Clarity by John Mayer
I worry, I weigh three times my body
I worry, I throw my fear around
But this morning, there's a calm I can't explain
The rock candy's melted, only diamonds now remain
Ooh ooh ooh ooh
By the time I recognize this moment
This moment will be gone
But I will bend the light, pretend that it somehow lingered on
Well all I got's
Ooh ooh ooh ooh
And I will wait to find
If this will last forever
And I will wait to find
If this will last forever
And I will pay no mind
When it won't and it won't because it can't
It just can't
It's not supposed to
Was there a second of time that I looked around?
Did I sail through or drop my anchor down
Was anything enough to kiss the ground?
And say I'm here now and she's here now
Ooh ooh ooh ooh
Ooh ooh ooh ooh
So much wasted in the afternoon
So much sacred in the month of June
How bout you
And I will wait to find
If this will last forever
And I will wait to find
That it won't and it won't
Because it won't
And I will waste no time
Worried 'bout no rainy weather
And I will waste no time
Remaining in our lives together
Thursday, September 23, 2010
Tuesday, May 18, 2010
Older
Ok I'm back...
Before I wax lyrical about Geriatrics, I realized I missed out on one core aspect of Geriatric medicine.
Paediatrics isn't the only specialty where you have to treat the patient as well as the caregiver. It's the same in Geriatrics, just that the ages of the patient and caregiver are reversed. Also, caregiver concerns are different. in Paediatrics, parents are more concerned on whether the child's illness affects his/her long-term development. Caregivers of elderly patients are concerned instead with how the patient's illness affect his/her quality of life. In Geriatrics, like paediatrics, patient welfare indefinitely impacts on the welfare of the caregiver. Patients with dementia, especially the spouse, are distressed by their loved one's gradual but noticeable change from someone dearly familiar to a total stranger, even a nuisance, an outcast. Like children with debilitating illnesses, Geriatricians aim to palliate the patient as best as they can, and offer comfort and respite to the caregivers where possible. I have personally witnessed the sheer outpouring of gratitiude of a family to a geriatrician who helped them cope with their father who was ailing due to both cancer and dementia. The scene touched my heart.
And therein lies the beauty of Geriatrics. One wonders why it isn't given the same appreciation as Paediatrics, given their similarities. One need no more than look at societal priorities and biases to see why. And yet in this same society, Geriatrics is needed more than ever. The ageing population and the shrinking of family size forces us to confront the inevitable elderly dependant burden on society and forces us to decide the place of elderly in society. More and more families are casting their elderly out to nursing homes. The reasons for doing so include many genuinely distressing ones, but what is worrying is how some people can leave their mothers and fathers in the home and never return.
Can we accept this? I urge all to take a good look at your mothers and your fathers and think hard: will you want to take care of them in future? Will you shelter them in your home for as long as they live, or will you cast them out at the slightest bit of inconvenience? Will you bathe them when they are dirty, clean them when they soil themselves, feed them when they too weak to feed themselves, comfort them when they cry from sorrow of depression or worthlessness? We shy away from this, yet we were once given that amount of care by our beloved parents. Instead we care not about dirtying our hands when we tend to our young ones- but even that practice is now slowly being handled by strangers-maids. Unsurprisingly, children now also hand their elderly parents over to maids, even though I accept that increasing work demands may force the hand of even the most dedicated of children.
When I walk in the wrads of Renci, all around me are old men and women, frail and beaten down by age and disease. But look harder and the years roll back- see the construction worker whose hands grew coarse from the rough work in the day but still lovingly cradled his baby son at night. See the virtuous wife whose now-heavily varicosed legs covered every inch of the house floor as she cleaned, swept, cooked, cried. See the political leader whose heavily-creased brow underlined all his years of servitude to the nation. See the young man or woman who was once not very different from us- full of hope and promise, yet full of trepidation at the challenges of life that awaited them. Above all, see the collective effort of an entire generation that has taken this country from the slums that they inhabited to the skyscrapers we now admire- an effort that has caused their backs to grow crooked, their bones to grow brittle, their knees to stiffen, their bodies to become weak.
Truly, they deserve better.
Before I wax lyrical about Geriatrics, I realized I missed out on one core aspect of Geriatric medicine.
Paediatrics isn't the only specialty where you have to treat the patient as well as the caregiver. It's the same in Geriatrics, just that the ages of the patient and caregiver are reversed. Also, caregiver concerns are different. in Paediatrics, parents are more concerned on whether the child's illness affects his/her long-term development. Caregivers of elderly patients are concerned instead with how the patient's illness affect his/her quality of life. In Geriatrics, like paediatrics, patient welfare indefinitely impacts on the welfare of the caregiver. Patients with dementia, especially the spouse, are distressed by their loved one's gradual but noticeable change from someone dearly familiar to a total stranger, even a nuisance, an outcast. Like children with debilitating illnesses, Geriatricians aim to palliate the patient as best as they can, and offer comfort and respite to the caregivers where possible. I have personally witnessed the sheer outpouring of gratitiude of a family to a geriatrician who helped them cope with their father who was ailing due to both cancer and dementia. The scene touched my heart.
And therein lies the beauty of Geriatrics. One wonders why it isn't given the same appreciation as Paediatrics, given their similarities. One need no more than look at societal priorities and biases to see why. And yet in this same society, Geriatrics is needed more than ever. The ageing population and the shrinking of family size forces us to confront the inevitable elderly dependant burden on society and forces us to decide the place of elderly in society. More and more families are casting their elderly out to nursing homes. The reasons for doing so include many genuinely distressing ones, but what is worrying is how some people can leave their mothers and fathers in the home and never return.
Can we accept this? I urge all to take a good look at your mothers and your fathers and think hard: will you want to take care of them in future? Will you shelter them in your home for as long as they live, or will you cast them out at the slightest bit of inconvenience? Will you bathe them when they are dirty, clean them when they soil themselves, feed them when they too weak to feed themselves, comfort them when they cry from sorrow of depression or worthlessness? We shy away from this, yet we were once given that amount of care by our beloved parents. Instead we care not about dirtying our hands when we tend to our young ones- but even that practice is now slowly being handled by strangers-maids. Unsurprisingly, children now also hand their elderly parents over to maids, even though I accept that increasing work demands may force the hand of even the most dedicated of children.
When I walk in the wrads of Renci, all around me are old men and women, frail and beaten down by age and disease. But look harder and the years roll back- see the construction worker whose hands grew coarse from the rough work in the day but still lovingly cradled his baby son at night. See the virtuous wife whose now-heavily varicosed legs covered every inch of the house floor as she cleaned, swept, cooked, cried. See the political leader whose heavily-creased brow underlined all his years of servitude to the nation. See the young man or woman who was once not very different from us- full of hope and promise, yet full of trepidation at the challenges of life that awaited them. Above all, see the collective effort of an entire generation that has taken this country from the slums that they inhabited to the skyscrapers we now admire- an effort that has caused their backs to grow crooked, their bones to grow brittle, their knees to stiffen, their bodies to become weak.
Truly, they deserve better.
Old
By now people who have talked to me about specializations and what I am interested in would have known that I have for the better part of the year been struggling with what to choose. I basically have narrowed down the list to 2 primary considerations-Geriatrics and Emergency Medicine, though it is prudent to say I haven't thoroughly ruled out any others yet.
The people who have spoken to me would usually have been taken aback at my preference for two specialties of apparently polar opposite nature.
This is not the post where I attempt to thrash out my thoughts and come to a conclusion, I suspect it will come but not so soon. Instead, this will be my attempt to coalesce my feelings and reflections on both specialties so that when the time comes, I have these written entries to look back on and aid my eventual choice.
I realize I should have started this when I was in the midst of my Emergency Medicine posting, but it's better late than never. I'll start with Geriatrics first, since ruminations of it are freshest in my mind.
I realised right away when I stepped into ward 8 @ Renci that I had made a terrible mistake, and also what an idiot I was to not have realized it way back earlier. Why put a Geriatrics psoting immediately after an Emergency Medicine one? The abrupt change in pace hit me like a wall. I had little time to adapt when I was ushered into my first ward round. Amazingly, I was still scanning the ward for people to set plugs on (Emed had driven me nuts I tell you, but in a good way- more on that next time).
If you haven't been paying attention to Pharmacology, or like me and most of the general medical student population have conveniently forgotten details like drug interaction and elimination etc, then Geriatrics will drive you up the wall. Each patient has a corundrum of comorbidities, and an accompanying cornucopia of medications. Every ward round is among other things an intense exercise on finely balancing patient physiology against multiple drug effects and interactions. Getting asked "why is the dosage so high? Can we lower this and increase that, take this out and replace it with this other one?" is NOT FUN, as a medical officer and even more so as a sotong student. For the first time in months I was dusting off the covers of my Katzung and flipping through the pages. Even now, 2 weeks into the posting, I can assure you I haven't sorted everything out.
Apart from polypharmacy, there is the effect of multiple comorbidities itself on elderly. We have the triumvirate of conditions drilled into medical students ad nauseum and chanted like a Buddhist scripture at almost every patient's round- hypertension, hyperlipidaemia and diabetes, the "Big Three". Then there are their complications- stroke, ischemic heart disease, pheripheral neuropathy, peripheral vascular disease, etc. There are the other conditions associated with elderly-osteoporosis with fractures of the long bones, osteoarthritis, and the inevitable malignancy. But what burdens both patient and caregiver the most must be the diseases that affect the mind and affect. Dementia and associated psychosis and depression are the most frustrating and energy-sapping conditions in the elderly. But they are also why the elderly are such a sorry lot of people. Imagine having your intellect and awareness and eventually self-dignity and civility slipping away into nothing-death- but then again if you were the patient you wouldn't feel it, instead your friends and loved ones suffer as your consciousness and their patience erode away slowly and painfully. Watching an old lady cry sorrowfully for her daughter every waking moment was so painful. Witnessing a previously vivacious lady reduced to nothing different from a very old baby-like creature was heart-rending. After 1 week in the subacute ward, I went home and cried.
But within all the burdens, the heartaches, the stresses, lies the beauty of Geriatric Medicine. As many have come to discover, it is worth all the effort to discover. More on my next entry, as I have run out of time. Perhaps you should relfect on what has been written...
The people who have spoken to me would usually have been taken aback at my preference for two specialties of apparently polar opposite nature.
This is not the post where I attempt to thrash out my thoughts and come to a conclusion, I suspect it will come but not so soon. Instead, this will be my attempt to coalesce my feelings and reflections on both specialties so that when the time comes, I have these written entries to look back on and aid my eventual choice.
I realize I should have started this when I was in the midst of my Emergency Medicine posting, but it's better late than never. I'll start with Geriatrics first, since ruminations of it are freshest in my mind.
I realised right away when I stepped into ward 8 @ Renci that I had made a terrible mistake, and also what an idiot I was to not have realized it way back earlier. Why put a Geriatrics psoting immediately after an Emergency Medicine one? The abrupt change in pace hit me like a wall. I had little time to adapt when I was ushered into my first ward round. Amazingly, I was still scanning the ward for people to set plugs on (Emed had driven me nuts I tell you, but in a good way- more on that next time).
If you haven't been paying attention to Pharmacology, or like me and most of the general medical student population have conveniently forgotten details like drug interaction and elimination etc, then Geriatrics will drive you up the wall. Each patient has a corundrum of comorbidities, and an accompanying cornucopia of medications. Every ward round is among other things an intense exercise on finely balancing patient physiology against multiple drug effects and interactions. Getting asked "why is the dosage so high? Can we lower this and increase that, take this out and replace it with this other one?" is NOT FUN, as a medical officer and even more so as a sotong student. For the first time in months I was dusting off the covers of my Katzung and flipping through the pages. Even now, 2 weeks into the posting, I can assure you I haven't sorted everything out.
Apart from polypharmacy, there is the effect of multiple comorbidities itself on elderly. We have the triumvirate of conditions drilled into medical students ad nauseum and chanted like a Buddhist scripture at almost every patient's round- hypertension, hyperlipidaemia and diabetes, the "Big Three". Then there are their complications- stroke, ischemic heart disease, pheripheral neuropathy, peripheral vascular disease, etc. There are the other conditions associated with elderly-osteoporosis with fractures of the long bones, osteoarthritis, and the inevitable malignancy. But what burdens both patient and caregiver the most must be the diseases that affect the mind and affect. Dementia and associated psychosis and depression are the most frustrating and energy-sapping conditions in the elderly. But they are also why the elderly are such a sorry lot of people. Imagine having your intellect and awareness and eventually self-dignity and civility slipping away into nothing-death- but then again if you were the patient you wouldn't feel it, instead your friends and loved ones suffer as your consciousness and their patience erode away slowly and painfully. Watching an old lady cry sorrowfully for her daughter every waking moment was so painful. Witnessing a previously vivacious lady reduced to nothing different from a very old baby-like creature was heart-rending. After 1 week in the subacute ward, I went home and cried.
But within all the burdens, the heartaches, the stresses, lies the beauty of Geriatric Medicine. As many have come to discover, it is worth all the effort to discover. More on my next entry, as I have run out of time. Perhaps you should relfect on what has been written...
Wednesday, March 31, 2010
For you
If you just realize what I just realized
We'll never have to wonder if we missed out on each other now...
:)
Friday, March 19, 2010
Guilt
My whole life changed on 20 September 2003.
Before that I was probably a self-centred, immature, spoilt boy who was full of himself but who had in truth little direction in life.
Maybe I still am, but I think it would be alright to say that I have been making an effort to change.
Anyway back to the topic. Can you think of another person who would still wait for his cancer-stricken mother to make him breakfast at 6 am? Anyone who still depended on someone who was exhausted from repeated chemotherapy sessions to wake him up so that he wouldn't be late for school? Anyone who went out to have fun and wasn't contactable when his mother collapsed at home?
This is a very dark part of my past that till now I have not revealed to anyone, because I am so ashamed, so disappointed that I had let those events come to pass. I still don't have guts to tell this to my closest friends up front. Such cowardice eh?
When it was first discovered my mother had cancer, I was 11. My parents had decided amongst themselves that I should not know the details of her diagnosis till later when they felt I was more mature to handle the information. It was also because the cancer was discovered early, and she had a good chance of cure, so they figured that it would be counter-productive to give me such a scare.
At that point in time I was only aware that my mother required surgery for something and that after that she would be fine. Quite close to the mark really, except that obviously I didn't know then what I know now- the full extent of my mother's condition, and the complications that could have occurred- and the complications that eventually did.
So when my mother started to experience loss of weight, loss of appetite and abdominal bloating, I was actually very taken aback but because of previously said immaturity, sunk into denial and treated everything as if nothing had happened. Then, when it eventually came to a point when I was forced to face up to reality, I backed away, choosing to naively believe that my mother would, like before, go thorugh something that the doctor ordered and come away as good as before. No interruptions to life.
This idiotic manner of thinking stayed with me all the way till the day my mother collapsed at home while I was out watching a movie.At this point many people woul, I believe, have screamed into my face: "why weren't you at her side? why didn't you look after her when she was sick?" I can only say that I chose not to care, chose not to see that my mother was withering away in front of me, chose rather to believe that my mother was just "going through a phase of illness" and that she would get better soon without any help from me. Or probably, I was too lazy and self-absorbed to lift a finger.
Obviously when I got home, I got one of the biggest shellings of my life from my dad. Even then I didn't flinch, such was my dissociation from the situation. It was only in the car, when we were driving to the hospital, when for the first time in my life I saw my dad weep openly in front of me and wailing his disappointment, that i snapped back to the real world.
At the hospital, everything came to a head when my eyes fell upon my barely conscious mother on her ward bed. As all my relatives trained their eyes on me, it was as if nothing else matter to me when I ran to my mother's side and started bawling my eyes out, apologizing for what a failure of a son I had been. My mother, barely conscious at the time, still summoned the strength to lift her hand and stroke my head. It only served to make me cry even more.
She made it through that episode, and after she was discharged I swore to take care of her as I rightfully should. However, as her condition got better, I started to lapse into the lackadaiscal attitude of before. Perhaps seeing her improve so much made me complacent, believe that it was alright not to do so much anymore. So, so wrong.
A very unfortunate turn of events led to my mother stopping her chemotherapy as her cancer was on the retreat, and months her tumour markers had risen rapidly and her tummy swollen again. I again retreated back into my shell as I heard the doctor tell us that she would have to be started on even stronger chemotherapy drugs.
Two weeks after her first dose of the revised intensive chemotherapy, my mother passed away. My father and I were by her side as she took her last breaths on her bed at home, at 9:30 am.
When her heart stopped, I didn't even blink.
During her funeral wake of 5 days, I acted as if I was handling the situation very well, Talking rather calmly with guests, relatives and friends who had come to pay their respects.
At the very last, when my mother's coffin was rolled into the incinerator for the cremation, All barriers were broken down, and I could not contain my tears. after that, I don't remember what happened for the rest of the day.
Why do I say all this?
One reason is that I am looking for forgiveness from somewhere, that I am repenting but still tormented by this period of my life. The scars will not wither, and I cannot help but constantly think that I had in my utter selfishness and reusal to pluck up enough courage to accept the truth, caused my mother to die.
The other reason is that the real reason for me wanting to become a doctor is because of all this. Because of what had happened to my mother, and my guilt for not having done what I could.
I know in my heart that my mother has definitely felt my pain and forgiven me, such is her blessed good nature. But I have never found the space in my heart to forgive myself. I hope someday I will. And I hope when the time comes, the special person I am waiting for in this life will come to hear this story and forgive me too.
But for now, I try to be a good doctor, so that others can and will not have to face what I have faced before. Fate has determined that I receive nuturing from such a good mother, but has also deemed necessary for me to have her taken from me prematurely, to truly appreciate the depth and unconditional nature of her love. It pains me that I had to leave it so late to see it.
I am so grateful for you mom, but so sorry that I never truly cared till it was too late. So sorry.
Before that I was probably a self-centred, immature, spoilt boy who was full of himself but who had in truth little direction in life.
Maybe I still am, but I think it would be alright to say that I have been making an effort to change.
Anyway back to the topic. Can you think of another person who would still wait for his cancer-stricken mother to make him breakfast at 6 am? Anyone who still depended on someone who was exhausted from repeated chemotherapy sessions to wake him up so that he wouldn't be late for school? Anyone who went out to have fun and wasn't contactable when his mother collapsed at home?
This is a very dark part of my past that till now I have not revealed to anyone, because I am so ashamed, so disappointed that I had let those events come to pass. I still don't have guts to tell this to my closest friends up front. Such cowardice eh?
When it was first discovered my mother had cancer, I was 11. My parents had decided amongst themselves that I should not know the details of her diagnosis till later when they felt I was more mature to handle the information. It was also because the cancer was discovered early, and she had a good chance of cure, so they figured that it would be counter-productive to give me such a scare.
At that point in time I was only aware that my mother required surgery for something and that after that she would be fine. Quite close to the mark really, except that obviously I didn't know then what I know now- the full extent of my mother's condition, and the complications that could have occurred- and the complications that eventually did.
So when my mother started to experience loss of weight, loss of appetite and abdominal bloating, I was actually very taken aback but because of previously said immaturity, sunk into denial and treated everything as if nothing had happened. Then, when it eventually came to a point when I was forced to face up to reality, I backed away, choosing to naively believe that my mother would, like before, go thorugh something that the doctor ordered and come away as good as before. No interruptions to life.
This idiotic manner of thinking stayed with me all the way till the day my mother collapsed at home while I was out watching a movie.At this point many people woul, I believe, have screamed into my face: "why weren't you at her side? why didn't you look after her when she was sick?" I can only say that I chose not to care, chose not to see that my mother was withering away in front of me, chose rather to believe that my mother was just "going through a phase of illness" and that she would get better soon without any help from me. Or probably, I was too lazy and self-absorbed to lift a finger.
Obviously when I got home, I got one of the biggest shellings of my life from my dad. Even then I didn't flinch, such was my dissociation from the situation. It was only in the car, when we were driving to the hospital, when for the first time in my life I saw my dad weep openly in front of me and wailing his disappointment, that i snapped back to the real world.
At the hospital, everything came to a head when my eyes fell upon my barely conscious mother on her ward bed. As all my relatives trained their eyes on me, it was as if nothing else matter to me when I ran to my mother's side and started bawling my eyes out, apologizing for what a failure of a son I had been. My mother, barely conscious at the time, still summoned the strength to lift her hand and stroke my head. It only served to make me cry even more.
She made it through that episode, and after she was discharged I swore to take care of her as I rightfully should. However, as her condition got better, I started to lapse into the lackadaiscal attitude of before. Perhaps seeing her improve so much made me complacent, believe that it was alright not to do so much anymore. So, so wrong.
A very unfortunate turn of events led to my mother stopping her chemotherapy as her cancer was on the retreat, and months her tumour markers had risen rapidly and her tummy swollen again. I again retreated back into my shell as I heard the doctor tell us that she would have to be started on even stronger chemotherapy drugs.
Two weeks after her first dose of the revised intensive chemotherapy, my mother passed away. My father and I were by her side as she took her last breaths on her bed at home, at 9:30 am.
When her heart stopped, I didn't even blink.
During her funeral wake of 5 days, I acted as if I was handling the situation very well, Talking rather calmly with guests, relatives and friends who had come to pay their respects.
At the very last, when my mother's coffin was rolled into the incinerator for the cremation, All barriers were broken down, and I could not contain my tears. after that, I don't remember what happened for the rest of the day.
Why do I say all this?
One reason is that I am looking for forgiveness from somewhere, that I am repenting but still tormented by this period of my life. The scars will not wither, and I cannot help but constantly think that I had in my utter selfishness and reusal to pluck up enough courage to accept the truth, caused my mother to die.
The other reason is that the real reason for me wanting to become a doctor is because of all this. Because of what had happened to my mother, and my guilt for not having done what I could.
I know in my heart that my mother has definitely felt my pain and forgiven me, such is her blessed good nature. But I have never found the space in my heart to forgive myself. I hope someday I will. And I hope when the time comes, the special person I am waiting for in this life will come to hear this story and forgive me too.
But for now, I try to be a good doctor, so that others can and will not have to face what I have faced before. Fate has determined that I receive nuturing from such a good mother, but has also deemed necessary for me to have her taken from me prematurely, to truly appreciate the depth and unconditional nature of her love. It pains me that I had to leave it so late to see it.
I am so grateful for you mom, but so sorry that I never truly cared till it was too late. So sorry.
Saturday, March 13, 2010
Picture in my head
No wife to hold my hand. No children sitting by my side. No friends watching over me.
My greatest fear in life.
Will I ever find someone's hand to hold?
I wish I could hold your hand now, the only one which I know will never let go of mine.
Thank you for your life.
My greatest fear in life.
Will I ever find someone's hand to hold?
I wish I could hold your hand now, the only one which I know will never let go of mine.
Thank you for your life.
Infidel
I wonder if men are really that bad.
Okay this is not me indirectly saying I hate my own kind, but even now I find myself wondering if I could be capable of such despicable action.
I won't know till I get married I guess.
The current feeling that is running through me is that if anyone caught me committing such an act could have all right to shoot me in the head.
Okay this is not me indirectly saying I hate my own kind, but even now I find myself wondering if I could be capable of such despicable action.
I won't know till I get married I guess.
The current feeling that is running through me is that if anyone caught me committing such an act could have all right to shoot me in the head.
Making choices
I think the last week spent in KK has convinced me at last where I belong in the large world of Medicine.
I loathe having to decide so fast. I'm not alone, it's a fact. It feels so abrupt, like we're being pushed into things. And it doesn't seem as beneficial as they purport it to be. Things are so unclear.
Does one really know where one can and should go, without having any real experience in it?
Hats off to those who claim to already know like an arrow's path the direction they want to take, but there is the majority who haven't much that same conviction or perhaps the benefit of prior experience.
But at last, I hope, I know where to go.
The niggling thought still: why am I rushing?
I loathe having to decide so fast. I'm not alone, it's a fact. It feels so abrupt, like we're being pushed into things. And it doesn't seem as beneficial as they purport it to be. Things are so unclear.
Does one really know where one can and should go, without having any real experience in it?
Hats off to those who claim to already know like an arrow's path the direction they want to take, but there is the majority who haven't much that same conviction or perhaps the benefit of prior experience.
But at last, I hope, I know where to go.
The niggling thought still: why am I rushing?
I want
The last few years of my life have been spent pining for people I want to share a part of my life with but could never get close enough to do so.
Is this life telling me that I'm never meant to share karma with these people?
A person who I took for granted for the longest time... a person who is always there one moment and then gone the next... a person whose heart is with another...
Such superficial aspirations, I tell myself. Weakness of the heart, indecisiveness, unwillingness to let go of fantasy and return to reality.
But it is so hard isn't it?
Is this life telling me that I'm never meant to share karma with these people?
A person who I took for granted for the longest time... a person who is always there one moment and then gone the next... a person whose heart is with another...
Such superficial aspirations, I tell myself. Weakness of the heart, indecisiveness, unwillingness to let go of fantasy and return to reality.
But it is so hard isn't it?
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