The M Word

I've reached the ripe old age of 26, and I've noticed that wherever I am, or whoever I'm with, the topic of marriage has come up more frequently. Friends left, right and centre are getting engaged and married, begging the inevitable question: "When is it your turn?".

Yes, the question is usually asked just to fill a gap in the awkward silence that usually accompanies being in my presence, but I have started answering it with "Why, have you got someone in mind?" (because it wouldn't hurt to make things that bit more awkward). Their answers have more or less been a no, and either way, I'm not sure I'm a fan of the 'spouse via referral' methodology. I know there are people who are living happy lives (as far as I know) with people who they've pretty much blind-dated their way into marrying, but I think it can be way too risky. When two people are talking to each other for marriage purposes, everything can be so artificial; for the short periods of time that they do meet, everyone is on their best behaviour, and there's so much chance to pretend to be someone you're not (this is also assuming your thorough 'background research' into the person, which requires some degree of trusting referees, produces no red flags). The potential to discover something unsavoury about your partner later on is too great, but I suppose this danger exists whichever road you take.

The alternative to the 'spouse via referral' method? Meeting someone out in the big bad world also does carry massive risk. In fact, this whole marriage thing, whichever way you approach it requires some dice-rolling and praying that you find someone who isn't a psychopath (and remains that way; because people do change believe it or not). Why not just avoid getting married at all you ask? As pertinent as that question is, despite me absolutely enjoying the 'freedom' I have to go out whenever I want, and spending time with friends, there are those moments alone where you think 'well, this sucks; this experience would be much more enjoyable if I shared it with someone I'm in love with', and as many of my friends are beginning to move on with their lives, I find those moments becoming more frequent. Plus, children don't just come out of thin air.

Before I continue, let's just establish one thing: human beings are not perfect, and a lot of the time, human beings suck at being decent people. The trick is to find the special ones who value other people over themselves, and then hold on to them. I think finding them requires a degree of trial and error, inevitably leading to people getting hurt, so it would probably be a good idea to have a set of criteria before continuing the search. Two issues arise here: what are one's criteria; how does one formulate these criteria? And what happens if you meet someone you really like, but they don't exactly match the criteria you have in mind?

I haven't really got exact answers for either of these questions; some people do, and good luck to them, but sometimes having a rigid list of what to look for in a person can be limiting. Having said that, apart from having a 'feeling inside' that I like someone, there are things that I probably can't compromise on.

I love Allah (swt). And even though I am continuously ungrateful for what He has given me, He has been there every step of the way on my journey. In the future, I would like to be in a position where I hate every sin that I commit, and love doing good deeds for His pleasure. I need someone who holds similar values to me in that respect; someone who can motivate me to be better.

There are obviously other things that are essential: physical attraction (defo), personality (I'm surprised at how many people overlook this quality), intelligence and the ability to hold a conversation that doesn't kill my brain cells. Someone who's kind, and can tolerate the presence of children. I think that's about it. Oh and someone who isn't tied down by pointless culture. Can't deal with that nonsense.

Yes, I realise I've just semi-compiled a list of criteria. But these are things everyone should be looking for. What we see unfortunately is human beings feeling insecure, and the second someone shows them a smidgen of attention, the 'single' label goes, and later on they find that they're with someone who they don't actually connect with.

I've been told that as long as the girl's heart is in the right place, then I should go for it, and worry about the other things later down the line. But what if she doesn't pray for example? Do I raise the issue before or after we get married, and is it fair for me to go after someone who may not necessarily do these things and then expect her to change afterwards? I have met some beautiful people whose hearts are in the right place; in fact some of the best people I know are amazing character/moral-wise, but may not fulfil certain other criteria. And conversely, I've seen people who tick all the boxes religious obligations-wise, but completely lack manners or personality. I've probably had better conversations with a box of tissues than some people to be honest (but that story is for another day).

So where do I stand? Alhamdulillah I've got more than my fair share of female attention for some reason, but how do I know who I should 'go for' and who I shouldn't, if at all? Apart from the qualities I've mentioned above, it would probably be a good idea to get my mum's input on this. The issue is that her criteria restricts my choice quite dramatically. Whilst I respect her opinion and take it on board, there are things I disagree with to some extent, but understand her reasoning for having such criteria. I've learnt that many, many females out there are a waste of the oxygen they breathe (without being judgemental or anything, but it's a fact), and having a system to sift out the best candidates from the rest would probably be a good idea. There's just an inner conflict inside me that makes me wonder if being too strict would make me ignore the real gems whilst I'm looking to get all my boxes ticked. This is assuming people would want to marry me in the first place :P

Everything is already written. Our life partners and our children have already been decreed by Allah, but the fact that we don't know who they are makes us worry. What do we have to do to find them; are we doing enough? Do I wait for a girl to express her interest in me or do I have to take the first step? Have all the 'good ones' been taken in the time it's taken me to write this blog post?

What I need to do right now is keep working on myself and my relationship with Allah, and just maybe inshaallah the right person will just pop into my eyeline when I'm least expecting it.

"...And whoever fears Allah - He will make for him a way out. And will provide for him from where he does not expect. And whoever relies upon Allah - then He is sufficient for him. Indeed, Allah will accomplish His purpose. Allah has already set for everything a [decreed] extent." [At-Talaq: 2-3]

Post-Hardship Ease

I remember there was one particular week last year when things were getting pretty tough. In addition to the problems I was facing, a depressed friend who I was trying to look after had 'attempted suicide' (I put this in quotes because he knowingly took a dosage of paracetamol that wouldn't harm him), and I had to be the one who picked up the pieces afterwards. I'm not even sure his parents knew what was going on at that point, but I knew that I didn't need this. That Friday I had an exam which I was trying to revise for whilst on my placement out of London, and also at the same time I was the lucky guy who acted as an intermediary between a friend of mine and the friend of a girl he liked. Things were becoming all too overwhelming, and I was lucky that the Quran competition that was due to be held on the Wednesday was postponed; I don't know if I could've coped with the added travelling to/from London, the intensity of the Quran competition (which yes, was my own choice, but still), and the emotional strain I was under at the time. This week was but one example of what I faced during my fourth year.

Alhamdulillah I got through all end of year exams unscathed, and here I am now in my final year, only months away from being a doc. Although life problems aren't in short supply, I thought I'd share my experiences of the week that just went by, which I think proves that if you try your best to show patience, good things will happen to you. It began with the news that a close friend of ours had passed his retakes; this friend had himself gone through so much during the year, culminating in him losing his mother, and on top of that learning that he failed one of his exams. We did our best to help him out, but you could tell the strain it was all having on him. So hearing of his success did make my day. Then I heard my Quran teacher had got his PhD; he successfully defended his thesis (which apparently you have to do do get one), and the years of work he's put in have finally paid off. The bittersweet thing is that now he's going to go back home to Saudi, which means that we have to hurry when it comes to getting my ijazas from him.

The above news would be enough to keep me happy all week, but that Friday something extra special happened. As we were arranging our weekly Quran lesson through our Whatsapp group, we hear that we'd be receiving a special guest that week: Abu Bakr Alshatiri!!!!! Like, THE Abu Bakr Alshatiri, the world famous Quran reciter, who is one of the only two Quran reciters I ever listen to. The Quran circle was beautiful, and he listened to me recite and didn't feel the need to correct me at all. He led maghrib and isha, and he sounded just like he does in all his recordings. There was another Quran reciter there, and voice was also breathtaking mashaallah. That next morning, I had to check my phone recordings to see if I'd dreamt it all or not!

listen to ‘Unexpected Guest’ on Audioboo

During the weekend, I was using a memorisation technique Abu Bakr Alshatiri suggested we try out. As I sat in Regent's Park Mosque (a place I usually visit when I want to be alone), I noticed that all around me people were using sign language. It was surreal! I later learnt that it was the annual meeting of the UK deaf Muslim group. So there I sat, repeating to myself the last page of surah al-an'aam, a surah for one reason or another, I had spent ages trying to memorise (apparently it's the hardest surah to learn and retain). Maghrib time came, and what did the imam recite? Yep, the last page of al-an'aam. It was moving. I actually felt like it was a message from Allah to keep going. Yes, I did shed a couple of tears.

After the prayer, I went down to bathroom, and I saw a friend of mine who works in security tending to a man who'd slipped and fallen in the wudu area. When I approached, he was one of the deaf Muslims. I tried to put myself to good use (lesson of the evening: I need to learn sign language), and ended the evening having felt slightly useful in life, as well as meeting loads of the people from the deaf group. A pleasant end to a nice week alhamdulillah. (The man was alright by the way, just a minor head injury and a broken wrist.)

Endure

At the end of every academic year, I like to think back to its highs and lows and come up with a general theme that I can take with me on this journey. This year, with its endless stream of placements, logbooks and amount of knowledge to be retained, the theme for this year is one of resilience. Yes, the weekends and holidays we sacrificed in the library to get SSCs done and exams passed did need effort, but I'd like to talk about the people I've come across this year who despite all odds, just manage to keep going. Starting with my friends; some of them have undergone extreme hardship; financial, emotional, losing family members; but with their added burdens, it has only made them stronger.

Every placement I've been on, I've seen patients whose whole lives have been turned upside down. An expectant mother coming in for a routine scan, excited that after so many years of trying, she's pregnant, only to be told that there's no heartbeat, or that the pregnancy is ectopic. A previously active man who has been told that he'll never walk again. A little girl born with an extremely rare metabolic condition, leaving her physically and mentally disabled for life, and her single mother who has to care for her. A middle-aged woman who constantly has pain in all of her muscles and joints, only to be told that there's no real treatment. A mentally unwell man who spends his whole day hearing voices that constantly insult him, or a lady who believes the world is ending around her, and she is the only one who can save it.
With each instance of hardship I've seen this year, I've also witnessed extraordinary displays of resilience; not letting something like illness break one's resolve. But also incredible are the medical professionals involved in these people's lives day in and day out. Especially the nurses.

Pain suffered by others should prompt me to look introspectively and make me both grateful for a relative lack of misfortune, and question how I would react if something bad was to befall me. You will encounter people and situations that will make life a living hell for you, but you are resilient; you will surprise yourself by how much you can cope. We have been built to endure, so endure for now.

Psychiatry

Never before have I come across a speciality that involves so much conflict and clashing agendas. I've learnt that to be a good psychiatrist, you need to be a master at the art of negotiation, delicately choosing words that would cause least patient resistance. It's difficult trying to convince a mind to adhere to medication when that same mind is in the throes of psychosis.

The patients have been interesting; whilst many neglect personal hygiene, and it may take some time getting used to the smell, what really does keep you intrigued is the extent of some people’s psychoses. From believing that the world is only 42 years old and built by a computer, to fearing the world (doctors included) is out to get them. Unfortunately I also saw some of these thoughts reinforced by family members, probably based on cultural norms back home; the brother of a patient was open to the possibility that the patient's ex-wife had colluded with the doctors to admit him. Let's say the ward rounds, despite their hours-long duration, always had something interesting going on.

As well as having the ability to negotiate with patients, psychiatrists need to be able to detect subtle cues extremely well. They could be the difference between someone being well and potentially extremely dangerous to themselves or others. But they must also bear in mind the definition of 'normal', taking collateral histories from relatives to establish a 'baseline', as well as realising that really, no one is truly 'normal'. Psychiatry makes good use of extended silences to allow the patient to say what's on their mind, and whilst acknowledging that the patient is mentally unwell, it is essential to listen to their wishes when it comes to management of the condition. It depends on the individual patient, some may prefer (or need) the paternalistic approach instead.

During my stay, I learnt there's something that I cannot ever get used to (and this was even after visiting the child psychiatry section), and that's seeing people who experience auditory hallucinations. There are many different types of auditory hallucination, from someone talking directly to you (usually in a derogatory manner, or giving you orders), to repeating your thoughts out loud, or even hearing two people talking about you. The amount of mental toughness needed to blank out these voices and try and live a normal life is phenomenal.

Overall, whilst my time in psychiatry has been enriching, and it's been a beautiful reminder of how easily my life could be dramatically different, but I think paediatrics is still my calling :)

More than a city

Barcelona, where do I begin? I think the only reason I came here was something to do with looking at the list of upcoming marathons, and finding that the Barcelona one fit with my schedule (it perfectly being the weekend after my exam). That and also me hearing good things about it; one particular friend saying that it was my kind of city, and he wasn't wrong!

I think it would be difficult to find a place as pleasant as Barcelona. And a large part of this is thanks to its people. They seem extremely chilled out and happy (and with such beautiful weather, who could blame them?). I spoke to a German guy in the airport on the way back, and we were talking about the crowd's support along the marathon route, and he mentioned something interesting: they weren't really cheering the runners along, they were cheering the fact that you chose their city to run in. I could tell from the start that they were an extremely proud bunch of people; not really in the bad sense, and you could see their familiar red and yellow striped flags adorning balconies and shop windows everywhere. They have their own language. They're extremely proud of their football club (and who could blame them; Messi is a legend), whose fitting motto is 'more than a club'. Barcelona were actually playing the evening after my marathon, but with my aching legs, and my lack of expertise dealing with the black market ticket touts in another language, I thought better not to. They won 7-0, Messi scoring a hattrick, becoming the highest ever scoring player for the team in its history, and I heard the whole match commentary (not in English) blaring from a neighbour's flat nearby. I think I may have made the wrong choice.

Anyway, here in Barcelona, you could tell that they were happy with who they identified themselves to be, and with the stunning city they lived in. I liked the way old men relaxed together under the shade of trees, or how a neighbour would have a chat with you, not because they wanted anything, but just because they were friendly. I don't know what makes them like this, but I'm sure it has something to do with the weather; imagine the UK was more sunny, how we'd be! (Actually, I'm sure we'd find some way to complain). It could be something to do with many of them being descended from immigrants, and the social cohesion needed to keep everything working. Either way, they were an extremely welcoming bunch.

I'm not oblivious to the fact that there are social problems. Apparently unemployment is extremely high, and the Catalans want to separate from mainland Spain (also interestingly, the German guy also told me how barely any Spaniards support their national football team, because the populations of each region are 'patriotic' to their region and their region alone). There also seemed to be a more sinister element which I didn't completely understand, reflected in a lot of anti nazi graffiti I saw. And then of course was the whole episode over privatisation of their health system (which we can obviously sympathise with).

On the topic of graffiti, I found that a lot of it actually beautified the city and made it more colourful. The whole city seems like thought has been put into its design, and I'm sure this Gaudi artist guy has had some impact. Even after my marathon, with my aching legs, I felt so happy (yes, genuinely happy) walking for hours on end in this city. And getting lost. That is one of the positives of travelling alone; no one will get annoyed at you for losing your way, and instead you can take your time and ask directions from the locals, and maybe even take a detour because a certain place looked interesting (and trust me, there was loads of that).

In terms of the marathon itself, it was amazing (if you don't count the latter half which involved extreme pain, cramps and searingly hot weather). The pre-race atmosphere was like none I had been in before (with confetti and everything), and the people along the route enthusiastically cheered you on (oh and they could pronounce my name properly!). As nice as the marathon was, I still think nothing I have seen so far matches up to London, but Barcelona comes in a close second.

I also saw Muslims. But what saddened me was that it looked like, apart from being an obvious minority, they weren't in a happy place economically (I'm talking about the residents, not the random Arab tourists who walked up and down La Rambla like it was Edgware Road). The Pakistanis seemed content with their fruit shops and small takeaways, and there was a mix of other nationalities. Maybe it was just the short amount of time I spent there, but it did not look like Muslims were particularly people of a high social class in Barcelona, and this reflected in the main mosque being near the red light district (well, I saw women loitering on doorsteps; I didn't ask too many questions). Compare this to when Muslims were ruling Spain for 800 years before the Spanish Inquisition, being at the height of civilisation and the envy of the rest of the world. Whilst it saddens me to see us in such a helpless state, I know things will change, but that will only come when we better ourselves and the people around us. It also saddens me how the locals aren't Muslim, especially with how nice they are, and how awesome they'd be if they were guided to Islam. One day.

Overall, Barcelona was a breath of fresh air, exceeding all my expectations. I definitely want to come back and spend more time taking it all in, maybe alone, or maybe with friends who have the same 'wanderlust' as me, and who won't lose their patience if we decide not to take public transport everywhere. And yes, since I've been back in the UK, getting on the tube in this not-so-pleasant weather, I have been tempted to learn Spanish/Catalan and disappear to Barcelona, maybe working as a doctor there before I run out of clean clothes and come rushing back home. :P

Paediatrics

Ever since my second year at Barts, I think my mind was more or less set on doing paediatrics as a career. So you can imagine my levels of anticipation when my paeds firm at Newham was about to begin (as well as my apprehension; what if I didn’t like it?). I’ve had loads of exposure to children both before and during med school. I currently am still involved in Teddy Bear Hospital after I was president of the society 2 years ago, I am on the committee for the paediatric society, I helped set up and still am part of the East London branch of Street Doctors (a charity that teaches young offenders life-saving techniques), and I have just become part of our new playscheme at Barts, meaning I’ll be playing with sick children at the Royal London quite regularly. Not to mention all of the academic things (SSCs, conference attendances etc) I’ve done paeds-wise. So you could say I’ve invested quite a lot into the idea that paediatrics is my thing.

There were six of us on our four-week firm, all male (apparently the first time it’s ever happened), and we were split up into groups that would spend a week each on a certain section. First week was neonates, a fitting start I thought. The neonatal ward had extremely strict infection control policies in place, after there had been some klebsiella-related deaths recently. In terms of patient-interaction, there wasn’t much, even in terms of examination. All we could really do was stare at the tiny neonates through the plastic of the incubators and watch their little bodies survive with the help of the drips, surfactant syringes and CPAP machines. This is where I first saw what was to be the biggest lesson I took away from this placement; the amount of love and care that a mother puts into her child. There was a poor mother sitting by an incubator who had clearly gone through a lot emotionally (and this was after the trauma of a probable natural birth). I saw how reassured she felt following the doctor’s words, but I knew that there were probably other mothers who wouldn’t receive such good news.

By the end of the neonatal week, I wasn’t overly impressed; maybe this was due to the lack of teaching we received from the team, but I have a feeling it also because neonatal medicine mainly involved walking from incubator to incubator, adjusting things here and there on the more-machine-than-human subject, before moving on and doing the same. What did excite me however were the baby checks. I had read up beforehand on what I was supposed to do, and I felt like a fish to water! I’m sure having five younger siblings contributed to my confidence handling babies, but I remembered I was there to do a job, despite the amount of fun I was having.

After the winter break, we resumed our placement, with me and my partner being on Rainbow Ward for the week.  Despite the regular bedside teaching we received from the amazing registrar throughout our four weeks, which did expose me to the ward patients earlier, I thought being given free reign over the ward would be slightly different. It was an interesting experience, but at first I did feel hesitant to approach patients in their beds, maybe out of fear I was inconveniencing them and their parents. I think I removed this barrier by simply spending time on the ward and taking in the atmosphere, joining in with the kids whilst they were playing. The ward rounds were slightly too business-like and thorough, and I couldn’t really take in the whole atmosphere, but I did have a chance to speak to a few parents myself, particularly the mother of a 3 year-old girl with B-mannosidase deficiency, a rare metabolic condition that has left the child in a terrible state, requiring multiple hospital admissions every year. Again, I saw the amount of dedication mothers have towards their offspring, almost an unnatural amount of love that you would not see anywhere else. I saw a range of patients, from teenagers with cerebral palsy to a delightful 3 year-old boy with a port-wine stain and lymphoedema in one painful leg. Again, my impression of paediatrics based on my ward experience what was not what I had anticipated.

This had all changed once our A&E and outpatients week had begun. I had actually gone to A&E the Friday before to see if I could get any of my logbook filled, and I instantly fell in love with it! It could possibly been to do with the autonomy I was given; in neonates and on Rainbow Ward, diagnoses and treatment plans had already been made, and we were simply monitoring their progress. But on A&E, there was the challenge of the unknown. And for the first time I really got to experience for myself the unique three-way consultation (I always forget the word used for it), interacting both with the mother and the child, and observing the interaction between them both. I loved it. I was also surprised at the amount of composure I had when I was made to hold a screaming child’s arm straight whilst blood was taken. Although I believe I have a degree of empathy for the patient, I also realise what’s essential for their best interests, and if anything, I felt more empathy for the parents. I recall a mother who brought her child in who had sliced the top of his finger off; the child didn’t seem too bothered by it, but the mum was an emotional wreck, and she needed more comforting than the little boy. Paediatrics is interesting in the sense that the patient doesn’t really appreciate your presence, and if anything, fights every move you try to make; with psychiatry the only similar speciality that comes to mind. My outpatients experience was also a breath of fresh air; on one occasion, the consultant gave me my own room to see patients in, and I loved how absolutely anything could walk through the door.

I had always considered community paediatrics to be something I’d like to go into once I’d ‘settled down’ and was tired of on calls etc. Although the children who came in had interesting conditions, I was physically exhausted after seeing only two patients! The first (a young boy with autism) was extremely difficult to assess because of his non-compliance, and the second just wanted to climb on my back and have piggy-back rides. I was also told of the large amount of paperwork involved, and the court appearances that had to be made in abuse cases, and I felt that this wasn’t the type of medicine I wanted to practice, but I shall keep an open mind until that decision has to be made.

Paediatrics as a whole has been a breath of fresh air. Whilst I acknowledge that every speciality will get repetitive after some time, I believe general paeds is somewhat different because of the vast amount of knowledge and practice required; it’s not only one organ system involved. It’s probably similar to being a GP, minus the remaining static in one room thing that I could never tolerate. Maybe it’s my medical student enthusiasm doing the talking, but I genuinely felt alive and excited by everything I did during my 4 weeks. Giving a young premature baby a Hep B vaccine was just the icing on the cake, and generally the whole paeds team were extremely enthusiastic getting us involved. This placement has only strengthened my desire to become a paediatrician, and I constantly wonder why more people don’t choose it as a career.