flux

balancing on this knife edge of uncertainty
i want to fall off the precipice
which side doesn't matter
as long as I fall
to end this state of confusion
and emotional torment

Memories

Watching the first episode of "Grey's Anatomy" brought back memories, both good & bad, of my own internship. The busy calls, "Nazi" residents, wonderful consultants who actually treat you like a person who is there to learn instead of just a grunt worker...these were so real to me. I wonder how laypersons reacted to watching how some of the interns were treated (made to look like fools). Doesn't seem too humane, does it? But it happens (unfortunately).

This looks like a promising series - I look forward to watching, and remembering, more.

Pride & Prejudice the Movie (*Spoiler Alert*)

Die-hard Jane Austen fans would hate this movie. Not only did they change & condense bits of the story (especially Darcy's explanation to Elizabeth about Wickham's past behaviour), but the screenwriters also modified some of the dialogue of the characters.

Me? I liked it. I especially liked the lead actors playing Elizabeth (Kiera Knightly) & Mr Darcy (Matthew Macfadyen); Donald Sutherland also did a superb portrayal of Mr Bennet & the scene in the study where he asks Lizzie about her true feelings for Mr Darcy brought me to tears. Judi Dench, as Lady Catherine De Burgh, did not fail to live up to her reputation.

The emotional angst & passion in the story were turned way up compared with the mini-series starring Colin Firth, & will satisfy the ladies who will swoon over Mr Macfadyen's Darcy. The scene in which he strides through a misty hazed meadow towards Elizabeth before they finally declare their love for each other, did for me, what the scene of Colin Firth in a sodden white shirt at Pemberly, did for Bridget Jones. Sigh...

I survived my first Teenage Party

No, not as a participant (I had my fair share of such do's eons ago), but as a Supervising Parent (God, I feel so old as I type that). My older son celebrated the end of the semester, as well as his 14th birthday this past weekend at our condo pool.

Having sixteen 13 & 14 year old boys & girls all in one place is no joke, man, I tell you... All those adolescent hormones raging, one boy was literally almost climbing the wall by the pool till my panicked husband stopped him! They were chasing each other around the pool, in the pool, out of the pool, singing songs, girls screaming/dancing....my poor neighbours...

They had to let out steam I guess, 8th grade is hard work, & it's been a strenuous Semester for the kids with almost no break since Aug (apart from a couple of days over Thanksgiving) till now. If I were them, I'd be screaming too.

But well, I survived to live another day. Don't ask me when I will organise another one of these things again - I need to recuperate first...I have another 2 years before my other son turns 14, so that should give me some time...

Christmas Spirit (or the lack thereof)

My son commented that I had lost the Christmas spirit this year. This was triggered by the fact that till today (count:10 more days till Christmas!) I have yet to put up a single Christmas decoration, let alone buy a tree!

"Why?" you may ask.

Well, first of all, I think that in the local context, getting a real tree is such a hassle, as there are no garbage trucks that pick up the used tree for recycling when the season is over.

Secondly, I have not felt that Christmas magic in a number of years. This is magnified by the fact that in the local context, the original meaning of Christmas has pretty much gone down the drain... I thought that Christmas was the celebration of the birth of Christ? For many (especially kids), it's just another excuse for giving (getting) presents. Oh, I know that there are Christians out there who know that there is more to Christmas than the presents & the tree, but I would hazard a guess to say that if you go out on the streets & interview one of the many shoppers thronging O. Road asking them what Christmas means, 8 out of 10 will tell you "Getting Presents".

I plead guilty to being one of those indulgent parents who tried to bring the magic of Christmas alive, with the tree & the stockings by the fireplace (we actually did have a fireplace while living in the US) & the cookies/milk for Santa etc. etc. Moving back to this tropical clime, this was hard to maintain (how does santa come down the chimney if we don't have one???). Believe you me, I tried to delay the inevitable Truth About Santa from my kids (they believed till they were 9 & 7 respectively!).

Sadly, with growing up also comes the loss of that faith in the magical (there goes the Tooth Fairy). And being caught up in the rat race of life has also resulted in a certain jadedness & a realisation of the hypocrisy over the whole Christmas rigmarole.

Perhaps I need to dig down deep inside & examine what Christmas has really meant to me all these years. Perhaps it has become more than just a religious celebration. Perhaps it is also a chance for us to celebrate the love & togetherness of a family, and a willingness to give joy & happiness to our loved ones. This does sound like it is getting all mushy, isn't it? Perhaps it means that I am starting to feel some of the Christmas spirit after all...

Elitism?

This letter to the editor in today's newspaper gives a different perspective on the difference between the "elite" and "neighbourhood" schools locally. I have heard of similar views from a friend of mine whose child goes to one of these "elite" schools.

I had been grousing to her about my dissatisfaction with the education that my kids were getting in the local system, and had thought that perhaps, it was because they weren't in one of the "elite" schools that the quality was lacking. She then replied that the only difference between these schools & a neighbourhood school was that most of the kids in the elite had the resources available to them to go for extra tutoring & "enrichment" courses; hence they managed to get better grades in their exams.

It was certainly an eye-opener for me that the education system has changed so much from the time that we were in school till the present time. Come to think of it, I remember getting a phone call from my son's Chinese teacher when he was in Pr 1, asking if he had anyone tutoring him in Chinese. At the time, being newly from the US, I had naively thought that putting a 6 year old child through extra classes outside of school was ridiculous, so had resisted doing so. The teacher had been shocked when I said no, & insisted that I should engage a tutor for him, as it was not possible for her to bring his grasp of the language to the acceptable standard without outside help.

Which brings me to the next question: if the teachers themselves think that they are unable to teach a child adequately & requests for the child to get extra tutoring, and if schools ROUTINELY schedule remedial/supplementary classes in addition to the normal school hours, does that not mean that something is not right with the system???

And another thing...I wonder why these "elite schools" tend to be grouped in districts where the affluent live? I know of at least 3 "neighbourhood" schools which have been displaced from their previous locations within these affluent districts (they still maintain their original names a couple of which were taken from the street names where they were located), & their sites taken over by the "elite" schools. Another form of social engineering, hmmm?

Lessons Learnt

Why do you want to become a doctor?

This question has been asked countless times to potential medical students during their pre-admission interview.

Standard answers probably include things like
a) "I want to help people"
b) "I think it is a noble profession".

More realistic reasons would probably include
a) pleasing the parents;
b) thinking that doctors lead glamourous lives (as portrayed on medical TV dramas),& are like the white knights of the days of old, charging in on their gallant steeds to protect patients and slay the disease-dragons
c) wanting to achieve a certain standing in society (doctors have historically been placed on a pedestal by society).

In rare cases, a student truly feels that it is his/her calling to become a physician.

The truth is, yes, you do get to help people -and this is invaluable. What they don't tell you is that you also get a lot of crap in return. And also, that white knight on a steed? Well, sometimes they have to deal with a blunt sword or being able to afford a steed at all; their king may also close off short cuts leading to the patients, & instead decree that they have to take the path that is laden with strewn logs & brambles.

So do I regret the decision I made of becoming a doctor? No. The decision was made according to the circumstances surrounding my situation at that point of time.

And do I think it a waste that I have stopped working as a doctor (for now)? Again, no. I believe I have put in my share of blood, sweat & tears; I do believe that I have saved countless lives, or at least improved the quality of life of many of my patients.

And in return, my experiences & knowledge gained during these years are priceless. I have learnt of the fragility of human life, and the resilience of the human soul to survive seemingly insurmountable setbacks. I have learnt that underneath all that skin, no matter what color it may be, we are all the same. I have learnt not to take life for granted. I have developed "thicker skin" so that ill-meant remarks don't cut as deep (thanks to certain 'senior' doctors during the houseman days). I have learnt to be a (hopefully!) better mother who doesn't panic at the slightest whimper of my child (thanks to postings thru neonatal ICU & pediatric surgery). I have also learnt that this is not a perfect world, and that sometimes, wanting to do right & actually doing it right are two entirely different things altogether. And lastly, I have learnt that politics is inherent in everything you do in this society; no matter how good your intentions are, you still have jump through the right hoops to achieve what you want to achieve - not an easy task if you are one who is not politically-inclined (read: good at brown-nosing).

So to all you potential doctors out there, don't let my rantings & the rantings of other doc blogs discourage you from becoming a physician. Just make sure that you don't go into it with rose-tinted glasses, like some of us did, & you will be fine.

Learning English

This letter in today's newspaper reiterates the point I was trying to make in a previous post.

Learning a language (be it English, Chinese, Malay or Tamil) is more than just filling in the blanks or multiple choice questions. Let's hope the folks in the Education Ministry realise it soon...

Gimme a Break!

Ever since I started my self-imposed sabbatical away from the world of medicine (both clinical & non-clinical) 6 months ago, people I meet, be they family members, friends or even newly acquainted persons, ask me why I stopped working & when I will be going back to work.

My much repeated answer to the first question is, to summarise it: disillusionment, dissatisfaction, re-prioritization of my life.

Why disillusionment? I must admit that this started way back in the first years of my residency, when I was posted through the then-compulsory outpatient rotation (in my case, a polyclinic posting). The workload back then was just as bad (if not worse) than it is now. I remember my personal record of seeing 100 elderly patients with chronic illnesses on a Saturday morning from 8.30 am to 12.30 p.m.!!! It was literally come in, sit down, measure blood pressure/pulse, listen to heart/lungs, repeat prescription & out they went. Not quite the ideal situation for consults, as you can imagine.

Another eye-opener for me was the lack of scruples in our fellow man. My inherent (& perhaps naive) idealism in the goodness of human nature took a battering when I came across numerous malingerers (especially those NS guys -sorry, but this was based on my personal observations) hoping for MCs.

And in more recent times, I have grown increasingly disillusioned with this so-called "noble profession" as I see the dog-eat-dog world of corporate medicine, fighting to get contracts with companies, with undercutting and fancy packages (with sometimes dubious value) geared to attract HR managers. Doctors have become assembly-line workers, churning out patients from their consultation rooms. The higher the number of patients they see, the better it is for the practice since more consults = more $$$. I know that this is not reflective of all doctors, & that my skepticism & jadedness is a result of my personal experiences, but I am sure there are many fellow physicians out there who feel the same way.

And then there are the patients. Period. I am sure angrydoc's blog will give you many examples of doctor's dealings with patients which can be rather, ahem, challenging :). I have also recounted some of these experiences in some of my previous entries.

As for the 2nd question, the answer is simply: I don't know. I have yet to feel the urge or the calling to resume clinical practice. Whether or not I will ever feel it again, I don't know...I may still go back to practising part-time or as a locum, just to keep the neurons firing, but not just yet...let me take a break first.

What a Classic Line!

"I was born naturally, but brought up Caesarean." - Adrian Monk from the series Monk

I heard this line last night on the latest episode of Monk & cracked up! I think it will be a classic. I had to think deeper after my initial response (i.e.ROFL) to its superficial comedic delivery by the talented Tony Shalhoub to figure out what Monk meant when he said that. My personal take on its meaning is that Monk was born, like most everyone else, a normal baby. But subsequent "interventions" (i.e. situations which occur , and people he interacted with during his life) - hence the term "Caesarean" upbringing- resulted in the neurotic person that he is now, with all his oddities & quirks.

I love the analogy & I think it applies to all of us, as each & every one of us have our own distinctive neuroses & dysfunctionalities (to different degrees!).

I love Monk! More, more!!!

English Lit.

The movie adaptation of Jane Austen's "Pride & Prejudice" will hit the local cinemas in December. I have already asked a couple of my ex-schoolmates if they would be interested in coming along with me to watch this chick flick (hubby had resignedly said,"If you really want to watch it, I will accompany you." Sweet intentioned that he is - hee hee - I won't submit him to the torture of sitting through 2 hours of Jane Austen's dialogue).

Reason why I am so keen to watch this is because I remember reading this book for English Literature, one of my favorite subjects in Secondary school. What made it even more fun was that some of us were assigned "roles" (characters) from the book, & we read out the dialogue as if we were acting out the book in a play. Reading this book brings back many enjoyable memories of reading & learning to appreciate the beauty of words & what emotions some words can evoke in me. I remember reading Poetry which could stir up emotions in me that I never knew existed!

Admittedly, Jane Austen's austere & rather long-winded writing style frustrates me immensely at times; and yet, I am still drawn to reading her books (as a matter of fact, I have all her novels); perhaps I am a masochist! I even have some of the previous movie adaptations (Sense & Sensibility, Emma) as well as the TV series version of Pride & Prejudice in which Mr Darcy was played by a rather wooden Colin Firth (highlighted in Bridget Jones' Diary).

Literature is no longer a compulsory subject in local schools, which is a pity. It is a shame that many of our children will not know writings of Shakespeare or Bronte or Austen, nor the poetry of Yeats or Keating. It is obvious that the standard of written & spoken English locally has deteriorated tremendously in the last decade or so. Someone in the Ministry of Education should realise that the study of a language does not comprise solely of filling in the blanks of Cloze passages (what the h*** does Cloze mean anyway??? Can't find it in any respectable dictionary!) & answering multiple choice questions. Children need to be exposed to the different forms of writing & not only will they grow to appreciate the power of language, but at the same time learn so much more about the world around us.

When my older son first transferred to the international school system after spending 5 years in the local system, he struggled with Reading & Language. Yes - this despite the purported high standard of English in the local schools. He realised that what he had been doing previously was just skimming the surface. In his new school, he had to actually read books, analyse paragraphs, and learn to use different tools in writing. It took him a couple of months to change his mindset as far as learning the language was concerned. And it is only recently that I see a change & vast improvement in his language skills when he had to review a poem (below) by Langston Hughes called "A Dream Deferred".

Not bad for a 13 year old, eh?

A Dream Deferred:
Why it’s Memorable

“A Dream Deferred” by Langston Hughes is very memorable because of its vivid, detailed imagery. His use of pauses and hyphens causes the desired, unsteady beat to create stress in the poem. For example, he put “Harlem” at the beginning, asks a question, and he has an off-beat question at the end and they all don’t follow any steady rhythm like the middle of the poem does. He probably did these things in this poem to show that a dream deferred is random and out of place. Hughes also used harsh “st” sounds and “s” alliterations to create undesirable images and slithering, flowing sounds to show slyness. For instance, he wrote, “Or fester like a sore – And then run?” this creates an ugly or even painful image of a sore in the reader’s head. Another example: he wrote, “Or crust and sugar over – like a syrupy sweet?” which creates an encroaching, slithering manifestation of a rotting candy. Using all kinds of devices, Hughes creates a lasting impression in the reader’s mind.

Harry Potter & GOF

Watched Harry Potter & the GOF tonight. Have mixed feelings about it. Loved the special effects, and the stars of the show did a wonderful job, but somehow felt like the movie had a rather chopped-up-then-put-together-again feel to it. I guess the director was trying very hard to squeeze all the important elements of the story into it, without ending up with a 4 hour movie! I wish that some of the supporting characters like Cedric, Fleur & Cho had been given more screen time & allowed to develop their characters a bit more. Even Snape didn't get to show his colors as much this time around. And Sirius was reduced to literally ashes in the fireplace in just one scene.

A-n-y-hoo, I think it's worth a second look (we are such movie buffs that we tend to go a bit overboard sometimes!) to catch some of the minor bits & nuances which we may have missed the first time around. Hmm...maybe will try Gold Class.

Of Witches, Wizards, Magic & Hogwarts

What is it about Harry Potter that draws grown-ups into his world & his adventures? We bought advance tickets for Harry Potter & the Goblet of Fire last week when the tickets first became available for sale. I am probably more excited about the movie than my sons! I have even marked the date on which we are watching the movie in RED on my calendar, that's how excited I am!

I bought the first Harry Potter book (Sorcerer's Stone) out of curiosity about the hoo-ha that surrounded its popularity. My older son was not even old enough to appreciate it at the time. My husband soon got drawn into it by the time the 3rd book came out.

I guess part of the appeal is the fantasy world of magic, where bones can be mended with a potion, or time can be relived using a magical necklace. It's a form of escapism from the real & often mundane world. Something about living in a boarding school also appeals to the teenager in me, who used to read the Mallory Towers series by Enid Blyton, wishing that I, too, could do the same.

I know that come Nov 18 when we are watching the movie, I will be on the edge of my seat with anticipation as the scenes unfold and JK Rowling's words are transformed into the images on the big screen. I also know that I will wish that the movie will never end - that's how it's always been in all the Harry Potter movies- and that the magic will somehow continue...but it never does, and eventually, it has to come to the bittersweet end.

Must-See TV...NOT!

I was appalled at the standard of a local TV drama series which premiered last night called "Lifeline", which is about a group of paramedics & police officers. I am all for supporting local talent if it exists! I wonder if the TV stations have quality control people who screen through the programs first before they are allowed to make the cut into prime-time!

I was cringing through the 1-hour episode with the wooden acting, poorly scripted dialogue, unimaginative storyline; even when the credits were rolling, the background showed a scattering of what was supposed to be ECG tracings (I think!) which looked more like the scribblings of someone testing out a pen at Popular (a local chain of stationary/book stores).

Sigh...local TV needs to be revamped, especially the programming. For the last decade or so, prime time slots of between 7.30 pm to 9.30 pm have been reserved for mainly locally produced comedies, reality programs & now dramas, while award-winning TV programs like Desparate Housewives, CSI, & previously X-files, E.R., Chicago Hope etc were relegated to late night slots of after 10 or 11 pm.


SOAPs are like DOPE

Do you realise that soapy dramas like One Tree Hill have an almost addictive effect on its viewers??? I watched one episode of this series (targeted mainly at the teenage female audience)during one of my "nothing-better-to-do" moments & was reluctantly, slowly, but surely, drawn into the convoluted happenings of this small town called Tree Hill. The story revolves around characters from the local high school - two of them, Lucas & Nathan are half brothers on the basketball team. They share the same father (Dan) whose brother (Keith) is in love with Lucas's Mom (Karen). There is a plethora of other characters like Jake (a single parent to an infant girl), Brooke (Lucas's ex-girlfriend), Peyton (Brooke's best friend whom I think had a fling with Lucas but I am not sure cos I wasn't watching the series when it happened), Haley (Nathan's girlfriend & now wife!) & Jessie (???I think that's her name??? - anyway she is the mother to Jake's baby girl). Latest cliffhangers in the season finale has Nathan's mom (Deb) having a one night stand with Keith; Lucas leaving Tree Hill with Keith; Dan having a heart attack; Coach Whitey (basketball coach) on the verge of discovering the diagnosis of his eye condition; Jessie trying to find Jake who has run off with their daughter after she threatened to fight for custody; & Haley & Nathan finally consumating their relationship after a quickie wedding. Confused enough??? My husband begged me not to tell him about the story ("No, no more...enough!!!") when I was trying to explain it to him while I was watching the taped final episode of the season. I think I will try to cold turkey myself off this series even when the new season starts....

Something's Gotta Give

A renowned advertising executive, Neil French recently resigned after creating an uproar over a remark made about why women don't make it to creative directorship. He said something to the effect that because of motherhood, women just do not have what it takes to get to the top of the heap in the advertising world.

In my personal opinion, his remarks probably holds true for many other professions, including Medicine. The demands & time needed to, first of all, complete medical school, then internship, and then possibly traineeship, are arduous & draining, both physically & mentally. I know that there are thousands of ladies out there who have become excellent clinicians and heads of departments, or set up their own GP clinics working morning noon & night for most of the week and at the same time, have managed to start families, balancing work & family life with amazing dexterity. But one wonders if the quality of life achieved is satisfactory, and whether their families (especially the children) suffer as a result of this tenuous balance.

We may want to be Supermom & Superdoc concurrently, & there are probably some women out there who can be both, but I think that is the exception rather than the rule. Like it or not, women ARE from Venus & men ARE from Mars, and apart from our physical differences, the psychological and emotional make-up of the two genders are very different. Somehow, when men are at work, they are able to focus totally on their job - forget about planning for dinner or whether the kids have homework, or whether the kids are revising for their tests/exams etc. Women, on the other hand, often times have to multitask - seeing patients, planning what's for dinner, making up a grocery list, worrying whether the kids are doing their homework...

I told my ex-boss once after lamenting about the shortage of doctors in our practice: it's tough hiring female doctors, isn't it? What with maternity leave and going part-time once the babies arrive, and children's MC etc... He just smiled & said "You said it, I didn't!" I guess many people don't voice out what is quite obvious in their minds for fear of repurcussions (a la Neil French). But we have to admit that something's gotta give...

Flame on people (:::putting on my asbestos suit:::)

Music & Magic

I brought my younger son, an aspiring percussionist in his school band, to watch & listen to the Cincinatti Pops Orchestra at the Esplanade Concert Hall, in the hope that seeing them perform will inspire him to greater heights with his music. I did not expect to be moved myself, but indeed, moved I was by the magic of movie music brought to life by an amazing orchestra.

The resounding percussion introduction of the theme from "Lawrence of Arabia" actually gave me goosebumps, while the theme from Star Trek: The Next Generation stirred up memories of this TV series - I think I watched every single episode of this sci-fi saga (sigh...I miss Capt Jean-Luc Picard & his crew...).

The versatility of this talented group of performers showed in their interpretation of music from Broadway (Cats, West Side Story), to Disney (Mary Poppins, Beauty & the Beast, the Mickey Mouse Club, to name a few) to epic movies (Star Wars, Harry Potter, 2010: Space Odyssey, Jaws, E.T., Lord of the Rings etc). Their encore finale of a Benny Goodman tune from the Big Band era almost had me Lindy-hopping in the aisles!

What a night it was.

Things that go Bump in the Night

I watched a pseudo-documentary yesterday about movie director M. Night Shyamalan, who has given us great thrillers like "The Sixth Sense" (my favourite of all his movies), "Signs", "Unbreakable" & "The Village". All these movies have the common theme of 'things are not what they seem to be'. The documentary, done in a very tongue-in-cheek manner, implied that Night himself 'sees dead people', much like the character, Cole, did in The Sixth Sense. Although I loved the movie, especially the twist at the end, it scared me to bits! Boy, was I glad then, that my night call days were over & I did not have to wander the hospital from ward to ward in the still of the night...

I have heard stories of certain hospitals here being haunted by spirits; unsurprising, as many of them were pre-war buildings, & were used during the Japanese Occupation for God knows what. One of these hospitals, apparently had hidden tunnels under its grounds, in which the Japanese invaders imprisoned patients & left them there to die.

Fortunately, I do not possess a sixth sense (thank God!) & would be totally oblivious even if an unsettled spirit waved its appendages in front of my face & did the mamba - a blessing, as once upon a time, I did have to wander through the dark corridors of an old maternity hospital to patients located in different blocks...it certainly had the right atmosphere for a horror movie.

Colleagues have told me that certain areas in certain hospitals are notorious for being "inhabited" by restless spirits, but I have yet to hear a first-hand account of such an encounter. So far, it has all been just hearsay. Maybe someone should compile a "True Hospital Ghost Stories" book.

We ARE Human After All

Recently, I attended a lecture by an eminent professor who spoke about medical errors and its impact on not only the patients but also the doctors & healthcare professionals who treat them.

The topic of Medical Errors is an important & interesting one, which was brought to the forefront after the report ”To Err Is Human” from the Institute of Medicine in the USA in 1999, which highlighted the alarmingly high mortality rate & cost of adverse events.

Doctors, nurses & other healthcare professional do not go to work everyday with the intent to kill/maim/injure their patients. We are not God (although some may believe & behave like they are), and human error is inevitable. It is a fact of life. Misdiagnoses, missed diagnoses, mis-treatment, omissions of treatment all happen. Is it avoidable? Absolutely.

A huge first step needs to be taken in changing the climate of fear that surrounds every medical error that happens now. The first reaction (after correcting or attempting to correct it) is usually one of how to cover up the fact that the error had ever occurred in the first place. There is usually a blame fest that surrounds such an error, with fingers pointing every which way. This culture of blame needs to change within the medical community, first, before systems & processes can be put in place to address the problem. Without the fear of punitive action, people would be more willing to identify errors or near misses. After all, if you don’t know where the problem lies, how will you correct it? Currently, who would dare to report the problem for fear of being blamed for the problem in the first place. A vicious cycle, eh? And how would the person who made the error feel? Pretty damned awful.

Now, what systems am I referring to, you may wonder. An excellent example that was given by an expert on patient safety is that of the ATM machine. Previously, people would often leave their ATM cards in the machine after withdrawing their money. So a system was put place whereby the machine would alert the user (with an incessant beeping) to retrieve his card from the slot before issuing the cash withdrawal & receipt. It is almost impossible for the user to leave his card there now, as the machine WOULD NOT proceed with the transaction until the card had been retrieved.

The aviation industry has improved by leaps and bounds as far as safety is concerned, and is often used as the gold standard. So why can’t similar systems be put in place in the healthcare world to minimize risk of errors? In fact, many healthcare facilities in the USA, the UK and Australia have done so with encouraging results.

Here’s a little factoid for you to mull over: the chance of you dying from a medical error in a hospital is higher than you dying in a plane crash or from a nuclear accident. That is to say, being a patient in a hospital is more dangerous than flying in an airplane or working in a nuclear plant – think about it…

It’s time to start making changes, and accept/admit the fact that mistakes do happen in the practice of medicine. We are, human, after all.

Racism & Medicine

Racism reared its ugly head recently in the news, when two bloggers were charged with putting up racist remarks on the Internet. I wonder how many doctors have encountered racism in the line of duty. Don’t get me wrong, I don’t believe that racism is a huge problem here, but I think that racial intolerance does exist even in this so-called multicultural, multiracial country. Usually this is subtle but I have come across overt racism against physicians.

I know of instances in which patients request NOT to consult with a certain doctor because of his/her race (and it was NOT even a language problem because the patients spoke English). This happened in a GP setting in a multi-doctor clinic, and I am pretty sure that this has happened in the hospitals & specialist clinics as well. I am not sure how other clinics or hospitals would handle something like this, but at this place, the clinic acceded to the patient’s request. And this was not an isolated incident. Unfortunately, many local organizations are not progressive enough to face up to such behavior, for fear of losing the business of the clients. Basically, they have sold their soul.

From another angle, I was once accused of racism by a patient and that the medical staff was treating him differently because he belonged to a minority race. Now, being accused of racism by a rather inebriated patient in the wee hours of the morning at the Emergency Department wasn’t something I was going to take lying down. I replied civilly but indignantly to this gentleman that it didn’t matter whether he was black, purple, green, yellow, brown or white, he would be treated just the same. He clammed up after that.

What would you do if you encountered either of the situations above? What would your employer or the institution that you work for do? Would you treat your patient any differently because of his racist attitude? As for me, in the first situation of knowing that the patient is racist, I treated the patient’s medical problem, as I would any other. However, I admit that my behaviour towards this person was colder than normal although I did not go as far as giving a lecture to the patient about racial prejudice. I felt that if I had done so, it might have compromised the doctor-patient relationship.

What would you do?

Ethical Aesthetics & Lifestyle Medicine

I'm sure many have heard of the term "Lifestyle Diseases" - conditions like Diabetes, Hypertension & even Obesity which can be contributed by factors like sedentary lifestyles, bad dietary habits etc.

The term "Lifestyle Medicine" came to mind when I noticed the increasing number of physicians catering to people looking for medical means to "correct" imperfections, be it wrinkles, freckles, love handles, cellulite, flabby thighs (you get the picture). Don't get me wrong, I am not trashing Aesthetic physicians or plastic surgeons; I believe that it is their prerogative to assess and treat these patients if they feel that there are benefits, and I believe that most are ethical & make the right decisions.

However, when I read about things like 'Mesotherapy', 'Carboxytherapy, 'Laser Lipolysis' (not cheap procedures, by the way!), I start to wonder at the true efficacy of using these methods to "treat" patients. The thought of fat being dissolved by lasers/chemicals delivered to the subdermal layers to be subsequently removed by one's own body sounds too good to be true (unless one was living in the Star Trek Universe. I have always wished that we had one of those tricorder devices used by Dr Beverly Crusher in the Star Trek:The Next Generation TV series whereby she could diagnose an illness just by waving one of these thingeys over the affected body part -cool!- but then I digress...).

I hope that these physicians also advise their patients that if they continue with their previous lifestyle habits (not applying sunscreen, not eating right, not exercising regularly), these "conditions" would, more than likely, recur & require more treatments, which means more moolah spent (and correspondingly received)...food for thought, eh?

Michael Buble's concert was a Blast!

Talented, charismatic, good-looking and personable, this dulcet-voiced cutie-pie gave his all & more at his concert tonight! He charmed us all, male & female, with not only songs from his albums but treated us with a touch of opera and a little bit of rock 'n' roll.

Thanks, spacefan, for going above and beyond and getting me a program autographed by Mr B. himself! It was great to meet you finally. I am sure you will be giving us a brilliant review of the concert & a detailed blow-by-blow account of your pre-concert meeting with him (you lucky devil, you!).

Weighty Matters

Have you noticed how many ads there are in the newspaper/TV/magazines for weight loss centers lately? Most of the models used for these ads look underweight - BMIs of probably less than 17! The use of popular TV celebrities for such ads is also very common, despite the fact that these personalities were probably not in need of weight loss in the first place.

Growing up in the 70's & 80's, the obsession with weight (or the lack of it) was already rampant, and I've always had to deal with the "overweight" issue, no thanks to thoughtless comments made by well-meaning relatives & friends. I look at photographs of myself in my mid-teens & to my present self, I looked skinny!!! Fortunately I did not become bulemic or anorexic, but I do believe that I had suffered from a mild form of body dysmorphism, thinking that I was something that I actually wasn't. I only became comfortable with my self after moving out of this country & living in the USA for several years. It was somehow "more acceptable" to be heavier than the so-called beauties that one saw in ads & on TV.

Moving back here again, not only was I inundated with all these images of skinniness that one is supposed to strive for, but shopping in the stores for clothes which actually fit was a nightmare & absolutely depressing. The only clothes which could fit a size 14 (considered "normal" sized in the USA) could only be found in the Womens Plus section. And these clothes were not exactly the epitome of fashion either.

A few years ago, a local celebrity almost lost her life when her liver failed due to her taking a weight loss supplement that was hepatotoxic. She did not appear to be overweight in the first place, but probably under pressure from her peers or from her job requirements, she started taking these supplements. Fortunately, she survived after a liver transplant.

At that time, I thought that it would be a wonderful platform for someone like her to promote being healthy (having learnt her lesson which almost cost her her life) instead of chasing that never ending goal of looking like the models in a fashion magazine & being obsessed with reaching a BMI of less than 17.

Unfortunately, that did not happen & the next thing you know, she appears in ads as a spokesperson for a weight-loss center.

Adolescents these days are faced with so many societal pressures, especially the girls - I wonder what it will take for that all-important wake-up call that health and a good self-image is more important than being skinny. I wish that the media & celebrities would take a lesson from Dove's Campaign for Real Beauty, and start sending the message that self-worth does not depend on what you look like, how large or small you are, what colour your skin is, and how old you are; I know it's cliched, but it's what's inside that counts.

RENT!

Yeehah! Just booked excellent seats to this award-winning Broadway musical that will be performed here. During our many visits to the Big Apple, hubby & I would often say "Hmm, maybe we should catch 'Rent' this time." but we never did. With 2 kids in tow, and given the exorbitant cost of Broadway tickets so that we had to think of the most "cost-effective" way of the whole family enjoying the theatre experience, we always ended up watching more age appropriate performances like "Grease" or "Stomp" (which are both excellent performances as well, by the way). And when we do try to get tickets, it's perpetually fully booked.

But now it's coming to our neck of the woods, & I HAVE TICKETS {jumping for joy!}!!!

One other great thing about this performance is that it is supposed to be direct from New York (although it is also featuring an Asian actress/singer) so I don't have to struggle with understanding Australian accents - historically, "Broadway" plays which come here seem to be mainly produced and performed by Australian casts (nothing against Australia - beautiful country, warm & hospitable people; just darned difficult to understand their speech:)).

A Doc's Life - Memorable Moments 10

This is my final installment in my mini-series of Memorable Moments. Note that these moments occurred over a span of over one & a half decades, and I hope that I haven't given the impression that a doctor's life is full of these "unusual" happenings :). In most cases, a doctor's life is usually routine, oftentimes mundane, and not as glamourous & "happening" as portrayed in most TV series & movies...

Scenario: GP clinic

I am sure that a lot of doctors out there have had the experience of meeting with rather ignorant patients not being terribly clear about their medical conditions & treatment. Eg, when asked about what kind of medication they are taking for diabetes/hypertension/arthritis/gout/heart problem, they reply "One round white tablet, half a blue oval one, & a small red one" like we are supposed to know what kind of medicine they are referring to just because we are doctors).

Patient was an elderly gentleman who was there for a medical examination for insurance purposes. He was accompanied by his wife & son. I took the usual medical history (nothing significant, according to the patient & his family).

When I exposed his abdomen, lo & behold, there was a mid-line abdominal laparotomy scar, at least 8 inches long! The following exchange ensued (note: patient's dialogue has been translated from a local dialect into English, so pardon the glaring grammatical mistakes):

Me: "I thought you said that you had no surgery done before? What was this scar for?"

Patient (grinning):" Oh, small thing only lah. 16 years already - not important!"

Me: "This is a very big scar. Didn't the doctor tell you what was wrong with you before you had the operation?"

Patient (gleefully): "No lah, doctor say cut so I go and cut lor!!!"

I was speechless.

A Doc's Life - Memorable Moments 9

Scenario: GP clinic in the heart of town.

Patient was a lady in her mid-40's complaining of a vague vaginal discomfort of 2 weeks duration. No significant medical history of note; menstrual history was also normal, with LMP 2 weeks prior to consultation.

After taking her history, I proceeded with an abdominal examination and then a PV during which I was surprised to feel a firm irregular mass in the posterior fornix of the vaginal vault. Thoughts of "tumor", fungating mass" etc ran through my mind, but I didn't want to say anything until I could visualise it. I proceeded with a speculum exam & saw a brownish colored FOUL SMELLING mass with a tail - it was a retained tampon (her LMP was 2 weeks prior, which allowed for Lord knows what kind of micro-organisms to proliferate in that very fertile medium...).

The patient was shocked when I told her what it was, & I could tell that until I actually showed her the offending object, she could not believe that she had forgotten to remove it.

My consultation room smelt like something had died and was decomposing, even after the patient had left; and we had to allow it to air out for several minutes, spray plenty of air freshener before it was fit for occupation again. The last time I had experienced something so malodourous was as a medical student doing the forensic path posting and had to undergo the "traditional" exposure to a decomposing body - that smell just sticks to your clothes for the rest of the day...

A Doc's Life - Memorable Moments 8

Scenario - Labour ward of a teaching hospital

I had just helped bring into the world a healthy baby, and had delivered the placenta. I was repairing the episiotomy when suddenly, I hear a "PLONK" of something dropping on the floor behind me.

"Did you drop the baby???!!!" I yelled at the nurse in panic, in the middle of a stitch.

"No," the nurse replied calmly. "Daddy just fainted" she continued matter of factly (I guess it was a fairly common occurence for the men NOT be able to take the bloodshed, gore & trauma of childbirth).

I had to check Dad for head injuries (fortunately, he was fine) after finishing the repair.

I have always known that men are not as macho as they'd like you to think. Somehow, the sight of the episiotomy & the placenta being delivered are the things that tip them over...

A Doc's Life - Memorable Moments 7

Scenario: Local teaching hospital - Internal Medicine ward

My first encounter with death. I was an intern, and medical school definitely did not prepare me for dealing with death, the dying & their loved ones.

The patient was a 40+ year old lady with advanced CA Breast that had metastasised to her lungs. Despite the oxygen mask, she was gasping desparately for air. Her pre-teen daughter was at the foot of the bed, crying; her husband was at her bedside, crying & pleading with his wife to "hang on, fight it, fight it..." Before our very eyes, she was being asphyxiated by the cancer cells that had taken over her lungs.

I wanted to yell at her husband to stop, to comfort his wife instead of asking her to struggle on, I wanted to cry with the daughter, but it was not my place to do so...I had to leave the room to compose myself before I broke down. I did not re-renter it until the patient had passed on. Fortunately, I had an understanding MO.

A Doc's Life - Memorable Moments 6

Scenario: Largest maternity hospital in the local scene; I did a 6 month rotation through the Neonatal ICU.

I saw and did things which I would never have imagined if I hadn't gone through this posting. Among the unforgettable are congenital abnormalities some of which I would be unlikely to see again in this lifetime.

SIRENOMELIA: Or the Mermaid Syndrome. This baby was a BBA (our acronym for Born Before Arrival), still birth, born to a Malay family. It (unclear of it's gender) had just one fused limb with a single toe. The upper half of the baby looked absolutely normal.

CUTIS APLASIA: The baby was literally born without any skin. According to literature, this rare condition usually affects part of the body, most commonly the scalp. However, in the case that was admitted, the ENTIRE baby had no skin. He was covered by a thin transparent glistening membrane. You could see his muscles, superficial blood vessels etc. We kept him as comfortable as possible; setting an I/V on him was a nightmare. He survived for 3 days before passing away.

ANENCEPHALY: This was an undiagnosed case, because of lack of antenatal follow-up. The baby was a stillbirth.

ACHONDROPLASIA: This was also undiagnosed antenatally, despite adequate follow-up. Understandably, the mother was depressed. We kept the otherwise healthy baby boy in the ward longer than normal to prevent the parents from doing anything "drastic" in the immediate post-partum period, and arranged for them to see a counsellor.

One of the most heart-wrenching, gratifying, stressful, tedious tasks we had to perform was the resuscitation and intensive monitoring of premature babies, some as small as 700 grams. Blood gases, electrolytes, parenteral nutrition all had to be closely watched to keep them alive. It became a bit of a moral dilemna for me after watching the effects of surviving prematurity: CP, BPD, developmental delays, mental retardation (some more severe than others). Was it worth saving their lives? I had to accept that the moral decision was not mine to make; as doctors, we were there solely to save lives when called to do so. There was even one instance of a mid-trimester TOP who called for the NICU MO-on-duty (moi) to go to the gynae ward to resuscitate the 23 week old fetus who had been expelled & was actually crying! This little life clung on for 3 days before letting go...It was hard not to weep with the mother, who, for whatever reason, had to go through this ordeal and live with her decision.

This posting was the most stressful and at the same time the most enriching one I had gone through. Not only did I learn so much about the resilience of babies (they are not as fragile as one might think), but it would later serve me well for my adventures as a new mom (I did not become one of those panicky moms who would call the pediatricians when Baby refused to stop crying/refused to suck/poo-ed too much/poo-ed too little). And in the rare free moments, the nurses taught me how to feed/burp/bathe the babies - this definitely was good practice!

A Doc's Life - Memorable Moments 5

Scenario - Orthopedic Dept of a teaching hospital. Patient is a young gentleman involved in a RTA.

This happened midway through my Orthopedic rotation as an intern. It was early in the morning when this patient was admitted through the A & E department. He was a motorcyclist who had skidded and ran into a roadside barrier.

His right knee had been almost totally amputated, and was literally hanging by a skin tag posteriorly. The tibia/fibula had been avulsed from the femur - we could see the glistening white femoral cartilage of the knee joints. It had been so "cleanly" (for lack of a better word) torn off that not even the meniscii nor the cruciates had been left behind.

The team tried to reattach the limb but unfortunately, by the 3rd POD, it was obvious that the distal limb was not going to survive, and had to be amputated. Understandably, this young man at the prime of his life developed clinical depression and had to be transferred to the psych ward later.

During my Ortho postings as an intern as well as an MO, I saw countless injuries, some mild, some fatal, due to motorcycle accidents. I decided then that no child of mine, nor family members, nor friends would get on a motorbike, if I could help it.

Terror Strikes Again

Bali, once a haven & paradise destination for thousands of tourists, has again become a victim of religious fanatics. What makes someone become a willing participant of such an awful act? And I am not talking about just Muslims. Other religious extremists like Christian white supremacists are just as guilty.

If a psychiatrist interviewed a group of such people, would he find that they have some kind of neurosis/psychosis? I just cannot believe that a sane person would do something so vile. I NEED to believe that mankind is not that cruel.

A Doc's Life - Memorable Moments 4

Scenario: Emergency Dept in a small suburban hospital (refer to earlier blog on MM1) at the end of a particularly busy shift.

The hospital operator calls the A & E department to inform us of an incoming patient in labour being driven to the hospital by her husband. Note: this hospital has no O & G Department as it had been recently transferred to a larger maternity hospital. There were also no neonatology facilities.

I was the only doctor on duty that had experience in O & G as an intern, and had also done a rotation in the Neonatal ICU as an MO, so tired as I was, I gowned up in preparation for the patient's arrival. Fortunately, we were equipped with an obstetrics kit.

When the car arrived, I found the mother in the backseat, with the baby already delivered, and apparently healthy (to my relief), still attached to mum. Dad was understandably in an anxious state. I had to go into the backseat area to cut the cord so that mum could be transferred into the hospital where I delivered the placenta, and repaired the small perineal tear. Fortunately, I had delivered enough babies during my internship posting to remember how to check the placenta, secure hemostasis and do the repair.

Mother & child were both well, when we later checked with the maternity hospital which they had been transferred to later, and the labour ward staff were apparently very happy that I had done them a "favour" by repairing the tear for them!

As for the car, I have always wondered what Dad did with the amniotic-fluid-soaked backseat...

A Doc's Life - Memorable Moments 3

Scenario: Health screening facility (same as in MM 2)

This is not quite medical related but it left a mark because it was my closest brush with the showbiz world so far :)

Celebrity 1 - a world renowned movie star from a country in Asia. Very pleasant lady, down-to-earth, with none of the airs one would associate with mega-celebrity-dom. She looked exactly like she does on the big screen. Pity that my fluency in Mandarin is so lacking, and my interaction with her was purely business (i.e. health screening related); it would have been nice to have chatted with her about life as a big-time movie star. But then I am not the sort who would fawn over a star (well, I might make an exception for Tom Cruise or Brad Pitt - hehe). The other staff WERE fawning, and posing for pictures with her etc etc.

Celebrity 2 - not so well renowned the world over; more on the local scene. Rather introverted but pleasant enough, I suppose. Can't blame her for wanting to keep to herself, given some of the crazy fans who can "stalk" their idols. Didn't really know her marital history too well (I am not a huge fan of the local Chinese dramas) so I think she was surprised when I asked her during history taking, what her marital status was. :)

Other "celebrities" I have come across during my time with the corporate practice included MTV VJ's & some local "stars" whom I had to do pre-employment checkups on. Some were more full of themselves than others - I think I probably put them down a peg or two with my ignorance of who they were until after they had left the clinic, my more star-strucked assistants enlightened me on whom they were and what shows they starred in.

I wonder if my reaction would have been the same if someone like Tom Cruise walked through my clinic doors for a consult...

A Doc's Life - Memorable Moments 2

Scenario: Health Screening facility in the heart of the business. Patient A is a SYT (Sweet Young Thing) who is there for a medical check-up - part of her benefits from her company who has signed up for standard package deals for their staff.

As part of the check-up, PAP smears are also included for ladies who need them. I routinely ask them, during history taking, whether they are married or sexually active, before informing them of the neccessity of doing the PAP smear. Ladies who are VI(virgo intacta), I tell them that they don't need to have it done until they start being sexually active.

Me: " I see that you are single; are you sexually active?"

Patient A (bashfully):"No."

Me:" OK, so you don't need to have the PAP smear done today."

Patient A (anxiously): "But isn't it included in the package?"

Me:" Yes, but only married ladies or ladies who are sexually active need this test done. Since you are neither, you are not at risk. Moreover, you are a virgin and doing the test would be extremely uncomfortable or even painful."

Patient A:" But since it's included, I might as well do it."

Me:" You really don't need to, you know." I follow on with a short explanation about the discomfort & possible bleeding that can result from the smear.

Patient A:" Never mind - I want to do it since it is paid for already."

After noting in the case notes that the patient insisted on the test being done despite explanations, I proceed with the procedure at the end of the check-up. Needless to say, it was not a terribly pleasant experience for Patient A...I will leave the nasty details to your imagination...

Sigh...a fine example of the Singaporean trademark of kiasu-ism.

A Doc's Life - Memorable Moments I

Scenario: 7 year old boy, admitted to the Emergency Department of a small suburban now-defunct Hospital on a sweltering Saturday afternoon.

This little chap had the misfortune of catching his unprotected foreskin in the zipper of his shorts. Now, I don't know why, but in the local situation, many parents do not seem to see the wisdom of having their young sons put on underwear thereby exposing their nether regions to the hungry teeth of zippers.

Anyway, usually, with such patients (& I had seen a few, young & not so young), I'd apply some topical LA (for what it's worth :), probably more for its psychological benefits than anything else) wait 1 minuntes, then yank the zipper loose and "Voila", the member is free with nothing more than a mild abrasion. The patients would then be sent home with some topical antibiotics without further ado.

In this case, however, and exceptional large piece of foreskin had been caught by the zipper (sorry guys, I can imagine the winces and thighs clenching together) and the aforesaid method did not work. I must admit that this patient was extremely brave and did not cry a tear.

Undaunted, I asked the nurse for a pair of forceps, hoping that I would be able to pull off some of the zipper's teeth, hence freeing the patient's organ. Now, this was a particular busy Saturday afternoon, with many patients and staff outside the treatment area (separated by a curtain). There I was, sweating buckets, trying my damnedest to loosen the darn zipper, and the boy yelling at me,"Don't touch my penis!!!" repeatedly, and me responding," I am NOT touching your penis!". I wonder what the other patients must have been thinking...

Unfortunately, my attempts proved unfruitful, and the boy had to be admitted to the Surgical Department, where, apparently, even under GA, the surgeons were unable to remove the foreskin from the zipper. The patient ended up with a circumcision.

The Force is With You

Patients, my young Padawan, will prove to be both the reason AND the bane of your existence. They will be the ultimate test of your abilities to resist the Dark side.

You will face the challenge of remaining calm when faced with a storm of demands from multiple patients and their families.

You will face the temptation of profiteering by selling generic drugs at brand name prices.

There will be times when you will feel the urge to succumb to the Darkness called MHCs.

There may even be times when you will feel overwhelmed by Anger & Frustration as you try to deal with these entities called Patients who will test your endurance to the limits with their unending questions about their ailments, and demands for cheap and immediate treatments for their illnesses.

Remember to take a step back, breathe deeply and focus on the reasons why you took the steps towards becoming Medi Masters at the Beginning of your Journey. Find strength from within and from the Force of the Hippocratic Oath and remember the Medi Masters of the past who have had to deal with greater Patient loads than you.

May the Force be with You.

"Must-see TV"

LOST
This series is like quicksand: it sucks you in bit by bit, week by week, till you are stuck and enmeshed in its sometimes complicated plots & flashbacks. My favourite character is Locke - the ex-paraplegic with an astounding knowledge of weapons & the art of survival, who mysteriously regained the function of his legs after the plane crash. I can't get away from watching this!

CSI (the original series)
Somehow, the characters from the original CSI (based out of Vegas) are more appealing with their quirkiness & idiosyncracies, especially Grissom. I must admit that it took me some time to get hooked to the series.

Las Vegas
A light drama, not terribly imaginative with its stories, but its fast pace & unique camera work & editing is addictive. Plus its characters are appealing, with eye candy for the guys as well as the girls (Josh Duhamel - yum).

House MD
The latest medical drama, which I believe has garnered a few Emmy nominations. Appealing to me as a doctor because its main character voices out loud what many doctors keep inside...their true feelings about some of their patients and the practice of medicine today. Hugh Laurie does a great job in the lead; it is hard to believe that he is actually British.

Gilmore Girls
This much ignored series has wonderful dialogue with lively exchanges between Lorelei & Rory Gilmore (mother & daughter). It makes me wish for a similar relationship with my own mother...

AGING SUCKS

I am beginning to feel more aches and pains these days. No matter that I didn't too anything extremely strenuous; it could be just from sitting or lying in one position for too long. The MCP & IP joints of the fingers are also feeling it. I tried playing the piano after long years of not touching a keyboard - my fingers didn't feel like my own. I used to be able to do scales & arpeggios like nobody's business. Sigh.

I played tennis with my boys a few weeks ago. OMG, when I tried to hit a ball overhand, I felt something pull on the right side of my back, snapping like a broken string of a guitar. Thank God the pain was only temporary. But it made me realise that my body is aging faster than my mind. Sometimes, I still feel like the teenager who used to play tennis for ECA.

The eyes are also starting to go. Reading the road directory is a chore now, especially the street names. And trying to read the lipstick color off the base? Fuh-get it. I can still read the newspaper...but I know I am fighting a losing battle & will need reading glasses in the coming year or two.

Sigh.

Circumstances

My niece has been groaning & moaning about school & the system. She wants to join a school that offers the more well-rounded IB program but cost is a huge factor as my nephew is already attending it. Her mum can't afford to put both kids in there, & out of her 3 kids, My niece is "the one most likely to survive the local system". Unfortunately, this will probably mean that she will end up in the local uni with its straight laced programs & parroting form of learning. Hopefully she will choose to major in something that will allow her to widen her horizons after she graduates.

I feel melancholy when I heard the phrase in bold above, not that I fault my sister at all. But I was in the same position as my niece during my schooldays. As the "brainiac" of the family, I made it into JC & then in NUS. Not so for my sis & bro. Because of their "lesser" academic abilities, they were given the chance to pursue their studies overseas & in "alternative" albeit more expensive methods. My parents could not afford to do so for all of us.

Ironically, I found myself trapped in a system that did not encourage me to explore & stretch myself, & subsequently, followed the safe & tried route of becoming a well-respected professional. I can't say that I made the wrong decision in my choice of career, as I made the best decision I could given my circumstances & what was available to me at the time. But I want & hope that my own children will be given wider choices as they develop & find themselves. Hopefully, they will end up doing what they love & have a passion for, and be able to earn a living doing so.

Hence all the sacrifices that A & I are willing to put up with, in placing them in an excellent international school with a curriculum & teachers which even the local university would envy.

I can't help but find myself wondering "what if"...if I had been given the chance that my kids have now, would I be doing something that I passionately believe in & love? I guess I will never know...

Human Nature

Watching the afternmath of Hurricane Katrina, human nature has reared its ugly head. Looters, rapists, murderers taking advantage of the catastrophe. And all the political finger-pointing which to me is pointless now. Get a grip, people! Use all that energy for more constructive purposes, puh-leese!!! Leave the blame fest till later!!!

Loss

Yesterday, I attended the wake of a classmate's 16-year-old daughter. She had passed away from a congenital heart disorder which she had been diagnosed with in the antenatal period & had not been expected to live beyond the first weeks of life. She miraculously beat the odds & survived till her 16th year without any corrective surgery.

I cannot fathom the heartache & sorrow which my friend & his wife must be going through on losing their child. Although they had 16 good & fulfilling years with this miracle child, & have 3 other children to help them bear their loss, she was still their daughter.

I cannot imagine losing either of my children, and hope that I will never have to go through the experience...

Neither Here Nor There

I guess that's kinda like what I am feeling right now. We have finally moved & settled in (more or less). Part-time maid started today so I don't feel so stressed about housework now... Kids started school last week & we have to get into the new routine of the long commute.

Next step for me is figuring out what to do with my spare time - volunteer work? Art courses? Riding lessons? Start my own consultancy business???

House M.D. - new series about a cynical, jaded senior consultant with horrible bedside manners! The dialogue really cuts to the chase about how doctors (moi, for one) think & feel about their profession & some of their patients! House: "Treating illness is why we became doctors; treating patients is what makes so many doctors miserable."!!! His response to a mother who refused to give steroidal inhalants to her son for fear of "powerful" medicines was also a gem. Wish I could have used some of these House-isms when I was working at Shenton!

Insomnia

Haven't been able to sleep well/enough the last few days. Probably due to the fact that we are in the midst of preparing to move into a new apartment which we have just completed renovations on. Now the hard part of packing & & cleaning & moving things over.

Had a garage sale last week to try to find "better homes" for some of our belongings. The preparation that went into this was very much like going through the memories of the last 15 years. Bittersweet sometimes, nostalgic, a bit sad, as I realise that my kids will never be babies again, and that I will not have anymore babies to hold (until one of the my boys give me grandchildren!) Going through the photo albums was especially emotional, looking at pictures of people who looked so youthful, some gone forever, some ageing gracefully, some not so gracefully.

I can't wait for this move to be over and done with...maybe I can get some sleep then...

quickie

just a very short entry now: been too busy to post. New home, moving, packing, sorting, organising, worrying, stressing...you get the picture. Add sleep deprivation to that & it's not a pretty picture.

more later...

BLACK, WHITE OR GRAY

MJ was found "not guilty". I admit I am relieved that he is not going to jail. Have never been a huge fan of his but couldn't help but get caught up in the media frenzy over this child molestation thing.

Poor guy has psych problems. I don't think he molested the kids, but definitely exhibited inappropriate behaviour. I remember the interview he did with 60 minutes or 20/20 or some other primetime news/talk show in the US after the first allegation back in the 90's. I remember his responses to the inteviewer's question (was it Ed Bradley???) on whether he thought it was OK for an adult man to share the same bed with a young child. He had been adamant that it was an innocent act...something special....nothing dirty about it. I remember thinking -"he has problems"...

I hope he gets psychological or psychiatric help to work through is Peter Pan issues & self image problems.

And I hope that the parents of so called victims come to their senses...

Phases

I have been asked if I have had any regrets in my life. I believe that we go through phases in how we answer this question.

In my 20's, my immediate answer would have been an immediate "Yes!" I would have studied ______ instead of ______, I would have done this instead of that, etc.

In my 30's, my answer would have been a "Maybe, but..." where I would be waffling between alternate options.

Now that I've arrived into the 40's, I have a much more philosophical approach to this question. I think that all the decisions which I have made in the various stages of life were the right ones given the particular situation that I had been in at the time. Yes, I definitely have regrets in the directions that I have taken in life, but I don't think I could have done any better even if I could live my life over again under the same circumstances.

So I think I should make do & be grateful with what I have & look forward to the second half of my life with enthusiasm!

Men are from Mars & so on & so forth

It's true! When you leave them to plan their schedule, somehow, some way, it gets messes up! If it's not work related, you can be pretty sure that a pre-arranged engagement or dinner, or music lesson will be forgotten. Doesn't matter if he's 14 or 44 - they still forget...

Day Four

My fourth official non-working day today - I still have not come to terms with the fact that I am not employed.

I don't understand why I have these conflicting thoughts & feelings of guilt when it comes to this. I know that I feel more relaxed now, less headaches. And yet, there is this nagging doubt in the back of my mind that I should be doing something more productive than just spending time with the boys or pursueing leisure activities on a weekday!

Hope it gets better. I really need to find an art course or writing course to take up. Maybe take riding lessons...

DON'T MESS WITH MOM!!!!!!

I came across this poem on the Internet a couple of days ago. It was posted by someone in response to an SOS from someone who was having attitude problems with her brat.

Fortunately, I am not having such problems yet (& hopefully never!) but found the poem amusing nevertheless...

DON"T MESS WITH MOM

My son came home from school one day,
With a smirk upon his face.
He decided he was smart enough,
To put me in my place.

Guess what I learned in Civics Two,
That’s taught by Mr. Wright?
It's all about the laws today,
The "Children's Bill of Rights."

It says I need not clean my room,
Don’t have to cut my hair.
No one can tell me what to think,
Or speak, or what to wear.

I have freedom from religion,
And regardless what you say,
I don't have to bow my head,
And I sure don't have to pray.

I can wear earrings if I want,
And pierce my tongue & nose.
I can read & watch just what I like,
Get tattoos from head to toe.

And if you ever spank me,
I'll charge you with a crime.
I'll back up all my charges,
With the marks on my behind.

Don't you ever touch me,
My body's only for my use,
Not for your hugs and kisses,
That’s just more child abuse.

Don't preach about your morals,
&n bsp; like your Mama did to you.
That's nothing more than mind control,
And it's illegal too!

Mom, I have these children's rights,
So you can't influence me,
Or I'll call Children's Services Division,
Better know as C.S.D.

Of course my first instinct was
To toss him out the door.
But the chance to teach him a lesson
Made me think a little more.

I mulled it over carefully,
I couldn't let this go.
A smile crept upon my face,
He’s messing with a pro.

Next day I took him shopping
At the local Goodwill Store.
I told him, "Pick out all you want,
There’s shirts & pants galore.

I've called and checked with C.S.D.
Who said they didn't care
If I bought you K-Mart shoes
Instead of those Nike Airs.

I've canceled that appointment
To take your driver's test.
The C.S.D. is unconcerned
So I'll decide what's best.

I said "No time to stop and eat,
Or pick up stuff to munch.
And tomorrow you can start to learn
To make your own sack lunch.

Just save the raging appetite,
And wait till dinner time.
We're having liver and onions,
A favorite dish of mine."

He asked "Can I please rent a movie,
To watch on my VCR?"
"Sorry, but I sold your TV,
For new tires on my car.

I also rented out your room,
You 'll take the couch instead.
The C.S.D. requires
Just a roof over your head.

Your clothing won't be trendy now,
I'll choose what we eat.
That allowance that you used to get,
Will buy me something neat.

I'm selling off your jet ski,
Dirt-bike & roller blades.
Check out the "Parents Bill of Rights,"
It's in effect today!

Hey hot shot are you crying,
Why are you on your knees?
Are you asking God to help you out,
Instead of C.S.D.?"

Last day!!!

Hmm...I can't explain how I feel about this, my last day of work. A bit sad, a bit anxious, I must admit. Definitely looking forward to having time for myself!

Here's to the beginning of a new phase of life!!!

Communication

Lines that connect
Between people and places
And across time.

Simple and complex,
Lines can Function,
Dysfunction, Malfunction.

Lines broken, interrupted
Repaired, re-joined
Strengthened, weakened
Maligned, aligned, ignored.

A network, a framework
The fabric of society.
A scaffolding that holds up
Or collapses in dis-unity.

Transitions

I must admit that the thought of not working is bothering me somewhat. Don't get me wrong - I am looking forward to the extra leisure time that I will have to pursue interests which have been put off for so long. But I think Society (here, anyway) has ingrained the value of being a "contributing member" by being in the work force, that I have absorbed some of it through osmosis.

I am going to remind myself that becoming a SAHM again will mean that I can be more involved in my children's lives again; in this sense, contribute to their development so that THEY in turn will become well-rounded individuals who will contribute to society.

I am going to remind myself of the yearning that I've had to exercise some of the creativity that I believe is hidden within me, and take up a course in Painting or Creative Writing or something similar which would hopefully start some of the creative juices going.

I am going to remind myself that this will give me more time to exercise and lose some of that mid-life bulge.

And finally, I am going to remind myself that it is OK to think of Me, once in a while.

The Little Black Ant

I watched today as a little black ant made its way around the perimeter of my computer screen. Round & round it went, at least 4 laps before deciding that it was a worthless venture with no end in sight.

To me, it was a great metaphor for this journey called Life, and it made me wonder what lies at the end of the road for all of us. Could it be that this Circle of Life which we are all a part of, is being observed by a greater being who is, even now, watching us with amusement as we go around in circles, much like how I was amused by the pointlessness of the little black ant's journey.

I guess we will never know...

3 Weeks To Go

Well. 3 more weeks and that's it. No more work. It will be the first time in a long time since I've had time to do "Me" stuff. Even the 6 years spent as a full time SAHM in the US doesn't count as I had two young children to take care of. Who had time to take yoga lessons or art courses or riding lessons or go to the spa etc etc?

It will feel strange not earning my keep, so to speak. It will be interesting...

Commitments

We made an offer on a condo a couple of days ago. I must admit that I felt rather apprehensive just before doing so, although it makes more financial sense rather than pouring money into a rental.

I guess part of the apprehension is due to the fact that this means a commitment to staying in one place in the long run....for someone who has been literally on the move for the last 13 years, this is a big change of mindset.

I have often pondered over the concept of home and what it means to different folks. For me, I guess the most important aspect would be where my family is (spouse & kids) - in that sense, "Home Is Where The Heart Is" is very true. And yet, having lived halfway across the world, I know that in my heart of hearts, although home may have been Jacksonville, FL or Schwenksville, PA for a transitory period, ultimately, Singapore is where I feel most comfortable in.

This doesn't detract from my ambition to see the world and experience as many cultures & countries as possible; all it means that when I reach a stage where I am unable to be as mobile as I'd like to be, I would be quite happy to see the end of my days in the country where I spent my formative years.

Letting go

I wonder how many mothers out there are really prepared for their child's first romance...

My first born is taking another step towards adulthood. I just found out that he is the "apple" of someone's eyes in school, and has been the recipient of "sweet" messages from this certain someone.

I have to say that I did not expect the wrench of my heartstrings when I discovered this new development. It hit my gut like a punch. I am not ready to let go of my "baby", and for him to be the object of someone's puppy love. I admit that I am jealously guarding him (probably in futility) from female advances of the romantic kind.

At the same time, I don't want to hinder his emotional and social growth so that he would become one of those men who are unable to hold a decent conversation with a girl without breaking into a sweat or stuttering.

This motherhood thing is gut-wrenching!!!

Check your Breasts!!!

Had my yearly mammogram done yesterday - this is the 2nd one I've done. It's scary, when the radiographer says that she has to do 2 additional views. Paranoid thoughts race thru your mind, wondering "Did the radiologist pick something up?" This is made worse when you are 'invited' to the ultrasound room for a supplementary scan to be done.

Just as scary is when you are waiting to pick up the results. After what seems like an eternity, the clerk calls your name and hands you the big envelope. With racing heart and shaky hands, you open it and search almost frantically for the report. You breathe a sigh of great relief as you read the Conclusion: No evidence of malignancy. Spirits lift again, as a great burden seems to come off your chest (no pun intended).

I wonder if it's just as scary or even more so for non-medical people.

Ladies, check your breasts monthly, and if you're over 40, do routine mammos yearly scary though they may be...it could save your life.
.

Grow up!

I wonder when Singapore will grow up. I hear the arguments put forth by anti-casino groups and to me, it all sounds very self-righteous.

It's time to treat our fellow Singaporeans as adults who should have free choice on whether or not they want to step foot in the casinos. Don't impose your own morals and religious values on others. Stop asking the government to make the decisions for us. It's time to grow up and make our own decisions whether it involves watching a movie uncensored or engaging in occasional gambling for recreation.

Evidence-based Medicine or Medicine-based Evidence?

EBM or MBE?

The term “evidence-based medicine” has been much bandied about for the last decade or so. It has been used globally as the “in” way of practicing medicine.

As far as the scientific process is concerned, EBM seems to make the most sense in terms of giving the patients the best available treatment to treat their respective medical problems. In layperson’s language, we doctors are using proven methods of treatment.

However, Medicine is not purely a science – many would agree with me that it is also an art. One hopes that with the use of EBM, physicians will not lose that extra touch of compassion that should come with healing the sick. Patients are not just subjects of scientific studies. They are human beings first, who happen to be sick.

Speaking from experience as a physician, a patient and now a pencil pusher, I notice that the art of communication between doctor and patient has been lost. I hear of many complaints arising from either a lack of communication, miscommunication, or insensitivity in communication between the doctor and his/her patients. Have we become so evidence-based that we now lack the human touch when it comes to dealing with our fellow Man? Is the process of keeping the patient and his family involved in managing their own health so difficult, or has it just become a low priority in the busy doctors’ schedules?

Perhaps the “touchy-feely” aspects of medicine is not emphasized enough in medical school. Communication, compassion, and empathy are all important parts of the doctor-patient relationship. Oftentimes, harried doctors, jaded by their experience with upset patients & family members neglect to develop these “softer” skills of being a healer. Hard as it may be, it is time to take a step back and consider practicing “medicine-based evidence” (to coin a phrase that I recently picked up while attending a very enlightening seminar) in concurrence with evidence-based medicine.

Instead of referring to a patient as a bed number (“Bed 12 needs a urine culture done.”) or a diagnosis (“The Ca Liver needs a LFT done today”), we should refer to them by their names and remember that they are first and foremost, someone’s mother/father/daughter/son. We should also remember that doctors are first and foremost, human beings. Somewhere along the way to attaining a medical degree and becoming a doctor, perhaps because we have focused so much on the evidence-based Science of Medicine, many of us have forgotten or lost the Art of the Practice of Medicine.

I hope that the Faculty members in NUS will consider including an extra module in the medical curriculum to “teach” and show budding doctors the importance of the softer and more human side of Medicine.

Utopia

Working in the civil service the last 6 months has been an eye-opener for me, not just in terms of learning about the workings of local politics, but also of realising how utopian my own view of - "the way things should be" - is.

It amuses me that looking out from the inside, people are actually very fearful of the government (although it shouldn't surprise me <>). Literally. You say jump & they jump.

Another thing that I've realised (and here , I admit that I have been rather naive) is how powerful "The Government" is. Example: I attended a meeting today where there was discussion over how to manage a potential national problem. The meeting was attended by consultants, heads of department, very respectable & knowledgeable people in their fields. And yet, they raised the issue that without support & "recommendations" from the government, their suggestions on how to handle this problem would be moot as the administrators would rather look at the bottom line! Amazing.

My view of medicine is : if it's right, do it. However, when you are within the political system, this view has to change to: if it's right, do it in a politically correct way, although it may mean do it differently. Confounding to me, but I guess I have to live with the system & lower my ideals.

It's About Time, People

In today's newspaper, a reader wrote in to add his view to the recent discussion about withdrawing treatment or life support in extremely ill patients. He wrote that doctors should not think themselves as God in making this decision. Another reader, an ICU specialist, wrote in, coming from the other side of the coin, explaining that doctors have to communicate with their patients and their families, giving complete and clear information to them in order for them, ESPECIALLY the patient, to make their own decision. He also emphasised the importance of the Advanced Medical Directive as many times, patients who are critically ill & have not signed this directive, are unable to voice their wishes, resulting in much distress to their families & themselves, as well as a huge financial burden.

In response to the first reader's view that doctors think themselves as God, I feel that he has erred in his thinking. Doctors don't think themselves as God; patients think of doctors as Gods and allow them to make the decisions for them. Majority of patients don't question the medical management given to them - they just accept it as "if you say so, it must be OK." It is time that patients empower themselves with the knowledge that is so readily available now, especially with the powerful Internet search engines. They should start researching for information about their own health. It's time to stop being lazy and to stop accepting your doctor's word as the Bible (a good doctor wouldn't mind - in fact, it would help that you understand in some detail what is actually going on).

The second reader is absolutely right about the importance of communication with the patient and his family with regards not only the withdrawal of life support, but also any kind of information that relates to the patient's condition and treatment. Sad to say, the skill of communication is lacking and not addressed in medical school. I say it's time to review the curriculum, and add on a module on "How to Communicate" in medical school - maybe use some of that 200 million dollars that was just donated to the medical faculty to start such a program.

In addition to communication, trained counsellors or psychologists would also be helpful adjuncts to dealing with families whose loved one is terminally/critically ill. Often, the families are trying to deal with their grief and their loss, and one reaction is to try to find someone to blame for "causing" their beloved to die.

Unfortunately, I see many such cases in my line of work, where a combination of poor communication, and the loss of a relative leads to much unhappiness with the medical care given (despite this care having been appropriate).

It's about time for a paradigm shift in the way we practice medicine and in the way we "receive" medicine.

The Suspense is killing me

Man, I hate not knowing...are we moving? Are we staying?

I like to plan ahead. I don't like last minute surprises - stresses me out.

Gaah!!!

This Painfully Wonderful & Perilous Journey Called Motherhood

My son fell and bumped his shin & scraped his knees yesterday. I saw it happening but was too far away to stop it from happening. It was a hard fall and I know it must have hurt tremendously, especially on the shin judging from the large hematoma that formed very quickly, but my 11-year-old "I am not a baby" son was too brave to cry though I could see that he was trying very hard to hold the tears in.

I could feel a tugging in my heart as this event occurred and even after it had occurred - almost as if I was the one who had been injured. I wouldn't call it a physical pain, but it was definitely not a comfortable feeling. I think all mothers feel this "pain" when they see their children physically or psychologically hurt. It comes with the territory of being a parent. Whoever said "This hurts me more that it does you" while punishing his child was right. This bond between parent (I think it is more pronounced for moms!) and child is a strong one and will never break whether the child is still a child or has become an adult with his/her own famiily.

Bali…Island of the Gods

My family visited Bali for the 3rd time last week. It is truly a great place to go to chill out and basically do nothing if you are so inclined. Alternatively, there are a variety of sights (eg.Gunung Batur, Tanah Lot), cultural activities (Indonesian dance & musical performances like gamelan) and artsy areas (i.e. Ubud - overrated & overly commercialised, in my opinion...need to find a local to look for more reasonable prices) to visit. Shopping, for Singaporeans of course, is a no-brainer.

We stayed on Nusa Dua - a nice beach but rather touristy with numerous beach touts selling their wares and assorted water sport related services. The sea was not terribly clean (plastic bags floating around) but had an abundance of sea life which made exploring the rock pools at low tide a great adventure. My younger son and I spent a wonderful time doing just that, discovering live coral, starfish, crabs, seashells and the occasional dead fish (paranoid kid that he is, he said, "A tsunami is coming!") It was one of those snapshot moments which hopefully in the years to come, will be something he will look back on fondly as quality time spent with Mom.

I still remember the vacations I used to spend with my family as a kid in a beachfront bungalow in Port Dickson, Malaysia, with a number of cousins, aunties, uncles and grandparents. We frolicked (<-- ha! Always wanted to use this word!) in the sand, played water games, explored the tiny "caves" which were exposed at low tide, looked for fish (only found mudskippers) in the rock pools and literally spent every waking hour in our swim suits. Of course, we all got terribly sunburnt (those were the days before sunscreen) but that never deterred us kids. Indeed, those memories are one of the precious ones which I will never let go.

Short takes on...

...the Da Vinci Code Debacle:
Hello, people!!! This is a work of fiction! I thought the book burning days were long gone.

...American Idol technical problem:
I wonder how this will affect the results. My fave is still a tie between Bo Bice, Carrie Underwood & Anwar Robinson. :)

...the Aids issue brought up by Dr Balaji:
Lets hope that the hoohaa about whether this is a homophobic statement or not will not cast a shadow over the larger problem of keeping the transmission numbers down, hopefully with Public Education programs to BOTH hetero- & homosexuals.

Changes

"Courage is the power to let go of the familiar." - Khoo Swee Chiow-

This local adventurer who has scaled Mount Everest, reached the North and the South Poles, swam the Malacca Straits, and plans to swim the English Channel this year (despite having just learnt to swim last year!) gave a motivational talk at work today.

This phrase that he used struck me, as our lives will probably undergo some major upheavals this year, with a move to a foreign country. The kids will have to acclimatise to a new school, we'll need to find a new home, and probably have to try to learn a new language as well.

Frightening, exciting, unfamiliar changes. But I know we can do it....we've done it before, and will probably do it again many more times. Do I wish that we have a stable place to call home? Undoubtedly, I sometimes do. But I believe that the experiences that we, and especially the children, have been/are/ will be exposed to, will enrich our lives, and hopefully help us grow to become global citizens who are more tolerant of the world and the people who share it with us.

Life is an adventure, as someone once said. Let us have the courage to live it.

Milestones

I wrote about milestones too, in my surge of inspiration. 2004 was indeed a year of milestones - I reduced my working hours and changed to part time work instead, then decided to get away from clinical medicine altogether, and made the extremely unorthodox move of joining the civil service instead. Man, did I feel like a dinosaur (still do!) People I met within the Ministry were unsure of what to make of me, with my background of coming in from the private sector, and my "maturity" (ahem) and experience.

This was my "Milestones" entries from 2004:

**************************************************************

Milestone #1:

I turned 40 this year. As I approached this milestone, I pondered over my life – its quality, its priorities, and my mortality. Was it worth it to slog on in the clinic, seeing my children & husband only after work in the evenings & partial weekends, usually fatigued & drained? These precious hours were sometimes reduced further by attendance of CME programs in order to accumulate those much needed points for registration.

I made a decision to reduce my working hours, spend quality time with my 2 children, who, after all, will (hopefully) go on to college in 6 to 8 years’ time…not a lot of time left, I reckon. I am fortunate that I am in a situation that enables me to work on a part-time basis. But I wonder about the quality of life of my colleagues, especially those GP’s who have set up their own practice, working 6 to 7 days a week, often doing morning, afternoon & night sessions. Where do they find time to spend with their spouses & kids? They seem to be killing each others’ businesses by keeping their clinics open up to 24 hours a day, trying to compete for the same pool of patients. Getting locums to cover some of their sessions may be difficult at times, especially during “peak periods” like school holidays, or public holidays & weekends – and yet they persist. I admire their tenacity & dedication to the practice of medicine…or is it just a matter of survival in this competitive environment? The Government polyclinics have jumped into the foray by opening night clinics. I wonder if there is a way of working together so that these hard working people can have some semblance of a family life.

Milestone #2:

Our new PM has given a promising speech about what we can expect in the coming years under his leadership. It looks like he is trying to improve the quality of life for Singaporeans. Can we take a break from the rat race & start smelling the roses again? Will it be possible for the “kiasu-ism” prevalent today, to be diminished? Will the “gracious & civilized” society that was wished for by former PM Goh be a reality? I think these are all inter-related – if we can break away from that mindset which makes us give priority to win at all costs, and to chase after the 4 “C’s. Instead, we can do the best we can & enjoy the journey on the way. I believe that this can be achieved. We would start giving way to off-loading passengers first before embarking on the MRT train; we would stop honking impatiently on the roads & stop tailgating; we would stop loading our trays with excess food at the buffet table, but just take what we can eat; we would start having more kids because of the joy they bring us, and not because of the Baby Bonus or the extended maternity leave; we would start bringing used dishes, utensils & trays to the collecing area instead of waiting for the cleaners to do it for us. Wishful thinking? Maybe not.

Milestone #3:

My son turned 12 last December. His hormones seemed to kick in with a bang after that. He is no longer a boy but looks like a young man. He has sprung up 6 inches in 6 months; his voice is starting to sound like a man. And yet, when I see him, I still see my little boy whom I used to hold in my arms & pat to sleep with his baby cheeks against mine as his head lay on my shoulder. Now, his body seems to be too large for his head! Suddenly, he seems like a klutz, tripping over steps, bumping into banisters, knocking over glasses on the dinner table – it is like his brain has not quite come to terms with the new increased length of his limbs!

Physically, he looks like a teenager. Oh, yes, I see the occasional emergence of the adolescent trying to look cool when he is with his friends, and I know that girls are no longer the creatures which make him say “Yuck!” anymore. And yet, inside this rather grown up body still resides the mind of a pre-teen, who still gets excited over seeing his favourite sports car on the road, who still asks 101 questions about things in the world around him that are still mysteries to him, and who still is not too embarrassed about giving his Mom & Dad a hug & kiss before bed every night.

As he matures into a young adult, I hope that his future holds the realization of all his dreams and aspirations. I hope that his youthful fervour for new knowledge will never fade. I hope that as he grows into adulthood in this new, exciting, shrinking, frightening and competitive world, he will never lose sight of the beauty that still surrounds us, in spite of us.

*********************************************************************************