one wonders what whim has possessed me to be on blogger at this time, all i can say to answer this is perhaps that i'm simply procrastinating or escaping from the anxiety that should have befallen me by now, seeing that i have my first ever job interview tomorrow!!! royal melbourne intern, imagine that... me, a doctor... one year, even scarier - 7 and a half months, from now, that could well be reality... patients' lives falling into the desperate realm of my responsibility and counsel... a humble fluffy bug doing all he can to heroically thwart the attempts at conquest being made by bugs of a far more sinister kind...
meanwhile, all excited by such stuff, the mind has been contemplating truth of physical reality to the minutest detail - that is, quantum (argh - took me 3 goes to spell that word properly!!!) mechanics... jus finished reading a fascinating account of the search for an accessible interpretation of quantum reality by john gribbin called "schrödinger's kittens"... it culminates in a rather dramatised unveiling of a fairly commonsense interpretation, which is nevertheless very impressive, that is cramer's transactional interpretation...
basically - transactional interpretation tackles the difficulty of explaining quantum reality (as suggested by experiments) by using the following principles:
-time can stand still (it does, for a photon... or anything that "travels" at lightspeed)
-things can be implied to go backwards in time (backwards communication, by virtue of the use of quantum waves to communicate quantum state, is in fact simply atemporal from the point-of-view of the quantum wave - so nothing truly does travel backwards, it's jus happening simultaneously)
-the quantum states of an object and all dependent objects, are simultaneously determined
i'm struggling to come up with a way to make this into an easy explanation... - oh well... but the paradox, anyhow, goes that an electron is within a closed box with a partition that can be moved to close off one half from the other... the electron's position is indeterminate at this stage... the partition is closed, and two identical capsules (one connected to each half of the box) are opened to the box, so that the indeterminate electron will enter one or the other capsule... each capsule contains a diabolical device, which releases a poison gas if it detects the presence of an electron... each capsule also contains a cat, and all the necessary goodies to keep the cats alive (and yes, in these miraculous capsules, telomerase and antioxidants are abundant - these cats don't age!!!)... - each capsule then fires off in opposite directions across the universe, and they end up, say, millions of light-years apart...
tradition says that the electron is in an indeterminate quantum state until the presence of an "intelligent observer" intervenes to "collapse the wave function" into a defined presence or absence of the electron... so, this traditional interpretation has puzzled scientists by implying that each cat is in an indeterminate state (or a superposition of states, both dead and alive simultaneously) until some intelligent observer opens the capsule and consigns one cat to its fate by collapsing the wave function (and simultaneously consigning the other cat, a million light-years away, to the opposite fate)... - einstein called this "spooky action at a distance", and it makes some degree of sense, and, believe it or not, has practical application in instantaneous faster-than-light communication in quantum cryptographic techniques...
but how can stuff travel faster than light?!? this is what so puzzled einstein... and many others... including richard feynman, whose theories regarding the nature of light ironically inspired the transactional interpretation of cramer... - the scenario, in the transactional interpretation, would be that, once an interaction occurs (that is, observation of the cat - because reality for the observer is grounded in observation), the quantum state is communicated backwards in time, through the poison gas, through the diabolical device, through the electron, back to its original box, and then forwards in time again, to the other capsule... - this is possible because quantum states traverse time, and photons and quantum-state waves have no meaning of time - and therefore can seemingly travel backwards (even though no time elapses for them)... the quantum states are, from our viewpoint, collapsed (and consign the distant cat to its fate) - but the quantum reality is that, as far as any conventional time-frame is concerned, one cat was dead all along, and the other was alive all along!!! there was no superposition of states where the cats are both dead and alive...
if this is hard to make sense of, it's probably coz i haven't explained it very well... ;p but anywayz... i better go now... and return from fascinating phenomena of physics to a state of mind where i'm once again contemplating a career as a competent, caring clinician... ;p with Christ as my guide, i shall hopefully be one next year at royal melbourne!!! - wish me luck!!!
God bless,
dave ;p
Tuesday, May 24, 2005
Monday, May 16, 2005
Tiredness... but happy ;p
had a wonderful weekend of relaxation and fun!!! went to beaufort with a group of uni ppl, trekked around a bit on mt cole, and had some nice food... were there to also see the hospital (beaufort still has a nice hospital with comprehensive range of ancillary services in addition to general practice, despite being such a small town) and talk with some of the staff there, to get a feel for what rural practice involves and so on... ;p
was a great escape tho!!! on the back of a busy psych rotation, it's nice jus to have a change of scenery and not have to worry about anxiety, depression, substance abuse, psychosis, eating disorders and suicidality for a change... especially good was to finally have some quality time with sally and jus enjoy each other's company for a while, to know and appreciate in each other the qualities God has blessed us with, without so many other things on our minds... we have too few moments like this... 's the problem when we're both jus such busy ppl!!! (yes, med can be mad...) still hanging in mood for a break now, not particularly itching to return to study!!!
-----
to now respond to request for the recipe for long-case success:
despite popular advice, long-cases aren't what you do from day to day in the ward with patients once you start working... in the real world, rapport and friendliness are paramount, to gain the trust of the patient, to ensure that your alliance is one forged on honesty and genuine care, and to bring about some simple therapeutic effect thru the wonderful healing power of human interaction...
long-cases, on the other hand, are meant to be a systematic, short-lived chance for you, as medical student, to demonstrate to examiners that you can obtain and organise information from a patient about him or herself to conform to a structure, such that others in the profession can rapidly understand and anticipate your thinking and clinical judgement... there is far less importance placed on rapport and friendliness - instead clinical precision is what's required...
so what's the recipe?!? - you could get any patient at all, so don't start off with the patient in your head... you'll put this together in a structured fashion as you do your history and examination... you start off with a bony structure that goes something like:
-opening statement - name, age, ethnicity, occupation (or social support modality), lives where, with whom, presenting with (insert brief one-phrase summary of history of presenting complaint) on a background of (insert most salient features of background history)...
-history of presenting illness - chronology is important and probably the best way to organise this info... pick an important event (or when the patient was last well) in the recent past and go thru the steps of detailing the key symptoms and outlining relevant symptom groups... detail is very important here - don't spend forever on it, but this is one area where you cannot afford to cut content... make sure also to put some detail in here abt possible precipitants...
-relevant history - recent, longstanding, or pertinent episodes, conditions or operations... make sure to talk about indications, course of illness, treatment (especially recent changes in medications) and prognosis of all relevant conditions... - the key word here is "relevant"... you should highlight relevant conditions first before going onto the next section...
-past history - all the rest of the medical/surgical history that's not relevant to the case at hand... this is more-or-less a list, and little detail is required...
-medications - i like to put medications here, but this may go immediately after history of presenting complaint if, for example, the recent illness has been triggered by a change in medication, or a side effect of medication... alternatively, medications may hold little relevance, in which case a passing comment is sufficient (e.g. this patient is not currently on any medications)... in any case though, especially at this stage, no medication should ever be dismissed as trivial, and all details should be obtained as much as possible (i.e. what medication, how much, when to take, how long they've been on, indication, side effects, and patient's adherence to prescription)... don't forget over-the-counter medications...
-smoking/drugs/alcohol - i put these all together... like medications, if particularly relevant, this can be put immediately after the history of presenting complaint... remember that detail is important, and examiners usually don't like the use of the term "social drinker", or "occasional user"... if possible, give an idea of how often and how much... and if dependency is a possibility, go through symptoms of dependency, pattern of use (morning drinking, for example), how central patient's life is around the drug, withdrawal symptoms, past overdoses, attempts at quitting, thoughts about quitting... if illicit drugs, be wary and suspicious and make the connection with crime, especially for the more lucrative ones such as cocaine and heroin... forensic history can follow this too, if relevant...
-family history - this is cursory... don't get confused and start talking about the complex developments in the patient's family life... family history simply means genogram of immediate family (i.e. family structure), causes of death if any, family function (do they live together, or parents divorced, for example) and presence or absence of any particularly relevant medical conditions or operations within the immediate and extended family...
-social history - talk about educational, occupational, social development and current status here... tailor detail level depending again on how relevant you judge the information to be... most importantly, since social history often encapsulates the essence of the person's day-to-day routines, this is where one of the most important issues of illness and its impact may be highlighted... i'm referring, of course, to functional impairment... it's difficult to overstress how important and useful an outline of functional impairment can be, especially within the context of a patient's life and the things the patient regards as important to him or her...
-developmental history - can be relevant also, particularly in psych patients... talk about pregnancy, birth, early years (milestones), separation anxiety, primary and secondary academic, sporting achievements, and socialisation at school... family environment at home (high expressed emotion, for example, can play a part in the incidence of relapse of psychosis) or any particularly relevant losses during the patient's childhood should be commented on...
-systems review - optional, but often encouraged to be put in here... most frequently, it's jus a heading to show that you've done systematic questioning about other health issues... almost always, you'll say "systems review was unremarkable" (because if you picked up anything relevant, you'll have put it earlier in your history)
-risk - keep this in mind when you're interviewing, especially if patient is depressed or has chronic pain or chronic illness... risk is about risk to self, to others, of absconding, and of non-adherence to treatment... insight into the patient's condition may be of particular note...
okay, you now have a backbone... this is to be stored in the head, and if possible, written down on a proforma just moments before you see the patient... in the interview, ensure that the patient is comfortable at the start, because you'll be putting a lot of pressure on him/her with all your questioning!!!
how to question in a long-case is very different from seeing patients as a continuing care doctor... it's more like seeing them at a once-off visit, where you need to make a diagnosis quickly and arrange a bare-bones treatment plan you know will work, and you never see the patient again... what i'm saying is that a big emphasis on rapport and empathy is not going to help!!! (of course, be sensitive, but let them know that you're going to ask a lot of questions in a short amount of time - and just do that)... - you want to keep in charge of the interview, no matter what...
i'd suggest starting by asking lots of closed questions to fill in the opening statement (what's your name, how old are you, are you living at home, who's at home with you, are you currently working etc), patients expect you to ask these anyway...
from there on, direct the interview to the current situation with a question like, "what problem has brought you to hospital?" or "what has been happening in your life recently?" - then, keep focusing on the current issue... if the patient starts straying, don't let them stray too much into the past, unless they're clearly feeding you very relevant information (like the course of their ulcerative colitis for a patient who's presented for rectal bleeding, for example)... if the patient says anything very striking, e.g. they mention pain, then jump on it and keep asking specific details about that symptom until you've fully characterised it... when the patient has given you a good picture abt the presenting illness, then review with specific questioning any relevant symptoms they haven't described (so, if they've talked a lot about the headache, then ask about any loss of consciousness, faintness, weakness, numbness/tingling, visual problems, hearing problems, photophobia, neck stiffness etc)...
steer the interview then to focus on medications, or past medical history (whichever you feel is more likely to be relevant to the case based on what you know so far), and explore each of those areas in detail... remember to separate medications into "now", "used in past", "recently changed"... and remember to ask about adherence to medications... remember to separate past medical history into relevant and less-relevant... and present the relevant ones in detail, but the less-relevant bits as no more than a list...
continue in this fashion, asking lots of specific questions and keeping the patient on track, sticking to the skeleton outlined earlier...
make a point of considering the other important issues throughout as being functional impairment and risk (see later)...
when it comes to physical examination, remember that the most important step is inspection!!! the reasons why - you should give the examiners a very good idea of what the patient looked like (describe both general appearance and behaviour, in addition to any signs you looked for specifically)... so, something like "Kim was a young-looking woman of Chinese ethnicity, lying on the bed wearing a hospital gown with 2 pillows and the head of the bed raised to 45 degrees... she looked uncomfortable and appeared cyanotic, with bluish lips, and was wheezing... she had two ventolin inhalers lying on her bedside table..."
then, given limited time only in the exam, you should go straight for the examinations that you anticipate you'd have findings... quick hand-inspection is always worthwhile... as are all vital signs (get temperature from chart if you don't have a thermometer)... oximetry and blood glucose are also extremely valuable in most settings...
risk assessment - a section you're only formally taught about in psychiatry, but is quite important for all long-cases really... risk assessment should elaborate in features of the history if they are already prominent there, but needs to be stated here separately, because it is so important... risk assessment consists of four main elements (for inpatients) - risk of self-harm, risk of harm to others, risk of absconding, risk of non-adherence... these four aspects have to be detailed in terms of current and past relevant thoughts and behaviours (e.g. high level of suicidal ideation currently, but no previous attempts)... if there is a positive past history of suicide attempts, then detail the method, intent and setting...
formulation/summary - don't simply repeat your opening statement, but recap it... this is where you start to present interpretation... up until now, you have done absolutely no interpretation, not made any diagnoses or anything, except that you would have done well to have presented it in a manner that shows that you understand the patient and their illness (show this by the way you group symptoms and examination findings, and the relevant negatives you talk about - also, don't neglect the all-important symptom of functional impairment)...
structure of formulation - you should talk about predisposing, precipitating, perpetuating and protective factors, in that order... make these quick, with maximum of 2 sentences for each category (preferably one sentence for each)...
diagnoses are last... followed by management... remember that principles are most important, so rather than diagnosing asthma immediately (unless it's obvious), then you should say something like "my differentials include all causes of acute respiratory distress, in this case, most likely asthma, but could also be bronchiolitis or pneumonia..."
better go now... may write more later... but have tute!!! ;p get lots of practice, and happy long-casing!!!
God bless,
dave
was a great escape tho!!! on the back of a busy psych rotation, it's nice jus to have a change of scenery and not have to worry about anxiety, depression, substance abuse, psychosis, eating disorders and suicidality for a change... especially good was to finally have some quality time with sally and jus enjoy each other's company for a while, to know and appreciate in each other the qualities God has blessed us with, without so many other things on our minds... we have too few moments like this... 's the problem when we're both jus such busy ppl!!! (yes, med can be mad...) still hanging in mood for a break now, not particularly itching to return to study!!!
-----
to now respond to request for the recipe for long-case success:
despite popular advice, long-cases aren't what you do from day to day in the ward with patients once you start working... in the real world, rapport and friendliness are paramount, to gain the trust of the patient, to ensure that your alliance is one forged on honesty and genuine care, and to bring about some simple therapeutic effect thru the wonderful healing power of human interaction...
long-cases, on the other hand, are meant to be a systematic, short-lived chance for you, as medical student, to demonstrate to examiners that you can obtain and organise information from a patient about him or herself to conform to a structure, such that others in the profession can rapidly understand and anticipate your thinking and clinical judgement... there is far less importance placed on rapport and friendliness - instead clinical precision is what's required...
so what's the recipe?!? - you could get any patient at all, so don't start off with the patient in your head... you'll put this together in a structured fashion as you do your history and examination... you start off with a bony structure that goes something like:
-opening statement - name, age, ethnicity, occupation (or social support modality), lives where, with whom, presenting with (insert brief one-phrase summary of history of presenting complaint) on a background of (insert most salient features of background history)...
-history of presenting illness - chronology is important and probably the best way to organise this info... pick an important event (or when the patient was last well) in the recent past and go thru the steps of detailing the key symptoms and outlining relevant symptom groups... detail is very important here - don't spend forever on it, but this is one area where you cannot afford to cut content... make sure also to put some detail in here abt possible precipitants...
-relevant history - recent, longstanding, or pertinent episodes, conditions or operations... make sure to talk about indications, course of illness, treatment (especially recent changes in medications) and prognosis of all relevant conditions... - the key word here is "relevant"... you should highlight relevant conditions first before going onto the next section...
-past history - all the rest of the medical/surgical history that's not relevant to the case at hand... this is more-or-less a list, and little detail is required...
-medications - i like to put medications here, but this may go immediately after history of presenting complaint if, for example, the recent illness has been triggered by a change in medication, or a side effect of medication... alternatively, medications may hold little relevance, in which case a passing comment is sufficient (e.g. this patient is not currently on any medications)... in any case though, especially at this stage, no medication should ever be dismissed as trivial, and all details should be obtained as much as possible (i.e. what medication, how much, when to take, how long they've been on, indication, side effects, and patient's adherence to prescription)... don't forget over-the-counter medications...
-smoking/drugs/alcohol - i put these all together... like medications, if particularly relevant, this can be put immediately after the history of presenting complaint... remember that detail is important, and examiners usually don't like the use of the term "social drinker", or "occasional user"... if possible, give an idea of how often and how much... and if dependency is a possibility, go through symptoms of dependency, pattern of use (morning drinking, for example), how central patient's life is around the drug, withdrawal symptoms, past overdoses, attempts at quitting, thoughts about quitting... if illicit drugs, be wary and suspicious and make the connection with crime, especially for the more lucrative ones such as cocaine and heroin... forensic history can follow this too, if relevant...
-family history - this is cursory... don't get confused and start talking about the complex developments in the patient's family life... family history simply means genogram of immediate family (i.e. family structure), causes of death if any, family function (do they live together, or parents divorced, for example) and presence or absence of any particularly relevant medical conditions or operations within the immediate and extended family...
-social history - talk about educational, occupational, social development and current status here... tailor detail level depending again on how relevant you judge the information to be... most importantly, since social history often encapsulates the essence of the person's day-to-day routines, this is where one of the most important issues of illness and its impact may be highlighted... i'm referring, of course, to functional impairment... it's difficult to overstress how important and useful an outline of functional impairment can be, especially within the context of a patient's life and the things the patient regards as important to him or her...
-developmental history - can be relevant also, particularly in psych patients... talk about pregnancy, birth, early years (milestones), separation anxiety, primary and secondary academic, sporting achievements, and socialisation at school... family environment at home (high expressed emotion, for example, can play a part in the incidence of relapse of psychosis) or any particularly relevant losses during the patient's childhood should be commented on...
-systems review - optional, but often encouraged to be put in here... most frequently, it's jus a heading to show that you've done systematic questioning about other health issues... almost always, you'll say "systems review was unremarkable" (because if you picked up anything relevant, you'll have put it earlier in your history)
-risk - keep this in mind when you're interviewing, especially if patient is depressed or has chronic pain or chronic illness... risk is about risk to self, to others, of absconding, and of non-adherence to treatment... insight into the patient's condition may be of particular note...
okay, you now have a backbone... this is to be stored in the head, and if possible, written down on a proforma just moments before you see the patient... in the interview, ensure that the patient is comfortable at the start, because you'll be putting a lot of pressure on him/her with all your questioning!!!
how to question in a long-case is very different from seeing patients as a continuing care doctor... it's more like seeing them at a once-off visit, where you need to make a diagnosis quickly and arrange a bare-bones treatment plan you know will work, and you never see the patient again... what i'm saying is that a big emphasis on rapport and empathy is not going to help!!! (of course, be sensitive, but let them know that you're going to ask a lot of questions in a short amount of time - and just do that)... - you want to keep in charge of the interview, no matter what...
i'd suggest starting by asking lots of closed questions to fill in the opening statement (what's your name, how old are you, are you living at home, who's at home with you, are you currently working etc), patients expect you to ask these anyway...
from there on, direct the interview to the current situation with a question like, "what problem has brought you to hospital?" or "what has been happening in your life recently?" - then, keep focusing on the current issue... if the patient starts straying, don't let them stray too much into the past, unless they're clearly feeding you very relevant information (like the course of their ulcerative colitis for a patient who's presented for rectal bleeding, for example)... if the patient says anything very striking, e.g. they mention pain, then jump on it and keep asking specific details about that symptom until you've fully characterised it... when the patient has given you a good picture abt the presenting illness, then review with specific questioning any relevant symptoms they haven't described (so, if they've talked a lot about the headache, then ask about any loss of consciousness, faintness, weakness, numbness/tingling, visual problems, hearing problems, photophobia, neck stiffness etc)...
steer the interview then to focus on medications, or past medical history (whichever you feel is more likely to be relevant to the case based on what you know so far), and explore each of those areas in detail... remember to separate medications into "now", "used in past", "recently changed"... and remember to ask about adherence to medications... remember to separate past medical history into relevant and less-relevant... and present the relevant ones in detail, but the less-relevant bits as no more than a list...
continue in this fashion, asking lots of specific questions and keeping the patient on track, sticking to the skeleton outlined earlier...
make a point of considering the other important issues throughout as being functional impairment and risk (see later)...
when it comes to physical examination, remember that the most important step is inspection!!! the reasons why - you should give the examiners a very good idea of what the patient looked like (describe both general appearance and behaviour, in addition to any signs you looked for specifically)... so, something like "Kim was a young-looking woman of Chinese ethnicity, lying on the bed wearing a hospital gown with 2 pillows and the head of the bed raised to 45 degrees... she looked uncomfortable and appeared cyanotic, with bluish lips, and was wheezing... she had two ventolin inhalers lying on her bedside table..."
then, given limited time only in the exam, you should go straight for the examinations that you anticipate you'd have findings... quick hand-inspection is always worthwhile... as are all vital signs (get temperature from chart if you don't have a thermometer)... oximetry and blood glucose are also extremely valuable in most settings...
risk assessment - a section you're only formally taught about in psychiatry, but is quite important for all long-cases really... risk assessment should elaborate in features of the history if they are already prominent there, but needs to be stated here separately, because it is so important... risk assessment consists of four main elements (for inpatients) - risk of self-harm, risk of harm to others, risk of absconding, risk of non-adherence... these four aspects have to be detailed in terms of current and past relevant thoughts and behaviours (e.g. high level of suicidal ideation currently, but no previous attempts)... if there is a positive past history of suicide attempts, then detail the method, intent and setting...
formulation/summary - don't simply repeat your opening statement, but recap it... this is where you start to present interpretation... up until now, you have done absolutely no interpretation, not made any diagnoses or anything, except that you would have done well to have presented it in a manner that shows that you understand the patient and their illness (show this by the way you group symptoms and examination findings, and the relevant negatives you talk about - also, don't neglect the all-important symptom of functional impairment)...
structure of formulation - you should talk about predisposing, precipitating, perpetuating and protective factors, in that order... make these quick, with maximum of 2 sentences for each category (preferably one sentence for each)...
diagnoses are last... followed by management... remember that principles are most important, so rather than diagnosing asthma immediately (unless it's obvious), then you should say something like "my differentials include all causes of acute respiratory distress, in this case, most likely asthma, but could also be bronchiolitis or pneumonia..."
better go now... may write more later... but have tute!!! ;p get lots of practice, and happy long-casing!!!
God bless,
dave
Friday, May 13, 2005
Relaxation time...
hey all ;p long time - no post... been kinda busy lately, had the concert yesterday and an exam today... really glad the exam's over!!! a cloud casting a shadow over my head lifted, and allowing the light of enjoyment to truly re-enter and bathe me once more... ;p not that things haven't been enjoyable... ;p
concert went mostly swimmingly - awesome solos by julien, sally (go sal!!! the brahms was excellent!!!), matt/kat/julie and linda ;p sure missed out if u didn't come along...
today's exam - hmmmz... went better than i anticipated actually... to be honest, wasn't really sure what to expect or how i would go... had been warned abt the patient with a long history with multiple past admissions and millions of treatments that don't work... coz they're so difficult to interview, examine and present in the time allocated, and apparently most medical students fall right into the traps laid bare with a case like this (if u want tips on how to successfully negotiate such a patient, will be happy to write something on that in maybe my next post or sth)... and guess what - i get one of those patients!!! not his fault of course, God bless him, and really wishing him all the best in finding an effective, stable treatment for his illness...
managed to present the full case in 10 minutes (yay!!!) and answer most of the examiners' questions... a couple of them were pretty obscure for a student who comes out clueless from a 6-week psych crash-course (that's pretty much how it felt)... but oh well... nothing i can do abt it now... but overall, quite ok with how i went, i suppose... praise and thanx to God for pulling me thru!!! ;p
anywayz... - i think it's jus reminded me that, thru the difficulties, challenges and criticism, these are jus some of God's way of refining us into the people He has set aside for Himself... ;p God amazes me, that He can use the things we dislike in this world, and make them positive influences on us!!!
now to look forward to a weekend of relaxation ;p
concert went mostly swimmingly - awesome solos by julien, sally (go sal!!! the brahms was excellent!!!), matt/kat/julie and linda ;p sure missed out if u didn't come along...
today's exam - hmmmz... went better than i anticipated actually... to be honest, wasn't really sure what to expect or how i would go... had been warned abt the patient with a long history with multiple past admissions and millions of treatments that don't work... coz they're so difficult to interview, examine and present in the time allocated, and apparently most medical students fall right into the traps laid bare with a case like this (if u want tips on how to successfully negotiate such a patient, will be happy to write something on that in maybe my next post or sth)... and guess what - i get one of those patients!!! not his fault of course, God bless him, and really wishing him all the best in finding an effective, stable treatment for his illness...
managed to present the full case in 10 minutes (yay!!!) and answer most of the examiners' questions... a couple of them were pretty obscure for a student who comes out clueless from a 6-week psych crash-course (that's pretty much how it felt)... but oh well... nothing i can do abt it now... but overall, quite ok with how i went, i suppose... praise and thanx to God for pulling me thru!!! ;p
anywayz... - i think it's jus reminded me that, thru the difficulties, challenges and criticism, these are jus some of God's way of refining us into the people He has set aside for Himself... ;p God amazes me, that He can use the things we dislike in this world, and make them positive influences on us!!!
now to look forward to a weekend of relaxation ;p
1 Peter 1:3-9
Praise be to the God and Father of our Lord Jesus Christ! In his great mercy he has given us new birth into a living hope through the resurrection of Jesus Christ from the dead, and into an inheritance that can never perish, spoil or fade—kept in heaven for you, who through faith are shielded by God's power until the coming of the salvation that is ready to be revealed in the last time. In this you greatly rejoice, though now for a little while you may have had to suffer grief in all kinds of trials. These have come so that your faith—of greater worth than gold, which perishes even though refined by fire—may be proved genuine and may result in praise, glory and honor when Jesus Christ is revealed. Though you have not seen him, you love him; and even though you do not see him now, you believe in him and are filled with an inexpressible and glorious joy, for you are receiving the goal of your faith, the salvation of your souls.
Sunday, May 01, 2005
Random writing...
trying this exercise of typing with no real agenda at all, jus whatever comes to mind... it's quite strange, coz i'm trying not to stop typing all the while, coz if i stop, i give myself time to think and defeat the purpose of the exercise... oh well... anywayz...
today was last day of missionary convention, celebrated at our church... we played violin in the orchestra as part of the worship, which was really quite an enjoyable thing... they're encouraging impro, altho most of the time we have long notes and stuff, it's fun jus playing whatever comes to mind and trying to fudge it so it still sounds good and fits well with whatever the singers are singing etc... the band seems to be really quite experienced at the whole impro thing, but violins, errmmm... me, hmmmz - i've done some piano improv, but violin is so different - only one note, and have to fit in with everyone else... think i caught myself playing quite a few strange notes in the middle, but somehow think God must've intervened and made it sound ok to the audience ;p God is wonderful!!! but there were five other violinists in addition, so maybe my strange notes were blended in amongst their proper harmonies ;p always a good thing abt playing in orchestra, you're able to make some mistakes and still sound ok...
the message, brought by david cook (from a sydney bible college), was one that was really powerful and reminded me of my calling to Christ through a book called "a fresh start" by gary chapman... was based on a passage from romans 10, where it talks about the contrast between God's truths and what the Israelites, zealous though they were for God, believed would bring them closer to God... the mistake the Israelites made was believing that the way to God was through obedience to the law, which is impossible to achieve by any human... this is similar to the blueprint followed by most religions in the world (in fact, probably all religions apart from true Biblical Christianity), which are based on the "do" principle - i.e. you must do something to be made right with God... Biblical Christianity, on the other hand, is based on the "done" principle - i.e. God has already done all that was needed through Jesus in order to bring us back to Him... (this contrast was first brought to my attention in that awesome green book that helped bring me back to Christ nearly two years ago!!!)
there are a few things, i suppose, that can be said to elaborate on this...
-firstly, the rift that was made between man and God was initiated by original sin in the garden of Eden... this was man's rebellion, and while we are trapped by law, we are enslaved by sin... this is one reason we are unable, because of the entrapment, to fully obey the law, and are dooming ourselves to failure if this is the way that we choose to make ourselves right with God again...
-secondly, since this is an impossible task for us, who then should the law pertain to if it isn't issued for our own salvation?!? it points directly to Jesus - the one who was able to uphold the law, for He alone is righteous of all ppl on earth!!! this is the reason why the law was given... instead of us trying to make superhuman efforts to make ourselves right with God by the law, we ought to trust and have faith in Jesus, who is God's bridge to us, the way to make ourselves right with Him... He came down to earth, we don't need to try to ascend to Him in heaven... we need not fear death either, for Jesus has defeated death, and we can see this by His resurrection...
-thirdly, the story of everything, from creation through history through to the future, is God's story... God is at the centre of everything, and ought to be the centre, the focus, of our lives also... Jesus, by overcoming death through love, humility, righteousness and sacrifice, is God's love gift to the world!!! what a wonderful thing it is, that God should love us so, all the more glory and praise to Him who deserves all honour!!! God sits upon His throne ;p the Holy king of the universe ;p
what then is there for us to do?!? we ought to remove ourselves from the centre of our own lives, and stop trying to win God's approval through observation of the law alone, for such attemps only prove futile... we ought to simply place our faith in Jesus, the way that God has provided, and put Him at the centre of our lives, responding fully in love for God and for one another, in the way that Jesus has taught us through his exemplary life and teaching... how are you going to respond to Jesus?!?
today was last day of missionary convention, celebrated at our church... we played violin in the orchestra as part of the worship, which was really quite an enjoyable thing... they're encouraging impro, altho most of the time we have long notes and stuff, it's fun jus playing whatever comes to mind and trying to fudge it so it still sounds good and fits well with whatever the singers are singing etc... the band seems to be really quite experienced at the whole impro thing, but violins, errmmm... me, hmmmz - i've done some piano improv, but violin is so different - only one note, and have to fit in with everyone else... think i caught myself playing quite a few strange notes in the middle, but somehow think God must've intervened and made it sound ok to the audience ;p God is wonderful!!! but there were five other violinists in addition, so maybe my strange notes were blended in amongst their proper harmonies ;p always a good thing abt playing in orchestra, you're able to make some mistakes and still sound ok...
the message, brought by david cook (from a sydney bible college), was one that was really powerful and reminded me of my calling to Christ through a book called "a fresh start" by gary chapman... was based on a passage from romans 10, where it talks about the contrast between God's truths and what the Israelites, zealous though they were for God, believed would bring them closer to God... the mistake the Israelites made was believing that the way to God was through obedience to the law, which is impossible to achieve by any human... this is similar to the blueprint followed by most religions in the world (in fact, probably all religions apart from true Biblical Christianity), which are based on the "do" principle - i.e. you must do something to be made right with God... Biblical Christianity, on the other hand, is based on the "done" principle - i.e. God has already done all that was needed through Jesus in order to bring us back to Him... (this contrast was first brought to my attention in that awesome green book that helped bring me back to Christ nearly two years ago!!!)
there are a few things, i suppose, that can be said to elaborate on this...
-firstly, the rift that was made between man and God was initiated by original sin in the garden of Eden... this was man's rebellion, and while we are trapped by law, we are enslaved by sin... this is one reason we are unable, because of the entrapment, to fully obey the law, and are dooming ourselves to failure if this is the way that we choose to make ourselves right with God again...
-secondly, since this is an impossible task for us, who then should the law pertain to if it isn't issued for our own salvation?!? it points directly to Jesus - the one who was able to uphold the law, for He alone is righteous of all ppl on earth!!! this is the reason why the law was given... instead of us trying to make superhuman efforts to make ourselves right with God by the law, we ought to trust and have faith in Jesus, who is God's bridge to us, the way to make ourselves right with Him... He came down to earth, we don't need to try to ascend to Him in heaven... we need not fear death either, for Jesus has defeated death, and we can see this by His resurrection...
-thirdly, the story of everything, from creation through history through to the future, is God's story... God is at the centre of everything, and ought to be the centre, the focus, of our lives also... Jesus, by overcoming death through love, humility, righteousness and sacrifice, is God's love gift to the world!!! what a wonderful thing it is, that God should love us so, all the more glory and praise to Him who deserves all honour!!! God sits upon His throne ;p the Holy king of the universe ;p
what then is there for us to do?!? we ought to remove ourselves from the centre of our own lives, and stop trying to win God's approval through observation of the law alone, for such attemps only prove futile... we ought to simply place our faith in Jesus, the way that God has provided, and put Him at the centre of our lives, responding fully in love for God and for one another, in the way that Jesus has taught us through his exemplary life and teaching... how are you going to respond to Jesus?!?
Romans 10:1-17
1Brothers, my heart's desire and prayer to God for the Israelites is that they may be saved. 2For I can testify about them that they are zealous for God, but their zeal is not based on knowledge. 3Since they did not know the righteousness that comes from God and sought to establish their own, they did not submit to God's righteousness. 4Christ is the end of the law so that there may be righteousness for everyone who believes.
5Moses describes in this way the righteousness that is by the law: "The man who does these things will live by them." 6But the righteousness that is by faith says: "Do not say in your heart, 'Who will ascend into heaven?'" (that is, to bring Christ down) 7"or 'Who will descend into the deep?'" (that is, to bring Christ up from the dead). 8But what does it say? "The word is near you; it is in your mouth and in your heart," that is, the word of faith we are proclaiming: 9That if you confess with your mouth, "Jesus is Lord," and believe in your heart that God raised him from the dead, you will be saved. 10For it is with your heart that you believe and are justified, and it is with your mouth that you confess and are saved. 11As the Scripture says, "Anyone who trusts in him will never be put to shame." 12For there is no difference between Jew and Gentile—the same Lord is Lord of all and richly blesses all who call on him, 13for, "Everyone who calls on the name of the Lord will be saved."
14How, then, can they call on the one they have not believed in? And how can they believe in the one of whom they have not heard? And how can they hear without someone preaching to them? 15And how can they preach unless they are sent? As it is written, "How beautiful are the feet of those who bring good news!"
16But not all the Israelites accepted the good news. For Isaiah says, "Lord, who has believed our message?" 17Consequently, faith comes from hearing the message, and the message is heard through the word of Christ.
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