[ Fight Song , 嵐 ]

새로운 시작은 늘 설레게 하지

모든 걸 이겨낼 것처럼---

내가 지쳐 쓰러질 때까진

어떤 이유도

어떤 변명도

지금 내겐 용기가 필요해---

It's always exciting to start over

Like you're gonna get through everything---

Let's start from now

Whatever the reason,

whatever the excuse

I need courage right now---

[ 시작 by Gaho (Itaewon Class OST)]

credits : https://lyricstranslate.com

 

//Trying to concentrate in Epilepsy Made Easy online course. Felt so long ago I joined a full-day course... The new norm, teachings are done online, social distancing is priority to break the infection....

When I joined MMed programme for Internal Medicine, Year 4 seemed so far away... The registrars at that time were very impressive, detailed, and confident. I wondered if I would be able to get to that stage one day.

That was in mid-2017.

3 years have passed, it's 2020 now. A lot has happened; we're still in the midst of pandemic and living in a new norm.

At the end of our second last posting, in the feedback session, I realized I still haven't overcome one weakness of mine that has plagued me for as long as I remember. I knew at that time I said to myself, give me a little bit of time, I'll overcome it.

Then we had the exam in February, where the self-confidence just plummetted further realizing I still don't know much... I take it as a miracle that I passed the theory paper. Clinical exam however is postponed due to COVID-19.

Now we are progressing into the new semester, some of us suddenly upgraded to being (pseudo)-Registrars of the ward. That title alone gives me chills and puts a heavy burden on my shoulders. 

They say "with big roles, come big responsibilities."

And I realized it's mainly because I still haven't overcome my (ultimate) weakness: Self-Confidence.

which I don't have.... Self-doubt? I have that, a lot. But the confidence to carry this responsibility as a Registrar, and when we passed, Specialist... I wonder why does it still sound like a far distance goal, something that is out of my reach when it's near?

"The more you learn, the more you don't know"

Yes, we hear that a lot too... and I know this, experiencing it and I still feel like I still have a lot to learn... I still feel like I'm taking small steps and I'm still new to this field. And that scares me.

I guess it's because to have that confidence, you have to know your facts... and facts are something that I don't think I have enough. Yes, you can say all the more reason to learn in MMed... I am trying... But I still don't find it enough... 

And that thought is running through a never-ending loop in my mind, feeding further to the self-doubt that is already peaking inside me... it's like a repeated cycle, an obsessive thought that's running in the background.

I have some real issues here...

...

So maybe.... maybe this break that we unexpectedly received before the second part of the exam is the break that I need to sort out these issues. 

Time to reflect and find solutions. Time to build something.

Time to get used to be in this position and to take a step further...

I have a feeling that I'll be jotting down a lot more entries than expected this year, leaving more footprints, taking it one step at a time. So remember these, Wani :

Try to take a step forward on your own, utter "Ganbatte!"--

まずは自分で踏み出してみて

「頑張れ」そんな安いヤツでいい---

First, try to take a step forward on your own

"Do your best"　Such a simple phrase is fine---

[ Fight Song , 嵐 ]

credits: https://yarukizero.livejournal.com/40047.html

P/S- I love love LOVE the drama Itaewon Class! The development of the storyline & characters, the OSTs, the casts; everything!

Related post : Reflection : One Step - my first entry entering Masters

Post-It Note, entering mid-2020

Just a little note for myself,
for future reference, when we look back to the year 2020
And a little bit of Madrasah Ramadhan this year...

I called 2020 a “Waiting game with rapid shuffling surprises”

It lets the Earth rest for a bit,
It opens our eyes to humanity and humility,
and how to be humble;
But it also showed some true colours of human being,
including the ugly truth...
And how small human is, really

This year has brought a lot of changes,
challenges upon challenges,
myriads of emotions,
And lets us think on how to face the days ahead
with sometimes sudden turns that require us to choose completely different, sometimes unthinkable, untrodden paths...

But one thing for sure,
NEVER abandon social distancing even if you're family members, friends, or colleague
(NEVER see patients without proper mask/goggle/face shield)
MUST ALWAYS practice adequate hand hygiene,
and wear mask appropriately.
It NEVER hurt to be extra careful and OCD
In this COVID-19 era

A note to myself...
There's always hikmah behind all this,
if not now, later insyaAllah...

Selamat Hari Raya everyone,
Eid Mubarak
Stay safe

Till next Ramadhan, insyaAllah

Wani Z.
May 23rd, 2020

A.Pause.

Dear World,

فَاِنَّ مَعَ الۡعُسۡرِ يُسۡرًا ۙ‏

 اِنَّ مَعَ الۡعُسۡرِ يُسۡرًا ؕ‏

Indeed, there is ease with hardship.

Most certainly, there is ease with hardship

 Surah Al-Insyirah (94:5-6)

One Step At A Time- #3 EatHealthy

I thought we could start with food first before the physical exercise, because basically when you choose to loose weight, you choose to modify your lifestyle and a big part to it is your food selection.

To be honest, I'm not the best person to advice on diet, but these are the things I've tried, modified a bit from our consult in Endocrine clinic & tips from my trainer:

1. Most important and difficult- CUT ADDED SUGAR. If you take coffee in the morning, take it black or with skimmed/high calcium milk. The same goes with tea.

2. Breakfast
-try overnight oats. Use rolled oats, not instant as instant has higher GI (Glycaemic Index). Make 3-5 jars on Sunday, and just grab one every morning. I top up mine with lots of different nuts plus/minus apples, oranges, banana, peanut butter, dark chocolate, honey

//Overnight oats. And yes, that's Weet-bix at the back- love it!

//For this one, I cooked the oats instead. See the chocolate pieces?

-if bread, choose wholemeal or wholegrain. If you notice, Gardenia has GI value at the back, lower is better. I love mine toasted with butter & avocado as a spread, or peanut butter/strawberry jam/cheese spread

//GI value at the back of Gardenia's bread. White bread has higher GI, opt for a lower choice

//Lately I added Laughing Cow's cheespread to couple with my avocado toast

//Let me tell you that this is incidental but it's so yummy that I'd eat this every day if golden kiwifruit isn't expensive! Above is a mix of plain yogurt, (Green Hut) granola with roasted nuts and golden kiwifruit

//Smoothiiiiieeeessss!!

-cereal-wise, I chose granola-based, add a bit of cornflakes, sometimes topped with nuts or fruits
-add on above options with an apple or banana
-also tried a bit on smoothies- Pinterest has lots and lots of recipes!
-lately been trying salad + cheery tomato + Kewpie roasted sesame dressing, sometimes with toasts too. 😋

Roughly, 1 cup of rice = 2 pieces of bread = 4 pieces of plain cream crackers (in terms of calorie)

//Yup, packed these 2 (above and below) for breakfast combi. I added nuts and granola in my salad to give that 'crunchiness'

3. Main meals
Follow the recommendation from KKM- "Suku Suku Separuh", meaning of your plate, a quarter portion is wholegrain, a quarter portion is lean protein and another half portion is fruits/greens/vegetables.

Option: change white rice to brown rice, this is what we tell our diabetic patient, mainly because of the lower GI with brown rice. Some opted to avoid rice- not saying that it's bad, but I need my rice 🤣

4. Snacking- I don't because of no time. But if you choose to- fruits or nuts. Or carrot or cucumber.
Be aware that some fruits have high sugar content like grapes and durian
Fruits that contain less sugar we adviced our diabetic patients include the green ones- guava, green apple etc

5. IF- I don't do Intermittent Fasting, simply because I need my breakfast. The bulk of my job is in the morning so I need a good breakfast to sustain me till lunch hour at least.
If you want to do it, fasting for 16 hours or more will give you more benefit so for example, last dinner at 6 pm and next meal is after 10 am
If you want to fast, I suggest do puasa Isnin-Khamis instead 👍

This is mainly notes for myself.


Next post will be a little technical, but basically, it will make you understand how I choose the exercise regime.

One Step at A Time- #2 GetFriends

//Thursday's Les Mills Tone with serra_lin@IG; a killer session every time, but worth it!

Get acquainted. Get friends. Don't do this alone. I mean, get serious friend(s) who either get into the journey with you or someone to monitor your journey.

Reasons- you need someone to keep a tab on your progress & to keep on motivating you. And trust me, you will get tired and demotivated at times.

//Easy walk at KL Tower Eco Park

//Hiking @ Tabur East

//Picnic & walk at Frim, Kepong

//Coway Run this year

If you have the means (time and financial) invest in a gym membership. Gym places usually have classes- Les Mills (under FF), HIIT-like classes, zumba, yoga etc. You can go to these classes for a starter until you find what you like, your niche- we'll talk more about this in later entries.

Invest in a personal trainer (PT) if it's within your reach/budget- because they can tailor the workout for you and they can correct your forms to avoid injuries. And because at times when you feel like you cannot go on anymore, they will push you past your limit, and you will be thankful for that.
Ask around and talk to the trainers on what they can offer.

//Burn class under Fitness First

//The fun bunch @ FF!

//Another fun bunch (quorum x complete) at the gym

My working hour isn't as flexible and I sometimes ended up finishing late- I can't keep up with some of the classes hence getting a PT was my best option. And hey, like someone said, results don't lie. [Honorary mention : khairulmuzzamir@IG]

Alternative is you can always join programme like Jom Kurus 1Malaysia or Fat Loss Challange programme by Anytime Fitness. Point is, don't walk this journey alone.

We'll talk more about workouts, exercise, and trainers in later posts.

Share with me your experience.

One Step at A Time - #1 The Trigger

This is one post that I've been delaying for months and contemplated many times simply because one, my journey isn't as great compared to others; two, I was never a sports person; and three, I wasn't and still am not sure if I could maintain this (read: istiqamah). The 'what if?' kept coming back.

But as I got more questions on how, perhaps I can share a little bit based on what I know and have practiced. I'll break the journey into different parts with different themes. So we go with first step today:

If you want to lose weight, find your reason(s) / trigger(s) to shed that kilogram and anchor it with (a) goal(s)- must be measurable, do-able and realistic.

Mine? The trigger was patient's comment while I was running the obesity clinic (something that went along the line 'but you're also not as fit to give me this advice on how to lose weight' 😑)

I had many other reasons to start losing weight- I was easily feeling tired and the timing just fit. It was around the time where I no longer need to do weekends round and someone (read: cousin Ummi) was pestering me to join the gym- more excuses to lepak with cuzzies!

So first step: Find your absolute resolution. Write down your do-able goal(s)

Mine? To get to ideal body weight, normal BMI, meaning to shed off 10kg. The aim was ~1kg per month (that's what we advice in the obesity clinic- ~1kg per month in the first 6 months)

What's yours?

#wanizsnotes

#onestepatatime

Haematology, a humbling posting

//Above is a snapshot of an abnormal blood smear magnified under the microscope

I'm doing Haematology posting. To be honest, I have always though that Haematology as a world of its own, a foreign sub-specialty even though we learnt the basic stuff in medical school. The first day of my first weekend round in Haemato, Dad sent me to the hospital and asked which posting I am in currently. When I said Haemato he went, “About blood only right? It should be easy, yes?”. I almost went berserk at that statement XD

Blood composed of a lot of constituents which include red cells, white cells, plasma, coagulation factors, platelets etc. Your white cells further have different types i.e. your granulocytes (neutrophils, basophils, eosinophils), monocytes, lymphocytes (B-lymphoctyes, T-lymphocytes, NK-cells). Each of these red and white cells as well as platelets come from a common precursor/immature cells called haemapoeitic stem cell that later differentiate into different cell lineage. Amazing yes?

During the process of differentiation and maturation, at any step the process could go wrong and thus causing your haematological cancer (leukaemia, lymphoma, multiple myeloma), and there could also be structural defects or enzymatic / constituent defects for example in red blood cells (thalassaemia, sickle cell anaemia, iron defienciency anaemia, G6PD (enzyme defiency which cause your red cells to breakdown when exposed to certain agents), haemolytic anaemia where your red cells breakdown for different reasons e.g. infection, malignancy, immune mediated where your immune system attack the red cells), or deficiency in any of the other blood products (e.g. coagulation Factor VIII or IX deficiency in haemophilia or thrombocytopenia which is low platelet which can be due to different reasons) or too much production for example in polycythaemia rubra vera where red cells production is excessive. Not only that, your bone marrow i.e. the factory that produces blood can also have problems i.e. not producing enough blood like in aplastic anaemia, myelofibrosis or abnormal production e.g. myelodysplastic syndrome. I can go on and on and on and the list will just continue.

For us, once you recognize a problem or an issue, the next step is how to manage it.

Back in medical school, our Dean Prof Hatta, taught us a prayer that I still recite until now - "O Allah the Most Merciful, the Most Benevolent, please let us be the tool of your Mercy in serving the humanity regardless of race, creed and religion"

I currently have a few patients under my care who are around my age- One gentleman with a very rare refractory extranasal, extranodal NK-T cell lymphoma whose disease is far ahead of us and kept coming faster than the next cycle of chemotherapy and he would be in pain, because the cancer “grows” on his muscles and bones. If you want to look at it from the point of “fighting cancer”, we’re definitely at the loosing end. Patient and family however is still looking for a miraculous cure.

Another gentleman with progressive lymphoma, now affecting his central nervous system which made me learn about Omaya Shunt and intraventricular chemotherapy. His condition is complicated with many infections after infections which affect his chemotherapy schedule. He asked “why did I get (all) these (infections), Dr?” My reply, because he's immunocompromised, meaning his immune system is low hence he could easily catch any sort of infection. But beneath that question is, "Why me?"

Haematology for me is a very humbling posting- from dealing and learning from these patients, to learning from my consultants and specialists; amazed at the level of passion and care they have for their patients, and it made me realized again and again that the more I learn, the more I don't know...

"Which then of the bounties (favours, gifts) of your Lord will you deny?" 
[ar-Rahman 55:13]

Panda Run! I mean, Panda Rolls

 So yesterday I had my first fun run; after days being "badgered" by a colleague to do so (and she succeeded in pulling not only me, but another friend as well) I repeatedly said to them I can't run (which was true) and we would only walk. And since we're all on the same page, that was really the agreement.

Until I kinda.... walked slightly faster than them (>.<)
To be honest, I kinda surprised myself- at the little stamina that I had to sustain short run and fast-pace walk, and at how much I enjoyed it. Maybe those hours at the gym helped. Maybe my sister's advice on "try to go as fast as you can without compromising your breathing pattern". Maybe putting on upbeat songs while walking/jogging/running helped.

//Us, before starting

//And we finished!

//See how cute the finisher medal is!

So after run, we makan la kan? XD

Anyway, now entering 2nd year, we have a bit more time over the weekends if not doing on-calls. Supposedly that time is filled with studying, yeah I know... but one thing lead to another, we have yet to restart the engine of the study group. Past 2 semesters, we used the time after work to sit down and discuss questions, but now even after office hours we're still seeing referrals so there need for a dedicated time over the weekends for group discussion.

But 3rd sem is approaching the end fast and we're still yet to start the engine... Being into rotations with minimal people is also not helping. Ilham and I were having hard time adjusting to it; it's slightly better now but we're still agitated receiving referrals.

And I've added an extra activity into my already busy schedule- trying to keep up with 150 mins per week of physical activities. I guess there was a reason why I got into Endocrine as my first rotation this sem- giving advises like "cut down your sugar" and "you have to exercise at least 150 minutes per week, activities that make your heart rate goes up and you to sweat" are only believable when you're doing it yourself. At least now I can look into my patients' eyes and say these mantra without feeling guilt.

Working out for me also means venting out all those frustration and pent-up anger etc. You kinda literally feels lighter and satisfied after a good session, thanks to the endorpins and dopamine released. I think I have a better sleep and better energy at work too.

And those days I go to the gym, those are my happy-pill days because I got to spend time with my cousins! 

//Ok, this was when we went out for dinner, but these 2 girls are part of my support system for a long time :)

Now that I steadily scheduled exercise into my routine, the question is, how to fit in studying into the equation? Questioning myself this means that I'm entering a panic mode. Exam is only 3 semester down the road. (>,<)

Sticky Note 1-2018 : Madrasah Ramadhan (1)

//Sticky Note:

I am still somewhat green in this field, still learning the ropes and steps but sometimes when you’re working in this field, in general medicine especially, you’re sort of "immune" when you’re dealing with dying patients / death. Automatically there’s this invisible, protective barrier surrounding you, devoid of any emotions so that you can manage your next patient without having the recurrent thoughts of that particular patient looping in your mind.

I still remember the first time I encountered a patient that we (the team) issued “DNR” (read: not for active resuscitation, for best supportive care) in my second posting as a House Officer, I was shaken and I almost cried (read here). At the time, I kept asking myself if I did the right thing.
Nowadays, issuing DNR when indicated (i.e. when we postulate that the prognosis is poor) is something that is not as hard as before.

But my first referral in Resus during on-call last Monday, I lingered around longer than expected, trying to make sure the patient and family knows what was happening, what was bound to happen and how we planned to deal with it. A young gentleman with terminal metastatic cancer and we know that nothing much we can offer except for comfort care; to counsel him while he was still awake and aware, something struck my core.

He’s not much older than me, and he’s probably at the end of his life. I wonder how it feels to be in his shoes; not being able to do much and depending on others to care for him, with shortness of breathand his bloods showing multiple organ impairments… when I was counselling his sister, I myself almost tear up.

Another recent young death, Mr Ali Banat, also resonated in similar way- a young gentleman who passed away recently due to cancer, being able to contribute up to his last breath. These people were given chance by Allah, to prepare before they breathe their last breath.

But what about us?
Have we atone enough?
Have we seek for forgiveness from The Creator and other mankind whom we’ve wronged previously?
Have we settled all our debts?
Have we save enough merits for the hereafter?

“Ya Allah, iftah ‘alayya”

May 15th

//Zira, Mama and Me

This is my mom, the middle one.
Every year, there will be wishes of "Happy Mother's Day" in mid-May. We're lucky that Mama's birthday falls on May 15th, a couple of days after Mother's day. Mama is even happier that her first grandson's birthday is only a day before her birthday- when my SIL's EDD (expected date of delivery) was on 24th of May, she was praying it fell onto her birth date instead XD But Muhammad was born 1 day earlier. Nevertheless, it's like a double celebration.

Everywhere children wish their mothers Happy Mother's Day; some celebrate with special occasions, dinners or meals, some write on lengthy but beautiful speeches on social media, some forwarded gifs and wishes online and on whatsapp; anything to get the message across- Happy Mother's Day, thank you Mum(s). To most, their Moms are the best Mothers; well, logically they are right?

Mine's too.
She was working when we were growing up, but took early retirement because Dad was transferred to East-Coast. That was when I was 16. 2 years later, I went and studied abroad and one advice that stuck on to me even until now is- "whatever you do, let us (parents) know first before we find it out through other people (we have got spies all over)"- that was said to me when I was 15, while I was still in KL and I brought it with me even when I was in Perth :P
So she was the first one to listen to my ups and downs, my tales and wails, my adventures and sorrows when I was in Australia. She was a patient ear to my every phone call and I was glad I could tell her everything.

Only later on when I came home did I learn that she wasn't too keen of me pursuing my dream back then in studying medicine (abroad) but never once did she object it in front of my face, and I am glad she did not... In return, my sister and I decided to do our housemanship away from home, so she and Dad wouldn't see it firsthand how 'gruesome' the journey could be (okay, that was an exaggeration but not that far off.. the two years flew quite fast than expected).
Even so, she was there when I decided for a semi-impromptu day-trip back to KL to watch a movie (and accompanied me for breakfast and lunch in MidValley XD ; entry here) and joined ChocoMon's trip to USJ and Legoland (entry here) where she was sorta 'tricked' into getting onto the Revenge of the Mummy (sorry, Mama, really, I am!)

Then I came home to continue working as a medical officer in Putrajaya, commuting daily from KL; and she's still there, supporting me in every step- every littlest story that I have, to every non-spoken gestures I made, she's still here. Even when I decided to take that impromptu trip abroad before getting into Masters programme, she came with me...

No words can convey how thankful I am, how thankful we are to you, Mama.
Happy Birthday and Happy Mother's Day, for being awesome superwoman you are. May you always be blessed and be healthy always, Ameen.