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Maria-Syamsi

From My Heart

Month

July 2013

Learning From the Dying

I was in Palliative Medicine for more than three years, mainly recovering from a deep wound, taking small steps each time. The question often asked is, how can you stay in Palliative Medicine for that long and not feel depressed?

Rather than hurting, it actually healed.

It helped me learn to live, seeing death and the process of dying. Day in, day out. It’s something that you don’t get to learn elsewhere in life.

* * *

It was July 2011, almost about the same time now. A patient was admitted under our care with lung cancer which has spread to the brain. She had some pain and headache.

Early afternoon on a Thursday after a quick lunch, we were called by the nurses, telling us that she started fitting. We attended to her urgently.

True enough, she was fitting. All her limbs are moving, her eyes rolled up, saliva drooling, her breathing noisy and heavy. The high flow oxygen already in place. Her daughter crying next to her.

We had to gave her a few medications before we could sustain her fit-free. Diazepam twice. Then phenytoin. It didn’t work.

I cried giving the second dose of diazepam. “God, please stop this. Please. Have mercy on her, on her family. You are the Merciful.” But her fits just wouldn’t stop. Her daughter was crying and calling other family members. They came within the hour, set a few prayer mats in the room and started praying for her in congregation.

In the end boss decided to give phenobarbitone. Yes, that worked.

It took us a few hours to settle her.

* * *

I was not around the day after, the two bosses and I went to Penang for an international conference, which left Jaspal and Kamalah to care for her.

The fits finally stopped, phenobarbitone infusion continued. However she developed death rattles – that gurgling sound of lung secretions that you can hear when someone approaches death. It doesn’t happen to everyone, and if it happens we do have a few medications that we could offer to reduce them.

As with the fits, they needed to try a few medications before settling with the largest dose.

* * *

She passed away on Sunday, three days after she started fitting.

* * *

It was not something that was easy for me to see.

I texted a few of my good friends, during her few minutes of fit-free period.

They responded to my anguish.

The image is still clear until now, it’s been two years.

It changed my views of life, and death, and dying.

At the same time, it enabled me to answer some questions people ask about a dying person. You see, we believe that a good death would only come to a good person, and vice versa. But seeing a bad death, how would we know that it really is bad?

Sometimes it does take a long time for someone from a critically ill, barely conscious state up to the actual death. For some, it’s short and easy.

Seeing difficult dying process, many asked me, “Don’t you think there’s something that he/she has done, something he/she has not let go?” I’d tell them, “This is a test for everyone. For you, for me, maybe for her. We can’t judge her for this.”

I mean, we don’t know, you see. They may appear to be suffering but we don’t know how they actually feel deep inside. What they actually are seeing. It’s a test so that people will learn not to associate difficult deaths with unforgivable sins. It’s a test so that the family and friends would continue to pray for them, not just during the dying process, but also when they have left.

Most importantly, it’s a message for us to prepare. To take our steps to get closer to Allah. So that when our time comes, we will feel welcomed to our next life.

It’s a message for us to make things easy for others in this life, so that, hopefully, Allah will make it easy for us when the time comes.

No matter what we think they might be feeling, suffering should be alleviated. The fits, the rattles, the pain must be settled, or at least reduced. Especially so when they could not tell us what they feel, we need to feel for them.

Seeing such death really reduced my mood at that time. Lost all the excitements in life. That’s how deaths heal – because you know that all the pain, loss and suffering in this life are temporary, and are means to achieve greater good in the next life.

* * *

Thank you my dear ones, for being there for me at that time. You may have forgotten, but I could still recall it.

* * *

I was so far from You

Yet to me You were always so close

I wandered lost in the dark

I closed my eyes to all the signs You put my way

I walked everyday further and further away from You

Allah, You brought me home

I thank You with every breath I take

Alhamdulillah

Alhamdulillah

All praises to Allah

All praises to Allah

Alhamdulillah

Alhamdulillah

All praises to Allah

All praises to Allah

I never thought about all the things You have given to me

I never thanked You once

I was too proud to see the truth and prostrate to You

Until I took the first steps

That’s when You open the doors to me

Now Allah, I realize what I was missing by being far from You

Allah, I want to thank You

I want to thank You for everything that You’ve done

You’ve done for me through all my years I’ve been lost

You’ve guided me from all the ways that were wrong

Indeed You gave me hope

Allah, I want to thank You

I want to thank You for all the things that You’ve done

You’ve done for me through all my years I’ve been lost

You’ve guided me from all the ways that were wrong

I want to thank You for bringing me home

“Thank You Allah” by Maher Zain

* * *

I am forever grateful to Imam Suhaib Webb, Wardina Safiyyah, Mariam EmirIbrahimi, my kakak Yasmin Mogahed, and the gentleman behind Islamic Thinking (whoever that might be), for helping me through. I pray that Allah will continue to show us all the right path, and keep us there.

* * * 

Hazrat Ibnu Umar (Radiyallahi~Anhu) said: “I was one among ten people who came into the presence of Prophet Muhammad SAW. One Ansari stood up and asked Prophet Muhammad SAW: “Who is the most intelligent and careful person?” Prophet (Sallallahu Alaihi Wasallam) replied: “Those people who remember death most and prepare for it most. These are people who have excelled in the nobility of this world and the honour of thehereafter.”

[Reported by Ibne Abud Dunyaa and Tabraani in Jaamizlos Sagheer with a good chain of narration. Ibnu Maajah has reported it briefly with a good chain of narration as it appears in Targheeb.]

Learning From The Dying – Love Your Parents

SONY DSCRamadhan brings me lots of memories. Today I was brought back to Ramadhan in 2009, when one of our patients passed away peacefully.

* * *

Mr Kassim (not his true name) was transferred to us from Hospital Kuala Lumpur Oncology Unit. Boss told us that he is fairly independent, but he has no place to stay as his family would not take care of him.

He was unfortunate to have had a terrible nasopharyngeal carcinoma (cancer of the nose and throat) which has eaten up his nose, the sides of his nose, the bones around one of his eyes, and his upper jaw as well. Because of radiotherapy, his face was even more scarred and he could not open his mouth to eat. He could only feed himself through an opening where his front teeth has dropped.

There were many nodules on his face, which would swell and cause severe pain to him. They would one day rupture and his pain would subside. When they rupture, they would discharge foul smelling pus and sometimes blood. It happened again and again throughout his stay with us.

The cancer is probably not the most unfortunate thing that happened to him.

He is married and has a few grown up kids. His wife would come in bright red blouse and scarve, scrawny and sulky, asking for money. She doesn’t come everyday. If she comes, she’d pull the chair towards the end of the bed and looked at him with disgust.

He’d struggle around looking for his ATM card. She’d bring him down to the ATM machine, withdraw his money and go home happy. He’ll be left alone for another few days.

We rarely see his children.

One day his wife came to the ward, asking us to write some letters to the bank saying that Mr Kassim is too ill to go to the bank, so that she could withdraw his money easier. Thing is, if he was lying on the bed, to weak to walk, we would have written that letter. However, he could still walk around, go to the toilet himself, feed himself. In fact, he could actually be discharged and they could go to the bank together. So we did not write the letter for her.

One weekend when I was on call, my nurses called me to his room, telling me that his face was bleeding. A lot. When I went into the room, he was standing in front of the mirror, tissues on his face, he was trying to stop the bleeding himself. His son was there in the room. When he saw that it took us some time to settle him and make him go back to his bed, the son came near, Mr Kassim’s ATM card in his hand, and shouted, “What’s the PIN number? What’s the PIN number?? Where did you put it??”

I was so shocked that I didn’t have anything to say. My nurses and I just went on and helped him with his bleeding tumour nodules.

Another day came, his wife walked into the ward, angry, because the bank no longer let her withdraw any money from his account, because apparently the bank officer called our ward and asked about his condition. She had a huge fight with him, and he ran out of the ward. We came out from our meeting to see what’s the commotion all about.

The wife was furious and let is go on Astrid. She said, “This is ALL your fault! You never helped me with his money and now the bank doesn’t trust me anymore!!” Astrid, having seen this for so long, told her off, “Well, you seldom come, and if you do, you only come for his money!! THAT’S why we don’t trust you!” The wife started mumbling and walked out of the ward, looking for Mr Kassim. In the end she got what she wanted.

There was one day, he complained that he was hungry. We all know that he couldn’t open his mouth. But what did his children do? Buy him some cream buns, put them in front of him.

I was so sad, I bought him baby nestum that’s so fine so that he could mix them and put them through his teeth.

He became weaker within Ramadhan. He often stumbled when he walks, so we had to put him near our counter instead of his room.

One day after iftar (breaking fast), my nurse went to check on him.

He was lying there, quiet, his soul has left his miserable body.

He passed away without anyone near him.

We cried at his state, but we know that he’s in a better place now.

Scrubbing the Pots – We’re A Bunch of Bullies

Sayang,

 

Now that we’ve welcome you into the family, please let me say a word or two. 

 

First and foremost, it would be nice if you could excuse my uncles’…erm…behaviour…towards you. From some outsider’s point of view, they, or we, are probably a bunch of bullies, but I can assure you that we’re not.

 

I’ll tell you why, and how.

 

From past experience, I decided to forewarn you that you will have to scrub and wash the big pots after the reception ceremony has ended. That is, after our family members have packed all the leftover yummy food to be eaten tomorrow as none of us would have the energy to cook.

 

So now I can hear them telling you to make sure the pots from today’s cooking are clean.

 

No, I’m not going to object to that. The most that I’m going to do for you is tell them that “we’ll do it first thing tomorrow morning.”

 

I’m pretty sure that for the next few weeks, they may find things for you to do. For instance, help light up the barbeque fire, be the bilal during tahlil, or if they see fit, you may be asked to be the imam for our prayers and monthly tahlil. You may also be the person who will need to carry pots, plates and carpets from one house to another during our monthly family event. Maybe change the lightbulbs, clean the dinner table, sweep the gazebo floors, mow the lawn, sweep the dry leaves, pick the durians. No, you’re not going to do that alone. My friendly but sometimes not so talkative young male cousins will do that with you. They will show you where the stuff are, or who to ask for the stuff. 

 

Of course, Adib will find a way to follow you wherever you go, dig out some of your (and our) secrets, tell you gross jokes, pull your leg once in a while. 

 

I know some men can’t take it. I know for a fact that some ran to their parents and tell them “her father and uncles made me do this and that…such bullies..” 

 

I know, my dear.

 

That’s why I need to tell you the reasons behind their never ending orders (that, if you notice, come with laughter).

 

You know as junior doctors we were ordered to do so many things. We were the ones who see the patients first, take their bloods, set IV lines, run to the lab when it’s urgent, call other teams to review our patients, speak to the radiologist and anaesthetists…the list goes on and on. We all understand that it was done that way so we will be orientated into the workings of a hospital, what’s important and what’s not. The training is handed down every year, to every house officer that comes along. 

 

The same goes to our family.

 

You may have noticed by now that my father has 10 siblings, my mother 11. On my father’s side I have close to 40 cousins, and many of them are as close as my own siblings. It sure is daunting to get to know their names; it doesn’t help that some of them look alike. So helping us out, carrying things from one house to another, is a way to get to know all of us. 

 

We also need to know (although it’s a bit too late now you’re married to me) whether you’re the responsible type or not. Whether you’re going to leave me behind when times get rough, or are we going to hold hands and face the world together. Whether you’re the kind of person who will try to get to every family event, or use “on call” as an excuse for you not coming because you just hate to see all those bullies. 

 

Really. 

 

Maybe you weren’t family before the ceremony, but you ARE after the ceremony. I’m sure there’s nothing wrong in helping everyone out cleaning the place up after such an event, although ours is probably the smallest. It’s not like my mother is asleep in the room up to the afternoon, or my father carried away with his laptop. You see everyone’s doing something. 

 

The most important thing is, we do want to like you. Me included, although we’re married, we need to grow, you see. 

 

We do care about you. You should worry if everyone decided to ignore you, not joke around or laugh when you’re around. The thing about us is we love to joke around and “kacau” others quite a bit, but we wouldn’t do it towards someone we don’t like.

 

Well, actually we might ignore you in the end, once we’re comfortable with you because that’s when we’re comfortable enough to just sit in silence without it being awkward. That will come way later. 

 

Oh, furthermore, you’ll have some other new cousins coming along. Their turns will come too. 

 

So, sayang, welcome to this huge family of Milatu.

 

Don’t worry about the hard work, we ARE a family, we love to get together a lot, and there’s a lot of hard work to do here. It’s not like we want to use up your energy for our own good, as a family we need to stick together and help each other. I’m pretty sure that’s the kind of family that you’d want to build with me, right? Hence the process starts with us being helpful and useful ourselves.

 

It’s not like I’m going to sit around like a queen well, unless you told me to. 😉 

I’ll be in the kitchen preparing a hot butter cake for you and everyone, with teh tarik or coffee. Or would you want some high fibre, high protein and high GI sandwich? That Starbucks instant coffee to come with it? Or just a few pieces of Jacob’s cream crackers? 

 

Anything for you, my dear.

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