the little secrets of life

7:20 PM | 1 August 2019

Five years ago when I started medical school, I had expected to learn the truth about human life – how we breathe, how we eat, how we sleep. Literally. But what I have stumbled across is far, far greater than that. I’ve learnt how we feel, why we feel. The little secrets of life, you know? Yeah. And how a dua – a heartfelt prayer – works.

We sit on the prayer mat and raise our hands in supplication and cry our hearts out, our foreheads kissing the ground, our souls trembling. We utter our hearts’ deepest, darkest desires. Then we get up from the prayer mat and we expect heaven to have been laid right before us, right away! Not so fast, people! Not so fast!

It’s a process. Slow and steady, usually. Also awe-inspiringly quick, sometimes. A fetus takes nine months to grow into the baby that the mother gives birth to after a tiring labour. I’ve seen duas being answered like that. I see it now, too. I see the ease in the difficulty. “For indeed, with hardship will be ease.” (Surah Ash-Sharh [94])
It’s amazing how I can even see it. Another one of those hugs from God, you know? Pour in a little love, a faith that loves to play hide-n-seek, also throw in an ounce of fear – “what if my prayer isn’t answered?” – and lots and lots and lots of patience: that is your dua. And then the magic begins to show itself; a  few trips here and there, maybe a disaster or two, a couple of heartbreaks and a huge river of tears later..it happens! At the perfect timing, in the perfect way. Perfect here is synonymous to His will, okay?

And so it’s happening! It’s happening and I am in happy awe of how beautifully He is managing the universe! The little ants who get their sustenance; the chirpy birds; the poor cobbler at the end of the lane. Me. You. Us.

We all have such a beautiful relationship with God. He has little secrets with everyone, all of us. That’s so incredibly fascinating, is it not? How He brings ease into my life will be very different from how He sends a hug your way. But the interesting bit is that we all see it. Not always. Just sometimes. And in those “some” times, lies the secret to all of our time on this little planet.

Everything wonderful is on the way. Yeah? Yeah.

 

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The Glasgow Coma Scale

| 9 June 2019 |

During our end of rotation exam, the spot for neurosurgery had a question on epidural hematoma. The question was a case based CT scan image, asking us to state the GCS of the patient, the radiological findings, and the subsequent management plan.

The Glasgow Coma Scale (GCS) is the scoring system used to describe the level of consciousness in a person following a traumatic brain injury. It evaluates the eye, verbal, and motor response of the patient. In simple words: from a total of 15, the lower the score, the worse it is.

As a doctor-to-be, I often find myself wondering how the world would be if there was a consciousness scale for basic human qualities like kindness, empathy, compassion, forgiveness, mercy. Would we have been as concerned if the ‘score’ was low? Would we have made friendships and nurtured relationships on the basis of this score? More importantly, would we have really believed in the credibility of this score to establish how “alive” a person really is, how “conscious” they are, how “healthy” they are? Will the heart and soul ever win over all that the eyes merely see?

This black and white film illustrating an important organ of the human body is more than that if you choose to think about it. If you choose to think about it. Drifting through the mundane motions of life – waking up, eating, going to work, paying the bills, filling up the car’s tank, all of those worldly tasks – the desire to worship through love and kindness drowns in the darkness of fear and confusion and “what will people think”, and we’re left with nothing but an emptiness that tires us. Tires us because our scores are low. And because they are low, sometimes, the sunrise stops becoming the alarm clock for another happy day of happy miracles; and when the foamy waves hit the shore, you only see them too late – going back, not rushing to hug you.

If only medicine had the cure to that. If only.

brain MRI
Source: Google

what i realised during the urology rotation

| 22 May 2019 |

You’re just a patient here; not a businessman, not the most popular guy in class, not the head of the local committee. Just another patient presenting to the OPD with complaints of whatever is keeping you up at night.

There’s an old man here, accompanied by his wife. He’s probably tired but he plays away with time by rolling down the beads of the rosary in perfect harmony with the holy words tasting sweet on his tongue.

A middle-aged man is tense. He sits upright, eyes downcast. Married for six months and no baby shopping in sight. His wife’s reports are normal. He sits alone outside the urologist’s clinic.

An old lady. She hasn’t slept properly since the day before yesterday because of the pain in her left iliac fossa.

One of them is accompanied by a cute little boy who wants “iiik kreeeme”. That’s how they say ice cream with love. I do, too, now.

Seeing one patient after another with the consultant, from one file on to another, I realise that I’m not the same anymore. Maybe it’s not signs and symptoms I’m interested in anymore. Maybe it’s something more…if a more does exist.
Life is sung as love and kindness and smiles, empathy and compassion and humility.
I wonder if all doctors have forgotten that.
Or maybe they, too, are waiting in another waiting area.

 

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Dr Ziauddin Hospital, North Nazimabad, Karachi, Pakistan

PCOs

This post first appeared on Sehat Kahani.

Sara was an unmarried, twenty-four-year-old obese young lady who presented to the gynaecology clinic with complaints of irregular menses. On average, she told her doctor, she had one period every five months. When she does, she experiences heavy bleeding and passage of large clots. The cramping, she frustratingly states, leaves her confined to her bed, unable to carry out her daily activities with ease. When asked about excessive facial hair, she did admit to having to frequently shave them off. Severe acne and hair loss just added to her problems.

Did she notice any change in her voice recently? No, she did not.
Did she notice any increase in the size of her muscles? No.
Did her mother have similar problems? Yes!

Described above is a typical case of what is known as the polycystic ovarian syndrome, or PCOs, for short.

Affecting almost every other woman, PCOs go undiagnosed until a girl gets married and is ready to conceive. Unmanaged, it is one of the leading causes of infertility and also the most common endocrinopathy in women of reproductive years.

What causes PCOs:
High levels of the luteinizing hormone and increased insulin resistance beginning soon after a girl starts her first menses work together to cause ovarian growth, androgen production, and ovarian cyst formation. This is manifested as an irregular and painful menses, excessive facial hair growth, acne, weight gain, and later diabetes and diabetic complications, and cardiovascular diseases.

What to do if you experience any of the above signs and symptoms:
See a good gynaecologist at your earliest.

What is your doctor expected to do:
You will be advised to undergo a few laboratory tests ( LH and FSH on the third day of the cycle, fasting blood sugar, serum testosterone, serum estrogen, serum progesterone) and a pelvic ultrasound to detect the cysts on your ovaries. Based on your test results, your doctor may prescribe you certain medications and refer you to a dermatologist (for treatment of severe acne) and a nutritionist (to help you lose weight by eating healthy).

Take home message:
Do not panic or stress out. Easier said than done, true, but managing your stress level is as important as compliance with medication. PCOs can be nerve-wracking and in order to lead a happy life, it is important that you come up with your own strategy to deal with it. As you educate yourself and talk to other women with PCOs, remember that every human body is different, and you may not experience all of the signs and symptoms characterizing PCOs – no single criteria is sufficient for a clinical diagnosis.
A healthy diet, regular exercise, and a positive frame of mind can do half the job!

 

PCOs
Source: Google

 

A letter for her (XVII) – we’re… good

3:01 PM | 25 January 2019

So imagine this: a little boy in middle school is in a bad mood. He woke up late. He spilt milk on his uniform as he tried to gulp it down in time to climb the honking school bus outside. Whoosh! He misses the bus, of course! Quickly changing into a fresh uniform, he is rushed to the school by his cranky dad who is also getting late for work. As you can guess, this kid is late and punished by the teacher. He’s made to stand outside the classroom. He can see his friends giggling inside. He knows they’ll make fun of him during recess.

He is suddenly angry. This isn’t fair. The world is cruel.

He rushes outside the corridor. He starts running. He runs fast towards the playground. He’s running and he’s furious and his little mind doesn’t know of any other way, yet, to take out this anger. And he keeps running.

Bang!

He crashes into his P. E. teacher – his favourite teacher – and spills the sport’s day balloons that he’s carrying all over!

“Oops…..hahahahahahah!”

Who wouldn’t laugh at the sight of a small kid and a grown-up lying on the floor, astounded, balloons of all colours flying over their heads?

So life’s like that, too. I’ve been running and running and running – sometimes away from the monsters and sometimes towards them – and in all this confusion, I forgot to laugh. Until today. And now I wish to bottle up this feeling forever. I laughed and smiled and it doesn’t matter how hard the road ahead seems to be; it doesn’t matter that unconventional, difficult decisions lie ahead; it doesn’t matter that things are probably not going to go my way – it doesn’t matter because that’s natural and I’m still here – waking up to the cuckoo’s song each day – and a smile and gratitude, and a heartfelt prayer, and a crazy desire for some crazy fun and a happy longing to be happy is all that matters. Spreading smiles is all that matters.

Do you know who taught me that today? Dr H. F. at N.I.C.V.D.
And I’m beginning to think that the magic dua I made before starting this rotation worked! It’s not that bad; it’s turning out to be nice and fun, and that patient who loved Mirinda reminded me of you, and we’re learning, and Z & I have been giggling away like teenagers, and even the library is nice, and we’re… good. So far. It’s going to stay that way, isn’t it?

Please.

Miss you all the time.

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They think it’s okay.

9:54 PM | 4 January 2019

They think it’s okay. And that it’s a job well done, “surviving and shit”.

It’s amazing, I think, how perfectly this game can run its course. Look at all those Facebook pictures; the smiles will lie easily. So easily. But there’s a ruggedness about it that I can’t seem to understand. Or maybe I am simply avoiding it. I’ve become pretty good at that, you know. Avoiding a feeling, ignoring a thought. That kind of thing. Maybe it’s ‘all for the best’.

I look at the others and I find myself watching this show with amusement. It’s like a ball, a ‘coming out’ of young girls in good, old Britain. They want just one dance with you. And it’s that exactly: one dance, one music, just living up to the act. And then there’s that one – that one other new soul who seems to know you but you are just too scared of all of that again. Because you need to be sure that if you trip during the dance, there will be someone to catch you. But your memory is a wretched old friend and reminds you that trust once broken is exactly that and the pieces are scattered all over and you don’t want to pick them up anymore. You’re angry, perhaps. Maybe you’ve even had nights of struggling breaths. But it doesn’t really matter because it has never mattered and you must only forgive yourself.

It’s an act, sure. But one you will want to live up to because you know that kindness and love are the only way you can be happy and because even memories seem to be cheating on you. So you get up and smile and have your eggs and tea in the morning and you make your way to the hospital and you see your patient on bed number 6 in room number 325 and you remember your grandmother and think of the time she told you that your presence comforts her and you smile a sad smile and think how awful it is that she was probably the last one to think so and then you also remember how she looked that last time you saw her and it all comes back with a bang and you rush out of the room and stand by the wall and take deep breaths and let the tears flow and you grieve – for then and for now – and you decide to go on. You decide to go on. You refuse to let loss cheat you, too. A love that rips you apart is no love, you tell yourself. It must let you make others smile, it must let you love a little kindly, like Him. So yeah. You do that and you don’t sit and mope. Not at all.

You know you’ll get there. Everyone deserves a chance. Other people, too. Kindness deserves a chance. As do you. So you now know that the game must go on and you must “survive and shit”. Yeah.

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A letter for her (XVI) – everything reminds me of you.

4:26 PM | 27 December 2018

A young man in the M.I.C.U. passed away today from dengue haemorrhagic fever. His lifeless body reminded me of a lot of things – emotions felt, the time that has passed, a haunting nightmare. It reminded me of your lifeless body, lying there. I couldn’t make it in time. How could that cheerful body lie there like that? Like that.
His mother’s screams, her tears.

“Myn kaisay rahoun gi abb! Yeh zulm ho gaya. Beta uthh jaa, pukaar mjhe!”
(“How will I live now? This is so cruel! Son, get up, speak to me!”)

There was nothing any one of us could do. His mother’s tears reminded me of my own loss – the seconds ticking by reminding me of how it will always, always pain the same – and how the moments proceeding the hospital formalities will be tinged with disbelief, grief, helplessness, anger, and that very fiery feeling of wanting to rip your heart out. Of wanting to go into a deep, deep slumber and never wake up again. How when today I go home and carry on with the eating and drinking and complaining about all that is wrong with the world, that mother will have buried a part of her soul, sitting amongst the crowd of sympathetic relatives and neighbours, in the incense of disbelief, the rosemary in her hand moving with the realisation that this is the only thing she can do.

Why am I writing this – such a sad account – here? Because this is also real. Far more real than the filtered smiles that social media uses to give us all self-doubt and anxiety issues. This is real enough to make us cherish each happy moment that we find ourselves fortunate enough to be celebrating. I write this as a small reminder – first for myself – that we must value and guard with reverence and gratitude all the good, all the love, all the chances at happiness that come our way.  I write this to tell you that I remember; I’m trying, and everything reminds me of you.

A small cup of warm tea by the dusty roadside, with our favourite crazy people making fun of how red the tip of my nose can turn in winters, may just be the biggest blessing in life. Right?

Miss you every day.

 

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