We have no other choice, really. Hope, it is.

10 August 2019

When we started our paediatric rotation for our final year, I was expecting to learn a lot. But things never go as planned, do they? An unexpected incident gave me the red light and I lost my pace.
The Ziauddin alumni would know what a darling the Paeds department is so that didn’t help either.

I may not have learned as much about little kids and their ailments – but I’ll get there because I want to – but I was certainly tutored in how to battle anxiety and stress and not fret over that which is beyond our control. Fretting over the scary end-of-rotation test and a gargantuan syllabus was not going to help. Neither was worrying over a future that could potentially steal the golden hours of my present. Being happy, staying happy, is a choice; I was beginning to unveil the curtains looming over my subconscious.

So like the generous August downpour greeting our dusty Karachi, I began to feel a certain level of generosity towards the concept of mindfulness and Tawakkal (unshakeable, unconditional faith in God). Let’s just say that I decided to be eternally hopeful.

The rising sun, the eclipsing seasons, each new heartbeat, each new step forward, each new advancement made to better humanity, every little baby being named something sweet – all of this is a reminder that nothing lasts forever. Not joy, not sorrows. So we must go on having hope, we must go on having faith that everything will be fine.
Yeah. Everything will be fine.

We have no other choice, really. Hope, it is.

It’s a strange place to be in as the hands of our clocks slowly tick by. There’s a whole new life lying ahead of us and there are important decisions to be taken. Like any other final-year medical student, I, too, am tired. There’s a lot on my plate and I just keep getting a bigger plate; maybe the exhaustion is waving at you from my words, maybe not. Maybe it’s time to take a step back and just enjoy the light drizzling, the melodies of summers gone by, the excitement of a promising future, and a life of purpose, and laughter, and love.

Paediatrics, thank you for teaching me that, at least! It’s all peaceful now, finally. Thank God!

 

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Photo: Maham Noor Darabu

 

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There are six weeks left until five years of this journey comes to an end.

10 June 2019

The man looked really, really, really angry. Clad in a plain white shalwar kurta, he held a slip of paper in his hand, waving it around frantically. We had just reached the orthopaedic OPD – a good sixty minutes late because we knew the consultant was never punctual – and were prepared to wait for another hour till the clinic would begin.

“I will report you in the media! What nonsense is this! I’ve been waiting for an hour for this doctor to show up! Why have you written the time 2 PM here when he comes late? Is our time not valuable?? You charge us an exorbitant fee and make us wait for hours at an end! This is ridiculous! I will make a video and circulate this on social media! ”

We quietly crept back into the clinic. Crept back, yeah. Because we knew that man was right. We knew how valuable his time was. Maybe he had taken a leave from his workplace to especially bring his patient here. Maybe he had travelled a great distance to get to this hospital. But maybe none of that was true and he was just tired of waiting. Because time is valuable. Whether it’s his or ours or the very respectable doctors’.

There are six weeks left until five years of this journey comes to an end. I’m not very sure about how I feel. Ecstatic? Relieved? Accomplished? Scared? Apprehensive? Anxious? Maybe a little bit of all or simply none of these. But my heart is only beating to one realization – as we walk on this thin rope of life, we owe every human being we meet the sincerest form of dignity, respect, compassion, and kindness.

Just six weeks left. I will keep praying that all of us – every single person I’ve shared that lecture hall with – graduates with a kind, kind, kind heart. Amen.

 

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Nestle Nutrition Symposium – HMO

23 April 2019

Lean, lanky boys and girls running around under the blazing Karachi sun, calling out to each other as they play a simple game of ‘catch-me-if-you-can’, is a very common sight in any of Karachi’s lower socio-economic area. A doctor’s eye can very easily tick off all the essential nutrients that their bodies are low on. Not surprisingly, these kids grow up on tea and rusks and soupy lentils when they are old enough to say goodbye to the diluted cow milk that their mothers had – either by choice or circumstances – been forced to feed them during infancy.

To repeat what numerous medical experts, including the American Academy of Pediatrics (AAP) and the American College of Obstetrics and Gynecologists, have always voted for, exclusively breastfeeding the child for at least the first six months of his/her life goes a long way in ensuring their healthy lives in the future.
Amongst other vitamins, proteins, and fats, breast milk contains high amounts of the human milk oligosaccharide (HMO) which is very important for the growing child.

I had the chance to attend the Nestle Nutrition Symposium with my fellow global health representative, Dr Talaiha Chughtai – a paediatrician herself – where the experts on the panel talked about the recent research that has uncovered the many benefits of this unconjugated complex carbohydrate that is not found in formula milk.
So what does this HMO really do? HMO reaches the child’s gut intact, and is hence, able to deliver the prebiotic properties that are needed for healthy gut functioning. It also prevents the adhesion of the harmful bacteria on the gut lining, while also strengthening the immune system.
The oligosaccharides that are currently included in the formula milk do not deliver the same benefits because of their structural differences. So – we repeat – it really is a clear deal: the mother’s milk is an excellent early source of nutrition for the child.

The problem, as also recognised by the panel, lies in the fact that approximately only 37% of the newborns in our country feed on their mother’s milk. Besides the medically accepted reasons for not being able to breastfeed, the why questioning this statistic calls for more than a social take on the matter. The problem runs deeper – there’s a lack of education and awareness hounded by false beliefs and myths, and the malnourished mothers themselves.

What can be done to effectively address this national health issue that inadvertently puts the future of our children at stake? As global health practitioners, it’s time to step out and create solutions. And we’re doing just that!

 

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There’s still something missing within. I’m still looking for it.

| 29 December 2018 |

The final year of medical school kicked off with the infamous Nephrology rotation (the Ziauddin alumni will understand why I have used the term ‘infamous’ here!) and in retrospect, I’m rather glad for it. With her no-nonsense attitude, the very competent consultant expected us to shadow the house officers and that – for lack of a better word – shepherded us towards studying strategically. But there’s more to it that, obviously.

One patient to the next, interpreting arterial blood gases and chasing lab values of patients on end-stage renal failure; somewhere along the way we also learnt the importance of making wise, patient-friendly decisions. The consultant that we were rotating with, had a zero-tolerance policy for unnecessary lab tests ordered by her residents. With health inequity prevalent as a huge problem in a country like ours, it’s peremptory to realise that majority of the patients delay or avoid treatment because of the expenses of the tests required for diagnosis and the proceeding treatment. While all these tests are necessary, an equal emphasis is to be made on the signs and symptoms that the patients present with. While it’s easy for a senior consultant to differentiate between the absolutely necessary and the avoidable ones, to expect your subordinates to make decisions at par with your level of expertise, is, of course, a little too much.

What really hit me, though, was the ferocity with which the feeling of losing a patient crumbles you. Of course, declaring deaths is something that doctors often have to do hours apart, even. But how do you guard yourself? That small piece of yourself that threatens to desert you every time you lose a patient? This question knocked at my door when I turned up at the M.I.C.U. one early morning to follow up on my patient only to find the bed occupied by an unfamiliar face.
“He expired last night.”
“Oh……….inna lil la ha wa inna ilaeye rajioun.
(“We belong to God and to Him we shall return.”)

I went home later that day hoping – praying – not to be scared of my own death, to do enough good to look forward to it like an old friend, and to not let a ‘daily truth’ like death take away from me who I want to be.

There’s still something missing within. I’m still looking for it.

 

My heart is my own, after all.

9 AM | 22 December 2018

You can see the sign of ‘Cafe Zee’ behind that old umbrella, I’m sure.

I love Saturday mornings like these. The otherwise depressing atmosphere of the hospital switches over to the merriment of a desi breakfast of halwa puri warmed by a steaming cup of doodh patti that the overworked doctors and the sad, sad students (what else would you call a bunch of final years who measure time as the jump from one existential crisis to another, clouded by the vastness of all the knowledge that they are supposed to have and that which they don’t?) seem to celebrate.

I love these mornings simply because they gently remind me of how graceful is the happiness that you steal from the threats of circumstances beyond your control, and that I really don’t have to walk with the pain that nostalgia tends to bring and that not everything is beyond the horizon.

My heart is my own, after all.

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Tomorrow is another day!

It’s time to say goodbye to the sun-baked benches of Keemari that have often eavesdropped on the little moments of our lives there; rants over strict teachers, last-minute exam revisions, the hushed secrets, giggles over the phone, sad smiles, many a happy birthday. The year passed away a little too soon, I tell myself. Exhausting me, teaching me. Those dusty leaves of the faithful trees crowning those benches have sheltered many a sigh, many a smile, a little anger, a few disappointments.

Shahid Bhai’s first-floor cafeteria has always welcomed us with a homely comfort otherwise alien to the sound of ‘Keemari’. It’s warm, milky tea steaming with the joy of life-long friendships, meaningful – and meandering – conversations, even a few sad tears, a lot of fights with the best friends, and a square-table conference over the important matters of the world (and the heart) that absolutely demanded an opinion upon – that’s more than a comfortable haul to take home as I empty the Keemari locker.

The fourth year of my medical school has thankfully drawn to an end. I’m not particularly ready for the exams ahead, or for the grill of the fifth year. I’m just looking at tomorrow because “Tomorrow is another day!”* and while we live, we will hope, we will smile, we will Love.

*from Gone With The Wind, Margaret Mitchell

 

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your eyes are even smaller, yet they behold the world

A day before our ophthalmology exam, one of my friends shared with our clinical group a snap of Conrad Fischer from the Kaplan lecture series, relating a well-received saying by “our friend, Rumi” to explain how the cornea in our eye is home to a thousand layers of cells:

‘My heart is so small
it’s almost invisible.
How can You place
such big sorrows in it?
“Look,” He answered,
“your eyes are even smaller,
yet they behold the world.’

The ophthalmology rotation is notorious here as one of the driest, and hence, difficult ones. Add to it the unfortunate fact that I was too busy for university even, this rotation was easily one of the most challenging ones, catalysing a kind of growth that I had never anticipated.

The cornea, the lens, the iris, the optic nerve. Cataracts, glaucoma, conjunctivitis, macular degeneration.

As the rotation thankfully ended, I realised that myopia is not merely short-sightedness of the eye. Often enough, we fail to recognise what really is important to the eternal soul and the mortal bodies – myopia of the heart, maybe? To be able to see – in this day and age – that the honour and dignity of human lives lie in kindness, humility, compassion, forgiveness, love, and empathy, is one of the biggest blessings that you can enjoy. To even consider it to be a blessing is a blessing in itself. Just like the proteins in the lens accumulate to turn into the pathology of cataract – clouding your vision and making it ugly and blurry – our prejudices, our egos, and our insecurities scar the beauty of our happiness, leaving behind a tragic trail of lifelong regrets and struggling souls. Weighing the worth of happiness against the bias of religion, caste, creed, and social status is – sadly – How You Kill Love and Happiness.

Maybe one fine morning, we will wake up to a world of mortals where the beauty of the soul will be the joyous Phoenix.

 

Photo credits: Sabrina Merchant (https://www.instagram.com/sabsescape/)