By Slma Shelbayah, CNN

Follow @SlmaShelbayah

(CNN) This Ramadan, Amina Jabbar faced a difficult decision.

The University of Toronto medical student’s rotation at Sunnybrook Health Sciences Centre began around July 9, the start of the Muslim holy month.

That meant working unpredictable shifts for as long as 26 hours while fasting from eating and drinking during the day.

The fast-paced hospital environment was already challenging Jabbar’s ability to keep up with colleagues and patients. As a new physician, she felt more “error prone” and said fasting would increase her anxiety on the job.

Ramadan requires “slowing down,” Jabbar said, an impossible task for a first-year medical resident whose job requires fast decisions and clear thinking to save lives.

The 29-year-old Muslim was torn.

Should she fulfill her professional duties, eating regular meals so hunger would not distract her from patients’ critical needs? Or should she honor her religious obligations by observing the fast, a practice considered a “pillar” of Islam?

“I am spending 60-80 hours (at the hospital) and I don’t get to slow down for Ramadan,” Jabbar said. “It felt unfair to my colleagues and patients to tell them to slow down for me.”

At the same time, Jabbar said she feared that fellow Muslims would criticize her if she didn’t fast. “There’s a certain amount of shame when we talk about people not fasting,” she said.

The decision not to fast during Ramadan, the holiest month in the Muslim calendar, is somewhat taboo in the Muslim community.

READ MORE: The Belief Blog Guide to Ramadan

In Islam, Ramadan commemorates the time when the angel Gabriel imparted the Quran to the Prophet Mohammed.

Many Muslims throughout the world commemorate the month by fasting, refraining from sex and smoking, and dedicating more time than usual to praying and reading the Quran.

Some exceptions are generally allowed during Ramadan, which ends August 8. Pregnant women, travelers and sick people are not expected to observe the fast, for example.

But for many other Muslims, especially first responders and others with stressful jobs, the choice of whether to fast can cause its own kind of anxiety.

When Jabbar blogged about her decision not to fast, she received a mix of reactions.

One Muslim accused her of looking for an “excuse” to shirk her religious duties. Some questioned her devotion to Islam, asking if she performs other required Islamic rituals such as daily prayers.

“Of course I pray," Jabbar said. "I am just choosing not to fast. We have a lot of pressure to demonstrate to our community that we’re Muslim.”

Imam Khalil Abdur-Rashid, head of the Iqra Mosque in Brooklyn and Muslim Chaplain of Columbia University, said that observing the fast during Ramadan is a religious obligation for every Muslim who is considered mature, mentally sane, healthy and not traveling.

There are no fatwas – or religious rulings – that grant fasting exemptions for first responders, he added. But, Abdur-Rashid said, one is definitely needed. In fact, he generated one immediately after speaking with CNN.

"The purpose of the fast is not to place the fasting person in the face of harm, but to teach self-restraint,” Abdur-Rashid said.

“And the moment the fast becomes dangerous, or external conditions place the fasting person in harm's way," he said, "then the fasting person is not only permitted, but in many cases, religiously obliged to break their fast.”

Abdur-Rashid's new fatwa may be especially valuable to Muslims like New Yorker Ahmed Sabree, who battles fires while wearing heavy equipment during the searing summer heat.

Sabree, 42, said the arrival of Ramadan this July took him back to his training days with the New York Fire Department nearly eight years ago.

Sabree endured intense physical drills that included racing up six-story buildings, pulling up hoses and crawling on the floor.

Trainers told the budding firefighters to “hydrate, hydrate, hydrate,” Sabree recalls.

He contemplated breaking the fast, at least to drink some water, and researched Islamic texts for guidance.

Sabree concluded that his training, though grueling, was insufficient reason to drink water during the day.

Ramadan is not just about enduring physical hardships for hardships' sake, Sabree said. Instead, the holy month has a deeply spiritual dimension.

The firefighter said Ramadan's rituals offer an opportunity to “get back on track” and become more conscientious of his responsibilities to God and his fellow man.

That doesn’t mean fasting is easy for Sabree, so he takes precautions to lighten the load a bit.

For instance, he volunteered for the lunchtime watch shift at his firehouse in Harlem, New York, while others are eating in the kitchen, better to keep the alluring aromas of food at bay.

And if a fire breaks during the time of breaking the fast, Sabree responds immediately. To the fire that is, not his stomach.

“If it’s time to break the fast and there’s a fire, you gotta go,” Sabree said. “I’ll break my fast with some water and go.”

READ MORE: Muslims have mixed views on TSA Ramadan advisory

Deputy Chief Mike Jaafar of Wayne County in Michigan is also fasting this year.

Jaafar says Ramadan is “kind of a cool time,” but he doesn’t mean temperature.

In fact, for the last several years, Ramadan has fallen during the hottest summer months. The holy month is calculated by a lunar, rather than fixed calendar, so it rotates from year to year.

“Unfortunately, I can’t adjust my schedule in the profession I am in. This year is going to be a tough one,” Jaafar said. He is expected to keep the same long hours and fulfill the same duties as his fellow officers.

But there are some perks to celebrating Ramadan in Michigan, home to the largest concentration of American Muslims in the United States. When the holy month comes around, fasting isn’t much of a foreign concept, even for those not Muslim.

This understanding translates into small workarounds for Jaafar. Sometimes, if he begins his workday early enough, he is able to finish in time to get home for dinner.

“My hours can be flexible, and usually I can break my fast with family,” Jaafar said. He uses this time to visit his mother every day and to attend the mosque with his children.

As for Jabbar, the medical resident is trying to make up for not fasting through other spiritually fulfilling options, such as praying and helping heal her patients.

“Spirituality has to become part of my clinical practice, because I spend so much time of my life there,” she said.

But Jabbar said she still misses the slowing down that Ramadan's daytime fasting requires.

"I am trying to make it up in terms of remembrance," of God, she said. "It doesn’t always feel sufficient."