THE BOOKS I READ IN SEPTEMBER

 It has been a crazy month, with the family relocating to Ireland. During the busy times of settling with family, going to work, and doing a million admin tasks, I came across a beautiful public library in Sligo City, as I was walking from my Hospital to the Antenatal Clinic. The public libraries in Ireland are very big with a great supply of new and classic books. We can join for free, take up to 12 books per card, my toddler can even have her own library card, and there is no fine for late return of books. I took one novel for myself and three children’s books for my toddler. 

The first book I picked was by Fern Britton, The Beach Cabin. It was the easiest read I had ever had. It was printed specifically for people with dyslexia. It was a contemporary story tackling problems of modern families, when teenagers are always grumpy and hard to impress, on their iPad all the time, and are picky with family dinners. While all these things are happening to the kids, the parents are having their own personal and career challenges. In the middle of all this, the father decides to bring the family to a beachside vacation, and a lot happens. 

I read a book about a balanced lifestyle in the modern world. It was short, and I read it mainly on the bus commuting to work. I did not take a picture of the cover or record the author's name, and the book is back at the library. It started with basic family values and appreciation, and inner peace, to later work on other interpersonal relations. 

The third book, which I was very excited to see in the village library, was by Stanley Tucci, What I Ate in One Year. I follow him on social media, and I know he has cooking programmes here and there. I always enjoy his movies, even though he is usually playing a very influential supporting actor. He starts writing on the second of January 2023. His writing is simple and has a good sense of humour. He portrays his day-to-day life. The challenges of acting, rehearsals, and constant travelling. He also has young children. He tries to be a hands-on father, trying to prepare kids for school and make them breakfast and dinner. There are recipes that he shares in the book. He is originally Italian and his favourite dish is pasta! There are many other Italian dishes that I didn't know and had to look up. I was impressed that he still incorporated regular Pilates and yoga with his instructors to try and stay fit. He stays in the UK, and I was impressed that he is a Harry Styles fan; they dine together whenever he is not busy or on tour. It was a very interesting read, even though I am not a fan of Italian food, but it is interesting to have a glimpse of the celebrity lifestyle. 

MY BIRTHDAY MONTH

 It is September! It is my birthday month. I am turning forty this year. It is a great milestone. I am surely getting older and wiser. becoming a mature woman. It has been quite a busy year for me. Receiving a job offer in Ireland in May changed many things. Between having a full-time job as an OBGYN, we had to start renewing our passports and apply for a new passport for my daughter. Apply for ACLS and BLS courses, which require a lot of preparation and a dedicated full weekend of hands-on training. By the end of June, I had received my work permit, and the online Visa application was done, and we were waiting. By mid-August, we had our Visas and we had to book our tickets, organise accommodation abroad, pack our bags, and move as soon as possible. 

While the full-time stressful job is going from 7:30 to 5pm, along with the baby drop off and pick ups from school. I was going through a huge emotional turmoil with my own family. My work family still did not know about my plans. My colleagues and my Boss found out about everything at the beginning of August. By mid-August  I was submitting my resignation letter and sorting out a million things with the human resources department. Long story short, tickets were booked for the 8th of September. and I started packing bags and shipment boxes. I had to look at all the sentimental items in the house and decide what needs to be packed and what goes to the box, and what needs to be donated. 

All this happened, and still, friends and family made my 40th birthday special. My best friend took me to Mount Grace for a lovely Spa day. It was an amazing drive and a relaxing day. We got together with my family and the in-laws at the end of August and had a beautiful farewell lunch. and I got very beautiful gifts. My colleagues got together at work and threw a farewell party at which made me cry. We spend more time with our work colleagues than we do with our families. The last day of work was the 31st of August and everything went smoothly. My packing was finalised, the house furniture was sold, and some last-minute paperwork was done. Looking at the empty house made me feel sad, but it is a sign for a new beginning. I am looking forward to my new adventure! 

DAYDREAM

 It is a random Saturday, and I am at work in the hospital, going through the handover and a big antenatal ward round that takes the whole day. I would probably not be at work, and then my imagination started going wild, wondering where I actually want to be! I would definitely need a Spa day, probably on my own. I definitely do not want any family members or friends with me. I want to relax, have a fancy massage, then swim in the heated pool. After swimming, I want to relax in the steam room. After the relaxation is over, there comes one of the real joys of life, which is food. I would like a green salad, grilled prawns, some sushi, and fruit to eat. I love my tea, preferably some black tea. I want to sit and sip on my tea and read my new book, and get lost in the story without worry,  rushing, or interruptions. 

What I like about Spa days is that they give a brief break between the day-to-day hustle. They do not need extensive planning, packing, and travelling. I have a little baby and I do not want to be away from her for too long. So a little half-day break on my day off will be manageable. 

I love my little daydreams! They help me escape the brutal, non-stop working reality of life. They allow me to drift away and go to places and do the things I want to do. One of my favourite things to do is to travel back home to Grandma’s house. Imagine that it is around lunch time, when we usually just eat lunch and watch TV at the same time. I really don't care what grandma is watching, as long as we are together. It will feel good. It is September now, and extremely warm back home, but us Middle Easterners do not care; we should still have our tea. I miss the relaxing days of sitting with my grandma and listening to her stories. I miss her house and the old furniture. 

Even though we have circumstances in our lives where we can not change, we can change the way we think and drift away every now and then. 

MEMORIES OF MY CHILDHOOD

 I have been very nostalgic and sentimental recently. I am planning to move abroad. I sit and empty out the cupboards most nights, trying to figure out which items are going with me, which items to be sold, or to be donated. I came across a very special box which had very precious photos, some cassettes and CDs which I am keeping. My school uniform tie from Jeppe Girls was signed by my friends. Beautiful and tiny crochet baby boots! The baby boots really blew my mind. It humbles you knowing how tiny a baby is until it grows up. 

My first childhood memory goes back to around the time I was 5 years old. I had vague memories of Cyrus, my brother, when he was born. I remember Dad’s mother visiting us, and the house was full of visitors. It was quite disturbing. I remember trying to help my mother set the table or take the dishes to the kitchen to be washed. Up until now, I haven't liked guests, especially the ones who sleep over. I feel like they invade my space,  eat all my food, and make my house messy! I prefer to meet up with my friends in a restaurant. You will never find me trying to cook fancy food and set fancy cheeseboards to try and entertain people in my house in my adult life.             

Back in those days, we did not use disposable nappies. There were white cloths that had to be washed, disinfected, dried, folded, and stored in the cupboards. Another vague memory is when mom used to wash my brother's bump in the basin. He was definitely under six months. I went to school from the age of 3 years. I definitely was a very depressed child who had separation anxiety. I did not play with anyone; I hardly had friends. I would skip most of the school days. I was crying most of the days when I was in grade one in primary school. I remember Grandma was in charge of me during that time. Mom would drive me to primary school, and my brother to my old playschool. Grandma would help me with my homework, and most nights I would sleep in her bed, which was very fun. 

My brother grew up and became more fun. We would spend our days running around the house and the yard, screaming and shouting. We had a two-story house with a big basement. I remember I always enjoyed going to the basement area where my uncle used to study. Granny and Grandpa used to tell me I must not go there because there are rats there! One day, I went there all determined, shouted to keep the rats away,
and went to the basement, feeling very triumphant. My mom had to take us to the parks so we could play and have fun. I remember my first bike ride on the street. My dad was showing me how to keep the bike balanced, and I was very excited!

EXERCISE IN PREGNANCY

 This is a question I am often asked in obstetrics consultations regarding exercise in pregnancy. Most of the women we see take part in some sort of recreational physical activity, but only 15% of them exercise at the recommended level, which is 30 minutes of moderate activity every day of the week. 

Most women believe that pregnancy is the time to eat everything and gain as much weight as possible. Too much pregnancy weight gain can lead to problems such as Gestational Diabetes, large for gestational age babies, and a higher rate of caesarean section. We know that the woman's body changes during pregnancy, for example, her blood volume is increased by 40% and the stroke volume by 10%. There is decreased vascular resistance to enhance the placental perfusion. The growing uterus can shift the center of gravity and cause lumbar lordosis and back pain in 50% of pregnant women. The ligaments of the bony pelvis also become lax and can lead to severe discomfort. 

Moderate exercise can have multiple benefits for the mom and the baby. It can decrease the gestational weight gain and decrease the rates of pre-eclampsia, insulin resistance, and gestational diabetes. The guidelines suggest that overweight women should not gain more than 10% of their body weight in pregnancy. The recent trials have not found an increased risk of preterm birth or low birth weight in women who exercised in pregnancy. 

In summary, moderate exercise is encouraged in uncomplicated pregnancies. There is no evidence that moderate exercise can harm the mother and baby. We do not recommend exercise for women with chronic diseases such as severe anemia, cardiac disease, intrauterine growth restriction, or extreme morbid obesity. Forms of exercise such as horse riding, scuba diving, or skiing are also not recommended. I personally found moderate walking in the third trimester very helpful, although I was in so much pain and felt that my symphysis pubis in ripping apart. I tried to bounce on the gym balls as well, although I did not go to spontaneous labour and required induction of labour, but my labour progressed well, and I feel the exercise played an important part. 

FRECKLES

 I am back to reading fiction, and I am enjoying it. Back in the day, I used to enjoy novels from local authors, Jane Austen and Agatha Christi. In my late 20s, I decided to strictly read non-fiction books about politicians, famous people, etc. I think the last non-fiction book I read was Laura Bush’s memoir. I came across this book in the library, and the title suggested it must be a girly story. I finished it in less than two weeks! It was a beautiful and touching story about a girl who grew up in a boarding school from the age of five. She would spend time with her dad on weekends. They stayed in the rural parts of Ireland on Valentia Island.  Her mother left her after she gave birth. The book describes the girl's relationship with her dad beautifully. He has always been there for her and understood her. She had her freckles from her dad’s side. 

After finishing school, she moved to Dublin to pursue a career and to find her biological mother. Her struggles in Dublin are described in detail, and how she is shy and awkward around people. She comes across a guy who tells her she is the average of the five people she spends most of her time with. She is trying to find those people amongst influential celebrities, and starts writing to them. For sure, she knows her dad is at the top of the list of influential figures in her life. She even tries to find that popular girl from her school days that she always wanted to be friends with. At the end, she realizes she has enough friends and influential figures around her already who inspire her and love her. 

The moment of truth in the book is when she finally introduces herself to her biological mother, and it is quite a surprise. Another touching moment in the book is when she is in a hair salon, and her biological mother is doing her hair, and she is loving it! I enjoyed reading contemporary fiction where people post things on Instagram, send emails, and have smartphones. She is a hardworking girl trying to figure things out while trying to build her self-confidence and pay her bills. There is a lot of growth in her throughout the story, and her love for her father is as strong as ever. It is quite unique because he is the one who wanted her and raised her. 

HPV VACCINE

 It breaks my heart when I come across patients who have negative misconceptions about vaccination. We have come a long way in medicine when we used to have various infectious diseases wipe out a whole population, or leave thousands with multiple disabilities. The discovery of the Human Papillomavirus by Harold Zur Hausen as the causative agent for various cancers, such as the cervix, anus, and oropharyngeal, was a major scientific breakthrough. He won a Nobel Prize for this. Later on, we had the HPV vaccine coming around 2006, to prevent our youth from being infected with the virus, and decrease the rate of precancerous cervical lesions and other HPV related cancers. 

The HPV vaccine has been available in South Africa since 2009. There have been numerous international studies showing that the vaccine works. The number of women diagnosed with precancerous lesions has declined after the introduction of the HPV vaccines. What we need to do as health care providers is to educate young women, to get vaccinated before they become sexually active, around the age of 9. HPV is a sexually transmitted disease, and boys also need to be vaccinated. Due to financial constraints, the governments are funding women to be vaccinated. 

The rise of vaccine misinformation in conventional and social media has contributed to growing distrust in vaccines in general, including the HPV vaccine. All related health care workers, such as paediatricians, Obstetricians and gynaecologists, and public health experts must respond with evidence-based messaging that emphasizes cancer prevention. Social media sends controversial messages that the HPV vaccine causes infertility, autoimmune disorders, or promotes early sexual activity.   

PALLIATIVE CARE

 When we are in medical school, we have a totally different mindset, we enjoy learning the science and the pathophysiology of diseases, and we are eager to save the world. Later, during our clinical rotations and patient interactions, we eagerly await hearing the cardiac murmur, lung sounds, and crackles, among other findings. Then we grow up a little more, and we learn the various blood investigations and imaging. As time goes by, we probably touch the patients less and spend more time figuring things out through the investigations. 

There are certain clinical situations when a diagnosis has been made, and the patient’s prognosis is poor. We feel like we have done our part, and perhaps not much can be done from our side. There is still so much that the team looking after a patient with end-of-life issues can do. It is important to be straightforward with the patient from the day the diagnosis of cancer, or organ failure such as cardiac failure, liver failure, or dementia, has been made. We are not God, and we might not know how much time they have, and they may end up being very sick at some point. They need to have those important conversations with their loved ones while they are relatively better, to be able to make plans for the future. 

If they need additional support, the social worker and the palliative care team can come to play. We need to ensure that we have a support structure for our patient and make sure the family member or caregiver who is looking after them is coping. We need to guide them in terms of hospice placement. Make sure they are not in pain and make their end-of-life journey as easy as possible. I am an OBGYN and I often bring babies to the world, but I also have a special interest in the oncology field. Perhaps one day, when I retire, I will volunteer to help these patients and provide support. I was so touched when I saw our palliative care team had brought Art therapy to our ward, and the patients are creating crafts and feeling busy and happy. 

MY FIRST MAMMOGRAM

 I can not be an advocate for women’s health and not look after myself. The challenge with a screening test is that a lot of women have no symptoms, and they tend to postpone and not make time for it. Another factor is that most women feel uncomfortable getting that gynaecology exam or getting naked and getting their breasts exposed for the screening test, or they might be terrified of the findings.  I was trying to get the mammogram done during my leave time, but the appointment was full, and I finally managed to squeeze it in the morning of my work day. 

Overall, I had a pleasant experience. The staff in the radiology department were very friendly. The atmosphere was pleasant and welcoming. There was a private changing area for me to change my clothes and get into a gown. There wasn't a long waiting time until the mammogram was done. There was an interval between the mammogram and the routine ultrasound. I had a cup of coffee. The sonographer who examined my breasts was very friendly. One thing I learned was that it is advisable to do your mammograms and exams in one radiology center, to allow the team to compare the images and make the right diagnosis. 

I was very anxious about the results. The report was emailed to my referring Doctor and me, and I was even able to access the images on the radiology link. My medical aid paid for the exam, and I even had vitality points. I feel happy that for the next three years I do not need to do this. Next up are some blood tests and a dental check-up. I have also decided to keep a digital copy of all my medical records. 

ME AND MUSIC

 I have a special relationship with music. I am listening to a 90s playlist and writing this. I grew up in the eighties and '90s in a Middle Eastern country where music, especially Western music, was banned. I had some music exposure while I stayed in South Africa between 98 and 2000. We were struggling financially and still didn't have a CD player. I remember the new Westlife Album was released, and my High school friend Sandra recorded it on a cassette for me to listen to. It must be somewhere in my grandparents’ house, along with a hundred other cassettes I recorded from different radio stations and channels. I used to be crazy about Celine Dion. I would play her music, record my voice with the microphone, and feel like a diva! These days, when I listen to her old songs, I feel sad…I think about the days I used to be wild and young and free. 

The world of music became more colourful for me after we managed to get a satellite TV around 2005, and in those days, I could watch different international videos and enjoy them. Shakira and Jennifer Lopez were the new emerging artists in those days, and they are still going strong and going on tour. By then, I had given up on becoming a singer and was going to medical school. By 2010, when I was an intern, I got my first MP3 player. It was so life-changing! Having music while walking to work or using public transport was lovely. I was using various internet channels to download music. 

Life is amazing now with music streaming platforms such as Spotify! A lot of the artists probably miss the good old days when they would sell records, making less money through these platforms.  With a small monthly subscription, I listen to a wide range of music on my devices. There is no need for downloading or recording cassettes, CDs, or MP3 players. I listen to a wide range of music from my home country, French, Jazz, classical, Arabic, Indian, Latino, and pop from the '60s up to now. The only time I feel like a diva these days is when I am driving and I sing along to my favourite song. I have a little fantasy to have a little band and sing in a bar or something when I retire…

I still have my first MP3 player; it is such a sentimental item to me

MY HAPPY PLACE

 I am an introvert. When I was small I enjoyed doing my own thing, listening to children’s story cassettes, playing with my Legos, or drawing. Whenever we had visitors I would get irritated as a child because the house was so messy, mom was busy cooking, setting the table, or clearing the table and washing the dishes. Later on, I started having a special interest in books. I enjoyed reading a wide range of fiction. From Authors back home, and the classics from British and Russian authors. 

Another introverted and creative joyful activity for me was drawing and painting. It started with sketching in high school art classes and then became more sophisticated such as watercolour or oil on canvas. A lot of the artworks are framed and on the walls back home. Three of my favourite works are framed by mom’s house, 2 other nice oil paintings are by my brother’s house and a small daffodil painting and some random watercolour work are in my office. My life has been crazy with all the medical school and specializing, getting married, and having a child. I have not had the passion or energy to frame any new works or put them on the wall in our house. 

Recently I started gathering pictures of some of the previous art and decided to laminate some others and put them on the walls in the spare room. Some of my early favourite sketches are from the book I found at my grandparent’s house and which had beautiful black and white pictures of ballerinas from the Bolshoi Ballet in Russia. I used to love those beautiful and graceful ballerinas. Later on, when I grew up I watched the movie Black Swan and it changed my point of view on the ballet story. 

After having a baby I lost my identity. The whole day and night revolves around the care of the baby. Only now that the child is about two and half years old and can play with herself independently and go to school I am starting to find myself again, and reflect on my favourite hobbies and activities. One of my very favourite places to go are the bookstores and libraries. I try to avoid the bookstores because I can't control myself and I end up buying books that I won't read or need. The Norscot library has a beautiful building and garden, and it offers a very tranquil environment. I usually go there once a month to unwind, do some deep reading or writing, and pick some interesting books for myself and Aryana.