20th September is my mother’s birthday. But as I was still granted by Allah to feel the love and comfort from someone called mom, I was reminded that someone else is probably losing hers.
Makcik was starting to pass out black fluid, and I told her daughter it was probably melaena.
And she replied:
“akak,ape mksd akak drah dr prut or intestine yg da lme x kuar kak?”
Busied by ‘Eid celebration, my answer to her message was delayed. How could I selfishly have fun during Raya when someone else was overwhelmed by sadness.
She then continued to message me:
4.31pm
“doakan keshtn mak pulih kmbli ye kak? Hati cedh sgt skng.nnt apa2 hal sy update akak.”
8.21pm
“Oh,sory lmbt.hm,melaena tu biasa trkumpul bila ada pdarahan pd bhgn perut atau bhgn usus yg atas2.sbb tu dia ambik masa yg agak lama (usus kta pjg) utk smpi ke anus dan kluar mlalui jln blkg.mgkn tumour dlm perut mak tu dah bleed.tumour mmg byk blood vessels”
8.35pm
“ow,cmtu.Thx a lot kak.x benti bleedg ni kak.isaw”
8.59pm
“Dah ckp dgn Dr?”
The reply was late. And it read…
11.08pm
“akak,mak tgh nazak ni. Skng tgh monitor cardiac n bg o2”
Saturday
21st September 2009
12.12am
“Maaf lmbt,mak mcmana?”
12.15am
“mak half conscious.spo2 kjap naik kjap trun.cmne ni kak?”
12.24am
“BP brapa?mak sob lg ya?”
12.25am
“s.0.b lg.bp x sure.tp doc lajukan flow NS coz dia kata nk tggikan bp.”
Deep down inside, I was still hoping for a miracle to occur. Yet I felt a strong impulse to advise her and say, “You have to be strong, and be prepared for the worst… Ajal maut di tangan Allah tapi kita kena redha kalau mak betul2 pergi…” But the strength I had was only sufficient to reply:
12.30am
“Ok.adik beradik smua ada kat situ?”
And by saying this, I actually meant “Kumpulkan adik-beradik semua, kalau boleh biar semua ahli keluarga ada di saat-saat terakhir mak…”
4.05am
“ada.fmly smua ada kat cni.sory lmbt reply”
And as I was busy preparing for the 2nd day of Raya, the inevitable news came…, the one message which I was hopeful would not arrive… But it did.
9.01am
“akak, mak dh xde”
I felt like a bullet was shot through my heart. Although I did prepare for the worst, I had no idea it would be this painful.
9.37am
“Allah, innalillahi wa inna ilaihi raaji’uun.yaAllah..”
“YaALLAH,akak sdih sgt2..xdpt jmp mak kali trakhir hr tu..akak hajat kalu mak blk rumah lps raya, akak nk lawat mak kt rumah, tp Allah lbh sygkn dia..akak xteman dia masa dia mninggal,rasa kesal sgt2 =( tp skurang2nya anak2 dia smua ada d sisi dia..hm, awk ok?munirah mcmana?”
No reply. Probably they were all preparing for Makcik’s funeral. So later I messaged her:
12.57pm
“Tiada satu balasan pun di sisiKU yg diperuntukkn utk hambaKU yg mu’min,jika Aku mcabut nyawa kekasihnya dari golongan ahli dunia,kmudian ia mgharapkan redhaKU (dgn mninggalnya kekasihnya td),melainkan balasannya itu hádala SYURGA” (HR Bukhari)"
And that was a story of how I lost someone who took a special place in my heart…
The next day, her daughter replied,
“akak, sdeh la… rindu kat mak…”
Having no experience of losing someone close, I did not know how to react. I felt very sorry for her, but I could never say I knew how she felt, because I never had the same feelings before. So I remember replying:
“Bersedih tu takpa, ia fitrah manusia. Tapi sbg seorang hamba, kita tetap perlu redha. Segalanya hanyalah pinjaman, termasuklah nyawa kita. Sampai masanya, pasti kita semua akan dikembalikan kpd Pemilik kita yg sebenar. Ingat tak, dulu masa Rasulullah baru nak mula berdakwah secara terbuka, dia dpt byk sgt tentangan. Tp, Abu Talib selalu melindungi Nabi, dan Khadijah sentiasa meniupkan semangat dan memberi sokongan pd dia. Mereka berdua penyejuk hati Nabi. Tiba-tiba sampai suatu ketika, Allah cabut nyawa keduanya, pada tahun yg sama pulak tu. Allah tak tarik nyawa mereka ketika dakwah dah berjaya berkembang luas. Tp, Allah tarik nyawa dua kekasih Nabi di saat Nabi paling memerlukan mereka. Seolah-olah, Allah nak berkata pd Nabi, “Kau hanya ada Aku sbg tempat pergantungan, maka bergantunglah padaKU, mintalah perlindungan hanya dariKU”. Mungkin, itu yang Allah cuba nak didik awk skrg. Mengadulah pada Allah, sesungguhnya hanya Dia yg mengerti perasaan kita.. Dan bersabarlah, semoga kesabaran itu ganjarannya syurga…”
And a few months later, I found this hadith:
Dari Abu Hurairah,
ﻤﻦ ﻤﺎﺖ ﻓﻲ ﺍﻠﺒﻂﻦ ﻔﻬﻮ ﺸﻬﻴﺪ
“Sesiapa saja yang mati akibat sakit perut (spt kelebihan cairan perut, diarrhea, dan ada yg mengatakan seluruh penyakit yg menyerang perut), maka ia mati syahid”
(HR Ahmad & Muslim)
I pray that Makcik diganjari anugerah mati syahid. Dan semoga kita semua akan mati dalam keadaan husnul khatimah, dan sentiasa menanamkan niat utk mati syahid, mulai saat ini…
Last ‘eid painted an unforgettable memory in my medical-student life...
Friday 11th September 2009
No matter how hard I tried, my eyes did not seem to be sleepy enough to fall asleep. Despite a hectic day and a chaotic last minute preparation of packing up stuffs for my one-week Orthopaedics posting in HoSHAS Temerloh, these eyes of mine are still fresh. I could not get my mind off the patient I saw earlier today.
She, was the same patient assigned to me 7 months back. She, was the only patient I got involved with, emotionally. I was contacted by her daughter during Ramadhan and was surprised to learn that Makcik had been readmitted to surgical ward, 4C. She was fasting at home and needed to go to the toilet when she accidentally fell down and hit her head against the wall. She sustained a laceration wound on the scalp with quite profuse bleeding. I visited her around day 3 of admission.
And to my surprise, she was skinnier (read: much much more cachexic) than she was before – although last time she was already very very skinny after losing more than 20kg of weight to malignancy. Her abdomen was grossly distended by ascites, and the fact that she was very thin, made the abdominal distension even more prominent – it seemed like she was trying her best to endure an unbearable agony. She was only managed palliatively, but even so, painkillers were no longer helping. Her suffering showed, in her deeply jaundiced eyes. She was on diapers, and could not even change her position herself. Her lower limb was already oedematous. Even to catch a breath of air, she needed to struggle. Perhaps pleural effusion had also set in by then. She recognized me, but was unable to say or do anything. How painful it was to watch her suffer. Indeed, it must have been even more painful for her.
Friday 18th September 2009
On this day I just came back from Temerloh posting the night before, accompanied by an unfinished case-write up which needed to be submitted on Friday, the 18th of September, 2 days before Raya, which is – today. A tinge of exhaustion which almost always escorts write-up-submission day was ignored due to the fact that our supervisor threatened to check our logbooks after being severely disappointed by our performance in Temerloh. So Friday evening was spent exploring the whole hospital for the normal Dracula-hunting procedures: blood taking and branula insertion. Plus certain additionals pertaining to Orthopaedics posting...
I had the urge to visit Makcik in 4C. How I strongly felt that this might be my last chance to meet her… at least before Raya, because she had been admitted for over a week and by Raya usually patients request to be discharged.. And I would love to wish her “Selamat Hari Raya Makcik, semoga Makcik Allah sembuhkan… Maaf kalau selama makcik kenal hana, hana ada buat salah silap pada makcik”
But the procedure-seeking was just soo compelling and although I already went to 4C, I don’t know why I didn’t visit her. Perhaps it was due to her curtain screen which was almost always closed, especially because they needed to change her diapers, and she normally performed solat with the screen closed. Or perhaps because I felt quite uncomfortable since her sons were there too. Or was it just because… I fear that I could not contain myself, seeing her suffer.
So in the end, I went home for Raya without visiting her for a second time.
But along the way, her daughter whom I grew close with, kept in touch by messaging me.
Kenaikan harga gula sebanyak 20 sen baru-baru ini digambarkan oleh pelbagai pihak sebagai usaha kerajaan untuk mencegah penyakit berkaitan gula seperti kencing manis namun tidak kurang juga pihak yang mendakwa ianya sebagai satu alasan untuk menyejukkan hati rakyat.
Bagi merealisasikan gagasan kencing manis ini,adalah dijangkakan paket gula keluaran masa depan akan dilengkapi gambar-gambar penyakit berkaitan gula sepertimana yang dilakukan pada kotak rokok pada masa ini....
Selaras dengan itu, gula juga berkemungkinan menghadapi nasib yang sama dengan rokok,iaitu tidak akan dijual dalam skala kecil sepertimana juga rokok yang hanya akan dijual minima 20 batang sekotak.Penggemar gula mungkin akan disyaratkan membeli minima 20 kg pada masa depan. Manakala bagi pesakit diabetis pulak mungkin disyaratkan membeli gula dalam pek yang lebih besar iaitu sekitar 50 kg minima.Ini bagi mengelakkan mereka dari membeli gula sekaligus dapat membantu mengawal kandungan gula dalam darah mereka...
Just got back from the hospital. Makcik has been transferred to the 1st class ward at level 8 HTAA. When I saw her just now, she seemed better than the day before. The 1st thing she asked me was, “Hana dah baca ke pasal penyakit mck ni?”
Poor mck. She waited the whole day for me, and I came to see her only at 10.00pm in the night. How guilty I felt. I tried my best to explain in a professional way about her condition and her limited choice of treatment due to the advanced stage of her disease. Even chemotherapy would not be that helpful in gastric ‘tumor’, I told her. Along the way I avoided using the word cancer.
She asked, “Kalau Dr dah tak boleh nak buat apa, katalah chemo pun tak boleh juga, ada tak cara alternative yg Dr boleh cadang utk ubatkan penyakit mck?” I felt really hesitant to answer, because she seemed so hopeful. At last I talked to her daughter regarding the most Dr could do would probably be palliative treatment and to improve her quality of life.
Before going back, as usual I salam her and cium both her cheeks, the cheeks that showed obvious wasting of the masseter muscles as a result of her massive loss of weight. Suddenly she broke down into tears. As if that was the last time she would see me. She told me, “Apa-apa pun, kuasa Allah mengatasi segala-galanya. Kita ni manusia hanya hamba.”
I sat close to her, almost whispering, “Betul mck, kita manusia ni hanya boleh ikhtiar je. Tapi Allah yang menentukan segala-galanya.”
She continued, “Hana doalah kat mck, hana ni mulia, byk tolong orang…”
I replied, “Eh, yaAllah, takde pun mck, hana baru belajar mck… Mck pun doakanlah hana ya, org yg sakit ni doanya dimaqbulkan”
“InsyaAllah, mck doakan hana mcm mck doakan anak2 mck jugak..”
“Hana pun dah anggap mck mcm mak hana sendiri…”
She kissed me twice. She really made me feel like a daughter to her. It was a really really hard moment for me, what more to the patient herself, after listening to such unpromising explanations… When I turned my head towards her daughter, she was almost weeping. After shaking her hand, I quickly went out of the cubicle, tears running down my eyes… “Ya Allah, please make me strong, but please make my patient stronger…”
Upon further reading, my assumption right now is that she might have gastric carcinoma with secondary metastasis to the liver and neck LN. (these are just my mere postulations since the results are yet to be known.
As I continue my reading, my heartbeat was drumming faster and faster. I find myself reluctant to know more, since the reality is too painful to swallow.
"Gastic carcinoma is a HIGHLY MALIGNANT adenocarcinoma” was the 1st sentence of the subtopic Gastric Carcinoma. I braved myself to read more.
"This aggressive cancer metastasizes early by way of lymph nodes, blood stream, and peritoneal spread".
As I scrolled more down the topic, I learned that treatment of this cancer involves radical surgical resection, either partial or total gastrectomy with resection of adjacent lymph nodes as well. It provides the only hope of cure and is also the best way to palliate the patient’s symptoms.
Unfortunately, the few last sentences were really heart-wrenching to me: “A palpable tumor in the left upper quadrant or an enlarged liver is an ominous finding, usually indicating advanced, inoperable disease. Radical gastric resection is contraindicated if liver metastases are present. These patients cannot be cured.” And in another book, “The detection of liver metastases often alters the surgical management of patients with cancer. Since most of these patients will have incurable disease, the primary goal of surgical intervention is to palliate distressing symptoms rather than undertake radical surgical resection. Overall, less than 10% of patients will survive more than 1 year after diagnosis."
Ya Allah… Beratnya rasa dada ni… Innalillahi wa inna ilaihi raaji’un...
"Setiap bencana yang menimpa di bumi dan menimpa dirimu sendiri, semuanya telah tertulis dalam Kitab (Luh Mahfudz) sebelum Kami mewujudkannya. Sungguh, yang demikian itu mudah bagi Allah. Agar kamu tidak bersedih hati terhadap apa yang luput dari kamu, dan tidak pula terlalu gembira terhadap apa yang diberikanNYA kpdmu. Dan Allah tidak menyukai setiap orang yg sombong dan membanggakan diri…” (Al-hadid: 22-23)
I began to wonder how am I going to explain these harsh facts in a patient so hopeful to be cured. Especially after I grew close to her 2 daughters. Everyday when I salam her to go back, she will hug me and whisper, “Doakan makcik sihat ye Hana”. But just today, she looked into my eyes and asked, “Dari bacaan laporan makcik ni, penyakit makcik ni dah teruk ya? Kalau dia buat lagi teropong tu, katalah memang asal ketumbuhan dari perut, jadi Dr nak buat macamana? Boleh lagi ke nak baik penyakit makcik? Kalau tak, makcik nak cuba rawatan alternative”… I felt like crying...
This patient is religious too, she is the only patient in the female ward whom I saw praying when she was sick. Sometimes when I visit her during my oncalls, she would ask, “Ni semua ni kerja tak tentu masa ya?” I replied, we have oncalls every week. Then she adviced me so softly, “Nanti dah kerja esok, sebelum keluar rumah tu niatlah dua perkara, nak cari rezeki dan redha Allah. Barulah dapat kedua2 perkara ni. Kalau nak cari rezeki je, dapat satu je.."
Antara cara yang dianjurkan oleh Islam untuk mengingati mati adalah dengan menziarahi qubur, dan menziarahi orang sakit. Just nak muhasabah semua medical students, nurses, doctors, etc… berapa ramai patients yang kita jumpa setiap hari? Ramai kan? Tapi, berapa kali kita mengingati mati dalam sehari? Bila kali terakhir kita mengingati mati sampai berdebar dada, menggeletar badan dan menitis air mata? Bila kali terakhir? Adakah hari ini? Semalam? Bulan lepas? Tahun lepas? Atau tak ingat bila last time kita ingat mati?
Atau, setiap kali kita jumpa patients tu, hanya utk kepentingan studies kita semata-mata? Nak cari case best2, nak cover patients utk case presentations, nak cari case write-up, nak present case kat OT… macam selfish je bunyinya kan?
7.45pm As a medical student, I try very hard not to get involved emotionally with the patients I see everyday in the ward, especially those patients assigned for me to clerk, examine and follow-up. However, despite preventive measures, these attempts – of not getting emotionally affected – usually fail.
I was recently assigned a female patient who is 52y/o, nearly the age of my mother. Because this pt is sooo motherly and kind and caring, I grew sooo attached to her and began to love her more and more everytime I see her.
She presented with massive hepatomegaly (enlargement of the liver), so massive that the liver capsule is already stretched and thus causing her pain. Lower border of her liver could be palpated 18cm below the subcostal margin (imagine how big the liver span would be), and even the left lobe was enlarged, huge enough to be felt in the left upper quadrant, up till 10cm below her left costal margin.
Back to her case, suspicion of hepatocellular carcinoma was rendered unlikely by blood investigations of liver function test which was relatively mildly impaired and alpha fetoprotein which was normal. Hepatitis screening was also negative.
To cut the story short, the primary tumor turned out to be a gastric tumor. Biopsy showed atypical cells but the histopathologists were unclear of the exact diagnosis. Therefore gastroscopy was adviced to be repeated for a second tissue biopsy. However, currently the patient refused due to unbearable pain and discomfort during the process.
This evening I tried persuading the patient to redo the endoscopy and she asked a lot of questions regarding whether or not the agonizing process would affect her Mx later on. I promised her I would read more and explain to her again tomorrow, including the treatment options that the patient was so interested in.
At the time of posting, the URL http://www.heraldmalaysia.com/hambaallah.html returns HTTP error 404 (file not found). The screenshot's time was 8:25 pm, January 4th.
The message in the screenshot is clear, and is translated as follows:
we will not keep quiet as long as you still use ALLAH name. save the sanctity of ISLAM
If you are wondering what this is all about, search/Google for "herald allah". The Malaysian Insider has a scoop on the defacement here.
Anyways, here's a summary:
Herald Malaysia has been using the word Allah to refer to the Christian God in the Malay language version of the newspaper
Some time in 2009, the Home Ministry banned The Herald to use the word Allah. It's main reason was that it might confuse Muslims, as Allah has been used to refer to the Islam God.
On 31st December 2009, the High Court ruled that the order is illegal.
