Eric Tian

One of the greatest ironies is that to be happy, you need to experience sadness.

If you are always happy, you are not happy. That is your normal state. Happiness ranges from contentment to immense joy, and these only exist if a discontent and immensely sad side of the spectrum exists as well.

Over the last few weeks, I’ve been hit with waves of sadness. Patients passing away. World issues. Getting silly questions wrong in an exam. They all suck in the moment. Some days I seriously considered disappearing just to get rid of it all. You could call it a season of sadness.

But there is always a light at the end of the tunnel. When you crawl through the battlefield, scathed but alive, a different person emerges. You have metamorphosed into a more complex, appreciative and tender creature.

Change is always difficult and often follows sadness. But these low moments are what make the high moments ones shine, like how the bliss of sleep feels warmer after a long, hard day.

As a cyclist, I hate traffic lights. More specifically, I hate the moment when the light goes from green to orange. In this moment, there’s this grey zone where it’s not clear whether you should speed up to make the light, or slow down to a stop. This uncertainty is one of my biggest dreads, and hesitating in this moment has led me nearly getting run over multiple times, or braking to an abrupt stop.

One day, I was riding my bike and realised that for most of the times I was slowing down for a red light, I could’ve easily made it if I sped up. From that moment, I told myself I would try to make the orange light every time if I was reasonably close enough. This meant I would accelerate towards green lights as much as possible, and once past a certain “point of no return”, I just maintained a high speed until I got through.

The most interesting thing about this experiment was the shift in mentality in other areas of life. There are many “orange lights” in our day-to-day experience. These are moments where you have made progress in an area, like applying for a job, finding a romantic partner or finishing a project, but there is a final hurdle waiting to be overcome. And the annoying thing is, the hurdle is time-sensitive.

If you wait too long to send a job application, the recruitment period will be over. If you wait too long to ask your love interest out, the other person may have lost interest in you. If you procrastinate on a project, you face a criticism from your boss or your own self-talk.

You have a choice in these moments. Speed up and chase for the green light, not letting the opportunity pass, or slow down in the face of a potential rejection. Make it or wait. What I’ve found is that meeting an orange light and accelerating through it through the finish line is the best feeling ever. You feel an amazing breeze against your face, and the world around you stops as cars wait for their turn to go. In that moment, you feel like the world is watching you.

And braking last minute at the red traffic light, knowing you could’ve made it if you put in just a little more effort, is terribly heartbreaking.

My favourite piece in chess is the pawn. Why, you might ask, a pawn, when there are far more powerful, interesting pieces like the almighty queen, the elusive knight or the game-deciding king? The reason is because of the pawn’s potential. A pawn, upon reaching the back rank, can become any other piece in the game. It can start off the game as a most ordinary henchman, but 40 moves later, turn the tables as a game-winning queen. To me, that is beautiful.

My favourite moments in life are the ones that force change. Most of my life decisions are driven by a search for sights, conversations and ideas that make me go, “wait a second, let me reconsider that”. My hobby of reading gives me insights to new ideas, my career in medicine gives allows me unexpected conversations, and my practice of journalling allows me to reflect on these for change.

The frustrating thing is that change is difficult. We hope it will be as simple as taking the pawn off the board and replacing it with a queen, but it rarely is. Change often requires two processes: recognising a flaw in ourselves and initiating its necessary death. Both are immensely difficult to do.

For similar reasons as the pawn, the caterpillar is one of my favourite animals. Its transformation into a butterfly is extraordinarily beautiful, and unique in the animal kingdom. But the process of change in a caterpillar is far from easy. From The New York Times:

“It turns out that the inside of a cocoon is — at least by outside-of-a-cocoon standards — pretty bleak. Terrible things happen in there: a campaign of grisly desolation that would put most horror movies to shame. What a caterpillar is doing, in its self–imposed quarantine, is basically digesting itself. It is using enzymes to reduce its body to goo, turning itself into a soup of ex-caterpillar — a nearly formless sludge oozing around a couple of leftover essential organs (tracheal tubes, gut).

Only after this near-total self-annihilation can the new growth begin. Inside that gruesome mush are special clusters of cells called “imaginal discs,” which sounds like something from a Disney movie but which I have been assured is actual biology. Imaginal discs are basically the seeds of crucial butterfly structures: eyes, wings, genitalia and so on. These parts gorge themselves on the protein of the deconstructed caterpillar, growing exponentially, taking form, becoming real. That’s how you get a butterfly: out of the horrid meltdown of a modest caterpillar.”

Did you catch that last line? The origins of the beautiful butterfly are from the meltdown of a modest caterpillar.

I often wonder what goes through a caterpillar’s mind as it begins releasing enzymes to digest itself. Is it terrified at the pain it will endure? Does it consider dropping out halfway through its metamorphosis? Does it ever ask itself, “Who ever said I needed to be a butterfly? I’m damn happy being a caterpillar and will stay this way.”

But of course, we know that becoming a butterfly is the natural progression of a caterpillar’s life. A caterpillar deciding to not metamorphose is like a child deciding to not become an adult. Even though the change is difficult, causing a destruction of itself in the process, it must happen.

Change is difficult, but simultaneously necessary. It requires a painful dissolution of the old, and a slow rebuilding of the new. Yet like a pawn becoming a queen or a caterpillar metamorphosing into a butterfly, the result is beautiful. And because of the effort required for change, its beauty is exponentially greater.

For most my life, I assumed the worst in people.

I assumed people were dangerous, untrustworthy, naive, stupid, uninteresting and pathologically selfish. It was up to them to prove to me that they weren’t these things, and then we could start being friends.

These questions made me terrified of interacting with strangers. I make no eye contact when walking in public, interacted solely with my friendship group and rarely revealed my secrets to anyone.

But recently, as part of a social experiment, I’ve decided to take the opposite approach: to assume the best in people. That means to assume people are trustworthy, intelligent, kind-hearted, immensely talented, can keep secrets and have a strong moral compass. With this baseline, everybody is a friend by default. If they later prove to me that they shouldn’t be a friend, I gently let them go.

This experiment has gone on for about one year now. Having to drastically re-engineer my worldview has been exhausting at times, but overall it has been a wonderful gift.

What I’ve come to realise is people tend to become the person you perceive them to be. If you don’t trust anybody and keep to yourself, people owe you nothing and have less reason to back you. But if you give people the responsibility of your trust, they generally live up to it and prove themselves to be trustworthy.

If you think people are dumb, you will never ask anyone interesting or difficult questions so they will never have a chance to prove their intellect. But if you believe people are smart and give them a chance to speak, even the most unreflective minds might surprise you. The way you see people is the way you treat them, and the way you treat them is what they become.

I wish I could go back and tell little Eric to chill out a little more. I would urge him to see the world as a good place, rather than an evil one, because this would make the world a better place. Being cautious has its context, but to constantly walk in fear and suspicion seems like a sad road to embark on.

I’m fascinated by kids.

Whenever I look at one, I think about all the possibilities life has in store for them. Will they be an athlete or a scholar? A lover or a hermit? An optimist or a pessimist? The infinite paths that they can take, and the different people they can become, is exhilarating.

But in a way, we adults aren’t too different. Even if we’ve graduated, started full time work and even started a family, there is always opportunity for change. Even if our life is at the end of 30 years’ of roads, there may be decades more in front of us.

Choose your paths wisely.

In providing a service, the art of delivery is just as important as the actual service itself. If Amazon shipped all its products in a cheap crumpled up box, its stocks would plummet, regardless of how good the product was. You want the whole buying process – from browsing the website, the shipping and the delivery – to be as high quality as possible. This is where Amazon beats other companies, with its lightning fast delivery times, comprehensive catalogue, and strong customer support, making Jeff Bezos the richest man in the world.

This applies to other domains. Over the last few weeks, I’ve noticed that the best doctors aren’t the smartest ones, the kindest ones, nor the most empathetic ones. They are the ones that make the patient feel like that doctor is the smartest one, the nicest one and the most empathetic one. And when a patient feels this way, they’re more likely to listen closely, take their medications and get better.

You can be smart, but fail to articulate your words clearly, thereby making you seem dumb. You can be kind, but say something the wrong way, thereby making you seem rude. You can be the most empathetic person in the world, taking on all the burden and guilt of the speaker, but forget to acknowledge them, thereby making you appear seem cold. And this matters a great deal, because as Maya Angelou put it,

“People will forget what you said, people will forget what you did, but people will never forget how you made them feel.”

In the world of business, this is where marketing comes in. Does your brand appear trustworthy? Legitimate? Able to succeed? Billions of dollars are thrown into making people say “yes” to these questions because a good company image drives consumer spending.

The importance is not lost in human interactions. Your tone, eye contact, body language and clarity of speech can make the difference between being a hopeless or talented doctor; a trustworthy or unreliable colleague; a wonderful or bad friend. If someone’s perceptions of you matter at all, then your delivery matters a great deal, for this drives how you make them feel.

And how you make someone feel, I would argue, drives everything else.

A common thread in the best decisions I’ve ever made: nobody knew about them.

Ten years ago, I woke up and thought, “I want to record down today’s events.” That day, I found an old notebook and began writing my first journal entry.

Four years ago, I woke up and thought, “I want to run a half marathon.” That day, I looked up a running schedule, found a running club, and attended training the next day.

Three years ago, I woke up and thought, “I want to start a blog.” That day, I looked up some guides on how to blog and the following day, it was live.

Last week, I woke up and thought, “my friend Tom makes these really cool Instagram quizzes. I want to do that too.” That day, whilst on the toilet, I put up a quiz.

A lot of nothing gets done when we ask for permission. If I asked my parents for a proper journal, my journal practice would’ve been delayed. If I asked my friends if they wanted to run a half marathon, there would’ve been a lot more hesitation. If I asked my family if I should start a blog, they might’ve talked me out of it. If I asked my colleagues if they would do my Instagram quizzes, they might’ve looked at me funnily.

There are an infinite number of reasons why you shouldn’t do something. Not enough time. Not important enough. Not good enough.

But what if none of that mattered? What if you just woke up and did something, not because people asked you to or because you were good, but just because you felt like it, like it would tickle that part of your soul? That would change everything.

Your time is yours to spend.

Make it count.

For the last two weeks, I’ve been conducting a social experiment on myself. It involves saying hi to people.

Basically, the rule is: If you make eye contact with somebody that isn’t preoccupied, go up and say hi.

Sounds easy enough, right? But let me tell you: as an introvert, this challenge was tough.

In the hospital, it takes two minutes to scan open the doors, drop off your bag in your locker and leave. But in that span of time, you often bump into at least three or four colleagues and staff, and it’s almost impossible to brush past them without them noticing you.

The first day, I saw a colleague in the locker room who I’d noticed before but had never spoken to. He looked up as I walked in, and quickly glanced away. From what I’d observed, he was soft spoken and kept to himself, but always attended morning ward rounds. He was taking out his stethoscope when I approached him.

“Hey.”

He looked up, surprised, when I spoke. I suspected he wasn’t used to people greeting him in the locker rooms.

“Oh, hi.”

“Morning ward rounds?”

“Yep.”

After a brief pause, I asked about his ward experience so far. Slowly, the awkwardness subsided. He revealed how he has to wake up at 5am to get to hospital but likes to see the sunrise so it doesn’t bother him, and I said I envied him being able to wake up so easily.

“When I wake up before 8am, I have to play Wordle to stimulate my brain, or I just fall back asleep,” I said. He laughed.

When we said bye, it seemed like I had made a friend. Our conversation wasn’t awkward at all, and despite only lasting a minute or so, I felt we were on good enough terms to talk more in the future.

Not all interactions were so easy. There were moments when I made eye contact with someone, but they looked away, preoccupied. There were moments when I said hi, and they said hi back, but we were both walking in different directions, or with other people, so it wasn’t clear if we needed to start a conversation. Then there were the moments when I said hi, but whether due to fatigue, not hearing or simply not in a talking mood, they ignored the greeting. Those hurt the most.

But these were the minority of cases. Most interactions were surprisingly easy. It almost felt like they were waiting for me to say hi, and when I did, they seemed to open up naturally. That surprised me a lot.

Overall, after meeting a few dozen new people, there are three lessons I’ve taken away from this social experiment.

1. Superficial conversations are often a prerequisite for genuine connection.

For the first few days, a lot of time was spent discussing the weather, how study was going, or any interesting patients that were seen on the wards. Pretty generic stuff.

But I’ve since learnt that these initial interactions are all part of proving that one can trust another. By talking about a safe and common topic, one can gauge whether to trust another with more important, personal information like values, family or politics. In every conversation, one assesses, “Do I feel like I’m being listened to? Do I feel safe sharing my opinion? Do I feel like I’m being judged?”

The first few conversations are a test to see whether you deserve to hear more personal and controversial topics later on. The real connection begins once you’ve earned this right.

2. “What do you mean?”

This phrase works wonders if you feel a conversation dying, or you want to probe the speaker a little more.

It shows you’re interested enough in what they’re saying, and listening close enough to notice any inconsistencies or gaps. People generally love to elaborate.

It also acts as a get-out-of-jail card if you had a lapse of concentration while they were speaking, though people never interpret it this way.

Another substitute for this is, “tell me more,” but this feels a little too confronting for my personal taste.

3. People are usually waiting for you to say hi.

If you ever wonder why nobody says hi to you, chances are everyone else feels the same way. For nearly all the conversations I started, a common thread was, “Oh hey, I’ve seen you around too, but never said anything.”

When we finally did start talking, they seemed pleased, almost relieved that the tension had been broken. Most people, I’ve found, are pretty happy to talk. They’re just too tired, scared, or shy to make the first move. Once an introduction has been established, turning strangers into acquaintances is surprisingly easy. The first greeting is often the hardest one.

If there’s one thing I would say to my younger self after this experience, it would be that people are far less scary than you think. Introduce yourself readily and you’ll come across extraordinary people. Once formal impressions and masks are stripped away, there’s a lot of beauty in the world.

The first move is yours to make.

Names and details have been changed for confidentiality.

“You’re free this morning right? Good. I’m in theatre – go and take histories from these patients.”

As my general surgery HMO rapidly lists off names, bed numbers and conditions, I fumble with my pen to write it all down. Bed 204, day 3 post-whipple. Bed 205, day 6 post-cholecystectomy. Bed 209, two years of esophageal cancer with a tracheobronchial fistula, having a stent inserted tomorrow.

At this point, I’ve lost track of what she’s saying and for the last two patients, I only manage to write down their bed number. It’ll be fine though, I tell myself. I’ll just talk to one or two and call it a day.

“I’ll be done around 1pm. Let’s grab lunch together then and you can present those cases to me.”

Damn. No escape.

“Thanks Dr. Wu. See you then.” Beep.

As I walk into the hospital, I look down at the five bed numbers on my notes and realise I am terrified. I have no idea what half of these procedures mean, and am not in a talking mood at all. But because I have only three hours to talk to everyone, I walk past reception and press the lift.

I find room 201 quickly, then 202 and 203 next to it. Tiptoeing next to 204, I peek through the crack. It’s an elderly man with glasses reading a novel on his bed. I can’t quite make out the title, but it looks like one of those crime or drama books hospitals love to sell. He looks happy reading his book, I think. Maybe I should tell Dr. Wu he was busy.

But then, a realisation hits. What am I so scared of? This interaction is only mine to gain, with nothing to lose. I could learn so much from his story, having not studied gastrointestinal conditions for nearly a year. Feeling encouraged, I walk through the door.

“Knock knock,” I say. He puts down his book and looks at me curiously. I squint my eyes so it looks like I’m smiling through my mask. “I’m Eric, the medical student here… could I have a chat with you on why you’ve come into hospital?”

Without the slightest hesitation, he puts his book down, smiles at me and says, “grab a seat.” I breathe a sigh of relief and begin transcribing his story.

And what a story! As well as explaining his complex medical history, he spoke about his experience starting a family business, his fascination with crime books and his multiple injuries playing football. He revealed his emotions upon first hearing his diagnosis and I felt myself welling up inside. He told all this with dignity and humour, always looking me in the eye. When the dietitician shooed me away to speak to him, I didn’t want to go.

The other patients were similar. Standing outside their room, I felt palpable fear. What if they didn’t like me? What if I didn’t like them? What if, what if, what if…

But looking back, these interactions were special. There is something extraordinary about uncovering somebody’s life, seeing the world through their perspective, and simultaneously sharing the same space as them. If I decided to cower away at the door, too tired or scared to enter, I would have missed out on these moments.

This day reminded me of two things:

• Courage is not the absence of fear, but acting in spite of fear
• The best things often lie on the other side of fear

May we all lean into our fears.

Not all cholesterol is bad. Generally speaking, you can think of low-density lipoprotein (LDL) as being unhealthy, but high-density lipoprotein (HDL) is actually great. To make a sweeping statement condemning cholesterol ignores this essential nuance.

Like cholesterol, there are multiple forms that “bad terms” can take.

Take crazy, for example. Those who greatly changed the world were usually thought of as crazy for their time. Not necessarily a bad thing.

Take lost, for example. Those who don’t have a destination can land in incredible places. They are not restricted by neat, calved out paths. Not a disadvantage at all.

Take poor, for example. Those who lack resources find other means to reach the same end as others, usually leading to rapid growth in the process. This can be a wonderful strength.

The name of the term is the same. The interpretation is up to you.