January 2018

Day of Doom

I’m surprised that humanity didn’t reach its doom, by January 2018. Many prophecies in my lifetime predicted the end of the world. Also, I’m amazed that my vocabulary evolves to include phrases as such as: “in my lifetime”, or “in the last 20 years.” I kept revisiting the concept of being old whenever I create a music playlist. It’s funny when I play 90’s or early 00’s song to the young generation and tell them: “this song is older than you.” Definitely, I have some songs which are older than me too. My Spotify account is: “sweetmare” I welcome followers.

As I’ve grown into my early thirties, which could be my recent writing theme, I have too few new things to try for the first time. I remembered writing like 8 or 9 years ago about the list of things I want to do before reaching 40. Anyway, I strive to inspire joy from little things I do. The fun of making a music playlist is immeasurable. All I can say that it brings back nice memories of the last 2 decades of my life. It’s funny how difficult it was to obtain a CD of good music. It was only available in wma format, mp3 wasn’t created yet. So, you can squeeze only 60 or 70 minutes into a CD. I remember going far and beyond in Damascus roads and old neighborhoods to have Backstreet Boys or N’sync last albums. How I could wait for hours to download a single audio file. Everybody is enlisting the new year resolution and my resolution is a music playlist and resume blogging.

My father generation’s witness the “jump” in basic life needs. You know, here in Saudi Arabia 60 years ago, there were no cars, stable electricity grid, or sanitary infrastructure.   Yet, we survived and still living the information revolution. I really wonder if all the humankind knowledge and everything we create or produce is available online. It’s far beyond music, books, or porn for all that matters. If interested, the "pornscope" episode on the Big Mouth show did a nice illustration. The big data where everything can be told or monitored. So, the basic idea; is all the produced and preserved porn through our civilization, which extends for more than 100 thousand years, uploaded on the internet? That could be the ignition of an endeavor to spend a “lifetime” only on the net. Then, after a person expires, we all fancy that he/she could save everything stored in their mind somewhere on the cloud. Imagine if we can do that for Shakespeare’s or Einstein’s or even for Stephen Hawking’s brains.

I’m sure all of you are aware of Einstein’s brain story. How Thomas Harvey, a pathologist at Princeton hospital, stole Einstein’s brain after his death and underwent a tremendous amount of troubles in order to save it. Afterward, the brain was studied extensively, and some slices were sent to scientist around the globe. Last study to my knowledge was published in 2014 restating that Einstein’s brain structure and cells proportion is different than other humans. So, what makes an individual smart, criminal, or poet? Anyway, what’s brilliant about Einstein that he didn’t want to be idolized. He wanted his remains to be cremated and scattered secretly. You can refer to this article.

I decided to start writing again, on monthly bases. I’ll publish on the last day of every month. That could be the only way to keep a piece of me alive long after I pass away or my super inflated ego thinking “Einstein” of itself. Indeed, Arabic communities being too passive relying on producing a hire as a guarantee of eternity. Nah, I’m kidding, this is just a water drop which will be lost and long forgotten in the ocean of the scary internet. Until next month, I thank my beautiful wife for trying her best to spare me a time to write.

CanMEDS

Two weeks ago, Feb 5, 2014, I was invited to a course sponsored by my hospital. The CanMEDS Framework is an initiative by The Royal College which describes seven rules for a competent doctor. The one day course was held in The Novotel Business Center. It was conducted by two physicians from National Guard Hospital, a pediatrician, and  an obstetrician. All the residents of the hospital were invited, but fifty only attended including a rotating residents in the hospital.

The Novotel has a good advantage of spacious parkings outside. The lobby is very big, and well lit by the sky light. There’s a coffee shop and the seats are crowded with what looks like a businessmen, in contrary to Sheraton, where the atmosphere is more chitchat and friendly. The meeting room on the ground flood was medium size. It was very irritant and shaken by the ventilation ducts for the AC. The sound system was average. As I suited in the first table, I think people on the back faced difficulties listening and looking. The lunch was good, with wide varieties of food. However, we where assigned to specific tables. For the rest of tables, were for other companies. 

The workshop was running too rapid to catch up with the schedule. It was very good of the tutors to start on time. However, the contents were supposed to be covered in two days, at least. They emphasized on some points which were supposed to be directed to fellows, at least, or consultants. They tried to be interactive, involve the participants, or start a small groups discussion. In addition, they used some video clips to demonstrate some points. Again, the time was very limited. For sure, I’ve learnt something new after this workshop. However, are we ready to integrate such changes or improvement in our programs?

First, it’s a very nice gesture of the hospital to invite us. The aim to improve the residents and expand their knowledge, competency, and efficacy is always appreciated from our centers, specially non academical institutes. According to the mentors, another session a day later will be suited for the senior stuff in the hospital. That gives me more hope to be on same page, and have same expectations, with my directors and seniors in the hospital. Specially, with a proposed framework which implements many changes, modification, and nonacademic activities. This, hopefully, may facilitates the process of observing a different approach in teaching residents, as well to involve us in such activities. 

After this course, I had an example to compare my current situation to. Indeed, the Canadian model is more advance and richer. So, what’s CanMEDS? A patient centered approach is the most essential pillar in the healthcare. This should be a definite point, as the patient is the primary receiver/costumer for our services. However, dealing with the super inflated ego doctors is a major obstacle to deliver the service. Also, many doctors lack the skills in fields which intersect with the medical knowledge, or clinical skills. In addition, professionalism with patient and colleges is a fundamental aspect for a competent doctor. Throughout the day, we passed through the seven roles in CanMEDS framework. And I have a lot to say.

The roles are: Medical Expert, Communicator, Collaborator, Manager, Health Advocate, Scholar, and Professional. To be a better doctor, a physician should obtain these skill. I discussed few points in the previous paragraph, and I realize the discussion may expand longer to cover such roles. You may reach the website to read more about them.  What prevents us from applying such framework in our residency program? A doctor timetable for one day covers most of these rules. You should be expert always. We talk and listen or try to listen to our patients. Honestly, listening is an important skill. I learned to ask  patients after conducting my interview if they have any questions. Yet, their lack of knowledge in my field limits their question to the time and length of surgery.  We manage the resources; humans and materials around us. We read research papers, we learn, and teach on daily or weekly basis. But all this may pass unnoticed by us or by the director/moderator. Therefore, the course is conducted for seniors and juniors.

The major difficulty is: the perspective of a resident here and in Canada. We can’t partially adopt a model, either we take it all or leave it. The resident is a cheap labor who is expected to work until exhaustion. The situation varies from a center to a center, but in general we only work, mechanical work, like robots. Meanwhile, in the other side of the world, residents don’t take a twenty four hours on call, or more, like what we have here. In many occasions, a research paper which is made by the resident will have a consultant name before him or her. Most of the times, a resident will be limited to work in the clinical setting excluding him or her from being involved in the decision making on the level of a policy, program, or department. Until we become consultant, the consultant thinks of us as immature doctors. Anyway, I don’t want to be pessimistic, many things start to change, and I hope to witness the change. 

How to improve the image of the health stuff? This was encountered briefly during the workshop. The answer provided by the mentor was to follow an organization which regulates, protects the stuff like the saudi health commission. Still, the commission isn’t capable of controlling all the doctors under its umbrella. Despite the meticulous process of approving and verifying the doctors credentials, fatal mistakes occur. Beside that, our community is medically illiterate. I would blame mainly the doctors, as they lag behind applying the role of health advocate and promoting medical education.

To sum it up, the fact of arranging the course by the hospital is a promising gesture. The tutors were very thoughtful and helpful. We’re learning something outside the clinical side, this will provide the community with more competent doctors. This way, we may regain the sympathy and trust of our community.

Why Anesthesia?

The first rule is: "Be humble." That's all it takes. This is the initial advice of my mentor, and it’s the one which he emphasized on the most. It may reflect on every aspect of my life. As it drives me to realize that all the knowledge I have is nothing in comparison to the universal knowledge. It makes me more sympathetic with juniors and appreciating the seniors. Modesty puts everything in order. Yet, why doctors, in general, are arrogant? 

It took me 7 long crude years to be a doctor. During that period, I've seen people around me graduating, starting families, establishing businesses, and moving around. All I had is my books, my mild depressed attitude, and a big wholesome of worthlessness. Children can't appreciate the time. It's pointless to promise them for something tomorrow or after a month or a year. A direct reward system is the best for them. Some over grows this habit, however, it's stuck with a lot. In my scenario, I didn't come to realize how long it may take for me to reach the goal, until I chose medicine. This's a big dilemma for high school graduates. How are they supposed to choose their life path while they lack knowledge and guidance? Also, not to confuse guidance with imposing or forcing an option.

I will be at least 35 until I start my golden time of my career. Then, I should be a consultant, an active member in forming health policies, and a successful husband and father. Still, in reflection, every time was a golden period. Because, I didn't expect a peaceful period. There is always a battle going on. As I win, it's always a golden time.  And as perspectives vary dramatically along people, everybody has his or her own battles. Despite that, we live to prosper and flourish. This's our only chance. In the fact, we could be the only chance in this massive universe. Or, we're the first prototype, aren't we? Since our universe is very young to have an opportunity to formulate a smart life form. It took around 13 billion years to provide, gather, and interact all the elements to create us. For sure, it'll need longer to have a smarter form. 

From anesthesia to the universe is not a far trip. We deal with physics, chemistry, and biology of micro and macro scale. Though, it's not like high school or university, for there's always a life on the steak. I'm now on the first step of my trip in this field. I'll build and be built from scratch. Yet, I feel like there's a big bang inside of me. There's a lot of energy, enthusiasm, and hunger to learn and work. For the sure, the universe has a purpose. So, is it called luck to choose something I like, to find out later it leads me to another thing I like more? 

Every specialty reflects its own character on the doctor behaviors. I think anesthesia reflects quietness, self control, discipline, and modesty. Why is the modesty? Because despite how expert I may become, I should know that my abilities alone may fail me. So, in contrary to surgeons, anesthetist shouldn't be fooled by their skills and competencies. So far, I did around sixty intubations. Would you imagine my feelings after 600 or 6000 intubations? Here lies the trick. 

Let’s talk practical anyway. My choice is based on personal preferences. That doesn’t mean everybody choosing a particular specialty have similar personality. I prefer short term encounter with patients. I’m self centered when it comes to appreciation. I don’t need someone to thank me or acknowledge my efforts. In fact, I forget the patients I deal with quickly, as they do. I wish they did, as I remark to my success with the status of amnesia. I like to utilize my medical knowledge, and anesthesia is more like a combination of surgery and medicine. We deal with a wide variety of morbidities, surgical conditions, and in remote areas. In contrary to internal medicine, I have different skills and direct intervention. Most of the times, our management is absolute, not compensatory. In contrary to surgery, we manage the airway, we know how to deal with medical conditions and emergencies. I like to see a quick outcome. I’m the pain killer. Also, I’m the master of the OR. And it’s very easy for us to put people to sleep. Do you imagine how important sleep is, especially when a person suffer amnesia? Also, I like well controlled and quiet atmosphere like the operating room. Anesthesia is a relatively new field which is promising to expand and offer more opportunities. 

Anyway, after a long journey of studying, working, and practicing I'm here starting from point zero. It's too early to formulate a future plan, but I shouldn't delay such step. However, I’m very lucky to start with an excellent mentor who is very helpful and concerned how to formulate my career life. I’m building out of scratch by him. And the six month's encounter I had with him will be engraved in my memory, style, attitude, skills, and knowledge. It's too difficult to catch up with everything, and my time is short, but I’ll try and keep trying.