Saturday, May 30, 2009

SGH Day 2

Dad is running a fever today. His first "spike" as the nurse termed it.

His temperature was at 38.0 Degrees Celsius when I asked the nurse while she was doing routine monitoring on Dad. She already called for the doctor on duty today.

Just this morning, a doctor from the oncology team called to inform about Dad going for his CT Scan around noon. I did not catch her name, but she said that Dad was well and had no complaints during their rounds.

Visiting hours starts only at 2:00PM to 5:00PM and another at 7:00PM to 8:30PM. The hospital is adhering to these times strictly now to prevent introduction of the Swine Flu or H1N1 virus to everyone in the premises.

Both Mom and I waited for Second Eldest Brother to come back from work To visit Dad. He was picked up Eldest Brother from his home and then fetched us from our parents' home. It was about 5:00PM when we reached the hospital.

SGH is limiting only 2 visitors per patient at any one time, so Mom and I went to see Dad first and settled some stuff Dad we brought from home.

A young lady doctor came into the room to check on Dad. Looking concern, she introduced herself to me but I could not recall her name later on as I was quite shaken inside seeing Dad not looking as good as he as yesterday.

She woke Dad up and started asking a series of questions about his condition for the past two weeks. Some questions were specific in relation to the current Swine Flu scare.

Dad suddenly developed a fever after coming back from the CT Scan done before noon. So when we arrived, Dad was already had cold packs on his forehead and neck.

He appeared tired and shivering a little. His dinner was left untouched on the table. It was worrying to see Dad like that.

Mom was quite reluctant to leave Dad so soon as we both had to leave so that both my elder brothers could see Dad. Yet, something unpleasant happened...

Once we went down to the ground floor and out from the flu screening stations, we handed over our stickers to my elder brothers. They queued to register their names to enter next. Mom and I left and headed to Cheers convenient store to buy some stuff she wanted.

That was when Eldest Brother called and sounded furious.

The staff at the registration counter asked for Dad's ID card number as verification to allow entry. My Brothers were turned away after explaining to the man that they were the sons and had only Dad's ward, room and bed numbers as verification.

With the strict rule in place to screen each individual before entering, the hospital has limited the number of visitors per patient to a maximum of 8 immediate family members or caregivers. I had to nominate the 8 people in the family, while had to leave a few out.

I had a tough time deciding while I did it at the Admissions Office yesterday and even tougher time to call each and everyone of my siblings to inform who can and cannot visit Dad, and reasons why I chose the way I did.

Fortunately, everyone was understanding and supportive of my choice, though everyone was anxious to see Dad.

I doubled as quickly as I could push Mom on her wheelchair to the screening station to find both of my elder Brothers already out from the queue and appeared disgusted and pointing to the counter that turned them away.

I was appalled at the type of verification he used.

I was not asked this particular question when I registered numerous times to enter the ward during these two days. The other counters asked me for the ward, room and bed numbers to search for the patient in their computer and then asked for the patient's name as verification.

Elder Brother-in-law did not have trouble going through registration yesterday with the same questions. That was practical.

The counter staff told me that it was easier for him to search and verify using the patient's ID Card number, but I had to prove my point bluntly to him.

I asked him if he remembered his wife's or child's ID card number before he asked for any one else's...

"If you can remember any of them, then my brothers should remember their father's too."

I told him that it might be easy for him, but he was making already anxious family members coming to see their loved ones undue stress by asking such a question just to simplify his work. It most probably came from his own idea since the other counters had not.

He accepted my reasoning and allowed for my brothers' ID cards to register again.

This time, their names were not listed in the 8 nominated names on the computer.

I had to explain to him the possibility of them not updating the nomination list fast enough to their central database as Dad was admitted only last evening. That was why only 3 names appeared... Mom's, Brother-in-law and me had registered yesterday.

He finally let my brothers pass through. It was such an unnecessary ordeal. I had not known there were so many eyes on me then. When I realized the attention I gave myself, I noticed several heads nodded in agreement with me.

I believe everyone knows the hospital is doing their job as best they can among the chaotic situation with that many visitors. Most of whom are already stressed from their daily lives, straight from work to visit and with an anxious mind, to go through such cumbersome process just to visit their loved ones.

Yes, it is for everybody's safety but some individual bright ideas may go weary and ignite a flame with some stressed out people bursting with anger. I could feel that brewing in me at the point.

Both elder Brothers went up quite fumed, but came done subdued after visiting Dad.

Mom and Eldest Brother went back to our parents' place to Woodlands while Second Eldest Brother and I went the opposite way back to the east.

Eldest Brother is keeping Mom company for tonight. Mom is staying with Elder Sis for the duration Dad is in the hospital. Youngest Brother will come by our parents' home to take care of their plants for the time being.

Friday, May 29, 2009

Riding The Storm

I took the whole of Friday off work to take Dad to his Oncologist well before his scheduled routine appointment at the National Cancer Centre in the morning.

It was to be on 19th of June 20009, but Dad developed breathing difficulties for the last week or so and became really acute the past few days sleeping sitting down to get some reliefs.

Being Dad, it was quite hard to spot if he was feeling unwell because he hides his pain so well. Only Mom can noticed the subtle changes she sees in Dad from his easily agitated reactions to actually seeing him sleeping upright on the sofa in the night.

The straw that broke the camel's back was when for the first time, Dad did not want to accompany Mom and Elder Sis for Mom's routine medical checkup at Woodlands Polyclinic. He had never done that before. He had never missed being with Mom for her checkups and outings.

So when asked why, Dad finally broke the news that he had been feeling giddy and was not able to walk long distances anymore.

The tall-tale signs were there already about a week or so. Mom noticed it, but Dad used his anger to stop her from probing further.

Mom noticed that his beloved potted plants in the corridor garden were not watered for a few days. Dad stopped going to the supermarket for groceries... in fact stopped entirely. He loves going to Sheng Siong Supermarket at Woodlands Centre, most probably because it lets him be outside the house and I believe, he feels independent still and in control of his life.

While waiting for the blood test and the consultation, I slowly coerced him to tell about all the changes he had been feeling the past two weeks, Dad admitted that his sputum has more blood than the usual pinkish dots. There is always blood in it nowadays.

He especially becomes more breathless and has lost his appetite... the reason I managed to make him agree for an immediate consultation with Dr. Lo. Friday was the earliest when I called on Tuesday, but the hospital asked to take him to A&E if it became acute before the date.

When his queue number was given after his blood was drawn, the scaled tipped at 57.50KG when Dad was weighed. A 2KG drop in weight in a month!

It was uncomfortable to think of what is coming...

Dr. Lo Soo Kien found that Dad was breathless upon examining him. The classic symptoms of weight loss, breathlessness and more blood in the sputum suggest that Dad's tumor has metastasized.

She ordered for an immediate X-ray done after her consultation and come back to her again at 2:00PM after taking our lunch.

Lunch at NCC's outdoor cafe was nice. Both Mom and I had full rice meal, while Dad struggled to finish two slices of tuna sandwich, even though it was his favourite.

Upon coming back to the consultation room, both Dad and I were shocked to see the X-ray flashed on Dr. Lo's computer as we walked in to sit down.

Th whole of Dad's left lung appeared white. A totally different view we saw when we stepped into her consultation room for the first time. Then, Dad's X-ray had only a small white spot indicating a 3CM growth. Now I could see only the right lung!

"Now we know why you have been breathless." Dr. Lo said to Dad, looking into his eyes.

Dad forced a smile, but was afraid what came next.

Dr. Lo requested for an immediate admission to the hospital, "Pakcik must get warded so that we can take care of you and make you feel better again."

I repeated the dreaded "warded" word to Dad again. Obligingly, Dad nodded in agreement, which really surprised me. He did not put up any resistance and appeared reluctant to be hospitalized. I believe Dad was really worried for himself this time.

By 4:30PM, Dad was lying on the hospital bed, Ward 48, Room 10 and Bed 1. While Mom accompany Dad, I went to the Admissions Office to settle the paperwork and Dad's Medisave.

Everything was a little taxing due strict screening of everyone having to register when entering the wards.

By the end of the in-processing and buying toiletries for Dad, I had many colorful stickers of different sizes and green and red chops on my arm from multiple entries to the ward.

"I feel much better with the oxygen." Dad said. He coughing was lesser too.

Mom and I saw that he could finish his rice dinner. It was even encouraging to see him finished a bowl of chicken porridge several hours later after his dinner.

We bid him farewell about 8:30PM. The visiting hours are strictly followed now that all medical centres on the island are screening and preventing spread of the Swine Flu or H1N1 virus.

I slept overnight at my parents' to accompany Mom for the night. Eldest Brother had volunteered to stay with Mom on Sunday. Mom will stay at Elder Sis' place for as long as Dad is in the hospital.

Youngest Brother will be going to our parents home to check on things there and to water Dad's precious babies... his plants.

Saturday, May 23, 2009

Bukit Timah Reserve

We had a good workout today.

Wifey and I decided to go for an outing, exploring nature at Bukit Timah Nature Reserve... finally.

Born over 40 years ago and living on this island all our lives, yet we never set foot on this hill before. It was our first on the "tin-bearing hill" as the Malays called it. Despite its name, the hill has no tin but granite.

The hill got its name from the Malay word for the Temak trees that grow abundantly there. Another name for it is Keruing tree or dipteracarps - two winged seed. Bukit Timah is the highest point on the central part of the island.

It was a strategic position during World War 2 as a stronghold for the British where most of the ammunition and food were stored there. During the Japanese Occupation, the Japanese built a Shinto Shrine similar but smaller version of its National Shrine in Japan, but demolished it before the British recaptured Singapore again.

Today, this couple concurred the hill! To many, it may just be like walking over a road bump as compared to say... climbing Mount Everest, but it rewarded us with personal triumphs and worth every effort!

Incidentally, the newspapers have for the past few days published the incredible feat a group of our local steely ladies had accomplished. They have scaled to the summit of Everest! Maybe, that was the subconscious choice that made us chose to "climb" Bukit Timah ourselves.

Though it may not be the highest point on earth, we settled for the fact that it is the highest point in Singapore! Unlike many nature routes we had taken on our family outings before, none of the terrain can rival the steep slopes of this hill. Wifey was utterly shocked when we first saw the slope up.

In retrospect, I think we made a bad spur-of-the-moment decision to climb the hill today.

We took a risk with Wifey when we went ahead to climb the steep slopes anyway at the start of the Red Route that reaches to the summit. She had not taken her once-daily preventer asthma medication this morning. She did not remember to bring along her reliever inhaler with her for the walk either.

I was worried that she might get an attack from over exertion during the climb, so I suggested that we turned back. I suggested that we take the flat-land jungle route instead and scale the steep slopes next time, but Wifey was adamant to continue.

I was also concerned that she might get an episode later tonight, but Wifey had full confidence that she could reach the summit safely. She has been exercising on the treadmill for some weeks now, coupled with some strengthening exercises on my home gym.

Still, I was worried inside but kept a confident look trying hard to trust her instincts. I was playing the action plans in my head should she develop an episode. I had the park ranger's emergency number on speed-dial in my iPhone just in case.

The Red Route from the Visitors Centre all the way up to the summit started with a steep slope and became gradual after reaching the first post called Kruing Hut at about 100 metres high. Wifey did very well then as we stopped at many spots for me to take photos of the signs and flora along the path.

It was not until we reached the Simpang Hut at 140 metres high that I became very worried for Wifey. That was where the steep steps were and reading the expression on Wifey's shocked face, I was ready to turn back.

"Slowly." Wifey told me. "I'll hold your arm while you climb and pull me up..." she said gasping a little, "slowly, I can do it."

As we were going to start climbing, it started to drizzle. Phew!

"Let's take shelter first." I told Wifey hoping we could not continue. I was totally worried about her but did not have the heart to break her spirit, "I don't want to get my camera wet." Giving my excuse as her little gasping made me nervous for her.

I was hoping for rain so that we had to turn back, but the little droplets stopped as soon as we sat down and quenched our thirsts. We rested a little and I suggested the Blue Route instead as I pointed it to her.

Her answer was "Let's go!" Wifey said with gusto, but to the summit. "There's no rain. It's the leaves rattling that sounded like rain."

She led in front of me to the steep steps, held my wrist ready to climb and exclaimed, "I want to reach the top."

It was definitely a tough climb for Wifey. Each step was too high and taxing on her legs. We stopped many times and at one point she was gasping hard and bent over to catch her breath.

It was the most scary moment for me. I took out the cell phone checking for signal and was ready to call the ranger at her slightest wheeze. "I'm checking if Sonny had replied my SMS." I told Wifey when she asked, not wanting let her know how worried I was.

Wifey's determination and will to be at the top were inspirational. It was as though she persevered for me because she knows I love rugged terrains and wanted to be a part of it. She is that selfless.

I let her take as much time as she needed at the steps and as many stops to recuperate. We finally reached the Summit Hut where the bold spot is, the highest point of Singapore at 163.63 metres high.

Unfortunately, no panoramic view. The whole view is covered with thick and tall vegetation.

Nonetheless, the summit is marked with a large boulder bearing the hill's altitude, a testiment to Wifey's strong will to achieve her undertakings. A personal triumph over her condition which makes me totally proud of her.

Yes, she gave me a few scares along the way, but she did it. An awesome lady!

Taking a picture with the marker rock reminded me of my Mount Ophir climb in Johor, Malaysia. Gunung Ledang as it is called in Malay, I scaled the mountain with a group of my army buddies back in my early twenties.

That climb took a day to reach the summit at an altitude of 1,276 metres high, the 64th highest mountain in Malaysia. We camped out on the summit for the night before scaling down in the morning to reach the bottom in the evening.

Now that mountain had a fantastic view from the top! A personal triumph for me, but that is another story all together.

Today, Wifey made me proud of her again as much as she is of herself.

I realized that she has more confidence to take on the hill than I gave her credit for. I would be rooting for her 100%, but only if she had her inhaler with her. Fortunately she proved me wrong this time.

Unnoticed to me, she had been building her strength and stamina at home all these weeks when she had started to feel better again after months of regimented asthma preventive treatments. Her exercises have proved to improve her health so much now.

She has been working out to having more endurance for nature walks and outings with me rather than window shopping at the malls. Though she loves being at home on weekends doing creative handmade jewelery, she rather joins me outdoors with my photography than being confined at home watching TV.

That said, I made her promise to take her reliever for our walks regardless of the terrain. It may not be as important to her nowadays, but it is a calculated risk I rather take as long as it involves my loved ones.

Friday, May 15, 2009

Wild & High

My parents have lived in a 3-room flat in the old Woodlands housing estate for over 5 years now. When their last chick flew and left the nest, they moved from their larger 4-room flat in Tampines Street 22, a second home of 20 years, for a smaller, more manageable home on the west side of the island.

Tampines New Town was our first apartment building living we moved into when our village was taken over by the government for redevelopment.

Since I first noticed the grassy hill behind the block of flats opposite my parents' the first few times, I have always wanted to explore that patch of nature. Seeing the hill while waiting for a cab with my parents at the car park entrance, I was curious of what the hill was like at the top.

Little that I know it was already a public park for the residents there. The entrance to the park is obscured behind blocks of flats and its view is hidden by thick mature trees. Driving by or walking pass by the roadside does not reveal much of what is in store there.

My curiosity was further aroused when I visited a local Blogger's Seen This Scene That site about Woodlands Town Park East. It prompted me to visit the park the first chance got when I was at my parents' place.

I finally made an effort to visit the park after taking Dad back home from his cardiology appointment on Wednesday.

The large boulders seem to be the park's signature. From the entrance and upwards to the top of the hill, the pathways are lined with boulders and softened with a variety of flowering plants and bushes.

The large shades are provided mostly by the current blooms of the Tanjong trees, I believe. The noticeable sweet smelling flowers filled the air around the park as I explored the hill top.

The view at the top of the hill is beautiful and is not blocked by the block of flats around it. It is higher than the highest blocks of flats there... a nice change to see "forever" as far as the eyes can see.

Though there were many joggers and groups of people enjoying the cool afternoon breeze and the view, the whole place felt actually very serene and tranquil... very pleasing to me.

It is unfortunate that the park is not wheelchair or tram accessible. Else, my next spontaneous impulse would have been to bring both Mom and Dad to enjoy the park that is situated practically right in their backyard... so near, yet so far.

As the day was getting dark, and that I have to work the next morning, I did not get to explore the wooded area where the shaded path leads to. Nevertheless, I know I will be back there again to explore it further and downwards this time. I noticed the path also leads to a large pond at the bottom of the park separated by the road.

Hopefully, my parents may well be able to visit that portion of the park. Wifey has got to see this park as well. Slowly, but surely, she will be able to climb the gradual steps all the way up the hill to experience the view and tranquility the park has to offer all its visitors.

Wednesday, May 13, 2009

Heart To Heart

Well, what do you know…

I was back in a hospital again today. On Monday, it was for Wifey and today for Dad. I took leave off work the whole day today to accompany Dad for a cardiology follow-up.

Dad was hospitalized late February 2009 due to a blood clot detected in his heart. A CT scan meant for his lungs after his 3rd cycle of chemo, but the Oncologist detect a clot in his heart instead.

His chemo stopped abruptly, and the blood thinning medication was started immediately as soon as he checked-in to Singapore General Hospital. Dad was discharged a week after on 3rd March 2009.

He was on anti-coagulation medicine, Warfarin at full dosage of 5 mg for his age initially and was then reduced a week after that when his International Normal Rate or INR was returning to a non-threatening rate, yet the slight risk of a stroke was still possible.

The next couple of weeks saw Dad back at National Heart Centre checking his progress from the prescribed dosage of 4 mg, a brown and a blue pill every morning. He did well but not well enough, so was on a reduced dosage of 4 mg for the next two weeks until today.

Dad’s appointment was at 9:55AM, but we registered 10 minutes later due to the Swine Flu screening before entering the hospital premises.

The same regime again, the queuing, questions on our recent overseas travel and present health before being issued each with a mask and an OK sticker on our clothes, just after our ID details were keyed into their computers for traceability purposes.

Everyone inside the many specialty clinics was seen donned with a mask on. One old man was seen with his mask worn inside out, making me check my own mask if I had put it on correctly.

Dad was an expert on masks. He pointed out to me to have the top side with the metal wire up and pinch in to follow the nose contour so as that it will stay on without slipping up onto the eye… a lesson he learnt from the same place he went a week ago for his CT scan and heart checks.

Today, after taking his blood test at Room 12 where the Pharmacy was, we returned to Clinic A for Dr. Lim in Room 4.

Dad's assigned Cardiologist, Dr. Victor Lim saw him this morning him good news.

After checking through his present Blood INR for today, CT scan and other tests done a week ago, he said that Dad can now stop taking Warfarin entirely. I smiled the widest, I think. I was so happy to hear it.

Dad has always been a fighter and strong-willed. He takes his medicines religiously and sticks to healthy foods. He likes to keep himself busy with house work until he perspires profusely to stay physically active and does hours of gardening as a therapeutic outlet for the soul.

I think the fact that he was active in sports made him kept a healthy lifestyle. Being an awesome looking bodybuilder back in his twenties, Dad still likes to be physically active even today.

As a child, I remember seeing an only picture of a young and buffed Dad in his posing trunks. He looked awesome then. He once told me before that he shared his passion and volunteered his time coaching his fellow mates at the gym where he trained.

My older brothers also told me stories about Dad’s many trophies he won from his bodybuilding competitions days. The brass trophies however, were sold off at one point to the rag-and-bone man for money to feed our large family back then.

I reckon that is probably why I took up weight training and stuck with it since I first picked up a dumbbell in my teens… well, the fact that I was wafer thin back inspired my to be just like Dad. I have never compete before, much less achieved that awesome physique that had, but what stuck with me until now is to keep myself fit and now my family too for a healthy lifestyle… just like Dad.

Coming back to Dad’s condition…

Dad is given Aspirin as a blood thinning agent but to be taken with Omeprazole to protect his stomach against the gastric side effects of Aspirin and Bisoprolol to reduce his rapid heart rate. All 3 medicines were given for a supply of 3 months that cost S$31.50.

He is it take this medication for life. With this too, Dr. Lim hands over Dad back to his Oncologist, Dr. Loo Soo Kien from the National Cancer Centre urging that Dad should resume his chemo treatment.

The time spent alone with Dad on the journey to and fro the hospital, the lunch at Banquet and the unsuspected longer journey we accidentally took back to his home from the Woodlands Regional Bus Interchange were worth it.

I got to know more about Dad and “reacquainted” with him once again as he refreshed my faded memories with those old but nevertheless interesting stories he once told a long time ago.

It was nice to hear it again from him. It helped me understand and appreciate him more of the instances and decisions made back then that were buried deep in my mind and left forgotten, were explained and clarified in the here present where I am more than old enough to comprehend.

We got home a little later than expected, but fortunately Mom did not fuss over for making her wait in hunger for her lunch. Instead she laughed hard when Dad told her of our wrong and long bus route that took us 20 minutes to my younger brother’s home instead of the their flat that is only 2 bus stops away from the interchange.

Monday, May 11, 2009

Breathe Easy Now

I accompanied Wifey to Changi General Hospital today.

I thought the Swine Flu alert level in Singapore was brought down back to yellow, the lowest of 5 levels, a few days ago so there was no longer a need for flu or fever screening before entering the premise.

Yet, unsurprisingly, we were met with a long queue of people being screened at the makeshift blocked entrance as soon as we alighted from the cab at the drop-off point.

Though seemed like it was a long queue, both patients and visitors were processed rather quickly. It was rather an interesting experience, having to go through the actual process after reading about it numerous times since during the first SARS outbreak some years back.

When it was our turn at the counter, we were made to produce our ID cards to the staff who were all dressed in yellow smocks and full-grade face masks. Followed by the once too often, but nevertheless important “Are you feeling feverish or having flu?” question on our present general health… which was none to both.

Our names and residential address were keyed into the computer for traceability purposes in case of any breach detected in the hospital that day before the IDs were returned back to us.

We had to state our purpose of visit to distinguish between patient seeking medical attention and the visitor that was me. We got our IDs back and given face mask each.

Wifey as given a different type of face mask while I got the elastic ear loop ones. We were also handed two plastic chips - one green and the other blue before proceeding to the entrance that was armed with a thermal imaging scanner to detect for any feverish people. Not so sure what the colored chips meant though… either distinguishing between man and woman or patient and visitor.

Once given admission, a blue oval sticker with the current date was pasted onto our clothes and the two chips surrendered back.

Everyone was to wear the masks at all times as long as we were in the hospital cordoned area.

Wifey’s specialty Clinic C for asthmatic patients is on the second floor. She registered herself and was given a queue number 1503 for consultation Room 3. About 20 minutes later, she was called into the doctor’s room.

The doctor's examination did not take long, but the consultation on the reinforcement of habits and medication administration by the Staff Nurse was. They cannot emphasize enough on the importance of asthmatic patients to avoid allergens and exhaustion that could trigger asthma, and the consistency of taking the correct dosage daily.

We have modified our home to rid of unnecessary allergens such as carpets and dander from pets, but I guess too much housework for a house-proud Wifey, coupled with too much excitement from the previous day’s Mother’s day celebration dinner and the weeks of stress she felt for Sonny preparing for his midyear exams had taken a toll on her otherwise controlled condition.

We collected Wifey’s four months supply of inhalants cost S$87.60 after a 40% subsidy at the Pharmacy on the ground floor. With so many people and so much activities going on there, added with all the flashing of queue numbers on the side boards and at each counter, it was like a stock trading place.

Wifey was very glad we could finally get rid of the masks at the exit point as she felt harder to breathe with it on. All visitors departing the hospital was asked to use the hand sanitizer supplied at the exit as a protection to not inadvertently introduce any to the external public.

Fortunately, her condition is not serious and in fact, she has been given a lighter dosage for her few months supply of inhalants.