Tuesday, April 29, 2003

A Period Of Grieving

Today's entry is dedicated to 2 Singaporean doctors who died from SARS. For readers who are recently acquainted with my blog, Dr. Alexandra Chao was a respected and rising vascular surgeon, and was also the only child of Prof. Chao Tzee Cheng, who was our nation's foremost authority on forensic pathology. The following are excerpts from an article in The Straits Times today, garnered through interviews with his wife, mother and various colleagues.

His character:

"He was the type of guy who wrote letters of encouragement to his friends during examination time, or thought nothing of spending an evening helping younger students."

" He was an affectionate husband who made cards and sang to (his wife). He loved to sing at weddings and sometimes even prayed with his patients. He sang to bless others."

"The nurses told me that when they wheeled him into the ICU, he was holding his Bible and even waved at them."

"In 2001, he established the Lower Extremity Amputation Prevention (Leap) Programme, which succeeded in bringing down the percentage of amputations done. There are now plans to set up a fellowship in his name."

The impact of his death on his loved ones:

"On his way to be admitted to hospital on April 15, he went by his Faber Hills house. He stayed in his car and waved to his girls ( ie. his 2 daughters). That was the last time Beatrice, 4, and Berenice, 1, saw their Papa.
Berenice is still too young to know daddy's gone. "When she sees his picture, she still asks for Papa," says his widow, Dr. Koh Woon Puay, 34. "But my other daughter is a survivor. When she heard her sister calling for him, Beatrice said, "Papa is no more. Papa has gone to heaven."

"His devastated mother, Mdm. Wong Yoke Choy, 65, said last night, "Losing Prof. Chao was a big blog to me and before the wound has healed, now comes an even bigger blow. The pain is almost unbearable. Sometimes I wish it was just a nightmare but I have to be brave and I have to live on. I've always been very proud of him. Life has to go on."

"We were a team. I have lost my soulmate." -- Dr. Koh Woon Huay.

The latest SMA News will be available online by this evening or tomorrow morning. Eulogies for Dr. Alex Chao and Dr. Ong Hok Su will be included, written by Prof. Low Cheng Hock and myself respectively. I've added the link in advance.

Below is an email that Hok Su's fiancee, Tania Oh, sent to me, with her approval for posting on this website. My thanks to her for opening her heart and sharing her innermost feelings with us.

"Dear Hok Su,

I don't question why God took you away - we both know that our lives are in His mighty hands and His ways are not our ways. The only thing I ask is why I have to go through the grief and pain -- to fall in love with you, build our dreams together and then to lose it all before it comes to pass. I guess in His time, the answers will come, but it is the hope and promise of seeing you again in heaven which gives me strength to finish my own race.

In a way, I likened it to the days when you were in London at St Bart's Hospital medical school, and I was back in Singapore working. It was not easy getting through those years. If it wasn't for our daily phone calls and my friends who distracted me, I don't know how I would have made it through waiting to see you during our holidays. Now, the friends still remain but the phone calls have ceased.
For all the nights we used to pray together, I now pray on my own, believing that somewhere beyond the distant star, you will hear what I'm saying, that you feel the relentless pain in my heart and see the unending tears that flow.... and flow..

You were my best guy friend, my confidante of 8 years who listened and only gave your opinion when I asked for it. You never judged me, even when I told you of my foul deeds. You just loved me in your own simple way - totally and faithfully.

Do you remember the nights when I would sit in your room at college when you were in Sydney waiting to go to London's St Bart's? I thought you studied too hard, and would tell you that you were already too brillant. And even though you were the top boy from ACS to go to ACJC, I still didn't know that you existed in ACJC. I always thought that the people in SC1 never mixed well with the outside world. How wrong you proved me.
The 8 of us in college looked up to you as the head of our kampong and we always knocked on your fresher alley room 106 when we needed a listening ear. Your room was always the warmest, (you cranked up the heater to the fullest). Remember how we used to call it our tropical paradise? It was the only place we could wear our summer clothes even in the coldest winter. On hindsight, it wasn't the warmth of your room that made us go there. It was just because we liked your company and you made us all
feel loved.

Even in your unobtrusive way, you motivated me to do well at university. The late nights when I came back ( and it wasn't from the library ), I would walk by your room and see the light still on - it was enough to spur me to hit the books and finish my tutorials before I slept. Imagine how silly I felt when many years later, you confessed to havingthe habit of falling asleep with the lights on. Oh boy. :)

Then the day came -- you asked me to marry you and I wondered how 2 people who were total opposites could spend their lives together. But as time went by, I was more and more convinced that God knew my character better than I knew myself, and He knew that you were what I needed. You gave me stability and I drew you out of your shell. For the last 9 months that you were back in Singapore,we planned our lives together, planned our wedding togetherand I still remember you at all the visits to the bridal shop, everyone loved you and called you my handsome handbag. You would look at me parading in all the different wedding gowns and tell me with so much love that I looked beautiful no matter what I wore. You were so undiscerning in helping me choose my gown that I had to enlist my Godmother's help and you galantly took the backseat.

You were always supportive in my numerous activities, even though you thought I was overactive. I miss the times when you'll pick me up after French class, cello class, golf games and the Saturdays we spent going for Bible study together. I miss our quiet times together and I miss your laughter. I miss you telling me not to go diving and wakeboarding, because you'd be devastated if you lost me in an accident. I miss you because you were my friend. I miss you.

Perhaps your mother is the most fortunate person out of this whole tragedy, she gets to leave this bad dream and wake up to find you happy, healthy and full of God's love.
Time has stopped for me. I can only wait to see why God spared me from SARS and let me live on without you. The 7th of April 2003 will be etched in my mind and heart not because the dreams and plans we made died alongside with you, not because a part of me died with you that day and not because I learnt what grief and pain meant, but because it was the day I laid my friend to rest -- the one I laughed with, dreamt with, cried with and will forever love.

jusqu'a ce que nous puissions nous revoir, mon cherie."

During our email exchanges, Tania and I discovered a shared appreciation for the music of Josh Groban, in particular, one of his most famous songs, titled "To Where You Are". She related how she played this song many times over in recent weeks, and the lyrics are especially poignant, not only because of Dr. Chao's and Hok Su's deaths, but for any of us who have lost a loved one any time in our lives. If you'd like to listen to the song, go to Josh's website player.

To Where You Are

Who can say for certain
Maybe you're still here
I feel you all around me
Your memory so clear
Deep in the stillness
I can hear you speak
You're still an inspiration
Can it be

That you are my forever love
And you are watching over me from up above

Fly me up to where you are beyond the distant star
I wish upon tonight to see you smile
If only for a while to know you're there
A breath away's not far to where you are

Are you gently sleeping
here inside my dream
And isn't faith believing
all power can't be seen
As my heart holds you
Just one beat away
I cherish all you gave me everyday


In times like these, we often take a moment's silence to remember the person who has passed on. In keeping with that tradition, I shall not make a blog entry for a day or two, and shall write again perhaps on Thursday.

Monday, April 28, 2003

If you've been wondering why I didn't post till now, well, let's just say I've been suffering from a major case of "burnt-out syndrome". Although I haven't been on call for more than a week already, my weekend was spent sitting down, or lying supine, or falling asleep in the middle of drinking my mug of root beer. This morning's round didn't help either, with patients giving problems in a variety of frustrating ways, and another event that has recently been affecting me emotionally, but which will hopefully pass over the next few days -- I will provide an explanation soon.

A comment in The Sunday Times yesterday caught my eye. A doctor here related how in the past, most of us carried on with our work even when we had a fever, 'cos if we took medical leave, we'd be viewed as "wimps". How true. I don't know if this occurs overseas, but over here, most departments are short-staffed, and if certain people are on annual leave, it leaves very little leeway for others to take MC. I myself experienced this problem when I was a houseman doing paediatrics. I had sinusitis for 2 weeks, and after returning to work after 10 days of popping antibiotics, my temperature still hovered at around 39 - 40 degrees Celsius, and I did rounds wrapped in a sweater, taking Panadol every 4 hours, and yes, doing night calls. Finally, after being unable to eat or drink during one such night duty, I left the hospital in the middle of the night ( I'm still forever indebted to the friend who took over for me ) and got admitted at the Singapore General Hospital, registering a temperature of 41.5 degrees. On other occasions, I've done calls nursing sore throats -- sometimes not even being able to speak -- and how can I forget a X'mas Eve call in 1999, when I puked my guts out for 4 hours then went out to see some more patients, and carried on with rounds later that morning?

Those're just my stories. Let's not overlook the countless others who've done the same thing -- a friend who didn't know she had pneumonia till she had a chest x-ray done for a severely high fever, seniors who don't go post-call, who run clinics and perform operations even when they feel like they've been hit by a tonne of bricks. But with the SARS epidemic, this trend will of course come to a screeching halt. It has its good points, no doubt, but this also means that the baseline manpower shortage is now being stretched further. And with the absence of "professional locums" like those in the UK -- who can take your night call with the snap of a finger, mind you -- this has resulted in the cancellation of annual leave and off-days, which reduces morale significantly. Let me repeat -- I need leave. Is anyone reading this?!

And speaking of sad things, the upcoming SMA News will be online very soon, with eulogies for both Dr. Alex Chao and Dr. Ong Hok Su. I had the chance to read the former, which is written by the esteemed Prof. Low Cheng Hock from Tan Tock Seng Hospital's General Surgery Department. This is an important issue, and I look forward to having the rest of the world read it once it's ready.

Let me tell you another story so I can get it out of my system before I log off. ( This blog is very therapeutic for my frazzled psyche :))
This morning at around 7:30pm, I was driving to work and was in the process of turning right at the junction of Simon Road and Upper Serangoon Road. As I waited my turn, I caught a glimpse of an SUV stopped in the middle of the road ahead, and spotted a lady squatting over a figure lying on the ground. As my car was in moving traffic, I had to turn anyway, but subsequently made a U-turn and stopped a few metres away from the SUV.
The minute I got out of the car, a man standing nearby shouted for me to call the ambulance, which I did immediately. The person on the ground was a lady in her 20s, who had been hit by the driver of the SUV, a lady in her 40s. The younger woman was thankfully fully conscious, and didn't complain of any pain anywhere. However, she had a head wound, and a rivulet of blood had already flowed from her scalp down the road. Worried that the gash may still be bleeding, I quickly cleared her cervical spine and sat her up to check for any active spurting. There was none, but we took the precaution of placing a thick wad of tissues and applying pressure till the paramedics arrived. A middle-aged gentleman also stopped at this time, and offered us his handkerchief for reinforcement.

The ambulance arrived within 5 minutes -- very impressive! -- and a traffic policeman also showed up. The young lady was soon transferred to the nearest hospital.

It was only after the stretcher had been loaded that I looked down and saw that my left hand and forearm were stained with blood. In my efforts to move and examine the victim, I'd inadvertently smeared some of it onto myself. Under pre-SARS conditions, this wouldn't have fazed me, and although I doubt the woman has SARS, it suddenly dawned on me that I'd just put myself in grave danger. My mother, who learnt what happened after I gave her a call later, was understandably upset, but she knows that I would've stopped my car no matter what, even if she had been sitting right next to me yelling for me to drive on. :)

The one thing I wasn't happy about was how nobody else stopped to help them. It was a congested road, a busy morning, loads of people drove past and saw the accident, and STILL NO-ONE PULLED OVER. Perhaps if this had happened elsewhere, for example in the centre of town, things would have been different.

Saturday, April 26, 2003

Our Senior Minister Lee Kuan Yew has finally given a press conference on SARS. Yesterday, he revealed for the first time how his wife was actually in the same room with a SARS patient at the Singapore General Hospital ( of course, the patient wasn't known to have SARS at that time ). They were separated by only a thin curtain, and the radiographer who attended to the patient later came down with SARS. I couldn't help smiling when SM Lee recounted how he and his wife were both quarantined, and called the doctor in the middle of the night when one of their temperatures hit 37.8 degrees Celsius -- the lousy Thermoscan again! This definitely reinforces the fact that SARS can hit anyone, anywhere, anytime. Even our most high-ranking politicians aren't exempt. SM Lee's call for Singaporeans to rally round local healthcare workers is also greatly welcomed. We've been described as the country's "first-line defence", which must not be broken at any cost. Let's hope our fellow citizens will heed this call and stop acting like undisciplined children.

This week's Time (Asia) magazine has yet another series of terrific articles on the SARS epidemic. And after getting an unpleasant shock from their coverage of the China debacle, I had yet another major eyebrow-raising experience from Time's report of the Hong Kong mess. Here're a few samples.

" Hong Kong's response, by comparison, has been marked by what appear in hindsight to be tardy half-measures... But even after it became clear that a potentially deadly mystery illness was loose in the wards, visitors and outpatients came and went freely for several days, despite mounting evidence that the disease could be highly contagious. "

And regarding the Amoy Gardens outbreak, "authorities stopped short of immediately shutting potential victims in their homes, as Singapore had done. Instead, they were told to report daily to designated clinics for monitoring -- meaning suspected SARS carriers were actually being required to venture out among the masses.
Another glitch was timing. The quarantine measures did not go into effect until March 31, 3 days after they were announced. That lag proved crucial. In the interim, SARS cases at Amoy Gardens soared from 7 to 213, and before a lockdown could be implemented there, 113 families living in the complex packed their bags and fled. Instead of separating them from the rest of the city, health officials lost track of them. About half of the families who fled the complex had been located by the end of last week. But the Hong Kong Police Department is still tracking down the remaining 45 families. In some cases, they've yet to even learn the names of the missing residents."

Time described this as "slam(ming) the ring-fence gate after the killer has left the pen", stating that "the advance of the epidemic in Hong Kong stands in marked contrast to the situation in Singapore", which has clamed a "full-court press" on the virus. WHO scientist Dr. Osman David Mansoor says, "..there's no doubt the disease is being controlled here in Singapore."

Comforting news. And lately, politicians have encouraged Singaporeans to get out of the house and spend to help the already-miserable economy. Although I don't think that's an all-bad idea, I would advise people to wait a little longer, especially since the new punishment guidelines under the Infectious Diseases Act are just taking effect. Once I see clear results, I'll think about venturing out.

If you get your hands on the Time (Asia) issue I just mentioned, don't miss an excellent piece by Pete Davies, titled "The Cycle of Death" . In it, he discusses the origin of SARS, as well as its impact on human society. One of the more alarming statements include "The virus survives and thrives by constantly mutating -- so that just as our immune systems recognize and kill off one strain, a new one emerges against which our defences don't work." But the more depressing piece of news is how he writes that "We cannot be sure whether the next pandemic will be this bad, any more that we can be sure when it will come or where it will start. There is only one thing of which we can be certain: that it definitely will happen again. We can also be sure that, as so often before, it very likely may begin in southern China."

Before I end off for today, I want to salute yet another group of courageous doctors at Tan Tock Seng Hospital -- 3 of them recently recovered from SARS, and have volunteered to collect mucus samples from those still having the infection, for testing purposes. With still so little known about the possibility of mutation in the coronavirus, not to mention the number of strains that may actually exist at this point in time, and thus whether you have real immunity or not, these are huge acts of courage and selflessness that make us proud. Bravo!
Just adding a clause for self-protection. I've been informed that the local press is reading this blog, and that I may get quoted. Good thing I consulted an old friend of mine, who's a top legal eagle here, and whose advice I trust without reservation. So to the Singaporean reporters who visit this site, think twice.

Be advised that no part of my website or any quote of my writings here are to be used without my express permission, written or otherwise.

My deepest appreciation to the friend who alerted me to this problem, and the lawyer pal who repeatedly dishes out free legal pointers to me. :D

Friday, April 25, 2003

Remember my suggestions to cane those who break home quarantine, as well as publish their names and photos? Parliament is now reviewing the "name and shame" method, but I still think caning would be an equally effective deterrent.

By the way, I strongly encourage anyone who visits the site to please contribute your views. I've been informed that my blog is now linked to The Guardian newspaper in the UK -- you can see their review at this link -- and have received quite a few emails from people in Britain who actually read your comments. I always maintain that this site would be nothing without the readers, and I thank you for making this a lot more than it actually is. :) Keep it up!

The SMA News will be delayed till early next week, while the eulogies for the 3 doctors who passed away from SARS are being compiled. This is one terrific issue, so don't miss out. I'll let you know once it's available online. The new housemen will be getting their copies -- minus the eulogies though -- during the housemen seminar this weekend.

Also, your remarks about Dr. Alex Chao have given us great insight into his character and work ethic. This additional information makes his passing even more tragic. Our medical community has lost a truly great doctor.

On a non-SARS note, I'm ecstatic about Simon Cowell's comments on last night's American Idol 2. He has already picked the top 3 finalists -- Kimberly Locke, Ruben Studdard, and yes! Clay Aiken! My money's on Clay all the way, but Ruben may pose a real threat. Still, I have a feeling that the former will win the majority of the votes. If you think about it, Clay can sing Ruben's songs, but is the reverse true?

And before I sign off, here're a few more DVD reviews -- I should be studying, aargh!

Swimfan -- If you're a fan of teenage thrillers and "Fatal Attraction" scenarios, you'll enjoy this movie. Jesse Bradford ( Kirsten Dunst's love interest in "Bring It On") plays the hunky school swimmer with the perfect life -- great girlfriend ( Shiri Appleby from "Roswell" ), a possible sports scholarship from Stanford -- but throws it all away in a moment of weakness, which comes in the seductive form of Madison the pouty blonde bombshell with a serious case of insecurity. Not the best script around, and it's a premise that's been worked over ad nauseum. Its only saving grace is the acting, which is pretty good ( but that's just my opinion :)) Not a bad way to spend a couple of hours.

Spirited Away -- aka the cartoon that beat Hollywood heavyweights to clinch this year's Oscar for Best Animated Feature. A well-deserved award, 'cos this is one of the most eye-popping shows I've seen in a long time. Gorgeous hand-drawn animation, an imaginative story, lots of surprises, unlike most run-of-the-mill American productions, which usually have bosom-buddies-on-a-quest or save-the-princess themes. Don't miss it.

I Spy -- Owen Wilson has carved a career out of being the ideal sidekick, and he works his magic again in this hilarious espionage adventure. Eddie Murphy also ups the laugh factor with his black-guy-on-amphetamines routine -- if you saw "Shrek", his performance here will definitely conjure up images of his turn as Donkey in that film. Wilson is boyish and charming, as always, but I think he should be harnessed for a proper action thriller one of these days, so his comic timing can take a backseat for once. I liked it, so you may want to give it a try.

Thursday, April 24, 2003

Thought I'd share this with you. It's an email which a friend from another hospital sent to me.

"Am doing an MICU call. It is very tedious. Gown up, wear gloves, take off gloves, wash hands, take off gown and wash hands. The goggles are killing me (though they are reputed to be expensive ski goggles)...The masks are getting more and more ill-fitting.

I tell you some of us are really worried. More and more people here are hit. I feel especially sorry for Alex Chao. It is such an irony. He was not with the surgical team that was exposed and subsequently quarantined. Hence, he didn't have to go to TTSH. During that time, he gladly answered blue letters for the General Surgery department. He did an op for one of the patients in MICU, and even helped transfer patients to TTSH during the big move from wards 57/58. I just feel very vulnerable right now, but what to do. I dread the day when I take my temperature and it is high ( after the horrible scare 2 weeks back ).

Morale is low. Everyday is more tentative than the last and we are shuffled round like cattle ( ie. change wards every few days). Calls can change at the last minute as well.

I just hope everything is back to normal soon. I wish that on days when you expect to see 30 patients during the round, your team doesn't change suddenly, no ID measures are needed, and we can go to the houseman canteen at will. Sure beats getting bad news everyday."

My neighbour's kid has a fever, and she's still going to kindergarten and probably running around town as well, with her parents' blessings. Just the other day, after they returned home, I heard the child asking her mother whether she can take a bath, and her mom said, "No, you have a fever." Wonder how she got past all the temperature-monitoring at school.

As for more neighbourhood news, the food centre and medical hall that the wholesaler reportedly visited during his many doctor-hopping sessions are now closed, with employees under home quarantine. I live within walking distance of these places, so it's a little unnerving when you realize that I could've perhaps stood next to him or walked past him without even knowing it, since I eat and shop there quite often. Which just reinforces my opinion that Singaporeans really need to be more considerate about their personal actions, especially when they're aware of being previously exposed to SARS cases/contacts. Uncontrolled community spread is a real and potential danger.

Wednesday, April 23, 2003

Yes, yes, PM Goh Chok Tong's letter to the Singapore people was right on the money. ( Interested parties can search for The Straits Times website and read the entire message there. ) But this comes a little late, as I'm sure many of us have been aware of the irresponsible behaviour of our fellow citizens for at least a few weeks now. Heck, I even wrote in to The Forum Page about it, but they rejected it for publishing. ( I posted it on my blog, so you can scroll through my entries dated a couple of weeks ago, titled "Singaporeans' Sense of Responsibility". )

In summary, some SARS cases defied a doctor's orders to stay put at a neighbourhood clinic, and walked off to eat at a crowded food centre instead. Another spent about a week clinic-hopping before finally ending up at Changi General and susequently shipped off to Tan Tock Seng. And let's not overlook this wonderful chap with his big photo in the paper today, who just returned from Guangzhou with a fever and cough, was immediately transferred to TTSH straight from the airport, but refused blood tests and x-rays there, then walked out of the hospital and took a taxi home. He hasn't been diagnosed with SARS, but is definitely highly suspect, and has been served home quarantine orders. These are just a few of the many others who breach containment measures and take matter into their own hands. Parliament is drafting new policies that will enable offenders to be charged without having to appear in court. In my humble opinion, I think caning and putting these idiots' pictures in the papers should be included. I mean, they're endangering other people with their callous actions. A fine is just a slap on the wrist!

Almost got a heart attack this morning when my mum woke me up with, "Jen, time to get up! Alex Chao died!" Dr. Alex Chao, for the benefit of the uninformed, was a cardiovascular surgeon at the Singapore General Hospital, and also the son of the very illustrious Prof. Chao Tzee Cheng, a world-renowned forensic pathologist who was involved in the high-profile Flor Contemplacion case ( you can search the web for more details ). I was extremely shocked by the news, of course, and the gist of the report in the Straits Times suggests the cause of death is as yet unknown -- not SARS, as the rumour goes. Yet another saddening event, as I met the younger Dr. Chao at TTSH when I did my first surgical rotation in my 3rd year of med school, and he was very accomodating towards us. His dad, however, was greatly loved by all who knew him -- jovial, perhaps the most humble person on earth, and very fatherly and kind. It is a tragic day for our medical community. I'll keep you updated on further developments.

Tuesday, April 22, 2003

We had a major -- I mean huge -- SARS update this morning, given by our chairman of the medical board. There were maybe 200 of us crammed into a rather small room, and comprising members of departments ranging from internal medicine, geriatrics, general surgery, orthopaedics, ophthalmology and the A&E department.
It was informative, and the general anxiety was palpable. I realized that all except one of the SARS cases was taken care of by my department, a fact that hit me hard. Of course, the scariest part was how these patients got past the ER in the first case -- not entirely the A&E's fault, if you hear the whole story. However, with SARS being primarily defined by "medical symptoms" like fever and cough, anyone with either of these gets shunted to us for evaluation. And although those down in the ER are the gatekeepers, those of us upstairs spend much more time with any individual patient, having to see them multiple times and take blood and other samples of bodily fluids as required. Why do you think 2 nurses here contracted the disease? I'm grateful for each day that passes where no doctor here gets hit by SARS. Let's hope that never happens.

Another issue brought up was about segregating doctors from different hospitals. But this is clearly not possible for doctor couples -- in particular, the married ones. A show of hands in this meeting alone had at least 4 who have spouses from other medical institutions. And let's not forget others who have boyfriends/girlfriends/fiances/fiancees/relatives scattered throughout these hospitals.
I'm not for it -- though I'm not affected by these restrictions -- because when you go to work and stare potential death in the eye day after day after day, going home to your loved ones may be the only thing helping you through this crisis. I don't support separating families/couples unless absolutely necessary. We can minimize this through simple personal hygiene and strict precautions at work.

Last night's call was especially distressing for those on duty. Apparently, all other hospitals declared that they had no more beds left, and cases were redirected to... you guessed it, us! We already have a strict policy against admitting people who were warded at other government hospitals within the last 21 days, but a man who was warded elsewhere only a week ago was still let through and sent up to our isolation ward, after the previous hospital rejected his admission there. If we think about it, you can't possibly admit a patient if you have no beds left, but if this situation continues, does this mean we're back to square one? The lady I signed up on March 30th -- who was later diagnosed with SARS and is cited as the one who spread it to her daughter-in-law and the nurse and housekeeping staff who had contact with her -- was warded here after being discharged from TTSH. This problem has "DANGER" written all over it, and it is my wish that it gets solved ASAP.

The protective gear load increases steadily. It started out with masks, then gloves, then gowns, and now, we have goggles! The N95 masks are giving some of us headaches and claustrophobia, not to mention difficulty breathing, allergic reactions and profuse perspiration -- one MO jokingly said it was giving him more blackheads. I work in a non-air-conditioned ward, and whenever the weather gets more humid than usual, I have to stop in the middle of the round ( which takes approximately 2 hours ) to take my mask off and dab at my face. Not fun.

On a programme on SARS screened over Channel NewsAsia this evening, a WHO official said, "If Singapore can't control the spread of SARS, no other country can." Encouraging words which are badly needed by all of us, and greatly appreciated.

Monday, April 21, 2003

So the topic on everyone's lips today is: How could China have been so irresponsible?

I was reading 2 interesting articles on this subject last night, and thought I'd share a few snippets of information below.

From an article in The Sunday Times ( 20th April 2003 ):

"You have to die to be counted as a SARS patient in China." -- Prof. Lin Qingxin from Beijing University.

"The most important vacation in the life of Chinese people, Chinese New Year, was coming. We didn't want to spoil everyone's happy time." -- Feng Shaomin, director of foreign affairs for the Guangdong health department, on why authorities withheld important information about the SARS outbreak in late January this year.

"Chinese lives are seen as cheap, while foreign lives are expensive." -- a Chinese academic who asked to remain anonymous.

From the latest Time (Asia) magazine issue dated April 21:

"Don't believe the government -- they never tell you the truth. They say it's a deadly disease with 4% mortality? Are you kidding me? The death rate is at least 25%." -- a nurse at Beijing's You'an Hospital.

"Our primary concern is social stability, and if a few people's deaths are kept secret, it's worth it to keep things stable." -- a Shanghai-based respiratory specialist.

"Most doctors are too frightened of losing their jobs to tell the truth about such cover-ups... instead of instructing doctors on how to contain the disease through public-education campaigns, medical officials told physicians they were forbidden to publicize the SARS deaths in order to ensure stability."

"Wearing a mask will scare the patients. We do not want panic." -- hospital administrator, when questioned by a concerned doctor on why medical staff were not allowed to protect themselves.

"In 2002, the Chinese leadership revised its HIV estimate from 30,000 cases to 1 million -- IN A SINGLE DAY."

The one thing we can be thankful for is that no matter how many flaws the Singapore government may have, at least it doesn't practise obfuscation. Protective gear is supplied readily, latest developments are openly shared, and medical facilities here are top-notch in terms of expertise and cleanliness. Sure beats some isolation wards in a Beijing hospital, where patients ( including doctors and nurses ) "piss in the room, crap in the room and eat in the room."

The above articles also offer valuable insight into the link between China and the subsequent global spread of SARS. The first case is postulated to have begun as early as November last year, but was initially concentrated in the Guangdong province. The pivotal character was a certain Dr. Liu, who treated a SARS case in his country before staying at the Metropole Hotel in Hong Kong and later infecting fellow residents there, 2 of whom are the original index cases for Singapore. One can only wonder if this disaster could've been avoided if the Chinese government had investigated the outbreak instead of opting for a 5-month wait-and-see-if-we-get-caught strategy.

Over here, it looks like only one other MO and myself will be covering the ICU during the day next month. With 2 MOs turning registrars ( aka senior residents ) and another going on no-pay leave, the choices are severely limited, and I was approached to cover the unit full-time!! I passed on the assignment, partly 'cos my mother would kill me if she found out, and partly 'cos if anything were to happen to me ( touch wood ), nobody can take care of my parents. However, I still worry, as I will be doing ICU duty during night calls. But when help is needed, you discover whether you have a conscience or not. Hopefully I still do. :)

Sunday, April 20, 2003

Hi everyone. It's Sunday morning, and I've got a few minutes to spare before the round.

The MO gathering last night didn't get full attendance, but those that went definitely made the most of it. Unfortunately, whenever you stick a bunch of doctors together, they almost always end up talking shop, and I'm pretty sure the diners around us picked up on our profession early on, as I spotted a couple next to us staring really hard -- but not in a bad way. The restaurant wasn't crowded -- a sign of the bad times, 'cos this place is usually fully booked -- but the food is excellent, the liquor sublime, and the ambience classy and perfect for romantic occasions ( not applicable to us, but we enjoyed it nevertheless :)). No freebies, sadly, but when we paid up using the SMA credit card, we did get respectful acknowledgements.

It was a good time to catch up, and we shared some really funny stories about our experiences in the various wards and the MICU. Did you know that the thermoscan, which records your temperature via the ear, is totally useless? Everyone who's used it says the temperatures in the 2 ears can differ by up to 1 degree Celsius, after which most just revert to the good ol' under-the-tongue method. Other accounts weren't as amusing, as we heard how certain medical/surgical services are shunning isolation wards and making specialist referrals impossible. And if my blog has been one-sided in its high praise of medical personnel, well, let me bring you crashing back down to earth as I reveal how some fellow MOs, upon hearing that the posting has been extended one more month, have opted to go on no-pay leave, and another may resign at the end of this month. Others take medical leave for the slightest complaint -- one chap got 2 days off for complaints of cough, with NO FEVER, and a NORMAL CHEST X-RAY. Then there are those who refuse to help when the sick ones can't do their calls, and some who still whine about getting days off in the midst of manpower shortage. Over at TTSH and the CDC, my colleagues tell me some MOs who are given night duties at the dreaded SARS wards just refuse to turn up. So yes, we have our black sheep too.

But at last, The Straits Times featured a great article about 2 courageous docs at TTSH today. One of them is my fellow med school classmate, Dr. Anuj Gupta, currently an internal medicine trainee, who volunteered his services to care for SARS patients when the hospital asked for assistance. I don't know him well, but he's always come across as quiet and unassuming. However, this revelation has definitely shed new light on his character, and he really makes us all proud. Bravo, Anuj!
The other doctor interviewed is Dr. T. Umapathi, who is a consultant neurologist at the Neuroscience Institute and comes over to Changi General to see neurology referrals. He is a very good doctor, and an extremely good person, and I've never met anyone who doesn't have the highest respect for him. He's also of the "quiet and unassuming" variety, but cares deeply for his patients, and never fails to answer our queries even when he's rushing around seeing cases.
Personally, I think the bravest ones are usually those who have the least propensity to brag. I had no idea these 2 doctors were on SARS duty until now. They embody the altrusim that the medical profession aims for, but doesn't always achieve, and I'm very inspired by their stories. I take my hat off to them both.

Before I forget, I thank you, the readers, for your words of encouragement. :) I'll try to email you once I find some time -- hopefully today. After all, it's your interest that keeps this blog alive.

On to the morning round. Till next time...

Saturday, April 19, 2003

In keeping with my decision to take a break from reporting on SARS, here're some DVD reviews for your perusal. ( And with most of us staying in nowadays, this should be useful :))

Ghost Ship -- Totally overrated, with trailers that are ten times better than the actual film. Yawn.

The Tuxedo -- Jackie Chan is always good for a laugh, and he doesn't disappoint here. High-kicking and cracking one-liners along the way, he's in his element as a bumbling chauffeur turned international superspy. Jennifer Love Hewitt isn't too bad either, but I've always found her kinda old-looking and scrawny, despite John Mayer singing about her body being a wonderland and all. Jason Isaacs, however, is smooth and sexy as Clark Devlin ( Chan's on-screen boss ). This is the guy who played Mel Gibson's nemesis in "The Patriot" and Lucius Malfoy in "Harry Potter And The Chamber of Secrets", and here, he's a completely different character yet again. Quite enjoyable.

The Ring -- This is the Hollywood-ized version, aka the brainchild of Tom Cruise himself. Not too bad, but I found the Japanese original much creepier -- perhaps because that was the first time I ever saw a ghoul with long hair crawling out of the television. Naomi Watts is competently horrified in all the key scenes, and the pace picks up later in the movie. But if you're looking for a real scare, I recommend "What Lies Beneath", "Stir of Echoes", "The Sixth Sense" and "The Others" any day.

White Oleander -- This one was a surprise. I rented it for only 1 reason -- Michelle Pfeiffer -- but it turned out to be one of the best 2 out of all the DVDs I got this time. Pfeiffer is fantastic and gorgeous, as always, and newcomer Alison Lohman is absolute dynamite reminiscent of Kirsten Dunst ( "Interview With The Vampire", "Spiderman", "Bring It On" ). It's a talkie, and based on a chick novel, but it had even my parents at the edge of their seats, so you can imagine how good it is. :)

The Good Girl -- Now this one's goooooood ( no pun intended ). Indie, low-budget, but starring some famous names like Jennifer Aniston and Jake Gyllenhaal, it traces the destructive path taken by a bored small-town housewife when she becomes tempted by a young co-worker to commit adultery. Aniston is appropriately dowdy and turns in a nicely understated performance, but the true star is Gyllenhaal. This promising young actor was in "October Sky", where he sensitively portrayed a poor boy who later became an astronaut ( based on a true story, by the way ). He also appeared in "Bubble Boy", a complete turnaround ( being a rather silly comedy and all ) that showcased his ability for comedy. Here, however, he is lovesick, depressed, an alcoholic with suicidal tendencies -- ie. a total basket case -- and yet manages to be lovable. Beat that, Leonardo!

And who would've thought The Bachelor 2 is capable of teaching us something? Gwen, the sweet and pretty blonde, offered some wise words on how to live
life to the fullest: "Work like you don't need the money, love like you've never been hurt, and dance like nobody's watching." Too bad she doesn't get the proposal in the end -- oops. :)

To everyone who emailed to ask how I am, many thanks, and yes, I'm feeling much better now. In truth, my mood was already on its way up on Thursday afternoon, after my fellow team doctors bought me a giant ice-cream cone called a "Superhero". Thanks, guys. :)

Last but not least, the female surgeon in TTSH ICU is, contrary to rumours, in stable condition. A nice piece of good news. Get well soon.

Friday, April 18, 2003

I'd just like to make a short post here, after hearing some very disturbing news from a good friend.
It seems a number of my colleagues reacted nastily to something I posted yesterday. That post has since been removed so my friend will not have to endure further insult. But I'm appalled by the adverse reactions it generated, and whoever are responsible for hurting my friend's feelings should be ashamed of themselves. If this is the sort of behaviour that my blogs are going to incite, then I have no choice but to keep everything under wraps.

My deepest apologies to my friend.

Thursday, April 17, 2003

Sorry about not posting anything yesterday. My fellow MO got called down to run clinic because we were shorthanded yet again, and while I was attempting to write something before the evening round, my registrar ( aka senior resident ) came by and after that, I was too tired to blog.

Actually, there aren't any new updates. But for the benefit of those who don't read the Singapore news, the past few days have been rather depressing:

1. Dr. Ong Hok Su's mother, also a doctor, passed away from SARS a few days ago. This is about a week after Dr. Ong himself perished -- he was 27.

2. There were reports that the public, when stopped from visiting patients in the hospitals ( due to new guidelines on restricting the number of outsiders allowed into the wards ), hurl vulgarities and even spit at hospital staff.

3. At Alexandra Hospital -- which is the only government hospital where the wards remain untouched by SARS -- reported a case where a male patient lied on a health screening questionnaire. When asked if he had any contact with SARS cases, he left out the fact the his own wife was warded in the ICU of TTSH with suspected SARS. Good thing this omission was later found out and he was immediately transferred to be isolated.

4. Dr. Leong Hoe Nam is being investigated by authorities for possibly endangering the lives of other airline passengers when he boarded a flight to Frankfurt despite having a fever and having been in contact with SARS patients in Singapore before his trip. The upside is, 2 senior doctors here defended him in the press after the news broke, and no passengers were infected by him.

The last month or so has been taxing for many of us in the medical profession, but I suspect I'm only starting the feel the full effects as of now. This is evidenced by an overwhelming sense of loss and sadness that I felt this morning -- and which was duly noticed by my fellow colleagues, who did ask me about it. I couldn't explain it at the time, but I'm pretty sure I can pinpoint it now. A young doctor and his physician mother are dead, 2 other doctors are in intensive care, numerous healthcare workers are getting hit with SARS, those left standing are overworked and equally fearful, annual leave is being cancelled... there will always be a breaking point.

Most of my friends are coping okay, but some are not. Though I'm not based in TTSH or the CDC -- I can't even imagine how the doctors there are handling it -- I was especially upset by Dr. Ong's demise, and now, when a surgeon I once worked with is also in intensive care, I don't even want to think about what else could happen next.

I'm in desperate need for some leave -- 2 or 3 days would suffice -- but when I spoke to a consultant today, he says the Ministry of Health is still considering that option. The last leave I took was in December, initially for the purpose of taking a trip to New Zealand ( I was looking forward to visiting the many places where The Lord of the Rings trilogy was filmed ) but those plans were unexpectedly put on hold when my mother had to go for emergency eye surgery. I spent my leave in her room at the Singapore General Hospital, and didn't even get much rest in the end. And after returning to Changi General, it's been non-stop ever since. I'll be rotating to CGH's A&E Department in June, and my exams are coming up in August/September, so a few days of rest will do a lot of good. But like I said, the MOH is "thinking about it". At this rate, it looks like the only way any of us can get away from the hospital is to get a fever with forced MC. Sigh.

The race for the diagnostic SARS testing kit is on. Hopes are high, but I'm more interested in the search for a cure.

With regards to the media, I think I'll stop talking about The Straits Times for a while. Mr. WashYourHands is obviously concerned with my "lack of objectivity", and though I have a comments section, I don't exactly enjoy having my views questioned every time I post something. Anyway, my blog is supposed to concentrate on SARS, so let's do that. :)

Still, Ms. Chua Mui Hoong's little propaganda piece in Life! today -- the "Spend And Relax Strategy" -- made me laugh so hard I actually felt pretty good after that. She should do some standup comedy, using her columns as its main content.

And as usual, I just saw Clay Aiken's latest performance, and can't wait to see it on TV tonight. He sang "Tell Her About It" -- the theme being Billy Joel songs ( a little strange, but hey, it's their show ). Not the best choice -- I think "The Longest Time" or "Uptown Girl" may have been better for him -- but BJ songs are mostly easy, singalong-campfire-type pieces, so Clay would do well no matter which one he picks. I'll bet he'll make it through yet again. :)

Tuesday, April 15, 2003

Hi again. Some of you will notice a slight change in my previous post, and I thank a fellow colleague for pointing something out to me so I can reign in my emotions and avoid a lawsuit. Thanks! I needed that piece of advice. :)

Not much to add at this moment. Just adding a cool link for your enjoyment -- taken from the always fabulous Dave Barry Blog.

And by the way, about 14 of us medical MOs will be having a dinner at a nice hotel come Saturday evening. I didn't tell the staff my profession when I made the booking, so it'll be interesting to see how they and the other diners react should they pick up on the fact that we're doctors.
To readers outside Singapore, I'd like to ask you this: Does the media all over the world behave in the same annoying manner towards the local medical community, or is that a trait that's unique to my country?

The call was quiet, thanks in large part to public awareness and paranoia. When usual admissions total 30 on Mondays, I only saw 12 last night. No complaints there. :) A couple of patients even discharged against medical advice in the middle of the night. Even better! :D

Now Raffles Hospital -- a private institution -- has stepped in and offered to help offload the overworked and understaffed government organizations. My deepest gratitude to them. This is exactly what we need right now, instead of a tonne of hot-air-blowing from smart-alecks who whine from the safety of their comfortable press offices.

Monday, April 14, 2003

I didn't manage to attend the morning SARS meeting today as a patient suddenly collapsed in the ward at 8am sharp, and we only finished with the resuscitation after 8:30. In any case, the latest facts are probably available in the news, but with a few added details from my end.

1. The old lady I saw on the 29th of March during my call, and who was later cleared of SARS by the WHO, has been reclassified as having the condition. Good thing the 10-day incubation period is over, as all those who saw and cared for her in the ward remain well. Neither did she pass the bug to the other patients in her cubicle. After the initial anxiety and fear, many of us are now heaving a collective sigh of relief. :)

2. The female doctor from Singapore General Hospital who saw the index case there and later passed it to other staff members is now in intensive care. I worked with her about a year ago during a surgical posting, and am most saddened by the news because she's a really nice person. Her dad's a well-known professor of surgery, but she always downplays that aspect of her life, and is one of the most hardworking and dedicated doctors I know. I can still remember one night early last year, when we were both on call, and I assisted her in a laparotomy for intestinal obstruction in the middle of the night. There we were, 2 tiny women, yanking out loop after loop of dilated bowel, retracting and dissecting till our arms almost fell off. Took us 3-4 hours, but I recall the look of satisfaction on her face after the operation -- it was her first solo laparotomy! She is a very promising and skilful surgeon, and I sincerely hope she'll recover and continue with her excellent work.

3. This month's SMA News, which will again focus on SARS, will be available online probably this Friday. There will be tributes to the fantastic medical staff all over Singapore, with a contribution from myself as well. Don't depend on the media for praise. They're only capable of saying good things about themselves.

4. To any Straits Times reporters who read this -- just want to let you know that certain members of your staff ( particularly those who write big columns in the paper ) are universally loathed by the medical community here -- meaning ALL the hospitals. Your commentaries in the papers are insensitive, inaccurate, and shamefully biased. A friend of mine, who works in the surgical department of another local government hospital, was so upset that she emailed me a draft of a letter she wanted to send to the Forum Page, excerpts of which I have posted below.

"With regards to my collegue's behaviour; if someone should not work on mere aching muscles, they would be reagarded as lazy. The fever came when she was on call and there was no one to cover her call. Also she was seen and discharged as well on Wednesday after a CXR and blood test. At that time, who would have suspected SARS when our hospital was described as being a SARS-free campus?"

She also writes about the isolation guidelines for patients recently discharged from TTSH who later got admitted at her hospital, but I've decided not to post this in case the hospitals involved get uptight and try to find out who she is.


I'm on call again today, and hope it'll be a quiet one again.

Sunday, April 13, 2003

It's official. Our postings have all been extended for another month. This means the medical officers ( residents ) and housemen ( interns ) will remain where they are till the end of May, while the new wet-behind-the-ears med school grads will join us on 2nd May. The current housemen will turn MOs on the same day, which makes for some interesting developments -- one day they're professional blood-suckers following orders, the next they're expected to perform more complex ( and dangerous ) procedures and make important decisions. But fear not, 'cos we residents ( who are starting to feel really old and tired ) will be there to help during the transition. Can't say I'm thrilled about doing calls for another month, though. I miss the ER...

No news to report on the SARS situation here, but we have daily morning updates at the hospital from Monday to Saturday, so I'll fill you in again from tomorrow onwards.

I do, however, have a giant bone to pick with a couple of Straits Times reporters. This morning's Sunday edition had a 2-page spread featuring articles written by 5 ST journalists -- all female, for some strange reason. In summary, the 3 pieces on the second page were a little less self-absorbed than the first 2. Yep, that's my assessment of the standard of writing in our national newspaper.

At a time when healthcare workers and other vital peripheral organizations are carrying out their duties despite great personal risk, ST editor Bertha Henson chose to shine the spotlight on her "gung-ho" reporters. Nice move. Nothing boosts morale like a commentary on how brave members of the media can be when pursuing a good story.

But the one that really ticked me off is written by Salma Khalik, who also blew the lid off the inquiry involving Dr. Leong Hoe Nam -- and for the record, Dr. Leong is one of the most accomplished yet humble and generous doctors I know.
Ms. Khalik's article, titled "In the hazard zone", claimed to give the "inside story" of the SARS epidemic in Singapore. She even tells us she was "the only journalist who went into a SARS ICU and isolation ward".
If that was her original objective, she has failed miserably. She didn't provide any information that other Singaporeans don't already know -- she merely rehashed what's been printed in her own paper over the past few weeks. The only additional insight she gave from her "exclusive tour" at TTSH was her description of how she had to suit up prior to entry, how paranoid everyone was, and of course, a not-so-obvious pat on the back for herself for being spunky enough to venture where no-one else would.
Her greatest crime, however, was her remark regarding a young lady who is one of the first index cases here, and who unwittingly spread the virus to her loved ones and a large number of medical personnel and fellow patients, leading to a significant number of secondary and tertiary cases as well. This poor girl has already lost both her parents and her pastor, and Ms. Khalik SENSITIVELY wrote:

" How much loss can one person take? To make things infinitely worse, she will always be plagued with the guilt that she brought to Singapore the virus that killed her parents, and infected over 100 people here."

She even names the person in question. Bravo. Sure, the reporter then makes an attempt to exonerate the woman, saying it is "unwarranted guilt, for she herself is a victim. She had not done anything wrong.." But let's face it, Ms. Khalik has merely poured fuel on a raging fire. There are some things that are deemed inappropriate, even for journalistic purposes, and this is certainly one of them.

Interestingly, a fellow ST writer mentioned in her own piece -- which is on the page directly opposite Ms. Khalik's -- that she recently received a message from the abovementioned patient's irate brother, asking, "Could you tell your paper to stop using my sister's name?" And here we have a whole paragraph devoted to how she's responsible for making a hundred people sick.

I used to write to the Straits Times Forum page regularly, and was even published a number of times, but ever since I started criticizing the reporters and voicing objections to some government policies, I've been completely shut out of the paper. Thank goodness for blogs then. :) I thought about asking you readers to email the paper and voice your opinions, but that would only make their heads swell even more. So if you've got anything to say, say it here in the "comments" section.

It's a Sunday afternoon, not much sun, just the right degree of mild windy conditions, and yes! my neighbourhood is dead quiet -- well, save for the occasional yelp from a small yappy dog down the road. I'm on call again tomorrow, but won't be covering the ICU this time, and come to think of it, I haven't even recovered from the last call yet. Ever wonder what perks me up when everything else gets me down? My apologies if I share some personal stuff right now, but hey, it's my blog after all, haha. :D Feel free to stop reading if you're not that interested.

1. American Idol 2 -- namely, Clay Aiken! He's got a beautiful voice, a great smile, and was an undergrad studying special education before he got thrust into the limelight. In his free time, he volunteers at the YMCA, and hangs out with a 13-year-old autistic boy. He remains humble despite his large ( and adoring ) following, and is only rivalled by Ruben Studdard as a contender for the final 2. It's my bet that even if Clay doesn't win -- which I hope never happens, ack! -- he'll get a lucrative recording contract. In any case, Mr. Aiken's the high point of my week nowadays, and I've got all his performances downloaded onto my laptop. :) Watch this every Thursday 8pm on Channel 5.

2. Monk -- Tony Shalhoub won a well-deserved Golden Globe this year for his spot-on portrayal of a genius homicide detective plagued by obsessive-compulsive tendencies. Every episode is a real treasure of twists, turns and hilarious incidents that play on Monk's numerous phobias. Airs every Friday 8pm on Channel i.

3. C.S.I. -- The 3rd season is being shown over cable ( Wednesday 9pm, AXN Channel 19 ), and continues to put our brains through a vigourous workout. The latest episode had the team solve an 18-month-old case, with nothing more than a skeleton stuffed in a metal chest in the middle of nowhere, and aided only by a colony of ants. Wow...

4. Josh Groban's Pasadena Auditorium concert -- Most of you won't know what the heck I'm talking about, but in short, Josh is 21 years old, and has one of the most gorgeous voices I've ever heard. Deep, effortless, and capable of producing heart-rending versions of "The Prayer" and "Starry, Starry Night". His concert DVD is not available in Singapore -- don't have a clue why -- but I taped it off cable a few weeks ago, and have been watching it quite a few times since. :) He is a spectacular live performer, and also showed off some nifty piano-playing skills, woohoo! My favourite song, though, is a collaboration with John Williams ( the prolific composer of themes from "Indiana Jones", "E.T.", "Schindler's List" and "Jurassic Park" ). Here, he conducts a lovely, lovely piece from "A.I." ( the movie from Steven Spielberg starring Haley Joel Osment and Jude Law ) called "For Always", and it's sung flawlessly by Josh. Takes my breath away every time, and I must've seen it at least 20 times by now. :D

5. Simple pleasures: giving my cat a hug, just spending time with my parents at home ( don't go out much with the SARS problem ), writing ( for my blog, as well as the SMA newsletter ), enjoying good music ( Class 95's dance party programme every Friday night is a big favourite of mine :)), a cold Root Beer after a long day, a hot shower, a good night's sleep, yet another day of good health... Funny how you re-evaluate your priorities when faced with the risk of mortality.

6. Church -- I never preach, and I'm not doing so here, but being a new Christian and all, I can see the big difference in my life before and after baptism ( this was in early February ). For me, any opportunity to spend a morning at church always renews my strength and helps me find a way to cope with the future. And of course, prayer is also an important part of my daily routine, during which I ask not just for myself, but for all my friends and colleagues here in Changi, and for the entire medical community in Singapore and all over the world. Cynics will typically ask, "How do you believe in a God that allows his people to endure such suffering and does nothing about it?" Let me tell you something -- I too was once a cynic, perhaps the biggest cynic that ever lived even. It took me 15 long years to convert, and how that happened is known by only a very small group of close friends and relatives. But all you need is that one event -- may be earth-shattering, may be happy or sad, something said, seen or done -- and after that, your whole perspective changes so dramatically you'll wonder why you ever doubted at all.

7. And if you're still reading after my little digression there -- ;) -- the last ( but not least ) thing that brings me lots of joy is... your visits! When I first set up this blog almost a year ago, it was more of a personal hobby, with the main aim of providing readers with reviews of good films and TV shows. But now, with my accounts of SARS, which have elicited so many well wishes from people here and all over the world, it really helps ease the pain and despair that I sometimes feel. I thank you all again for taking an interest in the goings-on here in tiny little Singapore, and hope you'll continue to spread the word and voice your opinions.

It's started to rain. Logging off for now, so I can download more Clay stuff. :P More tomorrow.


Saturday, April 12, 2003

Early morning post -- yes, it was an uneventful night call. :)
New link to add here: SARS Watch is a great site to visit for insighful news on the epidemic. I found the bit from China the most worrying, but can't say it's unexpected either. Thanks to Tim, who runs the site, for kindly adding me to his list!

Friday, April 11, 2003

Thought I'd make a short entry here.
I take a lot of interest in the people who visit my blog, and just want to thank all of you who helped spread the word about my website. I spotted posts on SGDR.com, as well as the Pacific Internet forum and a few personal webpages. Really appreciate all your support! :)

A special mention to the MO who saw the housekeeping staff during his call last night. Unfortunately, he didn't wear a mask when he examined her, and upon finding out she could have SARS, he was understandably upset and frightened. Spare a few moments for this friend of mine, who's got a great life ahead of him -- he's an emergency medicine trainee who's taking the Part 2 with me later this year, and will be getting married in October to a really sweet girl. I find that prayer does help, so any additional good wishes would be good for him.

No definite news on the extension of our postings yet, but rumours are flying everywhere. All you new med school grads, take heart, 'cos we seniors will take good care of you. Just make sure you protect yourself at all times, and don't hang around crowded areas outside of work too much. Sure, it's pretty dangerous right now, but you may never encounter something of this scale ever again in your lifetime, so make the most of your experience during this historic event. Years from now, you can tell your grand-children -- or your great grand-children! -- "Yes, I was at the frontlines of the SARS outbreak!" :)

Keep your comments coming. A few of my fellow MOs and HOs also drop by, and would love to hear your opinions.
A housekeeping staff here has "probable SARS". She was admitted last night but only revealed to doctors this morning that she worked in the ward where a SARS patient stayed -- the latter is the old lady I saw during my call on March 29th, and who passed away that same night ( read previous entries for more details ). I guess this incident reinforces the importance of astute history-taking. Sure, we're all aware of asking about travel and contact histories from a more general perspective, but there will always be little details that, if inadvertently overlooked, and worse, not volunteered by the patient himself, will result in a delay in isolation and timely transfer to the CDC.

And speaking of poor histories from patients, I'm currently taking care of a woman with persistent pneumonia, and who was recently admitted to a private hospital which housed a SARS patient. I was given information from my superiors regarding the exact ward involved, and asked the patient if she could tell me which unit she stayed in. Her answer: "I can't remember." And when I called her son to ask him the same thing, he said, "I don't think there was a ward number, but she stayed on the 9th floor."
I'm shaking my head as I write this. I was informed of the exact ward number that housed the SARS case, and here we have 2 lucid adults telling me they can't recall such simple facts. Does anyone still wonder why SARS is spreading like wildfire despite all our efforts to contain it?!

And guess what? A SARS patient at the CDC walked out of the centre and disappeared into the night. Yippee.

Tonight's my 2nd time covering the ICU this week. Just tried on the space suit, which is surprisingly light and really cool. There're 2 air filters that we strap around our waists, and the hood has positive air pressure. But I hope I won't have any reason to use it today!!!

A patient's relative personally thanked me today for doing good work during the SARS crisis. There's also been a recent media blitz -- both on radio and television -- paying tribute to doctors and nurses in Singapore, which we appreciate. But... it's rather sad that it takes such a major epidemic and significant rates of morbidity and mortality among medical personnel to garner praise and gratitude from the public. Anyone who's a doctor or nurse will tell you that patients in Singapore are mostly demanding ingrates who complain about the smallest things and leave without ever saying thank-you. Hopefully, this experience will change their attitudes.

Last but not least, Clay's made it through to the next round! Congratulations! :)

Thursday, April 10, 2003

My thanks to everyone who's emailed me or posted comforting comments. But as of now, I'm still getting goosebumps every morning when I go to work.The call last night was quiet, but for obvious reasons. With news of the SARS cases in my hospital, the public is actively avoiding us, and admissions were kept to the bare minimum. Which just goes to show how a lot of people abuse the healthcare system. I had no ICU admissions, but had to intubate an unexpected collapse case in the general ward -- and since it wasn't an ICU case, I didn't have the chance to don a space suit. The guy was being treated for the garden variety type of pneumonia, but with the current crisis, I have my worries. However, at 3am in the morning, I didn't give this that much thought, and just wore a mask and gloves during the resuscitation. The patient was 51 years old and in perfect health prior to his hospital stay, but judging from his ECG, he probably had some form of coronary artery disease, resulting in a sudden heart attack. His family was distraught, adding to an already physically and emotionally exhausting 24 hours for me.

No doctors here have been diagnosed with SARS, but a mysterious fever is making its rounds here, with most attributing it to the common flu. 2 housemen and 3 MOs are on MC, and I reluctantly left my team-mates at 2pm today, after being unable to think straight due to my post-call state. We were working at half-strength, 'cos one of the housemen with a fever is working with us. But my fellow MO is truly one of the nicest people I've ever met, and gamely shooed me home. The other HO was also post-call, but willingly stayed back to help out. I owe them both a huge meal at the end of this saga.

At around 5:30pm today, I got a call from Clinical Services, asking about my contact with the "suspected SARS" patient, who has been cleared by the WHO as non-SARS, to our relief. They're still being careful though, so we're being monitored closely. The good news is, the 10-day incubation period is over, and we're so far okay. But yesterday was quite a nightmare for me. Trying to manage medical problems while wondering if I could get a life-threatening disease is a terrible experience, trust me!

Just an update: The SARS issue of the SMA News is now available on the Net. And later this month, the April issue will feature tributes to medical personnel in Singapore, as well as a special mention of Dr. Ong Hok Su, the 27-year-old cardiology MO who sadly perished from SARS a few days ago. I will also be contributing a piece, so hope these will boost morale a little.

Side point here, but I can't help it. :) I've downloaded an MP3 of Clay Aiken's latest performance, and it's absolutely fantastic. In my sadness and anxiety, his voice never fails to bring a smile to my face.

P.S. This blog entry should be backdated to yesterday, 9th April. Was trying to load it but the server was down. Have more news today as well, but no time to write, aargh, so more another time.

Tuesday, April 08, 2003

How shall I put this delicately. I AM TERRIFIED.

It's official. As of this morning, I felt my first pang of unadulterated fear as I stepped into the hospital. It was confirmed last night on the news that 2 staff nurses here are down with SARS, but both came from the "fever ward", which I never step into. The alarming bit of news came from another source. Guess you've heard about the Filipino nurse from Orange Valley nursing home who's intubated and already diagnosed with SARS, which they say came from an inmate at the home. And this inmate apparently was warded at TTSH recently, and sleeping right next to another patient who has the condition. The inmate in question was subsequently discharged from TTSH, and lo and behold, admitted here a mere 2-3 days later, because she became breathless. She was seen by the geriatric team and treated for both pneumonia and heart failure. Wait, there's more.
Where I come in is on the day the lady died. I was on call, and asked to review her in the afternoon -- it was Saturday, March 29th -- which I did, thankfully with an N95 mask and gloves. She was also seen by the registrar on call, who took the same precautions. This was despite our not really knowing that she was a high-risk candidate for SARS. Really thank God for pushing me into masking up... I later signed her up after her death. But during the call, there were other admissions in that ward, and when I walked around, I didn't wear the mask 100% of the time. Feel kinda stupid about that slip, but it's too late to regret now. 10 days have passed, and all those who took care of her are still okay. Understandably, we're perplexed as to where the nursing home worker got SARS from.

My parents freaked out big-time last night, and were even more anxious today when I confirmed that the patient I reviewed is the one the papers has classified as a "suspect SARS". But life goes on, and all of us turn up for work each day, taking full precautions during rounds, measuring temperatures twice a day -- sometimes thrice. A bit apprehensive about covering the ICU today, but what can any of us do. I definitely know it's my duty as a doctor to carry on as per normal, but can anyone blame us for feeling just a little selfish once in a while? I mean, we're throwing ourselves into the fire and getting burnt, so to speak. I worry about my health not because I don't want to die young, but because I'm an only child, and I don't know who will care for my parents and support them in their old age.

I urge all of you who are reading this to once again, no matter what religion you are, pray hard for the world, which is going crazy right now. Save one little prayer for Singapore too. Much appreciated.

Monday, April 07, 2003

Things have taken a turn for the worse. Healthcare workers are getting hit with SARS -- the latest being a staff nurse/midwife from Kandang Kerbau Hospital ( she came into contact with 503 patients during the course of her illness, but so far everyone's ok ), plus 21 medical personnel in Singapore General Hospital ( 20 nurses and 1 doctor ). The latter group is a little more unpredictable and scary, 'cos they hail from a surgical ward, and no-one has any idea who the original case is. At the moment, I hear that the affected people are "suspect cases", not probable or confirmed as yet. Still, the hospital has shut down the surgical wards, and heavy screening of visitors is going on.

Earlier during lunch, my friends and I witnessed a long line of visitors being equipped with masks by hospital staff down in the lobby. And in the wards, all healthcare workers have to take their temperatures twice a day. The fear is palpable, and although my team hasn't resorted to doing rounds with masks yet, we definitely wear them when seeing new cases. I'm on call tomorrow, and covering the intensive care unit. This is one of the scarier places to be right now, especially when patients with non-specific pneumonias +/- heart failure come in and need intubation. Reminder to myself: look for the ICU MO later so he can teach me how to wear the space suit!

There're also rumours that our postings will all be extended. Aaaaaaarrrrrrrrrghghghghgh! Sorry. internal med is a fun posting, but 6 months is more than enough. Anyway, I miss emergency medicine, and need to get down to the ER so I can practise for my upcoming Part 2 exams in August. Help!

Finally, PM Goh Chok Tong called for Singaporeans to be socially responsible in today's edition of Streats. And my reprimanding letter was not printed when I sent it to The Straits Times more than a week ago. Anyway, I see a small improvement so far. Fewer people in the streets, though parents still take their kids out -- what gives? Can't anyone stay at home anymore? But one major peeve is how the public is treating healthcare personnel -- when faced with nurses, bus-drivers refuse to stop, taxis zoom right past them, and public transport passssengers move to the other side of the vehicle. Doctors don't face such stigmatism 'cos we don't wear uniforms or stethoscopes outside the hospitals. But c'mon, think about what the nurses are doing -- risking their lives everyday for YOUR sorry sakes. Is this the thanks they get for the incredible courage they display? I'm so fed up right now.

Friday, April 04, 2003

Short entry to encourage you to read a hilarious bit from Dave Barry's Blog, which caused me to choke on my hot Milo this morning. :) It's one of his 1998 columns on the US-Iraq conflict, and the part that made me spit was "goat-oriented nations". What a joker!
Sorry, I get euphoric post-call, and when something good happens the morning after, I just want to share it with everyone. Enjoy!
Late night entry here. On call, and just finished reviewing and clerking a whole chunk of cases. Sigh. Had an alarming admission of a lady with metastatic cancer involving the lungs with ?superimposed pneumonia -- nothing unusual, except that she stayed at TTSH for 10 days, and was discharged about a week ago! I took no chances and donned the N95 mask, though it didn't feel very protective. Anyway, we're observing her for now as she doesn't exhibit classical signs of SARS, but I kinda feel sorry for the other patients in her cubicle, who are oblivious to her history. Crossing my fingers for them :)

Anyway, thought I'd add a link to this other blog, whose author is an American family physician, and who somehow came across my blog and included it on her site. Many thanks! Let me return the favour -- you can read visit her webpage at this address.

I think the SARS epidemic will settle soon. I'm currently trying to allay my parents' fears so I can have a life again -- the department is understandably still quite demoralized, as the TTSH patients are swarming to CGH in droves, adding to our already heavy workloads and making us all very exhausted. So I've been assigned as the "social IC" and am expected to organize an MO get-together at some posh place, followed by pubbing ( you guessed it, I'll probably pick the newly renovated Bar None :)). I always get arrowed with the task of taking people out. Could never understand it!

I'll make my way to the call room then. Still have a few empty beds left, but as long as they don't come in till after 8am, I'm happy. :D

Btw, Corey Clark was kicked off American Idol for failing to reveal a prior police record. Due to his absence, there was no voting process this week, so everyone stayed on. But with Corey gone, my hopes for Clay are now even higher, 'cos I considered the former the only serious threat to the latter. So Clay, here's wishing you a smooth journey to the finish line, and a sweet victory!

Wednesday, April 02, 2003

Hi everyone. Apologies for disappearing off the radar for a while there. Well, actually, I was contemplating remaining silent for another week or so, but I saw the Site Meter counter and I can't believe how the number of visitors has suddenly tripled. Who ARE you people??? Not that I'm complaining, of course :), but please, I enjoy reading all your comments, so please write something, anything, the next time you drop by. Thanks again for reading -- your visits have thus inspired me to write something :D

Anyway, I'm sure many of you are wondering about the SARS situation. Let me remind you that I don't work in TTSH or the CDC, and Changi General is still considered a SARS-free hospital, but overall, the news we receive every morning follows that in the news very closely -- latest tally of total and new cases, new discoveries, updates on new protective equipment, and, the part I hate, the latest death toll. Our main concerns are the 2 critically ill doctors, one a young cardiology medical officer in TTSH, the other a physician at NUH. I received more details about the former, who is the ex-college mate of a fellow MO in my current department, and apparently hailing from a family that's full of distinguished medical professionals. I was told that he's clinically brain-dead, but we're all hoping and praying for a miracle, and that he will recover. Some people tell me that the NUH doctor is also very unwell, but as I have no reliable source from that angle, I can't provide more information at this time. Any of you out there who can offer prayers for these 2 unfortunate souls, please do so.

This month's SMA News will concentrate on SARS, with a significant number of contributions from respected professors of medicine. I've seen the draft already, and the online version should be available very soon, so please take a look. I will also be writing a piece as a tribute to Singapore's many courageous and dedicated doctors, which will be published next month, so if I write less on my blog, that's the main reason. :)

Anyhow, I'll keep this short 'cos I have a deadline and have to get back to the article. I'll leave you with this great Clay Aiken link, a real treasure that offers terrific downloads of audio and video clips -- everything from his performance of "Open Arms" to the latest disco night show ( he rocked yet again! ). You'll also get a chance to read the guestbook -- where I contributed an entry on March 30th. It's my latest addiction, and in these times of war and epidemics, Clay is a comforting presence.

Thanks again for reading. If you've got any burning questions, just ask. :)