Take my hand

I’ve been mulling on this for awhile whether I should write about this. Since it is National Suicide Awareness month (in the US but whatevs), I thought it’s time I talk about this.

Ok I’ve never been in a state where I want to take my life away but I can understand how doctors can come to that point in their lives. More and more nowadays we hear of doctors disappearing and those taking their lives away. At least three of them occured during or just after their shift. Many of them occured after having complaints being made on them.

Earlier part of this year, I had a situation where I misjudged a patient’s condition. He looked well enough and didnt have any signs of serious illness. I did decide to have the patient be observed as he wasnt completely right yet and his condition improved within hours. Another colleague saw him, agreed with my diagnosis and discharged him. He came back within 8 hours… delirious, confused, quickly becoming ill in front of my colleagues’ eyes. He was intubated and ventilated. He had meningitis. I was told about it the next day. I went to see him in ITU and bumped into Dad – His dad said he was fine when he was discharged. Even hopping out of the unit. He deteriorated a few hours after at home.

The whole situation shook me. I spoke to many consultants, trying to gauge if I did anything wrong, thinking how I could prevent something like this next time. All of them agreed that they wouldnt have done anything else. These things happen they say. Yes, I know it happens.. I just dont want it to happen to me.

I couldnt shake off the incident. I began doubting my judgement. I would make a decision and then mull over it a few hours later. Over time, my confidence was affected. As a person who can be fairly anxious, I became even more anxious. Going home from oncalls or a busy shift, I would worry about patients, constantly thinking I might have missed something, worried that one of those I discharged will deteriorate or worse, come back dead. I couldnt sleep properly. I was crying more (more than my usual). I can get to a point where I would overthink things and panic.

This was a gradual process by the way. The anxiety went to higher levels bit by bit, it snuck on me that I thought this was somewhat normal. It dawned on me eventually how not normal it is. I couldnt bring myself to be too happy. I thought whenever I ‘lose’ myself to a good laugh or be happy… watch it, dont be too happy now, something bad might happen. By bad I mean a patient of mine would deteriorate or die because of me, I would lose my license and go to jail. It sounds ridiculous right… even writing this now sounds ridiculous to me.

I confided in the counsellor who I spoke to years ago when I was failing my exams. I reconnected with her and she made me realise how my feelings were affecting my thought processes (or is it the other way round?). She gave me practical tips on how to overcome my anxiety. I also spoke to an extent with my supervisor and another consultant who was supportive and reassuring.

The thing is… I never really spoke about it much with my family, friends and colleagues. I didnt know how to say it. I really didnt know how to tell them the magnitude of my anxiety. “Uhh I dont want to laugh too much now because you know, something bad might happen…” It was also easier to not think about it. As my mood spikes and wanes, it was easier to forget about it when I was having a good day.

I also didnt want to be seen as weak or be the failing doctor. It was if that by being anxious, I thought people will think my ability to doctor (can I make it into a verb?) is reduced. I didnt want people to judge me (and trust me, often medics are the worst judges of their own colleagues). Let me judge me. And this, I think, is why doctors get driven to that point. We bottle it up, paint a picture of absolute normality, get on our lives… not only do we not want to be seen as being impaired to work but we are also in denial ourselves. You just plod on.

Take my hand

and hold it tight.

Please remember

that it will be alright.

Reach out for someone

when you feel alone,

the panic, the heaves,

you’re not made out of stone.

Just remember

it will get better,

somehow someway

(and it might be a long way)


the sun will shine

and you will find

that you’ll be just fine.

The clouds will part,

it will no longer rain,

and you realise

that you deserve to be happy once again.

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Finding joy

Lately I’ve been stuck in a rut. Unmotivated. Lethargic. Uninspired. I admit to feeling like this from time to time and my usual go-to pick up is to find a project to fulfill this void.

On the other hand, I have so many things that I have to do. Work stuff to complete – audit, case report, e-portfolio (big groan). Start preparing for my START assessment – kinda like an assessment to see how well prepped one is to be a consultant (even though I’m two years away but have been advised to start doing it now, so I can work on any weaknesses/recommendations). Extra curricular stuff that I wish I can just stop doing. Need to get more fit. Teach kids more malay. Be more active in islamic teaching. Sort my stuff in the back room. Finally finish up the Japan scrapbook. Oh and go to work and do a good job out of it (once many moons ago as a house officer, my registrar told me a good day is when you don’t kill anyone. I love and agree with her standards).

And then it gets overwhelming and I just don’t want to do anything anymore.

Do you ever get the feeling that your life is becoming out of control? Instead of taking charge of it though, it feels easier to just let things be and just do things when they are absolutely necessary or when I feel up for it, whichever comes first.

What I have realised is that when Marie Kondo said we should only have things that brings us joy, she doesn’t just mean things in a materialistic way and actually mean every aspect of our life.

All these things that I’m doing – is it bringing joy to me?

Of course, not everything in life can be joyful to us. Paying bills and finding the best car insurance deals does not exactly flutter happiness in one’s heart – unless you love the satisfaction of finding good deals? Those are essentials. But accepting they are essentials and getting on with it is crucial to finding that joy.

There are plenty of things in my life that is not essential and does not bring me joy. So I think it’s time for some decluttering of activities and ‘hobbies’ (does facebook stalking count as a hobby?). And insert more things that brings me joy.

On that same note, there are things that I feel I have to do, like teach my kids malay. It feels like hard work at times and no wonder the kids feel like its hard work if their teacher feel the same way. There are times though when it’s easier, like when I’m reading Malay books to them at bedtime – somehow they’re more receptive then. I get their attention and we can have conversations in malay (by that I mean, I speak in malay and the answer is in english. If I’m lucky, I might have the odd malay words repeated back. Small steps….).

Perhaps not everything will be joyful – some things will be hard but it’s finding the more joyful parts of it to keep one going.

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Just gotta push through

Today a teenage patient went through a bad day. She has done some steps forward in her progress. But today, today she was in a rut. Today she didnt feel like she was improving. I told her that she has to push through today. That when she is at her lowest, she has to push even harder through it.

Sometimes you just want to put everything down and wish life will pause itself. No, the stars still shines, all lights flicker out and when you open your eyes, the sun will come out again. And you, you still need to push through it.

And now, I have to echo my own words to her, back to myself. Just gotta push through it. Sleep tight and tomorrow will be another day again.

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Being inspired to learn

Have you ever met people who makes you inspired to learn more? I like teaching and whenever I think of passing knowledge, I think of several people who have made me motivated to learn.

The first is a house officer who took my clinical partner and overall BFF under his wing during our care of elderly stint. He taught us during and after ward rounds. He gave us practical tips on the clinical exam (Just bullshit your way through but with confidence) and as a house officer (as above). The thing is he was not arrogant at all, he was hardworking and so clever. He did get hit by a patient with a stick once – he dealt with that patiently.

The second one is a consultant who probably does not even realise how much impact he had on me. He was not my supervisor and we didnt work that many times. However, he encouraged me to do case presentations and present in the regional meeting. He was just enthusiastic in his specialised interest and all round cool guy. He made me interested in neurology.

The third one was the beloved Dr Hoskyns. I did my clinical exam three times and each time I would go to his bedside teaching. It happens on a weekly basis and even if you’re the only one who turned up, he would still do it – fully prepared, on time and with patients ready to be examined. We would trek between wards (4 wards) and swiftly see a patient, examined, grilled and roasted. With his poker face and old school grilling, it sure did prepare me for the exams. It also tested my nerves – all that time when I answer stupidly (so obviously stupid that I want to facepalm myself) and he would just give me the correct answer afterwards, thankfully without a ‘Dont be so stupid’ look. Not just that though, even observing him talking to parents and doing the ward round, I learnt so much. I miss him, I’m sure I’m not the only one and I hope his family realises how much impact he had on the trainees.

Nowadays work feels more like service provision, and less training and learning from seniors. I quite miss the group ward round and being asked qs along the way.

I think all those who I mentioned above probably never realised how much it meant to me, their encouragement, time and teaching. Which brings me to the point that we never know how our words and actions affect people we pass by. It might just have a big impact in shaping them.

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Does learning the minority language matter?

The other day, I was talking to my colleagues about teaching our languages to our kids. One is British born Asian, who speaks Hindi with her parents and her husband speaks Punjabi growing up. One learnt Cantonese as a child. His wife is English and aside from his mum, he doesnt really speak Cantonese much. Then there is me – I speak Malay with my parents and older generation in my family. I speak a combo of Malay and English (Manglish?) with my siblings, younger gen of family and friends. As for daily life, my kids are only exposed to Malay with me. Like my colleagues – we are essentially the sole speaker of our language to our kids.

Fair to say, they were where I was last year. I always thought the language would just permeate into their lives like osmosis. I’ll just keep talking in malay (though reality is that it was 80% english and 20% malay) and they will just get it.

Except they didnt!

There was also the thought of he’ll get it one day, when we go to Brunei. Except I can see that as they get older, the need for the language dissipates and their comfort in English grows.

Would it matter anyway for him to speak Cantonese? We’re going to stay in the UK and its only his grandma who speaks Cantonese. My colleague muses.

I guess, for someone who is multiracial, only they can answer if being multilingual benefits them. Will it fill a gap in their cultural identity? Or will it not matter because you wouldnt know what you’re missing if you havent had it? Certainly knowing an extra language is always useful (also fun when you can use it as code speak). But does it matter? Will we only know decades down the line whether it is a regret not to teach the language? (I dont think anyone who is bi- or multi-lingual ever said they regretted learning another language)

In my kids case, I want them to speak the language so they can communicate with their grandparents (my parents) better.

We’re far from the goals I’ve created for them (to speak and write like a native of their peers and have a flowing conversation with grandparents) but I can’t give up.

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Books inventory: February & March

February and March have been really slow in terms of reading. I realise now that I’ve partially abandoned the things that makes me happy. I’ve stopped running, doing yoga and only managed to read two books (and a half).

So February and March read includes:

1. It’s All in Your Head

I would thoroughly recommend this book to medics out there. It made me rethink how I perceive those with medically unexplained symptoms. In paeds, I would see girls (it almost always are girls) coming in with suddenly unable to walk or ‘pseudoseizures’. There are also plenty of symptoms that we couldnt find a cause to – chronic abdominal pain or headache or lethargy. We do various tests and even when we’ve done it all and it came back negative, parents want more. There must be something wrong. For medicolegal reasons and also often to appease parents, we carry on investigating. Some of the more experienced, old school consultants will be more firm, enough is enough. There is no organic cause to the symptoms. I get it, the symptoms are distressing, your child is not your child anymore. How do we communicate better though? Without judgement, inwardly eye rolling and to give the same compassion and respect to all patients. Sure, they might seem dramatic but they’re experiencing the pain right? Pain is pain, whether we think it is real or not. One thing I’ve learnt from this book is once we have made peace that we’ve done all the investigations and found no cause to it, we need to communicate well to patients and parents quickly on how to go forwards. It also means truly acknowledging that to them, these symptoms are real. They do feel the pain. They do feel tired. Just because there’s no real medical cause to it, it doesnt mean they dont feel it.

The author has summarised that the more delayed we confirm to patients of it being functional or psychological, the more we medicalize, the more difficult it would be to treat it. The author recommends involving psychiatrist or psychologist early on. Due to the long waiting list of CAMHS and clinical psychologists, perhaps this is  not a bad idea after all.

If illness seems to be helping solve the problem of loneliness, then treat the loneliness and the illness will disappear. Or find out where the gain lies and address that. Or if the problem lies in maladaptive responses to the messages the body sends, that can be relearned.

Picture of book

When we encounter somebody who is severely disabled with purely medically unexplained symptoms we should treat that person with the same respect that we would give to anybody else with any other diagnosis.

2. The Nakano Thrift Shop

Bought this before we boarded flight to Japan. Terminal 2 Heathrow is so nice btw.

Anyway, it starts out slow and the flow of the book is halting. I think it’s supposed to be in Japanese and then translated to English, maybe thats why it has the halting flow of speech. Language is also bit formal, but maybe its just how Japanese people speak? I wouldnt know I guess unless I really learn Japanese.

The story line turned out to be interesting and you grow to adore each main characters. The ending though made me feel like “Huh?? That’s it ??!!” You know … when there is a happy ending but not quite an ending, you kinda just have to imagine what happened next. Boring! This time, I want a hollywood ending please.

3. We are all completely beside ourselves

This is a bit of weird one.  Just couldnt relate to it but totally didnt expect the story to pan out like how it did. Haven’t finished it … Incouldnt quite bring myself to finish it. Kinda forcing myself to keep reading.

Shall I just carry on reading even if it doesnt bring me happiness? Perhaps I will learn something new or at least know how the story ends? Or do I say C’est la vie, life is too short to read books I dont like?

I hate not finishing a book though.

Books to read:

  • The Night Circus
  • Good Immigrant

Over and out,

Hopefully more books in April!

Total books read in 2018 so far = 9

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Japan: Food for the tummy and prayers for the soul

Places to eat

I’m not good at food reviews but bear with me. As per last Tokyo post, this is not in chronological order or ‘most favourite’ order.

1. Shinjuku Gyon Ramen ouka

The good bits: Halal, punchy with flavour, yummy food. M got the wagyu ramen which cost a bomb but was well yummy.

The downside: Pricey and long waiting time. We waited about half hour which to Zayan’s hangry mood is super long time. He did finish everything on his place – the humongous chicken pop stick, ramen noodles, rice, miso soup, boiled egg and even the broccoli and corn. So it must have been worth it.

Also word of warning: there are levels of spiciness. We chose 4 and was SO spicy (she said malaysians usually chose 3, I dont know why we chose above it especially me yang inda tahan panas!). It was burning sampai inda tahan makan – yet we went for more – that I asked to change to non spicy broth. Even M who can taha spicy food found it too much. So next time just choose level less than 3.

2. Hanasakaji-san

The good bits: Fairly quick service. Nice ambience. Ok if you want to try halal shabu shabu style, but guessing it’s standard ‘nyaman’.

The downside: The broth was not as flavoursome as I would like – read: tawar sikit. We finished all the food though HAAA.

3. Asakusa sushi-ken

The good bits: Halal, so can eat the meat yesss. Good sushi. Like mouth watering good sushi. And the meat meal I had – so tender I want to cry (lots of things in Japan that made me want to cry though). Clean and fairly quick service. Even have prayer room above it.

The downside: No downside.

4. Food court at a mall near Ueno Park

The goodside: Standard pasta (tomato and broccoli) and marinara pizza. Cheap.

Downside: Just standard food.

Note: Carry around with you bottled water or buy from 7-11 or family mart. Way cheaper than buying from these food courts.

5. Restaurant at Hakone Onsen

Sat on the floor, so mesti buka kasut. I quite approve this Japanese obsession of taking off shoes. #cleanfloors

Different menu to the usual japanese food. More traditional. Tried yam puree (ech), fish cake and diced tuna (sashimi, you can never go wrong with sashimi).

Kids ate the soba noodles and caned it. Mumtathil had the grilled unagi rice set.

Good bits: Cheaper than most of our meals so far. Noodles and rice were good.

Downside: The fish cake tasted like crabsticks with similar texture – this is not cake! Not a fan of some of the side dishes but at least I can say I’ve gone out of my comfort zone.

6. Tempura Tenfusa, Tsukiji Fish Market

So crispy! Best breakfast/brunch ever.

Zayan being patient and thinking why he has to wait everytime before he can start eating.

Five star reviews for the food!!

Everyone (on tripadvisor and travel blogs) was saying to eat the fresh sushi there but some recommended avoiding the long queue and trying less-sought after establishments. Came across Tempura Tenfusa on tripadvisor and can now join the throngs of good reviews there. There are only 12 seats so we had to wait around 15-20 minutes. There’s only three things in the menu (all seafood) but the two that we tried were so good. Crispy light batter, not greasy at all. Kampung hawker style seating (but inside). Was so good though, we were the only foreigners there so it must be good. And there was never an empty seat and constant people queuing outside.

Downside: Some waiting time but not that long.

7. Fresh sushi and sashimi in Tsukiji Fish Market

Take away saja, cheap sushi. So fresh and tender I want to cry.

8. Gyumon bbq beef

This was fun and the dipping sauce was yummy. Zayan wanted to eat all the meat/chicken. Slightly pricy but maybe because it’s halal meat? Was well worth it though.

9. Couldnt catch the name of this Kyoto resurant because it was all in Japanese.

Not halal so went for the seafood option. For me – Sashimi with rice and along with it the biggest, juciest salmonroe.

Ok I’m bored now. Here’s the list of halal places we also came across:

– Halal Restaurant in Arashiyama – cant remember name but they have kids set too. And there was a lot in kids set! Potato wedges, rice, noodles, fried chix.

– Osaka Ramen – slightly salty ramen but the kids ate chicken rice which was nice.

– Kenny Asia in Osaka – after a week or so of Japanese food, it was heaven sent to see a malaysian restaurant. Its like OMG I MISS YOU SAMBAL AND KARI! I coughed with the spiciness of ikan asam kari but maybe it was because I have gotten used to the more soy and miso based dishes in Japan.

Places to pray

Surpisingly not that difficult to find in Japan. Or maybe Allah made it easy for those who tries to find a way to pray. Anyway there is a place to pray in all the major tourist places, here are the areas in case you are near them (when you have kids, you dont want to walk more/backtrack).

1. Noa Dougenzuka, Shibuya – This looks like an apartment complex and there is a room rented out at 11th floor that has been modified to be a prayer room.

2. Prayer room above the Asakusa sushi ken. Asked the waiter if there is prayer area but he said no (not sure if he really understood). When we went to the toilets upstairs, I saw a guy who looked like he just ambil wudhu and looked Malaysian. Spoke in malay and he showed me the prayer room close to the toilets.

3. Prayer room in Takashimaya Times square complex, Shinjuku

This looked like a posh shopping complex and the room is SO nice. Like I just wanna sit there all day. Plus you can stalk for hours at the food hall at basement.

4. Tokyo Station prayer room

5. Osaka Station prayer room

6. Prayer room in OIOI shopping complex, Kyoto 

Just some more food pics…

Their strawberries are expensive but oh so sweet!

Krispy Kreme

From L-R: Cookies and cream, One with cream cheese filling and the kawaii one with melon filling

Do buy a cute lunch box and make your own meal. Here is the ready made noodle (plain) with some soy dipping sauce. Go to the abundant small supermarket to get such things – its all in Japenese though. So we just had to choose the most plain looking (nada inti inti) one.

Also go to the bigger shopping complex – a lot of the big train/metro stations have a shopping complex attached to it. We came across Daimaru and Toby – Daimaru’s basement have the most mouth watering desserts and bakery. Usually cheaper than the more upmarket cafes.

Breakfast for us consists of food from bakery or buying bakery from the FoodMart (small supermarket). They’re not into brunches/eggs and toast very much here!

Ok thats it from me. Enjoy the pics x

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