Infectious disease

The stark contrast between am and pm.

Situated adjacent to the plastics outpatients, and the fully private "well being" clinic. Lush, soothing, natural colours, pleasant lighting, soft courches and pot plants. Clean toilets. Well dressed young professionals from the ministry of foreign affairs, travelling from Africa, to South America, to SE Asia, and more. Members of parliament who without speaking a word seem to convey, I'm special, don't you know who I am? And a modern day rich man's wife, with an air of superiority, but a silly blond giggle. A huge sparkling ring, perfectly crafted make up upon her aging features, telling us about the nearly thirty porters she will hire for herself and her husband on their upcoming adventure trip.

The secluded clinic, in a building far from the main hospital. An old building, no airconditioning in the waiting room, open wooden windows with faded paint, tired looking plastic chairs. Sit back, don't sit too close to the patient, don't ask them how they contracted it, were the instructions. Men who lived alone, patients who dressed casually, avoided avoided disclosing their diagnosis to even their GP, those who suspiciously asked for bottles and bottles of cough mixture, who were on the methadone program, intravenous drug users (goodness knows how in this place, with campaigns such as the recent posters to party clean - with death and caning cited as some of the consequences for taking drugs). Actually, often you wouldn't be able to tell. The young man with trendy clothes and gelled hair, an average looking couple attending a dual consult, a grandma in a wheelchair.

The closed body language, the dodging of eye contact, the reluctance of acknowledging a smile and nod. Hey, relax, it doesn't bother me, I'm not judging you, and obviously it doesn't bother the doctor either, they take care of patients with this condition every single day. Home is good in a way. I don't embrace or encourage the "lifestyle", but as a country we probably do better to include these individuals as equals, rather than scums, lower class citizens. As sinners, we all need grace. Who are we to say that our sins are minor and acceptable, whilst theirs is shameful and immoral?

Difficult relationships - part one

I haven't been subtle in writing about my distate for particular friendships.

As I write, I know the sentiments are not very loving. Too much unwillingness to forgive and hate, especially for someone who claims to follow Jesus (and reflect his image).

As I write, I do half expect someone to confront me and say - hey, you can't just love those who love you, and be a friend or care for those who "deserve" it. Do you remember and practice the instructions to love and forgive as God has loved and forgiven you, don't you remember what Paul tells the early churches to love each other and be united in one purpose, don't you recall the first Corinthians passage on love.

Well, I did receive the rebuke and correction I anticipated, and needed. Through a book I bought, not for myself, and for a different purpose altogether.

It spoke of the difficult relationships which I would much rather ignore and avoid.

Different friends

"This is my friend..." - that word has so many meanings.

I always say that I have a lot of pseudo friends, acquaintances. I've been surprised to hear people who I would consider "social butterflies" explain that this has been their experience too. I was apprehensive to be back here, because I knew that after a period of time away, I would quickly be disappointed by those whom I thought were friends, but were really just people you (metaphorically) greet and pass by.

Back there the acquaintances were people who I saw weekly, or more, but always kept their distance. Not making an effort there, certainly I don't expect to see their faces here. I don't understand, it's draining, and at times I don't see the point. There are other difficult friendships, here and there. Notably those who shamelessly take without giving, and are constantly selfishly concerned with what is convenient for themselves.

Yet, there's always the beautiful too. Here I'm reminded of the many generous and kind friends. Friends who invite me to their home, are busy but always make themselves available, are willing to be flexible, who welcome not only me but my friends, who are always happy to meet, dine, sing or dance together. Blowing away my cynicism, realising not all friends disappear with time and distance.

And even back in that cold city, there were the friends who were there with me during semester, and during exams. Who, perhaps unknowingly, cheered me up by a few words, or brought stability into my inner world by simply being there, preparing and studying together, zoning out afterwards with our favourite game, a walk, and a food trail through the city. And apart from them, there are a few others in that city with whom I can enjoy chats over meals with, time after time.

You know who you are, your friendship is much appreciated, thank you.

Coins and squares


The image is from a year 12 English past paper.

The story has been told, in one way or another, by several authors. Including myself. The events highlighted, the emotions, the assumed intentions are so vastly different that it has been the ultimate example of looking at the same series of happenings from different viewpoints, perspectives, two sides of the coin, or more accurately four sides of the same square. Which is the real version?

Some were outright with what they saw happening, others didn't see the point in conversing. At one point I would not have accepted that there could be a different spin on the story. You could have, and maybe did, write me off as immature and exaggerated in my response, and I could have just easily dismissed you as clearly inappropriate in your behaviour. Or this time, I would be put off by that seething hatred, stubbornly held onto season after season, and similarly, you would close your ears as you accuse me of being blinded. What is the point, of telling them how I see it from here, and how they see it from there? What is the point, when talk alone never changes what is, and we are each set firmly in our opinions about one another.

Maybe, listening is the first step in acknowledging that your views, and feelings, are worth considering. That you may be right, and I may be wrong, or we both may be right, or wrong. Maybe, when we understanding the back story, the hate and anger will dampen, and gradually be replaced by forgiveness. Not unlike what that psychiatrist said about BPD patients - if you could connect with the troubled little girl behind the anger and chaos, you may be able to care for them better, and be more patient with their behaviour.

Maybe listening does have something to do with patience, loving thy enemy, and dealing with the overwhelming anger and hatred that comes so naturally.

Everyone should be quick to listen, slow to speak and slow to become angry, because human anger does not produce the righteousness that God desires. - James 1:19-20

Side note 1: This time I woke up. And had to think for awhile whether it was real. Then I looked at the orange colours in the bottle and realised it was real.

Side note 2: Not an invitation to extrapolate "truth" in human interactions, to truth in general and say that there is no absolute truth.

Study life - day one

a) Looking at FB
b) Searching the fridge
c) Thinking about useless things
d) Feeling sad, and a bit annoyed
e) Room is getting progressively messier
f) The house is so quiet
g) It's strange not to meet people
h) No class, I thought I would love it
i) Bored, disconnected from the world
j) At least there's a cat on my lap
k) A 10 minute walk, or run
l) Feel like eating, a lot
m) Three lamb chops, yum should be full
n) Another look at the fridge
o) Two oranges, a nectarine, an apricot
p) Mmm, passionfruit yoghurt
q) Maybe I'll have some of that raspberry yoghurt too
r) A packet of Shapes
s) And some raisin toast
t) Still hungry
u) Where do I eat out tomorrow
v) Check deals, and Urbanspoon
w) Elective forms, insurance forms
x) S & S - who wants to meet up?
y) Bored, tired, the songlist is getting old, screechy
z) Sleep

Ongoing

In no particular order:

Section A

I've thought alot about it this week. The time, and resources I would happily give, if it was before. But it's not the same. Of course I've known that for a long time but still don't understand your unwillingness to be open and clear, when we knew each other so well and talked so easily. Not hating you for being loyal, but for your mixed messages. What can you possibly mean by saying you care, and never initiate conversation. How do I interpret you wanting distance, then wanting "occasional" good chats. That time, we talked about having to celebrate our twenty firsts. Then you promised to catch up, saying of course it matters. But it doesn't.

Being in the same city can be far away, when you want it to be that way. You, and that other bro, are the same. Pretending to be old friends, but only there when it's convenient. "I'm quite busy" - I genuinely believed it. I'm good at believing excuses and lies. But now that it's been months, a year or more, it just means to me sorry I can't be bothered to make time, that I prefer to be surfing FB than to see you. Hate to realise it, but we always have time for friends that matter.

Section B

The learning is great. But it's a matter of perspective, on the social interactions. Some weeks are good, and some aren't so. The opportunity is that without a cosy nest, it frees you to mingle with those who are older, younger, alone, different, or just don't really belong - the people who I used to ignore when I had my nest. And leaves plenty of lunches to spend one on one with people outside. But other times, like this time, I feel that it's really going nowhere all semester and that doesn't look like it's going to change. I can't help but hear a mental snigger every time we talk about this place being welcoming. Sorry, about being judgmental. To me it seems that they will politely converse with you, if you look for them to, but save the real conversations, laughs, with the insiders. If you speak the same lingo, have the right connections, then your social calendar will be filled with gatherings and dinners, but if you're not, you will never be invited. It's petty but we all have feelings. If you're inside, you will be given roles as time goes by, and if you're not, I suppose you don't meet the criteria of popularity, which is strangely associated with your commitment. Good thing is you learn to do, quietly, the way it should be done. Maybe if you were pretty, cute, or handsome, and available, they would converse with more interest? Yes I suppose there's no point getting to know someone with whom you have no romantic potential, and anyone who is paired clearly has more than enough in terms of their social needs.

Mmm, that's terribly cynical. Some weeks I am thankful, optimistic even, that this is the place to be. But this time, when I'm meant to be thankful I just feel discontent. And it's sad, knowing that this is supposed to be a hospitable family and be a great symbol of love. If only for the social aspect, the dance class group, or any random club, can be better family than this. I long to be elsewhere, but I do remember that I have a task here, and I will know when it's time to fly away again.

Conferences

Five things I realised:

1. It seems that I can wake up and be motivated to attend things without much problems if I know that there will be morning tea, coffee, lunch, afternoon tea and ice cream breaks. Yum.

2. Not that I needed to do this but - the opportunities for networking with others in the field when people meet face to face. Sure you can contact people via whatever means, but the human touch of real life interactions is irreplacable.

3. Global health, vaccines, and WHO work is interesting.

4. Talks are more about sharing ideas, ways to explore an issue, discussions, debates, inspiring better approaches, rather than purely delivering a lecture on a topic people don't know about.

5. You can have great quality data, do a good research study, or have a great idea about solving a problem. But presenting it is just as important - it just doesn't look very professional if you have your "poster" presentation as a few loose black and white, A4 sheets in the regular size 12 font.

Closing a chapter

Whenever I think back, I feel thankful, and amazed. I've been wanting to write this, but unfortunately thankfulness tends to be easily swept away by dissatisfaction.

First impressions - odd, self promoting, and abrupt. I was offended that first day when you asked me what percentile I was, and quickly came to the conclusion that I was playful, wanting to do the minimal amount of work, and clearly anxious because of my legitimate questions. I thought uh-oh. Actually, I was irritated even before we met, with the months long lags between the email correspondence. My fears were confirmed in the following weeks and months with your unorthodox ways, and how you refused to engage in my questions in a straight forward way.

I was plucking ideas out of thin air, attempting to implement them with the active discouragement of those who were supposed to help. And just when the plans were to be executed, the internal strife, the gossip and knowing looks, and your boss pulling me aside and asking me to pick sides. You went away temporarily and the person replacing your role almost didn't want to do what she agreed to do, when she became angry after seeing that you had taken her material. Then, you left unexpectedly in the last few months, and they said I should be okay to sort things out, myself. Not once did I have any direct feedback about the final product from anyone there, or anyone else, until the process was complete and buried. Indeed, perhaps as you've intended, I've learnt much through the process. But to this day I can't decide whether your method was intentional and effective, or whether the free reign (or negligence, depending how you see it) went just a bit too far. You were right, I was anxious. The uncertainty, and how out of my hands the whole process was, disturbed my sleep more than any exam.

I disliked you intensely, but I read God's word and prayed constantly too - avoid gossip, be respectful, reflect God's character, and work as if we're working for God and and not for man. Over time, the interactions changed, rather - God transformed them. Far from perfect, but workable. In the end, you had surprisingly positive comments and well wishes. And I wrote to myself, "I never thought I’d cry at the end of this whole thing. Cry because of his sickness, because I don’t like to see suffering or hear of suffering to that degree even in the person I once loathed. I have to thank God, thank God and only God for helping me have a neutral and eventually positive attitude towards his strange ways. And thank God for him being receptive to me too."

During the time, when all that felt dark and hopeless, I was also hurt and shattered by the intentional lies of someone I trusted, and weaving through the complications that followed. Like Job, I felt God was sabotaging various areas of my life. I wanted to trust God, that he had good plans for us, that he promised to be with us and never forsake us. Much of the time, I probably didn't believe that, but other times, I did. Since there was no consistent guidance, and I didn't know what to do, I always made the comment that God was the one who was guiding me in this work. So when it came to penning acknowledgments, I thanked all the usual suspects, and (after contemplating whether it would be weird and deciding I had to include it) thanked God for giving me the people whom I thanked, and "for being the source of my purpose, strength and guidance each day." I worked, but it was through (or together with?) what God had given me.

I thought that was it, but there was one last thing. And finally when that was complete, we could close that chapter. There's nothing extraordinary in any of this, but walking with God makes ordinary paths (with its ups and downs) special, and when I look back, I'm amazed at the journey and where he's brought me. Although it's tempting to think I did it all myself - see the passage below.

When you have eaten and are satisfied, praise the Lord your God for the good land he has given you. Be careful that you do not forget the Lord your God, failing to observe his commands, his laws and his decrees that I am giving you this day. Otherwise, when you eat and are satisfied, when you build fine houses and settle down, and when your herds and flocks grow large and your silver and gold increases and all you have is multiplied, then your heart will become proud and you will forget the Lord your God, who brought you out of Egypt, out of the land of slavery. He led you through the vast and dreadful desert, that thirsty and waterless land, with its venomous snakes and scorpions... You may say to yourself, "My power and the strength of my hands have produced this wealth for me." But remember the Lord your God, for it is he who gives you the ability to produce wealth, and so confirms his covenant, which he swore to your forefathers, as it is today. - Deuteronomy 8:10-18

I stop to remember and record, because it's easy to quickly forget. God wants his people to remember, make a monument, mark the milestone. The Passover feast was to be a yearly reminder to the Israelites of how God spared the Israelites who had the blood of the lamb on their doors, whilst striking the Egyptians (when Pharaoh refused to let the Israelites go). Similarly, after the second crossing, God instructed Joshua to command the people to make a stone monument to remind future generations of what had happened.

Furry friend

Why does your breathe smell so bad everytime you open your mouth. It is lovely though, to have your warm body on my lap, and that constant, rumbling purr. Then silence, and lots of ear twitching, as you fall asleep. You're the only cat I've ever really liked. But I'm keeping an eye out on those unpredictable, evil claws that always manages to prod into my skin through my clothes.

Lost in translation

Ha. What a stereotypical, overused title. Oh well.

Our previous hospital was predominantly of Anglo-Saxon background, and throughout the whole year we saw less than a handful of patients who couldn't speak fluent English. This hospital, similar to other metropolitan public hospitals, has migrants from everywhere, Italian, Serbian, Vietnamese, Chinese, Greek, you name it. This time there was an elderly Asian gentleman in the wards.

"He speaks Chinese, anyone speaks Chinese here?" the consultant looked around.

I hesitated, remembering the disapproving tones we had from our tutors at the mention of students being used as interpreters. Plus the last time I spoke in Chinese was an awkward international call to organise my elective. I had said "hello", instead of "喂", and the lady handed phone to someone else saying, "她在说外国话".

But since the Asian intern didn't volunteer herself, I said, I can speak it, to some extent. They wanted to know if he knew where he was, and the day and month. Okay.

"你知道你在哪里吗?今天是星期几?现在是几月份?

Ask him if he's coping at home. That's tricky, I had to think hard, and came up with a half formed phrase (can't remember the exact wording) which he understood and replied that for small things he could handle it, but some of the more strenuous activities were difficult. He seemed happy to be able to converse and be understood properly. And we moved on to the next patient, and I reflected on the experience.

We've had many HP/EP/PD tutorials about using interpreters, and speaking to people from different backgrounds. We're always told, you should always use a trained, professional interpreter. Really? Yes I'm totally far from fluent but if you're asking about which day and month on ward round, how essential is it to find an interpreter. Or, the man in ED with his chest pain who was brought in by his daughter, are you going to wait for who knows how many hours for the only Serbian interpreter in the region, or are you going to ask the daughter who is also able to give good collateral history?

Our teaching has always focused on what can go wrong. The classic dilemma is the scenario where children are used as the interpreter, then they tell you that in their culture, it's better not to tell their terminally ill parent what is going on. See, they say, the children should never have been used to interpret in the first place. Or the example of awkward interviews, and misunderstandings with a doctor who speaks the patient's language as a second language. So the blanket rule is, always use an interpreter. Oh of course, how could people not understand that, I thought.

But now I disagree. Why do the tutors shake their heads when our classmates say they themselves, or the patient's family, were interpreting for a patient? True, there's lots of things that can go wrong in using non professionals, but there's also lots of things that can work better. It's impractical to call an interpreter for everyone who has some difficulty with English and clinician know it. If you work on those principals, how about calling an interpreter for every doctor who finds it difficult to communicate fluently in English?

In our society, it seems that having a certificate is a tick of excellence (and not having one, equals being inadequate). After working in hospitality, I realised that in some places, it's compulsory to have a food handling certificate. Before my hospital placement last holidays, I had to have a "hand hygiene certificate". Our hospital never provided one, so I searched online, answered a few MCQ's and printed myself one from the website. Do you really think there was any difference between my hand hygiene practices before and after the certificate? The point I'm making is that having a professional with a certificate every time doesn't mean you've optimised communication. Look at the interpreter who was called in, only to discover he spoke the same language but in a different dialect to that of our patient. Hmm, (nice man he was but) very useful? Or my friend's experience where the professional interpreter was interrupting the flow of the interview by cutting in, when the patient began to express herself in English. On the other hand, professionals can be great - I saw an age care assessment, and mini mental performed by an experienced interpreter, and it flowed seamlessly.

Consent for surgery, yes you wouldn't want to use someone who fumbled with the language, or emotionally involved, as an interpreter. On the other hand, ward rounds every day with basic questions, the family member can probably do a better job of helping you out with history (since they are often involved in the care too) than the professional.

Four o'clock

I thought today was an improvement.
I wanted to thank God.
But, tossing and turning in bed.
Thinking about waking up tomorrow.
Getting more and more agitated.
I suppose, no one can be expected to keep you company.
Not at 4am. So I sit here and talk, to myself.
Maybe double digits is a bad year,
I hate birth. Days. Not to be ungrateful to my family.
And the friends who wrote me thoughtful messages.
Or C, who always has a lovely word and card.
But they're distressing. Days.
I hoped for quiet, familiar, company.
Instead I dined and talked with a stranger.
A nice stranger doesn't take away the bitterness.
Really. It's been building up for longer, beyond that day.
M, the city of distant ghosts, cold faces.
A place I loved, or a bad and lonely place?
The cars. Deadly trucks. Angry cyclists knocking angrily.
The closer proximity, the heightened expectations.
The distateful mess. The fatigue. And a poisonous aftertaste.
Pointing. It's your fault. No it's your fault.
The inability to say a caring word. How sad.
Sadness is irritable. And sadness. Is isolating.
The episodes makes functioning. Rather difficult.
And sleep. Rather difficult too. Don't think DSM.
I thought there were old friends and new friends.
On good days there are. Opportunities to love.
But on bad days I see the popular, shunning the unpopular.
And lament that it happens at church. Of all places.
It could be seasonal. You know, summer and winter.
The lense needs a cleaning. Dark in darkness dwells.

Bearers of bad news

Earlier in the week it was about breaking bad news in a medical context. On Sunday, it was about prophets being bearers of bad news for God's judgment.

Previously in Amos, we've studied the imagery of God as a roaring lion, warning his people of impending destruction because of their sins. In Amos 7, God gives Amos a series of visions indicating judgment and destruction, and Amos had the task of warning the Israelites.

Prophets were often bearers of bad news. As the preacher pointed out (and as our aged care tutor pointed out), nobody likes to bear bad news. The prophets themselves were often reluctant to carry out the task. When Moses was asked to lead Israel out of Egypt, he said, "O Lord, I have never been eloquent, neither in the past nor since you have spoken to your servant. I am slow of speech and tongue." (Exodus 4:10). Similarly, when Jeremiah was appointed prophet to Judah (southern kingdom, Israel the northern kingdom had already been destroyed), he said “I do not know how to speak; I am only a child.” (Jeremiah 1:6).

What was the response of Israel's priest to the news of judgment to come? Amaziah the priest twisted the words of Amos, slandered the prophet, and reported to the king that Amos was raising a conspiracy against the king. He then said to Amos, "get out, you seer! Go back to the land of Judah. Earn your bread there and do your prophesying there." (Amos 7:12). Oh dear, preaching judgment is unpopular. Would you be offended if you entered a church which preached the bad news - that all will face God's judgment for sin, which will determine if you will inherit eternal life or eternal death?

How about the picture of the holy and wrathful God throughout the old testament who punishes nations with plagues, deaths, destruction, for their sins? Or the same God in Acts, who struck Ananias and Sapphira dead when they lied about how much of their profit they were donating to the church? When we think about "the wages of sin is death, but the gift of God is eternal life in Christ Jesus our Lord," (Romans 6:23) do we fast forward to Jesus' love, and not pause to reflect on how seriously God views sin? I do, often. How important is it to be "saved" when we as the church, are reluctant to tell you about the death you're being saved from?

The old testament God is unreasonable? Would you then happily attend a church which offers blessings, prosperity, an easy solution to all your problems? "God wants you to be promoted! Amen!" (true account from a classmate). Is the God you believe in gentle, meek, forgiving, essentially good? Sin doesn't really matter to him... or does it?

This is what the Lord Almighty says:
“Do not listen to what the prophets are prophesying to you;
they fill you with false hopes.
They speak visions from their own minds,
not from the mouth of the Lord.
They keep saying to those who despise me,
"The Lord says: You will have peace.’
And to all who follow the stubbornness of their hearts they say,
‘No harm will come to you.’ - Jeremiah 23:16-17

It's easy, and popular to preach the "good" news. When we were on holidays after high school, I flipped through one of the books mum bought - Joel Osteen's "Your Best Life Now". I remember reading a few paragraphs and thinking, this doesn't sound right. Later I saw that it was a bestseller in the local book shop - how unusual for a Christian book, I thought. I don't have a copy of the book personally, but it's easy to go online and see extracts from the book:

The Scripture promises: “All things work together for good to them that love the Lord.”  If you love God, he’s working life to your advantage, and it will all work out for your good... At first, it didn’t appear that we were going to be able to find a place to park. A half dozen cars were circling the parking lot, waiting for somebody to back out so they could pull in. I was having a good time, cutting up a bit with my family, so I said to everybody in the car, “You watch Daddy. I’m going to get a front-row parking spot. I can just feel it. I’ve got the favor of God all over me!” On and on I went, really making a big deal about it. Then, to everyone’s surprise, just as I steered our car past the front row of parked cars, another car backed out as I approached. It was almost as though we had timed it perfectly; he pulled out, and I pulled right into the open spot. I hardly had to slow down. Better yet, it was the premier spot in that parking lot. (See more.)

Really, can Christianity solve my parking problems forever? Do you know what all things working together implies? Good times, bad times, joy, suffering, laughter, mourning, blessings, persecutions. Yes, God can plan something as small as giving you a parking lot in a particular time and place, should it be his will. But we're not to "name it and claim it", wrongly assuming that it is his will. I've read a similar book that I promptly took to the recycle bin after reading halfway. It was on promises of supernatural physical healing for everyone. In that case, we will never need to see a doctor, never need to be on tablets, never even need to buy a grave site. God can and does heal, and we are to pray for all our concerns, including those about our health. Yet, can we look at examples of healing and deliverance in the Bible, claiming that for ourselves and ignore the suffering and death of say, John the Baptist, Stephen the martyr, or even Jesus himself? I also wish for a smooth life with no sickness or pain - that would be lovely, but believing in God of the Bible doesn't guarantee that at all.

Bad news and those announcing judgment, destruction, suffering are unpopular. But this is as much part of the Bible as the good news is. For those who do believe in the Bible as the word of God, let's be prepared to hear the truth (not the things our ears are itching to hear), and share the gospel message faithfully (not thinking that we need to change it to make it more palatable).

Preach the word; be prepared in season and out of season; correct, rebuke and encourage—with great patience and careful instruction. For the time will come when people will not put up with sound doctrine. Instead, to suit their own desires, they will gather around them a great number of teachers to say what their itching ears want to hear. - 2 Timothy 4:2-4

Living and dying

"It is better to go to a house of mourning than to go to a house of feasting, for death is the destiny of every man; the living should take this to heart." - Ecclesiastes 7:2

The times where death is in your face. I dug up a few entries from the old blog. The time we heard about the death of our high school classmate, not long after his 21st birthday. Although we weren't close, I knew his birthday well. We shared birthdays. Knowing that this car accident could have been any of us, made us think about the fragility of life. We visited the graveyard. My sister, four years old at the time, came along. I asked her, do you know what it means to die? She shook her head and said uh uh. She asked whether people get dirty when they're buried. I think she knows a little more now. She points out dead rats in the garden to me. She said to mum that she felt sad there when the family went to visit grandma and auntie's graveyard.

Eight years ago, the year dad remembers well. Being whisked away in the middle of high school to be by grandma's bedside when she had metastatic cancer. How I cried when I heard over the phone that she was in a coma. When we visited her, maybe she had a few lucid periods, maybe she teared when she saw us. Surprised that, walking out of the ward, one of the doctors in a white coat was my aunt. Later in the year, the same aunt who had long standing system lupus erythematosus, who was actually supposed to be dead when I was a toddler from bacterial encephalitis, died from bowel perforation after a month in ICU. My cousin was just over ten.

A month before you got sick I called you for the first and only time, on my own accord, with mum's international phone card. You sounded sleepy from your afternoon nap but you were so excited to hear from me. You were always very excitable, and silly. You bought me pretty clothes, and I still have them archived somewhere. I think in the older generation, you're the only one who draws, and you drew brilliantly. How could you, you missed my lovely sister by half a year. We included your name in one of my sister's Chinese name characters, and maybe she's a little similar to you. These years, I want to tell you, hey I'm studying medicine too. Like me, was your decision a last minute one too? After you died, I had a vivid dream where I met you but I woke up and realised it was just a dream and I cried. I don't think often about you, but I had a less vivid dream about you this year, and felt sad again. The first few anniversaries, the family sent emails, poems, reflections, in remembrance. Time passes, grave visits happens less, and this year is the first year that we didn't receive these emails.

Seeing death is an inevitable part of clinical school. The man last semester, who grew progressively worse from his renal failure after making the decision to stop treatment. Shadowing the palliative care consultant last week, we saw people who were alive and walking, but barely. Off colour, thin, in pain, and very tired. Without the spark in their eyes, as mum put it. The grief of the crying daughter, the concerned husband - I see their pain, and I feel incredibly sad. I see the non existent boundary between them, and us, the professionals who give an air of being immune to the infirmities of mortals. And it scares me (the process, the grief, less so death itself). I started medicine thinking, I would care, but at arms length to be able to perform the job properly. I'm not sure what made me think I would be able to do that. Sure, it's easy to switch off the emotional connections altogether, but that doesn't seem right either.

Later in a tutorial, we talked about confirming death and communicating death to family members. Would you talk to the dead person while you perform the physical exam to confirm his or her death? Our group giggled. Like a friend said, we do laugh and joke about death to be able to talk about it. The tutor asked us to say dead, D.E.A.D. She gave amusing examples of how euphemisms can cause confusion with people from different cultural backgrounds. A dead man's son who asked for his father in the hospital, after getting a phone call from the staff that "he's passed on". Since his father has moved to a few different parts of the hospital, the son had thought the father had just passed on to a new ward, hmm awkward. Another story was that of a family who were confused about the treating team coming around saying solemnly "it's only a matter of time", every day. A matter of time til what? They wondered.

Back to the verse at the start - why would a house of mourning than a house of celebrations? Knowing the endpoint sets clear direction and priorities for living. But I'll direct you to the writings of another blog writer to think about that verse.

Love and hate

"Love your enemies and pray for those who persecute you." Matthew 5:44

I hate with intensity. I hate those who hate me, the liars and cheats, those who bask in or misuse their power, the unjust, those who are selfish and cause problems in my life, the two faced individuals who pretend to be a friend but are gossipers. Praying for my enemies - a fellow believer prayed that the person would know God and be saved, and I paused for a long time wondering if I could say amen with sincerity. If Jesus, in his life, dealt with people worse than these individuals, I can't imagine what motivation there would be to love.

The Pharisees hated him, were jealous of his miracles and popularity that they even tried to kill the man Jesus raised from the dead. The Pharisees were self important, love to be praised for their piety, but really, they were hypocrites who loved money and power.

Then, there were his disciples who didn't understand who he was, or what he came to do after being by his side everyday for three years. Worse, one was disappointed that he didn't come to establish an earthly kingdom, and sold Jesus for thirty pieces of silver. The others fell asleep when Jesus asked them to pray for him before he was executed, and ran away, even openly denied to have known Jesus, because they were afraid to be associated with him. Good friends to have, aye?

There was the crowd, by the influence of the religious leaders, hated him, mocked him, and wanted him to be whipped and crucified. Pilate, the judge who knew that Jesus was innocent, but wanted to keep his job and the crowd happy at the expense of a man's life. And finally near his death, the insulting thief who taunted and challenged him.

Is it for people like this (and the people I hate) that Jesus came to Earth, to live and die for? What did God see in these people? If I had every authority to judge, like the disciples I would call on fire upon the people who treated me unfairly, and strike them to their destruction. Make sure they had the humiliation and punishment they deserved. Meekness and majesty.

O what a mystery
Meekness and majesty
Bow down and worship
For this is your God

It's easy to see their failings but I guess, we've also hated you God, hated each other. Like the Pharisees, aren't we often more concerned about feeling good, and having a good status in society, even in church, rather than being devoted to God or caring for the poor? Doesn't our jealousy for the talents of others lead to hate and snide remarks? Like the disciples, how easily is it for us to claim to know Jesus but quickly exchange him for other priorities of this world? Faced with death, would we also deny our God? Like the crowd, doesn't our society also mock God and make all sorts of disrespectful jokes about him? Given the same situation, maybe we would have easily been the unlovable characters.

Surely, it's love that prompted him to respond with patience and forgiveness in life, and an offer of eternal life in death.

"This is how God showed his love among us: He sent his one and only Son into the world that we might live through him. This is love: not that we loved God, but that he loved us and sent his son as an atoning sacrifice for our sins." - 1 John 4:9-10

How about my hate? I try, and ask for help. Try to remember how Jesus loved. That judging others, I will also be judged. That I can't say I love God and "curse men, who have been made in God's likeness". That love is a command. Today I read ODJ and came across an article on forgiveness - praying "as we have forgiven those who sin against us" (Lord's prayer) is an implicit prayer for God not to forgive us, if we harbour unforgiveness.

Psychiatric scribbles

Concentrating hard in class. Or maybe psych just lends itself to visual interpretations.

Many faces:


Bipolar, magic mushrooms, and the wave:


Transforming the mental exam into picture tiles:


(See the drunken rat and more...)

Puzzles

Hello, fellow night owls.
We all love a good mystery.
Playing detectives is fun.

In my profession, and in your profession
Aren't we the experts in thinking about history,
Collecting signs, and sifting through differentials?

Own up and explain why you're prying.
Tell me, is it genuine, friendly interest
Or are you just being sneaky and intrusive?

(I mean seriously, what are you looking for? Psychiatry? - you're in the wrong field. God? The daily happenings? Thoughts and feelings? You want to see how the story unfolds? Are you trying to annoy me? Are you just waiting for a not-so-subtle message like the one that's right here?)

I am cracking the code.
You know who you are,
And I know where you are.

I am watching like a hawk.

Shrinkery

The awkward moment in a role play when your acted role becomes blurred with your own experiences. You begin to wonder if the psychiatrist can feel that the acting is too realistic. They sound genuinely concerned (see, they are good actors, my friend commented that therapists are cheats pretending to care). So genuine, that you begin to worry if they feel that you are the patient. Then, you almost ask the psychiatrist in the middle of role playing for a corridor consult, feeling that, talking to a caring therapist is quite soothing.

How have you been feeling this week? Do you feel like you should cut down on the drugs? Yes, sometimes people self medicate to drown out the difficult feelings. Perhaps you can find some different ways to cope, how about getting out more and scheduling some activities throughout the day. Another awkward moment. The subconscious transformation of the dinner conversation from social to therapeutic becomes conscious.

The disturbing Mount Misery comes to an end as the psychiatry rotation comes to its last week. The only book I've managed to read during semester without major disruptions to my routine - reason being, I can't stand it for more than short spurts on the train, or in between waiting for patients. Freud, penis and mothers, dude, what were you thinking? Insightfully put in the narration, "the real perversion of Freud and analysis was to take the essence of something and reduce it to something else - the present to the past, love to hate, joy to misery, life to death - and to do it under the guise of understanding..."

Ah, so long, the land of slow coffee breaks, sweet normality of working hours and waiting for patients instead of patients waiting for you. Nodding nonchalantly at a patient's printed book of erotic poetry, stalking patients to their house, and calling them through their bedroom window to wake up and open the door to let you in. Goodbye shrinks with their long silences that forces you to say more than you intended, shrinks who have long buried skills in sucking blood or managing medical conditions, shrinks with a beard and long hair slightly neater than your average hobo, the ever patient shrinks who delivers care to those who slap them or threaten to kill them. Goodbye imposter parents, successful entrepreneurs, rock stars, devil's clutching hands, televisions that give special messages, armed robbers, drug addicts, arsonists, and people who blow up like balloons on medications.

I wish I could say, goodbye human suffering. But we'll just be going back to a different sort of suffering. In fact, we can't escape the groaning pains and decay as long as we are in this world. And unfortunately, I don't seem to be coping with my own emotions any better than before these six weeks began. Sad. Only thing I realised is that I do self therapy, alot. Extract from observing today's session. Now, what would you tell a friend? To take it easy. Maybe you can tell yourself that when you're feeling upset. (Tick.) What are some things you can do to feel better? Apart from eating tasty food. (Tick.) Take a hot shower? (Tick.) Maybe rubbing your arm (Tick.) or massaging your own shoulders? Next time I want you to write down what you're feeling at the time and your thoughts (Tick.)

I'm beginning to enjoy doing mental exams on anyone whose demeanor or expression catches my eye. That well groomed, unpleasant, sour faced, distracted and irritable hairdresser yesterday. Lack of insight. Damn you, you cheat, this is how people get sued. Fortunately for you, no one sues for hair because it grows back. I was offered a tailored therapy (not self therapy this time) - now, you feel that she ruined your evening, but is it true? You want to harm her? Jesus loves her. Pfft, why would Jesus love someone like her. Besides, I'm not Jesus and I hate her. But we're supposed to be like Jesus. Okay, still! Distract me.

Oops we've sidetracked. How strange it will be to go back to "real" medicine. But, the benefit is that our eyes and ears will be attuned to another layer of the patient's story. To some extent, what Roy said in Mount Misery will be true:

"Much of what I saw was psychiatric: belly pain, anxiety, phobias, depression, suicide attempts, hallucinating crazies. Before, these had been "turkeys," unfathomable and untreatable, mocked by us real docs and turfed to the shrink or back out onto the street. Now they were familiar, and easy. In a few minutes I got the feel of where this person stood in the world. I had learned something in my year of psychiatry, something about how to listen to intense feeling without flinching, how to make sense of it."

See you soon

Your silliness, affectionate hugs, infectious laughter and quirky questions. After the recent farewell, there's really no reason to go.

But, it's you who I miss the most, always. Because neither of us can communicate well on the phone, neither of us really enjoy Skype. You're the only reason I endure sitting next to big blokes who should really be paying for two seats, and screwing up my sleep cycles by being awake in the depth of the night.

See you soon, you teeny-weeny little girl.

A quiet day

Doing. Emergency with ears tuned for ambulances, a free and blissful holiday, conferences near and far, brunch with my favourite B friends, family and talkative toddlers, measuring waists at the "oversize" station, driving in the storm with poor visibility, switching between anger and melancholy, hate and empathy, chilli pork trotters, singing C-pop and drinking milk tea, and writing, taking photos, chomp chomp, and writing some more.

A quiet day, at home. Lovely easy-going people, the perfect lazy purring cat, two funny, occasionally infuriating, hungry hungry dogs. But two or three months later I'm still thinking about the town, the place, the friends, cooking feasts, the badminton tennis footy, the lake, running past black swans, the home baked goods and fellowship. On a quiet day, can I be back there instead? When my calendar is blank, I uncover this uneasiness about being here. First year I used to love this place with a sense of awe at its night lights and deliciously cheap eateries. Love is fleeting, or at least infatuation is. Bigger is not always better. Community over flashiness any day. Maybe I can hope for a second love affair with M.

Maybe a quiet day is time to clear the distraction and know God, realign that compass. And do some study.

Very early in the morning, while it was still dark, Jesus got up, left the house and went off to a solitary place, where he prayed. - Mark 1:35

Roar of the lion

You are taking a leisurely stroll, or a trek through tough wild terrain. Suddenly you see a hungry lion in front of you. He opens his huge jaws with a roar, baring his teeth, how would you feel? (No cheating, you're not a vet and you don't have access to any anaesthetic agents, no restraints, no cage, just the lion and you with your bare hands.)

"The Lord roars from Zion and thunders from Jerusalem..." - Amos 1:2

In Amos God is likened to a roaring lion. Israel at the time was prosperous, experiencing a time of peace and wealth. They had "beds inlaid with ivory" and dined on "choice lambs and fattened calves", strummed away on harps, drank wine "by the bowlful" and used the "finest lotions". They took pride and security in all that they had. They even conducted religious ceremonies, brought sacrifices and tithes; but they exploited the poor, ignored justice, and were corrupt. For their sins God warned that he was about to bring destruction and disaster on his people. Amos urged the people to heed God's warning. I find it strange that I have fear imagining a wild angry lion, or a terrible earthquake, but feel apathetic or dismissive about God's wrath.

The lion has roared - who will not fear?
The Sovereign Lord has spoken - who can but prophesy? - Amos 3:8

If God roared, how would you feel? What's our image of God? Pastors sometimes mention how churches today emphasise (overemphasise?) on the appealing qualities of God. The gentle Jesus, the forgiving Father, the all embracing, all accepting, all loving God. God of the Bible has great love, but also is holy, just, with fierce wrath against sin. Even in the New Testament, "the wages of sin is death".

God is untameable. Consider God's dialogue with Job:

Look at the behemoth, which I made along with you and which feeds on grass like an ox. What strength he has in his loins, what power in the muscles of his belly! His tail sways like a cedar; the sinews of his thighs are close-knit. His bones are tubes of bronze, his limbs like rods of iron. He ranks first among the works of God, yet his Maker can approach him with his sword. - Job 41:15-19

Can you bind the beautiful Pleiades? Can you loose the cords of Orion? Can you bring forth the constellations in their seasons or lead out the Bear with its cubs? Do you know the laws of the heavens? Can you set up God's dominion over the earth? Can you raise your voice to the clouds and cover yourself with a flood of water? Do you send the lightning bolts on their way? Do they report to you, 'Here we are'? Who endowed the heart with wisdom or gave understanding to the mind? - Job 38:31-36

It's easy to picture the grandfather with a long beard, or the good natured Santa Claus - as some authors put it, a "safe" God. And incredibly difficult, in our society, in our time, to see God as God. Perhaps that's why I find it incredibly difficult to understand why Isaiah cried "I am ruined!" when he saw God seated on the throne, or why Moses and later the Israelites hid their face from God because they were afraid. Not being able to understand the great wrath of God, means I often can't grasp the full significance of the cross and the great grace it brings. Why would anyone feel excited about the good news of Jesus if they didn't see their sins, or if they didn't understand how a holy and just God views sin?

The fear of the Lord is the beginning of wisdom, and knowledge of the Holy One is understanding. - Proverbs 9:10

On that last point

More on the last point. If you have a hunger for information, have an issue you need to sort out, find me in real life, give me a buzz, write to my inbox, instead of creeping like a coward under the shadows of anonymity.

Rare sighting

In a way, I was mourning and burying the dead all these years. But you are actually alive. I know because I caught a brief glimpse of that ghost after almost three years. Almost like the dream where I saw you through the window of an apartment.

It didn't make me freeze, or cry, at least not at the time. And amazingly it made me walk straight past for the sake of not stirring the brewing bubbling pot. I would have never have pictured that to be my response. Certainly I never responded like that in those recurrent dreams.

I've labelled you these years, said you're emo and weird. But no matter what I felt or what anyone said, I never presented a one sided picture - that is, I've often spoken about both the beautiful and the ugly, spoken about the stupid things you did, and the stupid things I did. In these years I never hated you or had any malicious thoughts. In fact, though I'm a pseudo stranger, I probably have more understanding and compassion of where you're coming from than most. And I guess, that's only natural after what was shared. Ha, and especially able to empathise, when history repeats itself - in that, you are partially right.

I wished so, so, so much that animosity would be replaced by healing and a normal friendship. I haven't completely given up. But with this, I've learnt to be more patient than I could ever have imagined myself to be.

Finally I want to address the friends. All that gossip. Does it make you feel special having knowledge about the secret lives of others? But hey, you know what, it's not a secret. I dare you to ask me to my face, and I'll tell you the story from beginning to end. There's nothing about it that I'm ashamed of - though that's not to say there's nothing in it that I don't regret.

Close to heart

Three weeks of psychiatry and I've had enough. The conditions are interesting and I wouldn't mind talking to more of the patients (consumers?) myself, but sitting in with psychiatrists during those long interviews I've come close to nodding off to sleep so many times. Which always makes me laugh because it reminds me of the referral letter I read about a patient having issues with his previous psychologist who often fell sleep through therapy.

Sometimes I go through a psych lecture thinking, I don't want to be reminded. We had the talk about suicide. Oh... is it unusual to be preoccupied with thoughts of death, and plan how you might go about it? If society made it easier to access easy, painless, non-gruesome, high "success" methods, I would be long gone. Is a risk assessment forming in your mind now? I've learnt to throw out those thoughts into oblivion whenever they appear. And walking with God these years, there isn't the thoughts of everything being empty, meaningless, weary - that is the most life draining thought of them all.

Still, when my mood and sadness overwhelms me sometimes I wonder why I have to be stuck in this world I don't feel like I can live in. It seems that small things can tip me into a dark place with this drowning sorrow and thoughts that's painful and hard to shake off. It makes me wonder how I will deal with the bigger issues in life - if I have problems with marriage, if someone close dies, if I get a serious illness. At these times I wonder, why am I going to be a doctor (or, why am I talking to psychiatric patients) when I can't deal with my issues. Physician heal thyself.

Maybe the plus side of all this is that I'm constantly conscious aware of promoting my mental health. Often reflecting to understand why I feel and respond the way I do, consider how I can interact better with other people, talking to a good listener (friend, not a psychiatrist yet), praying and fellowship, getting out of the room even when I don't feel like it, caring about other people even when I don't particularly want to care, write or draw to deal with my feelings, make sure I get enough sleep, have a regular schedule, eat something nice when the appetite comes back, don't try to use alcohol to deal with mood problems.

I recognise that they are people loved by God, they often had a tumultuous upbringing, and well, they have an illness. But I find it seriously hard to respond with compassion and patience at angry, threatening, accusatory patients. Just you wait. I'm going to kill you. I don't know how psychiatrists take it.

I can't make my mind whether I really hate Psych, or if I can grow to love Pysch. I'll have a good think about Psych's effects on my psyche at the end of the rotation.

Psych is following me around. Personification, paranoid delusions. Today's topic at Christian medical fellowship was on psychiatry. Part one covers secular and Christian models for mental illness, and part two covers psychiatric therapies from a Christian perspectives, whether voices are demonic. Part two also briefly touches the question "are Christians delusional?"

The arts students

For years I haven't spent any significant time on campus. Unless you count a quick look around the nightclub-like library, or the trip to buy a bubble tea. But today we were on campus for a conference that involved students from across the faculties, including arts, law, commerce, engineering and us medical students. It's a good time to hear about all those issues like carbon market, global warming, and sustainability that I've never understood. And a good time to learn about other students from my university. I can't help but stare at the arts students. The interesting and elaborate hairdos, the strange clothing, and the ideas.

Mum always said that arts students have a different way of thinking to science students and I didn't quite believe that. But we saw a presentation from a visual artist which really demonstrated the leap from idea to idea, the big picture, the abstract thinking that is baffling to us medical students who are bound to reality (after all, would you really want your doctor to have creative and artistic ways to manage your illness?) The artist's approach to climate change was spreading empathy, spreading empathy is what we need - an empathy virus. Or the sustainable fashion talk yesterday. Sustainable fashion, buying boutique non mass production fashion? Involving the fashion industry to sustainable fashion? To me these ideas are too abstract. How about something practical like stopping clothes production altogether and reusing the plentiful items we already have. Finally, in the afternoon I casually flipped through the student publications magazine with a strong arts bias that is so different from the science student publications. I came across an article elaborately describing the life of pigeons on campus, and another with vivid descriptions of good and bad kissers, and other obscure topics that makes me feel like I'm in a different world.

Their worldview is so different it's fascinating. It's the passionate ideas and visions, without solid grounding in reality or an imaginable mechanism that confuses me. Castles in the air. Innovation? And not to be mean but we're sure some of them take marijuana and the likes to get in touch with their creative side. It makes you wonder, what is the role of our arts students and graduates in society? I guess it's a certain skill set. Ideas and creativity are useful, people who can talk with conviction about something abstract and unclear is useful too. These are some of the more vocal people in society, the activists about current issues, world issues. Any arts students there with a different view?

Organic basis

The psychiatrist today talked about how he feels it's important to do a dexamethasone suppression test on patients with depression because if it comes back as abnormal, patients feel better about having an organic evidence of their disease.

How does it matter?

The tutor likened PMS to mini depressive episodes. I thought about that. I have distinct mood changes before my periods (sometimes, not always), but I can have PMS-like mood at any time. So if I feel emotionally unwell, and on retrospect realise it's due to "hormone changes", should I feel better knowing that there is an organic basis for my mental instability?

One of his slides had this amusing Pyschiatric Hotline joke, of which you can find various versions online:

Welcome to the Psychiatric Hotline.
If you are obsessive-compulsive, please press 1 repeatedly.
If you are co-dependent, please ask someone to press 2.
If you have multiple personalities, please press 3, 4, 5, and 6.
If you are paranoid-delusional, we know who you are and what you want. Just stay on the line so we can trace the call.
If you are schizophrenic, listen carefully and a little voice will tell you which number to press.
If you are depressed, it doesn't matter which number you press. No one will answer.
If you are delusional and occasionally hallucinate, please be aware that the thing you are holding on the side of your head is alive and about to bite off your ear.

Psychiatry

Psychiatry is so strange, dealing with illnesses of the mind. A brain is tangible, but we can't even begin to understand what is the mind and how does that relate to the brain.

So, if I'm asked, what do I say tomorrow?

Sorry, I thought it would be more appropriate for me to take time to reflect on my own psychological state and attempt to stabilise that before coming in to hear and learn about the psychological suffering of others?

I'm reading the psych chapter of OHCS and came across a few interesting things:

1. "If this mirrors your own state after trudging through endless handbook pages, shut this book, and have a good holiday."

2. Preventing suicide (some of it is pretty strange) - "less: poverty & dead-end work; alcohol/drugs; isolation; sexual coersion. More: God; family caring; shared meals; justice; sexual equality; poetry."

Great, I'm glad sharing meals last semester was promoting our mental health. Yum yum.

Back from the grave

This is supposed to be dead and buried. But no, somehow it manages to magically crawl and leap through the dirt, up out of the grave, into broad daylight.

It troubles my mind, it troubles your mind, and yours, and yours. Why do we need to go through this (history repeats itself is your explanation?), what are you trying to achieve with your weird comments, your hate is consuming and you need to deal with it for your own health. And you, I'm most troubled, disappointed about you. Why are you:

1. Careless about how you feel, how you make others feel, how you hurt relationships.
2. Selfish about what benefits you, what is convenient for you, and therefore unwilling to make changes.
3. Impulsive and just plain sneaky by invading people's privacy.
4. Stupid. Not intentional, but foolish. Damage doesn't need to be intentional. I've warned you so many times.
5. Stubborn. Too stubborn to listen.

An empty church

A grand church with impressive music and singing. It wasn't a regular service, and it's fine to use the church as a venue, but it amazes me how empty a church can feel. An empty shell, when the focus is on tradition, architectural grandeur and artistic value instead of meditating on God's splendour. Far from a heart of worship:

"Yet a time is coming and has now come when the true worshipers will worship the Father in the Spirit and in truth, for they are the kind of worshipers the Father seeks. God is spirit, and his worshipers must worship in the Spirit and in truth.” - John 4:23-24

And I wondered as the choir and congregation sang hymns declaring "heaven and earth are full of the Majesty of thy Glory", do you really believe that? I wondered, is it disrespectful to God to offer songs of praise lightly when your mind is turned away from him? Certainly it was wrong for the Israelites to offer blemished sacrifices and complete temple duties with an insincere heart. God told them to stop.

“Oh, that one of you would shut the temple doors, so that you would not light useless fires on my altar! I am not pleased with you,” says the LORD Almighty, “and I will accept no offering from your hands. My name will be great among the nations, from where the sun rises to where it sets. In every place incense and pure offerings will be brought to me, because my name will be great among the nations,” says the LORD Almighty. - Malachi 1:10-11

On a similar note to singing hymns when you don't want to know God, a few weeks ago we discussing why families have weddings and funerals held at churches, for people who are (or were) never interested in God.

Mysterious ways

At least one puzzle has been decoded. I had no idea what you were talking about. Now your cryptic comments still play over in my head. I'm not sure it's something you see and hear, or if it's just what you see through lenses of hate. Out of his hate he says it's your sly schemes, but I'm more inclined to believe you mean well. Of course a friend's word weighs more than yours, but you've planted a seed of doubt and fueled my already heightened sensitivity to such issues. I'm not sure whether to believe your "prophecy" or not. Out of spite I would say no, that's just how you want it to be, that would never happen. But honestly, who knows.

Then there is the mystery that surrounds my friends. It's interesting that I can spend a lot of time with these friends, do lots of activities together, even considering them to be some of my closest friends here. Yet they can give little or no clues at all to what they're thinking, what they think of our friendship. That is, the conversation rarely moves from what is happening, to how they feel day to day. I talk a lot and share a lot with anyone who I have a genuine interest to talk to, and (I can imagine but) can't understand why there are people who wouldn't. In fact it even offends me a little because I'm showing you who I am because I can be bothered, and I'm trying to learn who you are because I care. But you don't want me to know. My guess is that some people are selectively expressive, others are too polite to cause rifts with their opinions, or find it awkward to talk "deep". The mysterious friends, maybe you can enlighten me on your ways sometime.

The way we're taught

The medical curriculum

The only part of our university medical curriculum I remember having strong opinions about is the lectures in preclinicals where highly respected professors or academics in the field would get up and whiz through a topic we have never heard of with heaps of technical terms we (okay, more specifically I) didn't understand. Which, combined with my own bad sleeping habits, made me fall asleep almost every single day. Which didn't inspire my interest in medicine. Worse still, I realised that they would give the same talk in the first week of first year, compared to several semesters later. Actually, some of them never seemed to care who their target audiences were - the lecturer sometimes stopped in the middle and asked, so what year are you guys in? Hmm, tailoring your talk to the level of your students? Learner centred education?

Aside from that, I actually respect the way the university reviews and revises its curriculum, having a dedicated education unit, and constantly updating and comparing its curriculum with other institutions around Australia and around the world. I liked how the weekly problem based learning correlated with practicals and lectures for the week. How in the microbiology and immunology semester, we learnt about the laboratory tests relevant to the case of the week. In clinicals, I enjoyed the mix of clinical time and tutorials, the focus on long cases to help us learn how to take a good history and examination.

Aboriginal health, racism, and on being Asian

Then recently there was an orientation for the rural health module, where we spent three days having talks and doing cases about rural and Indigenous health issues. Having a real interest in the area, and having spent a weekend at a national rural health conference several weeks ago, I was looking forward to the sessions. And gee, they were bad. At the national conference some students commented that even though they've heard about Indigenous health year after year, this was the only time that they began to take an interest in the area. In their experience, Indigenous health has always been poorly taught at their universities - an Aboriginal person would talk about the stolen generation, in an accusatory tone towards a room full of students, over half of whom were Asian or International students. They thought to themselves, umm, neither we nor our ancestors were even here back then.

I had fairly neutral experiences with Indigenous health teaching until recently. This time, we had a panel of Indigenous healthcare workers, half of whom were of Aboriginal descent, speaking to us about Aboriginal health. The first thing I noticed was that everyone on the panel looked at us without a smile. The talk itself, well it was condescending, it showed a lack of respect towards the medical profession. The very thing you told us not to do - that is, to be disrespectful or talk down on an Aboriginal patient, you did it to us. Whilst most of my classmates mentally or physically zoned out, I was busy jotting quotes down as examples of the tone in which we were spoken to:

"One thing I tell you students when you work with me..."

"I always tell the students, the Aboriginal workers can get so much more out of the patients than doctors ever can." Yes we respect Aboriginal liason officers for their insight into culture and community, but Aboriginal healthcare workers also need to respect non Aboriginal doctors and nurses for their medical role.

"Some have the luxury of having me (Aboriginal liason officer) in the consult."

"I don't like taking no very often."

"We are different to everybody else." How about the refugees from Africa, or the elderly grandfather from South East Asia. Do they not need the same patience and cultural sensitivity as an Aboriginal patient?

"Aboriginal people have a sixth sense, they can pick up when people don't like them because of their race. They (the Aboriginal patients) immediately think - I don't like that person, they are looking down at me." Okay, I can make instant (often erronous) judgments about others too.

I understand that they may have had bad experiences with mainstream nurses and doctors. I respect the work that you do. But talking down to future doctors isn't going to help improve Indigenous health. And yes there are challenges Aboriginal people face that other Australians may not face, such as the trauma of the stolen generation, family and community issues. However, when is it your own perception vs real racism?

What would you say if I were to say, hey I don't like the way I'm treated, people are always treating me different. Do you know, when I go to the shops in the supermarket, as I wait in the deli or seafood section to be served, I always feel that other (white, middle aged) Australians are served before me. And my first thought is, it's just because I'm Asian. Or even when I talk amongst a group of Caucasians, and when some people exclude me from the conversation, I think, it's because I'm Asian. Or when tram inspectors come on the train and scrutinise my ticket carefully I think, look, you only chose to come up to me because I look Asian. At times the racism is real, conscious or subconscious, but at other times it's just the way I perceive people's actions.

This is the scenario we're often given - a nurse or doctor said something insensitive, and the Aboriginal patient never trusted medical staff or hospitals again. I'm sorry if you (the panel) or your patients have had bad experiences. But you can't label the whole healthcare system as racist and evil, or avoid healthcare altogether because of the action of some individuals. When I went to a school camp in year five, a group of us went swimming at the local pool. I vividly remember an Aboriginal kid saying rudely, "Chinese, go back to where you came from!" I was upset. How about if I say, I had a bad experience, I'm not going to a public swimming pool again. Or alternatively, I don't want to have anything to do with Aboriginal people because they're racist.

It's unfortunate that we face racism. We need to respect others. Yet only you (and I) can choose how we respond to unpleasant experiences, and how we move on from those feelings you described of worthlessness, anger, alienation. On a similar note, we need to provide appropriate healthcare for Aboriginal patients, and have resources and funding allocated to close the health gap. But, only patients themselves can choose not to drink and smoke excessively, or to break out of the unfortunate cycle of abuse and unemployment (and that must be difficult if that's all someone has ever known, but whilst people can support these patients, no one else can make that decision on their behalf).

We don't deliver babies

The next day we had a group discussion with a midwife. We've heard and continue to hear all the horror stories about the hostility between midwives and medical students (and especially to females). About how medical students spend hours and hours waiting for the woman to give birth, and in the last minute the midwife gives the medical student a task and ushers in a midwifery student to delivery the baby. I'm sure midwifery students have similar stories about medical students. Ah, the midwife vs medical student rivalry.

The midwife tells us about a woman who chose to give birth "naturally" at home, surrounded by her family. But the evil GP or obstetrician advices her against it, and wants to take her away from her family to the local hospital. And she was upset that the doctor was not supportive of her decision, and even called her birth a delivery ("never say delivery - pizza are delivered, not babies," said the midwife). According to the midwife, he (the doctor) said "oh I delivered your baby," thereby not acknowledging her hard work over the last 9 months.

I hope you don't egg patients on to feel that their decisions aren't respected by their doctors. I believe in patient autonomy, yes it's my body, the birth of my child, and I can choose where it happens. But we are such a self centred society. The world revolves around me. If you choose to have a baby outside of well staffed, well equipped hospital where emergencies can be attended to, please don't complain that the doctors aren't bringing all that to your house. Doctors can be arrogant, dismissive, but they aren't the only evil ones. Patients can be selfish, and have unreasonable demands.

I wish I could say that I learnt much in those few days, but I feel that the sessions have taught interprofessional (unprofessional) hate, and portrayed patient selfishness instead of giving me tools to be a better doctor, or work well in a multi disciplinary team. Do you know why I was angry after the sessions? Medical students are prone to tune off when the topic isn't direct clinical, or science content. I care that we learn about rural and Aboriginal health in a way that inspires myself and my classmates to help, and not to dismiss social and healthcare issues as a "complete waste of time."

Have you been to Facebookville General Hospital?

I recently visited Facebookville General Hospital. Wow, the myriad of doctors, nursing and other hospital staff. The types of medical staff range from junior doctors, to registrars and consultants. Across  all the departments you would expect to find in your local hospital - medicine and surgery, ED, maxillary facial, pathology and more.

With patients (eg. The Malingerer and The Frequent Attender), their relatives (The Intense Relatives) and even the Hospital Ghost! Of course, no hospital is complete without the Painfully Enthusiastic Medical Student! If you ever wanted to know what hospital politics are like, or wondered what your doctors talk about amongst themselves, what they think of you, what they think of each other, what they think of the nursing staff, midwives and so on, Facebookville General Hospital is the place to be.

A satire. A virtual hospital, which seems to be based in London.

How you felt

A psychologist talked to us about feels in a consult. For example, if a patient feels angry about the world, the clinician can subconsciously begin to adopt similar feelings of anger and annoyance. Doesn't that also apply outside the realms of clinical consults?

I'm sure it was awkward for you, and I felt awkward too. I bet you would answer "no..." and give me a weird look if I asked, but were you actually nervous. We exchanged so few direct sentences that it can probably be counted on one hand. Sometimes I think, without the external influences we can still be great friends, but sometimes I think maybe we wouldn't be friends anyway. You tell me that the reason you don't talk is because you don't have time and don't like chatting online, but actually, in your own words you stay up til late, sometimes chatting, sometimes just doing random things online. You're inconsistent, I feel like you're either hiding something from me, or purposely creating distances in our friendship and I hate that.

That's okay, we hardly have contact and when we do I can put that at the back of my mind and be civil. Only thing is, whenever the issue comes to mind it makes me feel sad that this is where we've come, and a bit angry at you for making it happen this way.

Edit: Herodotus has advised to look more into transference and countertransference, so for the sake of using the terms in an accurate way, I won't include references to the terms during this post.

Everyone who has been given much

I spent the past year in a small church, in B. We had a fantastic pastor and friendly church members who always welcomed new people, connected them to others who had similar interests to them, invited us for meals and small groups throughout the whole year. I miss that.

Now I'm back in M. There are plenty of strengths about the teaching, the fellowship here, but a conscious effort needs to be made to include those who are not part of the "core" or "in" group. I know what's it like to grow up in a church, and use the mingling time after fellowship as a time to hang out, tease, make jokes with old childhood friends whilst ignoring that person standing alone on the other side of the room. I know I should... but what do I say, he looks so old and we have nothing in common, oh maybe someone else will go up to her - hmm, I've done that so many times even after leaving D and realising that it can be difficult starting out at a new church by yourself.

As a newcomer to B, I was showered with plenty of undeserved kindness, care, attention, out of each family's love for God and the church. So much so that it would be unreasonable for me not to show the same love to others. So much so that on the weekend, when I wondered how I might talk to, or help the newer people in my current fellowship feel at home, I thought back to all that I've learnt subconsciously through what others have done for me. I've been blessed, and therefore I have more to give.

“The servant who knows the master’s will and does not get ready or does not do what the master wants will be beaten with many blows. But the one who does not know and does things deserving punishment will be beaten with few blows. From everyone who has been given much, much will be demanded; and from the one who has been entrusted with much, much more will be asked." - Luke 12:47-48

This time

Who would have thought I would be back so soon. I hope, that I won't leave this rotation thinking why on earth am I living in M.

The second crossing

The first crossing

But the Israelites went through the sea on dry ground, with a wall of water on their right and on their left. That day the Lord saved Israel from the hands of the Egyptians, and Israel saw the Egyptians lying dead on the shore. - Exodus 14:29-30

Everyone's heard of the Red/Reed Sea crossing. We even have the movie/cartoon/musical, the Prince of Egypt, with the Israelites escaping on foot and Pharaoh's chariots closely behind them. Then there is the dramatic scene where Moses splits the waters in two, allowing the Israelites to escape from the Egyptians, from slavery. But have you thought much about the second crossing?

The second crossing

Now the Jordan is at flood stage all during harvest. Yet as soon as the priests who carried the ark reached the Jordan and their feet touched the water's edge, the water from upstream stopped flowing. It piled up in a heap a great distance away... all Israel passed by until the whole nation had completed the crossing on dry ground. - Joshua 3:15-17

The speaker at OCF reminded us of the connections between the Israelites then, and Christians now. The first crossing symbolised the Israelite's freedom from slavery. Sin is often described as slavery, as something that lords over us. And I guess the experience is true - whether it's as obvious as drug addictions and pornography, or something more subtle like greed, lust or hate. Just as God rescued the Israelites, so we too, cross over from being slaves to sin, to being free from sin. That is, we are cleansed from our sins and no longer live in sin when we accept Christ's sacrifice for us.

Don't you know that when you offer yourselves to someone to obey him as slaves, you are slaves to the one whom you obey... what benefit did you reap at that time from the things you are now ashamed of? Those things result in death! But now that you have been set free from sin and have become slaves to God, the benefit you reap leads to holiness, and the result is eternal life. - Romans 6:16, 21-22

The second water crossing led by Moses this time, signified entry into the promised land. Finally, after forty long years of wandering in the desert! In between the first water crossing out of slavery, and the second crossing into the promised land there were many years in the wilderness. Although the Israelites had experienced the power of God in the exodus, many grumbled against God, worshipped idols, and did not hold onto God's promise. God promised the Israelites the land of Canaan, an inheritance, yet it seemed that God had forgotten about the promise, and that it wasn't coming.

Now if we are children, then we are heirs - heirs of God and coheirs with Christ... - Romans 8:17

If accepting Jesus is the first crossing for Christians, the second crossing is the second coming of Jesus, the judgment day. The day feels like it will never come, we don't really understand the value of our "inheritance" (not land in this case, but entering into God's kingdom), and we easily forget the promise. Like the Israelites, we can accept Christ but never make it to the second crossing. We need to always remember salvation, but look ahead to what's coming too.

Who were they who heard and rebelled? Were they not all those Moses led out of Egypt? And with whom was he angry for forty years? Was it not with those who sinned, whose bodies fell in the desert? And to whom did God swear that they would never enter his rest if not to those who disobeyed? So we see that they were not able to enter, because of their unbelief. Therefore, since the promise of entering his rest still stands, let us be careful that none of you be found to have fallen short of it. - Hebrews 3:16-4:1

That means how we live in the meantime matters. We are to live in light of God's promise. And if we truly believe it, above all else our eyes will be fixed on eternal things, on walking and working for God. As the speaker put it, do we live in a way that says to God "I don't believe in your promise"?

Kind strangers

I’ve been told about the strangers who can brighten your day. A kind word, a smile, just asking “how are you.” And I didn’t really believe them. Sure they can politely ask “how are you” – but why does it matter, they know nothing about your life to begin with! Yesterday though, the kindness of a stranger did touch my heart.

Recently I’ve been settling back into the city, and there have been difficulties. The long hours on public transport for a trip that should take ideally less than 10 minutes. The cars, oh the number of cars, the limited parking, with complicated parking signs (9am-5pm 2P ticket Mon-Fri, 9:30-12:30 2P ticket Sat, clearway 4pm-6pm etc). So, I finally found a carpark next to the hospital. But it was a 2P ticket zone, sigh. I only needed 5 minutes to drop off a document. I walked over to the ticket machine and deliberated whether it was worthwhile to buy a ticket… or should I just make a dash in and out of the hospital. Then an elderly man rolled down his window and said, “do you need a ticket, for about half an hour?” He handed me the piece of paper, “it’ll only last until 4:30 though,” he said apologetically. I told him that’s great as I only needed to be there for a little while. I thanked him and he gave me a broad smile and drove off.

It was a simple gesture, just a small piece of paper, and cost him nothing but a little thoughtfulness. Yet it was so kindly given that it felt warm. It helped me to view strangers, and patients specifically, with a bit more optimism. It’s easy to be cynical about patients. If a stranger can affect our mood, our views, then the question to ask is – do I show kindness to strangers? Do you show kindness to strangers?

Want to hear one more story? Back in Singapore, I wrote a short story about another kind stranger.

Singapore has temperamental and excessive weather – from glaring, hot sunlight to buckets of rain that begins to flood the grasslands and pavements. The city has an extensive network of deep open drains and wide canals to deal with the rainwater.

I dislike carrying umbrellas because wet umbrellas wet your bag, and are heavy on the shoulders. Besides, droplets of rain don’t hurt anybody. That afternoon I was walking from the bus stop to the hospital. As usual, cars were jammed because of the downpour, though I’m not sure why cars jam when the rain is heavy in Singapore. Anyway, I waited calmly to cross the road. I waited and felt the rain begin to soak my hair and my long flowing skirt. One car was kind enough to slow down to let me cross.

Reaching the underground staff canteen, a couple of impolite men sitting around a table smirked at me. Perhaps I was paranoid, or perhaps they were really staring at my dripping hair. I ignored them and walked on. Then I came to cross the road, so that I could catch the free shuttle bus back to the train station. The walkways are nicely sheltered, but the crossing was open.

I strolled towards the crossing, knowing a bit more rain wouldn’t make much difference to my current state. I gazed ahead and caught the eye of a young man, dressed well, probably a medical student or a young doctor. He was walking towards me, heading for the opposite direction. He walked towards me, smiled and offered me his umbrella, and I was taken aback. Puzzled I mumbled, ‘oh no, that’s ok’ and he replied, ‘no no, that’s ok’ and changed his direction to offer his umbrella and walk with me. The scene was almost funny. I thanked him and he disappeared with his friend.

Did he pity me? I don’t know. But what a gentleman! I thought. A kind stranger who couldn’t have had any ulterior motives because we were perfect strangers and unlikely to even remember each other’s faces. The experience was surreal.

Those tails

Of the three blind rats, three blind rats, see how they run, see how they run. I love nursery rhymes and fairy tales as much as my little sister does, maybe more. Welcome to my new blog, which is really a continuation of 19-tails.blogspot.com, and "Cheese and Whiskers" (rats-tails.blogspot.com).

Do you know I’ve been wanting to start a new blog for almost a year now? And the part which stops me every time is the setting up process, picking a domain name, picking a name for the blog, setting up the layout. I finally picked a name, and oh no, it's rat related again. Sorry. I was tossing up between rat references and something more along the lines of chasing after the wind (Ecclesiastes). Then there was the difficult question of - should I use Blogger, or Wordpress? After a little experimentation, and much frustration with Wordpress, I've come back to Blogger.

Blog writing has really evolved over the past few years for me, from a cautious experimentation to a method of regular reflections and sharing. My very first blog was a joint blog with a friend, in which I was much more excited about creating the website and coding, than I was about writing. Funny, now it’s the opposite – I love just being able to write and not worry about designing or formatting.

Four years has resulted in hundreds and hundreds of posts. Writing online has always been a delicate balance betweeen sharing, but not going into details about everyone, and everything in your life. Over the years you read back on your posts, some which you would love to keep, some which belong more to the diary than an online media.

Starting a new blog is about clearing a bit of space. I will always write my personal blog primarily for my own reflections, but over the years I have an increasing awareness of the “audience” (both the friends and the randoms) and of God. Over the years too, my focus has drifted away from relationship dramas and emo-ness (?depression). Ah don’t worry, I’m sure there will be occasional juicy posts about relationship issues and dabbles of deep dark thoughts to come.

Many things to say

There are many things to say, but writing hasn't been possible without internet access for the past few weeks. I wanted to talk about the healthcare system, the hospital, the patients, and doctors in D. About packing and unpacking, and leaving the house that has been home for over 10 years. About my darling sister, about family, about the futility of attaining possessions to build happiness. About missing my home (of just a year, but feels longer) in B, about missing the church family there, about settling into M which has always been a cold place - metaphorically. But I will just talk about the last point for now.

People tell me that I must be glad to be back in civilisation - and I, in turn, find it hard to understand how they don't understand that I've never, ever, ever found B boring. Secretly, I think it's city snobbery (although my best friend tells me city kids picture regional towns as outback deserts), and people assuming everyone who is in rural clinical school is there because they couldn't get into metro. It was my number one preference, I loved it and I thank God for a fulfilling year of friendships, learning, cooking and more.

Frankly, I don't miss the life I had two or three years ago in M. At the time there were aspects I loved about it, but hanging out in the CBD or even the prospect of being able to explore a million food possibilities doesn't have the same appeal the second time around. I much prefer the few meaningful relationships to mass outings and superficial chatter that were common in the first two years of uni. I don't look forward to dealing with quirky old acquaintances, although to be fair, I never understood them enough to give them a chance. I definitely don't like the association the place has to my tangled rollercoaster of relationships, although those connections have largely faded in time.

I've gone from being a timid first year, to being nearly in my final year. I'm more aware that I have a purpose for being in M because I believe in each place that I've lived in, God gave me work to do - in school and in ministry, lessons to learn, people to encourage and relationships to build. Approaching these areas of life with a God-centred perspective, rather than for my personal ambitions and desires, is what makes your treasures eternal rather than temporary. Walking with God is what makes the days meaningful, fulfilling. And it is my prayer, that I will continue to walk with God in the coming semester.

"Do not store up for yourselves treasures on earth, where moth and rust destroy, and where thieves break in and steal. But store up for yourselves treasures in heaven, where moth and rust do not destroy, and where thieves do not break in and steal. For where your treasure is, there your heart will be also."

Awkward friendships

A few days ago I was thinking again about the people who have come in and out of my life. Especially the group of students I hanged out with in first year. Surely that was memorable! It is where we first learnt how to cook, how to do our own laundry, how to do our own shopping. That was also the group of people whom I first went to the markets with, explored the Italian restaurants along that street, and Asian foods in the city. I lived with them for half a year and saw them regularly thereafter for at least another half a year.

Yet most of them are strangers now, and worse than strangers because at some point we talked, hanged out, took photos together. I was thinking about why I didn't become friends with most of them. I guess they were always more my ex's friends than mine to start with, and when we stopped talking they stopped talking to me too. Maybe I didn't spend enough time with them, maybe they didn't click with me because we were different (ha, I remember how they used to tease my "Australian accent"). Still, I can't help but feel resentment for the sake of the seventeen year old version of myself. What was wrong with me that you didn't want to be friends with me? Back then, I would want to be friends with someone or a group (haha, the stereotypical thing of teenagers wanting to fit in, maybe) and be quite sad when they ignored me. I guess now when people don't show interest in conversation or prefer other friends to me, I'm less bothered because I recognise that for whatever reason, we don't get on fabulously and that's okay - after all, friendship has to be two ways.

Then last night my mind was bothering me about all the other people in my life that I have awkward relationships with. It was simple when we were little - there were people you liked and were friends with. Then there were those you didn't like, you might hate each other and either be friends again, leaving all that in the past... or you wouldn't talk to each other and never had to deal with each other again. Now I have "friends" who were never friends in the first place, and I wonder what it will be like when I move back to M because I'll be bumping into plenty of them. Friends who I made an effort to be friends with, but who didn't respond. I have friends I'm sure have some underlying dislike for me, but ask to catch up nevertheless, goodness knows why. Perhaps that's a notch better than the friends who hate me and never want to see me again. Friends (that I've known for years) who remove me on Facebook without any precipitant cause, and especially if they are people who I will definitely meet and have to talk to in the very near future. Even if I don't happen to click on their profiles, it's just sooo obvious when you have them in the "people you may know"/"suggested friends" section. I have friends who I get annoyed with, and who get annoyed with me, and I suppose sometimes we get over the sourness and sometimes we don't, but it's hard to tell. Then there's a bunch of people who I don't know, and who don't know me, but we are wary about each other because they are caught indirectly between relationship issues - eg. they're the girlfriend of someone you were close to, or they're good friends with someone who hates you, or they had a strange fling with the guy you're going out with, or whatever the case may be.

I felt sad, thinking about how I've accumulated so many friendship issues that make me feel ergh inside when I think about them. I guess I don't need to think too much about things that have past, but will try to start on a new page when if I happen to meet these people again. Oh yeah, just to keep things balanced - there are a handful of good, meaningful friendships too, and some acquaintances whom I never had the opportunity to get to know better, but would be delighted to do so. It's been better in the past two years since I left M, and I'm not sure if it's the nature of the people I've come across or if it's changes in my own character that has made friendships easier to come by.
 

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