Wounded

I really cannot take it anymore. This week has been over-eventful.

Why things have to turn out this way? Why things with good intention will be interpreted as risk and harm?

I really don’t care about what people will think of me. I really did it with good intention.

But it feels so darn awful when things get shot back in the most unexpected manner, and it’s no longer about whether you care what others think of you. Because YOU is now an understatement. It’s the identity you carry along with your name that’s involved now.

I feel really upset God L

I know I shouldn't but I really feel more awful when such things happen, You didn’t leave me alone, neither is Your grace. You once again has proven to me that I am in the right place where You can make me stronger. My heart is wounded, self-esteem crushed, confidence plunged to the bottomless pit - yet the team backed me up as if there's tonnes of spirit backing them up too. The bitter and sweet taste. And warmth.

Thank you for the thoughtful voice.

Thank you for the angry voice scolding me that you'll slap me if I really shed a tear for that matter or person.

Yet when strings of things come to me one after another, is it really not me?

And if it’s me, what could I have done better?

God have you planned all these before hand? If you haven’t then why I have to leave this country at this point of time?

God, if you could, can You ensure that I won’t get into situations that can terrorize people again?I am sufficiently frightened.

The Only Good Inside Your Heart is the Good that Jesus Brings

Good evening folks! Lately, I had the habit of listening to some old christian songs I used to have. Suddenly I came across this song and thought of sharing it here. It's really uplifting.

I think I haven't shared this with you before. I am thinking of signing up medical missionary trip sometime soon. Got this link from sharon, call it escapism perhaps, but I really hope to step out of Singapore to see how God can use me in this field. You might not know, sometimes, it's really hard to reach out when you're a healthcare professionals. A big part of your profession requires you to use drugs judiciously, and find the best treatment for your patients - if the patient wants to be treated. Of course, there will be patients who want to be treated conservatively - ie, DNR (do not resuscitate) when emergency happens.

But when you are a healthcare professional needing to treat your patients with the best therapies you can think of, have you ever thought that you're playing God? At some point of my career (3 weeks only!), I kept asking me if I really am playing God. At some other times when I am really trying very hard, making very vigorous interventions to the doctors to escalate certain therapies, I cannot see God in what I am doing but I can see myself doing what I am doing.But at times, when I really don't know what else can I give to the patient, my heart tells me to commit into our Saviour's hand.

So, being good is just a fable. Even in healthcare.

I have decided,

I'm gonna live like a believer,

Turn my back on the deceiver,

I'm gonna live what I believe.

I have decided,

Being good is just a fable,

I just can't 'cause I'm not able.

I'm gonna leave it to the Lord.

There's a wealth of things that I profess,

I said that I believed,

But deep inside I never changed;

I guess I'd been deceived.

'Cause a voice inside kept telling me,

That I'd change by and by,

But the Spirit made it clear to me,

That kind of life's a lie.

I have decided,

I'm gonna live like a believer,

Turn my back on the deciver,

I'm gonna live what I believe.

I have decided,

Being good is just a fable,

I just can't 'cause I'm not able.

I'm gonna leave it to the Lord.

So forget the game of being good,

And your self-righteous pain.

'Cause the only good inside your heart

Is the good that Jesus brings.

And when the world begins to see you change,

Don't expect them to applaud.

Just keep your eyes on Him and tell yourself,

I've become the work of God.

I have decided,

I'm gonna live like a believer,

Turn my back on the deceiver,

I'm gonna live what I believe.

I have decided,

Being good is just a fable,

I just can't 'cause I'm not able.

I'm gonna leave it to the Lord.

I have decided,

I'm gonna live like a believer,

Turn my back on the deceiver,

I'm gonna live what I believe.

I have decided,

Being good is just a fable,

I just can't 'cause I'm not able.

I'm gonna leave it to the Lord.

I have decided,

I'm gonna live like a believer,

Turn my back on the deceiver,

I'm gonna live what I believe.

When the world laughs at you 2

Hello world, how have you been?

Truthfully, things have not been that good for me in the past 2 weeks. Just wondering, do you find it harder to find God’s grace in the midst of trials or when your life is “smooth-sailing” and monotonously stable?

Anyways, this is already my 3^rd week as an inpatient pharmacist. Today while I was taking train home, I was quite astonished to see my reflection on the MRT train windows. Such a haggard me. Suddenly, I feel as if I’ve blend into the working world. I used to think that I’m different from the other working adults who have been working for years, BUT I realized that I was wrong, I look exactly like any of them, and I dislike it.

Since last week, my ward load has increased from 1 to 2. I have been handling 2 wards and just yesterday, I hit the highest number of beds. Just to put things in perspective, there is no correlation between the number of beds I am handling with the competency or what so ever. It is just natural for inpatient pharmacist to handle an average of 2 wards.

But I think I have not been handling my life well. Last Friday, a sister in my fellowship group shared something that happened in her life lately and a statement she made then really brought me back to reality. She said “when the spirit is right, everything will become just so right”. I guess I am just experiencing the absolute opposite of this statement, that is when the spirit is not right, everything will become so wrong.

Things have been so wrong lately. I don’t know why. Guess which pharmacist had to report 2 e-HOR in 3 weeks? ME! Yeaps, 2 medication-related errors happened in my ward these 2 weeks and even though I wasn’t the one doing it, I am the one who has to face the score when such things happen because I am the ward pharmacist. Actually I didn’t feel things were so wrong even when the e-HOR took place, because I know that errors happened and one happened during a public holidays when the discharges at the main pharmacy was like horribly enormous; and another one happened just to remind us to be more alert to the multiple strengths medication in the pharmacy. Didn’t blame anyone, just that, I am so wow-ed by the frequency of such things.

And I also don’t know why, I seem to have an intrinsic mechanism that attracts all the weird cases to my wards. One Bangladesh patient came in because of fits and it was found that there’s worms in his brain. Rare case for AH but I got it man. Bought in the medicine for him because AH doesn’t keep so many of such medication and in the end, before he’s even completely healed, the employer wanted him to be discharged because of the bills. It took me a couple of phone calls just to persuade the employer to agree to pay for the treatment for this patient and to come down to collect the medicine. Not cheap I have to acknowledge, but it’s necessary. At least he’s willing to buy 2 weeks supply of the medicine, instead of 1 month as prescribed by the doctors.

One day, suddenly I received a call from the ward saying my consultant wanted to PERSONALLY administer IV tensilon to this patient. Tensilon is a medicine used to diagnose myasthenia gravis. It’s an exemption drug, ie not registered in Singapore, hence no hospitals will stock up this item in their pharmacies.. We only kept 1 vial but it was used up the day before, for the same patient -_- SO SO wasted. Wilson helped me to call TTSH, SGH, NUH – ALL of them had 0 stock. I was darn panic that morning, I shouldn’t be. L

Another case - patient needed midodrine for orthostatic hypotension. Again, this is not a usual drug and hence we don’t keep in AH. Oh, first time in my life to come across EBA –Epidermolysis bullosa acquisita also.

Imagine doing all these and reviewing the patients in your wards at the same time. It is so so difficult L It shouldn’t be, if I have time. But it seems like everyday I get to encounter this kinda weird weird stuff and at the end of each day, I really get a real big mental block.

Many times, it felt as if the weight of the whole world is on me. I have been asking myself, why am I so jaded these days? Why do I always look so tired and I seem to have lost the joy that I used to enjoy?

And it’s until Friday that I realized why I am the way I am.

You know, the spirit is not right from the beginning. I have been handling things myself and my mind has always been running too quickly, or trying to think about solutions or how to carry my points to this doctor or that doctor. Things have not been mad. But the severity of the un-mad things has been magnified when the spirit is wrong.

I have been so occupied with things that I forget that He is with me and I can draw strength and wisdom from Him. And why do I have to make myself so tired and worried when He is the one in control and things have not been bad for me, not in the past, not now, and it won’t be in future. The only thing that’s changed is the intensity and frequency of matters that I have to deal with – seems to have increased. But I realized that actually, I don’t need God to give me wisdom to handle them.

Above all these, I really need to seek God and have the right Spirit first before I even start thinking about the problems/ situations. Why is it so hard fix my eyes on the unchanging ONE when I am surrounded with so many things that are changing?

Sigh.

When the world laughs at you 1

Laugh back at the world.

Yea, what happens when the world seems to be laughing at you? Laughing at your ignorance, your insufficiencies, your inertia to know about what you should know... what will you do?

CM once told me that when that happens, just laugh back at the world.

Just some updates...

My siblings and I have just bought a house last Saturday. It's at Punggol, Edgedale Plains. Not "bought", cos we haven't paid the full sum, but we offered the buyer and got accepted. So now we are in the midst of doing the procedures at HDB and bank sides. Will be moving in November.

I was a little overwhelmed actually. We have been viewing houses these 2 weeks and often, the houses are either too inconvenient, too old (and thus needs excessive renovations), too expensive etc etc etc..

But when my sister and brother saw this house, they really wanted it so much, despite it's beside LRT, no MRT. They actually called me while I was at work, to ask me if we can invest in that house. I was quite shocked that they made up my mind so quickly. It took my brother 1 week to buy an iphone, but few hours to want to get that house. And because of that, I know this is the house that the God has provided for us - for it's extremely hard to please my brother and if he really says yes, it really is good I believe.

This house wasn't my first choice. For many reasons, (1) It's far from work and 2-3 times a week I need to be work at 730 or 8am, it means I have to wake up very early to travel. To both Yishun/ Queenstown. (2) It is a bit higher than our projected budget (3) I still think we can wait for better offer.

But my brother actually took the effort to convince me. You know, this is the first time I saw him seriously hoping I will nod my head. Suddenly nothing became more important than this. Hahaha. So I agreed, we made the offer, and the house is ours, if we give our downpayment neat in September.

It's really a nice house. 3 years old, minimal renovations. I see the point, every reasons to buy it, although it's not my most favorite. I know I will grow to like it, it's just a matter of time. I felt quite bad when I told people that my siblings like the house (discounting the "me" in the statement). I know I shouldn't . Sigh, silly me again. It may had given ppl the impression that I am forced to buy the house. Really felt like slapping my mouth when the words came out!

I will grow to like the house. This is the house that is given to us after many prayers and searching. And I should stand on the same side as my siblings.

In fact, there were many struggles over these few days, especially after the decision has been made, contract signed. The down payment of course. Never in my entire life so far my bank account has 5 digits. But I need to get ready a 5 digits sum by September. Not only me, my sister and brother too.

I know I should have expected it when I said I wanted to get a house. The financial issues, the expenditure etc etc... they are all important considerations. But I simply chucked them behind me thinking they will be settled in the most natural ways if God really wants to give me a house.

Then the questions came to me..

"How are you gonna settle the 5 digits sum? Credit-line? loans?

How come you don't know what's your CPF contribution?

How come you don't know these don't know that?

How can you be so ignorant when you're now working already?

You don't even know how bank loans work, the interest rate etc etc.."

I was quite upset when such things were shot at me. I know I should check all these before I happily declared that I wanted to buy a house with them, but many times, when I checked the bank websites, I simply cannot understand the ? per annum thing etc etc.. I know I shouldn't make excuses but I really don't know how CPF contributions work and I know being a 2 weeks old PR is a good enough reason for me to must know all these.

I also know that I had the smallest role to play in the entire buying house game that we're dealing with but I just don't know how. I don't want to say "God will provide" words like these because it has become a "cheap grace" in your eyes.

SIGH.

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:) )