Provoking the Manic

Good afternoon!
Its a quiet Sunday and I've just completed the first week of an online course I'm taking about developmental psychology in children and adolescence. The University of Edinburg have done a fabulous job of presenting its content in a professional, yet very natural way. Some parts of the class are actually filmed in a children's playground, and while Dr Jo speaks about language development, little noisy creatures running from imaginary dinosaurs are around her. It is funny and very interesting!
Mental health is a big deal and understanding it and working with people with ailments in that sphere, is a treasure to society. However, most of my friends who already know of my interest in psychiatry seem to downplay the importance of psychiatry in medicine. Thinking it is something probably para-science or para-medicine. And I have never given up on coming up with arguments to try to prove to them its importance. Yesterday something happened that, without much effort from my side, left a friend of mine (who is particularly pro-clinical and anti-psychiatry) astounded and tachycardic :D
We were sitting in campus and a woman came up to us with a pain of slippers in her hand. A 40-ish looking woman, speaking quickly and with quite an animated face. Initially I thought she was trying to sell me the slippers. So, as I usually do to mobile vendors, I look at them, listen for a few seconds then say "No thanks" and look away.
When I did so, the woman protested "I'm not trying to sell you these slippers! I'm trying to tell you that the people in the toxicological centre are making plots against me, trying to make me buy expensive slippers!!"
She looked offended as she spoke and probably expected me to agree with her.
I immediately picked up that there was something psychologically wrong with this woman...hmmm perhaps delusions of persecution? paranoia?
I asked "aaah so there's people plotting against you? Who else is plotting against you?"
The woman immediately answered and gave me names of people and organizations who are out against her trying to make her life difficult. And she was especially frustrated about this slipper plot she was facing.

Yep. Delusions and Paranoia.
Nice.
Speaking alot, inappropriately animated, irritable, hyperactivity.
This woman was probably in mania right now.
Bipolar with paranoia. 
I smiled to myself. Welcome to my world.
I looked over to my friend, to find her staring at me, quite shocked.
"lets get up and go, okey?"
"No way dude, we're staying. I want to prove something to you"
 The woman walked away and sat around 2 meters away from us. And as I spoke to my friend, the lady was speaking loudly to herself (hmmm auditory hallucinations?)...and when she caught our eyes, she tried to talk to us too. Mainly she was going over and over about how horrible these people who plotted against her were, and "who do they think they are? Do they think I'm stupid or retarded or what?"

My friend, looked like a threatened kitten, cornered. I could tell from her body language that she was genuinely afraid of this woman and what she could do. I, on the other hand was completely relaxed. Yes, this woman could get aggressive...but it is unlikely that she'd be, unless provoked.
I wanted to sit there and observe what other symptoms this woman would exhibit and more importantly I wanted to demonstrate to my friend, that psychiatric illnesses are a real thing. It's not just crazy, homeless people roaming the streets. It could be in very ordinary looking people and it could (and almost always does) destroy their lives and the lives of those around them.
Psychiatry isn't JUST people who have problems at home and relationships who need to talk. Or people bouncing off the walls and talking to themselves. And psychiatry doesn't involve JUST listening to people cry their hearts out and offering support. It is this massive umbrella of therapy for people who have dysfunction in their ability to operate in their everyday life.
Just like hepatology deals with dysfunctional livers.
Psychiatry deals with dysfunctional psyches.

And for functioning I'm referring to the basic things that we all need to do
1. Fulfilling our basic needs (sleep, eating, biological functions, financial sourcing)
2. Fulfilling social needs (interpersonal) (forming and maintaining relationships, adjusting to societal and cultural norms)
3. Working, learning, striving towards something.
4. Ability to maintain a relatively stable intrapersonal state of being (ie average mood with healthy fluctuations, resilience to difficulty and adaptability)


Some of the reasons for the inability to do the above things may be purely societal (eg poverty and illiteracy preventing one being financially independent) or purely medical (thyrotoxicosis preventing one from sleeping well) or purely psychological reasons (a deep seated fear of social situations and people, leading to inability to go out and work and form relationships).
 But often more times than not, the reasons are an overlap of the three.
Psychiatry aims to treat people who are dysfunctional in their lives by excluding medical factors, recognizing and attempting to reduce the social influences (mainly the job of social workers who work closely with psychiatrists and psychologists) and focusing on treating the patient's psychological state. Through adjustment of the neurotransmitter imbalances (which oftentimes do provide visible improvements especially in biplor and schizophrenics) and by providing the patient with cognitive and behavioral techniques to help them manage their dysfunction.

Now lets go back to the story of me and my friend on the campus bench with a bipolar lady nearby.
My friend has already seen that psychologically disturbed people can be weird and unpredictable
I wanted to show her more than that. I wanted to show her that they can also be a threat to themselves and their environments, should they be left unhelped.
I'd like to show her that without psychiatric help, how bad these patients could be and I was hoping that she'd finally admit that the field of psychiatry isn't only real but necessary.
The point isn't that OUR system of psychiatry is totally correct.
The point is, a specialty is needed that can help these people, because simply, no other field can help them.

So how do I go about proving this to her?
Other than provoking the patient to make the scary side show even more?
I know how immoral and terrible it is to do something like this. But, the little challenging side of  me arose and said "I dare you. Prove it to her"
The lady came back to stand before us and started to talk again. I asked her the question that most psychotic patients would find very offensive and would immediately start denying. Psychotic patients are disconnected from reality and hence have a very difficult time differentiating between what's in their mind and what is real.
So, I asked her "Ma'aam, are you being treated in our psychiatric clinics?"
And just as I suspected the woman's face changed. An interesting beetroot red colour danced on her cheeks.
She took one step towards us and leaned her face in and said
"What did you just say? psychiatric??"
She gave out a disproportionately loud, ridiculing laugh, raising her head to the sky
"HUH?? PSYCHIATRIC? You think I'm crazy?"
Another laugh.
By then, my friend was fully petrified. I could almost smell the adrenalin she was hyper-secreting.
The woman came so close to our faces. And looked so threatening, I was just waiting for her to grab me by my blouse.
The events that ensued need not be written here, but I'm sure you'll be relieved (or perhaps not) to hear that I was not beaten up by her. Which is kind of disappointing, since I was so keen to show my friend how these people could get physically aggressive. However the way the woman acted was a framed certificate of how a mentally unstable patient could be an adversity to our society.
And in a matter of 10 minutes, one can fully grasp the idea of why we need a solid system for psychiatric help to our people.

A squirrel called life.

Oh I am overjoyed.
Absolutely over the moon and elated at one small little thing that happened to me today in the ICU.
I dont know why but I have this certain fate with ICUs, I experience truely shaking experiences in there that teach me about life and everything else.
I was taking the blood pressure and other vital signs of the patients in the ICU (They're connected to monitors, dont get me wrong...however, the monitors seem to have an opinion of their own, giving astronomically inaccurate results for some reason). One of the patients I was attaching the cuff to, was called Siham. A plump, motherly looking woman, on a mechanical ventillator. After reading her clinical progress notes I found that she has HCV and liver cirrhosis and came presenting with disturbed conscious level. Hepatic encephalopathy?
The measures for treatment of encephalopathy were carried out (Rectal enema, lactulose,  rifaximin etc), made no response. They carried out a brain CT which revealed thalamic infarction. So this lovely comatosed lady was candidate for stroke rehabilitation. She aspirated and developed an unpleasant pneumonia (as if there's a pleasant kind of pneumonia anyways! lol) and frankly, her condition looked pretty bad.
She looked pretty much dead. But it's my job to take her vital signs nevertheless.
While lifting her arm to attach the cuff, I found that she, herself lifted her arm to assist me. I looked at her face. Is she aware? Or was that a reflex movement. I continued with inflating the cuff with a finger on the radial pulse (I like to do palpatory method to get the rough systolic before auscultating), then deflated slowely, listening carefully to the brachial artery for korotkoff sounds. A blood pressure of 160/90. Ok. Took note and started detaching the cuff. She, again lifted her arm as if to assist me in removing the cuff.
I had to test this out. Is this lady conscious? She was known to have GCS of around 5 or something. I looked at her face again...she had her eyes closed, nasogastric tube hanging out of her nose, an oropharyngeal tube attached to a ventillator and a series of tubes and other weird looking thinsg I didnt recognise coming out of her face. How could a conscious person tolerate all this. Surely this is a reflex movement.
I whispered "Madame Siham...can you hear me?....if you can hear me, open your eyes"
Pause.
Who are you kidding, open her eyes eh bas?
To my utterly horrified pleasant surprise, she opened her eyes to look at me.
HUH?
"Madam Siham...could you blink once for yes and twice for no? I'll ask you a question...are you feeling cold right now?"
She blinked twice.
WHOAAA DUDE! She's alive! And she can hear me and she can understand AND she can respond.
DESPITE all that mess she's in.
WOW.
I was overjoyed. I was so happy to see this I nearly bent down to kiss her.
Life.
Oh how precious life is. She has that life spark still inside her. She wasnt gone yet. She was actually alive.
I have never ever felt the preciousness of life up until this moment.
I felt that having 'life' or the spirit of being alive is like a shy squirrel hiding within the crevices of this lady, and I had called it out..and it responded to me.
I have just seen the rare glimmer of life within a seemingly dead body.
What an honour and a precious thing.
I was pleased for her.
I was also sad for her, she was awake and she experienced all this? She can feel the tubes in her and the uncomfortable position and the noise and the pain and every horrible thing and still not be able to do say or do anything about it?
Painful.
Oh how resilient and beautiful you are.
I was struck with a strange ray of love and respect for this woman.

It was a strange time for me. I was so intently focused on this goosebump moment that I was completely oblivious to my surroundings. It was like time had stopped and the whole universe was silent. It was just me and this woman and the little squirrel within her, which I called life.
Weird triad, but nevertheless...it makes my heart melt just remembering her eyes as they opened.
Alhamdulilah
Alhamdulilah

Perhaps this woman's little squirrel will run off and she'll be lifeless and dead soon enough. This is all of our fates...but that's not the point. In the moment, in that brief sacred moment I felt the true preciousness of having life.
Alhamdulilah

On Twigs and Love

In the city of Salzburg, the locals like to pick up a small twig and throw it into the shaft of an abandoned salt mine. Two or three months later they return and extract the twig. Which emerges utterly transformed – covered in sparkling crystals; it looks amazing. It doesn’t matter what kind of twig you use, the result is always the same. The twig has been crystallised. Of course we know how this happens: the moist air of the mine is filled with tiny salt particles which attach themselves to whatever is left in there long enough. 

The French writer, Stendhal thinks that a related kind of crystallization occurs when we fall in love. Someone who is fairly nice comes along and gets suspended – as it were – in the moist, salty atmosphere of our imaginations. We encrust this person with all our hopes, our longings and ideals. They are transformed by our imaginations from the perfectly decent human being which they are into something astonishing – the best person who has ever lived, the answer to all our problems. This is the process of falling in love. 

If we get together with this person, the rough and tumble of life tends to reverse the process. Gradually we get to see the other person as they really are, not as our fantasies have made them. The magic wears off. We toss them aside. And then along comes another interesting twig…

 This was an excerpt from "On falling for the wrong person" in the Books as therapy website (http://www.booksastherapy.com/), that I frequently like to read. The idea is exemplified perfectly by the twig and its crystallization process. I think the key idea here isn't that we shouldn't love other people, but rather for us to understand that in early stages of a budding relationship, one has a tendency to- a word I think I made up- glitterize the object of their affections. To basically sprinkle them with mental glitter. Making things very pretty and ideal, in an unrealistic way.

I'd like to add that the twig, the uncrusted, uncrystallized twig is just as beautiful. In fact I feel that when you finally get to see another person for who they really are, with all the rawness and scratches and vulnerabilities, as beautiful or ugly as it may be...and they trust you enough to let you see those...and you are able to trust them enough to see you figuratively (and I'm stressing on the word figuratively lol) naked...that is, in my opinion the most intimate and sacred experience one can have with another person.
What does it matter if you are in love with a superman?
Everybody can love superman
What counts is how you can see past all the defenses and masks and embrace a human for what they truely are.
Perhaps, that is love.

Religious Cut and Paste

What do you think of this picture?
Initially reading this verse and looking at this picture your heart could melt a little bit thinking
"awww, that is beautiful..what it means is that there are somethings we consider to be minor but to God it is a big thing...like being kind to homeless people, or smiling in the  faces of our brothers/sisters...like we shouldnt underestimate the gravity of the things we do"
Cute.
And the comments on this photo were all like "subhanAllah!" "mashallah!" "Allaaaaah how beautiful"
Stuff of the sort.
While I scrolled past this picture, I realized that this wasnt even a verse, it was HALF a verse; ie someone had gotten a verse from Surat Al Noor, verse 15 to be precise cut out the first part of it and just left the second part of it. This way, the aya could be completely misinterpreted first because it is not complete, and second because it is completely out of context. Where is the context in which this verse was written?
No context at all.
This is the complete aya:

This changes everything.
Here is the translation from Sahih International

"When you received it with your tongues and said with your mouths that of which you had no knowledge and thought it was insignificant while it was, in the sight of Allah , tremendous."

I particularly liked Sheikh Abdullah Yusuf's interpretation 

"There are three things here reprobated by way of spiritual teaching: (1) if
others speak an evil word, that is no reason why you should allow it to defile your
tongue; (2) if you get a thought or suspicion which is not based on your certain
knowledge, do not give it currency by giving it expression (ie dont talk of it) ; and (3) others may think it is a small matter to speak lightly of something which blasts a person's character or reputation: in the eyes of Allah it is a most serious matter in any case, (but specially when it involves the honour and reputation of pious women.)

Intruiging. Allah's verse aimed to teach us something else entirely.  It teaches us something quite profound and beautiful and I am glad I did take the time to read up about the verse instead of just 'liking' the picture and commenting with that cliche religious rejoicing tone. 
1. Just because others speak badly, doesnt mean you should too.
2. Dont talk about that you are not certain/doubtful about
3. Dont speak badly of others, especially if it hurts their reputation/honour...this is a big deal.

There are a certain group of humans who try to defile other peoples' religions by looking for 'weak points' in the deen. Famously, the verse talking about killing the enemies of Islam and not allowing a single one to live is used to indicate the sheer barbaric-ness of the religion. It is snatched out of the context and placed in a certain way that it'd look like it is supporting their point of views. 
Most logical Muslims would say, this verse is out of context! you people are just trying to prove your fake opinions by using childish cut and paste.
 That may be true.
But, we as Muslims ALSO do the same thing. We take verses and religious scripts and cut them out of context in order to feed or to prove something we want to believe.
Why am I making this point clear?
I am stating that when people want to justify something they believe in, they will look for all sources to support them. Even if these ways are completely wrong. Even if it means cutting and pasting religious text out of context.
It is human nature to mess up like that.
HOWEVER, by being aware of this phenomenon, we can be on the look out when we find ourselves justifying...to stop before we go too far. And also, when others do it, for us to be aware and try to prevent it from progressing. 

On challenging Nietzsche

Good afternoon!

Today I was talking to a friend who, in her opinion, faces nothing but strife in her life. She expresses avidly that her life is a series of unfortunate, unjust and meaningless suffering. I sit there nodding and "hmmm-ing" until she finally stops talking to ask me "So, what do you think?"
At this point, I've learnt that when people are in the "I'm suffering" mode, it is best not to judge or think about what they say. Rather, absorb them and try to reflect back something of meaning, through asking them introspective questions. They ask and answer themselves. I have found it to be an effective technique.
So I proceeded to asking her questions about what the possible interpretations of all this could be.
And while I was listening I realized that Nietzsche's quote of "What does not kill me, makes me stronger" is quite imprecise and incomplete.
Lets break it down.
What does not kill me (aka any situation that is severe and harsh yet not fatal eg a failure, a personal defeat, a terrible traumatic experience, sudden and unexplained loss, severe morbidity)

Makes me stronger (ie. gives me immunity and strength to face further challenges)

I think that it should be rephrased. "What does not kill me, COULD make me stronger. But it could also make me bitter. Depending on how I choose to interpret it"

Everything is meaningless unless we put a meaning to it ourselves.
A death of a limb, leading to an amputation could make you stronger, because you've faced such a horrific loss of a much needed bundle of tissue, so clearly if you could tolerate this, you could tolerate more.
But it could also make you a bitter person. A person who feels inherent injustice and decides that this is not fair and I hate this world, it is so unfair. Why my limb? This world sucks, man. I never even asked to be born..and the downward spiral of world-hating ensues.

Suffering could lead to strength, but just as much, it can lead to bitterness. It's all about the interpretation.
Which leads us to another Nietzsche saying; "There are no facts, only interpretations"
The same way as there is nothing that is truly good..or truly bad. Everything is inherently neutral. We are the ones who put labels to it.
This is somewhat of a liberating concept. Imagine this, you can re-label everything you've ever experienced. A previously terrible accident, could be perceived as a blessing from the heavens, if you just decide to think of it so.

On Stoicism.

Stoicism is a philosophy which flourished for several hundred years starting off in ancient Greece and Rome. Seneca, Epictetus and Marcus Aurelius were the hallmarks of this philosophy.
Before I start to delve deeper, lets define what is stoicism...or rather, who is a stoic?

According to the online Google dictionary it is defined as: "a person who can endure pain or hardship without showing their feelings or complaining"

I find that definition too superficial and simplistic. Being a stoic, or following stoic philosophy shouldn't be defined by the external manifestation. It is actually defined by the internal processing and perception of the world, which will eventually lead to the external response to the world.

For example, a person who is subjected to great pain may not show feelings or complain for several reasons:
1. they are dead
2. comatosed
3. acting
4. apathetic
5. hopeless and drained.
6. they are aphasic.

I know some of those reasons are comical, but it is equally ridiculous to describe a philosophy based on the end result. The idea of philosophy is that it helps humans think and live life in a fulfilled and meaningful way. It also aims to help us look deeper on life and possibly find solutions to everyday issues.
That is why I love philosophy. It is so theoretical and yet with the right attitude you can translate it into real life.

For me stoic philosophy has influenced my life greatly. A lot of my attitudes to life can be reflected in stoic philosophy. And the first and foremost idea behind it is to only truly concern oneself with what one can control. To not be overly optimistic about life and expectations from the external world (have intermittent periods of thoughtful pessimism). The belief that the external world is, for the most part already determined...and the only thing we can actually be free on, is our attitudes and mental processes. Knowing that your negative reactions of the world and especially anger are a result of faulty cognition and overly optimistic expectations from the world.

To expect the very worst and not attach to externals over which we have no control, could lead to a human who is calm and ready in the face of adversity. Someone who isn't overly horrified with the atrocities of life. Undisturbed by the unexpectedness or inconveniences of life. People following stoic philosophy could be seen as complacent, passive or even submissive. Sometimes even perceived as someone who is disconnected from reality and lives in their own world. Just because a person isn't overtly resistant or expressively disgusted from the corruptness of the society in which they live doesn't mean they are oblivious of it...they know of it but they chose not to give mental energy to such things on which they have little control over. 
They don't complain much, not because they're repressing it, but because they don't actually care too much for complaining. They have high levels of tolerance, not because they're explicitly strong or unemotional, but because they understand that suffering is alright and something not to be fought. It is a fact of life.

Starter kit to Stoicism


Further elaboration of Stoicism

A random assortment of pictures I found lovely. Source: Desktop.

Diagnosis: Death

I have had a strange week, with quite dark themes. On an almost daily rate, patients have been dying this week when I'm close by.
It started with an old woman who has had a long history of liver cell failure and this time came presenting with behavioral abnormalities (in the form of aggression, cursing etc) alternating with disturbed consciousness. She was loud and hyperactive and very vulgar in the way she spoke. When I used to take her blood pressure every afternoon, she'd almost bite me or spit. It was the effect of ammonia and other jumbled up neurotransmitters in her brain; hepatic encephalopathy. 
A few days later, I was walking in the ward, looking for a box of latex gloves, when one of the relatives came up to me to tell me that this woman was not waking up. I went over there, reluctantly somehow knowing that I'd find something not so good over there. And surely, as I approached her bed I could distinctly tell that she was either in deep coma or dead. After checking for her vital signs and for pupil dilation, I confirmed that she was to a large degree, dead. Her skin was cooling, her pupils were fixed and dilated and her blue tongue protruded from her mouth. She looked almost comical. I know it is so morbid to say so, but I couldnt help but notice that.
I was at the bedside with her relatives all around me. In my mind I was saying "Hmmm ok so she's dead, probably not a candidate for CPR...can i announce death now? naah...i dont have that authority or experience to announce something major like that. What to say, though? The relatives are all around me...what on earth do I tell them now? I cant reassure them...and at the same time, I cant make a bold statement."
I looked up with a calm, neutral face...to see the relatives all staring at me right in the eye, waiting for a word.
I lowered my eyes and stood up straight. "you'll have to excuse me, I need to get my senior to take a look"
Phew..good one.
They knew she was dead. I knew she was dead...but neither side was ready to recieve or say.
I called on my senior and told her to take a look.
She was announced dead a few minutes later.
The ward fell silent.
There was no longer that echoing of curse words and hissing. She was gone for good. And it was a secret relief for her family, who'd been suffering along with her.
~~~
Today a well-built 40ish year old man with a thick strong musctache came up to me to give me a referral sheet containing details of a young male patient (28 years old) who had acute leukemia and came presenting with disturbed conscious level (DCL)...glascow coma scale: 3.
3?
3 is like equal to a vegetable. Perhaps if you poked a potato, it'd react more than a glascow coma scale of 3 in a person.
My mind was wondering about the possible causes of this disturbed consciousness in a man with leukemia. Blasts infiltrating the brain causing it to swell and herniate?
Blasts lysing and causing severe hyperkalemia which caused an arrthymia, which turned fatal and messed up the blood reaching the brain?
I thought of all the possible, weird, unlikely mechanisms but not the most obvious one...Leukemic patients have thrombocytopenia (in this patient it was 16K) which leads to a high likelihood of hemorrhage, especially in the brain. He's a ticking timebomb, waiting for a brain hemorrhage. And that was probably the most likely cause of his DCL.
They wheeled him in. Initial look, I knew he was dead. Checking vitals, confirmed that he had no pulse. And after monitor attachment, he was asystolic. The call for CPR was initiated and I stood there with the timer, while interns took turns to compress the chest of this lifeless man.
He was beautiful in a way. So young and serene and surrendered. He was wearing a T-shirt with some company's name on it and trousers that matched. He was wearing gray socks. At some point, he was awake to pick those clothes out of his closet and put them on. At some point he went to the barber to get his hair cut (which looked quite recently cut). During that time, he was awake and aware like us. And now, he's in the unknowns.
I was timing, each intern taking 2-minute cycles. I noticed that those who often find it hard to complete the cycle were the ones who have an over-confident beginning. They compress so hard and so fast for the first few times, then their triceps fail them.
Anyhow, the young man did not respond to the chest compressions, nor to the IV adrenalin. He was adamant to stay the way he was. I did notice something interesting though, his gums were swollen, hypertrophied. That was interesting since I knew that leukemic patients often had blasts infiltrating into their soft tissue including gums.
I guess the blast cells were stressed out, since their livelihood depended on the livelihood of the host. No host, no more blasts.
Silly, blasts. You are walking towards your own demise.
Cancers are so stupid. They're parasitic leeches that strive to live and divide in the host extensively, so selfishly. They get so greedy that they kill their host which results in their own extinction. I think viruses are smarter. They get what they want from their host and move on by infecting other hosts.
In a competition between viruses and cancers, who'd you think would win?
Oh and when virsus and cancers unite and join alliances. BOOOM. Major shit is going down.
HCV being the king of the castle. That's another story.
The 20 mins ended and the young man did not respond...and since I was the one with the timer I was one who announced the end of the CPR.
"3..2..1.. ok, doc you can stop now."
I looked up and once again found myself surrounded by relatives. They asked me directly "Is there hope after this?"
I looked at the most resilient looking one and said "No, I'm sorry. Al baqaa2 lil Allah"
That was the first time I'd announced the death to a family. Alhamdulilah they didnt beat me up or shout in my face or cry hysterically. They quietly wept and asked me what to do next.
I was shaken, in a way.
I had just announced the death of a human. Calmly. I did feel a certain sacredness in what just happened. I knew that such situations needed silence and contemplation. I grew irrirated at the surrounding buzz of interns behind me, going on their conversations as normal.
It's not their fault of course...but death is a sacred time. It is a time to at least realize that this is the fate for all of us.
I just hope that I dont need CPR. The idea that my sternum and rib cage will be disturbed this way, is unbearable. It'd be a blessing to die peacefully and quietly while no one is noticing.

Everyday patients keep dying. Patients I spoke to or even laughed with. It's not depressing, more than it is enlightening. It makes one less afraid of death, since its a common fact of life. Like giving birth and like getting old. The holy and sacred aspect of "what comes after it" is what needs to be remembered.
We should not become "immune" to the idea of death, just because we work in medicine. I'm not saying, lets cry everytime....there will come a point in which you will feel nothing after the death of a patient. But the idea is to consciously remind ourselves of our own finity. And remind ourselves of our post-mortem journey.

اللهم إنك عفوا تحب العفو فـاعفوا عنا

Blood Bank and Wild horses.

Today was the first day of the most overrated and exaggerated rotations in internship. Internal medicine. People speak of it and try to avoid it as if it's the plague, just by hearing about it.
Typically, because I live in my own mental bubble and because I frankly distrust the opinions of experiences of other people, I just took internal medicine as any rotation I ever start; with optimism, good will and a willingness to just do well, whatever the circumstances.
And alhamdulilah more times than not, I am pleased to discover that within every wreck is a treasure, or something useful you could do or something to add value to.
Let's speak about my enlightening journey to the blood bank today. I had requested a bag of packed RBCs earlier for a patient of mine with chronic renal failure and a hemoglobin level of 6.3g/dL. I walked out of the hospital with my sky-blue icebox (which in fact contains no ice) and the patient's admission sheets and an intention to go get it.
After walking across the bridge and into the main gates and then towards the main hospital to enter the new emergency hospital and finally to the blood bank, it took a little bit of energy, but nevertheless my spirits were still intact.
I walked in and the technician was busy sampling several specimens of blood, grouping them. I looked into the see-through doors of the fridge and found that the blood I had booked was sitting there, innocently and quietly waiting for me to receive it.
My brain immediately said "well, why am I waiting?? the blood bag I'm here for is sitting right there! I could just go grab it..or at least the technician should stop what he's doing and get it for me. It's right there, it wont take him time. He can stop sampling the other blood and just get me my stuff, then go back to his thing"
I started to feel impatience rise up in my esophagus, the same way hydrochloric acid crawls up stealthily. I began to tap my fingers on the table.
"come on dude! I'm in a hurry! I need my stuff! I'm hungry and I'm tired and I need to get that patient her blood!"
Of course, that was all mental conversation. My affect was perfectly serene externally.
The technician continued patiently with the blood grouping, moving at a steady rate.
Then, at some moment a thought struck me. Or rather, an internal voice, whom I'm coming to realize is probably my superego.
"Wegdan, what the hell do you think you're doing? Do you think that you're at the centre of the world? Just because you're here and you need something doesn't mean that the world should stop and do things for you. The technician wont stop his sampling just to serve you...and he shouldn't. You arrived while he was in the middle of something, he should finish what he's doing...there are other people he's serving too. You definitely aren't the most important thing in this place...."
I realized that I'd forgotten something very important. That in this life, its a bit like a theatre. And everyone's an actor. On stage, everyone has his limelight moment...a time for them to recite their lines. Everyone has a role somewhere. In that blood bank I was not the starring character and it wasn't my turn to receive my limelight, why the hell am I expecting to get served and get the attention at the time when it's not for me?
I realized that I should wait. I should wait for the other actors to receive their fair share of light, just as I would like to receive mine. and no matter how much I'm BURSTING to say my lines, I cant. It would be immature and unfair. And the whole production would be a mess.
I needed to stop thinking that the world revolved around me...and that I am entitled to special care.
A sense of entitlement or inflated importance is one of the most fatal and tragic beliefs one could have. No, you arent special. No, the world wont stop for you. No, you must wait. No, you arent the star of the show. You are just like everyone else and you need to realize that in order to be treated fairly you must be willing to treat others fairly.
And this has nothing to do with a corrupt system which is inherently unfair.
It's unfair? Let it be unfair. However, do not trample on others' rights.
You need to stand there, and when its time for your turn to recite, do it full heartedly.


I came home and after receiving some interesting news, which initially made me feel impatient because it involved me waiting for a certain amount of time before something I've been planning for could happen. I reminded myself of my experience in the blood bank. My father at this point in time was the actor on the stage and it was his turn to recite his lines. It wasn't my turn. It was his turn and because it was his turn, he was entitled to do whatever he wanted.
I had to wait. Even if I didn't like it, I had to wait. It would only be fair.
Even if you release your wildest horses to trample on the scenery on stage...I wont do anything to stop it because it is not my time. When it is my turn to act, I will do what I want.
But for now, I'll wait.