A year of wilderness - part 1

 

'For God gave us a spirit not of fear, but of power and love and a sound mind.'                    2 Timothy 1:7                                                                                                                               

It took me a while to realise that I am in the wilderness. 

I finished 2019 on a high. Passed my fellowship exams, had a great time in Prince Charles Hospital functioning almost like a consultant doing most operations independently, spending more time with my wife and kids and just being relaxed most of the time. And then I started the transplant fellowship at the Princess Alexandra Hospital in February this year. That's when I started on a slippery slide toward stress and anxiety, depression, relentless self introspection and scrutiny, constant feeling of inadequacy and failure. 

I had thought that this job is many years in making - how God has guided me to PAH since I was a resident in Sunshine Coast, assisting in my first ever retrieval with Prof Fawcett and Nick Butler (he was SET 5 then) when they came up to Nambour Hospital, assisting Andrew Robson when he came up to Cairns for retrieval and then again at Royal Brisbane Hospital, meeting Kellee Slater in core course and forming a connection, driving past PAH everyday on my way to work in the past 2 years and having a prompting in my spirit that God would lead me there one day. I had heard that PAH is tough place to work in, like a modern day 'Babylon', where the culture is toxic and unfriendly. I would never have imagined that I would one day work there, if it weren't for the assurance I had in my heart that that's where God wanted me to be. 

I must admit that before I started, I had thought that I would be like Daniel in Babylon in the bible, experiencing triumph in a hostile environment because I believe in God. I thought I was 'good enough' for PAH. After all, I did excel in Royal Brisbane. And all the stories I have heard about people failing in PAH, I thought it must be because they just 'weren't good enough'.

Ah.. What a naive thought. I could not have been more wrong in my life.

Six months into the job, I was more depressed than I have ever been in my career. I have never felt so lousy about myself. I found myself very fearful of certain individuals, fearful of what they thought of me and the influence they have over my future. Whenever I was with them, I became paralysed. The skills and gifts that I have just became dormant and inoperative, and I looked like a dead chicken in front of them, which further fueled their distaste of me. So many times I ended up saying yes to people when I really wanted to say no, because their approval matters so much to me. Often when something happened which triggered painful memories, or something that someone said, my entire soul just goes into a messy tangle and downward spiral which would take days for me to get out from.

For the entire time, I could hardly focus when I was with my family because of my preoccupation with myself. I was worried about my future. I thought my career is over. Dr Kanagarajah had told me many times: 'this is meant to be a fun year for you. You have just finished your exams, you are not planning to do transplant so everything is learning exercise for you. You should enjoy.' 

But I could not.

I did not realise these were all symptoms of a bigger spirit at play. And now I realised what it is -  the spirit that's at work behind all the symptoms.

It's the spirit of intimidation.

Just imagine a really nice big house with brand new furnishings in it. But there is a hole in the roof. When things are going well, the house is a really nice place to live in. But then there is a thunderstorm, and everything in the house gets soaked and dirty. And then you have to spend all the energy and effort to clean everything up and replace the furnitures. When it's all done, the next storm comes, and the house is in a big mess again. And you clean everything up again. Only for the next storm to undo everything. You just keep cleaning the house and fixing the damage. At some point you are going to become depleted, spent and exhausted. You might even lose hope on the situation. 

You see the root problem here is the hole in the roof, not the dirty furniture. If only you would fix the hole in the roof, none of the above would happen. Likewise, the root problem in my life was the spirit of intimidation. I felt intimidated by certain toxic individuals at PAH, and in doing so, I gave them the power and authority over me. But all I did for the problem was trying to fix the symptoms (the dirty furniture) - the negative feelings, the fear, the depression and anxiety. I tried to exercise more, sleep better, read my bible, fast, practise positive thinking, visualization etc. And all the while, I ignored the root problem. So each time when I think I have got over it, the next storm comes, and everything gets undone and I go into depression. The cycle continues. 

Next I will share about how i got myself into a mess and allow the spirit of intimidation to get a hold of me. 

Guidance for next year

'All that I have done today has gone amiss. What is to be done now?' Aragorn

I will lead the blind by ways they have not known, along unfamiliar paths I will guide them;
I will turn darkness into light before them, and make the rough places smooth.
These are the things I will do; I will not forsake them.
           
                                                                                                                                               Isaiah 42:16


Lord I am hoping you will speak to me about plans for next year. I don't have a job. What should I do? Should I actively go look for one? Or should I wait? I feel like if I were to do it my way, I would charge into the world, and fight for my own dreams and passion. I am so used to figuring out life on my own, solving problems, fighting battles. But I am not sure if this is the way God wants me to live. Well, life is not meant to be lived like that - on our own. I am meant to walk in intimacy with the Lord, to seek counsel from Him - the wisest and kindest and most living person in the universe.

So Lord, what should I do next year? My options are

1) HPB fellowship at PAH or RBH. These positions have both been taken...

2) HPB fellowship at Mater or Gold Coast.

3) Upper GI fellowship in RBH

4) General Surgery fellowship

5) HPB fellowship in Interstates

6) Take a year off. Be house daddy, do research, finish my masters, private assist, travel etc.
 
Well option 1 has pretty much been decided for me. Both positions have been taken. And unless if one of them pulls out, I would have no chance.

Personally I am not so keen on option 2. These fellowship positions are not as established as option 1. I know this sounds arrogant, and I am aware of the fact that 'no job is a waste of time', but in an ideal world, I would prefer to do 2-3 years of solid HPB training in reputable units like RBH, PAH, Royal Prince Alfred in NSW, Fiona Stanley Hospital in Perth or Austin in Victoria.

Option 3 is a very lucrative option for me. Because my aim is ultimately be a minimally invasive HPB surgeon, spending a year in Upper GI in RBH is great because it helps develop advanced laparoscopic skills. The problem is, Dr Finch has offered the job to a good friend of mine - Kevin Lah, who is the current Upper GI fellow. Because his year has been affected by Covid-19, Finchy offered for him to stay for another year.  Given his current circumstances, it is quite likely that he will remain in QLD for another year.

Option 4. This is not bad a option to keep my general surgery skills up and help to feed the family, except that I don't have interest to do it. The nearby Gen Surg fellowship positions are Caboolture, Redcliffe, QE 2, Logan and I don't feel particularly drawn to these positions. I also don't feel they would significantly contribute or 'value-add' to my ultimate goal to be a MIS HPB surgeon. Yes it is a good way to kill time and maintain my general skills, but I don't feel like this is an area I am lacking in.

Option 5. Well, we are having our third child in October so that makes traveling interstate very difficult, almost impossible. My wife is not keen to uproot the whole family to go to a new place with a newborn. While my wife is happy for me to go on my own, and she will remain in QLD with 3 kids, I don't think that is the right thing to do. I cannot imagine being away from my family for that long, even if I could travel back on some weekends to see them. It's just not the same.

Option 6. If all the above options are out, this is likely what i would be doing next year. It is actually not a bad option. In fact, it is pretty tempting. To finally not have a 'stable' job, to be able to spend more time with the family and do what i like and pursue my hobby of running, write a few papers and do my Masters etc. Besides I can privately assist David Cavallucci, Nick O'Rourke, Richard Bryant or some of my PAH bosses eg Shinn Yeung, which would be a great learning opportunity for me. Yes finance would be a bit tight, and the year of 'no formal training' does not look good on my cv, but hey, it's still fun !

I spoke to Cav and Nick - two of my bosses in RBH this week, and had a long chat with them about the future. Nick recommends that i do option 5 and Cav reckons options 1, 3 or 6 are good. In fact, Cav mentioned about Tan Tock Seng Hospital HPB fellowship job in Singapore, coz it's the only unit in Singapore that is recognised by ANZHPBA. Besides the head of unit - Terence Huey, used to train under Nick and Cav in RBH in early 2010s. If they put in a word for me, and if the position is still vacant, I should stand a good chance. I have also been thinking for a long time to move our family back to Singapore/Malaysia for a year for the kids to spend some time with their cousins and get cultural education, so this seems like a great opportunity. I left Singapore since 2006 for my university education, and it still holds a special place in my heart. I looked up the HPB unit in TTSH, and it appears that they do a fair bit of MIS HPB as well. So it is in fact a really good job to do with high case volume. Plus our family and the newborn can be close to both of our families. Except i am not sure if the position is still vacant.

Not having a clear plan and being at the mercy of other people is hard. It's almost the end of June. Most people would have figured out their fellowship plans for next year by now, or started making effort. I feel like that I am not making progress, and I am waiting for things to happen. Waiting is hard. It sounds like a passive thing to do.  Do nothing. Be vulnerable. Thus I am getting stressed out - which then hurts my ability to discern what God is saying to me. Which only increases my desperation to hear, and the whole thing is spinning into a tight, little Gordian knot. I have to pause, back up and consecrate myself and the matter at hand. I have to let go of my constant attempt to 'figure things out'.

Lord I don't want to decide this matter on my own. For I know I will almost definitely act on this based on my own selfish ambition, even at the expense of my own family. Teach me to hear Your voice, in the midst of some many competing noises and priorities. I want to do Your will. It is fruitless for me to seek your counsel while being privately committed to one course of action over the others. I must surrender my agendas and my 'best thoughts' on the matter. I must surrender my secret desires. When I do this, i will be in a much better place to receive His thoughts on the situation.

Laurence Webber, my HPB fellow last year, who is a great role model for me

Assoc Prof David Cavallucci and Nicholas O'Rourke, two of my HPB bosses in RBH. So much to learn from them!

My naughty wife tied both of our boys' hair up

Jeremy Boy's and Ethel's newborn - Matthias Cheah

New addition in Oct 2020!

Missing the grandparents !

Coming back

It's been so long since I last visited this blog. I guess this reflects how hectic the past few years have been, and writing has really taken a backseat in my life amongst many other competing priorities. But lately, I have been feeling the urge to write again. I like to write. About anything. It's not that I think I have any interesting things to share, or that my life experiences are important. The reason i write is simple - to connect with another human being. You may ask: why publish your writing in a blog where everyone can see it? This is where things get prickly, but i think most people aren't being true to themselves if they don't agree at least a little but with what i am going to say next. There is no reason to post one's life on the internet other than to feel as if you have some sort of agency as a human being. That is, that your actions - and posts - are meaningful to someone other than oneself and that they affect other humans in some way: to inspire, comfort, invoke joy, or inflame etc. The blog allows others to see you, provides an audience, and that helps tremendously to validate one's existence.

This started as blog to describe my journey in running - the highs and the lows, the lessons, trainings, victories and defeats. But I don't run as much anymore. Now other things have taken priorities: marriage, children, surgery, friends etc. Each aspect takes up huge proportion of my time. I intend to only write things that i think will be helpful and meaningful to share, not only for other like-minded people, but also for myself when i look back many years from now.

My dream is to write a book. People ask me what I intend to write. I think writing about my own life is going incredibly boring, selfish and bordering between self-aggrandisement and narcissism. The book has to be bigger than that. It's going to be about a collection of stories about people i have come across, people who have impacted my life in a deep way in different areas, that i believe will inspire other people. Many years ago i read a book titled - Soul Survivor by Philip Yancey. It's about how 13 unlikely mentors helped his faith survived the church. He interweaves the story of his own struggle to reclaim his belief with inspiring portraits of people who have succeeded in the pursuit of an authentic faith. I have not quite thought about the exact theme of the book i am going to write yet, but  it will be something along this line.

I thought the best way to start is revive my blog again, and start writing about things - anything. This way, at least i get to record the significant events or lessons in my life.  And this will all contribute toward my dream to writing a book. So here we go!

Family. Celebrating Rachel's Birthday

two boys practising yoga!

Camping during covid lockdown period

medical mission

Here we are in the Phillipines.

We are here for the first time to do medical mission with the local church to reach out to the poor in Santa Rosa, a settlement area for the victims of Typhoon which plagued Philippines in 2013. Mission has been something that is very close to my heart since before I started medical school, and it is interesting that after such a long hiatus from medical mission of 10 years (our last trip was in 2007 in Cambodia), we are with the same team again, this time with more knowledge, experience and hopefully wisdom too.

So how did we end up here?

If you had told me last year that i will be volunteering my time in mission this year, i would have stared at you blankly and say: Sorry i have got no time. Also I am not in the right frame of mind and spirit to do this. My work and family are more important.

The past few years have been years of wandering for me. My entire focus during that time was to be the best that i can be in order to excel at work so i can enter into the surgical training programme and flourish in it. This became my world, the thing that i took a lot of pride in. I eventually got accepted into the SET programme and started my surgical training in 2016. There began a slippery slope toward either alternating self aggrandisement (when things go well) and self-destruction (when things go bad). I thought this was going to be a fun ride, i finally got what i wanted, but instead, it was a journey marked with a lot of pain and deep struggles. Feeling lost so many times, feeling concussed from a massive whack on the head out of nowhere, going through anxiety and depression, confronting many things which i did not, absolutely did not like about the world and myself. 

Of course it would be inaccurate to say all of it has been mired with frustration and struggles. I did experience a far deeper measure of God's grace through the dark valleys, and there were interesting days and experiences filled with joy and small victory. But as humans, we tend to let the bad things stick more than the good. 

Now i see it all as part of God's breaking process for my life. Had He not allowed me to crash and break into many pieces, i can't imagine what monster i would be right now. And yes surely i was headed toward a certain gravely path had God not intervened. Not that i don't still have those monstrous elements in me right now, but God in His infinite wisdom, brought me thru dark valleys, which in turn, saved my soul.

Thankfully He placed people in my life to guide me in the right path. Two such people are my wife and son. They have taught me more about what is important in life than anyone else. My wife had told me that i needed to come to this trip, despite the fact that she is 5 month pregnant and had to look after Jonas when i am not around. She said God is not done with me yet. Even though what we are doing here mostly is treating cough and cold, infections, skin diseases, asthma, stuff which i knew little about, the fact that i am once again immersed in God's works advancing His kingdom purpose rather than mine, is in itself a reward. I am deeply grateful for her encouragement and sacrifice.

I don't know what to expect. But the words of Jesus: therefore go and make disciples of all nations, baptising in the name of the Father, Son and Holy Spirit. (Matt 28:19) resonates deep in my heart. So here's to a great adventure in the Philippines!

At the Cairns airport, waiting for departure

Having lunch with the local church

Reminded by my wife to drinking Vitamin C everyday :)

Cairns

We have started a new life in Cairns. I am second year into my surgical training, my wife got a job as a pharmacist in Cairns Hospital, and our boy - Jonas has settled in his daycare - Pelican Early Learning Centre. We have moved into an apartment in Lake Street called the Edge Apartments, about 1km from the hospital and very close to the daycare as well, so everything is within short distance of each other. It makes commuting very simple and it saves a lot of time for us.

One of the most exciting things i was looking forward to is being close to a very dear brother of ours - Jeremy. Jeremy and i have known each other since 2006 when we started medical school together. For the few years we were in school, we have climbed the highest mountains, dived the deepest seas, and hiked the longest valley together. He is a guy whom i really enjoy being with, because of his simplicity, the values which he holds dear to his heart, and the similar passions that we have, which are adventure and mission. We then got separated in 20010 when i came to Australia to complete my medical school, and a series of life events/changes also happened between 2009 and 2013 which brought us further apart. I am really glad God brought us back to each other again and we are able to work in the same hospital and live close to each other again. The older i get, the more i am convinced that life does not consist of material abundance or accomplishment, but the depth and quality of relationships we develop.

Here is to a great and adventurous and fun 2017. :)

Spending time with cousins in Singapore

First day in Cairns

Being on call and trying to eat my lunch

A fun evening with Godpa Jeremy at Botanical Garden

Surprising my wife with a convertible, a fun day out at Tableland and roses for our 4th year wedding anniversary 

Lake Barrine 

Curtain Fig Tree\

Running along footpath in Esplanade

Jonas running toward daddy when i picked him from daycare

Jonas' best friend - Mason

Last days in Nambour Hospital

What a ride it has been!

My past two years in Nambour have been nothing but spectacular, fun and adventure-filled. There were stressful times as well, occasions where i have made mistakes and felt terribly sorry, or got scolded by bosses or nurses. But all in all, I have had such a great time and I am bringing so much precious memories with me.

I have just finished two and a half months of night shifts. Night shifts are scary. You are the only person representing Department of Surgery and you have to be able to deal with all kinds of emergency in the hospital. Bleeding, perforation, obstruction, peritonitis, trauma were some of the common emergency we have to deal with.  I was feeling really anxious prior to starting my night shifts, worried that i might kill someone or not be able to save someone due to my incompetency.

I am glad to say I have done neither. Some of the really interesting moments were dealing with massive upper GI bleed post Whipple with Dr Aseervatham and Priscilla, massive lower GI bleeding from radiation proctitis with Thushara, a couple of open splenectomy with Dr Grieve and Dr Aseervatham, laparoscopic assisted small bowel resection for closed-loop SBO with Scott, a laparotomy and adhesiolysis with Dr Donovan, and a perforated diverticulitis with Priscilla and Peter. Every surgeon has a unique way of operating and i have learned so much from all of them. Dr Aseervatham is very particular about techniques, and always tells me to learn how to operate with both hands to the point where i forget which hand is dominant. One night, he had to come in to do laparotomy for upper GI bleed post Whipple. We started at around 10pm and finished at 2.30am. This was followed by a Hartmann procedure for a 120kg man with LBO. We started at 3.30am and ended up finishing at 6am. He had been up for 24 hours, spending his last 8 hours performing really stressful operations. Yet he never complained. He remained very calm and composed. I am so touched by his dedication and perseverance, and i hope i could emulate him when i am a practising surgeon.

I also really like Dr Donovan's minimalist approach to operating: where he does only the absolute necessary during operations, things that truly matter to patient's care. He doesn't waste time doing unnecessary manoeuvre, and he has a great sense of judgment in knowing when to and what to do when dealing with complex situations. I just wished i have done more emergency shifts with him.

Not to forget all the smaller operations I have done with the registrars. I have done about 15 laparoscopic appendicectomy with Anna, Kim, Katherine and Peter. All of them have taught me important lessons in doing a safe operation. I feel i am ready to do one on my own now.

I am going to miss all the residents i have worked with. Harrison, Bryan, Stephanie, Madeline, Isabel, Sean, Edwin, Fiona, Dave, Tahira, Chris, Karina, Ali, Stuart, Sam, Claire. All of them are awesome residents and are much better than me when i was one.

All the nurses in 1B and 1C - I can't finish naming all of you. Helen, Leanne, Jen, Ae-ran, Sheree, Roshni, Maggi,  Sarah, Nicole, Abby, Trilby, Kate, Jade, Maria, Jacki, Jenny, Raj, Bronwyn, Sharna,  Bec, Coralie, Deidra, Cadie, Trevor. You guys are amazing.

The specialist CNC - the beautiful Lauren, Erin and Caroline, you ladies are doing such a great job.

All the other doctors from other specialty. Lisa, Vinesh, Neil, Julia, Anjanee from Medicine. Graham, Karin, Nicola, Ben, Paul, Lauren, Courtney from ED (thanks for your non-stop referral during nights!). Mark from Ortho. Paul, Jonathan, Troy, Madeline, Glenna, Dan from Radiology. Chris and Andrew from Ultrasound.

Too many people to name. Thank you all of you!

Now I am off to Caboolture to begin the next chapter as a SET 2! See you again!

Running with Dr Donovan

All the awesome registrars - Manilka, Linda, Scott, Kimbeley, me and Peter

Anna, me, Peter and Manilka

Thushara (red) - the most friendly consultant who has helped me tremendously in my career

Dr Grieve - the person behind all the research projects in department of surgery in Nambour Hospital. I did both the colonoscopy and lap trainer research with him.

Operating with Dr Aseervatham - my mentor. What an honour.

The hallway to work

Jim Pryor Begonia Prize, Provincial Surgeon Australia 2015

On October 30, I attended the Provincial Surgeon Australia conference in Lismore, NSW. 

I was there to present my research (Development and Evaluation of an Inexpensive Home-Made Laparoscopic Trainer for Surgical Training) for the Jim Pryor Begonia Prize. There were a total of 7 presentations. 

Jim Pryor was a distinguished General Surgeon in the City of Ballarat from 1963 to 2002. The Jim Pryor Begonia Prize, was a memorial to Jim's contribution to country surgery. He conceived the Begonia Prize session of the PSA annual meeting to enable surgeons to exchange views about procedures large or small, instruments they had found useful or techniques they have found worked. The presentation had to be brief (3 minutes) and he instructed the Judge to award extra points for originality. 

At the end of the session, i was announced the winner. I had such a great time at the conference meeting new friends and learning new things. The GALA dinner on Friday was especially memorable, to see all the surgeons letting their hair down and dancing like there is no tomorrow! 

Next year's PSA will be held in Albany, Western Australia, in early August and it promises to be a great one as well!

Sally Erickson (right) - finally got to meet the lady who is behind every GSA event

John Henderson - this man has a spirit of gold. In his 80s, he still contributes to every RACS event by being the photographer

Dr Graeme Campbell (right) - receiving Rural Surgeons Award for his contribution to Rural Surgery

Dr Stephenie Weidlich (left)  - Surgeon from Darwin. She was the person who suggested i should present my research idea in PSA! She also recently Supervisor of the Year award from RACS. Thanks Stephanie!

Here is my presentation

Good Afternoon ladies and gentleman.

One disadvantage of working in regional or rural hospitals is limited access to surgical simulation. If you are interested to purchase a commercial laparoscopic trainer to practise at home, a FLS (Fundamental of Laparoscopic Surgery) trainer cost $3360,

So I am here today to show you how to make one with just $84.20 in less than 30 minutes.

To construct a home-made laparoscopic trainer, firstly, we need a box. I got the IV fluids Baxter for free. The sides and the front of the box are cut.

We then fixed a white tile on the base to serve as a platform for laparoscopic tasks.

We then glued a strip of velcro onto the tile. 

We used four pieces of elastic bands each tied to a clip, and they are attached to the four corners of the box.

For light sources, we used a LED ribbon strip, and that was glued on the inside roof of the box.

We used a high definition Logitech C525 webcam with autofocus ability, and mounted on the side of the box.

We made two holes for the instruments.

This is the final product.

This is a list of materials and cost needed to construct the lap trainer.

This home-made lap trainer has been successfully validated by 30 participants in our hospital and found to be comparable to the FLS trainer, and it was extremely well-received by the participants as well. 

Now some of you may be thinking: What can i do with this home-made lap trainer? Well, sit back and enjoy.

Video: A collaborative effort between Dr Grieve and I (ps: he did the harder tasks)

Finally, the best thing about the home-made lap trainer, is even my son can play with it.