Cemeteries: The Biggest Difference Between Civilizations

In Elif Shafak’s book “10 Minutes 38 seconds in This Strange World”, D/Ali asks: “If I were to ask you what the biggest difference is between Western European cities and our cities, what would you say?”

He answers his own question saying that the biggest difference is the burial grounds. “At some point in history,” he says, “Europeans had the brilliant idea of sending the dead to the outskirts of their towns. it wasn’t exactly out of sight, out of mind’, but it was definitely ‘out of sight, out of urban life’.” And like that, the dead were separated from the living. This was very beneficial for them, for when they no longer saw tombstones at every other corner, they “pushed death out of their daily routines” and they could focus on other things, things like inventing new things and colonizing new places… Leila then asks D/Ali: “What about Istanbul?” and he answers:

“It’s different over here. This city belongs to the dead. Not to us. In Istanbul it was the living who were the temporary occupants, the unbidden guests, here today and gone tomorrow, and deep down everyone knew it. With headstones met citizens at every turn – alongside highways, shopping malls, car parks or football fields – scattered in every nook, like a broken string of pearls.” and he says this resulted in people loosing their appetite for innovation, and this caused renovation projects to fail, because people were constantly reminded of death.

This is so true and Elif Shafak very beautifully put it into words. If you’ve been to Istanbul, you can clearly see what she means by “this city belongs to the dead.” Tombstones and cemeteries are everywhere, in the backyards of mosques and near schools and in the middle of universities. I’ve seen the same thing in a few other Turkish cities, and a little bit in Ankara (not much probably because Ankara is a newer city built to match European cities?), in fact there’s a graveyard on the campus of my university.

Me in the cemetery of Suleymaniye Mosque in Istanbul – August 2019
A cemetery in the city center of Konya – June 2019

The presence of tombstones everywhere might indeed have an indirect effect on the lives of people and the way they think like Elif explained. Can you think of other aspects of cities that have similar effects?

If you’re the smartest person in the room, then you’re in the wrong room

03.09.2021 – Observership 1.7

You’ve probably heard of the quote that says: “If you’re the smartest person in the room, then you’re in the wrong room.” It’s quite a wise quote. I’ve heard and read it many times but never really took the time to think about it and appreciate it. There are so many benefits of surrounding yourself with people who are better than you, whether smarter, kinder, more experienced or just better in any other aspect, because when everyone around you knows a lot more than you do, there’s room to learn and grow.

Last Friday, I completed 7 weeks of an observership at a hospital in Lebanon. This was my first experience in a hospital, as we only start our clinical rotations at university in phase 4 (that’s 2 years from now) and I am so so happy that I got the chance to spend time there and learn so much from the hospital staff! I am thankful that I’ve been surrounded by people that know much more than I do, and so grateful that I could learn so many new things from them.

This experience included a first in so many things: my first time in an OR, first time to suture, first time to witness death and so many other things I’m sure I won’t forget that I did for the first time at this hospital!

This post is a thank you to every surgeon who explained an operation in detail for me, every physician who answered my questions and every nurse who taught me how to take an ABG sample, suture a wound, insert an IV or record an ECG.

Beginner’s Mindset in Physicians

29.08.2021 – Observership 1.6

At the hospital I had the chance to see some patients with a doctor who I thought was quite interesting. He’s a well-known doctor in his sixties, a good doctor, too. It was obvious that he liked his job. One time I heard him tell a doctor that he got so bored from sitting at home that he hopped into his car and decided to come to the hospital. That’s not something you commonly hear doctors say. He once asked another doctor to accompany him to see a patient in the ICU who wasn’t his patient but whose case he thought was interesting. I went with them. The patient had Bells Palsy. The two doctors asked her a few questions and asked her to smile/frown/raise her eyebrows to see how the muscles of her face were functioning.

The other day, he heard about a procedure that was to be done with another doctor at the hospital. He asked if he could tag along and observe. After the procedure was over, he asked so many questions regarding it to the much younger and less well-known doctor who had performed the procedure.

This doctor, who has been practicing medicine for long years, obviously didn’t suffer from the physician burnout most doctors his age experience. He was enthusiastic and curious to learn new things. He had a beginner’s mindset. He is at ease with himself enough to ask questions and say things like: “please explain this to me, because I don’t know it and you do.” On the other hand, I know many students who would never ask the questions that this experienced doctor asked for fear of sounding ignorant. They’d never answer with “I don’t know” to any question.

We must always remind ourselves to adopt a beginner’s mindset, so what’s that?

The beginner’s mindset is a term used to describe the mindset of a beginner, it can described as “having an attitude of openness, eagerness, and lack of preconceptions when studying a subject, even when studying at an advanced level—just as a beginner in that subject would.” A person with a beginner’s mindset has an open and a humble mindset and accepts that he/she does not have all the answers.

Patrick Buggy explains it this way: “Just think back to what it’s like when little kids learn about something. Children are overflowing with questions. Their imaginations run wild. They ask both simple questions that are obvious, and profound questions that you’ve never considered. Children are natural at this, because they’re always beginners at something. But as you get older, it’s easy to lose touch with the qualities of mind that once came so naturally.”

I think of the importance of physicians adopting a beginner’s mindset. It surely allows them to learn new things, prevents the boredom that may accompany seeing patients with similar cases every day for long years and surely slows down physician burnout.

I’ll end this blogpost with this quote from Brian Herbert: “The capacity to learn is a gift; the ability to learn is a skill; the willingness to learn is a choice.”

Here’s an article in which the author talks about the benefits of developing a beginner’s mindset and simple exercises that can help you build one. I’m sure you’ll find it insightful!

كبرياء المرضى

18.08.2021 – Observership 1.5

كنت في قسم العناية الفائقة. كان في السّرير الأول رجل مسن يطلب شرب الماء بلا توقف. لا يعطونه لأنه قد خرج من عمليته للتو، ولا ينبغي له أن يشرب أو يأكل شيئاً قبل أن يسمح له طبيبه بذلك. بين الحين والآخر يذهب ممرض أو ممرضة ويشرح للمريض سبب عدم تمكنه من شرب الماء. ثم يعاود طلب الماء من جديد.١

:بقيت في القسم لنصف ساعة أو أكثر، وظل الرجل يطلب الماء طيلة ذلك الوقت. تذكرت عندها ما قالته رضوى عاشور

“.أسوأ ما في المرض أنَّه يكسر الكبرياء” 

لا أعرف عبارة أكثر دقةً في وصف المرض كعبارة رضوى. لا يمكنني التفكير بوضع أو حال يكسر كبرياءَ المرء كالمرض. وعلينا نحن، ممرضين وأطباء وطلبة طب وعاملين في الحقل الصّحي، أن نعمل جاهدين كي نحفظ كبرياء المرضى الذين نرعاهم ونعاينهم… ينبغي أن يكون هذا هدفاً من أهداف الطبابة: الحفاظ على كبرياء الناس عندما يكونون في أكثر الحالات كسراً له.١

Reflective Writing as a Way to Build Empathy

I have been going to a hospital five days a week for the past 5 weeks to complete an observership. This has been my first experience of being in a hospital setting with the physicians and nurses who work there since I’ve started medicine school in 2019. Since day 1 of my observership I’ve been spending hours both in the hospital and at home writing in my personal journal about the patients I’ve seen, physicians I’ve talked to, diseases I’ve only theoretically learned about but saw them for the first time in real patients, about life and death and hospitals and healthcare. I’ve shared a glimpse of my writings here on this blog. Why do I write and describe and reflect on a lot of what I encounter? Because that’s what I’ve known and have been doing my whole life, I document what I see, what I experience, and I write my reflections on it. I’ve always kept a diary from the days when I couldn’t write and only scribbled, to the days when I had a childish handwriting to the days when I was learning Turkish and wrote my diary entries in Turkish to when I started medicine school till today. Keeping a diary is a habit I’m proud and happy that I’ve maintained over the years, and I owe this to my parents, whom I learned the importance of writing and documenting my life from.

The other day, I was reading the Winter 2017 edition of the magazine of Yale School of Medicine, and I thought Kathleen Raven’s article “Writing Toward Better Care”  was interesting. Raven talks about Geoffrey Z. Liu, M.D. who has always believed in the power of reflective writing in increasing empathy in medicine students and physicians, and that’s extremely important because studies show that medical students are the most empathetic at the beginning of medical school, but empathy decreases in a very scary way as the students start clinical training. And I feel this has happened with me as well, I haven’t started my clinical years at university yet, but I feel as if I’m slightly less empathic towards people’s sickness as I started spending more time in the hospital this summer.

Reflective writing, defined here as “writing with the goal of finding significance in personal experience,” (1) helps physicians become more aware of their own emotions and consequently improve their ability to be empathetic towards others (2).

Today, many universities, include mine, have incorporated reflective writing into the curriculum of medicine schools for the reason of “humanizing” medicine studies.

For me, I didn’t really write what I wrote during my observership to make sure I don’t lose my empathy or anything. In fact, I haven’t thought much about why I write and document a lot of what I see and experience at the hospital. I just do it because that’s what I’ve been doing my whole life. But now that I know that reflective writing can be used as a solution to the declining empathy in medicine students, I can see how writing about the patients I’ve been seeing and how I felt while at the hospital made me see the patients beyond their diseases. I suppose I will start looking at my writing with a different perspective, knowing how important it is. I hope I’ll be able to maintain this habit when I start my clinical rotations and internship and whatever I decide to do after that..

References:

(1) G. Z. Liu, O. K. Jawitz, D. Zheng, R. J. Gusberg and A. W. Kim, “Reflective Writing for Medical Students on the Surgical Clerkship: Oxymoron or Antidote?,” 2016. 

(2) E. M. Hirsch, “The role of empathy in medicine: a medical student’s perspective,” 2007. 

Stereotypes in Medicine

10.08.2021 – Observership 1.4

Two male medicine students and I were in the operation room, shadowing a surgeon during his nephrolithotomy surgery today. The surgeon asks us what we’re thinking on specializing in after we graduate. The boys say they haven’t settled their minds on any specialty yet. The surgeon turns around to look at me and asks: “You’re thinking about specializing in gynecology or pediatrics, I suppose?”

I answered with “no, actually I’m thinking on specializing in …”, but I was surely left not really not sure what to make of the his very stereotypic question.

Med School = Blackhole?

While driving the other day, I was listening to Dr. Adam Bataniya’s podcast (it’s in Arabic). He was talking about how doctors begin to be very immersed in their everyday routine job as doctors that they forget about creativity in medicine. He talks about the importance of having an impact on the healthcare sector apart from practicing being a doctor, whether that’s by volunteering somewhere or contributing to research or building medicine-related content. I think that’s very important. He also describes medicine schools as blackholes that devour and consume many students. These students only leave the other side of this black hole very drained and aged 30.

First Time at the Renal Dialysis Unit

19. 07. 2021 – Observership 1.3

I entered the renal dialysis unit at the hospital I’m doing an observership in for the first time today (I wrote this on the 19th of July). The nurse, who seemed to love working at the unit, very kindly explained in detail how things work around there. “In fact, the patients are more like psychology patients,” he said. And I could see very clearly how having to go through dialysis a few days a week could demoralize a person. Like in most dialysis units, in a big room every patient was sleeping on a bed of his own, the hemodialyzer right beside him. The room was completely quite except for the beep of this machine here and that machine there. Most of the patients were sleeping, some were eating, but no one was talking, even the nurses spoke in hushed voices. “Many patients stay up at night the day before coming to the hospital and sleep while their blood is being cleaned.”

There were some isolated cases as well, for patients with hepatitis B and C. “That patient there has traveled a lot around here in Lebanon, and have been to Egypt and Irak in order to get a kidney transplant, but every single time it had not worked out. She’s in a very bad psychological state right now,” the nurse explained to me. Most of the patients have sessions 2 or 3 days a week, and every session lasts for approximately 4 hours. I asked if the patients were allowed to have visitors during the time they spend there, and I was glad to hear that the answer was yes. The nurses in the unit were all very nice with the patients and very caring for them. I am sure these patients need a lot of care and love.

A few days ago a patient came to the ER because he had a tiny kidney stone that was hurting so much. He seemed to be in so much pain. Feel free to take this as a kidney appreciation post 🙂

Death in the ER

24. 07. 2021 – Observership 1.2

I witnessed the death of a man in ER today. 

I was sitting when the nurse beside me literally jumped out of his chair and ran outside. That’s when I noticed, on the screen projecting a camera outside, a car that had just stopped in front of the ER door. The man was quickly brought inside on a wheeled stretcher, and was taken to a room. Every single person of the ER staff rushed to help out. The ER doctor was called and I went with him inside. The patient had a heart arrest, and was brought to the hospital with his kids. CPR and artificial ventilation was performed. They tried everything but the man was already dead. He has come a long way to reach the hospital.

After long minutes CPR and artificial ventilation, a nurse covered his body with a blanket, and the doctor left the room to give the news to his family. When I left the room minutes later, two men (perhaps the deceased man’s sons) were on the floor, in tears. A nurse was comforting them. I was so so glad to see that the nurse was there, soothing their shoulders and handing them tissues.

This is probably not a new scene for everyone working in the ER, I could see how everyone was casual about it. I can totally understand that, they’ve seen this tons of times before, and they’ve gotten used to it. but this is new and shocking for the deceased’s family, and we must always keep that in mind, and we must act according to that.

Alhamdullilah, I have little previous encounters with death and dead people. I’ve been to a handful of funerals in my whole live, and the only corpses I’ve ever seen are the lifeless faces of my grandparents, may they both rest in peace, years ago. So this was new to me. I was a little bit overwhelmed, andI had to leave the ER to take some fresh air outside.

The corpse was later moved to the morgue. It was to stay there while the family prepared their house for the funeral. His son, looking very weak and tired and helpless, came to ask what he should pay. A nurse told him not to worry about that now. Other family members later came to the hospital to see his face. I’ll leave a lot of what has been said in the room to myself and my personal journal for now.

Please take a minute to read Al-Fatiha for his soul 🙏🏼.

Book Review: “10 Minutes 38 Seconds in This Strange World”

Elif Shafak has a few causes (the rights of sex workers, labor rights, rights of transgender people…) that she cares about and wants to talk about, and she uses her books to do so. And she does that in a very smart manner. I disagree with Shafak on many topics, I think she uses her books to give a bad picture of religion and religious people.

I love love love Shafak’s writing style. What other author is able to come up with a description like this one:

“Night-time in the cemetery was not like night-time in the city. Around here, darkness was less an absence of light than a presence of its own-a living thing, breathing entity. It followed them like a curious creature, whether to warn them of a danger lying ahead or to shove them towards it when the moment came, the could not tell.”

The fact that Shafak included events that took place in real life and places that are actually found in Istanbul made the story relatable and realistic.

Shafak portraits Istanbul in a precise way: a harsh city that has no mercy to anyone living in it, be it a helpless sex worker or a lonely student or a poor worker. She says: “Istanbul is a liquid city. Nothing was permenant here. Nothing felt settled.” This is exactly what crosses my mind every time I’m in Istanbul. The city is full of tourists and students and dealers and workers, all of whom aren’t in Istanbul to stay there forever. They’re there to either make a deal or visit some places or graduate, and then they will all move away from Istanbul, and new people will take their places in the big city. These people won’t really affect the ancient huge city much, because as Shafak puts it, Istanbul is “a city of willful amnesia”, but this city has life-long effects on everyone who’s ever set foot in it. When Shafak speaks of Istanbul, she speaks of it like it’s not just a city, and if you’ve ever visited Istanbul you know very well that it’s not.

Istanbul – August 2019

Shafak also shows the sides of Istanbul that only those who’ve lived in it for a long time would know. While tourists see the Blue Mosque and Hagia Sophia and the Bosphorus, those who’ve lived in it for a long time know that there’s much more to Istanbul than that. They know that the streets of the city are full of sorrow and harshness.

Shafak’s characters are realistic. She has the ability to make you feel like these characters are real breathing people that you’ve known for a long time. I especially found Sinan quite relatable.

While I liked Shafak’s “The 40 Rules of Love” much more than this one, I’d recommend reading it, and I’m excited to check out her other books!