Saturday, December 29, 2012

wall here and there

I am obliged to answer only to my Creator, my family members, and my four angels above. Apart from them, I basically put up a wall against others. You might observe me telling a lot of things and think, "Hey, she's opening up to me", but if you've met me, I can be pretty talkative and nope, don't assume I'm opening up just because I decided to tell this and that. I can only be my true self with especially my lovelies - Hannah, Kishie, May, and Epa. Trust me, apart from these people, I did not tell a single soul how I am actually feeling, thinking, and my deepest insecurities. Yes, I don't choose who to befriend, but I certainly choose people to whom I really open myself up. I can tell entertaining stories to others, but nope, they're only for listening and entertainment purposes. Personally, it's not high-school. Shit such as they're my bestfriends, I can only hang out with them and no one else is just as shitty as Shin Chan's drawing of a shit. If there's one bad but true thing a colleague had said about me is, "Zahirah plays mind games". Yes, I do and I enjoy it. So, now you know, but don't worry, I'm not misusing it for evil purposes... much. It's just that others' reactions are something so fascinating to watch. It might sound horrible, but you're not necessarily suffering when I'm on it. Reactions can be a lot of things. Sad? Happy? Touched? Every single emotion is special and worth observing. If you're a negative person, you'll think that I'm a manipulative person (sometimes I am). If you're a positive person, you'll understand that I'm just a little more observant than you are (most of the time). On a whole, I'm a pretty good-natured person, but when I decide to be evil, I just can't stop myself from starting yet another mind game. Nevertheless, each one of us has our own circles of friends, but in the end, after a tiring day, all I want is to sit down with them and have a good cup of coffee.

Wednesday, December 26, 2012

reassuring them little kids

I was doing an extensive filling on my patient when suddenly my colleague, Zue, came to me, pale-faced. "Z, tolong aku boleh tak? Aku nak buat block pada patient ni tapi aku macam...", she mumbled and I just couldn't say no. I left my patient awhile and went to her dental chair. Her patient was a five-year old boy, super adorable especially with his frightened gasps. According to Zue, he's super scared of dentists. I couldn't comprehend the reason completely because he had all his deciduous teeth in place and no restoration at all. Most probably he heard bad stories about dental visits. Haih... I feel like choking every single screwed up person who spreads such stories, but ah well, we're at fault anyway. If only all of us gave more attention on providing dental treatments with as less pain as possible.

"Siapa budak comel ni? Apa nama adik?", I asked the boy.

He frowned back, tearful.

"Okay, sayang, nama akak Kak Z. Kakak nak tengok sikit gigi comel adik boleh?"

He didn't answer and looked away, still tearful.

"Sayang, Kak Z nak sedut air liur adik. Banyaknyaaa air liur awak ni", I told him and gently put the suction tip on his forearm. He gasped and looked at it. Slowly, he held the suction tip. "Okay, sekarang, adik Mikad letak dalam mulut penyedut ni boleh? Kak Z tak nampaklah dalam mulut awak bila air liur awak banyak. Oooh, ulat banyak niii, Kak Z risau Kak Z tak boleh sedut ulat keluar kalau awak banyak air liur". Zue tried to guide him at inserting the suction tip, but I told her to just let him do it himself until he was assured enough.

To make sure his topical anaesthesia would work fine, I made it a point to dry his mucosa properly. "Kak Z nak tiup sikit gusi awak boleh. Ulat dalam mulut lari kalau kena angin". I blew the triplex syringe on his forearm. He hesitated but allowed me to do it onto his gum when I said, "Ooooh, sejuk kan angin ni? Haa, manade sakit. Kak Z kata dah. Kak Z pun rasa sejuk dengan angin ni". I attempted to apply topical anaesthesia on his gum, but he refused. "Hm... Mikad, Kak Z takde buat Mikad sakit kan? Okay sekarang Kak Z nak letak gula-gula jeli strawberry ni kat gusi Mikad. Takde benda pun". Again, I applied it onto his forearm. "Boleh, sayang?". He slowly nodded. "Pandai sayang Kak Z sorang ni", I complimented him.

I rubbed and patted his shoulder while stealthily take the syringe that was loaded with mepivacaine. "Mikad, sekarang Kak Z nak tidurkan gigi. Tak sakit pun. Semut gigit lagi sakit", and I asked his parents and Zue to hold him still. Then I administered the local anaesthesia. He screamed, but I was sure it wasn't because of the pain because the scream came before I even pricked his gum. "Okay, okay, Mikad, Kak Z dah cucuk dah pun tak sakit kan?", then he continued to cry. He was acting up, obviously. And then I faked a gasp, "AHHH! Ulat keluar, Mikad duduk diam, ulat banyaknya keluar aaaaaa", I screamed, just to play along with his games and he sat still. Then, I loaded the rest of the content without him resisting.

"Gusi gatalllll", which means my local anaesthesia was working. He was anxious to experience the anaesthetic effect. "Shhhhh, Miikad, jangan tekan-tekan gusi. Kak Z nampak gigi tengah nak tidur tu. Mikad suka tak kalau Mikad tidur orang bising-bising lepas tu tolak-tolak Mikad?". He shook his head. "Haa, dah tu, Miikad jangan la kejutkan gigi. Kalau gigi Miikad terbangun dari tidur nanti aaa Miikad rasa tak sedap". And he sat silent and started to calm down. That's when I was completely sure that he didn't actually feel pain. He was stressed and anxious. That's all. I stroke his small cheek and then resumed treating my own patient.

Later, Zue came to me, "Thanks, Z, thanks sangat-sangat. Tadi bila aku tanya dia nak datang dental treatment lagi tak dia kata nak. I learned a lot today". I just want to cure this anxiety towards dental treatments especially among kids. Glad I helped this evening although my own session this morning was screwed up. LOL.

Saturday, December 22, 2012

no pushing

I'm the sort of person who will do whatever I say I'd do. If I had said never to talk to me again in such manner or I shall never forgive you the next time it happens, I mean my every word. If I say I will bring you down, I will try my best to bring you down. I can be the best person you'll have around you and I can be your worst enemy too. So don't try flick my angry mode on. It's not that I'm proud of being such an egomaniac person but I have had enough of others taking advantage on me and treating me according to their convenience. When they're in a bad mood, they blast every shit in my face. Look, I get it, you're stressed. You really think I'm always in a cheerful mode when I'm with every single person? For the love of God, I always try to control myself when it comes to being expressive about certain things because I cherish and care about others' feelings, but I have learned a long time ago that not everyone is willing to give and take and those kind of people aren't worth keeping. So, no, I don't intend to tolerate anyone else's bitchiness (unless it's inevitable). Not beyond this point. 

Nevertheless, if I still respond to your sudden burst of anger, then be glad because I still have enough love to argue in return, but if I became silent and started to smile instead of showing an angry face. That's exactly the moment I had made up my mind that I will eliminate you from my life. So far there hasn't been any turning point when such thing occurs. I simply don't allow it to happen. I may accept your apology but things will never return to how they used to be.

Thursday, December 20, 2012

to give and take isn't something everyone does

Sometimes, although you give all your love to a person as if he is your own younger brother, all you get back is just shit. You get shouted at. You get cussed at. And being the short-tempered person you are, you once blasted him back, but now you cower and decide to just let your tears flow only when you're alone. In the end, you'll be asking yourself, "Is this person really worth your effort? Or is he just using you all these while? What if you serve no purpose to him? Will he still be around entertaining your whines?". This very second, I had decided - it's time to pull yourself away from this so-called brother because he had just showed how little respect he still has for you. In fact, you'd be surprised if there is even a minute amount of respect involved, because you're secretly telling yourself that you're just another object for him to use according to his convenience. I can't forgive you this time.

Wednesday, December 19, 2012

the joy : it's the way you look at things (medical and dental jargons ahead)

Nayli and I (pictures and story were published with her mother's consent)

I remember meeting this girl about a year ago for the first time ever. She was the youngest patient I've ever had so far - she was only four. She was scared of dental treatment. I studied hard on how to give painless local anaesthesia (LA). Actually this is bullshit. The current advances we have at the student polyclinic doesn't allow us to give an ultimate painLESS LA, but provided correct techniques being applied, the score pain patients give us may go down to 1 out of 10. That's even better than the bite of a red ant. I studied hard on nerve supplies to make sure I don't mess up during such procedure. Handbook of Local Anaesthesia by Stanley F Malamed was and will always be my best friend. Truth to be told, I was so afraid of inflicting pain on my patients that I began performing root canal treatment only during my fifth year while most of my colleagues had done at least one RCT during their fourth year. 

When I met her, she was having a large abscess around her upper labial sulcus and her upper lip was actually lifted upwards due to this. Had to prescribe her antibiotics a couple of times before I was sure abscess wouldn't be in my way in anaesthesizing her teeth (failure in treating the main cause after fifth day being on antibiotic and the abscess might start to grow rapidly again). Did so many extractions, pulpotomy, crown strips, stainless steel crown (SSC), and a Nance appliance and finally, she learned to smile widely. I love how she calls SSCs as 'gigi robot' (robotic tooth). After completing her treatment plan, yesterday, I met her again, just for a follow up. She had been practising whatever I taught her. "Nayli, gigi bersih ni", bagusnya. "Dia taknak tidur selagi tak gosok gigi sebab dia kata takut hantu datang kejar orang gigi buruk (and so I made up stories)", her mother, Kak Na, said. A year ago, I loved bringing Nayli and her elder sister, Ariesya, to the medical school cafe, because I know that that's the only time Nayli would be eating her veggies (and so Kak Na said). "Kita nak jadi tinggi macam Kak Z", she would smile while wincing from eating bitter veggie. She'd try to take whatever food I took. Her favourite dish was a plate of white rice with a fried chicken and nothing else. When she finished eating, she would sit on my lap and turn to me, asking me to wipe her mouth. I'm not the type of lady who carries a handkerchief or tissue papers around, but whenever I knew I would meet her, I would carry one along. The day I thought I would be finishing my DDS, I received a text from Kak Na saying, "Z, budak-budak ni taknak ke sekolah sebab Kak Z tak nak jumpa diorang". I actually cried. One of the things that pumped me up to resume my studies was meeting them once again.

Yesterday, as usual, while doing medical asepsis (proper hand wash), Nayli ran to me and jumped while clapping "Yay, yay, Kak Z, kita dah sampai, kita dah sampai!", she exclaimed and quickly grabbed my wet hand and led me to her mother. As soon as I brought her to my dental chair, she said, "Kak Z, Nayli seghonok jumpa Kak Z hari ni. Lama tak jumpa Kak Z". As usual, she prefers to be covered with a blanket. When I went away to get her blanket I was surprised to see her standing beside me. "Bakpo Nayli ikut Kak Z?", I asked her. "Nayli takut Kak Z pergi", she answered. She missed me, and so she said. She followed me wherever I went. The thing about my body is I get hot flushes randomly. Not sure why. Nevertheless, she was always grasping my hand so tightly, as if she was afraid I would disappear anytime. When I completed her recall visit and pushed her blanket aside, she looked at me as if she wanted to say something. She's a very quiet girl. She wouldn't talk to you unless she's comfortable with you.

"Kenapa, sayang?".

"Kak Z, nanti kita pergi makan dulu sebelum papa sampai boleh? Lepas tu kita pergi tengok buku okay?", she recalled.

"Alamak, Nayli, papa kata dah nak sampai. Nanti papa marah".

"Kak Z, call la papa. Cakap kat dia. Nanti mesti dia wi", I would call her father if Nayli and her sister insisted on tagging along with me during my lunch break, but unfortunately, it was 4.45pm already and all shops and cafe were closed already. While filling up certain documents, again, she looked at me while twisting her fingers.

"Nayli nak duduk atas peha Kak Z?", I asked. She didn't answer but climbed onto me instead. She was wearing rubber gloves I gave her. "Kak Z, Nayli nak jadi doktor kiki macam Kak Z", and she imitated the way I usually flex my fingers whenever I put my gloves on. I laughed. When her father arrived, I brought her to his car and carried her onto that Triton. "Bye, bye, Nayli. Kalau datang KL oyak la ke Kak Z okay?". "Bye bye, Kak Z! Nayli sayaaaaang Kak Z", she waved, kissed me on the cheek, and started to cry. "Papa, bawalah Kak Z naik kereta". I could only smile and waved back. No words can describe the love I have for this little girl. I always admire the way Kak Na and her husband brought these kids up to be such loving people. 

Yet another meaningful moment in my life.

Monday, December 10, 2012

the prodigy : self motivation

I have this one little girl I treat who I honestly think of as a prodigy. A very bright and talented girl who is afraid of dental treatments. After two visits, I decided to start introducing local anaesthesia (LA) to her. When I told her that today's filling will require LA, her face became pale out of anxiety. I was supposed to do a composite strip crown on her deciduous canine. She had been smiling very shyly because her canine was simply jet black. "Ika, ready ya, akak nak tidurkan gigi dah". 1mm of needle penetration while pushing that Scandonest 2% slowly, she started to push my hand away. "Aaaaa ulat terkeluar", I was forced to lie and she sat still. Then I slowly advanced the needle little by little. "Ok, sayang, dah siap dah cucuk", I patted her shoulder. She looked at me, bewildered. "Eh tak kan dah siap? Kenapa tak sakit? Semut gigit pun lagi sakit". After finishing her strip crown, I asked her whether I can extract her deciduous molar during our next appointment. "Beres, Dr Z oyak ja bila" and smiled happily, knowing LA administration isn't as painful as most people think. "Zahirah, you did a very beautiful restoration. Congratulations", Dr Mon Mon complimented. Real satisfaction is when your patient compliments you, that's what I think. After that, I noticed her smiling widely for no apparent reasons. "Dr Z, gigi kita come. Kan best kalau Kak Z jadi doktor gigi saya sorang. Terima kasih. Bye bye", and she shook my hands. I smiled with satisfaction.

This morning, I saw Prof Zainul rushing towards Prof Sam. Then he came to me and asked me to fill up his friend's son tooth. I did it in a rush since I had only 40minutes and the tooth was broken by half its height. After bidding that kid goodbye, Prof Zainul came back. "Prof Sam cakap awak student year 5 yang boleh harap buat anterior restoration. Saya sendiri tak tahu takat mana awak tampal, good job, Zahirah. Thank you. Really, thank you", he said and waved. Another satisfying case this morning. Actually it was an easy case because that kid already has a denture replacing his 21 and 22. So I just compared the shade guide to the ones on that denture. I was experimenting actually, and I guess it worked. Nevertheless, I'm pretty sure I'm in trouble now that the sister saw me treating a patient ten minutes beyond office hours. Ahh, whatever. I prioritise my patients.

This evening however, I guess I really worked too hard today, running here and there trying to treat as many patients as I could while maintaining the quality of my work. I was supposed to construct a special tray for my final porcelain-bonded to metal crown patient during this extension. I went to the lab, saw Puan Haslina to follow up my very first two veneer cases which I will be issuing tomorrow, and I shoved my lab coat back into my locker. "I'm too exhausted mentally. I feel like vomiting already", I said to myself, and made my back to my room. The sun was extremely bright this evening. In two hours time, I will be going to Ly Studio to practise for this weekend's performance with my band. 8-10pm. Hopefully I'll have enough strength. Hopefully my brain and body will bear with me. So much focus for so long. All will be fine, insya Allah.

Saturday, December 8, 2012

patients are homo sapiens too

Setiap hari kita (dentists/dental students) nasihat pesakit datang periksa gigi setiap enam bulan. "Saya takut", the response we usually receive. Admit it, even you dentists/dental students are anxious about dental visits too. Year by year we study about stress and anxiety in dentistry and yet most of us decide to do nothing about it. For dental students, they often have this thinking - "Alah, dapat rawatan percuma lagi nak demand lebih-lebih". Have we ever thought of it this way instead - we are being honoured to treat them although they already know that we aren't certified yet? Tray after tray, we shoved into their mouth just because our impressions aren't good enough, still, they smile and say "Budak baru belajar, takpo kito pehe"? Don't those mean anything to you? For those who had never received any restoration, you might not understand the pain and anxiety a person experiences receiving dental treatments, but for us who had, you should act upon this problem to not repeat the same thing our dentist did to us.

The usual answer dental students will give, "Ish, aku tak pandailah nak kasi painless local anaesthesia (LA)". Well start with studying your textbooks properly first. You know very well (to those who still don't know, well a facepalm to you, but at least you know now. Better late than never) that our topical anaesthesia only works 1-2mm superficially, dah tu nak cucuk straight away full length 4mm memanglah orang rasa sakit. If you're working already, I will understand it because of course, you have a long queue of patients waiting for your treatment, but if you have extra time, why not? Sometimes, it's even more disappointing when a number of students refuse to give LA to their patients during deep caries management just because it'll consume their time and when patients become less cooperative during the course of treatment, they complain about it. First thing first,what is LA? It is a form of pharmacological BEHAVIORAL MANAGEMENT. So start loading those syringes and let those patients be at peace.

Personally, I prefer providing less painful dental treatment to my patients. The reason behind this is I had a deep amalgam filling done on my first mandibular molar. During that time, I begged to be given LA because the pain was so intense that I clenched the armrest of that dentist's dental chair so hard that it was torn a little bit. I was teary, but I wasn't fighting back because Umi said to me, "If you fight back, you watch out when we get back". Although my ambition at that time was to become a police officer instead of a dentist, I swore to myself that if it happens that I become a dentist, I will not do the same thing to my patients. It's just cruel and causes more problems in a longer run. Patients refuse to come for regular dental check ups due to this fear and they end up having bad cavities, sometimes they're beyond being restored already and end up getting extracted. I love doing extractions, especially if I leave a neat socket behind, but the idea of extracting them alone is sad. The cost of replacing teeth is always more expensive than maintaining its existence. An implant will simply cost RM6000 in private sector. RM1400 and above for bridges. RM400-500 for dentures. A filling? Max RM200. Taking care of a tooth so that it doesn't decay? A few pennies. Di Kelantan yang besar jumlah pesakit yang datang daripada kumpulan berpendapatan rendah, lagilah. Ada yang sanggup tak bergigi langsung sebab tak ada pitih.

At least... try to win our patients' heart. They are humans just like us. Free treatment or not, we are being given the responsibility to take care of our patients. Be merciful. Have empathy. Books may provide you answers. Lecturers and seniors will guide you. If there's a will there's a way.

Friday, December 7, 2012

noon gloom

Alhamdulillah, this muscle pain around my thighs is reduced to half than initially. I tried to fight back so I went to the dental school yesterday and walked here and there, opted for stairs rather than escalators. Come to think of it... I might've became a health freak, but that's better than being a lazy couch potato.

My noon is rather gloomy today, I'm not sure why. Might be because it's time of the month. Took a nap, hoped it would last for four hours but barely an hour later, here I am, making this entry. I was listening to a playlist I named 'Sad' and I woke up to it feeling yes - rather sad.

"Like how you said would call but never at all"- Decorate cover by Kuizz Shah. I hate being left hanging. I won't bug you with reminders, but I will be annoyed and I shall not make it less obvious. You and your promises, all for nothing. Beautiful words, they're all just a facade to something so empty. Shit, I wonder why I have such friend and most importantly, why am I holding onto this?

I feel like getting a pair of aviators. Ah haa. Tunggu biasiswa masuk. Okay, random.

I need to get a new pair of jeans too. My latest pair was bought about two months ago and they're already loose. It's getting rather annoying to keep pulling them up while I walk. Well now that I can fit in easier, no need to buy Dorothy Perkins clothes anymore. Previously I couldn't fit into clothes normal clothing lines sell, so I had to opt for DP and heck, DP is always so pricey. Just a simple top costs RM100+. Look, I'm not a paid dentist yet and that puts a burden on my shoulders. Well now this problem is eliminated. Yeehaw!

I'm thinking of going for a gig tomorrow at KB, but ahhh, le juniors have their own stuff to do. Might need to just laze around in my room once more especially because it's so hot out there these few days. I don't even feel like driving around much. Monsoon season, Y U NO BE PREDICTABLE THIS TIME?!

Monday, December 3, 2012

a turning point

This entry is to answer so many people's question on how I lost weight.

I was 99.5kg (tersilap tulis before ahuehue) before and currently, I am 65kg, making my total weight loss 35kg, but in truth, I started to become more strict on my diet during the past 6 months. And during the last 3 months, I began practising low calorie diet. My weight loss was slow during the first half of this one year. I began with reducing the portion of my every meal, and yet I stuck with rice. To begin with, I don't have that 'wajib makan nasi' taste bud. So I stuck with noodles instead. During my first 6 months I only lost 10kg (22lbs), which I considered slow since I had large residual weight to lose. The principle is the more weight you have to lose, the faster you should be losing weight once you reduce your calory consumption. So don't expect similar thing to happen if you're just a BMI 24 and below person. During my second 6 months, I began on bread and fish only diet and to be honest, I restrict my calorie consumption to a maximum of 600kcal daily (and my daily need is 2200kcal) which makes it about 23% of my daily need. I never starve myself particularly because I am born with low metabolism. I hardly sweat even after 2 laps of consistent jogging (sadly I had to stop jogging due to knee injury). This bread and fish diet consists of three slices of Gardenia Breakthrough bread (109kcal/2slices) and Ayam Brand light tuna. I also include raw tomatoes and lettuce into this. I spice things up by adding McIlhenny Co Tabasco sauce (very low in calorie but high in sodium content) and McCormick ground black pepper. For lunch it's about the same thing although I sometimes change from tuna to either lean chicken breast (only grilled/boiled/steamed, don't eat the skin or fat part although the former is the best tasting one) or grilled/steamed fish (you may opt for ikan berlauk but do not take the lauk), except that I reduce my bread to two slices instead. For dinner which is at 6pm it's one slice of bread either without any topping or sometimes with tuna again. Once a week I will have my cheat meal (not cheat day) consisting of either a meal at Kenny Roger's Roasters or Secret Recipe. So within 6 months I lost 25kg. Since my height is 165cm, that makes my BMI 23.4 which means I am within ideal range. Nevertheless, I am targetting BMI 21-22. Since my fat is mostly gone, I am now left with somewhat flabby areas, which means I need to tone up my body. For this, I recently began to go to a gym to workout. I have my junior, Ziyad, to help me with this. He's good at his thing, so might as well learn from him.

Currently, I am keeping an eye on my weight. I might need to increase my calorie intake a little bit just to make sure I don't end up being lethargic the whole day for having insufficient energy. My workout is basically a weight loss workout, NOT a bodybuilding one. Weight lifting actually boosts your fat burning rate. So that's what I'm looking forward to. I don't want to have just a thin body which is not toned at all. Well then, for you guys who want to try this, bear in mind - mind control is crucial. Don't give excuses to yourself and say, "Ah, I'll let this one go", because once you do that, you will never achieve your goal because you WILL repeat it again and again. And anything such as roti canai or chapatti or shit like that - they are made with butter and flour - both high calorie. So the choice is in your hands. Don't cheat and come to me complaining about your weight not budging much.