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People die. They disappear, have their stuff sold, inherited or thrown away. And then Life goes on. People still go to work, wonder what they will have for lunch, worry about what the future holds for them. And then, they forget. I guess leaving is kind of like dying. You pack up all your stuff, say your goodbyes and then poof, disappear off the grid. Friends may wonder what has happened, then after a while they stop wondering. Soon you become a ghost of the past, talked about in past tense.

We fly tonight! It's incredible, how we've planned for this for ?1 year. I guess we leave with ambivalence. One good thing that came out of this is how we cleared out our refrigerator, and discovered a pool of gross zhup lingering in some corner (probably spilt some soup and never saw it there). Well that's all cleaned up and we have a spanking new fridge. Looking at it gives me a sense of excitement, kind of the same feeling you get when you move into a new house :D

If it sounds too good to be true, it probably is. My mum has a personal maxim that she'd rather lead an okay life than a supergood life. If Life is too good, you better start feeling scared. She thus always reminds me to make good of what I have been blessed with to bless others. I am of the opinion that God is fair, and its probably true that no one can have the "perfect life". Yes yes, there are tons of these Facebook Lives that are like all-too-perfect, and if they are truly so then said person should start to feel worried. So putting things in context, while Life has been good, I have been dealt some bad cards as well.

25 July, visit to the A&E. The first of many perhaps. I once wrote an entry about Chronic Pain (which for the life of me I cannot find now), and now I am beginning to feel the ache. Angels abound - AK, S, Z, DH, M, YK, and I could not be more thankful. Would appreciate prayers.

Of late I have been thinking of what songs I'd like to be played at my funeral. Not morbid, I think it saves whoever is planning for my funeral some work of thinking about what to sing. If I should suddenly die, please inform whoever is planning to use the following songs. Thanks :) Edit: Filler songs to use a PianoGuys playlist please (to include Happy Turtle)




We'll touch, we'll hear, we'll taste, we'll see
The wonders of eternity
Creation new, we’ll finally be at home

Closing song:

National Tragedy

Woke up today with tragedy plastered over the news and a nation with a heavy heart.

Source: Straits Times

IPMN

There are some kind of favours that no amount thanks or gifts can ever repay. One can only hope that an opportunity may arise that the favour may be repaid in kind.

D was recently diagnosed with pancreatic cancer. The hows and the whys remain a blur to me, but it started off with persistent epigastric pain. Given the timing and circumstances, I did whatever I could in my capacity to expedite treatment. I remember the day the report came out, I thought long a hard about how to find a surgeon. I had a terrible posting as a houseman in Surgery, and hardly made any long lasting friendships to be able to pull any strings. I had asked around, and many big names came up, top surgeons in particular from SGH who do complex oncological surgeries. I thought long and hard about how to get an appointment with these people whom I have absolutely no personal connection with, and found no other way other than to ring up the SGH hotline and ask for an appointment the conventional way.

Somehow Dr A's name came up later on. Once, twice and a third time. He was young no doubt, compared to the other old birds in the field, but up and coming nevertheless. It then occurred to me that he was my Facebook friend (!!). From the days of Surgical OSSEs, I wondered whether it would be really creepy and weird to drop the Professor a Facebook message to ask him for his opinion. He was always the deadpan funny tutor who sacrificed his afternoons and nights to teach us. His wife taught me during the BASIC course, and I remember poring over his family's facebook photos pre-MBBS in MD6. And so I did, I actually dropped him a Facebook message. Within 4 hours, we had a first slot clinic appointment on the Monday morning and before we knew it, D had gone for surgery within the week.

Perspectives are different being on the other side of healthcare. But understanding what happens behind the scenes made me rather zen to everything that happened. Movement in between clinics, blood tests, doctor speak and pre-operative assessments. I crossed paths with many angels along the way. M has been understandably anxious. The longer the wait outside the OT, the exponentially worried she got with thoughts of complications from surgery and anaesthesia etcetc. Grateful for friends like K who gave me live feed updates from inside PACU and M who even got the chance for MIL to go in for a bit. As the "doctor in the family", I had to give answers to many difficult questions that often have no good responses. Is D going to be okay? What did Dr A mean when he said suspicious stomach lesion? Does he need to go for chemo? I could give a good medical answer to all those questions, but unlike in the usual situation, I myself needed to deal with the uncertainty that comes with vague replies that doctors always give. Fifty-fifty, as we always say, which essentially means "I don't know".

Long clinic waits, many blood tests for which the patient never knows the reason for, days in the hospital unsure of what happens next, various choices that are given which never make any sense to the uninitiated, incessantly beeping equipment in the HD (stupid IA line waveform), worries about appetite and pain and post operative care - the patient experience is a torturous one, one that hopefully I in my capacity may help to ease for the patients who come my way.

SJ says we all should face death right in its face, and I fully agree, though not many may find easy to stomach. Death remains a certainty, in the same way we have assurance beyond death with hope in Christ.

4 May 2015

Saturday July 2012. I was still a houseman. I clearly remember seeing his gangrenous fingers from the three ionotropes he was being supported on. The stumps of the bilateral BKAs that he had undergone in a life-saving measure. My patient died not long after. I remember thinking to myself, it might as well have been a blessing, compared to having had to wake up to no more feet left.

My call two nights ago was a heart wrenching one. Into the OT as one whole, and out with an AKA stump. I was not sure if he knew, when he woke up from the anaesthesia. He was trying to say something, but I was not sure if I could bear to answer. Gram negative bacteremia announced its arrival later that morning. Then there were two little six and seven year olds sobbing by the bedside of their father, whose body was slowly growing cold from the call of death.

On days like this, I feel like medicine can be so great, but so helpless all at the same time.

#ThankyouLKY

"Dear Papa, hope you get better": PM Lee pens a message for Lee Kuan Yew at Tanjong Pagar CC. (Photo: Kimberley Spykerman)

Aiyoh I feel so sad now. I just spent the last hour surfing articles about THE Lee and his life, the good, the bad and the ugly. Sending Mr Lee a virtual hug #hug.

Happy New Year Pull Your Ear

Apologies for the lack of activity on this space. My word-finding ability fails me as to how I wish to express my thoughts in a place like this. As the year draws to a close, and with the new one a fresh beginning, I realized that I have blogged an embarrassing total of 75 times this year! Going through them does bring back certain memories though.

The year started sluggishly and I wrote a seemingly bitter new year entry, in the company of lots of pathology specimens. We were studying through the festive season, again. Well, it was certainly not without company, and I am thankful for library dwellers over every mugging season. Then came the highlight of our years in medical school. My electives were a blast, and I don't think I would have done it any differently (Ok, maybe just slightly). I met the most awesome doctor who taught me real medicine and showed me what it meant to add life to days. The month of May was spend in a faraway place, which was essentially an extended holiday under the guise of an elective placement at the St. Thomas Hospital, London. This was closely followed by exciting times travelling in Europe during which I got to spend time with friends whom I have grown to treasure.

Starting the final year was not easy. I wrote a code of ethics, of which I confess not to have fulfilled faithfully, especially when the 1st two weeks of Paediatrics threw me challenges that I did not have the moral courage to handle. We quickly hurried on to the internships, during which I had my own fair share of magic moments, learnt to eat breakfast, and also when my inadequacies were made most apparent to me. Still, there was lots of joy and grace to be thankful for. In the process of final year, I was angry at things that I didn't know how to articulate, yet continue to forgiven by people who love me. In September, my CMPS patient passed on, and I attended his funeral. I last saw him on the Thursday before he passed away.

99 days, and now 64 days. While MBBS continues to be the thing that hovers ominously over this new year, there are so many more things that lay the setting for this one big hurdle that I need to cross. Mum who cooks yummy nutritious food, Bros who crack me up with stupid jokes and friends who share this arduous journey.

Anyway just for the record, my brother almost died on the last day of 2011! 3 stitches to the head, an ATT injection and 100mls of blood loss. Still, God is faithful, and 2012 will be testament to that.

The Other Side

Today I finally experienced what was on the other side. Beyond the green sliding doors that bring in people who experience severe, retrosternal, crushing chest pain, polytrauma and the collapse cases, I saw real people, real life.

The Resuscitation Room is like a haven. A haven for medical professionals I mean, but unfortunately not patients. It has restricted access, meaning no relatives are allowed in (or if allowed, only 1 per patient) unless under special circumstances. Doctors and nurses work without being under the scutiny of emotional friends, angry parents or agitated spouses. What we do, we do it in the best interest of the patient, but we by no means have the ability to bring the dead back to life.

So over the past 3 weeks, we've seen a handful of collapse cases. Most collapse cases refer to someone who has suffered an injury which has resulted in inability of the heart to pump sufficiently. This results in the absence of a pulse, and an indication to commence CPR to maintain circulation and most importantly blood supply to the brain. The previous cases that we've seen were typically a result of a massive heart attack. Having seen a couple of similar patients and dealt with them, we were familiar with the management algorithm of these patients. Their modes of presentation were generally the same.

Two of them came in last night, one just after another. The typical medical student reflex to be involved in resuscitation kicked in, and we all took turns to perform CPR. After a few cycles, there were intermittent period of a returning pulse that would drop after a few minutes. The poor prognosis just became more evident. Then, I noticed the doctor in charge leaving to speak to the relative of the patient.

I'd never seen the doctor speak to the patient's relatives before (I don't really know why) so I decided to accompany the doctor this time. I need to learn holistic management, I thought to myself. However, the moment I stepped beyond those green sliding doors, I felt a great sense of fear. I saw the patient's wife, alone and anxious. She was the one who saw him collapse, called the ambulance, and waited for 25 minutes by his side until the sirens finally drew close. Death comes quickly.

The doctor spoke with her and explained the situation, leaving messages in between the lines, each sentence to prepare her for the worst, yet most probable outcome. No one can prepare for the loss of a loved one, regardless of how ill the patient has been for the past months. Composed to distressed to teary eyed to uncontrollable sobbing. Death is shocking.

Can you help me doctor? Please? Can you just try to revive him even if for a while? I've heard of this expensive injection that you can give? Please?

Even the most wealthy and educated are not spared from the trauma of death. 30 minutes later, we announce the passing away. There is more sobbing, and even more sobbing. Amidst it all, there is admin work to be done, papers to be signed and phone calls to be made. Death is troublesome.

As I returned back to the Resuscitation Room, all had returned to normal. The nurses were sorting out inventory, doctors doing administrative documentation and the medical students fussing over plug setting and history taking. Where is all this in the grand scheme of things?

A husband, a father, a son lost. Their lives will never be the same again.

Now listen, you who say, "Today or tomorrow we will go to this or that city, spend a year there, carry on business and make money." Why, you do not even know what will happen tomorrow. What is your life? You are a mist that appears for a little while and then vanishes.

James 4:13-14, NIV

Two years

Photo Source: Amazon.com

Till then

In memory of a dear friend, Christine

20 December 2009

Last night, I went to bed at 9pm. It was the end of my Ortho posting, the beginning of my holiday, and time to finally surf the net aimlessly without guilt, do random things for no good reason, read the books that i've been wanting to read, and just bum around. Instead I plonked onto my bed, turned off the lights and just lay there.

I prayed. I prayed for my friend Christine, trying to imagine what it would be like to be her. A sense of helplessness, hopelessness, fear. Christine told us before, what it felt like to have a seizure- the consciousness of it happening, and the tremendous fear that it would never end. I imagined the pain, the immobility. I remembered the Christine i never really knew, the time when i held her hand even though i never knew her prior to her illness, the time when we ate pizzas in her ward, the time when we sang songs as she did her EEG. I felt angry. God, please put an end to this, if not through healing...

I woke up at 12:06am. i had to check Christine's blog, and so i did on my handphone, and it was indeed updated. my heart skipped a beat when i read "Had to select some photos of my sister to send to Pastor...". I read on, and was relieved.

This morning, i received news of her passing.

* * *

If life had no value, then death would be of an equal insignificance. i remember a friend once told me, the reason why we feel sad at death (be it that of a loved on or any stranger on the road) is that our minds deem death as an unnatural progression, as though death was wrong, and that life was meant to go on forever. in this way, God set eternity in the hearts of Man.

If life had no reason, then suffering ought not to be questioned. there is no reason for life, and there is no answer for suffering. nothing needs to be justified because things happen with no intention, no origin, direction or finality. it is only in the context of Sin as written in Genesis, Christ as the sacrifice and the promise of salvation that there is reason for suffering, and beyond that the hope that surpasses even death.

If death were the finality of life, there will never be justice for the misgivings of the world. those who suffer for righteousness will never attain their deserved reward, and those who live a life of carnality would have been too easily let off the hook. but in light of Christ and the final judgement that He brings, all will be set right before the true Judge- He who is blameless, faultless and without sin- to restore all things to order, to set right the things that our courts have failed to.

In this moment of grief and loss, let us remember that it is because there is an inherent value of human life, a reason for which we live and the salvation that Christ brings that even in death, there is hope- a hope of justice, a hope of righteousness and a hope of eternal joy.

Christine- i would love to see you smile again (: till then, G

In the sweet by and by

We will meet on that beautiful shore.

One Year On

The things that I love
I hold dear to my heart
They are borrowed and
Not mine at all
Jesus only let me use them
To brighten my life
So remind me, remind me dear Lord

Roll back the curtain of memory now and then
Show me where you brought me from and
Where i could have been
Just remember I'm a human and human's forget
So remind me, remind me dear Lord

- Remind Me Dear Lord, by Connie Smith

MCF Christmas Party

i must say that last night was surreal.

it has all come full circle.

and we're only human too.

Days with My Father

From Philip Toledano, Days With My Father. See it for yourself.

...

Sometimes, when we're talking

My dad will stop, and sigh
and close his eyes.

It's then that I know, that he knows.

About my mom.

About everything.

turning 60

happy birthday. :')

dealing with death

my mum once told me that men are the most upset at the time of a loss. they cry the hardest, hurt the most. the women provide the support then.

then it blows over, and life returns to normality. men get over the loss quickly. but that's just when the women begin to cry.

40/31

Central Nervous System Ischemic Response

This response refers to the effect of cerebral ischemia on the vasomotor center. When blood pressure drops below 60 mmHg, blood flow to the central nervous system neurons is compromised and cerebral ischemia occurs. The consequent build up of carbon dioxide and hydrogen ions due to reduced blood supply very strongly stimulated the vasomotor center. (Hypoxia directly depresses the vasomotor center). The vasomotor center is maximally stimulated at blood pressures of about 15-20 mmHg and hence this response has been referred to as "the last ditch stand". This response is an extremely powerful one and may even cause complete shutdown of blood supply to peripheral organs in an attempt to maintain blood pressure and hence blood supply to the brain.

Papa, carry me

In memory of my father whom I love dearly and will always remember. 23 January 2008

...

Memorial Service - 24 January, 2000 hours, Singapore Casket Diamond Room

Good evening everyone. Thank you for being able to come down tonight to share this time with my family. My father’s passing was not a sudden one, and in a way, was something that my family and I were quite prepared for. My father himself was prepared for a time like this.

As I look back on my father’s life as I’ve known it, I thank God for all that He has provided and blessed my father with. He had the means to finance all his medical treatments, did not have to endure too much pain until the very last stage, and had the strong support of my mum, his children and my uncles and aunties.

As I grew up, my father always emphasized the importance of family. He taught me the need to spend time together regularly and always reminded me to help out in the family wherever I could. When my brother Han left for education overseas, my father made it a point for us to webcam every weekend to keep in touch and updated on each other’s lives, however short the session had to be. My father loved to eat, and so in the past he would bring my brothers and I out for breakfast every Saturday mornings for some porridge and dishes at the hawker centre nearby. He also made it a habit for my entire family to have dinner together every Saturday night, where he would bring us out for a big meal. One of his favourite places was a Chinese restaurant at Bukit Merah. Should any one of us have to be away for another social event, my father would be visibly upset. Even though my father was not one to show his emotions easily, he showed his love and care for his children in other ways. One such example would be in the past when my brothers and I fell ill, my dad would whip out an antelope’s horn bought from a Chinese medicinal hall, and begin shaving it to prepare a drink that would make us feel better, however terrible it tasted.

In the past year, I had the opportunity to spend more time with my father. It was during these times that he shared with me the stories of his youth, like how he had many suitors, how he was once caught at gun point by a robber, and also how he successfully mediated a worker’s strike. He shared with me the hardships that he went through to get where he was, having come for a relatively poorer family background. He taught me life lessons and that the ways of the world were not as simple as I thought them to be, warning me not to be too easily taken in by others. My father also recounted to me the time my family and I were in Disneyland in the States for a holiday, during which I kept pestering him, “Papa, carry me, carry me.” Admittedly, I was quite plump then, and he would tell me how tiring it was for him. As my father’s health deteriorated over the years, I soon realized that it was time for me to carry him, as he had carried me.

My father was diagnosed with colon cancer in 1999, before I had turned 11. It was at quite a late stage when it was discovered. I remember clearly the day he was diagnosed and we just received the news. The doctor told us that only 50% of the people at such a stage live beyond 5 years. Then, I asked my brother quite ignorantly, “korkor, cancer is the one where you drop all your hair is it?” By the grace of God, my father was given another 9 years of life with a reasonable quality of life. In the past 9 years, my father went through 3 major operations, 2 rounds of radiotherapy, and 3 full rounds of chemotherapy, each lasting between 3 to 6 months. Every round of therapy meant months and months of poor appetite, weight loss, nausea and hair loss. The cancer went into remission twice, but returned shortly another two times. Yet, my father fought hard and strong against the disease, trying out alternative medicines and different ways and means to improve his health. Only in the final month did the discomfort become too much to bear, and my mum and my brothers could only try to make him feel as comfortable as possible. My father told us to pray for him, that all official matters could be settled soon, and that he could go soon, end his suffering and not be a burden to the family.

Indeed, God has been faithful. My father persisted right till the very end and was allowed to see my brother for the final time as he rushed back from UK. My friend shared with me this verse yesterday - It says in John 14:1-3, where Jesus said “Do not let your hearts be troubled. Trust in God; trust also in me. In my Father’s house are many rooms; If it were not so, I would have told you. I am going there to prepare a place for you, I will come back and take you to be with me that you also may be where I am.” There is reason to rejoice, because my father is now enjoying eternal joy and happiness with God in heaven, perhaps doing what he loves most – eating, enjoying a heavenly banquet. He is rid of any bloatedness, pain or discomfort. This physical separation between my father and us is only temporary, and I look forward to the day we are reunited in God’s kingdom.

I’d like to thank my mum for being a faithful caregiver, my Uncle Seung Po who was always there to pray with and for my father and the household, my maid Wali who faithfully boiled Chinese medicines over these years and saw to my father’s requests, and my uncles and aunties who visited my father when he could no longer leave the house.

In closing, I’d just like to say that my father’s resilience is one that I will always admire and remember. He was a fighter, a strong one. To me, he never lost the battle to cancer – he had already won the fight long ago.