Sunday, September 08, 2019

Everything will be alright once I start running

75km in 3 days over breathtaking trails in Sweden. I signed up for it without a second thought. What a way to kickstart my 6-week of time off from work! To prepare for it, I ran a total of 3 x 10km trails in MacRitchie reservoir (one time even when I was post-call!).

I packed light for my trip as usual, bringing just 1 running vest, running shorts, dri-fit t-shirt (in case it got cold), arm warmers, gloves, full length compression tights and my Vibram Fivefingers shoes. I will discover how grossly inadequate my packing list was in the days to come...

Friday: Stage 1 (24km)
Everyone was decked in their hydration vests and had windbreakers stashed away. There I was in my 2-Iayers, arm warmers, compressor tights and shorts. I felt sorely under-dressed for the cold and what lay ahead.

The run started off well with my Vibram gripping onto every surface with ease. I felt like a mountain goat skipping across the terrain. Trail running works your mind in a way conventional city running does not. One has to at all times plan one's footing, watch for danger and continuously reassess one's plan of advance. Furthermore, trail running utilises more muscle groups compared to city running and this somehow makes it less tiring (maybe it is just the exposure to nature that excites and invigorates me).

At the finish of stage 1, my feet were so sore that walking was almost unbearable. It was then that I realised I did not have enough mileage on my Vibrams prior to this event; my feet were unprepared for the punishment that was metted out. In order to survive stage 2, I decided against the old adage of not wearing a pair of untested shoes on race day - I borrowed a pair of Icebug Acceleritas 7.

Saturday: Stage 2 (29km)
Sleep does wonders. I woke the next day with renewed vigour and less sore legs. The first 10km was amazing, my legs were firing and the shoes provided excellent grip on various surfaces which made running carefree. Things went downhill after that though. However perfect those shoes were, the fact was that I had never broken them in before; my feet ended up broken by them instead. At the 24km mark, I was in so much pain that I decided to walk the last 5km bearing in mind that there was another day of running in stage 3 the next day.

Sunday: Stage 3 (22km)
I woke to a rude shock that ALL my running paraphernalia was soaked from the rain overnight. I left them out to air, using the same attire for all 3 days (I know, I can be digusting). It was 3hrs to the start, there was still time. I wrung my clothing and started to look for tips online for quick drying. To my surprise, there were many lifehacks available! Placing my semi-dry clothing into a dry towel, i wrapped it up and stepped on it to remove excess moisture. I then left them out to air dry.

By the time it was to get dressed, my clothes were damp but almost fully dried. It is an experience to wear damp clothing and socks on a cold day prior to a race. I was at my lowest in terms of morale. My foot was taped up a various pressure points to prevent blistering in a shoe that I was not used to. It was the worst possible way to start a race.

Once we started running though, all my concerns went out the window. Which brings me to my point: everything will be alright once I start running.

1. The cold sorted itself out once I ran and generated heat.

2. My tired legs went into motion after 4-5km once my muscles warmed up.

3. Blisters and pain somehow disappeared when I ran possibly secondary to the release of endorphins or the scenery that was around me.

I played back the last 3 days of running as I was dragging myself to the finish line. Life parallels trail running: you never know what to expect, and have to adapt to the situation and terrain as needed. Furthermore, there are times when you are too tired to go on, but somehow find it deep within yourself to eke out just that little more, placing one foot before another. Repeatedly. You will get there as long as you keep moving. I find this deeply sobering when extrapolated to life.

I will get there as long as I keep at it and persevere. Until then, keep running as everything will be alright once I start running.

Sunday, June 09, 2019

6-monthly reflection 2

This week long annual leave came at a rather apt time. This was my first break in 2019 (not counting the 5 days taken for the exit MCQs). Among the many things jostling for my attention, one stood out the most - my journey in becoming a surgeon.

As to when exactly did I begin to become numb to my work I cannot remember, but I would place the period sometime after my KTPH posting. It was only recently that I realised I do not recognise this person I have become. I was just going through the motion of work, the flame was gone; I was just an outer shell, not unlike a machine.

WHO has now defined burnout in its latest edition of the ICD-11 as “a syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed.” The syndrome was characterised by:
1.       Feelings of energy depletion or exhaustion
2.       Increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job
3.       Reduced professional efficacy

I came across the above while reading some articles about depersonalisation. Reading it felt like I was reading about myself, every word rang true and it was scary. I have always been a very private person, choosing to sort things out on my own rather than seek help. Understandably, I do not believe in counselling - that process was for people who are weak. I cannot be more wrong.

This time away from work, albeit short, has kickstarted in me a process. I have sought help from a Christian counsellor, met up with a lifecoach and very roughly made plans for the next 6-months of 2019. I believe when you are at your lowest point, the only way is up. I have to alter my trajectory if I wish to continue on my journey to become a surgeon.  

“Do you still want to become a surgeon?”

I recently read Atul Gawande’s Complications, the chapter ‘when good doctors go bad’ stood out especially to me. I am sure that if I do not do something about my situation, I might end up harming patients like Dr Hank Goodman. I appreciate that there is a system in place to address this behaviour before it spirals out of control or before someone gets harmed.

The answer to the question above is: “YES”, and I will and must bring about change that is sustainable which will see me through the rest of my career. I am looking forward with fear of the unknown but filled with hope that something good will come out of this. That I am sure of, in the end, it will be OK.

Monday, July 09, 2018

6-monthly reflection 1

Hearing the news felt surreal. I was not surprised as I had already prepared for the worst. It was also the only obvious outcome when I found out that my meeting was scheduled forward. In that instant, I felt an immense sense of injustice. I had completed all the milestones required for progression but I was held back by those 4-months in KTPH.

That posting coincided with the darkest days in my short life thus far. I only managed to trawl myself out of it a few months after. I did not feel a need to share this with anybody and perhaps that was why it seemed like I was ‘out of sorts’ by many during that period. I am not trying to find myself any excuses to pin all of this to, but perhaps the only shortcoming I had was the way I handled it all. I feel that the assessment that I am perhaps still a little too immature for progression is probably not too far off. I am just disappointed in myself, and this feeling had made me a little sore.

For the next few weeks, I allowed myself to let the gravity of being retained sink in. I refused to reflect on the situation and pondered alternative outcomes based on the various choices I could make. It did not help that one of my fellow colleague shared that he was quitting. I allowed myself to entertain the idea of leaving all this behind and just call it quits. I harboured the thought of taking an extended break from work to ‘rejuvenate’ myself and coming back stronger. I told myself I was jaded from work; I was burnt out. I told myself that I could not push on, not in such circumstance.

One thing that any endurance athlete can tell you is ‘mind over body’. I have had personal experiences participating in Ironman Triathlons to know that it is when you reach a nadir in the race that you experience your second wind. You get into a sort of trance state where just a moment ago you wished you were relaxing on your couch. Your body goes into auto-pilot and you just carry on like you were possessed. The thing is, you have to reach that state of absolute suffering in order to experience such liberation. The mind is a powerful thing.

Thinking back, I was acting like a spoilt brat. My mind was weak and it ended up telling me that it was not possible; that this retention was the end. I allowed myself to believe that this was pervasive and permanent. I just cannot deal with failure. My life up until that moment has been pretty smooth sailing. I do not think that I have ever learnt to fail, to pick myself up and go again, to become stronger. I have been blessed and it has made me take many things for granted. This was my wake up call. This is God giving me a life lesson to learn from.

1 Corinthians 10:13 says: ‘No temptation/testing has overtaken you except what is common to mankind. And God is faithful; he will not let you be tempted/tested beyond what you can bear. But when you are tempted/tested, he will also provide a way out so that you can endure it.’

I now take this in my stride. I will use this opportunity to build myself from the ground up, to gain more experience, to become a better person, doctor, surgeon, son, husband, and father. The one thing that has prevented me from taking the easy way out of this situation is my son. Having grown up without a father, I am still grappling with learning how to be a man, a father. I cannot fathom a day where my son comes to me for advice in life and I would be none the wiser. Passing up this chance for growth will then become a life-long regret.

The race is long and 6-months is nothing much compared to the grand scheme of things. I will focus on the bigger picture and continue on even when it seems so tough and that I cannot possibly go on. Then and only then will I experience my second wind, my breakthrough and see the light at the end of the finish line.

Sunday, February 23, 2014

Conversations in the dark

"Thank you for giving me the opportunity to love you."
"I'm glad I did."

Wednesday, February 05, 2014

Building Bridges

Destiny is the bridge you build to the one you love. – Old man in My Sassy Girl

Tuesday, February 04, 2014

Hope, Courage & Faith

3rd February 2014 
Are you coming back tomorrow?' asked one patient as we made our way towards the entrance of the hospital at the end of a long day. Around her, many other patients lie waiting expectantly in their beds for their operation. Some have been waiting since 30th January 2014. 

Nil by mouth, wait, feed; nil by mouth, wait, feed. The demoralising cycle repeated for some patients. 

'Yes we are', I replied with a smile. 'We will be here tomorrow first thing in the morning.' A wave of relief swept across her face. 

'Thank you so much.' Mustering whatever energy she had left against the weight of her goitre, she flashed a megawatt smile. Hope. A very dangerous concept, but what more can these patients do apart from that. It pains me to even imagine... 

It was the end of Day 4 of our time here at the surgical mission. Many were extremely exhausted by now; the 8am-1am routine was not readily tolerated. Furthermore, due to many complicated cases, operations took longer than planned and many scheduled cases were postponed. The list looks much more insurmountable than ever before. Surgeons, anaesthetists and scrubs nurses were functioning from their reserves. 

4th February 2014 - Last day
The inevitable happened. The list was truncated. Patients who came from afar were given priority, the rest were turned away to wait for the next mission. 

'Please swallow.' I proceeded to examine a patient's goitre before he was being put to sleep. Putting myself in his shoes, I was amazed at the amount of courage and faith he needed to have to be here. For some stranger to put you to sleep, to oblivion; for another stranger to explore your neck, where the great vessels lie, in order to remove a lump that has been with you for the greater part of your life. Trust. That is what patients do with their lives, placing it in our hands. 

Today, standing over that patient, I was reminded of the sacredness of our profession. Many times, a patient gets reduced to his or her diagnosis. Sebaceous cyst, lipoma, goitre. We zoom in on the problem and miss the big picture. I am guilty of that sometimes. I find this especially important in the field of Surgery where proficiency is often sought after by performing yet another sebaceous cyst, lipoma or goitre. We become fixated on the diagnosis than the patient. 

Perfection. The art of Surgery is the constant repetition of a skill until that is attained. You owe it to your patients to be perfect, to be the best version of yourself - that is a constant process. 

To be able to put one's hands to work where they are sorely needed is a blessing. You succinctly brought across what I felt. Indeed, it is a blessing to be able to bless others. I am blessed by the patients I encountered through this surgical mission. I just hope that those patients who were turned away this time do not lose hope...

Friday, December 27, 2013

Mount Batur

2:23am. The crescent moon hung lazily in a sky littered by lights invisible back home. There was a certain clarity in that moment, a certain knowing that this was how things were supposed to be. Singapore might have transformed itself from a sleepy fishing village to a cosmopolitan metropolis but not without relinquishing its identity and romantic charm so often documented by travellers in the 70s. Those graphic depictions of the city state can never be conceived by its citizens in this day and age.

The van meandered along skinny roads lighted only by its powerful headlights. Around it, the landscape was bathed in darkness. Over the horizon, it seemed like I was staring out to sea. Houses like lighted ships dot the vast sea of darkness, rudely interrupting its homogeneity. I knew then that I made the right decision to wake up at this godforsaken hour. I was in for something special.

The van pulled up amongst other similar looking vehicles. Around me, like-minded people gathered presumably to make the climb. No words were needed as we smiled at each other. I was introduced to our guide, Made. Conversation came effortlessly. He is a day older than me and works as a full-time trekking guide. Soon, we were joined by Kesti, an 11-year-old girl on school holiday earning a living transporting soft drinks up the mountain for sale. Decked in fashionable Nike sneakers and jeans, she ambled up the terrain effortlessly.

I made it a point to take in everything by engaging all my senses on this climb instead of just focusing on the terrain. I stopped momentarily at various intervals to soak in the experience. Above me laid the mountain, the full 1,717m. The starlight surrounding it served as a spotlight of sorts, lending it some form of stardom. After all, every morning, groups of people made this journey to its peak. Surely Mount Batur enjoyed celebrity status. Behind and below me were fireflies lining the trail like a landing strip albeit a crooked one; the other climbers were spread out comfortably. I looked ahead and stared into darkness; surely there must be groups ahead of us. It was then that I was reminded of what a friend said while we were watching planes one night - light travels in a straight line. Human beings do require constant reminders of seemingly obvious truths for we tend to get lost amongst the cacophony of day to day activities. Soon, I saw the fireflies ahead as the trail zigzagged up the mountain.

Being a Hindu, our guide stopped midway at an altar erected somewhat randomly along the trail to make offerings. Out in the wild and stillness of twilight with only the crickets interrupting the silence, his deliberate act only seemed more deliberate, more pure. I watched on from a distance, not wanting to disrupt his ritual. Taking in all that my lungs allowed, I felt privileged to be breathing this clean, unpolluted air.

We continued heavenward after the short break. 'Sun not wait for you, you wait for sun. You reach top and knock on door of sunrise', Made joked. Another reminder that time and tide waits for no soul. Our party of 5 reached the peak at 5:34am, just as the first sign of dawn pierced through the darkness. Many climbers positioned themselves for that National Geographic worthy shot, braving the cold winds. Others huddled inside a makeshift shelter, a refuge from the elements, in keen anticipation for the much-vaunted sunrise.

I decided to descend onto an outgrowth of lava rock for an unobstructed view. Having severely underestimated the weather, in T-shirt and shorts, I could not feel my fingers after awhile. Deciding to focus on what is before me took away much of my 'suffering'. Ethereal clouds streamed in with the winds and they caressed the mountains ever so gently. God is indeed amazing. Before long, sunlight peeked from behind Mount Abang and Mount Agung like a shy child. Being alone out there on the outgrowth rock allowed me a certain stillness, a sort of serenity. I guess I can understand why the ancients retreat to the mountains to find themselves and to meditate. Nothing else matters somehow when one is up there. The hustle and bustle going on down below is merely ant-like activity; there was a form of dissociation, a beautiful one no less.

I felt that I was meant to be exactly where I was, where stars aligned and made me being there possible. I have never seen a sunrise before in all my 26 years on Mother Earth. It was a disgrace. To defend myself, I did on 3 occasions placed myself in sunrise situations but it was either the weather or clouds that thwarted my experience. Made explained on the way up that the group yesterday was left disappointed by thick clouds but he believes that today will be a success. I somehow knew even from the night before, with quiet confidence deep down inside, that I was going to witness my first sunrise. His assurance confirmed my confidence.


Seeing the ball of fire popping from behind the mountains blinded me. I put on my sunglasses to better visualise the fiery globe of life. Darkness was banished, the cold lost its sting; life begins with a new day.