Sparkle in the dust

Last year was my worst year so far, in terms of mental state. I was depressed most of the time. I was not interested in anything at all, not interested in any clinical presentation or rare diagnosis that will make my peers jump in excitement although not literally. I dreaded going to hospital, walking under the sun, climbing up the smelly staircase to my ward, being part of the crowded and forever busy ward. I didn’t remember learning anything actively. Anything retained in my brain from Year 3, was there by means of natural osmosis, not by my hard work. I had mind block halfway clerking patients. I had to force a smile while thinking back the last question I asked my patients, and the next. My mind was a chaos. I felt like escaping every stressful bedside. Negative emotions accumulated inside me, I let them out by crumpling the medical notes I was holding. Squeezed them until I felt the hardness of each angle of the crumpled paper. I still attended most of the classes, even though without the ability to concentrate.

In my room, when I cried I can’t stop. I cried until my eyes were swollen and my double eyelids were gone as a result. I cried I had to breathe through my mouth.

Then there was this patient I randomly clerked. His AML was not officially diagnosed yet when I met him. He was still well, he still can talk when I first clerked him. Then his condition deteriorated and could not speak in full sentences anymore. The second time he was admitted, he had an arm abscess at IV branula site, an infection as a result of chemotherapy. He was the only patient I remembered clearly from last year. He was nice and was willing to talk to me even when he was very ill. I remembered it was a hot afternoon. I went to medical ward to check up on him. My every movement felt reluctant and heavy. When I was in the hospital lift, I put my hands in my lab coat and looked at the floor. I pressed the lift open for another person to enter, didn’t look up nor reply anything when he said thank you. I felt like a non-human, walking in an alien environment that doesn’t belong to me. That was until I saw the patient in the ward. He was lying on the bed, worse than how he was the day before. I smiled to him. Just like that, he made me smile from the bottom of my heart, when I didn’t even want to make eye contact with anyone. It was like a sparkle in the dust, a sprouting flower in the desert, a tiny drop of rain in drought.  

But I was not sure how he was coping with chemotherapy, or more blatantly, if he is still alive now. He was 78 last year.

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“As medical students, we are confronted by death, suffering, and the work entailed in patient care. While being simultaneously shielded from the real brunt of responsibility, though we could spot its specter.”

“ All at once, it dawned on her and she began to cry: wherever this ‘Practice EKG’ had came from, the patient had not survived. The squiggly lines on that page were more than just lines; they were ventricular fibrillation deteriorating into asystole, and they could bring you to tears.”

The first urinary catheterization I witnessed in my life, was performed on a patient who is now dead. He died in the afternoon, in the crowded stuffy medical ward with regular beeping from ECG machine. He has died before I cared to look at his face properly, to know his name. I eagerly observed the procedure, performed by a houseman assisted by another houseman, without knowing the patient's story. And he died.

Being surrounded by life and death, having to witness all kind of difficult lives, I have learned to blind my emotions. Until I forgot, an ECG of asystole doesn't just mean asystole. It means someone has died. We are learning through people who are dying, or who have died.

与你的小时光

星期五和你去了那间我一直想去的花卉咖啡馆。你看见玻璃冰柜里放着的不是蛋糕，而是一束束的鲜花。你说不如买一束送给我吧，随后想起我不喜欢会枯萎的鲜花。你说再送我一束永生花吧，看看那网站还有什么漂亮的花束。服务员捧着草莓奶昔和迷你粉红玫瑰花束送到桌上，这么小小的花束就能让我开心和珍惜。你说咖啡馆里的小小抽风机好可爱，玻璃吊灯很华丽，以后的家里肯定要有。

星期六和你出外吃饭，在你喜欢的toast and coffee吃你喜欢的咸蛋料理，喝我喜欢的鸳鸯。今天人不太多，你东张西望后说道。常常在那里看到很多看起来像是游客的人，在太阳下背背包拍照，和在对面的面包老店排长龙。你说有点像马六甲的老街，我说可是没什么好逛。第二次在街角店买一个RM3其实很贵但很想吃的葡塔，变成午饭后的小美好。

星期六下午是你懒洋洋的时光，躺在床上感叹时间过得真快，一转眼忙碌的O&G posting就即将结束，还剩一份你还没找到动力开始做的oral assignment。星期六下午是我们等待tesco delivery的时候，两人一同下去底楼的卡车旁，感受引擎热气一边确认货品，你总让我拎最轻的袋子。星期六晚上我替我们熨衣服，你故作委屈地说前一个礼拜都穿皱巴巴的衬衫去医院，幸好有白袍遮掩。我站着熨衣服，在坐在沙发又开始说时间过得太快，原本还在segamat rural posting准备考试。我说差不多两年了，你也退得太远了吧。你又喃喃地说原本还在考A-levels，原本还坐在UPSR的礼堂里考试。我们一起笑了。

相遇以前，我们都在不认识对方的时空里经历着相同的事情，为相同的考试拼搏，烦恼同样的烦恼。庆幸在这漫长旅途的一开始遇见你，让每一秒都在流逝的琐碎时光见证我们的成长与日渐成熟，我们的欢笑与泪水，我们始终如一的快乐。

Goodbye May

你一上车，我一转身，就立刻想念关于你的一切。那些还会延续一个学期的日子，在这里。差别在于我们的空闲与忙碌将倒置。我在你床上读书，做assignment，看戏或玩手机；你坐在书桌背对我读书，做assignment，看动漫或打游戏；我们肩并肩坐着一块儿做每个人都不喜欢的HSM, EBCP quiz或forum。5月斋戒月是外卖促销的季节，我们吃了不少。5月你送我马六甲旅行当作生日礼物。酷热的天气之下，成为成群游客的一份子，走在我们第3次一起走的古街，吃我们想念的食物。艳阳高照，你依然有耐心替我照相，一张接着一张。想念你在人海中紧紧拉着我的手，在人海中紧贴在我后面保护我和书包，如初。想念我们3月的演唱会，你的陪伴，你的爱。想念你你叨叨絮絮给我的嘱咐，我真的每一句都照做。想念你孩子般的笑，想念你说我像小孩，想念和你在一起的最舒服。前天晚上替你敷面膜，你说你的脸比我还白了。昨天半夜你忙着收拾房间和行李，事后还要检查我的电脑到底出了什么问题，原来只是没电量而已。你说两个礼拜后见，你说把小猪带回房间取代你的陪伴。你是不是也和我一样，一转身就开始想念你。

End of Psychiatry Posting

Already miss psych posting so much. Appreciate all our tutors who have taught us so much, through direct teaching, their passion and patience, their superb communication skills with the patients. What inspired me the most is the sincerely friendly smile they gave to psychotic patients (whose behaviours caused them stigma and hostility), their pure intention to wish the best for their patients. Exposure I have gotten in psychiatric ward and clinic (with forever gentle Dr Hashim) in H.S.A is the most invaluable experience I would never forget, especially the easy interaction I observed in the ward round team, which I believe is an important element contributing to effective and healthy work environment.

Transition from H.S.A to Permai is interesting. Being able to observe the different clinical presentation among acute male patients and chronic female patients is an experience I treasure, not forgetting the ward round I joined once, led by a psychiatrist whose name I forgot but whose personality and working style I immediately fell in love with.

Dr Jeya said every patient has a different story, that is what made psychiatry interesting every day. I couldn’t agree more. Behind every bizarre and eye-opening clinical presentation is a pure heart, who still loves their family, thinking about them all the time during their hospitalization, despite the fact that their family no longer share the same love, and are planning to abandon them due to social stigma and lack of education regarding mental health.

I wish to give them some love, now and in the future.