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Maria-Syamsi

From My Heart

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September 2014

A Letter From Hell

I don’t know why I’m spending this precious Saturday morning writing this letter to a naive junior colleague who is currently working a few thousand miles away from this hell. Perhaps I feel obliged to tell him, or whoever feels that this is worth reading, what this so-called “system from hell” has made us what we are now.

First I have to say, I may have written this post:

https://mariakamalmilatu.wordpress.com/2013/09/21/what-the-public-doesnt-know/

…which may have sounded like just a bunch of complains to some of the readers, feeling that probably I (and many other doctors around me) have lost our integrity, our honesty, to serve the people.

But then, I also wrote this:

https://mariakamalmilatu.wordpress.com/2014/03/02/a-day-in-a-doctors-life-in-remembrance-of-allah-swt/

…because as Muslims, we have our purpose in life, and we need to remind ourselves about it every once and then. It is with this remembrance that we could get back our spirit and motivation to go through fulfilling our responsibilities as true Muslim doctors.

You see, adik, I am, like, you, an overseas graduate. My name is followed by MB BCh BAO (Ire), and I hope, soon it will be followed by MRCP (UK). Not yet, but striving for it. I took a loan from the government and guess what, I’m still paying for it. I could have worked overseas as I am not totally bounded, but I chose “hell” instead. I am also paying for my exam cost in British pounds, with my own hard-earned ringgit.

Is this truly a hell, though?

Those were our thoughts before we start housemanship. We were scared by our seniors who decided to stay back overseas because they heard it is hell here. They have never worked here, so how would they know?

Of course, it was not entirely wrong, but neither was it entirely true!

Yes, all of us wished for shorter working hours. All of us wished that we could go home the morning after being on call. All of us wished we had shift system. We all know how working overnight affects us, we have experienced it, we have tried to do something about it, and things have improved, you see.

You may have noticed that culturally, Malaysian and British are different. I am sad to say that we are more manipulative and cunning in a lot of ways, hence ANY system at all would not be perfect if we aren’t good INSIDE.

If you are responsible, any system is good.

But if you were born with a silver spoon in your mouth, brought up having had everything you ever wanted given to you at your doorstep, you would probably grow up thinking that the system should change you. You would end up believing that a perfect system is the only way to cater a good healthcare.

That’s where you’re wrong, adik.

I have to admit, we have all felt frustrated before. Those who have worked in university hospitals would feel frustrated with the lack of service they could offer in a district hospital. Those who started working in a first world country would feel deeply frustrated that the system is not as “perfect” as it was back there in those cold (and wet) countries. Even for myself, who have only worked in two specialist hospitals, have felt some frustration about the service that we have.

Now THAT lack of service bred different kinds of doctors we have in this country.

Some stay back passively and just go with the flow.
Some work hard to spark a change and make the world a better place for patients and healthcare workers alike.
Some quit their jobs to look for greener pastures.

Nobody is wrong in this sense, we all have our own lives and problems to think about.

Before I go any further, I would like to remind you that I’m not saying we should not improve. I’m not saying that the system is unchangeable.

I’m talking about what we should do while change is happening.

I don’t know whether you were a student paid by the government to study in the UK. If you were, then you were obliged to come back and serve the people, like your other friends.

Do you know why you were sent overseas to study?

Or let me rephrase that. Do you know why studying overseas is actually good for you?

I’m sure you were blessed with some degree of intelligence, that you were accepted into a scholarship programme. With that intelligence, you were expected to learn from the mat sallehs and BRING BACK all those good things that you have learnt over there.

Studying overseas opens our eyes to a lot of possibilities, experience, discoveries, and teaches us to maturely appraise a system for the benefit of the patients. The British text books even taught us how to deal professionally with the juniors, with the nurses, with our senior colleagues. Have you come across those texts yet?

So instead of loudly wanting to slap the senior doctors over here, why not do it the mat salleh way? Talk it out in a professional manner, discuss the ways to improve working conditions, and help out each other so that better healthcare is delivered.

You see, adik, a good healthcare is not just about better working hours or conditions. It is up to you, deep inside, to serve your people in the best way that you ever could.

We were blessed with good grades in school, and to some, it signifies intelligence. But for me, intelligence does not mean a thing if we expected to be served by a “system from paradise”, rather than trying our best to help the people, with whatever we have in hand.

There are people on the top level who can’t prioritise on which sector needs money the most. There are those who think more of entertainment than the health of their people. Sadly there is not much we could do at this particular moment to change their attitudes. Personally I think our best bet is by educating the younger generation to make decisions wisely and campaign against corruption.

What does that leave us with?

OURSELVES.

You probably have heard this quote before: “BE the change you want to see in this world.”

You have not worked here, so you have not met the various amazing consultants who work in government hospitals. You have not met those who have served decades in this “hell of a system” and made a difference wherever they go. You have not met those soft spoken gentlemen, those hardworking ladies, who lead their departments and made the most out of the little budget given by the government.

You have not met those who actually go out of their way to train themselves overseas with their own hard earned money, and come back to be a better surgeon.

Even the not-so-senior ones like me and my colleagues, we are trying to train our juniors in the best way possible. We are trying to be more patient, despite the poor attitude shown by some of our juniors. We strive to be more professional, unlike those horror stories that you heard from here. Of course there ARE seniors who still speak unkindly to the juniors, letting out rude words, attacking personally rather than correcting someone in a proper way.

A good healthcare is not only provided by giving the best medications and equipments, from the freshest looking doctors who work 60 hours per week. Obviously, that would be really great, I would welcome that with open arms and a happy heart.

There is so much more to job satisfaction than just working hours or conditions. It is also about seeing that smile from them after we have tried our best to improve their health, about sitting and talking to them about what has happened in their lives that made them stop caring for their own health, it’s about empowering the patients to get up and work hard for a better life.

It’s also about talking to the loved ones when the worst is coming, preparing them, getting them to come together, make peace with each other and say their final goodbye, or even encouraging them to write their wills, so that when the end is reached, there is no more guilt.

You could work in any perfect system, but still be unhappy and frustrated, as proven by many horror stories that we could hear from the UK.

Or we could work in a seemingly imperfect place, but still be happy and satisfied because we know that we have done to the best of our abilities to help those in need.

In the end, it all comes from within.

Almost There

I don’t know why, this image of a college in London has become one of the motivating factors in my struggle to pass this exam.

Let me recall…

I decided to pay that college a visit, since a close friend of mine was a student there many years ago. We have been walking the whole day, starting from the hotel to visit The Gherkin, and then Lloyd which is actually right around the corner, then another long walk looking for the right train station. We were lucky, because although the day was a little icy, the skies were bright and blue.

We stopped by outside Tower of London for my little sister to play ice skating. I did not join her as I have aged a bit, hence my coordination was not as good as it was 15 years ago. So I watched her and took a few photographs.

We walked again to the Tower Bridge, where we (somehow) spent a considerable amount of time on the top floor itself, in the museum. When we finally crossed the Thames, we walked about to look for a place to pray, before walking again to look for this college which seemed to be quite far from the City Hall.

Well, it was not! We walked through the train station just to find out that Guy’s Hospital was right across the road!

As the building I was looking for gets nearer, I became more excited.

Like I said, it was a beautiful day, with bright blue skies with a few patches of cloud, but no rain. The day was almost dark, it was probably around 3pm at that time. We’d better hurry before the sun sets, and that was not a part of London I was familiar with.

Then we saw it. The red bricked building with the roots of some creeping plants up its facade, which would be replaced with green leaves in summer. The sun shone on our faces. The winds blowing and the brown leaves falling.

It was beautiful.

I stood there reminiscing how it felt to be a medical student, wondering how stressed the students might be in those libraries, and then took a few photos, and then we left to get to Architecture Association near Oxford Street.

While walking through the open halls of the college, I looked around and thought, there must be loads of researches going on in this college at the moment. The people here must have gone all over the world to give lectures and speeches about medicine, from the basics to the advanced sciences, the latest findings and the best manners to deal with patients.

Where did that place me? The humble doctor who’s still struggling to remember, which one of the inotropes would cause more tachycardia, and which one would cause peripheral vasodilation. The girl who’s still asking around what cortical blindness actually means.

I had to do something. I had to take this short contemplation as a motivation. I must also take those Muslims in their golden era when modern science were developing, when new inventions were produced so that the world would be an easier place to live, for the good of mankind.

I left with a renewed sense of purpose.

* * *

The other day I had the chance to sit with the makcik again.

This time around, she told me about her son, whom she did not need to force to study. He has his own conscience, she said. He would study when he needed to, and he is very disciplined.

I wondered in my mind, how did he make room for everything, seeing how busy he is with his extracurricular activities.

As if knowing my questions, she said, “He’s the kind of person who would get up and do something immediately when it needs to get done. He doesn’t wait, and he moves very fast.” She continued, “He could go up a flight of stairs with just three steps!” Then she laughed.

* * *

I can’t believe the exam is so near.

Actually I can’t believe that I have reached this final stage. It has been a long and arduous journey, challenging me mentally and at times financially.

I am forever thankful for the strong support and prayers from my family, and those who truly love me. So many of them have been with me since the start, and some just recently, but I guess in the end the outcome will have to come from within me, and of course, His Grace and Mercy.

I don’t know why I’m making such a big deal out of this. Perhaps it’s just the drama queen in me.

Or perhaps it really IS a big deal.

Wish me luck.
More importantly, please pray for me.

* * *

Hampir Ke Situ by Mendua
Aku sadar bukan mudah untuk mengejar mimpi indah
Pernah suatu ketika dulu ku punya harapan besar
Kini aku tak pasti
Dapatkah ku miliki

Sudah jauh kita tempuh, kekalkanlah impian lalu
Mungkin ada hikmah yg akan menunggu di penghujung jalan
Biar nanti kecewa
Setidak-tidaknya cuba

Jika halangan menduga perjalanan kita
Janganlah kau putus asa
Kerna ku ada di sisi, setia menemani
Andai semangat mu gugur, genggamlan tanganku
Kita hampir ke situ

Adakala ku terasa
Ketabahan tak setegah
Tetapi apakan andainya
Berhenti separuh jalan
Percayalah padaku
Aku yakin kita mampu

Biar orang katakan rapuhnya harapan
Bukan mereka tentukan tapi kau ada aku, dan aku punya kamu
Dapatlah akhirnya tetap bersama

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It’s the Little Things

Mother Teresa said, “Not all of us could do great things, but we could do small things with great love.”

* * *

March 2010. It was almost sunset. We were on our way down from Kuala Terengganu to Kijal. I was looking hard for wedding presents for a friend who’s getting married that April, but I could not find anything suitable yet. We wondered whether any shops would be open at this time of the day, as it’s almost prayer time.

We stopped by at a small road-side shop selling home decorative crafts (and some useful stuff too), mainly made of mengkuang and rattan. An elderly man came to greet me and showed me around his dusty little shop. For every item I touched, he’d tell me the price, followed by its discounted rate. He followed me around but not in an uncomfortable distance.

Honestly I couldn’t find anything for my friend.

It could have been any other shopkeeper, but this man is different. He is kind, patient and polite. Even when the sun almost setting, he did not ask me questions about why was I still running around at that hour, why was I accompanied by just two ladies, where are the men, etc. He did not grumpily follow me around with a close distance. He did not make any kinds of faces other than a friendly face.

So I bought two items from him, which I found the use a few months later.

* * *

I was in a mamak shop in Kota Damansara very recently. I was eating mee goreng mamak and obviously the sides of my mouth started to feel oily. As there were no tissues, I wiped the oil with my little finger, intending to ask for a piece of tissue from the waiter.

I did not need to ask for one, as when I looked up, one of the waiters was already walking towards my table with tissues in his hands.

Similar thing happened a few years back when I was having lunch with a fine gentleman in a mamak shop. The mee goreng had just been served, and I turned my head to the counter. This gentleman immediately stood up and get the tissues from me, even when I have yet to face the counter.

* * *

My tailor had a problem this Eid season. She got pregnant so she was a little unwell, making it impossible for her to finish all the stitching.

I was told by my mother that she called the day before and told my mother that she could only finish one set of baju kurung for us. So I went to her shop just a few minutes from my parents’ place on the day before Eid. Only her sister was there.

The sister showed me a pair of green baju kurung and it wasn’t mine. She told me that that’s the only pair of baju kurung that she was told to give away. The rest is still not done.

Now that’s not a good news to hear, especially a few hours before Eid. So I asked her, are you sure? As it was my mother who told me that the baju were done, it MUST be ready by now. The girl just stood there and said there are no other pair of clothes done. Just the ones that she showed me just now.

I asked her again, are you sure that it’s not placed anywhere else in the shop? The shop is kind of messy so it might be hidden somewhere. But she was still standing at the same spot and repeating the same answer.

Out of desperation I started searching for them myself. I went through the cupboard and another rail of clothes, and the stack of bags at one corner of the shop (this tailor usually puts the finished clothes back into the bag we sent them in). I managed to find our bag but the only thing in there were the sari material that have yet to be stitched, not the green ones i was looking for.

I wasn’t entirely annoyed that the clothes weren’t done. We have other nice baiu kurung that we could wear during Eid.

What made me angry was that the girl did not even make an attempt to help me with the search. She stood at the desk with her handphone in her hand and a passive face telling me if it’s not this green one then it’s not done.

You see, at least, even when she’s so convinced that the baju kurung was not done, just go through the shop and look, at least an act, just to show that she actually cared, and at least reassure me that she will confirm with her sister afterwards.

* * *

There is a ward in this hospital that is taken care of by a specialist. He has never shown any appreciation towards any of his staff, be it the nurses or the doctors. No kind words of encouragement ever escaped his mouth.

One fine week, he was not around. Another specialist took over for the week. One day this person was doing rounds with the rest of the staff, and as always, the house officer would present to him the cases, helped by the medical officer.

After the house officer finished talking about he patient, the specialist said, “very good.”

The nursing sister of the ward who heard that felt very light in the heart, as if her troubles melted away. Just because of the simple kind words that was given by the specialist.

This particular specialist is rather generous with his praises. Those who worked with him regularly were used to it, and at times don’t think that half the praises were deserved.

But for those staff who were deprived of any kinds of appreciation, a simple phrase like that made a huge difference to their day.

* * *

Narrated ‘Aisha R.A, The Prophet Muhammad SAW was asked, “What deeds are loved most by Allah?” He said, “The most regular constant deeds even though they may be few.” He added, ‘Don’t take upon yourselves, except the deeds which are within your ability.”
– Sahih al Bukhari, The Book of Heart-Softening Narrations, No. 6057

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