The Pledge

We, the citizens of Singapore,
pledge ourselves as one united people,
regardless of race, language or religion,
to build a democratic society
based on justice and equality
so as to achieve happiness, prosperity and
progress for our nation.

我们是新加坡公民，
誓愿不分种族、言语、宗教，
团结一致，
建设公正平等的民主社会，
并为实现国家之幸福、繁荣与进步，
共同努力。

This was the pledge as I knew it, when I was little.

The Mechanist

I've been thinking. It doesn't happen that often these days, but old habits die hard.

I'm doing a masters at a certain university in the west right now in something very esoteric. It wasn't my choice, and it was a mistake.

Many of the modules are poorly taught by foreigners who can barely speak English, let alone communicate complex concepts to the students.

One of the modules is taught by a Professor who speaks English fluently and clearly thinks in a very high-level way. So much so that he, too, cannot communicate the basic concepts to anyone who doesn't think at the same level.

One of our projects involved tens of thousands of computations to arrive at the desired outcomes. After all of two slides - about eight lines of text on the subject. It left me with a bitter taste in my mouth, and a desire to ask him :

Nabei. You &*(&*er (yes, asterix and all.) If I give you one lecture on performing a Whipple's operation and then told you to go do it over the weekend as homework how would you feel? What if I made my lecture really really technical and told you to go home and read what Kocherisation is by yourself before I examined you in your operative technique?

How would I like to be taught? I'd like to be taught by people who know what they are doing.

I'd like to be taught by people who can relate to me, who I can relate to as well, who can communicate clearly with me, who take my desires into consideration, and most of all, know what they are doing.

In that light, let's take a look at the elections.

In all honesty, this elections will not see a fundamental shift in power. I was reading Temasek Review until they went down, because, gosh darn it they were funny. The place is dominated by immature, rabid anti-establishment morons with a single agenda : bring death to the "PAPies" (or whatever)... and half of them write like speechwriters for... the Chinese Communist Party or something. But in their vitroil they're actually quite... entertaining, and some of the pictures they put up are pretty amusing. They're baying for blood, and Change RIGHT NOW.

Mr Chen Show Mao knows better - he didn't return as the messiah to redeem the nation from the clutches of a one-party system. He said as much - he was coming back to initiate the process of change, to start in motion the machine that would someday restore a credible opposition.

And therein lies the truth of it : the face of politics has evolved so... far so that our opposition is now in-credible.

Some of the individuals look promising, but there is no dream-team. There is no opposition. Single individuals do not a party make.

This election is not about an overnight shift in political leadership.

It is about the individuals and their candidacies, or claims to candidacy.

Who do I want in parliament?

I want people who know what they are doing. I want people who take my desires into consideration, who can communicate clearly with me, who I can relate to, and who relate to me as well.

There are promising candidates in all the parties - the PAP included. I want to know just how promising these people really are. I'd like to judge them as objectively as possible, because... these are people who will be Governing, for God's sakes.

Take Dr Puthucheary for instance - a man does not get to become a senior consultant in Pediatrics - in KK hospital not less - without an iota of EQ. I'd like to hear more from him - not read second hand what he purportedly said, in response to something he was purportedly asked. Has anyone ever seen that particular interview everyone's so upset about - anywhere online? I'd like to know how he thinks, and what he thinks about healthcare, for instance.

Take Nicole Seah, who looks (comparatively to someone else...) so very, very promising in her razortv speech, having had ample opportunity to do her past-year-paper rehearsels to some very familiar questions. I'd like to hear what she has to say when she's really challenged, and break it all down to understand how she thinks. She sounds very persuasive and mature - but that's what she does for a living - she sells images. She's an advertising executive. What policies would she personally like changed? How would she personally approach them? (not just party lines, but real, off-the-cuff thoughts and opinions)

I enjoy watching interviews when the candidates are clearly thinking; it's a little bit like debating. You see it in their eyes, their eyebrows furrow a little, or their eyes go a little vacant. The wheels spin. Intelligent things happen, or don't. And then the words come out and you Know.

In contrast when everything's been carefully rehearsed, the answers come a little too quickly, without pause. Faces bear relief, or are stony masks while words come flooding out in breathless torrents, and perhaps the words don't quite make sense when lines or words are missed here and there and the recital goes a little wonky but the narrative just carries on, and on... because all thoughts are focused - not on the question - but on the answers.

you Know too, then.

*********

What is UP with Singtel and Facebook?!

*********

“The person in the photo is just my friend. He works for a community club. We took that photo during one of the grassroots leaders’ wedding.”

“He was never my boyfriend. I find the episode extremely funny,”

Just a thought.
This is actually the wrong response.
It just struck me why.

If I were in her shoes - or if any of you were in her shoes, would we be finding it amusing that our friend was getting bashed online for associating with us? The guy's been called fat, ugly, unworthy - and a host of other things.

How is his personal life suffering? Is there any backlash to his own relationships? If he's truly just an innocent bystander, he deserves our sympathy. Perhaps even an apology.

And he deserves the sympathy of his friends most of all.

Extremely funny?

Got funny meh?

Miyagi Dowan Tin Pei Ling

Mr Miyagi writes why he doesn't want Tin Pei Ling to be a member of parliament.

This isn't the heart of the tin man, the eye of the tiger, the center of the storm in a teacup. This is a fringe thought that doesn't need redress, because his isolated deviant thoughts are insignificant when there are bigger issues at hand.

Only a very few people are willing to dissociate maturity from age, and only they are struck by how mature TPL is, or is not; how much depth her replies to Razor TVs interviewer displayed - or did not. How much her present self - and past self - thinks for the future, than for today - or does not. And since only a few people constitute a minority, they are not of substantial consequence.

The sad but real reason our public is angry isn't because they Don't Want Tin Pei Ling, but because they Want to BE Tin Pei Ling.

And hence the vitriol, the rabid dredging through facebook and twitter, and the raking of the coals. Hence the allegations of sleeping with the enemy / boss, the rants that she is too young.

This, being the "majority vote" (google Tin Pei Ling. You'll be amazed at how many pages of angst appear) is worthy of redress, and the Powers that Be have done so. This is bad behaviour, and it shows you are all Blathering Idiots, and therefore Wrong. (and frankly, they are right.) It is a Simple Extension therefore that Since you are Wrong, Tin Pei Ling is the Right Candidate.

Whether she is the right or wrong person for the job, and whether she should button her top button up or not are beyond me.

What I get out of all this, is an immense sadness that we have had so many years as a nation to grow, but this is what we have become.

The SALAH Handbook

In a sudden moment of catharsis...

... rumours abound on the net how Dr Chee Soon Juan is actually a PAP plant to cause the opposition to own-self explode from the inside-out...

... well the TPL fiasco... maybe, just maybe... the opposition is... could it be? naah...

... but it all fits so well...

devious!

*****

randomthoughtsofamedstudent.blogspot.com is facing his imminent return to the welcoming arms of our local healthcare system with some trepidation, what with all the bad press the local inmates have given him.

Reading him brings me back to when I first came back, and reminds me how I'd wished there was some kind of handbook or manual for me to read, perhaps not to help me cope with what are ultimately very personal issues, but rather to let me know that I wasn't alone, and that someone else out there gave a damn, and really understood. It reminds me of the handfull of people who have asked me what working here is like, after already making the decision to come back and rendering any useful advice I could give (like "DON'T!!! NIET! NEIN! BU YAO!") invalid.

So here it is, the very first draft of the

Singaporean-medics Abroad Looking At returning Home (SALAH)

Handbook.

**************

Welcome to your new life as a houseperson in the world-renowned medical hub that is Singapore.

To successfully make your transition from normal human being to cockroach as seamless as possible, please peruse this entire document before disposing of it.

These are the Fundamental Tenets upon which your new and wonderful life as a physician or surgeon commences :

1. You are Beneath Contempt.
You are Houseman. Your sole purpose is to perform "Changes" (ie menial jobs like taking blood, ordering X rays, etc.)
From time to time you will hear nice words like "learning opportunities", and "protected teaching time", and "mandatory post-call rest hours".
These do not apply to you, since you are not Resident. Residency is reserved for those who have already been Assimilated. One day after your Assimilation you may be afforded Residency. For now, you are Probationary, coupled with Houseman and therefore beneath contempt. (Contempt is Houseman. Resident Houseman is ConteNt.)

As a subcitizen you must realize that you are expected to perform an unreasonable number of changes in a very short time, every day, and to not leave hospital until your changes have been done. In addition, you must complete your changes in time for the results to be ready by the exit round in the evening.

I was fortunate to return as a medical officer and didn't have to suffer the pain of Housemanship in Singapore.
I've watched my housemen coming to work... early... and leaving... late with some sadness, before letting the Medicine of it all wash over me as my housemen drone the results to me, and we go through the checklist of who is well and who isn't. It's just the way it is.

2. You must conform to working hour restrictions.
The ministry now mandates that you keep a log of the number of hours you work in hospital. This means that you must finish your changes in time, and ostensibly knock off work and be out of hospital before a certain time. Regardless of the realities of sheer volume of changes. A houseman who goes beyond their mandated working hours is judged to be inefficient and may be unofficially penalized. A department which has housemen going beyond their mandated hours is judged to be noncompliant, and penalized, officially.

Here are some short phrases to expand your vocabulary :
Everybody likes a team-player.
Truth is subjective.
"Performance Appraisals" are Very Important.

3. The nurses are not your friends
I remember the nurses from the UK who were peers, and interested in what they did.
Our nurses, for all practical purposes, are sentient machines. Much like you are, except you are a Change-making Machine, and they are Bed-Making, Patient-Turning, Report-Passing Machines.
They are a superior model to you, and you are beneath them. This is important to remember, because if ever you overstep your authority on an individual nurse, you will get away with it. She will act subservient to you to your face.
And then all hell will break loose, in a very subtle / not so subtle way, after her colleagues begin to discriminate against you, and after her Sisters get in on the gangbang.

You must remember that they are a separate community, and when push comes to shove it reverts to "Us versus Them" in this country.

I remember an OT nurse from the days when I was in Orthopedics. She was young, pretty, capable, and bright as a button. One of the Profs recognized this and used her to close all his wounds. I first discovered this when I was closing a knee, and she decided to lend me a hand. We smiled at each other and she started closing the opposite end. We shared a silent cameraderie. I marvelled in the privacy of my mind that a nurse could stitch, and so well at that. (OT nurses specialize in counting.) Our two strands met in the center and the result was Immaculate. It was almost a Movie Moment.

Unfortunately, her Sister walked in the door at that point. The result was a mess.
And Loud.

We are not here to work with each other. We are not working in tandem to improve patient welfare. We are working for our own Kind, exclusively. Patient welfare is an incidental byproduct of this union - sometimes.
Bear that in mind, when you are laughing and joking with them, or perhaps flirting lightly - they are not the same as the nurses from where you came.

Be advised to avoid flirting. One of the nursing subroutines is Gossip Making Machine, and Gossip can have unexpected consequences one day in the very, very distant future.

4. Your Role is Different.
The Patient-Doctor relationship is always unique to each consultation, but here in Singapore there is a strong bias towards a Client-Service Provider relationship. This is more frequently than not a more stressful relationship, with less satisfaction afforded to the physician, and more to the patient (or their families).

Young people (read : Me generation) here want to be in control, even if they don't have any fundamental grasp of the salient medical or administrative issues at hand.

They have an understandable perception that they are entitled to a lot, since they are paying a lot.

However many fail to realize that they aren't paying a lot at all, with the government subsidizing most of their healthcare. And that by the same argument that entitles them to be rude to their surgeon / physician, and/or barge in on someone else's consultation and demand to be seen because they have been waiting for too long outside the clinic, and/or complain when they see a doctor leaving clinic / eating food in the cafeteria prior to clinic / complain when they do not get the same doctor for all their visits / complain when they are seen by junior doctors or students -- by that very same argument - that money rules all - private patients who are paying more than them are entitled to more. The straits times forum over the last few days tells a different story though; double standards are sadly the norm and the system backpeddles to save face.

They also don't want to hear it - they don't want to hear that everyone else has been waiting just as long, that the patient you're barging in on now deserves as much time to be seen as you and you're eating into his time wasting time barging in on my room with the only possible outcome - of you being shown back out the door to await your turn - happening whether you vent your frustrations or not. That the doctor leaving clinic isn't even running the same subspecialty as the one you're consulting for / is going to attend to a ward emergency. That the doctors have just finished a long round seeing sick someones who aren't your Grandpa today, but might well be tomorrow... and are snatching a bite before going to run clinic for the next X hours at the very real risk of forgoing lunch, and food is one of those things that keeps people buoyant enough to face a long clinic with a sort-of smile. That junior doctors rotate in and out and even middle grades change teams or hospitals from time to time and that is why you can't see the same doctor through the years, unless you are consistently seen by a consultant - ie a private, paying patient. That big teaching hospitals are teeming with students who will one day be sitting across the table from you as your consultant, and they need to start somewhere too, or else wind up being shitty, incompetent half-trained doctors.

They don't want to hear it. They just want to be told that they are right, and they are king. They want to feel that they are in control, and the fact that they are called later after barging in to the room is proof positive that they made a difference in the grand scheme of things.

What can we do about it? Well, we can eat a hearty breakfast, then grin and bear it... We can be the face of the faceless organization and stonewall the patients politely. We have to - it's Us, or Them.

Speaking of which, I remember once upon a time firmly telling families requesting a "denial of service (information)" to the patients (mum won't be able to take the news that she has cancer. you musn't tell her!) that my patients were my priority, not their families, and that it sounded like they had communication issues and that lying wasn't going to achieve much, since frankly the patients would know eventually - it's their bodies. And that they would be even unhappier being kept in the dark. I would tell them that I'd be back in half an hour to break the news, and perhaps they could use that time positively.

Things are different here. Your role is different here. Your role is to write down in capital letters on the top of the case sheet PATIENT DOES NOT KNOW DIAGNOSIS, or else see to it that someone else does. Because the structures of the family units are different here. The heads of the families are the middle-aged childern, not the elderly. It's all rather confusing, and counter-intuitive. But eventually it strikes you - the old fogies really, really don't want to know. Most of them anyway. They just want to lie in bed and be doted on by their kids, and let the tides wash them whichever way they will. And for the select few who, years later find out after countless colonoscopies that the little operation they had to take out a small harmless lump was in fact a hemicolectomy for carcinoma of the colon, and are outraged... well... nobody really cares about how they feel. They only care that you betrayed the covenant of silence. Prepare for a complaint letter from the family. (Interestingly, the "betrayed" never think to write in and complain about being kept in the dark by their loved ones. Fascinating.)

4. The Patients are Different.

Language for one. It may be a relief to be able to speak in Singlish - for a while. Until that monolingual patient who only speaks Hokkien comes in. (Hua Yi Buay Heow) Or Cantonese. Or Tamil. Or Malay. Or...

Communication is often suboptimal because of this. We rely on family members to help us translate things. Things get lost in translation. Things like "you have cancer" turn into "don't worry there's nothing wrong, you just need a small operation." Things like "I'm sorry we did all we could" turn into "nothing lah."

Old fogies are more passive, as mentioned above.

Young punks are more aggressive.

Overall, people are less educated - not in terms of highest standard of education attained, but in terms of information. They are less informed, and more opinionated - they've read one or two dodgy articles online, or heard something from somebody's aunt, or their dad lived for five years with cancer of the lung before some doctor killed him off after he was admitted to hospital, or their TCM consultant has told them something different -- and suddenly they're the experts, and you're someone to be suspicious of.

These are of course the exceptions to the norm. Most of the time things will pass by smoothly enough. But when you hit a stumbling block like this, what will you do?

It was hard when I first came back, having to explain to a belligerent, inappropriately aggressive family member that novo-7 is not the standard of care for an intracranial haemorrhage, and that grandma might still be dying even with it. It was difficult to think with his face so close to mine that the spittle from his mouth as he shouted was landing on my glasses. I chose to be civil and attempt to explain it to him, with aid of the internet, over and over again until it became apparent that he was not here to hear, but to shout. At which point I told him as much, and left the ward, and hit a wall some distance out from the ward in frustration. (Hitting the wall, it's a turn of phrase, isn't it?)

Now that I've been Assimilated, I do what everyone else does. Talk until their time is up (approximately 5 min) then excuse myself and leave. If they didn't take anything on board in those 5 minutes, in clinic, on the ward... if they were too busy making themselves heard to hear in return - then nothing you say will make a difference. If there's a complaint letter hovering somewhere in the background, chances are it's already been written, and posted to the New Paper - even before Ms X showed up on the ward full of righteous fury.

Interestingly, sometimes Ms X shows up for the first time, after Ms Y and Mr Z, her sister and brother have spent the last month with dear old dad, and are completely informed and understanding. And Ms X will be the one to rain fire and brimstone upon the incompetent healthcare providers so obviously intent on killing dad, nevermind that she doesn't know why he's even been admitted. There's a simple reason for that, I think, and I think it's guilt. Ms X actually deserves more time; I usually give her about 15 to 20 minutes before packing it in.

People are different here.

5. The Other Doctors are Different.

Perhaps these are biased memories, but it seemed easier to be happy with Medicine while back in the UK.

You'd be hard-pressed to find someone here happy and fulfilled in their medical lives. The common grouses are excessive hours, incommensurately low pay and lack of public gratitude.

I think you'd be missing a fundamental truth if you chose to focus on any one single point of the above - or even on all of them combined. The truth of the matter is many doctors are depressed. Cast your net wider and you'll see it's not just doctors.

I remember how everyone used to go get pissed thursday (or was it wednesday?) nights at the pub, from the consultants to housemen. And how we'd all dance and generally make fools of ourselves.

I can't help but compare those memories to the present-day infrequent department parties, when professors and peons auto-segregate, and professors remain... professorial.

Yes, there is decorum and aplomb, and dignity befitting of royalty here. But maybe we've just... forgotten how to have fun.

How to cope? Just remember that fun here starts when you step out of hospital. Remember your family, your wife and your children are what make living worthwhile. I don't know if it works, but that's what everyone does.

7. Ethics are Different.
Be prepared to back down on those ethics your medical school ingrained into you. And prepare yourselves for the changes in your own ethical code which will invariably follow. It's a natural progression.

Perhaps the only real rule is to stay out of trouble, and don't offend anyone, be it your colleagues or your peers.

A few random names to google :
S***n Lim
Eu K*ng W*ng

Also, there is a "right" way and a "wrong" way to effect diplomacy. Again, see the above.

More random terms you need to know before you start:

"Do Not Resuscitate" - what is the difference between this and...
"Max Ward Care / Not for SICU / Not for intubation?"
Dangerously Ill (DIL) - what is the difference between this and...
Dangerously Dangerously Ill (DDIL) ?

Hypothetical question :
Is it ethically permissable to inform a family who lives far away that their father / mother is dangerously ill and they should hurry down as soon as they can to see him, if the patient is fading fast and their chances of making it in time are about as high as an opposition team winning a GRC? If not, perhaps it is kinder?
How about if the patient is already dead from say, a massive MI?

8. The Administration is Different.
This goes from the ministerial level, to the SMC, to the SMA, down to your local hospital administration.

There are notable differences between administrations of different countries.

Ours is a strong administration, that is efficient in achieving its aims.

Do not bemoan your "low starting pay" as a cockroach though. There have been recent revisions. Prior to them housemen were truly earning a pittance, at levels inappropriate for university graduates.
Pay revisions are not pegged to civil service. Medical professionals are servants, but apparently uncivil.
There is doubtlessly a reason for this. Perhaps there are just too many of us.
Do not stir the pot, or bite the hand that feeds you. Spectacular things have happened in the past.

The system is oddly dichotomous when analyzed from a financial perspective.

Either way you need to decide early on what your career path will be. Early on is now, when you have just graduated from medical school - because you are a graduate student and significantly older than the rest. There is an unhealthy obsession with age in this country. Life stops after 20, yet 27 year olds are too young for politics...

If your priority is to make money fast and have a comfortable lifestyle, become a GP. The net earnings over time will outstrip those of a government specialist.
The alternative is to give up medicine altogether and use your degree to seek another job. As ridiculous as this sounds now, it isn't. Senior Pilots for instance bring home $50k or more a month. Politicians need money to remain honest and uphold their integrity, so they earn... more than I can count in my head.

If your priority is to make ridiculous amounts of money to swim in, then specialize NOW. Choose your specialty NOW, even before you graduate. Join a residency programme NOW. It's what everyone else is doing, right now... and exit early, and go private. And become a very, very rich one trick horse. Just avoid $24 million bills.

If your heart is in it for your art (ie surgery) or the intellectual challenge (ie medicine) then tough luck. You're doomed to stick it out in government service and earn less than your peers in many of their lucrative business careers, and your lot is to whinge about it for the rest of your life, or else to just put it out of your head altogether and do what you enjoy most. If you fall in the latter category you are admirabe, but probably deluded or else dysfunctional in some way. Sadly, I am in that category.

9. Everything is Different.

Yet everything is the same.
Some things are better, some things are worse. It was the best of times, it was the worst of times and all that.

Standards of living here are good, possibly even high.
Costs of living are also high, if you seek the lifestyle of a young, executive professional, which although you kind-of are, you're not... (remember the cockroach) Decent sized condominiums cost in excess of a million dollars. Landed property cost about four to more times this. COEs are expensive. Annual road tax is about a month's salary.
If you are comfortable with a lower standard of living, you can achieve this comfortably, eg living in a HDB flat - which is fairly good and comfortable, functional living.

Things are clean here. Really clean. Sidewalks are clean, roads are clean, HDB landings are clean. Ministers are clean.
It's just the public toilets that are filthy... MRT toilets made the news today.
For some strange reason people here like to drape toilet paper into the bowl and trail it out, in the mens loos. Perhaps its to line the seats while they squat on the sitting toilets? Nobody ever lifts the seats. This makes for pee-water tracking out onto the floor thanks to inconsiderate laws of physics (capillary action).

This highlights something unspoken about our population.
It is a tiered population. Clean and dirty.

These should be sufficient for now.

Beginning of the End

Back in the day when I was still a bushy-eyed, bright-tailed spring chicken, I remember how some of my less anatomically confused peers would wax lyrical about how they wanted to enter politics to fix the PAP from within.

I used to snigger cynically and think privately that the machine will never change from within, but just assimilate all who strive to be different.

I've never been interested in politics in Singapore despite once having been a debator, because, well, there are no politics in Singapore. There's no debate, no engagement of intellects. Motions are passed at the time of conceptualization, not in parliament. (Interestingly I remember a very dignified old Englishman who, post craniotomy for a devastating brain bleed, when asked if he had passed motion replied grandly, "young man, motions are only passed in parliament!") AS I've aged I've realized that that's what makes Singapore special though. Brutal efficiency translates into instant action. The players don't matter as much as the process.

The fielding of Tin Pei Ling has struck a chord within me though. It's a bit like the tolling of a bell that just won't stop.



Let's see how people have reacted to her thoughts :

temasek online

Temasek Review

Online Citizen

Onesingaporean

Rockson Tan (by proxy) - this one is priceless. hahhahahahahaha

Let's see what Tin Pei Ling has to say...

Hmm.

Well, what I will say is this - I remember Desmond Lee. We used to call him "The Minister" - not because of his father, but because of the his demeanour - staid, sombre and sincere to the extent of being priestlike.

I'm glad for the people like him entering politics - on both sides of the fence. I'm glad for the people who are willing to do what it takes, to make the changes that need to be made, or to pull an Atticus Finch with the hopes of achieving an aim, even at the cost of a personal loss.

I just can't help wondering this time around though, just who is the underdog here? The public is crying foul - while the rest of us spectate with bated breath.

On blogging and Other Things

I once took my blog down after being stalked by a clinically-diagnosed Schizophrenic I'd never met. I'd dealt with the mentally ill before, mostly in medical school. I understood her condition well (Psychiatry was, strangely, one of the things I really found interesting in med school) and that she couldn't help herself. It didn't help in the least bit to lessen the slowly mounting sense of alarm when the phone was ringing for the xth time, or when the gifts started showing up at the gym I went to. It didn't help when I picked up the phone, and conversations took oddly predictable yet incomprehensible slants, and somewhere in there I felt sorry for, and concerned for - someone else's patient.

I hope she's doing better now.

I tried to restart the blog some time later when things had simmered down. It had been hijacked by a porn site. Laugh.

These days I just can't find the time or will to write, and there's just so much happening in real life...

I ask prospective bright-eyed bushy-tailed hatchlings why they want to study medicine when they could be doing so, so much else.

The answer is always the same - I want to make a difference, I want to help people (or some permutation thereof). Always so rehearsed, and so unconvincing.

I can almost understand why the NUS interviewers asked me what they did : So why do you want to do medicine, aside from all that being nice and saving people shit?

Almost, but not quite. I would never ask that. There's the off chance that this person is actually for real - it happens - and not just in it for the "prestege" or "money". And right now, right here, he/she believes it with his/her heart. So just pause, and wait for the rest of the story. And then I tell them, I'm glad, because this will stay with you.

And if they haven't got a story, they just... want to help people, because.... well... it's good.

Then I inhale, and start telling them about how they'll feel one day in the distant future, watching their friends grow up around them while they languish in career infancy, drowning day to day in multitudes of thankless calls, succumbing slowly to Real Life after the glow fades.

I'm still glad to do what I do. I tell people it's because I like cutting off legs, and in truth part of me does (well, I like doing things well, and I think I do that pretty well... heh). But I much prefer saving legs. I say it's because I like the nature of the operations, and I really, really do. But, well : there's many other things I like too, and I really, really would like to be retired with all the time in the world to write, lounge around, and relax too :)

I've been asked what the point is, since these people will just go back to smoking anyway, and you'll see them again soon, and they'll be dead even sooner.

I guess I just have a story.

Much ado about Nothing

In the aftermath of events still unfolding in Japan it seems almost wrong for everyday, humdrum life to go on. It feels as if we shouldn't... be going about our daily chores, making inane chatter at work, screwing over colleagues for personal gain, stabbing each other in the backs... it just seems so wrong, somehow. And then the weirdos pitch in and start spreading hoax nuclear rain SMSs and make light of a tragedy of monumental proportions, and then self-centered morons write into the straits times complaining about how personally inconvenienced they were by the disaster (SIA where were you etc)... word. People are fucked up. Bigtime.

The Susan Lim scandal has lost momentum; knocked for six it will plod on now-unnoticed to a public that has cast judgement and moved on. Few people are left to care as the smoke clears.

I can't help but wonder what precipitated this bizarre show-and-tell by the Singapore Medical Council. The layman may not be able to discern the trees from the woods, but to an insider... it's even more bewildering. Wood? There's just matchsticks here.

I don't imagine that the court case is going to be cheap. Who will pay for it? Why we will of course - us doctors who pay our annual subscription, wonder what happens to it for a moment, and then stop caring... (ah suddenly the clouds are parting. This is the true destiny of our subscription monies!)

The butterfly effect had started... public mutterings of discontent, of rich and poor, of greed on an unusual scale so at odds with the "noble" field of medicine" were already rippling outwards and building to a crescendo just before the hammer of Mother Nature fell upon Japan and turned the mountain into a molehill.

Like the layman I'm burning for answers too - but to different questions.

I don't care how or why Susan Lim could have asked such outrageous prices. It's easy to understand how someone like Susan Lim could have asked the going prices that she did. Just put yourself in her shoes for an instant.
In her head she was "up there" with the best in the world. The much-touted Medical Hub of singapore had arrived in her mind, and she was the epicenter.

Her corporate website proclaims that common knowledge splattered all over wikipedia, and the web, thanks to unifem and the australian high commission - that she is the first surgeon to perform a successful liver transplant in asia.

Trawl back through time and reality emerges. The first liver transplants in Asia - living donor related (1989) and cadaveric (1964) - were done by the Japanese.

Susan Lim performed the first liver transplant in Singapore - not Asia. And she did it when she was young - in her mid thirties, as a young consultant.

Look still deeper and you will see the names of the three surgeons who were members in the team she "led". All of them Professors, all old enough to be her father (kind of), "assisting" her through one of the most difficult operations known to medicine. And suddenly the picture becomes much, much clearer.

Conjecture? A favourite amongst favourites, public recognition, going private.
Sounds a bit like a Taiwanese medical drama...

I don't know Dr Lim personally, and I don't think I'd care to after reading her reproduction of erroneous claims to regional fame.

She strikes me as someone driven to market herself at all costs. Someone selfish and self-centered.

This is what the public resentment really centered about - doctors aren't meant to be selfish or money-faced! They swore the Hippocratic oath! They're all meant to be paupers and Saints who toil without rest, and live hand to mouth until they die from it!!

Well fuck you. Doctors are people too, same as you are. And if you had the means to make big bucks - and if you ran a big business involving marketing yourself - you'd probably go the same way Susan Lim did. Don't kid yourself.

Granted, a larger proportion of medics don't than average, and not through want of talent. Medicine does weed out the oddballs that prioritize the needs of others over their own, and are willing to try to help alleviate suffering by forgoing some of their own pleasures of the flesh. That's what the "rigorous selection" is for, innit? But no system is perfect... and bear in mind that it's still just a job. In the same way that not all politicians are noble, not all models brainless, and not all lawyers incorrigible - not all doctors are blathering goody two-shoes who buy breakfast for their impoverished C-class patients every day and serve it on a silver platter, balanced precariously on bended knee.

Having said that, Dr Lim achieved her aim - she got to where she was through hard work and aggressive marketing and one (or two?) misleading claims - but this doesn't detract from the act that she got There. People came to her - rich people, like the Bruneian Sultanate. That alone shouts volumes about her regional reputation.

And frankly, if she was on the level - world best, patronized by royalty - then she had every damn right to charge the way she did. The UK surgeon who charged five hundred thousand pounds for two days consultation with this same patient -- two days -- why isn't anyone wondering about that? Why - because the white man must have been a world expert of course. His time was valuable.

So too, was Susan Lim's. She is an expert - in her patients' eyes - as much a world expert as Woffles Wu. So she charged tens of millions of dollars - so what? This was a very demanding patient that treated her more as a personal retainer than a consultant surgeon. The patient-doctor relationship was skewed towards client-consumer from the start. Respect appeared to be a one-way street. The patient demanded, the patient received.

Dr Lim claims she made her fees clear to her patient beforehand. The patient spent years prior to her death paying exorbitant fees apparently without complaint. This appears to corroborate those claims.

And everyone knows that when you do favours for asian royalty you get kickbacks. Perhaps Dr Lim doesn't have a thing for camels, Maserati's or expensive wine and just likes cold hard cash - we'll never know. This sort of stuff doesn't come out in court.

At the end of the day, this was a mutual agreement between doctor and patient. You treat me like a servant, take me away from work, and endanger my eyes - well sod you, I'll charge you like the royalty you are. (Just doing a House.)

Dr Lim did what all of us wish we could when dealing with our own patients from hell. And I kind-of applaud her, while hating her for it at the same time. I can empathize with her, even though I don't agree and certainly wouldn't have done it myself.

Was what she did so wrong? Step away from your pre (mis) conceptions of saints and doctors, and Hippocratic oaths (which just says we shall do no harm... and well. Taking money from a willing, very, very rich donor isn't exactly doing harm... Oh but wait, but the patient died! Surely that's evidence of harm! Think again. The woman had cancer. She was dying from the get-go. A recurrence? Was there curative surgery that... failed? Bollocks. You get cancer, you get cured, it comes back - them's the breaks. That's just bad luck and statistics, not a failure of the physician.) and look at it anew with unbiased eyes, from the view of a healthcare professional.

Does Susan deserve to be "disciplined" for entering into a mutual agreement with a willing patient? Did she deceive the patient in any way? Is it even overcharging when your patient is pre-warned about exorbitant costs and wants to go ahead? Would anyone bat an eye if Dr Lim had been a lawyer, or a businesswoman? Or a minister?

How much do the doctors-turned-ministers earn before they "fall from grace" and accept their paycuts to don the white short-sleeved shirt and long pants again? How do you think they were earning such big bucks before signing up for their one true calling? By seeing thousands of patients a day -- or charging big bucks to a privileged few?

And why, why on earth would the SMC build a case against it's own public image?

That's what bugs me the most. Why in the blue blazers would the one organization that was created with the sole purpose of protecting the profession seek to encite the public against itself? What could it have taken to bring this about?

One more thing.

1) Susan Lim sends bill to Royal family
2) Royal family complains to Ministry of Health
3) Ministry of Health assigns Singapore Medical Council to mediate
4) SMC raises disciplinary hearing
5) Hearing dissolved - allegations of prejudice
6) Susan Lim brings SMC to court to prevent hearing being raised again
7) Press involved

Hmm. Which one doesn't quite fit in there, one wonders? Which ones are closed-door events, and which open to the public?

Let's take a look at the key players.

Salma Khalik and Prof Satku aren't strangers to each other. Let's see what Prof Satku had to say about her reporting style, even if it was oblique. Not... exactly the best of friends, eh.

I've seen it said on forums that poor Prof Satku is a victim himself, removed from his position of power as Registrar to the SMC (hmm. once director medical services. Registrar must be a step up?) because the Men in White are staging some kind of cover up. The poor deluded fools.

Perhaps what Susan Lim herself has to say about Prof Satku can shed some light on his abrupt reassignment of duties, and why a new position - non-constitutional - was created and legalized expressly for this trial.

Does anybody smell a warm, fuzzy, long-tailed mammal?

In Fairness

While talking to the other half it struck me that no, it wasn't always like this. Being a doctor wasn't always rough - I enjoyed my housemanship.

Pause. Crickets chirping, and somewhere in the background the sound of locally-trained claws coming unsheathed.

Sure, I did my housemanship overseas where everyone's a wimp and nobody there works as hard as we do here, etcetcetc, people actually go out and drink on wednesday evenings and show up bleary eyed the next day for work, shock horror.

And horror of horrors we started work at 8.30 am, long after sunrise (especially in summer when the sun came up at four).

No horror stories there of people trudging to work at 6 am and leaving at 9-10 pm, sometimes midnight. No whinging about the tedium of running around ad nauseum arranging scans and taking bloods etcetc.

The thing is, we did work till late - not every day perhaps, but often enough. I remember well still being on the wards at 8.30 pm and bumping into my urology sister Cid who was also working past her hours and laughing about it. I remember how the other housemen used to be there too, and when the NHS started enforcing the calman act how we used to change into civvies and go on working.

There was something different about the feel of it all; we did it for our patients, whom we knew well and actually gave a damn about, and for the sense of cameraderie we felt for each other. We were happy.

It's the whole rat in an electrified cage thingie; the houserats here are trapped against their will receiving electric shocks unpredictably. Depression sets in.

We dictated our own suffering, we opted when to suffer and when not to, and we justified our pain in our heads as sacrifice, for other people so they wouldn't have to hurt so much.

I was happy as an SHO too, working crazy shifts that had me walking home in the wee hours past frozen lakes and leaving footprints in the snow. Same story.

The truth is being a doctor isn't all doom and gloom, and it isn't all drudgery and tedium.

I watch my housemen constantly losing their struggle day to day, and I watch myself occasionally berating them for not getting things done quickly enough, and I can't help but think maybe it doesn't have to be like this... Maybe there's some way to fix this mess. Maybe we could start work a little later, maybe enforce laws to restrict doctors' working hours -- transforming overtime into an act of volunteerism and selflessness. Maybe we'd be surprised at how good we really can be, at heart... instead of dictating that anyone failing to make the cut as a tireless mule is a "failure". But as each day passes yesteryear fades in memory and I begin to forget the way it used to be...

I'm still happy being a doctor, from time to time. I love stitching little things together, and I love being senselessly irradiated as I twiddle some wire down a long, narrow tube. But there's the crux - "from time to time".

In fairness, maybe it's possible to float through medicine on goodwill, selflessness and happy thoughts -- just not here, not now.

The Retelling

Talking to a friend of a friend the other day, or rather was being plied by him for answers about what it was like to be a doctor.

Listening to him tell me he wants to make a difference, and help where he can, when he can puts me in mind of a different time and place...

I was him once, all earnesty and bright eyed, waggy-tailed sincerity. An army of old men telling me to be prepared - do you really really want this; you must really want this, because the sky's the limit but the sky has a low ceiling... a legion of old men couldn't dampen my hopes.

A panel of four interviewers listening intently while I tell them just Why; tell them about how my father (whom I love a great deal but just can't bring myself to show it - it's just how I was raised and who I am now) treated my grandmother in her last days as she succumbed slowly and painfully to the ravages of hepatocellular carcinoma; watching his stoic silence as he put up her morphine, watching how he made the long trek across the island every day to be there with her after work... watching as the life drained out of both of them day by day made me realise I wanted to be like him; I wanted to be Good. Perhaps it showed in my eyes as I babbled incoherently, who knows : but the interview panels wanted me. And I wanted them, because they didn't throw me tired, bitter lines like "Why Do you Want to be a Doctor aside from Saving lives and All that Crap"... but simply wanted to know about me, and why I wanted what I did, as much as I did.

Cut back to present day, and I'm telling him : this fuzzy feeling you have right now isn't enough; it will melt away - it's inevitable. We can't be that person all the time, and as time passes you'll be that person less and less. You need something more... you just have to really, really want this; i'm mindful how I was told the same thing once upon a lifetime ago, and I thought secretly, but I'm not like you, I'll be different... and I secretly pitied the doctor on the other side of the conversation intimating that he was burning out; I'm not like you, I won't falter... I know I really, really want this.

And I realise how futile it all is; or perhaps I'm just choosing the words wrong.

So for those of you hopeful bunnies for whom its not too late, and for the rest who I would like to share this with - S, I wish I could have told you this since you told me what being a vet was like, and Agent J, who's busy saving the world right now and loves me enough to feel outraged on my behalf...

Being a doctor is getting that phone call after 3 gruelling hours of medical statistics made Hard (ie taught all wrong) and racing back to hospital at ten pm to fly into OT. Not because you want to impress the boss, or even because of a sense of duty to help him out while he vanquishes the monster, nor even because you owe it to this poor patient whose liver just keeps packing up post liver transplant, but because you need to know what went wrong, and you need to learn how to fix it; because you need to be there, for no particular reason. You just do.

Being a doctor is scrubbing out at one am, and gazing glassy eyed at the desolate, deserted road stretching out before you.

Getting home and eating cold carbonara out of the fridge because you're so damn hungry you can't wait the two minutes it takes to nuke it back to life. And marvelling at how divine it tastes - cream is such a wonderful, wonderful thing!

Dropping your clothes in a trail behind you like Hansel and Gretal did (well, perhaps those were tidbits and not clothes, but clothes would make for a more exciting story, no?) as you meander towards the toilet (say hello, late-night cockroach) to wash the sebum off your face and out of your eyes.

Flopping into bed and picking up that biostats book because time is short, and tomorrow is another day - and thinking Thank God this is me having an Easy Time, imagine if I was full-time right now.

And yet feeling - yes, this is what I want. It sucks ass, and some of my friends are being paid triple my salary and don't have to fork out thousands of dollars for radiation protection wear. For high powered operating binocular spectacles. For all sorts of things the government will shriek at when I try to claim it from them.
And said friends are working maybe half the total number of hours I am each week.

But it doesn't matter, because this is... me.

Legacy

The thing about blogs is that they immortalize us.

The last time I spoke to Slinky she was still with The Boy; she was worrying about the future and where things were going. That's how long ago it was.

Reading Slinky's posts about Labradorboy, and Captain Starlight (although it gets too a bit too intimate and iccky for comfort) I can't help but marvel at how much happened in the span of a year.

The Straits Times article didn't make any mention of Celina Chua being a blogger; I suppose being a straight cut-and-paste job from the Australian newspiece it wouldn't have done...

The thing about blogs is they immortalize us - but usually only an impression of us, whether it be that part we want to be best known for, or whether it be that part in us that we wish existed, or want the world to believe really exists... Online personas are like that... Look over a long enough period of time and the cracks in the mask start to show.

Sometimes we write down what we really think, sometimes we hide what we think for fear of persecution or ridicule. For some they're vehicles to advertise their "faces" or their lifestyles, but for some others they're private journals laid bare to the world for all to see.

I guess, as House puts it, everybody lies. And almost everybody has an agenda.

But once in a while people just write - about their lives, their loves, their pasts and presents, their doubts about the future and the things that make them laugh and cry... and yes, perhaps as some of Singapore's "top bloggers" are wont to say, these people aren't really bloggers.

Perhaps they're something else, because who knows what a blogger really is in these crazy mixed-up days?

These people, the way they write... their blogs pay them tribute after they're gone. They capture their essence in some way, and let you know who they really were. They make you feel and empathise with the writers, even through that one-way looking glass of yesterday. And perhaps they make you wish you had known the writer a little better.

And I realize again what I realized a while ago: that even though I had not been happy in years, even though I am chronically sleep-deprived and exams are in two weeks, even though I'm always broke and I have no idea where my future is headed, I am happy with my life. -- Slinky, Saturday October 31, 2009

I'm glad you were, Slinky. I'm glad.
Be well, now.

Farewell

I first met her online, in the immediate aftermath of the last breakup when I was feeling a little distraught and betrayed, and the gradual creeping realization that I'd been a terrible judge of character - of my own volition - and loved and trusted someone who I shouldn't even have been friends with was starting to set in.
I was at turns bitter, disappointed and resigned, and was spending a lot of time hanging around the lab working on a project because of the quiet and solitude it offered me away from trivial thoughts of red flags that I had ignored, balances in relationships, people taking other people for granted, and whether it was inevitable to stray when absolute trust was gifted; I needed to do.
I think it was a Sunday afternoon; I remember the evening sun streaming in. I messaged her on a whim, she was one of the strangers on my gchat, friend of a friend, and author of a blog which I liked to visit from time to time.
She was studying for an exam - either path or physiology - but took the time out to listen and offer what comfort she could. We spoke in between doing our work far past sundown and got to know each other. I remember she was funny, humorous and a good listener. And that she was happy - so happy - to be chasing down her dream of becoming a veterinarian, under all the growly resentment of having to mug for the malignant "basic" science exam-monsters that I once slew myself.
Everyday life got in the way, and we spoke less and less frequently. She flew back once and rang me up, and we came within a hair's breadth of meeting up for a coffee, but our schedules were just a little too busy and it didn't quite happen.
Life went on, and she became The Person who Posted Funny Snips about Being Assaulted by Horses and other Farm Animals on my facebook wall. I took it for granted that she would always be there, and that we would meet someday in the distant future; that she was a stone's throw away on gchat and sms. I treated her the way I treat most of my friends, which is poorly.

I saw the post by one of our mutual friends on facebook yesterday while I was dozing off in the tea room waiting for the operation to start; I followed the link and read the newspaper article. And somewhere along the way the pieces finally fell into place, in my muggy post-call, food-deprived head. My God, this person - this faintly familiar firstnamelastname - was Her. Double whammy, She was dead.

Dead in the worst possible way, at the prime of her life, in a trivial moment that cost her her life, driving her family back to the airport, the unlucky sole non-survivor of a tragic accident, dying on site just as help arrived with her family incapacitated all around her. Five weeks away from graduation, from attaining her dream.

Dead and gone. Her facebook wall is flooding over with sadness, with people pouring out their grief about missing her and hoping that she rests in peace; that's what bubbly, cheerful, brave people get when they die.

It's just not enough.
What they deserve is life; to be going on doing all the things that we loved and knew she loved doing.

Goodbye Slinky. We never met you and I, face to face, but you were one of the few good people I'm honoured to call "friend".

I'll miss you.

Apathy

Life passes by, and suddenly it seems I'm teetering on the brink of senility forgetting which day of the week it is. Give me another minute and I'll be on the other side of the looking glass, the guy in the hospital bed wondering why he's in hospital as hypoxia eats away the last vestiges of his sense and sensibility.

I remember what it was like to be a houseman; I really do. And I remember all the times I spent with L and A and D (hmm. my three closest friends. Left anterior descending... laugh) wondering about what we would be when we grew up.

I remember falling in... like... (because first reaction's always denial when it's real innit) with ***** surgery, impressionable baby houseman that I was. But there were so many possibilities then, and we all of us fancied ourselves a little bit of a House ourselves, a little bit of a Carter... Even bits physician and cool ER physician. No committments, just trial and error, a series of torrid affairs and blah relationships with subdisciplines, a life squandered. Come full circle, here I am again for real now after shopping thrice around the block for something else I could fall in like with and coming up nearly empty.

There are a few things I like, and they center about fine work; not because I fancy myself an artist but because there's something wonderful about sitting down and losing a few hours of your life doing something that feels slightly beyond your grasp and capabilities... and getting there against your own expectations.

Cruel irony then that thanks to the boss's excellent teaching I found myself flying through a laparoscopic operation today when in contrast I spent the rest of the day labouring on my own through much smaller operations.

All very boring.

Take home message, time flies, buildings collapse, people die, bad shit happens, and we turn into old farts.

I'm becoming a stereotype, blogging about work all the time. Work is becoming my life. Everything I feared, once upon a lifetime ago when I was roaming the streets of London as a free man are here and now.

And strangely, it's so very hard to care.

******

The other half is following xx's blog, and keeping me posted about her wedding and how her posts are blatent advertorials, her comments about expecting only the best if she has to pay for stuff because everything's given to her free these days, the rags to riches fairytale and forgotten roots, etcetcetc.

I find myself saying, well she wanted all this and she got it; good for her... and finding it... somehow unsurprising. Hard to really care.

And, well, really. Good for her... on to more interesting news...

sigh

It's been a while.

Enough time to witness some bad things go down and wonder about healthcare and doctors in general in sunnyland. And to watch my boss recoil for fear of rocking the boat / repeating previously failed outcomes, and realise that perhaps one day i'll be like that too.

Listening to someone tell me today that I ought to complain to MOM about my seven day work week I felt like laughing.

And just tonight....

sitting down all ready for dinner, then the telephone call... we want to send for your case; we'll call you when we're sending ok?

hmm enough time for a shower then.

shower... riing.... hello? your patient is in OT now.

fume.
helter skelter pell mell back to work (twenty min, record time) dash in to OT, and .. voila, the gas men are only just wheeling the patient in to start the spinal.

sigh.

Without a clue

Yesterday's news was all about a diplomat who allegedly ran down three people, killing one. Mainstream media went orgasmic, going to the extent of casting a verdict even before the trial had commenced (and in all likelihood will never begin thanks to diplomatic immunity). It was the kind of behaviour you'd expect from bloggers acting amateur sleuths (nancy drew without a clue) but not from people tasked with some form of responsible journalism. It reminded me how our supposed bastion of information is at the end of the day just another tabloid catering to the whims of a few.

Found out about the incident retrogradely; one of the consultants mentioned in passing on new year's eve that someone was getting the "gift of life" in emergency theater (ie a transplant). Didn't take much to connect the dots as more information came to light.

Badness begets badness. The perp who hit and ran deserves to be brought to justice whoever it was. But the lynch mob jumping the gun and pointing fingers with bloggers at the helm ought to be brought to task too.

The reality of the world is that neither will happen. Such is life.

*****

The Wheel of Time

A cathartic moment as I was bringing a couple of the fledglings through a sebaceous cyst excision the other day...

I remember back when I was first starting out at an un-named district general hospital, and how the MO(S) used to talk me through the op before each op, and then observe me struggling and take over for a bit to show me a trick or two. I still feel like the same inept rookie sometimes, even doing something as simple as an excision biopsy - but I've learnt a few tricks through the years to make things easier for myself, and I know enough to guide my baby MOs back on track when they're so certain that sebaceous cyst with that almost unnoticeable scar-distorted punctum is a lipoma...

... and then it struck me that I'm the other guy now. Perhaps more patient than KR had been, or perhaps less. Perhaps spoon-feeding too much, or perhaps taking over too-often. I don't know. It doesn't really matter anyhow.

I thought to myself as I drove home how it feels like I learnt most of my basic surgical techniques in day surgery a lifetime ago, prompted along by veteran nurses itching to go home, and how lucky the kids are nowadays that we make it a point to always be there with them till they're ready to fly solo... and then I realise that one day those kids will probably be feeling the same way too, driving home from a long day's work, or not.

Learning how to do angioplasties today from M, realizing that one day I might well be the one teaching the rookie how to do something as basic as set a peripherally-inserted-central-line... something he said sank in through my haze of trying to look calm in the midst of my (hopefully) concealed panic and bewilderment at an unfamiliar routine - "they come back. They always come back."

He was talking about stenoses reoccurring in blood vessels, in arteries clogging up again after ballooning.

But somewhere in the disjoint mess of my head I know he's right - everything comes back in the end. Everything comes full circle. Life goes on, the scripts keep writing and unwriting themselves.

For Life

"I've slept with a few hot chicks in my time..." he said.

"How about you? How many girls have you fucked?"

I looked at him, and thought : this is him when he's sober?

"You don't need my stamp of approval." I said.

"Damn right I don't, I've already got her, and I'm marryig her" he said, missing the point entirely.

It turns my stomach sometimes, interacting with elements of "high society" in Singapore.

*****
I've made some monumental mistakes in my time, loved people I shouldn't have bothered with and hurt people I loved; told a few misguided then-white lies that have caused too much pain, spoken too bluntly and caused more.
I remember things wrong, I'm emotional, I'm fraught with fallibility.

But if there's one mistake I don't ever want to make, it's to rush headlong into a marriage destined for disaster.
Because marriage is for life... not for-ever, but for life. For a shared life that ought to be special to two people.

Not for anything else, wealth, fame or power. But for life.

What's Hot and What's Not

Hypothetical scenario.
Imagine a bloke. Goes out clubbing to meet girls. Meets and flirts with a lot of girls, gets it on with one or two, hooks up with one, gets her believing that they're committed to each other.
After an undefined and variable while decides that he is stuck in a rut, starts going clubbing and flirting with other girls again ("acting single", a nurse I knew once put it) even while continuing to claim love and committment to the first girl, perhaps gets it on with one or two, then loses the first girl for the second. Feels no remorse about it, because after all he didn't love the first girl, and it's not really cheating right... and it's all about me! Repeat cycle ad-nauseum, over and over again.

What words come to mind?
Certainly to mine, all sorts of unpleasant ones.

Now turn it all on its head.

The other half has been following the blog of a girl who's just like that. (of course, she goes out with blokes and not birds.) She thinks that must make the girl hot.
I guess it's one of those societal stereotypes...

Sometimes we have the same discussion about one of her some-kind-of-friends who is kinda skanky and puts out a lot; boasts to her about being fingered by strangers in public etc, and for some crazy reason the other half thinks makes her hot.

I look at said friend and see someone who just isn't hot. She's just... cheap. And a little sad. I feel a little sad for her.

It's the same with the girl in the story above. Sad.

These people call themselves hot. They desperately want to think of themselves as hot, and they want the world to see them that way too.
But at heart they're unhappy with themselves. They're insecure. They're just... ill.

It strikes me as just a little funny, and unfair in an odd way that we automatically peg guys who "play" as bastards, but girls who "play"... must be hot to play. Men get moral judgements, women get assumptions into the way they look.

Hot isn't about being able to sleep with a lot of men at once, or to turn many of them over like an autumn gust of wind turns over leaves.

You can be ugly. Short. Fat. Have weird cheekbones. A weird nose. Bad teeth. And still sleep with a lot of men / women, or run through girl/boy friends like water. If you're undiscerning, if you're cheap, if you don't really care... the point is. If you don't treat relationships like they're special. If you don't treat your partners like they're special. If you only treat yourself like you're special. Then you get all that...

You don't have to be hot. Just very, very self-centered.

Hot is... simply about being hot.

Hot is in the way a girl's eyes light up when she laughs, the way her hair falls across her face, the shape of her lips, the way she moves. Perhaps the shape of her body, the length of her legs, perhaps the way she speaks.

Hot is something unconscious that you simply have, or that you learnt, or that you were born with.

I never thought either of the two girls above were hot. I thought one of them was attractive, once - but that was because she wore an elaborate mask, built entirely out of lies.

*********
It's easy to play; it's easy to run through women like water, or men like a hot knife through butter. You just have to show that you want to play, and that you don't really... care. You just have to... put out.

S wanted me to play; she wanted me to be the guy in the book. She thought I might need lessons, that it would do something good for my self confidence.

She didn't quite get it right.

I don't need to play. I don't even want to.
One of J's friends - an image consultant who creates "players" - was rather acerbic when she was asked to work on me, once upon a lifetime ago. She said but you're already right, just the way you are...

I know I could play; it would be so very, very easy. I know the words; I know how to time the little smiles, I know how to make that kind of eye contact. I know how to reach out and touch at just the right moment, I know how to lie.

I don't want to. It wouldn't... give me anything worth remembering.

******
A friend of mine once told me how lonely he was; he was fucking a different girl almost every night. He went out clubbing, and got drunk, and the half-drunk girls thought he was kinda cute; best of all he gave off the vibe - I'm not serious, I don't want to know you, I just want a fuck.

And so he got fucked; it was that simple. Some of it's mind games, some of the girls wanted to "win", to change him. Some of them just wanted to fuck, and recognised a commitment free lay when they saw him. He got lots of action with all sorts of chicks, some hot, some not, some rather... cough... underaged.

On the surface he was happy, carefree, well-fucked.

Sometimes he'd confide in me though, and that was when he'd talk about how he hated his life, how little meaning it all had, how he missed The Girl, the one girl he went so crazy about he wrote poetry - imagine that! - and how they spent all summer together and didn't touch that much, and how he fell in love with her.

******

Fucking a stranger isn't a special memory. Regardless of how hot he or she was.

Special memories aren't the ones that are just about "me, me me."

Special memories are the ones that are shared. The things that really give us a sense of fulfillment are the things we share, the moments when we touch the lives of others, and have our own lives touched in return. Moments of actually giving a damn about someone other than yourself.

I think human beings are hard-wired that way; I think it all ties in with that unspoken fear of being alone, living alone, dying alone without meaning anything to anyone else. Of passing through this life unremembered, and being forgotten.

Bad Apples

Much ado about nothing :

Singapore's best choice for the much-coveted crown of Miss Singapore World apparently goes, quite simply, to the best-looking contestant. (bad run this year, hey)

Nevermind if she turns out to have kleptomaniac tendancies and an almost-criminal-conviction for fraud waived for the "fact" that she's schizophrenic to boot.

Aside from the unspoken but obvious point that Sandra Bullock made a lifetime ago ("...world peace?") that International Beauty Queens are as much about an idea as an appearance... about quasi-diplomacy and representation on a world-stage of... many things... about choosing someone with that something extra special from a crowd of incredibly beautiful women, well.

Ris Low isn't exactly beautiful. Perhaps good-looking at best (though not to my eye).
Nor does she possess a heart of gold (it takes an even measure of self-centredness, malice, and sheer stupidity to try to pull off credit card fraud on an ex-customer, methinks) and she doesn't have an impeccable integrity, or, now, even the semblance of one.
She doesn't have poise and grace (most commonly conveyed through cool-headedness, wit, and clear diction)

In short, she doesn't have anything remotely special, that might make her stand half a chance in a crowd full of women possessing at least some measure of the above - who have been SELECTED by their countries BECAUSE they possess qualities that stand out.

I can only hazard how she won her crown (hint, it involves a lot of Boomzing).

I don't know. I think I'd choose a well-spoken plain-Jane (plain but not ugly of course) with grace, poise, wit, intelligence, kindness and... a lack of a criminal record... to represent Singapore any day over a... badly-spoken plain-Jane with... none of the above.

I might even go with the first girl over a beautiful but inarticulate, self-centered, graceless, witless and stupid ah-lian... simply because it's all about putting our best foot forwards to the world. As opposed to our worst.

Yes, it's choosing to represent Singapore in a certain light, in a way that perhaps it's not. Our people aren't well-spoken (thank you, Beyonce) as a whole. Yes, it's all wayang.

But every other country out there is doing just the same. And none of those girls who'll appear on stage on the fateful day looks remotely like the average girl from her country, nor sounds or thinks like them. And none of them has a known criminal record.

Because it's impossible to fall in love with someone who is grasping, selfish and deceitful, if even for an instant, sitting at a desk with three other judges - or sitting halfway across the world in a sofa with the remote in your hand.

And that's what Miss World is about - the paragon of womanhood that all humanity falls in love with.

*****
People who lie, who cheat, who steal, who use, who hurt - selfish, self-serving people.
They are common. They are all around. They are the monsters within us set free by owners who love themselves too much.

*****
Talking to a friend the other night we found ourselves agreeing that you must never try to see the best in some people. And that it becomes too late if it gets personal.

I used to want to believe in people. I thought that perhaps being placed in positions of responsibility over other people made people think a certain way, and that maybe it was because people weren't doing much to contribute to other people's lives that they became self-centered and selfish enough to hurt others for their self-gain. Maybe if they did, they would change for the better. I used to think that criminals, given half a chance could be reformed, and that you can't help being born the way you look, the parents you were born to, the neighbourhood you grew up in... maybe if things were different then, well who knows.

I realise now that I was making excuses for them.

The truth is what I learnt living and working in London for the many years that I did.

Some people just steal because they want to - because it gives them a sense of achievement.
Some people just want so much to win, or to be loved, or to be worshipped... anything at all -- that they are willing to lie, cheat, or hurt others for their own gain.

That's just the way it goes.

Some people are just bad. You can't help them - and they don't want to be helped anyway - they want to be bad. And You must never try to see the best in them. Because if you do and it gets personal, then it's too late.

Other people are just ill. You can't help them. They will die ill. That's just the way it is.

Said friend says he can suss out within minutes who is "real" and who is not, and that the real people are few and far between.

They are; and they are precious.

These are people we are the richer for knowing, for however long we know them.
These are people who were good, or who chose to try to be good, or who turned good from bad - because they wanted to.

These are people to keep close; these are people worth remembering.

I came to the (now obvious) cathartic conclusion when I was very young, perhaps ten or so - that we only live life once. And then I had a host of existential worries about the lack of meaning of life; the lack of a reason for life at all, for order in a world doomed to chaos, for darkness in a world of fading light. I felt an overwhelming need to live my life "right", to tread carefully in places of light and avoid the darkness, to never take a step wrong. I was afraid that the darkness would infect and take some meaning away from who I thought of as "me". I thought that in that final moment just before we died... in that moment when we thought back and remembered our pasts, that that would be the clincher. That would be when I knew whether my life had meant anything to me, or not, or whether I had wasted and cheapened it.

Today I still think that the meaning in life is in how we live it. And I know first-hand that the darkness does rub off on me. Perhaps it does detract from some of my life's meaning, perhaps the bad people steal some of it away for themselves.

How we remember it is entirely up to us.

We can choose to remember the good people, and to not dwell on the bad. To remember the people who gave us truths, and forget the ones who lied to us.

******
Sometimes the other half worries that I might still love my past.

Perhaps it was because I was badly hurt when I met her, and having never been betrayed herself she equates the pain and confusion I felt then with love. I was "emo", and
unhappy.

Two of my ex girlfriends lied to and cheated on me.

One had the decency to come clean about it to me; the other didn't have the decency to even admit it to herself.
It hurt me both times, a lot. And it taught me something - about how to react to betrayal, I think. I'm still not quite sure. But it made a few things clearer in my head.

The reasons it hurts when lies start becoming exposed are - as they like to say in medicine - multifactorial. Firstly it shows you just how bad a judge of character you have been - these were bad people, not just at a moment in time but since they were born, the telltale clues were all there all along; Secondly it leaves you wondering just where and when truth ended and falsehood began - or if there was ever any truth at all. Lastly it makes you feel like your life has been cheapened, and some meaning taken away from you.

It's a different feeling to just breaking up with someone on honest terms. It's more than just disappointment, and it has nothing to do with residual love.

It's bad. Evil, almost.

The thing that lingers in your heart and mind isn't the person, but the betrayal; the pain they wrought on someone else without care - while claiming they loved them.

The people are easy to forget; they were betrayers and can never be trusted again. People like this are no good for friendship - much less love.

I made the mistake of trying to be "good" and to do the right thing and find forgiveness in my heart both times. Once I wound up being infected by the darkness and telling what I thought were white lies in the process.

Ironically in the immediate aftermath of the later-day ex I reestablished - if only for a while - contact with the "old testament"-ex and it was her words : these things (ie girls betraying) happen to you because you are too weak - which made me realise just how these people think. (and had me feeling "dirty" for even bothing to reply to that ex again)

How blind they are to the people around them. It takes infinitely more strength to live for someone else than to live for yourself; to inconvenience yourself for their benefit; to back down when you are right and they are wrong. How full of conceit and twisted they must be to feel that things like this are about the strong and the weak, and to borrow a phrase from Ris Low - "all about me!" (...Boomz)

I realised then that the solution is neither forgiveness, nor hatred, nor hoping for karmic retribution in the future, nor being assimilated and going rogue in return.

The solution is moving on and away, forgetting the past. Re-minisce, no more.

Changes

One of the peculiarities of the singaporean healthcare system is the "black tag". Scaling the rungs of the responsibilitity-ladder earns you a nondescript black name badge that looks suspiciously similar to the low-cost primary school "monitor" tags we used to get as kids. People invariably wear them, it's a sort-of status-symbol cum insignia of "rank" - donning the tag confers on the wearer some form of intangible power which most patients and relatives probably don't know - much less care - about, but which identifies you to another doctor as a "senior" doctor.

The irony is that the nametags for junior doctors are actually kind of nice - sure, the hospital logo tends to rub off over time, but it's actually aesthetically quite appealing.

I've been watching one of my colleagues making the switch to his black tag with a little amusement; shortly after passing his surgical exam he - in typical fashion for him - took to wearing his new badge (almost with... wild abandon...) after his previous badge ostensibly "went missing" in his bosses car. Nevermind that he's wearing the trappings without having to don the associated mantle of responsibility of registrarship... the tag makes him happy, and well, we all share his happiness at taking that step towards the rest of his life. We all know how proud he is of, well, himself. :)

I've been slowly suffocating over the past fortnight after abruptly turning into the registrar-in-lieu for my team, our previous registrar having taken the opportunity to scamper for freedom once I swapped into her team. I don't begrudge her her holiday - I've been doing this a mere fortnight and I'm nearly running on empty... I can't begin to imagine how tired she must be after six months on the job... and I knew what I was in for when I decided to commit my life to my subspecialty. Still... the body is tired, the joints actually hurt (gee) and my back is aching... it's all somatisation I know, all in my head. But staying back till eleven in the evening post-call to chop off bits of my patients because there's nobody else who can do it, and because if I wait too long they're going to die... dozing off multiple times on the drive home... it's sobering.

I'm loth to put on my black tag. I'm not "official" yet, I'm still me. And I'm still weak; I want what little time I have left to zone-out before all this becomes all too real (as it is... right now...) and I can't wait for my reg to come back from her holiday... It's exciting to be handed that instrument that till-now only the consultant would wield intra-op and be told to go ahead and throw that stitch, and it's rewarding to see that anastomosis hold-up. It's.... a little frightening to be told to carry-on without senior support in ops which I've only ever watched or been brought-through once or twice before, but never actually flown solo in... and really rewarding to throw that final stitch and know that my patient ought to be just-fine. And it's humbling to be confronted with a retroperitoneal, retrocaecal appendix and be caught in a dilemma -- to play the registrar you're not-quite-yet and open the retroperitoneum -- or to call for senior support because if anything goes wrong you're still technically a junior - and realise that you're really not all that brave after all.

I guess I'm different from The Gentleman. I'll wear my blocky black tag when I have to - when I'm taking my team on the round when maybe, just maybe it makes that much of a difference when I'm doing battle with that nice old irish man's ex-SPG battleaxe of a wife who's inconsiderately called me out of operating theater just so she can try to browbeat me into keeping him in hospital - against medical advice and against his own wishes - because she needs time to formulate a concerted campaign in her quest to lodge a complaint about the ward nurses. But in between, well, I really like my old tag, and I still like cutting out little tiny skin lumps and creating cosmetically pleasing scars in the quiet sanctitude of the day-surgery OT making small talk with my nurses and patients.

Freedom

Words of wisdom to the inexperienced : never argue with your examiners.

Life after the final furlong, aka the membership examination... goes on. Going out for drinks and meals without a textbook in hand comes like a refreshing breeze after a stagnant summer's night; and then the "arrows" come flying thick and fast, and suddenly there's just too much to do all at the same time, amidst preparing to host the local examinations, applying for advanced training, and returning to on-calls.

Speaking of which, after a month's reprieve from calls, the First Call was absolutely exhausting. The body forgets these things, the way a night without any sleep on your feet feels (which is completely different to a night on the floor or in bed reading a textbook in an adrenaline-charged last-minute frenzy). At one point my back, feet and calves hurt so much I began to wonder if perhaps I was experiencing sciatica...

In older news, I remember a colleague and newfound friend de-stressing with me after work and chatting about life in general; for some (mm. some time back, but perhaps it was after we met the chest-drain bottle product rep) he volunteered that pharma reps are generally manipulative people, because in his opinion people self-select into their jobs. Once upon a time I might have argued that maybe it's the other way around; jobs change people. Looking around at my other medical colleagues, at him, and at myself, I realised he was right. People self-select into jobs; not just doctors, lawyers, drug reps... but pretty much every and any one. There's a reason orthopods all drive flashy cars, and why general surgeons don't...

Maybe it's the ones who selected wrong the first time who cross-careers... maybe... just maybe I'd be happy sending people to jail instead. Hmmmm...