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. 

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.

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.

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…

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

Getting it off my chest

Clearwater, Florida. Ironman 70.3 World Championship. I never for once took this opportunity to participate in the above-mentioned race for granted. I never believed in going there just to complete the race. I even set targets for myself to smash at the event. It was to be a personal best, all out, flat out race for me...

However, things never turn out the way you want them to. 2 back-to-back bike incidents put me off running for 2 months. On top of that, ever since Ironman Switzerland, I have never really gotten back the feeling of what it means to swim, cycle and run. I could not find the reason to continue doing what I used to love most. There are times however that I battle this mindset and take myself out in the course of training. I was fighting both the body and the mind. It was tiring. There are occasions when I get a glimpse of what training is supposed to be like, but those days are few and far between.

Words cannot describe the disappointment I feel when I go out for an intended 90km bike ride and stop short at 30km because I just simply cannot will myself to carry on. It is not out of physical exhaustion, but I was mentally dead. Each day that passes draws me nearer to the race; each day passes with me losing the meaning of this sport.

I cannot understand how people like Joshua Li or Jonathan Ma sustain that fire within to keep pressing forward to greater heights. What drives them? People like Ling Er who came back from a broken femur to win Ironman 70.3 Philippines and subsequently qualify for the Ironman 70.3 World Championship. What drove her?

Perhaps the only reason why I am still trying so hard to train and race amidst all this shit going through my mind is this: ego. Ego can sustain your drive for a while, but in the long run you lose yourself and become someone you yourself cannot recognize.

I started to reflect on this recently and posed myself some hard questions. If I stop doing triathlons or stop training, will I still be me; will I still be Norman? Will my friends view me differently? Who am I, actually?

To be very honest, I have no answers to the questions myself. All I can do is to keep asking more questions and let time reveal the answers to me. I have no idea how I will perform at the race next Saturday. I have no idea how I want to race. I do not know what I will learn from this experience or how it will shape the way I decide about things in the future, but I guess for now I have to put my ego down and wake up to the fact that probably the best I can do there is to complete the race.

I am sorry to all who has put your faith in me.

Closer to the edge

Pain is pleasure; I discovered that today. Many times we fear the unknown, fear what is beyond that burning sensation in our thighs or calves when we cycle or run. I was always one who never really ventured beyond that barrier. I was cautious.

However, there are times when we throw caution to the wind and embrace the pain like it is a form of suicide. Escapism. Like what Lance Armstrong said: "All endurance athletes are running away from something". When we undertake such an act, sometimes we might even surprise ourselves.

1. You discover that after crossing over the pain barrier, there is no more pain. As the saying goes: "Numbness is Ironman foreplay".
2. You discover your true limit. You are pushed to the edge by yourself (if you have the guts to reach that stage).
3. You come out a happier person. Endorphins?
4. Add on new things as you experience them =]

So go ahead, push yourself to the edge, test how brave you are.

Belief.

Belief is a dangerous thing.

It has the potential to falsify everything the world once hold to be true. However, not many stand by their beliefs; they let the world dictate it for them. Those who stand by theirs are seen as radicals, whom few can relate to or understand.

Do you have to balls to stand by your belief no matter what?

K.O.M. Ipoh 2010

I completed what I set out to do. I conquered Cameron Highlands!

My plan was simple, to ride up the entire way without dismounting =] I saw this race as more of a gauge of my cycling and as a really good form of training. It was an insane experience, I have never been so familiar with the lowest 3 gears of my bike until the race! However, if this race is still on next year, I will definitely be back there again.

I have learnt quite abit about myself while slogging my way up; there is still much more work to be done for my cycling. However, the greatest take-away I had was in fact something I knew all along:

If you’re going through hell, keep going. – Winston Churchill

Tough times do not last, tough people do. No matter how hard the journey is, as long as you strive on, you keep moving ahead no matter how slow, you will get there. You will get to your destination.

Dream. Believe. Do.

Bikes behind where I was sitting =]

Words of wisdom

"Seize this chance, rejoice in it and let no power or persuasion deter you in your task." – Chariots of Fire

What you can do, or think you do, begin it. – Johann Wolfgang von Goethe

How true.

A blessing...

My main race in a series of 5 races in 5 weeks was finally here.. I could still remember my Aviva 70.3 2009 experience vividly; it was the most memorable race of my life. It will be the benchmark of all my races that are to come...

I always believe that a good race experience is more than just the results; it should entail the process of training for the race, the enjoyment of the race, the supporters and the entire race atmosphere. Results are just a bonus.

I planned as I did last year on my goal for this race - 5hrs 15mins was the time to hit. The splits are as follows: 40mins for the 1.9km swim, 2hrs 40mins for the 90km bike, 1hr 50mins for the 21km run and 5mins for transition and 'chill-laxing' time.

In the transition area before the race

As the gun went off, I mentally prepared myself for a long race ahead. I entered the water and started to find my stroke for the swim. The waters were relatively calm and the swim was comfortable. Upon exiting the waters from my 1st loop, I glanced at my watch and the split was within reach =] I did a mental calculation in the water on my 2nd loop and decided to up the tempo abit; I came out of the swim within my targeted time!

I mounted the bike and started to churn away. I was going faster than my targeted speed as I felt really good and comfortable. This was probably where my race went wrong...

I remembered 3 weeks ago during the 90km time-trial that Jon Ma, Amos and I did that I started conservatively but ended strong. Today, that was not the case. I could not replicate the form I showed that day. My first 2 laps were within my targeted splits, but the 3rd loop took me 58mins. That was where the additional 5mins came from. The timing was not my major concern, what worried me was the run that is to come. A glorious 21km more to go...

As I ran into transition, I overshot my transition area and had to back up, loosing some time in the process...I have to work out a system of identifying my area as it was David who helped me point out my bike after the swim (yes, I was pretty lost in T1 as well).

I felt weak on the 1st km on the run as my leg muscles spasmed away and threatened to cramp up on me. This was the portion of the race that I learned from the most.

One thing that came to my mind while running was that what I am doing now is a priviledge; It is not an entitlement. This thought really got me going as I remembered my 2 month plus hiatus from exercising late last year. I thank God for keeping me healthy to be able to enjoy this sport.

I also remembered what Coach David told me a few days before regarding relaxing your muscles in order for them to perform and I put it into practice. It was not easy to hold yourself back knowing that you can go faster, but I did and it paid off.

My muscles felt so much better after the 2km mark and I continued to slowly increase my pace but maintaining the rhythm and the 'lightness'. I only had one thought on my mind:

"Float like a butterfly, sting like a bee" - Muhammad Ali

I kept repeating it in my head and pushed forward on the run. It was really a battle of the mind under the crazy Singapore sun beating down mercilessly. All I wanted to do was to finish the run quickly and 'pang kang' (Hokkien for stop work), but I held back the temptation to go faster for I knew if I did, I would have crashed out with major cramps.

The support from friends and relatives made the run so much more enjoyable - it was the ONLY thing that motivated me to reach the 7km U-turn point after every lap. I dare say that the support from close ones were equal, if not more compared to the electrolytes and water at the aid stations.

Thank you everyone who took time out to support us today! =] Without you there, it would have been so much more painful and it will not have made this race so memorable.

With 2km to go, I increased my pace and surged for a strong finish. It was finally over. As I crossed the line after 1hr 56mins on the run, I felt really good. It was merely 4mins faster than my run last year in the same event, but I died real badly for the 2hrs last year. I felt strong today and that is a good sign =]

After the race, we hung around the buffet area and I caught up with Renny whom I met during my Ironman in Switzerland. He was here promoting the new Taiwan 70.3 race. It was nice seeing him again =]

As Jon Ma had a high chance of getting a Clearwater 70.3 World Championships slot via roll down, we decided to wait and see if he gets it. The thought of being able get a roll down slot myself did cross my mind but I got over it quickly when I saw my name on the no. 9 spot. There were 8 people before me and there are 2 slots, what are the odds? I thought it to be very very low.

It was only after the automatic qualifiers slot allocation was announced that I saw a glimmer of hope. The top 2 in my age-group did not claim their slots which means that Jon Ma will definitely be going to the World Championships and I might have a small chance of going too!

It seriously DID NOT cross my mind that I could get a slot, so when it finally came and was finalised, I was really elated and thankful to God for this unexpected blessing. It seemed so surreal! =]

Jon and I settling the paper work

This is a new experience and something to look forward to, but first, let's get down to training =]

The hibernation is over.

The thought of deleting this space has occured to me many times.. I find it really dumb (pardon the use of this word, I cannot find a more apt alternative) to blog about the things I do, my opinions on matters and talk about my private life on this cold space called the Internet.

However, one thing that prevented me from going ahead with my action plan was a simple word - inspire.

I do not claim to have inspired people to do things beyond what their minds can conceive nor think of myself as an inspirational figure. I do, however, believe that a blog can serve its function to perhaps stir up that thought inside you that laid dormant for so long.

Reading Ashley's account on his Ironman in Langkawi a few weeks ago really inspired me to be disciplined in the things I do. So many times, and especially during races, we often comment about how fast this guy was or how strong that guy is, and fail to see what happens behind all the glory the guy is seemingly basking in. He worked his ass off to get to where he is currently; that is discipline wherein lies the glory.

Glory is not merely about the results; it is what you did to get to where you are.

I guess that was the lesson I was supposed to learn from my Ironman experience in Zurich, Switzerland in July 2009. I truly enjoyed the process of preparing for the Ironman. Countless crazy sessions on the swim, bike, run with Nicolas can never replace the Ironman finishers' medal. The process is my own unique experience and nobody can take it away from me =]

It is the same for my family in NUS - Aquathlon. I never fail to get goosebumps whenever we race as a team and do well. The process, all the times we died together during the swim sets and the crazy hill intervals, was truly memorable and bonded us as a team; the results was just the icing on the cake =]

NUS biathlon and the end of the biathlon season is 2 weeks away. I look forward to see stars rise among our ranks.

In conclusion, I will come out of hibernation and hope that my future posts will touch you in any way that leads you to live life to the fullest!

It feels good to be back..

Cold water shot through my system like electricity; I struggled to breathe. My arms felt like lead, disobeying my command to move. Invisible creatures welcomed me with sharp stinging pains; the sodium felt nice in my mouth. I was at peace in the water...

It felt really good to be back training with the team after being out for so long. I knew this week was going to be tough, but I paced myself and tried to ease back into training slowly.

Something I never shared regarding my Ironman experience was the emotion I had when I crossed the finish line in July 2009. I had no emotion. I had visualised that moment prior to the race so many times in my mind; Would I cry? Would I be too overwhelmed for words? There was nothing of that sort that day. Blank.

Until now, I still cannot understand what happened back there in Zurich. I am hoping to find an answer and I know there is something to be learnt. Time will tell. For now, I am happy to be able to do the things I love to do and once again feel the sensation of sand rubbing against an abraded ankle =]