Where the streets are made of gold
In Your presence, healed and whole
Let the songs of heaven rise to You alone

No weeping, no hurt or pain
No suffering
You hold me now, You hold me now
No darkness, no sick or lame
No hiding
You hold me now, You hold me now

Today we ended at 12.30pm. I forgot how awesome that feels.

Reviving old literature. Thanks Gareth, and dedicated to Ern.

PART 1 – In which the protagonist is introduced

Once upon a time there lived a young boy named Billy. Billy was five years old. He had blond hair, brown eyes and a cheery disposition.

Today was Billy’s first day of school. Because of this, Billy was very excited. “It’s my first day of school!” he said happily, as he skipped along the pavement holding his mother’s hand. “I’m so excited!”

Billy’s mother smiled down at her son. “Now, now, Billy,” she said, “calm down. We’re almost there.”

Billy continued to frolic in joy and delight. The brightness of his smile blinded a nearby mosquito, which fell to the ground in shock and was squashed by Billy’s foot. But Billy was too excited to notice.

“It’s my first day of school!” he repeated joyfully.

“Indeed it is,” Billy’s mother said proudly. She quickened her pace to match her son’s.

When they finally arrived at school, Billy rushed to his first class, leaving his mother waving wistfully behind. He sat down at the front of the classroom and waited.

And waited.

After five minutes the whole class had arrived. Most were sitting trembling at the back. “Come on up here, children!” said the teacher in a friendly voice. “I won’t bite, you know!”

So the children (apart from Billy, of course) moved cautiously to the front. Billy beamed at them. They stared uncertainly back.

“Today we’ll be doing a little bit of art,” said the teacher cheerfully. “I want you to use these crayons” – she pointed to some crayons – “to draw this apple.” She pointed to an apple. “Doesn’t that sound like fun?”

There was a pregnant pause. The children shuffled their feet.

“Yeah! That sounds great!” said Billy happily. He grabbed some crayons and started drawing. The other children stared.

A large bead of sweat formed on the teacher’s head. She had never encountered a class quite like this one. “Come on, children,” said the teacher in an encouraging tone. “Look at” – she checked her roster – “Billy here. See how fun it is for him?”

Billy beamed again. The other children nodded slowly.

The teacher sighed. It was going to be a long day.

To be continued…

PART 2 – In which the stage is set

Billy skipped down the pavement, a smile affixed on his face as he hummed to himself. What a great day at school! he thought. He broadened his smile and widened his stride.

What a great day at school! he thought again. He flailed his arms about in gladness. The children walking home with him shuffled away nervously.

Eventually Billy turned down the street to his house, waving goodbye to the other children, who smiled uncomfortably back. He scampered along the pavement, pushed open the gate, rushed down the pathway and burst through the door, colliding with his mother who had come to greet him when she had seen him outside.

“Hi mom,” he gasped, and promptly raced up the stairs. His mother blinked. She closed the door delicately and went back to chopping broccoli.

Vegetables, Billy’s mother reflected, are much easier to understand than little boys.

Meanwhile, Billy had raced back down the stairs and was rummaging through the pantry. Billy’s mother was drawn to the racket. She looked at the mess and sighed.

“What are you doing, Billy?” she said.

“I’m looking for a fruit,” he said.

Billy’s mother raised an eyebrow. “Oh?” she said. “Why is that?” Inwardly she was ballooning with excitement. Goodness, she thought, my boy is growing up! Asking for fruit to eat, I’ll say!

“It’s an assignment for school,” Billy said. “I have to draw a fruit.”

Billy’s mother didn’t respond. She was enraptured, her hands clasped together in front of her starry, vacant eyes.

“Uh, mom?” said Billy. “You ok?” He went and fetched a stool to stand on, and then climbed on it and snapped his fingers in front of his mother’s face.

“Wha?” said Billy’s mother, looking wildly around. “Oh… oh. Yes dear, I’m fine.” She smiled. “So which fruit would you like to eat?”

Billy blanched. “Jeez, mom!” he said. “I’m not gonna eat a fruit! Eeeew! I just need to draw it for school!”

Billy’s mother deflated. “Oh,” she said weakly. “Right, of course.”

“So?” Billy said. He crossed his arms and tapped his right foot.

Billy’s mother recovered swiftly. “How about an apple?” she said.

“We did one in class today,” Billy said. “I want something special.”

“An orange?” Billy’s mother said.

“Not original enough,” Billy said.

“A banana?” she said.

“Not colorful enough,” Billy said.

“A grape?”

“Not big enough.”

“A bunch of grapes?”

“Too complicated.”

“A grapefruit?”

“Too big.”

“A strawberry?”

“Too cute.”

“A durian?”

“Too spiky.”

“A kiwi fruit?”

“Too furry.”

“A rambutan?”

“What the heck is that, mom?” Billy said exasperatedly. “Forget it. You’re not helping.” He stormed up to his room to sulk.

Billy’s mother sighed. Still doesn’t know what’s good for him, she thought, and chopped more broccoli.

To be continued…

PART 3 – In which a mystery is revealed

Billy’s eyes were fixed upon the fly buzzing around his head. Ever so slowly, he brought up his electric fly-swatter and positioned it just so… and swung wildly.

He missed.

The fly-swatter hit the coat-rack, which toppled and landed on the bed, which wobbled, causing the basketball to bounce upwards, allowing it to be caught in the ceiling fan, which nearly malfunctioned, nonetheless resulting in the basketball being eviscerated, causing basketball shreds to fly everywhere, knocking over the table lamp, the plushie toy, and the alarm clock. The alarm clock fell to the ground and a battery rolled out, squashing a nearby caterpillar which would later be the key to unlocking the secrets of the universe. Thus humankind never discovered the true meaning of life. But that is another story.

Eureka! Billy suddenly thought. I know! I’ll draw a passionfruit!

Billy was energized by his new idea. He raced down to the fridge and searched its deepest, darkest recesses and finally found what he was looking for – a shiny round passionfruit. He hugged it close to his chest. Billy grabbed a few crayons and a piece of paper and started drawing.

And drawing.

Billy drew the passionfruit for the whole night. And when he went to bed he had dreams of shiny bathtubs flying through space, with singing passionfruits scrubbing themselves inside them and an orange caterpillar bounding across the moon.

The next morning, Billy was in school bright and early. He smiled widely around the classroom until he realized it was empty. So he smiled at the whiteboard, and the tarantula, and the colourful posters.

Ten minutes later, Billy folded his hands and continued smiling.

Class started another half-hour later. By this time the other children had filed in. They quietly seated themselves at the front, although those nearest to Billy looked tense and apprehensive, and those farther away looked relieved. Billy thought this was strange.

“Alright, class!” said the teacher jovially. “Who wants to show me their homework assignment from yesterday?”

“Oooh! Me! Me!” yelled Billy immediately, waving his hand in the air.

“Okay, Billy,” said the teacher, shooting him a disturbed glance. “What have you drawn?”

Billy produced his work with a proud flourish.

“Oh, very nice, Billy,” said the teacher pleasantly. “But… what is it?”

“It’s a passionfruit, ma’am,” Billy said. He flourished his drawing again for good measure.

The students froze. The teacher froze. “Wh-wh-what did you say it was?” she asked, her voice trembling.

“A passionfruit, ma’am,” Billy said again, with emphasis. He beamed proudly.

Slowly, ever so slowly, the teacher’s face turned red and blotchy with anger. “Passionfruit?” she shrieked. “PASSIONFRUIT? HOW DARE YOU SAY PASSIONFRUIT?“

She put her hand on her chest and took a deep breath to calm herself down. “Go immediately to the principal’s office,” she said. She ushered Billy outside the classroom and hastily slammed the door.

Billy was bewildered. He didn’t know what he had done wrong. So he trotted merrily along the hallway until he realized that he didn’t know where the principal’s office was.

Billy scratched his head. He scratched his chin. He also scratched the back of his neck because it was itchy. He then decided that he would just have to find the principal’s office.

Billy wandered and wandered and wandered, until finally he came upon a smooth brown-black wooden door that looked different to all the other doors. “Prin-ci-puls of-ice,” he read from the gold-embossed letters at the top. “Yep! This must be it!” he said happily. He pushed open the door.

The principal was a large, balding man with three double-chins, coarse hairy hands and a big (but friendly) red face. At this moment he was working on solving a difficult logistical problem on his computer. But he turned towards the door immediately when it opened.

“Ah!” he said genially, eyeing his diminutive visitor. “A student! What may I do for you, my lad?”

Billy was happy to see that the principal was so friendly. “Well sir,” he said, “I was in class, see, and-”

“Wait!” the principal interrupted. “Your name is Billy, am I right?”

Billy was surprised. “Why, yessir, it is,” he said. He beamed at the friendly principal.

“I met your mother just yesterday! What a coincidence!” the principal chortled.

“Haha, yes, a cons-dense!” Billy said happily.

The principal laughed. Billy laughed. A bird chirped gaily outside.

“Anyway, back to business,” the principal said, suddenly serious. “What were you trying to say?”

“Oh, right, yessir,” Billy said, remembering his manners. “I was in class and I showed the teacher my drawing of a passionfruit and for some reas-”

The principal cut Billy off. His three double chins convulsed in shock. His large red face turned purple. “D-d-did you just say” – his voice dropped to a whisper – “passionfruit?”

Billy nodded vigorously.

The principal gasped. “Passionfruit?” he cried. “PASSIONFRUIT? HOW DARE YOU SAY PASSIONFRUIT? That’s it! I’m expelling you, you insolent little brat!” The principal lifted his bulky form from his chair, opened the window and single-handedly threw Billy out.

“And never come back!” he yelled, slamming the window shut. Angry spittles of saliva rained all over Billy.

The principal took a deep breath to calm himself down. When he was sufficiently relaxed, he returned to his game of Solitaire.

To be continued…

Unbelievably, for the 2nd week in a row I managed to drag myself out of the house to run 10km. Keep this up and I might actually have some semblance of a healthy lifestyle going. I’m trying to be optimistic.

Psych posting is over and I’m grateful having gone through it. I still remember the first patient I tried to go “cold turkey” on in Gen Med posting… this elderly gentleman who thought he was a 20 year old fireman. I was petrified. This was before I found out you could check the TV screen at the nurses’ station to avoid all the “PSY” patients.

Then in Surg, there was ”a good case to clerk… but she has depression so better not talk to her.” We were afraid we’d make the depression worse, or whatever.

So I started Psych posting apprehensive, not knowing what to expect, since all the patients I had steadfastly been avoiding were now all going to be in the same ward. I admit I must have had a misconception that Psych patients were fragile, and somehow “weaker” than everyone else for breaking under the pressure. And so this minimized the idea of their suffering - made it harder to be sympathetic, to believe and want to help them.

But I was wrong. 4 weeks in Psych humbled me greatly. Each patient was different – each one had his own story to tell; I realized that it didn’t matter how they came to be where they were, that their illnesses were very real. I’d had no understanding of what it means to feel like life is empty and meaningless, like nothing interests you anymore, not being able to sleep or eat or function, always thinking of ending your life, or hearing voices telling you how worthless you are. A man with psychotic depression who saw a ghost every night, telling him to kill himself. A lady who thought her neighbours were out to get her. An alcoholic deeply depressed about his circumstances. Another lady, once a successful professional, now pacing the corridor and incurably anxious. A stick-thin girl who cried when a plate of food was put in front of her. A man with panic disorder and a dependent mother, fearing for his job and livelihood. A lady with OCD, whose family had been pulled in to ”help” in her checking behaviour. A chronic polysubstance abuser, on a secret and special mission. A man with schizophrenia who tried to strangle himself with raffia.

It was sobering. It was also very emotionally exhausting to talk to patients for 1-2 hours at a stretch. So although Psych is incredibly interesting, I don’t think I’m cut out for it. At least I can say that after 4 weeks of exposure, I’m not going to be avoiding any Psych patients now - I know how to handle the 20 year old firemen.

I also come out of Psych convinced that I have a lot of maladaptive personality traits. Paranoid, narcissistic, etc. So that was useful.

The previous week was a good week! Posting to IMH was eye-opening. After all the stories, it turned out to be better than I expected. The day before EOPT we got posted to the Child Guidance Clinic at HPB for an afternoon – very fun, the 2 ADHD kids we saw were very cute. Heh. Gen Med results came out, finally. And EOPT went well.

Alas, my 11 glorious weeks at SGH are now over.

The worst thing about having EOPT today was snapping awake at 6am with a funny feeling in my stomach. Not in the past few years, I think, have I woken up at 6am on Saturday. It’s even worse than med EOPT. This is on top of knowing that Patho CA is soon, and having to watch enviously as others skipped out of SGH, almost every day this past week, with their EOPTs over.

The stars were aligned. I had a nice young (English-speaking!) lady who gave me a straightforward history. My examiners were very friendly (and also very late), which allowed me to think through things properly. I had time to write down nearly everything I know about acute pancreatitis.

Someone should have mentioned that vascular cases are so popular in NUH. 3/8 in my CG. I will miss CG13, they are all great ppl, who laugh at my jokes. Sometimes.

There’s a lot of luck involved, running around the wards.

For example, lipomas are supposed to be fairly common. In 7 weeks of surgery, I have seen one – a 1cmx1cm lipoma on a patient’s foot. I tried to elicit a slip sign and that leetle lump just buried itself out of sight.

This is not for lack of trying. I’ve been going to clinics and scouting the pre-op lists when I can. The closest I came was when I went down to ASC to see this lady who was supposed to have a lipoma on her back. Talked to her for a bit, asked her for some NS advice since she works in CMPB. She said the lump was quite large and was bothering her a lot. I nodded sympathetically and told her that the surgeons here are excellent. Inside me, that depraved medical student was doing cartwheels because she has a big lipoma! Wow!

So I asked her if I could just examine the lump quickly before the op. Sure, she said, why not. I wandered off to get a chaperone, and when I came back… she was handing over her valuables and prepping for op. This is where you submit your story to the “FML” website and people vote and tell you “you totally deserved it.”

This other time, I was in HPB clinic. My reg was seeing a lot of follow-ups so I thought I’d pop over to the consultant’s clinic for a while. I waited outside and walked in after this pleasant-looking Indian gentleman walked out.

He had Dercum’s disease.

Argh.

So, luck. Or Murphy’s law or whatever.

But it’s ok. There are other things that make up for it. Last week during rounds, we passed by this guy who looked like he had a paraumbilical hernia.

Cool, I thought. Never seen a paraumbilical hernia before.

So we went back to look at him after that. Not only did he have a paraumbilical hernia, he also had hepatomegaly, a colostomy bag, bilateral ballotable kidneys, asterixis, and a grade III PSM.

After 7 weeks in surgery, it’s so good to hear a PSM again.

Today we spent the day in OT! It was a histopathology day. Followed a pelvic mass specimen sent for frozen section and got to see how the pathologists work – ended up being a ?dermoid cyst / teratoma. Then they let me cut open a resected colonic segment and GB. Really cool.

I think we’re incredibly lucky to be in SGH surgery.

“If the main purpose of your life is to study hard and be a good doctor, then studies are hard, but life is easy.

But if your life’s calling is to know God and make Him known, then life is hard, and studies are easy.”

- Ninja S, 3rd year medical student

I still wonder what would have happened if I’d done surgery first. Mostly because there’s this nagging feeling that I should have worked harder and learned more during gen med. I slept through that first posting.

Still, there would have been no coconut trees. And no life lessons or interpretations of the true import of death. That alone makes it worthwhile – and there’s always electives.

This past week in urology has been eye-opening. The first day we stayed back for exits, which comprised 2 patients. Yes, 2. Next week more than half the department is going on leave. I mean, in which other specialty are you able to function at less than 50% manpower?

Urology is awesome! They really spend a lot of time with each patient, in the ward or the clinic. The diagnosis is straightforward – stones, infection, or CA. And there are all these cool trans-urethral procedures they do.

Past 2 days especially have been great! Thursday turned out to be an accidental hernia day. Everyone else had decided to crowd up at the OT to watch a radical cystectomy, so I had the clinic to myself in the morning. Straddled 2 rooms and popped by to procedures every once in a while. I bumped into the incredible Dr HH at a cystoscopy, and it so happened the guy had an inguinal hernia as well, so I got an impromptu hernia tutorial. Then went to follow Dr T on call, and it just so happened that she was seeing an incarcerated hernia at A&E.

Yesterday a tutorial was pushed back so I went to the OT early. Watched the last part of a TURP, then hung around as the next patient went under. The anaesthetist was awesome, he let us pump the bag. It was terrifying in the best possible way. I have never felt so acutely before that someone’s life was in my hands.

There is our IHD therapeutic seminar to prep for, case write-ups to do, colorectal to study for next week, patho to mug, script to write, letters to draft… so many things and so little time.

My brother came back Saturday from playing in 74/08. A batchmate just posted some videos on facebook. 3 years, 12 batches later, the first thing that comes to mind is that feeling of weight on my shoulders as my hat started to spiral downwards. Haha.

Totally by accident, now I think I understand a bit better. Humbled and contrite again.