I know… that it has been more than 2 months since I last wrote in this humble blog of mine. For the countless times, I had broken my promise to write consistently, at least once per month. But, my dear readers… trust me…. I have some really good reasons for not blogging once per month as I had promised.
Reason No 1: My Macbook screen was cracked and broken a few days after I posted my last blog post in August. And I took my sweet time repairing my Macbook screen because the repair cost was too expensive for me, especially since I had just spent a lot of money to pay for my CASC exam. I just couldn’t afford to repair my Macbook screen just yet. (Very good reason, no?)
Reason No 2: Exam! (Enough said. LOL)
My CASC exam was held on the 18th of October 2019 in Hong Kong. I am not exaggerating when I say it was the hardest exam of my life. At the end of the exam I felt like crying bloody tears. There were 16 CASC stations altogether and we were allocated 7 minutes to perform the task in any particular station. My problem with CASC was that I always felt like I didn’t have enough time to perform the task to my heart satisfaction. So, there would be times when I covered enough depth… but not the range that was required to pass the task. That was what happened during my first CASC attempt. My study partners were always telling me “You tak payah tanya dah yang lain-lain tu. Cukup criteria for diagnosis, move on. Tak payah tanya everything. Banyak lagi nak tanya….past psychiatric history, family history, risk assessment, coping, drug and alcohol. Kalau tanya detail sangat, yang lain-lain tak sempat. ”
Okay, but that is my problem. I whiningly told my friends “Susahlah. Aku rasa tak puas kalau aku tak tanya bagi habis semua symptoms for that diagnosis even if symptoms yang aku dah dapat tu dah cukup untuk diagnose. Tapi mungkin dia ada more symptoms yang aku tak cover lagi, right?” I would still feel like I might have missed something. That was the OCPD part of me that was ugh!! really troublesome for me. I just didn’t have enough time to cover the task for each station to my heart satisfaction.
There was a time when I had to give myself a serious pep talk. “Afiza, this is not about your heart satisfaction. This is about the examiner’s satisfaction! Please get this into your head! Just because you have covered the depth that is required to make the diagnosis, you still wouldn’t pass if you didn’t cover the range of the marking scheme. Range and depth! Not depth alone! 7 minutes is all you have and you cannot be too detailed on just one thing. Prioritize! Come on!”
CASC is so different compared to Part A and Part B. In Part A and Part B, I could still indulge my OCPD-ness to a certain extent. For example, for each question in Part A and Part B… even if I already knew that the answer was E, in my head I would still go through my own method of reasoning regarding why A, B, C and D were not correct. I just had to check and double check each answer even when the correct answer was quite obvious already in the first glance. I did all that because… yup, I have some OCPD traits that just could not be ignored at times. LOL.
But CASC was a whole new ball game. I had to learn to think quickly and to not ruminate. I had to learn to cover just enough in depth and then quickly move on so that I could cover the breadth/range of the task. It took hard, intensive practice for me to overcome and suppress my obsessive tendency but Alhamdulillah… as the exam date was geting near, I was able to overcome the urge to dwell on one thing in too great a depth. But ah… it was hard. I am the ruminating type. When something doesn’t make sense or when a story just doesn’t have enough details to it, well… it bothered me. (Which kind of explains why even as a child, I had a lot of questions about anything that was taught to me especially in learning the religion. The same obsessive ruminating trait that was so bad in exam, was the same trait that allowed me to discover the beauty of having real faith and real conviction in my religion. Because I questioned stuff, I now understand Islam better and it was the best thing that could ever happen to me especially when I was in my early 20s. So yeah… I don’t always regret having this OCPD trait. But I must admit it can be troublesome in certain situations… such as in exams. LOL).
There was one time when I was so frustrated while studying for CASC that I felt like giving up. Seriously… CASC is the worst exam for many of us. The financial burden was huge! Some people had to borrow their parents’ money to take CASC exam one more time because they had already run out of all their savings courtesy of previous payments of past CASC attempts.
Some of the candidates were already consultants or specialists in their own countries… but they took this MRCPSYCH & CASC so that they could work in the UK. They were so much more senior than us…. what chance do we have in competing with these people?
There were also times when I felt angry at myself for not passing CASC the first time. Doctors are always hard on themselves when they don’t pass exams, you know. Because the experience of failure is so rare and far in between. Most doctors are top students their whole lives. When they got into medical school, then they realized that there were so many other people who were just as good and clever as them, if not better. Then they would feel overwhelmed by the competition. And if they actually fail, they would feel like the stupidest person on earth. Even though failing your professional exam is quite common, it is still a bitter experience for any doctor to have to undergo.
Alhamdulillah, Allah created me with an ability to self-motivate. I am a very optimistic person, in general. And for that, I thank my parents very much. My father always encouraged repeated efforts in order to gain success. The concept of putting in an effort was very prominent in my upbringing. “Kena usaha! Sampai dapat!”. And until now, I internalize that concept. And it is a very motivating concept. Because my dear readers, Allah sees your effort. And I believe it wholeheartedly and behave accordingly. I don’t believe that my effort guarantees anything. I just believe that effort is required to qualify for God’s help. And I need His help in everything that I do. And therefore I have to make myself qualified for His help. So I put in my effort, hoping it would be enough.
And it is true that it is in the remembrance of Allah that the heart finds rest. It is really difficult to feel bitter about not passing an exam when I know that Allah has blessed me in every other aspect of my life so mercifully… that it would be very stupidly ungrateful of me to indulge in endless self-pity. I was afraid that Allah would punish me for being an ungrateful slave. Very difficult to pity myself after that. LOL.
One of the ways I calm myself is by reading and writing, which is something that I am sure you guys already know about me. I love reading stories and seerah. I also love composing poems of religious themes because I think they are motivating, uplifting, always relevant…. well, Islamic poems are evergreen, no? Because Islam will always be relevant in our daily lives as Muslims.
So I wrote a poem to remind me to be a grateful slave of Allah. To always be mindful that I also have another test to pass. The test of patience and fortitude and the test of NOT despairing of Allah’s mercy. And the outcome of this test would only be revealed in the hereafter which makes it far more important to me than passing CASC would ever be in this world. It doesn’t even begin!! to compare!
So I moulded my thinking accordingly and asked Allah to forgive me. I wrote the poem below around 3 weeks before my CASC exam in order to gather my thoughts properly. It was the most therapeutic thing I had done in a long time. The title of my poem is Remember.
Once upon a time, I stretched my arms faithfully upward Supplicating in silent soulful solitude Hoping You would deign to look downward And grant Your slave in prayer stood All the wishes and dreams of her heart to fly to heavens, a brand new start.
But the hand of fate was full of pain Dreams of mine went down the drain I wondered why my prayers were in vain When You have the power to grant my gain.
Did I not to You faithfully worship? That You had so forsaken me Have I not for You a love so deep? That You entirely shunned me Have You withdrawn from me Your favour? To bleed my heart all over.
But immediately I felt a twinge of shame What You must think of me, I’d take the blame As I imagined the response You exclaim To this ungrateful slave that I became.
Remember Ya Ibadi, When you prayed to me with outstretched hand For things you thought I wouldn’t grant Instead I bestowed you a better one Gratefulness for Me you displayed scant.
Remember Ya Ibadi, Sins You committed I’d overlooked Without you begging My pardon Still your soul-cleansing I undertook All that you lost I then returned.
Remember Ya Ibadi, All the promises to Me that you broke Hoping it would be of little concern Still your heart purification I undertook Your will and resolve I then hardened.
Remember Ya Ibadi, Good things happened you didn’t ask how Glorious miracles you asked to allow They happened without your bargaining vow How could you forget all my blessings now?
Remember Ya Ibadi, Did you suppose things happened in coincidence? Did you not see the purpose in all happenstance? Should everything go your way in every instance? What do you suppose your reason of existence?
I remember now, Ya Ilahi, And fervently I promise to do better Pardon this slave, in need of Your favour Forgive my sins past, present and future Have mercy on my soul now till the hereafter Only to You I place my worries, my fear I accept Your decrees, doubts burst asunder Whatever transpires, to My Lord I surrender.
-Afiza Azmee- 29/09/2019 6.00 pm
Allah, the Most Gracious, the Most Merciful, has bestowed upon me his blessing once again.
Alhamdulillah. Alhamdulillah. Alhamdulillah. A wave of happiness and gratitude filled my heart so overwhelmingly that my eyes teared up as I informed my parents the happy news. That I have passed my CASC exam.
I imagine that once upon a time when Allah had created the story of my life in the Luh Mahfuz, He had probably written “Today, Afiza will be filled with happiness for passing her CASC exam.”
I hope it is not too late for me to wish everyone a blessed and productive Ramadhan. Just hang on for a moment while I wipe away and clear out all these dust and cobwebs in my website. 😛 Been awhile since I last clean up around here. Adeh!
Gosh…. it’s been quite some time since I last update my blog. I have been super busy with studying. I always promise myself that I will write in my blog AT LEAST once a month. Just because writing is therapeutic for me. And because I want to prevent Alzheimer’s Disease by exercising my mind in a mental gymnasium of creative written expression. Haha. But obviously, I have failed to write anything in the month of April. So here I am… planning to make it up by promising myself to write 2 entries in the month of May. Hopefully, I won’t break this promise too. (Gosh, I need to step up!)
My exam is next week, peeps! I have come to the stage of tawakkal already. I have accepted that I will never be able to cover everything and I am gonna forget stuff. I am just human, after all. I accept that we can only try our best and the rest is in Allah’s hands. I will try not to be so neurotic towards the end of my exam preparation, ehem! Just ‘enjoy’ the exam , right? (Yeah, right. Haha. I am not THAT positive, yet. I can NEVER enjoy exams, darn it! )
Please pray for me, folks. I need all the prayers and good wishes I can get. And the best part of this is, we are in the blessed month of Ramadhan…so hopefully, all of our prayers will be granted by Allah. I remember how I took my final high school exam (SPM, of course) in the month of Ramadhan too. And Alhamdulillah, me and most of my friends got straight As for it. So, I hope I can repeat the same feat for my final specialist CASC exam in this Ramadhan too. (But I have come to know that the passing rate for CASC exam is only 50%. So, there is only 1 in 2 chance that I can make it. Oh, is there a glimmer of light at the end of the tunnel? LOL.)
Well, we have to do what we have to do, don’t we?
But whatever the outcome is, I will accept it, move on and act accordingly. I can always take it another time if I can’t make it this time. That takes the pressure off my shoulder somewhat. (But, ah… if only money grow out of trees, I will be one heck of an avid gardener. LOL. This exam cost me almost RM11,000 in exam fees and preparation course. And that is excluding my flight ticket and accommodation. *sigh*)
Such is life, folks. Not everything is a bed of roses. Even roses have thorns. We take risks, face the consequence, move on and persevere. Well, life is like that. Like riding a bicycle, people say. You can’t keep your balance if you don’t keep moving (well, unless it is an exercise bike… which is stationary anyway. In which case, the purpose of moving is to lose weight rather than to keep your balance. Which reminds me, that I haven’t exercised for awhile now. *sigh*)
And that is why, ready or not, I must take this exam. Keep on moving. Maintain my balance.
While revising my academic materials, I was reminded of how I had played ‘verbal fluency’ game with my nephew one year ago. (To those who don’t know, verbal fluency is one of the cognitive test administered for frontal lobe assessment in the clinic). I laughed in the middle of studying this part of cognitive exam because I remember how I had lost to my 6 year old nephew in this verbal fluency game.
Guys, ageing is real! I lost to my 6 year old nephew that day, you know! God, the horror of it! Of course, to Eshan, I had said, “I only pretend to lose to make you happy,”
Of course, he didn’t believe me. Haha .
So please play this game with your family members as a form of mental exercise to prevent Alzheimer’s, ok! This is one of my favourite games to play with my nephews and nieces (because I am too afraid to play Scrabble or Chess with them… the shame will be too great if they defeat me in those too. Haha. Eshan and Aayra are making me feel my age so acutely. Seriously, guys… not even kidding.)
In that video, all of us were wearing purple for the wedding of my younger sister. We were all exhausted after entertaining all the guests and the kids were bored, so we decided to play this game while waiting for our Asar prayer. Yup, we left our parents in the ceremony hall to entertain the guests themselves. *walk of shame*#IKNowIamBad
My parents were pseudo-cool about it…. they didn’t mind me and my siblings’ disappearance act a’la Houdini in the middle of a wedding. LOL. They are so used to it and have become habituated to their children’s lack of social skills. We always avoid socializing more than the absolute necessary amount. Haha. (But they did say, “Nanti korang juga tak kenal saudara-mara. Asyik tak mau sembang dengan orang.” Hahha. But then… I blame my father’s genetic. He is even worse than me when it comes to small talk. My mom is the only one who is good at it in our family.) I didn’t even know most of the guests anyway. And making small talk with people I don’t know is one of the things that I dread. Not that I have social phobia or anything like that… hahah. I just don’t like crowds and noise too much.
And verbal fluency game is more fun anyway! LOL.
Notice how I went blank a couple of times and Eshan just couldn’t wait to count to ten as fast as possible so that he could win. Hahah. He is more competitive than my Kak Long ever was.
In the second video, even Aayra (my 5 year old niece) was helping me. Oh, the shame. (What was wrong with my frontal lobe, guys?!)
I swear, after exam is over, I am going to time myself for 1 minute and practice coming up with as much words as possible so that I can beat them in the next battle. Practice makes perfect, right? Raya is coming soon and they are gonna ‘balik kampung’ to my parents’ house…. so we can have the next battle during Raya. We will call it Aidilfitri Verbal Fluency Contest, si?#AndJustWaitEshan #MakNgahWillMakeAComeback #MakNgahWillDefeatYou
For the record, I know what bison and walrus are (I know how they look like in the kids dictionary hahha), I just don’t know what they are called in Malay (excuses, excuses LOL) But ah… I have such a smart nephew and niece. I have to step up my game and be careful not to lose to them in the future. Adeh!
One day, I am gonna organize a verbal fluency test in Malay….. Eshan and Aayra will not defeat me in that one. Because my Malay is better than theirs (I hope!)
I leave you guys with a reminder (especially for myself) to enjoy this Ramadhan and make the best of this month with prayers and excellent good deeds (exams not withstanding). May Allah strengthen our faith and make us among the righteous in the hereafter. Amin.
Until next time. Much love and May Allah bless all of us.
When I was an IB student in KMB, part of the World Literature component that we had to study was the novel The Great Gastby, authored by an American novelist, F. Scott Fitzgerald.
Though at that time as a teenager I was not that enamoured with this magnum opus of F. Scott Fitzgerald, the FIRST TWO SENTENCES of this novel had stayed with me until now.
In my younger and more vulnerable years my father gave me some advice that I’ve been turning over in my mind ever since.
“Whenever you feel like criticizing any one,” he told me, “just remember that all the people in this world haven’t had the advantages that you’ve had.”
We had to analyze the novel as a student. And I just kind of wrote in my literature analysis that we shouldn’t be judgmental towards other people because we don’t know what other people have gone through in their lives to cause them to behave a certain way now. By the way, I got an A for my literature analysis of The Great Gatsby at that time. But all I wrote in my essay was some wishy-washy namby-pamby crap that I feel embarrassed to be recalling now.
Trust me, I have changed my mind. I think the longer I am in psychiatry, the more objective I become about things that I read and what I should tolerate and not tolerate. Or maybe it is just the effect of me being older and wiser.
I believe that what happened to you in your past DO affect your life now…. but only up to a point. Whether or not you let the past haunt you, it is ON YOU. It is YOUR DECISION.
If I could go back in time and do the literature analysis all over again, I would probably changethe tune of my essay and write something like this instead: “We all have different life story. OF COURSE none of us will have the same kind of advantages and disadvantages. That’s just life. It doesn’t mean you can excuse yourself when you do something bad or maladaptive. Instead of wallowing in your disadvantages in life and comparing how other people’s lives are much more advantageous than yours, you should move forward and think about how you could make your life better, isn’t it? Mr. Gatsby deserved what he got in the end! He should have moved on a long time ago and stop pining for a married woman.”
Trust me, I have no sympathy for the great Mr. Gatsby.
As a psychiatry MO, I am going to be honest and admit that I have favourite cases and favourite patients. I mean, that is only natural. That’s why we have subspecialty, right? Because we don’t always like all types of cases even though we DO see and manage them all to the best of our ability.
And, let’s face it. We do have favourite patients, don’t we? We don’t discriminate our patients in terms of treatment and resources but there are certain patients we like to see MORE than others. That’s just human.
So, what sort of patients do I like? Well, I like patients who help themselves because it makes it all worthwhile. Because without the patients helping themselves, there is nothing much I can do to help them that would work long term. We can psychoeducate till kingdom come, or do daily home visits, or call them every day to update on their progress, or we can repeatedly give them compliant therapy…. over and over again…. but nothing will stick long term until they accept their illness, and make THAT VITAL DECISION to take the meds and perform all the non-pharmacological measures we tell them to do. My whole investment in effort and time to maketheir mental health better depends LARGELY on the fact of whether or not they themselves will do what I have told them to do! I can do my best… but it won’t work if THEY don’t do their best. We are not going to be there for them 24/7. And we shouldn’t haveto. Part of the responsibility should be shouldered by the patients themselves and their family members.
So yup… I do have favourite patient’s family members too. The more cooperative the family members are, the bigger the smile that I bestow towards them as a form of greeting at the start of the conversation. LOL.
It is kind of disheartening sometimes. When the reward for our hard work (seeing the progress of our patients is a reward) depends on the patients themselves taking that leap of change…. it can be disheartening because some of them just refuse to take that leap.
So when patients (or their family members) ask me about their prognosis or if they will ever get better, I said truthfully “You will get better. Not all conditions can be cured… but they do get better. But how much better you get depends on YOU.”
And that’s the problem. And that’s also the solution.
YOU are the solution. Regardless of your background! Regardless of your advantages and disadvantages in your past! Regardless of what had happened to you in the past and the present, YOU are the solution to your own problems. Make that decision to take your medication. Make that decision to not let your past determine your future. Make that decision to put some effort in doing all those lifestyle changes! Make that decision to do your CBT homework! Make that decision to feed your thoughts with positive self-affirmations as you were taught to do in your CBT sessions. Make that decision to practice that deep breathing exercise and the relaxation techniques taught to you. Do it for you!
Because I cannot do it for you.
What are the values you must internalize in order to move forward DESPITE your past andyour disadvantages?
Because trust me, if everyone can behave badly by citing random disappointing things that had happened in their lives as the cause of their depression/borderline personality/ antisocial personality/addiction, then everyone can get away with crimes because “oh, it is not my fault. I had a deprived and disadvantageous childhood, you know”.
“Oh, I murdered that guy because he reminded me of an ustaz in a Maahad Tahfiz who had sexually abused and sodomized me when I was younger! It’s not my fault. Don’t judge me if you don’t know my past.”
But when you are arrested by the police and subsequently sent to be evaluated in Hospital Bahagia Ulu Kinta, we will only determine whether or not you were of sound mind when you had committed that murder and whether or not you are fit to plead! Regardless of whatever bad past experiences you had, we are only going to be interested in the soundness of your mind! We are only interested to know whether you knew what you did was wrong and contrary to the law! That’s it! We might be interested in your past… but only up to a point. The court may take note that you used to have a disadvantageous childhood… but you will STILL be punished. It is only right for you to be punished. Your bad past will not suffice in the court of law to justify your crime!
Regardless of whatever childhood adversities you have experienced, by the age of 18 you will be treated like an adult in the court of law! You would be assumed to have had the maturity of an adult and you are accountable for your own action. You cannot turn around and blame your parents when you are addicted to drugs… because your siblings who are NOT addicted to drugs ALSO have the same parents as you! The judge in court will not entertain wishy-washy, sappy sob story of an excuse like that! Even in Islam, we are accountable for our sins at the age of puberty! The reality should not be distorted to adjust to YOUR subjective experience! Instead, regardless of whatever bad experiences you have had, you must make the effort to adjust to the reality. If anyone can be excused based on ‘subjective’ experiences of childhood disadvantages, then that’s it! There should be no law and order. Everything must be grey and blurry, then!
Likewise, the reality is such that when you behave in a counter-productive manner or in a socially inappropriate manner, most people will reject you. Regardless of your past! People who are going to deal with you day in and day out are not going to care about how difficult your past was after a certain point! Their sympathy can only go so far. So the onus is on YOU to rise above your past and change your behaviour if you want to lead a fulfilling life. And we are here to help you do that. But you must be willing to put in some effort without always blaming others for every single thing that goes wrong in your life.
In Psychiatry, we also learn that there are certain risk factors that predispose someone to having depression or other mental illness. But some people do cope well with life despite having those risk factors! How come?
So my take home message isthis: Your past DO affect you… but ONLY up to a point! You are not totally helpless against your past! Because the rest of your life is determined by what you are going to do now in moving forward.
And you can turn over a new leaf by internalizing certain values in your life that I am going to enumerate below. Please take note that I am not disregarding or invalidating all your past experiences and all the injustices that had happened towards you. I am just giving you a way to move forward.
“Doktor, ingat senang ke nak usaha? Pesakit depressed memanglah tak larat nak exercise, nak buat behaviour activation semua. Bila doktor cakap kena usaha… macam stigmatizing. Ada doktor suruh pesakit kencing manis usaha supaya pancreas diorang keluarkan insulin? Tak kan…”
“No, I won’t tell type 1 diabetic patients to put in an effort to force their pancreas to produce insulin. However, I do tell them to put in an effort to take their insulin, to controltheir diet, to exercise and keep a healthy lifestyle. And this is what I am telling you to do too. It is not stigmatizing. It is factual.” This was my answer to the patient (who also had some component of personality on top of her depression). Very matter-of-fact, very reality-based.
To be honest, I NEVER like the ‘mental illness stigma’ poster that compared depression with diabetes. It is so inaccurate, and we should stop saying “Jangan stigmatize pesakit depression. They cannot help their behaviour. They lack serotonin. Just like pancreas orang yang ada diabetes tak boleh keluarkan insulin, orang depressed pun tak boleh keluarkan serotonin. When you tell depressed people to put an effort, it is a stigma! You don’t tell diabetic patients to produce insulin, do you?”
Ugh! Gosh! I cringe inwardly whenever I hear misleading things like that.
I agree that we should not stigmatize mental illness! But I disagree about depressed patients not having to put in any effort in dealing with their depression! Asking people to put in some effort should not be construed as stigmatizing! In ANYTHING we do in life, effort is vital! In ANYTHING!Stop trying to tie our hands from telling our patients to put in some effort! What do you want me to say then…. tak payah usaha langsung?
As a Muslim, Allah will not help us without us putting in our effort! To Muslims, that’s a fact! I am not going to distort reality just to align myself with the content of a bad poster. I am not going to distort facts just to appear FALSELY empathetic and sympathetic when the reality is different! If we cannot tell them to put in some effort, then how about asking them to go to occupational therapy? Doesn’t that require some effort? How about asking them to attend their CBT sessions or their psychotherapy? Doesn’t that require effort for them to do their homework?! How about asking them to practice deep breathing exercise and do some physical activities? Doesn’t that require effort?
The only condition that doesn’t require your effort is when you are in a state of coma! You don’t tell ICU patients to put in any effort, sure! But for the rest of us, the requirement for a good, healthy and balanced living is our effort. The faster you internalize this idea, the faster you will improve your life, Insya Allah.
So, please! Please stop promoting mental health awareness by comparing depression with diabetes! That’s like comparing apples and eggs. They are not even in the same category! (at least, comparing apples and oranges can fall under the category of fruits! But apples and eggs are two different categories altogether, get it?). For one thing, there is no component of the ‘mind’ in the Pancreas! There is no intertwining interpersonal conflicts and ongoing social stressors in the development of Type 1 Diabetes! So Type 1 Diabetes patients really cannot change anything much in the way they behave to help their condition. But this is not the case in depression! So, how is this a good and fair comparison? Neither the diabetic patients nor the depressed patients are treated fairly by this comparison.
And Wallahi, this comparison should cease to exist! (Adoi, penat! Too much emotion has been invested in writing about this alone, LOL. Pheww!)
To quote Kevin MD:
Diabetes is a disorder of insulin metabolism. Insulin is produced in the pancreas. The (depression-diabetes) analogies disregard the intimate intertwining of brain and mind. For the pancreas, there is no corresponding “mind” that exists in the realm of feelings and relationships.
I prefer to compare depression with having a fractured lower limb in terms of how effort would improve your outcome. “Katakanlah awak mengalami kemalangan jalan raya dan kepatahan kaki lalu tidak boleh berjalan. Lalu, saya pun beri kepada awak tongkat untuk bantu awak jalan. Sudah tentu berjalan dengan tongkat dengan kaki yang patah lebih susah berbanding sebelum kaki awak patah. Tetapi tongkat itu serves its purpose untuk bantu awak bergerak walaupun memerlukan lebih banyak tenaga. Tapi jika awak masih duduk di kerusi dan tidak mahu berjalan walaupun sudah diberikan tongkat, maka tongkat itu langsung tak berguna! Bila awak duduk dan baring sahaja, ini akan membawa risiko mendapat bedsores dan secondary infection yang lebih teruk lagi. Apabila saya berikan awak tongkat dan suruh awak berusaha untuk berjalan, tak bermakna saya menidakkan kemalangan yang berlaku dan kesakitan yang awak alami kerana patah kaki. Tetapi saya bantu awak untuk move forward WALAUPUN ya, saya akui awak kemalangan dan ya, saya akui awak memang sakit dan patah kaki. But the tongkat is here, isn’t it? Are you gonna take it and walk or are you going to just sit down, not using the tongkat and instead repeatedly go back and forth questioning why the accident had happened to you? And why aku patah kaki dan orang lain tak patah kaki? Because think about it….How is that going to help you? Now… let’s get back to your depression. I am giving you your medication and I have scheduled CBT sessions for you with our clinical psychologist… will you take it? When I told you to put in some effort to do all these measures, to try to go to work… I am not denying your depression and I am not saying it is going to be easy! It is hard! Of course going to work while being depressed is ALWAYS going to be much harder than going to work without any depression… that goes without saying! However, now I have given you some medication, and you will be seeing our clinical psychologist for CBT sessions….these things are the tongkat! Yes, it is still harder to go to work compared to when you were not depressed… but now, going to work is becoming more achievable, isn’t it? Compared to when your depression was not treated at all, now even though it is STILL hard… it can be achieved right? Just like it is still painful for a man with a broken leg to walk with a crutch, but at least with the crutch, the man with a broken leg can now walk, isn’t it? Will you at least try first?”
Most patients who already have some spark of optimism inside them can relate with the ‘patah kaki’ analogy FAR BETTER than the diabetes analogy, in my experience.
Really… I am not a vague, wishy-washy person. I am always the ‘bottom line’ kind of person! I want to know the truth, the reality, the actions that I need to do and what is the possible outcome I can expect. And therefore, I don’t like to comfort people with half-truths. I do adjust my style of giving away the real truths to my patients depending on their personality and the appropriate context…. but I am not gonna give them empty words of comfort. I am not gonna tell them it is okay when it is NOT okay. I am gonna tell them, “What happened is not ideal but what are you gonna do about it? Let’s face it and deal with it! It will be hard but it can be done. I will help you… but again, it will only work if you help yourself because a lot of things require effort on your part!”
And most patients recognized the truth and they gravitate towards it! The sunnahtullah is such that deep inside, all of us want to know the truth. And when we give the truth to them, it builds trust because they know that this doctor is not lying and pretending to care about them! Sure, some of them don’t like to hear the truth and they might hate us for awhile. But the seed of doubts regarding their actions has been planted in their minds…. and eventually they will think and evaluate the matter again.
But patients who STILL persisted in playing the victim card (usually a personality component is involved here), will continue to deteriorate. And my heart sinks.
As a psychiatry doctor or a therapist, among the first thing we should do (after allowing them to ventilate and express their distress), is to get them to internalize the value of effort! We will not get anywhere if they still persist that they are victims of their past and therefore they will always be ill and flawed because their past can never be changed and therefore there is no use for them to put in any effort.
That is really such a tragic way to think about life. We must pull them out of that mindset before anything can ever change. But unfortunately, it is STILL their decision to change their mindset! At the end of the day, we can only do so much to help them. The ultimate outcome lies in their decision.
Having A Growth Mindset
The opposite of having a growth mindset is having a fixed mindset. The worst thing that can happen to anyone is to have a fixed mindset. Having a fixed mindset would wreak havoc in your life because you have basically internalized learned helplessness. Learned helplessness is bad, folks! With learned helplessness, people can be driven to suicide because they believe nothing they do will ever change the situation and there is just no hope left.
Biologically, we learned about brain plasticity which is the ability of our brain to change through life with our experiences and our training! It correlates perfectly with the value of having a growth mindset.
From the psychological point of view, Piaget’s theory of cognitive development talks about how our mind and our mental schemas are always adapting and accommodating…. for the rest of our lives. So we are not always stuck in our bad childhood memories. Provided you put in some effort, you can overcome your disadvantages!
While I do think that me hearing out your feelings and allowing you to ventilate your problems do help to de-stress you while you are facing your crisis, I am more interested to know what you are going to do about overcoming your limitations in life? That’s the BOTTOM LINE always.
With a growth mindset, you will have a positive and optimistic outlook in life because YOU JUST KNOW that whatever it is that is happening to you, you can master the steps that you need to take to overcome the challenges! You just need to grow your mind by expanding your horizon with new skills, new set of positive thoughts and new set of behaviours. When you have a growth mindset, you know you can learn and re-learn and un-learn your way into a better coping mechanism.
You won’t say things like “Dah aku memang macam ni. Family aku dulu ajar aku macam ni. Memang dah tabiat aku. Memang aku tak boleh nak ubah… nak buat macam mana?”
I am not saying that it is easy to change your habits! A person with a growth mindset ALSO might be resistant to change because they are already comfortable with their own habits and personality. But when it is important for them to change and adapt (perhaps, there is something at work that they have to be in-charge of that requires a new set of behaviours and habits), they will make themselves change their habits and behaviours because they know that the only constant in life is change! And if they have to do it, then they have to do it!
So, will you continue to practice? Will you continue to study and acquire knowledge and skills for the betterment of your future? Will you be willing to put in some time and effort (goes back to effort, doesn’t it?) to do what has been taught to you during your CBT sessions so that your new skills slowly become second nature and would be automatically activated in the future with much less effort than what you have to put in now?
You will do it, when you have a growth mindset.
If you have a fixed mindset… don’t worry. This is the beauty of the concept of having a growth mindset. You can unlearn that fixed mindset NOW, and start to learn to have a growth mindset.
Having An Internal Locus Of Control
In psychiatry/psychology, locus of control is defined as the degree to which people believe that they have control over the outcome of events in their lives, as opposed to external forces beyond their control.
If you have an internal locus of control, you believe that events that happen to you is the result of your own doing rather than the external forces outside your control. For example, when you have an internal locus of control, you would believe that you had passed your exam because you had studied hard and went to all the lectures and tutorials that were given at the uni and because you had prepared accordingly. You did not think it was the external factors beyond your control that had made you pass. You did not think that it was just luck or because other people were doing even worse than you or because the teachers like you better than your other classmates. You are less likely to conform to your surroundings when you have an internal locus of control.
If you have an external locus of control, you believe that you had no control over the events that had happened to you and there was nothing you could do to influence the turn of events. For example, you believe that you would never pass the exam because the subject was too hard and the lecturer did not like you. So there was nothing you could do to pass your exam. You believe that the result of your exam somehow depends on all other external factors except your own effort. Having an external locus of control makes you more likely to conform to expectations and environments because you want your life to progress smoothly.
In general, when it comes to motivation and drive, having an internal locus of control is much healthier than an external locus of control.
However, having too much of anything is never good. Having a much too internal locus of control can also cause you to blame yourself and will make you feel unnecessarily responsible for something that you could never help. And that can also predispose you to depression. See the diagram below to see what I mean regarding imbalanced locus of control and why it would be bad to have too much of either.
The key word here is balance and reality check! I have mentioned before that I like the truth! I like reality check! Those are the two words I use a lot with my patients. You are entitled to your feelings and you have a right to them because it is YOUR feelings…go ahead and have them. But at the end of the day, your feelings do not necessarily reflect the reality. And if adjustments need to be done, your feelings must be compromised to give way to the truth or the reality! You must start learning to feel the right thing! (yes it can be done!) Because your feelings, even though you have a right to them, are subjective. But the truth and the reality are the objective facts! It will make your life much easier and less turbulent if you can learn to feel the right thing.
As Muslims, we know that things that happen to us are decreed by Allah. But because we don’t know the decrees of Allah yet (I don’t know whether I will pass my exam or not, for example) we are ORDERED by God to put in some effort to attain what we desire. So the locus of control is balanced here. You are neither too sad nor too happy about things that happen to you in this life. Because you know that whatever bad or good things that happen to you have already been decreed by God and eventually anything bad and good will simply run its course! It will pass! There will be a next challenge to conquer and then the next, and the next…. until you breathe your last air! Bad events hurt… but give it time. Put in some effort, work at it again! Continue! Persevere! Feed that internal locus of control.
And when a disappointing outcome arrives… recognize that some things are out of your own control but it does not nullify your effort at all. It’s just life!
For example, someone passing their viva is a combination of effort, studying and doa (internal locus of control) and examiner factor, your health issues during the time of exam, and the type of caseyou get (external locus of control). That is the reality! Nothing in life is TOTALLY in your control. And nothing in life is TOTALLY under the control of the external forces. Perhaps, when you realize this fact, your feelings about anything will be in moderation.
I suggest that people take up reading as a hobby. Not because it is my hobby and I am very much in favour of that habit (haha… mungkin ada juga komponen biased sikit. Because I will always think that reading is superior to any other hobby hahah… so yup, ada biased sikit) but because it is the one good hobby that will benefit anyone regardless of gender, social status, and whatever past experiences you have had.
Even if you read commercial fiction like Harry Potter, you will feel like “Wow…. this kid could fight the evil Lord Voldemort by the virtue of his effort and perseverance. Setakat kena marah dengan consultant, that is nothing to be scared about. I will turn up to work and finish my housemanship regardless of how bad I kena marah. I can overcome this!” Hahha. Okay… that is an extreme example. After all, Harry Potter is a fictional character and most people don’t try to relate their lives with fictional characters to sooth their feelings. So, you might not think that reading Harry Potter can ever motivate a disillusioned houseman (though actually it works with a lot of ardent readers out there! It certainly works with me!)
But you can also read biography/autobiography of really inspiring people. Autobiography books are real-life events! In my last blog post, I talked about the biography of Muhammad Ali and how inspiring he was. If you are a Muslim, you can read the seerah of our Prophet and his companions (I have mentioned before that Umar Al-Khattab is my favourite superhero). Read about the history of Jerusalem and the oppression committed by Israel towards the Palestinian people who are still persevering and fighting for justice and freedom (Netanyahu is worse than Lord Voldemort, okay!). Read the biography of Mahatma Gandhi and Nelson Mandela and the sort of sacrifices they had to make for the sake of freedom and social justice.
I am not saying that reading protects you from depression or neuroticism. But it broadens your horizons, knowing that people are always struggling sometime, somewhere. You get to live the lives of many people through reading, and you get to find out how all these various people cope with their own mistakes andtheir own troubles (After all, the best way to learn is to learn from other people’s mistakes and troubles…. rather than making the mistakes and having the troubles yourself, right?).
If you just read (the right material), you will have a better coping mechanism. It improves your logical thinking and your abstract reasoning which will make it easier for your therapist to work with you. Some of your CBT homework require some reading too. You are more likely to do it if you already love reading.
If you don’t like reading, don’t worry. Focus on getting a growth mindset, first… and then you will know that you can adapt your brain into loving to read… and it WILL benefit you.
For Muslims, it is no coincidence that the first verse that is revealed by Allah to our beloved Prophet Muhammad (PBUH) is to read! Iqra’, remember? Get some knowledge! Internalize the values that you read and use it as your guidance in making any decision! Our parents can only teach us so much… because they have only their own experiences to tell you about. Their way of doing things and their experiences may not be applicable to you. And so, we read in order to experience the lives of many people so that we can have a big arsenal of weapons to choose from whenever life strikes us hard.
And as a therapist, sometimes we need to set up boundaries with our patients. We have to let them experience the consequences of their own behaviour. We should not be enabling and reenforcing their bad behaviour by always giving in to their demands for attention and validation when what they are doing are obviously wrong and maladaptive.
They have to stick to their appointments and learn to deal with the consequences of being late to theirCBT/Psychodynamic session. When they throw a tantrum, we should ignore them until they are willing to behave well and until they can state exactly what sort of problems they want to discuss with us in a rational and calm manner. Behave like an adult and we will treat you like an adult.
Some patients will manipulate their counsellors or their therapists or their doctors. It is important that we recognize that behaviour and not accidentally rewarding them.
A few years ago, I myself had terminated a therapeutic relationship with one patient when he had thrown a tantrum at the nursing counter in order to see me. My late HOD, Dato’ R, happened to be at the counter at that time and managed the situation by telling him that I was covering addiction clinic and he must see other doctors. The patient should have come during his allocated appointment time but he didn’t.He had come earlier than his scheduled appointments so many times in the past and I had told him not to do it. I told him that he had to learn to deal with his feelings by the techniques that had been taught to him. And I told him that he should go to the ED for any emergency that crops up in between appointments. I was hoping that by making myself less accessible, he would learn to deal with his distress by himself using the techniques that had been taught. But he still didn’t.A few days later, he came tothe clinic again (again, without an appointment) and I decided to see the patient one last time to terminate the therapeutic relationship. I told the patient that what he did at the nursing counter a few days ago was unacceptable and I think he should see other doctors. I was very firm. You must follow the rules, or bear the consequences. After I terminated the therapuetic relationship, he did not see any specific doctor since then and was placed in the general pool for any doctor to see. As far as I know, there is no issue since then.
One day, I happened to bump into him at the supermarket. He was polite and did not try to detain me when I said that I need to excuse myself to finish shopping. That was a huge improvement! A few weeks later he came to the clinic, and he had requested to see the doctors in room 2 (happened to be my consultation room on that day). The clerk at the counter was firm and said “But you didn’t follow appointment. Pergi bilik 5. Lepas ni kalau nak request doctor mana, datang ontime.” And he abided by that instruction without insisting to see me in Room 2. Very good behaviour that he had displayed there! So, I have made a decision that if he ever comes on time later on and requests to see me, I will grant him his wish as a reward for his much improved behaviour.
I am very particular about time and sticking to agreed rules and negotiated terms. That is one of the ways I know that the therapy is working. I have an aversion to being manipulated and controlled. I don’t like it and I won’t allow it in my therapeutic relationship with my patients. On this, I am very firm. I don’t think it is healthy to be there for your patient 24/7.
At what point is your patient going to be able to learn to think for themselves andsolve their own problems if you are always there to be depended on whenever they are in crisis? Once we have agreed on the negotiated rules and terms, we must stick to it. Early in the treatment, there might be some adjustments and hiccups along the way. But by the time the adjustment period is over and the patient is still crossing all sorts of boundaries… then a serious talk must be conducted to establish what is okay and what is not okay in this therapeutic relationship. Any more crossing of boundaries is no longer healthy for either party and perhaps we should pass the case over to our colleague.
And that’s what I did.
Maybe as I grow older and mature into the profession, I might learn differently about what to expect and what to tolerate with regards to therapeutic relationship with my patients, but being controlled and manipulated and being forced to give in to that kind of behaviour will not be something I will passively tolerate. I don’t think that will ever change about me.
On the other hand, another patient of mine who had successfully internalized the values of effort, and having a growth mindset and having an internal locus of control (unfortunately she STILL hasn’t internalized the values of reading, haha) had successfully managed all her crises in the 3 months when I was not around in the clinic (because I was doing my forensic attachment in HBUK at that time). When she saw me shortly after I returned from HBUK, she had said “Doktor tau tak dalam masa 3 bulan ni banyak sangat benda jadi kat saya. Tapi saya boleh handle sendiri, doktor. Doktor tau tak saya dah berhenti kerja yang dulu. Waktu tu saya sangat stressed dan nak sangat jumpa doktor… tapi nurse kata doktor pergi attachment. So saya pun pendam sajalah and handle sendiri. Alhamdulillah, sekarang saya dah dapat kerja baru. Dan gaji saya lagi bagus dari kerja saya yang dulu.”
I was overjoyed that she could handle things for herself. I said to her something along the lines of “Bagus! Memanglah semua masalah kena handle sendiri. Kalau saya ada pun, apa saya boleh buat? It’s your job, it’s your life… you have to make your decision and stick to it and then put in the hard work. And then, there will be another challenge… and you will handle it again just like you have handled it in the past. These things will continue for the rest of our lives. Memang awak boleh buat pun. Congratulations! Lepas ni bolehlah bagi appointment 3 bulan sekali pula.” I teased.
“Dua bulan dulu lah, doktor!”
I laughed. “Saya tak ada tiga bulan hari tu, awak okay jer! Pernah dengar tak, necessity is the mother of invention? Bila benda dah jadi dan kita terpaksa handle sendiri, waktu tu lah kita discover our real abilities. The situation NECESSITATES us to grow! We must start creating opportunities for you to handle crises yourself in between appointments. You can do it! In fact, you have done it when I wasn’t around!”
I cannot wait until I can give her a four monthly appointment. Hahah. Yes, she is one of my favourite patients. Because she internalized those values I had listed above, she is much better now. So, I like seeing her because I feel like all the time spent in my session with her was not in vain. Not wasted. But eventually, it is our responsibility to make sure our patients can be confident to let us go. One day, I might have to move elsewhere, work in another state. I am not going to be there for them 24/7. It is an unrealistic expectation to be placed on any doctor or any therapist! And I refuse to do it for any of my patients. It is kinder in the long run that we maintain boundaries and make them self-sufficient. It is the kindest thing you can do to anyone…. to provide them with a fishing rod instead of a limited supply of fish of uncertain duration. That kind of uncertainty will create unconscious distress in them because they will always be wondering “Can I survive without my therapist?”
So, I have told her that next time, we are going to try for a 3 monthly appointment regardless of whether or not she feels ready. She just smiled… because she knew I always do what I said I would. Or maybe it was a smile of someone who is confident enough not to worry too much any more.
Why worry when everything has been written and all you have to do is to go through it and do your best until you breathe your final breath.
I leave you guys with one of my favourite songs by Sami Yusuf. This song teaches us that when it comes to dependency, there is only ONE entity that we REALLY cannot live without… and that’s the way it should be in this life. That’s the reality. All the dramas in your life should take a pause to acknowledge this fact once and for all. And trust me, you will be happier for it.
It’s been a long time since I last talked about my favourite topic ever…. ehem…. BOOKS!
I am obsessed with books. If I ever become a hoarder, trust me, I will be hoarding books. If you come to my house, you will see my 4 big bookshelves. And now, I am in need of a 5th one. (Maybe, I am already a hoarder haha).
Once you have stepped into my house, you will feel like you have entered a small-scale community library! And if you love reading, you will love spending time in my house (ok, tengah perasan rumah sendiri best hahah. But seriously, “rumahku syurgaku” is the right sentiment for me, Alhamdulillah. I can stay in my house for weeks… kalau aku tak perlu keluar kerja dan cari makanan LOL!)
As an obsessive book lover, this is my #Confession #Rants
And this confession was brought on by someone who still has not returned my book. (The stress is real, folks). And also brought on by some issues in the social media that disturb my peace of mind.
Aku kedekut! Super kedekut!
Aku kedekut untuk bagi pinjam buku kepada orang. This is the one type of kedekut that I still find it hard to change (Dulu kedekut lagi dahsyat. Makanan minuman tak nak share langsung sebab geli. Now, at least, I can share some.)
Zaman duduk asrama dulu, bila aku pinjamkan buku kepada orang, apa yang akan terjadi adalah samada buku aku hilang atau pun orang tu ambil masa yang sangat lama untuk pulangkan. Atau pun bila dipulangkan, habis lasam buku aku macam buku buruk! Padahal waktu aku pinjamkan pada dia, buku tu masih baru dan cantik. I wanted to cry!
In my mind, I will feel like “Why can’t you buy the book yourself? I bought my book myself, didn’t I?” My friends could buy an expensive perfume or Body Shop toiletries (zaman sekolah menengah, this was considered luxury item, ok!) or eat at a cafeteria everyday (instead of at the Dewan Makan) and could prioritize buying just about anything else… except their own fiction! But then, they wanted to borrow mine!
I was so stressed. In my heart, I was like “Aku tak pernah pun nak pinjam kau punya Body Shop perfume ke or whatever it is yang kau dok beli selama ni. Barang-barang mahal kau boleh pula beli. Tapi kenapa buku kau tak boleh beli? Aku menabung lama tau nak beli buku ni! You had no idea how much I love this book… and you just wanna borrow it like that? Iys!” Haha. You guys had no idea how difficult it was for me to hide my displeasure when I had to lend my books to people when they asked (in order to be polite to them). Memang aku terpaksa mengaku, aku tak ikhlas nak bagi pinjam.
You see, part of the pleasure in buying and reading books is in discussing them. So when I was a teenager, I usually would discuss with people about certain books I had bought and read so that they could be interested to read the books too and then we could analyze the content together! Get it? Readers just LOVE discussing books… it’s just how we are wired. We are nerds through and through (but we have learned to disguise our nerdy-ness as we grow up LOL).But then, I learned that whenever I did that book discussion with people, somehow it would end up with me having to lend the book to them. I remember, aku sampai fobia nak cakap kat orang buku apa yang aku beli. Hahah. So, I kept my excited thoughts about books to myself after having learned people’s tendency to just wanna borrow my books instead of buying the books themselves.
Disebabkan aku ini sangat kedekut nak bagi pinjam buku kat orang, aku sangat hargai bila ada orang sudi bagi pinjam buku kat aku…. and as a show of appreciation, I will return the book within a few days (paling lama aku pinjam pun hanya seminggu, tu pun sebab cuti sekolah and tak dapat nak return stat). I would just finish reading the book as soon as possible sebab aku tak nak pemilik buku tu tertunggu-tunggu bila buku dia nak dipulangkan semula. (Whereas with my friends, they took MONTHS to finish a 400 page book. Gila slow! Kalau kau tahu kau jenis tak boleh concentrate nak habiskan buku in one seating, atau kau ni busy gila sampai tak dapat nak habiskan buku cepat-cepat… then please don’t borrow the book yet. Wait until you have more free time to read the book before you borrow it. Tak lah owner of the book rasa stress).
I think this is just adab. You don’t understand how an obsessive book lover think! They are in distress every time they are apart from their books. This is not an exaggeration… at the back of their mind, there is always that constant wondering of when the book will be safely returned.
Cannot empathize? Cuba orang minta pinjam Iphone korang? Get it, now? It is almost the same thing to us.
To a book lover, every single book of theirs is as precious as an Iphone. Please understand.
As I grew older and had my own money (initially from MARA scholarship and then nowadays I got my own salary), I became less stingy with my books because I could buy them so easily now without having to menabung as I used to. (When I was in school, I depended on my allowance from my parents only! And I didn’t like asking them for more money than what they had already allocated for me. So I had to save my allowance to buy books. Tu pasal aku kedekut… sebab susah payah aku berjimat nak beli buku cerita, ok! hahah) But seriously even with my current financial independence, I STILL don’t prefer to lend my books to people. When I discuss about any book with you, please don’t think that it is an invitation for you to borrow it. It is NOT. It is just me being a fellow good reader, trying to guide you on your next purchase. I am just trying to be helpful on what sort of good books are out there for you to buy and enjoy. That’s all.
Perhaps one the best things about me being a book lover is that, I don’t care about branded stuff. I will probably enjoy having them…. if I have them. But not having them is neither here nor there to me. I am indifferent to it.
I go for quality rather than brands. Sebab itulah sampai sekarang aku tak pernah cuba membeli Iphone (because for me, I will only use it to make a phone call, to message or whatsapp… which are the things that ANY smartphone can do. And I also use my phone to snap pictures…. so the only deciding factor on which phone to buy will be the camera feature. And with Huawei and Oppo in the market… Iphone becomes even less relevant to me camera-wise) But I did purchase a Macbook… because Macbook has the most ‘value for money’. (My Macbook very rarely hangs! I don’t even have an anti-virus for my Macbook. I have been using my Macbook since 2014 and it works just as well as when I first bought it!).
So, it really weirds me out when I saw news such as below.
And then I was more aghast when in Malaysia, apparently the parents are stressed out about their kids asking them to buy an expensive Smiggle item just because their friends at school have the same Smiggle item. WTH??
I have heard about how expensive Smiggle items can be and I have read about how parents were complaining about it, before. But the issue on Smiggle resurfaced after the news on the banning of wearing expensive coat in British Schools hit the social media. Some people believe that maybe Malaysian Schools also should ban certain items from being worn/brought/used in school.
One such example of a parent who had lamented on this Smiggle issue can be read below:
While I can see the concern of this particular parent and indeed sympathize with his dilemma, I really find myself slightly bewildered by the whole thing. I just fail to see why we can’t simply go ahead and tell our children NO when they ask for something that we cannot afford to give?
Aku tak faham. All of us used to be a kid too. But we handled our jealousy and disappointment ourselves, didn’t we? Tak perlu pun nak kena ada peraturan “semua orang tak boleh pakai benda branded” just because aku tidak mampu pakai.
Like I said, I don’t buy branded stuff in general. Tapi waktu kanak-kanak dulu ada ja kawan-kawan pakai barang-barang branded… dan ada juga aku rasa teringin. Tapi bila kita minta kat parents and parents kata tak boleh, then we accepted it and WE LEARNED TO DEAL WITH OUR OWN EMOTION!
Kenapa pula kita nak kena suruh orang lain jangan beli benda yang kita tak mampu beli? One day these children will grow up and need to handle their emotions including jealousy and disappointment. And during school is the best way to learn that, and of course, guided by parents.
Ibu bapa yang senang dan berada boleh ajar anak-anak how to be compassionate “Even though I bought you a Smiggle bag, it doesn’t mean you can mock other kids who don’t own one. If you do that and I happen to find out about it, I will throw your Smiggle in the bin! Be kind!”
Ibu bapa yg tidak mampu pula can teach kids to be grateful “Even though I cannot afford to buy you a Smiggle bag, but I will make sure you have enough food on the dinner table, a pair of school shoes and two sets of school uniforms for you to attend school.”
Ajar sajalah anak-anak. Talk to them. Jangan nak ajar value ala-ala komunis “semua kena sama rata”.
Do not create an asinine blanket rule that does not stand reality check.
So when you go shopping for school stuff with your kids and one of them ask for a Smiggle item, you can say “Look, mommy only have RM 50 to buy 2 pencil cases; one for your sister and one for you. If mommy buy you a Smiggle, your sister would not have a pencil case for herself; that wouldn’t be so cool, right? I am sure, you being such a kind brother, would rather your sister get a pencil case of her own too rather than a Smiggle for yourself, wouldn’t you?”
Engage with their minds! Ask them to evaluate…. which one is better? One Smiggle pencil case or two pencil cases that look just as nice but very much cheaper? Teach your kids not to be selfish by asking them to think about the needs of their other siblings too. And furthermore, teach them about fairness … tell them resources must be fairly divided between all the children according to needs and urgency. You talking to them and discussing issues like these with them is how they get to develop their judgment. This is the sort of conversation that you can employ to teach them the right values. Perhaps this would be one of the conversation that your kids would always remember you by.
Because the truth is when you are long gone, they will remember the values you taught them…. not the toys you bought them.
Alhamdulillah, today my nephew Eshan has received an award for being the first in his batch (Anugerah Terbaik Keseluruhan Darjah 1), the best in Math (Anugarah Terbaik Matematik. Not surpising as my Kak Long’s doctorate is in statistics LOL) and Headmaster Special Award (Anugerah Khas Guru Besar). All of us are so proud of him. The first member of the 3rd generation in Azmee’s family has really done us proud.
I told Eshan that I wanted to buy him a present as a reward for his excellent academic performance. So I asked him what he wanted for a present. He said, he just wanted a book. A Star-Wars book! LOL.
I laughed. I was like “Yeah, I should have known.” Genetic/Nature is one thing (my father loves reading, and so do all of my siblings and now even the grandson has followed suit) but the environment/nurture plays just as much importance in developing the habit of your children.
My Kak Long was asked by other parents regarding how she gets Eshan and Aayra to love reading. She was stumped. To her, there was no fancy technique that she had to employ to get her children to read. There is NO TECHNIQUE. Your children pick up that habit from you! Do you spend the bulk of your time reading and writing? If you don’t, then do not expect your kids to do the same thing!
In her own words, while she was commenting on the Smiggle issue on my Facebook status, she wrote “Bagi aku senang… salah mak bapa tak pandai guide. It might sound harsh but it is the truth. I mean everything starts from home. On a different issue, a friend of mine was talking about the techniques on how to improve children’s’ interest in reading. I honestly think there’s no fancy technique. Soalan aku senang ja, mak bapa dia into books ke dak? Children just imitate what the parents do. It all starts from home. So sama juga dgn Smiggles ke Kinder Bueno ke.. mak pak jadilah parents untuk anak-anak. If you can afford, you buy; if you can’t, just tell your children. It’s ok.”
YOU are the parents! Kenapa pula kamu yang nak kena susah hati bila anak-anak minta Smiggle dan kamu tak mampu bagi? YOU set the rules… not them! THEY need to know that the household has got some sort of structure! Kalau you lenient tak tentu pasal, it doesn’t provide them a sense of security or a secure base. They need to know you are consistent and reliable, even as you are saying NO to them. Just tell them you cannot afford it! Tell it as it is! Be honest! Don’t worry, the children can handle it if you start that honest pattern of parenting soon enough in their childhood. It might even teach them empathy… because they get to know and appreciate their parents’ difficulties and sacrifices. I could handle it when my parents said no whenever I wanted even more story books than what they had bought for me. I handled it by saving my own money and buying the books myself (and hence aku kedekut nak bagi pinjam aku punya buku, hahha. I never sold any of my medical books to my juniors when I no longer used them. I kept them all until now…. ehem, like a hoarder. Hahah)
I can just imagine what my father would tell me kalau aku cakap kawan-kawan aku ejek aku sebab tak ada barang-barang Smiggle. He would probably say something like this, “Kalau diorang ejek Kak Ngah, Kak Ngah cakap sajalah Kak Ngah tak perlukan Smiggle untuk dapat nombor satu dalam kelas. And prove it by getting number one in class.”
And I would go, “Good idea, Dad. I will say it exactly like that!”
See? Every interaction, every difficulty in life… is an opportunity to instil values! In this case, he would be teaching me how to respond to hurtful taunts and stand up for myself! But you MUST talk to your kids! You must coach them how to handle life’s situation and then let them handle it themselves. Don’t create A DIFFERENT REALITY or ANOTHER RULE just to protect your kids’ feelings. You are not doing them any favour that way! They will never grow up.
And this is the reason that me and my siblings are not on board with Dr. Maszlee’s idea that Tahap 1 students will not have exams next year. Aayra will go to school in another year and she is so looking forward to exams. “Aayra nak dapat nombor 1 macam Eshan. So, Mak Ngah kena beli hadiah kat Aayra juga.” She is so competitive.
I didn’t have the heart to tell Aayra that she might never get the chance to get number one like Eshan next year… because there will be no exams, my dear.
Some parents said, “Weh, bagus juga tak ada exam. Anak-anak stress. Kecik-kecik darjah satu dah kena pergi tuition!”
What? Siapa suruh you hantar anak you pergi tuition? My sister never sent Eshan to any extra class or any tuition! YOU as the parents are the ones who stress them out about exams! YOU are the one who send them to all these classes to get them a good result. Academic jadi tak fun and exam jadi menakutkan because of you. Kalau diorang just pergi sekolah, balik sekolah and face the exam (without going to any more extra classes) they get the chance to handle the life situation of facing an exam! They get the opportunity to face the anxiety and deal with it! At the same time, they still have enough time to play and enjoy their childhood when they don’t have to attend all these unnecessary extra classes at the tender age of seven!
I am all for children enjoying stress-free childhood. But not at the expense of their education. Reduce their stress by employing wise parenting in deciding what extra classes are necessary and when! Not by abolishing exams!
Exams are good indicators of students’ understanding of the syllabus. There is a purpose for having an exam! Undeniably, the pressure is there but it is manageable. The UNMANAGEABLE pressure comes from you, the parent! You send them to tuition classes after school hours, and then YOU tell us they are stressed? And then, you salahkan exam kat sekolah pula? This is so skewed, God!
Unless your kids have ADHD / Autism / Learning Disability, there is NO NEED for them to go to other extra classes other than the ones they have at school while they are STILL in TAHAP 1. I can still understand if you send your children to tuition classes in their UPSR/PMR/SPM year, but not in other schooling years. Because they need to learn how to live a life and how to be a functioning happy human being too… not just learning the syllabus. Other than one month of intensive private tutorial for Add Maths at the end of my Form 4, my parents did not send me to any regular tuition throughout my schooling days! They believe that tuition class is not necessary if you can focus in class and do your homework properly. Kids learn resilience when they have to face the disappointment of not getting the best result in their exams and the jealousy of seeing their friends getting a better result than theirs. That disappointment and jealousy must be handled. I can only imagine how Eshan would feel in the future when he may no longer get number 1 in class or may not get an A in some subjects…. we all had faced that situation too; it was disappointing, but we handled it, guided by the response of our parents and our family.
So parents, BE A PARENT! Read to your kids, discuss the moral values of the books you have read with your kids, interact with them at an intellectual level and instil values in your kids. Talk to them, reason with them. You will find out that these children of yours are smart and they can handle stuff … if you can be a parent!
I leave all my dear readers with videos of my Eshan telling an imaginative story about Galaxy’s New Planets. He is so creative, Masha Allah. My favourite planet is the Chocolatey planet. What’s yours? 😉
There are times when I sit back, to wonder and reflect on what I have done to deserve so much blessings in my life. Whenever I feel like life has become a little too mundane, a little too predictable or a little too comfortable (until I could feel my soul withering away in the midst of the same repetitive routine) God will send me a new experience to waken up my soul and rejuvenate my spirit. He didn’t let me continue being heedless and ignorant, comfortable in what little, insignificant things I have done in this life. He guided me to search for something MORE in life that would make my existence meaningful again… colourful again… hopeful again.
If God were to let me continue being the old me without any wonderful experience for personal and spiritual growth, I don’t know where I would be at this moment. Perhaps, I would be bored and disillusioned with life by now. But Alhamdulillah, every now and then He would send me to a #life #BootCamp to beat the disillusionment out of my soul and thrash the cynicism out of my heart.
Relief Mission: Imaret4Sulawesi
I believe that the year 2018 is my year for volunteerism. And it so happens that 2018 was not my exam year (unlike the two previous years) and I could devote more time on social issues that I believe in. (God has perfect timing and perfect planning in the timeline he has created for the plot in my life story. Thank You, God.)
I volunteered to be a PACA in April/May 2018. I remember how MUCH I learned just by mingling with people of different background than me. Just by being involved in the process of election, I gained a lot of insight regarding the political arena in our country. Those are the knowledge I could not get simply by doing my favourite pastime of reading. Though it pains me to say this, I must admit that reading is not ALWAYS enough (I stupidly used to feel like I can pick up any book to learn on any subject without having to get out of my house. LOL). Reading only provides you a certain level of intellectual insight on any particular subject but it would not provide you with emotional insight, nuances, perspectives, reflections and most importantly #SpiritualGrowth and #PersonalMaturity which you can only gain by being in the field. It doesn’t even BEGIN to compare! Deductive learning (by reading) is great…. but inductive learning (experience in the field) is almost always superior!
When the news of earthquake and tsunami in Palu hit the media, I was devastated by the heartbreaking destruction and the numbers of life lost. My friend and I registered our names to several NGOs to volunteer to help, either as a medical/psychological team or just general aspect of volunteerism (food and basic needs distribution/cleaning crews / setting up tents). At last after 3 weeks of waiting with no response by any NGO, IMARET answered our application to volunteer as part of a medical team in which our tasks would include giving general health service as well as #PsychologicalFirstAid(PFA) to survivors. I can still recall how ecstatic me and Dr. H were to be called upon to serve in this relief mission by IMARET. Thank you, IMARET for giving us this opportunity to experience relief mission abroad. It was an experience of a lifetime that will never be forgotten, Insya Allah.
IMARET has slowly but surely gaining recognition for all their good humanitarian works which had first begun in December 2014. Just recently, IMARET had received the Iskandar Malaysia Social Hero Awards (IMSHA) in the category of Disaster Relief NGO. The IMARET tagline of “Charity Begins with You” conveys the principle that ANYONE can contribute to humanity in whatever capacity we can. There are many categories of volunteerism including arts, social services, health services, community empowerment, public safety, environmental protection, and disaster relief. If you are not a doctor but you are passionate about the environment for example, then join the relevant NGOs like Environmental Protection Society Malaysia or Malaysian Nature Society.
Personally, as a doctor, I joined MERCY, Islamic Relief and IMARET as platforms for my volunteerism. But I also joined other NGOs related to writing/arts. There is always something you can contribute to the society regardless of your career or your lifestyle. You just need to find it and take the leap. (For someone who is very skeptical to join any organization unnecessarily, I am all in when it comes to organizations involving volunteerism. I am not even a member of Malaysian Medical Association (MMA), see? But when it comes to volunteerism, I would join without a second thought.)
Let me share with my readers a certain insight I gained a few years ago about life. Most people think that volunteers are very altruistic and noble-hearted, who do all these charity because of the nature of their good hearts. While I am sure that those are, of course, true, to a certain extent, but it doesn’t explain the whole picture. As a psychiatry MO, I believe that behavior is sustained when it is rewarded. I don’t think of myself as kind, altruistic or noble by any stretch of the imagination (hahah! Really! Those who knew me KNEW that Afiza garang… mana ada dia nak baik hati tak pasal-pasal. Soft-spoken pun tidak. Mother Theresa jauh sekali bagai langit dengan bumi. Haha). But I volunteered anyway because the act in itself is rewarding to me. I have my own selfish reason for volunteering. For example, I gained immense satisfaction, pleasure and euphoria when I witnessed the previous government was brought down and replaced by PH when I volunteered to become a PACA. I volunteered then not because I was so noble… but because I was so angry and because I had things in life I cared about and I wanted to champion those issues! Not really because I was that good, or that nice or that altruistic who would sacrifice all pleasures in life for the sake of others. I am too practical and too realistic to ever achieve the kind of nobility and altruism that are usually associated with volunteerism. Seriously, Mother Theresa, I am NOT.
So why did I volunteer to go to #PaluSulawesi recently? Again, not because I was that self-sacrificing or that altruistic with no self-interest whatsoever. Volunteering is addictive, you see. I did it FOR MYSELF! I did it for the experience it would give me. I did it for the knowledge and the wisdom I could gain. I did it to know how people cope with trauma and to experience the effect of their resilience on my own soul. It cleansed me in ways I could not even properly describe and explain. It must be experienced and felt. And that’s why I encourage all my readers to volunteer for a cause that you guys truly believe in… experience that feeling and that emotion first… go inductive… and come back and tell me whether or not you can describe yourself as altruistic when you decide to volunteer again and again and again. Once you have tasted it, you would KNOW that you volunteer for YOU! For the benefit that it gives YOU! For the wisdom and insight it gives YOU! Things you can never get by staying home and doing the same old thing over and over again. So, volunteerism actually benefits YOU! That’s the reward that sustains the behaviour. Really, for your own private reasons, you actually volunteer for yourself MOSTLY… not just for others!
So yeah, I volunteered to Palu because I remember how it had felt while volunteering previously… and I wanted to experience the emotional fulfilment and the cleansing of the soul and the mindful reflection that would come with the experience. Those are the rewards I gain by my volunteering. See? As I said, behavior is sustained when it is rewarded. The Sunnahtullah is such that charity benefits the giver more than the receiver. And that’s the truth.
The Wonderful Colours Of Diversity
In this mission, I have met a journalist and a full-time Humanitarian worker. It was great to get to know people of different career background than me. For the first time in many years, I made non-doctor friends with whom I can hit it off immediately.
Usually, it would be quite difficult for me to feel at ease with people who did not have any common ground with me. Because, really… what would we talk about? I am not really a people person. When I talk to someone, there must be a reason for that communication to happen. I don’t seek interaction just for the sake of interacting… it would not be enjoyable to me.
But while being on a mission when you have to share the same limited space in the car for hours to reach a very deserted area where all the unmet needs are, you get to know each other better. You get to know their habits, their life philosophy, what makes them tick…. those are points of learning you wouldn’t get by interacting with people of the same background. Nothing challenges your preconceived ideas more than when you had to hang out with someone of a different background than yours. And boy… we had numerous conversations that challenged each others’s preconceived ideas and belief system. It was heated but it was fun. We didn’t always agree with each other but we reflected on each other’s points and it opened up our minds.
I guess, in that 10 days I felt young and youthful again. We could even argue over songs and lyrics played on the radio in the car… thinking that each other’s interpretation was somehow less accurate than our own. Haha. It was silly but still it was intellectually stimulating… a conversation I haven’t had with many people since I joined medical school.
When I was in MRSM Langkawi, my friends were those who wrote poetries, composed short stories and read literatures. We talked about books all the time. We talked about social issues and politics even when we were just secondary school students. My ambition then was to be a lawyer or a writer or a journalist…. things involving social sciences rather than pure sciences. But alas, my scholarship was in medicine and nowadays I found myself surrounded by people who are mostly clinical rather than creative. I still read and write…. But I no longer have the same type of friends who share my interest and with whom I can talk about books and social or political issues that used to fire my soul when I was younger. (One of the reason I fought so hard to get into psychiatry was because this field has the closest resemblance to social sciences compared to other specialties).
I guess, for that short 10 days I felt young because I was learning and absorbing knowledge like a new baby being thrusted into the world for the first time. Just like a baby whose world shifted from that of the mother’s womb to that of the planet earth, MY world shifted from the cocoon of all that is medicine to the larger concept of what humanitarian is all about. THAT is the difference between volunteering in an NGO than in MOH… you get a taste of a different flavor. A forgotten flavor that I used to taste and now fully remember. And it was refreshing.
When you hang out with a journalist or a humanitarian worker, they told you of their experiences covering news and volunteering in war zones. The conversation was new, novel and interesting. They told you stuff that you only read from your thriller novels all these while… of international intelligence network, of humanitarian issues, of battles and conflicts that you could only see on TV.
They taught me and Dr. H the concept of having a ‘grab bag’. They said that as non-civilians, their grab bags are something that would always be with them wherever they go. They have been trained that way…to always be ready to run and leave everything behind with only their grab bag in hand. Since then, me and Dr. H created our own grab bag… a much simpler version of their own grab bags. Ours only contained our purse, phone and passports. Theirs contained money, phone or any other mode of communication, passports, laptop or any gadget required for them to complete their mission, change of clothes and survival necessities (water/ simple energizing food).
Listening to their stories, looking at their inspiring Instagram pictures of all their previous missions… I felt a certain amount of poignancy and nostalgia. Suddenly, the poem ‘The Road Not Taken’ by Robert Frost knocked my mind. I wondered then, how my life would be if I had said no to my medicine scholarship.
People Who Touched Your Heart
And then there were the survivors… fellow human beings who touched your heart with their beautiful resilience and amazing coping mechanism.
We met survivors who had continued working at Puskesmas (Pusat Kesihatan Masyarakat) while dealing with their own loss and grief. Their welcoming smiles totally warmed my heart. It embarrassed me when they thanked me over something that I felt so small and insignificant. We were at Puskesmas seeing cases in the general clinic and never expected to be given lunch or anything. We brought our own breakfast bars for lunch. But look at what they provided for us every day we were there! Great yummy lunch that we never expected to get while on a mission! We felt like our own small effort is nothing compared to their own acceptance of our presence. It was a truly humbling experience. It is amazing how you can develop closeness quite effortlessly but deeply just because all of you have the same mission and the same goal!
Look at our lunch!
Dapat ikan besar lagi!
In that 10 days in Palu, there were times when I surprised myself by thinking “Now, I know why relationship is important. Why networking is vital in a mission! It makes your work process so much easier!” I used to feel like “I can sacrifice relationship over my version of truth, my principles and what I believe as right. You either follow me or you don’t. But I am gonna do it and there is nothing you can do to stop me!” I am even like that with my own parents and my family… and they have learned to accept that part of me so selflessly all these years and I never thought a thing about it. I took it all for granted. To a certain extent, I STILL believe that truth and justice should always trump everything else in life. But these days, I started thinking that maybe there are ways I can have my principles/truth/justice and still maintain heartwarming relationships with people and mind their feelings a little bit. Well, I don’t know. Cognitive dissonance is hard to detangle.
And the kids! They were entertained by the simplest of things. It was so easy to coax laughter out of them. Look, I am not great with kids, in general. I am not entertaining enough and I don’t know how to act all adorable and silly with kids. I mean… heck, I am a serious person most of the time. My jovial side can only be accessed by someone I am already close to and even then, I am not all that humorous, LOL. But when you are on a mission, you have no choice but to strengthen your free-traits and put aside your biogenic traits for awhile. So that’s what I did. Performing and conducting one class full of kids every day are hard work, guys! At the end of each session…. I was drained and exhausted. But it was a good kind of exhaustion! The best kind!
Towards the end of our mission, we the Sierra Delta group members (the 4th group sent by IMARET to Sulawesi) had experienced hardships and joy, tears and laughter, quarrels and reconciliation. I would say, we knew each other’s characters and annoying habits quite well at the end. Hahaha. (I know, I can be annoying. LOL. Tabik spring to them for their kind tolerance).
After all our numerous daily talk and conversation about songs, one of my group members could already predict what sort of songs I would like or dislike. One day, he just told me to find this particular song on YOU TUBE that he was sure would be my type of song. I was very skeptical about it initially. But I clicked on the song anyway for the whole Sierra Delta group to listen to. And what a surprise… I was immediately in love with that song. The title of the song is Menimbang Rasa by an Indonesian singer, Oslan Hussein. I was so amazed that he could predict my taste in songs so well! Haha.
We played that song while being on a journey to various deserted areas to conduct PFA sessions and I have come to think of that song as a theme song of our experience in Palu Sulawesi. Our group song!
Until now, I keep putting the song on repeat. Haha. This is what I call as #CannotMoveOnSyndrome.
Have a listen and let me know if you love the song like I do. 😉
I end my reflection of my experience in #PaluSulawesi here, my dear readers. Until next time, I remain, your humble blogger.
My next post would InsyaAllah be on the details of the actual mission itself. And there were a lot of details to write about but it would be too cramped to share everything in one post. So if you are interested in humanitarian mission and would like to know the mental and physical preparation required, the actual work involved and everything else, stay tuned!
You guys know that I love reading. The plot is important. But so do characters and characterization. Even with a good plot, having boring characters would fail to launch the plot into a beautiful story.
Allah is the Master Storyteller of this universe. For each of us, we have been given our own characterizations. There is a grand plot for the world (the beginning started when Adam and Eve came down to earth, and the first exciting conflict in the grand plot began when Abel and Cain fought one another, and then life went on for many millennia with battles and wars and great flood, and the rise and fall of great kingdoms, the rise and falls of civilizations, the failure and success of various propagandas and ideologies, ….all these might continue for thousand of years to come…until finally, the earth is destroyed on the day of apocalypse).
But God has also created for each of us our own plots that serve as micro-plots that would fill up the general progress of the grand plot. Micro-plots and micro-characters like us are needed to launch the grand plot. And sometimes these plots of ours will intersect, interconnect or interact in some beautiful (or nasty) ways. Our characters will have to learn to live with one another, or love one another or hate one another. Or simply indifferent to one another.
Or maybe…God has designed for us to never come across one another ever in this life.
But the main point is : We all have our own plot. We all have our own purpose in this life. We all sometimes may be at cross-purposes with one another, creating tension and conflicts at various points in our lives. But at the end of our plot, we will understand why things happened the way they had.
According to Gretchen Rubin in her book “The Four Tendencies”, when it comes to societal interaction and expectation, there are FOUR indispensable types of personality profiles that can be found and they are all important in the society. These four are called Upholder, Obliger, Questioner and Rebel. Each of them can be good, valuable, and necessary in the society. But each of them can also be bad and troublesome… but VERY MUCH indispensable.
We need ALL FOUR TYPES to make up a balanced society. Whether each of the character types are good or bad or neutral depends on the context and the plot that is involved or laid out to you.
In my opinion, I fall into the category of questioner (ehem, with some rebellious tendency).
In short, the concept of the four tendencies is simply described as below:
1)Upholder will meet outer expectations and meet inner expectations
2) Obliger will meet outer expectations and resist inner expectations.
3) Questioner will resist outer expectation and meet inner expectation.
4) Rebel will resist outer expectation and resist inner expectation
Kita mungkin terfikir bahawa menjadi ‘upholder of values’ adalah sesuatu yang baik. Walaubagaimanapun, ini bergantung kepada konteks dan keadaan. Sekiranya beliau berada di kalangan pembuli yang majoritinya mempunyai norma moral membuli, maka beliau akan berkeras mempertahankan tradisi membuli itu. Contohnya, beliau mungkin akan mengatakan “Ah, setiap tahun kita sambut juniors dengan ragging. Biasalah. Dulu kita kena lagi teruk kot. Tradisi ni menyebabkan kita lagi tough duduk asrama. Inilah caranya kita baik dengan senior dan kenal dengan senior. Aku dulu enjoy ja orientasi. Senior ragging sikit-sikit tu biasalah.” Hmm….ini memang perangai KLASIK Upholder. Mereka tidak nampak apa yang salah dengan tradisi yang sedia ada. Mereka comfortable dengan keadaan semasa. Jadi mereka ada kecenderungan untuk meneruskan tradisi, walaupun tradisi yang buruk. (Ini satu lagi contoh perangai Upholder dalam masyarakat Melayu : “Baca Yassin malam Jumaat ni dah lama kami buat. Kenapa tiba-tiba nak tukar kepada Al-Kahfi? Kami pun dah lama amalkan tahlil kematian. Pandai-pandai jer kau nak kata Bid’ah. Kau ni Wahhabi ek?” Itulah contoh perangai Upholder. Sticking to tradition and resistant to change.)
Tapi sekiranya beliau berada di kalangan orang-orang yang mempunyai nilai-nilai yang baik, maka menjadi upholder of values adalah sesuatu yang sangat bermanfaat untuk dirinya sendiri dan kepada masyarakat. Contohnya ketika di mana ada golongan yang cuba memperjuangkan hak perkahwinan sejenis di Malaysia, beliau (sekiranya seorang Muslim yang hidup di dalam masyarakat yang mungkin kebanyakannya beragama Islam) akan bangun menentang dengan lantang “Buatlah apa yang kamu nak buat di belakang pintu. But to formally recognize and legalize this, NEVER. Jangan kucar-kacirkan adat dan budaya di dalam masyarakat kita.” Di sini, beliau akan dianggap sangat berjasa oleh ahli-ahli masyarakat beliau yang beragama Islam di atas ketegasan beliau mempertahankan nilai-nilai agama.
Kita SANGAT memerlukan Upholder dalam masyarakat kita terutamanya apabila keadaan tengah stabil dan tiada apa-apa isu yang sedang bergolak atau perlu diperbetulkan. Sekiranya masyarakat kita hanya dipenuhi oleh Questioner dan Rebel, masyarakat tidak akan stabil, nilai atau polisi bertukar-tukar setiap tahun sesuka hati dan kelangsungan hidup jadi celaru.
Mungkin kita terfikir bahawa obliger adalah seorang yang senang dibuli. Dia akan ikut saja apa orang mahu daripada dia dan tak pandai menjadi tegas mempertahankan hak sendiri. Tetapi, jika kebetulan dia berada di kalangan orang-orang yang baik atau pandai, dia yang nakal atau malas belajar mungkin akan cuba perbaiki akhlak diri dan rajinkan diri sampai pandai. Sebab masyarakat di sekelilingnya expect dia pun baik dan pandai. Jadi dia cuba untuk oblige that good expectation of the society. Namun begitu, jika dia berada di kalangan pembuli-pembuli yang expect dia untuk ikut cakap mereka and cater to their needs, habislah Obliger itu! Asyik jadi bahan buli jawabnya. So take care of yourself, please. Because I like you best (compared to the Upholder or the Rebel!)
Kita sangat memerlukan Obliger dalam masyarakat kita. These people will play nice with all characters. They would try to ease social discomfort by catering to people’s expectation and smooth the way out of conflict. Mereka ini pelincir dalam masyarakat.
Kita mungkin berfikir bahawa menjadi rebellious adalah perkara yang negatif. Tetapi jika seseorang mempunyai watak rebellious di kalangan surrounding yang suka membuli, mungkin dia akan terlepas dari dibuli kerana dia berani membuat tunjuk perasaan dan membangkang. So, good job, oh my dear Rebel! But if you are in a good surrounding with good rules and yet you STILL rebel, then it can only lead to disaster for your own selves. So think before you give in to your tendency to rebel.
Masyarakat SANGAT PERLU kepada Rebel ini ketika mana sesuatu keadaan yang tidak adil sedang berlaku, dan semua Upholders and Obligers tak rasa nak ubah apa-apa. Mereka sangat diperlukan sebagai pencetus perubahan yang akan menyedarkan golongan-golongan lain di dalam masyarakat untuk berubah ke arah sesuatu. Ya, Rebel adalah pencetus, penyemarak dan pembangkang.
As for questioner (I think that’s me. Haha), kami ada kami punya nilai sendiri. I have a set of values that I pick up from my upbringing… and ESPECIALLY from my reading. As a Muslim, semua benda yang jelas dalam agama, I will agree to it. Tetapi semua ruang kebebasan yang telah diberi dalam agama (perkara-perkara harus), aku akan ikut kepala aku sendiri.
Jadi adakalanya, aku tak dapat ikut apa yang masyarakat nak daripada aku sebab ia bercanggah dengan apa yang aku nak atau apa yang aku rasa betul. To get me to do something, you simply must make sure your expectations fit my inner expectations of myself and my worldview of how the world should be.
Orang macam aku tidak gemar berpersatuan sangat. We are okay fighting alone. Of course it’s good to have a group of friends who will cheer you on and fight along with you… but it is not strictly necessary to us. We are not great in society though we can try to work and compromise with them in certain things… but we minimize the need for society because there are things (like principles and our own ideas and expectations) that cannot be compromised.Kalau aku yakin yang kamu boleh terima karakter aku yang penuh dengan soalan, then I will be happy to join your society. (For example, I did join usrah in Australia. Because the seniors welcomed my questions and did not force me to comply to things I wasn’t ready to). Kalau aku puas hati dengan jawapan-jawapan kamu, aku akan ikut. You might confuse me with a rebellious person. But no… I don’t rebel against what I think is good. Only in what I think is bad. I follow rules when I can see the rational for it (and a lot of rules are rational and make sense, I must admit). Sometimes the rules are neither good nor bad… it is just the way it is (I will try to follow these type of rules when it is convenient. But if it wasn’t convenient… well, oops!)
BUT! when following rules would result in a greater evil, I will resist your expectation of me. I will break the rules. And I will fight it, bear the consequence and pray Allah will ease the way for me.
Because you see, Allah is the Master Storyteller. I put all my trust in Him. He gave me this particular character for this particular plot that He had set out for me. My responsibility is to make sure that I use my character that He bestowed on me in the way that He would approve. At the end of the day, He will be the one who will take care of me and it is to Him that I place all my reliance.
* * *
Believe me, your character suits your purpose in life. Suits your life plot. Allah designed it for you because He knew you are going to need it in the plot that He had specifically created for you.
However, the good thing is, characters are not carved in stones. Some aspects of your character are fluid and malleable. Allah asks us to get to know one another and learn good things from each other in order to grow into a more accomplished and well-rounded version of ourselves. I learned that some rules that are neither good nor bad (but just inconvenient) should not be questioned…buat penat jer dan no point for you to spend all that time arguing and questioning a neutral rule. (Waktu aku muda dan belum matang, semua benda pun aku rasa nak question haha) Kalau sempat comply, kita comply. Kalau tak sempat comply, mungkin tak boleh comply…. Tapi tak perlu buang tenaga dan meletihkan minda untuk question the rule. So, I adopt sikit perangai Obliger kat sini.
Apa-apa saja yang melibatkan prinsip yang jelas dalam agama, aku adopt perangai Upholder. (Unless kalau kau cakap tentang sesuatu perkara dengan konotasi agama yang tidak kena tempat dan mempergunakan imej alim untuk mepertahankan sesuatu yang salah… that’s another story. Contohnya, bila kau suruh orang yang didera atau dibuli untuk sabar dan redha tapi kau tak komen langsung betapa buruknya akhlak si pendera atau pembuli… haih, ini bikin aku panas, dong! Kau cakap macam tu depan aku, daripada aku nak adopt perangai Upholder, terus bertukar perangai Rebel pula jadinya. And I will call you out on your skewed judgment.)
Apa-apa saja benda yang melibatkan systematic injustice (injustice that has been legalized or accepted as a norm), I adopt sikit perangai Rebel!
Regardless of what your character is… you have your own agenda in life. Your agenda sometimes might be at cross-purpose with another character. For example, the Questioner might get in conflict with the Upholder but find it easier to team up with a Rebel or even with an Obliger. On the Upholder’s part, he would feel like the Questioner are stirring things up for no reason with all his questions. (“Dah memang macam tu, kau ikut jerlah. Nak tanya banyak buat apa” the Upholder might feel irritated) The Upholder would ALSO find the Obliger as a better team mate.
(Obliger is well-liked by everyone. Hahha. Tapi dalam hati, entah-entah dia depressed kot! Sebab asyik nak kena oblige orang.)
Bayangkan bahawa pada masa dahulu, betapa banyak watak-watak telah berinteraksi bagi membolehkan sesebuah revolusi berlaku. Contohnya, dalam plot penghapusan amalan hamba di Amerika. Watak Rebel sangat perlu, bukan?! Watak Questioner who questioned the norm of the slave system was very much needed too. Mereka ini mungkin akan bergabung menentang watak Upholder yang masih mahu meneruskan sistem hamba di Amerika (as part of the Southern American culture). The Upholders at that time upheld the Southern culture and insisted on continuation of the slave system.
Boleh jadi ke ada watak Upholder yang mahu menghapuskan slave sistem pada ketika itu? Yes, mungkin ada watak Upholder juga yang tak suka slave system. Tetapi, diorang akan cakap “Okey, aku pun tak suka slavery semua ni. Tapi kita fight secara polisi dan diplomasi. Diplomasi ni memang adat kita dari dulu. Kita go through the channel. Tak payah lah nak question atau nak rebel.”
See? Upholders are not necessarily against the agenda of the Questioners or the Rebel. They might all have the same agenda and the same purpose. But they differ in their opinions regarding the methods of how it should be done. Yes, that can happen. Upholders can also side with the Rebels (imagine that!).
So things are not always as clear cut between Upholders, Rebel, Obligers and Questioners. Different type of characters can have the same goal.
Pada pendapat aku, asalkan kamu mempunyai matlamat yang sama, kamu tidak perlu nak halang orang lain yang mahu memperjuangkan isu dengan cara mereka sendiri.
Upholders might want to go through the diplomatic route… tapi itu adalah sesuai di peringkat policy-making atau di peringkat pentadbiran. Memang sesuai sangatlah untuk mereka menggunakan cara diplomasi tu sebab mereka yang dok attend meeting dengan pihak-pihak lain. Takkan dalam meeting dengan pihak lain nak bergaduh macam Rebel.
Tapi untuk orang biasa-biasa, rakyat marhaen, golongan bawahan yang bukan policy-makers… mereka akan merasakan “There will be no change in the policy, unless awareness has been created first.” Untuk golongan yang tak terlibat dalam pentadbiran dan tak attend apa-apa meeting, apakah peranan yang perlu mereka mainkan apabila mereka melihat sesuatu yang mungkar telah berlaku?
Sedangkan Allah asked us to fight evil with our bare hands or our tongues or with our hearts, whichever we can do best! Everyone has a role in this. The role of forbidding evil is not limited to those attending diplomatic policy meetings at the admin level!
It takes a Rebel to create chaos, FIRST! And then the chaos must be reported and widely publicized, FIRST! And then, Questioners and Rebels must loudly DEMAND for policy change continuously and incessantly, FIRST.
Lepas tu, barulah ada ‘political will’ dan ‘society pressure’ untuk berubah sehinggalah orang atasan (yang kebanyakannya Upholder of policies) terasa dah sampai masa untuk kita buat polisi baru. Lepas tu Upholders yang budiman (yang dalam diam menyokong Questioners and Rebel selama ni) bolehlah memainkan peranan…. when you go to that meeting pentadbiran, please use all your expertise in arranging diplomatic words to champion our mutual cause. Kerana kalau yang pergi meeting tu adalah the Questioner or the Rebel, meeting tu akan penuh dengan pergaduhan dan akhirnya polisi tak digubal-gubal sampai ke sudah sebab Questioner nak tanya semua benda. Hahaha.
So, Upholders tak perlu nak kacau method orang lain yang memperjuangkan isu yang sama. Kita semua ada watak-watak yang perlu dimainkan sebelum sesuatu benda terjadi. Just because you want to fight things diplomatically at the round table of any meeting, doesn’t mean you don’t need the Rebels and the Questioners to stir things up in the society. You guys perlukan kami untuk dapatkan political pressure… barulah senang korang nak insist dan point out ‘the need for change’ dalam pertemuan penuh diplomatic nanti.
Our methods can be used simultaneously in parallel! That’s the point!
Dalam apa saja bentuk perjuangan (Renaissance/ Menuntut Kemerdekaan/ Menuntut Sistem Hamba Dihapuskan / Penyebaran Agama Islam / Menuntut Wanita Dibenarkan Mengundi/ Menuntut Orang Kulit Hitam Dibenarkan Mengundi / Mengubah kerajaan BN kepada kerajaan PH), kronologi akan lebih kurang begini:
Telitilah APA SAJA bentuk perubahan atau perjuangan, plot dan kronologinya akan lebih kurang begitu! These are the sort of books that I read all my life; makanan harian aku. I recognize that the plots in these sort of stories don’t differ much! To Kill A Mocking Bird is about treatment of Black People, and Go Set A Watchman is about the rights to vote among Black people, and 12 Years A Slave is about slavery. Dalam matapelajaran Sejarah, kita belajar bahawa kewujudan Protestant yang keluar daripada Katolik pun begitulah kronologinya! (Injustice had happened first apabila rakyat biasa tak puas hati dengan Spanish Inquisition yang kejam dan juga marah dengan paderi yang tamak mengutip duit indulgences/ duit pengampunan. Maka, berlaku perjuangan kecil-kecilan – memerlukan Rebels dan Questioners kan? – dan kemudian perjuangan ini bertambah lantang. Akhirnya muncul mazhab Protestant yang diasaskan oleh Paderi Martin Luther. Paderi Martin Luther menang bukan hanya kerana Rebel and Questioner… ada juga golongan atasan Upholder di kalangan paderi yang menolong beliau dengan cara diplomasi di meja runding. My point is : kita perlukan SEMUA watak, get it?).
Menuntut kemerdekaan Tanah Melayu pun begitu juga (British SUDAH TENTU kata pejuang kemerdekaan adalah pemberontak! British pun akan label orang-orang yang menentang Malayan Union sebagai orang yang ‘caustic, uncooperative, trouble stirrer’. Tapi sebab mereka QUESTION dan REBEL lah maka Malayan Union dibubarkan dan kedudukan Raja-Raja Melayu selamat hingga sekarang! At last bila public sentiment lagi kuat, Tun Abdul Rahman guna cara diplomatik merunding kemerdekaan dengan British. Tapi mana mungkin tiba-tiba British nak berunding kalau sebelum ni tak ada siapa cetuskan public sentiment! Think about it!) Aku dah banyak baca buku-buku melibatkan sejarah dan antaranya termasuklah autobiografi Mahatma Gandhi dan Nelson Mandela. Ini semua adalah sunnahtullah perjalanan melakukan perubahan! Read! Read and you will know why I believe the way I believe. I am influenced by my reading and by my basic knowledge of the course of history (yes, my history knowledge is very basic… but I have read enough to be able to detect the similarity in the plot pattern. You cannot possibly miss it when you have read enough!)
We all have our own roles to play. I won’t question your method when we have the same goals. Our characters have been made that way by God for a reason! Kalau semua orang mempunyai karakter polite Obligers, tak ada isu yang akan meletus untuk mencetus perubahan polisi.
Kalau adalah watak Questioner who are AGAINST my own goal, I will STILL oppose him. Walaupun kami ada watak Questioner yang sama, do you think we would mingle well together regardless of our similar character? No! Selagi mana aku rasa kau mempunyai sentiment yang salah dan bercanggah dengan apa yang aku rasa adil dan betul, aku tetap takkan mix well with you no matter how similar our characters are.
So… I don’t oppose orang yang berlainan watak dengan aku. Aku cuma oppose siapa-siapa saja yang bercanggah matlamat dengan aku, especially bila ini melibatkan soal keadilan dan ethical conduct.
Questioners and Rebels need Upholders. Just like Upholders need Questioners and Rebels. And we all need Obligers to support our causes because they will make up the majority!
Bila kita nak memperjuangkan sesuatu isu, make sure kita semua ada matlamat yang sama dulu. Lepas tu, let us work in our own way according to our own character. Jangan lah ada yang nak memaksa orang ikut cara dia. Sedangkan dia sendiri, jika dipinta, tak boleh nak ikut cara kita, kan?
* * *
Dulu! Dulu zaman aku naif dan berdarah muda, aku selalu cakap dengan kawan-kawan aku “Apsal kau tak lawan jer? Kenapa kau kena bertahan?”(Dalam hati: kenapa kau lembik sangat, hah?)
“Aku tak nak benda jadi lagi teruk. Ada cara lain yang lebih okey. Sabar tak semestinya mengalah.”
Dulu aku tak faham kenapa orang tak boleh be more assertive. Tapi sekarang I have become, ehem, wiser. Aku faham diorang tak boleh jadi macam aku. Plot cerita diorang lain. Character diorang lain. Plot cerita aku lain. Character aku lain. So, I appreciate them better and have stopped questioning how other people do things.
But that doesn’t mean I will follow their method. Like I said, my plot and my role in any particular event is different than yours. Our plots are now intersecting and interconnecting (like God has pre-ordained in the creation of His story) but we have different roles to play.
“Afiza, kau dah matang sekarang ni kan? Kurang melenting sikit. Tapi kau tetap cakap apa kau tak puas hati tanpa menidakkan point orang lain. That was very well done. Dah diplomatik sikit la ni” said my friend one day after I had finished debating an issue in one of our numerous whatsapp groups.
I just laughed. Because now I understand. And I can laugh. (Kalau dulu, tak cukup perkataan aku nak kritik… diorang lembik, tak reti nak speak up, tak reti nak fight, tak nak cakap benda yang betul and so on and so forth. Now I knew better. You do it your way, I do it mine. May our route converge to the same goal, Amiin. But if you have different goals than me, I will always oppose you regardless of what method you use. Sorry, nothing personal. It so happens that your goal is opposite mine).
Upholders yang pandai berdiplomasi dan bersopan santun di meja perunding, takkan nak jadi outspoken macam aku tiba-tiba. Setiap watak ada advantage and disadavantage masing-masing dalam pelbagai situasi. I will die of suppressed anger (or boredom) at meja perundingan. The meeting won’t end well if I open my mouth when I am too upset. That’s why dalam meeting apa pun I usually don’t pay attention that much and selalunya senyap (unless that meeting is interesting in some way, then I pay attention). Because the meeting table is not my turf. Meetings and me… we don’t do well with each other.
But I can, Insya Allah, thrive in a harsh environment that challenge my values because my character suits that kind of environment. That was how I survived housemanship. My attitude was “Lagi kau buli aku, lagi aku nak tunjuk aku tak kisah dan lagi aku nak stubborn. Jangan ingat aku takut nak datang kerja jumpa kau just because semalam kau marah aku tak bertempat dan tak hormat maruah dan air muka aku. No way! Aku takkan EL. Aku takkan MC. Aku takkan MIA. Sebab lepas aku keluar daripada department, lepas aku bukan lagi HO, aku akan fight isu HO cukup-cukup dan aku tak nak kau ada alasan nak jawab yang aku ni ‘not tough enough’ when I say what I say or write what I write. Bila aku raise issue, you can never say that it was because I could not survive the hostile treatment… because I could and I did… WITHOUT ANY EL/MC/ MIA… but I STILL complain because it was the truth!”
This is just how the Questioner (and the Rebel) do things! #SorryNotSorry
In the saga of housemanship training, Miya Wong plays the role of a Rebel. I stick to my role of a Questioner. We also have many Obligers who keep sharing her post all over social media.
The awareness is there already. Insya Allah, political will is getting there.
Now to upholders of system (they keep saying to go through the system. Go through the right channel. What if the channel is broken, though? Sampai bertahun-tahun HO Orthopaedic Sungai Buluh ketakutan dicabul kot! Channel apa slow sangat ni!?) and upholders of politeness (“diplomacy is the best way because we cannot fight alone,” they say. But I never minded fighting alone. But perhaps, I won’t get far.)… you guys can now play your role because the Rebel Miya Wong had stirred up an issue and the Questioners/Rebels/Obligers pun dah share dia punya status all over social media to create awareness and stir public sentiment. This is the ideal time to change the culture and win our mutual goal. Use your charming diplomacy at the meeting table NOW and prove to us that it works!
Oh all Upholders, are you going to uphold the bullying of house officers (in which case, I will continue to fight you and I will keep creating awareness in the social media and rebut all your biased posts. Sorry, nothing personal. I am just playing my role), or are you going to use your diplomacy to uphold the principle of Primum, non nocere in the training of housemen.
Primum, non nocere. First, do no harm!
Please , if you are going to uphold anything, uphold that, first!
After recently doing an attachment in another hospital, meeting other MOs who are based in many different hospitals all over Malaysia, I’ve had an opportunity to discuss with them regarding health care issues at their respective setting, and about how they run their service in their respective hospital. My eyes were open to the fact that no system and no service is perfectly run. But we must continually improve the system, regardless. The conversation that I had with fellow attachment doctors reminded me that I had written about some of these issues that we have talked about a long time ago.
I wrote this article below about one year ago, before the GE 14. But I did not publish this post publicly because it was still a bit of a sensitive issue at that time. Now that we have changed to a new government, I decided that I should publish this post publicly. One year ago, I had written this article after a very emotionally-charged encounter with a patient that made me feel defeated. That made me feel like I couldn’t do much for her. That made me question myself regarding why I was even a government servant? That made me want to migrate elsewhere! That made me feel very hateful of the BN government! Last year, there were so many issues that affect the provision of healthcare in Malaysia that made me wonder if I could ever be the kind of doctor that I had always envisioned myself to be.
And I blamed the government then. Hahah.
Of course after the GE 14, I am all hopeful and optimistic these days. But I also think that the issues I had ranted about one year ago are still relevant. And therefore, since I am having a writer’s block at the moment and have no materials or issues to update in this blog for the time being, I decided to publish this old article of mine that had been collecting dust in my hard drive. (One blogger had asked me regarding how I manage to maintain my blog since 2009 and not suffering from a writer’s block like her? Most of my friends’ blogs were not updated for many years. Writer’s block is real, people! It is the most dreadful thing that can happen to a writer. So I told her that I write a lot of things that I don’t always immediately publish in this blog and simply keep them in my hard drive. When I have no materials with which to update my blog, I will simply choose one of those unpublished articles to be posted. Writer’s block sometimes can persist for months, folks. So when I do have things to write, I would go on a binge writing session and put those articles away as reserve. When the next writer’s block strike, at least I would still have something to post in this blog. So that’s the secret. Maximize your articles productivity when your thoughts are clear and chockablock with ideas but don’t publish all of them immediately in your blog. Keep a few of them away to tide you over in the months when you are suffering from lack of productivity secondary to writer’s block)
So here’s the article I had written one year ago and it was about social justice. Enjoy!
For The Sake of Social Justice
The problem with me is that I have a pretty high expectation about most things. I really do.
I am not a perfectionist, though. I am a practical idealist (though some would argue that the term ‘practical idealist’ is an oxymoron).
You see, there are times when I can relate to difficult patients, because I am pretty difficult myself (with very good insight about my difficult temperament. Hahaha). Trust me, you don’t want me as your patient.
For example, if I had waited for four hours to see a doctor, you can bet your little finger that I expect a lot from the consultation later. A lot!
I would feel pretty disappointed (like I was short-changed)if the doctor simply asked “Ada dengar suara bisik kat telinga? Ok, tak ada. Ubat makan tak? Boleh kerja? So, semua okey? Okey, kita sambung ubat macam biasalah.”
Four hours of my time yields only 5 minutes (or even less) of consultation?! Any REASONABLE patient would feel short-changed (let alone a demanding and a difficult one!). The patient might even decide to default follow up next time because he/she didn’t feel the consultation was worth the trouble and the waiting time. (I certainly know that I am the type of person who HATES waiting. Hahaha. Orang macam aku takkan mau dah jumpa doktor kalau aku rasa tak berbaloi! I won’t do something that don’t give me worthy outcome!)
Sometimes, I feel so terrible about my inability to spend more time to see each and every one of my patient. There are times when I want to prolong the consultation simply because I want the patients to feel that their waiting was worth it. But when I look at the piles of cases left to be seen in front of me, all my good intentions fly out the window.
However I always make sure that I ask a token question of “Ada apa-apa dak nak tanya lagi?” or “Nak habaq apa-apa ka sebelum kita habis?” or “ada apa-apa lagi nak bincang dengan doktor sebelum habis?” (Nampak tak perkataan ‘sebelum kita habis’ dah ada unsur-unsur nak kejar patient? Unsur-unsur nak menutup consultation, tetapi masih berlapik. Hahah)
You know, it is laughable. Usually we said “Sebelum kita habis, ada apa-apa lagi ke nak tanya or nak habaq?” for a conversation that has been going on for a long time.
BUT! If they just came and ‘bontot pun tak panas lagi” and then suddenly I used the phrase “sebelum kita habis…” Hahaha. God… it is ridiculous, isn’t it? (If I were the patient, I would go, “You mean, we are already about to finish? We barely even started, doctor.”)
Most patients would say no. That they have nothing else to say or to ask. And some chronic Schizophrenic patients with negative symptoms really have nothing else to ask. In the first place, some of them are monosyllabic in answering questions. And some of them have poverty of thoughts and would not volunteer any information that is not directly asked. They don’t elaborate much on their answers because after years of illness and cognitive impairment, they are not able to produce the sort of spontaneous speech that we all have taken for granted.
And some patients who are rushing to pick up their kids from school really don’t mind that the consultation is short. (“Saya tunggu lama sebab nak ambil ubat ja. Memang saya nak rushing balik kerja/ambil anak/nak masak. So tak pa lah, doktor sambung ubat ja lah.” they would say with an annoyed tone because they have been waiting for so long just to continue medication) But I still ask that token question of “ada apa-apa nak bincang dengan doktor?” just to comfort myself that I have done my job. That I have invited them to say their piece. That I have fulfilled my obligation to hear them out after they have waited for so long. And if they said they were fine, then I won’t feel guilty if I decide not to probe further. So it makes me feel better that I have asked. (As if my ‘ajak-ajak ayam’ to talk further is good enough! LOL)
Of course, we KKM staff can comfort ourselves by saying “Ni hospital kerajaan. Nak buat macam mana? Kalau nak cepat kena pi private. Patient lain dok tunggu lagi lama. Kalau tak boleh tunggu lama, pi lah private.Kalau nak luah perasaan lama-lama, kena pi private. Kalau nak dapat doktor yang layan awak macam raja, kena pi private.”
Is that gonna be our tagline? “Kalau malas tunggu, pi private” or “Kalau nak demand, pi lah private”, dan yang sewaktu dengannya?
Whatever the patients want that we cannot fulfil, let’s direct them to the private clinics, huh?
So, other than our routine core business of seeing patients (furiously fast) what are we doing here as a government staff?
See…we in the government, have no choice but to prioritise. Some cases are difficult and we do spend more time exploring their issues to their hearts’ content (and our hearts’ content). Not all cases can ‘touch and go’. Affective disorders (with new stressors) will take up almost half an hour of our time, at least (and in the mean time ,’to be seen’ cases keep piling up in front of you. Patients keep knocking on your door, asking for you to hurry up because they have some other urgent matters elsewhere).
Some people think Schizophrenia is difficult to see. (“Pesakit Schizophrenia mesti aggressive. Susah. Mesti lama nak kena settle,” some inexperienced non-psychiatric doctors might think). But actually, psychotic disorders are the best cases to handle when you are rushing. When they are aggressive, you just jab them with IM Haloperidol. (If they are already stable and not aggressive, you just asked “Dengar suara tak? Kalau tak dengar suara, dose ubat ni kira dah oklah. So, kita sambung ubat macam biasa.” End of consultation. That’s the main gist of it, with some variations. When you are rushing, you cannot be as thorough as you like. It is so sad.)
It is the affective disorders that always make me feel guilty when I cannot see them longer than I want to. They would cry, then they need to talk…and talk…. AND talk. And they will cry some more. They deserve my time… and I cannot fulfil their expectation, sometimes. Not because I am rushing to go out for lunch. But because other patients are waiting too and they keep rushing you! I could forego my lunch if patients are willing to postpone the rest of their activities just to wait for me to thoroughly see each and every one of them. But they are not willing to postpone picking up their children, are they? They are not willing to postpone going back to their office too, are they? They are not willing to postpone getting back home so that they can carry on with their routine, are they? THEY couldn’t wait! And therefore, I couldn’t spend more time than I would have liked to if it were up to me.
But when I DO spend my time with them, we get distracted a lot. By noises! By people going in and out. By conversation crossing over, here, there and everywhere. I lost focus. My irritability raises quite a bit when I am forced to converse in noise. I hate it.
It’s just not ideal.
The ideal side of my ‘practical idealist self’ finds it intolerable. But the practical side of the same self know that I should learn to acceptthe situation and make do with whatever we have.
If I were the patient, I would write a letter of complaint to Pengarah and said “Dahlah masa menunggu lama. Bila masuk bilik, jumpa doktor tak sampai 5 minit. Dalam 5 minit tu pun, bilik penuh, sendat macam dengan apa. Saya cakap pun kena kuat-kuat, sebab bising. Bila saya cakap kuat, pesakit sebelah lagi pun cakap lagi kuat sebab dia pun nak didengari juga. Doktor saya pun terpaksa cakap kuat sebab bising. Doktor sorang lagi pun akan cakap lagi kuat. Belum lagi medical students yang dok berkeliaran sana sini. Saya rasa saya lagi stressed out. Dalam bilik tu kena share punya ramai orang! Ada 4 doktor dalam satu bilik, campur empat pesakit dan campur keluarga mereka sekali dalam bilik tu. Dan student-student dok pi mai, pi mai. Rasa-rasanya, saya ada mood tak nak cerita masalah peribadi saya dalam suasana yang macam tu?”
(I told you that I am a difficult person. You really don’t want me to be your patient. See? You have no idea how thoroughly I can voice my complaints, and how profoundly I can elaborate on it. When I have something to say, I REALLY say it. Haha)
But as a pragmatic, we deal with the limitations that we have. We make things work because we have NO OTHER CHOICE. And this situation is similar in ANY government setting. Consultation rooms are shared because there are simply no more extra room to be used. When I talk to my friends elsewhere, they told me that in certain settings in KKM, even the pantry is used to see patients! (Again, if I were the patient, I will definitely complain.)
We in KKM might say, “So what? Bayar RM5 saja, dah mengada-ngada. Patients tak berhak nak demand dengan RM 5,” Eh? Betul? Cuma kita sebagai doktor, patut ada rasa tak puas hati bagi pihak pesakit. Kita kena ada rasa nak improve kita punya service. But who would care about what the doctors had voiced out to the admin? People would only start to care once the patient himself/herself complains against any hospital in the social media and it becomes viral.
Imagine if all doctors told their patients, “Encik pi lah mengadu. Nah….ni borang aduan. Lagi banyak encik mengadu, lagi senang kami nak justify buat perubahan. Semua ni perlu budget yang kami tak ada.” Why don’t we encourage patients to complain against us?!You see….that’s what the practical side of my ‘practical idealist’ self would think as a good solution. My practical side thinks that encouraging our patients to complain against us is the most effective way to get the ball rolling. To get the attention of the higher up.
But no! Once you are in admin, you don’t want to hear complaints kan? Sebab nanti kau yang nak kena jawab. So…I don’t know. It’s a Catch-22 situation. Damned if you do, damned if you don’t. Maybe admin should welcome complaints as a method to pressure the powers that be to pay attention. When called to produce an explanation letter, we can simply write as follows: “I have nothing to explain. The patient was right in everything she said. Now, you deal with it! How can you help me to improve my service with the paltry, minuscule budget you are giving me? Call me when you have the answer. I am most anxiously waiting.”
Tak cukup staff kat ward sebab memang tak ada pengambilan staff baru… okey, we deal with it.
Tak boleh start appropriate medication untuk patient sebab tak ada quota, we deal with it.
Tak boleh nak provide more comfortable consultation environment for the patient, we deal with it.
Tak boleh claim elaun untuk provide good community service during oncall, we deal with it.
We are okay to deal with it as long as we think the government has no money through NO FAULT OF THEIRS. But that is not the case! The case is they are very much at fault! Where the hell is the GST money?Budget cuts for health is starting to affect our patients.
The case is, the government is very incompetent through blatant corruption that has been swept under the carpet again and again.
The case is, all these difficulties are secondary to greedy politicians swindling money right, left and center!
That’s the case!
So nowadays, I push all my patients to apply for OKUcards and allowance. I used to dread seeing the OKU forms being brought by patients…. because it meant that I would have to go to my specialist, wait outside her door and pounce upon her once she has ended her consultation with her patient in order to get her to sign the OKU form. I hate waiting. The time waiting for my specialist to sign the OKU form can be used to see patients. That’s why I used to feel a sort of chest heaviness whenever I saw my patients bringing OKU forms that needed to be signed (In my mind, I went, “habislah masa aku terbuang menunggu depan bilik specialist untuk sign OKU form”. I generally don’t like to interrupt an on-going consultation and would wait until my specialist has finished with his/her patient before I would ask them to sign the OKU form. I project my own tendency to feel irritated when people interrupt my session with my patients. So I would have to wait in front of the specialist’s door until his/her patient comes out of the room… only then, I would enter the room to get the form signed.)
But nowadays, I stop rushing or thinking about wasted time. I give away OKU forms to most patients who don’t yet have an OKU card, even when they didn’t ask for it. “Nah, ni borang OKU. Akak balik isi borang ni, nanti bawa mai kat saya.” Some of them did not know that such welfare money is available, but I would voluntarily tell them to go and apply for it, overzealously pushing them to get the OKU card.
I want my patients to get the money, because otherwise those money will only sit around waiting to be swindled by other greedy hands. My patients have the illness, and they are entitled to it, in a way that no politicians are. At least I know that some of the taxpayers money are spent where it should be. That is my version of social justice. Distribution of wealth of the nation must be fair. In the cases when it is grossly unfair, then we should do everything in our power to help tip the balance.
In my current situation, the only thing I can do is to promote to every patient to apply for all sort of welfare aids that are available in the country. My patients are more deserving of the money than undeserving kleptocrats. Khalas! And if it means that I am going to have to waste some time getting the OKU form signed, then be it! For just a little bit of social justice, the wasted time would be worth it.
Because, really, what else is there to do? When you are working as a public servant of a corrupted government, what else is there to do to ensure just a little bit of social justice takes place? Maybe… the time has come to really grieve.
When I read back the above article that I had written one year ago, I remember again all the anger and frustration I had felt at that time. But I also experience that bittersweet sensation one usually feel after having defeated an oppressive opponent in a torturous drawn-out battle.
Bitter from remembering the anger I had once felt against the government! Sweet because I had played a small part in toppling the kleptocratic government when I became a PACA for PH!
When I heard that a movie has been made about the saga of GE 14 and it would be released this September, I just couldn’t wait to watch it! Guys, I don’t usually watch local movies, but I do watch all local movies when they are about patriotism! And this one is special… because this patriotic story happened in my lifetime. I was a witness to a great history! And now that it is made into a movie, I will not miss watching this.
And what makes the movie even better is, one of the directors for the movie, Nik Amir Mustapha, was my batchmate in MRSM Langkawi! So, there are so many reasons why I am so excited to watch this movie.
Come on guys, let’s watch it when it is released on 16 September 2018! Tempt yourself by watching the trailer of the movie below. The trailer is inspiring!