Doktor Diktator

"Kenapa doktor zaman sekarang perlu menjelaskan semua informasi kepada pesakit?"

Pertanyaan doktor forensik tersebut membuat aku ternganga. Kalau zaman dulu tak payah ke?

Hubungan doktor-pesakit telah berevolusi seiring masa. Seabad lalu pesakit menganggap doktor sebagai tuhan. Tak lama setelah itu method Paternalistic diterapkan; seperti hubungan ayah dan anak di mana si anak harus menuruti segala perintah sang ayah dengan kepercayaan bahawa keputusan ayah sentiasa terbaik.

Beberapa dekad terakhir, informasi adalah segalanya. Kenapa?

1. Pesakit semakin cerdas, mereka mahu membuat pertimbangan dan keputusan sendiri.
2. Pesakit tidak percaya lagi kepada doktor.
3. Doktor tidak berkompeten lagi untuk membuat keputusan terbaik.
4. Tumbuhnya undang-undang yang tidak berpihak kepada sistem kesihatan.

Semua di atas adalah sebab, namun menurut doktor forensik tersebut, penyebab utama adalah dari doktor itu sendiri.

Doktor sekarang tidak sama lagi dengan doktor sejati di zaman dulu. Kenapa?

1. Dulu, sangat sukar untuk menjadi seorang doktor. Maka setiap mahasiswa yang memilih perubatan sebagai profesi akan berfikir masak-masak dan benar-benar bersungguh untuk menjadi doktor yang baik.
2. Dulu, doktor sedar fungsi mereka adalah mengubati dan merawat. Sekarang niat kebanyakan doktor selalu melencong ke arah material.
3. Dulu, mereka yang masuk ke jurusan perubatan benar-benar layak dan terpilih untuk belajar ilmu perubatan. Sekarang siapa saja boleh menjadi doktor.

Kita beri satu contoh. Seorang pesakit kanser payudara dianjurkan untuk menjalani operasi untuk membuang benjolan pada dadanya. Seorang doktor harus menjelaskan pilihan-pilihan operasi yang ada, kelebihan dan kekurangan setiap satunya dan outcome dari setiap pilihan.
Dengan memberikan penjelasan, pesakit dapat menilai adakah doktor tersebut benar-benar tahu tentang penyakit tersebut, doktor dapat berkomunikasi dengan pesakit dan mengetahui keadaan dan kemahuan pesakit dan menyesuaikan dengan pilihan operasinya nanti.

Kita melihat hubungan demokrasi doktor-pesakit ini memang yang terbaik untuk masa ini, namun kenapa dulu paternalistik sempat diterima dengan baik? Malah sekarang cara ini masih digunakan sesetengah doktor. Ini kerana seorang doktor bertanggungjawab memilih yang terbaik buat pesakitnya tanpa melihat status sosial, kemampuan dan kecenderungan finansial doktor sendiri.

Sekarang doktor cenderung melayan pesakit seperti klien atau pelanggan produk. Sesungguhnya hubungan peniaga-klien dengan doktor-pesakit merupakan dua hubungan yang berbeza.

Peniaga boleh memberikan mutu service bersesuaian dengan bayaran yang diberikan klien. Doktor tidak. Apakah pesakit kaya atau miskin, perkhidmatan harus sama rata.
Peniaga boleh menutup kedainya bila masa saja dia mahu dan menolak memberikan khidmatnya. Doktor tidak. Tak kira waktu dan keadaan, bila seorang pesakit memerlukan bantuan, dia harus menghulurkan segala kemampuannya.

Boleh dikatakan bahawa method paternalistic masih applicable jika seorang doktor itu benar-benar menjalankan amanah yang telah diberikan dengan jujur. Doktor boleh saja jadi diktator, selagi mana dia adalah doktor yang baik dan mempunyai ilmu. Semahir apapun seorang doktor berbicara, kalau tidak ada ilmu di dada, untuk apa komunikasi?

*Agak runsing dengan penyalahgunaan amanah yang semakin berleluasa di pelusuk dunia. Kes Hospital Internasional di Jakarta, korupsi Bank Century, krisis Wall Street, protes 'Baju Merah' di Bangkok Thailand adalah beberapa saja dari kesekian kejadian.

-IMAN NAILAH 2010-

Betapa Lemahnya Iman Ini

Susah hidup di zaman ini.

Banyak orang jahat,

sedikit orang baik,
hampir pupus orang beriman.

Bukan senang nak jaga iman di uzurnya alam. Yang batil dianggap normal, yang baik dianggap aneh. Yang menegakkan yang benar biasanya kalah. Yang menang adalah suara-suara ramai.

Demokrasi dan majoriti memegang cemeti.

Tak salah demokrasi, tak salah majoriti, selagi yang banyak itu benar. Tapi di akhirulzaman ini, kebanyakan manusia itu layaknya kanak-kanak belum mumaiz. Kalau belum masih boleh diselamatkan, tapi nampaknya seperti tidak pernah dan tidak akan.

Sejarah beberapa dekad menunjukkan betapa kita di penghujung jalan. Kita melalui titian rapuh tak berpegangan. Kita berjalan tanpa panduan, kita bergerak tanpa haluan, kita berpecah saling berlumba menuju arah yang tak jelas tujuan. Kita sesat.

Na'uzuibillah, semoga bukan kitalah 'kita' itu.

Sesungguhnya lemah jiwa ini berdiri di tengah dunia yang hampir hancur dengan makhluk-makhluk di dalamnya melata tanpa arah, penuh alpa dan dosa. Lelah melihat dosa, resah melayani rasa, hampa menyusuri arus manusia.

Aku takut disoroti lampu noda sampai silau pandangan dan akhirnya buta.
Lemah, ya aku lemah kerana aku insan biasa.

Aku meminta agar Allah mengurnia keteguhan yang tak terharga menghadapi arus dunia demi satu; SYURGA.

-IMAN NAILAH 2010-

Peringatan Buat Diri

بسم الله الرحمن الرحيم

	Sami Yusuf - Supplication .mp3
	Found at bee mp3 search engine

"Orang yang berakal itu ialah orang yang dapat menundukkan dirinya dan bekerja untuk (bekalan) setelah mati. Orang yang bodoh itu ialah orang yang mengikuti hawa nafsunya dan mengharap dari Allah berbagai harapan."
-Al-Hadith

Kita dunia
Seperti penunggang ombak
Kita tetap duduk
Sedang masa berlalu
-Imam Syafie

"Yang dekat (hari kiamat) telah makin mendekat.
Tidak ada yang akan dapat mengungkapkan (terjadinya hari itu) selain Allah.
Maka apakah yang kamu merasa hairan terhadap pemberitaan ini?
Dan kamu mentertawakan dan tidak menangis?
sedang kamu lengah (darinya).
Maka bersujudlah kepada Allah dan sembahlah (Dia)."
- An-Najm : 57-62 -

A Beautiful Mind

A beautiful movie indeed.

I've heard about this movie for the first time from dr.Kris, a resident in Psychiatry Department, that was more than 10 months ago. It was just yesterday I watched it and I regretted for not doing it much earlier, when I'm in the department.

But better late than never.

A Beautiful Mind(2001), a film inspired from the life of dr. John Forbes Nash, a mathematical genius who made some of greatest discoveries in economic history. He is always unique in other people eyes, asocial but that's the thing that attracts people to him. He met his wife, Alicia Larde which is also one of his students at MIT. At the same time he works as a code broker for a classified bureau, and not long after that a tragedy occurs. This is when his life changed 180 degrees.

I don't want to spoil the main twist of the story, but I have to mention this; the movie are very successful in showing me a perspective of a troubled man's eye, that millions of other people out there were also suffering. And what's extraordinary about this story is that he achieved what people thought is impossible. That's an inspiration.

I insist all of you who read this, please go watch this movie. The first 15 minutes might be a little bit dull and too complicated for us to understand, but then the pace will get better and let you stuck to your seat till the end.

I have to remind you that this story isn't truly based on dr. John Nash's actual life as many facts were deliberately omitted from the film.

*A Beautiful Mind starred Russel Crowe, Ed Harris and Jennifer Connelly and directed by Ron Howard.

-IMAN NAILAH 2010-

Quiet Quote of Mine

What signifies you is not just being right, but to know that what you are doing is right.


It is easy to believe. What's difficult is to think, and then believe.


Friends are everything that connects you to life.


FAITH is the door, KNOWLEDGE is the key that opens the door, and LOVE is the thing that keeps you inside the door.


Chance is a dodgeball. It come so fast you gotta be alert to your surrondings. There's only one time you are going to be hit by it, you gotta catch it or you lose.


-IMAN NAILAH 2010-

Lost in the Surgery Jungle

Okay okay I admit. 12 weeks was too long for not updating my blog. I'm not busy. I'm lost in Surgery Jungle. Now I've made my way home. So let me tell you about my 12 weeks journey.

1. Emergency Room was amazing. Best experience in the department. I got to be the first to attend really sick people, to access their problems and get to a number of differentials. I did history takings, I took their blood for lab exams, I infused them and inject them their medications, sent them for x-rays and scans, it was a good thing that we have to stay there for two weeks, cause its a great feeling for being able to ease their discomfort and complaints. I'm not saying we are having a good time all the time, but the adrenaline, all the running for the sake of a person's life, and the satisfaction you get when all the hardship pays, it's priceless. Until now, I'm still hoping I can repeat it all once again. But with the new emergency room (air-conditioned and a bit smaller), it will be quite different from what it was, not saying one is more exciting than the other. One thing for sure, now you can't hear the sound of the ambulance anymore.

2. My LN (Luar Negeri) was in RS Islam Faisal. Sharing the room with other coass, they put a telephone in the room so if there's a need for any of the coass, the phone will just ring. So everytime it rings, all of us (Paeds, Internal Meds, Neuro and Surgery) will look at each other, guessing whose is it. In each of us praying, hoping that it's for other coass, please please please~ Then the moment of truth: usually it will be Paeds or Interna, but later on it turns out that Surgery had become Faisal's favorite. On two in the morning it rang and rang for this one sleepy Surgery Coass. When I got up to see who's the lucky patient, it was a guy with a tiny laceration at his neck, saying he was stabbed by a 'taji' that the locals believe to be poisonous. The chaos started when all his gang came and showed dissatisfaction on what had happened to him, holding for a revenge on the guy who had done this to their member. As the only 'doctor' there, this is quite terrifying for me, but I had to pretend that I'm not afraid. God knows how I really want to get off of their stares.
Yet, the nurses are super nice and sporting(most of them), Dr.Erwin had been nice and taught me a lot, dr. Ira is so much fun, and here is where I met dr. Cholis for the first time (note this!).

3. The WARDS. One by one subdivision really testing your patience and endurement of all the nonsence, irrationals and abundant jobs that were burden on you especially when most of your group partners were master of 'kalasi' or the sneakiest person you ever know. Well, I'm not that hardworking or dilligent, but I know my responsibility, and unfortunately I really spend times in doing my job. The job that should've took a few minutes might took me an hour to finish it. Or maybe I was distracted. I don't know. Most of my days in surgery, I'll go back at 4-5pm eventhough I'm not on-calls. When I arrive at my room sweet room, my bed was the only thing that matters.

4. Some patients stick neatly in my head and my heart until today. They are a few special people that caught my attention, and I think it was fate. A is an extraordinary boy who was born with incomplete formed bladder and he lived with it for 14 years. He can't feel when he urinates, and it's causing people to avoid being near him, because of the bad smells. He suffered mild depression due to the social rejection, and because of that too, he was absent in a lot of school days, making him a little late in the academic level. Fortunately, his 2 months waiting in the hospital was not worthless. With the collaboration of many divisions in Surgery Dept of Wahidin Sudirohusodo Hospital and the specialists from Jakarta, he can now go to school with a smile. He had already has his bladder made from his colon, and in a few months he will undergo another surgery to reconstruct his penis.

Mr.D was just another patient when he came in the Urology Ward. He caught my attention when his urine catheter kept on obstructed and took a lot of energy and time to be . It's interesting that for almost one month the dr. Aga and other doctors were struggling to get him operated for his prostate cancer. His grandson kept on telling me he's quite worry about his grandfather's condition if he undergo operation because of his age. But I said it's gonna be fine. Yes, he IS old, but the doctors are considering everything in order to get him in his best state. After a few weeks full of transfusions (almost 10 bags of Packed Red Cells/Whole Blood and 4 bottles of albumines I guess), lab tests and controls, converting his medical insurance status, at last he entered the operation room and the prostate was. Not long after, I discovered that his real age was not 70, but 90! Then it all comes to me like a puzzle; he is senile, he can barely walk and he actually looked old enough to be 90, he looked like my old grandfather in the last days of his life! Yes, and he get through it all. I hope he lived long enough to enjoy his un-retented bladder~ Well, he made me miss my grandpa more (he does look a little bit like him), maybe thats why he is special thru my eyes.

5. The Doctors. Well, I'm sure many of you can guess who's on the list of my favorite surgery doctors. I told about them too many too much I guess. Let just mention and not tell a tale. They are: dr. Johan G. Gama, my all time favorite teacher and idol(doctor), dr. Alders who had inspired me and taught me a lot, dr. Syukur who is so friendly and always generous at giving 'tenteran', dr.Cholis, Sp.U who always wants to teach and remembers my name ^_^, dr.Willy, Sp.BS who made me realize I must do better, dr. Subchan Aga whom I'm in debt( don't worry, I'll pay you before I go back), funny and friendly dr.Fikhi, dr. Asdar and dr. Irsal who have helped me through my exam with Prof AAI, and many more whom would make a list: dr.Erwin Patabang, dr. Ira Umar, dr. Ahmad Wirawan, Sp. A, dr. Rizal(who taught me applying splint), dr. Toton, dr. Reny, dr. Chairul (ortho), dr. Sugianto, dr. Ronald, dr. Tantowi, dr. Made, dr. Billy, sp.B, dr. Gunadi, Sp.B, dr. Warsinggih, Sp.B-KBD, dr. Sofyan, dr. Rizqi, dr. Yoskar, dr. William, Sp.B-Onk, dr. Ari G Hoste, dr. Mulawardi, dr. Pipin, and a lot more. I'm sorry if I forgot to include your name, all much appreciated. Thank you.

It's a great coincidence that dr. Johan was there while we are taking this picture.

It's a crime not to include him.

6. Bad memories are kept as a lessons so it won't happen again. One of them is when I'm in Thorax subdivision with a patient named Mr. B. He has a vascular disease called Deep Vein Thrombosis and he only have her mother taking care of him. While he can't walk and her mother doesn't speak and understand Bahasa Indonesia, many of his matters has to be done by somebody else, usually its nurses or coass. One time, his wound was biopsied and the sample need to be taken to the lab. So I willingly offer my help as I thought it would be simple, when actually it's not. I have to photocopy his documents and send it to an office to get stamps, then queue to get the result codes. So I gave the documents and the codes back to the patient, asking him to take care of it, explaining how important they are for his medical record. A few days after I leave the subdivision, I was called by the nurse where Mr.B was treated and was asked about his insurance guarantee documents. I told her what I did and she got so mad cause I didn't return it back to the nurses. I was confused, where would it go? Then I asked Mr.B and he said they might have lost all the documents because they kept on moving from a bed to another bed. I searched again and there's nothing left except his ID. The nurse holds me responsible for the loss of the documents as they are the only thing that pays for their medical expences. I was terrified. I don't know waht to think and I'm so afraid they were going to ask me to pay for Mr.B. After a few days another nurse came and ask me to manage his insurance guarantee at the Jamkesda Office. In a few minutes, alhamdulillah, it was all done. I've passed my charges.
I still remember what he said," I know your intentions are good, it is to help, yes. But sometimes a good intention itself is not enough. You need to do it right, sometime with an evidence that show you really did it."
I've learned my lesson.


Everybody is going to get through this jungle. It's gonna be different, but I assure you, it's gonna be priceless.


-IMAN NAILAH 2010-
Makassar, Sulawesi Selatan.

*kalasi = the act of running away from responsibility, talent of vanishing from scene.
*taji = a moon-crest shaped, sharp edge weapon