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 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

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.

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...

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.

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...

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

Medical facts...or not!

This are some interesting stuff I got from Fake Science. Enjoy! =]

The 'real' food pyramid

'Truth' about earwax

Brain freeze 'facts'

Understanding artherosclerosis

The whole cycle repeats itself once more..

...but this time, there shall be change.

I just got back a few hours ago from Jogjakarta, Indonesia. After returning from London Heathrow on the 8th of August, I found myself back at Changi airport the next morning for my flight to Indonesia! Talk about hardcore travelling... =] That's a whooping 5 flights in 36 days!

I am now tossed right back into the thick of things as the semester kicks off yet again. However, I am determined to break the cycle... There is much to be improved, much to be learnt and done; proving this, I am now going through the webcasts of 8 lectures that I missed while in Indonesia.

In the following days, I will update my Ironman and the Eurotrip experiences on this space so that the memories will be with me when I look back.. Ok, back to the lectures.. =]

All about the Influenza virus

After my morning nap from 9.30am-11.30am, I checked my email and to my surprise, I saw that there was a compulsory assessment that I had to take after reading up on an E-module from NUS school of Medicine regarding the Influenza virus. Cool beans! Even though I am pretty pissed that they are giving us this in the midst of my holidays, I am also quite interested in the topic! =] So here are some of the things you have to know about the virus..

The Influenza virus is an ancient virus that still continues to haunt mankind. In 1918, it killed anywhere between 50 and 100 million people and when autopsies were performed, the victims’ lungs were found to be blue and sodden - indicating death by drowning, apparently triggered by a massive overreaction of victims’ immune system to a new virus.

The world has become more vulnerable due to the one feature that most differentiates present day transmission scenarios from those in 1918: the advent of large-scale air travel.

In the old days, geographical distance at least provided a measure of protection as signs and symptoms had time to develop and those afflicted could be screened at border entry points. Today, with hardly an airport unreachable within 36 hours from any point on our planet, the speed - and pattern - of microbial movements has altered dramatically.

This pandemic will and can return to strike us; so much so that scientists tell us the question is not “if” but “when”? Many scientists are warning that the current H1N1 flu outbreak has all the hallmarks of a pandemic, there are others who say it may turn out to be no worse than the normal flu.

In her declaration of the present outbreak entering the phase 5 level of threat on 29 April 2009 (signaling a pandemic was imminent), WHO Director General made a reference to the fact that “it really is all of humanity that is under threat”. Was she exaggerating? Think about this and decide for yourself. For if and when the big pandemic flu finally hits us, it would be too late to realize that our complacency has not only been costly, but possibly terminal! Currently, the outbreak is in phase 6 level of threat, indicating a pandemic.

Hence, it is important to stay vigilant and informed. Some websites to stay tuned for information are: World Health Organisation (WHO), Ministry of Health (MOH) and Centers for Disease Control and Prevention (CDC).

The Influenza virus is very 'smart' as it can mutate leading to evolution of new strains in a process known as antigenic drift. This helps the virus to evade the immune system of its host and enables it to circulate in human population.

Also, the virus is capable of antigenic shift which is a process usually resulting when viruses from different host sources (e.g. humans, pigs, birds) concurrently infect the same host and are allowed to mix. The resulting hybrid product's potential to wreck havoc depends on its virus virulence (potency or aggressiveness) and the ease of human-to-human transmission.

Human-to-human transmission occur primarily via droplet transmission or contact transmission. Droplets are produced during sneezing and can travel up to 1 metre before hitting the ground. Physical contact with an infected person through handshakes, hugging or kissing can direcly transmit the virus. Physical contact with inanimate objects that have been contaminated can indirectly transmit the virus too if you do not wash your hands prior to touching your nose, mouth or eyes.



It is hence important that we have social responsibility to the people around us. When we have flu-like symptoms, we should put on a mask, visit a GP and avoid crowded places. Every single person is important in combating the Influenza pandemic.

Also, to protect yourself from contamination, you should wash your hands not just frequently but thoroughly. Avoid touching your face unnecessarily and avoid touching surfaces that other people may have contaminated, such as escalator handles, door handles. If you are unable to avoid touching them, wash your hands thoroughly as soon as you can, and remember not to touch your eyes, nose or mouth. It is also recommended to avoid crowded places if you can help it and to keep rooms when ventilated.

All information cited are from the National University of Singapore's Department of Epidemiology and Public Health in collaboration with Centre for Instructional Technology.

Happy day!

My past 3 days were spent at church camp.. It was a superb time to recover from all my training and prepare for my IPPT this Saturday. =] I have gleaned a lot from the people around me and the workshops given during my time in camp, and I hope to be able to apply them in my life.

I left early today to meet Nicolas for our medical screening at Raffles Medical located in OUB Centre. The entire thing took about 4hrs. When we left the carpark, the parking fee shown was a whooping $16! Needless to say, we both exclaimed in astonishment. Madness beans! I have never incurred such a hefty parking fee before in my entire life.. The conclusion was that parking in the CBD area is killer.

After the medical screening, I made my way to the post office to collect my airmail from the USA. My 2XU wetsuit has arrived! =]

Brand new wetsuit for just S$180 with shipping included! My goodness..killer deal man!

I tried it on and had a really tough time getting into it. I think I need to get some Body Glide to apply.. All in all, the suit fitted me well and I am really glad! =]

Now, there is one less thing to care about for my Ironman in 29days time! Another thing to add to an already happy day is that I passed my 1st Professional MBBS examinations! I got a B. Whoots! Now, I can fully enjoy the rest of the holidays without having that at the back of my mind! Praise the Lord! =]

Week 3 round-up

This week was one of the toughest weeks of my life..I have never studied so hard for an examination before in my entire life! Medicine is really in a league of its own..

Monday: 1st Professional MBBS Paper 1
Tuesday: 1st Professional MBBS Paper 2A
Wednesday: 1st Professional MBBS Paper 2B
Thursday: 1st Professional MBBS Paper 3; 4.5km swim
Friday: 1st Professional MBBS Paper 4
Saturday: 180km bike
Sunday: 20km run (2km warm-up, 18km pace run)

Total Swim Mileage: 4.5km
Total Bike Mileage: 180km
Total Run Mileage: 20km

Anyway, I am even more motivated to train harder for the Switzerland Ironman as Lemin and Michelle are both coming up to support us! Whoots! After which, we will travel Europe together. Super killer rocks sia..

A new friend to be made...

This is currently my favourite clip from Youtube:



I hope you like pain...

=] This actually ties in to my post-examination plans in a way.. Pain. Pain is a friend too, and I have to make friends with it too. After my spots examination today, I met up with Coach David for lunch at Parkway Parade and then chilled at his place for awhile discussing my training programme for the upcoming Ironman in July.

Exciting sets are to be done; insanity is a strong pre-requisite. I personally feel that after the whole Ironman experience, I will be a better person. There is so much to be learnt, reflections to be made and challenges to overcome. I am very excited.

After the discussion, I met up with Nicolas and Mr Ho in Victoria Junior College to catch up, leaving just before the skies pee-ed on the eastern side of Singapore. Weather nowadays is getting super erratic, I hope it does not affect any of my trainings! =]

Into the wind

Today saw the burden lessen with all heavy papers for my 1st Professional MBBS cleared. There is a final paper tomorrow where they give you specimens and you have to identify them and answer questions related to them.

I really feel that the examiners are expert mind-gamers (Jason, you pale in comparison). A neuroscience question in the physiology paper, no neuroscience questions in the neuroscience, head and neck and musculo-skeleton paper! There was also the physiology question in the anatomy paper too. Sometimes, you do know the answers to all those questions but you begin to doubt because the paper type was specifically told to you! Well..thankfully I answered to the best of my abilities..

After the paper today, I really craved for some sort of exercise. Ever since last friday's 21km run prior to church service (killer post on this after the exams), I have not done anything other than hardcore, insane mugging. Hence, I decided to swim today. The weather was good and I initially decided to do a 4km swim. However, something overcame me in the water and I decided to add 0.5km to the mileage. I completed 4.5km in 1hr 47mins in a comfortable, relaxing manner.

I felt really good to be back doing the things I love. I felt so at peace in the water today that I almost fell asleep! Sleep deprivation has had its toll on many many of my course-mates. I have heard stories of some of them sleeping during the examinations! Seriously man..all this studying is just to pass the examinations, let alone ace it! I have never experience something as BIG as this before. The 1st Professional MBBS examinations showed me the limits of my mugging capacity. It has never reached such frontiers before; I'm in unchartered waters (in my life).

Anyways, I had a mini-reflection during the swim today as I focused on my strokes and gliding technique. I realised that the more you struggle, the more you sink. That is the same for life. Chin Ee has been the latest to impact me with his words. Trust your brain. That was what he said prior to the paper on Tuesday. There is no point panicking and wallowing in past actions, look forward to the future where your actions might still be able to effect some sort of reaction.

I really have to thank all those (tagboard people) who have showed me encouragement after the paper yesterday. Thank you! Jason, who self-proclaimed to be my source of encouragement through my entire examination, your support has been really evident =] Nicolas, thanks for that phone call, it really made a heck of a difference brother! Not forgetting God who has never left me throughout this entire time even though I felt that He did; I was the one who moved, He didn't.

Lastly, I will end off with something the man of the moment, Chin Ee, texted me:

When everything seems to be going against you, remember that the airplane takes off against the wind, not with it.

What else can I say...

I took my 3rd paper in 3 days this morning...So far, the 1st Professional MBBS examinations has abolished so much of my once-held-in-high-esteem-thoughts about examinations.. I never believed in 'hugging the buddha's leg at the last moment' or simply put - mugging right before the start of the examination. I always saw it as redundant and would rather use the time to calm myself down for the paper. This examination has seen me waking up at 5.45am to study prior to a paper at 9am; not once but twice, so far..

I could always finish studying almost everything there is to be studied prior to a paper. However, that is not the case for Medicine. There seem to be an endless amount of stuff you have to know.. I was dealt 3 hard blows from the past 3 papers and all I am asking is to pass. I hope I do pass. I need to pass.

I will hang on..with 2 papers left, I must..God, save me..

Week 2 round-up

This week was pretty disappointing for me in view of how much I have achieved last week..Well, something's gotta give. I focused more on my run mileage this week. It is just 5 more days to pure training.. I can do it!

Monday: 3km swim followed by 21km run (evening)
Tuesday: 40km bike ride (ended prematurely due to rain)
Wednesday: Mug
Thursday: Mug
Friday: 21km run (evening)
Saturday: Mug
Sunday: Mug

Total Swim Mileage: 3km
Total Bike Mileage: 40km
Total Run Mileage: 42km
Total Mug Mileage: insanely high

I, Norman

I, Norman, am going to Ironman Switzerland 2009! =] The idea above was inspired by Joshua who saw that with a play of characters, IRONMAN can be NORMAN! The rest is history, as you can see..hahahas..

I'm currently de-stressing from my biochemistry metabolism by meticulously creating the above.. I really love the look of it..Ok, time to hit the books again!