Last day of internship

Finally together with all my friends, i have completed my internship. This means i am a qualified, registered junior doctor now! Looking back at the day when we started, there is definitely a big change in all of us. I think i am more matured and less scared as compared to our first day. Surprisingly it has not been all that stressful as TV series eg Scrubs or Grey's made it out to be. There were definitely stressful days, especially when i was doing emergency medicine (such that i still have palpitations whenever i walk by ED), but as a whole, i thought it was pretty manageable.

Now i am looking forward to my next term - General Surgery. Being the only 'more senior' resident amongst all the new interns, I am sure there would be expectations placed on my performance. I have a few goals in this new rotation. In order of priority, they are 1) complete my daily task as a resident to the best of my ability such that patient care will be a quality one, 2) spend as much time in the theatre as my work allows without compromising 1) and hone my surgical skill, 3) brush up my surgical anatomy 4) complete an audit project or write up a paper to be published in a journal.

Just to recap what i have done in the week, Sebastian - a friend from Holland that Raymun and I made when we were in Blue Mountains, decided to give me a surprise visit. He stayed over at my place for about a week, and though i was busy at my work, we managed to make time for good conversation. We talked about everything from creation to evolution, aliens, God, the exclusive nature of truth, morality in the face of utter human corruption, the meaning of marriage, the meaning of sex, the hypocrisy and failure of christians and the church etc. Sebastian definitely has shown a lot of maturity for someone his age (he is only 19). He believes that the earth was created (rather than evolved), just that he doesn't think the creator is the God of the bible. I am just glad to have the opportunity to speak to him. On the last night, when we were both tired and spent from talking, i offered to pray for him. He agreed. At our prayer, I asked God to make Himself known to him.

Another highlight of the week is,  for the first time of my life, I completed the grand slams in Glasshouse Mountains. Having lived here for almost a year now, I have never attempted more than one mountain at a given time. On Friday, Sebastian and i attempted all four on the same day. Mt B (556m), Mt Tibrogargan (364m), Mt Ngungun (253m) and Mt Beerburrum (280m). It was extremely hot that day, so getting from one mountain to another was a challenge. But we managed to complete three (Mt B, Ngungun and Beerburrum) before lunch time, and i went on my own to tackle Tibrogargan in the evening to round up the Grand Slam.

I learned something about this expedition. Running uphill and hiking uphill are two different exercises which recruit slightly different muscles. I don't really know how to explain this in a simple way. Running uphill requires fast turnover of the feet, thereby ensuring efficient release of stored energy in the muscles each time you land and push off. Hiking uphill, on the other hand, requires your feet to be on the ground much longer (i.e slower turnover), and such action not only slows you down naturally, it also requires more power on the part of your feet to move the feet up steeper gradient. When running uphill, the gradient of the slope is usually gentler (otherwise if the gradient is too steep, you won't be to run up). Hence it doesn't require so much energy to push off, especially when you have a quick feet turnover. However when you hike up hill, due to the fact that your feet stays longer on the ground before push off (longer ground contact time), the energy transfer isn't as efficient so you require more energy to complete the task.

If you can run uphill well, it does not mean you can hike steeper hills just as well. In my opinion, they are both different exercises which need to be trained for any serious athlete wanting to do well in mountain races.

Hmm.. My fiance and I really want to go for mission revival prayer meet in Gunung Murud in Sarawak, Borneo in July next year. But i am doubtful of my ability to take leave at that period. Sigh.. Dear Father, if You want me to go, You will make it happen. I just have to surrender, trust and obey.

Now I am going to sleep soon so i can wake up early to reach work by 6.45am. Good night!

Total distance: 47km

Total elevation: 2264m 

Total time: 6hrs41mins

Ascent in Mt B

View from Mt B

Yes you pretty much have to be on all fours when coming down

Peak of Mt B - Seb and I

Running across Malaysia 2014

Sometime in the beginning of last year, I chanced upon Raymun's post on facebook regarding Dean Karnazes' latest solo 354km run in under 2-3 days. Almost instinctively, I made a random comment about us running from Perlis (the most northern state in Malaysia) to Johor (the most southern state in Malaysia) together sometime in the future. Raymun, being child-like and enthusiastic at heart, responded immediately with a resounding YES! Other friends who saw our post also joined in the madness thinking that we were just joking; one of them whose hometown is Taiping offered us Chee Cheong Fun (literally translated as pig's intestine) if we make it past his hometown. It's one of those times when you don't think too much about what's being said and you just go with the flow of the conversation. But when all the fun eventually settled, the reality of what was said was beginning to sink in and it's time to get serious and think about what we just said. Later that day, Raymun sent me a message asking: 'Bro, are you really serious about this?'

Ideas, they say, are a dangerous thing. They are more stubborn and resistant than the most fulminant disease. In this case, i cannot agree more.

We did not talk much over the next few months. I think we both kinda know that this project has struck a very deep cord in our hearts, such that it almost felt like a life mandate that we have to fulfil. It's as if we were summoned to carry this out, entrusted with the gift of running to bring this to completion. In the meantime, we just let the idea slowly gain more strength and form in our hearts and minds as we carry about our daily business. 

But, what purpose is big enough for us to do this? Surely it's not about setting records, nor is it about being the first persons to do this and the kind of bull-crap. I was just reading Roe Grant's book recently (Ron was the first person to run around Australia,  he completed the circumnavigation of 13,383 km in 217 days for an overall daily average of 61.67km), and i noticed how self-centred and individualistic his goals were. Yes he said he was doing it for charity and ya-da ya-da, but it seemed clear from his writing that his deepest motivating factor is he wanted to be the first person to do this, he wanted finish everything in the fastest time, he wanted to set national and world record, he wanted the significance that comes from accomplishing a major feat. His ambition was governing him like a ravenous beast, making him go from a feat to another, to the point where he neglected and lost his wife and family in the process. Later on, there were other similar individuals such as Gary Parson and Pat Farmer who also arrived at the ultra-running scene and attempted similar crazy feats. You would have thought that they would be good friends, since they shared such similar passions. But no. They are not. There is too much ego and rivalry involved such that they can't see eye to eye. 

Personally, I don't think there is anything glorious in accumulating accolade or achievement. Life is not measured by what you could do for yourself. Whether you can run 10km, or 42km, or 100km, or 100 miles, or beyond 100 miles in a single day, really has no bearing whatsoever to the person sitting next to you. Yes there is nothing wrong in doing these things, but if that's all you are all about, then you are a sad person who has nothing else important in life. 

So come back to our story, we thought hard about why we wanted to do this. Or more like - what do we really want to accomplish out of this? To raise fund for refugees so they can continue to pay their rent for an educational centre? Or for orphanage for the kids to buy some food and stationery for their daily needs? Or to raise fund for other charitable organisations or cancer foundation?

From 30 Nov to 3 December 2012, we both decided to take a short 3-day retreat to the Blue Mountains, Sydney, to discuss about this. We spent our day discussing the objectives, mapping out the route, plotting the time line etc. Every now and again, we would head for a leisure run in the trails, exploring the mountains around. I wish we could do this for a living!

At Three Sisters

Mt Solitary from a distance

Brain-storming activity

As you might have guessed, our education and involvement with patients in the hospital on a daily basis have a huge influence on everything that we do. As such, we both contemplated on the subject of health of our fellow countrymen. We both know that when a patient ends up in the hospital with heart attack, it's usually not because he was 'unlucky' or have bad family genes or this is just an accident. He lands himself in the hospital because he decided to, i.e all the past 30-40 years of his life, he had made decisions which he thought were seemingly trivial eg adding extra sugar to his teh-tarik, eating nasi lemak or roti canai or bak-kuk-teh frequently for breakfast, smoking, leading sedentary lifestyle and not getting his bum up to do exercise. These decisions ultimately result in him having a heart attack, or having a diabetic foot, or having kidney failure, or losing his visions, or having a major stroke. For some, it cost them their lives or results in permanent disability. Not to mention heaps of other problems such as obesity, chronic joint pain, lung disease, depression, insomnia, all of which are easily preventable if you pay attention to your lifestyle. 

Hence, we thought this is what we are going to do: We are going to run from one town to the other, starting from Kangsar in Perlis, and educate the local people on how to lead healthy lifestyles. More than that, we want to radically define meaning of health to the people. We will focus on children, housewives, families, or anyone who is willing to listen to us, and give them easily digestible tips, practical advice and resources on health. As such, we are not in the rush to finish the whole project in the fastest time possible. We need to make sure we still have energy left at the end of the run to talk to the people in the town that we pass by.

Recently we read of a Malaysian doctor - Dr Ghantan, who walked over 1000km from Bukit Kayu Hitam to Johor Bharu to raise awareness on organ donation. The newspaper article of his feat is available here. He battled adverse weather conditions, blisters in both his legs, and sometimes he even had to sleep in bus stations, just to collect pledges for organ donation from the people that he met along the way. We were really encouraged by his sheer determination and courage, and we know we are not alone in this. There are doctors out there who, despite the apparent flaws in our national health care system, believe in playing a part at contributing to the health of our nation. 

As you can see, the focus is not really so much about the run. 'Running' is sort of like our means of transport to get from one point to another. Of course, if a kid sees us running and wants to pick up running as a hobby, we will be more than happy to run with him or her. Running also shows to people that we humans need to always be on the move, to allow better blood circulation and cardiovascular health, brings down your blood sugar level and blood pressure, and elevate your mood at the same time (the best cure for depression!). 

So what transpired from our discussion in Blue mountains are the following,

The primary purpose of the run is simple: We want to go around peninsular Malaysia and radically define health to our fellow countrymen. To educate, raise awareness on this topic of HEALTH in general. 

This will take place in December 2014, across 40 days, covering approximately 1400km. We will run anywhere between 30-50km in a day, and we will finish each day in either a major landmark or smaller towns to bring to people the message of HEALTH. 

We will both take 2-3 months off our work to run around peninsular Malaysia. 

The tentative route is as shown in the map. (See below).

With regards to fund-raising, we are still undecided. We have given a lot of thoughts to this topic of charity fund-raising, and recent examples of misuse of fund has not been very encouraging. I will write more about this in future post when i have time what i think about charity bodies like cancer research foundation, non-profitable organisations etc. For now, we don't see the dire need to raise fund as yet. We may change our mind later on. 

We need a crew of members. For now, we already have a sport nutritionist, a free-lance professional photographer, a videographer, and three ladies capable in administrative matters. We still need two more persons. First is someone who catches the essence of this project, who will be our leader and oversee the entire project from head to tail. The next person is someone who is skilled in IT and internet website designing. Anything related to social media and publicity will be handled by this person. If you think you have what it takes, please contact me at tee_jimmy@hotmail.com, and i will explain to you more. 

We want to make a video documentary out of this project, detailing the entire journey from the beginning to the end. 

My dream (i am not sure if this is possible) - is to write a book with Raymun on this project as well. I just want to share a little on who we are, why we want to do this, and the people that we have met in this journey.

Let me reiterate that there is no tangible (eg financial) reward for anyone who wishes to join us. The only reward is knowing that you have made an effort to touch the soul of another human being, and potentially save the life of another person because the person heeds your advice on looking after his or her own health. 

As i said before, and i will say it again, the focus on this project is not the run. The run is merely a tool, a method to attract people's attention to the true message that we carry in our hearts, i.e. we want to bring across the message of HEALTH to anyone who is willing to listen! What better way to do this than to run from one town to another from north to south and back to north again in our own country! :D

Now let's hope everything come to pass!

Dear heavenly Father, You know our heart desires. You know our dreams, as well as our selfish motives - nothing can hide from You. If there is something displeasing to You, please make it clear to us. Break us Lord, if necessary, that we may not persist in our foolishness. Otherwise, grant us the strength and the wisdom to do this, and do it well, to the glory of Your name. In Jesus' name I pray and ask of You, Amen. 

Planning our route

An overview - the first draft

The route across different states

TOYing with speed

For the past few weeks I have been playing with speed in running. I have never really considered speed an important factor in ultra-running all these while as i have always thought that the fast ones will die fast too. Not until in recent times when you keep seeing ultra-running records come tumbling down. These records in 50 miles, 100km, 100 miles weren't just broken; they were smashed! A big reason to this is runners, athletes alike are paying more and more attention to speed work. Gone are the days where ultra-running is just about running really really long hours covering really really distance. Now the competitive scene in ultra-running is about covering really really long distance in the shortest time possible.

In my personal journey as a runner, i have never been fast. Prior to completing my 100km this year, i have never ran 10km under 40 mins. My best half marathon time so far is still 1 hour 29 mins and marathon time is 3 hrs 21 mins. Speed has never been my trump card in any race; my strengths are in my ability to last really long without fading, and in climbing hills.

So in this period when i don't have the time to run long hours due to work commitment and marriage preparation, i decided to cover all my running in as quick a time as my body allows. Of course i listen to my body very carefully. If i had a really hard run yesterday, today i may go semi-hard, or i might rest to run hard the following day. Another thing i try to do is to add as much hills and elevation as possible in my running, and i thoroughly enjoy the process of treading up steep hills (slowly but never slowed to a hike), and blasting downhill afterwards.

So i have seen my timing go down in a variety of distances and my ability in holding a good speed for a long time improved. A few notable achievements in the past few weeks were,

I managed to cover 12km in 47 mins

A week later, i managed to cover 15km in 59 mins.

My best 3km time is 10m42s and 4km time is 14m20s.

Last week I managed to break a long-standing course record in an extremely hilly road run in Mt Mee. I did 12.9km with a total elevation of 300m in a time of 53m33s. The previous record was held by Ian Kent, current Towoomba Marathon record holder (2hr22m) in a time of 54m43s set about 10 years ago. Ian Kent set this record 3 years after setting the record in Towoomba marathon, when he was still running 35 mins for 10km. (unfortunately a poisonous fume accident released by an agricultural farm while Ian was out running resulted in his lungs being severely damaged and he was not able to run anymore after that).

I have been pleasantly surprised by what the body could do. Previously speed training has never been an area that i wanted to go near, simply because of its high intensity nature and that fact that it results in injuries easily. I dislike slogging out in the trail whilst i was supposed to take easy and enjoy my surrounding. Now that i am doing that quite often, i realised that it is not that difficult after all to run at a reasonably fast pace in a long time, so long as your body is conditioned to do it. I am curious to know how i would fare in 21km and 42km now that i have a lot more speed training under my belt.

Finally just some updates on the statistics for the past two weeks.


10-16 Dec 2012

Total distance: 48.5km
Total elevation: 1161m
Total time: 3hr52min
Average speed: 4.80 min/km
Speed work (Thursday): 2 X (5x400m). Each 400m around 1m 10-15s

17-23 Dec 2012

Total distance: 71.3km
Total elevation: 1547m
Total time: 5hr46min
Average speed: 4.85 min/km
Speed work (Thursday) : 5 X 800m. 2:40, 2:40, 2:38, 2:36, 2:33

My cute little nephew. I hope he is ready to be our wedding page boy next year! 

Photo present from my fiancee!  

Post-run treat. What a way to quench thirst!

I went to learn cooking in a Thai Restaurant so that i can cook for my future wife one day. :)

My first Thai Special Fried Rice! :D

Visiting my neighbour who breeds beagles! Beagles and retrievers are two of our favourite dogs!

Breast-feeding the pups!

Mt Mee. Stunning scenery. Planning to move here next year!

Winery in Mt Mee

Visiting Mt Mee Community Mountain-top Church

Angel

Spend all your time waiting
For that second chance,
For a break that would make it okay.
There's always some reason
To feel not good enough,
And it's hard, at the end of the day.
I need some distraction,
Oh, beautiful release.
Memories seep from my veins.
Let me be empty,
Oh, and weightless,
And maybe I'll find some peace tonight.

Chorus

In the arms of the angel,

Fly away from here,
From this dark, cold hotel room,
And the endlessness that you fear.
You are pulled from the wreckage,
Of your silent reverie.
You're in the arms of the angel,
May you find some comfort here.

So tired of the straight line,
And everywhere you turn,
There's vultures and thieves at your back.
The storm keeps on twisting.
Keep on building the lies
That you make up for all that you lack.
It don't make no difference,
Escape one last time.
It's easier to believe in this sweet madness,
Oh, this glorious sadness,
That brings me to my knees.

You're in the arms of the angel,
May you find some comfort here.

My favourite song. 

A friend once texted me the lyrics of the song when i was down and having insomnia. What a comforting thought. Thank you. Wherever you are, i miss our friendship. :)

When art meets surgery

The British sculptor Barbara Hepworth met orthopaedic surgeon Norman Capener in 1944, an encounter that proved to be fruitful in many ways. One of Hepworth's daughters, Sarah, had osteomyelitis (infection of the bone) and Capener had operated on her at the Princess Elizabeth Orthopaedic Hospital in Exeter. The artists struck up a friendship with the surgeon, and Capener later visited the family in St Ives where Hepworth taught him to carve.

In return, Capener suggested that Hepworth observe him operate, initially in Exeter and later at the Royal National Orthopaedic Hospital and the London Clinic, where she also observed orthopaedic surgeon Reginald Watson-Jones and ENT surgeon Edward Rodney Garnett Passe. The rapid sketches she made in the theatre led to a remarkable series of almost 80 drawings and paintings, 35 of which are now on display at the Hepworth Wakefield's Barbara Hepworth: The Hospital Drawings.

A highlight is the series of six paintings based on her observations of Garnett Passe performing delicate “fenestration” of the ear operations, to reverse otosclerosis. She noted that she was struck by “the long concentration, the minuteness of the work and the weight of the equipment and the power of control behind the work”. Hepworth's drawings convey both the manual dexterity and compassion of surgeon and theatre sisters at work, and she sought to capture the abstract quality of surgically gowned figures moving within confined spaces. 

Hepworth later recalled how: “I became completely absorbed by two things: first, the co-ordination between human beings all dedicated to the saving of a life, and the way that unity of idea and purpose dictated a perfection of concentration, movement, and gesture, and secondly by the way this special grace (grace of mind and body), induce a spontaneous space composition, an articulated and animated kind of abstract sculpture very close to what I had been seeking in my own work.”

Such is the beautiful art of surgery. Whilst I am far from possessing any of these qualities portrayed in Hepworth's paintings, I certainly hope to emulate the amazing and unique works of these surgeons one day - where amidst the rush, the imperfection, and sometimes crude exchange between the theatre staff, something as magical as Hepworth's painting would be made manifest and witnessed again by another human being.      

Dr Capener - delicately putting on his gloves, eyes full of compassion

Barbara Hepworth at work

The scalpel

An ear operation

Orthopaedic operation

The scalpel 2

A theatre sister

Delivery of baby

Gowning up - a process which remains unchanged today

Ward call

In an hour's time, i will be driving to the hospital to begin two weeks of overnight ward call. For those who are not familiar with term, ward call is basically a job where the on-call doctor is called upon to respond to all medical needs that may arise in the hospital when all the day doctors have left for home. The call can range from anything trivial (eg writing medication chart), to life-threatening emergencies (eg heart attack or pulmonary embolism).

Typically when i think of ward call, i have shivers down my spine because of the unpredictable nature of it. I remembered the first call i ever received was to see a mental health patient who was spiking temperature, aggressive in a semi-comatose way, and he had a needle found in his groin (he is a drug-addict). Was it drug intoxication? Was it sepsis (infection in the blood stream)?  Was it drug-induced psychosis? Those were my thoughts as i traipsed to the mental health ward.

Notwithstanding the fact that i had great difficulty getting a cannula into his vein (drug addicts have notoriously difficult veins because of all the times they have stabbed themselves), i also had no idea how to deal with someone extremely un-cooperative who has the potential to do harm to us if he is tipped off the wrong way.

That was indeed my cruel introduction to ward call.

Things did improve along the way. Slowly i learned how to deal with the common problems in the hospital, and to be a detective to investigate why is this person sick or presenting in this way at this point in time. Because this is the first time we are seeing the patients, we have no idea what they came to the hospital with, the past medical history, the progress in the hospital, the medications they are on etc. I would look thru past notes, pull up the lab results, glance thru their medication chart and vital signs etc, with the hope that i might be able to find out the reason for his or her current problem.

Thankfully, most of the jobs that came after this horrendous mental health call were trivial stuff. Later on, i was told that that mental heath call was more of a rare case rather than a norm. Ward call doctors usually go thru most nights without any major difficulty.

Whilst i hope this would be the case for tonight, at the same time i am looking forward to some challenge. I think immersing ourselves in difficult situations is the best way to learn. Yes knowledge plays an important role during this period, and all doctors should always be doing some form of reading up, but to be able to apply the knowledge when one is placed in a highly stressful environment is the quality that distinguishes ordinary doctors from extraordinary doctors.

In South Africa

Week summary (19-25 Nov)

This week, i have done some trail running, mountain running (ok, more hiking than running), and road running. Each activity allows me to work on a particular area of my running, thereby strengthening it. Trail running allows me to learn to deal with the technical aspect of running, avoiding rocks, negotiating with sharp bends and balancing myself on extremely uneven and rocky surface. Mountain running (hiking) builds the leg strength in general as the entire musculature of the lower limbs are being worked during ascent and descent. In the long run, it actually improves one's running economy, allowing a person to use up less oxygen for the same energy expenditure of the legs. And last but not least, road running allows me to work on speed and high intensity stamina. Running in trail for too long, you will gradually lose your speed and the ability to maintain top speed for a long time. It's good to throw it some road running every now and to train you to be fast. So that's what i have been doing this week! It's really fun to add variety into one's training, something which i did not do much this year.

Ahh. Why did i end up talking about training again? I don't mean to do this. I have been intentionally keeping myself from running or talking about running too much in this period as I have other priorities at the moment. But oh well. Since i am posting my week summary log, might as well just share about what i have done in the week.

I am really excited to going to Blue Mountains, Sydney with Raymun next weekend. A massive project coming up in Dec 2014. Stay tuned! :D

Total distance: 55.8km
Total time: 4hours36mins
Total elevation: 1132m 
Average speed: 4.95 min/km