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...)


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.


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

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