I am a practising full-time doctor in sport and exercise medicine in Singapore and had been a fairly successful competitive athlete locally in endurance events ranging from 10km, 21km, 42km run events, duathlons and sprint-distance to Ironman-distance triathlons. However, I was never good enough to be a national-level athlete to be part of the Anti-Doping Singapore testing pool.

In my job in sport and exercise medicine, I had few encounters with athletes who required me to check medications for them, or ask me if the treatment plan for them have implications in doping sanctions in their upcoming games. It was easy to check on World Anti-Doping Agency (WADA) Prohibited List when I have such encounters. I would not have expected that this would work against me in the manner as below.
 

Background

The story goes back to at least 2016, when I planned to begin a Master of Family Medicine (MMED FM) degree program in mid-2018. I went into overdrive and trained really hard from 2016 in order to complete two full Ironman-distance triathlons in 2017. Then, I focused on only running in the first half of 2018 so that I could pack up my racing shoes/ bike/ goggles once the program commenced. I love to multi-task, so achieving personal best times in the triathlons, half, and full marathons spurred me on further. Even as I stood on the start line of the Gold Coast Marathon on 1st July 2018, I told myself, “this is the last race for a long while!”. The Masters program was to start three days later, but I earned a massive PB in that event. I went on to register for Standard Chartered Marathon Singapore (SCMS) in December 2018, even though I had promised myself that Gold Coast Marathon would be the last competition for me till I complete the MMED FM. I made a conscious effort NOT to put myself in the Elite category even though I was invited for it. I thought it would be “less stressful” that way. I was so wrong.

The MMED FM course work was tough right from the word “GO!” on 4th July 2018. I had to put in 1-2 evenings per week working in a family clinic to meet the course requirements. That was on top of my daytime work in sport and exercise medicine. Add on the constant need to read, study, do practice diary write-up, amend write-up, prepare for clinical and academic tutorials – I was constantly faced with endless tasks. It was a full-time degree load, on a part-time basis, on a compressed timeline, in a working doctor’s life. And this was my second chance at it after having dropped out of this same Master program in 2009 to switch to an A&E traineeship.

At the same time, I had a full marathon to run. Training became really hard to work into my schedule. Training sessions were skipped as the Masters coursework took precedence. Thoughts of DNS hit. Sleep deprivation was real. Then I chanced upon a medication called Modafinil. It was (mis)used by students to stay awake and improve their concentration for school work. Caffeine no longer kept me awake and this appeared to be a life-saver. A quarter tablet of Modafinil worked on those tough days when I needed to stay awake to complete coursework after a day of work/training. I was careful to use it really sparingly in case I developed tolerance to it.
 

The Misfortune

8th December 2018: I had the usual Saturday morning clinic and did a short shake-out run from the hospital after it finished. By some luck, I stepped twisted my ankle stepping awkwardly off of a sidewalk kerb. I cursed and swore loudly as I sat on the kerb hugging my ankle and sobbed away. Maybe God really meant me not to run the marathon. My kind physiotherapy colleague taped my ankle after I washed up. The cursing continued. I went home to continue my course work, crying away. I decided to “see how I feel” the next morning with regards to SCMS.
 

The Event

9th December 2018:
I woke up to a bruised and swollen ankle. But I could step on it. I took an Arcoxia together with a quarter tab of Modafinil because I knew the Masters coursework would be waiting for me after I finished the marathon. I also counted my blessings that I hadn’t entered in the Elite category. What a joke it would have been. I ran the race and it wasn’t that painful. Knowing I had nothing to lose helped me ran an even and conservatively paced marathon. Then came the infamous “heartbreak hill” of SCMS, along Marina Bay Sands, and there I saw the defending female champion. That could not be. I stopped and asked her if we could run together to the finish. But she encouraged me away, “Go ahead Baoying, this’s your year!” I ran away from her with tears in my eyes, incredulous. I knew how much this race meant for her. I turned to look back at her, but she was walking. And so I ran. I heard people cheering. Along the Esplanade, I stopped briefly to vomit. A fellow male runner paused and egged me on. It was all a blur. So I kept running until I crossed the finish line; then I laid down flat after having won the race.

I waited for the next female finisher who was the defending champion. She pulled me up, with genuine happiness for me. Reality hit me when the Anti-Doping Singapore official approached me as I was ushered to the winners’ holding area. I struggled to think what class of drug was Modafinil on the WADA drug list. I wrote everything down on the declaration form and submitted my urine sample as per protocol.

Modafinil is a Prohibited Substance under the WADA 2018 Prohibited List under the category S6, Non-Specified Stimulants. It is a non-specified substance and is prohibited in-competition.
 

The Aftermath

My life changed after the race. I was hit with an avalanche of congratulations, but, at the same time, I was scared. Within the following two days, I had told my closest of friends and colleagues about my likely positive test. Shortly after that I told my boss as well. 

Within the week post-race, I relinquished the title by writing to Ironman Asia (race organiser) and the president of Singapore Athletic Association (SAA). And I asked to be linked up with the Athletics Integrity Unit (AIU), which was handling my urine sample. I wanted the declaration and the relinquishment of the title to be swift, but it was not to be. Meanwhile my life went on. I felt like a hypocrite shaking patients/ fellow doctors/ runners’ hands as they congratulated me, while I felt like I was dying inside. Many days passed with me lying on the floor at home alone, imagining the worst case scenario: being struck off the Singapore Medical Council, losing my job, being called a doper/ liar, not able to hold my head up. Tears accompanied my days as I tried to get on with my daily life.

The notification from AIU about the positive doping test finally came in February 2019. Correspondence shot back and forth as they enquired about the circumstances of my drug ingestion. More correspondence was exchanged between me, and my hospital corporate affairs department and the medical board. After all, I was still a doctor representing the institute. I accepted the sanction given to me. The Singapore media learned of it few days before the AIU listed me on their website. The response was muted. Or maybe it seemed that way after I learned how to selectively mute the notifications from my social media accounts, thanks to the “coaching” I received from the hospital corporate affair department.

I could clearly see who my real friends were, who believed in my integrity, who were willing to work tirelessly helping me craft my statement (which was never released as the hospital corporate affairs department took over my communication), who reached out to ask if I was coping. It also revealed who were the fair weather friends and acquaintances.

I thanked those who reached out to me to express support. I continued my Masters coursework and my regular work. Internally, I still felt like I was dying. Dark thoughts loomed daily. The carpet of my world kept being pulled from under my feet. I lost my clinic sessions at the Singapore Sports Institute, where national-level athletes go to seek medical attention.

I was called into a hospital internal review panel and I was sent to see a psychiatrist to ensure that I’m was not dependent on drug. The doctor psychiatrist was kind and noted that I was really low in mood. But I still had my life to work on. My mood was snappy. Exam stress didn’t help at all. I got called into the Human Resource Department multiple times as well. That was terrible timing, coming in just before my major academic milestones. I poured my heart and soul into clearing this MMED FM program. All that the sacrifices I had made had to lead to success, right?

Solidarity came from my Family Medicine group tutors and the College of Family Medicine program deputy director. They threw their support behind me. Should there be more controversy or if the MMED FM program rejected me as a trainee, or if the Singapore Medical Council decided to strike me off the registry, they would vouch for me. My lovely course-mates, and notably my study group-mates, dragged me out of the dumps to make me fight on in the months leading up to the MMED FM exams. They didn’t judge me; they saw me as a person. I felt much love and warmth from my cohort and I was able to passed the examination.
 

More Challenges Ahead

By contrast, I felt written off as a member within Sport and Exercise Medicine. AIU did not reduce my period of ineligibility as “the Athlete is an experienced athlete and a physician specialised in sport who has served several times as a physician in Major Sport Events (including the Youth Olympic Games) over the past decade. The Athlete failed to exercise even the most elementary caution; in short, she has no excuse.” This point was damning. Even senior sports physicians who knew me personally regarded me as a disgraced member. What made it worse was that I was on the path to seek specialist recognition after the MMED. Now it was uncertain whether I would be accepted into it.

All this time, I continued my work in the hospital sport and exercise medicine clinic and volunteering some time to help out at the Accident and Emergency Department when COVID-19 hit.

I had to seek clarification from Anti-Doping Singapore in early 2020 on the nature of the sanction and how it would effect my work and life outside the scope of sports. The opinion was that “the sanction should not affect (my) professional career and/or career progression.”  

Article 2.10.1 of the World Anti-Doping Code ‘prohibits the association by an athlete or other person with an Athlete Support Personnel who is serving a period of ineligibility. According to Article 10.3.5 of the Code, athletes or other persons if found violating this provision can be banned between 1 to 2 years.’ This restricted my practice to seeing non-elite athletes (i.e. those not subjected to anti-doping test).

ADS opinated that “this article prohibits the association by an athlete or other person with an athlete support personnel who is serving a period of ineligibility. This Article is targeted at an athlete, not the person serving a period of ineligibility. Notwithstanding the above, the views that expressed by our legal advisor do not have any force of law as ADS was not in any way involved in the proceedings held against you. As such, he is of the view that redress or clarification should be sought from either AIU, which is the sanctioning body, the International Federation involved, or WADA.”

I was not reassured by that response.

I had concurrently written to AIU for clarification as well. The issue was that AIU gave a delayed reply in mid-February 2020 to my email enquiring on the nature of the sanction and its effect on my professional practice, stating that AIU “would consider the contents and get back to (me) as soon as possible next week.” I have not heard from AIU since then.

The lonely path I tread, the uncertainty that I face, and the constant feeling that I am being judged by the person whom I’m talking to, I am amazed that I’ve held up this strongly so far. I definitely do not deny that I am fully responsible for ingesting the banned substance in-competition. But I really could not comprehend the full impact of a doping sanction on a person’s life. I could live with not competing as an athlete, but I need my day job. Sometimes I wonder if I had made the initial appeal, would that have changed the trajectory of my life? I am supposed to be informed person due of my work, yet navigating the anti-doping processes is still a maze to me. The lack of support from any personnel was stark the moment I was given the sanction.

Does my case help support the WADA vision of athletes to “Play True”? I would say no. Perhaps to make fear a part of any athlete’s life who is a potential subject of anti-doping testing. Being objective and presenting a deterrent to doping in sports is important, but punishment for an act without consideration of the circumstances is a broad brush that simply sweeps those details under the carpet.