“would you date a doctor?”
“i would date anyone who wants to date me.”
“oh come on shun, don’t be desperate.”
“i’m not desperate…just being honest.”

and i was. just being honest, that is.

i’m not my mother. my mother had 20 guys falling for her at the same time, sending her postcards, flowers, photographs with inscriptions like “let’s be friends!” on them (it was the 50s). they cycled past her house to say hello. they came flaunting their wealth and good looks, hoping she’d be impressed. no one expected her to marry my father, an average-looking guy from a poor family and nothing but diligence and honesty to his name.

my mother had the privilege, or burden, to choose.

i have never had that luxury. i’ve been asked out a grand total of ONE time, danced with two guys (causing grievous injury to their toes in the process), and that’s all.

at one immature point not too long ago, i thought the problem was me – that i’m fat, boring, unfeminine. but even at my thinnest (which wasn’t very thin…i have accepted that i can choose to be healthy but i’ll never be thin), no one asked me out. so that’s that. or perhaps i haven’t tried hard enough. maybe making sandwiches and sending cards, text messages, remembering birthdays and making an effort to meet up with people isn’t enough to get out of the friendzone.

it’s taken awhile, and it’s really cliche, but it’s not sensible, or possible, to be anything but myself. it’s better to be comfortable and have some savings than awkwardly stylish and perpetually making minimum payments on my credit card bill. it’s also better to be happy with who i am, where i am than to think things will be different if i were everything i’m not. i think i put enough thought into the way i look, i’m clear about what i like and what i don’t…

it’d be a lie to add the inevitable, straight out of a self-help book slash episode of the oprah winfrey show slash some women’s rights radio program slash black lady neck hand action gif animation line and say “…so screw whatever everyone else thinks, i don’t care; i am awesome” at the end of the previous paragraph. i’m a human being with feelings, of course i care.

when no one asks me out with the intention of getting to know me better because i do seem awesome to him and he thinks i may be worth his time, and not because he’s desperate or i’m in his “what the hell” category, that little voice (which sometimes appears in the form of my FATHER) comes back and says, “see? you’re not good enough.”

which brings me back to being honest. i’m old enough to be at peace with myself. if no one’s available to watch rafael nadal beat “the greatest of all time” over a girly beer at a bar with me, i’m good with going alone and exchanging friendly words with a bartender named jamie, whom i suspect is from the philippines.

but that doesn’t mean i’m some hardcore feminist who wouldn’t date a doctor, or would only date doctors, or someone who earns more money than me so i can call medicine quits and be a kindergarten teacher, or whatever. it just means i’ve already done whatever i could possibly do. i’m maxed out.

so yeah. i’m maxed out. that’s about it, really.

oh and on a completely unrelated note…happy year of the dragon everyone!

i turned my attention to music. the first song was about a “what if” relationship, an unfulfilled longing and a noble decision to “wait for life”. i did the appropriately emo thing and let my eyes wander out of the window. the diminishing sunlight was just enough for me to make out a pair of vagabonds walking along the tracks. they carried small bags on their shoulders and walking sticks in their hands. yet rather than wonder where they were going, about the epiphanies they must have collected in their sojourn, i thought about trespassing laws and how dangerous their actions were.

i was startled by my lack of imagination and romance. i had just finished reading murakami’s “norwegian wood” – a love story of sorts, chock full of youthful idealism and hedonism that is stereotypical of the 60s. last night i identified with the protagonist’s quiet pain and naive martyrdom, so much so i felt my own heart breaking every time i inhaled. i fell asleep to shallow breaths and woke up this morning embarrassed by my private display of irrational grief.

but barely half a day later, i am devoid of all emotion. i spent the next 2 hours on the train trying in vain to sleep, crossing and uncrossing my legs, feeling every bit as uncomfortable as my neighbour. i tried to let my mind wander again, tried to squeeze a little bit of feeling from the events of the last couple of days – but even my wistful “what ifs” from an encounter over coffee which, at the time, were worthy of a song of their own, were insufficient to stir me. it was a lost cause.

is it an inbuilt mechanism, designed to ensure that i can function at work tomorrow and the days following that? erasing the tracks of my heart and putting my head back in control? it was doomed to be a miserable ride back to reality, but i never anticipated it would be that bad.

is what we’re talking about so sensitive that there is a need to exclude our colleague, our friend? are we so insecure with the english language? or is there a feeling of superiority in being able to shut someone out so easily just by changing our language of choice?

recently, a friend vented her frustration about being around her chinese peers because we switch to our “mother tongue” when we get together. we would be talking about work, movies, an amusing event from the day before – harmless drivel – but it’d make her feel a little victimised all the same. she recounted an incident where two chinese colleagues conversed in mandarin the whole time she was in their presence. it was obvious some exchange of knowledge was going on, but she was blatantly excluded from the conversation.

some may feel she was a tad sensitive, but i thoroughly approve of her walking out when she had enough of that scene. in a profession where apprenticeship plays a significant role, keeping wisdom and insight from one another is a sin. to do it employing a difference in culture borders on racism.

i didn’t choose to be most comfortable with english, and this isn’t a rant about people who are able to communicate better in other languages. perhaps it does make work a little less dreary when use a medium we are best acquainted with.

but there has to be a line, a professional line, when it comes to using different tongues at the work place. a little more courtesy. a well-timed, sincere apology for using your mother tongue in front of someone who doesn’t understand.

many of my colleagues display that kind of professionalism; i wish everyone would.

this article by ken murray has been making its rounds on facebook over the last couple of months. the author has not only very eloquently expressed how i’ve felt about death ever since i knew my grandfather described CPR as the worst pain anyone could be subjected to, but also drawn attention to the fact that so many different factors contribute to how a terminally ill person lives out their last moments on earth.

murray wrote:

“One of my patients was a man named Jack, a 78-year-old who had been ill for years and undergone about 15 major surgical procedures. He explained to me that he never, under any circumstances, wanted to be placed on life support machines again. One Saturday, however, Jack suffered a massive stroke and got admitted to the emergency room unconscious, without his wife. Doctors did everything possible to resuscitate him and put him on life support in the ICU. This was Jack’s worst nightmare. When I arrived at the hospital and took over Jack’s care, I spoke to his wife and to hospital staff, bringing in my office notes with his care preferences. Then I turned off the life support machines and sat with him. He died two hours later.

Even with all his wishes documented, Jack hadn’t died as he’d hoped.”

a couple of weeks ago, i encountered a woman whose heart was so damaged by chemotherapy that it was barely functioning. she underwent surgery for a strangulated hernia, got better for awhile, then deteriorated. after lengthy counseling by both the primary and intensive care teams about her prognosis, her family opted for intubation and intensive care, but not any other forms of active resuscitation. although their intentions were for her to hang on until her father could bid her goodbye, she passed away not long after she was brought into the icu.

part of me was angry that she was subjected to an invasive procedure, an unnecessary transfer and a possibly painful last couple of hours alive. her family’s decision for intubation and ventilation support but nothing else felt…confused. ill-informed.

but another part of me empathised. i wasn’t there when they were counseled on what intensive care meant and how it would (or wouldn’t) affect her outcome. maybe they didn’t understand, or their judgement was clouded by grief.

or, as murray wrote:

“The problem is that they may not know what’s reasonable, nor, in their confusion and sorrow, will they ask about it or hear what a physician may be telling them.”

it seemed like a confused decision because it was exactly that – a confused decision. i can’t even bring myself to think about whether it was right for us to comply in the first place. it gives me much too big a headache.

anyway i’m just going to continue being an open book and put it out right here: should i ever be stricken with a terminal illness for which treatment will only stand to prolong my suffering, i do not want to be subject to any active resuscitation. harvest every part of my body that is fit for donation even if my family refuses to let you. i want the only thing left of me is the memory of the (hopefully) good things i’ve done.

that’s how i want to go. perhaps that is the best way to go.

these days, i have no patience to reflect on every aspect of the past year. too much has already been said about the political climate in this country, the unrest in the world, natural disasters, the medical profession, lady gaga’s latest controversial music video. even this post must feel rather obligatory, something i have to do in order to fulfill my KPI as a blogger.

i’ve already blogged about my year as a junior houseman. i’ve tried my best to be a good daughter and friend. as usual there is absolutely nothing to write about my non-existent love life…

…so i’m gonna do a meme.

1. what did you do in 2011 that you’ve never done before?
stuck a tube between someone’s vocal cords. successfully. multiple times.

2. did you keep your new year’s resolutions?
i don’t do resolutions. but if i did, the answer would most probably be “no”.

3. what countries did you visit?
singapore. that’s it. oh wait…no. yup, singapore.

4. what would you like to have in 2012 that you lacked in 2011?
what i have always lacked – belief in myself.

5. what was your biggest achievement of the year?
i did not kill anyone on the job. at least i think i didn’t. hmm.

6. what was your biggest failure?
not writing a single damned thing.

7. did anyone close to you die?
mei-mei, my faithful canine companion for 14 years, died in  february.

8. what was the best thing you bought?
can i be an annoying hipster and say “my iphone”? but only because i didn’t really buy that much stuff. yeah right.

9. where did most of your money go?
food. oh ipoh you will bankrupt me.

10.  what song will always remind you of 2011?
adele’s  ”someone like you”, only because it’s the titanic song of the year. besides, she’s lying through her teeth in that song. if it really wasn’t over for her, she wouldn’t wish “nothing but the best” for both her ex and his wife.  i mean, come on!

11. what do you wish you’d done more of?
writing. reading. traveling. even more reading. running.

12. what do you wish you’d done less of?
regretting things i didn’t do.

13.  how did you spend christmas?
with the people i love most. i don’t spend enough time with them. we’re running out of time so fast it’s not funny.

14. what was the best book you read?
i didn’t read enough books this year to be able to choose a “best book”. maybe “veronika decides to die” by paolo coelho.

15. what did you want and get?
[ insert annoying hipster answer here ]

16.  what was your favourite movie of the year?
i didn’t watch anything artyfarty so i’d have to say it’s “the adventures of tin-tin”. even “harry potter and the deathly hallows, pt.2″ comes second to it.

17. what did you do on your birthday?
i was on call when i crossed the line into “late 20s”. made up for it at a japanese dinner the next day with some good friends from work. =)

18.  how would you describe your personal fashion concept in 2011?
too little, too late. by the time i find something in that i both like and look good in, it’s out.  i can see why my mother has never changed her style in 40 years – fitted, tailored dresses with a late-60s/early-70s vibe look great on her.

19. what issue stirred you up the most?
don’t get me started. i don’t write essays as well as i used to anymore.

20. tell us a valuable life lesson you learned in 2011.
it’s never too late to achieve your dreams. at 68, my father has everything a man could ever want – a loving wife, successful children, a grandchild, financial independence, fulfilling hobbies, due recognition for his contributions and, just recently, a holiday home. that gives me 40 years to do the same. =)

merry belated christmas and a happy 2012 ahead!

it usually doesn’t take long. even with one failed attempt, passing over to the next person almost always does the trick. there’s no need to oxygenate in between because the preoxygenation would have been sufficient to prevent desaturation. there are preset drills and a flow of action in the event that a patient cannot be intubated.  it’s rehearsed a thousand times.

but when i take the mask off the patient’s face, grab the laryngoscope and shove it down his throat…i feel my heart stop. every second that passes until i pass the tube through his vocal cords and see the vapour rise with his breath is a second that i withhold my own breath from the world.

my peers and superiors alike have questioned me about the tense stance i have whenever i’m at work. i know that every discipline of medicine is frightening in its own way. when a patient walks into the hospital, it’s not always that they walk out.

but somehow standing at the head of a patient who has been electively rendered apnoeic, with his own consent…it makes me feel alot more responsible for his life than i would for someone else who had a cardiopulmonary arrest because he wasn’t compliant to treatment for his disease.

does this bias make sense?

once, i had quiet sorrows, a reservoir of emotions and sentiments that i saved so i could divulge them only to someone i loved. but when that love went unrequited i found myself left with shreds of the remaining secrets i didn’t share…and they broke me.

i don’t have that many private thoughts anymore. my views on the world, my work, life in general…those are made known to everyone who would care to listen, or to read. i know what i like and i indulge in the things that make me happy, bringing with me people who find pleasure in the same things. i read and recommend books that flesh out my life. i answer questions truthfully, bluntly. i empathise, sympathise. if you want to know something about me, i’ll tell you. i’ll write about it.

and why would i prefer to be an open book when being a mystery would fit better into the plot of a romantic comedy in which every woman desires to play the leading part? because those shreds of secrets left unshared were are still an unbearable burden to carry.

i never again want to save parts of my soul for someone who has yet to materialise. i don’t believe in that kind of hope.

being a doctor is very different from studying medicine.

as a student, i had the luxury of hearing out a patient’s complaints, holding their hand, or running from a difficult relative. as a doctor, i am responsible for a patient’s experience in a hospital and achieving his or her desired outcome.

it’s not easy ensuring that a patient gets to go home at the end of the day. it starts in the morning during the first review. the investigations taken the day before must be interpreted and translated into treatment plans to be discussed with the medical officer and specialist. the patient’s current condition must be taken into consideration, with additional examinations and tests to be done based on how they’re feeling today.

surgeries are scheduled with care, all precautions taken so the patient is in optimum condition for the procedure in question, medications served, necessary instruments ready. clear, concise instructions must be given to support staff to ensure everything is in order so that theatre time is well-utilised.

i arrive at the operating theatre before my medical officer, to dilute antibiotics and label them clearly, to put the patient’s details up on the board, to be scrubbed in and ready to assist the surgeon. after the surgery, i should ideally be there to review the patient post-op, to tell them the findings and what to expect. i assure them that the surgeon will tell them more later, that there will be a plan as to how we will proceed from there.

everything done in the morning must be followed up in the afternoon. every investigation result is traced and analysed. important information about patients is passed over to the team on-call doing the night shift. trival tasks are settled before going home.

—

there is so much hoo-ha about housemen, the overcrowding of hospitals, our working hours, the “flexi-shifts”. i, too, have an opinion on every aspect of my life as a doctor.

but when i think about the things that have been mentioned whether verbally or in print…it still boils down to the fact that being a doctor is very different from studying medicine. it’s something many housemen fail to come to grips with and it’s the reason for the criticism we get today.

the last year has helped me understand why my lecturers always stressed more on patient care, work ethic and pride in the profession than on gaining book knowledge or practical skills. they expected us to be in the wards early, to be well-dressed, to take ownership of the patients whose surgeries we observed (“don’t enter the OT unless you see the patient post-op!”).

their aim was to rid us of the “medical student” mentality as soon as possible. while i sulked about it as an undergraduate, i am immensely grateful for it today.

the first year of the rest of my life has gone by so quickly. i am bruised and battered but i am better for it. it’s exciting to know i am still moving on.

she neither slit her wrists nor ingested a lethal dose of medication. in fact, she was enthusiastic about life, despite sustaining burns on her face and hands, injuries which deferred her chemotherapy and delayed her treatment. she recovered from the burns, underwent surgery to restored her skin to its former glory, and she went through it all with a smile on her face.

until she was told that she was dying.

i’m sure that everyone diagnosed with a terminal illness knows that one day, the disease will take their life. it’s an unspoken truth that holds great power in being verbalised, made organic only by words.

i felt it during the few minutes between the time she stopped breathing and the time i declared her dead. before i looked her son in his eyes and told him his mother had gone, everyone in the room held onto the slim possibility that she could wake up if she wanted to, that her flawless skin wasn’t a shade of grey, that her death was merely an illusion.

“i’m sorry, but she is dead.”

…and a floodgate of tears and broken prayers came crashing into the void left by her last breath as it floated from her body.

one year of housemanship and i still feel my heart break when someone dies, especially when it’s out of defeat. it’s a reminder that medicine is more than drugs and vital signs, it has alot to do with optimism and hope.

at least i know oncology is not the field for me.