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:

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;  mildness, soft-heartedness, tender-heartedness,kindness, sympathy, liberality,  indulgence, tolerance, generosity,magnanimity, beneficence

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.

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!

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. 

We can make use of our disadvantage. 

How?
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.

Pinnacle!

Good afternoon!
It's good to be back. The life we live is like a massive ocean and we're surfing on the waves trying to keep our heads above the water. Some of us are just surviving and some are up on the high tides and some are sinking deeper with each passing wave. And we dont stay in one place, one minute you could be sinking and the next minute you are elevated to take a breath of air.
I would like to announce that in my current state (and for a few days now) I've been surfing on the high tides. It is really quite exhilarating. Things are going well, I feel extremely alive and sociable and snarling and ready to take any challenge that meets me. My social circles are expanding exponentially and I am beginning to really culture some of my skills to my benefit.
I am on the pinnacle of youthfulness.
I know it sounds so manic or perhaps hypomanic, and so what? Even if it is, as long as I'm functioning and I'm Ok with it then that's all that matters.
I know of course that this state of being on the pinnacle wont last for too long, because nothing we experience is ever permanent. We have to rise then drop then rise again...then stagnate for a while and so on. So I wont attach to this feeling of awesomeness, because I know that it'll slip through my fingers as soon as I try to grasp it.
It's alot like grains of rice...they will stay in your hand if you just gently let them stay...but as soon as you clench your fist to grab them hard, they'll slip through the cracks between your fingers.
It's not worth the trouble. It is alright to just experience the moment and enjoy it while it lasts.
I have also come to realize that being anhedonic is really not all that bad. To be completely present and living in the moment.
The past is gone and the future is still to come...so just focus on what you have now.

Another thing that happened yesterday that made me realize how humans have this inherent impulse to provide comfort or justification. It is a good thing however in other times it is entirely inappropriate and counter-intuitive.
In times of crisis or emotional volcanos one of the ways to deal with people experiencing it, is to just give them space. To not speak a word. To not provide comfort or justification. To frankly just shut the hell up and just be present.
Realize, that no matter how logical your words are, they will do NOTHING to help a bereaved person. They will do nothing to lighten the blow for a person who has just recieved acutely distressing news. Or a person who is reflecting melancholic-ally.
I entered the ER as an intern and, as I often like to do, stand in the corner and observe the movements and behaviour of the people inside. The injured, their families, the doctors, nurses, interns, the security guards. Everything! The dynamics inside the ER is a rich and nutritious medium for any keen observer.
So I decided to focus my attention on the resusitative attempts made on a thin, frail, 60 something year old man who had just sustained injuries as a result of motor vehicle accident. The doctors and nurses were swarming around him, inserting tubes and attaching monitors and all those medical things. He was mumbling and kicking and slightly combative.
When suddenly the monitors went flat and everyone was alerted that this man has just gone into cardiac arrest.
And so the cardiopulmonary resuscitative measures started. Young muscular interns standing on chairs opposite the patient's bed and taking turns to compress the heart. It looked like a desperate attempt to awaken the dead. Futile. But they continued on anyways, for around 15 cycles. Which, according to my limited knowledge is a few fold above the recommended cycles to be attempted. Injection of adrenaline. Hema-gel infusion. A little something here and a little something there and finally they stopped. Nothing worked and the man was declared dead.
As soon as the declaration was made the swarms dissolved. It was a brilliant show! The appeared so quickly and seemed so vigorous and suddenly when the curtains closed they evaporated.
And they arent wrong to do so. This is a dead human who no longer requires the service of the living. They cant help him and he cant respond to them. And not forgetting that humans, by nature are very uncomfortable with the idea of being in the vicinity of the deceased. Perhaps because it reminds us of our own mortality and finity.
I continued to stand there to watch the aftermaths.
I watched the process of the policeman coming into to document the death, the sons of the man arriving and seeing their father dead. One of them was tearful and unable to withstand to look at his father...he looked once or twice then turned his face to one side and covered his eyes and weeped quietly. The other son was full of anger and began to shout to the policeman to tell him, that who ever did this to his father will pay for what he did and that we shouldnt let this pass...etc.
Both men are hurt and disturbed but each one represents it in a whole different way.
I think that perhaps the one that weeped will be the one who recovers and accepts it, quicker. I dont know, just my hypothesis.
Then I watched as the nurse gently tied feet and hands together to prevent his limbs from expanding laterally after the process of rigor mortis and the process of covering him up.
I touched the old man's arm, as I was curious about whether he'd gone stone cold, as I read in scary books. He was cool, room temperture. Then I realized that now that he is dead, he is no longer warm-blooded mammal. His temperture is a reflection of the external temperture, similar to a reptile which we refer to as cold blooded.
The dead are so docile and non-defensive. It does seem morbid and dark of me to make such an observation, but I couldnt help but think that way. He is no longer defensive. You can say anything to him and you can inflict any injury on him and he won't flinch in defense. His face wont colour up with frustration and his words wont get offensive and vulgar...or at least he wont cross his arms in physical defense. He will lie there, submissive.
It is our natural state. We were born completely helpless and submissive and we return to that state at the end of our lives.
Living is a sandwich, of submissive helplessness on each pole and a fire of strife and struggle in between.
As I was standing there looking at my deceased friend with cloudy eyes and total disconnection from the buzzing around me in the ER, a colleague approached me and I nearly jumped out of my skin from being startled.
He looked at me right in the eye and seeing that my eyes were clouded with a thin film of tears and a strange mesmerized facial expression he asked me if I was alright. I smiled and nodded. "Why are you standing like that? Don't be upset about it...we are all going to die and turn to dust anyways...it's not a big deal"
I was thinking...so you come and disturb my thoughtful tranquillity with your bullshit justifications and comforting? I started to feel myself getting defensive and angry...however I realized that he was not worth my time or words.
I nodded... "yeah, I know...it's alright I know"
He looked at me right in the eyes and said.. "Well, my name is David anyways"
"Nice to meet you David, I'm Wegdan"
His smile was a concerned smile, but I didn't care. I just needed him to go away, because with every passing second I was getting agitated from his insensitive disruption.
And then I realized that David wasn't the bad one. David was just a human being, doing what all human beings do on autopilot when they see someone who's upset or disturbed or whatever. They say bullshit and empty justifications.
It made me ever-more aware of what I say when I'm faced with disturbed and upset people. I'll tape my lips together and only speak if I have something meaningful to say. No autopilot comforting.

The Wind. Park Wang Kyu

Today's blogpost is gonna be simple. It is something I'd like you to listen to. This is from the soundtrack of a pretty amazing kdrama called Empress Ki. Park Wang Kyu's voice is absolutely amazing here, so throaty and expressive. I particularly loved the ending which was escalating and emotional.

Love in the ICU

On the verge of death, he was.
He knew he was dying. The beeping machines were reminding him of every time his heart beat. The pulse oximeter on his finger. The wires attached to his chest.
The beeping was so continuous and so persistent that it began to sound like a countdown timer. A countdown in which we didnt know when it'd stop, but we were sure it'd stop eventually.
He opened his eyes and asked me the time.
"It's 2 oclock in the morning, father"
He nodded. "2 oclock in the morning.." he repeated thoughtfully.
I wondered what he was thinking and whether 2 am meant anything to him. In that intensive care unit, day was like night.
Even daylight doesnt dare enter such places.
Not because it's scary. But because it's the place where most human beings die slowely. In nature, these people would have died long ago. It is their natural course. However, human 'advancement' has allowed people to live longer and die slower.
He cleared his throat. "Do you know that I taught my children to love...to truely love. Do you know that?"
I smiled and asked him how. He went on to say, "I'm talking about unconditional love. The love that isnt associated with what you do or what you look like. For example, you are standing here a beautiful young girl...that's not the reason to love someone. But real love is to love for everything a person is, as a whole. Just like that."
I nodded again.
"My children love just the way I taught them, I'm not a philosopher but I've seen a lot from life..." he stopped and I could instantly read his face changing and crumpling with emotion.
I looked down to give him a chance to regain his composure.
He said gently "You can go now, please"
I nodded without looking up and walked away.
After a few minutes I returned to tell him that if he needed anything, I'll be waiting a few meters away.
He didnt answer and his eyes were closed, but I am certain he heard me.
I wonder if I'll find him in this state tomorrow.
It is intruiging that most of the patients I speak to in the hospital, when they know they are ill or on the verge of death, they never speak about their financial accomplishments or what they've won or the positions they have reached.
They talk about family and love and mercy and God.
They speak of loved ones who have stood by them, or have died. Their eyes overflow with tears and they bite their lips trying to control their emotions.
They speak of God's blessings and how they were saved or looked after by God.
They give advice like "keep your heart pure" "forgive" "love openly" "submit to God" "always be grateful"
They'd say "alhamdulilah" and sigh.
They feel self pity, some of them. And some, feel as if they've been given a pass to a new level of spirituality.
I treasure my moments with the terminally ill.
I wonder if I'll die a slow death and get the chance to reflect and give advice too. I wonder what I'll say or what I'll cry about.
What memory will make me bite my lip and look away and fight back tears?
As I write this, I am fighting tears already thinking about what I might cry for. I might cry for how I've lived so well and been blessed so much yet not giving enough to pay back some of the debt.
I might cry for the gentleness and love of my parents for me and how I sometimes returned it with harshness and how I regret that.
I might cry for not being grateful when the whole world was at my feet.
I might cry for not asking for forgiveness when I should have done so, to someone I have wronged

It the things we didnt do, that would make us cry.
I'll try to remember that.

The graciousness struggle

"courteous kind, and pleasant, especially towards someone of lower social status."

synonyms:

courteous,  polite, civil,  chivalrous, well mannered,  decorous, gentlemanly, ladylike, civilized, tactful, diplomatic; kind, kindly, kind-hearted warm hearted, benevolent, considerate, thoughtful, obliging,accommodating, charitable, indulgent, magnanimous, beneficent, benign;  friendly, pleasant, amiable, affable, cordial, hospitable

Such beautiful adjectives. I beg to differ, however on the "towards someone of lower social status" part. I think that in our day and age, the idea of being courteous and pleasant is considered gracious even if you are dealing with your equal. I think that graciousness is more towards "especially to those who have wronged you" rather than those of lower social status.

I have always had this central gravitation towards a life of graciousness. In my perfect and untainted state, my core is graciousness. I try to become as courteous and as benevolent as I possibly can. There are times when those traits falter and I can be the absolute opposite of courteous. 

A monster.

synonyms: rude, impolite, uncivil, 

discourteous, ill-mannered, 

bad-mannered, unmannerly, uncouth,

 disrespectful, ungallant, 

insolent, impertinent, 

impudent, churlish,

 boorish, gauche, cavalier, 

offhand, unladylike, ungentlemanly, 

blunt, gruff, curt, terse, sharp, 

short, surly, unfriendly,

 hostile, unkind, 

inconsiderate, insensitive

Notice how the words 'being blunt" and "being sharp" have exactly the same meaning despite being in descriptive terms, the opposite?

I find it intruiging!

So clearly is there is two poles of anything inside a single body, there is a conflict...a sort of 'tearing apart' sorta conflict but the idea is that, the dominating, most treasured pole is the one with the upper hand control. And I believe that this sort of struggle between gracious vs ungracious is one I'm willing to experience daily until my graciousness muscles have hypertrophied and my ungracious muscles have atrophied. 

They wont dissapear, but they will atrophy with the right amount of effort and time.