A&E ...

... is what I have spent the last two and a half month doing and to be honest, it is not my favourite department/subject on earth ... the work itself can be tedious (with about an interesting-rate of 1/10), the staffs can be difficult (some are absolutely amazing though), the hours are just plain awful (all those evenings at the department, seeing only the moon) ... I sometimes wonder why I choose to be a clerking machine for 4 months ...

Then, on Friday, we had a stimulation day (where plastic robot acts like patient) and for once, I actually know how to deal with an acutely ill patient. My technique is still pretty poor (I am never going to be a vascular surgeon) but I somehow managed to absorb some knowledge about patient management (and not only when they have psychiatric problems or falls or being confused or generally unwell - yep, I am sent to see such cases all the time).

So maybe, just maybe, these four months are not wasted. Somehow, in the midst of the repetitiveness, I have learnt something ... Maybe there is some goodness to be found among the mundanes ...

The Lives of Others ...

... (German: Das Leben der Anderen) is probably one of the best films I have seen for a long long time ... Watching the lives of those around you, with the ability to affect their densities ~ Will one try to do good? Will one seize the possibility, without guarantee of success? Will love for mankind triumph over national pride? Can one do the right thing, even if one has gone down the wrong path for so long?

There has been a lot of arguments about "The Lives of Others" as some critics felt that it is not reflective of what happened in Eastern Germany with the Stasi force. There has been no documented case of Stasi operative trying to save their subjects. Yet, this is where the beauty of the film lies ... It allows one to believe in the goodness of humankind, even in the darkest of place ...

"Remembering Maria A" by Brecht was read during the film and summarises the possibility of holding onto something good:

"It was a day in that blue month September
Silent beneath the plum trees' slender shade
I held her there
My love, so pale and silent
As if she were a dream that must not fade

Above us in the shining summer heaven
There was a cloud my eyes dwelled long upon
It was quite white and very high above us
Then I looked up
And found that it had gone

And since that day, so many moons in silence
Have swum across the sky and gone below
The plum trees surely have been chopped for firewood
And if you ask, how does that love seem now
I must admit, I really can't remember
And yet I know what you are trying to say
But what her face was like, I know no longer
I only know I kissed it on that day

As for the kiss, I long ago forgot it
But for the cloud that floated in the sky
I know that still and shall forever know it
It was quite white and moved in very high
It may be that the plum trees still are blooming
That woman's seventh child may now be there
And yet that cloud had only bloomed for minutes
When I looked up
It vanished on the air"

Goodbyes ...

... are probably one of the hardest things to say, especially after you have spent an intense weekend with a group of people who you dearly love but do not see often, due to the geographical distances, various commitments, the general busyness of life ... Such weekends always remind me of the scene in "Snoopy, Come Home", in which Charlie Brown said the following wise words, while looking at the abandoned dog-house of Snoopy:

"Why can't we get all the people together in the world that we really like, and just stay together forever. Someone would leave. Someone would always leave, and then we have to say good-bye. I hate good-byes. You know what I need? I need more 'hellos'."

I wonder why too ... maybe that is the answer to our sadness sometimes ...

Life's unexpected ...

... is always around the corner, waiting to make itself known ... sometimes, it is hard to know how to react, when it drops by to say hello. January has passed in such a flash with job application and random A&E shifts, but I will always remember the miscarriage I witnessed on a cold winter night ... the unexpectedness of the situation, the anguish of the mother, my inability to face the pain, the helplessness we both felt ...

I thought that with times, I will grow stronger as a doctor and be able to face with what life throws at us, as we are constantly witnessing pain, illness, devastation, disappointment, death at first hand ... In a callous way, A&E has hardened my heart, as sometimes it is tough to love some of the patients we see ...

Yet, whenever I am struggling with such emotions, I will encounter a case which makes me genuinely care again. The pain is sometimes harder to bear, but as Mother Teresa said: “I have found the paradox that if I love until it hurts, then there is no hurt, but only more love.”

The unbearable lightness of being ...

... is a book by Milan Kundera. It's involves 4 characters, with Czech modern history as a background, and a lot of philosophical rambling. It has many awesome ideas in the book (and some not-so-great ones). I particularly like the following paragraphs;

"We all need someone to look at us. We can be divided into four categories according to the kind of look we wish to live under.

The first category longs for the look of an infinite number of anonymous eyes, in other words, for the look of the public. That is the case with the German singer, the American actress, and even the tall, stooped editor with the big chin ...

The second category is made up of people who have a vital need to be looked at by many known eyes. They are the tireless hosts of cocktail parties and dinners. They are happier than the people in the first category, who, whey they lose their public, have the feeling that the lights have gone out in the room of their lives. This happens to nearly all of them sooner or later. People in the second category, on the other hand, can always come up with the eyes they need ...

Then there is the third category, the category of people who need to be constantly before the eyes of the person they love. Their situation is as dangerous as the situation of people in the first category. One day the eyes of their beloved will close, and the room will go dark ...

And finally, there is the fourth category, the rarest, the category of people who live in the imaginary eyes of those who are not present. They are the dreamers. Franz, for example. He travelled to the borders of Cambodia only for Sabina. As the bus bumped along the Thai road, he could feel her eyes fixed on him in a long stare."

This is a fairly interesting way of looking at people, and in many ways, it is true ... the eyes are personalification of what is important in their lives ... The first category can represent power/wealth/being known, which is similar to the second category, except in the scale and the "controllability" of the eyes. The third group is love (in its various forms, be it the flickering love of a lover, the adoring gaze of a child, the approving nod of a parent), whereas the last group consists of those unknowns which we hold dear; the lost love, the One, the never-ending possibilities, God ...

Do people metaphoresis from one category to another, because of the changing nature of their beliefs and the harsh experience of life?

India ...

... is definitely one of the most fascinating countries I have ever visited ... it was just so different; the people (always smiling, no matter what they are facing), the crowdiness (I will always remember the Sunday market outside Jama Masjid), the slowness (my sister called it "Indian Stretch Time"), the chaos (you do as they say, not by the rules), the randomness (haggling involves asking for 50% off original price --> walking away --> the shopkeeper calling you back and selling it at your price but with 50 rupees extra --> more head shaking --> deal closed), the poverty (a child offered to jump into a crazy waterfall for 50 rupees: 60p), the sense of hope (they will knock and knock on a car window for some changes), the sense of desperation (homes made out of cupboards, sheets of fabric) ...

It does have some awesome architectures (Taj Mahal, Agar Fort, Hawa Mahal, Humayan Tomb etc), interesting history (Mughal emperors, Hindi kings, British Indian Company, Gandhi, Pakistan), a certain degree of religious tolerance (from an outsider's point of view, although I have no doubt that it is debatable), exotic food (way tooooo spicy for me, but prawn curry at United Coffee House is awesome!), creative modes of transports (I have been on an elephant, a camel, a horse, a rickshaws, an auto, a very slow slow moving train, a bumpy 40 seats plane) and the most amazing massage ever (although it did involve a lot of flours and hot oils?!?!?)

I have also observed my own family in close quarter (I have not spent more than 5 days with my family in one go since 2003), got to know my brother-in-law, learned a tremendous amount about myself and having my habits and views challenged.

Rabindranath Tagore wrote a poem on Taj Mahal ~

"You know Shah Jahan,
life and youth, wealth and glory,
they all drift away in the current of time.
You strove therefore, to perpetuate only the sorrow of your heart
... Let the splendour of diamond, pearl and ruby vanish,
... Only let this one tear-drop,
this Taj Mahal glisten spotlessly bright
on the cheek of Time for ever and ever.
.... Oh king, you sought to harm time
with the magic of beauty and weave garland
that would blind formless death with deathless form...
This mausoleum stands still and unmoving in its place."

Never let me go ...

... is the title of a book by Kazuo Ishiguro and was very popular about a year or so ago ... I suppose we are all trying to find someone who will hold onto us, who will never never let us go, who are our anchors, stopping us from being swept away by this world. Yet, sometimes, as Tommy said in the book; "I keep thinking about this river somewhere, with the water moving really fast. And these two people in the water, trying to hold onto each other, holding on as hard as they can, but in the end, it's just too much. The current's too strong. They've got to let go, drift apart. That's how I think it is with us. It's a shame, Kath, because we've loved each other all our lives. But in the end, we can't stay together forever".

The desperation, the helplessness ... summaries so well of life in London ...

In the book, there is this idea of Norfolk being a lost corner, where all the lost property found in the world goes to ... If only such places do exist on this earth, so that "when we lost something precious, and we'd looked and looked and still couldn't find it, then we don't have to be completely heartbroken. We still had the last bit of comfort, thinking one day, when we were grown up, and we were free to travel around the country, we could always go and find it again in Norfolk".

This is, however, a dangerous ground to tread on, as during the process, we develop ways to cope with our losses; pretending, devaluing, decentralising, replacing ... and eventually, we do not even recognise the tremendous darkness of our losses ...

Memories ...

... are powerful - you can distort it, relish it with happiness, relive it with anguish ... but can we ever unload its emotional impact? We may put on spectacles with tints of rainbow, viewing snaps of our lives in the colour we choose ... Yet, deep within, we still feel the pain and sometimes, the joy, it brings ...

Robinton Mistry wrote in "a fine balance"; " How much Dina Aunty relished her memories. Mummy and Daddy were the same, talking about their yesterdays and smiling in that sad-happy way while selecting each picture, each frame from the past, examining it lovingly before it vanished again in the mist. But nobody ever forgot anything, not really, though sometimes they pretended when it suited them. Memories were permanent. Sorrowful ones remained sad even with the passage of time, yet happy ones could never be recreated - not with the same joy. Remembering bred its own peculiar sorrow. It seemed so unfair: that time should render both sadness and happiness into a source of pain".

Definitely a source of pain, but maybe sadness and happiness generate a different type of pain ...

A man of wisdom ...

"Flatter me, and I may not believe you.
Criticize me, and I may not like you.
Ignore me, and I may not forgive you.
Encourage me, and I will not forget you.
Love me and I may be forced to love you.”

~ William Arthur Ward

This is definitely how I feel ... love and encouragment are impossible to refuse ... Is is true for you?

Rainer Maria Rilke said ...

... For one human being to love another; that is perhaps the most difficult of all our tasks, the ultimate, the last test and proof, the work for which all other work is but preparation.

... Perhaps everything terrible is in its deepest being something helpless that wants help from us.

... Perhaps all the dragons of our lives are princesses who are only waiting to see us once beautiful and brave.

marriage ...

... is probably the subject which I have been talking the most of this week ... it is emotionally draining ... I talked about it with my little sister, my friends, my patients ... sometimes you wonder how many "couple therapy" one can endure in a day ... it is strange in that those at the start of this life-long marathon sound so optimistic, so hopeful of what the future will bring ... next along the lines are those who have been married for a while, with their soles of sorrow, painful joints ... and at the end, there are those who have endured a quarter of a century together, with their broken promises, bottles of tears, glasses of misunderstanding shattered on the ground ...

... it does make you wonder ... but hey, some people do make it through intact and smiling ...

Jeff Buckley ...

... amazing version:

Well I heard there was a secret chord
that David played and it pleased the Lord
But you don't really care for music, do ya?
Well it goes like this :
The fourth, the fifth, the minor fall and the major lift
The baffled king composing Hallelujah

Hallelujah ...

Well your faith was strong but you needed proof
You saw her bathing on the roof
Her beauty and the moonlight overthrew ya
And she tied you to her kitchen chair
She broke your throne and she cut your hair
And from your lips she drew the Hallelujah

Hallelujah ...

(Yeah but) Baby I've been here before
I've seen this room and I've walked this floor, (You know)
I used to live alone before I knew ya
And I've seen your flag on the marble arch
and love is not a victory march
It's a cold and it's a broken Hallelujah

Hallelujah ...

Well there was a time when you let me know
What's really going on below
But now you never show that to me do ya
But remember when I moved in you
And the holy dove was moving too
And every breath we drew was Hallelujah

Hallelujah...

Time ...

... can be measured by the moving hands of a clock, as it ticks away the seconds, the minutes, the hours ... but what does one turn to when we reach the days, the months, the years ... do we refer to a calendar? or our diary? What is the mind map of our life on earth? If I ask you: "Where were you last year when they were showing the firework?", how will you search for that day in your mind ...

Some people may anchor it by their travels, "ahhh, I missed it as I was at the Big Apple"; or by their jobs/studies, "On-calls, on-calls, on-calls"; or by their relationships, "I watched it with my ex"; or by their feelings, "Very stressed out that day - can't remember what I thought of the firework"; or by our beliefs, "God seemed a distant memory then" ...

Maybe how we divide our lives, both in reality and in our minds, shows what has the uttermost prominence in our lives, but as C.S.Lewis said:

"The Future is something which everyone reaches at the rate of sixty minutes an hour, whatever he does, whoever he is".

"read my mind" ...

... is a song by The Killers and probably one of my favourite songs at the moment - it always brings a smile to my face when it plays on my ipod as I walk up towards the hospital in the glorious autumn sunshine ...

... it asks this question "Can you read my mind?" and one of the classic questions in Psychiatry is "do you think people can read your mind?" (for the non-medics: thought broadcast is one of Schneider's symptoms of first rank for schizophrenia). Most people just look at me as if I am mad ...

But how would one feel if people can truly read your mind? Most people will probably shrink from such an idea, as no one wants their inner thought to be known to all, as it may reveal how shallow/deep/lonely/envious/funny/sarcastic we are ... It also renders conversations to be meaningless (as you can read everything off a speech bubble and the conversation will take on so many tangles, spreading like a spider web). We all have listened to people revealing their deepest fears/latest invention/new-found-absolutely-can-do-no-wrongs-other-half, when we are secretly thinking what to order from the menu ...

Yet, what if we can select whom we reveal our thoughts to? What will happen then? Will it make life easier, more bearable? When we can "tell" a passerby how much we love their gorgeous blue shoes, our parents how much we appreciate their sacrifices, our friends how much our lives have shined because of their lights, the person how much we have liked them since the beginning of time, those we have hurt along the way how truly sorry we are ...

But as Dana Gioia wrote,

"So much of what we live goes on inside–
The diaries of grief, the tongue-tied aches
Of unacknowledged love are no less real
For having passed unsaid. What we conceal
Is always more than what we dare confide.
Think of the letters that we write our dead."

flowers ...

~ by Wendy Cope

"Some men never think of it.
You did. You'd come along
And say you'd nearly bought me flowers
But something had gone wrong.

The shop was closed. Or you had doubts -
The sort that minds like ours
Dream up incessantly. You thought
I might not want your flowers.

It made me smile and hug you then.
Now I can only smile.
But, look, the flowers you nearly bought
have lasted all this while."

Food ...

Today, I decided to write a really silly entries about food that I like ... to be honest, noone will be interested but it is kind of fun to make piles and piles of lists, which no one will read, except yourself a few years down the line ... always interesting to note how one has changed and the constancy in oneself can be reassuring too ...

So here it goes:
 sushi in any form, except Octopus ones ... (and also unsure about all the raw and exotic fishes which I haven't tried)
 tempura - how can anyone say "no" to that?!?
 pasta in pretty much any sauce ~ I haven't found one which I don't like, but my favourite is probably spaghetti wrapped in a paper, with seafood and tomato sauce (I should pretend to be posh and use its Italian name, but sadly, my Italian is limited to "Ciao") ...
 noodles - fried, in big swimmingly bowl, with way too much sauce (yep, some of you have seen me eating this one, and looked on in disbelief!), Pad Thai ... I can literally survive on noodles ...
 dim-sum ~ except chicken feet ... some people will say that I am not Chinesey enough, but I just hate that thing ...
 Shanghai cuisine & peking duck
 chips ... sometimes, I just have to have it, no matter what I am having for the main course ... I quite like steaks & burgers too, especially when it is cold and rainy outside ...
 chocolates, especially Green & Black Almonds ~ definitely saw me through finals!
 ice-creams; Hagen Daze ~ I love to indulge myself at Hagen Daze at Leicester Square (I think I have taken most of my friends there!) ... the thought of walking in there with soooo many ice-cream to choose from is just sooo comforting ~ it is a bit liked Tiffany to Holly Golightly, although that is way more classy!
 tea - absolutely adore it, earl grey, lady grey, strawberries, mint, mango, green, apple, jasminie etc etc, but I don't like Bush tea ... hmm ... and proper chinese tea (way too strong!)
 cakes, of course chocolates one, closely followed by carrot cakes, cookies, banana bread, flap-jacks ... I also like crumbles ... basically, I will never say "no" to desert, unless it is sour!?!?
 fishes - again, any kind, unless they are too meaty or bony ... also, love lobster, crab, prawns ... basically most seafood, except octopus & squid - I don't like chewy stuffs!
 soups - I really like Covent Garden ones ~ it has recently become one of my stable diet during on-call, for lunch, and if I am too tired to cook ...
 curries as long as it is not spicy; Indian, Thai, Japanese, Chinese ...

Basically, I eat everything ... just in case that you are planning to cook for me :)

May 2012
A slight update, as I have become a pescatarian since June last year.   I actually can still eat most food on the list, except for peking duck and certain dim sum ... These are some foods I have found along the way ...
 Butter squash and cranberries, courtesy of Whole Food
 Quinoa salad
 Frozen yoghurt with lots and lots of toppings
 A prawn dish at Gambia ... the chef at the hotel felt sorry for my pescatarian status and just cooked me this gorgeous dish out of the blue!

Is love enough?

... is a question I have been reflecting on recently ... if you have asked me about it a month ago, I would have echoed the whole room with a resounding "yes" ... but recently, I have had my doubts. One of the most fascinating aspects of psychiatry is that you are constantly confront with real life, but sometimes, the pains involved can be more than one can bear ...

I was on-call the other day, and at around 5am, I was bleeped by A&E about another overdosed patient (it is staggering the number of overdoses we see a day, so many unhappy people out there). Maybe it is the early morning - everything seems surreal in the hospital around that time ... but my joyful feeling zipped out of me the moment I laid eyes on her ... Yet, no matter how they make you feel, they are patients at the end of the day, so the psychatiry interview began ...

My patient overdosed on 40 antixiolytic, her 2nd attempts in less than 2 months. She adores her husband and children, and worries and loves were clearly written on their faces when they came to see her in the morning ... But all these are not enough to hold her back from the brim of darkness which has descended among her ... maybe sometimes, love is just not enough ... maybe William Somerset Maugham is right when he said "The love that lasts the longest is the love that is never returned." ...

understanding those around you ...

... are difficult and I was talking about it to a friend today (well, I was ranting and he was listening!) ... We all aspire to understand our friends, our families, our loved ones, but can we? The amazing thing about being a Psychiatrist is that you gain access into people's lives and minds; they will tell you things which no one else knows; good and bad things (although to be honest, it is mainly the latter) painful events which happened in the past, unrequited love, their fears, their dreams ... sometimes, you talk to those closet to the patients, and they would not have a clue ... the patient could be ill for ages, and they would not have noticed or knew ...

That is not because they do not care, but how much we understand someone depends on how much the other person is willing to reveal ... and also, depends on our past experience, knowledge and emotions, as together, they will affect our ability to interpret the other person's actions, ideas, and ultimately our understanding of them ...

Alas, "If each man or woman could understand that every other human life is as full of sorrows, or joys, or base temptations, of heartaches and of remorse as his own . . . how much kinder, how much gentler he would be (~ William Allen White)” will be a good starting point.

Pablo Neruda ...

... I am going through one of my phases which I start to get obsessed with a poet ... this is another peom by Pablo Neruda which I love ... now I wish that I have paid more attention during my Spanish lesson, instead of getting a "D" in my GCSE mock and all I can say is "Hola. Me ilamo Carol. Vivo en Londres" ... it must be absolutely stunning in Spanish ...

"I do not love you as if you were salt-rose, or topaz,
or the arrow of carnations the fire shoots off.
I love you as certain dark things are to be loved,
in secret, between the shadow and the soul.

I love you as the plant that never blooms
but carries in itself the light of hidden flowers;
thanks to your love a certain solid fragrance,
risen from the earth, lives darkly in my body.

I love you without knowing how, or when, or from where.
I love you straightforwardly, without complexities or pride;
so I love you because I know no other way

than this: where I does not exist, nor you,
so close that your hand on my chest is my hand,
so close that your eyes close as I fall asleep."

The Dead Woman ...

... by Pablo Neruda, is a poem quoted in "Truly, Madly, Deeply", which pretty much sums up this bittersweet film ....

"If suddenly you do not exist,
if suddenly you no longer live,
I shall go on living.

I do not dare,
I do not dare to write it,
if you die.

I shall go on living.

For where a man has no voice,
there, my voice.

Where blacks are beaten,
I cannot be dead.
When my brothers go to prison
I shall go with them.

When victory,
not my victory,
but the great victory
comes,
even though I am mute I must speak;
I shall see it come even though I am blind.

No, forgive me.
If you no longer live,
if you, beloved, my love,
if you
have died,
all the leaves will fall in my breast,
it will rain on my soul night and day,
the snow will burn my heart,
I shall walk with frost and fire and death and snow,
my feet will want to walk to where you are sleeping, but
I shall stay alive,
because above all things
you wanted me indomitable,
and, my love, because you know that I am not only a man
but all mankind."