Iceland: A Healing Journey [Prologue]

Up till March 2022, my personal journal has been filled with unspoken words of anxiety, worries, self-contempt, and burnout cries. I was finding it difficult to move on, a lot of factors contributed to that, and I wondered if it was even worth it to keep going.

So when there was an invitation to travel and just break away from everything else, I jumped into it.

Perhaps, it was what I needed.

Iceland, to be honest, has been a healing journey for me.
The next coming entries will be about our trip to Iceland; maybe interspersed with some rants here and there

Kinda dread going back to work next week, to be frank. Fortunately Ramadhan will join us in the next couple of days so I'll be using that and writing the travel log for the Iceland trip to keep my mind away from work.

Introducing the travel companions, N in the middle, D at the back, and me in the front.

One of my favourite photos. Actually, there are A LOT, I just don't know which one to choose

Reasons

I feel like... I have no reasons to keep on going
Every day feels like I'm forcing myself to get up and go to work
Every day is a struggle to find reasons to keep on moving for the day... and even with no reason, I just walk along aimlessly and at the end of the day, I wonder why am I still here, why can't it end?

This has been going on for slightly more than a week now...

I wonder how long this weight will last?

Mask

I intended to pen down our journey rushing back to Temerloh using the alternative route before it became an island and totally inaccessible; which happened last Tuesday, after studying and frequently getting updates on the roads' condition. It was my first experience of brainstorming the routes while weighing between the pros and cons and the safety vs urgency of coming back to the place where I'm currently residing for working from my hometown in the heart of Kuala Lumpur.

What used to be an hour and forty minutes drive of 130km road via the highway turned into a 7-hour of 400++km journey via Kuala Pilah-Jempol-Muadzam Shah-Gambang-Maran to Temerloh. 2 cars, 3 drivers including my dad while frequently checking the road access.

The next day, the last leg of the journey had become inaccessible.
But at least Medical Department has another extra 4 physicians to mend the department including clinic, wards, peripheral referrals, covid wards, and on call.

The routes we took on Tueday, 21 Dec 2021

The routes last night, the highway has reopened and water receded in many places already

However, that is not the reason I'm writing today.

Today is one of the days when again I question myself as a physician.
The patient was so young, even less than half of my age. When my colleague passed over the case, we had that 6th instinct telling us this might be a complicated case... and true enough... the quick decisions made while weighing and thinking what's going on, the adrenaline rush while attending the rapidly deteriorating case, the added information that didn't make sense & didn't tally with the previous clinical judgment... you keep on thinking what's going on now and why is this happening?

I am grateful that the same colleague was oncall along with me; she was waiting for the never-arrived patient in critical care unit to do bedside scan and when she called the ward to ask where the patient was and got to know we're resuscitating the same patient, she came up and helped.

It was a while now, me almost breaking down while informing the grim news to the father.
But sometimes in this profession, you just had to put on that mask and wore that hat saying you're okay while delivering the gut-wrenching update in front of a large crowd.

Sometimes it made me feel like a heartless robot.

It was a very painful and difficult decision to call off the on-going resuscitation. But when we made eye-contact, we knew of the prognosis and to keep on going was probably causing more damage... At the back of our minds, what else have we missed?

As you climb up the ladder and you learn more things, you carry more weight.
You give your best maximum capacity and effort and then you pray for the best.

Today, that weight seems a little heavier. 
But you know that whatever happens, you still need to move on and attend to other cases.
So you tuck aside this case at the corner of your mind.

So that when you are all alone and the night has blanketed the world,
You can cry yourself to sleep at the incident and sift through the event to look for any pitfall or weakness on your side.

Rabbiyassir wala tu'assir
"O Allah the Most Merciful and the Most Benovelent, please bless our knowledge so that we become the tool of Your Mercy in serving the humanity regardless of race, creed, and religion"
-prayer taught by our previous lecturer and Dean, Prof Hatta S.

UKM 49th Convocation

Nov 28th, Sidang 2, Faculty of Medicine UKM

Because the date is worth a mention here.
The day we met each other day again after a while, those whom I partly owe the success to and those who walked the same paths;
The day we received our scrolls, names being mentioned, new title being announced;

Honorary mention:
Majid, JK, Agni, Ilham, Dalleen, Hema, Maryam, Ezzaty, Cheong, Hamizah, Amalin

The new norm, no guests (parents) were allowed in the hall, but families were able to watch the convocation live telecast online.

Took the opportunity to take family photos as well after the convo session;
After all, I owe my family A LOT for allowing and easing my Masters journey

And the day before, the girls took the opportunity to take photos together.
(The MDTs (MultiDisciplinaryTeam), Keep on Moving & TsumTsum girls)
These girls who were the pushers, motivators, witnesses, supporters, colleagues-came-good friends, and more like sisters in the fraternity
Each has a different background, different stories, and journeys, different struggles, different pages even though we walk the same path-

Missing Amalin

Looking back, all the blood sweat and tears, was it worth it?
Yes.
It was difficult, yes, but made easier when you had colleagues who were team players and mentors who guided you along-  
And now, each of us is walking a different pathway;
I pray the friendship lasts forever and that our paths will cross again someday.

New role, new commitments
Who knows what's in store for us in the future

Ending page "MMed Journey",
Turning to page "Physician Journey"

Rough Patch

Today is one of those days when you look back at the decisions you made and you question those decisions, wondering if you should have done it differently and if it would change the path and course that has now happened.

Today is one of those days when you question yourself if you have done justice.

I honestly don't like the day like today.

Boost(er)

A quick note.

14 Oct: Was informed that tomorrow there would be slots opened for staff who opted for booster dose; those who received their last dose at least 6 months ago, voluntary basis

15 Oct: Took the opportunity to do so, even though the next day I was oncall... better now than never yes?
So, just wanted to put this here, as a reminder.

Side effects of this 3rd dose? Pain at the injection site for slightly more than 72 hours, muscle-ache mainly at the injected arm and left chest area that lasted for 72 hours or so, a bit of flu-like symptoms but resolved within 48 hours. 

Overall symptoms were much less compared to the 2nd dose, Alhamdulillah not needing ant analgesia this time. I was still able to do oncall the next day; my MOs had a bit worse side effects and it showed on their faces during oncall, poor fellas....

The booster dose is on a voluntary basis given to higher risk groups including the frontline health care workers, the elderly, and patients with comorbid.

Afternoon Nap

I was stationed at the clinic a few days ago. And one of the patients came in. Sometimes, my opening question would be, “So, how are you today?”

And this patient suddenly burst into tears.

Putting the papers aside, I positioned myself to face this patient directly, I knew the disease follow-up questions had to wait, there’s a more pressing matter to attend to- to find out the cause of this unexpected turn of events. It’s not unusual that this kind of episode to happen, but it’s also not frequent.

This was one of the people who still must come to work throughout the pandemic. Due to the increased workload, staffs were rearranged, more work coverage for them and less off-time. Those factors and key-in other personal and non-personal factor(s), life can sometimes be too overwhelmed.

When this patient described what’s been going on leading to the sudden outburst, it was as though I was looking at myself a while back, not too long ago, recurrent in different timings & situations. It all felt too real, I needed no further probe to understand what’s going on.

I was that person.
I was in this person’s shoes.

I had no courage to call or contact Psychological First Aid back then. But I know this person needs it, and an MC to rest at least for the day.

Work burnout is real.

If someone indicates that he or she is stressed out, on whether they realized that it’s a burnout sign or not, do take a little bit of time to listen to them. Sometimes, just having someone to listen would be a great help. 

Especially now.

Filler 3: Reflection

Certainly, I didn’t plan to wake up on my birthday to being informed I misdiagnosed a patient.

However, I’m grateful to meet a few people who distracted me from being down the whole day. Conversations upon conversations later made me realize perhaps it’s not the issues of confidence and competency, rather the perfectionist side of me that’s making me afraid to take the next step until I’m ‘perfectly’ ready. That in turn discourages me from calling the shots until I have all the facts in my hands and remember everything in my mind.

It’s probably the reason I’m being too hard and too harsh on myself- that every mistake, small or big exposes my weakness and vulnerability. And this in turn drags me down further, unable to move on and got stuck at the “fact” and “conclusion” that I’m not good and I’m incompetent. That mantra kept on playing at the back of my mind until I believe that it was who I am.

Forgetting that I’m human and that human err.
Forgetting the fact that I have achieved success in the past, no matter how small they were.
Forgetting that I overcame the trials and tribulations in the past.
Forgetting that I got up from many falls, with the help of numerous people and the strength that God lend.

Maybe the fact that God sent a senior officer to point out the miss I made was meant to be. Maybe if I didn’t find the weakness and “confusion” that the patient had, we wouldn’t even diagnose the stroke, and maybe if that happened worse things could happen.

And to realize this now, finally putting the pieces together after such a long time, we came to the conclusion what’s meant to be was meant to be and if we make mistake, learn from it and don’t make the same mistake in the future.

And that I’m not perfect.
No one’s perfect.

Filler 2: Permission to-

Settling into the new place, environment, and working routine,
This will probably take some time.

In a way, it's perhaps physically slightly less taxing;
But in terms of the weight of the responsibility, and mentally, it's more and heavier.

First active general medicine on call as a physician, okay not so bad...
First passive covid on-call, so far still okay.

If there's anything that resurfaces from my ever-so-existing weakness,
It's my own insecurities and sense of incompetency and feeling unsure about everything
This, I need to "fix" it myself, and I need to improve.
This, I know will take longer than expected.

But for someone who has trouble adapting to new places,
I probably purposely jeopardize my own sanity by choosing to be deployed for the pandemic mobilization, not knowing where I'd be placed when I signed up for it...
And now they assigned me to a whole new place, I'm wondering if I'm pushing myself beyond what I can chew and if I just like to get myself into troubles.... -.-;;
Perhaps I should have just sat quietly here to adapt and get used to the new environment D=

Let's see what will happen in the next 6 weeks...

Filler: Voice

Previously while waiting for gazettement placement, gazetting specialists were allowed to choose their floating placement. Not this year, the pandemic limited that options and I decided to go to Hosp Sg. Buloh, for a few reasons. Part of it is because I wanted to see how's the situation there and learn from the team managing the pandemic fully for the past 1 year and a half.

Although many people were surprised by the 'brave' decision I took, I never regretted it but feeling much grateful and thankful for the given opportunity.

I learned and gained a lot more than expected, I worked with hardworking and helpful teams and driven consultants, I was given the chance to meet and work with hardworking albeit tired MOs, most being contract MOs & medical registrars, reliable nurses and Sister and efficient MAs and PPKs. It was a short one month but I am honoured to be given this chance.

One of the backbones of the team apart from the nurses were the MOs. I feel the pain of their uncertain future amid the heavy workload on their shoulders. Their worries are always at the back of their minds, some have lost hope and motivation even. While I can support the campaign and movement for their fair treatment, I am not in their shoes. 

But one thing is for sure: How can one work with a peaceful mind not knowing if they will be terminated by the end of the year or once they are deemed no more critical for the service?  

To these junior colleagues of mine, I pray that solutions will be there for you guys.

This issue isn't the only one that plaques the HCW during this time when the number of cases keeps on increasing. The cry of the burnout colleagues resonates through and through and every day I pray those involved, these frontliners' journey will be eased and they are given strength to trudge through the coming days.

Everyone is looking forward to the day when we can finally breathe with ease and a smile.
Never stop praying, never stop hoping.
The journey is still ongoing;

And for me, tomorrow comes another new page, a new chapter, and a new phase in this book of life.