Living The Moment

Many people asked me shouldn't I be a specialist first, learn hospital management, business and management or something to run Hospitals Beyond Boundaries? Oh well, if I spend all my time studying to be ready, I will never stop studying, and I will never start. A good idea evolves over a long time period. It is important to start while you are young and have the energy to execute. Many people are so afraid of making mistakes, they become paralyzed. But it is necessary to learn from mistakes. Contrary to learning theory from books, you can never forget the experience and pain of a mistake. There is no mistake you cannot recover from except if it kills you. I am doing something that I really care about, something I have passion in, something I love. For me, that is more worth it than a bunch of degrees and certificates hung on the wall. I've had some tough times convincing people about my idea, but then it occurred to me: If they don't like my idea, I never have to see these people again

Of Simplicity and Detachment

I think the best thing I learned these couple of years is to live a life of simplicity and detachment. Many associate detachments with apathy, detached of emotions and meaningful relationships with other people: being a robot. But actually detachment and apathy are very different things. I think it was through the words of dead Ottoman Muslim poets I discovered in Istanbul that I learn the true concept of detachment.

Detachment is being detached from the consequences of your thorough choices, from things that make you feel negative or sad, detachment from materialistic things in life that you must have in order to make you feel good everyday, or from the things that a person mistakenly say or do instead of the person itself. It is about letting go of utter control and feel okay with it.

Being detached, you will have peace of mind knowing that what is meant for you will come to you, and what is not meant for you will pass. When you are free of attachments, it gives you freedom and courage to venture out into the world, travel far and wide to see the world in search of meaning and marvel in the creation of the Creator. You will know that you will have nothing to lose with travelling. All the money you spent is replaced with experiences that stretch your mind wide, that it is impossible to return it to its original narrow dimensions.

Being detached, you will love and appreciate the people around you better. You love someone with no strings attached, not because of what the person has, what the person says or do, or what the person looks like. Attachment towards a person will only make you weak, you are hurt by the slightest negative remark, you become overly sensitive and you would stop loving someone just because the person said the wrong things in the heat of emotions. You will learn to love unselfishly.

For me detachment has a lot to do with simplicity, because when you live simply, you are not attached to many things. I have always been a devotee of simplicity, a minimalist. I am a minimalist in arts & designs that I like simple, sharp angled and crisp things. I like things that are simple but refined, like a piece of square block that looks insanely simple from afar but look closer and you see chiseled carvings that has a story to tell. It gives meaning. I clean and organize my room regularly and I found out it is a good way of avoiding your mind turning into a mess.I like to travel simply and lightly, so I don’t have to worry about having to stay in the smallest spaces for the night, worry about my belongings getting lost or having to move my luggage frequently from one place to another. 

Living simply does not diminish anything. The only things you diminish are clutters and rubbish in life, that in the end leaves more space to fill in things that has meaning. Heavy baggage, either physical or emotional, drains you. So live a simple and detached life, clear out all the physical and emotional clutter. You will feel happier, lighter, more creative, more energized, and you will realize sooner or later that your life becomes more fun!

My First Step in the Thousand Miles Journey

In the medical profession that emphasizes on evidence-based studies, I know that the only way forward inside this field is through journalistic articles. They say that a thousand miles journey starts with a single step. The article above is to remind me that this is my first step: my first article published in a non-medical student journal, or to look it in another way, my first article in an international doctor's journal: the International Journal of Public Health Research (http://www.ijphr.ukm.my/Manuscript/vol 3 no 1 2013_30.pdf).

I Have a Cricket Living in My Ears

Tinnitus/tin·ni·tus /ˈtinitəs/ : Ringing/buzzing in the ears; may cause depression and insomnia

The night I got it will never be erased from my mind. The thud, the pain, the sound in my ears as if someone opened a window as a plane was flying. Like all the air around me are sucked into my ears. Maybe that is why I find it hard to breath. Then the vertigo came, the world went spinning. I fell to the ground. But I felt as if I never landed. I was free falling. I was lying flat on the ground but the world kept spinning and I kept falling. At that time, I wish all of this is a dream. I waited for the moment to wake up. Please wake up, please wake, please wake me up. But I didn’t. Instead, I have to pull myself up and walked to the nearest checkpoint. Everybody else was still too busy playing the stupid war game. The ‘enemy’ must be happy that they shot me a plastic bag full of flour water right to my head during their ambush. What they didn’t know is that it changed the trajectory of my life for good.

To think of it, it is amazing how this small organ, the ear with all its parts, outer, middle and inner, can perform such a vital function that when it is damaged, a person could not hear, walk or feel the ground. The person who threw the bag of flour water must have done it with a very full force. Not only my ear drums are busted, the high speed energy must have driven the bones in the middle ear right into the inner ear through the oval window, so hard that the brain fluids began leaking out through the cochlear. I called my parents. I might be very lucky that my dad happens to be an ENT surgeon. At that time I didn’t know the extent of my injury. All I knew is that it is freaking painful. The eardrums being the most sensitive organ in the human body to pain, I might scale the pain 11/10. I could not sit still in the clinic until they gave me that jab of painkiller. My dad told me that eardrum perforation is common and it will heal in time. It got me relieved, and I went back to the hostel. Meanwhile, fluids are still coming out of my ear, dismissing it as flour water from the plastic bag.

I went to bed. I couldn’t sleep well with the eerie sound in my ears. It woke me up every hour. It was then that I noticed it. On my pillow, the fluid that soaks my pillow made the wet area look peculiar. Then I remember it: the ‘halo sign’ of CSF. I still remember my Professor’s words: In a head injury, always ask if you feel a dripping sensation on the back of the throat, and if the fluid drips out of the nose, test it in a white cloth for ‘halo sign’, which indicates the fluid is from the brain. “This is exactly how it looks!” I thought. I freaked out and called my dad again. I told him that I can feel the fluid pulsating out of my ears. Being a surgeon, he said this calmly but with a sense of urgency: “get back to UKM Hospital as soon as possible”.

It was in the middle of the night. I woke up one of the facilitators, telling him how severe the condition is. He straight away drove me back to Kuala Lumpur from Janda Baik. If my dad was not an ENT surgeon, if I hadn’t remember the lesson about the ‘halo sign’, I might just dismiss the fluids coming out from my ears as a normal physiological response of my ear to clear up flour water in my ears. Like how I sneeze and my nose become watery when there is too much dust.

I was hospitalized for 2 weeks. It was a harrowing experience. I can only stay still. If I walk, I fall. I couldn’t walk straight. My balance organ is damaged. I could only pray to Allah that this damage is not permanent. At that time, I don’t care about the hearing lost in my left ear and the newfound sound that won’t leave me alone 24 hours a day. I only start to care when I turn on my iPod and listened to it using my left ear. It sounded exactly like a broken radio. I can only hear some frequencies of sound but not another. Losing my ability to hear clearly left me devastated. I couldn’t walk, I couldn’t hear properly, and there is this weird sound that has always been with me since that night. In the wards, they gave me antibiotic cover every day to prevent my brain from getting infected through the leak in my ears. There was a very high possibility, with the flour water in the plastic bag kept for days. There is no questioning what type of bacteria is in it.

After nearly two weeks, I was discharged home, but I still have to take antibiotics. I still could not walk straight, but it is improving day by day, which was a good sign. I read that when the balance organ in one side of the ear is damaged, the other ear will adapt and tilt the balance to normal again. How powerful is Allah’s creation! But the effect does not remain physical. Emotionally, I was torn to pieces. If there was a point in my life where I someone to take care of me most, that was the point. I am glad that my families and friends gave me a visit. My parents were always there, but everyone has to go to work in the end. I have no one who I can talk to any time that I needed to.

I became depressed. A few weeks later after my balance has returned, I decided to return to class. Some lecturers suggested me to skip the whole posting and repeat the posting after exam along with the students who had fail. But I am not the kind of person who gives up easily. I skipped 2 weeks of Opthalmology and came back into Anaesthesiology posting. Because I skipped the 2 weeks, I still have to complete the tasks in my log book, do case write ups and sit for mini-CEX. So from morning until 3 or 4 pm, I was in the operating theatre for anaesthesiology. 4 to 6 pm, I went to the Opthalmology clinic to finish my log book with the patients that are left (clinic ends at 5). I was basically doing 2 postings in one. I survived. I completed my log book, passed my mini-CEX and did my case write ups.

It didn’t came without repercussions. The full day I had distracted me from the trauma, the tinnitus and the remnant sense on imbalance. But at night, when it is silent and I am alone. The world became a dark place to live in. I am usually a reserved person when it comes to my emotional thoughts. When I am depressed, all I need is to remain silent and withdraw into my cave of silence. Have a good night sleep. This time around, silence only exaggerates the ringing in my ears. I couldn’t sleep. How can I handle this suffering? This went on for weeks. I withdrew from society; I deleted all my existence on the internet, deactivated my Facebook, and live in seclusion. I pushed everyone away, even people who were close to me. I became over-sensitive and would lash out at the slightest thing. My friends told me that I am not myself anymore.

I am very good at hiding my feelings. When I go to the clinics, I put on fake smile and lived life as usual. I survived the first few months, until I came into psychiatry posting. We were at the clinic, and I was putting on my best face, knowing it worked well. But in the psychiatry clinic, it didn’t. Psychiatrists are trained to read people’s thought through their demeanour and body language. When the clinic ended, the Psychiatrist Professor asked me to stay back. It was amazing how she sensed something was wrong with me. When I told her about everything that happened, she was not surprised. She knew I went through something traumatic. She could see it in my eyes. She even offered me for short course of medications but I refused. Then we started talking about behaviour therapy. I told her I shut out everybody and lived like an anti-social. I told her I was off the internet, and never made an effort to reply every concerned friends on Facebook. She told me it was a wrong thing to do, and at times like these, I was in need of social support from my friends the most.

I received the news after a few follow-ups at the ENT clinic that my partial hearing loss is permanent, and so is the tinnitus in my ears. Most people would be devastated to learn about this permanent damage, but the only thing that got me through is that my balance has returned. I can walk straight. I can run! The months that follow was life-changing. When I sleep, I have to turn on tinnitus masking sounds on my laptop. It helped with the tinnitus. I kept myself busy to distract me from the noise.

Tinnitus has stayed with me from that night right until this moment. It has nearly been 2 years. I now take it as an indicator. Tinnitus gets louder when I am stressed, fatigued or at times of heightened emotion. I used it to remind myself to lay back when stressed, rest when fatigue, and be patient when I am about to get angry. Tinnitus serves as a reminder for me that I survived the worst, that I can walk and run without feeling that my feet are not on the ground. Tinnitus sounds like a cricket in my ears. So when I am in the middle of a hectic day, when I feel too worn out, I take time to listen to that cricket and remind myself that it is better to be busy doing something useful rather than lying around helpless, like how I was when I was admitted.

What happened has changed me, and changed the trajectory of my life. It was as if I was given a second chance at life. I appreciate every moment, and have become much more patient with people. I take time to listen. I thought that my life is too short to be miserable. There was a possibility that I die if I keep on dismissing the fluids as a normal ear response and catch infection to my brain. I swore to do good on earth realizing that life is too short. I might not have started my charity NGO in my final year if not of what happened. Without a traumatic event, there is no motivation for me to start building a hospital for the poor as a medical student. I will still be caught up in the idea that I have to fulfil all my degrees, be a specialist and stable before embarking on a journey to save others. My tinnitus taught me to say ‘Screw that, life is short. I’m doing it now!’. My tinnitus is like a magical cricket in Disney. What’s his name again? Jimney? He’s always there to remind me things get bad. It serves me some kind of comfort knowing that he’ll be there until I lie on my deathbed.

A Journey of Self Discovery

It has almost been 2 weeks since this journey began. From Phnom Penh going 150 miles north to Siem Reap and back again, this travel has opened my eyes to the harsh reality of living in a country still haunted by a recent tragic past that drives the country into extreme poverty. It has made me realize how absurd I was presenting about health care in resource stricken countries in air-conditioned conference rooms, when actually being here among the poor, going through the sweltering heat, thinking “how can these people live like this?” is an absolutely different thing. If my years spent living in Indonesia shapes my worldview of developing countries, Cambodia confirms this viewpoint. Yesterday we visited one of the best hospitals in Phnom Penh and I was still surprised to see a patient fresh off brain surgery put into a hot, dark room crammed with other patients. Being perfectly healthy, I could not maintain being there more than 5 minutes without being drenched in sweat. I can only imagine lying helplessly in pain or gasping for air when the air is already hard to breathe in. It reminded me of a patient back in Malaysia who demanded to change bed because the air conditioning is too strong. How we are blessed with choices when here, there is no such option.

My time in Phnom Penh was purposely devoid of living in hotels in order to immerse myself into the local culture. Living with the locals has allowed me to learn a bit of their language, eat their local dishes and live their daily activities. Each day is fully taken advantage of. Cooler mornings were spent writing or reading the numerous books written about Cambodia’s tragic history under the Khmer Rouge regime. Work starts near mid-day, where we would visit our proposed hospital site, visit the school which our collaborating NGO runs, go to our meetings, or scouting for a suitable site for our health screening project scheduled in a few months time. As young doctors, there seems so much for us to do, but so little resource we have. Sometimes we feel helpless compared to the gargantuan task of building a hospital in this resource stricken area and improving the health care of the community and their economy as a whole. However I kept holding on to a humorous quote I found: “Dream big, start small, but most important of all, start!”

The late Steve Jobs once said “The only way to do great work is to love what you do. If you haven’t found it yet, keep looking. Don’t settle. As with all matters of the heart, you will know when you find it”. I believe that I have found it through this journey. I set out to discover this so called ‘Kingdom of Wonder’, but it ended up as a journey of self-discovery. My days have never been happier doing all this work that I am doing now. It is very tiring, but when you love doing something, it is as if you did not go to work at all. All I wish is that this passion and excitement would not simmer down once I have started my housemanship training. Time and again I saw my friends lose their passion in the things they love to do, the things that really creates meaning, after beaten down by the harsh life of a young doctor. Things will not always be easy, but when everything seems to fall apart, I hope I will always remind myself of the worse hardship I see during this journey. When I do, everything else will pale in comparison.

Phnom Penh, 16 May 2013