Thoughts On Trauma and PTSD

Writers, in general, find inspiration by things that happen around us. As a doctor (who happen to have an interest in writing), things that happen around me are things that happen to my patients or to my colleagues or to myself.

Lately, we have a couple of PTSD cases in our ward. One of my patients developed PTSD after being involved in a relatively minor road traffic accident. 

Just a few weeks ago, I was asked to present a topic on psychological management of patients with Burn Injury and one of the subtopic that I covered in my talk was PTSD among war veterans living with blast injuries.

And just yesterday, one of my colleagues had a minor accident on the way to work, and she jokingly said, “Oh no, I hope I don’t develop PTSD like our patient.”  She is one of the funniest person in my department but part of me feel worried if she might not be joking about her worries on developing PTSD. She admitted to me once that she is the OCD and anxious type. 

It reminded me of my own impending PTSD last year (I use the word ‘impending’ because I never actually developed one. But I could have developed one, I think, if I didn’t straight away get a grip on myself and took steps to prevent it from developing. One of the steps I took was by refusing to talk about it or mentioning it to anyone other than to my family members who knew about it. And I continued doing my daily routine as though nothing serious had ever happened to me. My method worked because Alhamdulillah, I don’t have PTSD).

All in all, I feel like this is PTSD month for me and therefore this is what I am inspired to write about.  

***

If you have read the non-fiction book ‘Shrinks: The Untold Story of Psychiatry’ by Jeffrey A. Lieberman (The Former President of American Psychiatric Association and one of the key contributor to the development of DSM III, a dramatically and drastically more systematic manual than the previous DSM I and DSM II), you will find a very interesting chapter that he wrote on how unique, personal and mysterious the development of trauma can be. 

download

Why does trauma occur in some people and not in others? And how come the development of trauma has nothing to do with the scale of danger involved? Jeffrey A. Liberman related two events that had occurred in his life; one incident was life threatening (he was held at gun point by a robber in his house), and the other was just a minor accident (he accidentally dropped an air conditioner from a multi-storey building and the air conditioner almost hit the doorman downstairs but in the end, no one was actually injured) and yet he developed PTSD over the minor accident rather than the one that might cost his life. 

Below was his own thoughts regarding how puzzling the development of trauma can be:

“What is it about traumatic events that produce such intense and lasting effects? Why does trauma occur in some people and not in others? And how do we account for its seemingly unpredictable incidence – after all, it seems rather counterintuitive that dropping an air-conditioner elicited PTSD-like effects, while a violent home invasion did not. During the latter episode, I was assaulted and my life was in genuine danger; during the air conditioner’s plunge, I never faced any physical hazard. Was there some critical factor that determined how my brain processed each event?”

When I read this particular chapter of the book, I remember thinking that “PTSD is so fascinating.”

Out of all 265 diagnoses in DSM-5, all of them are defined without any causes being explicitly referenced, EXCEPT for substance use disorder and PTSD. While we all know that drug addiction is due to actual effect of  chemical reaction leading to neural changes in your brain, PTSD is a psychological reaction to an event that produces lasting changes to a person’s mental state and behaviour. Like substance use disorder, the cause for PTSD was clear cut (unlike other diagnoses in DSM-5). Before the event, a person was mentally healthy. After the event, the person is mentally wounded. (and treating a mental wound is a whole new headache that is not as straightforward as treating a physical wound. A mental wound is something you cannot see directly. In a sense, it is like ‘benda ghaib’ that you cannot fully grasp. How do you treat a ‘benda ghaib’? It is so difficult and it can be so frustrating sometimes, trust me).

 ***

Until now, it remains a mystery to me as to why I was able to move on with my normal routine after I was involved in a major MVA last year, but in contrast, I was an emotional wreck after the passing away of my ex-classmate many years ago. 

I was very emotionally affected after the death of my ex-classmate when I was 18 years old. Something about mortality scared me as a teenager. The unpredictability of death – that it could occur to someone as young as my ex-classmate in a sudden manner – shocked me out of my complacence about life in this world. I never had to think about death before. Intellectually, I knew it could happen to anyone at any age. But spiritually, emotionally, I was just a teenager who was enjoying life and didn’t think about mystical, existential stuff like that… until the death of my ex-classmate. I was not in any danger when the news of her death was informed to me. I remember feeling shocked but I was not affected straightaway. So I could not understand why a few days later I found it difficult to sleep and this continued for months. (But my appetite was intact, Thank God. Maybe NOTHING can ever reduce my appetite. Haha).

Last year in Ramadan 2016, I had made plans to visit my sister on the weekend. We were going to meet in Tanjung Malim and we were going to hang out in KL to have some sisterly fun times. On Friday, right after my sahur meal, I made that journey to see her. It rained heavily that morning. I ALMOST did not fasten my seat belt when I started my journey. In general, I didn’t like wearing seat belt. I felt that it limited my movement and made me feel very uncomfortable to drive. But I don’t know why on that day, I decided  to fasten my seat belt. Something about the heavy rain  gave me pause and made me decide  to err on the side of caution. (I thank God for that decision every day of my life and I never again drive anywhere without fastening my seat belt.) 

I had just passed the Pendang area on the PLUS highway when I accidentally hit a big puddle of rain water while driving in high speed and all of a sudden, I lost control of my car and it spun around so many times and then it actually went into the air before it flipped over and I ended up upside down inside the car. While the whole thing was happening, my mouth only said “Ya Allah, Ya Allah, Ya Allah.” (Seriously, I could not remember the complete syahadah at that time. I guess, the complete syahadah is something I associate with dying in bed rather than while struggling with my car).  As my mouth kept uttering the name of God, my mind kept thinking that “I am going to die soon.” Then I thought of what my family members would feel. And then I remember thinking “Well, at least,  I die in the month of Ramadan.” But a glimmer of hope inside my head also said “If not death, then at the very least, you might end up in ICU.” I thought about intubation, brain injuries and chest tubes while struggling with my car.

 

I have never experienced such an absolute loss of control over anything before in my life. That was the first and only time that I truly felt that my whole fate was out of my hands (even though, when you think about it, your whole life is NEVER in your hands. You are never in complete control. Everything has been written.)

Alhamdulillah. Alhamdulillah. Alhamdulillah. I did not sustain any fractures. I did not even sustain any bruising. Not even an abrasion. I was upside down in the car a few seconds after the whole crazy movement ceased and I thought to myself “I am alive!” I still remember the song that was playing on the radio at that time while I was digesting the fact that I was alive. (It was an arabic, Amr Diab song.)

Suddenly, an elderly stranger broke the window of my car, and pulled the door open and lifted me out of the wreckage. He thought I couldn’t walk, so he just lifted me up without asking whether I could walk myself. (I remember thinking “Hopefully I am not too heavy for you.” haha) I tried to tell him that I could walk, that I sustained no injuries. But he didn’t hear me due to the heavy rain. And I was too exhausted to shout twice. I would forever be indebted to him. He was such a kind-hearted man.

He was so surprised that I was unharmed. He said, “Ingat mesti dah pengsan, patah riuk dah.” I reassured him that I was fine. I thanked him very much for helping me out of the car and for going back inside my car to retrieve my handbag, and my phone. A few people also stopped by my car to help. 

“Nasib baik kebetulan tak ada kereta lain waktu tu.” said the kind uncle. 

Yup, it was a major accident involving me and the divider only. Thank God that I did not cause any injury to anyone else. (I don’t think I could live with that.) It was because I hit the divider that had caused my car to stop spinning. But unfortunately instead of stopping, it went into the air and flipped over. And the most miraculous thing is the impact from the collision did not even trigger the air bag to deploy. If it did, I would surely have some remarkable injuries on my face.

I called my father to tell him that I was involved in an accident. I didn’t tell him how bad it was over the phone. (In my experience, whenever I was involved in an accident – even when it was not my fault – somehow he would blame my driving. I must be driving too fast, he would say. But seriously, other than this particular major accident which only involved me and a highway divider, the other accidents were not my fault… all the police reports confirmed that. How would my fast driving cause other drivers to make mistakes in their own driving? In the previous two accidents I was involved in, the other drivers themselves had admitted that it was their mistakes. My own NCB was not affected in any accidents I had had before this one) 

While waiting for him to arrive, I prepared myself mentally to be scolded by him. (Because unlike the others, this one must be my fault. I can’t exactly blame the highway divider, right? I must have lost control of my car because I hit the big puddle of water, isn’t it? So this IS my fault. And I knew I would surely ‘kena leter’). But to my surprise, my father did not say anything after he saw the condition of my car. Perhaps, after seeing how bad the accident was, he was too shocked to the point of speechlessness. Or maybe he was just relieved that I escaped without any injuries.

Because he did not scold me as I had expected, I actually burst out crying right there and then. I was holding myself really well before that. I did not burst out crying until he arrived in front of me without a word. Perhaps when I saw how very uncharacteristic the behaviour of my father was, it then really hit me that I could have died. I could not remember the last time I cried in front of my father prior to this incident. It must be many many years in the past since I have cried in front of anyone. See? Even I was behaving uncharacteristically on that day. Haha.

My father eventually made a joke “Sejak bila Kak Ngah jadi pelakon stunt, buat lagak ngeri ni?”

I laughed in the midst of tears.

On the way back home, me being a PSY MO, I thought about PTSD. I have seen a few patients who stopped driving after being in an accident. I have seen patients who have panic attack while driving. I was afraid that I might develop such symptoms. Which would be so troublesome, because I don’t want to have to depend on other people to get me to places I could so easily drive myself. That kind of dependency, resulting from unreasonable out-of-control fear, would limit my freedom. And I really love driving. Despite what my father always said, I think I am a skilful driver. (It is just that my skill is so good that it belongs in the race track. Haha.)

I started to formulate ways on how to prevent myself from developing PTSD. I didn’t know whether or not it would work, but I had made all these plans inside my head as my father was driving me home. 

1)Start Driving Again Straight Away

In one of the books I read, the protagonist develops fear of horse riding after she fell from her horse in one of her practice session. Her tutor had told the protagonist, “You should have gotten back on the horse straight away after your fall. Everybody knows that the longer you wait to get back on your horse after a fall, the harder it is to regain your confidence.” So based on that principle that I remember reading from a Sweet Valley High novel, I decided to straightaway drive my father’s Ford Ranger a few hours later in order to go to the workshop and retrieve some of my leftover stuff from my wrecked car.

My father and my mother offered to accompany me to go to the workshop since it was so soon after the accident (2 hours post-MVA!) but I told them that I had to do this by myself. I had to drive by myself because I wanted to be able to drive by myself for the rest of my life. I don’t know whether there is a window period, within which time, you must create a new experience to undo the bad ones. (this was just my theory, at that time. Not sure if it is scientifically proven or true. Haha) So, I decided to hasten the process of driving again after my accident. Alhamdulillah, I was fine. No anxiety (well, maybe just a little) and no panic attack whatsoever.

 

2)Start on your normal routine straightaway

I stayed at my parents’s house on the day of my accident to please my mother (because my mother was remembering how my cousin had passed away one day after his accident despite being discharged from A&E with no detected internal bleeding. His passing away was a shock to the whole family.) But the next day, I told them that I wanted to go back to my own house. I wanted to see whether I can stay at home by myself after the accident. Having my own space to relax and read and escape from noise and hectic environment is important to someone like me. Being able to enjoy my solitude without fear and anxiety is imperative to an introvert like me. We need our alone time in the same way we need our basic physiological needs (well, maybe not in the same way we need oxygen, but almost in the same way we need food and drinks.) I need to be able to do that. And I wanted to test my ability to do that straightaway. My mother did not approve of my plan but my father had no objection. I think my father understood the practicality of my decision… it was just as practical as my decision to start driving straightaway.

At the end of the day, we must control our anxiety and our fear by facing it head on and moving on. We must prove to ourselves as soon as possible after an event that there is nothing to be anxious about and nothing to fear. The sooner you get the ‘testing and proving phase’ done and over with, the sooner it stops having any power over you. 

Even though I had no injuries, no scratch and no abrasion whatsoever, the muscles all over my body started to ache slightly and felt a bit stiff the day after the accident. My mother suggested for me to take a leave on Sunday. But I decided not to do that. I wanted to get on with my routine as though nothing traumatic has happened. In my normal life, I get to work on Sunday, and therefore I MUST go to work on Sunday as usual.  Routine, routine, routine… my main aim was to get back to my normal routine.

The muscle ache? I just pretended  as though I had a heavy work out at the gym. 😉

 

3) I kept my accident a secret from everyone at work and even from my best friend.

On Sunday, they asked me why I was driving my father’s Ford Ranger instead of my usual Toyota Rush. I told them that I had an accident (I didn’t tell them that it was bad and it scared me shitless when it was happening. Hahha).

A few weeks later when they still saw me driving my father’s Ford Ranger, they commented that the workshop where I sent my car took too long to repair the car. I simply shrugged my shoulder and said “Yeah, I don’t know why they took so long. Maybe insurance issues or something.” I ended up getting back my car after 3 months of repair work. And my friends kept saying “Why does it take so long?” 

Hmmm… 

I just didn’t feel like talking about it. I was studying for my Part A MRCPSYCH exam at that time and I had read that debriefing was not recommended for PTSD. In my mind, I felt like talking about it might be like some sort of mini-debriefing and therefore I simply avoided talking about it by making it a secret. I think it worked.

(Deep inside, maybe I kept it a secret because I was afraid people would comment or tease me about my driving skill like my father always does. I am quite touchy about my driving. I hated it when guys think women are bad drivers. I think I am a good driver and I don’t want anyone else to think otherwise. Haha.)

 ***

So Alhamdulillah, I can really tell you that I did not get any PTSD/anxiety/fear of driving/ fear of rain/ panic attack after the accident. In fact, when I compare the emotional impact between this accident and the death of my ex-classmate, I can honestly tell you that  I was more affected by the death of my ex-classmate than this accident. I had no trouble sleeping at all after the accident.

It was weird. But as Jeffrey A. Lieberman had said, development of trauma is such a mystery. Does it have anything to do with our brain processes while the trauma was happening or our brain processes after the trauma has happened? Our amygdala, hippocampus, and our prefrontal cortex are all involved in the pathophysiology of trauma. But when do they start forming the ‘traumatic memory loop’? Why do some people never develop that loop despite whatever traumatic experiences they have gone through?

Until now, I am still wondering. Could it be that I had prevented any development of PTSD (traumatic memory loop) by normalizing my life as much as possible right after the accident? Maybe somehow, I had stopped the process of ‘traumatic memory loop’ formation by tricking my brain into thinking that everything was normal and the next day was just another day. 

Whatever it was, one of the things I told my colleague after learning about her accident was, “You must drive straightaway.”

Because it helped with me. So hopefully, it helps her too.

In the whatsapp group, all of us were sharing the pictures of our previous encounter with road traffic accidents. And needless to say, my picture won the prize of the most horrifying accident to ever happen to any of us. And then it occurred to me, “Wow, I finally talked about my accident after all these months,”

***

With my colleague’s accident, I remember again all the thoughts I had about my own accident in the aftermath.

I had thought, “Maybe I didn’t deserve a Ramadhan death, after all. I am not that good as a person.” (God, that sounds depressing but unfortunately, it is the truth. I have that much insight about my impatience and my lack-of-tact and diplomacy.)

I had thought that “Well, maybe God saved me because He loves me and He wants to give me a chance to repent and do as much good as possible while I still live.” (This sounds less depressing. Hahha)

After nearly tasting death, you realize that things that happen in this world are so insignificant that you should not stress yourself about it at all. Nearly tasting death gives you a strange sense of freedom. You knew that the most stressful thing that can happen to you is death.  And if that is the worst thing and you have nearly encountered it, what makes you think you cannot handle the rest of the other life stressors that may come your way in the future? Life is one struggle after another …so don’t be afraid, stick to your principles, speak the truth and do what is right no matter how much it would compromise your position because ‘in this world’ is your only chance.  Death can happen at any time. And thoughts of death renders everything else in this world meaningless. But paradoxically, it can motivate you rather than pull you down, if you have the right methodology in thinking about it.

I remember thinking about miracles and guardian angels after the accident. In Islam, we know about the Hafazah angel…

For each one are successive [angels] before and behind him who protect him by the decree of Allah . Indeed, Allah will not change the condition of a people until they change what is in themselves. And when Allah intends for a people ill, there is no repelling it. And there is not for them besides Him any patron. (Quran 13:11)

According to Wikipedia, The Arabic term al-mu’aqqibat (commonly encountered in the definite plural, Arabic معقبات “those who follow one upon another”) is a term occurring in the Quran (Q.13:11) which some Islamic commentators consider to refer to a class of guardian. Therefore also these Angels are also called al hafathah (الحفظة) which means the guarding angels. They protect us from the harm of evil jinn and shaytan (شيطان).angels who keep people from death until its decreed time.

In Islamic tradition a guardian angel or watcher (angel) (raqib “watcher”) is an angel which maintains every being in life, sleep, death or resurrection. The Arabic singular for mu’aqqibat would be a mu’aqqib “a person which follows.” These angels are included in the hafazhah (“the guards”) and the concept of the guardian angel in Islam is similar to the concept of the guardian angel in some Jewish and Christian traditions.

At the end of Ramadhan last year, I reflected about my remarkable experience by writing a poem entitled ‘Hafazah’. In that poem, I was meeting that guardian angel  when I make it to heaven and we were having a conversation. Hahha. It was a fanciful poem but it was deeply felt.

The month of Ramadhan has always been special to every single practicing Muslim out there. It is the month of miracle. I knew that before. Intellectually, I believe that. But now God let me emotionally experience the miracle. It was a blessing, actually. And so, I have nothing else to say but Alhamdulillah.

 

Hafazah

Katakanlah nanti suatu hari
Kita bertemu sekali lagi
Jasad, jisim, jirim ukhrawi
Bukan di sini, di syurga abadi
Akankah kau aku kenali?
Akankah aku kau dekati?
Akankah kau aku hampiri?
Lantas berkata dengan lirih,
“It was you then, wasn’t it?
In the world once you’d saved me,”
Akankah kau menjawab kembali,
“No problem, dearie, you don’t owe me,
It was my job, so I did it. 
The ink has dried, the pen is lifted.”  

Akankah aku berkata pula
“Sudah lama ingin berjumpa,
mengenali dia gerangan mana,
menjaga aku tika bahaya,
mengiringi ku dalam duka,”
Kemudian kau akan ketawa,
“No problem dearie, you don’t owe me,
It was my job, so I did it. 
The ink has dried, the pen is lifted.”

Akankah aku melirik padamu,
Lalu dengan suara esak tersedu
Mengucapkan puisi dalam sendu
Yang kau balas dengan menyeru.
“No problem dearie, you don’t owe me,
It was my job, prescribed by God 
So I did it, not for you
I swear, nothing else is true,
It wasn’t your time, or it would be done”

Atau mungkin kita tidak akan berjumpa,
Kerna layakkah aku menapak ke syurga?
Mencarimu di sana adakah terdaya?
Mungkin madah ini takkan termakna
Hanya tinta beku coretan pena
Catatan kaku selama-lamanya.

5/7/16, 30 Ramadhan 1437

5.30 pm

The People Not Worth Mentioning

#RamadhanReflection

Whenever Ramadhan arrives, my heart deeply misses my Muslim sisters in Newcastle. They made me realize something I would always be grateful to them for.

They made me realize that all the Israiliyat stories I had questioned in the past….well, I was right in questioning them. They opened my eyes – widely! – that religion IS logical.They made me realize that religious people are not weakly passive, terribly soft-spoken or yawningly dull. Because THEY were not dull and  yet they were one of the most religious people I have ever met.

They made me realize, that in matters of religion, there are rooms for people like me…. the ruthlessly logical and aggressively out-spoken people like me are also acceptable in Islam. That I was not un-Islamic when I questioned things I really didn’t understand. In fact, they were delighted by my questions and when they in turn answered my questions, I was delighted by their answers! Because now, it makes sense! Finally!!

They made me understand that my concept of religious people as people who “asyik cakap lemah-lembut, pakai baju besar dan tudung labuh, pijak semut tak mati… tapi asyik suka bagi orang rasa bersalah bila kita tanya balik kat depa benda yang kita rasa langsung tak logik!” was so wrong! I was wrong to stereotype ‘religious people’ and I was delighted about being wrong, at that time! I knew then, that there did exist outwardly religious people who were also inwardly Islamic in their principles and worldviews. 

I was intrigued by the sisters when I went to Melbourne for the Summer in my first year of med school (initially just to have a fun holiday for a month) and the Melbourne sisters then took me and my friends under their wings and taught me to understand my religion beyond its mere rituals. Because of them (supplemented by YOU TUBE videos of Nouman Ali Khan, Yusha Evans and Dr. MAZA) I understood the core principles of my religion and I stick to it as much as I can.

Some of them were one of the most energetic people I have ever met. And all these while I thought “Orang agama ni mesti jenis jalan menunduk all the time.” Well, not them!

Listen to this clip by Dr. Maza about how ‘kewarakan’ and ‘kesolehan’ has nothing to do with you “jalan lembik-lembik menunduk, konon soleh”. (Gosh! I get really irritated by pretentious people like that. *rolled eyes*)

Let me recap on the main point of the video. Sahabat-sahabat menyatakan “Sesungguhnya kami telah melihat Umar Ibn Al Khattab. Bila beliau berjalan, dia cepat. Beliau bercakap, ianya jelas. Bila beliau pukul, sakit. Tetapi beliaulah yang paling warak dikalangan kami.”

So this is to me, an image of a Muslim I could relate to! Cergas! Cerdas! Kuat! Tegas!

Our religion celebrates differences in personalities and habits as long as they are not against the syariat.

In fact, they told me “Saidina Umar Al-Khattab was very outspoken. When others made the hijrah in secret, he had boldly said, “Whoever wants his mother to mourn him, his children to become orphans and his wife to become a widow should meet me behind this valley to try and stop my Hijrah.” And no one dared follow him out. He had such spunk!”

Since then Saidina Umar is my favourite figure in religion, after Prophet Muhammad (PBUH). Not because I think Saidina Abu Bakar and the rest of the companions are not as great. No! But I can RELATE with Umar. Saidina Abu Bakar might have diplomacy and patience…. but I am weak in those aspects and I couldn’t relate to him the way I could relate with Saidina Umar. How am I supposed to be patient when something really unjust is happening right before my eyes? I couldn’t relate why I could not simply call it out and tell them frankly to their face that what they are doing is wrong, regardless of who they are in the society! While I admire Saidina Abu Bakar just as much, it is with Saidina Umar r.a that I can relate the most.

Saidina Abu Bakar made the hijrah in secret together with the prophet, being so patient in facing the adversities and the terror of being chased by the enemies of Islam. Whereas Saidina Umar R.A had boldly challenged anyone to try to stop him from making the hijrah. And BOTH of them made it to Madinah at last. Even though one had patiently travelled in secret, while the other had boldly travelled in the open, BOTH of them reached their destination and their goals. So, BOTH are equally admirable… but I am more likely to do what Saidina Umar did, because I can relate to that. In my mind, I would be so angry that the people of Makkah was trying to stop my basic human rights to move wherever I wanted. That kind of nonsense would spark my temper and I would go, “Apsal pula kau nak halang-halang  aku ni? Kau siapa? Apa hak kau nak halang aku? You are not making any sense. Nak halang juga, cubalah kalau berani! Jangan cabar aku, okey!” 

Thats’ my fi’il… my tabiat…don’t force me, don’t cross my principles, don’t violate my boundaries. Because I will fight when it matters enough! You don’t get to me by force. You get to me with kindness and patient reasoning. The way the Newcastle and Melbourne sisters did. 

They taught me something I have always known: Sabar itu bukannya merelakan diri kena tindas kemudian menyatakan “yang aku ni sabar.” Sabar itu adalah menentang semua kezaliman yang ada kemudian bersabar dengan akibat yang kita terima disebabkan kita berani menentang kezaliman itu. They confirmed my belief that sabar in Islam is not something passive the way the Malays were doing it when they were being a coward!… but Sabar is an ALIVE, ACTIVE struggle. Saidina  Abu Bakar made the journey to Madinah with patience too…. and then He succesfully arrived in Madinah. His patience, just like Saidina Umar’s boldness, yielded the SAME result. He arrived with Rasulullah in tow! That kind of Sabar is productive! The concept of patience in Islam is NOT “biarlah kita bersabar kena tindas di Mekah.” (This concept of Sabar is always being adopted wrongly by Muslim Malays. When they used the word Sabar, what they usually really mean is ‘jadi penakut. Jangan cakap apa’.Haha)

I was so impressed by the things I was taught in Melbourne that summer. This!! THIS is the version of Islam that was never taught to me in Malaysia. This version of Islam taught us how to live and live well! And live honourably! And live courageously! 

They also instilled in me the concept of speaking up against injustice. Speak up… not because you think you can change anything by speaking up. But speak up because it is THE TRUTH and on the judgment day you can AT LEAST say to Your Lord “Ya Rabb, I spoke against that injustice when it happened!”

They told me to learn and internalize the lesson from the Quranic verse surah Al-A’raf 7: 163 -165

Dan tanyakanlah kepada Bani Israil tentang negeri yang terletak di dekat laut ketika mereka melanggar aturan pada hari Sabtu, di waktu datang kepada mereka ikan-ikan (yang berada di sekitar) mereka terapung-apung di permukaan air, dan di hari-hari yang bukan Sabtu, ikan-ikan itu tidak datang kepada mereka. Demikianlah Kami mencoba mereka disebabkan mereka berlaku fasik. (7: 163)

Dan (ingatlah) ketika suatu umat di antara mereka berkata: “Mengapa kamu menasehati kaum yang Allah akan membinasakan mereka atau mengazab mereka dengan azab yang amat keras?” Mereka menjawab: “Agar kami mempunyai alasan (pelepas tanggung jawab) kepada Tuhanmu, dan supaya mereka bertakwa.” (7: 164)

Maka tatkala mereka melupakan apa yang diperingatkan kepada mereka, Kami selamatkan orang-orang yang melarang dari perbuatan jahat dan Kami timpakan kepada orang-orang yang zalim siksaan yang keras, disebabkan mereka selalu berbuat fasik. (7: 165)

“Cuba tengok, Afiza. Dalam ayat-ayat ni. Ada tiga golongan di sini. Golongan pertama, yang melakukan kejahatan. Golongan kedua, yang menghalang kejahatan. Golongan ketiga, yang berkecuali … malah golongan ketiga ni siap bertanya kepada golongan kedua, kenapa nak sibuk-sibuk bagi nasihat? Kemudian dalam ayat 7:165 Allah memberitahu akan nasib golongan pertama yang melakukan kejahatan itu….. yang mereka ditimpakan azab. Nasib golongan kedua yang menasihati dan menghalang kejahatan, mereka ini diselamatkan. Tapi apa jadi dengan golongan ketiga ini… golongan yang berkecuali tadi? Apa nasib mereka?”

Hmm… I had no idea. The Quran didn’t mention what happened to them. I shrugged my shoulder at the naqibah and shook my head. 

“Bila Allah tidak sebut nasib golongan ketiga ini… maksudnya mereka adalah golongan yang tidak layak disebut.”

I was stunned.

“Jadi, ketika kita nampak kezaliman berlaku, jadilah orang yang berani menegur “Ini Zalim!”. Janganlah jadi orang yang berdiam diri, yang berkecuali, yang akhirnya nasibnya jadi tidak pasti. Neither here nor there. Not worth mentioning!”

Desmond Tutu was really wise and quite Islamic (whether he realized it or not), when he said “If you are neutral in situations of injustice, you have chosen the side of the oppressor. If an elephant has its foot on the tail of a mouse and you say that you are neutral, the mouse will not appreciate your neutrality.”

***

Believe me, there are times when I really miss how I was when I was in Australia. I think my behaviour was at its best when I was there because the environment there made it easy for me to be nice. I was not exposed to much injustice that would disturb my psyche at that time. I surrounded myself with nice, and intellectual people who could satisfy my thirst for knowledge and could sooth my insistence for things to be fair and logic.

Then I returned to Malaysia as a houseman. I was shocked.

“Hang pun tau, aku dah inform MO yang patient tu punya Blood Pressure low and Pulse Rate tachycardic. Dia kata suruh observe dulu. Run fluid fast apa semua. Sekarang patient ni bleeding teruk… tiba-tiba dia kata aku tak inform. Padahal dia yang tak attend.” said one of my fellow HOs to me when I was in my first posting. I told her to report the matter to the specialist. That I would accompany her to do it! She didn’t want to. Since this incident involved her, I couldn’t do anything much if she herself didn’t want to fight for herself. Takkan aku pula nak lebih-lebih involved?

But what I did was, I told as many HOs as possible about what had really happened. So that among HOs, we knew she wasn’t guilty. But I was ashamed of myself because I didn’t do what I was supposed to do… to internalize the Al-A’raf concept and speak up LOUD that the MO was the culprit! I didn’t do the most I could have done. Instead, I gave myself petty excuses by saying “I am just a HO… what can I do? Sekurang-kurangnya aku benci benda ni dalam hati… tu dah kira selemah-lemah iman. Yang paling aku mampu buat setakat ini adalah benci dalam hati.”

Screenshot 2017-06-16 12.23.08

 

But my weakness haunted me for the rest of my first posting because I felt that I had fallen short of my own standard that I had nurtured for 5 years in Australia. I could not get over my boiling anger at the injustice and at myself… so that when I finished my posting, I wrote about things that had happened in the department that disturbed my sense of justice! I needed to let that out and purge it out of my system. Sue me if what I said was wrong! (I didn’t intend for it to become viral. But it became viral when I was already in my 3rd posting… by that time I have done all the major posting including surgical and medical… I was already a senior. They couldn’t do anything to me. I was ready to face anyone, anyway. My father said, “Don’t worrry. Jadi apa-apa, kita ada lawyer.” But Alhamdulillah, nothing actually did happen. I wasn’t even called to explain myself even though I was ready for it.)

In Malaysia, people don’t reward being nice. Instead, being nice gets you bullied. Bullying is something I have never experienced until I became a houseman… even then, I didn’t tolerate it for long! By the time my blog became viral, no MOs dared to bully me anyway. “Takut masuk blog.” they joked to me about it. (Hahha) Most of them were simply curious about me and I ended up becoming friends with most of them. Instead of being targeted and my life being made difficult (the way other HOs had predicted), my life became even more smooth after my blog became viralled. I thought that… maybe, hopefully… it was Allah’s reward for me because I wrote the truth. Maybe HE rewarded me because I finally returned to the principle of justice I had lovingly nurtured when I was a medical student in Australia. I was a coward just like any other housemen when I was in my first posting. Allah taught me to never again be like that! To maintain my outlook in life and let Allah handle the rest.

In Malaysia, you can request for one tiny reasonable thing in the most gentle tone you can muster, but it would get rejected as long as they think they can get away with it. By the time you raise your voice and threaten to take some action, only then you get what you want. So, the Malaysian culture rewards me when I am being my loud, rude self. The culture doesn’t reward me by complying to my reasonable request when I am being nice.

So I then learn that if I want what I want, I will have to be tough and fight with my bare hands until I get it because with you guys, diplomacy doesn’t work!  Even my younger sister had experienced the same thing once she started working. By the time she threatened legal action against the PPD in Sarawak for withholding her husband’s BKLP (Bayaran Khas Lokasi Pedalaman) allowance, only then they decided to comply to her demand. And so she won! PPD gave her husband back his rightful BKLP money.

Screenshot 2017-06-16 13.53.27

My father looked at me and Alida, and he said “Alida dah mewarisi perangai Kak Ngah.” (In my family, I was called Kak Ngah Singa. Singa jadian…that is me. Hahaha.)

Then we looked at our father who was also just like us and said “Di mana tumpahnya kuah kalau tak ke nasi?” 

(I asked Alida to do a personality test once. Turned out that Alida is also an INTP. Go figure! I too, always tested as an INTP and sometimes INTJ.)

Some people said “Alida, buat apa hang pi cari  lawyer tu… lagi mahal kau kena bayar lawyer daripada duit yang kau akan dapat balik. Buat rugi jer.”

These people… they don’t get it!. Their priorities are not the same as us, the INTPs/INTJs. Our priorities are truths, justice and principle. Money comes second. Preserving harmonious relationship comes second (sometimes last!) It is okay if you have different priorities than me…. BUT!, don’t push your misguided notion on me! As long as we can afford our principles, we will go all out for it, khalas! If you are the sort of person who don’t have principles, you would not understand.

Initially, Alida wanted her money because it was rightfully hers! She requested for it reasonably. But when people were being unjust, difficult and refused to do the right thing, suddenly her priorities changed. Suddenly, this was NO LONGER about the money! She didn’t want it anymore! Now this was about justice! And she was willing to spend money to win against the PPD because they were being unjust! Let Alida be the lesson the PPD would never forget! And I supported her all the way by encouraging her to play their unjust game to the end by hitting below the belt and threaten them with not just legal action but ‘viral action’ too. My father supported her by offering to pay for the lawyer. And viola, suddenly it was so easy for the PPD to give her back the money that was rightfully hers.

See? See how they reward our frank, hard ways instead of our initial reasonably nice, soft ways? *shakes head*

When Alida got her money, only then the parasites who had told her “Hang pi lah fight. Tapi, aku rasa tak dapat punya” came to her, seeking her guidance. They asked her for a copy of what she wrote to the PPD so that they too could claim their money by using her letter as an example to write their own. Sheeshhh..

What sort of respect do we feel for these kind of people…. who didn’t want to do the dirty work of fighting in  the first place… but when winning is finally assured, only then they came running, asking for how to get it done! When Alida had first asked them to fight together with her, they didn’t want to move their lazy bums to do it and in fact, had discouraged her from fighting! But afterwards, their behaviour went exactly the opposite!  Isn’t their behaviour the perfect epitome of shameful cowardice? 

***

Dear adik-adik (medical students, HOs, junior MOs)

Allow me to impart you an advice I always believe in. Giving this advice is part of my civic duty and social responsibility as a senior MO (now that I am already in my second year of UD48 Hahaha. Senior la kan?). When you see injustice happens, call out on it.

Because Al-A’raf!

Because that is  the most Islamic thing you can do!

Because that is ACTIVE Sabar!

And don’t give yourself excuses that ‘at least, aku benci benda ni dalam hati.’ (I tried that excuse when I was a HO; it didn’t sit really well with me and I could not respect myself).

If you were a HO, maybe you can be forgiven to still be in the ‘selemah-lemah iman.’ To just ‘benci dalam hati’.

But if you are already an MO, or one day a specialist, a Jusa, a Dato, a Tan Sri, a Pengarah here and there…. there will always be someone higher than you who would tell you to do something your conscience says is wrong! Even when you become a DG, you still have someone else higher than you who would dictate to you things that are so unfair and so wrong that your blood boils because of it! Jadi, takkan sampai ke sudah hanya nak benci dalam hati dan berpuas hati dengan hanya memiliki ‘selemah-lemah iman’? Hanya kerana ia adalah arahan orang atasan?

Come on, por favor!

By the level of MOship, you should set standard for yourself… that I will speak up. As an MO, dah sah dalam jawatan, takkan masih selemah-lemah iman? Speak up! By the time you are a specialist, the standard should be “I will  speak up AND take action in the best way my position allows me to when I see injustice happens.”

For example you can say, “I refuse to allow my staff to oncall if you don’t want to pay their mileage claims. It wouldn’t be fair for them. The MOs can oncall by themselves if my staff cannot claim their mileage.” 

Or say, “Apa kata kita potong pengarah dan penolong-penolong pengarah punya elaun, potong orang-orang management punya elaun… korban sorang sikit bagi pada staff yang nak claim! Gaji staff lagi kecik daripada gaji korang kan! Gaji diorang lagi kecik daripada gaji orang management yang asyik nak potong claims orang padahal orang management tidur sedap kat rumah. This is not fair to my staff! How can you justify doing this to staffs whose salary are much less than you… but when there is financial constraint, it was THEIR claims you decided to cut first. Ini zalim!”

Say, “Everyone is innocent until proven guilty… so how can you devalue him by putting him in a department where he cannot utilize his excellent skill? Why not put him in Ortho/districts/Klinik Kesihatan where his skills can be put to its optimal use?Inilah ketidakadilan…. tidak meletakkan sesuatu kepada tempatnya. Tidak meletakkan staff yang kemahiran post-basicnya patut boleh diletakkan ditempat yang lebih memerlukan skill tersebut. But instead, you put him in my department? How could you do this to him… devalue him like  this… when you said he is innocent? And how could you do this to my department… to only place someone with a tainted reputation into our department time and time again! How could you devalue our department by always sending us staff of questionable calibre? In this case, you had created a lose-lose situation for him and for us! Your management is zalim! And I am calling you out on it!”

***

One of my friends told me, “Kalau kita speak up pun, kena ikut arahan juga. Orang management memang macam tu! Buat penat argue ja.”

I frowned. In my head, I reflected, “I know… I know that most of the time, kita speak up pun takkan dapat apa-apa. Buat kita rasa frust saja. Sebab at last, mungkin kena ikut arahan juga. Tapi can you imagine kalau yang speak up to ramai dan bukan seorang? (Like Alida’s case. She spoke up alone, she won! But how easier it would have been if ALL OF THEM had spoken up together in the first place) Tapi katakanlah dah ramai-ramai speak up pun, masih kena ikut arahan yang zalim, so what? The reason we SHOULD speak up is… because Al-A’raf. Remember? We speak up so that  we can say…. for the record, I oppose your injustice. For the record, I have made absolutely clear what I think of you when you made that decision. So that I can stand before God, and say ‘I have spoken, Ya Rabb.’ Because for the record, I can say that YOU KNEW you were wrong… I have made it so clear to you… now, the guilt is on you! It’s on you! I speak up because I am NOT content to always be in selemah-lemah iman like you.”

Because Al-Araf 7:164. 

Because I don’t want to be among people who are not worth mentioning.

Inspired!

Assalamualaikum to all my blog readers.

I hope it is not too late for me to wish all of you, my dear readers, Ramadan Mubarak and happy fasting.

May Allah grant us our best Ramadan yet. Amin. 

I have been so busy that I haven’t had the time to write these days. I think I am about to burn out. But never fear; if I am still reading (even when I am not writing), then my burn out is not so serious. 

And at the moment I am reading a book written by one of the most inspiring person I have ever had the fortune to know. Dr. Azlan Kamalludin is an emergency physician who I first met as a houseman in the emergency department of HSB. During my first few months of being a houseman in the ED, I had no idea who Dr. Azlan was because at that time, he was in Makkah being part of the medical team for Malaysian pilgrims. But a lot of senior housemen told me that Dr. Azlan was very good and very efficient and I was told that he was so inspiring to listen to when he taught housemen and MOs during morning rounds. 

And days before Dr. Azlan returned from Makkah, HOs/MOs were already talking about how much they missed Dr. Azlan’s teachings. So, of course, I became even more intrigued to know who was this Dr. Azlan. On the day he finally returned from Makkah, I found out that what they said about Dr. Azlan was not an exaggeration. Not at all. 

Me and a few of my friends had our end-of-posting assessment with him. In that short session, he shared his experience as an MO fighting for his patient’s rights. I have always been inspired by that.  

The day when I had my end-of-posting assessment with Dr. Azlan was the last day of my housemanship. I went to psychiatry after that. (But I added him on Facebook. Haha.)

Dr. Azlan had talked about wanting to write a book a few years ago and through Facebook he asked my opinion about what to write. Him, his wife and I met at Coffee Bean a few weeks before he got posted in Langkawi 2 years ago and we talked about his wife’s cancer being in remission and about things in general. I told him that ED HSB has suffered a great loss by him going to Langkawi. (But then, Langkawi ED is very lucky to get him.) 

On Monday last week, it was a very pleasant surprise for me when he and his wife came to the Methadone clinic to see me and present the book that he had been writing since working as an ED specialist in Langkawi. The title of the book is ‘Three Cancers in Ten Months: When Doctor Becomes Caregiver.”

18765737_10154433754581022_6496833530199996539_n

He had autographed the book with a personal message for me on the first page. It was such a great honour to be receiving such a gift from him. A book given for free, and delivered into my hands by the great author himself! I was very humbled by all his effort. ( Furthermore, I have always loved having books that are personally autographed by my favourite authors.)

Screenshot 2017-05-30 20.21.54
My facebook status on the day I received this gift of a book. 

As my readers probably know, there are not many specialists (or anyone in the position of authority) that I actually find inspiring. I respect any specialist who is nice… but not everyone who is nice is also inspiring. He is one of the few that I actually do find inspiring. In general, I am impressed by anyone (regardless of their position in the society) who can speak up their minds and say what they mean and mean what they say. No deceitful diplomatic crap is ever going to impress me. I like people who have strength of conviction and will do what is right no matter how hard they have to fight. No matter WHO they have to face! These people will always earn my lasting admiration. 

I am now half way through his book, and so far, it is such an inspiring read. It is highly recommended.

Below, is my Amazon review of his book.

Screenshot 2017-05-30 20.26.26

I have mentioned before that after housemanship, I was placed in ENT. But I have zero interest in ENT. My interest has always been in psychiatry. I fought so hard to get into the field of my interest. I went to see the Hospital Deputy Clinical Director, initially. Then, I went to see the Hospital Director herself! I wrote an appeal letter…. then, I wrote another! Deep inside, I know no other department will do for me other than psychiatry. After not getting into law school (because my scholarship was for medicine), Psychiatry was my SECOND CHANCE to do what I actually love! I was not going to give it up! Not that easily. 

But even so… I had written in my appeal letter that “If you can’t give me psychiatry, place me in Emergency rather than ENT!” Because in the emergency department, working with outstanding specialist like Dr. Azlan will inspire you to be better too. To fight for your patients to be admitted when all specialties reject your referrals! To be outspoken and bold “fine, I will call your specialist myself!”. To NOT BE AFRAID to fight for your rights and for your patients. 

I can do that! I can do it! Arguing and debating… well, that’s my second nature. I love psychiatry, but I wouldn’t mind being placed in ED even though the department is busier than ENT. ED would be my second best choice after PSY. Because I can sense that Dr. Azlan has the same kind of work ethics I have always respected in anyone. Because other than real interest in the field you choose to practice, working environment matters too. And if Dr. Azlan is in the ED, then the working environment should be fine, I thought. More than fine, in fact. 

I am thankful that I became a psychiatry MO. The environment in my department is quite good. Everyone is so nice. But being too nice sometimes makes for a perfect condition to be bullied by others! 

And my one absolute abhorrence is being bullied by unjust authority in the position of power. They hide their real agenda behind various circulars and ‘surat arahan’. And we have no choice but to do what they ask. 

I hate that! It violates my belief system! Because deep inside, I believe we always have the choice of fighting. The only problem is, are we willing to do it?

 I don’t like being bullied! 

So in this month of Ramadan, I declare, that I will NEVER be too nice! I will always ONLY be just ‘nice enough’… but no further. If you push my bullsh*t button, you will witness my massive retaliation. 

It just makes me SO BLOODY FURIOUS when I see injustice happens. 

Or maybe most people just have a passive personality. Maybe the world cannot accommodate too many people who are aggressive and abrasive… because then there would be wars happening every few minutes. Hahah. 

And now… even though it is Ramadhan and I am supposed  to have nice, benevolent, charitable feelings…but I cannot deny the truth. My feelings at the moment is far from nice….

In fact…

#AkuBengang!

But then, it IS Ramadhan.

So, I took a deep breath in and let it go. For now.

“Positive vibes, please come to me stat!” I craved silently.

But then I remembered that I still haven’t finished Dr. Azlan’s book. That’s the positive vibes, right there, waiting for you! 

So I smile and continue my reading.

And the world is right again. For now.

Medblogsphere And Confidentiality

The truth is there is an epidemic explosion of doctors who blog, showing to the public that physicians are not robotic and cold. That their heart beat just as passionately as the rest of humanity. That the logistics of their work is not just about doing the best for their patients (unfortunately), but they also must deal with excruciating paperwork, sound or unsound hospital policy, budget cuts, (nice or annoying) superior’s instructions despite what they think is best for their patients, and the list goes on.

I am not at the stage where I have to worry about making hospital or departmental policies, but when the policies are made, they do affect the quality of my work. (what investigations I can order for case work up, whether I can admit my patients into the ward or not, what meds I can prescribe)

What you said you wanted to do when you said you wanted to become a doctor (to help people, to make a difference, to save lives), you said all that without reading all the fine prints that came with the contract of being a doctor. Life is not so flowery when you cast away your rose-tinted glasses, alas.

If you are a frequent blog reader and are familiar with blogger doctors all over the world, you will notice that there are SO MANY doctors who blog but at the same time there are just not enough ethical guidelines regarding what you can write and cannot write in your blog. This is still a grey area that must be carefully manoeuvred… but nothing an experienced blogger can’t handle.

I began this blog when I was a medical student in 2009. So many years ago! Even then, I had already researched about what I could write, what I shouldn’t write at all and how to manoeuvre and manipulate the matter so that even if I write something that is borderline forbidden, I can still get away with it. I might get in some trouble, but nothing anyone can really pin down to make a case. I know my way around med blogging. So whenever people express concern about doctors writing about their cases in the blog, I just take note of their concerns but still continue to do my thing. Because I know my way around medblogsphere. I would never do something risky without a potential exit plan. (but I humbly admit that sometimes exit plan can have loopholes… but nothing that a good lawyer cannot rectify).

I know how to write about cases so that no one can identify my patient, not even my own colleagues. And not even the patient will know it.

I have written about Mrs. H once. But her name doesn’t start with H.

I said that Mrs. H went to KL after her divorce. But that wasn’t where she went. 

I said she had a son with a previous marriage. But how many previous marriages did she have? Or she might actually have a daughter.  Or she might actually have more than one children. See?

I said that Mrs. H has to sell sandwiches to support herself. But in reality, she might have never sold a single sandwich in her whole life, but perhaps she sold something else…. or even had another job altogether, say, a cleaner. 

If the Mrs. H (whose name doesn’t start with H) were to read my post, she wouldn’t even be able to recognize herself. Because as a doctor, I am only concerned about the main lesson/point in her life story that I can share with my readers. But in other aspects of her story,  I am like a writer who is given free reign to manipulate all her personal information, from how she looks (whether she is beautiful, whether she wears a hijab or not, whether she has any scars or personal defects) and her personal information (her age, her race, her job, her other illnesses, who her husband is, how many children she has) and her general characterization.

It’s like writing a short story or even a novel.

A good writer KNOWS that plots do not vary much. You read a few variations of each genre once, then you have read them all. (that’s why we have genres. Boy meets girl and falls in love – that is romance. The plots won’t vary that much. Good guy defeating the crazy villain – that is mystery/thriller. A vampire collaborating with a demon to create a high-tech powerful device to conquer the world- that is paranormal sci-fi.  Most plots, depending on their genres, are always the same. Over and over again. Any reader KNOWS that).

So a good writer knows that a good book MUST have great characterizations to counter the overly-used plots, so that the readers would love the characters themselves, even though the plot is same old, same old. A good writer would invest a lot of time to create a good characterization if he/she is smart.

So let’s go back to Mrs. H.

Mrs. H, if she ever comes across my blog, would NEVER be able to say in absolute certainty that “That’s me! That’s me the doctor had written about!”. 

But she might recognize the main plot of her story “a woman who was tricked into marrying an elderly man whose family wanted a free maid and financial provider for their aging father”. But how many people in this world have been in the same ‘story’ as she? Legions! She would most likely end up saying, “Wow, looks like I am not the only one in this world who suffers through the same thing. There are other patients like me.”

In the VERY unlikely event that she were to sue me, she would end up paying my legal fees when I win the case!

This is just an example of what I meant by knowing your way around medblogsphere. You have to manipulate the characterization of your case. We are only interested in the main lesson and take home messages from a certain case. Readers don’t care about the details of the patient’s character. So, use that to your advantage. Purposefully disguise your character without compromising the actual point/lessons of the case. Then, you should be reasonably safe.

Another important aspect of knowing your way around medblogsphere is to know how to use disclaimers! This is so important! Once you put a disclaimer, you are also reasonably safe. I have an existing general disclaimer for the whole blog from the day I started working in MOH (you can scroll  down and find the disclaimer at the bottom of your right hand side) and also for each specific post that I think requires an additional disclaimer.

Below is an example of my own disclaimer which has been standing for the past seven years.

“Afiza Azmee is an individual, and My Life Poetries That May Not Rhyme is a personal blog. The opinions expressed here are the author’s product of her thinking process. And they do not represent the thoughts or opinions of anyone related to the author and especially NOT the author’s employers (the ministry of health).

The information in this blog is provided ‘as is’ with no warranties and confers no rights. Please use your discretion before taking any decisions based on the information in this blog. Author will not compensate you in any way whatsoever if you ever happen to suffer a loss/ inconvenience/ damage because of/while making use of information in this blog.

Author reserves her rights to a change of opinion in the future. She is, after all, an open-minded person.

All images in this blog, unless stated otherwise, are courtesy of Google Images. Thank you, Google.

Author welcomes your comments, your disagreements, your views about any of her posts in this blog. But she reserves her rights to delete those that contained profanities, vulgarities, unrelated topics, and annoying anonymity.”

I subscribed to Psychiatric Times which is a very reputable online magazine for psychiatrists in the US. The doctors there write about their cases all the time. One example is given in this link below. The title of the post is ‘A coin flip’. To read the case, you can click H.E.R.E  

http://www.psychiatrictimes.com/residents-corner/coin-flip

The famous Kevin M.D blog also writes about cases frequently. The blog has even more tips about how to write on clinical cases, which PROVES that writing about your case is not absolutely forbidden. You just must know how to do it right. If you want to read the tips, you may click the link H.E.R.E

http://www.kevinmd.com/blog/2011/09/doctors-write-clinical-cases-online.html

When I was a HO, I had written about one particular case, disguising the character and the patient as I have always done since I was in medical school. A doctor wrote in the comment section that “I shouldn’t be writing about cases. Not even for educational purposes due to confidentiality issues.” I knew she was an MO in the same hospital as I and at that time my blog was viralled because of something I had written against a particular department in my hospital when I was a HO. She meant to reprimand me in her comment but I knew what I was doing. Like I said, I learned ethics thoroughly. I may not always be professional in what I said, wrote or did as an MO, but there is ALWAYS poetic justice behind every action I took. Someone must have crossed my boundaries and my principles, causing me to snap and when that happened, I wouldn’t answer about what I am capable of doing. So I replied by saying “Based on what I have written in this post, why don’t you track her down, find out who she is and locate her, and then get her to sue me for breaking confidentiality. I’ll wait.”

She never replied to that comment. Perhaps, because she never bothered to track the patient. Or perhaps because even if she wanted to track the patient, the patient would be untraceable.

We CAN write about cases. If cases can’t be discussed even for educational purposes, how would lecturers teach medical students? 

Sometimes a patient talks to you specifically about her situation, without knowing that you will be discussing the case with your specialists or even with your other colleagues later in the day… is that okay?

For example, most of us have not told our patients, “Kes awak nanti, kami akan discuss dalam meeting pagi-pagi. Dalam meeting tu ada student nurses, student MAs, student doctors etc etc.”

Remember, these students are not even our own staff… they are students who do not actually see the cases themselves but come to know about all those cases when they are discussed in meetings/audits/mortality reviews.

So, ARE cases allowed to be discussed for educational purposes? Yes! And also… No! Depending on the situation and how the case was discussed or written.

So the MO who had written the comment of how ‘cases are not allowed to be discussed even for educational purposes’, was just plain wrong.

You cannot give such a blanket statement over this matter. This issue is rich in nuances and must be treated and analyzed in a case-by-case basis. Otherwise, we will be contradicting our principles with our own actions when such a blanket statement is given.

Regarding cases discussed in blogs, there was never a clear black-and-white guidelines about it other than making sure that identifying information are not included and discriminating information are edited! That is the only important rule! The rest are carefully manoeuvred, again, on a case-by-case basis. For example, if the case is high profiled and well-known, just changing the identifying details may not even be enough… so, you must improvise even more.

Again, I suggest to read Kevin M.D blog post from the link I provided above, regarding how to go about editing identifying information.

***

I have heard of stories of how some master students who suffer from depression were so betrayed by their supervisors when their conditions were revealed to other lecturers and then their whole batch found out about it! And things like these happened in the academic setting of our own medical university!

Confidentiality ke laut!

How about housemen? When I was a HO, I found out from another HO that there was this particular HO who was under psychiatric follow up! Apparently, somehow, words got around. But how?

Maybe confidentiality is only preserved for hotshot specialists or only applies for HODs or ‘orang ternama and berpangkat’. But, perhaps not for the HOs? Once a HO (or a university trainee) is diagnosed of some mental disorder, somehow it is okay if their cases are discussed around?

If you are in Australia, the trainee could sue her supervisor! But in Malaysia, you don’t do that unless you want to fail your master program. Hahha.

For aspiring medbloggers out there, don’t worry if you want to start a blog to record the journey of your career as a doctor or simply to vent about your daily grievances in general. This has been going on for years in the West and Malaysians are catching up so admirably in this aspect of medical culture. Internet and social media are such an integral part of our everyday lives and it does not show any signs of fading. Older generations who are not internet-savvy have either retired or retiring. In fact, even older physicians who were not born as Gen-Ys (non-millennials older doctors) do have a blog. By the time internet-savvy doctor-bloggers become specialists and HODs, blogging doctors would be mushrooming all over the place.

This phenomenon cannot be stopped. It can only be regulated.

You just have to know the ropes and the absolute do’s and dont’s. The rest are in the realm of the grey areas. Just employ your creativity to disguise the details of your cases and make sure your disclaimer is well-written.

Good luck!

Ultimately, my responsibility is for my patient!

wp-1488725417036.png
My facebook status today!

My life would have been a lot easier if I can be someone docile with no principles and no backbone to fight for what I believe as right.

Unfortunately, my father raised me to be outspoken and to fight when I believe I am right. (so my life is full of the drama of me being a rebellious anti-authority) I am taught to fight for the underdog and to crush the bullies in the society.  I am always going to be the one who cheers for the losing team against the favourite team. I am always going to be pro-housemen, in general. I like it when the underdogs win. I like it when the underdogs DARE to fight for the sake of truth and justice. Truth and justice are like my life’s theme, around which I build my personal saga on.

And 90% of the time, I always win whenever I fight for something. Another sunnahtullah that I believe in is that Allah will help you when your intention is sincere and you are doing it for the right cause!

I might be a rude, loudmouthed virago in the society. But when you are looking for a sidekick to fight with you for the sake of justice, I am the one you want by your side! I will get things done, insyaAllah. And I won’t stop until I get it! My patients are lucky if they get me as their doctor… I will fight for them if they are ever in a situation of injustice. I can face my superiors and debate with them until I get them to agree to give what my patients need. If my patients need something that my superiors won’t allow me to give, I will find another way to get it for them if I believe  they deserve it.

My job is my ibadah. And I take it seriously. I may not look deeply religious. I may not be able to quote Quranic verses out of thin air or effortlessly talk about hadeeth narration on top of my head. But I understand the core principles of my religion. And I stick to it. I can even be pretty rigid about it. Like an autistic kid who would throw massive tantrum at the  existence of the slightest deviation to his normal routine. When it comes to things involving my principles, I am very strict. Principles are not to be stuck with just when it is easy to do so. The purpose of having principles is to help and guide you make the right choice in the situation when it is so hard to choose. If you are going to balk and cower down at the slightest pressure by any authority, then what’s the use of having principles?

My job is my amanah. When I am oncall, my patients depend on me to argue their case on their behalves. If I think they need admission, I am willing to argue and fight until I get them admitted. If I think community treatment is the one that is best for them, I can spend one hour just cajoling and persuading the relatives to bring the patient home after acute treatment has been given. On the one hand, I will have to persuade my boss to allow me to admit my patients when I think they require admission. On the other, I will have to persuade the patient’s relatives to bring the patient home when I think the patient’s best treatment should be in the community. Ultimately, I do all that for patients. Not for myself.

My patient is my amanah. I don’t work for bosses! I don’t work for my hospital director. I don’t give a damn about KPI! I don’t give a damn about kissing my superiors’ ass. If they punish me in any way, shape or form (public reprimand, giving low marks for my annual appraisal etc etc), I STILL don’t care. I don’t need a high SKT marks for MRCPsych program. So, I don’t need to kowtow to anyone in the work place. And that’s my power. Because you can’t blackmail or threaten someone who don’t give a damn!

If I am nice to you or polite to you, I do that out of common courtesy and because I genuinely like and respect you. I have no ulterior motives to be nice to you, otherwise. Because I don’t need you that much to pretend differently. If you have pissed me off, I won’t even bother to hide my disdain. I am transparent, that way.

I have designed my life so precisely according to my cardinal trait and my central trait. I have also designed my life so precisely according to my most enduring overvalued idea. My overvalued idea is “Power tends to corrupt! And absolute power corrupts absolutely!” So my life is lived in such a way that I don’t have to need anyone for anything and I pray (so hard!) that I will never be forced to sacrifice my way of life as it is. This is liberation! I pray that no power can ever threaten to corrupt me.

wp-1488729602506.png
Another facebook status of mine!

I respect good reasoning! I respect excellent clinical judgment. I respect genuine intention of someone wanting the best for their patients regardless of what the KPI or the hospital policy says. I respect someone who can bravely do what is right even if tomorrow they will have to face the displeasure of someone above them, judging their clinical decision. Having a responsible, honourable boss like that will gain my utmost respect.

I abhor cowardice. I hate indecisiveness. I despise incompetence. And I don’t care what position you have in the society or in the government! If you are my superior and you are indecisive and unnecessarily anxious, I will find it VERY HARD to respect you. I may not go out of my way to challenge you for every single annoying thing that you do that affect me. But once you get in the way between me and my belief system (which include doing the right and honourable thing for my patients), I am going to fight you.

So, don’t get in my way! Because I am not moving! When it matters to me enough, I can be either an unstoppable force or an immovable object.

immovable object
Physics  101, anyone?

The best thing is: When you TRIED to get in my way, and then I fought you until I got what I wanted. And AT LAST, I was proven right for fighting for what I wanted.

That, dear readers, is the sweetest feeling in the world. Such a sweet, euphoric feeling! My own version of cocaine. Yup, to be proven right is my cocaine! (Hahha. I am so immature when it comes to wanting to be right and wanting to win)

Thank you, Allah! For always giving me the signs that it is worth it to fight for the right thing.

I leave you with a repeat of my facebook status with the extension of the comment section. Just a little private joke to those who know the story. 🙂

wp-1488725417036.png

wp-1488836343370.png

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 which I devoured in my teenage years. Those books shaped my worldview and my principles in life.).

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.