Abdul was born on 22nd October 1961 in Pakistan, in a village close Rawalpindi. The family was poor. His father worked on the land but his mother did not work outside, staying in the house most of the time. As far as he can remember his mother wore a head-scarf but she did not cover her face. Abdul did not go to school but he would spend his days playing outside with the other boys.
In 1971 the family emigrated to England in search of a better life. They settled in Oswaldtwistle in Lancashire, where his father obtained employment in a textile mill. Abdul went to school in Oswaldtwistle but he did not play out very often. They lived in a terraced house without a garden.
The textile mill in which his father worked closed down but he was able to obtain work as a labourer in a cement factory and the family moved, again living in a small terraced house. After leaving school with no qualifications, Abdul worked in a factory as a battery filler. In England two more children were born to the family but they were not as healthy as Abdul was in childhood. One suffered from learning disabilities and the other was congenitally deaf.
Abdul had always been of low weight and small in stature but in 1993, at the age of 32 years, his health deteriorated. He visited his family doctor with symptoms of lethargy. He was 52 kilograms in weight and initial blood tests showed that he was anaemic, and further investigation showed that he had advanced renal (kidney) failure. He was clearly critically ill and his family doctor therefore arranged for him to be admitted to the hospital as a matter of urgency. Full assessment included an ultrasound scan that showed the kidneys to be small and shrunken, the result of progressive inflammation over a period of perhaps ten years, usually driven by an immune process. The disease was not reversible.
Abdul was started on the life-saving dialysis and was put on a maintenance programme. In 1996 he received a kidney transplant.
On further investigation he was shown to have a low serum calcium level in the blood, and the serum parathyroid hormone (PTH) concentration was very high. The combination of the two indicates biochemical features of osteomalacia, due to vitamin D deficiency, and he was given the vitamin D supplement that was necessary. The vitamin D supplement had to be stopped quite early as the blood calcium level rose to above the normal range; he had developed tertiary hyperparathyroidism, a rare but well-recognised complication of advanced chronic renal failure.
In 1995 Abdul sustained a fracture of the scapula, an unusual fracture that was almost certainly a manifestation of continuing osteomalacia.
The next development was in 1997 when he developed enlarged lymph glands in the neck, cervical lymphadenopathy. Chest X-ray showed more enlarged lymph glands, within the chest. Biopsy of the neck glands confirmed the clinical suspicion of tuberculosis and he was given a six-month course of treatment with rifampicin, isoniazid and pyrazinamide.
In 1998 Abdul developed sudden onset of weakness of his left arm and this was due to a cerebral infarction, a stroke. In 2001 he was admitted to hospital as an emergency on account of sudden onset of chest pain. ECG showed features of myocardial infarction. On that admission he was found to have a high blood glucose and a diagnosis of diabetes was made. He later went on to receive treatment with oral hypoglycaemic agents.
In 2002 his kidney function deteriorated, and it appeared that the immunological / inflammatory process (glomerulonephritis) that had damaged his natural kidneys was now damaging the transplanted kidney.
In October 2004 he was admitted as an emergency on account of sudden onset of weakness of the right leg. He had sustained a further cerebral infarction, or stroke. Blood tests showed deteriorating renal function. Despite this huge burden of illness during the past ten years, Abdul remained cheerful and optimistic. This was the last time that I saw Abdul.
In December 2004 he developed a staphylococcal septicaemia. Despite full intensive care support his kidney function deteriorated rapidly and he died. His age was 43 years. The good life that Abdul´s parents expected for their children had failed to materialise.
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