How to supervise HO or junior doctors - my perspective

We have heard about story about competency of doctors nowadays especially HO. As HOD, I can see a lot of differences between HOs today and HOs many years back. I think there are various factors involved that make that differences. I can list down a few factors that I think are relevant for the differences.

a. Many years ago, there were only a few established local universities were recognised to train medical students with enough lectures and facilities. Selected students will be sent overseas to study medicine in recognised universities. But now, anyone can go to any universities for political reasons even to the unrecognised universities. We are now looking more towards numbers rather than qualities. We can't really blame the students for not performing sometimes. When you asked them, they said that they didn't have any exposure in certain disciplines. Lectures used to be cancelled many times due to many reasons. Sometimes they have to learn on their own without guidance. They learned from videos rather than real patients. Well, technology does play an important role in learning but to become a doctor I feel that we have to learn from a real patients.

b. I agree that we need changes in life or education system if the need is there. But don't make those changes for the sake of making changes or based on political pressure. When we politicised education, it will bring the whole system down. If the education system is almost perfect to produce good doctors why we have to change to a terrible one. If the changes needed, it should be done slowly and not abruptly. The education system keep on changing before you can see the outcome from the previous changes. When the minister change, the system change regardless how good the system is. I felt that the new medical education system is making the medical students more a follower and memorizer rather than having a critical and analytical thinking process. Their way of thinking is very compartmentalised rather than generalised. Intergrated system doesn't seem to help them in connecting their knowledge toward disease and patient as a whole.

c. Student factors. There are two extreme conditions. Those who got 4 flat during exam, all of them wanted to become a doctor even though they have no interest. Sometimes they are being forced by their parents. The parents dictate what their children need. Those who didn't get 4 flat but wanted to be a doctor badly have to go to the other universities in overseas where the training was terrible. There were another group of students who are second grader, badly wanted to be a doctor, went to the cheapest and affordable universities abroad under their parents scholarship and manage to go through the medical school with difficulty. Another group of students from the private universities whom their parents are well to do and not on any scholarship, don't really bother what's going on. Social background also play an important factor in determining the product of the good doctors. Mental, physical and innerself strength are important for the medical students to have because as a doctor, stress is part of our life. From my observation, our junior doctors are very weak and fragile on top of having lack of knowledge and attitude problems.

HOs many years ago easily can be trained, most of them. There were faster learner. They can stand alone after one month of initial training. They were more proactive and ever willing to learn. No questions asked. There will be no parents or politician interference. Rarely you hear that consultants or specialists being threatened by parents for teaching their children to become a good doctors. Now it become fairly routine. Yesteryears HOs were more polite and respect their seniors and superiors. Again I must say most of them. Therefore, one year HO training is adequate for them to be a safe doctors. They managed to handle many patients at one time. At the end of their housemanship, you will be able to see their maturation and competency. Now, the HO training is extended to 2 years duration. They have to go through all the disciplines in medicine before they can go out and practice on their own. Some of them need more than 2 years. There are so many of them, out numbers the patients. They come from various universities that you never heard before. 2 patients under their care, they can't even remember.

I attended a few motivational talk given by well known motivators talking about how to train the HOs. Look who is talking. I just smile to myself. Most of these motivators, they have left the government service long time ago and they don't really have the experience of training the new breed of HOs the way I and my friends do. It is very tough. The things that they do, the mistake that they have done are beyond our imagination. "Bodoh sombong pun ada". Sometimes you really have to go into the basic of medicine as if you are teaching the third year medical students. Attitude problems another one to handle. The worse thing is, went they make mistake they have no regrets. No guilty feeling. Caring is not in their vocab. Politeness is too far to practice. Some of them have no insight. For me, if the young doctors are incompetent and willing to learn, I will go all out to teach them and make them competent. It is my responsibility to ensure they are safe and the patients are safe as well. I am willing to take that challenge and I will do it my own way. You have to be firm and consistent. As a teacher or supervisor to these junior doctors, our aim is to make sure that the quality of medical services are up to the standard. If your are fast learner, you will leave my department on schedule but if you are slow learner, you will be with us till you learned. I don't really care what people say.

Exam - really a tremendous pressure for students

Last month, May was the month of professional exam for fifth year medical student. I was involved in the exam for UIA and CUCMS students. It was a busy month for me. With my injury, I have to travel to Kuantan to fulfill my duty as examiner. My husband and my daughter, Ana accompanied me. I felt not safe for me to go by flight even though my knee injury was getting better. I could walk with one stick instead of crutches. It was really tiring to be the examiner for 3 full days from 8am to 5pm. However, the feeling of tiredness immediately disappeared when the students were able to answer the questions well. Most of the students performed well except for 4 of them. I guess that was a very good achievement. I was happy because my trip to Kuantan in my condition was rewarding. I am happy for the students and I hope they can become good HOs when they start working in a real patient and hospital environment. At the same time, I took the opportunity to bring my family for the holiday. During the exam, I met my old friends, who were the examiners too that I haven't met for a long long time.

Another exam to go which was CUCMS final year students. The students were some sort special to me and Dr Hafiza because this batch of students, both of us involved in teaching them since they were in the 3rd year, early clinical year. They came back to have teaching with me during their fifth year and could see their maturation in their training. Some of them were doing better than the others but generally, all of them improved a lot. I really have a very high hope that all of them will make it through the exam. I warned them many times to do their very best for the coming exam because I could see that they have the potential but very playful. I wanted them to take the exam seriously. During the final weeks, before their exam, I made the point to teach them despite of having difficulty with my knee injury. During the exam, I was paired with AP Dr Jamil who is my old school mate when we were in UKM before. We did not see each other since we graduated. It was fun to see my friend again. Many things we talked about. He is a psychiatrist now in HUSM. During the exam, I could she my students were in the great distress. They looked panic but calm. Some of them required many prompting questions to get the correct answers. They knew the answer but just couldn't say it out. I could see the frustration on their face when they couldn't answer the questions. I guess they don't want to disappoint me as their teacher. But thank GOD, all of them made it. All of them passed their exam. I hope they can become a good and successful doctors in the future. As a teacher, I shared their happiness.

That evening, after the CUCMS final exam, I got a phone call from my daughter, Iya. She was crying and kept saying that she disappointed me. She failed one of the exam paper that she had to reseat the paper in 3 weeks time. She passed the rest of the papers. She cried to the lecturer, Prof Hamid and asked him for his advice. For everyone information, Prof Hamid was my teacher when I was in the medical school in UKM and now he is teaching my daughter. He told her to calm down and try to study for the next reseat paper. I also told her the same thing. There was useless to look back to the result because it wasn't going to change the result anyway. What she needs to do is to prepare for the next exam. I know it is a great pressure for her because the expectation of the lecturers and her ibu's friends if she fail her exam. Everyone know that she is a daughter of mine. She wanted to show to me that she could do it but she failed. As for me, I know the terrible feeling that Iya has to go through. I hope she can learn from her mistake if there is any and try to be better next time and more focus. Medic is not easy especially if you want to be a good doctor. Failing in medical school is a common thing but don't make it as a must. Iya asked me whether I failed my exam during my medical school day?. The answer is yes, once, the pharmacology paper during end first semester exam due to cultural shock being in the medical school trying to remember too many drugs but I recovered very well once I knew how to study medicine. Since then I was doing OK in all the exams including professional exam. What I learned is that, you have to slow down on your social life a little bit and study more. "Bersusah susah dahulu bersenang senang kemudian". Don't miss the class. Be friend with your lecturers. Always ask their advice. Form a study group consisting friends that you are comfortable with and don't listen to the voices that wanted you to loose your concentration. Whatever you do, do it for yourself and not for anyone else. Don't waste government and your parents money and effort. Most of all, you can asked me if you need to.

Love your parents deeply without prejudice

When I was small, I used to follow my dad everywhere. I don't need to go to kindergarten. My childhood life filled with activities with my friends, siblings and of course my dad. No worries. If my Dad went to work in the paddy field, I will be helping him, not really helping actually because I was too small to give him a hand. What I did was giving him more problems. My Dad had to take care of me, scared that I will go to the river or to the nearby parit and got myself drowned. My dad won't allow me to use cangkul or anything sharp. So, he will make me a modified cangkul from a small tree, just look like a hockey stick to keep me busy in the pool of mud. I followed what he did. When he swing his cangkul, I will swing my hockey stick. He never get tired to attend to my stupid questions. He never scolded me or lay hand on me even when I was naughty. At noon, my mum will bring food for us. Before we had our lunch, my dad took me to the nearby parit. The water was crystal clear and cold. I could see some fishes swimming up and down the parit. He bathed me as well as cleaned himself. After that I waited for my dad to perform his prayer. Normally by that time my stomach was singing a keroncong song. I was so hungry but patiently I waited for my dad to finish his prayer. My mum left the food on the platform under the small hut in the middle of the paddy field where my dad and I normally took a rest or had a short nap. She could not wait because she had to go back home. My house was about 25 minutes walk from the paddy field. As a father, my dad fed me first. I knew he must be very hungry like me but to him I guess, I was the top priorities. Actually, I did a lot of activities with my dad. He never say no to my request. Of course, he will turn me down if I asked something beyond his capability. I still remember when I cried and wanted him to buy me a toy gun. He told me that it was a waste of money. I insisted to have the gun. Instead of turning me down completely, he made me one, a wooden gun complete with the bullet. I was so happy. I don't really care about the price as long as I have the gun. He taught me a lot about life and how to survive. He shared his valuable experiences. He loves to tell stories about our beloved prophet Nabi Muhammad SAW. We came from a very poor family but my Dad and mum believed that education is the most important element to change your life with brighter future. Good halal food and education are the most priorities. My Mum and dad worked so hard to bring up all 9 of us and instilled good values in our heart. They taught us the importance of strong family ties. Respect each other no matter how or when especially to your big brothers and sisters as well as our elderly. All of us were taught to be a strong Islamic believer. My parents showed us an excellent example by turning our family into a very respectful family now from such a poor family that everyone looked down on us. We don't take revenge. What we need to do is to show our gratefulness by helping others who are in need. "Harta bukan milik mu, milik mu hanya rezeki. Terkurang himpun lagi, terlebih memberilah". I always remember these phrases. They have a beautiful and hidden meanings, the way I see it.

My parents showed us that nothing is impossible to be achieved as long as you believe in yourself and at the same time not to forget our duty to the all mighty lord, Allah SWT. Always ask for HIS guidance and blessing. My dad always stress on us many times not to forget the ground where you stand. The higher you go, the humble you become. "Jangan sesekali berasa bangga dan riak kerana ia adalah perangai syaitan yang akan menyesatkan kita". He reminded us to maintain our eastern values as well as the original adab melayu. As far as our parents are concerned, they have sacrificed their youth and life for all of us. No doubt, it is their duty to give us education, food, clothes, shelters and love but we will never be able to repay them for everything that they have done for us. Never. Of course, both of them are not "maksum". They could not run away from making mistakes in their life that might affect us to a certain extend, but whatever it is, we have all the love that every children ever wanted. We should love our parents to the deepest of our heart and take care of them till the end of their life. We should be there for them always in whatever situations. Jangan ada sebesar zarah kekesalan atau pun kepayahan in taking care of our dearest parents. That the only minute thing that you can do for them in return of what they have done for you.

Doctor as a patient

My doctors fellow used to say that medical personnels especially doctors are the worse patients that you can have. They normally don't listen to your advise. They have their own way to carry out your instructions. They alter your treatment. They have poor compliance to medications. I do agree and disagree. Not all of us like that. Yesterday, I had a F/U with the doctor for my unhappy triad injury of my left knee. He was quite surprise to see the improvement of my knee comparing with the first time he saw about 2 and a half week ago as well as comparing with the MRI findings. The pain in my knee was almost gone and the range of movement of my knee also was so much better. There was very minimal effusion left. I was very happy. He complimented me for following his advise strictly. He said to me,"If all my patients are like you Dr.Norra, my job will be easier". My daughter, Ana looked at me and add on, "she is a good patient". I told the doctor that I will definitely follow his advise because I want to get better faster and back to my feet again. With my daughters help, I put ice on the injured knee frequently, not to step on the leg at all. I used wheelchair, crutches and walking frame whichever more comfortable and easier until I developed pain in my shoulders and wrists in supporting my left leg. I went for regular physiotherapy and continue to do it at home. Puan Misnah is so kind to teach me a few exercises that I can do at home. I am really scared if the doctor has to do surgery on my knee. Now, I am not worry anymore after the doctor told me that if I am doing well, there will be no indication for surgery. He advised me not to weight bear for 3 more weeks before I can try to partially weight bear. Earlier, a few of my students who have experienced the same injury were giving me advise and their experiences and it does help to reduce my anxiety. We still can learn from our students, no harm. I can see that they are able to walk normally now without surgery. But of course they are young. The healing process is good. I am not saying that I am old but I am very much older than them.....Anyway, I am happy with myself. I will continue to exercise at home in order to strengthen my muscles so that I can walk again. I didn't take any pain killer for my injury. Therefore, not all doctors are difficult patient....

Life and faith

I grown up in the family full of love and happiness. I have 4 brothers who are always there for me, 2 elder sisters thats so kind and caring and 2 youngest sisters that always make me feel needed all the time. No doubt at this age, when all of us have grown up and have our own life, we do have misunderstandings once in a while or arguments, but when it come to making decision that related to the family matters, we are together. We put our differences aside. Of course we are free to say our views and opinions, we make the decision what is the best together. My mum and dad taught all of us to respect our eldest especially our brothers in whatever situation. All of us play our own roles. We don't really care who contributed most to the family. Who has more insight, time, money and think that you can do more than others, go ahead and the rest will acknowledge it accordingly. The question of "why it always me to do this" never arise because everyone know their responsibilities to the family. I guess my dad taught me well. I don't look back. Pass is pass. I always looking forward to the future. The only thing that I look back is to learn from the pass mistake so that there will be no same mistake. The only thing lacking in the teaching from my mom was how to find a good husband or wife I guess. All these we need to learn ourself and decide. My beloved mun and dad used to say, "we don't really care who you choose to be your husband or wife, as long as you feel that he or she is the best for you. We also don't care what colour or what race or from which state as long as he or she is a good muslim and can lead you". Kamu yang nak melayarkan bahtera, carilah nakhoda yang sesuai agar tidak tenggelam di kemudian hari. Well, there is a truth in it.

Most of us have our dream girl or guy to be our our lifelong partner. We normally will set a fairly high standard of a person that we want to be with. That's normal because we should love ourself more and give ourself a almost perfect man or girl in many ways. I think this is very important because if you set so low standard, it is easily achievable and you wont be happy. You have to value yourself and of course, you deserve a better person. Life partners is for lifelong. Most of us wanted the best for ourself because we value ourself very high and we should. But, in many circumstances, we cannot get 100% perfection of our choice. We fail to find someone that can fulfill all the criterias that we have set, 85% achievement will be fine. Even with this, occasionally after we make our commitment, we still fail. The life partner become a short one. The failure of making this important choice could have happened due to wrong assessment and judgement, too short time to evaluate the character of a person, changes that occur after being influenced by people around them. No matter how careful you make that choice, occasionally many people fail but of course the percentage of failure will be low compared to those who couldn't care less to make a choice. Probably the choice that we have made at that particular time was the best for us, but after so many years, we realized that the choice was a wrong choice. As muslim we have to believe in takdir. Ketentuan tuhan. God advice us to use our wise judgement to lead our life and follow the right patch. There are two words that we have to remember "tadbir and takdir". We tadbir our life according to our wisdom, intellegent, knowledge and experience but we have to accept "takdir" that determined by almighty GOD, Allah SWT. When we know this, than timbul lah perkataan "redha" if anything happen along the way, not the way you want it to be, we have to accept it with an open heart because we know GOD knows what is the best for you. You can get back to HIM and ask for HIS forgiveness and guidance because HE is always there for you. Occasionally, some people do say that they "redha" on what had happened to them but their action showed a different things where they developed "dendam dan prasangka dan lain-lain perasaan yang negatif". Kita perlu mengajar diri kita supaya lebih banyak bersabar kerana sebagai insan kita hanya merancang dengan kemas which is "tadbir" tetapi yang menentukan adalah tuhan yang maha pengasih lagi penyayang which is "takdir". Just think about it........

Unexpected injury - you can't really predict it.

We know injury or accident can happen to anyone at any time. You can't predict it unless you are intended to harm yourself. It happened to me last weekend on Saturday. It was a terrible accident. My routine during weekend is to bathe my dad because my elder sister has done those duties during week day. Normally my husband will help me to bathe him and I will prepare breakfast for everyone. Last Saturday morning, the day that we were going to have 40 days kenduri tahlil for my beloved mum, at 9am to be exact, my maid and I carried him to the wheelchair and I pushed him to the bathroom. It took me a little bit longer because my Dad decided to pass motion. I waited. After that I cleaned him up. When everything completed, I wheeled him out to the room, dried him with towel and my maid put powder on his body. What I normally do, I will make sure that the water dripping from the wheelchair to be wiped by my maid but that morning I didn't remember to ask my maid to do it. She offered herself to carry my Dad to another wheelchair to put his pampers but I said I could do it myself like I always did. When I just about to transfer him to the other wheelchair I could feel that my left leg slipped to the side which I couldn't control it anymore. Of course, I could not let my dad go, it will be disaster if I did so, so slowly both of us fall down and my dad fall on me without injury except he sustained a small laceration on his right hand. I experienced severe pain in my left knee followed by a click. I screamed my lungs out until I waken up everyone in the house. I was crying due to the severe pain and also due to the frustration and carelessness that I have done. I was in severe pain and my Dad was beside me trying to calm me down. Massaging my knee. His action even make me so sad. My maid called my sister Dek Anor to help to lift up my dad to the wheelchair. I tried to stand up but my knee was giving away and I fall again. I was panic. I stood up again but the same thing happen. Ohhh no!!! I am doom. I couldn't walk. I never given up and I tried again but again I almost fall down. My sister had to get me a wheelchair. a wheelchair that my late mother sit and had her last breath. That situation really make me sad and I cried non stop. My left knee was swollen. My sister advise me to go to the hospital for check-up.

My daughter, Ana drove me to the ED Hospital Serdang. For the first time, I have to allow her to drive and surprisingly she drove well and very careful, full of tension, I guess. On the way to the hospital, I called the orthopedic surgeon on-call, Mr. Maher and asked for his help to assess the injury that I had to my knee.

In ED, they did a good job. Dr.Fahmi, my former HO was there and wheeled me to the observation cubicle. Thanks to all the staffs in ED that attended to me on that day. Everything went smoothly. Well, I was a good patient too. Mr. Maher came and examined my knee. I was suspected to have ACL injury. I still remember my orthopedic knowledge and I know ACL injury was pretty serious. I still hoping that it won't be so serious. Now, I am an OKU, partially. I hope it wont be long. I need to go to work. I am bored. Mungkin ada hikmahnya juga,.....................always look at it positively.

Now I partially dependent on people. I feel everything is so slow. Ana and Iya have to take care of me now temporarily. I still can do many things but my movement is so limited because I need to use wheelchair in the house. I use crutches sometimes but too tiring. Give me a shoulder pain. Huge bandage on my left knee. Tomorrow is the F/U in the clinic. I hope this bandage can be removed.......counting the days...

Ana and Iya - pearls of my eyes

The end of this year girls, you are going to be 20 years old. Time really fly and I didn't realize that you are grown up women. Since nenek left us, Ibu feel so empty and lonely. If ayah didn't come back, my life even more miserable. Ibu keep hoping that both of you will be staying home because I feel so lonely in this big house. When you are around at least I can make myself busy for you. Ibu is very lucky because adik is travelling from home to college. I see adik everyday and we watch spongebob square pants every night. Ibu don't want to force you Iya to travel with me because your lectures start at 8 o'clock in the morning. I need one hour to dress up and I will make you late to attend your lecture. But Ibu will learn to dress up faster so that we can travel together in the morning to work. I am very happy to have both of you around me all the time. Anyway, Ibu are very grateful to both of you for always being there for me. I guess you cannot run away from me either. We need each other right. When you were born, nenek advised Ibu to keep your umbilical cords in a safe place the way she did for the rest of her children including my umbilical cord. She said the reason for it was, wherever your children go, they will be close to you and they wont go far away. That advice was from your great grandmother to nenek. I guess, looking retrospectively, untill her last breath, at the age of 87, all of her children were always with her, at least every weekend. The morale of the story is, Ibu will keep your umbilical cords safe in my bag so that both of you won't go so far..... InsyaAllah. Frankly speaking, I think the umbilical cord story is just a taboo. The most important thing is, you yourself. All of us have taught you and brought you up in the very best manner that we could. Ibu doakan both of you successful in you future undertaking and make the family proud of you.

Do you still remember your 18th birthday? Ibu wrote a poem for both of you and I was crying when I read it to all the guests. Emotional pulak masa tu. Anyway, the guests were your brothers, sisters, aunties, uncles and of course nenek and atuk were presence as well. ibu would like to put it here so that you can read from time to time and share with others too.

Nukilan untuk Ana dan Iya dari Ibu

23 november 91 mengimbau kembali

Rentetan sejarah tercatit kini

Gelaran ibu anugerah ilahi

Puteri nan kembar bak bidadari

Lahirmu penuh tanda tanya

Kehadiran dua mu tidak diduga

sayup suara tangisan pertama

Bahagia ibu yang gundah gulana

Hadirmu berdua membawa cahaya

Mengisi kesunyian jiwa yang lara

Syukurnya ibu tiada tolaknya

Hendak ku tangis tiada suara

Syukurnya nenda mu bukan kepalang

Keraguan di hati segera hilang

Sangkakan satu dua yang datang

Pemecah tradisi si anak minang

Putih kulitmu bak telur dikupas

Keayuan wajahmu pandang tak puas

Bisikan azan di telinga dilafaz

Moga awalan mu tak tercemar balas

Kaulah permata buah hati ibu

Dirimu dibelai umpama ratu

Kasihnya ibu tiada sekutu

Mendidik dirimu tak kenal jemu

Amanah tuhan semesta alam

Keatas ibu siang dan malam

Kasihku baja sayang ku siram

Moga jiwamu tak di intai kelam

Anakanda berdua belaian jiwa

Nasihat ibu bukan bersahaja

Datang dari cebisan rasa

Berlandaskan fakta serta agama

Pastikan dulu arah tujumu

Tanamkan azam tekad di kalbu

Kekuatan dan keyakinan sudah bersatu

Gelombang yang datang gentar teraju

Dengarlah sayang ibu berkata

Di atas tinta curahan rasa

Hati keruan berdebar dada

Risau nasib mu di hari muka

18 tahun cabaran usia

Pancaroba datang tak kira ketika

Jangan kamu lalai dan juga alpa

Moga remaja mu mekar berwarna

Dewasa kamu gelisah menanti

Bimbang bencana menerjah diri

Doa ku pohon tiada henti

Jangan maruah dipandang sepi

Wahai puteri ku cahaya mata

Selami keluhan hati ibunda

Nasihat ibu pantang didusta

Kelak dirimu akan kecewa

Sekian kali mendengar bicara

Kepercayaan ibu jangan di noda

Jauhi sikap tipu dan dusta

Sejahtera hidupmu dimaya pada

Berdiam diri bukannya sudi

Gerak langkahmu ku kawal rapi

Dosa dan noda jangan dicari

Binasa hidupmu membakar diri

Andai kau tewas tanpa diduga

Hancur hati ku penawar tiada

Kemaafan ibu usah dipinta

Umpama tenggelam timbul tiada

Pabila ibu anakanda khianati

Kesan nya dasyat tidak terperi

Akan ku tutup hati nurani

Derita ku bawa sampai ke mati

Berperi ibu bukannya benci

Menyiksa dirimu jauh sekali

Harapan hati menggunung tinggi

Matang berfikir jangan bermimpi

Sayang pada mu tidak terperi

Sanggup ku gadai nyawa dan diri

Sabarnya ibu terbatas tepi

Berputih mata rela kau pergi

Ana dan Iya buah hati ku

Pada mu berdua ibu berseru

Cekerawala batasan ilmu

Terokai ia jangan kau jemu

Taburlah bakti sepenuh jiwa

Untuk agama, bangsa dan negara

Jangan balasan diharap pinta

Syurgawi pasti buatmu di sana

Noktah kehidupan sudahlah pasti

Ayah dan ibu mu tidak terkecuali

Saat dan ketika mengundur diri

Airmata dibuang jangan sekali

Perjuangan mu anak ku belum berakhir

Pemergian ibu memang di takdir

Panjatkan selalu doa dan zikir

Mudah urusanku penangan bibir

Tinta keturunan pantang digadai

Bak pantai indah dilanda badai

Bergegar bumi ikatan terlerai

Salasiah nendamu pastikan bersemai

Indah namamu manja bak puitis

Mewarnai maya umpama perintis

Harapan Ibunda kaulah waris

Penyambung warisan minda yang arif

Lanjut usia mu doa di pinta

Bahagia hidup mu lindungan Esa

Anakanda berdua belaian jiwa

Berjuanglah kamu bagai satria

Duhai puteri ku tambatan sukma

Pesanan ibu jadikan pusaka

Kemenangan dijulang sedetik masa

Namamu dikenang selama lama

Berakhir sudah gurindam rasa

Cetusan hati ayah dan bonda

Buat pedoman anakanda berdua

Untuk menempuh alam dewasa

Budi dan sanjungan

When we are talking about "budi", all of us experienced it. Many people play an important role in our life and make us the way we are today. Kita terhutang budi kepada ibubapa, ahli keluarga, kawan-kawan, guru-guru dan lain-lain in many ways. I guess we cannot run away from receiving "budi" from people who really care about us. The question that I used to ask myself is whether can I repay back all the persons "yang telah berbudi" to me. Well, I guess I can in certain extend but not all. I remember one Malay proverb mentioned about "budi", "hutang emas boleh dibayar, hutang budi dibawa mati". I completely agree with this proverb because I feel that you will never be able to repay someone who has "berbudi" to you be it in the form of monetary, success or any form of repayment. I would like to tell you a story of one of my friend who was in great trouble. He needed RM2000 to pay his dept to a company within 2 days. If he failed to do so, his property will be taken away. At that time, he didn't have that amount of money. He kept asking around tried to borrow money from his friends and relatives but none of them could helped him. He only has one more day to find the money. Suddenly, he approached me. He had to put his ego and pride aside and asked me whether I could lend him the money. I felt sorry for him and straight away I said yes to his request. Furthermore, I have extra money that month. He promised to pay me back once he gets his salary in the following month. My other friends felt that I shouldn't have given the money to him because they thought that he won't be able to pay me back. Well, at that time I felt that I have to help him because I have the extra money. Sincerely I gave him the money and he thanked me many times. To cut the story short, the following month, he came to me and paid me back the whole amount. Before he left my office he said, "thank you very much, now I tak hutang you apa-apa, zero zero, OK". I looked at him and smiled. Is it true that he didn't owe me anything? Yes, in term of money because he already paid me back, but no if we are talking about "budi". No doubt that I got back my money but if I didn't give him the money in the first place when he was in trouble, probably his property would be gone by now. My sincere heart with God willing make that move to loan him the money despite the negative advice from my other friends. Can he pay back my sincerity in helping him when others rejected him? I think he can't. That's why I do agree with the above Malay proverb. "hutang budi dibawa mati". No such a thing as zero zero. Agree? Think about it..............

Some people when they do good things they want to be known. Suka disanjung-sanjung. I still remember my dearest Dad used to say to us all," sekiranya seseorang itu suka disanjung sanjung, itu adalah tanda orang yang tak beriman". So, kita janganlah suka di sanjung sanjung kerana ia akan menjadikan kita seorang yang angkuh dan sombong. I remembered one retro song, sang by Hermantino. Really an old song. I don't think youngsters know it. I heard the song on my way to work on the radio. The lyrics were so beautiful. It says.........

"tangan kanan memberi, sorokkan tangan kiri", "derma bukan tontonan, lakukan seikhlas hati"

"harta bukan milik mu, milik mu hanya rezeki","terkurang himpun lagi, terlebih memberilah"

"begitulah ajaran Nya, fikir-fikirlah sendiri". Kita mestilah selalu muasabah diri kita and try to make ourself better from time to time, follow the right track. Whatever we do, do it with sincerity and don't ask for something in return. Semoga Allah berkati kita di dunia dan di akhirat sana. InsyaAllah..

My beloved Mum - Missing you so much

I have not been able to write anything in my blog for almost a month. I just don't have the mood. Trying to get the strength and pull myself together. Too many sad things had happened to me and my family. Many people said that the year of rabbit will bring you happiness and prosperity. However, it is the other way round. Year 2011 is not a good beginning for me. Too much to contain at the very short period of time. Early of this year, my good friend that I have known her for almost 11 years has betrayed me and make me so distress and very sad. I just couldn't believe it myself. My eldest son, after all these years, for all the things that both of us went through, many things that I have taught him to be a better person with vision, having a meaningful life, more mature in attitude and decision making as well as in thinking process, at the end he disappointed me in many ways. I don't blame him for that because I know, it is not easy to change unless you really wanted it badly. His action was predictable and it didn't surprise me at all. I hope he will sit down, open his mind and think what best for him. As mother, I only can pray for his happiness and safety. Since the year 2011 came to say hello, I went through a tough time but still managed to continue my day as usual unnoticeable of the heart ache that I have to bear. I have no more energy to think of anything else. HOs in my department are giving me headache everyday. To make thing worse, the final blow to my sadness was I lost the women that I love so much, my dearest mum on the 12/2/2011 at 10.30am about 30 days ago. It happened so sudden and too fast. Split second I was alone. She took away my life and my strength with her. I couldn't think properly. I was so weak and helpless. I cried most of the time. I have no mood to go to work or do anything at all. I felt the whole me was empty. I walked around like a zombie. I became very forgetful. I just follow my heart. My mum death really affect me so deep to extend that I felt suffocated. I didn't feel the presence of other people around me. Even though I have my family and children and yet I felt so lonely and aimless. I saw my mum everywhere in the house. I felt her presence. I saw her sitting on the chair in front of the house like she used to do. Watched me from far off to work and looked at me while I drove away with my car . She smile and commented on the dress that I wore everyday. In the evening, she was sitting on the sofa when I came back from work. These memories will make me cry. I heard her voice and I heard her coughing in her room. I couldn't bear to open her room. It is too painful.

On the day my mum was gone, my brothers and sisters came back to give their last respect to her except abang Madin because he was on his way to Barcelona. We performed 7 days prayer and tahlil for her. Many family friends and relatives came to help in the kenduri. After one week, everyone was gone except my family and my youngest sister Dek Anor. Everyday my daughters went to visit their grandmother's grave. Yes, it it hard. For the first few weeks since she left me, I was struggling to pull myself up. Feeling of emptiness was pulling me down. I thought when I am looking after my mum all these years and be with her all the time, I will be satisfied with the time that I spent with her. Quarreled with her sometimes if she forgot to take her medicines which I regretted. But it was too late now. I do know that one day I have to face the fact that she will leave me, it is just a matter of time but not so soon. I thought I won't be so devastated when she left me. But I was wrong. I took it very badly compared to my other siblings. They didn't see her everyday. I did. She is gone now and left me when I still needed her. I remember that a day before my mum passed away, I spoke to my elder sister, Kak Pucu that I wanted to get another maid to take care of her and my dad because I felt that one maid wasn't enough to take care of two handicapped parents. However, she left me before I could do anything. Furthermore, that morning on the day my mum passed away, my sister and I were getting ready to bring her to the hospital because she became more breathless but it was too late. I was with her till her last breath. My sister was shouting and crying demanding me to do something for her. At that time I felt that I was such a useless doctor who didn't know what to do. I was like crazy doctor running around tried to find something to help her to breath but at the end I just hold her and cried. My maid was with her all the time. I felt my heart stopped beating. She went off peacefully. It has been almost one month she was gone, I still haven't been myself yet 100%. Still trying to cope with the fact that there will be no more women called mum to be with me at all times. I keep telling myself that it is fact of life. I have to go to work. I have to teach the medical students. Life have to go on. I can say that I am lucky to have a husband taht loves me very much and daughters that supported me to go through this terrible and hard time. My two sons Aiman and Hanif were always there for me during this difficult time. My other son, I don't know where he is, uncontactable and no news from him. My nieces and nephews are wonderful and very understanding on the situation that I have to go through in my life. They come back to visit me more frequent. What I intent to do from now is, to pray for her everyday and take care of my beloved Dad. "Semoga Allah yang Esa permudahkan perjalanan emak di sana dan semoga diampunkan segala dosa". Amin. Anak mu akan tetap merindui mu sampai ke akhir hayat.

Friendship - Does it means something to you?

I still remember what Kak Zila, my bestest buddy and friend said to me many years back about true friend. A true friend is someone who will remember you always, be there for you either during good time or bad time, share your sadness and give you a shoulder to cry on and not only remember to say hello to you because they need help or a favor from you. I am bless to have so many true friends that care about me even though we only meet occasionally. We understand each other very well and our commitment to our work that preventing us from seeing each other more often. I would like to share with you a story of my life in the opening year of a Rabbit. The incidence really make me sad and felt being betrayed by my own friend and colleague. I wouldn't say that she is my true friend but I have known her for 10 years and treated her son who has neurological problem since his infancy. Currently, her son is 11 years old. Being a friend, and now working together in the same organisation, anytime when she need help, I will try to accommodate her request. Sometime, I received a phone call from her or her husband during odd hours including middle of the night when I was not on duty. Even though sometimes, when my clinic was so busy but when she asked for help, I still make time for her and family with the thought that she is my friend whom that I know for so long. Basically, I am treating all her children who have allergic disease and asthma including her own self. Well, I don't really mind because these are the only thing that you can do for someone that you know who needed help and furthermore she is my friend, my own colleague. I treated her family sincerely like my own. I know her character all these years. Due to that, she is a loner. Many people cannot get along with her. Furthermore , she is only make friends with someone who will give her benefits. I don't really bother about it because as a doctor, I treat all children that need treatment from me and will not take into consideration the attitude of the parents. But, for your information, all of the parents of my patients are wonderful parents. Many time when others talk bad things about her, I normally back her up and explained to them why she was behaving in that notorious manner until they always address her as "Norra, that's your good friend" in cynical manner when she passed by. Not only me that she used to ask for help, my other fellow colleagues in the department. All of us basically tried to accommodate her need sincerely. She used to talk to me about how she and her son were badly treated by other doctors in the other government hospitals. Basically all the hospitals that she had attended. Infact, from KB to Selangor including Hospital Kota Bahru, Hospital Kubang Kerian, Hospital Alor Setar, Hospital Selayang, IPHKL, Hospital Putrajaya and Hospital Serdang. She worked in all of these hospitals before and got monthly salary to support her family. None of the doctors in these hospitals managed to satisfied her for whatever reasons that I believe I know why now. Even she showed me the complaint letter that she sent to KSN against the hospital staffs. I looked at the letters with an open mind because I knew her background. She believe that the only doctor that really has a professional conduct is her. She really believe that she is the only one working with sincerity and put the patients' interest first before her or her family. Anyway, all of us know her attitude and deficiency but we didn't make any complains to KSN or DG or Menteri or any outsiders because we are considering that she is one of our colleague and we don't want to cause her any problems or give bad name to our beloved hospital. Whatever problems our hospital have as a result of her inefficiency, the trouble that she created with her subordinates, our director will settled them internally. I remember one day, my close friends asked me,"Norra, how could you tolerated this kind of people, she is crazy, mad and rude. If I were you, I won't get near her. She is pain in the neck". I replied,"well, I don't really look at her or her husband but I am concern about her son. I guess, I don't loose anything in helping her". To make the story short, her action recently towards me and all of my colleagues in the department is beyond my expectation thinking that we are friends. Obviously she couldn't care less about friendship at all. Friendship mean nothing to her. The only thing in her mind is how to use her son condition for her own benefit. I don't understand why the husband allowed her to do this to her friends and her child. We, as a government servants, we have to follow certain ethics and conduct and need to act professionally. Her accusation toward all of us in the department was beyond limit. Similar complain that she wrote toward all the doctors in Hospital Putrajaya. She showed me the letter before. I just couldn't believed all the things that she wrote in the letter because I know most of the doctors concerned, personally. However, I just looked at it and said nothing. Recently, her son was admitted to my ward. She was being treated by my staffs and doctors very well thinking of her position in the hospital and most of them know her. Even, I have warned all my staffs earlier about her personality and attitude and advice them to comply with her demand and not to say anything. They obeyed my instruction even though they were treated badly by her. She used nasty words and interfered with the management until my staffs couldn't do their work properly. My staffs voiced out their unhappiness toward the unprofessional conduct of "this friend of mine" and wanted to write a memorandum of complaint against her to our director. I advice them not to do it until I discussed that matter with the hospital director. At that time, I felt that it was inappropriate to do such thing to your own colleague. However, as expected, I knew that my department will get a complain letter from her because she took AOR discharge from my ward. She wrote nasty things against me and my staffs which we knew that she was lying. As aresult of her complain letter, all my staffs and I, the hospital director and his deputy, have to prepare a report within 24 hours. Our KSN and DC wanted it. We have to reschedule our clinic, meeting and our clinical work in the ward just to write an explanation letter. The quality time that we should spend to treat our patients was wasted. The hassle and the heartache that we have to go through. The situation really make me feel so sad and devastated. It took me a few days to get over it. Not only me but all the staffs that involved in managing her son in the ward. Lucky we have all the support from various people right up to the state level because most of them know this lady very well and this is not the first time. Even, we received full support from my private colleagues that involved in managing her son when she left our hospital. She has been telling everybody that KKM must pay her the amount of money that she asked for long time ago in making her son to be an OKU child. The amount that she had received wasn't enough. She always address her son as OKU child but all of us address her son by his name. We don't need to say that the child is an "OKU child" because it is very obvious and we know his medical problems and we don't think there is the need to do so. I guess KKM should investigate her and look into her medical illness. This women need help. She is mentally sick and disturb. Her mind is not sound. She need a psychiatrist and psychologist assessment as well as counselling. With all the nasty words that she has thrown to me and my staffs, I am not keeping it in my heart. What I am going to do is, learn from this situation, keep my eyes open, to be more careful in choosing a friend. One of my good friend used to say to me,"Norra, be careful. The leopards will not change their spots". I really do sympathized with her and her husband especially the son. The other two children of hers, from my observation and interaction with them, they are now behaving just like her, oohh goshh...beyond description. May God bless her family.

Generic drugs

Today is Tuesday, date of 11.1.11. As usual, grand round that I have to do in the morning. All my specialists were around. They have informed me earlier that the ward was full. I went to the GICU first to see 2 of my patients who were ventilated. One baby with intracranial bleed was recovering, extubated and ready to be transferred back to the ward. However, I have no idea how bad is the outcome of the bleeding to the neurological development of this baby. No matter how much we give public education on the use of cradle either in the newspapers, magazines, health articles, forum and etc..etc , still people don't really learn. I hope the baby will recover completely without any neurological deficit. My other patient was not doing very well. The lungs were so bad. He was in HFOV and all the lung medications that he required. He still developed multiple episodes of severe bronchospasms that required resuscitation. The bronchodilators didn't seem to work even though maximised. A real headache. We were using all generic drugs without proper QC. Sometimes it work and sometimes it doesn't. I wonder, how could we rely on medications with no proper QC to be used in the treatment of life threatening situation. No doubt that we are looking for cheaper drugs and I am not saying that generic drugs are all not good but we have to be more selective for the acute life threatening situations like my patient suffered of. I guess the government should look into this matter. We make complaints but no action taken. Sometimes I feel that we are not being fair to the patient. Just changing combivent generic to the berodua original product, the child has less severe bronchospasms. We managed to bring down the dose of intravenous ventolin that make the child tachycardic. In my experience, Astalin, the generic for ventolin is never work mostly for my severe asthmatic patients. I have to ask my MO to go and buy ventolin ori from the pharmacy in Kajang because we have no more stock in the hospital. the hospital is getting the generic astalin from pharmaniaga. Probably astalin can be used in milder cases but not in severe cases and life threatening situation like this. Well, this limitation make us feel so frustrated as a doctor who really want our patient to get better and out from the danger. When you talk to the parents, your heart will just go......don't know what to say. There are many other instances that related to the use of generic drugs. For example, drugs for sedation. You need to give a very high dose to sedate the patients. Sometimes, despite that high dose, the patient failed to be sedated. Sometimes, with the correct dose, they took few days to wake up. Many radiological appointments such as MRI or CT need to be cancelled as the child failed sedation. Or if they do get sedated, the effect of the drug only apparent after a few hours post injection of the drugs. Basically, rescheduling of appointments are very common and my MOs are quite used to it but it is not cost effective because for any procedures, the parents have to take leave and many other arrangements have to be made. Frustration, anger, .......for how long? Malaysia boleh!!!