Eric Tian

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.

Bit tired. Lazy dump.

“We all fear death and question our place in the universe. The artist’s job is not to succumb to despair, but to find an antidote for the emptiness of existence.” – Woody Allen, Midnight in Paris

“I believe that love that is true and real, creates a respite from death. All cowardice comes from not loving or not loving well, which is the same thing.” – Woody Allen, Midnight in Paris

“Pain and suffering are always inevitable for a large intelligence and a deep heart. The really great men must, I think, have great sadness on Earth.” – Fyodor Dostoyevsky, Crime and Punishment

“Love is not simply giving; it is judicious giving and judicious withholding as well. It is judicious praising and judicious criticizing. It is judicious arguing, struggling, confronting, urging, pushing and pulling in addition to comforting. It is leadership. The word ‘judicious’ means requiring judgment, and judgment requires more than instinct; it requires thoughtful and often painful decision-making.” – M. Scott Peck, The Road Less Travelled

“If prostitutes attract us so little, it is not because they are ugly or stupider than other women, it is because they are ready and waiting; because they already offer us precisely what we seek to attain… The secret to a long-lasting relationship is infidelity. Not the act itself, but the threat of it. For Proust, an injection of jealousy is the only thing capable of rescuing a relationship ruined by habit.” – Alain de Botton, How Proust Can Change Your Life

Occasionally, I like to open my old journals and read what I was thinking in an earlier time. It’s always amazing to see the stuff I used to worry about.

In year 8, I wrote how terrified I was when I was late to maths class. It was one of the first classes of the year and looking through the window outside, I saw the teacher had already begun teaching. I was too embarrassed to walk in and face the ridicule of everybody so I waited outside, trying to find an opening to sneak in when the teacher wasn’t looking. I think I would’ve spent the whole class outside if another teacher didn’t walk past and ask me what I was doing. Embarrassed, I walked in. The math teacher didn’t even look up.

In year 11, I wrote how frustrated I was that I wasn’t improving in a video game. “How did I lose 10 games in a row today? Either I’m the worst player ever, or I have terrible luck,” I wrote. That was it for that day’s entry.

In second year university, I wrote how neurotic I was about my grades. “I have ten lectures I need to watch by tomorrow”, I wrote at 11pm one night. “Time to get cracking.” The assessment was worth 15%.

Reading these entries made me smile. From my current perspective, these worries were hilariously unnecessary. Even though it felt dreadful in the moment, I wouldn’t feel much less stressed at these situations now.

One of the greatest benefits of journalling is the ability to find patterns in behaviour. And one resounding message that transpires from my records is that everything will be okay.

It will be okay!

You are breathing, you are safe, you are healthy. This problem you’re worrying about will probably be the same one you laugh about in a year’s time.

So let your neuroticism chill a bit. It will be fine.

This week three patients died on the hematology ward.

I had met them all before, though in varying degrees. Two I had only met on the morning ward rounds, perhaps a few seconds of eye contact here and there. I had chatted to the third for 30 minutes last week, trying to take a history, but mostly talking about his life. He was still able to smile and talk fondly about his family. Weak, but still breathing. Still alive.

It feels strange to walk on the ward now, new patients sleeping where they once laid. Because I wasn’t there to see their body pronounced dead and wheeled off somewhere else, it’s like they only exist in my memory and the hospital’s electronic records. Friday afternoon, they were there. Monday morning, they were gone. There’s no “this is where patient X once laid” or photographs of them anywhere. They’re just gone.

But the strangest thing of all this is how little emotion I’ve felt. When I heard the news, I was shocked for a bit, but didn’t think too much of it. Just paused, whispered a “rest in peace”, and got on with my day. It was only when my colleague brought it up did I consider how significant it was. Yeah – the man I had spoken to last week, who told me about his childhood and love life, is now no longer alive. Isn’t that crazy? I expected, even hoped, to feel a larger wave of sadness, perhaps an inability to focus, maybe even some tears. But it just didn’t affect me that much.

Three years ago, I wrote a post outlining my fear of becoming an emotional void. It was one of my most honest and personal posts I had ever written. And now I worry my fears are coming true.

Why didn’t I feel more emotion at the news? Am I too sleep deprived, and just numb to any input? Am I too used to death, having experienced heavy loss growing up? Or am I still unconsciously processing it, waiting for the tears to erupt randomly one day?

The Dictionary of Obscure Sorrows has a phrase called the wends:

n. frustration that you’re not enjoying an experience as much as you should, even something you’ve worked for years to attain, which prompts you to plug in various thought combinations to try for anything more than static emotional blankness, as if your heart had been accidentally demagnetized by a surge of expectations.

Maybe I’m going through the wends and expecting too much of myself. Maybe death is just no big deal and a natural part of life. Maybe it’s fine, even good, to feel little in the face of death, as a sign of resilience.

But if it comes at the cost of my humanity and my empathy, then dear God, please let me be more sensitive. Please let me love more readily, let me cry more heavily, let me sleep less easily. Let me feel again.

RK, may you rest in peace.

Today was an objectively good day. I had a great night’s rest, called my family, spent quality time with my partner, studied interesting topics, did some work, ate delicious food and even won a close volleyball game.

But even with these good days, my heart silently breaks at the injustice and suffering in the world. It breaks at the billions starving worldwide and the 600 million who live in extreme poverty. It breaks at the 700 million people who cannot read or write, who will be forgotten by history, and will never know a world outside theirs.

It breaks at the one million people who take their own life every year, the 20 million to attempt to, and the many more who suffer quietly in ways that people and numbers can never know.

It breaks at the cruelty of war and the spilled blood of innocent people. It breaks at the powerfully manipulative forces of religion, media, and cults, which promise connection and salvation, but often deliver division and pain. It breaks at the practices of racism, sexism and other -isms which lazily judge people by their group identity rather than the individual.

But maybe there is hope. Maybe there is hope in the power of human ingenuity, which has led to amazing feats like the lightbulb, electricity and mathematical questions that elegantly describe the world’s architecture. Maybe there is hope in the power of technology, which has given us the internet, the moon landing, and devices with unprecedented capabilities. Maybe there is hope in human expression, which has given us gifts of music, art, theatre and literature. Maybe there is hope in a deity, or time, or something greater than my understanding.

One time, I asked a Buddhist friend how he felt about injustice in the world. He said, “life is suffering,” and shrugged his shoulders. The first of the four noble truths. I remember how he smiled warmly at me. I remember thinking, “Maybe that’s true. Maybe that’s just how things are.”

But often, like tonight, it just doesn’t feel enough. It feels like we can do better than a that’s-how-things-are mentality – that we have a duty to better the planet we were placed on.

Perhaps we can only keep improving ourselves each day, one step at a time, until it’s our turn to change the world.

Something the hematology nurse said to me after I failed my first venepuncture this week:
“To get good at taking bloods, your job is to get through your first 50 fails as fast as possible. Celebrate your wins, sure. But only after you’ve failed 50 times will you finally begin to get good at it.”

Just one of those many examples where quantity beats quality.

Related: The Parable of the Pottery Class

When someone asks us for advice or feedback, it’s easy to accept the implied limits. But often times, the most effective answer is one that extends beyond the given boundaries.

Are there any typos here? No – but maybe we should talk about the unnecessary chapters.

Should I order a salad or fries? Depends – maybe we should talk about what your goals are.

Should I quit my job and pursue my dream or stay financially secure? Are there no other options?

One exercise I’ve been trying recently is to answer any closed, non-factual question with a “none of the above”. I say non-factual because some questions, like what gene mutation commonly causes acute promyelocytic leukemia, have correct answers. But for the others, where more subjective opinions or feedback are required, then unorthodox answers are usually a more honest and useful answer to the listener.

But more importantly, answering this way forces us to constantly re-examine our values. Choosing from a set of multiple choice questions is easy. “Do you think A or B is right?” You could flip a coin. No effort required.

Having to create a new answer, one to a deeper question, takes an enormous amount of energy. It forces us to enter empathic listening – where you tap into the speaker’s perspective – and work from there. When when you reach that place of empathy, it’s easier to understand a person’s real wants or needs. And over time, as we step into many people’s shoes, our own beliefs begin to evolve as well.

The best answers I’ve ever heard have always been “none of the above answers”. Take, for instance, Derek Sivers on the question “When you think of the word “successful,” who’s the first person who comes to mind and why?”

“The first answer to any question isn’t much fun, because it’s just automatic. “What the first painting that comes to mind: Mona Lisa. Genius: Einstein. Composer: Mozart.”

This is the subject of the book “Thinking Fast and Slow” by Daniel Kahneman.

There’s the instant, unconscious, automatic thinking. Then there’s the slower, conscious, rational, deliberate thinking.

I’m really into the slower thinking. Breaking my automatic responses to the things in my life, and slowly thinking through a more deliberate response instead.

Then, for the things in life where an automatic response is useful, creating a new one consciously.

So what if you asked, “When you think of the word successful, who’s the third person who comes to mind, and why are they actually more successful than the first person that came to mind?”

In that case: first would be Richard Branson, because that’s like the stereotype – the Mona Lisa. And honestly, you might be my 2nd answer, but we can talk about that later.

My third and real answer is we can’t know, without knowing their aims.

What if Richard Branson set out to live a quiet life, but like a compulsive gambler, just can’t stop creating companies? Then that changes everything, and we can’t call him successful anymore.”

An unorthodox, but brilliant answer.

Do not mistake somebody’s ignorance for your limits. There are always more options than meets the eye.