cancers are terrible

One time when I was oncall in Lahad Datu, ED referred me a non local lady with fungating breast mass.

I looked over her blood investigation results and CXR before I went to see her. Diagnosing was relatively easy with the mass and that kind of CXR. It was a case of metastatic breast cancer. The hardest thing to do was counselling for what's next to come.

I went and see the patient. She was around my mom's age but she looked way older. Hardened by age. She was accompanied by her daughter. I introduced myself and asked questions to ascertain her functional status and social background. And then questions regarding the mass and symptoms.

She hid them for years. Only came in today because her daughter accidentally saw it. Typical mothers. 

And then I asked to examine the mass.

I then took a seat beside the daughter and broke the news. Her daughter cried. 

I gave them a minute and told her we need a tissue biopsy to see what kind of tumour it is to decide on chemotherapy and CT staging to see the extent of progression. But eyeballing, it was stage 4 already. The mass was infected already. Her lungs didn't look good. And I told her we will treat symptomatically but investigations and treatment will cost her a lot of money, we will arrange for aids as much as we can. 

She didn't want to do anything and trouble everyone. I knew she would say that.

Her daughter wanted to do everything. I knew she would say that too. 

I held her hand and looked at the patient in the eye. I told her it was probably too much to take in and I suggested we meet in clinic after they've spoken with the rest of the family. I told her there was no right or wrong decision. What was important was everyone had time to come in terms with this disease. In the mean time we will address the foul mass. 

She was still politely adamant and wasn't even keen for TCA. I would so too, if I'm the patient. Working in Lahad Datu and exposed to all these adult diseases made me realise I'd rather be dead then be bedridden and a burden. If I was diagnosed with a terminal illness I'd be taking a long leave away from people. 

But if it was my own parents, flesh and blood. I'd do anything for another extra minute with them. 

So I told her that she had done a great job at raising her children, so let this be the time for them to take care of her as much as they can. Let them have their sorrow, because I would want that too.

And at that point my voice cracked and my eyes became blurry. I sniffled my apology and smiled. She understood me and agreed to come to clinic next Monday.

I missed my mom so much that time. 

hello there readers, it is i the blog master

Hi, this is Atiqah writing from the laptop.

To be honest I've been writing from the phone for as long as I can remember. I barely use the laptop except to do presentation and truthfully the last time I used this was during quarantine after coming back from Lahad Datu to binge on Netflix.

But today I'm writing from the laptop because there were some posts on Facebook that deserves immortalization in the blog. So I've been copy pasting some backdated posts since lunch, listening to Debussy.

This blog has been going on since 13 years. I've changed, matured I guess in a way. Or maybe I haven't. There's the idea of publishing it into a book, mostly just for my sake, but it's a bad idea considering the cost and let's admit, I don't think I'll touch it anyway. 

I also realised there are some traffic on this blog. Majority from US. I've disabled the Google searching for this blog long time ago and I wonder why would I get traffic. Unless it's a bot or some people actually read this with interest... but why?

Drop me a comment below will ya?

i dont like clinic duty

If I can avoid going to clinic, I will. Because the staff nurses are so so loud and always gossiping, it's cold and phone line there sucks. But last week I was in charged of clinic so that's where I was from 9am till noon. I try to dash off as early as lunch break.

I'd be in a cubicle with my music on. I don't like earphones actually so my phone will be on medium volume, enough for me to hear and block out everyone else. I'll be seeing patients or most of the time reading Ashcraft or fanfiction or playing Ball Sort.

I'd be playing recordings of concertos or symphonies. My surgeons would pass by and querry what music is that. The nurses would say that's Dr. Atiqah.

Yesterday Vebster dropped in my cubicle and asked me why am I suddenly listening to "classical music". 

I looked at him a bit impressed. He used the correct term. The nurses had been calling it opera music and I didn't bother to say anything.

I told him this isn't sudden and smirked. 

Actually I'm just drowning my thoughts. I think too much and too deep. With the music on I'd be analysing the music instead, the up bows and down, the phrasing, the rhythm and most importantly the feelings it evoke. And I wouldn't have singers putting words in my feelings for me. 

thanks for waking me up though

I was with friends. We were in an inn, sort of camping. It was nearing dusk and it became clear to us the place was haunted.

And being the person who grew up with a haunted village home, I was more or less unperturbed. I saw it coming when I turned around, its black hair long and unkempt, eyes deep and menacing, jaw unhinged and mouth wide open silently screeching towards me.

I chanted a few taught zikr and my arm held out. I was going to slam its head in.

And then I woke up, frozen. My mouth was still chanting. I kept on chanting until my body relaxed and I could move slightly. I turned my head around and saw the grey sky. How long did I nap for? Dammit I missed evening prayer. My hand reached for my phone. It was 10 minutes to dusk.

Wow. Time was of the essence. I scrambled out of bed and went to prepare for prayers. 

Bad idea to nap in the evening, but I woke up just in time with that kind of weird dream... So was it the devil or the angel who woke me up? 

had recurrent UTI post op, but keeping well for now

Previously on https://atiqahhanifah.blogspot.com/2018/07/bilateral-vur-post-bilateral.html

This kid came for TCA yesterday. I saw his name on the file and excitedly ushered him and his mother into my cubicle.

"Yoyong! Besar sudah kau! Jenuh aku mengasuh post op dulu hahahaha."

My surgeon looked out from her cubicle berating me for making a ruckus.

"A**** ni Miss! Bilateral VUR kita buat bilateral reimplantation!"

Besides that one night all night making sure the kid didn't pull out ALL his drains (which Boss asked to remove the next day anyway) I remember him well because he's cute and it was the first ureteric reimplantation we did in Likas and also was my surgeon's first reimplantation. (I used to keep count whenever I assisted my surgeons' first something to keep tabs on all the KFCs they owe me haha.)

His mom looked at me sheepish.

"Kau masih tinggal di Kudat?"

"Iya doktor."

I was so proud I remember him still despite leaving for Lahad Datu the past one year. He has grown, not as cute as when he was a baby toddler now with his eyes fixed at his mobile phone and ignoring me.

surgeons gave me an earful during PM round

One of our patients from PSICU got transferred back to ward. Infant with large cystic hygroma post sclerotherapy. Intubated for procedure, but did airway study due to on off mild stridor. ENT found bilateral cord palsy so they tracheostomied the child. Nothing more on our side, we did the sclerotherapy already and earliest next in 6 weeks. 

So the child got sent back to ward for trachy care and feeding. Surgeons were shocked that the patient was transferred back to OUR ward.

"Kenapa sini? Kenapa bukan K5? Siapa yang accept patient transfer in?" 

"Saya tulis seen by pagi tadi di PSICU. Saya tulis t/o M3." I admitted. 

Because no one told me we're handing over primary care to ENT. Sure I know we're not doing anything more but kid was initially primary under us. We admitted him for the sclerotherapy. I didn't know we're formally passing over primary care. I would remember if anyone said this ever.

My surgeon said "I dah bagitahu dah." When? I started to flip the case note. Positive I never heard her say that to me, lemme see that in writing. "Tak silap I ada Kumaran tulis dalam review semalam."

I turned every page to find said plan. None, no one wrote anything about passing over to ENT ward, not for the past 1 week since the patient did tracheostomy. 

"Staff reti ke jaga trachy? Tak kan. I nak selamatkan my MOs je. Selamat la korang malam2 duduk jaga trachy budak ni. Siapa yang accept patient ni, setelkan la." My surgeon was telling me passive aggressively. 

Okay. Let me give ENT a call. 

"So kita tukar primary team kepada ENT?" 

"Bukan soal tukar primary." At this point my HOD was staring me down and her tone was hard. "Staff kita reti ke jaga trachy. Nak buat apa kalau budak ni desat malam2? MO I mana reti jaga trachy. I tak tahu la kalau orang lain." Was basically what my HOD said with her eyes fuming staring at me, and she looked away at her last sentence. 

I stared at her throughout her rant. Never cower down from a ranting lady, it will just frustrate them more. Also don't say anything, let her rant until she realises she's actually ranting. 

I wasn't smiling under my mask and as she kept her rant, my stare turned into that of a pity look. I just said "Okay" and wrote the seen by in the case note. I didn't apologise (for what? For not knowing your plan when no one not even you told me of it or document it in) and what more speak up. 

First, I don't think we understood each other when I said "tukar primary". What I meant was, kita dah habis our Surgical part kan? Nothing more from us kan? Betul la primary team jadi ENT for the rest of his current admission. It doesn't take away the fact that the kid has a huge cystic hygroma. That's what "tukar primary" means kan? Ke I salah guna term for this?

Consulted Kak Elli. I guessed next time just stick to "For ENT to take over."

Second, I feel sorry that she thinks so lowly of her MOs. Yeah they're juniors. I guess she didn't know enough about trachy and thus she didn't teach her MOs that. Thank you Ms Doon for teaching me whatever bits I remember of trachy care. Ah those days of suctioning thick plugs from TBI patients. 

Third, does she not lump me together in her pool of MOs? If by "her MOs" means incompetent doctors who panic headless when patients on trachy desat, yes I would be honoured not to be lumped in together.

Fourth, I know she's going through a health scare. I'm sorry that you're going through so much and you're not the best at controlling your emotion right now that you have to lash your frustration on me. 

Everyone else was silent. Meryem came back and said she's already told the ENT MO next door to take over the kid. Thanks Yem, I'm proud of your quick wit. 

Chief walked pass me and said "Why is she fussing so much? It's just a trachy."

I nodded. You and me, chief. We both got General Surgery training. That's why we think she's making a fuss. 

So I wrote in the review. 

Plan/

1- discharge Surgery 

2- transfer to K5 (S/T Dr. Ron MO ENT) 

3- cont trachy care

4- inform back prior to discharge from K5

5- KIV repeat sclerotherapy in 6-8/52

We continued our round. The burn kid was supposed to take swab c&s during dressing today. Naveena told our surgeon "tadi tak ambil."

"Kenapa?" She turned to Naveena with a glare. "Tadi I dekat sini masa round specifically cakap ambil. Nak kena I ada time dressing juga baru ambil?"

Wah, still frustrated eh. But yeah. Plan wasn't carried out. Bising pun benda dah jadi. Esok pun budak ni dressing jugak. Remember je la untuk ambil esok. 

You're the surgeon. Leader of the team. If you want to create that kind of condescending atmosphere then that's on you. Have fun in your own bubble, ciao. 

We continued the rounds. I was silent unless spoken to. I was still peachy about being lashed at. 

My surgeon then turned to me and asked me nicely about another patient. I replied her in my usual semi-nonchalant manner. 

My HOD also then turned to me and spoke calmly to me about being careful exposed to patients since it's COVID time. 

I know they're embarrassed for fussing over a matter that can be easily solved. But that's on you. I'm just trying to not think too much about it. I'm postcall and on clinic duty this week. I don't even need to be doing PM rounds today. Why am I even here. Why do I have to deal with these people. 

After round we had a baby going for omphalocele primary closure. I wanted to see how they're gonna do it but heck why. I'm interested of course but I also need to take care of myself. 

It's almost 4. I can ciao and go to Sugud, no? Cool down a bit. I was still peachy. 

I went to pray. Punched out. Went for ice cream, bubble tea and grilled skewers instead. Sat in my car for a bit and listened to Bach Violin Sonata. 

attended my first violin concerto

Woke up. 

Showered. Washed my hair. 

Put on the new nicely fitted long sleeved black shirt and good jeans. 

Breakfast of Singaporean fried meehoon with lots of keropok. Tasted nothing like a Singaporean fried meehoon though. Couldn't even come close to my favourite Summer Cafe's Chinese fried meehoon. Ahh but what choice do I have being so far from Lahad Datu. Saved half for dinner. 

And a cup of good coffee, the Nescafe Gold Flat White ones. 

Still got time. Cleaned the room. 

How should I wear my hair today. Leave it down? Low ponytail? Ah. Braided thy hair. 

Some matte lipstick in the colour Fiery and two sprigs of black musk perfume. Because it's a concerto and I gotta dress up. 

A glass of chilled almond milk, just because it's Australian. 

Attended the concerto. I'm excited. 

So nice. It sounded so beautiful I could fall asleep. Ohh that third movement is actually really good. 

Clapped at the end of third movement. Bowed out and waved goodbye. 

Now... Although I'm still full from breakfast and almond milk, let's go have some bubble tea.

Edited:

So I waited for afternoon prayers before going out and washed the perfume on me because let's admit it, two sprigs was too much. Even one sprig is a lot. I could barely breathe. 

Afternoon prayers done. Finished my fried meehoon leftovers. 

So comfortable. So sleepy. Cuddled with Jiyong and slept for god knows how long. 

Woke up to a bleary world. Ahh. It rained, no wonder. 

But should we still get that bubble tea today? We should continue this date today. 

Went down. Housemates were having tea and they invited me. I ate a piece of keropok and went back up for evening prayers. Went back down and sat for Earl grey tea and two pieces of roti jala with kari ayam. 

It's 7pm now. Usrah online in an hour and half. Let's get that bubble tea babe. 

simp sibelius!

Twoset's Sibelius violin concerto is happening tomorrow and I've been looking forward to it since they dropped the date 4 days ago. I put the event on my calendar and by God, I've been living the past 4 days looking forward to Saturday.

Believe me when I say I haven't been looking forward to anything since I could remember, at least not past 6 months. And living looking forward to something was.. Refreshing. I felt actually alive.

So Luqman called me just now. We talked for close to an hour. He was oncall and complaining how busy his call is since his general surgery trainee been picking up 8 cases already.

Anyhow his intro was how different I sounded. I thought I sounded the same. He said it was my tone. I sounded alive.

I said I found my safe place. He tried digging and I told him he knows the place but I didn't want him to know where it is. 

He guessed Inobong and then Mesilau, probably pointing to that place we had our brunch. Now that I think of it, yeah that place is worthy of being a safe place. 

He asked what was my turning point. I think it was me going home. 

I also told him I'm loving the feeling of looking forward to something, and that something is tomorrow. And tomorrow the concerto is happening. 

Anyway. He actually closed our conversation with "can I conclude" and concluded that I'm not much in despair, I'm less anxious depressed etc etc etc. I acknowledged that "less is the word".

I told him I hope he's doing well. He told me not to hope so much. I asked him what's stopping him. He corrected me "what's slowing me" was the feeling of a bonfire nearing the end of the burn.

I genuinely told him that I know he always get through things one way or another, and I know he'll get through this too. He said that's a comforting thought. 

I thanked him for checking up on me. I didn't tell him that I'm sorry I'm not good at comforting as he is to me.

If you ever find this, know that you're always my favourite brother. Thank you.

deciding people's name by whatever sounded nice

So I was at home, on my bed, typing up my night update for the rest of the team by memory. There's this one kid whose name I remember in full so I typed in her full name.

Nana Kim Rara

Or is it Rara Kim Nana? I don't remember. N before R right? Or do they not work that way? Which sounded better? Rara Kim Nana or Nana Kim Rara?

I decided Nana Kim Rara sounded better, so I typed in her name as such. 

Guess who got joked on for mistyping the patient's name hahahaha. 

idiot who doesn't know how screen recording works

Focused on the 2.5 hour long webinar on Chemotherapy for Gastric Ca Peritoneal Mets. Such interesting discussion. Stage 4 TLC has a 4 months overall survival? What a terrible disease. Quality of Life need to be top notched for a disease with OS less than 1 year, yes I concur. Such interesting therapy, yes please elaborate more on your clinical trials. 

I observed their scientific presentation style and planned to adopt my own. Rolled over on my bed for the last 30 minutes of it, almost 11pm, I'm tired. I've got the recording up since the beginning, so excited to replay and share with everyone else. 

Checked the recording. No sound. Fast forward. No sound. Check other videos. No sound at all. 

SOMEONE EFFING FORGOT TO TURN ON THE MIC!

that nation no one wants to be acquainted with

When I was playing Maple back in high school, I once trained with a player and he said he's an Israeli. I oh-ed and remembered feeling awkward. I shouldn't be friends with him. 

When I went to Fukuoka in 2019 my table mate was a pretty lady and we stroke up a conversation. She told me she's from Israel. I told her I'm from Malaysia. Then she asked me where have I been in Fukuoka and I flexed my travel itinerary, how I went up to Itoshima to see the Futamigaura on my touch down in Fukuoka. She told me "you have all the most beautiful beaches in Sabah and you come here looking for beaches too?" Yeah I did that. Thanks Luqman for coming along. 

Nowadays I'm listening to classical music. One of the best recordings there are are those of Itzhak Perlman. Guess what nationality he is. 

It's not that I've gotten complacent. It's just me knowing how to thread with things. Like how LGBT is. Religiously it's wrong and illegal, but when Arif told me to judge a person based on his appearance (he wanted me to say the word gay) I told him I don't judge, I accept people how they are. I thought then telling him that one of my best mate is openly gay probably wouldn't be a great idea, kid would be shocked. 

I can't change people. But I will always pray for them.  

review TCA #1

Let's make this a standard review

Hobbies

-Reading fanfiction

-Masuk hutan

Advantage

-High functioning depression

Disadvantage

-Overthinking

-Always cold

Things I'm good at

-Working

Things I'm not good at

-Having proper meals

Complex

-I wanna talk to someone but I don't want to talk to anyone

Best 3 food

-Rice with omelette 

-Steamed dumpling

-Kimbab / onigiri

Worst 3 food

-Peas

-Taucu

Favourite word

-"Okay sure" 

Favourite colour

-Black

Favourite song 

-Tchaikovsky violin concerto

Favourite type of people

-Partner material

Respected people

-Parents

Current happiness

-Twoset Violin

What I bought recently 

-Warm clothes

Hardest thing ever

-Falling asleep

-Waking up for work, it's easier if cm was a day off

How to spend off days

-Sleeping in

-Aimless walks

Places to visit 

-New York

-Australia

What to challenge

-Study more

-Sleep better

What I want to do with my friends

-Birding

-Jump into deep waters

never forget leak

All my 3 calls since 2021 has been busy. I barely slept and still had to work the next day all day and then I'd still have trouble sleeping on my postcalls. Anxiety gets me. I don't know how to shut my brain off.

Anyhow. My most recent call was on Sunday. I did my rounds in the morning and the sickest kid in our acute bay was worrying me. She was a POD 6 bowel anastomosis done and had spiking fever all night. I thought she was more tachypnic and tachycardic and her abdomen was distended compared to when I last saw her on Friday and I planned to repeat cultures for her now. I need to exclude leak as well.

My surgeon came and said the abdomen is full. Yeah it is but it's distended too is it not to you? She told me to monitor the temperature first and repeat culture if another spike in. To off her Ryle's tube and to allow her breastfeeding today. But do one AXR first before feeding her. 

I remember thinking I wouldn't dare to feed a septic child with distended abdomen post bowel anastomosis until I've totally excluded leak. But she was the surgeon and she did the anastomosis. Okay then.

I settled my ward work. I waited for the AXR and called Radio twice for it. Why are they late, I need AXR for my patient TRO intraab sepsis. Cmon now. I was jittery because I had referral from COVID tent and I need to settle her first, who knows how long the referral will take me. 

Xray came and I urgently asked my nurses to go trace the film. They came back much later than I know it would for a round trip to xray with food in their hands while there I was pacing. Dammit. They should have told me they were getting food too, I would have gone to xray myself.

Her bowels were dilated with paucity at right lower abdomen, exactly where the anastomosis would have been. Damn. Can we not feed her?

I updated my surgeon. I asked her if she still wanted to feed the kid. She told me to keep NBM. Thank God. I would have gone behind her back and kept the child NBM anyway. 

I went to COVID tent. I exited it after an hour to a text message from my staff nurse telling me the kid was getting more tachypnic. Which was 30 minutes ago. God! I remember breaking into a run while replying "Insert a Ryle's tube first! I'm on my way!" 

I stared at the kid's eyes while I stood next to her, my sweater off and my gloves on. She looked at me smacking her lips and nasal flaring. She looked so sick. 

God help me, please help me help this kid. 

Supported her airway and breathing. Decompressed the abdomen as much as I can. Repeated all her bloods and prepped her for laparotomy. Made sure she got her stat dose of escalated antibiotics. She looked puffy but her urine colour isn't as good as I hope so and her peripheral circulation are not as good as her central. I need dopamine, she had accumulated positive 3000ml balance already and I didn't dare overload this kid unless I'm ready for her lungs to get wetter and intubate her. She already had atelectasis. 

My surgeon texted me about the adhesive obstruction I attended in COVID tent. I told her the kid is obstructed but stable, but this one here is not. I told her everything I was doing. She replied me that she agreed with my plans and told me she'll come after Maghrib. Maghrib was in an hour. 

Took me two hours resuscitating the kid before my surgeon showed up. The first thing I said to her was "PSICU ya Miss? Sorry but I wrote in my review TRO leak."

"Yeah I think so too." I just needed that one greenlight. She's the gazetted surgeon, I'm just a medical officer. A scared medical officer who knew this kid could have died faster if she was fed today. 

Ken came and pushed her straight to PSICU. Dr. Hidayah reviewed her straight away and started her on the dopamine. It was only 8pm so I asked my surgeon if we're going in tonight. She said to get an ultrasound first. I called up Radio. The MO came straight aeay since I told him that we need to go in for the kid. And yeah, it was a massive complex ascites.

INR was 4 plus. Dr. Hidayah said they'll correct all the bloods and push to OT first thing cm. I couldn't thank her enough. I knew the kid was at least in a better care than it would have been with just me and my ward nurses. 

My night was sleepless with referrals afterwards as I periodically checked up on her, powered by 1g of paracetamol and a short 30 minutes nap. I had to despite one more COVID tent referral; my head was pounding probably from hypoglycaemia and dehydration. By 4am I was done with my work and I was famished (last meal was breakfast at 12pm) but damn sleepy. Forget food, I need sleep. I refused to sleep on a hospital bed so I went home and slept on my bed. Groggily and super reluctantly got out of bed two hours later.

They went in while I finished my rounds. And then I had to go to clinic where my nurses greeted me with "Doktor ada makanan untuk kau dari BFF kau kali. Kami tidak kenal."

I went to the back and there it was a pack of bomboni doughnuts and coffee milk. Written on the packaging was "Good day Tiqs. XOXO" 

Mizah texted me in my hectic morning asking whether I'd be in clinic or OT today and only then I remember reading them but not replying them. I replied her then that I love her. What would I do without people feeding me. I'm so bad at that.

I finished clinic at noon. Went up to see the kid post op in PSICU and saw she was extubated. Read the op note and remembered feeling terrified of the op finding. 

It was a dirty abdomen. Slough and bile everywhere in all corners. 

What if I was too late? What if I had been ignorant? The kid wouldn't have survive. I'm so glad I caught it and thankful God had mercy on her and on me. Oh God we should have opened her on Sunday morning itself. 

almost one year later

When I first started working I dutifully wore baju kurung to work, but I stopped wearing them during my 5th month of working because it hindered me from jumping onto patient's bed to initiate CPR. Nowadays I only wear baju kurung for eid and when I'm attending weddings, and even that I try to wear my black jubah. So I told mom to give all my baju kurungs away.

Mom said no one wants baju kurungs anyway. Orang Asli prefers shirts and pants. She told me to wear baju kurungs on dates instead.

First - that's fake. Baju kurung is the epitome of a graceful Malay lady, which I'm not. I'm a simple practical person who appreciates practical things.

Second - the last time I went on a date I wore denims and shawl. But maybe I shouldn't have tried so hard.