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.

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.

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.

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.

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