Rocky Mountain Spotted Fever

Tonight I lay in bed thinking about the future. There has been much in the press lately about residency and specialist tracks. Our futures all seem to be hanging in some sort of limbo. But then again, what's new. Doctors, not so great at manpower planning.

Work aside, the year is drawing to its end in it's final quarter. A new work place, a new season. New worries and uncertainties. Not many words to express these thoughts, but we number our days and leave it in our Saviour's hands.

Happy birthday Z!

A wise (young) man had asked SJ and myself, about two weeks into becoming parents.

Have you discovered any biblical truths as parents?

I thought it an unusual question. After all, most of the questions that I was handling in that season of my life were things like Is she waking up every 2 hours? Are you breastfeeding? Are you eating enough nutritious food? 

I admittedly did not have a good answer, and gave a polite smile and some nondescript response. One year on, I might have better answers, and I discover and experience why God is made known to us as our Father. Always watching, always worrying, always praying might sum up my one year of motherhood.

Uninhibited laughter, warm hugs and slurppy kisses, balanced out with big tear drops, balukus, projectile vomitus and more laundry - all in a day's work. To every new mom who is going through the newborn phase where people are scaring you about hourly feeding, crying and sleep problems, I'd tell you that that is the easy part (hah). There are far greater challenges ahead than the above!

Happy birthday dear Zoe. We decided to buy you a cake after all :) (Too bad you couldn't eat it, ha)

Dong dong dong qiang

Kind of feel like I missed out on the turn of the new year because I was working over the long weekend, so I guess this gives me a second chance. Happy new year! Zoe is almost 9 months. We missed CNY last year, so this is pretty precious. 

Support group of a support group of a support group

M supports D. G supports M. Who supports G?

Been spending my last few weeks of maternity leave just chilling with parents and baby. Life is good, and we are thankful for every day. Many thoughts about the (new) future and what it holds, but I'm also reminded that unless the Lord builds the house, the laborers labor in vain.

I also just developed an eye stye on my left eye. Sian.

An Olympic gold

Coming to about a month since we've been home. Lots have happened since. We celebrated the nation's 51st birthday, and J Schooling won the nation's first Olympic gold medal today. The weather gently eased us in from rainy and cool to the hot and humid that this country usually is.

Just enjoying the last few weeks of my maternity leave, spending time watching baby grow (they grow quickly!) and also preparing myself for return to work. Mixed feelings about that, with some anticipation and also trepidation.

No real point to this post. Just a random mental note to be thankful for each day.

Reinforcements have arrived!

SJ's parents have arrived in the US of A! And they seriously brought a whole lot of food. We asked them to bring like 4 packs of BKT but they ended up bringing at least 10 packets of different soup varieties. I think it was because they initially couldn't find the original one we wanted and started buying random types. Oh, pineapple tarts...

Happy to have family in town, but at this point I am also relatively less mobile and a little less able to walk as intensely as before. They have otherwise been very thoughtful and are happy to bring themselves around. I feel like after a certain age/life stage traveling no longer it about checking things off the To-Do and To-See list but just enjoying a new city with your favorite person. And it seems like that's what they're doing!

We had initially booked an Airbnb near St. Mark's Place but the host cancelled the booking just 2 weeks before their arrival (no reason given). We ended up booking another place along Mott which in retrospect really was a blessing in disguise. It's much closer to where we stay and just a stones throw to Chinatown which has been their favorite haunt in the past 2 days that they've been here. :) Chinese Singaporeans just cannot be too far away from their fried noodles and dim sum heh.

Change

Always amazed at how adaptable some people are to change. On a scale of 1 to 10, I think my adaptability lies somewhere about 3-4. I dislike change. I enjoy the routine, and will gladly accept the mundane. There is safety, comfort and peace in being able to anticipate what comes next, and being able to prepare for it.Once in a while my inner sky-diver accepts the challenge on a whim, and says okay to something like moving halfway across the world. Just once in a while.

Which makes me wonder why I am feeling this way towards M. Rationally I can understand M's decision, but somehow emotionally there is still that feeling of abandonment...and the scary R word.

Hou Seh Ah!

As children we love Chinese New Year (I guess). The food, the angbaos, the "gambling". I remember in our old house my mum would wrap extra angbaos and hang them on a little money plant in the dining room and we would play low level intellect card games (thus suitable for children) and collate points and the person with most points gets to pick a free angbao off the tree. I thought that was pretty fun. Then there was the crazy eating. Man, I loved it.

Then came the in-between age, of starting to become conscious of people ranting about CNY. About visiting the once-a-year relatives and answering once-a-year questions. It has almost become a cliche. We nonetheless still went about visiting, albeit a little more occupied with our smart phones and technology rather than making small talk.

I always remember my Dad telling me how important Family is, that when the world betrays and forsakes you, Family will (should) always remain. My Dad always made it a point to do CNY properly, visit his older siblings, give out the important angbaos and make sure we said the important auspicious sayings. I don't think he was superstitious, he just wanted us to learn the heritage from which we came from. He was pissed one year when I said 恭禧發財 instead of 身体健康, and made me feel so bad thereafter :x 

So then comes this age where I've crossed over to the giving end of angbao exchange, and on the brink of investing in my own angbao-collecting human. And being many miles away from home I can see why my Dad emphasized the importance of family. I definitely feel envious of the insane feasting, bakkua, CNY snacks and yes, the random small talk about gatherings. Skyped the folk back home at reunion dinner, just to say hi. As I celebrated this quiet CNY (SJ refused to let me play 1 min of CNY youtube music), I decided that CNY comes out amongst the tops of my favorite holidays. 

Nothing beats celebrating family. :) Have a happy Monkey!

My brother gets hitched!

My family says the weirdest things. I think we might be slightly dysfunctional.

On the morning of Han's wedding
Shin arrives to pick Han up as the driver. On arrival, he says, "Where's Han? Is he crying in his room?"

o_O

*  *  *

The day after the wedding
My mum is fussing around the house cleaning things. She says, "Ah, so glad to be back to my normal boring life..."

o_O

Tor Tee To

Anyone who grew up in 5 Stevens Close would fondly remember our favorite afternoon snack. A plate of oily and soggy Tor Tee To! It essentially is potato strips panfried (not deep fried) and dripped out of its oil on a kitchen towel. My lovely grandma cannot say "potato" for nuts so she gets by with "tor tee to". And the legend it is! We all grew up eating it. And I daresay it made us all smart :)

D0

People die. They disappear, have their stuff sold, inherited or thrown away. And then Life goes on. People still go to work, wonder what they will have for lunch, worry about what the future holds for them. And then, they forget. I guess leaving is kind of like dying. You pack up all your stuff, say your goodbyes and then poof, disappear off the grid. Friends may wonder what has happened, then after a while they stop wondering. Soon you become a ghost of the past, talked about in past tense.

We fly tonight! It's incredible, how we've planned for this for ?1 year. I guess we leave with ambivalence. One good thing that came out of this is how we cleared out our refrigerator, and discovered a pool of gross zhup lingering in some corner (probably spilt some soup and never saw it there). Well that's all cleaned up and we have a spanking new fridge. Looking at it gives me a sense of excitement, kind of the same feeling you get when you move into a new house :D

If it sounds too good to be true, it probably is. My mum has a personal maxim that she'd rather lead an okay life than a supergood life. If Life is too good, you better start feeling scared. She thus always reminds me to make good of what I have been blessed with to bless others. I am of the opinion that God is fair, and its probably true that no one can have the "perfect life". Yes yes, there are tons of these Facebook Lives that are like all-too-perfect, and if they are truly so then said person should start to feel worried. So putting things in context, while Life has been good, I have been dealt some bad cards as well.

25 July, visit to the A&E. The first of many perhaps. I once wrote an entry about Chronic Pain (which for the life of me I cannot find now), and now I am beginning to feel the ache. Angels abound - AK, S, Z, DH, M, YK, and I could not be more thankful. Would appreciate prayers.

Of late I have been thinking of what songs I'd like to be played at my funeral. Not morbid, I think it saves whoever is planning for my funeral some work of thinking about what to sing. If I should suddenly die, please inform whoever is planning to use the following songs. Thanks :) Edit: Filler songs to use a PianoGuys playlist please (to include Happy Turtle)




We'll touch, we'll hear, we'll taste, we'll see
The wonders of eternity
Creation new, we’ll finally be at home

Closing song:

Chillin'

The reason I'm so furiously updating this space is 1) I'm very free and 2) I recently discovered my old blogs! Horror of horrors. Bad writing (still bad) and weird teeny bopper stuff, just for laughs really! As K recently pointed out, our lives are so full of stuff that it's easy to forget. That said, best moments are the moments you never get a chance to capture on camera.

Two weeks in unemployment, what have I been doing? Other than being bogged down my last planned exam of the year that I took yesterday (official holidaying thus begins), have been doing simple things that I've been putting off again and again. Spending time with my mum, my grandma, reading newspapers religiously and actually understanding world news, having quiet breakfasts, sending SJ to work, actually exercising. I must say that I often feel fearful that I'm wasting this time that I have on my hands, but in truth, time spent with loved ones is never wasted and I'm thankful for this chance in this time and season.

My countdown app says 10 days to go :s

Boring photo of regular latte art

Flu is gone and I'm back in action! Went to watch Jurassic World today, reminiscent of the good old Spielberg films, though probably not as good anymore.

Had a bad dream last night that woke me up at 6:20 AM. Mum, dad, 5A and a lot of weird stuff. Maybe more in my next post...

The unhappy triad

Pain
Malnutrition
Depression

IPMN

There are some kind of favours that no amount thanks or gifts can ever repay. One can only hope that an opportunity may arise that the favour may be repaid in kind.

D was recently diagnosed with pancreatic cancer. The hows and the whys remain a blur to me, but it started off with persistent epigastric pain. Given the timing and circumstances, I did whatever I could in my capacity to expedite treatment. I remember the day the report came out, I thought long a hard about how to find a surgeon. I had a terrible posting as a houseman in Surgery, and hardly made any long lasting friendships to be able to pull any strings. I had asked around, and many big names came up, top surgeons in particular from SGH who do complex oncological surgeries. I thought long and hard about how to get an appointment with these people whom I have absolutely no personal connection with, and found no other way other than to ring up the SGH hotline and ask for an appointment the conventional way.

Somehow Dr A's name came up later on. Once, twice and a third time. He was young no doubt, compared to the other old birds in the field, but up and coming nevertheless. It then occurred to me that he was my Facebook friend (!!). From the days of Surgical OSSEs, I wondered whether it would be really creepy and weird to drop the Professor a Facebook message to ask him for his opinion. He was always the deadpan funny tutor who sacrificed his afternoons and nights to teach us. His wife taught me during the BASIC course, and I remember poring over his family's facebook photos pre-MBBS in MD6. And so I did, I actually dropped him a Facebook message. Within 4 hours, we had a first slot clinic appointment on the Monday morning and before we knew it, D had gone for surgery within the week.

Perspectives are different being on the other side of healthcare. But understanding what happens behind the scenes made me rather zen to everything that happened. Movement in between clinics, blood tests, doctor speak and pre-operative assessments. I crossed paths with many angels along the way. M has been understandably anxious. The longer the wait outside the OT, the exponentially worried she got with thoughts of complications from surgery and anaesthesia etcetc. Grateful for friends like K who gave me live feed updates from inside PACU and M who even got the chance for MIL to go in for a bit. As the "doctor in the family", I had to give answers to many difficult questions that often have no good responses. Is D going to be okay? What did Dr A mean when he said suspicious stomach lesion? Does he need to go for chemo? I could give a good medical answer to all those questions, but unlike in the usual situation, I myself needed to deal with the uncertainty that comes with vague replies that doctors always give. Fifty-fifty, as we always say, which essentially means "I don't know".

Long clinic waits, many blood tests for which the patient never knows the reason for, days in the hospital unsure of what happens next, various choices that are given which never make any sense to the uninitiated, incessantly beeping equipment in the HD (stupid IA line waveform), worries about appetite and pain and post operative care - the patient experience is a torturous one, one that hopefully I in my capacity may help to ease for the patients who come my way.

SJ says we all should face death right in its face, and I fully agree, though not many may find easy to stomach. Death remains a certainty, in the same way we have assurance beyond death with hope in Christ.

Tough times

Times have been tough.

MICU is a weird environment. Things are changing all the time. Patients, bosses, labs, things, patterns, where things are kept. It's a wonder people actually survive an ICU stay. Everyday is a surprise, be it the deathly ill patient who improves, or the patient who has been apparently doing well suddenly deteriorating. My friends say I have "good call luck", with infrequent admissions on call and generally nice patients. They say that once you've seen MICU, nothing fazes you anymore. You can just about stick a tube into any part of the body to introduce or withdraw things as you please. It's true, medicine and technology have come a long way in organ support. Man can be kept alive artificially for a long time. It can be a blessing, but people sometimes fail to see how that becomes a curse. The curse of ICU, my boss would say, on discussing the case of a patient on day 59 of ICU, with a tracheostomy and no reasonable room for any improvement. It's been a tiring month, and yet another month more.

On a personal front, family matters have seen my frequenting NUH often these days. Thankful for many many angels that God has put in our paths to provide the best possible care. From an instantaneous clinic consult, an early surgery date and just the right people to spy on the back end to make sure things are alright. Even people whom I've just barely said hi to from a long distance away have been ever ready to lend a hand. I've come to realise also that SJ are highly unemotional and inert people. I make up for it by conscious social equilibration, but SJ really does not bother at all. We discussed what each would do if one of us fell ill, and both decided that death was the better alternative. Life goes on regardless, no moping allowed.

I'd like to write about the patient experience, but that is for another day. Work starts tomorrow as usual, 6:30AM, regardless of the fact that it is Saturday and part of a nice long weekend that I cannot enjoy. Just to remember that in this time of mundane madness,  SJ has been wonderful. After a terribly long day, I get to come home to a clean house, washed laundry and a hot home cooked dinner. Poor long suffering husband.

The Big C

Today I clicked one of the many tags I've saved on my blog posts over many years: Oncology. Brought back memories of my time in NCC, the patients I encountered and that people I was inspired by. I haven't written about cancer in a long time.

Everyone gets cancer.

It's true. If you told me that I have cancer today (at the age of 27), I would hardly be surprised. My father had colorectal cancer diagnosed age 50, my father's sister had breast AND ovarian cancer, my cousin had lung cancer, another cousin had colorectal cancer at something like age 25 and died within a year of diagnosis, my maternal grandfather had esophageal cancer and my maternal aunt had ?ovarian cancer. Talk about family history. So given all that impressive family history, it should really be nothing of a shock if a panscan revealed a mitotic lesion lurking somewhere in my body right now.

The big C word can be terrifying, though. Things like acute myocardial infarction, stroke, multiple sclerosis or HIV does not incite such fear as cancer. I guess people just don't realize that all these other diseases and their associated morbidities could be far worse than cancer.

I have seen many people die since I started working as a doctor. The AMI is quick (though angina is hardly painless), and stroke is prolonged and debilitating. Many people are affected when someone dies - clearly the patient who died had to experience suffering of some journeying to the End. Then there are those who are left behind, the ones who mourn and feel pain beyond the event of death.

If I could choose a way to die, quick and painless is definitely the way to go. But these deaths are the most difficult for those left behind. I once encountered a patient who presented to the emergency department multiple times of refractory headaches. It turns out that these 10/10 headaches started after she witnessed her neighbour whom she was playing mahjong with collapse in front of her and died of a heart attack instantly. Slow and painful are the difficult ones to cope with. Mr A, whom I was recently caring for, had a known diagnosis of metastatic esophageal cancer diagnosed 2 years ago. A long and painful journey landed him in the intensive care unit in which he stayed for 35 long days. A month long with a tube going into his lungs, connected to a ventilator, and lots of lines running medications and toxins in a out. When his time finally came, his wife had long been prepared, and his exit was a quiet one.

So I guess a good death has to strike a balance between both. One that results in minimal suffering for the person who makes the journey, and also one that provides enough time for those who are left behind to prepare for the day to come. Cancer does not provide that luxury, so I guess the C word is still something that most people gravely fear.

A selfish me still opts for quick and painless, and my consolation for my loved ones left behind would be "see you in heaven!".

#ThankyouLKY

"Dear Papa, hope you get better": PM Lee pens a message for Lee Kuan Yew at Tanjong Pagar CC. (Photo: Kimberley Spykerman)

Aiyoh I feel so sad now. I just spent the last hour surfing articles about THE Lee and his life, the good, the bad and the ugly. Sending Mr Lee a virtual hug #hug.

#SCGS

This is a pretty cool photo of all the SC girls in the Tan family, taken during CNY 2015 :) We are missing a couple but generally this is it. Am not sure how that happened, but I guess someone decided that my mum would go to SCGS and the rest, as they say, is history. Small girl second last to the right is currently in P3. I guess school has changed much, but once an SC girl, always an SC girl. Everyone knows how to sit properly for the camera!

Existential

On a day like this, I really wonder why people go on living. Life is hard, full of suffering. If not now, later. There is sickness, pain, death and separation; anger, hate, hurt.

We are so quick to judge. Oh, too noisy. But I wonder, when the noise stops and the air is still, will you still say the same?

Choosing to be a parent should be one of the hardest lifetime decisions to make. I think people make it too flippantly (oh judgemental me). Why did you choose to have children? Oh,  because it would make my life complete. Oh, so that our marriage would be enriched! Oh, so I can nuture another human being to be of value and contribute to society. Yes, all valid. But what if the child is sick? Grows up to harm someone else? Rebels against all law in his or her teens? Hurts you with stinging words? Then one day, you will die. And yet another relationship truncated. Heartbreak. The cycle goes on.

I was recently made aware of a potential change in life circumstances in my family. I am a creature of habit and dislike change. I thought about what would happen next, and felt scared. Fear of the unknown, fear of the future.

A small part of me often wishes that I never existed. The philosopher would argue that that itself is an invalid thought. I honestly think it is not always true that it is better to have loved and lost than never to have loved at all.