A train ride to remember

The highlight this week was definitely the travelling to and fro via railway to Ooty. We arrived at the railway station on Thursday at 10pm to catch our 7-hour train ride to Mettupalayam. Throngs of local families laid all around the station waiting for their trains to arrive. We were fortunate to get tickets for our trip having been on the waiting list right up to the moment we left the hostel for the railway station.

After an uneventful train ride through the night, we arrived at our destination the next morning.

Ooty was a 3-hour bus ride up from Mettupalayam and the further we went up, the cooler it became. What a refuge from the heat wave back in Vellore!

We spent most of our time in Ooty sightseeing and enjoying the weather.

Chocolate shop

115th Flower Festival

'New Zealand' looking place

Check out the litter on the ground!

Meditation gives you wings...

My Havaianas snapped but I got it fixed with some rafia =]

Rose Garden

Before long, we are on our way back to Vellore. This time, only 2 tickets were confirmed and having no choice but to return for posting the next day, we bought 4 general class tickets. Travelling in general class is strongly discouraged by many online websites and travel books, and we are about to find out why.

At the second stop, the 2 girls went over to the guys who had the 2 tickets in third class, leaving the 2 of us to rough it out for the next 6-hours. It is really amazing to see how the locals manage to find even the tiniest of spaces to sit or lie down. Some even improvised a hammock from their saris to coo their babies to sleep. It was really an eye-opening experience =]

Public humiliation at its best

Time seems to fly by and soon we arrived at our destination; we survived the train ride and are proud of it!

The Heart

Heart: A hollow muscular organ which by contracting rhythmically keeps up the circulation of the blood; the seat of the affections or sensibilities, collectively or separately; the inmost or most central part of a thing; the most important or vital part.

The heart is a very mysterious thing. Being attached to Cardiothoracic Surgery this week, I came face to face with it beating inside a human chest for the very first time. That moment, everything around me seemed less important compared to the perfect synchrony of the dual pulsation made by that muscular machine. The heart is an engineering marvel; it promises you what no other thing can – beating for every single second of your life from the moment you were born till the moment you breathe your last. The heart never fails to amaze me in that it NEVER rests!

However, this loyalty comes at a price. The heart can take years of insult without flinching because it was engineered with reserves. It learns to deal and cope with the numerous atrocities we commit against it until it is too late. I have seen patients with hearts encased in fats and wonder how do us humans treat our bodies? It boils down to one simple truth: we took it for granted.

As with many things, once you start taking something for granted, you stop working at it. When that happens, everything goes downhill from then. Is it any wonder then that matters of the heart also suffer the same fate when we take the relationships we have for granted?

I have learnt something today. Whether be it the heart as an organ or the heart as the other definitions stated above, one must never take it for granted.

My virgin local railway experience

I set off by foot from my hotel at Chennai to Egmore railway station on the suggestion of the counter staff when I asked how do I get to Chennai airport other than by auto-rickshaw.

Before long, I was at the station. The walk there took about 5mins as estimated by my information provider. However, chaos ensued as I was the only Chinese person in the ticketing queue. Every local acted like I did not exist, even the ticketing agent! Even though it was my turn to purchase a ticket, everyone else leapfrogged me and got their tickets. I was seriously pissed. I pushed and shoved the locals to get out of that hell hole and after asking around, realized that I was in the wrong queue!

Ticketing hell hole

The railway system is similar to Singapore's MRT

Gosh. I then made my way in search of the right ticketing counter. That was when I met Prabu, a friendly local who was going to the beach with his girlfriend/wife. We both needed tickets for the same platform albeit our trains travel opposite to one another. He brought me to the counter and even helped me foot the extra 1 Rupee for my 6 Rupees ticket as I only had 5 Rupees spare change with me. He told me to ask around for help in Chennai as the locals are very helpful. This was very true! After spending a week here in India, I have come to realize that as long as you ask, there will be someone who will help you. Everyone here is very friendly and helpful (except for those buying railway tickets!)

For the brief 10 stations journey on my virgin railway ride, I felt like I somehow got the stamp of approval from the locals in the same cabin as I was. I was living India.

I have made it to my destination!

Things in context

I love ice-cream. All kinds of them…Today, after a hot day of travelling, I bought a popsicle while waiting for the bus to arrive. A little local boy saw me and started pestering me. I thought he was begging, hence I passed him whatever coins I had with me. This did not satisfy him; he kept at it, refusing to let me enjoy my popsicle. I chose to ignore him at first, but afterwards, I realized he was pointing to my popsicle and the ice-cream stand.

Therefore, to test my hypothesis that he was like me, an ice-cream fanatic, I took him to the ice-cream stand and got him a popsicle at S$0.30. He was finally satisfied.

It is so ironic that the same S$0.30 that some people would die trying to save could make the day a little better for that little boy. I have no idea whether it made his day, but if I could just make him happy during the time he ate his popsicle, I think that it is a good thing…

Ugly tourist

Since when did travelling become an activity like visiting a zoo where the tourist pays and expects to ‘experience’ something? The tourist adopts a condescending attitude in his interaction with the locals, often oblivious to the numerous insults spoken behind his back (or into his face) in their native tongues. He sees travelling as a service industry – I pay for it, I deserve it.

Since when did saving S$0.30 become of utmost importance that people make enemies out of possible friends? In my opinion, the art of bargaining entails a clause stating that both parties should benefit from the deal. S$0.30 might not mean much to us, but it straddles between the ‘hungry’ and ‘full’ line for some locals. More often than not, the ugly tourist benefits, and the local, in order to minimize his losses, strikes a disadvantageous deal. He has no choice, and the ugly tourist often forces this hand. I like the way Bernard views this issue, “I don’t mind paying that extra bit because it doesn’t amount to much when you convert it back and you make the provider of services happy, adding further to the global positive experience of the whole trip.”

No doubt, tourism has evolved over the years into a sort of service industry. People will do all sorts of things to never experience hunger ever again. Hence if they know that ignorant fools from abroad are coming to throw money at them for something they wish to ‘experience’, they will lap at it. There is however a substantial population of backpackers who have managed to preserve the loss art of travelling. They do not pay for experiences, but often get them via communication, genuinity in interaction and love.

I strive to hold myself to the higher standard of a traveler. The traveler knows that he is but a passer-by in a native land and views the locals as fellow human beings; as equals. He immerses himself into the heartbeat of the native land and connects with its life source. The tourist, high up in his ivory tower, often misses out on this aspect. Even if he claims to have experienced some semblance of an immersion, it might not be as authentic as the cash he paid to ‘experience’ it. Hence, the tourist usually returns back home thinking that the trip was ‘nothing much’. The traveler’s experience can never be bought with any currency in the world. He has with him the arsenal of human interactions and connections. He often returns home a humbled person...

 

"There are no strangers, just friends we haven't met" - Professor Low Cheng Hock

Unexpected...

Riding to the hospital is becoming more and more of a routine for me nowadays. However, this morning was something different. I came across a road block on the route I usually travel on. It was a no go. I then asked the officer which way I could take to get to the hospital, he mumbled something in a language I did not understand (thankfully he gestured too). I figured that there must be a detour from the other side and hence decided to explore a new route to get to CMC from Modale. I turned my bicycle around and rode off in the opposite direction, praying hard that I will eventually arrive at CMC somehow.

The new route has less traffic and the road was smoother. It was like a small winding lane where stallholders are busy setting up their businesses flanking the lane. I rode until I saw something familiar then took a turn unto the main road. I had successfully detoured the road block after about 10-15mins of ‘gut instinct’ navigation. It was a wonderful experience having learnt a new route.

I joined my team at the wards where we completed rounds and proceeded to the clinics. All I wanted to do today was to leave after the morning clinics as I wanted to rest before travelling to Chennai later in the day. Somehow, whenever you wish for time to pass faster it slows down; whenever you wish for time to slow down it passes faster. Time seems to be our eternal enemy…

I thank God that I stayed until the end of morning clinics for I had on several occasion felt like leaving halfway. I left today a humbled person for the patients that came in taught me so much and impacted me in so many ways…

The first case was this man who has bladder exstrophy. Prior to today, I have never heard of such a condition before! Apparently, it is quite rare. There is reading up to do tonight…

The next case was this 12 year-old boy suffering from end-stage renal failure awaiting renal transplant. He looked jaded and frail in his dirty clothes, but his eyes and actions told a different story. He was a fighter. He is fighting to live. I later learnt that Dr Ravi has put that boy’s medication on the department’s tab because he is too poor to afford medication. At that moment, it occurred to me that this boy could very well have been fighting all his life – he has got the survival instinct.

I have always felt that modern human beings have lost the edge. We have lost our animal instincts; the most basic primordial instinct needed for survival. Throw a businessman into the middle of a jungle and I bet you he will not survive. We have been too accustomed to the comforts of life – air conditioners, computers, television, mobile phones, cars and the list goes on. Without these inventions, I firmly believe that many of us find it hard to ‘survive’. However, think about it, are all these necessary for survival? I like what Tyler Durden says about such things in Fight Club,

“The things you own end up owning you.”

“It’s only after we’ve lost everything that we’re free to do anything.”

Human beings are being caught in this viscous cycle of consumerism. We are always on the prowl for the latest, the best. We feel that owning such things define who we are, but do they? Society defines a man to be beautiful when he has status, possessions, and achievements. Now, strip him of all his statuses, possessions, and achievements, is he still beautiful? Does his nakedness, his core still reflect that beauty? Many times the answer is a resounding no, because more often than not we focus too much on the outer man. We heap tons and tons of resources building thick walls on the outside and neglect fortifying the inside. At the end of the day, everyone is just an actor involved in a play called life; everyone is living a double life; everyone has a façade. Are we truly living then?

The next patient who came in presented with a recurrence of his Hodgkin’s lymphoma. When his mother was told the news, she fought hard to hold back her tears, appearing strong for her son who seems to have given up the fight. He appeared nonchalant.

How many of us fail to give thanks for the greatest gift of all every day? The gift of life. We let ourselves be caught up in the rat race, often pushing our bodies beyond what they were created for. Even robots and machines need rest! I find myself to have also at times taken this gift for granted. It is time to cherish what is important and see things with an eternal perspective.

Lastly, there was this 14 year-old boy with a new presentation of a left scrotal mass that has been there for 10 years. I was told to examine him, and I carried out the inguinal hernia CEX. I have never successfully reduced and occluded the deep ring preventing the hernia from re-forming. Today, it worked like what was described in the textbooks! When I removed my finger and told him to cough, the hernia re-emerged confirming my diagnosis of an indirect hernia probably secondary to a patent processus vaginalis. He was listed for a herniotomy =]

Learning here in CMC is a new adventure every day for me. Like a child receiving a Kinder Surprise egg, I find myself not knowing what I will get in a day at the hospital, and I like that feeling…

Paediatric Surgery

I realised something interesting this morning...that I took as fast as the local bus on my bicycle to the hospital. Perhaps it was the early morning traffic where the number of vehicles on the road was significantly lesser compared to the afternoons and evenings. Maybe it could be due to the fact that the bus has to stop at every stop while I rode on. Well...

As I reached the ward, Dr Ravi told me to grab a chair from the nurse counter. I pulled one and was unaware that a computer wire was around one of its legs; the CPU crashed onto the ground and the screen turned hazy. I was at a loss for words. There I was standing stunned in the middle of my team with the senior doctors present. I am so screwed, or so I thought. What came next was a reaction that totally took me by surprise.

"Nice work Norman, I always wanted to do that, seems like you did it for me."

"Great! Now we can get a new computer!"

There was a buzz and soon the attention was taken off me and diverted to the computer. It was really a funny experience I must say. Everyone here is super friendly and willing to teach. Ward rounds are a joy as the doctors explain each case and you really learn a lot from them. One thing I realised today at rounds was that sometimes in life when there is no one the patients can place their hope on, including the doctors, they turn to God (as this is Christian Medical College hospital). I see bibles on beds, people praying in the Chapel and I come to the conclusion that at one's most desperate hour, one will seek a higher power or being for hope.

After rounds, I went to the Operating Theatre where I spent the next 8hrs of my day. As there was only two doctors present in my team today, I was 'hired' for the day. The most memorable surgery I encountered today was this 14 year-old girl who presented with a pancreatic pseudocyst from pancreatitis secondary to gallstones. She was scheduled for a cholecystectomy and pseudocystojejunostomy. I had no idea what the latter was and hence was pretty excited to see it. Apparently, Dr Ravi was going to surgically connect the pancreatic pseudocyst to the jejunum so that the contents of the pseudocyst can drain into the bowel. A Roux-en-Y anastomosis was performed. I was particularly impressed with the skills of the surgeons here. They operate with confidence and have very sleek handling of their equipment. The best part of the surgery was witnessing the two anastomoses being sutured to perfection (such a procedure is usually done using high-tech staple guns in Singapore). One of the main reasons why I chose to do an elective here in India is because I wanted to see how Medicine is being practised in its most fundamental form - no frills. After that operation today, I knew I was in the right place. I always leave the OT learning something new =]

After leaving the OT, I had an early dinner, went to the Chapel and then cycled back to the hostel to settle my laundry before I leave for Chennai tomorrow. The weekend beckons and so the fun begins!

Coincidence? I don't think so...

I am barely into the Preface of Fearfully and Wonderfully Made but I know without a shadow of a doubt that it is by no mere coincidence that I have brought this book up to read in India.

3 years ago, Jesselyn bought me In His Image and after reading it, I was on the prowl for its prequel - Fearfully and Wonderfully Made. The search for that book took quite a while as major bookstores in Singapore did not have stock. I managed to acquire a copy after about a year of persistent trying.

It might come as a surprise to many why I am only reading the book now and not back then when I bought it. I do not know the reasons too, but I can be pretty certain that schoolwork played a major factor. As the months and years pass by, it laid in the midst of my ever increasing 'to read' section of my bookshelf.

Last week, while packing for my trip, I decided to clear some books from that section, and Fearfully and Wonderfully Made caught my eye. It was like the other 20-odd books were not even there. My eyes were only focused on it. Little did I know, the series of events that unfolded would sweep me off my feet...

On Monday, during the welcome speech, I caught a glimpse of a familiar name in the background, Paul Brand. He was the co-author of both Fearfully and Wonderfully Made and In His Image!

Paul Brand's Medal in Orthopaedics

It was then that I realised that I could very well be doing an elective in the very hospital that Paul Brand worked in and served. It was as if I was tracing his steps in history. Prior to making it here, the word Vellore was just another name of a city to me. It was just a word. However, reading it in a book and being here at the moment of reading somehow gave me an invisble connection to Vellore. I felt like I had all along been destined to be here some point in my life - now.

A few pages more revealed that in India where less than 3% of the population claims to be Christian, nearly a fifth of all medical work is performed by Christian doctors and nurses. This is the ideal place for me to experience first hand about missions! This tied in perfectly to what happened on Sunday...

After my practical paper, Weihao and my discipleship group met at my place for our monthly session. If given the choice, I will very much not like to have the session and just have some down time before my evening flight. However, a commitment was made to one another at the very start that attendance for each session was imperative. Therefore, I denied the flesh as it was the right thing to do. During the session, we discussed about spiritual gifts and uncovering them. At the end of the session, we also shared about how we are going to make use of the 1-month before the next session to better identify our individual gifts and areas of ministry. My specific task is to share the gospel with someone in India, preferably through the healthcare system.

As I flipped through the pages, the words that I read resonated so strongly with ideals and beliefs that I have held on to for the longest time. The words rekindled the ember that was almost extinguished in my heart into a raging fire that is burning brighter than ever. It reminded me the reason why I chose Medicine - to uncover the greatness of God through the study of His greatest work, the human body.

Paul Brand wrote, "I have come to realize that every patient of mine, every newborn baby, in every cell of its body, has a basic knowledge of how to survive and how to heal, that exceeds anything that I shall ever know. That knowledge is the gift of God, who has made our bodies more perfectly than we could ever have devised."

When one coincidence occurs, you can label it as such; when two coincidences occur, you can attribute it to good fortune; when three or more coincidences occur, you must be severely devoid of spiritual belief if you are still adamant on it being down to 'good luck'! Therefore, here I am believing firmly that whatever reasons I have being here, God has plans intended for me to grow and mature in faith. Coincidence? I don't think so...

Cycling in Vellore, India

Today, I cycled to the hospital on my rented bicycle. The journey was nothing short of amazing as I find myself falling more and more in love with 'Incredible India'. The lack of orderliness, numerous pot-holes in the road, pedestrians walking like they have a stake in the road's ownership and the unceasing beeping, clinking and honking all culminated in my authentic experience of what it was like to travel like a local.

Throughout my journey, I got responses as varied as weird stares, amused smiles, delightful waving and approving nods from the locals. Many people think I am pretty crazy getting a bicycle (or two-wheeler as they term it here) to travel over here in Vellore but some are quite supportive like Ms Sheela from the Dean's Office. My mother was pretty indifferent, probably due to the numerous things I have done over the years that have numbed her fears, all she said was "be careful".

Cycling here is very enjoyable for me as the traffic flowed like fluid; it moves around you, but never at you. I felt like a fish back in the ocean weaving in and out of traffic, meandering around other two-wheelers and pedestrians; I was in my element.

Another reason why I wanted to travel on the bicycle is so that I can better recognise the roads and places. I always believe that there is no better way to travel and discover a place then walking the ground personally. It is through such first-hand experiences that you connect with the people and become incorporated into their way of life. It is only through such means that one can truly be immersed in culture - you eat, shop, travel and do everything like the locals.

After the ride in the morning, I was even more convinced that I needed to buy a bicycle. Therefore, I rode to the rental shop to meet the boss during lunchtime. He was pleasantly surprised at my offer to buy a bicycle and quoted me 1500 Rupees for a very decent secondhand bicycle. That bicycle looked pretty new compared to the one I rented before and I immediately agreed. I took the bicycle for a spin to make sure that the chain did not keep falling out like what happened on the previous bicycle. It was a smooth criminal; each stroke of the pedal felt as smooth as butter between tongue and palate. I went back, borrowed some tools to true the handlebar to the front wheel as it was pretty off and paid the boss. I was the proud owner of a two-wheeler! Words could not adequately describe how happy I was as I made my way back to the hospital for lunch. I intend to donate the two-wheeler to Modale International Student Hostel when I leave so that if future batches of students ever need a bicycle, it is available! =]

I had the same thing as yesterday, Chicken Briyani, as I wanted to spend some time in the Chapel after lunch.

I found an empty seat in the packed restaurant and asked for permission to occupy it. The man then asked where I was from and we started a lunchtime conversation. His name was Daal and he used to work as a non-medical researcher in Cardiothoracic Surgery. He also shared that he graduated with a degree in English Literature and was currently teaching English. This explains why his English was so fluent and why we managed to even go beyond the superficial formalities of a brief conversation. Daal left after his meal and I went to get another Pepsi and 1L bottle of water as I was seriously dehydrated from the heat. Cool Pepsi never tasted so good! The weather here is so hot that even if you refrigerate drinks, they will never be ice-cold...

Incredible India

10:15pm India time. I am finally here. I was hit by a wave of warm breeze when I stepped out onto the Indian tarmac.

Modale International Student Hostel was a good 3-hour drive out of Chennai, we looked for our driver and was on the road in a matter of minutes. India has its own sense of rustic charm. On the plane looking down, I noticed that the amount of lighted areas were few and far apart compared to the intensely bright skyline of Singapore; I was living in a country of excesses...

Time seems to pass by faster when you are enjoying every moment of it, and before I knew it I have arrived at my accomodation for the next 1-month. I was pleasantly surprised at its level of cleanliness and safety. In my opinion, it is a 3-star accomodation. I proceeded to unpack my backpack and got ready for bed as it was almost 2am!

Army standard layout =]

I woke up at 5.30am and the sun was already peeking through the clouds. A new day beckons and my medical experience in Vellore, India is about to begin. We took breakfast at the nearby canteen and then a short tour around the vicinity before heading to meet Ms Sheela for my posting throughout the 1-month here.

Al-fresco dining at the canteen

Free shuttle bus to Christian Medical College from our accomodation area

I decided that I should learn how to take the public transport to the hospital, hence we hopped onto bus 2. By some strange stroke of fortune, we managed to get seats on the local bus, something which she claims as being very rare. The ride was around 15-20mins and cost less than S$0.30!

On board the local bus

After arriving at the hospital, I was orientated to the grounds and attached to my team in Paediatric Surgery. Monday was clinics day and so I spent the morning in clinics. The clinic had a spartan set up and it resonated with me. I simply love the unassuming-ness of it all. It was basic. It was sufficient.

Dr Ravi, the person I was attached to, was very friendly and always tries to make every case a learning experience. I learnt so much in the brief 2-hours I was in his clinic. Before long, it was lunch time. I decided to explore the surrounding area around the hospital since we had almost 3-hours of free time before exit rounds. After walking through various lanes and streets, we stumbled upon a local food place. Seeing that many locals were eating there, I figured that the food must be pretty good. We entered, ordered and ate. It was delicious! What a benchmark to set on my very first proper Indian meal (breakfast was omelette). Gastroenteritis was a concern no doubt, but I personally believe that every food-seller has a moral and social obligation to uphold and I was contented with this. So far, I have not been proven wrong =]

My first Indian meal

After lunch, we continued our exploration of the area until we could not take the heat any longer, retreating to the chapel inside the hospital to cool down before exit rounds. Exit rounds was concise and every case was an eye-opening learning experience for me. After 45-minutes, my first day in the hospital ended. It was a relaxed pace, enriching learning experience which has whetted my appetite for what is going to happen in the next few days.

Seeing that the hospital was pretty near our accomodation, I decided to purchase a secondhand bicycle to commute between the two. This set the stage for our quest for the old bicycle. Getting around in Vellore is the same as everywhere else - you ask for directions.

Ask, and it will be given to you; seek, and you will find; knock, and it will be opened to you. - Matthew 7:7

After a long search, we finally found our shop and I rented the old bicycle pending a possible purchase when the boss returns from his business trip. We then got onto the bicycle and made our way back to Modale. Cycling in Vellore is an absolute pleasure. There is a sense of ordered chaos about how things flow and operate; people somehow can read one anothers' minds and everything moves with the precision of a highly-complexed timepiece.

Orderliness in chaos

After washing up, we went to Darling restaurant for dinner. It was situated on a roof-top with a pretty city view to enjoy with the food. The meal was nothing short of delicious and we were both pretty stoned after the meal, reclining back into our seats and enjoying the warm breeze of India typical in this time of the year. Relaxation was the theme of the night.

Pasta and Naan with butter chicken gravy

My old bicycle

Like candles that guide my path...

I guess this academic year has finally taken its toll on me; I am feeling pretty restless and quite jaded before my final paper tomorrow, I just wish it to be over as soon as possible. There are so many thoughts wrestling for dominance in my mind that I find it hard to carry out my final revision for tomorrow. The only thing that I am looking forward to is my trip to India, but even that is filled with its own set of issues. Perhaps I am thinking too much, only time will tell.

It is important to surround yourself with friends who resonate and connect with you as Coach David always say. I find that to be very true. They are like the candles that light up my path in this dark world; the guiding lights that I use to orientate myself whenever I am lost. Thank you for your call; thank you for making the effort to come down and catch up; thank you for your love, care and concern; thank you brother.

Aal izz well (all is well), aal izz well.