How the super busy dean keeps his cool and going

"How many days are there in a week? Seven? Five?"

Grins.

"Actually there's only one day in a week. Just Sunday. Because when Monday comes, you start thinking of next week or the end of the week. When Wednesday comes it's already the end of the week.

When you think of it that way, it makes things a lot easier."

Another cool grin.

Wolf

Today instead of general surgery class with Dr. Shady, we had a lecture on diabetes mellitus in surgery with Dr. Raafat. Last week when Dr. Shady told us about this, the whole class went "wooow~"

He stopped announcing and asked, "Is it a good woow or a bad woow?"

"A good one of course!" Haha.

Anyway, today. Our class arrived at the venue before 12 because we were told it was at 12 and Dr. Raafat had this gentle menacing way of making you regret crossing him. No doctor showed up until Dr. Mohamed Saeed Gomaa arrived, surprised at seeing us.

"All of you are earlier than me, and I'm a guest here today. The one invited me isn't even here yet."

I was at the back then, just finished praying. I came to the front where I sat and it was behind him. I greeted him with a salam and grinned, "Dr. Mohamed, happy birthday."

You should have seen his surprised face when he realised what I said. Who wouldn't be caught off guard, so far I had failed to commit to his Saturday 7.30am classes (despite been impressed with his class since he taught us Ascites in Fifth Year) so he probably barely recognise me as his student. But I'm not exactly a stalker either... but yeah I do stalk his lecture slides upload for all his class I missed (which is a hell lot).

Anyway, he happily replied a thank you and it made me embarrassed that I couldn't face him nor the customary prayers that follow a wish, not even a basic kullu sanah hadrotak toyyib. Awkward kid.

I compared myself to Khadijah who always stands tall when she faces a doctor in a personal matter. She's a real people's people. God I envy people who aren't awkward in front of people they admire. I have a lot of regret in this 23 years of life because of this trait of mine, thanks to dad's gene. Hahaha.

Regardless, thank you Facebook!

---

"Did you know we used to be in the same class? I have known Dr. Raafat since 1976, long before any of you were born."

I laughed. My parents weren't even married yet then, not sure if they even had known each other. I wanted to ask if they were classmates then how come Dr. Raafat's hair is all white while his is still black? Is surgery perhaps more demanding? But I had a feeling Dr. Raafat will boom out laughing and then ask for my name and ID number to deduct marks out of my final exam for making fun of his hair :|

Bwahaha.

---

It was legendary. Today's lecture was actually a joint meeting between Department of Surgery and Department of Internal Medicine for postgraduates attended by including the HOD, some seriously super-experienced-looking doctors plus Dr. Yahya Safwat who gave the much appreciated Burn lecture. Dr. Mohamed gave a very elegant lecture on diabetes mellitus, insulin protocol and it's application in patient facing surgery. I really was enlightened.

Then Dr. Raafat continued with diabetic complications in surgical practice comprising of infections and diabetic foot. Diabetic foot reminded me of mom because diabetic foot care was her thesis for her degree from Australia's North-something University that I spend late night grammar-checking.

Hi mama. I miss you.

Dr. Raafat showed slides of his patients with acute necrotising fasciitis, if I remember correctly was one of the topic for his thesis, including a picture of the bloated abdomen of a female with abdominal acute necrotising fasciitis referred to him by Dr. Hussein Khairy. Gruesome. It wasn't bloody, but those pictures were really of the most heinously dead limbs and torsos I ever saw.

"These are the most palatable of the pictures I have," he commented since everyone seemed rather excitedly disturbed by such. "Others are even more disastrous."

Thanks for the consideration.

When we came to diabetic foot management, he elaborated on the advantages of medical honey as a wound dressing.

"... it has antimicrobial properties, and you can even make yourself a sandwich while dressing the patient..."

Egyptian and their love for sandwiches! Actually I imagined slathering the honey on the wound and sandwiching the foot between two slices of bread, God why is my imagination so gross.

Still in his medical honey slides, we then came to a slide of a debrided big toe of a 21 years old single female with osteomyelitis even.

"Everyone wanted to do a below-knee amputation but I used my personal charm of threatening people to resist. She improved within months of the honey dressing and kept her toe."

Read that again in his gentle menacing tone.

That was when I realized why I like studying under Dr. Raafat really much. He's confident nearing cocky because he knows his stuffs and he really is good. He doesn't need anyone to agree with him to do what needs to be done.

He reminded me of a wolf.

Another person who reminded me of this devil-may-care attitude is Dr. Ehab Abou Zeid of ENT I deduced back then as an impressive melancholic.

"She had a thrombus to her frontal lobe, that's why she's behaving like a child. I know that, that's why I didn't kill her haha."

There is no such thing as "Good luck",
There is only work-work and "Good work".

We finished our Cardiothoracic Surgery round today. It had been fun because the doctors were legendary in experience and Dr. Ayman Gado amused us with tales of the common Egyptian patients that made it easy for me to remember the management for different cases, Dr. Waleed's approach that made sophisticated things easier for me to understand and memorize and Dr. Soliman who somewhat reminded me of Don Corleone as he drew away with coloured chalks. The secretary was a young female and she was helpful and prompt and greeted us every morning with a friendly smile. And the janitor standing guard at the door greeting us good day as we passed.

Department 24 of Kasr el Ainy sure was awesome. Dude. Is this really Egypt? Wahaha.

During this round I learned a lot among them the value of trust, to not scandalise my fellow colleagues and most importantly how to bloodily kill a person. Hehe. Just kidding.

Anyway, I know Special Surgery is fun whatever may come because it is a small class of 14 people that I get along very well with and we're going to be a group together for the rest of our Surgery rotation. Teehe.

Bloodlust

Okay so tonight's hospital was sixth floor of Batnah Hospital. The attendant greeted us in and chaperoned us to the last room where the doctors had gathered to perform a landmark-guided central line insertion in a lady with hepatic encephalopathy.

Wooh. Blood blood. Calm down, don't smirk excited, they might refer you to Psych.

The attending doctor was at the head of the bed in a sterile gown and all. I stood on the right side of the patient and halfway done was told to resume restraining the patient's arm.

So the question is. May I consider myself have assisted a central line insertion or not? May I tick in my Batnah student logbook? Haha.

Anyway, the procedure reminded me of a story Dr. Ayman Gado told us, about a resident in the ER flabbergasted when his young chest trauma female patient was asystole and he needed to give her adrenaline but the central line had somehow dislodged. Her big burly father was outside and menacing and if his daughter die, the poor doctor will be dead too.

"Ha'mil eeh ha'mil eeh!"

Give it through her ETT while waiting for a senior to set a new line. Need three times the normal dose, put some saline with it and proceed with ambu. Although the 2010 ACS Guideline says ETT route is dubious, alas, better than nothing.

---

So tonight there was me Umair Syaimaa and Iskun. The three of us girls were in the same General Surgery class and so we made reference a lot to Dr. Refaat Afif while history-taking.

"You forgot to ask blablabla. You'd get slaughtered by Dr. Refaat."

"The other day we answered incisional hernia's types were paralytic and defective because we didn't remember the name of the second type but there was a defect in the wall so why not defective, and his reply was "What defective? Are you a medical student?" Hahahah!"

"Hey don't forget this point. I got killed the other day because I forgot this."

"Okay Umair present the case. I'll be Dr. Refaat."

"... living in Ain Shams..."

"And where was she born in?" With a soft but there was the unmistakable predatory tone.

"I forgot to ask, sorry doctor."

Strike one. And so forth we kept attacking and questioning our reasoning and ripping our basics apart to come out on the more enlightened side. Finally at the end of the night Iskun who was in another class commented that we had a really tough doctor in our class, as opposed to his.

"Yeah it's a real slaughterhouse. Join our class if you want, he teaches every Tuesday. Come before 12 though."

"Why?"

"He'll divide us according to beds available and you'll have like fifteen minutes to take the sheet. Then everyone will gather at the first bed and a person from the group there will present the case and then be killed. Examination and further killing. Discuss management. Move on to bed two and another person will be killed. A ward round."

Somewhat Dr. Refaat-obsessed. We were killed but we learned a hell lot and that's why he had such a huge impact on us "useless white-coated harmful organism" (quoting the epitome of legend Dr. Hosam Mowafy). I'm always a little scared at the prospect of his class but more than anything I'm looking forward to it. When else did you get the chance to really stand up to a doctor who will hit you with his best ques and you have to stand firm, remain calm with everything that you know. Take his shots with confidence however misguided for he will definitely guide you then. This is the time to die and resurrect again and again.

Definitely looking forward to it. I hope I still have plenty of lives left.

The silent lambs

There are certain black or white areas in this world. For everything else, there you have plenty more of grey areas.

Premise One.

Nowadays, whenever I choose to care, I care more of the reason a person decides on a decision than the decision itself. Our standard of what's right and wrong may differ, so for me as long as you have a firm and legit-by-your-strong-belief-and-basis reasons, you can very well do whatever you want.

Premise Two.

I have ego that translates into my sense of responsibility. Thus I feel honoured when a person treats me accordingly and expect something appropriate of my level. I get personally insulted otherwise.

And because of this, I like how most of our lectures were conducted. Our doctors highlight the key points and the recent trend of management. Despite the grave importance of the physiology, anatomy, pathology and such aspects in a disease, the doctor will go through it rapidly because theoretically we have studied this thoroughly during our preclinical years. This is the time to integrate everything we have learned this past six years.

I'm not good at integrating because it is my own fault for having poor recollection and this chronic fearless laziness, but whenever the doctor spoon-feed instead of simply refreshing, I'd feel like a child. A grateful one at that.

Currently on Tuesdays, my General Surgery class is a ward round with a super specialist that can be likened to a slaughter session for us yet-competent house officers. Despite the more stressful atmosphere that leaves me feeling inadequate, I like this kind of class because it slaps me to be better than the best... or maybe I just have inborn masochism. Dr. Refaat Afif is not scary, it is failing in front of him and unable to stand up for my answers that scare me the most.

Tell you what. I had a low grade fever running since yesterday and this afternoon I presented my group's patient with this nasal tone and such. Died during the discussion and examination wahaha. 

After class, my temperature spiked and I had to take a PCM and anti congestant while running for my next lecture. Thank God for empty-stomach-friendly drugs, let's worry about the liver later.

"I distribute my books for free in Egypt, but outside Egypt the publisher is crying. They are selling it for 129 dollars."

"We will start our class at 12pm sharp. If you arrive early you may have extra time for taking the history. Those who arrive after 12.10 will be considered absent, he may attend the class but his attendance will not be taken.

I will not teach history-taking because you are supposed to know how to take a history. Unless you make a fatal mistake.

My words are non-negotiable. I am pro democracy."

You just have to laugh at that last statement. Today's class was a ward round, and so every Tuesday's. Dr. Raafat Afifi divided us over five beds and afterwards we rotate all beds with presentation of history, examination of the patient and discussion of the case. We had a pilonidal sinus, mass in right iliac fossa, diffuse goiter, breast mass and the last was an incisional hernia.

The class was basically an enlightenment of my basics. His insistence on everything basic was rightfully intimidating, something we always overlook. Elbow parallel to palpating surface, definition of every anatomical landmarks. To be confident with every single examining skills we have that has become our routine.

"You have to do it the proper way. Some people say it is okay to do things whatever way as long as they get the correct result. This is bullshit."

But the most precious was the doctor's etiquette with the patients. He was very polite with the patients when he addressed them respectfully with a humble tone, asking them to do dynamic tests politely and his proper professional exposure of the patient and fully covering them when we weren't examining.

You can practically see the patients' eyes glittering with respect for him.

"You have to know something, or everything about everything. It may seems insignificant, but at the end of the day it is going to be helpful to your work."

Really, about everything including carpentry, taxation, and mathematics, among other notable references made today. Let's not forget about political management, pet control in a hospital and his disciplined way. Despite never making a direct statement, his political inclination was pretty obvious.

"When you show interest and knowledge in the patient's work and some other aspect of his life, you will build a bond with your patient and he will trust you. When he trusts you, he will listen to your advices and recommendations. Compliance will be built. Even when a complication occurs after your management, the patient will still be okay with you because he trust you.

If you are snobby, you are inviting trouble. Patients are waiting for you to make a mistake to cause trouble for you."

Dr. Raafat is classic. He is the type to ask for normal values in an exam and, the one who will catch you off-guard by asking how do you get the mid-clavicular line.

His is one signature I am going to get ★v★

In which the schoolgirl goes "Kyaaaa~♥"

Our lecturer today was a bespectacled well-groomed gentleman in his fifties. Trimmed greying hair, tailored dark greyish brown suit in white striped shirt and soft grey tiled ties that looked pricey. His shoes were Oxford in mustard, a colour choice that surprised me in a good way.

I liked his ties. I liked his ties very much. It always makes me happy when our doctor wears nice ties, it seemed like someone was looking after his appearance. The dean came into our hall midway through the lecture to greet Dr Mohamed Khattab (he had his own lecture in the hall below) and the difference in their appearance was so stark I wanted to cry. He's a very kind good dedicated man, please God send someone to look after him!

Ogling aside, sitting in the front row got me targeted a few times to answer during lecture. It was quite unnerving to have the doctor staring right into you but all was well because he only asked about the things that was Dyslipidemia today. Oh, and he had kind grey eyes.

The lecture ended and as a sign of respect, I waited for the doctor to walk pass before exiting the hall. I stood up and thanked him with my best smile as he passed by my bench.

"You're welcome," he smiled kindly. "What's your name?"

The doctor asking for my name! Maybe he noticed my excitement during class, haha.

"It's Hana*." My grin grew bigger, the Chesire cat would be so proud.

"Hana*? Meaning old?" He made reference to the Kaaba nicknamed Baitul Atiq in the Quran.

Yeah.. but I wouldn't buy that one. I personally believe Hana* means independent and liberating. My parents named me believing it meant honorable. My naqibah yesterday shared with us another meaning, so I told him that.

"Unique."

"Hana* means old, valuable, of precious value."

And I was... No one ever made that comment. I blinked my surprise away and smiled softly to convey my gratitude. "Thank you doctor."

Second crush of the year! ♥v♥ I will be a great doctor and make you proud!

Serendipity

I had been unable to sleep properly these past weeks and thus was too inhumane in the morning to go to the dean's morning class, but I vowed to change this winter break. However, my sleep cycle worsened in spite of my efforts and his resumed class starting last Sunday saw me absent (as usual).

I contemplated this last Tuesday while staring far-off into the opposing wall. "Takde jodoh."

Nadie besides me looked at me perplexed. I turned to her and asked, "Jodoh tu ape?"

"I think it's serendipity. A happy encounter by accident."

"Oh."

---

Today was the first day in a very long time that I slept before midnight. I woke up happy. I even had breakfast before I set out with springy steps for the dean's class.

Only to arrive to an empty class and found out there was no class today. I looked up into the beautiful sky. "Takde jodoh."

On the way home outside the entrance of our campus, I saw the dean. Washed out light green shirt with yellow stripes and grey suit. The familiar uncombed hair, dialling his phone. I smiled and greeted him a good morning. He greeted me back awkwardly.

An encounter by accident. I was happy. Good morning indeed.

Aah

Today in the Neuro class with Dr. Heba Mostafa, she taught us etiquette.

"In the faculty, don't use too much 'masyi' or 'okay'. Use instead 'na3am' or 'laa'. You can use as much 'okay' you want outside the faculty.

Like in the exam and the student didn't hear my question, don't say 'eeh? (what?)' It is improper. Say instead 'Yes?' or 'Sir?'"

At home we were taught to respond people with "Ya?" and I always had to scold Hakim who replied back "Ape dia!" That monkey, haha. (Okay I admit I do this sometimes too, but my tone was more polite.)

Our colleague asked the doctor. "What about 'aiwah'?"

"That is a little bit better than 'okay'."

Aah. But I usually use 'ah' that is the shorter form of 'aiwah'. So that makes my etiquette the worst I suppose.

See, if you don't tame your stubborn kids properly at home, they become wild in the community. Like me. Keh3.

The Door

The door was to be pulled from inside and it had no handle either from inside nor outside. Today it was closed somewhere during our session and we couldn't open it to let the patient out.

One of the guys tried to pry it open. No avail. Dr Solaiman slammed on it to attract the staffs outside. The girls borrowed my knife ("Please don't let the doctor see I bring a knife around") and tried to pry it open. No avail.

Minutes had passed. I was getting edgier. Calm down, silly girl, calm down.

Dr Solaiman made a comment about brainless human. He typed in Ammu Abder Rahman's number and called him to open the door for us. The secretary came and tried to open it with a makeshift handle. No avail.

He went to take the door's key and tried it. The door yielded.

Turned out somebody locked the door. With the respected 70-plus-year-old doctor and a whole class of student in. I hung my head. Brainless Egyptian.

The doctor yelled asking which animal locked us in and demanded someone own up. They were shouting in the hallway. Dr Solaiman came back and said one of the cleaners thought the class was empty and thus locked it. "And she'll go to slack off work and come back tomorrow to open it in the morning!"

Thank you doctor for going livid. If you didn't, I would have had a breakdown. I hung my head to hide tears threatening to fall down. Damn brainless Egyptian. If there was a fire, none of us could have gotten out.. Effing brainless.

"Donkeys," Dr Solaiman muttered and addressed us. "Thrombocytopenia will present as..."

Life goes on. I need to get over this.