On the present.

One look and I knew his eyes were not normal. His head was tilted, he walked with an ambling gait and his eyes were... different. Little did I realise what his condition would teach me.

Decisions, decisions.

A final year medical student is faced with them. Last week, faced with many things about the future, I was heavy-hearted one night. So what do I do, where do I go? What if this happens and I become like this, and what if that happens and I forget about mission work?

Fear comes in in the face of uncertainty.

Have you ever been faced with a situation where you had to make a decision too? And were you afraid of making the wrong choice? Perhaps, the scary part is not in the decision making itself, but in realising how this decision at hand may affect the path you take for the rest of your life. It could be choosing your course of study, applying for a job or choosing to make a decision like marriage or having kids. There's no turning back sometimes.

When the patient walked into the clinic, the phone rang. As my mentor attended to the call, I took the opportunity to speak with the patient, whose eyes were deviated on both sides with a divergent gaze and flickering persistently with nystagmus.

"I heard you asking the patient if his vision was better when he looked in the distance or at near objects. He said it was better on close-up right? And why so? This is because when his eyes look at something nearer to him, they converge. Hence, his vision improves."

That was a revelatory moment for me.


His vision improves on close-up. It reminded me of what a friend told me when I shared with her how frustrating and scary it was to think about the future, with regards to specialising and medical missions. To which she said, "Don't look so far ahead, Wai Jia. It'll just make you confused and frustrated. Just focus on the present, and trust that God will lead you step by step when the time comes."

Focus on what's close at hand, because looking too far ahead sometimes simply blurs one's vision. As we go step by step closer to our destination, things become clearer in time.

"And why do I say that this patient has had this condition of nystagmus (flickering eyes) since birth? This is because he's walking about absolutely fine with that nystagmus. He has adapted to it. If he had acquired this condition at a later point in his life, it would have caused him immense discomfort and distress. He wouldn't even be able to balance."

It made me think. Many of us are unable to tolerate uncertainty. Most of us prefer having a goal to work towards over having too many choices. Even as a child, I remember having an ambition at every point in my life, even if it was an unrealistic one- a painter, a teacher, a writer, a veterinarian, a National Geographic journalist, being Oprah (ha), a nun, a social worker... At every point, I needed my eyes to be fixed on something. And whatever ambition I had at that point largely influenced what I did with my free time- hence my makeshift aquarium of self-caught tadpoles and frogs and stacks of National Geographic magazines at one point.

I thought to myself, it's no wonder this period of uncertainty has been discomforting- this vocational nystagmus, like acquired nystagmus, has certainly thrown me off-balance, indeed. On the other hand, people with congenital nystagmus (from birth) or who've never really had an ambition before, learn to adapt and go with the flow easily.

I am learning, that to rid myself of this perpertual giddiness, I must learn to control my eyes and focus on what's at hand, what I can do, and trust that God will reveal just enough each time for me to make the decision at hand, instead of feeling distressed that my vision blurs on looking far ahead. My vision will then become clearer as I learn to focus on the present, trusting that His vision for my life will guide me to where He wants me to be eventually.

"After all, how can you want the best for yourself and for the needy more than God does? He'll put you where you'll best be. Don't look too far ahead."

"This is because when his eyes look at something nearer to him,

they converge.

Hence, his vision improves."

- Dr Z.

"Trust in the LORD with all your heart

and lean not on your own understanding;

In all your ways acknowledge him,

and he will make your paths straight."

- Proverbs 3:5-6

Nystagmus.

They never stopped moving. They were dancing, jerking quickly back and forth like hyperactive elves on steroids. It was disturbing to watch them swinging to and fro like a pendulum on fast-forward. I watched them, I watched to whom these eyes belonged to and was filled with compassion, suddenly.

It is called Nystagmus. Congenital nystagmus refers to these involuntary jerking eye movements present from birth, often due to blindness.

Adil (*named changed to protect identity) was a patient I saw at my professor’s neurology clinic today. She had come in because of seizures, which had become more frequent because of her poor diabetic control. Though she laughed and joked with my professor, I could tell that her highly strung voice and pressured speech were filled with curiosity and a certain desperation. “Doctor doctor,” she said, “I want to ask you ah. My friend said… about my diabetes... Is it true?”

“And also ah, I want to ask you this, and this also…”

The consult was over, but she would not move. Her eyes jumped back and forth, as if desperately hunting for answers. My professor answered her every query patiently. I watched her pressing in for the answers to her endless questions, as if they were a way to fill the gap which her blindness had dug. She sat at the edge of her seat, relentlessly asking questions with her shrill, childish voice. I thought she was seventeen. I later learnt she was more than thirty.

There were many patients waiting outside, and my professor was keen to politely end the session. But as soon as she got up from her chair, she reached out her hand for mine and said, “Thank you. You're my doctor's student, right?”

The black beads in her eyes bounced back and forth like bullets.

I could not resist but ask, “Were you blind from birth, dear? How did it happen?”

“Oh,” she said, “I was born blind.”

Her elderly mother who had accompanied her answered, “She was a preterm baby, born at 7 months. The doctors said she became blind because of oxygen toxicity. It was either her brain or her eyes- they needed to get the high levels of oxygen to her brain to save her at the expense of her eyes.”

Adil interrupted her mother, explaining, “You know… I told myself, my brain is more important than my eyes, so even now, I still continue to be strong. I read Braille, I go out with friends, I help my mother with the housework…” All this time, her head hung low and her eyes continued to dart aimlessly, as if groping, searching for something.

She continued, “Do you know how I ended up in this hospital? My friend told me the eye doctors here are really good. Many years ago when I heard that, I thought there may be a chance I could see! To see!! Wow, I thought to myself, finally I could see… my mother’s face, flowers, the sky, colours… the colour RED! Wow. But then the doctor told me they could not help me, that’s when I broke down and cried… but now... now I think my brain is more important than my eyes.”

I held her hand. “Thank you for sharing.”

Later on, I asked a friend, “Why is that people born blind have such glaring nystagmus?”

“Oh, it’s because they can’t fixate their eyes, dear.”

People who are blind from birth have congenital nystagmus because their eyes are unable to see, and hence unable to fixate. Their eyes dart about aimlessly, because they cannot focus.

The blind can’t fixate their eyes.


Am I blind, too?

Of late, my eyes have been so unfocused. With the new medical programme and demands to decide on our area of specialty SOON, NOW, RIGHT NOW, my eyes have been roving, scanning the horizons for a glimpse of a glorious meadow. To and fro, back and forth they scan, but find nothing. God, what do you want me to do? Why is it nothing seems to fit? I wish I could tell you I knew what to do, that I found something I loved and knew I could do for the rest of my life. But it is not so. What I love I do not think I could do forever, and what I think I could do forever I do not love with that giddy exuberance. It is like forcing me to marry now. It’s not fair, and I’m not ready to make a decision of such gravity. My eyes are tired from searching, and I want to fall asleep. My lids are heavy. The System is making me decide, and I am afraid. Is it Ophthalmology, is it General Surgery, is it Obstetrics or is it Internal Medicine? Is it none of the above, is it Public Heath?

In general, nystagmus improves when the patient tries to fixate or look directly at an object, worsens when the patient is sick or fatigued and may even stop in certain directions of gaze, or when looking at objects closely, with convergence.

I wondered, would my own emotional and spiritual nystagmus improve when I started to fix my eyes on God, too? Would they finally be aligned and would my vision be clear once I stopped roving and started to look in the right direction, started to fixate upwards?

So perhaps, it is not that I have been myopic that I have failed to see. But maybe, simply impatient and looking in the wrong directions. My eyes are scanning the horizon anxiously, without the ability to fixate.

And so I pray, that my eyes may be drawn back to the One who really matters. Because it is only when I look up and fixate my eyes on what’s truly important that perhaps, my sight and 6/6 vision will be restored again.

Photo by Xi.

"Let us fix our eyes on Jesus,

the author and perfecter of our faith,

who for the joy set before him endured the cross,

scorning its shame, and sat down at the right hand of the throne of God.

Consider him who endured such opposition from sinful men,

so that you will not grow weary and lose heart."

- Hebrews 12:2

Finding My Half.

It's not everyday one reads an article in the newspaper that leaves one changed, never the same.

There was an article in The Sunday Times last week written by Nicholas D. Kristof from The New York Times: Kevin Salwen, a writer and entrepreneur in Atlanta, was driving his 14-year old daughter, Hannah, back from a sleepover in 2006. While waiting at a traffic light, they saw a black Mercedes coupe on one side and a homeless man begging for food on the other.

"Dad, if that man had a less nice car, that man there could have a meal," Hannah protested. The light changed and they moved on, but Hannah was too young to be reasonable. She pestered her parents about inequity, insisting that she wanted to do something.

"What do you want to do?" her mum responded. "Sell our house?"

And sell the house they did. Selling their luxurious family home, they donated half the proceeds to charity and used the other half to buy a more modest replacement home. The crazy, impetuous and inspiring project is chronicled in a book due to be published, entitled The Power of Half.

The family eventually pledged US$800'000 to sponsor health, microfinancing, food and other programmes for about 40 villages in Ghana. Hannah, a high-school junior hoping to become a nurse, says, " Everyone has too much of something, whether it's time, talent or treasure. Everyone does have their own half, you just have to find it."

The article brought me many months back when God made it very plain and clear that I'd to give Alisha the money meant for the new roadbike I had been praying and yearning for. It helped me to see how our wants can cost someone else their need; It taught me, that loving God and people requires sacrifice at times; More importantly, the article challenged me to consider, that our characters may be judged not only by what we give away, but also, by what we have and keep.

My new bike, called Faith, is finally coming. The adaptor finally came. And though we're still waiting for the wheels to be shipped in, my dear friend has decided to lend me hers in the meantime so Faith can be ready by my birthday next week. Over Chinese New Year, we have been buying many things, shopping around for affordable parts to build Faith from scratch. If it had not been for the fact that my friends bought the bike frame for me, and my parents were so touched by their gesture that they insisted on paying for the rest of it instead of allowing my friends to donate their bike parts to me, I think it would have been utter agony trying to buy a bicycle for myself.

These wheels could buy an orphanage a television set. The groupset/gears could sponsor five African children's education for a year. The installation cost could buy 30 kids a meal they would never forget. Reality is stark, even in our society of instant gratification.

I have been lucky. Blessed beyond words. Some days I wake up knowing I deserve none of it, and that the day will come where I start working and can no longer rest in the luxury of daddy's pampering. There will come a day where nothing but conscience and the steel of will would stand in the way of myself and an extra pedicure, a more expensive piece of clothing, a better bike. There will come a day I can no longer rest in blissful ignorance, and will have to make choices against my natural will. And that would be the true test of character.

Would I have the heart to find my half to give away?

I am glad God worked things out, bringing me back to Ophthalmology in a roundabout way. I know, if it had not been so, I would forever despise myself and doubt my sincerity for the subject. Now, I finally see my genuine love for it, though the glamour factor, the comfort and the prestige of the specialty will forever remain a potential snare, and an evil temptation. Even the doctors themselves admit this specialty is a particularly worldly one.

Someday, I would make my own money. Chances are, if I do surgery which I love, I may even have more than I require. But perhaps, it is not how much I make, but how much I give away that determines my standing with God. Perhaps, it is not even how much I give away, but what I keep for myself that does so.

And it humbles me to know that God is teaching me about these things, even now, so I understand the meaning of prudence, self-control and gratitude. I have been challenged of late to look at not only what I give away, but what I buy, consume and own.

It has been, to say the least, sobering.

Do I really need a tri-suit to take part in a triathlon. Do I really need those more expensive wheels to match the rest of my bike. Do I really need to spend money going overseas to study, or is there a genuine purpose behind it?

I have just been thinking.

So that someday, when God calls me to sell my house or give to the poor, or take in children, and give my bike away, it would be a little bit easier, and less difficult, maybe, to find my half to give away.

What is your half?

"Do not be afraid when one becomes rich,

When the glory of his house is increased;

For when he dies he shall carry nothing away..."

-Psalm 49:16-17

"Men of high degree are a lie;

If they are weighed on the scales,

They are altogether lighter than vapor...

If riches increase,

Do not set your heart on them."

- Psalm 61: 9-10