World Mental Health Day 2018

Today is World Mental Health Day; a day dedicated to the awareness of mental health. 

When I first started studying medicine, psychiatry seemed to be very vague, something 'not quite as important' as the other acute illnesses that were meant to be studied. 

Over the years, that perception changed quickly - I realized how important mental health was, and how so few people placed importance on it. How people with psychiatric disorders were stigmatized, and for some, how difficult it could be to move forward. 

I've sat with a friend talking him through a grandiose dream for an hour while persuading him to seek help. 

I've brought people I know to hospital for depression, because they couldn't see it for themselves that it wasn't just a case of being sad. 

I've stood my ground against people in a psychotic rage, as uneasy as it made me. 

These were young people, in the peak of they lives, who had succumbed to a mental illness at some point or other. This year's theme for Mental Health Day focuses on youths and adolescents, and the rise of mental illness with the rise of an increasingly interconnected world. 

Mental health disease will continue to rise, but are we ready for it? 

If you know someone who has a mental health problem, please encourage them to seek help. Help is always available, and they are never alone.

Building A Healthy Lifestyle

People be like "Oh you're so skinny!" 

People also be like "Oh how can you eat so little rice?" 😒 

.....

I don't remember how old I was when I decided that health would be a priority in my life. Was it due to the frequent hospital admissions I had as a sickly asthmatic child? Was it a conscious rebellion against the thought of weakness? 

Whatever the driving force was, it was one that led me to good health habits which has probably allowed me to maintain myself at a healthy weight for the past twenty years.

There are no shortcuts - it's just diet and exercise.

I believe I have a healthy relationship with food, and I've never had to diet - although over the years I have made conscious efforts to eat healthier; from the attempts to reduce sugar to advocating portion control, to the occasional attempt to add superfoods to the diet.

I eat at consistent times (thanks mama and ayah for ingraining that in us!) and rarely eat heavy meals past 8pm (except for special occasions). At certain times when I'm not as active as I usually am, I won't feel as hungry and I adjust my meal accordingly. I also have no qualms at leaving food on my plate if I've been served an extra large portion. 

 

I started exercising at home since my teens, and despite being far from fit, somehow I managed to consistently do something that would contribute to my fitness at least once a week for the past 20 years. 

These are all habits that were built over years. 

I like to think that a lot more people are starting to embrace a healthier lifestyle, but at the start of change it can be an uphill battle. Changes don't happen overnight, unless you're going through an intensive program, and that may not always be sustainable. 

Make small changes. Take smaller portions. Do a few hundred extra steps a day. Don't beat yourself up if you slip up, but make sure you get back up and try again.  But most importantly, be consistent about it.

Our health is a precious gift, and one that should never be taken for granted.

Appreciate Your Health

It's been so long since I've been sick that I've forgotten how it feels like to not feel like 100% of yourself. The feeling of weakness to the point that you struggle to get out of bed, or the chest tightness, or the muscle pains. 

It reminds me of my patients, with their strokes and injuries, and their multiple problems and morbidities. With their spastic muscles and their struggle to undergo their daily activities, and the need to put in extra effort and energy just to overcome the weaknesses of their bodies, day in, day out. 

There is value in illness. 

It reminds me to be grateful to be blessed with health, for my usual endless energy. As a doctor, it is a reminder to empathize with my patients, in a situation where it's too easy for a possibility to become detached from the job. It's a stark reminder to take care of my health, for it is something that could easily be taken anytime.

Breaking the Addiction

I’ve always had a sweet tooth, but this week has been horrific in terms of my sugar intake.

I know how awful processed sugar is, and I’ve been trying to eat healthier; however the thought of reducing sugar in my diet has always been an uphill battle. The introduction of the new food pyramid, and how it cuts out sugar entirely, is an additional reminder of how much sugar isn't an essential part of the diet at all.

After a solid week of eating a pack of 400g M&Ms per day, I’ve decided that something actually has to be done – I actually need to break the hold that sugar has over me; I cannot deny that it’s become an addiction of sorts, and like any addiction, it needs to be dealt with.

Wish me luck!

The 30 Minute Rule

Family Planning

It is always interesting to speak to people regarding their reproductive choices. 

At an age where most of my friends and peers are getting married and starting to have families, I find it interesting to see how few people actually don’t plan their families, and how insulted people can get when you advise them on these choices. 

When I worked in the district, part of my job was to attend to antenatal patients, and quite often women would come in with a second pregnancy very close to their first. I would always ask them if this was planned, and more often than not they would shrug and smile, and sheepishly tell me that they did not expect to get pregnant again so soon. I would just advise them to give themselves some time in between pregnancies to let their bodies recover. 

There would also be ladies who would come in on their sixth or seventh pregnancy, claiming they did not want to push away Allah’s rezeki, and I would just smile and tell them that it was also imperative to plan for these children’s futures, and to please consider taking a break from childbearing to focus on rearing their current brood. 

It does seem that a large majority of Malaysians do go into marriage either not thinking about planning their family, or the buzzword seems to be ‘jangan menolak rezeki’, or don’t deny the blessings that are given to you. 

Family planning IS important. 

It is every couple’s right to choose for themselves when they want to start a family, but it is important to go into the process making a conscious decision to conceive and thinking about the challenges that come with it. 

For newly married couples, it is a healthy discussion to have before marriage -  at least to ensure that both parties are on the same page with regards to reproductive choices. After all, some people might want to enjoy the company of their partner prior to starting a family.

It is especially important to start taking care of the mother’s physical health, to start taking folic acid prior to trying to conceive to reduce the chance of neural tube defects. For women who have had prior complicated pregnancies, it is even more essential to drop by your obstetrician and find out your risks about future pregnancies.

And it so SO important to discuss caring responsibilities and careers and what will happen after the baby is born  - I personally find it important to negotiate who does the nappies!

There's a lot that goes into this whole process. When I ask about family planning, in no short terms am I telling you not to get pregnant – but it is something that warrants a little more thought and planning; after all, one is placed with the responsibility of bringing new life into the world, and all the wonderful things that come with it. 

The Food Controller

My husband tends to overeat.

Slightly before we got married, I started taking an active part in controlling his portions after he realized he could no longer fit into any of his trousers for work – and he willingly allowed me to do so. It became a habit between us, and a bit of a joke as time went on. 

I would always gently remind my husband that he had enough rice on his plate, only to have my mother object and tell him he could have more. To give Behr some credit, he would sneak a look at me with a cheeky smile and regretfully decline. 

It did become interesting after awhile, seeing how people’s reactions were to my portion control, especially in a society where one is encouraged to eat, and feeding the ones around you are akin to a type of love. 

So much so that it is often said that men tend to put on weight after marriage as a sign of contentment. I would laugh off this comment, and firmly tell people that it just wasn’t going to happen. 

As much as it may be a sign of affection, my idea of love is to keep my loved ones healthy and fit. From the very beginning I told my husband how important it was to me for us both to have a healthy lifestyle, and he grudgingly follows me intermittently to my yoga classes and eats relatively well. 

In an age where lifestyle related diseases are rife in our community, it was a conscious decision on my part to live as healthy a lifestyle as we could. 

Regardless of how people may raise an eyebrow whenever I tell my husband he’s having too much rice when we’re in public, at the end of the day it was a decision we both made to honour, and it remains a mutual understanding in our relationship.

Impressed.my - A Juice Cleanse Trial

I’ve heard so much about cold-pressed juice and juice cleanses that I decided to give it a try and see how it works considering I’d been feeling a bit tired and bloated for the past few weeks. I opted for a one day cleanse (more than 24 hours without food? No thank you) from Impressed.my, which consisted of six juices spaced out 3 hourly and downloaded their schedule from their Facebook page.

7am: Drank first juice called Rise & Shine (basically alkaline water, lemon and cayenne pepper). The juice itself was nice, not as acidic on an empty stomach as I thought it might have been (but then again it’s alkaline water duh), and the pepper was a slight kick. 

8am: Starting to have slight hunger pangs. Still alert. 

9am: Drank second juice (spinach, cucumber, celery, lettuce and green apple). Surprisingly yummy considering the number of veggies they’ve stuck in there. Also one of the few ways I’ll actually bother eating spinach. 

10am: Mildly hungry. I generally tend to get hungry at this time anyway. I’ve also realized that I probably don’t drink enough and now I’m starting to drink regularly I’m also getting frequent urges to go to the toilet. Damn bladder! 

11am: Stomach starting to rumble. Not exactly hungry but there’s that gnawing feeling that something is missing . I’m also starting to fantasize about the next juice. Feeling surprisingly light though, and not getting that mid-morning lethargy that I get on occasion. 

12pm: Had the I6 (watermelon, beetroot and mint). Not too sweet, and had diluted a little bit as I probably didn’t shake it well enough. It was only a hint of beetroot and mint, so nothing too overwhelming. 

1pm: OMG so many toilet breaks. Is this what a detox does to you?

2pm: That weird feeling of being hungry but not. 

3pm: Hallelujah for almond milk, which also has alkaline water and agave nectar in it! Not as thick as I thought it would be, just a hint of cinnamon. I've always loved almond milk so this one is a definite plus!

4pm: Busy running errands, which almost made me forget about that weird feeling of fullness but not. Not that I'm busy I didn't actually have time to analyse how weird I felt. Interestingly, at no point did I feel tired or lacking energy to go about my routine.

7pm: Was actually so busy that I didn’t actually get to drink my 6pm juice (the spinach-veggie-concoction) until 630 on my drive back. By this time I was getting used to that weird feeling. Man, I’ve never looked so forward to a bottle of juice in mt life. 

8pm: Buckled down and had peanut butter sandwich after seeing dad make himself one. I’m so weak. Then again, I wasn’t entirely clear how strict you had to be with food for this sort of thing, and you can’t really go wrong with a sandwich can you? 

9pm: Last juice of the day was the I1 (green apples and carrots). I have to admit to having a sense of achievement at actually making it though most of it. 

How do I feel? 

It took some time to adjust. Apparently when you first do a cleanse your body will start to crave sugar (it was the exact feeling I had when I first quit sugar for a bit, just not as awful). I had this constant gnawing feeling as I would keep anticipating that next juice. 

Cons: Finding a way to store the juice was a pain, especially if you’re someone always on the go like me. Considering how you have to have something every three hours and being highly mobile, it takes commitment. Ideally I would have liked a coldbox of sorts but I had to make do with one of those insulated bags, which probably wasn’t exactly ideal. Probably better if you're in an office environment of sorts with a fridge, or if you're going to be at home.

Pros: I did feel a lot less bloated after the cleanse, and pretty good the few days after (okay, I might have overdone it by having half a bag of Famous Amos chocolate chip cookies to congratulate myself on that achievement – which probably undid a little bit of the good I’d done), but overall it felt like I’d done my body some good. I generally eat reasonably well so I didn’t expect to feel a lot different, but it did feel good, whether it was a placebo effect or not. 

I agree with the evidence that juice cleanses probably wouldn’t do too much good and isn’t a healthy alternative for long term weight loss, but it does the job if you’re trying to kick start a commitment to healthy eating, and is great for giving your body a bit of a break in the short term. 

I got my juice at Impressed Nu Sentral – their beginners set is RM65. Check them out on Facebook here or on Instagram at impressed.my for some yummy cold-pressed juice!

Fighting Yourself

Grandma is looking a lot more frail. 

She’s 83 this year and has led a long, active life. She’s always been one of those women who are always on the go, from her active career as a teacher, to her involvement as Wanita UMNO’s longest serving district head at Pagoh, to her insistence of her presence at the local festivities, to her pleasure at joining our family holidays locally and overseas. 

During Ramadhan she insisted on praying all twenty three rakaats standing up, even though she has osteoarthritis, despite our insistence that she take things easy. That's the Bukit Treh ego right there.I think that obstinacy and drive runs through the females in the family. 

Needless to say her knees gave way by the end of Ramadhan. 

She could barely walk from the pain, and it nearly killed her that she had to give up her daily routines of walking to the local mosque for her prayers. She fought tooth and nail when family members insisted we move her to a daybed downstairs so she didn’t have to navigate the stairs. 

I feel for her. 

That loss of independence must have been difficult, especially for someone who is used to being so active. She obviously hated using a walking stick, insisted on pushing through the pain despite how obvious it was that she was in pain. It took the combined efforts of four of her six children at the same time to persuade her to move her things downstairs and use the day bed so she didn't have to go up and down the stairs.

I have met many people like her, whose hearts and minds do not match up to their physical selves. Their hearts are still young, and it is the loss of their physical activity and independence that slowly eats away at their souls. 

Alhamdulillah my grandmother’s health is slowly improving. She embraces her physiotherapy sessions and narrates her activities with such enthusiasm that I can’t help laughing, from the electrical stimulation, to how they taught her to use her stick, to the other patients who are concurrently doing physiotherapy with her. 

I can only hope I have that same spirit when I age. 

Age is just a number after all.

Fighting Age

Grandma is looking a lot more frail. 

She’s 83 this year and has led a long, active life. She’s always been one of those women who are always on the go, from her active career as a teacher, to her involvement as Wanita UMNO’s longest serving district head at Pagoh, to her insistence of her presence at the local festivities, to her pleasure at joining our family holidays locally and overseas. 

During Ramadhan she insisted on praying all twenty three rakaats standing up, even though she has osteoarthritis, despite our insistence that she take things easy. 

I think that obstinacy and drive runs through the females in the family. 

Needless to say her knees gave way by the end of Ramadhan. 

She could barely walk from the pain, and it nearly killed her that she had to give up her daily routines of walking to the local mosque for her prayers. She fought tooth and nail when family members insisted we move her to a daybed downstairs so she didn’t have to navigate the stairs. 

I feel for her. 

That loss of independence must have been difficult, especially for someone who is used to being so active. She obviously hated using a walking stick, insisted on pushing through the pain despite how obvious it was that she was in pain. 

I have met many people like her, whose hearts and minds do not match up to their physical selves. Their hearts are still young, and it is the loss of their physical activity and independence that slowly eats away at their souls. 

Alhamdulillah my grandmother’s health is slowly improving. 

She embraces her physiotherapy sessions and narrates her activities with such enthusiasm that I can’t help laughing, from the electrical stimulation, to how they taught her to use her stick, to the other patients who are concurrently doing physiotherapy with her. 

I can only hope I have that same spirit when I age. 

Age is just a number after all.

Fighting Off the Flu

I was always the weakling child. 

The one who would get bouts of illness. The one who would go in and out of hospital for asthma. I was always sickly, and my parents banned me from sporting activity out of concern for my health. 

My younger sister was the strong one. Never ill, forever active. How I envied her. 

I don’t remember much of hospital, but I remember how much I hated that white sterile environment. They could chuck in all the pink sheets and murals they wanted to, but there was always a certain smell about the hospital that I hated. And I hated being there, bored to death in my ward, with restricted movement. Ironic that I still pursued medicine after all that.

I was sick this week; struck by a bout of fever and asthma that knocked me off my feet for a good couple of days. It had been so long that I was that sick, and I had forgotten what it felt like to have difficulty breathing. 

How it felt to not be able to take a full breath, like there was a tight band around my chest. 

How it felt like breathing itself took effort.

How it felt to have no energy and no appetite, to the extent that every single moment was focused on recovery. 

I cannot imagine those who undergo chronic illness, to constantly feel less than themselves in their everyday lives. 

Health is a blessing, and it is only when it is taken away that you are reminded of how precious your strength and your health is to you. I am thankful for the reminder, least of all at a time when I myself am dealing with ill people every day, and to remind myself that I am in a position where I should be able to relate to those who pass me by every day.

The Perfect Body

I've followed Casey for ages, a fitness guru who runs Blogilates on YouTube, and I love her approach to health - how absolutely positive she is and her emphasis to a healthy body image.

I've been lucky to have grown up with a great body image, and even more so to be surrounded by friends and loved ones who have a similar mentality.  It's natural for women to focus on their flaws, especially through teenage years where there's an increased awareness of physical changes and an increased attention to how one looks.

This video she's done is probably one of the best things out there; to relate how every woman is subject to body shaming and criticism, and a physical representation of how you feel.

Definitely worth a watch for everyone, regardless of gender.

The Man Beyond the Disease

He is a wizened, skeletal husk of a man. The cancer has eaten away at his flesh, leaving skin which stretches across his bony prominences, stretched so tightly across his skull that it seems I can see underneath the face of the man.

He smiles at me as we do our rounds, surrounded by his family, and I am buoyed by his optimism.

He has had cancer for four years, been operated on twice and has undergone four courses of chemotherapy and radiotherapy. He is currently admitted for complications of the cancer and for nutritional support, to prepare and strengthen him for another upcoming operation.

He is always with family, and his wife and daughter are always there, holding his hand.

Despite his ordeal, his spirit seems unbroken. He always smiles. He is always polite and positive. He never seems to berate the medical staff or blame the universe for the fate that has befallen on him. His family always smiles. 

He helps us keep our spirits up, the spirits of his treating doctors and medical staff. He helps us believe that good things will happen.

I admire his spirit. 

He looks like a husk of a man. But his spirit makes him more than all that.

The Common Cold

So I’ve succumbed to the flu – after two days of minor sniffles and cough, I found myself waking up with achy joints, nausea and the biggest headache I’ve had for awhile. I found myself unable to get out of bed due to lethargy, and ended up just calling in sick to work – the first time I’ve called in sick for a long time. 

My concerned grandmother kept popping in to see if I was okay, and although I passed it off as a minor ailment, she insisted I had a fever and told me not to bathe. 

What? Not bathe? 

“You have a fever, it’ll make it worse to bathe,” she said. 

Naturally, being scientific minded, I took a shower anyway, but it got me thinking about the perceptions that people have about the common cold. A majority of my patients come in for cough and cold, insisting on MCs (that’s another story altogether), with all sorts of ideas about their symptoms. 

Firstly, having a cough and runny nose are symptoms of nose and throat irritation, which can be caused by environmental allergens or an infection. Most commonly, it’s a combination of both. With most infections, it can be either bacterial or viral, and the confirmation of the diagnosis leads to the available treatment. 

For a regular cough and cold, the prescription of symptomatic medications is sufficient – this means giving medications to relieve the irritating symptoms. It’s also important at this time to drink lots of plain water, as the irritation will worsen when the throat is dry. The use of honey is often also recommended to soothe a sore throat, or lozenges. 

Sometimes, parents are advised to give their children ice cream to relieve their throat – this is when your doctor finds the tonsils to be enlarged. In young children, this might result in coughing and vomiting as a result of the sore throat. 

Secondly, antibiotics are not something that is regularly prescribed to everyone. The use of antibiotics is prescribed for bacterial infections , and this is a diagnosis that is reached with a combination of the symptoms and the physical examination (on occasion, this is also confirmed with a blood test). Usually doctors prescribe antibiotics when they find a source of infection, such as exudates from the tonsils, or reduced lung noises, which may lead them to suspect a bacterial infection. Antibiotics do not work for viral illnesses, which is the major cause for most flu illnesses. 

Because the cough and cold are infections, some myths are not correct – you can shower when you’re having the flu (even if you have a fever). If you have a high fever, this might even help keep the temperature down! If you choose not to, this really is a personal preference. 

And because most treatments are designed to treat the symptoms, not the cause of the disease, anything that helps you personally with the illness is more than welcome. Most of the time, your body will heal itself, because that’s what our bodies are designed to do – fight infections and the like.

Understanding The Emergency Department

There has been a lot of focus on emergency departments of late – complaints about long waiting times and not being seen immediately. I think a lot comes from the lack of understanding about the role of emergency departments. This is written to further the understanding of how our emergency departments in Malaysia work (for Malay link, please click here).

Most emergencies are divided into three major areas: 

1. Red Zone (critical zones – patients just died/about to die and requiring urgent resuscitation). These patients are seen immediately. 

2. Yellow Zone (semi-critical cases – patients who may potentially worsen or are unstable in terms of their vital signs or certain ‘red flag’ diagnosis. These patients are seen within 15-30 minutes of presentation. 

3. Green Zone (non-critical cases – cough and cold, minor scrapes and lacerations. There are further subdivisions in the green zone based on age and critical cases). Waiting time depends on staff, number of people and can go up to 4-5 hours. 

Protocol 

When first attending the emergency department, patients are seen at the triage desk – which then will send the patients to the appropriate zones. Triage desks are basically manned by medical assistants (M.As) who will make this decision based on the complaint, the presentation of the patient, and if needed, the secondary triage will further re-classify the case based on the vital signs and/or relevant investigations.

Staffing and Working Hours 

The emergency department is staffed by doctors, medical assistants, staff nurses, community nurses (J.Ms) and health attendants. They all have their own responsibilities, but in the emergency department, only doctors are allowed to see patients (in some district clinics, medical assistants also see patients), and medical assistants and staff nurses help with the monitoring, procedures and other administrative duties. They work on a three shift system which is 8 hours long per shift, which is often a gruelling situation, and staff may have to work two shifts per day at times. 

On a night shift, depending on the staff available, there may only be 1-2 doctors per zone and when there are too many patients in the red or yellow zone, the doctors from green zone will assist the other zones. During these shifts, it is common to try and sneak a bite to eat or a prayer break when possible – because often you have no idea when patients are going to start pouring in! 

What Is An Emergency? 

An emergency includes problems like heart attacks, seizure, severe asthma or respiratory diseases, severe motorvehicle accidents, patients going into shock (among others) – cases that need to be seen urgently and treated as quickly as possible. 

As a general rule, if you can walk, talk and breathe, you may not be considered an emergency. Please understand that as health professionals, we will try our best into see you – patients are not turned away from emergency departments, but please understand, that just because you only pay a paltry RM1, it does not mean you should be flooding the emergency departments. 

If your child has a cough and cold – do not come to emergency immediately. Try giving some Paracetamol first and sponging to bring down the temperature. Most pharmacies sell over the counter medications, as does Seven Eleven. There are private GPs or government clinics that will be open. If you have pain somewhere, please understand that we will not triage you to yellow zone if the pain does not seem to be severe. 

Working in emergency is challenging – sometimes more than often you are tired, overworked and often faced with patients banging on your door demanding to be seen when they have been waiting for three hours, only for a cough and cold, or a mild pain. It is high volume, relentless work and a lot of this comes from people who do not understand the role of emergency. 

At the end of the day, Malaysians also have the understand the system is such to serve critical cases – please do your part as responsible consumers before making those complaints.

Bring On the New Year

Mental Block

What was it about this sickness of the mind that seemed to transmit itself in a variety or physical manifestations? 

 

It was in the wan face, the tired, dead eyes. 

 

Sleep would become unrestful, appetite would be suppressed.

 

There was no one symptom, just a vague collection of pains and aches that established themselves in a variety of way. Things would never be the way they were, or there would always be some new pain, some new ailment that would be debilitating to their daily activities. 

 

Their physicians would umm and ahh and investigate for a cause of these ailments, but their investigations would never bear fruit, and they would be forced to concede to the bitter truth, that the mind had so thoroughly convinced the physical self about it’s own weaknesses that it had all but incapacitated itself. 

 

It was all in the mind, these poor sufferers. 

 

May the find the strength and support to lift these blocks.

Invincible

Start to A New Life

It's been a busy enough start to this chapter. 

Working in a government clinic, where things are done manually, where patients bring in books filled with doctors notes where I scratch my head to decipher the writing of the previous doctor to come to conclusion with the diagnosis - is a far cry from the ease of using a computerized system that I was used to in my previous hospital. 

I see about 50 patients on my own, and half the time I'm desperately trying to remember the official clinical guidelines off my head so I can make a decision based on good clinical practice as opposed to just starting something based on experience. 

I realize the burden of healthcare and how it stretches across the board, to these well-meaning kampung folk who come in and listen to your spiel, and hope that your clinical skills are enough not to miss the things that shouldn't be missed, and that your conversation with that little old lady about her diabetic medications should be remembered. 

 I'm tired at the end of the day, but it seems worth it. 

Times like this I'm glad I do what I do.

Now I just have to keep the momentum and keep learning the things that I do not know.

To Be Thankful

If you could live your life over, would you have chosen the paths you do now? 

I am at a point of my life where decisions need to be made; at crossroads with my career and an uncertainty over what will happen over the next few months. 

Who knew that being a doctor counted as a critical service? Long hours, a grueling job which is occasionally a thankless one, and pay that sometimes seems inadequate compared to the work we put in. 

Being a doctor is definitely not something for those who are not willing to dedicate themselves to service. 

I am thankful that I love this job. 

The hours are long, but every minute extra spent can make a difference in someone’s life, and every minute spent is pahala. 

The job is grueling, but it builds character – or reveals it – and helps you walk through the shoes of others who are less fortunate. It trains you and tests you so you are aware of your own inadequacies and fallacies, and keeps you humble. 

It is thankless at times, but even the most thankless of days is still one spent improving the life of another individual. 

Our pay may not be as high as those working in the private sectors, but Alhamdulillah, it is comfortable enough to live through. I have enough to live comfortably, to have clothes on my back and food on my table, and that is something in itself to be grateful for.

I am at a point of my life where I’ve had to evaluate my path, and found that perhaps it is not always the road not taken that makes all the difference. 

I wouldn’t have had it any other way.

There is still a lot of improvements that can be made in the working lives and the training of young doctors, and we are still far from being a country that emphasizes a work-life balance, but we are hopefully heading to a direction that will bring this service and our country from strength to strength.

It will be interesting to see what will happen in the years to come.