What I want to learn to do well before I die — for myself, and not for anyone else

1. Speak french
2. Cook delicious food
3. Play the piano
4. Learn how to read the best books
5. Paint

An uncertain future

Now I’m coming at the end of my housemanship, I am stumped as to what I should do next. Feels like matric all over again when I had to choose my UPU.

I had chosen medicine or environmental engineering. I got my first choice in UPM. And the rest is history.

All my postings: internal medicine, surgery, paediatrics, O&g, orthopaedics, anaethesia presented me with wonderful teaching moments. I’m lucky to be here, and feel extremely privileged to have been given this opportunity. There are frustrating things about the culture of “teaching” housemans I wish I could change, but there’s not much I can do there.

Going back through my blog, I realise that considering which specialty I want to do is a recurring theme that I’m still unable to figure out.

Anyway, my 21 year old self was really useful in this matter. I’m quite glad I wrote a blog post 7 years ago about this. I really want to thank her in person, but I realise she doesn’t exist anymore. She might be emotionally retarded and naive, but her insight is postively inspiring. She said:
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2011 blog post>>>>

My dream specialty must entail the following:
1. Lots and lots of independence. I cannot live without it.
2. Plenty of room for thinking and creativity
3. Opportunities for research (this rules out surgery, hahaha)

So..

1. Basic sciences- I’m interested in taking up pharmacology since medical advances in drugs are unprecedented. Haematology would also allow for some clinical work. Pathology, especially forensic would allow a degree of freedom I’d favour.
2. Take up O&G. Become involved in women’s issues: domestic violence, etc.
3. Second degree in something. Nanotechnology? Discover new advances in medicine.
4. Internal Medicine/ Family Medicine. Just so I can exhaust learning medicine as to satisfy my curiosity.

2013 blog post>>>>

Immunology
Haematology
Pathology
Oncology/Palliative Medicine
Acute Medicine
Infectious Disease
Emergency Medicine
Family Medicine
Psychiatry
ENT
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This is before I knew what the O&G or Medicine MO oncalls were like though. Going through my postings, I suppose I wouldn’t mind Medicine or Paeds. I thought I had settled on ID as the specialty I was going for.

After everything that has happened.. I have been contemplating. I feel like my talents would be at better use in research, and the clinical field doesn’t seem to allow for a lot of freedom in doing research. I’m strongly considering crossing over to non-clinical field instead. I still want to seen patients, but being a proper scientist seems like a dream job.

Urgh I don’t know. Ultimately, I have to ask myself. What kind of problems do I want to solve?

i am human

how ironic the job that makes us deals with humans at their most weakest is so dehumanising in its very essence. just a houseman. that’s all i ever am in anyone’s eyes. a provisional human being. i have no thoughts no opinions no colour to who i am, because i am just another product sliding on the conveyor belt of this massive doctor making machine. this is not who i am. this is not what i signed up for.

“you don’t look like a mother”. i’ll show you my stretchmarks, on my breast, thighs and abdomen, my episiotomy scar if you like. all my scars in and out. i’ll show you a picture of me before i have to wake up 7 to 8 times a night to give milk to a child who is sick. such a nice girl. i’ll give you a memory of a time, when i couldn’t answer a fundamental question, during rounds, infront of everyone during rounds, because i don’t remember the last time i picked up a book, and my brain is all wired differently now postpartum hormones bathed it.

they insist (passive-aggressively): how can my opinions matter? how can i possibly know what suffering is? how can i even begin to dare to know what loss is? even when i’m right, i am most definitely wrong and will have to bite my tongue. keep schtum, and hope the emperor notices he is indeed naked. and when i’m wrong, and i’m wrong a lot of the times – i am such an utter failure, i wish i was six feet under instead.

i regret nothing. i am so lucky to be here, to be trained like this, what a great platform for learning. how disgraceful for me to want to give up at this point. how entirely distasteful for me to have anything but gratitude for this blessed life, that so many crave. this life, which would have filled the hunger in anyone else’s soul.

i am learning. and re-learning what i have already known. seeing it in new perspectives. perhaps i don’t know enough of what i already know.

i love this child. this child keeps me going. he inspires me in so many ways. he makes me know what it is to be human. he connects me to every other human out there — those who has lived, living and those who have yet to live. he tries learning to walk, and he falls down every time in the beginning. now he is running, for his life. calling my name, laughing like a madman, begging for me to chase after him.

In the mood

Have you ever imagine being interviewed and they’d ask you something random like, “What’s your top ten favourite songs about love?” Which you subsequently spent hours thinking about so that in case if for some inane reason, someone asked, it’d be like reflex.

So anyway, my daydreaming this week has led me as such:

1. The Pretenders- Stand By You
2. Blondie- In The Flesh
3. Francoise Hardy- L’amour Ne Dure Pas Toujours
4. Sinead O’Connor- Nothing Compares 2 u
5. Feist’s cover of Bee Gees- Inside and Out
6. Barbara Lewis- Baby I’m Yours
7. St Etienne- Only Love Can Break Your Heart
8. That youtube girl’s cover of Santeria, can’t remember which channel
9. The Smiths- There Is a Light That Never Goes Out
10. Dido- White flag

At this point in time. I may regret my decision later.

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In the end

The reason why you think you’re so much better than everyone else is because your victories are etched so much more clearly in your mind than your failures. When you are just like everybody else, struggling no less. Anyone can do what you do because absolutely every single person on this earth is obsolete, replaceable.

I am never going to forget my failures.

I am never going to believe I am a better human being than anyone else.

And I am never going to wish evil upon anyone who has wronged me, only absolution.

So with this precious limited time lent to me, I’m going to enjoy it with people I care about than worry about what anyone thinks about me.

Call me naive, whatever.

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Searching for solitude and isolation

Sometimes I wonder why I bother to write- I enjoy my private life. But I learn more about myself than I would have if I didn’t.

I have lived in too many cities to enjoy living in them. I want to get away from the city, its traffic and its toxic fumes. I want to avoid their endless yuppies. I’m tired of everyone comparing their glittered and filtered version of a life via facebook and instagram. I want to live a simple and humble life in a rural area surrounded by green.

But I need money and I want to be financially secure. I want a great and shiny career. I want to be a specialist, no – a subspecialist in Internal Medicine, possibly in ID or geriatrics, anything that is really just a broad generalisation disguised as a subspecialty. Because it seems the higher up your ranks is the more you can do as you please. I want to learn all the time and I want to do research. I want to meet tons of people and constantly evolve. I want to earn enough to convince my husband to be a house husband who takes care of the kids while I build up my career.

I also want to give up sometimes, and be a stay at home mother. Learn to cook for my kids, do fun science experiments and be a teacher that homeschools them. I want to impart knowledge and teach new languages, history and art – to learn as much as they are learning.

Basically, I am a sea of contradictions and I want to live in a kampung with really fast Wifi. Sigh. You can’t have it all.

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No shampoo resolution

Can I please have this hair?

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Since my son kept pulling my hair, and also cos I felt old from my motherhood, I had cut off my hair into a bob. I certainly like that my hair is now fuss-free, but I also miss braiding it and just generally feeling womanly.
So I have decided in my quest to have really long hair, to not shampoo my hair for a year.
Don’t be disgusted… It’s an actual thing I’ve learnt from pinterest. Apparently you eventually just wash grease off once every month with bicarbonate solution and condition with cider vinegar. It’ll leave it looking prettier and lighter than you would if you washed it regularly. Since I am a cheapskate, I’m going to give this a try. Shampoos are expensive. Starting from March, maybe.

Links:

1. 30 Days With No Shampoo: What Washing With a Cleansing Conditioner is Really Like
Read more at: http://beautyhigh.com/how-to-go-no-poo/#_a5y_p=2037583

2. Grow it long, grow it strong.
Read more at: https://almostexactlyblog.wordpress.com/2013/04/10/grow-it-long-grow-it-strong/

Dear pregnant ladies going for checkups,

Congrats on yr pregnancy! Anyway, to the point.. I’m no obstetrician, so it’s best to refer to your specialist for further questions. However, I feel it’s important to clear the misconception when it comes to booking and check-ups, at least.

First up, much has been said about the slowness of government clinics and hospitals; how private hospitals are better. If I was a layman, I would probably be swept along with the current of common pre-conceptions. I am speaking as a mum; as a patient who was under Klinik Kesihatan(KK)/Klinik Desa(KD) follow-up, and as a patient who gave birth in a govenment hospital. No doubt, I am biased because I am a government servant. Based on my experience as a student who has done attachment in a variety of MCHCs, HKL, Hosp Serdang and currently working in Hosp Selayang, I am mostly impressed by the efficiency of our O&G team. Infact, most of Malaysian clinical practise are based on international guidelines and evidence based medicine.

Yes, you may wait a bit longer relatively depending on the influx of patients and sometimes there is patient overload, their smile might wear off as the day progresses (they’re not robots!). However, I was safe in the knowledge that my check-ups were complete and that my baby was safe. In the end, that’s all you really want- a safe pregnancy and childbirth. In conclusion, government healthcare services- don’t knock it. As a mum who went through pregnancy, the basics of follow-ups:

1. Ideally, before you’re pregnant, you should be as healthy as possible and taking regular folic acid. Easier said than done- I actually skipped this as my pregnancy was unplanned, never exercised or took supplements. I was super tired throughout pregnancy though. Mark your periods on the calendar so you’re sure of your dates. There’s this formula we use called Naegele’s rule where we calculate your Estimated Due Date (EDD) from your 1st day of last normal menstrual period. Even though I did this, my menses was irregular, so I had to use a dating scan for my EDD.

2. Book your pregnancy as early as you can at a KK or a KD. Booking just means you get a pink book (the most complete document you will have about your pregnancy) that you will guard with your life. In there an initial blood pressure, full blood count, infectious screening, weight, full history and systemic examination is recorded. An antenatal card from a private clinic that has all these things will do in place of an antenatal book (I have seen a bunch of good GPs who do great follow-ups, but I have seen a lot of terrible ones as well).

3. A dating scan is the most accurate at 10-14 weeks. Which is why booking early is important. In the second trimester, dates can be off by about two weeks, whereas in the third trimester dates can be off by three weeks. Don’t come to the hospital fully dilated with no antenatal book, thinking pregnancy and childbirth is easy. It’s terrifying and anything can happen, to almost anyone. Malaysia has shown a significant decline in maternal mortality from 770 per 100,000 live births in 1940 to only 28 per 100,000 in 2000, which is improving even more since we are trying to meet the Millenium Development Goals before the deadline in 2015. I am perhaps more impressed by the O&G department than any other department because of the significant reduction in mortality statistics. It used to be so common to have women dying from childbirth, which is almost unheard of nowadays.

4. Regarding scans: In your first trimester, you should have at least one dating scan. In your second trimester onwards, at least one monthly is good enough. By the time you’re term (37 weeks+), you should get a scan weekly. You might need more, depending on your individual pregnancy. I don’t think KKs have enough scan machines to comply to all patients, so you could always scan at private clinic and have them enter a bit of your notes in your antenatal book. A detailed scan (18-22 weeks) is usually done by Maternal Fetal Medicine specialists, usually only done if indicated. I’m sure most private Obstetricians can do it for just about anyone though. It’s not necessary if you have an uncomplicated pregnancy, but it’s nice to have one. I had a detailed scan and a biophysical profile done by Dr Idora at Pantai Hospital, and she gave me a bit of 3D/4D imaging and Doppler along with it. Super nice lady, kind of wished I delivered under her. Maybe the next one. In 5 years. Haha.

5. You should do a maternal glucose tolerance test or an MGTT (i.e horrible tasting sugar drink test) at least once at 28weeks if you’re 25 an above or with any specific indications.

6. I recommend going to antenatal classes, to learn position yourself along with breathing and pushing techniques. Childbirth was insane, and I think if someone had put a knife close to my carotids I would have perhaps pressed the knife to stop the pain. Sorry for being dramatic. Whatever happened or whoever I was during delivery, that was not me, I take no responsibility on the way I behaved when I was in pain. Wish I had gone, maybe I would not have panicked as much.

7. Signs you’re going to deliver soon: you have regular contractions every 10 minutes, show (reddish brown jelly like substance) or leaking. Please come immediately to any hospital, have yourself assessed. 8. Postpartum, get yourself and baby checked 6 weeks after delivery with pap smear as well. If you have gestational diabetes, you might need to do a repeat MGTT as well to see if you really have diabetes.

9. There will be a community nurse doing home visits at the first 10 days, 14th day and 20th day post-delivery. Make sure the KK/KD nearby knows that you’ve delivered, so you can get this service.

10. Plan your next pregnancy ahead. Wait until your child is 2 to 3 years for your next one. Our KKs can offer a lot of free contraceptive methods. Make sure your body recovers well before getting pregnant again.

Look, I’m no authority on this topic. I can only speak as a fellow mother to another. Obviously, there is a bunch of other stuff to know. I am only advocating for women to be more knowledgeable on the topic. Even though I hated every minute of pregnancy, and I had so much postpartum issues, sometimes I look at pregnant ladies or when I see little girls, I wish I was pregnant again. Is that weird? download

The working life

Mikael is sleeping. After a shower, breakfast, making a mess of the whole living room and going through 7 story books. Finally. I’ll just wash his bottles and the dishes, and put away the laundry and read 2 pages of O&G and type up a blogpost. I feel a bit random today.

Well.. I finished being a med student in April 2013 and started work in July 2013, so I can’t say that I have worked for a long time. A long time in dog years, perhaps. Anyway, I do feel that I am somewhat different. Ramblings I want to get off my chest:

1. I am able to handle stress better. I probably do need to work on stress management still, but sometimes I think about working in a 9-5 job, and the bosses that come with it, and I think it’s all the same. In any working environment, you’d get the same old stuff. A bit of rudeness, racism and sexism, anywhere one goes in the world, one finds humans repeating themselves over and over. Wonder if they know how cliched life is.
2. I used to think I was an introvert. But now, I find myself really enjoying having conversations with patients and getting to know them. Sometimes even looking forward to seeing more of them. I am most probably an ambivert, if that’s a real term.
3. I don’t read anymore, which makes me feel a bit empty in the head and heart sometimes.
4. Managing one’s finances is not easy. One of these days I have got to work up the courage to look through all my receipts and expenses.
5. My final conclusion is that being a doctor isn’t all there is in life. I had been so single minded before but this is exactly the life that I chose for myself. I didn’t trip into it, I am conscious the entire time. There is family and there is love and there is an abundance of wonder to be explored out there.

Life isn’t so bad

I feel like I only write here when I’m sad. I want to be articulate, more artistic, more adventurous in my life, but the nature of my job doesn’t allow me to make the time. Or my time management sucks. One of those.

I feel like I’m turning into this other facet of my self, the one who always gossips, the one who’s lazy and lacks motivation. This isn’t who I want to be.

God I wish I could take a month off of work and just be with Mikael- hear him laugh and cry. Apart from being a mother, I feel like the light at the end of the tunnel is so far from my reach, and that housemanship is a daily choice that I make to preservere with. Don’t get me wrong, there are inspiration to be found here, and it’s a great opportunity for learning. But I’m not as talented or smart or well connected as my other colleagues. If anything I’m good at, it’s probably at being mediocre.

At least I enjoy the patients, and the nurses (save a few) are great to hang out with.

I am going to be a good specialist one day, despite what anyone says or think of me. I have decided, and it is going to happen no matter what. It might take me a while, delays are inevitable because I’m not naturally talented. But I will get there.

I keep waiting to complete O&G to plan to do this and that. Now that the inevitable has happened, I can’t be waiting all the time to be the person I want to be. This is me reclaiming my life and my self.

O&G has been interesting. You just survive by doing what is necessary- preservering. I have been plagued by doubts about myself and continuing housemanship but I’ve realised that no MO or specialists will believe in me unless I believe in myself first. I’ve learnt a lot about humility and working with different types of people in general. I think what this posting has made me realised so far is that when you get down to the basics I want to graduate housemanship as a kind and safe doctor. Beyond that is a bonus. I’ve also have recently been aware of my shortcomings- sometimes you think you have it all figured out and it turns out you’re actually a long way off. Sometimes I think I can come across a certain way and it’s not what I intended. I think change is always painful, but worth all the effort in the end if you come out better.

I don’t think of myself as especially smart or hardworking- perhaps the opposite; but I can be so much better.

Maybe a child is only a distraction from lifelong melancholy. One day, maybe I’ll be so sad even my husband won’t be able to snap me out of it.

I don’t know.

Maybe I should just give up at everything.

I don’t deserve my son or my husband. They’re the most wonderful people in the world.

Finishing paediatrics

I’m going to miss it. Really. Weird, though. I was always going on about how I was borderline depressed in NICU, but now I’ve gone through it, it wasn’t all that bad. It was a lot of fun once you’ve adapted.

Things I’ve learnt though (or re-learnt):
1. A first of a fourth or a sixth poster is potentially just as good of a houseman as the other. Perhaps the sixth poster knows his shortcuts around the hospital better or a way to ask the staff nurse to get things done quicker; but it’s all just confidence tricks.
2. Do not ever forget what you were like as a medical student and where you came from. I will always remember how tiny my world was prior to working.
3. I have got to take better care of my body. It’s all going downhill from here. I keep telling myself that it’ll take 9 months for me to recover from pregnancy as an excuse for lazing around and watching the Voice. It’s just sad.
4. Children are wonderful, and their innocent souls are made of unicorns before TV /the internet /iPhones ruined everything. I don’t think I can ever be a Paediatrician. I keep feeling like I’m not worthy of this field. Also, I keep feeling that if the kid turns out to be a criminal in the future, I am somewhat responsible. I’m pretty sure Hitler was once adorable, but then the doctor or the nurse that treated him at the clinic when he had that bout of URTI didn’t think to give him a speech on how racism is bad. It doesn’t make sense, but whatever.
Anyway, Paediatrics probably brings out the PMS in me. Yeah, sometimes I re-inforce my own stereotypes.
5. Be kind, be humble and for the love of God, stop talking shit about people behind their backs. If you have accidentally talked shit about that person, you can cancel it out by saying a good quality of theirs you admire. (Does it cancel it out though? I’m not entirely sure)
6. Having a baby is tough you guys. Housemanship is also tough. Nobody really likes you or respect you. I wish there was a stronger word than tough. In case the masochist are all like, “Yeah, I can do tough.” There is no glory or money or hot looking guys here. Go home, straight A students. Go do IT or something.
7. I am not going to be one of those people who whine about how they never have enough. Not enough money, not enough shit in their house, not enough food. I have enough. I’m good where I am.

I like being alone. I like to eat alone, read alone and go out by myself. The only relationship I can muster the energy to maintain is with Sufian, and even then, I’m not too sure if I do have energy for that.

But I can be social, I can eat lunch and have conversation with others; it’s all mimicry though. I just do what you guys do and I pretend I’m not me. I’ll force myself to go out once a few months with a few friends, so I fulfill my social quota. I’m pretty good at it, I think a lot of people are fooled into thinking I’m normal.

I’m just super tired of everyone. There needs to be cave somewhere with my name on it.

Just things floating about in my head

I thought I was getting the hang of things now. Don’t get me wrong, I’m still an idiot. But I’ve made major progress on the little things. Example, if I am taking morning bloods for the ward alone, man can I prepare them bottles. Or that time when some patient needed a really weird ultrasound, and I only took 10 minutes to present the case and got an early appointment.

I was wrong though. Same old me, different department. You know how every time you start a new posting and you’re momentarily a noob again? Well, NICU feels to me in the beginning like 10x worse than being a first poster in Medicine.

I blame my stupid postnatal problems. Please remind me to stock up on a lot of ravin enema, daflon and lactulose. All of the said medications I still need at 4 months postpartum. I should probably see a urogynaecologist and a surgeon about my problems or something. I can’t really be bothered, or have time. Whatever, 60 year old me will hate my current self, but that’s her problem later.

I love my kid. He is so damn beautiful. Sometimes I think: Everyone’s right. I am a baby who had a baby. I don’t deserve to be a mother to someone so wonderful. What kind of mothering can you do with this kind of work? What kind of doctor can you be with this kind of life arrangement?

And then I argue with myself for hours: Kau ni macam babi. Boleh tak berhenti berfikir, bagi aku tidur kejap.

I am surviving on less than 3 hours of sleep per day. Didn’t think I’d be able to do it, but I’m kind of surprised that I did without realising it. I am ambivalent now about housemanship in general. There is no love or hate anymore. I just feel like I want to learn and be competent as much as possible, and then to get the hell out of Selayang.

If I sound a little defeatist, perhaps I’m misrepresenting myself. I’m pretty hopeful about the future. I still want to go for Internal Medicine after housemanship. But a part of me is thinking, that I should just save up as much money as possible and finish my government bond within the agreed 10 years without a hitch. Perhaps I can pursue another kind of life for the sake of my kid.