Eric Tian

I was eating pho the other day when two men sat in a table near me. They were, I guess, in their mid-twenties, and it became apparent that they had met on an app and this was their first time meeting in person. I did not mean to eavesdrop, but it was very warm outside and I was feeling sleepy, so I caught bits of their conversation while lazing around.

There was something about their conversation that seemed off to me, and I could not figure out why at first. Then I realised that they were not having a conversation at all. What would happen is one person would talk about himself for a few minutes, and then the other would suddenly interject and talk about himself for another few minutes. They alternated in this tug-and-war for over half an hour, in which neither of them asked a single question.

At one point, one man explained that he had come back early from his year-long vacation as his father had just passed away. The other person did not offer a single condolence, but instead resumed telling stories of his sister who worked odd jobs.

The thing was, both men’s lives were fascinating. One had travelled to four different continents in their gap year from dental school, and the other had recently launched their own business. I wanted to ask some questions, but both seemed only interested in themselves. It was like watching two people read their own Facebook updates to each other.

Sometime during this, an elderly couple arrived and sat a few tables away. The man had a walking stick and was helped to the chair by his wife. The waitress came and took their order with a smile: they seemed to be regulars. After this, the couple held each other’s hands in silence. The lady was peering around at the restaurant and the man was simply staring at his wife. When their food arrived, he offered her his portion of bean sprouts and she shook her head. Only when they picked up their chopsticks did they finally let go of each other.

No words were exchanged, but their connection seemed far deeper than the endless chatter across from me.

I remember an interview that Hozier did with The Irish Times:

“If I was to speak candidly about it, I found the experience of falling in love or being in love was death – a death of everything. You kind of watch yourself die in a wonderful way and you experience for the briefest moment – if you do believe somebody and you see for a moment yourself though their eyes – everything you believed about yourself is gone.”

This week I felt this truth. Meeting my niece has been the ultimate death of the ego, where time and space converge into her two brown wide eyes and goofy smile. She will likely forget these moments when she grows up, but for me, in these seconds of contact, my whole world collapses.

As Jane Hirshfield put it in The Weighing:

“So few grains of happiness
measured against all the dark
and still the scales balance.”

8am, my niece on my lap. My goal this morning: teach her a new word.

She points to her toy rabbit. “Rabbit,” I say. No response.

She points to the tissue box. “Tissue,” I say. No response.

She points to me. “Eric,” I say, with more enthusiasm. “Uncle Eric”. Still, no response.

She points to the clock. “Clock,” I say, beginning to lose hope. And then, from her tiny larynx:

“Clock”!

I laugh and clap in amazement, until she says it again. And I realise she cannot pronounce the letter L.

“No no, cLock”, I repeat, emphasising the critical letter. But it is useless: she chants her newly learnt word over and over again, giggling to no end.

I have succeeded in the worst way.

“Hey, could I get some water please?”

I did not blame her for not hearing the first time. There was a crying baby a few seats ahead, and turbulence made steering the trolley a hassle. But this was the third time she had missed me and I was getting more thirsty and frustrated by the hour.

The boy looked up at me, then back to the flight attendant. His father in the aisle seat was dozing and the attendant had moved past already. As I was about to raise my voice, a water bottle transpired on my lap. I looked at the boy – he was transfixed on his screen, watching a cartoon.

A few hours later, I felt the boy’s head fall on my shoulder. We sat like this for over an hour: him dreaming, me watching inception, my humerus providing a cushion. This would be my gift back for his kindness.

His father eventually noticed and quickly moved his head away.

“Sorry,” he said. “And thank you.”

“No,” I wanted to say. “Thank you.”

In 1958, a 20-year-old Hunter S. Thompson was asked by a friend about advice on life. His response, captured in a letter, is worth reading in its entirety, but here is one memorable section:

“Let’s assume that you think you have a choice of eight paths to follow (all pre-defined paths, of course). And let’s assume that you can’t see any real purpose in any of the eight. THEN— and here is the essence of all I’ve said— you MUST FIND A NINTH PATH.

Naturally, it isn’t as easy as it sounds. You’ve lived a relatively narrow life, a vertical rather than a horizontal existence. So it isn’t any too difficult to understand why you seem to feel the way you do. But a man who procrastinates in his CHOOSING will inevitably have his choice made for him by circumstance…

I’m not trying to send you out “on the road” in search of Valhalla, but merely pointing out that it is not necessary to accept the choices handed down to you by life as you know it. There is more to it than that— no one HAS to do something he doesn’t want to do for the rest of his life. But then again, if that’s what you wind up doing, by all means convince yourself that you HAD to do it. You’ll have lots of company.”

George Mack recently suggested that there is no such thing as being working too hard; there is just being under rested. Here is a short excerpt from the post:

“1. Winston Churchill used to work 16 hours per day in his old age during the war — but he also worked in bed every day until 11am. He had a nap after lunch, and a 2 hour nap before dinner at 8pm before working late into the night.

2. John. D Rockefeller took a 30 minute nap everyday at 12pm. No meeting was important enough to move this out of his calendar.

3. Advice I’d give my younger self: Don’t focus on energy output (working too hard). Focus on energy production (recharging activities). If you produce more energy than you burn, it’s impossible to burn out.

4. The person that is well rested might be able to work 16 hour days 6 days per week. The person who never works but scrolls TikTok all day can struggle to do 30 minutes without burning out.

5. Josh Waitzkin has this concept called the “Simmering Six”:

“Most people in high-stress, decision-making industries are always operating at this kind of simmering six, as opposed to the undulation between just deep relaxation and being at a 10. Being at a 10 is millions of times better than being at a 6. It’s just in a different universe.””

---

I do not completely agree with this idea – I think a job devoid of meaning, recognition, or support can be debilitating regardless of rest – but it illustrates an important point: that we should include rest in any discussion of being overworked or burnout.

I have developed multiple running injuries over my life, and all of them were due to inadequate recovery. I was not running significantly more or harder than others, but I failed to prioritise areas such as nutrition, sleep, and mobility alongside the ‘work’. Yet when I presented to my physiotherapist, his immediate response was, “You were running too much.” I think we missed the broader picture.

The Chinese described this cycle of rest and work as Yin and Yang centuries ago and it still remains relevant today. If we feel overworked, we may simply be under rested. Perhaps better recovery, not less work, is the key.

A few years ago, a psychiatrist I was following said something along the lines of:

“Loneliness is the biggest risk factor for physical and mental health that we do not talk about. In medicine, we focus too much on the disease, like blood sugar levels, renal function, or CT scans, and ignore the person’s connection to others.

It is the greatest silent epidemic that medicine is doing nothing for.”

At the time, I found this statement hyperbolic. There are clear clinical benefits for investigating blood markers and imaging – these help prevent and treat a staggering amount of illnesses. In medical school, our exams revolve around being able to interpret and correlate these findings, which are often backed by strong clinical evidence. To say that loneliness was on par with this was, well… surely an exaggeration.

But over the years, my view on this has shifted. Search “loneliness” into pubmed and you will find hundreds of papers in the last year investigating the link between loneliness and health – and that’s physical health, not just mental health. Consider some of these statistics from the CDC:

• Social isolation significantly increased a person’s risk of premature death from all causes, a risk that may rival those of smoking, obesity, and physical inactivity.
• Social isolation was associated with about a 50% increased risk of dementia.
• Poor social relationships (characterised by social isolation or loneliness) was associated with a 29% increased risk of heart disease and a 32% increased risk of stroke.

This is in a context of 1 in 6 Australians experiencing loneliness (a statistic likely underreported), and increasing rates of loneliness in Australian youth aged 15-24 since 2012.

Anecdotally, I have found that patients admitted with few or no social supports tend to have poorer outcomes compared to those with strong, supportive networks. This has manifested in sudden deteriorations or passings that were unexpected. Too often for coincidence.

So a few years on, I think this psychiatrist was onto something. Loneliness is most definitely a crisis. And it is the role of modern medicine to recognise this and intervene, similar to how we would treat a broken femur, or an infected lung: compassionately, alongside patient wishes, and urgently.