Break The Siege!!

Wahai Tuhan kami,
sesungguhnya kami letakkan Engkau di batang leher musuh-musuh kami,
kami jadikan-Mu sebagai pendinding (kepada musuh-musuh) kami,
dan kami berlindung dengan-Mu daripada kejahatan mereka.

Wahai Tuhan kami,
binasakanlah kesempurnaan mereka,
dan pecah-belahkanlah jemaah mereka,
dan gagapkanlah perkataan mereka,
goyahkanlah pendirian mereka,
dan hantarkanlah anjing-anjing ke atas mereka dari anjing-anjing Mu,

Wahai Tuhan Yang Maha Gagah Perkasa,
Wahai Tuhan Yang Maha Berani,
Wahai Tuhan Yang bersifat Murka,
Ya ALLAH, Ya ALLAH, Ya ALLAH.
Tuhan yang menurunkan Kitab (al-Quran),
Tuhan yang menjalankan awan,
dan Tuhan yang menghancurkan tentera al-Ahzab,

Hancurkanlah mereka, dan bantulah kami ke atas mereka,
Amin. Amin. Amin Ya Rabbal A’lamiin..

WE DO CARE ABOUT PALESTINE, DON'T WE?

LifeLine4Gaza Info.

OCD Monk.

Monk, the real OCD.

"Watch your thoughts, for they become words,

Watch your words, for they become actions,

Watch your actions, for they become habits,

Watch your habits, for they become character,

Watch your character, for it becomes your destiny"

The Monk series reminds me of Bandung... My housemates and I back in Bandung used to watch Monk while having lunch and dinner EVERYDAY ^_^ Monk is seriously genius and funny! Probably because of the disease that drove him crazy - Obsessive Compulsive Disorder. A psychiatric disorder.

On that note, let's talk about OCD and how could it possibly helped Monk going into details of all the investigations being done. Mind you, the 'Holy' book in Psychiatry is DSM-IV which is quite a number to be memorized. But I'll try to simplify them for your convenience okay. I just pray that my memories are not tangled inside my brain, especially during exams. Na'uzubillah~

By definition, well, you can google it if you find mine is not that convincing. It's just that I prefer to create a story every time I hit the medical books so that I could chain all the infos together without losing any.

The essence of OCD are..
1. Obsession : Thoughts - recurrent, intrusive.
2.Compulsion: Behaviour - repetitive, to relieve anxiety in response to obsession.

It is a disorder characterized by recurrent and persistent intrusive thoughts, impulses or images from one's own mind which are unpleasant that makes one anxious because they can't resist. In turn, one shall 'obey' the obsession to neutralize the disturbing thoughts by doing it over and over again up to the point where it could harm the patient. Worse if it affects the functioning either socially or occupational function.

The same happened to Detective Adrian Monk. He can't stand it if the spoons are not symmetrically arranged, the books must be placed in order with definite and accurate measurements, not even an inch of difference. Once, he was trapped and tied along with some other people by a bad guy in a room with an unsymmetrical window blind at the corner. He managed to grab a sharp stuff and untie himself, however, instead of rescuing others, he stormed to the window blind and fixed it real good! I can't imagine being one of the other victims, watching an open door being locked as soon as I think I'll be free. Lawak btol Pakcik Monk ni.

Also, if I were to list all the phobias that he has, I might as well make a book out of it because it reaches over hundred items!!

Come to think of it, I realize that being a detailed person makes Monk a greater detective as to how he can remember exactly all the images at the crime scene, the evidence be it verbal or non verbal and so on. Pure genius.

Anyhow, like Monk, patients with OCD usually have good insight about their sickness. They know that they worry about unreasonable stuffs excessively. They are aware of it and they wish to get rid of all the intruders!

Poor Monk. This could be due to some stressful life events during his childhood. His father was not that "fatherly" you know. Once he got OCD, the course usually varies but like Monk, it is chronic with only around 30% of patients showing significant improvement with treatment.

Another important thing in psychiatry is to manage the patient as a whole. By that I mean considering 3 major aspects which are BIO, PSYCHO, SOCIAL of the patients. For instance, how to treat OCD:

Bio: SSRIs are the first line drugs, preferably in higher doses. Last resort would be ECT.
Psycho: Obsession - behavioural therapy (touching the dirty floor without washing hands), anxious mood (need to bear with the thought of dirty hands) - relaxation techniques.
Social: Social skills? (sukati je :p)

Monk has his own psychiatrist, Dr. Charles Kroger who constantly and patiently listened to Monk's progression each time they met. Psychiatrist memang sangatlah penyabar! Sometimes Dr. Kroger gave him suggestions like trying to mingle with some other people in a normal way.. but it didn't work out, mostly :( Tapi dia terer siasat! :)

So from thought to words to actions to habits to character to destiny.. I guess it's clear enough that we can create a good chain of all those by initially having good thoughts and of course, a good heart ^_^

Bismillahirrahmanirrahim~
Say, "I seek refuge in Lord of Mankind",
The King of Mankind,
The God of Mankind,
From the evil whisperings of the evil whisperer,
Who whispers into the hearts of men,
From among jin and men.
[surah An-Nas]

*Currently busy doing my Case Write Up (CWU) on Major Depressive Disorder. My patient came in with a slashed wrist, a suicidal attempt, and she's only 20 :'(

Nature or Nurture?

I was looking at the ground..

I nearly forgot that we're actually made from it -_-; The forgettable origin.. am I forgivable? Astaghfirullah~

Humans have characteristics similar to the ground from the ground up. Humans, like ground, (byknye ground) are soft and weak, rough and hard, some are generous and charitable like a fat land, like the rich soil that gives rise to many many fruits and veges etc. On the other hand, there are stingy humans, like a barren land not permitting any veges popping out, very dry almost like a wasteland. In other words, humans are different from one another, a diversity.

When walking on the ground, we watch our steps to prevent us from getting tripped or fall down. Stepping on a hard path causes no worries. From the other standpoint, stepping on a softer surface needs extra precaution.

Prophet Muhammad (pbuh) said:
"Allah created Adam from a handful of dust taken from different lands, so the children of Adam have been created according to the composition of the land. Therefore from mankind we have white, red, black and yellow ones; we have good and evil, ease and sorrow, and what comes in between them"
-Sahih al Bukhari

That's why we need to be considerate while managing human diversity. People are not all the same. What more as a future doctor, I have to be able to assimilate with all the patients that carry along different behaviours. For me, behaviour is a hint to one's perspective and decision making. Also, a hint to the way we're being nurtured. Or is it nature that actually shape who we are? Putting aside choosing 'both' as the conclusion, let's try picking a side. Nature vs Nurture. Hmm..?

By the way, this is a poem which I love so so much from a book I got from Indonesia. I think the author truly master the magical 'construction' that lies inside a human body:

Manusia wujud dari lapisan perkara,
Ia adalah daging, tapi punya seajaib nyawa.
Ia adalah tulang, tapi mampu bermimpi,
Ia adalah darah, tapi boleh berempati,
Ia adalah benda, tapi mampu berlari,
Ia adalah tubuh yang diisi roh,
Dan roh bersatu menjadi penting bagi kemanusiaan itu sendiri.

Subhanallah.

It's my nature to cry when I watch sad movies :"> It's my friend's nature not to cry when doing the same thing, maybe because she was nurtured to be tough :p

What say you?

*****

Sometimes... I don't understand how does a person feel, what's bugging a person, what does a person need, what do I have to do to clear things up.. I don't get it, I'm clueless and I don't know what to do. I tried so hard to cope but failed in the end most of the time. I tried to ignore but the thoughts keep running. It hurts so bad I can't take it sometimes. Is this normal? Because I don't want to end up being in the psychiatric ward with a reserved bed. I need education, a strong one :(

Patients: yesterday I managed to clerk a lady with Panic disorder w/o Agoraphobia in front of my supervisor for the very first time. It seemed like I was the one who needs all the anxiolytics available. Menggelabah sungguh~
Book of the moment: Currently in love with the Interview Guide for Evaluating DSM-IV Psychiatry Disorder and the Mental Status Examination. Handy!

Pesanan Akhir As-Syahid Syed Qutub Rahimahu'llah

Dublin, May 16th, 2010

Salam BFFs and readers alike.
Happy Teacher's Day!

I came across a book, and couldn't help noticing this bit of wisdom shared in it.
Off we go.

Pesanan Akhir As-Syahid Syed Qutub Rahimahu'llah

Saudara!
Seandainya kau tangisi kematianku.
Dan kau siram pusaraku dengan air matamu
Maka di atas tulang-tulangku
Yang hancur luluh.
Nyalakan obor buat ummat ini
Dan....
Teruskan perjuangan ke gerbang jaya.

Saudara!
Kematianku adalah satu perjalanan,
Mendapatkan kekasih yang sedang merindu
Taman-taman di syurga tuhanku bangga menerimaku
Burung-burungnya berkicau riang menyambutku
Bahagialah hidupku di alam abadi

Saudara!
Puaka kegelapan pasti akan hancur
Dan alam ini akan disinari fajar lagi
Biarlah rohku terbang mendapatkan rindunya,
Janganlah gentar berkelana di alama abadi
Nun di sana fajar sedan memancar....

(Ditulis beberapa ketika sebeleum menemui SYAHID)

Tergetar jiwa bila membaca pesanan ini.
Jelas sungguh As-Syahid dengan matlamat hidupnya.
Bagaimana pula dengan kita?
Moga kita sabar dan thabat dalam perjuangan.

Asma dear, all the best for your exam.
Leya, enjoying the busy life? Hoping the best for you.

Selamat Hari Lahir Nadiah Zainal Abidin. :)

p.s: no of patients met: 8? (but I can't take a proper history or do a proper physical exam)
book currently reading: You can be the happiest woman in the world, by Dr Aid al-Qarni (hak milik seorang senior yang sudah pun bergelar doktor.)

worldly justice revealed.

Venue: Tutorial room, XYZ Department, ABC Hospital.
11 medical students were waiting for the doctor.
Teaching session was about to start.
The door was finally opened...

Dr.: Why so many of u? (manglish)

Pause.

H: Because there are UNPAD students here.
Dr: Oh so you guys are here? Raise up your hands, I want to know you.

They were reluctant at first, but they put up their hands anyway. The 3 of them - W, I, N.

Dr: Why are you here? You don't belong here. Why did you jump from there to here?

Tense. Pause.

Dr: Kidding!
The Dr. went outside for a while to meet the registrar. He was discussing something more important.

W: What was that just know?
H: What? The Dr asked and I gave him/her the answer. What's the big deal?
W: Why did you bring up this UKM - UNPAD thing? I don't like what the Dr said.
H: Well then it's not my business.

***********************************
To H, like it or not, WE'RE STAYING!

BFFs, this heartbreaking incidence happened just recently. And it's not the first time. It has been a year since we touched down and we managed to experience some sorts of discrimination, being compared, been given some kind of drive to URGE us the twinning program student doctors to be better, preferably, better than the ORIGINAL UKM students. No less.

I guess it's a norm that people sometimes are skeptical when it comes to new things, new people or anything new to them. I look up to people that has a powerful adaptability. The ones whom do not feel threatened or annoyed by the presence of unfamiliarity in their lives but acknowledge them with respect. I always wonder how does the faculty perceive us, the very lucky twinning students especially as we enter the clinical year here. Are we beneficial in any way? I might sound like an oversensitive, cry baby type of girl but this is how WE actually feel after hearing those kinds of hurtful words all this while. We feel like our existence here is planned but somehow unwanted by certain people. Putting aside the minority cases, we value all the lecturers that had given us so many precious knowledge and something to be kept for a meaningful life, wholeheartedly. Not to forget, there are hundreds of wonderful friends who accepted us with open arms here. All in all. we feel privileged to be given such honour to receive the best of both worlds - UNPAD and UKM. And maybe being hurt is the price to pay for it.

"Do men think that they will be left alone because they say, ‘We believe,’ and that they will not be tested?" [Al-Ankabut: 3]

Kang Abik's new release!

Can you buy me this book? I'll remember you for the rest of my life!

Patients seen: 4 beautiful persons..
1. A woman with Chronic Schizophrenia
2. A man with Major Depressive Disorder
3. A woman with Mental Retardation
4. A woman, undiagnosed with abnormal behaviour

BookS of the moment: Toronto Review Notes on Psychiatry, First aid to Psychiatry, Handbook of Kaplan & Sadock, DSM-IV-TR, Oxford Psychiatry! Lotsa reading to do 0_O

Depression is AWESOME

MELANcholia

Morning worsening of symptoms/PsychoMotor agitation or retardation/early Morning wakening
Excessive guilt
Loss of emotional reactivity
ANorexia/ANhedonia

If you happen to experience all the above disturbing stuffs, then find yourself a way to relax and diminish all of them. You might be depressed with melancholic features.

Depression is AWESOME

Affect is flat
Weight change (lose or gain)
Energy decreased
Sad/suicidal/social withdrawal/sexual inhibition/sleep change
Others like guilt, lost pleasure, hopeless
Memory loss
Emotional blunting

Most Used: SIG E CAPS

Sleep - Insomnia/hypersomnia
Interest - anhedonia
Guilty
Energy - fatigue
Concentration - eg. difficulty making decision
Appetite
Psychomotor - retardation (feels like walking in a mud, talking slow)/agitation
Suicidal

"Allah (alone) is Sufficient for us, and He is the Best Disposer of affairs" [Ali 'Imran: 173]

I want to be H A P P Y~
:'(

I see U. (ICU)

Dublin, May 2nd 2010.

Salam best friends, and fellow readers.

It's warm outside, the sun is shining after a day of pouring rain.
Dublin is currently as green as it can be, and the mood cannot be any healthier. If not, merrier.

I was having a halaqa in the midst of St Stephen Green Park with my sisters last week, and I can't help snapping a few shots of the surrounding beauty.

The last two weeks was a challenging experience for me. I wasn't alone, yet I feel like I went through things by myself.
I just started my SSC (Student's Selected Component), I supposed like a mini research, and I was lost. Completely and utterly incapable of comprehending what exactly I was supposed to do.
I chose to be under the anesthesiologist’s team, so I have to be in the ICU (Intensive Care Unit) for the rest of the 6 weeks. If what I was going through wasn't enough, try seeing patients that can't talk to you or even look at you.

I have never learnt anesthetics, and I was clueless at what was going on around me. I followed the anesthetic’s team around for the whole first week, yet all I learnt was a medical student in the ICU is no more than a walking wall. That left me devastated.

I was eager to learn, yet nobody seems to have the time to teach me. (I believe this is too normal in a medical setting).

When I came in the General ICU for the second week, I didn't expect much, I just want to get the hand over finished with and be done for the day. That's when I met Dr. Masood.

'Hi! Will you be here for the rest of this week? Just this week?' He asked.
' No, I'll be here for the next six weeks.' I said.
'What year are you in?'
' Er, I'm in the third year'
'Okay, I'm Dr Masood, a senior registrar here,' He smiled.
'Would you mind if I follow you around?'
'Yeah, definitely!'

From there on, he kept on introducing me to all the patients we met and I mean ALL of 'em in the ICU, passionately unearthing possible causes and different types of treatment for the patients. He made sure I was right beside him all the time. That was the day when I fall in love with the world of anesthesia (I am not exaggerating). If before anesthetist to me is just the doctor who sits in the OT (operation theatre) and sneaks out every now and then to sip coffee after sedation is finished, today I learned anesthetist really does take care of patients. Inside out. The surgeons even joked that anesthetist are the doctors who skipped anatomy.

The day went on with me taking a patient's history in one of the rooms. I wasn't sure whether to interrupt the nurse on duty to give me some insights for the patient's status.

That's the thing. Please do ask the people around you for help. It doesnt matter whether they are willing to help or not, the point is, just ask. Nicely.

Alhamdulillah. Everyone was there to help me. ICU never feels so homely. :)
Alhamdulillah, Allah shows me time and perseverance are essential to acquire knowledge.
Alhamdulillah, I learnt that things don’t always go smoothly. Give it time, give yourself the opportunity to make mistakes and learn and learn.

Alhamdulillah, thank you for the guidance, the smiles and the acknowledgement. How simple gestures made my day, and lifted my spirit to gain more.

*****************************************

IT DOESN'T HAVE TO BE PERFECT THE FIRST TIME.

Do remember that Izzati.

*****************************************

2 minggu lepas, saya buntu, bukan setakat dengan kerja-kerja seharian, tapi mungkin dengan my plan for the future. Frankly speaking, I was never serious to think of how I would lead my life.
Implicitly, the way the events built up around me the past week really got me into thinking, I need to know what I want. What I want to achieve, and how I want to make that happen. I can't keep expect things to resolve by itself, and I will be happy with whatever the outcome is.
Nevertheless, I am aware that Allah the Almighty is the Greatest Planner. The best Planner.


'Wahai sekalian orang-orang yang beriman! Mintalah pertolongan (untuk menghadapi susah payah dalam menyempurnakan sesuatu perintah Tuhan) dengan bersabar dan dengan (mengerjakan) sembahyang; kerana sesungguhnya Allah menyertai (menolong) orang-orang yang sabar ' [3:153]

Saya ingin mengulang ulasan seorang penulis mengenai ayat di atas,
Ayuh kita hayati makna ayat ini:

Solat digandingkan dengan sabar kerana perpaduan ini merupakan mata air yang tidak pernah kering dan bekal yang tidak pernah habis. Mataair yang memperbaharui tenaga , dan bekal yang menenangkan hati, sehingga tali kesabaran semakin panjang dan tidak mudah putus.

Solat adalah hubungan langsung antara manusia yang fana dengan KEKUATAN YANG ABADI.

Nota kepada diri dan sahabat: Kalau rasa ada sesuatu yang mengganggu diri anda, and you can't put your finger where to, ambil wudhu' dan solatlah. Dia Maha Mendengar, Dia Maha Mengetahui.

* P.S: Thanks asma dear, for listening.

P.P.S: LEYA! Ganbatte for the coming week! Selamat memulakan hari sebagai medical student semula!

P.P.P.S: No of patients met: Loads.

Books currently reading: Arabic Course for English Speaking Students (Madinah Islamic University) by Dr. V Abdur Rahim. (a friend of mine from Saudi invited me for lunch today, Izzati needs to brush up her Arabic language skills, or else it’ll be like itik and ayam this afternoon) :)