From My Heart


October 2009

Under GA – Confessions of A Doctor

Disclaimer: I’m sorry for the subtleties that comes with this note. Those who know the real story behind it would be in the know, and those who don’t, maybe it’s not time for you to know yet.

I found that lately it’s heartbreaking to see people in the stretcher, coming back from OT. Recently I saw the nurses pushing back patients to their respective beds, and it suddenly occurred to me that I’ve never really searched within me, what I actually felt all those times, one and two years ago. I learnt from the course about ‘Grief and Suffering’ by Hospis Malaysia that in order to understand your response to your surrounding, you should search and understand your own heart.

I can’t believe I’ve been under GA for four times in my life. They may be for some small things but they still are significant. I realised with a jolt yesterday, and it was even carried on into my nightmares….

Maybe I’m a doctor, but at times it could be more scary, knowing what may happen when you trust your life to the anaesthetist and surgeon. Maybe it’s true, ignorance is bliss.

A nice anaesthetist would do a lot of good for the nervous patient. Calmly asking us our medical background, our allergies, listening to our lungs. Mine actually knew Dr Mary Cardosa, having worked in Selayang before.

It was an adventure, really. Experiencing what we’ve always sent others for.

That wait for OT call…trying to read a magazine or two….

And when the nurses finally come you do wonder where the hell is everyone else….my advice is be sure to accompany your loved ones to OT because they’d really really hope that you’ll be there holding her/his hands. It’s scary, you know…

Again, it helps when the anaesthetist is nice and friendly. He was the person I looked for when I arrived with my blurry vision in the OT.

“So where shall I put the line?”
“My line is not difficult, you know….I have large veins. Put here.” I pointed to the dorsum of my hand.
“Oh no….I don’t want to put it there. I think this is better.” He pointed to the larger vein on my wrist.
“I don’t want. That will be painful.” My heart said, I’ve always put the IV line THERE for my patients. Oh no…
“But I’m not confident to put it there, I want to put it here. I don’t want to poke you more than once.”
Again, it has been my prayers each time before I poke a patient. I thank God now….
“I’m sure you can put it here….last year the MA downstairs in the emergency simply put a green line here…”
“No, I’m not confident. I still want to put this on your wrist.”
“Nevermind, it’s a baby branula. See..” It’s the yellow one we use for subcutaneous line in Palliative Care. I was relieved. “Ok.”

It was not painful. I’m serious. Just a small prick.

Fentanyl…..not painful.
Propofol….oooooouucch!!! My wrist all burnt!!I looked at it….ok, it’s not red. It’s not scalding. And the anaesthetist told the nurse to take off the BP cuff. I thought, this is soooo painful! Lucky I know I’m going to sleep soon….I’m going to sleep soon….I’m going to…..

“Maria, wake up. It’s all done.”
Urgh….groggy…I just want to sleep….let me sleep….

“My jaw hurts,” I told my anaesthetist.
Hey, last year the other doctor massaged my jaw a bit….haha…but it’s oww kayy…

All the hassle and worry had masked the fact of a loss. All the hassle and worry after that would mask anything you feel. The bills, the discharge, the travel home. Funny this now feels like a pathological grief, where you don’t feel it until months later.

Lessons learnt.
It’s worth having a nice doctor, who would help you through tough times.
It’s worth being a nice doctor, hoping that when you’re in trouble, a nice one will help you too.
Be there with your loved ones when they’re going through this journey. It’s scary.
When you’ve lost something, don’t worry about mourning over it. Try not to pretend to be strong for a few days at least. A human needs to feel and needs to mourn. But do wake up after that.
Pray that you only need to poke your patients once for blood each time.
When you’re in pain, it’s hard to ‘score’ the pain.
When you’re in pain, you just wish that the pain goes away, or else you’d just want to sleep through the pain.
Propofol injection BURNS!!

Sixth Sense

People always talk about mother’s instinct, which, I found, is often correct. Some of us have better sixth sense compared to the others.

Like my boss.

It happened one fine evening when I was on call.

I do passive calls, so I could go anywhere I want and only come in when there’s something important I need to settle. So I went home, but stopped by in Shah Alam to have a dinner and long chat with Liza.

After dinner, at around 11pm I received a call from my boss.

He said he went home at around 6pm, then had dinner with his family. Suddenly he had this really bad gut feeling about a patient. He really didn’t feel good about it, so he said to his wife that he really really needed to go back to the hospital to see a patient. And he did.

As soon as he arrived, the patient actually started to complain of chills and rigors. He told the nurse in charge to take his temperature, and it was 39C. So my boss took his blood cultures and started him on a strong antibiotic.

After a few days, the blood culture showed that the patient did have some bacteria in his blood.

Initially I did wonder why did he not tell me to come in at the first place. But then again if I were to do something out of pure gut feeling, I would do it myself and not let other people check on it. Because there still is a chance that your gut feeling is just gut feeling.

I realise that my boss’ instinct could be quite accurate, on patients as well as their family members and his staff too.

I guess sometimes when you love what you’re doing, or the people around you, or that one particular person (whoever it might be), your instincts about that person could at times be stronger.

Like when I call my mother, esp when I’m away, she doesn’t need to see the handphone screen to know who’s calling.

Often, when I was in General Surgery, I would have woken up from my sleep about 5 minutes when my nurses called me saying that a patient had collapsed or stopped breathing.

Or one day in Ramadhan my nurses and I were talking to no ends about this one patient who’s been with us for quite some time, talking about his life and his fate – he passed away10 minutes after that.

Of course, so much more things are untold and unpredictable.

But I guess being at peace with the world and sensitive towards our surroundings would make our instincts stronger.

Romantic Inclination 2 – The Play

This is a continuation of my previous note, Romantic Inclination.

I’ve begun to like one of Siti Nurhaliza’s new songs, Ku Percaya Ada Cinta. The first thing that attracts me is the song arrangement. This song, composed by the award-winning Audi Mok, has a very theatrical feel.

I’d imagine a video clip in which two different people are watching the same musical show, the performer would be Siti, of course. This lady and gentleman probably knew each other at another place and time, but they happened to be in the same theatre on that day, sitting in different places.

They would each think about their past love and life. While in the background ballet dancers would be performing around Siti when the waltz part is played. Then they’d run out when the slow tango begins. Another group of dancers would run in and play something like a pantomime. Another one or two groups will come in and out of the stage, while these two people stare away, partly enjoying the song, partly engrossed with their own stories.

The gentleman would at times look towards the lady, mesmerized with her beauty, wondering what the girl would be thinking of right now. She was smiling to herself and the man wondered what has made her happy. Is it another man in her life? But she seems like she’s carrying a weight in the background, some kind of calm maturity that is written all over her.

And this lady, noticing the man’s stare, but at the same time too careful to look back at him. She knew the look of a man, when he’s attracted. Though she’s keeping it slow and a bit playful.

The ballet dancers waltzed in again. Siti’s voice so sweet and beautiful, they both were brought back to the real world, fantasy lingering on the back of their minds.

The lady looked back at the man, when she thinks he didn’t notice.

The game went on and on during the show.

In the end they left, not without looking into each other’s eyes, meaningful and passionate. But they kept that passion to the slightest.

She walked to her car. The ballet dancers following in the background, having finished their performance that night.

And on her windscreen, a red rose and a note waited for her.

* * *

Mereka meragui wujudnya cinta yang sejati
Tidak hati ini
Semenjak dari mula
Ku yakin ada cinta
Cintalah yang memungkinkan segala

Ku rela biar betapa pun perit tertusuk duri
Jalan berliku tiada bertepi
Ku percaya tidak sia-sia aku diuji
Demi cinta tersembunyi hikmahNya pasti

Pandang-pandang alam ini
Sambil pandang difikiri
Mana bumbung langit tinggi
Mana lantai bumi
Tidak satu yang terjadi
Tidak mungkin tersendiri
Cuba cari jawapannya andai meragui

Mereka meragui wujudnya cinta yang sejati
Tidak hati ini
Semenjak dari mula
Ku yakin ada cinta
Cintalah yang memungkinkan segala

Ada hikmah yang pasti..
Sejak mula ku percaya ada cinta
Cinta itu memungkinkan segalanya
Cinta suci yang abadi

* * *

This is what happens when Maria stays up alone in a quiet night…

Romantic Inclination

I was driving back from work this morning and the song “Aku Cinta Padamu” by Siti Nurhaliza was aired in the radio. I don’t know how the song managed to win the Anugerah Juara Lagu some 10 years ago, despite it being suspiciously similar to Celine Dion’s “I Love You”. Usually I would change the channel if this song comes up (not that I hate Siti Nurhaliza), but today I carried on listening. Maybe it’s just for me to shout along in the car.

I didn’t mean to write about that today, actually. I just had the inspiration on starting my notes this time.

You know, this week I had this “romantic” kind of inclincation. Not exactly that 18sx kind of way, but more of this cosy, comfortable and breezy feel following me around.

Like on Wednesday. Our hospital held a Raya-Deepavali lunch in the sports complex. The food were inside, and chairs were lined up outside in the corridors. There are tall shady trees surrounding that area.

I was a breezy day. My Palliative colleagues and I were not too busy that afternoon. So we lingered a bit longer after lunch.

The I saw this one physician and his female colleague, sitting near each other with just one chair in between, talking, discussing. They were well outside earshot and it’s just the two of them on that corridor. Somehow, they appeared so comfortable, at ease with the day and the climate, softly talking about things. I said to my friends, “I know they’re just colleagues, but the whole picture is so romantic.” Maybe it’s just me. I just love this kind of ambience.

A bit later in the afternoon, when we became a bit busier, we went up to another ward to review a patient. Then I saw a male colleague explaining to a female patient’s relative about something, I guess it’s a diagnosis. He was patiently showing her diagrams, and after that they continued discussing, him with a concerned face, and she was listening and asking and listening again, standing quite close to each other. Again, I know there’s absolutely nothing going on there but I seemed like they were so engrossed in a conversation that everything else around them is not important anymore.

I don’t know why I had those thoughts.

Maybe I spent so much time in the gazebo beneath all those durian trees, with wind softly blowing the cool air, and beloved family around.

Maybe it’s the songs I listened to.

Maybe I was so into sharpening my communication skills that I imagined myself talking, and listening, and talking…..listening and accepting with open mind and open heart, talking in a manner furthest away from being judgemental or prejudicial or suspicious or overly sensitive. Showing that I care instead of being half-listening and half-hearted. I know I have so much to learn still.

Or maybe it’s just a phase. A mixed happy-blissful-euphoric-melancholic phase.

No matter why, I’d just enjoy this peaceful feeling while it lasts.

* * *

“Di sini kau dan aku terbiasa bersama menjalani kasih sayang….bahagia ku denganmu….”

‘My Heart’ is an almost perfectly beautiful song by Acha Septriasa and Irwanshah. It reminds me of the time I’ve just started working. Selayang Hospital looming into view when I drive up there. The empty and lonely hostel room that I stayed in regularly for about half a year. That void but happy feeling I had at that time. And the beautiful moments that followed.

It’s all gone but the hospital is still there, with me working in it. It’s been three years by now. Three muddled years ago…who would’ve ever thought…..?

I’d cherish the beauty, and leave behind the dark thoughts. Anyway, that’s what life is all about. To not face the trials and tribulations means to stand back and watch life to go by. I’ll just soldier on, I’d strive to give meaning to everything I do.

“Bilah yang tertulis untukmu adalah yang terbaik untukku, akan ku jadikan kau kenangan yang terindah dalam hidupku. Namun takkan mudah bagiku meninggalkan jejak hidupmu yang telah terlukis abadi sebagai kenangan yang terindah…..”

Wow. Don’t worry about me. I’m going to be fine.

Pretty Confident

Last Sunday I read my cousins’ Seventeen magazine. I don’t know why they bought it, or maybe it’s not even theirs, it’s in their car. The topics there are really shallow – all about boys, girls and being skinny. Although I do found out a few things about which I wouldn’t have asked anyone.

Anyway, there’s a letter written to the editor that sounded somthing like this:

“One day I was at the beach with a friend. And then a group of guys came by, and they stopped to chat with us. I realised that they were talking and joking and paying more attention to her than to me, although I’m thinner and prettier. She was laughing away and chatting and joking with them. Then I realised that it’s not so much about beauty. It’s more of self confidence and personality. Since then, when I go out, I don’t only make sure my hair is in place, I would make sure I have a great smile of confidence carried with me.”

It’s worrying that many young girls are obsessed about their looks and shape. That skinny is pretty. The images shown by the press are just not healthy.

On the other hand some just do not take care of their health well. Eat and drink just about anything and exposing themselves to all sorts of health risks.

Again, it’s always about balance.

I do agree with the girl, though. I found that a great personality and self-confidence would shine through, no matter how small or big you are. It’s not like you don’t need to take care of yourself. Simplicity is the best way of life.

I found that obsessing about our looks all the time just takes away our energy and our glow. Just imagine being self conscious while trying to chat with our friends, or a person we like, or our crush. The conversation won’t go smoothly and we may not turn out to be as attractive as we actually are.

Oh, and I found that looking at someone straight into his/her eyes and then smile, makes a huge difference. And when they smile back….. 😀 😀 😀

Ghareeb 3 – Of Doctors, Engineers and Reese Witherspoon

Recently we had this misunderstanding against an engineer. Well, it’s more of, we explained, and her being unable to understand the concept of medicine. Anyway, not many doctors understand palliative care, but yes, she asked us the same question over and over again.

My dear colleagues (friends) and I were talking about it, about why it was difficult for her to grasp our explanation. Even our dear boss has explained a lot of the neurological phenomenon so many times. Just imagine, neurology itself is not a favourite topic to many medical students, even to neurologists there are so many grey areas that are yet to be explored. Now, try explaining these grey areas to an engineer. Hmm…

My brother (a financial analyst with strong memory of biology) told me that, yes, it IS difficult for (some) engineers to understand that sometimes, in life, there’s just no definite answer. He once had a debate with a colleague, who has a degree in mathematics, on how the H1N1 statistics are not correct because according to formula there should be more deaths than reported, so the government is lying to us and hiding facts so that we do not panic.

He said the maths graduate did not even consider prevention efforts, background illness of each patients, isolation, quarantine etc. And the maths graduate could not fathom the way human beings work. Or the way diseases are spread, or contained.

(By the way I’m proud of my brother for his logical thinking)

I surmised this much:
An engineer would say, 1+1 = 2.
For a doctor, 1+1 = depends on what you add on.

One apple + one apple = two apples
One glass of milk + one glass of milk = one big glass of milk
One mummy + one daddy = three in the family, sometimes more.
One breakthrough morphine 30mg + one breakthrough morphine 30mg = one transdermal fentanyl 25mcg/h.
And the list goes on and on….

I read in Reader’s Digest, they interviewed Reese Witherspoon on raising kids. She grew up in Nashville, Tennessee. I would like to quote the last paragraph:

“In the South, there’s a real sense of community – the feeling that people come into your life for a reason. Because I grew up with that, I take my children to church in Los Angeles. It takes you out of your personal experience and universalises it. You understand that whatever you’re dealing with, someone in that room has either dealt with the same thing or will do in the future.
We are all struggling to figure out what life is about. We are all just looking for answers.”

Don’t you think it’s sooo true?
Sometimes when we’re having a problem, or just confused with life, it’s useful to socialise, to talk to someone open enough, and in the end you know that you’re not alone. If they can face it, why can’t we?

I’ve never, ever, in my life, attempted to finish one whole durian alone.

Today, as I arrived home from work, I saw Cik Jib, Cik Lina, my mum, Wak Nas and Nadia at the gazebo. So I dismissed my need to go to the bathroom, and headed straight to the gazebo.


My mom was making tempoyak.

So Cik Jib chose a nice one for me, opened it…..and there you go.


One by one I ate…when I realised I’ve already taken half the durian!

But I just had to stop. I still had space. I just needed to stop, because there’s something about me that won’t take one food if I’ve eaten too much of it. I was scared that I wouldn’t want to eat durians anymore.

Therefore you didn’t see this status from me today: “Finished one whole durian on my own. Broke my own record.” Because I did not. Haha.

I wanna wake up early tomorrow. I wanna go for CME.

Rezeki Halal – My Simplified Understanding

Rezeki halal.

Not just the nature of the job.

But also what you DO with the job.

Kerja mesti betul – betul. Tak boleh ponteng. Tak boleh short cut.

Kerja mesti berkhidmat, bukan asal siap.

Kerja mesti fikir untuk menyumbang kepada orang lain, bukan untuk lepaskan diri sendiri saja.

Kerja datang awal, balik lambat. Kurang-kurang cukup masa.

Timbangan dan claim kena tepat.

What are we going to do with the rezeki anyway?

Kalau tujuan untuk perkara wajib – insyaAllah berkat. Mungkin Allah gandakan dalam cara yang kita tak tahu.

Kalau tujuan berbakti kepada orang tua dan ahli keluarga – insyaAllah berkat. Harap Allah gandakan dengan cara yang mungkin kita tak sedar.

Kalau tujuan beli benda yang halal – insyaAllah berkat. Tapi kena hati-hati.

Tujuan tujuan lain, antara diri sendiri dengan Allah. Berani buat, berani tanggung. I won’t be judgemental.

This is just my simplified understanding. I promise myself to do better each day (although sometimes I do fail).

Make It Worth the Pain – The Climb

Someone said this before, and I can’t remember who it was. This person (I think it’s a he) was away from his parents, studying, I suppose. So he studied hard. And he said, “This distance between us is difficult for me. So I might as well make it worth the pain.”

Which made me think, and changed my perception, my motivations a little bit.

You know people always say, there’s always a silver lining. There’s always light at the end of the tunnel.

In the Quran it’s mentioned twice in Surah Al-Insyirah. It means something like this, “There’s happiness after difficulties. Indeed, there’s happiness after diffictulties.”

In times of pressure and stress, I have to admit that it is difficult to believe in that. At times problems arise, one after another. Sometimes the list of responsibilities and burdens are just endless. And people’s mouths are always foul and criticising and condemning and demoralising.

Often consoling words are offered. They always come out like this, “I know there must me something good coming your way. I believe that.” Those at the rock bottom would have thought (or maybe said), “It’s easy for you to say that. For me this is endless.”

It occurred to me just now, well, if you think it’s endless, it IS endless.

God has promised us that good things will come after a test, a challenge, a period of difficult times. God has promised us that He’ll grant whatever we pray for, or give us not exactly the things we asked for but replace it with something even better. God has promised us that He won’t change the fate of a person, unless that person works to change his own fate.

During hard times, it’d be easy for us to bow down to defeat. It’s easy to give up. It’s difficult to hold on to our faith. It’s difficult to believe that something good IS coming our way.

Well, when I think about it, of course nothing good will come our way if we stay in bed crying everyday.
Nothing great will come our way if we sit down and fret about our misfortune.
Even worse things will happen if we hang around blaming others and spreading untruths about why we have failed.
Even worse things will happen if we continue harping about the fact that we’ve fallen, without plans to climb back up.

Everybody knows that life IS a bed of roses – it consists of nice flowers with sweet smell, but it also comes with the thorns.
Everybody knows we’ll lose once in a while.
Everyone knows that life has its ups and downs.
Everybody gets hurt. Some harder than others.

Why can’t we make it worth the pain, then?
It’s worth going through the pain if we’re going to be a better person.
It’s worth going through the suffering if we’re going to be happy later on.
It’s worth climbing up after the fall, when the view is great and the top is beautiful.
It’s worth holding on to that faith, the faith that says, “God has promised us….this is His promise, and He’ll hold on to it.”
So why can’t we hold on to Him too?

Because if we don’t, it’s not worth the pain at all.
It will only be an empty space that means nothing.
And our lives will mean nothing too.

* * *

Miley Cyrus’ The Climb

I can almost see it, that dream I’m dreaming
But there’s a voice inside my head saying, “You’ll never reach it.”

Every step I’m taking, every move I make feels lost with no direction
My faith is shaking

But I gotta keep trying, gotta keep my head held high

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

Ain’t about how fast I get there
Ain’t about what’s waiting on the other side
It’s the climb…(and the view is great)

The struggles I’m facing, the chances I’m taking, sometimes might knock me down
But no, I’m not breaking

I may not know it but these are the moments
That I’m gonna remember most, yeah, just gotta keep going….

Sense and Sensibility

Just now during Journal Club, part of the ethics-related article discussed about management of resources, and its connection with decisions on patient management. I was then reminded of a Hadith by our beloved Prophet Muhammad (PBUH and family). I can’t recall the exact words but I sure took in the essence of it:

“Even if there’s a river behind your house, there’s no need to use so much water for ablution.”

It means, even if there’s so much water, use judiciously, just right for your needs. For ablution (that’s cleaning parts of our body before prayers/reading Quran etc) one do not need much water. And if you could keep it till the next prayer time, why not.

It goes the same for other things in this world.

From things as simple as electricity, food, water, money….because you never know when you’ll be taken off all that.

It stays true for us medical personnels, especially when we’re living in a comfortable country.
Example, using gauze, syringes, canullae…we usually simply use the 10mL syringe for almost anything, not realising that it may be the last of the stock before the next one comes in next week. We do a lot of unnecessary procedures, write up many unnecessary medications, just because we can. Sometimes when treatment is most likely to be futile we still do something just because we can.

Hence the ethical discussion we had (actually, the people in the case had). That man has fairly good prognosis, only if he’s compliant to his medications, and takes care of himself well. But his only interest in life is tobacco and alcohol, and he’s homeless (runs away from the welfare home after a week there). Spending thousands of dollars for his anti-retroviral (HIV) therapy alone may lead to different pros and cons – towards him, and the society.

Those thoughts led me back to Rasulullah’s words. Although it seems like such a simple guide for life, but when you think deeper about it, you’d find that it covers so many aspects in this life that we may never imagine.

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