I hopped on the bandwagon to apply for a Neurosurgery elective in London. In a feeble attempt to demonstrate to the outside world that medical students can enjoy as vibrant, authentic and normal a university experience as any other undergraduate (this is not accounted for in our annual tuition fees, by the way, nor do sufficient loans exist for us to apply for), the heads in-charge of refining the already-polished programme included a month-long elective programme for all of us. We were reminded time and again that this is a degree requirement -- but one that gives you the liberty to do anything you'd like. The catch is that you've got to be able to justify how the elective grooms you to become an all-rounded, compassionate, intelligent, talented individual. So that's how I spent 14 May to 22 June of this year with my fellow buddies.

Just so happens that I've finally set aside some personal time and put in effort and strength garnered from the rest period after a gruelling M3 year to peruse the book When Breath Becomes Air. It so damningly coincides with the Neurosurgery elective (people actually asked if I was inspired to take on the elective after reading the book; at that point in time I haven't actually gotten into the whole mood of reading). The details of the pursuit of life amidst dying were intricately entwined with the entire hospital situation, and there were just too many occasions on this trip where I was reminded of this threshold of life and death. Here I am back home, going unnoticed in the busy hub of Singapore, buried in the book and finally finishing it after being released from the clutches of Procrastination. Words still resonate within me, beckoning the memories of the past month I spent abroad -- the longest I've been abroad so far.

The first week of the elective felt like the most rewarding one. That was, of course, almost expected as it was my first ever time experiencing Medicine in the context of a foreign land. It came to me as a culture shock -- never have I needed to make small talks with so many people -- but at the same time a great sense of achievement came upon me. I never knew how it was like to feel at home in a foreign land. It seems Medicine is a universal thing after all, that all doctors are united by one faith and belief, and there exists some form of commonality between patients. In no time, I befriended the staff at the hospital cafeteria, asked them how their day was, learnt how to count the shilling fast, grew accustomed to maintaining eye contact with a waitress rather than to call for her, left tips for customer service, became willing to spend pounds as though the prices were quoted in Singapore dollars...

Just thought that I would pen down some of the most memorable times that I recall from my short stint.

GCS Business

Mr. L was only a few years older than I am, and came in for a revision of his craniotomy. He spoke Romanian, yet day after day the different registrars who took charge of the morning rounds spoke English to him, hoping to get some reply from him in order to score his GCS. Not that I ever heard him speak Romanian. After my entire month in the ward posting, they still continued to assume that he was deep in sleep.

One morning when Dr. R took the rounds, he raised his voice and said, "Good morning Mr. L, how are you feeling today?" It was as though such was a daily occurrence in the neurosurgery ward. Moving with grace and experience, he already expected that there would not be any verbal reply. His hands were one step ahead of his mind (and a few more ahead of the oblivious patient), and he had already proceeded on to the next step -- a sternal rub. He pressed two fingers down firmly onto Mr. L's chest, moving them in a hasty circular motion and continued to verbalise, this time shouting as loud as the hospital could possibly have allowed. Other patients were roused and looked over. It doesn't seem like a daily occurrence after all. The three of us watched intently, hoping that Mr. L would finally respond so that Dr. R can leave him with some peace and quiet for the rest of his sleep (it seemed he was getting a lot of sleep anyway). Mr. L lay unresponsive.

By then, I was already feeling irritated. Just let the poor patient rest already! Dr. R continued to stir the patient and this time instead of performing a sternal rub, he aimed for Mr. L's supraorbital ridges and jammed his fingers straight onto them. Probably an attempt to elicit response to pain, I thought to myself. That was something I couldn't phantom -- how can anyone not wake up from this if he were still alive and not comatose?

After about a minute of inflicting discomfort and pain not only on Mr. L himself but also on us, the onlooking bystanders, Mr. L showed signs of life. He furrowed his eyebrows. At the same time, Dr. R was making casual jokes on how he should try to score Mr. L with his lack of response, while we were reeling with bewilderment. He hadn't seen Mr. L's subtle display of annoyance and was about to walk away, tempted to score him a zero (the lowest GCS possible for a comatose patient is 3, by the way).

The massage continued half-hearted, and this time I could feel Mr. L's anger as he rose from deep sleep. The anger finally manifested as physical movement, as Mr. L garnered just sufficient strength to raise his limp right arm up to his face to slowly but firmly brush off Dr. R's mangy paws.

"There, finally. It's a 13?"

Dr. R mocked and beamed again. "Have a good morning, Vally." The ward nurses almost appeared annoyed, but none of them spoke a word.

As we moved on to other patients for the rest of the ward round, I couldn't help but let an unfounded sorrow envelope me. In neurosurgical terms, a GCS is probably one of the finest tools for helping a clinician to gauge a patient's consciousness level, and to plan for further interventions. After my elective, it struck me that there were so many confounding factors and ways that GCS scoring can go wrong -- language barrier, paralysis, aphasia, mental disorders, etc, and the list goes on. Watching the numerous debates amongst the different registrars about the GCS scores they each gave also brings in the subjectivity of this scoring system. What about patients with ever-fluctuating scores -- what should be done for them? Does a 1-point discrepancy make a significant clinical difference (of course, I'm excluding the existing clinical thresholds of 3 and 8)? Is every patient nothing but a score to the registrars? These questions of mine mostly likely have their answers buried somewhere in the course of a neurosurgery residency, and these observations that I've made have probably been witnessed painstakingly by predecessors. However, fact remains that such a primitive method has already been used for so long. One should hope that at some point in time, a compassionate neurosurgeon would think of ways to better refine this scoring system. At least that would piss less bystanders off in future.

Fitting In and Fading Out

I forgot to mention that there were so many people in our neurosurgical ward rounds list that stayed at least the entire duration of my elective (1 month). Sucks to be them, I thought. At the same time, if I had been more optimistic about the whole situation, maybe it's not a bad thing for me -- I got to follow through some cases from clinics, to wards, to the theatres, and then back to the wards (but there were none that I saw that made it through to discharge yet). Midway through our neurosurgical posting, Vally went into status epilepticus, or in other words, went into a continuous fit which lasted more than 30 minutes without any break in continuity (I hope this definition is right). This was more or less an emergent situation. We were loitering around the doctor's room waiting for something to see or do after the morning ward rounds and team breakfast, when a crash cart was hastily pushed past us and a few of the unfamiliar ward staff followed swiftly behind. The curtains were drawn, like a reflex response to resuscitation action, immediately closing off the clutter and cacophony from the rest of the unsuspecting world. Being the usual curious and action-seeking medical students that we are, we stealthily sneaked our way to the eventful ward. Thankfully it was empty.

The stroke and neurology doctors were already attending to Vally by the bedside, calling for orders for setting a line, blood tests, diazepam, ECG, vitals monitoring, preparation for intubation. Were we that late to the party? There were consultants amidst the herd, and one unfriendly-looking SHO (Senior House Officer) whose face I'd remembered. The hierarchy was functional -- the consultants kept quite silent until they had to voice something out, the registrars/residents were in control, the SHOs were fussing all over the patient, one trying to enter all the orders electronically while another dispatched orders to the ward nurses, the other bystanders just... eyeballing. I forgot to mention the medics; even up till now I still had no clue what their role is, except knowing that they can be quite in control in times like these. Might be the code blue team. The neurosurgery specialist registrar, Dr. R, just stood there spectating. I wondered why he wasn't in the action.

Anyway, being THE medical students, all we could do was to observe. I have to admit that I think I'm pretty good at eyeballing and looking very intense. Well, that's because I AM really interested, and it partly also helps to take a load off my mind a little, from knowing that I was just standing around but had no capacity to help.

I continued my vigil. Most of the orders went through (thank God) and were duly and timely acted upon. Some that were deemed as less crucial by a team member got stuck in the flurry of activity. This is where the shouting began. The hostile SHO turned to our direction and said, "Can someone get me the ECG monitor? And call the radiographer."

Was she actually referring to us when she meant "someone"? Damn, we're just overseas elective students who haven't even found our way around the hospital. Where on the Almighty earth is the ECG monitor? The three of us threw puzzled looks at each other and responded with a blank stare.

"Staff nurse? Anyone?"

The responsibility has shifted. I took a slow and steady breath, which disproportionately reflected my relief at that moment. It came upon me that if an emergency situation required my assistance, I may not be able to respond well enough to contribute to some form of aid. Hopefully it would be easier back home. I started quizzing myself where the resuscitation trolleys and ECG monitors were placed in the wards that I had been in during my time as a third year wide-eyed and unsuspecting medical student. Would I have been able to rise to the occasion should someone need CPR, since I'm certified to do so (at least for this year). I felt so much like burying my face into the curtains so that none of them could remember the blank and incompetent look on my face. But I remained stoic.

Having gone through one gruelling year of clinical postings, I thought it was a formidable feat and that I couldn't be battered any much more. My knowledge burst through the seams of my brain like never before, spilling out and threatening to evaporate after every major examination (even though honestly speaking I hadn't studied as hard as a good student would). The hours I spent being attentive and actually learning something increased as the year went by, when I was getting comfortable with the extraordinary lifestyle a typical university undergraduate would never experience in their schooling lives. Sleep came as a massive privilege. It was almost like I was working full-time and had to study at the same time, just that there are a lot less responsibilities in question. And I thought I was Miss Know-It-All?

How could I have deserved to be Miss Know-It-All?

It made me realise how important it is to place the patient at the centre of every learning opportunity, rather than being caught up with the zest of knowledge acquisition. As Atul Gawande eloquently expressed in his book Being Mortal, medical students these days seem to fear the lack of knowledge more than anything else. I am guilty of scorning over the artificial patient-doctor experiences that were deliberately set up for us to practice our consultation skills, the times we spent in simulation laboratories (and had the rest of the day free for ourselves) only to look forward to the end of it so that we could declare and afternoon off. If Vally's relatives were there, I wouldn't have known how I would explain the current situation to them -- his uncontrollable fidgeting, why intubation might be needed...

While I was preoccupied with handling my thoughts and looking at the resuscitation, a personnel in dark blue overalls like what the SCDF personnel would wear in Singapore, took a glance away from the action to engage us. "Are you guys medical students?"

Ain't that obvious. We nodded in agreement. I got the feeling that we were judged substantially, but at the same time I also thought that he would have stopped in his tracks to talk to us about things or even teach us if he hadn't been caught up with such a messy situation. He made eye contact with me cursorily, and then turned back to face the action.

The radiographer appeared in a scrub top but his own long pants, with his portable CT scanner or X-ray machine of some sort. Everyone near the entrance, including ourselves, made way for the gargantuan device. He parked it right where he wanted it and stopped, waiting for instructions.

Samantha, our ever-friendly and cheerful SHO with a great sense of humour (I mean it the way I say it), abruptly appeared and muttered under her breath, "Shit, he's in status. You guys know what's going on and why?" We nodded again. She must be thinking, why are these Singaporean students so difficult to engage?

"So he's post-op craniotomy, and had some intermittent CSF leaks. We checked his wound and it's okay. What year are you guys in? Has anyone gone through with you guys about post-op complications?" Thankfully, the material and cases I've gone through in my General Surgery posting were still somewhat intact in my knowledge bank, unsacrificed. I ploughed through my mental recesses and recalled that page in Andre's Surgery notes. Stroke, PE, AMI, pneumonia... The three of us looked at each other. Why do we always hesitate and pause for such a long time before coming up with answers. I forgot who took the first wave of answers but Sam continued, "There are a few things we typically think of, like respiratory infections... Is wound infection a likely reason here?"

"No", I replied almost immediately. Sam jerked backwards, almost surprised that my response came so quick for the first time. "And why is that so?"

"It typically occurs later in the post-op period. Like... I don't know, 5 - 7 days?" I always waver when answering questions. It takes a Prof Jimmy So to force me to not give wishy-washy replies. "That's absolutely correct. You guys could stay here and watch a while longer while I go sort out some paperwork." Sam then went to converse with Dr. R, seemingly to provide him with additional information and updates about Vally.

"Excuse me lady, come and move over to this side," a Black lady looked at me and said. I looked over my shoulder and hurriedly shifted a few steps to my right. She held my shoulders and walked me along. "I'm so sorry."

"Never mind," she replied with a slight chuckle. She wasn't being condescending or anything, and was nearly affectionate.

Vally was not in control of himself. I don't know if he had lost continence or anything, but the situation didn't look too good. He had some bloods taken and the SHO had given him drugs through the line (sedation? antiepileptics?) By then, I observed that the laryngoscope was prepared and the endotracheal tube had been released from its sterile packaging. Shit. When did they decide that it's time?

A registrar in scrubs of a rather short build for an Englishman was handed the laryngoscope. I'd seen him many times while I was going in and out of theatres, along the stairways, around the neurosurgical ward, but I had no idea which speciality he was from. Not neurosurgery definitely. He made many movements and appeared slightly flustered, yet at the same time cocksure of what he was doing, as though he'd done it at least twenty times before. As he inserted the laryngoscope, Vally didn't gag (given adequate sedation probably). It seemed like a lot of hard work; I could appreciate the contours of his forearm and biceps while his muscles flexed and did a lot of jerking movements to get the laryngoscope through. That must hurt a lot for Vally. At this point, I was also thinking to myself, if I were to be in his position in years to come, no, not if but when I am in his position, would I be able to use the left-hand laryngoscope? Do they have right-hand laryngoscopes for left-handers like me? Then again, I might be better with my right hand in procedures because I handle sutures and venepuncture or lines setting just like a right-hander does.

In no time, the ETT was inserted, and they prepared to wheel him to the operating theatre for emergency operation. It seems that one of the consultants (or perhaps the only consultant?) finally noticed the presence of the radiographer. Or did he? Anyway, the radiographer asked, "Do you guys still need this?" He gestured towards the white bulky device. "Not now I guess. He should be getting some scans downstairs in any case. Sorry, and thanks buddy."

"No trouble." The radiographer casually wheeled his fancy equipment off without any look of disdain or disgruntlement, as though he's been here and done the same for thousands of times. Had he been unseen and unheard one too many times?

The show was over. The crowd dispersed and we dismissed ourselves for lunch and never discussed this incident again.

Desperation

In Mr. N's clinic, I met with a middle-aged man who wasn't native to London, Mr. B. He came accompanied by a friend who did a lot of the translation work. Mr. B wore a solemn look on his face, and was casually decked in a sports jacket and track pants. That look mustn't have been something new to him, I thought. Judging from his appearance, he couldn't have been older than Dad, but how is it that whatever's left of his youth is smothered?

When the consultation started, he complained of hearing loss, instability, and appeared to have low mood due to his declining function. Mr. N continued to perform a physical examination on him -- one of the first most complete physical examinations I'd seen in my entire posting, looking for residual function of CN8, 7, 5, 6 and also testing his cerebellar function. In a bid to involve me in the consultation, he finished off and told me, "Feel for his masseter bulk and let me know what you find."

"Hi Mr. N, I'd be placing my palms on your cheeks. Could you clench your teeth tightly together for me, like this?" I demonstrated and he instinctively followed. When I looked him in his eyes, I could sense his bewilderment and even fear. "His masseter is wasted on the left side." I thanked him and returned to my seat.

Mr. N went through in great length the scans and treatment options for Mr. B, who'd expressed his interest in an operation as soon as possible. Towards the end of the consultation, Mr. B added with the help of his translator friend, "Doctor, how long do I have to wait for the surgery? Is it possible if I have the operation earlier? I cannot take this anymore, I feel like I'm going into depression because I cannot do anything about it. Please."

Mr. N told him that instead of waiting for the typical three months, he would try to schedule him in a month or two, and to await a letter from the hospital. Mr. B and his friend left, grateful yet not fully convinced that his life would get better in the near future. After their departure, Mr. N explained in detail to me this case on acoustic neuroma, and I listened in as he did a voice recording for his consultation. I don't know if he meant to keep his word on the promise to try and arrange and earlier slot for the operation; he was as expressionless as I've seen so far. Deep within me, I prayed that this man gets his life sorted out really soon.

On our second last week, a familiar name popped up in the theatre list for Thursday. I counter-checked the surgery to be performed and I confirmed that it was for Mr. B. Thrill came over me but I don't remember how ecstatic I was. I told Brandon and Russell, "Hey guys, this was the patient I was telling you guys about in Mr. N's clinic. I can't believe he got a surgery scheduled to happen months later sorted in just one week!" They responded with approval. I had to observe that operation.

Having gone for an acoustic neuroma operation the week before, I totally understood how gruelling it was for the surgeon and the attending. I spent the entire day from 9am to 5.30pm just watching one operation, and I left even before the theatre scrub nurses could finishing washing down the place. Mr. N had demonstrated his patience and humility in the way he performs his operation; he'd probably done these a hundred times, but he still treats every operation very seriously, treading cautiously and never compromising safety for speed. He took so long to just cut open the skull to gain the perfect exposure for the later part. He positioned himself in a prime posture, manoeuvred the microscope in a way that everyone could see what he was doing, handled the cautery with care, closed the dura personally... there were too many instances to name. To place this experience in juxtaposition with my friends' observation of the foramen magnum decompression for a patient with a Chiari malformation is simply jarring. I left the theatre ill, hungry (didn't manage to get lunch), tired, but I didn't complain, for I had just witnessed the product of culmination of years of neurosurgical training, combined with the comfort of knowing that Mr. N is still humble and fantastic at what he does best.

This time round, Mr. I was to take on Mr. N's case. Mr. I was a newly-appointed consultant in the department. He certainly had a presence, and even a reputation. Scrub nurses did not like working with him, for he was "demanding" and at times disrespectful in theatre. We were quizzed by him many times during our stint, only to be humiliated or be thrown off by sarcastic remarks. Regardless, we respected him a lot for his knowledge and willingness to teach. Mr. N took us through the case (as did Vas before he scrubbed in) and gave commentary while Mr. I was working on Mr. B.

It's strange how one could tell the nature of a surgeon just by observing the way he works. Surely Mr. I knew what equipment he wanted and the steps to take. However, some stuff he did just seemed amiss to me. There was hesitation in his movements, uncertainty in his techniques, negligence and carelessness in his thoughts which translated into a poorly exposed field for the microsurgery as compared to the one I'd seen a week before done by Mr. N. It almost reflected his youthful arrogance, and lack of consideration for the patient as a human being. Who am I to judge? He's already a consultant anyway. We watched on.

The entire time I was so focused on the facial nerve monitor. I haven't heard it beeping so many times during the previous op. Each time the cautery probe touched an unknown territory and the machine beeped, I look a frantic glance at it and then turned my attention back to Mr. I, hoping that he would stop mangling Mr. B's facial nerve. Mr. N's words came to my mind, about the worse thing that could happen in facial nerve palsy -- exposure keratitis. The thought of it enraged me. It should be prevented! This continued on for the longest 6 hours of my life, before Mr. I was stumped by another obstacle.

We'd seen him help Mr. M in theatre for a transphenoidal removal of pituitary tumour for a patient with clinical Cushing's. At some point, there was blood loss that continued on for a long time, so much so that I did not even realise when the tumour had already been removed. It seems Mr. I has a thing for blood. This time, while he was debulking the tumour, the blood loss was rather significant. His tyrannical ways emerged.

"Up the suction please. Why is it not working? Change the sucker. Don't play around with my sucker." He grew more annoyed by the minute, and the atmosphere in theatre also became more tense. It didn't help that the scrub nurses failed to reconnect the suction system after pulling it out. They started berating each other about why nobody knew how to connect it. The scrub nurse handing equipment to Mr. I and Vas had to scrub out and fix the suction by herself. Again, I wished I could help, but I knew nothing.

When Mr. N finally came back, it was past lunch time. He warned us that the operation would go on well into the afternoon, and to go grab lunch soon. We told him we would later. He left. We were still there. Mr. I was stuck at some point, and thankfully Mr. N came back to the rescue (of both Mr. I and us). He swiftly but skillfully debulked the tumour and checked for haemostasis, before finally closing up. He turned to us and said, "You guys had a long day, go now and have some food."

Mr. N was such a respectable man. Beneath his hardened and rigid expressions and "what-do-you-wants", he was experienced not only in his surgical techniques, but also in his display of compassion towards people around him.

Depression

A neurosurgical ward, in my honest opinion, is one of the worst wards to be in. Thankfully in Charing Cross Hospital, the ward is brightly let and high-spirited with fun-loving and caring staff. Otherwise, it can really be quite a gloomy place. Ms. Volks was a patient whom we were asked to examine. Brandon took the UL examination while Russell took the LL. I hope she knew that we were examining her and not just disturbing her from her sleep. She appeared to not understand us and had her own speech going on at the same time we were examining her. When we left she even appeared slightly cross. Until now, I still don't know what to make of her response.

We also had the opportunity to perform a complete cranial nerves examination for an old lady, whose name I have forgotten. She was ever so pleasant and kind. I did the examination, and never have I felt more pressured to put a smile on my face. It came on naturally after the initial awkwardness when I asked for permission. Since she preferred not to sit up due to a back pain, I conducted the examination with her lying down. This was a bad idea. I felt that I was constantly looming over her, with my shadow obscuring her face. Nevertheless, she was still warm and ever so loving with her comments. It took me awhile to realise that my tone of speech naturally became more varied and comfortable and my pitch went up as the examination went on. She didn't seem to understand my instructions (somehow the Singaporean way of communicating doesn't work quite well here in London). At several junctures, getting her to cooperate with me became slightly difficult that Brandon, being a bystander, couldn't bear to watch me and finally intervened by helping me out. "Oh I see... so that's what you meant! Silly me!"

I'm the silly one. Minutes went by but it seemed an eternity to me. Beads of perspiration were beginning to form and trickling down my back and sides of my face. I casually wiped them off with my sleeve, hoping to douse away my anxiety and disguise my clumsiness along with them. At the end of everything, she still was a hundred and one percent cheerful, unbeatable. I said a word of thanks in the rigid manner that the communication skills workshop had taught us back home, "Thank you very much for letting me examine you, Ms. ? Hope you get well really soon!"

My words were returned with a phenomenal reply, "Oh not at all! You've been very kind and sweet young lady, and your friends too!"

Why am I so awkward when it comes to such situations. I managed a feeble smile and then left with my friends. We went on to discuss the case. I realised that I was so focused on the examination and my emotions throughout that I forgot the signs that I elicited. "Isn't she normal?" I asked with a genuine interest of knowing.

Brandon shot me a questioning look, and replied almost immediately, "What do you mean normal? Didn't you see? She had visual field defects. She couldn't see when you went this way, and... this way. That makes it a right inferior quadrantopia. Remember?"

It was all slowly coming back to me. Yes. Yes I remember now. She had difficulty seeing. The visual pathway flashed across my mind like how an oil on canvas painting laid across the walls of an art museum. I tried to work out the details and verbalised out loud, "So which part of the visual pathway is affected?" We discussed where the Meyer's loop and Baum's loop were, while Russell gave his usual blank look. I swear I had to get this whole visual pathway shit right once and for all (I'm trying to make sense of images now as I type).

A heck of a mixed-feelings kind of experience.

Passer-by

As literal as the title can get, we walked past an old lady during rounds. Well, not exactly just walking by; we hovered for a little while but for a much shorter duration as compared to the other patients. She was telling Dr. R how she had made a lot of improvement, independent, wanting to get back to her old self, motivated with physiotherapy... I thought Dr. R appeared slightly impatient, yet he still managed a smile and nodded as she went on with her stories about her family. "Good for you, Mdm, I'm really glad to hear that." She went on and on, getting increasingly emotional and began tearing up.

I always get a strange feeling when I see patients cry, no matter how young or old they are, no matter the reason. This absurd sensation takes over me. I could almost feel a stretch from deep within (no idea where it's coming from), and then tension builds up. The stretching becomes so taut that I start to clench my teeth. My cheek muscles harden, my jawbone locks. At the peripheries, I imagine blood emptying from the vessels in my fingertips, leaving the nail beds thirsty. Yet my heart races and on taking a deep breath, I shudder. It is just me against the atmosphere. The intense, attentive gaze that I wore is torn down, the lines on my forehead disappear. Pupils dilate and there I was looking in the direction of the patient. My arms screamed, my heart churned, and I wanted so much to lunge forward to provide some comfort. But somehow I remained rooted to the ground, just like all the other passers-by, lacking the strength to bring myself to her.

I'm no different.

After a few attempts of appearing patient, Dr. R got his way. The old lady either sensed that by then, she was holding back the doctors for too long, or that she had run out of stories to tell. "Alright alright here I go again. Sorry for making you hang around for so long listening to me go on and on. I appreciate all you've done for me. I'm gonna just do my best and hope that I can be out of here real soon."

I hope you do, Madam. I don't know you now, didn't know you then, but now I know your story.

Bombings - Borough Market, London Bridge, Vauxhall

One moment it's here, and the next it's gone -- such is the fragility of life. It is an epitome of a living paradox in itself. How can something be so great that it forms the basis of nearly everything on Earth, whether good or bad -- scientific advancements, crimes, feeling happy, playing football, political tension, travelling to another planet, even death -- be lost in just a flash? Without this entity, all of the above would never have been made possible. As intangible as it is and at any point in time, one slip and everything fades away instantaneously. The moment -- nobody knows how it feels like, how it sounds like, unless they've ever been too close to the doors of Death. There are so many moments when people think they've nearly died, and then later take it as a joke to tell others. Climbing all the slippery slopes and hiking, I felt that when my feet gave way, I could have died. Maybe I would have died a thousand times on a single trip. Perhaps my time in the mortal world isn't up yet? There are so many moments when people think others deserve to die, and then later be put down by others to not curse. With that will and motive, it's still not that easy to harm with words, but when it happens, it seems all too easy.

My group of friends and I were on a day trip to Brighton on 3 June 2017. We were thankful that the weather's great, food's great, company's great, and we all had a fulfilling trip. In the morning, we had gotten our return tickets and were set to leave Brighton at 8pm to reach Blackfrairs Station. There were adorable Chinese and Korean kids on the train and that kept us laughing throughout the ride. As entertainment, we also had drunkards who'd ask for song dedications and sing all the way down the train. It all felt like a typical great day.

Upon arriving at Blackfriars Station platform, we were freezing since it was raining heavily and the winds were mad. They almost gave no mercy, howling and beckoning everyone to take short, powerful and hasty strides to generate enough heat to get us out of the tornado fast. It was the coldest night we've had in London. When we transferred to the Underground, a huge notice board at the front of the ticket concourse told us our nth bad news -- that the train service on the Northern Line was disrupted all the way to West Ham, and that there were alternative forms of transport available, namely by walking and bus. Cass whipped out our handyman Google Maps, which told us that we were just a while away from Southwark Station, from which we would continue our journey home towards Green Park Station via the Jubilee Line. So we braved the storm, obviously insufficiently prepared for the winds and with chattering teeth. The rest of the journey home was unremarkable.

When we finally reached at around 2245, we were dead beat. I went to shower and returned to the living room with my laptop and started to blast some music. Brandon looked up and asked, "D'you know that there's an incident that happened at London Bridge?"

I was... informed. "Oh I don't... lemme go check that out."

To my horror, news of the incident had already been spreading like wildfire that's impossible to contain. There were so many sources before me, and I wished someone could just summarise all that gibberish into a few simple words for me to understand. I typed in the keywords "London incident", "London Bridge", and right beneath the search bar the words "London Bridge incident" were in large font and bold. Accompanying the words are the date and a photograph on the right hand side. It looked vaguely familiar. My eyes wandered to the search results that were yielded, and it was the first ever time I saw timestamps that read "n minutes ago" and "live". Footages, videos, articles, social media posts were all over the place. Shit, it's happening now.

And it wasn't just London Bridge; there were nearly simultaneous attacks in three different locations. I felt so cornered, suffocated and helpless.

I couldn't even decide which news source to turn to. There were live updates from The Guardian, and I also had The Telegraph, BBC and Twitter tabs all on. By then, I was frantically switching between each tab and reading up on what happened.

Cass was totally freaked out. All she could do was gaze at the air, occasionally meeting my eye, and then later returning to her phone to resume reading about the horror incident. The cycle repeated. "Guys, weren't we around there just about half an hour ago?"

That struck me deep. Her voice echoed inside my head, bouncing off all the walls of my skull at the same time, creating a destructive cacophony. I suddenly so felt heavy-headed that I could no longer process new information. A sick feeling developed in my gut which left me so cold and nauseous. We were so close.

"Let me ask my friends what they know about this."

"Should we ask on the class telegram group if everybody's fine?"

"I wonder if our parents know of this."

"Why didn't MFA inform us about the incident?"

I texted my parents on our family whatsapp group about the incident and that I was safe. I sent a link from The Telegraph (which I thought had the best information) to Brandon, since he was already crafting a message to post on the class telegram group, and continued reading the news. There were so many of us in London on electives. Are they all fine? I asked Shauna if she was alright. I asked Russ to ask Prash if he was alright. I asked Colin on Instagram chat, only to find out that he's safe in Glasgow. I thought of the others, but I didn't know them enough. Disturbed and sick, I made space and downloaded the MFA app on my phone, then asked for everyone's details for registration (again). At the corner of my eye, I could see Cass turning off-colour. I told her to keep calm and go get a shower. She wasn't going to be able to sleep. Somehow the boys seemed less affected by this.

Guess I've always taken safety for granted; back at home, I could go out till late at night, take a casual stroll back home in the wee hours of the morning and still be alive and waking up in my comfortable bed. I had no idea why Dad was always harping on coming home early; what's there to fear? I was so sick of how unsafe London is. We've planned to not go out unnecessarily for the last week that we're in London. Nigel was scheduled to arrive the next morning and bring Cass away to Wembley, but with a new twist of events, Cass told Nigel to head to our apartment before deciding on anything new. We were going to take the bus instead of the tube whenever possible. It seems outrageous that so much planning had to be done, but in actual fact, no one knows when, where, why, how and what exactly would happen. Now that safety was compromised, I felt so feeble and vulnerable to everything and anything. Now that terrors were so close by, nowhere was home to me.

Cass and I stayed up because we were too anxious to fall asleep.

The next day was a Sunday. We took a bus down to Marble Arch and walked to our lunch place. The streets were unusually quiet, but people seemed at ease. Everyone was out and about doing their thing; cafes were filled with breakfast doers who sat out in the sun enjoying the summer's heat. The smiles on their faces erased away the remaining anxiety that spilled over from yesternight. After we took a turn at a corner, a bigger street came to view. Police vans were parked by the roadside, seemingly ever-ready to tackle anything that came their way. Later in our trip on the General Election Day itself, the same police vans were parked in the heart of Leicester Square. Shop owners of food stores brought an entire tray of buffalo wings to the policemen to thank them for their service. It was a pretty heartwarming sight.

It eased me to see the good in people even when disaster struck, but that doesn't change the fact that I won't return to London for a long time.

I made too many observations during my stint, most of which I can't recall by now. All in all, here are the important ones:
1) Many at times, understanding can be a huge problem in neurosurgery -- whether it's the patient understanding your instructions, or you as a clinician understanding the difficulty of not having a presence of mind.
2) Emotional -- the brain controls a being, everything from movement to speech to vision to breathing to emotions. It is so essential in life. When it screws up, life can fall apart easily.

Uncle's diagnosis, cousin. As much as the diagnosis is damning, I thought to myself: maybe it isn't that bad after all; he's lived a lot, seen a lot, has a great family. There's always something about a cancer diagnosis that's ever so unnerving. The thing is, nobody deserves to get cancer, regardless of age or whether or not they are inherently evil. Even in this day and age, it is still seen as a death sentence, the worst of all medical conditions with the most unimaginable (or imaginable) consequence.

Thoughts running through my head while writing this entire post:
1. Shit, I gotta get into the right mood for writing this
2. Shit, I forgot how intense I felt
3. Shit, I haven't written in such a long time that my writing skills are all over the place now

Right now, I can't even think of a proper closure to this. Wow, that took a few days man.