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The perfection that we seek can only be found in God.

(via islamicrays)

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Eid Mubarik to everyone celebrating eid today. Stay blessed. Remember us all in your duas.

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Empathy-Symapthy..

2 months into clinical practice. And each time I encounter a critical patient, my heart frantically prays that they get better, stay with us. And my brain is constantly nagged by the thoughts of what if they don’t? How much of it would be my fault? The first time I lost a patient, I was all “empathy, not sympathy” and it worked out pretty well. But when I lost another few, I didn’t want to. I delved into their stories and took time out to feel sorry for them. And that’s when I realised what my brain had been storing. The last interaction with each patient. The last request they had for me, the last complaint they made, the last look when they just got better before worsening. I took time out, shut others out and wept. Because I wanted to. Because I wanted to feel a part of the pain that the families were going through. And I don’t have any explanation for it. Am I becoming a sadist? Is this against the code? I did not weep with them. I wept for them, away from them, for myself. It has made me feel better as of yet. And this makes me feel maybe it was the right thing to do.

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I'm new to this feel but relate so much to the need for this 1 minute to cry every now and then. And the getting back to being a doctor. Ahh, being a doctor is a constant rollercoaster ride..

on doing what little you can

Sometimes the meaning seeps in around the edges.

I’m on a 3+1 schedule. After a block of wards, I had one day off and then started my ambulatory week. I started it tired and a little hungover. Wards was miserable and I then attempted to cram an entire social life into one 24h period. My clinic day was basically ok, though everybody showed up, which is always difficult; our schedules are not designed for that. In doing my pre-rounding for tomorrow, I saw that one of my more challenging patients came in when I was away and the attending who saw him decided he didn’t agree with my planned opioid taper. It wasn’t even that he thought I was wrong, he just didn’t think it was important, so he refilled the guy at his previous dose. That is his prerogative as an attending but given that I had clearly documented my plan (and the plan of the attending who was supervising me when I made it!), and this was his first time meeting the patient, it was profoundly disrespectful and annoying to do so without talking to one of us. It makes my job so much harder. And my job is hard enough without being undermined by my attendings. 

So I leave clinic feeling pissed off about that, and go down to the cafeteria to grab dinner before going home for a House of Cards mini-binge. As I sit down with my food, I notice a lady pulling her jacket over her face and crying her eyes out at the table in front of me. Now, I would like to claim to be a deeply good person who definitely only thought about how I wanted to help this suffering soul. But I am a broken-down, worn-out medicine intern who actually deeply wanted to eat food and go the fuck home. 

Groaning loudly on the inside, I took my dinner and sat down at her table and asked if she wanted to talk. She said no. Then she uncovered her head and saw the white coat, and started talking through the tears. Her husband is dying. He’s abusive, but she loves him. He only abuses her because of the alcohol. Now he’s dying from the alcohol. Why does he love alcohol more than her? Why does God make her suffer like this? And also, somebody stole her wallet and she’s hungry…why must God add insult to injury? She’s a good person. 

I bought her a couple of meals worth of food and called the chaplain, because my atheist ass has zero insight into why God might be doing anything. Mostly I just asked questions and listened to the answers. She stopped crying and started eating her sandwich. We made a plan for tonight and tomorrow. One day at a time, I told her. I offered her a hug, which she accepted. 

I left. Ran into one of my favorite fellow interns in the elevator and appreciated his always-warm smile. Got into my car and put on Sigur Ros and took a minute to cry…because I was so tired, because I didn’t actually have space for any more suffering today, because life is unfair to people and I don’t deserve my good fortune, because I am so rarely able to solve the problems that really matter. 

That said, buying a lady a sandwich definitely felt like the most meaningful thing I did today. 

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Started to work this month and this couldn't have come at a more opportune time.💗

Living the Nightlife: Tips for surviving night shifts.

I’m not talking about clinical skills; if you’ve gotten this far, you can do it. My tips about the techicalities of night shifts can be found in my Tips for New Junior Doctors post. Nope, it’s just hard to get used to night shifts at all. I’ve spent quite a bit of time chatting to various colleagues, and gathered a few things that seem to work for me, so this is a lost of suggestions which might help for those struggling to ease into the world of working nights. Not mandatory, by any means. I don’t really feel it’s a complete list, but I do feel like putting it out into the aether. If you have any tips, feel free to add to the list :)

In the lead-up to nights:

Sort out your life admin. On-calls don’t leave much time for other things.

Try to go to bed a bit later than normal. This is easier if you have a weekend or a day off before you start.

Let yourself sleep in late in the leadup to nights. The aim is to shift your body clock closer to when you will be on nights, so that you will feel less of a shock when everything flips.

Tell your friends and family you will be on nights. Anyone likely to text/call/whatsapp you during the day. Not to brag or whinge, but so they know that they shouldn’t disturb you, or sulk if you don’t answer!

Schedule any deliveries for the days before your nights, or only for times you know you don’t plan to sleep on your nights block. There is nothing worse than being woken up by a ring at the door halfway through your sleep. If you wake up it is harder to snooze off again.

Plan your ‘packed lunch’. Yup, 12 hour shifts are long, you WILL be hungry. Your doctors’ mess may not be well-stocked. The hot food and vending machines at your hospital may also be broken; always plan in advance; I spent my first night shift snacking on huge piles of shortbread because the machines were broken and there was nothing else in the Mess. Never again.

On the day:

Get as much sleep as humanly possible.

It may be easier to sleep in until late, then get up and go about your day before your evening shift sets in.

Or, some people prefer to get up at a relatively normal time, and take a nap in the afternoon preceding the night shift. There is no right answer.

Eat a good ‘breakfast’ before your shift starts. I usually eat ‘dinner’ in the morning (before bed), then ‘breakfast’ when I wake up (before work) then halfway through the shift when it is less busy (2-4am) I have ‘lunch’.

I feel it helps to set out the day pretty similarly to normal days, because it feels less jarring. Trying to eat at reasonably regular intervals also helps avoid that hypoglycaemic feeling of despair and not being able to cope. And the hangry rage.

I also pack snacks because long days are exhausting.

Don’t forget plenty of loose sheets of paper and your clip board, request forms etc.

The shift itself:

You will get a pile of jobs as soon as you start. The aim is usually to band to gether as a team to clear them as soon as possible.

Make sure that the person who handed over those jobs gave you all the right infromation.

Make two jobs lists: urgent jobs, and the ones that you ‘can do if you find a spare moment’

If you are lucky, it will become more peaceful around 2-3am.

If you are moderately busy, you will catch a breather around 4-5am as people stop wandering around or going to A+E.

You need to eat. If it hasn’t petered out by 2-3am, talk to your counterparts to plan breaks and cover each other.

You don’t need to have no jobs or patients on the list to eat or got to the toilet. If there are no urgent ward jobs, you can eat quickly.

If the patients waiting to be seen on the acute take have been triaged as low risk, are clinically stable, and have not been waiting long, having a cup of tea and a quick sandwich is not harmful. They will be monitored by your nurse colleagues. Just let your senior know so they can crack on with seeing patients.

You cannot look after patients to your best ability if you are exhausted, hungry, dehydrated or bursting to go to the toilet.

You never know when 30 people will turn up to A&E at once, or when 5 patients will fall on the wards in rapid succession. Take it easy when you can.

If it’s not bad on your take, help your ward equivalent.

If it’s not bad on the wards, check the A+E list for referrals and help your colleague clear patients.

Update the list whenever you have time.

If you don’t have time to eat but are feeling completely exhausted, a hot drink or some juice, or even a cup of water can work absolute miracles.

caffeine in reasonable moderation is your friend.

After the shift:

Do not drink caffeinated drinks after your shift.

…Unless you have a long drive ahead and need it for your safety.

Don’t drive long distances after night shifts. If possible, d not drive or cycle at all: you will be hugely exhausted and sleepy so are at particular risk of accidents.

Eat your ‘dinner’ when you get home, not long before ‘bedtime’. The postprandial effect may even help you drift off more easily.

No matter how awake you feel, go to bed, just as if it was night time.

Don’t get out of bed, even if you don’t feel sleepy.

If you wake up, don’t sweat it. It may be harder to get to sleep, but you can keep trying. Just stay in bed, don’t play on your phone or computer and you are much more likely to drift off.

Read about good sleep hygeine.

Don’t play on your phone; that will only kee you up.

Blackour curtains or a sleep mask are an absolute must.

Close your windows.

Put a note on your bedroom door/fridge/etc to let your flatmates know that you are working nights.

Explain to them that being noisy is the equivalent of you banging pots and pans around in the middle of the night for them.

Silence your whatsapp/text/ringtone. Everything that is not your alarm clock should be switched off.

Give yourself a good 7-8 hours of sleep. I always try to sleep more hours on nights than I do normally, by being stricter with myself. It actually means I barely feel sleepy on nights at all!

When you wake up, leave a good amount of time to eat and get to work.

Night shifts are 12=13 hours long usually. Even with sleep accounted for, if you don’t live too far away from work you still get a couple of hours to eat/watch TV/catch up with someone close/chill. Try to de-stress in that time.

After nights:

You get days off! YAY

But getting your body clock back to normal will be brutal.

Personally, I recommend not sleeping through the day that follows your last night shift, if you can. This will leave you more sleepy when it is night time, and hopefully make it easier for you to go back to normal sleeping patterns.

If you must nap during the day, keep it short and set an alarm so that you don’t end up sleeping the entire day and lying awake all night.

Despite your best efforts, you’ll probably find that you feel more sleepy during the next few days, and find it harder to sleep at night. That’s common, and your body will eventually settle back.

Practise sleep hygeine as best as you can, to settle into a normal pattern quickeer.

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Writer's Block

Sometimes, I lift my pen,

And the words come easy,

Just flowing through my veins onto the paper,

But sometimes,

Each syllable gets stuck,

My imagination is choked..!

There's no pattern, no algorithm

to define What makes these times alternate..

But moments come to pass,

The tides of emotions rise and fall,

The winds of inspiration make their way,

And what stays in the end is a steady flow,

It may be short-lived,

But it always promises to come back soon enough,

And that's what keep me going..

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I GRADUATED

All praises to ALLAH Almighty.. It’s strange to realise how this journey started and how it has ended. An how this little blog came along the way. Not a medschool student anymore. Seems surreal. And the huge responsibility of people’s health that somehow seems too real now. May ALLAH Almighty enable us to always be grateful and mindful of our responsibilities.(Ameen sum Ameen) May ALLAH Almighty ease our paths for us and guide us at all points with His mercy.(Ameen sum Ameen)

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Intention

Of all things good and pure Intention is what I crave.. For like the stone that turns everything to gold It can purify each deed done..

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Then which of the favors of your Lord will you deny..

Tiny little hearts Shine in my eyes As I look about And there are gifts spread all around.. The gifts I could never imagine Now sit at my feet And happy little hearts Fall from my eyes into my palms As tears of gratitude.

All praise is due to ALLAH Almighty.

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Note to self

What ALLAH Almighty has for you is so much bigger than your expectations. Learn to have faith.

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When I thought that I was steering my life, My heart was afloat, at the mercy of the waves, And no anchor did I see to hold it in peace.. But then a sign of mercy came From Him who is the true Sustainer of us all, And my heart felt at ease, My life found direction, And the troubled waters ceased. So now, I believe in You, ALLAH Almighty, You hold us all together, You save us from drowning, And You help our struggles bear fruit.. الحمد للہ انشاءاللہ

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If you love me, lead me back to faith on the days I feel lost. Remind me that this life is temporary. Ask me if I’ve prayed and the times that I haven’t, smile and tell me it’s not too late. Talk about me to our Lord everytime you make dua. If you love me, always remind me of Allah.

Shadesofherink (via shadesofherink)

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Don't waste time doubting yourself because you, undoubtedly, are weak and capable of error. Instead, channel your energies in trusting ALLAH Almighty for He is flawless and He can do anything. May ALLAH Almighty bless us with the best of His blessings in both the worlds.(Ameen sum Ameen) May ALLAH Almighty make everything easy for us and help us through all times with His Mercy and Grace.(Ameen sum Ameen)

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May ALLAH Almighty make easy for us the times to come and may ALLAH Almighty exalt us with His blessings in both the worlds.(Ameen sum Ameen)

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I'm different With a different set of deeds Than last year when I was here, But Your(Almighty's) mercy Is as flawless as before I prostrate before you, I pray for the best of blessings From the treasures that only Your mercy can unfold, Ya ALLAH, Bless me with that which befits Your mercy, And save me from my deeds.. Ya ALLAH, Save me from myself, And make my paths easy for me.(Ameen sum Ameen) May ALLAH Almighty bless us with the greatest and best of His blessings in both the worlds.(Ameen sum Ameen)

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This trial is not a burden For it's paving my path For great things ahead, And while I'm here Divine mercy is helping me through So blessed to know That while waiting for the greatest joys The mercy is here to save me from bad thoughts And is keeping me hopeful.. الحمد للہ May ALLAH Almighty bless us all with the best of His blessings in both the worlds for all times to come.(Ameen sum Ameen)

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When heart worries, but remembers that it's not our effort but ALLAH Almighty's mercy that can help us through all times. And faith lights up the path again.

My deeds were in my hands Such little particles of time My fists didn’t even seen full I bowed my head thinking What could these be worth? But then I heard in my head That my Rabb(Almighty) is All-Powerful, Merciful And my heart was filled with peace Knowing that when it’s my Rabb(Almighty) who I pray to What obstacle could stand in my path When He fills my heart with hope Then blessings are already on my way And it’s His mercy that will help me through To the end of this time where joys await For me to say shukr and be grateful Because the battle may seem great But the size of blessings that my Rabb can endow upon me Will overshadow all I have to pray And ask for ability to do my best And then I have to have faith And wait for His blessings to reach me While having strong faith in His mercy.. O my Rabb(Almighty)! I pray to you My deeds and thoughts are far too small But when I pray, these are not what I see What I see is Your all-encompassing mercy My power is over none Your power is over all My life’s imperfect Your all qualities are beyond perfection I look to You To help me through And help me gain What my heart yearns I am little and nothing But I have faith in Your mercy Help me through Bless us with more than our hearts can imagine And guide us to be most grateful to You Our efforts are small But Your Rehm is great Shelter us from our littleness And bless us with the great blessings that only You have power over.. (Ameen sum Ameen)