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Maria-Syamsi

From My Heart

Month

March 2014

I Don’t Know

If you have a doctor as a life partner or relative, or if your children are doctors, it is most likely that you have experienced the following. While some of you may have stopped asking, some will still pretend that they have never had the same answer before.

Ask a doctor the following questions, and the answers that follow:

1. Are you joining us for the wedding next month?
“I don’t know.”

2. What time are you going to finish work tomorrow?
“I don’t know.”

3. Will you be able to join us for dinner Wednesday next week at 7pm?
“I’m not sure.”

4. When will you be free to come over to the bank and sign the agreement, within next week?
“I don’t know..I have to check with my colleagues, that is only if I’m not too busy.”

5. If we plan for a holiday overseas in 6 months time, would you be able to come with us?
“I don’t know.”

6. You’re working this Saturday? Will you be able to make it for my mother’s birthday lunch?
“I don’t know.”

7. Will you be the photographer for your cousin’s wedding in 4 months time?
“I’m not sure.”

8. Will you be around for the family gathering during this coming public holiday next month?
“I don’t know. I didn’t work previous public holiday so they might put me on call the next public holiday.”

9. How many days off can you get for your wedding?
“I don’t know.”

10. When is your exams going to be?
“April 23rd.”

Heheh.

Affected

I don’t know why I am so affected. I don’t even know any of them.

My tears flowed steadily when I first read about it last night, before trying to get some rest in the on call room.

I cried the whole way back from work, which was about 40 minutes. I reached home, switched on the TV and cried even more.

I’m sure many of us Malaysian are affected by the lost aircraft MH370, even when we don’t know the passengers or the crews. Many of us organised prayer events for ease of searching the plane and strength of their loved ones in facing these troubled times.

Personally for me, there are many things that went through my mind.

I love traveling, and I love flying. There are times that I wish I could take flying lessons and be a pilot.

It doesn’t mean I don’t get worried everytime I fly, or when my loved ones travel.

It reminded me of all those days spent praying for the safety of my loved ones – my mom, my dad, my brothers, my dear little sister, my grandparents – whenever they travel.

Dad used to fly almost every week, doing what he did. No, he’s not a pilot but he visited Sabah and Sarawak so often those days. I used to wait at the airport whenever I could, for him to come home. It was nice to hear his stories about the flight crew, the pilots he spoke to, and now I wonder whether he knew any of the crew involved in that fateful incident. As nice as it was, I knew he must have had a few scary moments on board the airplanes he rode.

I could still remember all those moments wondering whether those were the last moments I see them. Alhamdulillah, up to this day, with His mercy and protection, they are still alive and well.

My parents (and the rest of the family) make a huge deal of goodbyes. We make sure we hug everyone before leaving, and the person who’s left behind would at least stand at the doorway and wave until we’re out of sight. Of course there are days that one of us may have left feeling angry, flustered, sad…but thankfully nothing very bad has happened so far.

May this be a lesson for us, to mend everything before we say goodbye.

I remember the days before the long distance trip I made with my little sister. All those moments praying that all will be well, making the effort to say extra prayers anytime I could. I remember the anxiously-happy (if that is even possible) feeling when we step on board Etihad Airways, knowing that anything could happen, also knowing that the risks are rather low. Yes, our prayers were answered, with His Mercy, the trip went very well, and we escaped a horrible storm by a few days.

I remember my grandmother’s final wave at us, longing and sad at the same time, when we left to meet our parents in Kuching. That was the last time we saw her alive, as she passed away suddenly a few days after.

I am lucky that I started flying so early in my life that I can’t remember when my first flight was, but there are flights more prominent than the others in my memory. Like the first time flying alone (with some strangers supposed to be my classmates) to Ireland.

Then I wondered whether any of those passengers were first timers. Imagine the excitement, the anxiety, the expectations; packing for stuff hoping that you don’t miss anything, planning to get souvenirs for the family, plans to spend more time with loved ones after the trip, wondering about the weather there at that foreign country, hoping for a better future at a new work place, wishing for more recognition in another country, dreaming for a more peaceful life…I could only imagine what the loved ones are feeling right now.

I remember the time when almost all of my family flew to Miri for a wedding last year, and I was left behind for a few hours because of work commitment. I was extremely worried, should anything happen to them all in Miri, i would have been devastated. There must be at least 20 of them and they were my pillars of strength, they still are. I flew in to Miri and we spent one of the best weekends of my life there. 20 of us flew back in one flight and that was probably the most beautiful, the happiest flight I’ve ever been in.

I was brought back to the same period of time five years ago, waiting alone, being in the dark, uncertain of my future, dizzy and drowsy all lumped together, receiving news from people whom I don’t know whether I could really trust them, and finding out they could not be trusted, sadness and anger and confusion all playing in mind….only to find that hopes are crushed and sweet memories are gone.

But none of those could compare to what the loved ones are feeling right now.

Therefore, I pray so that the loved ones of the crews and passengers of flight MH370 will stay strong in facing this life.

Palliative Medicine: More Than Just Morphine (Part II)

Assessment and management of patients with advanced cancer involve physical, cognitive, psychosocial and spiritual aspects. A holistic approach would ensure that the aim of care is achieved. Much of the assessment would require the physician to spend time with the patient, asking relevant open-ended and specific questions, listening to the related as well as seemingly non-relevant answers. Effective communication skills will point us towards the hints and signals that the patients give away.

Physical management involves symptom control – pain, difficulty breathing, dryness of mouth, early satiety, as well as the ulcers and wounds as direct results of the tumour itself, side effects of medications or from the disabilities caused by the cancer. Since many of the patients need to be treated with opioids and steroids, careful approach need to be taken when starting, maintaining and counselling the patients about these drugs. Education need to be given to each patients to encourage them to manage their symptoms, learn about the drugs they use and undo the stigma that comes with those medications. There is still much to do in terms of training physicians regarding their use and safety as well.

Advanced cancer affects the cognition and mental capacity of a person in many ways. Patients may have metastatic brain lesions, hepatic encephalopathy, uraemia, hypercarbia, acidosis, anaemia or simply lethargy or depression. Even when the disease is incurable, and the solution of many of the above is “treat the underlying cause”, there are much to be done to control those symptoms.

It is an art to be able to draw a line between searching aggressively for the cause of symptoms, and controlling the symptoms, without compromising patient’s quality of life. This makes it useful for future physicians to have early exposure to palliative medicine, as this is a skill needed in practice, especially in General Medicine when it’s too easy to list down a line of investigations despite the patient being terminally ill.

It is also an essential skill to be able to make it clear patient’s loved ones why certain investigations and procedures are not carried out, as they may not be of patient’s best interest at that point of time. It takes a combination of sound knowledge in medicine, genuine concern for the patient and good doctor-patient-family relationship. Despite all the years in palliative medicine, I still am pleasantly surprised on how much understanding some patients and their families have on death, dying and futility; at times with more comprehension than the average physicians themselves.

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Searching for the Unknown

First and foremost, I would like to express my utmost gratitude to those involved in the search and rescue mission for MH370. Their hard work and sacrifice for the sake of those unknown to them is highly appreciated.

Although I do not know the nature of a search and rescue mission like this but after much listening and watching, as a doctor, I could empathise and feel for what they are facing.

I’m sure most of my colleagues have similar experience.

For us working in hospitals, patients would come in unwell, for one reason or another, we diagnose them with certain conditions, give treatment and hopefully in a few days time, we could discharge them home, in a better shape.

However, for some people, it is not as easy as that.

There are patients who have persistent fever despite having given antibiotics, even when the antibiotics given are changed to stronger ones. When it persists, we’d need to start investigating again, to search for the source of fever and give the right medication or treatment. We would need to take more blood samples, do some scans, sometimes proceed with other invasive, more complex procedures, even with surgery, to be able to get the answer.

Sometimes patients might have abscesses but despite drainage, the fever doesn’t come down. At times we could not find the type of bacteria causing the infection, making it difficult to decide on which antibiotics to use, sometimes empirically given.

At times we could not even find the source of infection, even after two or three weeks in the hospital.

The same goes as cancer. After doing some scans, some growth could be seen but biopsy may be inconclusive. Or even when the biopsy says cancer, we could not get the actual origin of cancer as the cells were so badly mutated.

Believe me, we would ask for other expert opinion, from different teams, and even different hospitals, to make sure that all possibilities have been explored and all areas have been covered.

Sometimes time would run out, patients get more ill and somehow we could not get the answers we wanted.

No, doctors don’t know everything, and even with current technology, we can’t say we could detect everything that has gone wrong.

That’s not the only problem. Conveying the message that we couldn’t find the answers to patients and their families could be difficult. They would be more and more frustrated as their loved ones become more unwell.

Those who understand the mysteries of life and limitations of human capacity would be able to accept our shortcomings, but not all of them do. Some become angry, demanding quick answers that we wish we could have given to them, threatening to sue or lodge a complaint. Some become anxious and unable to let the doctors do their jobs, asking the same questions every few hours despite given the appropriate explanation.

Some would give unreasonable suggestions that is not suitable for the condition or situation, and some might refuse investigations, thinking that doctors were treating them as “guinea pigs” when in reality, we’re trying to search for the answers via various means.

Even worse, some might resort to other methods, other opinions which could be from non-medical professionals trying to sell them expensive supplements and wonder drugs, or “bomoh” (shaman) who, most of the time, have better communication skills than many doctors but no idea what they were doing.

Some patients and family members refuse certain treatments or investigations because of advice given, or stories heard, from people around them. Most of the time, they thought they know medicine just because they frequently visit the hospital or have friends who have similar diseases or they are member of multilevel marketing companies selling wonder drugs that could cure all illnesses.

Sadly, some refuse to comply to therapeutic medications just after reading a few hadith from Prophet Muhammad SAW, claiming that all they need is “natural, Islamic remedies”, while not even being aware of the basis of Islamic medicine. They are not aware of how people like Ibnu Sinna, Ibnu Qayyim Ajjauziyah (and many other Islamic medical scholars of old) did their researches. They are not aware of the complexities of human body that could not be cured by “just depending on honey and habbatus sauda”. Much of the modern medical research (without them realizing it) is evidence based, the similar way that Prophet Muhammad’s Hadith are researched.

* * *

Back to searching for the lost aircraft.

I notice that not only people are sad, angry and frustrated, they try to speculate and if they could, intervene with the search and rescue mission. Many think they could have done better, even better than those experts who are involved in the mission. Many make unreasonable speculations and inappropriate remarks about the loss and the mission. There are those who have sceptical response to everything our national leaders are telling us, or even when the professionals speak.

I wish, and urge my fellow countrymen, to leave it to the professionals in searching for the missing aircraft. Although some sources are not reliable, but I’m sure they are doing their best to look for the missing plane as soon as they could.

Last but not least, I would want to extend my prayers for loved ones of the passengers and crew of the missing MH370, so that they will stay strong through this ordeal.

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The Baggage

A few months ago I saw someone posted on facebook a photo of Dato Seri Anwar Ibrahim with his wife, Datin Seri Wan Azizah, and their three youngest daughters. It was a beautiful photo, and many men commented about how they wanted to become Dato Seri’s son-in-law, saying things like “When will I be able to call you father, Dato Seri?”.

This post is not at all related to politics, or Anwar Ibrahim, or his daughters. It’s about something that I have always wanted to write about, but haven’t gotten an idea how to start, until I read those comments.

Are these men really up to it?
* * *

I hope I do not offend anyone, as I do not intend to do so. All I wanted to talk about is about challenges in life, and the companion we need to travel with.

You see, the divorce rates are rising, and among those marriages that are still intact, you’d wonder how many of them are truly harmonious. I believe that part of the reason is people feel frustrated as they do not get what they wanted or expected from the marriage, having been fed and supported through their lives by their parents, given everything they ever wanted. There are also some who probably could not stand the challenge that life throws at them, failing to be there for the partner when trouble comes along.

There are men who left their wives after she miscarried for the second time, or after finding out that the wives’ parents are having marital problems/health problems, and worse still, divorced their wives when they found that the wives have breast cancer (or any other illnesses), rather than being there for the wives.

“I am suffering, I have my needs too,” said some breast cancer patients’ husbands. Or later, ex-husbands.

Then there are parents who could not stand seeing their sons suffering, or facing difficulties in life. They want the best for their sons and the definition of “the best” is for him to not face any challenges. So they became unhappy, some mothers even told the sons to divorce their wives when she failed to get pregnant after two years of marriage! Some said, “My son has never failed any exams, until he met you. He was so stressed because of you,” to the daughter-in-law (these are not just Malay drama material, these are real life issues).

What hope do these men have if they marry into such a troubled family life like our ex deputy prime minister’s?

Just imagine, you met a girl, nice and pretty, you wanted to marry her. But her father has personal issues, her mother is trying hard to cope with her father’s issues on top of being unwell and ageing herself, her brothers and sisters are on the verge of breaking down because of the troubles the parents are in, when they are supposed to be growing up happily.

The family is breaking because nobody could trust the father anymore, although he was the one who raised all of them with all his love, fed them, educated them.

This girl you wanted to marry, it is likely that she is part of the reason why the family is still intact. She might be the one who have told her siblings that they should love their parents no matter what. It might be her who have supported her family financially, helped out when parents were unwell.

When you marry her, you might want your own family life, but would she be happy just leaving her family behind like that?

She’d want to be her mother’s confidante as she always was. She’d want to be there for her brothers and sisters when things become too much to bear.

She would need your full support when the father runs into problems again, she might become needy and emotional, and she would need more of your time than you’d want to give. She would need your listening ears, as difficult as it is to fit that time into your busy schedule. She might even cry further if you said the wrong things and complicate the already troubled matter.

She may not be able to join your parents in all family events, because sometimes even with a long standing issue, there might be some new problems that come along and she would want to be there for her family.

Would you let her go, even if it means not having her home-cooked meals for a few days?

Or do you think taking her away from all this, would make her happy? Would you calm her down by saying, “my parents love you, why can’t you be happy with my parents? Why should you miss your own parents when mine could give you everything?”

Her father might not be the best of man, a man with not the kindest behaviour, someone who has been labelled all sorts of things by his own family or neighbours or even the whole country. Her father might have gone to prison, and there are possibilities that he will be incarcerated again. You might believe that he is indeed a bad man, you might think that he doesn’t like you.

But he is still her father.
He is still the one who raised her with all his love, fed her, educated her, despite his own shortcomings, despite his own weaknesses to all things wrong and illegal.
He is still a big part of her past that made her the person you wanted to marry, or already married.

The moment you married her, he became your father too, and he should be treated with respect and love, like your own father.

The moment the two of you are married, her problems become yours. You can’t take that away from her because those made her the lovely person she has become. In fact, without all those troubles in life, she may not have become such a mature, amazing person that you fell in love with.

Marriage is about companionship, a friend told me. Nobody said marriage is easy. Nobody said LIFE is easy, but the journey in life becomes easier, the baggage becomes lighter when travelled with a trustworthy companion.

So, are you up for it?

Are you that trustworthy companion, or just an additional baggage that she has to carry around with her?

A Train of Thoughts

I have so much to write about! So much!

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

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.

The first step. Women’s journey to partnership. A short one.

Imam Suhaib Webb’s lecture on education in KGPA.

How to focus in solat – lessons from Imam Suhaib Webb’s lecture in KGPA

Surviving medicine.

Inspiring senior medical colleagues – the amazing government hospital specialists and consultants

Learning from the dying – It’s too late

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 is what coffee does to me. I get agitated. Wish me luck! 🙂

Sinus Tachycardia

I was running.
The screen showed some numbers. 155. 160. 167.
My heart rate.

I breathed faster, trying to get more oxygen.
I ran further.

I’m on call tomorrow, in cardiac ward.

If I see those numbers on the cardiac monitor of a patient, my heart would race a bit.
Tell me it’s just sinus tachycardia.
No way it’s just sinus tachycardia. It’s more than 150. Of course it’s not.

Then what?
Are the complexes broad? Or narrow?
Is it regular?
AF? No?

What’s the blood pressure?

I was brought back to a patient I saw one month ago.
Breathless.
Like I was just now.

But for her, she’s breathless while just sitting up. Lying in her bed.
Unlike me, she did not know when it will be over.
Because her heart will keep on pumping too fast.
She will keep on feeling short of breath.
Until we manage to help her. Until we helped her with a machine.

Empathy.
Compassion.

The key in medicine.

A Day in a Doctor’s Life – In Remembrance of Allah SWT

Being a doctor is not easy. The days are long, the nights even longer. We work weekdays, nights, weekends and on holidays. There are always people who are unwell, and it will never stop.

It takes a lot of courage and strength to stay in this noble profession, as many of us have actually quit our jobs to do our own business, to work with large multinational companies in related fields, or to spend more quality time with our beloved children and husbands.

As Muslims, our aim in life is to achieve success in this world (dunia), and the hereafter (akhirah). In fact, whatever we do in this world is aimed at getting blessings from Allah SWT, which can be done in many ways. We’re adviced to spend our days, our time, in His remembrance.

From the Quran, surah Adh Dhariyat, verse 56:

“And I did not create the jinn and mankind except to worship Me.”

Allah SWT says in Surah Al Hasyr, verse 18:

“O you who have believed, fear Allah. And let every soul look to what it has put forth for tomorrow – and fear Allah. Indeed, Allah is Acquainted with what you do.”

How do we achieve taqwa? How do we obey Him in our busy day as a doctor? We are indeed very blessed that Allah SWT has given us this opportunity to serve Him with our responsibilities as a doctor. We are obliged to gain as much knowledge as we could to be able to help our patients to our best abilities. We are also responsible of passing down our expertise to our junior colleagues, to teach and nurture, as well as educating our patients about their health and illness. These duties are highly looked upon by our beloved Prophet Muhammad SAW:

‘Abdullah b. Mas’ud reported Allah’s Messenger (ﷺ) as saying:
There should be no envy but only in case of two persons: one having been endowed with wealth and power to spend it in the cause of Truth, and (the other) who has been endowed with wisdom and he decides cases with the help of it and teaches it (to others).

Many of us Muslim doctors look at others with envy; they get to perform taraweeh every night in Ramadhan, they may follow that with i’tikaf in the masjid daily especially during the final 10 days of the holy month, while we’re stuck in the hospital being on call every few days, or even every other day. Yet we should not despair, those hours spent attending to the needy are not in vain, when done in the name of Allah SWT.

As Ibnu Abbas RA once said in his tears,

“I remember the man who rests in this grave (that is Prophet Muhammad SAW) once said, whoever walks to fulfill the needs of his brother, this is better for him than performing i’tikaf for ten years. And whoever performs i’tikaf for (just) one day, seeking Allah’s pleasure, Allah will place three trenches between him and the fire of Hell. Each trench is wider than the distance between the Two Wings (the expanse of the East and West).”

The rewards of helping others in their troubles is further emphasised in the following hadith, as reported by Abdullah bin Umar RA:

“Rasulullah SAW said, “A Muslim is a brother of another Muslim. So he should not oppress him nor should he hand him over to an oppressor. Whoever fulfilled the needs of his brother, Allah will fulfill his needs; whoever brought his Muslim brother out of discomfort, Allah will bring him out of the discomforts of the Day of Resurrection; and whoever screened a Muslim, Allah will screen him on the Day of Resurrection.”

There are so many of Prophet Muhammad SAW’s examples that we could learn and put into practice in our daily lives as doctors. They would make our jobs easier and our days brighter, filling barakah in every single corner that his teachings have touched. Simple things such as his smile, giving salam to fellow Muslims and good greetings to the others, giving advice when someone comes for it, the way Prophet Muhammad SAW spoke to others around him, his humility, fulfilling his obligations to the best of his abilities, and many more. Just imagine how much time we could spend following our beloved Prophet Muhammad SAW’s examples  everyday!

Basically we could spend our days and nights in remembrance of Allah SWT, even at our workplace. Of course we often wonder why did we choose this profession at the first place? Why do we spend so much time in the hospital when others happily go on in their lives, perhaps even earning more than we do while working less hours? We spend more time studying for a lifetime, even when we have graduated, not to mention sitting (and paying) for professional exams. Our fellow Muslims go around doing charity work and we are stuck in the hospital.

It would be beneficial to look at it in a different way. One day we will all leave this world, and our deeds in life would be measured during the Day of Judgement. That is the day when we would all regret of not doing enough deeds, and end up wondering whether they really are enough to grant us jannah (paradise).

Ibnu Mas’ud narrated:

“The feet of the son of Adam shall not move from before his Lord on the Day of Judgement, until he is asked about five things: about his life and what he did with it, about his youth and what he wore it out in, about his wealth and how he earned it and spent it upon, and what he did with what he knew.”

All of us struggle in one way or another, at some point of time in our lives. It is easy to forget the beautiful Quranic verses and the sunnah of our beloved Prophet Muhammad SAW when we’re stuck in a stressful situation. While it is not wrong to rethink our position in life, let us reflect back and be thankful to Him for this opportunity to spend our days in His remembrance, with not much chance to spend our time and energy to be carried away with this world.

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