Psikiatri Komuniti :)

Bissmillahirrahmanirrahim...

Assalamualaikum wbt.

En Kambing..apa khabar...hari tu teman dtg singgah kejap dkt kandang...baru teman bercerita separuh jalan, en kambing dah tersembur2 menangih...kensel separuh jalan, teman x jadi cerita...tunggu en kambing dah stabil balik, lain kali baru kita buka cerita tu semula ye...

Semalam ni kawan se-koridor teman, En Mizwar Abduh (bukan nama sebenar) ada mintak teman bagi komen sikit pasal kejadian amuk dekat putrajaya tu...baca kat sini ye...teman idak le nak komen apa2..agaknya sungguh le perempuan tu mmg ada masalah psikiatri..wallahu'alam...

Apa yg teman tau, bila keluar cerita tu smlm, teman tetiba teringat...masih ada lagi cerita masa teman buat attachment dipsikiatri yg teman belum cerita sini :)

Alkisahnya, masa teman buat attachment di psikiatri hukm dulu, selain menengok patient di wad dan klinik..teman kena jugak buat rotation di bhg psikiatri komuniti...bila dgr org cerita, komuniti psikiatri ni best jugak...sbb byk jalan2 ziarah patient di rumah...komuniti lah katakan :) masa awal2 tu teman saspen la jugak..berapa org yg pegi??kalau apa2 jadi, apa aku nak buat...hehe..ternyata tak matang betul pemikiran tu...bila teman tengok staf2 yg pegi tu..semua rileks je...takde mende nak takut...selalunya patient2 psikiatri ni kebanyakannnya stabil...sekali dua je dpt yg amuk bawak parang begitu...hehehe...

Komuniti psikiatri ni adalah satu team di bawah jabatan psikiatri yg mana team ni akan menziarah pesakit2 yg disahkan stabil di rumah & memberi rawatan kepada pesakit2 ni di rumah mereka...Team ni agak besar- ada doktor, misi, paramedik, kaunselor, psikologis & terapis carakerja...selalunya pesakit2 ni ada masalah utk dtg ke klinik (masalah kenderaan etc), jadinya utk mengelakkan drp mereka tertinggal rawatan, team psikiatri komuniti ni sedia berkhidmat utk pesakit2 :)

Teman ingat lagi 1st time teman ikut mereka naik van, misi2 dan paramedik2 semuanya lawa2 & hensem pakai baju jalan2...tak pakai uniform pun...tujuannya utk mengelakkan stigma daripada jiran2...apa pulak org kata nanti ye..kalau sekali seminggu ada misi dtg rumah bagi ubat....nampak sgt ada penyakit tak stabil...teman mengangguk senyum...betul jugak ye...

Kitorg pegi nak dekat 5 rumah jugak haritu....pengalaman dgn patient tak payah cerita lah..mmg kelakar....ada yg sampai marah teman sbb tak lahirkan lagi anaknya setelah 7 tahun mengandung...tapi apa yg teman nak cerita dekat sini adalah kegigihan team komuniti psikiatri ni dlm memberikan yg terbaik utk pesakit2 mereka...mula2 teman ingatkan tugas mereka sekadar memberi ubat suntikan, top up ubat2 pil...tapi rupa2nya mereka lakukan lebih 100 000000xxx daripada tu :)

Sesampainya di rumah pesakit, deme akan bersihkan sikit apa2 yg patut...kadang2 sampai buat gotong royong bersihkan rumah pesakit...semak samun, lalang semua di tebas...barang2 tak berguna, sampah semua dibuang...

Lepastu hehe..masa utk menyolek pesakit..hehe...capailah apa yg ada...kalau ada sikat, disikatnya rambut elok2...diikat kemas2..kekadang kalau pesakit belum mandi, deme akan suruh pesakit mandi dulu, lepastu lagi best bersolek..

Kalau pesakit nampak agak serabai, rambut, kuku dah panjang, deme lagi seronok..abih semua dibersihkan :)

 Yeahh, adik paramedik kita dah mula mencukur misai patient..

Okay, adik perempuan terapis carakerja pun dah mula memotong kuku...

Sorang lagi adik paramedik menggunting rambut pesakit :)

Lepas dah siap semua tu..deme akan sama2 pastikan ubat patient cukup sehingga lawatan selanjutnya...dan untuk memastikan patient mudah ingat nak makan ubat, mereka bersungguh2 buat carta macam ni supaya patient tak lupa :)

Hmmmm.....bagus takkk???? Teman sgt tersentuh masa tgk carta ni pertama kali...besaq tau...besaq kad manila tu...jadinya, kalau patient lupa atau degil nak makan ubat pun, kurang2nya kami boleh kesan le :)

Lepas dah selesai sebuah rumah..benda yg sama akan dibuat ke rumah seterusnya....so, kome boleh agak la betapa letihnya teman bila dah selesai semua rumah tu...tup tup, masa nak balik tu, teman tengok kitorg ambik jalan lain pulak...bukan ke arah hukm...teman tanya misi..'kita nak ke mana ni?'

'Nak pegi stesen bas kejap Dr, nak tolong carikan keje utk patient tadi tu'

Hah??tolong carikan keje utk patient??sampai mcmtu sekali u all berkhidmat utk patients ye :)) terharu benor le teman waktu tu...tapi teman terpikir pulak...nak cari keje apa?pemandu bas ke??hehe...bila sampai di sana baru le teman paham....nak dicarikan keje sbg cleaner sbb patient tu dah stabil dan perlu menyara diri sendiri....masa kat stesen bas tu, pegawai psikologi pulak yg main peranan hantar resume patient dan memberikan keyakinan pada majikan yg patient tu dah sihat dan stabil :)) suka teman...majikan pun nampak puas hati & takde masalah...rupa2nya sblm ni pun team komuniti psikiatri ni pernah hantar pesakit mereka utk bekerja di sana..dan rata2 pesakit2 tersebut semuanya bekerja dgn rajin, takde mengulor mcm sesetengah kita ni ;p

Ni gambar kami kat stesen bas tu...whole team of community psychiatry..muka puas hati sbb berjaya dptkan pekerjaan utk patient :)

On the way balik dari stesen bas tu, tetiba adik perempuan terapis carakerja tu tanya teman,' Esok Dr free?'
'Ada kelas esok, kenapa?You all ada nak pegi mana2 ke?'
'Ha'ah...nak bawak patient2 jalan2 tengok kilang roti'

Hah??bestnya!! tapi tak boleh ikut...huhu...'You all mmg selalu bawak patient jalan2 ke?'

'Selalu jugak Dr, dlm 2 minggu sekali...diorg pun takde siapa nak bawak jalan kan...daripada tak buat apa2, baik kami bawak jalan2..kurang2 diorang dapat rasa mcm org biasa...selalunya pegi dkt tempat yg diorg boleh belajar something la, Dr..'

Teman senyum lagi...banyak benor jasa mereka2 ni pd patient2 psikiatri hukm ni..mmg beruntung la pesakit2 psikiatri di sana...dah la mereka ni kreatif fikirkan mcm2 cara utk menghiburkan patient2 tu, buat pulak dgn hati yg ikhlas, muka yg manis, tak marah2 atau sekadar melepaskan batuk di tangga (betulkan pepatah teman ni ? hehe)...Moga Allah memberikan ganjaran berlipat2 kali ganda buat mereka semua :)

Balik je daripada home visit, teman masuk pula meeting dgn pihak polis..mereka bermesyuarat mcmmana nak handle pesakit2 psikiatri yg mengganas di rumah...apa caranya utk dibawa ke hospital etc...panjang jugak meetingnya...akhirnya mencapai kata sepakat dari kedua2 pihak polis dan kesihatan tentang cara2 nak handle aggressive patients...it's always nice kalau wujud kerjasama daripada 2 badan berbeza...sbb kepakaran kita berbeza, and we cant deny that we all need one another...

Teman balik ke rumah dgn hati yg riang haritu...akhirnya menjadi saksi kpd khidmat kesihatan yg betul2 berkualiti..kalau mcm ni lah taraf servis yg kita mampu berikan pada pesakit di seluruh negara, who's to doubt that we're a developed country?? :))

Ketua unit psikiatri komuniti sewaktu teman buat attachment tu adalah Allahyarhamah Prof Ruzanna Zam Zam...Beliaulah yg banyak memberikan idea dan perancangan utk team tersebut sehinggalah team komuniti tu betul2 berjaya...Bila beliau tak begitu sibuk, beliau juga turut serta dalam home visit utk menziarah patient2nya di rumah...Namun, prof sudah tiada pada hari ni...Ternyata Allah lebih menyayanginya dan telah menjemputnya pulang pangkuan Illahi pada awal tahun 2012 ni...

Teman ingat lagi sewaktu teman buat posting tu, arwah selalu batuk2...disangkanya batuk2 biasa...namun bila sudah berlarutan & dibuat x ray, barulah dikesan tompok2 putih yg kelihatan seperti kanser di paru2...setelah dibuat CT scan, arwah disahkan menghidap Kanser Ovari tahap ke-4, kerana telah pun merebak ke paru2...

Seperti yg kita semua agak, mesti arwah begitu terkejut waktu tu..kami hendak melawatnya, tapi prof memberitahu bahawa beliau tak mampu hendak melayan tetamu...prof kemudiannya mengambil mc untuk beberapa bulan...

Namun, setelah lebih kurang 4-5 bulan prof mengambil mc, beliau tiba2 sambung bekerja...beliau bukan saja setakat merawat patients, tapi jugak mengisi jadual beliau dgn memberi ceramah 'How To Lead a Happy Life' kepada staf2 kesihatan etc..

Prof ada juga dtg ke jabatan teman utk memberikan ceramahnya...diceritanya bagaimana pengalamannya sewaktu mendapat tahu beliau menghidap kanser...mmg terkejut, depressed dan sebagainya..sampai lah satu ketika Allah memberinya ilham, 'sampai bila aku nak macam ni?memang semua akan mati, tapi tak perlu lah kita sekadar menunggu mati itu tiba' ;)

Jadi sbb tu arwah kembali bekerja...diceritanya kepada kami bagaimana suaminya pada tiap2 tahun akan book flight utk berjalan2 di luar negara...tapi pada tahun itu, suaminya mcm tak tau nak buat apa...arwah memberitahu lembut kpd suaminya, tempah sajalah tiket itu, kalau ada rezeki, kita pergi sama2... ;) masa tu mmg airmata audience semua dah berderu2 mengalir...melihatkan seorang wanita yg  sudah tahu ajalnya begitu dekat namun masih gagah bercakap di hadapan, memberikan semangat kpd org lain ;)

Di akhir kata-katanya, arwah memberitahu, 'Sebenarnya dari dulu saya tertanya2 kenapa Allah jadikan saya seorang psychiatrist...dan bukan kepakaran lain...lama saya fikir tapi saya tak pernah tahu jawapannya...tapi sekarang saya tahu...Allah jadikan saya seorang psychiatrist sbb Allah nak saya bersedia untuk hari ni...supaya kepakaran saya dlm memberi kaunseling & terapi kpd patients saya, dpt saya gunakan utk diri sendiri supaya saya tenang menghadapi hari2 akhir saya ini'

Ayat yg teman tak akan lupakan sampai bila2 insyaAllah...dan tiap2 kali teman ingat ayat ni, mesti hati teman tersentuh...ayat yg teman rasakan cukup matang, dari seorang yg tahu ajalnya akan tiba tak lama lagi...Selang 1-2 bulan dari ceramah tersebut, Allahyarhamah Prof Ruzanna Zam Zam meninggalkan kita pada 16/1/2012...namun legasinya tetap berterusan, khidmat komuniti psikiatri masih berjalan dan nama baik dan jasanya tetap menjadi ingatan...

Semoga Allah memberkati rohnya dan menempatkannya di kalangan para mukmin insyaAllah ;)

Al-fatihah...

Wasallam.

Apabila seorang ibu tidak mahu anaknya berjaya

Bismillahirrahmanirrahim...

Assalamualaikum wbt.

Pekabar pelawat en kambing sekalian...Lama rasanya tak menulih...Byk cerita sebenornya..tapi masa tidak begitu mengizinkan...ni pun teman curi masa sikit nak berceloteh..periksa teman udah dekat benor..lagi berapa hari aje lagi insyaAllah...lepastu lega la sikit kepala teman...lama benor dah teman membaca buku..tak terkata dah nak baca mcmmana lagi dah...huhu

Baru2 ni teman ambik cuti..saja nak ambik cuti supaya boleh study sendiri..tapi walaupun teman cuti, teman tetap pegi ke klinik...dengan tujuan boleh practice tengok patient..sbb exam teman yg minggu depan ni mmg practical pun...so lagi banyak tengok patient, lagi bagus la hendaknya insyaAllah...

Sesampainya teman di klinik, perut berkeroncong la pule..jadi teman singgah dekat kedai makan sebelah klinik teman tu...sedang teman makan nasi lemak sambal kerang kegemaran teman yang ummpphhh tu dtg sorang makcik berumur 60-an duduk semeja dengan teman...agaknya saja nak bersembang sambil makan kot...teman orait je..dah memang jenis suka bersembang pun..haha

Tapi bila teman perhati lama2...makcik ni sebenarnya dlm keadaan marah...sedih pun ada...mukanya mcm  dlm keadaan bermasalah....jadiknya tidak le teman buka mulut dulu...teman tunggu makcik tu membuka bicara....ewah...

Betul tekaan teman, tak sampai 2 minit makcik tu tetiba cakap...

Makcik : Lama betul makcik menunggu kat klinik...Dari pukul 7.30 tadi...skrg dah pukul 10.30 pun belum ambil ubat dekat farmasi lagi...Nombor makcik 80, sekarang ni baru nombor 60.

Teman senyum simpati dan mengangguk kecil....

Makcik : Dah la rumah jauh...pagi tadi pukul 6.30 dah keluar...ni nak balik satlagi mesti jam ni....

Teman: Oh ye ke...rumah makcik dekat mana?

Makcik: Ampang....makcik bawak kereta sendiri pagi tadi...kalau nak ikutkan memang dah tak berani nak drive sorang2 dah tua2 ni...tapi apa nak buat....anak semua keje....pakcik pulak sakit kaki, gaut....abih tu, kena berani jugak la bawak kereta datang ke sini...

Makcik hirup sikit teh tarik nya...lepastu sambung lagi..."Makcik ni pun bukan la sihat sangat, mata tak terang, lutut tak kuat...tangan pun dah terketar2 ni ha...masuk gear pun kena tolak kuat2...maklum la, kereta lama.....hmmh...itu pun tadi jumpa Dr kat klinik tu, dia nak tambah ubat lagi..entah apanya nak ditambahkan...tak termakan dah makcik tua2 ni"

Teman angguk lagi....tak berkata apa2....suasana seolah2 tidak menggalakkan untuk teman berceloteh mcm biasa...jadi kami pun makan dlm keadaan senyap...sekali sekala makcik mengeluh kecil....

Selang beberapa minit, makcik bertanya lagi kepada teman...

Makcik: Dah kahwin?

Teman: Dah (senyum kecil)

Makcik: Dah ada anak?

Teman: Belum lagi (senyum lagi)

Makcik mengangguk....

Makcik: Entah la, kadang2 makcik pikir, bagus jugak kalau kita ada sorang anak yg tak berapa menjadi....Kurang2 ada jugak sorang yg boleh jaga kita dah tua2 ni...

Teman pandang makcik....tapi makcik tak pandang teman...seolah2 malu nak katakan apa yg tersirat dlm hatinya....

"Anak makcik berapa orang?"

"Empat...semua bekerja...sorang manager, sorang arkitek...semua menjadi..tapi yelah...bila dah bekerja tu, siapa la pulak nak menjaga mak ni...."

Makcik sambung lagi," Bukannya anak2 makcik tak ambik berat...semuanya bagus...hujung2 minggu semua balik....tiap2 malam semua telefon tanya khabar...tapi takat itu aje lah...yg susah payah hari2 ni,kita sorang aje lah yg tanggung..."

"Ini pun makcik saja tak nak bawak telefon..kalau tidak anak2 makcik mesti akan telefon tak henti2 risaukan makcik drive sorang2...tapi yelah...semuanya bekerja...susah nak ambik cuti semata2 nak bawak makcik ke klinik ni..."

"Baru2 ni ada makcik bersembang dengan jiran sebelah rumah...dia mengadu dgn makcik, anaknya jantan yg kecik tu asyik melepak aje kat rumah...kerja tak nak...apa pun tak nak...tengok tv aje kerjanya....makcik cakap dengan dia...jgn marahkan sgt budak tu...esok2 kau tengok la...budak tu la nanti yg dapat teman engkau kat rumah tu...kurang2 berteman kau sampai tua nanti..."

"Tuhan tu Maha Kaya...kalau anak kita tu tak berapa cerdik...tak berapa menjadi...ada la sebabnya tu...tak payah kita nak sibuk2 paksa dia belajar kuat2..."

Makcik sambung makan...pelan-pelan dia habiskan laksanya....

Tetiba dia berkata.."Tapi sebenarnya walaupun makcik kadang2 terpikir mcmtu, makcik tak sanggup nak berdoa pada Tuhan minta anak makcik tak menjadi...sebab makcik risau lepas makcik mati nanti, apa la nak jadi pada anak makcik tu....

Makcik pandang teman..matanya berair....teman mengangguk faham.....

Sucinya hati seorang ibu....dijaga dipeliharanya anak bagai menatang minyak yang penuh...pilu di hati diketepikan walau terguris....dan dalam keadaan susah payah, kesengangan dan kejayaan anaknya masih menjadi keutamaan...biar dirinya yang merana....asalkan anaknya bahagia...

Teman faham sangat apa yg dikatakan oleh makcik ni...selalu teman terpikir, apa guna teman belajar tinggi2 ilmu kedoktoran ni, kalau tak mampu berkhidmat utk mereka yg bersusah payah menghantar teman ke sekolah....tapi mampukah teman berada di sisi mereka setiap masa?setiap ketika? mana lagi dengan tanggungjawab kepada suami dan pekerjaan....atau adakah teman hanya akan menjadi sorang anak yg hanya akan menelefon bertanya khabar setiap malam? :'(

Wasallam.

a sad but sweet day :')

Bismillahirrahmanirrahim...

Assalamualaikum wbt.

Walaupun sibuk hari ni teman rasa nak kongsi jugak cerita hari ni..

hari ni dlm bahasa melayu..sbb rasa 'relax' sikit..haritu stress...tu yg keluar bahasa omputih tu..kuang kuang kuang...

Eh eh..lama plak teman tak tegur en kambing ye...kesian en kambing...bukan ku tidak mengingati dirimu..tapi teman skrg ni tgh biol nak exam tak lama lagi..nanti kita buat study group sama2 dlm kandang en kambing ye...

Hari ni ada sorang uncle cina masuk dlm bilik teman...bilik klinik la ye..karang ada yg salah paham plak...uncle tu dah tua..dah 85 tahun pun...tapi steady lagi...ada darah tinggi skit...tapi yg lain2 semua takde..dia dtg dgn anak dia...senyum manis je uncle tu..fasih berbahasa melayu...

Mula2 tu teman buat consultation mcm biasa..tanya apa khabar...ada makan ubat tak...ada apa2 masalah tak...uncle senyum saja...semua okay katanya....

lepastu teman bukak komputer nak tengok keputusan darah uncle tu...(ye, dkt hukm, laporan ujian darah, x ray, laporan masuk wad terdahulu semuanya masuk dlm sistem komputer, so senang nak trace...yg tahun 2006 pun senang je nak cari...cita2 teman nak buat mcm ni dkt klinik kesihatan nanti insyaAllah...doakan ye)....tengok2 takde...yg last sekali bulan 7 tahun 2011..

teman pun tanya anak uncle tu...'eh, kenapa takde keputusan darah ye?tak sempat ambil ke haritu?'

jawab anaknya...'oh ye...tak sempat nak ambil...mak saya baru meninggal hari tu..'

'Oh ye ke...sorry ye...bila meninggal?'

'Baru 3 minggu lepas.....'

'Ooooo' teman menjeling uncle sekilas...uncle masih lagi tersenyum..lepas tu uncle kata 'Dia mati pun takdak sebab apa2...sakit apa pun takdak...dia tido saja..lepastu tak bangun...terus tido saja'

Teman angguk..dapat rasakan yg uncle masih nak bagitau sesuatu...

Dia masih tersenyum...tapi matanya dah bertukar sayu....Bila uncle diam saja, teman sentuh lututnya...'Uncle okay ke..?'

'Saya banyak ingat sama dia....55 tahun hidup sama...satu kali pun tak pernah gaduh...sekarang rasa byk sunyi....rumah byk orang, tapi byk sunyi....'

teman hanya mampu tersenyum dan mengangguk..

Tiba2 uncle ambil wallet dari poketnya....ditunjuknya teman gambar hitam putih mereka berdua sewaktu muda....'Ini gambar sudah 55 tahun dlm ini wallet...saya tak pernah tarik keluar' ...Air mata uncle sudah mengalir...mata teman pun dah basah...cepat2 teman buat2 tgk komputer...

Sedihnya waktu tu Tuhan saja yg tahu...semestinya sukar utk org tua sepertinya berada dlm kehilangan org tersayang....walaupun teman pasti yg mereka telah pun lama terfikir akan kematian, tetapi bila tiba waktunya..kehilangan itu tetap pahit utk ditelan....

'Sekarang saya pun rasa tak payah dtg klinik lagi...hidup lama2 pun mau buat apa...dulu saya ingat saya mati dulu..saya lagi tua 10 tahun drp dia...'

Ya, org yg ditinggalkan selalunya akan merasai kesedihan yg lebih hebat drp org yg meninggalkan (huhu..kesian sumi san i....i sayang u tau) Teman tak tau nak cakap apa masa tu...jadi teman cuma cakap apa yg ada dlm hati teman ,'Uncle kena kuat, tengok ni..anak2 cucu2 semua sayang sama uncle...semua mau tgk uncle happy...bagus la uncle ingat sama auntie...mesti auntie dulu pun byk happy sama uncle dgn anak2...tapi skrg uncle kena cuba kuatkan hati ye'

teman pun tak tau apa yg teman cakap...yg pasti teman dpt rasa kesedihannya walaupun dlm tempoh beberapa minit uncle berada dlm bilik teman...sampai kecut2 jantung menahan sebak dibuatnya...

hargailah pasangan yg telah ditetapkan oleh Allah buat kita kerana sesungguhnya dialah pasangan terbaik buat kita...dan sesungguhnya mati itu pasti..sejauh mana sedalam mana cinta kita kepada manusia, manusia itu tetap akan mati..dan seandainya cinta itu hanya kepadanya,maka rugilah kita...kerana cinta agung itu tetap milikNya...

p/s: kepada en suami, semoga kita jua dapat menjadi tua bersama2 insyaAllah...bimbinglah isterimu ini hingga ke syurga :')

ideal situation? or not?

Bismillahirrahmanirrahim..

Assalamualaikum wbt.

Sbg seorang pelajar masters..we have been trained to answer questions mengikut skema...sometimes we dont even have to stop to think, because we already know the standard answer...for an example..if there is a question about a patient who does not have any symptoms but requested for a full check up including tumour markers, CT scan etc, we know that at the end of the day, our answer will be- to politely decline the request..in fact we even come up with our own scenarios and test ourselves on how to answer it the best way..just so we could go into our 'automatic' mode during the exams and just write the answers without thinking much...coz time is really an issue during exams..

So, i've already been drilled a few times on this rather popular question on a patient who have an acquired physical disability who would like to continue driving. A common scenario would be :

A 40-ish year old lorry driver who have very poor diabetic control complains to you that he has numbness over both of his legs for the past few months.

Well, other than solving his present complain of numbness and trying to achieve better control of his diabetic condition (by denying him practically all types of food that u can think of..hehe), we also have been reminded again and again that he should be referred for a proper driving assessment by the JPJ to see whether or not he is still fit to drive that big lorry. And, if for some reason, the JPJ decides that he is unfit and may impose some liability to the society, he will then be advised to stop driving and we will just assume that he will simply look for another job and settles down happily ever after full stop. And we will insyaAllah at least pass the question with 5/10.

The mind boggling thing is that...things are not as simple in real life.

Two weeks ago, a patient came to me with a form from the social welfare department. He appeared nervous but at the same time determined and i could even sense a bit of...'arrogance' in the way he walked and held his nose high. Looking retrospectively, i think that bit of arrogance that i sensed was perhaps just a shred of pride that he was holding on to while handing me that piece of paper seeking for help that he needed.

He was a 45 year old man with 2 amputated fingers on his right hand due to industrial injury 16 years ago...Since 16 years back, he had never gone to the welfare department requesting for any sort of financial help because he was still able to work in a nearby factory (hard labour which involved carrying heavy things without the need of fine handwork) however, since 6 months back the factory had to shut down and he was left....jobless...

This patient is a regular guy with a family, 5 children..all still schooling....youngest 6 years old...and was in serious need of money when 4 months ago his neighbour offered him to drive his groceries van...and so, he took the offer gladly and Alhamdulillah with that little amount of pay, the family of 7 was still able to breathe, not as comfortably maybe..but enough..

However, thinking that his little ones still have a long way to go, he finally decided that it was time to get some financial aid, which i supported with no hesitations.

The problem that i had while looking at him was however...how do i tell him that the only source of income that he has now; which is driving a van (with 2 amputated fingers if i may add) may jeopardize his own life and the others on the road...how do i tell him that i have to refer him to JPJ for a driving assessment where he runs a risk of getting his licence being revoked by the authorities?? who am i to deny his children food and money to go to school...??

A toughie it was...but thinking of those who may get injured on the road just because i failed to do the right thing when i had the chance to is just unacceptable...so i took a deep breath and told..whatever that needed to be told..i tried to be gentle but firm at the same time..and all the while that i spoke he just looked at me with that sad expression on his face...God, it was tough...

But in the end..he looked down at his shoes and gave me a small nod...he told me that he agreed with whatever that i said...and he understood the risk that he was imposing on to the others on road...and he himself didnt want to be held responsible for injuring others while driving....but he told me he needed time...time to come up with a new plan...to discuss with his wife on how to generate income for the family....i agreed...provided that he does not take too long...okay he said..so we fixed an appointment for him to come back..where i could refer him to the occupational therapist and the JPJ for a proper driving assessment...i pray that the JPJ passes him though...it will be less complicated...but even if he fails the test, hopefully by then he would already have a back up plan insyaAllah...

I suppose that incidence really showed me that life is not like what we learned in the textbooks...and ideal situations may not be easily applied to every single scenario that we go through everyday...it's these litte things in life that make us wiser and prepares us for the next challenge...and when we should never abandon the things that we learn in the textbooks or the standard answers in the exams, we should also also learn on how to make the best out of any situations in life- and that's exactly what i've got to do now :)

Wasallam.

"Listen to me,Dr..I'm telling you something!"

Bismillahirrahmanirrahim...

Assalamualaikum wbt.

Selamat hari raya en kambing n pelawat2 sekalian...En kambing raya kat mana tahun ni??oo, dlm kandang...dah abis kuih raya en kambing? teman punya ada lagi..sebijik2 teman makan lepas balik keje...rasanya boleh simpan sampai raya haji kot...hehe

Skrg ni teman tgh keje kat kecemasan...Dua bulan teman kat situ...penat betul rasanya..ye lah, mana taknya..semua kes kecemasan, asyik nak cepat je...tak boleh buat keje lambat2..dah la tu, kena perah kepala buat diagnosis cepat2...kalau tak patient makin menimbun kat kecemasan, nanti ramai yg kena tunggu lama kat kecemasan...kesian pulak...

Alkisahnya bila jadi Dr kat kecemasan ni, memandangkan kerja kena cepat dan efficient pada masa yg sama, para Drs kena cekap pilih informasi mana yg relevant, yg diberi oleh patient supaya kita boleh faham cepat apa yg berlaku pada patient..So, memang adakalanya informasi2 yg tak berapa relevent tu, teman kadang2 buat tak endah saja dan concentrate pada benda yg penting. Contohnya lah, kalau patient complain sakit dada, dan pada masa yg sama dia bagitau matanya rasa kering...sudah tentu teman akan concentrate pada simptom sakit dada, dan akan make sure ECG dibuat untuk pastikan sama ada patient tu sedang mengalami heart attack atau tidak...Simptom mata kering yg tak berapa specific tu mungkin hanya akan diteliti selepas teman dah pasti tidak ada perkara 'life threatening' yg patient tu sedang hadapi waktu tu...

Having said that, baru2 ni ada kes kecemasan kelakar yg teman nak share..Bila teman pikir2 pasal kes tu, mesti teman akan tersenyum dan menginsafkan teman agar jadi org yg lebih humble dan dengar.....betul2 dengar apa yg patient nak cuba cakap pada teman...

Hari tu ada seorang apek ini dlm limgkungan umur 70 lebih dtg ke kecemasan, dia datang jauh dari Karak, Pahang...anak2 dia bawak dia ke kl ni...sbb diorg tinggal kat sini...so senang la nak jaga bapaknya...

Kata anak2nya, apek ni tiba2 saja develop slurring of speech dengan severe giddiness sejak dari malam semalam...hmm, apabila dengar saja 'slurring of speech' tu, semestinya mana2 Dr pun akan risau pasal stroke...jadi teman pun bersungguh2 la check apek tu, suruh dia angkat tangan, angkat kaki...angkat kening, senyum...(ye, kalau org kena stoke, sebelah mulut akan senget sebelah, so kira senyum sekerat aje la)...bila dah check semua, nampak mcm apek ni kuat je...takde pun lemah separuh badan...senyum pun hensem lagi...siap cakap kat teman "ini semua gigi original tau..bukan tipu punya" hehe...okay lah uncle...lu pakai colgate ka, gigi banyak kuat...

Tapi bila bercakap memang bunyi mcm lidah ketat...Itu aja yg teman jumpa...tapi memandangkan senior teman yg mula tengok kes tu pada awalnya dah order CT scan utk tengok otak, jadi patient tu pun dihantar utk CT scan...dan spt yg dijangka kan, memang CT scan tu normal...tak nampak mcm stroke pun...so teman pun sembang balik dengan apek n anak2nya..

Kata uncle, 2 hari sebelum dia ke kecemasan..dia terseliuh tangan...jadi dia pegi ke klinik untuk terima injection....balik aje dia di rumah, tetiba dia tersedu2....lama dia tersedu2....pastu dia pegi balik ke klinik tu, klinik tu bagi ubat untuk dia...2 jam lepas makan ubat tu, tetiba lidah dia jadi ketat and dia rasa mulut kering....haus sangat...kepala mula rasa pening.tapi takde lemah separuh badan ke...kebas ke..semua takde...

Hmm...teman pun naik pening dengar cerita dia...masa teman dengar cerita apek tu, yg teman risau 2 benda...ubat apa yg klinik tu bagi...dengan pasal lidah ketat apek tu....teman masih risau kalau2 ada penyakit saraf lain yg apek tu ada...and teman tak peduli sgt pun pasal apek tu cerita yg dia tersedu2....and pasal mulut kering dia tu...

Kebetulan masa tu, anak dia ada dekat teman..kejap2 bapak dia mintak air...kejap2 air....yg terlintas kat fikiran teman masa tu, ish apek ni ada diabetes ke....apa hal asyik nak minum air je...

Yang teman lega sgt masatu, tetiba anak dia kata dia ada bawak ubat yg klinik kat Karak tu bagi kat apek tu..teman pun tengok...."Chlorpromazine" nama ubat tu...Terbeliak mata teman menengokkan ubat tu....mana taknya...ubat tu ubat utk penyakit mental Schizophrenia!! teman pun tengok balik pada anaknya....make sure yg tu ubat yg betul diberi oleh Dr di pahang tu...beriya2 anak2 kata..itulah ubat yg apek tu dpt haritu....teman pun bisik "Bapak u ada penyakit mental ka...cakap sorang2 ka..."

Anak dia pulak yg terbeliak memandang pada teman..."Haiyoo....takda la....apa pasai, itu ubat org gila ka?"

Teman tersenyum..."ya..tapi saya pun tak tau kenapa itu Dr kasi dia ini ubat...takpa, sini ada nombor telefon klinik tu, nanti saya telefon sekejap"

Teman pun telefon la klinik kat Karak tu...mcm2 benda main kat fikiran teman waktu tu....nasib baik ada Dr kat klinik waktu tu...tapi malangnya,bukan Dr yg merawat apek...Dr lain pulak yg cover...

lepas teman memperkenalkan diri, teman pun cerita psl apek tu...Dr tu pun bagitau daripada record mmg uncle tu ada datang 2 kali...sekali pasal sakit tangan...masa tu, Dr yg merawat bagi injection Voltaren (pain killer), tapi malang sekali lagi...masa apek datang utk kali kedua...Dr yg merawat tu hanya rekodkan nama ubat yg diberi je...tak ditulis pulak diagnosis atau sebab ubat tu diberikan...and memang betul ubat Chlorpromazine tu la yg diberi pada apek...

Yang peliknya, ubat tu hanya diberi utk 3 hari...pelik kan...kalau apek tu betul2 gila...dah tentu kena bagi ubat tu bertahun2....huwaaaaaaaaaaaa!!!teman nak nangis waktu tu...betul2 tak tau apa kena dgn uncle...lepas berhempas pulas teman tanya mcm2 kat Dr locum tu (Dr tu pun agaknya dah berpeluh2 menjawab soalan2 teman...kesian dia...dah la tak tau apa2 psl patient tu), teman pun was already on the virge of giving up and saying good bye...

Teman: Well, thank you very much la for helping me out here..

Dr: Sorry, for not being able to help much...But there's no documentation here of why the medication was prescribed

Teman: Yeah.....what to do, maybe I will have to call later when the other Dr is in then...haiyo....I dont know what to do la...so pening...the only thing that the patient told me was that, he had some hiccups then he went back to your clinic for the 2nd time (dengan nada putus harapan)

Dr: Wait a minute...he had hiccups??

Teman: Yeah...why?

Dr: Oh i see!!then maybe that's why la the Dr gave him Chlorpromazine!! sometimes we give short course of that medication for hiccups!!

Teman: Oh really????!!! I've never heard of it!!

So basically, teman tak pernah tau pun yg kalau tersedu ni boleh diubati dgn ubat Schizophrenia....hehe....hampeh..(yep, I still have got sooooooooooo much to learn!!) ...so, lepas thanking the Dr profusely, I put down the phone dengan rasa kemenangan yg puas! Yes, finally, I got the diagnosis!

Apek tu sebenarnya sedang mengalami side effecst of the antipsychotic drug...which is called 'extrapymidal symptoms' (boleh google ye) and simptom2 nya adalah seperti slurring of speech, dry mouth (hence the thirst and continuous drinking of water *slaps forehead*), giddiness, agitation and macam2 lagi....and to think that I was trying to just disregard the non specific symptoms that the patient was trying to tell me! MasyaAllah..thank you for saving me from committing such crime!

So, dapat je diagnosis tu (dengan rasa ala2 puas mcm dpt solve misteri dlm cerita CSI) , teman terus je bagi antidote pada ubat antipsychotic tu...and Alhamdulillah...after about half an hour...the patient dah boleh cakap dengan bunyi yg jelas....no more slurring of speech!!! ;))

It's really satisfying seeing patients improving in front of your very eyes...but of course the earlier part of looking for the root cause is a real headache la...but i guess..it's worth all the effort that you made!

Note to self and to all who inspire to become doctors :

- Never ever stop learning...you can never become 'too good'...Ilmu Allah tu luas...carilah sebanyak mana yg mungkin!

- Listen to your patients!! Listen to what they say...dont disregard something that u do not know as unimportant...coz the brain does not know what the ears cant hear/the eyes cant see!

- Never, ever be cocky...always remain humble like how you were when u were a medical student...coz that's what u'll be for the rest of ur life...a student! ;)

With that, I thank you for visiting my kandang kambing!

Wasallam.

My 1st target for Ramadhan Kareem :)

Bismillahirrahmanirrahim..

Assalamualaikum wbt.

Ramadhan kareem is just around the corner :)

Jom kita sama2 register utk masuk ke Akademi Ramadhan!

moga bila graduate nanti menjadi hamba2 Allah yang lebih baik insyaAllah...

So, apa target pertama teman untuk Ramadhan kali ni..?

hmm...teman rasa teman nak cuba untuk menunaikan solat tepat pada waktunya..

tak nak lengah2 lagi...doakan teman berjaya ye!

teman tinggalkan mi-ke dengan cerita yg teman suka bebenor...never fails to make my eyes moisten each time i read it!...enjoy! :)

"Last Minute Solah"

He remembered his grandmother' s warning about praying on time:

'My son, you shouldn't leave prayer to this late time'.

His grandmother' s age was 70 but, whenever she heard the Adhan, she got up like an arrow and performed the Solat.

He, however could never win over his ego to get up and pray.

Whatever he did, his Solat was always the last to be offered and he prayed it quickly to get it in on time.

Thinking of this, he got up and realized that there were only 15 minutes left before Salat-ul Isha'.

He quickly made Wudhu and performed Salat-ul Maghrib.

While making Tasbih, he again remembered his grandmother and was embarrassed by how he had prayed.

His grandmother prayed with such tranquillity and peace.

He began making Dua and went down to make Sajdah and stayed like that for a while.

He had been at work all day and was tired, very tired.

He awoke abruptly to the sound of noise and shouting.

He was sweating profusely. He looked around. It was very crowded.

Every direction he looked in was filled with people.

Some stood frozen looking around, some were running left and right and some were on their knees with their heads in their hands just waiting.

Pure fear and apprehension filled him as he realized where he was. His heart was about to burst.

It was the Day of Judgment.

When he was alive, he had heard many things about the questioning on the Day of Judgment, but that seemed so long ago.

Could this be something his mind made up?

No, the wait and the fear were so great that he could not have imagined this.

The interrogation was still going on.

He began moving frantically from people to people to ask if his name had been called. No one could answer him.

All of a sudden his name was called and the crowd split into two and made a passageway for him.

Two angels grabbed his arms and led him forward. He walked with unknowing eyes through the crowd. The angels brought him to the centre and left him there.

His head was bent down and his whole life was passing in front of his eyes like a movie.

He opened his eyes but saw only another world.

The people were all helping others.

He saw his father running from one lecture to the other, spending his wealth in the way of Islam.

His mother invited guests to their house and one table was being set while the other was being cleared.

He pleaded his case, 'I too was always on this path. I helped others. I spread the word of Allah. I performed my Salah. I fasted in the month of Ramadhan.'

'Whatever Allah ordered us to do, I did.'

'Whatever he ordered us not to do, I did not.'

He began to cry and think about how much he loved Allah.

He knew that whatever he had done in life would be less than what Allah deserved and his only protector was Allah He was sweating like never before and was shaking all over.

His eyes were fixed on the scale, waiting for the final decision. At last, the decision was made.

The two angels with sheets of paper in their hands, turned to the crowd.

His legs felt like they were going to collapse. He closed his eyes as they began

To read the names of those people who were to enter Jahannam.

His name was read first.

He fell on his knees and yelled that this couldn't be,

'How could I go to Jahannam? I served others all my life, I spread the word of Allah

to others.'

His eyes had become blurry and he was shaking with sweat.

The two angels took him by the arms.

As his feet dragged, they went through the crowd and advanced toward

the blazing flames of Jahannam.

He was yelling and wondered if there was any person who was going to help him.

He was yelling of all the good deeds he had done, how he had helped his father, his fasts, prayers, the Noble Qur'an that he read, he was asking if none of them would help him.

The Jahannam angels continued to drag him.

They had gotten closer to the Hellfire.

He looked back and these were his last pleas.

Had not Rasulullah [PBUH] said, 'How clean would a person be who bathes in a river five times a day, so too does the Salah performed five times cleanse someone of their sins?'

He began yelling, 'My prayers? My prayers? My prayers?'

The two angels did not stop, and they came to the edge of the abyss of Jahannam.

The flames of the fire were burning his face.

He looked back one last time, but his eyes were dry of hope and he had nothing left in him.

One of the angels pushed him in.

He found himself in the air and falling towards the flames.

He had just fallen five or six feet when a hand grabbed him by the arm and pulled him back.

He lifted his head and saw an old man with a long white beard.

He wiped some dust off himself and asked him, 'Who are you?'

The old man replied, 'I am your prayers.'

'Why are you so late?! I was almost in the Fire! You rescued me at the

last minute before I fell in.'

The old man smiled and shook his head, 'You always performed me at the

last minute, did you forget?'

At that instant, he blinked and lifted his head from Sajdah. He was in a sweat. He listened to the voices coming from outside.

He heard the Adhan for Salat-ul Isha.

He got up quickly and went to perform Wudhu.

Pass this on to your friends and family......

Maybe, you can help someone open their eyes.

And who knows?

Maybe, this is a good deed that can help you during The Day of Judgment. INSHA-ALLAH

فَإِذَا قَضَيۡتُمُ ٱلصَّلَوٰةَ فَٱذۡڪُرُواْ ٱللَّهَ قِيَـٰمً۬ا وَقُعُودً۬ا وَعَلَىٰ جُنُوبِڪُمۡ‌ۚ فَإِذَا ٱطۡمَأۡنَنتُمۡ فَأَقِيمُواْ ٱلصَّلَوٰةَ‌ۚ إِنَّ ٱلصَّلَوٰةَ كَانَتۡ عَلَى ٱلۡمُؤۡمِنِينَ كِتَـٰبً۬ا مَّوۡقُوتً۬ا
"When ye have performed the act of worship, remember Allah, standing, sitting and reclining. And when ye are in safety, observe proper worship. Worship at fixed times hath been enjoined on the believers."[An-Nisa':103]

Semoga kita semua memperoleh kemenangan di Ramadhan ini ye :))

Wasallam.

is it your call, or mine??

Bimillahirrahmanirrahim..

Assalamualaikum wbt.

Following my previous post on 'ambiguus genitalia'...today, im going to 'try' (even though not very successful) to answer a question posted by sister azyan azilah:

salam kak sarah. saya selalu baca cerita akak tentang kisah belakang tabir hospital ni.

dan kita tertarik nak tanya pasal khunsa ni jugak la. kita selalu dengar pasal "transgenders" yang kata, kami lelaki tapi naluri kami perempuan. ada yang cakap,dulu diorang khunsa (ada dua kelamin) tapi mak bapak diorang yg decide untuk diorang sama ada jadikan anak mereka lelaki atau perempuan. kira macam mak abah silap percaturan la. jadi mereka seolah-olah salahkan parents diorang. jadi ada yang persoalankan, golongan ambiguus genitalia patut diberikan peluang untuk membesar sebelum ditentukan jantina mana yang diorang lebih cenderung. ini untuk elakkan kes macam ni la. macam dulu pun rasanya ada cerita zaman Rasullah s.a.w yang hamba tu wanita tapi boleh tidur dengan hamba wanita yang lain. kira bagi chance diorang besar dulu la before decide jantina.

jadi rasanya apa pendapat akak dalam kes ni? maybe soalan ni mcam nonsense dari pihak medical or professional, tapi sebagai orang yang curious dan langsung tak ada pape pengalaman dalam ilmu medical ni saya nak tahu jugak la pendapat pakar. hihi

Okay azyan..this is my answer for you:

Dear azyan,

thank u so very much for the very interesting questions...and i took sometime searching for the answer as i had to look for the right people to help me with your question..Alhamdulillah, i managed to speak to Prof Harlina Siraj today and i may have some answers for u even if it's not complete...

First of all, u have to know that the issues pertaining to ambiguus genitalia have not been studied thoroughly...we have yet to sit down with all the specialists and ulama' to understand the terms and to discuss the issues that may arise in these kinds of cases...and i am definitely not the 'pakar' in this issue :) just merely sharing with u bout what i've learned these past few years..

The reason why i mentioned that we need to clarify reg the terms with the ulama' is because, in the Al-Quran, khunsa is mentioned to have both genitalia...that was what Allah said..however, we as medical practitioners (with whatever limited experience that we have) have never seen any cases like that..so, we assume that ambiguus genitalia is one of the categories of 'khunsa' or haemophrodite...however, since we are not very sure of this..sadly to say, that i myself have never mentioned the word 'khunsa' in front of the parents and have also never discussed the repercussions involved if indeed the child is a khunsa in the islamic point of view with them...it is my weakness definitely, and may Allah be with me..insyaAllah i will do further research on this issue in the future..

from my discussion with Prof Harlina, previously when chromosomal studies were still not available, mmg byk masalah..the parents had to just simply choose one gender and bring up the child as how they perceive the gender is supposed to be...and mmg bila kanak2 ni membesar, some of them (i do not have the percentage..sorry!) will have some inclination towards the opposite gender..thus the problems such as what u mentioned arise..

however, even with the chromosomal studies that we have nowadays, it does not guarantee that the child may remain/act according to their biological gender...there have been a few cases of ambiguus genitalia of whom the chromosome was xx, however when the child reached adolescent age, her behaviour became more masculine and she decided that she wants to become a man...we cant really blame them..because even though their chromose is xx, however they may have more androgens or testosterone hormone in their body that's influencing them to behave like a male...

so, what's the point of having the chromosomal study then?well, i guess it helps the parents to clear up their mind a bit..and helps them to raise the child according to the biological gender..we can imagine how disturbed the parents may be right?so, at least with the chromosomal analysis, it helps to guide them on how to bring up the child...HOWEVER,the child and the parents MUST be on regular follow ups..and the parents MUST be counselled and forewarned that the child may behave differently when he/she reaches adolescent age...and if the child then decides to change his/her gender, it must be taken with an open mind and further discussions must be made with the drs/ulama' etc...that is why, maybe the plastic surgery for the reconstruction of the genitalia should not be done during the early years..and maybe it should be decided by the child him/herself...(obviously, this is easier said than done considering the amount of anxiety that the parents will have to bear and please dont ask me the hukum of doing the surgical reconstruction in the first place...i have not yet consulted an ustaz to answer that..huhu)

so, to answer your question...yes, it may be fair to let these children to grow up and decide their gender for themselves as to avoid any confusions/problems in future :)

im sure u still have many questions...hehe..i do too...and im sorry that my answers contain many 'maybe's...as i said, many questions are still unanswered and some other drs may have other opinions rather than the ones i stated here...

i hope to do more research on this...insyaAllah, i hope to see another professor soon..if i have anything to add..i will update u ya..?

thank u again for bringing up the issues..

if anything, can email me at sarahsofian@hotmail.com or meet me at facebook! :)

wasallam.

p/s: there's a very good article on 'gender and sexuality' by prof harlina that was published in solusi volume 25...try this link!

p/s/s: i've never heard the story reg 'khunsa' masa zaman Rasulullah SAW that sister azyan mentioned..could somebody enlighten me on this??thank you!!