For A Happy Life, Make Life Decisions Based On Your Cardinal Trait

I was asked for tips regarding how to pass MRCPsych Part A at one shot.

The truth is, I don’t really have any tips. I can only tell them what I did (mainly doing a lot of questions and covering 80% of Stahl’s Psychopharmacology). But how would I know whether any of the things I did were REALLY what made me pass? I have mentioned before that I passed by the mercy and grace of Allah. Even after the exam, I wasn’t able to tell for sure whether I was able to make it.

So my tips would really be worthless. Because some people didn’t do what I did, and they still passed. And some people did more than I did and they still did not pass. So, you can ask me and I will tell you what I did but don’t blame me if it doesn’t work. Hahah.

To me the most important thing is to KNOW YOURSELF. You have to know your weakness and your strength, your style of studying and revising, whether you can deal with last minutes cramming or you are the steady and constant type, whether you are good at memorizing without having to understand or whether you must understand before you can memorize, whether you can study in noise or whether you need peace and solitude, whether you can deal with distractions or whether you need to shut yourself off somewhere to focus.

Once you know all that, you can start planning to study in your own way and style. Never let anyone tell you or influence you to do what they think is best. No one KNOWS you better than you know yourself.

I know I don’t like distractions, even minor ones, when I am deeply enmeshed and engrossed in certain stuff. When I am focused in certain things, I can shut myself off in my house for days and weeks and not contact anyone and just do my thing. Any attempt to contact me would be rebuffed and rejected.

When I was preparing for my exam study, some specialists suggested to me that I shouldn’t have to sacrifice my annual leaves for study time. Instead, I should just come to work as usual  (punch in and punch out to record my attendance) and just be around the clinic without having to do any clinical work. They said that they would allow me the time to study in the clinic, but I must ‘be around the clinic’ instead of at home. Even if I am not doing any clinical work, I must be around, they said. 

I thought that was ridiculous of the admin, by the way! Why should I come at all if you don’t expect me to work? If you only want me to come to work to be around while I am studying, why can’t you allow me to study at home? How come other master students can take unrecorded leaves without having to be around at all? That’s just unfair to me and Dr. T! Until now, whenever I think about how many years I have covered for everyone’s unrecorded leaves… but when it comes to my turn, you guys create so many administrative issues to deny me the SAME privilege that others have enjoyed before me… when I think about that, I become angry all over again. Me and Dr. T got over our anger eventually but damn, it was hard! Hahha. I still feel angry on and off. Which goes to show that I don’t get over things involving fairness and justice easily. I will always remember stuff like that. I might not show my dissatisfaction anymore, but I will always remember it. That’s just how I am. 

I decided that, “Fine, I didn’t need the unrecorded leaves that you so begrudged!” I could use my annual leaves because I had so much of them (I don’t have children for which I have to use my annual leaves to care for them if they fall sick. I don’t even need my annual leaves for balik kampung because my kampung is right here in Alor Star and I can always  see my parents during the weekends. I have so much accumulated leaves from previous years  that I can afford to use up some of my annual leaves to study) Since they were going to create so many obstacles for me to have my study time, then I could afford to sacrifice my annual leaves. But I refused to do something as stupid as just coming to the clinic to punch in and punch out and being around without having to do any clinical work. What’s the point when I KNEW I could do better in my own domain. I study BETTER in the solitary of my own house. I might want to study until 3.00 a.m and not want to have to wake up early just to come to the clinic to punch in and ‘be around’. Or I might want to sleep early and wake up to study from 4.00 a.m non-stop until 9.00 a.m. I might want to wear comfortable clothes while I am studying and I can’t do that if I have to ‘be around’. When you asked me to ‘just be around in the clinic’, you took away MY FREEDOM to arrange my schedule any way I wished at the most critical moment when I needed it the most.

Because I knew myself and my need for peace and solitude, I told them that “I prefer to not be around even if I have to sacrifice my annual leaves for it.” I need my solitude. My time alone. My space. And I will do whatever I can to get it! If it means I have to use my annual leaves, well be it! But I will always remember that other master students did not HAVE to use their annual leaves and simply took unrecorded leaves without having to ‘be around’. No one made a fuss when THEY took unrecorded leaves.

You see, that’s my cardinal trait. I want justice to be upheld. Things must be fair and balanced. In books that I read, the theme of justice and fairness reigned supreme. Most books that I read involved a struggle for justice and a journey to find truth (Books like ‘To Kill A Mocking Bird’, ‘The Tenant of Wildfell Hall’, ‘A Time To Kill’, ‘Twelve Years A Slave’, and many, many more especially books written by John Grisham).

Another one of my cardinal trait is: being free. Freedom is important to me. I need it so much that I am willing to sacrifice anything I can afford to get it.

So whatever choice I make, at the forefront of my mind, I will always ask my self “Will I still retain my freedom if I make this choice? Should injustice happens to me, will I get the freedom to fight back without suffering unmanageable consequences?”

So some of you without any psychiatric background may still wonder what is this cardinal trait Afiza is talking about. Well here’s a little background story:  Gordon Allport was an American psychologist who was considered as one of the first founding figures of personality psychology. He was also one of the first modern trait theorist of personality. He looked at thousands of personality traits and then organized these traits into three hierarchies; Cardinal Traits, Central Traits and Secondary Traits.

trait-theory

Well… cardinal trait is this characteristic that you have that dominate and shape your behaviour and collectively known as your master control; your ruling passions. It tops the hierarchy of your traits.

Some people don’t have cardinal traits (only central traits and secondary traits) and therefore might find it difficult to understand those who do have them. But to those who have cardinal traits (and there are not few of us who do. I have known some.) they make all their life-altering decisions based on their cardinal traits.

Including me.

Some people with cardinal traits sometimes can make the mistake of choosing a certain life option that opposes their cardinal traits (because at first, they thought they could handle it) and they usually live to regret the decision they have made. It is not easy to constantly and consistently live in a manner opposing your cardinal trait. One day, something got to give.

So, if you have a cardinal trait, you should respect it. Otherwise, you shouldn’t have one (even though whether or not you have cardinal traits is beyond your control). Admittedly, it’s easier for those who don’t have cardinal traits because they won’t be bound by it. But for those of us who do, never make the mistake of tricking yourself into thinking you can be someone you are not.

I believe that we should not always remain the same and unchanged…. because we are not perfect. We should always improve ourselves… but only according to our own cardinal trait.

For example, I don’t want to remain as just an MO even though it is comfortable enough for me. I have to change! I know that. Remaining the same and stagnant does not do justice to what Allah have created you to potentially become. I should improve myself and study to become a specialist. I knew that. But now, I have two options to go about doing it: master program or MRCPsych program.

I knew from the very beginning that MRCPsych program was the one to choose because it celebrates my cardinal trait (even though at that time I did not have any idea about trait theories just yet. I just knew that master program will never be for me)

When people asked me why I didn’t choose to do master and had chosen MRCPsych program instead, I told them a lot of things such as:

1)It is internationally recognized. My undergrad medical degree from Newcastle University is internationally recognized and I want the same for my post-grad qualifications too. (Should I need to move elsewhere outside Malaysia, I would have more choices regarding where I can practice).

2)If I pass this exam, I know that I am at par with the World Standard. Not merely the local standard. (The local standard might also be at par with the World standard but getting the world to recognize that is another matter entirely).

3)I like the lack of hassles and the flexibility.

4)I don’t want to owe the government a large sum of money should I fail to complete the Master program.

I told them a lot of things regarding why I chose MRCPsych  but only one thing matters the most to me: MRCPsych appeals to my personality and my cardinal trait.

As I mentioned before, my first Cardinal Trait is justice. I want justice to be served and fairness to be upheld. Not just for myself but for everyone.

I have heard so many horror stories about the master program. Some of the situations were so ridiculously unfair that if I were put in that situation, I would have the tendency to answer back and argue with my superiors. And if they then make my life difficult due to my inability to suppress my dissatisfaction at them, I would have no choice but to bear with how they treat me for my, ehem, insubordination. Or maybe I will have to suppress my tendency to fight back (and thus I cannot celebrate my cardinal trait of fighting for justice and fairness). At the same time, I could not just quit because I would then be owing the government a lot of money. So, there goes my freedom too… another one of my cardinal trait that I have to suppress if I choose the master program.

So repeating the questions that I always ask whenever I have to make a decision (“Will I still retain my freedom if I make this choice? Should injustice happens to me, will I get the freedom to fight back without suffering unmanageable consequences?”), would a master program ever appeal to me?

Nope! Not in a million years!

Now, compare the situation when I am taking MRCPsych program. I don’t owe money to anyone. I use my own. There are no lecturers or supervisors to annoy me (until I have to do  attachments later on…. but by then, insya Allah, I would have passed the major exams already). Should I, for any reason, decided to quit, I can do so without suffering any unmanageable financial setbacks due to the owed debts.

Of course, I do have superiors in my own hospital that occasionally annoy me (like all superiors anywhere else do. Let’s just admit that all of us cannot be in the same page with all our superiors all the time. It’s the facts of a working life. Colleagues and superiors annoy one another. That’s just how it is). But most of the time, I know I can answer back. Even if they can make my life difficult (most of my specialists are generally nice. None of them are malignant. But I am speaking theoretically and hypothetically), I know I have the freedom to walk away anytime I like after giving them a piece of my mind. I can simply quit and work with my father. No one will have any absolute power over me… ONLY relative power because of their position as my superior. But at the end of the day, I can keep the image of me as a free human being, unafraid of anyone.

How can I do that if I take the master program? How can I retain the mental image of me as a free person, able to say what I want to say and do what I want to do without being afraid of anyone… how can I retain the ideal image of a free self… when fighting back would make my life miserable and at the same I can’t just walk away because I will then have to settle a huge debt to the government?

Our religion taught us to FEAR debt. Because debts can take away your freedom. Debts can force you to remain in an oppressive situation because you have NO OTHER CHOICE. (in other words, no freedom). Our religion doesn’t want us to be in debt because it curbs us from doing what we feel as right… because we are too afraid to speak up. And therefore we were taught to pray the doa that I always say at the end of my prayers; the doa that would help us avoid being in unmanageable debts:

اللَّهُمَّ إِنِّي أَعُوذُ بِكَ مِنَ الْهَمِّ وَالْحَزَنِ وَأَعُوذُ بِكَ مِنَ الْعَجْزِ وَالْكَسَلِ وَأَعُوذُ بِكَ مِنَ الْبُخْلِ وَالْجُبْنِ وَأَعُوذُ بِكَ مِنَ غَلَبَةِ الدَّيْنِ وَقَهْرِ الرِّجَالِ

“O Allah I seek refuge in You from worry and grief, I seek refuge in You from hopelessness and laziness, I seek refuge in You from miserliness and cowardice and I seek refuge in You from overwhelming debt and from the force of men”.

I love this doa so much. One of my favourites of all time! Seeking refuge from hopelessness and laziness… that’s awesome! Hopelessness is one of the symptoms of depression and this doa reminds us to protect ourselves against it. I also love the part where you are seeking refuge from cowardice! One of the things I never want to be is a coward. And finally…. you are seeking refuge from ‘overwhelming debt and force of men.’ Have you ever wondered why overwhelming debt and force of men are being grouped together in this doa? Because they are related! Once you are in debts, you are weak enough to be forced upon! In the past, your inability to pay debts could turn you into a slave!

So this is why I am in love with the doa, which is included in one of the Al-Mathurat verses! This doa encompasses everything I want for myself! From the very moment I learned of this doa and its meaning when I was in medical school, I was struck by how much this doa suits me to perfection!

I work because I like working. I don’t want to have to work for money alone just for the sake of making ends meet and settling debts. That would be a miserable life. I want to work for myself to serve my society because that’s what a good Muslim does. Even if I am ever lucky enough to marry a rich king (haha, not that I believe I am at par with Neelofa who is now gossiped to be in a relationship with one of the royals out there), I will still want to work because being able to contribute to the society is our basic need. It fulfils our needs for esteem and self-actualization (Abraham Maslow theory of hierarchy of needs). It resolves our middle adulthood conflict of generativity vs stagnation (Erik Erikson Theory of Psychosocial Stages). It fulfils our need to create and nurture things that will outlast ourselves.  In fact, being able to function is one of the main criteria being evaluated in psychiatric assessment.

Productivity is what makes us a happy human being, folks.

Feeling useful is a need. Even if you are born rich or a princess, you will still need an outlet to be useful. So these rich people would then devote themselves to charity organizations or to become presidents of NGOs etc etc. When they accomplish something altruistically for the sake of the society, their reward is the inward joy that they feel in their ability to contribute for the betterment of humanity. That’s why… eventually, no matter how wealthy and privileged you are, a life of hedonism and enjoyment would not satisfy you anymore and you will want to find meaning to your life by being useful to the society. Everyone needs something to do! According to Joseph Addison, ‘something to do’  is one of the three grand essentials to happiness.

joseph-eddison

So, work for yourself! Love your work. If you can’t love your work, it might be because your work is oppressing some integral part of either your cardinal traits or your central traits. Try to find another job that is more in tune with your cardinal traits or central traits. But if you need your job and cannot afford to follow your natural inclination (and therefore you have to be practical rather than ideal), have some form of outlets in hobbies or favourite pastimes that would spice up your life.

I will NEVER choose to do anything that goes against my Cardinal Trait, if I can help it. Once you put yourself in a situation that is repugnant to your core principle, you might as well just be prepared to deal with discontent for as long as the situation persists.

So I leave you now with my happiness maxim: “For A Happy Life, Make Your Life Decisions Based On Your Cardinal Trait”

Trust me! I always stick to this maxim and the doa above! And Alhamdulillah, I am content all the time and happy most of the time.

harmony

Defensive

I think that I am pretty tough as a person. I was raised that way by my father. No one can bully me without me fighting back. No one can ever try to put an unfair blame on me without me lashing out right back.

Speak it loud, speak it proud and justify! That’s my modus operandi, always. Justify what you do if you believe in it enough.  My father encourages that sort of thing in all of his daughters. So that when people criticize us (and we disagree with that criticism because we have our own reasons), you can bet YOUR LIFE that we are going to be very blunt in defending ourselves. Some people would call us defensive.

If I am defensive, so what? From your position, of course you would prefer that I just nod my head and agree to your criticism. But how about from my position?  Kalau hang attack aku and then aku tak defend diri aku, syok kat hang la kan?” Hahha. But I am only defensive in things that I believe I was right or when I have a very good reason to do what I do. If you are going to criticize me, you can at least try to understand where I am coming from. If after having understood my position, you still believe I am wrong, then fine! Give me your counter-argument! Go ahead and silence me! I dare you! I want to know when I am wrong. Challenge me and make me see. Make me learn! Make me shut up simply because I have nothing else to say to defend myself. Defeat me! Go on!

Otherwise, just admit that I am right. (Yeah, sometimes I am so immature. Haha)

You see, me and my siblings don’t run away from confrontation. Even with each other, we are just like that! We are really loud girls! When we grow up, we realize that other people would find us rude instead of frank. But unfortunately, our manners were set already by the time the realization and insight came to us.

Of course, being adults, we are now quite good at softening our manners somewhat. *coughs*

But still a leopard can’t change its spots… but sometimes the leopard can hide the spots, disguise them. (by making a promise to ourselves to be more polite and more humble yadda yadda yadda. Make it a personal jihad to be nice and so on and so forth. Hahah) But the leopard’s spots do not stay hidden all the time. The disguise could unravel anytime, especially during time of stress (when someone pushes our button and irritates us that we just went, “ugh!!” Then all our resolution to be nice is forgotten! Haha) Sometimes we slip up, our amygdala takes over and our REAL nature comes out. So when that time comes, you beware. It’s either my biting tongue or my sharp written words. You choose! 

With that sort of background growing up, I always think I am a strong, independent person. I can live by myself without feeling afraid. I can drive all the way from Alor Star to JB by myself without any worries. I have traveled on my own across the seas thinking of it like another solo adventure. I can argue and defend myself against anyone if I believe in something strongly enough. If  you piss me off enough, one day just you wait for my retribution because you will get it.

I was raised believing that if you want something badly enough, you just have to work hard until you obtain whatever your heart desires. My father said that it is sunnahtullah. “Aturan alam… you usaha, you dapat.” And my father proves it right, most of the time.  When he wants something, he would insist, persist, and go at it until he gets it. When I had to do my History Project (Projek Salasilah Keluarga or something along those lines when I was in Form 1), I had to do a biography of my father. I interviewed him to complete his biography in the project and when it came to his motto in life, he told me that it was ‘usaha selagi daya’.

His name is Azmee….in Arabic, it means determined, resolute, purposeful. Like the name Azam, I suppose. Berazam… It is about persistence, perseverance and firmness of purpose. So at 13 year old, it struck me as such a beautiful coincidence that his motto in life kind of matched his namesake and his personality. Haha. So then, that became my motto in life too. Do whatever you can, and you will get what you want because you have followed the sunnahtullah of ‘berusaha’. Allah will give it to you. So, ‘learned helplessness’ is not in the dictionary of the Azmee girls.

We are strong ladies. Or so we thought.

Well, but now I admit I am weak in other ways. I am not good at accepting disappointment or failure or setbacks. This is a natural weakness for someone who is raised the way I was; raised to think that effort and systematic planning would always yield good results. People who were raised this way are really bad at dealing with things not going their way. We are such control freaks. That’s our number one weakness. My emotion when dealing with disappointing events is raw and immature and I just want to shout on top of my lungs, rebel at the source of my disappointment or otherwise withdraw myself into a corner to THINK!! about how to deal with this raw, immature emotion! (at least I have good insight about my weakness).

When I have done everything I could possibly do … I couldn’t handle it if things don’t go the way I expect it to go. It perplexes me. Why? What did I miss? What have I done wrong?

Alhamdulillah, I have been so blessed in life. All my difficulties are not that difficult, really. All my trials are not that trying. I haven’t experienced losing someone close to me. There is no such a thing as ‘the greatest lost of my life’ for me. Pfft. I have NEVER lost anything I can’t replace. Even my previous life disappointments are not that severe. It might feel bad to be disappointed at that specific time when I was dealing with it, but I could get over it by simply shrugging my shoulder, moving on and telling myself “well, it doesn’t matter anyway. I don’t really need it all that much.” (or maybe that’s my defense mechanism at work) Because in the first place, I REALLY don’t need anything much to feel happy. I have a great, amazing support system in my family and friends. In terms of material, I just need enough money to afford my freedom and enough money to afford my books. (And I thank God, I love the  job that has given me that money.) I also need enough time and space to be on my own to recharge. And then I am good to go. Good to move on. 

Disappointments in my life are rare and far in between… that I don’t get enough PRACTICE dealing with disappointments. Even when I experienced some initial setbacks, my family would push me to work harder until I obtained what I wanted at last, so that the initial setback felt as though it never happened. If I have been disappointed many times in the past, maybe I would be better at accepting it when things don’t go my way or follow according to my plan. I have been so spoiled to think that I can always get what I want if I work hard enough.

Now life taught me that my math is faulty. That the equation involving effort and outcome is not always right.

It is right only most of the time. But not always. Sunnahtullah cannot beat fate! Cannot beat qada and qadar.

For example you could have done all you can to make sure your patient gets the treatment she deserves, and then things go awry. Badly awry, that it devastates you.

For example, you could have planned everything to make sure the patient’s relative understood what he was supposed to do, but then he didn’t do what you told him to do. And then, you got blamed for it. Even though there was no way you could have foreseen what the relative would end up doing despite of your clear, specific instruction.

For example, you could passover your case to another center as flawlessly as you could over the phone, but things still ended up haywire and not properly carried out from the other side because of their own lack of communication with each other. And then, you got blamed for it.

I don’t mind being blamed. I can defend myself really well and I don’t care whose butt or feelings I hurt when I am being defensive. If you are going to attack me, I am not letting you do that without you understanding my position. If I sound defensive, be it. I AM defending myself, so OF COURSE I will sound defensive. Come on, what did you expect? You can label my behaviour whatever terms you want and I will keep on doing it because that’s what I do. I have been labeled ‘defensive’, ‘keras kepala, ‘stubbborn’, ‘asyik rasa dia saja betul’…. hahaha. Even my own mom said that to me. And then I said the same things to my own sisters, too . But really… deep inside, we understood that we are these stubborn defensive people not for ‘saja-saja’, you know. It’s because we have our own reasons for doing what we do. It’s because we believe that you have laid the blame at the wrong person and we are just trying to enlighten you until you see it. You can call it as ‘being defensive’, but I am still going to do it. As long as we know why we do it, we can ignore what you call us and keep on right doing it.  

But when things go badly awry for a patient – something you didn’t expect – it is really disappointing. Really disheartening. There is no one to blame. Nothing to be defensive about. Nothing for me to do. But just to deal with the feeling that I don’t have enough practice dealing with.

Disappointment really sucks. Full stop. 

But I will get over it.

I will shrug my shoulder and get over it. 

But…this time, how do I just shrug my shoulder and say “it doesn’t matter.” Because it matters.

My Mother’s Epiphany

My patient came to me recently, with a tinge of happiness in her voice, as she said, “I did as you said, doctor. I am finally free. I am so happy now.”

I swallowed. “What did you do?” I waited with bated breath. 

“I’ve left my husband. I gave him 3 years but he never changed. I am done with that useless man”

“Are you doing this for you? Are you doing this because this is really the right thing to do, FOR YOU? Or did you leave the man because you simply wanted to follow what I said when you asked me what I would do if I were you?”

“I have always known you were right. I just didn’t have the courage to do what I have to do. Your words gave me the right push to make that move.”

She is an educated lady of nearly 60 years of age and thus our whole conversation was in English. She is one of my favourite patients. 

I do have favourite patients, you know. I can’t help it. I treat all my patients the same – that is, I give them what they need. But with some patients,  consultations with them feel more stimulating than usual because they themselves are psychological minded and they ‘get’ what you are trying to say. These people usually have the capacity for self-reflection, self-examination, introspection and personal insight. When you ask them a question (which is meant to get them to think for the answers themselves, even though you already knew the answer) they give a delightfully honest answer that helps you to help them. I like these kind of patients.

This particular patient, let’s call her Mrs H, is a well-off lady. She has her own pension and has invested in a few lands as an asset. She has her own house in KL prior to coming to Alor Star. She plays the piano as a hobby, and she already has a grown-up son from her previous marriage. Unfortunately, when she first came to me in 2013, she had just recently remarried to a 70 year old Kedahan man, for whom she had left her KL hometown. She was stressed by that marriage. She felt cheated, used and taken advantage of by her new husband and his family. She was in the clinic crying her eyes out because she felt like she had made a huge mistake.

Even though at that time, I wanted to tell her that “yup, you probably did make a huge mistake” but I refrain myself (of course). You see, therapists in general TRY not to impose their own opinion on their patients. It is okay if you cannot help having judgmental thoughts, but you should not APPEAR to be judgmental. You MUST preserve the illusion that you are always on the side of the patient. The patient should always feel safe to confide in you about anything… and they would only feel that way if you give off the vibe of being understanding and non-judgmental. But human beings, as a species, are active thinking beings! Judgment and thinking are what make us so special. I would be LYING if I say I don’t judge what my patients do. Part of the evaluation process HAS to be judgmental. If you don’t judge, you can’t diagnose. If you can’t diagnose, you can’t treat.

If you go back to the psychoanalytic era when Freud and his followers reigned supreme… they could make snap judgment about others without any evidence whatsoever and they called it psychoanalysis. Hahha. Those were the DARK AGES of psychiatry, in my opinion.

So to be clear, I am a judging, thinking being. (Believe me, ALL OF US are. I am just more upfront and honest about it). But I just don’t have to tell my patients about what sort of judgment I come up with, that’s all. Instead, I store that judgment in my head and use it to treat the patient. I use my judgment to help them.

Some patients have zero insight about their marital problems.

“Saya tunggu dia nak berubah. Saya okay ja. At least, mak mertua saya baik. Suami saya pun kadang-kadang baik.”

“Apa contoh kebaikan yang puan dapat dengan dia? Tadi puan kata, dia tak cukup duit, kahwin sampai tiga. Siap perabih duit puan nak tanggung isteri ketiga.  Kereta dia pun puan bayar. Kalau puan rasa dia baik,  puan report kat saya benda-benda yang tak baik saja saya dengar selama ni. Apa kata puan habaq apa yang dia baik pula hari ni?” Nice, soft tone was used to mask the biting sarcasm. (So, dear readers, please reverse and read again my dialogue in a softer inquiring tone. Haha)

Some patients have good insight about their marital problems.

“Doktor, saya memang tak tahan dah dengan suami saya. Saya memang nak bercerai. Ni lawyer suruh mai psikiatri, sebagai bukti yang saya trauma dengan perangai suami saya. Senang ada surat doktor kalau pi mahkamah nanti. So saya mai lah.” This patient is direct, honest, and knows exactly what she wants. I like these sort of patients too. But…

“Baguslah puan dah ambil keputusan yang tegas dalam hal ni. Cuma saya tak bolehlah nak buat-buat puan ada kemurungan kalau puan tak murung.” I am also direct and honest. I like direct and honest patients because I reciprocate and mirror their own style, which is really my default style, anyway.

Some patients know what to do already, but they couldn’t commit to any action because they are afraid of the unknown.

“Saya tak mau orang mengata. Saya tak mau jadi janda kali kedua.”

Mrs. H belong in this category – fear of the unknown made her stay on until one day she couldn’t take it anymore. And neither could I.

So, it took her 4 years (2013-2016) to ask me “What would you do, if you were in my place?”

I was very upfront about it. “It is not my place to tell you what to do. After all, it is YOUR marriage and you are the one who have to live your life. Not me. But since you asked me about what I would do if I were you….well, I would leave him. But then, you have to understand that we make decisions based on specific context and our own natural inclination, and our own personality. My personality and my personal inclination is such that I can never love someone I cannot trust; and I can never trust someone I cannot respect; and I can never respect someone who cannot fulfil his responsibilities. I am very strict about these things. If I have a husband such as yours, I would have left him a long time ago. Of course, some women have such a huge capacity for love that she can continue to love just anyone regardless of whether or not she can trust and respect  that person… so if she’s okay with that, who am I to insist otherwise?” I paused, allowing her to digest what I really meant.  “At the end of the day, we live with the decisions we have made. I don’t mind to continue seeing you, because trust me, medication cannot cure you. Your husband is the perpetuating factor to your depression.”

She is an intelligent woman, dear readers. She knew that I also had had enough. She knew that my “some women have such a huge capacity for love” is an euphemism for “misplaced loyalty”.

I have mentioned before that it is not enough that we do what we like. We have to learn to like the right thing. For example, I have to learn to like literature. Haha. And I end up liking it.

Love and loyalty is also like that. Learn to love and be loyal to the right person. The person you can respect and trust.

So when one day she finally said, “I am finally free, doctor,” it truly made my day. It took her four years of suffering before she would commit to a decision. And that was only because she had asked me personally about what I would do, and I was impatient enough to actually give it to her. Who knows what would happen had she asked the question sooner.

Some psychiatrists would probably say that I am unduly influencing my patients.

Well, to be honest, we all influence patients in variable ways and extent.

I don’t like to stick to only one blanket way of dealing with patients. I would use different approaches for different kinds of patients.

As a doctor (and especially in psychiatry), we learn that there are a few models of doctor-patient interaction, namely:

The Paternalistic model: It is assumed that the doctor knows best and the patient is expected to follow the doctor’s decision. Usually this approach is desirable in emergency situations. However, this approach may result in clash of values.

The Informative model: The doctor is seen as a dispenser of information. The choice is left wholly up to the patient. May be useful in one-off consultations, but may not work well if strictly followed on long-term professional relationship.

The Interpretive Model: Here, the doctor will be treating the patient for a long time and might know his/her patient well and understand the circumstances of their micro- environment. Here, shared decision-making is established.

Deliberative Model: The doctor here may act as a friend or counselor to the patient, where information dispensing is coupled with advice on a course of action. This is commonly used to enable lifestyle modification and to address maladaptive coping.

Some doctors like to use only one approach regardless of what type of patients they are dealing with. Maybe they like that particular style and think it is the best interaction style with every patient. For example, some prefer the informative model because they think it is the most neutral and would suit most people. Maybe they don’t know the patient enough and therefore doesn’t want to feel responsible should something bad happens as a result of the patient following their advice.

I don’t know. To me, in each specific case, whatever model of doctor-patient interaction that we use, it actually reflects on our own conviction or our own insecurities about that particular case.

We learn from experience and we would know what approach to use for each of our own patient. Paternalistic style won’t work well with manic patients, for example. It would only make them more irritable towards you and you would then lose the patient.

I would use the informative model for someone who is educated, and like to make her own decision, especially if I don’t know this patient all that well (other than that she is educated and has good judgment skills). I would NEVER use this informative model for someone with low education level. I wouldn’t want to take a chance of her making the wrong choice as a result of her disadvantaged background. This model requires that the person on the receiving end can make sound judgment based on the information that doctors have given. This is not the case in patients with low education attainment.  

With Mrs. H, I have known her for 4 years. She is educated, and yes, I could stick with the informative model if I chose. But I know her case inside and out. I know her micro-environment. So, I think I am still within my professional boundaries if I use the Interpretive Model and Deliberative Model with her, especially when she had specifically asked me about what I would do if I were in her place. (To be honest, interpretive model is my preference, most of the time. Followed very closely by deliberative model. If I just want to be informative, I could just ask the patient to read a lot and google, right? Pfft. A doctor is more than that.)

She asked me a question. I gave her the answer.

Whether or not she would follow my advice, was totally out of my hands.

***

When I was in my early 20s, my mother imparted to me a piece of her wisdom when she said, “Older women and older men are not the same. Older men benefit more when they remarry after having lost their wives. But older women would lose a great deal if they remarry after having lost a husband. If anything happens to your father, I will never remarry.” She declared, confidently.

She came up with that epiphany after listening to the woes of her friend who was in the situation of suffering after remarrying at a very mature age of 50. It was not unlike the situation that Mrs. H herself was in when she remarried at the age of 60 in 2013.

At that time, I thought my mother was being loyal when she said she would never remarry. But actually, she was just being smart. She was right. There is very little benefit in remarrying when you are already old.

All the benefits are on the elderly man’s side – they get a free maid and a free nurse, all combined in one person. In fact, sometimes they even get a free financial provider if the women they marry are richer than them. 

Mrs H could have enjoyed her own money and her own freedom had she remained single at that age of 60. She has the company of her friends from surau and the care of her own son.  She could have been far more well off than she currently is if she did not remarry a man who was older than she was (and therefore, couldn’t even work or provide for her financially because he was too elderly). Had she remained single, she wouldn’t be expected to do any housework or housechores if she didn’t want to. She didn’t have to cook or clean or look after another person when she herself was at the age of 60. Her son wouldn’t come to resent her because she had to obey her new husband and hurt the feelings of her only son. She wouldn’t have to play the role of a breadwinner to an elderly husband when she herself was not that young.   

But…unfortunately… she had remarried.

Her pension, which should have been enough for herself, was no longer adequate. So she had to work, selling sandwiches, because her husband was no longer fit to work. Her husband’s children expected HER to care for THEIR father just because their father had married her.

This is the problem with our society!

The elderly man who had lost his wife wants to marry again. And their children also prefer their elderly father to marry again…so that they won’t have to be the ones who have to care for their own father and their father doesn’t have to live with them, disturbing the dynamic in their own household.

BUT, they don’t provide their father the money that is required for their father to be a husband again. So the new wife suffers! The household money would not be enough. In the case of Mrs H, the husband’s children often scolded her when she asked them for money. Such nerve! Such audacity!

Don’t get me wrong. I am not giving a blanket statement that elderly people shouldn’t get married. I am questioning the fact that some responsibilities might not be met with such marriage. (so, if you can fulfil your responsibilities, go ahead and marry even if you are already at 100 year old of age)

My own grandfather had remarried at the age of 72 to a 40 year old woman. That means, my  new step-grandmother is younger than my own father!  My grandfather remarried NOT because my father refused to care for him, but it was because my grandfather preferred to marry. I remembered feeling so perplexed that my grandfather at the age of 72 STILL wanted to marry another woman. It was all done within 6 months after my grandmother died. It just boggled my mind at that time. I didn’t say anything to my grandpa about what I felt. To be honest, I was really disappointed because I had expected that my grandfather would live with us.

I did NOT expect that he would remarry! My grandpa should have looked forward to playing with his great-grandchildren instead of playing house with another woman. I felt quite personal about the whole thing.(well, but to be fair, my sister was not yet pregnant at that time and there was no great grandchildren around to play with, yet.)

But since my grandfather just wanted to marry no matter what, my father had asked around for anyone who wanted to marry his 72 year old father. We NEVER thought it would ever come to anything. I mean, WHO would marry such an elderly man, right?  But miracles happened. Can you believe it?  A 40 year old woman agreed to the marriage. I was flummoxed by the development. My grandfather remarried when I came back from Australia at the end of my 2nd year in med school. (At least, he waited for me to come home before he tied the knot). I was by his side when he pronounced the akad. I had accepted (reluctantly) that it was his decision to marry and maintain his own household.

My father increased the monthly allowance that he gave to my grandfather so that my grandfather could provide for his wife. A small house was bought where they could live together, so that my grandfather didn’t have to pay the rent. My step-grandmother is a full time housewife and DOES NOT have to work to support my elderly grandfather. My parents were in charge of all my grandfather’s appointments with doctors and did not simply leave the care of my grandfather to his new wife.

Mrs. H was not as lucky as my step grandmother. Mrs. H was the financial provider, the carer and the maid, all in one. (It’s like being a mother to a big toddler, ain’t it?)And on top of that, her 20 year old son who is still a student resented her marriage and did not get along with her new husband. If I were the son, I would resent the whole situation too. Here’s an elderly man taking advantage of his mother! If his mother disobeyed this elderly man, the religious line “I am your husband. You must obey me,” would be flung around. Isn’t it ironic when a dayus husband insisted to be obeyed? It’s a trick designed to make the wife feels guilty, in order to deflect his own inadequacies. His mother was better off not marrying that man. When she married him, her life deteriorated right before her son’s eyes. It violates all sorts of social-exchange theory I have learned. In this marriage, the risk-benefits assessment skews in GREAT favour for the elderly man and a HUGE disadvantage for Mrs.H. 

I couldn’t bear it if I were the son. I would probably perform some serious rebellion and would say “You have to choose between your son or your husband.”. (Hahah. I am a dramatic diva like that.)

But here lies the problem. Talak is NOT in the woman’s hands.

That’s why when an elderly man remarries, his children don’t feel that they have lost their father as much. In fact, they would feel like they have gained a free carer for their father. A man holds all the executive decision making. So, his children won’t feel that they have lost their father so completely. If they want, they could influence their father to make any decision that would favour them against their step-mother and the father would say, “Okay, I have made my decision. My children were right. I am your husband, so you must follow me.”

But when an elderly woman remarries, the children would feel the lost acutely. Now THEIR MOTHER who they have known their whole lives is the new wife of a complete stranger. The happiness of their mother lies in the hand of someone they are not sure they can trust. And this stranger holds the power on their mother. Even if the children could influence their mother for a specific decision, what can the mother do if her new husband disagrees? Even if eventually their mother wants to be free from the marriage, talak was not even in her hands.

So a mother remarrying would be taken as a loss for her children, because like Mrs H, now her whole life and energy revolves around the new husband… as a breadwinner, a maid, a nurse! What’s left of herself for her children?

The bottom line is: The elderly man’s life becomes easy when he remarries. The elderly woman’s life becomes harder when she remarries.

And therefore my mother was right to decide never to remarry should anything happens to my father. (I wouldn’t allow it, anyway. I would be very forthright about it too.)

Of course, there is context to everything. Just like there is an exception to every rule. For example, the elderly woman could have married a richer guy, right? Haha. But then putting my self in the shoes of the richer  guy, I might as well marry a young woman instead of an elderly one (haha, just trying to think like a man). So MOST OF THE TIME, an elderly woman ends up with a poor elderly man whose children might or might not provide financial support for their father to enable him to provide for the new wife. 

So in general, my mother hit the nail on the head when she declared her epiphany.

Imagine if your elderly mother remarries? Can you bear the thought? I am not talking about young mothers, but elderly mothers! What benefit do they get from such marriage? Would you advise your elderly mother to remarry? Am I (and my mother and sisters) the only one who think like this, I wonder?

So that day, after Mrs. H finished telling me that she was now a free woman, and she was going back to KL, I smiled at her and said, “I wish you all the happiness in the world. Don’t hesitate to come back should you need anything else. If you need to talk to me about anything, just call the clinic. You know, I will always take a call from you.”

Since then, she had called me twice.

We kept in touch.

***

Disclaimer: Some details are hidden, altered or disguised to preserve Mrs. H’s privacy. But the gist of the case remains the same. This is not only the story of Mrs. H, but also the tales of many other women, even when they marry as a young woman. When they marry as an elderly woman, it gets even worse. Take care of your elderly mother. Never make her feel like she has to marry again for companionship. In most cases, it’s just not worth it.

What If? (The Exam Musings of A Panic Psychiatry MO)

What If?

What if it doesn’t work out,
What if all my dreams shattered,
buried under layers of shroud,
What if I come home battered,
or become  lost in the crowd,
Nothing to show for my effort,
But bruised, bleeding pride.



Ah…but someone wise had once
Whispered to me with love,
"I’d rather with danger prance,
Roughshod ridden, punched and shoved, 
Than with cowardice partnered in a dance,
Still with nothing much glorious to prove."



So, with those words of thought,
I bit my lips in a monologue,
“What if I fall... but what if I fly?" 
“I want to live...but what if I die?”
Will I take the chance? 
Or wonder for decades hence?



“My love, would you merely wait to exist,
in the life of no risks and 'what if?'
Or  would you prefer to thrive, to live,
With "oh well, next hurdle please,"


Thus, courage becomes my reprieve
Be gone, oh, the fear of 'what if'
Give me a lifetime of ‘oh well’
Because the chance of heaven after hell
Lies in facing the question of 'why not'
Because at last, all shall die and rot
The life of this world easily beguiled
One day as you say goodbye, do it in style.

-Afiza Azmee-

And so it went that I paid RM3000 examination fees to Royal College of Psychiatrist a few weeks ago.

After all that musings, angst, self-doubts and poems…I thought to myself, I have to take this step. Part with my money and risk failure. *sobs sobs*

If you know anything about my personality type, INTP, you would know that we hate failure. And that’s why we obsess about stuff. It’s not healthy. Nowadays I have controlled that tendency to a manageable level. That’s the perks of being a Psych MO; we manage our own anxieties and fears ourselves and pray it doesn’t seem obvious to others. Hahah.

Rudyard Kipling had once written the beautifully insightful poem entitled ‘If’. It has become a coming-of-age poem that every school student memorises at one time or another. I love that poem to bits. It is a poem about having a sturdy moral compass; how to conduct oneself in life. So when I wanted to write about my fear of failure, I naturally chose the theme of similar colour. Adding ‘What’ to the ‘If’.

I wrote this poem ‘What If’ because this is my weakness. ‘What If’ is my automatic negative thoughts in any new life direction that I contemplate taking. What If is always in my mind. I would never take the next step if I cannot  make sure that I have a pretty good chance of an excellent ‘What If’ in store for me.

You see, the thing is, I am very satisfied with my life. I see no reason to change things the way they are. I love my work, I love going back to my house relaxing, reading fiction, writing poems/stories, playing with cats. I mean, why would I want to change things the way they are? Why should I purposefully make my life difficult? I don’t have to be a specialist to be happy. I am just as happy now. Hahah. In fact, there is a high chance that the process of becoming a specialist (the wasted money if I fail, the rigorous studying, the withholding of pleasurable activities for exams) would burn me out and make me less happy. Right?

But sometimes, you can’t be more than you potentially should by remaining satisfied. That’s  the self-actualisation part of Abraham’s Maslow motivational theory. (Damn, the theory is accurate! When I was a HO, I thought I would be satisfied just being an MO…I mean, I don’t have expensive needs. My salary is more than enough for a modest lifestyle and an occasional luxury. I really don’t need a lot to be happy, you know. But Maslow had anticipated that people would never be satisfied for long. At the top of the hierarchy of needs is the concept of self-actualisation…the need to be the best of what you potentially can be. How to self-actualise if you cannot do what you want as a doctor because you have to follow what your specialist says regardless of whether or not you agree or disagree with him/her? When that happens too many times,  you will feel like “damn it, I wanna be a specialist and then I can make my own decisions.” Self-actualisation is empowering, and that’s why it’s in the top hierarchy of needs!)  

So, I have no choice. I have to take this exam…take this first step to becoming a specialist. Even if I am risking hard-earned money and battered pride in the process. (Failure is quite a high possibility. Not many of my acquaintances had passed this exam, previously. And they are quite smart,  themselves. I am really quite apprehensive about this. Which is why I wrote this poem. For a psychiatry MO, I am really not that good at talking about my own feelings unless I disguise it in a literary piece of poems or short stories. I am like Taylor Swift, in that sense. Hahha)

While writing the above poem, I talked to myself like a psychotic patient in the midst of a severe hallucination: “Let’s live the life of ‘oh well, I tried’… than the life of ‘what if'”

P/S: Still, my heart aches a bit when I see the balance in my bank account.  Oh, well. 

Hail the new addiction MO!

God doesn’t give you what you ask for. What you want doesn’t simply materialise from the great blue sky.

Life doesn’t work that way, alas.  

Instead, He gives you the means and the tools and the experience that you can make use of to attain what you want.

As I have mentioned before, I asked God for patience as I am fully aware that I am  lacking in the quality of patience. I am easy-going in mundane, daily matters. Mundane routine don’t flap me, don’t faze me, or disturb my mood. I couldn’t care less about which restaurant serves what good dishes, I am not a hypercritical foodie. I eat anything and everything. (I am only particular about coffee. But not even the brands of coffee do I care. Just any good tasting coffee will do no matter what the brand is). I am not a fashionista. I am not brand-conscious. I wear whatever that is nice-looking and cheap. You don’t have to please me with expensive presents. When in doubt, just give me the latest book that has won an Orange Prize or a Pulitzer Prize or a Booker Prize. 

I don’t get offended easily. I don’t have an opinion about food, clothes, houses, cars, the best way to clean or cook. I am not a fanatic fan of football/celebrities/dramas/movies. I can never understand how fights ever get started at the stadium. Just doesn’t make any sense to me. I am, however, an ardent fan of books but it’s been a long time since I last got worked up about which book  is better than the other. 

But when I feel some people have crossed certain boundaries, certain concepts of truth/justice/fairness (my version of it, at least) or certain universal principles that I think everyone should have, I cannot calm myself down. In such situations, I am adamant that things should go my way. My way of thinking is better. And if you refuse to see it and put the blame on me, manipulate me in anyway (or try to)… if you don’t immediately see that I was right (that I don’t insist you to go my way because it is MY way, but because it is the right way and the most just, the most righteous for everyone), then I get immediately upset. 

You see, a beauty queen will be upset if people criticise her image.  A surgeon is defensive if people criticise how he approaches a certain surgery. A  designer is upset if people criticise her design. A singer would feel humiliated if people criticise her singing. A chef/a cook feels defensive if people suggest that there is a better way to cook rendang, for example. (Been to any gotong-royong memasak, recently? You will get what I mean about how sensitive and defensive a cook can be, it is so funny!) 

I consider myself as a self-developed thinker and ethicist (hence, this is my area of sensitivity). I don’t defend only myself, but I also defend others, especially my patients, against stigma, against their bosses, against their tormentors (read: husbands). I have called up employers, I have called up husbands, I have called up instructors (pretending to ask for collaborative history but actually really just want to SUBTLY let them know that ‘hey I know what you are doing to my patient. She confides in me. I am on to you, now. You better be careful in how you proceed with my patient from now on. She is no longer alone in this. You better watch out’ Hahah. Contrary to the belief of my family members, I can really be charmingly harmful and subtly dangerous when I put my mind to it, as opposed to stormily harmful and obviously dangerous. The storm and danger can come later, if required. There is an art to subtle threat that I have learned in the past. Sometimes, just doing the phone call is helpful…sometimes you need to follow-up on the phone call with a more assertive action. Once, I even offered to accompany my patient to lodge a police report against a particular member of her family… so that she won’t chicken out at the last minute and  things will actually progress SOMEWHERE! But she didn’t take up on my offer and I was left frustrated. Maybe I should be less over-involved to protect myself against this sort of frustration. Some people will never take the assertive action  that they should, it makes you want to pull your hair in distress on their behalf. Maybe I should really learn to accept that some people just deserve the problem that they have. Even Allah won’t change the condition of His slave without the slave himself putting in some effort. So who am I to try to do anything more? I couldn’t, even if I want to.)

There are risks I took without consulting my specialist because I know if I consult them, I might get a different management plan altogether that would not allow me to do what I want to do for my patients. It doesn’t happen always. Most of the time, management is pretty straightforward and we see eye to eye. But when it does happen, it makes me feel stressed. 

(I think most MOs feel the same way, anyway. Many MOs take risks of doing something behind the specialist back because that’s what they want for the patient. I am not the only one. Many MOs in other departments also, if they are senior enough and if they feel bothered enough, would have learned how to manipulate the system to get what they feel their patients deserve. I bet, many specialist when they were an MO would have done something like that as well. So they really shouldn’t be upset if their MOs now do the same thing. It’s part of our learning process and that particular action of taking-risk would enrich your clinical experience and eventually serves you well as a specialist. We are no longer HOs who just follow mindlessly. Sometime we make mistakes and commit errors in clinical judgment but those experience must be gone through.  Sometimes we need the freedom to determine what we want for our patients, right? So, there are minor things you do for  your patients that you won’t consult with your boss if you know he/she won’t agree with you. Or you will manipulate the system in your own way, present things in a different way. I know which specialist will sign OKU form easily so that my patients can get a much needed welfare money, before some politicians can swindle the money away. I know which specialist will allow me to admit patients into the ward. If my patient needs expert counselling that I cannot deliver due to time constraints and lack-of-expertise,  I know which specialist will willingly takeover a difficult case if I consult the case with her. I know which specialist will deliver a good scolding to a patient who needs that scolding. If I don’t want to give something that a rude demanding patient insists for, I know which specialist will have the same line of thinking as I do and I will consult with that specialist so that I can tell the patient “Sorry, even my own specialist say no. See?” Haha. All of my bosses are good in their own way and I have learned to choose and pick with whom I can discuss regarding which type of cases. That’s how MOs manipulate the system… and this is like an open secret. I am not saying anything new here.)

So, because I think of myself as a logician, a thinker and an ethicist, I get defensive if people criticise my logic and my ethical reasoning and how I want things to be done. (Well…everyone is allowed to be upset about SOMETHING, right? Like the beauty queens, the designers, the surgeons, the singers and the chefs of this world. Depending on how you define yourself, you get defensive about those things.)

I also pride myself of being an amateur linguist. I would probably be quite sensitive about anyone criticising my essay or my short stories. Once when I was in Form 5, I had argued with my English teacher when she criticised my English essay. (But I never, for example, argued with my Math teacher because heck, I knew I was bad in maths, so why would I get defensive about it, right?) My excuse for arguing with her was because she said the essay that I wrote for the monthly test was plagiarised from a novel. I asked her, “which novel?”. She couldn’t name it, of course. Just because my essay was good with a different plot twist, doesn’t mean it was plagiarised from a novel, for God’s sake. (she hated that plot twist because there was a controversial element to it that she opposed to, being conservatively religious as she is, compared to me at that time. In my defense, I was just being creative. If she didn’t like that plot twist, she could just tell me so; rather than accusing me of plagiarising!) My sister was a novelist! My father wrote poems and quotes at the first page of all his text books when he was younger! My younger sister is a TESL teacher. My inclination towards language and literary creativity runs in the family!  All my siblings are great readers! We talk about books all the time and we compete with each other in coming up with great phrases all the time. So can you imagine how upset I became when I was accused of plagiarising a non-existent novel?? (By the way, the essay was written in a test. How the heck was I supposed to plagiarise during an exam? Did she suppose I have an amazing photographic memory or something? Did she suppose I memorize a whole lot of paragraphs of that non-existent novel and had committed into my amazing photographic memory of every ‘and’ ‘or’, ‘if’ and ‘but’, every conjunction, every phrase, every colon and semicolon? Did she even know what plagiarism even mean? In any creative writing, having similar plot does not suffice to accuse a writer of plagiarism. If you read mysteries often enough, every novel feel similar and familiar after awhile. All ‘drama pukul 7’ on TV3 are more-or-less the same romantic stories… do we get to accuse the scriptwriters of plagiarising each other?? That’s why genre exist! Similarities in plots are related to genres, my dear readers! It doesn’t matter if the plot is similar, it is the style of writing that matters!  And in my case, I hadn’t read any such a novel that she accused me of plagiarising from! I wrote that essay in an exam, where I could not open any book for reference without anyone noticing! It wasn’t like the essay was written as a one-week-assignment where I would have the opportunity to ‘copy and paste’ some paragraphs out of some books. If that were the case, then her accusation would make some sense! As it was, her accusation only made me assume that she was not pleased that I had written something controversial that she could not accept as  a religious, tudung-labuh-wearing muslimah. Just because she had never read any amazing, grammatically-correct, controversial essay from students in her short duration as a newly-graduate TESL teacher before, doesn’t mean she would get to accuse me of plagiarism. I was instantly inflamed!) Such an unjust accusation, not supported by any evidence, directed towards my ability which I took most pride in…. My God, my 17-year-old self wanted to blow up at her! I called up my parents and told them what this teacher said to me. My father was very angry when he heard about it. I had no idea that he could be that upset over it, or else I wouldn’t have told  him.

For the record, my parents were never the sort who would fight my battle for me. Before this incident, they would always assume that I deserve whatever rare scolding I might get from teachers. If I got bad marks in any of my test, it must be because I did not study enough rather than because the teachers were bad at teaching. They have never confronted any of my teachers for anything…. until this! I was surprised when my mother and my elder sister came to MRSM Langkawi bringing a bag full of my previous essays and short stories that I had written in the past to show to the teacher that writing have always been my hobby and I have always written with the objective of being creative. That my essays have always been this amazing (hahah, my parents’ words, not mine!) That just because I introduced a plot twist that her conservative self may not like was not enough justification to accuse me of plagiarising. 

I tried to stop them from coming. But my father vehemently insisted that I should be defended. (My father has always been a fighter and would push us to do the same in anything!) I felt so stressed that they wanted to come. It was so ironic. All these times, they never wanted to side with me when I felt I was unfairly scolded by my teacher. But when I didn’t want them to come, (because heck, I was already 17 and I could fight for myself) they insisted in coming! I didn’t know whether to feel touched or irritated.

The teacher finally apologized to me after my mother and my sister went to see her. (I was not there when they confronted her because I had a Math test.) And I also apologized to my teacher because I knew how forceful my mother could be when she was feeling angry. I was thankful that it wasn’t my father who came. Or else, the situation would totally be out of control. And I learned from that experience that I should never tell my parents things that I could handle myself. Haha. (This sealed my fate as a very skeptical person towards authority, in general. I became even more skeptical after 2 years of housemanship. I swear I will never put myself in the position of needing any validation from an unjust authority ever again. I avoid authority because I never want to kiss their ass. I think of all authorities as having a tendency to abuse their power until proven otherwise. I don’t know how I am going to cure this overvalued idea of mine… just knowing that I might not be thinking fairly doesn’t cure my tendency to feel exactly like that! I have met many nice people in the position of power, and I think of them as the exception rather than the norm. I guess, even I can be illogical at times.)  

I also pride myself of being a good reader, so I was VERY DEFENSIVE when I first met the brilliant Miss A who interrogated me on my choice of reading which, I now admit, was not as sophisticated as her own choice of delicacies consisting of many notable classic literatures that I had never even heard of before our paths crossed. Compared to Miss A, I was a novice in reading. My defensive stance became meek when I realised I could actually learn from her.

Well, everyone has some stuff they get very sensitive about and thinking, reading and writing are mine. I am sensitive when I am criticized in those. 

c67ce34cc2f677063c80d36738ef4c27

But whatever it is, no matter what I said to defend my temperament, it does not justify my lack of patience. Like Miss A had said, we should aspire to be the one with the bigger heart. Ignore minor annoyance, walk away from the source of your major irritation, and if you can’t ignore those things any longer, then educate people with kindness. Don’t snap! 

Or perhaps, I have attained the age of maturity to have learned not to respond to anything and everything. Just walk away. If they never see what you see, don’t force the issue. (I feel more wise and matured just writing about this! Haha. But even now, I cannot imagine how I could have dealt the situation with my English teacher any better. I mean… even maturity and wisdom have a limit somewhere.)

So, having an excellent insight about my severe lack of patience, I plead to God to bestow on me some measure of patience. Make me nice, lol.

And He answered my prayer by making me into an Addiction Medical Officer.

Hahaha. Yeah. He gives me the tools and the experience I need to acquire patience. He doesn’t just arrange for me to wake up one day and be Mother Teresa.

Addiction patients can be manipulative. Check.

They sometimes use religious concept out of context to justify their actions. Check

They don’t have baseline standard criteria that I demand in people around me. Check.

They tick all the boxes that would totally TRY my patience. And if patience is a sort of muscle that have remained atrophied all my life before, I am gonna get a lot of exercise these days, trust me! Haha.

So, wish me luck. Hopefully, I can become a nice person through this experience. Something good may come out of me having to deal with the population in which anti-social traits are prevalent. 

After all, who am I to judge people? We never know how we will end our lives. Just because some people are not up to snuff now, doesn’t mean they will never change. Maybe the ongoing never-ending struggle that they have to face to overcome their addiction (although at times they fail in their struggle again and again) gives them one massive pahala jihad people like us don’t get. 

You earn pahala through struggle, right? It is not the outcome/natijah that brings you the reward from Allah. It is your effort that counts. And with drug addicts, the effort is constant for the rest of their lives. And every time they fall from grace, fail in their struggle and then repent, they get pahala taubat each time.  Who knows, maybe some drug addicts are more beloved in the eyes of God, than us normal people who only go through life blindly and repetitively with no major struggle whatsoever.

A food for thought, huh?

So far, life as an addiction MO is nice. I get to stay in my own Addiction room at the back, that’s the best part. Even though anyone can use that room at anytime (it’s not like I am given an exclusive right to it by my HOD, unfortunately) but not many MOs go to that room anyway, because the room is quite isolated at the back of the clinic. So I have come to think of that room as mine. (I am quite possessive of that room, to be honest. Even though my name was not written on the door of that room, I really think of it as mine and would feel quite forlorn if some other MO sits in that room instead of me. Haha) The isolation space that the room provides is the best part…. a space for me to do my work and to think out loud while listening to my kind of music. It’s like a separate universe from the rest of the crowded chaos at the front.

Ah… peace and serenity! I could really get used to being an Addiction MO. Having my own room is sweet! Sweet, indeed! I love it. My patients love it. We can talk privately without background noises disturbing our conversation. No patients knocking on my door, asking “Lambat lagi ke, doctor?”, annoying me with their disturbance while I am talking to another patient.  I can focus on my patient in tranquility. They feel heard and satisfied. And I feel satisfied. That is the sort of environment conducive for proper consultation and disclosure. 

That room at the back is also very conducive to turn me into a Miss-Nice-Girl. LOL.

So, that’s how it comes about that this ‘being nice’ business is not so hard these days. In fact, it is rewarding in its own way. 

So, until next time, folks! I shall try to update once a month. Might be hard though with the exam looming near. 

Until then, I remain, your humble blogger. 

So This Is How It Feels

I was informed by my specialist that a patient who I saw one month ago had committed suicide at home. He killed himself by hanging.

I was shocked.

“Afiza yang last jumpa dia. Bulan lepas. Tapi sebelum tu ada banyak doktor lain lagi yang jumpa dia. Nasib baik Afiza ada tulis yang ‘patient denied suicidal ideation’.”

I felt terrible almost immediately. I have never lost a patient to suicide before. No patient on my regular follow up has ever committed suicide before.

Medical Officers don’t always see the same patient each time the patient comes for follow-ups. Patients are seen by any medical officers according to which medical officers are available, unless the patient specifically requests to see a specific medical officer. I have a few patients who will only see me but most of the time I see general patients who are not on follow-up with any specific doctor.

When my specialist told me the name of the patient, I just could not recall who he was and how he looked like. It made me feel even worse. He died and I could not even remember who he was.

I asked my staff to trace his OPD card.

Sure enough, that was the first and the last time I had ever seen the patient. I gave his next  appointment in one month time.

God, maybe I should have given him an earlier appointment date. (Regret number 1)

I looked at what I had written in the card, hoping it might help me to remember. But all I saw in my mind was a blank picture. (Regret Number 2)

I looked at what I had written in the card and I felt sick that all I had written were only five lines of documentation: (Regret Number 3)

-Symptoms improving

-Mood is much better

-Appetite still low

-Sleep requiring Stillnox

-Denied suicidal ideation

There are not many times that I feel like kicking myself. But this is one of those times. Ya Allah… Afiza, couldn’t you have written in greater details? My only saving grace is the fact that I had actually documented that the patient had no suicidal ideation, which only meant that I had asked about it.

But did I ask earnestly enough? Did I see his face when he denied having suicidal ideation? Or was I busy writing, rushing to call out another patient on a busy clinic day? Maybe if I was not in a rush, he might feel encouraged to say something that would  clue me in on his suicidal ideas. Maybe if I had watched his face carefully as he was denying the suicidal thoughts, I might have seen something.

A flicker of sadness in his eyes… maybe.

A sad, wry, self-deprecating smile… perhaps.

A finality to his demeanour…

Just something! Something that would prompt me to explore more, dig deeper.

The problem is, I couldn’t remember a damn thing! And that might be a good thing. If I feel THIS devastated for losing a patient I could not even remember, maybe I would feel a thousand times worse if I could actually remember the whole interaction. By not remembering, God spares me the regret I would feel if indeed I had done a sub-par job. 

On a busy clinic day, I might have spent 15 minutes talking to a patient. But I might only scribble a few lines of simplified documentation because I am in a rush to see the next patient. Or I might only see the patient for a few minutes and thus the documentation was brief. So the length of my documentation does not always reflect how much time I have spent exploring his issues.

The problem is I cannot recall anything, including how much time I have spent with him and whether or not I spent any minutes exploring his issues properly.

I went home on that day with a feeling of something deuced uncomfortable in my chest. Not exactly like sadness. But more like a heaviness…. that I associated with a feeling of regret.

If I feel this bad for losing a patient I have seen only once, I cannot imagine how shattering it would feel to lose a patient who is on your regular follow up. You couldn’t help feeling that you are responsible somehow. That you have missed something. Was it something you said? Was it something he said that you did not pick up? Was it just fate and happenstance? Or are you just a crappy doctor?

I packed my things and stayed with my parents that night. I need my mom’s comfort food. I need to see her face. I need to hear the sound of her voice telling me things that I already know. That I couldn’t have predicted these things. That  things happen. That there might never be anything different I could do that would change the outcome. That many psychiatrist have had patients who had committed suicide.

That I am not to blame.

Now, I know….this is how it feels. 

So I followed Julie Andrews famous advice in The Sound of Music: When the dog bites, when the bee stings and I am feeling sad. I simply remember my favourite things….and then I don’t feel so bad. (Don’t you just love how Julie Andrews and the kids look so adorable and happy in that song?)

So I did my favourite things.

I started writing in my blog,

And then, I lie on my bed at my parents’ house, reading my novel and start losing myself in the story. Getting drunk in someone else’s journey.

Thank God, for favourite things! It soothes the blow of this crappy feeling!

INTP: The Logician, The Sincere

The problem with me is that I am too blunt.  Too direct and too forthright.

I don’t know how to soften my speech when I am irritated. I don’t know how to criticize while making it sound like a joke. In fact, I really despise people who do that. Double dealing, double face….I am too old for that game.

9188135f4c84b0bc796c0894dce801ef

When I joke, I joke. You don’t have to wonder whether I am secretly being sarcastic towards you. I made it a point that people would not be offended by my joke. I don’t have any hidden agenda when I joke. I want to give you a laugh and we could have a good time. The joke would not be a disguised attempt at making you ‘terasa’ in a public setting. That’s just weak.

When I want to criticize you, you can bet your life that I will be utterly forthright without bothering to disguise it in a joke. I can only promise you not to do it in public. However, if our argument happens in public, and I feel attacked, then I will have no choice but to defend myself. (So, don’t call me out in public if you cannot handle the return heat. I have no problem causing a scene.)

I don’t mean to offend people. But when I do, it is always because I am provoked, first. Perhaps you are being argumentative yourself, and I am just replying and defending my position. When you are too slow in comprehending my point, I become impatient and then I snap. Sorry, but damn it, please don’t argue with me if you are not up to it. (Just know that I am right. Hahha)

I won’t leave you guessing about what I really mean. Am I serious? Am I joking? Am I angry? Am I pleased? Am I entertained? My words, my moods and my facial expressions are all congruent. I am an open book, easily read. 

With me, ‘passive-aggressive’ is not something I do very well. If I am aggressive, there is nothing passive about it.

At least with me, you know where you stand.

Pretension is really wearying to me.

I suffer inwardly just by pretending to agree (either with bosses or colleagues). Something inside me want to rebel when I cannot say what I really want to say. And is it surprising that I tend to avoid authority (or anyone else who makes me feel uncomfortable) when I cannot be myself?

709b8dd4c74374de9d2a20a0bbb4b1d6

That’s why I am not a team player. I can work in a team…but you have to assign me a solitary task that we then compile at the end of the dateline. Don’t ask me to share my workload because what will usually happen is, either I end up doing everything myself (satisfying my standard and my specification) or I just let the other person do whatever she/he wants while feeling dissatisfied that I have to compromise on what I want to be done (yeah, I am a control freak with poor insight).

3d6a9af140c40e847cc7f9329f9dacba

I do my best work alone. If I need help, I shall ask for it. Otherwise, I really don’t want any interference. I don’t want supervisors. I don’t want team mates. I want freedom to do whatever I please, as I please, without worrying about having to convince, cajole, persuade, beg, or seduce (hahah!) anyone into agreeing with what I want to do. It’s just too much effort.  Being in the society is too much effort.

But that’s utopian. Something I can never attain.

So, I learn to tolerate society. In small doses.

My best friend is someone who knows me automatically without me even having to explain why I am upset about a statement/an action/ a concept/ a worldview. She would glance at me and said

“I knew…you  hate this, right?”

“I know what you are thinking….don’t say it.”

“Ni bagi kat Afiza….memang siap budak tu.”

With her, there is no effort required for me to be understood. No explanation is necessary. It’s all easy.

And because she is an extrovert (but a logical one), our relationship is mutually beneficial. She is happy to talk and I am happy to listen. Only interrupting when I want to clarify ambiguous points. Ours is  a harmonious symbiosis. 

***

INTP makes the best debater.

Do you know why?

We are logical.

Yes, we can be emotional too. But we are emotional about things having to be logical. We are emotional about things having to be fair. Following a certain rules and pattern of logic. 

When you speak of facts that have nothing to do with the  issue, it makes us annoyed.

I will give you an example. When I question about the delay in the way Mahkamah Syariah deals with divorce cases, some people would then say;

“Mahkamah Syariah adalah sistem yang digunapakai untuk menguatkuasakan undang-undang Allah. Syariat Allah adalah yang terbaik dan paling adil untuk semua orang. Kalau bukan Allah yang mencipta kita yang paling mengetahui apa yang terbaik untuk hamba-hambanya, siapa lagi yang lebih layak untuk undang-undangnya dituruti?”

I wanted to pull my hair! (Kau ni faham bahasa tak? Dulu belajar subjek pemahaman/comprehension, kau gagal ke subjek tu? Nak suruh aku cakap bahasa apa bagi kau faham ni! Kau tak payah nak cakap kat aku undang-undang Allah lah yang terbaik. Yang tu aku pun tau! Aku persoalkan kau punya sistem. Sistem kau tu tak perfect sebab sistem tu kau yang buat dan kau ni  memang langsung tak perfect. Kalau aku cakap direct macam ni, kang kau dah sentap. Waktu tu, baru kau nak faham ke?)

The words in the blue bracket were the things I REALLY wanted to say…but because I have learned to be polite, I could not say it. So I suffered inwardly.

Oh, how I suffered.

So with a tight face, I only said “No one is questioning the perfection inherent in the laws of God. We are questioning YOUR system of implementation,” Faham tak lagi? Kau nak suruh aku pakai ayat apa pula ni bagi kau faham apa pokok persoalan yang sebenarnya? Janganlah berleter benda tak berkaitan just nak tunjuk konon kau ada point! Sedangkan the real issue kau tak address!! (ini sambungan ayat dalam hati sajalah. Dah berapi dah jiwa aku! Sikit masa lagi, for sure aku akan snap!)

This is a tactic some uses in debate, you know. They don’t really address the question. They just say general facts that people cannot dispute and rely on that facts to make it seems like they are right.

(Contoh general facts: Undang-undang Allah yang terbaik…. Keadilan yang hakiki hanya dalam undang-undang Islam…. Langit itu biru… Bumi itu berbentuk sfera… Lautan adalah 2/3 daripada bumi… Bulan memantulkan cahaya daripada matahari…. Jirim terdiri daripada unit asas yang dipanggil atom…. Atom terdiri daripada elekton dan nukleusnya terdiri daripada proton dan neutron) These are all indisputable facts. So when they quote these facts, of course people cannot argue with them. Whether or not the facts that are used have anything to do with the debate, they don’t really care. They just think they have a point. Gosh!

I admit that I myself have, at times, done such a tactic in the past when I was desperate. The difference is, I am aware of what I do and if people call me out on it, I will admit the fairness of the criticism. But some people don’t have that self-awareness… and reasoning with them becomes a lesson in endurance.

***

One day, a whatsapp message appeared in my whatsapp group asking me “Afiza, it is your turn for CME presentation.”

And my reply was, “I am not going to present. There are 4 others who were scheduled to present their topics a few weeks ago and no one presented. Ikut turn lah.”

This has happened many times in the past. I adhered to my date of presentation in the past. But not many people did afterwards. And then no more CME. Every year it is the same old story. This year, a new schedule for CME has been produced. There were a few names scheduled to present before me, but none of them did. Suddenly this week, they asked me to present.

I was not going to do it.

Looking back, I could simply shut up, right? Just ignore it. I could simply deal with that question the way others did.

“Oops lupa.”

“Oops EL”

“Ooops MC.”

And in the past, everyone just left it at that. They did not have to compensate for their turns. So looking at previous pattern of events, I could get away with it without bothering with any argument, kan? Why bother, right? And coincidentally, I really was on leave. I could have just said “Oops..on leave. Not in Alor Star.”

Yeah, I could just say that. Avoid confrontation. Avoid argument.

But pretension of any kind is my abhorrence. I won’t deal with it like that! The truth is, I did not forget to prepare my presentation. I remembered very well when I was supposed to present. In fact, the day before I was supposed to present, I already told one of my colleagues clearly that I was not going to present tomorrow because others before me hadn’t.

I don’t do EL. I never had any EL so far. I never had MCs since I entered my department.  So, those were not the excuses I gave for not presenting. 

My issue was: Others have not presented before me. So, why should I? Why enforce the rule only on some people and only for some of the time? Why not enforce the rule for everyone from the very beginning? Why me??

That’s my issue. That’s my honest issue. And that’s how I deal with it. By stating exactly why I was not presenting. Not by citing any other reasons (lupa, EL/ MC), cuti), avoiding my real issue, and hoping it would go away and I wouldn’t have to justify why I was not presenting. 

I am not created that way…giving excuses. I want to rebel with myself if I do not say what I want to say. And at that time what I wanted to say was “It is not fair that you ask me to present CME today when others have skipped their turns!”

So when someone then issued statements such as “CME is actually for knowledge-sharing. It is not to burden the presenter. It is actually a good learning process.” (General facts. Like the moon and the sun and the earth and the atoms. Got it? I am allergic to those statements.Why are you making statements that I did not even question in the first place? Why did you offer such statements when those statements were not even in dispute, to begin with?)

So I said. “No one is questioning how good CME is. No one is questioning the purpose of having CME and that sharing knowledge is good. That is not the issue. I am questioning the SYSTEM of knowledge sharing. In this case, the system is to ‘take turns’ presenting. “

The issue is, why do I have to present when others before me haven’t? Why do you enforce it on me and ignore others? CME as a a good way of learning, is not the issue in dispute, here! 

Comprehension, people!!

I have trained myself to automatically attack fallacious argument. Just giving away standard statements that sound good and sound true, doesn’t mean you contribute anything to the actual point of the argument. It’s like in debate. Even English teachers cannot be a good judge in a debate  if he/she is not trained in basic logic, comprehension and fallacies.

Having good command in language is not enough (although it is a good start). You have to know logic and patterns. You have to be trained at spotting fallacies. You have to be sensitive at contradictory statements so that you can pounce on them!

And that is something INTP is deadly accurate at. We love patterns. Spotting discrepancies in statements is a hobby! It invigorates our brain.

Some people would feel at lost in an argument. “Aku rasa macam aku dah betul. Tapi bila dia cakap pasal CME ni bagus, sharing knowledge ni bagus….apa aku nak cakap balik? Memang apa yang dia cakap tu betul. Kenapa nampak macam aku yang salah?”

You can never trick an INTP like that. We deal with it dead on. We just tell you that you are confused about the issue of the debate. We said it straight “I never question the statements that you are making. So, why do you feel you have to say those statements? I don’t know what prompts  you to suddenly offer such statements that don’t add anything to the issue we are dealing with.”

And when I am in that argumentative mood, I trample on people’s feelings (unfortunately). Feelings become secondary and less important compared to the truth that I want recognized.

That’s the great thing about being an INTP. But it is also the worst thing about being an INTP. We hurt feelings….and sometimes we don’t care.

But sometimes we do care. But oopsss… we did it again. Hahah.

Luckily, INTP don’t need much friends.  We are introverts.

And we are happiest  that way. Leave us to our books and we are content. The society is just too unpredictable…illogical…no patterns.

tumblr_m9xop8MhPH1rse70ro1_500
I know, I am harsh. Look, I am working on being nicer. Just…haih…it’s so difficult!

***

So the conclusion from the whatsapp conversation is that, from next week, everyone must adhere to the dates of their presentation. If they somehow cannot make it, they must find a replacement. Fair and square.

Isn’t it lucky that I made everyone face the issue by simply refusing to present and then tell them the real reason why I refuse? It solves the problem. The problem being: people not adhering to the system and demotivating others who follow the system in the past. Now that the issue is out in the open and not swept under the carpet (thanks to my forthright manner) everyone will know not to simply EL / MC / disappear without finding a replacement for their presentation, next time.

I am satisfied.

040924c402952cd023a14c74d5b9d4b8
Hahahha! Yeah! I soooo get it!