you did a good job

Yesterday in OT we were doing a tubularise incised plate urethroplasty for a 10yo kid who had subcoronal hypospadias with whole wound breakdown post MAGPI procedure.

Mr Fitri trimmed the skin and dartos nicely. There was a small skin loose end at one part that he seemed to didn't care and I used my pickup to flip the end silently. Just flipping it here, there, glaring at it annoyingly but not saying anything to my surgeon. He looked on in equal silence and got my message. He then took a tenotomy scissor and trimmed the end. 

I wanted to laugh at the absurdity that was me. But I'm a person who work in silence so I didn't. 

He then said to me that he wanted to try doing the urethral suturing interrupted instead of continuous and he asked me if he should. 

I paused for a moment. Why is this surgeon asking me. 

"I've... I've never seen anyone do it interruptedly. If so, how close should your stitches be? The next layer will be suture line on top of suture line right, wouldn't that increase risk for fistula?" 

"What do you mean?" 

"You're going to close the next layer midline as well, correct?" 

"Yes." 

"So the skin suture line will be on the uretheral suture line. If the wound breaks down, wouldn't that be a fistula?"

He was silent. I hurriedly added "But I wouldn't know." Cause man, I don't know shit. I'm not someone who has done a urethroplasty, I just assisted... Few. But who am I kidding, I like urethroplasty the best. The on-table creative decision is so fulfilling. 

He proceeded to do the suturing continuously and I'm like... Did I just doubted a surgeon? Hahaha wth I don't care anymore. 

He was done in around 30minutes. Although I barely did anything, I felt a swell of pride and fulfilment at how nice the outcome was. I wanted to say "cantik" but I felt like he knows that already and I didn't want him to think I'm licking his ass, so I didn't. 

In restrospect I should have told my surgeon he did a really nice job. Everyone deserves to hear they did a nice job. 

of course i can do it, it's just i don't want this unhappy life

I need to be kinder to myself because who else is. My stuffy nose is giving me headache and I don't know where I stashed my PCM, so here goes me hiding in the surau cause the rest of the hospital is freezing cold.

I'm a good doctor. I know things, not much, but enough to not kill patients.

On Sunday when I was oncall, ED referred me a perianal abscess in our POD 40 transanal pullthrough. Child not septic and I've never seen one before, but I know this is his coloanal anastomosis leaking and he has a pelvic collection that trickles down to manifest as a gluteal abscess. I presented so to Mr. Fitri and he agreed that we need an ultrasound next morning to confirm. 

That morning the rest of the MOs asked me why I label him as pelvic collection when the thing looks like a regular gluteal abscess, my answer is that when you have an anastomotic leak that low in the pelvic, they manifest with tachycardia a bit, fever here and there as per Mr Mughni taught me. Just small things, until the collection is big enough to manifest externally. Kid ended up with a stoma and I&D. 

And then we had a POD 4 transanal pullthrough (stoma down) girl who was discharged that morning and came back that night with persistent vomiting. I admitted her thinking of enterocolitis ddx adhesion obstruction and wanted an AXR cause I need to figure why she's vomiting. Mr. Fitri said to observe first since her vomiting was non billious and her abdomen wasn't distended. 

Turns out her vomiting persist to high billious output during the next 4 days she was warded. We ended up doing an ultrasound (which showed TZ at jejunum) followed by an AXR the next day where we saw her small bowel centrally dilated with paucity distal bowel. We did adhesiolysis for her. 

Kirosha applauded me for being right. In retrospect I should have said to Mr. Fitri that I needed an AXR to rule out proximal small bowel obstruction since her abdomen wasn't distended. 

Today morning I presented a systematic review critic for laparoscopic versus open appendicectomy for complicated appendicitis in children. 

What happened was that after breaking my brain half heartedly looking for a paper, I decided on the topic yesterday evening and got complained by my surgeon "esok nak present kenapa petang ni baru tanya". Sorry miss but I have been searching few days and can't find a better one. Been mentally preparing myself for the past 1 week but here we are.. 

She said to go with it. So I went back around 6pm, dinner and date with Jehoon until 9pm plus, and only around 11pm did I open my laptop to study the CASP checklist on criticising a systematic review. Thank you Ms Doon for teaching me this thing exists and it was actually my first time using it. I finished my slides close to 2am and slept until 7am. 

And then I presented. I was preparing my script for the presentation opening with "I'm not good at this but I should start somewhere" but I didn't say those. I didn't do badly, I think it was okay. We had a good discussion.  

Perhaps these people are right. I can do this. But hey the issue nowadays is not that I cannot do this, it's that I don't want to do this. 

But I'm still here. I'm still taking one step at a time. Like that time I hiked up Maliau Rim feeling so mad because I didn't want to but I still made it up there, cursing and all. What now? 

To be a surgeon is to be a better doctor. It's a different standard. I have to improve. 

#jaditraineetiadaharapan

Last week I was in OT assisting my surgeon with a urethral stricture surgery. He was asking me to straighten the penis up so he could make a straight cut, and his words to me were

"Atiqah tolong tegakkan bird tu sekejap."

I did as instructed but inward was sighing. People been referring to him as Bebird King because he does a lot of hypospadias surgery but help me God I felt triggered whenever I hear that term. 

You see, I like birds. Literal birds, the ones flying freely and always so elusive and mocking me with their lovely songs. Not this. Penis is not a bird. Why do we term them birds. I wanted to complain so much but I shouldn't make a fuss but dear God it happened last week and I'm still thinking about it.

I want to go birding so bad. 

elango belanja saya makan

On this blessed Friday my registrar bought me lunch and we had a deep conversation about life over ayam penyet and teh c ais kosong.

The good thing for me is that I have known these people from when I was a service MO. They're the only ones I can talk to now that I've joined them in the program, whose questions of "are you okay" I could answer long and truthfully.

He's figuratively patting me on the back because to them I'm a "hardworking, responsible person, although sometimes can be kepochi". I don't feel that about myself. What does kepochi means anyway.

Good advice on to quit now rather than wait for whatever. "Don't think about others, don't think about who's going to do oncalls" at this point I laughed because that's so me. I should just die. 

"Be careful of the young surgeons. They collectively give you a bad assessment but never said anything in front of you. The only good person here (in the fraternity) is Mr. Mughni. He's like the badan berkecuali."

"But don't worry. What happened to me won't happen to you. I know."

How do you know? I want to know what makes people think I can make it. But Elango just told me he knows and to trust him. 

"There are other ways to become a paediatric surgeon, and you wouldn't have to be attached to these fucked up people."

Good morning, 2022

I wrote this on December 20th but I kept it on my phone unpublished because I hope the feelings will change. It hasn't, as I woke up today staring at the ceiling wanting to stab myself in the heart.

---

Today I woke up regretting that I had another day alive. I then walked to work hoping something bad happens to me and I die on my way. My eyes watered thinking my mom would probably cry, but I hope I don't survive. 

I crossed the road safely looking right and left. I made it to work and I punched in. 

And I greeted my colleagues and staffs and worked like nothing was wrong. I even had lunch because we were in clinic and my surgeon told us to go have lunch before facing the evening crowd. 

Work done around 5.30pm. I hung around to make sure nothing was needed of me. And then I went for prayers. I thought I should wire my money to my baby sister and some to my brothers. To my uncle who works harder than me with six mouths to feed but his pay just barely one fourth of me. 

I should go up to the roof again but the place is covered and barely any sunlight be seen. 

And as I walked back, I wondered if a person could just die suddenly. If I were to work and just suddenly collapse in the ward. Will they successfully revive me or would I just pass on? I hope I pass on. What would the cause be put? I wonder if they would talk about me, how they think I look thinner, how I've always been quiet and just do my job. 

They will, people always think they know you. But here I was, functioning but oh how I wish I'm dead. 

Mom would cry and I wish I could talk to her but nah they wouldn't get it. Talking to them will make me even sadder. I should just get my will sorted out and go somewhere far and quiet to go. Some place I wouldn't be a nuisance. 

I wish to die but I wouldn't harm myself. It's illegal. But I'm going to sleep now. I hope I don't wake up at all. 

I love you and will always thank you. 

Atiqah

i wish we will always be kind

The first time I needed help on a personal level in HTA was when I was oncall first time there but I forgot my charger at home. 

My battery was around half when I asked for help from my Ward 11A staffs that night, if anyone has a type C charger. I was met with frowning eyes and harsh tones "dah tahu oncall kenapa tak bawa charger".

That happened last week but even writing this now made me cry. It will always hurts how deeply those words cut. 

I left the ward. I asked the guard up front if she had a type C cable. Although she was echoing the same eyes and tone, she showed me her charger to see whether it was what I needed. It wasn't. I thanked her and left. 

I went to Ward 11D but I stopped myself from asking the staffs because although I feel the staffs in 11D were nicer than in 11A, I didn't want to risk experiencing the same thing not so soon. Then I remembered there were Ortho HOs in that ward usually stationed at the computer station behind the counter so I went there.

It was empty, but there was a charger at the power point below the computer. I went for it and it was a type C. Thank God... I stayed there for a while to charge my phone. It was just a short while before I had to leave. 

I was in the procedure room looking for a vein when my battery died. It was almost 4am and I didn't even rest save for praying Asar, Maghrib and Isya in one sitting at 9pm before going to ED. I left the ward and ran to 11D to look for that charger but it wasn't there. I guess the owner went to rest and took it with him/her. 

Then I realised the people who would definitely have a charger in the hospital are the patients. Realising that, I went inside every cubicle, during that 4am, asking every awake mom if she has a type C charger. Every single one of those awake mother would, without asking any question, show me their charger to see if it was what I needed. 

It was the fourth mother I approached who had a type C charger. Cheah's mother. I borrowed it, got a half full, before I dropped it back in her paper bag because she was back asleep by the time I was done. 

So Dear Atiqah,

whenever anyone need your help, don't question their need. Just help or do not. Imagine them being you and how much it takes for you just to ask, so please always be kind. 

Be kind because Allah has been kind to you, be kind because people have been kind to you. And I will always be kind to you. I promise I will always be kind to you. 

Just don't expect the same from anyone else and you'll be okay. It's okay. We're gonna be alright. 

payau masak kicap

Atteh's father is previously a hunter and they grew up on game meat in Kinabatangan. He said his mom is famous for payau masak kicap and that that's his favourite.

That night we went for dusk safari before dinner and we kept seeing sambar deer. But all I could see was payau masak kicap. 

salut d'amour

Today I passed in front of one of the patients' room and I heard salut d'amour playing from a child's music box. 

The room was occupied by a 2 months old Chinese patient who had an eventful neonatal period with multiple surgeries done, and this time presented with another pathology. 

The child was being discharged today and I thought, how classy. I passed in front of it few more times because it's one of my favourite piece (I particularly enjoy Itzhak Perlman's recording) and I always listen to it whenever I want to feel loved. 

The child must have been so loved. 

day 2 in hta

It's a computerised hospital and has so many patients in a ward, and we have like 3 wards? I'm starting to pick up but apparently not fast enough.

I forgot how time flies as I was swamped with work and Dato' said to me today "Time in KL moves fast. If you're still in Kelantan or Sabah time you will be behind. If the patient went down to USG at 2pm, we want the report by 1.55pm."

Well that makes total sense. 

In a way I'm glad at least he remembers where I'm from. Or perhaps I shouldn't. Sorry Mr. Tar and Mr. Mughni, Atiqah is a disgrace.

Today in HTA the junior service MOs were complaining to one another how their own colleagues left them shits. I just sat in between them, in front of the computer, doing my work with a small smile and keeping silent. 

I'm not here to change anyone, I'm not here to tell anyone how to live their life. I'm here to lay low and learn. 

Then Durrah turned to me "Dekat Likas pun ada ke service MO yang buat kerja sambil lewa?" 

I smirked. "Dekat mana2 pun ada benda macam tu."

I guess that's how this life is. Either you stay long and find yourself turning into a villain, or you transform for the better into a trainee. 

to become a surgeon who can plan a service

reported duty to our program coordinator and head of paed surgery unit UM prof shireen. the first thing she said was "there are so many people applying but only 3 of you were chosen. remember that. don't make us regret choosing you." she said so on first day online and second day when we met her at the ward. laughingly, but point taken. 

copuk applied twice. chip applied twice. i applied once and got accepted, the heck? what am i doing here? what were the committee thinking of the Atiqah that i portrayed? what does that say about the applicants? 

people have faith in me but heck why don't i? hahahaha God, help.

she emphasized that master program is a challenging and transformative journey from being a service MO whose duty is "to show up and get things done" to a trainee whose duty is to become a surgeon who can plan a service. 

"but it can be an enjoyable roller coaster ride."

---

we have noble intent. i don't want to save the world like tharisini did, i just want to give back what i have been given. i think i reflected this in my essay for UM. i had no energy to write much so i just gave them a 2 paragraphs one.

REASONS FOR WISHING TO UNDERTAKE THIS COURSE

AND FUTURE CAREER PLANS AFTER COMPLETION OF COURSE

Coming from a medical professional household, it has been ingrained since my childhood that I will one day partake in medical field. I have the fortune of being involved in Paediatric Surgery since my first practice as a house officer in 2015 and have been under the tutelage of great teachers in this field from Hospital Raja Perempuan Zainab II Kelantan and Hospital Wanita dan Kanak-kanak Sabah. The journey has been humbling and enlightening thus the next rational step is to further my studies, since there is limitation in what I can offer as a humble medical officer and I believe there is more to offer once I become a gazetted surgeon in terms of expanding the service.

This world is beyond me. My future career plans will be service to the outreach community as to extend the health equity and this will also indulge me with the beauty and tranquility of the district nature and the humbling community. I plan to further my subspecialty for self and professional development in Urology as there lies my special interest, with research activities pertaining to this field.

---

Urology, because Dr. Shenoufy is a urologist. Damn I love that man, the mere mention of his name brings tears to my eyes.

211021: in today's episode of Going Where You're Not Supposed To

Ms Haz said if I think my life now is huru hara, it is way more huru hara when I enter the programme.

She didn't exactly encourage me but she told me I have nothing else to do anyway and why did I went to Lahad Datu if it wasn't to pursue Master (I hitched and almost told her the truth of wanting to get away from the drama that was Likas). She signed my contract form as a witness, but her words has been subtlely telling me to think about this. 

She told me to ask my MOs namely Luqman. 

"Well Luqman didn't suggest. And he didn't respond when I complained to him."

She nodded. "Luqman is a person who wants chill life."

Hadi said if I want to quit, I better quit now. Because it will feel worse when I enter the programme.

That's the thing. I can still hold out now. I'm overwhelmed but I'm doing things one by one. I'm checking boxes. I'm getting there, some day.

Should I quit on the basis of not wanting to get through the worst of it? I am lazy and I hate studying, I had a hard time studying for MRCS God that was the worst for my mental health. And I have no reason not to pursue Masters other than because I hate studying.

Reasons to pursue: well there's plenty. There's no use for a mere MO in Paediatric Surgery. 

just an email

Help, I'm feeling overwhelmed again.

I'm at home. We're heading for kampung the day after tomorrow. I've to print some documents and pack my bags. There's the verification slip from UM that I still haven't received yet, my colleague has. I just realised so today and have emailed to UM for confirmation. It's a Sunday so probably they'll reply me cm.

It's just that, I think. But I'm over my head. I feel like running away now. 

I need to calm down. Help. Where's my safe place here? 

dancing dangerously in the moonlight

Smooth, kind and polite easily mistaken for interest, sadly non committal. That is us with each other. We don't change. 

Our game of beautiful full moon is a dangerous one, whenever it happens it make me do things I shouldn't do. Like texting you. 

And now that you know I'm coming and with your promises of free lunch, I sincerely hope our path doesn't cross. 

buaya mengkabung

Today in clinic as I wrapped up my review, I saw that my patient was from Kg Mengkabung, Tuaran.

"Mak, rumah kau tepi Sungai Mengkabung itu kah?"

"Iya doktor."

Excitement level raised exponentially. "Kau ada bot sendiri kah?"

"Kami ada doktor."

I was then grinning giddy out of my seat. "Ada nampak buaya kah baru2 ni?"

"Ada doktor. Dua ekor mereka depan rumah kami. Orang kampung kasi makan."

I was running out of my cubicle "Misssss patient kata depan rumah dia ada buayaaaa" but then I remember my teammates are not fond of crocodiles. Also I'm a doctor and we shouldn't be running in clinic praising God for crocodile sighting. Anyway the mother was obviously amused.

"Minggu lalu aku pergi sana ada pakcik bawa naik bot tapi tidak pula aku jumpa buaya."

"Ada nama mereka tu doktor."

Ada namaaaaaa? I wanna make friends! "Nama apa mereka?"

"Si Gagah sama si Siti."

Wth hahahahaha.