Saturday, 22 September 2012

A Matter of perspective

Okay so I stumbled upon a few notes I had written back in 2009 that have absolutely nothing to do with medicine but I decided to share anyways.

This first one is called "A Matter of Perspective"


"Hey, sorry I'm late. The traffic was just ridiculous today? Did you see the car accident on the bridge?"
"Hey, no, no I didn't. Listen we need to talk."
"I know, you scared me on the phone. Is everything alright?"
"Before we talk, promise me you won't get angry. Promise you'll keep your composure."
"I don't understand. What's the problem?"
"Just promise."
"No, you're obviously going to say something that's going to aggravate me. I'm not going to promise you anything. Now spill it. What's wrong?"
"I don't know how to say this… You've obviously noticed there's been distance between us lately."
"I have, I remember clearly you excusing yourself on account of stress at work. I obviously knew you were lying and would tell me eventually what's wrong when you were ready. Guess that time is now then."
"Why do you always have to assume I was lying?"
"Well, clearly, it wasn't an assumption. You're just about to prove my point right now aren't you?"
"I hate when you do that. I hate your "holier than thou" attitude and your assumptions. Work has been really stressful. It's the end of the fiscal year and we've got so much paperwork. Obviously, you wouldn't understand seeing as how you're always on top of everything."
"You're diverging again. Just tell me what's wrong already."
"This is exactly what I want to talk about."
"What are you talking about?"
"This, this little argument right now. I love you. You know I love you, but I can't just keep taking this abuse from you."
"Mental abuse yes. You're always thinking you're one step ahead of the rest of us. Always trying to prove your point and win your little debates just to satisfy that ego of yours."
"So you're saying it's my fault that everyone we meet is an idiot and I shouldn't even bother to speak my mind just so the idiots can feel at ease? What the hell is this really about?"
"See, there you go again. I'm presenting you with a fact. But you're not even willing to listen to me, because in your mind you've already made the decision that I'm trying to hide the real problem from you. You think everyone has a personal vendetta and everyone thinks in layers. Sometimes what you see is what you get."
"Are you serious?"
"I'm dead serious. This isn't a joke. Please wipe that smirk off your face."
"Wait, wait, wait. Let me just get this straight. You're breaking up with me because I think for myself and speak my mind? You're breaking up with me because I don’t go with the flow?"
"I never said I was breaking up with you. Why are you even suggesting that?"
"Obviously, you're hinting at it."
"Stop claiming you know me inside out! No. There's no hidden implication here. I'm telling you how I feel. I'm being honest here."

"No you're not. You're trying to break up with me, but you don't want to say it. You want to piss me off and get me riled up and angry at you. You want me to see that there's no other solution. Clearly, you knew how I'd react to this and clearly you realized that I'd see no other solution. I mean after all, I do think 5 steps ahead, don't I?
"No, that's not it all. Why is it always extremes with you? I'm telling you because I'm hoping you might find a solution to this mess."
"You're lying. And I can't tolerate this any longer. Here's the money for the coffee. Goodbye and have a nice life."
"So that's it. It's as simple as that? You're breaking up with me?."
"Spare me your drama. It's what you wanted. Just once, just once, be honest about yourself. Take care of yourself and know that I still loved you even with all your flaws. Never once did I want to change you."

And he left.
And she cried and talked to her friends about it. They called him an asshole.
And he was angry and talked to his friends about it. They called her a slut.
And that was the end of that.
It's all a matter of perspective in the end . Was she the paragon of virtue and him the renegade?
Or was it the other way around?

Wednesday, 25 July 2012

Why the Health Care System in Cairo is Doomed.

Well it's not exactly one reason. There are a number of reasons the public health sector in Egypt is entirely flawed and not up to par with any golden set of standards imposed on it by even the saddest of developing countries.

Lack of finance, lack of resources, lack of decentralization. These are all very valid points.

But let's focus on one that can be changed but won't ever change due to how the health care system works.
I'll call it the Circle of Residency.

Now bear with me because I'm about to compress a lifetime of a medical student in a few measly sentences.

First off, let's consider the student that just got accepted into medical school. Let's even assume he actually wanted to go to med school and wasn't forced to fulfill his parents' failed dreams of success. He's ecstatic, he's hopeful but most importantly he knows he wants to be a doctor to benefit society. He makes an oath to himself, swearing to study hard and become a success despite the poor teaching conditions in most of the public universities here.

He finally finishes those 6 years, still wide eyed and full of hope. He guarantees a good enough grade to work in the hospital with a guaranteed teaching position.

Then he starts his internship, and that's when things start to turn sour. He witnesses the corruption, the poor ethical standards, the abysmal working conditions of the resident. He starts to realize that maybe, just maybe, life isn't going to be that easy. He's still set on making a change though. He brushes off all the horrible attitudes the residents take and tells himself he will not be THAT resident. He finds a field he's comfortable with and decides to spend all his free time there, soaking up and absorbing all sorts of information to prepare him for when he becomes a resident.

The year ends and he finds out he was 2 marks away from getting that field he wanted.
So he settles.
For a field that that he wasn't so in love with in the first place.

No matter though, his heart will not be broken, his spirits uncrushed, he moves on! He goes into the field wholeheartedly, anticipating all the excitement. After all, he's a resident now. Now is when actual professors will give him advice on management and treatment and he'll finally notice how much of a difference he makes.

Until the professors never really show up. And he's forced to make decisions based on his minimal experience and then he unintentionally harms a patient because he was forced to make a gut decision due to the fact that there was no one there to guide him.

His mind begins to jade.

And when the professors actually show up, they don't offer guidance or help. They ostracize and demean the poor resident. They put him in harsher conditions not offering him even the tiniest bit of solace or gratitude.

He soldiers on.
He tells himself, "It's alright. I'm going to be an Assistant Lecturer in 4 years. Then I won't be the one getting shit from the professors. Not only that, but I'll show them. I'll show them how it's supposed to be done. I'll teach the new residents. I'll be there all the time and guide them and make my hospital a better place."

The man falls in love with a girl. They get engaged and soon to be married. Just as soon as he finishes his residency.

He succeeds and gets his Master degree thus ensuring his position as assistant lecturer.
It can only go uphill from now, he thinks to himself.
He gets married, his wife gets pregnant and he's there teaching the new residents and enjoying his life.
Then he realizes the money isn't enough. That he needs to work in the private sector.

"It's only a few days a week. I can manage. I can do both."
But then those days become weeks.
The new residents call him on the phone, asking for the guidance but he's too busy. A month passes and he finally shows up and sees the department in a mess.
He shouts at the residents for their poor management skills. He tells them how he barely made these mistakes when he was a resident.

He forgets how hard it was.

Eventually as time goes by, he becomes exactly what he hated, and the cycle repeats itself.
Believe me when I say, that I haven't even begun to shed light on what happens to residents in public hospitals. Believe me when I say, I totally understand why we become jaded, cynical and just not the greatest of human beings.

It still doesn't make it right though. 

Sunday, 15 July 2012


So we were sitting the Emergency ward me and a few other residents (one of whom is a Muslim non veiled girl because yes, they've become a ridiculously rare breed in the public sector) and we had two patients that needed an incubator. One let's call Mohammed, the other let's call Peter.

They both needed to get operations done and they were both in pretty bad shape.

Now, amazingly enough, we actually had an empty incubator available. Fucking fantastic, only until you realize I used the singular version of the word. Thankfully, it wasn't our choice; the ICU surgical resident (who gets to decide) decided to choose Peter (for actual medical reasons, he had a somewhat better prognosis), and we had to somehow explain to Mohammed's parents that Peter was going in and Mohammed wasn't.

They didn't take it too nicely.

Here's what they said and forgive me if it's not word for word:

"Well OF COURSE you're going to pick the Christian kid. This is what happens all the time everywhere. We get treaded on while the Copts get all the special treatment. It's not fair."

This was of course directed to my non-veiled colleague.

My Muslim non-veiled colleague.

Let's break this down and go over that sentence again.

Mohammed's mother,

1- Assumed the doctor was a Christian and so gave preferential treatment. This is fine. I'll forgive her for that. I've seen it happen before and I don't really mind it. I've never seen it during a critical call though. Just silly shit like donations and stuff.

2- ACTUALLY fucking said, "This is what happens all the time".  Here. In Egypt.

In a Muslim Brotherhood run Egypt.....
......During the aftermath of what was possibly the worst year Copts have had to endure when it comes to death.

3- Further reassured her point by saying "It's not fair"

Fucking Copts. Seriously you guys, aren't you all going to die already? Your 10% is totally putting a damper on the 90%.

Rest assured, I explained the situation to her, not calmly of course.
I told her why Peter was chosen. I had a beard. She had to listen to me.
And all was well (until he arrested and died but that's not the point).

You might be wondering, "Well, doc, it DOES happen! I've seen Christians give other Christians preferential treatment or whatever"

You probably have, and that's your fault. Majorities have to to tend the minorities and let's face it, we haven't been a pleasant majority now have we.

Everytime you wonder why some Christians give other Christians preferential treatment, remember the last time you said something along the lines of
"Oh man, it's a shame he's a Copt."

It's our fault for putting them in that particular situation, and if anyone needs to start a peaceful (and non hateful) coexistence, it should be the majority.

Funny end to this story: The resident (non veiled) came up to me and said, "How do I prove to them I'm a Muslim?"

I told her to tell them the Shahada (There is no God but Allah) so that they'd think they converted her out of shame.

She didn't.

Some people can be such spoilsports sometimes.

Friday, 13 July 2012

I'm Sorry.

After almost 6 months of being a resident, this is the one thing that's still pretty difficult to deal with: Telling the father or mother of a child that their kid is either terminal, hopeless, or just not going to be their same old son or daughter anymore.

 It's an emotional rollercoaster that's always different with each family. There's no routine to how it works or what you're supposed to do. I'm sure abroad there's a whole system or class teaching you how to deal this particular piece of information out but here, it's just an afterthought.

Which sort of sucks.

It's gotten to a point where I jump at the possibility of delivering bad news to families because I feel I'm the only one equipped with the ability to emotionally convey bad news and at the same time, share the emotional fuckage the family experiences. I don't think I'm better than my colleagues at it. I just think that they've been at this longer than I have, and that they've reached a certain jaded level of consciousness I'm not sure I'm ever going to get to... or want to at least.

It's also a whole lot harder to do than say, telling the family their kid died. There's a finality to death. But with terminal illness or affection, I always feel like I'm damning them to both feel the loss of their child profoundly but also hope that maybe, through some sort of God given miracle, their kid will be the 0.0005 percent that miraculously becomes okay.

And man, do they stick to that hope. Because after all, "God is almighty and works in mysterious ways."
I sometimes thank God that I don't have to deal with atheists and agnostics. It becomes a whole lot easier to accept when the doctor says something like "Well, God is here and this is what He wanted to happen so who are we to judge."

And I feel like a prick every single time I say that because it works every.single.time.

So yay for Egypt not having any atheists.

Another one that's always harsh is "Was there anything that could have been done to prevent this? Was it my fault doctor? Was I too late? Did I do something wrong?"

I pride myself in honesty, but goddamnit does that become a whole lot harder when I say, a single shot of Vitamin K could have saved their newborn from having intracranial hemorrhage and subsequent brain atrophy for the rest of their life.

And I tell them that. But I also tell them it's never their fault (unless it's aspiration pneumonia, ESPECIALLY after I've told them not to fucking breastfeed their kid but that's a whole other story entirely).

After all, ignorance is rather rampant here as you might have sussed out from my previous blogposts.

I have a few stories about a few of these moments and I might or might not share all of them here but here's one that really did a number on me.

We had a 10 year old girl who got admitted into the hospital for having pancytopenia (all blood cells, including Red , white and platelets are decreased) Now, there are alot of causes for pancytopenia but we usually screen out leukemia first by doing a bone marrow aspirate and sometimes biopsy. So we managed to book her aspirate a few days later and I remember going upstairs to the labs to pick up her report.

She had leukemia.

I'm not going to lie. I felt nothing reading the paper at first. To me, this was just another girl who had cancer and we were going to tell her parents that and then she was going to go on to the Cancer Hospital and get her treatment and then maybe get better, or maybe not.

Pretty standard stuff.

But then I bumped into her father, who had been waiting for hours outside the lab for the test results.

"Did the results come out Doc?"

His eyes were wide open, full of worry and anxiety.

"Yes, let's sit down first."

So we sat on the bench in the hallway.

"Well, your daughter, she has leukemia."

"You mean cancer?"


Then and there he just broke down in tears, as if crushed by this immense weight. Not as if. He was, and there I was, sitting next to a crying middle aged man who just found out his 10 year old girl had cancer.

I felt like shit.

I felt like shit because I felt nothing a few seconds prior to seeing him, and now here I was, just emotionally syncing with him and feeling every ounce of sadness seep out of him.

That's a lie, because obviously I couldn't even experience a fraction of what he was feeling, and even that small fraction was already too much for me.

"It's not the end of the world. It's tough. It's going to be very tough, but I've seen kids with leukemia go into remission and get better and move on with their lives and become healthy individuals."

"So you're saying she's going to be alright?"

I fucking hate that question.

".......... Listen. We're all going to do our best here. You're going to do what you can and the doctors are going to do what they can, and well, the rest we can leave to God. Okay?"

He was still crying.

So I hugged him.

Might have not been the by the book thing to do. Might have not even been the right thing to do.

But there we were; two sad men sitting on a bench trying to get through life's hurdles.

And boy are those hurdles high for some people.

Saturday, 10 March 2012

Saving Lives and Trying Not To Get Shot

It's been a really long time since I posted anything here.  I'd like to attribute it to ungodly hours at the hospital but most of the time I'm just really tired and couldn't be bothered. Gotta say though I did not expect to ever reach 12,000 visits , although to be fair 8,000 of those were people looking for pictures of  Yousra naked and/or Demon picture searching. Read my post on my Psych ward days. It's somewhere in the archives and I'm too lazy to actually get a link.

So I'm finally a resident in our local Pediatric government hospital. It's been a month now and the things I have witnessed, ranging from bitchy nurses to crazed parents, I suspect, have taken their toll on my psyche. But not to worry folks, that just means more stories for you, ESPECIALLY if I know you in person. Now a lot of things have happened in the one month so it's tough to choose a particular story, but seeing as how I haven't updated in a while, let me tell you about the time I almost got shot.

It was like any other day in the emergency department. The flow of patients was unbelievably horrible and we were trying everything we could to stay on top of things. Among those patients, were 2 neonates (less than 28 days old) who were ridiculously sick. They both needed to be admitted into incubators (of which we had none available) and so we told them to go out and call as many hospitals as they could in hopes that one hospital would have an incubator available to move them into. Before you start wondering why we leave the patients' families to call hospitals and label us assholes, it's simply due to the fact that staying on the phone takes a long time and when you have a dozen patients at any given moment, you tend to use every given moment to good use on the patients you can actually help.

Anyways it was all well and good, until suddenly one of the mothers lost her shit. She started shouting at us and called us 'fucking corrupt assholes'. Apparently, what had happened was that there was another patient that needed an incubator too but because those people had 'connections' with the hospital staff they were able to free up an incubator for them. When mother of sick baby number 1 asked mother of baby going to incubator what was happening, she literally told her, "It's because we know a certain doctor here"


Needless to say, it didn't take too long for both families to descend on our asses with full force. Not only were we outnumbered but there were other patients that needed management and they were just getting in the way of that. So I decided to go outside and talk to about 10 maniacally angry family members, who saw me as the devil's bastard son that never lived up to the devil's expectations. Like Peter The Pied Piper, I lured them all outside with my white coat, that they thought needed a little bloodying.

Keep in mind I did not see this 'fabled doctor' that brought a patient upstairs. So I operated on the basis that this did not happen, and that the mother was full of shit.

I went outside, and decided to talk to the two fathers; one very calm and one very VERY angry. Very angry dad shouted obscenities at me and kept threatening to destroy the hospital and everyone in it (normal fluffy stuff for doctors who have been to the Emergency department) and I tried to summon every ounce of my being to appear sympathetic. Its not that I wasn't. It's just that it's very hard to be sympathetic to a man who's constantly slurring at you with violent obscenities and things he'd like to do with your anus. After successfully calming him down (by promising to show him that we really don't have any incubators available) calm father decided to interject.

"Doc, listen. I work as hospital security for another hospital, and I know and you know, that if I want to secure a place for my son, I'm going to go ahead and do so."

Very normal, albeit a little bit irrational, statement from calm father. Now the thing is, he was saying this to me as he was pulling a gun out of his jacket.

Puts a whole new spin on that last sentence now doesn't it?

So there I was, not quite at gun point because he never pulled it out entirely, but still very much stressed out by a man with a gun who just threatened to kill me.

I did what anyone would do at said moment.

I smiled and laughed.

Okay maybe not anyone.

I asked him "Are you threatening me?"
"Not at all, I'm just showing you what I'm capable of."
"So you are threatening me then. Well let me ease this for you. If you kill me right now, that still won't free up an incubator for your son. The only way you can free an incubator is for me to direct you upstairs and have you kill one of the babies inside one."

That totally caught him off guard thank God.

"What the fuck are you saying? Of course I'm not going to kill a baby."
"So you're going to kill me? A man trying to stay awake for 24 hours and at the same time trying to help as many sick kids as physically possible."

That shut him up.

He put the gun back in his pocket and started crying.

I took everyone outside and gave every cigarette I had to everyone and we all shared a smoke and calmed our nerves down. That was it. Just as easily as the situation escalated, it was easily defused again.

There is a happy ending and there is a sad ending to this story. Angry father's baby managed to stay stable enough for them to find an incubator the next morning. Calm father's baby didn't.

There is no point to this story. I am not angry at the man who pulled the gun out on me. He was a father and didn't know what to do. I'm not sad at the kid that died. He was young yes, but there was alot wrong with him so he's definitely in a more comfortable place right now. I'm also not angry at the hospital due to their surprising lack of incubators (one might argue they have the money and they're not spending it correctly or one might argue that we don't get enough funds but that is neither here or there)

I guess I'm angry at the fact that it's never enough maybe. I don't know. This story was supposed to be surreal and funny, and to my friends that I've told this story to in person, they can vouch that it was.  I think it's because writing it down makes it seem a whole lot more real that it actually felt. A man resorted to something he probably thought he'd never do in his life to save his son.

It's so sad, stupid and brave all at the same time.