Monday, April 14th, 2008
Since 2008 started, I lost 13kgs, knackered my knee, tore my rectus abdominus, twisted my ankle and possibly developed a small crack in my leg bones. I haven’t had much chance to do some of the things that usually help me cope with pressure. The beach is being taken over by large money making machines and there is not a spot where you can reflect in solitude any more. I am never off to go diving. I cant do skiing because of all the injuries and have absolutely no time for reading. Its not quite the start I was hoping for.
I’ve always known that my view of the world will change in 2008. It was just an inevitable result of the way the path I walk is structured. There are parts of me that are different, some I like and many I fear. On some deep level, I am sure I am really just who I started with but on the surface, I am going through turbulent times.
I am not the sort of person that gives up easily. Long ago, I foresaw my life and worked hard to build its little pieces just the way they looked in my dreams and for that purpose, many sacrifices were made. I would have not gotten so far without the support of a source that is neither finite nor conditional and for that I am ever so grateful.
Wednesday, January 2nd, 2008
Half of my friends don’t believe that I used up my annual leave so early in the job and actually spent it doing a course rather than travelling � what�s with that? I am quite happy with the way things turned out. The course is now finished and I will soon be back to work, in a new department though.
I spent last Eid in the desert with some friends where it was a nice break away from the norm. Truth be told, I am an urban person. I like the desert, but I also like my internet connection and hot showers. We had no tents and no sleeping bags but had some blankets so we laid in the open around camp fire and woke up frozen yet refreshed with the first rays of the morning. This is somewhat different from my experience in Qatar where I’ve been for the last few days where you kind of have all the luxuries of the city in the middle of the desert. The culture of camps is much more active in Qatar where everybody seems to be part of one camping group or another. Guys chip in and establish a base in the desert full with electricity generators, TV and satellite connections, kitchen, toilets, etc. Probably more suitable for urban creatures like myself.
2007 just rolled past us. It feels like yesterday when it started. While I did not tick every item on my last year resolution, I am quite happy with where I got. The biggest change in 2007 was starting my life at home which has been on hold for the past 10 years. I have a sense of needing to run twice as fast as everyone else just to catch up. Like the year before, I came to know some of my friends better than I would have guessed even few years ago while some friendships faded with the passage of time. I am closer to achieving stability both on a spiritual and personal level. This time last year, I was still not too sure where I stand with some of my beliefs. Richard Dawkins both enlightened and confused me but on the whole, I am much closer to God than I ever been in my life. I know myself better and I am doing more of the things I want to do and less of the things that I just have to do because of circumstances. Professionally, while I feel much more confident as a physician, my career progression is on hold because of the coming military training which is interfering with exams, memberships and residency schemes. Part of me is feeling guilty however because I feel I could have given it a little bit more even with the overriding constraints. Business wise, I made some deals and reaped the benefit of some decisions and risks I took few years ago. I still did not achieve my material objectives but I am heading in the right direction.
My resolution for 2008:
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-Be a better person who is more approachable and helpful to those around me.
-Pray more on time.
-Socialise, socialise, socialise.
-Start a new business.
This coming year will probably have much less medicine than the three years before it.
PS: This post is dedicated to Jonathan Harris for his project �We Feel Fine�. Never before have so many feelings looked so beautiful.
Wednesday, December 19th, 2007
May you all have a happy and blessed Eid and may all your sins be forgiven and all your wishes come true.
On this day, we commemorate together the acts of obedience and submission performed by Prophet Ibraheem and his family when he was commanded to take Hajar and their son Ismaeel to an uninhabited, barren, distant land and leave them there alone. He submitted and obeyed. When Hajar realized what was happening, she cried out, “Ibraheem! Are you going to leave us in this valley where no people live?” She repeated the question yet she received no answer, so she asked him, “Did Allah order you to do this?” He replied, “Yes.”
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So she said, “Then Allah will not let us perish.” Thus she submitted. Furthermore, when his son Ismaeel became older, Ibraheem received a command from his Lord to sacrifice him. He submitted and so did his son. The family of Ibraheem was a family of obedience and submission. They were tested and tried again and again, but the result was always submission and obedience. Both ‘Eid al-Adha’ and ‘Eid al-Fitr come after performing a pillar of Islam and an act of obedience. Hence ‘Eid Al-Adha and ‘Eid al-Fitr are annual reminders that this life is a test and we must be obedient if we wish to be successful.
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“All who obey Allah and the messenger shall dwell in the company of those whom Allah has favored with His Grace: the prophets, the sincere lovers of Truth, the martyrs, and the Righteous who do good. Ah! What a beautiful companionship!” (An-Nisaa’ 4:69)
Monday, December 17th, 2007
Few weeks back, I was asked to see a patient in our hospital Emergency Room at about 11:00 PM. It was one of my busier oncalls and after tearing myself away from the wards, I headed to ER. My patient had a number of his relatives by his bedside and as is sometimes the case, each gave a different and conflicting account of what has really happened. The old Papa (as some of my Asian colleagues like to call older patients) had cellulites (an infection of the skin) but due to conflicting history and difficulty doing a meaningful examination, I could not rule out DVT (a clot in the deep veins) so I figured I am going to admit the patient, start him on antibiotics for his infection and scan his leg for a clot in the morning. I explained everything to both patient and relatives and sent them upstairs to the ward. They seemed happy.
Half an hour later, I got a call from the duty manager. Someone has been on the phone to her asking to refer my patient to the consultant cardiologist because “he has a weak heart” and “someone mentioned clot”. I explained the situation and told her the clot we are looking for is in the deep veins of the legs and has nothing to do with the heart. She hung up and half an hour later she called again. Apparently, they have been trying to pressure her to pressure me to call the consultant cardiologist (at midnight) and she told them if they have issues with the medical management, they should call me and talk to me directly. Soon afterwards, I had a call from one of the relatives:
- Hi doctor, I am X (job description), and I am calling about Y (the patient), why are you refusing to refer him to the consultant cardiologist.
- Because his problem have nothing to do with his heart. As I explained to the family earlier, he has an infection and a possible clot in his leg and we are doing everything that should be done for that now.
- But he has a heart problem; he should be seen by the consultant cardiologist.
- I understand he has a heart condition, but this has nothing to do with his current admission and there is no reason for me to get the consultant cardiologist from home to see him. If it would make you feel more at ease, I am going to ask my Cardiology Resident colleague to cast an eye on him.
- No I want the consultant to see him now. I know the consultant personally and he would not mind, and I also know Sheikh X.
- If you know the consultant cardiologist and feel he would want to see your father at this time, feel free to call him and ask him to come. Why are you asking me to do that? I have no justification to drag him to hospital at this hour of the night.
- Your Bosses would not be happy to know you have not called the consultant cardiologist when I asked you to.
- I assure you, I am doing what should be done to the patient now. If my boss wants the cardiologist to come and see him, he will have to call him himself because I will not. In any case, you can go through the duty manager to speak to my boss.
*CLICK* (He hung up the phone)
I went back to speak to the relatives and found that the person who called me was not even one who bothered to come with the patient to hospital and was probably trying to make up for it. They apologised for his behaviour and were grateful for what we were doing. Next day we scanned the patient and he did not have a DVT so we discharged him home and it was a happy ending.
Friday, December 7th, 2007
I took more time off work as pressure mounts before military training starts. Again, the clinical load here is no where as much as it was in the UK where we used to be worked like there is no tomorrow. The difference here is the lack of cover so that although you do 6 or 7 maximum admissions per 24 hours compared with an average of 8-10 admissions per doctor per 12 hour shift in the UK, you feel mentally and physically drained afterward because you are working on your own, with limited senior cover and no hospital protocols to guide you. There is also the never ending problem of people interfering with your decisions. I have so many stories to tell.
While people here were going a little overboard with national day celebrations (what’s with drivers turning their cars into oil canvases and the dancing through open rooftops?) we decided to have a quieter holiday in Sawadi Resort which had some of the most beautiful beaches and islands in this region. There are 16 dive spots and we are working our way through them. We did two locations in this last trip and finished our AOW requirements but we will be back no doubt if the weather doesn’t turn too cold too quick.
I am half way through a course conducted by KF which has some really interesting and enthusiastic participants. I am quite happy that I got to know such a dynamic bunch.
In terms of social life, it’s simple: I don’t really have much of it these days. I am feeling a little aware and guilty actually that there is an increasing number of social commitments that I just can not attend – things that make our society what it is: weddings, majles gatherings, visits, etc. I am hoping to make up for it with professional progress.
Monday, November 12th, 2007
I have been quite busy recently that I could not update. The first few weeks at work were somewhat light, giving me the time to have a life and do things outside work but the later weeks were hectic, with 1 in 6 on-calls for 24 hours (one day out of every 6 days including the weekend) in addition to management on-call duties. Those have nothing to do with medicine and if it was not for the nature of our hospital, I would have thought they are a total waste of time. They expose us to administrative things that we don’t usually have to think about. I did it once for 24 hours and hated it. I feel sorry for my boss who is practically on call for this sort of thing 24/7.
In my hospital, I believe, the standard of care is excellent. Patients ask to be transferred from all over the country to us because they appreciate how we work. Everyone tries their best to save lives, which is extremely difficult when people turn up in your clinic and stop you in the corridors without appointment expecting you to leave everything you are doing and see them. “But he has cancer doctor, please see him” yes, everyone has cancer, this is actually a cancer clinic, and if I see your dad without an appointment then I have to move someone from today’s list down the line. One thing that surely irritates me is patients’ relatives. For some reason, they believe it’s their right to get doctors to speak to everyone in the family individually, 5 times aday to repeat the same thing. (Multiply 10 patients * 5 demanding relatives * 10 minutes each). When people are not happy with what you say, the next thing you hear is: “I am well connected doctor; I know Sheikh X or Sheikh Y”. I never seen people advertising their connections to get you to do things for them in my 10 years of medical training.
I am also disappointed by other hospitals in Abu Dhabi. Few days ago, I tried to shift a patient who was in a very critical condition and needed an intensive care bed that we don’t have into one of the three neighbouring hospitals and they all refused. One of them actually had no shame in saying they had a bed but they will not accept the patient because his chances of survival are very slim.
It’s not all bad. People do appreciate what we do. Boss is very patient and understanding to both patients and doctor’s need and he tries his very best to please everyone and it sorts of cascades down the organization. Nurses here are far more competent than NHS nurses and it does help a great a lot when you are having a bad night. I find morning meetings fascinating as our consultants come from all corners of the globe and each was trained differently. It is interesting to see the different opinions of the same clinical scenario.
Saturday, October 20th, 2007
It pains my heart to say that bad quality services are the standard here. Businesses go for the cheaper option, they import cheap labour, they do not spend on training their staff and they certainly do not appear to care what you think. I emailed the letter below to Carrefour through their website, but, as expected, I heard nothing back (I spoke to their duty manager in person then emailed her straight away and included all my contacts hoping they’d care enough to write back or aknowledge the feedback at least)
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To: Rana Zantout. Duty Manager
Carrefour. Airport Road. Abu Dhabi
Dear Rana,
I hope this reaches you in good health. Many thanks for agreeing to discus the complaint regarding my encounter with your team today the 16th October 2007 at 23:00. I had a disturbing experience which left me unhappy with the quality of your services. This is a summary of our discussion:
- You are obviously under staffed for the number of customers you serve. I had to wait for 15 minutes today for someone to be available in the electronics section before giving up all together. I also had to wait for 30 more minutes to speak to someone from customer services.
- Your staff appear to go out of their way to avoid customers. They avoid eye contact, constantly appear to be rushing from one end of the isle to the other and talk to people in few shorts words while quickly passing giving a fantastic impression of: “look, we are too busy to stop and talk to you – what do you want?”. I actually had to physically tap a sale’s person on the shoulder because I could not get his attention any other way.
- Your customer service disk is manned by a Trolley boy (that’s actually his job description) whose sits cross legged responding to every query with “Yes” even when the actual question is “Who is the duty manager tonight?” My guess is that trolley boys aren’t really trained in how to appropriately respond to disappointed customers.
Good eye contact, unthreatening body language, team work and even smiling when talking to customers are all basic skills that people working in consumer-related industries should practice. I believe your sales people fail in all four tonight.
Based on my experience, I would rate your service as “very unsatisfactory”. I intend to stop shopping in Carrefour and take my business to your competitors.
Yours sincerely,
XXX
Cc: Customer Services Manager. Carrefour . Dubai
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Its at times like this that places like thelounge shine. CarrefourUAE could probably learn a great deal from the way these guys do their business and treat their customers. And no they are not based abroad, they are in Abu Dhabi only 5 minutes drive from Carrefour.
Thursday, October 11th, 2007
Mbarken 3eedkom w 3asakom men 3awadh. May you have a happy and blessed Eid and may all your sins be forgiven and your good deeds doubly rewarded.
Tuesday, October 9th, 2007
Few days ago, I walked into the cardiac investigation room where a colleague was hopelessly trying to convince a local patient that he needs urgent angiography. He had three months of chest pain associated with exertion and when we put him on the treadmill, he did not last more than 90 seconds before his cardiac monitor was all over the place - an indication that one of the big vessels in his heart is blocked. I thought there was a good chance for me to put some of Manchester communication skills into a local setting. The patient wanted to go home and come back after Eid to have the procedure. We wanted to do him straight away because he could drop dead any minute. I introduced myself and asked few questions about his history and explained the results of the test and the need to further evaluate him with angiography. He was having none of it and responded to every sentence I said with “After Eid after Eid!”. He must have repeated it about 30 times in the space of 5 minutes and that’s all he said until I decided to pull some Manchester tricks on him.
- Look, uncle, you really need this test right now or tomorrow at the very latest.
- After Eid after Eid.
- This wont do, we need to find whats wrong with your heart.
- After Eid after Eid.
- You may not have that much time with your current results.
- After Eid After Eid.
- Look, you may drop dead in the car park before you even leave the hospital.
As soon as he heard the word “dead”. He looked at me in shock and anger, graped his head turban and said with a tone of finality:
- I am leaving!
and that was that.
I decided to retreat with some dignity and leave him with his original doctor. Later, I saw him at the reception where he had his angry eyes fixed on me as I crossed from one end of the corridor to the other. So much for trying to help! Luckily, a colleague with more local experience was able to convince him to stay and have the procedure done which confirmed that he had significant blockage around his heart and needed urgent surgery.
Moral of the story: you are not allowed to use the death card on local patients.
Thursday, October 4th, 2007
My new hospital is dominated by RSCI graduates and Canadian trained consultants. The medical protocols are mostly American. The UK appears to be off the radar screen of most people. Its frustrating and takes more hard work to be in the same ball game as everyone else. There is a little bit of chaos too: people turn up on the ward not having been admitted via the usual entry routs into the hospital (A&E and outpatient). They kind of just speak to someone in charge and show up for admission - which I have experienced before in the UK but to a much lesser extent.
The patients are a joy to look after. I have not yet come across a local patient who did not say a prayer before leaving the room. They tend to make a mess of their health though by picking and choosing services. They would come to us for a consultation, ask for a report, speak to private doctors, go to the next door government hospital, visit Thailand or India or where ever, have something done there, come back to us and ask for something else that we did not recommend in the first place. We are often left to pick up the pieces here and there.
On a personal level, its a little bit of a challenging time. I am trying to distract myself with hobbies and interests but its not an easy job. Inshalla things will work out for the best.
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