Breaking the Silence: A Return to Writing and a Cry for Humanity

Assalammualaikum. It has been two long years since I last poured my thoughts onto this blog. Life happened, as it often does, and amidst the chaos and routine, my writing took a back seat. 

There's an undeniable pressure when you've been away for so long. You want the first words after a hiatus to be profound, impactful, and meaningful. Yet, the more I dwelled on this desire for a perfect return, the harder it became to take that initial step to start writing once again. 

Hence I decided to just start and if there's one topic that deserves an immediate voice, it's the haunting atrocities and genocide being committed against the Palestinians. In the year 2023, it's disheartening that such acts persist while the world watches in silence. 

I am baffled at how, in an era where even the smallest mistakes can go viral and result in swift consequences, a whole ethnic group is being subjected to violence without the intervention of the so-called world police. It just shouldn’t happen. 

Some people say the Palestinians were born in the wrong land and into the wrong ethnic. I strongly disagree. Their resilience and determination to defend their homeland, even in the face of unspeakable atrocities, make them the most fitting inhabitants for that sacred soil. They are the chosen people. Not all of us possess the strength to endure such trials, let alone stand up against them. 

I can't imagine how the doctors, nurses and paramedics can still work, when their mother, father, children, brothers, sisters, cousins, second cousins, bestfriends are dying front, behind, left and right. I can't help but reflect on my own experiences in the COVID ICU, realizing how challenging it would be if my loved ones were at risk. If I were in their shoes, facing the threat of COVID in my own family while working in the ICU, I doubt I could maintain focus. Yet, these heroes continue to save lives, fully aware that the next patient coming through their door could be their own flesh and blood. 

My connection to the plight of the Palestinians goes back to my A-Level days. Over the years, I became less vocal about it, perhaps thinking that feeling for them in my heart was enough. I find myself slightly embarrassed now, realising the importance of using my voice, no matter how small, to speak up for those who can't. Watching videos of their suffering brings me to tears, and often, I can't even finish watching. The sense of helplessness and hopelessness creeps in. 

I dare not even pray to be there with them even as a medical doctor because I am not even confident of my own capability in such troubled times. I am so used to “modern and equipped medicine” that I am not sure if I can function well there. 

I've long procrastinated educating my Facebook friends on the Palestinian cause, grappling with the first sentence. My Facebook friends are made of many races and religions and I feel I can make bigger impact there than in my Instagram. But the first step is truly challenging. I need to really sit down and think of my sentences. 

Thank you for reading, and here's to breaking the silence. 

Until next time. 

-Because life is a test- 

-AkMaR- 

 http://nur-akmar.blogspot.com

Hectic ICU Pool

Assalammualaikum.

 

In my workplace, we pool the medical officers into OT pool and ICU pool. As the name implies, one pool of doctors will only work in OT and its related services for example pre op assessment clinic, pre op assessment in ward. The other pool works in the ICU, and takes care of all the other critically ill patients in the ward, and sometimes ED. 

New doctors will usually spend a few months in OT before being allowed to enter the ICU pool, as it is a tougher, and more demanding job. Perhaps because I am a Masters student, or because we really don't have enough manpower, I was put in the ICU pool in January - my second month here. That is a real fast-track. 

For that reason, during the first long weekend of January, I wasn't oncall. They can't have a totally new (to the system) doctor to be oncall on a weekend.  Hence I had the 3 solid days to myself, and even went to GH Premium Outlet!

Little did I know, that was the calm before the storm. 

My first day in ICU pool - ie 4th Jan was a nightmare and it demotivated me so much I started to consider if this is really the path I want to take. I've never felt this way before, not even when things were crazy back in HO time and during my time in the district hospital before. 

The situation was way worse because of the current COVID situation. We are not supposed to take care of COVID patients - in fact, we weren't prepared for it. But things have gotten so bad that we are suddenly faced with so many critically ill COVID patients in our hospital. My bosses were very busy setting up the ICU to cater for COVID and PUI patients - things change on a whim, so many new instructions and guidelines being posted in our WhatsApp group, I can't catch up with them. To make things worse, many of my colleagues in ICU pool had to be quarantined, hence the workload increased tremendously for all of us who are not. 

This is a COVID patient's x-ray. This is bad, nearly no normal lung tissues. 

I had to reintubate two patients that morning - 1 COVID positive, and 1 PUI. I was blessed with a chill and calm Specialist. He guided me well, considering the fact I have never worn the PAPR (that spaceman suit), as I've always used a different kind of protective gear in my previous hospital. The reintubation went smoothly but it delayed my work for the rest of the day. 

I missed my lunch, had some leftover mushroom soup and biscuit at 3.30pm while my colleagues were busy moving things out of our on-call room to be put in a new ad-hoc room. I went home two hours later than usual, and by the time I reach home, I started to have a migraine, was exhausted and famished. 

Things were a little bit better on Tuesday since there was no reintubation hence I had enough time to settle all the work. But we have more and more ill COVID positive patients. I still went back later than usual. And no, we cannot claim overtime - no such thing in our profession. 

I was on-call on Wednesday, took care of all the critically ill patients OUTSIDE the ICU - had only two hours rest within the 24 hours and unable to keep my eyes open during the drive home. It was dangerous but I didn't have another option. I can't sleep in the hospital as they are limiting the nos of people in the room, and there is no place for me to sleep midway since my house is <15km from the hospital. Thursday was a rest day, I woke up nearing 3pm, hungry.

Friday was hectic too, as it was my first day in the newly transformed ICU. I struggled to remember all the details of the patients - their culture results, blood results, antibiotics, and plan. 

Oncall again on Saturday, this time in charge of INSIDE the ICU. This was by far the worst day of the week. I cried silently underneath my N95 - overwhelmed and overstretched. Tears and sweat mixed together beneath the mask and the face shield as I looked out the window, trying to recollect myself. It was 3pm, I had so many works undone, rounds have just finished, I felt inadequate because I didn't know the in and out details of all the patients hence the round was longer than usual, I have not had my lunch, the air conditioner was switched off, it was freaking hot in the PPE. I've not had a single drop of water since 9am and one of my COVID patients was scheduled for a scan and I was supposed to accompany the patient down to the CT suite which will easily take another hour. The nurses were pressuring me to order meds, blood investigations from the system (only doctors can do this online), everyone was tired and exhausted, politeness is at the bare minimum. So I broke down. 

But Allah was with me the whole time. My Specialist (who was already outside at that time), realised the trouble I was in, and instructed another colleague of mine to accompany the patient to Radiology. I managed to go out at 4pm, had my shower, gulped down litres of water in one go, and had a quick lunch, before going back into the ICU at 6.30pm. One of my patient passed away that day, it broke my heart to inform his son that the patient was dying and no one is allowed to come and pay their visit in his last hours. The patient only had the nurses to be with him during his last moments. 

Sunday is another much-needed post-call rest day - managed to cook dinner and prepare my next week's BuJo spread sheet. 

 

I didn't realise I was showing signs of exhaustion but my husband noticed that I obviously look very drained this one week compared to the 3 weeks in OT pool in December where I was very bubbly and active. He even brought me out to Secret Recipe on Friday for some cheering up before my on-call. 

I keep a log of the patients I see, and to my surprise, I encountered a total of 41 patients in the 3 weeks in OT pool in Dec, but within this first week of January, I have already encountered 43 patients. That is a quantitative measure of the workload we are facing, taking care of the ills in the hospital. No wonder I was on the brink of collapsing. 

Hoping For The Best

Every day, I shudder to see the number of patients in ICU and ventilated patients released by the MKN - they just keep increasing. I hope things will be better soon, please all adhere to SOPs, stay home if no important issues outside, and don't go back to visit your elderly parent yet. If you love them, protect them. Despite seeing my mother every day, I can't remember the last time I actually touched her - salam / hug her. I was too scared of passing the virus to her. She's asthmatic and diabetic - I don't think I can keep calm if she's ever infected. 

Let's all do our part and pray for the best.

'til then.

Akmar

The (TRUE) First Day of Work

Assalammualaikum! 

Today is my real first day of work, since yesterday the closest and the only time I got to a patient was manually bagging a child while my new colleague gas him to sleep. I spent the first half of the day mostly by waiting; waiting for the admin clerk, wait for them again, then again. Then waited to see the consultant in charge of us, then a bit at the ICT department, then a bit longer at the Security Unit to get our ID card done (yep, they took pic there and then and yep also, as predicted - I didn't look like how I pictured myself smiling to the camera)

| Today |

I was in charge of E2 today ie the Emergency OT mainly for Orthopaedics cases. Lawak gler, I didn't know the semi-e case that my colleagues posted in the WhatsApp grp yesterday was meant to be my first case this morning. So I kinda ignored the patient, and the Sp at the patient's bed! 

She called me to give plan about the patient, I didn't even know she is my Specialist; hence I almost did not want to come to her. Then she introduced herself, and I smacked myself in my brain. Nasib baik dia tak garang. 

So my first and ONLY case was an acetabular fracture plating. Quite straightforward case - not much bleeding, the Sp induced with me and she allowed the HO to intubate with me standing by. 

After that, even though we had a long list, none can be called because all COVID RTKs were still pending 😑

| Premed |

After lunch and Zuhr, I went for premed. I had to premed only two surgical patients; but was delayed because 1) No OTMS yet, and 2) Deym Purple Code.

Purple Code is the code activated during the transfer of a positive COVID patient - hence the whole corridor needed to be cleared off staff and patients and visitors. So I was trapped and cannot go to the ward I wanted to. 

Only two patients; but I already feel very exhausted by the end of it. I think I am getting old (myself 10 years from now will snort at this remark. Kalau hidup lagi la)

| Balik Rumah |

It took me about 25mins only to reach home, including the time taken to refuel my car. Not bad eh? The jam has not started when I leave hence the short travel time. 

Tapi sampai rumah je, I felt so sleepy, I feel like going to sleep. 

Gone, gone is my plan to study. Even now, I am supposed to be studying but instead, I am writing my blog 😒

So I am ending this now, gotta go wash my face and kunun-kunun do the 100 Korean skin care steps and sleep early to go to work tomorrow. 

-Because life is a test- 

 -AkMaR- 

Starting Work in Two Days Time, Oh The Anxiety!

Assalammualaikum!

I've only been able to properly sit down in front of a computer past one week or so, hence the long hiatus. 

Before entering Masters programme, we need to clear off our annual leaves, since we are technically leaving KKM and entering KPM hence our KKM annual leaves cant be used anymore. 

I had 26 days left, used 22 of them and took the last 3 weeks of November off.

My last day of working was 4th Nov! 

I'm gonna leave the whole story of my moving into KL and renovating and decorating the house in another post and focus on my work in this. 

My new work/study spot! No I didn't bother tidying them up for the photo because I'm lazy liddat. 

My uni intake was on the 1st of Dec so I thought I will start working in my training hospital on either the 1st or 2nd. But boy was I wrong. The university orientation programme took the whole week, but the best thing is, they are all done online!

So it's a first of Work-From-Home experience for me. Mana ada (clinical) doktor yang can WFH, cannot touch-touch patient through screen ma. Too bad Akmal's were online only for the first session. All the subsequent sessions required him to go to the university hospital (Don't tell him but I suspect his programme coordinator is a typical boomer, because he actually had to go there to JOIN the ZOOM meeting while students from other programme stays home. Blergh, and weird!)

So my first day in the hospital is this coming Monday, Dec 7th.

And I was added into the roster request WA group since mid-Nov! Bapak scary. 

And I'm gonna be oncall on the 10th, that's only like my 4th day in the hospital! 

| THE ANXIETY |

I'm so anxious to resume work after one month, dh la tu in a new environment, with a different title plk tu - "Masters Student".

Scary weyh, nanti org expect kau tau but you don't. Nanti kena tempelak or sarcasm camne?

Or what if they expect so low of me because I come from a small district hospital? 

One of my dear friend advised me, and I am going to heed this, 

"Doa byk2
Psycho diri ko 1st yr ni memang susah
Org look down
Byk benda xtaw
Expect the worst "

Mcm scary kan advise dia?

But I think I have to hold on to that now. 

I am scared dapat big case and I can't handle it. 

I've never done AAA open repair in my prev hospital, we wheel them off to the nearest tertiary centre. 

I've never used the Level-1 blood transfusion machine before. 

I am not that efficient in TIVA yet. I've never done anaesthesia for respi procedures before. 

What if I get these types of cases and I can't handle them on my own? 

"Apa kau belajar kt district ni?"

- Agak2 will I get this kind of insensitive, derogatory remark?

Akmal said, "Lek lek dlu awal2 ni. Jangan perform sangat. Nanti kalau perform awal2 ni, lepas ni merudum camne? Buat bodo2 dlu, lepas tu baru perform"

Ha amek, that's from a man's point of view. Lek lek dlu~

Ok, I think I rant enough for the day. 

I am hoping to read this back sometime in the future and laugh at myself, just like how I laughed (but completely still resonate with) at my pre-HO anxiety. 

 -Because life is a test- 

 

Preparing For A New Home

Assalammualaikum!

Source: [Instagram]

So I mentioned I will be moving back to KL soon.

And I have found a house, well it is my mother's other house to be exact, and it is in the same housing area as my mum's so yeah, dduk balik almost bawah ketiak mak. 

Anyway, I have been imagining having my own house and being able to decorate it with love and passion and whatever, and now I get to do it! Akmal and I already own a house but we can't stay there yet because we have our own jobs and they are not in the state we are in so long story cut short, I can't really decorate that house because we are not going to stay there yet. 

I've also not been able to decorate this house nor my previous house in Putrajaya because well, they are rented and I don't feel stable enough to decorate them, as we might move out anytime. 

So this time, it is almost perfect 💓

It's my mum's house, which means I can do whatever I want, the house might be handed to me anyway and we'll be staying there for at least 4 years (that's the minimum time for a Masters programme). 

All I can think about now is how to decorate the house. 

I am thinking of the colours of the wall, should I install wainscoting and if I do, do I want to do it myself or hire someone to do them? I also want an accent wall but that's a bit too much to DIY, but a bit too extravagant to hire an interior deco.

Accent Wall: [Source]

Wainscoting: [Source: Facebook Hafis Ishak]

Master Bedroom | I am thinking of putting an accent wall on my bedhead, but I wonder if it will make the already small room looks even smaller. I want a King-sized bed, which might make the room even smaller. I already worry if there will be space for us to pray in the room. I already own a 8x8' wardrobe, and I wish I have the money to buy a new, more modern looking dressing table.  

Kitchen | The previous owner already built a kitchen top without the shelves, but they are green. Algae green, not emerald green. And I don't like it. Even the floor tiles are the pale green colour. It cost too much for me to overhaul the cabinet and the floor so I plan to put on some wallpaper to the kitchen top and live with the green tiles. Sew or hire someone to sew a curtain for the exposed kitchen cabinet. I also want to paint one of the kitchen wall emerald green, making it a feature wall and make the kitchen brighter. 

Living Room | We are buying a new sofa yes! I want to make our living room blue + white so I really hope we can find a sofa that suits both our budget and my theme. I wish to buy a new TV console too, this time with a drawer so that we can chuck things inside and make the living room looks more tidy. 

Dining Area | There is a small dining area in between the kitchen and the living room, but it is right in front of the toilet door. I hope I can decorate this area to look modern and chic and minimalist. We already have a big glass dining table, but no suitable dining chairs. One dining chair cost at least RM200 so if I want to buy 6 chairs, that is RM1200 there already. 

What I should be Doing Now

Not waste my time on trivial matters. 

I really should start writing them down; my budget, the paint codes, the designs I want etc, instead of just having them in my mind, abstract. 

Maybe this is the best time to resuscitate my dead BuJo.

I shall name it "Project Home" 😁

'til then,

-Because Life is A Test-

My First Awake Fibre-Optic Intubation

Assalammualaikum!

I came home two days ago super thrilled! Can't even wait till we get to the diner before blurting everything out to Akmal once I got into the car. 

Excited sgt, belanja gmbr Captain Ri satu.

There was a patient scheduled for an emergency operation and he was 180kg!

He very likeyly has severe OSA based on his STOPBANG score and that itself is a big big risk for intubation and general anaesthesia.

Dr Rey was there and she decided for Awake FibreOptic Intubation (AFOI), I was actually manning the OR next door when I peeped into the OR at the right time and was offered to do the AFOI instead!

Non-anaesthesia trainee might not know this but awake fibre-optic intubation is a very important, advanced airway skills that we must have. I've observed it multiple times before but never did it myself. I've even paid hundreds of ringgits late last year for the Beyond Basic Airway course and already practised multiple times on mannequins but never on an awake human being. 

The procedure requires us to insert the endotracheal tube into the patient's airway while the patient is AWAKE and mildly sedated and instead of using laryngoscopes and our bare hands, we use a fibreoptic scope with camera attached. We insert the scope into the patient's nose or mouth (in my case, it was the nose) and manipulate the end of the scope to slide down the patient's throat, into the major airways until we see the carina ie where the trachea diverges into two. 

A random picture of AFOI I found on the Internet. A still cut of a [YouTube video]

I had my first CVL a few weeks before I left the hospital I completed my housemanship, my first CSE a few weeks after starting in this hospital and my first AFOI not long before I leave this hospital for my Masters study. Isn't this just great?

I wish I can master this AFOI skills soon. 

Masters life, please be nice to me. 

-Because life is a test-