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.

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*

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.
                       

this is emie. she's a doctor.

there are different ways we get introduced to people.

it almost always start with your name, followed by maybe a little bit more information about you.

like, this is emie. she was my friend in college.

or she was my neighbour.

or she works in JB now.

or she's so and so's daughter/sister/cousin etc.

you get the picture.

a small polite conversation then usually follows this introduction.

but what happens after you get introduced to people and they mention your occupation instead?

like, this is emie, she's a doctor.

well, when you get introduced as a doctor, most times you get these raised, often questionable eyebrows first as a response.

at least i do. as if to say, really? she doesnt look like a doctor. 

or really? i thought she's a teacher (refer to another previous blog entry. this i take as flattery) .

or she sure isnt dressed like one. (this will make my aruah mama go i told you so. she told me so soooo many times).
or really? she's too cute to be a doctor. (okay, i made that one up).

then other questions usually follow. 

if you're a doctor, some people may ask you where you work, which hospital, is it a busy/nice place, even maybe which medical school you went to etc.

or some people will just straight up ask you a medical question, more often than not, pertaining to their own health or worries about a certain ailment that they have, rather than a general question like, how about that zika,huh?

itu okay lagi. you still try your best to answer their questions.

but it's a little awkward when this is at a funeral, or you're visiting someone ill at the hospital, and you get introduced to the person's relatives who are also visiting, like what happened to me recently. a friend's close one was critically ill and admitted to the icu, so i went to visit. the atmosphere was sombre, the person was on a ventilator, with tubes and wires running to and from his body, the machines were beeping. there was another relative there so i was introduced by my friend as emie, old friend. she's a doctor. the relative then proceeded to asking me what i initially thought was going to be with regards of the ill person that we were visiting. understandably. may be she's hoping i could help explain certain things further.

but no. she actually went on to tell me about how she was also hospitalized in the same hospital a few times already for multiple surgeries, the last one on her uterus, just last year. i just listened politely and nodded a few times, i see, i see.

she then went on to tell me she is still having some symptoms which she wasn’t sure if it was related to the surgery or the underlying condition that she had, or whether there is a new diagnosis or if it was all part of the aging process, and asked if i knew what they were.

errrrrrrkk…

so i said, well i'm not a gynae so maybe you can ask your gynae next time you see him/her. i looked over at my friend and saw that HE looked real apologetic.

seriously.

that's not the worst scenario though.

imagine a kenduri kawin. you are really hungry, and boy does that nasi minyak look yummy & inviting, let's quickly find a seat. a relative sees you and calls you to sit near him/her. you gladly walk over, that plate of warm nasi minyak + rendang daging + ayam masak merah also calling you to quickly grab a seat so you can quickly eat (hey that rhymes!)

another introduction of ini emie, anak so & so, dia doktor kanak-kanak by the relative to a pakcik you dont know and his family.

this pakcik you were introduced to then briefly looks at you, washes his hands (he was eating) and lifts up his shirt to show you that rash/mole/growth/something-that-looks-like-a-map-of-somewhere on his belly/chest/armpit (!), and asks you if you know what it was, he's had it for awhile now, so can it be cancer?

the nasi minyak suddenly turns cold and no longer look appetizing.

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!

trip to turkiye

turki.
turkey.
turkiye.

anyways, i was very fortunate to be able to visit this beautiful country back in November last year.
went with a couple of girlfriends.
hubby didnt come with.
he's still not fond of flying.
plus, by going with my girlfriends, it's easier to save on money, because we could divide everything equaly between us including our accommodation.

we took emirates to fly to istanbul via dubai.
spent overnight in dubai so we can see the city. arrived at dubai airport around 9pm and took a cab for a drive around the city. our cab driver was a filipino woman who could speak english well, (most of the people there can speak english fairly well) and she took us around the city, and then to the architectural wonders like the burj khalifa and burj al-arab, drove past the famous palm jumeirah resort, and then dropped us off at jumeirah beach. this beach was described to be THE place to hangout and stay for tourists, because it is lined with many hotels and restaurants. so we did. stay at the beach. literally. like, on the beach. we slept on the beach that night. after a long stroll looking at other people hanging out at the cafes and restaurants, we had falafel at a place called operation:falafel and around 3 am were just too tired to do anything else and so we parked ourselves on the beach and slept.
the next morning we had a simple breakfast at one of the many cafes, walked along the dubai canal (i think that's what it's called) and wandered some more (and got lost for awhile) before taking the train back to the airport.

and then we reached istanbul.
we stayed at a small family-owned hotel near the sultanahmet square called the piport hotel. stayed for 4 nights there. visited the blue mosque, the hagia sofia, the topkapi museum and a couple other museums by the square. visited the grand bazar as well. went on the bosphorus cruise.
tasted and experienced the turkish ice-cream, you know, there the ice-cream vendors not only sell the ice-cream but they also tease and joke with you when they are handing you the ice-cream. the ice-cream themselves are yummy too, kinda "chewy". my only regret was not having more of them.
the highlight of the istanbul, for my friends at least, was the istanbul marathon. they ran the 10k, and although i didnt run, i was extremely proud of them. it was their 1st run outside of malaysia too.


after istanbul we travelled to cappadocia by bus. it was a 12-hour ride at night, which helped save money on accomodation. the bus was comfortable too..they give you light snacks with coffee/tea soon after you get on and later as the day breaks and you approach your destination.
cappadocia has amazing one-of-a-kind landscapes. we took guided tours there, went hiking and up a hot air balloon at sunrise. we also went for a turkish bath or hamam, just to see what it was like. it was fun, you sit in a sauna and then have someone lather you up with soap and scrub your whole body. sounds like something you'd find in a nice spa here right? well, not really. 'cause all this are done in groups and you sit in a circle, while other people sit on the side waiting for their turn. we then opted for a massage afterwards. i think the hamams in cappadocia cost cheaper than those in istanbul, but there are not that many to choose from especially if you want one that separates the men from the women.

we stayed for only 1 night in cappadocia, but the hotel was the best one out of the 3 that we stayed in in turkey. that's because it was a cave hotel, which is one of the attractions in cappadocia too.
next we travelled to kusadasi and pamukkale. again, we travelled by bus, and again it was a 12-hour ride at night. we stayed for 2 nights in kusadasi at a hotel called akman hotel, and took guided tours around kusadasi and pamukkale. main attractions include the ancient greek city ephesus and roman ruins hierapolis where you can also bathe in the ancient pool and walk at the beautiful and scenic travertines. we also went to a carpet factory, and totally fell in love with the silky hand woven carpets, and i was almost taken aback as to how very expensive these carpets can be!

finally on the last day, we went to izmir airport, which was about 1-hour away from kusadasi, to fly back to istanbul. we flew on turkish airways, and just like on emirates, we totally liked the food they served us. speaking of food, before going for the trip i read on many people's blogs that seem to say that many people got bored with their "dry" kebabs and missed malaysian foods instead. well i'm glad we managed to try so many different types of food there, and have to disagree on that. i totally love turkish dishes, and i'm sure my friends did too, because every time we eat we would google the dish up to find the recipe and see if we can recreate it when we are back home. hahaha. who am i kidding? i know i'd better google up where i can find good turkish restaurants in kl/jb if i ever want to taste turkish foods again. that or travel back to turkey. ooo, that sounds awesome!

it was in turkey too that i got to taste fresh figs for the first time, and after telling hubby about it and how much i love it much more than the dried ones, he actually planted a few fig samplings behind my mom-in-law's house in muar, so soon i can have as much fresh figs as i want. yay!

so all in all it was a great trip. there are still a lot more places we didnt get to see. we also didnt get to see the whirling dervish dance which we planned to. it's unfortunate that right after we left there were news about the bombings in istanbul and ankara. ugh..why do people want to bomb other people? why cant we just respect each other and live peacefully ever after?? i want world peeaaceee! *read in whining tone*.  my thoughts and prayers to the people in turkey and everywhere else in the world. may we get world peace. and more travels.

baby news

no. i'm not pregnant or having a baby.
i don't mean MY baby news.

eva & ryan. on their 2nd.
blake & ryan. on their 2nd.
megan & brian. on their 3rd. and they are supposedly divorced!
chrissy & john just got one.
and to top it all off, E news was also showing awesome celebrities who got preggers after they turned 40.

so yeah, their baby news.

i put this up as my FB status after i saw the E!news show.
hastagged it maybe i should stop following E news and watch real news instead.
and that maybe i'm jelly. u know, the slang for jealous? (just learned it).

so on to local news.

the maid we hired to help my mom-in-law can't come back to work for us anymore because she is now pregnant.
with twins.

bah!

forget the news.

ps: bah? who says bah anymore? that's like from the days of reading Archie.


GAH! I want!!

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.

cerita menjelang tahun baru.

1st year marriage:

mr hubby: sayang, it's so cool that we got married hujung tahun kan. and that your birthday is just a few days after that.. on new year's day! everywhere we go the mood is so festive. and everywhere there's fireworks! love it!

2nd year marriage:

mr hubby: sayang, it's so rugi that we got married hujung tahun kan.and that your birthday is just a few days after that. flights and hotels are so expensive because of the super-peak season it's so difficult to get reservations! dok rumah jelah. celebrate kemudian ok.

moral of the story: takpe, yang penting dia still sayang ;)
happy anniversary, baby.

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.

winds of change

no. this is not a political post.

it has been a year since my last entry here, you think i would waste in on politics?
but since we mentioned it, i would just like to mention here that it was my 3rd time voting (made me feel like a veteran) and somehow, this time around, the election day and the days going to it felt really ""festive".
maybe because there were way more voters this time.. with many having to "balik kampung" to vote, plans were made to book leaves or change calls (for those of us having to do oncalls), travel plans (to avoid traffic jams etc).
maybe the indelible ink has got something to do with it too, with evryone making a fuss about how truly/falsely indelible it actually is.. and all the blue (or red) finger tips u see posted by voters on FB and Instagram etc.
(i have to insert this story here too, just heard it from a friend --> apparently quite a number of voters marked the X on the voting papers using the ink on the fingers thinking that was what the ink was for!!!! aha-ha-ha..!!)
i know of some non-voters who actually felt "left behind" this time around because of their blue-less bare fingers on that day.
plus i think the fact that we have FB and Twitter etc now(we had them on the last elections too but they werent utilized as widely and openly as they are today) which makes even the most ignorant and disinterested people (like moi)more aware of what is going on. the atmosphere that day was simply.. i dont know.."electric:? i guess..(no pun intended ;)) with evryone waiting anxiously for the results.. and it did take a ridiculously long time for the results to come out too!

but hey. like i mentioned earlier, this is not a political post.

i mentioned somewhere in my last few postings that 2011 was a blur for me what with the final exams and my mom getting breast cancer and then being transferred back to mlka.

then 2012 came and went.
i  completed my masters (finally!) and have now been transferred further south in JB to serve.
work-wise is the same.. cant expect to not be busy when you are in the medical field, but the are some differences of course. different colleagues, different bosses, different staff, different hospital. different city.

my mom completed her chemo and radiotherapy mid last year and was well for awhile but unfortunately now has a recurrence and needs to do chemo again before we proceed for a mastectomy. we are obviously all bummed about that but she is otherwise still up and about around the house so we are still very thankful.

i got married (yea, okay, you can perhaps say "finally!" here too.. to others it may seem that way but to me i think the word "actually" is probably more befitting...as in "i actually got married!".. yes i couldnt believe it myself!)
no. it wasnt an arranged marriage.
no. i wasnt drugged/comatose/hypnotized/held at gunpoint.
no. it wasnt the sultan of a certain state as i planned.
yes. i fell in love with another commoner.
yes. i was in love.
and yes. i am still in love.

now, with the change of title to my name (i'm still amused by the realization that i am an actual Puan now when the salespeople address me randomly as that..heee), it is interesting to note the change to people's  reaction to anything that i do or say as well.
when i was single, the feedbacks i get to almost anything is "dah kawen belum" or "bila u nak kawen ni?"
eg. (Me vs P (people))
  1.  Me: Hi.. lamanya tak jumpa!!
          P: Yelah..u nampak sama macam dulu...dah kawen belum? Belum? Bila u nak kawen ni?
  2.  Me: Hi..lama tak jumpa!!
          P: Yelah..u nampak lain sekarang.. still belum kawen? Bila u nak kawen ni?
  3.  P: Happy birthday!
       Me: Thank you!!
       P: Bila u nak kawen ni?
  4. Me: Selamat hari raya!
       P: Selamat hari raya. Bila u nak kawen ni?
  5.  Me: Nice wedding.
       P: Yelah.. bila u punya wedding pulak?"
  6.  P: Hey, the 47 yo singer is finally getting married! Bila u pulak nak kawen ni?
  7.  P: Hey, so&so is getting married-the 3rd time alrdy! Bila u pulak nak kawen ni?
  8.  P: Congrats dah jadi pakar... bila nak kawen pulak ni?"
  9.  P: Wahhh.. dah beli kereta baru... bila nak kawen pulak ni?"
10.  P: Your mom has cancer? So sorry to hear that..bila u nak kawen ni?

you get the picture.
well, now that i am married.. things change.......... or have they?
eg.

 1. Me: Lamanya tak jumpa!
     P:   Yelah.. dah ada anak? bila nak pregnant?
 2. P: Happy birthday! Bila nak pregnant?
     Me: Ha-lo..i got married 3 days ago (it's true.. i got married 3 days before my bday)
3.  P: U transferred to JB alrdy? Dah pregnant belum?
4.  P: U look like u've gained weight. Dah pregnant ke?
5.  P: Sedapnya tengok food u makan (posted in FB). Dah pregnant ke?
5.  P: U still drink that much coffee? When u get pregnant u cannot drink anymore haaa..
6.  P: U demam? Pregnant kot...
7.  P: Hey, nice new baju. Are u pregnant?
8.  P: U coming back to KL to vote? Good for u. Dah pregnant belum?
9.  P: U drive JB-KL-JB by yourself? Careful.. mana tau pregnant ke..
10. Your mom's cancer is back? so sorry to hear that.....so, are you pregnant yet?

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

shoutout to all family & friends: belated thanks for coming to the wedding, thanks for all the well wishes, here's a prayer for all of us to always love and be loved, to respect each other, to remain united, to be safe and for happiness always. ameen.

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!!

KONY 2012 - save the children

Whatthe hey-? A medley.

1st week back in Melaka. Conversation with one of the bosses:

JT: so, in case you don’t know this yet emie, our department here is very fertile..
Me: huh?
JT: yea, everyone seems to end up pregnant here.. so I better warn you.. ha-ha (nervous laugh)
Me: umh.. ha-ha (real nervous now..whatthe hey-)

2nd week in Melaka. A female security guard waved at me, she actually remembered my face.
Guard: Hey doktor, lama tak nampak.
Me: ye kak, saya pindah KL 2 tahun.
Guard: oo..sekarang dah balik sini balik?
Me: ye kak *smile*
Guard: oo..baguslaah… Gemuk dah doktor sekarang ye!
Me: ..haha..yelah kak .. *smile*

The next day. Same guard, smiled at me. I smiled back.
Guard: Doktor, dah memang kerja balik sini lah ye?
Me: ha, ye kak..
Guard: Doktor gemuk betul la sekarang ye..
Me: ..haaa.. y e .. k a k… *smile paksa*

Later that same day. Same guard, with another guard. I could feel it coming. Smiled at me and waved. I waved back. Prayed that the elevator doors would open immediately as I pressed the button. They were  just a few feet away from me.
Guard (telling the other guard): tu doktor tu kerja sini dulu, sekarang dah balik sini balik. Dah gemuk dah dia sekarang..dulu kurus.
Me: (whatthe hey-?) *acute depression*

2nd month in Melaka. Doing post-call rounds in adult ICU, 7am, in scrubs, haven’t showered yet. Approached by the ICU staff:
RN: doktor, you HO(houseman a.k.a graduated doctor in-training AND mostly very young) GA(general anaesthesia) ke HO surgery?
Me: *Stunned*
RN: Eh, doktor, doktor ni HO GA ke HO surgery?
Me: err..saya MO (a.k.a medical officer..and mostly older more mature doctor)  ..
RN: oh ye ke.. sorry, sorry, ingatkan houseman tadi.
Me: (what the hey-? You made my day!!!) *perasan smirk ON!*

Just yesterday.  Doing oncall morning rounds by myself. Approached by a houseman from my own department, who has worked with me for at least the past one week:
HO: you jaga jaundice cubicle jugak ke?
Me: huh?
HO: you jaga jaundice cubicle jugak ke?
Me: still huh?
HO: …realization hits as she slowly starts to recognize and remember who I was again ….oh, sorry doctor, I thought you were the houseman here…so sorry..
 and dengan penuh sheepish-nya she left me…
..and again I was stunned.
Ok, but that HO memang known for her dumb-blonde attitude lah... but, seriously?
Whatthe hey-?