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Maria-Syamsi

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Poppy and Friends

Work-related issues. You know…poppy…opium…? Get it? :)

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Ten Years In Service

Ten years ago today, I started working as a doctor. 
Ten years of service, the biggest lesson I learnt is, the greatest regret a person could feel in his life is because he was not good enough to his parents. Did not spend enough time, did not act kindly enough.

I learnt that, no matter how stressed I become while at work, it is often reduced when I listen and talk to the patients.

I learnt that we understand more about life when we understand death. We live life better when we embrace that death is surely a part of life.

I learnt that positive thinking attracts positive surrounding. 

Ten years in service, I realize that no matter how advanced technology is, sometimes we need to rely on our instincts, an our patients’ instincts too.
I learnt that, if we really wanted to help, we could always find the way to help, even if it is not what we planned to do at the first place.

I understand that everyone has 24 hours, but you need to be wise to use it fully.

It is from the early years of service that I learnt, if we wanted to do something, there is no such excuse as ‘being post call’ or ‘too busy with work’. If doctors use that excuse all the time, the only things we see are patients in their beds, and our own beds. I learnt that we should go wherever we needed to go, whenever we needed to.

I learned that every specialty has its importance, and we should never look down on others. If we think we know more, then we should educate. If we think people look down on us, perhaps there really are things that we should learn about more.

I learnt that doctors are fighters because we see too much suffering with our own eyes. Even when others don’t appreciate it, even when people call us names, we still fight for them. 

I learnt that anger consumes energy. Too much energy.

I learnt that humility and gentleness goes a long way, even when many fellow Asians don’t agree with being gentle, thinking “people won’t listen to gentle people”. Trust me, being humble, kind and gentle is the right thing to do. No matter what the outcome is, people will never be able to blame us for being just that. 

And I’m still struggling.

I learnt that honesty is the best policy. An honest doctor, an honest nurse, and yes, an honest patient. If a patient lies to a doctor/nurse, he would bring detriment to his own health and people around him.

I learnt that there is no point doing something if you expect something in return from that person. Help someone because it is the right thing to do. But he will never be able to pay you back, because of his imperfections. 

And..

Ten years in service, in a field where science is supposed to top others, I believe in God even more than when I started off.
Yes, science could cure some infections, detect cancer early, open up blood vessels, make a blind person see again.
But like all else in this universe, science is limited. Science helps but is not the answer to all.
Science can’t help a daughter to feel at peace while she’s caring for her mother who has dementia.
Science can’t tell you why this four-year-old has to die because of cancer. 
Science can’t tell an octogenarian to get up and walk after antibiotics have cured her pneumonia, because she refused to walk as none of her children visited her.
Science can’t tell why a mother of five did not survive the breast cancer but that single lady lives on intact.
Science could not tell which ‘20%’ is not going to be cured from cancer, and why.
Science won’t tell you why this life is imperfect. 

Only Allah does. Allah tells us how to care for our parents, why some people don’t survive until age 20, that life is imperfect that everyone will go through some kind of suffering in this life. Allah tells us that different people could overcome different kinds of challenges, we need His help to do that. Allah told us about death so we could live this life as better, gentler, kinder, more generous, and contented people.

Selamat Hari Jururawat

Doktor dan jururawat bagai isi dengan kuku. Tak boleh dipisahkan.

* * *
“Doktor, cepat-cepatlah pass exam. Buat baik-baik. Nanti lagi ramai doktor pakar.”

“Takpelah, doktor, saya ni umur dah 37 baru kahwin, sekarang ni mengandung. Tengok macam akak yang tu, umur macam ni baru dapat anak satu. Jodoh, rezeki semuanya Allah dah tetapkan. Biarlah orang nak kata apa.”

“Doktor, tadi patient ni tachy. Saya check gula dia 3, saya dah bagi D50% 30mL. Sekarang gula dah ok, tak tachy lagi,” kata jururawat itu pada tengah malam.

“Doktor, ni donut, tadi anak patient tu bagi kita,” kata nurse itu. “Eh, belum makan ke?” tanya kami. “Kami tunggu doktor..” jawab mereka.

“Doktor, jangan risau. Yang itu kami buat. Doktor yang baik memang kami akan tolong. Doktor tinggal je. Pergi buat kerja lain.”

* * *
Kata sepupu saya, “respect betul dengan nurse. Diorang boleh pegang, cuci orang yg diorang tak sayang pun. Hebat.”

Saya katakan padanya, “Mereka ada perasaan sayang pada pesakit, walaupun baru jumpa. Memang tak macam mak ayah sendiri, tapi perasaan sayang mereka tetap ada.”
* * *
Siapalah doktor tanpa jururawat?

“Nurses are very obedient,” kata Dt Mary Cardosa.

Hampir 10 tahun saya berkhidmat.
Jururawatlah yang melaksanakan arahan doktor. Membancuh dan memberi ubat-ubatan, IV drip, menghantat pesakit ke tempat prosedur. Kalau kawasan khas seperti ICU, unit rawatan jantung, mereka juga mempunyai ilmu yang tinggi, selalunya lebih tinggi daripada doktor yg menjejakkan kaki pada hari-hari pertama di ward tersebut.

Ditambah pula dengan perkara-perkara tambahan seperti menyuapkan makan, menukar lampin, memandikan pesakit. Walaupun itu semua adalah tanggungjawab anak-anak/ahli keluarga pesakit tersebut, mereka lakukan juga atas rasa kasih terhadap manusia lain, terutama yang tidak terjaga oleh anak-anak.

Malangnya di negara ini, jururawat dibebankan dengan banyak paperwork yg sepatutnya dilakukan oleh administrator atau kerani. Kalau di negara maju, tugas-tugas paperwork ini semuanya dilakukan oleh kerani/pegawai lain.

Tugas jururawat sepatutnya hanya berkaitan dengan pesakit. Kertas kerja yang patut ada hanyalah vital signs dan report. Hal2 barang dalam ward, harta hospital, katil, langsir, CSSD juga, saya harap ditangani oleh pegawai lain.

Bagi saya pula, jururawat bukan hanya di samping pesakit.

Merekalah peneman kami di kala waktu malam on call, yang kadangkala sunyi, selalunya sibuk.
Merekelah teman bercakap, senyum, bergurau, agar hari-hari yang dilalui tidak begitu menekan.
Merekalah tempat meminta nasihat. Pengalaman mereka luas, mereka telah bekerja dengan pelbagai doktor pakar, belajar juga dengan mereka. Walaupun pakar-pakar itu sudah tiada, nasihat mereka disimpan oleh jururawat ini.
Merekalah mata dan telinga doktor, mereka berada di hadapan pesakit hampir sepenuh masa, memerhatikan mereka, mendengar keluhan mereka.

Dan personally, bagi saya, mereka juga tempat meluahkan perasaan, berbincang hal kehidupan, sama-sama menaikkan semangat dalam menempuh dugaan hidup.

Saya berharap benar, masyarakat akan lebih melayan jururawat dengan hormat. Memang ada jururawat yang mulut kurang baik, tangan kurang pantas bekerja, tapi janganlah kerana seorang, yang lain dipandang hina.
Saya harap masyarakat tidak menghamburkan kata-kata kesat di hadapan mereka, mahupun di media sosial.
Orang yang sakit mungkin lebih cepat marah, tetapi kami nampak, orang yang memang berbudi bahasa orangnya tetap akan menjaga akhlaknya walaupun dalam keadaan sakit.
Saya harap suami/isteri jururawat dapat memahami beban kerja mereka. Bukan mudah berhadapan dengan kerenah manusia.

Maafkan kami, para doktor yang kadangkala termarah, terbebel, dan macam-macam lagi.
Mari kita sama-sama tingkatkan kualiti kerja, tingkatkan kasih sayang sesama manusia.

Selamat hari jururawat.

Kanser Tahap 4

“Demi masa, sesungguhnya manusia kerugian.”

Saya telah bekerja selama hampir empat tahun di wad pesakit kanser tahap 4, yang mana hampir semuanya meninggal dunia dalam masa setahun. Saya telah berjumpa dengan sekurang-kurangnya 400 orang pesakit sepanjang bekerja di wad tersebut, dan kisah-kisah mereka di penghujung hayat telah banyak mengajar saya tentang erti kehidupan.

Memang kebanyakan doktor menyangka bahawa menguruskan pesakit-pesakit yang sudah hampir pasti akan meninggal dunia membuatkan doktor/jururawat sentiasa berasa sedih. Tetapi bagi kami, hidup kami lebih bermakna kerana kami memahami bahawa setiap saat di dunia ini amat berharga dan perlu disyukuri.

Kanser tahap 4 adalah waktu di mana seluruh keluarga harus bersatu. Inilah masanya untuk merapatkan kembali hubungan yang renggang atau terputus dalam keluarga.

Anak-anak perlu berusaha mengambil hati ibu bapa yang telah sakit. Walaupun mungkin ibu atau bapa telah melakukan sesuatu kesilapan pada masa lampau yg membuatkan anak tawar hati, harus diingat, hubungan itu kekal sehingga hari kemudian. Ibu tetap ibu, bapa tetap bapa. Walau apa pun caranya, anak-anak wajib berbaik dengan ibu bapa semasa hayat mereka.

Kanser tahap 4 adalah waktu yang tinggal untuk anak-anak meraih kasih sayang ibu bapa dan keredhaan Allah SWT. Inilah waktu yang tinggal untuk menyuapkan ibu bapa makan, memandikan mereka, mencuci najis dan menukarkan lampin, membantu mereka solat, bercakap yang baik-baik sambil memberi perangsang kepada mereka. Sekiranya ibu bapa yang sakit berada di hospital, belajarlah untuk menukar lampin mereka sendiri, memandikan mereka sendiri, bukan menunggu jururawat yang melakukan semuanya. Ya, mereka boleh membantu, tetapi tanggungjawab hakiki masih terletak di bahu anak-anak.

Kami telah menyaksikan terlalu ramai anak-anak merasakan penyesalan yang tidak mungkin berpenghujung. Mereka ini selalunya terdiri daripada golongan yang tidak pernah menjenguk ibu bapa semasa sihat, tidak pernah membantu ketika sakit, menyimpan dendam terhadap ibu bapa sendiri, tidak bercakap dengan baik kepada ibu bapa. Mereka akan datang pada saat-saat akhir, di mana ibu bapa tidak lagi mampu bercakap, mendengar atau membuka mata. Mereka akan memarahi adik-beradik lain, atau doktor/jururawat, menuduh yang bukan-bukan, sedangkan mereka tidak mengambil peluang untuk berbaik-baik dengan ibu bapa ketika sihat.

Kanser tahap 4 juga adalah masa untuk adik-beradik berbaik-baik. Semuanya perlu mengambil giliran untuk menjaga ibu bapa yang sakit, bukan hanya meninggalkan tugas itu kepada surirumah atau yg tidak bekerja sepenuh masa.

Kami dapati, orang yang redha dengan pemergian ibu bapa adalah anak-anak yang sering berada di sisi ibu bapa semasa hayat mereka. Hidup mereka lebih tenang tanpa penyesalan.

Kanser tahap 4 juga adalah waktu yang paling penting untuk urusan surat-surat dan dokumen tentang harta. Semua harta seperti tanah dan rumah perlu dinamakan dengan tepat, dijelaskan nama pemiliknya, dikira hutangnya. Sesudah seseorang itu meninggal dunia, tidak ada lagi peluang untuk menjelaskan pemilikan tanah, nama siapa, siapa yang bayar. Memang ini hal duniawi tetapi terlalu banyak kes yang tidak selesai kerana ketiadaan rekod. Akhirnya ramai yang tidak mendapat hak, ramai juga yang makan hak orang lain. Semuanya akan ditanya di akhirat kelak.

Berbincang tentang harta peninggalan mungkin nampak seperti taboo, nampak tidak patut, tetapi kita perlu berpijak di bumi yang nyata. Kematian itu sesuatu yang pasti, meskipun bukan kerana kanser. Pengurusan harta adalah sesuatu yang serius di sisi Allah, maka perlu diselesaikan dengan sebaiknya.

Kanser tahap 4 bukan masa untuk duduk di sisi ibu sambil mata menghadap smartphone. Bukan juga masa menonton TV. Masa untuk bekerja keras membahagiakan ibu dan bapa. Menunjukkan kasih sayang selagi mereka ada. Tatap wajah mereka. Simpan dalam ingatan. Bukan waktu selfie berderet-deret. Berapa ratus gambar pun tak akan sama dengan perasaan menatap mata ibu bapa yang penuh kasih sayang semasa mereka hidup.

Kanser tahap 4 adalah masa untuk keluarga, peluang untuk membuang yang keruh. Air dicincang tak akan putus. Allah telah memerintahkan manusia untuk berbakti kepada ibu bapa, Allah juga telah menjanjikan kebahagiaan kepada mereka yang menurut perintah-Nya dengan penuh kesabaran. Setelah menyaksikan beratus-ratus pesakit meninggalkan kami, beratus-ratus keluarga yang ditinggalkan, kami dapat melihat dengan mata sendiri bahawa janji Allah adalah sentiasa benar.

Ada juga persitiwa, yang mana ibu yang sakit tidak memaafkan anak, anak juga masih marahkan ibu. Ibu meninggal dunia bukan dalam keadaan tenang, anak yang ditinggalkan juga terus hidup dalam kemarahan.

Kanser tahap 4. Terlalu banyak pengajaran.

Dekatilah ibu bapa. Berbaiklah dengan mereka. Mungkin suatu masa dahulu mereka tersilap, mungkin tindakan mereka tidak rasional. Berbaiklah sebelum sesalan melanda. Meskipun mereka kelihatan masih marah, dekatilah mereka walau apa pun caranya. Dalan hati mereka pasti masih ada kasih sayang.

Hidup kita tidak panjang. Tidak perlu dendam, tidak perlu sesalan.

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The Doctor’s Advice

When the doctor tells you to quit smoking,
It’s up to you to follow his advice.
If you do not, you might or might not suffer the consequences.
It’s your choice.

When the doctor tells you to lose that extra weight,
It’s up to you to follow his advice.
If you do not, you might or might not walk with painful knees, get diabetes, or have sleeping problems.

When the doctor tells you to give birth in the hospital,
It is up to you where you choose.
You may or may not bleed to brain injury, and your child may or may not suffer even worse brain injury.
Your choice.

When the doctor tells you to vaccinate your kids,
You may think it is up to you.
But you have to know, it is a social responsibility to vaccinate, never really a personal choice.

BUT

If the doctor told you to come back and see your ill mother,
You would better do it.
You don’t have a choice.

Because it often means she is leaving this world.
If she does, and you did not follow the doctor’s order, you will regret it in your entire life.

Doctors could try to save lives.
But doctors could not wake up the dead.

They Were Upset and I Wondered Why

As with other doctors, I am no stranger to taking exams upon exams, some more difficult than the others, at times passing, but sometimes not making it through.

With that, my colleagues, senior colleagues and mentors would know my results, good or not as favourable.

Thing is, whenever I don’t get through the exams, some of them would recieve the news with fallen faces.

It often seemed like their response is worse than my own, when I looked at my own results.

I was never comfortable with it.

I never understood why they should be so upset when I have yet to give up on myself, and when I was not as frustrated as they appeared to be.

Until one day I heard about a dear friend. I have not met him for about a year.

A few weeks ago I saw another colleague who came to my ward to look for cases. So I asked her about him and some other friends who took the same exam at the same time.

“Oh, all of us got through, except for him. He had to resit that exam,” she said.

I felt rather sad.

The news bothered me. The fact that he did not go through the exam resurfaced a few times on that day, in between seeing patients.

I hoped and prayed that he will make it soon.

He was one to encourage me to focus on my exams and get through it quickly.

From that day, I understood how it may have felt like for all those people to hear my news.

I’m not going to ask why anymore.

Neurology

Disclaimer: this is a story about my time spent with neurologists, and only a little bit about neurology as a field.

One of the reasons I asked to be transferred to the current hospital I’m working in is I wanted to do a rotation in neurology. I wanted to see whether I truly love this field.

I had interest in neurology since I was a student. I thought I wanted to be a neurosurgeon. Towards the end of housemanship, with plans of building a family, I thought of becoming a lecturer in anatomy with special interest in neuroanatomy.

However, after discussion with a few important people in my life and career, I chose the clinical path to become a physician with some thoughts of being a neurologist later. Some thoughts. I didn’t know for sure yet.

So after two years being in this place, I was posted for four months (like other rotations), into neurology department. Like the other colleagues, I was nervous but eager to learn new things.

You see, neurology is not a favourite subject for many doctors, even among physicians. The structure of the nervous system is complex, the functions even more so. There are so much that human beings still do not know about the human brain.

Hence there are so many neurological diseases of which the cause has yet to be found, and worse, the cure is limited and the hopes of recovery poor.

What is damaged would often remain damaged, although some may improve with training and perseverence. Some diseases like epilepsy could only be controlled, and for some others like multiple sclerosis, we could only hope that relapses don’t happen.

With that realization, many would think that neurology is a depressing field to be in. You speak to the patient and examine him, by then you already have an idea of the diagnosis. You confirm it with many investigations, some take many months to complete. When you finally clinched the diagnosis, you look at the patient and the family, wondering how they are going to cope with that illness, the uncertainty of whether or not there will be recovery, and if he has no hope for cure, there’s no way of telling how long he has left.

Unlike cancers, I personally found neurological diseases a lot more difficult to prognosticate.

After four months in the posting, I had mixed feelings towards the field itself. But it was sister Yasmin Mogahed who made me realise how amazing neurologists are.

Ilmfest Putrajaya was held right at the end of my neurology posting, when I was already having some withdrawal symptoms by thinking that I was not going to work with those people again. So sister Yasmin was talking about her friend who had four disabled children, when it hits me that some of the most amazing people in this world are those who fight for the people who could not speak for themselves.

Then I had a flashback of my four months there.

They would speak kindly to the patients, even when all they get back was just a blank stare.

They would try to examine every single part that they need to, because they wanted to make sure they don’t miss anything, and to make sure no new problems arise. Even when, or more so when, the patient is bedbound and fully dependant.

They would try to relieve every single physicial symptoms a patient have, even when the disease is incurable.

They are the happiest when a patients show the slightest improvement, even when it’s from a blank stare to an eye contact. Even when it’s a flicker of movement from no movement.

As seniors, they listen to every single word you say, every single question you ask, and answer you, even at 3am.

As seniors, they are such good judge of character, that they appreciate the hardworking ones.

They remain dignified no matter what kind of behaviour others show to them.

They are such compassionate people, they work as hard on weekends as they do on weekdays.

Their eyes are so keen and pair that with good hearts, they could see your pain and would try to help as much as they could.

They are such gentle people, I have never heard them shout. Perhaps only some firm voice when needed but nothing more that.

Combine compassion and perseverance, they have the patience to wait for patients to recover their function, of course after multiple physiotherapy sessions.

They would be the happiest people when the patients recover from not being able to swallow, to move, to speak, and a few tortuous months down the line, the patients would be talking and eating like they did before.

As seniors, they would make sure we get something out of our stay there.

“Maria, are you okay?” would be the question whenever I was in clinic, every time I was finishing with a consultation. Lengthy teaching would come after each patient, which I have so much gratitude for.
I know my fellow colleagues had that too.

* * *

I went into neurology posting to learn about neurological diseases.

I got a lot more.

Thank you so much for showing me patience, perseverance, dignity, gratitude, and compassion.

Thank you for your listening ears, and concerned eyes.

And of course, thank you for all the knowledge poured on to us. We all did learn a lot from you.

Thank you.

Your Health, Your Choice

You see,

When us, doctors, advice people not to smoke, they mock us and say “oh, my father smoked for 50 years and he had cancer only after he quit smoking.”

When we advice them to control their sugar, they whine and say they can’t stand looking at all those food.

When we ask them to not bring their young children visit their ill grandparents in the hospital, they look at us like we’re being overly rigid.

When we promote about vaccination, they laughed and belittled us for “blindly following Western medicine.”

When we promote safe labour options, everyone starts fighting and nobody in the media asked the opinion of a consultant obstetrician.

* * *

Of course, you might want to say it is YOUR rights to choose whether you want to smoke, drink, eat whatever you may want, have all the sex with any prostitute, give birth anywhere in any place you like, expose your kids to any life-threatening infections, or drive as recklessly as you want.

You think it’s your choice.

You think doctors will not have a job if nobody falls sick.

You are WRONG.

There are so many people who are unfortunate to get severe, chronic illness, without even asking for it.

There are so many people who get cancer, lupus, thyroid problems, epilepsy, lung fibrosis, asthma, antiphospholipid syndrome, uterine fibroids, endometriosis, infertility, multiple sclerosis, myasthaenia gravis, muscular dystrophies, mucopolysaccharoidoses, acute glomerulonephritis, and so many other diseases.

You know what, these diseases (and many others) have no cure, and for most of them, no cause is found. That means anyone could get them no matter how they care about themselves. People who have these diseases will need to go for frequent follow up in hospitals. The medications they take may cost thousands or millions of dollars in their lifetime.

Thing is, the psychosocial impact of the above (and many other diseases) are huge. Doctors need time to tackle these issues, on top of explaining to them about their diseases, the treatment options (or lack of it, at times), the medications and their side effects, and a whole lot more on patient education.

We sincerely wish we have all that time to spend with such unfortunate patients.
We really wish we could listen to all their worries, give them words of encouragement so that they could go through this difficult life in the best manner possible.

But we don’t. We simply could not.

Because there are people out there selfish enough to say, “my body, my rights.”

By getting into trouble, choosing to not care for themselves, they crowd the hospital emergency departments, wards, outpatient clinics, specialist clinics, together with the above unfortunate people.

They mock at doctors first and come back later begging for help. For oxygen, for pain relief, for money.

And yes, we do help them. Some sincerely, some not as much (as weak as a human may be). We give oxygen, pain relief, and “referral to welfare”.

At the same time, occupying the doctor’s time that could have been well spent for those who did NOT look for trouble but fell ill anyway.

They selfishly took away the time and resources that the doctors could have spent on those unfortunate patients, because it’s their body, it’s their rights to damage it the way they wanted to.

* * *
Dear fellow colleagues,

This is more of a reminder for myself than for everyone. But I’ll say this anyway.

I know we have encountered very challenging attitudes from people around us, including the one-sided media. I know it is so easy to lash out and be as emotional as those “lay people” out there.

Many of us have spoken out in various manners, including myself.

But I guess it is true, we must not stoop down to their level. We must not reduce our educated minds to their random guesses. We shall not fight recklessness with rudeness. When people seek the opinion of the unlearned, we must continue to learn from the true experts.

We are way better than that.

Indeed, wise people of old times said, we may be able to win an arguement with an intelligent man, but we will never win an arguement with the ignorant.

So let’s stop arguing, because we’ll never win.

* * *
Perhaps it would be useful to hear this Sheikh Yasir Qadhi’s lecture on part of the surah Al-Kahfi. This part spoke about the importance of preserving life, and the sanctity of our lives.

“We shall be brave, but we shall not act foolishly. Why should one die pointlessly, when he could stay alive?”

Sheikh Yasir Qadhi: Tafseer Surah Al Kahfi, part 6.

Of House Officers and Hard Work

Reading the grumblings of house officers and reply letters from medical officers, registrars, specialists and even the Director General of Health Ministry made me look back at my own experience during housemanship. It brought about some really great memories throughout those years.

I might write about it later but what I’m going to do now is to write about surviving this two rather difficult training years (which is the beginning of many many long and hard years). I know our colleague Dr Lutfi has written quite a good list of some survival skills:

Idiot’s Guide to Surviving Housemanship

My list is perhaps a little different. We’ll see.

1. The beginning will always be difficult
It is human nature to struggle when we start something. When a baby starts walking, he keeps on falling. But he doesn’t give up. At first he might cry when he falls, but you’d notice that after getting up and falling again, and getting up again, trying to walk, he’d not only start running very soon, but he might also laugh if he falls.
You cannot give up learning. Everyday as a doctor is a learning process – for a house officer, medical officer, registrar, specialist or even a consultant. To start learning is difficult but if you open your mind and heart, you will soon start running.

2. Not only doctors have it difficult. Everyone goes through the same thing too
If you think only junior doctors struggle, you should talk to other people. When my brother started working as an analyst, he worked day and night, with small pay. He had to work weekends and, unlike us, don’t get to claim much “overtime allowances” despite considered a professional.
My grandfather used to complain that my aunt, despite having studied overseas for her accounts degree, worked day and night for the first years in her working life, earning a few hundred ringgit per month!
Another brother of mine started his own business after graduation, working hard weekdays and weekends, and after two years just starting to see some improvements of his income, managed to pay a few workers, and even take university students as interns!
I’m sure you could find lots of other examples. Talk to your parents. Have they gone through difficulties in life? What did those experience teach them?

3. Hard work IS essential
I’m sure you’ve heard the when-I-was-a-houseman story many many times before. But let me tell you this, if you really want to be a successful doctor in the future, look at the consultants. Talk to them. Dato Razak once told me that “you could die standing” if you were a medical officer in his time. You see where he is now. He would never reach his current level of expertise without that much hard work.
Dear parents, please know that all those smart-looking, respectable and/or rich consultants and professors did not reach that level without spending long days and long nights in the hospital. The great quality of care that you feel you may have enjoyed after seeing those consultants in Sime Darby or Gleneagles or KPJ or Prince Court Medical Center could never have been achieved if they have cried to their parents or write a letter to the prime minister saying that work have been really hard on them.

4. However, you DO need a shoulder to cry on
While I believe in hard work, I do believe that we will feel stressed, sad, frustrated or burnt out. As much as we love our jobs, our body would feel it and send some signals. The problem with Asians is we expect too much from each other. We expect doctors to work like superman and judge them when they say “I’m tired.” I saw a snippet of a newspaper article saying that “healthcare workers should not feel tired as they should have been mentally prepared for a busy job.”
I don’t think it’s fair to expect someone to work long hours everyday for weeks without end. However in some situations, it might not be avoidable. It happened to me when I was a house officer in orthopaedics and general medicine.
I was lucky that my early years were not only bearable but enjoyable because I had someone on my side. Someone whom I looked up to and would always guide me whenever I have doubts. Someone who had gone through it all and even more. Someone who was protective enough but at the same time encouraged me to move on. Someone who encouraged me to work hard and was patient with me if I had to leave work late, which happened a lot during housemanship.
You NEED social support. You need it whether you’re sad, happy, stressed or feel like quitting the job altogether. Be it your own colleague, your life partner, or even your parents.
I do sincerely hope that parents, on top of being their shoulders to cry on, would encourage their doctor sons or daughters to stand up straight and carry on learning. I hope parents would motivate their children to become compassionate and responsible doctors, the way they expect their own doctors to be.

5. PLEASE be nice to the support staff
If there’s one thing that could help you survive and enjoy housemanship, that would be to be nice with the support staff. Mainly the nurses. A house officer and the nurses spend the most time in the ward with patients. Please don’t look down on the nurses. Many of them know better than you. There’s so much we could learn from them.
Talk to them with respect, say your please and thanks, be friendly, maybe buy them supper when you work nights with them, even take your short break with them (in turns, of course). Nothing else get Malaysians closer than having a meal together.
The ward attendants and even the cleaners are also great helps when you need them. Just look around, they are there for you.

6. Take a break
This is related to point number 4. It is not always possible, but try to plan some leave, some quality time with family, or just for yourself. Discuss with each other, take turns. If you could ALL learn to do work more efficiently, I think your seniors would not mind having less house officers to work with. The important motto is: “as long as the work is done.”

7. Remember your purpose
I’d say that this is the first principle. It’s the same with everything in life.
First you need to get your purpose right. Then you need to gain the knowledge to achieve your purpose, and you must use the knowledge you have for that matter. In the end, you must reflect on whether or not you’ve achieved your objectives, and are there any collateral damages of not reaching your targets.
Example (1): Your objective: manage atrial fibrillation with rate control, rhythm control and anticoagulation. Knowledge needed: medications, procedures, side effects. Apply knowledge. Reflect: review heart rate, rhythm, symptoms of failure, presence of side effects.
Example (2): You’re a doctor. Purpose: save lives and/or keep them comfortable, maximise quality of life. Knowledge and application: from years of long days and hard work. Not achievable by missing in action and spending energy complaining the whole time. Also not achievable by being calculative with friends and seniors. Reflect: the amount of confidence others have in you. So if you’re not off-tag after two weeks, or extended in the department, please think deeply of what you have not achieved. Your seniors mostly want you to be safe when you finish housemanship. Imagine, if your best friend said he trusts you for his mother’s life, would you be able to trust yourself?
Example (3): As Muslims, we believe that the purpose of this life is to serve Allah as His humble servants, in order to get His blessings for an eternal happiness. It can be achieved by fulfilling specific obligations that He has prescribed, and giving benefit to the mankind. One of those ways is by working hard, helping other people, being kind and friendly, and avoiding things that would distract us from remembering Allah. By being responsible doctors, we ARE fulfilling our purpose. Gain knowledge (ilmu) and apply them (amal). Reflect (muhasabah): Look back on how we treated our patients. Would Prophet Muhammad SAW be happy if he saw us like this? Do we need more knowledge? We will ALWAYS be in need of more knowledge.

Let’s strive to serve our purpose. We have people’s lives in our hands. There is no shortcut to perfection, there is no easy way to succeed. Not many will appreciate our hard work, and they will always complain no matter how hard we try to explain that we are humans. But first, do no harm. That could not be achieved unless you start and continue learning.

Good luck.

* * *
This article is in no way defending abusive attitude of some seniors. By abusive I meant those who shout and swear for no reason (nobody should swear), calling names, and even sexually harassing (directly or indirectly) junior colleagues. These bullies exist in ANY profession. You might run away from this job but others have it hard too.
This article does not defend those unreasonable seniors who extends house officers without valid reason. In the first place you should look into yourself and gain some insights on how you’ve performed so far.
Colleagues please try as much to be honest, even if that person is “somebody’s” son or daughter. It’s sad that such a culture still exist where you don’t “touch” certain doctors just because they are connected. But that’s another story altogether.

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