Fresh Off The Boat

Wah! Today the news NUS student got punished for making freshmen orientation look like lup sup bar! Actually what did they do huh? The picture on the ST website shows the freshmen dancing line dance niah. The article also mention the Arts Faculty got student kennah kar chng bua gu you (butter backside) for simulating rape during orientation? Wah really karma lor. Some say these the ginnahs kennah punished very buay kum wan since these were traditions pass down by seniors. Wah lau, you NUS elitistest (I invent this word one elitist plus -est), senior tell you to jump then you jump meh?

Dr Og is genuinely quite disturbed since I have a daughter. Also nowadays boys all very weak. If son kennah groped (by other boys) during orientation also will get traumatised. But lets leave the future aside, Dr Og's daughter still small, and reminisce about the past......

Long long time ago, Dr Og was also an undergrad freshman. Sadly, my orientation was also traumatising but no where near so happening as the Arts Fac people leh.

When you join the medicine orientation, first and foremost is disappointment. Somehow, most of the chio girls fail medicine interview and all go dentistry. Left maybe one or two not bad ones. To begin with already not so many girls coz that era got quota for female medicine undergrad. By orientation time, the few pretty girls (actually only two) already chope liao. There was a medicamp where I suppose is orientation for orientation and those girls got hitched liao. Dr Og of course din attend, wah lau, army not enough camping ar????). And so begins a merry go round of inbreeding.

What did we do in the medicine orientation as freshman? There was no hanky panky. There was no simulated games of any kind. There was no lewd cheers. Boy, was it traumatisingly boring! Actually, we were making some float (the Chingay float kind of float) for Rag and Flag. Build some imaginary boat which is mounted on a motor vehicle is already very boh liao, but to have to build some Disney themed float is as regressive as it gets. I thought we go Uni to become adults? At least do some Sci Fi or Horror, Vampire vs  Alien design la (last time no Zombies yet, now I sure suggest Zombie apocalypse float).

So Dr Og decided just stay under radar and quiet quiet follow instructions. I quietly stick colour papers (and pray silently for all the unnecessarily dead trees) on the float but then suddenly, this self appointed as leader skinny girl come and scold me.

"Why you tear the paper never use scissors to cut??!!!" She screamed at me.

Hello aunty, the judges sit how far away look at your float? You think they can see the paper is cut or torn meh?

The girl buay song went to complain to a senior year two medic who was some mad socks president. He came over and attempted to ask me to use the scissors. I picked up the scissors, put it in his hands and told him, own time own target, carry on. Senior tell me to cut then I cut meh? I flip my motorola clam shell phone open, call my buddy Ah Bui, "Bro meet you Arts canteen eat beef kway teow!" There sure more happening!

NB: The point of the story? If you blind blind choose to follow tradition and do what your seniors did, then don't kpkb when you kar chng tiok bua gu you!

Many many pain Part II

The Little India Riot really took Dr Og by surprise. Like I always emphasize, Dr Og is apolitical and this blog is not to kpkb about anything. But you see, working in a hospital, you tend to have met all kinds of people. From the migrant workers to the atas-nose-in-the-air Singaporean towkay who is too cheap to forsake his right to subsidised care.

One phenomenon about migrant workers is their pain threshold. This is something very important to understand as they may have clinical implications. (Disclaimer: As I am a fake doctor writing a humour blog, please don't quote this as scientific evidence. All facts presented in this blog are fake.)

The thing is that different races of migrant workers react to pain very differently. Our Thambis from India have the lowest pain threshold while the Thai migrant workers are on the other side of the pain threshold spectrum. The Chinese workers probably fall somewhere in between.

For the Indian worker, during palpation of the abdomen for suspected appendicitis, he grimaces and screams, "Mmmmmany mmmmany painnnnn.... ah mahhhhhhh". Only that my hands are still in the air and I haven't even touched you can... (And Dr Og is not a practitioner of Qi Gong or any form of martial arts capable of transferring energy through air.)

For the Thai worker, during palpation of the abdomen for suspected appendicitis, I am pressing hard on the right iliac fossa, I see the worker face turn green and is sweating away BUT he tells me, "No pain". CT abdomen then shows a ruptured appendix!

If the doctor is not careful or unaware of these cultural differences, unnecessary operations may take place or necessary operations may be delayed! In any case, all cases must be seen promptly and all evaluated carefully regardless.

So it came as a surprise, the Little India Riot. I always had this impression that our Indian migrant workers were timid gentle people with low threshold for pain. I dare not imagine if the riot had involved migrant workers from other races.

Mai Jiak Yok!

Lokun: Uncle you drink alcohol?

Ah Pek: Ya, I lim jiu with my kah kee at the kopi tiam every night. Song song drink until midnight den go home. You know la, dun wan hear the wife nag nag nag.

Lokun: Smoking?

Ah Pek: Wah I smoke more than 30 years. You dun ask me quit ok. They say too old quit smoking can die one! Now hun kee very ex, I only smoke one pack a day niah.

After completing the rest of the clerking...

Lokun: Uncle, looks like your condition like that need to take medicine. This one you take one tablet twice a day.

Ah Pek: Wah... like that ar... Mai jiak yok er sai boh (Don't take medicine can or not?). You know western medicine got a lot of side effects. You see the bottle here write POISON! Jiak liao sure tiok tiao! Will dependant cannot come off.

Lokun: No la. This medicine ok one. Anyway your condition needs it.

Ah Pek: Mai la mai la. Medicine no good one. Got anything natural or not??

It often fascinates Dr Og how patients are so paranoid towards "Western medicines". It is of course true that medications have side effects (sometimes severe) and drug companies have in the past attempted to play down on the side effects. But it really irks me when people who smoke and drink tell me they are afraid of taking medications (for fear of dependency and ill effects). Seriously? With all that addictive poison that you are already putting into yourself?

Now, if they stop smoking and drinking, they may actually not need the medications. 

Dr Og's Off-White Paper on Preparing Singapore Healthcare for 6.9 Million People

Dr Og is apolitical and will not comment on the quality of toilet paper in public hospitals let alone the recent White Paper on Population. Honestly Dr Og is a small lokun with little helicopter perspective and the last time I comment on TCM also tio scolded... haiz

Anyway, whether in 2030 we got lak bak gao chup ban lang (6.9 mil) or not, Dr Og thinks we better start preparing our healthcare system and hospitals. Don't goondu goondu buy super tight skinny jeans and discover after Chinese New Year all the goodies cannot wear liao, right!!??!!

So Dr Og presents his:

Off-White Paper on Preparing Singapore Healthcare for 6.9 Million People (And A Core of 3 Million Singaporeans).

1. Health Promotion

HPB monkey! Source: HPB loh

Health Promotion Board has always been very solid in providing educational materials to promote good health and well being. From animals to vegetables, their adverts (almost) always strike a cord with fellow Singaporeans. In fact I think they are well prepared because the mascots they use are very international, like generic elephant, giraffe and monkey instead of recognizable local species like orang utan or dugong. So our ever increasing international crowd will have no problems identifying with these beasts.

However, in my Off-White Paper, I will like to propose having overseas health promotion! After all by 2030, most of our residents will be foreigners. It will be too late for any brainwashing form of health promotion by the time they are parachuted in at their middle age. And don't you want to see those HPB monkeys speaking in Tagalog?

2. Training of Doctors
If you are not in the medical line, you may not know that postgraduate / specialist training for doctors has undergone a major change in the past few years. We have cleverly adopted the American system of residency training (think Dr Doug Ross (George Clooney) in ER or Dr Meredith Grey (Ellen Pompeo) in Grey's Anatomy). That's cool right? Particularly when we are becoming a really international nation.

What is even more cool is that while the old training trains doctor to be fast and accurate when seeing patients, the new residency programme allows the trainee doctors to slowly take their time. But with 6.9 million where got time, tio boh?

Therefore in the new residency, not only need to learn how to see patients fast fast, also need to learn to hold urine and skip lunch. The exams will not be about clinical work but how long your bladder can tahan before you need to use rubber band (for guys, for girls, can someone from the female sex advise?). Indeed, with 6.9 million people, there will just be people(not urine or faeces) overflowing toilets lor!

3. Improvements in Hospitals
3a. Increasing Hospital Beds

Hospital Beds in 2030!

Given that there is simply a lack of hospital beds now with just 5.3 million people, there needs to be innovative ways of increasing hospital beds! We are already parking beds on corridors. So Dr Og suggest triple decker beds! Never mind if its so crowded until like those 雾锁南洋 (The Awakening) refugee boats! By then we all will be so use to being pack like sardine and be totally desensitized!

Since there are so many water features and ponds in hospitals, we can also have floating beds on them. So patients can now truly enjoy the soothing sound of water running. These luxurious water beds will of course only be opened up to rich private patients.

3b. Translators

Being truly international, we need to hire translators. No, we do not need translators for the various South Asian or exotic European languages. First we need English to English translators. Strangely in the hospital, everyone speaks English but nobody seem to understand each others' English because of the accent. For eg. we will need a translator for someone to translate Indian English to Singlish or from American English to Filipino English. The combinations are scarily more than Street Fighter 4 combos and we need to hire translators now!!!

Secondly, we will also of course need translators for our local spoken languages and dialects as we will soon be the minority. Even now, our ah pek ah emmm are having a hard time communicating with the medical staff in the wards and clinics!

4. Engage TCM and  other traditional healers
My last suggestions. Get TCM and traditional healers to help out! Sure, they don't practice evidence based medicine but so what? There are 6.9 million people can?!! And all deserve some form of medical help right?

Mostly, I'm adding this in to appease the dude who posted an angry comment on my TCM expose. :)

My humble thoughts on the SMRT Strike 2012

So now they officially call it a strike. And as you know, strikes are illegal in Singapore.

Nowadays COE so expensive, Dr Og also gotta take public transport. Compared to many countries, our transport system is very steady (bom bi bi) liao loh. In some countries, strikes are so common that they become a part of daily living. But usually, you have local people buay song their gahmen unlike in our case.

The Straits Times yesterday (not me hor) aptly pointed out  that Singapore is so reliant on foreign labour and talent even in healthcare sector.This to me is quite scary.

If strike how?

As we approach the ten years anniversary of SARs (Severe Acute Respiratory Syndrome - Singapore, 2003) and with news of a new strain of coronavirus (SARS-Like Virus Resurfaces And Infects A Family In Saudi Arabia) lurking, I can't help but wonder whether we can depend on any other than Singaporean healthcare workers should another pandemic erupt.

Gostun!

Gostun is the Singlay (Singapore Malay) word for reversing.

Eg. Lai. Gar Gar (dare dare) gostun your car!

Gostun can also be used metaphorically to mean a reversal of any kind. Today, Apple made a super gostun! Just as everyone anticipated a iPad 3 or iPad HD, Apple song song released the new iPad as "iPad". Aiyoh, how can???

While analyst confirm that this will not affect the sales of the new iPad, it does pose a serious problem. Imagine this scenerio.
HO: wah Boss, new iPad ar?
Consultant: Are you asking if this is a brand new original version of iPad or a new new version of iPad?

Evidently, when nomenclature kennah gostun, communications can become a problem and our ward rounds shall never end. Of course the only reason why the Consultant bought the new iPad is because he believed he was going to get a pay raise. But as the saying goes, do not count your eggs before they are hatched. In the land of ever changing constitution, it should be "do not count your eggs until the chicken grows up".

Firstly, the lokuns struggling in lokun chu were told they could expect a 10-30% per raise in their basic pay in April this year. Then as announced here, they say and I quote:

"The new framework will be implemented in phases and doctors will, on average, see an increase in total compensation of around 20 per cent by 2014.

Phase One will commence next month, and doctors will start to receive their pay raise according to their job levels.

Associate consultants in hospitals will get an increase equivalent to 20 per cent of their base salary, while consultant family physicians in polyclinics will get a 10 per cent raise.

Doctors will receive further increases when the framework is fully implemented in 2014.

Dentists' pay will also be adjusted."

 Dr Og always readily admit that my England no powderful but I would assume that the passage means that in April, ACs will get a 20 percent increase to their base salary, etc. Dentist of course we don't care la. There are so few in public sector and they are not even real doctors :P

But for those who have been briefed by the men in black from the ministry next to a lokun chu, our pay raise also kennah gostun liao! Apparently, in April, we will only get some funny component which the above said people refuse to commit to. Wah biang, whats this? Early April fool joke ar?

Wei! Don't like that can or not? My lao pek, lao bu, wife and kids all read in newspaper big big that I will get 20% pay raise. But actually boh leh. How I explain to them? Wait my wife think I keep mistress and never bring the dough home how? Wait I really already keep mistress and cannot upkeep her how? Wait I preorder the iPad, engrave name, cannot even sell in eBay liao, how?

医生们，有没有被骗的感觉？

Spinal Reflex

Once upon a time, in a country not too far away, there were a series of bank robberies. Based on the CCTV recordings, the robbers wore full-faced motorcycle helmets while committing the heinous acts of crime. No one could see who they were. The authorities decided to ban all full-faced motorcycle helmets in the country.

In the next few months, the number of bank robberies reduced. Even though the number of motorcyclists who sustained severe head injuries and the number of fatalities from road traffic accidents increased, the authorities were happy since there were less bank robberies.

Within the next few months, there were a series of bank robberies. Based on the CCTV recordings, the robbers wore ladies' stockings over their heads while committing the heinous acts of crime. No one could see what they looked like. The authorities decided to ban all sale of ladies' stockings in the country.

In the next few months, the number of bank robberies reduced. The sales of razor blades in the country increased rather significantly and the number of shops that do waxing sprung up all over. The authorities were happy since there were less bank robberies.

Within the next few months, there were a series of bank robberies. Based on the CCTV recordings, the robbers wore toy masks over their heads while committing the heinous acts of crime. No one could see what they looked like. The authorities decided to ban all sale of toy masks in the country.

The children cried.

===

In many places, knee jerk reaction is the norm. The reason it is called a spinal reflex is because the reaction does not use the brain.

Beggers ARE Choosers

As doctors, not only do we treat illnesses, very often we have to attend to the social needs of our patients. As with everything in medical science, we gave it a name and called it holistic care.

Doc: Mr Tan, so how are you.

Patient: Ok loh, this new medicine very expensive leh.

Doc: You need this medicine, all the old ones didn't work for you. So how? Found a job?

Patient: The one the social worker recommend no good lah.

Doc: Why?

Patient: Wah lau, ask me to be cleaner. So smelly and dirty.

Doc: How about security guard, I know they got lots of openings.

Patient: Wah lau, lagi jialat, 12 hrs shift wor! How to tahan.

Doc: What do you want to do then?

Patient: Mebbe something got aircon like office work that kind and pay must be more than $2000. But I don't know computer leh.

Doc: Are you getting any financial aid from CDC?

Patient: $400 dollars lah. My brothers also gimme some money loh.

Doc: So enough?

Patient: Wah lau, nowadays where got enough? Go Geylang one time all finish liao! Wah lau why now medicine all so expensive? Can cheaper or not?

Doc: Your medicine is more expensive because it is new. The prices are set by MOH.....

Patient: But you doctor mah, why you never go ask gahmen to make it cheaper??? Its your responsibility!

Dear gahmen, my patient wants me to tell you (apparently my responsibility to do so) that he cannot afford his medications because he spent all his financial aid in Geylang probably for the purpose of hookers, booze and of course smoking.

Thank you!

The Holiday Season

It is the September school holidays and Mr Tan was all ready to set off for a short vacation to Hong Kong with his family. He had promised to bring his son to the new Disneyland.There was however just one little problem before they board the late afternoon flight to the pearl of the east. He had to dispose of his wheelchair bound mother.

"Damn that Ah Heng!" He cursed his younger brother under his breathe. Ah Heng was to have taken in the old lady but he called last night to tell Mr Tan that he was on his way to K.L

"You know lah, my wife complain hardly see her parents. So school holidays, I can bring the children all over. No so lucky like you ok, stay with mother!" His younger brother told him.

With that, Ah Heng was out of the question. Mr Tan tried calling his younger sister but she was busy with her sick father-in-law. "Some more there will be no place to sleep for mother! You think my place like your condo? I stay 4 room flat can?!"

He could have kept her home with the maid but his wife already has her hand full with the two older boys. They needed the maid to look after the youngest of the three, a two and a half year old toddler. "I don't care, the maid must come along. You try feeding the little one and see!" His wife had screamed at him earlier on. Indeed, only the maid can make that rascal eat.

So once again, Mr Tan had to resort to that last trick up his sleeves. He drove his mother in his MPV to Accident and Emergency. On the way there he was rehearsing his excuses, fabricating symptoms with his limited medical knowledge. Well, they were not really excuses. "Mother really had been coughing for the past two weeks. What if it was pneumonia or something? Better play safe, send to hospital. No harm getting another check up by the doctors..... "

They had arrived at the A and E at about 1pm. Mr Tan was getting increasingly anxious with the long queue. He had to go back home, pick up his wife and kids and rush to the airport. He took a peek at his mother who had been quiet all this while. She hasn't been talking much after the stroke which left her wheelchair bound. Flashes of memories of his mother bringing him and his siblings to Tao Payoh park appeared in his mind. Those days she was a big strong woman. When he saw his mother turning to look at him, he quickly turned away, afraid to look at the old lady in the eyes. At 4:30pm, they finally saw the doctor.

"Sir, I don't think there is anything serious enough to ward your mother for." The emergency doctor rejected his request. But he came prepared.

"What???!!! After I spent more than a hundred dollars on the private ambulance to bring my mother here, you say don't admit??? Can you be responsible if something happens? I want to complain!"

The part about complaining always worked. Mr Tan left the A and E at 5pm.

********************

"What's the story?" The Medical Officer asked his Houseman.

"75 year old lady. History of CVA with left hemiplegia. Social admission lah." The Houseman replied.

"Oh yeah, now is the September school hols. Season for granny dumping. December even worse!"

The Medical Officer spoke in Hokkien to the old lady, "Aunty how are you?"

Of which she replied in her slurred speech," Can have Milo? I never eat since morning."

As the two doctors walked away to ask the nurse for some food, Mdm Ong struggled to take out a picture of her grandsons from her pocket with her good hand. She missed them already. All she wished was that they had a good time in Hong Kong. It was just one week. One week later they will come, pick her up and she can go back home again.

Don't Look Back in Anger

After working for a few years, some of us developed this “switch” inside us that we can switch on and off. Like what was mentioned in some of the earlier posts, it is probably a defense mechanism to protect ourselves from being too emotionally affected. Please do not get me wrong. We do not want to be devoid of emotions. The day I no longer feel anything will be the day I decide to hang up the stethoscope and do something else. Maybe be a lawyer or something. =P

An incident happened some time back that “jammed” the switch inside me. I came across this Primary School girl who was adopted since she was a baby from a foreign land. (We shall call her Sally) The adopted parents thought that they could not have their own child. They loved Sally. For about a year or so.

A year after the adoption, the adopted mother became pregnant. The adopted grandparents were overjoyed. They sincerely felt that Sally brought luck and good fortune to the family. However, the mother hated Sally. At that time, it was only a small seed. But it would continue to grow. She had a couple more children during the next few years and the hatred for Sally intensified. She forbade the rest of the family from caring for Sally.

The mother tried to return Sally to the country she came from. She was told by the relevant authorities that this could not be done. She tried a few more times over the years and soon, the children grew up.

Sally was not allowed to go to KFC, BK or MacDonald’s like her adopted siblings. The family would bring home leftovers for her. Take note that it is leftovers, and not a new set of Happy Meal with some toy inside that they decided to “takeaway” for Sally back home.

When the family went to the Zoo, the Monkey Park etc., Sally was made to stay at home. Sometimes with the maid, and sometimes by herself.

Sally was not supposed to be seen or heard when the parents come home from work. She was to stay inside her room and stayed quiet. If she was sighted or a noise/voice was heard from her, she would be scolded or punished.

Sally slept alone. She can’t even remember from what age she did that. At around 9 p.m., she had to switch off her lights. She told me she could sometimes hear the mother telling bedtime stories to her adopted siblings in the room down the corridor.

Sally loved reading. Because she was not allowed to buy her favourite story books, she ended up reading magazines, her siblings’ books that were just too simple for her, and apparently, she read the manuals lying around at home. In theory, she would know how to operate the air-con and some kitchen appliances quite well.

I cannot really describe what I felt when I heard the above. I thought nothing can really surprise me anymore. Certainly if I was watching some local television show or some Taiwanese serials, then I would not be surprised. This happened in real life. I was disturbed, angry and sad at the same time. And I am still feeling this way whenever I think about it.

The last time I spoke to Sally, she smiled and told me that she still misses her adopted parents and believes she will move back with them soon. I forced myself to smile back. She still does not know that the adopted family was only too glad to get rid of her.

I know that I am not allowed to think this way, but one word popped into my mind.

Retribution. Just like in those serials.

P.S. "Sally" is staying with a friend's friend now. She is no longer neglected. In fact, her life now is opposite of what it was previously. She's still adjusting though to the love and concern.

The Road Home

Leukemia is different from most malignancies in that it afflicts young people. What strike me most during my time in the haematology ward (where leukemic patients are treated) was not just the suffering but something else.

The story usually goes like this. A young girl is found to have leukemia and admitted for chemotherapy. During the first admission, her bed is filled with flowers, ballons and cards wishing her well. Her good friends visit her everyday and her boyfriend stays with her til the ward is closed late night. You hear laughters and words of encouragement as her friends supports her through the ordeal. Strangely, the patient in the next bed with no visitors never seemed envious.

After a while, the flowers disappears and the friends dwindle. You see the boyfriend reading his book and the patient listening to her walkman (MP3 player not invented yet), quietly looking at the ceiling. You start noticing the mother, often a small plumbish lady. Perharps you missed her earlier as the patient was surrounded by too many friends. The mother comes day in, day out, preparing food for the young girl. They seldom talk.

Into the 3rd admission, her bed is quiet. No cards, no ballons, no flowers and no friends. Her boyfriend who was still coming on alternate days last admission has stopped coming altogether. You see signs of resignation on her face. She is not depressed, just resigned to fate. The girl chats with the patient in the next bed. The patient tells her, "Its like that." She has been through it. Now you notice her father. He comes after work in the evening, standing quietly beside the mother.

It is not easy. The many cycles of chemotherapy. Her hair drops and with that her morale. This time, the girl hugs her mother and cries. Her mother cries with her. You wonder how long they have not hugged each other. Her father still stands there, his eyes are wet too.

With treatment, she will pull through. With her family's love she will recover. She will wear a cap until her hair grows again. She will go back to school and her friends will once again flock to her with words of encouragement. But this time it will be different. It is different.