Believe it or Not, This is Our Lifeless Life

10 things people don't know about doctors (especially houseman):

1. We are busy. Much busier than prime minister's PA :p

2. So busy that sometimes we have to 'tahan kencing'.

3. We usually did not eat lunch.

4. We have at least twice a week of 36 hours++ service which is called ONCALL (rarely with sleep).

5. Most of us might have vitamin D deficiency as we rarely see the sunshine (from home 6am, go back at 7pm).

6. Most houseman has experienced at least one car accident due to post-call/*tagging exhaustion or sleepiness.

7. Unlike other jobs, we don't have weekend off (at least medical in HSB don't have). Work until you drop!

8. We are so busy sometimes we cant even have time to attend everyone the way we should have done. I'm sorry to all my patient if I have ever made them feel ignored, please forgive me.

9. No excuse. Sleepy? Tired? Hungry? Are they more important to be fulfilled than your patients? No. So no excuse.

10. No room for mistakes. But human always make mistakes. That's why, we are not depending on ourselves, but we are doing our best and leave it to Allah. Keep close to Allah, He'll guide us to the right path.

~Some were exaggerated, most of them were the truth, but none are lies. These are written to show the real world of houseman and for us doctors to find the real passion in this profession. We can always be human, but superhuman is built from the heart. Let's be proud of this profession for the sake of human lives, insyaAllah there will be blessings for us when we do it with passion.

~Thanks to my family and those who have helped me through my days of fatigue and tears. Only Allah can repay the love you have given me.

*Tagging: the first 1-2 weeks of adaptation in a department/posting where we have to stay from 7 am to 11pm.


-IMAN NAILAH 2011-

Manusia untuk Manusia

Aku meraba-raba tanpa tongkat dan kaca mata
Di arus insan bersaing dengan masa
Tiada ruang untuk kesilapan mahupun airmata
Lelah dan marah hanya dalam rasa
Aku memakai topeng muka
Mahu dan mampu, senyum dan suka

Tiada erti lapar dahaga
Biologi diri teraniaya
Luka manusia yang bermakna
Bila diri bukanlah manusia?

keluh diri kadang bersuara
malah memakan hati, yang rela jadi terpaksa
benih tak berbunga
terlupa akan janji dikata harus dikota
asal tebalnya kitab buat beramal
bukan kot putih atau label di dada

Ada apa pada nama
Ada apa pada takhta
Bila tiada RASA?

Inilah kita, berjuang demi nyawa
bukan tidak berharga, bukan dilupa
tapi akan lebih bermakna
bila pengorbanan jadi sedetik lebih ceria
untuk makhluk bernama manusia.

Soooo Not Cancer!

Wonder why in the last few months I never write about interview, getting letters from SPA, busy settling and preparing things for housemanship and the fact that I'm going to start my first job in the next two weeks?

I'm so in denial.

I'm running away.

When it's all over your head night and day, then the first thing to do is to try distract yourself with something else. That's what I'm doing. I try not to add the stress by talking about it and not trying to act like it is all okay. Yes, it's scary, that's what I really feel, not discouraged, but scared at the fact that my life will change 180 degrees starting next week.

I'm swallowing this fact like going through 5 stages of grief in cancer.


Okay okay, too much to be compared with cancer. Nonetheless, the first stage went well. I skipped second stage, or at least went through it by putting all of the emotion to myself - no one to be blamed but myself right? - and I'm not sure whether I arrived at bargaining stage yet. Can I have a little more time? :p I really hope to just skip the fourth stage cause it's only gonna eat me up - no good. oh Mr. Five, there you are. I can see you now.

Okay. This is really just nerves talking. I'll be fine. Innallaha ma'ana. Bismillah.



-IMAN NAILAH 2011-

10 Sebab Kenapa Koas Tak Sabar Nak Jadi BCL

Kenapa semua koas tidak sabar jadi BCL(Bukan Coass Lagi)?

1. Sebab koas tempatnya paling bawah dalam hierarki petugas kesihatan.

2. Sebab koas kerja dia TNPS (vital signs) trusss... Emang kami monitoring machine??

3. Sebab kalau ade something wrong, or somebody messed up, coass is there to take the blame.

4. Sebab kalau doktor penat atau badmood, die boleh marah koas, kalau nurse/midwife stress die boleh marah koas, kalau koas depressed nak marah sape? Makan hati jela.

5. Sebab kalau org lain tidur itu namanya rehat, kalau koas tidur tu namanya malas.

6. Sebab koas kalau pegang patient, itu dinamakan malpraktek. ???!

7. Sebab kalau doktor atau nurse taknak buat keje tu, sila serahkan kepada koas. Jadi koas dapat tindakan paling tidak best di dunia.

8. Sebab selain pelajar medik, koas juga boleh dijadikan sebagai delivery boy/girl. Tolong fotokopi, tolong belikan nasi kuning, tolong hantarkan sample urin ke lab. Tinggal order saja 24-7...

9. Sebab koas itu secara umumnya dianggap serba tidak tahu. Kalau terlalu tahu (dapat jawab soalan yang doktor tak dapat jawab) kata nak tunjuk pandai. Kalau dah memang tak tau, nama pun koas, apela die tau...

10. Sebab ya, emang kami masuk kedokteran mau jadi koas? Mau jadi dokterlah! :p

Ditujukan buat semua koas ;) Semua doktor pun pernah jadi koas, jadi faham sangatlah life as a coass. Of course we learn a lot too, despite all the ridiculous things that we have to do. This does not apply to everyone, as every coass has different journey to go through. Enjoy ur moments.. The time will come when u look back and laughing at the unforgettable memories.

*Coass/koas = Co-assistant : Istilah untuk pelajar perubatan yang sudah masuk ke fasa klinikal di Indonesia


-IMAN NAILAH 2010-

MIRACLE

Have you seen the face of a newborn baby? Have you ever hold them with your bare hands? Have you smell the scent while touching your nose to their warm, fragile skin?

It's like seeing a vivid, glowing ray so humid it makes you dwells in it. And even when you are in the bottom of the world, the darkness of no hope, the suffocation of no air, it comes like a door to heaven, a light so bright, a breath of fresh air. You are not only seeing it, but experiencing a miracle.

God made us from the conception of two different cells that fits each other in a way, then combined to grow into a human being. A process no man can replicate, even being studied for hundreds of years, happened from the days of Adam and Eve, not a single thing changed until today, but still it impresses us in awe. The fact is: we are the best creation ever made, the most perfect thing we will ever seen in our life. And to see things in their best form is when they are brand new.

I've watched hundreds of mothers gave birth to babies, the hurdles, the tears and smiles, we all will be there, InsyaAllah. With every birth of a new life, obviously no words can describe the feeling of the birth giver, but witnessing it for me, over and over again, the feelings never change. The warmth still covers your heart, filling it with live. I'm so glad I can appreciate this panorama again and again, being astonished every time and reminding me back to The Most Intelligent, The Creator, Allah s.w.t.

Once, I've seen a mother in labour of her child, she seems so exhausted, she might have been doing this for a few hours already. The doctors keep on motivating her to continue and not giving up. After a half an hour at last the baby was born. He is silent, no movement, and there's no effort to make the baby start breathing. The family was called, and the baby was given to them. They already know if the baby had already died inside the mother's womb. The mother showed no emotion, probably relieved after going through hours of exhaustion trying to give birth to the pulseless child, but in her eyes she seems so lost, staring empty. At the corner of the room, her husband was holding and kissing the baby with tear coming down his cheek.

My heart was throbbing, trying so hard not to shed tears while discovering a feeling of parents losing their child. They never seen him, they never touch him, they never got to know him, but they love him like they never love anything in the world. They weep for him like they know him their whole life. The emotion is inevitable.

Recently, I encountered some similar cases of mothers admitted to the hospital due to vaginal bleeding, together with high fever and looked very pale. After knowing the patient is pregnant, Ultrasonography was performed to confirm the diagnosis. No surprise, they provoked themselves to terminate their pregnancy, whether using pills (consumed or applied somewhere around the cervix area), an algae-wood called 'batang jarak' or bay the help of 'dukun' or 'mantri'.

Usually the cases circles around teenagers who 'terlanjur' and were not expecting baby from their illegal sexual activities, but shockingly I have met more mothers doing abortion because of too many children. In Indonesia there is a campaign of limiting maximum two children for every family, yes, but by using contraceptives, not abortion. Most of them have been pregnant for more than five times, sometimes even reaching 10. So I understand the burden of raising children with only the farther working as 'tukang beca', adding one more would not be an option.

There is one patient, a 32 year-old mother who already had four children, had two miscarriage (claimed to be spontaneous without any provocation), and now again having the third abortion. On USG the doctor found four 'batang jarak' in her womb. She lose words.

We asked why she did it, she said nothing. We asked why didn't she use contraceptives, she said she stopped hormones injection because her husband's complaint of lack satisfaction during intercourse. Then we ask if she wants to have a permanent contraceptive; tubactomy, she said her husband still wants another children. Then WHY SHE DID IT?? At last, we turned up at the first question.

Pregnancy preventions; contraceptive are all around from the cheapest to the most expensive, right next door marts (condoms) to the operation table (tubectomy or vasectomy), you choose. People always have a choice, desperation only appears when you chose not to choose another option, then you were left with the only option.

Killing human being is cruel and inhuman, but killing a miracle is denying God. If you are denying God, what else do you have?

~Thanks UMI, my inspiration~

-IMAN NAILAH 2010-

Memanfaatkan Kesulitan

Kita selalu mendambakan yang indah dan selesa. Senang dan gembira. Tapi hidup selalu menafikan harapan, kerana selalunya kita punya pengharapan yang tak seiring kenyataan. Kita tahu hidup itu ibarat roda, hidup penuh liku dan cabaran, tapi kenapa bila datang susah dan payah kita mengeluh dan merudum jatuh?

Orang yang berjaya bukanlah yang paling banyak cabaran dan kesusahannya, kalau begitu orang miskin, tukang buruh dan pesakit kroniklah yang harus berada di puncak. Tapi yang memanfaatkan kesusahan dan cabaran itulah orang yang benar-benar berjaya.

Di saat kesibukan yang mencengkam, melelahkan jasad yang sungkam, aku menemui manfaat kesusahan. Baru, baru inilah aku menyedari rahsia sang pejuang. Mereka bukan pelajar ilmu kebal, bukan juga peminum tongkat ali atau kacip fatimah, belum tentu juara maraton 20km, tapi merekalah yang mencari bahagia di celah kusut dan beban.

Rasulullah saw, idola semua idola (bukan idola cilik ye), merupakan orang yang paling hebat memanfaatkan segala ujian dan kesulitan hidup baginda. Baginda memang diizinkan Allah seorang yang ma'sum, tapi baginda mengaplikasikan konsep 'maintain and improve' berbanding 'inherit the goods'seperti kebanyakan manusia. Kenapa Rasulullah sangat sabar? Bukan kerana baginda diciptakan mempunyai sifat sabar yang luar biasa, tapi kerana baginda melatih dirinya dengan setiap cubaah yang diberikan. Ketika rumah baginda dilempari najis, baginda memilih untuk mendapatkan pahala kesabaran, sekaligus mengagumkan para musyrikin serta menarik hati mereka ke arah Islam.

Dan barulah aku rasakan kebenaran dari sabda Nabi, sesungguhnya solat itu adalah istirehat, bila kesibukan melanda, waktu yang sedikit itu aku dirikan solat dengan penuh ketenangan. 5 minit yang singkat itu terasa sungguh menyegarkan, otot-otot yang kelelahan terasa kembali cergas, minda yang kusut dan hati yang sungkam kini semangat. Rupanya inilah kebahagiaan sejati. Seandainya aku tak merasai keletihan mental dan batin ini, adakah aku akan merasakan ketenangan sejati itu?

Betapa Maha Pengasihnya Tuhanku, Dia sentiasa pastikan ada insan yang membimbing dan menyokongku bila saja aku merasa perlu. Kadang hati tidak kuat menahan sakitnya cemuhan dunia, kembalilah kepada yang tersayang kerana cinta mereka bukan tiruan. Aliran kasih Allah, seperti embun yang menitis di pipimu. Sangat berharga dan bermakna.

Kesulitan hidup itu lumrah. Jadi tempuhilah rimba dengan bakul di tangan, buat mengutip buah di perjalanan, jangan cuma digigit serangga dan ditimpa hujan, sampai sesat tanpa haluan.

Rimba tebal bakal disinggah, Ramadhan yang penuh berkah. Sediakan dirimu dengan kekuatan dan stamina, dan mari manfaatkan!

*Sedang melalui masa-masa penuh cabaran, tulisan ini sebagai peringatan buat diri yang sering lupa dan kelelahan. Terima kasih umi, abah, babal dan sume yang memberi kekuatan. And for u who reminds me that patience is a part of me. :)

-IMAN NAILAH 2010-

The Pain We Want to Feel

A wise man said: No pain no gain. But in anesthesiology, it's the opposite.

If the art of life is the art of avoiding pain*, then anesthesiology is what every living people should be learning. Well, hypothetically.

Anesthesia came from the Greek words 'An' which means 'without' and 'aisthēsis' meaning 'sensation', basically it is the condition of having sensation (including the feeling of pain) blocked or temporarily taken away. So anesthesiology means a study about preventing some sensation especially pain.

Four weeks in this department, it made me realized one thing:

To treat pain, you must first feel the pain.

This, I meant in both literally and metaphorically.

Theoretically, pain occured when there is stimulation at the peripheral pain receptor which would go through a track of processes like tranduction, transmission, modulation and last perception by the brain. So knowing and 'feeling' this process can lead you to many solutions to pain.

Then, when I was in the ICU (Intensive Care Unit) it came to me that we must also 'feel' the pain of the patient to treat them.

In the most equipped unit of the hospital, we have the best physicians and nurses serving for the most critical patients. On the paper, this seems to be the best place for the patient to recover. But that's not it. They are labelled as the best because of one vital component - being CARING. They feel for their patients.

For the first time ever, I'm seeing doctors working diligently taking care of patients without any complaints, they never seemed tired eventhough we all KNOW they are beyond exhausted. They are always concern if there's something wrong with the patients, what's their current problem, is their needs fulfilled, and what more can they do for them.

I might say, they act like 'REAL DOCTORS', as if the rest is not. No, I'm not belittling the other doctors, no. They are a lot of super-fine, genius, very compassionate doctors out there that are very committed in what they do. I'm trying to emphasis how sincere they seemed to be doing their job. That's how every doctors should become. Eventhough the patient doesn't need intensive care, that's what we ought to give.

I have respect for them. Salute for Anesthesiologists~

-IMAN NAILAH 2010-

*Quote by Thomas Jefferson

The Reality of Malaysian Medical System

Being a medical student and struggling for almost two years in Indonesian hospitals, my thoughts are always about coming back to Malaysia and serve my country with pride. I heard about people leaving their country for a better offer abroad, but this gives me a shock. I never thought there was another reason.

Why we left and why we will continue to leave...

Posted by: MS Mohamad

I read an interesting article today about a few prominent figures addressing their concern over the increasing UKM and UM medical graduates who have left the country to continue their medical practice overseas.

After reading the news for 3 times, I called a very close friend, an MD (UKM) graduate to ask his opinion on how the news might have affected him. He has been working in Singapore for more than a decade as a Consultant Surgeon with a certain sub-specialty

"Why be a slave in your own country, when you are a king in another?" He replied.

By the word slave, the writer does not exaggerate. He came out with his own experiences.

I still remember the days when I was doing seeing patients and rounds as an MO, while the staff nurses would mind their own business, having breakfast in the pantry, or having gossip chats at their own leisure. My House Officers would then have to do merely all the labour-work, up to the extent of setting intravenous drips, and serving medications. If I am to expect the nurses, my patients would have been dead, or the work would have been too slowly or incompletely done.

When I was a House Officer, I had to run down 4-5 floors just to review a blood investigation of a dying dengue patient. The ward staff would either be nowhere around, or will say that he is busy (busier than the doctor?) or the answer I got at that time:

"Doktor nak cepat, doktor turun sendirilah, gaji doktor lagi banyak dari saya"

Even when I was a Specialist, the staff nurses had to be called again and again just to make sure the management plan for the patient would be done. I was already used to answers from them:

“I’m busy with something else"

“My shift is already over"

...it was routine for me.

One time when I was a District Hospital Medical Officer, I was conducting a delivery of a baby. An MA insisted that I remove my car which was block-parking his car. I answered through the phone that I was busy.

He came to the labor room and yelled "Semua orang pun sibuk jugak, macamlah doktor seorang yang sibuk!”

This maybe just a few people, and the writer is unlucky enough to meet these kind of people over and over again. I myself had only experienced working and interacting with the non-goverment medical servants and they gave a good impression on me. So this might be biased, as for sure a 2 weeks experience cannot be compared with a two decades. Suddenly coming back to Malaysia (which is already a scary idea looking how unprepared I am to be a doctor) seems so terrifying.

The state health or Hospital Director would just give another inspirational talk (of bollocks) on team effort and beauty of teamwork.

Ooh, now I know how I got the wrong news.

The author also stated some comparisons with other countries including Indonesia:

A few colleagues who graduated from UK choose to serve there:

"The pay is more, and we get the respect we deserve"

Another works in Brunei:

“Here the staff nurses respect Malaysian doctors, and they are very co-operative" (He ended up marrying one)

A few are consultants in Singapore (working with me):

"Here we are treated well, we spearhead the management, and every else do their work to the best of their capabilities".

A few even enjoys working in Indonesia:

“The work-load is horrible since there are a lot of patients, but we are well respected by every hospital personnel" (They have migrated there for nearly a decade)

Now I might even consider staying in Indonesia. (On a second thought, no, no. Maybe not.)

I find that Malaysia is the only country that is making doctors' lives miserable and treated like rubbish. It was never about the pay in the first place. It is about the treatment we are getting and the false political-based promises. Do you know that the so-called circular about doctors can have the day off after working 24 hours straight released JULY 2009 is not yet implemented? Do you know that the raise of UD 41 to 44 does not involve every doctor in the government service?

I did not found this surprising, knowing our country and it's full of 'janji manismu', it's likely to happen. Yet, most of the bad treatments from fellow workers such as nurses, medical assistants, and management officers made me feel sad. And if we were not bound by ethics to serve our best for patients and to save lives, would we become like them too? We can bare the hardships and exhaustion for the good pay (eventhough still lower than other countries), could we when it's not as sweet as it used to be?

Instead of doctors demands for respect, we must first give to gain. Maybe this is where the problem first started. The respect must be recovered.

See here to read the full article. Credit to Apai who linked it at Facebook.

-IMAN NAILAH 2010-

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-

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

Membedah Ilmu Bedah

Assalamualaikum wbt~

Hello cyberworld! Online kembali (dengan komputer) setelah 4 minggu berhibernasi dari dunia internet.

Sejak 4 Januari 2010 saya stase Bahagian Bedah, mengerah segala tenaga, keringat dan darah (pesakit), harta dan wang rupiah demi menyelamatkan nyawa insan amanah Sang Pencipta.

Penat.

Sakit.

Sempat bengkak kedua belah kaki, sangat sakit bila berjalan. Sekarang masih ada rasa kebas-kebas di hujung ibu jari, tanda inflamasi(peradangan) belum benar-benar sembuh. Sabarlah kaki, inikan asam garam kerjaya penuh cabaran tapi mulia. Kejarlah pahalanya.

Belum reda sempurna bengkak di kaki, selsema dan batuk datang menjenguk. Nasib baik subdivision pertama di bedah anak atau pediatric surgery, salah satu subdivision yang paling relaks, walaupun masih ada tuntutan bangun tengah malam dan berlari ke sana ke mari. Lumrah belajar, mana pernah senang. Kuatkan semangat Iman!

Dugaan.

Bedah didominasi residen lelaki. Bahayanya kalau tak kuat iman boleh tergoda atau digoda. Jujur saja, kalau 24 jam 7 hari kerja dengan orang yang sama tak mustahil ada yang tersangkut. betulkan niat, jangan lupa doa banyak-banyak semoga perjalanan di bedah ini suci dari anasir dosa dan maksiat.

Ilmu.

Terlalu kaya dan sarat, tak tergendong dan terkumpulkan dalam waktu yang sedikit. Apa lagi kerja 'tahpape' berlambak-lambak, antara lain mengumpulkan data pesakit yang hampir 50 orang semuanya, dari hasil laboratorium, foto dan ubat-ubatan, semuanya mesti yang terkini. Sudah itu ditaip, diprint dan disebarkan untuk doktor-doktor tersayang. Apa yang kita dapatkan? Ada, tapi DAPATkanlah, jangan cuma buat kerja buta-buta, nak dapat gelaran RAJIN atau nak tunjuk tanda kepatuhan kononnya. Kuncinya: jangan malu BERTANYA.

Pesanan ini disampaikan dari lubuk hati yang masih waras mengingatkan jasad yang kelelahan, TETAP SEMANGAT!!!

-IMAN NAILAH 2010-

Menelusuri Terowong Bunyi

Telinga Hidung Tenggorokan atau Ear Nose and Throat merupakan bahagian di mana saya menjalani clinical selama 5 minggu bermula 23 November 2009 yang lalu.

Mempelajari ilmu di bahagian ini, saya semakin memandang ‘kecil’ tiga indera ini, terutama telinga yang sepasang. Dari mata kasar saja ia kelihatan kecil, bila kita menelusuri kompleksiti susunan serta proses yang dijalankan komponen-komponen yang membentuknya, kekecilannya sangat mengagumkan.

Secara anatomi, telinga ibarat suatu terowong panjang yang berjalan satu hala menuju masuk ke dalam gua. Kita bahagikan terowong ini kepada tiga; luar, tengah dan dalam. Di luar, ada sebuah cekera besar (daun telinga = aurikuler) yang akan menangkap bunyi masuk ke dalam terowong. Bayangkan pintu Gua Mulu yang menganga, mengalu-alukan masuknya pengunjung ke laluan gua yang kecil dan dalam. Satu pertiga luar dari terowong dibina dari kartilago, sejenis tulang lembut yang dan elastik, dan dua pertiga lagi dibina dari tulang. Kalau kita korek telinga, ada satu batas di mana kita takkan masukkan lebih dalam sebab terasa sakit. Inilah batas yang memisahkan kartilago dan tulang. Di penghujung terowong luar ni, kita akan temukan sebuah gendang bulat yang kita panggil gegendang telinga. Semua bunyi yang masuk akan bergetar pada gendang dan dihantar masuk ke terowong tengah. Dalam terowong tengah ada beberapa buah tulang yang bersusun rapi, masing-masing diberi nama Malleus, Incus dan Stapes. Bila Malleus mengetuk Incus dan Incus mengetuk Stapes, bunyi menjadi semakin besar 22 kali ganda. Hujung Stapes bersambung dengan sebuah tingkap yang menghubungkan dengan terowong dalam.


Terowong dalam berisi dengan sebuah lingkaran siput berisi cairan yang dinamakan Koklea. Bunyi yang dihantar oleh Stapes akan menggetarkan cairan dalam koklea, yang saling bertolakan seperti domino yang jatuh satu demi satu dengan aturan yang sangat sistematik.





















Aliran ini akan berubah menjadi tenaga elektrik dan akhirnya dihantar melalui sebuah serabut saraf. Ia kemudian menyambung dengan saraf ke-VIII yang terus berhubung ke otak. Akhirnya otak akan menangkap bunyi ini dan menginterpretasikan ia sebagai sebuah bunyi yang dikenali, misalnya bunyi kokokan ayam. Oh, sudah subuh rupanya.

Apa yang saya jelaskan hanya penjelasan simple dari proses yang sebenarnya jauh lebih canggih dan kompleks dari kemampuan fikiran manusia. Buktinya, walaupun para spesialis dan pakar mampu menjelaskan mekanisme dan proses yang terjadi sehingga ke tahap biomolekular sekalipun, bila mana sebuah telinga sudah rosak, fungsinya tidak dapat dikembalikan seperti asal oleh mana-mana pun cendekia ini. Kerana semua hanya pinjaman, copyrightnya ada di Pencipta.

-IMAN NAILAH 2009-

Antara Laxadine Syrup dan Supposutoria

Suatu malam di Hospital Labuang Baji, seorang pelajar perubatan berjalan malas ke wad Baji Kamase 2, melihat ke dalamnya, suasana sepi. Hanya kedengaran suara pesakit mengerang kecil, ada yang sesak nafas tak dapat tidur. Semuanya permandangan biasa bagi si pelajar, apa lagi mata sudah mengantuk, tugas ini ingin cepat-cepat diselesaikan.

Dia datang kepada seorang pesakit dengan suspect penyakit Limfoma Maligna untuk melakukan follow-up tanda-tanda vitalnya. Seperti biasa dia meminta izin kepada pesakit dan isterinya yang setia menjaga di sisi untuk melakukan pemeriksaan. Pasien yang sedang menahan kesakitan mengangguk pasrah kerana sejak kemarin lagi beliau diperiksa setiap satu jam. Setelah selesai memeriksa tekanan darah, nadi, pernafasan dan suhu pesakit, tiba-tiba isteri pesakit bertanya:

Isteri pesakit : Doktor, tadi saya disuruh beli ubat ni… (sambil menunjukkan preskripsi ubat bertulis Laxadine syrup).

Pelajar perubatan : Ooo, ni pencahar makcik, untuk lancarkan buang air. Kan pakcik (pesakit) tak buang air besar sejak 2 hari lepas, kena minum ubat ni supaya senang keluar.

Isteri pesakit : Ya doktor. Tapi tadi saya pergi farmasi, harganya Rp25,000(=RM10). Boleh tak saya beli bentuk pil yang masuk dalam punggung?

Pelajar perubatan : Ooh, yang supposutoria? Kan doktor dah preskripsikan ubat minum. Sama je kandungannya.

Isteri pesakit : Kalau sama, saya beli yang supposutoria jela doktor ye…

Pelajar perubatan : Pakcik tak boleh minum ke? Sakit ye kalau menelan?

Isteri pesakit : Eh, boleh je doktor.

Pelajar perubatan: Ha kalau macam tu lebih baik beli yang syrup. Lagi untung, boleh pakai lama. Kalau supposutoria sekali pakai je.

Isteri pesakit : Takpela satu kali pun takpe, daripada takde. Kalau bentuk pil tu Rp9,000(=Rp3) je. Kalau yang syrup Rp25,000, saya tak cukup duit.

Pelajar perubatan : (terdiam)

Isteri pesakit : Takpelah doktor, saya pun ingat nak keluar dah esok. Duit cukup-cukup untuk balik je. Saya kena balik sambung keje untuk cari duit, dah takde orang lain dah.

Pelajar perubatan: Anak makcik?

Isteri pesakit: Anak makcik pun sakit jugak. Sejak kemalangan aritu, dah tak boleh buat keje sangat dah.

Pelajar perubatan: Emm… makcik tunggulah dulu sehari dua lagi ye. Lagipun pakcik kan nak dibiopsi, nak pastikan penyakit die. Lepas tu kena berubat makcik, tak boleh biar je…

Isteri pesakit: Takpe doktor. Pakcik pun dah elok sikit semenjak masuk sini. Saya ingat nak balik keje untuk kumpul duit dulu. Nanti kalau dah ade duit saya datang lagi… kalau umur pakcik panjang…(diam sebentar). InsyaAllah…

Pelajar perubatan:InsyaAllah…

Isteri pesakit: Jadi saya beli yang bentuk pil je doktor ye? Kena tukar preskripsi ke doktor?

Pelajar perubatan: Takpe, esok saya bagitau doktor supaya tukar ye. Lagipun dah malam, farmasi mesti dah tutup. Makcik sabar ye…

Pelajar perubatan itu berfikir panjang setelah keluar dari wad tersebut. “Duit makcik tu tak sampai Rp25,000. Astaghfirullah… sudah susah, diberi lagi dugaan sakit yang berat. Sesungguhnya Allah tahu mana hambanya yang kuat bersabar. Dan wallahu’alam, aku rasa aku tak sekuat itu…”.

Malam yang biasa-biasa itu mengetuk hati pintu si bakal doktor yang selama ini selalu menganggap enteng kisah hidup para pesakit. Hatinya yang membeku dek dinginnya angin malam dicairkan oleh wajah hangat si ibu tua.


-IMAN NAILAH 2009-
Catatan: Dialog disesuaikan ke Bahasa Malaysia untuk memudahkan pembaca.