The unexamined life is not worth living

buddhism, medicine (as a medical student), personal life :)

“Elegance is the only beauty that never fades.”

—   

Audrey Hepburn (via bibliophilebunny)

I would rather say that beautiful women in middle age and beyond tend to exhibit elegance as their main form of beauty. Whereas younger girls have innocence, playfulness, energy as part of their beauty. I wouldn’t find elegance in an 16 year old as attractive as in, say a 45 year old woman. Rather than “a beauty that never fades”, elegance is rather “the main form of beauty that emerges with increasing age”. 

Sorry, sounds quite anal doesn’t it? But it does fascinate me what constitutes as beauty. 

quotes on reading

"Read the best books first, or you may not have a chance to read them all" 

- Henry David Thoreau 

My thoughts exactly. Great minds think alike! *runs and hides* 

"I cannot remember the books I’ve read any more than the meals I have eaten; even so, they have made me" 

- Ralph Waldo Emerson 

Makes me feel slightly better that the classics I’m swallowing are nesting somewhere in my brain, though definitely not in my hippocampus. And also I’m not the only one with this problem. 

new yorker articles - sprinklings of thought

Been reading a slew of New Yorker articles, as, apparently, they have opened their archives for these couple of months. Will be updating this from time to time if I feel the urge to, haha.

Profiles 

  • Reading their profiles on Lang Lang, Dr. Luke, Taylor Swift…. it is not a single interview. Rather, the journalist seems to follow the celebrity around over the course of several weeks (perhaps only a privilege that this magazine gets to enjoy) and meet them here and there. Other people that are relevant to the story are also interviewed. The writer usually leaves little space for judgment, and ends without a final remark to summarise the celebrity’s character, which is done in most interviews. You’re left slightly lost, as if having met a friend for the first time and leaving without knowing what to think of them, tasting an interesting dish without knowing whether you like it or not, reading a Shakespeare play without being sure whether you understand it or not. 

intuition vs. reason; intention vs. outcome

I recently listened to a series of talks on early buddhism given by Bhante Sujato and Ajahn Bramali (available on youtube) - the part about ethics. 

How do we decide if the decision is the right one we make by ‘Buddhist standards’? It has to benefit us. It also has to benefit the other person. That, of course, leads into a whole other discussion on what benefitting means, but let’s leave it as “the action is good for me and good for you” at the moment. This is how we evaluate decisions. But, in reality, most decisions are made based on intuition. Some are made based on reason and logic. So far so good for me. But this is where what I’ve learnt so far ends. 

The Value of Good Intuition (it is not inferior to reason!) 

Ajahn Brahmali goes on to say that intuition is usually accurate, except in two situations. 

  1. Where situations are “ethical dilemmas” (the classic medical ethical dilemmas of abortion, euthanasia, stem cell research) where intuition fails and doesn’t give us a clear path to proceed. 
  2. Where intuition leads us astray because we don’t have the clarity of mind to make good decisions with our intuition. 

It is the latter point which intrigues me. In high school, we’d been taught to not make decisions based on intuition (which implied that it was done without thought and based on emotions) but to make decisions based on reason and logic. Logical thinking is superior. What had never come to mind before was that intuitive thinking could be a good way to make decisions. 

He further went on to say that our mind is full of defilements that cloud our judgement and our intuition. Only a stream-enterer, or someone who has seen the truth, can make a decision with reliable intuition. Usually normal people can’t rely on intuition, we have to use reasoned arguments to make the best decision. Which means to say that the decisions that belong to cat. 2 is a large pool at the moment, but can shrink as our mind clears and our defilements set straight our intentions and intuition. 

Multiple Intentions, Not One 

He then went on to ask about what ‘a good act’ was. True, donating to the BSWA is a good act. But it could rise from multiple intentions. Guilt (and need to do some sort of good act to negate it). Ego (your friend donated so you have to). Spare change in your pocket. And finally, a sincere wish to help. I used to judge people for their “blatantly obvious dirty intentions”. Like, that guy befriended so and so a doctor just to get himself up the ladder. This woman is organising a fundraiser just because she wants to look good. I would think that these people were nothing like me - everything I did, my intentions were pure and wholesome. But that’s really not the case. Why did I do community service this summer? I needed to do something to qualify as a summer project - meet my faculty’s requirements. Why did I continue tutoring a kid without getting paid? A sense that I was doing something good, a sense of duty and habit (I’d already been there several times, can’t let the organiser and the kid down), a sense of pride hoping that the kid will look up to me. Perhaps in these neither truly pure nor bad intentions were the genuine desire to help. Why you do the things you do - it is not a dichotomy - every decision, even every gesture and thing you say to a friend arises out of a mixture of good and bad intentions, good and bad feelings. Your friends accompanies you out of a dinner because - yes, she misses you, but she also feels guilty over the fact that she was talking to someone else during the dinner. A guy that sits across you from the bus wants your number because - yes, he thinks you are pretty; but also because he wants a stranger to share his sorrows over his recent breakup with his ex. Very little acts in this world arise from pure intention. Probably one of the most pure I’d experienced recently was the giving and receiving of Dhamma books. The fact that we were so aligned in what we believed was a good gift, the fact that we value Dhamma this much, the surprise at finding each other in sync, and the joy from being both able to give and receive it brought me a kind of happiness I don’t feel very often. 

After listening to Bramali’s talk on how everything we do is a mix of intentions, and that it is best to work on our intentions, it brought me to think about two things: 

  • Well-intended acts really do make the recipient feel better. These acts, things you would see from a simple, open-minded person, from a monk or nun, are natural and spontaneous. On the other hand, ‘good acts’ with the usual ‘grey’ (as Ajahn puts it) mix of intentions makes you feel uneasy - your friend insisting to pay the bill (goodwill, yes, but the grey: wants to be the bigger, more generous person), a colleague doing most of the (supposed) shared work (grey: self-sacrifice, doesn’t believe the others are up to it, etc.), buying a thank you card for a colleague at work when you finish your stint (guilt, perhaps even an excuse to ask for their number in the “P.S.” area) 
  • My professor used to say the same thing - all actions are based on a mix of intentions. However, he came to a different conclusion - that how good / bad the act is should only be judged in its outcome. If it was useful, if it helped, who cares about the intentions. In fact, you can’t say for sure what someone else’s intentions are - so don’t bother guessing. Before writing this post I thought what my prof said and what A. Bramali said were conflicting. But no, the wisdom runs through both. This is a way to look at others, but not at yourself. Speculate less on others’ plausible bad intentions, and focus on correcting your own :)

to-write list

A Long List of Things I Plan to Discuss soon: 

buddhism / personal dev 

  • intention vs. outcome: the 2 differing views of my professor and a. bramali
  • truth - your understanding of it very much depends on how it is presented and your state at the time

new yorker articles 

  • pop, fashion industry - different world, thoughts
  • style of interviews / profiles
  • article on reading & forgetting
  • feminism - changing stance

recent personal events 

  • wish to cultivate metta, weaknesses exposed from interacting w/ friends
  • reactions to “true love” 
  • what is the best way to spend time? const. worker, final year ahead

medicine 

  • personal qualms about approaching evidence-based medicine
  • general med ethics & buddhist ethics: we ain’t that much better

values

"…we have a variety of standards of Good and Bad inside and outside of Buddhism. For instance, we have personal preferences, such as Excitement is Good, Stillness and Quiet are Bad, or the exact opposite. We have societal norms: Getting Rich is Good, Working Hard is Good, Being a Nobody is Bad, Quiz Shows that evoke greed for stuff and money are Good, Pornography that evokes lust is Bad. Our standards often shift if we think about them. at all. For instance, is it really Good to be beautiful, talented and famous? It certainly did not work out so well for Marilyn Monroe or Elvis Presley in the end. Skillful and Unskillful are indeed Buddhist standards for Good and Bad, and are endorsed by the Buddha, but remember they are not divinely ordained. These must compete in your set of values with other standards. It’s your choice."

Beautifully said by Bhikkhu Cintita in this article - that in life - Buddhist values, personal preference, and societal values all compete to make your set of values. These are conflicting. Furthermore, Buddhist values can sometimes differ depending on who you listen to what you read. Personal preference changes, of course. Societal values differ depending on which social setting you are in or what forms of culture you are exposed to, and for bilinguals like me it is an extra tricky situation. 

Yet I’ve noticed a pattern. 

After I meet with a friend, and we talk about Dhamma, or spirituality, or similar - I feel good, refreshed, and just.. “in the right place” after the meeting. However, if I meet with another (non-religious) friend and we gossip, talk about competition for jobs and money, complain about other people, tease each other about boyfriends or crushes…. after the meeting, I feel lost and uncomfortable. I realise now I can use the phrase “strayed from the path” - I feel like I’ve strayed from the path - and know what exactly it means now, instead of the cliche it’s always sounded to me. 

I’m too tired to evaluate now, but at least I can say my visceral response is certainly guiding me towards one particular set of values :) 

bus guy

I took the public bus home. The bus is arranged so that two rows of people face each other, kind of like on the subway. Two guys, around my age, got on at the next stop after I got on, and sat opposite me. The bus filled up with people and I forgot about them. The people slowly filed out of the bus one by one. When it was time for me to get off at the last stop, it was only me and the two guys. I was about to get off, when one of them waved at me - “Hi”, and pointed at his phone - “can I have your phone number?” We all got off. I was quite bewildered. I told him “no!” but he looked like a pleasant guy, and said something like “oh pleeeease let me have it, I’m so worked up that my ears are all red”. Several thoughts flashed through my head (apart from the judgement on looks, manner, personality, etc.) - 

  • I myself was planning on asking for someone’s phone number in the near future. Do to others what you would want them to do unto you, and all that. If I didn’t do it, karma might bite me in the back and I might not get what I want later. (I know, horrible right) 
  • The adult dating game seems to be a different ballgame from what it was like as a teenager. As a teen, you develop relationships because you happen to be close to someone because they are your friend in the first place. However, adults seem much more “obvious” about the whole dating thing - things like asking for people’s numbers, blind dates, introducing mutual friends - all with the intention of wanting to get with someone in the background. I am too shy to maintain natural social interaction in settings where the main intention is so overt (i.e. getting a partner). I must get used to this new, mature, slightly more “assertive” form of dating and getting to know new people. 
  • I’d rejected the previous few people who’d approached me this way. Maybe I should relent and see what happens. 

So I relented. 

We’ve only been texting for a while, and these are my thoughts. 

  1. I’d never had any intention of dating him, and now even less so - he works as a blue-collar worker near where I study. This is one of the few times when I really felt a social gap. Previously, I’d only felt that I was not very well-off compared to some of my classmates, but now I’m seeing it through his eyes - he watches university students pass by, day in day out. He is the same age as them, yet they are a miles from him. How unfair is that? He could walk into campus and blend in perfectly, yet he is not one of them. All along I’d thought being a university student was a given. That what distinguished you was what and where you studied. I thought that the problem of whether even getting into university or not was only a issue with my parents’ generation. But no, here are kids, looking smarter, younger, trendier than me, yet resentful and envious seeing us walk around.
  2. When I imagine talking to patients, the idealist in me always emerges. I see myself as a sort of ~guardian angel~ or ~mother teresa~ sort of figure listening, absorbing, and understanding all their woes and the intricate subtleties they give off in their stutters, hesitations, and body movements between the lines. I then give them a series of ~life-changing advice~ with a wise and kind smile, and they are forever grateful. Perhaps this is why psychiatry appeals to me - I imagine changing people’s lives through (pretty much) the virtue of my kindness and patience, and being the ~only one~ who can understand them fully. When this guy started talking about his sorrows, this feeling to listen and offer kind and stirring words arose in me, and I imagine myself to be some sort of “saviour” to this “fallen youth”. 
  3. And of course, there’s the fear in all girls that guy might turn out to be psycho creeper, etc. That is a gamble that largely based on intuition in these situations, when you have to decide fast. 

Issues 

  1. Can people of different social backgrounds be friends? (I know this sounds “classist”, but I am honestly asking. Keep my context in mind) Or will jealousy or different mindsets get in the way? 
  2. Mother Teresa Idealism - evaluate. Is it effective? Is it sincere? Or is it only a persona you want to project? Is it too unrealistic? 

at a loss - reflections

I rarely follow up on my posts, but to be very honest, I have chosen this patient as one of my homework assignments - a reflection on pain and suffering, hence I have to follow it through. Do not worry though, nothing will ring false and I will still use my utmost sincerity here. 

It’s been a while since I’ve seen the patient (it was over a week ago) so the emotions take a while to come. 

The adjuncts that come with pain and suffering. 

Helplessness and frustration. 

The larger the group, the less responsibility an average person will take on. As I was with 4 other classmates, when it was time for us to talk to her, I felt like I was waiting for my classmates to speak up first. I was unsure of what to say, afraid of saying something wrong, frustrated that my classmates were not speaking up, yet frustrated at my lack of proactivity when they spoke to her first. I remember a classmate whom I had the privilege of attending a group bedside session with once, and I remember the easy and unaffected way in which she went up to each patient we saw without any hint of hesitation or self-awareness - it was just her way of doing things. Her parents were Christian missionary doctors, and she’d had a colourful childhood in many countries, following her parents wherever their work led them. As I was standing there, facing the amputee patient, the image of my classmate came to me - she wouldn’t just stand here right now! She would be going up to her and saying all sorts of lovely things in the confident, comforting manner. Why aren’t I doing that? I was embarrassed to step out from my semi-circle of classmates, and I knew once I felt the embarrassment, my manner towards her would not be spontaneous and natural anymore. 

Pity 

Another thing which I disliked was how we (us students) were looking at her with eyes of pity. Actually, I myself was in hospital due to an injury a month ago. Every time I saw other patients being visited by their family members I was dead envious and felt a bit sorry for myself, however whenever my parents did come, I felt irritated at their worry and pity. The obvious worry in their eyes communicated to me, and made me feel despair and almost claustrophobia under their gaze. It was up to me to muster the strength to assure them that everything was alright with a smile. This patient didn’t have the strength to do that. She felt the pity that we had for her. We felt sorry for her, and it made her feel even more sorry for herself, which made her condition seem worse to her. 

Which brings us to how we should talk to patients, or their relatives, that are going through this sort of thing. 

I once read a story about a woman who was dying of terminal cancer. Even in her final days, she refused to admit anyone into her hospital room apart from a monk. Why a monk and not anyone else, not even her closest relatives? It had nothing to do with their religious background, but the woman explained to the monk “When people talk to me, they talk to the sickness instead. You talk to me as you would to a normal person.” 

from an experienced nurse

The real world out there’s a dark place. Just as how the 10 fingers on our hands aren’t the same length, in the same way people (i.e your boss) will prefer some people more than others. You got to take it with good humour; if it’s not you, shrug and laugh it off with others and go off for dinner amongst yourselves - that’s how to take these things.  

at a loss

(Does it only seem like I’m only talking about the things in life that upset me? Well, too bad, this is a blog which basically replaces the function of a diary, so it will be full of things I need to vent about, or get off my mind) 

My friend mentioned the other day that she believes spirituality is important, if not vital, for becoming a good doctor (I won’t use the words ‘well-rounded’ or ‘holistic’ doctor because these are simply cliche words thrown at us during class that (as yet) have no personal meaning for me). This is true for me. Often, in times of either public or personal crisis - the recent MH plane crashes, a personal tiff with a classmate - I would always look towards Buddhism for help. What should we do in these kinds of situations? How should we act? How can we reconcile with our anger, our grief? What does the Dhamma say on this? 

Today is another one of those days in which I do this. The following is the event interspersed with the thoughts going through my head at the time. 

We visited a rehabilitation centre today. From what other classmates have related, I thought we were simply going to play around with the physiotherapy and occupational therapy equipment. We did do that, but we were also assigned a case - an amputee. When I first heard that, I felt slightly nervous. Though I feel slightly nervous before approaching any kind of patient, I felt particularly nervous for this one. Was she going to look very deformed? (sorry, not going to add filters here) How were we going to ask questions about her missing limb? I was also having higher expectations of myself in terms of answering questions and keen to show off to the others as I deemed myself quite familiar with physio and occupational therapy, having attending the two for the past month due to a finger injury (haha, that didn’t quite work out well, but that’s beside the point - it was just a confounding emotion). 

Then we met her and the physiotherapist wheeling her over. The physio started introducing her and telling us her story - she was a woman in her early forties (god, so young!), with three children, who had a work-related injury at a factory machine caused her upper forearm to be avulsed. Re-implantation was difficult as the limb was twisted and badly crushed - the wound was closed and they formed a stump instead. I listened with a mixture of horror, incredulity and concern. How could she talk about this, so insensitively, right in front of the patient? And so… callous is not the correct word, neither is flippant… but the almost casual and conversational tone she said these things in also shocked me. She further went on to get into the details of rehabilitation - pressure garments were applied to reduce the swelling, but dehiscence/leakage of the wound meant that they couldn’t compress the stump too tightly - she unravelled the bandages (“you guys can take a look at it”) as she was talking. I felt slightly ashamed at this point - this is not some kind of freak show! - and slightly panicky - I don’t know what to do once it’s unravelled! I think our small group of 5 were overwhelmed by a similar mix of emotions, and we stood there, penultimate year medical students, helplessly in an uncomfortable silence.

It was sometime at this point when the patient, who had been listening but not looking at us, started to stir and complain that she was dizzy and needed a cup of water. Tears came down her face and I, uncomfortable at first, got even more uncomfortable. I felt incredibly sorry for her. The physiotherapist asked a nurse for water and tissues (we grabbed at the chance to pass them over - as least we were then doing something to help instead of just standing there). She spoke softly to her - “do you see the world spinning around you? …. you feeling better?… here, lean against me” (it became clear that they had built up a close relationship in the two weeks since she’d been admitted). The patient, still in the wheelchair, rested her head against the physiotherapist behind her and the physio automatically started stroking her hair, while continuing to talk to us in a softer voice - about how her episodes of dizziness were psychological, some PTSD perhaps and how talking about the event or hearing about it is traumatic for her (wait, you can say these things in front of the patient too?!). Looking at the physical interaction between the two women, I felt a rush of affection and tenderness towards the patient - a young mother of three, if you think about it, showing such vulnerability and dependence - the kind of interaction you would see in a pair of young sisters sharing a bed, perhaps. Not the best simile, and I don’t want to indulge in sentimentality, but it was beautiful and very tender.  

I knew that the moment when we would have to talk to her was coming, and I was dreading it. I had no idea what to say, yet I longed to say something that was meaningful, that would make her smile. When the patient felt better - she apologised for her “outburst” - “sorry for bothering you all”. What?!!! Why are you apologising?! We should be the ones that are apologising. I’m so sorry. I’m really sorry. We’re making all this emotional turmoil in you rise. I was too agitated so I was afraid that my words would come out similarly choppy, hence I remained silent. All we managed as a group was another classmate piping up “no, not at all!” and nervous laughter from us. In hindsight, she was probably embarrassed at crying in front of five strangers and making us feel uncomfortable, and her apology was her way of expressing that. I was too agitated to think of why then. 

The physio then told her to demonstrate a few exercises for us - involving pulling at ropes slung across her shoulders by rolling her shoulders forward. I was very ashamed again that she had to be “put on show” again for us, and felt almost bad for looking. The physio indicated for us to talk to her with a smile - a silence - then we asked her questions like “is it tiring? how long have you been here? what other exercises do you do?” This may or may not be the case, but from my perspective these questions were stilted, abrupt and only skirted the surface of the huge vat of emotions that we were afraid to tap - both on our side and her side - when what I wanted to do was go up to her, crouch by her side, hug her, kiss her cheek and head and stroke her hair. We quickly ran out of steam, and looked at the physio with a mixture of pity and desperation (we don’t know what more to say!). She knew, of course. She smiled and said in a purposefully light tone - “ok… if you guys don’t have anything more to ask…we can always continue to the next room!” and directed us to the next room. We rushed to unlock the patient’s wheelchair (finally! something we can do again) and pushed it along. The patient got up and walked with us, hand in hand with the physio. 

This is pretty draining and I haven’t even gotten to the reflective part yet. Will have to work on it soon. Things I want to address:

  • helplessness, the ideal classmate 
  • drawing in buddhism to help - see them as a person — the eyes of pity (my exp too) 
  • my injury - fortunate
  • beautiful role of physios and OTs vs. doctors (my exp too)