22 June 2005

What do I know?

Anthony de Mello once said: 'When you come to see you are not as wise today as you thought you were yesterday, you are wiser today,' and 'Wisdom tends to grow in proportion to one's awareness of one's ignorance.'

We physicians pride ourselves with our knowledge. We have conquered anatomy, physiology, biochemistry and all the clinical theory we can possibly learn in five years of medical school. Then we have specialised and again grappled with enormous amounts of scientific facts and applied them to our patients. When our patients ask us questions, we steel our faces and speak with authority. We know. We are all wise.

Even the language we use every day betrays that assumption. The word diagnosis means to know (gnosis) through-and-through (dia). And prognosis is to know in advance! How many professions claim to know even the future! How we pride ourselves with our knowledge.

Ironically, sometimes it is this knowledge that keeps us from truly learning and knowing. When I had finished my exams a year ago, the feeling was quite different. I had just been certified by a conjoint board of experts that my knowledge and skill was befitting that of a specialist. I overflowed with knowleedge, there was nothing I couldn't handle. Only a year but many difficult cases later, I have to admit I know nothing.

What do we really know? The evolution of medical science is testimony to how much we didn't know 10 years ago, and what we think we know now will be laughable in just 5 years. And what do we know of our patients besides the labels we give them? How does the man with cancer feel about his disease? What motivates him to seek treatment? What about death - how will he face it? How do our patients make sense of disease and death, where do they find meaning, how do they carry on? I think I have more to learn from them than I have to offer.

As a physician I have been given the privilege to be in such close contact with the rawest of human experiences - pain, suffering, death. What is the purpose of these? What were they put here to teach? What have I learnt? Are there clues about life and living that I have missed? Perhaps it is in the throes of suffering and inexplicable pain that we can find some answers.

But beyond that, there must be a sense of mystery. For what is science, what is medicine without uncertainty and mystery to keep us plodding and searching? Perhaps when I let go of what I know for a while, I might actually begin to learn...

"What, concretely, is Enlightenment?"
"Seeing Reality as it is," said the Master.
"Doesn't everyone see Reality as it is?"
"Oh, no! Most people see it as they think it is."
"What's the difference?"
"The difference between thinking you are drowning in a stormy sea and knowing you cannot drown because there isn't any water in sight for miles around." - Anthony de Mello

17 June 2005

Stand in the Gap

I'm in the midst of preparing a topic to be presented at a friend's church this Sunday. I'm going through a few of my favorite authors, picking out gem-like quotations that I have loved so much. Sayings that have insinuated themselves deep into my belief system and have traveled with me for a long, long way. As I collate these bits of choice words, typing them into my Reference Manager, they are already working their power over me.

This happens to me each time. When I'm called to speak or write an article, I invariably do two things - search my heart on what I hold dearest, and go back to my 'gurus' who have taught me the most. Then I try to weave these things into something coherent for my listener/reader. In hope that the magic that has worked in my life will somehow filter through my own experiences to touch them too.

As I do this, hunched over the keyboard, books all around, a solitary cheap table lamp to illumine my labors - I realise this: I love writing. I love words. I love the way they bring out my deepest yearnings and fire me up even before I speak them. Writing, is primarily for the writer. The farmer reaps the firstfruits... I am the first to be blessed.

But it is also not an endeavor in isolation. If not for the speaking or writing assignments I would never bring myself to do this. The discipline is very rewarding, but also because there is an audience. In the end I am a servant. I place myself at the feet of both the Giver of Truth and the Listener. And pray, and strive, and labor on my work to be true to both. I stand in the gap and hope that something from Heaven gets streamed through to reach Earth.

07 June 2005

The Learning Paradigm

Peter Sheppard teaches in his book, Life Matters the 'Learning Paradigm', which consists of:
1. What? - Concepts, facts
2. Why? - Principles
3. How we feel - Values, Attitudes, Motivation
4. How we apply - Skill, Technique, Method

Confucius says: What I hear, I forget, what I see, I understand, what I do, I remember.

Einstein says: I don't teach, I create the environment conducive for learning.

I remember how in med school, too much time and energy was spent on teaching and learning the facts which could have been easily gleaned from textbooks and even more quickly committed to memory if I was better motivated.

As a med lecturer now I am guilty of doing the same thing. Vomiting lists and tables and making their accurate regurgitation my end goal.

How artless this kind of teaching!

I'd do better helping my students find their personal motivation, whet desire and excitement to learn, and empower them by giving them things to do, ownership of their careers.

06 June 2005

Crawling home

Me and wife were stuck in the most horrendous jam outside of KL city, ever. We had decided to head to Ipoh on a day trip to visit a few good friends. It was a nice trip - nice conversations, good food, restful lepakking. We thought we were wise to leave Ipoh by 6pm to get back to KL just as light wanes.

To our horror, we slammed right into a brick wall of cars at about Tanjung Malim. For the first few km we thought, o... maybe it's this accident here, or that guy stopping there, or the lanes converging.. But we crawled, and crawled, and crawled. For at least another 20km. With every passing mile our nerves fell apart, we sighed and groaned and grimaced. Headlights from oncoming cars and tailgating buses totally blinded us and gave us headaches. Then finally, somewhere around the Kuala Behrang exit, we saw the gap between cars widen ahead of us. Freedom!

When it came to our turn to reach the end of the jam, to our double horror we saw the cause of the pile up.


Three police cars were parked by the roadside, spotlights perched on their roofs blazing onto the road. And they were just picking out cars at random to check, to fine, to harass, whatever. Are our police so lonely that they have to park in the middle of nowhere, at 9pm, and fish out hapless commuters for company? For that - what could've been a 2hr pleasant drive became a five-hour weekend killer.

You know what they say in statistics: Just because one thing is associated with another, doesn't mean it's causative. Just like jams and policemen. The police may not be present because of the jam, they may very well BE the cause of the jam.

Back to the nipple

I know they say the world is getting too plastic and automated. I know we are increasingly out of touch with nature and the raw experiences of life. With a steady diet of instant noodles, packeted fruit juice and encapsulated fish oils - we could do with a little splash in the mud of reality.

But there's a limit to going back to nature.

That limit is COLOSTRUM.

My dad's latest nutritional supplement obsession is just that. BOVINE COLOSTRUM. In case you don't know what that is, it's the sticky, semi-translucent, sanguine-colored discharge from a lactating mammal's nipples that precedes the flood of milk. It is packed with all kinds of proteins and immunoglobulins that give the tiny nipple-sucker a mega boost in protection in the hostile bug-infested world it has just entered.

I remember distincly my lecturer saying: 'Susu lembu itu untuk lembu, bukan untuk bayi kamu!' I even used that line in my final year exam, doing mock counseling for mothers. Today, I'm drinking bovine colostrum..

He has given me an entire bottle of vacuum-dried colostrum in powder form to take. My heart breaks to think of the hundreds of mother cows who gave up their precious fluids for that one bottle. It tastes no different from milk, and if I were to mix in coffee (which is the only way I can take it without a severe anti-peristalsis), you wouldn't know the difference. Heck, I could beat it and make waffles with it. But what kills me the most, is the image of a cow's nipples. Every time I drink it, I see pink cow's nipples and imagine I'm sucking on them.

God help me!

05 June 2005

He is here

The 14th chapter of John's gospel has been the subject of great debate and great comfort to Christians for centuries.

Today it brings home basic realities for me.

He (the Spirit of God) is called the Counselor by Jesus - who sends Him in His place. He comes alongside us, to strengthen, to illumine and even to defend or convict us. He doesn't, as one might project from 20th century linguistics psychoanalyse us or give career guidance. In short He does in our hearts all that God - Father & Son - does, effecting their Presence in our lives.

Such knowledge is beyond reason, but immensely comforting. I am never alone. I always have a companion and a guide. Someone to walk the journey with.

A nurse said to me today: 'Dr. Yap memang suka jalan.' I walk a lot and I can walk for miles without realising I've covered half the city. The greater the distance, the better. Walking just gives me the feeling of journeying - how getting there isn't as important as the adventure. And you have to have good company - so if you don't like yourself very much and God isn't there with you, walking can be pretty lonely.

Yet, more than that, it also means I needn't flounder in search for direction and truth. Of course, one has to wander, search, even grope for light sometimes - but the Way is never far from us. Truth and a sense of where our lives ought to go is there as the Spirit is.

Knowing that is enough to keep me crying out in times of darkness and plodding on in times of lostness.

He is HERE as much as I am lost. And He is STRENGTH as much as I am helpless.