Unrequited love

I haven't been posting much on this blog, since I have the avenue of Facebook now. However this topic is one I cannot publish on any of the social media I am on. The reason why I will reveal later.

I met my best friend during the first year of medical school. She was (and still is) beautiful, kind and funny. Like every teenage male with raging hormones, I fell in love with her instantly. There was just one problem - she didn't love me and was already in a relationship. She could sense my feelings towards her and let me down gently (or as gently as you can when you are being friend-zoned). There was nothing that I can do but accept the situation. 

Her relationship with her boyfriend continued over the years. They got married, have successful careers as doctors and have kids. She continued to be my best friend (but not necessarily out friendship was the same the other way around - her best friend was definitely somebody else). She was there when I struggled with my depression and through medical school. She was there when I tried to commit suicide and was hospitalized. She was there when I broke down in my first few days as an intern. She joined me at concerts and comedy gigs. She is one of a few people I keep in touch with over the years. And not once did I say to her how I truly felt.

I thought she had a happy marriage. It was shocking to hear last year they had separated and were getting a divorce. Apparently what you post on social media is not evidently what is happening in real life. Her husband thought of her more of as commodity rather than her wife. He displayed her as a trophy: "Look at my wife, a successful doctor, academic and mother to my children." It is alright to boast about your wife but not if you are contributing as well. He didn't help in raising the kids, although he has an excuse that he is jetting around the world to medical conferences. What really got to her is how he didn't support her emotionally. When she felt sad, he only complained that she was ruining his day by feeling sad. When she was tired on holiday (because she had to sort out all the logistics regarding their children), all he could say is she was ruining his vacation. Basically he was acting like a rich, pretentious, entitled prick. That is not surprising given that he comes from a very rich background. 

At this point I should say I've only heard from my best friend's point of view. She admits that his work is important and that he's good at it. Her husband is a really nice guy who I don't have any animosity towards. He is better than me in so many ways - emotionally, physically, financially, academically and professionally. I don't want them to get divorced, for the sake of themselves and their children. I told my mother about their situation and she said that all men act like that, even her husband / my father. 

When she told me she was getting divorced, the news brought up my repressed feelings towards her. I started to fantasize what it would be like to actually date her. Immediately I had to remove those thoughts, since I know it would crush me inside. but like the old phrase it is easier said than done. Of course I haven't told her how I feel about her - that would ruin her and our friendship. I can't talk to anybody about this. She would normally be the go-to-person for this kind of thing. I can't talk about it on any of my social media, since either she or her husband are on them. This blog is my only outlet, even though there is a small risk they could find this out.

The ultimate truth is I don't love her. I am selfish - I don't want to ruin my cosy existence for the uncertain future of dating and taking care of her kids. I continue to wallow in my depression rather than get better and improve myself as a person, trying to impress her. I know I couldn't let her try to cope with me and my depression. If I was truly in love, I would make the effort and sacrifice to do all these things for her.. but I don't. I also think I don't do these things because I know there is a strong probability she won't love me back.

I've been getting back into TV drama recently, specifically the DC TV Universe. I wish I hadn't because I identify myself in some of the characters or the situations. Unrequited love, loving somebody you cannot have - basically every emotional string that the screenwriters pull to captivate their audience.

There is only one aspect that I truly love her - I want her happiness, even if it without me.

Dread and motivation

Dread and motivation have something in common - they look to the future, something I do do and don't do respectively.

Confused? Let me explain.

Every morning I am woken up by my mother. Even at 40 years old, I've still need somebody to wake me up and force me out of bed, like an unruly teenager who doesn't want to go to school. I dread the day ahead. I hate being stuck in traffic for an hour, I hate being consulted by patients, I hate eating my packed lunch nowadays and I hate being consulted by more patients. It's worse when I wake up and my depressed part of me keeps saying don't go to work, take a sick day or resign. Unfortunately that part of me has been increasing steadily. People say it is the anticipation of a dreaded event is worse than the dreaded event itself. Everybody has anxiety before taking examinations but the actual test itself maybe not so bad. For me that is not the case. "Why won't it be 13:00/17:00?" is what I'm constantly feeling. Yes I know everybody have these thoughts. So why am I different? I should buckle down and get on with it but... I don't know, 

On the flip side I don't look to the future regarding motivating myself. I know I should study medical topics but I don't. I know I should clean up my paperwork but I don't. Even the obsessive compulsive things I do, like back up my podcasts, tidy up my Lego parts or watch movies I haven't seen that are on my Netflix "My List", I don't have the motivation for. I keep repeat old episodes of QI / The Bugle. Or try to refine my designs on my Lego MOCs (My Own Creations) on the Lego designer program. 

I wish I had less dread and motivation in life, rather than vice versa.

Obsessive compulsiveness as my (poor) coping mechanism

To avoid my depression sliding further down, I tend to perform repetitive tasks. Essentially I have somewhat become obsessive compulsive. I have not reached  the extent that my condition has become an disorder, affecting by daily routine, but significant enough for myself to acknowledge the situation is not ideal.

My first method was to collect photos of cheerleaders and race queens. Originally the material was to form an offline library for the purposes of... well you can guess what I - a single straight male - was going to use the photos for. However as time went on, it become more of an obsessive compulsive task and did not form any of its primary purpose.

Considering how much material there was on the internet, the logical & sane part of me knew I wouldn't be able to collect all the photos and would spend too much time browsing the internet. So the non-depressed and depressed sections of psyche formed an agreement, to place some criteria so I wouldn't be submerged in my own patheticness:

• I would only collect studio photos, so no pictures of events or in-action shots. I wanted a plain background. As to why I wanted a plain background...
• Photos from the same team had to be of the same dimensions (e.g. all the individual photos of the cheerleaders from the Buffalo Bills would be 400 x 600 pixels, if the majority of the individual photos were of that size). As some photos were of different sizes, I would have to adjust the dimensions and alter the background - having a plain background made this task easier. Considering how much time the editing took, I did cut down the time by downloading a program which performed the task more quickly.
• The photos had to have a minimum width of 200 pixels and minimum height of 300 pixels - basically I wouldn't have to strain my eyesto see the photos. There weren't any maximum dimensions but I did reduce some larger photos just so I could fit all the photos on one CD/DVD. 
• For naming of the file, individual photos would be numbered, group photos would be lettered (e.g. Los Angeles Lakers a, Los Angeles Lakers b).
• To stop me constantly searching the internet every day or checking the homepage of each team, I had to form a spreadsheet with the date I last checked the webpage and when I should recheck the webpage. 

I know this "hobby" makes me very perverted and extremely creepy. The collection started with cheerleaders and race queens, but did spread to other areas. At some point I came to the realisation this wasting my time and I had to stop. Eventually I did put an end to the photo collection, after seven years. The material is still stored on some CDs/DVDs and my external hard drive. I have rarely look at the photos since. Some part of me doesn't want to delete the files, consider how much time and effort I spent collating this hoard.

After ending this obsessive compulsive behaviour, I knew I had to focus my coping mechanism to something which was at least constructive. Since 2013, my way of ignoring my depression and real life has been vacation research. I plan my holidays to the minutest detail. Every aspect of the trip is thoroughly researched, websites are constantly refreshed for the latest prices, Google is repeatedly used to find the best discounts and the itinerary is revised for the 22nd time. All this research goes into spreadsheets. I even have material for vacations I wanted to go on but were cancelled or ideas I have had. There is a big file regarding a massive US & Canada road trip and a gigantic European rail journey that I did in 2016, just when I converted to being a part-time doctor and was really thinking of taking a year off to travel.

The fascination with spreadsheets continues, with another Excel document detailing my travel expenses over the past 5 years. Everything transaction is tracked, categorised and analysed. The logical part of me convinces myself why I keep a detailed travel expenses spreadsheet is so I can better plan my vacations but deep down I know is my obsessive-compulsiveness.

My obsessive-compulsiveness does have some limits. For example, another collection I have are the radio programmes and podcasts I have collected over the past 10+ years. Some programmes I do listen to again and some I don't. There are podcasts which have introductions to other shows at the beginning and end, or advertisements in the middle of the programme. But I don't edit those out - I know that would significantly waste my time. However I like to keep things organised (another way to say you are obsessive compulsive) by making sure the file is named the correct way, with the appropriate metadata (episode title, artist, collection name, etc.) properly labelled.


I tend to watch my favourite TV shows and listen to my favourite podcasts / radio programmes far too often. Even though I listen to "Fighting Talk" and "No Such Thing As A Fish", I tend to repeatedly play "The Bugle" and "The News Quiz" podcasts. I really have to force myself to listen to the first mentioned podcasts, which I tend to do when I'm doing other tasks - driving, doing my shoulder rehabilitation. The same goes with "Mock The Week" and "QI" - these are on a loop on my computer where I should be trying to use my Netflix more often.

My latest project has been Hong Kong hotel buffets. I have made several spreadsheets (what a surprise!) documenting nearly all the hotel buffets that are available in Hong Kong and finding what discounts I can get. If I had more computer skills, I would have set up a website. At least this time the project has been applicable, using the data three times in eating out and saving money.

I really wish my obsessive compulsive behaviour could be turned into something productive for work. I really should be trying to make myself write notes in preparation in seeing patients in specialty clinics but still I try to find the latest discounts on brunch buffets...

Death is hardest to deal with when it hits close to your heart.

It seems death has been a predominant theme for 2016. I'll go into celebrity deaths and the rest in a later entry.

In the early hours of Sunday 24th April 2016, my friend Aaron died. His death affected me in more ways than one.

Aaron and I have never met face to face. We come to know each because we enjoy the same radio programme, "Fighting Talk" on BBC Radio 5 Live. We have been friends for about two years, finding out that we have much in common. We both reminisce about the 1980s, especially about TV shows. He was great to engage online, chatting on music and movies. He loved quizzes and he got me playing "QuizUp" on my smartphone. He had a similar sense of wicked humour to mine.

The similarities don't end there. We both suffer from depression. We both been through trying out different anti-depressants to see which would fit us the best. We both had our up and downs. We both expressed our depression to our online friends without being afraid of what people think, that we were not afraid to ask for help. We both conversed with each privately about our depression, supporting each other through the rough patches.

Ultimately it was his depression that killed him. Although the details have been sketchy, primarily because the news I have been hearing has been delivered by proxy. Aaron had been going through a bout of depression in March. I had noticed it and had been conversing with him during this period. There was some time he was not online, around three weeks. I didn't notice, maybe because I was dealing with my own troubles with depression and work, and had gone on holiday. Only in mid April did I hear the news from a common friend that Aaron had been admitted to ICU for alcoholic necrotising pancreatitis. Apparently he had tried to commit suicide by consuming a copious amount of alcohol. This didn't kill him but caused the pancreatitis I mentioned before plus multi-organ failure. Most of his online friends thought he was pulling through, being on the mend. In the end, it seemed the damage was too much.

This is the second friend who has died at a young age. My friend from secondary school, Theola, died of complications of IgA nephropathy (a kidney disease) in early December 2014. I had written an entry into blog at that time. For some reason, I didn't post it. Both died in their 30s - Theola at 32 years old, Aaron at 36 years old. Both had died from complications of their primary disease. Their deaths had come our of the blue. I was chatting to Theola on Facebook only two weeks prior to her death, planning to meet up and crash at her place. We were joking I had to share a bed with her two cats if I was going to stay overnight at her home. I'm going to miss conversations like those. With Aaron, he had already been ICU for a few weeks. He had been planned for surgery, with family and friends visiting him.

As a doctor, I always feel I could have done more. For Theola, she was diagnosed four months prior to her death. She traveled back to Hong Kong to see if an expert nephrologist could do anything to help her but to no avail. With Aaron, the guilt is more so. As a friend, I could always talk to him and give my support, even though I was thousands of kilometres away. As a fellow depressive patient, I know the struggles he was going through. As a doctor, the guilt is even worse. I should have noticed Aaron had disappeared off online. I should have recognised the signs, since he was putting up posts on his Facebook wall of being down in the dumps. Other friends have said we have done everything possible and he would still have killed himself. Apart from being attached to Aaron, 24 hours and 7 days a week, we couldn't have prevented this but the guilt is still there.

Don't get me wrong, it's a tragedy more for his family, his closer friends and everybody around him. For Theola's death, it was horrific for her parents, her younger brother (who was going to be married a month after her death) and her husband (they had been married for less than two years).

With Aaron, there is always something I identify in his situation and always thinking, "that could be me". In the past, it would have been - I've lost the number of times I have tried to commit suicide or the number of times I have been hospitalised for my depression. Nowadays I know there is an alternative. I can always quit my job. I could always go back to England or go to Australia. I could always go into research or switch to public health. I've got enough money in the bank to last a few years (as long as my mum doesn't kick me out of the house).

As we grow older it will be inevitable we have to be more accustomed to death. It's not easy to deal with - it never is - but with the support of family and friends, it will get easier.

The lack of drive

I touched upon the subject of my lack of drive in a previous post back in August 2015. I thought the situation would change but the lack of drive continues to persist. Even trying to sum up the will to write this post took several months. Only because I want to write about another subject that I have to write about the lack of drive so that the next post makes any sense.

I looked back at my previous post and found nothing has really changed. My reasons for the lack of drive is the same. I still haven't done what I am supposed to do for my higher training: my consultation videos, my notes for the practice assessment, my clinical audit. Even the fear of being left behind, having fellow doctor friends or doctors who are younger than me being resident specialists, associate consultants or consultants, doesn't motivate me into trying. Here I am, still pondering about emigrating to another country or planning my epic months-long holiday (I've added a cross country trip of Japan into the lexicon, either as a rail journey or a road trip). I've excluded my ambition to join MSF as I know my depression will get in the way. When I'm really unmotivated to do anything, I become very obsessive-compulsive about doing meaningless tasks, i.e. planning my epic North American / European / Japanese trips, despite them being at least 2.5 years away. I watch / listen to TV/radio programmes I have watched / listened to before, instead of engaging into new stuff.

I've tried to find other reasons why I'm not motivated. Is it the fear of the stress that will be entailed if I do my Exit Examination? I've seen other doctors go through the endeavour and the whole process frightens me. I fear of relapsing into a major depressive state, something I never want to happen again. There have been many senior colleagues who have said the Exit Examination isn't hard but they didn't rule out the process will be stressful. I have learned I cannot handle stress well (hence why I won't be apply for MSF). One recent event has made me quite sombre lately (which I will write about later).

So what am I doing to help my motivation. I've agreed to participate in a clinical trial, to see if repetitive transcranial magnetic stimulation will help. Basically it is using a device to produce magnetic waves so it will stimulate my brain into being happier and more motivated. I'm in week 3 of 4 into the treatment and I don't think anything has changed. I know with this method of treatment that the results may not be seen immediately.

However in the end I know most of the motivation has to come within. But how do I motivate myself to become motivated?

At a crossroad

Back in February, I was in a poor state psychologically. My depression was still in remission but I kept on having acute episodes of depression. I would feel low for a few days and then, in the morning, I would wake up and was depressed plus anxious about the day ahead and challenges that it would present. I would become more depressed plus anxious, having my arms ache, my chest tighten, having difficulty breathing and feeling that my heart was racing. That situation came to the point I was taking sick leave one day every month. I didn't want this to continue, as it was unfair for the colleagues who had to deputise in my absence  the community in general since they paid my wages.

Something had to change - I discussed my problem with my family and then my boss about what I was going through and brainstormed some options. I decided to go part-time, which I only started recently. With the time off, I hope to sort out the rest of my higher training in family medicine and decide what my options are regarding my future.

The main reason why I have gone part-time is that I don't like my job as a family medicine doctor in the Hospital Authority's general out patient clinic. There are a lot of problems, from patients, other doctors, the health care system and society itself. I will elaborate about these issues at a later date, most likely when I leave Hong Kong since I will be burning a lot of bridges when I do that.

That's another problem I have as well - I don't like living in  Hong Kong. Or rather I feel I don't fit in here. Whether it is still the language problem (I'm not very fluent in Cantonese) or the cultural integration is still being resisted by me, I still spend a lot of time at home and not want to go out. Appearance wise, I'm Chinese but culturally, I attach myself to Britain - I enjoy British cuisine (stop sniggering, there is actually good parts about it), I follow mainly British sports and I watch mainly British TV shows.

I have gotten a lot of grief and ridicule when I describe myself as English or a "banana" (yellow on the outside, pertaining to my Asian looks, while being White on the inside, as I think like a Westerner). Mainly this comes from my parents, who often say "Why do you want to be British? They hate Chinese people and they don't want you as a citizen!" and some of my colleagues, who find it funny I like things like British food and the way of life, such as shops not being open on a Sunday - a totally foreign concept to them.

So with this time off, I'm hoping to finish up my family medicine higher training, although I may not need it. If I was going to stay in Hong Kong, it would be probably best to complete the training and take the Exit examination but it is not absolutely necessary. It just means I get paid less than the people who have passed the exam and I'm already well paid in this job already - why do you think I have the luxury of going part time?

I'm trying to find out if I can go back to UK or head off to Australia to practise medicine. I know I can go to Australia, since I'm already a Fellow of the Royal Australian College of General Practitioners, which means it would be relatively easy to work there. For UK, I might need to take a language proficiency examination and a medical knowledge examination but I don't think that is too much of a hassle. My only worry is that I need to pass my Exit examination here in Hong Kong in order to be able to practise in the UK. If that is the case, I'll just head to Australia instead.

Another option is doing my dream job and heading off to volunteer for Medecins San Frontieres for a while. I know that entails needing a Diploma in Tropical Medicine - again, another excuse to get out of Hong Kong.

I know I'm not going to make a lot of people happy about my decision and remarks - parents, friends, colleagues - but this is my life, my opinion and if they do like me, they respect the choices I have made in my life.

A vicious cycle

It's happening again. Every so often, I have "episodes. The duration between these episodes vary, from every two months back in my final university years to several months in recent times. Most of the times these episodes are not very intense and after a night's sleep, I "reset" myself and it is like nothing has happened. However this episode has been very severe, so severe in fact that I had to take a day off last Friday.

What am I talking about? The vicious cycle of my depression. The symptoms during the episodes are the same. I dread the oncoming day when I wake up with all the problems that I will encounter. I have difficulty getting up in the morning and lay there in bed, willing myself to start the day. When I get to work, the situation is no better. Throughout the whole day I just want to get to the end, rushing through my consultations as quickly as possible and saying "Yes" to almost every request and every question from my patients. After my work day has ended, there is still job-related tasks I need to do and I try to hide away from the responsibility.

Those are just my behavioural symptoms. Then there are the psychiatric symptoms of pervasive low mood. I laugh at jokes and watch TV shows / listen to radio comedy programmes with amusement but my baseline is always sadness. I completely feel drained all the time and always use weekend afternoons to nap - not a good use of my free time.  What hampers me most is the poor motivation and abysmal concentration. I have difficulty initiating tasks and maintaining focus is a chore. Even with programmes I like, playing them only results in pausing them after a few minutes. All of these psychiatric symptoms are surrounded by the baseline feeling of hopeless about my future, something I'll go into detail much later.

During intense depressive episodes, I get the biological symptoms. There is the chest ache and difficulty breathing but the somatic complaint I most commonly feel is the muscle ache in my arms. When I have the aching sensation in my biceps, I know I have a severe form of depression hanging over me. My appetite is the same, which I'm grateful for. I had a similar depressive episode 10 years ago which made me binge eat and caused me to gain 10 kg in a few months, which I have never been able to shed since. On the flip side, I'm excessively sleeping with wanting to go to bed straight after I had my dinner and evening shower at 21:30. Nobody of adult age goes to bed at that hour.

So why has this come about? My mum reminded me why I have these severe depressive episodes, A piece of advice I have forgotten since my university days, attending my psychiatrist and clinical psychologist. I have a tipping point regarding my depression - go past this point and you have the sombre side of me. I get closer to the tipping point if I have stress. I can tolerate low levels of stress, yet the more stressful things happening to me at once, the closer to the tipping point I get.

Lately my tipping point has been breached. There is the underlying work dissatisfaction, the worry about my future, the resentment of myself for being single for the rest of my life, the annoyance of still living with my parents when I'm in my thirties and the list goes on. Recent events include not finishing my protocol for the audit I have to do in my clinic for my GP higher training, starting an online diploma course on dermatology (skin diseases for the uninitiated readers) and just coming back from an excellent weekend trip to Singapore watching the F1 Grand Prix. I really should stop going on holidays, or more exactly going fantastic holidays where I do something outrageous. When I come back from a vacation is always a downer. I know everybody suffers from this but for me, I don't think my brain can handle the situation well. I really should go on shitty holidays from now on, or not go on holiday at all.

Thankfully for the past few days, my mood has improved. I still feel grumpy when I go back to work but at least I can do my job (just).

I hate going through these episodes. I always wish this is the last episode but I always know that it will always lurk around the corner.