Make every second worth living

As usual, nobody wanted to take the history. I didn't want to because the hardest part of Neurology sheet is the patient's complaint. But the patient was present and the doctor was insisting and I shouldn't give any excuses to be weak. So I took out my pen and notepad and "Maisarah, let's go."

The patient was a male, so when I stood up, I offered the guys again as whoever took the sheet got to examine the patient. As expected, nobody else wanted to take the history. Heh. And we all complain Egyptian system doesn't expose us to much clinical skills, bullshit.

I introduced myself and got his permission. Took the personal history smoothly and we came to his complaint.

I sweat-dropped and turned to Maisarah. "There's problem with his back and he's having difficulty in walking. But I couldn't understand the rest."

"Let's tick off symptomatology. Hana, ask leading questions."

I asked him if he had numbness in his lower limb. Bingo. Analysed it and suddenly, a hospital staff called the patient away. The patient smiled and excused himself. The doctor walked in.

"Wrong patient?" I asked him.

"Yes. You're taking motor neuron diseases today, not peripheral neuropathy."

I returned to my seat. Another patient came in and the doctor asked the class who would take the sheet. My head was down summarising what little of the history I had just took. He repeated the question many times until finaly he said, "Can the one who took the peripheral neuropathy take this patient's sheet?" I nodded, stood up and drew a chair while smiling and greeting the patient.

She smiled and before I could introduce myself, she launched into her personal history. Haha.

I asked her complain and jotted it down. It was quite a task trying to complete the sheet and listen to what the doctor was telling the class in the same time. The doctor turned to me and asked what she complained of. "Muscle weakness in the upper limb since two years and two months ago." I proceeded with the analysis while the doctor translated what I asked and the patient answers to the class.

Standard OCD, left or right, distal or proximal, erm what else? 

"Doctor how do I ask for the tone?"

The doctor said to me in Arabic and the patient answered straight away. I understood she meant hypotonia. "What else should I ask?"

"You have to ask about wasting. Do you know wasting in Arabic?"

"La' ma'raftush..."

The doctor semi-laughed. I'm sorry, I will go boil and drink the medical phrasebook right after class. He said the word for wasting in Arabic. I need to spell it in my head in order to get a word right, so I asked him to repeat. The patient then smiled at me and said, "Aiwah, ana 'andi wasting fi iidi.."

The class laughed. I laughed defeatedly and hung my head. Still laughing, I asked the kind madam "Maalish, il-wasting dah maugud fiin bizzobt?"

"Next you have to ask for fasciculation. Do you know what it is in Arabic?"

"It's raffah fil a'dalah." Oh boy was I proud with myself for nailing that one, lulz. The patient immediately rolled her sleeve and showed me her spontaneously fasciculating biceps.

It's embarrassing to think it has been months in Internal Medicine yet I still haven't memorized the Neuro sheet in Arabic. Must work harder la like this.

---

We came to the theoretical part of the session for motor neuron disease. The doctor said the mixed type we were taking, amyotrophic lateral sclerosis, has a 3-year survival rate.

"Once the patient develop bulbar symptoms, we are worried because next it will be the respiratory affection." And that was the end because they haven't found a cure for degenerative disease yet.

I stopped writing. The earlier madam was kind, helpful and cheerful. She said her condition started two years and two months ago, so that means she only have ten months to go. She has three children and the youngest is 11 years old...

Neurology is saddening.

Rurouni

Tonight, I sang to OneRepublic's Marchin On.

And then I stopped because I realised I was in no position to sing "But with what we have, I promise you that we're marchin on, we're marchin on, we're marchin on" when all I did was squat the life out of someone else's life.

Time to hit the road tomorrow.

---

Last night I told Umair what I'd like to name my first two boys. That night I was looping Nsync and I thought, if someone sang This I Promise You to me, I'd melt straight away.

I realised then it was the biological clock talking. During my course of anthropological studies, I observed stuff like this happened to middle-aged women. But I'm only 23... Maybe there is merit to that 48-year-old test result I received recently.

That night when I sleep, I dreamt (read: nightmared) my mom married me off to some skinny guy called Andy who we knew nothing about... The ridicule is creepy, plus I don't know any Andy except Andou in Dengeki Daisy and Shinhwa no Andy.

And today at school Fadzlin told me she asked Chot about Beit Muslim procedure on my behalf and Chot said it'd be easier if I tell him who I want and he'll proceed for me.

That reminded me of earlier after the fire and how I needed to find a place for one. The girls suggested for me to get married (once married, the both of us will move into a couple house and thus solve my need for a new place). During that time I was seriously considering all the options I had, so Fadzlin volunteered to ask Chot for me.

But now, with my head clearer from all the soot and inhalation-injury-inducing oxides of nitrogen, it seemed silly to solve two problems (that and I lost my gold ring) with another bigger problem. I thanked Fadzlin for her effort.

It's Ammar Khairy and Ali Nasrullah by the way. I'll include this in the prenuptial.

---

The latest update of Horimiya was hilariously heartwarming. Hahaha.

2013

January:
Paeds end round
Secretary for ABTHAL
WinG and war game
ABTHAL

February:
Kak Elle came
Akmal and Abang Effy cooked
Went for drinks

Balqis balik
Missed Abang Effy's graduation
Attended Cairo grad

STEP preparation

March:
Lost my ipod
STEP

April:

May:
Kak Nad married
Kids came to Cairo

Punched Arab
Kak Elle gatsby

June:
GMJ
Exam
Riot

July:
Gastric ulcer perhaps
End of exam
Home
Work conference
Birthday

August:
Run away to Irama Beach
Work conference
Refreshed soon to prove as short-lived

September:
Busan Namja invited me over for a quarter-life crisis

October:
Eid with family
Back to Cairo

Class soon to start

November:
Pipah BFG to UMS

December:
18 my house on fire.
24 referred by Sayyeda precint to go to HQ Cairo. The day before there was a bomb at Mansurah so I prayed nobody bomb the Cairo HQ that day and proceeded.
They refer me to Abbasiyah that I'm unfamiliar with. I probably need to skip more class and this is the most distressing part.

26 meet with ambassador. Asked for their help. Felt like successkid.jpg

Superseniors never endorsed me as a halQi member

We were writing attendance for the meet program with the ambassador. The girl next to me who introduced herself as a third year junior earlier passed me the paper and I saw her full name. I voted for this name during the recent PERUBATAN election.

"You're the new exco?" She nodded sheepishly. "Congratulations."

"Thanks. But it's more towards condolences."

I chuckled. "But you guys were running voluntarily, so I'm not sure whether I'm supposed to say condolences."

Her laugh sounded restrained. I probably just imposed on her the image of a weird senior. I wrote my attendance.

Hemorrhagic Infarction

Today in class we took Stroke. The doctor said when you have large surface of cerebral affection, you may need to do a hemicraniotomy or else the swelling will lead to conization.

"The patient will have dense hemiplegia (complete loss of motor power in one half of the body) but at least you saved his life."

Is it really that important to live?

After the fire, everyone kept telling me that what is most important is that everyone is safe. Yeah, I suppose. With everyone safe, the aftermath I have to deal with is a bitch in itself, if someone had died it would surely be a homicidal migrainous bitch.

It is a pain to lose everything and starting back from scratch, but having to locate and repair everything before it can be usable again is also a pain in itself.

I want to give up.

Learn and Adapt

1) Be a responsible and mature adult by picking up the pieces with confidence.

2) You have to do ample research to save time. But there is always an element of gambling in life, so take justifiable risks anyway.

3) You have to be on time. No matter who you are, time is always life. It shows your sincerity and your respect when you are on time.

4) There is no merit to skipping class. Most of the time, even when you think your business is more important, it is not worth it to skip class.

5) Don't ever stand people up. It's not your excuses they want to hear, people would just appreciate you telling them you were not going to make it. Calling people is a sign of respect. Not doing so and simply stood them up for whatever reason implies your time is far far superiorly more precious than theirs. That's just plain narcissism and pitifully conceited.

6) No matter how mature you try to act, you will always succumb to some random authoritative adult taking care of you.

7) It is good to be wary. A healthy dose of fear keeps you safe. Be calculative but don't be paranoid.

8) Not all police are thugs. The ones we met are actually very helpful people. As I said, be calculative but don't be paranoid.

9) Everything has its own place. Be organised and don't misplaced things, for sanity sake.

10) No matter how tough you try to act, you will always succumb to the kindness shown by random strangers.

11) You can speak and understand Arabic better than you think you can.

12) There are some social facts you cannot change. For everything else, do what you need to do and don't complain unless it makes a difference. Ranting will only make you feel better, but it's only temporary. You will feel stupid for complaining over unchangeable things afterwards. Instead, recite اللهم انك عفو كريم تحب العفو فاعفو عني over and over again and may God not make the sins you have done as the reason for you going through difficulties. What is important is things get done.

13) Vent out physically. Wear shoes and kick stuffs, just try not to do any damage in the process. Wear pants and walk all the way to your next destination.

14) Banana milk is the best. Don't buy chocolate milk.

15) You don't need company, it's just going to waste their time because things can be done by a single person, that is you. Company is mere moral support, you can get that by having a live-in strong character in your head. So be mentally strong and don't waste other people's time.

16) How many times must I say, time is life.

17) Don't beg for help, please don't ever beg for help. At the first sign of reluctance, back off straight away and restrategize. Persisting in asking for their help will only lead to accumulation of tears, and this is my next point.

18) Don't ever cry in front of anyone. Don't you effing dare to cry in front of anyone.

19) You are allowed to open up to one person at a time. Use him wisely, for he has his own things to take care of.

20) Don't worry your parents. You are only allowed to be vulnerable when you are face-to-face with them. Otherwise, don't effing worry them.

21) At the end of the day, you can only depend on God.

22) Don't bother people with small talks.

23) Don't yell at people who bother you with small talks.

24) Leave me alone.

25) Pretend that life is as usual, it will help people to live on.

26) You have to survive in order to live.

Aftermath is a Beach

The title is a pun.

There has been two options as of late. A, do what I want. B, do what will trouble the least number of people.

And thus I am stuck between being a happy selfish person and being a selfless submissive little sheep. I haven't prayed Istikharah yet. Maybe that's the main problem here.

I thought of asking random people which choice would they go for. Umair scolded me when I asked her A or B and told me instead to choose the third option of doing what I want and trouble the least number of people.

Except that further stump me, and here I am.

For someone who wants to make her own decision, I sure am indecisive. Maybe deep down I just want my dad to take things over for me and let me lay down on the floor of my room and stare at the leaking ceiling.

I understand now the desperation of wanting things to return to how it was before.

Always know what you want

They say I'm cool and brave and that the moment I lose my cool it is a sure sign of catastrophe, but right now I really want to sit in a corner and cry. They call me reliable and responsible, but right now I really want my dad to hear me out and take over things for me.

I want my dad to be here and take care of all this ordeal. Everyday he asked me how I was doing, if I was okay. I had to choose my words meticulously because I know they worry about me and helpless enough as it was, the last thing they need is to listen to me needing help but unable to help. It makes me feel worse to trouble them like that and at the end of the day, I still have to do this shit anyway so let's just walk through hell till the end.

I want to lay on the floor and stare at the patchy ceiling of mine, but dammit my place reeks of smoke now. So I crawl into someone else's bed, close my eyes under someone else's cover, and all I see is a flickering red in a sea of darkness and the sound of wood burning.

Slap me now. I need a psychiatrist.

Snow

It snowed today in Egypt.

But because the cold weather is known to induce bronchospasm in me, I decided to stay in my room and study, regardless today was the Family Day of PERUBATAN Cawangan Kaherah.

Suddenly, a drop of water noisily splashed onto the carpet. I stared at it and blinked. Another drop came down and I blinked again in denial. Third drop was even noisier and I let out an exasperated scream.

Kak Milah rushed out of the room to get a bucket and came to my rescue. She went around the house looking for leaking spots on the ceiling and fortunately there was none. I was the only misfortuned Ayyashian aboard.

I glared at the leaking ceiling and snuggled back under my cover, continuing my study.

Suddenly, a drop of water splashed on my head. I looked up and there was another leaking point exactly on my head. I screamed bloody murder as another drop fell down and pulled the cover over Kevin, my pillows and books.

Another bucket was placed on my bed, over the cover. Kak Milah and I stared at the bed. Where am I going to study now? It's cold and I need my cover.

"Three months... Three months and you guys will go back for good, and I'm out here." I muttered.

She laughed awkwardly.

We discussed whether to move the bed temporarily to the middle of the room or place it parallel to the other wall away from the leaking ceiling. The second option will need the study table aka the bookshelf to be moved as well, thus a total rearrangement of my side of the room.

It was tedious. "Books too heavy."

"We'll do it together."

Kak Milah has her Surgery second paper the day after tomorrow and here she was, staring along at my stuffs. I felt bad. I approached my bed to take my book underneath the cover and noticed water splash all over the cover. Pieces of ceiling paint were also splattered on the cover.

It was bad.

We moved the bed as per first option. But then with the bed in the middle of the room, it was messy and annoying, God!

"I'll think of something less tedious while I clean up later."

48 year old geezer

Today at 11.30am I stood in the doorway and stared into the kitchen and this conversation took place in my head.

"I want milk."

"We need to eat la last meal was 5pm dinner."

"But I want milk. Loads." I looked around the kitchenware and spotted two of my mugs; a heirloom from Kak Bid and a soup mug birthday present from Kak Biha. "One mug not enough, two mugs too troublesome, not enough anyway."

"We don't have tall mug."

"Must go buy tall mug tomorrow."

Spotted a small jug. "How about warm milk in a jug?"

"Yaa we have that straw."

I imagined myself studying while drinking endless milk from the jug via the straw. So after three minutes of staring I proceeded to gleefully make myself a jug of warm milk.

Brought the jug into my room. The warmth was heavenly on my palms, I decided to forgo the straw and drink straight from the jug. It was wonderful.

An hour later I had to go back into the kitchen for more warm fluid. Ended up cooking instant noodle for the sake of the broth.

---

I keep having to remind myself "You're 23, act your age, stop lazying, we have to excel this." But to no avail, I'm just too lazy. I suppose I'm still too youtful.

Until this test shattered all the illusion I considered reality. 48 years old grr.

Conflicted

I was going to study but then Haru said

"studying.. It's pointless! Since it's got fixed answers, it should be very easy, right?"

Says the guy who finished reading his materials way before.

ربنا يستر

Kak Milah said their Surgery paper today asked Anatomy questions like something-fistula (no not AV fistula) and anterior rectal fascia and whatsit. Their doctor comforted them pre-exam that the questions would be crystal clear but they didn't expect such crystal clear questions were of minor topics.

"We expected Anatomy questions would be like hernia.."

"Or neck, thyroid."

"Yeah."

So Ijud advised us to study minor topics well and #crystalclear had become a running gag.

It's cold today and the weather forecast warned of showers so I put on my usual winter coat this morning. But I didn't expect it to be that cold. The weather sure is bipolar around here.

There was an anti-coup demonstration on campus today but apparently I missed out because I was still at the hospital at that time auscultating a 41 years old female with double mitral, aortic stenosis and tricuspid regurge.

Dr. Abeer said the patient has small volume pulse so I checked her pulse and compared it with mine. It was similar. Damn.

"Does this mean I have small volume pulse as well?"

I had palpitation at rest a few days ago and with this revelation, I felt like going down to the ER and hook myself to an ECG machine.

And in Al-Azhar University, the military continued to violently dehumanize the students in particular and us human in general. There is an illusion of peace in this country with targeted and localized dehumanisation and if you stop caring, you will forever be a fool.

Our midround Internal Medicine exam was announced to be next Monday at 8am. Which is brilliant because we have Tropical Medicine endround exam at 12pm. On top of that, my group was scheduled to present our seminar on Fever of Unknown Origin at 9am same day but I couldn't confirm with the doctor whether it is still on or postponed (though logic dictates it is postponed but you never know, we do have Murphy's Law). We were scheduled to compile our work tomorrow.

Because it's cold, I am planning to skip out on our hospital session tonight. It's either that or be dependent on turbohaler.

To balance this post, an Arab colleague of Ijud commented on his status that the only good thing that happened to him today was when Dr. Hussein Khairy passed in front of him in the exam hall.

Now that is a sight for any sore eye.

random advice

it hurts. it's okay if you want to cry. you were so brave.
you are strong. you will learn from this. you will survive.

you will be okay.

We could feel tired at one time, I don't care about it either, give me a few more minutes

When I went to the 7.30am class this morning, my friends told me my eyes were puffy, didn't I get enough sleep last night?

Last night I crashed somewhere not my own and I more or less sleep less when I don't have Kevin with me, so the latter part was a possible. But I used the mirror this morning but I didn't notice anything amiss. I think I looked about normal.

Is it possible that my eyes are puffy every morning that I forgot what normal looks like? This is bad, I thought. If this goes on I wouldn't be able to differentiate mild eyelid edema in a nephrotic patient.

"Kenapa kata sembab? Kenapa bukan eyelid edema?" I asked her. "Kenapa tanya tak cukup tidur, kenapa tak kata nephrotic syndrome?"

"Kan nak kerja kat Kota Bharu!" She laughed at me. For the life of me, I didn't get the joke. "Orang sebut sembab la."

"Oh." Moments like this makes me feel so skema and need to get a life.

Class ended at 11. I went home, prayed Zohor and skipped Dr. Husam Mowafy's class in favour of catching up with my sleep.

Magnanimous

It has always been a habit, one of the things I do to remind myself of independence, to never let a guy pay for me. But Acap wouldn't take my money and if I try to slip the money into his jeans pocket, I'd be called a pervert. His sweater pocket was out of question because he kept his hands inside it all the time. With his slouching posture (I suppose it's the side effect of being so tall living among the rest of us minions lol) and hands inside his pocket, he reminds me of the ever cool Kakashi. 

Minus the hardback porn. Or maybe it's hidden somewhere..

Anyway, it reduced me to a sheepish "Thanks Acap." and later "Sure I don't have to call you Abang Acap?"

One of the things I learned today is that you cannot live being a frugal and minding person. We should limit our passion to effort and friendship.

The both of them were behaving like big bro and big sis today. They were taking the babysitter thing seriously, bullying me around and paying for my food. Using the Syria card to make sure I mop up my ice-cream when I was already full with dinner, it was evil. I was on the verge of throwing up and there they were, laughing at me. If it was anyone else they'd be long dead.

It was then that I realised it was a belated birthday treat. Ehehe. Friends don't usually celebrate my birthday, so it was a first in a very long time for me.

---

I believe that there must be balance in life, and since I bully pretty much anyone I can, I allow myself to be bullied by the people I respect at intervals.

Plus I'm more masochist than I am a sadist, so yeah..

Nuclear Bomb

The first Paediatric case I presented in class was a 6 years old boy named Ziyad complaining of abdominal distension.

His mom told me during the course of history-taking that her son was admitted 12 times because of respiratory infection, but that week we were supposed to cover Gastroenterology so I was too caught up with the abdominal part of the case and my pissing off with myself for not understanding some of the mother's word, his pneumonia simply went loss on me.

And so I presented the short case to Dr. Samuel Makar that day.

He asked about chest symptoms. I told him the mother mentioned but I didn't understand everything. He turned to the mother and asked her in their mother-tongue.

"12 times admitted from chest infection," the doctor turned to me. "This is a nuclear bomb you missed. A nuclear bomb."

You should have seen his face when he said those words to me. It was grim. I was stunned. I felt damn stupid, I was a disgrace to my family, my Paediatrician dad would be so ashamed of me I wouldn't blame him if he declare I was actually adopted.

"Abdomen and chest symptoms. What do you think?"

I don't know, so I told him so.

"This case might be tough for you, it's not a very common case," he continued. "This is a case of cystic fibrosis."

I reemerged from my self-pitying state with those words. Cystic fibrosis. I swore I will not forget that disease, the importance of good clerking and Dr. Samuel Makar who taught that class.

Anyway, since I presented the case, I got to examine the patient. Dr. Samuel seemed strict and firm with us but he was gentle with the boy, distracting him by asking what was his favourite show on TV and his favourite characters while examining his abdomen. He showed us the trick of palpating a kid's liver (running your fingers like playfully poking the child, but you're expected to palpate with the lateral border of the hand in an exam) and he let me palpate Ziyad's hepatomegaly.

I used that trick a month later while independently taking history of a naughty 4 years old boy with ITP. He chuckled.. so cute.

Other classes we had with him include a rheumatology case in which he taught the sheet for Rheumatology (a first for us) and a sad case of complicated hydrocephalus boy. I could see clearly his grim face as he addressed us, away from the mother, at the poor overall condition the baby was in and how his mother sought medical help late. Hydrocephalus was a relatively straightforward case, the boy's condition was generally preventable.

"I will not comment."

I learned the value of teaching without judging, how medicine is an art of educating people to do good to them without passing off judgement. We all have our battles.

Which reminds me of a story my dad told us about when he was stationed in Sarawak.

One time he frowned at a patient's son for bringing the patient late to the hospital. The son answered him calmly, that they lived far away from the hospital and the trip took a week or so via the river if the water-level is up to it, or else it would take a fortnight.

Dad was rightfully humbled.

Sex Ed For Dummies

When we studied Sexual Education under Andrology, our doctor told us that sex ed must be taught regardless the community we are in. But first let us define the basics.

Sex ed is organized information on sexuality that is related to the ethical principles of the community. The basic is that we are teaching about how to deal with the physiological, anatomical, and psychological changes that relate to growing up, so that everyone will have a positive attitude towards sexuality.

Since it is based on the principles of your audience, for a Muslim community, we are teaching people those basics I mentioned before. In the west, safe sex, prevention of STD transmissions and avoiding teenage pregnancy are probably a crucial part of their syllabus. Again, because of the principles of the community.

For a Muslim community, we are not teaching how to practice safe sex because extramarital relationship is against the principles of a Muslim community and we are not teaching how to have sex because this is innate, even animals do this and no one taught them how to. Though some people might need help in this department.. that is why Andrologists and Sex Therapists exist.

This teaching is ideally the responsibility of the parents to be implemented at a young age, as young as 3-6 years old. During this time, a child is going through the phase of gender identity. Teach him/her the differences between male and female, teach him/her humility, and teach him/her that some areas are sacred and not to be exposed/touched even by the opposite-sex parent. Also, the parents should answer simply and correctly if ever the question "How did the baby get inside mommy's tummy?" pops up.

That class made me wonder. With the easily-available porn of various degrees in our daily life and with news like this one no longer surprising, perhaps it is time to revamp sex ed curriculum among our Malaysian community.

That, or the doctor who taught us lives a happily oblivious or the idealest life. Hehe.