This allowed Saudi Arabia to remain in denial both about the health of the king and the wider political health of the nation. But even American medical technology has its limits. And now, with Fahd's death, Saudis could soon find the health of the nation also in sharp decline.
A succession - and a succession crisis - is at hand. Indeed, the very fact that they kept the king alive for so long shows the Al Saud family's fear of future divisions in its own ranks.
The king's death comes at a time when the wider Middle East is abuzz with talk of democratic change. From Egypt to Lebanon to Iran, political passions are mounting. Political debate is flowering as never before. Even the conservative states of the Arabian Peninsula are embroiled in lively disputes about women ministers, Shia representation, Islamist participation in the political process, and even the future of their ruling monarchies.
But like its moribund king, Saudi Arabia has remained trapped in a state of suspended animation, its body politic sick and infirm. Now it is caught between two choices: progressive reform or continuing paralysis and decay.
But the divisions in the kingdom are sharper than ever, and the king's death may well bring the schism to a head. Two rival camps, the so-called reformers and the hard liners, are forming between the 22,000 princes and princesses in the Al Saud, the world's largest ruling family.
The reformers, which include Abdullah, the new king, are the acceptable face of the Saudi dictatorship internationally, but they have less authority. They talk about municipal elections, national dialogue, and the rights of women, who they suggest very quietly may one day even be allowed to drive cars. But even these limited efforts are obstructed by the hardline Wahhabi camp, which controls the security forces, the judiciary, and the real levers of domestic power. Indeed, Prince Naif, the Minister of the Interior and leader of the hardliners, has either silenced or imprisoned hundreds of the key Saudi reformers.
One reason for the weakness of Abdullah's faction is that he has scant support within the family, because the Al Saud centre of power lies with the al Fahds - the late king and his six full brothers, most importantly Prince Sultan, the Minister of Defence, and Prince Naif.
On the surface, the succession seems settled. But Abdullah will not be able to shape the future, because he seems doomed to lose any showdown with Naif's forces. Abdullah's power base is in the National Guard, and his claim on the support of Saudi Arabia's modernising forces. Both are insufficient to check Naif. A key early test of Abdullah's kingship will be if he can succeed in freeing the hundreds of political reformers in prison, especially three respected academics who he encouraged to make reform proposals, only to be incarcerated by Naif.
Old scores among King Fahd's numerous brothers and half-brothers, not to mention the thousands of princes in the next generation, will also need to be settled. But don't look for hope in the new generation, which is neither necessarily young nor progressive. Indeed, the Al Saud clan's third and fourth generations are divided not only in political and religious affiliation, but also range in age from 20 to 90. All await a chance to rule.
So Saudi Arabia's people confront a pivotal question; can an authoritative ruler reunite the country in the progressive tradition of the late King Faisal? The sad likelihood is that given the power of the obstructionists under Naif, a decisive king is unlikely to emerge. The direction the country will take in the longer term can best be assessed by whom Abdullah chooses to name as the successor to Prince Sultan, Naif's chief ally who has already been named Abdullah's heir.
Perhaps if Abdullah can skip a generation there may be hope. But Naif, his full brothers - including Sultan - and their supporters in the Wahhabi establishment appear too entrenched to allow that. Like the geriatric successions that preceded the collapse of the Soviet Union, the accession of Abdullah seems to be only another step in Saudi Arabia's inexorable march toward political decay. Russia found a reformer in Mikhail Gorbachev too late. It may also be too late for Saudi Arabia.
The writer is a research fellow at Chatham House, and the author of Cradle of Islam: The Hijaz and the Quest for an Arabian Identity