boku no blog

Sharia law debate

2012-01-06T01:54:00.001+08:00

This is a debate on Sharia law that I attended almost a month back, between the UCL Atheist, Secularist and Humanist Society and the Islamic Society. It was quite a heated conversation, but I must say this got me interested in the whole range of Islamic beliefs and most importantly how misinformed we are that all Muslims believe in the same form of Sharia law.

As a side note, this kind of debate is the one thing that I'll miss in Singapore because the Singaporean government will never allow such "sensitive" debate to be held in public.

Lazy

2011-11-30T08:41:00.000+08:00

Haven't really have time to update my blog recently (and partly because I'm too lazy).

And I'm still too lazy now.

Advanced Dissection 2 - Mental Nerve

2011-11-05T05:32:00.016+08:00

Today we started doing our electives dissecting the lower jaw. Other groups got different parts of the body ranging from the arms to the brain (which is quite interesting I think) to the neck. It is nothing like our routine dissection that we are having in our core programme now, which is quite crude, with severed nerves and vessels everywhere, to be honest. In this elective we have to be really meticulous and take our time to dissect the structures in a presentable manner.

Having been told that if we produce a really good specimen, we'll stand a chance of getting it published somewhere, we decided to go about doing everything really gingerly.

We (Edward, Sarah and I) were given a head (yes, a real head) that is literally split vertically into half in the centre. It belongs to an old man. You can see all the wrinkles and hair on the face, and if you turn it over, you can see half the brain, half the tongue and half the nose inside half the head. I actually felt really grateful and touched that he decided to donate his body for us. I don't know who he was, but I know that he used to be a living human with a story behind him.

We spent quite some time discussing how to go about doing it. Unlike our routine dissection, we were not given a dissection guide so we have to plan our incisions from first principles. We talked about things like if we should flap the skin forward or backward to best present the structures (and that depends a lot on the location of the nerve of interest and which direction it runs). We discussed on how deep the incision should be, the boundaries. In the end we settled on cutting a rather small, probably 5cm x 5cm flap of skin on the chin area (circled below). That's where this nerve called the mental nerve emerges from the jawbone. It provides sensory innervation to the lower chin, lip and a bit of the gum at the front of the mouth. During facial surgery local anaesthesia can be administered to numb this area by blocking this nerve.

However the most important point of finding this nerve is such that we can trace it all the way back, through the jawbone, where it branched off from another nerve called the inferior alveolar nerve. The inferior alveolar nerve is the whole point of our group doing this elective, because we are investigating how the inferior alveolar nerve can be damaged during wisdom tooth extraction, as it passes right through the root of the tooth. Dentists got sued a lot if this nerve is damaged, because it can be a bit of a problem if you can't feel anything at the front of your mouth, and it can affect speech and chewing as well. Very unpleasant, considering how wisdom tooth extraction is one of the most common procedures performed.

We started by cutting vertically down from the corner of the mouth, stopping just about 1cm above the lower border of the jaw. At the same time, we cut the lower lip transversely across into half, and then cut the gum in front the teeth (or where they should be, since the old man had lost all his) and peeled it away from the jawbone (it is actually very easy to peel the gum off the bone, I can do it by just sticking a finger in, waggle a bit and the gum is detached). We then spent pretty much most of our time sticking scissors in and opening the scissors up (not actually cutting through anything, but rather displacing the nerves and vessels away using the outer edges of the scissors, while tearing connective tissues at the same time to avoid damaging anything). I'd say it's some really delicate work, and I must say it almost definitely helps to improve our surgical skill should we choose to be surgeons next time.

At the end of the three hours I think we will never ever forget the function of the mental nerve and its course along the lower jaw — we just spent 3 damn hours looking for it and then nursing over it like a baby.

Advanced Dissection

2011-11-01T02:20:00.002+08:00

Photo by MildlyDiverting

Chose Advanced Dissection as my Student Selected Component this term.

Essentially we get to pick our own body parts to dissect, and then use the dissected specimen to explain a clinical point (for my group, two clinical points, since we have 3 people instead of 2).

We decided to dissect the face, specifically the areas around the lower jaw and the cheekbone. Face is quite a difficult area to study for, so this is an extremely good opportunity to really get to know our anatomy. We will be examining the possible nerve damages that can occur during extraction of wisdom tooth, as there are nerves that run quite close to the tooth. As for the cheekbone, we will be investigating the fracture in the cheekbone and any complication to the eyes, since it forms the floor of the eye socket.

At the end of the module we will have to create a poster and present these clinical points.

Leeds Castle, Dover, Canterbury

2011-10-31T01:59:00.001+08:00

Over the weekend we went on this very budget trip that costs just £19.50 to Leeds Castle, Dover (a very very small part of it) and Canterbury (basically all we did there was eating salad wraps).

Photo by Patricia :) Thought this picture was really cute! I think it's the first time in my life seeing a black swan.

Leeds Castle has really gorgeous castle grounds, possibly the nicest I've seen. Maybe even better than the Palace of Versailles in France.

Dover

The white cliff

And this is obviously not my own photo, because when we arrived in Dover we were told it's only a brief one-hour toilet break (and the scenery didn't look particularly stunning where we stopped), so we thought we'll go to the Dover proper later on in the trip. My camera battery went flat as well so I didn't take a single photo in Dover. It is a very very beautiful place so I'm definitely going there again.

Canterbury

A sculpture of Christ on the gate of Canterbury Cathedral.

Didn't do much here, other than having a salad wrap and taking some pictures on the grounds outside the Canterbury Cathedral.

Disability Workshop

2011-10-28T21:22:00.003+08:00

We had a disability workshop about visual impairment today. Someone came down to us to talk about how it is like to be a visually impaired person. We then had to walk down the street outside our school either with our eyes closed or wear special simulator glasses to get a feel of what it is like being blind or visually impaired.

The instructor (who is severely visually impaired herself) started out by telling us to close our eyes and then asking us how we feel physically and mentally. There were like twenty of us in the room, and almost all of us described negative emotions when we had our eyes closed — helplessness, dependence, embarrassment, claustrophobia, sense of loss, disorientation, self-consciousness. It is interesting because this is how we assumed blind or visually impaired people to be feeling, and we as future doctors will often empathise with them in the wrong way. Blindness or visually impairment need not always come with emotional stress.

One thing I am also quite impressed about is how much support the UK government provides to these people, which you will probably not find in other countries. The Royal National Institute for the Blind, for instance, offers services ranging from leisure advisory to help visually impaired people in their leisure activities, to resource centres where you can buy Braille birthday cards, talking clocks and watches, thick marker pens, special grids to measure notes, signature strips, modified spectacles with magnifier, and other specialist equipment, to employment officers where these disabled people can seek career advice and even get someone to be your personal reader to read out stuff for you. It's quite an eye-opener how little we know about these people in our society.

We also realised how much trouble and responsibility it takes to keep a guide dog. Apparently trivial things like getting dog hairs all over your coat when you're out, as you can't see them and don't know they are there until someone points it out to you, can be quite frustrating (probably it feels a bit like having bits of vegetable stuck between your teeth). Then there's always the emotional transition when you started out trying to be normal, going out without walking stick, stumbling and fumbling over things, then realising that it's probably easier to just accept your disability and get a walking stick, because everyone will now know that you're visually impaired and therefore respond more appropriately.

Generally I really appreciate how our curriculum is not only focused on the medical science part of the thing. I for one enjoyed the morning session because being a doctor is more than being able to recite drug names off the top of your head and name every single part of the human body. There are still much for us to learn, in dealing with people, being sensitive and putting ourselves in other people's shoes.

Pub debate

2011-10-26T00:40:00.015+08:00

Last night I had a really long talk with Father Peter during the drink reception for the Debating Society debate on whether patients have a right to die. Naturally the entire conversation revolved around whether God exists, and what is the source of moral value if God doesn't exist.

The interesting thing is that I was with the president of the Atheist, Secularist and Humanist society, so it was quite a huge clash of worldview. One thing I realised about this kind of discussion is that almost always it will end in an impasse, with neither side willing to change their opinion. Both sides hinge on different sets of assumptions, and the most important one being the view that most atheists hold, that everything that exists must be natural, hence bounded by the space-time continuum and obeying the law of nature described by physics, whereas monotheists hold that a 'supernatural' entity exists. Everything else is irrelevant, in my opinion, because once you start from the proposition that a 'supernatural' entity exists, one which logic and physical laws don't apply, then Christians are free to throw out any argument they wish, because no matter how absurd these arguments sound, they can always fall back to the proposition that logic and physical laws don't apply to God. 'God exists' is an unfalsifiable claim. I regret not posting the question to the Father to ask him if there's any argument that will falsify the claim that God exists. I could not think of any such 'silver bullet' to make a Christian un-believe.

On the other side, atheists are committing exactly the same sort of intellectual flaw. Instead of starting from the proposition that there exists a 'supernatural' entity — an unreasonable claim, and by that I mean there's no way a believer can reason a non-believer into believing — atheists believe that all that exists must be natural or physical (i.e. energy and matter) — yet another unreasonable claim. That forms the basis for all their arguments. God could not possibly exist because it is illogical or contradictory (the rationalist argument) and there is no reliable observable evidence (the empiricist argument). Christians will then argue that rationalism and empiricism don't apply to God, and from this point onwards, really, there's nothing to argue about. Maybe thinking about it, Christians do have a 'silver bullet' against atheism — God is above logic. Argument ending.

So really after the two hours of debate, I am still firmly rooted in my original stand — open agnostic atheism. I can't know for sure that God does exist or God doesn't exist, and I'm tending very much towards the atheist side of the spectrum, but I do believe that it is plausible that some people could have gotten some form of 'spiritual revelation' (whatever that is), that it is plausible that an omnipotent, omnipresent and omniscient God, who is personal, and who has sent Jesus to atone for our sin exists, and that it takes a leap of faith to believe in such a God. I do not however believe one can reason their way to reach a conclusion that God exists.

Lecture videos

2011-10-20T20:19:00.000+08:00

This year our lecture videos are all posted online, and consequently I find myself skipping lectures very often because I find it more advantageous to just watch them online in the comfort of my home.

There are a few benefits of doing so:

1. I get to sleep late, and that means I get to wake up late, which means that I won't fall asleep during lectures. You may ask why can't I just go to sleep early and wake up early? The answer is that I can't — I'm very obvious a night person who functions better at night.

2. It takes me 15 minutes to walk to school, and 15 minutes to walk back. It takes another 10 minutes to dress up, comb hair, put on contact lens, wear socks and shoes, and another 10 minutes to take off. Counting in some delay time, it all adds up to one hour every day in preparing for school. A huge waste of time if I can skip school entirely and just watch videos online.

3. I can rewind the video and listen to it over and over again, whereas if I were to attend the lectures, if I miss something, that's it.

4. Going by the same logic, I can pause the video and actually google something that I don't understand.

5. I can pace myself. If I feel tired I will just take a nap before watching the next video. In the long run it's better to have a solid one-hour sleep and study with a clear mind for the rest of the day, rather than study for the whole day without rest and feeling really groggy.

That's about it for self-justification for why I skip lectures.

Medicine

2011-10-09T19:41:00.002+08:00

It has been just three weeks since I arrived in London and the end of the second week of school, but it felt like a really really long time because we have done so many things within such a short time. For the first week we did lots of shopping for household items like broomsticks, mops, bath curtains, towels, ironing board and so on.

University has been interesting so far. My current module, Movement and Musculoskeletal Biology, interests me a lot. It has got all to do with bones, muscles, tendons, ligaments, joints and nerves. I like how it is so macroscopic and that I can use my own body as a visualization aid.

For my electives I chose Advanced Dissections for Upper Limb, Advanced Dissections (Clinical) and Cognitive Neuroscience - Behavioural and Brain Development during Adolescence as my three choices, out of which I will only get one (or possibly none, because I have a feeling they are all oversubscribed).

My cadaver this year proves to be a harder one to dissect than the one we've got last year. He's a bigger chap and has got much more fats to clear away, and we probably spent 90% of the time in the dissection room just pulling away at fats to get a good view at the vessels.

I'm however looking forward more to our Neuroscience module starting near the end of next month. As of now I'm still interested in specialising in Neurosurgery, even though I've been told that it's a darn hard specialty to get into (and legal insurance is a major headache because of how easily things can go wrong in brain surgery).

Internet

2011-10-06T06:09:00.001+08:00

Finally got my Internet up and running at my new house!

Arab Spring

2011-09-12T02:20:00.010+08:00

The more I read about the Arab Spring, the more divided my opinion becomes. Many people take a very clear side regarding the Arab Spring, but I find myself kiting between the camp that says that the Arab Spring will usher in a new era of political instability and military escalation, to the camp that portrays the Arab Spring as a success in the making and will make the Middle East a far more humane place in the future.

I am really ambivalent regarding where I stand on this.

When I first read about the NATO sending in air support to enforce a no-fly zone above Libya, I thought that it was the right thing to do to protect the civilians from an imminent massacre. A few days later it was apparent that the no-fly zone has turned into an air raid to provide support for the rebel army, and in my opinion this went beyond the mandate for a no-fly zone that was initially aimed at minimising civilian casualties, and instead actively taking side in an armed conflict. I'm not so sure about whether this is a right thing to do anymore.

Then there is this issue that still puzzles me. Why do we intervene in Libya, and not Syria, Yemen, Bahrain, Sudan? Politicians seem to draw the line somewhere, though the arguments made were extremely nebulous.

For example, Hilary Clinton responded to a CBS interview about why the US did not intervene in Syria by saying that "What’s been happening there [in Syria] the last few weeks is deeply concerning, but there’s a difference between calling out aircraft and indiscriminately strafing and bombing your own cities, than police actions which, frankly, have exceeded the use of force that any of us would want to see."

My first impression is that she is saying that we should not intervene in Syria because the Syrian government is only shooting people, not bombing them like Gaddafi did. So is that where we arbitrarily draw the line between intervention and non-intervention?

I also find myself questioning whether a military intervention automatically guarantees human right. I still think that there's a huge logical gap here. The main reason for my scepticism is that the Arab population is still largely illiberal as far as I can tell, and there is this very prominent example of an illiberal democracy in the Middle East — Iran (though many people are very keen to deny the fact that it is a democracy at all) — that some argue is worse off, or at least no better than before the 1979 Iranian Revolution.

There is a transfer of power going on now, and some would characterise that as a power struggle. Those that are victorious may very well not be democratic, and those that are democratic are not likely to be liberal. In fact I think it's more likely that the Arab Spring will culminate with the establishment of several illiberal democracies, than Libyans and Egyptians and Tunisians and Syrians becoming liberal Frenchmen overnight. Nobody seems to give much thought to that. However, what is truly worrying is how the Europeans and the US will respond to these illiberal governments should they form.

The world seems to be cheering on when the revolution seized the whole region, but regrettably few pragmatists had gotten their hands dirty and talked about the less pleasant outcomes of the Arab Spring. The best scenario is of course these nations turning into Britains and Frances. That will make the world a better place and I'll be the first to celebrate, but I seriously don't see that happening any time soon. People should be more willing to tread into the grey areas and take a deeper look at reality to realize that we are not living in the world of Narnia. People and nations do not and cannot change overnight. We need to have more realistic expectations.

PS. Well, I realized that I drifted towards scepticism again even though I started off saying that I was neither here nor there. I noticed that there's not much to be said if you are not a sceptic, because human right is obviously important and that massacres are obviously wrong and pigs don't fly. No one is seriously disagreeing on these premises. However politicians still go ad nauseum about how we should not stain our conscience by not intervening, that we can have another success like that in Bosnia, that Gaddafi is an evil man, and violent crackdowns on protesters are deplorable, and so on. These are obvious, but we like to hear the obvious. It feeds our wishful thinking.

Vials

2011-09-05T16:57:00.003+08:00

Pretty vials of cells that will soon be frozen with liquid nitrogen.
I am so going to miss culturing cells.

Roadside

2011-08-30T20:48:00.002+08:00

I miss the Buffalo wings!
(I refuse to post the photo up. It is that good.)

Cell culture

2011-08-26T20:42:00.003+08:00

Cell culture.
My routine nowadays.

Microtome

2011-08-24T21:51:00.001+08:00

Spent the whole afternoon microtoming cells.
Research is ending so so soon...

Presidential candidates

2011-08-22T01:36:00.009+08:00

Having watched the TOC presidential debate...

1. Tony Tan seems to have no principles at all. He is definitely not independent. He's not even clear-minded!

2. Tan Jee Say is definitely the most outspoken speaker out of the four. In fact he's my favourite, if not for the fact that he seems to have quite a rosy view of the power of the President. If he's slightly more moderate and slightly ‐ only slight — less confrontational, he'd be a perfect candidate.

3. Tan Kin Lian seems very meticulous, but his ideas are all over the place. I like his idea of setting up a Presidential Advisory Team though.

4. Tan Cheng Bock is an honest man, and I actually thinks he's quite humorous (though not as humorous as TJS). However I think he's not sharp enough for the job because he misses the point in many measures he proposed (eg. Prime Minister having a separate office from Istana).

Given that Singapore is a single-party system, which in my opinion is not flawed in and of itself, it is definitely in need of a check-and-balance mechanism to ensure that the ruling party serves the nation. An elected President with veto power, backed by popular support, and willing and unafraid to exercise the veto power, will go a long way into ensuring that the government continues to function properly and legitimately.

Videos follow:

Political Functionalism

2011-08-15T23:59:00.010+08:00

Like it or not, immigration will continue, and the demographic of every country on earth will change. Any attempt to stop the flow of labour will inevitably fail, just like the isolationist and protectionists' attempts against global trade. The ease of information transfer also broke down the boundaries between countries, and more and more people become not merely connected, but hyper-connected. Globalization is unavoidable, not just on the economic side of things but also demographically and ideologically. Societies will become more and more pluralistic in terms of culture and ideology.

There is a contradiction in cultural pluralism and democracy (or specifically, liberal democracy). As capitalism has shown, people are motivated primarily by self-interest, and it's wishful thinking to believe otherwise. People can occasionally be nice and giving, as in how people donate to charity so readily for the greater good, but there's a reason why our economies aren't run like charities - people are self-interested.

And democracy feeds on the differences of the population. The theory goes as follow: people have different viewpoints, and democracy ensures that people are able to voice their viewpoints, discuss openly and ultimately come to a middle ground.

And here the contradiction arises. Democracy proposes that people will naturally gravitate towards a compromise. However, if people are ultimately motivated by self-interest, the differing viewpoints will naturally diverge from one another, seeking to tilt the balance towards themselves. As the number of differing viewpoints increases, a common ground may be harder and harder to find - and the society may not wait around for the political equilibrium to establish itself.

In a laissez faire economy, consumers are said to be able to vote with money, signalling to the market which goods to produce more and which goods to produce less. This political analogy can perhaps be turned in on itself when talking about democracy. A completely liberal political system faces the same problem as a completely unregulated free market - market failure. Self-motivated consumerism will neglect the external costs to the society and environment. A completely unregulated tobacco industry will result in a major abuse in tobacco, where people only consider their own costs and benefits before buying a cigarette. Public interests are generally not taken into account when making purchase decisions. Yes, there are people who spared a thought for others, excusing themselves to have a puff elsewhere, but you can not run an economy based on the goodwill of people. You need regulations.

The same can be said of the political system, especially as societies become more heterogenous and globalized. The political 'market failures' are all too evident today in many democracies - the poor and the minority being excluded and marginalized, too much political capital going towards maintaining the 'too ~~big~~popular to fail' welfare system, implicit concentration of power in the elites, the rich and the influentials, failure to take other countries into account as politicians are mainly accountable to their voters, irrationality of the masses, information asymmetry (the society does not understand the bigger picture, but often they also hate being lectured upon by their leaders). These are problems faced by many democracies nowadays, and I'm sure one can find examples of each.

The caveat here is not to veer towards fascism and totalitarianism, just like how a command economy may be indeed more disastrous than a completely free one. A balance needs to be struck, freedoms need to be traded off, both among themselves and against other goals like stability.

I argue for what I call 'political functionalism' (It may go by other names but I'm not able to find the correct label for such a view). I believe that a political system should be a practical solution to problems we face in society. We change our political institutions to best adapt to the changing circumstances.

Realise that political functionalism and democracy are not mutually exclusive - if a culture or a society demands for a democratic state, then by all means create one. Eventually, all states may very well become democratic, not because democracy is the true utopian ideal, but rather it's the system that functions the best. Similarly, if the situation calls for a more paternalistic government, then we should not feel the repugnance to create one.

The current Western-style democracy is the complete opposite of my idea of a perfect system - it is committed with a lofty ideal, and then indiscriminately try to impose the system on whatever society it comes across, regardless of their circumstances. It is uncompromising and rigid on various fronts, especially regarding the enshrined values of individual freedoms that are virtually inviolable, no matter what the situation is. Realistically, it is a monistic system that tolerates no other values or the possibility of any compromise, and I henceforth question: can such a system that declares itself the 'End of History' truly withstand the test of time?

London Riots

2011-08-11T09:35:00.010+08:00

It is wishful thinking that the riots are 'spontaneous' and 'nothing more than criminality'. Community leaders have made reference to underlying social and economic conditions that sparked the problem, and it's just pure denial and political irresponsibility to disregard these problems. But even if it is just recreational violence, the politicians ought to be asking themselves how did such a developed first-world country descend into this state of anarchy, senseless opportunism and jocular greed where people - youths and juveniles - just mugged and looted and murdered for 'recreation'. This is more sinister than any riot in Syria or Libya; at least people there are rioting for a purpose. This criminality and moral decadence is an endemic problem that has been brewing under the surface for a long time. There are plenty of room for reflection.

It doesn't matter that these riots aren't politically-motivated. Riots are an outburst of anger, where people often do not stop to put a voice to their anger, but rather choose to be engulfed in pure wrath. There is usually a clear message in protests, but you don't expect to find much rationality in riots. But Riots always have an underlying cause, social tension, urban decay, economic deprivation, unemployment, inequality, police brutality, discrimination, oppression. It is naive to think that any riot is spontaneous. It betrays a more chronic problem in society.

Four Temperaments

2011-08-07T09:11:00.001+08:00

Read about the Four Temperaments:

Sanguine
The Sanguine temperament personality is fairly extroverted. People of a sanguine temperament tend to enjoy social gatherings, making new friends and tend to be boisterous. They are usually quite creative and often daydream. However, some alone time is crucial for those of this temperament. Sanguine can also mean very sensitive, compassionate and thoughtful. Sanguine personalities generally struggle with following tasks all the way through, are chronically late, and tend to be forgetful and sometimes a little sarcastic. Often, when pursuing a new hobby, interest is lost quickly when it ceases to be engaging or fun. They are very much people persons. They are talkative and not shy. People of sanguine temperament can often be emotional.

Choleric
A person who is choleric is a do-er. They have a lot of ambition, energy, and passion, and try to instill it in others. They can dominate people of other temperaments, especially phlegmatic types. Many great charismatic military and political figures were choleric. They like to be leaders and in charge of everything. They can be very manipulative.

Melancholic
A person who is a thoughtful ponderer has a melancholic disposition. Often very considerate and get rather worried when they could not be on time for events, melancholics can be highly creative in activities such as poetry and art - and can become occupied with the tragedy and cruelty in the world. A melancholic is also often a perfectionist. They are often self-reliant and independent; one negative part of being a melancholic is sometimes they can get so involved in what they are doing they forget to think of others.

Phlegmatic
Phlegmatics tend to be self-content and kind. They can be very accepting and affectionate. They may be very receptive and shy and often prefer stability to uncertainty and change. They are very consistent, relaxed, calm, rational, curious, and observant, making them good administrators. They can also be very passive-aggressive.

I wonder which category I fit into.

I think that to a large extent I'm a sanguine, and to a lesser extent a phlegmatic.

Career Talk @ TTSH

2011-07-17T01:19:00.007+08:00

I have two takeaways today after attending the career talk:

1. I really like the idea of residency program in Singapore, because it saves time and gives me the freedom to go into a specialty directly. The British system seems really drawn out, albeit it gives us more insight into various specialties before we choose to specialise.
2. The hospitals here really seem not to discriminate much between international medical graduates and the local graduates. Good news for me.

The more I speak to people about ophthalmology, the more I'm drawn to it. The microsurgery, the quick recovery following operation, the low risk of surgery, the competitiveness (and the accompanying prestige), the potentially high income... Although I haven't been down to doing the more clinical stuff, I find the science quite interesting already.

Other thoughts:
- Anaesthesiology seems too medical for me. I want to do more surgical stuff with my hands.
- I can't help but feel like orthopaedics are glorified carpenters, with their saws and drills and nails and screws. However this won't stop me from majoring in orthopaedic science during my BSc year because I still want to give it a shot.
- There is no neurosurgery department in TTSH. I'm really interested in finding more about neuro.

IBN update 2

2011-07-15T21:41:00.006+08:00

I had the good fortune to participate in a retina transplant surgery done on the rats. Yesterday my research mentor and I spent about 4 hours in the operating theatre putting artificial retinal tissue into the rats' eyes. We did 10 rats.

Today I went down with my mentor to Duke NUS medical school to consult Prof. Ralph, a veterinarian pathologist. Being an ophthalmic surgeon, my mentor wasn't familiar with animal histology so she had to seek advice. This emphasizes how divided scientific knowledge is nowadays. One can be extremely proficient in one area and yet ignorant in another.

Besides that, I had little chitchats with some of the colleagues in IBN. Whenever they heard I'm doing medicine, they are curious as to why I chose to do research attachment. Two things struck me here:
1) there are very few doctors in Singapore doing research; the research culture among the health professionals is not quite there yet;
2) even researchers themselves believe that research is not as noble or worthwhile a profession as being a doctor.

On the first one, I had gathered from several colleagues that I'm one of the few medical students who intern in A*STAR. Most medical students who decide to intern in A*STAR, for some reason, seem to be overseas medical students. I know quite a couple of medical students who are also working with me, and none of them are from NUS (there are quite a few from Scotland, interestingly). Several possibilities here: NUS medics either manage to find their own mentors, too busy with other commitments like volunteering or preparing for orientation camps and the likes, or the research culture in Singapore is generally not prevalent.

I'd think that it is a combination of these. Local universities differ from that of the UK in a few fundamental philosophies. For instance, there is a huge emphasis on extracurricular activities: interhall games, orientation camps, sports, rag and flag... and they are often made compulsory to attend one of these at some point in time. In the UK, we do not have any of these activities (yes, not even orientation camps). The rather obligatory nature of these activities appears as though university students here have to be taught how to have fun, and have to be explicitly given the platform and opportunity to bond and socialise. I've heard some faculties here actually have matchmaking session during their orientation camps. Do people here really need to be taught how to love as well?

On the contrary, and quite ironically, I'd argue that the support network for students to get research and laboratory experience in Singapore is still somewhat insufficient, as compared to the UK. Many medical schools in the UK made it compulsory for students to pursue a bachelor of science degree in a specific field, along with their medical degree. For my university, we have customised BSc programmes for medical students, with majors ranging from immunology, to orthopaedic science, to international health, to medical philosophy. I know the Duke NUS school allow students one year off to do research, but I'm not so sure about YLLSOM. Also in the UK we have 'electives' that allow us to get some laboratory experience - I did one on antibiotic resistance and another on speech science. Local medical students seem to have to find their own research projects to do, because the support system isn't in place to lower the entry barrer into research.

But one thing I like about the Singaporean system is that medical graduates here will probably have a rock hard foundation. The exam-oriented culture and the focus on memorisation and regurgitation do have some advantages. Just look at how UK universities scraped essay-type exam questions a few years back. The General Medical Council argued that essay-based questions test study skills rather than thinking skills, as well as not being discriminating enough between the good students and the exceptional ones. Being in the Singaporean system for over a dozen years I'd have to agree with UK's GMC - the ones who have exceptional memory, or the really studious ones, will ace their essay questions, but these qualities alone seem not to be the traits one would associate with a good doctor. Having that said, I often feel that I have not really internalised what I learnt in my course as well as I did for my A levels.

Moreover, my notes nowadays often consist of trivial piece-meal statements like "dysplasia is always pathological and never physiological", "myofibrils in smooth muscle is NOT arranged into sarcomeres", "in blood vessels there is only circumferentially arranged smooth muscle", "patent ductus arteriosus DOES NOT cause hypoxia"... statements that seek to clarify concepts rather than to record information (partly because I think I can reproduce the details from first principles myself, and partly because there is no essay question for us to have the need to memorise hard facts). And I jotted down a lot of negative statements, which I almost never did when I was studying for biology throughout my secondary school and A-levels. The study method is very different from that of my peers in NUS, and I'd argue that we can evaluate information and spot mistakes better than local medical graduates, but we may not be able to recall facts as well or as fast as them (presumably haha).

On another note, I'm amazed quite a number of researchers in IBN feel that the research career is less significant as that of a doctor, which sounded to me to be more than just modesty and humility. One colleague went as far as to say that most research is a "waste of taxpayers' money". I actually do not know enough to make a personal stand, but I've heard some viewpoints from both sides. My director, for example, felt that research will eventually benefit humanity more than doctors, because of the wider application of research. However my mentor felt that being a researcher is often not a very rewarding job, because almost all the time the product of the research never materialises because there is a long train of commercialisation processes and transitional stages before, say, a drug will reach the market. Some research findings never even got that far to benefit anyone. As a surgeon, my mentor felt that saving or improving lives with one's own hands offers constant and immediate doses of satisfaction that kept her going, whereas she had worked on a single project for months and years, and the fruit of her labour still remained uncertain and beyond her control once she published the paper.

It has been a thought-provoking week so far, and I have never learnt so much in such a short span of time before. I really hope I can contribute something - by helping to optimise some procedures, design some material, coming up with new methods, troubleshooting, whatever - to have my name up in the list of authors when they publish their paper. In addition, my goal in the near future is to publish an original paper, before I graduate from medical school, so ideally I can pick up enough knowledge and inspiration and guidance to start one myself. Shall keep my eyes peeled, and fingers crossed, for that.

IBN

2011-07-12T22:38:00.006+08:00

My research attachment has been quite interesting so far. I just went for a workshop on vitrectomy (a kind of eye surgery) in the morning, then I went through a lengthy briefing on how to subculture a kind of eye cells called retinal pigmental epithelial (RPE) cells, followed by immunoflorescent staining.

Research and Work

2011-07-08T11:07:00.005+08:00

I am so excited for my research attachment starting next week! I still am not informed about the exact title of my research project, but I will be doing something on the eyes.

There is this vitrectomy workshop that I will be attending. Vitrectomy is this surgical procedure to remove the vitreous humour - the jelly-like substance that fills most of the eyeball. I will also be doing animal research, and hopefully get to operate on rats. Exciting hands-on stuff :) I will update with more photos next time, if confidentiality and research ethics are non-issues.

I know it's still a distant 5 years away, but I'm now thinking about my future career prospect in Singapore. At the moment, I disapprove of the NHS philosophy and the way the system is run, so working under NHS doesn't seem attractive to me. I think the only disadvantage of studying overseas is that I won't have the necessary network here; they will most likely prefer to work with fellow NUS graduates. But come to think of it such protectionism is not foreign to me, being a foreign student in Singapore since a very young age, I have always been missing out on awards, grants and scholarships and the opportunity to take part in competition because I'm not a citizen. Then there came application to university; in which international students like us have to again compete for the 20 limited places offered to us. And now I somehow managed to get an internship opportunity at A*STAR, presumably also competing for places with the locals and I'd think that A*STAR is not the easiest organisation to get in.

So fighting for a place in the residency programme here as an overseas graduate shouldn't be anymore different from everything else. In fact from the various employment talks MOH held in London it seems that at least it's not an insurmountable obstacle, and I gladly accept the challenge because I want to earn a residency place by my own merit, not by connections.

Italy Day 7

2011-07-06T23:56:00.003+08:00

Last day in Italy, and it's a short day as we prepare to leave for the flight back to London in the evening. Frankly I have gotten a little sick of Italy already.

Inner ceiling of San Marco cathedral.

We started our day with a visit to the Gallerie dell'Accademia, the museum you HAVE to visit when you are in Venice. If you remember my previous posts about paintings I want to see in Italy, I've basically seen all of them (and more!). I am a very satisfied boy now.

Evaristo Baschenis' Musical Instruments. He is quite a weird painter as his paintings are mostly about musical instruments.

The Feast in the House of Levi by Veronese. An extremely famous painting.

Giorgione's two famous paintings, The Tempest and the Old Woman.

The Dream of St. Ursula, by Vittore Carpaccio.

Departure of the Pilgrims by Carpaccio. Note the top right corner. I find the flag with the smiley face quite cute.

Dined at Trattoria alla Rivetta before making a trip to Arsenale for some contemporary art exhibition.

Italy Day 6

2011-06-30T16:39:00.001+08:00

Second day in Venice. We planned to go to the three satellite islands - Murano, Burano and Torcello, famous for glass making, lace-making and being the origin of Venice. We ended up missing Torcello as the vaporetto station was closed.

We walked down a street with a violinist. The other day we heard a pianist practising in his/her house. It seemed quite fairytale-like to walk in the Venetian street; it is as though everyone who lives there are all musicians.

The weather was unbearingly hot, and the sun was blazing. We felt quite uncomfortable while we walked on Murano, the island famous for glasswares. We didn't buy any as their prices were beyond our reach. Our first impression of the island is that it is a giant glass-making factory, and it is so targeted at tourism that it felt like everyone out there is out to get our money.

Towards evening, we took another vaporetto to Burano, the island specialising in lace production. It is also famous for its colourful houses.

We had our dinner in the same Chinese restaurant as the previous night, wearing the same set of clothes and sitting on the same seats. On hindsight I realized that food expenses made up the bulk of our travel expenses. I actually considered bringing some cup noodles and a kettle to make our own dinners the next time we go on a budget trip, because it will scrap a hundred over euros off our bill.

A partially flooded San Marco square.

We ran our way back to the boat, reaching just 5 minutes before it left.

Italy Day 5

2011-06-29T01:51:00.005+08:00

Woke up near noon because our previous day in Verona was quite hectic. We were quite excited about Venice because we've heard so much good things about Venice and we were just about to experience the City of Water and City of Bridges for ourselves!

I resolved to not make our stay in Venice as rushed as the day trips to Milan and Verona; we had wanted to cover all the tourist attractions as we will probably not return to the city in the foreseeable future.

We took a boat to Venice from our hostel, which cost a whopping £25 for a three day pass. It was those hidden expenses that we did not take into account for when we planned the trip.

Venice was a lagoon, a body of shallow water that is separated from the sea (and in the case of Venice, the Adriatic Sea, an arm of the Mediterranean Sea) through some form of barrier.

Venice was quite spectacular when viewed from the open sea. I've read that Venice will sink, or at least be flooded, by 2050. The San Marco square in Venice has already been periodically flooding due to high tides (acqua alta) - water literally seep out of the ground and over the quays, flooding the square to several centimetres when the tides rise. My grandchildren may not be able to see Venice as it is today, which is quite tragic as it is such a beautiful city.

Venice was built on wooden piles, which do not decay due to the anaerobic condition under water. The mineral-rich seawater turned the wooden piles into stone-like structures through the years.

Probably the most interesting thing about Venice is the myriad of little alleyways. It is very easy to get lost in the labyrinth of stone houses and bridges that look almost identical, but Venice is a relatively small island and one is bound to hit the shore sooner or later. A map became completely useless there.

I think Venice's economy is close to a perfect competition, one that is almost entirely targeted at tourism. The souvenir shops sell nearly identical goods, and the ristorante and trattoria have nearly the same price. There were odd shops here and there pricing at a slightly different rate from the other shops, but I've probably never seen such price homogeneity anywhere else in Italy. The demand there for the goods is probably quite high, and with the a low price elasticity the prices are driven all the way up. Either that or they have some form of tacit price fixing.

Many Chinese immigrants seem to own shops there, including pizzeria and ristorante selling Italian pasta and pizza, and hiring Italian waiters. I wonder how the Italians come to view these Chinese shopowners. Scheming opportunists who erode away at their culture, marketing the Italian culture as their own? Or do they just treat them as fellow Italians, as long as they are rich enough to own a shop? I doubt the second case. On the contrary, in Venice at least, the South Asians and the African largely sold merchandises on the road, such as counterfeit bags and some weird squishy, rubbery toys. There seemed to be quite a wide ethnical divide in Venice.

I saw on many shops with big signs stating that they do not import from China, or that their glassware and handbags and dresses are not China-made. I think there is really some lash-back from the world towards China-made products, because they are so cheap to produce due to low labour costs to a point that they are endangering local produces. I remembered reading that China labour advantage will disappear by 2015, with the labour costs equilibrating with the rest of the world, and possibly higher than some parts of Europe.

I find the irony in that during the colonial period, European companies like the East India Company produced lots of Chinese silk and tea and tapestries and porcelain cups and plates and other stuff and sold them for profit, at the expense of labourers in Asia. Asians used to be quite irritated with such exploitation but due to Asia's weak economy there wasn't anything they can do about it. Now that the tide is turning, with Chinese and Indian companies owning a bigger slice of European and American firms, and industries like automobile manufacturing and electronics and mining becoming more and more Asian-dominated, will they develop the same level of disdain and indignity towards Asians?

And that left me thinking about what determines cultural superiority, if there is ever such a concept? Is it physical attributes? Probably no, as the Africans have the strongest physiques, but that alone didn't seem to earn them enough respect. Is it intellect? Possibly, with the Europeans starting the Industrial Revolution and coming up with the concept of democracy and practically all the inventions that we use today. But then is it because of intellect or is it because they just have enough financial resources and the right motivation to do so? It is quite hard for people in China to want to invest the time and effort into developing machine when they did not have the labour shortage that Europe faced in the past. Asian economies like Japan, given the right economic and political environment, did come up with fantastic innovations like robotics and cutting-edge medical technology. Is it political power? Possibly not, as the Russians once was a major global superpower but they are not performing so well both economically and politically in today's world.

Okay I digressed. Food is really expensive in Venice, more so than other parts of Europe.

We got a free vaporetto ticket from a random White stranger. I thought he was trying to sell me tickets, which we didn't really need, but we wronged him. Apparently he bought a pass but he was leaving Venice before it expires, and therefore he was giving it away to us. We should have given him a bigger smile and a bigger thank you for his kindness. Vaporetto is the only form of public transport in Venice (except the Gondola, which is a really nice boat that cruise around the little canals, albeit at a very privileged price). It is analogous to buses, and in fact they are often called waterbuses.

We had dinner at a Chinese restaurant. We are still not used to eating Italian food, especially not for an entire week. The exorbitant food price are another hidden expenses that we did not take into account.

I find that Italian food seems oddly similar to Chinese food. As far as I know, nowhere else in Europe serves noodle (pasta) and rice (risotto) and dumplings (ravioli and tortellini). It may have arisen independently of Chinese but I'm just wondering if there was any influence in either way. There was this legend about Marco Polo bringing the idea of noodle from China into Italy, when he returned from China after serving under the Mongolian ruler Kublai Khan as his court official.

Bought a couple of Venetian masks. Costs about €9, but I thought it'd make a nice souvenir. The shopowner was really really sincere and friendly, so it felt really good to buy from him. According to Wikipedia, the mask would permit the wearer to act more freely in cases where he or she wanted to interact with other members of the society outside the bounds of identity and everyday convention.

On our boat ride back to our hostel, we still see many construction cranes and hydraulic excavators out in the sea, seemingly reclaiming land. I've read about this MOSE project in which 79 inflatable pontoons will be built on the seabeds, at three entrances to the Adriatic Sea, and once inflated will block these entrances during high tides, preventing the lagoon being flooded. Probably the cranes and excavators we saw were building these high-tech "dams".

Light beacons in the sea to guide vessels.

Italy Day 4

2011-06-27T13:48:00.000+08:00

Verona, the town made famous by the story Romeo and Juliet.

I said farewell to the innkeeper in Como, who was so friendly that he gave me a big wave when I left. Italians are warm people after all, probably less xenophobic than the Parisiens, and maybe even the Londoners.

Italy seems more homogenous demographically than the UK. 97% of Italy's population are Europeans, compared to just 92% of the UK population. Como and Milan are not very cosmopolitan, and I heard from my friend who's studying there that other cultures had only infiltrated minimally into Italy.

Italy's flag is coloured green, white and red; similar to the French tricolor. In fact it is directly inspired by the French flag as Napoleon brought it into Italy in 1797. The 1789 French Revolution had quite a wide repercussion around Europe, with Napoleon being the vessel that spread the democratic ideology around Europe. Almost every country I'd visited - France (obviously), Belgium (the Battle of Waterloo especially), the Netherlands and Italy had Napoleon's footprint. Napoleon did not set foot on Britain though, due to Britain's insurmountable navy in the past.

Villa Olmo.

We visited Villa Olmo before we left Como. It's one of the villas that aristocrats use as their holiday resort in ancient times.

The breakwater and the dock in front of Villa Olmo.

We took a train to Verona. Verona is a very historical place, once a fortified city in the Middle Ages.

A four-leaf clover. We are lucky people.

Had dinner at a Chinese restaurant before visiting the Roman Arena because we had such cravings for Chinese food after 3 days. We actually had to ask a security guard in MacDonalds, in Italian, where to find one nearby. But I know just about enough Italian to piece together the word "Chinese" and "Restaurant" to be able to get my question across.

The arch in front of the Roman Arena, a smaller version of the one in Rome but just as impressive.

Shakespeare. An example of how English culture was brought halfway across Europe into Italy.

King Vittorio Emanuele II, the first king after the unification of Italy from the various kingdoms.

The Verona Arena, built in AD30. It can host 30,000 spectators to various shows and games, and are still in use today.

The Town Hall.

The Piron Declaration on an old city wall, which says "Walled Towns are unique inheritances from times long past and should be treasured, maintained and safeguarded from neglect and destruction and passed on into perpetuity as irreplaceable Time stones of History". It is basically an international agreement to preserve old town walls.

The Veronesi built their streets around old landscapes, such as the drainage system above.

Part of the old town wall that are preserved even in the construction of new houses.

Walked down the multiple alleyways until we reached Juliet's House, a symbolic place featured in the Shakespearean tale.

The Juliet's wall, where lovers scribble their names on it for everlasting love. Such a romantic place :)

A wall filled with thousands and thousands of names and love declarations.

A performer in the Piazza Erbe, a plaza filled with merchants, locals dining in open-air cafeteria and, of course, a throng of tourists.

Piazza delle Erbe, which used to be the Roman Forum during the time of the Roman Empire where philosophers and politicians debate their ideas.

The Hunchback by Gabriele Caliari (father of the famous Renaissance painter Paolo Veronese), in the Sant'Anastasia church in Verona.

Riverview along River Adige, overlooking the Castelvecchio Bridge. The fortified bridge allows the Lord of Verona to escape from the castle in the case of rebellion against his tyrannic rule. A well-prepared ruler indeed.

Arco dei Gavi, a rather tiny arch near Castelvecchio. It used to be a gateway on the city wall before the French under Napoleon's rule deconstructed it and reconstructed it next to Castelvecchio, its present location.

Walked a long long way to San Zeno, the supposedly beautiful church where Romeo and Juliet got married. But after trying very hard to ask our way around with piecemeal Italians mixed in with very rudimentary English, getting lost multiple times and having to walk all the way there after a long day, we were really disappointed when we arrived, only to find it closed with ugly scaffolding up on its exterior.

If you wiki San Zeno, it's not a particular beautiful church in any case.

Took another train to Venice (had to run to the Verona train station after the detour to disappointing San Zeno), we boarded a direct train to Venice. Once we reached Venice we had quite an ordeal getting to our hostel. Firstly the instructions given in the hotel booking was wrong. We were told to board a certain bus at a nearby bus stop, but according to the signs on the bus stop, we could not find any information nor timetable for such a bus. We then tried to ask various Venetians here, but they were so unhelpful and rude. Probably the bigger the city, the less friendly the people get for god-knows-why.

In the end we followed another group of tourists who happened to stay in the same hostel we were going to stay at and reached the hostel successfully.

Italy Day 3

2011-06-20T17:14:00.004+08:00

Probably the most interesting day in Italy. We went on a daytrip to Bellagio, a small town along Lake Como.

I saw the first cockroach ever in Europe, and it was a really small one with long legs (I have a feeling it's not even a cockroach, but it's a very weird insects). Europe is relatively insect-free, as far as my experience tells. There were a couple of flies in our kitchen last time but that's about it.

Took a stroll along Lake Como after breakfast.

Lake Como is one of the most beautiful lake in Italy, as well as being the third biggest. There are many villas around the lake as it was frequented by aristocrats since the Roman times. Como is the hometown of Alessandro Volta, the inventor of battery.

A 'temple' dedicated to Volta.

Observation: While reading the Como guide, I made more observation about the Italian language. It seems a lot more streamlined than French. It has less 'filler' words unlike French: the ne, la, du, de, au, à. Italian uses articles but the grammar rules seem much less stringent than French, which requires article before almost every noun.

Lake Como is beautiful. Weather was good (although it started to rain in late afternoon. The hills around the lake are dotted with inquisite villas and small colour cottages. It must be really expensive to build houses on such hills.

Took a cruise to Bellagio from Como. Quite an uneventful one-hour ride.

Bellagio is basically a very serene town that has merchandise shops near the harbour and cosy houses inhabited by the locals further inland.

It is very clean but yet has a chic 1800s feel.

A street sign that left us wondering what does it mean.

A gradual rock-walled stairs leading further uphill.

Hill trek. Extremely extremely scenic place.

A shipyard, not sure if it's abandoned or not but it has a strange desolate feel to it.

Bellagio is perhaps a very suitable place for retirement.

People here usually own a cruise that they can use to sail around the vast Lake Como, which has a very scenic lake view perfect for fishing. The houses here are little cottages that seem really lovely to live in.

A really cute ladder we saw outside a house.

After getting quite famished, we finally returned to Como for a nice sumptuous Italian dining.

A mega huge portion of lobster spaghetti. The spaghetti portion was really generous. Not sure if it is worth it to splurge on supposedly authentic Italian food, but decided that since we are in Italian might as well eat something good.

The biggest cathedral in Como.

Limoncello with Wendi and Alexa. A kind of Italian lemon liquer that tastes stronger than it looks. 40%. Got a bit dizzy after a couple of shots but managed to walk back to my hostel safely.

Italians, especially in less urban cities like Como, really know how to enjoy life. A stroll along Lake Como, a train to Milan for shopping, another train to Venice for some art museums and sightseeing along the canals. I think I've become too accustomed to life in a metropolitan city and the high-pace, workaholic Asian lifestyle that I am just not used to not little things like not having food places open past 10 in the night. Are these things really necessity or are they just excesses that ought to be trimmed out altogether? Before I start my university I used to work in Singapore until 10 in the night on two separate part-time jobs, and I can find plenty of food centres around my house that opens well into midnight when I can have some supper. And yet very few shops open till this hour in Europe. This kind of long working hour may be an adaptation to the workaholic lifestyle of Singaporeans (or Asians in general).

I think to a large extent Asian countries lift themselves out of poverty by such workaholic attitudes. We did not have a headstart like the West in terms of industrial innovation nor colonialism. I think as a matter of fact, the Industrial Revolution is fated to arise in the West because they have a shortage of human labour and therefore it makes perfectly good sense to fill up the deficit in labour with machines and automation. In China and other Asian countries we have the advantage (or disadvantage depending on how you see it) of having a huge population and land that there is little reason for the idea of Industrial Revolution to spontaneously arise. We simply did not have the need to as we are more or less self-subsistent. The Industrial Revolution led to a drastic improvement in maritime technology and weaponry, which enabled colonialism (and the subsequent power vacuum when the West dismembered their empires) that crippled most countries but benefited an exceptional few like Hong Kong and Singapore by endowing it with a functioning parliamentary structure. Given we had such a heavy setback, I think some credit ought to be given to the workaholism spirit that brought countries like Japan, Singapore, Hong Kong, South Korea and China out of poverty in such a short time. Competition is harsh here, and the machine of growth is already heating up rapidly. Our generation is one that places a grave importance on economic growth than anything else, like freedom and liberty.

Italy Day 2

2011-06-18T00:41:00.005+08:00

Went to Milan. To be frank it's quite underwhelming for a city that markets itself as the mecca for high-end shopping.

Dined at my hostel. The breakfast is just a simple bun with butter, along with orange juice and cappuccino. Drinking cappuccino in Italy is so awesome! It's quite different from the English breakfast, which has hot food like baked beans, bacon and egg and sausage. It is also different from the French breakfast, which has the so awesome croissant and milk tea or hot chocolate. I personally prefer French breakfast.

Back to Como station.

A hand statue in front of the Como station.

The train service in Italy basically runs itself. We are supposed to buy a ticket from a machine and then proceed to "validate" the ticket by getting it stamped by a machine. All of these are unmanned and technically one can just hop onto the train without a ticket. Of course being good citizens we did not do that, since the train tickets aren't that expensive anyway.

A row of flower outside the Como station.

Observation about the Italian language: virtually all the Italian words end in a vowel, and the number of vowels in a word is almost always the number the syllables in a word. Quite a straightforward language to learn.

Reached Milan Garibaldi station in about an hour's time. The train stations in Milan are colour-coded, with the train carriage, the wall, the signs and the booths all coloured in the same colour as the line. It is a very interesting concept and makes it really easy to navigate around.

Got to Duomo from Garibaldi on the urban underground system. African immigrants are trying to sell us all sorts of stuff in the square. Some offered tourists pigeon feed to attract the pigeons in the square, and then pose for a photo. I saw a Chinese man foolish enough to let them do that, but was completely taken aback when they insisted that he paid for it. He needs to travel more to know how to ignore these people, because I fell into the same trap when I visited Paris.

Entered the Duomo, the seat for the Archbishop of Milan. It is the largest cathedral in Italy and the fourth largest in the world. The Milanese took 600 years to complete the Duomo, and it has the most intricate spires I've ever seen on a church. I have no idea how they manage to get the sculptures up there because cranes haven't been invented then. Such an engineering marvel. It has a really spacious interior.

Statue of King Vittorio Emmanuele II

Lunched at Spizzico, a fast-food pizza chain in Italy. Got a Margherita pizza with cheese cake and fragole panna and coke. Love the cheese cake.

Galleria Vittorio Emmanuele, a high-end shopping arcade that we basically walked past because we are too poor to afford anything there.

Saw a cute little pigeon on the road, seemingly trying to brood her eggs.

There were considerably more Chinese in Milan, and they seem to be really rich tourists out here to buy Prada Milano bags. Milan is a shopping town basically, with a high end shopping area called the Golden Quadrangle, or Quadrilatero d'Oro in Italian. Many flagship Italian brands such as Armani, Dolce & Gabbana, Gucci, Prada are found in Milan.

Next stop was Pinacoteca di Brera, an art gallery that has some really good masterpieces in Italy.

And there I started hunting for the few paintings I have noted in my previous blogpost, as well as other famous ones I've read about in the past.

The Kiss by Francesco Hayez. He is becoming one of my favourite painter.

Carlo Carra's Metaphysical Muse.

Umberto Boccioni's a fight in the arcade.

Supper at Emmaus by Caravaggio. This room was quite heavily guarded by a curator so I can only snap the picture from a blind spot. I couldn't resist.

Walked to the civico museum, which has nothing much other than the history of Milan with costumes and painting of their past events. Took the underground to Papinano, which I thought was some marketplace which turned out to be just a supermarket in the middle of nowhere. I suspect I've been to the wrong place but whatever. Such a wasted trip.

We then took the underground again to Santa Marie delle Grazie, the church that houses the famous Last Supper painting by Leonardo da Vinci, which, again, I failed to secure the ticket because they were sold out 2 months in advance.

So I snapped the picture of the roadsign to prove that I was there. Got a bookmark of the Last Supper as souvenir.

The church itself is pretty much unspectacular.

Getting late in the night with some time to kill, we went to Parco Sempione, the biggest park in Milan. This is the wall of Castello Sforzesco (have no idea how to pronounce that). Apparently it is one of the biggest citadels in Europe and used to house the duchy of Milan.

Observation about the Italian accent: they tend to stress the second last syllable in every word. cappuCCIno. PASta. PIZza. SpaGHEtti. I don't know if that's the pronunciation rule but I think you can make yourself sound Italian by doing that.

Amazed at how many migrants there are in Milan who are trying to make ends meet by selling merchandises and flowers. There were occasional Indian guys walking around trying to sell roses to couples. Such mongering is not that common in Singapore, or even in London (that I can remember, but I haven't exactly been to the touristy spots that often). London does seem to have more beggars though. Apparently there is quite a wide income gap and ethnic division in Italy. Possibly due to Italy's proximity to the Africa, many migrants find Italy an easy place to settle in.

The fountain outside Castello Sforzesco.

Tried to shop, but the shops are closing already as it was approaching midnight. Other than the big three-storey Zara store, I think there's more variety in London.

Had a measly dinner consisting of three sandwiches bought from a vending machine in the train station, because it was 8pm and no restaurants or whatsoever is open. Really really missed Singapore where all the eating places are open till 10pm in the night. Europe is really awesome, scenic and sophisticated, but Singapore is definitely a more convenient place to live in.

Got on the Trenitalia again, the train system that transits between cities in Italy (which we've been riding on since Day 1). Transportation-wise, Singapore has cleaner and newer train carriages, but the service frequency in Singapore is absolutely horrible, and during rush hours the passengers are packed like canned sardine. Definitely something to work on. Almost every European countries beat Singapore in terms of public transport. The solution is really simple - expand the capacity, but I just don't get why Singapore with such an enormous budget surplus cannot divert some into improving the transportation infrastructure.

Conclusion: Milan is still really ancient (not in a good way), despite being one of the fashion capitals in the world. There is nothing much to do there except to shop, and visit the museums if you are those artsy kind (or those that want to look at masterpieces just for the sake of looking at one, like me). Other than the Duomo, the architectures are generally underwhelming.

And also, Italians speak better English than the French, for some reason.

Italy Day 1

2011-06-17T21:13:00.002+08:00

Arrived in Bergamo Airport. Bergamo is a very small town that has pretty much nothing of interest. Due to me having a British passport I did not get a stamp as I passed through the customs, which is kind of disappointing because collecting custom stamps of the countries they've been to has become a weird hobby for many of my friends.

Italian accent is quite quirky, almost as ridiculous sounding as Singaporean accent.

We had quite an ordeal on our first train ride in Italy. We boarded the wrong train because we assumed all train with the same destination follow the same route, when in fact it doesn't (a mistake probably due to the linear, unbranched train system in Singapore). The train that we erroneously boarded did not pass through Como. Fortunately we checked with a local and got off at the next stop, before backtracking to the Bergamo station again. Still, we found that we have missed the correct train that we were suppose to board.

Having an hour to wait before the next train arrives, we sat at the train platform for half an hour. Then the announcement came saying that our next train is cancelled, and the next train is another hour away.

Feeling slightly pissed off at the inefficiency of the Italian train system, we got ourselves some Macdonald's and sat for a quite a while to kill time, then we decided to take a stroll along the periphery of the Bergamo train station.

I learnt a couple of Italian phrases just before I come. I feel that Italian is probably the easiest European language to pick up for English speakers, because almost all of its phonemes are present in English.

The Italians use Ciao for both hello and goodbye, which I find quite interesting because I don't remember another language with such a dual-use greeting word.

Some of the most common phrases I use over and over again in Italy. Got us by without any problem.

Good morning/afternoon: Buon giorno
Good evening: Buona sera
Can you speak English: Parli inglese
Thank you: Grazie
Excuse me/Sorry: Scusi
Dov'è: Where is...

I've heard from my friends Europeans can be quite snobbish sometimes, but from personal experience people may generally be nicer to you if you greet them in their own language and ask them if they can speak English before babbling off in English. It might be quite disorientating or insulting if you start speaking a foreign tongue to them. Therefore I make it a point to always ask if they can speak English before switching to English (if they can't I just have to play charade with them).

We got back to MacDonald's after walking for a bit and snapping some photo at some rather uninteresting churches along the way, just to find that the third train changed route and stopped at a couple of stops before Como: which means we have to wait for another hour for the train. Felt quite lost especially when we'll be boarding the last train, and we don't know what's our back-up plan if somehow we boarded the wrong train again or miss the stop. Are we going to take a cab? Do we have enough cash with us? Can we communicate with the driver? Will we get cheated? Is it safe? Not a very flattering first impression for Italy.

Returned to the MacDonald's again to kill time. But since it's the first day we didn't have anything planned (other than cancelling the dinner plan with Alexa's friend who studies in Italy).

Oh yes, I quite like the Italian MacDonald's which serve this yummy Smoky BBQ chicken burger. Got quite a shock while we were eating, when there was a loud bang and a flash of light from outside the MacDonald's. My first thought was a bomb blast but I figured that if it is not loud enough and the glass would have shattered. Probably a burst light bulb.

Italy looks older than I thought. Many buildings are rather dilapidated and the train has an urgent need for some revamp and clean up. I had the feeling that the train service has been running for decades and the usual sign of tear and wear was quite apparent. I was still quite apprehensive about the train because we weren't that familiar with how things work in Italy, and we were afraid that we got up the wrong train again. It's quite late at night and we didn't want to be stranded in the middle of nowhere in a foreign country.

Some random observations:
1. Italians tend to have blackish hair, and look to me like a cross between a Central Asian and a European. I'm guessing due to the proximity of Italy to Central Asia, there might have been some common ancestral roots between people of these two regions. I can possibly tell an Italian apart from the French and the English and other Western Europeans.

2. Had been wondering about the tipping system here. Does Italian restaurant work on a service charge system or a gratuity system? (Now that the trip is over, I concluded that Italy works almost entire on the service charge system).

3. There is considerably less Chinese, Indians, Africans around in Italy than London. Most of them are immigrants. I wonder how rampant racism is in Italy because these immigrants seem to be on the lower classes, especially the Indians and the Africans, and the Chinese seems to be doing rather unpopular businesses such as selling Made in China good, which Italians hate. London seems to better racism-wise, probably because it's a more cosmopolitan city than the Italian cities I've been to, and maybe because I'm in UCL where a huge proportion of the student body comprises international students. In fact, the more countries I've been to, the more I appreciate racial diversity and cultural differences.

4. Sometimes I feel that European cities aren't as new and clean as Singapore, but still they have such a glorious history and vibrant culture and I have to admit some of their ancient churches and architecture are remarkably stunning and well-kept. I may not agree with their inefficient bureaucracies and how things are run, but I can see that it is much harder to change things when one has been doing things a certain way for so many centuries. Perhaps it's just like me being the webmaster for both the Surgical Society and the Medical Management Society. Even though I may not like the SurgSoc's website that much, I feel that there's no need to change it because it's not exactly broken. Change for the sake of change is not a good enough justification.

I hope to buy a good camera when I'm back in Singapore, because I'll probably be travelling to more places in the next five years and I need a camera that allows me to capture my memories and experience.

Finally we reached Como at about 11.37PM. The hostel is going to close at 12 so I need to check in soon. Alexa's friend Wendi managed to inform the hostel reception that we'll be arriving late due to train delay, and thanks to her I wasn't locked out of the hostel.

Went to Wendi's house. She is staying with an elderly Italian landlady who looks really friendly. It was raining rather heavily so we sat in the living room and chat for a bit. Alexa stayed with her friend, while I walked to my hostel which is just 5 minutes away. Como's street is really empty at night, but at least there are lots of cars, unlike that of Edinburgh's (I could literally lie down on Edinburgh's road at night and not be worried that I'll be run over by cars).

The Italian innkeeper was really friendly and had a nice smile. I washed up and slept.

All planned for Italy

2011-06-08T05:33:00.013+08:00

I'm done with the itinerary for the Italy trip. I'll be visiting Como, Milan, Verona and Venice for a week in total.

After the first year, I'd have already visited:

London
Edinburgh
Glasgow
Scottish Highlands
Brighton
Bath
Cambridge
Paris
Brussels
Amsterdam
Como
Milan
Verona
Venice

... 14 cities. I know people who have visited much much more places. Hopefully I can go to more cities next year. I especially want to visit the Scandinavian countries because they are regarded as the best in everything ranging from healthcare to democracy to living standard to environment-friendliness. Travelling is really an eye-opener, and I'm especially interested in the language aspect of it. I aspire to learn more languages, but only just enough to appreciate their unique grammar. Mastering many languages is a far reach for me.

This is just a checklist of art pieces and architecture I'll be looking out for in my Italy trip.

The Last Supper by Leonardo da Vinci. I WILL NOT BE ABLE TO SEE THIS BECAUSE THE TICKETS ARE SOLD OUT!. It is housed in the cathedral Santa Maria delle Grazie. Tips to people hoping to see this: order the tickets months in advance.

Dead Christ by Andrea Mantcgna, housed in the Pinacoteca di Brera in Milan. Virgin Mary and St John watched and wept over him. Did a bit of research and it seems that the theme of lamentation is popular in Medieval and Renaissance Art. This seems to be quite an interesting because it centers on Christ's genitals, which is unique to this painting.

Marriage of the Virgin by Raphael. This marriage is a common theme in Christian Art and has been painted by many other artists.

Pieta by Giovanni Bellini. This is arguably the best depiction of sorrow and grief in Renaissance art.

Supper at Emmaus by Caravaggio.

The Kiss by Francesco Hayez, in Milan. This is arguably the most passionate portrayal of a kiss in Western painting. The man's red costume represents Austria-Hungary, while the lady's pale blue dress symbolises France. The kiss may either appear passionate or violent. The black shadow on the left signifies a lurking danger. Those familiar with history would have guessed the meaning behind it.

Dream of St. Ursula by Vittore Carpaccio. The angel comes in warning to the sleeping Ursula, telling her of her imminent martyrdom

Vision of St. Augustine by Vittore Carpaccio. He really has a thing with rooms and perspectives. I like the Maltese dog in the painting. Looks kind of funky.

Tempest by Giorgione. This painting is very puzzling because 1) the women is suckling the baby, but she did not hold the baby in her laps, but rather on her side. 2) The soldier seems to be looking at the women, but yet not looking at the women. The perspectives here is quite strange. 3) The broken pillars, the lightning bolt in the sky contrasted with the 'silent' atmosphere. Pretty enigmatic, isn't it.

Adam and Eve by Tintoretto. I've seen this before, and I'm quite sure many people had.

That's it for now :D

Tsunami

2011-05-30T23:44:00.002+08:00

A 50% discount lunch on an otherwise high-class restaurant.

Yellowtail Tartare, with fish roe and quail egg.

Grilled scallop.

Hira Unagi.

Teriyaki chicken.

Post-exam update

2011-05-29T08:33:00.011+08:00

Exams are finally over! Hopefully I do well. And the sociology question on NHS development that I bitched so much about in a previous post did come out as a 20 mark question in my exams. C'est la vie.

I absolutely love the freedom now, having nothing to study for. I'm currently making a website for the Medical Leadership and Management Society I'm in, and I will post the link up when I'm done. I stole the design idea from the HPAIR website, but I reverse-engineered the whole layout so I think that doesn't count as plagiarising (:p). Other than the design I wrote all the codes from scratch. I used to like programming so much in lower secondary, so I feel especially nostalgic with the thick reference book I borrowed for the library.

And also thanks to Iris, I've been playing Rubik's cube again. Used to have one back in Singapore that I loved to play.

It's a very fascinating game. Next time if I have a kid I will buy this for him and let him play around with it till he manages to solve it by himself.

Library

2011-05-08T21:47:00.007+08:00

Studying in the library. Stressed.

Yes, I got bored.

Brief thoughts on democracy

2011-05-08T08:56:00.008+08:00

Practically spent the whole day getting seriously distracted by Singapore's general election. 81 out of 87 seats went to People's Action Party, making Singapore effectively a single-party system, again.

Just a quick word before I sleep. I'm all for a single-party system in Singapore. The commonest argument against a single-party system is that it undermines democracy. But in my opinion democracy is a fantastic system for electing leaders and combating tyranny, but not necessarily ideal for governance. Yes checks and balances should definitely be in place, but not necessarily in the form of a second party. Partisan politics in a dual-party or a multi-party system is really the most destabilising system you can have. US is facing the threats of political shutdown every few weeks, and even Obama admitted that it is "not responsible" and it puts their "economic progress in jeopardy". Belgium has been without a government without a year because the parties just refuse to come together to form a coalition government. On the very extreme, there were also plenty of examples in history where the democratic process failed, culminating in military coups and the downward spiral down to authoritarianism. Democracy really isn't the holy grail of political development.

It is also important to appreciate the fact that Singapore is walking on a tightrope here. Nations in Europe, like Belgium, can afford to fail and go without a government, because they can simply fall back to European standards. If Singapore fails, we will fall back to South-East Asian standards, that of Burma and Cambodia and Laos. Singapore does not have the political infrastructure like the European Union to prop it up in times of political crisis and prevent it from imploding, so we really have to watch every step we take.

NHS Reform

2011-05-07T06:02:00.009+08:00

Absolutely love our kidney lecturer. Humorous, clear, concise.

I have just been to a talk on the National Health Service and I am quite enlightened about the issues facing the reform right now.

Just to summarise a little, the Health Secretary Andrew Lansley proposed a reform that can be largely broken down into three areas:

1. Structure of NHS as a whole
2. Education and training
3. Public health

It is quite a difficult reform to understand because it involves radical changes to so many areas. Even the panelists in the talk admitted that getting the message across and informing the general public about the various implications prove to be major obstacles.

I may be wrong on this, but I'll just try to explain the arguably most controversial topic on GP commissioning.The current system is such that the government (in the form of NHS Trusts) buys, or commissions, healthcare services from GP and hospitals. Andrew Lansley's criticism is that this is costly and doesn't improve health outcomes. The new change is therefore to give most of the money to the GP practices directly and allow them to commission services from hospitals and specialists, and thereby hopefully ensuring efficiency and health outcomes.

From the impressions I got, almost everyone from the British Medical Association to the General Medical Council to even University College London — my school — is against the plan (and yes they actively invited us to march in protest against the reform). Their opinion is that GP neither has the expertise nor the interest to take up the responsibilities involved in the planning and the rationing of the healthcare, and that more generally speaking this is tantamount to fragmenting the NHS. They will also inherit the growing debt and with the new responsibility, may be forced to introduce cuts and closures, which basically amounts to cleaning up the mess of the current system.

As a foreigner this is basically what I can grasp of the whole issue. There are of course the whole issues about the cost of reforming the system, if we are going to privatise our health system, issues on education and post-graduate training. I won't even dare to explain them because they are so complex.

Richmond Park

2011-05-01T00:22:00.004+08:00

To take a break from studying, we went to the Richmond Park in the Southern end of London.

Royal Wedding

2011-04-30T00:14:00.008+08:00

Don't ask me why I didn't take picture with William, Kate or the Queen.

Well, at least we saw the Fake William, Fake Kate and the Fake Queen...

Politics

2011-04-29T07:07:00.025+08:00

Just a quick post because it's really late.

Recently I've spent more time than I should watching videos on the Singapore General Election. This year is a really exciting year because never ever did the opposition parties put up such a strong fight. Just talked to a few British friends about the fact that Singapore remains an illiberal democracy at best, a benign dictatorship at worst. However from the videos I've seen, I remain quite doubtful about the capabilities of the opposition parties. Other than ideological objection to the continuation of the "benign authoritarian" regime, I personally feels that it is really best for Singapore to have an one-party system as on pragmatic grounds political stability and strong leadership are really crucial to such a small and otherwise insignificant state like Singapore.

On the other hand I'm also watching out for the politics here in the UK as well, especially the NHS healthcare reform. I think it's good spending such a long time in a foreign country because there's really an incentive for one to learn more about their politics when everyone else around them is talking about it. The whole NHS reform is a much debated topic, with a completely different set of problems, namely management and cost, from what we faced back in Singapore. I still feel that the welfare system that provides free healthcare is inferior to Singapore's hybrid public-private system. The Singaporean system involves patient copayment in the form of Central Provident Fund, with a portion of each paycheck going into an interest-bearing savings account, which can then be used to pay future medical bills if the need arises. For NHS, being almost completely free, the price signal is gone, healthcare professionals are more accountable to the bureaucracy instead of the people, health being more of a state responsibility than a personal one, and there is no disincentives to overuse the health service. The UK government effectively relinquish fiscal control over healthcare budget, because increasing tax or cutting healthcare funding are both politically unpopular, and the only way to do anything to the health system is on the supply-side, which is slow in response and often requires structural reforms which are expensive in themselves. Not a wise system if you'd ask me.

Hard Facts

2011-04-24T06:17:00.014+08:00

Some of the things I really hate studying in my course:

#1 Commonest bacteria in ___ infection

The worst things ever to remember, and yet it is stated explicitly in our learning objectives that we must be able to list them out.

For example, here are the commonest bacteria that cause pneumonia: Streptococcus pneumoniae, Haemophilus influenzae, Legionella pnuemophila, Mycobacterium tuberculosis, Mycoplasma pneumoniae, Chlamydia pneumoniae, Chlamydia psitacci, Coxiella.

The list of parasites that cause gastrointestinal infections: Giardia, Entamoeba, Crytosporidium, Taenia, Hymenolepis, Ascaris, Enterobius, Hookworms, Trichuris

The list of virus that cause respiratory infections: Rhinovirus, Coronaviruses, Adenoviruses, Parainfluenza, Influenza, Herpes simplex, RSV, Human metapneumovirus

You get the idea. Huge pain in the ass. I'm probably gonna ignore these types of questions in exam because the amount of effort needed to memorize them is not proportionate to the number of questions that will eventually appear. Ugh.

#2 Cytokines and receptors

Again, immunology is the killer. Cytokines are basically the signalling molecules that immune cells give off to coordinate an immune response. The bad news — they are all named with completely random numbers, supposedly the order in which they are discovered by scientists.

For example, one type of immune cells called the Th1 cell will secrete IFNγ and IL-2; another type, the Th2 cells will secrete IL-4, IL-5, IL-6 and IL-13; and yet another type the Th17 cells will secrete IL-17 and IL-22. And yes, we got tested on this in the February exams so we are supposed to commit these wretched cytokine molecules to memory.

On the same note, the receptors (membrane-bound proteins that are also involved in cell-to-cell signalling during an immune response) are also number-coded: LFA-3 binds to CD2, VCAM-1 binds to VLA-4, ICAM-1 binds to LFA-1, B7 binds to CD28 and CTLA4.

You get the idea. I can just hope that lightning doesn't strike the same place twice.

#3 Biochemistry

The fourth module in our year is about nutrition and metabolism. I thought it'd be interesting but in the end I was just bogged down with memorising names of various molecules and enzymes: acetyl CoA, acetoacetyl CoA, hydroxymethyl glutaryl CoA, acetoacetate, acetone, ß-hydroxybutyrate. These are the molecules involved in the production of molecules called ketone bodies, a sort of alternative fuel to glucose produced by the liver when it has an excess of fats.

I just happened to be revising on this now, but there are dozens more metabolic pathways to remember. For this I'm just gonna memorize the first and the last molecules and ignore everything in between. What's the odds of them testing me on the intermediate molecules!? But then again, the same thing can't be said of another much more important pathway like glycolysis, the first step in which glucose is broken down after being taken into cells — almost every freaking single intermediate is important, probably because glycolysis is the most evolutionarily primitive series of chemical reactions that occurs (with variations) in almost every organism on Earth. Interesting product of natural selection, but it's tough for me to appreciate it when I have to know their chemistry back to front.

#4 Normal values

Another major headache is remembering the normal values for a whole range of physiological variables. For example,

(The blood)
blood pressure: 120/80
blood pH: ~7.4
bicarbonate concentration in blood: ~24 mmol/L
pCO2 (partial pressure of carbon dioxide in blood): 40 mmHg

Along with size of red cells, red cell count, haemoglobin concentration, white cell counts, and a lot of other values that I can't remember off the top of my head yet. Maybe I will never bother to.

(Lung volumes)
Tidal volume (volume of air taken in and out during normal breathing): 0.5L
Total lung capacity: 6.0L
Vital capacity (breathe out fully, then breathe in fully, this is your vital capacity): 4.8L

And a whole lot of random values.

And there's ECG, or Electrocardiogram, the little wiggly graph that represents the heartbeat you see so often in movies. There are a lot of time intervals we need to memorize that I don't even bother to list them out here. After having to remember more than 50 values, you can so easily mix them up. I guess this is why we need 5 entire years to get these figures drilled into our head again and again, because just getting one time interval wrong when reading an ECG will result in us missing out an imminent heart attack until it's too late.

But for now, I'll probably forget about maybe 30% of it, at best, when it really comes to exam. It is just inevitable.

#5 Sociology

I don't even want to talk about this. I got 2/20 for a sociology question in my past exam. It is my nemesis.

Just to give you an example how bad it is, we had a whopping three lectures on the past and future of the National Health Service, the government-funded health service in the UK, and the learning objectives are as follow:

- Outline the development of health care in Britain and explain why the NHS was created and the principles on which it was based
- Summarise the main problems encountered by the NHS since 1948

SINCE 1948!! That's a hell lot of policy changes and reforms to remember. And I'm one who is completely out of touch with the British system so I need to read up on a lot of background knowledge, such as the whole Conservatives vs Labour Party thing and their ideologies and principles. I can't imagine what would happen if they throw in another 20 mark essay into the paper because that'll probably fail me no matter how good I score on the science part.

That's just the first lecture. Here's the second:

- Summarise the arguments leading to the reform of the NHS
- Explain why markets and commissioning were introduced into the NHS and the possible impact of these

That's a lot of reading and work to do!! I just really really hate sociology.

And the third:

- Summarise the main factors influencing the future of health care in the UK
- Outline the conclusions reached by the two Wanless reports into the provision of healthcare in the UK during the first decade of the 21st century

Until now I have absolutely no idea what the Wanless reports are. Time to do some bed-time reading.

Brighton

2011-04-21T19:04:00.003+08:00

Brighton is a little seaside town that I went to for a day-trip. Again due to the upcoming exams, only photos are uploaded.

Amsterdam Day 3

2011-04-21T17:49:00.004+08:00

Last day in Amsterdam. As we had to catch a flight on noon, there was nothing much we could do. We went to this row of seven country houses near our hotel. These seven houses represented the architectural styles of Germany, France, Spain, Italy, Russia, Holland and Great Britain since 1894.

Amsterdam Day 2

2011-04-21T16:58:00.004+08:00

Day 2 in Amsterdam. We visited the Sex Museum in the morning and then Keukenhof Garden in the afternoon for the Tulip Festival. At night we took a walk down the canal to look at the Skinny Bridge.

I'm not going to write much on this post as my exams are coming and I feel that I should start studying hard. So just pictures for the time being.

Amsterdam Day 1

2011-04-18T07:37:00.005+08:00

Took a Thalys train from Brussels to Amsterdam somewhere around noon.

Amsterdam Day One

The velvety red Thalys train.

Amsterdam is a completely different country from Belgium. It is known as the Sex Capital, with probably the most well-known Red Light District in the world. It is also called the Venice of the North, with its concentric rings of canals and radiating rivers.

The official flag of Amsterdam. They are apparently very proud of their open culture of sex.

The map of Amsterdam. There was really some massive urban planning going on when they built the canal system. They are impressive.

A very distinctive Dutch building that we have grown use to seeing.

The Royal Palace, or Paleis de dam, which we passed by on the tram.

The Dutch public transport composes mainly of tram, and to a lesser extent buses. As a result you see tram tracks everywhere, and they do get you everywhere.

And the Dutch cycles around a lot as well. Amsterdam is one of the safest city in the world, despite it being known for seemingly dubious sexual activities. For one thing, it is much safer than Paris and London.

Concertgebouw, a concert hall near our (first) hotel.

Our first hotel is a shared bunker room with 5 other people (totalling eight of us). There were only two when we checked in, neither to whom we spoke to as they were napping on their beds. Due to the ongoing Tulip Festival, this hotel cost almost as much as the much nicer, albeit more remote hotel in Brussels. We unloaded our luggages and went straight out to explore Amsterdam.

Rolls of carpet grass near Museum Square.

We walked past Van Gogh museum because we've been told, perhaps quite mistakenly on retrospect, that it wasn't worth a visit. There was this replica of his Starry Night on a store near the Van Gogh museum.

I Amsterdam, the tourism logo of Amsterdam based on a rather lame English pun.

Road sign on the way.

After a quick lunch in Wagamama, a Japanese restaurant that has branches practically all over Europe, we took a detour around the Vondelpark, the biggest park in Amsterdam, before going on a canal cruise. It is all rivers and canal from then on.

The Netherlands boast possibly some of the most beautiful flowers in the world.

The Hard Rock Cafe is very near our dining place.

The boat that we took. The boat in Amsterdam are very flat as the bridges themselves are not tall. On the boat there were commentary about the various attractions that we passed as we encircled the city.

The Dutch are quite a bunch of carefree people. You seldom see people strolling down the street on a Wednesday afternoon.

Playing a gigantic chess on the street

Kayaking down the canal

Relaxing in the park

A photograph of the bridge I took from the canal.

Our final stop that day was non other than the Red Light District, a popular tourist spot. We walked from the river there on food, as Amsterdam is really quite a small city that one can transverse from the outskirt to the Central Station in the city center in just under an hour. Dined at a Chinese restaurant, which was slightly overpriced, before walking to the Old Church (how ironic) where the Red Light District is situated.

By the way, the food prices in Amsterdam are horrendously expensive. Later on in our trip we told a service staff (I assume) who helped us to move our stuff from one hotel to another due to some misarrangement on accommodation matters, and he told us that we were not looking in the right place. It is indeed possible the city is so well-designed to make the more expensive restaurants visible to tourists. One meal can cost easily up to £12 and beyond, even if you just compare Amsterdam's Wagamama to London's Wagamama, you'd clearly see the price difference.

As he had been to London before, he claimed that London has much more expensive food prices. Yes, London is not cheap either, but it's much more affordable than Amsterdam I feel. He then recommended some eating place to us which are supposedly cheap. We found out much later than they are just marginally — £1-£2 — cheaper. Except for a rib store which I will talk about later.

Back to Red Light District.

A souvenir store with cows hanging upside down. The Dutch are known for their cows (or dairy products; think Dutch Lady), their windmills, their canals and tulips!

The Red Light District, De Wallen, along the river. Photographs are not allowed here to protect the identity of the prostitutes. The area feels safer than I thought, because most people are tourists who just walked past without actually buying their service. There are a bunch of old people and quite a lot of Chinese tourists. It got quite monotonous after a while, with basically sex shops, live sex shows and prostitutes dancing behind shop windows.

We would visit a sex museum later on in our trip, about the history of sex in different cultures. One thing about modern Western culture is that they don't see sex as a taboo like many Asians do. Amsterdam even endorse their sex culture as their tourist icon. On one side it may be quite dehumanising to treat women as simply economic commodities to generate revenue for tourism, but on the other end, so I've heard, the prostitute themselves actually felt that it is a legitimate job and do that voluntarily. Instead of clamping down on prostitution, the Netherlands provide support for it, such as the Prostitution Information Center, run by a prostitute, to advice and educate tourists about prostitution, involving safe sex and how to take care of themselves. I don't know what went on behind the closed curtain, but from the surface of it, this is probably the safest prostitution district around the world.

Returned to our little hotel to sleep for the night.

Brussels Day 3

2011-04-17T18:58:00.008+08:00

The third day in Brussels, Belgium is a rather interesting day. It involves a trip to the Flea Market, followed by a visit to the European Parliament again.

Brussels Day Three

Arrived on the late morning of the 12^th at the Flea Market in the South-western corner of Brussels. It is situated on Place du Jeu de Balle, or Vossenplein in Dutch, a rather large square where vendors display their goods on mats and tables.

It can be quite a rubbish dump sometimes. We postulated that these heaps are goods that were not sold by the vendors the day before, and thus they disposed them here to save them the trouble of transporting them all the way back to wherever they usually store their goods.

We had quite some amusing finds like the ferret skin below.

As well as some pretty delicate paintings that would certainly look nice on a wall.

African artefacts...

Then we took the Metro out of the city center to the Europarl again. One thing about the Metro there is that there are no gates, just little machines where u are supposed to insert the ticket. There is no one watching over the ticket machines so it is all based on good faith that you'll pay the fare for the ride. It is either 1) they have such a tight public transport budget that they decide to do away with employing watchmen or 2) their economy is based on trust, which is indeed very impressive. In any case, we are honest people so we used the tickets.

The European Commission, a separate entity but situated closed to the European Parliament.

On the way to Europarl.

The famous cylindrical dome of the European Parliament.

Went through the security check, and we arrived at a hall with all the 27 flags of the EU member states. I can recite them off the top of my head now, since we had plenty of opportunity to commit them to memory with all the brochures, pamphlets and posters we got.

The modern sculpture Confluence, symbolising the confluence of the different cultures of the member states, and how they are interdependent on one another. This sculpture has movable hinges, and when one part moves, the entire sculpture moves along.

The Hemicycle, the semicircular debating chamber where legislations are discussed and passed. The circular design makes sure that everyone is equal. Unlike the Westminster system, where the opposing parties sit on the opposing negotiation benches, the use of hemicycle ensures that the debates appear less confrontational.

We were each given a set of handheld devices, a bit like iPhones, from which we watch videos at each location. It is rather weird since we had a guide whose job was sorely to bring us from place to place without doing any explanation at all. For a while the whole bunch of visitors like us sat in the benches in the hemicycle staring into our handheld device in absolute silence.

That marks the end of our European Parliament tour.

The best escargots I have ever eating, which we bought from a random food van on the street of Brussels. I'd definitely die for another bowl of this.

Did some food shopping in a supermarket. We hunted down the famous Trappist beers. These are beers brewed by an order of Catholic monks called the Trappists in their monasteries. There are only 7 monasteries that double as breweries worldwide, 6 of which are in Belgium (the remaining one is in the Netherlands). We only managed to find 5 out of the 6.

Rochefort, Achel, Chimay, Orval, and Westmalle. The remaining one that we cannot find anywhere is the Westvleteren, if you know where to get it please tell me I feel incomplete not trying the last one.

They taste very different. Rochefort was really bitter and had a strong aftertaste. Achel was a milder but sourer version of Rochefort, with less of an aftertaste. Chimay had a distinct malt and yeast taste. Orval tastes more like your typical beer, but slightly bitterer. Westmalle is just flat, not as bitter but more maltier than Achel. I swear that if you blindfold me on that day I would have been able to distinguish between them.

In any case, the beer was generally quite strong for our taste and we used them as forfeits for some games that we played. We just could not appreciate these famous beers.

Brussels Day 2

2011-04-16T18:01:00.006+08:00

The second day in Brussels was our full day in Belgium.

Brussels Day Two

Got up early in the morning, lazed awhile, before we depart to the city center by bus. The Belgians are really kind, as on various occasion they let us onto the bus for free, or offered to let the eight of us buy a family ticket which was way cheaper than eight individual bus tickets.

A beautiful building on the way.

Belgian street

Walked to a Chinese restaurant in Beurs Bourse for a Euro 3.80 meal (which is damn cheap by European standard). I think I will really eat a lot back in Singapore because if you convert the price of a plate of chicken rice in Singapore to pounds or euros, it'd be only £1. You never ever ever find anything close to £1 here in London or even in Europe. It's usually three times the cost for the cheapest meal here.

The Belgians are known for their chocolates. They melt in your mouth, and even though I'm not a chocolate person, I really enjoyed it.

Our first stop was Manneken Pis, the peeing boy statue that everyone has learnt of.

The Manneken Pis is really very small, and the scale was a bit disappointing.

After stopping by to have some waffles — which was really good by the way — we continued to the remnant of an unnamed medieval city wall.

A rather cute graffiti on the wall in an alley. Pay attention to the caption which says "Hi! This is a background for taking photography... Please take a photo in front of me and send the picture to _email_ THANKS!" Quite cool.

A portion of the medieval city wall in the 13th century.

Continued to Place de L'Albertine, aka. Albertina Plein, aka. Albert's Square. One interesting point to note is that most Belgians are effectively bilingual in both French and Dutch. Belgium is divided into French-speaking South and Dutch-speaking North, likely due to the geographical proximity to The Netherlands and France on either end, and Brussels is a sort of an isolated French-speaking enclave in the Dutch North. Most people here can speak fluent English as well, making them trilingual.

Another attempt at artistic shot.

A beautiful boulevard of trees.

Next we took a detour to the European Parliament, which was quite a fair bit of walk outside of the city center, to the East of Brussels.

And finally the Espace Léopold, the legislative centre of the European Parliament in Brussels. It is a grand modern building with a futuristic design, where all the parliamentary debates are held. The official seat is however in Immeuble Louise Weiss, in Strasbourg, France.

Some of the flags of the 27 EU countries are raised in front of the glass dome. We tried to go into the building but it was rather late, and the visiting hours were past. We would return to here the next day.

Took a tram to the Atomium, the less impressive equivalent to the Eiffel Tower in Paris, built during the 1958 World Expo in Brussels (Eiffel Tower was built for the same reason by the way).

Navigating around Brussels is an art :)

The Atomium, a 165 billion time magnification of an iron crystal.

Another modern building on the way.

Comic strips graffiti on the road. Graffiti can really be a piece of art sometimes.

The Beurs/Bourse, the building that houses the Brussels Stock Exchange.

Another graffiti.

The Grand Place in Brussels, housing the guildhalls, the townhall and the Breadhouse (ironically also called Maison du Roi in French, the King's House).

A bar called the Drug Opera on the way. Wonder what is inside...

Went to Rue de Bouchers, an area full of restaurants where almost only tourists go, and the waiters will try to seduce you when you walk by. The food, advertised as authentically Belgians, wasn't really that nice and I doubt they are authentically Belgian. Anyway the service was really bad. They expected us to give them tips with such mediocre service, and when we refused they shooed us away. Giving tips in Europe is not mandatory, but later on in the Netherlands we did in fact felt that the service was exceptional enough to justify a tip.

Caught the last bus or the second last bus back to the hotel at the end of the day. Quite an eventful day :)

Brussels Day 1

2011-04-16T09:04:00.004+08:00

Went to Brussels and Amsterdam for my second Europe tour. Following the tradition, I will do a short write up of my trip.

Brussels Day One
Brussels is a very important city for the European Union (EU), being the seat of the European Parliament.

We went to Brussels by Eurostar train. It took about 2 hours to get to the Bruxelles Midi from London Victoria station. The three of us met up with another five, before we travelled to a rather out-of-the-way hotel somewhere between the city of Brussels and the city of Waterloo.

Porte de Hal, a 13th century City gate we saw on our way.

Did not manage to do much after dumping our stuff at the hostel, as it was already in the late afternoon. We had not expected our hotel to be so far from the city center. To be fair, the hotel is really awesome. There was practically no staff in the hotel. We unlocked the main entrance to the hotel with a code the hotel owner provided, then we retrieved our room keys from a safe with another code. Signed the registration form and dumped it into a letter-box. There were no one in the hotel except for us.

Had lunch at a fantastic Thai restaurant, the only eating place of any kind nearby, called Bois Savanes. We then walked to the city of Waterloo on foot, which took about 40 minutes. The weather was fantastic so it was not unbearable.

A dilapidated house along the way.

My attempt at taking artistic photo.

St. Joseph's Church next to the tourist information center in Waterloo. The city is really quite empty if not for the fact that it has such a prominent history.

It is a really famous city where Napoleon's Imperial French army lost the war against the combined army of the Seventh Coalition, mainly led by Duke of Wellington of Britain and Gebhard von Blücher, the Prussian general.

In memory of the lives lost at the Battle, the Dutch built the Lion Mound.

We climbed to the top of the mound. The view wasn't breathtaking to be honest, but we had quite a lot of fun up there, taking photos and watching a parachuter flying around on the sky.

End of first day.

City of Bath

2011-04-10T08:44:00.003+08:00

City of Bath is a beautiful city in Somerset, southwest of London. It was once used by the Romans as a spa resort, with the name Aques Sulis, from at least AD 43. In Roman times the worship of Sulis Minerva continued and messages to her scratched onto metal have been recovered from the Sacred Spring by archaeologists. These are known as curse tablets. Written in Latin, they usually laid curses on other people, whom they feel had done them wrong.

Streets of Bath:

Roman Bath:

Bath Abbey:

Royal Crescent and The Circus:

Jamie's Italian:

Borough Market

2011-04-08T02:30:00.005+08:00

I. Love. Borough. Market!! And the fact that it is officially spring. Time for a closet change!!

Pastries

Groceries

Miscellaneous

Spend nearly £30 today on all the yummy food. I love England <3

Gold-digger

2011-04-06T07:04:00.003+08:00

Beautiful chandelier in the Royal Society of Medicine. Love going there for talks and meetings :)

Just had a conversation about the fact that I graduate so late (at 26!), and that I need quite a few years to start earning a comfortable pay. This means that it is quite hard for me to get married before 30 because I'm just not rich enough to afford a grand wedding, pay mortgage, and maybe have kids.

Then I got a bit practical. Up till now I've been wanting to go into more challenging specialties like neurosurgery, orthopaedics, trauma (or in layman's term, brain doctor, bone doctor, accident and emergency doctors), but I realize that there is really a financial constrain here. I don't really want to be stuck in a public hospital working off wages. I kind of want to start my own private practice as young as possible.

This skews me towards specialties like plastic surgery (in particular oculoplastics, or cosmetic eye surgery), and ophthalmology, where you can go into private faster than most other specialties. It is just an idea though, because it's waaaayyy too early for me to consider this when I'm just a first-year.

Another way is that I should learn how to invest now — properly. I roughly understand how the stock market works and how to invest, because I've done that before. But doing it well and actually making money is another matter altogether. I really hope that I'll have some close friends in the financial industry that I will feel safe entrusting my money into next time.

Damn. Don't I just sound like a gold-digger right now?

Homerton

2011-04-01T18:33:00.004+08:00

Went to Homerton Hospital for my first job assignment in Medic Interpreters.

Just as I was about to leave home, I realized I lost my wallet. Frantically searched for it for about 10 minutes before giving up as I was running late. I ended up buying my third Oyster card in order to travel.

It's quite a big hospital in east London, comparable to the NUH in Singapore in terms of area. Made a few wrong turns before finally getting to the antenatal clinic. So as not to breach confidentiality, I have to be really vague here.

I translated for a pregnant woman who came to have her foetus examined, as well as some other conditions. We waited for half an hour to be called in by the nurse to take weight and blood pressure. It took 5 minute, and I only needed to translate stuff like "fold up your sleeve", "stand on the weighing scale", "are you feeling unwell". Easy piece of pie. We went out and waited again for another half an hour for the O&G doctor to call her in to do some checks on her baby. After that we waited for another half an hour before finally drawing blood for a blood test. The whole thing lasted an hour and forty minutes. I feel that it is quite an effortless way to make money. It's quite a good experience too, and I'd have done this for free.

The first week of holiday is going to be over! I need to sit down and read up on proper school stuff.

Strep. pneumoniae

2011-03-28T18:45:00.007+08:00

Writing my lab report now, and I've got some really nice bacteria culture here.

My lab partner Hui Ching's Miles & Misra growth plate, used to count the actual number of bacterial cells by doing some really quite simple mathematical averaging. Absolutely beautiful circular colonies. You can see the green tinge due to the partial degradation of haemoglobin (ß-haemolysis) as the bacteria try to grab the iron in it for nutrition. HCO, you should quit medicine and be a microbiologist in the future. For this, we counted about 50 million Streptococcus pneumoniae in 20 microlitres of sample. Quite a huge number.

An army of rifampicin resistant Strep. pneumoniae. It is amazing how fast bacteria can mutate. Next time when the doctor prescribes antibiotic make sure you finish the course.

Alright, back to my report.

Anatomy and Embryology

2011-03-25T07:50:00.003+08:00

I have been contemplating whether to buy an atlas for embryology, especially since I'd be getting a £20 Waterstones voucher next week during the SMSUK dinner.

But on second thought, doing any serious studying for embryology is quite stupid since not many questions will come up in the end. Hence I dismissed the idea.

Anyway, I stumbled across this beautiful online copy of Gray's Anatomy. It has 1247 anatomical drawings!! Granted, it doesn't look as modern as my copy of Netter's, but it has good educational value.

Spring is here!!

Ophthalmology

2011-03-21T04:50:00.013+08:00

I think I'm really overdoing it, but tada I attended Undergraduate Ophthalmology Conference in the Royal Society of Medicine. (It's not hard to see why I'm blogging about nothing but medical conferences nowadays, because *gasp* that's the only thing I've been doing). I find these conferences immensely interesting because you ALWAYS learn something new. The specialist surgeons are all trying to sell their specialties to you, and as a result I feel that I'm really spoilt for choice in terms of my career next time because there are so many fields to go into: orthopaedics, neurosurgery, ophthalmology, trauma, ENT, et cetera. I don't know about elsewhere but I really feel that London offers fantastic exposure to us future doctors and surgeons with such a high concentration of medical schools and societies.

For you non-medics out there, ophthalmologists are eye doctors (I just learnt how to spell it recently). They are the people who do Lasik surgeries, as well as performing plastic surgeries involving the eyes (such a subspecialty is called oculoplastics). They also repair detached retina, remove cataracts, treat eye injuries, remove eye tumours and other eye problems.

Operating on the eyes is quite a delicate thing to do. Other than the brain, the eyes are probably the most complex organ in human body. Opthalmic surgeons perform microsurgery, manipulating mini scalpels and surgical tools under microscope. Unlike other specialties they do not have ward rounds, their on-calls are not that bad, and they can easily go private. They earn big bucks performing Lasik and oculoplastics. They do not have crazy hours like the A&E trauma surgeons. They do not have to see people die so often like the trauma surgeons do. They don't have to deal with people who got shot, hit by trains, or jumped off a building with all their organs in pieces. Ophthalmologists have good lives.

I am not usually squeamish when it comes to doing surgery (nothing can get worse than cutting open dead bodies and dissecting all their organs anyway), but when I saw some of the videos about eye surgery I was thinking to myself: ouch. The needle goes right into the eyeball, and you have scalpels scraping away at the eyeball. That must be quite uncomfortable! But then again I haven't done anatomy of the eyes per se, and I think that once you've understood the anatomy of the organ you'd feel less squeamish and look at it in a more scientific way; fear is born out of the unknown. It's like when you've learnt that there's no pain receptor on your brain, you'd be more willing to play around with it (okay maybe not really). The flip-side is that I won't find joy in watching movies like SAW anymore.

So really, I am indeed swayed by them to consider specialising in ophthalmology. It is challenging, makes good money (once you go private), and I'll have more comfortable working hours. However I won't get to save lives (although making a blind person see again is just as good I guess).

Oh and by the way, the coffee at the Royal Society is really good.

Technology in Medicine and Surgery

2011-03-20T03:06:00.004+08:00

This blog is turning into a "Life as a Medical Student" diary. But to be honest I have little time for anything else nowadays.

Just came back from a medical technology conference in Imperial College, and like always I'll post some photos up here. Beware though there's one rather gruesome photo this time.

This conference is mostly about the latest innovations in surgical technology.

The proto-type of a self-refracting spectacles with adjustable refractive index using some kind of fluid lens.

An inflatable operating theatre used to train trauma surgeons.

A set of surgical tools. This "kit" is designed to be mobile and transportable, as well as being highly realistic, as the next image shows...

This is a model, with her beautiful squishy intestines out. It is actually quite squishy, so it has good value for simulation. The patient here supposedly suffers from a stab wound in the abdomen. The blood stains you see results from a severed artery which is squirting out blood, and the surgeons need to quickly locate the artery and tie it up as soon as possible.

Another simulation program currently being developed as an education tool, using Second Life as a platform. This time it is in the A&E department.

The victim suffers from a bomb blast which amputated his leg. His heart rate skyrockets, though his airway is patent and he is conscious. Blood type unknown. Massive bleeding on his left leg. The task now is to keep him alive as long as possible before the trauma surgeon and vascular surgeon can operate on him.

I really like the idea of practicing surgical skills while sitting in front of computer. The avatars are all controlled by real people, and parameters like the heart rate, respiratory rate, blood pressure, etc etc can all be tweaked by an instructor. There is a huge clock ticking behind so time pressure is rather real. This will be a really fun way to put what we learn into practice.

Advanced Suturing

2011-03-19T03:23:00.001+08:00

The subcuticular suture commonly used in plastic surgery.

Everything is done beneath the skin, so you won't see the thread at all.

Cheshunt & Stockwell

2011-03-19T02:37:00.008+08:00

Travelled to Cheshunt in Hertfordshire, a town slightly north of London, 1/3 of the way to Cambridge, for my clinical placement.

Cheshunt Railway Station

The GP clinic that I went to is called Stockwell Lodge Medical Centre. It is a nice, busy, little clinic frankly in the middle of nowhere by the standard of a city-dweller like me.

A random roundabout

The entire morning just whizzed past. I actually liked the experience more than I thought I would. One thing I realized about myself is that I'm really not good with talking to elderly people. In terms of patient interaction, I tend to feel more comfortable when I have a list of things to ask, so if people go off tangent too often I'd often be lost for words to say. I think I wouldn't be a good GP (General Practitioner) or a family doctor though, because you really need to sit down and give advice to people and follow through their lives.

It was quite a long journey. We took a tube all the way to Seven Sisters, this place in Zone 3 of London which is reasonably close to the outskirt, then we switched to National Express (East Anglia) train to Cheshunt station. We booked a taxi because we were unfortunate enough to miss the last bus.

We got there early and was directed to a staff lounge to wait for the other pair to arrive. After waiting for nearly half an hour, we were sent to be with a GP and observe some of the consultations. There was a patient who was rather uncomfortable with having a medical student around, so we kindly left the room. The second patient had quite a bad pharyngitis ('sore throat'), and was prescribed some antibiotics. We got asked the difference between penicillin and amoxycillin, and I falsely answered that they are different classes of drugs. Well, technically we haven't done pharmacology yet so I wouldn't blame myself too much on not being to classify drugs. The third patient had a more interesting case, but since it's quite an identifiable case I can't disclose too much since it will definitely breach confidentiality.

Then my partner and I interviewed two patients for about half an hour each, mostly asking about their dietary and exercise habits. It is quite amazing to talk to people about what they eat, and be taken completely seriously. Nothing particularly worth mentioning here so I shouldn't elaborate.

Debriefed by what I assumed to be the head GP there. Talked a little bit about the recent shift of funds from Primary Care Trusts (PCT) to individual GP clinics, and the resultant huge gain in managerial responsibility, albeit also with more authority and presumably autonomy for the GP. This kind of quasi-privatisation really calls for some management skills.

Finally learnt a bit about how to report patient history. Always remember names because patients are human. I can't believe how easily we forget that. If you just look at the notes I take, it is really just a list of symptoms, signs, medical conditions, as well as dietary and exercise habits. It can be quite impersonal to be honest. Other than that we also missed out key information like the length of treatment, chronic conditions (didn't manage to find out everything), and their family relationships. We asked about what they eat for the three meals, but not what they have for snacks.

You get the idea. It is quite like detective work really. We ask right questions to get the right answers (hopefully), then piecing the information together to find out what is/are their problem(s) and intervene appropriately.

Finally learnt a little about Orlistat®, the common weight-loss drug which works by blocking pancreatic lipase, the enzyme that digests fats, and therefore reduces fat absorption. You have to prescribe that if all dietary and exercise adjustments fail.

That's about it. Also, I spent a huuuggggee lot on travelling to and fro, partly because we forgot to (or rather we didn't know we have to) tap out between the tube and train. Still feeling quite a pinch now.

Way of life

2011-03-16T18:18:00.003+08:00

Busy busy busy. I realized that I really need to find time to read up more about current affairs and other non-medical stuff. 9 to 5 school days on most of the days, 2 hours of dinner-cum-chitchat session, and I'd only be left with about 3 hours of study time. I don't even have the time or motivation to blog like I used to, when I'm so inundated with information every day. I miss the days when I have the time to actually spare a few hours to study Japanese, or French, or physics, or programming, or just read a good novel. God I can't even remember what is the last novel I've read.

I need to change my way of life soon.

Sunday mornings

2011-03-13T17:00:00.003+08:00

I love Sunday mornings. I don't know why particularly, but I just love Sunday mornings.

Things that happened in the last few days made me discover more about my ideals towards love. Firstly, I really believe that one should enter a relationship with a possibility of getting married eventually. It is just a possibility, not a goal whatsoever. You definitely should not enter a relationship after having ruled out marriage. Secondly, I feel that expectations are very dangerous things to have, because more often than not they will smother a relationship instead of strengthening it.

A comic strip that I've always found inspiring: http://osorhan.com/bigo/

Mutating Streptococcus pneumoniae

2011-03-05T01:02:00.007+08:00

Had a go at mutating Streptococcus pneumoniae, the bacteria that cause pneumonia!!

Giving the bacteria a home!!

Bacteria's food!! Yum yum :)

Look at how happy they are!!

Centrifuging the bacteria, ie spinning them at 10000 times per second, not to make them dizzy but to cause them to all gather at the bottom of the tube.

I then collected the highly concentrated bacteria from all 11 tubes (anyone wants some bacteria concentrate?) and gave them a new home!! This time with the antibiotic rifampicin which will eventually kill all of them but those immune to it. Yes sounds very much like every single zombie film where at least one person has the immunity to the zombie virus, and everyone dies trying to get him or her to save humanity.

This is my first attempt to create mutants :)

National Undergraduate General Surgery Conference

2011-02-28T06:52:00.013+08:00

I've just been to this national conference held jointly by UCL and the Royal Colleges of Surgeons of England and Edinburgh, and have to tell everyone, medics and non-medics, it is the most well-organised event I've ever attended.

We had a series of lectures on the first day on a wide range of topics ranging from Minimally Invasive Surgery, to use of stem cells in surgery, to trauma surgery which deals with emergency situations like gunshot wounds and road traffic accidents. We have some kickass, legendary surgeons as speakers, some knighted by the Queen, some being the first to perform laparoscopic surgery in England, some inventing revolutionary surgical procedures like a way to administer radiotherapy for cancer concurrently with surgery and Robot Assisted Surgery.

However the workshops are the main highlight of the conference because we get to do a whole bunch of very interesting surgical procedures.

An exhibition about the different scalpels used in surgery

Operating a robot used to perform abdominal surgery. Nowadays you don't have to open up the stomach anymore when you want to do something to the intestines. The robot will make a small hole on your abdominal wall and put some long, delicate graspers and scissors, and you just need to operate the robot to make the cuts, stitch them up and you are done.

What's happening inside the abdomen

Then we had this knot tying workshop to tie a simple reef knot

Goofing around

We also learnt to do this procedure called central venous catheterisation, which basically involve sticking a tube down the vein in your neck to measure blood composition, central venous pressure or to administer glucose, or antibiotics, or for blood dialysis, chemotherapy, drawing of blood and many many other uses.

Basically it involves finding the internal jugular vein using a syringe until blood can be drawn out, then threading a metal wire into the vein. Finding the vein is not that easy unless you know where you are looking, and as you can imagine poking around with a huge syringe on someone's neck is really something you should get over and done in as few attempts as possible.

Then you make a small cut to enlarge the wound, and then do a whole bunch of fiddling with other tubes before finally putting the catheter in using the metal wire as the guidance. Pull out the metal wire in the end and we're done.

Finally we also did this thing call the cricothyroidotomy, which is an emergency manoeuver to artificially ventilate someone when he or she has a collapsed airway.

Basically you identify a specific entry point on the neck (FYI: between the thyroid cartilage and the cricoid cartilage), and then carefully making a small incision before putting a tube in to supply the lungs with air. The aim is to cut at a precise spot so that minimal bleeding and damage will happen.

It is a very simple procedure that can be done quickly during an emergency, but you must know where you are cutting because you are literally slitting someone throat, and there are two enormous arteries called the common carotids running quite close to the airway and severing one or both of them will almost guarantee death during an emergency. What's more if you go too deep you will stab the oesophagus it will be potentially fatal as well. This is really something that can go seriously wrong if you make the slightest mistake.

And the most important thing is that you must have the gut to perform on a living, suffocating person during an emergency. Yes this is reeeeaaallllyyyy painful and the tube is huge, but if this is the only thing that can save someone's life a doctor must be able to cut someone's throat without hesitation.

I think I did quite a fine job getting the tube into the airway. I can't imagine doing it on anyone alive though because it really sucks to have such a large tube down your throat through an open wound.

There you go.

I am really glad I came to UK to study because there are just so much opportunities for us to attend these kind of conference and be under the mentorship of some very prominent figures. Now the next step for me is to actually do a decent research project and try to get published.

Smile :)

2011-02-18T23:57:00.001+08:00

٩(͡๏̯͡๏)۶

Valentine's Day exam!

2011-02-14T05:52:00.002+08:00

Valentine's Day exam!!

The Brits here are so unromantic. How do I know? They put an exam on Valentine's day. That's very very inauspicious.

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David Bender's Introduction to Nutrition and Metabolism is such a rip-off!! It's great that our professors are writing books — it shows that they know their fields well at the very least — but the fact that these books are sooooo overpriced and so under-illustrated and under-formatted is not so great.

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I can't wait to live in my own house!! I want to decorate my room :)

Rant

2011-01-30T05:34:00.028+08:00

I think that I am so different from what I was a year back. I am always trying to meet others' expectations, and the harder I try, the more I feel that I am just not nice enough or am just not trying hard enough to be nice. I am constantly trying to compare myself to everyone else, because everyone else seems to be much better a person than I am. I just don't feel the sense of self-identity anymore like I did in the past.

I still remember I posted in June last year about the three values I set for myself: be humble, be positive, be selfless. I don't know how far I've gotten to actualize them, but looking back at the post I can say for sure that some of the qualities I once had was disappearing. I think I am not so assertive in social interactions and in relationship anymore, less insistent on my views and I don't brag to people about every piece of information I know and learnt. I tried to be more humble, to be more optimistic, hopeful and less skeptical, and to be less self-centred.

The problem is that I don't really know if I am comfortable with myself anymore. I used to be this little smartypants who goes around telling people every single thing I read, about philosophy, my strong opposition to religion and whatnots. I used to feel really proud of myself when I completed the whole H2 physics syllabus by myself, and went on to study Einstein's theory of relativity. I used to feel that I can understand things and learn faster than most people can. I used to mock people who are "stupider" than I am.

But now I just feel stupid. In terms of studies, I think I am taking medicine much much more seriously than A-levels, because I have my dreams and ambitions and I know that there is a huge responsibility involved in being a doctor. I was not so keen to read outside of my syllabus anymore. I kind of agree with what a neurosurgeon told us during a talk a few days back that being a doctor will eventually trample every last trace of talent and sentimentality we have in us. Very few surgeons have time to spare for their family, much less become an outstanding pianist or an active sportsmen. Yes, there are people who can manage that, but I am definitely not one of them. Being in medical school really ingrains some kind of humility in you, because you always know that there are people out there that are much more intelligent than you, who have already taken a degree and who was involved in sorts of healthcare experience, first-aid experience, being an expedition medics or army medics that you just feel that you have a long way to go before you can reach their level of competence.

On the other hand people will expect so much of you even from day-to-day, seemingly mundane activities. When you cook, people will expect you (or rather I'd think that people expect me, which has the same effect anyway) to be more careful of the knife and to slice things up really professionally. People will scrutinise your mannerism and will always tell you that you would not make a good doctor because of certain idiosyncrasy you have - too jumpy, too careless, not steady enough...... After a while, and whether if they are just in my head or people do indeed make such judgments, I feel that I am constantly under medical training and I can't just let go for a while. It is ridiculous that when I say I want to be a good doctor or even a surgeon, no one takes me seriously at all, saying that I just don't look like I can make it there. Yes maybe they are just passing comments, but the scary thing is that I see some truth in that as well, that maybe I'm just not cut out to be the best, and maybe after a while I will start believing in that as well. Maybe when you take something very seriously, any form of insult, however passing or unintentional they may be, really matters a lot to you. It is quite disheartening that after trying so hard to actually achieve something in the end, people tell you that you just don't "look like it".

And back to expectations again, I feel that medical training can be so taxing especially when it comes to the professional development part where we have to go out and interact with people and learn how to be professional and compassionate. I feel really stressed sometimes, like when we were asked to talk to elderly people last week about their experience in an elderly home. I think I'm not a very extroverted person deep down, and particularly I just dislike talking to people for the sake of talking. I again feel that I can't meet the medical school's expectations, because I am just not that kind of communicator that they are hoping to raise. Unlike other courses I feel that we medics have some kind of emotional burden on top of the intellectual burden. It is not just about how many assignments we have anymore — we do have a lot — it's also about that kind of professional stereotype we are trained to become and the type of emotional maturity we are expected to develop. Not many other courses require you to go out into the community to talk to strangers almost every week or every other week, while upholding the image of the profession and the school. Not many other courses have exam questions which say "Write two things you need to remember when you introduce yourself to a patient", or which ask you to write an entire 20 mark essay on how to advise a patient to quit smoking. I think no other course requires you to complete a portfolio at the end of the year with questions like "What experiences in your life do you think have shaped who you are today?" as part of the assessment. I don't know about other medical students, but at least I often feel that I won't make a fantastic doctor with my personality. I am just not clear-headed enough. I am just not steady enough. I am just not cautious enough. I am just not meticulous enough. I just don't have the kind of moral high grounds, social EQ and emotion maturity as what people would expect of doctors. I maybe am just not good enough.

In relationship as well I feel pretty much the same inadequacy. I am totally not a sweet person. I never was. But every time I tried I just feel that I am not putting in enough effort to make something really sweet. I just don't feel that kind of accomplishment some guys may have when they are making really nice cards or videos or baking really yummy cakes for their loved one. I know that it's something that most girls will like but I just don't seem to be able to put my heart into it. Does it mean that I don't love someone enough? Does it mean that I am just not sweet enough? I'd think that guys who are willing to prepare really nice presents felt some overwhelming sense of euphoria in the process of making the present, but apparently I don't. People say that it's the thought that count, but sometimes I feel that I am just so bad at making anything that I find whatever I make just not good enough a present for anyone, and just completely belittle and trivialize how I really feel. I am just bad at expressing myself by making gifts, and I'd think that I have my own way of loving one. But will the others feel that it's an excuse and that I am just not sweet enough? I don't know. Everything is just a huge mind game sometimes, or maybe I am just complicating matters a lot. Should I love someone the way I want or should I love someone the way she wants, because it's more sweet to do that? I don't know anymore. I just really enjoy doing things together and spending time together, but will it be too mundane? Is it not romantic enough? Is it not good enough?

So I guess that's why I feel that it has been so mentally exhausting the past few months. There are so much judgments and expectations that I face that I just somehow grow to not like myself so much anymore. I just feel that I am not good enough, be it in my studies, relationship or friendship. I was perhaps a really prideful and insistent person in the past, but now I feel that I am just letting everything slide and not holding on to my principles and ideals so strongly anymore. I used to feel that I am a deep person who knows what I want and who won't let myself be hurt in any way, but now I feel just so weak and vulnerable. I am such a disappointment to many people. I don't know if I like the present me anymore.

There's this line from Love & Other Drugs that I really like. Jamie said to Maggie: I've never known anyone who actually believe that I was enough until I met you. And then you made me believe it too.

Bacteria

2011-01-27T20:28:00.002+08:00

Streaked some bacteria today!

Streptococcus pneumoniae, the bacteria that cause pneumonia. It must be grown on a blood agar. What bloodlust it has.

B-lactamase positive E. coli

Ready for incubation :)

Mneumonics

2011-01-27T06:11:00.011+08:00

I am seriously experiencing an information overload right now. If you had your hands full with A-level biology, wait till you enter medical school. There are so much to remember in medicine, so it seems like a good idea to use mneumonics.

Some examples of mneumonics I have been using and which worked.

Treatment for tuberculosis:
R - Rifampicin
I - Isoniazid
P - Pyrazinamide
E - Ethambutol

I seriously have no idea how doctors can remember the drugs for all sorts of disease without using some kind of memory aids. I can't even remember if Gram-positive bacteria are blue or pink in colour.

Universal dOnor is O
Universal recipient is AB

I am stupid because I cannot seem to remember off the top of my head which blood group is the universal donor and which is the universal recipient, when it is SUCH A BASIC AND VERY VERY IMPORTANT CONCEPT.

And anatomy is just a hell of facts to remember.

C3,4,5 keeps the diaphragm alive. This is basically the nerve supply to the diaphragm. Again, random, patternless numbers that we must just remember. The rhyme does help a bit.

ABCS. The order of the major arteries branching off from Aorta: Brachiocephalic, left common Carotid, left Subclavian. This is quite contrived but somehow it helps *shrug*.

PAMT 3344. The four valves of the heart: pulmonary, aortic, mitral, tricuspid and behind which ribs they are located. Seemingly trivial but these are the places (roughly) where we have to place the stethoscopes to listen for heart sounds.

Yes I have totally no life right now.

To side track a bit, WHY DO WE HAVE EXAMS ON VALENTINE'S DAY!?!?

SSC

2011-01-23T08:17:00.007+08:00

My SSC just ended! SSC is Student Selected Component, an elective part of our course which we do something out of syllabus just for the sake of knowledge.

And hence just for the sake of knowledge, I decided to do the Science of Speech, which has everything to do with linguistics, phonetics and language science, and nothing to do with medicine whatsoever. After a couple of months of absolute regret, I have realized that I am probably not going to try doing something not remotely medical again. (Other than languages, of course.)

Basically we did the following ~~rather pointless~~ lectures:

Voice (lots of anatomy involved)
Source-Filter Model of voice (lots of geeky computer analysis of voice involved)
The sounds of world's language (lots of IPA - International Phonetic Alphabets - involved)
Speech is highly variable (lots of geeky computer analysis involved again)
Speaking and singing (This is actually quite fun, if not for the fact that I'm kind of scientifically proven to be a bit tone-deaf)
Disorders of speech production (slept through the whole lecture so I've got no comment on this)
How do we express emotions with speech? (The most interesting by far).

And finally I did a lab report on the accuracy of imitating familiar speech and unfamiliar speech, which is completely bullshit (but I got an A anyway); and I did a presentation on how children acquire language. 99% of the time I have no idea what I was talking about, and probably the remaining 1% of the time no one understood me because of the Singaporean accent I have. But whatever. It is over.

I'm now looking forward to my next elective, which will investigate the challenges of antibiotic resistance. This time I'd be doing some hardcore labwork WHICH IS RELEVANT TO MY MEDICAL DEGREE!! Good for me.

Day 5 of France

2011-01-23T06:32:00.004+08:00

This is the last day that we actually did anything significant. And it's a special day :)

Got up extra early to go to the Eiffel tower in the morning. Eiffel tower was built as an entrance arch to the 1889 world's fair in Paris. It was named after its engineer Gustave Eiffel (which is quite egocentric for him to do so).

We actually hoped to get up to the tower by getting the ticket on the spot. We need to pay a fee for taking the escalator up (and a marginally lesser fee for choosing to climb the stairs instead) to the second floor, and then another fee for taking the escalator up to the third and topmost floor. Apparently, and very disappointingly, the queue for the ticket was incredibly long when we got there. So we just lingered on the bottom of the Eiffel tower (which is really a colossal block of metal bars).

We took a lot of pictures there. It is a special place :)

Our next stop was Notre-Dame, a Catholic church in the centre of Paris. Notre-dame is basically the church of the Archbishop of Paris. It is a French Gothic architecture, and is famous for the coronoation of Napoleon and his wife Josephine (I actually went to watch a whole documentary on Napoleon after I came back from Paris. He is a really interesting historical figure).

Our day was rather short as we woke up near noon. At evening we sort of rushed to the Seine for a river dinner cruise.

Our dinner includes:

LES ENTRÉES
-Creamy quinoa with forest mushrooms &
-Parmesan and tomato shortbread with fromage frais and baby vegetable rocher &
-Hazelnut flavoured pumpkin velouté &
-Marinated swordfish bouchée with ferocious avocado &
-Foie gras harlequin with exotic fruit coulis

LES PLATS
-Smooth veal tournedos with morel mushrooms blanquette style
-Renowned roast grouper steak with subtle saffron flavoured fennel sauce and sweet potato puree

LES DESSERTS
Pear poached in hibiscus &
Light Bourbon vanilla cream dessert with imperial mandarin orange &
Smooth chocolate gateau

I completely loved the entrées, even though for the main and the dessert I've tasted better ones in London.

Nightview of the Eiffel Tower.

Recognise this place in the movie Inception? WE WERE THERE!! (And yes I did research, we were in fact truly there). Now with the UCL Library I've sort of been to many Inception places. The wonder of living in Europe :)

A special evening indeed :) This concludes our Paris trip!!

Day 4 of France

2011-01-12T00:59:00.008+08:00

On Day 4 I spent the entire day in Versailles. It is a really really beautiful place.

Early in the morning, we took the RER (Réseau Express Régional), the train line which transports us between Paris and the suburbs, to Versailles. With our passport and student card we gained free entry into the palace.

The Palace of Versailles is a royal château where Louis XIV lived in in the 1680s, until the royal family was forced to move back to Paris during the French Revolution, effectively as prisoners.

Statue of Louis XIV in front of the palace

The palace now is like a gigantic museum. Our first stop was tribune royale, the chapel where the king and the royal family heard mass.

There were also rooms and rooms of painting, mostly portraits, of the king and his family, and of utmost egocentrism.

A bronze sculpture called the Le Parnasse francais, showing the king with a pegasus on top of him and a number of noblemen.

The king's apartment (Grand appartement du roi) is arranged in a series of seven rooms named after the seven planets and the Roman deities associated with each of them: Diana, Mars, Mercury, Jupiter, Apollo, Saturn, Venus). Some of the rooms have the grandest ceilings I've ever seen.

And of course there is the Hall of Mirrors (Galerie des Glaces). The Hall of Mirrors is flanked by the War Room (Salon de la guerre) to the north and the Peace Room (Salon de la paix) to the south, connecting to the king's rooms and the queen's rooms respectively. The whole layout of the palace is symmetrical. The windows overlook the garden. The entire room is flooded with reflected light.

The seventeen mirrors are directly opposite the seventeen windows. It is the most beautiful interior architecture I've ever seen. In the 17th century, mirrors are apparently the most expensive things to possess and this room is a display of France's economical power in the 17th century.

The Coronation of Napoleon, Jacques-Louis David, 1805-1807. This was a replica by the painter himself as the original painting has been moved to the Louvre in Paris.

Distribution Of The Eagles On The Champs De Mars, Jacques-Louis David, 1804.

Next we went to a science exhibition (yes that's right) in the Palace. The French court is a place where significant scientific innovation had taken place. There were hydraulic pumps used to irrigate the garden, the various celestial and terrestial globes used for astronomical purposes, a miniature zoo and botanical garden in the gardens of Versailles. Louis XV removed some of the art pieces for scientific instruments, while Louis XVI set up a science cabinet occupying three floors.

A rhinoceros gifted to the French king.

Then we visited the gardens, and took a hell lot of photos there. I'd probably upload the photos onto facebook so if you're interested view them there.

At night, we went for groceries at Carrefour and met up with HD to cook dinner. Yes, cooking dinner in Paris while on a tour is extremely fun. We had salmon miso soup, curry chicken (with Singapore curry paste) and oyster sauce broccoli and mushrooms (done by me).

Day 5 of Paris coming soon!

Day 3 of France

2011-01-11T01:25:00.004+08:00

Day 3 is shopping day, which, to be honest, wasn't as fun as expected. Paris is good for upmarket shopping but downmarket shopping is really better and cheaper if done in London.

Our first stop was Galeries Lafayette, a rather high-end shopping mall.

There are fair number of luxury brands like Gucci, LV, Burberry, Dolce and Gabbana and etc. For most parts we just window-shopped because the prices are exorbitant. I was quite interested in some D&G stuff but I decided that I'd only buy them once I earn big cash, which won't be anytime soon.

Had lunch at some Chinese restaurant, then rather uneventfully we went to Les Halles, another shopping district.

Some protesters (I think) near Les Halles

Les Halles was a more downmarket place having familiar brands like H&M, Zara and Topshop. The prices there are higher than London's. Speaking about prices, I feel that Paris is actually marginally cheaper to live in than London (or at least Central London where I live in right now). However the housing prices there seem really high, probably due to Paris being such a small yet highly populated city.

We basically window-shopped again, and, yep, that's about it. We didn't buy anything at all because there wasn't any particular French brand that we really like, and that those familiar brands like Zara and River Island we can get the same design at a lower price in Oxford Street, so there was really not much incentive for us to shop in Paris.

In Desigual. I think Desigual has a nice concept but not everyone can pull off their clothes (and they are so overpriced too).

Day 4 will be interesting, so stay tuned!

Day 2 of France

2011-01-10T07:47:00.009+08:00

We met up with a friend studying at the Universite Paris-Sorbonne at noon for lunch.

I find it quite brave for a Singaporean to come to Paris to study. Firstly there aren't a whole bunch of Singapoeans here in Paris, unlike London. Secondly I don't think anyone is that good in French to hold a deep conversation with the native speakers. It takes a lot of courage to study alone in a foreign country like France.

Had some Italian fastfood.

We then travelled to Pigalle, the red-light district of Paris.

Here's the world-famous cabaret, Moulin Rouge.

I did a bit of research because I wasn't cultured enough, apparently, to know what Moulin Rouge is. It is a type of performance/comedy where girls dance, sing song and act basically. Moulin Rouge also gave rise to the modern form of can-can dance, originally a seductive dance performed by prostitutes. Moulin Rouge means Red Mill in French.

Some estate along Pigalle

We skipped the whole of Pigalle (filled with sex shops and sex cinema which we are apparently not interested in. And it was just 1PM.) Our next stop, ironically, is a Catholic church nearby Pigalle. I was joking that the priest will walk down the hill and visit Pigalle once they finish praying in the church.

A carousel.

Oh and one thing about Paris is that there are a lot of graffiti. This is something never ever ever ever seen in Singapore but so common in Europe. Sometimes they are really an eyesore, but it definitely adds a bit of flavour to the city. Paris has too much graffiti in all the wrong places though.

So our destination is Basilique du Sacré-Cœur, a Roman Catholic basilica. Sacré-Cœur is the French for Sacred Heart (which I think is quite a nice name). It is situated at the highest point of Paris, on top of the hill Montmartre. It is built in 1914 and consecrated in 1919.

We climbed all the way to the top after countless flights of stairs.

Finally the main basilica.

We didn't manage to take pictures of the interior because photography is forbidden. There were people praying and candles burning. The basilica is very spacious and well decorated. The one thing I didn't really feel right is that the whole basilica seemed very commercial. There were souvenir shops, donation boxes, and almost all the lighted candles have a box of unlit candles around them with the price tags on top.

Our next stop was the Arc de Triomphe, located at the western end of the luxury shopping district Champs-Élysées. It was about 3PM and we had some time to explore Paris before night falls.

Arc de Triomphe was built to commemorate those who died in the French Revolution and the Napoleonic War with the names of all French victories and generals inscribed on the arch.

The scary spiral staircase. It was quite a tiring climb to the top.

The view on top of Arc de Triomphe is astonishing. Paris is arranged with a circular symmetry around the Arc de Triomphe. We can see most of Paris (which isn't very big anyway) from the top of the arch.

Got down the arch and we walked down Champs-Élysées, the luxury shopping district. Brands like Gucci and Louis Vuitton have their shops there, and we literally got asked a couple of times by rich Chinese people to help them to get bags because of the two-items-per-person policy.

After about an hour of walk, we arrived at the Louvre!!

The Louvre is the most visited art museum of the world and is one of the biggest. It is housed in the fortress Louvre Palace built in the 1100s under Philip II. Most famously the Mona Lisa is housed in the museum.

We basically just walked around the museum looking at thousands of paintings.

The Nike of Samothrace, circa 190BC

The Mona Lisa, Leonardo da Vinci, circa 1503-1519. This is as close as I can get to the painting because it was cordoned off.

La Liberté guidant le peuple (Liberty leading the people), Eugène Delacroix, 1830

Psyché ranimée par le baiser de l'Amour (Psyche Revived by Cupid's Kiss), Antonio Canova, 1787

Venus de Milo, Alexandros of Antioch, 130-100BC

That's it. Had Starbucks and went back to hotel.

A very very eventful second day :)

Day 1 of France

2011-01-10T06:42:00.003+08:00

I just came back from Paris!!

Day 1 of France

I woke up early in the morning, had Macdonald's and dragged the luggages to King's Cross/St. Pancras station. It was a fifteen minutes walk. The station was really nice; almost castle-like.

Checked-in. Got onto the train and slept all the way to the Gare du Nord station. It was already noon.

With a bit of French (like "bonjour", "merci", "parlez-vous anglais") we managed to get the Metro/Bus week pass (It's called Navigo). I think I almost got my bag stolen here because I left my bag on the floor while filling in a form and I thought I saw someone trying to grab that bag while I'm not looking, but when I turned over he just turned and left. Oh well. That made me much more conscious that Europe is a very dodgy place. London wasn't that bad but Europe surely is.

Hopped on the metro, dropped at Barbés Rouchechouart, changed to Place de Clichy and finally stopped at Garibaldi. These stops are all at the north part of Paris.

Barbés Rouchechouart station.

To be honest Paris wasn't what I thought. It wasn't as charming, as romantic as it was portrayed to be. When I just got down from the metro I was really appalled at how old (in a bad way) the buildings looked. Granted that we were at a not-so-rich district for the first day, the buildings definitely looked much older and poorer maintained than London's.

Settled down at hotel and we went to Les Invalides!!

Les Invalides used to be a hospital and retirement home for the war veterans. Now it houses various museums such as Musée de l'Armée, Musée des Plans-Reliefs, and Musée d'Histoire Contemporaine (none of them we visited). It also is the burial site for Napoleon Bonaparte (which we didn't realize).

Pastry cart near the Metro station

My impression is that the French are very patriotic people. They love their French culture and language. Apparently the French will ignore you or be mean if you do not at least make an effort to speak French with them when asking them for directions. I didn't feel that way. In fact, I felt that they are very helpful. I think it's about respect. If you respect their culture you'll get that kind of respect in return too.

After spending a few hours at Les Invalides taking pictures and looking around, we decided to call it a day. The first day was not meant to be activities-packed anyway. We metro-ed back to the hotel.

Sidenote: We stayed at this hotel called HotelF1. It is reeeaaaally clean and cosy, and it's cheap. The toilets are clean and modern as well. Other than being in a slightly dodgy district I was really satisfied by the service. Here's me doing a free advertising for them.

... to be continued.

2011

2011-01-01T10:02:00.003+08:00

It's the start of 2011!! I've not got the habit to make new year resolution because I'd never remember them, and even if I did I will not implement them.

I think this is the first countdown party I've gone to in (at least) the past five years. We went down to River Thames to watch fireworks, which was quite alright. I actually had a pang of nostalgia when the fireworks died off. I miss doing the things I did when I was back in Singapore earlier in the year. I can't believe it's been a year since working as a tuition teacher in a tuition centre. Time flies.

It's only after I came to London I've bothered to celebrate holidays like Christmas and New Year and Halloween. It must be the company here; being here together in a foreign land bonded us together. I had quite an eventful Christmas holiday, filled with Christmas shopping and mahjong and various dinners, and of course the Paris trip next week!!

I miss everyone back in Singapore. So here's me wishing everyone a HAPPY NEW YEAR!!

Laparoscopic Cholecystectomy

2010-12-14T01:47:00.008+08:00

Removed a gallbladder using laparoscopy today :) The picture above wasn't my gallbladder though (it is a third year senior's) because I kind of punctured mine in the process with the bile leaking everywhere so it didn't look very presentable. The laparoscopy instruments are not the easiest things to maneuvre. It is pretty damn hard to stand there for an hour snipping off at the peritoneum joining the gallbladder and the liver and trying not to damage the liver.

Basically we have to identify the cystic duct from the common bile duct and the common hepatic duct, clip it with staples, and then cut just the cystic duct along with the arteries supplying the gallbladder. It is difficult because it's rather hard to tell where one duct ends and joins another duct. I think you need to be quite familiar with the anatomy here so I kind of cheated and got the surgeon to point out which duct to cut. Heck I haven't even done anatomy of the abdomen yet.

This is what the surgeon did.

You can see how she nicely separated the cystic duct on the left from the common hepatic duct on the right. It is not clear on the picture but the common hepatic duct actually goes down into the liver while the cystic duct leads into the gallbladder. It's okay to cut the cystic duct because that only means you can't store bile, but if you cut the common hepatic duct you will totally cut off the secretion of bile from the liver and basically without bile you won't be able to digest fats.

This is what I did after I cut off the cystic duct.

And it is extremely messy. But then again the surgeons are earning a few dozen thousands for a surgery so you'd expect them to do a better job.

The end result:

It was an extremely good experience.

Airway Management and Triage

2010-12-13T02:17:00.008+08:00

Had a workshop on airway management today.

'

Airway sometimes get blocked and it is the top priority to clear the airway during an emergency rescue.

I got to put this thing called the Laryngeal Mask Airway (LMA) down a dummy's throat, which holds the airway open for artificial ventilation. It is a relatively more pleasant alternative to intubation as the LMA doesn't go all the way down to the trachea (the windpipe) like intubation does, and just sits on the larynx (where your Adam's Apple is). Still, it is a huge ass rubber tube. You definitely do not want it down your throat.

We also did some triage today. Triage is the prioritisation of treatment and evacuation during a disaster or an emergency. We learnt how to assess the vital signs quickly and some basic rescue maneuvers.

In triage we group casualties into three groups: Priority 1 requires immediate treatment, Priority 2 requires treatment within 1 hours. Priority 3 requires treatment within 3 hours.

I think triage is an excellent instance of utilitarianism in medicine. The priniple of triage, do the maximum good for the maximum number of casualties, is almost a restatement of Jeremy Bentham's "Greatest Happiness Principle". We are taught to ignore those moaning and in great pain to tend to the casualties with the most need. We are taught that a casualty who is neither breathing nor conscious even after airway management is assumed dead. We are taught that even if someone has a knife stuck to his back, or an entire arm blown off by a grenade blast, as long as he can walk he is to be put on the lowest priority. We are taught that in a car crash, if someone's leg is jammed between the rescuer and someone else conscious, and that the former is unresponsive and in serious haemorrhage, it is acceptable to amputate the limb, killing the mortally wounded person in the process, to gain access to the other. We are taught to be procedural, and sometimes even cruel. The whole point of triage is to efficiently allocate limited resources to do the most for the most.

Utilitarian ethics is in play during an emergency where we have to make a moral choice in split second. Maximum good for the maximum number of casualties.

We are also taught about the dilemma between forensic awareness and rescue mission. The lack of forensic awareness was a huge problem during the 2005 London bombing. Paramedics are not supposed to move the dead bodies because the disaster zone is usually assumed to be a crime scene. The legal system ironically seems to be give more priority to the dead and legal justice than saving the living. Even if a dead body is blocking access to a living patient in need of medical care, the forensic team must be notified before the body can be moved.

And so, this is how I spend my Sunday :)

Laparoscopy

2010-12-09T10:52:00.017+08:00

I completely enjoyed myself during the basic laparoscopy skill workshop today.

Laparoscopy is a kind of minimally invasive surgery in which you make a small 0.5 to 1cm hole in the abdomen, put a video camera in and carry out surgery using a variety of tools.

... with a variety of tools which look like medieval torture devices.

Basically the video camera will be inserted into the body and record a video of what is going on within the body and display it real time into a screen directly in front of the surgeon. It really takes a lot of hand-eye coordination to operate the claspers and the scissors inside the body cavity.

In one of the task, my partner and I managed to stack up 6 sugar cubes and a bead with much effort.

... More tools.

The advantage of doing laparoscopic surgery is that your wound will heal much faster and there will be lower risk of infection and less complications during healing. Minimally invasive surgery is usually used for cholecystectomy - the removal of gall bladder (WHICH I WILL BE DOING NEXT WEEK!). I think now with robotic surgery you basically can get extremely precise when you want to chop things off in your abdomen.

But then again I kind of think laparoscopy is not really for me. I must admit I got quite impatient after failing to grasp anything at all using the claspers after 5 minutes. Well it's not exactly easy to tie up sutures inside body cavity with two 30cm long sticks.

Big ass mindmap

2010-11-28T07:59:00.013+08:00

I just love my big ass mindmap.

This is the pathogenesis mechanism for tuberculosis. I think I am mutating into a visual learner because I used to hate mindmaps and totally love reading chunks of text. Now I think mindmaps are really useful for quick revision.

I miss the day when I have all the time in the world to sit down and write about random things. Since I came to London it's been work, work and work. Other times I'd be too distracted to engage in anything remotely intellectual.

I miss people like HZ and WL whom I can talk geeky nerdy stuff with. I miss friends back in Singapore who I can really click well with. I miss T for all the time we spent together. I miss clubbing with TA. I miss E and her gang and her company bar. And, hell, I just miss everyone back in Singapore.

But hey. It's okay. Just six more years and I'm having hell of a time here.

Suturing again!!

2010-11-25T04:35:00.008+08:00

Performed a small bowel anastomosis today (stitched together severed intestines basically).

Just the usual interrupted sutures but this time on flimsy soft tissue. It's not as hard as I thought but I think that doing this neatly, quickly and cleanly takes a lot of skill. Basically we just did two instrument-tied surgeon's knots at either ends, hold the ends with artery clamps and then sutured the rest together.

Extremely interesting. There's a laparoscopy workshop coming up so I may go for that as well :)

Physicians' Top 20 Ethical Dilemmas

2010-11-23T08:10:00.008+08:00

I just got this article off the Medscape website and I think these moral dilemmas are interesting. (Source: Medscape)

Would you ever recommend or give life-sustaining therapy when you judged that it was futile?

Doctors' views:
"I once had a terminal patient who wanted to see his granddaughter before he died, so I prolonged his intravenous therapy for 3 days until she arrived. He died the same night."
"Some families have completely unrealistic expectations, despite my educational efforts. I would give continued care, but not happily."
"I do not have the right to determine futile unless the patient is brain dead. Futility is a matter of opinion. We all will die eventually."
"I would not recommend it if I thought it was futile, but I would give it if that is what the patient or the family wanted."
"Why waste money and time when results are nil?"
"I would do this if I felt it would give the family time to accept the inevitability of death."

My views:
I think the "why waste money and time when results are nil" is insensitive and completely disregards the emotional aspect of patient care, but I highly agree with the last comment, about how it gives family time to accept the inevitability of death. I would stick to the first of the GMC guidelines: Make the care of your patient your first concern.

Would you ever consider halting life-sustaining therapy because of family demands, even if you felt that it was premature?

Doctors' views:
"I do not participate in active withdrawal of such intrinsic life-sustaining needs. The family could find another physician if they feel so strongly."
"It depends on what you mean by 'premature.' I would feel differently if death is imminent and there's no hope, and the quality of life is poor rather than if there's no hope but some quality, or if there is some hope but the quality of life is lousy. I'd always try to think, what would the patient want."
"Not if the family insisted, but if the patient insisted on it, I would."
"This is why hospitals have ethics boards. I would refer cases like these to experts."

My views:
Pushing of responsibilities to the ethics boards, or to another doctor, is just irresponsible I feel. This is the typical problem of euthanasia which I feel is really very much a legal issue than anything else. You just can't generalize and pass a law and expect it to apply to everyone else, but sometimes such dichotomy between the law and other moral deliberations is necessary to prevent abuse, and hence is more pragmatic than normative. People are afraid that abuse due to family pressure and problems mental incompetence will actually lead to an escalation in suicide rate, but interestingly in Holland the numbers of suicide for people older than 50 fell by one-third since euthanasia has been made available. Who knows, it may give people the peace of mind that in that last moment of their life, when they felt that they have lost control of everything, they at least still hold the autonomy to choose.

Would you ever prescribe a treatment that was a placebo, simply because the patient wanted treatment?

Doctors' views:
"I think we do this all the time, with patients coming in with viral urinary tract infections who want antibiotics because they think it is the only thing that will help them."
"Lying to patients about treatments is never OK."
"I'm experienced enough to know that I can't help everyone, and I'm egosyntonic with being the occasional disappointment to my patients."
"A placebo produces a 30% improvement in some studies."
"Why not save money and risk for adverse effects by just prescribing placebos in cases when medications are clearly not indicated?"

My views:
White lies. I think on a personal level white lies are definitely okay but when it comes to the professional and legal areas my stand is to comply with the social contract because there are further repercussions beyond this particular issue. Doctor-patient trust is paramount to everything else.

Would you ever hide information from a patient about a terminal or preterminal diagnosis in an effort to bolster their spirit or attitude?

Doctors' views:
"Most of the time, I tell them exactly as it is; they need to know the truth, and who am I to judge what they should or shouldn't know? However, if the patient is very frail emotionally and physically and has a very supportive family, I may not."
"It's not about hiding information. It's learning how to talk to patients and giving bad news in the best way possible. All the information should be given, but any positive that exists should be also talked about."
"The truth, delivered with compassion, is a gift."
"I think patients deserve total honesty from their physician. They want to know."
"An elderly patient who is senile will not understand, benefit, or prepare, so it is senseless to inform them. However, a family member, next of kin, or whoever is the health proxy will be notified."

My views:
The truth, delivered with compassion, is a gift. I can only imagine how heart-wrenching it is to tell someone that they or their loved one are going to die.

Are there times when it's acceptable to cover up or avoid revealing a mistake if that mistake would not cause harm to the patient?

Doctors' views:
"Cover-ups are never OK."
"Everyone makes mistakes, but physicians are punished for their mistakes. I don't believe in covering up information, but in today's litigious society, a simple mistake could cost a physician his or her license."
"The more open the physician is about mistakes, the more acceptable mistakes will be to the patients."
"Why make a mountain out of a molehill if it will cause the patient more emotional upset than simply not saying anything, as long as no physical harm has occurred?"
"Do I balance the potential harm to a patient vs the potential harm to myself in publicly announcing 'a mistake'? Yes."
"I own up to all mistakes I make, but I explain their impact or lack thereof."

My view:
Lawyers, tsk. And my roommate is a lawyer. Double tsk. (Just kidding.)

Would you feel conflicted about dropping insurers that don't pay well, even though some longtime patients would probably stop seeing you?

Doctors' views:
"I would feel conflicted, but I need to survive as a business."
"There is a duty to serve and a responsibility to remain fiscally solvent that need to be balanced."
"I would fight for higher reimbursement and make clear to the patient that I was doing this because of my ethical obligation, and I would ask them to complain to their human resources department."
"I am currently in that situation but refuse to drop any patients."
"It cannot be just or mostly about the money. We must recall that we went into medicine to help people. I would feel I was abandoning my patients if I dropped the insurers."
"I wouldn't want to punish my patients because of a greedy, poorly run insurance company, but I would feel conflicted, because by not dropping them I am in effect condoning their actions."

My views:
The statistics is quite surprising: 57.0% said yes, 26.5% said no and 16.5% said it depends. I mean it doesn't really make sense to refuse to drop any patients at all but it will be really cruel to drop everyone that can be dropped. I would be more inclined to keep than drop patients. Businessmen, tsk.

Could you become involved in a romantic or sexual relationship with a patient?

Doctors' views:
"This depends on specialty. For psychiatry, never. For general surgery, potentially at a time greater than 6 months after the surgery and depending on the nature of the professional relationship."
"We shouldn't remotely entertain romantic thoughts when we see a patient. But if you ran into that person outside the office at a later date and 'clicked,' I see no problem. You've removed the hierarchical difference in position at that point.
"I would strictly guard against any entanglement and if I felt tempted would resign as that person's physician."
"It is totally exploitative and wrong."
"I did, and 30 years later, we are together and happy."
"My wife can shoot a tight pattern of .45 caliber handgun rounds into the groin area of a paper target at 15 yards without difficulty."

My views:
LOL @ for psychiatry, never :) And the last one as well :)

Suturing

2010-11-18T02:37:00.005+08:00

Had my second go at suturing! This time I learnt how to do the continuous suture as well :)

On a banana!!

It is harder to do on a banana than on sponge because it is harder to pull the "wound" close. It totally made my day when the surgeon told me I'm good in suturing :) *self-indulgence* (but hey you need a bit of self-indulgence to keep the passion burning)

I am totally going to try for surgery next time <3

Little passage

2010-11-06T09:17:00.004+08:00

I was reading a little handbook on clinical medicine and I found this really sensual passage at the beginning of the emergencies chapter:

There is nothing more intoxicating than spending a day saving lives, but as night creeps on, and you start losing more patients than you should, despair can hit with the force of ice. It is no comfort to know that you are now wiser and older. So when you find yourself washing yours hands between one death and the next, for one second be honest with yourself, and write of your errors and sorrows on the surface of the water — a few temporary ambiguous squiggles framing your thoughts and the life that is lost. This is not about audit and accountability (this comes later: now you need to fortify yourself to survive this onslaught) — so, in case a manager is looking over your shoulder, pull the plug, and as the water flows away, know that it mingles with the rising tide of our own failings at the bedside, through which we have surfaced — no doubt a little faster than we should. At your next bedside you may do better if you can buy time: time to take a history, time to think, and time to ask.

I guess being a doctor is a very intricate thing.

Blank mind and SSC

2010-10-28T06:15:00.002+08:00

Haven't had time to blog these few days because I am trying really hard to have a life and yet do at least a bit of studying everyday. We have two more days to go before we reach our inter-modular week, i.e. holiday!

I think when I am doing too much of the same thing, my mind goes into a blank. I can't find time to read philosophy books nowadays because I'm swamped by medical stuff. The opportunity cost of actually reading things outside of medicine is quite high and this can be quite discouraging. I miss the stretch of holidays earlier this year because I have so much time to actually learn random things like French, physics and philosophy.

But anyway I got into this SSC (something like an elective module) called the Science of Speech:

We will study the anatomy, physiology and acoustics of speech production and the logical organisation of spoken communication. We will look at the sounds of the world’s languages, the structure of the larynx and the vocal tract, the production of vowels and consonants, and the acoustic characteristics of speech. We will touch on how speech varies across languages or accents and also across different emotions of a speaker. We will also examine the relationship between speaking and singing, and discuss disordered speech/music production.

Sounds fun! I really love the kind of exposure we get here :) But anyway this wasn't my first choice for the SSC module. I wanted forensic osteology, which has to do with forensic science and bones. It sounds super fun but apparently I'm not lucky enough to get it. I'm trying for that again next term.

Genes and Economists

2010-10-23T03:41:00.005+08:00

Medical school is freaking hard, especially anatomy and embryology. There is a lot of self-studying to do.

The recent pedigree practical was really, really confusing, probably because I haven't done genetics for such a long time.

What is Sven's risk of being a carrier?

Got quite stumped by this question even though it is really quite simple if we fall back to the basics. Challenge to those who still remember their A-level biology and who are not studying medicine :)

We have covered quite a bit in our foundation module, from my most hated A-level style biochemistry, to histology (study of tissues, eg. connective tissue, nervous tissue, etc), to my favourite anatomy and to embryology (fun but boring at the same time).

We have basically no exam at the end of every module, replaced by this thing called the formative assessment which doesn't really count towards our grade. I've had no homework so far (unlike other faculties like maths or law or engineering which have a truckload of homework and coursework). According to my mentor the workload will really pick up once the foundation module is over, as this module is just for the benefit of those who didn't take A-level biology and for us to start on a level ground. Oh well.

===

And I just bought the Undercover Economist from Amazon for £0.01, and with shipping cost it costs just slightly under £3. Good deal. And I got a signature from the author himself :) He is a really interesting speaker as well

Hard to get into study mode

2010-10-11T21:10:00.005+08:00

University life is very different from JC life. We don't nearly get as much spoon-feeding and there's a whole lot of socialising to do.

It's only after I studied in London have I realised how exam-oriented and content-based Singapore's curriculum is. Here we have some formative assessments along the way but none of them count towards our final score. Instead we dedicate a lot of time to professional development and to the clinical aspect of medicine.

UCL also seems to be quite keen on this new evidence-based medicine (EBM) movement. From my understanding EBM contrasts with the traditional "concept-based" medicine where the effectiveness of a drug, for instance, is evaluated based on the theoretical understanding of the biological mechanism behind it. In EBM however there is not nearly as much emphasis on the mechanism of drug action per se, but instead the drug efficacy is evaluated based on statistical analysis such as randomized controlled trials, review of medical literature and risk-benefit analysis. EBM expects some kind of meta-analysis from doctors in knowing how to critically review medical literatures, above and beyond having the scientific knowledge.

I had a lecture on EBM on my very first week here, and the lecturer made EBM sound like it is a complete paradigm shift from the traditional concept-based medicine. Researchers are already using such randomized controlled trials and risk-benefit analysis in clinical trials, and health regulatory board are already doing review of medical literature in approving drugs and drafting of health policies and guidelines. EBM is to me, at best, a call for doctors to actively take on these roles as well in their daily clinical practice, which is quite sensible to me considering how much new information are being churned out everyday.

EBM aside, I am really excited at starting my SSC (Student Selected Components). They are basically enrichment modules which we can sign up for outside of curriculum. I chose forensic osteology, science of speech, baby and development and cardiovascular medicine. I am quite ambivalent whether to choose a language module (I would have taken French), but language is not something I would want to do in the form of a proper lesson because it'd be way too time-consuming.

UCL Medical School

2010-09-30T18:08:00.005+08:00

Finally I have some time to blog! Had been really busy and wild these few days so I haven't been able to sit down and blog. Anyway just to give some thoughts about the medical school so far:

Surprisingly my notes seem more comprehensive than those in NUS (in fact we have lecture slides AND notes). My notes for just the first two modules alone is about as thick as the entire J1 biology notes. That's a lot of readings and memorising to do.

I also like how the lecturers deliver the lectures in Queen's English which makes the lectures seem much more professional. My school premise is really big and extremely well-equipped. We have country clubs where I went to play tennis yesterday (and free flow of drinks/liquors!) and we have a medic-exclusive bar extremely near our school where beers and liquors are sold for a cheap price.

I've seen my first cadaver for the first time in my life and I was rather underwhelmed. The smell wasn't as bad as I have expected. The skin is shrivelled up and felt extremely leathery and hard.

I think the most exciting thing that UCL offers is the chance of doing full-body dissection. Very few medical schools in the UK and around the world allow the medical students to do full-body dissections, partly because there are a very stringent law governing the use of dead bodies. The cost of getting insurance and legal defence for the student is exorbitant and the whole process is subjected to heavy regulation.

Oh and there's an entire shelf of preserved foetus in the dissection room. I am damn amazed how they managed to get those live babies because there must be so much ethical and legal controversies over the use of babies. Other than that they have really beautifully preserved samples of organs like the CNS (brain and the spinal cord), completely intact and continuous, dozens of cross-sections of the brain and the thorax and other stuff.

Generally I love London and I think the medical school here is really well thought out. That's about it for now.

London!

2010-09-22T06:34:00.002+08:00

I'm really busy these few days. I think I have made friend with more people in London than my entire life (exaggeration intended) because the people here are really friendly.

And lots of fun but I'm too tired today to elaborate.

First 2 weeks in London!

2010-09-14T00:38:00.005+08:00

WOOT my first two weeks in London on my iCalendar :)

PAAARRRTTTYYY!!

5 more days!

2010-09-13T15:36:00.003+08:00

Life in London is going to be such a havoc :):) I have some activities lined up already once I reach London, and those include shopping with friends, fresher clubbing event (in a three-floor club in Central London!) and touring around London with a big group of friends!

I'm counting down to my flight to London because I'm soooooo looking forward to it. We have a 140 strong fresher batch and I really love everyone, medics and non-medics, who is going to UCL. What's more is the kind of experience living overseas will entail. I may be biased (having crashed NUS lectures a couple of times) but I think life in London will be much more fun than the university life here in Singapore. The reality that I'm going to do all my laundry, cooking my own food, tidying up my room and living with a roommate is starting to kick in right now. I think I will change a lot when I'm there, hopefully for the better.

I think during my university application process I really underrated the importance of a fun university life. If I am going to spend half a decade in university, I'd bloody well want my time there to be helluva fun and memorable. It will be literally a once in a lifetime experience.

Wittgenstein

2010-09-07T00:06:00.002+08:00

"The world is all that is the case.
The world is the totality of facts, not of things.
The world is determined by the facts, and by their being all the facts.
For the totality of facts determines what is the case, and also whatever is not the case.
The facts in logical space are the world.
The world divides into facts.
Each item can be the case or not the case while everything else remains the same."

- Tractatus Logico-Philosophicus, Ludwig Wittgenstein

Friends

2010-09-04T20:50:00.011+08:00

I'm about to fly off to London soon and I'm getting a bit anxious about the future.

It feels really bad leaving my best friends behind. I have to make new friendships from scratch and it can get quite daunting. I think I'm that kind of person who doesn't mind going my way out to make friends but at the same time I want someone close whom I can talk to and guiltlessly stick with when I'm really tired, drained and feeling introverted. I think I live a rather simple life. I go for the occasional running, biking, basketball and a bit of squash (while in JC), thrown in with a weekly dose of clubbing, pubbing and shopping but for the rest of the time I won't mind just bumming around at home reading books, watching tv or just studying. And in fact I would prefer a friend who's willing to do the more sedentary activities with me (like mugging) because I think this is the kind of friend that I'll feel the most at ease with versus those "playmates" in sports or social activities. I'm a geek who doesn't mind the occasional fun and adrenaline rush. And I really like geek friends :)

The fact that medicine is a freaking six-year course means that everyone not studying medicine will be returning back to Singapore three or four years from now and I'll still have three or four years left to go. My non-medic friends in OG said that I shall just fly back to attend another fresher camp three years from now and then make new friends that will last me through the rest of my time there. It's that long and I think I'd be quite sick of people leaving me.

But then again this is a really good life experience. The good thing is that from past experience I have a couple of really good friends in every single stage of my life and if I extrapolate the trend I will make a couple of really good friends over there as well. I think I have spotted potentially two or three people within medicine who have similar frequency as me and whom I find interesting. In fact I really really like our medic group because we seemed rather spontaneous and we have some really promising people like D the A*Star Scholar who single-handedly makes all our parents disappointed at us for not getting the A*Star scholarship.

Philosophy of Mind: Thought Experiments

2010-08-26T22:01:00.053+08:00

I have this urge to write again :P

The philosophy of mind is by far, I feel, the most interesting branch of philosophy. It is closely linked to developments in neuroscience and psychology, and while it leaves the experimental and procedural aspects to science, it has a significant influence in the process of hypothesis setting and, to a lesser extent, the interpretation of the experimental results. When it comes to an area as novel and dynamic as cognitive psychology or functional neuroscience, philosophy of mind will occasionally act as a negative ruling to dispel hasty claims such as "scientists have discovered the neurological basis of consciousness" and "psychologists have put forth an information processing model of cognition that explains human consciousness".

Philosophers of mind like to employ this theoretical device called the thought experiments. They are hypothetical situations in the form of stories invented, in the words of philosopher Daniel Dennett, to serve as an "intuition pump". Thought experiments break down otherwise abstract and obscure arguments into more intuitive stories we can relate to and participate in. They don't really "prove" anything per se, but they do act as catalysts to facilitate philosophical conversations. I am going to do a commentary on a few of my favourite thought experiments, and introduce some of the main themes of the philosophy of mind along the way.

1. Descartes' Demon

In the 17th century, René Descartes proposed the existence of an omnipotent, malicious demon who has "employed all his energies in order to deceive me". This demon induces every single thought in us, and these planted thoughts together constitute our perception of the world. The external world we perceive in fact never existed — "the sky, the air, the earth, colours, shapes, sounds, and all external things [may be] merely the delusions of dreams which [the demon] has devised to ensnare my judgment”.

This is perhaps the most definitive thought experiment in what later came to be known as Cartesian philosophy. Mostly importantly Descartes sparked off the debate between realism and scepticism.

In a nutshell, realists in the context of philosophy of mind believe that there is an external world, while sceptics argued otherwise. Think of the movie the Matrix, which in my opinion is a rather analogous modern rendition of the Cartesian Demon argument. Instead of an omnipotent Demon, the Machine put humans in a long slumber and continuously feed sensory information directly into their brains. The reality that they perceive is thus a simulated reality. But unlike the Matrix where a real world exists outside of the matrix, Cartesian sceptics have a more radical belief that there is no ultimate reality out there and the only fact that you can be certain of (and that the demon can never make you doubt) is that you yourself exists — I think, therefore I exist. While this sounds absolutely preposterous to us, interestingly there is no rigorous, logical argument to rule out the possibility that we are living in a simulated reality or an all-encompassing hallucination — or perhaps a prolonged dream, beautifully articulated in the recent movie Inception (unless there is some philosophical equivalent of the totem, if you get my reference).

2. The Philosophical Zombie

Imagine that there is a replica of you, identical to you down to the last atom, is completely indistinguishable from you neurologically and behaviourally even after the most thorough examination — and yet it lacks consciousness. By virtue of neurological and behavioural indistinguishability, this "zombie" is able to do complex mathematics, scream "Ouch!" when it steps on a nail and watch the Big Bang Theory and laugh to Sheldon's jokes; but while there is a rich and vivid stream of conscious experience in you, nothing really goes on in the zombie's head. His behaviour is purely mechanical.

This highlights the argument between dualism and materialism. Most scientists nowadays are materialists, and they believe that consciousness is ultimately just a complex series of physical activities going on in the brain. Dualists however believe that the mind and the body are two different substances, the mind being non-physical and immaterial while the body is physical and material. We can conceive of the situation where there are identical physical processes going on in you and the zombie, but the immaterial mind is what sets the two of you apart. The British philosopher Gilbert Ryle later used the metaphor ghost in the machine to describe such mind-body duality (albeit derogatorily).

This brings us to another rather related thought experiment proposed by David Chalmers, again inspired by the movie the Matrix (that movie really has a lot of influence in the philosophical circle, ironically).

3. David Chalmer's Simulated Reality

Consider a computer simulation in which our bodies (in the simulated world) are controlled by our minds, and our minds remain strictly external to the simulation. We can do all the science we want about this (simulated) world, but we can never figure where our minds are for they are strictly external to the observable reality.

This is one more argument that dualists put forth. For all we know, the observable universe is a closed logical system. The principle of logical inference is confined within this universe and there is no way to penetrate into the transcendental reality where our mind truly exists. This idea has a deeper repercussion into epistemology and metaphysics, but that's out of the scope of this post.

4. John Locke's Inverted Spectrum

There is another person who is neurologically, behaviourally and physically indistinguishable from you and yet have an "inverted colour spectrum". When both of you look at an apple, both of you would consensually describe the apple as being red. However if you were to look into his brain, you would exclaim "Hey! This is what I would call green!" Then, if the two of you were to look at a blade of grass and agree that it's "green", but again when you look into his brain you exclaim "Hey! This is what I would call red!" Although both of you would call an object "red", you have different mental representation within your mind. However since both of you use these colour terms consistently throughout your life and you never get to peek into each other's brain (not even in principle), such difference never manifests itself.

This illustrates another theme in the philosophy of mind known as the problem of qualia. Qualia is basically the subjective mental quality over and beyond the facts about our physical and neurological makeup. Materialists who believe that the physical facts about the world is all there is will have a hard time explaining how purely physical processes give rise to such subjective, strictly first-personal mental qualities known as qualia.

To take this further, consider the next thought experiment.

5. Frank Jackson's Mary's Room

Mary is a brilliant scientist who is, for whatever reason, forced to investigate the world from a black and white room via a black and white television monitor. She specializes in the neurophysiology of vision and acquires, let us suppose, all the physical information there is to obtain about what goes on when we see ripe tomatoes, or the sky, and use terms like ‘red’, ‘blue’, and so on. She discovers, for example, just which wavelength combinations from the sky stimulate the retina, and exactly how this produces via the central nervous system the contraction of the vocal cords and expulsion of air from the lungs that results in the uttering of the sentence ‘The sky is blue’. So on and so forth. What will happen when Mary is released from her black and white room or is given a color television monitor? Will she learn anything new or not?

If we grant Mary the Neuroscientist an idealized access to all physical knowledge about the brain possible and idealized deductive and reasoning capacity, dualists argued that she will still learn something new when she witnesses colours first-hand from the colored television monitor. Since, by hypothesis, she knows all the physical knowledge there is about colour, the new knowledge she acquires must be knowledge of a non-physical nature. Can this be qualia?

6. John Searle's The Chinese Room

Imagine you are in a room with a chair and a translation manual of Chinese written in English (and that of course you don't know Chinese). Every so often a native Chinese slips in a piece of paper under the door with a Chinese sentence written on it, and they look like random squiggles to you. The translation manual doesn't tell you what these words mean, but instead tell you that whenever you see a particular sentence, you scribble another Chinese sentence in response and pass it out under the door. In an idealized situation, you will become so good at "conversing" with the Chinese outside the door that he'd think you really speak Chinese. However in actual fact, you have absolutely zero understanding of Chinese.

This thought experiment is designed to challenge the philosophical view known as functionalism, which states that consciousness is analogous to a software being implemented on the hardware (brain), reducible to taking in some input and mechanically responding with a suitable output. This also highlights the problem of intentionality, our capacity to generate meaning (and hence genuine understanding) out of pure sensory stimuli.

John Searle argued that such a functionalist view of consciousness does not give an account of how understanding and meaning arises out of highly complex but still purely mechanical process. By the same token, John Searle claimed that artificial intelligence, no matter how complex they get, can never develop true understanding and thereby capacity to think and reason.

And I shall end here. Philosophy of mind is ridden with such thought experiments and I am just giving a very cursory and admittedly scattered treatment of the different themes involving consciousness, thought, qualia, intentionality and so forth. I think these thought experiments are really interesting short stories that make a specific philosophical point. As you can see, the philosophy of mind is a dynamic branch of philosophy heavily influenced by new developments such as computer science, artificial intelligence, logic and neuroscientific discoveries. If I were to ever become a neurologist I think this is one branch of philosophy that will neatly fit into my job scope.

Netter's

2010-08-18T21:06:00.011+08:00

Crashed the medicine lecture at NUS today! Have to say that it's rather fun yet boring. The company was fun but the lecture was the same biochemistry stuff, by a rather uninspiring lecturer, in a rather noisy hall, so it was boring.

And I just realized how many hwachongians are in medicine.

But anyway, I got the Netter's Anatomy atlas from NUS Co-Op! It has absolutely beautiful pictures :D

If you are getting overwhelmed by my zeal to start medical school, that's probably what you'd expect from most medical students. It takes one to really really like these medicine stuff to commit 5 years of study and a loooonnng and overworked career path to actually start earning a decent living.

And I finally know the schedule for my international orientation programme. It is a different concept from NUS' orientation prog because we don't have bonding games for nuts. Instead it's packed with bus tours and museum tours to places like Charles Dicken Museum, picnic at the park, BBQ and Jazz, and pub quiz (what the hell is pub quiz). While I'm kind of disappointed that there are no wacky bonding games like the NUS orientation, the aforementioned stuff sound pretty European and Londonesque, don't you think?

But yea, so far I'm really looking forward to school :D I'm a happy geek.

Crashing Med Lecture tomorrow!!

2010-08-17T19:20:00.006+08:00

My life is really aimless now.

So, I'm going to crash NUS med lectures tomorrow!! I'm mentally prepared to fall asleep though, because I really can't stand lectures.

Anyway I just realized Imperial offers Management as an intercalated Bachelor of Science degree (how weird is that)! It'd be damn cool for a med student to take a degree in accounting and management theories right!! I don't know what it can be used for next time unless for some bizarre reason you choose to manage a hospital. But when you can become a surgeon, why become a manager??

Medical school

2010-08-11T12:03:00.006+08:00

This letter outlines the professional behaviour and fitness to practise and it makes me feel like a medical student-to-be :D

"A student must always make clear to patients that he/she is a student and not a qualified doctor."

"Students are required to examine physically patients of both sexes (which includes touching and intimate examinations) in order to establish a clinical diagnosis, irrespective of the gender, culture, beliefs, or disease of the patient. In order to qualify as doctor in the UK, it is required that the practitioner is willing to examine any patient as fully and as intimately as is clinically necessary."

and blah blah blah. That's part of the things I'm looking forward to in medical school because it really makes me feel that I'm studying for a real-life profession with all the patient contacts and ethical guidelines.

One more month to go!!

I'm so freaking jealous of people starting school now.

Random ramblings

2010-08-09T00:55:00.006+08:00

I just realized that Christopher Nolan who directed Inception and the Batman series (including the Dark Knight!!) graduated from UCL!! Wow what an honour to have such an excellent director as the alumnus of my school :D Inception is possibly one of the deepest films I have watched.

And speaking of school, I have just slightly over a month to go till 18 September and I'll be off to London!!

I seriously can't wait to start medical school and geek myself out (maybe not!). It has been exactly a month now after I've quit my job in the tuition centre and I must admit that I'm really really really bored of school-less, work-less (other than the few random home tuitions here and there) and generally aimless life. I need something to work towards!!