to help her sleep better and alleviate her anxiety. It will take time, and me and my wife have accepted our loss - but we will never be able to forget the love that we had for our daughter and all the things she managed to achieve at such a young age but also left unaccomplished. It is painful to think of those things left undone. This world is merely a bridge - just a drop in the ocean compared to the Hereafter. And to our Lord, my Creator and Sustainer, I entrust my daughter’s fate.

We will bury her in West London according to the dignified Islamic traditions. I managed to protect her from the missiles and bullets in Afghanistan but I had never, ever thought that I would bury her in Hounslow, West london, so young and that this would be my daughter’s destiny on earth. The ink has dried and the pages have been written and lifted for all that Bahar has done with her time that she was blessed with when she was alive.  God willing, In her name we plan to establish an educational charity in Afghanistan and support the grand ambitions my daughter had intended to accomplish one day.

I hope this may be of benefit to those reading it especially for fathers and mothers who have lost children. I share your hurt and I may understand some of what you have experienced.

If you have been affected by any of the issues in this report and personal reflection and if you would like more information about subarachnoid hemorrhage and berry aneurisms - which is a “silent killer “ please visit your local doctor or neurosurgeon and this website Medline Plus from America (National Institute of Health) I hope may be of benefit: http://www.nlm.nih.gov/medlineplus/ency/article/000701.htm

Thank you for talking the time to read this and God bless.

Dr.Ghulam Sarwar Sakha

Bahar’s father