Doctor.

Assalamualaikum.

Up to this point it was all too surreal.

Alhamdulillah thank you everyone for your sincere prayers, my five years of medical school ended with a heartfelt gratitude and huge relief last Thursday. I haven't felt such sense of accomplishment in a very long time, almost like a little baby hitting her first developmental milestone. Allah has been so so generous with me sometimes I feel embarrassed thinking what I gave Him in return.

Thursday the 1st of May sent me into two extremes of emotions, at one end I was at the verge of tears in front of my examiners, determined that I had to repeat my long case, but by the end of the day I was jumping in tears, blessed with a thing I've been longing for.

I think this day deserves to be painted into this blog. A day I will remember for a very long time.


How Thursday, 1st of May 2014 changed my life forever:

12am
Went to sleep with a million things running through my little memory box, I couldn't sleep but I had to. Every time I shut my eyes I remembered a topic I haven't read or a chapter I haven't finished. It was disturbing.

3.30am
Subuh was at 4am. Woke up with a sudden adrenaline rush, knowing my final exam as a medical student is in less than 5 hours. Flipped through random notes, hoping my last minute effort will still count.

7.15am
Cycled through the light rain to the hospital. Numb from anxiety and sleep deprivation.

7.45am
Everyone gathered. Instructions given and phones taken. At this point I merely stared into blank spaces leaving everything in the hands of Allah. I was told I was in the last group to go. So I waited and felt a tension headache developing around my head.

9.30am
Called to get ready. Stethoscope checked, patella hammer, tuning forks, pen torch, notepad all checked. My white coat was literally loaded with tools, much like the pocket of doraemon. I was assigned to a lady in L***'s ward. I knew by heart that the ward was for respiratory/MedEl patients.

9.40am
Escorted to my patient, Mrs X, an 80-plus years old lady. Alhamdulillah the patient was extremely pleasant and helpful.

9.50am
History-taking went smoothly for the first 10 minutes, until she said, "I'm so sorry I'm gonna have to leave you for a minute, the medication I took last night is really working well, I need to go to the loo..." with an apologetic face. She struggled with her walking stick, taking small steps to the bathroom. I assured her that she can take her time as long as she's comfortable.

10.00am
She was still in the bathroom, I was back to my nervous state again knowing I only have 40 minutes with my patient before the examiners came, and I've now lost a good 10 minutes. Mrs X came back apologizing for taking away my time, and determined to tell the examiners later that I was short of 10 precious minutes.

10.10am
Mrs X's symptoms were a mixture of ambiguity and broad possibilities, she simply said she had "fibrosis". She came in with shortness of breath and night sweats, I was thinking along the lines of a respiratory case. I examined her, and heard a really loud murmur with an irregularly irregular pulse. "Mitral regurg and Afib," I thought. But none of her medications were treating those two. I panicked to the point that I had to listen to her heart a couple times. "I'm so sorry but can I just have another listen to your heart one last time.." Being the lovely person she is, she understandingly obliged to my every request without a fuss. Bless her.

10.20am
I was confused. My thoughts went from cancer, to fibrosis, to pneumonia, to God-knows-what. It was really cute seeing how nervous she is on behalf of myself, reminding me a million times that I'll do well.
"Oh by the way I think they mentioned a faulty valve in my scan yesterday," Mrs X said, trying to help me out. I dismissed the 'faulty valve' as something overlapping my respiratory differentials, and merely reflect the mitral regurg she had, and begin organizing my thoughts. At this point both my examiners were late by 10 minutes. Alhamdulillah for the extra time, again Allah is indeed the best planner.

10.30am
They finally arrived. Two sharp-looking superiors/consultants, I knew one examiner from my GP rotation, the other was a lady from my viva the day before (my horrible viva is a whole other story, which I won't dwell on now, except for the fact that the very same lady crushed my knowledge and confidence into a pulp of stupidity during my viva). You can imagine how anxious I am to be presenting to the exact same examiner again.

10.40am
I finished presenting Mrs X's history to my examiners. The lady paused for a moment, looking confused and coldly said, "Hmm, that's quite a broad differentials you gave us.." and she spent the next 10 minutes doubting my diagnosis and trying to get me to think of the exact problem that Mrs X had. She asked difficult questions, gave out confusing hints, until I finally came to my senses and said, "Infective endocarditis," with a silent "omg how can I not think of that.." in my head. Only God knows how low I felt at that moment, my eyes almost teared up but I know I need to buckle up for the next drill of questions from the second examiner. Alhamdulillah the second set of Q&A went well, I remembered each and every bit of acute AFib management (since Mrs X has AFib) from our study group discussion the day before (thanks guys love youss).

11.10am
My final exam wrapped up with a simple nod from my examiners and I was done. I shook hands with Mrs X, at which point my eyes swelled up again as I bid goodbye. This is a lady who came in thinking she was dying, and said she'd be happy to go as God had blessed her with a wonderful family and a blissful life. Such a lovely lady. I spent a few minutes thanking her for all the things she helped me with, realizing that she is my last patient as a medical student.

I looked at my watch and realized my long case exam went over the time limit. A 15-minute Q&A session ended up with a 30-minute torture. I suppose the intern who accompanied me to the ward was right, he said "the last person always has extra time but the session with the examiners will always be a bit longer". I almost choked for freedom as I left the ward. I arrived to our quarantine hall only to find my bag was what's left in the empty hall. Everyone else left, and I was indeed the last student.

11.15am
I went to the prayer room and met Pika. We exchanged our long case details, both worried of what tomorrow may hold. Some of our classmates were celebrating with champagne outside the hospital, some even went straight to the pub, while I cycled home full of anxiety and uncertainty. We were told to wait for an email confirming that we passed and do not have to resit the next day, by 6pm today. The next 6 hours were one of the most difficult wait in my life. These 6 hours hold the answer to my prayers.

2.50pm
Woke up from a long afternoon nap to brush off my disappointment from my long case that morning. Instead of feeling refreshed, I was exhausted and nervous at the same time. Whatsapped Mama, to ease my worry and asked for a little doa.

4.00pm
I went to Yan's room finding Suha and Ecah together. We sat and talked but I know deep within everyone was anxious about the email.

5.00pm
Pika barged into the room, and gave us the look that tells "The email is out." Everyone urgently grabbed their phones and ipads and within minutes, one by one showed a smile of relief, a smile of accomplishment. We group-hugged and in that instance, everyone was sobbing uncontrollably. It was a moment I would remember forever, because only we know how hard it was to get to this point. It was emotional, it was intense, it was surreal. We are finally, doctors. Sujud syukur alhamdulillah. There were happy tears everywhere.


I immediately called Mama and Abah, although they were groggily woken up from their slumber, I just had to share the good news.

Looking back, it was amazing how Allah put us through hardships to give us a sweet little ending. Five years went by so very quickly, and I still wonder how I passed the finishing line.

I still think about why my examiner did not fail me, and how it was not all about getting the one right diagnosis but the whole case was judged by the way we approached it, from history to physical examinations.

Within 24 hours, I went from really sad to extremely happy I felt like I could cartwheel around the globe. SubhanAllah, Allahuakbar. All praise to Him.


I've been waiting to add these alphabets to my name since 5 years ago, and I'm finally allowed to, so...

Dr Nur Zulaikha Zainol MB Bch BAO, University College Dublin.

Here's to many more alphabets inshaAllah! ;)

Alhamdulillah.