you did a good job

Yesterday in OT we were doing a tubularise incised plate urethroplasty for a 10yo kid who had subcoronal hypospadias with whole wound breakdown post MAGPI procedure.

Mr Fitri trimmed the skin and dartos nicely. There was a small skin loose end at one part that he seemed to didn't care and I used my pickup to flip the end silently. Just flipping it here, there, glaring at it annoyingly but not saying anything to my surgeon. He looked on in equal silence and got my message. He then took a tenotomy scissor and trimmed the end. 

I wanted to laugh at the absurdity that was me. But I'm a person who work in silence so I didn't. 

He then said to me that he wanted to try doing the urethral suturing interrupted instead of continuous and he asked me if he should. 

I paused for a moment. Why is this surgeon asking me. 

"I've... I've never seen anyone do it interruptedly. If so, how close should your stitches be? The next layer will be suture line on top of suture line right, wouldn't that increase risk for fistula?" 

"What do you mean?" 

"You're going to close the next layer midline as well, correct?" 

"Yes." 

"So the skin suture line will be on the uretheral suture line. If the wound breaks down, wouldn't that be a fistula?"

He was silent. I hurriedly added "But I wouldn't know." Cause man, I don't know shit. I'm not someone who has done a urethroplasty, I just assisted... Few. But who am I kidding, I like urethroplasty the best. The on-table creative decision is so fulfilling. 

He proceeded to do the suturing continuously and I'm like... Did I just doubted a surgeon? Hahaha wth I don't care anymore. 

He was done in around 30minutes. Although I barely did anything, I felt a swell of pride and fulfilment at how nice the outcome was. I wanted to say "cantik" but I felt like he knows that already and I didn't want him to think I'm licking his ass, so I didn't. 

In restrospect I should have told my surgeon he did a really nice job. Everyone deserves to hear they did a nice job. 

of course i can do it, it's just i don't want this unhappy life

I need to be kinder to myself because who else is. My stuffy nose is giving me headache and I don't know where I stashed my PCM, so here goes me hiding in the surau cause the rest of the hospital is freezing cold.

I'm a good doctor. I know things, not much, but enough to not kill patients.

On Sunday when I was oncall, ED referred me a perianal abscess in our POD 40 transanal pullthrough. Child not septic and I've never seen one before, but I know this is his coloanal anastomosis leaking and he has a pelvic collection that trickles down to manifest as a gluteal abscess. I presented so to Mr. Fitri and he agreed that we need an ultrasound next morning to confirm. 

That morning the rest of the MOs asked me why I label him as pelvic collection when the thing looks like a regular gluteal abscess, my answer is that when you have an anastomotic leak that low in the pelvic, they manifest with tachycardia a bit, fever here and there as per Mr Mughni taught me. Just small things, until the collection is big enough to manifest externally. Kid ended up with a stoma and I&D. 

And then we had a POD 4 transanal pullthrough (stoma down) girl who was discharged that morning and came back that night with persistent vomiting. I admitted her thinking of enterocolitis ddx adhesion obstruction and wanted an AXR cause I need to figure why she's vomiting. Mr. Fitri said to observe first since her vomiting was non billious and her abdomen wasn't distended. 

Turns out her vomiting persist to high billious output during the next 4 days she was warded. We ended up doing an ultrasound (which showed TZ at jejunum) followed by an AXR the next day where we saw her small bowel centrally dilated with paucity distal bowel. We did adhesiolysis for her. 

Kirosha applauded me for being right. In retrospect I should have said to Mr. Fitri that I needed an AXR to rule out proximal small bowel obstruction since her abdomen wasn't distended. 

Today morning I presented a systematic review critic for laparoscopic versus open appendicectomy for complicated appendicitis in children. 

What happened was that after breaking my brain half heartedly looking for a paper, I decided on the topic yesterday evening and got complained by my surgeon "esok nak present kenapa petang ni baru tanya". Sorry miss but I have been searching few days and can't find a better one. Been mentally preparing myself for the past 1 week but here we are.. 

She said to go with it. So I went back around 6pm, dinner and date with Jehoon until 9pm plus, and only around 11pm did I open my laptop to study the CASP checklist on criticising a systematic review. Thank you Ms Doon for teaching me this thing exists and it was actually my first time using it. I finished my slides close to 2am and slept until 7am. 

And then I presented. I was preparing my script for the presentation opening with "I'm not good at this but I should start somewhere" but I didn't say those. I didn't do badly, I think it was okay. We had a good discussion.  

Perhaps these people are right. I can do this. But hey the issue nowadays is not that I cannot do this, it's that I don't want to do this. 

But I'm still here. I'm still taking one step at a time. Like that time I hiked up Maliau Rim feeling so mad because I didn't want to but I still made it up there, cursing and all. What now? 

To be a surgeon is to be a better doctor. It's a different standard. I have to improve. 

#jaditraineetiadaharapan

Last week I was in OT assisting my surgeon with a urethral stricture surgery. He was asking me to straighten the penis up so he could make a straight cut, and his words to me were

"Atiqah tolong tegakkan bird tu sekejap."

I did as instructed but inward was sighing. People been referring to him as Bebird King because he does a lot of hypospadias surgery but help me God I felt triggered whenever I hear that term. 

You see, I like birds. Literal birds, the ones flying freely and always so elusive and mocking me with their lovely songs. Not this. Penis is not a bird. Why do we term them birds. I wanted to complain so much but I shouldn't make a fuss but dear God it happened last week and I'm still thinking about it.

I want to go birding so bad. 

elango belanja saya makan

On this blessed Friday my registrar bought me lunch and we had a deep conversation about life over ayam penyet and teh c ais kosong.

The good thing for me is that I have known these people from when I was a service MO. They're the only ones I can talk to now that I've joined them in the program, whose questions of "are you okay" I could answer long and truthfully.

He's figuratively patting me on the back because to them I'm a "hardworking, responsible person, although sometimes can be kepochi". I don't feel that about myself. What does kepochi means anyway.

Good advice on to quit now rather than wait for whatever. "Don't think about others, don't think about who's going to do oncalls" at this point I laughed because that's so me. I should just die. 

"Be careful of the young surgeons. They collectively give you a bad assessment but never said anything in front of you. The only good person here (in the fraternity) is Mr. Mughni. He's like the badan berkecuali."

"But don't worry. What happened to me won't happen to you. I know."

How do you know? I want to know what makes people think I can make it. But Elango just told me he knows and to trust him. 

"There are other ways to become a paediatric surgeon, and you wouldn't have to be attached to these fucked up people."

Good morning, 2022

I wrote this on December 20th but I kept it on my phone unpublished because I hope the feelings will change. It hasn't, as I woke up today staring at the ceiling wanting to stab myself in the heart.

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Today I woke up regretting that I had another day alive. I then walked to work hoping something bad happens to me and I die on my way. My eyes watered thinking my mom would probably cry, but I hope I don't survive. 

I crossed the road safely looking right and left. I made it to work and I punched in. 

And I greeted my colleagues and staffs and worked like nothing was wrong. I even had lunch because we were in clinic and my surgeon told us to go have lunch before facing the evening crowd. 

Work done around 5.30pm. I hung around to make sure nothing was needed of me. And then I went for prayers. I thought I should wire my money to my baby sister and some to my brothers. To my uncle who works harder than me with six mouths to feed but his pay just barely one fourth of me. 

I should go up to the roof again but the place is covered and barely any sunlight be seen. 

And as I walked back, I wondered if a person could just die suddenly. If I were to work and just suddenly collapse in the ward. Will they successfully revive me or would I just pass on? I hope I pass on. What would the cause be put? I wonder if they would talk about me, how they think I look thinner, how I've always been quiet and just do my job. 

They will, people always think they know you. But here I was, functioning but oh how I wish I'm dead. 

Mom would cry and I wish I could talk to her but nah they wouldn't get it. Talking to them will make me even sadder. I should just get my will sorted out and go somewhere far and quiet to go. Some place I wouldn't be a nuisance. 

I wish to die but I wouldn't harm myself. It's illegal. But I'm going to sleep now. I hope I don't wake up at all. 

I love you and will always thank you. 

Atiqah