Tuesday, September 23, 2014

Pieces of A Puzzle

Pieces of A Puzzle
Ever since I was young, my parents taught me so many things, so many rules about life and everything that revolves around it. Growing up as a Muslim and living in a community that upholds the Malay culture has somehow shaped my views and perspectives on things that happen around me, and I believe that is the case for many of us too. But I didn’t know where it goes wrong; sometimes I found it hard to accept the differences that I encountered along the way. Having to change what is ‘normal’ to me and adapting to a new paradigm have pushed me to be a little bit more open to others’ opinions without jeopardizing my faith and beliefs. Hence, this essay will talk about changes I have made so far, and the journey of getting there.
It’s a long journey to be a doctor. Along the way, we need to pick up and treasure every experience we could in order to be a good doctor at the end of the 6th year.  I went through at least 3 small tutorial groups every week. Sometimes I do presentations. Sometimes I meet patients. But most of the time, we have discussions. But the nerves of doing those mentioned were just the same. Being the only person who is ‘different’ gives me extra anxiety to handle. Sometimes I would stutter while throwing my thoughts because I was too anxious that people might not understand what I say. Sometimes it was so hard to put my thoughts into words that I chose to be silent. It certainly made me feel insignificant and unheard in the tutorials but thankfully, the feedbacks from the tutors were most helpful in terms of improving my self-esteem. I clung to the hopes from the feedbacks that were given to me and little by little I pushed myself to be better.
One of the most important events that ever happened to me was when I had that paradigm shift on HIV patient. What would come up to your head if I say the letters HIV? Well, for me, my association to HIV is that it has something to do with things which are impermissible in Islam such as infidelity or drug abuse. It never fails to irritate me when somebody mention about HIV. Until that day, a patient came to the lecture and told us how she had HIV. I was taken aback by her story. I was left speechless that day when she said she got it from a needle prick. Never have I ever thought that somebody could get it from a needle prick. Appalled by that very moment, I was still in my belief that I would be that kind of doctor, who will treat HIV patient by the way they contract it. Why? Because I believe that some people have choices, some are just unfortunate and it's unfair for those unfortunate people to get the same consequences as of those who have choices. That patient didn’t have the choice. She was simply unfortunate. Yes, I was still judgmental at that time.

My tutor asked, “But, will you be able to look past it when you have an HIV patient in front of you?”
“I think so.”
I attempted to be defensive.

 All eyes were on me at that time, probably thinking that this girl had gone insane. But that question left me defeated by the notion of what a good doctor should be. Doctors are there to help, not to judge people. They are there to relieve some burdens. Not to make things worse. My eyes swelled up and tears rolled down my cheeks on the day I realized how cruel I was to the people that never asked for such thing to happen in their lives. That paradigm shifted, bit by bit. I’m getting there.

I had a big cultural perspective change during my three-day placement in Ross Home. For me, coming from the other side of the world, the cultural differences are quite obvious. We had a few sessions discussing among each other on the idea of rest home, getting old and dying. But to me, having that huge religious influence in my life has always been a filter to whatever information that I get, and that, sometimes including repelling others’ insights just because they are not the same as to what I believe in.  Honestly I was being sceptical on the idea of rest homes because it is not acceptable in my culture and also because we embraced the idea of taking care of our own parents and even grandparents. It is also encouraged in the religion to honour and look after our parents as they had taken good care of us when we were small.  So off I went to the rest home, with this rigid paradigm and questions inside my head:

“Don’t they have children?”
“Isn’t it inappropriate to put your parents here?”
“Shouldn’t the kids take care of them instead?”
And many more.

While pushing the trolley to deliver the morning tea to the residents, I had a small yet powerful conversation with the caregiver. She answered the whole questions that immensely bothered me at that time just with a sentence; it’s a change of address, not a change of lifestyle. She explained more by saying it is like moving to a new house, but the residents still maintain their lifestyles behind the doors. The caregivers are there to facilitate them towards a better lifestyle.  It left me thinking for the rest of the day; my immature conclusion on rest homes is basically due to lack of understanding the New Zealand culture. I also realised that being dynamic is an important trait of a doctor or else it would jeopardize the doctor-patient relationship.

On the second and the third day of my placement, I was in the hospital level care unit where most people are immobile and unable to do things by themselves. Most of them have had a long list of medical conditions and they looked so fragile that moving from the bed to the chair would take ages to do and would be very painful as well. I have to admit that I didn’t really have the experience of handling elderly in Malaysia, let alone in New Zealand. Hence, I always have that feeling of insecurity if my way of treating them is actually offensive, again due to cultural differences.

At lunch time, I was assigned to help Nancy (not a real name) with her lunch. Nancy is a very old lady. Her eyes closed most of the time, and it appeared to me as if she was sleeping. I grabbed a chair and sat beside her. I called her name a few times and asked if she would like to have her lunch. She did not respond. I tried again and still no answer. Feeling a little bit uncomfortable, I looked at a caregiver not too far from me, and she obviously knew what was happening.  She came and shouted to Nancy, and apparently Nancy said yes.

“Nancy is a little bit deaf; you have to shout a little bit louder”

But it was a strange feeling having to shout to an old lady. It was totally contradicting from the way we usually treat our elderly.  We treat them with respect, talk slowly with a soft voice, and demonstrate best manners in front of them.  I’m not saying that the people here are disrespectful, but it was not easy adapting to a new ‘norm’.  I shouted to her ear soon after that to negotiate what she would like to have, or just asking if she wanted to have a drink in between the meal.

On my last hour of the placement, I was told by the caregiver to help Claire (not a real name) with her afternoon tea. I went to her room and greeted her. She couldn't move her hands but otherwise seemed okay. I slowly brought a small piece of cake as she opened her mouth, and very carefully brought her coffee in between the pieces of cake. I was a little bit shaky for a second. The content of the cup rippled due to the trembling hands, but then composed myself.  

“You did it pretty well,” she said.
“Thank you.”

It was a nerve-wrecking experience yet a good one to learn on how to interact with patients.

All in all, experience is the best teacher. I have learnt things that I could not possibly get from textbooks. I realised being a doctor is not only about developing our intelligence quotient but the emotion quotient as well. I learnt more on the human side of a patient and not being totally hung up to just his/her medical condition.  Another major thing is I learnt to accept others’ views and perspectives without jeopardizing my own and that is certainly a skill that I acquired throughout this year. Though it seems to me that everything that I learnt thus far sometimes is not making sense and a little bit hay wired, I hope I could see bigger and bigger picture as I go along in this long journey to be a doctor. Just like a puzzle, you wouldn’t see what picture it is until you are done putting all the pieces together in the right place and orientation. Just because I haven’t got it all figured out, doesn’t mean I never will. There will come a day when I will look back and say “Oh, that was okay”. But to get to that day takes patience, sacrifices and a whole lot of changes. I look forward to learn more in the years to come, and finish this puzzle, one piece at a time. 

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there's always a little truth behind every "JUST KIDDING ", a little knowledge behind every " I DON'T KNOW ", a little emotion behind every " I DON'T CARE ", and a little pain behind every " IT'S OKAY "