Posts tagged ‘News’

The Plight Of Housemanship Part 2

Thank you for coming back! Here’s Part 2 to yesterday’s post.

Still quoting from yesterday’s article from Wayang Party:

“There is a “macho” culture pervading the local medical fraternity that because medicine is a noble profession, all doctors are expected to put up with sacrifices and hardships which the job entails even at the expense of their own personal well-being.”

I can’t disagree with that. On bad days I fantasize about poker-faced administrators trying to pass a bill to limit the hours that doctors spend eating and sleeping, so as to increase productivity for the institution. Perhaps one day they will no longer pay wages to doctors, but instead make them reimburse the system for the gracious privilege of working for them.

<Laughs madly>

I do apologize, but the trauma of those days has permanently exacerbated my tendency toward self-centred whinging. Now and then it demands to be leached from my system.

To be fair, life did not remain as bad after that terrible year (if it had, the ward sisters would be wondering where all the potassium chloride had gone). Depending on the specialty you choose, ward rounds and night calls can, and usually do, become less lethal. More importantly, as you rise in seniority, you begin to see the purpose and meaning of the work you do, and that makes all the difference.

The sad and sinister bit is this: in order for senior doctors to ‘graduate’ from the cesspool of stooge labour, the labour has to remain in the stooge level. Which means that housemen will remain screwed until they get promoted, and the next batch of unfortunates takes over. Having escaped from hell, the survivors have no wish to turn back and re-immerse themselves in the pits. Which means that things are unlikely to change from that direction.

Things, however, are slowly changing. Initial changes included increasing the number of medical students and limiting the number of night calls housemen are allowed to do (I believe the current number stands at five or six per month). Hospitals also began employing peripheral staff to help draw blood and do ECGs. Right now, some departments are trying out a shift system, to reduce the number of hours that doctors are on active duty.

The most resistant item, I suspect, will be the mindset of doctors themselves. Strange and ironic, but true. Why? Because doctors still see housemanship as a trial by fire. If you’ve survived a gruelling housemanship, I can safely assume that you have a minimum standard of resilience and probably intelligence. But if your housemanship was all cushy, then you might be a soft spoilt brat from the new generation of whiny losers. Any Tom, Dick or Harry could be a doctor. What is the world coming to?

I can see this train of thought in my own mind, Judas that I am.

Still. I cannot forget how those dark days made me hate – really hate – everyone, from patients, seniors, fellow housemen, non-doctor friends, and most of all, myself. Anyone, who for any reason, deprived me of one minute of sleep, or detained me in hospital for one extra second, deserved to rot in hell. Anyone who was having a good time, or who patronizingly condoled me on my busy job, was a piece of shit. Patients were gloating enemies. Seniors were selfish sadists.

Tell me – how could any of that have made me a good doctor?

I tell you – it did not.

I think it made me a bad person.

Now I say that it was the grace of God that pulled me through that year and put me on the track to being a normal human being again. I married a wonderful man, got a suitable posting and found new friends who unknowingly preserved my sanity. Bless them. Given time to rest, read, love and laugh, I was able to remember the bits of me that housemanship took away. Still, it took years to undo the damage. Even now, I can still hear echoes of that long-ago rage.

Some of my colleagues never found God or someone to love. I don’t know how they kept going. I can think of several who are still full of hatred toward humanity. I think they are frightening, and keep my distance from them.

There’s no pat solution to this mess. In Ireland, where a law was passed in 2004 to reduce junior doctors’ working hours, 36-hour shifts still happen as a matter of course. It’s not so easy as passing a new law and assuming that things will fall into place. Issues like medical manpower, auxiliary healthcare and traditional mindsets still need to be addressed. Beyond those are abstract concepts like individual faith, character, resilience and support.

As for me, I take it as part of my work to be kind and reasonable to junior staff. Ditto for medical students when I teach them. Poor kids, for having Apollyon still lying in wait for them. Things may not be quite as bad now, but they can’t be a bed of roses either. Will I have a hand in creating a better place? I don’t know. Only time will tell.

This I do know: If I ever have children, I don’t think that I could, in good conscience, encourage them to become doctors.  

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April 8, 2009 at 21:20 10 comments

The Plight Of Housemanship Part 1

I just read an article, from Wayang Party, consisting of an unnamed doctor’s reminiscences on his hellish houseman year. Boy did it bring back a ton of memories.

Housemanship year in Singapore is divided into three postings of four months each. Each posting is a different specialty, such as general medicine, general surgery, orthopedics, etc. Guided by rock-solid hearsay and nail-devouring anxiety, fresh grads choose their poison and then spend the last precious month of pre-work freedom performing various last acts.

Then hell begins.

“A typical day begins with daily ward rounds at 8am. The house officers usually arrive half a hour earlier to prepare the case notes, familiarize themselves with the new cases and to trace results from the previous night.

The ward round which is often intimidating, seldom ends before 11am and sometimes stretches pass 12 noon if the cases are complicated. Then begins a day’s mundane work of drawing blood, doing ECGs (there were no phlebotomists or ECG technicans in those days), typing discharge summaries, arranging for urgent CT scans, talking to patient’s family etc.”

Oh yeah.

“If one is lucky to have lunch, it usually means a quick bite at the caferia provided the nurses are kind enough not to interrupt you during the precious few minutes when the new admissions will start to come in at the same time.”

Oh yeah. The takeaway-coffee lady was always my best friend.

“We had six to eight night calls a month which start at around 6pm and end at 8am the next day after which you are still expected to work till 1pm before you can knock off if there is enough manpower.”

Oh yeah. Night calls, by the way, are in addition to the normal day’s work, so you start work at 0800 today and (in best-case scenario) knock off at 1230 tomorrow, then continue business as usual the day after.

When you’re on-call, you function as (very thin) cover for the assigned wards, in which admissions, blood-taking, reviewing, collapses, and sometimes death, go on happening. These things are no respecters of time.

I remember the days when I would be too busy to even pee till 10 p.m., and then for every minute I spent in the loo, my damn pager would go off at least once, each beep signalling something else to do in some other ward.

The average amount of rest per call I got that posting was maybe half to one hour. The on-call room in that hospital contained two single beds and I was the only girl that posting… but at 4 a.m., in a state of exhaustion, I never had the energy to feel discomfited at the presence of a snoring fella in the same pitch-black room.

At worst, there were 9 – 10 calls a month, so we spent the whole time being pre-call (= anxious), on-call (= hounded), post-call (= dead), pre-call, on-call…

“I still remembered the Head of Department telling us during the orientation that “post-call” is privilege, not a right. Very often we don’t get to leave early after a hectic night deprived of sleep or if we do, in the late afternoons around 3 to 4pm.

You have to experience it for yourself to know how it feels like to be without sleep for 36 to 48 hours. Your mind gets switched off, your eyelids go drooping all the time and you get irritated very easily. The body craves for sleep and yet you have to force it to be up and running. There was once I dozed off at the bedside of a patient while talking to him!”

That year, I had my hair chopped uncharacteristically short, for reasons I can’t even remember now. My weight fluctuated like today’s oil prices. I stopped wondering why there were so many reports of housemen having breakdowns and attempting suicide. There was the potassium chloride, and there were the syringes, lying oh-so-casually in every treatment room in every ward.

“A Singaporean medical graduate from Australia quitted only after one week in the ward. On her first night call, she was so overwhelmed that she locked herself in the call room and switched off her hospital handphone. She was expectedly haul up the very next day to face the music dished out by the Head of Department who obviously didn’t take kindly to her ”AWOL” . The last I heard of her is that she is now working in a hospital in Melbourne and has settled down there.”

As much as I would hate having a colleague like that in this warzone, part of me empathizes. I was very often on the brink of giving up myself, what more someone steeped in a foreign culture?

Unexpected disappearances still happen. About a year ago, there was a ‘junior consultant’ from India who decided to come and try things out. He wore a business jacket and seized every chance to spout high-falutin theories, which endeared him to nobody, but which at least looked like signs of capability. He returned to India after about two months.

My recent favourite is the German doctor who impressively managed to get enrolled in the local registry, instead of being relegated to the ‘non-traditional source’ pool. He snagged a position in one of the best departments, turned up for observation sessions, asked decent questions and tried to be helpful. During formal orientation, he was brought to the wards. The next day, he vamoosed back to Deutschland. No more Doktor for us.

Too bad. I’d heard he was cute.

To be continued… thank you for reading this! I’m not quite done yet. I need to go put my fingers in ice water and recharge before coming back with Part 2 tomorrow. Stay  tuned. :) 

April 7, 2009 at 23:33 15 comments

Further Reactions To Dr. Allan Ooi’s Suicide

As if Dr. Allan Ooi’s suicide (which I wrote about on March 20, 2009) wasn’t already painful enough, someone has written a public letter that seems to imply that his family has no right to ask Mindef about the discussion Allan had with his superior about his bond.

It happened like this: Mindef published a so-called clarification about Allan’s bond with the Singapore Armed Forces on March 23. It cited mostly plain-vanilla bare bones, with no information on the extension of his bond. There was one tantalizing statement about Allan’s superior offering an alternative posting, but Allan never got back to him. In essence, the article was so pedantic and non-committal that it clarified practically nothing. However, given the local culture, that is no surprise at all.

Equally unsurprising was the family’s public response, asking for more information. They wanted to know “details of Allan’s discussions with his superiors”, “how a contract is subject to policy changes”, “why would a bond be breakable only in ‘strong, extenuating circumstances'” and the outcome of Allan’s letter to “HQMC Manpower in July 2008 with the intention of breaking his bond”, preferably via “an independent panel with oversight powers”.

Reasonable, what. Relevant, considering the distress Allan expressed over his job and contract. Furthermore, written in clear, restrained fashion. No soap-opera-worthy cries of, “Give me back my son!!!”

It’s just sad that they felt the need to publicize their request instead of writing directly and privately to Mindef.

Enter this silly moo with the following gem, “I can’t believe that his family is asking an inquiry into his death. Who will pay for this inquiry? Wh should taxpayers shoulder the ‘blame’ for his death?” (Errors not mine)

<Picks up jaw from floor> Excuse me? Could you possibly be a little more insensitive and thick-headed? These folks would like to know more about the main reason their son or brother committed suicide, and your fear is that someone will ask you to pay money?!

It sounds like this odd little man expects the Ooi family to do nothing besides cry quietly at home, marinating in self-blame and shamed-faced gratitude to the Armed Forces. Everyone else – wag fingers at them.

Mind you, he does raise other points that are not devoid of sense. It is fair enough to say that a contract should be honoured, and to wonder what the family did in the months that Allan went AWOL, and to say that Mindef is not 100% responsible. I have no quibble with these points.  

However, it is not fair to assume that the family was either completely ignorant or unconcerned about Allan’s problems. How would this chap even know, for goodness sake? Maybe they were distraught; maybe they persuaded to no avail; maybe Allan simply decided not to confide in them. Now that the worst has happened, of course they want to learn about details that they did not know – or perhaps were not allowed to know – that might have been important. What’s so unbelievable about that?

Gosh, I can just imagine the glee of the tabloid editors into whose laps this letter fell. Free, blameless publicity, guaranteed to ignite furore and indignation, and therefore sales. If you ask me, they are the big winners in this event. 

Unless… the guy was paid to write this letter… and Someone Up There is laughing at all of us dumb sods for taking this stupid crap so seriously…

Update: Read about my own experiences in the field here.

April 5, 2009 at 01:31 7 comments

The Baby Left To Die In Changi Airport

During a 7-11 blitz yesterday, I saw a tabloid front-page article about an infant who’d been abandoned at Changi Airport in a trash bag. Good grief! The poor thing was pronounced dead at Changi General Hospital.

The airport staff went into quite a frenzy. I’m not sure why, but a postulation was made about the mother having given birth at one gate and dumping the baby at another. Perhaps the child was still bloody. Or maybe there was a placenta. I didn’t buy the paper (refused to), so i don’t know the details.

As the baby was “fair-skinned”, the staff tried hunting for a “pale-looking woman”, but to no avail.

When I think about it, I suppose that it is not implausible for a woman to deliver a child in an airport. If she’d done it in a bathroom cubicle, probably no one would have thought twice about hearing the baby’s cries, or subsequent noises of things being stuffed into a plastic bag. Then it is quite common for travellers to lug big bags. Above all, people are, in general, terribly unobservant. These days, it is practically the norm to avoid eye contact.

Beneath the horror and disapproval, I must admit to feeling sorry for the mother. What a terrible experience to have gone through, alone among strangers and probably in a foreign country. Where was the love and joy that other mothers experience when their babies come? And to feel that her best option was to leave the baby to die, perhaps starving, shivering, bleeding and suffocated. I cannot imagine that she made these decisions easily. She must have been frightened and in pain.

I wonder where she is now. Somehow I hope she caught her plane and is somewhere far away.

Update: Yup, just found an online Straits Times article describing the baby being found at Terminal 1’s Gate 49, “bloodied” and with “the umbilical cord still attached”. Also, “it is believed that drops of blood were found in a toilet near Gate 40, where a woman is said to have given birth”.

March 27, 2009 at 00:10 3 comments

The Girl Stabbed By Her Mum

In the wee hours of  Thursday 19th March 2009, a teenaged girl was found dead in her Woodlands flat from a stab wound to her torso. Hours later, her mother was charged in court with murder.

Poor Eunice Chew was only fourteen. Her public photos show a round-cheeked girl who faced the camera straight-on with forthright smiles, a nice kid who shouldn’t have been worried about more than school, friends and boys. Although not particularly pretty, she looked likable and trustworthy, someone who’d make a good pal.

Her mother, 51-year-old Goh Hai Eng, was arrested and charged with great rapidity. She has been reported to suffer from mental illness, and is divorced, and has an elder daughter who recently gave birth.

I sense a certain tension in the related news articles. Considering how sensational a piece of news this is, there doesn’t seem to be much information beyond the repetition of meagre facts (or so I hope) – about date, time, place, etc. – and some half-hearted speculations. For instance, one source claimed that Mdm Goh had not eaten for four days, but other sources described the family catering a “buffet spread” for her grandchild’s full-month celebration, as well as neighbours having seen the two elder women smoking at the staircase – cigarettes being more costly than simple food in Singapore.

I would have expected proverbial storms to burst about welfare aid, or the association between mental illness and violence. I can’t help but feel that these issues are brewing and waiting to erupt, much like delayed ejaculation, but are being suppressed somehow. I don’t know. Perhaps I am jinxing the situation.

March 24, 2009 at 07:52 1 comment

The Dead Doctor

On 3rd March 2009, news broke of the death of a Dr. Allan Ooi. He was a 27-year-old Singaporean doctor who had signed on with the Armed Forces, but had been AWOL since last October. His body was found under the Westgate Bridge in Melbourne. He was last seen, by a passerby, getting out of his car on the bridge at 4 a.m.

He came from a privileged background – both parents are doctors in high-paying specialties, and his brother and sister are a doctor and lawyer respectively. Reports also mentioned his interest in ophthalmology, a specialty traditionally associated with the good-looking, well-heeled and strategically-connected stratum of doctors.

I never knew or met him, but I have friends who’d previously worked with him. They say that he was an excellent colleague. Besides being handsome and charismatic, he was also hardworking and helpful. People wanted to be on call with him. In this world, that qualifies as high praise.

Before he died, he wrote a long email, and had it sent out the day after his death. Although it was a very personal letter, addressed to ‘undisclosed recipients’, it has somehow come out in full in various media, for thousands of public eyes to see.

I confess that I have been nosy enough to snoop out this email. It states the reasons why he decided to kill himself. It is well-crafted and coherent, and makes me think he knew exactly what he was doing. His prime stressor appeared to be work. He described his job as “terrible”, a “prison”, bringing him “no joy, no satisfaction”. Signing on with the Armed Forces usually entails a 12-year bond, but his bond had apparently just been increased to 15 – 16 years “at will… simply by passing a paper”, and had been made “unbreakable”, leaving him in “utter despair”. That was “certainly the main cause of… severing of ties”.

Later in the email, he mentioned disappointment in his own “unsavory qualities”, the “failure” of his relationship with his one true love, “numerous flings”, as well as a “small betrayal” by his “best friend” that left them no longer on speaking terms, all of which he had come to regret. However, these topics were described with brevity and a flavour of acceptance, without the dramatic superlatives he used to describe his job, which suggest that these factors were not the primary causes of his suicide.

He spoke of his family, friends and personal blessings with love and thankfulness, and apologized for the pain he would cause with his suicide. He did not believe in God and hoped his death would be “final and absolute”.

Interestingly, he firmly stated that although “unhappy”, he was “not depressed”. That remark impressed me, because it showed his perceptiveness. Certainly he must have been very unhappy to wish for the complete obliteration of his existence. But he was one of the rare few who knew that unhappiness and depression are not the same thing. Unhappiness is the product of unfortunate events. Depression feeds on itself.

Painful and pitiable though Allan’s suicide was, human nature could not resist adding a heaping dose of sordid nastiness to the reporting of the event. One paper claimed that the “one poignant point” that “stood out” was Allan being “deeply hurt by the woman he loved most”. Another highlighted his name and picture under an article about gaming and violence, hinting that his status as “one of the top 10 Warcraft players in Singapore” had led to his death. A third that I heard about, but was unable to find, apparently cited gambling losses as the reason. I cannot help thinking that these very public postulations are opportunistic, irresponsible and unfair.

Free from the constraints of formal journalism, some personal comments on the matter are even more caustic. People have called Allan “shameless” and “spoilt”, a “pussy” and a “loser”, quoting Bible verses to prove their point, or going on to slime the Armed Forces, the government, the local elite and even Singaporean women for being exempted from National Service. To be fair, there were comments that were rational and compassionate as well. However, I was surprised at the amount of venom there was in general. Such sarcasm and such sneers. With a flourish of the keyboard, some people relegated Allan’s entire life to a meaningless non-entity.

Putting aside my cynicism about the veracity of online information – after all, what proof do I have that the email is even genuine? – these events offer much food for thought.

Do I think that Allan’s actions showed weakness? Do I think his fortitude and resilience were flawed? Do I feel some anger and a sense of waste over his suicide? Of course I do. I think that dissatisfaction with work is a silly reason to die. I think that being born privileged has its drawbacks in terms of character-building. I think that a bond is a bond and should either be honoured or negotiated to mutual satisfaction. I think that there must have been some other alternative – either legal recourse or simply sticking it out.

On the other hand, it hardly sounds fair for the Armed Forces to extend the length of the bond just like that. Was there no formal reason for the extension? No mutual official agreement? When my own bond to the govenment was extended, I was appropriately informed and given a choice, and there were documents for me to sign. It would surprise me to discover that the Armed Forces lack this procedure. Whether or not Allan was aware of and agreeable to the bond extension is an important point. Three to four years is a significant length of time.

As for the self-righteous, mud-slinging lot, I think they know nothing of the verse that reads, “Let him who is without sin cast the first stone”. 

However, that’s just my way of thinking. I have the benefit of being in a different situation and state of mind. Compared to Allan, I have the luxury of taking a dispassionate view from a distant perspective. My thoughts and emotions are not clouded by his misery. If it had been me, I might have done the same thing. Who knows? I am imperfect too, and am inclined to melancholy, self-centredness and pessimism.

So I ponder and comment and try to learn, and cannot help being somewhat judgmental, but at the end of the day, my own two cents are just that in the mint of wisdom.

Update: Read about my own experiences in the field here.

March 19, 2009 at 08:10 2 comments

The University Streakers

Over the past couple of days, there have been hilarious newspaper articles about a bunch of nine National University of Singapore students streaking through the campus. One month ago, the Eusoff Hall hostel students won the Inter-Hall Games, and these nine guys celebrated by getting pissed and then running starkers to their rival Hall in the dead of night.

Unfortunately for them, some of the female residents of that Hall saw them and reported them to the university authorities, and then it was Game Over.

Said a friend who has a daughter at NUS, “They covered their genitals but not their faces, which were caught very clearly on CCTV.”

Haiz.

Apparently, this is not the first time streaking has happened in a Singapore university, but it seems to be the first time the streakers were caught and the matter publicized. There’s even a ‘usual route’ for streaking.

I can’t say that I have no sympathy for the chaps. After all, they had just won a victory over a formidable rival, and they have been punished by being expelled from their Hall. Besides, there really is no better time to pull this sort of prank than in university. Any older and they’d have gotten arrested. Any younger and their parents would’ve dragged them to a child psychiatrist. I wouldn’t be surprised if there are people who feel angrier with the tattletale girls than with the naked fellows.

Also, I can’t help but feel a sneaky pride over this incident. I always thought that getting sloshed and streaky was the sole premise of Western universities. You see, here in straitlaced Singapore it’s a legal offence to even walk around naked in one’s own home. Under the Miscellaneous Offences Act, doing that makes you liable for a S$2000 fine and a 3-month jail term.

So streaking in Singapore… it takes balls. :)

March 17, 2009 at 07:02 3 comments

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My blog-name is Katie but I will not respond if you call me that in real life because it's not my real name. Yes, I do practise virtual-world paranoia. No, I do not enjoy stalkers. But I do enjoy writing and having folks reading said writing, so welcome to my world. It's nice to meet you.

Playing in my head over and over again argh

I'll Have To Say I Love You In A Song (Jim Croce)

Book(s) of the moment

Hogfather (Terry Pratchett)

Books read in 2010 and 2011

Harry Potter & the Deathly Hallows (JK Rowling) - 'cos the movie's coming out!
Frankenstein: Lost Souls (Dean Koontz) - ah, bugger, it's part of a series! Now I hafta find all the books...
Dismantled (Jennifer McMahon) - oh, good one
Tigerlily's Orchids (Ruth Rendell)
Shutter Island (Dennis LeHane) - reminds me too much of work
Holy Fools (Joanne Harris) - it's official: I prefer her scary books
A Series of Unfortunate Events; The Unauthorized Autobiography; The Beatrice Letters (Lemony Snicket)
The Little Friend (Donna Tartt)
The main books - 11 so far - of the Southern Vampire series; the Aurora Teagarden series except for A Fool & His Honey - that makes it 7; Sweet & Deadly (Charlaine Harris)
The Woman in Black (Susan Hill)
Full Dark, No Stars (Stephen King)
Room: A Novel (Emma Donaghue)
Miss Peregrine's Home For Peculiar Children (Ransom Riggs)
The Bachman Books (Stephen King)
Men At Arms (Terry Pratchett)
Carpe Jugulum (Terry Pratchett)
The Fifth Elephant (Terry Pratchett)
Beauty (Robin McKinley)
The Sandman, Vol 1 (Neil Gaiman)
The Burden (Agatha Christie) - her crime novels are waaay better
Snuff (Terry Pratchett)

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I started my first photoblog on 3 May, 2009. Each post features one picture, with a little story of how it came about. Do take a look by clicking on: Manx Pictures
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Disclaimers: 1) I cannot help but bitch about work sometimes, but everything here comes under the realm of personal remarks, and nothing here is said in my professional capacity. Nor does anything here reflect the opinion of the institutions that employ me. This is just me shooting off. 2) Most identities have been anonymized, particularly those of folks I know on a personal basis. Same goes for my workplaces. However, commercial and public places and figures remain named. Otherwise some things just wouldn't make sense. 3) Links and sources have been provided where appropriate and possible. They are not meant to challenge anyone's ownership. If this causes any discomfort or offence, please let me know.

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