Nov 16, 2018

The Thinly-veiled Curtains

I can't remember the last time I felt subdued coming back from work. If I'm to guess, the last time I encountered something that made me feel raw from the end of my hair to my very toes was when I came upon the undiluted rage as a grief coming from the relatives of the deceased patient. Sure, death comes and it goes. I saw more deaths since then. But over time they no longer shake me. I do fear of my own death but its crippling fear and sadness that blacken the grief just seem to mellow down.

In other words, death becomes impersonal to me. It simply became one of the simple yet unchanged outcomes of the patients coming in to the hospital. It does not change when I came to the ED. There's just so many things that need to be done, so many patients to look after, that Death bustles in and out in between the multidirectional torrents of people here like the easy flow of air. 

When you are too busy at work, deaths become harder to affect you. Sometimes it feels like there is a layer of veil that cover your eyes from the presence of the demise. That's what it always feel to me. I skirted here and there, fast on my feet maneuvering along the lengths of this thick curtain just to avoid getting tripped in the seams of Death. Anything but to deal with the grief that comes after the Death leaves. I make do with the necessary paperwork and occasionally I provide some explanations to the family, but never to witness the aftermath that follows. Deaths are impersonal, I reminded myself.

But it is never a simple, fail-safe neat trick. In came a man in his early 30s brought by the stretcher with an MA on it performing CPR to him. He was playing football when he suddenly collapsed on the field. We were already informed regarding the case beforehand and had already prepared one resuscitation bay area for him. Once he was safely transferred to the bed, the green curtains that cover each of the eight bays of the red zone, were drawn over Resus Bay 4. A number of things were done simultaneously - probes and cuffs were attached, lines were inserted, mask delivering oxygen was put on, and a small line of people queuing up for their turn to continue the CPR. Sheets of papers were filled up, passing of important figures and instructions were heard - all within the confinement of the drawn curtains separating between the attending staff and the onlookers.

However, there's simply no amount of curtains that can cover the anguish cries of his family members who waited patiently just outside the curtains. In between the thumping sound of the recoiling chest and the verseful of commands, all sounds and noises waved into frequency. Even during the hecticness of the situation, I could make out exactly everything that was happening. Of the soft voice of my MO explaining to the widow that there's nothing left that we could do, the beeps of the monitor yelling the level of Oxygen in the blood is fast diminishing, and the sobs of the deceased's friends who just arrived to the ED having learnt of the devastating news. It was getting all too familiar and all too painful. After everything is settled, I skirted again in between curtains in the red zone with only one or two glances towards the ones who are left behind. Again I said to myself, Death is ever impersonal.

Later at some time near midnight came in another patient, this time a middle-aged lady brought via a stretcher again being CPR by an MA from the triage. We quickly got into the usual routine and, "skreeet!", the curtains being pulled over. This time I handled with the things outside the curtains, namely getting the history of what's going on with her. The one standing outside was the patient's sister and after a brief of the history taking, I asked to talk to her son to tell me more about her condition as he was with her when it happened. In walked a teenager - lanky, medium build with dark brown complexion.

He gave off the impression of someone coming from a lower socioeconomic background, an impressionless kid coming from the suburban and rural areas - something that is actually expected. No 17-year old who spends time with school and friends should be knowledgeable about medicine and diseases, but it was a disadvantage all the same when taking a history from people apart from the patient themselves. Some patients don't even know or care about what's wrong with themselves, let alone of other people knowing about the health issues of the patient.

He said that his mother had been having breathlessness for quite some time now, and when he came back from exam that day (Day 1 of SPM), his mother told him that she had a fall. She didn't feel so good so she asked him to buy him dinner and so he obliged. She went to sleep early and sometime at 8pm she woke up and asked for water. The son later slept beside her and was startled when he noticed her mother's snore suddenly stopped. He tried to wake his mother up but she didn't wake up.

All the while when he was telling me of what's happening at home, I couldn't gauge his reactions at all. He was stoic. Unlike her aunt who was visibly distraught and near tears, he kept to himself and just stood at the corner beside the resuscitation bay silently. I couldn't see where his gaze was at and it was a bit unnerving. After more than half an hour of resuscitation attempt, she also succumbed to death. My MO then came out and stood in front of them, explaining that unfortunately the patient had passed away.

The aunt broke into tears and sobbed while hugging the nephew's head. Again, he was silent, but the gaze was no longer there. It just.. went away. He didn't cry, he didn't shout in anger, he was just neither here nor there. I did wondered, later that morning, whether he already expected the worst and was bracing for it to be confirmed. Imagine his love and his world gone forever but there she was, only inches from him. Imagine him going back home with one less person in it. The rest of the red zone was still the disarray and I was needed elsewhere, so after I was done I began to walk away from them.

And that's when I saw it - the curtains was pulled back a bit, not much, more like from the billowing of some unknown wind that lifted part of the curtain - of the boy, still silent, bending forward over his mother's head and kissed her forehead in the most serene and heartbreaking way of a son saying farewell to his mother. There's no tears coming out from him, only the act of love that will never be responded.

I was reminded that not all love are shown. Or need to be displayed. That we never know a person truly, only of what they choose to show. There are many layers of veil covering what's inside of us and what is outrightly display to others. When I looked at the deceased ID card taped onto the clerking sheet, I saw that of her round, smooth face covered with a scarf. It was a different person from the one I was doing crash intubation to.

It strikes me that for every patient that come to us, they are someone else's mother, father, spouse, child and etc. That in everyday's work, it's easy to forget that there are veils that cover who patients are and their mark into the world. That every patients have more than just a face and a name. Each and every one of them deserve as much respect and dignity when we are treating them. That at some way, we allow ourselves a few moments of time in silence just to think of them. And for that, I dedicated this piece of writing to remember them by, with prayers in-between, and a promise of work efforts that they all deserve.

Oct 26, 2018

An Infatuation of Fires

In the beginning, there was a fire. I guess I should say the fire is always there, sometimes reduced to  smoldering coal and sometimes it erupts into a great flame. I couldn't know when it first lighted up but I can feel it burns from time to time.

In the past, I had a great campfire. That fire burns for such a long time I thought it would last forever. It used to burn very bright and very warm, but it also came with such hazardous flame. I was burned quite often and over time the great campfire lost its fire and its warmth. The fire finally extinguished and I, exhausted and torched, moved on.

The thing about heat and its warmth that soothes you is that it comes in a lot of ways and sources. There is sunlight which is your primary source of warmth, there's heat from hearth or fireplace when you entered dwellings, there's heat from hot food and drinks, etc. But sometimes you will find yourself looking at fires that are dangerous. Volcanoes, furnaces, stoves, and if you can still play along, other people's fireplace.

But just looking alone is fine. You can't get burned from it. You may longed for its warmth, but you know you're not supposed to. Some fires do hurled itself to you, but most often it's only a small spark or a burst that will die almost immediately after it's being cast. Some fires are too enticing with its bright flames and sparks you feel like a moth being drawn to it. You can't help it so you do stupid things just to get near it. And sometimes you get burned. 

Not this recently ago I came upon a small and steady fireplace that gives me warmth. It is a petite hearth, unlike the great campfire in the past. It does not give off blazing walls of flames. It does not dazzle. But the hearth is as homely as I could imagine it could be, and the warmth is there. There is simply no inferno that will burn me. The flame may be small at the moment, and while other fires out there tug my heart from time to time I feel like I want to stay with this hearth of mine. 

Let the fire burns bright.

Oct 8, 2018

The Drilling Noise of a Heartache

This is her first time setting foot there. The place is big and crowded with people. Not to mention the weather was scorching hot and sweaty. It was bad enough that it took her quite some time to reach there. The traffic was simply horrible made worse by the construction with loud drilling noise that has been going for months, obstructively holding up both lanes with its makeshift alternative routes. But it's the only road leading to the hospital she's rushing to come to so she had no choice.

She felt very uncomfortable coming to the hospital. She was never being warded before and her distant relatives who were admitted for one reason or another were never close enough for her to come and visit in the past. She loathes hospital and anything unholy that resides in it. The groans and cries of the sick, the smell of medicine and the pus, the sight of blood and the broken bones, or the very air itself that seems to be stagnant in the corridors and linger among the patients there - she couldn't stand it.

Until her father fall ill and was rushed there.

It was sudden but late. Sudden that it happened out of the blue and late in the sense of her being notified about it. She was furious, but the anger abated as fast as the cold fear that started to creep in. She wasn't at home with him when it happened. She didn't have a clue. Her mother was there with him, in the kitchen where they usually are for tea break. One moment he's there, talking while sipping his favourite black tea and next moment he fall to the floor, unresponsive. Her mother dropped to his side, frantically calling him unsuccessfully before dialing the emergency numbers.

 She only knew about her father late in the afternoon after her class. She had a mini quiz that day and she remembered feeling good about it since she had studied for the course consistently. Her phone rang while she was on the way back to her room. It was her mom, and when she answered she knew instantly from her mother's tone of voice something horribly wrong had happened. She wanted to go straight there to the hospital but her mother forbade it. "It is late and it's already dark", she said. She asked her to come the next morning. She said not to worry a thing, that she was already at the hospital with him. Then the call ended.

It took her a few hours of driving to reach the hospital. Her mother told her that her father was transferred to the ICU. She may know not much about hospitals, but she knew enough that ICU is where the very sick people are being treated. Her mother told her a bit more about her father's condition but she found it near impossible to comprehend fully without looking at the issue with her own two eyes. Her grip on the steering wheel clutched tighter as she pressed the pedal harder.

When she arrived, she saw her mother is sitting on a long bench outside ICU beside her friend. They were talking, unaware of her approach. She saw her mother was still able to smile and talking energetically with her friend. She came to them and shook hand with the lady before asking about her father's condition. Still smiling, she said that they should be able to enter to see him very soon. There is a limit to the number of visitors that can come visit at a time so they were waiting for turns. So they waited and she just listened to them talking.

Then when their turn came she went inside with her mother at her side. There, in the corner was her father with a lot machines beside the bed with wires and thin tubes connected to here and there. There was a long and big tube connecting one of the machines that entered her father's mouth as well. Every rise in her father's chest made the machine beep with a soft sound. Her father's eyes were closed. He looked weak. She tried calling him but the nurse told her that he wouldn't be able to respond as he was heavily sedated. She stifled a sob.

The young doctor nearby came to them and started explaining about her father's condition. He told them that there's a huge bleeding in the brain causing him to lose his consciousness. With him being intubated there is a risk of him choking on the content of his stomach and causing infection back up to the lungs. His blood pressure has to be supported with multiple medication as it was too low. The chance of recovery is very abysmal, very slim, that they have to be ready to expect the worse. She couldn't comprehend anything beyond that point. Her mind was elsewhere. Her sight went blank. She was dimly aware of her mom's grip in her hand. She walked off in a dazed and sat back on the bench outside.

Outside, there were two guys sitting on the bench as well. They both work as doctors and had went in earlier to visit him. One of them is the son of the visiting friend. They were talking to her mother's friend. Then her mother sat down as well and they talked to her, explaining in a simpler way of what's going on with her father. There was nothing new that she did not already know, so she just sat there silently. The noise of the construction drill just outside the hospital seemed to drill into her broken heart, boring it bit by bit with each passing time. 

She couldn't see how her mother is handling the news this well. She was still be able to greet those who come and visit, ushering them to go inside the ICU with a smile. She was finding it very difficult to even open her mouth, let alone having to deal with all this. When they parted ways with her mother's friend, she said to her that she has to be strong for her mother. That if her mother breaks down as well then nothing will go well. Her eyes were already wet at the time. How pitiful of her mother, how she wishes that her mother is given the time to properly be sorrowful. That being strong all the time isn't always the good thing. That behind every smile and every warming words, there is a sadness that needs to be heeded.

Sep 29, 2018

Do You Want to Quit Housemanship?

This is a seasonal post, trust me. If you are reading this around the time this post is published, chances are you also have read the viral facebook posts by Miya Wong about the reasons why she quit being a houseman in Malaysia.

Statistically speaking, and I mean I don't know who came up with the numbers and there is no creditable sources to back this up, but again, statistically speaking:
  • 1 in 5 junior doctors undergoing housemanship do not complete their training and quit being a doctor.
  • 1 in 3 housemen having to be extended beyond their 2-year stint of housemanship

Before we start taking sides and bash each other with tonnes of personal tragedies and triumphs, we have to agree there are valid reasons why we sometimes feel like quitting our housemanship training program and just, be done with being a doctor altogether. Those reasons could be, in collection or isolated, included in this list:
  • long working hours (major stressor)
  • odd working hours
  • no leaves (major stressor)
  • not enough leaves
  • odd-hour leaves
  • shitty colleagues
  • no colleagues (major stressor)
  • shitty superiors (minor stressor)
  • really, really shitty superiors (major stressor)
  • really, really creepy superiors (major ALARM BELL)
  • homesick
  • no support system (family, spouses) (major stressor)
  • financial issues
  • health issues
  • realized that you hate working with people
  • realized that you hate healthcare service industry
  • crime
  • oh, salary
  • yeah, about that salary
  • benefits, bonuses compared to private sectors
  • business opportunities
  • being a celebrity
  • (insert your reasons here)

For whatever the reasons that nudge people closer and closer to the edge, please, and I genuinely plead that you respect their decision whether to make the jump or keep hanging on to the cliff. You are crude and arrogant to think just because you can endure it, that means everyone can and shall endure it.

I say this because as much as I think I enjoy where I am now, I still have the burnout and the lows when working from time to time. In fact, I am in a slum right now. The burnout is here and I have to deal with it. Always is and always will be. But even then I still remember very clearly what I felt when I first started working as a houseman. I still remember the dread, the loneliness, the emptiness that dwelt inside me in each waking hours and in every sleepless nightmares that came haunting. 

To emphasize again and again, you wouldn't believe how lonely Medicine can be to some people, oh if only you knew.

Then again, to those of us who are nearing the breaking point - take comfort in knowing that it is okay to have this feeling. I have friends who quit being a houseman, I have friends who regretted quitting housemanship, and I also have friends who quit and happily never look back. I understand the bottled and suppressed emotions that just begged to be released like a vortex into the black void. That feeling that you don't quite know what to do with it and there's no one that you can talk to that truly understand and empathize with you.

And you take it with you everyday. To work and back home, each day feels like a riptide being pulled by the Moon.  Each day feels heavier, there's no way out, and you cried to yourself alone at night. You started to lose hope. You started to lose sight. The future that you envisioned for so long just disappear in the mist of the blackest fog. You can't stand the stare from the onlookers that watched silently as you being roasted daily by the end of the patient's bed. You hate the stares, both venomous and full of pity alike. The coat and its stuffed pockets feel so heavy on your shoulders and your stethoscope around your neck just feel so suffocating. 

And that there's only so much that you can endure, that you can stomach. What happens when you can no longer stand it, can no longer swallow it - what happens when you can literally feel your body shattering into pieces, crumbled and billowed away? Would you want to listen to the endless rant of people who do make it, who triumphed over their demons, and practically prattling about their tips and their too-late advice? Would you?

If you have an ounce of humility in you, at one point or another, you would also experience if not all but a shred of what I once experienced. And if you are a broken soul, as I was and sometimes are, you would learn to recognize it in the eyes of your other colleagues. The same defeated eyes, the hunchbacked postures and the low speech pattern of those who are bearing the brunt and tired of getting the short end of the stick.

Offer a helping hand. Help others as much as you can. Be a good colleague to others. Be a good listener. Share stories and motivate as often as you will. Never be afraid to ask for help. Seek out constructive outlets. Indulge in your wants and desires. Invest in your soul-cleansing. Do not shy to ask for opinions, for a willing ear, or a shoulder to lean on. Never feel guilty for being weak. For being lost. For being less than whole. Never ever feel that you don't deserved to be saved.

I have been writing my experiences since before I started being a doctor and will continue to do so from time to time. Reach out if you want to talk and I will listen.

Sep 3, 2018

A Step Back

To give credit when it's due is what I should do and that is exactly what I am doing right now. Entering ED has given me ample time to think of my current situation and an idea of the path I should take next. While working in ED eliminates that nagging worry I sometimes had when working in wards regarding the progress of the patients under my care, it also gives off a false sense of security.

Work in ED screams hectic and urgency and all that, but it's basically just touch-and-go practice. Assess the situation, stabilize the patient, do basic investigations and initial referrals, then proceed with either observation before discharging or admitting to relevant wards. The clerking is brief with only relevant important positive and negative findings are asked. We expect the worse thus the nets are always cast wider to avoid missing catastrophic emergencies before narrowing it down to a number of workable diagnoses.

Because of the nature of working in ED is like this, it gives you a lulled sense of urgency of what you should be prepared about in the first place. ED is an elective rotation usually given at the fifth or final posting of housemanship. It's the last pit stop before you are burdened with real responsibilities working as a medical officer (MO). If I'm to caught up in the easy flow of coming to work mindlessly day in and day out, I will miss a lot of things.

The deadline for my annual meta life-reflection post is approaching. I tried not to think about it because if I do, I will just get upset and depressed. If I don't think about it, I can see a bit of a glimmer for the future. I would feel that I can do it. The periodic zaps of reminder for me to buckle up may be infrequent, but at least I am aware of it and what I should do. There are still lots of things I want to know thoroughly before I ended my housemanship.

It's time for me to get serious, like serious serious. I have to do this last rotation really properly. I may not get the chance to learn how to perform some of the clinical procedures other housemen did before this but I really want to know how to do it before I leave. This is the number one major concern of mine - I lack clinical skills. I want to know the management of all the cases that come under the sun, or at least the basic principles of them. I want to know how to read ECGs (my worst enemy), x-rays and CT scans better. I want to learn how to present and refer case properly and efficiently. I want to know how to prepare basic medication and memorize their doses (I'm still bad at this). I want to learn to do basic ultrasound scans and more importantly to make sense with what I'm seeing in those scans. I want to be prepared. I want to be ready.

And so I have a lot to thank my ED in this. The bosses are friendly and supportive. There's a lot of opportunities to learn here. So many cases coming through the door that beg me to learn them all. I have to stop procrastinating and kerja goyang kaki like I usually am. I don't mind being scolded (so far I don't meet any of the screaming bosses yet) as long as I get to learn. I hope I can do this. I hope my enthusiasm lasts. In sha Allah all will be well. Ameen.

Aug 28, 2018

Knowing People

Assuming you are not working in airline industry, how much do you know about airports and the people that work there?

This question that I pose arises from my long and deep fascination with people. I don't know when it all started but all I know is that I always like observing people. Back then when I traveled Europe (this was years and years ago – ancient history for me), I spent memorable time watching people (both locals and tourists) as they go along with their day. I would pick a comfortable place to sit, preferably under the shade or in the comfort a cafĂ© provides, and I would just watch, sometimes for hours at people.

It is not like there is so much fun that could be had from watching them. It’s not even exciting. But I can’t help it but to feel fascinated by them all. Even the mundane stuff, like a laborer lifting boxes at a construction site, or a street hawker selling their brightly collection of souvenirs for the tourists, or people walking the length of the Charles bridge, families enjoying their durian at fruit stalls beside the road, couples sitting at the steps of the Spanish Steps, watching people waiting for the London tubes to arrive, kids playing in the calm Kanching creek, or the stoic and silent orange-and-blue guards of the Vatican. There are millions of people, all different and unique and it just somehow seems so fascinating to me.

And what place of all fascinating people that can be found if not in airports? I really, really love airports. I like the serenity of it. The echoed announcements and the out-worldly feelings that you get where people literally come and converge at one place from all over the world. The buzzes of people and the squeaky rolls of baggage on wheels being dragged across the floor. Of the emptiness of it when the clock strikes past midnight and the owl-eyed occupants left are the stranded and the delayed. The waiting of many and the arrival of the missed ones. 

The people that work there – aren’t you ever curious how their lives are? What stories and gossips they are having of the daily ins and outs of the airport? Of secret smoking rooms and hidden pathways. The arrest made by the Customs and the angry arguments sometimes heard at the Gates. I love how inclusive some type of places and their people can be. The Airline industry, the Corporate world, the Bars of Lawyers (no I don’t think they are described like that), the media people, or politicians in senate hearings – called me childish or weird but I have deep fascination with the people I could only imagine what other life could there be and how much different they are to mine.

I only know one life and that is of healthcare setting. I know hospitals, the healthcare personnel and the patients that come to the hospitals and clinics. I am familiar with the diseases and the treatment, the procedures and the interventions, the blood donations and the post-mortems. Working in ED brings out the best sense of inclusiveness in terms of excellent teamwork and good sportsmanship or camaraderie. I like it when the MOs thanked me for my work every time I left work for the day. I feel like I belong, that I matter, that what I do helps, and that is important for me to know and understand. I know the significance of what we do and what public health should strive for. This is my circle.

And I could only imagine what other people from other circles with completely different lives wonder about what my colleagues and I do for a living. Do they know the struggle of working for the benefit of complete strangers? The fear that we have when patients deteriorate or simply that we did missed something crucial? Of the missed trips to the loos or the mirth of joy we had when there’s a feast being held in some pantry? On the other hand, it is how I ache to know about their world. What interesting way of working and the types of stresses they endure? How do they dress? Where do they go before and after work? Do they keep talking about work outside work? Do they bring their work to home? Their pets and the peeves?

The best history for me is always about the people. More so than any old relics or ancient ruins. That’s why the best style of travel to me is to go to where the crowds are the most. Not the parties or concerts. Not the gathering of woke people or the protests in the streets. But good people. Boring people. Ordinary people living extraordinary lives. I am in love with the discipline of the study of human and human behavior for a very long time. Deep down, I am always fascinated with Anthropology. I like History. I like Science too, but oh how I wish I have the opportunity to be immersed and good at both. The way society works, the cultures that nurtured for centuries, of languages being spoken, their myriads of accents and dialects, and how they all are just cousins and siblings to one another.

And lastly, assuming you are curious about people and their lives like I do, about their circles and their values – how far would you go to get to know them all?