Sunday, May 3, 2015

The Face of Sickness

Your face is your identity - when we think of someone, we inevitably picture their faces in our minds. Before all else, the face of the person will be the foremost of memories - way before we start thinking of the memories associated with that person.

And what kind of faces do we remember? That depends on what we tend to associate the person with. Happy thoughts with happy faces, sad thoughts with sad ones, and unpleasant memories with the ugliest depictions of the person we can recall. 

The face is our most important edifice of identity - in fact, it has been the subject of such adoration and infatuation that the cosmetics market is a booming one. It is so important that many of us, at a point in our lives, have wished that we could upgrade our looks. It is the premier asset we want to flaunt, the foremost display of confidence, and the very tool we use to attract attention to ourselves. Let us be honest, many of us wake up each day and stare into the mirror, only to find ourselves wishing that we could somehow look much better than our current state.

But for the medical student and the accomplished physician, the face is more important that just being a tool with which to garner social attention - it is one of the most important markers of one's health.

For example, you know a sick dog when you see one - the limping leg, the scabies-infested skin, the forlorn eyes, the gaping mouth with its weakly lolling tongue and the lifelessness of its gait.

The same applies to a human being. Ever thought of the phrase - to look like Death? 

Can it be that the diseased state of your heart, or lungs, or liver, or kidneys could be carved onto those facial creases - that one's dying moment can be seen in one's eyes? That one's failing bodily functions be set in that ashened face?

Having walked the wards for the past few months, I have learnt to identify what I call, the 'facies of the sick'. Somehow, having seen the faces of so many sick and dying, it is no longer difficult to tell the face of a healthy person from a sick patient. The dull eyes and sunken cheeks of the patient dying from stage 4 cancer, the heavily heaving chest and the pale lips of a person suffering from a paroxysm of asthma, the fatigued yet anxious face of a man with acute exacerbation of COPD trying his best to breathe through a venturi mask, the half delirious face of a man with hepatic encephalopathy or diabetic ketoacidosis and the hopeless look in an elderly man lying in a hospital, shaking from his rigors and driven half mad by his fever, knowing he is far from his loved ones in a foreign nation. 

The eyes are the window to the soul - true indeed. In sickness and in health, your eyes can be a very useful storyteller. And combined with a carefully taken history and a sharp eye, one can make a relatively good diagnosis of what is perhaps afflicting the person in question. 

Monday, March 30, 2015

In Hora Mortis - Death and the Physician

Many things made the headlines in the past week - the shockingly unimpeded preliminary approval for an amendment to Kelantan state legislature regarding Hudud; some chap deciding to be a doomsday prophet and announce Lee Kuan Yew's 'death'; the green light for the implementation of GST come April; hearsay of a possible collapse of the Opposition coalition and the 'cultural genocide' agenda of the Islamic State. Whilst the rest of the world was preoccupied with these matters, something else - significant in a way because it highlighted a commonly overlooked area altogether - stole the limelight in cyberspace.

And no - it wasn't about Nurul Izzah, some GST-bashing parody, or another dumb gimmick by some attention craving artist.

It was a photo of a grieving Emergency physician.

Crouched by the sidewalk to be alone with his thoughts, away from the hustle and bustle of hospital, with one hand clinging to the railings - and still in his white coat - is an ER physician. Grieving for the death of his 19-year old patient.

Some may ask - with such a hazy grainy out-of-focus quality - how could such an apparently amateurish piece of work garner so much attention?

The answer lies not so much in the external beauty of the picture - rather it is the message it conveys, the emotion it captures – now that, dear readers, is what makes this photo so special.

Poignant. Raw. True.

There was this patient I knew of, a young lady aged 30, diagnosed with chronic hepatic failure secondary to an overdose of traditional jamu about 3 months ago. She had been transferred to our hospital just earlier that morning, and had been in a semi-conscious state ever since. Her speech was incoherent, she was confused, her breathing was heavy, her eyes and her skin were as yellow as Stabilo highlighters. In between her laboured breathing, she would moan and call for her mother. Holding her hand, was her older sister. Seated beside her bed, and watching anxiously as her younger sister drifted in and out of furtive sleep, the patient’s sister could be seen reciting a few quiet prayers for her sister and every now and then, caressing her sister’s forehead.

And around the bed, one could see the flurry of activity– the housemen, the medical officers, the specialist – all in a heated discussion about what to do next. This patient was a Child Pugh C case – with all the lab results pointing towards a rather poor prognosis. To make things worse, her coagulation profiles weren’t too good either. And she had multiple esophageal varices too. There was heated debate about the necessary pre-emptive measures, a desperate flipping of medication and observation charts, alongside raised voices concerning repeated calls to the blood bank that weren’t getting the desired response, and beneath all that, the gnawing knowledge that there was once again all that bureaucratic red tape to beat. The fact that the patient’s sister persistently asked if the patient was going to survive didn’t make things better.

Later that afternoon, whilst the physicians were trying to stabilize her – the patient suddenly gave out a shrill throttled desperate cry – ‘Doktor, saya tak boleh bernafas!’. Her breathing was shallow, her pulse was tready, her tongue was blue and her face had that mask of fear and panic. Her fingers were digging into her bed, and her chest was heaving like a bicycle pump. The medical officers were shouting out orders, calls were made to the head of department, the housemen did all they could to resuscitate her – ventilation, inotropic support, fluids, heparinization, nearly everything they could do, was done. The entire place was chaotic. The drapes were drawn around the patient, and the doctors were racing against time.

The chaos of the ward suddenly died down when the cubicle where the patient was became dead quiet. The flurry of activity had stopped. And the housemen exiting the cubicle appeared ashen. We all knew she didn’t make it. She had died of a massive pulmonary embolism.

The patient’s sister started crying bitterly. She sat rooted to the chair, unable to stand, stumped by her sister’s untimely death.

And in the heaviness of that moment, I spotted the houseman who had attended to that patient. At the first glance, it appeared that she was busy doing the necessary documentation of the death, whilst cleaning her glasses rather repetitively and vigorously. But upon closer inspection, one could see a few tears in the corner of her eyes. Her glasses – were stained with tears.

When she saw that I noticed her tears, she immediately turned away, gave those glasses one more round of violent polishing, and then turned back – this time her face was stoic. And she told me – we cannot cry in front of the patient. It is unprofessional.

It is a rather interesting to note, that whilst we accept the weeping of patient’s relatives as perfectly normal, we stigmatize the weeping physician as ‘unprofessional’.

Why is it, that a man who has raced against time, placing the responsibility of saving his patient before everything else, to do everything that can be done to resuscitate a dying patient, to save someone who isn’t his flesh and blood – why is it that such a man should not be allowed to shed a tear when the patient under his care perishes?

A family member weeps because death has taken away someone close to them. But how about the physician, who is literally involved directly in the health and life of the patient?

In theory, we are taught (or rather, hinted at) to maintain a professional attitude towards the death of our patients. By common interpretation, this ‘professional’ attitude towards death means that one must maintain the theoretical separation between your personal feelings and your job. I have heard some doctors state that ‘You are not the one who’s dying – why do you weep?’

Some say – ‘You weep only if you know you haven’t done enough.’

And some prefer – ‘Tears cannot resurrect Lazarus’.

What irony – that we, who encourage teenagers to speak to their parents if in trouble; who cleverly  advise people to take good care of their emotional health; who confidently direct patients to seek help to reduce stress -  ignore the fact that in more ways than one, a physician is also bound to come across certain events on the wards where personal emotions and work will get closely mingled.

The junior doctor who puts in the drips, ventilates the patient, and administers the antibiotics – is the same person as the man who in his heart, hopes sincerely that what he is doing will be in some way helpful to the patient. The very same person as the man who, like the patient’s mother, hopes against all odds that the patient will turn out alright.

It is surprising that in a working environment where people still consider ‘pulling a fast one’ while performing certain aseptic procedures as rather ‘acceptable’, in an environment where empathy for patients is still considered perfectly ‘theoretical’, and in a work culture which accepts poor communication as an all-time norm – it is surprising that in spite of us closing our eyes to these (and many more) issues, we have decided to stigmatize ‘soft doctors’ rather than hit out at the larger issues pervading our hospitals.

In some ways, it may be reasonable (being overly attached to a patient and mourning unreasonably would have a disastrous impact on the flow of work in a busy ward). But perhaps we have taken it a little too far to so-call set it in stone that ‘a doctor cannot cry’. It is very much as un-empathetic as the men who coined the statement ‘real men don’t cry’.

Doctors do cry. It’s just that we have often glorified the image of the unperturbed, professional, steely-eyed doctor. So much so that we have forgotten that like everyone else, doctors do not lead double lives. A life where we have two perfectly compartmentalized aspects – personal and work – does not exist. There can be no such thing. If there was, then we wouldn’t need to employ psychologists and psychiatrists to deal with the ever rising hordes of patients who complain of work-life balance issues, or work-place related distress. The phrase – separation of work and personal life – disregards the reality that work and life will intermingle, since work is a part of life. It is the same mind, the same soul, the same person who is involved in these two aspects of work and personal life – it would be rather unrealistic to tell a person, especially a doctor, to forget everything work related once he steps home.

The fact that this picture has become so popular speaks volumes for itself – it captures an image which the public rarely see. It depicts a side of us which the world at large hasn’t been introduced to – our human side.

The picture does not depict a moment of weakness. In fact, weeping is not a trademark of the weak. Weeping is not a sign of breakdown. No, tears shed in hora mortis are not a sign of unprofessionalism, since medical ethics dictates that the major principle underlying our concept of ‘professionalism’ is ‘Primum non nocere’ (First do no harm). In what way is a weeping doctor of any harm to his already dead patient? I rather believe that forcefully burying all that grief deep down inside and trying to distance ourselves from our patients, is the one thing that is harmful to the emotional health of the physician himself.  True, our profession comes before all else – but it does not mean that we have to lose our humanity to achieve this.

Why would a doctor weep for his patient? A man who weeps for any Tom, Dick and Harry’s death probably has a problem, but a man who weeps for the person he has tried to help – that, is something else.

We encourage empathy – but suddenly in hora mortis, we require our doctors to be as distant as possible. Food for thought?

Thursday, March 19, 2015

The Med School Report Day 905 - SSC Stress

I am glad that this semester has seen me cut down on my coffee intake by nearly 80%.

On the other hand, my frustration levels (with certain parties) have reached an all year high. 

One thing for sure is, if I ever get married, it will definitely be to an Asian. At least our mannerisms, concepts of what is polite and what isn't as well as our higher tolerance threshold for even the most jarring differences in cultural practices, is better than getting hitched to somebody who doesn't know how our community functions. Period.

Whatever works on Mars does not work on Earth. Not in the same way. And maybe not at all. Or maybe it will, with plenty of tweaking needed. 

I think it is time we stop borrowing concepts whole-sale from others, and start formulating our own brand. That way we can suit it to our Malaysian context. Make it applicable to our local context, to the reality of our hospitals, to the reality of our patients (we must admit, with all honesty, that Malaysian patients are a whole different ball game altogether - ask any doctor).

Anyhow, I learnt from the wards today that pride never goes down well with your underlings. Yes, boss yourself around and try to use your 'bad day' as a cover up after that - but it doesn't matter. What matters is that you have just made yourself hated, feared to the point that it paralyzes working relationships even among your Housemen, denied innocent students of optimal support in learning (from you, you cocky bastard!) and perpetuated the curse of the Malaysian hospital - pecking order, pecking order, pecking order! 

I told myself - one day I shall make myself competent, to the point that I will sit in a place of influence and stop this nonsense. Monsters give hospitals a bad name. And it is because we let them run the wards, instead of putting them down and straightening the bad apples. 

No, this is not the SSC stress talking. It's that burning sense of anger with the sad state of medical education in Malaysian hospitals. Students know when somebody plays Jekyll and Hyde, or when somebody is on the take of blind pay. Putting on an air and forcing us to give you a rimming sadly only helps you to boost your pathetic ego. Which is unfortunate since medicine was never supposed to be like that. 

Unfortunate indeed that many forget 'Pride goeth before destruction, and an haughty spirit before a fall.'. 

Tuesday, March 10, 2015

Fragmented Thoughts and Poor Understanding - The Problem with Medical Education Today

I think I have forgotten - such a common tagline. So common that we have accepted it as part of life. 

But is it really an integral part of our medical career. Let's think.

It is alright for a medical officer to forget the finer details of physiology or those rare pearls of pharmacology, or  the in-depth anatomy of the Facial nerve. Lack of use, being out of touch with a student's life and aging - all these are important factors which contribute to the acceptable gradual degradation of knowledge so meticulously accumulated in 5 or so years of medical school many moons ago.

But when medical students begin to complain that they forget things easily - or that things don't really stick for more than a quarter of a year (or even over the summer break) - and that too, not just one but at least three quarters of the class - then this is a major problem.

Why so? Because if we can't remember what we've studied the previous semester, then what are we ever going to remember? Are we going to enter the hospitals with amnesia? Are we going to be so heavily dependent on DynaMed and Medscape that we can't even be confident in making clinical decisions for our patients without having to resort to these apps, or worse, resorting to that so-called Britannica of the Google age - Wikipedia. 

Ask any student in JC2 onwards - What are the anatomical landmarks demarcating the pathway of the great saphenous vein? Chances are that in every 10, at least 6 to 7 would have forgotten half of it. Or worse, ask a year 2 student about the various classes of anti-arrhythmic agents, and maybe they'll give you glazed looks. 

Oh. Wait. Most likely they will tell you: I know I've read it somewhere. On X SLIDE, in XX lecture. 

Was this meant to be? That we think in terms of SLIDES? That we're unable to understand a lecture as part of a greater structure, or see that Biochemistry isn't just a collection of 36 lectures but is instead a study of very interconnected topics - which, whether you believe it or not, has an important role in medicine (when you're wondering why a patient's having lactic acidosis, you'll know how important Biochemistry is). Ask a student about essential pharmacology, and they'll struggle to define what a therapeutic window means. Or if you could see thought bubbles, most likely you'll see students wondering 'Where the hell does this pharmacology lecture fit in?' whenever a pharmacology lecture comes around the corner.

It is alright for the older ones to forget some things, but when many students of our age begin to complain of 'failing to make the cut' memory-wise, and we KNOW that these students actually passed their exams, and of course, giving the benefit of the doubt that our exams are impeccable (so to speak), then what could have gone wrong? Are we more forgetful than our seniors of old? Something is wrong. But what is it?

Having been a tutor myself, I think I know what our problem is. I have a theory and I call itthe theory of FRAGMENTED THOUGHTS

Of course, I am not saying that students are to be spoon fed. But the point I am driving home is the need to provide students with a logical structure which allows students to see the flow in subject matter. 

Especially if we are going to use SLIDES as our major teaching tool. 

Slides are nice to look at, easy to read, and or course, less wordy than paragraphs. But what we fail to notice is that slides tend to lack one thing - FLOW. Unless you are a teacher par excellence, many of us have to be reminded time and again that good teaching involves making your student aware about the context of everything - how does one topic fit into the whole corpus of medical knowledge.

So why did I put 'slides' on the hot seat here? There is a tendency to make everything cut-up and piece-meal when we're constructing slides for lectures compared to when we're writing lecture notes in continuous prose. This is because when we are writing actual continuous prose, we are more aware about making the flow in thought obvious for our readers. However when it comes to slides, any disruption in the flow of thought is less obvious, since it is after all, a very much visual presentation. With the usage of slides, it really is up to the presenter to tell students how one slide is related to the other. Fine, so we actually have a so-called way of circumventing that problem - good presentation skills. But let's do a reality check - Do we actually do that? Do we actually help students see the whole picture when delivering our slides? Or do we just read off our slides and rush everything to fit it into 50 minutes. 

Some might say - we have learning objectives , so why not let the students be on their own two feet and let them learn based on the learning objectives? Well, that is true only if you make your learning objectives clear and memorable. Some institutions actually have a list of up to 15 learning objectives per lecture. But we fail to realize that although it looks nice on paper, there are many factors to take into consideration - having a detailed list of learning objectives in one lecture would necessitate that we be equally meticulous with all other lectures, and the problem about listing such a detailed list of learning objectives is that we turn students' brains into tick-box machines. 

Slides are bad at conveying 'flow of thought'. And if not properly delivered, there is a high tendency to think of a topic as stand-alone instead of being in congruence with other topics in medicine. Slides can't beat text when it comes to 'fitting it all in'. No, slides are meant for easy presentation, but not for excellent teaching (unless you are a seasoned teacher). Otherwise, being dependent on slides to deliver is a really bad choice. 

It is already well-acknowledged that comprehension and memory work is easier and less momentous when someone has been taken on a well-delivered narrative overview of a subject, and understands how each topic fits in. Being a Chemistry tutor myself, I know my student has literally got it all muddled in his head when he cannot confidently tell me in succinct sentences the connection between Oxidation, Reduction, Alcohols, Aldehydes and Carboxylic acids. However, if he knew (or if the tutor had taken the time before pluinging into all the nitty-gritty of electron transfers and bond-breaking to explain) that alcohols, aldehydes and carboxylic acids are all merely different oxidation products of the same primary substrate, and that these were common everyday compounds, then the student would be able to appreciate organic chemistry better. That oxidation isn't merely a play of electron counts on exam papers but is a process that happens on a daily basis, which we can actually harness using special methods to produce an array of useful chemical products. See, that is something bone-dry, piece-meal slides accompanied by 'monotonous read-along sound overs', cannot deliver. 

The same thing goes for Medicine.

We need to help students see the subject matter. Don't let them have the impression that Biochemistry is just a time-filler subject for First Year students. Or when it comes to pharmacology we ought not to say 'this you don't need to know' or 'that you don't need to know'. Instead we need to pay more attention to drawing a proper outline for students, telling them how each lecture is related to the other, how it can be applied to life, and why we need to know it. That Krebs and Glycolysis ain't really theoretical, they're very much daily life kinda practical. And once students know the flow, memory work won't be such a chore. 

A proper outline and consolidating the flow of thought is always the FIRST STEP. Not a long list of learning objectives. Not a thousand slides. A clear thought process is always the first thing to consider. Having an exhaustive list of learning objectives is never effective if one doesn't understand where everything fits in. 

If a student can only think of something as being 'on X slide, in X lecture' then we seriously need to consider another solution. Perhaps it is time to stop, think and reflect - have we been doing it right?

Sunday, March 8, 2015


I actually started writing this post more than a month ago. However, due to writer's block, I just stopped halfway, perhaps because I didn't know how to rephrase the incoming thoughts rather than a want of new ideas.

As we move on with Life, we change in many different ways, the most pivotal types of changes being a change in our outlook on life. For example, my 2008 Facebook status read:

I am a person who believes that life is to be conquered. Nothing comes easy.

We change due to the circumstances we are in. For example, I wrote that when I was undergoing a very difficult tie to even survive secondary school. I had no friends, I felt alone and well, desperate. I told nobody about my loneliness, and I couldn't, because the de facto associations whenever my name was mentioned were sterling academic achievements, a 5-year unbroken record of being top of the form, and a person whose only aim in life was to be his own maker.

How does it feel like to know that you are actually alone, no matter how much you try to be warm, now matter how hard to try to maintain a conversation, no matter how hard to try to be nice and ignore even the biggest and most obvious faux pas? You know somebody ain't genuine, but you're still pushing for some acceptance. So cheap, yet sometimes the feeling of rejection is way too powerful to ignore to think properly.

And medical school has sadly become like that. Some people can be wonderfully nice and sweet when they want my attention but God knows the things they say and scheme behind my back. The walls have ears, it so happens their confidants aren't that good with secrets, and just so you know, that chatterbox somehow let the cat out of the bag to my face. If there was one thing I could do - I would have taken a knife and gutted said person like a fish down the middle. But because I am bound by that stifling chain called Christian ethics, I have to forcefully close an eye and be charitable towards so-and-so.

Why is it that I cannot bring myself to be a real gunner? Why can't I act two-faced? Why can't I be a butt-licker, a pacifist, a player, a do-it-my-way free-thinker, a man whose ends determines the means? Why can't I be a man who doesn't need to fear anyone but himself?

I know I am beginning to sound like a free-thinking atheist, but there are times when I just challenge God, if ever He so exists, to prove Himself. In fact, I am beginning to question a lot of things. I believe in God, but I find it hard to keep on believing.

I am writing this because I feel so alone. I drown myself in work and studies and with attempts at being more intimate, but I know it ain't working for me. Some people tell me that one potential cure would be to land myself in a confirmed-and-chopped relationship, but I cannot do that because I know I am most likely unable to be fair to my significant other  in terms of time and attention. I want her to be truly happy too, and not play a game of wait and see-the-ring. For now, I want her to be fully free to mix around with her other guy friends and to live life to the fullest, instead of having to officially bind herself to a person who is most likely already engaged (and will later be married) to his Workplace. I have chosen not consolidated anything yet because I don't think it is fair to burden her with a man as incompetent as I am in providing time and attention to his significant other.

How does it feel like to be alone? Frightening, because you know only two types of people can truly stand being really alone - the dead when they are buried, and those who have a mind and will of steel. And if you are neither, and yet you know you are alone, how does that feel?  You have no alliances, no pacts, no friends close enough to call for help, or worse, the ones you have might not comprehend your problems.

Ah. It looks like what I have written in 2008 is still unfulfilled:

A guy who's looking for real friends in whom he can trust. Has intense dislike for traitors and backstabbers but would do anything to defend his friends.

I don't want to trouble myself looking for friends anymore. I really hope that this Lent, some prayers will be answered.

Saturday, January 31, 2015

Hospital Reflections

One more week has passed me by, and once again I find that my eyes have been opened even wider still.
The harvest is great but good workers are few. Compassion is lacking, and there is the stench of poorly-disguised indifference, the toleration and normalization of uncharitable behaviour on the wards, the nearly complete disinterest in the passing down of the art of medicine to one's future successors, the stifling sense of hierarchical feudalism, and the logic-defying red tape that runs the entire length of hospital administration - so much so that now I know why one elderly patient tells me that she fears the public hospitals more than anything else.
Seeing how one incapacitated patient's death was treated with such indignant disrespect made me all the more resolved; how some extremely sick patients are treated like bed-occupying lumps of inconvenience; how some nurses and doctors angrily assume their patients to understand in one or two lectures how cancers and pneumonias and nebulizers work.
And the fact that all these have been tolerated - to the extent we accept all these as 'normal'. How come?
One day things will change. Dead wood must burn, in the pits, if possible. Good men must be placed in their rightful places of power, instead of Jekylls and Hydes. We tolerate too much, polish other's boots way too long, and forget that the good man, if he has a clear conscience, should fear nothing.
But on the other hand, it was comforting to know that there are still good men walking the wards, and convincing me that not everything is lost yet. Not everyone sings the same tepid song, and that is what is what still gives me assurance.

Sunday, January 18, 2015

Race and Religion - Tinderboxes?

Religion and Race - some people liken them to two tinderboxes. I used to wonder why it had to be so.

When I was a young boy, I never gave much thought to religion or race. I learnt about race only in Standard One - from textbooks teaching us the typical Abu, Ali and Ah Chong, and it really didn't seem to be important to me back then. And religion - well I thought religion was just a part of daily life - Bible readings by Mother at breakfast (and being forced to be at the table throughout without toilet-break till it was done) and quiet time, praying before meals, reflection before bed (which I regularly skipped when nobody was watching), doing unto others what you would like others to do unto you, going to church on Sundays, refraining from certain habits (no bad language in front of Mom, no cussing, no fibs) and the like. It was some sort of 'it's something I do at home' and 'it's all a part of the upbringing' kind of thing. Until I came across some words in a history book. Words like 'oppression', 'genocide', 'hate', 'racism', 'Reich','bias', 'holocaust', 'wars of religion'. I remember asking Mom when I was way younger, and she merely told me that they were 'bad things we do to people we do not like'. And full stop. That was it. Which was weird to me, since it seemed strange to me that somebody could think of killing over 6 million people he didn't like. How did he find so many people to dislike? (By the way, I was referring to Hitler). But since I was given a relatively simple answer, and the person in question did not seem to find it necessary to elaborate on it, I thought, well, just another weird thing about life. Apparently. 

I forgot all about it, until I was old enough to read the newspaper. And when I went to school.

There it was, Racism staring bald-faced at me. I remember a particular teacher disliking me, and I never understood why (I was eight). Everything I did was somewhat below-standard to this particular teacher, and I never understood why my efforts were always 'erroneous' to her no matter what I tried to do. Every piece of artwork I did surely had some fault to it. The way I wrote my numbers, my capital 'J's, the essays I wrote, were always wrong, unacceptable, and inferior to what she wanted. And I never understood why. Even the horror story I wrote for a school assignment was rejected. And as far as I remembered, I definitely had it double checked before submission. And all the while my parents just turned a blind eye. And one day, I remember coming home crying, and finally my Mother told me what it was. And for the first time I fully comprehended what they really meant: Racism. Bias. Hate. 

And from that day onwards, my eyes were opened. And it became all the more clearer. The teachers clarified it for me. My school made it all the more distinct. And I learned very quickly to avoid some 'malignant' staff like the Plague. 

And at the dinner table, everything suddenly fell into place. The concept of Bumi and non-Bumi, quotas, special rights, the concept of pendatang, the NEP, racial politics. But being very young, I never could accept why some of us had to have less priviledges just because we so happened to be of another colour. I thought it rather illogical, given that race was not like marks on a test - you didn't earn it, you were born into it. 

But years passed, and after a while, I accepted it as a part of Malaysian life. Until I learnt about the next tinderbox - Religion. 

I remember going to an interschool camp in primary school, which was aimed at creating a sense of 'integration' - another big word I didn't understand at that time. 

And I remember accidentally vexing this particular boy at the camp who then in his angst said something I could never forget - Cina K*f*r. As I came from an all-boys school, calling each other names, including jokingly labelling each other as some kind of animal (e.g. babi) was very very acceptable. However this new term had a particular ring to it which made me uneasy. And the steely look in his eyes made it all the more frightening. 

But I didn't think much about it. Until I came across part of an essay under my desk in secondary school (we used to have two sessions, so that piece of paper was most likely left behind by a senior). And being the curious cat, I read it. And although it was only the second page of an essay, I was left disturbed. The essay attacked a number of things I believed in, calling certain people blinded and led astray and liable to the wrath of God, so to speak. Its heavy usage of the K-word brought back terrible memories. To make it worse, it unforgivingly attacked certain beliefs I had long held to be a part of my life. 

I went home disturbed. I mean, I knew a little bit about religious supremacy, extremism and how some cranky people can plough planes right through a couple of towers in the name of their religion. But I had always thought that those were rather distant incidents. 

But that one essay changed everything. 

I began to learn a lot about the real world. At the news stand. From books being sold at Popular. From newspapers and magazines. 

And I wondered - why? 

I found out that there were people who thought that one religion was so correct that everyone else had to be its follower. And there were some who made it their life's mission to kill others for the sake of their religion. I learnt that there were people who thought it right, and in fact, divinely-inspired, to massacre or deprive of certain rights, people who did not see eye-to-eye on matters of faith. 

And what was even more puzzling to me was that this happened too within the same Faith. One Body, badly divided. Countless arguments and even wars being waged just because not everyone believed that some consecrated wafer actually turned into the Body of Christ himself. And crusades to wipe out heretics. It seemed Charity was something we all practiced when everything was going our way, and then it could be thrown out of the window the moment somebody comes up with some 'new ideas'. I could never accept the fact that God would condemn to hell people who have worshipped in a particular way all their lives in earnest. Would I go to hell just because I sincerely believed that it was upon Peter himself that my Church was built? Would I be regarded as condemned if I believed that the Communion was merely a memorial of the Last Supper? Was it at all logical, if one taught that God was merciful, to preach that some people are already predestined to go to heaven, and some to hell. One Body, divided for a long time. And some of us shatter it further. 

How wondrous - that the way one prays can be used against him. To mock him. To oppress him. That people actually invest time and effort in writing inflammatory articles and organizing talks just to teach people that everything is a conspiracy of so-and-so religion. That wafer and holy water is being used to erode one's faith. That so-and-so is being oppressed, when in fact, the very same is being done by said religion unto others elsewhere in the world.

For once, can we just let religion stay where it ought to be: In the heart. After all, religion can never be true unless someone believes it sincerely.

I believe that God is a Trinity - is it so mortally wrong that you burn churches and desecrate sanctuaries? Of what use is it to you, and would that be a goodly testament of faith? Would that assist God in any way?

I believe that the Church is defined as being inclusive of people who profess the common tenets of the Faith. Does that mean that people who do not believe in the speaking of tongues are any less righteous than those who do? Or that because I attend so-and-so church and believe in so-and-so doctrine makes me more blessed and at a greater advantage than you? As far as I remember, I was taught that God was a fair God. Each man sows what he reaps.

Religion for the heart, and race for purposes of identification only. Not more than that.