on my way home

I have moved

Sun, 01 Nov 2009 10:36:29 GMT

-- I have moved!!! --

blog.tablecolorworks.com

See you there! Make sure you say hi.

Update your bookmarks! Goodbye, Livejournal.

Leaving

Tue, 11 Aug 2009 08:56:07 GMT

I am leaving this livejournal.

And in real life, I am at the stage of preparing, too,
to move away again from where I was, and away from where I am.
After all these years, I still must move.

But I will be transferring this blog somewhere else -
I'll update with the details here when I have things set up.

Take care, everyone; and thank you if you're still reading.

Medical speak

Sun, 26 Jul 2009 09:36:44 GMT

Medical speak is fun.

"Nil evidence of sinister pathology" sounds more professional than "there is no need to worry",
"Domiciliary acopia" sounds more intelligent than "not coping at home",
"Intravascularly replete" sounds more diagnostic than "not dehydrated",
"Circumlocutory historian" sounds better than "I wish he could just get straight to the point",
and "Diagnosis not otherwise specified" really means "I have not much idea what's going on".

It is also interesting how different terms come together to form a completely different language. When reading the pathology report for a patient with suspected bullous pemphigoid:

There is a superficial perivascular lymphocytic infiltrate and a marked interstitial infiltrate of eosinophils within the papillary dermis, associated with overlying epidermal focal spongiosis ... Included in the differential diagnosis is hypereosinophilia syndrome, drug reactions and possible arthropod assaults.

I seriously laughed out at "arthropod assaults". It does indeed sound cooler than "check if the patient's infested with lice".

But it's not that funny anymore after looking at some pictures of arthropods.

How am I able to be a front-line doctor?

Sat, 04 Jul 2009 07:26:32 GMT

It is strange to see young guys and girls in the hospital - but I saw a couple of them in a row on a Monday night while working in the Emergency Department. They had all come in suffering from terrible cold/flu symptoms in this rainy winter and swine flu scare.

Those poor souls all looked absolutely miserable, I have to say, but they had nothing to warrant admission into hospital. So I said sorry and sent them home.

I remember thinking to myself as I walked out of the ED consult rooms - that I better not get sick after being in close contact with them!

And who would have guessed, the next morning during the post-acute ward round, I sensed an itchy throat creeping up. That very night and the following two days, my nose was running like a tap, my eyes were watering like a poor lemon being repeatedly squished, and I was madly sneezing in spasms every couple of minutes. I was practically bed-bound in a dark room, constantly feeling like tearing my sinuses out. I haven't had a cold/flu as bad as this for years!

Oh boy, how am I able to be a front-line doctor, if seeing a few infectious patients knocks me down completely for a few days and renders me weak like a kitten for a few days more?

I am at least glad I am recovering, by God's grace. Strangely I now feel like a special survivor.

It is wonderful, too, to be able to walk around comfortably without being sick.

Visiting Adelaide and Melbourne

Sun, 21 Jun 2009 11:18:55 GMT

Just back from a trip to Adelaide and Melbourne. Had a great time!
But I am now seriously shopping-mall-phobic.

I find it hard to believe too that I actually have friends whom I haven't met for 10 years -- that's gotta mean something about the stages of life we're entering!

GPO, Melbourne.

Melbourne's nightlife and the Yarra River.

Melbourne Central.

Something to explore at every corner of Melbourne's CBD!

Matsuri Restaurant, Adelaide.

The attack of the Mushroom Man!

Southern Cross Station, Melbourne.

--

Promises of satisfaction

Fri, 05 Jun 2009 09:44:28 GMT

Have you ever looked around and realized that the world is just replete with promises of satisfaction? Think about it!

Blockbuster movies, parties with friends, breakaway shopping sprees, travel trips, hunting for music, chasing good books, enjoying food, and all the colorful product advertisements everywhere - do they not all target at our search for satisfaction? And the world is just full of such promises of satisfaction - that it is blinding.

Many of them are short-lived. Some of them are lies. We all know. Yet it is easy to get lost, and in the process, all we end up thinking and speaking of is about ourselves. All of this is like "a chasing after the wind", as the book of Ecclesiastes aptly puts it.

There is much more to say, but I'll stop. It actually takes some effort to think about this in the context of our personal lives (yours and mine)! But tell me what you think.

Lost in life

Wed, 20 May 2009 11:39:34 GMT

Ramble: There were going to be two characters, but it was too much work for my schedule, so I had to scratch off the other one (-_-). I know the signs don't make much geographical sense. If she's not fashion-savvy enough, it's totally my fault.

---

Here's the non-colored version (which I think may actually even be better! urgh):

Whitewater rafting on the Nile River

Mon, 11 May 2009 06:51:47 GMT

( In continuation from the events described here... )

At the Nile River Explorers (NRE) Base Camp, a cliff above the mighty Nile River, 8kms downstream from the Bujagali falls, Jinja, Uganda:

It was almost dusk when we arrived, with exhilaration. Several small low buildings sprawled lazily across the yellow red compound, with some vehicles parked casually amongst them. We trekked to explore the surrounding area by foot before sunset, with a companion dog joining us halfway. The unceasing river streams drummed along steadily in the background, we could all hear.

This dog joined us halfway.

The roars of the river could be heard from far away.

Sue had chosen NRE over the competing company Adrift for the reason that Adrift’s campsite, according to Louise while we were in Kisiizi, had no mosquito nets. Then that night we realized NRE didn’t provide mosquito nets either! Lying on our beds, none of us dared to ask why nobody actually thought of this beforehand.

We decided to load ourselves with layers of insect repellant before going to bed, despite being told it wasn’t necessary. The night was, unsurprisingly, a sticky and smelly one, but a period of heavy downpour helped lullaby us.

* * * *

Early the next morning, we did a quick breakfast in downtown Jinja while our guide Alice, an Australian lady with an impressive tan and swimmer’s body, briefed us on the rafting over Grade 5 rapids that was about to happen. In all the build-up of nervousness however, we weren’t exactly listening. I did nonetheless consciously check to make sure my shorts were tied tight enough.

Onto the open back of our truck we hopped, bumping up and down on the dirt roads, in the subtle winds and under the sunny skies, as we traveled toward the drop-off site. Tiny villages of mud huts passed by around us. Some of the locals waved. It was truly exquisite – and felt just like an authentic “Lonely Planet” experience!

Soon we were standing – barefoot but equipped with helmets, full-buoyancy life-jackets and obsessively-applied layers upon layers of sunscreen – to challenge the Nile River now only a few steps in front of us. Its whitewater waves roared to snicker at us back, and we trembled a little.

Since back in Kisiizi a few weeks ago when I first decided to do whitewater rafting in Jinja, I had come to note “I thought I was going to die” as a recurring theme in the opinions even of experienced swimmers and adventure tourists who had been here before. Louise’s “When you get thrown into the water, curl up and try to relax. You’ll float up soon – but when you do, take a deep breath immediately, because you’ll probably be pushed back into the water again for a good while” ridiculously made me both want and not want to do it. And add to the fact that I was the worst-ever swimmer (more like a total non-swimmer in the context of the Nile River) – I began henceforth conversing consistently in conditional tense – “…if I come back alive from this trip!”

In fact, even after so long, I still shiver a tiny little at the recollection, but I was really fortunate to have done the trip together with a group of very supportive friends. The entire experience was amazing.

In the first few hundred metres of still-water, we had a quick lesson on how time becomes distorted underwater, how to hold the oar for either power or speed, how to respond when the guide shouts certain important commands, how to handle ourselves when we get thrown into the water, how to rescue others, et cetra. We had a practice swim and a practice flip, swallowing more than a few mouthfuls of water in the process, which, when compared to the actual journey, was nothing!

The real journey started. The Grade 5 rapids could always be heard loud and clear well before they were seen – their signature rumbles that grew from growls into thunders as we floated closer were always intimidating and ominous. It was something to be experienced.

Entering a rapid, it was like a warzone; the deafening roars, sudden unpredictable jerks of our raft, and maddening splashes of water from everywhere supersaturated each elastic moment. Amongst the chaos, nonetheless, was the need to maintain coordinated teamwork. Being flung into the water thankfully didn’t freak me out as much as I feared – I counted the seconds aloud in my mind in trying to be objectively aware of the passing of time. Rescuing people halfway through a rapid, and then quickly embracing for another possible imminent flip was fun too.

Before we knew it, we had already successfully traversed a few of the rapids – and were enjoying each moment! We also had a light lunch of fruits bathed in the waters of the Nile, on the raft, on the river. Watching birds land on the river while biting on a piece of freshly cut pineapple, it was totally like some exotic cuisine trip!

Taking a rest.

And it was mid-afternoon when we broke through our last and final rapid with a shout of accomplishment (and tiredness). Secretly, however, I wished that we had flipped a little more!

We climbed back onto land – scorching red soil it was under the high sun – trekking some uphill distance with whatever stamina we had left, barefooted on toasty stones and huge oars on our shoulders. We must be like ninja-trainees of the Zubichu clan or some wannabe-firewalkers in a Thimithi festival. When we finally got to somewhere with grass about ten minutes later, three out of the four of us had developed blisters under our foot!

Under the shade of some trees we had a proper lunch meal – a very nice barbeque (barbequed, to be precise) – before we hopped back onto our truck and proceeded to return to the NRE Base Camp.

There, on the open back of the truck together with various adventurers of all nationalities, a chilled bottle of soda each in our hands, I felt the effects of adrenaline now trickling away little by little – and it was sweet. My whole body slumped, but it was all right. I had just rafted the Grade 5 rapids of the Nile River, and I was still alive.

That same evening we bid the NRE camp and Jinja goodbye, and headed back to Kampala in a matatu – spacious for just the four of us, and cool in the setting sun. For a big portion of the three-hour journey, there was just silence amongst us, but that spoke more than words in the aftermath of all the excitement. We were tired, but not asleep – perhaps just mesmerized, rather. Riding and riding quietly on the highway into the orange horizon ahead of us, it felt so, so calm… So soothing, that it felt as though it would last on forever.

But reaching Kampala, we got reluctantly stuck in the city’s unbelievable nighttime traffic congestion for hours! Surrounded by queues of vehicles in a non-moving road, some locals even came to beg for money at our car windows!

It was a looong wait in the traffic jam.

* * * *

After what seemed forever, we finally arrived back at the lively Kampala Backpackers. There we were allocated a four-bed room called the “Nature’s Dorm” just to ourselves (I was starting to really think four is a good number to travel in). The room had a literally open window – without glass, curtains or blinds. Sue told us the last time she had an open-windowed room in India, monkeys raided her belongings. Thankfully the monkeys in Kampala Backpackers were better trained!

That night it poured down again heavily. Through the open window we had a gentle taste of the wind and rain, leaves and branches rattling busily in the background. It was a sound sleep in the storm, under the mosquito nets hugging our beds.

I caught the Nyakishenyi coach the next morning and left back for Kisiizi. Sue, Sally and Owen continued with the next part of their trip to Queen Elizabeth National Park.

And this time, I arrived in Kisiizi before dark!

* * * *

Epilogue:
It was a tired Sunday the next morning. I had just returned from a crazy trip to Kampala and Jinja the night before, and was still enjoying my sleep when Michael knocked on my bedroom door. Michael had stayed behind in Kisiizi to study for his upcoming medical finals which would happen just after his electives.

“Joseph, time to get up for chapel service!”

I fumbled to check my watch. “But it’s only 7am!” I mumbled semi-consciously.

“No it’s not. Daylight saving starts today, so it’s actually 8 o’clock!” Michael happily replied over my locked door.

“…What? Are you sure?”

“I am. Hey Gauda,” Michael turned his voice to our maid, who must had walked by, “It’s daylight saving today right?” After a pause of no clear answer, he continued, “Today, the time is one hour earlier, right?”

“Yes,” Gauda finally replied, half-convincingly.

“See? I’m going to the chapel now – I’ll see you there!”

So I laid in bed for a minute more, confused. I was aware that daylight saving was starting in the UK around that time, but daylight saving in an equatorial country like Africa? I remember even consciously asking myself if it was April Fool’s day! But it wasn’t, I was sure.

I climbed out of bed, got changed, brushed my teeth and walked to the chapel half-sleep. My body was aching from the whitewater rafting just the day before.

On the way there however, I saw Michael walking back, smiling.

“Sorry, my bad, there’s no daylight saving here!” He laughed, and walked back to the Guest House ahead of me.

Standing there alone, I gave a laugh at myself too. Michael meant well, though.

* * * *

Forced smiles after the whitewater rafting.

Which is the right decision?

Sun, 26 Apr 2009 05:57:49 GMT

What if you (or your wife) had just got pregnant - but, by some reason difficult for us to understand currently, was diagnosed with a breast cancer.

Chemotherapy is necessary, but it is also very rough and teratogenic - it will not go well with the expecting mum and the unborn baby. The problem was big and demanded a decision.

Here are two real stories about this - about real people in their real struggles:

1. Mum and dad decided to bite their teeth and carry through with the pregnancy without chemotherapy. The cancer spread in mom and she deteriorated quite badly over the course of pregnancy. Still she managed to barely reach 32 weeks when she was rushed to the delivery suite. She gave birth to a premature little baby boy via Caesarean section, and then received urgent chemotherapy in the delivery suite, then and there. The baby boy made it into the world alive and healthy, but mom passed away shortly a year after. Dad was left alone to take care of the newborn boy.

2. Mum and dad decided for an abortion. The lead-up to the abortion was fraught with many uncertainties, but the actual procedure was over way too quickly and easily. Mom and dad turned up together to the Cancer Centre a week later and began the chemotherapy cycles. The disease was as well-controlled as you could expect in modern oncology - but not without some sense of guilt that may never leave, no doubt.

But which is the right decision? Many circumstances in our lives are often just too hard for human wisdom. That is why there are so many regrets.

The story from Kisiizi to Jinja

Sat, 18 Apr 2009 10:21:04 GMT

( For those of you new here, this entry is the me still trying to catch up with memories, even two years after my overseas medical electives in mid 2007. How time flies - especially to think that I have graduated from medical school and completed my intern year since.

The previous entries on my travels can be found under the "Overseas Elective" tag, starting with an introduction and a 4-day journey to reach Africa.

The following few entries on the subject will be about my last days in the country of Uganda and then crossing the border into Kenya, before flying again a big stretch to North America. There isn't actually much left to put into words after this - although I still recall the sights, smells and sounds vividly and with much fondness.

Here is an obligatory warning for a heavy volume of text - but cutting down defeats the purpose. There is quite to tell! Thank you for reading. )

----

The Story from Kisiizi to Jinjia

It was in the calm and chilly wee hours of the morning, well before the breaking of dawn, that Sue and I lugged our bags, half-asleep, from the Guest House to the front of the hospital gate.

The two long fluorescent lamps on the hospital gateposts flickered quietly in the still darkness, but there was surprisingly a fair amount of activity already starting to happen at this hour – two other locals were also waiting for the Nyakisheni coach, a motorcycle rider came to drop some parcels off, and Benon the hospital guard was greeting the people with his signature rifle gun in his right hand.

The Nyakisheni coach, huge and noisy, arrived at about half past five in the morning with much flare – headlights, engine rumbles, people shouting and all that. So Benon waved us goodbye as we stepped up into the coach; what jumped at us immediately however was the loud African samba music playing inside – it was quite out-of-place, and probably to keep the driver awake too, we surmised!

We were setting off for the nation’s capital city, Kampala. Sue’s sister, Sally, and Sally’s partner, Owen, were coming to visit. We would be picking them up from the airport at Entebbe, then proceed to Jinja to raft the Grade 5 whitewater rapids of the Nile River – for which Sue, Sally and Owen were kind to have me tag along. That was the plan we had, brewed over the past week.

When the sun had risen up and high, we were elated to see Grace (yes, a guy’s name here) and Sandra board the coach too, midway at Masaka. Grace and Sandra were Kisiizi Hospital staff who were at the time on holiday – they were literally God-sent, because Sue and I were just starting to worry about not knowing how to signal, in the midst of the overly packed and busy bus crowd, for us to be dropped off at Kampala Backpackers en route to the Kampala central bus station!

With much thanks to Grace and Sandra, we got dropped off without a problem, standing, just the two of us, on the side of the brown downhill road. The dust was still floating around us. The backpackers was at the outskirt of the city, on a hill slope from which we could see the bustling Kampala central, covered in a perpetual blanket of haze from the excessive use of coal generators. A major part of the heat and humidity of the city must be attributed to the resultant greenhouse effect.

About a hundred meters to the left of us was the big Kampala Backpackers sign on a yellow cement fence. Surrounded by a quaint garden with some monkeys trailing around, we signed in at the lodge, smugly granting ourselves the elevated privilege of skipping the word “trainee” when writing “doctors” under our occupation field!

* * * *

Giving Kampala central a walk, believe me, was nowhere near as leisurely as it sounds. But a rest and a Western lunch at the backpackers later, we braved ourselves and decided to go for it!

We caught one of those public bus-vans called matatu’s down to Kampala’s central bus station. Thankfully it wasn’t ridiculously over-packed like what I saw in Kabale or Mbale - apparently the law of having a maximum of 14 people onboard was actually well observed in this capital city!

You can't mention Kampala without mentioning these unbelievable monstrous prehistoric Marobu storks!

And they fly! Many find them ugly. I find them scary. ...What poor birds!!

It was fun riding on a matatu for the first time – but we weren’t expecting to immediately embark on an unbelievably perilous walk to the city center afterwards!

Each step was like an unforgiving test of how sharp our senses and reflexes were: there were random potholes in the middle of walkways (real holes that you would need some serious help getting out of), ubiquitous crowds of people headed in all directions, motorcycles cutting in unpredictable curly paths on the pedestrian walkways, and barb fences hiding at unsuspecting places waiting for you to stick your hand into!! Crossing roads that had no rules was tricky as well – or perhaps there was a rule, which was that the size of your vehicle is directly proportional to your right of passage – but I trailed closely behind the locals, believing in safety in numbers.

There were lots of random hard-to-explain holes like this, in much tighter spaces...

Even bats succumb under the immense perils and dangers!

Then amongst the crowd of people, I felt someone pull on my bag from behind. I turned around, and indeed there was someone sneaking to open the zip of my backpack!

Seeing that I caught him red-handed, he gave me a silly laugh and uttered a nonsensical “Hello, my friend!”

What was droll was that he and his partner continued to follow Sue and I even after being found out (you’d think that after being caught, they would at least expect us to be keeping an eye on them) – we stopped to let them overtake us – but they comically did a roundabout turn to get behind us again! When we established eye contact with them, they laughed at themselves and disappeared shortly afterwards. =_=

Sue had a map of Kampala in her Uganda guidebook, but it wasn’t as useful as we would hope for it to be, so we put it away after a short study. Never mind that some streets were unlabelled in the map, almost all of them didn’t have any signs in real life anyway! I did see one road sign, I remember – but it was completely illegible because it had four coats stacked on it.

We split up. I needed to find the KLM flight and Akimbo coach offices to enquire about crossing the border to Kenya later in my trip (getting a little jittery, but all excited about it!) – which I was chuffed to be able to after semi-randomly traversing a maze of crooked streets, relying on whatever vague sense of direction I had. The KLM office was high up in an air-conditioned building with security downstairs that not only opened everyone’s bags, but also had a metal scanner that you had to walk through, like in the airports. Turning around and looking outside, I could easily see why – just across the street, people were sitting in front of yellow run-down buildings, half selling small second-hand (or stolen) goods and half begging for coins.

The Kampala views.

At the Garden City Mall, a two-storey shopping complex built not too long ago, I met up with Sue, nearing evening. From afar, its size and new white paint certainly made it stand out from the neighbouring small buildings, but the roads leading to it, being in the process of a renovation, were suffocatingly dusty (really)!

Consulting Sue’s guidebook for dinner options, we decided to give a pomp up-class place a try, for a change (yeah, just because we could) – Fang Fang Restaurant, on top of a business building of some international firm.

I must say, wow. At the flamboyantly decorated entrance, I was quite surprised to be greeted by two young Chinese (I presumed) waitresses. Where did they come from – it was rare to see Asians here, let alone younger ones – and what were they doing here in Kampala?? Did they not need to go to college? How long have they been working here for? … Or could it be that they were poor girls abducted by the evil uncle and smuggled into Africa as slaves!!? Surely beneath those little smiles their hearts were breaking, missing home so dearly? I was very bewildered, but too chicken to ask.

We were seated outside, beside a softly glowing round lamp on the handrail, overlooking the streets and traffic below, now dark slate blue under the setting sun and new crescent moon. We were served by our own designated waitress – a local Ugandan she was, and I should mention it was just a little disturbing seeing an African in a traditional Chinese dress.

The lights, the view, and the ambiance made the entire experience surreal. I offered to do the ordering of a proper Chinese meal for Sue and I. The meal was well cherished, even more so after the hard and long day! A hot towel each to start and a complimentary plate of fruits to finish, it was a good dinner at about USh 50k altogether – not bad at all for the experience as a VIP!

We caught a private hire (the equivalent of a taxi in Western countries) back to the backpackers, seeing that it was already nighttime. While most of the people were still chatting away in the backpackers lounge with loud music playing, we had an early sleep first in the shared dorm. It would be another long day tomorrow.

And to think that only yesterday we were still at the tiny Kisiizi village, southwestern end of the country.

* * * *

The new taxi park in Kampala central was an incredible sight to behold!

We got there early next morning – a massive plain field with shockingly innumerable swarms of matatu’s, all parked a hair’s breadth between each other.

Now, I wondered as I tiptoed to catch a glimpse of the entire park, where should we start searching for the one matatu leaving for the airport in Entebbe?

Again literally heaven-sent, one of the locals kindly offered to guide us (for free, too!). While it was amazing that he knew where the spot was amongst the jam-packed crowd of vehicles and people, what I found even more amazing was how the matatu we got in was able to later exit the park without much beeping and squeezing around. They obviously had some sort of system that worked!

And so we left, in a fully-seated wobbly matatu, for Entebbe.

It brought to my mind a tragic story. Only about a week before I got to Kisiizi, there was a fatal accident involving an overseas elective medical student, just like me, on her way between Kampala and Entebbe. She died on the spot. The Kisiizi community was mourning when I arrived there; I am sure many people dear to her were, too, over the world. Sad things unfortunately happen in this world that has gone out of order.

I was asked to sit in the front and in the middle – the driver on my right, another passenger on my left. If we were to get into an accident, I whispered to myself as I climbed onto the seat, then I was sitting right in the most dangerous position!!

The not-exactly-enviable view from the middle of the front seat.

And believe it or not, halfway to Entebbe on the national highway, we really did get into an accident! Just behind the windscreen and stuck pitifully in the middle, I bit my teeth in incredulity, preparing for the crash as I watched in suspended animation our vehicle smashing into the front truck. But thank God (truly) that it was a relatively slow collision – there wasn’t much damage other than a dent on the engine front and the left side-mirror flying off. I got off the vehicle and let out a quiet relief, glad to be unscathed.

The truck, from what we could later figure out as the matatu and truck drivers argued over matters, had suddenly pulled its break because of a motorcycle swaying into the main road. We also still had to pay Ush 1000 each for the halfway trip!

Standing like lost lamb at the side of the national highway, Sue and I started scratching our heads as we put our thumbs up to hitchhike for another ride. Vehicles whooshed past, and the wind blew.

A police car stopped, noticing the mess. Not wanting to get involved with matters, we tried not to pay too much attention to them, but soon we were called by the policemen too. They asked where we were headed for. When we said the airport, they told us they were going there as well. And that, in an amazing chain of events, was how we got to ride in a police car in Africa!!

Entebbe International airport was still looking very familiar from when I first arrived a few weeks back. We bought ourselves soda drinks and waited for Sally and Owen’s much delayed flight. We had arranged for a driver from the Nile River Explorers to pick us up there (a service they offered), so when Sally and Owen arrived, the four of us took of from Entebbe to Jinja the same afternoon – on a mission to stay calm in the 3 hours drive through fumes, dirt and heat!

Sitting restlessly in the steaming car then, and even now, in comfort a quarter of the planet’s circumference away, I recall the many funny things that plainly were beyond our control. But God was faithful.

This is our story from Kampala to Jinja. It was whitewater rafting in the roaring Nile River rapids next!

Capturing a wedding

Sat, 04 Apr 2009 08:09:10 GMT

My two friends got married last weekend, and I am greatly honored to be trusted to photograph their wedding!

It was no trivial responsibility, needless to say. I was so nervous in the final hour leading up to the ceremony that I seriously considered getting some oral diazepam from the hospital! The speed of the ceremony and the lighting on the day were all very challenging too for someone like me who was doing wedding photography for the first time!

But at the end of the day, when all is said and done, I had a lot of fun being part of the whole culture of uniting two persons, and having the opportunity to capture so much joy and spirit.

Here is a small selection of samples, taken with Canon EOS 40D, EF-S 17-55mm f/2.8 IS USM and EF 50mm f/1.8, Speedlite 430EX with Lambency Light Diffuser, LOTS of stress, and even more God's grace...

Four o'clock in the morning

Thu, 26 Mar 2009 15:00:17 GMT

Four o'clock in the morning.
Five hours into the night shift. It has been so stressful.

I almost entered a cold war with a nurse (How embarrassingly childish, I know, sigh...).
My hands shook like a wimp when I threaded the ET tube down the bougie into the
lady's trachea.
I felt like a complete idiot after speaking in circling thoughts to the medical registrar.
I found I had nothing to offer at all, having just certified an old woman dead with her husband
sobbing harder and harder beside. I've never even known what to say in these situations.

This is totally not about the grandeur of doctors realizing how little humans can actually do,
But rather how little I know - how unable and how incompetent I am,
And how frighteningly unloving, unjoyful, unpeaceful, impatient, and unkind I can be,
When dealing with all sorts of people, in all sorts of situations, four o'clock in the morning.

In between the days and nights when things are going smoothly and happily,
I really thank God for this realization.

It makes me go back to Him.

--

( 3am in the hospital corridors, on a less eventful night! )

Some things we keep doing

Fri, 20 Mar 2009 01:51:07 GMT

We asked if she smoked. "No," she answered flatly. "I stopped. A year ago." A glint of pride in the accomplishment, it seemed, flashed across her face with that reply.

But it was too ironic.

She was definitely not alone. In fact, too many are just like her - smokers for all their lives, who suddenly (and finally), out of their own intentions, quit smoking, only to be hit by a diagnosis of lung cancer shortly after. We see this again and again. Why do so many smokers stop smoking just before they get lung cancer?

Not all admit when asked, but often it is because they could feel that something was going amiss, and so they stopped in alarm. It might be some blood specks coughed up, or some strange weight loss that had worsened - not enough to make them see a doctor immediately, but enough to scare them to think, "Gosh, all my cigarettes may actually kill me one day!!"

But it is already too late; and what is done is done.

It is easy to point at others, but there are some things too - small and big - that we - all of us - keep doing, despite knowing they are wrong. Of course we pay, in the end.

People are fragile

Thu, 12 Mar 2009 07:42:48 GMT

There was this young lady. She had only recently been diagnosed with invasive cancer of her breast. She was heartbroken, like you and I would be.

Her fiance was soft-spoken and calm, and he sat close to her bed. The hospital curtains were pulled closed. The three of us doctors in the regional oncology team crammed beside her bed-space. She would need chemotherapy, the consultant medical oncologist explained.

"But how long will it take??" she asked immediately, very anxiously. "We were planning to get married soon!" She turned to look at her fiance, desperate.

"Dear, chemotherapy is more important. Our wedding can be postponed, don't you think?" her fiance spoke. She turned silent for a little while.

A few days later, the lady had gotten into a big quarrel with her fiance, we were told. Apparently she had taken her fiance's response to mean that he no longer wanted to marry her, because of her cancer diagnosis. She had become even more heartbroken.

People are fragile. Where do our securities lie?

After a long weekend spent in the hospital...

Fri, 06 Mar 2009 22:23:54 GMT

... I found this on my bedside table, Sunday 11:30pm.

The perks of staying with a homestay family. Har har!

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( On a side note, I hereby announce my aim to update this LJ weekly from now on!!
We'll see how it goes, and thank you for reading so far! )

Grandpa passed away

Wed, 25 Feb 2009 08:09:17 GMT

Grandpa passed away on the day I arrived home just before the last Christmas. It was a weird week that followed, beginning my holidays back home after several years overseas.

Weakly could he still nudge his head when he saw me standing beside his bed that morning, but it was a swift deterioration, and he passed away - so quickly - about nine hours later.

In retrospect, should I have spent more time with him earlier the day? Should I have insisted more strongly for him to be admitted to hospital earlier? I don't know; in retrospect there will always be many what-if's and if-only's. But I'm thankful I arrived home in time when he still had enough consciousness left to recognize me. I know he had always wanted to see me for the years I was away.

In the week that followed with the funeral service and relatives visiting, I realized, too, that there are many things so close, yet not usually talked about.

What other times in our lives do we talk about finding a good and suitable cemetery to buy a spot, in preparation for the future? What other times in our lives are we so open, even in the extended family about life, death and the next generations?

So I suppose I have grown up, my friends are getting married, my parents are soon retiring, and my young cousins now able to walk and talk. The people I have around me - many so very dear - are changing, and will not be around forever. Sometimes this is closer than we think.

Indeed we are all but a mist, that appear for a little while and then vanishes. Yet God has set eternity in the human heart. It amazes me, but I know many avoid the topic.

Do opposites attract?

Mon, 02 Feb 2009 13:22:24 GMT

( The larger version looks better. )

My superficial answer's inclined toward a 'yes'.
But what do you think?

--
(p.s. So I've broken my record of one illustration per year! This one took me forever.)

Happy CNY 2009

Tue, 27 Jan 2009 04:18:01 GMT

Happy Chinese New Year to all Chinese readers!

The markets, the sounds, the streets, the fireworks, the people, and of course the food (on top of not needing to cook when you're hungry) - it is good to be home for CNY after a few years.

The start of 2009

Tue, 06 Jan 2009 10:17:11 GMT

Have a blessed 2009, everyone!

Can you believe that I am averaging at completing one illustration per year!? Let's see if I can work on this in the new year! I'm such an amateur.

Leaving PN Hospital

Thu, 25 Dec 2008 07:39:51 GMT

During the final few hours of my job... Aww.

So I have spent my first year as a doctor here in this hospital.
It has been a fun year of embarrassing mistakes and heroic decisions!

It was very nostalgic meeting up with the fresh new-graduates during their hospital orientation a few weeks ago. I could almost see the slight glint of insecurity in their eyes - it only felt like yesterday that I was in their shoes, transitioning from a medical student to a real doctor!

But the company of colleagues throughout the year was amazing. I've come to be friends too with the nurses from the different wards at various shifts, and the ward clerks who invariably always save a House Surgeon's day knowing where things are kept!

With these things in heart, three farewell parties and several goodbye hugs, I'm ending my tale here in this hospital...

"So what are your thoughts?" asked the doctor beside me during one of the end-of-year parties. The music in the background was loud, but the clatter of conversations was louder.

"More bittersweet than I expected," I said. She laughed. Even though I have planned, all the while, to move on to a new city and hospital next year, it honestly still feels surprisingly difficult.

But as another colleague so wisely remarked, I probably would also have regretted if I stayed! Such is often the contradiction of man (of me, anyway).

So I'm moving on. Looking forward to 2009 - a new place and a new social circle, once again. Thanks for taking care of me here in Palmerston North, everyone.

Have a blessed Christmas and New Year.

-- Some photo highlights --

We are proud winners of the Doppleganger Award (for being the most easily confused by nurses, testified by plentiful real-life experiences!). The prize were these huge green "Hello my name is..." cards, lol.

Basketball after work was something to look forward to when on-calls haven't sapped our souls!
You can tell that we are complete noobs with our feet on the basketball.

Farewell get-together for the first-year House Surgeons at Caroline's.

I broke poor Caroline's window (and she had only moved into the house a few days ago!!) while setting up the camera for this group shoot. Fortunately she was a wise girl to have bought insurance beforehand that covered glass with no excess... phew!

When I wasn't away on epic excursions, I... (part III)

Sat, 15 Nov 2008 14:54:11 GMT

She's a star!

In Uganda, when I wasn't away on epic excursions, I...

9. Attended "Wednesday school"
Chatting with Louise (the UK physiotherapist) on Easter Sunday, I got to know that she had been helping out in "Wednesday school" - which really was a Sunday school session held on Wednesdays (I know, you didn't need to me to explain that), in the paediatrics ward.

So I poked my head around the following Wednesday afternoon. The "class" took place in a well-demarcated section of the paediatrics ward. We took tins with beans put in them, and handed them to the children - they were sick children with polio, malaria, and bad burns from spilt boiling porridge. We started singing songs, and everyone, including the parents, sang along loudly. It was amazing.

The parents clapped their hands...

...While the children rattled the tins with beans in them, as percussion instruments.

I don't usually say something as melodramatic as this (yeah whatever), but watching the smiles the children gave when they were shaking those tins and singing along was just priceless.

Time as though stopped for a while, and everything seemed worth it.

Louise then told the story of Jesus entering Jerusalem on a donkey on Palm Friday, with the aid of a picture book in her hand and a translator beside. It may sound strange to be telling this story after Easter Sunday, but I thought it was actually quite effective in making us think about what "Hosanna" really means!

To finish the Wednesday school session, we handed out crayons and paper for the children to draw Jesus on a donkey, but surprisingly, the moms definitely seemed to be the more eager ones in taking the task up instead!

Louise turned around, and half-jokingly remarked that as much as "Wednesday school" was for the ill children in the hospital, it was as much also for the parents. Indeed, I thought. There is sickness everywhere.

Some moms were definitely more keen than their children!!

10. Followed the community ante-/post-natal outreach team
While I admit I'm not terribly fascinated with obstetrics and gynaecology (sorry), I was glad I tagged along one of the hospital outreach visits to the neighbouring settlements for ante- and post-natal check-ups and immunizations.

We borrowed two of the local primary school classrooms for our purposes, while classes went on as usual just next door!

I palpated a few pregnant tummies, measured a few blood pressures, watched babies cry when being immunized, peeked at the bewildered students in the classroom next door, then played volleyball briefly after all of that ended.

I guess I was getting more used to being the beacon-like Mzungu by then.

Immunization makes a tremendous impact on reducing disease burden worldwide.

I just had to take a photo of this. If you wondered, I did ask for permission.

LEFT: UNICEF endorses the weighing method.
RIGHT: A cardboard needle box that was much more difficult to assemble than it looks!

The classroom next door. This small school didn't have desks.

11. Helped out during the "Sponsor an orphan"-project big assembly day

Amongst the various people whom we had the honor of knowing, via their short visits to Kisiizi during our time there, were Greg and Wendy from the UK, who were part of the coordinating committee of this UK "Sponsor an Orphan" project.

(Can you believe that part of the reason why I delayed this entry for so long is because I was so frustrated that I couldn't remember Wendy's name - thank God it all came back to me, haha!!)

One day, together with the local project staff they held this big assembly event in the Kisiizi primary school hall for all the orphans enlisted under the project. Greg and Wendy had over the past few days visited various schools to make sure the funds raised were spent wisely on shoes, books, uniform, etc.

I now can't remember if we had been actually asked to help out for the assembly event, but even if we hadn't been, I'm sure Mike, Sue and I would still unabashedly invite ourselves anyway, haha -_-

One by one the children were called to go to outside the hall for a photograph, while inside the hall, the other children were busy making cards that would be sent to their respective sponsors (together with their photographs). With various colored marker pens and some lovely stickers, they were asked to decorate their cards however they liked, and write some sentences about themselves - their name, date of birth, hobbies, etc.

I like how each of them had an identification number beside them while photographs were taken.

Mike, Sue and I, together with Louise, hovered around and showed some of the children what could be drawn on the cards. I drew one simple flower and asked the children to copy, while Sue was happily stamping her trademark sketches on every card the children presented her with, haha. I failed terribly when asked to draw chickens and cows - my animals look like deformed clay figures!

When all the photographs had been taken, and all the cards collected, Greg and Wendy then gave out the letters that the sponsors for the project have written to their respective sponsored orphans. The process was like a prize-giving ceremony - a name would be announced, and the child would walk up to receive the letter. Those who received letters were naturally overjoyed.

Always happy to receive a letter!

(Note the photo they hold is the same.)
The boy on the right wanted me to take a photo of him too - so he grabbed the photo from the boy on the left, because he hadn't himself received one from his sponsor...

The older ones sat down to read letters to the little ones...
I find this a really touching scene!! T_T

It made me wonder, though, about how those who didn't receive any letter from his or her sponsor felt... So if you are sponsoring a child in Africa or wherever, make sure you write to your sponsored orphan!!

After the long morning, we had some games on the big school field outside. We played "Trolls and Dwarves", which was basically a tag game except that we, the Mzungus, were fixed to be the "bad Trolls" (yeah, how predictable). MAN can those kids run!! I think at one stage I was even made fun of for my slowness...... Kill me.

Michael used the age-old trick of feigning death - then catching the unsuspecting curious prey!!
Except that he didn't succeed.

Bon appetit

We ended the eventful day with lunch en masse -- classic matoke, G-nut paste and soda.

Can't go wrong with those!

- End 終わり -

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(A way-overdue finale to parts one and two. Phew! *wipes sweat*)

A story of someone, and the people around him

Mon, 20 Oct 2008 04:54:49 GMT

Every time I walked past his room, I caught him at the corner of my eye. His face was like a human skull with living, brown skin growing on it.

We asked him if he still wanted active anti-retroviral treatment, and every time he would nod his head very weakly, almost drifting asleep in the process.

Clearly and dearly he was clinging onto his life - and why, you could almost ask. Certainly many of the nurses did. He had no friends that we knew of, and only one next-of-kin apparently - a cousin in a nearby town, but even she had disowned him one month ago... No longer wanted to be informed about him, no longer wanted anything to do with him.

"Why are we still treating him!? Can we put him on the LCP already?" some of the nurses would say, day by day. I have heard it so many times that I got a little annoyed.

And one day, when he became totally unrousable but his lungs still softly breathing and his heart still faintly beating, we finally decided to commence him on the LCP.

Then suddenly, as if from nowhere, more and more "family members" and "best friends" started appearing in his quiet room, sitting and standing by his bedside. Before this, we have always thought that he was lonely, with no friends or family.

I wondered, too, if he even knew that they visited him. He passed away shortly after. He is now fading in my memory.

He had late-stage AIDS, but that is not all. This is the story of someone during the last periods of his life, and the people around him. It is a sad story, I think.

What are your conditions

Wed, 08 Oct 2008 09:31:32 GMT

In the nursing station I overheard her say in a firm voice, “I told her clearly, ‘if you continue to swear, I'll just walk off and stop looking after your daughter.' I don't need to tolerate this kind of behaviour. I don't work to be abused.”

“Yes, but I don’t think she was swearing particularly to anyone though,” her colleague beside her tried to reason.

“It doesn't matter. This kind of behaviour is simply not acceptable, especially in a hospital ward."

Some patients or their relatives can be inexplicably rude and difficult to deal with, I can testify! Dealing with them have been terribly unpleasant and stressful experiences, needless to say. The conversation between the nurses about zero tolerance for abuse happened more than a year ago now, but somehow, now and then I still remember it and it makes me think...

What are our real conditions for helping someone?

Can you imagine someone helping you unconditionally? It's a very strange feeling to be at the receiving end, is what I think.

Sakura Festival

Sat, 27 Sep 2008 11:39:38 GMT

A few days ago was the Sakura Festival here in Palmerston North.
I was hoping for more cherry blossom trees, but the weather was too good to complain, haha.

Come spring. My days left in Palmerston North are now counting down. It has been so fast.

"Here I go again," is what I tell myself as I think of where to go next.
I am once again reminded of the blessings - and the assurances - that I enjoy.
Sound mawkish? Thank you.

--
(p.s. To the new readers of my petty blog - thanks for reading! Would love to hear from you as we go along.)

Punched

Mon, 15 Sep 2008 01:18:18 GMT

I got punched by a patient yesterday!! On my right shoulder, by the back of a fist. It wasn't that bad, and it becomes more hilarious the more I think about it.

I wouldn't blame him, though. He was a demented elderly man who was really grumpy probably because he was vomiting blood up, and yet I was jabbing him with needles, trying to insert a reasonably-sized cannula into his spidery veins. Poor guy.

It made me realize, though, that I haven't been hit intentionally for a looong time.
Can you remember when the last time you were hit was? It's not a nice feeling at all.

Oh the joy of dealing with all sorts of people.