Sunday, December 18, 2016
Thursday, December 1, 2016
力 / how to become yourself in 365 simple steps
i tried being an ear for a while, but couldn't quite hack it.
---
"Please test your servants for ten days: Give us nothing but vegetables to eat and water to drink."
- Daniel 1:12
---
1. 1 hour bible study 7am
2. 2 hours medicine 8pm
3. run 30 minutes a week
4. language study 1 hour
5. english / writing 2 hours
6. music 45 minutes
7. game dev 1 hour
8. admin 9am - 9.30am
9. fiction 1 hour
10. news 30 min
11. non-fiction 1 hour
---
a foot desperately trying to become an eye
---
how to stop growing
---
Their idols are silver and gold, The work of man's hands. They have mouths, but they cannot speak; They have eyes, but they cannot see; They have ears, but they cannot hear; They have noses, but they cannot smell They have hands, but they cannot feel; They have feet, but they cannot walk; They cannot make a sound with their throat. Those who make them become like them; so do all who trust in them.
- Psalm 115:4-8
---
... when you reach an age and realise, 'shit there's very little room to change what you are. you're no longer the age where you can differentiate into all kinds of cells. You've lost that pluripotency. That's what it means to invest in yourself. You have to study the market and pick your stock wisely. Time is the currency of life. You know the parable about sowing seed, it's not only about sowing into others. Being ready for the harvest means being prepared, being practical minded, pragmatic, conscientious. God doesn't want lousy stewards. He's not interested in bad businessmen. That's why the parable of the talents scares you.
---
Their land is full of idols; they bow down to the work of their hands, to what their fingers have made.
- Isaiah 2:8
---
what does the word 'sincere' mean to you? what does it mean to work with sincerity. andd integrity.
People will bear weakness, but halfheartedness is not an excuse. How to work wholeheartedly - how to be sincere in your work and give it your all. This is something I have to learn.
Sincerity is about doing the hard work when nobody is looking.
---
how to stop worrying about not being what you're not or what you are and instead focus on becoming what you want to be
---
But he said to me, "My grace is sufficient for you, for my power is made perfect in weakness."
---
to pursue.
follow or chase (someone or something). "the officer pursued the van" synonyms: go after, run after, follow, chase, give chase to
---
how to be a go-getter
---
I just finished an on call with Mr M. Mr M is one of the colorectal consultants and a bloody good doctor. Every so often in your career you meet these paragons of excellence, and you go 'wow... how does someone become that good?' When I grow up I'd be lucky to be even half the doctor he is. That's when it hit me - that's what discipleship is. Holding such a strong admiration for someone that you want to become them. The word disciple isn't used much nowadays - it's been supplanted by 'fan' or 'student', but if you want to be a good doctor, you have to be a disciple first, and choose a good master. Medicine is still an apprenticeship. You do the laundry and housekeeping for the privilege of observing them and assimilating their excellence by osmosis. How to be teachable - involves humbling yourself. Content yourself to writing their words down. That's how you know the mind of a man. By copying, appropriating, possessing his words. The system works. Mr Miyagi, the karate kid. All that cliche truism turns out to be true. Giving 110%. Failing to prepare is preparing to fail. It's all true. That there is virtue in the platitude. That sometimes repetition and rote memorisation come before understanding. The concept is as obvious and unpalatable as Donald Trump running for president, and because it's so blatant and patently unappealing we make light of it, brush it off, deny it until it's too late.
---
That's what separates the cream from the rest - some try and do it all on their own strength, and get impressively far - but the best have learned how to learn from others. How to tune out the mesmer of the internal monologue and tune into and understand another person. How to follow someone, instead of trying to lead all the time.
---
Nebuchadnezzar said to them, "Is it true, Shadrach, Meshach, and Abednego, that you refuse to serve my gods or to worship the gold statue I have set up?
- Daniel 3:14
---
"holiness is more than just focusing on other people's pain"
---
but let patience have her perfect work
---
'You'd better leave. You won't make it if you're going to continue like that.'
---
how to take a punch (and then get up again)
---
'that's a cool tattoo'
'Oh god. Please don't tell me it means chicken rice or something like that.'
'It actually means to be patient. Or to endure. See, that one means 'blade', and that one means 'heart' and together it means to persevere.'
---
"Please test your servants for ten days: Give us nothing but vegetables to eat and water to drink."
- Daniel 1:12
---
1. 1 hour bible study 7am
2. 2 hours medicine 8pm
3. run 30 minutes a week
4. language study 1 hour
5. english / writing 2 hours
6. music 45 minutes
7. game dev 1 hour
8. admin 9am - 9.30am
9. fiction 1 hour
10. news 30 min
11. non-fiction 1 hour
---
a foot desperately trying to become an eye
---
how to stop growing
---
Their idols are silver and gold, The work of man's hands. They have mouths, but they cannot speak; They have eyes, but they cannot see; They have ears, but they cannot hear; They have noses, but they cannot smell They have hands, but they cannot feel; They have feet, but they cannot walk; They cannot make a sound with their throat. Those who make them become like them; so do all who trust in them.
- Psalm 115:4-8
---
... when you reach an age and realise, 'shit there's very little room to change what you are. you're no longer the age where you can differentiate into all kinds of cells. You've lost that pluripotency. That's what it means to invest in yourself. You have to study the market and pick your stock wisely. Time is the currency of life. You know the parable about sowing seed, it's not only about sowing into others. Being ready for the harvest means being prepared, being practical minded, pragmatic, conscientious. God doesn't want lousy stewards. He's not interested in bad businessmen. That's why the parable of the talents scares you.
---
Their land is full of idols; they bow down to the work of their hands, to what their fingers have made.
- Isaiah 2:8
---
what does the word 'sincere' mean to you? what does it mean to work with sincerity. andd integrity.
People will bear weakness, but halfheartedness is not an excuse. How to work wholeheartedly - how to be sincere in your work and give it your all. This is something I have to learn.
Sincerity is about doing the hard work when nobody is looking.
---
how to stop worrying about not being what you're not or what you are and instead focus on becoming what you want to be
---
But he said to me, "My grace is sufficient for you, for my power is made perfect in weakness."
---
to pursue.
follow or chase (someone or something). "the officer pursued the van" synonyms: go after, run after, follow, chase, give chase to
---
how to be a go-getter
---
I just finished an on call with Mr M. Mr M is one of the colorectal consultants and a bloody good doctor. Every so often in your career you meet these paragons of excellence, and you go 'wow... how does someone become that good?' When I grow up I'd be lucky to be even half the doctor he is. That's when it hit me - that's what discipleship is. Holding such a strong admiration for someone that you want to become them. The word disciple isn't used much nowadays - it's been supplanted by 'fan' or 'student', but if you want to be a good doctor, you have to be a disciple first, and choose a good master. Medicine is still an apprenticeship. You do the laundry and housekeeping for the privilege of observing them and assimilating their excellence by osmosis. How to be teachable - involves humbling yourself. Content yourself to writing their words down. That's how you know the mind of a man. By copying, appropriating, possessing his words. The system works. Mr Miyagi, the karate kid. All that cliche truism turns out to be true. Giving 110%. Failing to prepare is preparing to fail. It's all true. That there is virtue in the platitude. That sometimes repetition and rote memorisation come before understanding. The concept is as obvious and unpalatable as Donald Trump running for president, and because it's so blatant and patently unappealing we make light of it, brush it off, deny it until it's too late.
---
That's what separates the cream from the rest - some try and do it all on their own strength, and get impressively far - but the best have learned how to learn from others. How to tune out the mesmer of the internal monologue and tune into and understand another person. How to follow someone, instead of trying to lead all the time.
---
Nebuchadnezzar said to them, "Is it true, Shadrach, Meshach, and Abednego, that you refuse to serve my gods or to worship the gold statue I have set up?
- Daniel 3:14
---
"holiness is more than just focusing on other people's pain"
---
but let patience have her perfect work
---
'You'd better leave. You won't make it if you're going to continue like that.'
---
how to take a punch (and then get up again)
---
'that's a cool tattoo'
'Oh god. Please don't tell me it means chicken rice or something like that.'
'It actually means to be patient. Or to endure. See, that one means 'blade', and that one means 'heart' and together it means to persevere.'
hocus pocus
Aristotle said that some people were only fit to be slaves. I do not contradict him. But I reject slavery because I see no men fit to be masters.
- C.S. Lewis, Present Concerns
---
to think that the darkness you harbor is deeper and darker than anyone else's is an inverted, perverse kind of pride, because if you can't be better than everyone else then at least you get to be superlative in your inferiority
Sunday, November 27, 2016
stupid question
google search: what does the bible say about love
---
So he got up and went to his father. "But while he was still a long way off, his father saw him and was filled with compassion for him; he ran to his son, threw his arms around him and kissed him.
- Luke 15:20
Friday, November 18, 2016
Saturday, November 12, 2016
what up, Prufrock
The theatre whiteboard read: 'Make Lancs great again!'
---
And the girl smiled at me
again today, wrinkling her nose
her hair tied up in a bun
and bags under her young
eyes, like shadows hanging
from the sun
---
Young guy playing
guitar outside primark
'Halleujah', 'he's good'
I said. 'He's only played
five chords.'
---
There are lots of teenage
girls in Preston on a Saturday
night, wearing ripped jeans
they seem to come in threes
and i feel guilty for noticing
---
I want to believe
but I have the facts
and reasons and inside
information and the polls all say
that I won't win
---
And the girl smiled at me
again today, wrinkling her nose
her hair tied up in a bun
and bags under her young
eyes, like shadows hanging
from the sun
---
Young guy playing
guitar outside primark
'Halleujah', 'he's good'
I said. 'He's only played
five chords.'
---
There are lots of teenage
girls in Preston on a Saturday
night, wearing ripped jeans
they seem to come in threes
and i feel guilty for noticing
---
I want to believe
but I have the facts
and reasons and inside
information and the polls all say
that I won't win
day of the dead
beauty isn't truth
excitable youth
---
- the right per-p-person could change everything
- i know. that's what i'm afraid of
---
excitable youth
---
- the right per-p-person could change everything
- i know. that's what i'm afraid of
---
And would it have been worth it, after all,
After the cups, the marmalade, the tea,
Among the porcelain, among some talk of you and me,
Would it have been worth while,
To have bitten off the matter with a smile,
To have squeezed the universe into a ball
To roll it towards some overwhelming question,
To say: “I am Lazarus, come from the dead,
Come back to tell you all, I shall tell you all”—
If one, settling a pillow by her head
Should say: “That is not what I meant at all;
That is not it, at all.”
Thursday, October 20, 2016
Saturday, October 15, 2016
rest in peace
"Are you sure it's not urethrostomy?"
"I'm sure."
"How do you spell urethrotomy?"
"U - R - E --" *BZZZZZZZ*
*BZZZZZZZ*
*BZZZZZZZ*
'Hey is that the crash--'
I don't have to complete my sentence. Before I know it we're already in the corridor. A flock of nurses all sprinting in the same direction confirms it and based on where they're headed I know exactly who has died. A nurse reaches the door of the side room before me and turns abruptly. Her eyes are wide with panic. 'Does she have a DNAR???' She asks. "No, she doesn't." I say, brushing past her to get to the arrest.
She had been in hospital for 3 months, suffered two bouts of pneumonia, had bled from her gut and now her heart had become so starved of oxygen that it was struggling to pump blood around her body and to her kidneys, which were slowly shutting down, causing potassium to build up and mess with the electrical activity of the heart.
We were this close to sending her home last week, before we had diagnosed her heart attack, and before her nursing home had decided to shut down, leaving her stranded here.
"She's going to die. You know this, right?" Our reg told us four hours ago in the privacy of the doctor's office. "The only question is when." And yet only an hour ago she was sat up in bed talking to the med reg, shaking his hand, asking if she could go home.
Now, entering the room - it takes me a moment. I know I should spring into action but I hesitate. I stand there, paralysed, trying to make sense of the situation, trying to comprehend the uncanny slackness of her jowl, her mouth agape and eyes like glass, staring past ceiling and into oblivion.
"HAS THE CRASH CALL BEEN MADE. SOMEONE CALL THE CRASH TEAM." Bristol yells and starts chest compressions. "WILL SOMEONE SECURE AN AIRWAY."
His voice snaps me out of it. I squeeze past Bristol to get to the head of the bed and perform a jaw thrust. It's my first time not doing it on a mannequin, but the training kicks in and my hands seem to move on their own, fingers slotting in snugly behind her mandible, palms resting on her temple as if they belong there.
"Can I have a bag valve mask please." I say, and one materializes within seconds. I clamp the mask down onto her face. I struggle to keep her head from rocking wildly as her torso bucks under the force of Bristol's chest compressions. "Is that 30?" I ask.
"Yeah."
Two breaths, watching for the chest to rise.
My mind is all numbers. I don't notice that the other house officers have arrived until one of them swaps with Bristol. All I can register are a pair of hands pumping furiously up and down a dead person's chest.
27... 28... 29... 30...
Pause. two breaths. Not too fast now.
One... Two... and the countdown begins again.
It's incredibly quiet in the room. Dead silent except for the creaking of the bed in time with the laboured breathing of whoever is doing chest compressions. By now, the anaesthetic SHO has arrived, relieving me of the mask and pressing it against the patient's face with undeniably superior technique. The med reg has also arrived and is stood at the foot of the bed, keeping track of how many cycles we're doing, what drugs have been given, what the heart monitor is showing. The on-call house officers take turns doing chest compressions. Fluorescent light envelops the room in stark, unwavering whiteness. There is a palpable discrepancy in the ratio of bodies in the room to the amount of activity taking place. It feels like strangers waiting in line at a bank, attentive and idle. The med reg is the teller, but instead of 'next please' he says 'listen to her chest,' or 'give her a shot of adrenaline.'
The trace shows electrical activity, but neither the anaesthetic SHO nor myself nor the other house officer can feel a pulse. We do another 2 cycles of CPR before stopping. Although there's no pulse she gasps intermittently, laryngeal muscles in visible spasm. "Agonal breathing," The anaesthetic SHO says by way of explanation.
At some point the med reg says "good job everyone," and it's over. "Time of death: 8:03." The crowd disperses and we vacate the room for the nurses to dispose of the detritus and get the body ready. Pattern, the patient's next of kin is already on her way.
The med reg tells me he'll speak to the family and I agree to scribe. When Pattern arrives, she is in tears. She's ushered into the doctor's office, where Bristol, myself and nurse K are present, listening to the med reg telling Pattern that she passed quickly and with very little pain. Pattern is still sobbing, thanking the med reg for being there, thanking the staff for their patience and kindness. "I know... you did your best to do what was right for her. And... I'm glad she's not suffering anymore." Nurse K offers Pattern more tissues and escorts her to the day room.
"I'll get the listing forms." Bristol says to me.
I'm instantly aware of the irony in that remark, and a day later I'll be able to articulate it. Now that the fuss and commotion has died down, we just carry on right where we left off. No ceremony or moment of silence to mark the occasion. To treat a patient's death as the expected interlude between two acts of a play. A minor interruption.
The med reg says to me, "I've certified her and documented the time of death. Thanks for your help." "Thank you so much," I say. "Thank you for coming."
The notes are sat on the windowsill in the doctor's office. It's 8:30 now, three and a half hours since my shift ended. Out of curiosity, I look to see what he has written -
"I'm sure."
"How do you spell urethrotomy?"
"U - R - E --" *BZZZZZZZ*
*BZZZZZZZ*
*BZZZZZZZ*
'Hey is that the crash--'
I don't have to complete my sentence. Before I know it we're already in the corridor. A flock of nurses all sprinting in the same direction confirms it and based on where they're headed I know exactly who has died. A nurse reaches the door of the side room before me and turns abruptly. Her eyes are wide with panic. 'Does she have a DNAR???' She asks. "No, she doesn't." I say, brushing past her to get to the arrest.
74 year old female, admitted with a blocked right nephrostomy. Nephrostomy exchanged and now draining well. Prolonged hospital stay due to social issues.
Background of CKD stage 3, type II diabetes, staghorn calculus, bed bound, morbidly obese, chronic lymphoedema and cellulitis, both legs.
Admission complicated by hospital acquired pneumonia, haematemesis, and most recently acute coronary syndrome and heart failure.
Over the last three days, eGFR has dropped from 13 to 9. Persistently hypotensive - systolic of 70 - treatment resistant hyperkalemia: potassium > 6.0 for past 2 days despite multiple dextrose / insulin infusions.
Assessed by renal, cardiology and ITU consultants, deemed not a candidate for dialysis, coronary artery catheterisation or escalation to ITU. DNAR discussed and refused on multiple occasions. For cardiopulmonary resuscitation despite poor prognosis
She had been in hospital for 3 months, suffered two bouts of pneumonia, had bled from her gut and now her heart had become so starved of oxygen that it was struggling to pump blood around her body and to her kidneys, which were slowly shutting down, causing potassium to build up and mess with the electrical activity of the heart.
We were this close to sending her home last week, before we had diagnosed her heart attack, and before her nursing home had decided to shut down, leaving her stranded here.
"She's going to die. You know this, right?" Our reg told us four hours ago in the privacy of the doctor's office. "The only question is when." And yet only an hour ago she was sat up in bed talking to the med reg, shaking his hand, asking if she could go home.
Now, entering the room - it takes me a moment. I know I should spring into action but I hesitate. I stand there, paralysed, trying to make sense of the situation, trying to comprehend the uncanny slackness of her jowl, her mouth agape and eyes like glass, staring past ceiling and into oblivion.
"HAS THE CRASH CALL BEEN MADE. SOMEONE CALL THE CRASH TEAM." Bristol yells and starts chest compressions. "WILL SOMEONE SECURE AN AIRWAY."
His voice snaps me out of it. I squeeze past Bristol to get to the head of the bed and perform a jaw thrust. It's my first time not doing it on a mannequin, but the training kicks in and my hands seem to move on their own, fingers slotting in snugly behind her mandible, palms resting on her temple as if they belong there.
"Can I have a bag valve mask please." I say, and one materializes within seconds. I clamp the mask down onto her face. I struggle to keep her head from rocking wildly as her torso bucks under the force of Bristol's chest compressions. "Is that 30?" I ask.
"Yeah."
Two breaths, watching for the chest to rise.
My mind is all numbers. I don't notice that the other house officers have arrived until one of them swaps with Bristol. All I can register are a pair of hands pumping furiously up and down a dead person's chest.
27... 28... 29... 30...
Pause. two breaths. Not too fast now.
One... Two... and the countdown begins again.
It's incredibly quiet in the room. Dead silent except for the creaking of the bed in time with the laboured breathing of whoever is doing chest compressions. By now, the anaesthetic SHO has arrived, relieving me of the mask and pressing it against the patient's face with undeniably superior technique. The med reg has also arrived and is stood at the foot of the bed, keeping track of how many cycles we're doing, what drugs have been given, what the heart monitor is showing. The on-call house officers take turns doing chest compressions. Fluorescent light envelops the room in stark, unwavering whiteness. There is a palpable discrepancy in the ratio of bodies in the room to the amount of activity taking place. It feels like strangers waiting in line at a bank, attentive and idle. The med reg is the teller, but instead of 'next please' he says 'listen to her chest,' or 'give her a shot of adrenaline.'
The trace shows electrical activity, but neither the anaesthetic SHO nor myself nor the other house officer can feel a pulse. We do another 2 cycles of CPR before stopping. Although there's no pulse she gasps intermittently, laryngeal muscles in visible spasm. "Agonal breathing," The anaesthetic SHO says by way of explanation.
At some point the med reg says "good job everyone," and it's over. "Time of death: 8:03." The crowd disperses and we vacate the room for the nurses to dispose of the detritus and get the body ready. Pattern, the patient's next of kin is already on her way.
The med reg tells me he'll speak to the family and I agree to scribe. When Pattern arrives, she is in tears. She's ushered into the doctor's office, where Bristol, myself and nurse K are present, listening to the med reg telling Pattern that she passed quickly and with very little pain. Pattern is still sobbing, thanking the med reg for being there, thanking the staff for their patience and kindness. "I know... you did your best to do what was right for her. And... I'm glad she's not suffering anymore." Nurse K offers Pattern more tissues and escorts her to the day room.
"I'll get the listing forms." Bristol says to me.
I'm instantly aware of the irony in that remark, and a day later I'll be able to articulate it. Now that the fuss and commotion has died down, we just carry on right where we left off. No ceremony or moment of silence to mark the occasion. To treat a patient's death as the expected interlude between two acts of a play. A minor interruption.
The med reg says to me, "I've certified her and documented the time of death. Thanks for your help." "Thank you so much," I say. "Thank you for coming."
The notes are sat on the windowsill in the doctor's office. It's 8:30 now, three and a half hours since my shift ended. Out of curiosity, I look to see what he has written -
Pupils fixed and unresponsive to light
No heart sounds on auscultation
No central carotid pulse palpable
No breath sounds on auscultation
Sincere condolences. May her soul rest in peace.
Wednesday, September 28, 2016
retrospectre
I have this tired preset response for whenever someone asks me what I'm doing in hospital after hours - which is most days. It's something along the lines of, 'I live here now' or 'I've got nowhere else to go!' and it started out as a cute little quip, grinning ruefully and bouyed by a gust of bravado, but lately I've gotten tired of saying it. It's become less of a joke and more a statement of fact delivered in a flippant manner - and after a long day, sometimes even the flippancy falters.
Why does it feel like my life can be summarised as what happens within the hospital.
Has split in two and the world has moved on, and I'm taking a different path that's leading further and further away from everything I've known. A current that leads away from KL and old friends' birthdays.
A day off, outside the hospital, feels strange. Feels like re-entering the atmosphere after having been isolated in space - or coming out of a 10 year coma with a tom hanks castaway beard, trying to remember what the word 'normal' used to mean
---
I went into preston last night, the streets were alive, the city's spark had returned. there were returners sauntering through the streets, and a bar filled with freshers, hunched over their drinks, warily scanning the crowd for a friendly face or something familiar. The outdoor terrace decorated with fairy lights, a young man holding a guitar and the group surrounding him, feeling a little unsettled by the new-ness of their surroundings. A few years later they will identify the feeling as homesickness, look back fondly at their initiation into a world bursting with potential and bright futures waiting to be claimed or squandered away.
Why does it feel like my life can be summarised as what happens within the hospital.
Has split in two and the world has moved on, and I'm taking a different path that's leading further and further away from everything I've known. A current that leads away from KL and old friends' birthdays.
A day off, outside the hospital, feels strange. Feels like re-entering the atmosphere after having been isolated in space - or coming out of a 10 year coma with a tom hanks castaway beard, trying to remember what the word 'normal' used to mean
---
I went into preston last night, the streets were alive, the city's spark had returned. there were returners sauntering through the streets, and a bar filled with freshers, hunched over their drinks, warily scanning the crowd for a friendly face or something familiar. The outdoor terrace decorated with fairy lights, a young man holding a guitar and the group surrounding him, feeling a little unsettled by the new-ness of their surroundings. A few years later they will identify the feeling as homesickness, look back fondly at their initiation into a world bursting with potential and bright futures waiting to be claimed or squandered away.
Saturday, September 17, 2016
Panacea
But he wanted to justify himself, so he asked Jesus, "And who is my neighbor?"---
Yet I hold this against you: You have forsaken the love you had at first.
---
Yesterday I made the other urology FY1 cry. Or rather, I was there when she cried.
We had both finished a mammoth day - neither of us had sat down for a second or had lunch. It was 6.30pm - an hour and a half after work had officially ended and we were in the doctor's office finishing up jobs. For some reason the phlebs hadn't taken any of the post op bloods we'd requested in the morning, which meant during grand round there were a grand round of dirty looks directed our way, with looming registrars telling us, 'these bloods should have been done.' Protesting, 'We ordered them this morning,' and receiving in reply a stern look that said, 'these bloods should have been done.'
By the time grand round had ended it was 3pm. 'Jon - let's go through the list. It doesn't look like there's much to do.' I had a referral that needed to be made by 5pm, because that's when the consultant leaves hospital, two urgent discharge summaries to write so that well patients can go home and we can free up beds, and now urgent bloods that should have been done in the morning. 'There are four patients in EDU to be seen. Let's go down and clerk them and then you can finish up and update the list.'
I knew what this meant. What the reg wants is for me to see patients with him, stay back late and sort out paperwork and add patients to the list so that he can go home at 5pm. Which is fine - I get it - but it wouldn't kill him to see one or two patients on his own.
'Uh, I actually have this urgent referral to do. You know, for Mrs Y.? I can join you in EDU afterwards.'
'You can do that down in EDU, can't you? Just bleep him down in EDU.'
Or I can do it from here, now and join you in EDU afterwards.
'I need one of you to come with me and clerk patients in EDU.'
Why?
Selfish. This has happened before. Don't do it
And if someone takes your cloak, do not withhold your tunic as well.
'Okay, sure.'
Two hours later I'm in the office updating the list and trying to sort out what to do with this referral I missed because I was assisting with a catheter and was told, 'Whoever is bleeping you, just ignore it. You're busy with a patient.'
And whosoever shall compel thee to go a mile, go with him twain.
After we got the catheter in, I washed my hands and scrambled to the nearest telephone.
'Hello dialysis unit.'
'Hi, it's Jon urology FY1, did Dr. X bleep me by any chance?'
'Oh he was here a while ago, but he's gone now.'
Perfect.
By the time I had gotten to the office it was an hour past quitting time and I was in a pretty foul mood.
I texted the other FY1; hey quick q have you ordered bloods over the weekend for ward patients?
Not yet
Which means I'll have to do it.
I quickly checked to see if the urgent bloods had all been done, and some part of me wanted the answer to be no, wanted something concrete to confront her with, and some cruel part of me was perversely glad to find that one of them had indeed been missed.
Normally I wouldn't have mentioned it at all and sorted it out myself. After all, what's a few more minutes when you've already over-stayed two hours. But I reasoned, if I continue to do this, she will a.) not realise that her responsibility includes checking that bloods have been sent off and checking the results and b.) believe that things will continue to magically sort themselves out even if she does forget to order or check blood results.
Plus, it wasn't the first time this had happened. We divide jobs into outliers and ward. I've pretty much been picking up after her every day for the past four days, making sure bloods have been ordered and adding patients that have been missed off the list.
The lock in the door behind me rattled, and she came in looking drained and older by about 10 years.
'Hey, how's it going?'
'Not too bad, do you know if Mr Z had his bloods done?' I asked, already knowing the answer.
'... I asked Zoe (the medical student) to check and she said the nurse was doing them.'
'Because it says on the system, it's been collected but... that was three hours ago.'
'Oh.'
'So it's not been done.'
'I guess not... I asked Zoe though.'
'Yeah but.'
'The rest of them are definitely done though.'
'Yeah but what about Mr Z?'
'I guess he's not getting bloods today then.'
'... So when the reg asks, why haven't bloods been done - what are you going to say?'
'I asked Zoe and she said... the nurse was doing it.'
'So you're going to say "Zoe told me it was being done?"'
She laughs. 'Are you afraid of the reg?'
'No, I'm not - but I just need you to know that... these bloods have to be done. It's not okay to just leave it undone. Do you understand?'
'Alright well I'll do it later then.'
'No - we can handover to surgeon of the week, or ask one of the nurses to do it. That's not the issue, what I'm saying is that Mr Z had an AKI so he needs bloods for today. Do you understand? You can't just leave assuming that that they're done. You have to check... '
Before I knew it there were tears rolling down her cheek. I had not expected this.
I sat there, unsure how to suddenly switch from lecturing to comforting her.
'Hey, what's the matter?' I said at last, trying to sound like a friend.
'It's nothing,' she said, still sobbing furiously.
'... is there... something at home? Something troubling you?'
She shook her head and dabbed at the tears with her wrist.
'... is it the job?'
She gave a small tentative nod.
'It's like... I can't do everything...'
'... As in, we try our best, but people still expect things to be perfect?'
She nods again.
'Yeah, I know... you'd expect them to understand that - there's just two of us... doing a four person job, and it's not like we're sitting around drinking coffee...'
The tears had nearly stopped now, her gasping reduced to a sniffle.
'And I don't know why they still act like it's reasonable to expect us to get everything done. I mean... either they know it's not possible or...'
And then I stopped speaking. Because I realised that I had been doing to her the exact same thing I resented being done to me. Being held accountable without a fair trial - without considering there might be more to the story - something wrong with the system rather than with the individual. She wasn't incompetent. She had sorted out the urgent echo request and another patient's heparin induced thrombocytopenia screen. To have done both by quitting time is no small feat. She simply hadn't gotten round to checking that all the bloods had been done. She was doing her best - and I had somehow convinced myself that her failure to check on Mr Z's blood was due to negligence or some kind of mental laziness.
And I was reminded of something I had already suspected; that cruelty comes from suffering. And that the kind of registrar who abuses their house officer is the kind of registrar who was abused as a house officer - and becomes the kind of house officer who abuses other house officers, and makes nasty private comments about the ward sister's weight and appearance, and gradually loses the ability to understand anybody's suffering beyond his own, and begins to convince himself that any and every minor inconvenience or mishap is part of some grand conspiracy or deliberate, concerted effort to keep him as miserable as he is now.
'Yeah, but I keep making mistakes... keep missing things out.' She says. 'Like yesterday I prescribed blood for that lady - only to find it hadn't been given... and I had to represcribe it, because apparently you can't prescribe 2 units at the same time...' She shook her head. 'I mean... sometimes it's just like... what's the point?'
'Yeah, I know what you mean. Like all that work is for nothing.'
She nods.
'I think maybe you're just tired. It's been a long week and you're only human. Have you been getting enough sleep?'
'I think so.'
'I don't think so - cause you have to wake up early to drive here, and you've been staying pretty late, haven't you?'
'But so has everybody else.'
'... I think what you need is to have a good rest - just spend some time away from work and come back refreshed. I think a lot of it is just stress. And it messes with your sleep too. You know, when you can't get your mind to switch off? I honestly couldn't sleep at all yesterday.'
And then I told her about my delirium dream that consisted of a consultant trying to explain something very basic to me, and me just not understanding at all, and watching as he became more and more frustrated.
And as we talked she managed a laugh, which manifested as a kind of sharp, brittle sound, which I recognised as being the very same one I made just over a month ago and fighting back tears a week later at someone else's house.
---
Above all, love each other deeply, because love covers over a multitude of sins.
---
Brothers, if someone is caught in a trespass, you who are spiritual should restore him with a spirit of gentleness. But watch yourself, or you also may be tempted. Carry one another’s burdens, and in this way you will fulfill the Law of Christ.
Wednesday, August 31, 2016
losing strategy
"Sell everything you own and follow me." is more or less Jesus' response to a rich man who wants to get into heaven. Resignation (sell everything) is one thing, but it is continual (follow me). Temptation is ever present to re-awaken your desire for whatever was given up. It is an infinite struggle. Also faith itself requires infinite scrutiny, or it becomes a lie.
---
And Jesus looking upon him loved him, and said unto him, One thing thou lackest: go, sell whatsoever thou hast, and give to the poor, and thou shalt have treasure in heaven: and come, follow me. But his countenance fell at the saying, and he went away sorrowful: for he was one that had great possessions.
I especially like Mark's account because it mentions that 'Jesus looked at him, and loved him.' That tiny detail makes me read it in a different way.
It's as if Jesus is doing a double take. It's like he's finally found a student who has done the required reading. It's like he's finding fruit in a land full of fake trees. He sees something in the young man - a glimmer of hope, a potential crop. Here's a young punk who turns up every day knocking. The kid has moxie.
So he tells him the truth - but the truth is a father willing to sacrifice his only son, a son sold into slavery, a servant in a foreign land, the head of a prophet on a silver platter and apostles in prison, an angry mob and three men in a furnace, a pair of wrists with holes in them, and Jesus standing in the doorway offering his hand, his eyes gentle and full of mercy, saying, 'leave everything behind and follow me.' Already knowing what the young man's answer will be.
Saturday, August 20, 2016
no team in eye
If the foot should say, “Because I am not a hand, I do not belong to the body,” that would not make it any less a part of the body. And if the ear should say, “Because I am not an eye, I do not belong to the body,” that would not make it any less a part of the body. If the whole body were an eye, where would the sense of hearing be? If the whole body were an ear, where would the sense of smell be?
[...]
But God has composed the body and has given greater honor to the parts that lacked it, so that there should be no division in the body, but that its members should have mutual concern for one another. If one part suffers, every part suffers with it; if one part is honored, every part rejoices with it.
---
people religious about health, religious about cleanliness - what does 'being religious' mean? adhering stringently to a set of actions and traditions - believing that rituals can save you - doing something obsessively in the belief that it isn't futile
---
When I was in fourth year of medical school a consultant stopped ward round and asked us, 'who is the most important person in the hospital?' We stared back at him blankly. "Is it Mr Najar? (referring to himself) (I've forgotten the consultant's name but he was almost certainly Indian) Is it the hospital administrator?" He gave us a wide and benign grin. "No, it's this person right here," gesturing to the lady who nobody had noticed before then, rendered inconspicuous by her dark green cleaner's uniform. She looked back at him and gave a bashful smile, unused to the attention. Mr Najar smiled back warmly at her. "How are you today?" "Fine, thank you." He turned back to face us. Our faces were so blank you could draw on them.
"If she isn't here, then the ward will be dirty. If the ward is dirty then patients will get sick. If this person doesn't do her job, then all our work here is meaningless. Do you understand?" Our heads nodded dutifully. "That's why I always say hello, good morning. Isn't it much nicer when people say good morning to each other? Good morning Rita!" A passing secretary beamed at him without breaking her stride. "Good morning Mr. Najar." The cleaner loitered in the background with her hands politely clasped behind her back, unsure if she was obliged to stay for the rest of the sermon.
I had forgotten about Mr Najar until now. I don't remember what happened before or what came after on ward round. It's lost in the sea of trivial mornings and medical school routine. I know now, however, with almost 100% certainty that none of us had understood the point he was trying to make. We just chalked it up to another eccentric consultant's production - the fanfare and palaver that performers feel compelled to deliver for a captive audience (who are themselves rarely desirous of it).
Last Thursday, as the ward round was entering the last bay, a tall, tanned Pakistani gentleman clad in a deep blue jumpsuit paused his mopping and stepped aside deftly, holding the door to allow the group through. Neither the registrar, who led the ward round, nor the consultant, who followed second, nor the core trainee, who hurriedly trailed after them, uttered a word of thanks.
Later that day, a nurse and a doctor were in the doctor's office. He was in the middle of writing up a patient's discharge letter. She was being strangely polite. She was a staff nurse, qualified a year ago, but it was her first time being in charge of the ward. It was subtle, but you could tell she felt slightly out of her depth - that the weight of responsibility had caught her a little off balance. "I'm sorry to keep barging in - you lot must hate it, us pecking at you all the time for this and that."
The doctor scratched his head and looked at his screen. "I don't think it's as bad as when you ask us to do something and we just look blankly back at you like... umm. I don't know how to do that--"
"-- I know and we're like, please don't look at us! We don't know what to do either!" They looked at each other and laughed, a genuine expression of relief, the sound of tension dissipating.
The doctor nodded amicably and returned his attention to the screen but continued, "So if it's something we can help with then... you know, it goes both ways doesn't it? At the end of the day, we're all on the same team."
And as they talked, you could sort of tell that the nurse and the doctor were listening to each other now, the way sometimes a member of the human race listens to another.
Saturday, August 13, 2016
Sunday, August 7, 2016
this is water
0. no answer
- so you're saying that good triumphs over evil in the end
- yeah
- not every time, but ultimately, good will prevail
- good guys don't really finish last
- no they don't
- they don't get stepped on and taken advantage of and blamed for things that aren't their fault
- .. no, they do
- so you're saying that this will change
-
- hello?
1. give and take / imposition / path
no matter what you choose the outcome is the same?
transferring dates into my diary from the rota: four months ago the future's entire course, direction, approach vector, angle of descent lay in my palm. I held all the cards. And now, the pattern of my sleep, my work and my rest will be decided for me for the next four months - and again and again for the next two years - and within the narrow confines of that conveyor belt I will get to make tiny, infinitesimal microscopic decisions that will accumulate and eventually amount to my becoming one or none of the following: a core surgical trainee, a failed poet, a recluse, a house-husband, a homeowner, balding, wealthy, unhappy
---
speed of light as a universal constant; you can change the future but you can't change how fast it comes
---
your word is a lamp for my feet, a light unto my path
- Psalm 119:105
2. Doctor's mess
Barring patients and medical students, pretty much everyone in the hospital is going through the same thing. Too many demands and not enough resources. The guy in ultrasound I spoke to will get another call within two seconds of putting down the phone, and he will have to deal with another harried request, and decide: 'will this need to be done now or can it wait?' And all of them have to be done now. 9 to 12 hours a day of strangers continuously demanding things of you, each request a unique amalgam composed of bullying and sweetness in infinitely varying proportions, carefully tweaked, calculated degrees of indignation and meekness. The nurses switch up tactics and employ their practiced strategies like an American football coach going through her playbook. You know this because this is what doctors do to nurses, utilizing whatever and whoever in order to do What Needs To Be Done. Here, ruthlessness is an asset and empathy a liability.
Efficient allocation of resources is the key that keeps the hospital running - no matter how run down and poorly equipped and understaffed. In these hospitals, economics is the governing principle, not compassion. If love means self-sacrifice then the best doctors love their patients more than family. So maybe the ideal doctor is the one who prioritises their patients above all else. Willing to walk through fire and burn bridges and be nailed to a cross if it means doing The Right Thing for their patient. I've always wondered why some doctors treat the people they work with like dirt - but the past three days have taught me: it's common sense, isn't it. It turns out that the self is a finite resource. And you get to choose the few you love
3. Mother tongue
Passive aggression as the lingua franca among healthcare professionals
Thou shalt despise the ones who never ask for your help
Thou shalt despise the ones who are always asking for help
Thou shalt despise the ones you need to ask for help
Thou shalt despise the ones who despise us for despising them
When you become a doctor you start classifying people into two categories 1. people who are helping me treat the patient and 2. people who are hindering me from treating the patient
lean mean people-hating machine
4. Muri shinaide
how to take care of others without killing yourself
Playing God - balancing the needs of one patient against another, deciding which requests and desperate pleas are to be granted and which must be denied
5. Conflict of interest / declaration of interdependance
This hostility is fixed into the system, entrenched - because on some level they know that if we manage to do everything we need to do to avoid getting shouted at, it would mean leaving some of the tasks they need to complete to avoid getting shouted at undone
---
The registrar has the patient's best interests at heart, at least that's what he tells himself. But maybe he doesn't realise that his best interests, ie having a newly qualified F1 trail him around the whole day means 1. his life is easier in the short term because he can delegate donkey jobs to the F1 and 2. that important jobs don't get done unless the F1 stays back for 5 hours after his shift ends - which results in the F1 being berated the next day because 10 of the 20 urgent bloods ordered yesterday had not been collected. It could be that he doesn't know he's being unfair, or that he knows it's unfair but justifies this by saying, 'that's how it was when I trained! Why should you lot have it better than us?'
But in this hospital, we don't have enough resources for us to go through what you went through without someone getting hurt. Will you deny that as a result of overexertion and a lack of senior support, patients were subject to avoidable harm - despite all your altruism and best efforts and good intentions? And is this really what you want
6. Insult to injury
- am I whining?
- kind of
- Is getting blamed for things that aren't your fault part of the job?
- Unfortunately yes
- you know we're only getting paid 7pounds an hour after tax right
- so stop going in on saturdays
7. Despise thy neighbour
The incurable tendency to focus only on your own suffering
urge to see nurses as the enemy
urge to see all nurses as the same
I have such massive newfound respect for F2s and junior doctors I met as a medical student - who suffered in silence and made small talk and tolerated my attempts to be helpful, and my tacit concealed disapproval, the comfortable distance I've enjoyed atop the pedestal of naivety and self-righteousness.
(The stony demeanour is a precaution against being taken advantage of - because if you say yes to everything, people will keep asking. This explains also the prickliness some of the nurses put on.)
But why does this adulation not filter upstream to registrars and consultants? Because they have it easy (easier) now? (what are you basing this allegation on? where is the proof of this? They are fighting a hard battle you know nothing about.) Even if it were true, why does that erase the merit of suffering? In all likelihood, they have gone through much worse.
I'll tell you why. it's because
1. they do not identify with our pain anymore - either they have forgotten it because the present is so good or chosen to ignore it because the past was so bad
2. They are the surrogate cause of our present suffering. If you wish to go further you could say that patients are the cause of our present suffering. Or you could go even further and blame it on something vast and abstract - you could go into liberal arts mode and say, actually, sickness and disease is the root cause of your shared suffering, patients, consultants and junior doctors alike. But then it is also the reason your job exists. Hospitals don't function without patients, without consultants, without disease, without imperfection, without weakness. If your sole purpose is to eradicate something, then you also owe it your existence. In heaven what do the doctors diagnose?
But the point is that we need each other to survive. No matter how much we disgust each other. But the consequence of this innate revulsion is that we band together with those close to us, and form factions and vilify the ones who aren't like us. They are flawed exactly the same as we are, but we hate the flaws in ourselves, so much that we use the speck of dust in our brother's eye to distract us from the beam in our own. We deny our own hideousness by focusing on the hideousness of others, using arbitrary, superficial differences to try and justify the discrimination.
We have to make the innocent guilty, we need a common enemy, a martyr for us to burn and huddle round for warmth, because there is comfort in being able to multiply joy and divide pain, to share and shoulder each other's burdens. But for there to be an 'us', there must necessarily be a 'them'. And in this kind of environment, we can't get by - we won't survive unless there's an 'us'.
(I've thought this for a while now, but doctors seem to be broken in a way that other professions aren't, which is to say that we are flawed in an oddly homogeneous way. Some well-concealed, insidious and socially acceptable strain of megalomania or white knight syndrome, and you'd think that would allow us to identify deeply with each other, and connect over shared experiences, but maybe its only in the crucible of tribulation that there is enough energy to overcome this mutual repulsion of like charges, and bonds them irreversibly. But as the charge increases, so does its electrostatic force. The larger and more homogeneous the group, the more violent and volatile its pull and push, towards outsiders - towards those who aren't part of the group.)
---
How to be kind to a house officer who hates you
8. welcome to the real world / Induction
"you can save this child's life, but only if you cut off this man's hand"
the way the hospital works is the way the world works - so sheltered, have never experienced it firsthand
total shift from being in university to working world - such separated by a rift as vast as the galaxies are from each other - as far apart as the east is from the west
the two realities are incomparable, incompatible
the unfairness of it all
how to preserve the lessons, values which instilled, kindness, courage, integrity, honesty now do not function, ineffectual impractical - get you killed if applied to your day to day white collar job
having to confront my naivety... do i still value it? envy it in others? is it right to despise it?
9. Hustle
For in this hope we were saved. But hope that is seen is no hope at all. Who hopes for what they already have? But if we hope for what we do not yet have, we wait for it patiently.
---
I have no right to say any of this. it's only been 3 days
But do you think it will get better?
I don't know. All I can do is hope, against all odds
Know that the trying of your faith produces endurance
The trying of your faith
The frustration of hope
But hope deferred maketh the heart sick, remember?
10. Muri shinaide pt 2
Hey kid, you don't have to force it you know. Just concentrate on loving the person in front of you. Value them, treat them with respect, whether or not you think they deserve it. Your job is to decide how you treat these people. Whether or not they get it is up to them
---
- let's say your mother and father are both drowning, and you only have time to save one of them, who do you save?
- what? my mother I guess
- wrong
- what do you mean 'wrong'?
- the answer is simple: you save the one that's closest to you
11. this too shall pass
Love never fails. But where there are prophecies, they will cease; where there are tongues, they will be restrained; where there is knowledge, it will be dismissed. For we know in part and we prophesy in part, but when the perfect comes, the partial passes away. When I was a child, I talked like a child, I thought like a child, I reasoned like a child. When I became a man, I set aside childish ways. Now we see but a dim reflection as in a mirror; then we shall see face to face. Now I know in part; then I shall know fully, even as I am fully known. And now these three remain: faith, hope, and love; but the greatest of these is love.
Tuesday, July 5, 2016
washroom sermon
He came to Simon Peter, who asked Him, “Lord, are You going to wash my feet?” Jesus replied, "You do not realize now what I am doing, but later you will understand."
- John 13:7
---
my mom and I were cleaning the bathroom today. The whole of the bathroom. When we got to the toilets and had to scrub the inside with the brush, I caught myself thinking, 'why don't we get the maid to do this...' 'I'm not even getting paid...' I had no problems scrubbing the sink, wiping the faucets, rinsing the floor, but when it came to the inside of the bowl... surely this sort of thing was not what I was put here on this earth to do. This is not my calling - in fact it's the opposite. This type of thing doesn't suit me at all. Manual labour I can handle, I only ask to be kept far away from sinks, drains, orifices of unsanitary receptacles in general.
After we'd finished, when both my mom and I were thoroughly splattered with flecks of soap and water from the bathroom floor, I started thinking - maybe this is a kind of proof. That the true value of the gift is in what it costs the giver. That you are willing to get yourself dirty in order to make something clean.
Sunday, July 3, 2016
Tuesday, June 28, 2016
such great heights
Sometimes when it's late at night, I like to look out my bedroom window at the other condominiums. We're surrounded by other condos in pretty much every direction, and since we're on the 6th floor the other condos tower over and around us - but not in a looming, intimidating way. It's actually kind of reassuring for some reason. We hardly ever look out the window unless it's to catch a glimpse of some fireworks going off. Even our view of the sunset is blocked by a row of condominiums huddled shoulder to shoulder in the distance. But I still can't help looking. I can't tell if the view is actually beautiful or if I just think it's beautiful because it reminds me I'm home. But to me at least, when I look at it, even up close and for a really long time, the appeal holds up. I can't help but see it as something gorgeous.
It's 7 minutes past midnight and most of the other units' lights are off by now, but an hour ago about half of them were still on, and I could make out - for the condo nearest to us at least (just across the road) - a few details about each living room. For instance, one of the rooms was coloured a very pale and diffuse blonde, its jaundiced incandescence resting lightly on a cream coloured faux leather sofa positioned just next to the window, which anchored it firmly in the foreground of my ogling. The strange part is that I started picturing, with uncanny clarity, the owner of the sofa schlepping around in shorts and slumping into the sofa in front of the tv, his flaccid and defeated posture already telegraphing what you assume to be a glazed look, an expression of neither pleasure nor displeasure, but just abject emptiness and boredom on his face. But of course none of this took place, except in my mind. The sofa remained vacant, cream coloured and un-sat upon.
Further away there's a block of condos at the end of the road where Michelle stays. There's one particular unit that's too far away for me to really make anything out specific, but its one striking characteristic is that it's generously lit. Almost overflowing with light, spilling out onto the building's facade. Its hue is more white and fluorescent than red or orange. You can tell it's not lit by those little yellow bulbs embedded into the ceiling -- you know, the ones that shine down precisely like a mini-spotlight at some art gallery or pretentious italian restaurant. Instead, you get the feeling that it comes from a warm white fluorescent bulb or tube, casting its easy light about, and it feels bright and untroubled and welcoming for some reason. The large, full length window faces us directly so I can see straight into the unit and maybe just about make out the shape of a kitchen counter. In my imagination it's speckled black and caramel and made of granite (these condo kitchen countertops are always made of granite). Behind it stands a well-stocked fridge (silver-gray) and next to the fridge in a small alcove sits a shiny modern oven the inhabitant has never used and does not know how to use. The tenant is, in my mind, a 24-27 year old business/finance type person. Maybe she works in advertising? Or tax accountancy perhaps. She's a very practical and pragmatic person, that's why she opted for the bright white lights over yellow - she doesn't need it to be fancy, just well lit. But she cares that the apartment is neat, and keeps it clean and uncluttered at all times, tidies it up regularly and religiously. There aren't many pictures or picture frames in her condo - pretty much zero ornamentation to be honest, but it still manages to feel comfortable, bearing the unnatural polish and sheen of a high class hotel bathroom. She's lived there about two years now. At work she wears business skirts and contacts but around her condo she wears shorts and an old T-shirt from college, her hair, dyed latte with streaks of darker brown tied up in a rough bun, and a pair of thick rimmed black glasses on her face. Her laptop is probably open either in the dining room or her bedroom, on its screen, a cursor blinking on a half completed excel spreadsheet. She lives alone, but will be having friends over for the first time next week. She's pacing the wide and ceramic tiled kitchen that adjoins the empty living room with an absent look on her face, stressing out a bit over what to prepare. Alcohol? That's a given right? Should I decorate the house? What on earth would I decorate it with? Balloons? She scoffs and shakes her head. She pours herself a glass of water. It's getting late and she's got work tomorrow.
I know this from experience. I know this moment will pass, and tomorrow I will not feel this way at all. No matter how meaningful or significant or sacred the experience. The daylight and travails and tasks of daily survival will wash it all away, all sentiment, all desire, like a dream upon waking.
(The one photo she does have is in the living room, and it's an old family photo of her and her parents and her brother on vacation. Her brother was a talented batter for her high school baseball club, and then worked as a graphic designer after a brief stint in the army.)
But for now I'm determined to make it last for as long as I can, and to love it as much as possible. To attempt to inhabit the moment fully. To sit and untangle this knot of emotions, to actually slow down and live this out second by second.
And now I realise why I can picture that scene so clearly, because it's an amalgamation of anime and old experiences and people I know. Korean reality shows where they invade pop-stars' dormitories, Makoto Shinkai's photorealistic depictions of Tokyo. My personal experience with the strategic deployment of creature comforts as a bulwark against the loneliness of big city living. And I recognise and identify so strongly with the person slumped in the sofa mesmerised by the screen because i've seen that person before. Been that person before. The modern, luxurious kitchen is a facsimile / pastiche of the interior of my friend's penthouse apartment down the road. And even my fondness for the bright fluorescent lights can be traced back to my paternal grandmother's house in SS2. An old terrace house with a massive mango tree in front of it, which has since been chopped down. Its great blinding unmoderated light colouring the memory of simpler times, raucous laughter, brash cousins and indecipherable dialects, funerals rites, a thousand relatives and mosquito bites. Everything I know of other people is plagiarised from past experience - a chopped up, flipped around and shoddily reassembled projection of my own life. But maybe this is the only way I know how to connect. Maybe the only way to understand other people is to amass a wealth of experience, a diverse catalogue of anecdotes and acquaintances, a personal library of blessings and regrets. For fiction to resemble fact you have to know a lot of facts.
But it's not just the light that matters. It's the darkness in between that makes it precious. This expanse of profound, unbroken nothingness. Except for the occasional pair of headlights cruising noiselessly along the main road - something distinctly asteroid-esque about its weary trajectory and pace - everything else is still, in a repose that seems to have lasted eons and does not appear to be ending any time soon. The inky absence of light feels like a kind of infinity. It makes the sun seem like something you've only heard of, something you've read about and maybe seen on tv once or twice, something made up. There are no stars tonight and the moon is nowhere to be seen, but the multicoloured glow of condo windows faraway and little orbs of electric light dotting the carpark and guardhouse and poolside are scattered and clustered below like a small galaxy. Pitch black silhouettes of trees interrupt your view of the continuous orange glare of streetlights down below, a river the colour of persimmon and aged cheddar guiding cars back home from a night out or on their late night commute, office workers who work in the city and are the last to leave the office at 11pm navigating the empty chairs and cubicles and blinking LEDs to get to a house where only the kitchen light is on and the family is already fast asleep.
It makes me feel less alone to think this way - to think that we could be tiny beacons of light and hope and warmth waving to each other from across the universe. To believe that given the right circumstances, even the tiniest peek into somebody's living room, or the colour of someone's sofa, or noticing the kind of light bulbs they've installed can conjure up memories of dead relatives and childhood, can tell us something of historical importance about other people and ourselves. The idea that when we allow people enough room to be themselves, and when we're willing to do the work of trying to see people for who they are, we find that what we have in common surpasses our differences by a magnitude of millions. We discover that we are so alike as to be almost identical. That we're all isolated in our little light-filled boxes, and it's good to let each other in once in a while. I don't know if any of this is actually true, by the way. Maybe it's all in my head. All I know is that when I look out my window on nights like this, for once it feels like a peaceful world.
It's 7 minutes past midnight and most of the other units' lights are off by now, but an hour ago about half of them were still on, and I could make out - for the condo nearest to us at least (just across the road) - a few details about each living room. For instance, one of the rooms was coloured a very pale and diffuse blonde, its jaundiced incandescence resting lightly on a cream coloured faux leather sofa positioned just next to the window, which anchored it firmly in the foreground of my ogling. The strange part is that I started picturing, with uncanny clarity, the owner of the sofa schlepping around in shorts and slumping into the sofa in front of the tv, his flaccid and defeated posture already telegraphing what you assume to be a glazed look, an expression of neither pleasure nor displeasure, but just abject emptiness and boredom on his face. But of course none of this took place, except in my mind. The sofa remained vacant, cream coloured and un-sat upon.
Further away there's a block of condos at the end of the road where Michelle stays. There's one particular unit that's too far away for me to really make anything out specific, but its one striking characteristic is that it's generously lit. Almost overflowing with light, spilling out onto the building's facade. Its hue is more white and fluorescent than red or orange. You can tell it's not lit by those little yellow bulbs embedded into the ceiling -- you know, the ones that shine down precisely like a mini-spotlight at some art gallery or pretentious italian restaurant. Instead, you get the feeling that it comes from a warm white fluorescent bulb or tube, casting its easy light about, and it feels bright and untroubled and welcoming for some reason. The large, full length window faces us directly so I can see straight into the unit and maybe just about make out the shape of a kitchen counter. In my imagination it's speckled black and caramel and made of granite (these condo kitchen countertops are always made of granite). Behind it stands a well-stocked fridge (silver-gray) and next to the fridge in a small alcove sits a shiny modern oven the inhabitant has never used and does not know how to use. The tenant is, in my mind, a 24-27 year old business/finance type person. Maybe she works in advertising? Or tax accountancy perhaps. She's a very practical and pragmatic person, that's why she opted for the bright white lights over yellow - she doesn't need it to be fancy, just well lit. But she cares that the apartment is neat, and keeps it clean and uncluttered at all times, tidies it up regularly and religiously. There aren't many pictures or picture frames in her condo - pretty much zero ornamentation to be honest, but it still manages to feel comfortable, bearing the unnatural polish and sheen of a high class hotel bathroom. She's lived there about two years now. At work she wears business skirts and contacts but around her condo she wears shorts and an old T-shirt from college, her hair, dyed latte with streaks of darker brown tied up in a rough bun, and a pair of thick rimmed black glasses on her face. Her laptop is probably open either in the dining room or her bedroom, on its screen, a cursor blinking on a half completed excel spreadsheet. She lives alone, but will be having friends over for the first time next week. She's pacing the wide and ceramic tiled kitchen that adjoins the empty living room with an absent look on her face, stressing out a bit over what to prepare. Alcohol? That's a given right? Should I decorate the house? What on earth would I decorate it with? Balloons? She scoffs and shakes her head. She pours herself a glass of water. It's getting late and she's got work tomorrow.
I know this from experience. I know this moment will pass, and tomorrow I will not feel this way at all. No matter how meaningful or significant or sacred the experience. The daylight and travails and tasks of daily survival will wash it all away, all sentiment, all desire, like a dream upon waking.
(The one photo she does have is in the living room, and it's an old family photo of her and her parents and her brother on vacation. Her brother was a talented batter for her high school baseball club, and then worked as a graphic designer after a brief stint in the army.)
But for now I'm determined to make it last for as long as I can, and to love it as much as possible. To attempt to inhabit the moment fully. To sit and untangle this knot of emotions, to actually slow down and live this out second by second.
And now I realise why I can picture that scene so clearly, because it's an amalgamation of anime and old experiences and people I know. Korean reality shows where they invade pop-stars' dormitories, Makoto Shinkai's photorealistic depictions of Tokyo. My personal experience with the strategic deployment of creature comforts as a bulwark against the loneliness of big city living. And I recognise and identify so strongly with the person slumped in the sofa mesmerised by the screen because i've seen that person before. Been that person before. The modern, luxurious kitchen is a facsimile / pastiche of the interior of my friend's penthouse apartment down the road. And even my fondness for the bright fluorescent lights can be traced back to my paternal grandmother's house in SS2. An old terrace house with a massive mango tree in front of it, which has since been chopped down. Its great blinding unmoderated light colouring the memory of simpler times, raucous laughter, brash cousins and indecipherable dialects, funerals rites, a thousand relatives and mosquito bites. Everything I know of other people is plagiarised from past experience - a chopped up, flipped around and shoddily reassembled projection of my own life. But maybe this is the only way I know how to connect. Maybe the only way to understand other people is to amass a wealth of experience, a diverse catalogue of anecdotes and acquaintances, a personal library of blessings and regrets. For fiction to resemble fact you have to know a lot of facts.
But it's not just the light that matters. It's the darkness in between that makes it precious. This expanse of profound, unbroken nothingness. Except for the occasional pair of headlights cruising noiselessly along the main road - something distinctly asteroid-esque about its weary trajectory and pace - everything else is still, in a repose that seems to have lasted eons and does not appear to be ending any time soon. The inky absence of light feels like a kind of infinity. It makes the sun seem like something you've only heard of, something you've read about and maybe seen on tv once or twice, something made up. There are no stars tonight and the moon is nowhere to be seen, but the multicoloured glow of condo windows faraway and little orbs of electric light dotting the carpark and guardhouse and poolside are scattered and clustered below like a small galaxy. Pitch black silhouettes of trees interrupt your view of the continuous orange glare of streetlights down below, a river the colour of persimmon and aged cheddar guiding cars back home from a night out or on their late night commute, office workers who work in the city and are the last to leave the office at 11pm navigating the empty chairs and cubicles and blinking LEDs to get to a house where only the kitchen light is on and the family is already fast asleep.
It makes me feel less alone to think this way - to think that we could be tiny beacons of light and hope and warmth waving to each other from across the universe. To believe that given the right circumstances, even the tiniest peek into somebody's living room, or the colour of someone's sofa, or noticing the kind of light bulbs they've installed can conjure up memories of dead relatives and childhood, can tell us something of historical importance about other people and ourselves. The idea that when we allow people enough room to be themselves, and when we're willing to do the work of trying to see people for who they are, we find that what we have in common surpasses our differences by a magnitude of millions. We discover that we are so alike as to be almost identical. That we're all isolated in our little light-filled boxes, and it's good to let each other in once in a while. I don't know if any of this is actually true, by the way. Maybe it's all in my head. All I know is that when I look out my window on nights like this, for once it feels like a peaceful world.
Saturday, June 18, 2016
love me when I'm down lah
hey
talk more, why are you so quiet?
come now, bare your neck
we won't bite
we just want to see
what it looks like
talk more, why are you so quiet?
come now, bare your neck
we won't bite
we just want to see
what it looks like
Friday, June 10, 2016
retry?
y / n
---
the most important thing in life is deciding what to believe in. Some people believe only in themselves and become incredibly 'successful' and miserable. Some people don't believe in anything at all. Some people only believe in money. Some people believe in something larger than themselves, destiny, God, crystal energies. Believe as synonymous for worship. Or maybe 'rely'?
---
it's my last day in singapore, and I'm starting to see the country a little differently. On the platform at stevens waiting for the mrt I notice the hum of trains in the distance and sleepy cavernous still-ness of the place. The librarian asks if it's my last day, and I say yes. Are you planning to come back, maybe we'll see you around? she asks, and I fumble for a diplomatic answer. "Possibly, who knows?" I shrug fecklessly and assume an awkward, idiotic grin. It's my last day here and I'm thinking, 'maybe this place isn't so bad.' Typical. Little india is a lot bigger than I imagined. The narrow walkways connecting shopfronts smell of flowers strung together and some kind of incense. Tourists litter the streets, carrying backpacks and wandering aimlessly and I feel a little more at ease. I ask 'do you sell em ping here'? and am met with slightly raised eyebrows 'belinju?' I try. With a gentle shake of the head, they resume their quiet bustling, indian children trickling in and out of shops and fans rotating oldly overhead. One shopkeeper takes pity on me and points vaguely behind me. I turn round to see a wall. 'There?' I ask. She nods sagely. Along the way, I pester a few more shopkeepers. The name 'sing-song supermarket' crops up, which turns out to be the way Indian and Malay shopkeepers pronounce Sheng Siong, a massive Chinese owned hypermart right in the middle of Little india. In Sheng Siong supermarket it's known as Sheng Siong, but in Little India it's Sing-song, and you can buy emping there at 1.50SGD a packet.
I meet with Wendy for lunch. It's our last day as medical students, but the day doesn't feel particularly special or memorable to me yet. After lunch she offers to pray with me 'since we won't see each other till July'. When she prays, she really prays. Earnestly. Sincerely. Unlike my half-hearted monologue, rattled off like announcements at a school assembly, all speech and no spirit. You can always tell when someone is really praying for you. Waiting for the bus home, I pretend I'm somewhere else. Japan. Malaysia. I look at the uncles and aunties and young men in smart trousers waiting and the bus lady waving impatiently for me to board and they start to look less like strangers and more like neighbours. Maybe home really is where the heart is.
---
the most important thing in life is deciding what to believe in. Some people believe only in themselves and become incredibly 'successful' and miserable. Some people don't believe in anything at all. Some people only believe in money. Some people believe in something larger than themselves, destiny, God, crystal energies. Believe as synonymous for worship. Or maybe 'rely'?
---
it's my last day in singapore, and I'm starting to see the country a little differently. On the platform at stevens waiting for the mrt I notice the hum of trains in the distance and sleepy cavernous still-ness of the place. The librarian asks if it's my last day, and I say yes. Are you planning to come back, maybe we'll see you around? she asks, and I fumble for a diplomatic answer. "Possibly, who knows?" I shrug fecklessly and assume an awkward, idiotic grin. It's my last day here and I'm thinking, 'maybe this place isn't so bad.' Typical. Little india is a lot bigger than I imagined. The narrow walkways connecting shopfronts smell of flowers strung together and some kind of incense. Tourists litter the streets, carrying backpacks and wandering aimlessly and I feel a little more at ease. I ask 'do you sell em ping here'? and am met with slightly raised eyebrows 'belinju?' I try. With a gentle shake of the head, they resume their quiet bustling, indian children trickling in and out of shops and fans rotating oldly overhead. One shopkeeper takes pity on me and points vaguely behind me. I turn round to see a wall. 'There?' I ask. She nods sagely. Along the way, I pester a few more shopkeepers. The name 'sing-song supermarket' crops up, which turns out to be the way Indian and Malay shopkeepers pronounce Sheng Siong, a massive Chinese owned hypermart right in the middle of Little india. In Sheng Siong supermarket it's known as Sheng Siong, but in Little India it's Sing-song, and you can buy emping there at 1.50SGD a packet.
I meet with Wendy for lunch. It's our last day as medical students, but the day doesn't feel particularly special or memorable to me yet. After lunch she offers to pray with me 'since we won't see each other till July'. When she prays, she really prays. Earnestly. Sincerely. Unlike my half-hearted monologue, rattled off like announcements at a school assembly, all speech and no spirit. You can always tell when someone is really praying for you. Waiting for the bus home, I pretend I'm somewhere else. Japan. Malaysia. I look at the uncles and aunties and young men in smart trousers waiting and the bus lady waving impatiently for me to board and they start to look less like strangers and more like neighbours. Maybe home really is where the heart is.
Thursday, June 9, 2016
Sunday, May 29, 2016
path of most resistance
Come to me all you who are weary
and burdened, and I will give you rest
Take my yoke upon you
and you will find rest for your souls
For my yoke is easy
and my burden is light
---
heart feeling so heavy lately
---
baby
don't you want my love
baby, here it is
no need to pretend
you don't want it
i won't say it again
come now don't be shy
this is the last time
don't be ungrateful
why
don't you want this
what's wrong with you
say something
you whore
open up
this door right now
before i break it down
last chance
you dumb filthy ignorant bitch
you self-righteous pompous hypocrite
why don't you want my love
you coward
you slut
you cu
i'm sorry
i'm so
so sorry
my love
you know i don't
mean it
i'll never do it again
i promise
my love
my sweet
now come out here
and forgive me
church of latter day sinners
what's a body for if not to draw you in, to hold you close, to keep you warm
---
we didn't always love each other right, but we tried. We tried real hard, the way families are supposed to
Thursday, May 26, 2016
last of the mohicans
By the beginning of the 1980s, more faster, more aggressive styles such as hardcore (e.g. Dead Kennedys) and street punk (e.g. The Exploited) had become the predominant mode of punk rock. Musicians identifying with or inspired by punk also pursued a broad range of other variations, giving rise to post-punk and the alternative rock movement. At the end of the 20th century, punk rock had been adopted by the mainstream, as pop punk and punk rock bands such as Green Day, the Offspring and Blink-182 brought the genre widespread popularity.
(the wikipedia summary for punk rock ends there)
---
it's not just about the end of a tradition - it's more personal than that. these bands are my childhood friends - and i realise it's the most cliche and nauseating thing in the world to listen to a kid complaining about how a band has changed or 'sold out' and lament how they miss the 'old fall out boy' or 'old paramore'. but change can be both good or bad (or neither), and if it's bad, then isn't the grieving justified? change is ultimately about gaining and losing, what you leave behind vs what you hope to achieve - when you meet again, did they gain a new dimension, and at what cost? or have they lost something essential? have they only demolished their monuments and hawker stalls to make room for condominiums and five star shopping malls
---
Thursday, May 12, 2016
Sunday, May 8, 2016
call
Deep calls to deep in the roar of your waterfalls; all your waves and breakers have swept over me.
- Psalm 42:7
---
really smart people saying interesting things make you think they're worth listening to, fallacy of the beautiful girl not always beautiful inside too. Just because they are making insightful observations taht are true doesn't mean they are full of truth. I'll say it again: Just because something is true, it doesn't mean it's truth. The way you know you are writing something real is that it draws the reader into their realer selves. ( makes them actually feel inside themselves for a change, and maybe respond, instead of eliciting an autonomous reaction, like laughter or disgust. )
and i don't know why that manifests itself so much like the feeling of loneliness
wanting to share something special, an experience
or because you feel someone really gets you someone really understands you
when you snap out of it and realise that person or entity is not actually present - ghost appendage sensation, losing something you never had to begin with
great writing cannot be completely dependent upon technique, really great writing requires you to dig inside yourself for the deepest part of yourself you can find. or else it won't reach anyone
deep calls to deep
---
is that what you think that the book is about then, loneliness?
I think that if there’s a sort of sadness for people under 45 it has something to do with pleasure and achievement and entertainment. Like a sort of emptiness at the heart of what they thought was going on. And maybe I can hope that some parts of the book speak to their nerve endings a little bit.
---
mothers day dinner 8/5/16: advice - make an effort to keep in touch with old friends. make the effort, it takes effort but it's worth it
Tuesday, April 26, 2016
sure
- based on my version of the facts, i'm always the hero
- and how accurate do you think that is?
- what?
- do you in your own estimation believe that you are in fact 'always the hero'
- what are you implying
- and how accurate do you think that is?
- what?
- do you in your own estimation believe that you are in fact 'always the hero'
- what are you implying
Monday, April 25, 2016
re: letter to a future self
24th April 2016
Dear past me,
noted, thanks.
Best wishes,
yourself
P.S. it's gonna be a bumpy ride, but don't give up.
Things will work out in the end
Dear past me,
noted, thanks.
Best wishes,
yourself
P.S. it's gonna be a bumpy ride, but don't give up.
Things will work out in the end
Saturday, April 23, 2016
letter to a future self
16th February 2016
dear me,
How are you? I hope this letter finds you in good health. I have no way of knowing when you'll read this. The future is a complete mystery to me. I do not know where I will end up in August or where I will be working or even if I will graduate medical school, or if I'll be in a different continent in 5 years time. The immediate future has never looked so uncertain. If I were to guess, I'd say my future plays out like this: I pass my final exams by the skin of my teeth and get accepted into a hospital either in Manchester or in the East Midlands. I then work there for two years and make new friends, start a new relationship that lasts 6 months, but we end it on good terms because it becomes clear to us that our lives are heading in different directions, but I still think about her and wonder how she's doing from time to time, wish her happy birthday on facebook and stuff.
Then things get worse for junior doctors, and Jeremy Hunt becomes prime minister of Britain and lobbies to start paying junior doctors in chocolate coins instead of real money, and the rest of the UK is like, 'yeah that sounds pretty reasonable'. So I travel to either Australia or Singapore or Thailand and start a new life there. I grow a beard. I take a year out to try and write a novel. I only manage to write about 50 pages, and then I give up and get back into medicine. I get involved with community outreach at the local church and get really motivated to go out and feed the poor and help the homeless. I try to do clinics and provide healthcare for the ones who need it the most and who can't afford it, but in the end it's financially not feasible and I abandon that pipe dream. As work becomes busier and I start to prepare for the competitive entry into ST3, I am forced to cut back on my community outreach activities. At this point I am seriously romantically interested in a colleague at work, an intelligent and ambitious woman who a few nurses and co-workers have privately referred to as 'cut-throat' and 'scheming', but I discover she has an unexpected soft side to her. I am also simultaneously attracted to a sweet and guileless, good-natured girl who volunteers often at church. I decide to pursue a relationship with the work colleague. This lasts for 2 years and then ends because she decides to move to the UK after securing a highly sought after training post that will advance her progression in the speciality of her choice. Also, she and I have never really seen eye to eye on why I insist on doing community work, and in one or two heated disagreements she has insinuated that I only do it to feel good about myself, to feed my own ego and get off on the delusion that I am more moral and altruistic and holy than everyone else. And I am not entirely sure she is wrong. The good-natured girl is now married. I shave off my beard and question my life decisions. I am now 35 years old.
And of course none of this will actually happen. When it comes to predicting the future I've discovered I have a 0% success rate. (4 years later, you receive an email from the work colleague saying she's in town for a medical conference and was wondering if you'd be free to meet up? smiley face. You agree and when you talk to her you find that she's like a completely different person. Softer. Kinder. She tells you that someone in her family was diagnosed two years ago with cancer and that her experience of being helpless and in need for once had given her a new perspective on life. She tells you she sees why charity mattered so much to you now, that you were right and she was wrong, and that she's sorry for saying those things. She didn't know any better. You tell her not to apologise, then she puts her hand on yours and you both share a moment together. Then she says she has to leave because her flight is tomorrow morning. Her boyfriend's name is Matt.) I wonder if you think this plot is hackney and boring. I'll admit it's certainly not the most original. I'll also admit it's kind of too neat and linear and is meandering and doesn't have any real point to it... like something out of a Judd Apatow movie. Or maybe the drama and conflicts are too cliche - does this sort of thing happen in real life? Or just in writers' imaginations. I have no idea.
I realise that in terms of 'real life' experience, I don't have very much. My experience of 'real life' and its ups and downs and tragedies and crises has been very limited so far, and far too limited to extrapolate from. I'm still not 100% confident in my ability to distinguish between 'reality' and mimesis. The man cheating on his wife. Do the TV shows get it from real life, or do people in real life get it from the TV shows? Which way round is it? I remember a couple of years ago my greatest worry was that I'd write something that the me in three years time would look back on and sneer at. Or worse, furrow his brow and say nothing at all. I think I haven't completely grown out of that yet.
It's been a while since I did this. Or maybe it hasn't. Maybe it just feels that way.
Maybe the most useful thing I can do is just describe the present, to remind you of things. Build a kind of time capsule. You probably know a lot more than me, you've probably (hopefully) grown and have learned things that I don't even know I don't know yet. and so I have very little to offer you really. But here goes.
You sit in your bear onsie typing this on an old ASUS laptop that has served you faithfully for the past 4 years, but annoyingly lags horrendously when you try to play games on it. You have forgotten when you bought the onsie (was it last year? or two years ago) but since then it has kept you warm throughout the winter months. Downstairs a rice cooker sits full of rice that you have to figure out how to use before it goes stale. In the fridge there's a ziplock bag with five or six chicken breasts that you don't know how to cook yet. You bought them like three days ago so you've got about 10 hours to use them before they go off. To your right on your desk sits the Oxford Handbook of Clinical Medicine 8th Edition, and your iphone 4 rests on top of it. You used it to take a picture of a google search that said 'how to cook chicken karaage cooking with dog'. The time is 2:53am. You have 19 tabs open. 8 of them are youtube tabs. One leads to Business Insider. The headline reads: "Science says lasting relationships come down to 2 basic traits". You have not yet found out what these two basic traits are, but you decide they must be pretty important. But also you are wary of any headline that leads with, 'Science says...' As if science is some dude on the street and also some kind of perfect oracle.
There's a half finished packet of custard creams and ritter sport white chocolate from Lidl on your desk. You've already brushed your teeth but the promise of sugar is calling out to you and you're beginning to think you don't really mind brushing them again. Two days ago you read about a man whose last words quoted Jesus as saying, 'I was in prison and you visited me.' You now fiercely believe that the highest calling of any human being is to feed the hungry, clothe the poor, heal the sick and provide shelter to the homeless. To live a life in service of the needy and unwanted. To devote your life to those worse off than yourself. Everything else is secondary. Your final exams are in 3 days' time.
dear me,
How are you? I hope this letter finds you in good health. I have no way of knowing when you'll read this. The future is a complete mystery to me. I do not know where I will end up in August or where I will be working or even if I will graduate medical school, or if I'll be in a different continent in 5 years time. The immediate future has never looked so uncertain. If I were to guess, I'd say my future plays out like this: I pass my final exams by the skin of my teeth and get accepted into a hospital either in Manchester or in the East Midlands. I then work there for two years and make new friends, start a new relationship that lasts 6 months, but we end it on good terms because it becomes clear to us that our lives are heading in different directions, but I still think about her and wonder how she's doing from time to time, wish her happy birthday on facebook and stuff.
Then things get worse for junior doctors, and Jeremy Hunt becomes prime minister of Britain and lobbies to start paying junior doctors in chocolate coins instead of real money, and the rest of the UK is like, 'yeah that sounds pretty reasonable'. So I travel to either Australia or Singapore or Thailand and start a new life there. I grow a beard. I take a year out to try and write a novel. I only manage to write about 50 pages, and then I give up and get back into medicine. I get involved with community outreach at the local church and get really motivated to go out and feed the poor and help the homeless. I try to do clinics and provide healthcare for the ones who need it the most and who can't afford it, but in the end it's financially not feasible and I abandon that pipe dream. As work becomes busier and I start to prepare for the competitive entry into ST3, I am forced to cut back on my community outreach activities. At this point I am seriously romantically interested in a colleague at work, an intelligent and ambitious woman who a few nurses and co-workers have privately referred to as 'cut-throat' and 'scheming', but I discover she has an unexpected soft side to her. I am also simultaneously attracted to a sweet and guileless, good-natured girl who volunteers often at church. I decide to pursue a relationship with the work colleague. This lasts for 2 years and then ends because she decides to move to the UK after securing a highly sought after training post that will advance her progression in the speciality of her choice. Also, she and I have never really seen eye to eye on why I insist on doing community work, and in one or two heated disagreements she has insinuated that I only do it to feel good about myself, to feed my own ego and get off on the delusion that I am more moral and altruistic and holy than everyone else. And I am not entirely sure she is wrong. The good-natured girl is now married. I shave off my beard and question my life decisions. I am now 35 years old.
And of course none of this will actually happen. When it comes to predicting the future I've discovered I have a 0% success rate. (4 years later, you receive an email from the work colleague saying she's in town for a medical conference and was wondering if you'd be free to meet up? smiley face. You agree and when you talk to her you find that she's like a completely different person. Softer. Kinder. She tells you that someone in her family was diagnosed two years ago with cancer and that her experience of being helpless and in need for once had given her a new perspective on life. She tells you she sees why charity mattered so much to you now, that you were right and she was wrong, and that she's sorry for saying those things. She didn't know any better. You tell her not to apologise, then she puts her hand on yours and you both share a moment together. Then she says she has to leave because her flight is tomorrow morning. Her boyfriend's name is Matt.) I wonder if you think this plot is hackney and boring. I'll admit it's certainly not the most original. I'll also admit it's kind of too neat and linear and is meandering and doesn't have any real point to it... like something out of a Judd Apatow movie. Or maybe the drama and conflicts are too cliche - does this sort of thing happen in real life? Or just in writers' imaginations. I have no idea.
I realise that in terms of 'real life' experience, I don't have very much. My experience of 'real life' and its ups and downs and tragedies and crises has been very limited so far, and far too limited to extrapolate from. I'm still not 100% confident in my ability to distinguish between 'reality' and mimesis. The man cheating on his wife. Do the TV shows get it from real life, or do people in real life get it from the TV shows? Which way round is it? I remember a couple of years ago my greatest worry was that I'd write something that the me in three years time would look back on and sneer at. Or worse, furrow his brow and say nothing at all. I think I haven't completely grown out of that yet.
It's been a while since I did this. Or maybe it hasn't. Maybe it just feels that way.
Maybe the most useful thing I can do is just describe the present, to remind you of things. Build a kind of time capsule. You probably know a lot more than me, you've probably (hopefully) grown and have learned things that I don't even know I don't know yet. and so I have very little to offer you really. But here goes.
You sit in your bear onsie typing this on an old ASUS laptop that has served you faithfully for the past 4 years, but annoyingly lags horrendously when you try to play games on it. You have forgotten when you bought the onsie (was it last year? or two years ago) but since then it has kept you warm throughout the winter months. Downstairs a rice cooker sits full of rice that you have to figure out how to use before it goes stale. In the fridge there's a ziplock bag with five or six chicken breasts that you don't know how to cook yet. You bought them like three days ago so you've got about 10 hours to use them before they go off. To your right on your desk sits the Oxford Handbook of Clinical Medicine 8th Edition, and your iphone 4 rests on top of it. You used it to take a picture of a google search that said 'how to cook chicken karaage cooking with dog'. The time is 2:53am. You have 19 tabs open. 8 of them are youtube tabs. One leads to Business Insider. The headline reads: "Science says lasting relationships come down to 2 basic traits". You have not yet found out what these two basic traits are, but you decide they must be pretty important. But also you are wary of any headline that leads with, 'Science says...' As if science is some dude on the street and also some kind of perfect oracle.
There's a half finished packet of custard creams and ritter sport white chocolate from Lidl on your desk. You've already brushed your teeth but the promise of sugar is calling out to you and you're beginning to think you don't really mind brushing them again. Two days ago you read about a man whose last words quoted Jesus as saying, 'I was in prison and you visited me.' You now fiercely believe that the highest calling of any human being is to feed the hungry, clothe the poor, heal the sick and provide shelter to the homeless. To live a life in service of the needy and unwanted. To devote your life to those worse off than yourself. Everything else is secondary. Your final exams are in 3 days' time.
Thursday, April 21, 2016
Saturday, April 16, 2016
Monday, April 11, 2016
Sunday, April 3, 2016
soul
My sacrifice, O God, is a broken spirit;
A broken and a contrite heart, O God, You will not despise.
- Psalm 51:17
---
no performers, no performance, just praise
A broken and a contrite heart, O God, You will not despise.
- Psalm 51:17
---
no performers, no performance, just praise
Saturday, April 2, 2016
show
no, I I disagree actually - I think it's possible for the performer to enjoy the performance... you know I think... I think most of them start out enjoying it - which is why they do it in the first place. I think what a lot of audiences perceive to be a performance is in fact just people... being themselves. but when they start believing it's a performance... the performers themselves, that is - if they lose sight of that, that thing when they first started out -- that thing that they loved so much about it... i think that's when they start hating it
gong
I am like the deaf, who cannot hear,
like the mute, who cannot speak;
I have become like one who does not hear,
whose mouth can offer no reply.
- Psalm 38:13-14
---
google search: brie larson is cool
---
google search: i don't understand the difference between being funny and being mean
---
google search: the performer never gets to enjoy the performance
google search: what he does enjoy afterwards is the glow of achievement
google search: you see, what the crowd wants is to see something funny, what the comic wants is to see the crowd laugh
google search: but the performer isn't enjoying the performance, he only enjoys the reaction it elicits
---
google search: how to care about people, i mean really care about them, instead of seeing them as means to an end, challenges to be dealt with, a crowd to be manipulated, tools to be utilised, opportunities for gratification etc
like the mute, who cannot speak;
I have become like one who does not hear,
whose mouth can offer no reply.
- Psalm 38:13-14
---
google search: brie larson is cool
---
google search: i don't understand the difference between being funny and being mean
---
google search: the performer never gets to enjoy the performance
google search: what he does enjoy afterwards is the glow of achievement
google search: you see, what the crowd wants is to see something funny, what the comic wants is to see the crowd laugh
google search: but the performer isn't enjoying the performance, he only enjoys the reaction it elicits
---
google search: how to care about people, i mean really care about them, instead of seeing them as means to an end, challenges to be dealt with, a crowd to be manipulated, tools to be utilised, opportunities for gratification etc
Wednesday, March 30, 2016
our past was here but our future was somewhere else...
- oh by the way I threw the cake away
- WHAT. WHY
- you didn't see it like I did. In the fridge, it was... fungating - no not just fungating... festering. it was evolving, gaining sentience. It was planning to send Arnold Schwartzenegger back in time to kill us
- ... do you mean like modern day Arnold Schwartzenegger or like 1990s Schwartzenegger? Because I think I could probably take on modern day Schwartzenegger
- you think you could beat the kindergarten cop?
- *raises eyebrows* you think I can't? *flexes biceps*
Friday, March 25, 2016
how to love the ones who are hurting you
But Jesus was saying, "Father, forgive them; for they do not know what they are doing." And they cast lots, dividing up His garments among themselves.
---
"And forgive us our sins, as we forgive those who sin against us."
yeast of the pharisees
But Jesus said to him, "Judas, are you betraying the Son of Man with a kiss?"
- Luke 22:48
---
the things we do to betray Jesus can look a lot like loving him
---
I tend to compare myself with people - look at other people's goodness and -- and -- "am I better or worse? And where does that put me with God?" And of course it doesn't put me anywhere with God
---
But he answered his father, "Behold, these many years I have served you, and I never disobeyed a commandment of yours, but you never gave me a goat, that I might celebrate with my friends. But when this, your son, came, who has devoured your living with prostitutes, you killed the fattened calf for him."
---
I know your deeds and your toil and perseverance, and that you cannot tolerate evil men, and you put to the test those who call themselves apostles, and they are not, and you found them to be false; and you have perseverance and have endured for My name's sake, and have not grown weary. Yet I hold this against you: You have forsaken the love you had at first.
---
the danger of trying to earn God's forgiveness
---
how much i need the cross and how often i pretend /fool myself into believing that i don't
---
When I survey the wondrous cross
On which the Prince of glory died,
My richest gain I count but loss,
And pour contempt on all my pride.
Forbid it, Lord, that I should boast,
Save in the death of Christ my God!
All the vain things that charm me most,
I sacrifice them to His blood.
Thursday, March 24, 2016
i have traversed many kinds of health
this past week alone i have diagnosed myself with
1. cyclothymia
2. frontotemporal dementia
3. narcissistic personality disorder
4. hypochondriasis
1. cyclothymia
2. frontotemporal dementia
3. narcissistic personality disorder
4. hypochondriasis
Wednesday, March 16, 2016
MAST Diary Week 1
Old Age Psychiatry:
Date: Tasks Performed: Reflections
10/3/16 Made some tea Not bad
11/3/16 Made some tea Better
12/3/16 Made some tea Better
13/3/16 Made some coffee More milk next time
Date: Tasks Performed: Reflections
10/3/16 Made some tea Not bad
11/3/16 Made some tea Better
12/3/16 Made some tea Better
13/3/16 Made some coffee More milk next time
Thursday, March 10, 2016
future
But I don't want things to change, she says, sobbing.
The torn linoleum listens patiently, places a kind hand upon her shoulder. Her petulant crescendo gives way to a whimper, her voice thin with disbelief. The washing machine whirs and hums in the background, uncomfortably shifting its weight and averting its gaze.
She stares blankly ahead and squeaks,
I don't want things to change.
---
Do you remember? When we were happy? When our days were filled with laughter and good company? Here is what I have learned - you only know it's perfect once it's passed.
---
My heart feels like bursting, to be reminded of the past 5 years and the joy you never noticed because you were too busy being joyful. Such a bittersweet feeling, to see these smiling faces and know that you are inexorably hurtling towards a reality that precludes any possibility of continuing to enjoy the warmth and genuine companionship that you've grown so used to. To be reminded of a treasure you cannot take with you. To leave behind old friends is to catch a glimpse of a bright and wonderful future that can never happen. I'm certainly not ready to say goodbye yet - I need more time. At least a year more. An intermission of 365 days to reflect - to pause and properly cherish and appreciate what the past 5 years have meant to me. If you're not careful, the future has a way of creeping up on you - before you know it, it's in front of you, and the past is already a blimp on the horizon behind you, receding at an ever increasing rate, out of reach and you're left with a handful of parting words and sentiments, which you stash hastily into your pockets or drawer because while you were busy looking at the disappearing past, the present had arrived and unfortunately appears to be quite difficult and will probably require a fair amount of discipline and attention to manage. The older I get, the more conscious and deliberate I have to be about appreciating the good things in my life. Otherwise I am in danger of finding myself forty years old, turning around and scratching my chin wondering why I am still not yet happy.
Blessed beyond measure - that is what I have been. I feel so incredibly thankful - sometimes it gets too much and I feel the urge to stop whatever I'm doing and watch as the present inexorably recedes into the past and wish desperately I could capture or crystallise each present moment and carry it with me. I have never felt so strong a desire to stop time as I have these past few days.
---
There are moments in your life that make you pause and take stock of your surroundings, and reflect on all of the events and accidents and happenings that have gotten you to where you are now. And if you really stop to think about it, I am always amazed and surprised at how little of it I could have predicted or planned, and at the same time how I cannot now imagine it any other way. All of a sudden these moments which seemed ordinary, when you lay them out together like a mosaic, side by side, it's clear to see that they are all part of a larger picture, a tapestry.
When I get in a certain mood, I look back and can only see my faults. My shortcomings. Wasted opportunities and days spent half-asleep. But occasionally, I am reminded of the good, of precious moments, ones that give life meaning and worth. Life-affirming experiences and other things that sound cliche, that we somehow so easily forget or take for granted. And then I realise how blind I have been, now that laid before me is the irrefutable proof, that the past 5 years have not always been easy, but they have been worth it. That my life is fuller and richer not in spite of the storms and difficulties but because of them. It is so easy to lose sight of that.
Maybe it's called growing sentimental, but when I look back on the last 5 years, and then ahead into the inscrutable future, I cannot help but get misty eyed and lapse into reverie. And I feel a tug deep inside, and I am convinced that this is joy: contentment laced with heartache, youth and loss, reunion at a funeral, a sweet and soulful affliction, the fact that you have loved something so much that its absence agglomerates into this strange admixture of pain and gratitude; a locket with chains; a kind of keepsake.
The torn linoleum listens patiently, places a kind hand upon her shoulder. Her petulant crescendo gives way to a whimper, her voice thin with disbelief. The washing machine whirs and hums in the background, uncomfortably shifting its weight and averting its gaze.
She stares blankly ahead and squeaks,
I don't want things to change.
---
Do you remember? When we were happy? When our days were filled with laughter and good company? Here is what I have learned - you only know it's perfect once it's passed.
---
My heart feels like bursting, to be reminded of the past 5 years and the joy you never noticed because you were too busy being joyful. Such a bittersweet feeling, to see these smiling faces and know that you are inexorably hurtling towards a reality that precludes any possibility of continuing to enjoy the warmth and genuine companionship that you've grown so used to. To be reminded of a treasure you cannot take with you. To leave behind old friends is to catch a glimpse of a bright and wonderful future that can never happen. I'm certainly not ready to say goodbye yet - I need more time. At least a year more. An intermission of 365 days to reflect - to pause and properly cherish and appreciate what the past 5 years have meant to me. If you're not careful, the future has a way of creeping up on you - before you know it, it's in front of you, and the past is already a blimp on the horizon behind you, receding at an ever increasing rate, out of reach and you're left with a handful of parting words and sentiments, which you stash hastily into your pockets or drawer because while you were busy looking at the disappearing past, the present had arrived and unfortunately appears to be quite difficult and will probably require a fair amount of discipline and attention to manage. The older I get, the more conscious and deliberate I have to be about appreciating the good things in my life. Otherwise I am in danger of finding myself forty years old, turning around and scratching my chin wondering why I am still not yet happy.
Blessed beyond measure - that is what I have been. I feel so incredibly thankful - sometimes it gets too much and I feel the urge to stop whatever I'm doing and watch as the present inexorably recedes into the past and wish desperately I could capture or crystallise each present moment and carry it with me. I have never felt so strong a desire to stop time as I have these past few days.
---
There are moments in your life that make you pause and take stock of your surroundings, and reflect on all of the events and accidents and happenings that have gotten you to where you are now. And if you really stop to think about it, I am always amazed and surprised at how little of it I could have predicted or planned, and at the same time how I cannot now imagine it any other way. All of a sudden these moments which seemed ordinary, when you lay them out together like a mosaic, side by side, it's clear to see that they are all part of a larger picture, a tapestry.
When I get in a certain mood, I look back and can only see my faults. My shortcomings. Wasted opportunities and days spent half-asleep. But occasionally, I am reminded of the good, of precious moments, ones that give life meaning and worth. Life-affirming experiences and other things that sound cliche, that we somehow so easily forget or take for granted. And then I realise how blind I have been, now that laid before me is the irrefutable proof, that the past 5 years have not always been easy, but they have been worth it. That my life is fuller and richer not in spite of the storms and difficulties but because of them. It is so easy to lose sight of that.
Maybe it's called growing sentimental, but when I look back on the last 5 years, and then ahead into the inscrutable future, I cannot help but get misty eyed and lapse into reverie. And I feel a tug deep inside, and I am convinced that this is joy: contentment laced with heartache, youth and loss, reunion at a funeral, a sweet and soulful affliction, the fact that you have loved something so much that its absence agglomerates into this strange admixture of pain and gratitude; a locket with chains; a kind of keepsake.
Wednesday, March 2, 2016
return with all your heart
"Two men went up into the temple to pray, one a Pharisee and the other a tax collector. The Pharisee stood and was praying this to himself: 'God, I thank You that I am not like other people: swindlers, unjust, adulterers, or even like this tax collector. 'I fast twice a week; I pay tithes of all that I get.'
"But the tax collector, standing some distance away, was even unwilling to lift up his eyes to heaven, but was beating his breast, saying, 'God, be merciful to me, the sinner!'
- Luke 18:10-13
---
It is day 7 of my fast and I am finding it harder and harder to think of anything other than my appetite. I have not been keeping up with my devotions. I have not heard the living word through the scriptures, I have not drawn any strength or wisdom from it, I have not felt my strength being renewed or my hunger sated the way I did when I first began fasting.
Today all I could think of was my own hunger. My mind was preoccupied with counting down the hours till 6 o'clock. I was not kind to people. All I could think of was my own survival. Only later, when I had a minute in the shower to reflect on how the day had gone did I realise that I spent the whole day selfishly focussed on myself. I was not compassionate to those in need. I deflected difficult questions and manoeuvred around other people's distress. I was not a good Christian today. And that's because I haven't been preparing my heart these past few days. Because lectures start at 9am or 10am, I wake up 30 minutes beforehand and rush to the shower and stumble down the stairs while trying to get my socks on and dash out the door, still half awake. Then throughout the talks I'm half trying to concentrate on gathering useful information, and trying to do Nicky Gumbel's bible in one year plan on my iphone. As if scrolling through and reading the words on the screen to the end is all that's required of a healthy spiritual journey.
Today in the shower I realise what I've done again. I've uncoupled the act from the intention. I've become focused on the ritual instead of the Holy Spirit. "Thus you nullify the word of God by your tradition that you have handed down. And you do many things like that." - Mark 7:13. It's not about what you bring to the altar, but the attitude -- the heart that you offer it with. "A person may think their own ways are right, but the LORD weighs the heart." - Proverbs 21:2. I've been so focused on the details, following the rules that I end up being unable to see the forest for the trees. The truth is that it's completely possible to keep your fast and pray (or at least con yourself into thinking you're praying) 3 or 4 times a day and do all the outward things associated with holiness and yet still be miles away from a healthy relationship with God. And to be constantly judging other people. And to be ungrateful and proud and full of contempt and empty of genuine compassion for others.
I have to keep reminding myself why I am doing this. Today Victoria was asking, and I tried to explain. I did a very poor job of it. I told her, 'There are two kinds of a fast. One is about discipline, training yourself. The other is when you ask for something - to show that you are serious about your request.' But 'serious' is the wrong word. It should be 'sincere.' In the old testament, whenever people fast it is an act of repentance. Either that or an act of mourning. It's about returning to God. It's not supposed to be a public statement, or open display of piety. It's meant to be a private and personal act of humility. "When you fast, do not look somber as the hypocrites do, for they disfigure their faces to show others they are fasting. Truly I tell you, they have received their reward in full." - Matthew 6:16.
Every so often I catch myself thinking, 'I have kept my fast so far - now God will have to grant my request.' Which is not only absurd but also betrays what an incredibly arrogant and disrespectful spirit. Thinking that a fast is a way of making God obligated to answer your prayer is like thinking an apology is a golden ticket to avoid being punished for something. Thinking I can bribe God by acting holy... Fasting is meant to be an act of humbling oneself before God. Of reminding myself of my weakness and fragile flesh and how much I must rely on God to meet my needs -- and yet I somehow manage to turn it into some parade of self-admiration and platform from which to look down on others. Tonight I will repent and ask God to forgive me for letting my prayers and fasting become a form of self-justification and self-worship. I will stop the blasphemous pantomime and re-consecrate my fast. Tomorrow I will wake up at 8 o'clock and do my best to start afresh - examine my heart carefully, and pray that God will help me to be like the tax collector. To teach my heart to fear the Lord again, to open my eyes to His holiness and how badly I need His mercy on a second to second basis.
---
"Yet even now," declares the LORD, "Return to Me with all your heart, And with fasting, weeping and mourning; And rend your heart and not your garments." Now return to the LORD your God, For He is gracious and compassionate, Slow to anger, abounding in lovingkindness And relenting of evil.
- Joel 2:15
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