Ambis

 

Just yesterday another hullabaloo happened in twitter (surprise, surprise). This time it was about an infamous stand-up comedian slash influencer who proudly claimed that he texted his employee after midnight regarding work matters. He also claimed that he - as a boss - was very, very strict (to put it mildly) and not hesitate to fire his employee. As expected, he got plenty of scloding because people think that he's being inhuman to his employee. I don't care about what his motive was when he proudly wrote that status. However, some of the interesting comments caught my attention. 

Some people said that in this 'cruel world', one shoudl be ready to work, work and work if they wanted to succeed. Someone even boldly (if not cruelly) claimed that work-and-life balance is a myth. It only existed for rich and priviledge people. The others who are not so lucky must gave more than 100%. Another comment said that 'rest' is something that does not exist in his life. He work 24/7. Literally. He spent what supposed to be his leisure time doing side jobs and he enjoyed it. 

Well I used to think that way too. As some of you might know, I used to be this brainbox girl ever since senior high school. I got the first / second rank in class. In medical school, I was the average survivor but most of my friends said I was so dilligent. And yes, I'm going to say it out loud now : I used to be an ambitious girl. 

That's me. 

Behind my calm appearance, I was that girl who studied practically 24/7. I felt guilty if I left the study materials unread for more than half an hour, I pushed myself to work on my assignments until I lost my sleeping time, etc. I was that role model student parents were comparing their kids to. Even as a little girl, I had studied Kumon and my math was about 2-3 years ahead of my school-mates. Those people who support me always tell me that we had to work if we want a bright future. Sounds familiar, eh? 

Well, to me now those words were like double-sided sword. In a way, it's good because we became discipline, appreaciate the time and digging our potentials. But on the other hand, it could make us ambitious to the point that we forgot what is life is all about. Sounds cheesy, right? But imagine this ... 

We never know how much time we had in this world. Of course it is a good thing to think about our future and prepare for it. Being ambitious and obsessed about it, is another story. Being ambitious means we practically gamble what we have in the present for whatever-it-is we're thinking our future might be. For example, once, I was pushing myself too hard that I got gastritis. The gastritis happened because I work, work and wokr until I substitute my meal with granolla bars and my sleep with endless cups of black coffee. I got admitted into ER and the doctor practically yelled at me for giving myself a break. I was forced to get 2 days off work. I spent my two days feeling guilty for resting of myself because people around me were making me believe that self-care is only for weaks and spoiled brats. 

Hell, one of my colleague who scolded me said : "You're taking two days break just because of gastritis? What kind of nonsense is that! Back in my days, my friend showed up to work with intravenous line still attached to his hand. Now that's what I called being a real doctor." 

Believe it or not, some of us were brainwashed by the society to think that we're nothing but a bunch of machines instead of human being. We're forced to normalize the super-toxic working environment that forbid us to rest and even pray. We were praised if we sacrifice our mental and/or physical health for work. As the time went by, we became more and more machine-like. We began to think it was normal to live with that kind of life rhytm. And if someone told us otherwise, we easily scold and accused them for being weak and jealous of what we had achieved. 

What did we achieve now, exactly? The money we stack in our banks? The A+ on our report cards? The praises we got for being the role-model student? The contents of textbooks we managed to cram into our heads? Were they worth our own health and sanity? 

My husband and I were quite the opposite in some ways. He, on the other hand, did not approve of being too ambitious both in career and academic. When he picked me up after I finished my board exam in Jakarta, he asked me about some of the medical students he met on his way. His questions were quite strange. 

"Why are they looking so zombie-like? Their eyes were blank. They seemed so absorbed in their own world. None of them were smilling. They were in groups but they didn't talk to each other.", he said to me. 

"Well, they probably went through one of the tough department ... like OBGYN or surgery or something...", I said. 

"Were you like that before?" he asked me. 

"More or less. I always bring a novel with me to put my mind at ease during hard time, though." I said to him. 

He shook his head, "Man, that was rough. And what for?"

"What do you mean 'what for'? We were taught to give 110% if we want to succeed.", I told him. 

"Okay listen. Here's the harsh truth about ambitious people. They work and work until they ill or worse, die. And what happen afterwards? The workplace would mourn for a while and then they easily replace them with another employee. What about the people they ignore like their families and friends? To them, they cannot be replaced.", he told me, "And was it worth having a good career and stacks of money in our bank if we're not happy and healthy? Is that life is all about?"

It hits me. He's right. Being ambitious was like being an addict. The 'reward' we got such as good grades, praises or extra cash were like the heroin injected into our vein. We felt intoxicated by them that we didn't realize it slowly kills us. We got so addicted that we didn't want to hear anything that contradicts our way of life. Even the people who genuinely care about us. 

We were told that dedicating our life to work will be worth plenty in the end. Will it? Imagine if we died just before we got that reward. How many 'if only's and 'what if's haunt us? 

If only I skip work for one day to have a day out with my parents

If only I wasn't so engrossed in my work that I pick up my child instead of yelling at them for being a brat, even though they're just want to play with their parents

If only I got more time to listen to my teenage child's problem, really listen to them and put myself in their shoes instead of taking a short-cut by telling them what an ungrateful brats they are and slamming the door in front of their tear-stained face 

What if I cut one hour of my studying/working time just to realize my surroundings? 

What if I gave myself more time to think about how my loved ones mean to me, instead of accusing them for being too clingy and needy before cutting their off my life and justify my actions for "get rid of distractions"? 

What if I give some of my earnings to take more care about myself, instead of stacking them in my bank and thinking 'I would do it tomorrow' every single day? 

etc, etc

People who are now familiar with the old me. I don't care if you're going to believe me or not, but in the end... all those 'earnings' we got, would mean nothing if we weren't healthy or happy. I guess 2020 taught us enough to re-think about our purpose in life. We thought we got everything figure out with our money and knowledge, then boom! Something happen. Plans were cancelled. We could only accept it with two options : spending our life in regret or trying to think outside our comfort zone in order to survive. 

Truth to be told, before the pandemic, I got some offer to improve my career. All I had to do is giving a little 'sacrifice' by being away from my family for half a year at least. The old me would jump into that opportunity in double-quick time. I got support anyhow. But at that time, I let the offer pass. Because I had enough of being so ambitious. Now, I just want to stop getting my nose on my book or my laptop and just re-live my life (whatever the heck that means). 

And even though I had no kids just yet. If someday I got my own children, I would not push them to do 'important' extra courses like maths or toher school subjects. I don't want them to grow up numbing their loneliness due to the absence of their parents with studying their asses off. I don't want them feeling the same fake-comforting of numbers and figures in math while forgetting that they're lonely. I don't want to guilt-trip them using the old phrase about how 'privilige'they are with all the opportunities, while I know for sure they lost their playtimes with the other kids. 

I am fully aware that my view would be scolded if I still live in the big ambitious capital city (or living my life like that). I would never be able to get enough money for my future kids or sweet easy life everyone dream of. I would waste my potentials, etc, etc. And you know what? I don't care. I'm now aware that there are things that are outside my control and working my asses of would not tame those things. As a believer, I know that each of us had our own sustenace and it would never accidentally exchanged. 

Why should I put my trust on promises people give to me and sacrifice my all for that? Allah had everything planned for me. Also 
 

Our rizq could not be taken by anyone. If it seemed like we didn't get what we deserve, that means Allah had another plan for us. In the eyes of the world, it might be 'worse' compared to what might have been. What is a simple 'thank you' from people we help compare to tons of money and prestige we actually 'deserved'? I'm not gonna lie, sometimes I felt disturbed to see how my friends still pursuing their career and in the meantime I seemed struggled with my own ... but then I remembered the quote above and both my mind and heart would be at ease. Even though you're not believer, I suppose you also believe the 'law of attraction' or 'The Universe' right? 

So why so ambitious? :) 

Memory Lane

 A couple of years ago, I'm this blogger who update (quite) regularly. Usually it's random thoughts, book reviews or poetry. I also love to hop from one blog to another. I followed some infamous blogger too. Sometimes I read across this interesting blogger and I started following them. One of them is Naomi Neo. Her old blog is pretty much still here. I remember one of her writing after a bad broken heart she went through. The title of her writing is 'The People Who Care Enough Will Show it to You' the introduction felt like a pang to me :

"I kinda grew up believing that everyone's nice and I always choose to see the good in people instead of their shortcomings - I tend to find reasons or rather excuses for them whenever they disappoint me. Like if someone decides to only text me after 2 days of disappearing, I'd convince myself they were just busy. Or when someone tries to manipulate me into thinking I've done something wrong when they were they ones who clearly made a mistake, I'd lie to myself that perhaps they are right."

Y same *sighs*. I tend to think positively towards people and I look the other way on whether they deserve it or not. 

"Took me a lot of regrets and mistakes to finally realise I've to stop making excuses for them, because the people who care enough will show it to you." 

The last few months of 2020 seemed like they wanna wake  me up to that one simple dang fact. Because as harsh as it might be, some people do not deserve that kind of 'positive thinking' for you. If anything, they might take advantage of them and only use you as their doormatt. Okay, some people went through A LOT. Sometimes all they wanna do is just minimizing their social interaction for a while. Including with you, and that's fine. They might wanna clear up their mind a little. That, we should pay respect to, yes. 

However, we should draw the line between 'taking some time off' and 'deliberately ghosting people', the second one doesn't worth your time. Personally, I never ask much. I just want a clear answer when I text 'Hey are you alright'? Perhaps something like 'No. I need some time alone.' Believe you me, people who think I might get mad or think negatively about them because of that are not those whom I want to call 'friends'. 

Yes, I said that. My 'friends' know perfectly well that I hate being ghosted. They know that if I want some time alone, I will tell them that I'm busy/ unwell. Why? Because they're my friends and I respect their feelings. Being ghosted sucks. People can get very, very upset (to put it mildly) because of being ghosted. So for the love of God, do be so kind as to tell your friends that you want to be alone. Guess what? They don't think you're owing them anything, but don't you think they deserve an answer when they ask about how are you doing? 

If you don't think so, then let's agree to disagree, shall we? Because right now I just want to sit back, relax and enjoy what I have. And I am not responsible to anyone's mental well being. 

Day ... of Twitter Detoxing

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Sudah hari (atau minggu) kesekian saya sign out dari akun microblog saya. Jauh dari ketubiran yang sudah jadi makanan sehari-hari, jauh dari 'Bung besar' dan 'Bung-bung kecil' yang rajin menyortir opini orang-orang untuk kemudian dijadikan bahan perundungan massal, jauh dari logical falacy yang digunakan sebagai senjata orang-orang yang mengaku 'berpikiran terbuka' dan jauh dari hal-hal toxic lainnya yang selama ini secara tidak sadar masuk ke pikiran saya. 

Beberapa akun 'txtdari'-blablabla itu contohnya. Mereka rajin melakukan tangkapan layar pada opini orang-orang tertentu, lalu menjadikannya bahan perundungan buat pengikutnya. Yaa memang belakangan ini mereka menyoret nama penggunanya, tapi sekarang penelusuran Twitter gampang banget digunakan untuk menguntit siapa yang mengirim post itu. Sudah bukan rahasia lagi, tinggal mengcopy-paste kata-kata yang ditulis di tangkapan layar itu dan voila! Dapat nama pengirimnya. Tinggal ditangkap layar lagi lalu disebarkan deh. Tulis saja balasan di akun 'txtdari' itu dan semua orang yang kepo langsung bisa dapat bahan rundungan baru. 

Ya saya setuju kalau fitur tersebut digunakan untuk menolong orang lain, misalkan menolong orang yang diancam / dikuntit / dll. Pernah ada orang yang mau menyebarkan foto telanjang mantan pacarnya di twitter, dia menyebarkan identitas mantan pacarnya tersebut dan warganet (yang waras) beramai-ramai merundung orang itu. Semua melaporkan akun tersebut, juga melakukan tangkapan layar untuk diberikan ke akun kepolisian. Beberapa LSM juga berkata akan mengawal kasus itu untuk melindungi korban jika fotonya beneran tersebar. Kalau untuk itu, oke saya setuju. Tapi kalau untuk merundung opini orang yang sebenarnya tidak berbahaya?

Dulu pernah ada seorang perempuan yang iseng memposting fotonya dengan caption yang mungkin agak cringe buat sebagian orang, tapi buat saya sebenarnya biasa saja. Hey, we all have our own cringey/alay times, no? Tapi dalam hitungan jam, ratusan balasan menyerang perempuan itu. Orang-orang itu niat banget membuka 'jejak digital' lama, menguntit sampai akun media sosial lain dan tentu saja ... bodyshaming habis-habisan. Ketika perempuan itu nggak tahan dan membalas, semakin banyak backlash yang dia dapat. 

Padahal, jujur saja apa yang ditulis perempuan itu tidak membahayakan kok! Ini juga bukan yang pertama kalinya orang yang ingin berbagi positive vibes malah kena rundung. Akhirnya boro-boro mau berdiskusi damai dengan menuliskan opini! Udahlah, saya putuskan untuk rehat sejenak. 

Saya lebih banyak menggunakan instagram dan itupun saya banyak follow akun-akun yang 'adem', antara lain madcatnip, lalaartwork, yesimhotinthis dan banyak lagi akun 'adem' dengan ilustrasi-ilustrasi manis yang siap menyegarkan pikiran saya setiap kali saya buka instagram. Saya juga download Wattpad, Noveltoon dan Storial. Yang saya rasakan? Pikiran saya jadi lebih tenang. Saya jadi bisa lebih fokus dengan keadaan sekitar. Oh ya, saya juga follow akun perempuan-perempuan yang saya sebutkan tadi. And their positive vibes are amazing! Sayang orang-orang yang gemar ketubiran tidak bisa melihatnya :P their loss. 

Mungkin sebagian orang penasaran ya ... kenapa nggak saya blokir atau senyapkan saja orang-orang yang membuat saya kesal di twitter? Mungkin nanti kalau saya niat :P saya akan bebersih akun twitter saya, mute orang-orang yang toxic lalu follow akun-akun adem. Sementara ini ... saya masih nyaman dengan aplikasi-aplikasi baru saya. Biarlah Twitter dengan segala ketubirannya. Saya mau senang-senang dulu, hihihi :) 

LSD - Between Good and Bad Trip

Few years back, I got a frantic phone call from a friend. It was 4 AM so between my annoyance being woken up before dawn, I asked him what the hell happened. He told me he was on this party and they did some drugs. At that moment, I just knew this wouldn’t be a nice phone call. He said he took some ‘acid’ and now he didn’t feel well. Everything around him seemed distorted. He was ‘seeing sounds’ and ‘hearing colours’. When I told him to go to the hospital, he fearfully told me he couldn’t because the medics would turn him in.

He had a good point, though ... the laws concerning narcotics in Indonesia is pretty strict. So out of desperation, I told him to find himself a green coconut water somewhere. What else could I do? His friends left him when he got too ‘high’. They just dumped him back at his place and left. So much for good friends.

Some of you might heard about LSD or ‘Acid’. They usually looked like stamps and people put them on their tongue. It was known as drugs used by hippies, besides marijuana. There is even a song about it, ‘Lucy in the Sky with Diamonds’. There are several positive ‘reviews’ on how LSD influence arts and society. Many said it was an enlightning experience, getting high on acid. However, I’m going to write a little bit about LSD and its effect.

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Lysergic acid diethylamide (LSD) is a classic hallucinogen drug. It worked by binding to the serotonin receptors in human brain, that mediates the hallucinogenic effect by activating the frontal cortex glutamate transmission. It mimics the effect of the chemicals on your brain called ‘glutamate’, causing an increasing activity of the part of your brain – the sensory and cognitive processing. LSD also binds the adrenergic and dopaminergic receptions, which is not the case for other classic serotogenic hallucinogens.

On a studies using validated psychometric scale on 2017, the subjective effects of LSD were predominantly positive in controlled settings. However at the dose of 200 μg negative effects also reported. LSD at this dose also used in LSD-assisted psychotherapy in Switzerland.

 

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The picture showed us which part of the brain activity is increasing after LSD exposure (right). This lasts for about eight hours. The hallucination or ‘psychadelic’ effect, was said to be a result of the increasing visual cortex communication with the other areas of the brain. This was similar to the psilocybin or ‘magic mushroom’. There was also a reduce in blood flow, so the neurons that normally act together lost its synchronization. Some volunteers in the experiment said that they feel themselves ‘becoming less a singular entity and melded with people and things around them’. However, the ‘good’ effects are vary. Some reported effects include : flashbacks, euphoria, anxiety and paranoid. 

LSD is relatively safe when used in medical settings and according to safety guidelines. However in unsupervised settings LSD could causes harm to the users. Acute adverse effects up to 10–24 hours after LSD administration included difficulty concentrating, headache, dizziness, lack of appetite, dry mouth, nausea, imbalance, and feeling exhausted. Headaches and exhaustion may last up to 72 hours. In my friend’s case, he said he’s not feeling well for good three days afterwards.

A case report on 2015 wrote that the user of LSD experience feelings of ‘trapped’, increasing heart rate, hallucinations and the subject was driven to the point of attempted suicide. The LSD was ‘25I-NBOMe’ a hallucinogen synthesized for research purposes. It has even higher affinity in the receptor. Thus, the ffects are also stronger. Most common adverse reaction is an acute episode of anxiety or panic (“bad trip”) that resolves with reassurance and the use of benzodiazepines. This NBOMes also caused tachycardia, palpitations, clonus, pyrexia, elevated creatine kinase, severe agitation, delirium, tonic-clonic seizures, renal failure, fatal overdoses and traumatic deaths.

There isn’t any ‘directions’ on the drugs one get form the street. The risks of overdose are pretty high, because one cannot measure the dose alone. We also can never tell which one is the real LSD and which one is not, as well as when will we get the good or the bad ‘trip’. The NBOMes is one of the drugs that difficult to detect, due to the high potency and small dose ingested. In conclusion, when one wishes to get high or hallucinating using the ‘acid’ they get from the street, they must remember that (1) the careless way the maker might use to make it and (2) one should not use it alone without a sober ‘friend’ and last but not least (3) the narcotics law.

Further reading : 

Cormier, Z., 2016. Nature.com. [Online]

Available at: https://www.nature.com/news/brain-scans-reveal-how-lsd-affects-consciousness-1.19727 [Diakses 14 July 2019].

Liechti, M. E., 2017. Modern clinical research on LSD. Neuropsychopharmacology, XLII(11).

Suzuki, J., Poklis, J. L. & Poklis, A., 2015. My friend said it was good LSD : a suicide attempt following analytically confirmed 25l-NBOMe I

DIY (??) Invasive Medical Treatment

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One of the social media influencer in Indonesia, who is also a beauty and trend icon had gotten herself into trouble few months ago. The problem was, she’s endorsing a breast enhancer product that required self-injection on the breast. Yes, you read that right. She was promoting some kind of crazy DIY invasive medical treatment and wihtout any hestation said, "This is a safe and risk-free product!" 

The product was sold online and the seller would give you the syringe as well as the ‘serum’ once you order it. As terrifying as it might be, many of her followers attracted to this kind of ‘beauty product’. I didn’t know about this until a doctor angrily post her disagreement on social media. She wrote ‘What on earth is wrong with this socmed influencer?? Doing this kind of ‘endorse’!! There’s a limit for endorsing, not selling the drug as well as the syringe!! Please help me report her. This is dangerous!’ Yes, as a doctor I can understand her anger. It’s like looking at a little kid running with a pair of scissors. When I saw the post I also thought “Safe and risk-free breast enchancer?? Now wait the hell a minute!” 

From what I heard, the ‘serum’ contains estradiol – synthetic hormones they used for hormone replacement therapy ... okay now hormone replacement therapy isn't a simple procedure. It needs several examinations before it even start, in order to avoid long-term risks such as cancer. Second of all, even though they claimed that it contains 'estradiol', how could we be sure that it's real?

Many people agreed with the doctor, because they also knew the danger. However, some of the social media influencer's devoted follower got angry at the doctor. "If you don't like what she promote, then simply don't buy the product! You're just jealous because nobody wants to endorse you!" is one of the backlash posted.  

Injecting questionable substance into one’s body has a lot of risks. The method itself isn’t something DIY. Without knowing anatomy, a mistake such as hitting a major artery or vein might happen.

You see that’s the anatomy of the breast I got from my Netter Atlas of Anatomy. If the substance enters the blood vessel, it could cause complications such as embolism (blockade of blood vessel) on the lung or the heart also there’s risks for infections entering your blood vessels directly. If the process isn’t sterile. If the infection was localized and formed an abscess (swelling area filled with puss) for me that is considered ‘light’ if the treatment ‘only’ required puss drainage. 

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The infection could also go through the blood vessel and reach the heart, thus creating infections on the heart called endocarditis. It’s not a ‘light’ problem, to put it mildly. If one did not realize the symptoms, untreated endocarditis could cause death within weeks and even days. The treatment of endocarditis required intra-venous antibiotic and sometimes surgery if the heart structure (mostly the valves) damaged due to the infections. If the valves could not be saved, a replacement valves might be used because of damages as seen below :

 

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Anaphylactic shock is one of the direct-fatal risks that could happen. It’s a severe alergic reaction, when your body doesn’t agree with the susbtance enters your body and releasing susbtance to fight it. The susbtance causes fatal symptoms such as dilatation of the blood vessels (that leads to blood vessel drop), increase of heart rate, spasm in coronary (heart) blod vessels,  swelling of throat/tongue/lips (causing airway blockade), confusion (makes you can’t think of what to do) and loss of consicousness. This reaction happens within minutes and need immediate emergency treatment otherwise the various organ system in your body will fail within short time.

Epinephrine injection – an emergency injection that could be used during anaphylactic episodes – could be bought with official prescription from a doctor, proper indication as well as clear instruction on how to use it. The ‘online clinic/shop/etc’ who sell the ‘beauty injection’ obviously doesn’t consider it because the seller might not be aware of the risks.

There are plenty of reports on unofficial beauty treatment gone wrong ... but that’s just the tip of the iceberg. Many people do not report such incident because they still think that having body modification is a ‘guilty pleasure’, something they do to feel good but it’s a shame if anyone knows about it. So if something goes wrong, the shame beats the willing to get better. Thus, the unreported incidents. 

Sadly, this is not the first time I heard questionable ‘beauty therapy’. When I just graduated, I work at some clinics and once I encountered a patient who wanted me to inject this ‘skin whitening serum’. When I refused, she was told me ‘The person from other clinic injected this before to me, doc! And it’s safe!’ I told explained to her that we could not inject susbtance the patients got by themselves, without any official referal letters from the hospital (I explained about patients with Hepatitis B and AIDS who sometimes got their injection medication at the clinic) as well as the safety guarantee of the substance (And ‘I bought this at official online clinic from Thailand’ is not what I meant). She finally left the clinic,looking upset.

What most people don’t understand is, we doctors are taking a lot of precautions when it comes to invasive treatments. We do not enjoy ‘making things harder’ for our patients and no, we’re not ‘jealous of the social media influencer because they got endorsement and we’re not’. Trust me, if a (sane) medical care giver were offered endorsement on ‘DIY invasive medical treatment’ they will immediately say ‘no’ as well as reporting the dangerous offer to the authority.