Stupid things we get into together

"I read an article about the things that best friends talk about that if other people hear it will cause a huge misunderstanding."

"Oh like what?"

"Like how you have balls and I have a pen*s."

"Bwahaha. Actually I was surprised you said that out loud in class yesterday. There were even guys in front of us."

We had a view of the Nile so beautiful. Can see Manial and the Salahuddeen Mosque behind our campus. The food was okay though I should stop eating fried chicken however fancy the description is when I go out. The music was good, catchy playlist that reminded me of Hakim when Wild One was playing and sang along to the stupidly fun One Thing by 1D.

The company was great. This is probably the last year to celebrate beautiful Syaimaa's birthday together. Happy birthday.

Stupidity is a chronic metastatic disease, like breast cancer

Dr. Ahmed Fikry of Neurosurgery once told the class a story. The patient was a respectable decent judge happily married since forever. One day his wife brought him to the clinic to have his brain checked. She was suspecting a brain pathology because her husband was behaving strangely all of a sudden.

"We went to a club the other day and suddenly he was flirting with some young girls. This is very strange," said the wife.

They did an MRI and it was a tumor.

Light shower in early summer

Today we finished our Urology one-week-compressed course, discussed the answer for the exam and took a picture. Like every loyal fangirl, I went up to Dr. Ahmed and said "May we have your autograph?"

He laughed and the fan-signing session commenced. I was among who stayed back as he finishes his autographing, dutifully and because he was using my pen. He answered some questions and talked as he signed.

How the treatment options in a disease is to give the patients the best service we could. "If you think of your patients as your father, mother, brother, sister, you will do your best for them. Even if you have to revise your books or consult your colleagues, there is no shame in that."

Yesterday's class, he apologised for the lack of hands-on clinical Urology sessions because he pitied the patient. "They are poor people and some doctors even shout at them when they refuse tutorial sessions, saying that they have to cooperate because this is a teaching hospital. But I disagree. The patients didn't come here because this is a teaching hospital, they come here because they have no money."

All our great professors will tell us the same thing; be kind to the patients. Which I hope I will forever keep in my heart, mind and practice however easy or hard it is for me to do so. Regardless the patient is humbled as I do my best to help or the patient is hostile seeking to cause trouble. It is not how people treat us that define who we are, but it is how we react. And that includes defending ourselves respectfully when trouble arises. 

He summed this up during a few class back when we took the topic infection. "Give advice in the best way and take it in any way."

He talked about Egypt and halfway through this point my eyes watered because I can feel his love for his country as he spoke. His gentleness was so palpable it made my heart ached at how Egypt is going on right now. And I almost cried because I realised then I really love Egypt. Stupidity, donkey-like people and all, I love this country. This is where I matured during the last six years, this is where I was humbled by life.

But I have to keep it together because I was sitting right in front of him and you don't cry in front of the man you respect. 

How his people don't know anything and the tendency of their heart to just believe whatever the media says. How it was very strange that a knowledgeable scholar could say a fatwa with vague definitions yet teaches his students something else. How he could feel the hatred coming out from a person's words. How strange it was that family could break up because of lies in the media, how a man could sell out his neighbour who looked after his family while he was abroad for ten years just because of what the media says. How strange that people would fall for what the media says and not believing their interactions with their neighbours since tens of years.

How the joke goes that Egypt is the richest country in the world because "they have been robbing us since 7000 years and there's still some money left." 

How despite all this, despite voting since 1992 hoping for improvement except for this latest one, he has hopes for his country that Egypt will become better.

How a person who has just enough competence could reach his target so long he is keen to advance and in the right track, even if it may take years.

He loves his country, you can tell even without him saying so. He did told us during class that they have a number of Egyptian Urologist in Cleveland doing cool things, but when asked why wasn't he in Cleveland as well, he answered "Of course not! I love my country."

How however frustrating a situation is, with love and responsibilities you could never give up on this.

He is a very cheerful man, with smiles reaching his eyes that make the usually solemn me really light up. Gentle as he spoke of all the corruptions and his face showed no malice at all. His commitment in teaching us, sitting on the table facing the class, crinkling a smile and "it's okay" as I apologetically greet him a couple of minutes late, his simplified ways to understand, his repetitively telling us to "don't worry, be happy" in his happy tone, advising us to "take a deep breath and answer"...

This is going to be my first time pledging using this word, so I will make it worthwhile. Fa 3uqsim billahil 3azim, I love this man. I really love Dr. Ahmed and I'm going to miss his classes. May Allah grant him and his family the highest there is in paradise and I meet him again, in the near future, in paradise, if not as a great doctor. Allahumma ameen.

Shit there's something in my eyes again.

That's a heart sign there. Haha.

CBD insertion 101

We had bladder cancer and revision of all topics today, followed by training on CBD insertion. Dr. Shenoufy handled the session before Dr. Mohamed took over and there were two penile mannequins for us to take turns.

I was assisting Izzah, my hand readied with a syringe for balloon inflation when I heard Dr. Mohamed commenting on the other mannequin.

"Usually the patient is not in this position-"

Looked over to the other group and saw it was Umair standing behind the penile mannequin and inserting a catheter. It appeared like she was catheterizing on herself.

It was damn funny I couldn't help myself. "Hahaha that's yours!"

We once made a joke that I have more balls than some guys we knew, but looks like she's the one with the other appendage.

"Don't worry, be happy."

These two days Dr. Ahmed Shenoufy's class dismissal words were the same.

"Don't worry, be happy.
Stay at home, try to avoid unnecessary places.
InshaAllah it will be safe. I think it will."

Yesterday I forgot it was the election and I already decided to go for a walk after class. So I went walking.

Some of the people in my path had red ink painted over their pinky. Some waved the national flag around. Some yelled out the zaghlatouh or whatever it was called. Some stores played the dance song celebrating the army forgetting those were the same group who killed their own people. And everywhere I look, there was posters of the people-killer that brought out the pyromaniac in me.

Those some made me realise how stupidity is infinite. I don't know what they want or why they're doing futile things. They get excited over an election which is illegal and pointless in the first place. They forgot they locked the real president somewhere in the desert.

Tun M said "Melayu mudah lupa." These people however have chronic ignorance, lack of tact and planning and advanced Alzheimer's to boot.

All those inner cursing made me forget where I was supposed to be going. Had to step inside a restaurant to reset my mind. Fortunately it had a better taste in music.

Nevertheless, most people I met on the road were ordinary, walking towards their destinations uneventfully.

Today only I will refer you by your given name

It's that time of the year that makes me feel a heavy longing in my heart. You always make me feel so, but I guess that's what I got myself into. 

I went out for cake tonight. Sorry for the lack of candle, but I wish you the best in everything. Happy birthday. I will always love you a hell lot.

Two crazy girls and a guy

We clerked three patients (one heart failure, one post pacemaker implantation and another severe mitral stenosis from rheumatic heart) and reviewed their cases for two hours. It was nearly 11pm. We left Dept 23 happily.

Ume: Iskun let's go to Dept 11. We'll introduce you to our resident Dr. Maged and selfie with him.
Iskun: Why. Is he even here?
Me: He should be. Guy said he sleeps in the department.
Ume: We will go and take a selfie and I'll upload on FB and I'll tell him to like it.

Ume proceeded to tell him about Dr. Maged and how he seemed charismatically reliable in the ward and OPC. Told them I found Dr. Mostafa leaving a bigger impression on me despite mostly doing his work efficiently without mingling with us, unlike the social Dr. Maged. And he doesn't speak English much.

Me: In the department he seemed mousey and nerd. But in the OPC, he was like the boss and in control. That was really charismatic.
Ume: (laughs)

Ume then showed me the picture of Fadzlin's crush Yehia and damn he really is a smoking hot guy. Complimented them on their good taste. Me and her talked other stupid stuffs and occasionally involved the more matured Iskun into our stupidity and finally we were at Department 11.

I led the way and in the front office, there was Dr. Mostafa sitting at the table doing some paperwork. I immediately hid behind a pillar.

"Damn it's Dr. Mostafa! I'm shy in front of him, I don't want to go in first. You go!" God I just praised the guy! It's embarrassing!

Ume flabbergasted. "No I don't want! I'm shy too!"

"Are we really going in just to see Dr. Maged?"

"Yes!"

"What if he's not in and Dr. Mostafa asks why are we asking for Dr. Maged and not him?" It won't look good if it was spread three Malaysians came at 11pm asking for Dr. Maged. "We need a cover story!"

"I don't have one! Hana, go and ask him!"

"Okay I know. I'll say we're here to see the ultrasound result of Mr. Khaled." I need it anyway to reorganize our slides to hand-in to Dr. Raafat. Smooth going there, brain. "Okay, let's go."

I emerged back into the hallway and Dr. Mostafa looked up and saw us. I grinned at him, he smiled back and I walked into the office. Remembering that he doesn't speak English much, I launched my best Arabic confidently.

"Assalamualaikum Dr. Mostafa, how are you?"

"Waalaikumussalam, good good."

"Is Dr. Maged in?"

"No he's not." He shook his head, still an amused smile on his face.

Smooth Hana, thank God for thinking ahead. I'm so proud of you! Bwahaha. Without missing a beat, "May I request to see the ultrasound report of Mr. Khaled (insert patient's three names)?"

"Mr. Khaled? Sure."

"Thank you."

We hid behind the wall as he finished whatever paperwork he was on.

Me: Wow, some spirit. I actually used all Arabic with him.
Iskun: What was the name of the doctor that you guys are scared of?
Me: You mean Dr. Raafat?
Iskun: Yeah. He wrote a book right? What book is it?
Me: Art of Clinical Examination, evidence based. His book is.. deep. MD level.
Ume: He's a renowned breast surgeon. He proposed a mechanism for metastasis.
Me: You should have seen him teaching us. He gave us a lecture on breast cancer and he said "this is useful for your fellowship.." and I was like :|
Iskun: So he treats you like MDs. Wow.
Me: Yeah. Tough.

Dr. Mostafa walked out of the office ("Khaled what?" "Khaled (insert patient's three names.") and into the report room (with the files lining up on an open shelf) slash resident room (it has a computer and a bed).

Iskun: So this is where the residents sleep?
Me: Well Dr. Maged said he sleeps on the couch in the other room.

We waited at the door and Dr. Mostafa handed me Mr. Khaled's file, opened at the ultrasound page.

"Here's the report."

"Thanks doctor."

He left us in that room and we snapped a picture of the report.

Me: See this? Doesn't it makes your blood boil?
Ume: Yeah.
Iskun: What?
Me: The report. "Findings are suggestive of thyrotoxicosis."
Ume: You don't need an ultrasound to tell you patient is thyrotoxic.
Me: Should we leave the file here?
Ume: Here. Did he took it from the shelf?
Me: Yeah he did. Okay just leave it on the table nice and neat. Let's go.

We passed the office. He was on the paperwork.

"Thanks doctor."

Nodding, "Thank you a lot and a lot."

Hahaha, what was the thanks for? Did we amused your quiet night?

Aleppo

Dr. Maged doesn't like the majority of Egyptian students very much. "They're undisciplined and they don't attend the class. Before your round, Dr. Raafat gave a session at 10 on Monday. He came and waited for 30 minutes. Nobody showed up. He didn't give a session to Egyptians after that."

Our resident is a 28 years old Yamani who studied in Aleppo University which according to him "is the best. Better than Kasr el Ainy." He graduated in 2009 and proceeded with the paediatric surgery fellowship in the university. The program was for six years but he only completed three years of it, until one fated day the army came to the hospital and attacked. He fled the hospital at 3am.

He came to Egypt leaving behind his books and belongings and started his residency in surgery at Kasr el Ainy Department 11B. He lives in Manial and pays LE2000 in rent for a place he uses for shower and storage for his clothes. "I have been in this department for about 4-6 months and I think I've only gone home properly for six times. I usually sleep here."

"So you sleep on the patient's bed?"

"No, on the couch."

Waaah that sounds fun. I haven't slept on a couch since last summer. But really, too much of it and you'll get back pain.

"Why are you here and not at the paediatric hospital?"

"I have to complete the residency in general surgery first, after that I can continue with paediatric surgery."

"Do you get paid working in Kasr el Ainy?"

"I get paid by my embassy, about USD630 a month. I pay Kasr el Ainy about GBP3200 per year for my fellowship."

"Wow. So you have to go back to Yaman once you complete your MD?"

"No.. there's no contact there. I have no contract with my embassy."

"We do. Our government pays us around USD420 per month and we have to go back after graduation to Malaysia with a contract of ten years."

"Ten years!?"

And it seemed like anyone studying under Dr. Raafat will feel pressured by his strict ways. "But I think he likes me."

"We know he likes you, Dr. Maged."

"How do you know? Because I am always with him? But he really is hard on me."

"I know because he lets you study and follow him around. And because he's tough on you so that you will learn. It's his tough love."

Radiologists are supposed to be more than yes-men

For our assignment with Dr. Raafat, we clerked and followed the case of Mr. Khalid. Our provisional diagnosis was diffuse toxic goiter and he was referred for an ultrasound. It was done yesterday so this morning I asked the resident about his result.

The report said diffuse heterogeneous enlargement blablabla and the radiologist concluded it was "suggestive of thyrotoxicosis".

Huh? For God's sake, I got more data by examination than this piece of A4 provided. I scowled at the report and returned it with thanks to the resident.

Went to Ara and complained.

"Remember that time when we had a breast discharge case and Dr. Raafat said the ultrasound didn't tell him anything more than what he already knew from clinical exam? He even said the doctor had limited knowledge."

"Yeah. What about it?"

"I totally understand his feeling. Our patient's ultrasound report is a waste. I don't need an ultrasound to tell me he's thyrotoxic, duh."

"Who signed it?"

"Some doctor named xxx. I hope he isn't on our Radio class rooster."

Ara scrolled through the schedule for our Radiology class and stopped. "Dr. Xxx?"

"Yeah."

"He taught yesterday."

"Bwahaha. I skipped yesterday." My bad, I even missed Dr. Hussein. I was too sleepy.

Don't get me wrong, I think highly of all professions we have in medicine, especially the janitor who takes a lot of merit by keeping the environment clean for us. Today's Radiology class with Dr. Edward George was fun and informative and specifically made me think highly of radiologists.

But the ultrasound report was just.. urgh.

---

"Hold up the first slide. There are eight of you in this group? Is the patient treated?"

"Well he's on medical treatment waiting for surgery."

"Eight of you! Why haven't you done the surgery on him?" Dr. Raafat laughed.

Hahahaha cmon Dr. Maged let's send Mr. Khalid up, you may scrub in and assist me. "That would be a crime, sir."

I'm starting to think I always get this case

Clerked and presented a case of inguinal swelling. Class discussion. Patient pulled his pants down, I crouched in front of him and commented my inspection.

Dr. Shedy: Okay, now palpation. Can someone get the gloves?
Me: (walks from the patient towards my bag, I still have a pair in it)
Humaici: It's okay, she doesn't need gloves. Not clinically indicated. (laughs)
Me: Screw you. Scabies! (found the gloves, puts on)
Dr. Shedy: Oh you are prepared.

Finished examining, patient was dismissed.

Guy A: Well done Hana.
Guy B: Good job Hana.

Yesterday I complained that we had five inguinoscrotal swelling patients on Thursday but Dr. Mohamed did all the examining. Now today, I had one for myself. Not a single blush on my face, I think I am immuned.

Me: I think I had too many scrotums.

I don't discriminate

If you chat with any HOs or senior doctors, the one mutual advice they give us medical students in order to survive houemanship is having the right attitude.

Behave humbly and politely.
Eager to learn.
Be diligent.
Yadayada.

They all repeat the same thing. I assume they tell us this in advance is for us to develop the right attitude right now, from this moment, now, before we step into the workforce. So that keeping a good attitude is easy for us by that time.

Go to class and respect your teacher and classmates.
Help each other out.
Be reasonable.
Be eager to learn.
Have depth in your knowledge to stand up for yourself.
Be nice to the patients.

I clerked this stuporous uncooperative patient once. She'd rather sleep than hear me out. She denied any previous operation while I was clerking her but when I examined her, there was a scar of previous hernia repair. Took everything in me not to smack anything.

Anyway. My batchmates are all grown up, at the age of marriage, they can do whatever they want and I should worry more about myself (I have difficulty sleeping early to be up for the 7am class. If this persists, how would I wake up before 5am for work?) But when you see your classmates ditching class, shoving clerking after clerking to you, shitting out bullshits like "if you assign me to present the case, I won't show up for class", you start to wonder how long does it takes before housemanship kills them and they drop out.

Dr. Ayman Gado told us that we should save the patient and try not to scandalize our colleagues. Today I learn that in  medicine, you have to save a patient's life and your colleague's ass.

I hope I don't trouble people by having them wipe my ass too much. And I certainly hope I stick around in this field.

Study well and don't make the doctors lose faith in us students

The other day our doctor had been telling us about the clinical indications for wearing gloves, which was examining mucous membrane and ulcer.

"But of course you will wear a glove during genital examination because you are grossed, but a difficult doctor might ask you about it."

So I was adamant after that that I won't be grossed out by genitalia. Which of course was big talk and totally short-lived, because for the next class we had a hydrocele patient and I immediately put on a pair of gloves. And thanked God for it as I stood near the patient and realized his last bath was probably days ago.

I know not everyone has the privilege of shower and I have to be grateful I naturally smell nice (or as Kak Junaidah said "you smell like trouble") but.. but.. I can deal with blood and organs and smelly kids but I can't stand to come near people who doesn't bathe. Extremely repulsive. I hate crowded trains.

Fast forward to today. I was going to examine the patient and Dr. Mohamed told me to wear gloves so I did, eventhough at the back of my mind I reminded myself this was not a clinical indication for gloves.

"You have to wear gloves because of scabies. There is high incidence of scabies and you don't want to catch it from the patient and then pass it to another patient."

Enough to say I was horrified and stunned. Dammit I forgot about scabies!

I want to marry a fisherman and together we will smell like the sea

"... and diabetic gastropathy in the form of indigestion and delayed emptying."

"Do you know the name of this condition?" He asked with a mischievous twinkle in his eyes.

She gave him a dirty look over her glasses. "Gastro.. it's gastroparesis diabeticorum."

"Excellent, excellent!" He laughed. "You may go."

"Thank you doctor. Have a nice day."

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.