You are always there

Looking back the past 6 months which flew by so quickly, I cannot help but see God's hands throughout my entire stay in Johannesburg, South Africa. I could still remember the palpitations I had on my flight in from Singapore, questioning my decision to do a trauma fellowship here. Had I known what I do know now, I would not have worried one bit! However, hindsight is always 6/6, I believe that I needed to embark on this journey myself to learn the many lessons God has intended for me.

I am particularly thankful for my partner in crime, Susumu Matsushime, a trauma surgeon and intensivist from Japan. We started our fellowships on the exact same day, and it really helps having someone around to figure things out with. On top of working together, we frequently meet up for meals to unwind; we even set up a foodie group to enjoy good food with other fellow international doctors! I will always cherish the many trips we took together to explore the other parts of South Africa, and doing crazy things like climbing 2 mountains in a day! Thank you, brother Susumu.

I am also thankful for God's blood of protection over me throughout my time here. I am thankful that I completed by training safely and without harm. I am also thankful for Dr Alan Peter who runs a hostel for medical students and professionals. He gave me home in a foreign land, and a family and community to lean on. I strongly recommend his accommodation should one ever consider coming to do an elective or fellowship in Johannesburg. Thinking back, the worst experience I had here were the 4 times I was pulled over for traffic related offences, but that is another story for another time...

In 1 Corinthians 10:13, the Bible says: "No temptation has overtaken you that is not common to man. God is faithful, and he will not let you be tempted beyond your ability, but with the temptation he will also provide the way of escape, that you may be able to endure it." I always believed that God will never challenge you beyond that which you can bear, and in my time here I intensely felt that He was in control of my training. 

Let me start off by saying that I have never ever worked so hard before in my life prior to my fellowship in Chris Hani Baragwanath Academic Hospital's trauma unit. My residency training was known to be brutal locally, but it was nothing compared to what I experienced in my first 2 months in Bara! In my first week, I was acutely shocked at the amount of violence there was in this place as the patients who presented to us with their injuries were a direct reflection of what is happening out there. I even found myself questioning whether I was in the middle of a war zone on a few occasions. However, once I got used to the injury patterns, it became like factory work. Whenever a patient presented, we had an efficient system to triage, resuscitate and manage their injuries. As I progressed in my fellowship, I was made to take more responsibility, and with it more operative experience. By the time I was in my last week there, I had ticked off all my checkboxes apart from cardiac stab injuries. I had resuscitated and stabilised them during my time here, but I have never operated on one before.

On my last call, I had Susumu as my registrar. It was so serendipitous that I started and ended this fellowship with him! That night, I remembered telling him that all I lacked in surgical experience here was operating on a stabbed heart, but that I was very appreciative for all the other amazing skills I have picked up, from vascular repairs to thoracotomies. We had 2 stabbed hearts that night, and I did my first and second median sternotomies to repair their cardiac injuries. I believe this is not down to chance, but divine appointment.

I am very grateful to all my mentors and colleagues in CHBAH trauma unit, and I will definitely be back to do calls and learn more from all of you! Thank you, South Africa, for being a part of my life's experiences; this is one that I will hold very dear to my heart forever.

What doesn't kill you makes you stronger

9th April, my second day in Johannesburg. I decided to explore the neighbourhood by running to the nearby Neighbourhood Square which was about 3.5km away. An easy 7km run, or so I thought...

I was barely in to my first 2km when I felt immensely out of breath. My heart was racing, I was gasping. Attributing it to a lack of fitness, I decided to head back. The walk back was sobering; if one does not keep working at something, the decline will begin, and this can make starting again very hard. I have made a promise to my sons that I will use this time away from them to become a healthier version of myself, and I was going to attempt at least 3 runs a week. Therefore, no matter how hard it seemed, I needed to get my first run in.

12th April, post 24hr call, I decided to get that 7km run out of the way. The run was uneventful, and I felt better after it, crashing into a deep sleep until the evening. I then discovered a function on my Garmin app which allowed me to plot out a course and upload it onto my watch for use during my run. I immediately set out to find a 10km course, and uploaded it onto my Garmin Instinct 2 Solar. I was excited about this function, and could not wait to test it out on the run.

16th April, after work. This was the day for me to attempt the 10km course. I started it on my watch and off I went. The GPS guidance was amazing, directing me throughout the entirety of the 10km route. However, I realised the difference in plotting out a course on the app and actually running it. The route was killer with many climbs and descends, the craziest was a sustained 3km uphill segment that killed me. I was reduced to walking up a portion of the route and catching my breath, with my heart threatening to pop out of my chest. It was a very difficult run for me, and as I was approaching the final kilometre, looking out into the horizon, it dawned upon me that I could be way above the sea level!

Similar view as I gazed into the horizon

Reaching home, I immediately checked my suspicion - this returned: Johannesburg is located in the Eastern plateau area of South Africa known as the Highveld, at an elevation of 1,753 metres (5,751 ft). It all made sense now, I was not that unfit to have felt breathless a week ago on my first run, it was just the altitude. Knowing this now, everything became more exciting for me. Not only do I benefit from training myself medically, I can also benefit physically with altitude training! 

19th April, after work. After settling my laundry for the week, I headed out for that same 10km course. This time, the course felt shorter, I felt a little stronger. I did not walk, willing my legs to go one in front of the other, I powered through the course. Phrased succinctly by the German philosopher Friedrich Nietzsche, “Out of life's school of war—what doesn't kill me, makes me stronger." I will overcome this course, it is only a matter of time. 

What am I doing here?

Reality hit me once I was up in the sky on my way to Johannesburg. Up until then, I had been so preoccupied with settling the various tasks for my new home that I hardly had any time to prepare for my trip. The kids were much more attuned to my leaving though. In the weeks leading up to my flight, Ansel has been deliberate in his attempts to spend more time with me. Noah, much more subtle in his approach, has also gone of his comfort zone to express his want for quality time. Earlier tonight, he hung around the living room past his bedtime so that he can be with me. When Olivia noticed it, she nudged me to speak with him. "I don't want papa to leave, I want to cry already." Hearing those words from my firstborn almost made me want to cry too, I just hugged and kissed him, mentioning that it will only be 2-months before we meet again in London.

Then, in mid-flight, a sense of fear gripped me. Why am I travelling to such a dangerous place for my trauma fellowship? I was almost paralysed with fear until sleep gripped me with its hold and I thought no longer. When I arrived, the list of things to do helped distract me: getting a SIM card, collecting my rental car, driving to my accommodation, settling in, video-calling home to speak with the boys, then driving to Chris Hani Baragwanath Academic Hospital to recce the place before starting work the next day, ending with lunch and grocery shopping before heading back to crash into an 11-hour sleep.

 

I guess the answer to my question will only be truly and fully revealed at the end of my sojourn here in Johannesburg. All I know is that God is with me, He will protect and guide me. Amen.

Noah's prayer for me in church

Sunday's recce to CHBAH

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.

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.

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.

Conversations in the dark

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

Building Bridges

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

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...

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.

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