the death deal

all of us die. death is the only thing 100% guaranteed for us mortals.
i deal with death and tend to dying patients everyday as part of my job.
paediatric patients.
children. babies. newborns.
it isnt easy.
but as difficult as it is for me, it is more difficult for the parents and families of these children.

the expected "normal" life cycle for us start within our mothers' womb. we are born as somebody's son/daughter, and then we grow and become adults, as our parents grow older and see us becoming parents ourselves, and they get to be grandparents. and when the time comes, our parents die and leave us to continue the cycle.

but when the child dies before the parents, the life cycle gets disrupted. it creates a huge black hole in the parents' lives. there is not even a specific term designated for these parents whose children died before they do. unlike "orphans", "widows" or "widowers".
although life can and will continue on for most of these parents and families, for some of them the major event disrupts their life cycle so significantly that it just goes spiraling down from there.

i dont have children of my own.
i did have 3 pregnancies.
i had a ruptured ectopic last year that almost took my life, and i didnt even know i was pregnant at that time.the closest i had to almost feeling like an expectant mother was for the 2 weeks after finding out i was pregnant before the 2 miscarriages i had, most recently about 6 weeks ago.
even then i was quite emotionally affected, so i can only imagine how it is for the other mothers out there who carried their babies for 9 months, or have already held their babies in their arms, breastfeed them, watch them grow, worry for them, play with them, scold them, love them.. and then to watch their babies & children die.

i see and talk to these mothers and fathers before and after their child's death. and that's how i know how difficult it is. i try my best to help them get though it. there is nothing i can do to bring the children back, but i try and help the parents get back on track. not by making them forget. i actually help them to remember. many dont want to be reminded. it is normal to be sad. but you should hold on to the lovely memories of your child as a way to move on. you can never forget. those who think or say they can, have merely put aside the memories of their dead child in a tightly sealed vault inside their memory bank and sooner or later the vault will explode open, and that's when you get problems.

i'm not just talking about depression, anxiety, anger management issues, alcoholism or substance abuse. these things can happen to any of us who have lost our loved ones, not just parents who lost their children.
but when it comes to parents who have lost a child .. the explosion of the bottled up feelings (that vault i mentioned earlier) can happen when the mother gets pregnant with another child and may cause problems in that pregnancy. or soon after the new baby is born ie post-partum depression/anxiety. it's one thing not being able to stand hearing about other people getting a new baby or even the sights and sounds of other people's children laughing and playing.. but what about their own children. losing one child does not mean you are no longer a parent. many of these parents still have other living children.. neglect, if not actual physical abuse, may occur to their other children, often without the parents realizing it.

even though i have been dealing with death and dying children everyday as part of my job, it doesnt get any easier. it doesnt make me "immune" or "numb" as some people may think ("emie mesti dah tak heran tengok budak2 sakit ye..dah biasa tgk budak2 sakit ye.."). some of these parents initially say to me too " doktor tak paham, doktor apa tau.."
i would be a heartless superhuman if all that was true. or the opposite. a non-human.
in paediatric palliative care, even though we know that there is no more cure for their disease, that their lifespan is now made shorter, that they are dying, and we make sure that the parents understand this, our goal is to try and make these children live as much as they can for the time that they have with us. as my palliative team and i tend to these dying children and their families, we get to know them and become close to them too. and even if it's true, that when the children die, we may not be as badly affected as the parents themselves, there's no denying that we are still affected. for the brief time that we had with them, they became our children. at least that is how i feel. but i know most of the medical staff in my team feel the same. we have debriefing sessions for ourselves from time to time to help us deal with the sadness and emotional pressure. because we also need to remember. we also cant forget.

why i am a 25 year old doctor. or at least look like one. at least to the eyes of my darling patient.

this was a conversation on whatsapp between a patient of mine and a staff nurse on my palliative team. the patient's nickname is "baby" and she is 10 years old with  congenital heart disease. initially when she was referred to us, she was so shy and i had a real hard time getting her to talk to me. her condition was slowly deteriorating, and her mom revealed to me that baby was becoming very moody and was often angry towards her mom and her older sisters. in order to get her to talk to me and gain her trust, i asked baby to come up with any questions that she may have for me. they can be about anything. i promised that i will answer all her questions or will at least try and find the answers for her. when i saw her 2 days later, she had written 6 questions for me, 3 of which were actually about her mood swings and whether they were related to her heart disease. i was happy that i managed to get straight to what had concerned her mother and  me, and i addressed the questions and explained to her the best way i could. according to her mom when we followed up on her recently, baby's mood has been much better at home now, and i'd like to think that our little q&a session helped her with that, even if a bit. 
as for the other 3 questions, well surprisingly, they were all about me.
she asked what my full name is, whether i am married, and my age. when i told her my age, she didnt believe me, stating that i look younger, and i laughed (happily, of course! i know i know.. she's only 10, what does she know about how 40 year-olds are supposed to look like, but hey.. i'm taking it in. or rather-sucking it in. get it? haha). anyway, that was more than a month ago, and at the time it was only she, her mom and myself during that meeting because she was too shy to even let my nurse in. but the nurse continued to visit her everyday while she was in ward, and later even visited her at home after she was discharged, and they have been keeping touch via whatsapp. when i had to go on leave for 2 weeks after my recent miscarriage, we had to postpone her clinic appointment with me, and that's why she asked if i was well too during the whatsapp chat. it's so amazing that even though she herself is unwell (she doesnt even go to to school anymore because she tires easily) she still thinks about my health. here's to you, your health and your happiness, darling baby. God bless you, not just for being so naive and kind for saying i look 25 ;), but for being the sweet strong thoughtful you, as a reminder for the rest of us to love life and always be thankful. 

bali break part 2

i went to bali with 2 of my girlfriends in 2007. (actually i didnt even remember the year exactly until i rechecked my previous blog post about the trip).
i remember during one of the taxi rides we took during the trip, the driver, upon finding out that the 3 of us were single (and although we were already working, a lot of them thought we were students)said that we must come again to bali, and that the next trip be a honeymoon trip with our husbands.
it was a great trip, the 3 of us enjoyed it very much, and i vowed to definitely visit bali again.

8 years later (wow) .. i did.
and i did go with a husband! well, my husband. it's our 3rd year of marriage this year, and i consider any trip i take with him where it's just the 2 of us as our honeymoon (awww..!haha).

so we went there a couple of months ago. it was my second time there and it was hubby's first. interestingly though, aside bali, the only other place i've been to in indonesia is batam, while hubby has been to jakarta, bandung, the riau islands, and even lombok. but he said for some reason he was never intrigued about going to bali. i managed to persuade him finally and off we went.
we took malaysia airlines from jb to kl and then to denpasar.
the flight from kl to bali was quite bumpy as there was a lot of turbulence. i'm usually okay with turbulences other that the motion sickness, but in lieu of the terribly unfortunate plane tragedies that shook all of us last year, we were quite worried.. i think many people were too.

anyway, we arrived safely, ahamdulillah, and were in bali for 5 days and 4 nights. we stayed at the grand inna kuta hotel, right by the kuta beach.
we spent 2 days taking day tour trips to kintamani, celuk (got another silver ring to add to my collection), taman ayun, ubud, bedugul, and tanahlot. we tried out the organic bali coffees at 2 places, wedang sari and tegal sari. we tasted the famous luwak coffee, it tasted okay but not all that great. the one who was really excited was actually my husband and not because of the coffee. luwak or civet coffee is special in that it is made from coffee beans that have been eaten by a "musang" or civet, i think it's a type of wild-cat but i may be wrong. the beans go through the animal's digestive tract but they dont get digested, and so when the civet poops, the beans come out together in its droppings. these beans are then cleaned and roasted and grinded, and you get the luwak coffee.
anyway, so hubby wasnt all that excited about the coffee, but he actually fell in love with the luwak or musang itself.why?
because, for some reason, his nickname back in school was apparently musang! some of his school buddies still call him by that name to this day! but this is the first time he actually came real close face-to-face with the animal, and even got to pet the fella, and he was immediately smitten.
and now he's on a quest to finding one to keep as a pet.
oh dear.

back to the trip. this time around i got to see the barong dance. (i saw kecak dance on the last trip)
makan-wise we didnt have much problem. the fast food places are all halal in indonesia. there are a lot more halal warung and restaurants in kuta now i think, compared to the last time i was there. i actually remembered warung nikmat, the halal restaurant i went to on the last trip and went there again. they have actually expanded now and there is now a budget hotel just behind it. the food is still good.

other than that we were mostly out and about town, doing a lot of walking (20k steps per day accordig to the app on my smartphone!) that by the time we get back to the hotel we were too pooped (again with the word-haha) to do anything else. we planned to but didnt even get to swim in the 2 swimming pools that were at the hotel !
we bought a few souvenirs, t-shirts, fridge magnets, but also since we are both nuts about nuts (we love snacking on them) we bought a few different types of bali nuts (their names escape me now) that were really yummy.

the last 2 days of our trip though, hubby had a toothache. it was an old problem, he had seen a dentist and was advised to have the tooth extracted but he kept on postponing it. i have been bugging him to go and take care of it, but of course, he didnt because the pain wasnt always there. so of course, the pain came back while we were on holiday! in bali! no point nagging anymore. but because of the pain we decided to ditch the plan to try the seafood dinner in Jimbaran as some people had suggested to us, because he couldnt chew very well by then and would not be able to enjoy it anyway.

all in all it was a good trip. the flight back was thankfully smooth, and hubby was actually talking about possibly going there again, yay!
note: he went to the dentist a day after we got home and got the tooth taken care of too. hee.. ;)

happy mother's day

i was in my bereavement clinic this week and was seeing a couple who had lost 2 babies in 2 years.
dad is coping fairly well, better than his wife because he feels that going to work and keeping busy helps.
mom (and dad) agrees that it is more difficult for her to cope because she mostly stays at home and when their other children (they have 3 older ones) are at school she will be alone. and because she is the mother. with the support of the husband, she is taking up sewing and knitting classes just to occupy time. i asked what else can she do at home and she told me "i dont know, not much. i try to watch tv but these few weeks have been especially hard because there are so many shows and ads about mother's day.....".
i immediately agreed with her on that.

tomorrow is mother's day.
today marks the 9th month of mama's passing.
life goes on,, the crying has lessened a bit, but i still dreaded her birthday, the coming ramadhan &  syawal, the date Aug 9th .. because i knew i will be missing her more on these occasions. for some reason i had sorta forgotten about mother's day until i first saw about it on tv a few weeks ago. so i guess you can say i was a bit taken aback, makes me miss her even more and made the tears appear again.
even when she was alive the mother's day shows and ads on tv can make me emotional, but back then i could just call her right away, tell her i miss her, love her.. or if i am in town, celebrate the day with her with our family, a special lunch or dinner.
this year onwards, we can no longer do that.

my sister called me the other day, crying as she heard a mother's day ad on the radio as she was driving (read:stuck in an awful jam) to work.
so it's not just me.. it's difficult for all of us.

the bereavement continues on.
we love you mama. alfatihah.

last year we celebrated mother's day and our dad's bday together. here they were with the 3 grandkids. i almost missed it because i was at a wedding. so glad hubby & me still tried our best and drove all the way to join the dinner. who knew it was the last time we were able to celebrate mother's day with our dearest mama. 

what i wish i could've wished for on my 40th birthday

1.1.2015.
new year's day.
my favourite holiday (not a public holiday in a few states in malaysia, including the one i am working in, buuuuut let's not get into that)
my birthday! (ONE reason why it is my favourite holiday).

i am now 40 years old. yikes!

actually, wow. i am 40. i have reached a milestone. THE milestone.

when i was 10, i probably never even imagined how or what i was going to be at 40. my own parents hadnt even reach 40 at the time. so anyone at 40 was just old.

when i was 20 i probably did imagine myself at 40, wishing that by then, i would become a successful doctor, with my own huge house with its own swimming pool, a really cool car, married with 3 kids. maybe, i dont really remember.

when i was 30, i do remember having a good time, enjoying life, dating, but not seriously thinking about marriage, and still wishing that at least in 10 years time, i would become a specialist, maybe a kid, a loving cat or two at least, a house, a cool car.

then when i turned 35, i decided to celebrate my birthday for the last time. not too confident about becoming or getting all of the above anymore. i stopped wishing for anything. i felt that there was no way i could get all that by the time i become 40, which was just 5 years then down the line. it seemed quite impossible. so i treated a few of my closest girlfriends to a small makan2 at a nice place in KL and told them i was doing this because this was the last time i was actually celebrating my birthday. anything above 35 already appeared depressing.

and i told myself to stop counting. stop thinking about turning 40.

but here i am, 40. yup, just a number. you dont need to be counting, but inevitably, you still age. everyone does. you have to face it.

i am now married. i have a lovely husband. i have 2 stepkids, although i dont get to see them very often because they are not staying with us. no cats yet. i bought a small apartment in KL, there's a pool in the courtyard, but since i am working away from KL, i'm staying at a rented place instead for now. my car is a small one, but it's still cool enough. keyword: affordable.

and yet the one thing i find myself wishing for on my birthday this year was something i never thought i would be wishing for at the "young" age of 40.
for my mama to still be here.
so i could actually talk to her about aging.
so i could whine to her about the growing numbers of grey hairs on my head, and the wrinkles appearing on my face, and how (depressingly) difficult it is to lose weight at this age (blame the low metabolic rate).
so i could make nasi ayam with her for my birthday, because her nasi ayam was the best.
so i could share with her all the corny 4-series jokes and hear her laugh.
and teased her about how she was in labor with me for 2 years (1974-1975, get it? ha-ha)
and most importantly, so i could hug and kiss her, and thank her, for giving birth to me, and loving me the way she had all these years.

if only i could wish that.
but that is obviously impossible.

so all i can do now is send her a prayer everytime i think of her.
which is still very often.