I didnt exactly feel like blogging but decided I would coz blogging to me is a way to record down your life's events and reflections and i dont want precious life moments to slip by without being fully appreciated and cherished for what it's worth. heh. alright, enough justification of taking time out of studying rheumato to blog.

Life's been interesting. heh. I was in some part of singapore which is famous for its durians, among other things, last night. but more about that later.

Med posting has been alright thus far. I've been operating on a new schooling motto of 'take it easy'. heh. Think I took school far too seriously for the first major posting and found that it wasn't worth it and took the fun and joy out of it. And so far it's been good. By take it easy i mean that whenever i feel the urge to be stressed or pressured I stop myself and tell myself to breathe and waltz along with whatever comes my way. so it's not slacking or taking things lightly, but just moderating my oft highly strung tendencies. heh. I really like the hospital I'm at, it's nice and pleasant, with a wonderful shopping centre nearby that has an amazing array of shops, food outlets to make life that much more exciting for our CG. And i've had space to breathe and rest and appreciate the finer things in life and spend time with people who matter and are dear to me.

My spiritual walk has been ever interesting. walking with God is never boring. So... where do i start. I've found that in this season my walk fluctuates very greatly. For several days I can be so close and intimate with God and then a flaming arrow comes and I'm just down and out for a while. Before grace finds me and picks me up again and the cycle carries on. spiritual walks tend to be cyclical, but I've personally felt that the intensity of my cycles is cause for concern. This week was particularly 'heavy' spiritually. And this has little, I'd say, to do with my circumstances. Life is pretty stable, at times even boring, for me. but just little things that trip me up spiritually, little seeds of discouragement that grow etc. I remember feeling flat out one night this week and I simply prayed 'Lord, help me. I need You.' Which also struck me coz it seemed as if I had not needed God in the same way till then which could mean that all along I've just been striving on my own strength, though thinking of course I'm living by grace when I wasn't.

And so God was at work and this week I've had the chance to re-connect with 3 people, and well still others along the way, who are spiritually dear to me. Had a very spiritually insightful talk today with someone, didn't expect there to be so much direction and light shed upon me through the discussion but somehow that happened. Little bits of revelation revealed that are helping me to make some sense of what's been happening in my life in this season. So it's been good, so good being with God's people and yet tough coz of the refinement going on in this season.

been enjoying the past few days at home. heh. nothing scheduled in hospital so thought we'd just stay at home and read up and well i think i've needed the past few days to just rest a bit more. it's been good. catching up with pple, slowing down, enjoying life. I suppose something i've acquired from uni life so far is just learning to slow down. partly coz doing too much gets you nowhere in school at times (grades seem so arbitrary and random at times) and well it's too tiring after a while. but it's been good.

started out the week quite grumpy. was quite annoyed going back to school. heh. variety of reasons. but been cheered up lots these few days. little things. as if God knew little me could do with some cheer and sunshine. heh. been enjoying being around my siblings too. my bro's playing his guit and singing jason mraz. haha. which is both funny and weird at the same time. back to school tmw.... bleagh. heh.

Haven't written anything in what seems like yonks. I seem to start my posts with various versions of that line quite often.

It is a nice rainy evening. It's been raining all day, almost all weekend in fact. It's been lovely to sleep in and wish you never had to wake up. I've been sleeping in a fair bit this weekend, partly due to sloth but mostly coz i've been having a headache since Friday. Nearly fainted on the MRT, i've never fainted or felt anything close to faint i think in my life ever. Med student's provisional diagnosis is one of a lack of rest. heh. Really. Been spending this week meeting up with people. It's surprising how tiring that can be. Not that I didn't enjoy the company I was with, probably enjoyed it too much that I ended up ignoring my body signals for rest. Funny how I was never under the weather throughout my posting even though others were and I succumb to it during my hols. Oh well, i've learnt that that's God's way of telling me to slow down and it's sad that I haven't learnt my lesson well enough to regulate myself.

So I start gen med posting tmw. Bleagh. I am really not looking forward to it. Hopefully being in the wards and the next hospital i've been posted to (which is supposed to be absolutely brilliant and salubrious and good for the soul. heh.) will change that. But yes, still wish i had about a month to crawl into a hole and hibernate and not come out for quite a while. I'd say that at this point i'm just about ready to say that I'm tired of med school. It's just not that stimulating. It's just a whole lot of work, which may or may not have any fruit to show for in the exam because of it's sometimes random and arbitrary nature. It's a lot of work. A lot of donkey work. I'm regretting slightly not starting on patho this holiday. But i really couldn't bring myself to and well i was much happier meeting up with friends so i think it's worthwhile in the end.

lots of things have happened since my last post till now. lots of things. wrote this to a dear old friend, heh.It's quite funny too coz of late I've really just been struck by the irony and humour of God. irony. this is quite random but i clerked a patient sometime back who told me he was homeless and i've bumped into him twice in the span of two weeks at two very disparate locations. both times he just stared at me but i suppose it took both of us time to register where and under what circumstances we got acquainted. not quite sure what to make of it.

but through all the tribulations i feel i've really drawn a whole lot closer to God, which is good. but it's been tough. i hate being refined, it's tough feeling like you have to deny your flesh and take up your cross when it seems that few pple around you are doing so or are having it easy. heh. ok but i'm generally fairly positive, not melancholic or anything. heh.

school wise... tts another toughie. heh. sometimes i enjoy medicine and sometimes i hate it. heh. coz it gets dry and very tedious at times. and i feel beyond stretching me because of the sheer volume of work, it doesnt quite stretch me mentally or intellectually. just trains up my perseverence and tolerance. sometimes i'm just tempted to leave medicine and do something else. haha. but dont think i'lll do that.

so yes it seems like life's quite tough. act uni life has been tough, though not unbearable, just tough. that somehow in the magnificent grace and wisdom of God, He has crafted our steps to be just what we can bear. i suppose were it to be easier i wouldnt be leaning and depending on God as much. that's something God's been showing me recently, that i get tired and weary coz i'm not depending on Him and only coming to Him when i've run out of myself.

but i think i'm still smiling in my heart. heh. oddly enough. though i wish i didnt have to face some of the above things, yet i think when i search a little deeper, there is this little, little morsel of quiet confidence that the Lord will see us through it all. heh. oh well. en garde. heh.

I'm lazing around at home this friday morning. heh. Yes I'm giving the wards a miss today. gasp. heh.

Yesterday was my EOPT. It was well... unexpected. The case I got was radiation proctitis/recurrent colon CA. except tt the patient didn't have any symptoms at the outset and began by telling me (and my other friend who had her EOPT tt same afternoon) about his vomitting and distension in july 2006 before he had his op. So i was really confused and spent 2/3 of my time clerking him based on his pre-op symptoms, which was beautiful because i totally expected colon CA (there's really nothing else to give as a colorectal surgeon except maybe diverticular disease. But no I got something tt presented like radiation proctitis (which is not a cat I must see must know or cat II good to see must know or cat III good to see good to know case.. it's only mentioned in one or two lines in textbooks as a complication of radiotherapy... i.e. how should i know much about it?!). so i got a beautiful colon CA history but when i proceeded to examine him, to my horror i realised that his abdomen was distended and i thought to myself i really can't be presenting his colon CA history tt presented in 2006. i cant. so i was so confused and utterly distraught and spent the remaining 10min doing a physical exam and clerking him, practically having to force out his abdo distension and PR bleeding symptoms. i suspected radiation proctitis but i thought it couldnt be possible coz i thought it presents early after RT but his RT was done in Jan-march 2007. turns out radiation proctitis does present late i.e. over many years.

so i was utterly distraught and unhappy tt i had such an 'unfair' case. and seriously, the UH radiologist and HOs agree! ok well. i promptly headed for the toilets after my test to cry a bit. heh. well.. on hindsight.. it actually wasn't so bad. the examiner said i did ok. but i suppose i was totally disappointed because i expected to score in a colorectal CA case. my colorectal set piece is really something [at least in my less than humble opinion. heh]. but it was ok and i really should be thankful.

so val and i decided we would chill out today. heh. seriously, after studying so hard for the posting and getting something like radiation proctitis, makes u really see life with a different perspective. heh. will be meeting up with my best friend before she starts school.

It's the day before my very first EOPT of med school. heh. Quite exciting/nerv-wrecking/interesting.

My heart's rather heavy now though. Not because of EOPT, hardly coz of that i think. My heart just feels very heavy for the various patients i've met, for some reason the cases have been more 'depressing' these days. Perhaps it's coz i went down to GH today to just have a feel of the place ahead of my EOPT. clerked a brilliant case. It was brilliant, classical history. very very very good signs. But tts coz it was end stage CA and of a particular disease tt manifests in a very classical way. My examiner's a colorectat surgeon so I've been going crazy over colorectal for a while. I get all excited and wide-eyed when i find a colorectal case, esp the classical ones, and esp pre-op. In UH there aren't as many [well there are but a lot of post-op] and so u seize onto any good case tt comes along. But back to the patient i clerked today. Just felt very heavy hearted after talking to the man. I guess coz his is a really end stage case [u dont mostly see such end stage cases in the wards, they're mostly operated on before it becomes so late stage or they're treated as outpatients/in hospices]. The man wasn't in say excruciating pain coz he could talk to me obviously, but you could tell the disease was really debilitating him. 20-30kg LoW in past few months. From the conversation you could tell he was 'fighting' the disease, as if it were some big abominable monster taking over his life, which i suppose in a way it is. I guess I've not seen illness in all its ferocity like today. How illness hacks away at a person, getting at everything until one day there's literally nothing left. He told/ordered me to feel his legs. 'see how thin they are, they're but sticks, see what this illness is doing to me'. really broke my heart.

Then there's another guy back in UH. I didn't clerk him but several of my friends did. very nice 35yo chi male with a very obvious succussion splash. tissue biopsy is aggressive type signet cell gastric ca. intraop findings of peritoneal metastasis. unresectable lesion, they did a bypass to alleviate his gastric outlet obstruction and closed him up. he's got a 5 month old daughter. hmm.

I guess these cases really hit home this week how medicine is about people and real life and death issues. So often we/I just think it's just another day of school and learning and honing one's clinical skills. But it's about people. The fragility of life is so stark. It makes you feel so human - so weak, so vulnerable, so transient. And it brings you back to what is truly important in life again, how so many things don't matter and how only when we accept death that we can truly live.

Sitting in the resident's room. kinda wanted to be on call but i'm probably heading home because it seems to be yet another quiet night here in GS. Everyone's been madly clerking because our EOPT's coming up soon. I too want to go on a mad clerking spree but I don't like disturbing and prodding patients overly. Hence I try to do as many calls as I can to catch the new cases when they come in, it's also less tiring for patients too i think.

Just read a mail from a church friend. She's a doctor who did her MRCS (some super duper post grad qualification) and yet walked away from it all. leads worship, serves joyfully in church. I happened to email her some time ago to ask why and how she did it given that right now in the rat race tt is even apparent to med students, specialising and heading somewhere is everything. Was really touched by her sharing. It couldnt have come to me at a more fortuitous time. As I watch the world around me, the bootlicking of the profs and consultants, the rat race, the selfishness of pple. It's quite annoying sometimes actually. A number of weeks ago I felt God tell me firmly and strongly that He will provide and that I didn't have to worry or fend for myselt. He would provide what was needed. And He has. Like today, it's been a bit disappointing but nonetheless a very nice HO brought me to examine a very very good case today and taught me lots of things. It just fell into my lap. I suppose it's things like these that help encourage me along and keep my eyes on Jesus. better than scouring the wards for hours on end only to find a few patients who are clerkable.

I've always known this but never really thought it would be true/so hard, but yes we are called to be different in the world. Not to be kiasu and selfish and with secondary agendas, but to love, to trust in my Jehovah Jireh, to be willing to be made low so that others may be lifted up. It's a very different calling, different direction from that of the world, yet nonetheless God calls us to that path. it's hard, but i know God's grace is sufficient.

Haven't written much in some time.

Clinicals have been very good. I've been having such a great and meaningful time learning and knowing people, the patients, doctors etc. I really love the hospital i'm at presently. I thought nothing could beat the hospital I was at in the previous posting but I'm definitely loving the present one i'm at. The pace of life is a bit slower, which has been unexpectedly good coz for M3 it allows you to go in depth about the various topics and cases, and the hos and mos are all really friendly and nice and take the time to teach and help you out. The hos esp, and the mos too though we interact less with them, have been simply amazing.

God's also been speaking to me in the wards. Was very blessed and refreshed going for YAM prayer meeting on wed. The discussion was on suffering and our response because Daniel's leading a series on a study of Job over these few weeks in church. Really added perspective to how I see and respond to things in the wards.

I went on call on Thursday too. It was really nice. It's quite fun staying on in hosp, the first time i've ever stayed over from night to the next morning. Bunking in with the HO, walking along the quiet corridors at night or in the waking hours of the morning. It's really peaceful, really pleasant (of course all this from the perspective of a student). There were several neurosurg cases that came in that night, which isn't quite what you want to see for gen surg but nonetheless we still followed along. There was this elderly man who was in the high d ward. Past hx of SCC of the R eyelid. As a result of that, his R eyelid had been stitched up to form just a tiny hole enough for light to reach his iris. He was in for an infarct, probably CN VII coz half his face was paralysed. He couldn't quite enunciate, due to the CN VII infarct, possibly CN IX and others affected too. Hx of prev ischaemic episodes too i believe. His body was a bit distorted, frail-looking. But i remember being up there at about 11pmish at night, standing by his bed as the HO tried to figure out how to treat his AF since digoxin wasn't working and the cardio team wasn't going to see him till the morning. I remember looking at his face, his cries of having a cough going a bit unheard by the pple around (coz u can't quite do anything about it, it's quite minor compared to his other problems). and i remember God whispering into my soul very distinctly, you see this man, he may look frail and insignificant and value-less in this world, but you know, He means the world to me. You are looking at someone who means the world to me, I gave my life for this man. How true, how deep and vast is the love of God. Something I've been learning lately is how different God's ways and standards are compared to the world. How differently He looks at pple. How in the world it's all about status, wealth, intelligence, success, and yet in God's kingdom it's the opposite. Those who are meek, those who are weak, the humble, the forsaken, the dejected, the lowly ones. Those are who God values the most. [i mean He values everyone equally.. but yes, the poor, the infirm, the marginalised, the sidelined, these are people who have special value in God's eyes]. I think I'm quite sure I want to do geriatrics after all these years. Sometimes in GS posting, surgery seems very attractive. Status, power, money, adrenalin-pumping. Everyone's eyes open bigger if ure a surgeon, and there are different gradations of surgeons (topnotch ones like colorectal, cardiovascular and less glamourous/impt ones like thyroid or maybe breast or hand.. i dont really know). Geriatrics? what's that? only for those who can't do anything else. who wants to work with the elderly who aren't even as cute as children, they're mostly stinky or frail etc. anyway. But the elderly matter so much to God and therefore they should matter the world to us too.

Being in the wards and in clinics brings tears to my eyes sometimes. Seeing the issues pple face, suffering, death at one's doorstep. And i reckon what breaks my little, imperfect, sinful human heart breaks God's heart immensely more. And it's enough for me knowing that His grace is sufficient, even and especially when I feel helpless or hopeless. God is there and God is enough.

Quick post from the airport. I'm at the budget terminal now, awaiting my flight to manila for australs. The budget terminal is really interesting. It's really budget. Not many places in singapore actually look like this i think.

I really don't feel prepared going for australs. Partly wondering why I'm here right now. Contemplated just missing the flight several hours back. heh. I am quite excited now that I'm here though. Just having the time to think and take a break from clinicals. Immersing in different environs and doing something that's quite different from my daily life. heh.

Clinicals have been great. I'm thoroughly enjoying myself. Enjoying being in the wards, knowing the patients, even the skills that we learn and the endless pool of knowledge we're supposed to acquire. Things just come alive so much more when you're in the wards which makes learning such a pleasure. Really happy to be in clinicals.

Clinicals aren't without their struggles of course. Many struggles still. The interesting thing is that you really get to see who you are as a person, what you value, the decisions that you make that reflect what kind of person you are. God's been near to me in this period. Just in the wards, feeling His love for people. I think that in the end i am very happy and so blessed and priviledged to be studying what i am. Being in the wards just reminds me of what's important, it points me to God and His love for people.

Today was quite a big day in the wards. 2 people passed away in the morning. The first time deaths have occurred 'just like that' in the wards for me. I'm with the trauma team so it's to be expected. Interesting seeing how people respond. The family that grieves at the bedside until even after I've left for home; the doctors and HCWs. i suppose after many many years in practice death isn't 'so big a deal'. And yet that's quite sad. hm.

Besides that a lot has also happened. Stuff that I don't quite want to write down in a public space. Need to catch my flight soon. praying for a good time in manila. I think i'm getting quite used to travelling. The changes in environment, the travelling etc aren't particularly shocking to my system as previously before. Going to a foreign place feels quite natural. Praying that God will be near and that I will hear and obey.

I got a bike! eee.... photos aren't of particularly good quality

and there happened to be some old photos i stumbled across. i looked so young i.e. i look/feel so old now it's not funny.