Déjà vu ?

It has been 2 weeks since LQ and YT worked in KTPH.

I think God really dotes on me. In the beginning of pre-reg, 5 of us knew so little about each other despite being classmates for 4 years. We came from different backgrounds, different groups of friends, and we each have very different characters.

LQ has a megawatt smile and a big heart. She is always so willing to give.

YT has a gentle heart and motherly instinct. She won't raise her voice at all no matter what.

CM, brother oh, or ah mien (all nicknames superawesomely created by me! :D ), is really our good brother and has always been a gentleman. He is also a very patient man who has a gentle heart, that's why he has a good gf too :)

HL, the prettiest gal in our class, who appeared to be aloof, somehow became my closest buddy in AH now (she is a very warm gal). She has a very graceful appearance and nice body (whoosh) - all doctors keep looking at her hee :) A very nice girl who also has a very timid heart - she gets hurt easily by ppl's expectation.

And ME - the most curt, honest, "so-called efficient", un-ladylike of all.

Yet despite the differences, I am really glad that God shapes our friendship. We have known each other better over time, and when the spirit is low, we still stick together and cheer each other on. There is a strong connection linking all of us that is further intensified in these 2 weeks, when LQ and YT are in KTPH, while me and HL are in AH, and CM is on leave.

We actually miss each other loads.

Perhaps it's the thick and thin for the past 9 months that made us so connected.

Looking back, each of us actually took turn and cried in the toilet before. I remembered myself crying in the cubicle when the rest stood patiently outside, waiting for me to calm down.

And I remembered the 3 girls always stayed back for me and accompanied me to eat dinner because I do not have home-cooked food.

I also remembered all of us just somehow stayed back together doing our own things until 10-11pm, partially because we all had things that needed to be completed, partially also due to the fact that we were reluctant to leave each other behind. It has become a common instinct to "never leave your partner(S) behind". Sounds like movie fireproof eh :D

I guess we shared too many stories together over the past 9 months. We even baked muffins together, complained together, felt sorrowful and lousy together etc etc...

Sometimes when HL gets really really upset with herself and things, God speaks to her through me. Sometimes God does the same to me too.

God, I feel really blessed. Many times, it appears as if all things are specially arranged JUST FOR ME. Like every thing is to my advantage and accepting things that come to me, even when it is not as expected, is never a bad thing to do. Because in the end, I am still the one reaping the benefits.

It has been a long day. :)

Hope 2 of you have been well :)

HL, remember what I said after that presentation? God will raise you up, and things are getting better, believe in it first and the rest will fall into place in its natural and timely manner. :)

CM,Me,LQ,YT,HL

Me and HL

All of us at pre-reg closing ceremony:)

God's grace is always sufficient for me :)

Season of Longing

Everyday when I step into the wards, my heart turns very heavy. I can't help but sigh. Sometimes, I really wish I can be on a long-term MC so that I don't need to face the score.

By right, I should be on cloud nine now that my pre-reg is over. I do not need to work my lungs and hearts out for project and tests anymore, and I do not need to stay back almost everyday until 9pm to clear many many outstanding stuffs.

But things also can go by left. :( And it is quite a moron to think the left- way because the thought itself is moron-ic.

I am darn afraid. Because now my name tag writes "Pharmacist", no longer the "Pre-reg Pharmacist" that once gave you the exclusive rights to "Don't know this and don't know that". Now, I can sign on prescriptions and I do not need a registered pharmacist to counter-sign anymore. Previously, I am the 2nd last barrier before a medicine reach the patient but now I am the last and final barrier. If things go past my hands, and go wrong, it's a medication error.

To sum it all, it's responsibility. I feel a heightened sense of responsibility now. :( :(

This is when you feel like going back to pre-reg all over again.

I actually brought a heavy heart when I came back to AH last Tuesday. That day was my very first day working as a pharmacist. An inpatient pharmacist. Honestly, inpatient is the only place I have always wanted to be, but when I am really getting it ...

For the whole of last week, I kept asking myself - Do I fit to be an inpatient pharmacist? Actually, my mind went blank when I see the number of beds I have to deal with. For each patient's medication record that I put before me, I have a burning desire to want to do something for that particular patient, but my mind just stopped thinking. Rather, I can't think of anything. Suddenly, I feel so ashamed of myself. Perhaps they should choose other people to be the inpatient pharmacist, I have so little to offer. Even when you said I have 0.00001% higher clinical knowledge than my peers, I think I now have -999999% lower.

First time checking discharges on my own. I was in great fear when I was putting down my signature there as a checker. I got a feeling that someday in future, it will come back and haunt me with some kind of errors and disasters translated to the patients.

Gosh, this is so diminishing.

God, am I up to it?

I have nothing to offer my patients, and doctors. :(

RAWRRRRRRRRRRRRRRR..

So this was me for the whole of last week. The same thread of thoughts kept playing in my mind like an auto-re-winded radiotape.

But I am really getting better now.

I asked God the same question when I stepped into the ward today.

"What can I do for my patients God?"

"What if something wrong happened and I didn't notice or worse still, I didn't even know that it's wrong because I have pathetically NEGATIVE clinical knowledge and skills?"

"What if I really really screw things up and give the nurse wrong dilution and drug infusion rate and my patient die stat or worse still, slip into permanent morbid status?"

But more vividly than last week, I heard some voices telling me a lot more.

Yes I have to be here.

And yes, I do not know everything now but it's the something that I have which God can use to its maximum potential.

And and yes, I may make error and I will definitely make error. But I do not do it intentionally and if it REALLY really happens, it's a learning point for me, an avenue of growth for me.

And yes, because God loves me and has arranged for me to be an inpatient pharmacist, I am therefore the most suitable person to be here and whatever things that happen now and forever are not to destroy me but to groom me to be a better person, as long as I face God in all that I do.

And why do I worry so much about endangering my patients' lives when I have committed them into His hands, whose wisdom and foresight are greater than mine?

Such a paranoid right?

I know.

Couldn't help it.

Shall end with an old hymn that reminds me about the little me and bigger Him:

Be Thou my Vision, O Lord of my heart;
Naught be all else to me, save that Thou art.
Thou my best Thought, by day or by night,
Waking or sleeping, Thy presence my light.

Be Thou my Wisdom, and Thou my true Word;
I ever with Thee and Thou with me, Lord;
Thou my great Father, I Thy true son;
Thou in me dwelling, and I with Thee one.

Riches I heed not, nor man’s empty praise,
Thou mine Inheritance, now and always:
Thou and Thou only, first in my heart,
High King of Heaven, my Treasure Thou art.

High King of Heaven, my victory won,
May I reach Heaven’s joys, O bright Heaven’s Sun!
Heart of my own heart, whatever befall,
Still be my Vision, O Ruler of all.

有上帝就好了

One week in Johns Hopkins. Phew. It's been a long and tough fight this week.

I remembered few months back, when I was told that I could go Johns Hopkins for my oncology rotation - I was really really overwhelmed with joy :) No pre-reggers have been to JH for oncology attachment - most go to National Cancer Centre, so when I was told that I can go JH - I really really was very happy. Secondly, it's Johns Hopkins! No 1 Hospital in USA - medical excellence, great patient care, prestige, skills, research - ALL there! Plus the latest technology. It will be an eye opening experience I believed. And I have been to NCC for my FYP - I've had enough! Hahaha..

And I really like JH the morning I stepped into that place. I was following the CEO and the team during ward rounds - and it felt really different. Together with a medical consultant, oncology medical officer, the nurses, nursing director, and pharmacist - we went from one room to another, examining each patient and planning the treatment for them. I saw a really desperate young chap. A very young man indeed, and I saw books on prayers and bible beside him.

And suddenly I feel that it's so true that man seldom think of God and what He can do until the day they become desperate with life, and death. Whenever I see such patients, I really really feel like sitting down with them and give them a gentle touch.

Well JH doesn't have that many patients in the ward because not many can afford the bills that accompanied the name of this hospital. Most patients here are foreigners and very very rich locals who are willing to go ALL OUT to get a CURE for cancers.

Something very different of US culture is that they value pharmacist input much. What ever you said - they listened VERY attentively. And chemotherapies are very deep and intricate drugs that will kill if not properly titrated or dosed according to conditions of each patient - the more they will listen and value pharmacist's input. I love the way things work here - a very integrated multidisciplinary approach. Following doctor rounds in AH is very different, people are less receptive - and I am sure it's the same with other hospitals. I hope that one day what I see in Johns Hopkins will happen in AH too.

However, it was also after the first day that I felt hard to go on. I was in the inpatient pharmacy and I felt really ill-treated. I really felt very bitter, very crushed and disappointed. And I was "banished" from the room most of the times. I struggled very hard with my bitterness because I had to stay around somewhereno matter what. There's no where I could go. I had to be in JH and in the oncology wards. And my Day 1 really ended with a low-spirit Hooi Ching who really felt like giving up.

And I needed to present a case on Friday, and the case chosen for me was a complicated breast cancer case - triple negative (ie no targets to hit during tx) and a very progressive and unfortunate case. I was really disappointed because she did not attempt to go through an overview of breast cancer with me, nothing NOTHING. and then i was banished out with this case.

First - this is a very specialized field which a novice will need guidance to start to even comprehend the complexity of cancer, chemotherapies,radiotherapy and disease management.

And my patient's case notes - 1 YEAR + thick.

HOW HOW HOW??!

The "coldness" radiated from her really plunged me to a shallow pit for some time.

Why God always put me into situations :( From AH to JH, just weird scenarios and situations will come my way. Am I such an unlucky fella who always get shits.

It took me some time to pick myself up. At least when I realized that the ward has wireless, I became so relieved. I then can use my itouch to surf net to search for information or find answers to the queries I had while reading the case notes (because she didnt allow me to touch any computer - and this is so so abnormal -_- ).

2nd day was better. I have gathered that whenever I get into these shitty situations, it also gives me another opportunity to experience God in a more apparent manner. My greatest consolation was that because I am so special, that's why the people and situations I deal with, have always been the special ones.

1 - I am the ONLY pre-reg in singapore doing oncology attachment in Johns Hopkins for 2 weeks --> I guess that's quite a breakthrough.

2 - I do not care about what people think of me, because I like to face God in all that I do, albeit out of norm at times.

3 - I know that God doesn't put me here to let me die, but rather to rely solely on Him and watch how He will turn situations around for my advantage.

With these few realizations, I became more peaceful. I slowly digest the case notes and understand my patient's conditions. I don't know how to treat breast cancer but at least I managed to get help from huilin to print the NCCN guidelines from AH (YES she doesnt even allow me to print guideline that is absolutely relevant to everything that I am doing! ).

The greatest surprise I got was that God actually increased my interest towards the case. A triple negative breast cancer patient (this is rather bad, because all sites negative means that your drugs have no target to hit!) and the cancer has spread to brain, liver, lung and bone. It gave me a very good picture on how an aggressive breast cancer can progress and amazingly, I understand the story as time goes on.

Suddenly I see the reasons that God wanted me to be the one dealing with this situation:

1- Breast cancer is No 1 cancer of death in women

2- My hospital is gonna have an oncology dept in the new hospital and I can play a part in it!

3- Rarely people has triple negative breast cancer - and this patient suddenly plunges me to know the whole breast cancer in greater depth because she is difficult and I have to keep reading widely to understand it better, thanks to no help

4- God wants the people who bully me to be embarrassed

5- God wants me to know that nothing is impossible only if I fix my eyes upon Him and His works in me

The presentation to the in-charge went well. She was pleasantly surprised and mentioned she didnt expect a pre-reg to be able to deliver a presentation this way, with such details. The other person claimed the credit - saying because she always made me go and read case notes. -_-

I felt really happy do you know?

Not because I did a fabulous job, but more on the fact that I now really really know that God never leaves me and He will support me with tonnes of strong spirits and make me shine despite situations - only if I also put my entire heart and soul to seek Him and His perfect will in every of my situations, and not to be blinded by what's seemingly bad.

And I started to sympathize her. Because I heard people saying bad things about her, complaining about her etc etc.. And suddenly I became softened towards her. For someone who doesn't see the wrongs in herself and keep living on like these around people who said such things behind her for 10 years - so innocently pathetic.

Now that I am in the main oncology pharmacy, learning more with the in-charge, I really really feel rewarded. I know more things will come - difficult people, difficult situations, hopeless scenarios - But above all, i know who's in control and that suffice. (He always turn shit into gold:) )

Johns Hopkins

First day in Johns Hopkins was really different. I was really intimidated, fearful, but excited with the ways things are. Felt as if I am dwelling with very rich people – mostly from Dubai, very reputable consultants and oncology doctors who speak in very good accentS, and I see a very integrated multidisciplinary approach in caring for the patients. There is a translator who serves as an intermediate between the doctor and the patients and this is the first time for me to hear Arabics talking.

With little guidance that I have, I was really afraid. It’s only Day 1 and I was already feeling it’s hard to continue on, but at the same time, a big part of me keeps telling myself not to give up despite circumstances – because I’ve been hoping for this to come.

TODAY will be different! I try to grill that into myself just now - because God is faithful. He will not let me be tempted beyond what I can bear. I know He will provide a way out even if I am tempted, so that I can stand up under it.

P/S: Does anyone know how to jailbreak itouch? I did once on mine but it restored to its original state after I updated the software L and the jailbreak website where I learnt from is no longer there. Will be great if anyone can teach me again, and to downgrade my software from 3.1.3 to 3.1.0 because the former does not support my Drug database.

Lord has created Me this way

Today I am working as a pre-reg on a beautiful Sunday in Alexandra Hospital.
Today is also my last working day in AH, as a pre-reg.

I am going John Hopkins tmr. Oncology.
Pray for me :)

Today, when I was dispensing to a patient at bedside, I was quite affected by his expression. He was quite impatient, skeptical and rude. And then I kept thinking - why is he like that? It didn't affect me a lot, because I have a lot of patients to counsel on, a lot of discharges to type, a lot of supplies to manage. But the incidence with this patient triggered my thoughts a little.

Why is he like that?

And who am I?
Why am I like that? WHY am I the way I am?

People who know me well, work with me everyday, will always have to hear me complaining "oh no i put on weight etc etc". People who know me better will know that "abscess" refers to tummy in hooi ching's context.

Yea. I always complain that I am putting on weight. Despite running up and down, from one end of the hospital to another end many times a day, running up stairs from basement to the highest floor, I still think I am putting on weight. And as time goes by, as my clinical knowledge grow a little, or as I deal with more patients, I like to use the term "abscess" and "need to drain away my abscess". As time goes by, I heard people talking about abscess of their own - and I felt, eh, how come my lingo has become a common term these days among them?

This is the way the Lord has created me. I do not have the hottest nor the slimmest figure on earth. Yet with the little roundness I have, it's still a shape :) I am not slim yet I look fine overall, in totality. I still can fit into the clothes I buy online and receive good comments from people. I have freckles and pimple on the face, and my cheeks are always red - yet people feel comfortable looking at me because I have a friendly and approachable voice. I am not tall yet I always have people taller than me as good friends - Mindy is one example! Haha. I am not the smartest people on earth yet I do fine overall in every area of my life. My hair is dry but the permed hair has made me more ladylike as time goes by. I am a fast eater and I eat faster than guys. Yet despite the pressure I always exert on people during mealtime, I still have people who like to have meals with me and chat with me.

Suddenly I realized that I love the way I am. All these characteristics on me suit me very well. If any of them were missing/ became what I desired, I will no longer be so special. And I really am unique because God has made my appearance unique, my past experiences unique, my process unique, my thinking is unique, and my future gonna be unique too.

Me going John Hopkins - isn't it another unique thing of me? :)

Human is just so weird. Often, we do not see that we are already the most beautiful - because we often look at what we don't have or desire, but little did we realize that we have never really seen or accepted whatwe already had. Lately, I am surrounded by people who are dejected, low self-confidence, and people who are really tired. Sometimes, I tried very hard to push sense into them but in vain.

Why do we always see the insufficiencies in us and neglect the fact that we already had a lot? The cup is half empty - but it is also half-full.
Why let the low self-worth mechanism errodes us away when you can do so much more with what you are equipped with, once you are willing to accept the way you are? It is ok if one is not validated by people on the good things she does, but it is not ok to live by the validations/ praises - because they are just so meaningless.

Do everything in love. Love never fails. Because love comes from God and God will never EVER fail us. AND more importantly is that God has accepted us the way we are, the problem is - have you accepted yourself?

Things can be that simple.

Secret

No matter how hard one tries, how spiritual one wants to become, the hidden secret is still hidden but not disappeared.

Things are still the same.

One is still as weak.

Still as emotional.

Feels like rejecting God.

Yet still can't live without Him.

Sigh.