KINDNESS IN HEALTHCARE

 I recently attended a very informative webinar by the Royal College of Ireland regarding “Kindness” in health care. It is a topic that is often not talked about or pointed out in medical school, and we only come across it when we interact with patients or our colleagues. Kindness is different from being nice; it is a necessary skill that we need to understand and cultivate every day. Esther Perel often talks about such skills as if they are muscles that need to be trained. 

I believe the first step to being kind to others is to be kind to ourselves. Try to enhance our self-care, and try to recharge our batteries from the struggles of day-to-day hustle. We do not want the empathy tank to run out while we try to give to others. It starts with basics, like good sleep, and some good body movements. I try to do as little as 5 minutes of squats or stretches in the kitchen while I am cleaning up. I know that sometimes the dirty laundry can wait to be hung or folded if I have had a busy day; this is a way for a working mom to be kind to herself. I try to set boundaries with friends and family, and say no if I am busy, to give myself more time to recharge. My favourite thing that keeps me going every day is sipping on my cup of black tea with no sugar while I take a small break. It takes me back to the good old days when I used to sit by grandma, drink tea, and watch the world burn down on the news. I enjoy going on walks, but it is more limited with my toddler.

One of the speakers on the webinar had a very interesting point. As doctors in medical school, we are trained to probe the signs and symptoms, run some tests, come up with a diagnosis and treatment, and feel good that we fixed the problem. There are times when, as a gynaecologist I am consulting a patient, and I know that I do not have much to offer, but just the gesture of listening to the patient attentively, allowing them to talk and not cut them off can go a long way. Learning to be a good listener is not an easy job when all we want to do is to interrupt the patients and tell them about the latest treatment options or clinical trials. Other aspects of being kind are having good follow-up plans, if we have booked an imaging or a test, to make sure it goes smoothly and does not get cancelled. 

Getting negative feedback from patients is not easy. I have had a few complaints from my consultants, which were feedback from my outpatient consultations, and one from the labour ward management. These are not big litigation cases when a patient was injured, or there was a very poor outcome. These were simply times when the patients felt unhappy with my behaviour. There is always room for more kindness, empathy, and attentiveness. In the webinar, we were introduced to a lot of books and reading material to help us cultivate kindness towards others. My senior consultants have been relatively good to me, and I thank them for their kind guidance. 

EARLY PREGNANCY

It is an absolute culture shock to relocate from Africa to a first-world country. After all these years of training, working, and saving lives, the first thing I hear is that only formal, departmental scans are accepted, and I do not have permission to scan because I have not been trained in the Irish system. We used to cover gynae unit calls as a registrar, and we would review up to 50 women with early pregnancy, with either vaginal bleeding or abdominal pain. In that busy setting, we would detect up to 5 ruptured ectopics, which we were managing laparoscopically if the patients were heamodynamically stable. Unstable ruptured ectopic cases, or unstable or septic incomplete miscarriage cases, would be taken to the theatre immediately, usually after the blood products are available. Most patients do well with IV fluids and blood transfusions. Still, some may require prolonged ventilation. The cases of missed miscarriage, or first-trimester miscarriage, will mostly be managed by Manual Vacuum Aspiration, which is done under anesthesia by the interns, in the MVA room with simple analgesia such as IMI diclofenac or pethidine. 

Women who have a viable intrauterine pregnancy are told to go to their local clinics to book their pregnancy and to take supplemental folic acid. 

In Ireland, women present to the ED with early pregnancy complaints, and then they are assessed in the gynecological assessment room, which gives us good privacy. If the patient is hemodynamically stable, they are booked for a formal departmental scan as soon as possible, if the point-of-care BHCG levels are more than 2000. The ultrasound department tries to accommodate these patients in the morning, and has the pregnancy growth scans later during the day. It will not be pleasant for these women to clash with heavily pregnant women and feel traumatized by their pregnancy loss. 

Women with a viable intrauterine pregnancy get assessed regarding risk of preeclampsia according to the checklist with moderate and major risk factors, and are started on Aspirin and counseled. Women with missed miscarriage or an incomplete miscarriage are counseled regarding their preferred mode of management, which can be conservative, medical, or surgical management. 

Evacuation of the uterus is done under anesthesia in the theatre by the consultants. Patients come on the day of the procedure, and are discharged on the same day to save bed space in the hospital and control the costs. There might be one ERPC done per week, and in the span of three months that I have spent here, I have seen 3 stable ruptured ectopics managed laparoscopically and 2 managed medically. All women with suspected pregnancy of unknown location or suspected early pregnancy are handed over meticulously, every day at the huddle meeting, so no cases are missed. 

The fascinating fetus is growing in a little gestational sac. This was me scanning myself after 3 months of amenorrhea, it was such a joy to see a fetus with a heart beat.

THE HOLIDAYS

 

life is an amazing journey, and time gives us a different perspective. It is fascinating when I look back and see that I started my blog in 2024, and I am still going.

I enjoy putting my ideas in writing, and various ideas about medicine and everyday life keep coming every day. Today is the first of January, and we are halfway through the holiday season.

It is a time of year that sometimes gives me a sense of FOMO (fear of missing out). The presence of social media makes things a bit worse.

I was born and raised in a Middle Eastern country. We do not do things like Santa, Christmas, easter, or even the tooth fairy!

there is no way that Middle Eastern parents11 would buy a gift for their kids, and give the credits to some fictional character!

But living abroad, and knowing the majority of people are celebrating Christmas, like setting up a tree, getting each other gifts, and having fancy Christmas food makes me feel empty,

because I am not doing any of it, and don't feel fully festive. 

There was a phase in my life when I was obsessed with my next holiday destination, and it would deplete my bank account because I couldn't afford any of them.

Today I am grateful that I can afford food and pay my bills, even though I am not on a tropical or exotic island resort right now.

Another category of people spend this time either on a fancy tropical island in the Caribbean or a ski resort. However, most people are currently battling with the economy.  

My in-laws visited us on the 22nd of December, and it has been quite nice to have them around. The city of Sligo is relatively small, and I am not very familiar with most of the interesting sites at the moment.

I have been asking around, trying to figure things out. The most popular places are at the beach, such as Ross’s Point or Strandhill.

We don't have a car, but it is nice to drive to different places and have fancy walks and hikes near the Benbulben mountain.

This one is probably not an option for me, who is on baby duty on weekends. I always pass the Glasshouse hotel in the city, and it looks very fancy, and I wish to dine in it on one of the weekends that I am out with the family.

My in-laws eat strictly halal food, so this is not an option for them either. Ireland has very wet and unpredictable weather, and does not have outdoor cafes like Italy or France.

People prefer to go to the warm and cozy bars and drink. I am not much of a drinker, so this would not suit me either. 

Sligo library is a nice and tranquil place that I visit on my free weekends, and it has a vibrant environment for my 3-year-old daughter to interact with the other kids, draw, and browse the vast collection of children’s books. 

one of my best moments of the holidays was taking long walks in the mornings, knowing my mother-in-law is home watching my child until I come home.

I had heard from one of the taxi drivers that there is a lake near where we stay, so on Saturday morning, after the Christmas holidays, I wandered and found this beautiful lake near the Hazelwood forest.

I watched the sunrise and felt very relaxed, spending time in nature. 

I am grateful for the holidays with family, and for another year. hoping for a year full of health and abundance for my family and me.

We don't need expensive gifts or fancy holidays to be happy. I am more mature and grounded these days, and it's funny that we now clean the house to the music we used to dance to in a club.