"Bu bayinya cuma sebesar 3 gelas aqua"

 

“Bu bayinya cuma sebesar 3 gelas aqua. Karena belum ada otot nafasnya, jadi nafasnya dibantu mesin ya bu,” kata bapak yassien si dokter anak andalan. A very practical way to describe 750 g. 

Fast rewind to the beginning of a day in my life:

Sakha left home to school. I blogged and posted a new writing, turned out people are actually opened the link! U rock guys. Really appreciate it.

Early policlinic. Finish late. Didn’t have lunch yet. Called my husband to grab lunch outside. He said yes, I bailed. Because of this tiny human being (walaupun terkesan i blamed the universe, sebenernya i felt honored, biasalah perempuan, suka gengsi) :

 

Meet Bayi Ny. A.

She is quite a fighter, and her mom also a fighter. mukanya cuma half of your palm..

Look how long her diagnosis is:

Absent end diastolic pada G4P2A1 hamil 27+6 minggu (USG TM 1), JTHIU, janin IUGR (p<2.5), air ketuban berkurang tanpa ketuban pecah (ICA 6), ibu dengan:

- superimposed preeclampsia with severe feature

- AKI dd acute on CKD (Ur/Cr/eGFR 51/1.5/43)

- asites

- hiperuricemia (9)

- hipoalbuminemia (2.2)

- obesitas grade I (IMT 28 kg/m2 )

- BSC 2x

Basically, she got underlying hypertension way before she got pregnant. Then, because of the presence of the fetus and placenta inside her womb, her vascular started to fail. The vascular in a proper function should be able keep the water and protein inside the vein. But, in this mother unfortunately, water and protein start to leak because of weak vascular wall. This is when the basic become complicated, the kidney, the liver start to fail, the eyes, hand, feet, all swollen like a bee sting but this is not localized swells. we decide to deliver the baby in order to save the mother avoiding further damage.

On the other hand, the baby is not fully mature. We needed her to be taken care of outside her mother womb because her surroundings cannot provide her enough. The baby was oxygen-deprived, she was not able to produce urine (she was thirsty inside). She wasn’t getting bigger her growth retarded. She supposed to be 10 more weeks longer in her moms belly.

The surgery was a some way more difficult, but compared to my own overthinking prediction, Allah gave a lot of ease. The mom was on obat anti pembekuan darah yang seharusnya dihentikan 2 minggu sebelum operasi. Because this was an emergency, who the heck would know to stop the drugs 2 weeks prior? So I expect its gonna a bloody c section. And because the water and protein leak had been so massive, we could see a fluid collection in her abdomen from ultrasound (which is no free flowing water should be in between abdominal organs). So this surgery was like a flood and bloody.

When we cut open the belly, we aspirate 1500-2000 cc free flow ascites. The womb so small, we need to resist the guts from going in our way. She got 2 previous caesarean section before, this means a bit more challenging compared to mothers with no previous history of belly surgery.

The placenta was in the anterior wall of the womb. This means I need to damage the placenta to reach the baby. Placenta is a thing you need to avoid in order to save blood. But in this case I need to parkour, jump n go straight to the baby, I cannot walk in the proper street. I need to jump right into the placenta which covered the entire anterior uterus. Kalo mau ke posterior/dinding belakang rahim itu lebih nyari kerjaan. Karena simply ototnya lebih tebel, susah ditembus.

We took the feet out first, then hips, torso, the hands, and yang paling susah kepalanya. The head was so fragile. Enyoy like pushing a plastic of gelas aqua. I felt like am I gonna break this fragile neck. The temporal bone is so like tulang muda yang direbus kelamaan.

Once the cut the umbilical cord, I handed the baby to the pediatrician, praying, nangis pls nangis. And she did. A very weak cry. But still. Huff. I didn’t kill the baby nor break the neck ehehe. Sebenernya the bone of a newborn still very mobile and flexible. It is hard to break a baby neck even thou we twist the wrong way, as long as you didn’t put power/pivoting the neck.

And mas yassien, the pediatrician, who deserves a post in my blog actually, said that the baby was small like 3 gelas aqua. I hope she will survive, although its very thin for 750 g baby. The baby was taken care in the baby intensive care with all sophisticated machines. And mom also went to intensive care but she is stable and no need sophisticated breathing support. I hope all is well.

I went from hospital to my rumah sakit pengkolan. And called my husband, can we have super late lunch to our favorite sate maranggi place. then we called it a day.

A Prayer to Die with Dignity

Sept 13, 2024 0645 hrs

Have you thought, wish, and pray on how you wanna die?

We do heart-pulmonary rescucitation in our daily basis to near-death patients. our hand plays like we are the god who can bring people back to life. In fact, I cannot resist the feeling for not knowing thing I did is just useless or gonna change something.

Obviously, I cannot see the line when a soul has leaved the body. I was just gonna stay there, be there pumping, focused on to bring the soul back. Being the one who hold on to this person, believing at some point she might come back. when i got tired, we switched to other doctor/nurse with the same belief that she will live again.

Her breath was shallow because she was intubated, the machine helps her breath. We pumped the heart, the heart was still at tone, but it was our rhytmical pumping on her chest doing compression. We faked a dead into a living. But we couldn’t resist the fact that she passed away. We called the time of death.

While she is there naked under green drapes. Leaving the world undignified. She might not wish to die like that.

Sadly, no one whisper laa ilaaha illallah to her. No one celebrates with her for the fact she was preparing to live in the permanent hereafter. No one plays role as a talkin, the one who lead her to say kalimat syahadat. We need ustad in our code blue team, definitely.

Recalling steve Irwin who died while doing things he loves to do. I think I was in summer school in the states when people was like whattt he died? By stingray? I thought hes gonna die by snakebite or crocodile chopped something off. I used to watched him with his great showmanship a lot of dangerous surprise movement to certain poisonous animals. That was an epic way to die.

my grandpa died in a plane crash. my grandma died in her sleep. my other grandpa died sick in hospital. my other grandma died in hospital. why? why Allah give such and such scenario what did they do back then to receive such way to die?

I recall I always pray shalat mayit in after every shalat fardu. So many people died in mekkah n Madinah. At the time, I think it was the ultimate way to die. To have people around the world actually prostrate to ask Allah to give the dead’s forgiveness.

Then I thought I wanna die in my prayer. They say, in order to die in certain way that you like, you need to do it often, most of your time, that ofcourse in fact increasing the chance to leave the world the way you wanted to leave.

That is what I have been praying for.

Although, every unhumanly midnight I need to drive myself in a hurry to hospital might be, you know, the foolish way to die. Masih ngantuk and adrenaline rush itu funny combination. But im just gonna add my preference to die in every prayer I made. 

an aircraft can stall anytime. do you think you have much time?

 

Sept 11, 2024. 1316 hrs

 

"those who gave you serpent when you asked for a fish. may have nothing but serpent to give." Sand and Foam. Kahlil Gibran

 

i dont know how to put it in sentence. but reading that phrase made me frustrated on how human connection can be wrongly accused just because we dont declare our intention or circumstance. Cant they just give and receive out of respect? So much niche for misunderstanding, so many steep ladder we could fall for being misperceived.

 

let me try to verbalize my urge to be someone who helps.

when i was in the car, pulling out from toll road and paid my etoll, i saw a women, got her ponytail, modest clothes neat not too much. decent bag and all matched. middle age, brown skin tone, with 5 cm wedges walking up the road. it seemed like she just got out of a bus/tebengan, and made her way to certain point.

"that seemed like a harmless women, and theres only one way from this jalan keluar tol to the nearest junction and its quite a walk. how about if i rolled down the window and let her come in to my car?"

and my moral compass might have been overly used compared to my logic agitatedly said, "gila emg ente din. in those bags, she might have a knife"

 

and i have that constant silent battle within me telling me to should or should not do this or do that. padahal kenapa sih mesti takut, i thought. for every sunrise and dawn God protects me, a'udzu bikalimatillahittammaati min syarrimaa khalaq. dear Allah please protect me with your perfect decree from corrupt form of Your creation. I have this invisible armor. So most of the time i just dive in.

I am mesmerized on how the universe works in a comprehensive way. Since then I never resent any wound, I enjoy every silver lining, I like the feeling of putting one feet on the edge of a cliff, and believe that we will not know what tomorrow will hold, but I bet God will make a better story than my head can comprehend.

Contented and grateful with what I have now, I came to realize that even in the assurance of the safest transportation mode, an aircraft can stall anytime. From various phase of life I have been experienced, this exact moment resembles the relieve of successfully putting my own emergency oxygen mask on. The vacancy in every worry has been patched and I am so ready to leave with the craft . I now have the power and urge put oxygen mask to other people.

But why some are so resisting?

the most inferior conduct an eye can do is judge

 

Sept 10, 0727 hrs

I once read a phrase questioning why human has two ears and one mouth. Being surrounded by arrogants, sometime self centred, and little altruist in hospital and how easily I got entertained by watching Simon Sinek, Trevor Noah, Hasan Minaj, Mufti Menk, Yasmin Mogahed, i easily judge people by the way they deliver their thought in sentences.

But why they only have one mouth thou? They speak beautiful language. I think because when you say something, congregate the chosen diction into sentence, and finally decide to vibrate your vocal cords, then the thought is ready to be spoken out and you are responsible for it. its a complete conciouss process

the ears on the other hand, they only receive and perceive and interpret of other peoples’s delivery. The ears are not crawling inside the opponent’s wiring brain and be a part of the thinking process. We need two ears to accept the stimuli and to understand and to patch each other with data they might miss.

This morning I got stuck in a long queue to get out from my housing complex. I left the book I currently read, Maktub by Paulo Coelho. A book was rather boring because he stops doing 'imply', now he 'tells'. I don’t need so much synapse to digest the book. But theres a story about a beggar and a bag of gold that I really like I wanted to post it, but I left the book.

Another book that stays in my car was the jungle books by  kipling, and the opposite of spoiled. I decided to open the book where I left it, where the bookmark divides.  And that was the end of a chapter saying :

 

“ These are the Four that are never content, that have never been filled since the Dews began—Jacala’s mouth, and the glut of the Kite, and hands of Ape, and the Eyes of Man.”

 

Jacala is the crocodile, kite was the bird. I don’t really care about those two. But hands of Ape implies something that struck me (this means kemaruk people is just an analogy of an ape). And of course the eyes of Man.

Why do we have 2 eyes? Beside of the physiological function that I understood back when I was in pre clinical class. We need two eyes to adjust the dimension to wire and give hint to the brain how much distance we need to get to certain object. BUT! Eyes also can be so deceiving. Try to close one eye. The light gets darker, your fingers are closer. I once hit the sidewalk when driving sambil ngucek2 mata. Because my brain processed my surroundings only by one eye.

But so many things we can obtained by using our two eyes. For me, I can see if the patient is in pain by seeing their walking gait. And I can directly assume that she is in labor, lets say. In the contrary, if I believe my eyes too much, I will stop confirming and stop asking further question to the patient, I wont ask "were u in pain?" "When was the pain start?" "Is it pain or pegel or what?" But to communicate is the most fundamental element in resonating ur worry. We need to reach with all senses we have. Not only by our own two eyes. 

I need to sense the contraction by my hand if she is in labor. I need to hear the gritted teeth if she was really in pain. I need her to squeeze my hand so I would understand what shes been through.

Put it in my daily virtual conversation such as whatsapp, text message, email, blog, whatnot. I judge too much. I cannot feel, I cannot smell, I cannot hear, I cannot palpate, i cannot see grimace. So limited source of information to understand a complex human being. How can we communicate effectively, build connections profoundly, having a long lasting relationship or friendship,how can we becoming the real entity for those whos never seen us? How can you believe the beauty of a nature in Instagram? How? Your eyes has cheated on you.

That is why I concluded the most inferior conduct an eye can do is judge. The worse consequences are judge incorrectly.

 

Touch is ecstasy

 Sept 4, 2024. 1736 hrs.

Its a tremendous feeling of excitement after reading this book. 

I have read 3 of Gretchen's books. "The happiness project" was my first exposure to Gretchen. She was very eloquent in describing feeling. Not too vulgar, but just right amount of naked expressions. And i have been falling for her since. 

My family, my mom especially is a hugger a kisser. I inherit the same character more than my 2 siblings. I kiss my mom and dad and son in lips and its very casual, my husband finds it awkward and strange. I kiss my girlfriend in cheeks. And i I always use touch to elevate connection with patients. All of my patients are female thankfully. 

As an obgyn, its hard to make people feel comfortable. Litothomy position is always awkward. I sensed that touch helps my patients to relax. I would touch the knees to assure them that everything is gonna be okay. And i never think that touch is also a strategy to make people relax and free from anxiety. I thought it was just my instinct until Gretchen said it out loud. 

Living in the states was like living my ownself. Im responsible for my own name, my religion, and my country. And finding that hug was a common way to build connection, i felt more like myself. I love german hugger, so sincere. 

Reading the book brings all good memories. Being a muslim from indonesia, we dont much hug at the beginning. But away from sexual intention, a sincere hug helps people. A lot. So unfortunate that it is not our culture and i stop practicing hug. 

Funny story thou how i like hug people, in certain circle i still kiss and hug. But now to hug a fellow male afser, i need to ask my husband for permission. Even thou my husband was exposed also to this hugging culture. I guess to him it exceeds his personal limit maybe. Lol and sad. 

And reading this, oh so much i long for zero barrier in expressing how some people meant to me. Sincere hug is so relieving i cannot portray. 

the struggle to believe in something bigger

 Sept 2, 2024 0734

the last one week has been unpleasant. but i fake it till i feel it. like i usually do. 

back when i was in residency i bumped into Kendl, an AFSer never met him in highschool, found out that we had something in common when i was in Jatinangor. Kendl took dermatology, i thought it was an easy minor. it wasnt. theres nothing easy when it came to residency. but he, gracefully said, "find little sparkle that keeps you going."

and here i am trying so hard i wanna puke to see little sparkles. we're gonna go retrospect. 

sometime in 2005

teguh and i was competing for representing school for newscaster competition. i had been working my ass off  for weeks improving my pronunciations and intonation. and i failed and broken hearted. my logic tried to comfort me, 'yaelah din, he spent such and such year living abroad ohio if im not mistaken,. u r just out of league.' and life goes on, still meeting each other every week, learned a lot from him as sparring partner in debate team. strived for many other competition as one team. 

sometime in 2006

teguh and i again enrolled for  exchange student program. its a 2 year long selection, started with 8000 students around indonesia. i passed, he failed. we went our own ebbs and flows. i told my mom, that a year ago i was having my low, and 2006 was my year, a lot of ups. snd this teguh has been my story, i always referred to that particular phase of my life. and i learned in a competition, no one really compete to each other. they compete with their ownselves. karena sebenernya ceritanya udah ada, how it ends is already written. 

July 2024, in Madinah.

i found one interesting particular person. but i believe in Holy Land, Allah makes a precise step to each individual. 

my cousin went to madinah also but with different travel agency, stayed in the different hotel. small chance i believe we would bump into each other in such big masses, unless we planned it prior. but turned out, we crossed each other on the way back to hotel one day after ashar. we took a picture, send it to our moms. the pict would be delightful for them. mas joko bilang, "lihat dari segini banyak orang, kita ga janjian, kita ketemu, siapa yg nuntun langkah kita kalo bukan Allah?"

i had been praying i could have 1-2 minutes to say hi (and bye) to this interesting particular person. i did not get the chance. until i went back to jeddah to madinah. i finally learned, everytime i prayed for Allah protects me, then Allah will protect me. for not reaching my wish was also because Allah planned so, He has been protecting me all the time. 

August 2024, in hospital

president was coming to our hospital. a lot of extra work a week prior his arrival. we do as we told, i tried to finish the obligation one by one. wishing i didnt have to take my work home. turned out the feeling was like extra exhausted, dull anticipation, not an excitement nor numbness, ga tau apa, rasanya asing, mungkin rasanya seperti mau ujian SOOCA (a kind of exam where i need to stand in front of the class explaining about one case and how it starts, from risk factor to therapy. 4-5 examiners would watch and stare di jaman gw belum tau rasanya berserah diri). in the end, full of failure sih according to my point of view. but then referred back to my highschool and my madinah story. the failure was merely Allah is protecting me from bigger shame/embarrassment or whatnot. 

i usually dont have this struggle. it seemed like letting God preparing my day is enough, He helps me chose the way. i dont have overthink anything. but august has been a roller coaster. cape bgt sampe seorang dinda nulis blog lg itu artinya melelahkan. but they said, thats the point when people grow stronger. maybe my relationship with Allah has been compromised lately. 

Sad puzzle and joyful puzzle

 Aug 28, 2023. 2258 hrs

I ended up my yesterday by arranging food for my son's birthday in his class. He had never celebrated his bday in class. I didnt think that celebrating bday in class would be so necessary. But my husband believed otherwise. 

I decided to drive my son to school and we discussed about things. I realized that there has been so much time i spent not to be with him. Either school, hospital, and most of the time, cellphone. But i sucessfully treasured the moment. God has answered my prayer, i can drive my son to school has been my objective since residency. 

That was a fun drive until i noticed sakha didnt wear the pramuka tie. I almost snapped, but i controlled myself by asking, "dont you get punished if u dont use the tie?"

And he said, no. Well, how much changes in the system nowadays. Back then i would be standing in forn of the class if i missed one of my property. 

I dropped him off and he made sure he had not forgotten our goodbye kiss. Indeed i raised him right with this level of affection he showed to me. And i prayed him ayat kursi. And i left.

Hospital has been crazy. Meetings, emergency room, policlinics, late afternoon meeting, and wrapped up by emergency cesarean. I planned to go home fast. I didnt expect the surgery has to be today. Why the patient come today. Why not yesterday or tomorrow? Why does she have to be there in my son bday exactly. 

Weary by all the sad puzzles, i came home only to accompany him to brush his teeth. My husband was already asleep. I have missed so much in a day. 

But then i believed that the day i had today, just a little piece of bigger puzzle. Today i had a dark color puzzle with a little white and pink and other nice color i might forget to be thankful of. And everyday, i just followed my heart to out one step after another to embrace whatever mystery. 

I am afraid if i resist what my heart say, i might not have such a long time, and i may not live my fullest. 

And my big joyful puzzle is i am a mom of a handsome 9 yesr old boy who still eager to kiss me goodbye. I am so blessed.

Next patient, please!

Aug 27, 2024. 07.40

"Why are you so nice to me, doc?"

"its not that im being nice to you. im being nice because u have depression."

sometimes people just dont understand that doctors go extra miles because we function that way. our surrounding raised us being completely aware of warning signs. its our nature to suspect the worst of a scenario until it is proven otherwise. 

i realized people are now loosing their time in screen trying to be loud of what they are doing. they seek much attention to an illusion. their instagram, whatever account they might have release the dopamine so much they got aroused by likes and hearts or comments. 

see now as a doctor i have treated so many patients that in fact i lost to count how many, thousands? i cant remember their names to be honest. i have encountered people lying, i can sense people hiding behind their happy mask only to find out they are in a greater burden. these people worth my time. i even asked my patients, " did u poop today?", i wiped their poop, some other time i took a shower bcs people cant control their pee.. so dont get me wrong when i even try to put people in the kitchen to share wisdom.

some people are just raised in a different games. some parents crystalize the value of being a straight A student. some parents let their kid go explore and learn from the nature instead. this is where the depression intercept. they are putting so much expectation in life trying to play the same game, while naturally they are not born to be the player yet people expect them to play the same game. 

people try to fit in to society so bad they loose themselves. i lost myself to when thriving to finish school. some people dont get it, they would say, i want to live my life to the fullest. and then, we will back to square one, how do u define living life to the fullest?

your way to live to your fullest might be completely insane and unthinkable and i would say that doesnt fit me. 

i met this guy who are extremely proud of his paddling activity, i just cant comprehend. especially to myself whos eyesight only effective within 20 cm. its the same way my husband cannot comprehend situation in operating theatre. its the same way with the only child who never learn to please anyone has lost so much due to the incapability to serve other people. thats where we dont have to meet people's expectation.  yet some people struggles to let go. some people doesnt have the need for having other people. and that is permissible. that is the dynamic of a society. you dont have to fit in, let yourself be just another color. 

Just stop trying to be a right-handed if you are a lefty.

Intercept

 No date. Because i wish this imply the summary of my lifetime lesson.

Every being i intercept, they will give lesson to learn, whether its the good or heartbreaking. 

And Allah The Most Merciful will let us for our own either to get up and restart or to surrender. 

Everyday i will look around to look for little sparkling the universe provides. Surprisingly enchanting. 

Bener2 Allah Maha Baik. He undestand and provides me. Among all darkness and finally put the sunrise. Sunrise is not gonna be there for long. So I obliged to enjoy it, absorb the meaning of beautiful amount of ray. And then it passes.

Too much ray blinds you.

But no ray makes you gloomy

Highway to heaven

 

Aug 12, 1730 hrs. 

Kematian itu selalu berat. Tapi seandainya mereka tahu dengan siapa mereka akan bertemu di surga, maka mereka akan mempersiapkannya.

We did everything, she came to our ER just too late. Lost of conciousness, no more bleeding, because theres no blood left in her system, no pulse, barely a heartbeat. Dari mana berdarahnyaaa. I need to search. Paling engga, pas kantong darah transfusi datang, itu sumber darahnya udah ga bolong. She might live.

Dr. Apang (my fellow anesthesiologist)  which happened to deserve a post in my blog, did the resuscitation. She died and she came back! Good Lord and to operating theatre we went. With so much hope and idealism. And we pray. 

The obgyns finished the job in the OR while anesthesiologists fighting over RJP. Countless cycle of RJP, no one kept tracks. We just believe she would come back like she just did. 

But she didnt. I guess the angel provides a highway to heaven. Tanpa hisab. Langsung surga. 

Al Fatihah.