Today I did variceal banding and withdrew colonoscopy

It was 3pm. Second colonoscopy for the evening. Pali came in the scope room and the first thing he announced to the whole world while testing the scope was "Aku tak mandi lagi!" 

What the hell this idiot. "Kau jonah sangat kenapa." 

"Aku oncall dengan Ms Doon."

I laughed. "So semua benda kau kena buat sendiri la kan." 

"Aku call dia 2am. Patient UGIB sampai transfuse 7 pint. "Fadhly you buat la, I nak tidur"."

I laughed harder. He let me withdrew for that colonoscopy and he sat down chatting not even looking at what I was doing. And then he disappeared. There was a polyp needing polypectomy. I want to do it, I think I could, but better let them do it. Mana abang. 

"Kak panggil abang tu jap," I asked the SN.  

Naveen came instead. He did the polypectomy (as easy as I thought it would be) and let me finish up. 

Turned out Pali was in the other room doing the other colonoscopy that he took over from struggling Naveen. He finished the polypectomy for that patient while still complaining of his unshowered state ("Kalau kau tak bagitahu, takde sape tahu kau tak mandi." This is the colonoscopy room, you'll never be the stinkiest.) and then asked me to take a picture.

"Amik gambar apa? Kau?" 

"Gambar aku nak buat apa. Gambar post polypec tu. System down." 

"Ambil la gambar Dr. Fadhly mengantuk tu." SN said. 

I obliged for both. Apparently the system was misbehaving and Naveen had been taking the pictures so far using his own so I took over from Naveen. 

Post procedure, I finished cropping ("Lemah la iPhone, tengok phone aku terus crop sendiri." "Ye aku setuju.") and sending the pictures to his WhatsApp (the scope findings and his postcall side profile) while he sat in front of the computer meddling with his messages. I was already back from sending the patient's file to the recovery and he was still not typing. 

I expected so. Last time I made him do it while I sat next to him, but today I was feeling sorry for this tired old fart. Petang ni kena buat preop for OT esok pula. 

"Mari la aku type report." 

Pali made way for me. I typed the report while discussing the findings with the him and even layan him borak. ("Tiga bulan kau di scope, kalau aku mengular lama dah." "Aku tak pandai scope, takleh mengular.")

"Report tunggu gambar upload. HPE dah buat. Takde apa dah kan? Pergi la tidur." 

He asked me to help discharge the patient as well and instructed me how to. I said I would.  

"Aku pergi eh?" 

"Bye." 

He then left. The patient was gone by the time I went to recovery, Naveen discharged her already. I then sent the picture of sleepy unshowered postcall Pali to Miss Doon haha. 

I think doctors are masochists

Pali started doing the OGDS when I came back from observing a colonoscopy in the other room. I wore my gown and gloves and just silently stood beside him. He finished the retroflex and suddenly handed me the scope with a "CLO test lepas tu withdraw." Then he unscrubbed. 

He's like that since he first told me to get an ABG for an acutely ill patient he was staring intently at from the counter on my first week in Lahad Datu. That time I laughed thinking he's treating me like a HO, and I was obedient because I respect him. 

I took over the scope happily. It made me wonder, why did I like to be told what to do by Pali? I felt respected despite being ordered around. Was it his tone, or because I was used to him? Or was it me being out of control of myself that I want someone else steering for a while. 

I took the biopsy for CLO test. think it's the latter. I am not assertive enough, I was brought up in a clinical setting where I don't ask for things for myself because my old boss dislike people asking for permission to do procedures, she would permit them herself when she felt they were ready. 

I thought he was busy, but that bastard (affectionate. You know this right? I like a lot of bastards.) wasn't even needed somewhere else. He was still around doing something idk what but I did the report while he was nosying with the CLO test result. Had I been a lesser person I would have thought he had a kick for ordering people around. 

Cik Fatin helping me

I self-referred myself for therapy by the end of July, because I was skipping work to lay under the cover. I did nothing worthy of my doctor title. I labelled it as burnout. 

My first session was 18.8.23. I picked the last session 4pm because I didn't want to spend more than an hour. I was sceptical of her, I was quiet, replying word by word. My DASS score was terrible,

Very severe stage of depression - 36

Very severe level of anxiety - 26

Severe stress level - 30

For reference, my previous DASS score taken on:

19.3.19

Severe stage of depression

Severe level of anxiety 

Very severe stress level

7.6.21

Very severe stage of depression

Very severe level of anxiety

Severe stress level

She suggested I quit because my mental health was ailing. That made me realise a lot of things, but quitting wasn't the answer. She asked me what do I want to do now, and I answered her I just want to sleep. She made me a referral for Psychiatry but she didn't give me the letter, just online form that I have to print myself. I used no printer as an excuse not to go and instead buried myself under the cover and was still skipping work. 

Second session was on 1.9.23 and it was almost two hour long. I ventured more openly. I cried at the mention of my brother. We listed what my stress points are and what I think might help. By the end of the session I was actually grateful to attend therapy and we decided that I have to start small; the aim was to wake up early and exercise more. 

I didn't really get to do much exercise, but I showed up at work. I don't think I have a perfect 5 days per week attendance, with me giving excuses to come an hour late on a good day, but at least it was something. I sent in my proposal. I had one study session. I went hiking once. It was very slow barely there progress, but at least I was moving. 

Today, 9.10.23. I mentioned that I feel my DASS score perhaps improved, but my issue is with anxiety shutting down my confidence level. We discussed few notable things. 

The mind thinks and manifests into feelings and actions. It's a cycle. 

The ABCDE model of rationale. I need to Dispute my negative Belief. Instead of thinking I'm troubling others, ask them directly am I troubling them. 

Overthinking is a clutter of drawers that needs to be organised. Jot things down and let them go. 

Deep versus over thinking 

- Deep thinking is one with solution, one I have been a good player at all this while. Overthinking is the shitty cause for anxiety. I need to stop it by coming up with logical solutions. 

Logical versus emotional support 

- Just because I was a logical person with immense self-sustained emotional support doesn't mean it wouldn't change. My problem now is that I have exhausted my own emotional support, thus logical support won't help me now. I need to replenish my emotional support.

I wanted to laugh. I didn't realise that I needed to be babied. She said it's not a weakness, it's just us being human. 

I asked if there was any other way of getting emotional support other than depending on others. She said since my tank is zero, I best get it from others. Some get by with positive quotes and such. I think I should try that. I wondered if mentioning Haru as my self-sustained emotional crutch will be helpful, but I did not mention that. 

She discharged me today. I have a lot to work on, but I know how now. 

DASS score taken today 9.10.23

Very severe stage of depression - 30

Severe level of anxiety - 18

Moderate stress level - 22

And I have to finish that book on Depression.