Post post post MBBS

Just a jumble of thoughts, laid out in minutes while being really tired...

Results:

Passed. Thank You for Your grace Father. I know that passing was nowhere near due to my efforts but rather from His blessings... So much happened during the study period and there was so much I didn't know, even more that I didn't cover. But somehow, the exams were a breeze. I could probably think up 4-5 different papers that could be set in a way that would make me fail but I still made it. Thank You for giving me the wings when You bid me to fly...

Ward work:

Compared to an SIP... I'm now licensed, I now have responsibilities and now am in a position where my words hold weight with the patients. It's a huge transition. And through it all, I'm reminded once again of what a privileged position I hold for patients to be able to confide and trust in me the very first moment I see them. Through their eyes, I'm in a position of power, in a position to be able to help them. But through my eyes, I know just too well the limits of modern medicine...

Just the other day, Mr N came over from a foreign country to seek treatment for his advanced cancer. I could tell the son cared a lot for his father but wasn't too financially capable. Yet, he brought his dad over, as a private patient, to seek help. After a 1 week stay, with multiple consultations with different oncologists, with whatever little English Mr N could manage, he uttered: come to Singapore for treatment, no treatment... shaking his head along the way...

The helplessness, the frustration and the despair... coming all at once.. I didn't know what to say. I couldn't say anything. There are just too many things that even medicine today doesn't know and cannot solve. I'm reminded of the phrase: to cure sometimes to relieve often and to comfort always. How true these things hold. Curing is hard. Impossible sometimes. Relieving is usually done instead. Mr N was discharged on a whole ton of painkillers and nothing more. But comforting.. is something that can be done by anybody for anybody... Just another learning point which can be so easily lost in the practice of medicine...

Coping:

It's tough. It's really tough. Keeping up with the pace of work while still maintaining standards. Expectations are far beyond my capabilities. I can only hope to learn and to improve, God being my helper. It's only a start but I'm physically and mentally drained. I pray hard that I would never be spiritually drained. This is the path that God has placed me on and this is the path I will tread. And while I am weak, His strength is made perfect. LORD, help me to love the people around me just as You have loved me, to go through each day, knowing You are here beside me.

MBBS

So it's just under 33 hours to the final MBBS right now...

Not too long ago, I was ranting about how the biggest irony about the MBBS is it is supposed to prepare us to be doctors. But what I really am doing now, is studying the academically important and ignoring the clinically important. Of course, there are overlaps between these two. But where the overlap ceases to exist, out goes the clinically relevant things and in comes the exam oriented information - because, and only because the big exam is nearing.

Yet, some reason, while this is the biggest exam thus far, my stress level is probably comparable to that of a routine class test. The last minute anxiety induced stress that has always been present for the past 10 over years is seemingly missing. While I am terribly behind time, I'm still studying at a relaxed pace, still able to take breaks, be it with the TV or a random online game - there's definitely time to squeeze in the midst of this mad rush, the mass hysteria that seems to be hitting the batch, and hard. There are so many gaps in my knowledge, or maybe craters will be a better word, but somehow, everything seems fine to me

Perhaps I've been numbed by the countless exams thus far, happening on average once every 1-2 months. Perhaps I've never had this much to study and I'm just jaded by this all. Perhaps I'm just cheesed off by the fact that we're studying for the sake of the exam, more so than anything else.

The study break itself proved to be more than just a break for studying. Every now and then, in came extra obstacles. Other important matters (unrelated to exams) just seemed to pile in during this time. I dare say my main bulk of my stress during this period was from everything but the exam itself. I was being thrown off course by not so random emails, events, various struggles and decisions that had to be made in a short period of time - all while I'm trying to drown myself in notes.

It's been a tough time. Once again, regrettably, I have forgotten God and just left Him towards the end of the day or only spoke to Him whenever I thought I felt like it. When things didn't go the way I wanted them to, I started having more unhappiness instead of more faith. As more things began piling more, these feelings only proved to become stronger, to the extent where I started feeling so tired, so unmotivated, even more so than I was at the start.

However, through the course of this tiresome period, deep down, I realise and I know that God is here by me, walking with me, guiding me along, supporting me. I thought back about all my previous life events, all the big ones. I recall that since the very beginning, being the horrible planner I am, I never really planned anything. But still, things always fell into place. From the time I made the decision to enter the medical field, to the application and even through the past 5 years, I never really made any proper plans. Still, for some reason, everything unfolded so neatly before me. There can only be one reason...

And that is the reason why I believe that, though I am unsure how I will get through this exam, though I am unsure about the future, everything will go smoothly. If God has called me to this path, He will see me through, just as he has been all these years.

If God calls you to fly, He will give you the wings

Recommitment

To recommit oneself... recommit to God. That's always one of the options provided by AC during REW when slips of paper are given out to everybody.

It seems like a good thing if a child of His ticks that box to say, God, I want to recommit my life to you once again. But what does it mean? It means that the child of His has strayed away, not giving two hoots about who God is, not caring about what He thinks, and just living a life like He never existed... To recommit, would mean that that child of God has realised this, and wants to go back into His arms. To recommit, it means that uncommitment had previously occurred.

The past few months have been rough - spiritually and in other fields too. While I found myself drifting, I found myself yearning to be back my God's side... but how many times must I recommit myself to God? How many times must I stray from Him before I truly stay with Him and in His word? How many times must I live my life as if I never knew God before?

Recommitment sounds like a good thing, but on a daily basis? Oh, for sure not.

My LORD, I pray I won't have a chance to recommit myself to you again, for if I'm always committed to You, recommitment isn't an option. May You keep me by Your side, now, and forever more, amen.

M5

Hard to believe that the final year starts in less than 10 hours time.

The past 4 years have been very eventful indeed. Apart from the mundane clinical work and studying on and off, it has been a real eye opener in the wards - learning experiences and heartfelt moments at anytime and anywhere. Doctors, patients, their families, there's always a learning point somewhere if you care enough to look.

The past few weeks in electives has made it even clearer that how much change one can make is really dependent only on how much time you are willing to spend. Everybody has a story to tell which will influence how the perfect care plan for them is carried out. In the general flow of things in the wards, patients are seen as diseases, nothing more. But if we are willing to take that one extra mile to see the disease as a patient, and to treat the patient rather than the disease, so much more can be done. Changing the life of one patient: it may not mean much in the healthcare system as a whole, but it will mean a world of difference to the patient who is being treated.

In the coming year, though unlicensed, it seems that we are actually working as doctors in the wards. Though it may be so easy to forget about these small things that can be done, it will be worthwhile to note that they can make big differences to the patients. I hope and pray that no matter how bad or tiring things get, I will still remember to treat patients, instead of treating diseases.

May the year ahead be filled with opportunities, both for learning, and for changing lives, God being my helper

You are Everything

Lifehouse's Everything Skit - somehow this skit came to mind on the way home. It was first introduced to me during the Khon Khaen 2007 mission trip to Thailand where we felt this video would speak to the Church over there. And indeed it does. It's such a powerful video depicting the Christian life.

It starts from the time of creation, where God brought us to life, making us trees, birds, everything around us, for us. We lived in harmony, living as one with God, enjoying nothing but the sweet fellowship with Him.

Then sin comes in and draws our attention away from God. Passion, greed, alcohol, pursuit of beauty comes in, with many more distractions in our lives, not included in the video. The first sin pulls us from God; our desire for worldly things snatches us away even when we know we want to turn back to Him. With each successive sin, God is blocked out and pushed away from the picture, further.. and further... Until we reach a point, where we become hopelessly empty. Nothing in life seems to be worth living for. Nothing seems to be going well for us. Nobody seems to be around for us. Our lives are just a total wreck, each day just passes in despair, we feel depressed and driven to the brink of insanity...

But, God's love for us is boundless. He sent His Son Jesus Christ to die on the Cross just for our sakes, such that we are able to turn back to Him, regardless of the sin that had possessed us. And as the Bible very clearly states, as we draw closer to God, He will draw closer to us. In a desperate attempt to recommit our lives to God, we fight with our sin. We struggle with them. We may be thrown down and weighed down by our sins which have held us down for so long. But we aren't alone. God is on the other end, pulling us towards Him. He wants to bring us back to Him. He always wanted that, even while we were engulfed in our own lives. In the process of reconciliation, our sin is washed away from us, we are made whole again. And finally, when we can no longer take it, Jesus bears the burden for us. He takes the weight of all our sins upon His own shoulders. He shelters us and gives us refuge under His arms...

It is then, when we repent and seek God, He frees us from what has chained us and we are able to reconcile with Him, and enjoy the Holy relationship that was meant to exist from the very start.

I've probably watched this video at least 5 times now. And each time, without fail, I would tear. I am repeatedly reminded of how I've drifted away from God, but how all these while, He is always there for me, always waiting to receive me again. How He is always ready to shoulder my burden, if only I ask. How true joy can only come when I am in Him alone.

Find me here, and speak to me
I want to feel You, I need to hear You
You are the Light that's leading me to the Place
Where I find peace again

You are the strength that keeps me walking
You are the hope that keeps me trusting

You are the life to my soul
You are my purpose
You're everything
And how can I stand here with you
And not be moved by you
Would you tell me how could it be any better than this?


You calm the storms and you give me rest
You hold me in your hands
You won't let me fall
You steal my heart and you take my breath away
Would you take me in, take me deeper now
And how can I stand here with you and not be moved by you?
Would you tell me how could it be any better than this?
And how can I stand here with you and not be moved by you?
Would you tell me how could it be any better than this?


Cause you're all I want, you're all I need
You're everything, everything
You're all I want
You're all I need
You're everything, everything
You're all I want
You're all I need
You're everything, everything
You're all I want
You're all I need
Everything, everything

And how can I stand here with you and not be moved by you?
Would you tell me how could it be any better than this?
And how can I stand here with you and not be moved by you?
Would you tell me how could it be any better-any better than this?
And how can I stand here with you and not be moved by you?
Would you tell me how could it be any better than this?
Would you tell me how could it be any better than this?

Good Friday

"But the servant was pierced because we had sinned. He was crushed because we had done what was evil. He was punished to make us whole again. His wounds have healed us." - Isaiah 53:5

It's always a time in the year where we once again commemorate the death of our LORD Jesus Christ upon the cross. Being thankful that He has been the sacrificial Lamb for our sins and remembering how we can only come to the Father through Him.

The message of the Gospel is so simple and yet so profound. It all revolves around the love that God has for us, how He wants us to have the best and how he wishes good for all of us. Good Friday is yet another reminder to us about this great love that He had, has and always will have for us. It reminds us that Christianity isn't so much of a religion, but of a relationship.

Grace is giving us what we do not deserve, while mercy is taking away what we deserve.

Psych and thoughts

It's finally the "holidays" (with an EOPT and pros both coming within the next 6 weeks) after 1 month in psychiatry.

My initial thoughts before entering psych was: Great. Psych. That was probably my differential for every presenting complain that didn't make sense to me.

Upon entering psych: This place is a madhouse. I'm probably going to go mad if I stay here long enough!

Well, 1 month has past. Admittedly, I still have my bias against these specialty - probably a major reason is because I simply cannot understand the plight they are going through (and there the doctors are saying that empathy is a very important part of the communication process).

How am I to empathise with them when I fail to understand what they are going through? Do I imagine the same voices that they hear, or imagine the torment they go through when they are infested with thoughts of germs and diseases? Or am I supposed to fake my empathy right in front of them while keeping that straight face?

Yes, I can understand some of the depressed patients, maybe the anxious ones too - surely all of us have went through periods of depression or anxiety, it's just how severe it was. But how am I to understand the delusional people? "There is somebody after me. They are spying on me. I don't know who but I'm very sure they are doing it" And they say it with such conviction that you would think they are telling the truth - if not for the fact that they are right there in the psychiatry ward.

Struggles with patients aside, the psych content itself has given me much insight about.. well, life. Life in general. It can get quite funny how we start diagnosing ourselves and others during lectures as we spot the uncanny similarities between psychiatric disorders and ourselves or people around us. And of course, the usual occupational hazard where everything around us is somehow related to hallucinations and delusions just because this is the psych posting.

Truth is, everything around us IS related to psychology - just that psychiatry focuses more on diagnoses and medication rather than psychology per se. There is always this concept of a spectrum between normal and pathological. Pathological could be defined by the standard DSM-IV criteria or ICD-10 that is being thrown around the wards, lectures etc. But what actually is normal? How is normal defined? If being normal just means not abnormal, then it is simply contained by the definition of pathological that in the first place, has been defined by other humans/psychiatrists themselves.

Going back to how we tend to relate school content to ourselves, it can sometimes be quite scary if we think about situations we are going through in life - could I be going through a major depressive disorder? Could I have a personality disorder rather than just the traits? The list of questions goes on. It even extends to people around us - are they suffering from a disorder, should I recommend them to seek treatment?

Or put it another way, again at the original question: how can I be certain that this current phase of my life can be considered normal? Am I over-reacting to the stimuli around me or is this actually deemed to be a normal response?

On a related, or perhaps rather unrelated note, I did think about something: How does all this fit together when you bring God into the picture? There are patients saying: Mary and Joseph told me to jump; they pushed me off the building. Others are saying: The voices tell me to jump, but the voice of Jesus tells me that these voices are evil - do not listen to them!

It can be quite confounding (for lack of a better word) when we try to delineate what makes a hallucination versus the true voice of God Himself. It makes a world of difference - one guy has schizophrenia which needs to be treated, while the other may very well be receiving visions from God or words of Knowledge and Wisdom. How then, are we able to differentiate these two? A fleeting thought comes to me: If I do hear the voice of God, I may actually be going mad. Or more optimistically speaking, I'm starting to hear God's voice for real.

Perhaps these thoughts are churned out by my mind which tends to go into a whirlpool of questions whenever left idle - which means all I ever do with my life is play and think about these questions. Not very productive indeed.

But sometimes, I find these questions can help to understand ourselves better, it can sometimes help to understand others better. Though I may not necessarily find answers to all these questions, I suppose it is good enough if it helps me to perceive things better in various situations. Whether it is myself, my loved ones, my patients, or even people unrelated to me.

~Just another Sunday night rambling just because I feel like penning out my thoughts~

Death

Prior to the A&E posting, I already knew that I would see the first deaths happening to patients right before my eyes. At that point, I didn't really know how I would feel, or how I would react.

Just 1 week ago, I stepped into the resuscitation room only to see CPR being carried out on a patient - she came in with a cardiovascular collapse, ECG showed asystole and VF at different times. In the midst of the chaos, I found myself rooted to the ground, not knowing what to do or what I could do. So all I did must utter a prayer to God: Father, be with her... be with her...

Minutes later, I heard someone say, "Game over. Stop CPR." My heart sank. I didn't know what to feel or how I felt at that point. Not that I had time to think - the next patient arrived at the opposite bed. Instinctively, I turned to that patient to catch up on what was happening.

She was a middle aged lady who came in for shortness of breath. She looked terrible, what medical people like to call "toxic looking". After a while, it was determined that only dialysis would help her, relieve her and possibly save her. When conveyed to her, her only reply was no, I do not want dialysis. She seemed to ignore us when we tried to persuade her and explore her reasons for rejecting treatment. Yes, we were taught that patients have every right to reject treatment, even life saving treatment as long as they are competent. Even so, something whelmed up in me - I started becoming annoyed, or should I say, angry that she would not even accept something that would help her. I couldn't see how somebody would always literally throw their life away when a life saving alternative was offered to them!

Upon reflecting on this incident, I couldn't find the reason why I would react so strongly when usually I would try to persuade the patient or perhaps, accept her decision because she probably knew what was best for her. I couldn't sleep that night till it was really late, thinking long and hard about the day's happenings... Turned out that fatigue got the better of me before I could put any pieces together.

Just yesterday, another collapse came in, with the CPR machine already on. Assessed rhythm was asystole at first, followed by PEA. Again, I said a short prayer to God, hoping that He would bring life back to this patient... After giving shots of adrenaline and more CPR, there seemed to have hope. His heart started beating on its own, his pulse returned. Just as the consultant was about to take his bloods, again, his pulse disappeared, returning to PEA. To my surprise, the consultant gave the signal to halt resuscitation attempts, stating how adrenaline can give such a phenomenon and that further attempts would not be useful given the history and since he was already brain dead.

Once again, there was this struggle within me. One part of me accepted what was given to me, the other part of me just wanted to continue trying... Medically speaking, further attempts would only be futile, and even if successful, would lead to a poor quality of life, if any at all, for the patient. But somehow, I couldn't rationalise these things on the spot. I could only stand at one spot, watching while the staff wrapped up his body, waiting for a completely flat strip on the ECG to officially document his death...

Many thoughts raced through my mind. Could we have saved him? Did we stop too early? Could other interventions be done? How much should be or shouldn't be done? How many lives can we actually save? Why did God give that shimmer of hope, only to take it away? And alone the same lines... are we actually trying to play God when we resuscitate a person with a collapsed heart?

Later on, upon thinking slightly more... I looked back at the other collapsed patient and wondered what is it in me that makes me so affected by such happenings in the hospital, which are not uncommon especially in the A&E?

Retrospectively, perhaps the past events in my life have really shaped me and affected me more than I thought it would have. I recalled incidents that happened years back and concluded that maybe, it has impacted my life so much, just that I failed to realize it back then.

Then, yet more unanswered questions remain. It ultimately boils down to: What is it that God has in store for me when He has called me and brought me in to this path down the medical field? I don't know the answer really, but I believe that in future, how much I can do will only be limited by how much He is willing to do through me.

Unless the LORD builds the house, its builders labor in vain. Unless the LORD watches over the city, the watchmen stand guard in vain.

What drives you?

M4 has started for a few months now. Currently in O&G which really makes me (or the guys for that matter) feel like a fish out of water. Somehow, I began to dislike this posting - the content, the interaction.... I don't know, it just feels like I'm dragging myself through each day hoping that the weekend would come soon enough. I totally could not find any passion in this area of Medicine. This posting was more of a necessity than actually a learning experience to me.

Incidentally, this HK drama started showing - a medical show "on call 36 hours". Yes, a drama will always be a drama. Scenarios are painted out with the aim of evoking emotions from the audience - some pretty far fetched. But on retrospect, these issues (though spiced up) are actually really real in our daily ward lives... Take for instance this doctor (in the show) who didn't take his work seriously. He just wanted to have fun and was always having problems with this particular patient. But the relationship improved overtime and he realised that he himself could make such a huge impact on the patient who promised to stop smoking if he stopped drinking soda. Unthinkable really but applied to our lives now.... patients have so much trust in doctors, they see them as people who will save their lives, change them for the better and ultimately, return them into the community in the healthy state they once were in... It is things like these which really bring out the rewards in being part of the healthcare profession.

One day over lunch, a casual question was brought up: has there been any patient now (O&G) that has inspired you? I can't remember my answer but I know for sure that yes, there were. In fact, more so here than in other postings. I've met so many patients, highly optimistic about life (maybe not so much their condition) regardless of how dismal it may have been. I can confidently say that the most inspiring patients I have met were over here in this posting.

Perhaps what makes this profession enjoyable and rewarding is really the people you meet, more so than what you can actually offer them - which can be very limited. In fact, what they offer you can sometimes be much more than you could imagine - their outlook of life, how they deal with challenges and the courage that they bring with them. It simply inspires us and gives us that nudge to keep us going.

Ups and downs in life

Just attended Charles' and Li Feng's wedding last Saturday. Part of the sermon went something like: our life is full of ups and downs. What matters is regardless of where we are, it doesn't really matter as long as we have God with us.

I've lately been in the valleys of my life for another mixture of factors and one predominant trigger. Not the first time it has happened and I know that, by the grace of God, it will come to pass. The most dreaded part about these downs is that, while I know God is a gracious God, it somehow happens that these downs in my life always seem to be the times when I'm furthest from Him - and it's when I'm furthest from Him that things in my life start to break into pieces, leaving me all disgruntled and exasperated...

But every cloud has a silver lining; I know that once this period passes, I will only come out stronger and it's by these trials where I learn to depend on God more, knowing that His will reigns above all.

On a brighter note, I'm reminded by Charles and Li Feng that the purest love that can be found between two people is only achieved by seeking Him first and letting Him point you to each other.

Another encouraging thing in my life now is that a good friend of mine is turning to Christ. How infinitely thankful can I be that yet one more person is accepting Christ into his life...

Father, though I walk in darkness now, thank You for showing me the light around me, and things that I can give thanks for. May You be glorified forever more, amen.