the unique tragedy

I just saw a videothat is part of a video series about death entitled For Those Left Behind, by ustaz Omar Suleiman from the Yaqeen Institute (https://yaqeeninstitute.org/watch/series). This particular episode (https://yaqeeninstitute.org/omar-suleiman/ep-11-losing-a-child-for-those-left-behind) talks specifically about parents losing a child.

Briefly, few points from the video:

1. Losing a child is a unique tragedy. For parents, having to grieve for a dead child is one of the heaviest and greatest trial in life. 

2. All children are pure, and they will definitely enter Jannah. They will also wait for their parents at the gates of Paradise. This is true whether they are children of believers or non -believers, whether they died after having lived for awhile, or miscarried as fetuses.

That is why, it was mentioned in the video, that we do not have to worry for the children that have died, for they are pure, and they are definite dwellers of the Paradise. It is us, the adults that are left behind that need to live on with the pain. And if we were to do it right, the way Allah intend us too, we will meet our dead children in Paradise as well.

3. The prophet himself, Muhammad (pbuh) lost 6 of his 7 children! And still, he himself cried, despite knowing about Allah's promise of what happens to these children in the hereafter, despite him already being able to see and smell Paradise with Allah's will. 

It is okay therefore, to be sad, to cry, to grieve. It is okay to acknowledge this great pain, as long as we accept the loss humbly and be thankful always to the Almighty for it. Allah has promised us the rewards - protection from the hellfire, and chance of seeing the children again in Paradise. We just need to make sure we continue to strive for it, insyaAllah.

 Subhanallah!

beauty and the bitches

Real life conversations that I've too frequently encountered, different versions and actual details, but  never failing in leaving me appalled & dismayed at the similar responses/comments.

Makcik: Kawan kau tu dah kawen ke belum?
Me: Belum, single lagi.
Makcik: Laa..apasal belum kawen. Lawa je budak nya acik tengok.

HO: This baby's mother is young, only 18yo. And this is her 2nd child.
Pakar: Is she married? How old is her other child?! How is she coping? Did anybody talk to her?
Matron: Yes. She came in the other day. She's really pretty, doctor. No wonder she was married really young.

MO: This baby is the 1st child for the mom's current union. She already has 6 other children from 4 different partners.
Pakar: Says here she's unemployed. Are all her children with her? How is she caring for all 7 children? Has anybody spoken her?
Sister: Yes doctor. She's a real player, this one. She's not even that pretty!

Colleague: Where were you? We called you few times to see if you could join us for lunch.
Me: I was seeing a case in Gynae ward, a 14 yo girl presented to ED with abdominal pains, just found out she's actually pregnant. Worst, she was raped by her own brother!
Colleague: Gosh, poor girl!! Is she pretty?

You see where I'm going with this?

If a woman got married young/early, most likely it is because of her looks.
If a woman has multiple partners, or is a "player", it must be because of her looks too, because we totally can't understand it if it's otherwise!
And the poor girl/woman who was raped, it was probably because the man who did it couldn't resist her looks!

Disgusting when I put it that way, right?
If asked again, why do you ask that (on whether she is pretty)?
The answer is often "Oh am just curious."
But that's not really what we're implying.
That's what our society is teaching our children.
That looks matter.

When I say society, for this matter, I'm sorry to say, it's mostly us, women.
The witches and bitches.
Suka sungguh gosip.
It's really not healthy ladies.
Can we change?
Will we change?

discharge please

"Tak boleh discaj ke doktor? Doktor saja je kan nak tahan anak saya lama2 kat wad ni,"
"Cucuk sana cucuk sini. Doktor nak buat anak saya bahan ujikaji/eksperimen ke?"

These are comments that my colleagues and I are quite familiar with receiving.
My short and immediate response?

"Tak."

Honestly, as a paediatrician working in a busy government hospital, I definitely do NOT want my ward to be full with patients. I prefer to have zero admissions. If patients do need to be admitted, I will try my best to make sure that they don't have to stay more than they have to. In paediatrics, patients are babies, infants, toddlers, children. So lagi la orang kata "Kasihaaann. Budak kecik."
So yes, the less veins we need to prick, the less pain we need to inflict, the better.
Believe me, even though pricking patients for blood or IV cannulation will help junior doctors to master this skill, no house or medical officer ever groans at me when I tell them "no need to take blood" or "no need to insert IV line". Lagi diorang happy adala.
For us, the less work the better.

So why do we still admit patients to the ward? Why do we keep some of them longer in the ward compared to others? Why do we send multiple investigations, not just blood, but also, urine, stools, sputum and even the often "feared" spinal fluid sometimes?

Well, why are the children brought to the clinic/hospital in the first place?

Children don't bring themselves to the clinic/hospital.
I do not go to your house or look around town for ill children to take with me to hospital.
YOU bring them, you the parents and caregivers.
Because you are worried that something is not right with them. They may be sick. Ill. Unwell. Not their usual self. Have a toy stuck up their nose. Breathing funny. Whatever.
If they are okay, we reassure you and send you home. If they are unwell, but we think you can just treat them at home, we send you home. But if we think otherwise, we ask to admit the child.

Various reasons.
The child is too ill.
We don't know what's going on so we need to investigate.
We think we know a little bit but we need to make sure.
We do know what's going on, but the treatment needs to be given in the ward/hospital, not at home.

Why do we keep them long in the ward?
Various reasons as well.
The child is too ill.
The treatment needs to be given a long time.
The treatment is not working. We need to try another way/treatment.
We still do not know what's going on.

Definitely NOT because we like or saja-saja.
We may "try" different treatments, especially if one is not working, but we're definitely NOT doing "experiments" or treating your child as a lab rat. We may not have all the answers but we can't and won't just give up that easily.

In the end, we want the same things as you. For your child to get better, so we can discharge you.
Less patients in the ward/clinic, means less work for us.
We do like having less work.
Don't take it personally.
We assume when there is less work for us, there are also less sick children out there. And that's always good.

Ah. But there are people that say to me "But that's how you make money whaaat."

Again, I reiterate, I work in a government hospital.
Ada patient ka, tak ada patient ka, gaji aku sama whaaaaat.

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.

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.

Dear you, it's me

Dear God, it's me.
Dear me, it's you.

Dear love, hug me.
Dear evil, go away.
Dear anger, don't slay.
Dear sabr, do stay.
Dear madness, don't be weird.
Dear joy, come play.
Dear grief, don't overwhelm.
Dear sadness, don't cry.
Dear happiness, be content.
Dear trust, don't lie.
Dear insof, don't abandon me.
Dear will, don't give up.
Dear doubts, don't bother me.
Dear riches, don't beg.
Dear time, thank you.
Dear past, no regrets.
Dear present, let me learn.
Dear future, may you be bright.
Dear life, be kind, will you?
Dear death, be gentle too.

Dear you, it's me.
Dear me, I love you.
                       

why i still haven't quit my job

i find work to be increasingly stressful and tiring recently. it isn't anything more than the ordinary of course, working as a doctor in a government hospital, it's all part of the job. but there are times when you feel really tired, both physically and mentally, to a point that, for me, i start to think about the possibility of quitting. this also isn't surprising or new, you can talk to any doctor, almost all if not everyone of us have thought of quitting more than once in our medical career. the worst for me was probably when i was doing my masters program. the pressure to perform well, pass your exams, finish your thesis, all while still providing service to the patients in the hospital and being oncall, at the same time trying to balance your personal needs and the needs of your family, was more than enough for you to think of quitting at a daily basis! it's definitely not as bad now, but from time to time, the feeling does creep up again.
so i decided to take a day off today just to unwind and "recharge" myself. i went to the bank, did a bit of groceries and some shopping and then went back home, cooked a bit and then started reading a new book-iban journey by golda mowe. by the way, i went to the bookstore just now only to buy a pen and a whatchamacallit the whiteout-liquid-paper-correction thingy, but of course i cant help from browsing the book section too, so i ended up paying about rm100 for 3 books, 3 pens and whatchamacallit the whiteout-liquid-paper-correction thingy,  . sigh. i really should have bought the pen at the grocery store.
anyway, suddenly there was a whatsapp message from the sister in my palliative care team, sharing with me a message she received from a patient of ours today. just yesterday, the patient came to the hospital for her cardiology clinic follow-up and went looking for me in the ward. she wanted to show me the tablet she got from the children's wish society (cws). she was referred to our team about one and a half year ago, because she has a congenital heart condition that is now worsening and is limiting her daily activities and eventually her lifespan too. she is a very shy and quiet girl and it took me quite an effort to get her to warm up to us, and some coaxing to get her to tell me if there was anything that she wished to have. in the end she wrote me a 2-lined letter stating that she would like a tablet.

so i referred her to the cws team who then got her the tablet she wished for just about a month ago. and so she came to the ward yesterday to show it to me, and then asked to take a photo together. and so we did, i chatted with her a bit and that was it.
who knew, after that she sent a message to the sister, sharing the photo that was taken, and inviting us to visit her at home for raya. but what blew me away was that she also said that she misses me and that she loves me like her own mother!

so what am i supposed to do, (other than cried like a baby) after reading that?

well i cant quit my job yet, that's for sure!

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.

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.

mama

last entry here was more than a year ago. looks like this is becoming an annual thing only now for me. sadly.
i blame FB and IG. maybe updating my status there, although not really very often, was often enough that i didnt feel like i needed to blog anymore.
until now.

16th Sept is Malaysia Day.
it is also my mama's birthday. it would've been her 64th this year.
but instead it will mark the 39th day of her passing.
how i miss her.
how we all miss her.

she has been battling a recurrence of her breast cancer, which, just about 6 weeks before her passing, we found out had already metastasized to her lungs and bones. when she got bilateral pleural effusion (fluid in her lungs) and was admitted to the hospital during ramadhan, i feared that that was it. that she might not make it to raya.
but she did. she was discharged from hospital after 10 days of being admitted there, just a few days before raya. i was fortunate to get a whole week off for raya this year, and even though it is supposed to be muar this year for me and hubby (his hometown), his mom and him decided that we spend raya at my parents' in KL first instead. both of us were glad we did. it was a very meaningful  raya for us. it was the 1st time all 3 of us siblings were around to raya in KL with our parents.
it was also the last raya we'll ever celebrate with our beloved mama.
she passed away on 13th Syawal, the 9th of August.

i thought i was ready.
i stayed with her in the hospital the night before she passed, kissing her face, her hands, stroke her hair, recited verses from the holy Quran for her as she became more unconscious.
in between that i even googled about the muslim preparations for  burial, the washing, the shrouding.
but no matter how ready i thought i was.. i was so shaken and couldnt stop my tears when we were told she was really gone.
having been familiar with the hospital and the things needed done after a patient dies in the ward, and also being the eldest, i imagined that i would be the one taking charge of things. calling people to inform, getting all the documents settled, etc etc etc.
but no.
my dad and my siblings took care of all that.
hubby had to pull me aside.. away from everyone, into a deserted area in the ward, where all i could do was sob uncontrollably in his arms.

mama was not only my mother. she was my best friend for 39 years.
we were apart for quite awhile when i was growing up. i went to boarding school at 13, and before i completed secondary school, she went overseas to work, with my dad and my younger brother. for 13 years after that we never get to spend raya together, and only saw each other at about once a year. but however faraway we were from each other, i always felt that we still remained close.
i could tell her anything. and i did. and i really miss that. just talking to her about things.
i could hangout with her. i like hanging out with friends of course, but i loved going out with her too. after she retired and was back in malaysia for good, even going to the pasar malam near our house in KL was something i would really look forward to. it's on once a week at midweek, so being away from KL, i dont get to go very often, and when i did, it was always with her (and also that's where i did most of my tudung shopping- and she was the best shopping partner ever).
we both love cooking shows, and she knew almost all the chefs on the food network channel. she had a couple of favourites, and she talked about them like they were her friends. ("oh Ina said we should cook it this way not this way.."she would claim. and we'll be like "Aina who-?", and she'll be like "alah..I-na.. Ina Garten kat food network tu..').
watching food network will never be the same again.

God, i miss her. i miss her laughter (wide smile showing her teeth, not much sound, but very often she laughed with tears in her eyes).

God, i really feel like i havent spent enough time in this world with her yet. but i know. that however much i love her, God loves her more.
and that makes me feel a bit better. that God, the ever merciful, the ever generous, had lent her to us in this world. so we could love her, and always feel loved by her. this great woman. our supermama.
and now i continue to pray for her. that she is happy and safe where she is now. and hope i will get to see her again in the gardens of Jannah.
ameen.

                                                    i love u mama.
                                                    al-Fatihah.

There's an obese kid in the room...cant u see??

Oncall again. Another resuscitation. Despite all we did, another child dead.

 This is the one thing about my job that I hate the most. But most times, I am able to deal with it, and tell myself that we had tried our best. I know as well that my colleagues and I have to often remind ourselves and each other, that no matter how bad we want to, we cant save everyone. I usually am most aggrieved when the child that died had been a relatively "well" child, no known illness, pretty much a normal kid. But in this case, although the family claims their child had been "normal & healthy" prior to getting this bout of infection few days ago, I really have to disagree.

One look at the patient you can tell that he has a serious medical condition. It was so obvious. But probably the family never saw it as a medical problem. I'm sure most of the people who knew him and had seen him (or other children like him) didn’t think so either.

The patient was 5 years old. He weighed more than 40kg.

He was morbidly obese! So much so that we couldn’t see his neck, and when he collapsed, the doctors in the ward knew right away that they would have difficulty intubating him but fortunately they manage to get the anaesth in to help.

But all was not well. His heart stopped 3 more times after that, and we couldn’t revive him anymore after the 3rd round. He died less than 12 hours after he was admitted.

It was so sad to see the doctors huffing & puffing doing CPR on a 5-year old kid! They should have been able to do the chest compressions using only one hand! But because of his big size, they still had to climb on the bed and do the compressions with both hands. And because his weight was waaay off the chart for his weight, his meds were given based on the ideal weight for his height, which was not as accurate as compared to giving meds to a kid with proper normal weight.

He had an infection yes, but his heart was actually already hypertrophied, and that's most probably why he succumbed quite fast. His heart was already in trouble no thanks to his obesity, and all the infection did was tip it off the edge.

Like I said, I know that many people do not see obesity in children as a serious medical problem, just like it is in adult  (and even that is only recently recognized and accepted by the public), because when I do see an obese child and pass the comment to the parents, the reaction I usually get from the parents (who would have brought the child in for another complaint usually eg. Fever/cough/runny nose/etc) would range from -- "Eh tak baiklah doktor ni cakap anak saya gemuk" or "ha-ah la doktor, tapi dia ok, main semuanya ok, takde apa2".

So in this case, although I am still aggrieved that we couldn’t save him, I cant help but feel that the adults are still to be blamed for letting him get as fat as he is. People need to recognize that obesity is a SERIOUS problem in children as well as adults, and that chubby fat kids do not equal cuteness, and do not especially portray healthiness (observe that many people will say "wahhh…sihatnye anak awak ni" instead of "wahh..obes-nye anak awak ni"). I understand that we dont want to hurt their feelings, we wanna be sensitive, which is fine, dont say it to the parents' face in public, or dont say it in front of the kid, but dont mask or hide the problem by implying that it's ok to be fat, the kid is still really cute. (in my defence, when I do make the comment above, that a kid looks obese, it is honestly out of concern for the kid, not passing judgement to the parents..but ok, I get it, people are sensitive... I should be more sensitive too..).

And when I say people, I do mean EVERYONE of us, including doctors and medical staff, because I know for a fact that there are doctors who prescribe vitamin supplements, and other supplements like omega-3-fish oil and colostrum to kids with cough and cold, in addition to the usual meds. It's one thing if it's for a skinny kid or even a normal kid with perhaps poor appetite, but if it’s a real chubby obese kid sitting in front of you in the clinic, you should findout why he/she is so, and then try and get them to lose the weight instead of supplying them with more multivitamins, colostrum and fish oil! (if it's simple obesity of course.. Other diagnoses need to be ruled out as a cause for the obesity ie metabolic syndrome etc whereby you would then need to refer them to the experts, but reducing weight still plays a huge part in the treatment).

Anyway, I'm definitely not an expert, but I do believe that we need to be able to identify that there is a problem first before we can actually try and solve it.

Kids, eat healthy, play more!
Parents, get ur kids to eat healthy and play more!!

my current life soundtrack

I can almost see it
That dream I am dreaming
But there's a voice inside my head saying
"You'll never reach it"

Every step I'm taking
Every move I make feels
Lost with no direction
My faith is shaking

But I gotta keep trying
Gotta keep my head held high

There's always gonna be another mountain
I'm always gonna wanna make it move
Always gonna be an uphill battle
Sometimes I'm gonna have to lose

Ain't about how fast I get there
Ain't about what's waiting on the other side
It's the climb

The struggles I'm facing
The chances I'm taking
Sometimes might knock me down
But no, I'm not breaking

I may not know it
But these are the moments that
I'm gonna remember most, yeah
Just gotta keep going

And I, I got to be strong
Just keep pushing on

Keep on moving, keep climbing
Keep the faith, baby
It's all about, it's all about the climb
Keep the faith, keep your faith, whoa

....................................................................................................................


Not a fan of miley cyrus, but this song fits with what's going on with my life right now.
sigh.
so i'm just gonna have to go at it again in 6 months time.
sigh again.
hopefully this "failing pattern" of mine stops then. once and for all.
God help me.

melancholic merapu

seeing things i shouldnt be seeing.

hearing things i shoudnt be hearing.

saying things i shouldnt be saying.

infuriating.

annoying.

frustrating.

disappointing.

depressing.

feeling like i shouldnt have these feelings.

hating for hating.

hating for loving.

loving to loving.

infuriating.

frustrating.

disappointing.

depressing.

dreaming, dreaming, and dreaming.

wanting.

why even bother wishing.

is it worth, the praying?

knowing that i shouldnt have these feelings.

drowning.

in desperation.

in own stupidity.

"to cure sometimes, relieve often, comfort always"

yesterday i saw this early morning show on tv called "tanyalah ustaz".

the topic was "jin & alam ghaib".

interesting, and something i have not much knowledge about, so i sat down to watch while taking my breakfast before leaving for my oncall.

at one point the ustaz was telling the viewers to always consider alternative medicine, in this case, perubatan islam- whenever we fall sick , and especially when doctors/modern medicine are unable to find the cause or definite diagnosis for the medical problem.

but then he also went ahead and made a statement which totally shocked me, that i almost choked on my karipap sardin!

he actually went on to advise viewers "bila2 doktor tak dapat cari punca atau diagnosis untuk sesuatu penyakit itu, mereka mesti nak mintak satu- ambil sum-sum tulang. tuan2 dan puan2.. kalau boleh, cubalah elakkan dpd perkara ini.. ambil sum-sum tulang ini adalah amat bahaya.. boleh menyebabkan lumpuh. jika doktor mintak ambil, cubalah dulu cara lain. ingat ye!"

!!!!

manalah i tak almost had to heimlich manouver myself!

no wonder lah selalu susah nak dapat consent for bone marrow and lumbar puncture!

the public has already been misinformed enough about how doing a lumbar puncture and taking cerebrospinal fluid (CSF) or air tulang belakang can paralyse people, now he is saying ambil bone marrow or sumsum tulang will also cause the same. both are totally different things, located at different anatomic sites, and the procedures done to obtain them are also different.

sigh..i'm not here to talk about how we do lumbar punctures or bone marrow aspirates, we do it multiple times on a daily basis at the hospital, especially in the oncology wards, and since malaysia still require us to take consent for these procedures, "berbuih mulut" to have to inform patients and parents about them already.

the ustaz no doubt is probably well educated in his own field, but i dont think he should make such bold statements about medical procedures before getting the facts right.

whenever patients at the hospital express their wish to try other means, be it "islamic", bomoh, chinese, homeopathy, etc.. we never say "no", as long as they can still continue their treatments or follow-up with us, and the alternative medicine doesnt interfere with ours. and i know for a fact that whenever most of us do something, or about to carry out a procedure, we always pray that everything goes well... no matter what religion/belief we have, or who it is we were praying to, we know that we are merely humans, bound to make mistakes, and the last thing we wanna do is harm a patient, and so we pray to higher powers to help us.

o well, i'm probably digressing now a bit at least, i'm sure.. but i've mentioned this over and over again, reminding myself, my colleagues, the staff, and especially the really junior doctors out there (although i still consider myself junior as well) that we should always treat a patient just as how we would treat someone dear to us, or just as how we ourselves would like to be treated, should we become patients ourselves.

to quote a few points from the oath:

"I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help."

to quit or not to quit.

oh crap.
i'm having those feelings again.
nak quit nak quit nak quit.
warrrrrrrrrrrrrgh. benci.

to be or not to be..........

i just realized that i only get about4-5 days off in a month now.
i leave for work at 7am, and most of the time reach back home at 7pm.
in between that i've to be oncall.

i've been told that i've lost a bit of weight.
i'm losing much more hair.
my skin's getting worse.

2 months ago i was really depressed and was real close to quitting masters. to my horror and surprise, i no longer had the passion to do paeds anymore...and that made me real sad.
but after much praying and soul searching (if i could call it that)and actually looking at other jobs/options in medicine, i decided to stay..for now. i've to admit that i still like paeds, but i'm not sure if i have the passion for it anymore.
i still have that feeling (of quitting) from time to time, but it's not as strong as it used to be. i can honestly say right now that if i was actually sitting for the exams right now and failed.. i would totally be okay with it..
so *sigh* we'll see.
i'm taking it a day at a time.

a new chapter begins..

yeah..so it's been awhile.
i sat for my exams (yet again!) in early may. i left it to God. if i pass, great. if i dont, then i'm still a doctor, and can just continue giving my services to the public... either be a service (chronic) medical officer in paeds, or join the peripheral health clinics. a friend suggested that i quit the ministry and open up my own clinic. kinda scary, but perhaps do-able.
my brother suggested that i adopt a child if i dont make it through the exam. he said maybe it's time i concentrate on something (or someone) else other than sitting for exams.
um, o-kay. that's even more scary!

so... thank God i passed!!*phew*

which means that i would have to leave melaka. this would have been my 8th year of staying there...so far the 2nd longest time i ever lived in a place. (i spent the 1st 12 years of my life in kl, then moved about 3 boarding schools in melaka, taiping & seremban for 7 years, then spent 6 years in canada). it was a mixture of emotions leavingmelaka.. there were a lot of memories built there, and i'll definitely miss it.

so here i am back in kl, transferred to a university hospital, and back staying with my parents. the last time i actually stayed with them fulltime was back when i was 12. then i went to boarding school for 7 years, while they went overseas to work, till my mom retired about 3 yrs ago and came back to msia.
intially, i had mixed feelings about staying with them, how ever much i love my parents, and happy to have them near me, the thought of living with them together in the same house fulltime was a bit.. i dunno.. ?invading.. ?kiddy-ish ..?scary.. ?less private..
so far, a week has passed, and working at the university hospital is just soooooooooo much more different than working at a ministry hospital. it's much more demanding, exhausting, depressing, confusing at times, and really degrading to me.. to see us doctors getting yelled at by the professors, snuffed at by the nurses, the horror stories of a few dcotors who got knocked on the head (literally).. i mean, even school kids are not being treated like that anymore!
so i know, that in order to get through it all, and survive the next 3 years there, is to actually swallow my pride, ditch any ego that i may have, bring down my self-esteem to a bare minimum, learn my lessons, pass the exams, and then get the hell-outa-there.
so having gone through a dreadful week so far at work, i'm gonna just bite my tongue and say that the fact that i actually get to come home after work, to the old house that i grew up in, with mommy dearest there to greet me (and home-cooked food ready for dinner :)) made me really glad and appreciate the fact that at least i'm home with my family, and thank God that i get that privelage.

best wishes, me!
gambate!

a silent outburst

the dreaded day came.
results were out friday.
only 2 people from my university passed.
i wasnt one of them.

i was nervous the whole night before that friday.
i was praying hard that i pass this time.
please dont let me fail again.
i dont know if i can handle another failure.

i thought i could pass you know.
i felt the difference this time around. the exam was still difficult, i didnt think i did too well on the 2nd day, but coming out of the exam hall on the 3rd (last) day, i actually felt a tiny glimmer of hope that maybe this time i can pass.
so when they told me i failed, this time i was shocked.
then disappointed.
and sad.
and i felt really stupid.
how could i have even thought i could pass?
i bawled like a big stupid baby driving home from work.

of course, i hate crying in front of people, so when i reached home, i still didnt feel like talking to anybody, went up to my room, locked the door, cried some more, cried in the shower, cried while praying, and then cried some more. a few people actually called me during this time (to ask me about different things, unrelated to the results), and i was surprised i could answer all the calls without a choke or croak in my voice (i probably sounded nasal, but that's how i sound normally anyway i think).

anyway, so i was initially planning to just sulk in my room the whole night but after about 2 hrs of crying, i got bored and actually felt dehydrated! so i decided to go out with a bunch of people for dinner. these are people i dont normally hangout with, and i'm not sure if they knew about my results, and lucky me, my eyes dont puff up even after all that intense crying, and so there was nothing physically evident outside that could tell them that inside, i was actually in a pretty devastated state. but i was glad i went out with them.. they were such a fun bunch, and i had such a good time that i actually forgot about the damn exam results.
by the time i got home, my housemates were in, probably all concerned about me, and because i was feeling much better, i was finally able to talk to them openly about how i felt..at least without anymore tears.

however the next morning when i wokeup, all the sadness and disappointment came back to haunt me, and the fact that i was oncall didnt help at all. all i could do was cry a little bit more, and pray that my call would be okay (thank God it was). in a way it was good that i had to work, cuz i could somehow distract my mind and thoughts to the sick babies i had to care for.

this morning post-call, i went for a facial, slept through the rest of the afternoon, still cried a bit, but just a bit ;) but am a lot better.
the past is done.
i need to work on the future.
i wanna figure out what my next steps should be.
this is my 6th time overall of sitting for these stupidsh*t exams!
that's more than enough to make me feel like a stupid sh*t!
right after i got the results, (i was in clinic, so i didnt want to talk to anyone about it face-to-face, afraid that my pipeworks will burst out in public and humiliate me to death!) i texted a friend who's also been unlucky in the exams department like me, and he simply said "this is it for me. i'm done with this. i'm leaving."
no doubt i'm feeling the same too. i wanna up and leave too.
but where would i go?
what's my excuse?
what are my plans?
i dont have kids to look after. i dont have a hubby that i need to worry about.
i have a turtle, but he's super low-maintenance ;)
i love my work actually (though i dont normally admit it).
i just hate these exams.
so maybe i'm not cutout to become a specialist, so what?
i'd end up a chronic m.o., or i could just leave the govt sector and be a doctor elsewhere. do locum. enjoy an exam-free life.
people would talk about me, make judgements, but i dont really care.
(anyway, digressing a bit here..i've heard of people who go to great lengths to hide the true facts about their results...sheesh..all that trouble just because you fear people looking down at you?
i came across this saying the other day in a book i'm reading "if you go through life wanting everyone to love you and no one hating you, you'll never have a happy life".
so there.)
back to me-the only other things is..i've been working with kids for like 6 years now (!)..so i dont think i can "do" adult medicine anymore. not without re-learning everything again.
and i hate these stupidsh*t exams that make me feel like a stupidsh*t. i already mentioned that.
so should i just stay on as chronic m.o. in paeds? i already mentioned that too.
will they let me?
is that what i want?
sigh.

as you can see, i still cant decide what to do next..

freakin' out

holy guacamoly!
the exam's less than a month away.
i might fail..again.
i'm trying to convince myself that it's not the end of the world if i do.
argh.
why did i put myself through this?
why?
why?
*curses*