Elkandren's Whisper

Verse I Didn't Get (VIDG) #1

2012-01-26T19:18:00.006+11:00

I'm hoping to revive my blog in a somewhat meaningful fashion! This is an attempt to start a series (possibly weekly or monthly) on interesting or difficult verses that I come across in my reading of the Bible. I am doing this mostly as a personal exercise, although in sharing this I do hope that others may benefit from hearing another point of view! By no means do I claim any of my own authority - and of course, I call on other resources in order to aid with my understanding. But in writing these things down, I find myself accountable to others to correct and criticise my understanding/exegesis. These verses inevitably have proven quite challenging - so much so that they take several re-reads in order to understand, often requiring a closer look at the original language composition/construction and the context surrounding them. One might want to check out John Piper's "Desiring God" blog, and a few of these links for more on regular reading (and how to read).

On a side note - it's interesting to read that John Piper was arrested! His post here shows how passionate he is about the rights of the unborn child. It is sad to contemplate the limbo-state of the unborn - their life and identity remains utterly fragile and at the mercy of those who would not recognise their existence as anything greater than a piece of flesh. The complexity of the issue is huge, however, and well beyond the scope of where I want to go with this post - can of worms for another time, keep it shut for now. Anyhow - enough of a digression - without further ado, the first VIDG!

Genesis 3:16

To the woman he said, "I will surely multiply your pain in childbearing; in pain you shall bring forth children. Your desire shall be for your husband, and he shall rule over you."

This is a hard text! While a coincidence, it is intriguing to note that there are many books of the Bible whose 16th verse in the 3rd chapter stands out as interesting - cf. John 3:16 and 1 John 3:16 to cite two of the most famous ones. I've chosen this one because it challenged me thoroughly, as a verse that appeared quite abhorrent and difficult to accept. Here, in Genesis, the first book of the Bible, we encounter a decree from God to the first woman, Eve, saying that as a result of sin (i.e. disobedience to God), He would:

multiply her pain in childbearing
her desire will be for her husband, and he will rule over her

This twofold decree sounds like a harsh punishment! In the first instance, pain is added to childbearing - why is it that the woman must endure this, and not the man? Secondly, she is to be insubordinated to her husband - which creates in her an inner turmoil, since her desire is for him! There is much to be said against this twofold decree, particularly in today's age where gender equality is the dominant stance.

Yet not is all as it seems.

Briefly, the first part of this verse is straightforward - pain in childbearing is truly evident in human experience; what this tells us is that it is by God's decree that this is so, and that this suffering is prescribed as a response to sin. That modern medicine (and perhaps alternative therapies) are able to provide considerable relief from this suffering is by God's grace.

The second part of this verse is far more difficult to accept and understand. On first reading, this appears to be decreed or mandated insubordination of women! In many ways, history bears this out. Indeed, reading the Bible seems to bear this out as well - just look at the narrative of the patriarchs through Genesis. Male dominance in society is fairly well assumed in a lot of history, and across the vast majority of cultures. It is easy for one to see that this verse can be abused by those seeking to exercise male dominance over women. However - does God decree that insubordination of women is right and good?

Here, we are reminded of the primacy of the man, Adam. Eve followed, and she was created as a helper for Adam - thus the order of the first couple determines the pre-existing nature of their relationship. The leadership was given to Adam in the first place. Closer examination of the first phrase in the last sentence of Genesis 3:16 ("your desire shall be for your husband") reveals that this has a parallel in Genesis 4:7 - the same word for "desire" is used here to describe sin's "desire" for Cain. This "desire" should therefore not be interpreted in the usual way - rather, it is a term that is imperfectly translated into English, one that encompasses the sense that the woman will desire to control her husband - and then, the verse goes on to decree that "he shall rule over you". The picture here is one of struggle, or one of conflict, or strain, within the marriage relationship. Note also that this verse describes marriage (the term "husband" is used), and not the relationship of all women to all men - therefore, this does not connote a mandate or decree by God that men are to rule over women in every circumstance.

For more on the marriage relationship, Ephesians 5:25-33 is positively helpful. Here, Paul describes marriage as an analogy for the relationship between Christ and the church. True sacrificial love (after the pattern of Christ) is encouraged. Right submission (which is mutual, see Ephesians 5:21) is to characterise all inter-Christian relationships, including marriage. The headship expressed by husbands in marriage is not to be of the domineering type.

Summary:

suffering is decreed by God because of human disobedience (sin)
there will be conflict within the marriage relationship (also as a result of sin)
there is no decree by God that men as a whole shall rule over women
there is, however, a right order (the husband's headship) in marriage, which is to be characterised by sacrificial love

Till next time, God bless!

Meditation

2011-10-03T00:27:00.004+11:00

"Driven", "energetic", "confident", "efficient", "productive", "professional" - all these words I have been trying to apply to myself in a desperate bid to transform myself into the ideal candidate for anaesthetics training at a major tertiary hospital in metropolitan Melbourne. Immersion in the culture of medicine has certainly served to drive me in this direction - one that would surely see me succeed at becoming that inevitable ultra-efficient utility within a public health system that is ever seeking greater efficiency, in a world/society that seeks that same end.

I wonder whether this is a healthy thing at all - efficiency.

In our bid to stamp out waste, efficiency as measured by production per unit time is promoted as the highest ideal, almost without question. No longer can we rest in the knowledge that our job is done - forever work accumulates in front of us in a never ending pattern of futility as we strive to see our list of jobs disappear completely. If, perchance, we encroach on earning a break, a rest, then all of a sudden we realise we must have forgotten something crucial - through furrowed brow, we search, trying to remember what we next needed to do - always there is something more to be accomplished.

I wonder whether it is better to see this for what it is - futile.

This cycle of modern life churns our personalities into mindless machines, preventing us from gaining true independence - a perspective that is lost to us, as we gaze through frosted eyes in the belief that our independence can truly be gained only through the daily grind. If only our lives could be turned the right way up again, and we could see life for what it truly is - or rather, what it truly should be.

I wonder whether there is more than just futility - purpose?

Meaning in our lives can only be gained by a change of pace - hard to come by in the scheduled life. The songs that resonate most strongly in my head are those that speak of stillness, patience, solitude. Waiting. Slowing down. Only then can we understand our purpose - because it exists well beyond the immediate and tactile reality that we are trapped within. So many things glow with the promise of gratification that they delude us, luring the unwary to accept the notion that all that exists is what is seen, and nothing further. How depressing! Slow down. Wait. Quiet your soul. Listen.

As the old adage goes - less is more. Go. Meditate.

"Surely I have stilled and quieted my soul..." - Psalm 131:2 (ASV)

IMPACT 2009...

2009-07-10T23:13:00.002+10:00

I'll preface this rather lengthy post by saying that these reflections are here mostly for my own benefit. It is really a simple exercise in remembrance of the wonderful teaching we received last weekend – and, as for any type of learning, revision is greatly beneficial in improving retention and application of the acquired knowledge. I do hope, however, that some will read this and enjoy it, perhaps even learn from it, and also be encouraged in living in such a way as to give glory to our heavenly Father!

Reflections

"He has showed you, O man, what is good. And what does the Lord require of you? To act justly and to love mercy and to walk humbly with your God." – Micah 6:8

As a medical practitioner, mercy really ought to be at the heart of my professional mission. However, it is frequently lost in our thinking – medicine as a job does not necessarily lend itself to rewarding mercy in practice. The environment is one of high stress, drive for efficiency, hierarchy - it all combines to push one's feelings aside, and the temptation is to feel like yet another cogwheel in the system, keeping things running. Patients are an inevitable part of the system, rather than a person in need of mercy. When we are stripped bare by the eyes of analysis, we realise the brutal truth, that the mercy given us is often not passed onto others around us. But as recipients of mercy – God's mercy – we are called to be more than cogwheels, more than instruments of diagnosis and treatment. We are called to become agents of God's mercy to those in need, and we are privileged in the health care profession to be able to reach out to so many, who might benefit from God's mercy through us.

IMPACT 2009, a conference of CMDFA (Christian Medical and Dental Fellowship of Australia) held last weekend in Geelong, brought together a nationwide body of doctors, dentists, nurses and other allied health professionals, and students, to learn about and discuss the theme of mercy.

Old Testament Insights

We were blessed to have Andrzej Turkanik, a theologian from Austria (as distinct from the land of the kangaroo!), be the keynote speaker for the weekend. As a theologian concentrating on the Old Testament, he presented us with some interesting character examples to illustrate how God's mercy works, and how we ought to apply these.

Moses

First, turning to Exodus 3, we learn of Moses's journey to the far side of the desert, a long way from the hustle and bustle of Egypt's cosmopolitan heart, where he had been known as a murderer. Here, Moses climbs Horeb (Sinai) and comes into God's presence. At this point in time, God, having heard the cry of his suffering Israelites, plans to rescue them from their plight. Moses is chosen for this mission. Upon the mountain, confronted with God's astounding mission, then goes onto ask two powerful questions of God.

"Who am I?" – Moses has had a privileged upbringing that may prepare him, as well as or better than most, for the task of confronting Pharaoh. However, Moses' question is a fairly logical reaction to the scale of the task (verse 11). Note, however, God's response. He does not remind Moses of his upbringing, or his preparedness. He, instead, says "I will be with you" – the connection here, is that Moses' identity is as one who is with God. His ability is not the factor that leads to success, rather it is God's presence. Compare this with 2 Corinthians 12, and Paul's experience with physical impediment (thorn in the flesh). God's answer to prayer was clear (verse 9) saying "my grace is sufficient for you". When confronted with life, tasks, hardship – God's grace, His presence, is all we need.

"Who are you?" – Moses asks this question, perhaps doubting God’s strength and power to save. However, God’s response is very revealing and powerful. In verses 14-15, God reveals Himself as “I am”, “the God of your fathers”, and “the name by which I am to be remembered from generation to generation”. He then goes on to promise deliverance to a new land, a new life. This reveals God as a constant God, one who is powerful, as proven in the past, who he presently is, and what he will do in the future. When confronted with doubt – remember God’s constancy.

What we learn from Moses is that God is someone whom we can trust, and that our reliance is only rightly placed with Him. He may ask much of us, but when the task is at hand, God’s grace and presence are sufficient.

Jacob & Leah

In Genesis 29, Jacob and Leah both feel hard done by. Jacob has worked hard for seven years, in love with Rachel, and finds out that he has been tricked into marrying the other sister. Leah clearly plays the role of despised wife. How, then, does their story display the mercy of God? Leah was shown mercy in being granted sons – indeed, many sons, and far more than Rachel. While she would not be loved by Jacob, she praised the Lord for His mercy. Indeed, the greatest mercy extended to her is shown in her eventual part in the line of Jesus’ own ancestors!

Judah & Tamar

In Genesis 38, within one to two generations of Jacob and Leah, we meet Judah (one of the sons of Jacob and Leah) and Tamar. Genesis 38 is one of the strangest chapters in the Old Testament – it is almost perverse when we look at it from modern day eyes. Perhaps a bit of background context is in order here. Tamar’s situation needs to be understood in the light of Canaanite law – their law obliges Tamar (a widow) to seek to provide sons (i.e. the all-important line of descendants) for her dead husband. This would be achieved by way of the dead husband’s brethren becoming husband to the woman, thus fulfilling the duty of the deceased.

We read of Onan’s wickedness. He entered into the relationship for pleasure, ignoring responsibility, and greedily seeking a greater inheritance for himself by not providing a son for his deceased brother. He was put to death (by God). Fearing the same fate for his next son, Judah deceives Tamar – however, he is himself deceived by her, once she learns of his deceit. Ashamed, Judah admits that she was more righteous than he. Despite Judah’s wickedness, and Tamar’s underprivileged position, God’s mercy is once again shown in the resolution of the story, and their ultimate line of descendants to Jesus!

Of course, this mercy is not lost on Judah. He is transformed by this mercy. Judah’s wickedness (as evidenced by his hypocrisy and fear, and earlier in his part in selling Joseph into slavery) is transformed into merciful, sacrificial character (as evidenced by his willingness to plead, and even substitute for his younger brother, Benjamin, in Genesis 44).

We therefore learn from Judah that God’s mercy, extended to the lowly, has mighty transformative power. This works to the glory of God – not because of our righteous deeds, but because of God’s sovereignty.

Elijah

The story of Elijah the prophet is one of despair and lost hope in the face of Queen Jezebel’s threats on his life, after the great showdown between himself and the prophets of Baal. We pick this up in 1 Kings 19, and Elijah flees to the desert. Note that Elijah is fleeing in the direction of Horeb (Sinai), because at the place where Moses experienced God’s presence, there he also desired to experience God’s presence. Elijah is representational of Moses – as prophesied in Deuteronomy 18. Fed by God, Elijah reaches Horeb – having received physical nourishment, he then comes to the place where he will be filled spiritually.

At Horeb, Elijah seeks refuge in a cave. This interestingly suggests that Elijah, having sought God, now wants to hide – but God’s thought-provoking question applies to us all, “What are you doing here?” Note then Elijah’s predicament, trapped within himself, as evidenced in his rather self-centered response. God’s revelation is also interesting. Rather than manifest in a powerful display, God chooses to arrive as a “gentle whisper”, or when translated more accurately from the original Hebrew text, as a “thundering sound of sheer silence”. God’s nature here is mysterious, but clearly more powerful than earthly (or even heavenly) displays of power and might. Filled with God’s presence, Elijah is (like Moses) commissioned by God to “go” and fulfill his purposes. Later on, like Moses, Elijah is granted the grace of meeting and talking with Jesus about Jesus’ own exodus (Luke 9:28). Such is the mercy of God that the spiritually exhausted are filled!

We learn much from Elijah. Just as we become disheartened or threatened, and dwell in self pity, we come to God for filling. God is gracious and merciful, revealing Himself as He chooses, but refreshing us spiritually so that we might play our part in God’s story, God’s plans. We can gain hope for the future from Elijah’s story, that we, also, will meet God face to face. In this lifetime, what counts is faithful obedience to God’s commission.

A Radical Prayer

“Blessed are the merciful, for they will receive mercy” – Matthew 5:7

Reverend Dr David Williams, a minister, missionary and medical doctor, taught principally about the meaning of mercy, developing the concept well beyond the traditional exposition of “withholding judgment”, describing mercy instead as active love and compassion for the lost and weak.

The Traditional View

A traditional view has grace and mercy being two sides of the same coin. Grace is the provision of undeserved blessing, while mercy is withholding judgment. Indeed, these are helpful ways of understanding what God has done for us at the cross – fundamentally, the freedom and eternal life we experience in Christ is God’s grace, while being spared the punishment of death and eternal separation from God is God’s mercy.

True Mercy

To understand mercy properly, however, requires an understanding of God’s character. Mercy does not seem a natural or easily understood attitude, when one thinks about our understanding of justice. Sin deserves punishment – even unto death. Exodus 25:17 describes the atonement cover (or mercy seat), the place of the ultimate sacrifice, an annual event involving the death of unblemished animals. This took place to (symbolically) abolish the chasm between man and God that had been created by sin, and hence restore the relationship.

If punishment were to be simply ignored, this would imply that justice is undermined. If God is completely just, then, how are we to understand that our sin goes unpunished? At the cross, we see that our sin indeed is not unpunished, but is completely accounted for – substitutionary atonement. Who took the punishment for our sin? It was Jesus, upon the cross, fully human, but also fully God, who took the punishment. The character of God, whose mind-blowing act of love it was to take the punishment of the world’s sin upon Himself, is perfect mercy.

Mercy, therefore, is loving kindness, compassion, pity. It beautifies relationships, for it produces edification of the lost and weak. For the mortal, God’s mercy enables us to learn and be filled with God-likeness. Because we have received mercy, we can understand mercy, and because of this we can show mercy.

Outworking of Mercy

In our lives, therefore, God’s mercy is active and alive in our own transformed inclinations toward others. God’s mercy is poured into our lives, and our calling is to take up our cross daily – thus, God’s mercy is extended to others. Our attitude is to be that of Christ, compassionate and sacrificial. This, then, is mercy.

The ingenious corollary of this is that our own lives are enriched if we are merciful! As Jesus proclaimed, “Blessed are the merciful, for they will receive mercy.” With an attitude of mercy, we are aided in our understanding of God’s own character – this, furthermore, is mercy, our own contentment in God!

A Radical Prayer

If our lives are to be characterized by mercy, as we hope, then we must cast aside all hindrances. And so we pray that our lives are God-centered. We pray for no riches, except in God alone (our example lies within scripture, in Proverbs 30:8). We pray also to find no rest, except in God alone (Hebrews 4). We pray that we may be able to love God more than our own families (Matthew 10:37).

Many find such prayer radical, for it goes against many of the things we are tempted to call blessings. Riches can be blessings, as can holidays and rest, and families are a wonderful blessing also. However – the problem lies in the possibility that each of these potential blessings are also potential idols. If we can pray these prayers, then this helps to refocus and establish our priority in God – these blessings are secondary.

Such is the nature of God’s mercy that we are able to understand His mercy when we draw near to Him, and we are abundantly blessed when we can know Him so well.

Bridging the Gap

Dr Alan Gijsbers, addiction medicine specialist and theologian, taught about mercy as the attitude or desire to bridge the gap, to heal, essentially God’s character and desire to bring about restoration since sin entered the world.

“Mercy” is used to translate several Hebrew words in the Old Testament:

Chesed – loving kindness

Chanan – grace

Rachamin – pity

Note that all three of the above are represented in Psalm 51:1, and all three are part of God’s character, as expounded in Exodus 34:6-7.

In the New Testament, “mercy” is used to translate four Greek words:

Eleos – kindness

Oiktirmos – pity/compassion

Splanchnon – affection

Hilaskomai – propitious/merciful

The many meanings of the word “mercy” as used in Scripture highlight its complex nature, and its broad meanings together form a significant component of Godly attitude. Once again, we return to Jesus as God incarnate for our prime illustration of what mercy looks like. Jesus healed the sick (Matthew 4:23). He associated with the needy (Matthew 9:9-13). Notice in this passage that Jesus exhorts the Pharisees to understand God’s plea, “I desire mercy, not sacrifice”, and again the very same exhortation in Matthew 12:7. God’s people had heard this before numerous times (1 Samuel 15:22-3, Psalm 40:6-8, Isaiah 1:11-17, Jeremiah 7:21-3, and verbatim in Hosea 6:6). Mercy is an attitude of the heart, one that Jesus displays so clearly throughout His ministry.

If we examine the beginning of Jesus’ ministry in Matthew 4-5, we notice something incredible. Jesus’ preaching comes in the context of His powerful healing ministry – i.e. Jesus was a medical missionary! Imagine Jesus overseeing His disciples, and the crowds of needy below, and proclaiming the Kingdom of God, all the while healing them because of His infinite compassion. This is mercy. Jesus instructs His disciples to be “salt” and “light”, likewise carrying out the deeds of mercy.

Mercy & Justice

"He has showed you, O man, what is good. And what does the Lord require of you? To act justly and to love mercy and to walk humbly with your God." – Micah 6:8

As has been alluded to earlier, mercy and justice are intimately related. Although mercy may seem the essence of God’s character, it is important to understand justice as being equally essential to God’s character. Mercy does not make sense without justice. Mercy requires a moral sense of right and wrong, a heart that feels wrenched at injustice, and a desire to set things right. Equally, justice is harsh and unsustainable without mercy – imagine a cold-hearted, merciless society, retribution without transformation. Wisdom is required amongst all of this to apply mercy and justice in our lives.

Micah challenges us to act justly, to love mercy, and to walk humbly with God. God’s example to us today is found in Jesus, who fully exemplifies the meeting of justice and mercy.

Mercy to Patients

As Christian health providers, we are challenged to enact justice and mercy toward our patients. In a sense, the implicit relationship is one between a healer and a broken individual. The responsibility of bridging that gap lies with us – and the secret to building that bridge is mercy, love.

We need only look at the perfect healer, Jesus, to understand how huge a challenge this can be. Love is easy when the attitude is mutual. However, the calling of a Christian is to be radical, and to love even our enemies. It is this type of love, which extends even unto those who do not love us, that transforms lives. It is this type of love that flows from a merciful heart. This sort of love, in our practice today, allows patients to have the freedom to be themselves, empowers them, and truly heals.

Again, wisdom is required to apply mercy properly – respectful, sensible boundaries must be set in the relationship, so as not to abuse trust.

Mercy on Ourselves

Amidst lofty standards, wisdom is required to keep the big picture in focus. It is tempting to think we can change the world, but in thinking so, there is a trap in being driven toward a career-oriented, unbalanced, unsustainable life. Mercy on ourselves involves maintaining balance in our lives, prioritizing important relationships (when blessed with family and church, our roles within each are given by God), and loving those who are close to us. Most importantly, we are to spend time with God, so that we can become more like God – holy (Leviticus 11:45, 19:2, 20:26), perfect (Matthew 5:48) and merciful (Luke 6:36).

Can Justice & Mercy Meet?

We are greatly blessed to have been taught also by Reverend Tim Costello, Chief Executive of World Vision Australia, lawyer and minister. On the theme of mercy, it was fitting for a lawyer to explore more deeply the relationship between justice and mercy in the light of Jesus’ ministry on earth. Jesus came to earth proclaiming repentance, for the Kingdom of God is at hand. Therein justice and mercy are immediately brought to the fore – repentance of a sinful generation before a righteous God, the chance to transform (mercy) in the face of imminent judgment (justice).

What exactly did Jesus proclaim? In Luke 4:18, Jesus quotes Isaiah, boldly declaring the arrival of good news to the poor. Jewish society was divided in essence into two unofficial subclasses – clean and unclean. The term “poor” alluded to the “unclean” – materially, in health, socially, and spiritually. It was these unclean people who were excluded from the inner sanctum of the temple, as it was felt that God’s holiness meant that only those clean, cleansed by ritual, were able to approach the throne. So it is with spectacular brilliance that Jesus’ proclamation of good news to the poor “cleanses” the spiritual divide, “cleanses” us from sin, and affords everyone the opportunity to approach with confidence the throne of grace (Hebrews 4:16)!

Jesus enacted justice and mercy in concert with His proclamation. The Kingdom of God was heralded with a compassionate healing ministry of immense proportion. Mercy flowed like a river, likewise, justice was not in the least ignored by Jesus.

Remember Micah’s challenge, to “act justly, love mercy, and walk humbly with your God.” At the global scale, we can observe these very things happening. Mercy and justice are both important elements in the work of aid organizations such as World Vision – aid (mercy) is being offered as a blessing to the poor (justice), and has always been paired with advocacy (justice). This is not for our own blessing, but for the fulfillment of God’s own plan for global restoration. In history, we also note the inspired work of Wesley and Wilberforce in the abolition of slavery.

On a personal level, what does this entail? Our calling (vocation – that part of God’s purpose for which we have been put on this earth), is where our deep gladness meets the world’s deep needs. It is our discipleship of God. Our vocations expose us to unique opportunities to enact mercy and justice at a personal level, and this is what God calls us to do in Micah 6:8. Faithful obedience to God means taking these opportunities – to do as Jesus did, to show God’s love to others.

“Can justice and mercy meet? Yes, and they must in order that the kingdom of God be realized. But they can only meet if we walk humbly with God.”

Mercy

Like Elijah, we have had the amazing chance to draw close to God, in our own Horeb. But God commands us to “go” – and overwhelmingly, the call from IMPACT 2009 is to go out into the world, to “act justly, love mercy, and walk humbly with [our] God.”

Provision of Grace...

2009-06-28T16:07:00.003+10:00

This blog post has been a long time coming! To believe it's almost a year since my last post is incredible - and to think that prior to that I had been posting so much more regularly, sometimes even more than once a week! I guess that blogging, a reflective (almost self-absorbed?) activity is one that easily fades into the background when you're married, and have someone else as a sounding board for ideas, complaints, innovations etc. Nevertheless, I feel determined not to let a year slip past between posts, so here I am again contributing my morsels to cyberspace.

Life once again settles down - after a year of marriage, we find ourselves in a stable situation where contentment and peace are the order of the day. All relationships have their roller coasters, though, and ours is no exception - occasionally the emotional second-guessing puts a seemingly insurmountable ocean-wave between us, and washes over us, so that we are shaken back into the reality that good relationships are never to be taken for granted!

Thank God for the blessing of a great marriage! And thank God for the reality and truth of His love in our lives, sustaining us from day to day. Like marriage, though, our relationship with God can easily be taken for granted - and much of the time we could do with a wake-up call. The low points in people's lives seem a great catalyst for change - they make one acutely aware of their desperate need for God, and they embark on a quest for meaning. Soul-searching, some people term it. Many people still call for the priest at their death bed, even though they may not have previously professed faith in Christ. Suddenly, knowledge of God becomes more important than ever, because meeting God becomes imminent. It's truly amazing that God indeed welcomes people back into his presence, at the last minute, even though they may have lived the remainder of their lives in complete rebellion against Him. But this is just the nature of God's amazing grace.

Working as a doctor brings with it the privilege of working with people at those low points in their lives. It's not an easy thing to bear witness to, and when patients are so sick, one often feels helpless - unable to offer hope, comfort and peace. Because the medical profession is so geared to circumventing death and disease, we find ourselves feeling defeated when there is nothing further medically that we can do.

But it is at these times when we should be most able to offer hope, comfort and peace, because vulnerability brings with it an amazing sensitivity to simple measures of care - a kind word, a gentle smile. I am as guilty as anyone else of being afraid to approach the sick patient, because I feel I can't do anything for them. Sometimes the kind word, the gentle smile, is in and of itself therapeutic. After all, being a health care provider has never been about defeating death itself - we are just setting ourselves up for failure, if this is our goal! Rather, it is about being able to provide for the wellbeing of our patients. And, as we are reminded from time to time, wellbeing is not merely limited to the physical domain, but extends to the psychological and spiritual as well.

Next week, Sal & I are attending the IMPACT conference, run by CMDFA (Christian Medical and Dental Fellowship of Australia). We attended this same conference last year, and learnt a lot about the role of Christians within the health profession - especially about how to be first a Christian, and then a doctor. I hope that we can be reminded of this again, and in doing so, be encouraged and empowered to be what God has called each of us to be!

100th post...

2008-07-01T17:45:00.002+10:00

Quite amazing, thinking that this is my 100th blog post! I think it started 4 years ago (or 3 and a half) - so that's about 1 post every 10 days or so, which is remarkable seeing that I haven't posted anything since January!

The first half of the year has been quite fun - settling in after marriage, Sal going away to China and seeing a whole different health system, moving to a new place, and working in ICU (finally, a place at work where I actually feel like I belong - so I might be looking at a career here long term).

It has been a great time of experiencing God's grace and mercy - in his providence he has given us a feeling of settledness about our relationship, a sense of direction about career.

The second half of the year will be interesting - and we will be deciding and finding out where we'll be headed next year (in terms of jobs, specialisation etc). I'm hoping to do anaesthetics/ICU - this is offered at most hospitals in a package called a critical-care year, combining jobs in emergency, anaesthetics and intensive care - and have applied to several different places, in hope of finding one that will take me under their wing, and train me up.

Anaesthesia seems like a good long-term option. I really enjoy ICU - but then, with the vision of participating in the medical missions field down the track, anaesthetics seems like a more portable (useful) specialty. Anaesthesia also serves as a great co-specialty and pathway into the ICU specialty. I guess I'll find out what the whole scene is like, and see whether this is for me. Sometimes, finding your role in this world (career-wise) is not a matter of a dramatic calling - it may be as simple as falling into an area where you feel comfortable, and I'm sure that God can (and does) use this as a means of saying that one can serve well in this way.

Watch this space!

New Year...

2008-01-10T14:35:00.000+11:00

Another new year, another blog entry, time to turn over a new leaf. I don't know about you, but I'm surprised that I'm writing in my blog again! Consumed with busyness over the past few months (yes, ever since starting that dreaded neurosurgery term) I never thought I would see the day when I would have both the time and mindset to compile thoughts to bring here again. Alas, I'm here - with so much (yet so little!) to talk about.

Many of you will know the biggest event of the last year for me has just passed - about a month ago! All I know to say is that God has been smiling so much upon me in bringing Sal and I together in marriage. It has been a fun time, getting used to one another, learning to love each other more and more, and doing everything together, mundane or thrilling. It really is about being together as one, in all circumstances, whether good or bad, sick or healthy, rich or poor - indeed even when right beside one another or on opposite ends of the globe. Our identity is now the paradoxical two-but-one, one-but-two, and we will probably be constantly trying to grasp what this concept really means for the rest of our lives!

Our wedding was a truly fun-filled occasion, and it was amazing, seeing friends from all different facets of our combined lives all gathered in one spot. Thank God that things went smoothly, and for turning on nice weather for us. I think we were quite blurred and hazy by the end of the day, and sometimes it felt strange being there - almost like watching a fairytale from outside. If something went awry, I imagine I would have snapped out of this mode and back to reality - but it all went so quickly, so well, that by the time we arrived at the hotel, it was like we couldn't believe we had just gotten married, a truly ethereal state!

Anyhow, if we didn't realise it then, we had each other to remind ourselves of our husband-and-wifeness over the next week. We flew south, to Launceston, and explored the sunny east coast, settling in Swansea for a few days, and exploring the Freycinet peninsula on foot and on kayak, with stomachs full of the freshest oysters! Then we had a few days in wintry Cradle Moutain, where the weather kept us inside for much of the time. Never mind though, the wallabies came to our verandah, and we were lucky enough to get a relatively unclouded glimpse of Cradle mountain from Marion's lookout. Our way back to Launceston was dotted with raspberry and chocolate tastings, and we traipsed through Cataract gorge park alongside peacoks on our last day before coming back home.

I have to say, it's been a difficult thing going back to work. Neurosurgery is by nature a very busy job, and I don't think I was really in the right mood to return to stresful, taxing hours just yet. A few more days holiday would have been just what I needed! But, indeed I am grateful not to be trading places with those whose care I am charged with each day.

Thank God for the past month, for all the enjoyment it has brought, and for the love He gives! Thanks for His constant grace too, for us to go on. Thanks to God also that I can keep this little corner of cyberspace alive! Before I go, I want to wish everyone a great New Year, filled with abundant blessings from our Father above, from Him who knows how to give good things too His children!

Pawprint...

2007-07-07T16:20:00.000+10:00

It's been such a very long time since my paws last left an imprint on the web - nearly two months! But not to mind, I'm still here and OK, still in one piece, albeit mindful of the fact that the wheels of this world still turn just as well whether I'm here or not. Anyhow, I still choose to write - if not for the benefit of anyone apart from myself, and for shaping my own reflections.

The last couple of months have been at once very interesting and very taxing - working at Peter Mac, a specialist hospital for patients with cancer. My job is surgical oncology, and under this banner come seven separate units which I cover, four surgical and three radiation. It's quite different from mainstream jobs, where the resident is headed by a single registrar and perhaps a small network of consultants. Covering seven units means I work under at least four different registrars, each who answer to a plethora of consultants, and so it gets rather confusing! The resultant disorganisation, because of lack of cohesion between the units at higher levels, can leave my schedule very scattered and leads me to do more hours than I should - normally starting by 7am (surgical starts), and often ending around 6.30pm (radiation ward rounds, and sometimes surgical again). The work itself is not too difficult, however, and often quite rewarding. So, as a job, it's quite enjoyable.

One of the best things about doing this particular surgical rotation is the amount of time spent in theatre. It's quite a blessing - this is my second surgical term since graduation, and I've done probably an average of five or so theatre sessions per week, which is probably more in one week than I did in my entire surgical term last year! It means I've been able to do some surgical lists cutting out skin lesions (the senior doctors see these cases as tedium, so delegate them to me), as well as the usual assisting, closing wounds, and seeing a lot of anatomy, which is almost everyone's weak suit in medical school. From an interest viewpoint, I am definitely keen on continuing down the surgical path, but it does mean a fair bit of sacrifice.

Unfortunately, surgery is the archetypal family-unfriendly career choice. While interesting, the hours (especially the early starts) are exhausting, and there is a culture of career first, family second, quite widespread amongst the surgical community. I guess that it's almost a tacit expectation for most junior surgeons, and in general those who want to prioritise other things are frowned upon. I suppose this is one area where I definitely want to be counter-cultural - family is more important than career - but it's not always easy to demonstrate this. I have to admit that I have been poor at balancing work and life outside work for these past couple of months. In general, I return home exhausted, and all I want to do is flop on the bed and not wake up until late the next morning. Perhaps I'm not really cut out for the surgical lifestyle. But then again, I hope to be able to answer that question for myself, whether or not surgery is for me, within the next couple of years - then I can decide whether to continue, or to take a sidestep onto a different platform, perhaps to become a physician or general practitioner instead.

Thanks to God, I now have three weeks of annual leave! Even this has its own list of tasks to eat through - wedding planning being among the top of them, alongside househunting. It's nice thinking about these things, and being able to contemplate the future, and how our plans seem to be taking shape. At the moment, we're looking only a few months to a year ahead, but these form the gateway to the years beyond, for which I'm sure God has planned for us an exhilarating journey!

I want to mention a documentary Sal & I watched last night, called Jesus Camp. Centred on a preacher who organises annual camps for Christian children in USA, the documentary raises a lot of issues - not necessarily taking a standpoint on any of them, but allowing us to really think and decide for ourselves what is really right or wrong. The belief of the children in Jesus seemed genuine, and for their age (many of them around 10 or 11 years, no more) they held quite a sophisticated understanding of a lot of issues that many of their age might not ever have considered. The concept of sin as separation from God, and Jesus' death in our place is not easy to grasp - the depth of God's love in this act is unfathomable. Yet, they articulated God's reality, their occasional doubts, and their passion for Jesus' message, in a way that defied their age.

What I found disturbing, though, was the way that minds so malleable can be used in a sense - one thing to teach them about God, another to teach them about topical issues such as creation, abortion and which party to vote for. One guy, a Christian radio announcer, expressed his concern, calling it "indoctrination", and not just in the realm of faith, but also in the realm of politics. I have to say, from the glimpse into that world afforded by the documentary, that I share his concern. The children, despite displaying an outward maturity and level of eloquence beyond their years, still have insufficient grasp of the depth of complexity within each issue, and are being presented with very one-sided viewpoints. They are also being fairly actively sheltered against alternate viewpoints. In one scenario, a mother homeschooling her child was discussing the issue of creation. As they talked, her belief in literal six-day creation was obvious, and Darwin's evolution was dismissed as no more than an absurdity. In another scenario, a prominent pro-life speaker came to preach at the camp, and together everyone in the room was summoned to join in corporate prayer against abortion. In yet another, children all around the dinner table were talking about how they weren't allowed to see Harry Potter because of the witchcraft portrayed - indeed, just earlier, the central preacher in the documentary had opened her message by saying Harry Potter was evil, and would have been put to death in the time of the Old Testament. To the eyes of outsiders (I would add, especially non-Christian outsiders) these scenes can look a lot like indoctrination. There did not seem to be much in the way of encouraging the children to consider the alternatives and make up their mind for themselves.

One obvious danger in this is manipulation. Another danger is that it leaves the children in a position where they find it hard to understand where others are coming from. When a non-Christian comes along, they perceive them with a degree of suspicion. When someone poses an alternative viewpoint, they laugh. When a hot political topic becomes the subject of discussion, they fervently rush to regurgitate the arguments they have been exposed to all of their lives, oblivious to the complete picture and the alternative. Forgive me for generalising, but this is the picture that comes across when I see these scenes.

All in all, I think that the documentary was quite thought provoking. Yes, I would love for my children to be brought up with a very solid grounding in Christian character development and understanding the Bible. I would certainly be hoping, praying, indeed doing all in my power to make sure they understand the truth about Jesus. But I would also not want them to be ignorant of what others think. I would want them to grow to be thinkers, able to critically appraise arguments put forward by others, and carefully consider them. And indeed, be able to accept them, if they are right. I don't think that the style of moral mollycoddling depicted in the documentary is the right way to do this.

Anyhow - I think this has grown into quite a monster of a blog! Please comment if you have views on the documentary, or just want to say hi. God bless!

Hear this recurring theme?

2007-05-13T22:59:00.000+10:00

I'm afraid I might begin to sound like a broken record when it comes to talking about work and the sheer busy-ness of being a junior doctor. Unfortunately, this week just past has not done anything to change my experience, and in fact might have gone an extra way to solidifying the well-known fact that junior doctors are run off their feet.

I have started working at Peter Mac, a specialist hospital for care of patients with cancer, covering some of the surgical and radiation oncology units. It's only been one week so far, but whew! It was quite a week. Getting used to a new environment is always taxing - there is much time spent having to introduce oneself to everyone else around, finding papers, patients and files. I'm also showing myself short in the fitness stakes - running the stairs to the ninth floor is quite exhausting! On the bright side, I should be fighting fit by the end of my thirteen weeks here. I have some hope that things will improve somewhat over the coming weeks, however. Tomorrow, many of the registrars return from conference or study leave, and I will have more people to share the workload with! Watch this space - my crazy hours might become more reasonable. I have to say, the work itself is quite enjoyable and rewarding. It's never easy dealing with such serious illness as cancer, but it means that each little difference one makes can make an incredible difference to the person's life and experience.

I guess I want to talk a bit about a seminar Sal & I attended last night, run by CMDFA (Christian Medical and Dental Fellowship of Australia). There were three speakers, each Christian doctors, specialists in their own fields, talking from their experience about witnessing in the context of medical practice. One had been pulled up by the medical board and found guilty of unprofessional conduct when he had prayed for a patient. The account of the story was such that permission to pray had been obtained, but as there was a bystander (the patient's friend) present, it was the friend who had been offended and brought up the complaint.

The issue of boundaries was addressed. I think that this is important, since we live in a society where we are closely identified to our occupational roles, which are bound with implicit expectations. We need to work within the framework defined by our roles. This includes boundaries, and it's important to not step outside these boundaries set by our roles, except by careful exploration. Take, for example, a doctor who offers his patient chiropractic services. Or a dentist who offers to fix up a patient's crook knee. Analagous is the practitioner who offers to pray, in the eyes of many. This is like offering a pastoral service - it lies outside the bounds of what is expected of a doctor, and hence represents dangerous ground on which to tread. The most important danger to recognise in breaching, or even blurring, boundaries is that any step out of the predefined roles represents an avenue towards role confusion. It is easy to see how role confusion already causes trouble - for example in the country town, a patient might be a friend of the doctor, or the partner of a relative, or something like that.

On the other hand, as Christians, we are first and foremost children of God, and only secondarily are we defined by our occupations. We are called to promote the Gospel of Christ through our lives, and this includes our work! This, then, has been a difficult sticking point for many Christians in the health profession - when is it appropriate to pray for patients? Is it appropriate for us to openly display our faith through our attire - e.g. wearing a cross? Back in the first century, Paul said that he had "become all things to all people, in order that I may win some". Also, he called early Christians not to be too caught up with their newfound freedom in Christ, but to think carefully about the impact of their actions on others. His experience reveals that we have to be culturally sensitive. Although here, twenty centuries later, our world holds as its highest value the elusive concept of "freedom", as doctors we should still voluntarily behave within its expected boundaries, so as not to upset the primary reasons for which our patients come to us in the first place.

Being a Christian doctor does require us to excel in our work. Being a good doctor is already a powerful witness for Christ. Being a caring doctor, coming across as a person whose primary aim in the doctoring role is to serve his or her patients, is already a wonderful testament to our loving God. Our behaviour, not just our words, can serve to point patients and bystanders in the direction of Christ, by showing forth His character. There is no rule against caring. So, firstly, we ought to do well in our occupation.

Secondly, there are times and places to talk about our own faiths, and those of our patients. On occasion, patients want to talk about their faith. If so, then this is one of the best times to think and talk about Christianity - but we need to listen, and find out where our patient is coming from. Some patients may already be Christians, and may wish to pray. Other patients might be agnostic, but might realise the increasing urgency to meet God, to find out if He exists or not. Yet others might come from a radically different background, and who knows, they may even try to preach to the doctor! Either way, it is safe to discuss faith issues if the patient brings up the issue in the first place - because their raising the issue is a sure sign that they are comfortable with talking about it, in some form at least.

I think it's worthwhile mentioning that there are chaplains and priests in many hospitals, whose services can be enlisted. Additionally, we can refer patients to a church, should they enquire or seem interested. It is too much for a doctor to pick up the task of pastorally shepherding a patient in the long term - ultimately, linking them with a welcoming church community is the best way to ensure their spiritual needs are met.

Anyway, I think it's time for me to sleep, and prepare myself to embark on what promises to be yet another busy week! God bless!

Continuation...

2007-04-26T20:32:00.000+10:00

I decided to post a continuation of the puzzle from before. This one doesn't require that you know the answer to the previous puzzle - I guess I just extended the story (honestly, though, I have no idea where the story is headed!). Puzzle writing is fun, I think. Anyway, have a go. This one's a bit more difficult than the previous one.

Sans Script

You awaken in the professor's house, groggy and tired after your ordeal the previous day.

You remember escaping from the cold, dark maze, then emerging into the blinding light of day - what was left of it, anyhow. It was late, and the sun began to set spectacularly after that. You arranged a rendezvous with your rescuer, who had helped you through a remote computer terminal. He introduced himself as a professor, one of a team unlocking the mysteries of the subterranean labyrinth in which you had been trapped. People appeared inside at various locations without warning, trapped by some sort of teleport mechanism. Some escaped, some didn't. You take some comfort in the fact that you are not alone in this - but feel sorry that some did not make it out alive. The professor took you in for the night, tending to your most immediate need - rest.

This morning, however, you see no sign of him. Evidently, he had left earlier in a rush, with a flurry of upturned papers strewn over the floor of the kitchen. All sorts of bits of paper haphazardly adorned the floor - article cutouts from Nature, Science, JAMA and many others. A hand-written note left on the table was barely legible. "Find me at the university in the relevant department". A sense of panic wells up inside of you as you realise that you hadn't been informed of what department that might be - indeed, you don't know what sort of professor he was. Your composure and sense of hope returns, however, as you examine the watermark behind the words.

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Night owl...

2007-04-20T04:35:00.000+10:00

On night shift again. Tonight's almost been an absolute miracle that we now have some semblance of peace and order in the department! When I got here, it was crazy, manic - many patients in the waiting room, some waiting for more than four hours, and with all sorts of problems. Just another example of how there is a serious shortage of health professionals all around the country, especially in rural regions.

One of the patients sleeping here tonight is an example of one that this health system, despite all the good will in the hospital, probably cannot help. An elderly gentleman with chronic alcoholism, he was brought in by ambulance when the pub he frequents had missed him for four days! But then again, it seems he doesn't want to get better. It might just be his confusion - but there are a whole heap of other possible things. I just hope we can help him and find out, but even if we can in here, it's hard to see him turning from his old habits in the long term.

Anyhow, I'm glad to see that this department has turned from something closely resembling ER earlier on, to something now looking more like? well? sleepy heads and shut eyes anyway.

Nobody has yet answered my puzzle! Maybe they're all off doing the CISRA puzzle hunt! It will be nice to see someone solve it soon, though. Perhaps after CISRA, they'll come here and do the puzzle. Oh well. I'll drop another hint soon.

I have been thinking about Christians and the way they're represented in the world. It's sad to see some people close to me so against Christianity because some prominent Christians (notably the leaders of our country and of the US) are viewed so negatively, because of their role in the Iraq war, because of seeming arrogance and self-righteousness, and because of their relationship with the church. I think that politics is one area where churches should be very careful. Financial contributions, for example, to the Howard government by Hillsong church, comes across as a dangerous alliance crossing the traditional separation of church and state established centuries ago. It is clear that the two bodies share similar ideologies. Members of the government make frequent appearances on the Hillsong stage, and receive resounding applause. For the public, it appears that politicians are hijacking the faith bandwagon to build their support base.

Is this a dangerous thing per se? I think it can be. It is true that it is God who enables those in power to govern, and it is He who placed them in that position. However, to then claim that they are God's appointed (and therefore mandated) leaders is a false extension of this truth. On one hand, it is an extension. On another hand, though, it is the complete opposite - claiming a mandate to do whatever I want to do, is much different to fulfilling my duty to serve the country. The agenda should be one of service, and not powermongering. Certainly, a government should not seek simply to be re-elected, but should rather seek to genuinely serve the population that they govern. Not that the current government are alone in spending so much on their public profile, however. Christian politicians everywhere are declaring their faith in order to try and par with the government, showing themselves to be men and women after God. I don't think this is a bad thing - it is nice to know that there are Christians in politics. However, I don't think that this should be a real reason to vote for them. It is easy to say I'm a Christian - it's hard to behave as a model Christian. Indeed, it's impossible, with all of our human failings, to live up to the standards that Christ Himself set for us.

I hope that Christians in the public light increasingly recognise their situation. As real ambassadors for Christ, especially with their profile, Christian politicians should even more seek to serve the public genuinely, and display their servant heart. It is true servanthood that is the hallmark of the true Christian.

Puzzle time...

2007-04-07T22:43:00.000+10:00

This one's for those who are suffering Puzzle Hunt withdrawal symptoms. It's just a puzzle I came up with one day, I can't remember how - but give it a go. Please post answer guesses in comments if you feel like, or else email me (so others can have a go)! I'll put hints in the comments area - if it seems like nobody's really getting the answer in a few days' time.

Anyway, here's the puzzle! Good luck! (Oh, and Happy Easter too - thank God for the Cross of Christ, that we may live!)

Flicker of Hope

You wander around the deserted complex, looking for a way out. The maze seems like a hopeless quest - each time you peer around the corner, your eyes stare deeply into an even longer corridor with numerous branches each way, illuminated only faintly with the dim, flickering yellow of well-worn ceiling lights.

Hours later, still wandering and ever more dejected, it is your ears, not your eyes, that finally give you some semblance of hope! A ticking noise emanates from a nondescript room several doors down, and you pick up your step in anticipation. Entering the room, however, there is not a living soul in sight. Several monitors flicker, most of them blankly, in what appears to have once been a crowded control room of some sort. The ticking noise comes through a speaker in the corner - at first you think it might just be static, but the eerie regularity of some of the blurts and blips that break through the noise makes you think there's more to it than randomness.

Next to the speaker, there is a monitor, less blank than the rest of them. Strange fractions scan rapidly across the screen in a repeated fashion. What could it mean? You grab a piece of paper and pen from your bag and jot down the fractions:

2/4 7/8 4/16 0/4 2/16 0/2 0/16 1/4 4/8 0/4 2/4 7/8 2/8 10/16 0/16 1/4 2/4 10/16 0/2 1/2 7/8 0/8 0/4 2/4

0/4 3/8 2/4 0/8 1/2 0/16 0/2 5/8 0/4 2/4 6/8 0/8 1/2 3/8 0/4 2/4 4/16 0/2 0/8 0/8 1/2 3/8 0/4 2/4

A-Team...

2007-04-01T21:34:00.000+10:00

Working in the ED again since yesterday, I've been sicker than some of the patients that have come through our doors! It's only a matter of time before this cough clears up, and the worst of it's over now. Either way, I'm happy to be working, as it seems to distract my mind from my cough and sickness (ironic, eh?) - and the moment I stop doing things, the cough starts up again. Oh well. That's life.

Anyhow, just killing time at the moment, end of my shift - and we've cleared the rooms pretty well! Not patients going "kaput!" if that's the idea you're getting - no, patients getting better and going home, by and large. This is the ED doctor's idea of nirvana, or as close as it gets in some ways. Some like it busy, but this - the sound of silence - can't be beaten, honestly! Given how busy it was at the start of the shift, it seems miraculous. Go A-Team!

Just recently, I bought a book by Philip Yancey called "Prayer: Does it make any difference?", a commentary on prayer and its role in our lives. I have found it very helpful, even from the outset. It begins by detailing some extraordinary statistics - 90% of Americans in a certain news-media survey claim to pray on a regular basis, with about a third praying at least daily. Some renowned historical prayer warriors, such as Martin Luther, used to spend up to four or five hours regularly, daily, on their knees, rising early to open the day with communion with the Creator. Other faiths, such as Islam, also perpetuate the idea of prayer as an essential way to commune with God, so important that they stop what they do in order to pray five times per day.

I admit, though, that I am not a model prayer warrior by any means. Daily prayer, yes. But, like most people, I spend barely 10 or 15 minutes in prayer, relating to God (our Creator, the most important relationship in my life) my honest thoughts and pleas, my praise for him and so on. And a lot of the time, I'm so tired when I pray, that my prayers come out a jumble of muddled up thoughts with no structure, little focus and concentration. I have thoughts like, if God knows everything, then why do we have to present our requests to him anyway?

I guess, first and foremost, we have to look at prayer in a different light - it is our direct means of communication and relationship with God. It is for our benefit, that God's presence might be felt, his blessing come down, as a stream rolls steadily down the mountainside. We are so privileged to be able to bathe in this stream - one that is accessible at any time, under any circumstance. Amazing, eh? It is more than just requests - after all, God does know our requests before we ask (although he loves to hear from his children, and answers our prayers as a father to his child) - it is our communion with God. What greater delight have we than to bask in the presence of God's glory?

Then, why do we spend so little time in prayer? Is communion with God not more important than pretty much anything else? Why do we lose perspective? Our perspectives tend to be guided away, in this day and age, by the immediate concerns of this world. Working hard in the ED here, I barely get time to think about anything else but my patients. Taking a moment to breathe (or cough) is a rare thing! And it's not just this kind of work, either. It is a problem everywhere - so much so that Thomas Merton, when asked to name the single greatest spiritual disease of our time, answered, "efficiency". Idle time is frowned on, we should always be working! That's why it's so remarkable to have this time now to write this blog. And think about God, and pray. Our perspectives get skewed. When we step back, and have a look at everything properly, we realise that the concerns of this moment are hardly a speck in the woods. In the moment, however, they are all the world to us.

What we need is to remind ourselves, every day, of this perspective problem. Take a step back, and look at your life from start to finish. Go outside, look at the sky and the stars. Go to the beach, watch the waves roll in - no matter what we do, these things never change. God is in control.

I hope that we can take this step back in the midst of our busy lives, and remember what really matters!

Facebook addiction...

2007-03-26T05:13:00.000+10:00

Yes, it is addictive - Jane says so too. I wonder quite why. You're at risk the moment you join facebook - and nobody is immune! Symptoms include having no time to work, clean up the house, or even socialise in real life due to overspending time on facebook. And, if you're not on, then you get the cravings, tremors, sweats and confusion - not too different from the DTs. Sound familiar?

It won't be too long before the epidemic of facebook addiction and withdrawal floods my Emergency Department!

Back in Melbourne now, the Melbourne University Puzzle Hunt is starting. It's been a blast the past three years, and this year promises not to disappoint! Watch out for my puzzle on day 3.

Atom feeds work!

2007-03-22T05:55:00.000+11:00

Argh, facebook is addictive! Worse than chocolate.

Anyhow, I managed to get Atom feeds working into Facebook - so my blogs go there automatically! Just for those who have a blogger blog, and wish to import their blogs into facebook (or anywhere else, for that matter), your hidden feed address is at (generic example):
Atom - http://yourblog.blogspot.com/feeds/posts/default
RSS - http://yourblog.blogspot.com/feeds/posts/default?alt=rss

Facebook is a useful resource though. And fun. And revealing! I was pleasantly surprised (actually, surprised isn't the term - it's hardly surprising that this very talented young man has gotten where he is!) to find out through the grapevine (internet) that Graeme (a friend from school) has been associate concertmaster of the Adelaide Symphony Orchestra for more than a year! Congratulations ;p

Uh oh, there goes my pager. That smells like work. Better go!

God bless ;p

Night vampire...

2007-03-21T00:06:00.000+11:00

It's been a virtual eternity since my last post in December! A whole 3 months and a bit - probably my longest blogging drought since this blog began many moons ago. Anyway, I'm working in Wangaratta at the moment, at the base hospital. I'm on night duty - making me the one vampire that haunts the roost until the sun rises the next morning! The night scene is new to me - I did one week about a month ago, and this is my second week-long stint on night duty. And the night brings with it many interesting customers - anything from the usual bread-and-butter chest pains that wake up in the middle of the night, traumas, sepsis, back pain from a bear hug, and (would you believe) coughs and colds. Weird old town, eh? Had a cough for a week or so - why not wander into the emergency department at 2am and see if we can get some antibiotics?

Anyhow, I thought I would write down some random thoughts. Thoughts about what drives us as humans? Why do we do the things we do? What keeps us interested, motivated to go on and watch time pass (or do our very best to ignore the fact that time is passing, for that matter)? I guess this is something that, really, we don't think about enough. And when we think about these things, we become depressed, or frustrated, at the lack of satisfactory answers.

One obvious level of answer would encompass the necessities of life - food, water, shelter, procreation - the things that, by very nature, an evolutionary system aimed at self preservation and survival would need to be concerned with. Just look at what we do from day to day, a diary log would reveal entries that support this viewpoint. Work. Eating. Sleeping. Sex. People like me exist because people are afraid of death, and we pour so much of our resources simply into delaying the inevitable. Survival, longevity. But then again, let's face it - this doesn't account for the activities that set us apart from other species. Sure, we do these things, enjoy them, and survive because of it. But humans are more complicated than that.

Perhaps we should be asking, what is it that we really want? People want to enjoy themselves. We do all sorts of other things: when we're not going about ensuring our survival, we go about seeking pleasure. Sometimes this is as simple as it sounds - playing games, hanging out, recreational activities, sharing a joke. But, layered on top of this, some interests are more ethereal. Fun? Maybe. But they seem to point to something higher.

Some forms of pleasure don't seem intrinsically to be linked to pleasure at all. After all, who would look at the hours of practice that go into learning a musical instrument and call that pleasure? These sorts of activities, however, do indeed aim at pleasure. They are geared towards bettering oneself in one way or another. They lead to a deeper sort of satisfaction - an inner sense of achievement, one that we are sometimes lucky enough to have. Yet others gain an altruistic satisfaction from aiding others - a sort of pleasure that can only be found in complex human society.

Another seemingly popular motive for the things we do is money. In developed societies, we all work for money, this buys us our necessities, and is a frequent means of attaining pleasure. There are the times, though, when money, in and of itself, seems to be a driving force. Ask the rich, and you'll quickly notice that many of the things they do are geared to further stretch their wealth - in spite of clearly having enough. Investments, property sales, tax optimisation (and evasion) are among those methods. Money can quickly become an intoxication. This is well illustrated by Mark 10:17-29, where Jesus teaches of the trappings of wealth, observing that "It is easier for a camel to go through the eye of a needle than for a rich man to enter the kingdom of God". The rich young man was virtuous in many other ways, but money proved to be his Achilles' heel. He was confronted with a choice between money, and eternal life, and chose not to give up his comfort - money. What then, is it about money that makes it such a strong allure? Is it the money itself? Is it the comfort, the security that it brings? Most people, when they see money, see beyond it to the things they can buy - food, new clothes, a holiday, a new car or house. Commodities geared to our comfort.

Comfort, pleasure, survival. This seems to account for most things.

But, then, many people seem to have these things in increasing amounts - and yet, they seem dissatisfied. Always striving for something else. Something more. There is more to life than being comfortable, having pleasure, and health, even procreation. Deep down inside, people yearn for something else, something better than life even. I wonder, then, whether this is one reason why so many people turn to religion, looking for a reason to live. So many religions exist, probably for this reason. Most are self-centred. Most leave it up to the individual to live a certain way, and therefore receive reward and fulfiilment. However the Bible reveals further purpose for mankind.

God created man. Ever wonder why God created the universe? It's not always intuitive in today's secular society - but if we look around us, we see nature, beauty, the work of the hand of God. Praise to Him, who created our world! This is, then, one of our greatest purposes - to be in a relationship with our God, praising and glorifying Him for what He has done. We are blinded by sin - that which separates us from God. But when our eyes are opened, when we find out our true identity as people of God, and as Peter says, "But you are a chosen people, a royal priesthood, a holy nation, a people belonging to God, that you may declare the praises of him who called you out of darkness into his wonderful light."

So, our personal purpose is intertwined heavily with the purpose of the whole universe. We have been made for God's glory, and He calls us through Jesus to join in this purpose. Praise Him!
As you come to him, the living Stone — rejected by men but chosen by
God and precious to him — you also, like living stones, are being built into a
spiritual house to be a holy priesthood, offering spiritual sacrifices
acceptable to God through Jesus Christ. For in Scripture it says:
"See, I lay a stone in Zion, a chosen and precious
cornerstone, and the one who trusts in him will never be put to
shame." Now to you who believe, this stone is precious. But to those who do not
believe, "The stone the builders rejected has become the capstone,"
and, "A stone that causes men to stumble and a rock that makes them
fall." They stumble because they disobey the message — which is also what they
were destined for.
But you are a chosen people, a royal priesthood, a
holy nation, a people belonging to God, that you may declare the praises of him
who called you out of darkness into his wonderful light. Once you were not a
people, but now you are the people of God; once you had not received mercy, but
now you have received mercy.
Dear friends, I urge you, as aliens and
strangers in the world, to abstain from sinful desires, which war against your
soul. Live such good lives among the pagans that, though they accuse you of
doing wrong, they may see your good deeds and glorify God on the day he visits
us.

- 1 Peter 2:4-12

Sleeping giant...

2006-12-16T12:16:00.000+11:00

I don't know what the title of the post means in relation to anything in this post, not really anyway. Except that sleep means a couple of things - this blog really is still in deep sleep, owing to work commitments (including 3 Sundays in a row!), and that sleep is something I am often in extra need of - and that giant simply refers to a bike I will hopefully be getting at some stage - model undecided (looking at OCR 3, CRX 3, Innova) - excitingness when I get it, I'm sure!

Currently, looking at the tail end of this year, I am in dire need of a break, but thanks to God that is only just around the corner now - just on 2 weeks left, then 5 weeks' leave - I'll be so lost for plans/things to do! After leave, I'll be in Wangaratta for three months, working emergency, and then coming back to Melbourne and doing cancer surgery at Peter Mac, and then a couple of specialised surgery terms at Royal Melbourne. I expect it will be quite challenging, but hopefully also interesting and confidence-boosting at the same time.

It's just on a week till Christmas morning, and I think it's a timely reminder to celebrate the Good News that we've all been given, the news of Jesus' coming into this world! Thank God for sending His Son to redeem us, bring us into a deep relationship with Him, and cleanse us from our sin. About a year ago, I wrote another blog condemning the commercialisation of Christmas (I think? or was it Easter?) - either way, I think that I've been in the shelter too much this year to notice the Christmas hype, and it's refreshing to think of it just as a time of peace and reflectiveness when the world slows down and people go away on holiday, taking rest as God did on the seventh day of Creation. And as we slow down and relax, may we, too, remember God's amazing present to us in His Son, Jesus!

God bless, happy Christmas and New Year!

The volcano erupts...

2006-10-08T23:40:00.000+10:00

Alas, Rabaul has reopened its mouth - the PNG volcano erupted for the first time in just twelve years. I am always amazed at the power of volcanoes, the unpredictable forces of nature hurling forth voluminous gushes of red-hot lava into the stratosphere from the bowels of the earth. It is a rare event, thankfully - God has enabled us to coexist with these awesome displays of His creative power.

As one volcano comes out of its dormancy, so also (as it would seem) does my blog - rather forlorn without a single entry for months! I guess work takes its toll, currently I'm doing general medicine at Sunshine hospital, a step back in pace from the relentlessness of my previous surgical rotation. Hopefully this means more blogging!

One other thing that has held me back from blogs was the loss of my laptop. Gone. Stolen. Without a trace. Along with my flatmate's. That was a few weeks ago now, but it still strikes me how low some people will go for a bit of money! It's been quite a setback, losing one of my main resources (information, communication etc), but thanks to God, nothing else was taken, and now I have my computer from home brought here, I can blog again, read and send emails etc. It's much bigger and heavier, far less portable, and far less stealable!

It's tempting, in times like this, to pray for those who have victimised us to get a taste of punishment, here, now. But Jesus teaches us something quite different. Yes, we live under a fair and just God, but He also is a God of mercy and infinite forgiveness - His grace is sufficient for all of us, who are sinners. By His grace, by the blood of Christ, we are made righteous. And we are to extend forgiveness likewise, to those who have done us wrong.

I'll finish now with the following parable that illustrates this kind of hypocrisy we are to avoid. God bless!

The Parable of the Unmerciful Servant

Then Peter came to Jesus and asked, "Lord, how many times shall I forgive my brother when he sins against me? Up to seven times?"

Jesus answered, "I tell you, not seven times, but seventy-seven times.

"Therefore, the kingdom of heaven is like a king who wanted to settle accounts with his servants. As he began the settlement, a man who owed him ten thousand talents was brought to him. Since he was not able to pay, the master ordered that he and his wife and his children and all that he had be sold to repay the debt.

"The servant fell on his knees before him. 'Be patient with me,' he begged, 'and I will pay back everything.' The servant's master took pity on him, canceled the debt and let him go.

"But when that servant went out, he found one of his fellow servants who owed him a hundred denarii. He grabbed him and began to choke him. 'Pay back what you owe me!' he demanded.

"His fellow servant fell to his knees and begged him, 'Be patient with me, and I will pay you back.'

"But he refused. Instead, he went off and had the man thrown into prison until he could pay the debt. When the other servants saw what had happened, they were greatly distressed and went and told their master everything that had happened.

"Then the master called the servant in. 'You wicked servant,' he said, 'I canceled all that debt of yours because you begged me to. Shouldn't you have had mercy on your fellow servant just as I had on you?' In anger his master turned him over to the jailers to be tortured, until he should pay back all he owed.

"This is how my heavenly Father will treat each of you unless you forgive your brother from your heart." - Matthew 18:21-35

Flock! And some other stuff...

2006-07-11T01:29:00.000+10:00

It's been such a long time since the last time I've written in this online journal. This time it's about something called "Flock" - you'll find it here. It's reputed to be the first taste of Web 2.0 available, and well worth it too. I'm writing this blog from within Flock, so if you're reading this now, then at least this part of the software has done its job remarkably! Its other features include integration with Flickr (online photos) and Shadow (online favourites), and hopefully I'll begin to post photos on Flickr rather than simply being a photo-less parasite viewing other people's pictures. Step one would be to somehow get photos onto my computer, perhaps a camera would be useful?

Anyhow, here am I, yet another late night in front of the computer, facing yet another sleep-deprived day of patient care. Fortunately, I've somehow survived on basic sustenance levels of 6 or so hours of sleep daily - but this won't last much longer. I'm beginning to take evening naps, but hopefully instead of eating into my proper sleep time (like now), it will serve to boost my net amount of sleep and hence my energy levels. So goes the plan anyway.

Weekend saw me attend two 21sts - the first of which was Sal's! Yes, finally, after all this time, the party happened. A much belated 21st - and much fun for all! I'm glad to report I'm fine - yes, haven't become sick after consuming my own fried rice. The other food there was lovely too (thanks everyone), we all got entangled in the knot game, and many an embarrassing moment was made light of in the speeches. Not that there are many embarrassing moments to talk about for Sal, who is quite the angel.

I thought I'd take this opportunity to present an authorised (and much amended) version of my speech then - and paint a clearer, truer picture of Sal, and how much she means to me. Sorry for the strange anecdotes in the original one, Sal!

"I've now known Sal for almost two and a half years, and it's hard for me to think back and imagine life without her. She has been such a blessing to me in many ways, from the moment I met her I couldn't help but think (and know) that I'd met someone very special. So talented in many ways, I was amazed at her enthusiasm, her achievements, her dedication to God - and I just couldn't help but think that I wanted to know her more.

Our relationship was initially built on common interests, these being music and medicine, but as time progressed, I began to see that not only was she an amazing person on the outside, but also the inside. Her inner glow became more apparent - her truly caring heart combined with ambition gave rise to a wealth of dreams that I just wanted to share in and make happen. And these were more than just air castles - her mind is a fountain of dreams and ideas that are heartfelt and genuine.

One of these dreams was that of going abroad to study French and experience a new culture - and so she jetsetted halfway across the world to Montréal, away from family and friend for six months, to realise this dream. Going overseas for a holiday is one thing - going overseas and having to establish a life for oneself is a totally different matter altogether, a real test of character and mettle. Combined with the cold, harsh winter of Montréal in December, Sal built a new home, made new friends, joined orchestras and church groups, and went exploring. For one who had little prior experience of living independently away from home, this is quite an achievement!

Another of her dreams was improving her already excellent ability on the violin. In fact, so much was her desire to do this, that I first met her on the premise that we would talk about how best to go about achieving this dream, whether to aim for an associate diploma or not, given that medicine is so demanding already! At the end of last year, she did indeed earn her diploma - and I have been privileged to witness her growth and maturation as a musician, and it's a real delight listening to her.

While our relationship has been a wonderfully joyful one (certainly most of the time), we have also had our trials. Such times expose character, when one becomes vulnerable. I have to say, I am truly thankful for Sal's immense love and unfailing faithfulness in this regard - where many would find it too much, she persevered; where many would find me difficult to love, she loved me anyway. When I was silent for fear of being misunderstood, she would encourage me to speak. Our love may not be perfect, but then, we are given a lifetime to learn to love, practise loving, and grow in our relationship. Thank God!

I am blessed to know such a wonderful person, doubly blessed to share my life with her in such a special way. I am more certain of God's amazing creative power because of her - so beautiful a person, yet so talented, and even more amazing, that she could possibly love me in the way she does."

Missing you heaps, Sal. All the way where the phone can hardly reach in Marysville! Anyway, I guess I should sleep now. Thirteen hours of work tomorrow! God bless!

Too busy to B-L-O-G?!?

2006-06-21T21:04:00.000+10:00

Hey all, yes it's been a long time since the last entry. I have so much to blog/write about - but at the same time, it's not really that important! In brief, I'm now doing the surgical resident job (colorectal surgery), which is busy, busy, busy - not the most busy, but just consistently so - just enough that I have scant time available to write blog entries. However, something very exciting has happened - Sal is back from her long absence abroad! So yes, when I return home all surgery'ed out at the end of the day, I have something to look forward to!

I have now become a "morning person" by necessity - starts at 7.30 every day, except for the few days when this becomes 7.00am (which necessitates arriving 15 minutes earlier, and waking up about an hour before that) - and the days are depressingly dark, with the sun still dim and beyond the horizon when I rise, and gone by the time I leave work in the evenings. I miss the sun! Not all is gloomy, though. Today (or tomorrow) is winter solstice - which means that the sunny parts of the day will only get longer from now on!

Murphy's law has proven itself quite reliable, unfortunately, over the last few weeks. Today was a great example of that. Twiddling our thumbs around 11am today, myself and my fellow surgical intern ("surgical intern" sounds better than "colorectal intern") were looking forward to an easy afternoon - a rarity in this job. He took the afternoon off, leaving me to do only a few, fairly easy jobs - but simply tedious. But as chance would have it, life took a turn for the worst for one of our patients who had surgery just yesterday - one of the clips decided to fall apart and bleed inside his tummy, making him very sore, and us very worried (and busy!). Most of my other jobs got knocked back to later on in the evening - it becomes very difficult to manage the ten other patients when one is so sick! Eventually, this man went to operating theatre around 6.30pm - and here's hoping that all goes well for his operation.

Murphy's law operated similarly yesterday - when a patient decided to turn up on our ward half dead and on his way to the afterlife, again making a lot of work for us! But I would probably call this one differently - it was a great stroke of luck that as he turned up on the ward, the nurse and I were able to assess him and recognise how severely ill he was to do something about it. One has to recognise that "do something about it" in this case meant "call for help!" - and before long, all the right people were in the one place, his life was saved, he was moved to intensive care - and although he's not yet out of the woods, at least he's not going further in!

Enough of my grumpy complaining, time to catch up on sleep, methinks! It will be good to finally get a proper eight hours of sleep - and hopefully wake up ready to face another day - another day at the office, another day that promises a whole heap of weird and wonderful surprises.

God bless!

Treasures of grace...

2006-05-21T22:15:00.000+10:00

Arrrr! I have returned with great fortunes from the St Jude's expedition to seek the legendary treasures of grace! With the delightfully dysarthric purple-headed Pirate Pete as our guide, we set sail (along the Western Highway) for that land-girt island of Ballarat, where the St Jude's Passion Convention was held this year.

We were blessed with a wonderfully entertaining speaker in Rob Forsyth, bishop of that far-flung, outer-outer suburb of Melbourne they call South Sydney. Amid jibes along the lines of "they held the Commonwealth Games down here? Really? Oh, I hadn't heard", the cheeky outer-suburbs man had a great message to share, preaching from various passages in the Bible on "grace", in particular God's immense grace, His gift, embodied by the Son, Jesus Christ.

What is grace, but the free gift of life from our Creator, at once so immense and profound, yet so simple that children have but to merely hear to grasp it? God's grace is lavish, a gift of mercy and love that bestows power on the incapable, and is at once the power of our God, from the beginning to the end, and fulfilled in Christ.

It is important to grasp what this means, and Christ is indeed the centre of it all. Whereas man is sinful in his ways, God's righteous character will never allow Him to acquit the guilty - all humanity have sinned and fallen short of the grace of God, and in our natural state, we all stand condemned and have no right to the life given us. However, God's character is twofold - on one side is righteousness and truth, on the other facet is love and mercy. John puts this as "grace and truth" (John 1:14), and this paradox is more extensively proclaimed in Exodus 34:5-8.

So how are these reconciled? Does God forgive us and simply forget our sin? And if God forgives, does this mean that all our wrongdoing is of no consequence? By no means - God forgives, but it is only possible because, in the words of J. I. Packer, "Jesus Christ endured, exhausted the destructive, divine judgement for which we would otherwise have been inescapably destined"! Christ died for us because God loves us!

It's worth a pause here... The treasures we have thus uncovered are amazing, wouldn't you agree? Near the convention centre was Mt Buninyong, an extinct volcano peaking at 719 metres and with a lookout tower on top offering views of the valleys and hills around (no cityscape or anything busy like that, only rolling hills and spot fires at occasional intervals - apparently in the country, people like to light fires). The crater is not at the peak - rather it is a neat bowl-shaped formation in the side of the mountain, a convenient detour off the beaten path. Someone smart had brought a soccer ball and a frisbee, and we played in the crater, strangely unfazed by the thought that, should the volcano wake up, we would be obliterated. At least we are all confident of where we would go from there! The mountain, though, makes for a nice view in all directions - and some have set up home on the slopes, raising livestock, horses, and all manner of other introduced creatures, amid the native landscape and wildlife.

Back to convention - so what then of grace? What are the outworkings of God's grace? If we are declared righteous (in one fell swoop, we are already justified by the death of Christ on Calvary's cross!), then why should we stop sinning? Paul poses this very question in Romans 6. "Should we continue in sin in order that grace may abound?" He immediately answers, "By no means! How can we who died to sin go on living in it?" Thanks to the grace of our great God, we are a recreated person - we have a new identity in Christ! Our sin then is not from our new identity, but from our old ways, which we are to shed.

Rob poses the following analogy. Somewhere in the suburbs of Melbourne is the Condie Poison Gas Factory (for those who don't know, Richard Condie is the vicar of St Jude's), which produces all manner of colourless, odourless ammunition for nefarious criminals bent on destruction. They are true professionals, and have been responsible for terrorist attacks all around the world. Then, one day, for some very strange reason, the company is taken over. The board is completely scrapped and replaced, and it's now no longer the Condie Poison Gas Factory, but the Patrick Therapeutic Gases Factory (Tim Patrick is St Jude's youth minister!) - a completely new company, a completely new identity, with a mission to cure the world of all its diseases! However, the factory and shipping department are still sometimes putting out poison gases. How can this be? They are used to the old ways, old habits, and take time to change. So while the company is a completely new company, it is a matter of process before the old ways are replaced by new ways.

The new ways should look like our Lord, Jesus Christ. So grace is given to us, so grace is also worked out in us. Grace (Greek "charis") is translated in many other ways in the Bible - just take 2 Corinthians 8, for example. Charis is translated as "grace", "privilege", "generous undertaking", and "generous act" - all within the space of one chapter. So grace is given to us in Christ, so grace is also worked out in us through our new ways, which reflect Christ. It is not simply that which we receive, but that which we give - we are put in a position by God to give, to be generous, and this is also His grace.

Our God is amazing, yah? We are to receive His grace - and not be afraid to do so! His gift of grace is free, and it is the greatest gift we can receive. We might start out reluctant, but all we need to is "take, eat"! I will finish with this poem by George Herbert, entitled "Love", from "The Temple":

Love

"Love bade me welcome: yet my soul drew back,
Guiltie of dust and sinne.
But quick-ey’d Love, observing me grow slack
From my first entrance in,
Drew nearer to me, sweetly questioning,
If I lack’d any thing.

A guest, I answer’d, worthy to be here:
Love said, You shall be he.
I the unkinde, ungratefull? Ah my deare,
I cannot look on thee.
Love took my hand, and smiling did reply,
Who made the eyes but I?

Truth Lord, but I have marr’d them: let my shame
Go where it doth deserve.
And know you not, sayes Love, who bore the blame?
My deare, then I will serve.
You must sit down, sayes Love, and taste my meat:
So I did sit and eat."
-George Herbert (1633)

Tired...

2006-05-14T21:38:00.000+10:00

Yawn. Again. It's been my busiest fortnight to date, although a far cry from the 80 hour weeks and 3 day shifts our predecessors had to endure, 113 rostered hours (plus overtime) over two weeks is hard enough! I was happy to stroll in the misty rain this morning, having a moment to appreciate the autumn colours and the moist leaves blanketing the ground, for once not feeling like I needed to be somewhere in a few minutes. And my brain relished that opportunity, as my mind simply floated, far, far away, out of the reach of beckoning voices. I'd almost as well have been drifting towards the edge of the universe. But the soft fall of misty rain on my face kept me awake, and I smiled as I returned to reality, thanking God for the gift of peace, and rest.

At church, we continued the series on Colossians. How singleminded we ought to be as followers of Christ! If Ephesians 1 is a constant barrage reminding us of our new identity "in Christ", then Colossians 2 is also. And in Him, we find our new lives! Long gone is the rule of the world and its deceptive philosophies - instead we are raised above them, having had our worldly ways nailed to the cross and put to death, so that we can now rejoice with Him!

Unfortunately, I find that it's often so easy to slip backwards, to profess that we have received our new lives in Christ, but to also fail to "continue to live in Him", instead eyeing the "basic principles of this world". Essentially, such basic principles are spirits of self-centredness or human focus, and the "deceptive philosophy" that stems from this includes ideas of individualism, legalism, exclusiveness, and hostile competition, all of which are so prevalent in this world. In any situation (I don't think it would be unique to a career like medicine), there are always dangers of ignoring God and instead relying on ideas of human origin to deal with the situation. If we think about it, it's absurd that we will happily yield some parts of our lives to God, and not other parts - as if we know better than God in our so-called fields of expertise!

While I'm on blogger - just a shout-out to Sal in France:
** HaPPy 21st! **
Party on way through the night!
Love you, & missing you heaps!

Anywayz, sleep beckons. God bless! And goodnight!

Of Anzac day and rabbits...

2006-04-24T22:56:00.000+10:00

Thanks to Yi-Ning for sending me this wonderful article about the frivolous, furry ball of fun we call the rabbit, and what this has to do with one person's walk with God! My mind is now rejuvenated, filled with phantasms of flipping, flopping, fluffy things that approximate the fluffiness of this horribly hopeless alliterator. Once tired, a bit of humour is better than the best tonic at transforming a soul from aimlessness to energetic direction. And hence this blog comes into existence.

Well, far apart from rabbits, the people here at Queen's hold a Monday evening program, which tonight comprised an eye-opening talk by a historian on the Anzac legend. The fact that we now have a public holiday in honour of a group of people, who almost a century ago fought in a battle halfway across the world, is a testament to the importance of the legend in the identity of Australia as a nation. At the time, Australia was still a youthful nation, barely a teenager (an infant as far as nations are concerned), and determined to prove its worthiness in its own right. And the battle of Gallipolli, a wonderfully tragic example of the contrast between brazen optimism and devastating reality, was where Australia did build its identity - although not in the way, it would seem, was originally anticipated.

The plan at the time was for Allied troops to storm the shores in a landing, whereupon the Turks (seen as vastly inferior, almost a joke) would then flee at the sight of the landing - thus leaving the Dardanelles undefended, opening up a water channel between the Mediterranean and eastern waters, and spelling the neutralisation of the Ottoman empire. Troops, as bold and brash youngsters, were full of confidence in this plan - but the rest, as you know, is history. The numbers of dead mounted and rose - the naïve strategy and underestimation of an enemy led to the death of 132,000 individuals on both sides. The battle, anticipated to be a pushover, became a war of attrition and a mass graveyard.

Why does this tale of loss and tragedy then go on to define a nation? And why war? I wonder, is it because of the nationalistic idealism that such death stands for? Or, perhaps, is it the complete opposite - the nationalistic unity that emerges from a communal grieving process? The answer, it seems, is both. On the side of nationalistic idealism stand the tales of individual heroism and bravery that came from the legendary battle. More than once have we heard of the soldier who dragged his injured mate to safety, and the one who kept going in the face of fire to land in hostile trenches and cause havoc amongst the enemy. Such heroism, such bravery, is the sort of ideal that becomes universal, crossing boundaries of rank and race, and this has become definitive of the Anzac spirit. On the other side, however, the massive number of Australian casualties cannot be ignored - and families were left fragmented, children left without fathers, wives without husbands, parents without children - a truly unanticipated outcome.

Over the next decades, the legendary status of Anzac became something to commemorate - and Anzac day was born. The march of veterans has been seen as a day to remember those who offered themselves in service of the nation, the loss of lives, and the tales of bravery. However, it has been met with controversy in all the times of its establishment.

Since its conception, Anzac day has been criticised for its seeming glorification of the grusomeness of war. Many people lost their lives needlessly, and have continued to do so in the many wars that have followed the Great War (ironically once thought to be the war to end all wars). No century has been more war-ridden than the 20th century, and given the political climate of the world today, it seems that this century may be even more bloody than the last. Each year, as soldiers are paraded to the shrine, children are fired up about the idea of fighting glorious battles - energised by the spirit of Anzac, and no doubt filled with the same brazen enthusiasm and confidence of those once young before they set off on the fateful ships to Gallipolli. It seems that experience is the best teacher. War veterans are the first to voice their opposition to needless sacrifice of lives in needless battles. They've been there, and they alone know like no other how terrible a waste it would be. Yet, it is the inexperienced who are in charge of the decision of whether or not to go to war. The Iraq war is a great example of such contrast - a needless war and excessive loss of life, waged to sate the whims of those in secure offices far from the front lines. In the Vietnam war, the soldiers were villified - but it was not their decision that the war should be fought in the first place. Perhaps the real villains were right at the other end of the chain of command, those who know very little the traumas of war.

Today, the greater controversy is in the commercialisation and capitalisation of Anzac day. It is a tragedy - we have sport, products, and spectacles that take advantage of it, in the name of commemoration, but they are little more than an attempt at capitalisation. This is far from the spirit that was so powerful as to stop the nation, transcend the barriers of rank and race, and call the name of Anzac sacred (so much so that in 1925, it was protected by law against commercial use).

In the end, I hope that this commemorative day does serve as a reminder of the tragedy of war, and how we ought to be involved in a concerted effort for its opposite, peace. Jesus said, "Blessed are the peacemakers, for they will be called sons of God" - Matthew 5:10. About the tragedy of war, I can't sum it up better than the poet Wilfred Owen, in his poem "Dulce Et Decorum Est":

"Dulce Et Decorum Est"
Wilfred Owen

Bent double, like old beggars under sacks,
Knock-kneed, coughing like hags, we cursed through sludge,
Till on the haunting flares we turned our backs
And towards our distant rest began to trudge.
Men marched asleep. Many had lost their boots
But limped on, blood-shod. All went lame; all blind;
Drunk with fatigue; deaf even to the hoots
Of disappointed shells that dropped behind.

GAS! Gas! Quick, boys!-- An ecstasy of fumbling,
Fitting the clumsy helmets just in time;
But someone still was yelling out and stumbling
And floundering like a man in fire or lime.--
Dim, through the misty panes and thick green light
As under a green sea, I saw him drowning.

In all my dreams, before my helpless sight,
He plunges at me, guttering, choking, drowning.

If in some smothering dreams you too could pace
Behind the wagon that we flung him in,
And watch the white eyes writhing in his face,
His hanging face, like a devil's sick of sin;
If you could hear, at every jolt, the blood
Come gargling from the froth-corrupted lungs,
Obscene as cancer, bitter as the cud
Of vile, incurable sores on innocent tongues,--
My friend, you would not tell with such high zest
To children ardent for some desperate glory,
The old Lie: Dulce et decorum est
Pro patria mori.

Blankness...

2006-04-17T00:25:00.000+10:00

Like the emptiness of space, my mind floats, drifting, a vessel without aim. Through the chasm of expansiveness, my eyes stare, glazed, into an imagined reality - the world that holds me fast, a world of cares and obligation and responsibility, that finds me thinking about one thing one moment, and another thing the next, and tricks me into believing it all matters. These eyes might as well be a machine's - each move a reflex, and thousands upon thousands of these each day mount up to exhaustion.

Yes, exhaustion - the point upon which life's release into the true reality is found - one slows down and steps out of his narrow-mindedness, and a measure of realisation dawns that our lives are of so little consequence in the end, and none of it really matters - then, only then, do we realise why we do what we do.

Back to reality. I need to sleep.

Happy Easter!

2006-04-14T00:19:00.000+10:00

Hey all, it’s been such a long time since my last update and I thought I ought to say something at least (even if not much). I am back in Melbourne now, having completed my emergency rotation in Mildura, and am working at Western Hospital as part of the general medical unit, which is quite a change of pace! Of course there are still stressful times – however, they are but mere moments amidst a sea of tranquillity, relatively speaking. For the first time, I feel far less guilty about taking a short break for lunch, and despite the longer hours, I have more energy to enjoy my time at the end of the day relaxing, hanging out, rather than simply slumping, exhausted, on the proverbial hay.

I caught up with a friend from my old high school today, Vince – he lives so close to me now, just five minutes’ drive away. He’s settling into a new job also, this time in the field of biomedical product manufacturing (things like plasma, factor concentrates etc). We ended up going to Max Brenner's chocolate haven for some hot chocolate, just the way to cool down after a busy week. It’s such a blast from the past, catching up with Vince – hearing about one person getting married, another person in India, yet another in Dubai, all creating havoc wherever they go! He has a cosy apartment, and the view from the rooftop is amazing in the starry night, overlooking the sleepy Melbourne cityscape on Easter eve.

Yes, it’s Easter. And I can't help but feel for my poor patients who are destined to spend this time cooped inside a hospital, being poked and prodded for blood and drips, being attended to by disgruntled doctors and nurses who were not spared the weekend shift. It's not the most fun kind of life, really, and it's quite a disempowering experience to be a patient. It's hard enough having to live with a debilitating illness. I imagine it must be doubly hard to hear the news that they are not yet fit to go home the day before Easter. If it's any consolation, perhaps even the diabetic patients ought to receive a big, juicy, diabetogenic chocolate egg! (And a big whack of insulin just beforehand)

Yet, regardless of our circumstances, now starts a time of celebration – a festival commercially linked with clearance sales and chocolate intoxication – a festival that serves, for Christ’s followers, as a stark reminder of the amazing sacrifice made by our Saviour, shedding His own blood at the cross. And for those who work, it’s either a time for holidays and going away, or a time for lamentation of the lack of such holiday (somewhat compensated for by the increased remuneration over the weekend). I pray that we can focus on the true meaning of Easter this year, and remember soberly the death of Jesus on Friday, the blood He shed as He took the punishment in full for our sins. I pray also that we rejoice and celebrate His glorious resurrection, and the eternal hope we have in it this Sunday!

So, without further ado, have a Happy Easter, eat some good chocolate, and God bless!

There are fish in the Yarra?!?

2006-03-22T21:49:00.000+11:00

It's my last week in mildura this week, and since I have Wednesday and Thursday off, I decided to pop back to Melbourne for a couple days break. But so many things have changed - the Commonwealth Games on, the Grand Prix around the corner - and there are fish in the Yarra! Yes, fish in the Yarra! 72 to be precise, and well - not in the Yarra, but floating on the surface (I guess if there were ever fish to be found in the Yarra, floating on the surface would be exactly where they'd end up rather quickly). But it's quite a display, each fish a unique piece representing a country of the Commonwealth. How Australia ended up with the eel I don't know - what happened to good old barramundi or Murray cod?

I have to say, I've had a pretty good first rotation as an intern - I've done my fair share of ranting, and I definitely haven't liked everything I've seen so far, but there's a strangely good feeling about having (nearly) completed the rotation and having come quite far as a doctor in this time.

One thing I can't help but notice though, is that things seem to come in waves. I distinctly remember early on in my rotation, I saw three patients with fractured femoral necks in very quick succession. Then came a run of wounds that needed suturing - well, they're quite commonplace, but there were a few very tricky ones (places like the scalp, face, fingers) in a short time. Then there were the dreaded abscesses - painful for the patient, not particularly pleasant for those of us who need to cut them open either (although Sharon claims to find it a strangely satisfying thing to see the pus ooze out - I don't quite understand, unless she means in the same way you feel "satisfied" after visiting the bathroom for relief). The epidemic of abscesses might well have been explained by the run of 40+ degree days that sent all of Mildura packing to the Murray and diving in. Including me. But I guess I got lucky, spared the trauma of developing any horrible pus-filled lumps. Then towards the end of the rotation came a run of positive troponins! I went so far, sending troponins off for any chest pain suspicious of AMI, none turning up a positive result (happy for the patient) until just last week. We had a standing joke that anyone with chest pain ought to see me - and it would turn out not to be a heart attack. Then, all of a sudden, two patients in a row return with positive troponins! Into hospital with the diagnosis of NSTEMI, and the unfortunate news that they've had a heart attack.

One drawback of working in the emergency department is that there is very little opportunity to follow up patients over time and see how they go in hospital. So, I had the unique opportunity to carry on some continuity of care when I moonlighted as the medical ward resident last weekend. I was happy to see how the patients I'd seen in emergency were improving, even to see that the patients remembered me and seemed happy to see me again. The poor guy who I had to inform about his metastatic cancer was still all smiles - understanding the weight of his diagnosis and prognosis, his friend took it much harder than he did. I don't know that I would be so stoic, if I were given the same news.

The negative things I've seen during the rotation, I hope will serve as teaching points for me. I've learnt the destructiveness of rumour-mongering and harbouring complaints. I hope that I don't fall into that sort of behaviour - it's unfortunately all too prevalent in the stressful, competitive world of medicine. I'm glad to have been blessed with good friends and understanding peers - and a caring, loving soulmate on the other side of the world! It's true, if we don't seek help and understanding from true friends, it'd be easy to get swallowed up in the culture and spiral down a black hole. There's almost no wonder that two registrars recently took their own lives - self administering lethal quantities of drugs found in the hospital (although one of them, it seems, was after a relationship breakdown).

In the end, I am thankful to God for the opportunities He has given - I just hope that I can embrace them, know His will, and make the most of each one. Till next time, God bless!

Nostalgic timeglass...

2006-03-09T01:18:00.000+11:00

Tonight, for some mysterious reason, I decided to look back upon my blog to its humble beginnings over a year ago, and think about change. This is the beauty of blogs, or of diaries, indeed - of any written record of thoughts contemplating the future. One can look back, reflect, and gaze as if through a timeglass, into the thoughts of the one that was. And predictions are borne out or falsified, resolutions are kept or broken, moods and thoughts develop. All these things seem far more interesting than a simple snapshot, a cross-section in time, that flashes a vivid picture and then is suddenly no more. But it's amazing to look back and see change. And it's even more amazing to think that our God, who transcends time, has view of all these things at once!

This bug has undergone a lot of change in the 14 months since this blog started, that's for sure. Now no longer "just a student", but a "doctor"; perhaps a couple of kilos lighter and less obsessed with chocolate; in Mildura and not Melbourne; with Sal on the other side of the world; owning a new car. The list could go on for a while. But so many of those changes are far less important than the changes inside - although it would be wrong to say that changes inside are independent of these external ones.

I think one of the biggest changes is my becoming far busier. Being busy, I think, has caused me to grow in the world's sense of the word "grow". This far into work as an intern, I've had to take a quantum leap in mindset to deal with being directly responsible for patients' welfare. Working life is also time consuming with most shifts lasting ten hours, and some lasting well over that. Sometimes, I'll come home from work and simply be so exhausted that all I'll do is flop on the bed and dream of sleep. And then I'll wake up in the morning, lights still on, my clothes still on, and look at the clock - panicking at the fact I need to be at work in under half an hour! Thanks to God, I haven't yet been late for a shift (well, not excessively so, anyhow). So far, I've learnt to deal with these things, and I'm definitely improving with regard to time management. Certainly, in the emergency department, one learns how to be efficient (although it may not seem so to the patients - who, understandably, have to put up with exorbitant waiting times while we wait for beds to become available, and for pathology to process our blood results, or radiologists to report scans - leading to the prevalent sighs of doctors in the department, "oh, where are my bloody bloods!") Indeed, times can be frustrating - but we grow up and learn how to deal with frustration, become desensitised, and become far more machine-like. Even out of work, there is little time spare to cater for our domestic needs (some would argue cravings) - time spent shopping, eating, sleeping, and surfing the net (probably one of my worst timesinks!). It leaves little room for thought, for dreaming, for imagination - the things that cause one to be both interesting and interested at the same time. And so it is with being busy.

I can't help but think that in all this, I've fallen a bit into a state of thought poverty. Instead of being busy thinking (as I was when I started Elkandren's Whisper), I find myself busy with a whole host of other things. Now, thought tends to take a back seat. Far from being foremost in my mind, the quest for meaning, for answering interesting questions like "what better things are there for me to be thinking about than this?", takes a back seat to the incessant worries of how my patient from earlier on in the day is coping with the antibiotics I prescribed. Even dreams are themed on decisions about a patient's management. And then, as exemplified by one of my patients just yesterday (who spontaneously reverted from atrial fibrillation back to sinus rhythm), the vast majority of patients we deal with would get better anyway, and 90% of the time we're intervening for no good reason.

And see, as I grow older, I become more cynical. Kids don't have this same level of worry, and they are full of the most interesting thoughts. Adults are weighed down by terrible grievances, age only wearies them, and woe betide them about every little thing that goes on! There's no wonder that ketamine is such a great drug in kids, and such a poor drug in adults. It's an anaesthetic whose effect includes that of inducing dreams. And it's the adults who come out from under its influence complaining of the worst nightmares, while children enjoy floating on clouds, seeing fields of flowers, and their favourite animals. Kids set for us an example that goes far beyond their cuteness and innocence, what adults often call "ignorance". We should be more like children, with an open mind - as Jesus taught us, we ought to come to Him as children, for theirs is the Kingdom of Heaven.

Perhaps in the end, I simply need to look at myself, take a breath, take a step back, and reflect. Jesus took many sidetracks along His journey to the cross, paying attention to things around Him, taking time out for prayer and contemplation, all the while on a life mission infinitely more important than my medical career! I need to follow His example more closely, and make once again more time for thought and reflection, for attending to the details that He has put in our lives, the many ways He reveals Himself to us every day. When I look back at the start of my blog, I realise how I was able to grow (in the true sense of the word) so much at the time - through reflection, reading God's word, and really seeking to dwell in Him. Although I have grown, it's important to know that now is no time to stagnate. I pray that God will help me continue to seek Him earnestly, and free up time to do so, to think on things which are important. I pray that God will help me continue to grow in the true sense of the word, God's wisdom, rather than in the worldly sense. And I hope that this blog, my public thought forum, will become far richer for it!

Quick update...

2006-03-07T00:42:00.000+11:00

It's been a while since my last instalment, so I might as well take this pre-slumber window of time to write a quick blog update. I guess, basically, I haven't had the most exciting couple of weeks lately, hence haven't felt the need to write anything - mostly been working (did a hard seven day stretch last week, which was exhausting and depressing), but on the up-side have had a little time to catch up with some old friends who are in their final year of med school, enjoying their last taste of relative freedom before the relentless holiday-less stretch of work as an intern begins.

James and Eric spent Thursday evening up here in Mildura, unable to resist the temptation of good food and wine to be had at Stefano's! It was a real treat, six courses of really well prepared mediterranean food, ranging from the entrée cold meat and salad, to stuffed calamari, to lamb roast, and the almost oversweet caramel dessert. Each course was accompanied by a glass of hand-picked matching wine, whether they be local or imported from Italy. After the wining and dining, the food was allowed to digest while we turned our eyes heavenward and enjoyed the country starscape featuring Jupiter near the horizon - you can see jus so much more in the country!

Spent the weekend in Melbourne - the drive so tiring and exhausting, just over five hours by the most direct route, precluded me from fully enjoying the time. I'm sure it didn't help my attempts to play violin again. The last time I played would have been about two months ago! Even so, I had fun reacquainting myself with it, battling through the Mozart A-major concerto. Also, popped into uni - found out I'm going to be giving tutes in physiology, so I thought to brush up on that with a copy of Ganong - and at the same time got some Chinese books to start learning Chinese with. Am enrolled in evening courses, so I'm really determined to get started and learning again (I haven't taken Chinese lessons for 14 or so years now!).

Uni brings back so many memories of my time there. Even though I'm so new to working, it still feels so nostalgic, as if it were years and not months ago that I was there. More vividly, it reminds me of Sal - as we first met at uni, and spent a fair bit of our time together at uni, doing activities, or jus hanging out. I know that my time at uni wasn't always happy, but it remains that almost every memory I have as I walk around is a happy memory. I guess that's the same for most things when I try to look back - mostly the happy stuff stays in my head, and not many stressful or negative emotional memories at all. I wonder whether we are simply selective with what we remember? Or perhaps it's just that each time a stressful or negative event occurs, we magnify it so it dominates our thinking at the time? (and therefore, they aren't seen as significantly when we look back upon them) Or maybe our negative memories are selectively suppressed.

Am missing Sal heaps, more and more each day. Even more so when we webcam - somehow instead of necessarily bringing us closer, it manages to jus reinforce and emphasise the fact of our physical separation. Looking forward to the day when we don't need technology to see each other again.

Anywayz, off to sleep - haven't really said much this time, and am too tired to say any more really. If you're bored in the meantime, check out this set of riddles! Good luck!

Who am I in Christ?

2006-03-07T00:28:00.000+11:00

I am...

A Child of God (Rom 8:16)
Saved by Grace through Faith (Eph 2:8)
Redeemed from the Hand of the Foe (Ps 107:2)
An Heir of Eternal Life (1 John 3:11-12)
Forgiven (Eph 1:7)
Led by the Spirit of God (Rom 8:14)
A New Creature (2 Cor 5:17)
Redeemed from the Curse of the Law (Gal 3:13)
Kept in Safety Wherever I Go (Isa 46:4)
Strong in the Lord and in His Mighty Power (Eph 6:10)
Living by Faith and Not by Sight (2 Cor 5:7)
Rescued from the Dominion of Darkness (Col 1:13)
Justified (Rom 5:1)
An Heir of God and Co-heir with Christ (Rom 8:17)
Blessed with Every Spiritual Blessing (Eph 1:3)
An Overcomer by the Blood of the Lamb and the Word of My Testimony (Rev 12:11)
The Light of the World (Mt 5:14)
An Imitator of God (Eph 5:1)
Healed by His Wounds (1 Pet 2:24)
Being Transformed by the Renewing of My Mind (Rom 12:2)
Heir to the Blessings of Abraham (Gal 3:14)
Doing All Things through Christ who Gives me Strength (Phil 4:13)
More than a Conqueror (Rom 8:37)

Mildura hit-and-run...

2006-02-22T11:50:00.000+11:00

Weekend tragedy - five, and now six, teenage lives lost needlessly. First, the shock, and now the anger, spreads throughout the close knit small town. Many ask the question, why could this be allowed to happen? Why should they die, and their killer - a drunk man, driving with his child on his lap - live? The danger period is not yet over, physical scars still threatening fragile lives, and emotional ones running still deeper, and lasting far longer.

I was fortunate not to be on shift when this happened, but far away in Melbourne, meeting the students I will be tutoring this year. The hospital had been packed, a kind of controlled chaos, taxing on all involved - doctors, nurses, ambulance, not least the victims and their families.

Whenever a tragedy like this hits, it is a sobering reminder of how small we are in the universe. Without warning, lives are taken away, and it could happen to anyone at any time - yet the universe continues on its course, predominantly unfazed by the transition of a speck of life (of light, of hope, of love) into eternal disappearance. We are made to feel so insignificant, yet our feelings are so great and true, that we cannot reconcile our existence with such an abrupt destiny. Can it be that life exists no more, beyond death?

Call it my stubborn denial, or refusal, or whatever - but God's message is a reassuring reminder to me that, in death, we are joined in heavenly reunion with our Creator. And this, I hope and pray, is the destiny of those who died on the weekend. Jesus died, but He also rose again from the grave to appear before at least 5,000 individuals after His death, in one of the best documented controversies of ancient history. In Christ, we have hope in this world, and much more - we have a certain future with God. Only in His love can we rest peacefully tonight.

-----
On a much brighter note - I received Sal's Valentine's card yesterday, so cute, so beautiful! Despite our distance, it's so awesome that love refuses to be bound by physical constraints. Thanks for all your love, ladybug!

End of another week - start of another weekend...

2006-02-16T22:35:00.000+11:00

Phew, today the hot weather returned! Just as the Commonwealth Games torch arrived in town, it was boiling enough outside without needing to heat up even more with a flame! The main mall in town was all closed off, along with some of the main streets, but hardly seemed like the whole town was there - jus a small crowd for the stageshow, and another small crowd watching the watermelon eating competition. Traditional Samoan and Pacific Island dancers shared acts with Koori troupes, with quite fascinating costuming and energetic choreography.

Energetic was quite the opposite of how i've been feeling most of today tho - last night completed a 15 hour day, from start to finish, and flopped on my bed, woke up at 6am this morning with my clothes still on and the room still bright! Had to still start early today - but thankfully, I have the next 3 days off (yay, can Skype with Sal 2moro!) - and am going back to Melbourne, to meet the first year students for my first official tutoring job at Queen's college.

Today - did my first lumbar puncture. Too scared as a student to do one, but then again most hospitals had policies that students weren't to be doing LPs anyway. The lady was quite large, so identification of the landmarks was quite difficult - but the needle went in fine after one first attempt hitting bone. Unfortunately, even with the needle (which is a pretty impressive needle, abt 15cm long) all the way to the hilt, all that dripped out was blood (known technically as a "bloody tap"), so it wasn't helpful in the end - the lab rang back saying that they couldn't analyse the sample. Poor lady, wouldn't wish that upon anyone - tho her condition was so terrible anyhow, after presenting with an indeterminate cause for altered conscious state, she's now requiring intensive care for airway management. For the rest of my patients, the news was far better - some category two patients I had the pleasure of sending them home with good news and no need for hospital admission. Needless to say, they were also very pleased about the results.

Anywayz, off to sleep soon, am yawning incessantly - at least I have a flight ahead tomorrow instead of a long energy-sapping drive. Till next time, au revoir, and God bless!

Melbourne weekend...

2006-02-11T21:53:00.000+11:00

Hey all, back in Melbourne now, if only fleetingly. Quite enjoying the relaxation and having home cooked meals again, catching up with family, and catching up with some (much needed) piano practice! Haven’t touched an instrument for so many weeks, so it was quite awkward and tense playing the first few scales and finding my coordination isn’t anything like what it used to be! I needed three goes just to get my hands together playing an E-flat major scale! Shuddering at the thought of how horrible my technique will be when the ten weeks in Mildura ends, and I have access to a piano once again. Thankfully, the hands still remember a few little pieces, including most of the first movement of Beethoven’s violin/piano sonata No. 1, which I’ll hopefully have in a somewhat more practised state when Sal gets back in a few months.

My parents and brother haven’t changed a whole heap. My room at home is still the controlled mess I left it in a few weeks ago – papers and envelopes scattered across the desk waiting for my delayed attention, a credit card statement with a daunting due payment, calendars and books, a bedside table emptied of all the photos, books and objects that I cling tightly to whenever I travel. My parents were eager as ever to share in the spoils of my first couple of paycheques, and we enjoyed a yum cha lunch at Shark Fin, our usual hideout. They’re also hanging out for the dinner at Stefano’s when they come visiting Mildura. As for my brother, he’s finally learnt to come to grips with driving the Magna (our sixteen year-old car – ah, so many memories!), and he continues to throw confusion into his diurnal rhythm, out at night til late visiting friends or partying, then coming home and waking up with the birdcalls in the morning.

Have been asked by so many people about how I’m finding intern life. Apart from being still under a hill (no longer a mountain) of annoying paperwork, I feel things are slowly being sorted out. I’m getting used to the whole working routine, although the mood is still one of groaning and reluctance each morning. Facing the day, waking up alone, knowing Sal is half a world away, is often depressing. But I know that I need to overcome this spectre of gloom and be thankful for the countless blessings I share in. I have a poster and a cross on the wall of my room in Mildura that remind me of my identity in Christ – they’re a great source of encouragement when I feel down, and help me get out of bed in the morning.

Once out of bed though, there’s no time really to stop and think about things – just make sure that I’m fed well enough, making myself presentable, and then fronting up at the Emergency Department, ready for another day. I think the biggest challenge is just remaining calm and trusting in the training we’ve received over the years, when confronted with such variety – anything from the chronic hypochondriac, to cardiac arrests, to traumas, to suicidal patients. The other day, I had to do my first seclusion order, which is when a doctor is required to assess a patient in seclusion room from medical perspective. In summary, check their pulse, breathing, hydration, alertness and orientation, and whatever other medical problems they might have. It sounds scary when one wonders about why on earth the patient was put in seclusion in the first place! Usually, they’re aggressive or unstable, and the doctor comes with a mini army of other personnel to help bring any trouble under control, should it arise. But the patient I was called to assess was quite docile and cooperative when I arrived, sick of being cooped up in a blank room. The poor girl, about my age, was already on such a long list of medications – it’s not surprising that her personality’s so unstable when she’s on so many psychotropic drugs.

The bulk of an intern’s work, though, is clerical. Requesting X-rays, chasing pathology results, documenting cases, reading old histories, researching management options, writing letters to GPs, and organising consultations with specialists, all takes up far more time than actually seeing the patients. It can be frustrating (for patients as well), especially in the cases where more time is spent waiting for results to come back than actually doing things. That said, I’m very fortunate to be working in the emergency department, since it offers such a great opportunity to see an incredible variety of patients (complete with interesting personalities and stories to tell), to do procedures of all sorts (plasters, sutures, needle and surgical drainage of abscesses, IV cannulation, fracture reduction), and to learn from it all.

Back to Mildura tomorrow, armed with a stack of new CD’s for the long drive up, and hopefully refreshed for another week in the sunny orange land. Till next time, God bless!

Long time, no blog...

2006-02-01T18:53:00.000+11:00

Long time, no update! Weeks later, I finally get internet at the flat here in Mildura. Not in my room though, have to come across to Sharon's for wireless access - we speculate it's probably the people immediately downstairs from her room who probably have the wireless router. Theoretically, I could sit outside and use it too, just that here where the average top temperature has been around 40 degrees Celsius, one would much rather be inside where there is air-conditioning. Thanks to our anonymous neighbours for having internet that we can piggyback on and use! ;p

This is my third week now of working here. Am working in the Emergency Department in this intriguing hospital - one of a rare breed of privately run public hospitals (who ever thought of such a system before?). The result of this arrangement is that we end up with a nicely furnished facility that looks quite homely, mismatched with an antiquated computer system (it took 10 minutes to recover when there was a power blackout) on which to get results, look up patient details etc. The ED work here is very much like a general practice mixed in with only the odd serious case (what would be far more commonplace in a big city hospital), since there are so few bulk-billing doctors here in Mildura. So we end up dealing with a lot of coughs, colds, cuts, and such like, we need to get adjusted to the mindset of sending a patient away from hospital with almost no intervention quite a lot of the time. As students in big city hospitals, we've become far more accustomed to admitting patients, giving drips, IV medications and fluids, operating, and having patients rapidly go downhill with hospital acquired infections, that sending the patient away having hardly done anything is actually quite a difficult thing to get the head around. That said, there have been several serious cases - some of mine have been admitted with surgical problems (e.g. two appendiceal abscesses, one with obstructive jaundice), and a couple with medical problems (one with atrial flutter, another was a lymphoma patient with anaemia for management). One patient I've had to transfer to Adelaide for further investigation, and one wanted to be transferred to the private hospital. Even the cushy furnishings of Mildura Base weren't luxurious enough - or perhaps the prospect of being examined and interviewed by students wasn't appealing.

Oh, that's another thing we've had to get used to. As interns, we now have some responsibility for the education of our future medical professionals (oh dear)! I have to say though, I quite enjoy having students to teach. They ask me questions, I supervise procedures, and at the same time I keep learning. They're very nice too - the two ED students are both Christians, whom I saw at Church on Sunday, and it's refreshing to see this side of their personality, a good reminder that they (and I) are not limited in our identity with the medical profession. Even the more senior doctors (the registrars, not the consultants) have been very sociable with us, we've been to several dinners, even the local Irish pub. One of the surgical registrars surprised me with a medical history including gout (likely alcohol-related) and his seemingly insatiable smoking habit. One of the consultant surgeons had been similar, but now chews gum in lieu of lighting up. His wife had died of smoking-related cancer of the lung.

So, what is there to do around Mildura? Small country town - yes. But the surroundings are rich with famous wineries, Lindeman's and Trentham Estate among them. Have a bottle of Lindeman's port here, waiting for the perfect dessert to accompany. And what better to accompany some of the country's finest wineries than some of the country's finest restaurants! Several decades ago, a man named Stefano de Pieri settled in Mildura and began cooking. His humble Italian restaurant became the talk of the town, and a restaurant became an empire. If you're enjoying fine food in one of Mildura's many restaurants, then chances are you're eating in one of Stefano's. The Avoca was our venue last Wednesday, an idyllic double decker boat on the Murray river, and the cuisine was quite special - fettucine Gorgonzola with antipasto, Barramundi from the river, and the softest crème caramel I've tasted - a real culinary delight. Then there is Stefano's itself, the pinnacle of dining in Mildura. That's for another time, and we will see whether the restaurant lives up to its boast as the only three-hat restaurant in the state outside of Melbourne.

When we're not working or eating, it's swimming. The heat here can be quite amazing. It was like going to Montréal, thinking we could handle the weather, and ending up spending several days inside because it was simply too cold. Likewise, here, we thought we could handle the Mildura heat - apart from the fact that it keeps topping the weather forecasts, we'd put up with 40+ degree days before in Melbourne. It couldn't be too bad. But coming here is another thing entirely, and 40+ for day after day with no relief is quite unbearable! Most of the days, thankfully, have been spent indoors one way or another. Many of them were spent working. But swimming can be done for $5 in the indoor pool (which would be considered quite a hot pool by most people's standards, but is really cool relief compared to the outdoor heat), or for free in the Murray River. The river is actually quite nice to swim in, apart from the fact that visibility is so short underwater. It's not the cleanest river around, but much better than the Yarra for sure! Still, there's often an influx of earache patients after a hot day - history of swimming in the river, ear pain. Luckily I have managed to escape the otitis externa so far.

Have seven and a half weeks left here. Mostly things have been enjoyable so far, but not always. Sometimes I'm bored. Sometimes it's lonely. Sometimes I feel like breaking and sleeping and not waking up for weeks. Or going on a long drive back to Melbourne for not much reason at all. And I miss Sal heaps. Sometimes all I want is her smile, her presence, to hug her. But I know that God will carry me through. We've survived so far, and at least we can look forward to seeing one another again.

Enough for one blog. Hope to write again soon. Til next time, God bless!

Off to Mildura...

2006-01-15T00:03:00.000+11:00

Tomorrow I'm leaving for Mildura, to begin my first day as a responsible doctor in a hospital, an emergency intern. It's a position feared by many, sounding ominous on paper (to be working in the emergency department in a rural area), but it's actually not as bad as it sounds. We're actually quite well supported in our role, the consultants who supervise us are understanding, and it's an excellent opportunity for learning and development. I hope that it turns out to be that way.

Another thing is the seven hour drive, and scorching heat. Buried in the northwest corner of Victoria, Mildura is famous for its heat, averaging a maximum of 32C in January, and recording a highest ever temperature in excess of 50C! I hope there's not too much hostile weather, or else I'll find myself working overtime.

The job itself sounds quite cushy, averaging 41 hour weeks (contrast that with the 60+ hour weeks some of my friends are starting off with!), every second weekend off and occasional weekdays off. We also get two return flights paid for, which is a bonus. Also, Sharon is coming up to work in the surgery team! So, at least I'll always have a close friend nearby. Praying for a safe drive up, hoping for good weather.

Enough about work - today is a day of celebration! Congratulations to Pearl and Martin on their marriage! It was a beautiful wedding - although today was just formalities to register marriage in Australia, there was a video of the ceremony in Korea, everything from the procession, taking of vows, photo shoots, traditional Korean music, and all sorts of traditional Korean ceremonial manoeuvres that I didn't fully understand with lots of bowing, pouring and sipping of drinks. Pearl's wedding dress was like out of a fairytale, and she was made up to near perfection with her hair done up in a traditional wreath like a halo above her angelic face. It was interesting, the move from the more Western formal Church ceremony to the traditional Korean ceremony. The bride had to exchange her dress for a coloured silk gown, as did all the other women in the family. Another cross-cultural touch was the playing of Pachelbel's canon on Korean stringed instruments.

Best wishes to you both, Pearl and Martin! May God bless you with many happy years together, overflowing with love, and honouring Him who created you!

Time now to sleep. Oh, lonely sleep, without Sal around. Am missing her so much. It's really so true, the saying that home is where the heart is. I feel like a stranger in this house sometimes. Anyhow, next time I update, I'll probably be in the land of oranges and wine, Mildura. Till next time, God bless!

Oh, back now...

2006-01-05T20:52:00.000+11:00

Have arrived once again in Melbourne, came back a couple of days ago. I'm a picture of tiredness and lack of motivation - jet lag? or more like the kind of blues that sets in when you miss someone so much? I don't think it's yet fully hit me, the truth that I'm no longer overseas and on holiday, spending every moment with Sal. I mean, it's obvious to me, but I'm still like a stunned mullet, simply swimming along in the stream of time, but doing little more than existing. Activities of life are more like chores now without Sal around to share them with. Other things - like sorting out my medical registration, setting up my bank account, talking to the people at Queen's to arrange accommodation for the year - get done out of sheer necessity. But when I'm doing things like that, I'm able to put on a successful façade of cheeriness, putting my true feelings behind me to simply observe and not interfere.

Sal, it's such an emptiness without you. Time passes so slowly now, while the past month seemed to go like a flash. Around you, everything seemed so much more vibrant and exciting, the mundane became thrilling, and it was awesome simply to discover all sorts of things during our adventures together. I guess I recognise that this had to come eventually, where I'd have to come back here and work, and leave you to study there. Maybe I wasn't prepared for the emotional difficulty, but I'm sure things will get better as time goes on, and the time draws closer to your return.

There's no shortage of stuff to deal with here at home though. While we were away, a pile of letters accumulated on my desk for me to deal with, most things dealing with starting work next week, one 21st invite for this Saturday (the RSVP was two weeks ago), and a few other bits and pieces. So I still have been running around doing things during the day, and today I officially became registered as a doctor. Just in time for work. Am slowly making my way through the papers, phonecalls, etc. to set everything in place. So much effort required just in this transition period, and I'm glad to have accommodation pretty much already sorted out so I don't become snowed under by all that as well. Coming back to Melbourne has also meant a return to the land of hay fever. I didn't count, but as I tried to return to sleep this morning (having woken up a bit too early) I sneezed about thirty times straight! I hope to adjust to this soon.

Shall sign out now. Thank God for His comfort, and the sense of perspective that we gain by looking to the cross and putting Him at the centre of our lives.

Busy, busy...

2005-12-17T16:03:00.000+11:00

Long time, no post! It's been such a busy time, travelling, seeing sights, packing, sleeping, eating. Just no time for blogging! But this is taking a crazy moment out from the busy-ness, at 12am, first day in Montreal, to write a little word about what we've been doing.

Our itinerary so far, just to sum up - New York for a week, Toronto for 4 days, Montreal.

The mix of places has been quite interesting, and varied. New York is the busy engine town, everyone set about their business, very efficient, but at the same time, very impersonal in its nature. If I had to sum up New York in one word, it'd be HUGE! The largest city so far, it stretches enormously north, south, east, west, and up. Put the tallest building in Melbourne among the buildings of New York, and it'd be inconspicuous. That said, there's so much to see, it's impossible to expect to do New York to any degree of detail in a week. Most of our time was spent at the major attractions, such as the Statue of Liberty, World Trade Centre (its remains, rather, ground zero), Empire State Building, Central Park, Metropolitan Museum of Art, and the American Museum of Natural History. If the USA ever had a reputation of wanting everything big, well, they deserve it.

Toronto is far more Melbourne-like, at least where it comes to scale, and also the friendliness of the people. Everyone is so approachable, willing to help, and the atmosphere far more relaxed. There's just so much less to be concerned about, and you feel really quite safe. Niagara Falls is just a short drive away (though the time might vary depending on weather conditions). When we got there, the weather wasn't too bad, just very misty and cold. But after lunch, a step outside left us all soaked because of the hostile rain! We decided to see the falls from behind them, from within a network of tunnels. It's quite scary, the thundering sound is overwhelming. We're left with a sense of wonderment and awe, although this might've been dampened by the sheer hostility of the cold and mist, which left the trees of the nearby forest snap frozen (and that might've been us too, if we'd stayed outside much longer). Went also to Inniskillin Winery - ice wine is something to taste, if you've never done so before! Just be prepared for the assault of sugar upon sugar, but the fruits are so nicely mixed, and a tiny amount satisfies the tongue after dessert.

Which leads me briefly to Montreal, which strikes me as a confusing mishmash of French and English. I don't know whether to make myself at home with English (perhaps with a slightly americanised accent), or to try my (very appalling) French. Alternatively, I'll let Sal do the talking, she seems to cope pretty well in French anyhow, although her French was described by the cab driver as more French than the locals. Alas, after the hot steamy bedroom (due to uncontrollable heating vents) in Toronto, it's a welcome change to have a comfy, albeit very cosy, room here. Will try out the bed tonight!

Have to comment on the weather. Ice, ice, ice. It's been following us around. First day in New York was the first day of snow they had there. Then we had the worst snowstorm Toronto has had so far this season. Niagara Falls had the most frigid, icy weather that our tour guide has yet seen in his career. If the trend continues, then predict ice for Melbourne in January when I land back!

Anyhow, lastly, but not least, have to say a big thanx to Sal's relatives in New York, and Stef in Toronto, for showing us around their respective cities. And of course, to God, through whom all things are possible. And He gives us blessings beyond belief. I pray that all of you are also enjoying a great festive season, and best wishes for our Lord's birthday, and for the New Year, if I don't write by then!

Cheers & God bless!

End of six years...

2005-11-20T22:15:00.000+11:00

The conclusion of my six years of medical training has arrived at last! In a couple of weeks, I'm going to be officially a doctor, scary as that may seem! Dr me, hmmm, at least we've been fairly well trained to deal with the situations we'll get into next year, however daunting they may seem. But it's still with some sense of anticipation and trepidation that I'll be stepping into the hospital environment next year alongside many others, with a newfound sense of responsibility, the guise of studenthood shed, and the mantle of great expectations placed firmly on our shoulders.

Anyhow, a couple more weeks till summer! And yet so busy, organising loads of things. Including something that'll take me away from the warmth of summer and plunge me into the icy depths of the coldest winter I'll have experienced. Yes, Canada beckons, complete with ice capped mountains and snow showers, and a white Christmas!

Don't really have any creative motivation right now. And have a couple of interviews tomorrow, and need to do research. Hopefully will write a longer, more interesting update sometime later ;p God bless!

One week to go...

2005-11-06T21:04:00.000+11:00

Last week of undergraduate medicine ahead now! So I'll embark on another week of general practice in Mornington, a term that's truly served to rekindle my optimism about medicine as a career, and reopening general practice as a long term option. I really have nothing to complain about in my life, in fact am feeling so blessed by God about almost everything - so those of you who only really enjoy reading blogs filled with anguish, complaint and confusion, there's not much in this one for you!

Oh, I do have one gripe, hay-fever. It's getting me. My nose is like a river, dammed back only by antihistamines, and an endless chain of tissues. Sniff, sniff.

In a week and a half, I'll have pretty much finished med! It still hasn't fully struck me that I'll be doing this for the rest of my life. My head's undergoing a constant reshuffling, helping me adapt to this mindset, and I'll yet have to keep getting used to the responsibility of a doctor, looking after the lives of patients. And the whole idea that I'll be out of home, earning money - it's something I don't yet know how to imagine well, but I know and pray that God will look after me in this transition.

Other events-wise, will be going to Canada with Sal next month! Really looking forward to it, the cold winter, the long plane flights - but jus the freedom of a time to relax, feeling like there's no great hurriedness to deal with "right now!", and new and interesting places to explore. Toronto, Ottawa, Montréal, Québec City, and hopefully get to see some of the national parks - can't wait! God's creation looks wonderful in photos, but doubly amazing when experienced fully. It'll also be a really good opportunity for Sal & I to focus wholly on one another, and on the amazing graces given us by God.

Anywayz, enough abt me - rejoice in the Lord, who rains down blessings from heaven! He who created us knows us so well, He sets everything in place, down to the smallest detail. Because of this, we should have all trust in the love of our God, knowing that He is in control, and that He never forgets a single one of us. And all thanks to Jesus Christ, through whom we are able to understand and relate to our God as He wills, because of His perfect sacrifice!

Psalm 8

O LORD, our Lord,
how majestic is your name in all the earth!
You have set your glory
above the heavens.

From the lips of children and infants
you have ordained praise
because of your enemies,
to silence the foe and the avenger.

When I consider your heavens,
the work of your fingers,
the moon and the stars,
which you have set in place,

what is man that you are mindful of him,
the son of man that you care for him?

You made him a little lower than the heavenly beings
and crowned him with glory and honor.

You made him ruler over the works of your hands;
you put everything under his feet:

all flocks and herds,
and the beasts of the field,

the birds of the air,
and the fish of the sea,
all that swim the paths of the seas.

O LORD, our Lord,
how majestic is your name in all the earth!

An (almost) country practice...

2005-10-15T22:11:00.000+10:00

As many of you know, I've just started my general practice rotation, which will be my final rotation as a medical student - if God wills, I'll be having exams after that and graduating at the end of this year! This is just a few short paragraphs I wrote about my first week at the practice, which I hope you find interesting!

I'm doing my rotation down in Mornington, about 50km from the city, a really beautiful area by the beach! The bright sunshine and the lazy pace of this beachside community are both reflected in the sunny, relaxed disposition of the staff at the clinic. Such a refreshing change from the early starts and rush of the city hospitals!

At this clinic, a stone's throw from the neighbouring Bays Hospital, there are six senior GPs and two registrars, four nurses, many friendly faces at the front desk, and many others behind the scenes. They service predominantly an elderly population, mostly of upper class, who come in with all sorts of complaints from the common ear niggle to frustratingly difficult-to-treat generalised pains. I recall a patient, thirty-something male, all neatly outfitted in a business suit, looking like he dropped in on his way to work. He complained of an occasional twinge in the ear. Cursory examination found no source of inflammation or focal lesion, and it was hardly distressing for him. The GP prescribed some drops for the ear, but other than that, the consultation was over within two minutes or so. The patient continued on his way to work. In stark contrast, another patient was a most interesting fifty-something man who looked more like eighty. He had so many medications, and a list of past history that filled the page, the sort of patient you would expect would require, at minimum, low level care. With profound weakness in all four limbs due to severe injury and deformity of his cervical spine, secondary to lesions of neurofibromatosis and steroid-induced osteoporosis (he also had a history of Crohn's disease), it was a wonder he could maintain any degree of independent mobility. But with his scooter and stick, he made his way around Mornington, and gets by with assistance from his daughter at home. The variety certainly keeps one guessing and interested in the job, from both the medical and psychosocial perspectives.

The nurses run the theatre, a small, three-bed room, reminiscent of a rural emergency department. Here, they and the doctors do (and provide me with opportunities to see and do) minor procedures, dressings, triage assessments, administration of injections (e.g. intramuscular, intra-articular) including immunisations, nebulisers and so on. Sometimes, I am allocated the third bed (which is in the room next door) to see patients by myself, which is a helpful exercise. This is also the place to catch up with the up-to-the-minute news of what transpires in the lives of each of the practitioners and their families! One of the doctors' rabbits had a baptism of fire - brought home from the shop, that night it escaped its pen and was mauled by the dogs. Poor rabbit, still battling to survive several days on. Not even the new medical student is exempt from ending up in the gossip channels. Most of them knew my name before I saw them, and rapidly found out about me having been to the same school as many of their children, my upcoming concerts, about my relationship, and about my planned trip to Canada! I think I should be careful what I let out of the bag.

The practice does mostly private billing, but bulk bills certain patients. It is good to see the doctors doing what they can to ensure that patients pay no more than they should, especially with regard to drugs and so on. I've learnt a lot simply through observing their discussions with patients about drug choice. It's easy to forget the financial burden of pharmaceuticals in the clinical setting sometimes.

Women's health day (Tuesday) was difficult for me, as a male medical student, with most of the women opting that I be excluded from their consultation. It's fair enough, of course. I don't plan on being an obstetrician or gynaecologist anyhow, but one of the female doctors with a special interest in women's health was kind enough to give myself and the registrars a tutorial ensuring that our pap smear technique is still competent.

One of the more surprising, but heartwarming, aspects of the practice was home visits (in addition to district nursing). My GP supervisor takes two or three half-days each week to drive around (in his huge four-wheel-drive, but it's necessary for getting around some bits of the region) and call on patients in their houses. He has some regulars, and some who need more intense follow-up at home after a visit to the hospital, or after a disease flare. Patients with mobility problems are given priority. Most home visits are unremarkable medically, mostly a brief "how are things going?", systems review, and filling prescriptions. But when I see these people in their natural habitat, I am provided with a wealth of information beyond what I would get in a consulting room. The fact that their house looks tidy, and doesn't smell, means they are really keeping quite well. And I get to see the luxury of many of the Mornington residents!

Enough babble from me. I never really gave GP much of a thought before. But this rotation, it's really growing on me. It has, in many ways, restored in me a faith in medicine (and the medical system) by showing me a more human side of the profession. I am refreshed to see doctors really connecting with and caring for their patients, and enjoying it too. I am thoroughly looking forward to the remainder of these five weeks!

Imitation of Christ

2005-10-08T22:42:00.000+10:00

I discovered this unassuming little book in my local library about a week ago, marked with the appealing and familiar title "The Imitation of Christ", by the saint Thomas à Kempis (1380-1471). So I began reading. What a consuming work! What devotion a man can have to God! Its truth written so simply, yet so passionately, it draws one into intimate understanding of the relationship the author has with Christ, and his amazing joy and longing for the Kingdom of God.

There is one bit I'd like to share, on the nature of God's transforming love.

From "The Imitation of Christ" - Book 3 On Inward Consolation, Chapter 5 On the Wonderful Effect of Divine Love

Love is a mighty power, a great and complete good; Love alone lightens every burden, and makes the rough places smooth. It bears every hardship as though it were nothing, and renders all bitterness sweet and acceptable. The love of Jesus is noble, and inspires us to great deeds; it moves us always to desire perfection. Love aspires to high things, and is held back by nothing base. Love longs to be free, a stranger to every worldly desire, lest its inner vision become dimmed, and lest worldly self-interest hinder it or ill-fortune cast it down. Nothing is sweeter than love, nothing stronger, nothing higher, nothing wider, nothing more pleasant, nothing fuller or better in heaven or earth; for love is born of God (1 John 4:7), and can rest only in God, above all created things.

Love flies, runs, and leaps for joy; it is free and unrestrained. Love gives all for all, resting in One who is highest above all things, from whom every good flows and proceeds. Love does not regard the gifts, but turns to the Giver of all good gifts. Love knows no limits, but ardently transcends all bounds. Love feels no burden, takes no account of toil, attempts things beyond its strength; love sees nothing as impossible, for it feels able to achieve all things. Love therefore does great things; it is strange and effective; while he who lacks love faints and fails.

Love is watchful, and while resting, never sleeps; weary, it is never exhausted; imprisoned, it is never in bonds; alarmed, it is never afraid; like a living flame and a burning torch, it surges upward and surely surmounts every obstacle. Whoever loves God knows well the sound of His voice. A loud cry in the ears of God is that burning love of the soul which exclaims, "My God and my love, You are all mine, and I am yours."

Thanks and praise to our God, who is love! I found a site at which can be found the whole book, for anyone who wants to read bits online.

God bless!

Sickness...

2005-10-03T21:06:00.000+10:00

I've caught the bug that's going around, so it seems. Fevers, sweats, cough and yucky mouth, muscle aches and pains, lethargy and weakness. It really only set in today, but I'm feeling a fair bit better through taking some rest and paracetamol. At the moment I'm taking a break from sleeping. ;p

Yay, Sally's back in Melbourne, since about a week and a half ago! It's been a while since last blog. I wonder why my motivation for blogging has dried up over time? I don't seem to be blogging anywhere near as frequently as I used to. But then again, I didn't always use to have such early starts, and I didn't use to have my timesink online game (utopia), so I probably used to have much more time to write!

Anyhow, utopia-wise, the current age is ending, so not spending as much time on it as I did a few weeks ago. We've just come out of hostile relations with another kingdom, and our province was absolutely shafted! We were being singled out as a target, and I made some silly errors of judgment that didn't help. I suppose, given the new ceasefire, we can now concentrate our efforts on destroying the dragon that ravages our kingdom. But for how long? I suppose it'll be over soon. And then we can begin a fresh start. Hopefully next age, we'll be controlling separate provinces within the same kingdom, which will be good for cooperation!

Real-life-wise, am doing my final week of surgical block! I'm with the trauma team, which means I see patients all the time who are not that different to myself (young, fit, healthy, no medical issues), and they come in with some horrific injuries from car and motorcycle accidents. It's a stark reminder just how vulnerable we are, and that anything can happen at any time! People mostly think of broken bones with trauma, but blunt injury to the abdomen caused by deceleration against an improperly worn seatbelt was what led to probably the most striking images I saw in operating theatre. The patient had been complaining of increasing abdominal pain, about a day after the accident. The day before, he'd had an arm fracture reduced and fixed, but the doctors became concerned about peritonitis with the abdominal x-ray showing subdiaphragmatic free gas. So he was taken to theatre for an exploratory laparotomy, and as soon as they opened the belly, there was the most dramatic rush of fluid and bubbles spilling out of the incision, and the nasogastric tube drew back a flood of foul black fluid, decompressing the stomach. Food seems to be a favourite for medical analogies - it was like a boiling pot under high pressure, and suddenly removing the lid, sending bubbles and liquid all over the kitchen floor. Today though, I arranged this guy's discharge from hospital, and he's probably now at home back to most of his daily routine, apart from just a bit of abdominal and arm soreness!

Anyhow, I'll probably be off now. Should get back to sleeping - I hope to be back to full functioning myself quickly. ;p Well, I'll sleep soonish. And sleep in tomorrow. Hopefully, armed with paracetamol, will be back to normal within a few days! Will leave with this passage from Philippians 4, on which we had a sermon on Sunday. When we feel snowed under with many tasks and worries, whether they be within or out of our control, and our troubles seem insurmountable, remember to cast all your anxieties upon Jesus Christ our Saviour, in whom we trust. God bless!

"Rejoice in the Lord always. I will say it again: Rejoice! Let your gentleness be evident to all. The Lord is near. Do not be anxious about anything, but in everything, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus.

"Finally, brothers, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable—if anything is excellent or praiseworthy—think about such things. Whatever you have learned or received or heard from me, or seen in me—put it into practice. And the God of peace will be with you.

"I rejoice greatly in the Lord that at last you have renewed your concern for me. Indeed, you have been concerned, but you had no opportunity to show it. I am not saying this because I am in need, for I have learned to be content whatever the circumstances. I know what it is to be in need, and I know what it is to have plenty. I have learned the secret of being content in any and every situation, whether well fed or hungry, whether living in plenty or in want. I can do everything through him who gives me strength." - Philippians 4:4-13

Missing ya

2005-09-20T23:58:00.000+10:00

Sally is in Sydney. I already miss her heaps. Even though I know so much of it is irrational, it was almost traumatic to say goodbye - all the while knowing that I'll probably see her on Saturday! Who says guys aren't emotional?

Now I begin to see and understand why some couples I know (though most of them are married), find it such a difficult consideration to be apart even for just a few days. I used to find this astonishing, thinking, "oh what, it's just a few days, so what's the difficulty?" - until I face the situation myself. It's like a part of me is missing, because it left when the other person went away. And my emotions irrationally behave as if no return is in sight. And it just doesn't seem to occur to me that it won't actually be so long before next time I see her!

Time passes, or doesn't pass (as it seems), it's now Tuesday - it feels as if Monday, when Sal left, was ages ago. Like a few long days, not just one. Time is a funny thing - it seems to take itself when we are saddened, and it loosens itself and runs away when we have fun.

Miss ya heaps, Sal!

(Unimaginative) update...

2005-09-15T21:43:00.000+10:00

It's been a while since my last blog - time for some sort of update! Lately, have been semi-busy with my surgery rotation at RMH, but in this time I've been concentrating on the day-to-day looking after patients on the ward, still haven't visited operating theatre this rotation! Must visit sometime soon, so I know where all my patients are disappearing to and returning from, nasty scars and all. Am attached to the trauma team at the moment, but far from being the rushed, hectic, heroic scenarios second after second, it's been quite laid back. That's not to say they don't do heroic things. It was quite exciting and frightening at the same time being with the team this morning, trying to salvage (against huge odds) the life of a man whose head had been run over by a forklift - mashed, essentially. He's surviving for the moment, which is good. But it'll be a touch-and-go matter, whether he can recover from the injury, and how the brain will come out of it all. Unfortunately, the eyes are all but gone. To imagine that all these patients are in hospital because of things that could happen to anyone at any time - motor vehicle crashes, falls etc. It's such a strong reminder that we ought to be thankful for each moment of life we have!

What else has been going on? Did UMO for first time ever yesterday! UMO = university maths olympics. It's more-or-less a running relay race (up and down stairs) and whirlwind maths competition combined. I was a last-second (almost literally) addition to the team (the other members being Sally, Nick, Andrew and Zhihong)! I think I was far more valuable for my running skill than any mathematical ability I have, which pales in comparison with the others in the team. For most of the race, amidst all the chaos, we were winning. That is, until one question, where amidst all the chaos, brains shut down and refused to work. Having solved all the questions up til that one, we doggedly (and perhaps foolishly) persevered, still arriving at no result after a few minutes. After Nick ran down several answers, we finally decided to pass, and in frustration, realised that we'd just relinquished our lead to teams that weren't so foolish. In the end, if we had passed that question, we could have added the next question (which proved to be far friendlier) to our points - and given us a better chance. Nevertheless, a team full of amazing talent (myself being the exception) ended up third - a good result. Although disappointing after being in the lead for almost the whole thing (we would have won had the competition finished only a few minutes earlier), and doubly infuriating losing to a team that proclaimed its team description "we're here to beat Sally".

Enough ramble from thilly me for now, looking forward to med ball tomorrow night! Perhaps there will be some photos in my next blog! It promises to be a great night!

God bless!

~Dave ;p

Inspiration...

2005-09-03T22:22:00.000+10:00

I'm going to try normal-style writing for blog now, seeing that I reckon all the triple dots and lack of proper punctuation makes it all hard to read. It's somewhat unnatural for me, since I'm so used to typing the other way. So I hope this is a bit better!

Sal & I went to an MSO concert last night, featuring Stephen Kovacevich as the soloist playing Beethoven's brilliant Emperor Concerto, and it proved to be an awesome performance! The first movement is a grand combination of virtuosic, rippling cadenzas and robust, stately melody. The beautiful, relaxing melodic line and improvisational style of the second movement is reminiscent of a calm ocean reverie. Finally, the third movement resounds with the abundant energy of its familiar regal tune.

What is it about music that's so enjoyable? Is it in its power to transport one to a different world? Like vistas of grand, oriental palaces and spectacular celebration in the case of the Emperor? Or its ability to make one feel as if every fibre of the body just wants to dance and twinkle like a sprite? Or, might I suggest, that it could have something to do with the sparking of memories and emotion tied up with especially familiar throes of melody? Whatever it is, it's truly one of life's greatest mysteries!

I hope that music is always part of my life. I've lived with music since I was so little! Thank God for the inspiration and happiness He provides through music!

Meanwhile - I'm sure everyone will know about the current ongoing disaster situation in New Orleans, stricken by Hurricane Katrina. Such a stark contrast to the comfort and happiness of my own life, it pains me to learn of the suffering of many across the globe. Not only has a natural disaster struck, but the authorities seem slow to act in the remediation of the situation. All the while, human sin rears its ugly head in the midst of desparation with an epidemic of looting, rape, and all kinds of lawlessness. Disease strikes and claims many lives while afflicting multitudes more. The entire city has been made destitude and with so many people dispossessed and stripped of all they had except what God gave them the day they were born, we are reminded of our vulnerability and the fact that our life is a precious, fragile gift.

But it's at these times that we have to keep hanging on, even though it is so hard. God sustains us, in all ways. Even when afflicted by an overwhelming flood of enemies, when we are stripped bare, we should try to remember that we have a God who knows and understands suffering, because He has endured it already. And we stand before God, knowing that it's just us and Him, and nothing else. Habakkuk realised this, when he questioned God about the disaster facing Israel. God's plans are not always fathomable, sometimes they baffle us no end. But yet, he could rejoice because he knew God. Likewise, by faith, remain strong in God, because He alone is our hope and redemption, and rejoice in the face of trials. And so this Psalm goes out to encourage and remind everyone of this reality.

Psalm 42

1 As the deer pants for streams of water,
so my soul pants for you, O God.
2 My soul thirsts for God, for the living God.
When can I go and meet with God?

3 My tears have been my food
day and night,
while men say to me all day long,
"Where is your God?"

4 These things I remember
as I pour out my soul:
how I used to go with the multitude,
leading the procession to the house of God,
with shouts of joy and thanksgiving
among the festive throng.

5 Why are you downcast, O my soul?
Why so disturbed within me?
Put your hope in God,
for I will yet praise him,
my Savior and 6 my God.
My soul is downcast within me;
therefore I will remember you
from the land of the Jordan,
the heights of Hermon—from Mount Mizar.

7 Deep calls to deep
in the roar of your waterfalls;
all your waves and breakers
have swept over me.

8 By day the LORD directs his love,
at night his song is with me—
a prayer to the God of my life.

9 I say to God my Rock,
"Why have you forgotten me?
Why must I go about mourning,
oppressed by the enemy?"

10 My bones suffer mortal agony
as my foes taunt me,
saying to me all day long,
"Where is your God?"

11 Why are you downcast, O my soul?
Why so disturbed within me?
Put your hope in God,
for I will yet praise him,
my Savior and my God.

Springtime!!!

2005-08-29T20:55:00.000+10:00

wow, last couple of days have been amazing ;p i don't really know what to say, but yeh, i feel so fully invigorated and renewed in my being after a really horrible couple of days... feel like rejoicing!!!

such a complete turnaround from jus couple of days ago... when sal & i were finding communication a struggle... even tho there seemed so little real reason for unhappiness, and i had every reason to rejoice, my world felt so empty... so empty that i felt like a dumb animal trapped inside a cave filling with mud, and nobody could hear and understand my anguish... my eyes gazed upon a world that i could not understand, nor could i make myself understood... not even my closest companion felt within reach... i felt like echoing the words of David in psalm 22:

"My God, my God, why have you forsaken me?
Why are you so far from saving me,
so far from the words of my groaning?
O my God, I cry out by day, but you do not answer,
by night, and am not silent."
- Psalm 22:1-2

but praise to Him who performs miracles!!!

human relationships are always so full of wonder and mystery!!! at once so fulfilling that one captures a ray of brilliant light from heaven... but at other times, one is driven to the depths of despair, one starts to enter into their own shakespearean tragedy...

anywayz - it's only 2 more days til spring!!! ;p and the weather has been very springy... hmmm... minus the hayfever ;p i hope it can stay this way for a lil while, sunshine illuminating the natural spendour of green grasslands and trees starting to bear all manner of colours... before i'm too busy sneezing to appreciate the scenery ;p - best remedy: mometasone furoate nasal spray (i'll refrain from using trade names here)... discovered that one on my elective term...

so i hope the change of weather heralds a good season of happiness and growth for all of us ;p - and may we always remember God's miraculous power of restoration!!!

On popular demand...

2005-08-21T21:42:00.000+10:00

hey ;p am writing coz have been bugged by ppl to update blog!!! yes, it's been a while!!! but yah, it's also been a while since i've practised music, felt on top of all my study, or done any exercise!!! so yah... hmmm, i'm not so sure blogging ought to be this high up on my priority list... but anyhow, as i'm here already...

am in a strangely enough happy state atm, considering tomorrow is monday... with another busy week ahead, i wonder whether i should be this happy... ;p but i'm not going to complain... i have far too much to be thankful for... as chapter one of ephesians (which sal & i are studying lately) doesn't tire of reminding us, we have a life of spiritual blessing granted us by God's grace for the praise of His glory, so this is the real reason why we should be rejoicing!!!

despite this, i've been spending far too much time on utopia - such a horrible timesink!!! it's exciting to see our province grow quickly!!! our military attack random enemies, and then hoping and doing all we can to stop enemies getting back at us... keep fingers tight ;p haha... scheming, plotting... warring... hmmm... why is it so addictive, i wonder?!? is it the thrill of entering the imaginary world of fantasy characters, even more so that we have control over some of them?!? is it the inner competitive spirit being fanned into flame?!? or just an escape from reality?!?

hmmm... anywayz, for those who don't know much abt utopia, it's an online game where u control a province, u're part of a kingdom, and in the world there are many, many kingdoms that partake in wars and tussle and compete through exploration and conquest to become the biggest, best, most honourable in the known utopian world... it's actually immensely complex and one can get lost in and among the intricacies, with thieves, mages, military, infrastructure and politics among the many domains of operation you have under your control... ;p hmmm... argh, we just had lots of spells cast on us!!! hmmmz... ;p war as we speak!!!

;p errrm, enough of utopia for a while... hmmm... shall go now... anywayz, the world we should fix our minds on is this one depicted in revelation 22, the true utopia (from today's odb):

"Then the angel showed me the river of the water of life, as clear as crystal, flowing from the throne of God and of the Lamb down the middle of the great street of the city. On each side of the river stood the tree of life, bearing twelve crops of fruit, yielding its fruit every month. And the leaves of the tree are for the healing of the nations. No longer will there be any curse. The throne of God and of the Lamb will be in the city, and his servants will serve him. They will see his face, and his name will be on their foreheads. There will be no more night. They will not need the light of a lamp or the light of the sun, for the Lord God will give them light. And they will reign for ever and ever." - Revelation 22:1-5

what an amazing thing we have to look forward to!!! Heaven ;p the place where God calls us to... no longer any curse, no more night, just our God who will have the created community He called from the beginning to serve Him!!! one day ;p it seems so different, so remote... yet we are called to fix our eyes on that future prepared in Jesus... and do what we can to bring God's purposes to earth... perspective, that's what we need more of...

God bless!!!
crazy dave

Busy bug...

2005-08-08T21:35:00.000+10:00

it seems like i'm just playing catchup again... 8am starts, need sleep, not much time to study, so much stuff i still want to do (music, dancing - yes, dancing ;p - more reading, swimming, running, utopia - yes, that timesink!!! - etc) - and it's all a bit hard with jus 24 hrs in a day!!! so hmmm, this is the life i choose to look forward to?!? - really tho, i like it... somehow still i can manage to do most things with my time, still spend time alone with God, and at the end of it all, i still have lots of stuff to catch up on (and hence look forward to!!!)

i don't think i usually enjoy being busy... now, i'm strangely quite happy and satisfied with being busy like this... but i don't think it's best for me to classify my state of mind as being satisfied with being busy, rather jus coz i'm satisfied and happy with the things that matter, that being busy jus no longer bothers me...

sorry, i should keep this blog short - need to sleep soon!!! ;p

shall leave with this passage... it's abt martha and mary, actually it warns us against being too busy!!! - it's a necessary and timely reminder for someone busy like me that what really matters is not the stuff we do here on earth, but rather how we carry our hearts in front of the Lord... so, despite being busy, i pray that i always can make time to spend alone with God and in fellowship with others celebrating God!!!

At the Home of Martha and Mary
As Jesus and his disciples were on their way, he came to a village where a woman named Martha opened her home to him. She had a sister called Mary, who sat at the Lord's feet listening to what he said. But Martha was distracted by all the preparations that had to be made. She came to him and asked, "Lord, don't you care that my sister has left me to do the work by myself? Tell her to help me!"
"Martha, Martha," the Lord answered, "you are worried and upset about many things, but only one thing is needed. Mary has chosen what is better, and it will not be taken away from her." - Luke 10:38-42

Driving force...

2005-07-27T12:44:00.000+10:00

last sunday, our Church embarked on a journey called the purpose driven life, a program by which we are made aware of our God-given purpose in life over forty days, based on a book called "the purpose driven life" by rick warren... just started reading through the book, it's really quite thought-provoking, think i can gain a lot from it!!!

the day 3 chapter talks about what drives us, which i read yesterday, and this made me think... some people are driven by guilt, their actions are set about avoiding confronting that guilt; others driven by anger and resentment, actions set about seeking retribution or avoiding arousal of anger; others driven by fear, perhaps of taking risks and consequences, perhaps of stepping out of their comfort zone, perhaps of losing control; yet more are driven by materialism; still others driven by need for approval... there are people who describe the whole human endeavour we call "life" as being driven by the denial of death, i.e. survival, on either or both a species and individual level...

but as Christians, our driving force is none of these things... or ought to be... our driving force ought to be God, love for Him because of who He is and what He has done for us through Christ, and love for others both for who they are as God's creation and out of reverence for Christ... God and love... well, God is love, so really, ultimately, we can say that our driving force ought to be God... and what more amazing driving force can there be than God?!? we ought to be driven people, never lacking energy, because of this...

but yeh, i guess that's where i know i fall apart sometimes... i'm not always like that... i often lack energy, i sometimes find myself unable to give thanks to God in everything, when confronted by trials i fail to trust and love as i should... where does this leave me?!? it probably means that i'm not always driven by God as i should be, and find myself instead struggling with the other issues - guilt, anger, fear, need for approval and the like... why is this?!? living in a sin-contaminated world, i guess i slip back sometimes into difficulty struggling with these things, slip back to a short-sighted and short-term view of the world, and slip back into struggling with temptation to sin...

how then to deal with it?!?

it pulls me back to a passage from the sermon on the mount (yay for summit!!!) - which i've now decided to make my one thing to work on... it's about mindset, and comes from a passage that's already appeared a few times in my blog i think!!!

Do Not Worry
"Therefore I tell you, do not worry about your life, what you will eat or drink; or about your body, what you will wear. Is not life more important than food, and the body more important than clothes? Look at the birds of the air; they do not sow or reap or store away in barns, and yet your heavenly Father feeds them. Are you not much more valuable than they? Can any one of you by worrying add a single hour to your life?
"And why do you worry about clothes? See how the lilies of the field grow. They do not labor or spin. Yet I tell you that not even Solomon in all his splendor was dressed like one of these. If that is how God clothes the grass of the field, which is here today and tomorrow is thrown into the fire, will he not much more clothe you—you of little faith? So do not worry, saying, ‘What shall we eat?’ or ‘What shall we drink?’ or ‘What shall we wear?’ For the pagans run after all these things, and your heavenly Father knows that you need them. But seek first his kingdom and his righteousness, and all these things will be given to you as well. Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own." - Matthew 6:25-34

it's easy to say, "do not worry" (or do not be anxious)... but so hard to do... how can we not worry about our life?!? it's not a matter of simply absence of worry, but rather something else to concentrate on... it's also easy to say, but hard to do - the key lies in the verse, "But seek first his kingdom and his righteousness"... just try to think about God's kingdom for a moment... it is hard to think about!!! because it's so amazing, so much so that even a lengthy string of superlatives would be far inadequate to describe it...

"What no eye has seen,
what no ear has heard,
and what no human mind has conceived—
these things God has prepared for those who love him" - 1 Corinthians 2:9

what's more, if you try to contrast this life with the next, our earthly treasures with heavenly treasures, we're trying to grasp the difference between tainted and unblemished, imperfect and perfect, temporary and eternal, finite and infinite... we cannot imagine it with our finite minds... it is only through God's Spirit that we can even begin to imagine things beyond our death, and it is only because of Jesus Christ that we know it is possible (but more than possible, it is certain!!!)... i like this bit from purpose driven life - "To make the most of your life, you must keep the vision of eternity continually in your mind and its value in your heart." God's flame never goes out, but we have to avoid being blinded by sin by continually concentrating on the flame...

so then, guilt and anger no longer hold sway, for sin is dead in Christ and we are forgiven... fear is conquered by love, and God is always with us... material motives become insignificant in light of the eternal, heavenly treasures in our eternal home... the need for approval of others is surpassed infinitely by the justification before God that we have by faith in Jesus... and death is no longer an end, but simply a transition into the life of unimaginable wonder!!!

i pray for God's strength, God's will, God's Spirit, God's love, to always be our driving force, in all circumstances!!!

God's plans...

2005-07-19T12:29:00.000+10:00

i jus got the news yesterday that i missed out on my first preference of royal melbourne hospital, so will be doing my internship at western hospital in footscray next year... i ought to be happy, but part of me, for a day, refused to accept this verdict... part of me, for a day, decided that there had to be something wrong with me in order for me not to have been selected at the place i so genuinely wanted to be next year... part of me, for a day, wanted to hang on to the head-borne idea that so vividly played itself in my mind - me, an intern, working at the same hospital i'd been trained through for the last two years...

so my mind's been zinging, ka-chunking, splicing bits around in order to dismantle the idea, and replace it with a new one, intern at western hospital... i suppose i've today come to accept it a lot better than i had yesterday... for a day, i was in a horrible mood, and must have been terrible company... for a day, i grieved myself, as if my worth were determined by my selection at a particular hospital... for a day, i failed to trust that God has much greater plans than my own...

today's odb has been particularly pointed, and refreshing, in light of this... it talks about God's mysterious plans...

"And we know that in all things God works for the good of those who love him, who have been called according to his purpose." - Romans 8:28

thank God that He is in control, and not us!!! i pray that God will help me not only accept this departure from my set ideas of before, but will help me use this unique and wonderful opportunity to grow to get to know Him better, and to serve in my capacity, as well as possible, the patients i'll be treating next year... i know that the experience will be a good one, and will turn out in a few years' time, wherever i'll be, to have been a greater blessing than i can possibly imagine...

for now, i think, i'll leave with the couplet from today's odb:

"My times are in my Father's hand;
How could I wish or ask for more?
For He who has my pathway planned
Will guide me till my journey's o'er." - Fraser

Summit ;p ...

2005-07-15T22:13:00.000+10:00

it's really hard to describe how i feel right now... kinda mixed emotions, on top of the world, and at the same time, trying to come to grips with the sad realities of the world i've returned to... it's like returning from another land, a land where ppl with a common purpose come together, a land far removed from the harsh reality of sin and greed that so dominates so much of this world... a land where God is exalted and brought into exclusive focus, where He ought to be in our lives... ;p

summit was such an enriching experience - for those who don't know, it's a camp run by melbourne uni's christian union where around 100 ppl gather and learn abt God, through studying His word... each year, there's a theme, and it happens that ethics was the topic of the week with an eminent bioethicist (douglas milne) and one of the pastors from st jude's (mike flynn) being the two principal speakers... bioethics was interesting, with topics such as ivf, embryonic stem cells and transplantation discussed, among other things...

the sermon on the mount was the key text (matthew 5-7), an amazing account of the teaching of Jesus, where He expounds on the law of God and the principles behind it... it talks about what really counts, the attitudes of the heart, the secret part of us that only God can truly see... it talks about the lofty standards of the life that God calls us to... it warns against the lure of worldly rewards, money and so forth, and against wrong conditions of the heart such as pride, hypocrisy and selfishness... and it speaks also of the great promise of God, that for all who follow Him, we are to be part of His family... ;p

i won't go into any real details about that here and now, am so tired from driving and sleeplessness... ;p but hopefully will have some time to concentrate on it over the next few weeks... so watch this space!!!

so where was summit?!? in the sleepy town of marysville, a lazy hour's drive past healesville, and jus half an hour shy of the white haven that is lake mountain... ;p i think it's such a gorgeous place, set so high up in the hills, and the steavenson's falls are a picture of magnificence among the misty green surrounds of the beautiful marysville state forest... ;p photos to come!!! - the falls were so amazing i'd been there four of the seven days we had for summit!!! it's an eerie sight by night, the blue glow of the floodlight looking quite radioactive, and wowing all the crowds that gather... it's quite a romantic hotspot, apparently... one of the christian union staff workers had intended to, and almost did, propose to his then girlfriend at the falls!!! ;p well, yeh, almost... it wasn't to be, not yet... but they are now married, several years down the track, and they have three of the cutest kids i've seen!!!

we'd visited the night falls vista with a fairly large group from the camp... we were blessed with a mostly rainless night, but the cold weather ensured we were shrouded in layer upon layer of wooly material anyway, scarves and beanies, and seeking each other's warmth... sal & i were among the first to end up at the platform that offered the closest vantage point, and we were simply content to hold each other and listen to the sound of water crashing upon the rocks below... there's such a sense of timelessness when surrounded by nature!!! it wasn't long before one of the staff workers and his wife appeared on the opposite side, and though it was dark, it wasn't hard to work out what they were doing, providing some amusement for a time, until their flashlight came and fell upon us, revealing our wool-clad embrace... oh well... i figured most ppl had come to look at the falls anyhow, so we didn't mind ;p

another time we explored the falls, we climbed to the top, trudging through mud-puddles most of the way up the steep incline... climbing was exhausting, but it was interesting to observe the vast landscape from a higher viewpoint, and the mystery of the mountain peaks hidden by an expanse of cloudy mist rolling across the sky... at times it seemed we were only a few metres from the cloud line!!! at the top we were greeted by the rushing waters of the top of the falls, whooshing over the edge to the rocks below... a sign somewhere said it was about 80m tall, but it's not one single waterfall, but rather a series of fall after fall, from the top (where we were this time) to the bottom (where we had been the other night and days)...

such immense beauty surely is the work of God!!! ;p i guess i can imagine that it somewhat resembles what the first man and woman would have experienced in God's garden, nature so minimally impacted by man, life abundant without worry, and a vista that somehow jus brings forth indescribable waves of joy... with sal, the woman i love, by my side... jus the sort of way i'd want to spend eternity...

so sad having to leave... coming down the windy road back to the big smoke again, i felt a tug pulling me back towards the mountain... but i have to say, having been blessed with so many wonderful memories, friends, time relaxing, and above all, time getting to know God, i'm so happy for this escape which has been one of the best weeks of my life!!! ;p

-

ps... read sal's blog!!!

Unending praise...

2005-07-05T22:29:00.000+10:00

;p a wave of relief overcomes me today as i realise the finality of exams after a long, long semester!!! was already 3 weeks ago when sal started holidays, now we only have a few days really for ourselves, then back to busy other commitments... summit starting on saturday (so looking forward to it!!!), and going for a week!!! well, things really aren't so bad then, yah?!?

this morning, as i set off for the exam, walked out of the house to realise the return of clear, blue skies for the first day in many!!! thank God that we'd been spared the rain during the daytime most days, but still the days had been gloomy and overcast... today though, blue was seen in more than jus a small patch of the sky... there was hardly a cloud to be seen!!! revealing in God's creation below the full beauty of nature...

really, creation is a hymn of perpetual motion singing the praise of God... ;p and so too ought our lives be... as humanity strives to discover truth and attain perfection, it's often so easy to acknowledge our setbacks and get caught up in the avoidance of pitfalls that we miss the beauty that clothes our existence... this unending hymn of praise, that even now is but a poor reflection of the perfection that is to come... ;p kinda like this passage in 1 Corinthians 13:8-13

"Love never fails. But where there are prophecies, they will cease; where there are tongues, they will be stilled; where there is knowledge, it will pass away. For we know in part and we prophesy in part, but when perfection comes, the imperfect disappears. When I was a child, I talked like a child, I thought like a child, I reasoned like a child. When I became a man, I put childish ways behind me. Now we see but a poor reflection as in a mirror; then we shall see face to face. Now I know in part; then I shall know fully, even as I am fully known.

And now these three remain: faith, hope and love. But the greatest of these is love."

it's like looking at a rainbow, but focusing on the distance between us and the rainbow... looking so far can make us vulnerable to feeling depressed and low, missing the point that there is a rainbow to be marvelled at... and all we do is try to get closer, all the time despairing that it eludes our clutch by so far... maybe for now, we ought to simply stand and behold the rainbow, its immense beauty...

so what's it all abt?!? i guess i'd been despairing upon setbacks and how things could've been better, all the while missing the simple truth that there is so much there to be happy abt and to look forward to... praise God that He is the rainbow to behold in our lives ;p

Meme time...

2005-06-29T01:16:00.000+10:00

no, this really ought to be exam-study-sleep time... but yeh, got this off jim's blog, via sal's blog... ;p how i let myself waste time like this is almost beyond me...

God bless,
dave

---------------------
FIRSTS
First break-up: december 99 (how freaky, same for me, jim... tho my answer should more accurately, but less precisely, be 2nd half of 1999...)
First screenname: alleycat (wow, brings back memories)
First self purchased album: jebs - of someday shambles
First funeral: my trumpet teacher... i hardly learnt trumpet, but my brother did for quite some time...
First piercing/tattoo: never
First true love: believe in this one... ;p

LASTS
Last car ride: back home with shaz jus a couple of hours ago
Last french kiss: um, not fully sure... few days...
Last good cry: a few weeks ago probably... in the depths of despair...
Last library book: a book on guillain barré syndrome... the things we do!!!
Last movie seen (in theater): hhgtg
Last beverage drank: h20
Last food consumed: rice with fish, chicken schnitzel and assorted vegies... ;p
Last phone call: sally
Last Time Showered: this morning
Last shoes worn: strangely my red flame reebok dmx's, which i don't wear very often now...
Last item bought: lunch at uni (mee goreng)
Last annoyance: at myself over being annoyed abt something else that wasn't worth being annoyed abt...
Last time wanting to die: a couple of yrs now i think...
Last time scolded: a few days... hmmm... ;p

RELATIONSHIPS
Who are your best friends?: gal, shaz, mary, and sal (my favourite person ever)
Do you have a girlfriend?: yeh
Do you do drugs?: no (did u know that "no" is some form of japanese theatre?!?)
What kind of shampoo do you use?: palmolive naturals for dry hair (atm)
What are you most scared of?: losing my mental faculties?!? jus from a discussion we had in a tute abt growing old... maybe i am afraid of growing old...
What are you listening to right now?: my brother's computer's noise and headphones, the sounds of warhammer... my computer is very well-behaved and silent!!!
Where do you want to get married?: a church where all my/her friends and family can be there to celebrate too...
What would you change about yourself?: would like to be more like Christ... turn away from my horrible ways of rebellion and self-centredness...

FAVORITES
Color: green, that speaks of nature's beauty...
Food: chocolate!!! my dopamine receptors cry out for satiety!!!
Boy name: hehe... names i like?!? or names i would call a boy?!? i like names with k in them, like kynan... but i'd probably go with a more traditional one if i had to choose, like thomas, or simon, or james
Girl name: kayla!!! or mikayla ;p - haha...
Subjects in school: physics... music...
Animals: dog ;p love labradors...
Sports: tennis... table tennis... ;p but i usually do lonely sports like running and swimming...
Perfume: calvin klein eternity

HAVE YOU EVER
Given anyone a bath?: nope... i don't think so, anyway...
Bungee jumped?: no...
Skinny dipped?: no...
Ever been in love?: yeh, like now...
Made yourself cry to get out of trouble?: when i was little...
Pictured your crush naked?: ...
Actually seen your crush naked?: no...
Lied?: yes...
Fallen for a close friend?: nearly...
Been rejected?: which 22 year old guy hasn't... (i hope u don't mind me borrowing ur phrase, jim ;p) - once, yes...
Rejected someone: yeh...
Used someone?: no...
Done something you regret?: yeh...

CURRENT
Clothes: jumper, and abt three more layers underneath... still wearing socks and pants from today...
Music: silence... (u know, that piece by john cage?!?)
Annoyance: me, very often me...
Smell: anosmic... no, not true... but nothing stands out...
Favorite band/artist: too many... ;p currently still like coldplay...
Desktop picture: spirited away, pic of chihiro!!!
DVD in player: the passion... and anne-sophie mutter playing beethoven disc 2...

LAST PERSON
You touched: shaz...
Hugged: sal...
You imed: gal, maybe?!? or shaz?!?
Imed you: as above...
Called you: sal...
You called: sal... ;p (kinda predictable, eh?!?)
Bought you flowers: hmmm?!? let me think... if i remember right, i don't know who would've bought them, but whoever for some music gig ages ago...

WHO DO YOU WANNA
Kill: nobody...
Slap: myself... i feel i need a slap ;p, or maybe jus some sleep...
Kiss: ummm, pretty clear already, huh?!?

WHICH IS BETTER
Coke or pepsi: poke...
Flowers or candy: flandy...
Tall or short: tort... doesn't matter, so long as have long hair... ;p

All I need is: God... ;p
Love: God, sal, music...
You dream of: strange things... even i find them strange... ;p that's weird...
Last person you danced with: i don't know... sal, probably... either at dance thingy, or at daniel's place... either way, was a while ago...
Worst question to ask: what if?!? (no, not always true... but yeh, i don't like asking this question of myself...)
Who makes you laugh the most: am in a mood i find hard to imagine what laughter even is... but yeh... some ppl succeed even still ;p
Who has a crush on you: i don't know... i know of several who "had", but believe they'd all be over it now...

DO YOU EVER
Wish you were a member of the opposite sex: used to... once upon a time... ;p there are some funny stories i can tell abt this, tho most ppl aren't ever going to find out...
Wish you were younger: not really... but yeh, i think i like 21, so maybe a few days younger...

NUMBER
Of times I have had my heart broken: ummm, depends on what u mean... once (see above), perhaps, might count... but my heart is well and truly intact ;p
Of hearts I have broken: i hope none... one probably, possibly a couple more, but i hope it can still be zero!!!
Of girls I've kissed: 2
Of continents I have lived in: 1

Exams coming...

2005-06-28T00:14:00.000+10:00

ohhh, starting to become aware of the fact that i have an exam on thursday!!! not really stressed, but yeh, to study i should go... jus finished what promises to be my last undergraduate assignment ever, yay!!!

my mind now is a jumble... rapp, rural, emerg, psych - fairly haphazard spread of what some term "fluffy" topics... doesn't mean i'm really good at them tho... well, i suppose emergency medicine isn't really fluffy, although i have to say the others really are... my mindset is quite hazy though, more suited to the fluffy topics, probably because i'm jus coming out from rapp now... rehab, aged care, psych of old age and palliative care... i jus hope i don't go into the exams faced with the situation of a trauma case in need of resus and start asking the patient abt their childhood and love life...

anywayz, back to some study now, then sleep... and drinking heaps of water... bulking up for blood donation... ;p at least i will have done one thing useful this week!!!

Repentance... More Deliberations...

2005-06-20T22:10:00.000+10:00

repentance is the change of heart that comes with recognising Jesus is Lord... repentance is turning from our sins, but further than that, turning to God... - and only by turning to God, looking to the cross, can we truly repent...

can i lead a righteous life?!? after all, Jesus did say that unless our righteousness surpasses that of the pharisees, we cannot enter the kingdom of God... - but no, inevitably there is a sinful nature within our flesh that will cause us to fall on occasion... - are we then banished?!? no, because by asking forgiveness and believing on Jesus, God sees Jesus' righteousness, and not our own... and certainly, Jesus' righteousness surpasses greatly that of the pharisees!!! so praise to God!!!

i think repentance is important, and often underemphasised... i mean, salvation is not something we can do by changing our ways by our own power... salvation is something we come by only by trusting wholly in Jesus... - and we will be judged at the final day, not by what we do, but by what Jesus did for us...

;p repentance is therefore important, not because it is what saves us, but because it *always* accompanies true faith... i mean, how else can we respond to one so wonderful as our God, except to obey Him?!? to seek forgiveness from past sins?!? to turn to Him and away from sin?!?

i think martin luther said it best when he said, "faith alone saves, but faith that saves is never alone".

River of stars...

2005-06-14T21:40:00.000+10:00

jus writing a post to announce the arrival of one of my really good mates on the blog scene ;p - shall i say, arrived with a succussion splash?!? in a cytokine storm?!? in a menorrhagic torrent?!? (sorry... i'll cut the corny med talk...) - in a river of stars, no less ;p check out galaxy's blog, entitled "nothings of eternity"...

anyway, things on the mind - had been challenged abt the notion of what is meant by repentance, and what it means in light of God's grace... a really important thing, if u ask me!!! coz repentance is such a core element of the gospel, so crucial a part of Christian living... jus to share what my take on it is, and leave it here, so that this moulded notion can be further challenged, corrected, and refined (plz leave comments!!!)...

-----------
REPENTANCE

i see the way we live - i.e. "making every effort to live in peace with everyone and be holy", loving God above all and each other as ourselves - as being the only true and possible response of a Christian to the gospel... it doesn't mean that we are allowed to go out and deliberately sin... we may sin, as we are still sinners, but this is because of our sinful nature separate from our new identity in Christ... God's grace does not give us the right to sin, but in all cases, because of God's amazing love, His grace is sufficient for our salvation...

so repentance, then, is the way we live... we are to live according to the law with "every effort"... but we are no longer bound by the law... because God has sent Jesus, sin is defeated, the law is overcome, and we no longer live in fear of the consequence of sin... - but it's the amazingness of Jesus, who we know personally, that inspires us towards a life of obedience!!! - so while we no longer fear sin's consequence, we live in greater obedience to God, by living in love, forgiveness and humility... because we are loved, forgiven, and raised with Jesus by God...

so what then of those who still sin?!? - for we are all sinners, with a sinful nature... can we escape the inevitability of sin?!? no, i don't think we can... so we continually need to ask for God's forgiveness... there is a warning against deliberately sinning tho (hebrews 12)... for God's salvation is no licence to sin... but rather a pardon from that which we do, because of our shortcomings... ultimately, faith is in the heart, and what is in our heart is reflected in our action... (thanx sally for helping me with that ;p) - so, in short, while being a Christian requires one simply to believe in Christ Jesus, repentance is still definitely a requirement of Christian living...
------------

anyhow, mind in crazy state atm, i don't know i have a lot of coherent sense to say anything remotely useful or interesting... ;p so, til next time, God bless!!!

love-in-Christ,
dave

Bug infested...

2005-06-05T23:33:00.000+10:00

am bug infested... big bug overrun with little bugs... they seem to have been having lots of fun with my body in the last week or so... got this picture of little furry bug things running around, and jus randomly going, "let's go over there" - "i wonder what this is" - "ooh, a macrophage!!! run!!!" - "ooh, it's got a multiloculated nucleus, it's a neutrophil!!!" - or "i wonder what we look like under a gram stain..."

bugs have been making me feel hot and cold, giving me generalised muscle aches and pains (these symptoms have resolved so far), intermittent headache, sore throat, taking away my voice (case for those studying for dmf exams?!?) - and it's frustrating for some1 like me, who likes to give his vocal cords regular exercise, not being able to talk!!!

despite all that, so many things to thank God for still ;p
-that i am still alive
-that i can still type
-that i can still whisper
-that other ppl can still talk to me
-that i can listen to their wonderful voices
-that i can still play music
-that i can still do ENT
-that the ear is so intricate
-that i have such great friends
-that i am still happy
-that God has made Sally ;p
-that God has revealed Himself thru Jesus
-that God is so amazing
-that God is so loving
-that God is so wonderful!!!

praise the Lord!!! ;p

On physics and job interviews...

2005-05-24T22:05:00.000+10:00

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

Tiredness... but happy ;p

2005-05-16T12:56:00.000+10:00

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

Relaxation time...

2005-05-13T20:35:00.000+10:00

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

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.

Random writing...

2005-05-01T20:59:00.000+10:00

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?!?

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.

Strange day...

2005-04-22T22:45:00.000+10:00

;p trying to think of a title for this post... inevitably, this has a title by the time you read it, so what's going on in my head at the moment might be a rather confusing, redundant ramble that won't really interest you anyway... so without further ado, i'll go on to describe a really strange day ;p

relatives have arrived here yesterday - seven of them, all of whom are my mum's siblings (there are 11 brothers/sisters total), are all staying at our place!!! somehow this seems to still work... only greeted them this morning, after being woken at 4am, and being grumpy, due to being unable to get back to sleep for quite a while... somehow was still able to exchange pleasantries, as is customary... ;p

set off today for train, miss intended train, and have to wait... get on train, conscious of running late to my 9am tute, but seemingly unfazed... miss tram at flagstaff and wait for ages, adding to degree of lateness... next tram comes, i see sandra on board - so good chance to catch up - incidentally, first of some bizarre bump-into-ppl things today... after sms'ing several ppl to inform of my impending lateness, i turn up only to find that not only am i the only student to turn up, but that the tutor has cancelled the tute too!!! feel much like idiot at this time, later learning that i ought to have been in the camp of the other students who either forgot, slept in, or were off with some other psych team... yeh, i could've slept in!!!

ah well... anywayz, get to rmh, in unmotivated, sulky mood, trying to cheer up self by reading blogs ;p yah... anyhow, cath turns up and tries to motivate me... she succeeds, we set off to interview a patient... on the way, bump-into-ppl thing happens and we see eunice and mark (haven't seen mark for yonks!!!) who take the opportunity to talk to us abt long cases... all those of u who are doing long cases in 5th yr, don't panic!!! - key elements are a thorough history, presented with "some structure" (you'll learn so many different structures, you'll get confused, but so long as you have some structure, u'll be fine), a focused physical examination (yes, really focus on what you expect to find given the history!!!), and topped off with an ability to ramble indefinitely if need be... ;p

anyhow, i digress... we continued on our way to ward... and meet a patient who happens to have all these roundabout connections to both myself and cath!!! we end up really connecting because of these coincidence things, and have heaps of fun really... shall discuss no further, lest i risk incriminating myself and breaking the hippocratic oath re: confidentiality... anyhow, really pray for her (our patient), she's really got a lot to live for!!!

finally have a good tute, my presentation went well (see, if i can do a long case, even tho it's psych, anyone can!!!) ;p some really helpful tips from tutor abt organisation of the psych presentation (e.g. grouping by diagnostic criteria, refined focus in mse)...

after tutes, wind up at uni, sally has to pick up this book, and the librarian asks about christian union... ;p so that's really awesome, she and sally get talking, and turns out they know some ppl in common, and are attending the same b'day party 2moro nite!!! coinkidink?!? or what?!? ;p God really has demonstrated His awesome reign and wonderful sense of humour today, i tell u!!! - so much so i had to indulge in half a pack of m&m's...

had some wonderful dinner... looking to start planning for next yr (yes, next yr already...) - but ought to sort out car troubles... hope it can be fixed in time for beaufort trip!!! mind tripping atm... need sleep... (get out of overdrive... haha... before i self-diagnose mania or schizoaffective disorder or something...)

God bless ;p

dave

On an article...

2005-04-15T15:06:00.000+10:00

hey - jus writing down some of my musings abt this topic in response to an article i read recently... the reference, for anyone who's interested is:
Fuchs T (2004). Neurobiology and psychotherapy: an emerging dialogue. Curr Opin Psychiatry 17:479-485

firstly, i'm hardly in a position to challenge the expert opinion of an associate professor at a major european uni... so what i'm saying, to go in the face of some things implied by the article, is probably somewhat foolish!!! but i jus thought i'd say it anyway... i guess what i'm saying doesn't really argue against anything that he says, but rather jus puts a different light on the findings described in the article... - i'll quit rambling, here goes:

fuchs' article outlines some exciting, recent developments that link, by correlation, psychotherapy and neurobiology, which are two traditionally separate scientific fields... neurobiologists probably see their field as far more "scientific", but as psychotherapy is increasingly pressured to join the bandwagon of evidence-based therapies in order to survive in mainstream psychiatry, studies are being carried out looking at brain changes brought about thru psychotherapy and comparing them to brain changes brought about thru pharmacological intervention... - neuroimaging has gone a long way to making this possible... some very interesting findings have come to light - these include the similar neuroimaging findings across the two modalities of therapy, the temporal dimension of change brought about by the two modalities, and the circuits involved in mediating the long-term brain morphological effects of psychotherapy...

i'll begin with a brief overview of psychotherapy - a modality of treatment consisting of courses of sessions with a psychotherapist (psychologist or psychiatrist, usually) that finds its origins in the psychoanalytic theories of freud... the image that comes to mind is one of the patient on the couch, and the psychiatrist in a chair, a cozy room, and the patient divulging intimate details about past lives to a psychiatrist with an ulterior motive!!! of course, there is in truth much structure to psychotherapy, and more recent incarnations of psychotherapy are short courses of 10-20 separate hour-long sessions in which certain themes in the patient's history are explored using sophisticated, controlled techniques in which the psychiatrist not only seeks to understand the patient, but his or her own reaction to the patient's story also... the current vogue is cognitive-behavioural therapy (CBT), which is a form of psychotherapy in which the patient is encouraged to exercise thought-pattern and behavioural changes slowly and consistently to overcome his or her problems, often employing goal-forming and distraction techniques to achieve these changes...

CBT has been found to achieve very similar brain changes on neuroimaging to pharmacotherapy for certain conditions, such as obsessive-compulsive disorder... this is an encouraging finding, since although both had some level of evidence that they worked, the neuroimaging findings support the view that a disturbance in the architecture of the brain (distinguishable at an anatomical level) is associated with the disorder itself, and not merely a confounder... on the other hand, different changes were observed between the two types of therapy when applied to depression...

the temporal aspects alluded to earlier were ones of a more top-down progression of change associated with psychotherapy, and a more bottom-up progression associated with pharmacotherapy... the implication here is that psychotherapy recruits the active involvement of the cortex, and reorganisation thereof causes secondary changes in associated circuits in lower centres, while pharmacotherapy primarily targets the lower centres... this makes sense as well, with pharmacotherapy being more targeted at different neurotransmitter pathways, which are usually localised in lower centres, while psychotherapy's involvement of the conscious mind implies the involvement of the higher centres (cortex), which has traditionally been described as the part of the brain responsible for consciousness, and "what makes us human"...

i guess this is the point that i find contentious... the point of view put forward commonly in scientific papers such as this one tends to ignore or exclude the existence of a mind that transcends the physical world... as a dualist (as in, one believing in an extraphysical mind), i tend to look upon conscious humanity as being an entity additional to, rather than emergent from, the physical brain... now what relevance does this have to the article?!? - the existence of mind-brain correlates, as found by neuroimaging following intervention, should not be interpreted to imply that the brain is therefore responsible for the mind-state... the brain, to me, is simply reflective of the mindstate, and certainly exerts influence over the mind as much as the mind exerts influence over it... the fact that psychotherapy, as every interpersonal relationship, is going to involve connection between minds, does not mean that psychotherapy implicitly will have no effect on the brain, since the mind and brain are very closely related units...

take memory for example... ppl talk about implicit and explicit memory, and different circuits in the brain being involved in each... yet these structures have been shown to be associated with memory formation, but no area has been proved to be associated with memory storage as such... - does this mean that memory isn't stored in the brain?!? - i don't think it's a wise thing to extrapolate and say that it definitely isn't, but i think that the distinct possibility that memory may be stored in a mind additional to the brain should not be discounted... brain changes related to learning also should not automatically be attributed to storage - since there are changes in the memory formation apparatus (refinements) that may well result from the process of learning...

memory is a really interesting concept - i can look at a scene, and take it in, and remember in great detail so many aspects of the scene... we can all do this, with remarkable success, through processes that are unconscious as well as conscious ones... an interesting question, though, would be whether the rich sensory information that is able to be remodelled with recall can be stored in some compressed, compact format in the brain itself... such a complex system of memory storage would be an amazing feat of association (between all five senses, previous experiences, and completely novel constructs with each experience), and an amazing metabolic accomplishment, since remodelling is constantly necessary to live a well-adjusted life... not only does memory cover perceptual experience, but also conceptual experience, whereby the mind forms or encounters abstract constructs in order to help make sense of the world... this, in effect, is imagination... anyhow, to think that such amazing things are possible with the brain in isolation, given the physical limitations of the brain organ, is quite mind-boggling... to me, it seems to make more sense that the mind allows us to transcend these limitations...

i can come up with counter-arguments to myself tho... what of the monkeys?!? do they also have minds?!? after all, they seem to have a fairly strong sense of declaritive and procedural memory too... it's a hard topic... i really don't know... but i'm always finding this interesting, and hoping to find out more...

anywayz, have been rambling long enough... ;p shall return to reality once more... ah, the responsibilities of being a member of human society...

Ages - no blog...

2005-04-14T22:39:00.000+10:00

fern's msn name is kinda relevant right now... "sometimes i wonder why, why i'm even here at all, but then you assure me, i'm a little more than useless"

it's true, God cares for me, God cares for each one of us... i mean, He created us in His image... we bear His likeness, so what more need we do but look in the mirror and see that God is with us!!!

had christian union meeting today - talked abt revelation 4-5, transport to heaven in Jesus' revelation to john... and how much more did God intend for us to have!!! God is with us already - but look at the middle of the passage, and realise that john was weeping, for there was nobody worthy to open up God's scroll - i.e. set God's plan in motion... - this is kinda where we feel we're at... incomplete, meaningless, useless... we weep too... for we find we are blind to what God has yet to reveal...

but the one who is worthy to open up God's scroll is, of course, Jesus... ;p He, the lion-lamb, has come to reveal the glory of God to us here on earth... so that we may be with Him in heaven in the time to come!!! our purpose is also revealed in this passage - that is, to worship the living God with all we are, and in all we do... praise God!!!

so why is it that i still feel useless?!? i want to be all things to all ppl... i want to go beyond who i am, to be who God wants me to be... and coz i fall so far short of God's standards, i'm overwhelmed by a sense of inadequacy... i wish to be able to extend and share my sense of God's presence with the world, and with those around me... yet i'm stopped by my own inability to recognise my own problems in the first place... i jus pray, full of the knowledge that God's plan is in motion, that Jesus has unrolled the scroll for my life... i wonder what will become of it in the end... i pray God, tho it's hard to see right now, that my life will be a true light for the world...

A void to be filled

2005-04-02T20:49:00.000+10:00

been feeling quite strange and grumpy again... hard to say why - i mean, i am the recipient of so many blessings from God, more than i could ever deserve - so then, how is it that i should feel like there's a void in my being that's in need of filling in?!?

firstly - a word of apology to all those who have been affected by my grumpiness... i hope i can make it up to u sometime...

also, talked to mary earlier abt this, thx mary for sharing and being such a great help to me... God bless u!!! i'm going to use this blog as a bit of a problem-solving slate... hopefully it'll help yield some answers?!?

some contributing factors to my mood:

fear/insecurity - i'm sure fear probably plays some role... i have all these blessings - yet, i don't deserve them... it only seems right that i'll be punished severely and lose all these blessings in the process... perhaps i'm fearful of such an event... perhaps i'm also fearful because i simply don't have my own handle on things - i'm not in control...

repression/denial - this isn't the first time i've felt strange and grumpy like this... if i repress/deny my feeling, then this is only as good as putting a starving monster back into a glass cage without dealing with it in some way... it'll come back twice as angry next time, bursting out of that insecure cage at the worst possible time, when one's back is turned...

inadequacy - this is something that also surely causes terrible moods, coz i am a sinner, no better than anyone, yet i seem to be the luckiest person when it comes to many things... i have nothing really to offer that nobody else can provide... i've got more than my share of the meal, but can't cook to save my life!!! i'd like to be able to learn, develop into someone more like who God wants me to be... i try, but it's a straining effort against the limitations of humanity and my own willingness...

competition - hmmm, this is a strange one to put here... but i think this is a true factor!!! pride, competitiveness and need for recognition all feature under this heading... i like to think that i'm good at something... yah?!? sometimes i need affirmation... and it doesn't help if i can't prove to myself that i'm any good at something i try... it seems cruel, but certainly honest that triumphing in competition (which implies comparison and hence loss for another person) can make someone feel better... pride in oneself confers a dependence on recognition in order to maintain that and feel good... but i have nothing to be proud of, and i ought to have nothing to be proud of - truly!!!

perpetuating factors:

this is where my eyes are being opened - i think... i've always been able to identify some possible reasons why i might be feeling strange... - but these have all been based on my characterising how i've felt at the time... fear, guilt, shattered pride, self-deprecation, are some of the things that dominate my mindset when i'm grumpy... this much is clear... but jus as clear is the solution - that God alone can fill my void!!! but then, why is it that i still feel this way?!?

there's definitely a difference between the intellectual knowing of God and experiencing a personal relationship with God... there are things that are hindering this, and these things are among the perpetuating factors that mean that this mood becomes an increasingly frequent recurring theme... i have been in a personal relationship with God since accepting Christ as my Saviour about eighteen months ago now... but like many, i think i might be encountering a spiritual wall, like a spiritual lethargy, in that my heart feels less free to give of itself unto God... much of my daily walk with God, from prayer to reading to every decision i make, becomes felt more like a restriction rather than freedom and fulfilment...

probably the first out of those factors is my tendency to ignore and repress my moods... often, i feel exhausted by the efforts i make in order to please others and become the person that God wants me to be... and it can feel like an unrequited love at times!!! effort goes in - but i am ignored, set aside, my efforts minimised or laid to waste in a gesture that's clearly not meant to insult, but can feel like a sledgehammer... but all the while, i continue to try, in the process keeping a pleasant façade, an exterior that says to the world that everything's ok... then i collapse suddenly - the feelings mounted to the surface, and overflowing... in this mood, i jus can't function - everything seems like a conspiracy, and it seems like everything i've lived for has all been chasing after the wind (like in ecclesiastes)...

probably the second of these factors is another thing inherent in myself - impatience... i am trying to breed patience, truly!!! and pray for it frequently... but it's hard... expecting that things are going to fix themselves within a short time, expecting that others will understand with little need to explain... thinking that it's a simple matter of one prayer and God will answer... - perseverance is needed too... perhaps i've jus slowed down too quickly and expected too much... but God has given us a lifetime...

the third - the fact that i've now been a Christian for about eighteen months, i'm probably jus emerging from that "honeymoon" period of feeling things with a freshness and driving me on... do i need a new way of worshipping?!? or do i jus need to persevere, trusting all the time in the truth that God will bring me out of whatever he brings me to?!?

solution:

hmmm... this is where i need to be working ;p am feeling slightly happier that i've sorted thru some of this... but mary made me realise that i ought to be acknowledging the simple truth and not putting on a façade... i need to let go of the pressure that i sometimes feel to be outwardly happy all the time, and instead be simply who i am... an unworthy sinner who needs God fully... and re: the spiritual lethargy, be honest to God that i am a person with doubts, who gets grumpy and frustrated without understanding it... there's never an easy process, but hopefully, by no longer denying and repressing my moods unhealthily, the lid can be removed from the boiling pot of uncertainty, fear, insecurity and inadequacy, and hopefully i can resume my walk with God in the direction He wants me to go!!!

Happy Easter!!!

2005-03-27T21:15:00.000+10:00

happy easter to all!!! ;p wonderful time of celebration, especially today this sunday, when we commemorate the resurrection of the Christ, Jesus!!! ;p praise God!!!

reading yn's blog before, hmmm, i wonder if there's more to this spiritual lethargy than meets the eye... before easter, i had similar lethargy, focusing on complaints and negative things, but today feeling mostly revitalised - reminded and refilled with the hope and assurance of salvation thru Jesus ;p truly, there is so much power and love poured out on us by God!!!

start of day was funny - went to city to meet with sal (thx for coming along, sal!!! ;p you always make my day!!! love u heaps!!!) - after that, my car wouldn't start!!! typical, it's happened b4... engine flooded... opened the bonnet, everything else seemed fine... was going to wait ages for racv to come along... thanx to God tho - this guy came along who was really helpful, opened up the filter cover, and told me to try again starting the car... so after a while jus pushing the starter motor, it started going, and we were able to make it to wcf on time!!! (well, 15 mins late, but jus missed a couple of songs only... so was ok!!!)

at wcf, saw quite a few friends whom i haven't seen for yonks (shaz, rene, mary, felicia, mel, james)... the message was really good, awesome presentation contrasting the claims of the "da vinci code" (book by dan brown) and the claims of Jesus ;p how well Jesus' resurrection and divinity are upheld by evidence and reason... - it remains one of the most well-established facts in history!!! - and thank God for that!!!

it's so sad sometimes tho - that such grandiose distortions of the truth are seen as fact, simply because of the claims made by one person that certain "facts" have been researched... the problem is that you can substantiate almost anything if you take certain bits of evidence and extrapolate on them, while ignoring other bits of evidence... - once a person gets led down one track, the more they want to believe it, or the more appeal a certain hypothesis has (whether because of sophistication, empowerment, simplicity, avoidance of the harsh truth, or any other reason)... once this begins, the evidence they review subsequently is seen in light of this desire to believe one way... - and the synthesis becomes simply a reinforcement of what they want to believe, while other evidence is conveniently ignored or repressed because it interferes with the neat case they have...

there was so much evidence ignored in the research apparently carried out by dan brown in the "da vinci code"... the evidence ignored was probably ignored because it promoted Jesus' deity and His resurrection from the dead... these were inconsistent with dan brown's hypothesis - so were dismissed... - but the evidence is overwhelming...

brief outline of today's message - reason tells us that Jesus' claim to deity was either a falsehood (knowingly so - a lie, or delusion - lunacy), or truth... - if a falsehood, if a lie, then why did Jesus die for a lie?!? why would so many others die for a lie?!? or if a delusion, then what of the rest of Jesus' character as it shines through the gospels that depict His life?!? Jesus was a remarkably awesome teacher, and not given to lunacy or delusion... and His followers were so firmly convinced of His claim also...

as for the resurrection - evidence points to many eyewitnesses to His crucifixion and resurrection... crucifixion was not a process of probable death, but certain death... - the depiction is one of slow asphyxiation as the sufferer struggles to breathe, a splinted diaphragm rendered ineffectual being supplanted by the tiring limb-driven efforts to expand and compress the battered thorax... this was preceded by an often fatal 39 lashes... see "the passion" and you'll have a good idea of what this means... - the resurrection was therefore hardly a hoax by a man who never died... but rather an amazing miracle, witnessed and testified to by over five hundred people, the first apostles and their contemporaries... furthermore, the transformed lives of those who believed points to the fact that they really did know Jesus was God, and that they weren't simply holding onto a lie... their knowledge of the truth was so certain that almost all the first apostles, and many of their successors, have suffered death for the truth...

this is jus the bare bones of what was said - and what can be learnt thru reading relevant and considered literature... a really good summary is "the case for Christ" by lee strobel... - would recommend it if you're interested to see this side of the story!!!

the pastor today concluded by exhorting those of us who believe to not simply believe, but be followers of Jesus... ;p for as God, He deserves our all... not only do we confess with our mouth, but we also believe in our heart - and we ought to live lives that reflect this belief!!! repentance is that often-ignored part of the gospel teaching!!! (and diet & exercise are the often-ignored part of easter egg eating!!!)

anywayz - i guess i'll leave u with this final passage... from the start of john's gospel, so that we may be reminded of the gravity of Jesus' life, death and resurrection... it so powerfully speaks for itself, who Jesus was - and what He makes possible... ;p God bless!!!

John 1:1-18

1In the beginning was the Word, and the Word was with God, and the Word was God. 2He was with God in the beginning.

3Through him all things were made; without him nothing was made that has been made. 4In him was life, and that life was the light of men. 5The light shines in the darkness, but the darkness has not understood it.

6There came a man who was sent from God; his name was John. 7He came as a witness to testify concerning that light, so that through him all men might believe. 8He himself was not the light; he came only as a witness to the light. 9The true light that gives light to every man was coming into the world.

10He was in the world, and though the world was made through him, the world did not recognize him. 11He came to that which was his own, but his own did not receive him. 12Yet to all who received him, to those who believed in his name, he gave the right to become children of God– 13children born not of natural descent, nor of human decision or a husband's will, but born of God.

14The Word became flesh and made his dwelling among us. We have seen his glory, the glory of the One and Only, who came from the Father, full of grace and truth.

15John testifies concerning him. He cries out, saying, “This was he of whom I said, ‘He who comes after me has surpassed me because he was before me.’” 16From the fullness of his grace we have all received one blessing after another. 17For the law was given through Moses; grace and truth came through Jesus Christ. 18No one has ever seen God, but God the One and Only, who is at the Father's side, has made him known.

So slack...

2005-03-22T23:36:00.000+11:00

hey all - ;p since previous blog, have been restored to a state of peace with myself, which can only come as a result of feeling peace with God... so thankful that i have come thru that thick cloud of negativity, that my eyes latched onto a ray of hope and have not let go - bringing me out of the cloud and into the realm of light once more...

attended helpful Bible study today on exodus 5-6, with moses petitioning to pharaoh to let his people go and worship God at God's command... but, as God had warned, pharaoh was hardened and did not know God, believing he was in control... in fact, pharaoh believed he was in some way God, the ultimate authority... of course, this was to be proven wrong... but what was the reaction of the israelites?!? this is interesting - because as God's people today, we mirror the same reaction...

the israelites were, for a time, pushed into a more severe hardship with unfair demands being placed on them in excess of their labour capacity... as slaves, they were harshly treated, and endured difficult work, and little reward... if anything, they were punished because they couldn't do the impossible... - but when this happened, they blamed moses, and appealed to pharaoh... their thoughts were that the power to restore fairness lay with pharaoh, and they failed to approach the mighty hand of God, the one who is always faithful and is ultimately truly in control... by approaching pharaoh, they demonstrated a lack of confidence in God, they distanced themselves from God's present reality...

are we like the israelites?!? i definitely can identify with them... difficult things happen, like the tsunami disaster, like war, like relationship troubles, like grave injustices, or gross immorality... and we ask, "where is God"?!? - too often, we then decide to resort to measuring things by our own thoughts and ideals, whilst ignoring God's plans and perfect timing... so we seek solace in comforts that are intrinsically worldly - gambling, drugs, sex, false religions etc... (a later example of this was seen when moses was up on sinai...) rather than simply petitioning to God, working to measure ourselves by God's standards, confessing sin and trusting in God's Son, Jesus...

lead us not into temptation, God... - but as our deliverer, saviour, and Father, constantly remind us of Your presence, Your mighty hand in control of everything, and your infinite love, wisdom, understanding and perspective... thank You so much for Jesus, whom you sent as an atoning sacrifice for our sin, and may we, by Your Spirit, be transformed in our hearts to follow faithfully and to bring glory to your wonderful Name... in Jesus' most precious name, i pray, amen...

God bless, love-in-Christ,
dave!!! ;p

ps... happenings - if you happen to read this on time, come to inu bar (union house) 7.30 wednesday 23rd march (tomorrow!!!), concert raising funds for aid organisations helping deal with the aftermath of last year's boxing-day tsunami... should be a great night, hope to see some of you there!!! (sorry for late notice!!!)

pps... soon about to finish emergency rotation - feel like i haven't done heaps, hours-wise... a really slack block... learn some really useful things though, and an opportunity to make the most of... but it's all over by the end of this week, and next week is a week off!!! shall hope to enjoy, not long before the end of this year comes upon us, and i become a (yes, very scary, ain't it) doctor!!! am almost certain to be intern at royal melbourne hospital next yr... ;p jus hope i can be a good one!!!

Caught in a web

2005-03-15T23:58:00.000+11:00

hmmmz, musing about depressing thoughts and things lately... i wonder why i'm so down?!? not much reason, really, i mean, what could someone want that i haven't already got?!? it's really silly sometimes when i muse about things and jus can't come up with a reason to explain my mood... perhaps it's jus tiredness... but perhaps it's more than jus that... perhaps so many things jus rolled into one web of entanglement, me the insect trapped in the middle flapping its wings in vain to escape its sticky grasp... the spider is sin, and i am its next dinner, except for God's salvation thru Jesus Christ... yet this insect doesn't always recognise this truth...

caught in the web with me are so many other insects... sometimes i want to know them, they could be my friends... but sometimes what i want is not so much to know them, but to feel appreciated and needed in a way... it's terrible sometimes, the feeling that the world could do without you... i mean, i remember thinking about some of my friends from the past, too many of whom i've jus completely lost touch with... and wondering, they mus be doing so well now, with so many interesting things to keep them alive and seeking truth, wanting more... it is they who so often seemed content with life, and it is they to whom i looked when i wanted a model to follow... i imagine them all together in groups, laughing and enjoying one another's company... i'm happy that they're happy, but i leave myself out of the picture... they don't need me, in fact they're doing jus fine, perhaps even better without me... mostly, i'm jus like a fly on the wall, at best an accessory, at worst an annoyance or distraction... maybe that's why they haven't stayed in touch, replied to my emails, or anything... a terrible realisation dawns, perhaps i'm not so real to them after all?!?

then i look at myself and those who remain in my circle... i suppose, they come and go... but equally, i look at them and realise their sufficiency and happiness, and wonder whether they will go the way of those who have entered the bowels of my past?!? neither needing nor wanting anything to do with me... i know this is such a selfish attitude to have, but its relevance is jus too clear sometimes... then, i'm sure it goes on to affect the way i deal with others... i whine and cry, i crave attention... i move myself into the way in order to be seen, because nobody likes to be ignored, but i'm sure i do no more than invite the ire of those who i disturb... i become more desperate, clinging onto the strands that connect me to others, only to pull too tightly with possessiveness and end up snapping the strands... little remains, only memories and schemata for me to play around with, hope for the future now a discarded remnant of what i remember... once again, i might as well be alone in this sticky web of entanglement, waiting for sin to engulf me...

as the spider draws near, inclement weather arrives and wracks the web, and a thread comes loose and me with it... i'm carried away from the menacing predator, its jaws ready to strike with ferocity... but that too, those open jaws, are but a remnant of what i remember too... i am carried through the air, til i land on a leafy green paradise, so many more insects like myself to be with!!! we have much in common, and we share stories... most often we talk about the wind that saved us, but sometimes we talk about the past too... i discover that i wasn't alone in my frustrations... loneliness followed us like a plague, but the more we tried to cling to others, the more lonely we became... but we are never lonely now... we have each other, and most of all, we have God, who sent the winds of salvation... how much more do we need to know that we are loved?!? how much more do we need to seek our own worth?!?

praise God, for His Son, and for His love, which never fails... may we never forget that we are all worth something, to one another, and above all else, to God...

Robinvale

2005-03-12T16:57:00.000+11:00

back, finally, from my 4-week rural rotation!!! last week spent in robinvale, a good 4-hr hike from shepp, situated along the murray, jus a short distance from mildura in that north-west corner of victoria... the mallee country is beautiful to behold, really striking ochre-coloured soil dominating the landscape and forming a stark contrast with the blue sky at the horizon... the clouds bear the reflection of the ground, issuing forth a pinkish glow from its undersurface...

the town itself was quite an unusual proposition, a mix of koorie, tongan, vietnamese, italian, afghani and south-african inhabitants dwelling in the small town, no doubt drawn there by the fruit-picking and vineyard employment opportunities that present themselves at most throughout during the year... many have settled, though, and there is a constant presence of about 4,000 people in the town, swelling up to as many as 7,000 in peak fruit-picking season...

's a funny thing - most ppl muse about random thoughts when they're in the shower... but my brain was in full random-thinking mode while washing the car today... i guess it's also a shower, of sorts, though most of the water covering my body was sweat, not that much from the hose... but it was really tough going, trying to get rid of all the mallee soil (which was everywhere in the air) out of the carpets, and all the surfaces inside and outside the car... at least it's clean now... and no more country driving to get it all dirty!!!

anywayz - random thoughts... i remembered in robinvale, seeing some graffiti inside the public toilet block that was in the middle of the road that read "rob-in-jail"... but it's an accurate reflection of robinvale's claim to the title of one of the most notorious crime-filled towns in the whole nation... my digital camera went missing, probably there in robinvale... but it's weird, how, if this were in melbourne, everyone's reaction would be, "dave, how could u be so careless!!! maybe u left it in your bag, did you empty it out, did you check it?!? could you have left it in the restaurant?!?" - but since it's robinvale, so many ppl seem so convinced that it's been stolen!!! "dave, you shouldn't ever leave your bag unattended for two seconds, you know... how many times have i told u?!?"

unfortunately, that means no fotos of mungo... i drove up to mungo national park, a really wonderful place to visit if u ever get the chance!!! long dirt road, about 120km, so quite a tiring drive for 1hr10mins or so... watch the kangaroos and sheep and cattle that inevitably wander onto the path!!! but arrival in mungo, pushing aside how dirty the car had become, was breathtaking... you arrive at one end of the lake, which is now a flat, dry lake bed, and feast your eyes upon the beautiful "walls of china" that dominate the horizon 10km away across the lake... the amount of history in the museum is phenomenal, chronicling 50,000 years of aboriginal inhabitance of the region, and their coexistence with strange megafauna, now extinct... imagine life as it was then!!!

went the 10km across to the walls of china... the brilliant layered appearance of the walls is caused by the erosion and deposition of various hidden layers of rock laid down by the repeated filling and emptying of the lake over the millenia... layers of red ochre-ish soil overlie the white rock that rises up steeply, small knolls preserved by the roots of hardy trees that hold them against the wind's erosive forces... atop the walls are the peaks of rolling dunes that move ever so slowly, the exposed side of the dunes holding solidly against our footsteps, in contrast to the liquid behaviour of the sand whenever it is disturbed on the leeward side of the dunes... it's almost surreal, just watching the lava-like motion of the fine sand trickling down the side and parting into channels formed by the ripples on the surface...

relics of early settlement by non-indigenous australians were dotted around the park, with goat traps, small tin huts and wells doing little to deface the immense beauty of a relatively undisturbed corner of the universe...

;p i think it's a beautiful reminder of God's creation, and well worth the drive, and even the car wash after the drive!!! - the road can be dangerous though, some friends of ours became temporarily stranded after their tyre blew out causing the car to run off the road... but yah, would be awesome to revisit sometime in the future!!!

anywayz - i think i should stop rambling now... jus want to leave u with a passage from 2 peter, which teaches us how best to be children pleasing to our heavenly Father... it's a challenging passage, because, although it's full of encouragement, it reminds us of what is so often missing in our walk as children of God - that is effort (in the passage, "selfcontrol, perseverance"), but which is born of faith in Jesus... but how cool is it, that as we focus more and more on God, we are reminded of His goodness, and the amazing promises that He has made to us!!! ;p

God bless u all!!!
dave

2 Peter 1:1-11

To those who through the righteousness of our God and Savior Jesus Christ have received a faith as precious as ours:

Grace and peace be yours in abundance through the knowledge of God and of Jesus our Lord.

His divine power has given us everything we need for life and godliness through our knowledge of him who called us by his own glory and goodness. Through these he has given us his very great and precious promises, so that through them you may participate in the divine nature and escape the corruption in the world caused by evil desires.
For this very reason, make every effort to add to your faith goodness; and to goodness, knowledge; and to knowledge, selfcontrol; and to selfcontrol, perseverance; and to perseverance, godliness; and to godliness, brotherly kindness; and to brotherly kindness, love. For if you possess these qualities in increasing measure, they will keep you from being ineffective and unproductive in your knowledge of our Lord Jesus Christ. But if anyone does not have them, he is nearsighted and blind, and has forgotten that he has been cleansed from his past sins.

Therefore, my brothers, be all the more eager to make your calling and election sure. For if you do these things, you will never fall, and you will receive a rich welcome into the eternal kingdom of our Lord and Savior Jesus Christ.

Rurality and mental health

2005-03-05T23:19:00.000+11:00

here's a lil essay i wrote jus over the past three days about rurality and mental health... hopefully some of u find it interesting... ;p

Rurality and mental health

Over about 10 days, we had the privilege of visiting the small rural community of Berrigan and the surrounding townships, and our eyes were opened to a very different context of medical practice. We observed and participated in the rural lifestyle, and were welcomed warmly and embraced by the local population. Clearly, not only do they recognise and wish to attract more health practitioners to their region, but their friendship and warmth is a genuine one that stems from a supportive community spirit. In this essay, in which I focus on mental health, I shall endeavour to use this context to illustrate some of the important points about mental health practice in rural Australia.

The township of Berrigan has a population of about 1,000. Mostly, the town serves as a farming support town, with the major industries being rice, wheat and maize. Increasingly, the population is aging, and the proportion of retirees finding their homes in Berrigan is becoming greater. There is one general practitioner in the town who works in a clinic attached to the 14-bed hospital. Alongside the GP, there are many allied health professionals, ranging from nursing staff, dentists, a pharmacist, a physiotherapist, and a psychologist, some of whom are based in Berrigan. Overall, with respect to health services, it is considered as part of a sector that encompasses the shires of Berrigan and Jerilderie, which takes in the towns of Finley, Barooga, Tocumwal and Jerilderie, in addition to Berrigan (see Appendix for ARIA and RRMA remoteness scores). Some services, including mental health services, are further shared with the neighbouring sector, based in Deniliquin, which is about 100km from Berrigan.

We encountered a member of the mental health team first at a social night. The psychologist was based in Berrigan, and was on a 12-month contract. Having come from the city, her impressions of the country were initially positive, with her appraisal of the community spirit as friendly and enthusiastic. She enjoyed the job, but had personal ties that meant she returned to Melbourne every weekend. Eventually, those same ties led to her searching for and finding a job in the outer suburbs of Melbourne, for which she was about to leave her employment in Berrigan after only 3 months there.

We met more members of the community mental health team in Deniliquin on a visit there with the drug and alcohol counsellor for the region. The team in Deniliquin consists of two psychologists (one for each sector), two general mental health nurses (three positions: child/adolescent, adult, and one for over 65 years, which is currently vacant), an Aboriginal mental health worker, and a mental health nurse for EDC&C (emergency, crisis). There are also administration positions. Other mental health practitioners work closely with the Deniliquin team across the sectors as well. They liaise closely with other health practitioners, such as drug and alcohol, general practice, and hospital staff. Consultation with psychiatrists is made possible through video teleconferencing (telepsychiatry), and facilities for this have been installed in Deniliquin and several other sites around rural NSW.

How does mental health differ between the rural and the urban settings? This is a complicated question to answer. While there are concerted efforts to improve access to mental health services in rural areas, such as outreach workers, Access Line (a 24-hour free phone number for advice and crisis support), brochures, posters, and close working with other health services, there are still differences highlighted in the statistics comparing rural and urban mental health. Perhaps the starkest statistic is that of suicide rates. Overall, comparing suicide rates between (crudely speaking) rural and urban Australia, there is little statistical difference between suicide rates of females, but male suicide rates are significantly higher in areas termed "rural" as opposed to "urban" (AIHW, Australia's Health 2004). Statistics on overall mental illness prevalence paints a slightly different picture: according to a 2000 ABS survey, it is greatest in large and small rural centres (19.4%), followed by capital cities (17.8%), and lowest among "other rural & remote" areas (15.7%). However, Meadows demonstrated in the same year that the proportion of unmet need for mental health care increased with increasing remoteness.

Why does this pattern/difference exist? It is important to understand that this difference is not simply the result of differences between mental health services available, and accessibility to them. Mental health is the result of so many interacting factors, which are social, economic, cultural, biological, as well as psychological. Diversity in all these factors throughout rural Australia means that a simple cross-assessment of all rural areas together might not yield meaningful results. Instead, an examination of these factors as they apply to areas of rural Australia might help to explain the difference, and indeed, provide more concrete targets at which to aim when developing solutions for rural mental health.

At the social level, perhaps one of the most interesting phenomena separating rural from urban living comes into play. In rural areas, where “everyone knows everyone”, people's networks consist primarily of strong ties, and lack weak ties relative to urban-dwellers. The effect of this on mental health is that such social networks tend to act as reverberators of information, and people are probably less willing and able to disclose concerns they may have. Also, the predominance of strong ties means more dependent relationships exist in the community, such that if one person suddenly falls out of their role(s), the community's networks will undergo an upheaval. These things are reflected in the stoicism and self-reliance stereotypically associated with rural-dwellers, and this attitude breeds a reluctance to acknowledge mental health problems and access mental health care. The stigma associated with mental illness further contributes to this reluctance, and compounds the effect that would occur if a diagnosis of mental illness were revealed in the community.

Another relevant social phenomenon involves the multiplicity of roles held by individuals in rural communities, where one’s activities in one role rapidly becomes widely known, and affects the other roles held by that person. For example, if a community leader involved in several different community clubs, on the school board, and mother of two school-age children, decides to send one of her children to a school in another town, then she would be seen as letting down the community and her role and relationships as a community leader would become strained. Similarly, if an individual were to undergo difficult circumstances, he or she might be afraid to seek help for mental health for fear that his or her roles would become disrupted because of the stigma associated with mental illness.

Among the economic factors influencing mental health in rural areas is the changing landscape of industry that drives the rural economy. Traditionally, rural areas have been portrayed as homogenous primary-industry-driven communities where a large proportion of the population dwelt on and made their living from farms, whether livestock, crops or orchards. However, the past few decades have seen a shift from this pattern. Berrigan is a prime example of this phenomenon. It is a town built on irrigated land, and crops of rice, wheat and maize cover the horizon from end to end. This much has changed little, but the way in which farming is practised has changed much. The land is now owned by far fewer people running far larger-scale operations, and their tractors are growing larger and larger in the quest for greater efficiency, as they struggle on the background of the recent drought conditions to break even. Small-scale farmers are a dying breed, most having had to sell out because they were running unsustainable businesses and drowning under the competition, and those who own small plots of land now run intensive operations such as pig igloos or fish farms in order to survive.

This changing economic landscape means that farming is less prominent as an industry in rural towns. One would also suggest that this trend in farming is not isolated, and is mirrored everywhere, including the decline of some rural towns. As society trends towards specialisation and competitiveness, a town must either follow or somehow be extremely innovative to baulk the trend and survive. In many rural areas, farming is being replaced by growth industries of tourism and aged care. Increasingly, country towns are seen as attractive for lifestyle reasons (and Berrigan’s congenial and welcoming community illustrates this well with their laid-back, relaxed pace and simple enjoyment of peace, quiet and friendly company). Those who are settling in the Berrigan area are mostly retirees, while the younger generation (who find themselves often without viable businesses to take over) are migrating to urban areas to seek opportunities for their career. A different pattern is observed in some other country towns such as Tocumwal, whose river location and airfield make it a wonderful magnet for tourists and the younger generation.

This has profound effects on mental health in rural areas. On one hand, the peace and quiet relative to the city would seem to ease stress on the population. But on the other hand, the changing economic climate and the competitive nature of industry is bringing the city’s stresses out into the country.

Rural Australia is also culturally diverse and dynamic. There are growing groups of people with different ethnic backgrounds entering rural towns, although there tend to be concentrations of certain groups in specific areas. For example, there are large Italian communities dwelling in the vicinity of the Murray River in towns such as Cobram, which is just across the border from Barooga, which is in Berrigan Shire. While the Aboriginal population is more highly represented in rural Australia overall compared to metropolitan Australia, the area around Berrigan has very few Aboriginal dwellers. Nevertheless, while ethnicity may contribute to some of the culture of an area, rural areas also differ culturally from urban areas in other ways. Some of this has been illustrated by the community-centric social structure of rural towns. There tends to be a greater sense of trust and loyalty amongst rural communities, because of the social proximity of people to each other, and the spirit by which neighbours look out for one another. Also, the lack of anonymity would tend to reinforce the sense of belonging that one feels in the town. These factors are reflected in the culture of community events, and people enthusiastically support community-run festivals, fund-raisers and other goings-on. Examples during our time at Berrigan were the overwhelming support shown for the Berrigan swimming pool at the swimming carnival fund-raiser, the strong membership of the local Lions club, and the crowd at the Finley tractor pull.

This community enthusiasm can play a particularly protective role against mental illness. There is a spirit of co-dependency among rural communities such that everyone helps one another. When individuals fall into difficult circumstances, often the community will rally to their support.

Part of the flip side of this community enthusiasm is a cultural resistance against external influences that attempt to exert themselves on the town. Without such resistance, small communities are vulnerable to external pressures, and among the health services, city-based authorities are often looked upon with disdain. It is unfortunate that small towns are at the mercy of decisions made by those who all too often have too little to do with the country to understand their plight. When one understands that differences exist between rural culture and urban culture, and that their needs are different, not only from metropolitan areas, but also from one another, it becomes obvious that the best solutions would originate from rural areas themselves.

While this is particularly evident at the level of health service infrastructure and funding arrangements, a simpler example of this can be seen in the pattern of acceptance of overseas-trained doctors in the rural towns. The general practitioner in Berrigan was trained in Iraq, and initially it took some time for the local population to accept him as their doctor. He faced language issues also, and was found to be “hard to understand”. However, time has once again proved to be a healer, and after being welcomed into the community, he has become, more and more, a member of the community. The town is now pleased with the much-needed services that he provides to the town, and most of the locals visit his surgery.

Cultural safety issues go beyond respecting the patient to respecting health care workers. A case of an elderly farm-dwelling male patient whose frontal lobe dementia has led to some disinhibition illustrates this point. Outreach workers regularly visit his home on the farm in order to investigate his progress, ensure that his living standards are maintained, and assess whether or not he is still capable of managing in his own home. However, his disinhibited behaviour has led to reports of sexual advances towards some of the workers, making them feel uneasy. Because of the isolation of the site, assistance for the threatened worker is not at hand, and the response of the workers to date has been to suggest some medication to alleviate the disinhibition.

Access issues can also highlight the particular need for cultural sensitivity in the rural setting. In a town such as Berrigan, where there is only one general practitioner, difficulties arise when cultural conflict occurs. A female Islamic patient, for example, may feel very uneasy with a male doctor, and may refuse physical examination. She would then have two options, either to continue visiting the same doctor reluctantly (perhaps with a compromise measure in place, such as the presence of a female nurse), or go to a different town in order to find a female doctor to treat her. The previous GP in Berrigan was female, and many of the males in Berrigan found it awkward to approach her as their doctor, and so were faced with a similar dilemma. The result of this is that many who should be receiving health care do not receive it, due to cultural or access issues.

This has strong relevance to mental health. The National Mental Health Survey (1997) investigated the role of general practice in mental health care, and demonstrated the vital role that general practitioners have in mental health. Nationwide, three quarters of those who used a health service for mental illness saw a GP, and half of these had their GP as their sole mental health practitioner. Furthermore, 71% of the community put that, if they sought professional help for depression, they would first approach a GP. The sparse distribution of GPs in rural Australia, and even sparser scattering of other mental health practitioners such as psychologists and psychiatrists, means that the interfaces between patients and mental health care are thinly spread in the country. If choice is limited to only one GP in a town, there are few practical options for the individual (highlighted previously), and often it seems most appropriate to forgo seeking help. In a secondary analysis of the BEACH (bettering the evaluation and care of health) study by Caldwell et al, rates of psychological problems identified by GPs per population were demonstrated to decline with increasing remoteness (as measured by RRMA score). Berrigan and surrounding townships have an RRMA classification of 5, which were shown to have significantly fewer psychological problems identified per population. Interestingly, there was little variation across all RRMA classifications in the rate of identification of psychological problems per number of GP encounters. The suggestion here is that the lower identification rate among rural and remote areas is largely due to a lower rate of utilisation of GP services in these areas, and that there is a higher proportion of unmet need for mental health care in rural Australia compared with metropolitan Australia.

Biological factors may also play a part in the rural-urban mental health differential. Overall, the health status of individuals in rural and remote communities is poorer than in urban areas. In particular, the mortality rate in rural Australia is significantly higher than in major cities. This is likely to be due to a number of factors, including a different demographic (with higher proportion of Aboriginal people who have life expectancies about 20 years shorter than non-Aboriginal Australians), poorer access to health care, poorer education status (perhaps associated with less effective health outcome preventative measures), and more hazardous environmental factors (e.g. motor vehicle accidents). Mortality from causes such as coronary heart disease, chronic obstructive pulmonary disease, motor vehicle accidents, and diabetes, feature heavily among the causes of excess deaths in rural Australia. Largely, these causes are modifiable to an extent by appropriate behaviours, such as quitting smoking, practising safe driving, or controlling diet. Perhaps more aggressive promotion of healthy behaviours would help to reduce these excess deaths.

It is also well known that mental illnesses such as depression are often linked to poorer health status. Diseases seen more often in rural areas such as coronary heart disease, chronic obstructive pulmonary disease, and diabetes, are illnesses that by-and-large cause significant stress for individuals, and contribute to the mental health burden.

So what can be done to improve rural mental health? The issues identified above largely fall into the categories of availability, access, and health promotion. Perhaps some of the “problem” lies in the culture of stoicism and self-reliance seen in rural-dwellers, but this is a difficult area to target in itself. However, it is possible that campaigns might be instituted to reduce the stigma associated with mental illness (and one such campaign is proceeding in the Hume area, encompassing Shepparton).

On the front of availability, strategies must be developed to recruit more health practitioners into the country. Communities are welcoming and mostly recognise the need for more services, and increasingly so in mental health as awareness of psychological illness increases. In Berrigan shire, positions are available and are mostly advertised as twelve-month contracts. This method of advertisement acts to lure practitioners by binding them only for a short time, leaving open the option to leave the position after that time, and positions frequently come packaged with a place to live or other incentives that serve to assist assimilation into the community. As one of the nurse administrators said, the plan is to attract them, and once they arrive, to get them so involved with the community that they are unable to leave. Recruitment is, however, limited by funding provided by the government, and lobbying for more funding to attract more health professionals is always an ongoing, difficult and complicated task.

Access is another major issue that should be targeted. The access problem is highlighted by the high suicide rate, which indicates that much mental illness may be going unidentified or unmanaged until it becomes far too severe. For less severe mental illness, access is also an issue, but is available through outreach mental health workers, travelling psychologists, and telepsychiatry. These arrangements are well established in Deniliquin.

Telepsychiatry, in particular, has been a topical issue since its advent many decades ago. It allows consultation via camera and television screen with a psychiatrist at a distant site, which is Sydney for those in Deniliquin. This facilitates access by cutting travel time and cost, and the time saved can often mean one less day absent from work or school, less disruption to family, or simply less to stress about. It also makes possible a quick second opinion to be given by more experienced personnel. Studies on telepsychiatry have demonstrated its reliability for child psychiatric assessments, depression and cognitive status assessments for the elderly. Positive outcomes have also been achieved with interventions administered by telepsychiatry. However, there is a suggestion that telepsychiatry is less reliable than in-person consultation for behaviours requiring visual observation, and it is not the modality of choice for patients with schizophrenia.

Overall, telepsychiatry is seen as an acceptable and cost-effective means of accessing psychiatric expertise from a rural area. Where such vast distances are involved, such as from Berrigan and Deniliquin to Melbourne, patients mostly prefer to use the telepsychiatry facility. Concerns are expressed about confidentiality and the impersonal nature of the teleconference, but the positive outcomes achievable by this modality demonstrates that it is a worthwhile step forward in improving access to mental health services in rural Australia.

Outreach workers exist in many of the disciplines associated with mental health. We spent some time with a member of the aged care assessment team (ACAT) on home visits to elderly patients. Their role in mental health is vital, calling on a vulnerable sector of the population, inquiring about problems they may be experiencing, and advising them on the allied health services available. They assess their need for services and are able to make referrals to services such as occupational therapy, mental health services and general practitioners. On this front, outreach workers are performing well at addressing access issues in those who have identified health concerns.

The greatest difficulty is in addressing the problems of those with mental illness that have not been identified. This is where health promotion and awareness must be targeted. Promotion of Access Line is one of the measures taken to address this. Access Line posters and brochures are visible in doctors’ surgeries, in hospitals and in community health centres. They make people aware that there is a free number they can call for assistance with any mental health concerns. However, these posters are hardly visible away from health facilities, where perhaps they are most needed. The other problem with this strategy of promoting awareness of services is that it relies on individuals with mental illnesses or their friends and relatives to identify their problems. As it would be costly, unethical and impractical to probe into the lives of every member of the community in order to catch those with mental illness, promotion of services is probably the most feasible method.

How can this be better achieved? Perhaps other media such as newsprint, television and radio should be more aggressively enlisted, in order to reach a wider audience. Perhaps community-driven events to promote healthy behaviours and strategies to identify mental illness might be effective. In some areas, mental illness is still a taboo topic, and so a campaign to reduce the stigma, such as in the Hume region in Victoria, might be synergistic to other promotion strategies. Mentally ill people will only come forward to seek help if they understand that it is OK to do so. In the end, however, these strategies can only be possible with more resources being made available for mental health promotion in rural areas.

Resources

Australian Institute of Health and Welfare (2004). Australia’s Health 2004. Canberra: AIHW

Caldwell TM, Jorm AF, Knox S, Braddock D, Dear KBG, Britt H (2004). General practice encounters for psychological problems in rural, remote and metropolitan areas in Australia. Aust New Zealand J Psychiatry 38:774-780

Fraser C, Judd F, Jackson H, Murray G, Humphreys J, Hodgins GA (2002). Does One Size Really Fit All? Why the Mental Health of Rural Australians Requires Further Research. Aust J Rural Health 10:288-295

Fuller J, Edwards J, Procter N, Moss J (2002). Mental Health in Rural and Remote Australia. In The New Rural Health (eds Wilkinson D, Blue I), Oxford University Press, South Melbourne, pp 171-86

Glover JJ (2003). Rural Bioethical Issues of the Elderly: How Do They Differ From Urban Ones?. J Rural Health 17(4):332-335

Harrison CM, Britt H (2004). The rates and management of psychological problems in Australian general practice. Aust New Zealand J Psychiatry 38:781-788

Humphreys J, Hegney D, Lipscombe J, Gregory G, Chater B (2002). Whither Rural Health? Reviewing a Decade of Progress in Rural Health. Aust J Rural Health 10:2-14

Hyler SE, Gangure DP (2003). A Review of the Costs of Telepsychiatry. Psychiatric Services 54(7):976-980

Hyler SE, Gangure DP (2003). Legal and Ethical Challenges in Telepsychiatry. J Psychiatric Practice 10(4):272-276

Monnier J, Knapp RG, Frueh BC (2003). Recent Advances in Telepsychiatry: An Updated Review. Psychiatric Services 54(12):1604-1609

Murray G, Judd F, Jackson H, Fraser C, Komiti A, Hodgins G, Pattison P, Humphreys J, Robins G (2004). Rurality and mental health: the role of accessibility. Aust New Zealand J Psychiatry 38:629-634

Special thanks must go to the people of Berrigan, especially our hosts and the hospital staff. Thanks and best wishes also go to the mental health team of Deniliquin for their valuable time, and their enthusiasm that went into showing us what they do and the special challenges they face.

Appendix

ARIA/RRMA Scores for Towns

Berrigan - ARIA 2.72, RRMA5
Finley - ARIA 2.59, RRMA5
Barooga - No ARIA score available, RRMA5
Tocumwal - ARIA 2.47, RRMA5
Jerilderie - ARIA 3.28, RRMA5
Deniliquin - ARIA 2.33, RRMA5

Source: Personal correspondence, Craig Winfield, Department of Health and Ageing

Praise God!

2005-03-05T16:16:00.000+11:00

taking break atm, been working on assignment - presenting on topic of "mental health in rural australia" on friday next, and will post up my essay when i've finished writing (probably tonight or something...) ;p

anyhow, jus read today's odb, from isaiah 55, such a wonderful passage of scripture!!! so encouraging, one that highlights the miraculous transformation that God is achieving in each one of us by His Spirit that lives within, and the Word that He sends forth into the world to sow a seed of love and beauty that will spring forth from those it touches...

Isaiah 55:6-13

Seek the LORD while he may be found;
call on him while he is near.
Let the wicked forsake his way
and the evil man his thoughts.
Let him turn to the LORD , and he will have mercy on him,
and to our God, for he will freely pardon.

"For my thoughts are not your thoughts,
neither are your ways my ways,"
declares the LORD.

"As the heavens are higher than the earth,
so are my ways higher than your ways
and my thoughts than your thoughts.
As the rain and the snow
come down from heaven,
and do not return to it
without watering the earth
and making it bud and flourish,
so that it yields seed for the sower and bread for the eater,
so is my word that goes out from my mouth:
It will not return to me empty,
but will accomplish what I desire
and achieve the purpose for which I sent it.

"You will go out in joy
and be led forth in peace;
the mountains and hills
will burst into song before you,
and all the trees of the field
will clap their hands.

"Instead of the thornbush will grow the pine tree,
and instead of briers the myrtle will grow.
This will be for the LORD's renown,
for an everlasting sign,
which will not be destroyed."

likewise, the truth that springs forth from Ephesians 1, which was last night's odb (actually from 2003), spoke of the blessings that God rains down on us as His children...

Ephesians 1:3-14

Praise be to the God and Father of our Lord Jesus Christ, who has blessed us in the heavenly realms with every spiritual blessing in Christ. For he chose us in him before the creation of the world to be holy and blameless in his sight. In love he predestined us to be adopted as his sons through Jesus Christ, in accordance with his pleasure and will – to the praise of his glorious grace, which he has freely given us in the One he loves. In him we have redemption through his blood, the forgiveness of sins, in accordance with the riches of God's grace that he lavished on us with all wisdom and understanding. And he made known to us the mystery of his will according to his good pleasure, which he purposed in Christ, to be put into effect when the times will have reached their fulfillment–to bring all things in heaven and on earth together under one head, even Christ.

In him we were also chosen, having been predestined according to the plan of him who works out everything in conformity with the purpose of his will, in order that we, who were the first to hope in Christ, might be for the praise of his glory. And you also were included in Christ when you heard the word of truth, the gospel of your salvation. Having believed, you were marked in him with a seal, the promised Holy Spirit, who is a deposit guaranteeing our inheritance until the redemption of those who are God's possession–to the praise of his glory.

so many blessings are we given, because of the love God has for us all... so here's encouraging all of us to be the humble and contrite hearts with which we receive such undeserved blessings, through our saviour Jesus Christ, and all glory and praise to our loving Father!!!

Bug splatter!

2005-02-22T21:15:00.000+11:00

owww, oww!!! mozzie bites everywhere!!! oh well... nevermind... ;p anywayz, today, had a lesson in country driving!!! decided to head off to see the famed conargo pub (and have a coke there, since i had to drive) and the mythical "treeless plain", jus a bit further than canargo... about 120km from berrigan... anywayz, went up via jerilderie, and about 5km out of berrigan, we were bombarded with locust and grasshopper swarms!!! you'd jus feel like u were driving into a minefield, and these creatures, millions upon millions, would jus swarm thickly and splatter all over the windscreen, haphazardly distributing their yellow haemolymph in such a way that u could hardly see anymore... by the time we'd passed thru canargo and up the dirt road to the treeless plain, i only had a small window left, and trails of smeared splattered-bug were left by the wipers after my vain attempts to clear a bit more viewing space...

anyhow, the view when we got there was quite amazing, hardly a tree in sight!!! the ground was as flat as anything, wild and uncultivated, but teeming with grasshoppers and locusts... i can only think that, had they any sense of emotion, they would've looked upon my car in disgust and mourned the most unceremonious losses of so many of their own kind... it's a wonder that the lot of them didn't jam the radiator and cause the car to overheat... they do say that's a major problem with driving around here, when u're hurtling along the highways and squishing bugs at over 130km/h (insert guilty admission)... popular science also has it that if u drive at 80-90km/h or below, they jus bounce off instead of splitting open...

at least, managed to find a service station on the way back to make the windscreen somewhat more permeable to light and more respectable from an aesthetic viewpoint...

who knows?!? i might be doing the country a service... the locusts and grasshoppers are seen as plagues, quite unstoppable, unfortunately... this is a worry that they're coming down as far south as berrigan and terrorising the farms around here... they've been worried about them for six months or so, and only a few km left before they're in the town... i wonder what the repercussions will be for the local industry...

but i think the bugs are angry at me... i mean, if i were a bug (of the insectoid kind, quite apart from the fluffy kind), i'd see it as a declaration of war to be ploughing thru my territory and causing massacre like that... i guess i shouldn't be surprised then, that the mozzies are out in force to cause me as much misery as they have...

signing off, your fluffy bug at war in the country... ;p dave

Country Life...

2005-02-21T16:21:00.000+11:00

feeling like on the set of mcleod's daughters or similar, out here in the middle of virtually nowhere, in a lil town called Berrigan... ;p nice place tho, really, been lodging with ian & inara fox, a really lovely couple... they own a 30 acre property and an american-style house made from imported american pines and things, but it's soooo comfy!!! jus now moved again, staying with lorraine & rob beard, who live jus across the road from the fox's, it's really nice here too, tho they're renovating their driveway atm (so my car's living outside now under assault from the beating sunrays) ;p but it's all good... soo nice of them to billet me here!!! get treated like a king by my wonderful hosts!!!

it's a nice lifestyle actually, once you overcome the isolation... get woken in the morning by the crowing of the rooster and the beams of sunlight piercing the curtains... the beds are so comfy u jus don't want to rise, but then the idea of a nice warm shower and cooked breakfast beckons, as well as a day's duties to attend to at the hospital... - well, for us, could hardly call it duties ;p more like tourism...

amongst other things, been out to horse farms: some famous horses and breeders came from up here around berrigan... seen the extent of primary industry around, with rice crops traditionally being the dominant industry in the area (though in the last few years, because of the drought, wheat and maize have become the favoured crops of some of the farmers)... there's also some dairy, grain milling, and the basic amenities available in the town... there's not a whole lot more to do, except get involved in community activities - had a lion's club meeting on wednesday (where a few young ppl from the area got up to talk about issues - the one who ultimately won put together a well-woven speech about the rural community and what it means to live here...), and the swimming pool was kept alive with a fundraising swim-meet on friday night...

outside of berrigan, there's the nearby towns of finley, tocumwal and barooga, the latter two being situated on the banks of the murray river... finley had a huge tractor pull event on saturday night - wow, the dust and noise were incredible!!! the machines had to pull weights that redistributed themselves in such a way that as the tractor pulled further, more force was required to drag them... it's a rich man/woman's hobby, with hundreds of thousands of dollars being poured into modifying and supercharging the agricultural engines, which guzzle a tankload of aeroplane fuel over their 100m or so course... it's quite interesting, but a day close to the action is pretty well guaranteed to wreck your ears for at least a few days... and probably do some permanent damage too... at the end of it all, there was a humorous demolition derby where the final two cars left alive battled it out at speeds under 10kph, their engines were so shot by that stage!!!

in contrast to the calamity of the saturday night, so much of the stay here has been spent observing the peace and docility of country life, and the beauty of nature... always reminds me of God's amazing creativity to see such diverse plant and animal life so richly abundant, and without rigorous structure and routine to follow... such a beautiful change from the hustle and bustle of city life... even decided to take a glider flight (at sportavia) and see the landscape so wonderfully expanded out below... the weather, unfortunately, wasn't ideal, and there were some spots of rain... and my camera ran out of film... so i jus hope that the shot i have from up in the glider turns out well!!! but the breathtaking scenery from the glider will probably draw me back to tocumwal to take a glider course sometime in the future!!! ;p the aerodrome is also planning to start hang-gliding instruction in a few months' time...

anywayz, will update properly when i get the chance... country life is really enjoyable, but at the same time, really looking forward to returning to melbourne... really missing friends (especially missing u, sal)... - but will be back in not too long!!!

God bless,
dave

ps... in future blog, will talk about the state of healthcare in this town... since this is the major reason why we get posted to rural areas... coming soon ;p

Country towns

2005-02-15T22:16:00.000+11:00

;p this is really going to be a short blog - need to sleep, coz morning i go to Berrigan, my small town placement, which is in NSW!!! only about hour and a half drive, though, i think...

country here is nice!!! in shepparton atm, been here since sunday, tho celebrated really wonderful valentine's day with sal ;p u are so special and full of pleasant surprises!!!

country towns are so clean compared with melbourne, went for a run around shepparton earlier and around the lake - lots of nice ducks and things... hospital is nice too, apparently servicing all the surrounding townships, as far as some places over the NSW border...

anywayz - better go... - shall look forward to writing interesting tales from Berrigan!!!