My Blog

something interesting happened whilst i was at work yesterday. i started in ward 18 but then out of sudden got sent to mau (medical assessment unit), because they could do with a pair of helping hands more. boy wasnt it quite a circus when i arrived.

after some time, this nurse called out my name and said, "can u please help me ’something’ mrs. E?" i couldnt quite catch what something was, but as i was paid to help, so of course i said sure. so we prepared the bowl of water, wipes, a white robe (quite unlike anything i’ve seen b4) and a few more other things-by now i already figure out that mrs E need to be cleant and changed. i noted that mrs E curtain was drawn all the time which is quite weird. 1st minute : "why is her skin so pale and yellow? she definitely bruises easily-her arms down to both hands were purplish!". 2nd minute : "why in the whole wide world hasnt she open her eyes and move at all? she could at least nod or acknowledge us!and this nurse keep chatting with her, calling her poor lovey and sweetheart and all that. by the way her hands were uncharacteristically limp when i removed her clothes off her". 3rd minute : "oh my god she’s dead!!"so there i was in the middle of the busy ward, with hands shaking and beads of sweat appearing all over my forehead, i helped clean, wash and change a corpse. after the fear and anxiety wear off, a feeling of sadness swept over me. i didnt even know her, but i couldnt help but feel sad.i hope she has had a good life. and i cant help but wander whether she’s religious at all, whether she believe in God at all, and where her spirit is at that very moment.

well, it takes me a full 3 minutes to recognize the signs of death, and i dare call my self a medical student. yeahh way to go! ( that actually means do sharpen up that observing and detecting skills of yours silly girl!)

being confronted by death is never easy and i’ve learned that a while ago. whether it involves a loved one or just any stranger i know nothing of. a large part is of course the emptiness that comes from knowing that a loved one is gone for good. but it also reminds me of my own mortality. and how i can never be fully in control of our own life, despite everything i have gained or achieved.

my first encounter with death was ages ago, when both my grandparents died in such a short span of time apart. i couldnt even bring myself to kiss them for the last time. i could even stand being in the same room. and long after, i still couldnt shake the feeling of regret for not saying a proper goodbye, but if time were turned back, i know i still wouldnt  be able to do what i meant to do.

then at 16 my friend died. she’s 2 years my junior, and was in the same dorm as me. as i was head of the dorm, i was being put in that role to take care of them, i supposed. the irony? i only successfully put the right name to her face 2 days before the incident. and the night before, i was mad at them (for simple forgiveable things)and gave every juniors of the dorm a piece of my mind. and then she died. out of a sudden. she complained of headache a few hours before, but of course being the stern, no-nonsense senior i was (that was a front i put at school, i dont know why, out of insecurity i guess, or just to look cool- dont we all strived to be ‘cool’ during our teens? well i get a wrong interpretation of how ‘cool’ is supposed to be), of course she didnt dare come to me for help.and then she died. it was sad if an old man or womean died (like my grandparents), but to have someone who has a whole life ahead of her died just like that and knowing full well that she has parents whose heart will be crushed when they hear the news-the feeling was simply awful.

this time a can stand staying in the same room whist she was being washed, cleant and wrapped. what i couldnt stand though, was saying my condolence to her mother.

i willingly choose medicine knowing full well that deaths are what i will encounter, again and again. by now i already decide that i would never take up palliative care or oncology, as i dont want to face it every single day if i can. and definitely not neonatology or paediatrics, beause apart from seeing a loved one dies, i figured seeing a little baby or a child die will be the next saddest thing.

by now i may say i have got a glimpse of what it would be like, doctors and death (not doctor death Harold Shipman). i remembered taking history from this gentleman with short complain of dysphagia but is otherwise healthy, and i concluded rightaway that he just had  stricture due to  previous peptic ulcer.  but sadly thats not the case. the verdict? end stage oesophageal cancer, and he only has 3 months at the most. and this frail old lady with pancreas tumor so big even i can easily feel it, and she’s just there because she is so weak to be moved anywhere, and the team taking care of her hoped it wouldnt be that way for so long, because they need to empty the bed. very sensitive of them, but what else is there to do?

it is interesting to note that life, in all its complexities and uncertainties, there is but one thing about it that is simple yet definite ; death. the weird thing is, i spend so much effort and time preparing myself to face all the uncertainties, for example reading about cushing’s as if my life depends on it and yet not one single question may appear in the next exam, but when did i actually prepare myself for my own death?

it’s look as though i’ve been thinking and writing about such gloomy subjects lately. on a brighter note, today’s weather is fantastic. i walked all the way to the gym singing out loud to my music, not realizing until a few people i passed by looked at me with raised eyebrows. after all that sunshine and workout, i feel i can face anything. never mind the 1 hour++ trip to kirkham for gp that starts at 7.30 every morning. come what may, no problemo!

i think i’m coming down with a full blown SAD. that’s seasonal affective disorder. it’s sounds just about right this time of the year. it’s bad enough when it’s barely 7 hours of daylight in a day, but when it’s raining 6 days a week whilst the sun stays truly hidden behind the clouds, it takes a lot of effort to find the will to smile. like today, just when the day looked promising enough to stay bright and sunny, and i’m enjoying my morning walk for the first time after so long, the rain came pouring. the weather will be quite high up on my list of ‘why i’ll be kissing britain goodbye after F1′. haha jpa will be glad to hear that.

enough about me. at least i’m still alive to be having this SAD. at least the topmost worry i have right now is how to stay dry and presentable in front of the consultant and the patient after weathering the pouring rain on the way to the hospital, and not how to go out and buy some food from the market for my hungry children and trying to stay away from a crossfire or any suicidebomber whilst doing my shopping. more than 150 people died today in a series of blasts in Sadr city in Baghdad-a Shia area, whilst more than 200 others were injured. earlier today 4 people were killed when US troops open fire at a minibus. a few minutes after the bombs erupted, a Sunni are came under attack leaving almost 10 injured. a group of attackers tried to break into the ministry of health building to take in hostages (like what happened in the education ministry last week).

it has been the bloodiest day so far since the march 2003 invasion, no doubt about it. it is  major even by Iraq standard-the news broadcaster said. so what did he mean by saying ‘iraq standard’? as if to say that, people is being killed everyday anyway so let’s not bat our eyelashes unless more than 150 people are dead in one day?
browsing through the western news, it isnt long till you have this feeling that iraq is a lost cause, iraqis are these barbaric savage people - labelled as militants- who just kill each other to further their cause, and no matter how hard the us and british troops tried to maintain order and security, they are fighting a relentless battle but nevertheless a losing one.
and since their presence there isnt halping anything or anyone, let’s talk about withdrawal. anybody dares blames us the coalition troops, we’ll say ‘hey, at least we tried’. nice one. i remembered this quotation by a us army, ‘we had our civil war too, it’s no big deal. so it’s time for the iraqis to get theirs done and over with and move on’. and there’s this more sinister quote,’at least they died liberated’. easy for them to say.

let’s go back to 2003 for a minute. who attacked a country who was still weak after years of sanction with all intentions to destroy the famous WMD that isnt there, and end up killing civillians, setting roads, buildings and bridges ablazed and Saddam’s signature statue toppled to the ground instead? after all that, they should have known better than to strip off all the army and police off their weapons (not before throwing those who dare argue to prison first) and discharge them. but no they didnt know any better than that. they intentionally make chaos and instability the order of the day everyday, by making a country leaderless (not to say ridiculing its once esteemed leader-at lest to his Baathist and close supporters- in a circus of a court run by us-selected jurist and judge under us-backed law who conveniently found him guilty), governmentless (or rather, government with ministers whose iraqi people never heard of before but was forced to vote for anyway because they were the only iraqis the us can find that will follow their every command, supposedly under the banner of democracy), and  without  an efficient  and fully equiped  police force whom the peolple can trust to protect their safety.

then chaos and instability did become the order of the day. people cant turn to the police when they were being robbed, so they take matters into their own hands and put trust in their own guns, or rather their clerics’ leader who does have guns and followers to mobilize when the needs arise. the situation became so violent that to have normal jobs become impossible and to travel become a suicide mission, so let’s just stay home and be more depressed and when thig get so out of control let’s resort to violence to end this once and for all. and not to mention all of the relatives and loved ones being killed by constant raids by the troops (or worse, being raped!-remember james baker and the 4 year old girl?) or being thrown into prison for no apparent reason only to be heard of later when the despicable pictures from abu ghraib were made public, why resist the desire for revenge?
so after 3 years and 7 months, they are saying the situation is gettiong out of control and nothing can be done to remedy this and yes, the future does look bleak for iraqis, but let’s go home to our ‘god bless america’. after all, we have gotten rid of donald rumsfield, the joke who put us here in the first place, so what else do you want from us?

sorry i sound so cynical and pessimistic. 150 deaths is too much. people are lying at the hospital corridors waiting to get treatment, but what could the over worked, scantily paid doctors with no high-tech operating theatres let alone simple antibiotics can provide? and i encounter patients here on a daily basis who complain about the hospital food (yeah, the 3 times a day full course meal which they get a menu so that they can coose and select, and teas and hot chocolates and  horlicks and biscuits in between).i truly hope and pray that there is a light at the end of the tunnel for all iraqis, in fact for all of us i-Allah. 

The first firm is over, yet I’m more confused than ever. I hope
it’s a good thing; the more u know, the more u realize there is a lot more that
u don’t know, hence the confusion. So far life as a medical student in clinical
settings for me has been a topsy-turvy; the undefined role brings me to the brink
of frustration at times, but there is never a patient or a doctor or a procedure
that ceased to amaze me just yet. I remembered watching a CT-assisted
percutaneous drainage of pseudocyst in an old man with long-standing chronic
pancreatitis with mouth gaping throughout. And I better don’t start about the
laparoscopic surgeries or the 7-long-hours cardio-oesophagectomy I’ve seen,
they are totally out of this world!

Every day is what I make of it, thus posing as a challenge
in itself. I love waking up to the uncertainty of what today will be like, and
sometimes even having to choose between a few options available; whether to
take history in the ward and follow the F1s, or go see endoscopy or hang around
in theatre or ring Linda and go to skill lab? And each night I’ll go to bed
relishing the experience of the day and feeling so good about myself, or
cursing myself for acting so stupid in front of this doctor or regret going to
this clinic and vowing it won’t happen ever again.

But the most important skill I have learned thus far isn’t how
to take good history or palpate the abdomen correctly, it’s to speak and work
with people, and learn a thing or two about medicine whilst doing that. In summary,
what I’ve picked up are;

1. the
        power of prediction and anticipation : So it’s going to be clinic today
        with Mr McCloy. The first few seconds when we exchange hellos I should
        know what his mood is like then and decide whether to be perky and chatty
        or cordial but courteous. Same when approaching a patient to take history
        from; she’s just came from icu with post-op complications and has had pain
        for as long as she remembered, so better get it over and done with fast,
        plus allow her to catch her breath when she’s talking.
2. go
        with the flow : alas, my prediction and anticipation prowess has proven to
        be faulty a lot of times, and just when I decide to be invisible and go to
        the furthest corner of the theatre as far away from Mr Pursnani as
        possible because the colonoscope couldn’t go as far as he would like it to,
        and the incompetent nurse made excision of the polyp almost impossible,
        out of the blue he became very chatty and asked me a lot of questions
        during the second procedure which is staging laparoscopy. Needless to say,
        as I was caught of guard by the sudden turn of event I came up with answers
        that made almost no sense for most questions.
3. demand
        for attention or stay invisible : when they ignore me, don’t take it to
        heart. They have jobs to do after all. Sometimes they are very busy and didn’t
        even have the time to glance up from what they are doing. Sometimes they
        are just like that. I remembered sitting in with Dr Chardwick during his
        surgery, Ning warned me beforehand that he maintains a wall as impenetrable
        as the great wall of China around him, and I came in with all the intentions
        of bringing the wall down. It was damn difficult. But once I have taken
        the first brick out of the all, the rest of the bricks fall easily enough.
        The trick? Hurl all the questions you can think of at him (be selective as
        well, stupid questions wouldn’t really help would it?) until he has no
        other option but to deal with you. But at some other times I just couldn’t
        bring myself through all that and stay quiet instead. (it’s totally worth
        it after the wall come crumbling down, but boy isn’t it hard work)
4. I don’t
        have to like the person and she/he doesn’t have to like me, but make a
        show that I really enjoy the company and the teaching, just enough to make
        me function well and for them to feel comfortable. Honestly, I don’t like
        Mr McCloy, and I sense the reverse is also true. I can’t relate to him. I’ve
        tried, but I just can’t. I could talk to him and ask him just about
        anything (medicine/surgery related of course) and laughed with him but it took
        me more effort to do so. Regardless, he had been a very treasured teacher
        and he’s very wise. But with Mr Ward, I can easily say that I like him as
        a person although I barely see him once a week. He seemed genuinely
        interested with what I have to say and made the effort to explain what he’s
        doing occasionally. Although I must say he fares better as a surgeon
        rather than a teacher.
5. There
        are people that I can just come up to and chat and have a good time. People
        like the F1 doctors and Tina the phlebotomist. Insiniya is ever so ready
        to help with anything, Fred is ever so nice and unpretentious whilst Tina
        is so full of life and bubbly that I can never run out of things to say.
        They may not be as wise or as important as the consultants but I can trust
        them to go out of their way to teach me or assist me with anything, and
        for that I was ever so grateful. They made me promised myself to always
        look out for other people especially medical students when I’m a somebody;
        a doctor, or better yet, a consultant.

Al in all, I love my life at the moment. There are times
when I am in my scrubs rushing down the corridor to the prayer room with
partially digested lunch in my stomach, I cant help but think there’s no other
place or anybody else’s shoes in the whole wide world I rather be in. There are
also times when I am coming home spent but still have pbl work to do that I ask
myself is this really going to be worth it, and I dream of becoming a housewife
to a rich consultant cum stay at home mum in a big mansion with lost of maids
and babysitters and do nothing all day but keep myself pretty. Haha yeah right.