Sunday, July 29, 2018

it's okay to cry

In practicing medicine, doctors generally cringe at the term "breaking bad news". Bad news in medicine can either be finding out that you have an incurable disease, or that you can never have children of your own, or that you will never walk again, or that you or your loved one is dying, or finally, that your loved one is already dead.

Back when I just started in medicine, and was a jovial, enthusiastic young woman who was proud to be a doctor albeit totally naive of what was expected to come, I used to believe that it is not okay for a medical staff, especially a doctor, to cry in front of a family or a patient when you are breaking the bad news to them (or "informing DIL" as what is commonly used in Malaysian hospitals today).
I felt that it is okay to show a sad face, but not to the point of tearing up or crying. I felt that crying in front of them made me appear unprofessional, that instead of showing sympathy/empathy, I would be showing too much emotion, and probably a sign of weakness too. I was even proud to be able to do all of my "inform DIL" orders without shedding a tear all all through my housemanship and into the early years of being an MO. Until one day, and I remember this vividly, I was an MO in charge of NICU, and we had this one particular baby girl that died.
The baby had been critical for many days from a severe infection, and we already had to actively resuscitate and perform CPR on her multiple times.  I had repeatedly explained to the parents that their baby was really ill and that the next time we have to do a CPR again, we might not be able to revive her anymore, and that she might die at anytime; standard "informing DIL" stuff.
Every time I told them the news, the mother would sob and cry.
The father would repeatedly mutter "Yelah, baiklah doktor," hands on his wife's shoulders, his own eyes red.
The nurse sometimes too can be seen wiping off her tears as she stood behind the parents.
And I would stand there and look at them, pausing my explanation for a moment of respectful silence, solemn look on my face, eyes dry, and in my head thinking "ok don't you dare cry too emie. ok how long is this gonna take, I have other babies to see". For me, in order to dissociate myself from the atmosphere of engulfing sadness and tears, I turned the baby into another job task, just a checklist on my long list of work to-do list.
On the day that the baby finally died, the parents have not reached the hospital and by the time they arrived, we had pronounced the death and I was already writing up all the necessary paperwork. So I went to see the mother as she stood by her baby's body and was ready to explain to her what happened; how she had continued to deteriorate and how we tried to resuscitate her. Again, standard stuff, when the mother turned to me and actually smiled. I was a bit puzzled seeing her smile at that moment so all I ended up saying was "Takziah ye mak" (I'm sorry) and she nodded and actually said "Thank you doctor."
Before I could say anything else, she said "Saya nampak setiap hari, pagi petang siang malam, bagaimana doktor dan nurse menjaga anak saya dan anak2 orang lain dalam icu ni. Saya tahu doktor dan nurse2 semua bekerja keras untuk cuba pastikan anak saya dapat baik dan hidup lebih lama. . Tapi Tuhan lebih sayangkan dia. Saya harap doktor dan nurse2 semua jangan putus asa ye. Dan jangan sedih. Saya amat2 menghargai segala apa yang doktor dah cuba buat untuk anak saya ni. Saya redha dia pergi."
(I know how hard you and the nurses work all day and night to help by child and the other children in this icu. I know how all of you have tried to keep my child alive, but God loves her more. Please don't be discouraged and don' be sad. I am truly grateful for all that you have done for my baby. I accept her death.)
And for the first time ever in my medical career, I let my tears roll down my cheeks right there in front of the mother. I couldn't stop them even if I wanted to. And I didn't dare open my mouth to say anything for fear that all that would come out are loud ugly sobs.
It was like a huge slap on my face. I was not sad at the time but the mother thought I was. Because I could be sad, and perhaps should be too. Because of her unexpected gratitude and encouragement, in the wake of her baby's death, I was woken up instead. That in being a doctor, it wasn't JUST work that I'm doing, that it wasn't JUST a job. A patient is a human being. A patient is somebody's mother/father/daughter/son/sibling/spouse/friend. He/She is somebody's loved one. Even if you don't know the family or the friends or the loved ones. A patient who has been under your care, whom you have looked after, whom you have tried to treat, who was your responsibility, of course you can be sad too if they die. You don't need any permission.You don't have to suppress your sadness. You can definitely cry if you want to. You don't have to of course, but it's okay if you do. (Hopefully not to the point of the patient's family having to console you instead of you them, but you get what I mean.) There's no need to be ashamed.
Because doctors are humans too. And we all need to remember that.





Saturday, July 21, 2018

kesah seorang boss

Alkesah, ada seorang boss.

Di suatu pagi di hujung minggu, di kala boss sedang bercuti, boss terima khabar ada timbul masalah di tempat kerja. Masalah itu bukan masalah baru, kadang2 memang boleh berlaku. Tetapi selain dari itu, boss diberitahu ada juga masalah kedua yang telah timbul, yang berpunca akibat dari kecuaian anak2 buah boss.
Boss naik angin lah.
Boss mulalah membebel. "Aku dah cakap kat diorang ni berkali2, jangan buat begitu, jangan buat begini. Budak2 ni degil juga. Tak mahu dengar cakap aku. Tak percaya cakap aku. Sekarang dah jadi macam ni. Aku jugak kena pergi selesaikan."
Suami boss yang mendengar di rumah itu mengangguk2 saja melihat boss bersiap2.
"Awak bersiap ni nak ke tempat kerjakah?"
"Yelah, saya nak basuh diorang cukup2!" dengus boss penuh marah.


Selesai bersiap, boss seperti biasa mencium tangan suaminya sebelum keluar. Kemudian dia singgah di bilik mak mertuanya yang kebetulan datang melawat dari kampung. Niat nak beritahu mak, dia terpaksa keluar bekerja pula.
Boss selalu mengingatkan suaminya, orang boleh kata suami itu "boss" kepada isteri, (atau isteri itu boss kepada suami - sukahatilah) tetapi mak tetap big boss kepada kedua2nya.

Tiba di bilik, dilihatnya mak sedang bersolat. Masa itu pukul 10 pagi.
Mula2 boss pelik, tapi terus teringat. Oh, mak solat dhuha.
Tiba2 boss insaf.
Baik boss ambil wudhu dan solat dhuha dulu. Sudahlah pada waktu hari2 bekerja boss memang jarang dapat solat dhuha.

Selepas solat, hati boss automatik tenang.
Boss tukar niat. Baik dia pergi kerja untuk cuba selesaikan masalah yang timbul itu dulu. Kemudian baru dia akan tegur dan tangani isu kecuaian anak buahnya itu. Boss tanam azam akan cuba tangani dengan berhemah dan profesional, tapi tetap tegas. Marah2 sahaja tak ada gunanya. Jiwa boss juga yang bertambah stress.

Boss bersyukur sebelum keluar bekerja dia sempat diingatkan bahawa walaupun dia seorang boss, ada yang lagi boss dari boss2 dan big boss.
Dialah the Almighty Boss, dan kepadaNya lah kita berharap, kepadaNya lah kita berserah.



Tuesday, July 10, 2018

tak menjawab soalan (based on real-life events part 2)

More ward round scenarios.

Scene 1
HO    : This baby is the one with the hypokalemia.
Pakar : What is the latest serum potassium level?
HO    : Err.. (flips the pages of the patient's file)..there is a half gram potassium in the drip, Doctor.
Pakar :  ?? (What'd I ask?)

Scene 2
Pakar  : (on the phone) Hello, can you tell me how many empty beds we have in the ward today?
HO      : Hello Doctor, yes lemme see..err..there are 26 patients right now in the ward, Doctor.
Pakar   : ?? (What'd I ask?)

Scene 3
Pakar   : How old is the baby today?
HO       : Err...He was born on 23rd Feb, Doctor.
Pakar    : ?? (What'd I ask?)



gosh i'm old..and fat..and old(based on real-life events part 1)

Okay, I've posted these scenarios before in facebook in a visual comic formal.
Just reposting them here mainly to keep this blog "alive", but also to practice translating them into writing.
HO = house officer/junior doctor
Pakar = specialist (in these scenarios all me)

Scene 1
HO                             : Mother is geriatric, this is her 10th baby..
Pakar                         :Geriatric?? How old is the mother?
HO (who is 25yo)     : 40yo, Doctor
Pakar (43yo, no kids): *cry*

Scene 2
HO    : Mother is obese..
Pakar: Obese? How big is the mother??
HO    : Well she's about your size, Doctor.
Pakar : *%^&**$#!*

Scene 3
HO   : We sent FBC, LFT, RFT, CRP, ABF, IEM, TORCHs, xray, urine..
Pakar: So many investigations!! Who ordered them?!
HO   : You did, Doctor.
Pakar: Oh, did I? *blush*