098: Intensity

Today was a day of utmost intensity.

It began with a run. Clocked in 3km, I am surprised that I managed to get myself dressed and out the door willingly before 10am. After almost 2 months of physical absence, my calves, hamstrings and lungs were slapped awake from its deep slumber.

After that, I showered and got myself ready for the inaugural AA sharing session - the first of its kind in the city. It is a session where sisters would gather and just offload thoughts, feelings and frustrations in a safe, judgement-free environment. It was first trialled in Morocco with success. The founder garnered fame in social media with her reflective videos. It was Auntie Adik who pointed me towards this session, and since my other half was away, I decided to go and try it out without any expectations.

About 3 hours later, I didn't expect to come out the other end bruised yet lighter in equal measure. The stories that were shared were so personal, and the lessons learnt were uplifting. The diversity of women represented in the circle also helped in bringing various perspectives to the table. There were tales of loss, struggles of faith, parenting lessons and professional setbacks. Honestly, there was not a dry eye in the house. I too opened up, breaking down in front of a group of strangers. Something that I have never ever done in my entire life. A sister brought up her story of loss, and it was so eerily similar to my story of loss regarding Bahyah. Her anger and frustrations were so familiar that I had to say something. And when I did, the floodgates opened, and the tears were unleashed. Although it has been 8 years now, the emotions still felt so raw.

One of the sisters asked, "Do you feel guilty? Not being there when he passed?"

Honestly, I had never thought about guilt until she said that. Maybe I do feel guilty, but I mostly feel so angry. It wasn't fair that I, having spent the whole morning by his bedside, wasn't given the opportunity to be there with him when he passed. Extended family who weren't with him the whole week got to be there instead. Till this day, I am angry that I never had a proper goodbye as he was already in a coma, one that he will never wake up from, when I landed in Malaysia. I know there must be a reason to all this, God's reason, but it is so hard to let go of.

"You have to forgive yourself. Not being there doesn't mean he didn't know that you loved him. He knew," she said.

The struggle of grief was something most sisters knew so well. And it was nice to be able to share the load. Because as mothers, sisters, wives and daughters, there is an expectation to "keep it together" all the time. It is a relief to be able to be vulnerable, and to be given a space to just offload to people who understand.

During one of the breaks, a sister and I were talking. She has lived here with her two kids for over 20 years now. She lost her husband suddenly several years ago, and since then remarried. We were eating at the time, and when she confided her loss with me, I was holding back tears. With my traumatic experience with grief, losing my husband is my worst fear in life. And seeing her, a woman who has lived and thrived despite great great loss, I found myself thinking, "How did you even survive?" I cannot fathom losing my life partner, the person whom my very existence is intertwined in. Losing him, will mean losing myself.

But meeting her gave me hope - that ultimately, loved ones will come and go, but your only lifeline and constant is Allah swt. If you have Him, somehow, you will survive through any storm. Even storms that tear your home apart, ones that leave you broken physically, mentally and emotionally, to the point you no longer remember who you were because the present self is only a shell of emptiness. Only faith is able to bring the broken pieces together again.

All in all, it was a very enlightening experience. I feel emotionally drained today, and in need of a well deserved rest. However, I also feel lighter, Alhamdulillah. Hope this session is the very beginning of an endless series of group sister therapy!

097: He was at the door

Last week, I was tasked on examining patients at the ward round. I knew the male patients on the ward, I was familiar with their cases - it shouldn't be that hard. So of we went, a team of 3, going around checking our patient's medical statuses. Most were medically fit, waiting for a package of care at home, or more physiotherapy, or the delivery of equipment to their flat. We wheeled our computer and cart carrying everyone's medical notes around the corner to Bed 6.

There was Mr F, a gentleman in his late seventies. A man who has been medically fit for a week now, but just waiting for the proper setup in his care home to be in place for him to be safely discharged. His body was frail, skeletal even and his mind was riddled with dementia. I remember him as being alert some days calling for my attention from his bed, and some days too tired to open his eyes.

*Details have been altered to preserve patient confidentiality

He was asleep when I approached his bed. I tried waking him up but he was engulfed in a deep circadian rhythm. I listened to his chest - it sounded crackly. His lungs were scarred from a long history of smoke inhalation, and looking at his history, his lungs were never clear. We suggested the nurse to start him on nebulisers to ease the shaky breathing. However, I did notice a few other strange things. His breathing was irregular, it was like he was intermittently gasping for breath. And his heart sounds seem to beat in a group of threes, spaced out with pauses. I peaked at his neck, his carotid pulse was very much visible due to the lack of anything but skin shielding it from view. That was regular. So I didn't really think much of it - I convinced myself: maybe he is snoring, and maybe I didn't hear the heart quite right. His observations were stable, nothing alarming to suggest he was ill. 'Discharge planning' was the plan. Off to review the next patient.

After seeing 2 patient after Mr F, the nurse drew the curtains around cubicle 6. I looked back from examining the patient in cubicle 8 to find that both my colleagues disappearing behind the curtain. I went to follow them to find Mr F's lifeless body.

"He is gone," said the nurse.

It felt like all the blood drained from my head. Panic-stricken, I asked my senior whether I should call for help. ABCDE? Cannula? Oxygen? Something???

"I don't understand. He was breathing 5 minutes ago?" I said, "How can this happen?"

"Don't worry. He just passed peacefully. If we were to put out a medical emergency call, they would not have intervened - he has a DNACPR in place."

Did I miss something? Could I have detected something earlier? Apparently no is the answer. I told my senior the pecularities of my examination findings and she told me that they were signs of dying. Agonal breathing, irregular heart beat - he was at death's door - and there was nothing that could have been done to prevent nature from taking its course.

Still shaken at this point, she asks, "Are you ok?" "No, I have never encountered this before. He was alive a few minutes ago. But its fine, lets finish the ward round." I have seen many corpses by now, and I have encountered patients that are dying from known illnesses, but this blindsided me. I had yet to encounter a medically well patient just slip away like he did. So quietly, with little warning.

After the ward round, I entered the meeting room to tell my consultant what had happened. By then, the news had already circulated around the ward. Another staff member uttered, "Did you know it was his birthday today?"

He came into this world on the same day he left.

096: A dead squirrel

I have been cycling on my new Brompton to work. Well, from the train station to the hospital - but that still counts! I take a different route to and from the hospital. This is mainly influenced by the route's specific degree of incline. I'd rather go short and steep, as opposed to long but less steep - if this makes any sense.

Anyway, on one morning, whilst cycling up the normal steep hill I take, I spotted an unusual object of curiosity at the wedge found between the pavement and the road. It was not yet autumn, but there were auburn leaves on the street. Amidst the orangey chaos of colour was the carcass of a squirrel. It looked like its life came to a literal halt after taking a leap to far, one that landed it in front of incoming traffic. Its stomach was split in half, dried blood was on the road and flies had begun to circle its lifeless body. I wasn't its only curious onlooker, the child walking down the hill holding his school bag in one hand, had also pointed to it in disgust, saying "Whats that thing, mom?"

I swerved my bike away from it like a skateboarder avoiding an orange cone. I didn't want its fur or blood or guts on my beautiful new tyres, no way! The same child also had similar ideas - he took a few steps away from his linear route. It was as if there was an invisible no-tread zone circling at least 10 metres from the squirrel. After my split second encounter, I didn't think much of it.

However, with every passing day, I would observe the shrinking existence of the carcass. As it was on cement road, I hypothesised that its degradation process was just much slower than if it was on soil. From full but broken form, to furless meat, to bone, it was finally reduced to nothing more than fragments of specimen. After a week, one would not even be able to tell that something had died at that spot a few days earlier.

It made me reflect on death. How when a soul finally leaves its home, it will most likely become at best an object of taboo, and at worst an object of disgust. We prevent ourselves from associating or being in close contact with a lifeless body, unless that is your life's profession. Even as a doctor now when death is a commonality, there is a different feeling when we have to either certify a patient's death or when visiting the morgue. It may be rooted from the uncomfortable feeling of realisation that its fate will soon become your fate. But most times this realisation is blanketed with emotions of fear and disgust.

Ultimately, even the highest and most powerful of people, will become that dead squirrel on the road. In death, they will become mere objects to be avoided, before they are finally reduced to nothingness. And such is the (pun intended) cycle of life.

095: #LDR

When you give your heart to someone in its entirety, no one warns you of the sheer emptiness you feel when it is not in immediate proximity. Maybe they do, but the rhythmic sounds of your heart held in the protective hands of your other half drowns out all advice. You see, when he is near, you still feel like your heart is in your chest. Close and safe, beating hard when we embrace. But when he is far away, like for work (ugh, work), you lay awake in bed at night hyperaware that there is something missing.

You stare at the ceiling, counting the days till he returns. 

Your hands protectively cusping a heart that is not your own - but his. 

094: A Monster Calls

This book and I had an accidental introduction. For my birthday, the husband got me a year-long subscription of monthly books handpicked by curators sent to my door. As a book lover, it is akin to opening a Christmas present every month. On Month 2, I was greeted by a parcel. Whilst half opening its bubble wrap, I let out a sigh because they sent me a book I have already read! Good on them for hitting the nail on the head when it came to my literature preferences. But this also means that I have to wait a little longer this month for my actual book.

We went to the bookstore to return the book several days later.
"We're really sorry we have picked a book you have already read. Do you want to pick a book now or do you want us to pick one and send it to you?" the book-whisperer said. Under normal circumstances, I will get flustered. In the oldest bookshop in London which is not only spread over three floors but filled to its brim with colourful books of every genre in the world, needless to say there are too many books to choose from! And to choose only one! Thankfully, prior to the visit, I have stormed the Goodreads website for good picks and I had my eye on one specific book. It received a lot of excellent reviews and many prizes. Not having read it felt like I'm missing out on an extraordinary party.

"Yes, I do know - I would like, A Monster Calls by Patrick Ness please," I replied.
With a smile, she said, "Excellent choice. We have copies right over here." That was the start. Little did I know, about 24 hours later, I would have tears welling in my eyes as I read the last lines of the book.

Man, this book is something else.
It was a holistic experience.
An out of body experience.

It was like a transcended into the book, then came out with a hangover. Its words will linger in my thoughts for weeks after. Despite it being a children's book, it touched on so many hard hitting and difficult subjects. The plot had so many layers to it despite being packaged in simple language. There is no doubt that Ness is an author that I'll revisit often in the future.

I was lucky to have finished the book a few weeks before the movie was due to be released. If it was to be months instead of days, the anticipation would have got the better of me. Husband, sister and I went to the cinema at Walthamstow (cheap-ish tickets!) to watch it right after wrapping up a day long final year revision course. I was tired, and not wanting to be disappointed, I walked in without any expectations.

Verdict?
The movie was a masterpiece.

Despite knowing the story, I couldn't help myself from bawling my eyes out. The acting was superb, and the composition as well as the animation was amazing. Often times, movie adaptations are like a disappointing sibling to the book, but this time - I felt as if the book and the movie both complemented each other. The one enhances the experience of the other - and thats really rare. Reasons like these are why I enjoy literature so much.

The following day, during one of the revision lectures, my thoughts sidetracked from endocrinology back into the film. I jotted some underlying themes of the story (below), but note that this list is not by all means exhaustive.

1. The stigma of diagnoses (and how ill-equipped society is to handle them)
2. The lies we tell ourselves and others, and its many evils
3. The complexity of the human being
4. The pain of uncertainty
5. Acceptance and letting go
6. Permission to be angry
7. Families are by choice

I think I would expand on each aspect in a future post, because I have lots to say about them. Ideas are bouncing in my head in need of coherency. But for now, take it as a teaser for whats to come. In conclusion, please read or watch A Monster Calls. I doubt that you will regret it.