In late-November, a 40-car motorcade drove through New York City toward Presbyterian Hospital, bringing Saudi King Abdullah along with dozens of his accompanying princes and dignitaries to an important medical appointment. The 86-year-old king, whose entourage reportedly took over the hospital's entire VIP floor and much of the Waldorf-Astoria Hotel, had come to New York for surgery on a slipped disk and a blood clot pressing on nerves in his back, according to palace officials. The medical treatment would keep the king away from his duties for many weeks, and, as with any patient of that age, there was a risk that he would not survive any of the series of operations that would follow. In this case, the patient in question happens to be a pivotal player in the Middle East: the leader of one of the so-called "moderate" -- or at least "Western-friendly" -- regimes in the most volatile region of the world, one that holds much of the oil that keeps the global economy running. The success of Abdullah's treatment, or the aftermath in Saudi Arabia if he did not survive, were of paramount importance for much of the planet.
Like Saudi Arabia, most countries in the Middle East are ruled by unelected -- or fraudulently elected -- heads of state. That creates a number of complications for foreign-policy planners in the rest of the world, who must deal with the very real possibility that the regimes they deal with today could undergo dramatic changes when the current leader leaves power -- whether by force, personal decision, or death.
The risk comes across starkly in one of the recently revealed memos in the Wikileaks trove, in which the U.S. envoy to Egypt discusses the future of that all-important U.S. ally. In the 2009 cable preparing for Egyptian President Hosni Mubarak's trip to Washington, Ambassador Margaret Scobey refers to the question of who will succeed the 82-year-old Mubarak, leader of America's "indispensible Arab ally."