...and we have touchdown...

Well, we are finally here. We landed in minus 3 degree Celsius weather under hazy conditions on a Friday night. As we disembarked, the first thing that hit me (apart from the frigid cold) was the smell of smoky fumes. Don't know if this was from emissions from the plane engine or the parking garage of the airport or from the famed pollution I've heard so much about...but I think air filters will definitely be a must in our new home.

We are in a serviced apartment for now until our new home is ready for us to move into in a couple of weeks.

No homesickness yet, however, saying farewell is never easy, especially to family members. That familiar cliche: 'Home is where the Heart is' is so true. Although I have my husband & children with me, part of my heart will always be with my other family: parents, sister, brother, best friends.

I have been nursing a cold the last couple of days, something I picked up during our last few days in warmer climes (no, one doesn't catch cold from, cold weather, thank you very much!). The dryness & cold here don't help my symptoms a lot, making my nasal & throat passages feel terribly uncomfortable especially compounded by taking antihistamines to stop the continuous sneezing & nasal discharges. Been trying to load up on fluids too - no need for silica gel here (humidifiers will be another must-have in our new home).

Hence my present entry at the unearthly hours of 5 a.m. in the morning...having been woken up by a very dry mouth (having to breathe through my mouth since my nasal passages are clogged up) & mild attack of asthma. No worries, I am fine - nothing that 4 mg of Ventolin can't fix. My good ol' trusty medicine pouch has served me well; it's something I always travel with - my own form of personal insurance, one may call it.

Ok, I am going to go read a bit, & allow the Ventolin to kick in & hopefully go back to sleep for a few more hours .

Weather aside, my first impression of BJ has been a good one - the people seem to be warm & friendly, very willing to help, and with customer service that beats Singapore. It has made this alien feel very welcome.

More later.

Happy Holidays

Hijacking my husband's laptop to wish everyone a happy Christmas, & happy 2007!

Zai4 Jian4*

*

Chinese for farewell




Well, my trusty ol' computer will be lovingly packed away tonight by my husband in preparation for our move.

I will continue blogging when/if I can during the interim. Once we are settled, I hope to write about the trials & tribulations & hopefully, joys of life in China as an "alien".

Ouch

Oooooh....I feel a tidal wave of reactions coming in response to this letter in today's Straits Times:

"Dec 14, 2006
'Hua Yu cool'? No, boorish Mandarin-speaking youths spoil the image

I can attest that Mr Peter Donkin's observations of young Singaporeans are true. I have many negative opinions of young Singaporeans too, despite being a youth myself.

My observations of inconsiderate behaviour among young Singaporeans almost always involve the Mandarin-speakers. While not implying that all Mandarin-speaking youths are rotten (nor are all English-speaking youth angels), an overwhelmingly large group of offenders are observed to be from this group.

This seems to stem from the Chinese school of thought which advocates 'If I don't take, I lose out' and 'If others can do it, so can I, otherwise I lose out', among other factors.

Before anyone takes offence at my discrimination, go on a MRT ride across the island first, and my theory will come to life.

On a train ride from Jurong East to City Hall last month, I saw three groups of Mandarin-speaking youths huddled with their handphones playing Chinese songs at full blast.

The three groups were in the same cabin. It was terrible. One couple left the cabin for another because they couldn't take the racket.

Many people glared at the youths. A girl from one of the groups declared in Mandarin and English 'Wa, wo men hen attract attention leh!', which translates to 'Wow, we are attracting a lot of attention!'.

Was she thinking that people saw her group as 'cool' just because her handphone played MP3 music and they were the latest Mandopop hits? I was outraged at the inconsiderate behavior.

The Mandarin-speaking Singaporean youths also seem to ignore rules that make the world an orderly place. For example, they ignore repeated reminders to keep to the left on escalators. They also ignore the markings that serve to allow passengers on trains to alight first.

A Malaysian classmate who recently visited Thailand spoke of how gracious the people there were, and their good etiquette on the train.

Step into a shop and you will notice that the Mandarin-speakers are rude to service staff and they never say 'please' or 'thank you'.

Based on their interactions with my peers, they take offence easily,

yet they have no qualms about being sarcastic and rude to foreign teachers.

Many young litterbugs are also Mandarin-speaking youths. When I visited Melbourne some months back, I was greatly impressed at the clean streets. I saw everyone putting their litter into bins, and there were no cleaners around.
While many Mandarin-speaking youths are nice on a personal level, their mentality can manifest the antisocial behaviour that I have mentioned.

My friends and I belong to the minority English-speaking

group and we are ashamed to speak in Mandarin in public. No, we are not elites, just normal teenagers.

Unless the association of bad behaviour with Mandarin-speaking youths can be negated, 'Hua Yu Cool' isn't going to work on us anytime soon.

Ang Lixing"

A rather unfair generalisation on the part of Ms Ang, I feel. There are boors in all segments of society, no matter what language they speak.

However, I must say that this boorish behaviour she describes is becoming more prevalent locally. It's the Me generation - forget about proper & appropriate CIVILISED behaviour.

Pity.

Supermom

There is a loud resounding silence as far as response to this letter is concerned.

Dec 2, 2006
Mothers deserve more support from Govt

I READ the articles under the heading, 'Disparate housewives' (The Sunday Times, Nov 26), with much interest.

I am a housewife by choice, having previously worked as sales support manager for a US-China joint venture after completing my Master of Science degree. I also have an MBA.

When our first son was born nine years ago, my husband and I decided that I would give up my career to be a full-time mother/housewife. This decision drew sneers from well-meaning relatives and friends, while my parents thought I was wasting my education and talents.

We now have four lovely children. Motherhood is truly a sacrificial and demanding task but I have no regrets. No childcare service can replace the mother. Mother is often the best caregiver and teacher.

However, what bothered me is the inconsistency in government policy. When I applied recently for permanent residency for my parents, the Immigration and Checkpoints Authority (ICA) rejected my application with the statement, 'You may wish to submit another application for our consideration after you are gainfully employed for a period of time.'

Does the Government think that full-time mothers are not gainfully employed? As reported, stay-at-home mothers/housewives contributed approximately 8 per cent of Singapore's GDP, not counting the long-term impact on Singapore's future. This has been clearly documented in academic-research finding after finding worldwide, including Nanyang Technological University Associate Professor Euston Quah's findings, as was also reported.

Since around 1999, the Government has been actively encouraging Singaporeans to have more babies, offering baby bonuses and tax rebates in the face of a declining and fast-ageing indigenous population.

While one can understand the Government's wish at the same time to encourage mothers to return to the workforce, a policy conflict-of-interests and dilemma is inadvertently created.

The future of Singapore is in mothers' hands. It takes commitment, patience and, above all, sacrificial love to nurture children, for the future of the country.

The letter I received from ICA was a true dampener. Should not mothers deserve more support and understanding from the Government?

He Ruo Fan (Ms)"

I guess one of the spin doctors in ICA is trying to craft a response that

a) empathises with Ms He's sentiments that SAHM's are important in the process of child-rearing;
b) will support the Government's call to have more babies;
c) calls for more companies to be more pro-family so that more SAHM's can return to work at least part-time (like being a mother is not work???);
d) will also support the Government's call for women to return to the workforce.

Maybe the silence from the general public is because many Singaporeans feel that housewives/full time moms don't really have a job? Forget about the night calls (i.e. night feeds/diaper changes for infants), nursing (i.e.sick child/sick husband), chaffeur (i.e. driving kids to/from school & activities), housekeeper (i.e. housework), accountant (i.e. keeping track of household accounts & making sure bills are paid), cook (self-explanatory), teacher (i.e. reading to kids/revision/helping them with assessments), COO (of the household). Oh, and also you cannot take MC as no one will be able to take over your duties, and also no vacation days either, for the most part.

Friendship

As the date of our departure encroaches, I find myself reflecting on what Friendship is, & how hard it is to find True Friends. In our new home in a foreign country, making friends is something I think of with some trepidation. Will it be easy? When one is far away from one's extended family, friends are such important & valuable commodities to have.

"Friends are relatives you can choose." I heard this somewhere that I can't recall at the moment. How true it is though. True friends are hard to come by. In my lifetime (so far), I have met so many different kinds of people & made different kinds of friends.

True Friends
These are the ones I have known from childhood or college. There are a couple whom I met as an adult, & despite being separated by continents, still consider ourselves dear friends. These are people whom I can share comfortable silences with - no need for small talk.

Good Friends
These are friends whom I feel comfortable chatting with, & who have gone through similar experiences (eg. Medical school classmates). When we meet, there are no awkward silences; we eagerly catch up with each other's lives & occasionally organise get-togethers to maintain this friendship.

Social Friends
These are the ones whom I may meet at various social gatherings or school functions. We may smile & nod at each other, then, if we happen to be seated next to each other at the table, are able to strike up a fairly interesting conversation about common topics like current affairs or the school system or medical cases (if they happen to be fellow doctors). Apart from these events, we would probably never see each other ever again.

It's a mystery to me how a friendship forms. Why is it that Person A can become one's closest friend while Person B, who may exactly the same interests as you, can not?

When I first moved away from Singapore to the US, I was petrified that I would be alienated, being a foreigner & all. This proved to be unfounded fears as I found a group of people in my neighbourhood who eventually became my Good Friends.

Returning here, I thought that I would be able to make more new friends, this being my home country after all. My True Friends have, needless to say, remained close, & we literally picked up where we left off. I also resumed contact with some Good Friends & made a few new Good & Social Friends along the way.

However, making new friends hasn't been as easy as I thought. Neighbours here tend to keep to themselves (at least the ones that I have had). At work, my life experiences although enriching, have made me into a strange amalgamation of being a local with a foreign "twist". In my kids' school, where foreign parents are abundant, I realised that befriending some of them is not as easy as it looks, as people still tend to be cliquish when they are in a foreign community...which leaves me sandwiched somewhere between the "locals" & the "foreigners". Plenty of Social Friends to be had, but hard to find Good Friends; & True Friends?....virtually impossible.

So I hope that in our new adventure in China, there will be more Good Friends to be made. If I am lucky, I may even find a True Friend.

A chocolate a day keeps the doctor away

Good news for fellow chocolate lovers out there!

This article from Medscape shows promising results that eating chocolate may have the same effect as taking an aspirin a day!

"Chocolate Has Antithrombotic Effects Similar to Aspirin"
Martha Kerr

November 17, 2006 (Chicago) — Subjects enrolled in the Genetic Study of Aspirin Responsiveness (GeneSTAR) inadvertently helped Johns Hopkins University researchers measure chocolate's inhibition of platelet function and show that eating chocolate slows clotting time. The findings may explain how chocolate and cocoa-containing foods exert a cardioprotective effect.

A group of 139 healthy individuals did not eliminate chocolate from their diet.

Senior investigator Nauder Faraday, MD, associate professor of anesthesia and critical care medicine at Johns Hopkins University in Baltimore, Maryland, told Medscape that "chocolate was just one of those things this group couldn't give up."

The subjects were ejected from GeneSTAR proper and were not randomized in the aspirin assessment phase of the study. But Dr. Faraday and colleagues took advantage of the subjects' noncompliance to assess chocolate's previously demonstrated role in cardiovascular risk reduction, using the same platelet function analyzer test employed in the GeneSTAR study.

The investigators measured agonist-induced platelet activation in the presence of shear and calculated time to closure in the system by a platelet plug. Platelet activation was also assessed on urinary excretion.

Chocolate consumption caused a significant increase in time to closure, but remained within the normal range, the investigators announced here this week at the American Heart Association 2006 Scientific Sessions.

"Chocolate, even in small amounts, was an independent factor in inhibition of platelet activation," Dr. Naraday said. It extended closure time, regardless of age, sex, smoking status, body mass index, systolic blood pressure, total cholesterol level, fibrinogen levels, or von Willebrand factor.

"The magnitude of the effect was quite small," Dr. Naraday emphasized. Chocolate had the same type of effect as aspirin, but by a factor of 5 to 10 times less, according to the assay used in the GeneSTAR study, he said.

Elliott Antman, MD, professor of medicine at Harvard University in Cambridge, Masssachusetts, told Medscape that he found the results intriguing. "It might help explain the tremendous variability among patients to platelet inhibition, particularly as seen in response to aspirin."

Dr. Naraday pointed out that "any time you shift the balance away from thrombosis, you set up a situation with the potential for increased bleeding time and other risks, but I don't think this is a big problem with eating chocolate!"

Dr. Faraday's study is funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health. Dr. Antman reports no relevant financial relationships.

AHA Scientific Sessions 2006: Abstract 4101. Presented November 14, 2006.

On Mediation Again

I wrote an entry about Mediation May 25th this year titled On Mediation. I was very skeptical about the workability of such a process here at that point of time.

In today's Today Online, this process is outlined & will come into effect next year. I think it is a good first step to take in trying to tackle the increasing numbers of complaints lodged against medical practitioners & healthcare institutions.


Now doctors can say 'sorry'

A freer, less painful approach to medical negligence cases

Loh Chee Kong
cheekong@mediacorp.com.sg

EARLY last year, Mr Surender Singh's wife died after she donated one of her kidneys to him. He still doesn't know why. He hasn't heard an explanation or an apology from the doctors concerned. The hospital is being fronted only by its lawyers — and for good reason.

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When something goes wrong, doctors worry that anything they say might be used against them in court, said lawyer Amolat Singh, who represents Mr Surender Singh.

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Starting next year, an initiative by Chief Justice Chan Sek Keong could change the complexion of medical negligence cases. All parties can meet before a case begins; patients or their relatives can find out exactly what happened; and, if necessary, doctors can say sorry.

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More importantly, everyone can speak freely, because the information exchanged cannot be used in court.

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In fact, experts said that if the move takes off, there could be less need to go to court at all. The air of mistrust can be cleared, and if an honest mistake has been made, the matter can be settled without relying on expensive litigation.

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Under this new protocol, once someone has paid a fee of between $75 and $100 for his medical documents, he should get a response from the hospitals and doctors within six weeks.

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After that, a face-to-face meeting can be arranged within two months.

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An average of nine medical negligence suits have been filed here each year since 1998. Most get settled at the Subordinate Courts' Primary Dispute Resolution Centre without going to trial.

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The new "open disclosure" policy could ease the pain further. Eventually, said Subordinate Courts Registrar Toh Han Li, it might even be applied to cases in the High Court, which hears civil suits involving claims of more than $250,000.

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Both doctors and patients could gain. More understanding — and fewer cases going to court — could bring down premiums on insurance policies for doctors and lower medical costs.

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Patients also know how hard it is to prove outright medical negligence. One of the last notable cases where a patient sued successfully was in 2001, when a botched operation shrank an American national's testicles to the size of a child's.

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Some patients get unnerved by high legal fees, while others find it difficult to find a medical expert to testify against his peers, said lawyer Peter Low.

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Doctors, caught in a legal tangle, get equally frustrated.

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Said Dr Chong Yeh Woei, a general practitioner: "When you get involved in a legal process, the first thing you do is to consult your lawyers and do what they tell you to.

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"You might want to say sorry — and sometimes, it's all the other party wants. But by saying sorry, you are admitting liability and guilt."

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Or, as Dr Melanie Billings-Yun, a consultant in conflict resolution, put it in her February lecture to a roomful of Subordinate Courts officials: "The adversarial system is based on faults. But in 80 to 85 per cent of malpractice cases, there is no fault to be found.

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"If doctors are forced by their lawyers or insurance companies to treat every adverse outcome as a dirty secret, is a patient or his family being unreasonable to imagine that fault must indeed lie behind a stone wall of silence?

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"With an open disclosure policy, doctors and nurses will no longer be made to hide as if they were criminals ... more importantly, they will find that their words have the power to heal their own wounds."

Loh Chee Kong
cheekong@mediacorp.com.sg

However, I am still skeptical as to how long it will take for the mindset of doctors & patients to change from one of blame & shame to one of openess & mutual understanding. As doctors, we have been so afraid of being open to admitting to mistakes because of the fear of litigation that I wonder how long it will take for us to embrace this new process.

And in addition, within our own community, this punitive culture is still prevalent enough to prevent most of us from owning up to honest mistakes. How many of us have, as junior doctors, been made to feel absolutely fearful & ashamed by our seniors when they belittle us for our lack of knowledge or skill?

Yup, this is a good first step. But I still see a rather long flight of stairs ahead of us...

Bizarro

Been getting really strange dreams this past week or so, possibly due to my subconscious mind reacting to the stress of the impending move.

Last week, I dreamt that my sister was married to Hugh Jackman! Not withstanding the fact that Hugh "Hottie" Jackman is already married, I really really really REALLY cannot imagine my sister falling for him. I do admit that in my dream, I was a trifle jealous (married woman that I am, I confess to a little crush on this hunk of a dude). The fact that I watched "Happy Feet" (in which HJ did the voice of Memphis, & was the first time I had heard him singing - lovely voice - wish I could have caught him on Broadway doing "The Boy From Oz"...but now I digress) last week probably contributed to the generation of this dream.

Then last night, I dreamt that I (Mary Jane Parker) went on some kind of weird vacation with Peter Parker (aka you-know-who) at this dumpy little motel located in what felt like a really bad part of LA. Every corner we went, there were these Hispanic gangs eyeing us, looking like they were about to attack us any minute....and dear old Peter refused to use his Spidey powers to intimidate these people!!! And I was quite upset by that. Bizarre. I think I have Spiderman on my mind after watching the latest trailer for Spiderman 3, which looks to be superb.

Maybe I am subconsciously calling for help from my superhero idols - Wolvie & Spidey - to help me pack & move house!!! Especially since my husband will be away for 2 weeks preceding the pack out, on a business trip & only arriving back here THE DAY BEFORE THE MOVERS COME!!!

Maybe tonight I'll dream of the whole X-Men team...

Organs For Sale?

There were two articles recently about kidney transplants.

The first was a heartwarming one about a 5 way swop of kidneys so that 5 needy patients with 5 willing but otherwise non-compatible donors, would be able to receive suitable kidneys. With the shortage of donors, this unconventional method of transplanting kidneys was a great success. Although it must have been a logistical nightmare, all came together with a resulting happy ending.

The second is about the legalisation of sales of kidneys in Iran. This is undeniably controversial. The question of ethics comes up. But if you were the patient, & had the means to pay for such a procedure, would you do so? Having said that, would this mean that only those who can afford it will get the kidneys they need while the poorer patients will have to wait till an available donor comes up, or till they die?

As doctors, our first response to such commercialisation of organ transplantation would most likely be that of disapproval. The idea of selling organs for money is a distasteful one. Whenever money comes into play, there is always the chance that eventually, the bottom line will become more important than the patient's health (IMHO, this is already happening - look at how aesthetic medicine is booming & how MHC's have affected the way medicine is practised).

But as humans, how do we condemn someone who only wants to live to see his/her children grow up & grow old with the one they love?

This is a complicated issue indeed, & something that we need to step back & look at from different perspectives...no easy answer to it.

Separation Anxiety

I think emotionally, I haven’t yet come to terms with the fact that we will be leaving Singapore in just over a month. I’ve been so busy taking care of the practical side of things like arranging moving dates, selling stuff etc. that I really haven’t had time to ruminate over what this move will mean.

This will not be the first time that I am moving away. Fourteen years ago, we left this island with an infant in tow. I was too excited about living in a new place & meeting new people to really be overcome with any kind of sadness over leaving. Definitely I missed my family & friends. But I was too busy with having to take care of a young child, & settling down to wallow in any form of misery (not that I am the wallowing kind in the first place!)

This time around, both my kids are more independent & don’t need round the clock care like 14 years ago (!!!). I will have more time to myself, since domestic help is readily available in China. I certainly don’t plan to immerse myself in self-pity. I hear that expats there make friends more easily than here in Singapore, for some reason. Hopefully that will prove to be true, as I find that the older I get, the harder it is to establish firm friendships like the kind that endures since childhood or college. That kind of comfort level where you can meet each other & feel immediately at home even though you have been apart for a number of years…that is the kind of intimacy that close & old friends share that is hard to capture in new friendships.

I know for sure that I will miss being able to visit with my parents/siblings/best friends when I feel like it. And I will miss the fluid efficiency of the way things are run here (despite our frequent complaining!), not to mention local hawker fare.

But with technology, Mom/Dad/Sis/Bro are just a phone or Skype call away, we can even use the webcam to have face-to-face conversations without having to worry about long distance phone bills. And a six hour flight is not that far away for one to visit or be visited by family.

busy, busy, busy

please excuse my absence. it's been a busy week, including a rockappella concert, and a short trip up to kl to attend a wedding of the son of an old friend of my mom's. talk about lifestyles of the rich & famous...this wedding was the wedding of the year in malaysia (imho). even the agung (king of malaysia, for the uninformed) attended. blessing ceremony by the lakeside; goody bags with amazing pressies for all the guests; carnival-like entertainment with magician, jugglers, pretty girls with pythons draped around their necks & parrot/parakeet on their fingers; hired band from singapore; beautifully made videos of the couple's love story (this beats, hands down, the usual slideshows played to cheesy romantic love songs that one sees at the "normal" wedding dinners) including the proposal video involving a mini cooper...you had to see it to believe it.

of course, no trip to kl is complete without the ritual rounds of yummy hawker food (wantan mee, char kuay teow, mee yoke, chee cheong fun, hokkien mee all cooked in ways unique to kl)...i think my arteries are semi clogged from all the cholesterol i ingested over 3 days!!!

now that i am back, it's back to the overwhelming task of preparing for the move. add to the list of things to do(refer previous entry):

1. choose furniture for housing (not easily done with pictures sent via email)
2. get influenza shots for family (hep a & typhoid already done; don't think we are at risk for jap encephalitis nor rabies so will pass on that for now...will have to warn kids to stay away from stray animals & rabid looking humans!)
   
3. get vital medical checkups done before leaving (ladies above 40, don't forget your annual mammograms!)
4. sell furniture that we are not bringing with us (almost done - surprisingly, lots of takers for 2nd hand stuff)
   
5. finish christmas shopping

add to this the 2 final locum sessions that i had earlier committed too, & you have one pretty busy lady. i didn't want to call the hiring doctor to say that i can't do the sessions, knowing that it's the school hols now & locums are in demand (especially lady ones)...ah well....i'll survive.


note: no caps in this entry - quite liberating. maybe i should try no punctuations one day, but then it would probably be too hard to read. :)

Aliendoc's Things To Do Before We Move

1. Sell home - check
2. Sell car
3. Decide what belongings to ship to new home
4. Decide what belongings to sell
5. Decide what to put in storage
6. Buy winter clothing for kids (IMPORTANT!)
7. Forward mail to either mother or sister’s address
8. Change address of credit cards/banks etc
9. Terminate some credit card accounts
10. Inform SMC of move - check

As can be seen only 2 out of the top 10 things to do before we move have been checked off. Which means that I STILL HAVE A LOT TO TAKE CARE OFF!!!

AAAARRGGGHHH!!!!!

On Being Parents

A couple of days ago, a toddler’s big toe was ripped off when it got caught on the side of an escalator. She was wearing rubber clogs (you know, the one that is damn ugly but damn comfortable). It was highlighted that these clogs are very pliable & hence would get caught & pulled into the gap between the side of the escalator & the step.

Hopefully, the clogs won’t be made the scapegoat of this kind of accidents. If you think about it reasonably, it would be quite difficult to edge your foot to the side of the escalator so that it would get caught. But knowing children, they have a propensity to stick things where they don’t belong. I have had to, on many occasions during my A & E posting, extract a variety of foreign objects from various orifices in the head of a number of children.

My point is this: an adult (usually the parent) is supposed to supervise the behavior of children, especially those under the age of 5. They are supposed to teach them that certain actions are dangerous, and that certain kinds of behavior are unacceptable in civilized society. They are supposed to teach them how to do certain things like crossing the road, going up & down stairs, going up & down escalators. Obviously, we don’t expect the kids to pick up on the safe way of doing these things immediately. You would expect the adult to hold the child’s hand, for example, while crossing the street (I still try to do that to my 12 year old, to his chagrin ☺). You would expect the adult to watch the child & admonish him if necessary, if the kid starts misbehaving on an escalator (like trying to stick his/her foot into the crevice between the step & the side…I don’t know if this actually happened in the above mentioned case, but it could have).


Parenthood is a full-time job. You need vigilance, care, and attention on top of TLC. It’s easy to love a child (especially your own☺!) but it is hard to keep them safe 24/7.

When my kids were little, I had child-proof locks on all my kitchen cabinets/drawers; child-proof covers on the knobs of the stove; a plastic shield attached to the front of my stove to prevent inquisitive fingers from reaching up & pulling a pot of boiling liquid on top of his head; child-proof gates preventing the kids from getting into the kitchen while Mommy was cooking (no maid while living in the US – I survived ☺); child-proof gates on the bottom AND top of the staircase, bumpers on the corners of my coffee table to prevent accidental bumps & scalp lacerations.

Whenever we ate out, I automatically would move breakable crockery or glasses full of liquid or hot dishes out of reach of grasping hands…I still do this if I happen to be dining in the company of small children!

Locally, many children are being looked after by domestic helpers. I think many parents become very lackadaisical when the time comes that they have to take care of their own child (eg. on the maid’s day off). They need to wake up, step up to the plate & take responsibility, not only for keeping their children safe, but also in teaching them how not to behave like hooligans.

“I yam what I yam!” (from Popeye the sailorman)

I read a report in the newspaper today about a 16 year old boy, D., who was convicted of robbery & given a 5 year jail sentence with 24 strokes of the cane (which is the maximum allowable). He had previously been sent to a juvenile facility for “reformative training”. D. himself shouted at the judge during his trial, threatening him & saying that this training was useless & that he should be sent to jail instead.

At first glance, the picture of this boy shows a typical face of a teenager. But look closely at his eyes & you see the vacuous expression, almost bereft of emotion. Who was it that said, “The eyes are windows into the soul”? How true.

This boy (yes, I consider him a child) is only 2 years older than my elder son. He started off in life with less than desirable circumstances - parents divorced, with dad apparently abandoning the family when he was just an infant. He is supposedly of below average intelligence as well – he has been faced with so many disadvantages in life already, I guess we shouldn’t be surprised with the outcome.


We are the result of our life experiences. As individual beings, we start off as a mass of organic material, with certain genetically pre-determined qualities. However, how these “lumps of clay” are shaped & what the end result is, is due to a complex interplay of factors including parental influence, family relationships, environmental push & shove and to a small degree, sheer luck.

Many of our neuroses stem from these factors. Whether we have been nurtured or battered by these childhood experiences & familial relationships, will determine whether that lump of clay will turn out to be a work of art, or just a rock to be hidden out of sight. I believe that all of us have, to varying degrees, dysfunctional families. If severe, this would express itself as neuroses. I would be the first to admit that I have issues to work out, all stemming from the factors listed above. However, I don’t think I am neurotic (yet…although it is probably matter of opinion, depending on whom you ask!).

It is sad that D. ended up where he is now in his short life. The African proverb “It takes a village to raise a child”, made famous by Hilary Clinton, is so true.

I guess D.’s village failed him.

Snapshots from Beijing

We managed to find some time to take in some sights in Beijing while we were there, in between looking at houses & schools. Here are a few of the more interesting shots:


External View of the Forbidden City
Some of the buildings inside were closed off for repairs. A bit disappointing.




Square inside the Forbidden City
Notice the worn out stones on the floor. Looks familiar? I think I saw it (or a facsimile) in a Jackie Chan or Jet Li movie. Or in a trailer of a Chinese epic... Those stones have probably been there for hundreds of years. Uneven & bumpy, could be hazardous for walking if you are not careful.




Speaks for itself!
The place to go to broaden your mind & expand your horizons!




East meets West, Old meets New
Want a cuppa Java? How about a Heineken? All available in the Forbidden City!




Ad on Bus Stop
This was an honest to God, true blue ad seen on the back of a bus stop along a busy street in downtown Beijing! I did a double take when I saw it. I guess this is the place to go if you want to become sterile? Looking at the Chinese words, I think it's for abortions & contraception (Chinese experts out there, jump in here to correct me if I am wrong).




Snacking in Beijing
Seahorse? Starfish? Bugs? Worms? How about live spiders (not in picture)?
I think I'll stick to satay or french fries, thank you very much. :P

Scoop

After reading the mixed reviews received by this Woody Allen movie, I decided to go ahead & watch it anyway (OK, OK, I admit it...Hugh Jackson was a BIG draw for me ☺), & managed to convince my guys to come along with me.

We watched it at the new mega-movie theatre at the spanking new mall called Vivocity (we're still trying to decide whether to pronounce it as Vi-VOc-i-ty -which rhymes with velocity- or Vi-VOH-City - derived from the Latin word "vivo" meaning life, I think).

I'm glad we did watch it, although it didn't blow me away. It showed my kids that comedy needn't always be the slapstick & pie-in-my-face kind that is typical of Jim Carrey and the SNL alumni like Adam Sandler, Rob Schneider & Mike Myers.

The dialog was, well, typically Woody Allen-esque, with witty comebacks & self-deprecating humor although Mr Allen's frequent stuttering (whether intentional or not) got a bit stale & annoying after a while. Scarlett Johanssen showed her versatility with her portrayal of eager, naive journalism student, Sandra Pransky, hot on the heels of her first scoop. Hugh Jackman didn't really shine here, although he looked mighty fine in Speedos (*GRIN*).

Sidenote: we were very impressed with the movie theatre. We were in Cinema Europa which is supposed to have a bigger screen, & allow movie-goers to enjoy the movie in an elegant & intimate setting. It was indeed very comfortable, & more "high class" than the regular theatres (tickets DID cost $1 more); but I wished that the seats could have reclined a bit more.
Sigh...which reminds me that I AM going to miss movie-going when we are in China...

Oh, & by the way, my kids actually enjoyed the movie & found it funny! I guess they are smarter than I think...heeheehee...

EEEWWW!!!

I came across this article on Medscape to which I subscribe. My very vivid imagination conjured up images I would have rather not imagined as I read it...ugh...read on, if you dare...

Circumcision, Religious Freedom, and Herpes Infections in New York City
Posted 10/17/2006
Howard Markel, MD, PhD

If you ever find yourself in the coffee line at a medical conference, be prepared to eavesdrop on a gaggle of doctors exchanging the medical equivalent of "war stories," wild tales of clinical misadventures and treatment plans gone awry. It was precisely at such a venue that I heard what easily qualifies as one of the strangest — and scariest — medical tale of recent times.

It actually began in 2004 when the New York City Department of Health received reports of 3 newborn, male babies who contracted herpes simplex virus (HSV-1). All of them required weeks of hospital care and intravenous injections of powerful antiviral medication. Tragically, one of them died from the infection.

Unlike a mere cold sore or an embarrassing, painful crop of genital blisters, herpes for a newborn is truly a life-and-death matter. Aggressive and relentless, the herpes virus can destroy an infant's brain in a matter of days. Every pediatrician who notices any type of blister on a newborn's body shudders as he contemplates whether its cause is merely an abrasive blanket or, far worse, a harbinger of a systemic infection with herpes.

But the story only gets stranger. Using a mixture of detective work and medical acumen, the New York City Department of Health figured out that all of these babies contracted herpes shortly after undergoing a ritual circumcision by the same mohel, the religious figure in the Jewish faith charged with conducting the ancient and spiritually important ceremony called a bris.

Under Jewish law, the mohel is required to draw blood from the circumcision site, ostensibly to remove what the Old Testament refers to as "impurities" and what we might interpret today as germs. The thought, back then, was that a flow of blood away from the circumcision site would carry these potentially dangerous entities away from the baby. But the traditional way to do this, a practice called Metzizah bi peh, calls for the mohel to use his mouth and suck out the blood.

To be sure, this peculiar means of viral spread remains rare. Nevertheless, there have been 11 cases of male babies who contracted herpes following circumcisions that included Metzizah bi peh reported over the past 5 years in New York, Canada, and Israel. In 2005, there were 4 infected babies in New York City and all of them were circumcised by the same New York-based mohel (who only recently was persuaded to take a prolonged vacation from his line of work).

According to Dr. Thomas Frieden, New York City's Commissioner of Health, coincidence is not an explanatory option. "There is no reasonable doubt that the practice of Metzizah bi peh has infected several infants in New York City with the herpes virus, including one child who has died and another who has evidence of brain damage," said Dr. Frieden.

Given that more than 70% of all adults 40 years of age or older are infected with the herpes simplex virus; that the mouth is the most common site of HSV-1 infection; and that most adults with oral herpes do not know whether they are infected, typically do not have symptoms, but can still spread the infection to others, one can begin to understand the potential public health problems associated with such a tradition.

Indeed, this is precisely why the Chief Rabbinate in Israel and the New York-based Rabbinical Council of America, which serves more than 1000 rabbis in the United States and Canada, began urging all mohels to avoid the potential spread of infection by using a tiny, sterile glass tube to draw the blood instead of putting their mouths directly on the circumcision wound. The overwhelming majority of mohels working today follow this interpretation of the custom.

Yet the ultra-Orthodox Hasidic Jewish community persists in adhering to ancient law precisely as it was written. That is, after all, what "orthodox" means. And despite the hedging and explaining by their less orthodox counterparts, Hasidic rabbis insist that performing the bris exactly as it was described in the Bible is essential to what it means to be Jewish.

So when the New York City Department of Health proposed a voluntary ban on the practice, the Hasidic community tersely told the government agency not to interfere in their religious beliefs or practices. Indeed, the ultra-Orthodox Hasidic community, one that has a great deal of political clout in New York City politics, has pledged to fight any health edicts restricting the ancient practice with the proverbial tooth and nail.

Even if such a law could be written, how would you enforce it? After all, the bris is almost always performed in the parents' home, out of the view of the health department or a police officer.

Certainly this means of contracting a deadly infection is rare. Only 7 cases of mohel-related herpes have been reported in New York since 1998, and each year there are 2000 to 4000 circumcisions performed in that city alone. But rare does not mean nonexistent. No one can deny that this practice presents a real and serious health risk.

Just as frightening, there have been reports of other Jewish parents who, while less exacting in their religious practices, hired ultra-Orthodox mohels without knowledge that they practiced the potentially risky Metzizah bi peh procedure.

Dr. Frieden, the same public health crusader who managed to get cigarettes banned from all public spaces in New York City, admits that negotiating the rocky shoals of this controversy represents the "most delicate issue I have had to deal with."

"My ideal would be to inform the community so that they stop doing this and a large part of the Jewish community has accepted it," Dr. Frieden explained to me in an interview. "But this issue is far from over and it is still going on among those who are most Orthodox. If it were simple, we would have dealt with it simply."

That's an understatement. It has been years since I studied Talmud, but I know what my Rabbi would have uttered in response to this quandary of Biblical proportions: "Oyyyy."

Howard Markel, MD, PhD, George E. Wantz Professor of the History of Medicine, Professor of Pediatrics and Communicable Diseases, Director of the Center for the History of Medicine, University of Michigan, Ann Arbor; author of When Germs Travel: Six Major Epidemics and the Fears They Have Unleashed (Pantheon Books)

Disclosure: Howard Markel, MD, PhD, has disclosed no relevant financial relationships.

Medscape Pediatrics. 2006;8(2) ©2006 Medscape

Wanderlust (II)

I’ve always wanted to see & experience new places. When I was young, I used to imagine myself under the Big Sky of Montana, or enjoying the sea breeze on the Greek Isles, or skiing the slopes of the Alps. Perhaps it was a presage of what my life has become as an adult with my own family.

We’ve moved multiple times in the last decade and a half, two of those moves halfway across the globe. I consider myself a global citizen, my ideas, perceptions, & values having been shaped (& still being shaped) by diverse & varied life experiences. An old classmate from Medical School commented recently that I have had a somewhat unusual life, compared to the rest of my cohort.

I don’t think this kind of life is for everyone. I know a few of my closest friends are befuddled at how I can do what I do. But it’s not that strange or unusual a lifestyle after all. There is a small percentage of the people of the world who are quasi-nomadic in nature. Their jobs bring them to different parts of the world, often far & vastly different from their home country. Their families are relocated every few years. Previously, these were mainly military families who went where they were directed to go. Now, with the globalization of so many companies, businesses are expanding to places all over the world, sending their senior managers to these places to help run their organizations. And these employees bring along there spouses & kids to unfamiliar environs.

Their kids are known as third culture kids. One usually finds these children in international schools, getting to know kids in the same shoes, from other cultures & ethnicities. And because they don’t live in their home country, they develop a unique culture of their own, assimilating views & opinions from their international friends.

I don’t think I would consider my kids TCKs. Half their lives were spent in their passport country, while the other half in their mom’s passport country. And part of the latter was spent assimilated in a local school while the other part in an international school. Perhaps a more suitable term would be “Different Cultured Kids”. I am not sure how this will affect them as adults. With our impending move to China, doubts & fears of settling into & living in such a different country arise, especially for my children, as they have to make new friends & get used to a new school. Heck, I will have to make new friends as well!!! And make do with less English movies/books/TV programs (sigh).

Despite how daunting the move may be, what I am sure of is that ultimately, their experiences & my own, will be unique and enriching. At least, we will be able to learn proper Mandarin!

Driving you crazy

And I thought driving in Singapore was bad.

I literally feared for my life while traversing the streets of downtown Beijing as a passenger as well as a pedestrian. This is what I learnt about traffic in Beijing:

A) Pedestrians DO NOT have right of way, no matter what color the little man is on the traffic light. It’s survival of the fittest as far as crossing the road is concerned. It seems like you almost need to have a death wish or at least faith that The Force Is With You. Even the pavements are not safe – you may suddenly find yourself leaping out of the way of a cyclist who decides that the pavement is a quicker (& less risky) way to get to his destination.

B) Horns in China are activated when you depress the brakes (& I suspect the accelerator as well). You honk when you need to let your fellow motorists/errant pedestrians/cyclist know to “Watch out, I am coming”/”Get out of the way”/”Move, you idiot”.

C) Cyclists are an entity unto their own – they have their own traffic rules which basically states that anything goes as long as you don’t get knocked down or don’t knock down anybody else.


Thank God I don’t have to drive when we move there.

goodbye, old friend.

just when i thought i was all cried out,
the tears start to flow again
trying to fill the void in our lives.

goodbye, old friend.
go in peace.

In The News

Pg H3, HOME Section, The Straits Times, October 18, 2006
Dispute Mediation helps both patients and dentists – Patients avoid legal bills and dentists pay less for insurance

by Salma Khalik

Hmm.

I didn’t realize that the Singapore Dental Association’s Ethics Committee handles mediation in patient-dentist disputes.

I wonder why the Singapore Medical Association doesn’t have a committee to do the same? Or at least facilitate the formation of a committee to do the same. I, for one, know that it is sorely needed.


Pg 23, World News, The Straits Times, Oct 18, 2006
Fast Track to Citizenship: Join the US military

This is an article taken from Reuters.

I find it ironic that PRs/immigrants in the United States are literally dying to take up US citizenship while Singaporeans & PRs here try all ways & means to get out of doing NS, or at least, to get their PES rating downgraded.

So much for patriotism, eh? It’s no wonder that the ICS responded to a reader’s suggestion to allow dual citizenship with this letter:

Oct 14, 2006
Singapore not ready for dual citizenship

I REFER to the letter by Mr Bertrand Teo Ming Shan, 'Can ICA be flexible in dual citizenship case?' (ST, Sept 27).

Dual citizenship is a policy that has to be considered carefully and thoroughly.

We have yet to reach the stage of nationhood where a Singaporean with a second citizenship would still retain his identity and loyalty to Singapore as his homeland wherever he goes, with his second citizenship being only of secondary importance.

Lim Jing Jing (Ms)
Senior Public & Internal Communications Executive
Immigration & Checkpoints Authority


Pg 20, World News, The Straits Times, Oct 18, 2006
Disabled girl without a home.

This story is about a girl named Charlotte Wyatt who was born 3 months premature in October 2004. Her parents had fought in the courts to require that doctors provide artificial ventilation if her condition worsened. I guess they succeeded, because she is still alive, albeit with serious brain, lung & kidney damage. Her treatment apparently costs close to S$900 a day; she requires 3 litres of oxygen every minute; she is fed & medicated through a nasal tube. Her parents are now separated (apparently due to the strain of coping with this situation), & now, social workers are looking for foster parents to look after Charlotte as both mum & dad are unable to do so.

I had previously blogged about this issue of sustaining life at all costs as part of an earlier entry.

Is it worth it?


Live Cell Therapy???

And finally, I spotted an ad in the Mind Your Body section of the papers for an organization called Villa Medica Asia which is “one of the few approved clinics to administer the live cell therapy”. A google search revealed that indications for this therapy which involves injection of animal derived cellular material into the patient, includes a whole host of conditions, ranging from exhaustion to menopause to retarded development in children! Wow!

Hmm (again). I wonder how MOH/SMC/SMA will respond to this amazing & miraculous treatment.

Wanderlust (I)

We will pay a visit to our ancestral homeland this week, my husband, our sons & I. This is part of our preparation for our eventual move there…a reconnaissance, if you will. This will be the very first time that I will step foot into the Middle Kingdom. I have never felt any pull to this country before. Any interest I've ever had to visit comes from a sense of wanting to experience different cultures & lifestyles, rather than from a need to “find my roots”.

Years ago, our forefathers left this continent for foreign shores, either under threat of persecution, or to seek their fortunes. Some planned to return after they had made their fortune, while others planned to grow roots in their new home countries.

Those who did not return spawned generations who developed their own culture, some very different from that of their ancestors. There are those who say that this is a bad thing. I disagree, as I believe that culture is a dynamic organism, which evolves & changes with the times. It is part of progression. This is not to say that we should forget the achievements of all those who have gone before us. But we shouldn’t dwell on the past & hold on to old practices & beliefs just because they were what our ancestors did.

I know this will be an eye-opening experience for us. I think it will show how different, and yet how similar, we all are, as human beings. I said the same thing about what I learned while living in the USA. Some will think that I am being deliberately paradoxical, but I’m not. Honestly.

Medical Tourism

Looks like Singapore is not the only country outsourcing its medical services. Dr Parker blogs about this phenomenon happening in the USA, where healthcare costs are ridiculously high, thanks to high insurance premiums & (IMHO) high litigation rates.

Unsurprisingly, this is creating a lot of unhappiness in the medical community & the patient's union. Quality of care, medical liability & follow-up care, especially in the face of possible complications are issues which have been raised & understandably so.

This particular patient is supposed to go for rotator cuff surgery & cholecystectomy in India. He would also go sightseeing on a two day tour that includes a visit to the Taj Mahal. The cost of the operations would be only 1/5 of that in the USA - a huge savings for his employer. But question is: who is going to take care of him if he develops complications post-op? Will the American insurance company still cover him for any medical care received as a result of such complications?

I know of someone whose brother, suffering from renal failure & undergoing hemodialysis for the past 20 years, decided to travel to China for a kidney transplant. It cost him about $60,000. Apparently he was hospitalised for a week before being sent home. He did develop post-op infection & required ICU care. His original nephrologist here refused to manage this problem, & he had to seek treatment in a different hospital.

Now we all have heard of the dubiosity (is there such a word??) of organ transplants done in China, & how the origins of these organs are rather hazy. (From executed prisoners? Sold by someone in need of money?) But aside from that, is it ethical for a doctor to refuse to give treatment to a seriously ill patient, who developed complications from such a procedure? No, I say. We may disagree with the patient's decision to go through the procedure. But we should not punish the patient by making life harder for him after.

The medical communities in countries where healthcare costs are escalating have to examine all these questions ASAP. Outsourcing is NOT going to go away. Especially in a world where money talks the loudest in most cases.

DNR

Here is an interesting entry about CPR & DNR in response to a New York Times article, The Last Word on the Last Breath.

I was surprised that an actual analysis was done & published in the NEJM on survival rates in CPR on TV!

I remember how dismal the success rate was during my stint in A & E oh-so-many years ago. Most of the patients who were admitted collapsed had already been down for more than 15 minutes. At that time (I don't know about now), the paramedical staff in the ambulances did not do intubations on the field. So most of the time, our efforts in the department were basically "going-through-the-motions" for a reasonable amount of time, before pronouncing death. Most of these collapsed patients had pre-existing co-morbidities & elderly or were victims of severe trauma, so our efforts were not unexpectedly futile. I remember the sickening crunch of breaking ribs while I did chest compressions, especially in the elderly & frail.

The only time I managed to bring back a patient was a gentleman in his 50's suffering from an acute exacerbation of COPD, who, right in front of my eyes, desaturated & went into ventricular fibrillation. Immediate CPR was instituted, & he was successfully resuscitated & immediately sent up to the medical ICU (whose MO was not terribly happy with accepting this very ill patient, but hey, what to do, A & E in those days were not equipped or staffed to monitor patients requiring close monitoring).

Even in the wards, many family members still insisted on going all out for the patient in spite of how gravely ill that patient was. Perhaps they didn't realise how traumatic CPR can be on an already weakened body. I can certainly understand why letting go is hard.

When my time comes, I will make sure that my family understands my wishes & let me go in peace. I admit I have yet to sign an AMD nor have I made a living will. It's one of those things which one keeps putting off, thinking that one still has time to do it. I really should get off my a** & get it done...

Heartbreak

I am an emotional wreck. We have made the heartbreaking decision to put down our very old, very large dog whom we’ve had since she was a pup. She has not been doing well since we moved into an apartment over a year ago. Arthritis, cataracts, incontinence – diseases of age – afflict her & makes it hard for her to get up & walk on ceramic tiles, & she leaks pee if you don’t bring her downstairs fast enough. Hard for everyone.

I’ve been putting off this decision while desperately trying to find a good home with a garden for her to enjoy her last years with some degree of comfort but alas, in a country where most people live in government housing that disallows dogs beyond a certain size, it has been a futile effort. The fact that she is almost 11 years old, weighs 80 lbs & has these health problems don’t help either. It would be hard to find anyone willing to accept a pet like this, & not fair to burden someone else with these problems. We looked at a no-kill shelter to see if it was an option but seeing how overwhelmed they are with the number of dogs they have to foster, we didn’t see how our dog could be happy in that kind of situation.

Euthanasia is emotion-ridden. I think my reluctance to face this ultimate decision is partly for selfish reasons too. I don’t want to go through the trauma of loss & grief. Tears have come at the most unlikely moments. But I need to also think about the quality of life issue. Should I, due to my selfishness, allow her to go on like that? It breaks my heart each time I see her trying to struggle to get up so that we can bring her down for her toilet break. I suspect she has some degree of heart failure as well, as she pants really hard from just walking less than 100 m.

This is hard, and it involves an animal. How much harder would it be if it involved a human life. I can’t imagine how Dr Kevorkian did what he did, although if you look at it in a cold, clinical & detached way, it sounds like a logical solution to an existence wrought with pain & suffering. Problem is, as human beings, we aren’t cold or detached when it comes to a loved one. At least, we shouldn’t be. As for being clinical, well, the arguments for and against euthanasia among the medical community have been & will always be an ongoing & controversial one.

Stop crying, aliendoc.

Note: In my opinion, euthanasia & the Advance Medical Directive are two different issues.

Compassion

"At the behest of Amish leaders, a fund has also been set up for the gunman's wife and his three children." YAHOO! News: Donations to Help Amish families (AP)

If one could find a silver lining behind the darkest of clouds, this would be it. The compassion shown by this gentle community for the family of the man who killed their young is something that should be emulated.

The Amish live in Lancaster County, Pennsylvania. I remember making road trips to this picturesque area, our car often having to follow behind horse-drawn buggies on the streets. Parking lots included areas of buggy parking. Towns with unlikely names like Bird-In-Hand & Intercourse (!!!), restaurants with names like "Good & Plenty" and "Plain & fancy", featuring traditional Amish (& very fattening) food like fried chicken, Chow Chow (a vege dish), Shoo-fly pie (so named, because its sugar content attracts flies!)...all these bring back fond memories of our lives in Pennsylvania. The Amish eschew modern conveniences like automobiles & electricity, and dress in plain clothes, the men wearing the characteristic broad-brimmed hats. They still speak in an old German dialect (despite the misnomer Pennsylvania Dutch, they originated from Germany, fleeing persecution because of their religious teachings.

Live Long & Prosper

Not for these people. First this. Then this. And now this.

Despite being married to an American & having lived in the US for several years in a typical suburban neighborhood, & pretty much assimilated into the lifestyle there, I still don’t get the obsession of some Americans with the “right to bear arms” portion of the Constitution.

My husband has tried explaining it to me from the perspective of American history & how, when the constitution was first written, it was meant to protect the citizens from tyranny. I can understand that scenario back in the 18th & 19th century, when lawlessness was rampant & there were no proper law enforcement agencies in existence or available to those living in remote areas of the country.

But now, in the 21st century, I don’t get it. I know that there ARE responsible gun owners. But there are also nutsos out there who, due to warped reasons of their own, decide out of the blue, that he needs to kill some people.

Then there are kids out there as well, hormone-ridden, angst-filled youths, trying to get by in the stressful times of modern day living, who have easy accessibility to their parents’ guns or rifles, who one day decide that it would be cool to use their fellow schoolmates as target practice.

I guess having been brought up with Asian values which places society above self (for the most part, anyway), it’s hard for me to support this “right to bear arms” argument. If I had to choose between that & an innocent’s right to live, it’s a no-brainer.

Words of Wisdom

I want to give this writer a standing ovation.

Patients and doctors must be loyal to each other

I REFER to the letter, 'Fees aside, pick the right hospital and doctor' by Ms Virginia Goh Min Wen and Dr Victor Teoh (ST, Sept 22).

It is obviously prudent in matters of health, to choose a hospital not based on the cost of treatment but the clinical outcome or effectiveness of therapy.

At the same time, it is not only the skills of the specialist or the quality of the equipment in a hospital that determines good clinical outcome.

Most of all, a patient needs a doctor who will act continually in his best interest.

Patients need doctors who are loyal and place their welfare as their first consideration, even at times at the expense of subjugation of the doctor's personal interest.

Patients, like all humans, have multiple and often varying interests.

Doctors, like all professionals, have multiple interests and commitments.

Some personal interests of doctors which may come into conflict with their professional obligation and thus the patient's welfare and interests include accumulation of wealth, fame, academic position or rank, or even the promotion of scientific innovation.

In today's medical-commercial complex, doctors can inadvertently be drawn to promote the interests of the pharmaceutical industry, companies that produce medical devices and equipment, insurance companies and even hospital bottom lines.

When conflicts of interest arise, there may be, in extreme cases, neglect of professional duties but more often a compromise of the independence of clinical judgment.

In a medical encounter, it is not only the knowledge and skills of the doctor that are important in the clinical outcome but also the independence and quality of the clinical judgment.

The judgment may be tainted so as not to serve the patient's best interest.

The clinical judgment can be compared to the plan and strategy of the diagnosis and therapy.

Thus, even with careful and expert execution, an inappropriate plan and strategy will not lead to a good outcome.

In addition, it is important for patients and the public to know that in the rapidly changing knowledge and technology of modern medicine, medical uncertainties are a common feature of medical practice.

New therapies and technology may not be fully validated.

Protocols of therapy continue to change and many areas of disease and treatment are still unknown.

Every patient brings his own special features to the illness and therapy.

There are large grey areas in medicine where the doctor must exercise clinical judgment.

Independent and good clinical judgment, based on scientific facts, clinical skills and experience and based on the particular patient's context, needs to exercised to serve the best interest of the patient.

To act in the best interest of his patient, the doctor must not only be up to date in his knowledge and skills on the diagnosis and various treatment options, but must also have a good knowledge of his patient and his interests.

Equally important, the doctor must have knowledge of himself and his motivation.

Unfortunately, in the hospital setting when a patient seeks a specialist consultation, the clinical encounter is transient and between strangers.

Many times, patients hardly remember the name of the specialist they consult, let alone the medical information exchanged.

The specialist who sees several patients a day remembers them as diagnostic labels in medical notes.

Specialisation in medicine no doubt increases expertise and more proficient practice.

At the same time, it runs the risk of compartmentalising the patient to organs and waters down the quality of the doctor-patient relationship.

For patients to benefit from a good clinical outcome, optimally utilising medical facilities at affordable cost, a collaborative effort is required between the generalist family physician who knows the patient well and the specialist who has the special skills to carry out the treatment.

It is not always easy for anyone, let alone the patient, to judge whether his doctor is acting in his best interest and welfare.

However, some professional behaviours are surrogate markers to show the doctor is acting in the patient's best interest.

A doctor who spends time and effort giving medical information and options to empower the patient to participate effectively in medical decision making, tells of his concern for the patient's interest.

A doctor who acts in the best interest of his patients not only keeps up to date with his skills and knowledge, but also fills in any gaps by not hesitating to consult his colleagues and getting a second opinion.

One's medical colleagues often have a better insight of their another's clinical competence and patient-centeredness of practice.

Thus the value of a medical referral to a specialist by the family physician.

Unfortunately, in today's society, the climate for and culture of having a regular primary or family physician is not strong.

For patients and their families to run around by themselves seeking the right hospital, right doctor and right specialist for the patient's illness is a common phenomenon locally termed 'hospital (or doctor) hopping'.

Information from books and the Internet leaves many gaps.

Hospital and doctor hopping is nearly always detrimental to the patient's welfare, whether in acute illness or chronic disease care.

It also erodes loyalty and continuity of care.

Nor is it cost-efficient.

The simple formula in choosing the right doctor for the patient, for a good clinical outcome at affordable cost, is for patients and doctors to be loyal to each other and communicate effectively.

The challenge for policymakers and the medical leadership is to build a climate, culture and system which will ensure and promote this loyalty and communication.

Dr T. Thirumoorthy

Duh Moments

Duh Moment #1

Patient needs PAP Smear done. I tell her to undress & lie on couch while I prepare the equipment. I return to the examination couch & notices that she still has her underwear on.

Me: "Er...you need to remove your underwear in order for me to do the PAP Smear."

Patient: "Oh, is it? I need to remove my underwear?"

Me: "Er...yeah" (Inner Me: "Duh")


Duh Moment #2

Patient complains of headache. After taking history, I tell her I am going to check her blood pressure.

Patient: "Do you want me to take off my watch?"

Me: "Er...no." (Inner Me:"Duh")

Heroes

I stumbled upon this new series called Heroes starting in the US on NBC Sept 25 while I was perusing my son's latest installment of Civil War (a new Marvel comic series) - OK, OK, I admit it, I still read comics...

Anyway, take a look at the trailer. I think it's going to be a hit & will especially appeal to superhero/comic/scifi/fantasy fans & geeks (like me!). We need a bit of fantasy & optimism especially when we are bombarded daily by news of bombs & terrorists & coups & wars.

Let's hope Mediacorp brings it in.

A Xanax Moment

I think I need some Xanax.

Why? Well, we’ve just found out that we will be moving to China.

Oh, don’t get me wrong, I am actually feeling very excited about this new adventure. But I’ve some trepidation about the transition. Been getting tension headaches the last couple of weeks while awaiting final news (which we received this past week) on this.

Things like the kids’ schooling: how they will adapt, whether there will be continuity in what they are studying here & what they will be studying there, the timing of the transfer - should we let them finish off the school year (which ends middle of next year) before moving them over (but then this would involve some logistical acrobatics as A’s new position starts next month) or transfer them in the middle of the school year (i.e. Dec!!!) so that the whole family stays together.

Things like what to do with our home: Sell? Or rent?

Our (very old & large) dog with a few health problems – a heartbreaking decision will have to be made here.

I think I had a mild anxiety attack last night while thinking about all this - slight chest tightness with a sensation that I couldn’t quite inhale completely. It lasted only a few seconds.

A. doesn’t understand why I get all angst-y (that word again!). I guess that’s the “Men are from Mars, Women are from Venus” thing going on. We women tend to think things through to the bone, gnawing over every small detail ESPECIALLY anything involving our children & their well-being. Guys? They just breeze through, with the attitude that they can conquer any obstacles in their way as long as our immediate needs (Food & Shelter) are taken care of.

Breathe, aliendoc, breathe…

Slow Hand

Eric Clapton

January 2007

Singapore Indoor Stadium

No Survivor?

Hmmm.

This is an interesting development.

Survivor 13 : Cook Islands started today in the US. And I notice Mediacorp hasn't got it on its TV schedule. Somewhat strange seeing that every single season of Survivor has been broadcast on the same day as the US so far.

Could it be the fact that a racial theme has been used to divide up the teams? Is Mediacorp afraid that Singaporeans won't be able to take it? Will our sensibilities be SOOOO affected by this racial divide? Are our values & morals so weak that they are afraid that this multiracial harmony in which we exist will be destroyed by this TV program?

I wait with bated breath to find out...

Letters to the Forum

Why do people write letters like this to the newspaper?

"No lunch served on SIA's flight from S'pore to Shanghai

I recently took SQ826 flight to Shanghai, departing Singapore at 8am and arriving at Shanghai at 1.30pm. I was very disappointed that no lunch was served on board. Food was served at about 9am to 10am, which was called brunch. It was breakfast to me.

When I asked about lunch, I was told that only one meal was served on that flight. I pointed out that the flight only landed at 1.30pm, so the one meal in the morning was not sufficient to fill our stomach. I was feeling hungry then, but the stewardess could only offer me cup noodles, peanuts or biscuits.

I was disappointed that not even light snacks were served during lunch time. Other airlines normally provide main meals and light snacks on board. SIA's management should ensure that passengers are served sufficient meals on board.

Tan Saw Bin (Ms)"


This lady could very well have written to SIA directly to voice her complaint and give her suggestions. I find it hard to understand the mentality of such people. It's the same with medical-related complaint letters. Instead of going straight to the hospital or clinic with their issues, patients or their kin write to the newspaper.



And it looks like this letter is going to open another can of worms...

"Don't salvage lives that will weigh on family

THE article, 'Parents of the disabled have a long list of woes'' (ST, Sept 13), serves as a launching pad for me to write to ST Forum on a topic I have felt very strongly about for a long time.

Of the long list of woes, one dominates that of all elderly parents: 'Who will look after my child after I pass on?' Many parents have expressed this concern to me.

In other cases, I have reminded younger parents to cease their globe-trotting in search of a miracle cure and set aside funds to provide for their disabled child while not neglecting their other children.

For those who can afford it, I advise them about setting up a trust fund. But many do not have enough money to provide for their disabled offspring for as long as the patient will live.

I understand the parents' pain and burden because I see it so often. It is one of the reasons I have written to ST Forum more than once about not salvaging lives that will be a burden to their family and society.

My conviction was further strengthened last Tuesday when a patient in his 50s, who I have seen for more than 15 years, came for his annual check-up with his sister.

Surprised, I asked what happened to the father who was the one who brought the patient every time.

'He passed away' was the sister's answer.

'But he looked in good health when I saw him last year.'

'Actually, he jumped and killed himself. He meant to take my brother with him but could not do so.'

I was greatly saddened. The father had asked me for help to find a nursing home for his son two years ago. I gave him a list and he phoned each of them, promising to will everything to the home which would promise to look after his son.

He had a landed property which he lived in, but that too would be willed to the home when he died.

Last year, he told me sadly that all the homes wanted money upfront and turned him down.

As medicine advances, more and more brain-damaged patients will be salvaged. We doctors are playing God all the time though we pretend we should not.

We are trapped between the old days when many of these disabled patients would die because medicine could do no better, and a rational era (which may never come) where doctors and families can come to a rational decision that 'enough is enough'.

As a First World country where millions of dollars are being poured into making us a cultured and vibrant society, could a few million dollars be spared to build nursing homes for disabled patients whose parents are getting too old to look after them any longer?

Dr Lee Wei Ling "

Our esteemed colleague had previously written into the papers with her views on the surgery performed on the Nepalese twins, one of whom apparently is not doing well, requiring full-time care from her family. I suspect this letter will also trigger off a spew of responses.

I can't say that I disagree with her views entirely, especially where it comes to building nursing homes for disabled patients or at least, some kind of daycare or support facilities to help care-givers with what must be an extremely difficult situation. I myself have asked the question "Why?" many times when I did my rotation through Neonatology, resuscitating premies, & taking care of severely ill neonates. Many end up vegetative or with terribly compromising health conditions likely leading to lifelong complications which tax not only the wallets of their parents, but are also emotionally draining. But it was not my call to deny or withhold available treatment. When called to resus, you resus.

Perhaps I am cold-hearted, but personally, if I had a child whom I KNEW was going to go through life with a multitude of health problems if we kept him/her alive with all our modern medical means, I would rather let him/her go peacefully instead of having to suffer through a life of questionable quality.

Singapore Dreaming & the IMF/World Bank meetings

The latest local movie production, Singapore Dreaming, opened last week. One of its producers is fellow doctor, acclaimed plastic surgeon, Woffles Wu. Together with husband & wife team, Colin Goh & Dr Woo Yen Yen, they do a credible job in creating something that shows the heart & soul of Singapore.

It revolves around the lives of an average Chinese-Singaporean family. Dad, Loh Poh Huat, is the typical wannabe, disdainful of HDB dwellers, & counting the days when he strikes Toto & can afford to move into his dream condo & buy his dream car & join an elite country club. Mum is a housewife, content with her duties of keeping house, cooking & brewing ‘liang teh’ (herbal tea) everyday for the family. Oldest child is Mei, a secretary married to an ex-Army regular, C.K., who now struggles to earn a living by selling life insurance. Mei has always struggled for her parents' love & attention, and being born a girl is a great disadvantage in this struggle. Younger offspring is Seng, the precious son, the ne’er-do-good, sent off to the golden land of America to get a degree from an American university so that he can return after graduating to earn a good living & repay the money spent by his father & his long-suffering fiancée, Irene, to support his studies. Or so it is hoped.

A multitude of local social issues are laid bare: our obsession with the 5C’s, our oftentimes hypocritical attitudes towards domestic maids, urinating in lifts, the preferential treatment shown to sons vs daughters. Swipes are taken at the kiasu-ism of Singaporeans, with a mother shown admonishing her kindergarten-aged son rather violently for scoring 95% in a spelling test instead of 100% like his classmate. Dr Woffles Wu even makes a cameo appearance as a family friend paying his condolences at the wake of the ill-fated Loh (“No need to give so much, OK,” he tells his wife softly, as they approach Mei to give her their condolence money, “They won 2 million dollars, you know.”)

It was a raw experience, watching it. So raw that it was almost painful. Although it sometimes seemed that the storytellers were trying to squeeze too many issues into one movie, it was all very real & familiar to me, as a Singaporean. Seeing it all exposed on the big screen made it almost embarrassing to be a Singaporean, although at the end of the story, everyone gets his/her comeuppance.

And what does Singapore Dreaming have to do with the IMF/World Bank meetings? Nothing direct, really (apart from the fact that the movie opened in local theatres just 4 days prior to the start of the meetings – hmmmmm…coincidence? ☺ ). It just made me think of all the aesthetic remodeling & “cosmetic surgery” (all of which would have done Dr Wu proud ☺) that has been taking place in the preceding few months to pretty up this little island of ours. After watching the movie, it became more obvious that we really needed all the surface touch-ups.

9/11

Five years past,
In disbelief I watched,
Mouth agape,
As planes smashed
One after the other
Into the two towers,
Televised “live” on CNN.

Oh my God, oh my God, oh my God.
This can’t be real,
It can’t be happening,
It must be a trick,
A camera trick,
A scene taken from a movie.

Then they fell
Like a stack of cards,
One after the other
Within seconds,
In a rising cloud of dust
That spread throughout Manhattan.

Another plane
Smashed into the Pentagon,
Another one into a field in Pennsylvania
One after the other.
Was that it? Was that it? Are there more?
Please, no more, no more, please.

Oh my God, oh my God, oh my God.
It felt surreal,
My mind numbed
By the thought of all those lives
Snuffed by unimaginable evil.
Terror transmitted halfway across the globe
Through the wonders of technology.

It was real
And yet unreal.
We lost our innocence
That fateful day,
No more trust
In our fellow man.

We have to find our way again,
Someone help us find our way again




Five years ago, on the night (in Singapore) of Sept 11, I watched CNN broadcast "live" as planes smashed into the two towers of the World Trade Center. It was an almost out-of-body experience, as my brain numbed, & my heart screamed "No!!!" in terror & disbelief, while I watched the buildings crumble down into nothingness.

I called A immediately - he was away on a business trip - he would call his mother as soon as we hung up. He had heard the news but had not seen the terror screened on the tube. She lives less than 15 blocks from where it happened. Fortunately, she slept through it (amazingly) as she is a late riser. He told her to keep her windows shut, & not to venture out into the streets due to the uncertainty of the situation. She had a freezer stocked to the brim with food, thankfully.

After that conversation, it became impossible to contact her as the phone exchanges in that area had been affected by the destruction. For three weeks we remained incommunicado, but was fortunate that A's best friend who lived in Brooklyn was able to contact her & let us know that she was OK despite the area being cordoned off.

Although America has recovered outwardly from this assault, scars remain from that fateful day. Although unspoken, suspicion remains of those who are of a particular faith, or who look & dress a certain way. But can one blame them?

My younger son still worries about his dad's plane crashing when A goes on his frequent business trips despite my reassurances that taking the plane is safer than driving a car. Until recently, he always made sure that whenever possible, A & I were accompanied by either him, or his older brother, whenever we went out, so that they could protect us in case we were "attacked" by terrorists. A sweet but illogical sentiment. But can one blame him? We lost our innocence five years ago.

TV Land

RS: Supernova

Final four are Dilana, Toby, Magni & Lukas.

Storm was ousted last week after repeated being in the bottom 3. I guess Supernova has to listen to the fans. She gave a heart-wrenching performance of Pink Floyd's "Wish You Were Here" which brought even Jason Newsted (Bass Guitarist) to tears; but that was not enough to save her.

Toby's original composition, "Throw It Away" won him the encore (and a brand new Honda!) which he dedicated to fellow Aussie, Crocodile Hunter, the late Steve Irwin. His rousing & energetic performance had everyone singing along. A potential chart-topper, it had excellent guitar riffs, brilliantly performed by the House Band's Rafael Moreira.

My faves to win? Either Dilana or Toby. Dilana has had a rough couple of weeks, & her popularity has dropped after her foot-in-mouth debacle with the media. She still gives impressive performances, although her weakness in songwriting may proof to be detrimental. Toby has the looks, talent & charisma to capture fans for Supernova, especially those of the female persuasion! And in an industry driven by popularity & moolah (more fans=more albums sold=more$$$!), this could give him the edge over Dilana.


Entourage

I loved the most recent episode screened this week! Vince Chase (Adrian Grenier), low on funds after committing himself to buying a multimillion dollar house, decides to do an ad for a Red Bull-like product targeted at the Chinese market. Bai Ling guested as the stunt co-ordinator, to teach him martial arts moves for the ad. She ended up teaching him not only kungfu moves, but also techniques totally unrelated to martial arts (ahem!). The episode ended with the final product - the ad itself, dubbed in Mandarin. Absolutely Brilliant!

aliendoc's top 10 peeves about driving in Singapore

I have been driving for almost 25 years, out of which 18 years were on Singapore roads. I have realised that the only time (OK, almost the only time) I cuss & use four letter words is when I am driving in Singapore. Here goes:

#10
Pedestrians who take there own sweet time crossing the road when there is a long line of cars waiting to pass through at a busy intersection (Think: Junction of Orchard & Paterson Roads just outside Wheelock Place).

#9
Waiting at the red light, then seeing the driver in the vehicle next to you picking his nose/ear, inspecting his finds then flicking it out his window.
(EEEWWW!)

#8
Waiting at the red light, then seeing the driver in the vehicle next to you wind down his window & projecting a loogie which misses your car by 3 inches.
(Double EEEWWW!)

#7
Motorcyclists who treat the lane dividers (or any space between two vehicles) as a designated motorbike lane.

#6
Motorcyclists in #7 who travel at a speed of 60 km/h (or less) on the expressway, making it difficult & dangerous for other vehicles to overtake him.

#5
Tailgaters who follow you like their car was magnetized to yours even though you are traveling at the maximum speed allowable.

#4
While waiting at a side road trying to get on to a busy road, you notice cars which don’t indicate that they intend to turn off into the side road, resulting in you missing a precious chance to turn out onto above said busy road.
(!@#%!!)

#3
When you indicate that you are trying to switch lanes, the oncoming car on the lane you are trying to switch to speeds up to block you off instead of slowing down.
(Double !@#%!!)

#2
Taxis which trawl for fares – they either travel at a snail’s pace; or make sudden swerves & stops to catch the passenger.

And aliendoc’s #1 peeve about driving on Singapore roads:

Drivers who allow their babies/toddlers/children to clamber all over the car- in between the front seats, on to the back ledge behind the back seat- or sit on the front passenger’s lap instead of being restrained in a child’s seat or by a seat belt. Don’t they know that their children would make excellent projectiles if they were involved in a collision???