Discourses in Shitology

Year of the Dragon!

2012-01-24T00:37:00.004+08:00

It is apt that, at the end of this Year of the Dragon, we travel to the Lonely Mountain to slay the mightiest of them all, Smaug the Magnificent. See ya on 14 Dec!

A Discourse in Shitology. Part II- The Golden Rule

2012-01-20T21:38:00.005+08:00

Do not use shit to fight shit, for you only create more shit

Over the years, as I was collecting ideas to form what would become my philosophy of Shitology, I developed a gloomy and sobering perspective: All shit can be created and destroyed, but it is more often created than destroyed. It is also transferred from one form to another, and very often is in the process thus augmented.

The rapid and exponential augmentation of shit arises because we simply don't know what to do with it. As we have discussed in the prelude, neither submission, nor vengeance, nor self pity, nor arrogance can serve as long term viable solutions to shit. This is the Great Paradox of Shitology, as a result of which shit is not just a nuisance but also a ticking time bomb.

Human beings have, throughout their history, tried to fight back, but in many pitiful ways which ensure that the shit returns to smack them hard in the face.

I bring to you this case which serves as a negative example of the Golden Rule of Shitology. This man, a compatriot of mine, was fed up with all the shit that Life gave him: bad public transport, rising cost of living, scarce housing and of course the influx of all those foreigners. The bald patch on his head presumably didn't do much to help.

In response, he decided to create some shit of his own and fling it back at the government, whom he viewed as the shitstirrers. Unfortunately, this came in the form of violent political cartoons which the authorities didn't find at all humorous and long story short, he is in very very deep shit now.

Do you need any more examples of how people have used shit to fight shit, only for more shit to be created? Sure. Read also the case of the teacher who used the f-word on his student in retaliation. I hope by then you'd get an idea of the golden rule.

Have you had the experience of having so much shit on your hands, so much shit that Life throws you, that you don't know what to do with it? I have. It happens often in my life, and I am sure Gary felt the same way too. But, the handling of shit is a sophisticated art and it is highly unwise for angst or impulse to turn things haywire.

Naturally, we would thus want to know the highest form of the art of shit handling. We want to know how to deflect that shit and reduce its disastrous effects. Regrettably, I'll do it another time and by then, I'd be invoking the name of a certain Sir William Osler.

A discourse in shitology. Part I The Prelude

2012-01-13T23:47:00.003+08:00

The first post of the new year will be about shit.

There are several ways to interpret shit, which comes in all shapes and sizes. Some are brown, some are black, some are soft, some are like hard pellets, and some pour down like heavy rain. Some are passed without incident, some take up those precious minutes of yours when you could be doing something constructive, and some burn and tear your anus.

It could be that you woke up early every morning faithfully to travel across the country to see day surg patients, with very little yield, and the day you decide not to come is the day you miss three good patients. Or it could be that you get caught in the trap of drugs, poverty, crime, abuse and whatever not. Never mind, shit is still shit, and all shit is smelly.

So what to do with all that shit?

You can choose to dump it on other people but you know where that brings you. You create more victims of shit. You create more shit, and I see people in the wards, bruised and broken, who have to carry that shit. Shit

You can choose to eat your shit regularly and pretend nothing has happened. But you know, things WILL happen. And one day, all that shit will come dripping out of your ears, and heck you'd realise you yourself have turned into some form of shit. Man is what he eats. Shit.

You can choose to get drowned by your shit but you know that is game over. Shit

You can choose to wallow in your shit and act like the world dumped all that shit on you, but guess what? People will hate you for all your shit, people will say you are wallowing in your shit. You become unpopular, you have no friends, you become alone, and that is even more shit. Shit.

Ahah! And some self important people think they have found the solution by taking pride in their shit:

"Look at me world, I went through SO MUCH shit. Bow down before me ye shitless farts."

"I ate more shit than you ate rice, son. My word is more important than yours".

Yes perhaps it is tempting sometimes to develop the illusion that one day all this shit will turn into gold, and that you are part of some grand scheme in this wide world which aims to turn your shit into a golden badge of honour. No one is prepared to think that sometimes they could be just going through shit for shit's sake.

Trouble is, how can someone smeared with so much shit be that dignified anyway? You'd never know if some other people take out their shit and show it to you and say "Hey, I too have shit". And perhaps the worse realisation is that you are not the only one with shit, and you are nothing special. The shit you are swimming in is no longer special shit. That is even worse shit. Sh-- oh forget it you got the idea.

So what to do with all that shit?

So, disappointingly, shittily, I don't have an answer yet. But one of life's purposes is to find that out, and perhaps in the meantime the solution is to not take that shit so seriously. Laugh the shit off. Play with it. Bathe in it. Have fun with it. For me, I've dedicated myself to writing about it, holy shit, and thus you now have

The Discourses in Shitology

Which, I say, will be pretty awesome shit.

2011 reasons to be unhappy

2011-12-30T22:55:00.002+08:00

I suppose I will ignore all of them and focus instead on the blessings amid what has been a terribly draining year:

1) CG mates

In M3, M4 and M5. After 5 years of being in YLLSOM, I've encountered many people who give me negative vibes, and heard of many horror stories of CG mates quarrelling, politicking and engaging in cold wars with one another. There must be more than one lucky star shining on me because all these years my CG mates have been AWESOME. Not only that, but most of the time people in the neighbouring CGs are great folks, some of whom I've had a great chemistry with.

Central to this bliss are a very pleasant model couple whom I've had the privilege of getting to be friends with.

2) India and Vietnam trips

Cannot belabour the point. While 45 weeks this year have been pretty much dull and laborious, the other 7 were journeys into fantasy worlds where there was no work or responsibility or expectations. In India I learnt how people could live simply but happily, and how to eat with the very same hand I use to wipe my butt. In Vietnam I learnt to conquer a mountain with 3/4 of my luggage stuck in the airport and with only one healthy painless eye.

In Singapore this notion of "heroism" is replaced by how many patients you diagnose correctly, how many questions you can answer during tutorials and your chances of getting into coveted Residency programmes. Nevertheless, I treasure the memories

3) Research mentors

Ok, so it was a long drawn out project. But whatever it was it was a privilege to work with a groups of driven individuals who never failed to be nice no matter how tough the going. Who were genuinely interested in my progress

4) Family

Sister graduated from JC, now moving on to tertiary education. Mother graduated from being a working mum, now moving on to become a teacher by day but fully fledged ah soh by night, what with all the line dancing classes at the community centre. Still the same old pleasant folks that stand tall in this gigantic shit stirrer that is life

My wishes for next year

Personally, I wish to pass the MBBS and find joy in whatever I do again, among other things. As for my wishes for the wider world, here they are:

1) America to clear her rubbish

I consider myself one of those old fashioned people who believe that if you have a problem, you either solve it directly or learn to be happy with it. That does not include sitting down, irritating the hell out of your government, and hoping that something falls from the sky(scrapers of Wall Street). If I ever find myself short of money, I'd either work harder and smarter, or learn to spend less, or both.

Apparently, in this New Age, it is fashionable to whine your way to a solution. And if you can find thousands of like minded people with whom to form a collective public nuisance, why not? Not as if your government, who goes by the ideals of democracy and free speech, can do a Tiananmen and mow the whole lot of you down.

Last I read, nations like America and Singapore weren't built by immigrants who sat down at the beach holding stupid placards.

Is that your name? Hahahaha

2. A vision
The heavens will open, a host of three headed angels will appear singing, and this gigantic guy with a shiny face will read from a golden scroll.... telling us where our healthcare system is headed to.

Why not? First there was just Singhealth and NHG, then suddenly there was NUHS. Now there is the Eastern Health Alliance whose pillar is the gigantic CGH, an enormous tertiary hospital in the east of Singapore that provides an extensive range of healthcare services.

Well to think of it, competition is good. Man Utd needs a Man City to keep them on their toes. YLLSOM needs the Duke-NUS. Gandalf needs Saruman. So, more healthcare alliances to break the monopoly can only be beneficial to patients. Way to go, government!

3. Our country to stop failing further
To build on the above point, I believe SMRT has monopoly over our public transport system. As such, it is indestructible. If another transport alliance group (whatever that will mean) were to compete with them, I'm sure there will be more vigilance.

Although we have not achieved the lofty heights of certain European countries in the art of screw-up, by our high standards bad things have occurred this year. The clean, green, orderly utopia of the 1990s may not appear ever again but hopefully there won't be further deterioration in the standard of public transport, healthcare etc.

An interesting discussion

2011-12-18T22:08:00.004+08:00

It all started with a letter written to the Straits Times- this lady was concerned about the lack of staff at night. She was promptly rebuffed by a male reader, L, regarding the possible increase in healthcare cost should more staff be hired:

Dear Mdm Goh, do you mind paying more medical fees for more nurses in night shift?More nurses at night requires more manpower and hospital needs to pay them. In turn hospital will have to charge you higher ward fees. Do you want it?Alternatively to be fair to others who do not need so many nurses at night. You can hire a private nurse at your own cost.

This prompted another retort from my junior in medical school, K:

She merely brought up a point of consideration, on top of acknowledging CGH's merits. I believe that her concern warrants attention even if it seems unreasonable to you. We do lack hospital staff. We should think of ways to improve healthcare for all instead of being dismissive. You, me, anyone else, can land up in the hospital one day and our children will be the ones complaining if there are no nurses to pour us a glass of water at night.

This newspaper and its replies made is way to Facebook and a senior of mine, J, a houseman, congratulated the junior on his spirited reply. I caught hold of the thread and went ahead to post my own comments, both on ST and on Facebook. The following conversation ensued:

Characters in the play:
K: My junior who wants to improve the healthcare system
J: My senior, who's already working as a doctor
L: The dismissive member of public who rebutted the original letter writer
G: A Duke NUS student who provided the epilogue
and me

I'd cut away the frills and thrills of the conversation eg. the emoticons and the adulation and get to the meat of it.

Me (posting on ST): Hi K, is there a concrete way we can increase manpower without increasing healthcare cost?

Me (posting again on FB): http://www.straitstimes.com/STForum/Story/STIStory_744592.html
My reply. As dismissive as L's reply sounds, he brought up a valid point. We can envision the ideal healthcare system as much as we want but we have to understand that these resources do not sprout from the ground, but ultimately come from the pockets of the taxpayer

J: Q: Is there a concrete way we can increase manpower without increasing healthcare cost? Ans: Me, at $7.85/h, it costs each of the 40 patients 0.20/h per extra me on duty.Health care economics is an OXYMORON guys.

K: Hi senior. I honestly do not know. Now you are probably thinking then why am I trying to talk here and acting like I know something. I remember an article which was posted some time back. http://online.wsj.com/article/SB121193074899024387.htmlregarding the risks of night shifts and the lack of hospital staff. Admittedly, the article focuses mainly on doctors and it may not a fair comparison. Also, I also concede that hospitals will never be as fully staffed during nights and weekends as compared to weekdays due to resource constraints. However, I merely wish to make the point in the earlier post that it is a valid point of concern that staff shortages can lead to lethal lapses in patient care. This is an implicit point in Mdm Goh's letter but I am sure you agree with it. This is especially so with nurses who happen to be the first point of contact with the patients. Whether or not there is a way to increase manpower without increasing healthcare cost, or for that matter, whether healthcare cost should be increased at all deserves a separate discussion and I am afraid I do not possess the knowledge and experience to discuss this further. :)

Me: Hi all, I know a lot of drs hate to bring in economics into healthcare, but allow me to point out that healthcare costs can be as much a burden to pts and their families as the disease itself. Some pts (eg. cancer pts) even discontinue therapy because of the cost. So, what's the point of practising healthcare without concern for finances? I don't think healthcare economics is an oxymoron, although its true economics isn't the whole point.Well, if you don't mind me quoting what we've learnt before, health is not the absence of disease or infirmity, it is the complete state of biological, psychological and social wellbeing. If we come to the point where healthcare measures put more financial strain on pts in this harsh economical climate, we may have to rethink.Thanks K for the article and I think it is food for thought :) To combat the current problem of fatigued doctors during nigtcall, institutions like NUHS and NHG have implemented the night float system. Drs are presumably fresher and I believe they aren't paid much extra (pls correct me if I'm wrong) since they didn't work extra hours. I'm not sure about the nurses really. Nevertheless, whatever healthcare measure we implement ultimately should be a balance between the pt's physical wellbeing with financial cost

G: Folks, in the absence of actual data, this discussion is no more than idle chatter. Too bad there's nobody actually tracking patient mortality and morbidity at night vs in the day. Or the price point at which patients drop out of expensive long-term therapy (ie, how elastic is demand exactly?). Even if everything is nicely documented in the case notes (har har) there's no overall analysis of data. Such a shame, considering each cluster has a vast treasure pile of patient information that we could potentially exploit to help improve care delivery. :/

If you, the reader, have made your way to the end of this discussion, I'm sure you are pretty saturated by now. Hence, I won't delve into another essay but will just make some quick points:

1) G, the Duke NUS student, has a point. You can't say anything in Medicine unless it is backed up by clinical evidence. Level A and B evidence preferred. In fact, my previous two sentences aren't backed up by evidence so you can believe it at your own risk.

2) The original ST article has a weak argument. The author has not demonstrated that the lack of night staff can prove fatal or injurious to patients.

3) Healthcare CANNOT be about making huge profits BUT

4) Healthcare CANNOT be a source of financial hemorrhage in our already vulnerable economy because a) We do not wish to bankrupt our patients, this defeats the purpose of healthcare and b) We cannot bankrupt Singapore's economy, simple as that. Drs have a duty to the country's economy too. Are you willing to accept this idea?

5) Whatever it is, I'm just glad everyone had a civilised discussion, unlike the hundreds of disgraceful mudslinging angst filled threads you have in cyberspace.

6) Note to FB stalkers: No you can't find this thread on J's, K's, G's or my own FB page. It is on an unlikely source haha you use your IQ to find out

Questions

2011-12-07T23:18:00.001+08:00

That have surfaced in my mind on and off like phantoms but I have found no answer to. Maybe someone could help.

Is there such a thing as knowledge? Or is "knowledge" simply our perception of this world based on the latest research, and more cynically the dominant voice? This is quite important, for in a few cases it may make the difference between a pass and fail in MBBS.

Rat races. Through a combination of hard work, detailed preparation and good luck, we entered medical school. Are you satisfied with simply being a studying machine, simply being a fanciful portfolio, trying to be the shiniest and brightest cog in the whole system?

Are we human beings after all just a bundle of animal instincts, with the will to survive and the will to pleasure?

Am I abusing grace? (Grace is not the name of any living or non living object and although I have friends called Grace this is a side issue)

Crutches

2011-12-03T00:22:00.002+08:00

Once upon a time, if you were not too caught up with the burden of academic life, you may have dreamt of the ideal world liberated by science. In that world, there would be no superstition, no conviction, no dogma. Humanity would be free from fear and conflict and would have entered a golden age, an age of progressiveness.

Well not so in real life. There's a reason why we call dreams dreams.

Never did I think that I'd be sharing photos from STOMP but this can hardly be ignored. Apparently, some students in a local university have resorted to praying to a bell curve god (BCG) to help them tide through exams. Of course this isn't really a joke as some have made out. If you spend about $20-$30 buying candles and tidbits for the BCG, if you bother to write a note on your room cursing those who don't follow your practice, then you are getting quite serious there.

So yea, I myself have my spiritual beliefs too. I'm not entirely the "rational man" either. But this article was surprising because I've often thought that Singapore was becoming more and more secular, especially among the younger generation.

In the medical circle, similar superstitions exist. On the day of a night call, no doctor will be caught dead eating a bun (bao), because you'd end up doing everything that night (bao ka liao). Instead, they'll try to eat steamed dumplings (shui jiao), so that they can have a good sleep (shui jiao)

These are not actions carried out by village idiots who've never heard of the 21st century. These are undergraduates and doctors, who have achieved much academically to be where they are.

To cure superstition, is education the cure? Apparently not. Then what is? My first suggestion would be the removal of fear. Not the trivial types like fear of the dark or of insects, but the fear of failure, of oblivion, of poverty. But as you know, that is nearly impossible.

Secondly, it would be the removal of greed and desire. From the desire to have a comfortable night's sleep to the desire to trump the bell curve. But as you know, that is impossible.

Every human being, no matter how intelligent or knowledgeable, has a dark side that cannot come to terms with this frightening entity known as the unknown. Each human being has their own way of filling up this gaping hole in their soul. The notion of human beings becoming truly rational can thus never, never, never take place.

Songs of innocence and experience

2011-11-27T23:43:00.003+08:00

This

"To care for our patients we need to defend medicine from the corrosive effects of commercialism and its failure to see beyond the cost containment dimension"

This

"...abuse occurs is because we have a system where people are not required to pay for what they consume. As long as you are not willing to change that, you will have abuse; until you are willing to change that, or until you are willing to police for and stop abuse if you find it, the problem will remain with you."

(First link courtesy of my FB friend Wen Yang who shared it)

Which one would you believe? To what extent?

I watched Tower Heist many weeks ago. It was a work of pure genius, not because of the decent plot, not because of the quirky delivery of the script by accomplished comedians such as Ben Stiller and Eddie Murphy. No, it was genius because of the bigger picture you see when you take a step back.

Tower Heist is a show about a middle class hero (Stiller) who leads a bunch of working class heroes to rob the property of the upper class villain, who apparently wasted their pensions on a bunch of failed investments. Of course, in the end the rich man goes to jail. The poor and middle class people watching this in the cinema are bloody jubilant of course.

But if you think about it, who ultimately profits from the movie? None other than the rich people themselves- not just superstars like Ben Stiller but also the wealthy executives at Universal Studioes. They were willing to make a movie stereotyping and vilifying people like them (ie rich) so that they could get more revenue. The best part is that the masses, you and me, are too darn willing to hand the money to them.

Therein lies the intricate genius of capitalism. I sell, and you buy willingly. Sure there is some persuasion on my part, but it is basically free will. No one held a gun to your head as you purchased those movie tickets.

The same, however, does not seem to work with healthcare. For good reasons too, because if it does, you'd bet healthcare costs will be skyrocketing through the roof and people will be jumping off them.

There will be an unfair advantage to the supplier (ie the doctor) if Medicine adheres by the principles of capitalism. Allow me to explain although I am no economist:

I believe economy to be about the balance between supply and demand. As a supplier (let's say I sell laptops) I can choose to raise the prices of my laptops from $2000 to $5000, then subsequently to $10 000, but that would mean a sharp fall in demand for my laptops. It makes economic sense to keep my laptops affordable.

As for healthcare, it is unfortunate that there would ALWAYS be a demand, because people always fall sick. Especially in the context of Singapore, there is a shortage of suppliers, compared to the consumer. The suppliers, if left unchecked, are free to raise healthcare costs to astronomical levels and the consumer's only two choices are to accept or die.

Of course, this is deemed immoral, therefore a vastly different approach is taken in public healthcare. Healthcare is subsidised, and the public are constantly being reminded that good healthcare is their right. I have no problems with that in theory. In theory.

However, reality is such that there will always be a loser. Capitalism can be said to oppress the consumer because of ever-inflating prices. On the other hand, try to oppose the forces of capitalism and inevitably the supplier takes shit, as evidenced by the isolated incidents of abuse of the healthcare system. I've seen a significant minority of patients who are malingerers, people who remain in hospital for the wrong reasons and people who manage to wriggle their way into a different subsidy class although they can well afford the full healthcare cost themselves.

If you view public health through a capitalistic lens, you'd be deeply bewildered. You have a bunch of highly educated people servicing, under sub-optimal working conditions and for a depressed price, the masses, who constantly want things cheaper and better. However, what keeps the system going is simply altruism, the idea that "we are doing this for the patient", that is being constantly sold by the authorities to the doctors. It may sound like a thin thread, a weak glue, but never underestimate the power of ideas, of a collective conscience.

Tower Heist- There is only one winner suckersssss

The American Pie Syndrome

2011-11-19T23:48:00.003+08:00

Don McLean's American Pie was the kind of song that had me captivated, and had me close to tears at some point. Well, closer to tears than most other songs. The only other candidate was "Cat's in the Cradle"

The significance increased when I read a full explanation of the lyrics' meaning, at least from some other layman's point of view. It seems that a few sources interpret the song as an account of the social change America went through in the 1960s. After the golden 1950s, it was a mad descent into the 1970s, while in between there was Kennedy's assasination and the Vietnam War, among other chaotic events. America of Don McLean's childhood had been beaten into the dust.

Nevertheless, I have to stop and think- was the 1950s that great, or was McLean simply an innocent child incapable of understanding the world's complexities at that time? Was the 1960s that terrible, or was it that McLean had grown up and had seen the ugliness of the world? I can't comment. I haven't even set foot in America.

However, perhaps a similar "American Pie" syndrome can secretly manifest in some of our lives. For me, if I were to name Singapore's Golden Age, it would be the 1990s. To me, it represented this nation at its clean, orderly and prosperous best. The later part of the next decade up till today, Singapore has been comparatively unrecognisable. Crowding, dissent (especially on the Internet), lots of people from other lands. While I don't want to be xenophobic it is hard to establish a social connection with people with strange jarring accents that disturb a peaceful ride in the train.

Of course, this is confounded by the fact that my "Golden Age" happened to be my childhood and thereafter the "Dark Age" is the initiation into my 20s.

Graduating soon. On top of concerns about MBBS and residency another hidden concern is the disruption to the tight knit family life.

In pursuit of happiness

2011-11-05T22:23:00.005+08:00

So first up, if any reader has the time, here's a cocktail of articles:

1. Khaw Boon Wan thinks that Bhutan is not as happy a place as we think

2. Bhutanese refutes KBW

3. Student, most likely Singaporean, refutes Bhutanese

Who's right or wrong here?

I'll start by saying this: I am 23 years old, I grew up comfortably in a first world country hailed by many around the world as a model for national development, I have wonderful family and friends. I'm studying medicine, I've ran marathons, I've climbed mountains, I've travelled, I did research projects and I study from an iPad and an iPod touch. But I've never really considered myself happy.

Unfortunate thing is, the more you have, the more you want. The more you work for what you have, the more you think you did not get the good end of the deal. On top of that, I've never really viewed personal happiness as the ultimate goal in life, but we'll leave that till later.

What is happiness? I went for a talk by Steven Levitt (Mr Freakonomics) a couple of weeks back. He asserted that happiness is proportional to the amount of money we earn. To those who say money isn't everything, they should try living in Rwanda and other destitute countries around the world. BUT, he also added that the happiest people he knew do not work for money too.

That's true. Once you have enough money to bail you out of war, riots, starvation and disease, how happy you are would pretty much depend on your perception of life. I stand by the ideas of capitalism/elitism (see this and this) but I never believed in ridiculing another's way of life to promote my own. Through a combination of a closed door policy and good fortune, Bhutan probably has escaped the disasters that have plagued Africa and North Korea. There are no iPads, no swanky restaurants, no BMWs, but if they can be content with what Nature has provided them, who are we to judge?

Of course, it is so dangerous for Singaporeans to think- even for a fleeting moment- that they can be happy without material welfare. Gasp! What would happen to pursuit of the 5Cs and the endless striving that occurs in the offices of Shenton Way? Our economy will collapse. Therefore, for the good of this country, for the continued growth of this ever expanding hot air balloon, let's continue propagating the idea that many other countries are filled with poor stupid farmers living on the dregs that life has provided them. WE ARE THE SUPERIOR PEOPLE.

"Because they don't know what life is, they're quite happy. They wake up, they brush their teeth, then they'll farm, and then they'll sleep. But do you want it that way?"

- SM Goh Chok Tong weighs in on the meaning of life by talking about farmers

On a side note...

This is NOT Bhutan. This is Ooty, India. If I ever get diagnosed with a terminal disease I'll do everything I can to return to that place and if any luck I'll die there. As of now, the other thing that brings me happiness would be to swim in NUS, then eat subway at U-Town, then spend hours at U-Town reading Chinese history on my iPad. Since MBBS is coming the third item has to be sacrificed.

Of course, great times with Mum and Marsha count a lot.

The mystery of the testosterone

2011-10-28T00:13:00.003+08:00

"Now to the unmarried and the widows I say: It is good for them to stay unmarried, as I do. But if they cannot control themselves, they should marry, for it is better to marry than to burn with passion." 1 Corinthians 7: 8-9

So said the single St Paul, who wrote this in prison. The cold stony walls of his jail cell served to build up, rather than to contain, his angst and passion, which he characteristically expressed in his letters.

I believe, however, his prison was more than physical. He was isolated from the outside world by his zeal for the new Christian faith, which in the time of the Roman Empire was a magnet for punishment. Nevertheless, the same plight- that of loneliness- seems to affect many people nowadays who share two of St Paul’s traits- being single and male

The battle hymm of the bachelor

With the increasingly stressful economy and the shifting away from the traditional views of marriage, single men-an enigma of modern society- are populating the world insidiously. Some choose to be single because they want to focus on their career and earning more money. Some want to have more fun, some may have been hurt by previous relationships and some are afraid of commitment. Some have not yet seized the opportunity and some, to put it very tactfully, lack the ability to be anything other than single.

Whatever the reason, I’ve found it widely true that the path of singlehood is fraught with its struggles. Having spoken to a few of my fellow singles, I’ve learnt that, like in my own case, a sense of emptiness and loneliness pervades their lives. There seems to be this sense of aimlessness and restlessness and it really manifests itself. From my own observation, males who are attached seem to have a greater sense of responsibility, and those who are single either tend to be roving, raving, female crazy animals or Peter Pans stuck in a childhood that no longer exists.

It’s the testosterone, silly

What of this strange feeling in a man that I’ve talked about above? It is not simply an eerie esoteric beastly instinct. From a chemical point of view, I daresay a man’s aggressiveness and hunger come from the hormone testosterone. It is like a wild animal that seeks release, although any mishandling leads to dire consequences.

I hope this offends no one, but consider why the Catholic church of today is fraught with its sexual scandals. I believe a leading reason to be the vow of celibacy taken by priests. The natural healthy instinct for woman, after its suppression, has thus mutated into something more awful. You notice that other religious leaders don’t usually get involved in such sensational scandals, and I’d say it is mainly because they are allowed to marry. (However, I can’t explain the case for Buddhist monks who also don’t marry. Maybe it’s because they don’t come into regular contact with a congregation. Or maybe they are just better, I don’t know)

Closer to home, you may have heard stories about how testosterone manifests in less than desirable ways. Quarrels, violence, abuse, or just plain obnoxiousness and inflated egos. Scary isn’t it? A chemical that aims to unite us men with women can end up making us more isolated.

A new hope

It seems sad to be stuck in a vicious cycle that ensures the continuation of the single status to eternity. But is there really no meaning to being single?

In finding that meaning, I really need to scrape the bottom of the barrel. Excuses have been given by the sources I’ve combed through: “You need to be complete as an individual before you get into a relationship”- It’s like telling a starving man to eat only when he stops feeling hungry. “Singlehood allows you to find yourself or pursue other things in life”- In my most cynical hour I’ve found this a little lame, just like how you’d console yourself with lamb chop after you missed a beef steak. Nevertheless, I have to concede that somewhere out there, your singlehood may have had a purpose for the wider cosmos.

Consider now our good friend St Paul- imagine if he had found a good wife, who’d occupy his heart and mind with her beauty, who’d soothe his heart and body with loving words and caresses. The righteous anger and verve, trademarks of his letters in the Bible, would be dissolved by the webs of marital bliss. Christianity would not be what it is today. Moreover, as you might know, given that St Paul had strong views about family structure and homosexuality among other things, the world today even beyond Christianity would thus be drastically different. (Surely any elaboration is unnecessary for the reader well informed about world issues. In any circumstance it can be left to another article)

What would your singlehood mean? A life of self centredness and self absorption, or a chance to exercise your gifts to change the world (be it for better or worse)? With the dark monster of testosterone fighting to be master of your mind and soul, the path is not easy. But it is through reflection (and prayer) that we can wrestle some control over the beast.

Unlikely!

2011-10-23T22:06:00.003+08:00

Two very good friends. One has gone to church with me for more than 3 years, another has invited me to Catholic Mass and I reciprocate. Both gave me for my 23rd books that are unlikely to be accepted by modern christianity.

By "christianity" I mean it with a small letter C, the version that is popular among many churches and youth groups today. The version where you distrust Science and the intellect and despise the homosexuals; the kind where you spend a lot of time on visions and tongues. I believe it to be significantly influenced by the ongoings in "evangelical" America.

I believe true faith withstands intellectual tests.

I've come to the understanding that were we to believe in a God, we must accept that this God, with the capital letter G, is infinite. This means that God is bigger than we can conceive. And he is bigger than our perceptions, society's perceptions, and maybe even doctrine. But this I understand to be a discomforting thought for many.

We could choose to pigeonhole God and feel safe about it, but we kill the big letter G. Or you could choose to embark on the deep dark dangerous ride with the Almighty. It's your choice. Are you ready for the rough and tumble?

Anyway, enough of that. THANK YOU FRIENDS!! Really good stuff. Must thank the family too for all their clothes and other goodies.

Some notable excerpts:

"Science, man's greatest intellectual adventure, has rocked his faith and engendered dreams of a material Utopia. at its most abstract, science shades into philosophy; at its most practical, it cures disease. It has eased our lives and threatened our existence. It aspires, but in some very basic ways fails, to understand the ant and the Creation, the infinitesimal atom and the mind bludgeoning immensity of the cosmos."

And then...

"Another childhood remembrance: on the train journey from Leipzig in 1860 I saw my mother naked"

Says it all.

This guy had the audacity to suggest this

2011-10-12T20:48:00.002+08:00

http://www.straitstimes.com/STForum/Story/STIStory_722231.html

Steve Jobs an example of capitalism's excesses?

TO ALL the laudatory comments about Apple co-founder Steve Jobs, I want to add a discordant note: Isn't it tragic that for the past few years, Apple, already a very successful company, had to rely on a dying man as its chief salesman and spokesman?

Instead of less stress and more rest, he was continuously selling iPhones and iPads.

To be sure, Mr Jobs was renowned as a driven man. Considering how hard he drove himself, he must have driven his subordinates really hard too. It would have been very tough working for him, whether as Apple employees or employees of Apple contractors.

The same driven personalities pervade Wall Street too, where already very rich investment bankers and hedge fund managers concoct ways to entice money out of investors to enrich themselves further; some schemes, like mortgage-backed securities, are merely dubious; others are downright fraudulent like those of investor Bernie Madoff.

While many hail people like Mr Jobs as role models, I see only a serious illness of American society: the relentless pursuit of greater success even as the average income of the working class has hardly risen for the past 30 years.

One consequence of this is stagnant consumer expenditure, thus making rapid economic recovery impossible. Apple's competitors, such as South Korea's Samsung, had to maintain the same relentless drive for efficiency and wage containment, thus spreading the same American contagion everywhere.

Karl Marx predicted that capitalism tended to over-invest and over-produce, while competition would suppress wages and impoverish the working class, and this would be a worldwide phenomenon.

It is interesting but sad to see this confirmed by the unbridled excesses of capitalistic icons like Steve Jobs.

Yuen Chung Kwong
--------------------------------------------------------------------------------------------

For my Ortho SIP I wake up at 430 am regularly, my mind understandably blank and stiff. Today however, the papers managed to arrive before I left the house and I must say this letter woke me up.

It takes courage to move against the current social trend of running the seemingly meaningless rat race. However, I'd like to offer an alternative viewpoint: The constant striving on our part is not simply to get more material goods, but also to learn and discover, and ultimately to live.

Take for example my previous SIP with NUH's Endocrinology team. Work started at 7am and rarely ended before 6pm, between which there was a lot of running around. After work ended I often went for a swim, or to the library to read a little, or both. There were overnight calls which involved me working from 7am to 12nn the next day without a wink of sleep. Understandably I was deeply fatigued by this heavy schedule, and was often walking around with tension headaches.

But it was one of the best times of my life. Why? Did it provide any remote chance that it'll grant me more material wealth? No, I was officially paid S$1 a day and ultimately even if I get my career choice, being an internist probably wouldn't afford me a mansion.

My sense of satisfaction came from my learning of the different working styles of various people, namely my fantastic colleagues, and more importantly the discovery of how far I could push my limits.

So perhaps the author has a low opinion of the workaholic "capitalist" lifestyle, but for others it is a way to interact with some of the sharper minds in human civilisation. You could choose to be laid back and content, though there exists the risk of unfulfilled potential.

On a wider social scale, I must admit that maybe the relentless push on the parts of companies to produce more have oppressed many a laborer. I am no economist to suggest a viable solution but I think it important for a human being to discover meaning in his work.

The rites of initiation

2011-10-07T22:45:00.004+08:00

One of the lessons I've learnt in clinicals is that as doctors we are not gods, so all the more having been through only 6 weeks of internship I've no right to judge humanity. Nevertheless through my observation of a variety of patients I need to express some thoughts over these folks.

What makes an ideal patient? We don't have the right to say for the duty of all doctors is to treat all patients. We have to understand that ill people and their relatives can be emotional about the situation. But the best working relationship occurs when the patient allows us to do our work. Questions are welcome, but not to the point where they doubt or belittle us. There is no need for presents or even a thank you actually, just no mean treatment.

However, these 6 weeks, despite the majority of my patients being very likeable folks, there are some whose actions, I believe, do not contribute to a constructive doctor-patient relationship:

1) Doctor, I don't want to be treated

There was a man who had a history of AOR discharges (At Own Risk/Against Our Recommendation ie getting out of hospital against the doctor's advice) who was admitted to our team after he fainted. He berated the team for having lost his handphone, although we repeatedly reassured him that it was with his wife. While in the ward he rejected insulin treatment and hypocount measurements for his diabetes. We gave in to his desire to be AOR discharged again.

Nevertheless I've learnt to be detached about AORs. We don't have the right to keep people against their own will, and some people have their reasons for AOR discharge, like the single mother who wanted to go home to take care of her young daughter, who would be alone. In the beginning though, I found it frustrating when our recommended treatment regimes were rejected

2) Doctor, I want to be treated for a disease which I don't have

I suspect that some patients are admitted purely for social reasons, namely because their family members cannot find them a place to stay. There was an old lady admitted to our team and was sitting out of bed looking very healthy, however she started coughing whenever a healthcare worker walked near. The nurses witnessed it, and I personally tested out this hypothesis and it worked.

Being meticulous, my consultant discussed with us the possible things that could have happened to the patient IF she had a real pathology. She then discussed at length with the patient the possible treatment of her "cough", which was simply lozenges. The whole encounter took 20 mins, and I did notice some of her family members giving a sneaky grin although I could be overly suspicious. I just thought the whole encounter was not a good use of healthcare resources, after all you did not need a US-trained specialist to prescribe lozenges.

3) The doctor is my enemy

No doubt, relatives of patients are under a great deal of stress, but it is not a solution if they don't see the doctor as being on their side. The house officer I was working under called the daughter of a patient, but he was curtly told by the husband that she was not available as she wanted to have her lunch in peace. I never knew that we were here to intrude into and mess up the lives of people but that's how some see it.

4) Doctor, I am an Emeritus Professor

I've had, with a bad feeling inside, showed a patient's X-ray to his moody daughter, who was concerned that his age and comorbidities made him unsuitable for surgery. She was quite convinced that it was a small fracture although in retrospect, I should have made it clear that it was a complete fracture of the neck of femur (Garden's II). Nevertheless, I walked away learning that if patients and their relatives are attempting to show their intelligence, you'd either be smarter or refer them to a higher authority. Given our junior rank, the latter option is more feasible.

Also, there was another incident where the daughter of this other patient called the nurse, not wanting to speak to the junior doctor but a doctor "well versed in medical terms". I should have told her that my House Officer actually passed his MBBS.

5) Doctor, I am the all powerful Minister of Health

Luckily, this did not happen to me. Rather, my relative was narrating the events surrounding my great grandma's hospital stay. Out of frustration she yelled at the doctors and she recounted this incident with pride, saying that it made her feel good inside. Undoubtedly, her ego trip must have wounded some House Officer or Medical Officer.

Another relative told me with gusto that if the hospital was understaffed, the senior doctors should help out with the mundane labour eg. taking bloods, setting plugs. "Tell them to come down at night to do the job la" I recalled her saying. While I acknowledge that some people have many opinions, I think they need to differentiate between what sounds good and what works. I can't imagine telling Bill Gates to help the junior programmers with writing some scripts, could I?

So much for the jadedness. Looking back, I've also identified two groups of patients/relatives which are a challenge to handle, but I've declined to lump them in the former category for the simple reason that their actions are reasonable and understandable. Doctors earn their respect and wages by learning to handle them:

1) Pseudo-malingerers

I cannot emphasise "pseudo" enough. If they are not picked up, both patient and doctor are in some trouble. There was a frail old man under my care who complained of what seemed to be musculoskeletal chest pain (ie not a heart attack or serious lung condition) and we investigated him without finding anything significant. This led me to conclude that he had a low threshold for discomfort.

A couple of days later, he complained of nausea which I decided to dismiss. I thought that staying in the hospital for a prolonged period makes many people uncomfortable anyway. The next day, my House Officer was called to see him because he skipped breakfast and lunch. I was genuinely ashamed because of this incident, after all skipped meals may lead to electrolyte imbalances, which can have profound effects on health.

There was another time, during a night call, I spent twenty minutes clerking and examining this young man who was complaining of a mild burning sensation in his limbs after a potassium infusion. Actually, these sensations are normal after potassium is given and there really wasn't anything wrong with the man. I grumbled about this man to my friend, for which I got a telling off. After all, laymen don't know about side effects of treatment and can be afraid of them. It is the doctor's job to manage expectations. Ok friend I'll learn.

Although I have the secret wish that patients complain only when something significant has happened, I know it is absurd for a doctor to request to treat only healthy people, unless he wants to do Derm or Plastics.

2) Doctor let me help you...

... A little too much. But really, it's ok. I've had relatives who showed me the patient's medication on their iPhone, asking if I need to copy them down. And the same people could go up to the computer, look at it, and ask a long list of questions. But then again, we have to empathise with these anxious relatives.

The textbooks taught me to deal with disease but scarcely taught me about humanity. It is humanity that stops Medicine from being a mechanical clockwork like profession. I admit that half of you would end up jaded about humanity and the other half more empathetic towards it, but both are steps you take while growing up anyway.

You? To anyone reading this, hopefully you'd share about the doctors you like and the ones you don't. Stay healthy and happy all

Very funny

2011-10-01T23:19:00.004+08:00

I was quite bemused to see, among the stack of guidelines the Ministry had given to us, a little booklet on the management of gambling disorders.

I was thinking that if I were to be a CEO of a hospital one day, I could place this gigantic cigarette vending machine next to the respiratory ward. The point would be to bring in revenue to the hospital so we can progress. No patients would be affected because er... the vending machine targets only visitors to the hospital. I'd make it such that patients have to pay twice the usual sum for a pack of cigarettes.

No worries, patients can control their own urge to smoke because they are in charge of their lives. And when all else fails, I can give my doctors brochures on how to advise patients against smoking, or even make anti-smoking advertisements in the manner of this anti-gambling ad that I've coincidentally found on the net:

http://blogs.straitstimes.com/2009/08/28/the-addiction-trap/

Really, no worries at all

The predicament of the "child man"

2011-09-25T22:46:00.004+08:00

"So the child-man is the young guy who finds himself in this new era of preadulthood and doesn't quite feel himself a man, and is of course not a child, but is still very attached to many of his adolescent pleasures, and hangs out a lot with his bros. He's the audience for a lot of the new media that have arisen to entertain him. And I'm referring to Maxim magazine, plenty of cable channels, and characters played by Seth Rogen and Adam Sandler."- Kay Hymowitz, in an interview with mydaily.com

Derm's over. It's the end of an era. I'll be enlisted in the Surgery SIP for the next month and before I go back to ~~camp~~ the hospital I thought I'd share with you a book that I've been reading during the short weekend.

The child man. What an interesting metaphor and picture (see above). They are not extinct in Singapore either. You have the "bro's" and the "dudes" who spend their lives hanging around with their own kind, drinking beer, gaming and whatnot, not taking greater domestic responsibility in their lives. But the question is, should I use "they" or "we"? It is with a little sickening self realisation that I'm not too far from this caricature.

I am a 23 year old guy who's never worked or been attached in his life. My Peter Pan-esque childhood has stretched unnaturally long. Living the life of a student, not earning his own keep, has now become stifling. And let's just say that the only model of manhood I potentially have... is gone. I'm not deluded about working life, I know it can be hell, but there is hope it'll bring along some dignity and the quiet solace that I'm now fully in charge of my own life, not shamelessly depending on a few aunties for pocket money.

That's why reading Kate Hymowitz's book can be even more depressing. In summary, from what I've read so far, I've picked up these points:

1) With the modernisation of society, ladies have become more educated and successful in their careers

2) As such, the traditional dependence on men for protection and providence has been deconstructed

3) Since it's now more redundant for men to step up to the traditional role of the head of household, many "men" channel their energies elsewhere- playing computer games, guzzling down beer, essentially bumming around in life

4) Ladies are on the upward spiral, men go downward, the trend being fuelled by "man-child" and "alpha female" personifications in movies/TV shows by the likes of Adam Sandler and Sarah Jessica Farker respectively. At least that's the case in America.

I would have liked to say that with such putting down of the modern "man", this book has jolted me to greater heights. Disappointingly though, despite the brilliant analysis, Kay Hymowitz has not offered a vision of the ideal 21st century man, a ray of hope that could salvage fallen creatures like us.

A quick check on Wikipedia shows that Hymowitz is married with adult children. Perhaps she could share a little about what made her choose her husband? However, she does not, and her book for all its eloquence remains a mere problem sheet crying the empty call to "man up"

Never mind. I'll offer my own solutions:

Study hard, graduate, get a good career. Something you'd be passionate about, that you can make your calling
Take up responsibility. I had a friend who told me that if I were to become VCF (Varsity Christian Fellowship) president, I'd get a girlfriend. I'd take this as a joke, because I know if I were to really do it, the line between God and Girl as the ultimate goal would be blurred. But I believe there are other areas you can take up responsibility in and I believe it is primarily in your career, so refer to point 1.
Exercise. Whether or not we came from or were intelligently designed to resemble apes, let's be real about the fact that humans have an animal instinct. So guys secretly like their girls to be a little like Anne Hathaway/Kim Kardashian, girls probably choose Orlando Bloom/ George Clooney and the likes. I have completed 2 marathons, 3 halves and 5 mountains (and 1000 buffets/ten course meals). What about you?
Travel and adventure. I believe that if all you see were your MRT station or that void deck, it's hard to be engaging to anybody. In the first world, I suspect many women like to engage in conversations about elegant Europe and artistic America. I don't think many Singaporean women would care if you got chased by that cow in Pondicherry, or braved the Vietnamese mountain with no luggage and a sore eye. If you don't have first hand information, at least know about them through books, articles and conversations. And you may start a constructive conversation yourself.

Yep, that's all I can humbly muster so far. The witching hour is coming and with that the brain starts turning into jelly so I'll stop here. Cheers to you all and I hope all my brethren out there will have access to this good book to spur them to greater things.

The thing is

2011-09-21T23:36:00.001+08:00

I've realised that since M3, I've been on a downward slide to jadedness. It's not just Medicine, it's life in general. I need to love life again.

Unsung hero

2011-09-20T22:49:00.002+08:00

I was at novena square eating lunch today when it started raining. A terrible traffic jam built up and amid the crowd of cars I saw in the distance this security guard directing traffic. He was drenched to the bone but still vigorously carrying out his task. I know he won't win any awards or kisses for this but I was thinking to myself that it is people like this that keep our society going.

It came at the back of a rotten morning. I examined this guy with a cranial nerve palsy in the ward and I botched the examination and presentation. J was asking why I was sweating but the truth is I was livid at myself for suddenly forgetting even the simplest things

Let's talk sex

2011-09-16T23:30:00.005+08:00

There is this strong invisible force built into Man, which some say is from God, yet is on the other hand also labelled as devilish by an overwhelming majority. No one can blame the latter because the fall of many prominent human beings have stemmed from that dark power, yet we fail to realize that it is this same energy that has sustained humankind for millions of years.

So a few days ago at the DSC clinic, the one at Kelantan Lane which specializes in sexually transmitted diseases, I came face to face with the beast. That brute, a good servant to humankind, had only been too eager to turn the tables and drag the unwitting ones to destruction. Husbands cheating on wives with commercial sex workers, man gettiing a new girlfriend, all getting diseases on their members. And in some cases, the only disease was fear, of getting the dreaded HIV.

I suppose it was eye opening. I mean, how many times in a clinic do you get to write down stuff like "last sexual encounter was __ days ago with prostitutes in Orchard Towers.("wah uncle you so rich ah" says the doc) No condoms, no oral sex"? And seeing a doctor having to painstakingly explain to a patient what he means by oral sex. In explicit terms.

Jokes aside, there was one thing that I took from this: Since my childhood many people around me have expressed the decadence of Western culture, what with them being so sexually liberal, but I daresay Asians don't pale in comparison. it's just that they know how to sweep things under the carpet, and pretend to be holy-moley Confucian-ey.

Hypocrites. A quick look at Chinese history reveals some of the most lurid details about our yellow ancestors- Qin Shi Huang's mother sleeping around, dropping bastards along the way. Tung Chi Emperor allegedly looking for prostitutes outside the Forbidden Palace. Last emperors of Western Zhou and Shang ruining their empires thanks to them women. So, sexual sin is universal, not limited to whites.

Some of my adolescent memories- writing Chinese essays about how "thanks to Western culture, our society has been negatively influenced in the following ways", and then knowing about a bunch of relatives watching this famous Taiwan porn video behind closed doors, the same bunch of mothers who would cane their kids if they did the same. But that's why life's interesting.

On a more serious note, I've rationalised the need for sexuality to be expressed within marriage. For instance, would you share your most intimate secrets with strangers? Casual friends? I suppose not. Likewise, you probably wouldn't want that most private part of your body and your spirit to be shared with someone random. But I know, some people think its just for fun, be my guest if that's how you view that part of yourself.

But it's hard. Freak. Not kidding here. But in life we all have our crosses to bear. You cannot hide them, you cannot be so hypocritical as to suggest they don't exist.They will not be taken from us because we have to learn to carry them. Sometimes you'll drop them and crack them. And then you have to pick it up again and submit these forces to a higher will.

The End of Poverty

2011-09-10T23:15:00.000+08:00

Today I received a knock on the head from God, who probably was tired by my whining about my unhappy life. It seems that while He had more important stuff to deal with, what with wars and oppression and destitution, I was spamming His inbox with sad trivialities.

This movie brought up some points which I wasn't aware of, such as the link between colonialism and poverty and the use of debt as a possible object of oppression against the Third World.

The ideas in this movie may be summarised as follows imho:

1) Colonisation is largely responsible for the poverty we see today in third world countries, who were former colonies

2) Colonisation not only robbed these countries of their natural resources but also of their culture and identity

3) Another crippling factor to Third World countries would be national debt. Newly independent Third World countries owed billions of dollars to the World Bank, and as a result had to let the World Bank dictate their economic policies, which were largely favourable to the First World and harmful to the Third. Third World countries were also made to take out additional loans to carry out the reforms requested by the World Bank, increasing their debt. Despite international grants to the Third World, the amount of money transferred from Third World to First is many times more.

4) There were Third World leaders who fought to protect their countries' resources from being exported, however let's just say that there were authorities in the First World that oversaw their overthrow or even assassination.

Whether or not poverty is more of the fault of the rich or of the poor, let's make sure we do not help any of such oppressive activities. If we cannot fight for justice, at least fight for charity, or at the very least be aware.

Happiness

2011-09-07T22:33:00.001+08:00

If people had no desire, this world could be a happier place.

A less mundane night

2011-08-28T01:58:00.002+08:00

So today in the evening I had a photoshot with Mt Fansipan buddies at Chinatown, dinner and Kinect with HCA friends followed by Timbre w CG and ex CG mates. All this amid checking the progress of the Presidential elections. I recall that as a reclusive 16 or 17 year old this would be the kind of "happening" life I'd long to have, but now at the ripe old age of 23, with the backdrop of being a year 5 with exams looming, this didn't seem too right. For a start I was wondering if I had been mugging enough during the 2 week break.

At a point in time when life lies ahead of you, you can't help but be a little more philosophical. For a start there is a practical purpose because I can't write that bloody personal statement. What does it mean to be a doctor, and do we know exactly what God had in store for us when He put us here?

I've heard stories so far. 30 year old man becomes a relief teacher instead of a Mediacorp artiste like he dreamt of, because a back injury rendered him incapable of working long hours. Middle aged man is plagued by a previous spinal injury, together with diabetes and migraines, and thus wants to put up his son for adoption since he, and his mentally disabled wife, are too ill to take care of him. You can view your role as contributing to the improvement of the health and thus the lives of these people, or you can see yourself as merely a plug setter/crowd clearer/clerk. Actually, both are right.

I'm just saying, sometimes our actions have bigger consequences than we can imagine. But that said I haven't gotten to the stage where I study for wholly altruistic purposes I must admit.

I'll state it as such: when I was in secondary school I listened to those Lit lessons which taught us about dreams and ideals and altruism. When I progressed beyond that stage I learnt that Mammon was a brother and a friend, and we can't do without him. Because we humans are essentially animals who just want to eat well and sleep well and mate well.

And perhaps later on there will be reconciliation. Or perhaps liberation from the demon of materialism. And perhaps one day when I grasp a vision of the face of the living God, I would disregard all else. It has happened before, even the thought of graspjng that vision clears your mind of the things which you formerly desired.

A gingerly attempt at purism

2011-08-22T22:28:00.005+08:00

So the online portfolio submission opened today. Like all wide-eyed and hungry final year students I was eagerly giving an account of my life to this invisible virtual being.

Every time I do this, I admit how cool it would be if I could do something like that at the end of my life before I apply to residency at a higher place. If the cancer isn't too debilitating that is.

I learnt long ago that life has an element of a rat race in it that cannot be ignored.

How many people truly consider their calling to the world when they think about the future? It's easier to climb up the ladder they can see, with all that beautiful career milestones. Prestigious titles.

I don't know how many people truly do research because they have a heart to change the world of medicine. It's apparent that some are interested primarily in getting papers published.

Because it's about KPI at the end of the day. And if you want to ignore that, look at Arsenal right now.

Life is not built entirely on dreams. We don't really do dreams here in Singapore. But deep down you know you need them, just that you don't often articulate them. You'd probably get stares.

Among the sea of realists I don't often see people who have retained that passion, the desire to live life at least a little as an adventure. I admit I'm not one of these people because in the years ahead I carry responsibility. So unless you count exams, housemanship, more exams and NS as an adventure, so...yea.

What is our dream? What are we here for?

To "change the world"? Whatever that meant as an 18 year old. To "serve the poor"? Though it is something more easily professed from the lips, and your political awakening may actually lead you to see their flaws. And some want to be missionaries, while some want to build clinics for the poor.

And I sincerely hope for these people's sake the vision doesn't get lost. For now I'll be happy going home knowing that I did my job competently. Gives you a good night's sleep.

"Justice" and "Mercy"

2011-08-17T10:26:00.003+08:00

"In medical school you will learn the art and science of medicine, but when you graduate you will learn the politics and economics of medicine."- My PBL tutor in M2, a prominent surgeon who has since left for private practice.

(I'm sorry if the ideas in this entry are too scattered but I have so much to write I just want to plunk everything down here)

--------------------------------------------------

I have noticed that since young I stood very much on the side of J rather than M, probably to a skewed extent. These recent years I have been oscillating across the divide, if there is any divide, for instance when I had to consider the case of this young Malaysian man sentenced to death in Singapore for drug trafficking. In the end, though I was originally very disinclined to, I helped to sign the petition.

More recently however, in my personal life, M has showed itself to have this perverse side, perverse because it exploits the conscience of decent down to earth fellows. ("What if he does something rash? Will you regret it?" "I can't believe these people are so unkind to me. I'm so lonely. Sob") Yes I believe in compassion but things can get to the point when the world is actually bending over backwards to accomodate the unreasonable. The exploitative. The abusive.

Reading the newspapers recently, I noticed that what I perceived of the riots in Britain to be an extension of my inner struggle.

The mess we see now is a failure of that society morally, and I'll let this article and this article explain more eloquently the situation. In my words, Britain has let M overpower J. M, the irrational whimsical lady, has put her boot in the face of Lady J. J probably has left Britain in a fit of disgust, and M's wayward cousin Chaos has come out to play.

Now onto Singapore. Yes, definitely we have a long way to go before we scale the heights that Britain have. Any discussion about Singapore starting to become like Britain is way too speculative, although I did discuss that possibility yesterday with my friend over dinner.

You may be wondering why I put that quote at the start of the article when all I've been talking so far was about unpleasant people and the British riots. Because I've been thinking quite a fair bit about healthcare subsidies in Medicine and whether they are as just as we think they are.

Consider this: A middle aged lady has not been controlling her diabetes well. She injures her foot, which her husband encourages her to seek treatment for. For three weeks she ignores him before she finally gives in. Luckily no amputation was needed for that wound.

A middle aged security guard, with a rare metabolic condition, comes in for his nth episode of hypoglycemia. Like all previous times, he vehemently refuses treatment. He insists that his handphone is missing although healthcare workers have repeatedly reassured him that his wife has taken it. But he is angry and bursts out at healthcare workers.

In strange circumstances, this elderly lady, under a curious request by her family members, has been transferred to this current hospital from her previous hospital. Presenting complaints point towards nothing other than a URTI but her family members seem to want her in this hospital. She looks and behaves very fine but starts coughing whenever a healthcare worker comes near. The endocrinologist spends 20 minutes at ward rounds thinking through her condition and counselling her about medications. Which are lozenges by the way.

And in case you are wondering, I am quoting real life examples.

J: Getting something you deserve, or not getting something you don't deserve. M: getting something you do not deserve. Will healthcare subsidies be an act of justice or mercy in that case? On one hand, as citizens of this country, we are said to be entitled to have healthcare costs taken care of by the government. It seems fair and just.

But then again, it is apparent that a significant minority (I am guessing, hoping, that it is the minority) of government subsidies are spent on the negligent and worse still the malingerers. Perhaps such labels could be a little harsh, especially on the first patient, because people's view of their health is affected by sociocultural status and also their economical well being. Nevertheless, it is public funds, the hard earned wages of the taxpayer, that are being used to pay for their healthcare which they hardly cared about. Is this just?

In the cases of these people, I conclude that subsidising them is an act of mercy. And all cynicism aside, I have been told by a wise friend that no matter what, our calling is primarily to love these people. It is an idea that I want to be committed to. And I admit it is a weak flame, a smouldering ember that stands alone in the darkness of my hatred of people who hold ransom the wider world (like that guy I was talking about).

Had I the power to fashion society, everything will be orderly and in place. People will understand that they are not entitled by any external source to live a happy life. They have to get it themselves. They don't need to be strong or talented but they will be responsible and disciplined. But at the end of the day it is part of our being human that we learn to love even those who are different. Those who may seem disorderly and irresponsible. Because God loved us first and foremost.

Change the world

2011-08-13T23:31:00.002+08:00

In my idealistic teenage and early medical school days I had the lofty dream to change the world and now in M5 I thought it would be good to try to revive the dream. But a line from Evan Almighty, showing on Channel 5 this evening, did strike me- people pray about changing the world but don't know where to start.

Evan, who ran for Congress, had the motto of "Change the world", deeply reminiscent of a certain black American President. He prayed for his motto to be fulfilled, but ended up having to build an ark. This was on top of changing his fashion sense and jeopardising family, career and social standing. In the end, through deep conversations with God, he discovered what changing the world truly meant- it started from the small actions like spending quality family time and being kind to others.

So in his case, "change the world" was indeed achieved, but with sweat and tears. As for me, "change the world" meant going on medical mission trips, or discovering things through research, or just being a good doctor. And while medical school did have its high points (friends, overseas trips, marathons, playhouse, research), it had its perils.

Come a point in time, I was deeply jaded because I realised medicine alone could not change lives. During SIP I saw handfuls of patients with poorly controlled diabetes as a result of their attitudes and poor social support. I realised that showering them with pills would NOT change a single ailment of theirs because they would simply not take them, or run out of them.

Some of them had terrible ailments that had no cure, for instance a stroke with multiple severe contractures. Some of them had no insight into their situation and refused treatment. This sense of frustration and anger developed within me as I perceived the futility of our roles as doctors, not to mention the bitterness at being unappreciated.

Therefore, a couple of weeks ago I shared this with a senior, a true woman of God, that I highly regard. As we were supposed to pray for something else (you know, like those group prayers) she had to cut me off and later even after we finished praying I noticed her to be in deep silent prayer. I have no idea if she was praying over what I said since she has a lot of issues on her mind. Anyway, this was her reply, as best as I can remember

"Marcus, we as doctors are not called primarily to solve problems but to love our patients. There are a lot of unloving things going on out there but do you stop loving our patients? Even though they may do wrong, we are still called to love them. There are many things we cannot control as doctors, we are not God, and the knowledge of that is so humbling."

Yes. Throughout most of my medical school life I have assumed the point of view of the problem solver, the taskmaster. And it is easy to think that, after 5 years of education, we walk among the sick people as gods. But we do not come close. It is on the battlefield against disease that we see our inadequacies, and that of medical science itself. Patients are pumped with antibiotics and/or steroids and they may not recover. It is a tedious process, watching the process of clinical recovery stagnating.

But love? It is a total different ball game. I never thought of changing the world through love. I thought it was through cold hard science, or sound policymaking. Love is so easy, in the sense that it is freely available, no MBBS required to show it, but yet one of the hardest things. It could have been buried within years of technical training, of deep seated anger and jadedness, much like how Captain America's shield got buried in the ice.

So I suppose I could learn, but it is hard. It is tough enough putting together the clinical signs and symptoms, even tougher if your some of patients are assholes. And since we are approaching residency, we have better things to do like build the CV, who cares about love?

But as you clerk the old lady who stays with her asthmatic granddaughter in the shelter, as you learn about the teenager who was so traumatised by medical students examining her that she cried, you realise that medical science really is inadequate. A more viable option would be this important intangible so easily neglected by the cares of daily life and self centred pursuits. Although frankly I don't know how.

So difficult to understand human disease, more difficult to understand human nature. Change the world? Gotta change ourselves first.

The Lord is my shepherd, I shall not want

2011-08-09T22:55:00.003+08:00

Lust is wanting something you are not meant to have. Have you had something you really wanted for a long time? Calling you to it in the dark moments when you are alone or unhappy?

Balance

2011-08-07T23:47:00.002+08:00

One small exam coming ahead, against the backdrop of the big one in the horizon. Significant question marks over Residency and the future. West Ham relegated again.

Gotta balance long term planning with fighting the fires of EOPT

Gotta understand the true uglier nature of people but also learn to love them, as always taught by VCF.

Gotta take some time off to live life if that is permissible given the heavy academic schedule. Now they come in little snippets here and there on random evenings, or the times when I walk to and fro school listening to music.

Gotta do practical things for the future but also understand that once upon a time as a teenager I had a secret little wish to change the world. Though now I'm not too sure how. I suppose everyone has his own part to play in some way. Being a competent and compassionate doctor, I believe, is already a significant contribution.

Shan't try to think so much. This is an exciting year.

Of being twenty something

2011-08-01T23:50:00.002+08:00

I guess it's easy to put effort into things which give you tangible results. So you can pour your efforts into work and career- get praised during ward rounds for a presentation you make, get to meet people, get good grades.

And it's easy to ignore the other things which don't give you the yield you want. You don't get that gratification from being with family, or taking care of your health, or trying to form a love life. But the results, though they don't happen in front of you right now, are still alive and kicking. Loneliness, broken relationships, disease.

It is one of the many sad ironies that plague our miserable lives that we are potentially so imbalanced in that aspect, so potentially deficient.

The other only greater irony I know so far is that Family Medicine, despite being the pillar of the healthcare system, is just so damn unpopular with resident-wannabes. On Saturday I was at the talk held by the family physicians, and one guy opened the door. He was invited in, but he asked to "just take the brochure" and went off.

Resume

2011-07-31T22:50:00.002+08:00

I spent more time than I thought I needed to re-editing my CV. While doing it I was driven by the need to impress, which to be frank is the purpose of all resumes.

I've now finished the tedious task, and thus have some peace. And I have been led to think, what on earth am I doing all this for? It occured to me that at the end of it all, we only have one account to give to humanity and the Higher Power ruling over it. I believe that in the end, be it as a corpse lying under a cold gravestone, or a pot of ashes, or as a spirit in another dimension, our lives will be reviewed by the vast creation that walks past, exposed and displayed.

And probably no one will care about how many projects or abstracts you have done or how your grades were, or what kind of networks you had. Instead human beings (and a higher being if you believe) would probably want to know:

If you were loved God and man

If you simply conformed to the pattern of the world and followed the rat race rather than lived a life true to yourself

If you neglected the people that truly mattered

If you were simply jaded by all the crap in this world rather than having taken an active effort to change it for the better.

How the world changed as a result of your life.

If I die right now I want people to know that I really have been jaded by many things over the years although I may not always show it. Once upon a time I made the effort to make things better but it ain't always working, have mercy on me. I don't need to make things better anymore, I've been so tempted to think, instead just live for myself.

Note: These lyrics are just for your enjoyment. I view them philosophically rather than literally so please I hope no one gets worried about their depressing nature. I'll surely be going for school tmr.

I am a poor wayfaring stranger
While journeying through this world of woe;
And there's no sickness, toil nor danger
In that bright land to which I go.

I'm going there to see my Father,
I'm going there no more to roam;
I'm only go-going over Jordan,
I'm only go-going over home.

I know dark clouds will gather â€˜round me,
I know my way is rough and steep;
And beautiful fields lie just before me,
Where God's redeemed there vigils keep

Making sense

2011-07-21T22:14:00.002+08:00

Many times I have been tempted to think that insanity is the best response to some things in this life :)

Or either that, good music

Light

2011-07-09T23:44:00.004+08:00

I swam again today, 24 laps in 45 mins. Words cannot describe the fulfilment it gave me after one week slogging away in the wards. I like the feeling of lightness, of not carrying anything, of being able to float in the water. It gives me energy to study afterwards.

Midnight mumblings

2011-07-02T00:56:00.002+08:00

I've tried for years to hide that I can be a philosopher sometimes. It has failed so badly, I might as well come out of the closet.

Black and white

Oh. Past a certain time in life and you realise they are so elusive. The bad guys don't all come dressed in monster costumes, all snarling and dripping with blood and saliva. They may come packaged in soft velvet with "vulnerability" and "psychological affliction" written on them. And as such your conscience is played with. It is the chief factor why you don't want to do anything definitive about them.

You linger around, alternating between stopping them and helping them. You let them continue their nonsense and emotional abuse.

Your friends don't really care. Too busy empathising.

It doesn't matter if their actions drain nearly the whole universe of its energy

It doesn't matter if they have the mentality that the whole world owes them everything. It's never their fault. Someone else's

It doesn't matter if they bite back at the people who help them.

Why do you want to stop them, oh you cruel thing. Don't you know they are suffering? Those poor creatures.

Vulnerability.

Somehow I think this incident has, in my eyes, dulled the boundary between those who truly need help and those who are just leeching off this world. I don't want this boundary to be dulled. I don't want to become jaded and unfeeling. But some people in this world are testing me very much.

I've never seen vulnerability being abused to such an extent before. That despite being such a drainer of energy, some people in this world manage to get the whole world to be involved in their situation.

And this is not because the world definitely like that person or don't see the person's flaws, but because their consciences have been played with. Or maybe they just don't know.

The worse thing is that the person himself DOES NOT KNOW OR CARE. It's people's duty to help him. It's people's fault if things go wrong. 10000 people in this world have wronged him and they owe him. So it's ok for him to continue with his crap behavior.

But can we do anything? No. That poor thing. How can we touch him?

Psychiatry

I don't want this to be a field of medicine where I end up having misunderstandings about after this entire saga. I think society needs to understand more about it. But I don't. Out of respect, I shall refrain from commenting further.

i swam again today oh boy

2011-06-25T23:22:00.004+08:00

82 laps in 5 days to be precise. On top of revision of course.

And I suppose after listening again and again to those psychedelic (and possibly drug induced) Beatles' songs I've become a little more psychedelic myself.

Today while I was feeling more relaxed I submerged myself under the deep end and looked up at the underside of the water surface. It was very curious looking- one portion reflected the pool interior and from the other you could see the sky above. There were two nice diagonal lines forming a V shape that separated the two.

I thought of refraction, refractive index and total internal reflection

And how nice it would be if I were to live in this nice fantasy world where there is this nice crystalline liquid-like membranous ceiling which partially reveals the sky and partially shows various shades of blue. It's like Strawberry Fields. Nothing is real, and nothing to get hung (up) about.

Well this indulgence must end someday. Week after next and I return to an incredibly straight laced world

While my guitar gently weeps

2011-06-24T01:05:00.005+08:00

I've tried to avoid giving detailed self absorbed chronicles of my mundane life. However, there are times, some special occasions, when I have no choice but to do so. This entry will save as a virtual time capsule, in case there are times in the future I feel nostalgic and want to look back.

Things I did for the first half of this year:

1. Helped to save lives- intubation, bagging

2. Went for a disaster medicine simulation session

3. Celebrated CNY whole heartedly for the first time in 5 years.

4. Ran an urbanathlon

5. Stayed away from home for more than a month

6. Survived 5 weeks of India without any diarrhea

7. Learnt to eat with my hands

8. Learnt to appreciate cricket and immersed in the World Cup frenzy (though only for a while)

9. Had a multi-national tutorial consisting of 2 Indians, 1 German and 1 Singaporean

10. Saw lots of cows along the street, and touched two of them

11. Sat on crowded Indian buses

12. Ate BEEF at a posh Western Restaurant in India

13. Watched a late night movie in Bangalore and fell asleep at the most important moment

14. Walked down the beaches of Pondicherry and Mahabalipuram. Had relaxing breakfasts in the latter

15. Jogged around an Indian village and got threatened by dogs and saved by villagers

16. Saw the tea hills of Ooty

17. Saw elephants, bison and deer in the Mudumalai Nature Reserve

18. Bought high quality Mysore silk for the family

19. Toured the Mysore Palace

20. Stayed till near 11pm at NCC, way after the consultants

21. Come close to tears on a couple of occasions

22. Submitted research abstracts

23. Got scolded on a Saturday morning during a tutorial during ELECTIVES

24. Went to election rallies and created a photo album

25. Voted

26. Learnt the finer details of patient clerking, working style

27. Became the temporary chief waiter of the lymphoma team. Waiter-ing is an art.

28. Missed a marathon I signed up for

29. Went for a great seminar

30. Climbed a mountain with 80% of my luggage delayed at the airport, and having a corneal ulcer on top of that

31. Endured three very cold nights on the mountain

32. Triple planked on the mountain

33. Drank alcohol to keep warm on the mountain

34. Fell down at a cave

35. Kayaked at Halong bay which had fantastic scenery

36. Ate cricket and silkworm

37. Played lots of Monopoly Deal, Saboteur and Bridge

38. Read many books on my iPod: The Scarlet Letter, The Rime of the Ancient Mariner, The Raven, The Black Cat, The Tell Tale Heart, The Pit and the Pendulum, Metamorphosis, Anthem. Incomplete ones include The Emperor of all Maladies, Shantaram and The Last Mughal

39. Revamped my iPod music collection, which used to be very classical music heavy. Now has an increased repertoire of great songs including Beatles, Bob Dylan, Oasis, JJ Lin and many more.

Right. So in M5, a different life awaits me. It'll be spent mostly in the wards and the library, and I'm ready!

Whether we are in Vietnam or India living like kings, or whether we are back home holed up in our little worlds of work and study, all things we do exist for one reason: to find answers.

So, let's go.

The meaning of life

2011-06-18T00:29:00.003+08:00

There was this quote in the ST today by Hugh Herr, this award winning inventor: "People who are creative don't view life as a series of successes and failures. They view life as a process of discovery and inspiration. From that comes the fearlessness required for creation and the ability to believe in something that doesn't yet exist"

It is an inspiring quote, but I hope it's not because it seems to negate the value of winning. That kind of idea would appeal to someone like me, whose life has been more or less average so far, with its own victories and losses. Nevertheless I really hope that I'd be spending my life discovering one thing after another rather than simply fight many rat races.

----------------------------------------------

It's June 2011 and I am on a jetty in Vietnam sweating under the hot sun, waiting to board a cruise. I think to myself how wonderful it would be if life was laid back, with nothing to expect but endless relaxation, in a world where the future took care of itself.

In that world, I'd be working 5 day weeks, and I take full possession of my weeknights and weekends. I'd be earning just enough to support my mother and I and I'd be single. I'd go on holidays to cheap good places twice or thrice a year, with many other weekend road trips. And I'd be happy, living in heaven on earth.

And I have that vision in my head for a few days, as I sit on that luxury cruise sailing down the beautiful bay, even though my eye is badly inflammed. Because I am now world weary, with a combination of an unknown future, a long project and a psychopath dragging me down.

It is not something I'm fond of, with Medicine and my future role as a doctor becoming my only identity. They conveniently address me as "doctor" even though I'm not one- the old lady in church, my trekking friends, my relatives. They don't care if I appreciate good literature or Chinese history or classical music or The Beatles. I yearn for escape.

It is a few days later. We sit in a restaurant receiving bad news that our flight has been delayed and we can't go home. To pass the time we play card games and chit chat. By some subtle cosmic intervention the conversation veers towards Medicine:

My father had an operation on his left knee. The senior consultant left it to his junior to operate and the junior screwed it up. The moment my father awoke after the surgery he felt that something was not right with his knee. The next few years he suffered great pain because of the botched operation. Doctors gave painkillers to no avail.

My grandmother had a swollen red leg which the doctor thought was a diabetic foot. He had it amputated but it turned out to be due to deep vein thrombosis instead. All my grandmother's children wanted to kill the doctor. We tried to seek redress, but the hospital protected the doctor.

But this is not the usual Medicine conversation that makes me metaphorically roll my eyes. Instead, something cold and sombre has struck me inside. Something visceral. The hard truth that a dip in standards could cost life and limb. I look into my friend's eyes.

And thereafter I refresh my memory of how to treat deep vein thrombosis, with much help from the friend, whom I used to help in medical school: Give 3000-5000 IU of LMW heparin. Warfarin 5mg PO daily and overlap for 5 days until INR is above 2 for at least 24 hours. Aim to convert to clexane asap and seek senior help. Analgesics are needed too- assuming a severe pain in a 70kg adult I'd give im pethidine 50-150mg with a maintenance dose of 15-35 mg/hr.

Well's score predicts the probability of a DVT. http://www.mdcalc.com/wells-criteria-for-dvt

This is not the typical epiphanic moment where all my life's events fall into place. But I'm well awake from the dream of the laid back life, of the happy traveller's life.

---------------------------------------

It's been a few days since I've returned from the trip. I've left the green plains and windy slopes for the sterile desks of the library and office. I spend some of my time reading in detail about abdominal pain, and meeting my mentor regarding the paper.

Later in the evening there is a Christian gathering whereby doctors are invited to talk about their lives. A beloved senior, now a resident, takes time off from work to talk to us, even though work beckons tomorrow, a Saturday morning. The discussion ranges from the nobility of the profession to its worst moments- fatigue and interpersonal conflicts. I look at the floor.

Had you a choice of your destiny, which would you choose? First, to be more of the happy carefree traveller unrestrained by the cares of this world, in full possession of his soul and identity. Yet, at the same time to have so little burden, to be so detached, that there is little to contribute or influence. Or discover.

Or would you rather tend towards the dark uncertain future, where lies the dirt of fatigue and demoralisation, yet studded with rare gems of learning and fulfilment?

Yet it may be said that being unhappy, the side-effect of commitment, is not a guarantee of discovery and achievement. But life has no guarantees.

And despite that we shall explore.

It is late. My words and sentences are slowly dissolving into mere dusty perceptions, and all I have left are vague dreams and memories.

---------------------------------------------------------------------------

August 2007. I sit in a lecture theatre and the professor talks about the cell. I eagerly make notes in my Powerpoint handout. It is my first proper lecture in Medicine.

July 2007. My proud auntie has bought me a stethoscope, along with Guyton, Netters and Moore.

May 2007. I, fresh from a terrible eye injury, return to Pasir Laba camp in the middle of my sick leave to settle some admin stuff. The platoon happen to have just returned to the barracks and start congratulating and saluting me.

18 May 2007. I've spent the sick leave playing some computer games and watching the Champions League final, despite that injury to my eye. It's Friday morning today. In some discomfort I turn on the laptop and log on to the webpage and see "Medicine" beside my name. I ring up my classmate to ask what this means and upon confirmation we congratulate each other.

30 April 2007. Miraculously, Hotel Company has an off in lieu. I spend the day at NUS being interviewed twice, once by a group of elderly men, another by the nursing dean and a medical student. One of the men tell me I've done well. The dean and the student seem pretty impressed with how I've carried myself.

April 2007. We finish our exercise and declare that we've not brought ammunition. Amongst the chorus of voices I declare myself Cpt Dr Lee Jin Fu Marcus.

November 2005. I am in a brown uniform, huddling together with other wide eyed college students listening to an emergency physician talk about her life as a doctor. She has time outside her work to do community service and run marathons. It inspires me to be like her. It seemed so distant back then, that all that idealism had to compete for space with those thoughts about money and career advancement.

last few weeks of life as I know it

2011-06-05T00:32:00.002+08:00

Given that I've started electives early in January, I really don't mind ending on time even if it means a long 5 week holiday, since M5 starts with the 2 week break. By this stage in Medicine, 5 weeks of break, of being minimally productive, is a heinous crime. Since JC I couldn't fathom taking such a long break because it probably implies being lazy, regressive and -gasp- letting the whole damn world overtake you.

But if you take into consideration that I still have some research to do, and that I'll still be studying moderately, and that I will NEVER have a 5 week break in the near future, barring accidents or illness, then I really think I should have this 5 weeks. Who knows, it may even be the last long rest before eternal rest.

The time is best used to catch up with the important people in my life. Eat dinner, watch movies, seek God, even simple things like these will be valuable. And to be myself, to be carefree, because thereafter I will be selling my life to the system and the patients. If I'd be a slave, I might as well be a happy slave and if I were to have these 5 weeks of unfettered individuality, boy I'd be happy. I would do whatever's in my capacity to slog my guts out later on and be happy about it.

-------------------------------------

I remember quite a while back a female friend described the gang of us as boys. And today when we were introducing each other during Mt Fansipan training some people couldn't believe that Andrew and I were in our early 20s. They thought we were older. So I'm not too sure, I guess I'm still somewhat a boy on the inside although life circumstances are moving towards adulthood.

You'd see some certain new people and certain new situations, and these cares of the world do drag you down. It's part of growing up I guess.

Of burden

2011-05-31T21:06:00.002+08:00

I was just thinking of something on the train just now, about the old adage of "suffer now enjoy later", coined by the forefathers of many Singaporean Chinese. The principle of this phrase is that we need commitment in order to achieve our goals, and that suffering comes with commitment. Yet, I can't help but think that this phrase is so simplistic that it may lead to many misunderstandings.

Firstly, it divides our lives into two distinct portions, the striving stage and the enjoying stage. The first stage consists of hard toil, maybe some bitterness but also the perseverance to bear it all. The second is simple pure Nirvana where we enjoy the fruits of our labour.

The thing is, I'm not so sure if our lives can be drawn into such clear periods. As far as I know, life is a continuum, an endless cycle between striving and achieving. For instance, I studied hard for my A levels and entered medical school, yet after enjoying the month long orientation period the reality of schoolwork began to sink in, and thereafter I needed to deal with my father's illness and my new found faith. The cycle continued with a pretty relaxed start to M2, then the horrors of MicroB.

This leads us to question the assumption that if we are to achieve our future goal of say, becoming a surgery consultant, we would be happy. Guaranteed, you work hard as a student and junior doctor to attain your position, but what makes you think that life thereafter is pure heaven? With the achievement of the dream, there are new challenges to pursue, new responsibilities to bear.

And in my opinion, there is everything right about having the continued challenge, or to have a consistent burden, as light as it may be, weighing down on your shoulders. Although we don't like it, these are the things that give us our life force, that we may go ahead and be relevant to the wider world.

If we were ever to reach the enjoying stage, what does this mean? Does it mean that we have no more challenges in life? We no longer need to push ourselves? In a pretty horrific scenario, this could happen at the age of 40, when a person may think that he has reached the pinnacle of his career and that he only needs to enjoy the fruits of his labour from now on. This is scary because it implies that life has ended at 40 for him.

Hence, my main beef with that adage would be in the second portion, where it is said that we "enjoy later". Yet, the first portion is also flawed. It seems to give us the idea that it is a pre-requisite for the present to be filled with suffering in order for the enjoyment to come later, and this happens to the extent that we think we cannot enjoy the present.

Nevertheless, what's wrong with enjoying the process, enjoying every progress you are making towards your goal? This is pragmatic, because it keeps you motivated. Another choice, on the other extreme, is to drive yourself forward based on sheer passionless and resentful determination. Not that determination itself is wrong, but this particular variant breeds bitterness. When you achieve your goal, what makes you think that you'd be transformed into a happy person?

And achieving that goal, now a joyless pursuit, is now meaningless.

So I gathered that although we should be working towards our goals, it would be unwise to deny ourselves even a morsel of happiness before we have reached them. Life is short, we need not punish ourselves. I gathered that as I was doing laps in the swimming pool, feeling the lightness of my body, after some worrying about the data analysis.

And if you have made your way through my essay, I'd show you what I've read that sums up some of my thoughts, that is pretty similar to what I've written here.

If eternal return is the heaviest of burdens, then our lives can stand out against it in all their splendid lightness.
But is heaviness truly deplorable and lightness splendid?
The heaviest of burdens crushes us, we sink beneath it, it pins us to the ground. But in the love poetry of every age, the woman longs to be weighed down by the man's body.

The heaviest of burdens is therefore simultaneously an image of life's most intense fulfilment. The heavier the burden, the closer our lives come to the earth, the more real and truthful they become.

Conversely, the absolute absence of a burden causes man to be lighter than air, to soar into the heights, take leave of the earth and his earthly being, and become only half real, his movements as free as they are insignificant.

What then shall we choose? Weight or lightness?

Milan Kundera, The Unbearable Lightness of Being

About loving and loathing

2011-05-31T20:35:00.002+08:00

After about 4 long years, I've decided that I still love Medicine, this despite the usual unpleasant stuff that occurs along the learning journey. For every unlovable person or pressurising situation, there is this wonder for the subject matter (I'm referring to IM) and some inspiring people along the way.

The mutual teaching sessions I'm having with my councillee.

The patient whom I spent one hour talking to, because I decided I was very free and could take things leisurely. We spent fifteen minutes talking about medical history and the rest about life. He was telling me that his cancer taught him not to be anxious in life. And my one hour with him must have made him think that all healthcare workers function that way, which leads me to question if this is a good thing.

The senior who's having a close walk with God despite going through housemanship, a shit time of her life.

The other senior who told me that housemanship is about mental tenacity rather than the level of intellect.

And heck about the fact that I've fallen in love with IM, one of the least lucrative specialities around. Heck I'll just invest in unit trusts and properties in the future, so I'll have enough money to take a taxi. If all goes well I can get a nice cosy 3 room flat somewhere in Queenstown. Maybe I can even afford a car, but we can't ask for too much, two meals a day on call is good already.

end and start

2011-05-26T22:14:00.004+08:00

It is a clear sign of ageing when you realise that the HO is just one year your senior and that you can pop over to say hi or chit chat (not for too long though) since you knew each other from medicamp etc.

I was talking to this HO for a short while today. During the conversation she asked me what I was doing, when electives were ending and I realised they would officially end TOMORROW. But I never felt it the end because after tomorrow I'd still be popping down to NCC to finish the paper and I even plan to say hi to the patient I've been following up this week.

Yea electives end tomorrow. The next time school starts will be in M5. I've been dreading it, but somehow it has been some elaborate plan of the universe for the past two months to serve as some kind of orientation to Life in Medicine, or rather the No-Life.

I mean after reading friends' blogs, I thought electives would be holidayish and enjoyable in the literal sense of it. January's MICU electives were something like that and February was a little tiring cos of the Emed shifts and the pressure to set successful plugs.

Come April, I really felt a significant level of stress. Not least because I had this awesome tutor who taught a lot but also demanded a lot, and her tutorials involved me getting screamed at in a ward on a Saturday morning because I missed the pleural effusion. On top of that there was the pressure over ESMO submission, only 2 weeks after I returned from India, and the hassle over authorship. I don't deny I've learnt and I embrace the challenge

May started off pretty slack and if you happen to follow me on Facebook I was following the GE, treating it as some welcome break to Medicine. I was also feeling rather lost and meaningless in Onco until the weight of the ward rounds started coming down on me. Ward rounds were enjoyable and had much learning value but everyday I woke up at 515am to reach at 715 to pre-clerk patients and present. Now I know this can't compare to what the Paeds and O&G sip people do but it was tiring enough for me. More to come don't worry, we all get there.

As an additional challenge there was this other registrar who demanded a very high level of detail in my history, examination and presentation. Once again, I admit I did learn a lot from him and I may go into a more detailed discourse in the future.

On nights when I am alone or stressed, there is a part of me that wants to go back to teenage years, to childhood, to run along the hills of Ooty or the beaches of Mahabalipuram and Pondicherry. To the rar-rar NUS orientations of 4 years ago. But there is another part of me who knows that that stage in life is dead and we only look forward. In fact, that happier stage is so dead it almost seems remote. To be honest now is a happy enough stage, not happy in the carefree sense but happy in the fulfilling sense.

It may be all the small things subtly causing the change. The tiring routine, the stress of projects, the humbling experiences seeing your cancer database patients in the flesh, or knowing of your personal patient's very poor prognosis, or seeing someone younger than you receive the shocking diagnosis of metastatic disease.

Or the nearqueen lorrysecond (codename for something that I won't publish) who's been harrassing you and your friends and suddenly you realise things like human relationships and even "religion" aren't so rosy anymore. On a side note it makes you wonder about the spirit of things, the nature of true faith, but once more I digress.

I don't admit to have turned super mature or something but I think things did change over the past two months. But hey! June holidays have arrived and I can be a boy again, and maybe up there in the Vietnamese highlands I can forget that the unpleasant events existed.

Life in onco

2011-05-23T20:47:00.003+08:00

My life now could just be a microcosm of what is to come later.

Actually the hardest part is in the morning when I trudge up the hill at 7 am. Thereafter when I'm in the wards I'm so into the thick of action that I forget about all the things making me unhappy. I become excited about what I'm seeing and come back for more, case in point when I returned to ward 48 after a clinic in KKH. Then I leave reluctantly.

Then I go home and the sian feeling comes back and I just feel I don't want to return. Heh.

Stories of India- the Pykara Falls

2011-05-15T22:29:00.004+08:00

Pykara Falls, Ooty, Tamil Nadu, India. The scenery was so good, you could just sit for hours watching. Unlike the rooftop view which I talked about in the last post, Ooty has a very pleasant cool climate so there isn't the typical searing heat of India to worry about. You can enjoy both the view and the cool air at the same time.

Yet, it was most ironic that it was one of those days I thought we had to rush through the itinerary. We needed to reach Mudumalai Nature reserve at around 4pm latest, meaning that we needed to leave Ooty at 2.30pm. It was 1.45 when we got to the falls, so I thought we could have lunch while sitting on the slope, watching the scenery.

With this kind of scenery, 45 mins is hardly enough. Everyone was roaming around the area taking pictures, enjoying themselves, plus we needed time to walk from the carpark to the falls.

Looking back, I regret that I was hardly in a leisurely mood. I was telling everyone as tactfully as possible to keep to the time and not take so long. Were there a lighter schedule, I would gladly have planted my butt down there for hours. But it was not to be. The feeling of wanting to rush remained in my heart. We left the place slightly late, near 3.

A slap in the face occured when I reached our destination, the nature reserve. Apparently the schedule had been changed so we were to start with an evening safari, meaning we could well afford to reach at 6pm if we wanted to. The manager of the reserve did tell me about the change the day before, but that was via email which I had absolutely no access to.

We spent the remaining hours playing card games in the lodge, when we could have been sitting and watching the scenery. Now, I have to be content with sitting down in the room, turning on the aircon, and staring at the pictures in my laptop.

Another place that I wish I had more time to look at. Just before going to the Pykara Falls, we were at this hill outside Ooty which had the best view. Needing to keep to the schedule, we spent around 20 mins taking photos. I wished we had 2 hours.

Stories of India- The Rooftop

2011-05-14T22:21:00.001+08:00

Right. After a long while, my slow brain finally realised the paradox of blogging. Whatever is too private should not be put online, yet whatever can be shown to the public might as well be put on Facebook anyway where there is wider readership. There is nothing much to be put here except for some half baked shit.

Unless of course, I show you my collection of photographs.

Rooftop of Asha Education Building, Christian Medical College, Vellore, India. We'd go to this place often to have lunch in the form of chicken or mutton briyani. Naturally we'd sit in the shade, but after some walking around the area I discovered this place where I could get a bird's eye view of Vellore.

It's a very refreshing view. On the right (not in photo) there's a hill and in front and on the left you get the endless array of rooftops, all in a different colour. Occasionally you may see someone coming up to do the laundry, or just simply hang around.

There is the sound of traffic in the distance. Up close, it would be really irritating to hear hundreds of cars honking at a time, but from where I'm sitting, it sounds almost like music. Despite the heat, you can sit there forever.

On and off I'd go to this place alone to eat a pie, watch the scenery and enjoy the peace. And try to imprint the image in memory forever.

Mumbling and mumbling

2011-05-03T22:26:00.002+08:00

Right, it seems that since April I haven't been going about my usual business with the same verve that I had. Maybe we really need exams to give us a kick in the ass. Or maybe it doesn't matter because after all this is the elective period. There's this jadedness I can't really explain.

Following the ongoing GE, coupled with reading William Dalrymple's The Last Mughal, brought home some points about myself- that actually I really do like the humanities. I may have said this once or twice and I don't mind repeating myself here. I like the way how several seemingly innocuous incidents or issues can come together and cause groundbreaking changes in our world. There are some incidents like the sepoy mutiny, covered in The Last Mughal, that seem obsolete and long ago, yet the lessons remain relevant if we bother to identify them.

Now some disclaimers about Medicine. I still am a fan of it definitely,for if I weren't, I wouldn't have bothered going to SGH for tutorials on TWO Saturday mornings, much less write a FB note about what I've learnt from my April tutorials. It's just that Medicine is more of serious business for me, not something that I read at leisure while lying on the bed. It's something which has standards and guidelines and requirements. Something which can make me tired and worried at times.

It could be that Medicine would be a channel for me to apply whatever I like or know about the humanities. After all, we serve people and they have their psychosocial issues also. Many times the progression of disease is due to social rather than biological factors. Why did someone's cancer relapse? Because she did not follow up on chemo. Why not? No money. Frightened. Of course, there are a long list of causes, non medical of course, why she has no money and why she's frightened of Western medicine.

These few days I just feel like retreating into my shell, watching election videos, finishing the book. Maybe Oncology hasn't started to motivate me as much because I haven't seen the ward patients yet. Maybe because it's only been my first day, and what's more it was cut short by conjunctivitis

a good rest

2011-05-03T00:00:00.003+08:00

I just realised today after struggling through 19.5km on a cold drizzling morning without any breakfast that I've lost the heart for long distance running. I'm sure I'll run in the future to keep fit, just not train for marathons or even halves

Gave myself a break from Thursday afternoon to Monday evening, with a long Gen Med tutorial right smack in the middle and some OSCE sessions with the M3s at the end. A break from a break haha. Onco starts tomorrow, and it seems that my mentor wants an SIP format. This means hard work ahead, and I'm glad that in anticipation I had my break

Struck by lightning

2011-04-29T23:11:00.004+08:00

April wasn't a very easy month, I'll reiterate. On top of post trip blues and a pretty hectic General Medicine posting, I had this abstract to submit, so the first two weeks were filled with a lot of number crunching and moments of great stress.

Nevertheless, as we are approaching the end of the month, here comes the General Elections to take my mind off work for a little while. On top of being a civic duty, it involves the things I enjoy namely the humanities and photography. Yea so I decided to go around Singapore, from outside my doorstep to the other end of the island, to capture memorable moments. They're on Facebook and I may place some here next week.

I am glad the General Elections are here because they have cleared some misconceptions.

1) Singaporeans are apathetic

If you look at Facebook and other blogs, there is a plethora of political opinion from ordinary citizens like you and me. Some of them are intelligent, but nearly all are passionate. It seems that the apathy is due to the walkovers in the past few decades. With no one to compete, there is nothing to talk about. In comparison, the past 5 years seem to have made for unsatisfactory living for most Singaporeans, chief issues being cost of living, influx of foreign labour, lack of housing and other bloopers by our government such as Mas Selamat and the Orchard Rd floods.

2) The government plays it clean

Resorting to attacks on the opponent's sexual orientation? Be a man Vivan!

3) The opposition are stupid people who cannot talk about tangible issues

Yet this year, the opposition have acquired a lot of powerhouses. Chen Show Mao is a Rhodes scholar, Dr Ang Yong Guan has MRC Psych, Tony Tan and Hazel Poa are government scholars (SMS and PSC). Even the young one Nicole Seah studied in the University Scholars' Programme in NUS. I've been reading their manifestoes and attending their rallies, and they are in touch with the issues I've just mentioned above, adding their touch of idealism in talking about a first world parliament and what it means to be a Singaporean.

So if anyone is still reading this, vote wisely! Don't vote for Party X because you've always been voting for it, likewise don't vote Y simply because you hate X so much.

Thoughts

2011-04-23T00:06:00.002+08:00

Today mj posted a link on my facebook wall that articulated some things that I've been thinking about the past few days. In summary, we spend so much of our time in an institution of higher learning acquiring knowledge and building resumes, but rarely having time to construct our vision of life. Sometimes I ask myself again and again why I'm doing certain things, chasing certain goals but not being entirely sure of their purpose.

I suppose many of us try to find some meaning behind the things that afflict us, our desires and our endeavors. It's not an easy task and it can be a depressing lonely process. Sometimes I find that even religious institutions and religious people cannot provide the answers. It comes across to me that their piousness is simply an easy formula for tackling big questions.

Anyway I went to church today on Good Friday feeling that I've only understood a fraction of what the man had done for us and what he symbolizes. It is such a big thing, and perhaps one day if I decipher more clearly what he stands for I'll know life a little better. Perhaps others have done so, it's just that it comes out as pious slogans hung on their lips.

Back down to earth

2011-04-10T23:32:00.002+08:00

Well, it would always have turned out like this- post trip blues. And if this was like the trip of your life thus far, then the feeling is memorable in its own grievous way. I remember dragging my feet and my heart to SGH last Monday morning, and throughout the week. I don't usually form attachments easily but once I do it's hard to let them go.

I suppose the contrast can't be more drastic. One week travelling carefree around South India, and the next week-thud!- having to deal with postings and projects. But I suppose the honeymoon is over and I need to re-orientate myself to this strange new land which is Singapore. Quite a joke isn't it, feeling homesick in your own country.

I don't know if I miss India in itself or what it represents to me- which is the carefree stressless life. No expectations or obligations, no exams. Evenings are spent meeting people from around the globe, eating, facebooking, uploading pictures or at times, studying for interests' sake. I suppose once you've had a glimpse of heaven, everything else seems to pale in comparison.

Ok! Won't rant too much, just wanted to get some things off my chest. It's quite a busy week ahead. Sometimes I wonder about the consequences of letting my life be consumed by work, but seeing that I've had such a long period of slacking, I can't ask for much more

Well well

2011-04-04T21:22:00.002+08:00

There were some things in life which I thought were pivotal, some things that I thought I must have or else the world collapses. I think India changed some things quite a bit, although to be sure I'll still get things done out of the sense of duty.

When you think about the hordes of people crowding the narrow streets, the auto drivers bargaining their way to earn a living, the cricket fans cheering the national team, the street urchins tugging on your pants, the old homeless lying on the dirt, the carefree peaceloving people staying in the heart of nature and the old leper who sticks out a fingerless palm for you to shake, you realise the world is bigger than that. I'd carry India around in me, and when I'm in M5 and beyond I'd take it out again to have a good look, through the looking glass.

Leprae

2011-03-15T23:32:00.002+08:00

The "leprosy hospital" was in the outskirts of Vellore, somewhere which served as the ideal setting for the Blair Witch Project. There were tall grass, trees, exotic flowers, and a football field which nobody used. Hospital was quiet with few patients and administrators who lived a slow pace of life.

There was a doctor who took time off to explain the cases to us. First off, the young man with the hypopigmented patch on his forearm. He was reticent and listened to our clinical discussion quietly. Second, the old man whose fingers had dropped off and thumbs were clawed. He carried everything between his palms and he shook all our hands after that.

We had this teenage girl with the characteristic patch on her face. She was very nervous and the file said that she was undergoing psychological treatment for her condition. Her lateral popliteal nerve was so enlarged, we could roll it about.

Sometimes, when I see these people, it just comes to me that there is a whole big world out there. These people live in a world that I do not know of, and vice versa. On one hand, here I am totally flustered by some emails from Singapore, worrying the hell out about my research project. Will I see the end to my project(s)? Will I ever be first author? Will my work come to naught? On the other hand, they have to battle stigma and physical disability. How to open cans of food, how to wear clothes, how to face their relatives.

Yet at the same time, surely I have the right to be concerned about the seemingly more superficial things in my life, to have ambitions? That other people suffer more than me, it does not take away my right to suffer from my desire to achieve.

We looked each other in the eye, we smiled at each other, we even touched each other. But somehow, beyond the barriers of skin, things are so different.

But sometimes, when I take a step back, it comes to me that God has been good to me. I could be born like everybody I see in and around CMC- the auto-rickshaw driver earning a paltry living, the street beggar, the patients infested with some of the worse diseases known to man. It may be cheap consolation in a time of self-absorbed distress, but even in happier days, the sight of such people and things serve as a sombre reminder of my blessings.

Lies

2011-03-09T19:59:00.003+08:00

I have just finished clinics today in CMC Hospital, Vellore, Tamil Nadu, India. It's been quite brain numbing really. For all of those expecting another update on my daily life in this wonderful country, you'd be disappointed because I'm only going to limit all that cheerful photo-uploading and witty statuses to Facebook.

Recently I've just heard about the Hansen's disease clinic that the hospital runs for lepers, and I've discovered that in a warped way, my heart was leaping with excitement. At the same time I get disappointed when I don't see patients with signs, when I simply sit around and look at people talking in Tamil.

I suppose, I have come to a point in time whereby the more I know about the ailments that plague mankind, the less I understand humanity itself. I won't belabour the point that many of my seniors have already made, about how patients become cases, and their value to some of us as human beings is simply reduced to the learning opportunity they can provide us.

And this to me would be rather sad, because this isn't just an academic discussion on empathy. After all, I've been in the shoes of the patient's family.

Apart from how the medical profession may dehumanise its fellow humans in this particular way, they are a few traits of this profession I have come to abhor. Firstly, it would be the subconscious but desperate desire to distinguish itself from the rest of society. Recently, I was chided by this ED physician because I used 'arm' instead of 'upper limb'. 'You are going to be a doctor already', he said in his distinctive accent, 'talk like a doctor la brudder! Still use "arm"?'

Doctor speak. You cannot simply say that the patient has a scar in between his chest and abdomen, you must speak of the rooftop incision that suggests a previous liver transplant. Medial, lateral, oblique. I can hear your voice on a temporal basis. Ha. Real life examples by the way.

Although you mean exactly the same thing, remember that language carries power. And in this case, the code you speak carries the secret power of the medical profession: the knowledge of the workings of the human body and its diseases which are unknown to the layman, and the secret ability to treat them. Remember too, that you studied so hard to be where you are. You are more intelligent than the rest of society and you better be able to sound superior to these smurfs.

With regards to the desire to be superior, I am reminded of another habit of medical students and doctors which I'm terribly guilty of. It is the habit to speak of work outside of work, when in front of non medical people. Now I find it hard to draw a line between that and a true passion for your work, because when my friends and I are in the mood, we talk about issues in the workplace which we are genuinely interested in. We don't say that to sound superior to people, or to show the rest of society who we are.

As a measure of retribution, there are times when I find myself among my classmates, caught in a conversation on medicine which I totally want to get out of. I mean, I want to talk about politics, about people, about places, about things that the newspaper reported, not about endometrial cysts or harmatomas. But like all other vocations, not just Medicine itself, you find yourself trapped in the work you do.

Because somehow, it'll start defining who you are, and you'd let it happen subconsciously. And that's scary, because the way you see your world, the way you see yourself, and the way you talk will be confined to doctorspeak. Probably, even unknown to yourself, you'd have this arrogance that you are healthy and these creatures before you are not, and you' re superior to them, and you have the right to turn them into your guinea pigs.

Of course, I'd reiterate that no matter what you do in life, teacher or banker or whatever, similar problems would plague you so my situation isn't at all special, just my own view on my own blog. All I'd say is that deep down, we need to be appreciated as individuals.

Not least of all, by ourselves

2011-02-23T22:45:00.001+08:00

Proof

2011-02-21T10:51:00.002+08:00

Did the Men's Health Urbanathlon yesterday, with 9 obstacles spread throughout a gruelling 14km route.

Before the race I stood there in the black singlet in the crisp cool morning air, feeling really awkward and out of place. Time and time again I've been running one race after another, some to prove myself to myself, and some in the company of others, therefore perhaps I was trying to prove myself to others. And yesterday I was alone, and there was nothing to prove anymore.

It's pretty much like my life in other areas like academics and interpersonal relationships, just an empty quest to keep proving myself. It created so much unnecessary anxiety. So from now on, I'll tell myself, there's no point. Nothing to prove anymore.

oh father

2011-02-15T10:12:00.002+08:00

I just realized last night that I have a soft spot for male middle aged patients with teenage children, especially if among them is a son.

Thank you doctor, you say in a very earnest voice typical of shy young men, when you see me sucking blood from the ETT. Actually, I'm not a doctor.

It's the start of another day, the start of another chapter of a young man's life, the first few days of which will be involved with despair and grief. There will be a lot of questions, a lot of asking how to cope with the new life ahead, with being the new "man of the house"

Emed

2011-02-14T11:34:00.002+08:00

What a posting! It has only been my fourth session there but there has been a lot of action thus far, and I have intubated, bagged, set plugs, set ABGs, taken blood cultures and catheterised. Plug setting was initially a failure but I had to grit my teeth against the agony of seeing the flashback fade away, and learn from my mistakes. Now I'm setting plugs more successfully.

On a more sober note some people have passed away but unlike last year, where I would ruminate a lot on those dead people, this year I'm more calm about death. The physicians are all also very calm. I think we have come to see death as a natural progression in the journey of life.

Introducing the Universe

2011-02-09T00:40:00.002+08:00

In the deep, vast, Universe, there are many stars which give out light. Planets rotate around stars, simple as that.

There are the asteroids, which by some freak chance have become too small to be classified as planets, and incapable of giving out light like the stars. The asteroids lead a petty existence, revolving around planets, or wandering aimlessly through galaxies. The resentment in them against their mediocre lives builds up slowly but surely. This has been a gross injustice done to them by the Universe, and as such all the creatures of the Universe owe the asteroids everything.

By some stroke of luck, the asteroids may find a nice planet to smash into... and BOOM! There goes life on the planet. It gives the asteroid great joy. They have destroyed one of the lackeys of this cold unfeeling elitist Universe, one of those lackeys that could only mollycoddle the stars which the asteroids were always secretly jealous of.

Even better, once in a lifetime the asteroid notices a supernova- the star grows so big that it explodes! Good for them, say the asteroids. It gives them great consolation that the star, the bright shining star that they aspired to be yet could never become, had been destroyed.

Now onto something similar, the black holes. Black holes, like asteroids, like destruction although they could never admit it. But black holes are thousands of times more dangerous. Because while you know what asteroids are made of, minerals and whatnot, the black hole is just a mass of chaos which you cannot define.

And they suck everything into oblivion. Everything! Stars, planets, asteroids, anything which dares to go near enough, are totally destroyed. Do you hear? They even suck light, and as such the light of stars is no more, there is only an ever-expanding darkness.

And you can opt to stay away from them, despite your niggling conscience telling you that the Universe shouldn't be so callous. BUT THIS IS UNTIL A NEIGHBOURING PLANET WHICH YOU TRULY CARED FOR HAS BEEN THREATENED WITH DESTRUCTION. And so fuck it, there is no time to care about your own wellbeing anymore, or to calculate the cost of failure.

(Note to anyone who tries to interpret the context of this meaningless rant- don't. You will never get more than half the picture correct)

The pilgrimage

2011-02-06T00:21:00.002+08:00

Today I went for a friend's birthday party. To be honest it wasn't really to celebrate the person's birthday as much as it was to be inspired by this person, to be spiritually renewed.

Just at the start of the journey I had a major bout of the sniffles and wheezing and inflammatory chest pain. It could be that I was infected with Marsha's viral urti and it triggered off some allergic response in the rest of my airway, since I have childhood asthma. Whatever the cause, it got so bad that I wanted to alight from the train and go home. I even began to suspect that it was God's will that I don't be spiritually renewed, that I don't gain faith.

However, another voice told me to stay on. In due respect to faith, the party was very inspiring, the source not being just from one person. My symptoms also took a turn for the better, though I thought I wouldn't survive.

As I look at such inspiring people, I can't help but wonder if it would be better to undergo great suffering and come out an excellent person, or to be free from great torment and be a little more ordinary. Hard to answer.

Well another lesson learnt is that faith must be worked out, and God does the rest.

Food. Food. Food. Food. Food. Food. Food

2011-02-04T21:28:00.028+08:00

I should have realised already, since late 2009, that planning an overseas trip is SO EFFING TOUGH. But I'm glad this time round I am working with a team of planners so I'm not overseeing virtually every aspect, if not I will die. And, at the back of my head there are so many other things to do also, research, academia, ministry etc.

Nvm... let's indulge in food porn to relax.

Someone gave candies to my mum.

Then, Tua Kor also cooked all these for us (not shown in previous food entry)

The next few pictures you'll see below are from our reunion dinner. Really, there's nothing much to say. You pay 50 million for Torres, you pay 80 million for Ronaldo, all you expect is quality, quality, quality.

However, sometimes you go shopping and you stumble upon Solskjaer for 1.5mil, or better still, Michael Ballack for free. So your commentary has to be more effusive.

Ho Kee porridge, one of the stalls in Maxwell food centre open on Chinese New Year. They are run by a group of Chinese nationals, who probably don't have visiting to do in Singapore during the festival

So, besides the tofu and chee cheong fun there was also porridge. I didn't taste it and it wasn't photogenic so there're no photos here. Nevertheless, my uncle and aunties seem to like it.

Next stop during CNY visiting was my great-grandma's house in Sengkang. When chor chor, now nearing 100, was still healthy enough to cook, we'd get goodies like bak kut teh, hokkien mee, gnor hiong etc. I'd forever remember her passing me my first chicken drumstick. Then, I viewed the brown object suspiciously, thinking it some strange fruit that tastes like pineapple or banana.

Now I'll just say that the daughter-in-law is a more modern woman. Her culinary skills are a pale shadow of the matriach's and she has also resorted to buying some stuff from NTUC to satisfy her guests. Ahh, if only I knew about food blogging in the 90s...

Ok, at first I thought my grandaunt (the daughter-in-law) had achieved culinary enlightenment but actually NTUC Fairprice (or whatever factory it was) gave her a huge helping hand in making these. Anyway, they were good!!

Lotus paste wrapped in fried dough. Never seen before alien contraption, but is sweet and sticky and entices the tongue.

So, not too bad but I'd miss chor chor's cooking forever. I wish I can talk to her but there are language and hearing barriers.

On the second day of CNY, my family went off to Tiong Bahru Plaza to catch It's a Great Great World, an excellent local movie. The next stop invariably had to be Great World City itself, located exactly where the old Great World stood. There are no more amusement parks or hawker stalls, but I'm sure Kenny Rogers is decent enough. Maybe a movie will be made about it next time hahaha I'm sure.

Appetisers.

My mum had this pot pie, hugely reminiscent of Mingjie's pot pie at the Soup Spoon. But Mum's seems much much better.

My half chicken, which hugely increases the preload to the stomach. As a result, output will also increase.

Marsha had this. Otherwise, our uncle and aunties ordered just about the same stuff. My second aunt had a salad but I didn't take a good shot

Some things will never be the same again

2011-02-02T22:54:00.003+08:00

1994

2011

A study of pre- CNY food

2011-01-30T20:17:00.028+08:00

Yea so it's not even CNY yet but I've been feasting already. Last Sunday I went to Hong Kong Cafe in Vivocity to try their renowned cheese baked rice. At first when cheese baked rice was mentioned I was metaphorically rolling my eyes because it is such a common dish exploited by mediocre restaurants. This trip, however, did not disappoint.

My dish, the chicken baked rice.

Pork baked rice
Going back to my chicken baked rice, it was a surprise because the chicken was fantastic. Many restaurants, they smuggle in some average tasting chicken, with the hope that the cheese will easily placate the palate. However, this is the first cheese baked rice I've had where chicken pwns cheese. Great flavouring! Very fragrant. A most unique taste of chicken I've ever had.

Nevertheless, cheese baked rice without the cheese is just kuay peng, so the cheese is important to blanket the chicken and the rice, creating a mystical seductive aura.

The whole meal, together with beverage and soup, was only about $12-13, a bargain. Like how Ronaldo cost Man U only 12 million pounds.

So a few days later, I met up with Zhen Chong and Mingjie at the Soup Spoon in Raffles City. This is not the first time I've been here, it's the second, and the third in total to all Soup Spoon branches. First time was here, to discuss the India trip. Second time was in Biopolis with the Playhouse crew. It has begun to tug at my heartstrings.

Velvety Mushroom Stroganoff, which I like because 1. It contains mushroom and 2. It is thick and velvety, true to its name. I don't mind eating this whenever I go to the Soup Spoon.

ZC ate this, forgot what it's called. Some chicken stew.

I ordered naan to accompany my soup. It is indeed creative of the Soup Spoon to transcend cultures and think of Indian bread to accompany a Western style soup. In truth garlic bread would not have sufficed.

Mingjie was gushing over the Chicken Mushroom Pot Pie and on first impression I thought all he ordered was bread on a cup. No such thing.

A fragrant simmering chicken soup lies beneath the crispy friable bread. The cost of my Mushroom Stroganoff and Naan was less than $10, similar to how Berbatov cost Tottenham only slightly more than 10 million pounds.

The meal ended off with a hearty conversation on life and relationships. Now I'll go on to today's lunch and dinner, the former being at Tiong Bahru Plaza's Xiao Xuan Feng (Little Tornado)

Yu sheng

Shark's fin

Some rather run out of the mill dishes so there won't be much commentary as of now

But here I must pause to comment. Whenever seafood is immersed in curious looking white sauce like this, it arouses my curiosity and imagination. Indeed, this milk flavoured sauce turned out good.

A sample of the fish you see above.

Dinner was cooked by my Tua Kor and it never is disappointing. A bonus is that we were eating it while watching Ai.

As usual, mushrooms, like thick white sauce, arouse my imagination and this dish had a peculiarly attractive flavour.

Fish, which got burnt in the microwave. Wanted to dip it in mayonaise but I had to stop myself, lest I become obese.

The vilification of genetic science

2011-01-23T00:06:00.003+08:00

Last week, I popped over to Ben's house for a movie marathon with some CG mates. It wasn't really a marathon since I left after the first movie and some karaoke, but what a movie it was! If you know me personally, you would know my "perverseness threshold" and if I say a movie is disturbing, it really is.

Splice is a show about two scientists, husband and wife, who create a hybrid being with both human and animal genes. At first it reminded me of The Island of Dr Moreau but it seems that the movie is way more perverse. I'll just say that the hybrid, known as Dren, is bisexual. We were very traumatised after the movie and had to sing karaoke to de-stress. I couldn't concentrate during church cell later on.

During and after the movie, I noticed a trend among several Hollywood films. It seems that the pop culture of today reflects society's suspicion towards genetic science. This field of science is portrayed darkly either as a means for ambitious leaders to fulfill diabolical aims, or for overly inquisitive scientists to satisfy their unhealthy curiosity. Ultimately, disaster results.

I don't deny that science has the capacity to propagate evil, that's why we have nuclear bombs, but the fear-mongering promoted by Hollywood against genetic science in particular is not helping society to see the benefits of this technology.

There are many sources that espouse such benefits, and in summary they are relevant to the study and treatment of many common ailments like cancer, Parkinson's disease, Alzheimer's disease and heart disease among others. For instance, by studying genes we understand the etiology of many cancers and can identify patients at high risk of contracting the cancer or having a relapse. We can learn how to target cancer cells specifically, and this would potentially be much less harmful than chemotherapy, which has many systemic side effects.

The greatest concerns among the public include how we may end up cloning human beings one day, and that by manipulating human cells we are "playing god" and not respecting the sanctity of life. It's true that there is much controversy surrounding embryonic stem cell research because we cannot clearly define when the embryo is a life and when it is not. Nevertheless, there is a less controversial form of research which involves adult stem cells, and the fields adult stem cell research is relevant in include orthopaedics and cardiology.

That being said, there are many grey areas surrounding the field of genetic science and I don't believe they can be resolved within a few years. However, it is important to view genetic science, and science as a whole, objectively, without caricaturing it as a form of sorcery, without being too quick to judge it based on our cultural beliefs, our religious beliefs, our personal superstitions. Hollywood can make all the fiction it wants, but as we walk out of the cinemas, as we switch off the DVD players, our heads must be tuned in to reality again.

Splice- Against her husband's repeated objections, the scientist Elsa Kast creates a animal-human hybrid, Dren. Dren is a symbol of evil in this movie and as she grows up, she develops more Satanic features such as a pointed tail and wings. Elsa is left pregnant at the end of the movie...

The Island- a group of ambitious corporate bigwigs illegally create a batch of clones who serve as organ donors for their parent versions. The clones are made to believe that they live in this post apocalyptic utopia. In one scene, the process of organ harvesting is shown to be brutal and inhumane. Above- a bunch of robot probes perform a brain scan.

In this adaptation of H.G. Wells' novel, Edward Prendick lands on The Island of Dr Moreau and finds himself surrouded by strange humanoid creatures. They live governed by a set of rudimentary laws but eventually rebel, and succumb to their violent animal instincts.

And... we must never forget our favourite Star Wars. Clone troopers are propagated to help the Jedi protect the Galaxy, but upon the issue of Order 66, they turn malevolent, heralding the coming of the evil Galactic Empire...

hiong

2011-01-19T13:47:00.002+08:00

I never thought the first two days of electives were to be more hiong than any of my days in medical school. Wake up before 6, start pre-rounds before 8, ward rounds end at 12. Then there is a temporary respite in the afternoon doing random tedious stuff like settling visa, before I go down to NCC. There are deadlines to meet so we stay until around 11pm to tidy up the data. I nearly regretted starting electives so early.

On to the medical ICU in NUH. Pre-rounds are rather boring affairs which involve us trying to understand as much as possible of the patient, and then chit-chatting to each other. Then around nine plus, the consultant Dr K will walk in. There are about ten patients to see. They are kept behind glass doors, clustered around the counter so that they are easily visible.

Outside the glass door, outside the patient's inner world where he is hooked up on many tubes and trying hard to breathe, we would discuss cases in great detail. The academic discussion is interspersed with moments of light-heartedness and there is little inhibition on the part of the residents towards their seniors. There is a lot of respiratory and cardiac physiology involved, a huge chunk of technical details about ventilators, and these are topped up by a light serving of endocrinology whenever relevant.

Time and time again Dr K will turn to us medical students, and we have to answer many questions. Many of them are beyond the syllabus and stretch our medical knowledge the same way a 40kg weight may stretch someone's biceps. We have to rely on whatever we learnt in physiology and answer accordingly, and actually he is pretty easily satisfied. He also gets us to try answering MRCP questions.

It is really quite taxing given the late nights, but I can feel the difference as compared to when I was in ENT, or Anesthesia or worse still, O&G. It had been more than a year since I stood by the patient, hearing physicians review them in great detail, discussing everything under the sun which are somehow linked to each other. It feels a little like standing in the middle of Old Trafford, I can imagine.

As for the research, I'm glad one phase is done and I can only pray to God that despite handling the gargantuan amount of data, the results will be reliable and clinically significant.

Nearly broke down from all that stress the past two days but I'm glad it's over, and today I can get the chance to come home in the afternoon and rest. But all these beats being in O&G, when I was just going around feeling so lethargic and unmotivated and stupid. Hiong is good, when you have motivation to be hiong.

A revision of Hong Kong

2011-01-13T14:48:00.033+08:00

The Hong Kong trip was in March last year, before I had discovered the powers of photo-editing. Now that Patho is over, I've taken some time to relook old photos and touch them up. Some photos that were originally mediocre have now been deemed fit for publication.

You can compare and contrast with http://thrasham.blogspot.com/2010/03/best-of-hong-kong.html

If you like the photos, don't thank me, thank Picassa. If you hate them, it's also not my fault. Blame Hong Kong

This was in the old collection but has been touched up to look a little more epic.

I climbed up the hill to the Monastery of Ten Thousand Buddhas and here's the scenery.

Down the slope.

Langham Place, one of the attractions in Mong Kok.

There was this stall around Mongkok (see below) where I could buy innards. Oh I'm starting to get that itch again: I see a cross section of the intestine, the cut surface is smooth and doesn't contain nodules, ulcers or haemorrhages...The lumen is unobstructed. The mucosal surface is tan and smooth....

Of all places, my hotel has to be in Sha Tin (something like having a hotel in Bishan). Here's the nigh scenery

I'd go to this area for breakfast.

Little Hong-Konglettes playing at the forum in Botanic Gardens

View from Victoria's Peak

So, LKY was taking a tour with his entourage when he had the privilege to bump into me. It is indeed his honour to take such a precious photo. Location: Mdm Tussaud's Wax Museum.

Roadside stalls. I think this was along Queen's Street, near Central.

Stanley. My favourite town.

Joe the pigeon, eaten around Ta Po Hui Market in the north.

HK Heritage Museum

Building, around Sha Tin

Tsim Sha Tsui, the urban jungle.

IFC tower looks more sinister now

Lantau island.

Worshippers at Lantau island

Coffee shop at Sha Tin

You will NEVER escape from Medicine

2011-01-12T02:39:00.004+08:00

Life's good after Pros, but I'm reminded of what happened a few days ago at home.

I was drained after a bout of revision and threw myself onto the sofa, needing a break. But in came my mum and she said, "Marcus, your [relative] has fibroids. Could you tell me more about it?" And then she went on to ask about the therapy offered by the gynae, whether surgery should be done, any risk of cancers and so on. I told myself, this is so much like the O&G OSCE!

You may think that professors ask tough questions, but members of the public may go one up. Can this supplement or Chinese herb cause this, cause that... I didn't study TCM in med school mind you.

There may be times when school has ended, or when you are having a lunch break, and your classmates are talking about stuff other than Medicine. Then, someone cuts in to say, oh my little nephew has a skin problem, my auntie has an abdomen problem. And everyone starts taking the history out of intellectual curiosity and go on about this and that condition.

I kind of feel irked when these conversations occur, not because I hate Medicine, but because we have once again failed to talk about stuff outside our textbooks. Nevertheless, cognitively I have accepted it as part of the process of being a doctor. After all, society has given us so many advantages such as a large tuition subsidy and an iron rice bowl (job guaranteed for 6 yrs after graduation). They'll expect us, in return, to know our stuff inside out and let it flow out of our ears, even in our dreams, even while resting on the sofa. Ah well, it's really a calling.

Here's some sarcasm to diffuse the patho stress

2011-01-05T21:33:00.004+08:00

A study of a church's watchnight service

2011-01-02T22:42:00.013+08:00

Watchnight-the service that spans two years, from 10pm on 31st Dec to the wee hours of 1 Jan. It is the first time I've been within the confines of Wesley Methodist Church later than 10pm, much less past midnight

Before the service. Thereafter, the sermon was about living worthily. Do I? Do we?

Communion offering. Have never had communion at night before. In all honesty I would liked to have taken more pictures of the ceremony, the pastor's face, the congregation's faces, but it's unacceptable to bring a camera up there. So this is the closest I've got. Taken while waiting for my turn.

And then there's like one hour or so of singing, praying etc.... then...

Bell strikes midnight! I realised that there was no countdown. But it's New Year nonetheless. People are celebrating and they look joyful.

The congregation settling down after their hugs and kisses. There are 6000 members and maybe 5960 strangers. Before I came to Wesley someone (non-Christian) told me it was a "rich man's church", implicitly implying that heartlanders like me shouldn't belong there. Nevertheless, all the people I've known so far are very down-to-earth. Many speak in dialect and their conversations are about family and school and recipes and children.

Pastor Alvin, in black, greeting his flock after congregation service is over. Besides being a pastor he also plays tchoukball and does triathlons. What an inspiration!

I joined my small group in the Prayer and Praise service in the hall nearby. I'm not for singing loud songs for 1 hour continuously. It is rather apologetically that I took time out to snap photos, but boy I love the pictures. I love capturing emotions.

Some songs have the impact because of good lyrics. Some need to resort to loud volume and repetition.
Ok I should have been singing. Hur.

It's over. Even the singers need to take a rest and the staff need to clear up. It's one am now. People are wishing each other goodbye. DSLRs are coming out to capture the moment but my digicam got there first.

2011. Who knows, perhaps it would be the last full year before Earth is obliterated by the alien vessels, or by that asteroid, or by the surprise nuclear package from _____. Either way it's definitely my last full year as a student, and graduation ranks up there with the aforementioned incidents as a Life-Changing Event. Apocalypse or not, the end of an era is coming.

Happy New Year.

My reflections on 2010

2010-12-30T22:59:00.002+08:00

On my wall there's this gigantic newspaper article on Lee Kuan Yew. Everyday, I can't help but look at his face for a few seconds. Sometimes, I take some time off to read the article itself, which is about how LKY avoids ageing.

On the other side of the room is the bookshelf and there are two books which I take out to read occasionally: Men in White, a book on PAP's early history, and the Memoirs of LKY (in Chinese). (To be fair I have The Fajar Generation too, it is a book written by LKY's enemies)

In a sense my room, other than being used for studying and recreation, is somewhat of a shrine to LKY. I can't say that I've met the man in person or really know how he's like, but he's become the very symbol of pragmatism and excellence that I have come to put on my "shrine". It's not really the man, but the symbol, or rather what I have interpreted of the symbol.

So why am I writing about this all of a sudden? Actually it's not a random musing, rather I just want to share here how 2010 for me has been characterised by a struggle between two invisible forces in my private world: pragmatism, personified by my elderly hero, and altruism/idealism. It is so inevitable, as you cruise along in life's journey, that you learn to cast aside your ideals and look at stark reality as it is. But yet you don't want to lose your ideals and your soul as well.

Besides being an intellectual struggle, there were real repercussions of this battle in real life, namely how I've come to view Residency and my career choice. It is tempting that at some point, you hop onto the bandwagon because everyone is doing so and you don't want to lose out in terms of material progress. In fact, LKY himself sanctioned the building of casinos because he noticed the Westerners were doing the same!

I've in fact come close, like what LKY has probably already done so, to believing that the world is not about who's "right" or "wrong" but rather the "winners" and the "losers". So what if the Barisan Socialis politicians were truly righteous? They rotted in their jail cells anyway, unable to make any tangible change to society during that time. So what if you think that Residency has 101 flaws, such as forcing people to make early decisions? You don't like it, then it'll be given to the grateful Dukies and foreign based students and rightfully or not, you'd most likely languish outside the system, unnurtured and neglected.

But by the grace of God, I've not lost my grasp over the knowledge of what is more righteous than the other. The idealistic/altruistic force, visualised in my mind as the person of Jesus Christ, has stopped me from sliding into mere nihilism. (Jesus stands for many other things as well but I'll leave it here).

And hence, that was the role of God in my life in the year 2010. It is not the ideal role of God in anyone's life but I'll just write about what is, rather than what should be.

Also, by God's grace, I've learnt that it is possible to come to behold the true value of your endeavours, beyond material enrichment. Honestly the idea of doing research started out simply as a means of jumping on the Residency bandwagon. Somehow in the middle, perhaps through some epiphany, I saw the value of exploring the deep dark unchartered territory which is Cancer.

And it's not because it has claimed the lives of some family members. Big deal, I mean, it is such a common disease, and I'll be blunt enough to tell you that the same calamity is likely to befall YOU as well. Statistics show that. On the other hand, the real reason is that I've come to see how the world is facing such a massive, complex enemy.

Mention TB, and we can say that it is caused by Mycobacterium tuberculosis which replicates in macrophages, and it is treated by isoniazid, rifampicin, pyrazinamide etc. Talk about jaundice, and we can classify its causes, and very likely an ERCP removes the stone responsible for the condition.

But cancer. We are not entirely sure of how Nature and Nurture interact to produce this calamity. The drugs that we give cause terrible collateral damage, and more often than not the cancer cells, seemingly with a mind of their own, learn to be resistant. It causes tremendous pain and discomfort, it can be recurrent and it certainly deserves the title of the Emperor of all Maladies.

I've come to see this disease as more than a chapter in the textbook, or the killer of some people I know, but as sort of a dream. I need not be an oncologist (but by God's grace, God's grace...), and I'd like to do whatever I can in the future to participate in the battle against it. Screening at the primary healthcare level. Maybe palliative care. Research perhaps.

How nice it would be, to be part of a generation that ushers in a giant leap in the revolution of cancer treatment. Ways and means that are not painful, not nauseating. That are precise and efficacious. There is much research done on immunotherapy, on genetics and epigenetics. You'd know, friends, that someday you'd likely be part of it. General surgeon, immunologist, paediatrician, nurse, healthcare policy administrator. Anything.

So I mean with regards to the book above, it is a chronicle of how great clinicians and scientists of the past have fought against the disease. I've bought it recently at $26 and it has been a page turner (when I find time among patho revision to look at it). Not only is it informative, with a crisp style of writing that I aspire to, but it reminds me that there's so much to look forward to in Medicine. More so than the grades, the residency, the people you don't like and some questionable organisations.

It is a pleasant reminder that we are not here just to survive or to climb up the social ladder. But to find our niche in this world and perform our duties to the best we can. To fulfill dreams.

And to borrow a quote from a great movie: Don't chase success. Chase excellence, and therafter success will chase you pants down.

My meditations on human desire

2010-12-28T23:04:00.002+08:00

If you read the Bible, there are many verses turning its reader away from sensuality. I have often wondered why some simple human passions are frowned upon by religion. The simple desire for money and success, the admiration of another's beauty, seems to be discouraged. The cynic may even ask if this a political weapon for religious organisations to subjugate mankind.

Nevertheless, if you want to believe in a God of order, which the Scripture illustrates, then some things may fall into place. As much as chaos exists in this unpredictable universe, a modicum of order is needed for life around us as we know it to function. Humans can live, breathe and eat because cells are organised in a structured manner and perform their required functions. Necrosis, which is death, occurs when this structure is lost.

Same goes with our desires. The ambitions to get into a residency, to have a companion, to drive the best car, must be put into place. For when they become our only perspective of life, the only means of shaping our identity, it is only too easy for there to be perversion, leading to one of the many woes that you see plaguing mankind today. The greed of Bernie Madoff. The terrible crimes of some Catholic priests. Or simply put, disgruntledness among the common men like us.

Might I suggest then, that the call to discipline our desires is not just a weapon for the power hungry and the pious. This discipline must come from inside out in the hope that we who practise it attain new life, free from the burden of materialism.

True enjoyment comes when our passions are disciplined. For me, it will come when I finally realise the true value of my salvation, which is the knowledge that God has come to empathise with man. It comes with the feeling that I'm at peace in the world and the intuitive knowledge that I'm in the part of this universe that I should be. And actually, all the rest are secondary.

Christmas, come and gone

2010-12-26T00:00:00.002+08:00

It's a slightly belated post actually, I didn't manage to catch in time the swift exit of Christmas Day.

I believe that whatever what we do, whether we know it or not, is a manifestation of our desire for some sort of salvation. Salvation from mediocrity, from previous hurts, from disappointment, from poverty, from fear, from some inner insecurity, from our conscience. That's why we do stuff like study, go gymming, take part in social activities etc. Maybe we want to prove somebody wrong, and that could be a certain other person, or an intangible but real shadow that exists within you.

Well, Christmas, as Christians believe, marks the birth of salvation. Of course, it is higher and more wholesome than the salvation I described up there. It's not something I can describe readily, but throughout this year I've learnt that it has to be worked out and that it can be elusive.

Hopefully, whoever reads this, regardless of their beliefs, will find some sort of salvation in their own way

Long way to go

2010-12-23T17:58:00.002+08:00

A few days ago this relative of mine had a little neck lump and I was asked to examine it. After some history taking and the examination, I came up with a certain diagnosis. Today on hindsight, I realized what a stupid diagnosis I made and went to correct it.

It was really a very elementary error, laughable even. The thing is, if this had been a hospital setting, or an exam case, I would have done it much better. I guess I learnt lots today about the necessity of always carrying around the medicine brain. Ican be glad I didn't make this mistake as a doctor

A study of people singing in a circle

2010-12-21T23:36:00.024+08:00

Today there was caroling at Kwong Wai Shiu Hospital, followed by a party at Jonny's house. Near the end we decided to form a circle to sing songs.

I was tempted to take out the camera because what I saw in front of me was a great variety of emotions and expressions, which I had to record for posterity.

More importantly, it occured to me that the circle of singers was but a microcosm of society, with people playing all sorts of roles:

The lead singer with the nice voice and the one who expresses herself very well while dancing. They are the centre of attraction

The skillful guitarists, without whom there would be no music. They, together with the lead singer and dancer, decide what songs to play.

The rest more or less sing along, or chip in with random suggestions. Those who can't sing keep quiet, then return to the chorus of voices when they can. Some sit there rather meekly but smile sweetly, making a sincere attempt to fit in.

And of course there's the Idiot, who can't sing anything since he listens to classical music, so he takes photographs.

A study of Coronation Plaza food

2010-12-20T23:17:00.006+08:00

There are two types of women men would like. First are very gorgeous kind which any guy can't help but feel affection for. Second, you have those who are more plain looking but are very much loved by their spouses because of the years of marriage that have cultivated deep feeling. You examine them a little more, and you realise that the second group do have attributes of their own that make them worthy.

Same goes for food. Which person ever notices chicken+fish rice sold in an eatery in one corner of the top floor of a not-too-well-known shopping centre? Furniture is spartan, waitresses are in their 50s and the food isn't as breathtaking as the crab I ate the other day (see previous entry)

But Coronation Plaza's Ke Ai Ji holds great memories for many Hwa Chong alumni. I remember eating there with the String Orch pple when I was in The Chinese High School (now known as the High School Section of Hwa Chong Institution), and also with my JC classmates after S-paper lectures.

I went back there today with CY, an old friend from TCHS, after studying Patho in the library. We also took the chance to go back to TCHS to take a look.

There was only one dish we could order and that was the fish+chicken rice we all loved when we were still HwaChongians. No photo editing today. Photos are sacred.

End of the school year in pictures

2010-12-18T01:46:00.006+08:00

Will miss you guys loads. Had some great times and great conversations with a bunch of nice, vibrant and smart people like you guys. Whether or not we continue as a CG in M5, we are not going to see each other for at least 6 months so that's going to be a long time. Will treasure the memories, starting all the way from Ortho posting 14 months ago.

After ENT EOPT we basically bummed around in the student lounge playing Wii and table soccer with other very random Medicine people, and then we watched the Playhouse video again. Though it was only two weeks ago, it brought back some nostalgic memories of the few rehearsals the stage crew had, and a sense of achievement shared by all who participated in the event.

I left immediately after the screening to celebrate Joshua's (church friend) birthday and we had crab in the famous Mellben Restaurant in Ang Mo Kio Ave 3 St 22 Blk 232.
For starters, this was some tofu like dish. The exterior was tough and crispy but once your teeth go past that layer, the inside virtually melts in your mouth. It has a softness that is quite beyond description and your teeth, though gently manipulated by the jaw, smash through them with amazing ease.

It's just like how some people seem tough on the outside but crumble the moment they are harrassed.
This was the first crab dish. The bee hoon, from my experience, play the role of the wing-man, the sidekick, but today it deserved as much mention as the main character, the crab. The sauce brings a multitude of delight to your tongue, which disseminates through your entire palate. It seems that the oropharynx and nasopharynx have at once experienced this heavenly joy (sorry I'm still having ENT hangover).

Crab was not too heavy on the taste buds, though very fresh and tender. This dish reminds me of a richly adorned, glitzy looking housewife married to a down-to-earth husband.

Chilli crab- a dish whose name adorns many a restaurant menu for the sake of mere customer attention. Yet the disappointed customer has tasted only a ghost of what it is supposed to be. Today, justice was served to the hallowed name, for this fine specimen of a crustacean not only had the freshest meat I have tasted, it was bathed in thick and tasty chilli sauce which balanced spiciness with texture with flavour.

Anything, ANYTHING, save Joshua's chocolate cake, can be dipped in the sauce and thoroughly enjoyed. Hence, the beauty of the sauce is in its universality, for it cries out to many a dish, "Come to me, all who are dry and unadorned and plain. Take up my yolk and be tasty"

But the star of the night had to belong to this wondrous contraption you see above. Had the crab been alive and able to walk, I would have personally laid out a red carpet so that it could strut down the aisle, with sauce dripping, while people revel in its golden glory.

Butter crab! Nevertheless, had you been alive, you would have been inedible. Hence it is one of the grievances I have in this world that you are dead as a donut- mute, unseeing, and unconscious.

Were I to talk to you, butter crab, I would liked to have known your journey as you were dipped in this wonderful amazing butter sauce, whose origins I am tempted to accredit only to heaven itself, for it is only from the stars such earth-shaking liquid could have fell.

So anyway after this life-changing, earth shattering dinner that made a dip in the flow of the universe's cosmic energy, we proceeded on to cut Joshua's cake in Macs. Despite its dark mysterious hue,the majestic cylindrical Goliath of a .... ah ok la the chocolate cake was also very good. Was getting very tired after that and am very tired now. Pictures are on facebook if ever you want to see haha.

Medical developments I'd like to see in the future

2010-12-11T16:31:00.003+08:00

Today in the Saturday segment of ST there were a series of articles on clinician scientists and their projects. It's really cool stuff because what they are investigating now could be the mainstay of healthcare when we become doctors. I remember too approaching Prof Yeoh earlier this year to help out with his gastric cancer project but I suppose since it was a high stakes $25 million dollar enterprise he didn't want a medical student bungling it up.

Anyway, I'm quite inspired to write down the new developments I wish to see in the medical field, say, half a century from now. I reiterate that I only wish to see them happen, yet whether they come to fruition or not depends on many other things.

Moreover, as you can see later, they are not limited to the field of science, but also public policy as well.

1) Cancer immunotherapy

The idea came about in the 80s but as of now, it is yet to become the mainstay of cancer treatment in Singapore. Why I want it to be the mainstay is because I've seen the poisonous effects of chemo and radiotherapy, and it is rather shocking how such a barbaric form of treatment, with so much collateral damage, is still given so many cancer patients. Unfortunately, this is because medical science hasn't offered us better alternatives that can be implemented en masse.

It'll be great if one day, for every single cancer available, we can offer the appropriate form of immunotherapy- to stimulate the appropriate immune cells to destroy the tumour cells and only the tumour cells. This comes about if we are able to recognise and tag various tumour cell receptors. More importantly, this form of treatment must be affordable.

2) The affordability of gene testing

Ian and I were talking about it during CTS on Thursday. He was saying how wonderful it could be if gene testing could one day be done en masse, just like today's FBC and U/E/Creat, which are very cheap investigations. We have it now, but it's very expensive. For instance, to test for gene translocations leading to GIST would cost around $1500.

We can test for patients' susceptibility to various acute and chronic illnesses, but the caveat is that these illnesses must be curable, or else you are just creating more misery. Better let them live in blissful ignorance!

3) Epigenetics and preventive medicine

I first read about it in TIME magazine earlier this year. They drew a small circle representing genetics and a larger circle around it representing epigenetics. How cool is that? It is the study of the bridge between nature and nurture, how environmental factors can turn on and off various genes within you, thus determining your susceptibility to various diseases. With that, we can relook patient's lifestyle factors and work on them.

I am reminded of a lecture a few days back during my current ENT posting, whereby the Prof was selling his theory about how the avoidance of certain foods can actually cure allergic rhinitis, eczema, asthma, and even rheumatoid arthritis. Apparently, the intradermal provocation food test which he is a proponent of can show a wider range of foods a patient is allergic to, whereas the skin prick test only shows IgE related food allergies.

Something like that. I wasn't really listening, but it was obvious that the Prof was more interested in selling his idea than teaching students. There must be more evidence based research, most ideally double blinded clinical trials, to prove his words. Nevertheless, I know at least a friend who will be interested in this field of study. YOU! Yes you, you know who you are.

4) Greater empowerment of primary healthcare

I'm moving from the realm of science into the realm of sociology from now, but nevertheless I consider these developments nonetheless.

There are many times in specialist clinics when I see the patient being put on a dose of steroids, or being given expectant management, and I wonder if a primary healthcare physician couldn't have done the same. I believe that the larger the proportion of healthcare burden is shouldered by specialists, the higher the healthcare costs, which need not necessarily be the case

For that, I hope the new family medicine residency programme can train a sufficient number of primary care physicians well equipped to manage a wide range of acute and chronic illnesses. I also hope more people will recognise the importance of family medicine as a means to provide affordable primary care, rather than treat it as a default career path and be unhappy doing it (eg being a GP cos they didn't get into a speciality).

Nevertheless, Singapore is likely to move in the opposite direction. Elitism (which I actually mostly subscribe to), is a driving philosophy behind many aspects of our society, healthcare industry included. Our healthcare system of the future will aim to cater to a larger international population so as to bring in more revenue and cement Singapore's reputation as a biomedical hub. As a result, disciplines like Orthopaedics, Oncology, Plastic Surgery, ENT and Ophthalmology will become more subspecialised and sub-subspecialised so as to provide greater cutting edge treatment.

After all I've said, I admit Fam Med is still my second choice, the first being Internal Medicine (cos I can't stand working with only one small part of the body) But I hope I'm not making Fam med a last, default choice but rather a second choice, if you get what I mean.

5) Making medicine a post graduate course

Yea maybe I'll be unpopular by saying this but I really hope we'll seriously consider going down America's path. This is so that prospective medical students are more mature in making their choice to commit to this discipline, which really isn't easy to commit to. Fresh out of an elitist public education system, an 18-year-old may want to do Medicine because it is another "elite" course, but it'll be rather tragic if this is the only reason. You'd preferably want someone older, someone more likely to have the heart to serve and who can rationally consider the pros and cons.

Weekly dose of sarcasm

2010-12-11T00:00:00.000+08:00

Desire leads to suffering

2010-12-08T22:46:00.003+08:00

Had you ever desired to get better academic results, you would have studied harder and smarter. Had you ever desired to run a marathon, you would have come up with an effective training schedule and stuck to it.

Yet, have you ever been so consumed by a desire which you cannot meet? Due to its fulfillment not being totally decided by you, or not being appropriate for the current time and situation?

the play and the marathon

2010-12-05T20:30:00.002+08:00

Photo courtesy of Alvin

Alright. I had the best weekend ever in medical school so I must do a nice chronology of it. Playhouse was fantastic and our play was epic, sweeping nearly every award available. Will be looking forward to watching the video playback, and maybe hopefully I'll catch myself bringing the throne and part of the bridge onto the stage.

This was the first major performance I've taken part in since 2004 (Hwa Chong Institution's 85th anniversary concert) and the first major Medicine activity I've taken part in, if you exclude Medicamp. I'm glad to have known some wonderful people in crew like Jon Chan, Debo, Ruth, Poying, Sheila, Quan You, Perry, Wei Ping , and my old friends Shaun Chan, Emmett, Sok, Jon Tang and Alon. Hope I didn't miss out anyone.

After that was the long awaited Standard Chartered Singapore Marathon. I was surprised to have slept well from 8 to 2am, waking up once only to pee. Maybe it was Playhouse making me very tired. I met Emmett, Wei Ping, Ben Ding, Fred and Mingzhou at the baggage deposit and we started off together, though some people including me ran off at our own pace.

Everything went fine until 20km until I noticed a very slight dull ache in my vastus medialis, and I was surprised the cramps could have come on so early, testament to how I had not been training well. They became signficiant at 24 km and by 32 I had a major onset of cramps that left me on the floor. Somehow, I just stumbled my way to the end and I believe my timing was a decent 4h 41min.

So anyway, I was thinking these past few months that running has become less enjoyable, maybe more of a chore. But I just keep on running because of the end result, namely the marathon T-shirt and the knowledge that I had run in good time, which I can then happily show off to people. There is also the sense of achievement that you have soldiered on bravely despite the pain and the terrible cramps, but in all honesty who shares it? Who saw your toil? This is all very self absorbed. The process of running is also really quite painful and burdensome.

Against my instincts I've signed up for Sundown 2011, which will be my third marathon and last in medical school. So why still sign up? Namely because of the shirt, and also because I know it could be the last chance in a long, long while, with my time as a junior doctor likely to swallow up my youth.

Some have suggested that I relax this time round and run marathons again in NS, but as far as I have estimated it would be at least a three year wait between Sundown 2011 and the next marathon. Three years... it's more than enough for a perfectly healthy person to turn into the perfect wretch, or the perfect corpse, through some cruel act of fortune. Who knows what will happen? Therefore, run as much as you can now and savour the memories later.

Anyway, to keep myself excited, I have decided to take on a new challenge in the form of the Men's Health Urbanathlon 2011, which is a 12km route consisting of 9 obstacles. It is a plunge into the unknown, especially since in NS I had trouble with the monkey bar that you see above. Nevertheless, despite the $128 price tag, the goody bag includes 2 shirts, 1 singlet, a free 6 month subscription to the Men's Health magazine, 1 water bottle and also a condom. Best. Am looking forward. 20 Feb 2011

ggxx

2010-12-03T22:55:00.002+08:00

Ophthalmo. A posting crammed between playhouse rehearsals and ncc meetings. But there's no excuse for some of the answers I wrote down today. Hai. I guess if I ever wanted to do internal medicine I have a long long way to go man. Must use electives to improve knowledge ttm.

Never mind. Playhouse tml, followed by marathon. Awesome weekend

Now's a bad time to drop dead

2010-11-29T23:08:00.003+08:00

Pardon some self absorption, but I think I'm in one of the most exciting weeks of my life thus far (just like many of you, I suspect). Playhouse is on Saturday and I may be only a crew member, but it's been 8 years since I participated in a large scale play. And I've been looking forward to Playhouse.

After that, there is the Stanchart marathon which I also have been looking forward to. Meanwhile, data entry for my research project is more or less done and the next step is data analysis and the churning out of some papers.

Interesting times. Today I walked up the hill to SGH and saw K pontanging O&G tutorial (at NINE AM wtf). Immediately after that I met M and he started the conversation with "Do you want me to tell you about inter-nuclear ophthalmoplegia?" Thereafter there was a fantastic mini-tutorial on inter-nuclear ophthalmoplegia. Only thing left is a flying pig.

A piece that's stuck in my head

2010-11-28T00:22:00.002+08:00

Shostakovich's 2nd Piano Concerto in F major. It has a very haunting melody, and in the middle there is a very turbulent interaction between piano and orchestra. Good video too! For those romantics out there

meh

2010-11-26T23:06:00.002+08:00

Opthalmo. A posting which doesn't really appeal to me, but which I just study for for the sake of learning. Something like O&G, except that O&G was a monster that was worth lots of marks. So many postings, so few that truly catch your attention. Same applies to cars, football clubs, movies and people.

Sin

2010-11-19T23:25:00.002+08:00

Having grown up in a comfortable environment provided by my traditional Chinese parents, it was easy for me to develop a black and white world view. All forms of deviancy (or at least what I perceived of it) could be frowned upon with ease- homosexuality, extra-marital affairs, school drop outs, mental illnesses.

But there are some things that gradually changed this perspective, not to the extent that I now condone wrongdoings, but that I think twice before firing off any moral judgments. The first thing is knowing personally the people who are guilty, and this brings me to the point: someone I knew a few years back has made the headlines for the wrong reasons.

When you know the person involved, you can put a face to the guilty party. He is no longer the one dimensional depraved perverted individual, but someone whom you know to have very humane traits as well. You know his hobbies, his character, his quirks. Not that I was close to that guy, but prior to this incident I had a image in my mind of him as a human being, not necessarily perfect, but not a monster.

Same too with my experience with homosexuals. As a teenager, it was easy to take extreme sides and condemn them, laugh at them. Looking back, I realised that all of these people I know are very humane. Of course they have their quirks, but they are not monsters. If I may add, some are good Christian folk. I am still of the view that heterosexuality is the superior way, but I no longer would label the homosexuals as scum of the earth.

That's a theological argument that we could talk about another day. On to my next point, a greater understanding of the deviancy in this world developed as I understood more and more the emotional complexity of people . Why do some teachers have extra-marital affairs with their students? Why make child pornography videos?

There is no excuse for such behaviour, but I'll just say that there are times in life when you'd feel isolated, and in these dark times temptation is great. We are not easy people to satisfy. There is the physical food- money, career and all earthly pleasures, and on the other hand there's this monster in the deep dark recesses of our soul demanding its thirst be quenched, through some means of empathic emotional catharsis. Even if this release is achieved by things our peers would deem perverse.

There are happy contented people living in their ivory tower looking below, condemning the sin of this world. But they may or may not understand life's complexity.

Nevertheless, the comprehension of the sophisticated subtleties of life must be coupled with the strength to make a stand. You don't know white if you haven't seen black or dark grey. So, at the end of the day, it's by seeing a wide spectrum of behaviour that you'd learn to be more discerning. Because if you don't, it's a slippery slope to the bottom.

Actually

2010-11-18T23:43:00.001+08:00

I read just now that men must love their wives as they love themselves. Actually, what if you hate yourself? Did St Paul think about that?

It's usually the internal med ppl that leave an impression on me

2010-11-16T23:26:00.003+08:00

Sunday evening. Ppl are doing some happening things. I'm trying to register a horde of workers for the Karunya clinic. There are lots of them today, we have to tell some of them to go home because there are too many. They go forward and push their work permits under your noses. Somehow I think it'll boil over into a riot.

So I go inside the room, and then there's this doctor wearing his hospital call-scrubs. He'd just worked on Sunday and chose to spend his evening here. There is no reason to complain from now on. Nice guy, he. Teaches me about contact dermatitis and folliculitis and how never to underestimate skin conditions, after all he had seen them lead to severe staph aureus bacteremia. Invites me to dinner.

He walks to his car, across a multitude of South Asians, in his scrubs, with a stethoscope hanging around his neck. Could have been fresh out of the wards. Later he wears a sweater to the restaurant.

We talk about work life balance and Christianity. About how medicine is a calling, but at the end of the day it's also just a job, and that we shouldn't let it consume us to the point that we don't know how to live. About how people are important. About how constant communication with God is important to keep us sane. And about a lot of theological stuff like free will and grace, how we are set free, but yet called to obey.

Good food, meaningful conversation. Could even be a message from God trying to tell me something. Worthwhile memory.

-----------------------------------

I admit I've been feeling angry these few days. Pathological. Self destructive. I feel like doing a lot of unpleasant things to relieve it. Twice I've cut my long runs short (32km to around 20km) because of this overwhelming sense of fury and futility.

It's the anger that the world is too small, or rather my world is too small. What do I know about the way this fucking world works? None. And we just plough on, move on, thinking that our way is the "rightest" way. The world outside could revolve in a different direction, but we don't know that, because all we've known is our own way, the best of ways.

Or more simply put, it's really scary when the only way of life you've known is your own. And there is actually life outside. But through some work of fate or personal folly you can't reach it. YOU CAN'T. YOU SIMPLY CAN'T AND THE ONLY THING YOU CAN DO IS TO WATCH.

It is always too easy to sink into a rut. Be habitual, narrow minded and, ON TOP OF THAT, self obsessed. And that's the only world you'd know. And worse still is, you'd be proud of yourselves over that. A fat worm sick from the gluttony of pride and self obsession, much like the Imperial China of old.

You have to break ruts.

I hope reading this isn't too awkward or unnerving... just wanted to get things off my chest

Limbo

2010-11-13T12:42:00.002+08:00

Much has been said about how working life sucks. But I sense the increasing feeling of... stuffiness at being a 22-year old student. It's like being neither here nor there.

Like the Overlords in Childhood's End, who helped mankind evolve into higher beings, but who themselves never managed to cross the bridge.

Or like the guy who's forever a friend, never the lover. Or the 40 year old registrar who never became consultant because he couldn't pass exams. You get what I mean heh.

Guess the most impt thing now is to cherish the present, so that I'll have good memories.

Epic day

2010-11-11T00:18:00.003+08:00

Today was one of the rare days in medical school that I felt I knew why I was in medicine, and felt really excited about it. We were training with the Human Patient Simulator, for the anesthesia posting

So I can't tell you any details since I signed a form swearing confidentiality, but today was really fun. Had entertainment value too. I think any trainee watching the videos will have a good chuckle here and there.

But today made me excited because we got to apply whatever we had learnt in our big postings previously, and as you know I have finished all of them. There wasn't any single discipline to adhere to, not medicine, not emed, not surgery, but just the art of healing as a whole. And it was practical.

If you ask me a lot of our practical exams aren't practical. A lot of it is just lip service, most probably owing to logistical constraints (ie lack of real patients to test procedural skills on). For instance, our O&G OSCEs consist a lot of talking to simulated patients. I hated it A LOT- all that BS and mere word play. "I will take FBC, U/E Creat.... do a pelvic ultrasound"

Many times, by talking, we assume that we can really do correctly what we said. Do your fingers really know how to put an anchoring stitch at the apex, and sew continuous interlocking sutures? Will they really not fumble or tremble, and let the needle accidentally penetrate the anal canal? But this isn't given a huge weightage. Even my tutor told me that episiotomy (which is what I've described above) is a talking station, with the technique occupying a small portion of the marks. Most of it is just saying out the preparation of the procedure and the principles behind it.

Like today. Many times we just said out what orders we wanted to take, and in the interest of time mentioned the drugs to give rather than actually give it. That can't work in real life. Many things happen along the way. Nurses may not have heard your orders. Venous access may not have been achieved. The wrong dose of drug may have been given.

So actually, hate me for all you like, but in the MRT train today I thought of the ultimate exam for medical students.

It would be like a SIT test/boot camp format whereby a batch of candidates are whisked to some living quarters near a hospital for 4D3N. No going home. All basic necessities provided. Daytime consists of theory exams, or the simple long-case or short-case as we know it today. But the fun comes at NIGHT. At VARIOUS POINTS IN TIME throughout the three nights (and no student will be told exactly when), students will be woken up and brought to the wards for a series of activities, including:

1. setting plug on a dummy, drawing blood

2. administering drugs, also on a dummy

3. counselling an agitated simulated patient (eg. ah pek who wants to pull out all plugs and go home)

4. examining a simulated patient in pain, assessing the need for emergency op. Must really carry out PE, no such thing as saying "I will examine his abdomen etc etc"

5. interpreting ECG and CXR

AND....

6. Resuscitating the human patient simulator (which will then involve all the above skills). Will have to work with nurses and be the team leader. No help from the examiner. Once again, no saying out of what you want to do, just do it.

AND...

7. Regurgitating the 100 ddx of (insert sign or symptom) to a demanding consultant. And answering all sorts of random questions on medical theory, including anat, physio, biochem etc.

Hmm quite a lot of lip service too... but balanced with some action...

Students will be assessed on:

1. Acumen

2. Teamwork (esp in resus)

3. Personal attitude towards patients other healthcare workers

I think this will be the ultimate test of mettle. I also know 1. As of now I think I'll flunk this shit and 2. Everyone who reads this will be damned pissed off with me and wish that karma will strike and I'll flop in some exam. Well, it's just a harmless blog entry, stay chill and enjoy life. Good night.

2nd chances

2010-11-05T23:29:00.012+08:00

During forensic pathology class, my friend remarked how the insides of our bodies looked so crude, and how she was disappointed that that was all we are. Yea true, looks like something from a butcher's shop really, and you don't expect people like you and I to be more than that.

4 people slashed 1 person a few days ago. There was this massive debate on TOC over what to do with the murderers. Many agreed that they should be hung. Some of these comments were really vengeful and hateful. Some advocated that the murderers should be tortured.

At the end of the day, you see people, regardless of which side of the law they are on, desiring the death and suffering of others. Which makes you learn that there is this innate savagery in us, existing across all echelons of society.

Am in no position to judge anyone. I used to be adamant that we should hang drug offenders, kidnappers and murderers. There were a few things in life that made me take a step back to reconsider. Long story. But anyway, for your viewing pleasure, here's a restaurant that I would remember for the rest of my life.

Just outside the Subordinate Court, there is this restaurant known as the Breakthrough Cafe, set up with the aim of helping ex offenders integrate back into society. More information at http://www.singaporevr.com/vrs/BreakthroughCafe/BreakthroughCafe.html. The headline above reads- "Ex offenders open a cafe: Judges and lawyers love to visit"

This cafe was set up by Breakthrough Missions, this Christian organisation aimed at rehabilitating convicts- http://www.breakthroughmissions.org/

Menu. I had a nice and filling meal for about $11. Can be cheaper definitely. Nasi Lemak costs $2 and fills up 3/4 your stomach. Order a little more dim sum, and the cost won't go beyond $8 per person I think.

$2 Nasi Lemak

Chendol. Loved the milk

So, coming back to the issue, you'd ask me what this restaurant has to do with the death penalty. After all, I don't suppose the ex-convicts working here used to be on death row.

Nevertheless, my point is that the most ideal consequence of punishment is reform. Punishment that causes only suffering, that only exacts vengeance, is an inferior version. From the utilitarian viewpoint, four more corpses won't really do society much good. On the other hand, four more waiters/chefs/restaurant managers would be much better.

Some people equate abolishment of the death penalty to abolishment of punishment. Nope, the murderers must be brought to justice. Jail them for a long long time, and cane them many times to make them repent. If they repent, there may be the chance of parole. If they don't, then by all means continue jailing them and caning them. Keeps society safe. I'm not sure if Singapore sentences people to life imprisonments with the possibility of parole (btw that's done in the UK, from whom our law is modeled upon)

I can't speak for the victim's family though. Maybe only the execution of the 4 people can bring them closure. Maybe to them, that'll be true justice. We as third parties shouldn't really quarrel with that.

Nevertheless, a truly civilised society is built by rational and empathetic decisions, not those borne out of vengeance and hatred. Let's examine ourselves as we formulate what kind of punishments to mete out to criminals

Forensic Pathology

2010-11-03T23:19:00.000+08:00

Was passing around human organs today...

I'm at it again

2010-10-30T16:23:00.002+08:00

When I started drawing this, the voice of someone I once knew whispered into my head, "What's the point of doing this? The only thing you can do in response is to draw." But I shook it off. Drawing cultivates character and patience, it increases your attention to detail and your ability to organise them.

There are times when life is devoid of meaning, so your art-whatever of it you have- will take over

Non-retirement

2010-10-29T18:05:00.004+08:00

These few days, there have been talk that the retirement age will be raised to 68 years old. Needless to say, many people have been deeply annoyed by the idea. I'm not too sure of the economic or political reasons behind this move, I can only guess that the government managed to calculate that this would be an ideal retirement age, so as to maintain a viable economy.

We can suspect that this idea was very much motivated by Minister Mentor Lee Kuan Yew. After all, he proposed that retirement will only cause degeneration of the mind and body, and that every human being should seek external stimuli to keep on going in life, that translating to work.

I'm actually a big fan of that idea, but only if there is passion for the job. For me, it'll be great if I can specialise in a field that I like, then continue working until my body fails me. It'll be ideal if at age 70, I can still go around attending conferences or teaching medical students.

Nevertheless, we should also take note that not everybody has the good fortune to find a career that they are passionate about. Many people just take up a job to make ends meet. It's very believable that many of them will rust after collecting their pension, but they have the right to rest if they want to.

Moreover, there are some jobs that simply cannot be undertaken by the elderly- namely all forms of menial labour. It'll be terrible for a 67 year old man to continue sweeping the floor despite his rheumatoid arthritis and diabetic retinopathy, simply for the sake of collecting pension to survive.

Nevertheless, there is no other solution to the problem, at least that's what I think as a layman. The other option is to import more foreign workers, which as you know is causing increasing social tension. My only solution? Find something you like in life and pursue it, as long as you have the good fortune to. I understand some people in Singapore have subsistence issues and can't really do the things that they like, I have no answer to that.

Being an inexperienced 22 year old, you don't really have the right to judge who is more correct, be it the middle class who favour retirement or the higher ups who want to raise the retirement age, but you can always choose your role models. It could be someone who's going strong even in old age (think LKY, Alex Ferguson or Bernie Ecclestone), or a jaded middle aged salaryman lamenting about many aspects of his work and looking forward to the day he gets his pension. The choice is yours, and as long as I'm not overly restricted by some domestic issue or unfortunate event, and as long as my faculties are intact, I know mine.

Life is a little puzzling sometimes

2010-10-27T23:00:00.002+08:00

As if it was a sign from above, yesterday for VCF we talked about the rich poor gap and what Christians can do about it. That particular study was supposed to be done last week but we swapped it with another, strange thing.

At the end I made a little statement about how certain mindsets could actually contribute to the widening of the gap. In response, Linus asked me if I knew this as a theory or from personal experience, and I sheepishly blurted out some answer that geared towards the former, of course.

True, time and time again I've said that I haven't experienced much in life. Even a couple of years back when my family fell on bad times, I think I was relatively well protected. There are so many bad things that can happen to you in life but so far I have been miraculously immune. I'm not rich but I can study without worrying about anything going on at home, I can enjoy $30 meals+ drinks and I have an iTouch.

11 lessons

2010-10-23T23:43:00.003+08:00

Right... I've been lamenting quite a lot about how I don't post many meaningful things here nowadays, but right now the whining shall end. Stroke of midnight comes and I turn 22. I suppose the most important things in life are not just the celebrations and the gifts, but what Life has taught you itself.

Henceforth, as a mini-sort-of celebration of my 22nd, I'll just pen down some of the things that I've learnt the past one year. I wanted 22 of them but I could only milk half the amount so you'll have to make do with 11. Here goes...

1. I'm no longer young- At 21, you have just dipped your toes into this metaphorical sea known as the "twenties". At 22, you are well and truly deep inside the ocean. Since the World Cup, I've realised that there are peers such as Ozil or Messi who are around my age, but are already earning gigantic salaries with big clubs. Move over to Singapore, and here I am, shamefully living off pocket money and being a student. As such, I can't wait to start working and be truly my own man. Not that I fancy the night calls and plug setting, but at least I'm no longer a parasite.

2. Life is really good to me- I'm not rich, but I have never lacked anything materially even during the most difficult times my family have went through. There are many things in this world that can easily ruin people, at least financially, but by the grace of God, Mum Marsha and I are still living a blissful cosy existence.

3. But life hasn't been good to others- Men were not made equal, but gross inequality is something I feel burdened for. It truly registered when I started reading The Online Citizen and knowing that even in Singapore, some people are denied the basic material comforts. For instance, if you follow TOC, you'd remember their articles on the "happy campers"- homeless people who have to live in tents. Many other isolated incidents served to remind me of the plight of the less fortunate. As such, this year I began stepping up my efforts to donate to charities, and it's not just the kind where you put coins in tin cans.

4. Our calling as doctors- Which brings me to point 4. I realised that when we started off in Medicine many of us had dreams to achieve things for the world, to serve the poor and go overseas on mission trips and cure disease. But for people like me, there comes a point when we are immersed in what Medicine can achieve for us- career prospects, lifestyle, money.

Nevertheless, as the hustle and bustle of daily life dies down, let's spend some time to reflect on our dreams and ideals. In light of point 3, I feel the calling to use whatever gifts I have, including Medicine, to serve those less fortunate. To partake in Christ's redemption of fallen creation, in terms of righting injustices and inequality. I don't assume this journey to be smooth sailing, because my life is truly about the continuous sparring between realism and idealism, with me see-sawing between the two.

5. Of Medicine- Other more technical stuff I've learnt include how to ask and examine for complications on top of signs and symptoms, and when to order appropriate investigations.

6. Guard your mind- When we were in school, there were teachers to moderate discussions and censor information, teachers who taught us how to process what we read and listen to. But we are on our own now, left alone to handle the millions of ideas circulating around us. The weak minded blindly accept or reject, but we have to toughen up and learn to see through lies ourselves. And, to guard against rhetoric used by the extremists.

7. About what girls want-I still have mixed opinions of this. Based on previous conversations, I once gathered that many girls are materialistic. Nevertheless, for want of a better term, I'd just say that many women look for a sense of security in a man, though it's true that sometimes this translates to the size of his wallet. But, my friend taught me that love is more than that. It is not about the list of attributes that can be ticked off a checklist, but also about whether there is someone suitable out there.

Being still rather confused, my only conclusion is to just establish my career first before looking for relationships, because now even I don't feel secure with myself. Ah... seems that my self worth is based on my career, but what to do I'm a guy.

8. About Christian love- You know, Bible always says not to be "unequally yoked" ie we should get someone who's complementary to you in terms of faith. Many people interpret this to mean to marry a good Christian spouse. But I can never imagine myself being with a "good" Christian girl for life, "good" in the conventional sense- goody, holy, upright, virtuous. Not that I like whores or sluts or bitches, but I find that sort of character too er... one dimensional. No offence. We have our own taste.

9. The joy of singlehood- So... it has all culminated in this eh? I was lamenting singlehood for a while, but I realised that if not for this independence, I wouldn't be able to sing country music out loud in the bathroom. I wouldn't be able to spend all that time on running or research or downloading cool apps onto my beloved iPod touch. Or thinking about my calling in life. You see, I'd be too busy entertaining the girl. People have different callings, some to marriage, some to singlehoold. Singlehood is fun!!!

10. I like the humanities more- Yea took some time for me to find out, but I understand Medicine to be an important bread winning trade and as a means to fulfill my calling. You have to differentiate between your mistress and your wife.

11. About differences, and universal acceptance- It's very easy, given a comfortable "elite" background and being surrounded by people with similar religious views, to develop this one dimensional perspective of the world. But I've had experiences which reminded me that people are DIFFERENT, and not always in a way that our personal value systems would accept. But our first approach is not to HATE, but to UNDERSTAND.

Moving on, I find it sad that people use the name of Christianity to denigrate the homosexuals and the pro-choice. I'm not blaming any anti-homosexual or anti-abortion views, but I'm blaming the name calling, the labelling of these groups of people as immoral.

Why this is sad is because Christianity was originally a religion of inclusion rather than prejudice. Christ ate with the tax collectors and prostitutes, and also with the Pharisees. In today's context, He wouldn't simply be dining with Obama or the Pope, but also this very people I'm talking about. Maybe the way St Paul wrote his letters, it would be very easy to interpret this as an open condemnation of the homosexuals, among other "sinners". It's not for me to comment but I'll be judicious about the way I apply St Paul's teachings to today's context.

So, 22 years ago I came out to this world timid and crying, and hopefully I'll live and exit this life in a more chivalrous manner. I suppose it has been worthwhile spending more than 1 hour of beauty sleep writing this little entry and I hope there has been some value in reading it.

Sunrise

2010-10-21T22:11:00.015+08:00

Other than going down to NCC to be a robot, I've been spending much of my time totally hooked on the iPod touch, attempting to furnish it into the most formidable machine on Earth. Other activities include sleeping till 11+ am, watching Taiwanese soap operas, and having Lady Gaga's Bad Romance stuck in my head.

I love holidays.

It has been a long time since I've put anything meaningful down here so let's do. Here's a series of photographs I have been working on- arbitrarily labelled as the Sunrise Series. So, whenever I wake up early for school and I notice a good sunrise outside my window, I'd snap away with my digicam. Here are the highlights:

The different stages of sunrise- Seen in Bintan, Apr 2010

Other than the "Sunrise Series", I did snap away at sunrises overseas. We went to Tanjong Pinang, Bintan, for a mission trip back in April and when everyone was exhausted and asleep in their rooms I got up before 6am to film this series of photos:

Technology rocks

2010-10-20T22:14:00.002+08:00

First post using my iPod touch! So for the past one day or so i have been playing with his gadget, trying to make it into he coolest machine ever to grace the earth. Apps are related to medicine, history, politics, art, astronomy, literature and religion. The music collection is also spectacular. And I still have 23 gb left.

Sometimes when I think about how I have been so absorbed with this machine, I think about what the Luddites have always feared- a world whereby Man is completely absorbed by, even dependent on machines. Like in The Matrix, they consume us and trap us in a completely fake world. Actually you may see that happening now, people who have larger than life online personas but are nobodies in real life- unassuming, even prosaic. I hope I'm not like that.

Joining the Apple Cult

2010-10-18T23:05:00.002+08:00

Right!!... So for my birthday my family have bought me the second best thing to an iPhone, which is an iPod touch... really really happy because there are some wonderful apps that you can download... and they include....

Growth chart
Snellen's chart
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no longer a closet uncle

2010-10-16T00:14:00.000+08:00

Don't drink alcohol

2010-10-10T23:05:00.002+08:00

Life

2010-10-09T23:32:00.002+08:00

When we applied to medical school to save lives and maintain their sanctity, maybe the excitement was too great for it to register that we were only 18, grew up in sheltered environments and had not experienced enough of Life yet. The event that occurred last week only further highlighted a whole host of issues that we as young 20 somethings needed to tackle- stress, competition, isolation. And perhaps there was one irony revealed, that we who wanted to save lives had much to understand about Life itself.

We may have been proven inadequate, but it is from there that we reflect and mature. There was thus this meeting on Thursday to discuss what could be done about the issue. I thought it was a good session for articulating problems and conceptualising solutions, but there needed to be more concrete action taken from there. Nevertheless, it was a good start.

When there are "crisis meetings" like this, ideally it should be MedSoc organising it, otherwise they should be playing a leading role in the discussion. Nevertheless, we shouldn't look to the "system" to change things. It starts with ourselves, with being nice to friends and empathising with people who have problems, since we all have our own. For me, I'm relooking the way I view Medicine, I need to find my way again.

Death and depression

2010-10-06T22:42:00.002+08:00

Forgot the causes of hepatosplenomegaly, electives still giving me trouble, just looked at the past year Paeds questions. What a head banging day. The incidents that happened over the weekend only serve as a gloomy backdrop.

I wanted to write a very unhappy post listing all my grouses but I have thought otherwise anyway.

Sometimes, you see some doctors who are about 40+, 50, or maybe only in their late 20s yet they can remain so cheerful and idealistic. And treat their patients genuinely nicely (rather than pretending). I used to take these people for granted until I realised that they went through 1) a couple of tough years in med school + 2)housemanship + 3) lots and lots of random shit suffered because they were doctors. Now I realise that the fact that they can remain such decent human beings reflect their true inner strength.

So lets just stay strong shall we. It may be a recipe for trouble, getting 18 and 19 year olds to commit to such a draining calling in life, but we are not really that young either. Let's grow up together, though it isn't easy. Time to tackle life by the horns

Catharsis

2010-10-02T14:02:00.002+08:00

It's true, everything I've been doing, from the mundane to the surprising, have been aimed at just one elusive thing and that is catharsis.