Mrs. Lee died yesterday

I never spent much time thinking about her, but she was important and beloved to those close to her. She was unusual for a woman of her time and I marvel that she found it in herself to choose to be known as the wife of the country’s first Prime Minister and the mother of the third, instead of as a brilliant lawyer in her own right. But more than that, I find myself wondering about how it feels to lose a life companion of over sixty years. I think that I would perhaps prefer never to know. 

The Perils Of Not Taking The MRT For Some Time

Stupid Me queued up with Corona and Watchman at an MRT station’s ticketing office, with the express purpose of exchanging my old EZ-Link card for a new one, because I had just learnt that the old cards expire at the end of the month. After fifteen painful minutes of queuing, I finally reached the counter, whipped out my card and brightly asked, “Hello, how do I go about changing this for the new card?”

The auntie behind the counter took one look at my card, fixed me with a baleful eye, and said, “That IS the new card. You don’t need to change it to anything else.” 

Oh.

The Other Side Of The Doctor’s Table

Would you look at that? That is my load from a recent clinic session. Each green file represents one patient (of course I have blurred out all identifying markers). There were twenty-nine patients scheduled for my 3.5 hour clinic. 210 minutes, which translates into about 7 minutes per patient. Tell me, how do I adequately greet, question, diagnose, comfort, treat and then shoo out folks who could be sobbing, or angry, or manipulative, or outright psychotic, in that kind of time? Often with concerned and inquisitive relatives in tow? I’d like to know, because I really don’t have the answer.

Know what the worst thing is? It’s that this is the desired state of affairs, according to senior management. The feedback most frequently given to the registrars about our clinics is that we see “too few” patients, which equates to “inadequate training”, and “how can we learn if we don’t see enough patients?”.

One of my friends’ response in a recent departmental meeting was that registrars see cases that are more difficult, that are beyond the scope of the junior docs, whose clinics are meant to cater to patients who are stable and just need continuation of medication. Difficult cases mean that they require more time for interview and treatment. Basic mathematics lead to the obvious conclusion that there should ideally be fewer difficult cases per session, as compared to simple cases. Right? Wrong. Junglelord answered my friend with a formidable shake of his head. “No,” he said. “Numbers are important.”

Oh. Right. How could I have failed to understand? After all, this is the hospital that supported the idea of triple-booking certain clinic slots in order to reduce time wasted by patients who default their appointments. And then they held a meeting to show the doctors that more patients were complaining about us being “rushed” and “uncaring”. Oh no, really? I do wonder why. 

The message I get is this: in order to obtain approval of the people in charge, I ought to be squeezing more and more patients into my clinics, and seeing them faster and faster. It goes without saying that I must also satisfy all the patients and their relatives by providing very caring, thorough and detailed consultations, so that they will give the hospital compliments. And at the end of the day, I, too, should be utterly grateful to the institution for all the first-class training I received just by running this clinic.

Please. Call the spade a damn spade. More patients equals more revenue. For the hospital. More compliments equals more recognition. For the hospital. And there’s no point in trying to disguise work as personal training. Do we look that stupid?

To think that I was trained to see patients, and not to deal with this kind of crap. This is the kind of thing that happens in real life, but which no one ever teaches you about. It just is there and you just have to handle it. Bah. I feel angry, used and insulted. Every day.

Shell National Day Promotion

While driving past this Shell petrol station on Yio Chu Kang Road today,

 

Mr. Manx and I couldn’t help but notice the long queue of vehicles leading up to it.

 

It went on…

 

And on… 

 

Right up to the intersection with Jalan Kayu… there may have been even more behind; I couldn’t see, so I don’t know.

Oh, and people were even trying to U-turn to cut into the middle of it, which is simply begging for an accident to happen, in my point of view.

 

A queue of this proportion, one would normally expect to find that the country had finally been boycotted by all oil-exporting nations. However, this IS National Day. And Sunday. So we figured out that there must be some extraordinary promotion going on, and were proved right by a radio ad announcing that Shell was celebrating the country’s 44th by giving 44 cents off every litre of petrol and diesel from 4 – 5p.m. 

Well, good for Shell, but ARRRRRGHHHH!!! How come so many people have that much time to queue for petrol? How much petrol are they gonna burn just by queueing up? How can each station finish that many vehicles in one hour? How do the folks at the tail of the queue even tell what they’re queueing up for?

Just to give you a clearer idea, here’s a trail I marked on Google Maps, showing, in red, the length of the line between the Shell station and the intersection with Jalan Kayu.

The distance calculator showed that this trail occupies roughly 1.1 kilometres. Ootz. Estimating that one vehicle takes up maybe four metres of space, there may have been something like >250  of them at this one station. And the Shell website lists 65 stations in the country. Wowee. Wouldn’t it be nice to be the boss of Shell today.

I Am A Victim Of O$P$

Look what happened to my front door last night!!!

OK, in Singapore, this is what happens when loan sharks – colloquially known as Ah Long – go after people for money. Traditional practices include splashing red paint on people’s front doors (as mine very clearly illustrates), leaving a pig’s head (now rarely done; I believe they are not cheap), or writing O$P$ (‘owe money pay money’ distilled to basic principles), which they also did here.

This, written on the stairwell wall, cited an address that was not ours, but a few doors down. Yes, living in Singapore costs an arm and a leg. But no, Mr. Manx and I have no truck with Ah Longs. What good is it borrowing from sharks to pay piranhas? We figured that this was a new Ah Long technique of forcing the loaner’s neighbours to pressurize the fella to pay. Either that, or the paint splasher was severely dyslexic.

The paint was very fresh when we discovered it at sometime past ten last night. If we hadn’t been taking pictures of the neighbourhood cats downstairs, there’s a good chance we’d have caught the bugger red-handed (hur hur), but on the whole, I’m kinda glad we didn’t.

We called the neighbourhood police, and two officers arrived about half an hour later. After taking a statement and taking some official pictures, the younger one, Officer Hooknose, told us that there’d been one identical report before ours. Someone else in the vicinity had just had the same thing happen to them, and the writing on their wall looked very similar to the writing on ours. We told them that other walls in our block had been similarly defaced over the past few months, such as the one in our ground-floor lift lobby. A fresh coat of paint always miraculously appears in a few days, but the writing is still visible.

There are at least three such messages on our floor now, also painted over, but still readable.

Despite the lateness of the hour, neighbours from the same floor began popping up to see what was going on. Everyone had the same reaction upon seeing the thick red dripping and puddling at our door. *Psycho music* (*Jaws theme also can*)

But once they’d realized that Mr. Manx and I had not been stabbing each other, they were very sympathetic. They told us that the current tenants of the publicly-named unit had gotten the same treatment a few months ago. These tenants had not borrowed any money from the Ah Long either – they were foreigners here to seek medical treatment for their young son. They gave the contact information of the actual unit owner to the older Officer Grumpy, whose night took a turn for the worse upon dialling the number, because all he got was shouted at by the woman who replied. Apparently her point of view was that her affairs were none of his business, which was a stupid stance to take in the circumstances, if you ask me. After finishing with Officer Grumpy, the woman said she wanted to talk to Mr. Manx. She swore that she knew nothing about any Ah Long, and expressed the hope that we would not pursue the matter. <Roll eyes>

The next thing that happened was that Officer Grumpy was taken to task by one of the neighbours for the failure of the police to do anything about the whole affair even though it had been going on for some time. I must say that he had a point, because there are cameras on the ground floor and in all the lifts (though goodness knows if they are anything more than plastic toys put there for decor). However, I thought his timing unwise, considering that he had a nearly-empty bottle of San Miguel in his hand and that he stood within reeking distance. I felt quite sorry for Officer Grumpy.

The strangest thing about last night was that it resulted in us talking to the neighbours for the first time since we moved in about five years ago. Not kidding. They seem quite nice. Very different from household to household.

I do wonder what’s going to happen about this vandalism. I must admit that I have fantasies about giving the clown what he deserves with a hardwood baseball bat and a box of long pins. Piece of cowdung.

On the bright side, I now have a very unique front door. All it needs now is a wooden plaque that says Dracula’s Keep, and I’m all ready for Halloween. 

Spotted: Gross Object In My Food

PUBIC HAIR IN MY CHILLI SAUCE!!!!!!!!!!! Cannot begin to express how gross this is!

Swine Flu: Bye Bye?

Two weeks on, and people have just about lost interest in the swine flu. There have been no cases in Singapore. Deaths have not occurred in droves. DORSCON status has been dropped from orange to yellow. Doctors can change postings as originally planned.

I get the impression that Asian precautions have been more stringent than Western ones. China is a prime example (Mexican? Canadian? American? I QUARANTINE YOU!). There was an element of hysteria in Singapore as well. Where I was, healthcare workers were ‘encouraged’ to stop eating at the hospital cafeteria because of all the dirty looks from the visiting public… many of whom, I have to say, were not even wearing their own masks properly.

It feels a little silly to think of the thousands of healthcare workers across the country, sweating and stifling in masks and gowns, when there hasn’t even been a single local case. I suppose the goal was to NOT be the person involved if and when the first case leaked through. Whoever and wherever it happened would have had to endure much finger-wagging.

The difference now is that many other countries are relaxing their alerts. That being the case, it would be dumb of us to continue as if this was SARS, because it simply isn’t. 

All the same, I do appreciate that the government was aiming to be safe rather than sorry. A cavalier attitude would have been inexcusable, particularly after SARS.

So the bottomline seems to be that the H1N1 virus is milder than previously thought. As such, it is destined to follow the course of most flus – inevitable spread around the world, with the usual sequelae of recovery in most and death in a few. Flus will always claim some victims among the very young, the very old, and the immunocompromised.

What I am not sure about is: should we be patting ourselves on the back that nothing happened, or feeling embarrassed that we freaked out and went emergency grocery shopping?

And, as I return to the Fruit Farm tomorrow, if it will be a homecoming, or the beginning of a spell in purgatory.  

Back To Work

It was back to work today after my leave. Thanks to swine flu (cannot break habit of calling it that), everyone was walking around masked.

There are basically two main types of mask – surgical and respirator. Surgical masks are the comfy type – simple paper with ear loops or long strings to tie around the head. Respirator masks, well, are hell. They are thick and are supposed to fit like a seal around the lower face, so that you breathe naught but filtered air, which is warm and stagnant. After some time, your face starts perspiring inside the mask, and the perspiration has nowhere to evaporate. So you end up breathing warm, stagnant and damp recycled air. Ewwwks.

And healthcare workers MUST wear these dreadful things at all times of human contact during work. Can faint. Despite that, I hear from a nurse friend that people at the hospital food court are beginning to act like the staff have leprosy. In fact, she advised me explicitly to omit wearing my name tag when I went to get lunch. Man, how sad. I don’t exactly blame the public folks, but still.

In this environment, I am now super-thankful for the luxury of being able to drive, and of having a car to drive. There’s really nothing like speeding home at the end of the day at 120kmh with the radio blasting. Although I must admit that I nearly let go of the wheel upon hearing the news that WHO might escalate the pandemic alert to level 6. Argh.

Swine Flu Update: Name Change

Swine flu has had a change of name. It is now known as H1N1 flu. Far less catchy, but much more pig-friendly. Methinks that this is a political move, partly to save the pigs, but mostly to salve the feelings of those with socio-religious porcine stigmatizations. Apparently, New Zealand ain’t having any of this nonsense and is sticking with the original name.

Whatever the name, Singapore is still at Alert Orange, but we are still case-free, thank God.

I think there are now two camps of thought about the severity of this illness. One camp takes it very seriously. The other is sceptical and talks about media-generated hysteria and mass control.

The Singapore government is taking it seriously. On the whole, I am pleased and reassured by this. It would be silly of them to sneeze at this. After the SARS experience, things moved into place quickly and efficiently. And although MOH releases statements like “the declaration of Phase  5 is  a strong signal that a pandemic is imminent”, the Health Minister also said that “we must also not go into unnecessary overdrive”, which I think is sensible. I do think that the measures being employed on the ground may qualify as overkill, but I won’t quibble with better-safe-than-sorry at the moment.

At the moment, WHO describes the situation as stable. The mortality rate isn’t exactly alarming so far. If nothing worse happens, then I suppose the sceptic camp will have won the day, and swine flu will go down in history as an international ‘meh’.

Swine Flu: It Grows

Looks like it’s getting worse. I just heard the first US death was that of a 23-month-old Texan [actually Mexican; just went to Texas for medical treatment] child. Cases have been confirmed in at least five countries, and there are suspected cases as near as Indonesia and Hong Kong.

It’s terribly easy for things like viruses to spread, isn’t it? A cough, a sneeze, a drop, a breath. Plus, this particular virus appears to be infectious even before symptoms begin, so the transmitter will not know that they should have been quarantined.

Speaking of symptoms, besides fever and chills, headache and muscle pain, sore throat, cough and malaise, it looks like swine flu causes more vomiting and diarrhea than the generic flu.

Whether it’s fascinating or frightening, science has not yet learnt to beat the common influenza virus. Over the decades, or maybe millenia, it just keeps evolving to outstrip natural immunity and developed vaccines. This virus learns and changes. That’s why it’s managed to kill so many people over time. Today’s strain, H1N1, looks to be a descendant of the Spanish flu that caused a pandemic ninety years ago, but it has become a cocktail of human, pig and bird origins. 

Right now, Singapore is on DORSCON (Disease Outbreak Response System Condition) Alert Yellow. It means that we are acting as if the virus has not ‘learnt’ efficient means of human-to-human transmission (yet), and so the main aim is separation of suspected cases. In terms of action, it translates to:

• Home quarantine for close contacts of cases
• Restricted visiting to hospitals and clinics
• Restricted movement of patients and staff between hospitals, except for emergencies
• Healthcare workers and arriving travellers to monitor their temperatures

Full personal protective equipment (PPE) has also been instituted in local hospitals.

Some hospitals have decided to be extra-cautious, and have upped their internal alerts to orange. They will assume that human-to-human transmission of the illness will occur upon close contact. That means strict containment of suspected cases – no visitors, no inter-hospital movement and possibly antiviral prophylaxis.

However, as WHO has just decreed pandemic alert phase 5, which indicates significant human-to-human transmission, my guess is that the nationwide alert will push to orange, probably by today, and red will happen soon after.

Taking off the doctor hat for a moment, I think that the current death toll from swine flu is not high. One probably has a higher chance of dying today from a car collision or a violent mugging, than from swine flu. Still, the situation is going to get worse before it gets better. It’s going to be important to keep our hands clean, take our vitamins, and get enough food and rest.

Over and above that, it’s a good time to remember our blessings and the people we love. It’s always a good time for that, but we’re such experts at forgetting the truly essential things in life. Life is so precious because death is always a certainty; the whens and hows are just details. In light of that, I’m going to make sure I have a good day today.

Update: Yup, we are now at Alert Orange. Thankfully, no confirmed cases.