'Tis The Season To Be Jolly

If I've said this already, I'll say it again. I love this time of the year.
More specifically, I love Christmas and all the days leading up to it.
It usually demands little sleep and lots of running around.


Where my time went since the last time I posted:- drove to the beach post-exams.
- played ping-pong badly (thank goodness no photographic evidence of that)
- played mahjong equally badly
- DMMs over late-night ice-creams
- christmas carolling at the nursing homes
- cupcakes


- bbq meat on skewers production line
-carols & songs around the crib
- bargain finds that make the day :)
- too many hours of choir practice
- a southern hemisphere Christmas.. at 34 degrees celsius!
- oh yeah, and passed ze exams
- retreat to the beach for the weekend with kind strangers which gave me the seabreeze, silence, and conversations that I needed to hear.
- yet more charity dinners



Tired today. Will post more substantially soon.
In the meantime, Merry Christmas & a Happy New Year!

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One Soul-ar Cycle of Searching

Today I handed in my forms and admin papers for my final rotation of the year. It has been my first year of clinical exposure. The feelings of incredulity still linger as I write this entry, I cannot believe how fast it has gone. Indeed, the past ten months have raced on leaving me with much mixed emotions and nostalgia for some reason.

Perhaps because I've come to know that I'm grown up. That I have responsibilities. That I am accountable. That I can no longer run.

With a year that has brought me to places I've never been before, within and without myself, I do not know where to begin. Shall I start with the bureaucracy of the system? The wonderful volunteers and professionals I met in the community working for the underprivileged? The dying geriatrics with so many issues, not least of all depression? The marvel of the inflating lung during cardiothoracic surgery? The twenty-something friend diagnosed with lung Ca? The funeral for a twenty-one year-old? The buzz of being able to answer your consultant's questioning? The sudden and unexplained lost of what could have been a wonderful friendship? The swimming sea of mountainous work? The forging of new friendships and the fading away of old ones? The loneliness of being alone. The unexpected and unrequited courtship? The demands of a higher calling?

And perhaps this is why it feels like a year of rollercoaster rides.

I've come to realise that embracing this profession means accepting that there will be moments where you will be lonely, even if you are not alone. Especially when you are not alone. It is lonely because it demands so much of your life away from friends, families and people and places you care about. It is lonely because you place yourself at the most intimate and poignant moments of a stranger's life and then it is expected of you to walk away afterwards. Nobody ever teaches you how to deal with that. So you carry it with you. I hate goodbyes but am grateful for the privilege of meeting.

Without supportive people who are in the same boat, my outlook on this year may have been very different. Because of them, I am encouraged.
Without a source of constancy in my life, this year would be meaningless. But it was not.
For even the smallest crack in the wall is enough to allow the light to enter.

It's been a year that has taken me to polarising emotions. How strange it is to reflect on my tiny place in this world. What wonder!

So the words to sum up this year:
Inspiration.
Fear.
Joy.
Humbled.
Bittersweet.
Incomprehension.
Laughter.
Driving.
Questions.
Path.
Fleeting.
Books.

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Breaking The Silence

I know I haven't blogged in awhile. What can I say, life got busy I guess. It's been an emotionally and physically draining few months. I could go into all the dramatic turmoils, epiphanies and self-discovery journey blah blah that's been this year. Let's not, or we could be here for awhile.

Anyway, ward work and the teams has kept me busy so there isn't a lot of reflection to begin with. One thing I like about it has been the routine it's given me, which is also the same thing I hate - I have troubles saying goodbye. Seven-thirty on a friday night and I can't seem to tear myself away from the team and our septic patient because I can't muster the guts to say I need to go home. Call that abandonment issues, whatever.

This is turning out to be one boring entry. Huh.
I'll write more later when I am more articulate.

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Keep On Keeping On

It's been awhile. Why haven't I updated? Life.
My good friend reminded me to do so again.With all that has happened, there hasn't been a chance to process it all and it's come to a point where there is so much inside and it's starting to get to me.

First of all, the beginning of something that may have been wonderful and the end of it. Realising that no matter how hard you try, reality catches up with you and then finding out you have already chosen the path to take long before without even knowing. When choosing to do med.

At the expense of being ungrateful for the opportunity that's been given to me, I'll say it; medicine is sacrifice. So much sacrifice. So much so that I've been ruminating thoughts of whether it is worth it, and the answer has always been the same. Yes. Don't ask me why, I cannot explain it yet. Still, a part of me feels like I'm mourning the intangible loss, the "what ifs".

So I guess this is my closure. Thank you for everything.

As for my clinical experience, it's been an amazing journey so far. It is a privileged world that one steps into, and it is a brotherhood of the pursuit of good (most of the time). However, I don't feel like talking about it now. It is becoming too much of my life already.

Sometimes I envision the future and I hope it will all fall into place. I sincerely hope to be amongst the ones with something special that survives anything. Need to trust more.

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What A Week!

Five deadlines later... I am grateful to have completed them by the same day.
In the midst of the race with time, I found out one of my friend has lost motivation for studying and deferred. In moments of stress, it made me question myself too - and that scared me a little.
What I do have, is hope that when I do bounce back, my resilience is stronger than previously. And that keeps me going.
Love keeps me going. And grace sustains me.
What this community rotation has done for me, above all else, is that it has made me love humanity more than I ever have.

Chesterton proposes an amazing paradox that I believe is so true and so accurate.

Can he hate [the world] enough to change it, and yet love it enough to think it worth changing? Can he look up at its colossal good without once feeling acquiescence? Can he look up at its colossal evil without once feeling despair? Can he, in short, be at once not only a pessimist and an optimist, but a fanatical pessimist and a fanatical optimist?

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Point My Way

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Funny Way of Showing Affection

Spent four hours today with possibly my favourite people. One reason that makes me pain over growing old too quickly.
This is my second favourite season of the year. When we share the most of our lives with each other in the community.
Struggling to express anthropological issues that plague our time. Help.
Struggling with self.
Eating cold chips and always hoping the next piece is salted.
Tomorrow belongs to you.

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A Tangential Learning Curve

Had my first grand round ever today! Thank you psychiatry. I will probably never forget BPSD now. Don't think I can say the same for bipolar disease and the intricacies of an fMRI machine. Yes, I was indeed fighting sleep and thank you for solving the mystery of the red carpet!
Nonetheless, I sat there and admired the fluidity, articulation and harrowingly complicated presentation. In between drifting off and dreaming of patients that day. (Did I mention I dreamt of bandaging my own leg ulcer a couple of nights ago???)

Moving on.
In the middle of a video conference call today i.e. tribunal hearing for one of the patient, her BPSD and in particular, behavioural problems were outlined. A thought occurred to me. Now, if these bizarre behaviours are manifestations of disinhibition of the prefrontal cortex...what do "normal" human beings carry around in their minds usually??

Another thing of note, pharmacotherapy for psychogeriatric patients is amazingly complex. They both challenge and frustrate you, and I think that's what makes it exciting.

I'm happy to call it a fruitful day. My world expanded a little more, the shades of gray became grayer but I love it all the same.

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Small Victories

Being a lowly third year, the commonest paranoia for me would have to be the "what if I never get there and won't be able to diagnose Px or treat with confidence" feeling everytime one cracks open a textbook, read, and get overwhelmed by the ENORMITY of the body of knowledge (thank you Robbins, you are both a blessing and the source of my self-doubt).

So it was kinda a good thing when every once in awhile one is able to pick up something in the clinic. I diagnosed BPPV and an inguinal hernia this week.

Other stuff I've been up to:

- magistrate/tribunal hearings for psychiatric patients as part of the Mental Health Act
- starting the lit search for suicide research
- venipunctures
- IM injections
- subcutaneous ones
All this before even starting hospital full-time.. I'm both excited and apprehensive at once.

It is these small victories that reaffirms my -dareisay- "passion" for the field. Ok fine, I will probably never reach the passionate state for it, but it does renew my motivation and interest, especially when you realise every story is a human story, and every disease is personal to someone. It's a strange feeling when one sits through a consultation that starts off with jokes, smiles and laughter and then progress to an almost unforeseen emotional breakdown. And it is these cases that makes one feels helpless and out of control. There are things completely out of our control.
I think it'll be a hard thing to deal with that, when you realise that you have nothing more to offer the patient. We treat, but it is Another that cures. It's humbling, and I hope I never forget that.

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A Room With A View

So I've spent now three weeks in my new rotation at a psychiatric hospital. I have enjoyed it because it has opened my eyes to a lot of fascinating faces of medicine. The place is also unique in that it was one of the first - if not the first- institution for psychiatric patients. Some of the buildings were built by convicts and the patients themselves in the earlier day, so a lot of the architecture has a distinct colonial feel to it. And I love this vintage stuff. Here's a photo to illustrate my love affair with archaic and asbestos-laden buildings.

This used to be the living quarters of the medical superintedent in the old days. The house over looks the river with beautiful greeneries and just.. so AWESOME!

Anyway, in between HIMYM procrastination, placement and the rest of my life, it struck me that i'm on a sliding scale into trivia knowledge oblivion. It started with not knowing what was on TV, then it moved to music and now, I have no idea what movies are in cinemas. Is that scary?
It is a little ,that I'm detaching from the world. At least I still know that there are problems in the Middle East but I guess that's only because I'm cheating and know that there will always be trouble in the Middle East.

Speaking of another part of the world, my clinical buddy (who has lived in multiple countries and have been to all continents except one) and I have been discussing the notion of living and working in other countries and culture. And for the first time, I am entertaining the idea. It's strange where life takes you, but it is stranger when your view on life changes too and your horizons are broaden by ideas that you thought you would never have.

I may just be another young, idealistic twenty-something who wants to change the world because leftist social groups in tertiary education institutions say I can. Or I may really have found my calling.
Or I may morph into this bureaucracy-loathing, part-of-the-system, cynical clone in the profession.

Whatever it is, I am happy to have the possibilities.

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I'm Gonna Be A Supermodel..Not Gonna Eat Today Or Tomorrow..

Things I've learnt from my first day in the new rotation:
- doctors do not eat
- they survive on a wide selection of beverage being coffee, coffee and coffee
- stab harder and faster
- there is a wonderful thai&laos restaurant nearby
- must revise anatomy
- misses my last clinical buddy, that's you sand-pand!

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Saying Goodbye

So my first rotation finished last night, not that there were any tears but I am sad nonetheless. Sometimes, when we meet the many faces of humanity, we are left feeling that the answer to all our problems are so simple. No matter our creed, our beliefs, our race, our capabilities, our disabilities, our knowledge, our potential knowledge, our life, or our potential life, if we only recognise the one humanity that we share, things can be so simple.
It is easy to connect, to become affective, and difficult to say goodbye, a bit like the bittersweet feeling of watching our hero going on alone into the wilderness leaving behind all.

It is particularly peculiar of a feeling to step outside the chain of knowledge and watch the passing of generations. In this field, it is the passing of knowledge, of stories, and essentially, of life. It's overwhelming and the image of a grandfatherly figure teaching us the ropes, reminiscing back into "those days..", I will not forget.
And with all this knowledge gathered through hardwork and sacrifice over the many centuries, sometimes I am curious and wonder what the ones who have gone before would say if they can see where we are today. Would they be proud of our progress and how far we've come? What would they make of the separation of the pursuit of knowledge and the common good?

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Time To Make Mud

This research block has been really free and I feel like I'm away from real medicine a bit but it has been good to me. It keeps things in context.
Anyway, tonight was quite busy and we were on our feet the whole night. Multiple facets of life; babies, children, teenagers, adults, elderly. :)

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Explain

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One Thing Leads To Another

I'll try and update this more frequently from now on. After all, this thing was started with the intention that it shall be a record of my experiences of clinical education in mind, albeit it won't be the only thing recorded.

My first rotation is research and so far it's been interesting. I've decided to work on refugee health and will be meeting with the [state's name] Refugee Health Services tomorrow. Although this rotation does not contain much content in terms of clinical medicine, it has been an eye opener. Coming into contact with the array of services just in our local government area alone has been overwhelming.

It made me realise a curious nature of human society. We go to such lengths to help those in need in such a disinterested manner. It's amazing. Throughout all the articles, legislations and policies that I have read, it is often stated as fact: that refugees have mental health issues and it must be cared for. The question was, why? What drives any such concerns? I guess one can argue on the need to maintain a cohesive and functional society, yet, I wonder why a society would choose to adopt displaced people, set up services to help them resettle and provide ongoing care when the return per capita to the state is uncertain and unspecified?

Because I cannot logically answer the above questions in terms of economic, social or structural advantages, I must settle that it is goodwill and the human spirit innate desire for good, for justice and for compassion. Given these desires are sometimes twisted or lacking in some, I'm glad that the ideal of the common good is still with us.

Sometimes, we do not have enough light to see our path to the end, or maybe to even see the middle ground, sometimes we just have enough light to see our next step. And perhaps, that is all we really need. One step will lead to the next. :)

This year, I shall trust more.

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Bottom Of The Barrel

Today school resumed.
And the blog title says it all really...it is the beginning of ladder climbing, not by choice of course, but by circumstance. =P

I hope this fear of sleeping in lectures as I may miss something vital which might save someone's life one day thing sticks. I really do.
This may sound completely craptastic.. but it finally hit me that I chose a path with many serious responsibilities, especially since just four years ago, the thought of responsibilities made me run.

This summer was one of many epiphanies. Realising I had grown up was one of them.

It is time to roll up one's sleeves and get to work, have a purpose and stay focus on it.

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Human Festivities & Drama Drama Drama!

So the MIA status has been due to such festivities that I hope the rest of the world still shares with me, because it's a strange, changing place out there.

I spent the Christmas season carolling with some friends, it is what we do every year. Now before you think of those annoying and cheese-filled jolly santa hats that rock up to people's homes in movies, no, we did not do that. We only sung where we were invited and welcomed. :)

We didn't go away this year and usually, that would mean NYE went uncelebrated. However, I was determined to be out of this house this time. At least in the beginning. A certain houseparty, a certain park near the harbour to watch the fireworks...yet, intertia kicked in, I got lazy (partially heat-inspired, the day was a stinker!). So, I spent the NYE at home, yet again.
The good thing about that though, was that it strengthened my resolve to stop ditching friends last minute in the new year.. and so far, so good!:)

With less than two weeks left before school starts again, must make the most of the summer.
Happy new year!

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