a young pakistani doctor blogs...
Saturday, December 31, 2005
It was an okay day. I’ll have clocked in only about six hours of studying before I go to sleep. There were power outages taking place all evening which made studying difficult because I find it a tad tricky to read when its pitch dark. I also didn’t sleep very well last night. I’m forcing myself to be far more regular in my habits so that my circadian rhythm becomes more cooperative. In the afternoon, when I was feeling really sleepy I thought that maybe I should change my time table so that I can sleep a little in the afternoons. Maybe I’d sleep only 5 hours at night so that I’d be tired enough to overcome my insomnia and get to sleep in the afternoons. But then I thought that I should give my body time to settle into a certain schedule rather than changing things around at the slightest hint of a problem. I think a couple more days of iron clad regularity in my getting-my-ass-in-bed times and getting-my-ass-out-of-bed times will do the trick. My mind will shut down to rest at the right times if I train it to follow a fixed, regular pattern. This should cure the insomnia.

The winter rains have finally started and today it brought on power outages. I think its just the electricity mains getting used to water. By the looks of things, the rain will be with us for days and days, which suits me fine because I like it when its cold and wet outside but comfy and toasty inside. I had to venture out today though to get bread. The maid has quit and my mother was too tired to cook bread herself, so I had to go out and get some. The roads where glistening wet and the damned windows in the car were fogged up inside. I could barely see anything. I drove slowly, hunched over the steering wheel, peering out of the windscreen like a 70-year-old woman. I’m not the most suave driver in the world and the conditions in the crowded markez I drove to didn’t do much to promote a James Bond image of myself.

My elder brother and his wife (my bhabi) came back from a little trip with their kids. My result had come out while they were away, so they greeted me happily as a doctor. My brother remarked that it only seemed like yesterday that we were filing my forms for admission into med school. How time flies.

I’m growing closer to my bhabi. I’m growing to respect her more and more as I get to know her better. Despite what my mother says about her, I think she’s a great mother to her kids and wife to her husband. She was really happy to hear about my result and came up to my room to talk to me. I feel bad for not trying to get to know her better before, but then again, I’ve been living away from home for the last six years and didn’t get to see her that much. That’s not much of an excuse I suppose. I guess a part of the reason I didn’t try so hard was because I believed what my mother told me about her, most of which wasn’t very flattering. I was always friendly towards my bhabi but never really genuinely interested in getting to know her better. Now that I’m back home to stay, I’ve learned how unfair my mother has been to her. Relations between the two are not good, and I think I’m in a position to ease things between them. I’ll have to make it a point to get to know my bhabi better and use that understanding to help her bridge the gap that currently lies between her and my mother. The house will be much more peaceful for the two of them because of it.
Friday, December 30, 2005
  Dulcius ex asperis
A far far better day for me today. I slept enough last night and woke up refreshed, then got straight to work. The last few days had been marked by irregular sleep due to an attempt to change my nocturnal habits. I would feel really drowsy all day and it was tough for me to study much because of that. I’ve finally managed to bring my sleeping habits to a steady state and I think I’ll do better from now on. Today was a good day for studying. I didn’t get that much work done – I only plugged in 6-7. It’s less than what I hope will be a regular 10-12 hours very soon, but it’s a good post-final-year-result start.

I don’t think its a good sign if one is feeling too happy and confident during these preps. I think a certain level of pain is required to keep your ass planted and your eyes glued to the page. If one is feeling too happy about life during a time like this, one might start to expect feeling that way everyday. Inevitably, when the joy wears out of the studying (as it inevitably without the slightest touch of a hint of nuance of a breath of a doubt will), then the study process will seem all the more harder. I’m beginning to realize the wisdom to the words a senior of mine once told me: if you enjoy what you’re doing, you probably ain’t really studying. It’s just got to be a little painful – you need that edge.

Through this blog, I’ve worked through a number of serious issues. The daydreaming escapist fantasies for one thing. While at the time, writing my way to stardom might have really seemed like a viable option, it was only after thinking out loud here that I realized I was just using it as a prop to avoid the pain of these preps. I’ve also realized that it’s now or never for me and if I don’t take the pain like a man, I’ll just be giving up on my dreams. I’ve not only firmly closed the door for the way out, but I’ve also managed to force my psyche to face in one direction and then gave it a good hard kick in the ass to get it moving. The sense of urgency is back – I pray that it’s here to stay, because while its no good for my peace of mind, it’s is for my study. If I’m persistent (a big if), I should get somewhere. Through difficulty, sweetness.

I could have studied more today, but I developed a backache and couldn’t bear to sit in the chair any longer. I’ll have to do something to make this chair more ergonomic.
  A very sad story (not about me!)
This here is a truly heart-wrenching story.
http://www.nydailynews.com/front/story/378866p-321753c.html .
Thursday, December 29, 2005
  *big sigh*
Today I got really scared. Things have been settling down now for me. The final year result is out - I passed and life is supposed to be more peaceful. A truly epic 7 month struggle came to a good end. Seniors of mine who have done well in the Steps tell me that the final year exam is by far the most stressful and difficult because so much junk is piled up on you at one time. They said the steps were less stressful. They were right about the final year exam being nerve-racking. It was very difficult to get through those 45 days of examinations. One after the other after the other.

Now that the result is out, I thought I would return to the books with renewed vigor. The draining effect of waiting anxiously for the result was gone. Relief and a vague, fleeting sense of achievement came and went and now I must truly batten down the hatches and get serious. I thought the last couple of days would see me get off to a good flying kick-ass start. A rejuvenated, encouraged optimistic me, going at the books with and a relatively unburdened mind. Things didn’t quite work out that way though. It’s been three days since the result came out and that ‘flying start’ didn’t come. For the first time, genuine doubt slithered into my mind and sat there brooding ominously. What if I don’t have what it takes? What if I’m not strong enough? From my track record, I really haven’t shown much strength of character in my studies. I don’t have much time left at all now. I’m down to the bare bones of it. Quite simply, if I don’t change my ways and pull out something from within me to get me going, I’m not going to make it. I’ll be a failure. I’ll be mediocre. I’ll be stuck depending on my parents for years to come. I’ve run out of words to describe how desperate the situation is. If this continues any longer… heck, I don’t know what I’ll do.  
Wednesday, December 28, 2005
  Go Aya!
Today will by Aya’s last day of her Step 1 preps. She’s going to give the exam tomorrow on the 29th. We wish her well.

Try as much as possible to relax on the last day. Don’t get nervous. Don’t get self-doubts. Be strong. Be positive. You’ll be fine Aya. Just fine.
Tuesday, December 27, 2005
  D’s Dilemma IV
D never told W everything his parents had been saying. She didn’t know how hostile they were to her. So it came as an immense shock when D’s father got her number (we still don’t know how he got it) and told her quite bluntly that it was never going to happen. I can’t imagine what she must have gone through on receiving the phone call, but she called D up and told him and soon after he called me.

Naturally, he was upset – to put it mildly. He expressed immense anger at his father for what he had done. He had hurt someone he loved deeply. It also became apparent to him that even if he eventually managed to bring his parents around, a line had now been crossed. Things had been said that couldn’t be unsaid. The relationship between W and D’s parents was poisoned right from the start. How could they ever put something like this behind them?

I really didn’t know what to say to D. What advise can anyone give that would make this mess better? I just comforted him clumsily. I wanted to remind him of the hurdles I had to overcome in my own journey, but truth be told, things were never this bad for me. It really did seem as if this thing wasn’t going to work out. D’s father wasn’t trying to convince his son to drop the idea of marrying W anymore - D’s father was out to sabotage the matter to the point of it being unsalvageable.

I talked to D on the phone for two hours, trying my best to make him feel better. I told him again not to go on the offensive – that such an approach would accomplish nothing. He agreed with me, but now he started talking about other things as well. He said that he’d keep trying with his parents, but if this thing really did fall apart, then he’s start whoring around with girls, start drinking, start doing drugs, maybe. He said what’s the point of living decently and sensibly when your own parents are the reason you are so unhappy. Why try to become a better person? To what point and purpose? Why not just let it all go and become a hedonist? There are ways to dull your pain.

To be perfectly honest, I understood where he was coming from. I myself had many dark moments in my own struggle to get my parents to agree to my fiancé, and there were times when I didn’t think things would ever work out. I thought if that did happen, I’d just quit medicine and go live in a city where no one knew me, and scratch out a living for myself doing something. Why bother trying to follow The Plan when you don’t have the person you love there to share it with you? If that person died in a car crash, then you could say it was a tragedy. You’d put it down to fate and move on, trying to rebuild your life. But when the person you love is taken away from you because of your parents’ pertinacious resistance? How can you cope with that? Who do you turn to for help? Your parents? No! They’re the reason your in this mess in the first place! I was thinking along very similar lines myself and although I sympathized, I didn’t say so. I just told him not to be silly, that he has a long life ahead of him and many other tragedies were bound to happen. If this thing didn’t work out, it was no reason to give up on a happy life. You can’t just throw in the towel when something really bad happens to you. People go through life with all sorts of things happening to them. They get cancer. Their children die. They lose a limb. They’re put in jail for something they didn’t do. What would it say about the strength of your character if you just gave up on yourself?

My words, although somewhat hypocritical, got through to him. He calmed down and stopped thinking such drastic thoughts. I told him not to give up. The choice of your life partner is just too important to leave up to the capriciousness of a parent’s outdated traditional notion of how such things work. I told him to keep fighting for his right to marry of his own choice. However he would tell W everything now and let her share in this burden. She would also have to make up her own mind over what she wanted to do. He was still upset after our two-hour talk, but then again, there are somethings that can’t be fixed by the best of advice and intentions.

D’s father never acknowledged that the phone call had been made. D and his father didn’t mail each other any more after that. D’s father’s health was not very good. He had gallstones that were troubling him and needed to go for surgery soon. D believed that his father deliberately timed the phone call right before his surgery, so that any further discussion about W would seem selfish and trivial in context to his father’s imminent operation. D was thus forced to sound supportive and caring when talking to his father thereafter on the phone.  

D and I had this conversation in late September, when all my exams had finished and just the vivas were left. D’s father’s operation was scheduled for the 5th of October, and D said that it would be at least two weeks after the surgery before he could even consider broaching the subject of W again. He was furious about this because he was convinced that the timing of the phone call to W was deliberate.

On the 4th of October, my final year exams finished.

On the 5th of October, D’s father had the surgery. It was successful and there were no complications.

On the 7th of October, I returned to Islamabad, finally done with med school in Peshawar.

On The 8th of October, a massive earthquake hit Pakistan.

On the 13th of October, D flew into Islamabad on emergency leave from his job.

He had to visit his hometown - Muzafferabad.

More later.
Monday, December 26, 2005
  An anticlimax?
So today was an important day. As my father put it, it was a day when two Doctors joined the family, referring of course to my fiancé and me. I was sad to hear of some friends not making it through with the rest of the class. One girl was due to get married in a week or so, but she’s failed in a subject. That must be a real bummer. For my part, I should be far more grateful than I am. I don’t know why today feels so anti-climatic. I don’t really want to do anything special to mark the occasion. I took the day off from studying, and felt guilty as sin for it. I have to return to the books with a vengeance tomorrow. However, it’s wonderful to say now that there lies nothing on the road for me now except the Step 1. No distractions. No worries. Just the You Ess Em Il Eee Step One.

I can’t really afford to take any breaks to ‘celebrate’. Nor do I want to. I really want to get on with my life – to reach that next stage. To get those kick-ass score in the Steps. To train in the US further with my wife. To earn money I can send back to my parents. To be independent. To move on.

There is a lot left to be done. If you detect a melancholy tone to this post, that’s because I feel melancholy. It’s practically blasphemous to think such thoughts when Allah has been so bountiful to me. I think it’s because of how the worry I had for the result was ruining my steps study. I’m seriously worried about it. I think that tomorrow, when I go at it with an unburdened mind, I’ll do well and feel better about myself. Tomorrow morning, there will be nothing to distract. It shall be focused entirely. Today I was released from the chains of a possible failure. Tomorrow I’ll make use of this freedom.

BTW, I’ll write the next D’s Dilemma blog tomorrow. Watch this space.
  A Red Letter Day
I was sleeping, having very restful dreams when I hear a knocking on my door. I had insomnia last night and slept late so I was still sleeping till 11am. I thought maybe my mother was concerned about my still being asleep – my parents are always paranoid about leaking gas heaters. So I get up to unlock the door (keeping it locked so no one can disturb me, especially my two little nephews) and my mother rushes in and says, “Congratulations! You passed!” Even has she starts to kiss me, my groggy mind still hasn’t taken it in.

“Wha…?” I say.

“You passed! F just called from Peshawar. The result is out and you both passed!” F being my fiancé.

I break into a smile, as my mother ecstatically repeats this simple fact. The weight of the news is too much to let it be after saying it just once. This needs to be shouted from the rooftops. Both my fiancé and I passed with good marks. My parents are very proud of both of us. Two doctors have just been added to this family.  

I’ve been calling people and people have been calling me. It’s been a frantic morning. I haven’t showered or anything. I guess I better go and get fixed up. There is much to celebrate!
Sunday, December 25, 2005
  Still feeling the pressure
A plague! A plague on the homes of my college administration! Still no result!

I think I should start doing baddua for them.

Ya Allah! Let them all contract Congo Fever and die horrible deaths from hemodynamic compromise caused by incontrollable hemorrhage from obscure orifices.


In other news today, I’ve become quite the expert on isolated systemic hypertension. I think I literally read 50 articles from studies and journals over the best treatment modalities for elder, diabetic hypertensives. I’m pretty sure an addition of a combination of a thiazide and losartan will get me some results, and that too with good long-term profiles with regards to decreasing strokes and coronary artery disease. When I get the blood pressure down, Inshallah, I’m also going to tack on a statin. The statins have also been proven to reduce end organ complications in diabetic hypertensives.

BTW, one of the largest studies on treatment modalities for hypertension was concluded a couple of months ago. To generalize, it found that the combination of Ca Channel Blockers with ACE Inhibitors turned out to be the best in terms of decreasing morbidity and mortality from complications due to hypertension. This is quite a departure from the traditional belief that first and second line drugs should be diuretics and beta-blockers.  
  Ugh! Mornings!
Ugh… why do the mornings nowadays feel as if I’ve come back to life from the dead? After eight hours of slumber, I feel as if I’ve been awake all night. My eyelids refuse to open completely and I’m strongly tempted to daydream of winning the lottery and spending the rest of my days alone, unbothered, in front of a super-stuffed chair and with good cable TV. I’d order food to be delivered to my door and watch my weight increase, my brain cells die and my life slowly become meaningless. Ahhh… that’s the life!

I think I’m not drinking enough water or something.  
Saturday, December 24, 2005
  Pressure Cooker
Damn it, I’m feeling tense. I’m worried about my result. I’m worried about my step 1 study. I just have a generalized restlessness today. I can’t fathom why this is. I’ve have these problems before, but I’ve coped well enough. When this wretched result comes out, the dust will settle and I’ll probably be able to focus better. I guess I should be stronger that I am, but hey, I worked for this exam for 7 months straight, and had to worry about it from the first day of final year. The score means a lot to me. I just wish I could get a grip. I usually take some propranolol when I get a bit of the jitters. It’s not a habit, but something I do occasionally to help get the day’s work done. So I’m not superman, so what? I once saw this act by Robin Williams where he suggests they should invent a drug called Fuckitol. Having a bad day? Fuckitol! Worried about the result? Fuckitol! Screwed up your Steps? Fuckitol!

I’m also concerned about my mother’s high blood pressure. A couple of weeks ago, she did a whole battery of tests to assess her pulmonary, cardiovascular and renal system. Everything was fine except the echocardiogram, which showed she had mild left ventricular hypertrophy. A previous echo 6-months ago show no signs of such hypertrophy. I started taking her blood pressure twice a day, suspecting hypertrophy secondary to hypertension and was surprised to discover she was walking around with a blood pressure of 180/70 mmHg. I examined the meds she was using for her blood pressure and found they were totally inadequate: 5mg/d of Lisinopril (Zestril) and 80mg/d of Verapamil (Isoptin). I upped the Verapamil to 120mg/d and the Lisinopril to 10mg/d. There was no response over the next two days, so I upped the Lisinopril to 20mg/d and got the blood pressure down to 160/70 mmHg. That was a start so I kept her on the same doses for another couple of days, but today her blood pressure is back to 180/70 mmHg. I’m upping the Lisinopril to 30mg/d from tomorrow and thinking of an increase in the Isoptin as well.

She’s got to stick with the Isoptin (a diuretic would be more effective, I know) because she’s prone to supraventricular tachycardia and the Isoptin takes care of that as well. I want her on the Zestril because she’s also diabetic and ACE-Inhibtors are great for hypertensive diabetics. So if I can get her blood pressure down with these two agents, I’ll be quite happy. I’ve still got some room to work with in terms of increasing the dose and I’m keeping my fingers crossed that a further increase in dosage will do the trick. To complicate matters even more, she’s gots a dry cough which I’m certain is due to the Lisinopril. If it doesn’t go away soon, I’ll have to switch to Lorsartan or another ARB, which I don’t want to do because the ARBs don’t have the same mortality-rate-decreasing profile in diabetics as ACE-Inhibitors.  

Refractory hypertension requiring combined therapy is a little tricky. Fuckitol is not an option here, I’m afraid.  I just hope I’m not treading too gently here in terms of upping the dosage. Maybe I should be more aggressive. Moiz, Aya, Zak, Usman – feel free to comment.  
  Who needs enemies?
This comes from KO Pakistan. Who needs enemies when we’ve got moron maulvis like these living in our midst?

Recently, many people have been asking about the permissibility of blogs, i.e. online diaries - I’m sure many of us have seen and read them. I submitted a question to Mufti Nawalur-Rahman about them, the answer can be heard here. English translation:

“Going to websites like these will not be permissible, because they contain personal matters and also they specify names/identities which can create a path for bay-hayaai (shamelessness), and unlawful relations, and It is a source that may leak out the faults/kharaabiyan ‘aayb’ of muslims. It will not be permissible.”
Friday, December 23, 2005
  D’s Dilemma III
D went back to London three days after the meeting with his parents. I had calmed him down quite a bit and although he didn’t talk much with his parents for the rest of his stay, he felt that he has a grip on the situation and that things would eventually work out. He would go back and write the letter and things would be sorted out.

He spent the first two weeks in London moving to a new apartment that was closer to work, and more comfortable. He could afford to move up just a little. He was so caught-up in the moving process that it took him about a month to get around to writing to his father. He wrote him a 27-page email where he poured his heart out and laid it all out in the open. It was the most forthcoming he had ever been with his father. He called me up to tell me he sent the email and that he had high hopes of things working out just fine. I agreed with him and was happy that he was so thorough with his email. I was back in Peshawar by this time, it was August, and my final year exam was breathing down my neck. He promised to keep in touch.

D called me about two weeks later. I eagerly answered the call although I was extremely busy with the books by then. I was certain of good news.

D’s father replied to his enormous email after about a week. D’s father derided his email, calling it a long thesis that presumed to lecture him and try to explain something he understood himself perfectly. He knew that D had done something very stupid, that D was extremely callous towards his family, that D didn’t care about anyone except himself and W. Well, if you wanted to marry W, he was more than welcome to but he would no longer be a son of mine, his father wrote. He said he was really surprised that D turned out to have such a ‘character’ and never imagined he could be so foolish as to let a girl entrap him in such a way. W was after his money, his career, his family home back in Islamabad. W was manipulating you, was turning you against your family, was making you hate your parents, and on and on the rhetoric went. Every possible argument that D had preemptively defended in his email was completely ignored. Whatever arguments D’s father put forth were completely unreasonable. Case in point: “W has a genetic disorder that will cause her to have malformed children.” (The genetic disorder was achondroplasia, the gene for which you either have or don’t have. There are no carriers, as D’s father was suggesting W was). I assured D that there was no way W could be a carrier for achondroplasia unless she herself had the disease (and that would be manifestly obvious as W would be a 4 foot tall dwarf.)  And of course, W was ugly, her teeth were too big, she was too dark, or short, or something else. These statements were thrown in for free.

This email finally brought home to D that fact the he was now fighting for his right to choose and marry a perfectly good, compatible partner with his parent’s blessings. He asked me what he was going to do now, and I couldn’t come up with an answer. I didn’t know how to advise him. Listen to you parents? They know what’s best for you? No. The truth is, parents make mistakes as well, and as decent, intelligent and level-headed as D was, capable of choosing a good partner for himself, his parents were making the colossal mistake of standing in the way for no good reason. Parent’s don’t always know best. Maybe they do when you’re 10 years old and think that playing with dynamite might be a fun way to spend the weekend, but not when you’re 25, gainfully employed and mature enough to think for yourself.

I just comforted him, not really able to think of a way out of his dilemma. I told him not to give up and to make his stand. I reminded him of my own nightmare of a battle to get my parents to agree to my own fiancé. It wasn’t easy at all, and although they were not as vehemently opposed to the notion as D’s parents were, it still took nine months to bring them around. I told him his story would have a good ending like mine did. My parents love my fiancé now and think I made a good choice, but in the beginning, I was faced literally with a ‘choose-us-or-the-girl’ type of an attitude. I told D that whatever happened and however bad the rhetoric from his father got, to never go on the offensive. I told him that however unapparent it seems now, his parents still loved him and wanted to see him happy. He would have to change their minds, but he’d have to be the bigger man here and not hit back with equally poisonous rhetoric. Otherwise, you’d have two parties just trying to beat each other into submission. That kind of compromise never lasts.

In next few weeks more emails were exchanged between D and his father. D mostly kept his cool and appealed emotionally to his father to start thinking logically and dispassionately about the issue at hand, but the response was always peremptory and rude.

Ominously enough, D’s father started asking for W’s phone number so he could call her up himself and talk to her. Not trusting his father with what he might say to her, D steered clear of giving him the number. Throughout all of this, W remained mostly unaware of the magnitude of the problem that was emerging between D and his parents. D had told her that his parents weren’t too crazy about the idea because they thought that he was too young to get engaged. He said he was sure he’d be able to turn them around soon. He didn’t tell her the whole picture because he didn’t want her to worry. She trusted him and was willing to wait for a few more months before the ball got rolling.

I heard again from him some one and a half months later, when my papers had finished and I had only the vivas left. We don’t talk that much when he’s away because we’re both so busy with our respective lives. We made do with enormously long phone calls every month or so. He called me while I was frantically making arrangements to practice OSCE examinations for my vivas. It was a depressing Sunday in Peshawar and I had a lot of work to do. He called me at about 5pm and we talked for two hours. I was pacing outside the doctor’s hostel glad to hear his voice again after so long.

“Everything’s fucked up man, everything!” he said on the phone. “My dad got W’s number from somewhere and called her. Everything’s fucked up. It’s over.”

More later.
Thursday, December 22, 2005
I just chatted with a friend of mine from Aga Khan who is in the US going for his residency interviews. He got a double 99, with excellent 3 D scores, and he’s worried about his chances. I’m sure he’ll get matched and go on to great things, but hearing that a double 99er is worried is in itself, worrying. Rather, it motivating, because it means I’ll have to put my ass to the grinder and score very well as well.
Wednesday, December 21, 2005
  D’s Dilemma II
D began to tell me the story as he drove. His father gathered the whole family in the room and started to talk about D and his sister.

He said that he was really disappointed in both of them because it seemed that neither seemed to care for the rest of the family. D's sister was married after a nine-month campaign to convince her parents. She had met her husband in England were she worked and he had proposed to her over there. They were a little disgruntled about the matter, although eventually both parents admitted finally that the man she had chosen was a good person and made a good match.

D's father claimed that the way they had settled their lives over in England proved that neither of them cared much for the family anymore. 'First it was you,' he said to D's sister, 'now it's D.' He continued on his critical line of thought until he finally surmised that W didn't seem like a good person, that her parent's didn't seem like good people (they met at the wedding), and a whole bunch of other stuff. He was vehement about his rejection of W and berated D harshly at having taken this step. He said that D was way too young (25) to get married now and that he was surprised that D had turned out to be so thoughtless.

D heard all of this in stunned silence. He couldn't believe what he was hearing. What really hurt him were the descriptions of W's physical characteristics. "She's too dark. She's too ugly. She's too short, etc…etc…" He asked his parents how they could say something like that about another person's daughter when they themselves had three daughters. 'What if someone tomorrow rejects them because of their looks?' he told them.

D tried to explain that he wasn't having some kind of an illict affair with W. They met in England, part of a big group of friends who were all from Islamabad. They got to know each other better in the group and they fell in love. Nothing salacious ever transpired.

D's father shouted at him to be quiet - that the conversation was over and that his answer was an unequivocal 'no!'

D’s listen to D recant the story in increasing disbelief at what I was hearing. I mean the kind of objections his parents were raising really were just callous. They didn’t make sense and seemed arbitrary. Having met D’s father many times and thinking he was a really cool guy, I couldn’t believe this might have been his response. Apparently D was just as surprised as I was. This was the last thing we were expecting.

This ‘meeting’ lasted for about half an hour over which many things were said, mostly by D’s parents. He tried to speak up and defend himself, and succeeded only in making noises that went unheard. His parents ignored or rejected all his arguments and just kept coming up with new things to shoot him down with.

When the meeting ended D was badly shaken. He expected this matter to be settled amicably. He thought that his father might insist that the marriage be post-poned until after he grew more stable financially, but that was something D was thinking himself. Never did he expect this unreasonable tirade of meaningless, irrational arguments. He never expected there to be shouting in front of his little sisters, who started crying as tempers flared and voices grew louder.

D was due to leave in three days. He hadn't planned to stay for long, having taken time off from work just to attend to his sister's wedding. There was little that could be done to turn this around. He didn't have enough time.

He went to sleep that night dazed, and spent most of the next day crying. The unforeseen turn of events had scared him. Forget about a smooth road to an engagement followed by marital bliss in a year or two's time. He was afraid that he might lose W altogether.

I couldn't figure out what the hell happened. I was confident that things would work out fine. I had grand plans of pilfering him for great dinners to be demanded as treats for his imminent engagement. We were never expecting something like this to happen.

Over the next three days, he and his parents engaged in that all-too-familiar mechanism of dealing with conflict: avoiding any talk about it. The conversations were painfully mundane. His parents acted as if there was nothing wrong. He busied himself in packing and in coming over to my place where we'd talk.

I thought about the problem a lot and eventually I thought I understood why D's parent's reacted the way they did. D's father is about 65 and his health is not very good. He also lost a lot of money in a bad business investment and financially, they were now hard up. D had worked his way through school while he was here in Islamabad. He always had some part-time job or another. He never took any money from his father because he understood the situation they were in. He made it to London and got a job there, working 20 hour days and not sleeping more than 3 hours a day. This went one for more than two years. He was literally living hand-to-mouth, but he never burdened his parents. At all times however, he was cheerful and optimistic about life.

I told him that now that's he's doing so much better, which a much higher paying job, his parents might think that after he gets married, he'll leave them and go live with his wife in London. I told him that they are probably insecure about their own future because his father's health is not good and he's still got two young kids (mid-teens) that have to be taken care of. D talks a lot to me about his responsibilities towards his family. He's the only son and he knows that whatever happens, one day, he'll have to move back to Islamabad to take charge of his family. He tells me this, but as you might have gathered, he's not such a great communicator when it comes to his parents. His parents don't know he's got such good intentions. They don't know for instance that W once told D that if he planned to live apart from his parents, then she'd never marry him. She told him that he has a responsibility to take care of his parents.

I told D that when he gets back to London, he should write a nice long, openhearted letter where he assures his parents that he'll never abandon them and that W is not the kind of girl who would let him do something like that. He should tell his parents that he'll always be there to take care of them and that they should never worry about his sense of responsibility towards his family. After I explained my thesis to him, D calmed down considerably and came to the conclusion that I was right.

I couldn't have been more wrong...

More later.
Tuesday, December 20, 2005
  D’s dilemma
My best friend met a girl about a year and a half ago. He was working in London, and she was studying there and they shared a common group of friends. They'd hang out together, she was a friend of her sister, so over time they got to know each other a little better.

He came to Pakistan for a visit a few months after the two had met, and told me that he had found the girl he was going to marry. I was really happy for him. He is a sensible, very intelligent, good-hearted guy and I was sure he had chosen a really nice girl. He had 'proposed' to her, in that he said that he'd like to marry her when the time was right, and she had said 'yes'. Of course, things are never so simple in Pakistani culture, even if it's in merry old England. Parents had to be enlisted to work through the necessary formalities, but my friend (let's call him D) didn't think there would be any problems at all.

He was rising up the ranks in his field and at the time was in a hand-to-mouth, two-jobs situation. He wanted to rise a few rungs up the ladder where he'd be in a better position to get married. She was studying at the time, so it was agreed that they'd wait for about 6 months for both of them to get somewhere in their respective lives.

After she finished her degree, she came back home to Islamabad, where her home is. She tried to get a job in London, but the problems of getting a work permit made that impossible. So for a while, he was there and she was here, and they faithfully continued a long distance relationship. I took the opportunity to take her out to dinner to see what she was like. After all, she was going to marry my best friend. She needed my seal of approval. I was happy to find her a modest, intelligent, self-deprecating woman. She had a good job here in Islamabad and worked hard. She was not snobbish or spoilt like many Islamabadi girls I've known. I was happy for D.

More months pass and D finally lands an excellent, long-term high-paying job in London. He's finally set and is thinking of approaching his parents soon. He flew over to Islamabad to attend to his sister's wedding. His sister also lived in worked in England and had come to get married before flying back to England again. D took out a loan to contribute to his sister's wedding. In the mean time, the girl, let's call her W attends the pre-marriage ceremonies and festive atmosphere of the house. She's D's sister's friend also, and she lives here in Islamabad, so it was only natural for her to attend. During this time, D's sister drops a few hints about W's good character and asked her mother if she doesn't think W is a nice girl. Their mother gets a little suspicious and asked if 'something is going on'. Thinking that it would be best for D himself to tell their mother about W, the sister denies that there is any involvement between D and W.

However, those few comments opened the door and D's mother grew a little suspicious and asked him if there was anything going on with him and W. He immediately admitted that there was. He didn't want to bring up the issue now, in the middle of his sister's wedding, but it had come out by itself. D's mother got hysterical and insisted that he had done a terrible thing and that he had broken her heart. D was taken aback by this outburst, but thought it was due in part to the emotional nature of all those mothers who only have one son. He was sure his father, who was a Canadian-educated PhD, would be perfectly alright with his decision. He told me that he was confident that now that the matter was out in the open, although the timing was not perfect, he could expect to settle this issue pretty soon towards an engagement.

The wedding took priority however, and after that initial outburst, no one talked about it for a couple of days. When the wedding was finally over, D got ready for a nice, long sensible talk with his father. I was glad things were going to be settled soon and was happy for him.

Sure enough two nights after the walima, D's father called a 'meeting', which included not only D, but his newly married sister (who had come back to Islamabad after the rukhsati to fly back to England with her husband, who was also settled there), his mother and the rest of the siblings in the house.

The next evening, D comes to my house and picks me up. Most of our time together has been spent talking in his car as we drove around aimlessly through leafy Islamabad. I hop in and we drive off to F-10, our favorite haunt. On the way, he tells me about the meeting. He looks like he's being crying a lot, and sure enough as he tells me what happened, his voice cracks many times.

More later.
Monday, December 19, 2005
  Results news, writing news, and tips on healthy eating
I’ve received word now that our result will not be out before the 25th of this month. It seems there is not much that limits the incompetence and inefficiency of our college authorities. I’m sure they’re trying to break new ground and reach new heights of ineptitude, it’s a hard-fought battle to be sure – to sustain a certain level of moronic disorganization and strive to reach new horizons in it, but I’m sure they are trying their best.

If I sound a wee bit bitter, it’s because I am. I’ve seen little professionalism during my days in Peshawar and there seems to be no end in sight. Two months will have passed since the end of the exam before the result will finally be out. I’ve practically put my life on hold, waiting to hear of the result before taking the breaks off, but this doesn’t seem the right way to go about my business. After all I’ll have to study after Step 1 for the Step 2 CK exam, and during the CK prep, the Step 1 result will be pending and on my mind. If I can’t deal with pressure now, how will I cope then; or any other time when I’m required to stand and deliver in the face an uncertain future.

I need to be tough on myself. I have to stop being a wimp and tell myself to be strong.

One good thing I’ve always thought about my experiences in Peshawar is that if I can make it there, I can make it anywhere!

Some good bit of news is the publication of an article of mine in a prominent publication. My father read it and really loved it. I often have to fight with the editors of the publication for my money, which sooner or later (almost always later) I finally get. But it’s not about the money, or the small degree of fame, or the delight in being recognized, or seeing my name in print… heck! why am I lying - it’s all about that! Guts and Glory baby! Guts and Glory!  

Seriously, these articles will make a nice addition in my CV. These and other publications of mine will help present me as a well rounded individual, which can help in garnering those precious interview calls for my residency. That, and of course, my charming personality. Hehehehe…

The other day, I was out for a nice healthy walk when I decided to get some samosay to reward myself for being so health-conscious. As the vender gave my a big bag of samosay, one of the samosay sitting in the big tray in his stand was knocked over and fell to the ground. I stood there to see what he’d do, and right in front of me, seemingly oblivious to any sense of decency, he wiped some of the greasy, muddy glop that the samosay was smeared with when it was on the ground and put it right back on the tray. He was careful to position the tray so next time he wouldn’t knock against it. He obviously thought he was being very thoughtful. I stood there staring at him, my own bag of samosay in my arms, all paid for.

He turned to look at me. “Thank you sir,” he said warmly.

Needless to say, I thought about throwing the samosay away right then and there and giving him a piece of my mind. That feeling lasted about 2 seconds, after which I walked away, munching away at my delicious samosay. I was hungry!
Saturday, December 17, 2005
  Bloggin' on joggin'
I'm cooped up in my room the whole day, hardly ever venturing outside. I think I need to start jogging again. Sitting down so much in one place can't be too good for the cardiovascular system. It's a marvel I haven't developed DVT yet. Well, the result isn't out yet. A few more days maybe. Maybe tomorrow. Don't really know.

Today basically sucked. The studying really wore me down and got me depressed. I think a jog in the evenings (as opposed to early mornings), when it's not so cold will do wonders to lift my spirits and also force me to get my bum outside on a regular basis. Being caged up in one place for so long can be unhealthy in both body and mind.

I don't have any deep meaningful thoughts for you all today. Well actually I do, but I lack the energy to write them down. I'm really tired and yawning enormously as I bang away at my keyboard. One thing I will say though, is that this blog has become very dear to me. I love being able to write here - to work out my thoughts, ponder over the day, self-examine and all that stuff. Often, I get ideas to improve myself or do things differently while I'm writing. For instance, realizing I had a problem with the internet and deciding to take the cable out were ideas that popped up while I was writing. Afterwards, having publicly stated that I'd take the cable out, I followed through and it worked!

Let's hope I start jogging again too… I really do need to start.
Friday, December 16, 2005
  Dreary wait in dreary days
The wait for the result is taking a toll. I'm suffering from insomnia and that's making it difficult to concentrate on my work. I remember something I wrote in the 2nd or 3rd entry of this blog:

I want both my parents to rest easy in the twilight of their lives. I want to be able to shield them for a change, to provide for them for a change, to tell them that they never have to worry about money again as long as I'm alive.

But if I don't do well in final year, how can they believe such a day will ever come? How can I? They'll worry incessantly about me until my feet land in America and I actually go there to work - if that ever happens! They'll keep treating me with no small degree of justified distrust, worried that this son of theirs may never make it all the way like they had once believed he could (and would).

How can I trust myself if I don't deliver in final year? I know I have it in me. I have to clean up my act. No more whimsical, stupid escapist day-dreaming (I do a lot of that - may write about that soon). My success will determine the happiness of people who are so dear to me. I can't afford to let them down.

It's not fair to have all your eggs placed for you in one basket. It's not fair to be a part of such a rotten educational system, where one massive exam at the end of an 18-month-long final year at med school determines your total score. If anything goes wrong…

I'm resisting the temptation to think too much about the result, despite the frequency with which I mention it here. However, the anxiety it generates still sits back there like a burning ember at the back of my consciousness, slowly drilling a hole through my mind. If it's not out soon, I'll go mad. And if the result it not good, I'll … sheesh, don't even want to think about it.

Nothing much to report about today's events. Study didn't go well. My lack of sleep over the last few days made it difficult to focus. I'm going to take a sleeping pill tonight. I don't want to waste tomorrow as well. Inshallah when the result comes out soon, all will be well… the pus will be drained, the fever will die down and I'll be able to sleep alright.
Thursday, December 15, 2005
  Worried about the result.
Today was a fine day. Study was totally on track. I took the LAN cable out when I started studying and it was plain sailing after that. My pace was good and spirits high. It's easy putting the LAN cable back in, I know - but taking it out is kind of like making the affirmation that I recognize the problem and am doing something to guard myself from it. I didn't feel tempted to put the cable back in or anything and the day went fine. For me, I guess the net is more like an insidious poison - I don't know I'm being affected till I'm well in its grasp.

I felt tense again regarding my final year result. I don't really know anymore when it'll come out. It should definitely be less than a week from now. I did a splendid job of not thinking about it the whole day. As a matter of fact, I don't know why the hell I'm mentioning it now…

When I finished my A-levels, and the result had arrived, I went to my school to go and get it. I had a great 2 years in A-levels. I learnt a lot, made good friends and really loved that time in my life. This period of bliss nurtured the sense that nothing bad was going to happen to me; the notion in fact never occurred to me. I walked into my school as cool as a cucumber, not nervous in the least. I was dead sure I had aced the exams and would have done great.

How naïve and young I was…

The enormous shock of the result only began to diminish some 3 months later when I (miraculously) got into medical college. Medical college itself was another series of disasters. I finally got my act together in final year and turned my life around. To be honest, this Herculean effort was due in large part to my fiancé's presence. Since then, nice things have been happening to me although this is the first exam result since the ball got rolling again, so to speak. It's so hard to trust fate after you feel it's cheated you over and over. Why will this time be any different from last time? Well, logically speaking, I do honestly feel that this time, I really do deserve to pass with flying colors. I really did turn myself around. But as I said, it's hard to trust your luck when it's let you down so many times before.

Pray for me.

Wednesday, December 14, 2005
  Going Cold Turkey
Today was marked by long breaks occasionally interrupted by short intense bursts of furious, guilt-ridden studying. I didn't get that much done today and I kind of feel bad about it. Heck, I feel like a big loser.

Ah, the theme never seems to change around here does it? Is it just me or do I go on about how terrible my studies are a bit too much? I figured that if I embarrass myself by telling you what a loser I am, it might shame me into taking some action the next time around. This tactic hasn't worked out too well for me so far. However, I am glad to report that I've managed at least to rid myself, hopefully permanently, of various causes of my dithering ways. One major cause was the persistent notion that I might still make it as a writer if I set my mind to it (now). I managed to firmly rid myself of this idea by telling myself that I'm very young, with lots of life yet (Inshallah) and will get a chance to do it all, but that for now I've got to have the stubbornness and persistence of a donkey and be single-minded about just one thing: the Steps. Things have also perked up with the start of the pharmacology video lectures. The lecturer is Dr. Anthony Trevor, a fine teacher - far better than the hopelessly boring Dr. Lionel of biochemistry.

Yet I've come to realize another problem. It seems I'm somewhat of an internet addict.

There, I said it. It's out in the open. Hello everyone, my name is DrPak, and I'm *choke* an internetholic. I find myself working quite contentedly at pharmacology, when suddenly I think: Hey, let's check my mail! Hey, let's see what's on google news! Hey, wonder if Firefox has a extension for … And one thing leads to another, and before I know it, I'm deeply engrossed in something I had no intension of looking up when I started.

I'm thinking of unplugging the LAN cable that hooks me up to the server computer in our house. I'll cut off my net connection while I'm studying and put it back in only at the end of my day. I guess I could easily plug it back in when the temptation strikes, but I'm thinking that the inconvenience of getting under the table and fumbling with the wires to do something wholly unnecessary might break the hypnotizing spell of the net. God knows, with my super-customized Firefox, it's amazingly easy to get to exactly where I need to go. It just takes a click or two and I'm flooded with distractions. Every time I'm tempted to check my mail, or do something equally useless, I'll just tell myself I don't really need to and my that future is more important…

Inshallah, I'll weed all my bad habits out one by one.
Tuesday, December 13, 2005
  Quake Quivers
I’ve gone back to my nocturnal routine. It wasn’t planned or anything. The other night, I couldn’t get to sleep, so I stayed up till 6 am or thereabouts. Rumor has it that the Result will not be out before the 20th, so I guess I have to stretch my patience for another week.

Last night, there was an earthquake at 2:52am local time. It started off as very mild shaking, making me stop and wonder if there really was an earthquake or if I was just imagining it. Silently, but steadily, the shaking grew stronger until there was no doubt and my heart beat and blood pressure reached the stratosphere. I just sat there thinking it’d be a minor affair of an aftershock, but it was unrelenting. It went on and on for about a minute until I finally got up, turned off the gas heater in my room and went out, not sure what to do. Everyone was asleep and no one had gotten up, but I just stood there, outside my room like an idiot waiting it for to pass. I couldn’t go outside because the doors and gates of our house are so thoroughly locked down, it would take a couple of minutes to open them all. Also, there was the dilemma of going to all the rooms and waking everyone up and having them come out with me. Afterall, if you’re caught standing outside the house in a quake and you’ve abandoned the rest of your family inside, that wouldn’t make you the most honorable person in the universe. It’s a weird situation to be in, because waking everyone up would take at least a minute, if I did it really fast. Then I’d have to unlock the doors to the outside, and that would take another minute or two. So if I did everything I was supposed to in a timely fashion, I’d be out of the house in two minutes flat after the quake hit. I’m pretty certain that if the roof were going to fall over my head, it would take less than two minutes (120 seconds) to do so – so what’s the point? Heck, I can't even jump out the window and say it was a ‘reflex’ because there are bars on the windows, and even if there weren’t, there’s a 30 foot drop to the ground to consider. It’d make a fine story if I had a broken leg from trying to get out of the house during an earthquake.

Anyway, this quake wasn’t an aftershock, it was a whole new one with a 6.7 magnitude and epicenter in the Hindu Kush mountains some 400 kilometers from Islamabad.

I just read that Stanley Williams was executed not half and hour ago. It’s kind of sad. I’m not against the death penalty, but I can’t really fathom a justice system that lets a man’s fate dangle in the balance for 26 years before the death penalty he is sentenced to is finally carried out. I’d think such procrastination and uncertainty would be a fate worse than death. Either you kill him or commute the sentence, just do it quickly - to be forced to live on death row for 26 years, that’s just cruel.  
Sunday, December 11, 2005
  Impatiently waiting
I felt really tense today in the afternoon as the impending final year exam result comes out any day now. The worst is not knowing when it’ll be out. What really kills me is the thought that I’ll be informed by someone that the result is out and then have to wait for a few hours while someone checks my roll number and tells me how I did. Oh, the agony of that wait. Few things, if anything,  in my life will probably squeeze the life out of me more than that dreaded wait. What I’d love is to get a call telling me all at once that I’ve passed and come through with flying colors – to have the news come unexpectedly and out of the blue, over before its begun. Otherwise, the experience is like witnessing an animated debate between two torturers as they discuss how best to inflict you with pain. If you’re going to torture me, get on with it, dammit! I had to take some propranolol to get the tremors and palpitations to stop (I’m such a wimp, I know).

I think I’ve done very well in this exam. I’ve gone through 4 sets of finals from this college, and with my vast experience at failing, I can gauge, with a seasoned eye, how I did in this exam, relative to my other less illustrious attempts at passing exams. When I sit down and think of it rationally, every time I tell myself that there is no way that you’ll fail this time around. I didn’t make any of my previous mistakes in this exam. I rose to the occasion in each of the nine papers and then again in the corresponding vivas. Still, when you’ve been what I’ve been through, you tend not to trust fate anymore. A good result will go a long way into re-establishing my trust in the cosmos, so to speak.

Well, Richard Pryor has croaked. I have some of his stuff on my computer. I also watched Live at Sunset Blvd about a year ago. As far as stand-up comics go, I think Eddie Murphy was the absolute master. His Delirious concert should be preserved as a ‘Culturally Significant’ work of art. It is quite simply a masterpiece. Unfortunately, Delirious introduced me to stand-up comedy and subsequently ruined all other acts for me, because none could compare to it. I thought all stand-up acts must be as good as this, but was sadly disappointed. I’ve gone through Chris Rock, Robin Williams, Lenny Bruce, Martin Lawrence (who is horrible!) and Richard Pryor. No one compares to Eddie Murphy in Delirious. For all you guys, if you haven’t watched this, go get it. It’s out on DVD now after all these years. For all the girls, you can watch the Ya Ya Sisterhood or something like that. Delirious, is a little uhhh, unsofostikated, if you catch my drift.
Saturday, December 10, 2005
  On prayers and writing
Well, I’m going to be very honest with you. After a couple of days, of being diligent in my prayers, I faltered again and went off track.

To some, who have been praying regularly from a very early age, this whole exercise (of getting back to praying regularly) that I'm chronicling here might seem a little strange. I envy you lot a little bit. On the up side, such ingrained regularity with your prayers never seems to falter as you guys seem simply incapable of missing a prayer. On the downside however, some of you (and I might be wrong here) will take your prayers for granted. It goes on to become a mechanical activity with little real spirituality behind it. I’ve seen despicable behavior from people who pray 5 times a day. All that praying doesn’t seem to stop them from doing anything wrong. That’s not how I see praying.

That is not to excuse myself from my own failings however. I’m not proud of where my efforts have led me, but I guess as long as I’m being honest and writing in this blog, at least I’ll have something to keep me trying. Inshallah, eventually I’ll get somewhere with this. I’ll try again and try to keep focused.

Praying has got to leave you feeling stronger morally than before you started it, or the whole exercise would seem pointless. If I don’t feel my faith re-affirmed every time I pray I’d think I could have done better.

Well, enough of that for now. I’ll keep you updated.

These days, the wait is on for a very anticipated final year result. I’m not DrPak yet as the result of my final year exam has yet to be announced. It should come out before the 20th of this month, and word is that it could be announced any day from now till then.

The result means a lot to me. It represents some 20 months of hard work in final year MBBS. Since we don’t have internal assessments or anything, the final exam represents the end result of all our efforts. Heck, it was such a tough time, I started a blog to help me through! Well, that result will finally be out now. The monstrosity of an exam that I was studying for in the first few months of this blog will have a result out very soon. I’ve already had a couple of nightmares about it. It really is a dreadful feeling. That one number can say so much about you.

Note to all: Whenever you find me away from the blog for a time, you should understand that something is wrong. The longer I’m away, the more screwed up things are. I hadn’t been blogging for a few days cuz I didn’t want to report back on my efforts, spiritually speaking. There’s also been the anxiety of the final year result. The last few days were spent in a funk. Today, for some reason, I woke up in a great mood. I have no idea why that was. Far it be for me to self-analyze my good moods. I’m just going to grin and enjoy them.

On another positive note, another one of my articles has been accepted and will be published soon. I love seeing my name in print. When I’m writing fiction, or a fictionalized account of a real event, as I do for this publication, Time is altered during the writing process - I get so into it that before I know it, hours have whizzed by. That is how it is when the prose is going smoothly. When I really feel like producing something and I’m stuck, it can be very frustrating. However when the flow is good, I sink into the process so thoroughly I forget everything else. I forget to eat, to cover myself if I’m cold, to go to the bathroom, to turn on the lights in the room when it gets dark outside… The whole process just commands all my interest. When I know the article is reaching it’s end, the words tumble out, arranging themselves neatly into satisfactory prose and the article ends with an exhilarating feeling of triumph.

At times, when I feel this way, I often think if I weren’t born to be a writer. I wish I could have a stab at it, but the fact remains that there is no way I can embark upon the extremely time-consuming task of writing a novel right now without compromising the goals I’ve already put in the dock. Sometimes I feel distressed, feeling that I’ve been robbed somehow of my true destiny. I put down such negative thinking however by telling myself that if I live long enough, I’ll have enough opportunities to do everything. I’m only 25 years old. That’s less time than Nelson Mandela spent in prison
Tuesday, December 06, 2005
  Spiritual Journey III
I got totally derailed from my “Spiritual Journey” set of entries. I was actually building the entries up to make a point, but I somehow got off track.

For a time, a couple of years ago, I was very regular in my prayers. I not only prayed the 5 fardh prayers (on time) and their associated sunnah prayers, but would also pray many nafl prayers and study the Quran as well. The resultant feeling of spiritual energy was amazing. Putting it into words will just have me sounding off a series of clichés that’ll make me sound like some phony religious-channel broadcaster (I hate them!). The bottom line is that I really improved for the better because of my adherence to prayer. I don’t mean just mentally, but physically as well. I had more energy, felt more responsible, infinitely more patient, (add your own clichés here). Everything that’s positive that religion is supposed to do, it did do, and I’m grateful I got a chance to experience living live through that lens.

Later on, I realized that I was really praying hard for the wrong reason. I was under the mistaken belief that somehow rigorous adherence to my prayers would yield me success in life. I would lead a successful life, professionally, martially, financially, etc… This bullshit concept is borrowed from other spiritual philosophies (don’t want to get anyone pissed off here by naming any!) and I fell for it hook, line and prayer-mat. Anyway, after about half a year, during which I had discovered the understanding-islam site and went through it thoroughly, I come across the following text written by Moiz Amjad which deals with piety and success (in this world):

According to the teachings of Islam, piety and adherence to divine guidance does not guarantee worldly success and ease. Nevertheless, true faith does provide us with the strength to face the failures, disappointments and hard times during the life of this world.

Firstly, during the life of this world, God has generally preferred to maintain a cause and effect relationship in the happenings with and around us. Thus, success would generally follow when a person has generally made due provisions for the factors which are necessary for that success. Thus, success is generally not related to the piety of the successful or the impiety of the unsuccessful individual.

Secondly, success and failure, if seen in the perspective of the life of this world, are in fact two aspects of man's test. Each person that continues to breathe on the face of this earth continues to take the test that can ultimately take him to the everlasting bliss of God's paradise or render him deserving of God's wrath in the burning fires of Hell. Even the supplications and prayers of pious individuals cannot call off the tests that God has decided for an individual to face.

Thirdly, the outcome which a pious individual may perceive to be as his own or his loved one's success may, according to the absolute knowledge and wisdom of the Almighty, be harmful for him and his loved ones. Under such circumstances, God saves the pious individual, even in the face of his prayers to the contrary, from the ill effects of his perceived success.

In the ultimate analysis, it is important to remember that strong belief in God does not provide us with a panacea for worldly failures and disappointments; on the contrary it provides us with the strength to live through all failures and disappointment and never to despair in God's all encompassing mercy and love.

This was a big shock when I first read it, but in due course it made a lot of sense to me. While it is obvious to me now, it was not as obvious then. We Muslims have this concept drilled into our heads until it’s even implicated through constructs in our daily language. I suppose people find comfort in the belief that their success, in whatever form, is something they assure for themselves if only they pray hard enough.

However, that’s not the way it works. If you don’t work for what you want, you can pray till your eyes shed blood – it won’t happen. I always remember something an Imam said at a Friday prayers khutba (unlike most Imams at Friday prayers these days, this one always had something of practical use to tell us). He said before the battle of Badr, the Prophet was up till late night praying and crying to God, asking for victory in the battle. The Imam went on to say, that if the Prophet was so concerned about winning the battle that he cried for success while praying for it, how can we, so much less than a Prophet, assume worldly success is only lots of praying away. You’ve got to work your butt off for what you want. An angel isn’t going to come down to feed you and your kids.

While I came to firmly believe in this concept, it also led me to pray less regularly. I had been facing a spectacular series of personal failures in my life and had reached a point that when someone told me that praying was the answer, I was receptive. Then the folks at Understanding Islam said that this wasn’t so.

We weren’t put here on earth to make lots of money, or be really famous, or otherwise breeze through life without any problems. We’re all going to get it bad sooner or later in life. That’s just something in the fabric of the Universe. That’s how Allah meant for it to be. Prayer doesn’t avoid it; it just helps you to cope with it.

However, my priorities were different. Also I loved the place I was in spiritually speaking, my motivations were selfish. I want to ‘succeed’ in this life. When I found out that I wouldn’t necessarily have that by all the praying I was doing, I unconsciously became less enthused with the concept. Eventually I got careless in my prayers, I lost what spirituality I had, and reverted back to all my old habits. I turned into a person I didn’t like anymore. However I always remembered the person I was during the time I would pray intensely. Although it was for the wrong motivations, I believe the effect would have been the same. At the end of the day, I was keenly developing a rapport with God and I still remember how tremendously positive that experience was for me. This is what I had lost. If perhaps I had not taken what I had for granted, then perhaps I wouldn’t have given it up so cheaply. In hindsight I recognize what a wonderful thing it is to have taqwa and how it’s something that must be strictly guarded against from complacency. I know things now that I didn’t know before

Which leads us to today, some three years later.

I started writing this whole spiritual journey stuff to clear my head. To sort of make a roadmap of how I got to where I am and chronicle the stops I made along the way. By writing it, I’m announcing my intention to try my best to regain that same spirituality I once had. By this, I mean to say that I’m going to try my best to pray five times a day, to pray nafl, perhaps to start praying tahajjud (I used to do a lot of that), to read the Quran more. Right now, I don’t pray at all. Over the last three years, I’ve tried many times to get back to that former spiritual state. Tried and failed. Many times.

I don’t know if I’ll succeed this time around. I’ve written it down, maybe that will help. If you have any suggestions, do make them and if you’ve had similar experiences, let me know.

And do pray for me! For my ‘success’ ;)
Monday, December 05, 2005
  Everything's eventual
Time passes by so quickly, it’s almost surreal. Sometimes I feel as if I’m going through a summery of someone else’s life. Everything’s predictable. Mornings, afternoons, evenings and nights. All have their hues and colors in the view outside my window, and it always looks the same. Then I sleep. Then I awake. It’s the same old thing. If medicine advances so the stage where our life spans can be stretched to over 200 years, would I even want to live that long? I’m 25 years old, but I feel aged.

It’s strange how our lives can seem to pass by paradoxically so quickly and so slowly. Slowly when we think of all that’s left to be accomplished. Quickly when we look back at all the ground we’ve covered.

Since long I’ve thought of this world as a matrix-like unreal world that God has placed us in to test our moral strengths. Soon, this world will pass and we’ll move over to another plane of existence. Some of us will go to a good place, others to a bad place. This world will cease to be anymore and we’ll all look back at the infinite worries we had during our stay here and think we were only dreaming. Our time here will seem so short and our worries so petty. We’ll wonder how we ever managed to be so preoccupied with a life that was bound to end, heedless of what was to come.

Time seems to be playing tricks with me.  
  Top a' the morning!
I’ve changed my nocturnal ways. I went to sleep last night earlier than I normally do in order to wake up in the AM. The whole nocturnal thing hasn’t been working very well for me at all, I guess I should realize that now. It was necessary for a time because my older brother would get home from work around 1 am and someone needed to be awake to open the door for him. We’ve got like 3 layers of doors and gates and stuff, to discourage the occasional burglar and they had to be opened from the inside in order for my brother to get back in. He won’t be taking the evening shift at work for a week now, so no worries on that front for at least that long. In the meantime, we’ll have to do something with the locks to help cope with his possible return to the evening shift later on. I certainly am not going to volunteer to stay up for him again!

In the meantime, I’m chugging away at my coffee, glad to be here in the AM. When you start your work early, you feel the whole day is ahead of you, full of hope and promise, available to be used to maximum effect unless you screw it up! Hopefully, study will pick up now.
  Note to self.
When your feeling really scared of how slow your going… when your worried your going to fail… when you feel like you won’t make it… when the books seem to daunt the shit out of you… when you feel that sick sense of impending doom…

… just stop thinking, block it all out, open the your book and start reading, casting all other thoughts to the wind. Afterall, no matter how far back you are, or how slow you are, or how bad your preparation is, its better to keep moving rather than be standing still.  
Saturday, December 03, 2005
  For those looking for the Kaplan Step 1 and Step 2 CK DVDs
To date, I’ve had more than a dozen google referrals from people who are searching for the Step 1 and Step 2 CK Kaplan USMLE DVD lectures. For all those people I’d like to tell you what I can regarding them.

In case you dropped into this blog entry from a search engine, let me say that I live in Pakistan. The Kaplan DVD lectures have been available here as far back as early 2004. If they were around sooner, I hadn’t heard of it. In Pakistan, these DVDs are pretty easy to find. You’d definitely find them in Karachi, Rawalpindi, Peshawar and Lahore. If you’ve got any friends living there, contact them and let them ask around any book store close to a medical college. That would be a great place to start looking.

Rumor has it that the DVDs are going to disappear soon because of this new wild thing called kopyright, it could be copyrite, I’m not sure. It’s quite a radical new concept. Anyway since I bought the DVDs a year ago, I’m not up to date on how easy it is to find them these days.

In my opinion, the Step 2 CK lectures, which I used when I was in final year, are very, very good and no matter how good a student you have been, going through the lecture notes without the actual lectures for the Step 2 CK will probably be more painful. Don’t miss out on them.

In contrast the Step 1 DVDs aren’t as good because the lectures are far more didactic and dry. They don’t add all that much to the material in the books but the lectures do teach them to you and so makes you go faster. If you’re the lazy type who needs to have things spoon-fed to you, like me, then the lectures are a great way of going through the 2700 pages of the Kaplan notes while someone is holding you hand and making soothing baby noises so you don’t get too scared.

Anyone going through USMLE forums should know about Goljan by now. If you don’t, then look him up. I have never heard a lecturer praised as much as this guy and I finally got his pathology lectures off Ebay. I strongly recommend you do the same. There’s a seller on Ebay called Christmasgift, or something who sells them (along with a ton of other material) for a measly 3 dollars, all burnt into a couple of DVDs. He’s a very reliable seller and I’d recommend him.
I need to clarify something from my last post. I certainly didn’t mean to say that ‘success=money’ is a great working formula for life. It isn’t. And yes, I shouldn’t have said “all people use money as an indicator of success”. I should have said most.

Actually, the entire post sprung from watching Oprah the other day (when I should have been studying! I didn’t want to say that I had been watching Oprah because then Moiz would say something and make me feel guilty, hehehe.) Oprah had Charlize Theron on the show and they were talking about luck and success. Charlize was telling Oprah that she believed luck brought her this far in life, what with all the success she’s had in life. Oprah countered that by saying that she didn’t believe in luck, that there was no such thing and that it was actually “preparation meeting opportunity” that produced results. Now Charlize couldn’t argue with Oprah cuz she had a movie to promote here, and she knows as well as anyone in show bizness that you don’t get on Oprah’s bad side, or that sista might not invite yo’ ass to the show next time. So Charlize nodded sagely in agreement, accepting these words of wisdom from big mama herself. “Yes, Yes Oprah, you’re right.” Oprah then nodded knowingly and changed the subject.

I was struck by how an intelligent Oscar winning actress like Charlize Theron allowed her beliefs to be changed so easily. Was it because she was only a millionaire and knew less about ‘success’ than the big O? What if me and Charlize Theron were having a coffee together in a diner and I told her the exact same thing Oprah told her. Would she agree then? I doubt it. But what if I had a billion dollars? Then my words would have far more wieght, because supposedly, I would ‘know’ what I was talking about. I have more money than you bitch, you’d better agree with me!

That’s what got me to thinking that all people… er, correction most people equate success with money. The more you have, the more successful you are, and the more preaching rights you have. I’m not saying I agree with this or that this is my my belief.

On a more personal level/I think having enough money to live a comfortable life is essential. I wouldn’t sacrifice my family or peace of mind for anything beyond that.

Incidently, I don’t believe the word is luck, I think it’s ‘blessing’. It’s easy to delude yourself into thinking you’re self-sufficient and self-made when in fact God played an enormous part in realising your successes
Friday, December 02, 2005
  On success
I find myself thinking more and more on the nature of success. Invariably, in this day and age, we treat the term as one synonymous with financial accomplishment. The more you think about it, the more you’ll realize its true. Of course, there is that big hoola about having a nice family and contributing to society, blah blah blah… but it all boils down to money. If you’re good at making money, you’re a success.

This is not a bad thing - I don’t mean it in a derogatory way. To me, success is most definitely the ability to make money. Of course, I will also keep the whole family and useful-member-of-society stuff in mind too, but for me, right now, the most urgent definition of success is money.

I’m not a greedy guy, not by a long shot. For me, money represents the ability to help others. I want to be able to provide for my family, to allow my parents to live their old age without them even thinking about money anymore, to give my kids a good life. All that needs money. I’ve never thought of money as the means to a obscenely luxurious life. Fancy cars and high living has never interested me. However for a young man like myself, at the verge of going out into the world (or trying to anyway), making money looms large in my things-to-get-done list. I don’t live in the West, where I can send my kids to a public school where education is reasonably good and free or where there’s a public health care system. I belong to a poor country and I have to take on burdens like these upon myself and ensure that my family lacks for nothing.

People who are ‘successful’ when gauged by the money criterion are usually greatly admired. I’m not talking about your average doctor or lawyer, who after all are just making a good living. I’m talking about your millionaires and your billionaires. The ones who employ an army of accountants to count their money.

I’ve been watching a little TV recently and I see people like Oprah and Bill Gates, both billionaires. I see actors like Tom Cruise, Julia Roberts, Cameron Diaz, Tom Hanks, all multi-millionaires. By ‘my’ definition of success, they should all be epitomes of accomplishment. They must have certain basic principles of conducting themselves that make them successful. They must be doing something the rest of us aren’t. There must be something to them that we should try to discern and learn from.

Or is there? What would these folks have done if they lived in a different time? If Oprah lived 300 years ago and was a black slave? If Tom Cruise lived 100 years ago when there were no movies. If Bill Gates was born 40 years earlier, and missed out on the entire computer revolution. Are these folks just in the right place in the right time? Actually, I think there definitely must be something to all these people that explains the extraordinary success that they’ve enjoyed. I don’t think you can write them all off as mere accidents of good fortune. However many people think of their ‘success’ as being directly proportional to wealth. Ergo, Oprah is more successful than Tom Cruise because she’s a lot richer – and Bill Gates more so that Oprah for the same reason.

After reaching a certain level of financial security (and this point is important), I suppose money shouldn’t an index to how successful someone is considered. Of course, it seems obvious, putting it like that, but think about it. Since everyone (me included) has pegged money as a direct indicator to the degree of an individual’s success, it seems logical to extend that reasoning further – that the more money you had, the more successful you were. That seems like a really shallow concept of success but I think it’s a very prevalent one. A billionaire is more successful that a millionaire.

As a corollary to this, it seems that it’s never a good mindset to be too self-assured. It’s very tempting to think that your destiny in totally in your hands, but let’s fact it, the ability to turn the thousands into millions and millions into billions is tempered in no small part by circumstance and opportunity. What if some person has the intelligence, the willingness, the motivation to do all the things needed to make him rich – but he was a black slave living 300 years ago where the opportunity and circumstance never present themselves. He’d never get anywhere but be reduced to being a slave for the rest of his life. The ultimate outcome of a person’s life in any case is not a reflection of his character, or intelligence, or anything else really related to his personality. It’s just a reflection of circumstance and opportunity. The natural conclusion one draws is that those making bucket-loads of money should never get too big for their boots. Rather, they should thank the Lord that whatever they’re doing is making them money and not let it get to their heads, in another life, they might never have done so.

And do not swell your cheek at men with pride, nor walk in insolence through the earth - for God does not love any arrogant boaster. And be moderate in your pace, and lower your voice - for the harshest of sounds without doubt is the braying of the ass. Do you not see that God has subjected to your use all things in the heavens and on earth? And has made his bounties flow to you in exceeding measure, both seen and unseen?
Surah Luqman, Verse 18-20
Thursday, December 01, 2005
  Do-or-die time
My silence in the blog these last few days is largely due to not wanting to chronicle my daily activities during this time. I fell off the bandwagon and I didn’t really want to write about it. For several days now, I’ve been doing very poorly in the study side of things. Things have come to the stage where I now realize that if I don’t come down hard on myself and get meet my targets everyday without fail from now till the day of my exam, I’ll just end up disappointing myself terribly. I just cannot, under any circumstances, for whatever reason fail in my goals. I need to score very highly. I need to get that residency. So much in my life depends on getting this right. So much depends on what I do in these next few months.

I was knocked off the bandwagon when I ‘wasted’ an entire morning taking my mother to the hospital for some check-ups. She could have gone alone, but I thought it was best if I go with her because what kind of a son (or doctor) would I be if I didn’t go with my own mother to the hospital. When I came back, I got involved in some other family matters that distracted my attention and the whole day went off kilter. Since then I’ve decided to change my timetable and become totally nocturnal. That way I’ll be awake when everyone else is asleep and no one from the household can bug me to do chores or to help them with some problem. I know it sounds really selfish, but I have to be selfish for my time here. I absolutely cannot say ‘no’ to anyone- I don’t want to disappoint – but at the same time, not everyone in the house appreciates that I’m not available to get groceries or answer the doorbell whenever it rings. Besides that, the peace and quiet of the night a wonderful time to get lots of work done. I’ve had trouble trying to change the timetable, but after a few days, I’ve finally readjusted my body clock. I’m a beast of the night now!

From now on though, I’ve really got my back to the wall. I’ve exhausted all the wiggle room I had in the timetable I set for myself. Now, if I don’t get cracking and stay the course, it will very simply mean that I won’t make it. I think somewhere, in the back of my mind, I’ve assumed that I will make it, simply because the consequences of not making it would be so depressing. I think I have to rewire myself and affirm to myself that unless I start working for it, I really won’t make it and all the horrible things I envision happening as a result of my failure will indeed come to pass.

This time is so very important. Perhaps in no other time in my life will my future lifestyle and way of living be so profoundly influenced by my actions as in the following months. I can be hard of myself and make my life miserable now, so that it can be easier later, or I can continue to wallow in the numerous defense mechanisms I employ to ease the pain. My life is in my own hands. It will be what I make of it. The more profoundly I accept this into my psyche, the better my odds will be.
Recent med school graduate from Peshawar, Pakistan. Started blogging when in throes of final year exams. Currently studying for USMLE Step 1. Aiming for the 2008 Match. I blog about my studies, my worries, and my thoughts on life. I live in Islamabad.

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