Do No Harm by Henry Marsh – From My Perception

“Doctors are human, just like the rest of us. Much of what happens in hospitals is a matter of luck, both good and bad; success and failure are often out of the doctor’s control. Knowing when not to operate is just as important as knowing how to operate, and is a more difficult skill to acquire.”

It is difficult for those outside health care to understand what a doctor’s life is like, how much apprehension a doctor faces day in and day out, how much training and experience a doctor needs to be a better one, what a doctor feels when faced with gravely ill person.

Many of us do write about our experience, in our own way, but I doubt many would understand or even believe what we say. The only thing that could make them at least slightly understand is to have a few lives in their hands and having to attend to them urgently at the same time, wishing to be able to do more for them.

Henry Marsh is a British neurosurgeon, working with the NHS. He was involved with two BBC documentaries, and was rewarded the Commander of the Order of the British Empire (CBE) in 2010.

This book was written to help people understand the difficulties that doctors face. In his book, he did not only tell us about the patients that he operated along his career, he went deeper on the challenges of making his decisions, the heavy heart felt when he had to break bad news, and what happens when things go wrong in a surgery.

It is written in chapters; although the stories are not exactly continuous, at times we could tell what he’s going to talk about in the next chapter.

My favourite chapter is Angor Animi, where he spoke about his journey of becoming a doctor. There were snippets of his experience as a junior doctor, and how he came about to be a neurosurgeon. One of the most unforgettable moments was his encounter with a man very close to his death.

“Angor animi – the sense of being in the act of dying, differing from the fear of death or the desire for death.”

His accounts on working in Kiev, Ukraine with a mentee, Igor Kurilets, was quite interesting. I made a few gasps while reading through those stories which may have turned heads if I were to read the book in a train.

The book brought me back to those days when I was a student in Ireland, back to the time I was doing my exams just recently, as well as those long days (and nights) as a house officer, spent in the operating theatres assisting the surgeons and their trainees. Speaking about neurosurgery, I was also reminded of a neurosurgeon in the hospital I work in whom I highly respect; it was a great opportunity to have worked with him during my endocrine rotation.

As much as I love the book, I did not agree with everything that he said. He did write about the human nature of doctors, how we can’t control everything in front of us, no matter how much we tried. However that humility did not extend further.

Yes, we have discovered so much with the technology that we have now. However, any neurologists or neurosurgeons could tell you that there are so much more things that we have yet to know about the human brain, about the human body. There are mysteries that keeps on appearing and there are always new things that we realise we do not know, despite our discoveries.

Somehow, not many scientists these days are humble enough to say, maybe Someone else Knows better. Not many have the humility anymore, to say that although we could not see something at this very moment, it does not mean that thing does not exist.

This kind of thinking and attitude would limit science and creativity, and possibly limits further discoveries. There are so many things in life that we know about now, could not be seen with our eyes 2000 years ago, but that does not mean they did not exist 2000 years ago.

If a good, well organised, scientific conference could not happen by chance, if an efficient public transport system could never happen by chance, how could our complex human brain with its neurones, neurotransmitters, synapses, that carry movements, sensations, thoughts, reasons, emotions, motivations, love and joy, happen by chance? How could our complex human body have happened by mere chance?

I would read this book again and again, perhaps some chapters more than the others, for it reminds me that we are all the same. We have the same deep concerns for our patients and should carry on doing an honest job for the sake of the others, as we were given this privilege, and hence responsibilities, to do it right.

I shall close this review with one of my favourite quotes from the book:

“The idea that my sucker is moving through thought itself, through emotion and reason, that memories, dreams and reflections should consist of jelly, is simply too strange to understand.”

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Another Train of Thoughts

On 8th of March (I think I was post call), I made a list of things I wanted to write about. Let’s see how many I have done, and how many topics am I adding on now.
* * *

1. The palm oil estate experience – written, but STILL not typed in

2. The strong ladies, are you worth it? After seeing Wan Azizah’s tears, I was reminded of so many strong ladies I know in my life. No,it’s not about Anwar Ibrahim, it’s about women and strength -> DONE!! Refer to The Baggage.

3. The first step. Women’s journey to partnership. A short one. -> I have forgotten entirely what I was supposed to write about. So I think I need to scrape this off. :(

4. Imam Suhaib Webb’s lecture on education in KGPA -> Even this, I only have the short bullet points, still kept on my busy board.

5. How to focus in solat – lessons from Imam Suhaib Webb’s lecture in KGPA -> refer to number (4) up there. :(

6. Surviving medicine -> Here and there, in Letter from Hell, and A Day in A Muslim Doctor’s life (eh, is that the title?)

7. Inspiring senior medical colleagues – the amazing government hospital specialists and consultants -> NOT YET!!!! I need to do this before it slips my mind!!

8. Learning from the dying – It’s too late -> Err….I think I wanted to write this in a different manner as compared to what I have in mind right now. But I guess the message would still be the same.

9. Learning from the dying – death with dignity. How people should spend the last days of their lives. No, we can’t really tell but there are so many things that people should know, including doctors -> This, will take some time. Coz it will need me to sit down and reflect.

I have added on a few more to my list of unfinished business, or rather, untold stories:

10. To parents: Never, EVER force your kids to become doctors. Or anything else in that matter.

11. Pantang selepas bersalin. Confinement period. Being superstitious or just plain clueless. Modern medicine may have shown what those elderly “angin” actually means, and how our health in old age is not singly determined by our health post partum. *slaps forehead*

12. About youth, being unconventional, success and dogs. I don’t know if I have the energy to even do this.

Wish me luck!!

Daughter by Jane Shemilt – A Book Review

A house officer in my ward has been limping for two days, and I did not even ask him why. My excuse: we had two very busy days and nights.

It somehow reminds me that I have yet to write a review of this book titled Daughter, written by Jane Shemilt, which I finished reading almost a week ago.

Although I found the starting pace of the novel a little slow, reading the description at the back of the book made me push through. After a while, I found that it was not easy to put this book down, despite not sleeping the night before as I was on call.

It is a story about a lady whose life was shattered. Her life was like a stained-glass box, which actually broke to reveal so many other broken pieces kept unseen inside that box. As she tried to find all the broken pieces, she found that there are more pieces that’s been missing.

It was discovering those pieces one by one that made it hard to stop reading.

As much as the mysteries binds us to the book, it leaves us with some room to reflect on our own lives. It makes us wonder whether we have done the right things in life, and wonder what lies beneath the calm facades of our loved ones. Are they truly happy? Or are they time bombs waiting to explode?

It made me cringe to see how lacking of insight the main character was, but although in the end she realised, after some unpleasant surprises, it was probably a little too late.

The end was somehow unexpected. The few chapters towards the end really made me hold on to the book even more. I ended up sleeping rather late that night, even though I was to be on call the next day.

Despite being grippingly mysterious, I would not read this book again, as almost all of the questions were answered, hence it would not be as exciting as reading it the first time.

Talk about mysteries, reading Harry Potter series gives us lots of questions, and later on, answers. However there are loads of memorable scenes (be it funny, sad or happy) that are worth to be read again and again and again, of which this novel lacks.

I would give 6/10 for this book.

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Edwin Smith – Ordinary Beauty

Disclaimer: This is my personal account of my visit to one of RIBA’s photography exhibition, which inspired me in many levels. I would like to apologise if I had some facts wrong, and please advise me on them if you found them.

I had a great opportunity to attend a photography exhibition titled Ordinary Beauty at Royal Institute of British Architects (RIBA) near Regent’s Park in London recently. It displayed the works of an architect, painter and photographer, Edwin Smith.

Edwin Smith (1912-1971) lived in Britain around the second world war. He trained as an architect, but grew fond of painting, and had an interest to photography. He started off photographing everyday objects and sceneries, and that interest became a passion.

He amazed me as he not only turned daily activities into beautiful pictures, he was also able to promote conservation of ruined buildings post-world war. He went around Britain capturing beautiful images of the damaged, and the left-over undamaged areas of the buildings, and managed to convince the government and the people to start rebuilding instead of demolishing them.

In addition to inspiring me with beautiful images of ordinary lives, to the point of almost crying in joy, it gave me a few points that I could take home. It encouraged me to continue exploring and trying new things with my camera. The pictures and storied told me that I am, indeed, in the right direction, which made me really happy.

(1) Most of the photos, coming from that era, were black and white. He did try some colour photography, but he did not like the results.

Personally, I have tried black and white, but never really practiced with it, neither have I read up about it. It’s not like I’ve never seen nice black and white photographs. A good friend of mine shot some portraits in black and white, and they were beautiful!

Maybe I should try those out one of these days. My sister and I did actually plan for a black and white photo shoot but we have not managed to do it yet.

(2) Since I have been in the UK within two weeks prior to visiting the exhibition, I tried to photograph old buildings wherever I went. The weather was often good enough that there were bright sunlight with almost-clear blue skies. At times, it was too cloudy.
Many of the buildings are situated along narrow lanes, so shadows is a problem. It is hard to get a clear image of the darker areas without over-exposing the sun-shone areas. It is also not easy to under-expose the dramatic dark clouds without making the buildings too dark that we can’t see any details of the old architecture.

Edwin Smith showed me that it is possible to do both – capturing the effects of those cloudy skies towards the general appearance of the area or the buildings. He also made it possible to use the shadows to our benefits.

Anyway, what is Britain without its clouds?

(3) What if I tell you that you could feel the emotions of the photographer through the pictures that he shot? The awe, the amazement, the curiosity, the excitement or even the fear, could be felt through the images. It could be a photo of an entrance to a church or hall, the lights that go through those doors, or the vast landscape of a country, or the group of people crowding around a roadside stall, the groom looking at his bride walking towards him, or the heat of a war zone.
It could be a planned shot, or something impromptu that the photographer said, “hey, that’s nice!” and immediately shot the image.

That was how I felt when I look at beautiful pictures, and I felt it when I was in the exhibition hall, looking through the photos, one by one. I smiled a lot of times, and there was once, I almost cried.

I do find that the photos that I took, the product would match my mood during that particular time.

(4) There’s something special about capturing daily activities of different people. Mr Smith has photographed kids running in the alleyways, children sitting in front of their house having a chat before running again to their next game, people working in a restaurant, a woman hanging her laundry on a windy day, or people rushing to catch their trains in the train station.

It gives a sense of familiarity, fondness and even sweet memories to those seeing the images.

(5) As an architect, he has particular appreciation for buildings. This love for structures, with the human nature of wanting to leave a legacy, made him work for a cause: conservation of ruins post world war. He managed to save many buildings from demolition by his campaign, carried out, in particular, with his photos. Although some buildings were not salvageable, many were preserved and rebuilt, retaining the Britishness of the country.

It proves that if we do something with all our hearts and minds, for the greater good of the people, the product of our labour would be incomparable.
* * *

I made this visit to RIBA on my day of departure back to Malaysia. I did not have much time, as I left home quite late. As much as I enjoyed it, I wish I was there earlier and longer.

It was an entirely inspiring exhibition. It made me strive to do more with regards to photography. It is a lovely feeling when you found that you’re doing something parallel to someone exceptional like this, although, of course, personally I have so much to learn still.

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Do No Harm by Henry Marsh

This is the second book that made me tear up with joy, amazement and understanding by just reading the preface.

The first is “The Quranic Phenomenon” by a German engineer named Bennabi. I have yet to finish that book as it’s very deep and I could only properly digest a page or two at a time. I would love to make a review of that book when I’ve finished it. I’ll need to make some notes about that amazing book, even more so after knowing about how the book came into production. It is a book laboured with faith and passion, therefore the product is almost out of this world.

Back to Do No Harm. I’ve only read three pages into this book (excluding the preface) after finishing Cecelia Ahern’s latest book. What I can say is, it gave me palpitations (imagine being the patient AND the surgeon) and reminded me of those days spent with the inspiring neurosurgeon in HKL, Mr Azmi.

I wanted to say just that for the time being. Since I’m done with exams (for the time being), I shall read the above two books in parallel. “The Quranic Phenomenon” needs to be studied with a dictionary and a notebook, perhaps on the table, and “Do No Harm” could probably be read as bedtime stories.

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November

Here I am in this unfamiliar place, yet I could feel the presence of two persons that I miss quite a lot; one more than the other.

You, and you.

Both of you were born only two days apart in November. To be exact, 14 years and two days. There are things that both of you could have a conversation about with each other, and visit certain places together without having to worry about boring each other out.

You, with whom I held hands while walking along River Thames last year. It was with you that I spent days of smiles, laughter or even a bit of anger. You were, and are still, the person who could understand exactly what I feel, without me having to say a single word.

We dragged those heavy bags together, up and down the trains and their stations deep underground. It was with you that I had such a harrowing experience of riding a crowded elevator, 11 floors deep into the earth. It was you whom I waited for, while you were going around Tate Modern, understanding things that I could only half appreciate.

It was you who were annoyed with my fear of dogs. Yes, I do find them adorable but I just don’t like their fangs and bark. I’m sorry.

We walked around from sun rise until it’s pitch black. We ate whenever we felt like it, and that is not very frequent. Even a snickers bar would do for lunch.

It was a trip that I did not regret even a second of it. When you left home, I felt thankful that we spent all those days together, because I don’t know when would be the next best time for us to go for such a trip again.

It was because of you that I asked him all about London and Edinburgh and where should you visit to encourage your already profound love for all things beautiful.

And you.

Even up to this moment, I could not understand why you were so important in my life. It came as a surprise for me when I realise it. You came in my life for such a short period of time but I guess you don’t know how much you meant to me. I doubt you will ever know it.

Here I am, arriving on a gloomy day, in this city with its red- (and grey-) bricked old buildings and narrow one-way streets. I wondered what I should do here, where should I go first. It’s not like I did not make a plan, but since reaching this place, I did not feel like doing anything at all.

You see, before coming over, before even deciding on where to go after the exams, I contemplated on asking you about this place. I knew, many other people have come to this place. They could have told me what to do, but most of them said, “there’s nothing there, go somewhere else.” The city intrigued me so I decided to come anyway.

Unlike the rest, I knew you would not say “there’s nothing to see.” I knew the traveller in you would have listed down a few places for me to visit and things that I could perhaps appreciate. I knew you would have encouraged me to go and explore this old city. Anyway it was you who wanted to be a travel journalist, while I dreamt of being a travel photographer.

It could have worked but it just won’t.

I decided not to ask you. In fact I have lost your phone number. Well, actually I did not lose your phone number. I changed to a new phone and your number is in my battered Blackberry. Because of our circumstances, I thought that it’s better for me to just leave it like that.

Now the dreamy part of me regretted not getting your opinion.
The rational part of me said it’s better for me to do this on my own.

* * *
I know you miss me as much as I miss you, and I know you wish to be here with me as much as I wish you were here.

And you, I don’t think I ever crossed your mind anymore, especially not these days. But it’s ok. Wherever you might be, whatever you might be doing at this moment, I hope you are well and happy.

* * *

“I know it’s hard to remember the people we used to be,
It’s even harder to picture that you’re not here next to me,
You said it’s too late to make it,
But is it too late to try..?”IMG_1587.JPG

Grand

I was sitting alone at Central Station sipping my cappuccino slowly when I saw an elderly man holding a pink back pack on one hand, and the other hand holding his granddaughter’s hand. She’s probably about five year old. They seemed to be waiting for someone. His face was soft and gentle, as if holding her hand is something that gives him the most peaceful feeling in his life.

I can’t help but shed a tear.

Well, I actually cried in the end, one hand holding my paper cup, another hand trying to wipe all the tears that fell.

I looked at this man wondering how much love has bound him and his granddaughter, how much time spent together, and whether the girl would have ran to him for all the things that made her cry, laugh or jump with joy.

Doing what I do, I see many elderly people who became unwell quite suddenly, and before you know it, they leave this world. So I can’t help but wonder, how much time together do they have left.

Will this girl be mature enough to understand, when one day her grandpa has to leave? Or will he be lucky enough to be alive and well to see her grow up, graduate or even get married? Will he always be the one she turns to when she has doubts about herself or about life?

* * *

I have seen so many elderly cancer patients come and go throughout my career, some I remember more than the others. I have spoken to them as if they were my own grandparents. I had joy sitting with them over the weekends while they shared their life stories. It gave me peace to see families coming together to care for their loved ones, even more when they are old and frail.

There’s something about these grandparents that warms me up inside, but I can’t really tell what it is. Perhaps it’s from their stories. Perhaps it’s the years of experience that has soften them up.

Or maybe they just reminded me of my own grandparents, whom I love and miss to no end.