Thursday, 31 December 2009

What goes around, comes around...

Assalamualaikum wbt

Last week had been a hectic one for me, but one I thoroughly enjoyed as it was about me 'giving' to others. I was invited by akhi Firdaus Rahim, a 4th year medical student in the Nottingham University to share my thoughts in the recently-concluded winter gathering called Fun with ILuvIslam's Youth Overseas, fondly known as FUIYO 2009, held in Telford, United Kingdom.



The so-called Abang Tampan (don't ask me why), full with exuberance and youth


In lieu with the event's theme entitled 'What You Give, You Get Back', I highlighted the importance of Muslims being on top of the pecking order when it comes to giving to others. Some people believe in the karma of what goes around, comes around. When you help a person today, you might get the payback when someone helps you in the future. I certainly have my own share of the so-called 'karma', when a person I've assisted in the past, helped me to remain in the UK for the crucial treatment of my condition, ie the high-dose chemotherapy and stem cell transplant.

As my mom often reminded me, "Afzal, kita tolong orang ni jangan nak berkira sangat. Sebab satu masa nanti mungkin kita pula perlukan bantuan orang." Yes mom, you are spot on.

However, giving or being of benefit to others should not just be solely done in anticipation of the so-called karma. Not just because you know that your help now will be rewarded one way or another. Rather, helping one another is an inherent quality of a Believer, one that is part of his/her akhlaaq (character).


خَيْرُ النَّاسِ أَنْفَعُهُمْ لِلنَّاسِ

"The best people are those who are most helpful or beneficial for other people." [Bukhari and Muslim]


It is worth noting that giving or helping in Islam should not just be seen only in the form of monetary, such as our sadaqah (donation) and alms. Offering some of our time to listen to our friends' problems or lending a hand with any kind of voluntary work is also equally as important.

Sometimes, we even forget that the simplest but yet profound form of giving are in smiling to others, as well as pardoning someone else's faults towards us. It doesn't require us to fork out a single penny or any of our 'precious' time. But the effect can be just as immense.



"Your smile to your brother is a charitable act." [Hadith]


Learn about yourself to see what form of 'giving' are you most comfortable at. As for myself, public speaking seems to run in my family, thus I have always enjoyed giving talks, be it educational or motivational to people especially the youths. Which is why I have never been bothered with traveling far on trains or buses, or even spending my money just to share my humble thoughts to others. When you enjoy 'giving' and try your best to sincerely perform it, Allah will put His barakah (blessings) in what you pursue, insya Allah.



The meaning of life is about giving to others


To the crew of FUIYO 2009, a job well done guys. I really enjoyed the fresh and creative concepts inculcated in the event, and I must admit that it will be extremely difficult, but nevertheless an interesting challenge for the successors to even equal the success of the event. Well, what is life without its challenges anyway.

Sunday, 20 December 2009

Congratulations Jep!

Assalamu'alaikum wbt and Hi everyone,

Having grown up with you for almost 25 years, this occasion of yours just mean as significant to me as it is to you. This event, will certainly be embedded in your memory forever, and it will be in mine too.

Through the thick and thin, I've seen you smile and cry from when you were just a kid until you've grown up to become who you are now. This time, I'm sure you'll be smiling and crying yet again, only that now I could not be there to witness them.



The three of us, always standing up for each other.


Jep,

I believe you know I would do everything to be there for your big day, but we can only plan so much, but yet the ultimate end of our plannings are in Allah's hands. If only you can feel how shattered I am that I couldn't be there for you when I know you've been there for me before. Nevertheless, I'm delighted to have at least spoken to you over the phone and found out that you've done well with your akad nikah =)



Us@London, December 2008.


Congratulations Jep for your wedding, I wish you and Kak Fifah all the best in life and in the hereafter. Life will certainly not be the same for you now that you have an added responsibility as a leader in your new family. But having known you all my life, I know Kak Fifah will be one happy woman having met you as her soulmate, insha Allah.



"If Allah grants a Muslim a righteous wife, this helps him preserve half of his religion (faith). He should, therefore, fear Allah as regards the other half." [At-Tabrani and Al-Hakim]



‘May Allaah bless for you (your spouse) and bless you, and may He unite both of you in goodness.’

Your brother,
Afzal.

Thursday, 17 December 2009

I know what you do not know...[part 2]

Assalamualaikum wbt and Hi everyone,

I'm sure a lot of us have come across this simple yet profound saying,

"Kadang-kadang Tuhan hilangkan matahari, dan turunkan hujan, menangis-nangis kita mencari matahari. Rupa-rupanya Tuhan ingin berikan sang pelangi yang indah kepada kita selepas hujan"





Yes, we sometimes whine for losing the ray of sunshine. Yet without us knowing, Allah sends upon the beautiful rainbow after the falling rain. And that is when we kick ourselves for hastily complaining rather than showing patience.

I remembered how in the story of Khidr and Prophet Moses as recorded in Surah al Kahfi, a seemingly innocent boy was killed by the former, prompting Moses to react rather fervently;


‘Have you slain an innocent soul, that is, a pure one that had not reached the age of [legal] responsibility, [one slain] not in retaliation for another soul? Verily you have committed a dreadful thing’ [18:74]


Killing the boy was one out of three rather 'distasteful' acts done by Khidr, the detail of which can be found in the aforementioned chapter in the Qur'an. They were so unpleasant in the eyes of Moses that he couldn't abide by their initial agreement where Moses cannot denounce Khidr for any of the latter's actions which Moses find offensive. Why would Khidr commit such acts???





How surprised was Moses to later find out that for every of Khidr's acts of which he condemned, Allah showed via al-Khidr the hidden reasons.


"And as for the boy, his parents were believers, and we feared he would oppress them by rebellion and disbelief. So we intended that their Lord should exchange him for them for one better in righteousness and nearer to mercy.'' [18:80-81]


Prophet Moses did not know that the boy was actually destined to be a disbeliever from the day he was created. If he had stayed alive, he would have been the cause of his parents' doom, both of whom are Believers.

If we let emotions ride over us, we may feel this story as being cruel and lacking justice. But this is Allah's way of showing to Moses, as well as to all of us, that we should be content with the decree of Allah, for the decree of Allah for the believer, if he dislikes it, is better for him than if He were to decree something that he likes for him.



"...and it may be that you dislike a thing which is good for you and that you like a thing which is bad for you. Allah knows but you do not know." [2:216]


Allah allows some things to happen within His dominion which appear to us as unfair (ie children suffering from cancer) because they serve a greater WISDOM which we, mere mortals cannot comprehend. And for things that we cannot comprehend, we must try to understand and accept, just like how we will accept a doctor's prescription when we fall ill because we acknowledge the doctor's specialty in the field. And Allah's specialty is absolutely boundless, one that has no comparison whatsoever.

Nevertheless, children afflicted with cancer will always have a place in my heart. For their courage, belief and strength at such a young age. I can really understand how hard it must be for them, and it was not a surprise that this video touched me immensely.






You are not alone, my little ones.

p/s 1: Salam Awal Muharram to all my dearest Muslims, all over the world. Let's start a new chapter, striving ourselves into becoming better servants of Him.

p/s 2 : Salam takziah untuk adinda Hilman atas pemergian ibu, yang berjuang menentang penyakit leukaemia semenjak 2 tahun yang lepas. Pastinya pemergian itu sesuatu yang perit, tetapi bagi yang beriman, pastinya ia manis kerana detik pertemuan dengan Allah menjelang hampir.

Monday, 14 December 2009

I know what you do not know...[part 1]

Assalamualaikum wbt and Hi everyone,

I must firstly express my deepest condolences to the family of almarhum Mohd Ariff Abdul Kadir and Teh Affifah, may Allah provides the strength to accept this loss and serve as a reminder that we will all eventually face death. I have met him on several occasions when he was studying in United Kingdom and he appeared to me as a person very committed to the work of Deen. May Allah bless his soul and grant him Jannatul Firdaus.

Over the past few weeks, I have been thinking a lot about the concept of destiny in Islam, and Almarhum's story has further prompted me to pen my thoughts down this blog. Teh Affifah has only been married to the deceased for about 3 hours, looking forward to living with her partner in life, only for Allah to decide differently. How sad can it be for her?!


In the eyes of some of us, life may seem so cruel and unfair. Especially when you think about the things that happen in this world, the innocent people that are inflicted with things you feel they don't deserve to get.



If only life is fair.


Having experienced what I've gone through over the last one year living with cancer and realizing how difficult it was to me, sparked a rather challenging thought in myself;


How could the Creator let children suffer in life, especially when they have done nothing wrong whatsoever in life just yet? On the same matter, I thought to myself, how can God test innocent children with cancer, a disease so frightening it sends chills down the spine of anyone who hears it??? We know that God sometimes tests someone with an illness as a way to expiate the sins they have comitted, or as a way to test their belief in God's plannings.


“Whatever misfortune happens to you, is because of the things your hands have wrought, and for many (of them) He grants forgiveness” [As-Syura,42:30]


But how can similar things be said of children?? It was difficult for me to imagine how these poor kids go through things I have experienced myself;

Chemotherapy and its side effects, bone marrow biopsies, Hickman line insertion, endless pricking with sharp needles, and the list goes on and on...



Bone marrow biopsy





These thoughts bothered me a lot.


But that is when as a Muslim, we should all return to the book of Allah, the Al Qur'an, to seek for an answer.

Allah says in Chapter 2 (Surah Al Baqarah), verse 30:

Just recall the time when your Lord said to the angels, "I am going to appoint a vicegerent on the Earth." They (the Angels) humbly enquired, "Are you going to appoint such a one as will cause disorder and shed blood on the Earth? We are already engaged in hymning Your praise, and hallowing Your name".

Allah replied, "I know what you do not know."



Allah knows that of we have no knowledge about. There is always a wisdom behind everything that He does. There MUST be a wisdom why Allah tries these innocent children with what we see as 'sufferings' in their life.





In Part 2, I wish to share a story mentioned in the Al-Qur'an about the wisdom of Allah's plannings that even a Prophet couldn't comprehend initially, only to learn that his Creator is indeed the best disposer of all affairs...

To be continued.

Sunday, 6 December 2009

Goodbye my companion...

Assalamualaikum wbt and Hi everyone,

It was my closest companion for 3 months. Whenever I went to sleep, I made sure I didn't impede on my companion for fear it might be damaged. I was very careful with my daily activities just to make sure that my companion is 'safe and sound'.

But last Wednesday, I bid farewell to my closest companion, my Hickman line. It was removed, for what I hope will be the very last time. Insha Allah. It had been literally part of me for the last few months, playing a pivotal part in my treatment.



Whenever the doctors need to take blood, or administer my Chemotherapy drugs or any other chemicals for that matter, the Hickman line has made it possible without the need to prick me with needles.



This is how it appears like attached to the body.


At the moment, I am recovering well from the high dose chemotherapy and transplant. My appetite has been brilliant, and my energy levels are improving with time, alhamdulillah. I've also been going out a lot more than I thought I'm able to, and I attributed that to the presence of my dad and my sister, Aiysha, both of whom are currently in UK for 2 weeks. Their presence has certainly provided me with the extra motivation to get out of bed and show them, Aiysha in particular, of what UK has in offer especially during the winter season. Although Aiysha doesn't seem to enjoy the weather so much I reckon.. =)



Aiysha's first ever visit to United Kingdom, accompanied by Dad...


Apart from plenty of rest at home, I am also scheduled to attend regular clinic appointments to assess my response to treatment, with the next one being on the Wednesday 16th December 2009. I am also due to have a scan done 3 months after my high dose chemotherapy, one that sends shivers down my spine, considering what happened with the previous scan I had after finishing my ABVD treatment.

But life must go on, and until that time arrives, I must tell myself to remain optimistic and positive. Believe in Allah, His plannings, and to not waste my time on uncertainties.

Before I sign off, I'd just like to extend my deepest gratitude to those who made the effort to visit me at home, some even from outside of Sheffield. The visits just kept on coming even though I'm no longer in the hospital, and I thank Allah for showing me the beauty of ukhuwwah (friendship). Not forgetting those who dropped by with messages of support and prayers via my blog, Facebook as well as text messages. I'd like to share with all of you this very moving hadeeth Qudsi (divine hadeeth).


“Allah will say on the Day of Judgment, ‘O son of Adam, I was sick and you did not visit Me.’ He will say, ‘O my Lord, how could I visit You, when you are the Lord of the Worlds.’ Allah will say, ‘Did you not know that My servant so-and-so was sick and you did not visit him? Did you not know that if you had visited him, you would have found Me there?’ Allah will say, ‘O son of Adam, I asked you for food and you fed Me not.’ He shall say, ‘O my Lord, how could I feed you and you are the Lord of the Worlds?’ And Allah will say, ‘Did you not know that My servant so-and-so was in need of food and you did not feed him? Did you not know that if you had fed him, you would have found that to have been for Me?’ ‘O son of Adam, I asked you for water and you did not give Me to drink.’ The man shall say, ‘O my Lord, how could I give You water, when You are the Lord of the Worlds?’ Allah will say, ‘My servant so-and-so asked you for water and you did not give him to drink water. Did you not know that if you had given him to drink, you would have found that to have been for Me.’
(Muslim, Hadith no. 4661)


Wassalam.

Sunday, 29 November 2009

You are not alone [Part 2]

Assalamualaikum wbt and Hi everyone,

Now and again, I have been invited by some people to share my experience of living with cancer. Giving some insight on how I try to face my adversity, with the hope that I can help others cope with their own difficulties in life.

I try to be sincere to the people that I talk to, telling them that I occasionally whine and cry to myself for having to go through such predicament. Because I am merely a human being and I have emotions just like anyone else.

But I try not to let emotions take over my life because as Muslims, we have always been taught to believe in the plannings of our Creator, no matter how difficult it might be. And I tell myself and the people I share my experience with, that the scale of the test afflicted upon us reflects how high Allah regards us. Allah knows that we have the strength in us to face up to the test that He gives, or else He wouldn't have given us one. As He has promised in His Holy Scripture,

God charges no soul save to its capacity, that is, what it is capable of bearing...[2:286]





It is the Mercy of Allah that even when we are being tested, Allah never leaves us alone without His nusrah (assistance). Being in the hospital for my recent treatment was without a doubt the most difficult period in my life, what more without my family around. But that is when Allah brings forth His assistance, and that is via the support of my fellow peers.

The people that mean so much to me, ever since I set my foot in this country.


How can I forget brother Eymen, who is the most frequent visitor to my little room in Ward P4. Never will he miss bringing his mom's special soup whenever he dropped by, trying his best to make me feel at home.

Or my dearest housemates, in particular Khairuddin aka M, who has been supporting me all the way through ever since all these started back in December. He has always been my chef, my good friend, constantly topping up my supply of fruits and juices whenever I'm warded in the hospital.

Paktam, Maktam and Ainul, for taking the hassle to travel all the way up from London to Sheffield just to make my day.

Not forgetting Abg Safuan, a person I treat as my own brother, for never ceasing to take the initiative to get the Malaysian community to prepare foods for yours truly.

My fellow Muslim brothers, be it among the Malaysians or those I know so dearly from the masjid for regularly visiting me during my long stay in the hospital. And for the same matter, Dr Asrar and Dr Shahrul whom both travelled from Blackpool, all in the spirit of ukhuwwah (friendship).

And to my dearest sisters in Islam (bukannya SIS yer), you know who you are, for volunteering to take turns to prepare food even though I'm sure all of you are preoccupied with other commitments too. Allah will certainly reward every second spent for the cause, insya Allah!



And the list goes on and on. Just to show how beautiful is the Rahmah(Mercy) of Allah. SubhanAllah.

It is through their support and prayers that I knew I cannot disappoint. These people have certainly provided me with the extra strength I was yearning for to get me going whilst I was in the hospital. And I can only thank Allah for giving it to me.

And Alhamdulillah, by the will of Allah, I have finally passed my final treatment, and all I can do now is plenty of rest and hope for the best. Insya Allah. Thinking retrospectively, after almost a year of trial and tribulation, I am reminded of a beautiful verse in the Qur'an:

No affliction befalls in the earth or in your own selves, which We have not recorded in a Book before bringing it into being. This is an easy thing for Allah. (This is done so that) you are not disheartened over what you may lose nor feel exultant over what Allah may give you...[57:22-23]

I have been destined to go through all these. For all the hardship that we have to face in life, they are all according to the pre-ordained scheme of Allah, which is already recorded in the Writ of destiny. As Sheikh Abul A'la Al Maududi famously said,

"If you are made to attain to success without passing through these hardships, weaknesses will remain in your character due to which you will neither be able to digest power and authority nor withstand the tempests and furies of falsehood."





So do not despair, Mas Afzal.

Tuesday, 24 November 2009

Is the battle over?

Assalamualaikum wbt and Hi everyone.

Alhamdulillah (All praise be to Allah), after 23 long days in the hospital, I'd finally come through my ultimate battle, though I wouldn't say unscathed. The whole experience was definitely one that I'll remember for the rest of my life, but if I'm being honest, it was one that I pray to Allah will never happen again in my life, ever.

It was a battle so daunting that I'm lost for words to describe it, testing me right till the very end. It was a battle of mind; the ability to keep on telling myself that I'll get through this predicament even though my body has raised the white flag. This treatment, in short, had certainly liven up to its name and reputation.


How can I forget the right hip pain that kept flaring up during the first week of my stay in the hospital, that I felt so helpless and could only wait for the pain to ease away whilst constantly praying to Allah for strength and patience?


Or even the allergic reaction I suffered from one of the chemotherapy drug that was given on the 2nd day of my stay in the hospital? My face was swollen, and I had difficulty breathing that the doctors had to intervene with anti-allergic medications and steroids.


I certainly wouldn't forget that one Friday when I had an infection so bad that I'd gone into a septic shock. My blood pressure was very low, my pulses were racing and my temperature was high that the doctors at one point considered transferring me to the High Dependency Unit (HDU) for close monitoring.





Not forgetting days and days of sheer tiredness and inability to do literally anything but sleep.



Or the mucositis I so dreaded, putting me off my food, causing me to lose 5 kilograms within just 4 days. The soreness was really bad, I was kept to just soup for almost a week and a half. The period in the hospital where I lost my appetite and was not able to tolerate solids was without a doubt one that I will remember for the rest of my life, as I've never felt so low and depressed.



To cap it all, not having any of your family members around to seek strength and support from. That was really difficult. Shaytan kept coming, creating bad thoughts in my mind on why my family members are not around when I really need them. Nauzubillah min zalik! [May Allah protect us from that (in case of harm)]

One must wonder after all my rantings, how did I actually remained sane for those 23 days?


وَللَّهِ الأَسْمَآءُ الْحُسْنَى فَادْعُوهُ بِهَا

And (all) the Most Beautiful Names belong to Allah, so call on Him by them...[Al-A’raf:180]

Allah is Most Gracious, Most Merciful. He never inflicts upon His servant a test he or she can't bear. Although it seemed my 23 days in the hospital were the worst one could ever imagine, I was never alone in the battle.

It was during those 23 days that Allah endowed upon me His nusrah (assistance), one that I'll share in my next entry...





To be continued.

Thursday, 29 October 2009

The Day Has Finally Arrived

Will be admitted to Royal Hallamshire Hospital today for the ultimate high dose chemotherapy and stem cell transplant. Expecting to be warded for at least 3-4 weeks, insya Allah.

Thank you everyone who has dropped by to provide your support and prayers. I have nothing but my sincerest gratitude and du'a. Jazakumullahu khayran katheera.

Allahumma yassir wa la tu'assir.

Friday, 23 October 2009

It's finally coming...

Assalamualaikum wbt

A date for my high dose chemotherapy and stem cell transplant has finally been decided. It will be on next Thursday, the 29th October 2009. Speaking to my consultant this morning about the treatment, I am already feeling a bit nervous.

BEAM chemotherapy is the regiment I'll be having this time around, before they end up with transfusing my stem cells back into my body. BEAM consists of:

* Carmustine (BiCNU®)
* Etoposide
* Cytarabine (Arabinoside)
* Melphalan

In short, the treatment will be given over a period of 8 days, which includes the stem cell transplant on the final day. The daunting bit will be how I respond to the treatment and stem cell transplant straight after, and for that reason I'll probably be kept in hospital for another 2-3 weeks. Altogether, it is expected that I'll be in hospital for at least a month this time around.

I've mentioned how the 2 ESHAP chemotherapy I've had in the past were stronger than the initial ABVD chemotherapy, and I ended up with worse side effects and longer recovery period than normal. But having learned the likely side effects of this BEAM chemotherapy, I seriously need to prepare myself both physically and mentally for what is to come.

Nausea, vomiting and extreme tiredness are probably side effects I'm quite used to, and hopefully ones that I can cope with even with the BEAM chemotherapy.

Obviously I'm always slightly apprehensive with the possibility of infection, being anaemic and risk of bleeding with this high dose chemotherapy. But what I am not really looking forward to is the other likely side effect I've never had in the past, in particular the mouth ulcer (mucositis).

As warned by my Consultant, often the mucositis gets really bad that patients need to be given morphine to ease the pain and can hardly swallow food and therefore had to be given nutrients via a nasogastric tube.



NG tube is inserted via the nasal cavity, goes all the way down into the stomach.


I must admit I already feel this is one task too daunting to bear, but I am not going to turn back now having made this far. I need to persevere.

I have Allah. I believe in Allah's plannings. I must.

At least I get an initial impression of what lies ahead of me from this video, showing Emma Hargreaves, a teenager with cancer who shared her experience of going through the BEAM chemotherapy and stem cell transplant. I'm not sure how she is at the moment, but she certainly has one strong character given her young age, and I wish her all the best in life.

Her video is one of the many videos that can be watched via the jimmyteens.tv website, a creative initiative by the Teenage Cancer Trust to share experiences of teenagers living with cancer. Spend some time watching a few of the videos, and you'll be amazed how strong and positive these young people are towards their condition. I have nothing but my utmost respect to each and every one of them.





6 days to go. O Allah, you are sufficient for me and a Great disposer of affairs are You. Make my path easy if that is Your Will.

Plenty of dua's please...

Monday, 19 October 2009

About trials and tribulations...

"So this is our famous Dr Mas Masarudin. Ever since you were interviewed by ITV last month, a lot of the hospital staff have been talking about you. Nice to meet you finally."

Those were the welcoming greet of the stem cell transplant nurse the moment I entered into the stem cell transplant room in Royal Hallamshire Hospital last Monday. Yup, my face did appear on national television last month when a group of representatives from ITV Calendar for the South Yorkshire region came to ward P3, where I was treated. They were interviewing me to find out how young patients with cancer cope in a ward where majority of the patients are elderly people.



The stem cell harvest machine, connected to the veins in the arm or the Hickman line.



The fluid bag with the brick-like color is the stem cells filtered out from the bloods.


I just love sharing views and opinions, especially when I know they are of benefit to other people. Even when I am in the hospital, the consultants would usually suggest my name to the medical students for them to take history from. I guess that is my way of helping people, and I always find joy and pleasure out of it.

And last weekend, I had the opportunity to share my experience living with Hodgkin's Lymphoma to the new group of students from Malaysia to embrace the United Kingdom for their studies. Even though I'm quite used to talking in front of people, the topics I've talked about in the past were never anything to do about myself. This was the first time ever that I've opened up about my disease in a public speech to mostly unfamiliar faces.

I did so not because I wanted them to sympathize with my predicament, rather I wanted to show to them that as mere mortals, we can't run away from being tested in life. But trials and tribulations are not meant to break us, as Allah has promised that He will never impose upon us a burden for we can't bear.

Just when we think that there can't be anyone more unlucky than us, just think about those people who have lost their parents before they can even see their faces.

Just when we think that God has given us the biggest test one can ever bear, just think about those innocent children living with cancer whose life revolves only around the hospital.

Just when we think that no one is going through a life as difficult as what we are facing, just think about the people in Gaza or Africa.

So do not despair and whine when we are tested, for it will bring us nowhere.

Face it. Stand up to it.

That was the message I hope I've managed to get across to these youthful students, full with exuberance. But come to think of it again now, that was actually a message I hope will remain ingrained in myself especially for the next few months, as the high dose chemotherapy looms closer.




Allah does not burden any human being with a responsibility heavier than he can bear. Everyone will enjoy the fruit of the good that one has earned and shall suffer for the evil that one has committed.(O Believers, pray like this to Allah: ) "Our Lord, take us not to task if we forget and lapse into error inadvertently. Lord! lay not on us the kind of burdens that You had lain on the people before us. Lord, lay not on us the kind of burden that we have not the strength to bear. Be kind to us, forgive us and show mercy to us. You are our Protector : help us against the disbelievers." [2:286]


p/s: Talking about stem cell harvest, I remembered adik Siti Nurain who a few years ago had her stem cells harvested just like me. But not for herself, but this young girl did it for her brother. The processes involved during and prior to the harvest are tedious and can be draining, as I've experienced myself, so it touches my heart to read this article and witness the sacrifice she made for her brother.

Friday, 9 October 2009

Am I ready???

"As-alul laahal azeem Rabbal arshil azeem An yashfiyak..."
I beg Allah the Almighty, the Owner of the Majestic Throne, that He should cure you.


"Antash shaafie. Laa shifaa-a illaa shifaa-uk. Shifaa-al laa yughaadiru saqamaa."
You are the only One who cures. There is no cure but Yours. Grant such (complete) cure that leaves no trace of illness.

That was roughly some part of the du'a I could remember from the one recited by the Imam on me after our Friday prayers today. He saw me sitting at a spot within the main prayer hall, walked towards me to greet me, sat down and instantly recited a du'a for me. He knew all along about the news regarding my condition and it had certainly brought a smile to his face to see me again after I've been missing for 3 weeks from the masjid.

Yup. Alhamdulillah, I've finally made my way again to the Muslim Welfare House of Sheffield today after what I personally regard as a long time away from my second home. Due to treatment and its recovery period, I've not visited the masjid for almost 3 weeks and I can only thank Allah for allowing me to garner enough energy to make the walk up the hill today.


The ESHAP chemotherapy is certainly a different opposition altogether compared to the previous ABVD treatment. It certainly affects me stronger than the latter, almost to points where I must admit that sometimes I almost lost the plot.

But let's not talk about how I felt those last few days. Let them be buried as past. I certainly have more daunting things to expect not long from now.

Since Wednesday and for the next 3 days, I have been injecting myself with Granulocyte colony-stimulating factor (G-CSF). The G-CSF, in plain term, is meant to boost my bone marrow to produce more stem cells, that will then circulate through my blood and be collected later this Monday as a preparation for my high dose chemotherapy. Those extra keen to know reasons for harvesting the stem cells prior to my high dose chemotherapy can refer to my previous entry entitled "Here we go again...".

Harvesting the stem cells are just part of the several tests I need to undergo prior to the commencement of the high dose chemotherapy. I've had an Echochardiogram done 2 days ago to assess the function of my heart and whether it has been affected by previous treatments. I am also scheduled to have a Respiratory Function Test to assess my lungs, a dental check-up to rule out possibilities of catching infections from any dental problems and a CT scan to evaluate the progress of my disease.





Plenty of things happening soon huh? Well, that is part and parcel of medical plannings when expecting something they regard as a 'critical and crucial period'.

To make sure that they have made all the preparations necessary.

As for myself, have I prepared myself enough? And I don't mean just physical wise for this upcoming heavyweight battle, but spiritually. Am I ready to expect what might come out of all of this?


SubhanAllah.


As people say, you can never understand something until you experience it yourself. When I was a medical student, trying to understand the emotions running through a person's mind prior to his/her life-or-death operation is a difficult thing to grapple with. But now, as I draw closer to my high dose chemotherapy, that emotion is all clear in me. It's a feeling you don't wish people to have, believe me.

Be strong, o heart.

Thursday, 1 October 2009

Living with Cancer : Living With Uncertainty?

Assalamualaikum wbt

As I meet and talk to people in the hospital afflicted by cancer, be it a cancer similar to mine or not, we all often agreed on one thing. That it is one of the most uncertain disease one can ever have.

Which is why patients who are successfully treated of their cancer are called 'in remission', and not terms such as 'completely cured' or 'declared cancer-free'. By saying someone is 'in remission' implies the possibility, be it small or big, of a 'relapse' in the future, ie the cancer coming back to haunt you.

However, it's not the term used that I intend to dwell on, but rather how this 'uncertainty' can affect our emotions in the cruelest of manner, if not dealt properly.

"I've just made plans to start work again after such a long break due to treatment. Time to play my part in helping out my family after all the sacrifices they have made."

Unfortunately the cancer relapses and all your plans go out of the window.

"I'm now 55-years old and it's probably the best time to take my family out to live in the countryside and enjoy our life again after what had been a torrid few months battling against cancer."

Unfortunately the cancer relapses and all your plans go out of the window.

"Finally I can now start to think about my marriage plans and starting a family. How exciting will this be."

Unfortunately the cancer relapses and all your plans go out of the window.

Those stated above are certainly not just made up blindly. These are all real-life examples of the people I have came across during my stay in the hospital. The uncertainty. Uncertain whether you can actually start a new chapter in life after being declared in remission from cancer without having to go through a hiccup.

"Well Mas, in your case, 5 years is what we call the magic number. It is unlikely that you will get a relapse after being 5 years in remission from the disease," a specialist nurse reassured me yesterday during our conversation.

Yes, 5 years is the prediction of clinicians based on their study and experience of dealing with the disease. But it is called prediction for a reason. Because all of us are mere mortals and we don't possess the power to say that things will happen for certain, thus we can only resort to predicting.

This shortcoming of not being able to be 100% certain of what lies ahead of you is part of Allah's beautiful plan for human beings.

Not sure when will death come to us.

Or when the Day of Judgement will be.

So that we don't wait until we reach 50-years old before learning to visit the mosque for our prayers.

So that it send shivers down our spine to have the gut to say, "Muda-muda kita enjoy, bila dah tua kita bertaubatla!" [Enjoy while we're still young, and repent when we get old].

There really shouldn't be a saying like, "Abah dah umur 70-tahun, eloklah banyakkan duduk di masjid dan sembahyang." [Dad, you are now already 70-years old, it's better that you now spend more time in the mosque and pray].

What if death comes to you before your dad?!

As for myself, I sometimes am left wondering about how exactly should I deal with this uncertainty filling inside myself. It's very difficult now picturing myself in 10 years time when in the past, I can see clearly where I want to be in the future. That's a feeling I guess myself and people with cancer share in life.

At least one thing is certain. I know I have Allah, and I just have to keep on praying and believing in His plans for me.


وَللَّهِ غَيْبُ السَّمَـوَتِ وَالاٌّرْضِ وَإِلَيْهِ يُرْجَعُ الاٌّمْرُ كُلُّهُ فَاعْبُدْهُ وَتَوَكَّلْ عَلَيْهِ وَمَا رَبُّكَ بِغَـفِلٍ عَمَّا تَعْمَلُونَ


And to Allah belongs the Ghayb (everything that is unseen) of the heavens and the earth, and to Him return all affairs (for decision). So worship Him and put your trust in Him. And your Lord is not unaware of what you (people) do. [Hud:123]


Ward P4, Royal Hallamshire Hospital.
1st October 2009.


p/s: I am currently in Day 4 of my ESHAP chemotherapy, battling hard against nausea and tiredness. If everything goes as plan, God willing, I should be able to go home by this Saturday. Keep the prayers coming everyone.

Sunday, 20 September 2009

Eid in Sheffield..and unconditional love

* Honoured I am to have my mom being the first invited guest to share an entry in my blog, Not the primrose path.

It is an honour to be invited to write in this blog...but I'm new at this, so please bear with me if I sound biased..I have no other excuse other than that I'm Afzal's Mom:

It wasn't an easy decision to make, but when I decided to spend Eid in Sheffield, it was because I can't bear the thought of Afzal spending Eid alone, tired and nauseaus after his second round of Eshap chemo. But eventhough the chemo was postponed,I still went ahead and took the trip....It turned out to be quite a celebration, one that brought me up close n personal with people who have touched Afzal's life in so many ways ever since Sheffield became his second home in 2003.

When he met me at the Sheffield train station at 11.20pm, 18th September, 2009, he looked tired,was coughing occasionally and complained of hair loss happening faster than usual. He also seems to have lost a bit of weight and my heart breaks looking at his tired smile welcoming me.

The next morning I started the task of preparing for Eid just like I would have done back home, just so I can bring a bit of cheer into Afzal's Eid celebration...He was just as excited, helping out in the kitchen and making open house plans, naming postgrads and undergrads he would be inviting. This year's Eid was made extra special with the presence of Pak Tam n family.

Actually we only went to one open house - that of Ezarad, a third year medical student, whose father, Tan Sri Elias Omar, helped clear a few things with JPA so that Afzal could remain in Sheffield to undergo treatment for his Hodgkins Lymphoma.

Tan Sri, a humble and charming man, told Afzal to go ahead and seek treatment in the UK and to just concentrate on getting well. He proudly introduced Afzal as DR.MAS AFZAL to his other guests and I couldn't help but admire his sincererity in helping my son. I have always also admired him as a man of principle, back during his PTD Officer serving days. And being a PTD Officer myself, made this meeting a lot more meaningful.



Us with Tan Sri Elyas' family


And then there were postgrads and wives of postgrads who testified as to just how helpful Afzal has been to simply everyone throughout his stay in Sheffield, that everyone was crushed when they learned of his predicament. They say he has such an amicable personality, its not difficult to like him. He helps other students, both undergrads and postgrads get settled in, put them up temporarily in his own rented house if needed, and is always very much involved in activities that matters.

What amazed me was that not only was he known throughout the Malaysian community but also among British citizens and other foreign students. One parent of a third year Yemeni student called him "an asset". I do not know exactly what he meant but nevertheless my heart was bursting with pride.

Occasionally throughout that 20th September, I asked Afzal how he was feeling and he said..."I'm running on reserved battery "..meaning, actually he is still feeling tired, but the wonderful feeling of Eid, surrounded by family n friends has made him forget the tiredness, nausea and hair loss....he even coughs less!

Alas, I am so lucky to have all these strangers looking after my son unconditionally ..thank you all and I leave it up to Allah to reward your kind deeds...Amin. This year's Eid in Sheffield is one special celebration I shared with Afzal and remain in a special in my heart......


KAMI.

Friday, 11 September 2009

Yet again I stumble...

In the Name of Allah, Most Gracious Most Merciful.

Assalamualaikum wbt and Hi everyone.

I was back in the anonymity again for the few days after I posted my last entry. As most of you might have figured out by now, my body seemed to have grown fond of ward P3. I was back in it again just as quick as I left it.

It was Friday evening and I was joining my housemates for the breaking of fast when I started to feel very shiverish. The temperature just rose gradually from there on, that by the time I put a thermometer under my tongue later that night, my body’s temperature has reached a high of 39.5 degrees. As 2 tablets of paracetamol didn’t do the trick, I thought it was probably wise ringing the ward and they agreed I should come to P3 as soon as possible.

Post-chemotherapy patients are immuno-supressed, ie they have weaker immune system than a normal person and thus making them more susceptible to catching infections, even from bugs that normally do not cause much harm. One of the classical signs of infection is a raise body temperature, and if not treated immediately in these group of patients, can prove to be fatal. Which is why my consultant has engrained this saying to me over and over again; “In case you have a temperature Mas, don’t wait. Ring us.” And I did just that.

The night I was readmitted, my vital signs were rather worrying. My pulses were racing so fast even I couldn’t keep pace with, my body was just boiling hot and my blood pressure plummeted to very low levels. At one point I even thought to myself, hey, is my body shutting down?? Except that I wasn’t feeling too unwell, though I reckon similar vital signs in a frail 70-year old person would probably make that person feel very poorly. For the first time since I started chemotherapy back in December, I have ventured into an unfamiliar territory. One I’ve never experienced thus far.

I was given 2 bags of gelofusine on top of my normal saline to help with the crashing blood pressure. I also had plenty of intravenous Vancomycin and Tazocin (both are antibiotics) as cover whilst they figure out what causes the infection. After 24 hours of close monitoring, alhamdulillah, my body started showing positive response and I was almost back to my normal self. In fact, I was really progressing well that the doctor gave the green light for me to return home that Wednesday afternoon. That good news was certainly what I was hoping for, as at least it will give me more time at home and prepare for my next ESHAP chemotherapy the coming Monday. But Allah certainly had different plans for me.

Remember “not the primrose path”?

Just as I was about to leave the ward for home, the nurse came to my room and broke the bad news. They have just received the results of my blood culture (which was taken during admission), and they have found a bug called Nocardia as the main culprit of my infection. As a result, I had to be kept for longer in the hospital to allow doctors to treat the bacteria. Gosh. I was that close to going home. It’s just not meant to be, is it?

Nocardia is a bacteria I’m not used to hearing. Not to say that I’m a bacteriologist, but having read my Infectious Disease textbook over and over again back during my medical-student times, I’ve never once came across it. Nocardia can be very difficult to treat, and it can pose detrimental effect on the central nervous system as well as the lungs. I was started on an antibiotic called Septrin, which is expected to deal with the bacteria and they have also arranged for a CT scan of the head and body just as a precautionary step. I’ve been coughing a bit more since yesterday, which my Consultant felt could possible be down to the bacteria. But his further management plans were one that rather shook me a bit.

Due to fear that the bacteria may pose effect on the Hickmann line and thus affect future procedures especially when it comes to harvesting my stem cells, my Consultant feels that it needs removing sometime soon. Yes, you heard me well. Removing the Hickmann Line and putting a new one.

As a consequence of the infection, my next chemotherapy which is due to commence this Monday has also been postponed to at least another week, to allow time for recovery from this infection, to remove the current Hickmann line and putting in a new one. I’ve also being told that I need to be kept in the hospital over the weekend to further monitor the infection. What I initially thought was just gonna be a few days of hospital stay has now turned into yet another week or longer visit.

Mom, you’ll always be my special friend

Verily, in every hardship there is relief. Although it’s been yet another miserable week, at least I look forward to next week. Several very important people in my life are coming all the way to UK and I don’t think it could have come at a better time. Mama has sacrificed yet again her money and time in Malaysia to spend Eid with this chemoboy. Just for the sake of this chemoboy. I don’t know just where does she get this strength to perservere travelling for 12 hours on quite a regular basis to come down to Sheffield. Mothers are truly remarkable creation of Allah, a miracle that Allah has blessed onto humankind.





It’s therefore sad to hear that a mother can look after so many of her children, yet so many children failed to look after their one and only mom when she needs the tender love and care. I pray to Allah that He gives me the quality of Uwais-al-Qarni, the noble person who lived during the time of the beloved Prophet Muhammad who is promised a high position in Jannah solely for his undying love and care for his mother.

And oh, by the way, the other important person to arrive in UK soon is PakTam and his family, as MakTam is due to start her one-year study in London. Pak Tam has always been an admirable person I look up to, he just cares for us as lovingly as he cares for Ainul. I’ve always seen Pak Tam as more than just an uncle to me, his fatherly qualities are so reminiscent of Mom’s motherly. And to have him around in UK will without a doubt provide me with the strength I need to keep me going in this uphill battle of mine.





We’re now in the last 10 days of Ramadhan. How time flies. It’s a shame I’m stucked here in the hospital knowing the mosque is literally 5 minutes away. Macam nak lari je pergi masjid, boleh tak?!!

Ramadhan Kareem everyone.

Room 3, Ward P3.
Royal Hallamshire Hospital.

Friday, 4 September 2009

ESHAP - My new nemesis

Assalamualaikum wbt and Hi everyone,

I’d firstly like to apologize to a lot of people who had been trying to get in touch with me over the past one week but failing so. It was certainly never my intention not to reply messages or answer phone calls but rather I’d just been literally knocked down by the sheer effect of the ESHAP chemotherapy. My last 5 days had just been what I can simply summarize as dreadful, to say the least.

Tired.

Nausea.

Add pain to the equation and what you get is basically NIGHTMARE.

Ever since I had the recent bone marrow biopsy, I've been getting regular nagging pains around the area of my right upper leg, most of which occurring at night. My Consultant played that down to an expected effects from tissue regeneration from the biopsy area, one that should calm down in a short matter of time. I don't think it's anything serious to go by (osteomyelitis is probably what most of you and myself will be worrying about), but I do wonder how long more will it take for it to be gone. The pain was at its worse three days ago when my housemates had to ring the hospital for assistance. I wasn't admitted for it, but M had to rush to the hospital at 1030 at night to fetch some tramadol (strong painkiller) to help with my pain.

It was a long, long night. One I wish I'd never have to come across again.



Osteomyelitis is infection in the bones. Often, the original site of infection is elsewhere in the body, and spreads to the bone by the blood. Bacteria or fungus may sometimes be responsible for osteomyelitis.


My longest stay in hospital yet


Never have I been in a hospital for this long in my life, as I was in since Monday morning and was only discharged on Saturday evening. The big delay is in part due to one of the chemotherapy, ie the Cisplatin, where a full 1 litre bag of it usually takes 20++ hours of continuous infusion. And there is usually a delay of at least a few hours before commencing on the next bag of Cisplatin. I basically need to have 4 bags of Cisplatin over the course of a few days, on top of the other drugs including Etoposide and Methylprednisolone which don't take long to be infused. They then give me a full bag of Cytarabine right at the very end of treatment for about 2 hours.

Apart from the ward rounds, meal times and vital signs monitoring (blood pressure, oxygen saturations, pulse, body temperature) performed by the nurses at regular intervals, my day routine in the ward was interspersed with frequent visits to the loo to pass water. By frequent I mean almost every half an hour at some point. Not because my kidneys are failing, but because they have also infused me with plenty of normal saline to hydrate my body, making sure it's not starved off adequate fluids. So you can imagine how difficult it was to even get a good few hours of sleep at night when every now and again you just have to drag yourself out of bed to make it on time to the loo.

It wasn't all terrible if I'm being honest. I am thankful to Allah that I was still perfectly able to perform my obligatory prayers within their stipulated times whilst in the ward. I've made some spaces by the side of my bed as my praying area, and the nursing staff were being thoughtful by making sure that I was not interrupted whenever the time was due for my prayers. I remembered during one of the morning when one of the nurses came to check my vital signs, she asked:

" Have you done your early morning prayers today, Mas?"

I smiled and replied, " I have indeed. At 5 o'clock this morning. Thanks for asking."

She took the blood pressure cuff off my arm and responded whilst filling in my observation charts, " No worries love, just making sure that you've not been a bad boy and missed your prayers, that's all."

We both smiled.





Just when you think you're the unluckiest


I know a lot of people dread staying in the hospital for any longer than a day, what more for one whole week. Lying on a bed with sick people all around you and with nothing much to do.

I wont go as far as saying that I love staying long in the hospital, but I've always been able to learn plenty about life whenever I'm in the wards, be it now or when I was in the O2 Day Ward Unit previously. Listening to other people's account of their diseases can only turn you into a more humble and gracious person in life.

Just when you think that no one can be as unlucky as you are in life, just think again.

James (not his real name) is a gentleman in his late 20s whose bed was next to mine in the ward. He has been diagnosed with Haemophilia since birth, and has had episodes of bleeding into his joints all his life.

He was in the hospital this time around for a left knee replacement, as the bloods pooling into his knee has destroyed the joints. He has had his right knee replaced for a similar problem a few years back. If I am fighting against feeling sick and lethargic, he was battling against pain day and night, surviving only with high doses of oxynorm liquid (a type of morphine, which all of us would know is a strong painkiller). He has never been able to play sports all his life for fear of internal bleeding, and needs to inject clotting factors into his body regularly for years now. Yet, his optimism and strong belief that nothing should stop us from aspiring big in life has without a doubt inspired me. I wish him all the best in life.

Quoting from the respected scholar Tariq Ramadan, suffering does not mean that we have made mistakes, nor does it reveal any tragic dimension of existence: it is, more simply, an initiation into humility, understood as a necessary stage in the experience of faith.

As Jep rightly says in his blog, Life is a long lesson in humility.

Take care everyone, and do remember me in your prayers.


P/s: Thank you so much to everyone who has been visiting me for the last few days, be it from the Malaysian community as well as my dearest friends from the mosque. May Allah reward each and every one of you, for fulfilling one of the responsibilities that is due from you. Barakallahu fik.

Thursday, 20 August 2009

Being an F1 and my special Ramadhan...

Assalamualaikum wbt

I remembered a decision I made back in December 2008, when I was advised by the JPA officials (my sponsor) that I should take the last 6 months of my studies off to focus on my treatment. It took me a lot of thinking but in the end, I decided that I wasn't going to delay my studies but to give it a go. Thinking about it now retrospectively, I believed that I've made the right decision, and I can only thank Allah for that.

Two weeks ago, I took the decision to start work as a Foundation Year 1 Doctor in Royal Preston Hospital knowing that it'll only be for a short while. A decision my Consultant fully respected, and one which rather surprised him as he thought I would've opted to enjoy on an extended break from work.

Alhamdulillah, the two weeks have gone by quickly, but I have relished every single moment of it. As people often tell you, life as a doctor will never be the same as when you were a medical student. You can no longer walk away whenever trapped in a difficult situation, and there are certainly a lot more critical decision-makings involved.

I remembered vividly on my 3rd day as a doctor when I was called upon by the nurse to see a patient with a known lung cancer who was acutely short of breath, looking very distressed and was profusely sweating. There wasn't any other senior doctors around and I knew I need to act immediately whilst waiting for more help to arrive. Macam cerita kat TV lah, every second counts kan. I went through my ABC assessment (A-Airways, B-Breathing, C-Circulation) and 5 minutes later, alhamdulillah the patient settled down. As I was about to leave the patient, the nurse said a simple, yet profound statement,

"Thank you very much Doctor."

Such a straightforward statement that makes this job all worthwhile. It really does.





I guess my short journey as a doctor would have to be put to side for now as I draw near to my first course of ESHAP chemotherapy. I need to have the sutures on my Hickman line taken out tomorrow, and start doing some packing for my admission to hospital this Sunday night.

The chemotherapy will be given from Monday morning for 5 consecutive days until Friday, and I was told by my Consultant that I can be discharged for the weekend if deemed fit enough.

This will certainly be one very interesting Ramadhan for me. Firstly, that this will be my first ever Ramadhan during the summer, thus the long day. Secondly, because of the chemotherapy and therefore the prospect of fasting whilst undergoing treatment. But before I worry anyone, let me reassure that I will not put my health at risk if I don't feel able to fast, insya Allah. In a way, I look forward to 'converting' the ward I'll be in later next week into a place of worship.

A place where I will perform my obligatory and terawih prayers.

A place where I'll be reciting the Qur'an and offer my supplications.

And hopefully show to the people around me what Ramadhan is all about for Muslims. Seems interesting, huh? Insya Allah!




Yahya related to me from Malik from Abu'z Zinad from al-Araj from Abu Hurayra that the Messenger of Allah, may Allah bless him and grant him peace, said, "By the One in Whose hand my self is, the smell of the breath of a man fasting is better with Allah than the scent of musk.' He leaves his desires and his food and drink for My sake. Fasting is for Me and I reward it. Every good action is rewarded by ten times its kind, up to seven hundred times, except fasting, which is for Me, and I reward it.' " [Translation of Imam Malik's Muwatta, Book 18, Number 18.22.58]


Ramadhan Kareem everyone. Kullu aam waantum bikhair.

Monday, 10 August 2009

The journey continues...

"Are you not afraid of death?"

I can certainly remember vividly that question Peter (not his real name) gave me when we were both having treatment in the O2 Day Ward Unit in Hallamshire Hospital. A nice gentleman he is, already in his 60s I presume, having being diagnosed with Multiple Myeloma a few years back. We met for the first time in the day ward during the 3rd course (I think) of my ABVD treatment and it was then that he found out about my condition.

"Well Peter, death will come to all of us anyway, and there is no escaping from it." I replied.

He smiled, as if the intention of his question was merely to see how I am coping with having a cancer. I always enjoyed my tete`-a-tete´ with Peter whenever we met in the Day ward. I've not seen him since my last ABVD treatment but wherever he may be now, I wish him all the best and may God give him the hidayah of the Deen, insya Allah.


أَيْنَمَا تَكُونُواْ يُدْرِككُّمُ الْمَوْتُ وَلَوْ كُنتُمْ فِى بُرُوجٍ مُّشَيَّدَةٍ


Wheresoever you may be, death will overtake you even if you are in fortresses built up strong and high! [An-Nisa:78]

....................................................................

Ever so often during my treatment, I am surrounded by patients all of whom are at least half-centurion, and it is obviously strange for them to suddenly see a bloke supposedly fit and healthy to join the "bandwagon".

My first ever admission to the hospital for my Hickmann line and bone marrow biopsy last week wasn't any different. Yet again, I was in a bay with three other elderly patients. Although we might think of them as being poorly and frail, just think again. Most of these people are strong at heart, fill with optimism not even people of our age could compete.

I remembered two of them, Jack and John (not real names), who both suffer from Acute Myeloid Leukaemia. Had it not been for Jack's reassurance, I would certainly dread the thought of having a Hickmann line.

"Don't worry Mas, it's just going to be a sharp scratch with the local(ie the local anaesthetic), and from there on you'll just feel some pushing."



If looked after properly, a Hickmann line can stay in for a few months.


Jack wasn't completely spot on if I'm being honest, as inserting the Hickmann line was quite an unpleasant 30-minutes experience. Nevertheless, things might have been worse had he not reassured me with his thoughts about the procedure.

Last Thursday was certainly not a day I'd like to remember much in my life. Not only that I had my Hickmann line inserted on that day, I was also scheduled to have a bone marrow biopsy just a few hours later. I've had one before back in December, and it wasn't pleasant at all as far as I could recall.

But never had I imagined it to be as traumatic as this time around. That was probably the most painful thing I've ever had for such a long, long time.



Bone marrow biopsy

My horrendously painful experience of having the bone marrow biospy reminded me of our beloved Prophet SAW. My mouth didn't stop from uttering words of dzikr as I was trying to bear with the sheer agony of the biopsy. That was all I could think of during then. But Prophet Muhammad SAW, he was different.

How in the midst of pain from Sakaratulmaut, Prophet Muhammad can still remember about his people and not about himself.

'Ummatii, ummatii, ummatii?' - 'My people, my people, my people.'

Allahumma solli 'ala Muhammad. How deep is your love to us, ya Rasulullah!


...........................................................................

I am still feeling a bit sore from both the Hickmann line and bone marrow biopsy, but I knew that will be the case for at least a few more days. My consultant has not got a definite date yet to start my chemotherapy, as he was still waiting for the results of my neck biopsy. However, he did say that they could probably fit in a date for my first chemotherapy sometime later this week, insya Allah.

In the meantime, I am still resuming work in Royal Preston Hospital. Enjoying my very short stint as a doctor, before I embark on a possibly long break from work. It's a great shame that I have to yet again put aside what I aspire to do for so long, but la tahzan (don't be sad). Allah knows best. He always do.

To my dearest families and friends, please keep the prayers coming. Thank you so much for all your support and du'as.

Friday, 31 July 2009

Here we go again...

Assalamualaikum wbt

It's been quite a while since I last posted an entry into the blog. So many things have been happening over the last 2 weeks, many of which are significant ones.

Firstly, the good news. Alhamdulillah, after a challenging (challenging is probably an understatement) last 6 months, by the will of Allah, I have officially obtained my medical degree from the University of Sheffield.



Now, the not so good news.

The CT scan I had on the 16th July 2009 further reinforced the results of my recent PET Scan. The disease is back. Hodgkin's lymphoma, which was found to be completely eradicated halfway down the treatment back in April, has relapsed.

Whilst waiting for my treating consultant at the 02 Day Ward waiting room this morning, I had already half-expected what was to come. I know managing a relapsing Hodgkin's Lymphoma will not be as straight-forward as the initial ABVD-chemotherapy. I was just not sure how intensive will the treatment be.

At the end of the consultation, it just dawned on me what an immense test I am likely to go through in the next 6 months.

Autologous Stem Cell Transplant. It basically means high dose anti-cancer treatment followed by a transfusion of my own stem-cells.

What I will have is very high-doses of chemotherapy, one that will completely kill all the remaining cancer cells in my body, but unfortunately the one that will also lead to IRREVERSIBLE bone marrow damage. This is because the marrow is highly sensitive to chemo/radiotherapy.

The transfusion of stem cells after high dose chemotherapy should supposedly allow my marrow to recover. They will move from my blood back to my bone marrow, where they start making more bone marrow and stem cells. Gradually, hopefully my bone marrow will recover and my blood count will return to a safe level.

For that purpose, I will also have my stem cells harvested sometime in the future. Here's a good explanation about how stem cells are harvested from the body.

In general, what will happen over the next few months are:

i. 2 courses of Chemotherapy over the next 2 months (to further reduce the number of cancer cells before stem cells are suitable to be harvested).

ii.. Stem cell harvesting

iii. High dose chemotherapy (I can't imagine how will I feel once my bone marrow is literally 'gone' when they give the high-dose chemotherapy)

* Bone marrow is where you make all your blood cells (red blood cell to carry oxygen, white blood cells to fight against infection, platelets that clots the blood to prevent further blood loss in case you have a wound). So imagine if your bone marrow is damaged!

iv. Stem cells transplanted

v. Hopefully clear remission from disease


Below is a nice diagram of the stages involved in an autologous stem cell transplant.





I have just had another neck biopsy taken this morning, and they have also arranged for a bone marrow biopsy to be done (not again!) as soon as possible. It does feel like going through the whole cycle again.

It's natural for a human being to be left feeling so frustrated having been so strong in facing such a big adversity, and coming out of it standing tall and proud, only to be knocked down again by an even bigger test almost immediately.

But as a Muslim, it is imperative that I believe in Allah's plannings. It might be that Allah is not giving me the ray of sunshine just yet, rather pouring me with heavy rains, only so that He can give me the beauty of the rainbow by the end of it. Insya Allah! =)

"Bila Allah uji kita dengan sakit, tandanya Dia sayangkan kita..Dia mahu kita jumpa Dia suci dari segala dosa dan hina kita di dunia..."

This is indeed, not a primrose path.

Wallahua'lam

Wednesday, 15 July 2009

Nobody said this journey was easy...

Assalamualaikum wbt

I'd firstly like to say thank you very much to a lot of my concerned friends out there who have been eager to know the result of my PET Scan done on the 5th July 2009. The scan went well, alhamdulillah, although the technician initially struggled to put a cannula into my vein (which is understandable, semua my veins pun dah merajuk sebab dah 6 bulan kena torture kot!).

My CT scan back in March was promising but unfortunately it wasn't the case this time around. I've been told by my Consultant that the PET scan showed some hot spots in the mediastinum, lungs and left side of my neck.



Senang cerita, mediastinum ni region antara the two lungs, ie bahagian tengah.


Now let me try and simplify how a PET scan works. With a PET scan you first have an injection of a very small amount of a radioactive version of glucose. The radioactive glucose travels to places in your body where glucose is used for energy. Since cancer cells are more active and take up more glucose than normal cells do, they become intensely bright on the scan and this is where the term “hot spot” comes from.

A handy information about PET Scan for those interested.

The tricky bit about hot spots are that they can also be caused by things other than cancer, for instance infections like viral illness or Tuberculosis. Although my consultant feels that the hot spots found in my scan are quite likely active cancer cells, he doesn't want to jump immediately into second-line treatment (stronger chemotherapy and possibly bone marrow transplant) due to their long-term effects.

We therefore felt that a wait-and-see policy is probably the best approach at the moment. My consultant has also decided to arrange for another CT scan tomorrow morning which should hopefully be a helpful adjunct on top of the PET scan findings. Insya Allah.

Since management of my condition will take at least months of close monitoring, I have been recommended to remain in the country. Which has certainly thrown my Plan A into a bit of an uncertainty. [Plan A = To return home and start work in possibly Serdang/Putrajaya Hospital]. These last few days have been spent sorting out my FY1 (Foundation Year 1) job in Royal Preston Hospital, as I am due to report for my induction next Monday (ie 20th July 2009).

I must admit there are so many uncertainties running through my mind at the moment.

Not being sure how things might pan out in the future in regards to my condition.

If I do start working as a doctor in UK, how will it be affected if I am to have further treatment for my condition?

If my sponsor does insist on me returning home, will I be sure that there will be no glitch in transferring the management of my condition to the Malaysian hospitals? How will the treatment and healthcare be like back home?

Indeed, no one said this journey was gonna be easy.

Tapi kita kan ada Allah. Ya 'Azim. Ya Rahman. Ya Rahim.

There is nothing easy except what You make easy. And You make the difficult easy if it be Your will.

p/s: In myself, I couldn't have asked for more alhamdulillah. Feeling good, fitness gradually picking up, my hair looking long enough to even consider visiting the barber! =)

Friday, 3 July 2009

Sesi Penghargaan

Assalamualaikum wbt

5 weeks ago, on this day, I had my 12th and last chemotherapy. It might have been quite a while now, but the whole experience of battling against the drugs is still vividly clear in my head, as if it has only happened yesterday.

Alhamdulillah, I am gradually picking up my level of fitness as days go by, thanks to the easily accessible swimming pool and gymnasium in my university. Contrary to my initial perception that people undergoing chemotherapy usually loses weight, I have actually gained almost 7kg over the past 6 months (dun wori, takdelah nampak bulat sangat =)

It's not that this weight gain is bothering me, rather it makes me feel blessed. Blessed that during the 6-months time when I was having my treatment, the people of Sheffield has played their part in helping out.

Today, as I was perusing through my inbox , I saw this email, sent about 4 months ago which reminds me just how thoughtful Malaysians in Sheffield are.

_______________________________________________________________________


Assalamualaikum & salam sejahtera kawan-kawan,:D

Sebagaimana yang telah kita tahu,kini saudara Mas Afzal sedang menjalani rawatan chemotheraphy dan amat memerlukan sokongan kita.

Jadi,beberapa minggu lepas, saya telah menghantar email secara personal kepada beberapa orang ahli smsa di kawasan Broomhall menanyakan kesudian mereka memasak dan menghantar makanan kepadauntuk saudara Mas Afzal.

Di bawah saya sertakan jadual giliran memasak pada mereka yang telah membalas email saya

HARI - RUMAH

ISNIN - 10 HOLBERRY (ROY )

SELASA - 27 HAVELOCK (SOFIAH)

RABU - 82B BRUNSWICK (SHAHNOM)

KHAMIS - 5 FILEY (KAK ELI)

JUMAAT - ABG ZAKARIA

SABTU - ABG SAFUAN



______________________________________________________________________

Not forgetting my dearest housemates especially Mr Chef Khairuddin aka M, and my neighbor Kak Lida for always dropping by to offer some of the foods that she had cook.

To all these people above, and their fellow housemates, I only have Allah to thank each and every one of you. May Allah allow all of you the opportunity to enjoy the reward of your deeds in Khurfat-ul-Jannah, the fruit garden of heaven, as has been mentioned by the Prophet Muhammad (may peace be upon him) for the people who visit and look after the sick.

This Monday at 1030am, I am due to be in Northern General Hospital for my next PET Scan. I'm assuming that the options possible once the result is up will either be :

i) Declared cancer-free and thus only occasional follow-ups in the clinic
ii) Further chemotherapy/ consider radiotherapy if localized

Insya Allah, whatever the outcome will be, I will need to tell myself that it is part of Allah's plannings for His servants and put my sheer reliance (tawakkal) on it.

Before I conclude, I'd just like to share with you a beautiful hadeeth that was forwarded to me from a very special friend of mine.

The magnitude of otherworldly reward is proportionate to the magnitude of worldly tribulation. When God loves a people, He tries them. Whoever is content will have divine pleasure. Whoever is displeased will have divine wrath. [ At-Tirmidzi]

SubhanAllah.