e 3 a s h i g R E F L E C T I O N S

After Long Absence

Four months nearly since my last update. This blog is being pushed to the background of my life for things that are far more important but my link to it can not be severed. Its here that I made friends with some of the most interesting people in the online community and it is here that I did a lot of work with great enthusiastic people who share lots of my interests.

When I last wrote in this blog, I had just finished four enduring months as a surgical intern. Straight after that, I joined the psychiatry team at the Royal Bolton. It immediately struck a cord and I enjoyed it a great deal. A colleague once said: people who join psychiatry fall into one of three types; Neurotics who go into psyche because they want to understand themselves and seek enlightenment about their life experiences and bla bla (the rest of it), Lazy Bastards who think psychiatry is a very laid back branch of medicine where you actually get to have a life outside the hospital, and those who love psychiatry FOR psychiatry. I guess there is a bit of all three types in me. One experience in particular will forever stick in my mind.

As a psychiatrist, you learn the skill of connecting with people and putting yourself in their shoe. You understand their feelings and what the world must look like to them. You live the experiences of your patient and you structure the world according to their rules. You merge with them into one. Then, as if by a super zooming out lenses, you detach yourself from that world. You put your patient and everything associated with them in the analysis box and you subject the package to careful studying, structure its chaos, and fit it into one of the pre-defined diagnoses of the ICD-10. At this stage, you celebrate your triumph on the human mind, as everything after is pretty much standard text book afterward.

One night few months ago, I was woken up to see a patient at the early hours of the morning in ER. No sooner that I started the interview with her that she asked me:

-Are you a Muslim?

Now, you learn in that job to leave your personal believes out of the equation:

-Yes I am a Muslim. Tell me a bit more now about those voices you hear.

She totally disregarder my question and proceeded to say:

- Will Allah protect me?

- I am sure he will. Let me now try and help you by understanding what these experiences are like, they must be frightening.

-The devil is coming to town. The devil is coming to town, the devil is coming to town.

I failed to establish any form of conventional rapport with this lady. She will only stop her ever louder and faster circle of “the devil is coming to town” to ask me again something that relates to both my protected religious believes and/or my private personal life. After giving up trying to connect, I asked my senior to take over the interview. She remained persistent in her attempt to explore my world and my personal life, even when I was no longer in charge of the interview. She will respond to my senior in few words then look at me and say

-What do you think of Osama Bin laden.

We made a decision to admit this lady to hospital. And we walked her up the corridor to the psychiatry department. On the way, she stopped at the entrance to the hospital Mosque, looked at me and asked if it is ok to go in. It was one of those questions that people do not want an answer for. She automatically proceeded into the mosque in her muddy shoes and blood stained clothes. I found myself standing outside, looking at her uncomfortably while she prayed that God to protect her from the devils that are coming to town – and failing to respond to the unspoken questions in the eyes of the rest of the company walking up the corridor with us “Is it ok for her to go in? Wouldn’t that dirty your place of worship?” She came out 5 minutes later and we handed her over to the ever so keen staff on the ward. An hour later, I came back to check on her. She said no word initially and kept looking at me with peculiar investigating eyes. Then when I was taking some blood, she said:

- What do you think of Osama bin Laden killing all those people?

- I think it is wrong.

- Why do you think it is wrong?

- I need to know a bit more about you now, we will talk about me later.

- But I want to know now.

- Its 4 Am now and definitely not a good time for talking about me.

- Do you have a girlfriend?

I dismissed her questions, finished what I was doing and quickly left. I felt a great deal of unease having to bring the weight of my private life into the management of one of my patients. It would have got the conversation going and I would have gotten more information out of her if I continued down her line of conversation but I refused to do that. We often draw a thick red line between what is personal and what is professional. And the closer we are to that line, the more uncomfortable we get. A doctor might find it extremely embarrassing and uncomfortable to examine the heart or breast of a friend or a family member, but it becomes so automatic and void of any significance when you are doing it to a patient. And equally hard is using your religious believes and personal life to relate and communicate with a patient.

I also felt uneasy with what felt like a reversal in the psychiatric-patient relationship. Instead of her being the subject of my examination, it so quickly felt like its me who is being examined. My world and beliefs are being put under the microscope of my patient. This is not right.

The care of this particular patient was taken over by another team and I no longer had to endure her questions or take decisions in the management of her condition. I almost forgot about her until one night, I was called to the ward to attend to another matter. As soon as I walked in, my eye caught her eyes and immediately, a cloud of unease engulfed the ward. It felt exactly the same when I first saw her in ER. Since that day, we had a very strange connection. I’d avoid coming across her and avoid eye contact with her but every time she sees me, she’d stop whatever she was doing, and fixate her eyes upon me. In my on call room, I’d log in to the computerized record keeping system and go through what happened to her that day.

I was having my first experience of transference and counter-transference.

Anyhow, psychiatry has not finished and I am now a medical House Officer looking after a whole different type of patients. I was dreading starting my medical rotation to be honest. There is a lot more autonomy in medicine than there is in surgery or psychiatry for junior doctors. I crossed surgery off my list of careers. I enjoyed psychiatry a great deal and now I am so enjoying medicine that I actually wake up every morning and look forward to coming to work.

Having said that, I was so close to signing and faxing my resignation from Dubai airport just before I came back in my last holiday. I came to UK on the 17th, October 1997 and it is May 2006 now. It is getting harder and harder to resist the thought ringing in my head: “It is time to go home”

I stopped and looked today at my New Year resolution. I didn’t do too bad at all. One exciting bit of news is that we have materialized on our project – (read: the problem and the solution for more details). Stay tuned for one of the region’s most exciting online ventures coming soon to your cyber neighborhood. I don’t want to say too much now but you will hear more and more in the coming two months.

With the help of very enthusiastic and energetic circle of friends, my interest in business and the little experiments I used to do have mushroomed into a series of exciting entrepreneur type projects currently underway. I am having a great joy risk calculating and managing my finances – which are spreading quite thin at the moment. What have I got to lose? I am young, single, and have a loving supportive family.

I just finished reading “Banat Arryadh” (translated to Ryadh Girls). Interesting read. The author indicated that it is not a novel in the strict sense of the word and I agree with that. It’s a collection of 50 emails she used to send to her yahoo group, describing the private and personal lives of her friends. It lacks the basic structure of a proper book or a novel. However, I was thrilled to read it because it is the first of its kind in our region – not too vulgar, nor too political, yet very revealing. I think a can of worms has just opened and we will soon see a flood of similar books detailing the problems that are so fundamentally wrong in our society yet so fundamentally essential to maintain its fabric. Well done to Raja Abdulla Al-Sane’ for your courage.

Also, well done to the people in charge of Sema Dubai TV channel. I am not a TV person but I always hated the fact that Abu Dhabi TV feel like it should be renamed: “Beirut TV” and Dubai TV feels like the Discovery Channel. Rare are the programs that address “local needs”. However, only in the last week I saw 5 programs at least on Sema Dubai that have a local theme and orientation to them.

I am also thoroughly enjoying reading “My Vision” by HH Shk. Mohammad Bin Rashid Al-maktoum. Since I was 18, I have always wanted to read an autobiography of him. This is not an autobiography but it’s the closest available alternative.