The mysterious ailments that inflict Mian Nawaz Sharif just became a bit more mysterious. The honourable Supreme Court of Pakistan (SC) has let Mian Sahib out of jail for a few weeks so that he can get treated.

The latest news about Mian Sahib’s health is that besides his previously undisclosed but now emphasised ‘seven’ stents and the known heart operations, he is now also suffering from diabetes and kidney failure. The only thing he is known not to suffer from is back pain that two previous presidents of Pakistan were severely afflicted with.

The latest news is that Mian Sahib has been admitted to the Sharif Hospital next to his home in Lahore. This hospital is famous for not being famous for care in any medical specialty. The choice of this hospital I suppose depends on the fact that all personnel including physicians working here are employees of the Sharif family.

At least Mian Sahib will feel entirely at home in this hospital but the choice does put into some doubt the seriousness of Mian Sahib’s medical problems.

In previous articles on this subject I have discussed in some detail the heart problems that Mian Sahib reportedly suffers from. In summary, his heart problems are about narrowed heart arteries that were initially treated with multiple medicated metal stents that were inserted on different occasions in London when he was there for ‘routine medical checkups’. And when these stents closed down, Mian Sahib underwent a ‘coronary bypass’ operation where the artery blockages were bypassed with veins from his legs and what else?

After all the recent visits to different teaching hospitals in Lahore, Mian Sahib did not undergo a coronary angiogram, a test that delineates with great clarity the present status of his heart artery bypasses and if any of them have closed down partially or completely. It is clear to me that Mian Sahib did not want that information to be available to the SC before it decided about his bail application.

For me the more worrisome information about Mian Sahib’s present health is the claim forwarded by his daughter on a number of occasions that Mian Sahib is suffering from ‘stage four’ kidney problems. If that is true then Mian Sahib will most likely end up on kidney dialysis within a year if not earlier and will require a kidney transplant to get better.

If indeed Mian Sahib has serious kidney damage mentioned by his daughter, then one of two things is possible. The information was either not correct or else Mian Sahib is in serious trouble and depression in jail or absence of it is not going to be of any help to his kidneys.

Kidney damage if really present is a major problem when it comes to the investigation and treatment of heart problems. Even a simple coronary angiogram requiring a small amount of medicine (radio-opaque dye) used to outline heart arteries and bypasses has the ability to make the kidney damage much worse, and any stent procedures that require larger amount of ‘dye’ can be that much more damaging.

As far as any open heart or coronary bypass operation is concerned, if Mian Sahib has any significant kidney damage, the chance of kidney damage leading to complete kidney shut down is very high. This I can say from personal experience of having operated on dozens of heart patients with pre-existing kidney damage including some who also had previous heart surgery.

The interesting question raised by many in the press before Mian Sahib got his temporary freedom was the effect of incarceration on his heart condition. Many talking heads on TV and op-ed warriors in the press seemed to have developed overnight expertise in the matter of stress, depression and worsening of heart disease.

Here in the defense of all the newborn experts on heart disease, I must admit that most of our great poets have written much about the effects of sorrow and sadness on their own hearts. Mirza Ghalib, arguably the greatest Urdu poet, suffered so much anguish according to his poetry that he probably had no heart but just a burnt out cinder left by the time he died. I am sure that if Mirza Sahib had lived in more modern times he would have used some words closer to ‘depression’ to describe his feelings.

Much modern research in psychiatry and different medical fields has been devoted to the effect of depression, sadness, loneliness and personal loss, on physical well-being. Frankly I am not aware of any dependable research that suggests that depression especially that related to physical incarceration in a jail can lead to or worsen existing cardiac problems.

More importantly the question is what exactly is a jail for? Is incarceration punishment within limits prescribed by law or is it a visit to some place where people like Mian Sahib do not quite have the amenities available to them at their Lahore or London homes?

One of the points raised in support of Mian Sahib was that as a three-time prime minister he deserved better treatment than ordinary ‘jailbirds’. I quite agree with that and as a matter of fact I have an important suggestion to make.

I strongly believe that elected former PMs, presidents, chief ministers and former members of the superior courts especially chief justices and of course all former chiefs of the army staff (COAS) should not be sent to jail but if convicted of serious crimes should be placed under house arrest and if need be, special hospitals/spas should be built for their ‘incarceration’.

The only problem with the above suggestion is that if presented in parliament, before we know all present and former members of parliament will also be included in the list of those deserving special privileges. And then, why not all other VIP types also? Eventually, the list could be expanded to include those that are willing to pay exorbitant sums of money to enjoy similar style of incarceration. Of course, these private payers could essentially subsidise this entire programme.

My prediction is that even before Mian Sahib’s bail expires, his doctors in his hospital that are in his employ will claim that Mian Sahib urgently needs to go to London for proper care. And that his treatment is not possible in Pakistan.

Coming back to Mian Sahib’s ailments, if his heart bypasses are blocked up and he is indeed suffering from stage four kidney problems then he might need a high risk heart procedure and or a kidney transplant or both, all this only possible in London where it might take months if not years.

Fortunately for Mian Sahib he should have no trouble finding a kidney donor for according to his political party there are millions that are willing to give their lives (jaan nisars) for Mian Sahib. For these people donating just a kidney should be no problem.

Finally, if it became possible for Mian Sahib to become PM for a fourth time, I suspect that he will become suddenly healthy enough even without any further treatment, except perhaps for a ‘routine medical checkup’ in London.