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.

Leprosy

I save Leprosy for the last when studying Dermatology. Because out of all the things I've studied in medicine, this one scares me the most. The worst that any other things could cause me is to make me cringe, but Leprosy downright gives me the scare. I remembered shuddering in the lecture.

The incubation period is very long, 2 to 12 years. So you never know whether you're infected or not upon an exposure. What is scarier than not knowing?

Long gone

We're having our Andrology exam this Saturday so it was only natural to study it while waiting for Dr. Ayman to arrive for our Cardiothoracic surgery class.

"What's the meaning of passive homo?" Ara asked.

"Passive homo is blablabla," I explained and then muttered loud enough for them to hear. "Now how the hell do I know that?"

She then asked why the lesion will be in the urethra and the rectum, so I launched into an explanation suit for a sex ed for dummies class, western format.

"And again, how the hell do I know that. Darn."

"She explained something to me back then, too." Umair endorsed my knowledge on this matter.

It bothers me that I know about this subject, ahh I curse you Japanese. I want my innocence back.

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.

Slow-cooked

I like it here, this seating I deemed mine. Somewhat like being near but slightly out of line of vision. Noticeable but easily unnoticed. Throw in my recent worsening of vision and you have me comfortably keeping my head down and looking up at intervals.

Yesterday was a first in a long time and I received a small smile and good morning nod. An acknowledgement of "somebody is awake today," but I don't suppose he's the cynical type. I was content even if I had gotten neither, I deserved it for playing truant. Small things like this makes me happy.

But to my amazement, today I was heard. It wasn't actively making myself heard nor actively keeping myself invisible, but I was heard anyway.

Means I'm noticed, no?

Proud cat

The first time I auscultated apical heartbeat on the right side, it was a case of dextrocardia complicated in the Paediatric Cardiac Care Unit of red brick hospital in Abou Rish. I was a noob medical student then (now even noober) and was elated. Dextrocardia bro, you don't come across that everyday.

Last Wednesday the police attacked the peaceful anti-coup demonstration in our faculty with liberal shots of tear gas canisters and shotgun. They came with their team of gangsters who attacked with bricks and glasses.

The day after, security was (every person passing through the gate has to brandish his student ID as proof of studying here. The downside of this checkpoint is that I can no longer freely enter whichever gate I want.

But the upside is that whenever I pass the guard flashing my ID, he'll cock his head respectfully in a "tafaddholi" and I feel acknowledged and cool.

Dude, I'm a Kasr el-Ainy Medical Faculty student. Not just some medical student, but a Kasr el-Ainy's. I study under THE Dr. Hussein Khairy.

Beating out a confession

In Ao Haru Ride, they were both into each other but they never confessed. When it was progressing good for them, another girl came to take Kou away and due to circumstances, Kou couldn't leave his newly-introduced friend alone despite knowing perfectly his sweetheart was devastated. Because nothing ever was verbally cemented between them, she confessed to Kou one day after she had calmed down from her broken heart and analysed the situation with what she had. In order to be properly rejected so she could properly move on.

I'm not sure why the Japanese really need a confession even when it's glaringly obvious they're into one another. Are they the police? Is it because they fool around on a daily basis? But it's not exactly a bad idea. You avoid assumptions and gain convictions. Once a confession was done, you cannot back out and be irresponsible (unless you are irresponsible). You will be sure this is all not just in your head.

But just because it's all in your head doesn't mean it's not real. Dumbledore said this.

The moral of the story is; don't fool around.

"Choose me a colour that wouldn't help a sniper ID me from a distance."

I've known a dear senior of mine doesn't like her pictures posted online since I've known her and I respect her wish. I used to think it was cool and life-saving since you lessen the likelihood of a contract killer getting a photographic ID on you.

There were times when I did or nearly did go against her trait, and she told me so in a way that made me feel okay to comply with her wish. This made me automatically obscure her face as much as I can if I was to post up any of my pictures with her, which usually I warn her of in advance.

On the other spectrum. I have a colleague of mine who wished to be respected in the same manner. Somehow my response to this situation was indifference, followed by annoyance, followed by working up the rationale to become indifferent again.

My rationale followed my common principle nowadays. Each has his own side and in a subjective issue, there is no right nor wrong. Maybe it was her being a boring sensitive person or it could be me being an insensitive prick. Probably me, I tend to go into prick mode and give no damn at all. This is probably why the dean's building has been running "To care always" message to me two days in a row.

Indifference made me comply, but I took a measure to make sure rats wouldn't become an issue again.

I entertained this thought for four hours until something else came up from her, which turned my indifference into a higher level of annoyance than the one before. Sigh.

I don't know why. This is still a mystery. Maybe I will wake up to have it solved.

---

I couldn't figure out girls. The more you know them, the more they are sensitive, clingy and annoying. Sometimes I have to tell myself that each person is a trial for himself and others and that includes me, that's why I have to tolerate because I'm a girl and I may be sensitive, clingy and annoying too. Other times I just decide if sticking around makes us annoy each other, I might as well go and take off. I'll come back whenever.

Guess this makes me straight. Or a cat.

Meaning of accomplishment

Today our patient was a 29 years old lady with neck swelling. She was cooperative, talkative and happy even, to tolerate us taking her history in broken Arabic and examining her neck.

I revised her history with our friends who took her sheet. To my amazement, she is married for 15 years and have 5 kids, the oldest is 12 and the youngest is 3.

I told this to Syaimaa and we laughed. She pointed her finger at me and jokingly said, "You have failed as a woman!"

"We have failed!"

What followed was a discussion of complications of teen pregnancies.

---

I turned back in my seat and stared at the profile of our patient.

I wondered what kind of children was raised by such a young mother. Did her children grew up like the typical gruff people you meet on the street? Will her children some day contribute to a better Egypt or will they be just another everyday men struggling to get by?

And such a life she had; raised 5 children in only 29 years of living. I wondered if she felt accomplished.

I wondered if I will feel as accomplished when I be at that age.

"You're considerate and reliable, you're my hero."

15 minutes late for my first day in Cardiothoracic Surgery. I entered the class and grinned at the absence of doctor. Safe.

I took my seat and my classmates noticed me wearing scrubs with my jeans.

"Hana are you from an OT?"

"Wow Hana went to the OT!"

I grinned at their misunderstanding. Seemed cool, I won't correct them, bwahaha. I overslept this morning and went straight for class after a shower and ironing my tudung. There was still sleep in my eyes and I hadn't any breakfast either. This somehow felt like I just got off a night shift.

Umair turned around and glared at me. "Hana you went to the OT without me? How could you left me out?"

They really are sensitive about this sort of things. Last Monday I got called out by another of my original groupmate for going to the ER without her (I went with my housemates). I don't handle clinginess well, but dude, cmon.

She turned around and wouldn't talk to me for awhile. Okay this sucked.

"Umair, I didn't go to any OT. I overslept and couldn't bother to iron anything. Other no-iron clothes are in the laundry basket."

The girls laughed. I laughed with them. I still felt cool though.

---

General Surgery class and the situation repeated itself with those who weren't with my Cardiothoracic round. I grinned happily at their misunderstanding.

Nadiah shot me down with her own grin. "She overslept."

Bwahaha cmon let me have some fun here.

---

Since my morning self is useless, the plan for tomorrow is decided the night before by my most reliable nocturnal self. Everything from the general plan of the day, what to wear, where is my first class of the day and what to grab before heading out. All the variables will decide how long can I sleep in, haha.

Useless in the morning... Oh shiz I forgot I got scolded twice for skipping Dr. Hussein's 7am already, argh and it's 2.30am!! Adios.

The Masochist S23 E09

Earlier this morning I found this historical tragedy manga called Wolf something. It revolves around a tyrant-controlled checkpoint pass and how the resistance tried to cross the border for many reasons but the shrewd tyrant figured them out and they were subsequently executed.

The art was good, the plot was even better and a proven tragedy that I couldn't proceed to read it past the tenth chapter. The title didn't stuck though because I've only read it in one sitting and I'm bad with Japanese title. Took me a whole fortnight to memorize Shiga Futari O Wakatsu Made.

That was in the morning. Just now I was having my breakfast (it's lunch hour but it's my first meal, so call it whatever you want) and suddenly some of the scenes flashed through my mind.

It's good that gory scenes doesn't get in the way of my meals but it was really troubling to think I was at ease and suddenly my mind chose to playback people humiliated and prosecuted. I cursed this troubled mind. No wonder I couldn't sleep well.

Logically speaking, for a normal better fulfilling life, treatment should start by stopping provocations. But I can see the downfall of it already, haha..

bear trap

today i was hanging out with gehad waiting for the lecture to start

"first row?"

"gotta sit at the first. i have bad eyesight, need to get a new prescription."

and another egyptian colleague came into the hall. she smiled at me.

"your name is syaimaa, right?"

"no she's hana," gehad answered for me.

"i always confuse you and syaimaa. but it was you who presented jaundice with doctor hanaa, right?"

i made a confused face. was it internal medicine seminar? i believe syaimaa presented acute chest pain and i presented fever of unknown origin, but during both there was no egyptian colleague in attendance.

"during paediatric," she added.

oh yeah i summed up last year's jaundice class up front. my jaw literally dropped when the doctor handed me LE200 because "you are very brave. if i was a foreigner, i wouldn't want to come up front in front of other locals."

"yes it was me." and then i realized. "wow you actually remember."

"yes. it was a very good presentation."

"haha." flattery. let's see where this leads us.

"why didn't you attend dr. hussein khairy's morning classes, hana?"

damn a trap. so this is what this is all about. confidently i told her "i have difficulty waking up in the morning."

half truth, maybe. this two days i was awake with ample time to get ready for the 7am class but yeah. this morning i told myself we're taking baby steps; remain awake today and tomorrow we will actually get up. looks like i really have to get up tomorrow... i mean in a few hours.

"you should attend his class. in my opinion it is more beneficial than the (general) surgery class at 10am."

"i intend to do so but yeah.." okay shut up with the excuses.

i asked for her name then. it was heejan, meaning a lady of honourable origin. will say hi to her at dr. hussein's morning class.

edited 18 february 2015

---

gehad was rapidly memorizing her surgery textbook and suddenly she stopped and turned to me.

"imtihan a'rob."

dude don't scare me. why are you scaring me, dude? what did i do? okay so i was fooling around but no need to scare me, gehad.

we're returning this mascot to upfront this blog.

"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★

You can sleep in scrubs

Stood patiently in front of the doctor in-charge of ER tonight as she talked to the patients. The rest of the staffs were already aware of our presence and Ammu Saeed the attendance welcomed us aboard, but it is respectful to ask for permission formally to the busiest person in the ER.

She looked up after a while and stared directly at me.

"Yes doctor how are you, are you joining us tonight?" In Arabic without missing a beat.

I did a take behind my shoulder, perhaps there was a real doctor standing behind me. There was none. She really was talking to me. "Yes, with your permission."

Did I look that convincing? If only the attire makes the person...