Wednesday, September 7, 2016

27

So I turn 27 today.

I've probably mentioned before that I'm not one to fuss about birthdays, least of all my own. My life is one big anti-climax.

When I was in primary school, birthday parties were all the rage, especially at the local McDonalds or Sugar Bun. You'd invite a few friends, have a cake and forbidden stuff like coke and fries, play games like pass-the-parcel and musical chairs. There would be little party packs of sweets and treats.

When I was 8 or 9 I had that wish granted. One of the things I distinctly remember is my parents preparing the party packs. My dad had gone out to buy an opaque shiny wrapping paper, whereas transparent patterned plastic wraps were the norm. I pointed it out and my mum chided my dad, who brushed it off. When you're 9 your parents are all-knowing, all-powerful beings who can Never Be Wrong, so it struck me as a little odd.

Then you grow up and realize your parents, who weren't that much older than I am now, were probably still struggling and trying to sort this thing called 'life' out, only with young kids in tow.

I've met a few female doctors who have had to take time off to have kids, from a year to five years. It's a bigger effort get back into the swing of work. They forget things like dosages. They struggle to pass exams. They've sacrificed so much for the sake of a family. I'm sure they are far more fulfilled than I am.

I've yet to face any major adversity in life, or make any truly big sacrifices, or enter the milestone of home ownership and marriage. Thus I still feel like I haven't really grown up. I'm still waiting for that catastrophic life event to embitter me and define my adulthood. Right now I'm just a teenager masquerading as a grown up (with a paycheck to boot).

Not pictured: boiled egg

I made mee sua for brunch, as is the foochow custom. My mother would make it, and I would eat it with an egg dipped in soy sauce while she monologue about how 'good' a baby I was. My older brother was a bot catastrophic when it was a kid, so it made me look like an angel. Now it seems I'm the late bloomer.



February 1997. I was 8, and on a family holiday to Australia. I climbed this very slope on this very park. 'Look, I can climb!' ohgodmyinnocencebringitback


The rest of the day saw me take an impromptu trip to the Tambourine Mountains with my brother, and have free ramen for dinner, finished with fancy Korean ice kacang. (And I wonder why I can't shake off the 3kgs I've put on since starting work)

I don't even think Hatakaya is good - it's extremely overrated. But I do not say no to free food



 I have been working as a PHO (aka 'registrar') for 3 weeks now. I still feel like that bastard Snow.
I thought I'd have had stuff figured out by now. Guess what.

(I ain't)
Most accurate and relevant picture 


 And so the drudgery of life continues.

Saturday, July 9, 2016

A passive observer of human behaviour

For fucks sake. This comparing shit has got to stop, Faye.

Remember, all you see is the tip of the iceberg. But if you have to tell yourself that, you are failing at not comparing.

What is our purpose in life? To work and pay a mortgage (which comes from French death pledge) for 30 years of our prime?

The average working life and path is oft shunned by the hipster types who make a living being a 'digital nomad', whatever that means. But what if I just want to own a home and the only way to do that is by secure employment for 30 years? What if I just want to settle down? It's enough if I don't hate that job most of the time. I really have low expectations.

I've had a taste of the whole travel-when-you're-young thing. It was alright. But not something I would trade for stability. As a tourist (or 'traveller' for the snobs), you never really experience what living there is like. The only way you get to truly know what a local lives like is to work for a living there. Just participating in a meal or festival it not 'experiencing the local life'. It is as phony as all those insecure Instagrammers inwardly longing for likes.

'There's more to life than this'...is a phrase uttered by jaded humans fazed and tired of the mundane and the repetitious. I believe everyone will feel like that at some stage no matter your career path. You just have to plough through the tough times because nothing great ever came easy (and conversely, easy things are not great). Those that manifest that saying by transiently changing their behaviour are said to be in a 'mid life crisis'.


I am happy with where I am at the moment. But society dictates that I should be feeling empty, lonely, starting to feel the slightest bit desperate and looking up cats for adoption online.

I wonder if there are lifeforms out there of superior intelligence out there doing anthropological observations on humans, a la Animal Planet. I can just imaging a David Attenborough style narrator going 'now observe how the maturing female of the species is confused by her lack of normal integration into their society....and how she takes to 'internet blogging' for 'emotional release' believing she is not erroneous in her judgement.' and the wide eyed (or whatever their sensing organs are) aliens oggling at screens.

I honestly wish I was a smarter person. But I barely know myself or what I want in this life. Many people thus then turn to things like religion but I have a sneaking suspicion religion is for the insecure. I read a joke somewhere saying 'as people grow older they get more religious ....it's just cramming for finals.'

I have bouts of insecurities myself - of course I do, as one can tell from what I blog. A fat woman who constantly tells herself she is comfortable with her body - how sure of herself do you think she is? I need not say more about the stereotype of men with big cars. And yet here I am blogging about how content I am with life, as though I mean it.

I should have done psychology *dry laugh*



Thursday, June 30, 2016

More flight of ideas

When I was in Primary One, our teacher told the class that when we reached Primary Six, we would be expected to write things as they were being spoken. She was referring to dictation, which is a fairly easy task to any literate person today. But as seven year olds barely learning how to write, this was unthinkably difficult and undoable. I was petrified, and spent a few sleepless nights mulling over this inevitable calamity.

I don't remember a great deal of things in my first decade of life, but somehow I remember that.

I currently cannot imagine being a Consultant one day, or the boss of anything for that matter. I'm deathly afraid of becoming a registrar in the near future. I can't.  できないだけど。I can't even get used to having a 後輩kouhai. (the intern). I feel like I should be leading in some way or other, but me? Insignificant, nothing, me, lead a confident, clever doctor only two years my junior? Perish the though.

Maybe it's the same as seven year old me desperately wishing Primary Six will not come, because I'll never be able to perform d-dict-dictation well enough to not have other people judge me badly.


How much of my present thinking is merely conditioning from my chinese school days? I wonder. (and the self psycho-analyzing continues)


They say you're never ready. You're never ready to make the drastic career change, never ready to get married, never ready to invest your money, never ready to do all those things you wanted to do because reasons. You just do it anyway. My head knows it, but like many average people I cannot action it and hence continue being average.


I've decided to go down the physician pathway for now. Because I cannot tolerate the cold (so nothing involving theatres including surgery and anaesthetics), don't like psych/derm, and don't think I'll fit into Emergency, which requires leatherhide skin. Physicians are typically a bit more 優しいwhich is what I think a softie like me needs. Someone to hold my hand and tell me I'm doing ok. (Plus you're not condemmed to 10 years of ulu-ness, which is a shame because I would've considered GP as well)


I studied medicine because I was conditioned to think it was what I would be good at it. 'Conditioned' is a funny word to use, but it is a strong one. I indicates I had the illusion of choice and free will, but it was just that - an illusion. It implies I may be blaming others for the decisions I made, which is not my aim. I never really thought I would be good at anything else (from the pool of specially Asian society -approved careers, at least) anyway. But for 17 year old me, it was a decision that never failed to meet with approval, and approval is something I did (and do) so crave for.

I don't regret studying medicine per se. I just wish, sometimes, that there was something in life I could love with uttermost conviction then make a career out of it. If someone asked how medicine was, my reply would be a lukewarm 'it's not bad' and not a fiery 'I love it!' But I do feel this concept of a passion-turned-career is as non-existent as the perfect partner or the unicorn that shits rainbows. It's a dynamic progression of ups and downs.

And I do think the medical fraternity is great. I am no salesperson and I flinch at the thought of having to find my own customers. Doctors by and large are held by a strong code of ethics and (most of us) are not out to make money out of patients. As someone who grew up in Malaysia and trained in the UK, both countries with free-for-all public health systems, I strongly believe that the option for free government-funded healthcare should be obligatory and a basic right for all. There's plenty of room for flaws there but that's a separate post in itself.

What I do not like about doctors is the way they knock other specialties about, especially the way inpatient specialties piss on generalist specialties like. GP and Emergency. The impatience, the eye-rolling at 'shit GP referrals' (yeah well the GP has to deal with far more shit than you and probably filters more shit from reaching our outpatient clinics - than you could ever know), the complaints that A&E cultures grew coag neg Staph and the fracture was not reduced with procedural sedation or the ascitic sample was sent in a universal container and not an EDTA tube and clotted (so you can't do a cell count to exclude SBP - what a bunch of idiots!)

Sometimes I wonder why do doctors do these things. Talk bad about each other. Or condescendingly question their clinical decisions.

And then there's feeling, or lack of. I see patients who are sick and/or dying, whose illness have impacted their lives and that of their families in a way that healthy me could not even begin to comprehend. Confession: I don't feel anything for them. Not sadness, not sympathy, much less empathy. They're just another job, another patient to see on the round, another set of bloods to chase and another potential crash call.

I used to think it was just a coping mechanism, that I would deliberately prevent myself from feeling to prevent emotional burnout and all that. But it's not a deliberate effort. I am unfeeling without even trying. This troubles me because then people can judge me and say I shouldn't be a doctor. So like the average person I avoid facts that make me uncomfortable and never speak of it.

I'm only writing now because random people on Quora say it's good to write something everyday. I've always appreciated that writing's a great outlet but like exercise, the hard part is starting.

One day I'll look back at these posts and think how changed or unchanged I've become. Probs the latter.

(inb4 fuck med reg-ing , worse job evar)

Tuesday, June 14, 2016

Open ended questions are bullshit, cause patients be cray

I can't help but to stare at her lipstick. It's a bright red, almost orange. I catch a whiff of her perfume.

'Doctor, I always wake up wanting to go to the toilet to pee. Sometimes at night I cannot go. I sit on the toilet for hours but cannot pee. You know doctor, sometimes I sit on the toilet so long at night I fall asleep on it. I almost fall on the floor.' She says in a single breath, in a slight European accent.

It is 2.10pm in general gastroenterology clinic. Not urology clinic.

I sigh inwardly for the 4th time. I'd read her chart. PMH IBS, fibromyalgia, depression/anxiety, chronic pain, multiple drug allergies. I suddenly understand why residents were meant to do this clinic.

The GP has written a one-sentence referral asking us to scope her. Something about a polyp years ago. Change in bowel habits. No reports, no histology. She used to shit everyday. Now she shits twice a week.

Tried any laxatives?

No.

Ok.

I sit as she monologues about her bladder issues, her complicated knee operation, her gynae cyst, her mother's arthritis, her pain control meds. And something or two about unquantifiable abdo symptoms.

I feel her tummy, listen to her chest, look into her mouth. I tell her I'll check with the boss but I don't think she needs a scope. Boss agrees. We spend twenty minutes trying to explain why. As she gets up to leave she seems genuinely grateful, but as I'm writing up my notes comes into the clinic room again and asks if she can take NSAIDs for her diverticulitis.

(I'm like GTFO)

*

The next patient is a 60 year old who lives with his 80 year old parents, who takes only a liquid diet of kombucha and 'herbal remedies' for his 'bunged up gut' due to a dental procedure gone awry in the 90s. He refuses to sit down. He says it's because of his ear infection.

I ask why he can't sit because of that. I ask what happens when he eats solid food. I ask why he thinks his teeth fillings caused his malabsorption. I try to pry out his GI symptoms. It's like squeezing water from a rock.

He answers my questions with a gruff, impatient air, almost reminiscent of my older brother when he goes on a tirade about 'why people shouldn't exist'. He literally facepalms 50% of the time in front of me.

He demands a capsule endoscopy. I wonder why doesn't he go to his herbalist and demand for stronger detox grass stems instead.

*

I finish clinic over 2 hours later and head back to the ward, where boss rounds are starting. Our 20-something jaundiced patient with ascites is reluctant to get inpatient alcohol rehab. Another young patient was just admitted with decompensated alcoholic liver disease. A lovely 86 year old lady waits for a repeat ERCP and hopefully stenting for Something Nasty In Her Biliary Tree. She looks young for her age, if not for the fact that she is the yellowest person in the whole hospital.

*

Sometimes gastro is quite literally and figuratively shit. Sometimes it isn't too bad.

We'll see.

Thursday, June 2, 2016

Monday, May 9, 2016

懐かしい

Is it possible to miss something so much it hurts?

The answer seems to be yes.

I miss my old life, my old self, the old days where we were just a simple Kuching family living under one roof.

Children can be despicable. You can love them unconditionally, raise them with care, spend a ton of money of them, yet they'll still turn around and hurt you where and when it hurts most. The traditional Asian retirement insurance plan is having kids, but it's really a terrible investment.

The hollow feeling I have in my heart now is my punishment.





Also, Tinder is a fucking waste of time. 

Tuesday, May 3, 2016

Lingual







One day, I shall be in possession of such wisdom. Alas! That day is not today. Thus I continue my befuddled existence; a firm believer in meritocracy, yet that being the source of my discontent, for I know I will never achieve what my consciousness desires.

Read more, create more.
Succumb less, consume less.

Thursday, April 14, 2016

An analysis of behaviour

I am afraid to make mistakes. I am afraid to fail.

I am afraid to show my ignorance.

These things bring shame. I need to avoid it.

I lack knowledge, and just that something that makes one tie theory with clinical reality. I'd know about some physiology or pathology fact, but just can't link it to the patient or case in front of me until someone points it out specifically.

I can rote learn (hence tend to pass exams) but just can't seem to remember things beyond the exam.

My young appearance and meek disposition and lack of confidence means I still, after graduating and working for over 3 years, get mistaken for the intern/medical student.

The thought of teaching junior colleague or students terrifies me. What if they already know everything? What if they ask something I don't know and look like a fool?

I have no interest in socializing with colleagues outside of work, believing that our interests are to dissimiliar for me to actually enjoy it.

Chinese primary school was a double edged sword after all. Memories of being absolutely terrified of forgetting to bring books or homework (you get canned), doing badly in a test (you get ridiculed in front of the class), attracting unwanted attention from the teacher (who was feared more than loved) shape my personality today.

When I was a kid, it was easy. All you had to do was be 乖 [guai], be good at memorizing, don't cause trouble. As a health professional in the western world, the value of 乖 is almost nothing. The problem is 乖 is the only real thing I'm good at (despite trying to be somewhat rebellious during some teen years).

My bosses don't want a 乖 doctor. They want someone who can think for themselves, reason and debate and justify, rather than just follow what the superior/senpai says. Being 乖 is a fast track to getting nowhere in this career.

There are good and bad with eastern and western culture. I just can't seem to shake off the perceived 'undesireble' aspects of eastern culture that have been somehow much more ingrained in me that other chinese ed people (despite my 'banana-ness' back home)

I've been told time and again since university in the UK, that I'm a bit conserved and shy and need to speak out more, be more confident etc. In Malaysia/IMU I was on club committees and organized things and designed posters and participated in sports and almost single handedly put our yearbook together. What happened to all that?

I just went from being big fish in small pond, to small fish in big pond. That somehow affected my confidence greatly.

Now what do I do?

Tuesday, February 16, 2016

spinnbarkeit

And so the love-hate affair with emergency medicine works. The hours suck, half your patients are crazy or frail, you play ball in specialty/referral centre tennis, and on top of that there's annoying paperwork and admin. I now need anti histamines to fall asleep because my body clock is completely wrecked from the 3 years of shift work I've been doing. For every sensible patient with proper pathology there are 10 rubbish cases waiting. Sometimes though, sometimes, the moment you diagnose the STEMI or stroke or meningitis or whatever - maybe makes it worth it.

I also have to thank ED experience for teaching me the ways of the real world. I was always in a sheltered bubble growing up in Kuching, surrounded by straight-A university-going peers from stable christian families and by default I tend to think the best of people until proven otherwise. ED doctors think the opposite and can smell bullshit from a million miles away. I'm slowly picking up that skill and I think it'll serve me well in life, if I don't get too jaded too soon.

(I also did a very clean looking spinal tap! Must remember to check if there were RBCs or I'm owed a bottle of champagne or something. )

However I do realize I'm way behind my peers in Malaysia. By my stage any decent doctor would have done a laparoscopic procedure, a Caesarian, an intubation, a chest drain and seen far more trauma than I do in safe little Australia.

(You also know you're getting Australianized when you call it ED instead of A&E)

Back to the title - I used to never think much of it, but now every month I think - whelp, that's another one gone. And then I contemplate my own mortality. Funny how aging changes your thinking.

Sunday, February 7, 2016

dong dong qiang


虽然已经说过了,【明年尽量要回乡拜年】 今年并尊重不了这希望。 还在拼命的在这红毛人国家打工。 可不可说有些后悔呀。 看着朋友们的 newsfeed  充满团圆饭,回乡,和亲人一起度过美好时间的照片,心里有点寂寞。自己父母亲呢都去外国旅行了, 兄弟们都也没特别计划。 就过着普通的一个星期日傍晚。

明年一定会,一定会计划好好来。

Since leaving home - I'd celebrated CNY at home when I was in KL/IMU because we had provisions for such festive seasons of course. When I went to the UK, as a student I barely came home but there was a close knit enough group of Malaysians of all races there and we would go out for dinner at a Chinese restaurant of something.

CNY2011 - first year in a white man's land. Dinner with the Malaysian Society then another one with the IMU seniors. Those were good times.





CNY 2012 - smaller scale dinner at a steamboat place - I remember harrying about finding a 'halal' steamboat place because we wanted to included our Malay friends.



CNY 2013 - was exam season but we put together a chap goh meh do with the juniors (because le gasp we were now the 'seniors'!) It was also a time of extreme relief as we were just past med school finals (pre results tho)





CNY 2014 - first CNY of my working life. I was a gen surg FY1 in Aberdeen Royal Infirmary. I'd also worked shitloads of nights before and after, and worked Christmas so I could get time off to come back to Kuching.








CNY 2015 - first year in Australia. I was working on the day the IMUians had planned a CNY dinner so had to make do with making my own, and had beg my brother to invite whatever friends he had over so I could have some semblance of atmosphere.





To be fair I did go to a CNY dinner last Sunday with some very new church friends, so yay I suppose. But it looks like I may have to go without a CNY folder this year.

Hmm I wonder if I have chap goh mei off.

Anyhows, happy chinese new year to you reader anons.



Friday, January 15, 2016

;_;

Been a while since I've had the snuffles. Called in sick. Don't think I've done that before.


Have some moe Snape enka. 

Good night sweet prince

Thursday, December 31, 2015

Again

I suppose of one of the foolish things I do every year is have an expectation that the moment a year turns over the to the next year will be something special, as though I'd feel some warm fuzzy feeling or sudden burst of joy and optimism. I don't have this expectation with birthdays though. New years are always anti climatic. Always.

So here I am, post seven 12-hour nights -over-Christmas, rather sleep deprived from he nature of the shift more than anything else, thinking of what to type and say. Truth is although I rarely post anymore, I always have a swirl of thoughts in my head that I'd like to pen down, for the unexpected reader to stumble upon one day. I've never been a diary-ist, if there were ever such a word, so these thoughts go unrecorded, to remain fleeting moments of my conciousness, perhaps one day to disappear altogether like the wisps of smoke dissipating from a birthday candle.

I feel bad about this, because somehow I have this feeling that it's maybe a teeny little bit important to record down the person I am today, so my future self can perhaps look back and reflect. Maybe I'll try harder this year.

It's been a year since I settled in Queensland. It's been alright I guess. Not mind-blowingly fantasic or awfully bad. Just alright. Work's work. I got all the sign offs I need for general registration except the last one due soon. After that it's career path bla bla bla.

The number of social media friends getting engaged/married has just exploded exponentially this year. It's as though someone turned on a switch. Everyone gets to that stage I suppose. Meanwhile I'm just doing what I do best - waiting.

To be honest I did kind of expect things to pick up after coming to Australia, which was my aim for so long. Now I'm here things haven't really moved at all, (though it's my own fault for being a homey stick in the mud) sometimes I think I'm sort of in a rut.

The New Year is supposed to be for resolutions but 所谓:江山易改,本性难移。If one could innately stick to their diets and budgets, one would do so at anytime, not just at the start of the year, which is just an excuse. Hence why I never really believed in new year resolutions.

Maybe my eyes just can't see the opportunities in front of me, but at the moment all I can see ahead of me is relatively short sighted. I'm still running away from the future because I don't know what I want and what I'll be and it scares me. If you ask me, I think I peaked about 10 years too early. Even at my heyday I never gave much thought to the future because someone I always took it for granted that by the time I reached the bridge I'd have a plan to cross it. Choices are only of value to those who know what they want to achieve.

Anyway, have a good year ahead, whoever you are.


Saturday, October 31, 2015

Kita!

Because all you 5 readers of this blog are still here, you get first peek.

http://tokyodeshou.blogspot.com/

Enjoy >:3

Saturday, September 19, 2015

Today was a rough day.



It was one of those days in A&E where there were nearly as many patients in the corridors as they were patients in cubicles, where the list of waiting to be seen patients was long and never ending, where worktops started to get really messy, where colleague fuses tend to run short.

I think I have a sort of love-hate opinion about A&E (not shaking off the UK terminology not sorry). I love the range and variety of presentations and how I get to do a bit of everything. I've done speculums and slit lamps and sutured and plastered and jabbed more kiddies throats with fake ice creams sticks than I've ever done before. It's great. I love the generalist-ness of it all.

The hate part comes not just from the crazies that come but from colleagues whose fuses are short probably in part when the workload gets harder. Then there's the colleagues whom I just barely manage to get along with at work. Me being the ok-with-anyone type personality can usually get along with most people. Perhaps that's what they can't stand about me. That I'm too wishy washy and don't stand for anything. In loud and proud Australia, being overly humble and meek and pandering is not a prized attribute. Nothing gets me down more than the disdain of a senior colleague and this can spiral badly.


A colleague snapped at me in front of some patients. I'd already had a less than stellar run with doing a backslab wrong and wasn't feeling too great. Another colleague comforted me in an amazing way by just letting me get off the floor for a few minutes to get some air and have a good cry. It's times like this when I wonder why can't I be this kind and compassionate to others.

Sometimes I wonder if I'm truly cut out to be a doctor, emotionally. I feel like I don't have empathy, especially with psych(o) patients. There are too many examples when I have thought dully to myself it would be better if they didn't exist. Everytime a registrar is caught up in resus with some repeat teenage overdose, or the multiple presentations alcoholic who uses his benefits money to buy more booze, the homeless druggies who end up intubated on a $4000 a night ICU bed-  I catch myself thinking why do we try so hard to save these people who are trying to kill themselves? Why can't we just let them be?

Is it wrong for me to think this way? Probably.

And then sometimes, someone just shows me so much compassion I wonder what I would have done without it. My heart overflowed with gratitude at his kindness but the only and best way I knew to repay it was to pay it forward.

But also, in times of stress and hardship, will I be like the colleague who snapped or the colleague who comforted? It is much easier to be nice when you are not under duress.

God grant me love and compassion in difficult times, towards people that are hard to love.