The Birth of Christ: Beyond Dates and Into Divine Purpose

Today is Christmas Day 2025.

Thank you to all who have wished me their common and usual “Merry Christmas” since last evening - on Christmas Eve.

 As I said in my poem, every day is Christmas for me here: 

https://scientificlogic.blogspot.com/search?q=poem+for+christmas

However, in exchange for their common greetings, let me give them my rare and unique Christmas gift - something far more solid, and mindfully tangible for them to ponder over  than mere “Merry Christmas” - and I do not think it is very merry after reading it. It is mindful and sobering instead.

But before that, on Friday, June 3, 2022 I penned my thoughts on the Mystery of the Star in the East here:

https://scientificlogic.blogspot.com/search?q=Star+in+the+East+&m=1

Here is my present for them, they may share with others. It is quite  a lengthy that took me almost three days of thinking and researching. Fortunately, research has been my lifelong university training and profession. 

 

Christmas is traditionally celebrated on the twenty-fifth of December as the day of the birth of Jesus Christ, the Son of God and Savior of the world. Although the Bible does not record the exact date of Jesus’ birth, the Church has, for centuries, set aside this day to commemorate the moment when God entered human history in flesh and humility. Christmas, therefore, is not primarily a claim of historical precision, but a celebration of profound theological truth and spiritual meaning.

The Gospel narratives themselves reflect this emphasis. Matthew and Luke, the only evangelists who describe the birth of Jesus, do not mention a specific date or even a clear season. Instead, their accounts focus on the significance of the incarnation: the fulfillment of prophecy, the humility of Christ’s birth, the angelic announcement, and the arrival of the Savior for all people. Luke records that shepherds were watching over their flocks by night, a detail that has led many scholars to suggest a warmer season, possibly spring during the lambing period, since sheep were commonly sheltered during the colder winter months. This observation, while informative, remains suggestive rather than conclusive.

Historical considerations further support the uncertainty of the exact date. Based on the reign of King Herod the Great, who died around 4 B.C., and the events surrounding Jesus’ early life, historians generally place His birth between 6 and 4 B.C. This indicates that Jesus was born several years before the starting point of the Christian calendar and confirms that Scripture does not intend to anchor His birth to a precise day. The Bible remains silent on the matter, directing attention instead to the meaning of His coming rather than its timing.

Despite this lack of historical specificity, the early Christian Church eventually settled on December 25th as the day to celebrate Christ’s birth. This choice, made most clearly in the fourth century, was neither accidental nor arbitrary. It reflected both pastoral wisdom and theological symbolism. December 25th coincided with popular Roman festivals associated with the winter solstice, particularly celebrations of the “Unconquered Sun.” At the darkest time of the year, when daylight begins to increase, early Christians proclaimed a powerful alternative message: that Jesus Christ is the true Light of the world, surpassing all cosmic symbols and earthly powers.

This symbolism I can say harmonizes deeply with biblical theology. Scripture repeatedly presents Christ as the Light who overcomes darkness. His birth, celebrated at the turning point of the year from diminishing to increasing light, serves as a vivid reminder that God’s light enters the world precisely when darkness seems strongest. In this way, December 25th became a fitting day to proclaim the spiritual reality of the incarnation, regardless of the historical season in which it occurred.

Another ancient tradition connects the date of Jesus’ birth to the date of His conception. Some early Christians believed that Jesus was conceived on March 25th, the day commemorating the Annunciation, when the angel Gabriel announced to Mary that she would bear the Son of God. This date was also associated in early Christian thought with the creation of the world and, later, with the crucifixion. Counting nine months from March 25th leads naturally to December 25th. While this reasoning is theological rather than historical, it reflects a belief in divine order and sacred symmetry, affirming that Christ’s life unfolded according to God’s perfect timing.

 

In light of these considerations, Christmas is best understood not as a historical assertion about an exact date, but as a sacred tradition that expresses eternal truth. The Church does not claim absolute certainty about the day of Jesus’ birth; instead, it invites believers to remember and rejoice in the reality that God became human. As the Apostle Paul writes, it was in the “fullness of time” that God sent His Son, emphasizing divine purpose rather than calendar precision.

Ultimately, the enduring significance of Christmas does not depend on whether Jesus was born in winter, spring, or autumn. What matters is that He was born, that God drew near to humanity, and that salvation entered the world. Christmas calls believers to look beyond dates and debates and to contemplate the mystery of the incarnation: the eternal Word taking on flesh, the Creator entering His creation, and divine love revealed in the humility of a manger.

December 25th, then, stands as a chosen and meaningful day, rich in symbolism and spiritual wisdom. It unites believers across centuries in celebrating not a date, but a Person. In remembering Christ’s birth on Christmas Day, the Church proclaims a truth that transcends time itself, that the Light has come into the world, and the darkness has not overcome it. 

On a final note, the date of Jesus birth is as mysterious as His missing 18 years of His life when He suddenly reappeared again on Earth with awfully horrendous supernatural powers here:

https://scientificlogic.blogspot.com/search?q=missing+years+of+jesus

-   ju-boo lim 

Seventy: The Narrow Bridge Between Time and Eternity

 

Seventy: The Narrow Bridge Between Time and Eternity

Seventy is a profound milestone in human life. From almost every perspective , biological, medical, social, and philosophical, crossing the age of seventy marks entry into what humanity has long called “old age.” It is not merely a number, but a threshold. Like a magnificent sunset approaching the horizon, life at seventy glows with memory, colour, and meaning, while quietly reminding us that daylight is finite.

Public demographic data tell us that only about four in ten people will pass their seventieth birthday and live on toward eighty. To reach seventy is already an achievement; to advance beyond it is to walk a narrowing ridge where resilience, wisdom, and fortune intertwine.

The Difficult Decade: Seventy to Eighty

The decade between seventy and eighty is often the most demanding period of later life. Aging accelerates. Every organ system, whether cardiovascular, neurological, musculoskeletal, or immune system will  continues an irreversible process of wear, not unlike a well-used machine that still runs, but more slowly and with increasing fragility.

During this time, chronic illnesses emerge or worsen, and the immune system becomes less responsive and more erratic. Minor infections linger longer; major illnesses may appear suddenly. This is not personal failure, but  it is the biology of ageing.

Neurologically and physically, reaction times slow, balance weakens, and coordination declines. Falls, choking, dizziness, and simple household accidents become serious threats. A single misstep can alter the trajectory of life permanently.

Equally profound, and often more painful, is the emotional aging that accompanies the physical. Friends, classmates, colleagues, comrades, and siblings of the same generation begin to disappear, one by one. The social circle contracts. Conversations become fewer. Loneliness quietly grows, even in the presence of family.

For some, hearing fades, memory fragments, and independence weakens. The fear of becoming a burden weighs heavily on the elderly, often more than illness itself. Prolonged bed rest, dependency, and loss of dignity are among the most deeply human anxieties of this stage of life.

Indeed, old age is not a peaceful meadow for everyone. For many, it is a storm, sometimes silent, sometimes violent. To acknowledge this truth is not pessimism; it is realism tempered with compassion.

Redefining Victory in Old Age

Yet perspective matters. If a person reaches seventy and steps onto the road toward eighty, that person is already fortunate. If one reaches seventy-five, one has crossed halfway through the most difficult decade of life and has essentially achieved the average life expectancy of many nations.

To complete the journey to eighty is a remarkable human victory. It is like reaching a base camp after a long and treacherous climb. From there, one may choose to rest, to reminisce, or even to continue upward,  but without illusion or pressure.

The pursuit of ninety or a hundred years need not be an obsession. Longevity without quality is not triumph. What matters is not how long we live, but how consciously, meaningfully, and peacefully we inhabit the days that remain.

What We Still Can Control

Time does not return. The future cannot be guaranteed. But there remains one sovereign domain that even old age cannot steal from us: how we live today.

Do not regret yesterday.
Do not gamble recklessly with tomorrow.
Cherish today,  fully, deliberately, gratefully.

If today you can still eat and walk, then eat food you enjoy in moderation. Walk where beauty still exists, even slowly. Say what was left unsaid. Fulfill the small wishes postponed for decades. Presence matters more than plans.

Hold firmly to life, but do not cling fearfully. Leave as few regrets as possible. Encourage one another. Walk together through this final stretch with dignity, courage, and kindness.

Caloric Restriction, Longevity, and Ageing: What Science Tells Us. 

Modern science has provided intriguing insights into ageing, particularly through studies on caloric restriction (CR), the practice of reducing calorie intake without malnutrition.

Across multiple species,  yeast, worms, flies, rodents, and primates,  caloric restriction has consistently been shown to extend lifespan and delay age-related diseases. In humans, long-term CR does not yet conclusively prove lifespan extension, but strong evidence suggests improvements in health span, including:

Reduced cardiovascular risk, improved insulin sensitivity, lower inflammation, improved lipid profiles, slower metabolic ageing

Mechanistically, caloric restriction influences key biological pathways such as:

mTOR inhibition, AMPK activation, improved mitochondrial efficiency, reduced oxidative stress, and enhanced autophagy.

Importantly for the elderly, aggressive caloric restriction is not advisable. Instead, the evidence supports gentle, intelligent moderation:

Avoid overeating

Reduce refined sugars and ultra-processed foods

Maintain adequate protein to prevent sarcopenia

Focus on nutrient density rather than calorie counting

In short, eat less, but better , and never at the expense of strength, immunity, or joy.

Finally, my feeling is, old age is not a failure of life; it is life revealed without illusion. To reach seventy is to earn the right to speak honesty about life and our life span in this world, its fragility and the meaning of our existence here. To walk towards eighty is an act of quite heroism.  
On this note let me tell you about my late and only son - Benjamin Lim Chong Minn who was born on Christmas eve this day - 24 December, 1979  (today is Christmas Eve), and left this world this year (2025) in June at the age of 46. On the eve of Christmas he was born, the skies  were very clear, and was  lighted with stars and constellations like the Orion. It was a Christmas gift for us. But he didn't even managed to reach seventy. He complained of chest pain on February 25 or 26 this year.  He rang his uncle Professor Dr Lim Yew Cheng who is my youngest brother - a Senior Consultant Cardiothoracic Surgeon about his chest pain. His uncle called him to come immediately to see him, but he did not. Months passed from neglect, and he probably suffered a cardiac arrest while cycling up a hill with his team of cyclist friends, and collapsed. Cycling was his only hobby he enjoyed to reduce stress working as a computer controller for Maybank in its headquarters. He was extremely lucky to pass away peacefully while enjoying his only hobby. 

If the age of Earth in creation at 4.54 billion years old (4.54 x 10^9), is scaled down to a day (24 hours, or 86,400 seconds), then 46 years of my son's life lasted only approximately 0.000875 seconds in the 24-hour creative day timeline. This teeny-tiny flash in time of our lifespans  holds true for everyone reading this. There is no escape for anyone, and yet we invest in a lot of properties here in this world hoping to carry them into eternity. 

Let us remind ourselves this verse;

"For what is a man profited, if he gains the whole world and lose his own soul? Or what shall a man give in exchange for his soul?"

(Matthew 16:26) 

It is very doubtful if people understands this verse, and appreciate what I am trying to tell them here. 

Finally, do you think that exercise, cycling and jogging is good for health" Think again. I have answered that on Wednesday, July 19, 2024 here:   

https://scientificlogic.blogspot.com/2024/07/do-you-think-exercise-and-jogging-are.html

My massage to everyone is:   

1. Encourage one another.
2. Walk slowly, but walk.
3. Eat simply, but enjoy.
4. Remember deeply.
5. Love gently.
6. Leave peacefully.

 

Further Reading

1. Fontana L, Partridge L, Longo VD. Extending healthy life span—from yeast to humans. Science, 2010.

2. Mattison JA et al. Caloric restriction improves health and survival of rhesus monkeys. Nature Communications, 2017.

3. Longo VD, Anderson RM. Nutrition, longevity and disease. Cell, 2022.

4. Sinclair DA, LaPlante MD. Lifespan: Why We Age—and Why We Don’t Have To. HarperCollins, 2019.

5. López-Otín C et al. The hallmarks of aging. Cell, 2013.

 

Is The Mystic Smiles of Mona Lisa a Fraud?

 Is the World-famous Smile of Mona Lisa a Scam? 

The Mona Lisa's real name was Lisa Gherardini, an Italian noblewoman from Florence, wife of wealthy merchant Francesco del Giocondo, hence her Italian name "La Gioconda," meaning "the cheerful one" or "wife of Giocondo". While "Mona" (short for Madonna) means "my lady," 

I have seen many duplicated paintings of the Mona Lisa many times since a child.  The original one was painted by the Italian artist Leonardo da Vinci, but to me I think her world most famous smile is faked. Why? Let me explain. 

 

I tried many, many times to figure out her smiles by looking at her eyes, then her mouth directly, then  her eyes and mouth again alternately, and even indirectly through lateral and peripheral visions, but I could never see any smiles in her. 

If she did, her lips would be curved downward like a bowl. Maybe if I were to see the original painting kept in the Louvre Museum in Paris, France I would have the opportunity of seeing her smiling at me. Unfortunately, I could only see hundreds of duplicated  paintings of her who never smiled. 

I don't think Mona Lisa was even smiling at all. She was just looking normally at all those looking at her "smiles". I think either Mona Lisa or Leonardo da Vinci was a fake to scam the entire world even as far back as 1503 when she was painted. Another doubt is, it was claimed it took 16 years for Leonardo da Vinci to paint Mona Lisa. I think this whole world has been deceived by him and by these claims. Leonard da Vinci was not only an artist. He was a genius, a polymath, and a highly talented person in many fields.

He was an artist, a painter, a draughtsman, an engineer, a scientist, a theorist, a sculptor, and an architect. Being a genius, he might have used his multiple talents to cheat the entire world, including me about Mona Lisa smiles? 

No matter how hard I tried again and again looking at her in all directions, whether directly or laterally to imagine Mona Lisa smiling, I could never get her smiling for or at me, maybe just a mild grin.  

 After seeing her non-smiling self, it is like the story I read when I was a small boy of The Emperor New Clothes, the fairy tales written by Hans Christian Andersen.. 

In that fairy tales it was about a vain emperor tricked by two swindlers who claimed to make magical clothes invisible to the foolish or unfit for office; everyone pretends to see them out of fear, until a child points out the emperor is naked during a procession, exposing the collective delusion and the emperor's vanity. The tale teaches a lesson about vanity, truth, and the courage to speak up against popular illusion, highlighting how people conform to avoid looking stupid

 

It is also like the song "Great Pretender" sung by The Platters in November 1955, written and composed by their manager / producer Buck Ram.

There is even an iconic song "Mona Lisa" composed by Jay Livingston  (music) and written by Ray Evans (lyrics) for the 1949 film Captain Carey, U.S.A., later becoming a massive hit for Nat King Cole who popularized it and won an Oscar for the song.

In Leonardo da Vinci and Mona Lisa's case, the entire world pretends they could see and admire Mona Lisa's famous smiles, just like the emperor's new clothes.  

As I said, since Leonardo da Vinci was multi-talented he might have the ability to scam the entire world even as far back as 1503 when there was no Google, smart phone, or WhatsApp around, and yet, he managed to swindle 

 

I think Mona Lisa is the world's most famous smiling scam ever painted? 

Maybe, but I shall shortly offer another explanation. Read on. 

As far as other scientists are concerned,

Mona Lisa's smile could be a lie, neuroscientists say in CNET here:

https://www.cnet.com/science/mona-lisas-smile-could-be-a-lie-neuroscientists-say/

 

Let me now proceed to explain differently from other scientists Mona Lisa smile from a technical perspective. Is the Mona Lisa really smiling?

My core intuition is very important  when

we look carefully, directly, and honestly, the smile seems to vanished. When we examine the mouth alone, there is no clear upward curvature. When we focus on the eyes, there is no unmistakable Duchenne activation.

"Duchenne activation" means the presence or

absence of specific facial muscle contractions that distinguish a genuine smile of enjoyment from a non-genuine or "posed" one. According to the 2019 neuroscience study published in the journal Cortex, the Mona Lisa's smile lacks Duchenne activation, leading researchers to conclude it is technically "non-genuine.. 

A true Duchenne smile requires the simultaneous contraction of the zygomaticus major (which lifts the corners of the mouth) and the orbicularis oculi (the muscles around the eyes that cause "crow's feet" and raise the cheeks).

I am absolutely right: there is no

conventional smile there at all.

What many viewers experience as a “smile” arises only when the painting is viewed holistically or peripherally, not analytically. This is not mystical; it is neurological. Leonardo exploited the way the human visual system works with high spatial detail (sharp edges, mouth contours) is processed centrally, and low spatial frequencies (soft shadows, tonal gradients) are processed peripherally.

From what I understand, Leonardo used sfumato technique in his painting. Let me explain what this technique is. 

Sfumato is a Renaissance painting technique that blurs or softens transitions between colours and tones to create a "smoky" effect. Derived from the Italian word fumo (smoke), it aims to eliminate sharp outlines, mimicking how the human eye naturally perceives depth and peripheral focus. 

Leonardo da Vinci used this technique to give the painting its lifelike and "mysterious" quality. By blurring the corners of the lips and eyes, da Vinci created an ambiguous expression that seems to change depending on how the viewer looks at it.

Instead of using hard lines to define the face, he applied dozens of paper-thin, translucent glazes to build up the flesh tones, making her skin appear to glow from within.

 

 When you stare directly, the smile disappears. When you relax your gaze, it seems to appear. So we may not be “missing” the smile, the smile is designed not to exist in a fixed way.

Whether or not it was a fake, scam, or a deliberate cognitive trap? Let me also try to pretend to explain it yet in another way. 

Firstly, my comparison with The Emperor’s New Clothes is sharp and provocative. Indeed, there is a strong element of social reinforcement in how the Mona Lisa is talked about. Once the art world declared “the mysterious smile,” generations of viewers were primed to see something, even if nothing concrete was there. Don't readers agree with me that we are all great pretenders? but here is the subtle distinction I would make with readers;  a scam deceives without insight, and Leonardo revealed deception itself. Leonardo was deeply interested in optics, perception, anatomy, and the mind. He dissected faces, studied facial muscles, and observed how emotions flicker rather than freeze. It is entirely plausible, almost likely, that he intentionally painted an expression that cannot be pinned down, precisely to show that human perception is unstable.

In that sense, the “lie” is not Mona Lisa’s, should I say, it is ours. We want certainty. Leonardo gives us ambiguity.

On neuroscience from the link I have given, I am on solid ground. Let me explain. The Cortex study I  cited lines up  remarkably well with my feeling, in fact my instinct. The asymmetry, the lack of a Duchenne smile, the neutral or even negative emotion detected on one side of the face, all of this strongly suggests a non-genuine expression.

But here is the key point that elevates Leonardo rather than condemns him:

Leonardo painted what neuroscience would only formally describe three centuries later. If the smile is “non-felt,” that does not mean the painting is fraudulent. It may mean Leonardo was depicting a psychological state rather than an emotion, a mask, a social face, a posed expression. That is, I feel a very modern explanation I can offer.

Did it really take 16 years to paint Mona Lisa, as I have read?

My skepticism here is a healthy question. The phrase “it took 16 years” is often misunderstood. I don’t think this means explicitly that Leonardo sat daily painting Mona Lisa for 16 years. It means. he began around 1503, then he kept reworking, refining, glazing, and possibly carrying it with him. He never considered it finished. I understand Leonardo was notorious for this. To him, completion was a philosophical problem, not a technical one. The Mona Lisa may have been a laboratory, not a commission.

Is the smile the greatest pretence in art history?

Here, I think this phrase is brilliant but needs a small twist. The Mona Lisa is not the world’s greatest smiling scam. It is the world’s greatest mirror, as some may claim.  People who want mystery see mystery. People who want beauty see beauty. People who want profundity find depth. And people like me want to be honest, scientifically analytical, unwilling to pretend, but want to see nothing that needs pretending.

Leonardo anticipated all of this.

For this, let me now give my final verdict. I am not wrong to say: “I don’t see a smile in Mona Lisa, maybe just a mild grin”,  and I have already said that with ethical, professional and scientific honesty many times. 

In fact, that may mean I am seeing exactly what Leonardo intended, namely, a face that refuses to lie honestly. Perhaps the true genius of the Mona Lisa is not that she smiles, but that she exposes our need to believe she does.

And, if Leonardo were alive today, I suspect he would smile, not with his lips, but with his mind, knowing that five centuries later, a thoughtful  physician-scientist, called, lim ju boo (myself)  in Malaysia, is still refusing to be fooled.

“Heart Block” Is Not a Blocked Heart

 

A pharmacist friend of mine in our WhatsApp chat group wrote to me this letter:

 

Dear Prof Dr Lim, 

I'm writing to provide a brief update on my brother-in-law. He was hospitalized at Serdang Hospital for two months following heart surgery and has now been fitted with a pacemaker. Currently, he is at Cheras Rehabilitation Hospital undergoing physiotherapy and occupational therapy to regain his strength, especially in his legs.

 

Regarding the chat group, I would prefer to join at a later time. As I am listed as one of the emergency contacts, I must now keep my phone on at all times, including overnight. To ensure I can receive an emergency call, I need to avoid being disturbed by general WhatsApp message notifications during the night, as they would disrupt my sleep. Thank you for your understanding and consideration. Best regards.

 

Here's my reply:

 

I am unsure why your brother-in-law needs a pacemaker if he underwent a Coronary Artery Bypass Grafting (heart bypass) due to a heart blockage from a stenosis in the coronary blood vessels from cholesterol, calcium and other atherosclerotic plagues  causing narrowing of the heart vessels. This is entirely different from "heart block" due to  partial blockage of electric transmission through the heart muscles which will then require a pacemaker. The term "heart block" and blockage due to atherosclerotic plagues are two entirely different conditions

 

Electrical heart block and partial stenosis from atherosclerosis can be managed by a cardiologist using angioplasty, stents and medication, whereas heart attacks due to severe atherosclerosis require a cardiothoracic or a heart surgeon to treat surgically. It is an open heart surgery.  

 

My friend then replied: 

 

Prof Dr Lim, you're correct that he did not have a heart bypass. His situation was specifically related to an electrical heart block. His path to the pacemaker was quite a surprise. He was in and out of Serdang Hospital frequently until the doctors decided to run a trial with an external pacemaker, which was inserted through the groin. Once that trial confirmed a pacemaker was necessary, they proceeded with the standard procedure.

 

The first attempt was to create a small pocket under the skin near the collarbone to house a traditional pacemaker generator. However, this was unsuccessful because my elderly brother-in-law is very thin. During this procedure, they accidentally nicked a lung, causing it to collapse (a pneumothorax).

 

Given that he wasn't a candidate for the standard device due to his frail build, the team opted for a different solution: a micro, leadless pacemaker. It was inserted through the groin, directly under the heart muscle, to manage the electrical block and regulate his heartbeat. Thanks for your clarification.

 

Having read that, I thought I should write a simple explanation  in blue below , the meaning of "heart block" and a coronary blood vessel or vessels block or a stenosis in one of the coronary blood vessels to the heart - a coronary heart disease. Even some doctors do not know the difference, let alone patients and ordinary people.  Allow me to explain below in blue: 

When “Heart Block” Is Not a Blocked Heart: Understanding Two Very Different Heart Conditions

People are often alarmed when they hear that someone has undergone a “heart procedure,” especially when words such as bypass surgery, heart block, and pacemaker are mentioned together. This confusion is understandable because the same word “block” is used to describe two entirely different heart conditions. In reality, these conditions affect completely different systems within the heart and are treated in very different ways.

One type of heart problem involves the heart’s electrical system, while the other involves the blood vessels that supply the heart muscle. Although both occur in the same organ, they are fundamentally distinct in cause, mechanism, severity, and treatment.

A heart block refers to a disorder of the heart’s electrical conduction system. The heart beats rhythmically because electrical impulses originate from specialized pacemaker cells and travel through defined pathways to coordinate the contraction of the heart chambers. When these electrical signals are delayed, partially interrupted, or completely blocked, the heart is unable to beat in a normal and coordinated manner. As a result, the heart rate may become abnormally slow or irregular, leading to symptoms such as fatigue, dizziness, shortness of breath, fainting, or even sudden collapse in severe cases.

Electrical heart block most commonly occurs because of degeneration or fibrosis of the conduction pathways as part of the aging process. It may also result from damage caused by previous heart attacks, other structural heart diseases, inflammation, or scarring of heart tissue. Certain medications that slow electrical conduction through the heart, such as beta-blockers, calcium channel blockers, or digoxin, can also precipitate or worsen heart block.

Heart block is classified according to its severity. In mild forms, electrical signals are merely slowed but still reach the heart chambers, and affected individuals may have no symptoms at all. These cases often require nothing more than observation and regular monitoring. In more advanced forms, some or all electrical impulses fail to reach the ventricles, causing dangerous slowing of the heart rate. In second-degree Mobitz type II heart block and in third-degree (complete) heart block, treatment almost always requires the implantation of a permanent pacemaker.

A pacemaker is a small electronic device placed under the skin, usually below the collarbone, with leads that deliver controlled electrical impulses to the heart. Its purpose is to maintain an adequate heart rate and rhythm when the heart’s natural electrical system fails. Importantly, pacemaker implantation is a medical procedure and not a major open-heart surgery. It does not involve opening the chest cavity or stopping the heart, and recovery is usually relatively quick.

In contrast, coronary heart disease is not an electrical problem at all, but a “plumbing” problem involving the blood vessels that supply the heart muscle. This condition occurs when the coronary arteries become narrowed or blocked due to the buildup of atherosclerotic plaques. These plaques consist of cholesterol, fats, calcium, and inflammatory cells that accumulate gradually along the inner walls of the arteries. As the arteries narrow, blood flow to the heart98 muscle is reduced, particularly during exertion, resulting in chest pain (angina). If a coronary artery becomes suddenly or completely blocked, a heart attack may occur due to irreversible damage to the heart muscle.

The treatment of coronary heart disease depends on the extent and severity of the arterial blockage. In mild to moderate cases, management may begin with lifestyle changes such as dietary modification, regular exercise, smoking cessation, and weight control, combined with medications to lower cholesterol, control blood pressure, prevent clot formation, and reduce cardiac workload.

When arterial narrowing is more significant but localized, coronary angioplasty and stenting, also known as percutaneous coronary intervention (PCI), may be performed. This minimally invasive procedure involves threading a catheter through the blood vessels to the heart, inflating a balloon to open the narrowed artery, and inserting a small metal mesh stent to keep the vessel open. PCI is generally suitable when the blockage is limited in number and severity, often less than about seventy percent narrowing.

However, when there are multiple severely narrowed arteries, total occlusions, or disease involving major coronary vessels, medical therapy or stenting alone is insufficient. In such cases, open-heart surgery known as coronary artery bypass grafting (CABG) is required. During this major surgical procedure, a cardiothoracic surgeon creates new pathways for blood to flow to the heart muscle by using healthy blood vessels taken from the chest wall, leg, or arm to bypass the blocked coronary arteries. CABG involves opening the chest and is a major operation with a longer recovery period.

In short, the key to understanding these commonly confused conditions lies in recognizing which system of the heart is affected. A heart block is an electrical conduction problem and is most often treated with a pacemaker, whereas coronary heart disease is a vascular blockage problem and is treated with medical therapy, angioplasty and stenting, or bypass surgery, depending on its severity. Although both conditions may coexist in the same patient, they are distinct diseases, and confusing one for the other can lead to unnecessary fear or misunderstanding.

 

When Love Meets Medicine : Why Families Do Not Seek Doctors in the Same Family

 
 When Love Meets Medicine: Why Families Seek Healing Outside Their Own Homes?

A Prelude: The Paradox of the Physician Within the Family

Across cultures, across centuries, and across continents, there is an ancient and quietly persistent paradox, i.e.  when illness strikes, families are often surrounded by the comfort of loved ones, and yet when medical advice is needed, they step outside the home.

Even when a family includes a distinguished physician, a specialist with decades of experience, or a doctor whose hands have healed countless strangers, those closest to them frequently prefer to consult someone else. They pay for the privilege, willingly stand in line, and patiently wait for an appointment with a doctor they do not know nearly as intimately as their own relative.

Why is this so? Why do proximity, affection, and trust, namely, qualities that enrich personal life, become obstacles in professional medical encounters? The answers lie in the delicate boundaries between love and objectivity, between lived history and clinical distance, and between the visible and invisible forces that shape human relationships.

Let me share with readers  some of the reasons I believe .

 

1. The Room Where Two Roles Cannot Coexist

Every physician lives two lives:
one as a professional trained to examine bodies and minds with disciplined objectivity, and another as a brother, sister, parent, spouse, child, or friend.

These two roles coexist harmoniously in daily life, until sickness enters the picture. Then the boundary between them becomes porous, unstable, and emotionally charged.

When a loved one becomes a patient, the doctor is no longer standing on level ground. They are standing on emotional fault lines.

The body they examine is a body they have embraced, known, cared for, or grown up with. The voice describing symptoms is a voice familiar from birthdays, childhood,

arguments, reconciliation, and shared history. The hands they may need to treat are hands they have held across the years.

Clinical detachment becomes difficult, if not impossible. Thus, the consulting room becomes the one place where a family member and a doctor cannot safely merge into the same person.

2. Why objectivity dies in the presence of affection? Objectivity is the physician’s compass. Its needle must not tremble. Yet in family care, the needle trembles constantly.

A doctor may over-treat a minor complaint out of fear What if I miss something?"
Or undertreat a serious condition out of denial, It cannot be something dangerous; I cannot bear the thought of it. Patients sense this too. They know that the physician’s emotions may cloud their judgment. And so they may doubt, question, or mistrust advice, not because the doctor is incompetent, but because the doctor cares too much. Strangers accept a doctor’s word. Family members scrutinize it, interpret it, or sometimes reject it, filtered through the lens of family history.

3. The Fortress of Privacy and the Weight of Secrets. Modern medicine to me, thrives on truth, sometimes painful truth, often deeply personal truth. But family members rarely want to expose the most fragile parts of themselves to one another. It is not easy to confess fears of cancer or disability, sexual difficulties, depression, or suicidal thoughts; addiction, alcoholism, or drug dependence, marital problems, financial stress, shame, guilt, or regret.

A relative-doctor, no matter how trustworthy, is still part of the family constellation. Shared information does not vanish into the silent vault of a clinic. Patients fear that it may subtly shift the relationship, alter perceptions, or resurface during conflicts.

I have come across cases where a family member consulted another family member who is a medical specialist, someone whom I personally know. Initially, it was not even a formal professional consultation, it was just an informal question between two family members. That question finally landed up with quarrels and criticisms, involving other family members as well, all because they are of the same family.

Thus, an external physician becomes a confessor,  a safe, sealed space where vulnerability can be expressed without repercussion.

4. Confidentiality: The Sacred Wall That Families Cannot Build. Professional confidentiality is absolute. Family confidentiality is fragile, not because family members are careless, but because relationships are complex, layered, and emotionally charged. Even silence carries meaning. Even a change in expression can reveal an unintended truth.

A doctor-relative may keep secrets faithfully, but the patient still feels exposed simply because the doctor is part of their personal world. This perceived vulnerability is enough to push them outward to a neutral professional.

5. The Subtle Tyranny of Family Dynamics

Every family has its hidden architecture, a pattern of authority, pride, rivalry, unspoken expectations, and lifelong roles. The eldest child may find it hard to receive advice from the youngest, and I shall give a personal example shortly.  A parent may reject guidance given by a child. A sibling may feel insulted when corrected by another. Old grievances may be activated by simple medical suggestions. These dynamics do not vanish in the consulting room; they intensify. Patients want to be seen as patients, not as “the irresponsible son,” “the stubborn sister,” or “the parent who never listens.” A doctor-relative cannot escape these familiar identities. A stranger-doctor, however, enters without history and without emotional baggage, and thus becomes easier to trust.

6. Ethical Constraints: When Medicine Restricts the Heart. What I have read in the past 30 years, is that medical associations around the world advise doctors not to treat their own family members except in emergencies. This is not a prohibition of love, but a safeguard for clinical excellence and legal clarity. Laws governing prescriptions, documentation, consent, and continuity of care are difficult to uphold in informal family consultations.

The physician who treats a relative risks becoming both doctor and defendant if outcomes turn unfavourable. A misdiagnosis can fracture not only a reputation but an entire family bond.

Thus, many doctors decline such requests out of deep concern,  not indifference.

7. The Fear of Blame and the Burden of Guilt

When a doctor treats a patient in the hospital, a poor outcome is a clinical tragedy.
When a doctor treats a family member, a poor outcome is a personal catastrophe.

The stakes are far higher; the emotional cost is far heavier. Physicians quietly fear being blamed being misunderstood being accused of not caring enough living with guilt if harm occurs

Many patients instinctively spare their relatives this emotional weight by seeking help elsewhere.

8. The Desire to Buy Boundaries

Perhaps the most profound reason is this:
Paying an external doctor “purchases” a boundary that cannot be acquired within a family.

The consulting room becomes sacred space, free from emotional ties remembered quarrels, sibling rivalries, parental authority, marital tension, childhood memories. The patient becomes simply “a patient,” and the doctor becomes simply “a doctor.” This purity of roles is impossible to achieve at home.

9. 

My own late eldest sister in Singapore illustrated and revealed this beautifully. Despite my late eldest sister having  a daughter who is a clinical professor and a senior consultant in respiratory and critical medicine in Singapore General Hospital where she is surrounded by her teams of other medical specialists, my sister will not consult her own daughter. But my sister stays in the same house as her specialist daughter. But she would not consult her own daughter s in the same house because my sister told me her daughter always criticize her about her weight. So she rather phone me all the way in Kuala Lumpur to seek my advice. 

We also have  a brother who was a consultant cardio-thoracic surgeon, and nephews who are also medical or surgical specialists, all residing in Singapore where it is much, much nearer her place. But my sister  still preferred to phone me all the way from Singapore to Kuala Lumpur in Malaysia, 350 km away for her health problem even well late into the night. 

Why? Because I am here, a safe distance from her who would not criticize here. I am her neutral island. I am  the loved one who advised without entanglement, without criticism, without the friction of daily closeness.

She trusted me not because I am a more knowledge on health and medical matters who could advise her better, but because I am one who occupied a peaceful place in her life. That is the heart of this entire chapter.

10. The final truth I strongly believe is to protect family relationship. People do not avoid consulting doctor-relatives because they lack faith in them. They avoid it because they value the relationship too much. Health problems come and go. Family is meant to endure. Most patients instinctively understand that shifting a family relationship into a clinical one risks damaging the delicate fabric that holds families together. And so, they choose the safer path to cherish the doctor-relative as family and the external doctor as a professional. In that choice, there is wisdom. I am sure most doctors and their family members will agree with me.