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
Tuesday, July 21, 2015
Monday, July 13, 2015
Wednesday, July 8, 2015
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
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
Thursday, July 2, 2015
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.
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.
Saturday, June 27, 2015
Fasciotomies and Mercy the Leader.
Good evening!
It's one of those peaceful nights alhamdulilah and despite being quite tired tonight I do feel like venting philosophically.
I am still interning at the ER dept but this week I am in a department known as dept 5. Notorious for being filled with sick, amputated or septic patients with horrible looking wounds. And for the the most part, it is true. This week while doing the dressing for some patients I have encountered a full set of exposed leg tendons in a woman with diabetic 'foot'...or rather diabetic 'leg'.
Or a young man who accidentally injected some drugs subcutaneously in his leg and developed a cellulitis which developed into compartment syndrome which required fasciotomy.
I dont know if what i saw was a fasciotomy, all i remember is that i saw the muscles of his legs contracting before my own eyes. It was a sorry sight, to see a young man so destroyed because of a useless harmful action. However, who am I to judge him?
Behind his action was ignorance and pain and poverty and escapism and self hate and alot of dark and terrible things. How can I judge him? He is a human who has despaired enough to lead himself to his own destruction. People dont go into drugs just because they're happy or OK with life.
It is clearly said in the Quran and in hadith that Allah is the most merciful. Most merciful. Meaning He (swt) IS the number one merciful. No one comes before Him in Mercy. Meaning that in your life, no one will be more merciful on you more than Allah is. Not your family not anyone.
So what exactly IS mercy? (aka in arabic: Al Rahma)
I looked it up on google and this is what it said:
So it means that God has all the power to destroy you, yet He shows compassion and forgiveness. He is lenient and is forebearing and forgiving and mild. Subhan Allah. Why is He so?
I can't conceive a wise enough answer, but I can reply with a simple sentence that makes sense to me. Allah is forgiving because Allah understands us. He can see right into our hearts, He can see our vulnerabilities and intentions and reasons more than we can understand them ourselves. Even when we're to be judged on the youm-al-hisab we arent judged on general guidelines and criteria. We are judged according to the content of our hearts and only HE can see that. Let's not be afraid. There's always a chance to fix things, there's always a chance to clean out the darkness within and make room for light.
Mercy is also another component of a true and sincere relationship. Famously, the cliche answer to the cliche questions of "what makes a good relationship?" is "love, ofcourse"
I can't disagree because love is a massive umbrella carrying beneath it so many tender and compassionate meanings.
Like when a group of birds are called a flock and a group of tigers is called a streak, a group of compassionate feelings are called love. It's not a singular term but rather a plural of many similar yet intrinsically unique experiences and feelings.
Usually, in any group there's a strong/dominating character that leads the flock. It is usually that leader that guides the direction of ambush or flight. If love had a leader that propelled it along...it'd have to be MERCY.
Mercy is the single-most powerful member of the 'love' family. It is the one that decides how the emotions will flow. It decides how desire will flow and everything else.
If there is love but with a recessive mercy, the whole group will flop. They will attempt to fly by themselves, but eventually they'll disperse and evaporate. Because it is the glue to them all. It's what keeps those other things in place.
Not all tiger groups are the same. And not all 'love' is the same. They may contain the same members eg caring, compassion, desire, intimacy, mercy, prioritizing the beloved etc but the strength of each member differs according to the gang.
If mercy dominates (ie being lenient, understanding, humane and tolerant) it is likely that this 'team' will fly well.
It's one of those peaceful nights alhamdulilah and despite being quite tired tonight I do feel like venting philosophically.
I am still interning at the ER dept but this week I am in a department known as dept 5. Notorious for being filled with sick, amputated or septic patients with horrible looking wounds. And for the the most part, it is true. This week while doing the dressing for some patients I have encountered a full set of exposed leg tendons in a woman with diabetic 'foot'...or rather diabetic 'leg'.
Or a young man who accidentally injected some drugs subcutaneously in his leg and developed a cellulitis which developed into compartment syndrome which required fasciotomy.
I dont know if what i saw was a fasciotomy, all i remember is that i saw the muscles of his legs contracting before my own eyes. It was a sorry sight, to see a young man so destroyed because of a useless harmful action. However, who am I to judge him?
Behind his action was ignorance and pain and poverty and escapism and self hate and alot of dark and terrible things. How can I judge him? He is a human who has despaired enough to lead himself to his own destruction. People dont go into drugs just because they're happy or OK with life.
It is clearly said in the Quran and in hadith that Allah is the most merciful. Most merciful. Meaning He (swt) IS the number one merciful. No one comes before Him in Mercy. Meaning that in your life, no one will be more merciful on you more than Allah is. Not your family not anyone.
So what exactly IS mercy? (aka in arabic: Al Rahma)
I looked it up on google and this is what it said:
compassion or forgiveness shown towards someone whom it is within one's power to punish or harm.
| synonyms: | leniency, lenience, clemency, compassion, grace, pity, charity, forgiveness, forbearance, quarter, humanity, humaneness,humanitarianism; |
So it means that God has all the power to destroy you, yet He shows compassion and forgiveness. He is lenient and is forebearing and forgiving and mild. Subhan Allah. Why is He so?
I can't conceive a wise enough answer, but I can reply with a simple sentence that makes sense to me. Allah is forgiving because Allah understands us. He can see right into our hearts, He can see our vulnerabilities and intentions and reasons more than we can understand them ourselves. Even when we're to be judged on the youm-al-hisab we arent judged on general guidelines and criteria. We are judged according to the content of our hearts and only HE can see that. Let's not be afraid. There's always a chance to fix things, there's always a chance to clean out the darkness within and make room for light.
Mercy is also another component of a true and sincere relationship. Famously, the cliche answer to the cliche questions of "what makes a good relationship?" is "love, ofcourse"
I can't disagree because love is a massive umbrella carrying beneath it so many tender and compassionate meanings.
Like when a group of birds are called a flock and a group of tigers is called a streak, a group of compassionate feelings are called love. It's not a singular term but rather a plural of many similar yet intrinsically unique experiences and feelings.
Usually, in any group there's a strong/dominating character that leads the flock. It is usually that leader that guides the direction of ambush or flight. If love had a leader that propelled it along...it'd have to be MERCY.
Mercy is the single-most powerful member of the 'love' family. It is the one that decides how the emotions will flow. It decides how desire will flow and everything else.
If there is love but with a recessive mercy, the whole group will flop. They will attempt to fly by themselves, but eventually they'll disperse and evaporate. Because it is the glue to them all. It's what keeps those other things in place.
Not all tiger groups are the same. And not all 'love' is the same. They may contain the same members eg caring, compassion, desire, intimacy, mercy, prioritizing the beloved etc but the strength of each member differs according to the gang.
If mercy dominates (ie being lenient, understanding, humane and tolerant) it is likely that this 'team' will fly well.
Friday, June 19, 2015
ABGs and Ramadan
I withdrew an arterial sample for ABG analysis from a patient a few days ago. After a couple of attempts I finally got it, and while I was almost 90% certain it was arterial, after the results of the ABG came out with a pH of 7.1 I immediately started doubting myself. How could this be an arterial sample? Surely I took a venous sample by accident...
Even so...are venous samples really that acidotic?
My urology resident asked me to tell him the results of the ABG on the phone and I hesitantly told him the results and was about to apologize about probably taking a venous sample. He told me that this wasnt a venous sample, but was in fact an arterial one taken from a patient with severe acidosis as a result of acute renal failure.
This little situation made me really think...It is hard to stay on your ground when things go unexpectedly wrong.
You expect certain things and when they go wrong after you do them, you doubt yourself. Did I really do the right thing?
People in uncertainly oscillate between arrogant/ignorant self confidence and the other extreme which is complete incontinent self doubt.
In medicine it is so important to be confident of oneself yet at the same time leave room for doubt. A margin of error.
Ramadan is here by the way! How intruiguing. This is the first time I spend most of my Ramadan in the hospital. Today I'll be breaking fast in the middle of the shift at around 7pm and then continue on working. I dont know how that will go, but it will be certainly something different!
I'll be back soon!
Thursday, June 11, 2015
Mass mentality cliches
For the trillionth time today someone asks me "why did you come back to Egypt?" with this distainful look on their face.
It is so boring. So cliche.
This is one of the issues I have with human beings. The mass mentality. Everyone thinks in the same pattern and the same old shit thoughts circulate in the same minds of everyone. And the very same assumptions and the very same complains. It is so boring.
(by 'everyone' i dont really mean everyone, i'm exaggerating)
How many times have I heard about how corrupted this country is? How many times have I heard people saying "...but you know, foreigners abroad do so and so...unlike us"
How many times have I heard people complaining about the messed up system in the hospital I work in?
How many times do I hear people say that they want to leave this goddamn shit country and live abroad cuz they're sick of being here?
How many times do I hear people say that here we learn shit but abroad in medical schools they learn better than us?
How learning here is all based on recall and abroad its based on understanding and practice?
How many times do I hear people ask me if I have the british citizenship (often men who ask this)?
Freaking hell...its SO boring.
I've heard it so many times. It's like this broken record. Or its like people have these implanted chips in their brains that have 'complain' mode on repeat.
This whole "we lack and they have" mentality is so retarded. It's the biggest and most ignorant generalization anyone could make. Most of the people who are this way are often the people who havent even left the country (and wont).
The idea is not "stop complaining guys, this country is the mother of nations" that's not true. This nation has its fair share of bullshit. We cant deny that. But isn't it about time we found something else to talk about?
It's getting old and boring and soooooo cliche.
Among the educated and well-informed it is a pure shame to utter such terrible generalizations. It should be crime. Circulating negativity should be a crime. It destroys people's livelihood and traps us in man made prisons.
If you've been occidentally shot in the leg while you were innocently walking in the street...or if you've acquired HIV while getting a blood transfusion...or if you suddenly developed multiple sclerosis. It seems unfair that you should be inflicted with such terrible things, when you had done nothing wrong.
It angers you first and then you go through all sorts of phases including depression and selfpity and all that. Then you're supposed to reach a level of acceptance and start adapting and living with it...and for those who have the hearts of heros, to start actually MAKE USE of their weakness and turning it into a point of strength.
You can raise the awareness on the dangers of guns...you can become a lawyer and aim to create stricture legislations on the licences to own guns. You can inspire young disabled people to make use of their lives. You can work in the field of neuroimmunology to find a cure for multiple sclerosis.
You can do so much shit with your 'disadvantage' to turn it into an advantage, a goal, a calling to pursue.
You live in a damned corrupted nation, complaining will do nothing. Nothing nothing nothing. In fact it is counterintuitive. It reduces morale of others, it increases pessimism, it discourages the hearts of the weak. WHY?
It is an act of cruely to be negative with others and inject negative hateful thoughts into their minds, especially young ones.
It is an act of cruely to be negative with others and inject negative hateful thoughts into their minds, especially young ones.
We can make use of our disadvantage.
How?
That's the question.
That's the question.
And the answer wont be 'words'. It will be in action.
I often like to pretend I'm a superhero and when faced with the challenges of everyday like a long, traffic jammed road, or faced with a bitchy aggressive nurse, or a cocky doctor, or a bureaucratic trip to several offices just to get one or two measly governmental stamps on a piece of paper...I like to imagine those as 'missions' and with the accomplishment of each one, I'm gaining more 'lives' or 'coins'. These lives represent stamina and patience for example.
I could even go to the extent of counting how many "lives" I gained that day. And I think of a way to make use of those lives that I've 'earned'.
I realized that we must survive and we must make it through our tough times. And the only way we can make it out of this is to maintain a healthy attitude of mind.
It is a disgusting, slimy journey passing through the mother's birthcanal at birth, the first and probably most traumatic experience in our human lives, but we gotta pass it. Whether you pass through happily or grumpily, you'll still have to go through it. So what the hell, you might as well try to make it pass with the least harm to yourself and to others.
Whatever corruption or shit you may be passing through, make it to your advantage. Shut the hell up and stop complaining and add value to your environment.
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