Happy New Year

Wishing everyone a happy new year, hopefully this new year and decade will be one full of exciting changes, new adventures, challenges, laughter, love, happiness, and above all else, good health. Salut!

Also, I've moved my blog here, should you be inclined to reading my ramblings in the future. I shall not be posting here anymore, but it'd be too sad to delete everything either. So I'll leave it in the digital ether, until such time when something else destroys it. Bye for now.

Hello 2019

The past year has somewhat gone by in a haze. Bits and pieces surfaced as I tried to recall how I made it through the year. Lots of stress eating, some heartaches, and definitely a lot of repressed memories. It's not all that bad: there were lots of booze, plenty of laughter, too much ice cream and duck fat fries than I cared to remember, and tears, the latter of which I hate to admit. It's the Asian culture that I grew up in that I can't yet shake away, that taught me- tears are for weaklings. And a weakling I am not. Thank goodness for a few good friends whom I can always count on. But even then, people come and go, all the time. That's just how it is. 2017 and 2018 were filled with a lot of growing pains; I learned so much about myself, some of which that surprised me and that I'm not proud of. But at least I know better now, and I'll learn from those mistakes I've made. This year though, will be a better one. I'm sure of it... or at least the optimistic self believes so. The goal for this year will be mastery- through perpetual progress, and building habits. The more zen goal, as trite as it may sound, is to be present. As Ferris Bueller puts it, "Life moves pretty fast. If you don't stop and look around once in a while, you could miss it." 😎

Back!

Baltimore, on a beautiful autumn day.

It's been more than a year since I last posted anything, not because I didn't want to, but I find myself losing the reason to do so. Some time ago, though, I got a random message from a stranger encouraging me to continue writing because he thought my thoughts were thoughtful and mature, and I thought that was very sweet of him to say so. Truth is, I've been meaning to write, and have actually gone as far as creating drafts, but never got around to finishing them up for a myriad of reasons, none of which is important- because now it'd just sound like excuses not to have done something, and excuses are for wimps. Yoda says, you do or do not, there is no try.

So many things happened in the past year. Lots of thoughts and reflections especially when I'm in the wards and in ICU, and in the shower. Some crude thoughts remained saved in the drafts, so maybe they'll become future posts.

It's getting colder, we had one snow day last week. Seems like this year's winter will be a bitter cold one. Keep warm, and I shall stick around and write more frequently. Adios!

Huis Clos

"Huis Clos", which is French for Behind Closed Doors, a play written by Jean-Paul Sartre. It's a play about three people who died and went to hell, and was placed in a room. And the whole play revolves around what happened in the room, hence the title 'behind closed doors'. I won't spoil the fun of reading the play for you, but the gist of the story is that they soon realized that they each annoy the hell out of one another so much so that they came to the conclusion that "hell is other people". If you're interested, the English title for the book is "No Exit".

But the reason why I'm writing this has nothing to do with the book itself, or the moral of the story. The reason is this:

Edited with Prisma App.

Every morning I go to work, and I have to go through this door, walk down a corridor to the very end of it, to get to my home base at work. There it is, the "No Exit" sign. It wasn't too long ago that they put it there. And so every time I see this sign, I'm reminded of the play, and I can't help but chuckle. Whoever's idea of putting this up must have a very dark sense of humor. 😂😂😂  

Or it could very well just be coincidence. Okay fine, I'll admit it most likely is just coincidence. But it doesn't take away the hidden link and humor that only I seemed to get. No matter. I'm fine with being the only person who finds it hilarious. 

I've since shared it with a few of my friends, whom I'm not sure if they entirely understood what I find so funny, or if they thought I think of them as hell. I hope it's not the latter. :/  And I hope I don't need to clarify that I never thought my workplace or my colleagues are hell to me.

That's it for this random post. Happy Saturday peeps!

Remembering

“Death is the destination we all share, no one has ever escaped it. 

And that is as it should be because death is very likely the single best invention of life.” 

― Steve Jobs

When there is life, there is death. Every new life that comes to this world is guaranteed nothing but death that will ensue, albeit it being just a far-off concept that no one ever thought of at the present moment. But of course. Why would anyone think about that when they're too busy rejoicing in the beauty of this bundle of joy in their arms, their mini-selves. Unless you're like me, who's weird and morbid at times. It's a good thing then, that I'm not in the position where I have to deal with the contradictory emotions.

In medicine, it's hard not to think about death, when you're dancing around it on most days, if not all the time. Fact is, mortality stares at you all the time. Healthcare folks somehow learned not to be bothered by it, and just kept an arms' length from it, I suspect to protect themselves from being too emotional or overwhelmed, and also to be able to function and carry out their tasks. It's a matter of habit, and one can usually go about his/her daily business, focusing on the science/medical aspects of the job, instead of the life and death that is the core of what we do every day. But-- when it comes to someone we love or care about, it'd be tough, if not impossible, to ignore this aspect at all.

In all honesty, I only knew her personally for a short while, so I don't think I have the right to be tremendously affected when I heard of the news. And yet, I felt disproportionally affected- more than I think I should, because in that short period of time I've grown to care for her. She was this amazing, extremely capable, independent woman, who had accomplished so much both in her professional and personal lives, always positive, generous, caring, selfless, and determined. So when she found out she had this terminal illness, her personality and character didn't allow her any other way to deal with it other than facing it head on, with that fierce determination to beat it. Her grit, her strength, even at her weakest moment, amazed me, and touched me to my core, and I wished I could've done more for her. I almost believed that if anyone deserved a reprieve from a terminal illness, it would be her. It has to be her. I want it to be her. But alas, cancer is a b--ch, and there's a reason why terminal illness is called a terminal illness. And so when I heard, though it wasn't completely surprising, it was still a shock (that it happened sooner than I thought).

I want to be mad at God (if there is one), for taking a mother, a wife, a sister, a daughter, and a friend away from those of us whose lives she had touched. But my upbringing and beliefs also taught me that: 1) death is inevitable, and 2) life is unfair.  Couldn't exactly get angry at impermanence of life now, could we. As for the second point, I don't think anyone has come up with a solution for that yet.

Sigh.

I will always remember her as the beautiful person that she was, inside and out.

To those reading this, it seems cheesy or cliché to say it, but really-- cherish every moment of your life, and those around you, for you never know...  Tomorrow is promised to no one, today is all we have.

The Beginning of A New Journey

Imagine Super Mario running the last ten yards, hit a mushroom, grew bigger, took all the coins and ran as fast as it could, and then he jumped! -- and successfully caught on to the pole, that brought him to the next level. Yassssss. Moving on to the next level.

That's how I feel now. Next milestone.  

That said, as exciting as it is, it's also scary. Because now Mario is back to the minion-size moustache'd boy-man, down in the dungeon, can hardly see, and has to grope in the dark until he figures out his way.

For those who are wondering what the heck I'm talking about, I'm starting my internal medicine residency training. Some people say, "oh don't worry you'll do great", others have this to say: "there's nothing you can do to prepare yourself for this; just plunge right into it, you'll learn as you go."  /gulps. Okayyyy. 

I'm optimistic though. It's going to be a lot of hard work, but it's also going to be fun! For now though, time to go study my territory and find more mushrooms, hidden stars and coins and superpowers. :P

My new work family. 

Taboo

Preamble

I've been saving this draft I wrote long ago towards the end of my fourth year of med school, uncertain if I should share it. Was worried that I'd get in trouble for sharing something like that. It's probably unlikely, given that I'm not sharing any identifiable information about the patient or the personnel taking care of the patient. Plus, it's been so long ago... I doubt anyone other than myself remembered this incident. I've considered deleting it and just move on, but some things are hard to let go, and this is one of them. Sharing it now because it was so hard to talk about it when it happened then. Perhaps sharing it here now will allow me to see it in a new light, and put it to rest. So... here goes.

-----

My Emergency Medicine rotation was a memorable one, one that gave me some of the best and worst experiences in my clinical years as a med student. One particular incident left a deep impression on me, and I had to pen it down while it's still fresh in my head. On one of our on-call nights, my friend and I returned to the ED (Emergency Department) from a quick dinner break, only to find the red zone to be almost empty save for this one patient with the attending and a house officer huddling around him. The ED was divided into 3 zones - red, yellow and green (like the traffic light) - and patients were triaged to a zone depending on the severity/urgency of their condition: red being the most urgent/severe and green the least like a cold or a minor cut, with yellow in between with the potential of escalating to the red zone. As most med students can attest to, we usually like to be where the 'action' is, if not actually making ourselves useful during such occasions, at least watching and observing to learn a thing or two. And on that fateful night, a thing or two we did learn, indeed, albeit not what we expected.

A 60 year-old pedestrian was hit by a motorcycle, and was found unconscious on the ground for an unknown period of time. Upon arrival, he was found to have GCS of 8, with an active bleeding somewhere in the oropharnygeal region. He had no external wounds, no broken bones. His condition warranted a tracheal intubation to secure his airway before being sent for a CT scan of the head to rule out an intracranial hemorrhage. Unfortunately, none of these happened and he was not intubated until two hours later. Meanwhile, this man was bleeding quite profusely and we were tasked to suction the blood out of the cavity, as they tried to intubate him. I watched helplessly, worrying about him bleeding out. At the rate that he was bleeding, I was almost certain the blood being transfused could not keep up. It took another two hours to send him for the CT scan, because while all this was happening, his abdomen became increasingly tensed and swollen. The consensus was that there might be internal hemorrhage, but they couldn't seem to agree with the next step. It was between sending him for head CT only, or whole body CT scan. At this point it was close to midnight, the red zone started to get busy, the surgical residents who were called for consultation were reluctant to bring the patient to the operating room for an exploratory laparotomy to potentially stop the hemorrhage in the abdomen. Deliberate discussion took place, and then some, and in the end they decided they wanted a whole body scan. As all those were happening, patient's BP kept going down, his pupils fixed and dilated, and all we did was keep giving fluids and blood products. Bad luck had it that the CT machine in the ED wasn't working, so he had to be brought to the radiology department at another site, which was a long way away. It took us at least another 30 minutes to gear up before we were finally on the move to the other side of the building. Alas, as soon as we got there, the man coded, test was aborted, CPR was started while we wheeled the patient back to where we were 10-15 minutes ago.

It was of no surprise that this man died after an unsuccessful resuscitation; and everyone carried on with other tasks and patients as if it was just another death. Everyone except me. I was bewildered, stupefied, but most of all I felt helpless. Perchance when he came in he was already a lost cause, perhaps death was inevitable with the severity of his injuries, but we didn't know that for sure. Even if we did, shouldn't our job be to do our best to save his life, the emphasis here being 'to do our best'? I was upset not just because a person died that night, but that in every step of the way I felt we as providers could've done so much better. I didn't (couldn't) understand why everyone acted as if it was just another green-zone case, why there was zero sense of urgency, why certain decisions were made (and took so long at that), and why everyone appeared to be emotionless and moved on so quickly. Throughout the entire time no one contacted his family members, no attempt was made, or at least none that I know of.

I tried to understand what happened, and what could've been done differently to prevent this from happening, but I was stumped. This to me should be a case to be brought up during Morbidity and Mortality meeting, but when I asked the attending about it at the end of our shift, her reply to me was this, and I paraphrased: "... you will see things that are done correctly, and things that are handled poorly. Good and bad decisions, and behaviors/attitudes. Just learn the good ones, and ignore the bad ones..." For the second time that shift, I was baffled. Sure, yes learn the good and leave the bad behind. But what about the patients?! By not doing anything, aren't we silently consenting to the wrongful actions or behaviors? Does that not make us complicit? That morning I had trouble sleeping. I felt I've failed the patient, and I couldn't get rid of the guilt. As I eventually dozed off, I think I died a little inside.

-----

Afterthought
I still think about this man once in a while. I wonder if it's just me being the med student who was 'young' and 'innocent' and this was some kind of rude awakening to 'how things are' in real life. An initiation of sorts. Because how else do you explain why everyone who was working there acted so nonchalantly and went about their business? Maybe they felt something too, but had to hide it to be able to function. If everyone dwelled, then no work could get done. Maybe it's the culture to act tough and move on. Maybe like me, initially it got to them, but after a while if this kept happening, they just had to wall their emotions off, toughen up and learn to shut up and move on. Maybe they all felt helpless at some point, but believed that nothing could be done to change this and so they just accepted the way things were and learned to live with it. I don't know. These are just my speculations, because we weren't allowed to talk about it. Because pointing out some behaviors, actions, or decisions that might be questionable is forbidden, I didn't get to understand the root cause in that context. I doubt they really understood it either. It's such a taboo that you just learn to sweep everything under the rug and do your thing. If you want to survive, that's the modus operandi. 

My writing this and sharing it here wasn't intended to criticise or to let known how bad things are back home. Situations like these happen everywhere. The point is, there is a need to talk about it, to discuss and address the issues so that we can improve. Pretending as if it didn't happen won't prevent it from happening in the future, and then it's just going to happen again, and again, and again... We owe it to our patients to do our best, and make sure we do not repeat mistakes that can potentially cost lives. Primum non nocere, in English, means 'first, do no harm'. To do that, we've got to set aside the ego, and be willing to take the first step to talk about things that went wrong. I do not know if things will ever change back home, but I sure hope it will. One can only hope. 

Spiralling Chaos

Posted by a friend on Instagram, thought it's worth sharing here. #repost (Thanks friend!)
Credit goes to the author, whose name I can't see clearly, but is the lady in the picture. 

To save you from squinting your eyes, I'm retyping the passage here:

When I was about 15 I got pretty overexcited when, through my combination of school subject choices, I came across the concept of duende. 

It's a Spanish word with no English translation that could be loosely explained as as expression of the feeling we all have that life is both incredibly heavy and feather-light at the same time. 

While my intense teenage attachment to duende as a concept has faded, there is something about discovering the word that sticks with me. 

Whenever I think of it, I'm reminded that language governs thought. The lack of the word duende in English doesn't just connote a cultural reluctance to discuss the feeling it represents. Instead, the fact it's missing from our vocabulary actually prevents us from conceptualising the idea fully - without the word, we can only communicate a pale imitation of what it describes. 

And now, as I try to find something useful to do about the parlous state of the world's most powerful - the unstable and dangerous Trump, and our Government's pandering to him - I run into a sort of similar problem with language. 

The verbs that describe the actions within our reach - organise, protest, resist - they're tainted. I'm not sure how it happened, but in my mind those words have come to be associated with privileged people complaining en masse because they don't understand others' realities, rather than with legitimate community movements. 

The fact that these words have been twisted like this seems to impede my ability to work out how we can best express our collective disgust at the actions of the people who now purport to lead us. 

But whether we reclaim these particular words or assign others to do their job, we need to find a way to stand together and say this is not ok; to say that collectively we will step in to prevent people being hurt by small men with big power. 

Language certainly governs thinking, but in this case we need to make sure its limitations don't prevent necessary actions. 

These days we keep waking up to ridiculousness, every day more so than the previous day. It's like watching some really bad reality-TV show, except it's not -- this is our f-ing reality.  The more I read, the less I want to write, the more I want to retreat. But running away, shutting the world out, isn't going to change anything. Although only tangentially related to what the passage is about, reading it reminds me that we all have a duty, a responsibility to speak up and participate in the current affairs, no matter where we are or what we do. Because the alternative - to just stand back as a by-stander, watching things unfold, or perhaps trusting that other people will step up and fight for what is right - is unacceptable. Now more so than ever. 

Whatever it is that you care about, go do something about it. Un-spiral the spiralling chaos. Or make it harder for it to keep spiralling. Make your voice heard. 

Peace.

Taste of Home

Happy New Year to all. I haven't been writing much since last year, partly because I was busy, but also partly because I had no words to convey how I felt about recent current affairs. I still don't, unless I want to spill my guts out about it, which would just be messy and ugly and not something I want to do right now. So while I wait for the wound to heal, I'm just going to avoid that topic for now, and share some pics, and talk about anything else but those that really matter. 

This year is the year of Rooster. Another year that I don't get to spend at home. Those who are abroad and away from home will know how it feels. Not to be overly dramatic or emotional, but it is true that celebrating Chinese New Year away from home is never really the same. You could replicate everything about it, the food and the decor, but the essence of this occasion is missing, and those can never be transplanted here. No matter how hot and humid it is back home, how bad the currency is right now, or how there's always something to complain about back home, it still is home. Where there are lots of family, relatives, friends, people who make you feel grounded. Sure, I am used to being away, but it still means a lot to me to do something that reminds me of home and of this festivity. Glad that my friends are able to make this happen for me. Best gift I can ask for on occasions like these. 

Feeding the phone before eating. Yes that's how the millennials do it these days. 

Steamboat aka hot pot is something my family does on CNY eve every year. 

So what's more appropriate for CNY eve here?! :) 

An obligatory wefie. 

Okay now it's time to feed the stomach. Bon appetit!

News vs. Facts

If a tree fell with a thud, but no one heard it, 

has it really fallen? 

If words of truth were written but no one read it,

are they still legit? 

If one was loved by another but he/she alone was utterly blind to it,

has it really happened? Does it still count?

Humans. Most of the time we seek evidence, trust only our senses and what we can concretely grasp, especially when it's in our favour or when it's convenient to us. When it's not, or when it's too complicated/overwhelming, we either a) choose to believe whatever we were taught when we were little (fall back to the primitive model instilled in us in our early years), b) jump to the next most convenient explanation (even if it's absurd), or c) simply walk away and ignore the problem.

Sure, these choices are tempting- they're easy solutions. They don't require much thinking.  Believing what we were told when we were kids is probably the easiest, most convenient, and natural thing to do- because it felt 'right'- when 'right' and 'wrong' were as clear as 'black' and 'white' as a child. It gives us and easy way out.  But that's why we educate ourselves. We go to school not just to get a piece of paper that helps us secure a job, but to learn to think for ourselves. To think through the information we're fed, to parse out the right and wrong (subject to individual moral codes, but that's a different matter altogether), the truth from lies.

These days though, it's increasingly hard to do so. A large part of it is because of the technology that is a double-edged sword- it provides us an abundance of information all just a few clicks away,  but it doesn't separate truths from un-truths/lies/propaganda. There's hardly any information police or regulatory body that fact-check everything, because it's just an impossible task. The onus then is on us to do the hard work ourselves, to check the sources, to analyze what we've read and make up our mind about it. Yet too often we fall into complacency and just reinforce what we already believed in by reading the opinions of those whose ideas align with ours, which makes it easy to skip the thinking part and just drink in what we've been fed. The danger of overly accessible information is like the sexy, seductive mistress who keeps flirting with you, completely intoxicating, irresistible, and- costly.

Too much has been said and written on the election results, and I don't think my two-cents on the postmortem of the event is worth mentioning. Everybody has an opinion, everyone has something to say. Most of them are unhelpful, and are noise. I'm more interested in how things move forward from now on, especially on the healthcare front and the environmental issues / climate change. One example- Standing Rock's fight on the Dakota Access Pipeline is something worth keeping close tabs on, and take action if feasible. Whatever it is, I think it's high time we all start caring about something and work to protect what's important to us and to those we care. Because if we don't, we might find ourselves losing it sooner than we realize. If there's a lesson to learn from recent events, it's to take nothing for granted. Nothing.

Peace,
J

The Girl

It was a rainy day but she needed to get out. Nothing could stop her, not the thunder or lightning, or flash flood warning texts. It was that kind of day.

On days like those, her yellow boots seemed to have a life of their own, and so off they went, taking her on a path that she had never come across. But she could hardly care. Or maybe she didn't even notice. If every thought process, every neuronal activity makes a sound, you'd hear the cacophony of clicks, buzz, and ticks inside that skull, going a little overboard not unlike the time machine that had gone wrong and trying its very best not to explode. Why is all this happening, she thought. She wanted answers. She needed to talk to a friend.

And just like that, she took charge of her path again, finding her way to the coffee shop. It's a hidden gem, on the second floor of an old mansion with a flight of stairs on the right, while the left side of the house was rented to an old tailor. Skipping her way up the stairs, turning right, zig-zagging past all the tables with very chatty customers talking over the soothing 20s' jazzy background music, and not really bothered to only step on the white squares on the floor, something she usually did when she wasn't in this harrowing mood. A dose of bff-pep-talk will make it go away, she mused, crossing the common area, turning left into the corridor with private rooms on both sides, and through the double doors into the kitchen, where her friend was helping her mom making coffee and toasts. Business has always been great, but it's even better when it's gloomy or pouring outside.

The relief of finding her friend lasted about as long as two milliseconds, which instantly evaporated when she caught a glimpse of her. Another two minutes into the conversation and she found that she couldn't possibly burden her friend with her problems when her best friend was having her own crisis as well. After helping out in the kitchen for about an hour, she excused herself, after giving her friend a hug and promising to call later to talk more.

So much for talking to a friend. Outside the color of the sky matched her own dark clouds looming above her head. Again she took off wandering the streets until she chanced upon to a man who seemed like he was expecting her. Out of curiosity, she asked if he knew her. "Come, girl, I want to show you something," he replied. Usually she wouldn't have agreed to that. But it wasn't a usual day, so she followed his lead. A few broken and battered paths away, there they stood, in front of a misplaced apple-green-turquoise minivan with huge floral patterns on it, one that looked like it got teleported from the 60s. To her surprise, the van was like Doctor Who's blue police box, only it wasn't just that. Inside was an entire world of itself. But there was something odd about it. Soon she realized it was a spaceship that was about to take off. And to accommodate as many passengers as possible, everyone had only a tiny caged space slightly taller than the height of a coffin. They were all stacked in twos, and the entire place was jam-packed with rows and rows of caged bunk-beds.

The man led her to her space, with her name labeled on it, and he left without any explanation. She was speechless. Were they expecting her? Why? Where were they going? She never signed up for anything! Was this a punishment for being pathetic? Were all sad and lost souls to be sent off to a faraway prison? So many questions! She didn't have energy to find or ask the man, though. So resentfully she climbed into her space on all fours, and lean against the bars, observing others.  Soon enough she realized, the others weren't forced to do this! They actually looked excited, preoccupied with their handheld devices, perhaps thinking this was some exploratory expedition to outer space or something. Was it?

She had no clue. All she knew was that she's tired, and she just wanted all this to go away. Disappear. She wanted to disappear. Can the ground crack open and swallow her whole? If she closed her eyes long enough, maybe it would happen.

After a long, long while, what felt like an eternity of denial and refusing to face reality, she opened her eyes. And there she was. On her own bed. Alarm clock next to her bed blinked 03:38. A nightmare. It was all a dream. Felt real though. What bizarre subconsciousness has she been suppressing that had to resurface as such in the dream?

More questions. But at least this time, she didn't have to fear being deported into an unknown space while she pondered upon the message of the dream.

Time-out

"For every decision you make, every path  you choose, you create a parallel life in which you relinquish  your rights to. You cannot think of the what-if's and could-be's, for that life is no longer yours.  All you can do is this: wherever you choose to go, go with all your heart." ~ friend

Thank you, friend. I needed that little reminder.  No matter how tough things are, how it might seem impossible to get through those things, how exhausted you feel, you just have to believe that it will all work out.  A little faith, a little self-hug, and a cup of hot chocolate, and tomorrow will be another beautiful day.

A Wrong Diagnosis

If you ever had that passing thought that "things couldn't go any worse than this right now", my advice to you is: please, stop. Stop that thought right now and switch it to something else, whatever that may be. Think of mockingbirds, ice-cream, the cute guy/girl you saw yesterday, your pet. Anything. Anything but that. Experiences prove, time and again, that every time that thought comes into mind, things will inevitably become worse. You may say, well maybe that's just my selective recall bias, an anecdotal fallacy, and not truth. Fine. Have it your way, but don't say I never warned you.

For the past few weeks I've been obsessed with rashes. Found every article I could and read about the differentials, examined for hours the images of each rash, read more than once about varicella, scabies, PLEVA, and a few others on the differentials. I'd wake up in the middle of the night from the itch, reached out to my phone and looked up other causes of rashes, or read up on one of the many skin diseases. I really shouldn't be going down the rabbit hole when I should be studying for boards, but I can't help it!! I can't stand not knowing what it is and why it's getting worse when it should be better! Arggghhhhhhwwarrrrghhhuuuurgggh!!! [That's me turning into Hulk, in my head.] 

So. As you can tell from the title of this post, turns out the rash wasn't chicken pox after all. Here's what happened. 

About two weeks after it started, when it didn't get better as expected for varicella, but in fact got worse, I started questioning the diagnosis. I would've got to the bottom of it all sooner if I wasn't so reluctant to see a doctor, or if I didn't hold on so tightly to the wishful thinking that it is the easier, simpler diagnosis. Because even though it's absurd that one could get varicella twice, it's still a shorter course of disease, self-limiting, and- I was banking on the probability of it being milder since it'd be a recurrent infection. I was really hoping it was "just" that, and be done with it. So when the rash started to spread, I convinced myself that I'm seeing things, that it's all in my head. Sigh. "For someone who studied so much, this type of reasoning was downright stupid," I can almost hear my dad say that to me. :(

And so it got to a point where I just couldn't lie to myself anymore and had to go to the university health center to get it looked at. The doctor being uncertain of what it was, referred me to dermatology. And with just two words, a huge portion of my anxiety melted away: pityriasis rosea. UGHHH. Really? I never thought bout it because there's no herald patch! And no christmas tree pattern as well! Here's another lesson learned, just because something is pathognomonic of a disease doesn't mean the absence of it precludes the diagnosis. I guess my frustration was noticeable, when I asked the dermatology resident: "How on earth did I get it?!" To which he calmly responded, as if trying to placate me, "It's nothing that you did or could've done to get this. It's a really common disease and a lot of people get it, but we still don't really know why it happens or what causes it." Great. Just great. Isn't this the majority of the case for almost 80% of the diseases out there?! That we don't know what the heck we're dealing with most of the time.  If I weren't in the medical field and could understand the unpleasantness of having to tell a patient that, I'd have rolled my eyes and stopped listening. But I get it, so I didn't pursue further.  Yes- I get it now, more so than ever, because now I don't only understand it from the physician's point of view, but also from the patient's. I know how it feels to be on the receiving end of that statement- and it sucked. 

Sure, I understand that a lot of medicine is still in the grey area, and that there are a lot that have yet to be discovered. But the simple truth is that logic never does make anyone feel better. It also makes me realise something about myself, which is probably also the nature of most human beings: that we always attempt to explain everything that happens to us (that's how the age-old adage of "everything happens for a reason" reasoning came along, isn't it? To make us feel better?), and we also try to do so in a way that attribute the cause upon something other than ourselves. In other words, we're always inclined to blame it on something else, anything but ourselves or our own deed. But when push comes to shove, we'd take the blame too, as long as there's a logical reason to it. We don't handle the "unknown" very well though. Indeed, it's the shrugged "I-don't-know-why-it-happened-it-just-does-and-I'm-sorry" explanation that makes us feel the worst. But why??? Why did it happen to me? What have I done to deserve this?!  Those are the thoughts that would plague one's mind, because one usually cannot fathom how a bad outcome could befall oneself when one has done everything by the books. Think of all the people who got lung cancer but never smoked a cigarette or anything in their entire lives. Or substitute it with any cancer that happened without a known risk factor in someone who had lived a perfect life up till that point. Think about the 30-something neurosurgeon who was about the complete his decade-long training only to find out he had terminal lung cancer. It's atrocious! How vile to have been sentenced to such fate when a 90-year old man a stone's throw away was probably happily puffing his cigarette celebrating his 70th-pack-year! But what can one do but throw up his hands and surrender to this thing called Life??! 

And when the initial emotions has passed and the dust settled, how does one cope with this kind of horrible outcome? Ironically, one tends to circle back to the "everything happens for a reason" argument to cope with it, or chose to accept and entrust one's faith to the higher beings. That, or one could go into self-destruction mode and start hating everything and everyone with the "fuck god, fuck the disease, fuck the world" mentality. 

Now I'm not being melodramatic, I don't have a terminal illness, I just have a skin condition that is also self-limiting, albeit one that will last 6-8 weeks. In the bigger scheme of things, I am thankful for being alive, for having "just" a skin disease. But being unwell is hard, especially for someone who's spent most of her adult life working towards being the person who provides care. Now that table has turned, it's a hard pill to swallow. I don't want or like to be reminded that I too am mortal, that I'm completely susceptible to any disease, and that the medical degree earned is not an immunity to any or all sickness at all. Alas, I, and all the other physicians who may share my sentiments, are just humans too. We too can die, can get heart attacks, dementias, stroke, or [insert your disease of choice here]. It's a silly, not-worth-mentioning known fact, but we don't really think about it until we have to. (One could argue that some deliberately avoid thinking about it, but that's a topic for another day.) The truth is, we all have to face mortality at some point, and we will all do so on our own terms. One way or another, eventually. (Unless you happened to be in a plane that miraculously disappear into thin air. Then sorry, no time for you to think about dying and death because your brain cells and every bit of you will be blown up into ashes before you could even conceive of what just happened.)

I write this before I had the chance to read Atul Gawande's Being Mortal, or Paul Kalanithi's When Breath Becomes Air (that's the neurosurgeon who had terminal lung cancer I mentioned above), even though those books are just sitting on the shelf two feet away from me. When I'm done with exam, I'll read them. Perhaps I will have additional thoughts on mortality then. But at this moment, as I'm writing this pondering upon mortality, grateful that I'm alive yet slightly (only slightly) resenting the cards I'm dealt with, I still think it's a good thing over all. I see some good coming from it, not because I'm a masochist, but because through this ordeal I had a taste of being a patient, of being unwell, without having to go through chemo or radiation (or worse- to die!).  Empathy and compassion often grow exponentially from first-hand experience. So hopefully this experience will help me be a better doctor. Then again- one could only hope, eh. :P 

Peace. xoxo.

Rocking the Pox

When I was 7, I was told that it's a good thing to have chickenpox at that time because once I got it I'll never get it again, for the rest of my life. I did a mental calculation, comparing the body surface area that I'd have to suffer the itch, pain and scars between the smaller-size me and the adult-me, and I thought this was the better deal. That was pretty much the one thing that got me through the horrendous days of chickenpox. 

Fast forward many years later. To 2016. About a week ago to be exact. I scratched on a pimple-like itch that was bothering me. I call it Pimple Zero. Everybody remembers Pimple Zero, don't they? I know I do. Even back when I was 7, when I didn't even know what it was, or that it would be the beginning of a very long ailment. It was just a fascinating, innocent looking pimple with fluid in it, and slightly itchy at the surrounding area, but not enough to poke through it because it would take a way the fun. Alas, much "fun" that was. 

Did you know you could get chickenpox twice in a lifetime? I didn't exactly think it was impossible, I just didn't think it possible to happen on me. But then again, that is human nature too, no? We never thought any bad thing would happen to us... until it does.  First thought- whattttt??? NOOOOOOO. Can't be! You've got to be kidding me!! Like a typical medical student, the first instinct is to self-diagnose the rash. I ran through a mental list very carefully, and chickenpox was not really on that list (it's in the don't-need-to-consider pile). Couldn't think of anything that would fit (seriously thought of everything from flea bites to bedbugs bites, scabies, allergies, even systemic cause like diabetes!). It bothered me so much (both the rash and the inability to figure out what it actually is), that I felt compelled to consult a friend, and that was when it hit me. As I was describing it to her, everything suddenly became crystal clear, that regardless of how improbable it is, it sounded just like chickenpox. Holy schmoly. F***. Crappety crab. Wow. Really? Is there a God? Is God playing games with me? 

But just as soon as the egocentric self tries to understand/question the why, being all pissed off that this is happening for no apparent reason (as if I don't have enough on my plate now), the other calmer zen self pushes back with a positive thought- hey well be thankful it's not shingles. That's right- it could be worse. Just like that, I felt much better. That thought would be what I'll hold on to till I get through this.

And so I'm sitting here drinking hot Milo (my comfort food), rocking my pox, pondering deeply on this. I have tons of questions. Why is this happening- scientifically? What triggered the reinfection? I've had it before, shouldn't I get immunity? Not to mention I actually got the vaccination two years back as well. Perhaps that's why it's a much milder case, but does that also mean it will stretch out longer? I feel well though, other than the rash and itch. I don't think my immune system is compromised in any way, I don't have more stress than the usual, I don't have any ill contact. So how did it happen? Can I exercise/run? Will the increased blood circulation and vasodilation cause the virus to go to more places and I'll have a more severe flare? What can I do to speed up the healing process? What can I do to ensure this never happens again? I'll have to find out. Guess this will keep me busy for some time.

xoxo. pox out.

Undoing

Been gone for a while, that's because I went searching for the cheerful, bubbly self who seemed to have lost her way. That go-getter, optimistic, fighter self went missing, and was replaced by a melancholic self. Seems rather childish to be quoting a children's film, but it felt almost as if the Sadness in Inside Out had been occupying the whole of me, and all I saw was blue and grey. Occasionally there were glimpses of rays but they didn't last, and then it was back to blue, grey and black.

Today, though, something happened. Don't know how, don't know why, but it felt as if the lid that kept me locked inside the sadness has suddenly been lifted, and as I climbed out of the hole I dug for myself I felt lighter, shedding layers of worries and melancholy with every step I take. I was in the subway on my way to work, and every motion of everyone around me seemed to turned into a slow-mo movie. Every sensation heightened, every sound echoed and dropped its frequency, everything seemed funny and amusing. It felt as if I were tripping, except I wasn't. Granted, it only lasted for a minute or two and it all went back to normal when I had to get out of the station, but it was awesome while it lasted. A kind of high that's hard to describe, and definitely not on any influence of drugs.

I realized, in that split second when I returned to my senses, that this, is all there is. This is all we've got. The present moment. It's more than words can explain. It's something we think we know as we read the words, but only superficially. We think we know, but most of the time we really don't. No really. We don't. We'd write about it, we think we know to live every moment, but we so often lose sight, and be blinded by things, events, people. More often that not, we don't really feel it, we're not aware of it. We go by our daily lives doing things because we're accustomed to doing them. It's habit, it's routine, it's something we "have to do". It's autopilot. We tell ourselves stories, the stories stick to us, and we live out the stories. At some point we aren't even sure if we write the stories or the stories own us. If the stories we told ourselves were lies, then lies were all we lived. And before we know it, we'd be at the very end of it, and only when we have to face death, do we reflect upon the gazillions of moments that we lived through, that made up the days, the months, the years. It is then that we'd realize that we let too many of those moments slipped by us without really making the best out of it.

I don't know what's gotten to me this morning in that subway, at that moment, when all this burst of thought came to mind. Maybe I'm going crazy; maybe it's a mini-epiphany that is a wake-up call to stop brooding. Maybe it's the Divine Being brushing past me, if you happen to believe in those. And if you're in Richard Dawkins' team, then maybe it's just synapses (over)firing and this happened to be one of the many billion thoughts that randomly occurred, thus making it just that- one of the billions of possibilities and nothing more.

All I know is this- I have nothing, except the present moment. No more, no less. I am exactly what I think of myself- whether I think of myself as a useful person or a worthless nut, I am right. And the last and most important thing of all, is this- I need to stop thinking so much. Stop thinking, stop worrying, stop being angry at myself, stop inflicting pain on myself.  Just. stop.

It's time I let go. And let go, I will.

Bits and Bytes of a Trail

Some thoughts on nature and us, and then some pixels I took of nature. What prompted it? Well it must be the warm Christmas followed by 3-foot snow, and the fluctuation of temperature. 'Tis global warming. Not as dramatic as the Hollywood films would have it, but it's happening... 

Anyway. Am not in the mood to discuss serious topic like that. I'll leave that for another time. Today is just some reflection with hot tea. Cheers all. 

"Nature is purposeless. Nature simply is. 

We may find nature beautiful or terrible, but those feelings are human constructions. 

Such utter and complete mindlessness is hard for us to accept. 

We feel such a strong connection to nature. 

But the relationship between nature and us is one-sided. 

There is no reciprocity."

Art installation along the trail and a frozen lake.

Book of life. 

 Elephant made from metal scraps and recycled items. 

Picture doesn't do the leaves and the surrounding enough justice. 

I'll have to come out here again when it's not gloomy and wet.

Queensland: The Sunshine State

The last stop of my Australian trip was Brisbane. There is so much to see in Queensland, and I only caught a glimpse of it. I'd have to come back another day, no doubt. My aunt and grandaunt were kind enough to host me, bring me around, cook for me, make me feel at home.  But the highlight of the trip, other than spending time with family, was the unexpected encounter with my aunt's friends at the community garden. Every Tuesday they go there to tend to their vegetable crops and some fruit trees, and they'd bring tea and cakes to share after a morning's hard work. I had the privilege to spend some time with the golden citizens, listening to their stories way back in the days while enjoying a cup of hot tea with strawberry shortcakes. 

There was this 80 year old man, Kasper, whom I was particularly fond of, who liked to introduce himself as 'Kasper, with a K and not C like the friendly ghost you know of'. I thought that was so cute it made my heart smile. He was kind enough to give me a tour of his fruit orchard (well not his but he was the main person who looked after it) and introduced me to the different trees and plants that I know close to nothing of. Loved listening to his stories about where he was originally from - Switzerland - and how he got to the land down below and grew his roots here. At that moment, sitting at the shed basking under the warm sunlight with gentle breeze on my face, being completely captivated by his stories and simply enjoying the old folks' company - that was one of the best moments of the trip.  I can only hope that when I turn 80, I'd still be strong and healthy and able to walk about doing stuff that I love, and sharing my stories with the younger generation. 

Aunt tending to her veggies. 

Nasturtium, one of the few edible flowers, which I find so beautiful. 

Man-made beach somewhere near the city. 

On the way to Gold Coast, or somewhere close to it, can't remember...

Waves that beat on the rocks, day and night. 

Exemplary state of impermanence.

View from some floors above, in the Twin Cities casino (twin cities being Coolangatta and Tweed Heads). Lots of retired folks. Kinda amusing seeing them around chillin', playing bingo etc... 

Somewhere out there. I can't remember where this was taken... Probably during a pit stop on our way to Gold Coast, at this clubhouse where we had coffee and cake.  

Some island that many people go to to check out dolphins and whales :)  

Ideal place for a retreat, away from the world full of noise and distractions.

One of my favourite pics. That's Uncle Barry's hand cut off, as I was taking a panoramic picture. 

Trippy...

The red lighthouse. Because every coastal town needs one :) 

This was taken at Manly Beach I think. Quite honestly I don't know what's so 'manly' bout this beach. 

Don't see many six packs around... :P 

But I do love the cloud formation... So fluffy, like it's out from Mario the video game back in my time, and you can jump from one cloud to the other. 

That just about summed up my trip to Australia. Wonderful trip, would love to be back, but for now, back to reality. (Well, technically I was back to reality many months ago, this was just an overdue post). Peace. 

Another Year, Here We Go

I used to reflect on the year before, and making new resolutions for the 'new' year, either here or in my journal. But for the past few years I haven't really been keeping track of whether I checked off the list of stuff to do. Part of it is because it's been the same resolutions, and they're more about self-building than a concrete thing to achieve. So this year I wrote myself a note on the eve of New Year's Day, and I thought I'd share it here, mostly just as a reminder for myself if things get tough this coming year, or if things don't happen as I'd hoped for. It'll be okay, I'll survive, and it won't be the end of the world. To all my good friends still reading this, cheers! Here's to a brighter, better year! 

A Note To Self

Words are cheap; promises even cheaper. Do not make promises you can’t keep, not to others, ever more so not to yourself.

Always be positive. When things don’t happen the way you had hoped, it doesn’t mean you don’t deserve it; it simply means you deserve more.

But that also means you need to pay your dues, work for what you deserve. There’s no free ride in this world, and you’ve got to work for what you want. Be contented, be grateful by all means, but strive to be your better self every single moment.

Be strong, be resilient. Never let the next obstacle stop you from getting where you want to go. If you’re serious about getting there, you will. Anything - given enough time - is possible.

Know what you want. Be curious, be passionate. Choose what you want to excel in. No one can have it all, nor can one do it all. Time is scarcity; time is luxury. Pick your passion, or poison. Stick with it. With enough effort and determination you will be great in it.

Have a plan. But know that it’s okay to change your plans or directions too. No one will fault you for changing your mind as long as you don’t keep doing it just for the sake of doing it, or because you give up too easily. You have a right to choose your path, and it may change over time.

Be kind to everyone, but most of all be kind to yourself. Practice self-compassion. Learn to love yourself, that is the first step to loving anyone else. That means knowing how to take care of your health- physically, mentally and emotionally. Again, you can’t do it all. Do not be greedy. Do not be too harsh on yourself either when you can’t meet all your goals.

Learn to take failures in stride. Every failure that happens is a learning opportunity. It is also a data point, to let you know that it doesn’t work, but that also means you’re one step closer to the thing that does work.

Always read. Read as much as you can. It’s the portal to the world you may never have the chance to see in person. Let it open your mind; learn from others’ experience so you won’t have to make the same mistakes. Expand your mind just as the universe is expanding every moment.

But more than that, write. Write everything that comes to mind, even if it’s silly, or politically incorrect. Sometimes it’s for entertainment, sometimes it helps to keep you sane. It doesn’t have to be shown to the world. Just let it flow, and do this for no one else but yourself. You will learn so much bout yourself and this Earth we call home, and everything in between.

Travel the world, go to places, see the extraordinary things built or created by mankind, talk to people. Learn their culture, learn the good things and bad- the good so you can emulate, the bad so you know not to repeat them. There’s so much out there to learn, see, know. They’re all beautiful in their own way, you just need to find a way to appreciate them.

Do something to contribute to the world, to humanity. Our time in this world is so short it’s probably just a millionth of a millisecond in the entire timeline of the universe. Maybe even less. But that shouldn’t stop us from adding value to humanity. We take so much from the world, the least we could do is give a little back during our however transient lifespan.

Most of all, always remember to be present. Live. Open your eyes, feel your surroundings, use all your senses and really live. Tomorrow is promised to no one; the past is nothing but memories. Live every moment as if it’s your last. Spend not all your time and energy anticipating for the next big break, next whatever, while you trudge through the now and forget to live, because when you get there you’ll find that it’s not enough and there’s always another next thing you want. It’s the classic cat-chasing-its-own-tail picture, because you will keep hoping for the next big thing that will change your life and make you happy, but you will get exhausted before you even get there, and you’ll have spent your time sulking and being unhappy, when you've already got what you need to be happy. Really- focus on the now, and you will find peace and happiness.

Adelaide: The Good Life

As years went by, I find it harder and harder to meet true friends who are willing to work on keeping the friendship going for as long as it can be. Not that there aren't people I can call friends, but most of the time it's usually with strings attached, or they're just not that interested in being true friends. It's understandable- most people at this age would already have their own family or have their own clique of friends; or they just want something from you, or it's just a fleeting encounter that couldn't be solidified into true friendships. And so it makes me value all my old friends even more, especially those you've bonded with since school days. Friends like those are rarer than any gemstone in the world, and I'm ever so thankful that I have more than one of these rare gems.  This is a super-belated post on my trip to Adelaide, my second stop in Aussie. Jun, one of my rare gem friends, who's also the reason why I was in Adelaide, picked me up from the airport. And so began our little weekend adventure!

Because my time there was limited, there's only so much we can see. My intention of this short trip was mainly to catch up with Jun, and then do some sightseeing. I'd say it's a pretty successful trip given that we had so much time to catch up - over meals, while walking the dog to the dog park, the drive to the little quaint German town called Hahndorf, the time spent at Glenelg beach. Come to think of it, this is the longest amount of time we've spent with each other since we graduated from high school! And so, when we weren't busy catching up, eating or drinking hot chocolate (or having ice cream lol), below are some pics we took over the 3 days that I was there. 

At The Loose Caboose where it's a restored railway station-turned-cafe that serves good breakfast/brunch and coffee. 

I don't remember what this is called, but it's delish!


This, I think is called the caboose cakes- potato croquettes with some mayonnaise drizzles and cabbage on top. It's really good too, but I'd prefer it without the mayo.


Somewhere in Hahndorf the German town there were two little cute bears having their tea, oblivious to the world around them. That's just awesome.


It's a beautiful day out- perfect for Birkenstock clogs shopping and fudge-shopping. :P
Had a craving for ice cream there, but managed to suppress it. Win. Yes.


Glenelg beach, which reminded me of my days in Santa Monica, LA.


Capturing sunset.


All smiles, because it's good to be alive and have great friends.


Same time, same place as the pic above, but a different view.


This was the real reason we were all smiles earlier- the anticipation of hot choc and ice cream!
Lol jk. We are grateful for being alive.
And yes I gave in to my cravings after all. No regrets though.


Had dessert before dinner. That's the right way to do it people.


This girl played so beautifully I couldn't resist but sat there the whole time until she's done.
Location- The Malls Balls at Rundle Street.


This is Niño saying bye to me, and vice versa.

It's been three awesome days, time well spent with friend. Looking forward to another trip/hangout like this, whenever that is. Thank you Jun, for being such a great host and friend! xoxo.

Indian Summer

It's what they call the warm days in between the colder fall days. We had a little less than a week of indian summer last week, but now it's over. It was just a wet, wet day today. Even as I type, I can hear the ruffling of tree leaves outside my window, and the splashes on the street every time a car passes by. I wonder how people back home are coping with the awful haze.

It's been close to two weeks since I got here. Things have been great, I'm so grateful for the people who have helped me get here, provided me a place to stay, people who have become family to me, people who are just so generous and kind. There are times when I wonder what I've done to deserve such kindness. Must've done something right in my past life. Makes me want to do as much as I can to give back in return. And that I shall.

More on the rest of the Aussie trip soon, for now it's the bed calling my name. Good night world!