Aug 12, 2017

A hiccup

This is far from over, but I'm taking a break.
Away from scrutiny, away from being judged based on what I write.
I want that peace; the anonymity and the untouchable realm of a writer
Yet remained relevant, personal, exposed,
Eternal.

Jul 8, 2017

A Mother's Strong Back

No one has ever truly appreciated what I do as a doctor and how I do it. I am in Peri team almost two weeks already - everyone has to be in that rotation for a fortnight - and I am counting days to finish with it. Being in Peri means you are going to do a lot of walking (and running) from patient to patient, ward to ward, and inevitably, from building to building.


I am covering the Ortho cases from the medical female and isolated medical wards which consist of the entirety of the 7th floor. There are four of us hamba orang (HO) covering the whole hospital that includes Paeds, Surgical, ICU, etc. so we divided among ourselves on which wards to cover. There is a lot of pro and cons covering certain wards, for instance: Covering as a Peri Ortho in Surgical ward will give you very few patients to review but the cases are severe. That is because the patients who are treated under two departments such as Surgical and Orthopaedics very usually mean that the patient is of multiple trauma e.g. motor vehicle accident.


And for me covering the medical ward, the usual cases I see are the diabetic foot ulcer, pressure sores, and infection of the skin (cellulitis). The cases may be simpler and after a few days, become repetitive, but the number of cases that I have to review every day is simply stagnantly a lot and burdensome. 


And for that reason, coupled with being chewed and gnawed by my super scary specialist after not presenting cases properly during round (because I didn't have the time to review them all), I had to come early to work every day. Like, super early as in I start reviewing my first patient of the day at 4 am in the morning. That's how early I have to be. And in the hands of newly and fresh MO out of the oven, work became inefficient and as a result, I hardly be able to go back from home on time.



There's one patient I met in the medical ward that strongly reminded me of my late great-grandmother, Nenek Ik. I was notified that there is one patient to be admitted into female medical ward from the Red Zone Emergency Department. She was brought to the hospital the night before, and only late in the afternoon the next day she was stable enough to be transferred upstairs.


She was septic and her conscious level is deteriorating. We were referred by Medical team to have a look at the cause of her sepsis which is her back sore (sacral sore). For those of you who don't know what sacral sore is, you can try research for it from Mr Google or Grandpa Wiki. The way I usually explain to the patients and their relative is sacral sore happened to the person who was bed-bound for a long time. What happened then is that the body's gravitational weight put a pressure on the point of contact between the body and the mattress. Don't be shock - even though the mattress is soft and comfortable, the long contact pressure of your body onto it can cause a break in the skin (like melecet, or bergesel) and once the skin breaks, then the muscle, tendons, and even bone follow suits.


Skin is one of the vital organs of our body - it is waterproof and the first wall of defense from micro-organisms that cause infections from entering our body. Thus when the skin breaks, the layer of body tissues underneath it are prone to infections.


When I came to see the patients, one of her daughters was sitting in a plastic chair at the end of the bed. I was unsure whether she has been with her mother since last night or she just newly arrived to accompany her mother to the ward but nevertheless, seeing her mother's poor condition I had to retrieve the information from her instead. She has nine siblings, and she is the third eldest. Her mother previously lived with the 5th son for a few years but for reasons unclear then she lived with the 6th son for the past 5 months.


She claimed that her mother memang dah nyanyuk sejak enam tahun lepas and needed assistance for eating, bathing and etc. When I asked what exactly happened that led to the admission to the hospital, she said she didn't know much but the one who is taking care of her mentioned of her not being responsive and was rapidly losing consciousness. They straight away brought her to the hospital. When I asked about the wound at her back, she said she didn't know about it.


At this point, my mind went straight away towards Nenek Ik and the similar circumstances of her illness. My voice went strange as I fought the anger in my voice from leaking out. I had to put down my pen as not to show to her my hands that were actually shaking. I had already read the review the ED Ortho team put down. The wound was big, necrotic, emitted really foul smell with pus discharge and slough.


"Anak lelaki yang jaga mak tu, bila dah perasan ada luka kat belakang badan mak dia tak bawak pergi jumpa doktor ke?" I asked her.

"Tak, dia tak bawak pergi jumpa doktor," she replied.

"Kenapa ya tak bawak pergi jumpa?" my voice went a quarter octave higher.

"Saya memang taktahu doktor," while shaking her head slowly a few times.

"Dia ada bersihkan luka mak tak?"

"Ada."

"Berapa kerap dia bersihkan?"

"Tiap-tiap hari dia ada cuci, doktor."

"Habis tu kalau dia cuci setiap hari takkan dia takperasan bau busuk?"

"Dia perasan, doktor."

"Bila dia dah perasan bau busuk tu pun dia still tak bawak pergi jumpa doktor?"

"Saya memang taktahu, doktor. Saya tak jaga mak saya."


Right on cue, four more family member came to see their mother. I was unsure whether all of them are the patient's children, but if they were, then that made two sons and three daughters were present when I reviewed the patient.


"Ni ha yang lain boleh bantu doktor" - while speaking to the rest of them while retreating to make way for them to come forward - "...saya dah takboleh nak tolong. Doktor nak interrogate korang pulak."


They also gave similar answers to why nobody taking care of her pressure sore properly. The daughter then showed to them (and me) the wound she snapped from the ED downstairs. It was small, roughly the size of the thumb that was black (gangrene patch). From the picture I couldn't determine where the sore really is but I highly doubt that is the extent of her wound.


Then one of the sons asked me the reason for the mother's illness. While I explained to them about sacral sores again I asked about their mother when one of them held up a handphone and told me I could ask the one who was taking care of her directly.


And lo and behold, the exact same story he told me, now added with excuses. He mentioned that because he was busy with business (berniaga, not cooperation that kind of business), he didn't have time to bring her to see a doctor.

"Habis tu siapa yang cuci luka belakang mak?"

"Saya la, doktor"

"Macam mana encik cuci luka mak encik?"

"Saya lap kemudian saya cuci dressing luka dia tiap-tiap hari."

I had stopped listening to him. I was so fed up and I handed the phone back to whoever that gave it to me in the first place while the caller on the other end was still talking. I had enough. Then I spoke to them all.

"Saya dari bahagian doktor sakit tulang. Saya sini nak tengok luka belakang mak ni sebab luka ni yang menyebabkan mak jadi sakit macam ni sekali."

I added, "Oleh sebab tu, saya nak encik berdua (while pointing towards the sons) untuk tolong saya pusing badan mak supaya saya boleh tengok luka mak. Yang lain pun boleh tengok sendiri luka mak macam mana. Sambil tengok luka saya kena ambil gambar luka tu untuk memudahkan kerja doktor yang merawat."

So I pushed the bed a little bit so that I could stand on one side while the other two could stand on the other side. I instructed them to don on the gloves and taught them on where to put their hands for the turning. Then on my count of three, I asked them to turn their mother's body 90 degrees side way.


And the sight of the wound was horrifying.


The older son whimpered. "Ya Allah, Ya Allah.. Mak.. mak.."


Once I quickly snapped a picture for documentation, again on my count we carefully turned their mother back on her back. Then the crying began.


The son's legs gave in as he cried into his sister's shoulder. The sister had to support him halfway, herself crying upon witnessing the actual wound on their mother's back. I heard him repeating himself, "sampai hati buat mak macam ni. Sampai hati buat mak macam ni." I could only pat him gently over the shoulder as I gave them space to grieve. The younger daughter slumped against the wall, covering her mouth as she cried. The anger I felt initially burst away, filled suddenly with a profound pang of sadness. I was reminded of Nenek Ik, again, and how she, too, went down when no one had properly taken care of her.


I had nothing to say to them. Nothing left to say that could help them. I finished writing down the findings and I ended my clerking with a heavy heart. I felt disturbed at the sight of them all and there was a huge lump in my throat whenever I glanced at their direction. I went back from work later that day, hoping to write this all down but the sight of the wound, the patient's dying condition, and the reaction from them made me stopped halfway and thought of my own mother.


There is no way I will let that happen to Mama. There is no way Mama will be treated in the future, even when the memory and the body should fail her. There is no way I would let it happen.


May Allah granted all mothers the highest order of jannah, for they have carried all of us and the burdens of the world on their stong back, thus so truly the heavens lie at their feet.




Jul 1, 2017

The Fast and the Houseman


The clutters and the voices are overlapping with the music blared through the corner place speaker where I am currently sitting at. It's McDonald's, again, and this time I straight away come here after work. It's so hard to find comfort food nowadays, and this eatery I'm frequently visit does not come out of the pleasure - merely the familiarity and the accessibility that it offers.


It's been a month of not writing anything here. I really missed writing, and the month that came and go was.. something to talk about, especially regarding the month of holy Ramadhan and the subsequent occasion that comes after it which is the Eid Mubarak. Yet, with my laptop failing me and me failing myself to find some time to write had brought the whole month passing by wasted.


It's surprisingly not that difficult to work while fasting during Ramadhan. Call it rahmah, or baraqah, or to simple-minded person the collective easing of personal burden, I found that fasting during Ramadhan while working as a houseman is actually quite fulfilling. For me personally, the topic of Ramadhan fasting has been on my mind since I was in medical school simply because I was wondering about it and no one has shared anything about the topic back then.


Well, now that I had lived it, I have to write it down here somewhere or else I would forget the first experience of it. The next encounter will always feel and be different than the first encounter in my opinion. During the fasting month, I usually will have my sahoor early around 4 am. I continued my sahoor diet I developed during my final year in medical school which consisted of 1 or 2 packets of Gardenia's sambal ikan bilis breads that I wolfed in between big gulps of plain drinking water.


The reason for the early sahoor should be obvious: I need the 1 hour sleep in between sahoor and the Subh prayer. When you become a doctor, you will realise that every moment you spend sleeping will keep you alive bit by bit. And that pretty much becomes the routine of my fasting days. Working may pose a little bit of challenge, especially when you work in a crowded, busy ward and the humidity is high, the heat is antagonizing, the patients are eating in front of you and some actually had the nerve to ask, "Doctor tak makan ke?" I know you all were just trying to be polite, but dear pakciks and uncles, makan la saya tak kacau.


When I worked a week in ED as part of peri Ortho (peripheral - meaning reviewing Ortho cases outside Ortho wards) and the subsequent one week in OT, there was a few changes that I like. For instance, time during sahoor and iftar can be considered untouchables - even OT will stop calling cases for operation because all the staff wanted to break their fast. And what made it more amazing is that, after iftar it would be too late to call for another case then (as OT for operation under local anaesthesia closes at 9 pm during Ramadhan) and hence, I got to go back to my room as early as 6.30 pm.


Two-third of my Ramadhan I had my iftars at the mosque across the road from the hospital. The food usually alternate between chicken, beef, and fish and that was pretty much more than enough for me. It's been closed than a year that I lost my glutton appetite of eating huge meals. I can eat a lot, but during Ramadhan sometimes eating kuihs can already make me full. 


Ramadhan this year though, to me, is one of my bleak moments in life. There was actually nothing wrong with my life, but I feel I have wasted it all. My room is a mess, my energy plummeted easily to the ground, and I felt so lonely and miserable. This is different from the time in O&G. Back then I knew there was a real external stressor (the whole department LOL). But for one whole month and onwards, I feel like out of sorts.


I tried to pinpoint the causes for it, but I don't know what they are. My logbook is okay, my assessment went well, I finally solved my sleeping condition problem in the room (I bought a standing fan, like duh~ what an obvious solution) - yet I am missing the blessing of Ramadhan. I felt angry, I felt disappointed, and more than ever, I felt defeated. 


To top it off, I did not get any raya leaves as I had used up all my cuti rehat when I had the 13-day MCs for the shingles I unluckily got some time before Ramadhan. It made my days more bitter as tomorrow will be the first day of Raya that I got. I have been working for two weeks straight and all hopes to buy baju raya or whatsover went out of the picture. Even when I finally have my off day starting as of now, the feeling of it has long evaporated. The only thing Eid-related that I can still enjoy is weirdly, but satisfyingly, singing to Sepahtu's Raya Sedondon song out aloud in the car.


p/s: I am writing this down using a 2-day old laptop that I just bought out of anger over my decrepit creaking laptop. It's Adele. 


May 23, 2017

Revisiting 13 Reasons Why

Back in 2012, I have made an entry about my Kindle app on my tablet. I was a huge nerd on novels (still am. really) and I am always proud of my e-book collection that I downloaded over the Internet. I organized those books using a software called Calibre, where I can do custom editing of the title of the books with a numbering system. That way, all my books can be displayed in the chronological order in my Kindle (I mainly collected novel series, not so on stand-alone novels). See, I already sound like a dork trying to explain it. Really, try looking at my collection 5 years ago here: http://safuannnnhkm.blogspot.my/2012/01/iqra.html


Now, it will be such a shame if I don't compare my collection as of now with my old collection, wouldn't it? 

















Anyway, there's this show over Netflix called "13 Reasons Why" that is generating a lot of buzz for these couple of months or so. I know it's a bit late but when the first time I heard about it I was like, "What? 13 Reasons Why?? How on Earth can they make a series coming out of 1 novel?" And  I remembered that I read that book waaaay back in 2012 it's like no, don't, it's a hellava sad story why would you kill your viewers with kind of story (I hate sad story by the way). Nevertheless, the novel was breathtaking and although you know the premise of the story, once you started reading you are compelled to see it through the ending,just like the protagonist of the story has to deal with Hannah's tapes.


So, seeing that me being invalid and writhing in pain for another week or so at home, I might use this window of recuperating to open back my wound and once again, into the breach of the life and death of Hannah Baker in 13 Reasons Why.

May 7, 2017

The Weekly Collective Thoughts

It's amazing how being a different department changes the mood you are in. I remember the despair and my reluctance to go to work. Of how I will get palpitations and tremors dreading the hours before having to don my clothes and walk out the room to face the horrors I will find in the hospital.


This is the sorry state I am living in for the past, hmm, one month? I had been sleeping on the floor for so long my bed is just there collecting dusts. All my (clean) laundry I just dumped them on the bed and not bothering to fold them because let's face it, I will use them back again soon. So why bother?


At the time of writing this down though, I just cleaned up my room to the state I'm proud to say suitable for human to live.


It's not like Orthopaedics is any easier. I have almost no knowledge about it, make it none at all, but the environment does really help me to learn. The bosses are easy-going but do not lax at work. They don't nag, they don't find your fault, and most importantly, they teach. That's a hugeee bonus.


The ward work can be a bit hectic every morning as we have to complete the list for the next day operation, but once it is settled, the work is manageable and very tolerable. The working style in Ortho is different from O&G and I will have to take some time to familiarize myself with it. 


The only thing I am not comfortable yet about Ortho is the fact we have to be on alert with Whatsapp texts. We share a Whatsapp group with all the MOs and the specialists, so when they ask for something it has to be answered. It will be a challenge for me as I do keep my phone lying around and not attending to texts straight away.


I just left my phone to take a dump and when I returned there are 132 texts???


But so far, I no longer dread coming to work. I know even Orthopaedics has its own emergency cases like PE, fat embolism syndrome, shock, DKA (a lot of DFU here, FUUUUUU), but the level of stress I encountered here is much more less than I found in O&G. See how much I am comparing Ortho with O&G? Hahah.


Okay it's time for some power nap. I am working PM shift today, so let's hope my night is gonna go well this time (the last time one of my patients had to be intubated in ward and the post night morning there's another patient went desat with fever and shit that is suspiciously PE or FES). Just my luck, huh?

Apr 30, 2017

We are What We Repeatedly Don't Do

One of the main reasons I write about my housemanship journey is because I want people to benefit from reading a first-hand experience of becoming a housemanship in this country. When I was a medical student, I was grateful to find a number of blogs that share their experiences of becoming doctors and if not completely, at least I had a rough idea what it is like to be one. Of course, the reality is a bit different as I figured it out now.


The other main reason for me to blog is as a way of practice to do self reflection of my actions. Now, self reflection to me simply means to objectively evaluate yourself as if you are evaluating other people and analyzing what went well or wrong and how to improve on those things. Way back in my first year of medical school, the first ever assignment in my course is on how to do proper reflection. Remember that reflection is a crucial tool for a doctor for reasons that doctors need to periodically reevaluate their standard of care and to always improve their practice.


No no this isn't doing reflection. This is checking yourself out.


It is not simple to make a self-reflection. One, it is very difficult to view myself and having to admit that I do wrong. It is a horrible feeling. Two, often more than not, I don't even realize that what I do is not right. And three, I make justifications for those actions of mine - a big hurdle when trying to improve oneself. So here I am, struggling with words to convey what I wanted to reflect. But, I need to do it, no matter how ugly it paints me.

________________________________________________________________________


Four weeks ago, I was once scheduled to work in OT (operation theatre) for one day to assist the surgeons with gynaecological operations. On that day turned out to have only one operation and that operation was not in the morning like they normally do but in the afternoon. Now, one of the jobs for houseman working in the OT is to do morning / pre-op reviews in the gynae ward for patients who are scheduled for that day's operations. 


Well, after doing my review, I thought that, well, I was free until afternoon. It made sense at that time because that's usually what happened. They will review their patients who will go for OT then waited until the patients being pushed for op in the morning. What I did? I went back to my hostel room to chill as I thought I don't have to do anything else for the morning.


It turned out the bosses noticed that the OT housemen (me and my colleague) were both not in the gynae ward during the morning rounds. Sure, the housemen in charge of that wards were there, but apparently the OT housemen were supposed to be there as well. Well, colour me surprised because they made a really big fuss about it. We were scolded by this annoyingly loud MO who later called the specialist, the MO in charge of the housemen, the HO leader, then telling everyone from the sisters to the staff in OT about what happened. We were asked to do an explanation letter and to meet Dr A, our specialist in charge. If you want to know how to do an explanation letter, here is what I wrote:


Dr A said that for houseman issues with attitude problems, we are going to be extended for a month. It's not a straight-away direct extension, for in my case, because I told them that I only went downstairs to study in the houseman's room, and that I was only away for an hour (it took me only 5 minutes from my room to the ward), I safely finished my O&G without any extension. Heck, I suspected they had forgotten the thing altogether. 


But why am I telling all this? There is one main point I'm trying to make now and that is:



We are what we repeatedly do (or don't do).

To understand this, I have to elaborate on my habits during my 5+1 years of studying in medical school. As a student, I was never a model student. I was not hardworking nor were I passionate enough about what I was studying. If there were lectures that I thought too boring or didn't make sense, I would skip going. If there were instances where teachings in the hospital were cancelled or during rare unsupervised self-directed studies, I would go back home in a heartbeat rather than to stay in the hospital to watch procedures or to clerk any patients. In simpler terms, I was lazy.


This 'cutting-corners' habit of mine, now that I reflect on it, persists until now. It makes me realize that habits that we develop during medical school will affect how you work as a houseman. If during your studies you don't familiarized yourself with procedures such as inserting catheters to male patients (like I didn't), you will painfully be ashamed when admitting that you don't remember how to insert one when asked by the staff or your bosses (like what happened to me yesterday). In short, what we repeatedly do will help us in the long run and what we don't practice, well, we won't.


If I got the chance to advice my past self who were still studying in medical school, I would want him (me) to change my habits as soon as possible. Old habits do die hard, and I am trying so hard to change it. Do a lot and a lot of procedures, familiarize yourself with it, and start having the right attitude. Do not cut corners, do not skip things for anything, and make sure no jobs are left not done.


But if you are like me, who are already messed up but aware of it, I think there are still ways to salvage the situation. I, for one, fully recognize my distasteful attitude that I need to fix. I am aware of the many procedures I am poor at. I don't run away from doing them anymore. Like the other day, I failed my ABG taking so many times. Even when I thought I got it right for the first time in my life, the results highly suspected it to be from an arterial line. And the recent shameful male catheterization - I am so stupid for not consulting my seniors and went ahead doing it wrongly. I know better now, but how I wished I don't have to learn it from mistakes.


I think I can change. I want to be better. I don't want people to badmouth me or talk about me behind my back. I don't want to be the houseman whose his name when mentioned during conversations will result in a collective groan and sigh from other people. But to change, I have to accept this. I have to accept that I have a problem and I need to work on it. I need to work out how to work well in the ward fast. I need to be be able to do this all by myself.


And for that, I need to start repeatedly do the things I didn't do before, and become someone with a better work habit. May Allah ease.